Soc Sct Med Vol 29 No 10 pp 1231-1232, 1989 Pergamon Press plc Printed m Great Britain

BOOK REVIEWS

Cross Cultural Trammg for Mental Health Professmnals, edited by HARRIET P LEFLEY and PAUL B PEDERSEN Thomas , Spnngfield, I11, 1986 360 pp $38 00

There is enough boggmess around the edges of psychmtnc dmgnoses to trap even the most cautious therapist operating wathm his/her own native language and culture The difficulties multiply when working m other hngmstlc and cultural t radl tmns This book is designed for the mental health professmnal bemg trained to practice effectively m just such a setting The authors Lefley and Pedersen, are, respectively, a Professor of Psychmtry m Mmml and Coun- selor Educator at Syracruse Umversl ty

Th~s 330 page volume comes in six parts, each deahng with a different aspect of training The first part (Chaps 1 and 2) is an mt roduc tmn which gwes the ratson d'etre of the rest of the book It includes an overview of cross cultural training for mental health professionals and introduces the authors and topics of each chapter m the book The mare ethmc groups addressed m this book are the American Indmn, the black African, Hispamcs, Hmtlans, and Asians Professor Lefley contributes a comprehenswe literature re- vtew on why cross cultural training Is necessary Her examples o f cross cultural m~smterpretatlon are taken mamty from the mental health fields of schtzophremc and affect~ve d~sorders Professor Lefley also d~scusses cultural strengths and coping mechamsms such as the social support of the church for blacks, the supernatural behef systems of the Puerto Racans and Cuban commumtxes and other strong kmsh~p networks

The second part (Chaps 3, 4, and 5) describes the rationale and opera tmns of three training programs These North American programs emerged m response to the mabd~ty o f the existing mental health system to cater for the speaal needs of ethnic groups The first, 'Ethmclty and mental health' , at Brande~s University, was based on an mterdlsc~phnary team approach The training format is described as ss the program evaluation by the trainees Obstacles are also discussed

The second program, 'Developing mterculturally skilled counselors ' at the Umversl ty of Hawan was a prototype for training between 1978 and 1981 It also uses a mult~d~sc~- phnary team approach, training of eight predoctoral trainees coming from psychology, anthropology, public health, educatmn, commumca tmn , and socml work for one year

The third program, "The cross cultural training institute mental health professmnals ' , operates at the Umvers~ty of Miami Th~s was developed by Professor Lefley It ran for 3 years and had 174 trainees The program was oriented towards mental health professionals working m chmcal facdmes, serving low income ethnically diverse popula tmns The training was under taken m one or more 8-day work- shops and emphasized practical skills and techmques Part five (Chap 14) concentrates on the detaded short range and long term evaluauon on this program

Part three (Chaps 6, 7, 8, 9, and 10) gives background reformation on the culture of American Indmns, black Africans, Hlspamcs, Hamans , and Asmns Each culture receives a chapter by an indigenous mental health profes- sional Al though these descriptions are deep and interesting, each reinforces a stereotype as tf each person belonging to

a culture shares the same behef system, the same experi- ences, educauon, and all live completely within their own traditional culture Just as it would be impossible to give one description of an Austral ian and make it accurate so too It ts difficult to beheve that this can be done wsth other cultures

Part four (Chaps I l, 12, and 13) reveals culturally specml- tzed Interventions bemg practised m areas of special need m the U S A Chapter 11 discusses various interventions pro- vtded by mental health professionals tn the black commu- mty, primary health care chntcs, schemes to prevent young first and/or second offenders being sent to juvenile detention centers, an affirmative action project to find employment for young black students over the summer vacation Child psychiatry (Chap 12) reveals areas m the cross cultural setting that need further research To unders tand the 'devi- ant ' , pathological child, parental roles, their culture, and their child reanng approaches must be understood Chdd mental health professionals need to dlfferentmte between social and pathological characteristics of the family setting Often seen a family's beliefs clash with what ~s taught in U S schools, where mdependence and personal-decision making ts encouraged

Chapter 13 concentrates on a family therapy training model for Hispanic famlhes It looks at s t rengthenmg the family system to help cope with drug abuse, intercultural, and/or mtergeneratlon conflict Al though the program IS dlscussed m great detail, no evaluation is mentioned

In part slx, Professor Wcldman offers a model for moving from a umcultural to a transcultural perspective m health care that encompasses mental hcalth care and the training of mental health professmnals

The book as written for mental health professmnals working m the U S A However some of the cross cultural training programs could be adapted for use elsewhere The chapter on evaluating a cross cultural program (Chap 14) could also be useful to those contemplat ing training pro- gram evaluatmn

Mental health professmnals certalnly need to be aware of different cultures and thelr own cultural values and biases They need skills m interpreting verbal and nonverbal mes- sages from chents of another culture But also, they must he able to differentiate behavmr specdic to a culture from abnormal behavlor and surprisingly, thls point is not em- phaslsed

Diversity occurs among people wlthm a culture as they hve there longer Acculturatlon, socm-econom~c, and educa- tlonal differences tend to widen Older Hispamcs react differently m one setting to more recent H1spamc imm~- grants Again, thls point recelves httle emphasls By being more aware of the different aspects of various cultures, mental health profcsslonals are certainly m a better position to orientate people from non-Western soctetles to acceptable behavlor m the U S context To help people from non- Western cultures wlthm the framework of thelr own tradl- tlonal culture, however, ~s not necessarily help For the mental health professonal to help Htspamc parents to keep the same hold over thelr grown children m the U S as they dld m thelr homeland is not helping elther the parents or the children With the move to the U S , Immlgrants need to make some compromlses, and the mental health professmn- als can help these people explore the alternatives that are

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1232 Book Reviews

possible In the case of oppressive Hlspamc parents, it may mean helping them to see that independence and self fulfillment are characteristics that are acceptable behav,or for their chddren in the U S On the other hand. U S culture can learn from the extended family and interdependent network orientation seen within H~spamc famdms There- fore Americans benefit by new customs being brought to

their country and people from different cultures slowly learn what is acceptable behavior m America

Department of Commumt) Medtcme

Westmead HospJtal Westmead NSW. Austraha

GILL1AN BARTON and STEPHEN R LEEDER

Health Research m Developmg Countries. edited by HANS JOCHEN DIESFELD Verlag Peter Lang. Franfur t Am Main. Bern. 1982 231 pp No price given

The good thing about at tending a conference is that you can pick and choose the papers which are of interest to you In between times you can catch up with old acquaintances. pursue partmular presenters to buttonhole, or simply let the dust settle

The bad thing about editing a collection of conference papers for publication is that each has to fit into a covenng template prowded by the editor Where the theme of the meeting is not too general and where the format of the papers is reasonably strictly adhered to. this task may not be too difficult However. where there is an over-general theme and where there ~s an unbalanced set of papers, it is ddticult for an editor to make a cohesive gel of the final product

Unfortunately. Professor Dxesfeld finds himself in the latter situation m trying to harness the 15 papers m this collecUon On a theme of approaching health research in developing countries with strategies more mindful o f local culture, th~s meeting of German. Dutch and Belgmn tropmal medical socieues encompasses a wide range and standard of contribution The meeting is orgamsed m four sections Health Services Research. Medical Anthropology. Nutri t ion and Non- lnfecuous Tropical Diseases Al though there are hnks between some papers m the same section and. more rarely, between some papers m different sectxons, the confer- ence theme is not sufficmntly tight nor are the papers written to a sufficiently disciplined format for the final result to be more than a collection of stand-alone research findings While Dmsfeld's presidential address sets the scene for these contributions, it is slgmficant that no at tempt Is made to link the papers mdwidually to the theme or to each other One feels, however, that this Is exactly what should have been at tempted

Geographically. the papers span South America. Asia and Africa Belgian research tends to be concentrated in Zaire. Dutch research in Kenya The common basis of tropical research is made somewhat loose by the inclusion of a paper from Korea (Seoul is about the same latitude as Llsbont). but th~s ~s a minor quibble

The Individual papers are rather unbalanced, varying from the laborious detail of the research emanat ing from the Belgmn and Dutch "field laboratories' in Kenya and Zalre to some short technical reports and qualitative reviews The section on Health Services Research covers papers on health care preferences m Ecuador and Kenya and two papers from the Kasongo project in Zatre. one on financing and utdisation of health centres and the other on enlightened supervision of health auxiliaries The message---that appro- priate and well-run rural health services can be provided at reasonable cos t - - i s gratifying, but one must be sceptical about the rephcatlon of expatriate-controlled model units to the real world o f government-run health care systems where management and motivation are less easy to reproduce

The section on Medical Anthropology contains two of the most readable papers Van der Veen's exposition of

how doctor-pat ient relationships evolve in India against a compound background of single- and multi-stranded relationships is a useful model m explaining the frustrating (to Westerners) tendency for Third World peoples to j ump queues, seek back-door favours and generally not obey the rules when Western-style structures are introduced into their societies The fact that both sets of ac to rs - - doctors and pa t ien ts - -can impose and be imposed upon by the power o f ascription (which is articulated through regional, caste and family loyalties) is brought out clearly in the paper

The other paper m this section which is highly relevant to the theme of the meeting is the expose of Slch et al of a 'folk disease' in Korea called 'Naeng' , which, apparently, modern practitioners are unable to view m the hohstm manner usually adopted by the populauon at large, with the result that few sufferers o f Naeng receive satisfactory treatment by modern practmoners

The Nutri t ion section contains papers from Thailand, Zalre and Kenya considering differences in nutritional status of settlers and non-settlers, rural and urban children and mothers, and pregnant and lactating women These studies are very detailed though the findings contain few surprises or revolutionary solutions to the problems identified The fourth paper m th~s secUon considers the technical problem of rater-relating an thropometnc parameters and, while the data is drawn from a sample of children in Indonesia, there is no reason why the paper is particularly relevant to the conference theme

The final section on Non-Parasiuc Infectious Diseases is somewhat artificially included as being an area neglected by the T D R programme of the W H O The three papers on dlarrhoeal disease due to enterotoxic bacteria Ebola virus and Lassa Fever are undoubtedly of interest to the virologist, but seen out of place here

On the whole, therefore, the collection is something of a mixed bag, and a very lop-sided bag at that The meeting which generated the papers took place several years ago and much of the research reported here has been updated and produced elsewhere The papers based on the Joint Project Machakos, for example, appear m a slightly different form m a much more cohesive text by van Ginneken and Muller [van Ginneken J K and Muller A S (Eds) Maternal and Chdd Health m Rural Kenya An EpMemtologtcal Stud) Croom Helm. Beckenham. 1984] If the same outcome is the case for the other papers, then there seems little point m publishing this collection for general consumption

A final grumble concerns the general editing While standardisat ion o f papers by researchers writing in their second or third language is not easy the English versions displayed here are often awkward and the whole set of papers would have benefited from a pass through the spell-checker of a s tandard word-processing package Even cheaply-produced photo-offset texts like this deserve better s tandards of edmng

Dwtston o f Famdy Health Ministry o f Health Natrobt. Kenya

ALAN G FERGUSON