Cultural psychiatry

1. Cultural psychiatry

2. ‘Culture’ • Culture refers to the meanings, values and behavioural norms that are learned and transmitted in the dominant society and within its social groups. Culture powerfully influences cognition, feelings, and self concept as well as the diagnostic process and treatment decisions. • The National Institute of Mental Health’s Culture and Diagnosis Group, 1993.

3. Race • An alternative view is that the number of alleles that determine visible differences is such a small proportion of the total genetic constitution that the term ‘race’ is inappropriate. • When actual allele frequencies are studied in ‘different races’, allele differences are found more often within each group than between groups.

4. How does ethnicity relate to culture? • Ethnic groups may approximate sufficiently to culture if the sample from which they are drawn contains a self selected cultural group. • If ethnicity is to be used as a key variable in research as a class of person its validity as a measure of culture, identity,religion and race must be fully established for the research to be meaningful.

5. Cultural formulation 1 Identification of the patient’s culture, including lan- guage and spiritual/religious affiliation, and multi- cultural identity; 2 Cultural explanations of the illness (i.e. idioms of distress, explanatory models, experience with popular and professional sources of care); 3 Factors related to the psychosocial environment and functioning (e.g. cultural influences on stressors, social support and stigma); 4 Cultural aspects of the relationship between patient and clinician.

6. College on stolen generation • May 1997 “Bringing them home” report by Human Rights and Equal Opportunity Commission • Removal lead to higher rates of: • Ill health • Arrest • Substance abuse • Premature death • College apologetic on behalf of profession for not having done more to prevent this

7. What should services aim for? • Accessible • Appropriate • Acceptable

8. Interpreters: practical considerations • Time- interviews usually take twice as long. • Seating- TRIANGULAR is the best • Take time for introductions • Define the nature of the interview • Ensure that the language is correct and acceptable • Political/religious/cultural differences should not affect the interview.

9. Practical Considerations • Age/ gender of the interpreter can be very important. • Confidentiality • Interruptions and clarifications • Ensure that the interpreter does not give their own technical interpretation • Ending the interview • Post interview de-briefing with the interpreter

10. Culture bound syndromes*

11. Culture bound syndromes*

12. Indigenous MI risk contributors

13. College ethical guide to ATSI

14. College on ATSI MHPs • Paid adequately e.g. because of varied work hours • Gender issues addressed • Respected as part of multidisciplinary team • Research • Lack of formal qualifications should not be a barrier • Should be able to review own budget allocation

15. Cultural depression

16. Odds and ends

17. Vicarious Traumatisation • Distress associated with working with victims of extreme trauma • Preoccupation and rumination • Intrusive imagery • Mood disturbance • insomnia • Changed world view, paranoid perception

18. Terminology

19. Terminology

20. Terminology

21. Terminology

22. Definitions

23. Definitions

24. Definitions

25. Odds and ends

26. Odds and ends

27. Bits and bobs

28. Names and concepts in psychiatry Malarial treatment of neurosyphilis (NobelPrize)Wagner von Jauregg Moral treatment; breaking chains in Saltpetriere Pinel (1745-1826) Primal therapy A. Janov Psychobiology Adolf Meyer (1866-1950) Psychodrama J. Moreno Reciprocal Inhibition Joseph Wolpe Self-instructional training Meichenbaum Social Learning Albert Bandura Sociological theory of suicide Durkheim Suicide Thomas Browne The Sick Role Parsons Therapeutic Community Maxwell Jones Transactional analysis F. Berne

29. Names and concepts in psychiatry Abnormal Illness Behaviour Pilowsky Advocated treatment without mechanical restraints Conolly (1794-1866) Aggressive and Creative Psychopaths Henderson Agnosia Term coined by Freud Alexithymia Nemiah & Sifneos Anxiety Lewis Crisis Intervention Linderman (1944), Caplan (1961) Development of Clozapine Kane Development of Imipramine Kuhn Ecological theory of suicide Sainsbury Gestalt Therapy F. Perls Hypnotherapy Milton Erikson Illness Behaviour Mechanic Interpersonal therapy Sullivan

30. Names and concepts in psychiatry Client-centred therapy: Carl Rogers Inferiority complex: Alfred Adler Novelty seeking: Cloninger Good enough mothering: Donald Winnicot

31. Names & concepts

32. Names & concepts in psychiatry

33. Names & concepts in psychiatry

34. Resource • World's Neurochemistry Portal <http://www.neurochem.org/pages/links_index.htm> - from the International Society for Neurochemistry http://www.neurochem.org/pages/links_index.htmWeb Textbook on Nerve Impulses <http://pb010.anes.ucla.edu/> - with interactive simulations of ions channels (this is an awesome web site)http://pb010.anes.ucla.edu/*Introduction to Neurobiology <http://instruct1.cit.cornell.edu/courses/bionb222/links.htm> http://instruct1.cit.cornell.edu/courses/bionb222/links.htmUS National drug abuse websitehttp://www.drugabuse.gov/NIDAHome.html <http://www.australian-news.com.au/FAS7cm.jpg>