Cultural Models of Health and Illness

Department of Sociology University of Texas at Austin Austin, Texas A physician diagnoses disease on the basis of signs and symptoms, and society evaluates and responds to sickness with understanding or condemnation depending on the moral loadings of the behaviors involved. For the individual experiencing symptoms, though, illness remains intensely personal and subjective. No one besides the ill person can feel his or her pain. Ironically, that intensely personal experience reveals the meeting...

Borderline Histrionic and Narcissistic Personality Disorders

In the case of Borderline Personality Disorder, the DSM-IV suggests that this disorder might not represent a culture-specific disorder because behaviors associated with it have been seen in many cultures around the world (DSM-IV, 1994, p. 652). In the case of the second disorder (Histrionic), norms for personal appearance, emotional expressiveness, and interpersonal behavior vary widely across cultures. Symptoms associated with this disorder (e.g., emotionality, seductiveness,...

Limitations of Etic and Emic Approaches

As most mental health professionals experienced in working with ethnic minorities would know, methods based on the extreme position that the Western mainstream model of psychotherapy is universal are simply too general to be practical. In addition, when translated into practice, the etic approach runs the risk of underestimating the overarching effect cultural frameworks have on every aspect of mental health services (Hong & Ham, 1994). These include conceptualization of mental health and...

References

Beyond cultural identity Reflections on cultural and multicultural man. In R. Brislin (Ed.), Topics in cultural learning Vol. 2. Honolulu, HI University of Hawaii, East-West Ainslie, R. C. (1995). No dancin' in Anson An American story of race and social change. Northvale, NJ Jason Aronson, Inc. Akutsu, P. D., Snowden, L. R., & Organista, K. C. (1996). Referral patterns in ethnic-specific and mainstream programs for ethnic minorities and Whites. Journal of Counseling...

Multicultural Metatheory

Multicultural psychotherapy models now include modifications of traditional theories, universal or culture-specific approaches, and multidimensional forms of psychotherapy. D. W. Sue, Ivey, and Pedersen (1996) have articulated the need for a metatheory or theory of theories to provide an organizational framework to study the salience or relevance of each multicultural psychotherapy model. A metatheory offsets the potential for a crisis of relativism (Cooper & Lewis as cited by Fukuyama,...

Modes Of Acculturation

According to Acculturation Theory (Redfield et al., 1936), people change in at least three basic ways acceptance, adaptation, and reaction 1. Acceptance is where the process of acculturation results in the replacement of the older cultural elements with new cultural customs. The end result of Acceptance is not just the assimilation of new behavior patterns but the inner values of the new culture. 2. Adaptation is when both original and foreign traits are combined so as to produce a harmonious...

Three Domains of Multicultural Competence

The second useful paradigm for cultural competence is presented by a number of authors in the field of multicultural counseling and psychotherapy (Arredondo et al., 1996 Pedersen, 1988 Sue, Arredondo, & McDavis, 1992 Sue et al., 1982), often referred to as Pedersen's Model of Training. This approach identifies three domains in cultural competence awareness, knowledge, and skills. These three domains or dimensions can be conceptualized as developmental levels with trainees progressing from...

Cultural Expressions

Asian American mental health research has made strides in dispelling myths that Asian Americans as a population have little or no mental health problems (Uba, 1994). The findings that Asian Americans tend to underutilize outpatient (S. Sue, Fujino, Hu, Takeuchi, & Zane, 1991) and inpatient psychiatric services (Snowden & Cheung, 1990) are no longer interpreted as the Asian Americans' lack of need for such services but as a reflection of various cultural and institutional barriers to Asian...

Xischizophrenia And Other Psychotic Disorders

Delusional ideas (e.g., witchcraft) and auditory hallucinations (e.g., seeing the Virgin Mary or hearing God's voice) may be abnormal in one culture and normal in other cultures (Castillo, 1997). For example, in the Nigerian culture, paranoid fears of evil attacks by spirits are part of the local beliefs involving fears of malevolent attacks by evil spirits (Kirmayer et al., 1995). These fears are examples of the culture-bound syndrome named Ode-ori in Table I. As noted by Kirmayer et al....

Anxiety Disorders A Panic Disorder

Symptoms resembling panic attacks are common in cultures where members have strong beliefs in witchcraft or evil spirit attacks (Castillo, 1997 Kirmayer, Young, & Hayton, 1995). For example, trembling or shaking, chest pain, fear of dying, palpitations, and other symptoms for Panic Disorder are generally reported by Hispanics with intensive fears of malign magic, malevolent attacks by witchcraft, or evil spirit attacks. These symptoms resemble the culture-bound syndrome named ataques de...

Culture Bound Syndromes Cultural Variations and Psychopathology

Department of Psychiatry and Behavioral Sciences University of Texas Medical Branch Galveston, Texas Inaccuracies in the assessment and diagnosis of psychopathological conditions with culturally diverse groups (i.e., overdiagnosis, underdiagnosis, and misdiagnosis) might result from a lack of understanding of the presence of cultural variants leading to symptoms resembling psychopathology. These variables have generally been described in the case of culture-specific disorders known as...

Objectives And Development Of A Culturally Sensitive Clinical Neuropsychology

The application of clinical neuropsychology to people of diverse cultural heritage is a relatively newfound scientific and professional enterprise. This development was due, among other factors, to both the growth of professional neuropsychology along with increasing societal concerns, both here and abroad, of the importance of understanding individuals in a broader cultural context (Puente & McCaffrey, 1992). The application of psychometric instruments standardized on White individuals from...

Presenting Problem

Language issues aside there are other basic steps that are important in initiating all clinical interviews but are of greater importance in the early cross-cultural interview. One of these is deterimining why is the patient here There are usually several components to this question with all patients What is the reason this person gives for seeking help now, and more importantly, what is the real reason help is being sought As reasonably good clinicians we know that there are often unspoken or...

Neuropsychological Assessment of Ethnic Minorities Clinical Issues

University of North Carolina at Wilmington Department of Psychology Universidad de Granada Granada, Spain The psychology of individual differences underscores the importance of understanding the unique qualities of the person. Of particular importance is the issue of understanding the role of culture in the assessment of psychological abilities and disabilities. Indeed, the third article ever published in English on psychological assessment (Willey & Herskovits, 1927) was entitled Psychology...

Partner Relational Problem

Cultural variables such as differences in the level of acculturation and the role of machismo and marianismo among Hispanic clients could lead to partner relational problems (Paniagua, 1998). For example, a Hispanic female may experience negative communication with her husband regarding their expectations regarding the role the wife should play at home if she does not share the values of machismo and marianismo. Similarly, an acculturated individual (e.g., someone who shares most values,...

Assessing and Treating American Indians and Alaska Natives

Apache Behavioral Health Services Whiteriver, Arizona and Alaska Native Mental Health Research University of Colorado Health Sciences Center This chapter begins with a discussion of general factors that might impact the assessment and treatment of American Indians and Alaska Natives.1 The history of American Indians and Alaska Natives is briefly summarized and followed by a description of the unique demographic, socioeconomic, and health characteristics of the population. Some common cultural...

African Americans

African Americans have largely been identified as the descendants of slaves brought to the Americas during the centuries prior to the Civil War, with their ultimate emancipation, but ongoing degrees of discrimination through the present era. Other groups with origins in Black Africa have continued to arrive, but in smaller numbers and with frequent identification by nation of origin to identify their differing histories and economic circumstances. Most studies in the United States have focused...

Credibility and the Therapeutic Dyad

In a reformulation of techniques for working with ethnic minority clients, S. Sue and Zane 1987 identified credibility as a process that is central in the beginning stages of treatment for minority clients. In their analysis of credibility, S. Sue and Zane distinguished between credibility that is ascribed and credibility that is achieved. Ascribed credibility derives from the position or role that is assigned by others in society. In Asian cultures, characteristics that often go with higher...

The Etic versus Emic Debate

Until recently, most training institutions prepared mental health professionals to apply universal methods of assessment, therapy and counseling to clients from diverse cultural backgrounds. Theories of personality development have been thought to be universal in nature, and therefore therapeutic approaches stemming from such theories should have wide applications. Generally, this is known as the etic approach to multicultural psychotherapy and counseling Fukuyama, 1990 . The etic approach does...

Racism And Prejudice Are Unique Characteristics Of White Therapists

Some multicultural authors e.g., Corvin amp Wiggins, 1989 Sue, 1993 demand openly that White therapists acknowledge and resolve their ethnic prejudices in order to better serve non-White clients, yet minority therapists are left unchallenged to confront their prejudices prejudices that equally can jeopardize the quality of services they provide to White clients and to dissimilar minority clients. Ethnic prejudice exists throughout the world as evidenced by the number of ethnic and tribal...

Multicultural Techniques and Interventions

As this review of multicultural psychotherapy has shown, most approaches rely upon an assortment of techniques and interventions drawn from different theoretical orientations when working with culturally different clients. This eclectic practice has made it more difficult to validate empirically any given multicultural psychotherapy model. Furthermore, research on the value and effectiveness of universal and culture-specific therapeutic strategies is limited and mixed at best. Atkinson and...

Minnesota Multiphasic Personality Inventories

The MMPI was developed to measure psychopathology constructs as defined in the United States using the psychometric technology available during the 1930s Helmes amp Redden, 1993 . The nature and specific definitions of these constructs have changed several times over a 60-year period Castillo, 1996 . As a consequence, MMPI interpretation soon relied on established empirical correlates that made the original diagnostic system and Caucasian normative sample far less relevant to the clinical...

What Defines A Culturally Competent Approach With The Mmpi2

In recent years, psychologists like Dana 1995 have strongly advocated for the culturally competent use of the MMPI-2 with ethnic minority individuals. Dana has argued that the MMPI-2 is so widely used by psychologists to assess individuals from different cultural and linguistic backgrounds that some standards, guidelines, or recommendations are needed in order to ensure that the MMPI-2 is not misapplied to these groups. Although we agree with Dana in principle, we disagree with his approach,...

Empirical Findings Of Acculturation And Mental Health

The relations of acculturation and mental health have been studied empirically using reliable and valid indices of acculturation and mental health. These studies have increased in number, complexity, and sophistication as a result of the development of improved acculturation measures Cu llar, 1999 . Two major reviews of acculturation and mental health are Berry and Kim 1988 and Rogler, Cortes, and Malgady 1991 . Both reviews found the relationship between acculturation and mental health to be...

The Role Of Culture In Health And Illness

Interest in the role of culture in defining health and illness and help-seeking behavior continues to grow because of the framing function that culture serves .in forming the backdrop against which all aspects of our lives are interpreted and from which our actions take meaning. Numerous general overviews and critiques of contemporary medical anthropology provide useful insights into the state of both theory and practice in the study of culture and physical and mental health e.g., Good, 1993...

Impact of Cultural Values

Cultural values effect the assessment and treatment process in terms of clinical judgments about normalcy. Erroneous judgments can lead to misunderstanding, overpathologization, or implementation of a treatment plan that is not culturally consistent. In addition, clinicians who lack understanding of these differences might unknowingly act in a manner that jeopardizes rapport and trust. Misunderstandings within the therapeutic relationship not only occur because of the language-related issues...

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Examined the effects of demographic variables, including ethnicity and presence of mental illness on the variance of MMPI-2 scale scores. The demographic variables contribute little incremental variance for the validity and clinical scales. No comparisons were made by ethnicity and race, and no exact numbers are given by ethnicity. No differences were found between the three groups. Please note the small sample size of Latinos. African Americans were elevated on the Pd and Ma scales when...

Chapter

Culture and Mental Health An Introduction and Overview of Foundations, Concepts, and Issues Anthony J. Marsella Ann Marie Yamada Department of Psychology University of Hawai'i Honolulu, Hawai'i I. INTRODUCTION A. Overview of Foundations 1. Emil Kraepelin Comparative Psychiatry In the early years of the twentieth century, Emil Kraepelin 1904 , the father of modern Western psychiatry, journeyed from his home in Germany to Asia and North America as part of a worldwide lecture tour. During the...

Xiisexual Dysfunctions And Paraphilias

In the case of Sexual Dysfunctions, the ethnic and religious background of the individual, as well as whether the client's culture emphasizes male dominance and control on female sexuality versus those that reward the opposite view should be considered during the assessment of Sexual Dysfunctions. These cultural variations may affect sexual desire, expectations, and attitudes about performance. In some societies, a female sexual desire is not considered very relevant particularly when fertility...

Parent Child Relational Problem

Parent-child relational problems may include impaired communication, over-protection, and inadequate discipline DSM-IV, 1994, p. 681 . Acculturation problems may lead to parent-child relational problems in the form of impaired communication. For example, later generation Asian and Hispanic adolescents may disagree with their early generation parents in certain issues involving customs and lifestyles e.g., dressing, dating because parents are less acculturated than their children into the...

Linguistic Equivalence

In linguistic equivalence, the intent is to ensure that performance requests are identical across cultures, or where regional linguistic variations are observed Drasgow amp Hulin, 1987 Hulin, 1987 . Or, as Helms 1992 has suggested, is the language used in test items equalized such that it holds the same meaning in the cultural groups being examined In terms of methods to increase the likelihood of linguistic equivalence, several have been identified in the literature. Possibilities for test...

Generalized Anxiety Disorder

Considerable cultural variations exist in the expression of anxiety. In some cultures, anxiety is expressed predominantly through somatic symptoms, in others through cognitive symptoms. The cultural context should be considered during the evaluation of worries about certain situations as excessive 1994, pp. 433-434 . This DSM-IV disorder may resemble the culture-bound syndrome termed Ode-ori Table I , which has been reported in Nigeria and includes excessive anxiety resulting from the sensation...