Psychologists, researchers, and mental health professionals live in an ethnically and culturally diverse world. This is an undeniable fact that forces us to question our positions, thoughts, theories, and entire worldviews regarding our knowledge base. Theories and models of psychological functioning, psycho-pathology, and treatment of mental disorders must all be analyzed across cultural contexts. Culture is a variable of undeniable importance in the study of all psychological phenomena.
For the purpose of this chapter, the variables of culture and ethnicity will be referred to as ethnocultural. Marsella (1988, p. 10) provides a good working definition of culture:
[Culture is] shared learned behavior which is transmitted from one generation to another to promote individual and group adjustment and adaptation. Culture is presented externally as artifacts, roles, and institutions and is represented internally as values, beliefs, attitudes, cognitive styles, epistemologies, and conscious patterns.
Culture is an extremely important dimension of human experience. Within the last 20 or so years, a self-consciousness of sorts has developed in the social and medical sciences. Scientists and practitioners in the United States and Western Europe have come to the inevitable conclusion that their way of seeing the world is not the only way of seeing the world. In line with Marsella's respect for culture and its role in human experience, these seekers of truth and knowledge have been obliged to question their worldviews with respect to nonwestern contexts. The reasons for this go well beyond the scope of this chapter and book, but for a more in-depth discussion of these issues, see Berry, Poortinga, Segall, and Dasen (1992) and their work on cross-cultural research.
A critical issue in the scientific enterprise is the generalizability of research findings. That is, does a researcher's findings in his or her lab or clinic actually translate to the real world? Do the findings generalize from the specific to the broad or more general? When a finding does in fact translate, this is taken as a form of confirmation and is viewed as a critical step in the scientific validation of knowledge. If it was otherwise, scientists could be creating elaborate fictions to explain the world, even if the world he or she is explaining is only in their lab, or worse, in his or her head. Just as theory and experiments have to translate to the real world, so, too, do they need to translate all of the different contexts of the real world. Obviously, variation in ethnocultural contexts is a reality of the world I am speaking of, and inasmuch as science addresses reality, it must therefore address all reality in all its variations. A theory that only works in some places some of the time is not a very powerful theory. However, it can remain respectable as long as its parameters and limitations are acknowledged. But as long as psychology is touted as a human science for all people, psychologists must strive for more universal validation of their work. This necessarily involves cross-ethnocultural inquiry.
Professionals and researchers have come to accept that such concepts as depression, PTSD, or even the mind or psyche cannot be taken for granted across all ethnocultural contexts. Ironically, perhaps, the search for scientific objectivity has led us to the acknowledgment of ethnocultural variation and subjectivity as critical variables in our search.
From a clinical perspective, this issue is extremely important. As stated in Gergen, Gulerce, Lock, and Misra (1996), "the culturally engaged psychologist might help to appraise various problems of health, environment, industrial development, and the like in terms of the values, beliefs, and motives that are particular to the culture at hand" (p. 1). In other words, efficacious and ethical psychological treatment and intervention will depend on the consideration of eth-nocultural variables. Perhaps the goal will be to build local knowledge bases rather than universal models of psychopathology and treatment. Perhaps conducting psychotherapy in Brazil for PTSD will mean something very different than it will in Wisconsin. The names for techniques and treatment modalities as well as disorders may vary. Professionals may observe similar symptoms with different linguistic and ethnocultural forms of expression or different symptoms that result from similar etiological sources and events. Etiologies may vary. Disorders as expressed may vary. Cures or treatments may vary.
However, before you throw your hands up in confusion feeling that there may never be an end to this seeming relativism, you should know that dedicated researchers and professionals have been working hard to clarify these muddy waters. The process of gaining cross-cultural and ethnocultural knowledge is ongoing, and perhaps the journey itself is the most important part.
My own clinical training regarding issues of ethnocultural differences between therapist and client has taught me that when working with patients or clients of a different ethnocultural background than oneself, the clinician should engage in an active effort to understand the client's ethnocultural frame of reference. Few assumptions should be made, and the process of listening and learning is tantamount. This is true, of course, for all patients and clients, even if he or she is of the same ethnocultural background. The issue of differences should be an explicit part of the treatment but not overemphasized. The process of learning about the client's ethnocultural background is a critical clinical tool in the development of empathy, the therapeutic alliance, and the facilitation of treatment through the establishment of a common language and conceptual backdrop.
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