Abstract
Objective: To highlight the value of viewing a patient through a “multicultural lens.”
Method: A case of a 36 year old married Indian woman who suffered psychiatric consequences of disseminated cerebral tuberculosis are discussed. The woman had failed to respond to medical interventions and consequently was referred to me for psychiatric management.
During the process of a thorough psychiatric assessment, my patient expressed some interesting comments and views which led me to explore how cultural beliefs influenced her understanding of the illness. These cultural beliefs produced several obstacles in her treatment. Interesting transference and countertransference issues were recognised and the case was formulated on the basis of the patient's cultural background.
Psychiatric interventions were based on a ‘liason model’. I found myself in a privileged situation to untie the cultural knots and release tensions between medical staff on one hand and the patient and her family on the other. Central players in the drama were recognised. As a psychiatrist, I adapted to the demands of this unique situation and demonstrated flexibility, changing roles as required. This meant a tight rope walk while endeavoring to maintain professional role boundaries.
The goals of the management included rapport – building, providing support and education and managing crisis situations. The various interactions and interventions one needs to put in place in such stressful and complex situations are highlighted. The various psychiatric and non-psychiatric interventions achieved respite and relief for the medical team, who were then able to focus on and work towards the best interest of the patient.
Results:
The patient and her family, once on the verge of leaving the country out of frustration, decided against it and stayed on. Their patience and co-operation following that contributed immensely to the overall favourable outcome.
The medical team achieved remarkable results in the woman's medical and neurosurgical treatment, which allowed for effective rehabilitation to follow. The woman is now back to a normal life, to the extent that she is able to support her husband at work as well as care for her new arrival.
The psychiatrist, quietly and painstakingly worked alongside the medical team. Thus by adopting a multidimensional and practical approach, a psychiatrist can experience a successful and rewarding outcome.