Chapter 44.Culturally Diverse Patients

In this chapter we discuss the role of culture in diagnostic assessment and treatment planning. In DSM-5, culture is defined as “systems of knowledge, concepts, rules, and practices that are learned and transmitted across generations. Culture includes language, religion and spirituality, family structures, life-cycle stages, ceremonial rituals, and customs, as well as moral and legal systems” (American Psychiatric Association 2013, p. 749). DSM-5 explains that “cultures are open, dynamic systems that undergo continuous change over time; in the contemporary world, most individuals and groups are exposed to multiple cultures, which they use to fashion their own identities and make sense of experience. These features of culture make it crucial not to overgeneralize cultural information or stereotype groups in terms of fixed cultural traits” (American Psychiatric Association 2013, p. 749). These characterizations of culture illustrate central issues in cultural psychiatry that are relevant to the practice of all clinicians: 1) all individuals, as social beings, belong to at least one culture whose interpretations about the self, others, the world, and human predicaments (Who am I? Why are we here?) are debated in relationships and institutions across the lifespan; 2) individuals use their relationships and social groupings to fashion a unique sense of self (i.e., “identity”) that informs their “psychology” (their understandings of thoughts, emotions, and behaviors); and 3) clinicians cannot make assumptions about anyone’s cultural affiliation(s) lest they risk assigning stereotypes that can endanger therapeutic rapport.