Dr Russell Lim of the American Psychiatric Association based the first edition of the widely acclaimed Clinical Manual of Cultural Psychiatry on the ‘Outline for Clinical Formulation (OCF) Continuing Medical Education’ courses. The OCF first appeared in the DSM-IV and DSM-IV-TR in 1994 and 2000. Major revisions to the definition of cultural identity came with the publication of DSM-5 in 2013, expanding on the DSM-IV elements of race, ethnicity, language and migration to include religious affiliation, socio-economic background, personal and family places of birth and growing up, migration status, and sexual orientation. The second edition of the Clinical Manual of Cultural Psychiatry reflects these DSM-5 updates. The book effectively consists of three parts.
The opening chapters discuss the ‘Cultural Formulation interview’ (CFI) introduced in DSM-5. The CFI operationalises the OCF into a 16-question core interview with 12 supplementary modules, allowing for a more comprehensive cultural assessment for various sub-populations. A copy is reproduced in Lim’s book together with instruction on building an accurate formulation by applying this framework for assessing the impact of culture on psychiatric illness. This is, in itself, a valuable tool for psychiatrists, non-consultant hospital doctors, medical students, psychologists and other mental health professionals. It is well explained with carefully selected examples and video vignettes, which appear throughout the book. The opening chapters offer a short historical perspective on cultural psychiatry and the shift away from the perspective that ‘patients are more alike than different’ (p. 4). It attempts to define culture in terms relevant to psychiatry and highlights how the complexities of cultural identity influences attitudes to health and illness. Advice on the use of interpreters and cultural informants is provided.
The second part of the book contains chapters on each of the four federally identified minority groups in the United States, namely African Americans, Asian Americans, Latino and American Indian, and Alaska Native patients. It is somewhat disappointing, albeit understandable, that discussion on a larger number of cultures and sub-cultures is not provided. Nonetheless, Lim’s book does provide an excellent appreciation of cultural diversity and the implications such diversity has in the various presentations of mental illness. For each group included, Lim discusses key issues to consider as well as tips in approaching each specific population and cautions regarding medications. The importance of key psychosocial factors relevant to each group is also examined.
The final part of the book contains entirely new chapters on lesbian, gay and bisexual issues; transgender and gender non-conforming patient issues; women’s issues as well as religion and spirituality. These chapters are rich in geographically neutral information and thus are more helpful for readers outside the United States than the earlier chapters devoted to the four federally identified minority groups. All chapters contain case examples to help illustrate important points and the video vignettes, which can be accessed online via www.appi.org/lim, illustrate key interview skills succinctly.
A chapter devoted to women’s mental health opens with a brief historical account of theories surrounding women’s mental health from the time of Hippocrates. The chapter goes on to give advice on gender-specific clinical assessment emphasising a life-cycle approach. A helpful summary of key clinical skills is included. Chapters on sexual orientation and transgender culture provide a description of the development of sexual identity from childhood. These chapters highlight the particular difficulties within certain cultural groups in disclosing sexuality and provide instruction on sensitively approaching patient interview. Guidance on conducting a spiritual assessment is provided in the last of the new chapters.
A chapter devoted to ethnopharmacology helps to clarify drug metabolism differences based on ethnic-specific polymorphic variability and highlights the implications for the practicing clinician. This short chapter discusses differences in the main cytochrome P450 enzymes from one ethnicity to another and provides a good overview on the subject. The chapter includes various tables and figures with specific drug examples.
As Ireland is increasingly becoming a multi-cultural society, it is important that our mental health professionals become more culturally informed and properly equipped to understand that ‘culture influences many aspects of psychiatric illness including illness management, coping and help-seeking behaviour’ (p. 43). It is imperative that we not only recognise the major part that culture plays in the presentation and expression of mental illness, but that we understand how to conduct a thorough psychiatric interview in order to be confident of an accurate formulation and diagnosis. This book is a useful reference for a wide range of mental health professionals and is presented in a clear, easily readable, practical format. Each chapter is extensively referenced, providing a useful resource to those requiring further insight and information.
