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This article reviews the historical evolution and progress of nosological concepts from exotic psychiatric disorders and culture-bound syndromes to culture-related specific syndromes. Approaches to classification and subgrouping these disorders are disccused and an argument offered for finding a place for culturally unique syndromes in the existing classification system. The characteristics of various syndromes are elaborated and suggestions are made for future research. Finally, emphasis is given to the need to be concerned with the impact of culture on every psychiatric disorder, not only culture-specific syndromes, to promote culturally competent care for every patient.

In this overview, the subject of culture and psychotherapy is considered broadly from five perspectives: (i) culture-embedded indigenous healing practices, (ii) culture-influenced 'unique' psychotherapies, (iii) cultural elements in 'mainstream' therapies, (iv) the practice of psychotherapy in different societies, and (v) intercultural psychotherapy. Various modes of therapy are compared with respect to their basic orientations, techniques and mechanisms of therapy. Culture-relevant psychotherapy requires technical adjustment, theoretical modifications and philosophical reconsideration. Practical suggestions are made regarding areas that need attention in order to conduct culturally appropriate psychotherapy.

Data was obtained by ethnic status from 411 outpatients at a psychiatric clinic in Honolulu, Hawaii, and were then analyzed according to demographic variables, welfare status, source of referral, primary compliants or symptoms, diagnosis, and duration of treatment received. Clinic utilization was highly related to ethnicity, with Caucasians highly over-represented in proportion to the population, and other groups, especially Japanese, being greatly under-represented. The Caucasians were more likely to be self-referred, to have subjective symptoms of anxiety and depres sion" and to receive a neurotic diagnosis. The Japanese, and to some extent all other groups, were more often referred after a crisis or severe mental illness, displayed more socially disruptive symptoms, and had a higher percentage of schizophrenic diagnoses. Ethnicity was thus highly related to utilization of mental health services; however, once entry into the system was made, review of therapist case loads and analysis of duration of treatment revealed no ethnic difference in the clinic's response to patients.

Chinese Culture and Mental Health.