Diagnosis As Cultural Practice

This book is about the doing and experiencing of diagnosis in everyday life. Diagnoses are revealed as interactive negotiations rather than as the assigning of diagnostic labels. The authors demonstrate, through detailed discourse analyses, how the diagnostic process depends on power and accountability as expressed through the talk of those engaged in the diagnostic process. The authors also show that diagnostic decisions are not only made by professional experts trained in the art and science of diagnosis, but they can also be made by anyone trying to figure out the nature of everyday problems. Finally, diagnostic reasoning is found to extend beyond typical diagnostic situations, occurring in unexpected places such as written letters of recommendation and talk about the nature of communication. Together, the chapters in this book demonstrate how diagnosis is a communication practice deeply rooted in our culture. The book is interdisciplinary and unusually broad in its focus. The authors come from different experiential scholarly backgrounds. Each of them takes a different look at the impact and nature of the diagnostic process. The diagnoses discussed include autism, Alzheimer’s disease, speech and language disorders, and menopause. The focus is not only on the here and now of the diagnostic interaction, but also on how diagnoses and diagnostic processes change over time. The book can serve as an undergraduate or graduate text for courses offered in various disciplines, including communication, sociology, anthropology, communication disorders, audiology, linguistics, medicine, and disability studies.

The publication of the Cultural Formulation Outline in the DSM-IV represented a significant event in the history of standard diagnostic systems. It was the first systematic attempt at placing cultural and contextual factors as an integral component of the diagnostic process. The year was 1994 and its coming was ripe since the multicultural explosion due to migration, refugees, and globalization on the ethnic composition of the U.S. population made it compelling to strive for culturally attuned psychiatric care. Understanding the limitations of a dry symptomatological approach in helping clinicians grasp the intricacies of the experience, presentation, and course of mental illness, the NIMH Group on Culture and Diagnosis proposed to appraise, in close collaboration with the patient, the cultural framework of the patient's identity, illness experience, contextual factors, and clinician-patient relationship, and to narrate this along the lines of five major domains. By articulating the patient's experience and the standard symptomatological description of a case, the clinician may be better able to arrive at a more useful understanding of the case for clinical care purposes. Furthermore, attending to the context of the illness and the person of the patient may additionally enhance understanding of the case and enrich the database from which effective treatment can be planned. This reader is a rich collection of chapters relevant to the DSM-IV Cultural Formulation that covers the Cultural Formulation's historical and conceptual background, development, and characteristics. In addition, the reader discusses the prospects of the Cultural Formulation and provides clinical case illustrations of its utility in diagnosis and treatment of mental disorders. Book jacket.

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Diagnosis in a Multicultural Context provides mental health professionals with materials to practice the application of cross-cultural variations on standard diagnostic guidelines. Freddy A. Paniagua offers clinical case examples to illustrate the cross-cultural variations applicable in the assessment, diagnosis and treatment of clients from four major cultural groups: African Americans, American Indians, Asians, and Hispanics.

Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.

DSM-5® Handbook of the Cultural Formulation Interview provides the background, context, and detailed guidance necessary to train clinicians in the use of the Cultural Formulation Interview (CFI), which was created as part of the 2007-2013 DSM revision process. The purpose of the CFI -- and this unique handbook -- is to make it easier for providers to account for the influence of culture in their clinical work to enhance patient-clinician communication and improve outcomes. Cultural psychiatry as a field has evolved enormously from the days when it was principally concerned with epidemiological and clinical studies of disease prevalence; it now examines a multitude of issues, primary among them the differing patient, family, and practitioner models of illness and treatment experiences within and across cultures. The editors, all of whom have been intimately involved in the evolution of the field, have designed the book and accompanying videos for maximum instructional and clinical utility. The Handbook boasts many strengths and useful features, including: A detailed description of each of the three CFI components: a core 16-item questionnaire, which can be applied in any clinical setting with any patient by any mental health clinician; an informant version of the core CFI used to obtain information from caregivers; and 12 supplementary modules that expand on these basic assessments. This material facilitates implementation of the CFI by clinicians. Over a dozen clinical vignettes are included to illustrate use of the three components, and the Handbook also includes multiple videos that demonstrate the application of portions of the core CFI, and several supplementary modules. Strategies for incorporating the CFI into clinical training are identified and discussed, furthering the objective of developing culturally-sensitive and astute practitioners. The theoretical bases of the CFI are explored, raising questions for discussion and identifying areas for further research. The CFI is a valuable tool for all patients, not just those judged to be culturally different. The CFI has been called the single most practically useful contribution of cultural psychiatry and medical anthropology to clinical psychiatry, primary care, and medicine in general. DSM-5® Handbook on the Cultural Formulation Interview is the only book on the market that equips readers with the skills and insight to incorporate the CFI into practice, making it a critically important addition to the clinical literature.

Culture and Mental Health takes a critical look at theresearch pertaining to common psychological disorders, examininghow mental health can be studied from and vary according todifferent cultural perspectives. Introduces students to the main topics and issues in the areaof mental health using culture as the focus Emphasizes issues that pertain to conceptualization,perception, health-seeking behaviors, assessment, diagnosis, andtreatment in the context of cultural variations Reviews and actively encourages the reader to consider issuesrelated to reliability, validity and standardization of commonlyused psychological assessment instruments among different culturalgroups Highlights the widely used DSM-IV-TR categorization ofculture-bound syndromes

Some studies estimate that each year, around a quarter of the population of Western countries will suffer from at least one mental disorder. Should this be interpreted as evidence for the progress of psychiatry, a discipline that is now able to identify and treat mental illnesses that have always existed, or might it be the case that modern life somehow creates new conditions, or social pathologies? This book argues that in fact something more fundamental has been taking place in recent years: the development of diagnostic cultures. Taking account of the phenomenon of patients themselves 'pushing for' pathologization - and acknowledging therefore that this is not simply a case of psychiatry pursuing an agenda of 'medicalisation from above' - this volume examines the emerging trend towards interpreting our sufferings in terms of psychiatric conceptions and diagnostic categories. Drawing on new empirical case studies of psychological diagnoses, including depression and ADHD, and employing both cultural-psychological and sociological analyses, it charts the development of contemporary diagnostic cultures and asks whether, in transforming existential, moral and political concerns into individual psychiatric disorders, we risk losing sight of the larger historical and social forces that affect our lives. A ground-breaking examination of the shift towards the pathologization of suffering and the dangers that this presents to human self-understanding, Diagnostic Cultures will be of interest to scholars of social theory and philosophy, the sociology of culture, psychology and the sociology health and medicine.

This open access book offers essential information on values-based practice (VBP): the clinical skills involved, teamwork and person-centered care, links between values and evidence, and the importance of partnerships in shared decision-making. Different cultures have different values; for example, partnership in decision-making looks very different, from the highly individualized perspective of European and North American cultures to the collective and family-oriented perspectives common in South East Asia. In turn, African cultures offer yet another perspective, one that falls between these two extremes (called batho pele). The book will benefit everyone concerned with the practical challenges of delivering mental health services. Accordingly, all contributions are developed on the basis of case vignettes, and cover a range of situations in which values underlie tensions or uncertainties regarding how to proceed in clinical practice. Examples include the patient’s autonomy and best interest, the physician’s commitment to establishing high standards of clinical governance, clinical versus community best interest, institutional versus clinical interests, patients insisting on medically unsound but legal treatments etc. Thus far, VBP publications have mainly dealt with clinical scenarios involving individual values (of clinicians and patients). Our objective with this book is to develop a model of VBP that is culturally much broader in scope. As such, it offers a vital resource for mental health stakeholders in an increasingly inter-connected world. It also offers opportunities for cross-learning in values-based practice between cultures with very different clinical care traditions.