Reflections on Cultural Psychiatry and Society

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After reading my blog, The American Sniper’s Psychiatrist,¹ a psychiatrist colleague privately pointed out an omission. She said that I had ignored the cultural component of the film. She seemed more sensitized to this issue than I because she said she “looks like” many of the people who had been bombed or killed in the movie.

Even though my blog was about the brief appearance of the Sniper’s psychiatrist, as a clinician who had focused on cultural psychiatry during my career (including providing care for refugees from the Middle East), I was embarrassed. Surely I could have included a sentence about the cultural component, couldn’t I?

Perhaps I took my own racial attitudes too much for granted? Perhaps others do too. For example, the 50th anniversary of the march on Selma, in light of various recent incidents involving the killing of black men by white police, tells us something about where we are now as a society.

At the University of Oklahoma, some have expressed horror at racial comments, including calls for a lynching, by members of the fraternity Sigma Alpha Epsilon. The president of the university claims that “this is not who we are,” but surely the actions of the students involved belie that claim.

In Madison, Wisconsin, we have witnessed yet another killing of an African American man by a white policeman. Protests, reminiscent of the Viet Nam War era, are occurring at the Capitol. In my home town of Milwaukee, one of those killed was a mentally ill black man.

[[{"type":"media","view_mode":"media_crop","fid":"34349","attributes":{"alt":"Cultural Psychiatry and Society, fishbowl","class":"media-image media-image-right","id":"media_crop_1818672619634","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3658","media_crop_rotate":"0","media_crop_scale_h":"132","media_crop_scale_w":"125","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"©stockphoto-graf/shutterstock.com","typeof":"foaf:Image"}}]]Overall, there have been improvements since Selma in the way society treats racial minorities and people with mental illnesses. “Drapetomania,” a psychiatric diagnosis during slavery times of flight from home “madness,”-flights made to avoid lynching-of course never made it to modern DSMs. Instead, on the positive side, cultural formulations have been emphasized in the diagnostic manuals. On the negative side, young black males are well overrepresented in jails and prisons, and they often have a history of PTSD and/or substance abuse. Native American youths have the highest suicide rate of their age group. Cultural competence caregiving is still an ideal, not an everyday reality.

We have had an Office of Ethnic Minority Affairs in the American Psychiatric Association (APA). Yet we have never had an African American president or medical director of the APA. America has its first African American President. And “people of color” are now in leadership positions in many professions and organizations.

However, we still have a long way to go, not only in society, but also in psychiatry. A time to regroup is this July. July is National Minority Mental Health Awareness Month. It was proclaimed by the US House of Representatives in 2008, to improve mental health treatment and services for multicultural communities through increased public awareness.

The societal stigma of being a member of a minority group, when coupled with the stigma of having mental illness, can double the negative effects of stigma. Don’t we have to re-double our efforts to reduce those stigmas and all the related consequences?

This article was originally posted on March 13, 2015 and has since been updated.

Disclosures:

Note to readers: As with all of our blogs, the opinions expressed in this commentary are solely those of the author. Comments not followed by full names and academic titles will either be removed or heavily monitored. –Psychiatric Times.

References:

1. Moffic HS. The American sniper’s psychiatrist. http://www.psychiatrictimes.com/blogs/american-snipers-psychiatrist. Accessed March 30, 2015.