Stigma and beliefs of efficacy towards traditional Chinese medicine and Western psychiatric treatment among Chinese-Americans

In this study we examined community attitudes of efficacy and shame to investigate the factors that may underlie mental health service underutilization among Chinese Americans. We administered an experimental vignette to assess beliefs of efficacy and shame toward using traditional Chinese medicine (TCM) as opposed to Western health services in a sample of 90 Chinese Americans obtained through a national telephone survey. Contrary to predictions, beliefs of efficacy for treating mental disorders were found to be greater for Western psychiatric services when compared with TCM. As predicted however, Chinese Americans perceived greater community attitudes of shame when accessing Western psychiatric services as opposed to TCM to treat a mental disorder. Furthermore, these differences in community attitudes of shame only occurred among respondents who received a psychiatric condition vignette, but not with respondents who were administered a vignette of a physical disorder. These findings suggest that perceived shame may play an important role in help seeking and that integration of TCM with Western psychiatric care may have implications for reducing shame for Chinese Americans.     

Understanding Native American healing practices

Counselor cultural competency with respect to Native Americans requires understanding of common healing practices and ceremonies and of their spiritual significance. Historical trauma serves as a general backdrop for Native America experience and identity. Particular tribal practices and the individual's degree of affiliation with such practices provide a more specific context for client worldview. Knowledge of the symbolic significance of common ceremonies and healing practices will support counseling efforts to be relevant and effective with respect to Native American clients. Direct interaction and involvement with Native American communities facilitate a deeper understanding of Native American cultural identity and healing practices.     

Adapting Manualized Treatments: Treating Anxiety Disorders Among Native Americans

Although there is a small but growing body of literature examining the psychopathology of anxiety among Native Americans, no data are available regarding the efficacy of empirically supported treatments for anxiety disorders among Native Americans. Moreover, exceptional challenges arise in adapting mainstream approaches to Native Americans, such as language barriers, contrasting beliefs about the cause and treatment of emotional illness between mainstream and traditional Native American culture, problems with homework compliance, allowing extra time for rapport building, and the need for a spiritual component in the treatment of anxiety disorders. Native Americans also confront the challenges of rural living and low socioeconomic status. The focus of this article is largely conceptual in nature, informed by the limited psychopathology data and the first author’s experience with cognitive behavioral treatment protocols for anxiety disorders and the provision of mental health services to Native Americans. In this article we highlight the unique challenges of adapting manualized anxiety treatments for Native American clients.     

Toward a Culturally Responsive Model of Mental Health Literacy: Facilitating Help‐Seeking Among East Asian Immigrants to North America

Studies have consistently found that East Asian immigrants in North America are less likely to use mental health services even when they experience levels of distress comparable to Euro‐Americans. Although cultural factors that may prevent East Asian immigrants from seeking mental health care have been identified, few studies have explored ways to foster appropriate help‐seeking and use of mental health services. Recent work on mental health literacy provides a potential framework for strategies to increase appropriate help‐seeking and use of services. This paper reviews the literature on help‐seeking for mental health problems among East Asian immigrants living in Western countries to critically assess the relevance of the mental health literacy approach as a framework for interventions to improve appropriate use of services. Modifications needed to develop a culturally responsive framework for mental health literacy are identified.     

Cultural Issues in Psychopharmacology: Integrating Medication Treatment with Lakota Sioux Traditions

Psychologists may soon be entering into the practice of pharmacologic treatment of mental illness. Although there has been some investigation of biologic differences in drug response among various ethnic and racial groups, very little attention has been paid to the nonbiologic differences. Cultural definitions of health, healing, and illness and specific cultural practices are likely to have a significant impact on various aspects of treatment, compliance, and interaction effects. This article addresses the issue of culture and the impact of cultural practices on the use of psychotropic medications with the Lakota (Sioux) people of the Northern Plains. Specific examples of traditional Lakota ceremonies and their potential interactions with psychotropic medications are presented with recommendations to prescribers for handling these situations in a culturally responsive manner. Emphasis is placed on creating collaborative relationships between prescribers and traditional spiritual healers in the care of Native American clients. Recommendations for future research are discussed.     

Mental health services for African Americans: a cultural/racial perspective

African Americans have made consistent progress toward first-class citizenship since 1965. Nonetheless, mental health services for this population have been biased, incomplete, and deficient because similarities to European Americans have been emphasized whereas differences were largely ignored. This article addresses some differences, including cultural/racial identity and the cultural self, that affect assessment, psychiatric diagnoses, and psychotherapy or other interventions. An assessment-intervention model illustrates how cultural information can inform service delivery and improve services to African Americans. Cultural/racial perspectives on mental health in a multicultural society suggest innovations in the design of these services and access to them that can increase utilization by African Americans.     

Counseling Native Americans

This article addresses the issues facing White counselors in providing services to Native Americans, whose values differ significantly from the dominant culture's. Native Americans have been consistently threatened with cultural assimilation. Previously published recommendations to counselors are reviewed and the relevance and possible uses of traditional Native American healing practices are discussed. One such practice, the vision quest, is described in detail. Counselors need to learn culturally relevant metaphors in order to promote healing and change and, in effect, must themselves undergo an acculturation process.     

Ethnic variation in depressive symptoms in a community sample in Hawaii

A modified CES-D was administered to a community sample of 176 European Americans (EA), 209 Native Hawaiians (NH), and 357 Japanese Americans (JA), yielding measures of depression, positive affect, depressed affect, somatic disturbance, and disturbed interpersonal relations. Positive affect was lower in JA relative to EA, consistent with findings among Native Japanese, a pattern attributed to cultural variation in emotion regulation. NH reported lower positive affect than EA, accompanied by elevated negative affect and somatic disturbance, suggesting generally higher levels of depressive symptoms. The three ethnic groups varied in mental health care usage with differing associations between depressive symptoms and experiences of stressful life events. Taken together, these results suggest ethnic variation in depressive symptoms may arise from differing cultural beliefs.     

Barriers between mental health services and Mexican Americans: An examination of a paradox

The paradox of underutilization of mental health services by Mexican Americans is critically examined. It is argued that Mexican Americans live under high levels of psychological and environmental stress that would ordinarily lead to mental health problems and an increased utilization of mental health services. A number of barriers to the use of mental health services by Mexican Americans are examined. Included among these barriers are such factors as the relationship between social class and treatment offered, stereotypes concerning Mexican American folk psychiatry, limitations imposed by language differences, and the effects of stereotypes between Anglo Americans and Mexican Americans. Paradoxical findings in some studies which show a positive perception of mental health services by Mexican Americans are seen to further underscore the need for more research on the Mexican American's position. Stereotypes and generalizations about Spanish-speaking and bilingual Mexican American's approaches to psychotherapy are challenged in the light of recent empirical findings. Recommendations for future research directions and for improving the delivery of mental health services are presented.     

The Client Cultural Competence Inventory: An Instrument for Assessing Cultural Competence in Behavioral Managed Care Organizations

The rapid growth in Behavioral Managed Care Organizations has led to increasing concern about the future availability of culturally competent mental health services for ethnic minorities. Prior efforts to assess cultural competence of mental health services have focused exclusively on agency providers and individual mental health professionals rather than on clients' perceptions of care. We introduce the Client Cultural Competence Inventory, which has several advantages over other cultural competence measures including its (a) lower susceptibility to social desirability bias, (b) ability to assess attitudes concerning a broader range of therapists, providers and plans, and (c) focus on clients rather than the psychiatric community as the central force in determining cultural competence. Preliminary psychometric analyses of the inventory are presented from data gathered in a group of parents with children who are severely emotionally disturbed.     

Chicago Urban Resiliency Building (CURB): An Internet-Based Depression-Prevention Intervention for Urban African-American and Latino Adolescents

Early preventive interventions for depressive disorders in racial/ethnic minorities may help to reduce lifetime depression outcome disparities by improving developmental trajectories and social outcomes. We describe the development process, intervention and evaluation plan for a culturally adapted, low-cost, primary care/Internet-based depression-prevention intervention (CURB, Chicago Urban Resiliency Building). CURB is culturally adapted for socio-economically disadvantaged African-American and Latino adolescents according to the PEN-3 model of health promotion programs (Airhihenbuwa in Health and culture: beyond the Western paradigm, Sage Publishers, Thousand Oaks, 1995). Based on the idea that health behavior is rooted in culture, the PEN-3 model contains three interdependent dimensions that influence health beliefs and behaviors. Within each dimension are factors (using the acronym PEN) that must be considered about the target culture. Application of the PEN-3 model occurred in 3 phases. In each phase, a dimension of the model was explored and subsequent changes were made to the intervention so as to be more culturally suitable. In the CURB clinical trial, adolescents ages 13–17 will be recruited from wait-lists for mental health services at community health care provider organizations and screened for risk of future depressive disorder in the primary care sites. Adolescents screening positive for persistent depressed mood will be randomly assigned to either the CURB intervention group or the wait-list control group. The study aims are to determine if participants in the CURB intervention group will have lower levels of depressive symptoms and/or a lower cumulative incidence of depressive episodes.     

Assessment of awareness of connectedness as a culturally-based protective factor for Alaska native youth

Research with Native Americans has identified connectedness as a culturally based protective factor against substance abuse and suicide. Connectedness refers to the interrelated welfare of the individual, one's family, one's community, and the natural environment. We developed an 18-item quantitative assessment of awareness of connectedness and tested it with 284 Alaska Native youth. Evaluation with confirmatory factor analysis and item response theory identified a 12-item subset that functions satisfactorily in a second-order four-factor model. The proposed Awareness of Connectedness Scale (ACS) displays good convergent and discriminant validity, and correlates positively with hypothesized protective factors such as reasons for living and communal mastery. The measure has utility in the study of culture-specific protective factors and as an outcomes measure for behavioral health programs with Native American youth.     

Mindsets of health and healthy eating intentions

Across two studies, we examined the relation between mindsets of health, expectancy‐value, and eating intentions. We also explored if relations are stronger for African Americans compared to White Americans. In Study 1, we conducted a correlational study (N = 158) to examine initial relations among constructs. In Study 2, we employed an experimental design (N = 205), and randomly assigned participants to either a growth mindset or a fixed mindset of health condition. In both studies, we measured participants’ mindsets of health, expectancy‐value beliefs, healthy eating intentions, past eating habits, and demographics. In Study 1, stronger growth mindsets of health predicted healthier eating intentions. Expectancy‐value beliefs, namely, the extent to which individuals value healthy eating habits and expect to be able to manage their eating, mediated this relation. In Study 2, we successfully manipulated mindsets of health and individuals in the growth mindset condition reported healthier eating intentions, compared to those in the fixed mindset condition. Expectancy‐value beliefs again mediated this link. Race only moderated the relation in Study 1, such that effects of growth mindsets on outcomes (i.e., eating intentions and expectancy‐value beliefs) are stronger for African Americans compared to White Americans. Study 1 provided initial evidence of a relationship between stronger growth mindsets of health and healthier beliefs and intentions. Study 2 offered experimental evidence. We discuss theoretical and practical implications.     

Health Care Behaviours and Beliefs in Hasidic Jewish Populations: A Systematic Review of the Literature

Cultural issues impact on health care, including individuals’ health care behaviours and beliefs. Hasidic Jews, with their strict religious observance, emphasis on kabbalah, cultural insularity and spiritual leader, their Rebbe, comprise a distinct cultural group. The reviewed studies reveal that Hasidic Jews may seek spiritual healing and incorporate religion in their explanatory models of illness; illness attracts stigma; psychiatric patients’ symptomatology may have religious content; social and cultural factors may challenge health care delivery. The extant research has implications for clinical practice. However, many studies exhibited methodological shortcomings with authors providing incomplete analyses of the extent to which findings are authentically Hasidic. High-quality research is required to better inform the provision of culturally competent care to Hasidic patients.     

The Role of Religion on the Health Practices of Mexican Americans

Twenty million Mexican Americans live in the U.S. (U.S. Census 2000 Summary File, 2000). It is vital that health care clinicians become familiar with and acknowledge the role of religion or religiosity on the health practices of Mexican Americans so that these needs may be addressed through holistic care. This paper reviews the origin and role that religion plays in the health practices of Mexican Americans. The potential benefits of addressing these client’s religious needs are examined and suggestions are offered on how health care clinicians may address these needs in a culturally sensitive manner.Josefina Lujan, MSN, RN is a first generation Mexican American who has been practicing nursing for 25 years in the Texas-Mexico border community of El Paso, Texas.Howard Campbell is an associate professor of anthropology at the University of Texas at El Paso. e-mails: jlujan1@utep.edu; hcampbel@utep.edu     

A Posture of Reciprocity: A Practical Approach to Collaboration Between Professionals and Parents of Culturally Diverse Backgrounds

The current emphasis on developing culturally responsive services for families of children with disabilities from culturally diverse backgrounds informs the need for professional self-awareness whereby professionals learn to recognize not only the cultural specificity of personal values and beliefs but also of their professional practice. We describe an approach, the posture of reciprocity, that enables professionals to acquire this level of cultural awareness. Examples to illustrate applications of the posture are provided.     

Native American Spirituality

ABSTRACT

Followers of the New Age movement and others have been exploiting and commercializing “Native American” spirituality. This exploitation is being fought by many Native people. Native American spirituality may be studied and appreciated, but use of Native American religious forms outside of Native American communities is considered misappropriation and cultural theft. Native spiritualities address the needs of present-day Native communities. A Native spirituality that ignores that need is no longer a religion of and for the community. Disconnected from a Native community, religious beliefs, ceremonies, and religious art forms lose their primary significance.     

Ethical principles and cultural integrity in health care delivery: Asian ethnocultural perspectives in genetic services

The tradition of Western thought is not always ubiquitous when working within the context of different ethnocultural populations, particularly that of Asian culture, and often poses ethical quandaries for health care professionals engaged in genetic services. For example, understanding the Asian ethnocultural perspective of patient autonomy, informed consent, and nondirective counseling from the Western perspective may be inappropriate and compromise cultural integrity and the delivery of effective genetic services because: (1) A distinction exists between the role of Asian (collective) autonomy vs. Western (individual) autonomy in the decision-making process. (2) The medical model is complementary to Asian expectations and respect of authority and may result in an uninformed consent to genetic professional's recommendations. (3) Misinterpretations of the normative decision-making process, misconceptions of normalcy, and the limits of tolerance of nondirective counseling may result in less effective treatment and compliance. Therefore, we suggest that acknowledging the impact of ethnicity and culture on ethical principles as applied in genetic services is essential in the assessment and delivery of ethically and culturally appropriate health care.     

Facing Down the Representation of An Impossibility: Indigenous Responses to a ‘Universal’ Problem in the Repatriation Context

This paper explores the ways Native Americans and Native Hawiians have responded to what Ernesto Laclau has called ‘the representation of an impossibility’—the discursive crisis faced by non-dominant groups who seek to advance rights claims in ways that are culturally rooted but universally audible to ideologically dominant audiences. Taking the NAGPRA law of 1990 as its case study, this paper asserts the need for a re-theorisation of indigenous religious discourse in order to illuminate the ways native peoples build rather than concede agency through self-representations in the current political moment. Pursuing this argument, the paper charts an analytical course specifying the relationship of rights claims to discourse, hegemony, articulation, tradition, and religion. The paper then focuses upon specific examples of religious claims in the context of the Native American Graves Protection and Repatriation Act to demonstrate the ways Native Americans have faced down an ‘impossibility’.