Table Of ContentDeterminants of Minority Mental Health
and Wellness
Sana Loue Martha Sajatovic
l
Editors
Determinants of Minority
Mental Health and Wellness
1 3
Editors
SanaLoue MarthaSajatovic
CaseWesternReserve UniversityofCleveland
Cleveland,OH Cleveland,OH
[email protected] [email protected]
ISBN978-0-387-75658-5 e-ISBN978-0-387-75659-2
DOI10.1007/978-0-387-75659-2
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Preface
The United States is experiencing a dramatic shift in demographics, with
minorities comprising a rapidly growing proportion of the population. It is
anticipated that this will likely lead to substantial changes in previously
established values, needs, and priorities of the population, including health
and mental health for individuals, families, and society at large. This volume
focusesondeterminantsofminoritymentalhealthandwellness.Thisemphasis
necessarilyraisesthequestionofjustwhoisaminorityandhowisminorityto
bedefined.
The term has been defined in any number of ways. Wirth (1945, p. 347)
offeredoneoftheearliestdefinitionsofminority:
We may define a minority as a group of people who, because of their physical or
culturalcharacteristics,aresingledoutfromtheothersinthesocietyinwhichtheylive
fordifferentialandunequaltreatment,andwhothereforeregardthemselvesasobjects
of collective discrimination. The existence of a minority in a society implies the
existenceofacorrespondingdominantgroupenjoyinghighersocialstatusandgreater
privileges.
Numerousscholarshaveassertedthatthecentralfeatureofaminoritygroup
is the power deficiency relative to that group (Blalock, 1960; Dworkin &
Dworkin, 1982; Geschwender, 1978; Wilson, 1973) and the resulting
oppression of one group by another. This imbalance of power may be
manifested in the economic, political, and social domains of life (Ashmore,
1970; Barron, 1957; Howard, 1970; Kinloch, 1979; Ramaga, 1992; Wagley &
Harris, 1958) through overt or more subtle forms of influence, exploitation,
domination, oppression, and discrimination (Meyers, 1984; Ramaga, 1992).
This power imbalance allows the establishment and maintenance of both
controlanddependency(Manderson,1997).
Within this paradigm, it is the relative power or lack of it that is
determinative of minority group status, rather than the numerical superiority
orinferiorityofagroup(Meyers,1984;Ramaga,1992).Thedisempowerment
andoppressionoftheblackmajoritybyawhiteminorityinSouthAfricaduring
theyearsofapartheidservesassuchanexample.Somewriters,however,have
refusedtocharacterizeagroupasaminorityifthegroupislargerinrelativesize
v
vi Preface
withinthepopulationunderdiscussionorifthegrouphasnodesiretopreserve
the characteristics which are believed to render it distinct (Anon, 2007;
Schermerhorn,1964).
Characteristicsthathavebeenlinkedtominoritygroupidentityincludesex,
sexualorientation,disability,ethnicity,nationality,race(withoutdebatingthe
validityofthatconcept),language,culture,andreligion(Baron&Byrne,1977;
Barron, 1957; Hacker, 1951; Pap, 2003; Rose, 1964; Wagley & Harris, 1958),
althoughreligionhasrarelybeenreliedupontodefineaminorityintheUnited
States(Minority,2008).Onescholarexplained,
Minoritiesaresub-groupswithinaculturewhicharedistinguishablefromthedominant
groupbyreasonsofdifferencesinphysiology,language,customs,orculturepatterns
(includinganycombinationofthesefactors).Suchsub-groupsareregardedasinherently
differentandnotbelongingtothedominantgroups;forthisreasontheyareconsciously
orunconsciouslyexcludedfromfullparticipationinthe lifeoftheculture ....Some
minoritiesarephysicallydifferentbutculturallysimilarwithrespecttothemajority...
othersareculturallydifferentbutphysicallysimilar...andstillothersarebothculturally
andphysicallydifferent....Theculturaland/orphysicaldifferencesbetweenmajority
andminorityactuallymaybesominuteastomakeitimpossibletodetectbysimple
observationwhoisamemberoftheminorityandwhoisamemberofthemajority.
(Schermerhorn,1949,p.5)
As such, an individual essentially inherits his or her status as a minority
group member and cannot change that status unless the status of the group
itself should change or he or she denies group membership, something that is
not possible in the case of skin color or biological sex (Harris, 1959). The
transformation of the Catholic population in New York from a despised and
persecuted minority to a powerful force in the City’s economic and political
infrastructureservesasanexampleofhowthestatusofaminoritygroupmay
changeovertime(Collins,2008).
Accordingly,eachofthechapterswithinthisvolumeaddressesmentalhealth
andmentalillnesswithintheframeworkofoneormoresuchgroups.Sajatovic
and colleagues lay the foundation for this exploration with their opening
chapter that examines the meanings of mental health and wellness. The
chapters that follow relating to urbanization, law, migration, media, health
care systems, and systems of support examine the impact of these systems on
minorityhealthandwellness.Community-levelandfamily-levelandfactorsare
discussed in the subsequent chapters that focus on religion, cultural
perspectives of healing, racism, psychoeducation, and family dynamics. The
importance of individual-level characteristics is addressed in the chapters
relating to gender, socioeconomic status, genetics, substance use, cognitive
functioning, and stress and resilience. The volume concludes with an
examination of methodologic difficulties inherent in the conduct of research
relating to mental health and wellness among minority groups and directions
forfutureresearch.
Several themes emerge consistently throughout these chapters. Foremost
among these is the discrimination encountered by members of minority
Preface vii
groupsdefinedonthebasisoftheirskincolor,ethnicity,biologicalsex,sexual
orientation, gender, and language. It is equally apparent, however, that
individuals face prejudice, hostility, and discrimination by virtue of their
mental illness alone. Consequently, individuals who both are members of one
or more defined minority groups and have a mental illness diagnosis may be
multiplystigmatized(Capitanio&Herek,1999;Herek,1999;Herek&Capitanio,
1999;McBride,1998;Reidpath&Chan,2005).
Second, the discussion focusing on the larger environmental context of
mental health and wellness underscores the complex nature of mental health
andillnessandthefailureofmanyofoursystems,includingmedia,healthcare,
housing,andlaw,toprovideadequatesupporttoindividualstoenablethemto
functiontotheirmaximumabilitywithinoursociety.
Finally,itisevidentfromthesechaptersthatminorityindividuals,families,
and communities often possess remarkable strengths that often remain
unidentified or underutilized in their efforts to address life’s challenges.
Guarnaccia’s final chapter highlighting directions for future research
challenges us to identify mechanisms to address the deficiencies within our
systems and to maximize the resources potentially available to individuals at
thelevelsoftheindividual,family,andcommunity.
Cleveland,OH SanaLoue
MarthaSajatovic
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Contents
1 HealthandWellness...................................... 1
SusanHattersFriedman,JoyStankowski,andMarthaSajatovic
2 CityLivingandMentalHealthinHistory..................... 15
SandroGalea,EmilyGoldmann,andAndreaMaxwell
3 MentalHealth,MentalHealthCourts,andMinorities ........... 39
LaraNochomovitzandFranklinJ.Hickman
4 MigrationandMentalHealth .............................. 57
SanaLoue
5 Media,Minorities,andtheStigmaofMentalIllness............. 73
SandraS.Swantek
6 MinorityMentalHealthandWellness:APerspectivefrom
HealthCareSystems ..................................... 89
SiranM.Koroukian
7 SocialSupport,MentalHealth,Minorities,andAcculturativeStress 125
DeborahGoebert
8 ReligionandMentalHealthAmongMinoritiesandImmigrants
intheU.S. ............................................. 149
Anahı´ ViladrichandAnaF.Abraı´do-Lanza
9 CulturalConsiderationsRegardingPerspectivesonMentalIllness
andHealing ............................................ 175
DeclanT.BarryandMarkBeitel
10 GenderandMinorityMentalHealth:TheCaseof
BodyImage ............................................ 193
LauraSimonelliandLeslieJ.Heinberg
ix
x Contents
11 FamilyDeterminantsofMinorityMentalHealth
andWellness............................................ 221
StevanWeineandSaifSiddiqui
12 Family-FocusedPsychoeducationalProgramsforMinorities
withSeriousMentalIllness ................................ 255
AmyWeismandeMamani,RadhaDunham,StephanieAldebot,
NaomiTuchmanandStephanieWasserman
13 SocioeconomicStatus:RisksandResilience.................... 273
LaraM.Stepleman,DustinE.Wright,andKathrynA.Bottonari
14 PsychiatricGenetics-AnUpdate............................. 303
PrashantGajwani
15 SubstanceAbuseinMinorityPopulations ..................... 313
W.A.VegaandA.G.Gil
16 NeurocognitiveTestingofMinoritiesinMentalHealth
Settings ............................................... 335
AmirPorehandAlyaSultan
17 StressandResilience ..................................... 349
AnnaMariaAguirreMcLaughlin,LisaStinesDoane,
AliceL.CostiucandNorahC.Feeny
18 MethodologicalChallengesinResearchontheDeterminantsof
MinorityMentalHealthandWellness........................ 365
PeterGuarnaccia
Index..................................................... 387
Contributors
AnaF.Abraı´do-Lanza MailmanSchoolofPublicHealth,Columbia
University,NewYork,NY
AnnaMariaAguirreMcLaughlin CaseWesternReserveUniversity,Cleveland,
Ohio
StephanieAldebot UniversityofMiami,CoralGables,Florida
DeclanBarry,Ph.D. YaleUniversitySchoolofMedicine,NewHaven,CT
MarkBeitel,Ph.D. YaleUniversitySchoolofMedicine,NewHaven,CT
KathrynA.Bottonari,M.A.,M.S. MedicalCollegeofGeorgia,Augusta,GA
AliceL.Costiuc CaseWesternReserveUniversity,Cleveland,OH
RadhaDunham,M.S. UniversityofMiami,CoralGables,Florida
NorahC.Feeney,Ph.D. CaseWesternReserveUniversity,Cleveland,OH
SusanHattersFriedman,M.D. CaseWesternReserveUniversity,Schoolof
Medicine,Cleveland,OH
PrashantGajwani,M.D. UniversityHospitalsCaseMedicalCenter,Schoolof
Medicine,CaseWesternReserveUniversity,Cleveland,OH
SandroGalea,M.D.,Dr.P.H. UniversityofMichigan,SchoolofPublic
Health,AnnArbor,MI
AndresG.Gil,Ph.D. FloridaInternationalUniversity,OfficeofResearchand
UniversityGraduateSchool,Miami,FL
DeborahGoebert,Dr.P.H. UniversityofHawaii,JohnA.BurnsSchool
ofMedicine,Honolulu,Hawaii
EmilyGoldmann,M.P.H. UniversityofMichigan,SchoolofPublicHealth,
AnnArbor,MI
PeterGuarnaccia,Ph.D. InstituteforHealth,HealthCarePolicy,andAging
Research,RutgersUniversity,NewBrunswick,NJ
xi
