Clinician’s Guide to Cultural Psychiatry

For several decades, Dr. Tseng has studied “the unique behavior patterns and life style shared by a group of people, which distinguish it from others.” The result, Handbook of Cultural Psychiatry (1), was published in 2001. The current compendium derives largely from it.

Clinician’s Guide to Cultural Psychiatry starts with chapters that define cultural issues and stress reactions. These chapters could be considered the theoretical basis for the book, reaffirming that most pathological manifestations are influenced by the individual’s cultural group and his or her environment.

Chapters 3 and 4 focus on specific phenomena and general disorders. The specific phenomena addressed in chapter 3 include the many specific culture-related syndromes that in the past constituted a great part of “cross-cultural psychiatry.” Chapter 4 refers to the psychiatric disorders usually addressed in the psychiatric nomenclature. The author reminds us that the Collaborative Study of Psychological Problems in General Health Care, a large-scale international multisite comparative investigation carried out by the World Health Organization, showed striking similarities in the distribution of a number of disorders around the world. Much more research is necessary to appreciate whether cultural factors make a difference in the presentation and diagnosis of most disorders.

The remaining chapters are more relevant to clinicians. How do we take cultural factors into account in the diagnostic assessment, psychotherapy, drug therapy, and choice of treatment settings? A good beginning might be to accept that cultural differences really exist and may facilitate or interfere with the work of the clinician; that psychotherapy may be more effective if congruent with the patient’s culture and values; that biological factors enhance or reduce the effects of medications; that culture may be a major factor in accepting a treatment setting.

The clinicians who may fish in this well-stocked sea of clinically relevant issues will be disappointed with their catch. They may not be satisfied with the size of the offerings (four pages on Hispanic American groups, one page on cognitive therapy). They may be happier if they see the book more as a display of potentially relevant issues than as a manual for the clinician eager to learn practical pointers on cultural psychiatry.