Few clinical disciplines can be subject to as much cultural variation as psychiatry. The social, cultural and spiritual shaping of clinical psychiatry varies widely between countries. The recognition of mental health issues may be highly related to political climate and level of economic development. While every undergraduate medical student requires competency in managing diabetes or orthopaedic trauma, the need to include anorexia nervosa or somatoform disorders on the curricula of medical schools may be seen as variable. If prominence in undergraduate medical curricula purely reflected local disease epidemiology, this would be in part understandable. Yet a major concern with psychiatric illness is the limited acceptance of the considerable prevalence of many illnesses owing to sociocultural barriers.
It is with this background that undergraduate teaching of psychiatry in an international context is discussed in this chapter. The focus here is on the following questions:
• In designing a curriculum in a non-Western country, are there core aspects of psychiatry that are generalisable or should curricula be based on indigenous models of mental health?
• Where the apparent prevalence of mental illness is low or unknown, how much emphasis should be placed on psychiatry in an undergraduate curriculum?
• Where many forms of unusual or aberrant behaviour are managed as social or spiritual problems, to what extent should a psychiatric paradigm be taught?
• When teaching undergraduate psychiatry in a different culture, what ideological and practical challenges are faced by both local and foreign educators?
The Scotland–Malawi Mental Health Education Project (Chapter 17) is one of many initiatives that link high- and low- to middle-income countries in terms of undergraduate psychiatric teaching. Some of the questions above are discussed in relation to teaching medical students in Malawi and with reference to other available literature.
The importance of psychiatry in medical curricula
The shape of psychiatric teaching in undergraduate medicine may well reflect the perceived importance of mental illness within a given culture. The paucity of psychiatric services and clinicians could easily prevent the establishment of psychiatric issues at the heart of medical training. Table 18.1 presents some gross indicators of psychiatric services in selected countries, which may be taken to represent Europe, Africa, South Asia, South East Asia and South America.