Cultural Competence and Corporate Culture

To the Editor: In the December issue, Lewis A. Opler, M.D., Ph.D., reviews a videotape of a cultural competence and diversity training program. He writes, "Being oblivious to this reality [cultural factors] is fraught with as much danger as being unaware that psychotherapy is influenced by transference and countertransference or that pharmacotherapy is influenced by the cleverly crafted marketing strategies of pharmaceutical companies."

The cleverly crafted marketing strategies are exquisitely depicted in the drug advertisements displayed throughout the December issue of the journal. The one that caught my eye was an advertisement for Zyprexa on the inside cover. In addition to the graphic visual message of the doctor (in a white coat) extending his arm to rescue the patient attempting to climb out of a ravine while standing on a large letter Z (color-coded throughout the ad), there is an interesting text, which, I believe is almost subliminally misleading.

The narrative begins by telling us that medication isn't the only answer to the treatment of mental illness. One would think that this is a reference to additional interventions such as psychotherapy or psychosocial rehabilitation. But instead the text goes on to describe how medication can "enable a strong therapeutic alliance" with the physician to establish a "solid treatment foundation and stay on course"—presumably to facilitate the patient's compliance with medication treatment. In other words, the importance of medication as an "essential component in the treatment of mental illness" is to help the physician to treat the patient with medication!

What is at issue here is not the role of pharmacological interventions in the treatment of psychiatric disorders, but, as Dr. Opler emphasizes, the need to recognize the role of cultural factors that influence psychiatric treatment—in this case corporate culture.

Mr. Wertman is director of adult mental health services at the Ohel Children's Home and Family Services in Brooklyn, New York.