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What Does “Culture” Mean? Evolving Definitions in Mental Health Service, Training, and Research
April 19, 2018 - April 21, 2018
The concept of culture has continued to evolve in mental health research and practice, in parallel with critiques of group-based definitions of culture in anthropology and other social sciences. Culture is often reduced to a principal group identity, usually an aspect of the person’s national or racial/ethnic background. In contrast, current definitions of culture in mental health – such as the one presented in the DSM-5 – conceptualize culture as processual, constituting a process of meaning-making that is under the influence of multiple collective influences that combine to constitute a person’s identity. These influences arise from diverse origins, including gender identity, sexual orientation, language, religion and spirituality, occupation, avocation, age, class, national and regional origin, and racialized and/or ethnic identity. Necessarily, every person’s “culture” is a kaleidoscopic mix of these influences, as they become more or less prominent at any given moment, in the presence of some interlocutors and not others, and in relation to what is at stake for the person at the time.
This annual meeting critically explores the implicit (or explicit) definitions of culture that are being used in current mental health research and practice. To what extent are process-based definitions of culture replacing or coexisting alongside more static group background-based definitions? For example, is culture conceptualized uniformly in key components of DSM-5, such as in the Cultural Formulation Interview and the Culture-Related Diagnostic Issues sections of each disorder? How does serious engagement with process-based definitions affect our established practices, such as the usual medical identification of the patient on the basis of age, gender, and race/ethnicity (e.g. “23 year-old black female”)? How does the global spread of mental health interventions potentially perpetuate simplistic notions of culture, to the potential detriment of programs? What role does the family play in creating/recreating these cultural influences? Does it make sense anymore to speak of a person’s “culture” in the singular?
Conference Learning Objectives
After attending this meeting, participants will be able to:
- Identify multiple definitions of culture from clinical, social science, and humanities fields and their implications for mental health research and practice.
- Discuss theories and concepts relevant to culture, including identity, power, explanatory models, equity, diversity, and meaning-making and their implications in the practice of cultural psychiatry and global mental health.
- Describe how various definitions of culture are used in diverse aspects of mental health work, including clinical care, training, advocacy, and research.
- Integrate the multiple conceptualizations of culture into the practice of cultural psychiatry and global mental health.
Examples of topics and domains related to the conference theme include the following:
- How does the definition of culture that we use vary with context and objectives? What are the multiple definitions of culture that are circulated and enacted in cultural psychiatry and global mental health? How do these definitions vary by our purpose? For example, do the useful definitions vary depending on whether we are doing clinical work with individual patients or whether they are being used in training or research? Or in individual therapies vs family therapies?
- Curriculum design and training activities – How do definitions of culture shape, or become shaped by, curriculum design? How do curricula and training programs address the concept of culture, directly or indirectly? What novel curricular structures offer opportunities for clinicians and researchers in training to engage critically and reflexively with notions of culture?
- Tensions of group-based vs individual definitions of culture – With increasing shifts away from group-based definitions of culture toward a focus on meaning-making, how is clinical practice affected, if at all? If group-based definitions of mental disorder rely on establishing what is not an “expectable or culturally approved response,” who is doing the “approving” when the definition of culture is based on an individually generated sense of meaning?
- How does DSM define culture and how does this influence practice? Is culture conceptualized uniformly in key components of DSM-5, such as in the Cultural Formulation Interview and the Culture-Related Diagnostic Issues sections of each disorder? How do changes in definitions put forward by professional organizations shape changes in practice, and where are the limits/barriers to further change?
- Research applications of processual definitions of culture – What research questions are best addressed through processual and meaning-making definitions of culture, e.g. exploring mechanisms through which culture patterns psychopathology, including the generation of cultural concepts of distress that are to some extent consensually determined by the group?
- How does the concept of culture relate to disparity-reduction activities? Many training programs have begun to address cultural psychiatry concepts under the umbrella of diversity, equity, and minority curricula. Is this simply a semantic shift? What is potentially lost – in terms of meaning-making, explanatory models, and other core cultural concepts – when we focus on more structural definitions? And what is gained – in terms of social determinants of health, resource inequalities, and other analyses based on institutionalized power relations? How can we best distinguish the “work” of meaning-centered approaches to care and those that focus on redressing health care disparities affecting underserved social groups?
- How do definitions of culture shape possibilities for policy-making and advocacy? What assumptions about culture underlie current mental health policy? If culture is best defined according to complex, multifaceted, and process-based definitions, how can we distill these concepts in ways that facilitate communication for advocacy and policy-making efforts? Do such efforts to make culture comprehensible ultimately “short-change” the lived experience of culture and mental health?
- Culture as both cause and cure of mental illness – How is culture conceptualized in causal pathways of mental illness (e.g. inability to meet culturally proscribed gender role expectations) and an essential part of its cure (e.g., tribal re-enculturation of American Indian youth as a therapeutic practice)? How do these competing notions of culture as cause and cure create tensions for the practice of cultural psychiatry and global mental health? What is the relationship bewteen culture and health or wellness?