749Cultural
 Formulation
Understanding the cultural  context of illness experience is essential for effec-
tive diagnostic assessment and clinical management. Culture  refers to systems of knowl-
edge, concepts, rules, and practices that ar e learned and transmitted across generations.
Culture includes language, religion and spirit uality, family structur es, life-cycle stages,
ceremonial rituals, and customs, as well as moral and legal systems. Cultures are open,
dynamic systems that undergo continuous ch ange over time; in the contemporary world,
most individuals and groups are exposed to mu ltiple cultures, which they use to fashion
their own identities and make sense of experi ence. These features of culture make it cru-
cial not to overgeneralize cultur al information or stereotype groups in terms of fixed cul-
tural traits.
Race  is a culturally constructed category of identity that divides humanity into groups
based on a variety of superficia l physical traits attributed to  some hypothetical intrinsic,
biological characteristics. Racial categories an d constructs have varied widely over history
and across societies. The construct of race has no consistent biological definition, but it is
socially important because it supports racial ideologies, racism, discrimination, and social
exclusion, which can have strong negative effe cts on mental health. There is evidence that
racism can exacerbate many psychiatric disord ers, contributing to poor outcome, and that
racial biases can affect diagnostic assessment.
Ethnicity is a culturally constructed group identity used to define peoples and communi-
ties. It may be rooted in a common history, geography, language, religion, or other shared
characteristics of a group, which distinguish th at group from others. Ethnicity may be self-
assigned or attributed by out siders. Increasing mobility, inte rmarriage, and intermixing of