Case Study 9

Case Study 9: Misdiagnosis of schizophrenia (Arab family)

Budman, C.L., Lipson, J.G. & Meleis, A.I. (1992). The cultural consultant in mental healthcare: The Case of an Arab Adolescent. Amer. J. Orthopsychiat, 62 (3), 359-370.

The case of Omar, an adolescent from Iraq highlights the consequences of the clinician’s not being familiar with culturally normal behaviour and treating presenting symptoms according to the clinician’s own cultural norms. This leads to misdiagnosis and inappropriate treatment for Omar and his family. At the core of this case and at the heart of cross-cultural psychiatry is the question, "Is this behaviour normal?" (Budman, Lipson & Meleis, 1992). This question must determine normality in its cultural context. This case study can be requested free of charge from your DHB library service or academic provider.

Brief background of the case

Omar, a 17-year-old boy from Iraq, was referred to a child and adolescent psychiatric inpatient unit for evaluation of sleep and appetite disturbances, phobic behaviour, and social isolation. Omar's problems had begun three years earlier, before migration. During the war in Iraq, Omar became anxious and reluctant to attend school, and withdrew from his usual activities and friends. After the family's arrival, Omar's symptoms worsened. It was when Omar's school truancy became marked that he was referred by the school to a local CAMHS for assessment.

This case (1) describes Arab migrant and cultural issues that may influence psychiatric diagnosis and management, (2) demonstrates how a team that includes a cultural consultant can influence the diagnostic process and outcome of psychiatric care, and (3) describes components of the role of the cultural consultant in psychiatric care. Four issues are particularly relevant for understanding this case: understanding the refugee experience and the impact of resettlement; understanding adolescent development and identity in the Middle East, family relationships, and somatic expressions of various mental states.