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Related Topics
Culture and Mental HealthReview - Culture and Mental Health
Sociocultural Influences, Theory, and Practice
by Sussie Eshun and Regan A. R. Gurung
Wiley-Blackwell, 2009
Review by Mark Welch, Ph.D.
Sep 15th 2009 (Volume 13, Issue 38)

This new text represents an attempt to answer two very simple, questions with complex answers: what is culture and how does it affect the experience, perception and practice of mental health?

These are issues of great significance, not only for clinicians, but also for all those involved in mental health care in an increasingly cosmopolitan, multicultural, intercultural and postmodern world.

The editors have gathered together a number of North American and international authors to develop a new text book. Although there is a preponderance of psychologists amongst them, there may still be enough of interest and breadth of scope for other disciplines. There are fourteen chapters divided into two sections. The first deals with general issues in culture and mental health such as assessment or the influence of religion or the meaning of psychotherapy. The second looks at specific disorders or clinical presentations, for example mood disorders, anxiety disorders, traumatic stress, psychotic disorders, eating disorders and suicide. The two halves read very differently, and as the chapters progress there is a sense of unevenness throughout, which if anything detracts a little from the overall appreciation of the work. Sometimes it seems that the authors and editors were in some doubt about the actual purpose and focus of the chapter.

It is not a text that is psychiatric in tone, or one steeped in the clinical criteria of the DSM IV-R. Rather the most interesting sections are those which attempt to describe the experience of expression of illness or distress, and to locate this in cultural values, norms and behaviours. As a result much of the focus is directed towards a counseling rather than diagnosis, and cultural differentials rather than etiology. It does not, for example, devote attention to cultural-specific phenomena or disorders. It may point out disparities in prevalence and incidence, but is more descriptive than explanatory.

The strengths of the text are in the way it emphasizes the dangers of assuming that the dominant Western way of approaching or expressing disorders is the only way. It issues a clear and consistent warning to its readers that great caution should be exercised when working with people from different cultures. The way in which an emotion or a disorder may be expressed, and to whom, may vary greatly, and in the culturally diverse world in which we live and practice, such considerations may become the norm rather than the exception.

There is some important space given to the cultural mix specific to North America; in particular the African-American and Latino populations. The notion of gay and lesbian cultural identities is also raised, and could perhaps have been developed a little further. Notions of White cultural identity are briefly discussed, but there could have been further exploration of class or urban/rural differences. However, it may well have been helpful to look at the changing demographics of the mental health population and how or if this is matched by service provision.

The tone that is set gives primacy to the individual’s self-identity, and in that way the text gives a polymorphous sense to the notion of culture. It is as though my cultural identity is what I say it is and not something that can be characterized in an objective manner. This ever-atomizing approach clearly rejects the reductionist analysis that suggests all people who are X (substitute your own term here, be it White, Black, African, Asian, Rich, Poor) are the same, but it also poses problems of its own: how then can anything or anyone be compared to anything else? How can anything useful be learnt or taught apart from the individual experience? How can anyone actually understand anyone else?

Some chapters attempt to answer, or at least wrestle with this issue – and some more successfully than others. Some definitions of what culture is, including that from UNESCO, are presented, but the critique remains at an undergraduate level. Some sections may not add a great deal o those more familiar with the basic literature on the topic. The question of cultural competence among clinicians is brought forward, but again not really pushed to a level of debate which challenges the assumptions.

It would have been interesting to explore the experiences of second and third generation immigration in more depth, and as it is aimed clearly at workers within North America, even the changing patterns of immigration and settlement could be considered.

The text presents its material in broad introductory tones. It is compact and reasonably short, and although there are some avoidable editing and typographical errors and some unevenness in the chapters, most likely as a result of a lack of clarity of purpose – just what is this section supposed to be doing and how does it contribute to the whole? - it certainly adds to the resources available for students in a useful way. It is likely to be most useful to undergraduates and those beginning careers in counseling and human health sciences. It provides a useful primer to the field and lays out many of the key questions that students will go on to explore. The writing should encourage further and deeper examination of a very important, significant and still debated area of mental health care. If it does that it will have achieved its aim.

 

© 2009 Mark Welch

 

Mark Welch, Ph.D.,  British Columbia, 2009.


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