Appalachian Mental Health.

252 Pages·2007·2.82 MB·English

DOCUMENT RESUME
RC 017 850
ED 327 347
Keefe, Susan Emley, Ed.
AUTHOR
Appalachian Mental Health.
TITLE
REPORT NO ISBN-0-8131-1614-7
PUB DATE
88
NOTE
252p.
Editorial and Roles Offices, University Press of
AVAILABLE FROM
Kentucky, Lexington, KY 40506-0336.
Books (010) -- Collected Works - General (020)
PUB TYPE
EDRS PRICE MF01/PC11 Plus Postage.
Cultural Background; *Cultural Context; Cultural
DESCRIPTORS
Influences; *Delivery Systems; Extended Family;
*Health Services; Mental Disorders; *Mental Health;
Regional Characteristics; Rural Areas; Rural
Population; Sociocultural Patterns; Use Studies
Appalachia; *Appalachian People; *Service
IDENTIFIERS
Utilization
ABSTRACT
In th.s book, 17 psychologists, anthropologists,
social workers and others explore important theoretical and applied
issues concerning the mental health of Appalachian people. Rejecting
the view of Appalachia as an area dominated by a culture of poverty,
these papers portray a strong regional culture based on family,
community, and religion. This cultural context has implications for
development of mental health problems and coping skills, and for
delivery of mental health services. Part I, "The Appalachian
Context," contains papers on past and present Appalachian cultural
systems, Appalachian family ties, and religion in southern
Appalachia. Part II, "Sociocultural Systems and Mental Health
Problems," contains papers on adaptive socialization values of
low-income Appalachian mothers; gender, class, and self-image; the
social context of "nerves" in eastern Kentucky; and social support
networks of families with handicapped children. Part III contains
three papers on factors affecting the use of mental health services,
ways to enhance service utilization, and diffe:ences in service
utilization between Appalachians and non-Appalachians. Part IV,
"Cultural Considerations in Therapeutic Encounters," contains papers
on cross-cultural conflict between providers and local staff members
and clients, Appalachian family therapy, and hospitalized Appalachian
adolescents. Part V contains two papers on "Problems and Promise in
Appalachian Mental Health Service Delivery." (SV)
Reproductions supplied ty :DRS are the best that can be made
*
from the original document.
*
APPALACHIAN
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Edited by
KEEFE
SUSAN EMLEY
THIS
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RESOURCES
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INFORMATION CENTER
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OE RI 130Sition or
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PRESS OF KENTUCKY
THE UNIVERSITY
0
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Copyright C 1988 by The University
Press of Kentucky
Scholarly publisher for the
Commonwealth,
serving Bellarmine College, Berea
College, Centre
College of Kentucky, Eastern
Kentucky University,
The Filson Club, Georgetown
College, Kentucky
Historical Society, Kentucky
State University,
Morehead State University,
Murray State University,
Northern Kentucky University,
Transylvania University,
University of Kentucky, University
of Louisville,
and Western Kentucky University.
Editorial and Sales uffices:
Lexington, Kentucky 40506-0336
Library of Congress Cataloging-in-Publication
Data
Appalachian mental health / edited
by Susan Emley Keefe.
p.
cm.
Includes bibliographies and
index
ISBN 0-8131-1614-7 (alk. paper)
I. Rural poorMental
healthAppalachian Region,
Southern
2 Rural poorMental health
servicesAppalachian Region, Southern.
3. Rural poorAppalachian
Region, Southern.
4. Appalachian Region,
SouthernRural Conditions.
I. Keefe, Susan E. (Susan
Emley)
IDNLM:
1. Mental Health.
2. Mental Health
ServicesAppalachian
Region.
3. Social EnvironmentAppalachian
Region. WM 30 A646)
RC451.4.R87A67 1988
362.2'042'0974dc 19
DNLM/DLC
for Library of Congress
88-20557
This book is printed on acid-free
paper meeting
the requirements of the American
National Standard
for Permanence of Paper for Printed
Library Materials.
410
Contents
vii
Lists of Tables and Figures
ix
Preface
Introduction
1
I. THE APPALACHIAN CONTEXT
Appalachian Cultural Systems, Past and Present.
1
15
Patricia D. Beaver
24
Appalachian Family Ties. Susan Emley Keefe
2
36
Religion in Southern Appalachia. Richard A. Humphrey
3
II. SOCIOCULTURAL SYSTEMS AND
MENTAL HEALTH PROBLEMS
Adaptive Socialization Values of Low-Income
4
Appalachian Mothers. David F. Peters and
51
Gary W. Peterson
66
5 Gender, Class, and Self-Image. Judith Ivy Fiene
6 The Social Context of "Nerves" in Eastern Kentucky.
81
Eileen Van Schaik
Social Support Networks of Families with Handi-
7
capped Children. Carl I. Dunst, Carol M. Trivette,
and Arthur H. Cross
101
III. MENTAL HEALTH SERVICE
UTILIZATION IN THE MOUNTAINS
Factors Affecting the Use of Mental Health Services:
8
125
A Review. Susan Era ley Keefe
Enhancing the Use of Mental Health Services.
9
135
Cathy Melvin Efird
,
1:
10 An Exploratory Study of Mental Health Service
Utilization by Appalachians and Non-Appalachians.
Susan Emley Keefe
145
IV. CULTURAL CONSIDERATIONS IN
THERAPEUTIC ENCOUNTERS
Cross-Cultural Conflict between Providers and
11
Clients and Staff Members. Thomas Plaut
161
Appalachian Family Therapy. Cynthia Cole
12
175
Hospitalized Appalachian Adolescents.
13
Rhoda H. Halperin and Marcia Slomowitz
188
V. PROBLEMS AND PROMISE IN APPALACHIAN
MENTAL HEALTH SERVICE DELIVERY
Conscience and Convenience in &stern Kentucky.
14
John White
209
Mental Health Professionals in Appalachia.
15
Melanie L. Sovine
223
Conclusion
240
Contributors
246
In lex
248
t
L.
Tables
Socialization Value Choices by Urban Middle-Class
4.1
Mothers and Rural Low-Income Appalachian Mothers
56
Social Value Choices by Urban Working-Class Mothers
4.2
and Rural Low-Income Appalachian Mothers
58
Selected Characteristics of the Sample Families
105
7.1
7.2 Mean Support Scores on Family Support Scale
1 as
7.3 Mean Scale Scores on the Questionnaire on Resources
and Stress
110
7.4 Mean Scale Scores on the Questionnaire on Resources
and Stress for the Total Social Support Scores
114
Sample Plan Components
143
9.1
147
1975-1979 Mental Health Service Utilization Rate
10.1
Comparison of Appalachian and Non-Appalachian
10.2
Status of Mental Health Clinic Clients and the General
Population
148
10.3 Comparison of Referral Agents for Appalachians and
Non-Appalachians to Mental Health and Detox Centers
153
Comparison cf Diagnosis at Intake of Mental Health
10.4
Clinic Clients
155
Figures
The Planning Process
136
9.1
Genogram of the Buckner Family
181
12.1
,
Preface
This book is intended as a guidepost in an as yet ill-defined field.
Pioneering works in Appalachian mental health were introduced in
1971 by David H. Looff and Robert Coles, but it is difficult to identify
of articles makes
a larger body of literature on the topic. This collection
the literature more accessible as it reviews many of the findings of
researchers from a variety of disciplines. The collection also presents
anthropologists, sociolo-
new data gathered by researchers including
gists, psychologists, psychiatrist;, and social workers, using metho-
dologies ranging from interviews to surveys to clinical data collection
forms. These data and the experience of the authors, who have done
research or provided therapeutic services in the region, form the basis
for a multitude of recommendations for the improvement of mental
health services in the mountains. These are summarized in the intro-
ductory and concluding chapters. If this collection also serves as an
impetus for further research and the practical appliration of findings
on mental health in Appalachia, it will have achieved yet another
intended goal.
This book grew out of a symposium on mental health in Appalachia
organized by Warren Johnson at the annual meeting of the Summer
Study Program on Rural Mental Health Services, in Madison, Wis-
consin, in 1981, and a follow-up workshop, organized by Keefe in
1982, on Appalachian mental health at Appalachian State University,
which was attended by practitioners from around the region. Prelim-
inary versions of the chapters by Beaver, Cole, Efird, Humphrey, and
Keefe were presented at one or both of these conferences. At these
and subsequent workshops and progams relating to mental health
in Appalachia, it has become apparent that there is a growing interest
in a regional perspective on mental health and culturally relevant
techniques that can be incorporated easily into clinical practice. This
collection has been directed to both academically inclined researchers
and practicing professionals ir the region. It is hoped this alliance
x
PREFACE
will continue and lead to further developments in the field of Ap-
palachian mental health.
A collection of this sort is always a group effort. I would like es-
pecially to thank Patricia Beaver who, then director of the Center for
Appalachian Studies at Appalachian State University, first invited me
to participate in a discussion of mental health in Appalachia at an in-
service training program in 1980 and who helped in organizing the
workshop held at ASU in 1982. I would also like to thank the De-
partment of Anthropology and the College of Arts and Sciences at
Appalachian State University for giving me time to devote to this
project. Teresa Isaacs has patiently and attentively typed the manu-
script; her help is always greatly appreciated. Finally, I am lucky to
have a supportive and loving family at144 must thank my husband,
Tom, and Megan and Rosemary, who have helped in so many ways
as I have worked on this book.
IQ
,
Introduction
SUSAN EMLEY KEEFE
Southern
This collection of articles addresses mental health issues in
Appalachia. There are two very good reasons for such a book. In the
problems
first place, the Appalachian region suffers from significant
and deficiencies in the delivery of mental health services. Appalachia
is underserved by mental health professionals and services, as are
Efird, Chapter 9); but be-
most rural areas in the United States (see
largest and poorest rural popu-
cause Appalachia covers one of the
lations in the country, its need is intensified. Moreover, the mental
health facilities that do setye thz. region tend to be located in urban
and low-income
centers, creating problems ,n accessibility for rural
residents. Social, economic, and cultural factorsincluding high rates
of poverty and unemFioyment, low levels of education, widespread
occupational and environmental hazards, and the lack of complete
integration into the natiunal social and cultural fabricwould seem
and a greater need
to indicate the potential for higher rates of stress
for mental health services. Yet, there is apparent underutilization of
the services that exist.
In the second place, there is general agreement that Appalachians
deserve special consideration
as a people are different and therefore
The basis for this different-
as distinct from mainstream Americans.
this collection see moun-
ness is controversial. Some of the authors in
taineers as a separate ethnic group. Others concentrate on the largely
rural and/or lower- and working-class nature of the region's popu-
lation. Certainly, Appalachians share many traits with the rural poor
elsewhere in the nation. Like
as well as with ethnic minority groups
these groups, the people of Appalachia have experienced historical
Chapter 1).
patterns of control and exploitation (reviewed by Beaver,
In fact, several authors compare the relationship of Appalachians and
mental health services to other systems of control in the region (see
Van Schaik, Chapter 6; White, Chapter 14; and Sovine, Chapter 15).
If nothing else, then, Appalachia as a region is clearly the product of
and its people have been
a unique historical experience of inequality,
1.%
2
SUSAN EMLEY KEEFE
set apart in both symbolic and material ways from the rest of America.
The "differentness" of Appalachia has often been conceptualized
as cultural and reputed implications about the significance of cultural
difference have been at the heart of the debate concerning the rela-
tionship between Appalachia and the rest of America. Therefore, this
essay first addresses the interpretation of cultural difference used by
earlier writers in the field of Appalachian mental health and the cur-
rent need for critical studies using a more informed concept of culture.
Second, it summarizes the content of the articles in this collection,
focusing on the distinctiveness of the Appalachian experience as it
comes to bear on mental health issues. The implications for regional
mental health services and iuture research are discussed in the con-
cluding chapter of the book.
THE NEED FOR CRITICAL STUDIES
Appalachia has not been dealt with in a tolerant or even-handed way
by either the larger society or academic scholars. The past century of
exploitation of the region's rich natural resources has been accom-
panied by a wholesale condemnation of the people and their culture.
This has occurred not only in the popular media, beginning with the
local color writers of the late nineteenth century (see Shapiro 1978),
but also in the academic literature, where Appalachians have been
described variously as "barbarians" (Toynbee 1947), "yesterday's peo-
ple" (Weller 1965), "regressive" (Polansky, Borgman, and De Saix
1972), and "nonrational" (Ball 1968). The correlation of political, eco-
nomic, and cultural domination of the area has been well documented
cross-culturally, and work in the last decade, especially by Gaventa
(1980) and Whisnant (1983), serves to demonstrate tile nature of this
relationship between the domMant society and the regional periphery
of Appalachia. The emergence of a critical literature concerning Ap-
palachia and the perception of its people is the result, I believe, of
real political end economic changes and a growing sense of power in
the region. Symbolic of these changes, in a way, has been the emer-
gence of scholars who are natives of the region and who have led in
founding the new field of Appalachian studies. Furthermore, ft,e re-
search of recent years has done much to redress the negative portrayal
of Appalachians and the inadequacy of previous analytical models
used to inte.pret the region.
The field of Appalachian mental health, however, has yet to receive
significant attention in the way of critical stucaes. This is surprising