It would be the treatment of psychiatric disorders taking into account both the cultural influence on the patient and the cultural influence on the psychiatrist. Although in the USA it exists as a subspecialty, in reality it is not, in the sense that every specialist in psychiatry should be transcultural. The mental syndrome or disorder must always be evaluated through a prism of a certain relativity granted by the cultural origin from which one comes or with which one identifies. Likewise, the psychiatrist must also be very aware of his or her own culture, so that it can influence the interpretation of the psychiatric symptoms manifested.
Culture is described as the collection of values, beliefs, social behaviors and language that are transferred from generation to generation and that one adopts from the community with which one identifies.
Culture therefore has the ability to influence the way we conceive and express emotions. It generally dictates the lintel of tolerance to both physical and emotional pain. In the same way, culture provides us with certain defense mechanisms to deal with these emotions whether they are due to a particular traumatic experience or to environmental stress. Therefore, culture is always related to the emotional or psychiatric disorder that concerns us.
Pathologies according to cultures
The now outdated DSM-IV R (Diagnostic and Statistical Manual of Mental Disorders) contained an appendix with 25 syndromes, called cultural bound. They were read as an anthropological curiosity, thinking that if you did not do tropical psychiatry, you were never going to see it. Like ataque de nervios, or susto, (Latin American subcategories of anxiety attack) or we saw that the same syndrome received different names depending on the area, for example Amok is the Malaysian term, from the Puerto Rican version of mal de pelea which is nothing more than the Itch’aa of the Navajo Native Americans. All of them describe a person who, possessed by an uncontrollable rage, decides to attack with a weapon to anyone who is in his way, to end up exhausted and amnesic of what happened.
So we see that culture not only gives it the name but also the “etiological” explanation. In certain cultures, madness in general is still interpreted as a state of demonic or evil possession. In African or Afro-American cultures, they attribute trance states to the “random visit of an ancestral spirit” and this is what in Western countries we call dissociation, fugue or depersonalization disorder.
In this sense, the current DSM-V wants to be more effective, and instead of speaking of these “cultural syndromes” as something from a separate showcase, what it does is to include in each definition of mental disorders, the possible other denomination that we could find in another cultural context different from the American-Western-Anglo-Saxon one.
Treatments in transcultural psychiatry
We see, then, that culture is very important for the understanding of symptoms, syndromes or mental disorders. Therefore, the psychiatrist must question how a given emotional reaction or behavior is perceived in the patient’s culture and try to determine if that is influencing the manifestation he or she is trying to assess.
For his or her part, he or she – the psychiatrist – should make a study of the physiological explanation, traditional or local, and try to integrate it into the more modernly accepted therapeutic approach, so that it makes sense to both the patient and his or her family environment.
For example, in a trance of a patient from Haiti, who for more than four days did not eat or respond to verbal stimuli, (despite a “normal” neurological examination), I had to understand that the prayers and prayers of the whole family were as important as it would have been for me to give him an antipsychotic. They told me of the need for the ancestral spirit to possess his body and thus return to this world.