Restricted accessOtherFirst published online 2008-12
Ethical and Cultural Considerations in Delivering Psychiatric Diagnosis: Reconciling the Gap Using MDD Diagnosis Delivery in Less-Acculturated Chinese Patients
Talking to patients from diverse cultural backgrounds about their psychiatric disorders requires knowledge of one's own culture, the patients' cultures, and the ways in which they might interact, both in positive and unexpectedly negative ways. In this paper, we discuss the issues raised by discussing psychiatric diagnoses with Chinese-Americans who hold traditional illness beliefs and are not familiar with Western conceptions of psychiatric disorders. We explore how cultural values influence this aspect of medical practice, and suggest practical approaches to communicating the diagnosis of major depressive disorder in a culturally sensitive manner. Our clinical approach is to develop co-constructed illness narratives with patients, and to aid this process by reframing different elements of the clinical process into more culturally resonant forms. The following steps are suggested: 1) elicit patient's illness beliefs; 2) understand and acknowledge multiple explanatory models; 3) contextualize depressive symptoms into patient's physical health and social system; 4) introduce Western psychiatric theories in ways that reflect assumptions shared by Traditional Chinese Medicine (TCM); 5) involve patients' families whenever possible; and 6) use terminology that avoids unintended stigma.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.
2.
Ankrah, E.M., & Gostin, L.O. (1994). Ethical and legal considerations of the HIV epidemic in Africa. In M. Essex, S. Mboup, P. J. Kanki , & M. R. Kalengayi (Eds.), AIDS in Africa (pp. 547-558). New York: Raven Press.
3.
Arato vs. Avedon. (1993). 5 Cal 4th 1172, 23 Cal Rptr. 2D. 131, 858P. 2D 598.
4.
Beauchamp, T.L., & Childress, J.E. (2001). Principles of biomedical ethics (5th ed.). New York: Oxford University Press.
5.
Blackhall, L.J., Murphy, S.T., Frank, G., Michel, V., & Azen, S.( 1995). Ethnicity and attitudes toward patient autonomy. The Journal of the American Medical Association, 274, 820-825.
6.
Cheung, F., & Lin, K.M. (1997). Neurasthenia, depression and somatoform disorder in a Chinese-Vietnamese woman migrant. Culture, Medicine and Psychiatry, 21, 247-258.
7.
Chih, A. (1981). Chinese humanism: A religion beyond religion. Chia Feng PrintingEnterprise: Taipei, Taiwan.
8.
Christakis, N.A. (1988). The ethical design of an AIDS vaccine trial in Africa. Hastings Center Report, 18, 31-37.
9.
De Craemer, W. (1983). A Cross-cultural perspective on personhood. Milband Memorial Fund Quarterly/Health and Society, 61, 19-34.
10.
Donoho, D.L. (1991). Relativism versus universalism in human rights: The search for meaningful standards. Stanford Journal of International Law, 27, 345-391.
11.
Fawcett, J. (1995). Compliance: Definitions and key issues. Journal of Clinical Psychiatry, 56, 4-8.
12.
Gadow, S. (1981). Truth: Treatment of choice, scarce resource, or patient's right?Journal of Family Practice, 13, 857-860.
13.
Gillon, R. (1985). Telling the truth and medical ethics. British Medical Journal, 291, 1556-1557.
Harrison, A., Al-Saadi, A.M.H., Al-Kaabi, A.S.O., Al-Kaabi, M.R.S., Al-Bedwawi, S.S.M., Al-Kaabi, S.O.M., et al. (1997). Should doctors inform terminally ill patients? The opinions of nationals and doctors in the United Arab Emirates. Journal of Medical Ethics, 23, 101-107.
16.
Hofstede, G. (1991). Culture and organizations: Software of the mind . London: McGraw-Hill.
17.
Jensen, P., & Hoagwood, K. (1997). The book of names: DSM-IV in context. Development and Psychopathology, 9, 231-249.
18.
Kaptchuk, T. (2000). The web that has no weaver: Understanding Chinese medicine. New York: McGraw Hill .
19.
Kleinman, A. (1980). Patients and healers in the context of culture . Berkeley, CA: University of California Press.
20.
Kleinman, A. (1982). Neurasthenia and depression: A study of somatization and culture in China. Culture, Medicine and Psychiatry, 6, 117-190.
21.
Kleinman, A. (1988a). Rethinking psychiatry: From cultural category to personal experience. New York: The Free Press.
22.
Kleinman, A. (1988b). The illness narratives: Suffering, healing and the human condition. Jackson, TN: Basic Books.
23.
Kleinman, A. (1995). Writing at the margin: Discourse between anthropology and medicine. Berkelely, CA: University of California Press.
24.
Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251-258.
25.
Kleinman, A., & Good, B. (1985). Culture and depression: Studies in the anthropology and cross-cultural psychiatry of affect and disorder. Berkeley, CA: University of California Press.
26.
Kleinman, A., & Kleinman, J. (1991). Suffering and its professional transformation: Toward an ethnography of interpersonal experience. Culture, Medicine and Psychiatry, 15, 275-301.
27.
Lakes, K., Lopez, S.R., & Garro, L.C. (2006). Cultural competence and psychotherapy: Applying anthropologically informed conceptions of culture. Psychotherapy: Theory, Research, Practice, Training, 43, 380-396.
28.
Lee, S. (1999). Diagnosis postponed: Shenjing Shuairuo and the transformation of psychiatry in post-Mao China. Culture, Medicine and Psychiatry, 23, 349-380.
29.
Lopez, S. (1997). Cultural competence in psychotherapy: A guide for clinicians and their supervisors. In C.E. Watkins (Ed), Handbook of psychotherapy supervision (pp. 570-588). New York: Wiley.
30.
Louis, K.B. (1985). Providing health care to Chinese clients. Topics in Clinical Nursing, 7, 18-25.
31.
Maciocia, G. (2005). The foundations of Chinese medicine: A comprehensive text for acupuncturists and herbalists (2nd ed.). Oxford, UK: Elsevier Churchill Livingstone .
32.
Mattingly, C., & Lawlor, M. (2001). The fragility of healing. Ethos , 29, 30-57.
33.
McDonald-Scott, P., Machizawa, S., & Satoh, H. (1992). Diagnostic disclosure: A tale of two cultures . Psychological Medicine, 22, 147-157.
34.
Meyer, J.H., Ginovart, N., Boovariwala, A., Sagrati, S., Hussey, D., Garcia, A., et al. (2006). Elevated monoamine oxidase a levels in the brain: An explanation for monoamine imbalance of major depression. Archives of General Psychiatry, 63, 1209-1216.
35.
Muller, J.H. (1987). On the boundary of life and death: Care of the dying by medical residents (Dissertation). University of California Press: San Francisco, California.
36.
Muller, J.H., & Desmond, B. (1992). Cross-cultural medicine a decade later: Ethical dilemmas in a cross-cultural context. The Western Journal of Medicine, 157, 323-327.
37.
Murray, T. (1994). Individualism and community: The contested terrain of autonomy. Hasting Center Reports, 24, 32-35.
38.
Nisbett, R.E. (2003). The geography of thought: How Asians and Westerners think differently . . . and why. New York: Free Press.
39.
Novack, D.H., Plumer, R., Smith, R.L., Ochitill, H., Morrow, G.R., & Bennett, J.M. (1979). Changes in physicians' attitudes toward telling the cancer patient. The Journal of the American Medical Association , 241, 897-900.
40.
Simone, C.B., Simone, N.L., & Simone, B.C. (II). (1998). Do we always need to tell patients the truth?Lancet, 352, 1787-1788.
41.
Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. American Psychologist, 53, 440-448.
42.
Triandis, H.C. (1995). Individualism & collectivism: New directions in social psychology. Jackson, TN: Westview Press.
43.
Tse, C.Y., Chong, A., & Fok, S.Y. (2003). Breaking bad news: A Chinese perspective. Palliative Medicine, 17, 339-343.
44.
Tseng, W.S. (1975). The nature of somatic complaints among psychiatric patients: The Chinese case. Comprehensive Psychiatry, 16, 237-245.
45.
U.S. Census Bureau. (2004). http://www.census.gov/Press-Release/www./releases/archives/facts_for_features_special_editions/001738.html.
46.
U.S. Department of Health and Human Services. ( 1999). Mental Health: A Report of the Surgeon General-Executive Summary. Rockville, MD: Author.
47.
U.S. Department of Health and Human Services (2003). http://www.hhs.gov/ocr/privacysummary.pdf.
48.
Veatch, R.M., & Tai, E. (1980). Talking about death: Patterns of lay and professional change. The Annals of the American Academy of Political and Social Science, 447, 29-45.
49.
Winters, N.C., Hanson, G., & Stoyanova, V. (2007). The case formulation in child and adolescent psychiatry . Child and Adolescent Psychiatric Clinics of North America , 16, 111-132.
50.
Yeung, A.S., & Kam, R. (2004). Illness beliefs of depressed Asian Americans in primary care. In A. M. Georgiopoulos & J. F. Rosenbaum (Eds.), Perspectives in cross-cultural psychiatry (pp. 21-36). Hagerstown, MD: Lippincott Williams & Wilkins.
51.
Yeung, A.S., Yu, S.C., Fung, F., Vorono, S., & Fava, M. (2006). Recognizing and engaging depressed Chinese Americans in treatment in a primary care setting. International Journal of Geriatric Psychiatry, 21, 819-823.
52.
Zheng, Y.P., Lin, K.M., Takeuchi, K., Kurasaki, K., Wang, Y., & Cheung, F. (1997). An epidemiological study of neurasthenia in Chinese-Americans in Los Angeles. Comprehensive Psychiatry, 38, 249-259.
