Abstract
Cultural diversity presents an important challenge for health care services in every society around the world. In this introductory chapter, we consider the changing meanings of culture and the ways in which different societies have responded to cultural diversity in mental health services. We show how these approaches reflect local patterns of migration and demography, ideologies of citizenship and theories of the place of culture in mental health. We outline the rationale and key principles of the cultural consultation approach: focusing on social and cultural contexts in assessment; recognizing the ubiquity of culture in the experience of patients and clinicians; understanding culture not simply as mental representations but as embodied and enacted; using systemic, interactional and self-reflexive views; emphasizing problems of power, position and communication; approaching culture and community as resources for healing, adaptation and recovery; and working within health care systems to foster change. We illustrate what culture adds to clinical care including diagnostic assessment and treatment through the contextual framing of psychiatric disorders. Social and cultural processes shape the mechanisms of disease, the symptoms of distress, and subsequent ways of coping or help-seeking. Systems of healing reflect cultural models of body, self and person that are grounded in distinctive ontologies or notions of what constitutes the individual and the world. Finally, we consider the importance of understanding culture and context for clinical empathy.
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Notes
- 1.
Here is how Walzer (1997, p. 44) describes Canadian society:
Canada is an immigrant society with several national minorities—the Aboriginal peoples and the French—that are also conquered nations. These minorities are not dispersed the way the immigrants are, and they have a very different history. Individual arrival doesn’t figure in their collective memory; they tell a story, instead, of long-standing communal life. They aspire to sustain that life, and they fear that it is unsustainable in the loosely organized, highly mobile, individualistic society of the immigrants. Even strong multiculturalist policies are not likely to help minorities of this sort, for all such policies encourage only “hyphenated” identities—that is, fragmented identities, with each individual negotiating the hyphen, constructing some sort of unity for him or herself. What these minorities want, by contrast, is an identity that is collectively negotiated. And for that they need a collective agent with substantial political authority.
- 2.
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Kirmayer, L.J., Rousseau, C., Guzder, J. (2014). Introduction: The Place of Culture in Mental Health Services. In: Kirmayer, L., Guzder, J., Rousseau, C. (eds) Cultural Consultation. International and Cultural Psychology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7615-3_1
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