title: Ethical and cultural considerations in delivering psychiatric diagnosis: reconciling the gap using MDD diagnosis delivery in less-acculturated Chinese patients.
abstract: Talking to patients from diverse cultural backgrounds about their psychiatric disorders requires knowledge of one's own culture, the patients' cultures, and the ways in which they might interact, both in positive and unexpectedly negative ways. In this paper, we discuss the issues raised by discussing psychiatric diagnoses with Chinese-Americans who hold traditional illness beliefs and are not familiar with Western conceptions of psychiatric disorders. We explore how cultural values influence this aspect of medical practice, and suggest practical approaches to communicating the diagnosis of major depressive disorder in a culturally sensitive manner. Our clinical approach is to develop co-constructed illness narratives with patients, and to aid this process by reframing different elements of the clinical process into more culturally resonant forms. The following steps are suggested: 1) elicit patient's illness beliefs; 2) understand and acknowledge multiple explanatory models; 3) contextualize depressive symptoms into patient's physical health and social system; 4) introduce Western psychiatric theories in ways that reflect assumptions shared by Traditional Chinese Medicine (TCM); 5) involve patients' families whenever possible; and 6) use terminology that avoids unintended stigma.
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA. ayeung@partners.org
authors.forename: Albert
authors.initials: A
authors.lastname: Yeung
authors.forename: Raymond
authors.initials: R
authors.lastname: Kam
mesh_terms: D000069:Acculturation; D001213:Asian / Q000208:ethnology / Q000523:psychology*; D003142:Communication; D054521:Cultural Competency / Q000941:ethics / Q000523:psychology; D003469:Culture; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000208:ethnology* / Q000469:parasitology; D004992:Ethics, Medical; D006801:Humans; D008516:Medicine, Chinese Traditional / Q000523:psychology; D010353:Patient Education as Topic / Q000941:ethics; D010817:Physician-Patient Relations / Q000941:ethics; D011570:Psychiatry / Q000941:ethics*; D012803:Sick Role / Q000941:ethics; D012945:Social Values