Cultural Beliefs Can Be Harnessed To Aid Outcome
Culture-bound syndromes. Indian men sometimes believe that they are losing semen in urine, but actually they are anxious and depressed, said Rajesh Parikh, M.D. Parikh is a consultant neuropsychiatrist at the Jaslok Hospital and Research Center in Bombay. Hispanic patients sometimes experience an “attack of nerves,” Mischoulon noted. It is similar to a panic attack, but often involves fainting or shouting. Some two-thirds of individuals who experience this syndrome are anxious or depressed, studies have shown.
Psychotic symptoms. Psychotic symptoms expressed by Hispanic patients may differ from those often seen in Americans patients of other ethnic backgrounds, Mischoulon said. For example, their auditory hallucinations may consist of hearing a knocking at the door, a doorbell ringing, or children’s voices calling one’s name. visual hallucinations might consist of “black” thoughts flying across one’s vision.
The symposium speakers also suggested ways of deploying patients’ cultural beliefs and expectations to bolster the therapeutic process. Among them:
Involving the family. With patients from India, it is crucial to involve family members in treatment, Parikh asserted, because family in their culture is very important. The same is the case with Hispanic patients, Mischoulon stressed. Also, bringing in family members can give a clinician more perspective on a patient’s issues, he said.
Relaxing boundaries. Many Hispanic patients expect clinicians to divulge a lot of personal information about themselves, which American psychiatrists usually do not do, said Mischoulon. Thus, providing a little personal information might further therapy with Hispanic patients.
Countering fatalistic beliefs. When Hispanic patients resist treatment because they hold fatalistic beliefs such as “the good Lord willing” or “Que sera, sera” (what will be, will be), Mischoulon might admonish them to “do the necessary leg-work to help God.”
Enlisting native healers. For some Hispanic patients, for example, it may help to enlist the assistance of traditional healers, Mischoulon asserted. The reason is that patients may respect the psychiatrist for being open to their ways.
These “practical tips for harnessing an individual’s cultural beliefs, support systems, et cetera, toward treatment” were some of the symposium highlights, co-chair Shamsah Sonawalla, M.D., an assistant professor of psychiatry at Harvard University, told Psychiatric News.
“The most impressive notion [of the symposium],” Fricchione believes, “was that modern psychiatry in the United States must become more sophisticated in its evaluation and management of diverse populations that increasingly seek treatment in our centers. This is because, while there are certainly psychiatric conditions that all groups share, with common symptom clusters and treatment responses, there are also important differences that will impact on patient access, compliance, and response to treatment.” ▪