The ability to view patients through a cultural lens is becoming increasingly important as a consequence of the growing diversity found in the United States and Canada. Moreover, larger forces of globalization and migration have encouraged a fresh look at culture in every aspect of psychiatry, including psychosocial assessment, the boundaries of normality, and ethnopharmacotherapeutic issues (see Chapter 30).

Research has clearly demonstrated that the cause, course, and outcome of major psychiatric disorders are influenced by cultural factors. For example, international studies by the World Health Organization have provided compelling evidence that the prognosis for schizophrenia is better in some developing countries than it is in England or the US. Wide variations in the prevalence of many psychiatric disorders across geographic regions and ethnocultural groups have been documented with current standardized epidemiologic survey methods. In addition, social and cultural factors are major determinants of the use of healthcare services and alternative sources of help.

Culture is the integration of human behaviors (which include thoughts, communications, actions, customs, beliefs, values, and institutions) of a racial, ethnic, religious, or social group. It represents the vast structure of ideas, attitudes, habits, languages, rituals, ceremonies, and practices peculiar to a particular group of people. Culture also provides people with a general design for living and with patterns by which to interpret reality.

Culture can greatly influence a person’s perceptions of health and illness as well as how, when, and why he or she would seek treatment for a health problem. This factor becomes especially important in the area of mental health. Many aspects of psychiatric care involve self-perception, roles and relationships, family dynamics and interactions, attitudes toward medications, values, and community supports. Before mental healthcare providers can administer appropriate and effective treatment, they must understand the patient’s cultural context and how it might influence his or her attitudes toward a particular health concern, its causes, and its treatment. Culturally relevant care is as diverse as the cultures represented. An understanding of the patient’s cultural context also is necessary to appreciate the patient’s attitude toward the clinician. This understanding is not a simple matter, as much has changed in anthropologists’ views of culture, from one of finely balanced systems to a recognition of high levels of individual variability within even very small cultural groups and the active ways in which individuals and groups make use of a variety of forms of knowledge to fashion an identity and a way of life.

At the same time, anthropologists have come to recognize the high level of individual variability within even small cultural groups, and the active ways in which individuals and groups make use of a variety of forms of knowledge to fashion an identity and a viable way of living. In urban settings where many cultures meet, individuals have a wide range of options available, and can position themselves both within and against any given ethnocultural identity or way of life. This has led the anthropologists to rethink the notion of culture or even to suggest that it has outlived its usefulness.