Overall Assessment

Overall Assessment

The aim of the cultural assessment is to integrate all of the perti-nent elements of the cultural context of the patient’s identity, ill-ness and social context in a formulation that can guide diagnosis and treatment (Hays, 2001; Tseng and Streltzer, 1997). Factors associated with one aspect of the formulation may have an impact that cuts across many dimensions of illness experience and be-havior. The salient aspects of culture vary across cases and may reflect issues in the dominant society as much as any intrinsic characteristics of the patient’s ethnocultural group.

For example, cultural notions of race and racism may profoundly affect every aspect of the cultural formulation (Pinderhughes, 1989; Patel et al., 2000; GAP, 2002). Racial cat-egories may impose a disvalued identity on the patient; this may be resisted by reconstructing identity in a fashion that imbues one’s background with dignity and “cultural capital” (Comas-Diaz and Greene, 1994; Kareem and Littlewood, 1992). Race may figure in explanations of the nature of illness. For example, some Native peoples have come to view alcoholism, diabetes and other conditions as “white man’s illnesses”, which they suffer in large numbers precisely because of the history of colonization and racist practices. High blood pressure among African-Ameri-cans has been linked to the stresses of racial prejudice and related economic and educational disparities (Dressler et al., 1998). In-stitutionalized racism may have a powerful impact on the level of stress and social support for individuals, families and communi-ties, which may fracture or unite around this issue. The legacy of racism may define the clinician–patient relationship, where it may influence the transference and undermine rapport.