“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.
As I stated above, Georgina is a curious clinician; she is thorough, thoughtful and sensitive. She desires to understand well and formulate well, following the principles of symptom contextualization that I have described in previous articles. Georgina also wants to facilitate the formulation and execution of a treatment plan that follows the principles of a bio-psycho-social and cultural approach (Please see my YouTube educational videos on the topic, Case Formulation, Part 1 and Part II).
A bio-psycho-social formulation is known more than practiced, but it is at least known by enough clinicians. However, adding the component “cultural” is less known, less accepted, less understood, and also less practiced. There are several reasons why this is the case, and one of the reasons is related to how culture in medicine, generally, and in psychiatry and mental health, in particular, has been portrayed, explained, or operationalized. This has to do with the type of reaction the term “cultural competency” has generated, including the way it has been ridiculed by many, though most would not want to admit to this.
In this series of articles, concerning cultural competency I intend to:
Describe the lies of cultural competency;
Explain what is missing about cultural competency; and
Outline what cultural competency is and could be about.
Here are two factors illustrating the lies of cultural competency:
1. It’s misconceived:
The definition of “culture” per se has been misconceived, and so has the definition of cultural competency. The conception surrounding cultural competency, as most have managed to understand or explain, is often described as, those who belong to the “majority” need to show respect for the “minority” by being “culturally competent.” Part of this misconception leads to what cultural competency could be about, when framed properly—the ability to “join in” with any patient or client, regardless of the cultural background.
2. It’s misleading:
Given the misconception about cultural competency, as a concept, or at least, the way it has been operationalized, explained, taught and practiced, it is rather misleading. It is misleading, because it fails to take into consideration the definition of “culture.”
Merriam-Webster Dictionary defines culture as: “The customary beliefs, social forms, and material traits of racial, religious, or social group.” It also defines it as, “The characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time.” A third definition by Merriam-Webster states, “The set of shared attitudes, values, goals, and practices that characterizes an institution or organization.” And a fourth contribution further defines, “The set of values, conventions, or social practices associated with a particular field, activity, or societal characteristic.” Looking at the definition of “culture,” focusing cultural competence on one specific group is therefore more about being politically correct, which is different from being culturally competent, and it is therefore misleading.
“Is this culture, personality, or pathology…?” Georgina, a bright, ambitious and curious clinician started with this question.
In summary: In this article, I explained that:
Georgina’s question was in line with the principles of symptom contextualization and those of a bio-psycho-social-and cultural approach;
While the bio-psycho-social approach is more or less known by most clinicians, this is not the case for the “cultural” component of this approach;
Part of the reasons why the “cultural component” of a bio-psycho-social approach was neither well known, nor understood, can be explained by the lies concerning cultural competency; and
Two of the main points illustrating these lies are:
Cultural competency is misconceived; and
Cultural competency is misleading.
In subsequent articles, I will:
Describe additional points illustrating the lies of “cultural competency;”
Explain what is missing about cultural competency; and
Outline what cultural competency is and/or could be about.
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.
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