CLINICAL GUIDELINES IN CROSS-CULTURAL MENTAL HEALTH Lillian Comas-Diaz & Ezra EH Griffith (editors) New York, NY, John Wiley & Sons, 1988, 384 pages
This is a unique volume, edited by a Puerto Rican psychologist and a Barbadian Afro-American Vale psychiatrist. Both are well experienced in their respective areas of expertise. Several chapters emphasize the differences among the Caribbean cultures. Comas-Diaz discusses clinical issues, and Griffith, the importance of religion and the church.
The first chapter, by JaIaIi, is on family therapy, focusing on crosscultural issues from the viewpoint of an experienced clinician. This is the lead article and sets the clinical tone of this edited volume.
The next chapter is about language and psychotherapy and discusses the importance of nonstandard English - for example, Black English - as a parr of the important behaviors, especially with regard to the expression of emotionally difficult issues with nonstandard English.
Geller discusses racism as important in the evaluation or misevaluation of patients. Baker discusses the historical perspectives which are important in understanding the issues in Afro-American families, that there has been a misunderstanding of the prevalence of the single parent families (three times more common among whites), and that historical misdiagnoses have been to the disadvantage of Black American patients. Of special interest is Baker's emphasis on the involvement of the extended family when psychotic illness or affect illness is involved. This is reminiscent of recommendations made with Asian American families. Again, there is a question about drug therapy with Afro-American patients since Shader has noted that 45% to 55% of Afro-Americans are slow acetylators and are more at risk for druginduced systemic lupus erythematosus upon exposure to drugs such as phenelzine.
Of special merit is the chapter on Mexican Americans by Martinez, who uses the advantage of his extensive experience with Mexicans in Mexico and Mexican Americans in Texas. He reprints a song "La Jaula de Oro" (The Golden Cage), the laments of an undocumented Mexican in this country torn between the material advantages here and the sentimental pull of Mexico. Martinez describes die family, both nuclear and extended, as significant and important in the dynamics and outcome of treatment for Mexican Americans. The description of the relevance of the "Wrgen de Guadalupe, " the patron saint, is especially poignant. Some patients have concerns about mal puesto (hexes) and susfo, "thought to occur when a person is frightened by a traumatic event, for example, witnessing an accident, or seeing a snake. It is thought that the soul leaves the body, leaving the person weak, scared, and anxious." Although he states there are no accepted culturebound syndromes, he has encountered the conditions îekk and papatus which he describes as "an anxiety episode, short-lived and perhaps with an element of secondary gain or temper tantrum associated.
The description of Southeast Asian refugees by Mollica and Lavelle has strong discussions of posttraumatic stress disorder in Southeast Asian refugees and the Hopkins SCL 25, which has been translated.
The book's weaknesses are only in its regional emphases, most contributors being from the northeastern United States or having a background of training in that area. Lacking are sufficient considerations of Asians other than Southeast Asians and native Americans. Despite these deficiencies, this book would be recommended for mental health professionals in the traditional disciplines as a source book in cross-cultural treatment planning.
(This work was supported in part by National Institute of Mental Health grant 1 R01 MH44331-01, National Research Center on Asian American Mental Health.)