Leaders of mainstream psychiatry vehemently reject this critique. Darrel Regier, director of the division of research for the American Psychiatric Association, said biomedical treatments for mental disorders had been objectively shown to be superior to any other system.
"To say you want to go back to nature and have all the benefits of close-knit families take the place of psychotropic medications -- that is wishful thinking and likely dangerous," he said.
Different Viewpoints
Historically, the problem is that psychiatry has been muddled by conflicting theories about the nature of mental illnesses, Regier said. While cultural variations among groups are useful to know about, he added, it is more important for psychiatrists to home in on genetic markers and the brain mechanisms that could be universal to all patients.
"Doctors in general are reductionist," he said. "A patient walks in and you have 10 minutes to find out what in their whole life story is significant. There is a tremendous screening process to cut out irrelevant material."
Columbia University psychiatrist Robert Spitzer, who played a key role in popularizing the medical model of psychiatry, said the cultural advocates are letting politics trump science: "They don't by and large do controlled studies. They mainly complain about the biomedical model."
Spitzer and Regier reflect the eagerness among mainstream psychiatrists to move away from the mushy complexities of culture and the myriad ways in which emotional problems are expressed by different groups, and toward a straightforward system that links groups of symptoms to particular disorders. Ultimately, they hope to find neurological evidence, genetic markers and laboratory tests to differentiate mental problems.
If malfunctioning genes and neurotransmitters can be shown to cause depression, for example, these experts say doctors will be able to treat such problems at their root, making diagnosis and treatment more effective, in the same way that the discovery of the virus that causes AIDS led to highly targeted treatments.
Advocates for cultural competence counter that no matter how much science learns about the brain, culture and the environment will continue to play a huge role in why people develop emotional problems, what treatments they respond to and whether they recover. Doctors, they say, cannot afford to ignore the numerous effects of culture on diagnosis and treatment that have been documented through various streams of evidence and multiple studies in peer-reviewed publications. Among them:
· Patients with schizophrenia, a disease characterized by hallucinations and disorganized thinking, recover sooner and function better in poor countries with strong extended family ties than in the United States, two long-running studies by the World Health Organization have shown.
· People of Mexican descent born in the United States have twice the risk of disorders such as depression and anxiety, and four times the risk of drug abuse, compared with recent immigrants from Mexico. This finding is part of a growing body of literature that indicates that the newly arrived are more resilient to mental disorders, and that assimilation is associated with higher rates of psychiatric diagnoses.
· Black and Hispanic patients are more than three times as likely to be diagnosed with schizophrenia as white patients -- even though studies indicate that the rate of the disorder is the same in all groups.
· White women in the United States are three times as likely to commit suicide as black and Hispanic women -- a difference that experts attribute in part to the relative strengths of different social networks.
