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Book Forum: Cross-Cultural Psychiatry   |    
Cross Cultural Psychiatry
Am J Psychiatry 2001;158:155-155. doi:10.1176/appi.ajp.158.1.155
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Highland Heights, Ky.

Edited by John M. Herrera, William B. Lawson, and John Sramek. New York, John Wiley & Sons, 1999, 406 pp., $150.00.

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This edited volume contains 32 articles organized into eight sections: Basic Mechanisms, Psychopharmacology, Diagnosis, Schizophrenia, Affective Disorder, Inpatient Treatment, Gender Issues, and Children and Adolescents. Because identifying "cultural" factors influencing diagnostic and therapeutic outcomes is the theme that ties the sections together, I will focus on the meaning of the term "cultural." In this volume, the terms "culture," "race," "ethnicity," and "national origin" are interchangeable concepts, with a primary emphasis on race. In fact, most of the research discussed is comparative in that it involves two or more "distinct" racial categories.

Most of the contributors, however, seem uneasy about classifying people and caution (if only with one sentence) against simplistic applications. Contributors Lin, Smith, and Mendoza point out that

cross ethnic differences in pharmacological responses are often substantial and of clinical significance. However, unless these findings are understood in the context of interindividual variability in drug responses that exist in any given ethnic group, they are likely to be interpreted stereotypically and simplistically. Such a misunderstanding might lead to the indiscriminate treatment of all persons from a particular group with a set dose range, thereby neglecting the need for individual tailoring of any treatment regimen in the clinical setting. (p. 48)

Likewise, Ilena M. Norton reminds us that the category of Native American and Alaska Native includes "over 550 federally recognized tribes and Alaska Native villages," each of which has "important differences in language, customs, family structure, illness experiences, and healing traditions" (p. 78). This uneasy, cautionary posture takes on even greater significance when we consider that the U.S. system of racial classification is undergoing a major revision. In October 1997, the U.S. Office of Management and Budget declared that, for the first time in U.S. history, people can identify themselves on the census and other official forms as belonging to more than one of the five racial categories. The five official racial categories are 1) white, 2) black, 3) Native American, Eskimo, and Aleut, 4) Asian, and 5) Hawaiian and Pacific Islander. The official ethnic categories are 1) Hispanic and 2) non-Hispanic. Note that Hispanics can be of any race. The Office of Management and Budget has yet to decide how it will count people who identify with more than one race. The number of racial categories could be as small as five categories or as large as 63, depending on how people respond to the race question. The number 63 represents the number of ways the five official racial categories can be combined.

The significance of this change may eventually change the way clinicians think about a patient’s race. The well-known case of the golfer Tiger Woods, who appears to be black, helps to illustrate this point. Woods’s mother was born in Thailand and is half Thai, one-quarter Chinese, and one-quarter white. His father was born in the United States and is half black, one-quarter Chinese, and one-quarter American Indian. (Woods has classified himself on several occasions as Asian and on other occasions as a blend of all races.) U.S. Census Bureau statistics tell us that Woods is not unique. One in every 24 children in the United States is classified as a race different from one or both of their parents. The rate varies depending on the parents’ classifications. For example, one in 43 children living with a white parent is classified as a different race; one in 15 children living with a black parent and one in five children living with an Asian/Pacific Islander parent are classified as a different race.

The lesson for clinicians and researchers is to think of race as a category into which people have been classified (or into which they have even been forced). At the same time, clinicians should not view race as an illusion, because the consequences of racial classification are real. In fact, the consequences of racial classification are so real that, for literally hundreds of years, clinical and other researches have ignored the "racial ancestries" they cannot observe from simply studying someone’s physical features.




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