Handbook of race and development in mental health

403 Pages·2012·3.9 MB·English

by  Christina A. Downey (eds.)

Handbook of Race and Development in Mental
Health
Edward C. Chang • Christina A. Downey
Editors
Handbook of Race and
Development in Mental
Health
1 3
Editors
Ph. D. Edward C. Chang Ph. D. Christina A. Downey
University of Michigan Indiana University Kokomo
Department of Psychology Department of Psychology
2263 East Hall 2300 S. Washington St.
530 Church St. Kokomo Indiana 46904
Ann Arbor Michigan 48109 USA
USA
I would like to dedicate this work to my
parents, Tae Myung-Sook and Chang Suk-
Choon. As immigrants, they sacrificed their
life paths so that my journey to becoming
a Korean American would be fruitful and
bright. I will always keep close, in my heart
and in my head, the pride I have of being
their child, and make sure to offer my own
path to my always remarkable child, Chang
Olivia Dae.
E.C.C.
This volume is dedicated to every mental
health researcher and practitioner who
seeks to understand context, history, and
the best qualities of each individual and
culture. In addition, I offer sincere grati-
tude to my family, friends, colleagues, and
mentors, for always showing me the best in
myself and in you.
C. A. D.
v
Foreword
A systematic understanding of positive human development and behavior did not
th st
originate with Western psychology of the 20 and 21 centuries. A rich source of
well-formulated positive psychology is found in Asian religions that go back more
than 2500 yrs. Most major Asian religions have at their core a psychology little
known to the millions of their followers, but articulated well by monks, gurus, yo-
gis, erudite people, and health professionals (e.g., Nikhilananda, 1942). Two Asian
psychological principles of virtuous ways of life are presented here briefly. First, a
most complex laid-out psychology is classical Buddhism, called Abhidharma (San-
skrit word), which lays out the principle that every action is motivated by under-
lying mental factors that are positive and negative (Govinda, 1961); this system
could be linked today to the stress-diathesis model of protective and risk factors
(Benard, 1995). Second, in Hinduism, the notion of dependency in human develop-
ment is viewed positively through the constructs of bond, bondship, and kinship
(Sinha, 1968). Using Seligman’s (2002) theory of positive psychology, the exercise
of bonding may be interpreted as interpersonal and social signature strengths, lead-
ing to positive emotions, engagement, and meaning, and resulting in happiness and
the promotion of well-being.
In Buddhism (Narada, 1968), factors in adulthood that interfere with medita-
tion in spiritual practice or concentration in occupational work are unhealthy, while
those that facilitate the mind’s focus are healthy. This means that to attain a healthy
mental state, unhealthy mental states are replaced with their corresponding polar
opposites. In the hierarchy of healthy factors, cognitive factors come first. Insight
is the central healthy state that suppresses delusion, the fundamental unhealthy fac-
tor. The essential partner of insight is mindfulness, and the presence of these two
factors is sufficient to suppress all unhealthy factors. When there is a thought of a
negative action, the twin factors of modesty (opposite of shamelessness) and discre-
tion (opposite of remorselessness) act as preventative forces, both always connected
with good judgment (called rectitude). Confidence is self-belief based on correct
perception. The configuration of healthy cognitive factors of modesty, discretion,
rectitude, and confidence together produce good behaviors, as judged by both per-
sonal and social standards.
vii
viii Foreword
The configuration of healthy affective factors of nonattachment (opposite of
greed/egoism), connectivity (opposite of aversion), impartiality (opposite of envy),
and composure (opposite of frustration) together replaces an acquisitive or reject-
ing attitude with an even-mindedness toward whatever object might arise in one’s
awareness. Another cluster of positive factors have both physical and psychologi-
cal effects and are: buoyancy (opposite of pessimism), pliancy (opposite of inflex-
ibility), adaptability (opposite of tightening/contraction), and proficiency (opposite
of low mental and physical energy) prevent depression and make one adapt physi-
cally and mentally to changing conditions, meeting whatever challenges that may
arise. Peterson and Seligman (2004) stated, “missing in the resilience literature is
any discussion about which protective factors are relevant for whom, under what
stressful circumstances, and with respect to what desirable outcomes” (pp. 79–80).
It appears that Abhidharma of Gautama Buddha (536–438 B.C) identified the pro-
tective factors of resilience for common, everyday folks who are challenged by
the limits of the body, senses, and mind that when overcome attain liberation from
limits.
In Hinduism, another major Asian religion, the ideal of lifespan development
emphasizes continuous dependency relations. In the extended/joint family, young
children occupy a special status of spiritual innocence and are rarely exposed to
prolonged frustration. They are continuously gratified bodily and reassured emo-
tionally, especially by their mother. Through such parental dynamic, children are
conditioned in the dependency relationship. The early permissiveness instills a
foundation of belonging, self-worth, and safety. Subsequently, at the start of school,
severe discipline follows to instill self-restraint, social harmony with siblings and
classmates, and above all, commitment to the family. Discipline also teaches the
control of anger and aggression. Particular social relations are observed with par-
ents, aunts, uncles, grandparents, siblings, and cousins. Each relative is addressed
with a respectful title based on the relative’s birth order or kinship through mar-
riage. Each stage of a person’s development marks a new network of dependency
relations. Each dependency relation is chracterized by a more or less rigid inherent
relational status.
Old age prescribes dependency on children, who are morally obligated to pay
back their parents. Filial piety is mutual exchange and ensures the full cycle of
reciprocity. The goals of human development are satisfying and continuous depen-
dency. Sons and daughters realize their social identity in a lifespan prolongation of
their original state of dependency. Relationships among family members provide a
model of positive interactions in all areas of life, work, and society, including lead-
ership, as well as rationales with inherently religious meanings.
As these examples illustrate, positive psychology can be traced to the ancient re-
th
ligions of Buddhism and Hinduism, just as it can be located in the early 20 century
existentialism and humanism, in counseling psychology’s prevention approach, and
in postmodernism, each with its own constructs of wellness. The credit, however,
st
goes to Seligman in the 1990’s and early 21 century for branding it and placing it
within the American Psychological Association’s (APA) policy (2006) of evidence-
Foreword ix
based practice. It’s exciting to read psychologists in this book, influenced by Selig-
man, to be focusing on strengths of racial, ethnic, and other marginalized people,
which make them resilient against challenges. The authors resist explanations of
psychopathology related to “cultural deficits/disadvantages” and/or low environ-
mental resources of minority children, adults, and the elderly. The universalistic
assumption within American positive psychology is a sweeping generalization and
has been corrected by the chapter authors with their understandings of group- and
development-specific positive factors.
With regard to multicultural psychology, whose goal is the empowerment of
racial, ethnic, and diversely identified minorities, Leong, Pickren, and Tang’s chap-
ter, A History of Cross-Cultural Clinical Psychology (in this book), brought to my
mind Martin Luther King, Jr.’s Invited Distinguished Address at the 1967 Annual
Convention of the American Psychological Associations. King said that psycholo-
gists who do individual therapy treat clients diagnosed with “Adjustment Disorder”
(defined as the development of clinically significant emotional or behavioral symp-
toms in response to an identifiable psychosocial stressor or stressors [American
Psychiatric Association, 2000]). However, King challenged that the goal of therapy
is to help clients become “well-adjusted” to the social world around them. As King
(1967) put it:
You who are in the field of psychology have given us a great word. It is the word “malad-
justed.” This word is probably used more than any other word in psychology. It is a good
word; certainly it is good that in dealing with what the word implies you are declaring that
destructive maladjustment should be eradicated. You are saying that all must seek the well-
adjusted life in order to avoid neurotic and schizophrenic personalities. But on the other
hand, I am sure that we all recognize that there are some things in our society, some things
in our world, to which we should never be adjusted….We must never adjust ourselves to
racial discrimination and racial segregation. We must never adjust ourselves to religious
bigotry. We must never adjust ourselves to economic conditions that take necessities from
the many to give luxuries to the few. We must never adjust ourselves to the madness of
militarism and the self-defeating effects of physical violence. (pp. 9–10)
King argued that for psychologists to make a meaningful contribution to people’s
mental health, they would have to find ways to help ordinary citizens develop their
capacity for what King called “creative maladjustment nonconformity” (King as
cited by Carson, 1995, p. 319). King’s fundamental argument was that psycholo-
gists who are actively engaged in healing society are themselves creatively malad-
justed, who model creative nonconforming behaviors to their clients to cope with
racism.
Like King, Michael Lerner (1998) said, “Most therapists don’t understand the
social conditions which lead to so much pain in personal life, so they are unlikely
to be able to uncover meaningful ways for individuals to deal with those social
conditions” (p. 325). Clinical psychology is symptom-focused than etiologically-
focused, which can discount the impact of context and social inequities on a client’s
life. While Lerner admits that therapy can help people be less self-destructive, he
also points out that “these benefits mostly fit into the category of ‘learning to cope
with an oppressive reality’” (p. 329). Like King, Lerner argued that most psycholo-
x Foreword
gists unwittingly play a restraining/repressive role in society because they squander
the opportunity to foster the strength of social justice advocacy in their clients, col-
leagues, and the organizations they serve. As Lerner put it:
Lacking a sense of social causality, most therapists interpret the frustrations of family and
personal life as individual failings. Instead of bringing their clients to an understanding of
the larger social forces that shape their individual experiences, therapists implicitly suggest
that the problems are individual in scope, and can be adequately solved by changes in indi-
vidual psyches or through changes in their family systems. (p. 323)
In the present book, I found chapter authors refer to common strengths across
American cultural minorities that are context-based, e.g., social network support,
extended family composition, watchful parents and older relatives, religiousness
or spiritual practice, guidance of cultural traditions and beliefs, and preference for
racial, ethnic, or cultural identity. Group-specific strengths have also been identified
by the authors.
Group specific strengths for African Americans include the enduring self-esteem
and resilience of children and adolescents (see also APA, 2008) and the religious
coping of the elderly. Respect for tribe/nation membership, spiritual practice, and
cultural elements of healthcare are strengths of American Indian and Alaska Na-
tive adults. For Asian Americans, children’s strengths include the maintenance of
group harmony, parental engagement, educational values for achievement, and bi-
culturalism that is inclusive of ethnic identity; adults abide by their collectivistic
worldview, and the elderly feel secure in their family cohesion and peer support.
For European Americans, children have a strong sense of purpose, an internal locus
of control, social privilege, and the security of having membership in the domi-
nant society; adults are cognitively involved, productive, and directed by positive
help-seeking attitudes; the elderly are change-oriented, adaptable, educated, and
engaged, and, therefore, have many resilience factors. For Latinos, their children’s
strengths are familismo values, bicultural competence that is inclusive of ethnic
identification, and bilingualism; these strengths continue through adulthood, while
for the elderly, who are first-generation immigrants, Hispanic cultural values and
religion play important roles.
Both common and group-specific cultural strengths need to be utilized in treat-
ments with racial, ethnic, and cultural groups to increase their general life satisfac-
tion and mental health. The adaptation of mainstream therapies to specific cultural
groups will increase the treatment efficacy of particular mental disorder presenta-
tions (e.g., Jackson et al. 2006; Shen et al. 2006). In a meta-analysis, Griner and
Smith (2006) found that interventions that were based on a theory and on research
of a specific culture were found to be almost twice as effective as interventions that
did not consider race and/or culture.
The word “particular” in the previous paragraph is added emphasis because the
individual, who varies in abiding by his or her culture owing to acculturation and/
or personal temperament is given as much importance as the individual’s universal
humanity and membership in a race, ethnicity, culture, or local context. Accord-
ing to Sue (1998), clinicians who are multiculturally competent are scientifically
Foreword xi
minded and have skills in dynamic sizing. In other words, they are in the practice
of making cultural hypotheses on the status of a particular client, including know-
ing when to generalize and when to exclude the experience of others in client case
conceptualization and treatment. Thus clinicians are able to adopt treatment models
to be sensible and acceptable to their individual minority clients.
Professor of Clinical Psychology Gargi Roysircar, EdD.
Director, Multicultural Center
for Research and Practice
Antioch University New England
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