A cultural psychiatrist could certainly argue the case that persons exposed to such systematic inequal- ities, who suffer cognitive impairment as a result, should receive some mitigation of their sentence. In these circumstances, however, the consultant might encounter considerable resistance from those who take for granted the culturally constructed inequali- ties of U.S. society (which emerged from the history of racism and slavery) or, indeed, blame these endur- ing inequalities on the victims of the legacy of histor- ical injustices.16 This discrepancy between the re- sponse to the compelling story of someone from far away exposed to genocidal violence and the familiar story of yet another victim of the unjust social system close to home, points to the danger of focusing on “culture” as a construct that elides the social, politi- cal, and economic factors that create structural violence.
Cultural psychiatry must attend to the culture of the familiar and especially to the interactions be- tween the values of the dominant society and those of local communities and individuals who are system- atically disadvantaged by the dominant ideologies and institutions. The focus of the cultural formula- tion on the culture of the “other” should be supple- mented with frameworks for assessment that cover matters related to the social predicament of specific groups, their histories of migration, and in particular their position vis-à-vis the dominant cultural ideolo- gies and practices of U.S. society. In the case of the United States, this must include the widespread im- pact of racism and its legacy on the well-being of individuals and on the functioning of the criminal justice system itself.
Although most discussion of cultural factors in forensic psychiatry focuses on the dilemmas of eth- noracial groups, the criminal justice system itself is a cultural institution based on specific concepts, per- spectives, and values that may not be in complete accord with other cultural traditions. This disparity is transparently the case with regard to the use of capital punishment—a practice in which the U.S. is unique among the countries of the West. Specific U.S. cultural values and attitudes must be invoked to account for the persistence and acceptance of the death penalty, where so many other countries have come to find it morally beyond the pale.