The research findings reported in this handbook indicate that there is a growing body of knowledge of cultural influences on mental health. Methodological problems have been plentiful and most challenging. Methodological advances are an integral part of the growing body of research on culture. Just as each ore has its own means of extraction, each cultural group requires its own emic-specific tools, measures, and indices if investigators are to fully understand that culture. Methodology is seen as the key to meaningful qualitative and quantitative understanding and interpretation of data with respect to culture.
Research helps build on scientific principles. Research also helps define practice by providing objective data on which to base interventions. The inclusion of cultural data provides meaningful, substantive knowledge upon which to formulate interventions and a treatment plan. Gross errors in diagnosing and grossly inappropriate services and interventions have resulted from cultural and linguistic misunderstandings. Service delivery systems, like the providers of such services, must at times adjust to provide more effectual and efficient services. Ineffectual services and interventions require significant restructuring and improvement to minimze cross-cultural errors. These errors can be minimized when a cultural formulation is incorporated concurrently with the diagnostic and clinical interview. It is imperative that clinicians be trained to recognize culture-specific influences related to assessment and treatment of mental disorders.
Communities are not homogeneous entities. All residents of all communities are cultural beings; that is, they belong to some culture that assists them in conducting economic and other endeavors as they live their lives. The culture that envelops the community provides meaning, education, structure, organization, and purpose. There may be several competing cultures within a community. A given community may be made of numerous cultures and numerous diverse ethnic/cultural population groups.
Many special problems and cultural conflicts emerge from multicultural environments. People use multiple ways to adapt to their environments. When people from different cultures interact, there are a host of possible outcomes with definite implications for adjustment. The modes of acculturation significantly influence psychological adjustment and risk for emotional and mental-health-related problems.
Emotional and psychological problems are closely linked to conflict, as are anxieties and neuroses (historically). Within any culture there are individual quests, such as the quest for affection, security, spirituality, prominence or fame, power, or wealth. Cultures provide vehicles for some and barriers for others in achieving and sustaining growth as each of us traverses the various stages of the life span.
MASTERY OF KNOWLEDGE IN CONTENT AREAS: KNOWING ABOUT VARIOUS CULTURES
An essential consideration in developing cultural competence with individuals from ethnocultural groups different from one's own is knowledge about that group. This is as basic as assessment of the individual to be treated. Knowledge of the cultural identity of the person being treated is essential to the understanding of the "self," the ideologies, including illness and health ideologies, values, needs, motives, and drives of the person being treated. The psychosocial stressors and meanings applied to them are important elements in understanding the psychological life of the person. The more one learns about the history, culture, and current life of a specific ethnocultural group, the better prepared one is to understand and help individuals from that group. Sometimes this is known as cultural awareness. Some critics have stated that cultural awareness is not enough, that more specific knowledge is needed to develop cultural competence. The editors concur. Cultural awareness is essential but not sufficient, and for this reason this handbook has gone far beyond awareness to include multiple domains of cultural competence both explicitly and implicitly. There is never too much to know or a point at which one knows all that is needed to know about any group. It is a continual process of learning, and many of the chapters are richly loaded with sociocultural, historical, and meaningful content knowledge about each of the four major U.S. racial and ethnic groups. Many of the chapters are particularly meaningful because they were contributed by an ethnic minority behavioral scientist writing about his or her own ethnocultural group.
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