Transcultural psychiatry: how our culture affects us

Transcultural psychiatry is the treatment of psychiatric disorders taking into account both cultural influences on the patient and cultural influences on the psychiatrist. It exists in the US as a subspecialty, but fundamentally, every specialist in psychiatry should be transcultural.

A syndrome or mental disorder must always be evaluated with full regard and consideration to the cultural origin of the patient, or to the culture with which they are most identified. Likewise, the psychiatrist must also be very conscious of their own culture, as it can influence the interpretation of psychiatric symptoms.

Transcultural psychiatry: how does our culture affect us?

Culture is described as the collection of values, beliefs, social behaviours, and language that are transferred from generation to generation and that we adopt from the community with which we are identified.

Due to this, culture has the ability to influence the way we conceive and express emotions. In general, it dictates the levels of tolerance to pain, whether it is physical or emotional. Culture also provides us with certain defence mechanisms to deal with these emotions caused by a particular traumatic experience or environmental stress. Therefore, culture is always related to emotional or psychiatric disorders. 

How are psychiatric conditions described in different cultures?

The expired DSM-IV R (Diagnostic and Statistical Manual of Mental Disorders) listed 25 syndromes described as cultural bound (linked to culture). Nowadays, they read like an anthropological curiosity thinking that if you did not do tropical psychiatry, you would never see it – take for example nervous breakdown, or the scare (Latin American subcategories of the anxiety attack – or when the same syndrome is attributed to different names in different cultures, like for example Amok, the Malaysian term for a psychotic episode, which is the same as the Puerto Rican version of the “fighting evil”, which is the same as the Itch'aa of the Navajo Native Americans. All of them describe a person who, possessed of an uncontrollable anger, indiscriminately attacks innocent people with a weapon only to finish exhausted and with no recollection of the event.

We can also see that culture not only gives the name but also the "etiological" explanation. In certain cultures, madness in general is still interpreted as a state of demonic possession, or evil. In African or African-American cultures, they attribute trance states to the "random visit of an ancestral spirit" and this is what in the western countries we call disassociation or depersonalization disorder." The current DSM-V aims to be more effective, and instead of identifying "cultural syndromes" as something of a separate showcase, what it does is, in each definition of the mental disorder, it includes all cultural contexts rather than just the American-Western-Anglo-Saxon context.

What are the most effective treatments offered in transcultural psychiatry?

We see that culture is very important for the understanding of symptoms, syndromes or mental disorders. Therefore, the psychiatrist must question how a certain emotional reaction or behaviour is perceived in the patient's culture to determine if that is influencing the manifestation that is being evaluated. The psychiatrist must study the physiological explanation, both traditional and local, and look to integrate it into the most accepted modern therapeutic approach, so that it makes sense for both the patient and their family environment.

For example, in a case of a patient in a trance in Haiti, who for more than four days did not eat or respond to verbal stimuli, (despite a "normal" neurological examination), the psychiatrist had to understand that prayer and the prayers of the patient’s family were as important as it would have been for him to be prescribed antipsychotic medication. The patient’s family told of the need for the ancestral spirit to possess the patient’s body and thus return to this world.