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Book Forum: Cultural and Ethnic Issues   |    
Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations
JOSEPH WESTERMEYER, M.D., M.P.H., Ph.D.
Am J Psychiatry 2001;158:1544-a-1545. doi:10.1176/appi.ajp.158.9.1544-a
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Minneapolis, Minn.

Edited by Israel Cuellar and Freddy A. Paniagua. San Diego, Academic Press, 2000, 486 pp., $79.95.

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Thirty-eight authors contribute 22 chapters to this well-edited volume. The chapters are organized into four sections: Overview Theory, Models, and Demographics; Methodology (devoted primarily to psychometrics); Assessment and Treatment (providing the content and the largest section, with 13 chapters); and Training in Cultural Competence. The content chapters cover cultural syndromes and diagnostic categories, psychosocial overviews on the largest ethnic groups in the United States, special demographic categories within ethnic groups, and the use of psychometrics across languages and cultures.

Topics well covered include epidemiological and anthropological concepts basic to the field, linguistic and psychometric equivalence in translating terms and concepts, clinically germane issues such as acculturation and ethnic identity, and use and misuse of psychometrics across cultures. Areas not well covered involve cultural aspects of pharmacotherapy, effects of culture and language on differential diagnosis (e.g., delusions versus cultural belief), and national differences in diagnostic categories and criteria.

In the main, the chapters are well written, extensively referenced, and thoughtful. Duplication is minimal for an edited work with so many chapters. Clinical vignettes cogently support the points being emphasized in many chapters. Educational challenges and principles presented in the final section largely apply to training of all health professionals. The sections on psychotherapy are informative insofar as they go, but they only scratch the surface; perhaps an entire book on this subject alone is needed.

A more suitable title would have been Handbook of Cultural Psychology, since the authors, their frames of reference, and their citations focus heavily on psychology to the exclusion of psychiatric nursing, medicine, and social work. Topics seldom encountered in the cultural psychiatry literature abound: e.g., leadership and culture, training of "peer counselors" for crisis intervention, terms like "neo-Kraepelinean" (applied to psychiatry) and "postmodern" (applied to the authors of this volume), and data obtained from college students and patients with adjustment disorders rather than inpatients or disabled outpatients. Therein lie both the book’s considerable value and its limitations for psychiatrists. It informs us well regarding current thought in cultural psychology, while omitting entire areas applicable to mental health generally or cultural psychiatry specifically.

One recurring paradox captured my attention. Several authors engage in Euro-bashing on several levels, i.e., conceptual frames of reference, research questions, methods, interpretation of results, "cultural imperialism," and so forth. In a book regarding culture, that is fair enough; but one would have liked to see specific examples rather than general condemnations. Incongruously, the same authors present the methods, findings, etc., that they just denigrated. Finally, as the book was coming to a close and a befuddled anti-Europeanism appeared to be a prerequisite for authorship, in chapter 21 Negy boldly proposes an end to such automatic assumptions of ethnocentrism. At once simple and articulate, his brief chapter warrants a read.

The cultural psychiatrist wanting an update on cultural psychology should relish this book (if the occasional dismissal of our field can be taken in context). The psychiatric generalist will find the reading a bit turgid and not very applicable to daily work.

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