Cultural psychiatry: international perspectives. Epilogue.

The psychiatry of the 21st century will have to be different from the psychiatry of the 20th century. The latter began its journey in a socially, compartmentalized world in which sharp categories and boundaries for the definition of mental illness were assumed to be relevant. International psychiatry completed its hegemonic hold over the territory of mental health and illness with a commanding home-stretch run of success borne in the confidence and optimism of its neurobiologic and culture free program and agenda. The world in which psychiatry now exists, however is changing rapidly and will continue to change and so of necessity will the practice of psychiatry need to change. This issue offers a guidelines and a vision of the direction that should be followed. Migration and transnational communication and awareness of cultural differences are changing the character of communities around the world. These changes considered in the context of world wide political economic factors are bringing into close physical and symbolic juxtaposition persons from distinct nations and ethnic groups. Clashes in world views, attitudes, spiritual orientation, and general philosophic and moral outlook are becoming ever-present realities of urban centers around the world. In traditional contexts and among persons who do not physically migrate, the power of communications media manages to psychologically migrate them; that is, to challenge their local, native cultural traditions about mental health with the scientific perspectives about mental health and illness. Advances in the social and cultural sciences have underscored ways in which assumptions of reductionism and universalism need to be chastened with an appreciation of human differences and humane considerations as these relate to mental health problems. The science of psychiatry of the 21st century will have to accomodate to this new creolized world of ethnic pluralism, cultural differences, and clashing perspectives between the traditional and the modern. The boundaries, categories, and the conceits governing the closed neurobiologic international program and agenda will need to be modified and broadened by the addition, sensitivity to and appreciation of cultural differences. This issue has reviewed the efforts of scholars around the world who are all deeply committed to the goals of the old international psychiatry but judge that a new vision and idiom is needed. A responsive international cultural psychiatry is based on a blending and integration of all facets of knowledge of the behavioral sciences, from biology, pharmacology, genetics on through sociology and cultural anthropology. In a new idiom it seeks to provide to all communities of the globe the best that the science of psychiatry has to offer in the areas of prevention, diagnosis, and treatment. The best psychiatry possible translates as providing expert scientific diagnosis and therapy in light of an appreciation of the role played by cultural factors in shaping human behavior. Contributors have covered the broad terrain of clinical psychiatry in a selective way giving emphasis to demographic, regional, and national needs in areas of mental health planning and therapy. The reviews of empirical issues and the formulation of conceptual areas needing further clarification provide a perspective of what a culturally sensitive and responsive international psychiatry should consist of.