Good Mary-Jo DelVecchio, Hannah Seth Donal
Harvard Medical School
Massachusetts Institute of Technology.
Transcult Psychiatry. 2015 Apr;52(2):198-221. doi: 10.1177/1363461514557348. Epub 2014 Dec 5.
The concept of culture as an analytic concept has increasingly been questioned by social scientists, just as health care institutions and clinicians have increasingly routinized concepts and uses of culture as means for improving the quality of care for racial and ethnic minorities. This paper examines this tension, asking whether it is possible to use cultural categories to develop evidenced-based practice guidelines in mental health services when these categories are challenged by the increasing hyperdiversity of patient populations and newer theories of culture that question direct connection between group-based social identities and cultural characteristics. Anthropologists have grown concerned about essentializing societies, yet unequal treatment on the basis of cultural, racial, or ethnic group membership is present in medicine and mental health care today. We argue that discussions of culture-patients' culture and the "culture of medicine"-should be sensitive to the risk of improper stereotypes, but should also be sensitive to the continuing significance of group-based discrimination and the myriad ways culture shapes clinical presentation, doctor-patient interactions, the illness experience, and the communication of symptoms. We recommend that mental health professionals consider the local contexts, with greater appreciation for the diversity of lived experience found among individual patients. This suggests a nuanced reliance on broad cultural categories of racial, ethnic, and national identities in evidence-based practice guidelines.
文化作为一个分析概念，越来越受到社会科学家的质疑，就像医疗保健机构和临床医生越来越将文化概念及文化应用常规化，以此作为提高对少数种族和族裔群体护理质量的手段一样。本文审视了这种紧张关系，探讨当这些文化类别受到患者群体日益增加的高度多样性以及质疑基于群体的社会身份与文化特征之间直接联系的新文化理论的挑战时，是否有可能利用文化类别来制定心理健康服务的循证实践指南。人类学家越来越担心对社会进行本质化，但在当今的医学和精神卫生保健中，基于文化、种族或族裔群体成员身份的不平等待遇依然存在。我们认为，关于文化——患者的文化和“医学文化”——的讨论应敏锐意识到不当刻板印象的风险，但也应敏锐意识到基于群体的歧视的持续重要性，以及文化塑造临床表现、医患互动、疾病体验和症状传达的无数方式。我们建议心理健康专业人员考虑当地背景，更加重视个体患者之间丰富多样的生活经历。这意味着在循证实践指南中要对基于种族、族裔和国家身份的宽泛文化类别进行细致入微的依赖。
