Columbia University Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
Department of Psychiatry, Flushing Hospital Medical Center, Flushing, NY, USA.
Med Anthropol Q. 2023 Sep;37(3):280-295. doi: 10.1111/maq.12781. Epub 2023 Jun 19.
Anthropologists have critiqued cultural competence programs in medical settings while introducing mental health clinicians to social theories on culture for practice. We explore how patients articulated narratives about themselves and how clinicians responded to such narratives through an intervention known as the Cultural Formulation Interview that anthropologists have helped develop. We conducted over 500 hours of fieldwork from 2014 to 2019 at an outpatient clinic in New York, analyzing multiple data (participant observation, medical records, patient-clinician sessions, and individual debriefing interviews) in a trial joining clinical and ethnographic methods. Our study enrolled 45 patients and six clinicians, yielding 117 patient-clinician appointments and 98 debriefing interviews. Most patients differed in how they presented their identities through demographic forms and discussed them in sessions with their clinicians. Two-thirds of the patients drew connections between their personal identities and experiences of mental illness. These results reveal why cultural identities should not be taken for granted in clinical settings.
人类学家曾批评过医疗环境下的文化能力项目，同时也向精神健康临床医生介绍了关于文化的社会理论，以指导他们的实践。我们通过一项名为文化表述访谈的干预措施来探讨患者如何表达自己的叙述，以及临床医生如何对此类叙述做出反应，该干预措施得到了人类学家的帮助和开发。我们于 2014 年至 2019 年在纽约的一家门诊诊所进行了超过 500 小时的实地工作，通过一项将临床和民族志方法结合起来的试验，分析了多种数据（参与观察、病历、医患会议和个人汇报访谈）。我们的研究纳入了 45 名患者和 6 名临床医生，进行了 117 次医患预约和 98 次汇报访谈。大多数患者在通过人口统计表格呈现自己的身份以及在与临床医生的会议上讨论身份时存在差异。三分之二的患者将个人身份与精神疾病的经历联系起来。这些结果揭示了为什么在临床环境中不应该理所当然地认为文化身份是既定的。
