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Pour citer cet article :
Ingleby D. Different approaches to caring for multicultural populations. Bobigny : Association Internationale d'EthnoPsychanalyse ; 2004. Available from : http://www.clinique-transculturelle.org/AIEPtextesenligne_ingleby_
multicultural_populations.htm

 

Different approaches to caring
for multicultural populations


David INGLEBY *

Summary :

•  Historical background of concern for multicultural health care

•  Comparison with other sectors : education and management

•  Different conceptions of "multicultural care"

 

Colonialism (1500 - 1950)	Monoculturalism(1950-1980)	Multiculturalism(1980-)
Assumptions : Genetic and cultural superiority of the "white race"	Desirability of cultural homo-geneity ; superiority of "Western culture"	Equal rights are a precondition of social cohesion
Policy : Segregation, discrimination	Assimilation of cultural minorities	Integration with respect for own cultural or ethnic identity
Service provision : Limited access for non-whites and working class	Oriented towards dominant culture ; minorities must adapt	Multicultural care : provisions adapted to the diversity of the users

 

Two areas in which cultural diversity is relevant :

•  International (comparisons between countries, transfer of expertise)

•  National (health care for culturally diverse societies)

 

Mental health care in the colonial era :

•  Global level

•  National level

 

Samuel Cartwright (Louisiana physician), in New Orleans Medical and Surgical Journal (1851) :

•  Drapetom an ia : cause s blacks to have an uncontrollable urge to run away from their masters. Treatment : whipping.

•  Dysaethesia Aethiopica : di sobedience, answering disrespectfully and refusing to work. Treatment : hard labour.

 

Mental health care in the monocultural era :

•  Global level

•  National level

 

Mental health care in the multicultural era :

•  Global level

•  National level

Relation to other sectors :

•  Education

- colonial era

- monocultural era

- multicultural era

•  Management

- "compensating for disadvantage"

- "commitment to diversity"

 

Different notions of "multicultural" care :

•  "Deficit" approach

•  "Empowerment" approach

 

Some issues in multicultural health care provision :

•  Categorical or integrated services ?

•  Dangers of "culturalism"

•  Importance of contribution from users

•  Accessibility

• Quality of service (effectiveness) ;

• "cultural appropriateness"

 

Questions for eliciting a patient's explanatory model :

•  What do you think has caused your problem ?

•  Why do you think it started when it did ?

•  What do you think your sickness does to you ? How does it work ?

•  How bad [severe] do you think your illness is ? Do you think it will last a long time, or will it be better soon, in your opinion ?

•  What kind of treatment would you like to have ?

•  What are the most important results you hope to get from treatment ?

•  What are the chief problems your illness has caused you ?

•  What do you fear most about your sickness ?

Kleinman et al., 1978

 

The peculiar characteristics of modern Western explanatory models :

•  Tendency to medicalise or psychologise

•  Dualism of mind/body, self/others

•  Faith in scientific professionals and especially in pills and talking

•  Expectation of non-authoritarian and detached relationship with person giving help

 

Implications for practice :

•  Qualitative research

•  Ways of bridging the gap :

- Change the client

- Change the professional

- Appoint a mediator

•  Dangers of too much emphasis on "goodness of fit"

 

 

* Utrecht University. E-mail : J.D.Ingleby@fss.uu.nl