Cultural formulation

Appendix I to DSM-IV contains an outline of how psychiatric cases can be culturally formulated. The outline includes:

• the cultural identity of the individual

• cultural explanations of the individual's illness

• cultural factors related to the psychosocial environment and levels of functioning

• cultural elements of the relationship between the individual and the clinician.

This is a feasible approach to routine patient care with members of ethnic minorities and recent immigrants and refugees that has a high likelihood of making that care culturally informed and culturally sensitive. Key to it, as it is to anthropology's core methodology, ethnography, is the display of genuine respect for patients, families, and their meanings and practices. That respect for the person and his or her illness experience is the indispensable condition of anthropologically informed care. It includes, as its first step, the ethical act of acknowledging the suffering of the other in his or her own terms as the basis for diagnosis and treatment. In this sense, it reverses the cultural preoccupation of the biomedical practitioner with the disease process, and establishes the interpersonal relationship as the grounds of knowledge as well as caregiving.

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