Book Review
Transcultural Psychiatry
Clinician’s Guide to Cultural Psychiatry Wen-Shing Tseng, Amsterdam: Academic Press; 2003. 493 p. US$59.95.
Reviewer
rating*: Very Good
Review by: Frank Frantisek Engelsmann, PhD, CSc
Montreal, Quebec
This didactic, detailed, and practical guide to cultural psychiatry is a remarkable contribution, enhancing culture-oriented clinical assessment and care. The text is an updated clinical elaboration of Tseng’s comprehensive Handbook of Cultural Psychiatry, published by Academic Press in 2001. There is a great need for culturally competent clinical care of the many ethnic groups in this time of global economy, large population movements, and increased international contacts.
Wen-Shing Tseng, professor of psychiatry at the University of Hawaii, was well prepared for his demanding task. He obtained training in psychiatry at the National Taiwan University and later at Harvard Medical School in Boston. As a consultant to the WHO for teaching and research projects, he visited many countries in Asia and the Pacific and conducted studies related to culture and psychopathology, family relations, folk healing, and psychotherapy. He has numerous scholarly publications.
The introductory chapters describe basic concepts of culture and its impact on the mind, on behaviour, and on psychopathology, with a focus on stress, illness reactions, and coping methods. Culture refers to the unique behaviour patterns and lifestyle shared by a group characterized by a set of values, attitudes, and beliefs. Race is a socially and culturally constructed category that may have little to do with actual biological differences. The author argues that the validity of race as a biological term has been discredited (p 7). Although it is difficult to generalize about national character traits in large societies composed of numerous ethnic groups and subcultures, the author mentions some characteristics of the American, Japanese, Russian, and Chinese personality (p 29–32).
The author analyzes the stress-related impact of culturally formed anxiety, culturally demanding performance, limitations of expression, sociocultural discrimination, and cultural uprooting or destruction. He presents concepts of traditional Chinese, Ayurvedic, and Galenic-Islamic medicine and discusses the distinction between illness and disease, the sick role, help-seeking behaviour, service use, and compliance. The core of the book deals with culture and psychopathology, presenting cultural aspects of anxiety disorders, cultural contribution to causes of depression, dissociative states, somatoform disorders, substance abuse, and suicidal behaviour. The author examines culture’s influence on the clinical manifestations and prognosis of schizophrenia and personality disorders. Cross-cultural information about personality disorders is limited and needs more investigation (p 199). The contribution of culture to psychopathology can occur in the form of pathoselective, pathoelaborating, and pathofacilitative effects, but the application of these innovative concepts needs more testing.
The Guide extends strong and repeated demands for culturally competent clinical assessment and care and culturally competent psychotherapy involving cultural knowledge, sensitivity, and empathy. The chapters offer advice concerning therapist–patient relationships and improvement of culturally competent clinical care of psychiatric in- and outpatients, emergency, and consultation liaison services. The text highlights the role of psychiatric nursing care. The final chapters address issues of culture and mental health disorders therapy with such subgroups as children, adolescents, aged persons, women, couples, and families. The author discusses culture-oriented therapy and care provided to 5 selected ethnic populations: the African-American, Asian-American, European-American, Hispanic, and Native-American groups. Other therapeutic considerations address such important issues as sociocultural change; migration and refugees; minorities; gender and age; and group violence, mainly in terms of ethnic conflicts. There is a renewed interest among psychiatrists and social and behaviour scientists in the relation between religion and mental health and psychopathology and psychotherapy. Hence, the text presents a review of major world religions and some religious movements in the US. The author holds that dimensions of religion and spirituality should be added to the training of future psychiatrists (p 482).
This comprehensive and highly informative text is clearly written, well structured, and easy to read, although some styles of inquiry seem obvious or elementary. It is a useful book that shows cultural psychiatry to be a broad field enriched by medical anthropology and cross-cultural psychology. The chapter on genetic and biological issues is the shortest. Culture and behaviour interact on different levels of complexity, but the author’s empirical approach meets the challenge of identifying cultural, ethnic, and social variations implied in mental health problems and disorders, assessment, and clinical care. The reader will find interesting medical anthropology information about customs, beliefs, and rituals. There are many case vignettes and illustrations in this textbook that will assist those training in the mental health profession. It will interest psychiatrists, psychologists, and other mental health professionals, as well as general practitioners, particularly those working in multicultural settings. It will enhance understanding, empathy, and culturally competent clinical skills in the assessment and treatment of mental disorders.
*Reviewer
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