Proofs - Personal Webspace for QMUL - Queen Mary, University of ...

More documents

Recommendations

Info

S82 A. Kleinman / European Psychiatry 27 (2012) / supplement n°2 / S81-S82 parents’ generation. They are also more likely than their parents and grandparents to be critical of local government, interested in protecting the environment, and oriented to middle class concerns for higher standards and eliminating corruption. This is a large culture change with serious implications for health and mental health care. How to take culture into account is another important question. Anthropologists have become increasingly critical of the dangerous effects of ethnic stereotyping, and for this reason they are hesitant to acknowledge culture as an independent variable. Cultural competence proponents have created a new industry by over selling the idea that they can train health professionals to become instant experts on how to diagnose and treat “culture” as a problem. At the same, ethnic politics have infi ltrated back into medicine. All of which makes research, like those research fi ndings reported here, more than ever necessary to get at hidden values and practices that infl uence people’s lives. The study of lived values is still in its early period, but we can expect it to expand rapidly in the years to come. And that study is part and parcel of research on immigrants, migrants and ethnic minorities, because when cultural differences make a difference they become issues in controverted and contested moral practices. Such research must begin with an understanding of the economic barriers and political pressures these groups face all over the world [1]. Those potent forces are intensifi ed by cultural differences which make race, religion and citizenship/ undocumented states additionally explosive in society, including its health care systems. Stigma associated with disease is easier to affi x on those without power who are already stigmatized by their social conditions. Marginality places poor migrants in settings that are at higher risk not only for violence but also for school problems, joblessness, and physical and mental health problems. The experience of cultural difference in the health care system, as the preceding chapters show, adds to the diffi culties immigrants have in getting quality health care. It also can make caregiving more challenging for professional caregivers. That is why practical interventions from medical anthropology and cultural psychiatry have been found useful in health care systems. This book adds to the expanding story of what can be done to improve services for immigrants and other marginalized groups. The presence of ethnic minorities like Turks who have resided in European countries like Germany for generations means that the entire health care system needs to be prepared to address cultural issues in care and that health policy experts have to understand how economic, political and cultural processes infl uence each other to affect access, quality, adherence and outcome. Here the case needs to be repeatedly made that these social and humanistic realities are so central to medicine and nursing that they must be systematically taught at all levels of the professional curriculum. The issue has two parts for medical educators and health systems managers: recognition that migrant and immigrant status really matters; and emphasis on methods that can be used to teach practitioners what best practices are in the care of ethnic, migrant and immigrant patients and families. The approach I have advocated is straightforward and has been spelled out in places like the Cultural Formulation in the Appendix of DSM- IV. The fi rst step is affi rmation and acknowledgement of the patient and family as respected persons whose religious and ethnic differences matter. Second is the effort to elicit their explanatory models of the sickness and the treatment as a basis for soliciting an illness and treatment narrative that focuses on what is most at stake for patients and families. Third is recognition and assistance over differences that matter: not just cultural but fi nancial, social relational, work- related, community- based, and so on. The purpose is not to achieve some idealized and exoticized cultural competency, but rather to practice empathic, competent and humane care. The major barriers that get in the way—language, class, fi nancial issues, time, bureaucratic structures, and professional indifference— need to be assessed as well. The template is commonsensical, and yet failures are still all too commonplace. I think the studies summarized in the preceding chapters give ample illustration of why. Medicine is inseparable from moral, economic, political and bureaucratic processes over which physicians and nurses have limited infl uence. But they do have some control. And anthropologists and health care researchers also have agency to improve practices. What needs to be done is for all parties to insist that these issues are as basic to caregiving as any, and they must receive priority. This book you are now reading provides the kind of information and understanding that can improve health and health care for vulnerable people. Let’s hope that it is evidence of a movement to improve the health care of at risk minorities everywhere. Proofs Reference [1] Good M - J D V, Willen S S, Hannah S D, Vickery K, & Park L T. Shattering Culture: American Medicine Responds to Cultural Diversity. New York: Russell Sage Foundation; 2011. 14_Kleinman.indd S82 14/06/2012 14:46:56
Proofs
Page 1 and 2:
68767 EUROPEAN PSYCHIATRY THE JOURN
Page 3 and 4:
Vol. 27, Supplement n°2, June 2012
Page 5 and 6:
Editorial © 2012 Elsevier Masson S
Page 7 and 8:
health of Turkish woman in Germany:
Page 9 and 10:
studies [8,6,27]. Commonly suggeste
Page 11 and 12:
lack of desire to obtain an educati
Page 13 and 14:
the study should be emphasised [4,1
Page 15 and 16:
clear is the picture regarding depr
Page 17 and 18:
SD=15.9; t(183)= - 2.575; p=.011).
Page 19 and 20:
as caring for children and taking c
Page 21 and 22:
© 2012 Elsevier Masson SAS. All ri
Page 23 and 24:
were then scrutinized independently
Page 25 and 26:
[6] Berry J, Kim U. Acculturation a
Page 27 and 28:
A. Heredia Montesinos et al. / Euro
Page 29 and 30:
3.2. Interrelations of stigma, depr
Page 31 and 32:
© 2012 Elsevier Masson SAS. All ri
Page 33 and 34:
F. Mammadova et al. / European Psyc
Page 35 and 36: [17] Su KP, Chiu TH, Huang CL, et a
Page 37 and 38: society, history (slavery and colon
Page 39 and 40: That the model is false suggests th
Page 41 and 42: 6. Ego disorders in psychosis - tra
Page 43 and 44: In this state, socially unaccepted
Page 45 and 46: generating a model of the self with
Page 47 and 48: Acknowledgements This work was supp
Page 49 and 50: to Kleinman, explanatory models con
Page 51 and 52: categories was performed very caref
Page 53 and 54: [31] Mayring P. Qualitative Inhalts
Page 55 and 56: patients (often with lower social s
Page 57 and 58: are listed by Turkish immigrants in
Page 59 and 60: [19] Schnegg M, Lang H. Die Analyse
Page 61 and 62: 1. Introduction The number of immig
Page 63 and 64: on the availability of service usag
Page 65 and 66: Studies in some European countries
Page 67 and 68: © 2012 Elsevier Masson SAS. All ri
Page 69 and 70: our study, we composed an assessmen
Page 71 and 72: With regard to content, the pilot a
Page 73 and 74: Acknowledgments We are very gratefu
Page 75 and 76: cross- cultural mental health train
Page 77 and 78: 3.3.2. German experiences Despite t
Page 79 and 80: [31] Mösko M, Gil- Martinez F, Sch
Page 81 and 82: 2. Psychosocial care as a necessary
Page 83 and 84: * First Rank Symptoms according to
Page 85: Epilogue A. Kleinman Esther and Syd
show all

Proofs - Personal Webspace for QMUL - Queen Mary, University of ...

Create successful ePaper yourself

Delete template?

Save as template?