196902
The Delineation of Transcultural Psychiatry
as a Specialized Field of Study
POSITION STATEMENT
Approved by the Board of Trustees, May 1969
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"Policy documents are approved by the APA Assembly and Board of Trustees… These are …position statements that define APA official policy on specific subjects…" -- APA Operations Manual. |
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The statement had been prepared jointly by the Association's Committee on Transcultural Psychiatry and the Committee on Transcultural Psychiatry of the Canadian Psychiatric Association; it was approved by the Board of Directors of the Canadian Psychiatric Association in February 1969. The comparative study of mental health and mental illness among different societies, nations, and cultures and the interrelationships of mental disorders with cultural environments has for many years occupied the interest of individual psychiatrists here and abroad. The growth of international collaboration in psychiatry since World War II, and particularly in the past decade, has greatly enhanced interest in the field, as has the rapprochement of psychiatry with cultural anthropology, sociology, and behavioral science generally. The ease of modern international travel and communications has also quickened the pace of development. An impressive body of literature has evolved.
The Transcultural Psychiatric Research Review, edited by Dr. Eric Wittkower, was established in 1956 as a specialized journal demarcating the field. Increasingly large segments of our own annual meeting programs and of international meetings in which the Association participates are devoted to transcultural psychiatry. Several university graduate education programs in psychiatry now offer training in this special field.
The Board of Trustees has witnessed the growth of transcultural psychiatry with gratification and considers that it offers great promise of eliciting new insights into the nature of the mental disorders that will advance the objectives of the Association.
In 1964 the Board of Trustees (then the Council) established a Committee on Transcultural Psychiatry.1 In 1967 the Canadian Psychiatric Association did likewise.2 These two committees have collaborated in formulating the following statement, which succinctly delineates psychiatry's role in transcultural studies, clarifies the terminology of the field, describes its interdisciplinary nature, and outlines its major objectives, problems, and areas of application.
The Board of Trustees is pleased to lend its endorsement to the statement following and hopes that it will further active research in transcultural psychiatry and understanding of the relevance of its concepts and data to clinical and organizational practice.
Psychiatrists and Transcultural Research The study of how human beings think, feel, and act with reference to the sociocultural contexts in which they are reared or live as adults is a principal concern of psychiatrists. This applies to subjectively experienced states and objectively observable behavior, whether defined as “normal,” “sick,” or “deviant.” It also applies to the attempt to recognize those aspects of behavior that are independent of or transcend particular sociocultural contexts (2).
Psychiatrists are active investigators in this area by virtue of their concern, as physicians, with matters of health and disease, and because their clinical training uniquely equips them to study human behavior. They are familiar with
mental functioning, in its covert as well as overt aspects, in a wide variety of settings including the catastrophic and encompassing the range of psychophysiologic and organic variations. Their recognized helping status gives them access to and enables them to participate in ordinarily inaccessible life experiences. All of these factors especially fit psychiatrists to engage in studies of the relationship between culturally institutionalized practices, motivational factors, character traits, individual and group behavior, and potentials for mental health or disorder.
Interdisciplinary Considerations and Labeling The conceptual framework of transcultural psychiatry is derived from the information and theory of the social sciences, the biological sciences, clinical medicine and psychiatry, epidemiology, experimental and clinical psychology, and psychoanalysis (5).
Investigation of the relationships between individual behavior and sociocultural systems and subsystems requires as precise and intensive study of sociocultural contributions as of individual contributions to behavior. The same is true for other environmental factors such as nutrition, endemic disease and immunity, geography and climate, and kinship and mating patterns (with their genetic consequences) that influence or are influenced by sociocultural factors.
The labels applied to this general field of study reflect the professional identities of investigators and their specific foci of study. Some of these labels, in addition to transcultural psychiatry, are:
cross-cultural psychiatry (4);
cross-national,
transnational, or
international psychiatry;
intercultural psychiatry;
ethnopsychiatry (3);
comparative psychiatry; and
social psychiatry. This last label is often used to include the others. Some labels used more often by nonpsychiatrists are:
psychiatric sociology,
sociology of mental disease (1),
comparative social research,
comparative behavior studies, and
culture and personality studies. Much research so labeled may be regarded as within the proper domain of cultural anthropology, sociology, social psychology, or even history; but these do not always include adequate definition of the personal human variable in health and illness. Other work falls within the field of epidemiology, defined as the study of the form, incidence, and distribution of disorders in relation to demographic, social, and physical environmental factors. Still other research may be recognized as an aspect of human ecology.
Objectives, Problems, and Areas of Application Research in transcultural psychiatry with potential clinical or social applications has covered such themes as: 1) similarities and differences in the form, course, or manifestation of mental illness in different societies and cultures; 2) the occurrence, incidence, and distribution of mental illness or behavioral characteristics in relation to sociocultural factors; 3) sociocultural factors predisposing to mental health or to optimal function or to increasing vulnerability to or perpetuating or inhibiting recovery from mental illness or impaired function; 4) the forms of treatment or of otherwise dealing with people defined as deviant or physically or mentally ill that are practiced or preferred in various sociocultural settings; 5) the influence of sociocultural factors on the assessment of clinical psychiatric issues (such as therapeutic approaches, progress, and diagnosis) and the adaptation of established psychiatric principles to varying sociocultural contexts; 6) the relationship between culture and personality as it may be approached through studies of the character traits shared by members of the same society derived from exposure to similar patterns of child rearing, and to positive and negative social sanctions; 7) the understanding of conflict in persons experiencing rapid social and cultural change; 8) attitudes and beliefs regarding behavioral deviance and the mentally ill, including the labeling of behavior; 9) the psychological and social adaptation of migrants, voluntary or involuntary, within or across national boundaries especially insofar as their cultural traits or those of the receiving society are significantly involved; 10) psychiatric or behavioral aspects of communication between individuals and groups from differing cultural or national regions; 11) response to varying culturally-based stressful situations; and 12) cultural determinants of transnational interaction and of public policy decisions within nations.
Specific projects may require the comparison of individuals, families, and other groups from differing nations, social classes, or ethnic groups; of those subscribing to different value and belief systems; of those subject to differing though transitory sociocultural conditions; of those defined publicly on the basis of social visibility or subjectively in terms of a private identity; of those who share fully in the values and opportunities of their society (members of the majority group); of those who are excluded or bypassed from full participation (minority group members). Other projects may be less obviously comparative but aimed more at the definition of particular behavioral states, relationships, or processes within a socioculture as they may be a function of its unique features. These may include studies of culture-bound reactions, syndromes, treatment methods, perceptual styles, and reactions to stress among others. Or they may be concerned with mass behavior such as group loyalties, the formation of stereotypes, or national misperceptions. All of these studies deal in one way or another with: 1) the relationships between the functions of whole sociocultural systems and those individual humans and groups who compose them (2), and 2) comparative aspects of sociocultural systems and their components.
lThe following named members participated in the drafting of this statement: Drs. Eugene B. Brody, then chairman, Horacio Fabrega, Ari Kiev, Joseph Lubart, Perry Ottenberg, Jean Fortin, Augustin Palacios, and Alfred Wiener. (The last three, as well as Dr. Brody, are no longer on the committee.)
2Drs. Eric Wittkower, chairman, H. B. M. Murphy, Ronald Wintrob, Jean Fortin, C. P. Hellon, Edward Margetts, and Robert Weil.
REFERENCES 1. Bastide, R.: Sociologie des Maladies Mentales. Paris: Flammarion, 1965.
2. Brody, E. B.: Transcultural Psychiatry, Human Similarities, and Socioeconomic Evolution, Amer. J. Psychiat. 124:616-622, 1967 (also in Lopez Ibor, J. J., ed.: Proceedings of the Fourth World Congress of Psychiatry, vol. 1. International Congress Series no. 150. New York: Excerpta Medica Foundation, 1967, pp. 239-244).
3. Devereux, G.: Mohave Ethnopsychiatry and Suicide. The Smithsonian Institution Bureau of American Ethnology, Bulletin 175. Washington, D. C., 1961, p. 586.
4. Murphy, I., and Leighton, A., eds.: Approaches to Cross Cultural Psychiatry. Ithaca, N. Y.: Cornell University Press, 1965.
5. Wittkower, E. D.: “Perspectives of Transcultural Psychiatry,” in Lopez lbor, J. J., ed.: Proceedings of the Fourth World Congress of Psychiatry, vol. 1. International Congress Series no. 150. New York: Excerpta Medica Foundation, 1967, pp. 228-234.