Hollifield Michael, Geppert Cynthia, Johnson Yuam, Fryer Carol
Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque 87131, USA.
Transcult Psychiatry. 2003 Sep;40(3):329-41. doi: 10.1177/13634615030403002.
Multiple cultural variables have effects on the psychobiology and behavioral manifestations of illness, as do patient and physician perceptions of illness. The interaction among these variables is at the heart of clinical psychiatry. This case of a Vietnamese man with selective mutism underscores the relevance of the 'cultures' of medicine, psychiatry, and war and trauma on the manifestations of illness and illness perceptions by patient and physician. The discussion focuses on how these cultures interact and play a crucial role in formulating diagnosis and treatment planning. Suggestions are given for shifts in medical education that will encourage relevant cultural paradigms to make their way into educational and clinical systems, which in turn should improve cultural competence in clinical psychiatry.
多种文化变量会对疾病的心理生物学和行为表现产生影响，患者和医生对疾病的认知也会产生同样的影响。这些变量之间的相互作用是临床精神病学的核心。这个患有选择性缄默症的越南男子的案例强调了医学、精神病学以及战争与创伤的“文化”对疾病表现以及患者和医生的疾病认知的相关性。讨论聚焦于这些文化如何相互作用并在制定诊断和治疗计划中发挥关键作用。文中给出了医学教育变革的建议，这些变革将鼓励相关文化范式融入教育和临床系统，进而提高临床精神病学中的文化能力。
