Difficult Patients Through a Cross-Cultural Lens by Helen Ullrich, MD, PhD (Psychoanalysis & Culture)

Cultural patterns in childhood socialization have an impact on the negotiation of normal narcissism, self-image, and autonomy. When individuals find their cultural ideals a poor fit, they are likely to fall into the category of difficult patients, i.e., patients who need life-long treatment as well as a supportive social network. This paper will examine adaptive aspects of socialized passivity among women in a South India community and its implications for two American patients with a history of anorexia nervosa. Individuals in both cultures whose childhood socialization gave them inner security successfully utilized mentalization, while those without inner security lacking the resources for mentalization were vulnerable for chronic psychiatric symptomatology.
Cross-cultural observations will examine the protection that socialized passivity may provide women against physical and mental abuse. As the culture changed with education for both women and men, assertiveness rather than submission marked appropriate feminine behavior. By comprehending the underlying psychodynamics necessitating passivity among South Indian women and the inability of some women so socialized to abandon passivity, learners will have increased empathy for difficult patients.

Learning Objectives:
• Participants will develop improved capacity for empathy through attention to sociocultural dynamics and their influence on mentalization.
• Participants will gain knowledge in treating patients with excessive passivity.
• Participants will acquire improved understanding of how cultural norms and roles influence personality development and character functioning.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of American Psychoanalytic Association and NOBPC. The American Psychoanalytic Association is accredited by the ACCME to provide continuing medical education for physicians. The American Psychoanalytic Association designates this Live Activity for a maximum of 2 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
IMPORTANT DISCLOSURE INFORMATION FOR ALL LEARNERS: None of the planners and presenters of this CME program have any relevant financial relationships to disclose.
Psychologists and Social Workers may also receive continuing education credit for this activity if their accredited associations or boards recognize CME credits.

Admission is Free.
Fee for 2 CME credits: $15 for NOBPC members; $25 non-members