“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 article of this series, entitled, The Lies About Cultural Competency: 2 Main Reasons, in which I explained that Cultural Competency is: (1) Misconceived; and (2) Misleading. In this current article, I will outline 2 additional points, illustrating the current lies about cultural competency. In subsequent articles, I will describe: (1) What is missing about cultural competency; and (2) What cultural competency really is and/or what it could be.
Here are two additional points illustrating the lies about cultural competency:
1. It misses the point:
In the previous article mentioned above, I explained that cultural competency is misconceived and misleading. A related reason here explains that cultural competency misses the point. Why do I say this? I mean here that cultural competency, as currently conceived or operationalized, sends a skewed message about the definition of culture. There is an unintentional biased message about which culture requires us to show competency, and it unintentionally sends the message about our need to be “politically correct,” as opposed to being “culturally competent” or “culturally sensitive” or “culturally appropriate” or any other term we have been using lately. Addressing the concept of “political correctness” is not only beyond the scope of this article, but it is also beyond the mission and vision of SWEET. However, my personal point of view, and it is only that-my personal point of view, “political correctness” may sometimes be a good thing, while at other times, it may not. It depends on how we look at it, how we understand it, the intention behind it, the impact, and the context. Nonetheless, as it relates to this article, the way that cultural competency is currently conceived, operationalized, explained, taught or described, it unintentionally sends a message of “political correctness,” and as a result, cultural competency misses the point.
2. Its effects can be paradoxical:
Related to the fact that cultural competency is misconceived and misleading and misses the point by conveying an unintentional message of political correctness, it also engenders the wrong sentiments. These sentiments are far from what it is intended to engender; sentiments filled with animosity, resentment, guilt, shame and embarrassment, which therefore leads to a paradoxical effect. These sentiments, while repressed, often manage to manifest themselves in other ways that are either subconscious or unconscious. The ramifications of this are rather far from what we have all wanted or hoped. Further, these types of sentiments are often from both camps, from those we perceive as the “majority” and those we perceive as the “minority,” on behalf of whom we are advocating “cultural competency.”
Cultural competency is: (1.) Misconceived; (2.) Misleading; (3.) Misses the point; and (4.) It can lead to paradoxical effects. It leaves out part of the definition of culture. It forces us to focus on a small part of the picture, instead of the big picture. It therefore engenders sentiments that are the opposite of what we are looking for. These unintended sentiments happen to be from both camps that the misconception of cultural competency has been generating.
In subsequent articles, I will: (1.) Describe additional factors illustrating the lies about cultural competency; (2.) Explain what is missing about cultural competency; and (3.) Elaborate on what cultural competency really is and/or should be.
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.
Kleinman A. Rethinking psychiatry: from cultural category to personal experience. New York: Free Press; 1988.
Bhui, K. and Sashidharan, S. P. (2003) Should there be separate psychiatric mental health services for ethnic minority groups? British Journal of Psychiatry, 182, 10–12 .
Brodsky, C. (1970) Macrocosm and microcosm: the interface between anthropology and clinical psychiatry . Comprehensive Psychiatry, 11(5), 482–491.
Berne E. Games People Play: The Psychology of Human Relationship. Newton Books, New York, 1964.
Kleinman A (1997). "Triumph or pyrrhic victory? The inclusion of culture in DSM-IV". Harv Rev Psychiatry. 4 (6): 343–4.