Abstract
We have read the Canadian Psychiatric Association’s Position Paper on Guidelines for Training in Cultural Psychiatry with great interest. 1 We offer some comments about what we believe is an omission after carefully reviewing the document. We concur with the definition of Culture offered in the document. But any definition of culture which omits the role and practice of religious beliefs ignores a clinical reality. That omission is reflected in the rest of the Position Paper. There is reference to “spirituality,” “faith leaders,” and “religion,” but they are not given any emphasis. Studies have indicated that most patients regardless of their cultural backgrounds have meaningful religious beliefs and practices but that they perceive that their psychiatrists do not value this, in their assessment or in their treatment. 2
The Royal College of Psychiatrists of the United Kingdom has a Position paper on Recommendations for Psychiatrists on Spirituality and Religion which emphasizes the centrality of religious beliefs and practices in Psychiatric patients. 3 In Canada, we are all cultural nomads, but religious beliefs and practices become an identity marker of our various cultural traditions. Patients carry her or his cultural appendages including food, dress, and values. But it is likely that her or his religious beliefs and practices will give greater currency in dealing with a psychiatric disorder even though the idioms of distress may be culturally determined.
The relationship between culture and religion has been debated since the times of Aristotle who regarded Greek culture as superior and non-Greek as “ethnos” or outsiders. This view continued with Western colonization in which non-European cultures were considered as “uncivilized.” 4
According to Roland Littlewood: “To recognise some other’s pattern as especially cultural is to assume a privileged perspective concerning it, whether colonial hubris or academic analysis.” (As Pascal had put it, we have the truth, but they have customs.) 4
A study of culture and religion would suggest that it is important to regard culture as encompassing religious practices but that immigration, globalization, and other social factors have altered the landscape of culture the world over, making it a dynamic and fluid process in which religions from one culture have taken hold in another culture in which it is regarded as an “add on.” This can cause social tension and divided loyalties.
