The impact of culture on the acute management of psychiatric illness

The goal of this chapter is to emphasize the impact of culture on the meaningful life story and behavioral perspectives of patients presenting to acute care settings, such as an emergency department (ED), in crisis. Evaluating psychiatric patients is difficult, and can be time-consuming under routine circumstances. In the ED, it is complicated by overcrowding, a fast pace, lack of privacy, and poor preparation of the patient who may be brought in under duress by family members or the police. Evaluating patients can be further complicated by language and cultural differences between the patient and examining provider. The intent of this chapter is to facilitate such an examination by focusing on the cultural differences and related aspects of interviewing and examining patients. The definition of culture includes the customary beliefs, social forms, and material traits of a racial, religious, or social group. Cultural differences play a role in assessment and treatment of patients, including the attitude and behavior of both the provider and the patient regarding illness. Notions of sickness are derived from systems of medical understanding that exist within a culture. Beyond that, epistemic systems dictate how an individual expresses suffering. In many patients, their indigenous understandings of medicine and systems of coping with illness may partially or fully persist and continue to exert an influence on behavior, despite the seemingly outward expression of complete adoption of the Western system of medicine and response to illness.