Having worked in psychiatry in several countries with people from different backgrounds, and having a varied ancestry, I have learned that mental health problems present in different ways depending upon culture, tradition and heritage, as well as the individual variations. I am not entirely convinced that the concept of transcultural psychiatry allows for the individual variations within a particular culture

What could be potentially challenging for many psychiatrists, it is also an amazing journey of discovery which can bring together patient and psychiatrist in a unique way. For the travellers to reach safe destiny, they have to walk the journey in an atmosphere of mutual respect, harmony and open communication.

What some people might interpret as a supernatural phenomenon, others might interpret it as a natural human reaction. It affects different populations in different ways, and even within the same population, it can affect individuals in different manner. The grief following the death of a loved one, inevitably has an effect on people. Even when a strong faith maintains and enhances hope, the physical aspect of the grief is there in most cases; reduced appetite, weight loss, sleep disturbance and low energy levels, which are a common occurrence.

When it comes to depression, some people who are not aware of it or think that it does not exist, have a very different experience from the ones who are aware of the psychological implications of it. The former experience more physical than psychological symptoms than the latter, and they tend to attribute the psychological symptoms to the disability caused by the physical symptoms. The physical symptoms allow, in a way, a reason to experience part of the sadness which is at the heart of the depression. This conversion of psychological symptoms into physical symptoms is in a way driven by the inner beliefs of the person who experiences it.

Anxiety can also manifest in different ways. When it is not recognised by the individual who experiences it, can also manifest with physical symptoms, like palpitations, difficulties breathing, sickness or in other ways. However, when it comes to stigma, it seems more acceptable than depression.

Awareness of individual beliefs is fundamental in order to make sense of their experiences. Somebody who is more concerned than usual with evil eye or black magic, could be experiencing fear of something bad happening; this is at the core of anxiety, and the psychiatrist or therapist should be able to identify it, accepting, acknowledging and respecting the patient’s beliefs. We all grew up with a set of core beliefs and understanding them is fundamental to interpret what the person in front of us is experiencing.

Faith and spirituality always aid the recovery process, gives us hope in hopelessness. For the patient, to feel understood and respected is crucial. The inner beliefs as well as the spirituality have to be taken into consideration. The former help us to make sense of the person’s experiences, and the latter is of invaluable help when it comes to recovery.

Many psychiatrists boast about transcultural psychiatry, but unless they are able to navigate through the person’s inner beliefs, understanding and making sense of them, they will not be able to provide the help the person requires.

Many of my patients know that if there is nobody booked immediately after, I spend as long as possible discussing issues which to the external observer appear to have little relevance to the diagnostic or therapeutic process.

However, to me it is most relevant, as when we discuss the importance of the collectivism, the generational respect, the faith, their individual inner beliefs and their own interpretation of them, I am actually getting to know this person with their unique characteristics. When they finally say “Jose, nobody asked me this before, but it makes sense”, I experience such priceless satisfaction and I feel that this a passion rather than a job. It always reminds me of Sir Winston Churchill’s quote “If you find the job you like you do not have to work again”. I also wonder, if we should move away from the concept of transcultural psychiatry and call it “transindividual psychiatry”, as all individuals are different.

WHEN PEOPLE ASK ME …