British Journal of Psychiatry, 182(4), April 2003, pp.289-290.
Publisher:
Cambridge University Press
This article argues that it is possible to derive two quite different meanings for social exclusion, with different evidential bases, and with different implications for social and clinical action. The first concept of social exclusion, Demos, has implications for citizens' rights; the other, Ethnos, has more-significant implications for the practising clinician. Demos refers to the range of access rights which are offered by citizenship of a given nation state. By contrast, Ethnos refers to a shared cultural community rather than a national community, and to the shared values, identification and sense of cohesion that are engendered by membership of particular social groups and communities. Interventions designed to have an impact upon social inclusion through Demos channels would include enhancing structures that promise and deliver greater access to services. Actions by psychiatrists to achieve service improvement through Ethnos-related measures would, for example, relate to greater emphasis within the psychiatric training curriculum on understanding the interrelationships between ethnic minority culture and the experience of mental illness. There is in turn an interplay between these two domains: Ethnos-related measures are unlikely to be effective without concurrent Demos-related changes.
This article argues that it is possible to derive two quite different meanings for social exclusion, with different evidential bases, and with different implications for social and clinical action. The first concept of social exclusion, Demos, has implications for citizens' rights; the other, Ethnos, has more-significant implications for the practising clinician. Demos refers to the range of access rights which are offered by citizenship of a given nation state. By contrast, Ethnos refers to a shared cultural community rather than a national community, and to the shared values, identification and sense of cohesion that are engendered by membership of particular social groups and communities. Interventions designed to have an impact upon social inclusion through Demos channels would include enhancing structures that promise and deliver greater access to services. Actions by psychiatrists to achieve service improvement through Ethnos-related measures would, for example, relate to greater emphasis within the psychiatric training curriculum on understanding the interrelationships between ethnic minority culture and the experience of mental illness. There is in turn an interplay between these two domains: Ethnos-related measures are unlikely to be effective without concurrent Demos-related changes.
Subject terms:
mental health problems, models, multicultural approach, multicultural society, psychiatry, social exclusion, social care provision, welfare state, black and minority ethnic people, communities, citizenship, cultural identity, ethnicity;