Cultural Factors Affecting Behavior

The assessment of cultural factors affecting behavior can be conducted by a psychiatrist or psychologist who is familiar with the language and cultural back- ground of the patient or who has access to interpret- ers and culture brokers.9,10 The cultural formulation in Appendix I of DSM-IV11 provides a framework for organizing cultural information relevant to psychiatric assessment and, although it was not designed for this setting, can be applied in forensic contexts.12,13 In support of this use of the cultural for- mulation, Boehnlein and colleagues presented the case of a refugee from Cambodia who was facing the death penalty and for whom many developmental insults and traumatic experiences evidently contrib- uted to criminal actions. The crucial factors in that case relevant to sentencing were linked to the impact of perinatal trauma (brain anoxia and subsequent damage resulting in poor school performance and impulsivity) and organized violence (which acts in many ways: directly, as a cause of physical and psy- chological trauma; developmentally, through im- paired parenting; and socially, through subsequent experiences of dislocation).

There is a long history of jurisprudence that rec- ognizes decreased culpability in people with evident cognitive impairments and that modifies sentencing on this basis.14 Recent decisions in the United States that prohibit the death penalty for individuals with intellectual disabilities reflect this basic principle of justice.15 As Boehnlein and colleagues8 pointed out in discussing their case, cultural issues arise mainly regarding the appropriate use of culturally fair and meaningful methods of neuropsychological testing or clinical assessment and the use of interpreters. These are important matters given that, for people from many backgrounds, culturally adapted and val- idated testing instruments do not exist, and most clinicians have little training or experience in work- ing with interpreters and culture brokers. However, these technical problems have obvious solutions, in- cluding changes to training programs and profes- sional accreditation.

Bringing awareness of cultural concerns to the at- tention of judges and jurors can play an important role in improving the functioning of the justice sys- tem. It is worth asking, however, whether some social and cultural circumstances are so familiar or taken for granted that they are not recognized or given weight as explanations for criminal actions. Would a young African American growing up in an urban ghetto exposed to repeated traumas and violence re- ceive a milder sentence if a cultural psychiatrist or psychologist provides an empirically based account of the ways in which his actions were influenced by his upbringing and current surroundings?