To the Editor: We read with interest the brief report by Griffeth and Bally, "Language and Cultural Barriers in the Assessment of Enemy Prisoners of War and Other Foreign Nationals," in the February issue (1). The mental health team described by the authors tried to do their best by using interpreters. However, the interpreters were not Iraqis and had little knowledge of the culture—and even had difficulty communicating.
We believe that the authors have made a fundamental error—that is, assuming that concepts of Western psychiatry as embodied in the DSM are universally valid. Western psychiatry is only one among several ethnomedical systems in the world. Western personhood emphasizes a personal and private self, whereas many cultures define a person as largely interpersonal and consensual and oriented to key roles and relationships rather than to what is deeply private. Social connectedness is a measure of value of self. In fact, among Iraqi asylum seekers in London, current social support was more closely related to low mood than a history of torture (2).
The authors are guilty of the error of "category fallacy," which is the assumption that because phenomena can be identified in different social settings, they mean the same in those settings (3). Terms such as depression and posttraumatic stress disorder and the meanings and responses that they elicit in Western societies are not directly applicable elsewhere, and many cultures do not have equivalent terms (4).
We are not sure whether it would work well for the authors to apply symptoms or even concepts of the Western world to people who may have other explanations, ranging across the physical, spiritual, moral, and political realms, and who may not conceive of illness as situated in the body or mind alone.
We also do not agree that educating interpreters in medical terminology can in itself benefit future assessment and treatment of prisoners of war and other foreign nationals unless the interpreters—or persons on the treatment team—are highly knowledgeable of the culture and of what is considered "normal" and what is not.
Dr. Mathews is assistant professor of psychiatry and Dr. Basil is a resident at Drexel University College of Medicine in Philadelphia. Dr. Adetunji is with MHM Correctional Services in Philadelphia.
Griffeth BT, Bally RE: Language and cultural barriers in the assessment of enemy prisoners of war and other foreign nationals. Psychiatric Services 57:258-259, 2006
Gorst-Unsworth C, Goldberg E: Psychological sequelae of torture and organized violence suffered by refugees from Iraq: trauma related factors compared to social factors in exile. British Journal of Psychiatry 172:90-94, 1998
Kleinman A: Anthropology and psychiatry: the role of culture in cross cultural research on illness. British Journal of Psychiatry. 151:447-454, 1987
Pilgrim D, Bentall R: The medicalisation of misery: a critical realist analysis of the concept of depression. Journal of Mental Health 8:262-274, 1999