(BQ) Part 1 book “Clinical manual of cultural psychiatry” has contents: Assessment of culturally diverse individuals - introduction and foundations, issues in the assessment and treatment of African American patients, issues in the assessment and treatment of Asian American patients,… and other contents.
Clinical Manual of Cultural Psychiatry Second Edition This page intentionally left blank Clinical Manual of Cultural Psychiatry Second Edition Edited by Russell F Lim, M.D., M.Ed Washington, DC London, England Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S Food and Drug Administration and the general medical community As medical research and practice continue to advance, however, therapeutic standards may change Moreover, specific situations may require a specific therapeutic response not included in this book For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family Books published by American Psychiatric Publishing (APP) represent the findings, conclusions, and views of the individual authors and not necessarily represent the policies and opinions of APP or the American Psychiatric Association If you would like to buy between 25 and 99 copies of this or any other American Psychiatric Publishing title, you are eligible for a 20% discount; please contact Customer Service at appi@psych.org or 800-368-5777 If you wish to buy 100 or more copies of the same title, please e-mail us at bulksales@psych.org for a price quote Copyright © 2015 American Psychiatric Association ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 18 17 16 15 14 Second Edition Typeset in Adobe Garamond and Helvetica American Psychiatric Publishing A Division of American Psychiatric Association 1000 Wilson Boulevard Arlington, VA 22209-3901 www.appi.org Library of Congress Cataloging-in-Publication Data Clinical manual of cultural psychiatry / edited by Russell F Lim.—Second edition p ; cm Includes bibliographical references and index ISBN 978-1-58562-439-3 (pbk : alk paper) I Lim, Russell F., 1961– editor [DNLM: Mental Disorders—ethnology Community Psychiatry CrossCultural Comparison WM 31] RC454 616.89—dc23 2014012210 British Library Cataloguing in Publication Data A CIP record is available from the British Library Contents Contributors xvii Foreword xxi Francis G Lu, M.D Preface xxv Acknowledgments xxix Video Guide xxxi www.appi.org/Lim Assessment of Culturally Diverse Individuals: Introduction and Foundations Hendry Ton, M.D., M.S and Russell F Lim, M.D., M.Ed Historical Perspective Critical Concepts Outline for Cultural Formulation Cultural Formulation Interview Historical Background Conclusion 36 References 37 Applying the DSM-5 Outline for Cultural Formulation and the Cultural Formulation Interview: A Resident’s/Early Career Psychiatrist’s Perspective 43 Angel Caraballo, M.D., Jennifer Robin Lee, M.D., and Russell F Lim, M.D., M.Ed Cultural Identity of the Individual 46 Cultural Concepts of Distress 56 Psychosocial Stressors and Cultural Features of Vulnerability and Resilience 60 Cultural Features of the Relationship Between the Individual and the Clinician 68 Overall Cultural Assessment 72 References 74 Issues in the Assessment and Treatment of African American Patients 77 Tracee Burroughs-Gardner, M.D., Annelle B Primm, M.D., M.P.H., William B Lawson, M.D., Ph.D., and Deborah Cohen, M.B.A Historical Context 79 Current Context 81 Applying the Updated DSM-5 Outline for Cultural Formulation 92 Conclusion 117 References 119 Issues in the Assessment and Treatment of Asian American Patients 127 Nang Du, M.D and Russell F Lim, M.D., M.Ed Overview of the Asian American Population 128 Immigration Patterns 128 Assessment and Therapeutic Techniques: Using the DSM-5 Outline for Cultural Formulation and the Cultural Formulation Interview With Asian Americans 134 Conclusion 174 References 174 Suggested Readings 181 Issues in the Assessment and Treatment of Latino Patients 183 Amaro J Laria, Ph.D and Roberto Lewis-Fernández, M.D Social Demographics and History of U.S Migration Patterns 184 Applying the DSM-5 Outline for Cultural Formulation 196 Overall Cultural Formulation 235 Conclusion 239 References 241 Issues in the Assessment and Treatment of American Indian and Alaska Native Patients 251 Candace M Fleming, Ph.D and Russell F Lim, M.D., M.Ed Current Status 254 Historical Issues That Relate to Mental Health 255 Mental Health Needs and Service System Issues 258 Applying the DSM-5 Outline for Cultural Formulation 260 Conclusion 279 References 280 Cultural Issues in Women’s Mental Health 287 Lisa Andermann, M.Phil., M.D., FRCPC and Kenneth P Fung, M.D., M.Sc., FRCPC Women’s Mental Health and the Women’s Movement: A Brief History 288 Epidemiology and Psychopathology 305 Clinical Assessment 306 Developmental Issues in the Woman’s Life Cycle 307 DSM-5 Outline for Cultural Formulation 321 DSM-5 Cultural Formulation Interview 331 Conclusion 332 Cultural Assessment of Gender: Summary of Key Clinical Skills 332 References 334 Sexual Orientation: Gay Men, Lesbians, and Bisexuals 339 Marshall Forstein, M.D., Jason Lambrese, M.D., and Tauheed Zaman, M.D Disclosure of Sexual Orientation to Providers 343 Epidemiology of Homosexuality 343 Psychiatric Disorders and Suicide in Lesbian, Gay, and Bisexual People 347 History of Homosexuality 349 Sexual Identity Terminology 358 Cultural Identity of the Individual: Development of a Lesbian, Gay, or Bisexual Identity 359 Common Issues for Lesbian, Gay, or Bisexual People Presenting for Treatment Throughout the Life Cycle 375 Assessment 379 Conclusion 387 References 388 Transgender and Gender Nonconforming Patients 397 Dan H Karasic, M.D Transgender Identity Formation 399 Transition Care and the WPATH Standards of Care, Version 400 Transgender Patients in Health Care Settings 402 Case Discussion: Outline for Cultural Formulation 405 Conclusion 408 References 409 10 Religious and Spiritual Assessment 411 David M Gellerman, M.D., Ph.D Performing a Spiritual Assessment 413 Using the Outline for Cultural Formulation to Organize the Spiritual Assessment 417 Conclusion 429 References 430 11 Ethnopsychopharmacology 435 David C Henderson, M.D and Brenda Vincenzi, M.D Introduction to the Pharmacogenetics of Drug-Metabolizing Enzymes 437 Ethnic Variation in Medication Response 437 Pharmacogenetics of Drug-Metabolizing Enzymes 442 Cytochrome P450 Enzymes and Environmental Factors 454 Importance of Nonpharmacological Factors 459 Conclusion 460 References 462 12 Conclusion: Applying the Updated DSM-5 Outline for Cultural Formulation and Cultural Formulation Interview 469 Russell F Lim, M.D., M.Ed Outline for Cultural Formulation 470 Cultural Formulation Interview 473 Final Thoughts 474 References 475 Appendix 1: DSM-5 Outline for Cultural Formulation, Cultural Formulation Interview, and Supplementary Modules 477 Outline for Cultural Formulation 477 Cultural Formulation Interview (CFI) 479 Cultural Formulation Interview (CFI)—Informant Version 487 Supplementary Modules to the Core Cultural Formulation Interview (CFI) 493 Appendix 2: DSM-5 Glossary of Cultural Concepts of Distress 519 Ataque de nervios 519 Dhat syndrome 521 272 Clinical Manual of Cultural Psychiatry, Second Edition port for its members The tiospaye, a Lakota expression of traditional lifestyle based on extended family, shared responsibility, and reciprocity (Mohatt and Blue 1982), is being revitalized in many northern Plains Indian communities Contemporary stresses on Indian families often work against smooth provision of support When the expectations not match the actual behaviors, tensions can develop among family members, leading to many possible negative emotions and behaviors Intergenerational Relationships The value of a strong extended family whose members from each generation actively support one another is very robust in American Indian and Alaska Natives Children are considered sacred gifts to be nurtured and protected Children are also considered teachers within the family and tribal nation Similarly, elders are carriers of valuable indigenous knowledge and wisdom Each phase of life holds tasks and blessings for the individual that will benefit the family and tribe These teachings about intergenerational harmony and support are being articulated more clearly now as tribal nations revitalize the ways culture is celebrated and practiced Families that have been challenged over the last three to four generations by the negative effects of boarding schools, out-ofhome placements of the children, substance abuse, extreme poverty, and other devastating outcomes of colonialism are not in tune with these teachings about the strengths of the extended family Thus, conflicts between generations often present concern at behavioral health clinics Family-centered approaches are considered to be promising and consistent with the values of most Indian and Native communities Levels of Functioning and Disability Culture very much defines the parameters of “normal” functioning and the assessment of abilities In Indian cultures, where belonging to and contributing to the larger group are highly valued, a child with severe developmental disabilities might be described as functioning highly because he brings wood into the house for the daily fire In this case, the contribution to the household, however simple, overshadows what might be called disabilities by other standards CFI supplementary module 3, “Social Network,” helps to outline how to assess a patient’s support system The 15 questions ask patients to talk about American Indian and Alaska Native Patients 273 whom they talk to about their problems and who gives them advice or helps with their treatment (see Appendix 1, pp 497–498) Cultural Features of the Relationship Between the Individual and the Clinician Case (continued) The clinician who evaluated Susie for poor school performance was a new behavioral health consultant to that public school’s new medical clinic, which targeted diabetes prevention in the school population She had not served Indian children before but was able to connect with Susie through drawing Susie did not want to talk about her cousin and did not bring up the singing; however, she did say that she missed her family from her former home The clinician sought the guidance of the school’s home-school coordinator, a Lakota woman who knew many families on the reservation The home-school coordinator believed that Susie’s extended family had many resources to give, and she urged the clinician to ask Susie to have other family members participate in the evaluation if she wished Two older aunts came with Susie’s mother for the intake interview at the new school They listened carefully to the observations of the school staff and provided background information when Susie’s mother indicated that she wanted their input They also made it clear what issues would be addressed by the family in their ceremonies Together, they came up with ways the school staff could support Susie and her mother through the challenging circumstances Just as the clinician has questions about the patient and his or her situation, the patient has questions and expectations about the provider and about the processes called diagnosis, assessment, and therapeutic intervention A focus on counselor characteristics and considerations is prominent in the publications by counselors, clinicians, and scholars regarding mental health interventions with Native American Indians (Trimble and Thurman 2002) Indians and Natives have ideas about—if not experience with—providers of mental health services from a Western health care system and also about helpers from indigenous healing systems (Tables 6–2 and 6–3) The latter group are variously called medicine men and medicine women, shamans, spiritual leaders, and healers, among other terms specific to certain tribes (e.g., the hand trembler of the Diné/Navajo) The non-Indian clinician may have difficulty with the belief systems associated with indigenous ceremonies and 274 Clinical Manual of Cultural Psychiatry, Second Edition Table 6–2 Native American patient’s expectations of a non-Native healer I expect the healer not to know much about Indians in general, let alone the history of my tribe, its traditional beliefs and values, current tribal organization, and its problems and resources I expect that the healer will not value healing rituals I expect the healer to consider only the deficits and to ignore the strengths of myself, my family, and my community I expect that the healer will understand reluctance to talk about my strengths and resources because it could be interpreted as boasting I expect that the healer will not understand how hard it is to honor Native traditions and survive in the host culture I expect to question the trustworthiness of the healer I expect to present a concrete problem before I talk about other kinds of problems I expect not to trust the mental health system because I believe it is likely to be patronizing (based on experiences with the Bureau of Indian Affairs and Indian Health Service) and nonsupportive of self-determination I expect that the healer will not talk about the mutual responsibilities of the healer and myself herbal medicines However, because many Indians and Natives hold great respect for indigenous healing ways, the non-Native clinician is exhorted to suspend disbelief and to listen to and hear whatever the Indian patient shares (Trimble and Thurman 2002) Although it is natural to focus on the differences in theory, belief, and approach between Western and indigenous healers, Torrey (1986) has described commonalities Indian and Native healers often exemplify empathy, genuineness, availability, respect, warmth, congruence, and concreteness; correspondingly, most Western mental health theories and styles predicate their interventions on a basic therapeutic relationship in which the provider communicates these characteristics to the patient Reimer (1999) asked Inupiat villagers in Alaska to state the characteristics they found desirable in a healer Their replies (described in Table 6–4) included expectations for community, cultural, and spiritual involvement, as American Indian and Alaska Native Patients 275 Table 6–3 Native American patient’s expectations of an indigenous healer I expect that the healer/diagnostician will identify my problems without prying too deeply into my personal life or asking many intimate questions I expect that family members will be involved I expect that improvement will occur quickly I expect the healer to “take charge” and solve the problem I will be hopeful, but the healer is the active one I expect the healer to consider all of myself: physical, mental, emotional, spiritual, and interpersonal domains I expect to be understood within the context of my relationship to Nature I expect that my individual hurt is also a community hurt I expect that “harmony and balance” will be considered important in understanding my situation I expect that the healer will understand how breaking a taboo or ignoring a tradition can result in my circumstance well as attributes and behavior conventionally expected to be a major part of the clinical encounter If domains other than mental health are the purview of the respected healer, it stands to reason that Indians and Natives might meet a Western-trained provider of mental health services and expect assistance with medical concerns, spirituality, financial issues, or the problems of persons important to the patient (Helms and Cook 1999) Empirical research, case studies, and clinical experience also identify the following clinician characteristics associated with effective therapeutic relationships: the clinician 1) is trustworthy (LaFromboise and Dixon 1981), 2) uses self-disclosure to show warmth and genuineness (Lockhart 1981), 3) provides practical advice and is flexible about the location of service (LaFromboise et al 1980), and 4) dresses and presents himself or herself in a way that reflects the community’s beliefs about leadership and authority figures (Littrell and Littrell 1983) (see Table 6–5) Some researchers say that the best match for an Indian or Native patient is an Indian or Native provider (Darou 1987; Uhlemann et al 1988) This seems 276 Clinical Manual of Cultural Psychiatry, Second Edition Table 6–4 Native American patients’ desired characteristics of therapists A therapist should be Virtuous, kind, respectful, trustworthy, friendly, gentle, loving, clean, giving, helpful, not a gossip, and not one who wallows in self-pity Strong physically, mentally, spiritually, personally, socially, and emotionally A good therapist Is respected because of his or her knowledge, disciplined in thought and action, wise and understanding, and willing to share knowledge by teaching and serving as an inspiration Is substance free Works well with others by becoming familiar with people in the community Has good communication skills, achieved by taking time to talk, visit, and listen Knows and follows the culture Has faith and a strong relationship with the Creator Source Adapted from Reimer 1999 to be particularly true of patients who are involved with their Indian/Native heritage (Johnson and Lashley 1989) In a study by Bennett and BigFoot-Sipes (1991), Indians said that being matched with counselors whose attitudes and beliefs were similar to theirs was more important than shared ethnicity Dinges et al (1981) acknowledged that ethnic match might support rapport building but asserted that perceived effectiveness (e.g., warmth, genuineness, respect, and empathy) is more likely than ethnic match to sustain the therapeutic relationship Herring (1999) pointed out that because very few Indians and Natives are mental health professionals, non-Indians will serve Indian and Native patients for quite a long time to come Thus, although shared ethnicity is important, all clinicians need to be knowledgeable and skilled in assessing and treating Indians and Natives Using a cultural consultant, clinician, or community member who is familiar with the patient’s reference group is helpful in determining normative and nonnormative behavior and symptoms In addition, there are specific techniques that are likely to be helpful in engaging the patient (Table 6–6) American Indian and Alaska Native Patients 277 Table 6–5 Developing trust between Indian and Native patients and their therapists Therapists who gained their patient’s trust Were attentive and responsive to the patient Gave structure and direction to the interview Showed respect for the patient’s cultural identity Used eye contact similar to that of the patient Sat erect in their chair Avoided references to time until the end of the session Source Adapted from LaFromboise and Dixon 1981 CFI supplementary module 8, “Patient-Clinician Relationship,” offers five questions for the patient and seven for the clinician after the patient has left the room Questions 1–4 are about getting a history of the patient’s relationships with therapists, and question addresses whether any differences between the clinician and the patient will affect their working relationship (see Appendix 1, pp 507–509) Overall Cultural Assessment Case (continued) Susie and her mother are clearly identified with their clan and greater tribal community At the time of referral for behavioral health services, the family had been separated from their extended family for a brief period and had not yet developed ties with their new community and its resources Clearly, it was wise to mobilize the extended family in support of Susie and her mother during the assessment of Susie’s needs The home-school coordinator was able to enlist the help of the family because of her wide knowledge of the several reservation communities and the ease with which family elders could travel the distance to the agency town and participate in sessions at the school The consequence of this collaboration with the family’s natural helping system was greater understanding of the severity of the illness experience (academic problems and worry) from the cultural point of view and clear expectations for appropriate intervention at the school 278 Clinical Manual of Cultural Psychiatry, Second Edition Table 6–6 Building effective therapeutic relationships between Indian and Native patients and therapists Explain to the patient that you will have plenty of time to get to know each other before discussing any concerns the patient may have Communicate that there are no demands to behave a certain way or talk a certain amount Avoid lengthy intake forms or questionnaires Accept the presence of a friend or family member Ensure that the atmosphere is relaxed, casual, and nonthreatening Use an informal, conversational verbal style Talk about practical issues of daily life before talking about intimate issues Use self-disclosure as a way to prompt self-disclosure on the part of the patient Avoid direct questioning for a while Communicate warmth, caring, genuineness, and respect The task of synthesizing the information gleaned from assessment that contains the cultural context of the Indian patient is one that will likely result in a formulation that is balanced with the identification of problem areas and strengths A key in the assessment process is to identify the Indian or Native’s level of affiliation with non-Indian and Indian cultures Another is to learn about the historical issues that affect the individual, family, and community Several recommendations for establishing a “culturally affirmative environment” (Herring 1999) for Indians and Natives have been identified These suggestions (detailed in Table 6–7) call for candor, flexibility, patience, openness to family involvement, development of trust, respect for culture, and maintenance of confidentiality (Herring 1999) Finally, certain therapeutic approaches may be more effective, such as a more direct, present-focused therapy that prioritizes problem-solving techniques One should avoid techniques such as explorative psychotherapy, promotion of catharsis, and a permissive approach American Indian and Alaska Native Patients 279 Table 6–7 Suggestions for working with Native American patients Therapists sensitive to Native American patients should Openly address the issue of dissimilar ethnic relationships rather than pretending that there are no differences Schedule appointments with gaps between appointments to allow for flexibility in ending the session rather than having rigid 50-minute sessions Consider the extended family as part of the patient’s community and allow them to participate in the session Allow time to build trust to develop before focusing on problems Recognize the uses and value of silence Act in ways that show honor and respect for the patient’s culture Respect the patient’s need for the highest level of confidentiality Source Adapted from Herring 1999 Conclusion As time goes on, American Indian and Alaska Native populations will increasingly become consumers in health systems that are not yet prepared for them The scenario that began this chapter can become a reality if certain developments occur to address the many knowledge and skill gaps that exist in mental health services for Indian and Native people Clinical training programs can include curricula and access to clinical sites specific to this population Researchers and clinicians can carefully document interventions that are effective not only globally with Indians and Natives but also with specific tribes Health systems can institute in-service training on a regular basis to providers, can hire Indian or Native providers whenever possible, and can develop linkages with the Indian community or communities within the region As Indian and Native communities continue on their journey of revitalization, they are becoming more active in designing health systems that work for them There is an increased awareness that behavioral health services are vital to bettering the overall health of Indians and Natives In Mental Health: Culture, Race, and Ethnicity A Supplement to Mental Health: A Report of the Surgeon General (U.S Department of Health and Human Services 2001), the 280 Clinical Manual of Cultural Psychiatry, Second Edition take-home message is that “culture counts.” The opportunity is ripe for establishing partnerships between the service provider sector and the Indian community The efforts of each of us can count significantly in this important venture References Allen J, Levintova M, Mohatt G: Suicide and alcohol-related disorders in the U.S Arctic: boosting research to address a primary determinant of health disparities Int J Circumpolar Health 70(5):473–487, 2011 American Psychiatric Association: Appendix I: Outline for cultural formulation and glossary of culture-bound syndromes, in Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision Washington, DC, American Psychiatric Association, 2000, pp 897–903 American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Washington, DC, American Psychiatric Association, 2013 Balsam KF, Huang B, Fieland KC, et al: Culture, trauma, and wellness: a comparison of heterosexual and lesbian, gay, bisexual, and two-spirit Native Americans Cultur Divers Ethnic Minor Psychol 10(3):287–301, 2004 Beals J, Novins DK, Mitchell CM, et al: Comorbidity between alcohol abuse/dependence and psychiatric disorders: prevalence, treatment implications, and new directions for research among American Indian populations, in Alcohol Use Among American Indians and Alaska Natives: Multiple Perspectives on a Complex Problem (NIAAA Monograph No 37) Edited by Mail PD, Heurtin-Roberts S, Martin SE, et al Bethesda, MD, National Institute on Alcohol Abuse and Alcoholism, 2002, pp 317–410 Beals J, Manson SM, Whitesell NR, et al: Prevalence of DSM-IV disorders and attendant help-seeking in American Indian reservation populations Arch Gen Psychiatry 62(1):99–108, 2005a Beals J, Manson SM, Whitesell NR, et al: Prevalence of major depressive episode in two American Indian reservation populations: unexpected findings with a structured interview Am J Psychiatry 162(9):1713–1722, 2005b Bennett S, BigFoot-Sipes D: American Indian and white college students’ preferences for counselor characteristics J Couns Psychol 38(4):440–445, 1991 Blue A, Blue M: The strain of stress White Cloud Journal of American Indian-Alaska Native Mental Health 3(1):15–22, 1983 American Indian and Alaska Native Patients 281 Blum RW, Harmon B, Harris L, et al: American Indian—Alaska Native youth health JAMA 267(12):1637–1644, 1992 Brave Heart MY, DeBruyn LM: The American Indian holocaust: healing historical unresolved grief Am Indian Alsk Native Ment Health Res 5:56–78, 1998 Brown ER, Ojeda VD, Wyn R, et al: Racial and Ethnic Disparities in Access to Health Insurance and Health Care Los Angeles, CA, UCLA Center for Health Policy Research and the Henry J Kaiser Family Foundation, 2000 Buchwald DS, Beals J, Manson SM: Use of traditional health practices among Native Americans in a primary care setting Med Care 38(12):1191–1199, 2000 Cross TA, Earle KA, Simmons D: Child abuse and neglect in Indian country: policy issues Fam Soc 81:49–58, 2000 Darou WG: Counseling and the northern Native Can J Counsell 32:33–41, 1987 Dinges N, Trimble JE, Manson S, et al: Counseling and psychotherapy with American Indians and Alaska Natives, in Cross-Cultural Counseling and Psychotherapy: Foundations, Evaluation, and Cultural Considerations Edited by Marsella AJ, Pedersen PB Elmsford, NY, Pergamon, 1981, pp 243–276 Dixon M, Mather DT, Shelton BL, et al: Economic and organizational changes in health care systems, in Promises to Keep: Public Health Policy for American Indians and Alaska Natives in the 21st Century Edited by Dixon M, Roubideaux Y Washington, DC, American Public Health Association, 2001, pp 89–134 Duran E, Duran B: Native American Postcolonial Psychology Albany, State University of New York Press, 1995 Escobar JI, Vega WA: Mental health and immigration’s AAAs: where are we and where we go from here? J Nerv Ment Dis 188(11):736–740, 2000 Evans-Campbell T, Walters KL, Pearson CR, et al: Indian boarding school experience, substance use, and mental health among urban two-spirit American Indian/ Alaska Natives Am J Drug Alcohol Abuse 38(5):421–427, 2012 Fleming W: The Complete Idiot’s Guide to Native American History Indianapolis, IN, Alpha Books, 2003 Gessner BD: Temporal trends and geographic patterns of teen suicide in Alaska, 1979– 1993 Suicide Life Threat Behav 27(3):264–273, 1997 Gone JP, Alcántara C: Identifying effective mental health interventions for American Indians and Alaska Natives: a review of the literature Cultur Divers Ethnic Minor Psychol 13(4):356–363, 2007 Gone JP, Trimble JE: American Indian and Alaska Native mental health: diverse perspectives on enduring disparities Annu Rev Clin Psychol 8:131–160, 2012 Gurley D, Novins DK, Jones MC, et al: Comparative use of biomedical services and traditional healing options by American Indian veterans Psychiatr Serv 52(1):68–74, 2001 282 Clinical Manual of Cultural Psychiatry, Second Edition Hatala AR: Spirituality and Aboriginal mental health: an examination of the relationship between Aboriginal spirituality and mental health Adv Mind Body Med 23(1):6–12, 2008 Helms JE, Cook DA: Using Race and Culture in Counseling and Psychotherapy: Theory and Process Boston, MA, Allyn & Bacon, 1999 Herring RD: Counseling With Native American Indians and Alaska Natives: Strategies for Helping Professionals Thousand Oaks, CA, Sage, 1999 Hodge DR, Limb GE: A Native American perspective on spiritual assessment: the strengths and limitations of a complementary set of assessment tools Health Soc Work 35(2):121–131, 2010 Horejsi C, Craig BHR, Pablo J: Reactions by Native American parents to child protection agencies: cultural and community factors Child Welfare 71(4):329–342, 1992 Jilek-Aall L: The Western psychiatrist and his non-Western clientele: transcultural experiences of relevance to psychotherapy with Canadian Indian patients Can Psychiatr Assoc J 21(6):353–359, 1976 Johnson M, Lashley K: Influence of Native Americans’ cultural commitment on preferences for counselor ethnicity and expectations about counseling J Multicult Couns Devel 17(3):115–122, 1989 Kettl PA, Bixler EO: Suicide in Alaska Natives, 1979–1984 Psychiatry 54(1):55–63, 1991 Kim C, Kwok YS: Navajo use of native healers Arch Intern Med 158(20):2245–2249, 1998 Kinzie JD, Manson SM: The use of self-rating scales in cross-cultural psychiatry Hosp Community Psychiatry 38(2):190–196, 1987 Kleinfeld J: A Long Way From Home: Effects of Public High Schools on Village Children Away From Home Fairbanks, AK, Center for Northern Educational Research and Institute of Social, Economic, and Government Research, 1973 Kleinfeld J, Bloom J: Boarding schools: effects on the mental health of Eskimo adolescents Am J Psychiatry 134(4):411–417, 1977 Kulis S, Hodge DR, Ayers SL, et al: Spirituality and religion: intertwined protective factors for substance use among urban American Indian youth Am J Drug Alcohol Abuse 38(5):444–449, 2012 LaFromboise T, Dixon D: American Indian perceptions of trustworthiness in a counseling interview J Couns Psychol 28(2):135–139, 1981 LaFromboise T, Dauphinais P, Rowe W: Indian students’ perceptions of positive helper attributes Journal of American Indian Education 19:11–16, 1980 Level of Need Funded Workgroup: Level of Need Funded Study (LNF Workgroup Report II) Rockville, MD, Indian Health Service, 1999 American Indian and Alaska Native Patients 283 Littrell MA, Littrell JM: Counselor dress cues: evaluations by American Indians and Caucasians J Cross Cult Psychol 14(1):109–121, 1983 Lockhart B: Historic distrust and the counseling of American Indians and Alaskan Natives White Cloud Journal of American Indian-Alaska Native Mental Health 2(3):31–43, 1981 Manson SM: Culture and depression: discovering variations in the experience of illness, in Psychology and Culture Edited by Lonner WJ, Malpass RS Needham, MA, Allyn & Bacon, 1994, pp 285–290 Manson SM, Shore JH, Bloom JD: The depressive experience in American Indian communities: a challenge for psychiatric theory and diagnosis, in Culture and Depression Edited by Kleinman A, Good B Berkeley, University of California Press, 1985, pp 331–368 Marano L: Windigo psychosis: the anatomy of an emic-etic confusion, in The CultureBound Syndromes: Folk Illnesses of Psychiatric and Anthropological Interest Edited by Simons RC, Hughes CC Boston, MA, D Reidel, 1985, pp 411–448 Marbella AM, Harris MC, Diehr S, et al: Use of Native American healers among Native American patients in an urban Native American health center Arch Fam Med 7(2):182–185, 1998 May PA: A bibliography on suicide and suicide attempts among American Indians and Alaska Natives Omega 21(3):199–214, 1990 Mock CN, Grossman DC, Mulder D, et al: Health care utilization as a marker for suicidal behavior on an American Indian reservation J Gen Intern Med 11(9):519– 524, 1996 Mohatt G, Blue AW: Primary prevention as it relates to traditionality and empirical measures of social deviance, in New Directions in Prevention Among American Indian and Alaska Native Communities Edited by Manson SM Portland, Oregon Health Sciences University, 1982, pp 91–116 National Congress of American Indians: Introduction to Tribal Governments Washington, DC, National Congress of American Indians, 2013 Available at: http:// www.ncai.org/about-tribes Accessed February 1, 2013 Nelson K, Cross T, Landsman M, et al: Native American families and child neglect Child Youth Serv Rev 18(6):505–522, 1996 Nelson S, Manson SM: Mental health and mental disorder, in The Health of American Indians and Alaska Natives Edited by Rhoades ER Baltimore, MD, Johns Hopkins University Press, 2000, pp 311–327 Norris T, Vines PL, Hoeffel M: The American Indian and Alaska Native Population: 2010, in 2010 Census Briefs (2010BR-10) Washington, DC, U.S Census Bureau, January 2010 Available at: http://www.census.gov/prod/cen2010/briefs/ c2010br-10.pdf Accessed February 1, 2013 284 Clinical Manual of Cultural Psychiatry, Second Edition Perkins R, Sanddal T, Sanddal N, et al: Alaska Suicide Follow-back Study Final Report Juneau, Alaska Department of Health and Social Services, 2007 Available at: http:// dhss.alaska.gov/SuicidePrevention/Documents/pdfs_sspc/sspcfollowback2-07.pdf Accessed April 28, 2014 Reimer CS: Counseling the Inupiat Eskimo Westport, CT, Greenwood, 1999 Robbins ML: Native American perspective, in Managing Multiculturalism in Substance Abuse Services Edited by Gordon JU Thousand Oaks, CA, Sage, 1994, pp 148–176 Robin RW, Chester B, Rasmussen JK, et al: Prevalence, characteristics, and impact of childhood sexual abuse in a Southwestern American Indian tribe Child Abuse Negl 21(8):769–787, 1997 Roll S: Cross-cultural considerations in custody and parenting plans Child Adolesc Psychiatr Clin N Am 7(2):445–454, 1998 Rural Policy Research Institute: Rural by the numbers: information about rural America Columbia, MO, Rural Policy Research Institute, 1997 Shore JH, Nicholls WM: Indian children and tribal group homes: new interpretations of the Whipper Man Am J Psychiatry 132(4):454–456, 1975 Somervell PD, Beals J, Kinzie JD, et al: Use of the CES-D in an American Indian village Cult Med Psychiatry 16(4):503–517, 1992–1993 Special Subcommittee on Indian Education, Senate Committee on Labor and Public Welfare: Indian Education: A National Tragedy, a National Challenge (Senate Report No 91–501) Washington, DC, U.S Senate, 1969 Tafoya T: Native gay and lesbian issues: the two-spirited, in Psychological Perspectives on Lesbian, Gay, and Bisexual Experiences, 2nd Edition Edited by Garnets LD, Kimmel DC New York, Columbia University Press, 2003, pp 401–409 Thornton R: American Indian Holocaust and Survival: A Population History Since 1492 Norman, University of Oklahoma Press, 1987 Torrey EF: Witch Doctors and Psychiatrists: The Common Roots of Psychotherapy and Its Future New York, Harper & Row, 1986 Trimble J, Thurman PJ: Ethnocultural considerations and strategies for providing counseling services to Native American Indians, in Counseling Across Cultures, 5th Edition Edited by Pedersen PB, Draguns JG, Lonner WJ, et al Thousand Oaks, CA, Sage, 2002, pp 53–91 Trimble JE, Manson SM, Dinges NG, et al: Towards an understanding of American Indian concepts of mental health: some reflections and directions, in Mental Health Services: The Cross/Cultural Context Edited by Pedersen P, Sartorius N, Marsala A Beverly Hills, CA, Sage, 1984, pp 199–220 Uhlemann M, Lee D, France H: Counsellor ethnic differences and perceived counselling effectiveness Int J Adv Couns 11:247–253, 1988 American Indian and Alaska Native Patients 285 U.S Census Bureau: The American Indian and Alaska Native Population: 2010 Washington, DC, U.S Census Bureau, 2010 Available at: http://www.census.gov/ prod/cen2010/briefs/c2010br-10.pdf Accessed April 26, 2014 U.S Census Bureau: Statistical Abstract of the United States: The National Data Book Washington, DC, U.S Census Bureau, 1999 U.S Department of Health and Human Services: Mental Health: Culture, Race, and Ethnicity A Supplement to Mental Health: A Report of the Surgeon General Rockville, MD, U.S Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001 Available at: http://www.ncbi.nlm.nih.gov/ books/NBK44243/?term=supplement%20to%20mental%20health Accessed April 26, 2014 Waldman C: Atlas of the North American Indian New York, Facts On File, 1985 Westermeyer J: Alcoholism and services for ethnic populations, in Encyclopedic Handbook of Alcoholism Edited by Pattison E, Kaufman E New York, Gardner Press, 1982, pp 709–717 Westermeyer J, Peake E: A ten-year follow-up of alcoholic Native Americans in Minnesota Am J Psychiatry 140(2):189–194, 1983 Whitesell NR, Beals J, Crow CB, et al: Epidemiology and etiology of substance use among American Indians and Alaska Natives: risk, protection, and implications for prevention Am J Drug Alcohol Abuse 38(5):376–382, 2012 Whittaker JO: Alcohol and the Standing Rock Sioux Tribe: a twenty-year follow-up study J Stud Alcohol 43(3):191–200, 1982 This page intentionally left blank ... Table 10 1 Table 11 1 Table 11 –2 Table 11 –3 Table 11 –4 Table 11 –5 Table 11 –6 Table 11 –7 Dimensions of sexual, social, and psychological orientation 360 Cass’s six stages of sexual... Adult Psychiatry Resident, Cambridge Hospital; Clinical Fellow in Psychiatry, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts xx Clinical Manual of Cultural Psychiatry, ... 15 Table 1 6 Cultural identity: advantages of assessment 16 Table 1 7 Conflicting explanatory models 21 Table 1 8 Kleinman’s eight questions 23 Table 1 9 Cultural