Cultural Formulation

The publication of the Cultural Formulation Outline in the DSM-IV represented a significant event in the history of standard diagnostic systems. It was the first systematic attempt at placing cultural and contextual factors as an integral component of the diagnostic process. The year was 1994 and its coming was ripe since the multicultural explosion due to migration, refugees and globalization impact on the ethnic composition of the U.S. population made it compelling to strive for culturally attuned psychiatric care.

Understanding the limitations of a dry symptomatological approach in helping clinicians grasp the intricacies of the experience, presentation and course of mental illness, the NIMH Group on Culture and Diagnosis proposed to appraise, in close collaboration with the patient, the cultural framework of patients' identity, illness experience, contextual factors, and clinician-patient relationship, and to narrate this along the lines of five major domains. By articulating the patient's experience and the standard symptomatological description of a case, the clinician may be better able to arrive at a more useful understanding of the case for clinical care purposes. Furthermore, attending to the context of the illness and the person of the patient may additionally enhance understanding of the case and enrich the data base from which effective treatment can be planned.

Juan E. Mezzich, M.D., Ph.D. is currently President of the World Psychiatric Association. An author or co-author of over 200 scientific journal articles and book chapters, he is professor of psychiatry and director of the Division of Psychiatric Epidemiology and International Center for Mental Health at the Mount Sinai School of Medicine, New York University.

Giovanni Caracci, M.D. is professor of psychiatry at Mount Sinai School of Medicine, New York University. Formally he was vice chair of the department of psychiatry at the University of Medicine and Dentistry of New Jersey. He lectures widely on urban medicine.