Cultural adaptation of globalized psychiatry [the interface between global and local worlds]

ABSTRACT

The management of psychiatric disorder includes all aspects of dealing with mental ill health at the levels of prophylaxis, establishment of diagnosis and therapy. Culture has an input at all these levels. Traditional families are more emotionally committed to their members and hence more able to prevent and compensate the effects of parental loss and mental disability. Members of traditional families develop group superegos and perpetuate the collective authority and responsibility of family elders to take decisions for healthy and sick members alike e.g. decisions on hospitalization of insightless patients, arranging marriages and fore-care and after-care of patients. Intergenerational conflict within traditional families has never been demonstrated to have pathogenic effects though it increases the likelihood of help seeking from professionals outside the family. Knowledge of contents and limits of culturally shared supernatural beliefs is essential for all therapists in order to define illness onset and subsequent recovery. Western models of doctor expectations and goals of treatment have to be adapted to patients' culturally conditioned expectations of greater dependence on therapists and interdependence in relation to others rather than individual independence. Establishment of a healthy therapist-patient relationship based on mutual trust is the common denominator of both professional and traditional therapies. The difference however, is that the former try to undo patients' projections on supernatural agents which the latter reinforce