Kamaldeep Bhui (Ed.),Elements of Culture and Mental Health: Critical Questions for Clinicians

Reviewed by: Latha Guruvaiah, Dudley and Walsall Mental Health Trust

Karthikeyan Veerasamy, Worcestershire Health and Care NHS Trust

Culture plays a central role in illness experience and behaviour and has a strong influence on the ways in which mental illnesses are expressed. Hence, understanding culture is crucial for mental health professionals to deliver effective care. This slim volume discusses some of the complex issues faced by clinicians responding to cultural diversity in mental health. Twenty brief chapters by clinicians as well as one service user address some of the challenges in the provision of psychological treatments to culturally diverse populations.

Several chapters discuss issues related to assessment and diagnosis and the use of interpreters in delivering psychological therapies. One chapter addresses the importance of incorporating spiritual/religious history in psychiatric assessment and treatment to provide a new dimension to mental health care. Another interesting chapter elaborates the broad concept of “well being” and questions the applicability of traditional biomedical approaches to assessment, diagnosis, and treatment to the recovery, well-being, liberation-focused models. The book also discusses the epistemic mismatch that may hamper psychotherapy and considers how it can be transformed into mutual enrichment for the patient and therapist. The contributors draw attention to the existence of implicit racism and its influence in the diagnosis and management of mental illness. In addition, there is a discussion about the difficulties in addressing the inequalities in the social determinants of illness with one common public health policy.

The book raises many thought-provoking questions: To what extent are current, standard diagnostic criteria applicable or adaptable to all cultures? If they are not, how can we arrive at common cross-cultural diagnostic criteria? Is this goal even feasible? It seems that in many contexts cultural factors are ignored—for example, practitioners working in war and conflict zones diagnose posttraumatic stress disorder but there is no provision in current nosology to address the key issues of collective trauma and social coping. With regard to treatment, are current practices in the prescription of medication broadly applicable, without taking into account various ethnic and cultural factors? Similarly, how do current techniques of cognitive behavioural therapy consider cultural, language, and ethnic differences?

As a way of addressing these complex issues, the authors suggest that clinicians should develop culturally competent skills but, at the same time, be careful not to lose their personal professional style. The contributors also highlight the importance of cultural adaptation, but more guidance on how to make such adaptations would have been helpful.

In summary, the book provides a concise overview of some key issues in cultural psychiatry but will probably be most useful and thought-provoking for psychotherapists as most of the topics are related to providing psychological therapy.