Ethnicity and culture

Culture can be defined as learnt thoughts, attitudes, and customs shared by a particular group of people, which are generally passed on from generation to generation. Culture may or may not include different ethnic groups. In order to establish a rapport with members of different ethnic groups, appropriate understanding of verbal and non-verbal communication is paramount. This is even more so within the realm of mental health issues. Certain traditional cultures with strong family and community values may have a better impact on mental health than more modern cultures defined by anomie. However, mental health stigma still remains a problem both for traditional and modern cultures.

Whilst there may be a host of overt and subtle differences amongst western and non-western cultures in the way they deal with mental health and mental distress, the relatively easy mobility of racially diverse groups migrating from their country of origin to another country means an ever increasing population of new settlers with various degrees of adaptation and integration into the accepting society. Generational differences may occur, according to the different degrees of tension between adaptation and integration of different ethnic communities who may be struggling to preserve their sense of identity. However, some ethnic communities with a strong sense of identity, such as the Chinese community, tend to deal with mental health issues within their own group and resort to their own traditional methods and helping agencies in aid of their own mentally ill members.

Sudden and traumatic displacements and immigration of various ethnic communities, along with language barriers, may cause mental health and social suffering related to the loss of community, family members, and language. During this process, cultural beliefs and values may become lost, altered, or even distorted. hence, there is a need for understanding and being open-minded in learning about experiences of immigration.

It is clear that diverse ethnic groups are now part and parcel of any modern society, and therefore cultural factors have to be taken into account in any form of psychotherapeutic intervention. In the last decade, the introduction of IApT in the UK has gone a long way in meeting the needs of the local population, including ethnic minority groups, in improving access to psychological therapies and psycho-education and in reducing stigma. The employment of interpreters and mental health workers with knowledge of a particular culture has facilitated this process. however, despite better language and ethnic matching, miscommunications can still be a source of misunderstanding. This is particularly so in those patients (or therapists) who have rejected or developed a highly ambivalent relationship with their culture or country of origin. Nowadays, it is vital for any therapist to be fully aware of the implication of working with ethnically diverse patients. Akhtar, for example, gives an interesting illustration of the tasks facing the immigrant analyst, whilst Bhui and Morgan address the importance of cultural and racial awareness in practising psychotherapists (see E Improving Access to Psychological Therapies services in Chapter 10, pp. 463-4).

In summary, the role of culture and ethnicity needs to remain in the forefront of any psychotherapeutic relationship, and its absence will inevitably affect communication and therapeutic engagement.

Recommended reading

Akhtar S (2006). Technical challenges faced by the immigrant analyst. Psychoanalytic Quarterly, 75, 21-43.

Bhui K and Morgan N (2007). Effective psychotherapy in a racially and culturally diverse society. Advances in Psychiatric Treatment, 13,187-93.

Department of Health (2009). IAPT Black and Minority Ethnic (BME) Positive Practice Guide. January 2009. Available at: M bme-positive-practi ce-guide.pdf.

Hayward P and Bright J (1997). Stigma and mental illness: a review and critique.journal of Mental Health, 6, 345-54.

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