Electronic Letters to:
|
|
eLetters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Psychiatry and the cultural influence
- Nandini Chakraborty (19 October 2006)
-
Cultural bias-a personal story
- Taiwo A Ajayi (19 October 2006)
|
|
|||
|
Nandini Chakraborty, Senior House Officer in Psychiatry NHS Ayrshire and Arran
Send letter to journal:
nandinichakraborty{at}doctors.org.uk Nandini Chakraborty
|
I read with interest the article on culture and assessment of manic symptoms (Mackin et al.) in the British Journal of Psychiatry, October 2006. As a psychiatrist who has worked both in India and the UK, there are some aspects of this study that I would like to draw attention to. It was when I started training in the UK in 2003, that I appreciated for the first time, how much more Indian psychiatric training was allied to American guidelines and recommendations rather than British ones. This is something to which I have found no published reference, no surveys so as to speak of; only my experience at what is considered both a tertiary clinical centre and research institute in Indian psychiatry. This seemed to apply more to the assessment and diagnosis of affective disorders than other categories. Though mostly a comprehensive approach, including both ICD-10 and DSM-IV was encouraged for most diagnostic categories, for affective disorders, DSM-IV was considered a more holistic approach. I remember the stress laid on distinguishing ‘relapse’ from ‘recurrence’, ‘remission’ from ‘recovery’, ‘continuation’ from ‘maintenance’ treatment. An approach reflected in DSM-IV’s defined approach to ‘partial remission’ and ‘complete remission’, terms missing in the ICD-10 classification of mood disorders altogether. It is possible that the findings of this study in some way reflect the closeness of the Indian approach to the American approach where affective disorders are concerned. The second point I would like to highlight is that the videotapes used were of two manic patients from America. Inspite of the uniformity that internationally used classifications systems like the ICD-10 and DSM-IV can bring into psychiatric diagnosis worldwide (albeit if practising clinicians care to read and use them regularly), it remains that clinical psychiatry will always be influenced by cultural expectations. The average behaviour, lifestyle and beliefs of the average American, does vary from the average British and certainly from the average Indian. Hence what constitutes ‘abnormal’ or ‘aberrant behaviour’, enough to suggest the possibility of an illness will have to consider the cultural baseline. The same applies when rating symptom intensity. In this context it may be logical to say that an Indian psychiatrist is the best person to assess Indian manic patients and the same for other cultural and societal settings. I would thus be less apprehensive than the authors of the current study in considering cultural bias in multi-country trials, as long as the rating was being done in each country, among its own patients by its own doctors, accustomed to local beliefs and practices. |
|||
|
|
|||
|
Taiwo A Ajayi, Staff Grade Psychiatrist
Send letter to journal:
taoajayi{at}doctors.org.uk Taiwo A Ajayi
|
I could not agree more with Mackin et al's conclusion that cultural biases influence the interpretation of manic symptoms( and perpharps all psychological symptoms). My first hand experience alluding to this hypothesis occured in the first year of my psychiatric training.The lessons learnt then have remained with me ever since. On a Monday morning handover meeting the nursing staff brought to my attention a "floridly psychotic lady of African origin" admitted formally over the weekend.She was self isolating and believed to be "paranoid" as she would not have any meals offered her.She repeatedly expressed nihilistic delusions that her heart has been taken away from her. I expected to see an agitated lady, but was puzzled to see a calm lady whose facial expression betrayed her relief at seeing a doctor she believed was of a similar cultural background. A careful history and mental state examination conducted in a culturally sensitive manner was revealing. Her "nihilistic delusion" of her heart being taken away was her manner of expressing her distress at the temporary seperation from her 2 year old son who was taken into temporay social services care when she was admitted. In parts of Africa the word "heart" is used for anyone who is dear and close to your bossom.Her explanation of her hunger strike was that she was not accustommed to eating meals not heavily spiced. On caferul interview I was unable to elicit any abnormality of mood,thought or perception. My impression of a misdiagnosis was confirmed later that afternoon at a multi disciplinary ward round.It was unanimously agreed there were no justifiable grounds for further detention. She was subsequently discharged within a few days without diagnosis of a mental disorder.She was not referred back to our service over the period of my 6 months rotation. The need for psychiatrists to be culturally aware and sensitive cannot be over-empahasised.However we must remember cultural awreness and sensitivity is a two edged sword.Home grown doctors need to understand cultural issues of the ethnic minority and the immigrant doctors the prevailing cultural isues in their country of practice. |
|||