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Philosophy's role for guiding theory and practice in clinical contexts grounded in a cultural psychiatry focus: A case study illustration from southern Norway
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Theology, Department of Theology, The Social Sciences of Religion, Psychology of Religions. (MPACT gresearch group, Area IV Health and Well-being)
2011 (English)In: World Cultural Psychiatry Research Review, ISSN 1932-6270, Vol. 6, no 1, 75-83 p.Article in journal (Refereed) Published
Abstract [en]

Abstract. The purpose of this article, influenced by research in northern European contexts, is twofold. First, it is to make the case for, and provide a working model of, the importance of having a foundational philosophy of mental health care for consistency in clinical decision-making relating to theory and practice in cultural psychiatry; and second, to illustrate this model in action through a brief case study from a clinical context in southern Norway. In Part I, a brief presentation of one of the overarching challenges for cultural psychiatry is noted, that being the disconnection between theory and clinical contingencies and practices. Use is made of the Mezzich and Caracci volume: Cultural formulation: A reader for psychiatric diagnosis (2008) to illustrate some of the underlying concerns, and consequent confusions, raised by the ways in which an approach to culture and cultural information was included or excluded from the DSM-IV. The findings of this critical review have implications not only for understanding the place of culture in current and coming nosologies as well as the utility and potential limitations of DSM-IV as a clinical and research tool in multicultural settings. More than this, it provides a thorough and very valuable base for understanding the sociopolitical process, a dimension of culture in itself, of constructing the DSM-IV. What one is left with is certainly not seeing culture as a common core of analysis and a fundamental element of not only all psychiatric distress but also psychiatric resilience. Due to the very tangible reality of different, though not necessarily totally exclusive, operative mental health paradigms that result in different consequences for approaching both diagnostic and treatment processes, the paper’s attention is then focused on the importance of articulating a clear and foundational philosophy of mental health care with reference to how culture and cultural information are to inform theory and practice. A working model of interacting levels for a clinical mental health context is provided. If the role of culture is considered essential for the foundational level of the operative philosophy of mental health then this needs to consistently inform the levels of theory and practice for diagnosis and treatment. In Part II, the importance and consequences of the integration and interaction among the model’s three levels for cultural psychiatry, are illustrated through a brief case study example from an outpatient psychiatry context for children and adolescents: The Department of Child and Adolescent Mental Health [Avdeling for barn og ungdoms psykiske helse, (ABUP)] is part of the local public hospital, Southern Hospital [Sørlandet Sykehus HF] in southern Norway. This clinical context, with a culture-focused perspective, has a population of primarily though not exclusively ethnic Norwegians. The centrality of culture, cultural information, and cultural expression for mental health programmes in Norway is briefly outlined as a background for understanding the centrality of culture in the particular clinical context. Drawing from interview data with the department director and treatment team members, as well as documentation, the characteristics of the philosophy of mental health based on the centrality of understanding culture and the need to gain access to the patient’s and family’s cultural interpretations of illness and health are explored. At the theoretical level a necessary competency in pathogenic knowledge needs to be completed by knowledge and methods from the social science and other disciplines, and the all important patient/family knowledge in order to most accurately engage in the diagnostic and treatment processes. Cultural knowledge is understood from a meaning-making perspective that views existential meaning as central for understanding cultural constructions of health and illness. The individual patient expressions of meaning-making in general and existential meaning in particular can be very varied. However, building a safe therapeutic space for understanding these expressions of meaning is central to the culturally-based process for all patients. This clinical context can not be viewed as representative of Norwegian mental health contexts. However, it serves as a living illustration, in cultural context, of the importance of the philosophy of care in relation to understanding and implementing a multi-dimensional, culture-informed mental health programme.

Place, publisher, year, edition, pages
2011. Vol. 6, no 1, 75-83 p.
Keyword [en]
Cultural psychiatry, psychology of religion, philosophy of healthcare, psychiatric diagnosis
National Category
URN: urn:nbn:se:uu:diva-166824OAI: oai:DiVA.org:uu-166824DiVA: diva2:478079
Impact of Religion
Available from: 2012-01-15 Created: 2012-01-15 Last updated: 2013-08-24Bibliographically approved

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