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Shooting the messenger: the science and politics of ethnicity research: The problem is widespread.
- Saeed Farooq (18 August 2009)
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Untitled
- Swaran P Singh (22 September 2009)
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Saeed Farooq, Consultant Psychiatrist Wolverhampton PCT, UK
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sfarooqlrh{at}yahoo.com Saeed Farooq
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The Editor British General of Psychiatry Subject: Shooting the messenger: the science and politics of ethnicity research: The problem is widespread. Professor S Singh(2009) has raised very important issues in his editorial1. I would like to point out that the problems he has highlighted lie at the very heart of discourse in Transcultural psychiatry as a whole, not just in relation to the ethnicity research. The discourse in Transcultural psychiatry has mostly been driven by ideological points of view and there are not many examples of converting the ideological and philosophical assertions into testable scientific hypothesis. Worse still, the field has rarely addressed issues of practical clinical significance. A good example is the language barrier. Language is the key investigative and therapeutic tool in mental health and the unmet language need is considered as one the one of key drivers of social exclusion and inequity in access to services2. The language barrier presents a two level (1) translation and (2) interpretation. There are scores of articles on translation of written material and questionnaires in the literature. Undoubtedly, this research has great value but this is mostly limited to detecting and quantifying the disorders in research and field studies and these questionnaires have limited applicability outside the research setting. Even as screening tools these have found limited applicability in practice. This may well be due to fact that the quality of these translation vary widely and these may not be acceptable to the indigenous populations. Transcultural Psychiatry has failed to develope consensus guidelines or a gold standard which could guide the translation and reporting of the scales/questionnaires when used in non English speaking communities. Even worse is the case of interpreters in Psychiatry. The use of interpreters requires skills which are neither taught in psychiatric training nor addressed in research. The literature in this vital area is limited to few descriptive studies which is lamentable considering the practical significance of the subject3. This is perhaps just one of the reflections of the field being bogged down by an agenda which has nether helped scientific study neither services. Jablensky (1994) claimed that transcultural psychiatry is an applied science4. However, to sustain this position Transcultural Psychiatry will need a fresh research agenda which could guide the development of research-derived concepts into reliable health strategies. Prof. Saeed Farooq. Consultant Psychiatrist Corner House Resource Centre Wolverhampton, UK |
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Swaran P Singh, Professor of Social and Community Psychiatry University of Warwick
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s.p.singh{at}warwick.ac.uk Swaran P Singh
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I thank Professor Farooq for his comments on the editorial. I entirely agree with him that transcultural psychiatry has often ignored the very real, immediate and pressing clinical issues that are relevant to the mental health needs of ethnic minorities, while pursuing ideologically driven and empirically unverifiable agendas. Blaming psychiatry for ethnic differences in mental health care has simply shifted focus away from the social adversities that underlie such differences. Selten & Cantor- Graae (1) have recently pointed out that such a shift of focus is convenient for politicians, since it makes it both safe (and cheap) to ignore the “epidemic of psychosis” among ethnic minorities. In the UK, there appears to be a genuine desire within the Department of Health to address ethnic minority issues in mental health. This is in sharp contrast to much of continental Europe, where the issue barely registers, even in countries with large minority populations. Language barrier and the role of interpreters in mental health are excellent examples of areas of practical and clinical significance which have received little research attention. Understanding and being understood must be the pre-requisites of any therapeutic interaction, and yet so little research has been conducted on interpretation in mental health care. Interpretation is not simply translation; it is the process to ensure that the full linguistic and cultural meaning of what is said is truly conveyed. Scientific literature in the field is however restricted to descriptive reports about difficulties that occur in clinical encounters when interpreters are used, rather than on what influences the process and outcome of interpretation (2). For transcultural psychiatry to make a real difference to the health outcomes of ethnic minorities, it is research and evidence in this and similar areas that will yield benefits to our minority groups, rather than psychiatry bashing. 1. Selten J-P & Cantor-Graae E (2009) The denial of a psychosis epidemic. Psychological Medicine doi: 10.1017/S0033291709005686, Published online by Cambridge University Press 20 Apr 2009 2. Tribe R & Lane P (2009) Working with interpreters across language and culture in mental health. Journal of Mental Health, 18, 233- 241 |
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