How accurately do doctors diagnose mental disorders in patients of another culture? Can certain psychiatric disorders be treated with acupuncture? Are oriental exercises therapeutic for alcoholics?
These were among the questions raised at the first International Congress of Transcultural Psychiatry Conference last weekend in Baltimore. Sponsored by Provident Hospital, the three-day meeting drew nearly 500 mental health specialists from around the world to exchange ideas and stories about how cultural differences affect care for the mentally ill.
"American physicians often do not have an appreciation for the significant differences in other cultures," said conference organizer Dr. Patricia A. Newton, chief of psychiatry at Provident Hospital and assistant professor at Johns Hopkins University and Medical School. Health care providers typically are trained to look for illness and are only beginning to understand what health and normalcy are for people in different cultures, said Newton, who has studied and lectured extensively on international health care.
Too often, people are misdiagnosed because doctors are unaware of these cultural differences, Newton said.
When health care professionals do not try to understand a client's background, it often harms treatment, Newton said. They may withdraw, she said, or rely more heavily on "the traditional healers of their own culture," including voodoo practioners, herbalists and astrologers.
American doctors are not the only ones with these problems. Foreign doctors practicing in the United States typically must overcome cultural and language barriers to reach their patients. Kripa S. Kashyap, a psychiatrist from India who has worked at Johns Hopkins Hospital for 20 years, believes that the differences are due less to ethnic background than to socioeconomic status.
Learning to listen, said Kashyap, is the therapist's most valuable tool. "Sometimes being foreign works to my advantage," he said, because he listens more carefully. In addition, he said his clients assume he is somewhat unfamiliar with their culture, so "they try to educate me, they give a more complete map of their lives."
During the conference, participants from around the world pointed out repeatedly that what western trained physicians see as nontraditional therapy -- such as acupuncture -- is actually quite traditional in other cultures. As the United States continues to grow as the world's melting pot, "there's going to be a demand made by consumers that the established medical providers understand their culture," Newton said. "Just because something is different doesn't mean it is inferior."
One example of how therapies from other cultures are being used here came from the Lincoln Medical and Mental Health Center in New York, where the ancient art of acupuncture and a form of martial arts called tai chi is used to help alcoholics and people with personality disorders.
Acupuncture, in which thin needles are inserted to stimulate nerve endings, helps regulate brain chemicals, said Khunat Ra, an alcoholism counselor at Lincoln. In some cases, it seems to help reduce a drinker's reliance on alcohol. Ra said the clinic has also had some success in using acupuncture in conjunction with counseling to treat impulsive and violent behavior in patients with a specific type of personality disorder.
Tai Chi, movement exercises from the ancient Chinese martial arts, is also being used at the Lincoln clinic, Ra said, because the slow but strenous exercise promotes concentration, helps lower blood pressure and reduces muscle stiffness.
Work relationships as well as therapeutic ones could be much simpler if people understood more about the basic philopsophy of different ethnic groups, said Dr. Edwin J. Nichols, a District psychologist who has worked for the National Institute of Mental Health and studied and taught in Europe and Africa.
For many Europeans and white Americans, the most important relationship is between man and object. For example, Nichols said, these people are much more likely to define themselves in terms of their jobs and belongings.
Among black and Arabic groups, Nichols said, the primary relationship is between man and man, where trust in interpersonal relationships is paramount. Therefore, simple courtesies like greeting someone when they come into a room is particularly important to this group.
Asians and Indians emphasize the relationship between man and the group, according to Nichols, which is why many Asian families are closeknit and often successful in running businesses together.
Being aware of these differences is essential, Newton said. For example she said, it would be disastrous to counsel a troubled young adult to "get out on your own" if, in that individual's culture, such a move would be seen as abandonment of the extended family. Newton said the primary rule for mental health providers is: "Don't impose your value system on theirs."