Social Systems PGY3 Spring, 2002
Instructors: Antonio Bullon, M.D.
David Geltman, M.D.
Seth Rafal, M.D.
Course Goals:
The goal of this course is to enhance residents’ clinical effectiveness through increased understanding of:
1) the culturally-derived assumptions which every patient and every clinician
bring to every clinical encounter, and
2) the cultural and historical determinants of contemporary psychiatric theory and
and practice.
In pursuit of this goal, we will focus on four objectives:
1) Acquiring generic skills essential for clinical competence in several specific
domains, including:
a) cultural formulation as an essential aspect of every clinical encounter,
b) working effectively with interpreters,
c) ethnopsychopharmacology, and
d) cultural aspects of transference and countertransference.
2) Acquiring a fund of knowledge of cultural assumptions typically associated
with selected groups commonly encountered in clinical practice in the United States (e.g., African Americans, Latino Americans, Asian Americans, recent immigrants in general, and gays and lesbians). Understanding the uses, limitations, and risks of demographic generalizations.
3) Developing an appreciation of the impact of culture on the presentation
of psychiatric disturbance, illness beliefs, help-seeking behavior, treatment selection, and treatment response.
4) Understanding contemporary psychiatry as a product of specific cultural
and historical forces, and appreciating the complex interactions
that arise in the triad formed by the worldview of the patient, the worldview of
the clinician, and the culturally-conditioned framework of psychiatric practice.
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Date: Topic:
1/02 The Dream of a Common Language
“Your culture,” “My culture,” and “Our culture.”
Understanding self and other in cultural context.
Reading: None.
1/09 Faculty case presentation
With solicitation of residents’ cultural formulation.
Reading: None.
1/16 Introduction
to Cultural Formulation
Understanding: 1) the patient’s cultural identity, 2) the patient’s explanatory model of illness, 3) cultural forces relevant to the patient’s psychosocial world, and 4) cultural differences (or similarities) which may influence the clinician-patient relationship.
Reading: Westermeyer, Joseph J. “Cross-Cultural Psychiatric Assessment,” in
Culture, Ethnicity, and Mental Illness by Albert Gaw. American Psychiatric Press: Washington. 1993. pp. 125-144.
1/23 Psychiatry
and Homosexuality: What is normal? Who decides?
A case study of culture and history as determinants of psychiatric theory and practice.
Reading: Geltman, David. “Science and Ideology in Psychoanalysis and Male
Homosexuality: More and Less than Meets the Eye.” Psychiatry. Vol. 61.
Spring, 1998. pp. 84-100.
1/30 Gay,
Lesbian, Bisexual, and Transgender Mental Health Issues
An overview.
Reading: “Table of Contents,” from Textbook of
Homosexuality and Mental
Health by Robert P. Cabaj and Terry S. Stein. American Psychiatric Press:
Washington. 1996.
2/06 African American Mental Health Issues
An overview.
Reading: Griffith, Ezra E. and Baker, F.M. “Psychiatric Care of African
Americans,” in Culture, Ethnicity, and Mental Illness by Albert Gaw.
American Psychiatric Press: Washington. 1993. pp. 147-173.
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Date: Topic:
2/13 African American Case Presentation
Resident presentation.
Reading: None.
2/20 Liberty
and Its Vicissitudes
Historically-novel complexities of psychosocial development in contemporary American society.
Reading: Rafal, Seth. “Liberty and Its Vicissitudes: The Psychosocial
Challenges Posed by Unprecedented Liberty, Diversity, and Velocity of
Cultural Change.” January, 2001.
2/27 Mock
Boards
3/06 Dynamics of Immigration: Acculturation,
Identity, and Community
Psychosocial challenges of immigration.
Reading: “Four Tracks in Identity Transformation Following Immigration,”
in Immigration
and Identity: Turmoil, Treatment, and
Transformation by Salmon Akhtar. Jason Aronson: Northvale, N.J.
pp. 75-106.
3/13 Harvard Day
3/20 Video Case Presentation: Identity,
Cohesion, Alienation, and
& Acculturation in an Immigrant Family
3/27 In-class viewing and discussion over two weeks.
Video: The Split Horn: Life of a Hmong Shaman in America.
Alchemy Films. 2001. 56-minute documentary.
4/03 Mysell
Lecture
4/10 Latino
Mental Health Issues
An overview.
Reading: 1) Garcia-Preto, Nydia, “Latino Families: An Overview,” in
Ethnicity and Family Therapy by Monica McGoldrick and Joe
Giordiano (Eds.). Guilford Press: New York. 1996. pp. 141-154.
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2) Martinez, Jr., Cervando, “Psychiatric Care of Mexican Americans,”
in Culture, Ethnicity, and Mental Illness by Albert Gaw. American
Psychiatric Press: Washington. 1993. pp. 431-465.
3) Canino, Ian A., and Canino, Glorisa J., “Psychiatric Care of Puerto
Ricans,” in Ibid. pp. 466-499.
4/17 Latino Case Presentation
Resident presentation.
Reading: None.
4/24 Working Effectively With Interpreters
An essential clinical competency.
Reading: Westermeyer, Joseph, “Working with an Interpreter in Psychiatric
Assessment and Treatment.” J Nerv Ment Dis. 178:12. 1990. 745- 749.
5/01 Freud and Archeology
An illustration of psychiatric theory as cultural artifact.
Guest lecturer: Diane O’Donohue, Ph.D.
Reading: Engelman, Edmund. Bergasse 19: Sigmund Freud’s Home and
Offices, Vienna, 1938. Basic Books: New York.
5/08 Hasenbush Lecture
5/15 Asia
is Half the World: A Sampler of Diverse Mental Health Beliefs
Reading: T.B.A.
5/23 Asian Case Presentation
Resident presentation.
Reading: None.
5/30 Psychiatric
Care of Native Americans
An overview.
Reading: “Cultural Influences in Psychiatric Care of Native Americans,” in
Cross-Cultural Psychiatry by Albert Gaw. American Psychiatric Press:
Washington. 2001. pp. 23-51.
6/05 The
Psychiatrist as Anthropologist
Assume nothing and pass the Boards!
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