“Is this culture, personality, or pathology?” Georgina, a bright, ambitious and curious clinician started with this question, as we met together. “Is this culture, personality, or pathology,” I repeated, allowing her enough time to collect her thoughts.
“I already know her constant somatic complaints are related to her culturally acceptable way of expressing her emotional pain. I know it can also be part of her personality, her character structure, or her temperament. I also know that her somatic complaints may be part of a whole separate pathology, possibly Somatization Disorder, bordering on overvalued ideas, or obsession-compulsion and even psychosis. But which is it? And given the strong cultural component, how do I tease out the difference?” Georgina added this in a serious tone.
This paragraph introduced the first two articles in this series, entitled, The Lies About Cultural Competency: 2 Main Reasons and The Lies About Cultural Competency: 2 Additional Reasons. In these first two articles, I explained:
The importance of contextualizing symptoms for an accurate understanding of the problem;
The importance of using the principles of a bio-psycho-social and cultural approach;
That many clinicians know the bio-psycho-social and cultural approach, though they fail to use it adequately; and
The cultural component of the bio-psycho-social and cultural approach is less known, less understood, and less practiced.
In these two articles, I explained that the reasons why the cultural component of the bio-psycho-social and cultural paradigm is less known, less understood and less practiced is related to major issues with the concept and practice of cultural competency, as known and implemented today. I described these major issues as the lies of cultural competency and I explained the following about cultural competency:
It misses the point; and
It leads to paradoxical effects.
Further, it misses the big picture and is unintentionally skewed, biased, and it puts both parties in the defensive. In truth, it, therefore, engenders unintended sentiments.
In this current article, I will describe three more factors, illustrating the lies of cultural competency. And in subsequent articles, I will further outline: (1) What is missing about cultural competency; and (2) What cultural competency is and/or what it could be. Below are three additional factors illustrating the lies about cultural competency:
1. It leaves out the real why:
Why cultural competency? Why do we need it? Why do we practice it? In other words, what is or could be our intention around cultural competency? What do we expect the impact could be? What do we think the response could be? As you know, our why is our purpose, our vision, the big picture, which when clear, leads the way, sets the tone, sets the direction and helps us focus on our goals, our objectives and our strategy. The why of cultural competency as it is, comes from a “shaky” foundation, mainly an emotional one, and therefore fails to pass the test of logic. Cultural competency, as it is today, leaves out the real why, and this helps explain the major concerning issues.
2. It’s far from real:
Related to leaving out the real why, cultural competency, as it is currently portrayed, is far from real. It stands on a “shaky” foundation, as I mentioned; it leads to repression of emotions, and it prevents clinicians, and patients and clients alike from being themselves. It, therefore, takes freedom away from both parties. It also creates an unintended and unnecessary sense of lack of safety; everyone tends towards being cautious, making sure he or she is politically correct, trying not to offend one another, not saying the wrong thing, or using the wrong word. Much energy is spent in the wrong area, without any meaningful change in behavior. Cultural competency is far from real, as it stands—by far.
3. Because we can do better:
Having said all this, we all know that we can do better, and this is both the final point illustrating the lies about cultural competency, but it also offers hope. We can do better, because we have principles of engagement that are proven to be effective, regardless of the people with whom we work. It is effective, because we have proper founded techniques that allow us to be flexible in the use of our principles, to tailor them to specific populations, settings and context, in a natural way, as opposed to in a state of fear. We can do better because we know “Us Together” works well, better than “Us versus Them.”
“Is this culture, personality, or pathology?” Georgina, a bright, ambitious and curious clinician started with this question, as we met together.
In summary: (1) We all need to strive to always contextualize the symptoms with which our patients and clients present; (2) We need to do our best to formulate and execute our assessment and plan from a bio-psycho-social and cultural dimension; and (3) We need to appreciate the fact that cultural competency, as it stands today is characterized by several lies, which I have illustrated through these seven factors: (1) It’s misconceived; (2) It’s misleading; (3) It misses the point; and (4) It leads to paradoxical effects. I also explained that: (5) It leaves out the real why; (6) It is far from real; and (7) We can do better.
Recognizing the issues with cultural competency is the first step towards fixing it, and in subsequent articles, I will describe: (1) What is missing about cultural competency; and (2) What cultural competency is and/or could be about.
For more in this series of articles, check below!
Dr. Sidor is quadruple board certified in psychiatry, with vast clinical, teaching, supervision, mentorship, and management experience. He also has extensive experience in public speaking, leadership, business, and research, in addition to a passion for program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the past Medical Director and Chief Medical Officer for CASES (Center for Alternative Sentencing and employment Services), where he continues to see patients and consult on challenging cases. He speaks and writes fluently in six (6) languages—French, English, Spanish, Portuguese, Creole and Italian.
Lee S (September 2001). "From diversity to unity. The classification of mental disorders in 21st-century China". Psychiatric Clinics of North America. 24 (3): 421–31
Beneduce, Roberto (2007). Etnopsichiatria. Sofferenza mentale e alterità fra Storia, dominio e cultura. Rome: Carocci.
Ustun TB, Bertelsen A, Dilling H, editors. ICD-10 casebook. The many faces of mental disorders. Adult case histories according to ICD-10. Washington: American Psychiatric Press; 1996.
Group for the Advancement of Psychiatry, Committee on Cultural Psychia-try. Washington: American Psychiatric Publishing; 2001. Cultural assessment in clinical psychiatry.
Kirmayer IJ. Cultural evaluations in the response to psychiatric disorders and emo-tional distress. Soc Sci Med. 1989; 29:327–339
Yap PM. Mental diseases peculiar to certain cultures: a survey of comparative psychiatry. J Ment Sci. 1951; 97:313–327.