The Place of Culture in Mental Health Services

Kirmayer, L.; Guzder, J.; Rousseau, C. (2013)

Cultural Consultation Encountering the Other in Mental Health Care. Kirmayer, L.; Guzder, J.; Rousseau, R. (Eds.)

Springer | 1-20

Cultural diversity presents an important challenge for health care services in every society around the world. In this introductory chapter, we consider the changing meanings of culture and the ways in which different societies have responded to cultural diversity in mental health services. We show how these approaches reflect local patterns of migration and demography, ideologies of citizenship and theories of the place of culture in mental health. We outline the rationale and key principles of the cultural consultation approach: focusing on social and cultural contexts in assessment; recognizing the ubiquity of culture in the experience of patients and clinicians; understanding culture not simply as mental representations but as embodied and enacted; using systemic, interactional and self-reflexive views; emphasizing problems of power, position and communication; approaching culture and community as resources for healing, adaptation and recovery; and working within health care systems to foster change. We illustrate what culture adds to clinical care including diagnostic assessment and treatment through the contextual framing of psychiatric disorders. Social and cultural processes shape the mechanisms of disease, the symptoms of distress, and subsequent ways of coping or help-seeking. Systems of healing reflect cultural models of body, self and person that are grounded in distinctive ontologies or notions of what constitutes the individual and the world. Finally, we consider the importance of understanding culture and context for clinical empathy.