In the field of emergency psychiatry, a person's ethnic background, race, religion, values, beliefs, customs, and language can affect the symptoms with which a psychiatric illness may present. A culturally competent evaluation of the psychiatric patient includes assessment of the cultural identity of the individual, the role of culture in the expression and evaluation of psychiatric symptoms, and the effect of cultural differences on the relationship between patient and clinician. The cultures of the clinician and system of care influence diagnosis, treatment, and delivery of care. Language barriers influence the authenticity of the informed consent process. According to federal classification, the four most recognized racial and ethnic minority groups in the United States are Hispanic Americans/Latinos, African Americans/Blacks, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives. Culture-bound syndromes in Hispanic populations include ataque de nervios (attack of nerves), nervios (nerves), and susto (fright or soul loss).

This chapter explores the relationship between culture and the experience of stress and describes a variety of culture-bound syndromes. Concepts of mental health, distinctions between mental health and mental illness, and distinctions between mental and physical illness are highly variable across cultures. Individual characteristics also interact with social roles in specific cultural contexts. Culture-bound syndromes may either form a distinctive class of disordered behaviors or ultimately turn out to be local variants of known psychiatric diagnoses. Reports on psychoeducational interventions for ethnically diverse families in the United States suggest possible adaptations. These might include involving extended family networks or community support persons, reducing the length of sessions, focusing on economic survival issues, eschewing egalitarian approaches and confirming the authority of group leaders, and other special cultural considerations. Cultural constructivists and symbolic interactionists remind us that all human behavior must be viewed in fluid interaction with ever moving cultural currents.