Plenary 5: Individual Cultural Assessment and Cultural Concepts of Distress [Roberto Lewis-Fernandez, MD]

Speaker: Roberto Lewis-Fernandez, MD

Individual illness experience is always understood within cultural frameworks that are learned, embodied, and reinterpreted. These frameworks are diverse, emerging from the various social groups that shape a person’s intersectional identity. Cultural concepts of distress are key elements of these frameworks; DSM-5 defines these concepts as "ways that cultural groups experience, understand, and communicate suffering, behavioral problems, or troubling thoughts and emotions" (p.758). Typically, cultural concepts of distress cut across biomedical dichotomies of mind-body or even health-disease and frequently invoke spiritual or supernatural etiologies or mechanisms. Clinically, it can be challenging to translate between patients’ cultural concepts of distress and professional nosologies and therapeutics. This presentation will explore the construct of cultural concepts of distress and how to evoke these aspects of experience using the DSM-5 Cultural Formulation Interview, a 16-item, semi-structured protocol to individualize cultural assessment. Eliciting culture-focused information from patients and families can help clarify their illness representations and expectations of care in order to orient diagnosis, treatment planning, and engagement strategies.

Conducting an individual cultural assessment using the Cultural Formulation Interview can help clinicians clarify their patients’ representations of suffering in order to overcome discrepancies in patient-provider nosological frames and treatment expectations, including disparate conceptions of mind-body and health-disease relationships.