This blog post is by Dr Gavin Miller, University of Glasgow, Principal Investigator for AHRC Science in Culture Theme Exploratory Award ‘Debating the First Principles of Transcultural Psychiatry’.

Corn(ed) Beef, n. Rhyming slang for deef (s.v. deaf) (Edb., Arg., Gsw., Ayr., Dmf. 2000s). […] *Gsw. 1985 Bulman TV drama 22 Aug: ‘Are you corn beef?’ ‘You mean Mutt and Jeff – deaf?’ ‘Naw, I mean corn beef – deef.’ Corned Beef, Dictionary of the Scots Language

Cultural competence is an important clinical aptitude in transcultural psychiatry. The culturally competent psychiatrist has a wide knowledge of cultural difference, including linguistic difference. This knowledge is crucial to successful diagnosis. Take the example of a phrase like ‘corned beef’. The culturally competent psychiatrist knows that a North American who sincerely claims that his parents are ‘corned beef’ is in the grip of a most peculiar set of delusions or hallucinations. On the other hand, she knows that a working-class Lowland Scotsman who makes the same declaration is probably just asserting that his mother and father are hard of hearing.

Within the framework implied by cultural competence, the job of transcultural psychiatry is to supply cultural data to the medical professional in order to prevent linguistic or cultural misapprehensions. Admittedly, transcultural psychiatry has been pre-occupied by polite successors to race (‘ethnicity’), but no doubt it will turn to axes of cultural variation more pertinent to our hypothetical Scottish male. These might include class, geography, and gender.

However, such a tidy vision of the relationship between humanities and psychiatry, with the former playing a service role, obscures potentially transformative questions that are far more profound and troubling.

For example, consider these two stories that transcultural psychiatry may tell about patients who present with unusual experiences and beliefs. A patient believes himself to see and be in contact with his long-dead ancestors. For a person in whose culture this is deviant, the presumed explanation is disease. For another person in whose culture this is normal, the experience is healthy (or, at least, not unhealthy), and insofar as any explanation is offered, it is ‘culture’. The culturally competent psychiatrist knows that what suggests incipient madness in a ‘European’ man from Glasgow, is culturally sanctioned as normal in, say, a Native American.

This psychiatric logic models culture as a simple stable entity, rather like a pathogen such as a bacterium or a virus. This medical habit of thought, however, conveniently avoids a number of troubling questions. Cultures are not coherent, distinct, and static. They are sites of contestation; they blend and mix, and are distinguishable more in analysis than in reality; moreover, they are dynamic, and open to human intervention. The ‘European’ Glaswegian who sees and communicates with dead ancestors might well wonder why he can’t simply borrow the Native American’s legitimacy, or why he can’t club together with other Glaswegian seers-of-the-dead to create a common culture (or subculture).

The cultural genie is out of the bottle. As I argued in a recent paper at the Association of Medical Humanities Conference in Aberdeen, texts such as Gail Hornstein’s 2009 monograph, Agnes’s Jacket, consciously use the language of anthropology and of identity politics (language, culture, nation, diaspora) to build a shared self-conscious culture and identity amongst psychiatric patients, particularly voice hearers. We might feel this is fine for voice hearers, but is it is so simple for self-harmers? What about ‘pro-anorexia’ culture? How far can one extend this gestalt switch between psychopathological symptom and marker of cultural difference?

The interesting questions for transcultural psychiatry have little to do with further mapping of cultural difference by the humanities for psychiatry. A far more interesting question – one amongst many others – centres on what the ‘mentally ill’ are self-consciously doing with the notion of culture. This problematic anthropological concept has entered into psychiatry via transculturalism, and is now a part of the everyday knowledge of psychiatric service users.

This is one of a series of guest blog posts written by AHRC Science in Culture Theme award holders. The Science in Culture Theme is a key area of AHRC funding and supports projects committed to developing reciprocal relationships between scientists and arts and humanities researchers. More information about Dr Gavin Miller’s exploratory award ‘Debating the First Principles of Transcultural Psychiatry’ can be found here.

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