Culturally Sensitive Diagnosis Cultural Concerns Can Play

Culturally Sensitive Diagnosis Cultural concerns can play a pivotal role in helping diagnose a patient and formulating the best treatment options for that patient, as indicated in the case study of Esteban. Esteban, a 21-year-old male from Columbia, presented with a wide variety of symptoms that could have biological or psychological causes. The first way that culture impacted an evaluation of Esteban was through language. Esteban's heritage indicated a possible conflict with languages; therefore, he was offered the MMPI-2, which is available in both Spanish and English.

Dealing with potential language barriers is a critical component of assessment. Esteban's sexual orientation was one critical area of potential conflict. Views of homosexuality vary widely from culture-to-culture. Many Hispanic cultures have extremely negative views of homosexuality. This could help explain why Esteban feels as if he must hide his sexual orientation and that it is a source of shame. However, it is important to understand that Esteban's guilt may not be simply due to his cultural concerns about homosexuality. He and his brother were involved in an incestuous relationship.

Almost all cultures have taboos against incest. Unraveling how much of Esteban's guilt is due to his homosexual sexual orientation and how much of it is due to his involvement in a sexual relationship with his brother would be critical to diagnosing and treating Esteban. Regardless of the source of his sexual ambiguity, it plays an important role in his relationship. Esteban's profile indicates that he identifies as heterosexual, at least in so far as attempting to establish heterosexual relationships.

However, he is "so self-preoccupied and unskilled in sex-role behavior that they never develop rewarding heterosexual relationships" (Butcher et al., 2012, p.138). Whether this indicates that Esteban is actually homosexual, which would be taboo in his culture, or is struggling with the sexual ambiguity that would likely accompany involvement in an incestuous relationship with his brother, which may or may not have placed Esteban in either a predator or victim role, is not clear.

Another culturally relevant detail is that South Americans are frequently Catholic, but still have a significant belief in superstitions. Esteban seems to have focused on these superstitious religious beliefs, as he has abandoned his traditional religious upbringing and joined a religious sect that is fundamentalist and seems to believe in some occult beliefs (Butcher et al., 2012). Esteban is having difficulty reconciling his sexual attraction to men with his religious upbringing and seems to be seeking a "magical" religious intervention that will end his same-sex attractions.

He appears to believe that, as a man with same-sex attractions, he is something to be reviled by people of his culture. As one might anticipate, Esteban's sexual relationship with his brother was not the only abnormal relationship in the family. Esteban's came from a wealthy family, with a banker father, and a stay-at-home mother. Both of his parents had their own psychological issues; the father struggled with depression and the mother being very controlling and overprotective of her children (Butcher et al., 2012).

It would be important to know if these parenting styles were typical of Columbian culture or if her parenting style was abnormal and may have helped create a family environment in which her children would be involved.