COUNCIL AWARD
World Association of Cultural Psychiatry, and the Chair of the Transcultural Psychiatry Section of the Canadian Psychiatric Association. In 2016, Dr. Fung was the recipient of the American Psychiatric Association’ s Award for Advancing Minority Health.
We recently spoke to Dr. Fung about his life and work:
You moved to Canada in the 1980s, what was that experience like for you and your family? My family came to Canada as part of the wave of people leaving Hong Kong before its repatriation to China. We arrived in Canada in the late fall and I remember thinking that Canada was very beautiful and very cold. We quickly became part of Toronto’ s established Chinese community and I would have to say that, all in all, I had a very happy childhood. Despite that, my younger brother and I still experienced tremendous cultural shock as we dealt with differences in language, how children played and interacted with each other and with adults, and some subtle as well as overt instances of racism. Initially, I even misunderstood instructions from my teachers as I had trouble understanding the Canadian-English pronunciation as opposed to British- English. Our parents also went through the common struggles of immigrant families in finding jobs and having non-Canadian qualifications recognized.
What led you to believe there was an unmet need for culturally sensitive mental health programs? I was doing one of my first clinical rotations in psychiatry during my second year of residency. One day, during rounds, I learned of a particular patient described by medical staff as being uncooperative. Among the list of behaviours that was being characterized as a manifestation of his mental illness was the patient’ s refusal to drink tap water. He insisted upon drinking only boiled water. When I realized that the patient was of South Asian heritage, I suggested to the medical team that this particular behaviour might not have anything to do with his health issues at all. In many countries in South Asia, people routinely boil tap water before drinking it.
It bothered me that my suggestion to consider culture was dismissed outright and I was perceived as colluding with the patient.
Why is it important to consider cultural factors when delivering mental health services to patients? Paying attention to culture is about delivering competent services that speak to the individual needs of the patient – it is the essence of patient-centred care. When dealing with patients, families and medical teams, it is helpful to take into consideration the effect culture has on how individual patients approach their illness. Many cultures have negative attitudes towards mental illness – lack of knowledge and awareness is one component of the problem that is common in all stigmas. Yet, at the same time, there are cultural differences that will cause the experience of stigma to be different. One culture may tend to blame the illness on bad parenting, while another community may tend to place the blame on karma. The effects of mental illness on a patient’ s family as a whole may also be different according to culture, with one family viewing mental illness as an individual disease, while another perceives the illness as having tainted the whole family and causing implications for their status in the community. There are also different perceptions on how best to interpret symptoms and get better. When these types of factors are in play on top of mental illness, things can get confusing for clinicians and we can fail to recognize the scope of problems, and lose time pursuing the wrong treatments. When we understand the whole patient, we can better tailor treatment to meet their needs.
Can concepts of cultural psychiatry be applied to the broader community? The lessons from cultural psychiatry have implications for all of us and studying diverse approaches to mental health means we explore other, non-Western models of human development that may have a better or different understanding of resilience and the causes of illness. I think the strength in Canada’ s diversity brings a richness that enables us to see a more holistic picture of medical care and ensure there isn’ t only one single vision of psychiatry. MD
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DIALOGUE ISSUE 4, 2017