Francis Lu, MD, DLFAPA
Kim Professor in Cultural Psychiatry, Emeritus, UC Davis
I wanted to update CCPS members on resources on cultural psychiatry issues. Please contact me at francislumd@gmail.com if you have any questions or suggestions.
- There were important changes about cultural and social structural issues in the DSM-5-Text Revision (TR) that was published on March 19. In Section I (the introduction), new sections were added on the impact of racism and discrimination on psychiatric diagnosis and how attention was paid to these issues in the DSM-5-TR. APA states that “As part of the changes implemented throughout DSM-5-TR is the use of language that challenges the view that races are discrete and natural entities:
- The term “racialized” is used instead of “race/racial” to highlight the socially constructed nature of race.
- The term “ethnoracial” is used in the text to denote the U.S. Census categories, such as Hispanic, White, or African American, that combine ethnic and racialized identifiers.
- The terms “minority” and “non-White” are avoided because they describe social groups in relation to a racialized “majority,” a practice that tends to perpetuate social hierarchies.
- The emerging term “Latinx” is used in place of Latino/Latina to promote gender-inclusive terminology.
- The term Caucasian is not used because it is based on obsolete and erroneous views about the geographic origin of a prototypical pan-European ethnicity.” https://psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/DSM-5-TR/APA-DSM5TR-AttentiontoCultureRacismandDiscrimination.pdf.
In Section II, the Culture-Related Diagnostic Issues and Sex-and Gender-Related Diagnostic Issues sections were updated with new text and references; more disorders contain these sections. The Other Conditions that May be a Focus of Clinical Attention are now primarily Z codes instead of V codes with additional important guidance for why they should be coded as part of the diagnosis: “A condition or problem in this chapter may be coded… “3) if it plays a role in the initiation or exacerbation of a mental disorder; or 4) if it constitutes a problem that should be considered in the overall management plan.” These conditions or problems correlate well with the social determinants of mental health (SDoMH), as studied by the APA Presidential Task Force on SDoMH: https://www.psychiatry.org/psychiatrists/social-determinants-of-mental-health-task-force.
In section III, the Outline for Cultural Formulation section titles remained the same except for Part D where “treatment team and institution” was added: “Cultural features of the relationship between the individual, treatment team, and institution.” Part C entitled “Psychosocial stressors and cultural features of vulnerability and resilience” had the addition of this extremely important sentence: “These [stressors, challenges, and supports] include social determinants of the individual’s mental health such as access to resources (e.g., housing, transportation) and opportunities (e.g., education, employment); exposure to racism, discrimination, and systemic institutional stigmatization; and social marginalization or exclusion (structural violence).” The Cultural Formulation Interview remains the same. One additional cultural concept of distress was added to the previous 9: Hikikomori.
- These recent APA Resource Documents provide outstanding guidance and teaching tools: 1) “How Psychiatrists Can Talk to Patients and Families about Race and Racism (2020),” which provides excellence guidance with clinical vignettes, 2) “Ethics at the Interface of Religion, Spirituality, and Psychiatric Practice (2021),” and 3) “Advocating for Anti-Racist Mental Health Policies with a Focus on Dismantling Anti-Black Racism (2021).” They can be found at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents