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Book Forum: PERSONALITY AND ITS DISORDERS   |    
Personality Development and Psychotherapy in Our Diverse Society
PEDRO RUIZ, M.D.
Am J Psychiatry 2000;157:480-480. doi:10.1176/appi.ajp.157.3.480
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edited by Rafael A. Javier, Ph.D., and William G. Herron, Ph.D. Northvale, N.J., Jason Aronson, 1998, 704 pp., $65.00.

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Drs. Javier and Herron attempt to delineate normality from pathology on the basis of the clinician’s personal perceptions of patients and their environments. The patient’s given behavior is, of course, influenced by his or her cultural heritage and current experiences. The clinician, on the other hand, is also influenced by similar forces and experiences. Based on this concept, this book explores the process in which the clinician defines and delineates pathology versus normality. Although it is not clearly depicted in the book, patients also play a major role in this dyad—in the process of noncompliance with treatment, for example.

In this context, the editors attempt to offer the reader an opportunity to explore the role of culture and ethnicity as they relate not only to mental illness but also to personality development. Based on this foundation, the book includes six chapters on theoretical formulations, six chapters on specific symptoms, six chapters on treatment implications, and seven chapters dealing specifically with the role of culture and ethnicity in personality development. Finally, the book has some recommendations for mental health policy.

The perception of mental illness, with its etiological mechanisms, its course, and the multiple culture-bound factors and social forces involved, is repeatedly addressed in this book. In a way, this interplay among psychopathology, normality, and clinician-patient perceptions and relationships represents both the challenge and the major contribution of this book. I very much enjoyed, for instance, the interplay of socioeconomic, political, and cultural forces represented by and/or affecting the psychotherapeutic dyad depicted in this book. It is very striking to examine the impact these very key factors in human life have on a people’s cultural identity and their view of themselves.

A limitation of this book is the fact that most of its contributors are from a similar school of thought as well as discipline. This situation makes this book limited from the point of view of a more comprehensive and thorough approach to psychiatric care, although very relevant and psychosocially interesting. Nowadays, within a managed care environment in which cost effectiveness and revenue production are more important than theoretical formulations and personality development, a book like this one faces major challenges. This statement by no means implies that we should give up and adapt to mediocrity, but we should take into consideration the realities of our current health/mental health care system.

In summary, I enjoyed reading this book, particularly because it deals with diversity and culture. I must acknowledge a certain bias in this regard, however. Given the pluralistic aspects of current U.S. society, a book like this can help the reader to become sensitized to ethnic and cultural factors. Additionally, it might help the reader in delivering psychiatric care within a realm of cultural competency.

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