Video Helps Residents Understand Importance of Cultural Factors

Carl Bell, M.D., CEO and president of the Community Mental Health Council in Chicago, explained the phrase “the witch is riding you,” which is used to describe some African Americans’ perception of the paralysis sometimes experienced when waking up or falling asleep. They may even experience what is known as a “sleep hallucination,” said Bell, during which the person sees or hears something that isn’t there. Upon questioning, the person may reveal that he or she has been “hexed” and that “the witch is riding me.” What really is a case of isolated sleep paralysis, Bell said, warrants reassurance and not necessarily antipsychotic medication. Upon questioning, the person may reveal that he or she has been “hexed” and that “the witch is riding me.” What really is a case of isolated sleep paralysis, Bell said, warrants reassurance and not necessarily antipsychotic medication.

The cultural experts in the video highlighted the role of alternative treatments. One of the things that clinicians must take into account, said Maria Oquendo, M.D., an associate professor of psychiatry at Columbia University, is that “patients know that doctors, nurses, and social workers don’t believe in shamanism or healers.” Thus, patients may not reveal their belief in these forms of treatment unless the clinician is receptive to a discussion about them. “The caretaker’s role is to help the patient feel comfortable about revealing this type of information.”

Oquendo also explored the culture of homosexuality in the video. “If you were to ask, ‘What is American culture?,’ you would get a million answers,” she said. “The same is true of homosexual cultures.” In New York City, she said, these multiple gay cultures exist side by side and may be differentiated along ethnic lines. Latino gay men, for example, may perceive themselves differently from the way an African-American or white gay man perceives himself. “A Latino may not consider himself to be homosexual” if he is not the receptive partner, she noted. This has become an important issue to address in terms of HIV/AIDS education and treatment, for instance.

The video offers plenty of additional wisdom on how to enhance the therapeutic alliance between patient and clinician from a cultural standpoint. Psychiatrists and mental health professionals are not culture free and must be able to free themselves from previously unquestioned assumptions about people from other cultures, according to several psychiatrists who appear in the video.

Bell has been the target of such assumptions himself. “I recall walking into a dermatologist’s office, and the receptionist, because I am black, assumed I was on public aid instead of assuming that I ran a $16 million mental health center.” She asked whether Bell had his Medicaid card. “I was insulted because she stereotyped me, and it destroyed our possibility of ever having a relationship,” said Bell.

The video also touches on important differences between refugees and immigrants, language barriers, and religion.

Harriet Koskoff, producer and co-coordinator of “The Culture of Emotions,” told Psychiatric News that she became interested in Lu’s work in cultural psychiatry a number of years ago and thought that a video would be an excellent tool to help clinicians grasp the complexities behind the “Outline for Cultural Formulation.”

“As a professional television producer,” Koskoff said, “I know that video is the most effective way to convey information about culture and its role in psychiatric diagnosis.” Koskoff has also produced “Despair,” a public television documentary on depression from a multicultural perspective.