Book review: Textbook of cultural psychiatry

Since the first edition of the Textbook of Cultural Psychiatry was published in 2007, the challenges and complexities facing cultural psychiatry have increased. In the interim, millions have emigrated and fled from their place of living. Many countries are increasingly multicultural, and clinicians are to a still greater extent exposed to patients with diverse backgrounds. This has huge implications for health care in general and psychiatry in particular as culture shapes both the incidence and content of mental illness. Should the clinician be ignorant of culturally dependent manifestations of distress, misdiagnosis might ensue. The aim of this book is to provide the reader with a theoretical framework for understanding the patient as a complex whole. To ensure this, a central argument is elaborated several times: to navigate clinically in multicultural societies acquiring cultural competency – an understanding of how cultural and social factors shape the individual – is essential. Furthermore, increasing evidence suggests that diverse ethnocultural groups respond differently to biological and psychological treatments.

The 66 authors are mainly from the fields of psychiatry and psychology but include other professions, for example, anthropology and theology. Their contributions have again been gathered and edited by Dinesh Bhugra, Emeritus Professor of Mental Health and Cultural Diversity at the Institute of Psychiatry, Psychology & Neuroscience at King’s College London and President of the British Medical Association, and Kamaldeep Bhui, Professor of Cultural Psychiatry and Epidemiology at St. Mary’s Hospital, London.

The new edition updates and expands on the previous work. The organization of the text into six major sections remains unaltered. Most of the individual chapters have been revised and updated with recent knowledge, though the difference compared to the previous edition is often modest. New chapters are included on topics increasingly pertinent to psychiatry such as globalization, telemedicine and social media. These new additions place the book in a contemporary international setting and are lucid accounts on how new technologies and the interconnectedness of the modern world implies both the potential of harm and benefit for the field of mental health. The new chapter on refugees is a sweeping report on the so-called refugee crisis and the reaction of the host countries, while a chapter on transgenderism sheds needed light on a complex and controversial topic.

The pages have a smaller margin in the new edition and with 680 pages compared to 610 of the first edition, this adds a lot of extra volume. The illustrations and figures are few, but where found they most often support the understanding of the text.

The breadth of Cultural Psychiatry as put forth by this book is vast and hard to overstate. The topics included span such diverse fields as anthropology, religion, phenomenology, pharmacology, colonial history and more. Not included are prescriptive answers to specific meetings between patient and clinician. The main strength of the work is providing a solid and wide-ranging body of knowledge to increase ones understanding of how culture and illness interact.

To the great extent the book is updated and tuned to the current state of the world it was disappointing not finding more clinical information concerning refugees. Giving the enormity of the refugee situation and the number of clinicians currently treating this population worldwide, it seems to have deserved more space. Also, many chapters could have benefitted from measures of association such as odds ratio, relative risk, hazard ratios, and so on.

I recommend the Textbook of Cultural Psychiatry to clinicians and researchers, working in the field of psychiatry or in health departments with multicultural interfaces. It gives a comprehensive overview of one of the broadest fields of medicine imaginable, while being both well written and humane. Importantly, in a scientific environment with great focus on neuropsychiatry, the book serves as a crucial reminder that research on mental illness needs a plethora of methodological approaches including anthropology and history to properly grasp its complex nature.