Lewis-Fernández R, Kleinman A
Department of Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts, USA.
Psychiatr Clin North Am. 1995 Sep;18(3):433-48.
As a discipline, cultural psychiatry has matured considerably in recent years and the ongoing quality of its theoretical, clinical, and research development holds great promise. The contemporary emphasis on culture as process permits a deeper analysis of the complexities of sociosomatics--the translation of meanings and social relations into bodily experience--and, thus, of the social course of illness. We also are learning a great deal more about cultural processes that affect therapy, including ethnopharmacologic and culturally valid family interventions that are directly relevant to patient care and mental health policy. And an important set of studies is examining the trauma experienced by refugees and immigrants. But at the same time many disquieting findings still point to the limited impact of cultural psychiatry on knowledge creation and clinical application in psychiatry. The failure of the cultural validation of DSM-IV is only the most dismaying. The persistent misdiagnosis of minority patients and the continued presence of racial bias in some treatment recommendations are also disheartening, as is the seeming contempt of many mainstream psychiatrists for culturally defined syndromes and folk healing systems. Widespread inattention to ethnic issues in medical ethics is another source of dismay. It is for these reasons that the culture of psychiatry itself becomes as important as the culture of patients as a topic for research and intervention. Most of the world still suffers from a terrible lack of basic mental health services, including life-saving medications and hospital beds. In the face of these limitations, and because of the increasing multicultural and pluralistic reality of contemporary life, the growing interpretive bridges linking indigenous systems of illness classification and healing to Western nosologies and therapeutic modalities become even more essential and the reluctance of mainstream clinicians to explore folk healing methods more incomprehensible. Psychiatry needs new ways of delivering culturally appropriate care to the disenfranchised and the destitute, for whom mainstream approaches are often too expensive, foreign, and centralized. As a profession, we also have much to learn from indigenous diagnosticians and therapists. Finally, psychosomatic, mind-brain, behavioral health, and psychopathologic investigations need to configure the social world in their paradigms of research if we are to understand better the sources and consequences of mental illness. Psychiatry can no more afford to be contextless than it can afford to be mindless or brainless.
作为一门学科，文化精神病学近年来已相当成熟，其理论、临床和研究发展的持续质量前景广阔。当代对文化作为一种过程的强调，使得对社会躯体学的复杂性——将意义和社会关系转化为身体体验——以及疾病的社会进程进行更深入的分析成为可能。我们也在更多地了解影响治疗的文化过程，包括与患者护理和心理健康政策直接相关的民族药理学和具有文化效度的家庭干预措施。并且有一系列重要研究正在考察难民和移民所经历的创伤。但与此同时，许多令人不安的发现仍表明文化精神病学在精神病学知识创造和临床应用方面的影响有限。《精神疾病诊断与统计手册》第四版（DSM-IV）文化效度验证的失败只是最令人沮丧的一点。少数族裔患者的持续误诊以及一些治疗建议中种族偏见的持续存在也令人沮丧，许多主流精神病医生对文化定义的综合征和民间治疗系统的明显轻视同样如此。医学伦理学中对种族问题的普遍忽视是另一个令人沮丧的根源。正是由于这些原因，精神病学自身的文化作为研究和干预的主题变得与患者的文化同样重要。世界上大多数地区仍然严重缺乏基本的心理健康服务，包括救命药物和医院床位。面对这些限制，并且由于当代生活中多元文化和多元化现实的不断增加，将本土疾病分类和治疗系统与西方疾病分类学和治疗方式联系起来的日益增多的解释性桥梁变得更加重要，而主流临床医生不愿探索民间治疗方法也变得更加难以理解。精神病学需要新的方式，为那些被剥夺权利者和贫困者提供符合文化背景的护理，因为主流方法对他们来说往往过于昂贵、陌生且集中。作为一个专业，我们也有许多要向本土诊断医生和治疗师学习的地方。最后，如果我们要更好地理解精神疾病的根源和后果，心身医学、脑-心智、行为健康和精神病理学研究需要在其研究范式中纳入社会世界。精神病学不能没有背景，就如同它不能没有心智或大脑一样。
