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Health Experience and Values in Person-Centered Assessment and Diagnosis

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Person Centered Psychiatry

Abstract

Subjective experience is central to person-centered psychiatry for ethical, conceptual, and pragmatic reasons. Experience is central to what is of greatest concern to patients and drives help-seeking, coping, and treatment response. In the case of psychiatric disorders, alterations of experience may be crucial signs and symptoms of illness, indicating the nature of the problem and providing targets for intervention. In this chapter, we consider some of what is known about the nature of the processes of embodiment, interpretation, and enactment that contribute to subjectivity. We discuss phenomenological, cognitive-interpretive, and sociocultural approaches to illness experience. Both the experience and expression of health and illness depend on bodily, psychological, and interpersonal processes of perception, attention, interpretation, coping, and communication. We outline an approach to clinical assessment that gives explicit attention to patients’ experience and values through understanding the meanings of symptoms and suffering in social and cultural context.

Juan E. Mezzich—Editor in Chief, International Journal of Person Centered Medicine.

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Authors and Affiliations

  1. James McGill Professor and Director, Division of Social and Transcultural Psychiatry, McGill University, Montreal, Canada

    Laurence J. Kirmayer MD, FRCP(C), FCAHS

  2. Director, Culture and Mental Health Research Unit, Institute of Community and Family Psychiatry, Jewish General Hospital, Montreal, QC, Canada

    Laurence J. Kirmayer MD, FRCP(C), FCAHS

  3. Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA

    Juan E. Mezzich MD, MA, MS, PhD

  4. Nelson Mandela Professor of Philosophy and Psychiatry, University of Pretoria, Pretoria, South Africa

    C. W. Van Staden MBChB, MMed (Psych), MD

  5. Secretary General, International College of Person Centered Medicine, New York, USA

    Juan E. Mezzich MD, MA, MS, PhD

  6. Editor in Chief, International Journal of Person Centered Medicine, New York, USA

    Juan E. Mezzich MD, MA, MS, PhD

  7. Former President, World Psychiatric Association, Geneva, Switzerland

    Juan E. Mezzich MD, MA, MS, PhD

Authors
  1. Laurence J. Kirmayer MD, FRCP(C), FCAHS
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  2. Juan E. Mezzich MD, MA, MS, PhD
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  3. C. W. Van Staden MBChB, MMed (Psych), MD
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Corresponding author

Correspondence to C. W. Van Staden MBChB, MMed (Psych), MD .

Editor information

Editors and Affiliations

  1. Dept. of Psychiatry, New York University Mount Sinai School of Medicine, New York, New York, USA

    Juan E. Mezzich

  2. Laboratory Ethics, Professionalism, University of Western Brittany, Bohars, France

    Michel Botbol

  3. Dept. of Psychiatry, University of Athens, Athens, Greece

    George N. Christodoulou

  4. Department of Psychiatry, WASHINGTON UNIV SCH MED Department of Psychiatry, Saint Louis, Missouri, USA

    C. Robert Cloninger

  5. Division of Alcohol and Drug Abuse, University of Miami Miller School of Medicine, Coral Gables, Florida, USA

    Ihsan M. Salloum

Appendices

Adapted from Kirmayer et al. [41] and from Mezzich et al. [49].

Appendix: Guidelines for Cultural Assessment

Adapted from Kirmayer et al. [41] and from Mezzich et al. [49].

The following questions can be used to explore aspects of illness experience and values in context. Not all questions are relevant to any given patient. The topics included and order of inquiry should be adapted to the clinical context to flow naturally from the patient’s concerns and priorities. Additional questions should be devised for clarification and elaboration of key areas. Questions about identity, background, and social context should be introduced by explaining their clinical relevance to the patient so that they are not perceived as intrusive or irrelevant.

Cultural Identity of the Individual

Ethnic or Cultural Reference Group:

  1. 1.

    Where are you and your parents from?

  2. 2.

    What is your ancestry? What background, groups, or nations are you mainly affiliated with?

  3. 3.

    How close, connected, or committed do you feel to each of these cultural groups?

  4. 4.

    Are there any differences in the background of your mother and father; of you and your spouse?

Language:

  1. 1.

    What languages did you speak growing up?

  2. 2.

    What languages do you know (e.g., can speak or read)?

  3. 3.

    What languages do you speak at home?

  4. 4.

    Which language do you use in your community?

  5. 5.

    Which language do you prefer to use in your health care or when discussing personal issues?

For migrants, Involvement with Culture of Origin:

  1. 1.

    What is your original cultural background, ancestry, or country of origin?

  2. 2.

    How close do you feel to your original culture?

  3. 3.

    In what ways do you keep in touch and participate in your culture of origin?

  4. 4.

    Do you use the language of that culture?

  5. 5.

    How strongly does it affect you if that cultural group is praised or criticized in the media?

  6. 6.

    Do you share the values (politics, religion, etc.) of that culture?

  7. 7.

    Do you celebrate that culture’s holidays?

  8. 8.

    Do you eat the foods typical of that culture?

  9. 9.

    Do you follow the newspapers, magazines, TV, radio, or Internet from that culture?

  10. 10.

    How closely do you follow the news or events related to your ethnic group?

  11. 11.

    What do you miss about the culture or community you came from?

  12. 12.

    Are there aspects of that culture or community that you are relieved to have left?

Involvement with Culture of Resettlement:

  1. 1.

    What is the culture or community to which you have moved?

  2. 2.

    How close do you feel to this new culture or community?

  3. 3.

    Do you use the language of this culture or community?

  4. 4.

    How strongly does it affect you if this cultural group or community is praised or criticized in the media?

  5. 5.

    Do you share the values (politics, religion, etc.) of this culture or community?

  6. 6.

    Do you celebrate holidays of this culture or community?

  7. 7.

    Do you eat the foods typical of this culture or community?

  8. 8.

    Do you follow the newspapers, magazines, TV, radio, or Internet from this culture or community?

  9. 9.

    What things about the current neighborhood, community, or culture you live in are most difficult for you and which do you like the most?

  10. 10.

    What are the main differences between the place you came from and the place you live in now?

Cultural Explanations of the Individual’s Illness and Help-Seeking Experience

  1. 1.

    What happened around the time you got sick (your problems, symptoms, illness, etc. began)? How did others respond?

  2. 2.

    Have you ever had anything like this behavior or difficulty? Has anyone you know ever had the same type of problem?

  3. 3.

    What do you call the problem you have in your own language or to others in your family or community?

  4. 4.

    How do you describe this problem to health care providers?

  5. 5.

    How serious is this problem?

  6. 6.

    How has this problem affected your life?

  7. 7.

    What do you find most difficult about this problem?

  8. 8.

    What do you think are the causes of this problem?

  9. 9.

    What do others in your family think about this problem?

  10. 10.

    Who have you consulted to get help for the problems you have?

  11. 11.

    Have you consulted any other sources of help for this problem? (Any traditional healers or community helpers?)

  12. 12.

    What kind of treatment do you want?

  13. 13.

    What do you hope the treatment will do for you?

  14. 14.

    Do you have any concerns about this treatment?

Cultural Factors Related to Psychosocial Environment and Functioning

On Stressors:

  1. 1.

    What stressful (difficult, challenging) situations or events have played a role in your illness?

  2. 2.

    How are these stresses or events affecting your life and family?

  3. 3.

    What do others in your community think about the stresses you have experienced?

  4. 4.

    How are these stressful experiences or events generally viewed in your culture?

  5. 5.

    How difficult would it be for you to reveal or discuss your symptoms or illness in your community?

On Supports:

  1. 1.

    Is there someone you trust and can talk to about personal matters?

  2. 2.

    What other sources of emotional support can you rely on?

  3. 3.

    What are your main sources of support—for information, finances, help with everyday tasks, emotional support, or help in dealing with symptoms or illness?

  4. 4.

    What role do your family, friends, and community play in your life?

  5. 5.

    What role do work, school, and other pastimes play in your life?

  6. 6.

    What role does religion and spirituality play in your life?

On Functioning:

  1. 1.

    How do your illness or symptoms affect your ability to take care of yourself?

  2. 2.

    How do your illness or symptoms affect your ability to work?

  3. 3.

    How do your illness or symptoms affect your interactions and relationships with your family?

  4. 4.

    How do your illness or symptoms affect your life and social relations in general?

  5. 5.

    What do others in your community think about these difficulties you have been having?

  6. 6.

    How are these difficulties viewed in your culture?

Cultural Elements of the Relationship Between the Individual and the Clinician

Assessing the clinician-patient relationship involves participant-observation and self-reflection on the part of the clinician, which can be guided by the following questions:

  1. 1.

    What are the salient features of the clinician’s own ancestry, identity, and cultural reference groups vis-à-vis this patient?

  2. 2.

    How do these facets of identity influence the clinician’s perception of the patient?

  3. 3.

    How does the patient perceive the clinician?

  4. 4.

    How do intercultural differences influence trust, communication, and rapport between clinician and patient?

  5. 5.

    How do intercultural differences influence the elicitation of symptoms and the understanding of their significance?

  6. 6.

    How do similarities between clinician and patient blur or mask other sources of social difference or evidence of psychopathology?

  7. 7.

    How do intercultural differences influence the determination of whether a behavior is normal or pathological?

  8. 8.

    How do intercultural differences influence the negotiation of diagnosis, treatment objectives, and the delivery of care?

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Kirmayer, L.J., Mezzich, J.E., Van Staden, C.W. (2016). Health Experience and Values in Person-Centered Assessment and Diagnosis. In: Mezzich, J., Botbol, M., Christodoulou, G., Cloninger, C., Salloum, I. (eds) Person Centered Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-39724-5_14

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  • DOI: https://doi.org/10.1007/978-3-319-39724-5_14

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