Cultural Psychiatric Services: Past, Present and Future
By H. Steven Moffic, M.D.
October 1, 2003
Dr. Moffic is currently the executive vice chair for managed care of the department of psychiatry and behavioral sciences at the Medical College of Wisconsin. He is also professor with tenure in that department as well as in the department of family and community medicine. Dr. Moffic was elected in 1998 as the president of the American Association for Social Psychiatry.
Given the increasing cultural diversity of the U.S. population, it seems likely that cultural influences will take on even greater importance. The increasing attention to and expectation of cultural competence should help improve psychiatric care to all.
Put simply, the writer George Bernard Shaw provided the core guideline to cultural competence when he said: "Do not do unto others as you would that they should do unto you. Their tastes may not be the same." In a more complex sense, clinicians can become more culturally competent by following the Ten Commandments for Cultural Competence (Table).
These commandments should improve the psychiatric care of all patients. As a field, cultural psychiatry needs to incorporate the cultural variable into our remaining cultural blind spots. These include incorporating cultural values into informed consent (Roberts, 2002), improving substance abuse treatment for ethnic minorities (Wells et al., 2001) and including the cultural variable in pharmacogenomic studies (Licinio, 2000). All treatment guidelines and disease management protocols should explicitly reflect and include the cultural variable.
Like many other things, globalization will likely have an important effect on the future of cultural psychiatry (Kirmayer and Minas, 2000). The global economy, Internet communication and mass population migration can increase cultural sensitivity and knowledge. Clinicians and systems of care in different countries may more readily be able to influence and teach each other. While modern psychopharmacology can be applied in developing countries, more traditional countries can teach us about the therapeutic use of trance and benefits of indigenous plants. Perhaps cultural psychiatry will someday no longer be a separate variable, but routinely incorporated into mainstream society.
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