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achievement gaps between certain racial or ethnic groups ACADEMIC ACHIEVEMENT on standardized tests in different subject areas and across AND MINORITY INDIVIDUALS grade levels. Other measures of academic achievement, such as grades and class rankings, show similar differ- The academic achievement of some minority individ- ences in minority and majority achievement. uals and groups remains a ubiquitous and seemingly Beyond the consistency of the disparities in minor- intractable problem in the United States. The problem ity and majority achievement, it is by no means clear is usually defined in terms of mean differences in what these discrepant scores really mean. To character- standardized achievement test scores between certain ize racial and ethnic differences as minority differences racial or ethnic groups. There is good reason for con- suggests that these groups have had similar experiences cern because on virtually every measure of academic and that these experiences influence their behavior in achievement, African American, Latino, and Native a similar way. However, this is not the case. There is American students, as a group, score significantly tremendous variability within and across racial and lower that their peers from European backgrounds. ethnic groups even though they are ascribed minority Moreover, it appears that gaps first manifest early in status in U.S. society. For example, native-born African school, broaden during the elementary school years, Americans and immigrants of African ancestry are sim- and remain relatively fixed during the secondary ilar in terms of race and minority status, but they have school years. had different culturally mediated socialization experiences that affect their achievement motivation and academic performance differently. However, because THE NATURE AND SCOPE OF THE PROBLEM academic achievement is usually reported as a mean OF MINORITY ACADEMIC ACHIEVEMENT score for African Americans, it is difficult to differenti- One source of information that has documented aca- ate the nature of the performance of either minority demic achievement trends among minorities for more group. But it is important to know which minority than three decades is the National Assessment of Educa- groups are performing high or low because such infor- tional Progress testing program. If the term “minority” mation is critical for informing appropriate intervention is defined as a racial or ethnic group within a larger for both groups. population, then the lower performance in achievement is associated with students from certain minor- FACTORS THAT INFLUENCE ity populations defined as African American and LOW MINORITY ACHIEVEMENT Hispanic. If the term “majority” is used to define a racial or ethnic group that characterizes the larger popu- Since the 1960s, numerous perspectives have been lation, then the higher performance in achievement advanced about the differences in academic achieve- is associated with students from European back- ment among minority and majority students and grounds. These data have consistently shown significant groups. Reasons include unequal opportunities to

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learn, limited access to educationally relevant resources, many members of a majority population hold about ethnic and racial stereotyping, and cultural incompat- individuals and groups who have been assigned ibility between the home and school culture. Each will minority status in society. In the United States, the be discussed briefly. effects of racial stereotyping have a particularly devastating effect on the academic motivation and achievement of some individuals from racial and Limited Opportunities to Learn ethnic minority groups, particularly those who have In reviewing the literature on who gets access to been brought into society involuntarily through slav- rigorous curricula in schools, it appears that, on the ery and conquest (e.g., African Americans, Mexican basis of standardized test results, a disproportionate Americans, and Native Americans). In the education number of racial and ethnic minority individuals, par- sphere, some individuals from these ascribed caste- ticularly those from low-income backgrounds, are like minority groups have rejected this form of stereo- judged as “low ability” and assigned to low-track or typing by developing coping mechanisms to protect remedial classes. In contrast, individuals of European their identity. In so doing, these identity-protection descent, particularly those from high-income back- strategies serve to dampen their achievement moti- grounds, are more likely to be considered “gifted and vation, which, in turn, results in low academic talented” and placed in enriched or accelerated pro- achievement. grams. Because track enrollment determines the level of courses students take and the quality of the curriculum and instruction to which they are exposed, Cultural Incompatibility this means that minority students, on average, are less Between Home and School Culture likely than their majority peers to engage in high- Schooling is ineffective for some children from caliber curricula. Diminished opportunity to learn high- racial and ethnic minority groups because classroom level material results in low academic achievement. practices may be incompatible with their cultural background. Cultural incompatibilities include a lack of Limited Access to Institutional respect for children’s conversational style and collabo- and Other Resources rative participation structures. Such misunderstandings can contribute to diminished commitment to academic Well-equipped libraries, mentoring, tutoring, qual- engagement and academic underachievement. ity teaching, rigorous curricula, low counselor– student and teacher–student ratios, small class sizes, extracurricular experiences, and computer and other RECOMMENDATIONS FOR technologies are examples of key resources in educa- IMPROVING MINORITY ACHIEVEMENT tion that may be viewed as preconditions for enabling high levels of academic achievement. Unfortunately, Reducing or eliminating the minority achievement a disproportionate number of individuals from certain gap remains one of the most serious challenges in minority groups (e.g., African Americans, Latinos, U.S. education today. Efforts to close the gap should and Native Americans), particularly those from low- take the following considerations into account. income backgrounds, are likely to attend schools with limited access to these resources, thus minimizing Disaggregation of Data their opportunity to do well academically. Moreover, many of these individuals live in economically dis- Individuals from minority groups have different tressed communities where they experience poor socialization experiences that have a differential health and inadequate nutrition, factors that place impact on their academic motivation and perfor- them further at risk educationally. mance. Disaggregation of achievement data is necessary to identify which minority individuals and groups are doing poorly and which are doing well. Such The Effects of Racial Stereotyping information on the variability in minority achievement Racial stereotyping is a deeply held, stigmatizing may then be used to target appropriate instruction for belief in unalterable genetic or cultural inferiority that different individuals and groups. A-Jackson.qxd 7/12/2006 2:10 PM Page 3

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Adequate Exposure to Ogbu, J. N. (1987). Variability in minority responses to schooling: Supplementary Education Nonimmigrant vs. immigrants. In G. Spindler & L. Spindler (Eds.), Interpretative ethnography of education: At home and School alone cannot ensure high academic achieve- abroad (pp. 255–278). Hillsdale, NJ: Lawrence Erlbaum. ment. Indeed, parents or significant others of high- O’Sullivan, C. Y., Lauko, M. A., Grigg, W. S., Qian, J., & achieving students recognize the importance of Zhang, J. (2003). The nation’s report card: Reading 2002. supplementary education and routinely make it available Washington, DC: National Center for Education Statistics. to their children over the course of their schooling. Retrieved July 27, 2004, from http://nces.ed.gov Steele, C. M. (1997). A threat in the air: How stereotypes Examples of supplementary education include academic shape intellectual identity and performance. American summer camps, after-school and weekend tutoring, use Psychologist, 52(6), 613–629. of libraries and museums as resources for learning, and access to mentors and models who are themselves high achievers. Low-achieving minority students must have adequate exposure to supplementary education. ACCESSIBILITY OF HEALTH CARE

Adequate Exposure to DEFINITION AND SCOPE High-Quality Teaching OF HEALTH CARE ACCESS Low-achieving students must have adequate expo- The health disparities and health care inequalities expe- sure to high-quality teaching that is responsive to their rienced by major American ethnic groups (compared strengths, needs, and interests. This means not only with CaucasianAmericans) have been well documented. that they must have opportunities to participate in cur- Health disparities are defined as higher rates of chronic ricula and instructional activities that are known to be and disabling illness, infectious disease, and mortality conducive to high academic achievement, but also that experienced by members of ethnic minority groups these experiences must be accommodative to their compared with Caucasians. One of the most important learning strengths and needs. factors contributing to health disparities is limited access to health care. Therefore, improving access to health Access to Educationally care is considered one of the greatest opportunities for Relevant Resources reducing health disparities in the United States. High-achieving students have access to educationally Access to health care can be considered at two levels: relevant resources in the schools they attend and through primary access and secondary access. Primary access their families and communities. Such resources must be involves entry into the health care system and access to made available to low-achieving students as well. basic care. Secondary access involves the quality of care received by individuals with primary access. Primary —Eleanor Armour Thomas and secondary health care access will be discussed See also The Bell Curve; Head Start; Intelligence Tests; with respect to four major cultural groups in the United Scholastic Assessment Test States: African Americans, Hispanic Americans, Asian Americans and Pacific Islanders, and American Indians FURTHER READING and Alaska Natives. Primary access issues include health Braswell, J. S., Lutkus, A. D., Grigg, W. S., Santapau, S. L., insurance rates and the accessibility of health care facili- Tay-Lim, B., & Johnson, M. (2001). The nation’s report ties. Secondary access issues include quality of care, card: Mathematics 2000. Washington, DC: National access to specialists, access to culturally similar health Center for Education Statistics. Retrieved July 27, 2004, care personnel, language barriers, and discrimination. from http://nces.ed.gov Gordon, E. W., & Bridglall, B. L. (2005). The challenge, context and preconditions of academic development. In E. W. AFRICAN AMERICANS Gordon, B. L. Bridglall, & A. S. Meroe (Eds.), Supple- Lack of insurance is considered the most significant mentary education: The hidden curriculum of high academic achievement (pp. 10–34). New York: Rowman & Littlefield. barrier to health care, and for a majority of Americans, Miller, S. (1995). An American imperative: Accelerating health insurance provided by employers makes health minority educational advancement. New Haven, CT: Yale care affordable. The uninsured rate for African University Press. Americans under age 65 is 19.9%. Unemployment is A-Jackson.qxd 7/12/2006 2:10 PM Page 4

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strongly tied to the lack of insurance among African Mexican heritage, and the remainder are from Americans; however, a disproportionate number of Caribbean and South American backgrounds. The African American workers whose employers do not uninsured rate for Hispanics under 65 years old is provide health insurance are also counted among the 33%, the highest rate among the major ethnic groups uninsured. Among African Americans, poverty and in the United States. The high uninsured rate among unemployment rates are 24.4% and 11.6%, respec- Hispanic populations is largely tied to immigration tively, compared with 8.2% and 5.6%, respectively, status. An estimated 72% of foreign-born persons in for Caucasians. this group are not American citizens, and public insur- Another primary health care access issue for African ance programs such as Medicaid deny services to Americans is the availability of health care providers. immigrants. Furthermore, immigrants are more likely In poor, ethnic communities, there is a limited supply to work in low-wage, low-benefit jobs that do not of health resources, primarily because patients in these offer health insurance. Hispanic Americans also rely communities cannot afford to pay for the services pro- heavily on public transportation, which necessitates vided. As a result, health care facilities cannot be main- traveling greater distances and incurring greater costs tained. This reality has driven the creation of community for medical care. health centers and hospital-based providers. Reduced With regard to secondary access, Hispanic patients geographic proximity to health care providers has a experience barriers similar to those of African Americans, particularly strong impact on urban African American including a lower quality of care afforded by lower-end communities that rely heavily on public transportation, insurance plans and discrimination. The language bar- which increases the time and cost of accessing care. rier is a significant secondary access issue for Hispanic A major secondary access issue is the quality of groups: Limited English proficiency on the part of care received by African Americans. Inequalities in Hispanic patients, combined with a lack of Spanish- medical care exist even when African Americans have speaking health care providers, can result in misdiag- insurance plans that are similar to majority group nosis and inappropriate treatment of symptoms. members. For example, African American patients with health maintenance organization (HMO) insur- ASIAN AMERICANS AND ance report more difficulty seeing a specialist and PACIFIC ISLANDERS obtaining tests and treatment, suggesting that barriers exist well beyond entry into the health care system. Asian Americans and Pacific Islanders (AAPIs) repre- Another secondary access issue is the lower num- sent a diverse group with more than 60 different ber of physicians from ethnic minority groups. This national and ethnic origins and more than 100 differ- decreases health care access for minority patients ent languages. This group makes up about 5% of because prospective patients are often reluctant to the total U.S. population (more than 12 million). visit health care providers who may be racially or eth- According to the Institute of Medicine, the uninsured nically different from them. rate for AAPIs under age 65 is 22%. The rates vary Language barriers also influence secondary access. significantly, however, among subgroups, and the Patient–physician communication has been reported highest rate is found among Korean Americans (34%), to be more problematic for African American patients who experience higher rates of poverty. The rates are than for Caucasian patients, even though both patients also higher for Southeast Asian and South Asian and physicians may speak the same language. Finally, groups. In addition to poverty, immigrant status is discrimination is a major barrier to secondary access, a significant barrier to obtaining insurance. Of the affecting physicians’ perceptions of patients as well as AAPIs who are foreign born, 52.9% are not American treatment decisions. For example, a negative percep- citizens and therefore cannot access publicly funded tion of African American patients is associated with a insurance programs. lower likelihood of recommending treatment. Even for AAPIs who have health insurance, poor perceived quality of care is a major secondary access issue. A large survey of individuals in a West Coast HISPANICS HMO revealed that AAPIs consistently had the worst The majority of the 35 million individuals in the access ratings across a variety of measures compared United States counted as Hispanic or Latino are of with other minorities. Limited English proficiency is A-Jackson.qxd 7/12/2006 2:10 PM Page 5

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also a significant secondary access issue for AAPIs. Finally, communication difficulties are important Census data from 1993 estimated that more than secondary access issues for AIANs. Compared with 1.5 million AAPIs live in “linguistically isolated” Caucasians, AIANs report more dissatisfaction with households, that is, those in which no person over age the quality of care received and poorer communica- 14 speaks English “very well.” tion with health care providers. Finally, discrimination affects secondary health care access for AAPIs. Because of their achievements CONCLUSION in the socioeconomic and educational spheres, AAPIs have been labeled the “model minority.” This label is Ethnic minorities in the United States have poorer misleading because it fails to recognize the tremen- health status and less access to health care than dous diversity within the AAPI group and because it Caucasians, largely as a result of lower rates of insur- can blind people to the real needs and problems of ance coverage. Although health insurance coverage AAPI subgroups. addresses the primary access issue, it does not address the myriad secondary access issues that minority Americans face after they get their foot in AMERICAN INDIANS AND the door of the U.S. health care system. These sec- ALASKA NATIVES ondary access issues include less accessible facilities, American Indians and Alaska Natives (AIANs) repre- poorer quality of care, language and communication sent a variety of culturally diverse and distinctive barriers, and discrimination. Greater attention to both groups who speak more than 300 languages and com- primary and secondary health care access issues is prise 562 federally recognized tribes. According to the needed to elucidate the processes that place minority 2002 U.S. Census, 4.1 million people (1.5%) identify group members at a disadvantage when they seek themselves as AIANs. The health care situation of health care. AIANs is somewhat unique compared with other eth- —Lisa C. Campbell nic groups because the U.S. government is obligated —Tamara Duckworth Warner by treaty and federal statutes to provide health care to members of federally recognized American Indian FURTHER READING tribes. The federal Indian Health Service (IHS) was established in 1955 to meet this need. Those AIANs Collins, K. S., Hughes, D. L., Doty, M. M., Ives, B. L., who can readily access IHS services can receive free Edwards, J. N., & Tenney, K. (2002). Diverse communities, common concerns: Assessing health care quality for primary care; limited specialty services are available minority Americans. New York: The Commonwealth Fund. free of charge through contracts with private providers. Retrieved January 13, 2006, from http://www.cmwf.org Unfortunately, the IHS faces a number of obstacles to Lillie-Blanton, M., Rushing, O. E., & Ruiz, S. (2003). Key providing health care access to those it was intended facts: Race, ethnicity, and medical care. Menlo Park, CA: to help. These obstacles include limited funding and Henry J. Kaiser Family Foundation. Retrieved January 28, geographical limitations. The IHS has 34 urban Indian 2006, from http://www.kff.org/minorityhealth/6069-index health programs, but these programs represent only .cfm 1% of the total IHS budget. As a result of the limited Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2002). Unequal treatment: Confronting racial and ethnic dispari- funding, many areas have no services. In addition, IHS ties in health care. Washington, DC: National Academies facilities are located on or near reservations, although Press. Retrieved January 13, 2006, from http://www.nap.edu/ the majority of AIANs live in urban areas away from books/030908265X/html/ their home reservations. Sohler, N., Walmsley, P. J., Lubetkin, E., & Geiger, H. J. The gap between the need for IHS services and (2003). The right to equal treatment: An annotated bibli- access to these services was highlighted by a 2004 ography of studies on racial and ethnic disparities in Kaiser Foundation study, which revealed that more healthcare, their causes, and related issues. New York: Physicians for Human Rights. Retrieved January 13, 2006, than one-third (35%) of AIANs under age 65 are unin- from http://www.phrusa.org/research/domestic/race/race_ sured and only 19% have access to IHS services. The report/report.html problem is worse among low-income AIANs, almost U.S. Census Bureau. (2003). Income, poverty, and health cover- half of whom (48%) are uninsured. Only 23% of unin- age in the United States: 2003. Retrieved January 28, 2006, sured, low-income AIANs have access to IHS services. from http://www.census.gov/hhes/www/poverty.html A-Jackson.qxd 7/12/2006 2:10 PM Page 6

6———Acculturation

One particular negative consequence of the accul- ACCULTURATION turation process is the phenomenon of acculturative stress. Acculturative stress is defined as negative ten- Early conceptualizations of acculturation described sion that can be directly related to threats, conflicts, or an interpersonal transformation that occurs when crises centered on one’s cultural identity, values, or cultures come into sustained contact. Social scientists other emotional and behavioral patterns of living. noted complex changes that can take place, including Prolonged stress, especially of an extremely high level, the conversion of values, the blending or separation of can manifest itself in both psychological symptoms of cultures, and personality and developmental growth. distress (e.g., anxiety, depression) and physiological Researchers attempted to use the acculturation symptoms of distress (e.g., pain, fatigue, dizziness). process to examine the impact of modernization and industrialization on various communities and cultures MEASUREMENT OF ACCULTURATION during the 19th and 20th centuries. In the early part of the 20th century in the United States, acculturation One of the greatest challenges in understanding the became synonymous with assimilation, the loss of role of acculturation in adjustment is the assessment one’s original culture and the adoption of a new host of this construct. Despite the shift in the conceptual- culture. This process was used to describe the experi- ization of acculturation from a one-dimensional ences of immigrants from an array of places (e.g., process to a multidimensional one, the measurement Europe, China, Japan, and Mexico). The ultimate goal of acculturation has failed to reflect this reformula- of American acculturation became the achievement of tion. Indeed, most of the published acculturation assimilation into a melting pot society. scales require respondents to choose among terms that Today, acculturation is considered a more dynamic assess the unidirectional movement of individuals process that occurs along various dimensions rather from traditional culture to majority culture, or they than a simple movement from a culture of origin include scoring techniques that reflect this unidirec- toward assimilation. In addition, acculturation can tional movement. However, there are a very small occur on both the group and the individual levels, thus number of measures developed recently to assess the considering more of the consequent psychological various dimensions of acculturation by measuring two adaptation and adjustment. Four acculturative stages or more cultures independently of each other. This have been described: contact, conflict, crisis, and measurement approach is consistent with the concept adaptation. Furthermore, adaptation can include sev- of biculturalism (or bicultural competence), namely eral strategies: (1) assimilation—the individual or that adaptation to a host culture is possible without group gives up (or is forced to give up) the cultural completely abandoning the culture of origin. identity of origin and desires a positive relationship The most commonly measured aspect of accultura- with the host culture; (2) separation—the individual tion is language, including spoken or written lan- or group retains the original culture (or is restricted guage, language preference, and language proficiency. from adopting the new culture through segregation) Cultural preferences—such as the preference for and desires no positive relationship with the host cul- engagement with people from one’s culture of origin ture; (3) integration—the individual or group desires versus the host culture, a sense of acceptance by a par- to retain the culture of origin as well as maintain ticular cultural group, or cultural pride—are other a positive relationship with the host culture; and popular indicators of acculturation. In addition, it is (4) marginalization—the individual or group no longer common for many scales to use demographic or proxy retains the original culture and has no desire (or is not variables of acculturation (e.g., generation of respon- allowed) to have a positive relationship with the host dent, place of birth, language of interview). culture. In a small number of acculturation scales, an assess- The dynamic quality of acculturation is further ment of adherence to cultural traditions, beliefs, and val- expressed by the gradual changes that occur in several ues is provided. Measures that focus on these cultural areas (or dimensions) and affect the individual and indexes may be particularly important for cultural potentially the cultural group as a whole (e.g., lan- groups such as African Americans or American Indians, guage, cognitive style, behavioral patterns, personal- for whom English-language issues, length of U.S. resi- ity, identity, attitudes, and values). dency, and immigration status may be less pertinent. A-Jackson.qxd 7/12/2006 2:10 PM Page 7

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Indeed, certain ethnic groups have been significantly and therefore have lower levels of psychiatric disor- underresearched in regard to acculturation. It has been ders than their U.S.-born counterparts. However, suggested that greater attention be given to developing research support for this position is limited. theories of acculturation that are specific to these Despite varying speculations regarding the nature groups’cultures to inform the development of sound and of the relationship between acculturation and adjust- appropriate measures. Similarly, little attention has been ment, it is important to avoid attempts to simplify focused on acculturation in children and youth; greater explanations. This relationship should be viewed as consideration to acculturation across the life span would representative of complex interactions among histori- increase our knowledge of the specific challenges and cal, social, cultural, group, and individual factors. In adaptations related to the age of the individual. addition, multiple measures of adjustment and stress may be required when examining the effects of acculturative stress due to emic (culture-specific) ways of THE RELATIONSHIP OF thinking about and expressing distress. ACCULTURATION TO ADJUSTMENT —Pamela Balls Organista Measures of acculturation are often used to predict psychological and physical distress symptomatology (e.g., See also Acculturation Measures; Acculturative Stress; depression, anxiety, substance abuse, physical pain, Biculturalism fatigue). Research conducted primarily with Latino and Asian American immigrants suggests that the relationship of acculturation to adjustment is a complex one. FURTHER READING Some studies suggest that newly arrived immigrants are Berry, J. W. (1997). Immigration, acculturation and adaptation. more vulnerable to symptoms because of a heightened Applied Psychology, 46, 5–68. level of acculturative stress. In particular, low English Chun, K. M., Balls Organista, P., & Marín, G. (Eds.). (2003). proficiency seems to be one of the most consistent pre- Acculturation: Advances in theory, measurement, and applied research. Washington, DC: American Psycho- dictors of psychological distress in these groups. logical Association. However, in most of these studies, it is difficult to know whether preexisting stressors (e.g., experience of torture and persecution, loss of loved ones and material posses- sions) encountered in the country of origin may have ACCULTURATION MEASURES predisposed these groups to experience the negative impact of acculturation to a new culture. Demographic In light of the growing number of people of color variables such as age, sex, and socioeconomic status represented in the 2000 U.S. Census, research in may lessen the effects of acculturative stress. psychology is working to expand the field’s under- Other studies indicate a higher level of accultura- standing of the needs of ethnically and culturally tion may be related to higher levels of psychological diverse populations. Besides documenting differences and physical distress. For example, an immigrant who in how people from diverse ethnic groups think, act, has lived in the United States for a long period of time and believe, the most progressive research seeks not may be more vulnerable to psychological problems only to determine where important distinctions lie but because of the loss of traditional cultural beliefs, val- also to demonstrate the meaning of group differences. ues, or behaviors, which may offer protection from Researchers have argued that the most meaningful dif- stress. In addition, long-term U.S. resident immi- ference, both between and within ethnic groups, is the grants or U.S.-born members of cultural groups may value that an individual places on his or her culture. be exposed to racial discrimination, social oppression, Recently, the measurement of that value has come in and new cultural standards, leading them to engage the form of acculturation measures. Designed to iden- in risky behaviors (e.g., casual sexual encounters or tify attachment to one’s culture of origin, to a new increased consumption of alcohol). Some large culture, or to both, acculturation measures can be studies have found this to be the case in certain Latino invaluable tools for understanding group differences. groups, such as Mexican Americans and Puerto The need for acculturation measures was created in Ricans. Alternatively, some theorists suggest that part by the problems researchers had interpreting find- newer immigrants are particularly strong and resilient ings when people of color were included in study A-Jackson.qxd 7/12/2006 2:10 PM Page 8

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samples. When people of color were combined into uniculturalism or biculturalism. Examples of measures one group (i.e., people of color versus Caucasian sub- representing this approach include the Acculturation samples), researchers struggled to determine what Rating Scale for Mexican Americans and the Bicultur- role, if any, cultural differences played in the results. alism Involvement Questionnaire. Furthermore, when people of color were separated The idea of acculturation was expanded even further into different groups according to ethnic identifica- in the 1980s and 1990s, when research began to address tion, researchers also had difficulty determining the a multilinear or typology approach to acculturative sta- role of culture within and between groups. That is, it tus. That is, researchers put forth the idea that individu- was and is unclear what role culture plays in research als could be classified according to their acculturation findings because researchers did not have a method perspective along four basic constructs. Specifically, for controlling or testing the level of “culturalness” individuals could demonstrate integration, assimila- present in a given sample of people of color. Within- tion, separation, and marginalization. Individuals were ethnic-group differences are often larger than thought to express attitudes of acculturation that com- between-group differences, and researchers needed a bined levels of adherence to the host and indigenous way to ensure that when sampling people of color cultures. Furthermore, the level of adherence could be from one ethnic group, the group represented a homo- measured and placed on a continuum. geneous representation of a specific level of cultural Integration is thought to be expressed when a attachment. Acculturation measures were thought to person is bicultural, or active in his or her culture of be one step toward untangling the effects of culture by origin and in the dominant culture. Assimilation is creating a method for assessing levels of cultural thought to occur when a person is active in the domi- attachment, especially within ethnic groups. nant culture and has little interest in aspects of his or Early models for acculturation measures suggested her native culture. Separation is manifested when a that acculturation was best conceptualized on a single person remains integrated into his or her culture of continuum. Advocates of this perspective believed origin and uninterested in learning about or participat- that acculturation is a process of moving from one’s ing in the dominant culture. Finally, marginalization culture of origin to the other end of the spectrum, occurs when a person is inactive in both the culture of whereby a person becomes a member of a new or host origin and the dominant culture. Although these ideas culture. Some measures of acculturation in this sys- are fairly new, efforts are under way to create measures tem indicated only high or low involvement in one’s that assess the four acculturation typologies. The main host culture (unicultural), and some represented a true difference between the latter perspective and the bicul- continuum from attachment to the culture of origin to turalism model is that the multilinear model includes the dominant culture (dual cultural). A central tenet of measurements of acculturation across different set- these approaches was that individuals cannot be tings and cultures. From their earliest inception, accul- equally immersed in two cultures at one time and turation measures, whether unicultural, bicultural, or likely have to give up some aspect of one culture to be multicultural, have generally been designed with the a part of a different culture. Examples of measures culture of origin in mind. That is, most measures are from this approach include the African American created to capture one’s attachment to the culture of Acculturation Scale, the Asian Values Scale, and the origin of a particular group (i.e., African Americans, Acculturation Measure for Chicano Adolescents. Asian Americans). Despite efforts to this point, the During the 1980s, several researchers began devel- field is still in its infancy, with most measures of accul- oping an extension to the previous notion that accultur- turation requiring greater research and stronger psy- ation was best represented by a linear progression and chometric findings before widespread use is possible. instead suggested that a unicultural or dual-cultural perspective ignored individuals who were bicultural. AFRICAN AMERICANS Biculturalism, in this sense, represents individuals who maintain adherence to more than one culture at a time. Targeting traditional African American culture, two Researchers proposed that acculturation is a bilinear measures of dual culturalism represent the available tools process with one continuum representing a process for measuring acculturation in the African American pop- whereby individuals can experience either marginality ulation: the African American Acculturation Scale and (adherence to no culture) or involvement and either the Scale to Assess African American Acculturation. A-Jackson.qxd 7/12/2006 2:10 PM Page 9

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Both measures offer promise to the study of accultur- based on the bilinear acculturation model. The scores ation among African Americans; however, the psy- on this measure give a general sense of attachment chometric properties of both measures are rather to an ethnic group versus attachment to American unclear, and greater study of their validity and relia- values. This measure represents the first step toward bility, especially their stability over time, is needed. developing a cross-cultural measure of acculturation, but more research is needed to determine its psychometric properties. HISPANIC AMERICANS The choices for measuring acculturation in Hispanic populations are more varied than for the African CONCLUSION American population and include measures of both Researchers recognize that people of color represent monocultural and bicultural acculturation. Further- more than differences in ethnic groups and bring to more, measures specific to the cultures of Cuban, bear their cultural influences on research findings. Mexican, and Puerto Rican Americans are available. Measuring the role of culture is the direction of the Several of the bicultural measures (e.g., Bicultural field, and to this end, several measures of acculturation Involvement Questionnaire, Cultural Lifestyle Inven- are available for use with different cultural groups. By tory, Bicultural Scale for Puerto Rican Americans, and including a measure of acculturation, researchers can Acculturation Rating Scale for Mexican Americans) be assured that their findings are the result of the study allow for measurement of attachment to the culture of variables and not necessarily within-group differences origin as well as the host culture, but they lack norma- among the sample. For these measures to be of real use, tive data to enhance interpretation for their use. These however, more research is needed to establish the psy- measures represent adequate psychometrics and some chometric properties of acculturation measures. evidence of construct validity. Moreover, new measures or updates of older versions are needed to keep up with changes in acculturation NATIVE AMERICANS theory. Research that addresses the construct validity and long-term stability of acculturation measures The Navajo Family Acculturation Scale, the Navajo would advance the field and allow for more sophisti- Community Acculturation Scale, and the Rosebud cated research questions. For example, acculturation Personal Opinion Survey represent the best tools avail- measures that address biculturalism and measure accul- able for measuring acculturation among Native turation status across settings are needed. Finally, American samples. Although there are more than 500 acculturation measures generally measure behaviors recognized tribes in the United States, each with its (e.g., eating habits, social preferences) associated with own unique culture, so far only the Rosebud Personal attachment to a particular culture or cultures, and this Opinion Survey is designed to be a general measure for may not represent the true nature of the acculturation Native populations. More research is needed to estab- experience. Focusing on behaviors only, researchers lish the psychometric properties of these measures. may neglect the importance of an individual’s values, beliefs, and knowledge, all important parts of cultural ASIAN AMERICANS adherence. Like the Native American measures, only three —Yo Jackson measures are commonly used with Asian American populations: the Acculturation Scale for Chinese FURTHER READING Americans, the Suinn-Lew Asian Self-Identity Acculturation Scale, and the Asian Values Scale. The Berry, J. W. (1980). Acculturation as varieties of adaptation. In latter two measures are designed for use with all sub- A. M. Padilla (Ed.), Acculturation: Theory, models, and groups of Asian Americans (e.g., Japanese, Korean) some new findings (pp. 9–25). Boulder, CO: Westview Press. and appear to have adequate psychometric properties. Berry, J. W. (1990). Psychology of acculturation: Understanding individuals moving between cultures. In R. W. Brislin Only one measure, the Multicultural Acculturation (Ed.), Applied cross-cultural psychology (pp. 232–253). Scale, is designed for use with all cultural groups and Newbury Park, CA: Sage. A-Jackson.qxd 7/12/2006 2:10 PM Page 10

10———Acculturation Scales: Acculturation, Habits, and Interests Multicultural Scale for Adolescents

Cuéllar, I., Arnold, B., & Maldonado, R. (1995). Acculturation surveys of early adolescents from varying cultural Rating Scale for Mexican Americans–II: A revision of the backgrounds. The AHIMSA includes questions that original ARSMA scale. Hispanic Journal of Behavioral are relevant to adolescents, including their choice of Sciences, 17(3), 275–304. friends, favorite music and television shows, favorite Kim, B. S. K., & Abreu, J. M. (2005). Acculturation measurement. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & holidays, foods eaten at home, and general ways of C. M. Alexander (Eds.), Handbook of multicultural coun- thinking. seling. Thousand Oaks, CA: Sage. The items include the following: “I am most comfort- Kim, B. S. K., Atkinson, D. R., & Yang, P. H. (1999). The able being with people from...,”“Mybest friends are Asian Values Scale: Development, factor analysis, valida- from...”“Thepeople I fit in with best are from...,” tion, and reliability. Journal of Counseling Psychology, “My favorite music is from...,”“MyfavoriteTV 46, 342–352. showsarefrom...,”“The holidays I celebrate are Landrine, H., & Klonoff, E. A. (1994). The African American from...,”“ThefoodIeatathome is from...,”and Acculturation Scale: Development, reliability, and validity. Journal of Black Psychology, 20, 104–127. “The way I do things and the way I think about things are Olmedo, E. L., & Padilla, A. M. (1978). Empirical and con- from . . .” The response options are “the United States,” struct validation of a measure of acculturation for Mexican “the country my family is from,” “both,” and “neither.” Americans. Journal of Social Psychology, 105, 179–187. The AHIMSA generates four subscores: United States Szapocznik, J., Kurtines, W. M., & Fernandez, T. (1980). Orientation (assimilation), Other Country Orientation Bicultural involvement and adjustment in Hispanic (separation), Both Countries Orientation (integration), American youths. International Journal of Intercultural and Neither Country Orientation (marginalization). Relations, 4, 353–365. Subscale scores are calculated by summing the number of responses in each of the four categories. The score on each subscale can range from 0 to 8. Researchers might ACCULTURATION SCALES: elect to use one or more of the four orientation scores ACCULTURATION, HABITS, depending on their research questions. The AHIMSA was developed through multiple AND INTERESTS MULTICULTURAL rounds of pilot testing and psychometric analysis. First, SCALE FOR ADOLESCENTS existing acculturation measures were examined to identify questions that could be simplified or modified for Acculturation—the interchange of cultural attitudes adolescents. This resulted in an initial set of 13 items. and behaviors—involves changes in styles of speech, These 13 items were shown to middle school students social behaviors, attitudes, beliefs, customs, celebration in focus groups to assess their interpretation of the of holidays, and choices of foods and entertainment. items. Items that were confusing were reworded. The Immigrants generally follow one of four general accul- set of 13 modified items was administered to a pilot turation patterns: (1) integration—combining aspects sample of sixth-grade students. Items with low variance of the new culture with aspects of the native culture; were eliminated from the scale. Item response-curve (2) assimilation—replacing the native cultural orienta- analyses were used to select a final set of items that dif- tion with the new cultural orientation; (3) separation— ferentiated students at all levels of the scale. The final retaining the native cultural orientation while rejecting set of items included eight questions. the new cultural orientation; or (4) marginalization— In a study of 317 sixth-grade adolescents in becoming alienated from both cultures. Southern California, the means on the United States Measuring adolescents’ acculturation levels in large, Orientation, Other Country Orientation, Both Coun- population-based surveys is difficult. Most published tries Orientation, and Neither Country subscales were acculturation scales for adults contain words or con- 3.93, 0.50, 3.25, and 0.26, respectively. The United cepts that young adolescents cannot comprehend. Most States Orientation, Other Country Orientation, and brief acculturation scales assess only language usage, Both Countries Orientation subscales were correlated which is only one facet of the acculturation process. with the subscales of a modified Acculturation Rating The Acculturation, Habits, and Interests Multi- Scale for Mexican Americans–II (ARSMA-II), English- cultural Scale for Adolescents (AHIMSA) is a brief, language usage, and generation in the United States, multidimensional, multicultural acculturation measure providing evidence for the validity of those three sub- for use in large-scale, classroom-based, paper-and-pencil scales. The Neither Country Orientation subscale did A-Jackson.qxd 7/12/2006 2:10 PM Page 11

Acculturation Scales: Acculturation Rating Scale for Mexican Americans–II———11

not appear to be a valid measure of marginalization, a of biculturalism and allowing individuals to rate their construct that is difficult to operationalize and difficult orientation to Mexican and U.S. mainstream culture for adolescents to conceptualize. independently. This was achieved by dividing the Inclusion of the AHIMSA scale in surveys of ado- original ARSMA items into two sections, one for each lescents provides a more complete understanding of cultural orientation. The ARSMA-II classifies respon- the role of acculturation in adolescents’ behavioral dents into one of four styles of acculturation: assimi- choices, which could lead to the creation of more cul- lation (highly identified with U.S. mainstream culture turally appropriate educational programs for adoles- only), integration (highly identified with both cul- cents in a multicultural society. tures), separation (highly identified with Mexican —Jennifer B. Unger culture only), and marginalization (low levels of identification with both cultures). See also Acculturation The ARSMA-II retains its original version’s behavioral focus but also includes an affective (positive/ negative) affirmation of ethnic identity. Scale 1 of the FURTHER READING ARSMA-II contains two subscales: the Anglo Unger, J. B., Gallaher, P., Shakib, S., Ritt-Olson, A., Palmer, Orientation Subscale (13 items) and the Mexican P. H., & Johnson, C. A. (2002). The AHIMSA acculturation Orientation Subscale (17 items). An optional Scale 2 (18 scale: A new measure of acculturation for adolescents in a items) was included to assess feelings of marginality and multicultural society. Journal of Early Adolescence, 22, difficulty accepting Anglo, Mexican, and Mexican 225–251. American ideas, beliefs, customs, and values. All items are scored on a five-point Likert scale ranging from 1 (not at all) to 5 (extremely often/almost always). Over- ACCULTURATION SCALES: all, the measure assesses three principal constructs: language, ethnic identity, and ethnic interaction or ethnic ACCULTURATION RATING SCALE distance. The ARSMA-II demonstrates good internal FOR MEXICAN AMERICANS–II consistency of subscales (alphas ranging from .68 to .91) and test-retest reliability (ranging from .72 to .96). The Acculturation Rating Scale for Mexican Additionally, the validity of the ARSMA-II has been Americans (ARSMA) is a seminal bilingual accultur- supported by significant associations with the ARSMA ation measure designed for use with both clinical and and generational status. nonclinical Mexican American populations. The The strong psychometrics of the ARSMA-II have development of the ARSMA was a timely response made it a very popular instrument, used in more than to the booming Mexican American population. 75 publications since 1980. The bilingual format, avail- According to the 2000 U.S. Census, the Latino popu- ability of a software scoring program, ease and brevity lation is now the largest ethnic minority group in the of administration, variety of content areas assessed United States, and 58.5% of this group is composed (moving away from relying exclusively on language), of Mexican Americans. Since its creation, the ARSMA and success in differentiating between generational has served as the model for many acculturation mea- levels are additional advantages. On the other hand, sures used with other ethnocultural groups. the ARSMA-II has been criticized for its limited The original ARSMA was a linear measure of applicability to other Latino ethnic groups, absence of acculturation developed by Israel Cuéllar, Lorwen C. an assessment of cultural values (e.g., individualism, Harris, and Ricardo Jasso in 1980 to assess cultural collectivism, familism), nonrepresentative sample (379 preferences and behavioral tendencies. In response to college students), lack of norms for children, and prob- criticism that their measure obliged respondents to lems with classification (portions of samples that do not choose between two cultures and did not accurately fall into categorical acculturation styles, insignificant reflect acculturation adaptation styles, Israel Cuéllar, differences between classifications). Bill Arnold, and Roberto Maldonado produced a A host of studies using the ARSMA and ARSMA-II revised version in 1995. The ARSMA-II was designed have empirically linked Mexican American acculturation to use an orthogonal, multidimensional approach to with a variety of constructs, including ethnic identity, acculturation assessment by capturing varying levels socioeconomic status, mental health, academic A-Jackson.qxd 7/12/2006 2:10 PM Page 12

12———Acculturation Scales: African American Acculturation Scale

attainment, gang involvement, relationship satisfaction, participate almost exclusively in the majority culture health risk behaviors, eating disorders, suicidal ideation, and have rejected most aspects of their culture of origin. depression, clinical elevations on personality tests, self- In the United States, the concept of acculturation has esteem, coping, and counseling expectations. Experts in generally been applied to immigrant ethnic groups. the field of acculturation underscore the need for longi- However, as the developers of the African American tudinal studies of the acculturation process to more accu- Acculturation Scale (AAAS), Hope Landrine and rately capture the developmental and dynamic nature of Elizabeth Klonoff, have demonstrated, the concept acculturation. Many urge that revisions to acculturation of acculturation can be meaningfully applied to scales should include direct measures of contextual African Americans. Despite the long residence mediators or moderators of acculturation (e.g., reason for of African Americans in the United States, individual immigration, immigration policies, attitudes toward African Americans, like individuals in other ethnic immigrants, political environment). minority groups, may choose to participate in the —Rebecca E. Ford majority culture to a greater or lesser extent. —Yarí Colón The AAAS is designed to tap some of the cultural —Bernadette Sánchez domains in which African Americans display relatively distinctive beliefs and practices, such as religion, See also Acculturation; Mexican Americans health, and child rearing. Scores on the scale have been found to be independent of demographic variables such FURTHER READING as education, income, and gender. Three versions of the scale have been published: The first version (AAAS), Berry, J. W. (1980). Acculturation as varieties of adaptation. In A. M. Padilla (Ed.), Acculturation: Theory, models, and published in 1994, contained 72 items that were some new findings (pp. 9–25). Boulder, CO: Westview divided into eight sections; a shorter version (AAAS- Press. 33), published in 1995, contained 33 items on 10 Cabassa, L. J. (2003). Measuring acculturation: Where we are empirically derived subscales; and a revised version and where we need to go. Hispanic Journal of Behavioral (AAAS-R), published in 2000, contained 47 items on Sciences, 25(2), 127–146. eight factors. The AAAS-R, like its predecessors, has Cuéllar, I., Arnold, B., & Maldonado, R. (1995). Acculturation been shown to be psychometrically sound, with internal Rating Scale for Mexican Americans-II: A revision of the consistency reliability of .93 and split-half reliability of original ARSMA scale. Hispanic Journal of Behavioral Sciences, 17(3), 275–304. .79. Discriminant validity of the AAAS-R was established by comparing African Americans with differing levels of segregation; African Americans with other ACCULTURATION SCALES: ethnic groups; and African American drinkers (who tend to be less traditional) with abstainers. AFRICAN AMERICAN The AAAS has been used in studies in several areas ACCULTURATION SCALE of psychology, including health psychology, mental health, and neuropsychology. In health psychology, Acculturation is defined as the extent to which an scores on the AAAS have been linked to cigarette ethnic minority individual participates in the values smoking and hypertension. In general, the research sug- and beliefs of the dominant ethnic-majority culture. gests that an individual’s level of acculturation may be Acculturation can be thought of as a continuum from related to (1) how much racism he or she experiences traditional at one extreme, to bicultural in the middle, (more traditional people experience more racism), to acculturated at the other extreme. Traditional indi- which is related to how much the person smokes (more viduals retain almost exclusively the values and racism results in greater smoking), and (2) how stress- beliefs of their culture of origin and do not participate ful the racism is perceived as being (more traditional in the majority culture. Bicultural individuals are flu- people experience racism as more stressful), which is ent in both their culture of origin and that of the related to hypertension (more stressful racism results in majority. Bicultural individuals can further be classi- higher blood pressure levels). fied as “blended,” having melded aspects of both In mental health research, AAAS scores have been cultures, or “code-switchers,” those who alternate shown to predict depression, stress levels, and coping between the two cultures. Acculturated individuals styles. Additionally, the relationship between mental A-Jackson.qxd 7/12/2006 2:10 PM Page 13

Acculturation Scales: Asian American Multidimensional Acculturation Scale———13

health and coping styles may be different for accul- shared Asian American identity and culture, which is of turated individuals than for traditional individuals. In increasing significance for Asian Americans. neuropsychology, the AAAS has been helpful in under- The items on the AAMAS were adapted from the standing why African Americans, particularly elders, Suinn-Lew Asian Self-Identity Acculturation Scale score significantly lower than European Americans on (SL-ASIA) and converted to a multidimensional format tests of cognitive ability. The AAAS has proven to be a by asking respondents to rate each item according to valuable tool in elucidating the unique role that cultural three referent groups: (1) their Asian culture of origin, factors play in the experiences and behaviors of African (2) other Asian American cultures, and (3) mainstream Americans in the United States. European American culture. The primary strengths of —Tamara D. Warner the AAMAS include its ability to provide a more complex assessment of Asian American acculturation along See also Acculturation; Mexican Americans cultural and domain-specific dimensions, as well as its ease of administration and use across different ethnici- FURTHER READING ties. The primary weakness of the measure is that, like the SL-ASIA, the AAMAS is primarily a measure of Klonoff, E. A., & Landrine, H. (2000). Revising and improv- behavioral acculturation. The AAMAS is intended pri- ing the African American Acculturation Scale. Journal of Black Psychology, 26(2), 235–261. marily as a research measure, and to date, the predom- Landrine, H., & Klonoff, E. A. (1996). African American inant application has been for this purpose. acculturation: Deconstructing race and reviving culture. Thousand Oaks, CA: Sage. ACCULTURATION DOMAINS Manly, J. J., Byrd, D. A., Touradji, P., & Stern, Y. (2004). Acculturation, reading level, and neuropsychological test In addition to the three cultural dimensions, performance among African American elders. Applied exploratory and confirmatory factor analyses support Neuropsychology, 11(1), 37–46. four specific acculturation domains: language, food consumption, cultural knowledge, and cultural identity. Measures of internal consistency for each domain ACCULTURATION SCALES: ASIAN by cultural dimension range from .65 (food consumption in the AAMAS-CO) to .89 (cultural knowledge in AMERICAN MULTIDIMENSIONAL the AAMAS-CO). ACCULTURATION SCALE RELIABILITY AND VALIDITY The Asian American Multidimensional Acculturation Scale (AAMAS) is a measure of acculturation based on Results of three separate studies provide strong evidence orthogonal assessment of three different cultural dimen- of the instrument’s reliability and validity. Estimates of sions, which comprise four specific acculturation internal consistency for each cultural dimension ranged domains. Advancements in acculturation theory have from .87 to .91 for the AAMAS-CO, from .78 to .83 for established the desirability of a bidimensional approach the AAMAS-AA, and from .76 to .81 for the AAMAS- to the measurement of acculturation, one that takes into EA, and estimates of stability over time ranged from account orientation to both the culture of origin and the .75 to .89. Evidence of validity includes a significant host culture, thereby challenging the zero-sum assump- negative correlation between the AAMAS-CO and gen- tion of a unidimensional approach in which accultura- erational status. Assessment of concurrent validity com- tion to one culture comes at the expense of the other. paring the AAMAS subscales with the Asian Values The AAMAS is based on a multidimensional approach Scale revealed expectedly modest correlations, whereas that includes orthogonal assessments of acculturation to for divergent validity, there was little to no relationship the Culture of Origin (AAMAS-CO) and to European with the Rosenberg Self-Esteem Scale. American culture (AAMAS-EA). The AAMAS further extends acculturation theory with the addition of a third ADMINISTRATION AND SCORING cultural dimension, a pan-ethnic Asian American cultural dimension (AAMAS-AA), which is unique to the The 15 items on the AAMAS are worded so as to AAMAS. This dimension assesses the formation of a facilitate administration across different ethnicities. A-Jackson.qxd 7/12/2006 2:10 PM Page 14

14———Acculturation Scales: Bidimensional Acculturation Scale for Hispanics

The instructions direct the respondents to rate each which acculturation can have an impact on behavior. item according to their own Asian culture of origin, Exploratory principal components and factor analyses other Asian groups in the United States, and the main- were conducted on the original responses (separately stream host culture. The items are scored on a scale for language-related items and social behaviors) to ranging from 1 (not very well) to 6 (very well). Only identify factors that accounted for large proportions of item 15 is to be reverse scored before adding up the the variance. The final scale includes items that had responses for each cultural dimension for a total correlations greater than .45 with a given factor and score, then dividing by 15 to obtain the scale score. did not load heavily in more than one factor. Using this method, a separate score is obtained for The BAS includes 24 items measuring linguistic each cultural dimension. usage, language proficiency, and electronic media —Ruth H. Gim Chung usage. Half of the items refer to English use or English-language proficiency, and the other half See also Asian/Pacific Islander addresses the same areas as they refer to Spanish use or proficiency. Each of the items is scored on a four- point Likert-type scale with anchors of “almost never” FURTHER READING (scored as 1) and “almost always” (scored as 4) for the Chung, R. H. G., Kim, B. S. K., & Abreu, J. M. (2004). Asian usage-related questions and “very well” (scored as 4) American Multidimensional Acculturation Scale: Develop- or “very poorly” (scored as 1) for the linguistic- ment, factor analysis, reliability and validity. Cultural proficiency items. The scale produces two accultura- Diversity and Ethnic Minority Psychology, 10, 66–80. Suinn, R. M., Rickard-Figueroa, K., Lew, S., & Vigil, P. tion indexes, one for each cultural domain, which are (1987). The Suinn-Lew Asian Self-Identity Acculturation obtained by averaging responses to the 12 items rele- Scale: An initial report. Educational and Psychological vant to each cultural domain (range of 1 to 4). An Measurement, 47, 401–407. average score close to 1 indicates a low level of cultural proficiency in a given cultural domain (e.g., Latino), whereas an average score close to 4 indicates ACCULTURATION SCALES: a high level of cultural proficiency on that same cultural domain. An average score of 2.5 can be used to BIDIMENSIONAL ACCULTURATION dichotomize respondents into low or high levels of SCALE FOR HISPANICS adherence to the specific cultural domain. The BAS has shown high levels of reliability and The Bidimensional Acculturation Scale for Hispanics validity. In the original study, the scale showed an (BAS) was developed in 1996 to provide researchers alpha coefficient of .87 for the items in the Hispanic with a relatively short measure of acculturation that domain and .94 for the items in the non-Hispanic could address the conceptual and psychometric limita- domain. Validity was established using a number of tions of other acculturation scales. The BAS uses two approaches, including correlations with respondents’ dimensions to define acculturation, avoiding the faulty generational status (r = .50 for the non-Hispanic assumption that gains in learning a non-Hispanic culture domain and –.42 for the Hispanic domain), length of imply losses in the individual’s understanding of or pref- residence in the United States (r = .46 for the non- erence for Latino culture. As such, the BAS measures Hispanic domain and –.28 for the Hispanic domain), respondents’ behavioral characteristics in two cultural age of arrival in the United States (r = –.60 for the domains: Hispanic and non-Hispanic. Furthermore, non-Hispanic domain and .41 for the Hispanic the BAS is useful in research with individuals from domain), and respondents’ own assessments of their all Latino backgrounds rather than with individuals acculturative status (r = .47 for the non-Hispanic from one subgroup (e.g., Cuban Americans, Mexican domain and –.38 for the Hispanic domain). In addition, Americans). the scale correlated highly (r = .79 for the non-Hispanic The BAS was developed by analyzing a large domain and –.64 for the Hispanic domain) with the number of items addressing a variety of acculturative Short Acculturation Scale for Hispanics (SASH). areas (e.g., language use, preference for ethnic social The BAS has been used with Latinos of all national events). A random sample of 254 adult Hispanics was backgrounds and all generations, and the validation asked to report preferences and abilities in 30 areas in study was conducted with Mexican and Central A-Jackson.qxd 7/12/2006 2:10 PM Page 15

Acculturation Scales: East Asian Acculturation Measure———15

Americans. The items that make up the scale in culture (assimilation), (3) with members of one’s English and in Spanish and the scoring instructions ethnic group and members of the host culture (inte- are available in the original publication. The scale has gration), and (4) with neither one’s own group peers been useful in providing a comprehensive understand- nor members of the host culture (marginalization). ing of Hispanic acculturation in areas as diverse as The EAAM items do not assess ethnic identity (i.e., physical health, mental health, drug and tobacco use, identity associated with belonging to a certain ethnic educational achievement, employment, and criminal group). Instead, ethnic identity among East Asian immi- behavior. grants may be assessed using the East Asian Ethnic —Gerardo Marín Identity Scale.

See also Acculturation; Acculturation Scales: Short NORMS, RELIABILITY, AND VALIDITY Acculturation Scale for Hispanics The EAAM was originally studied with 150 East Asian immigrants (75 men, 75 women) with a mean FURTHER READING age of 28.7 (SD = 6.40). The internal consistency Marín, G., & Gamba, R. J. (1987). A new measure of accul- (alpha) coefficients were .76, .77, .74, and .85 for turation for Hispanics: The Bidimensional Acculturation separation, assimilation, integration, and marginaliza- Scale for Hispanics (BAS). Hispanic Journal of Behavioral tion, respectively. Significant negative correlations Sciences, 18, 297–316. were found between separation and assimilation and between integration and marginalization. Length of stay in the United States was significantly and positively associated with assimilation and integration but ACCULTURATION SCALES: EAST significantly and negatively associated with marginal- ASIAN ACCULTURATION MEASURE ization. Normative data for the EAAM are currently being developed. Although the EAAM performed The East Asian Acculturation Measure (EAAM) is a well psychometrically on the initial sample, its psy- 29-item self-report instrument designed to measure chometric properties need to be established with other the social interaction and communication styles (both East Asian and non-Asian samples, including those competency and ease and comfort in communicating) with varying socioeconomic and educational back- of East Asian (i.e., Chinese, Japanese, and Korean) grounds and English-language proficiency. immigrants in the United States. CLINICAL PRACTICE AND RESEARCH MODELS OF ACCULTURATION Although many acculturation measures provide proxy Researchers typically conceptualize the acculturation measures of acculturation (e.g., generational status, of Asian ethnic groups as a unidimensional construct English-language proficiency), the EAAM allows that ranges from low acculturation, indicating a pri- researchers to assess a pattern of attitudes and behav- mary Asian identification, to high acculturation, indi- iors relevant to socialization and communication in cating a Western identification, with an imputed various situations along multiple dimensions. Such midpoint representing a bicultural identification. This information may be of clinical as well as social impor- model has three key deficits: (1) Acculturation often tance. The EAAM assimilation scale score significantly does not occur in a neat linear or unidimensional man- predicts increased willingness to use psychological ner; (2) the distinction between acculturation and eth- services, whereas the EAAM marginalization scale nic identity is often obfuscated; and (3) identification score significantly predicts guarded self-disclosure, a with neither Asian nor Western cultures (i.e., margin- potentially important impediment to engagement in alization) is not assessed. traditional psychotherapy. In terms of social function- In contrast, the EAAM is based on a multidimen- ing, the EAAM integration scale score signifi- sional model of acculturation and examines four modes cantly predicts perceived egalitarian treatment from of social interaction and communication: (1) with ethnic Americans, whereas the EAAM marginalization scale group peers (separation), (2) with members of the host score significantly predicts perceived ethnic-group A-Jackson.qxd 7/12/2006 2:10 PM Page 16

16———Acculturation Scales: Short Acculturation Scale for Hispanics

discrimination (i.e., “people from my ethnic group are An average score of 2.99 can be used to dichotomize discriminated against”). respondents into low acculturation (i.e., those with —Declan T. Barry average scores lower than 2.99) and highly acculturated respondents (i.e., those with average scores See also Asian Values Scale; Asian/Pacific Islander greater than 2.99). Further research has shown that, when needed, the scale can be shortened to the first FURTHER READING five language-related items. Barry, D. T. (2001). Development of a new scale for measur- The SASH has shown high levels of reliability and ing acculturation: The East Asian Acculturation Measure validity. In the original study, the scale showed an alpha (EAAM). Journal of Immigrant Health, 3, 193–197. coefficient of .92 for all 12 items and .90 for the first five Barry, D. T. (2002). An ethnic identity scale for East Asian language-related items. Validity was established using immigrants. Journal of Immigrant Health, 4, 87–94. a number of approaches, including correlations with Barry, D. T., & Grilo, C. M. (2003). Cultural, self-esteem, respondents’ generational status (r = .65, p < .001), and demographic correlates of perception of personal and = < group discrimination among East Asian immigrants. length of residence in the United States (r .70, p American Journal of Orthopsychiatry, 73(2), 223–229. .001), age of arrival in the United States (r = –.69, p < .001), and respondents’ own assessment of their acculturative status (r = .76, p < .001). In addition, the scale ACCULTURATION SCALES: discriminates between first- and second-generation Hispanics. SHORT ACCULTURATION The SASH has been used with Latinos of all SCALE FOR HISPANICS national backgrounds and all generations, as well as with individuals of limited reading ability. The scale The Short Acculturation Scale for Hispanics (SASH) has also been adapted for use with other ethnic and is one of the most frequently used acculturation scales national groups by changing the response categories in research with Latinos. The SASH was developed to more accurately reflect the group being studied. in 1987 after lengthy analysis of the responses of The items that make up the scale in English and 363 Hispanics (e.g., Cubans, Mexican Americans, Spanish are available in the original publication. A Puerto Ricans, and Central Americans) and 228 version for children is also available. Caucasians to questions dealing with ethnic contact A major limitation of the scale is that it measures patterns, proficiency and preference of language use, acculturation as a unidimensional phenomenon anchored preferred ethnicity in social relations, and characteris- at one cultural pole by a Latino dimension and at the other tics of media use. Exploratory principal components by a non-Hispanic dimension. Nevertheless, the SASH factor analyses were conducted on the original has a long history of effectively identifying Latinos responses to identify factors that accounted for large with low or high levels of acculturation in different con- proportions of the variance. The final scale includes texts and under a variety of circumstances. The Short items that had correlations greater than .60 on a given Acculturation Scale for Hispanics is particularly useful factor and did not load heavily in more than one factor. when a rapid measure of acculturation is needed because The SASH includes 12 items measuring linguistic of time constraints or length of study. The scale is also usage and preferences and the ethnicity of friends, useful when researchers need to dichotomize respondents social gatherings, and play partners for respondents’ in terms of high or low levels of acculturation. children. Each of the items is scored on a five-point —Gerardo Marín Likert-type scale with anchors of “only Spanish” (scored as 1) and “only English” (scored as 5) for the See also Acculturation; Acculturation Scales: Bidimensional language-related items and “all Latinos/Hispanics” Acculturation Scale for Hispanics (scored as 1) and “all Americans” (scored as 5) for the ethnic-preference items. The acculturation index is obtained by averaging responses to the 12 items FURTHER READING (range of 1 to 5). An average score close to 1 indicates Barona, A., & Miller, J. A. (1994). Short Acculturation Scale a low level of acculturation, whereas an average score for Hispanic Youth (SASH-Y): A preliminary report. close to 5 indicates a high level of acculturation. Hispanic Journal of Behavioral Sciences, 16, 155–162. A-Jackson.qxd 7/12/2006 2:10 PM Page 17

Acculturation Scales: Suinn-Lew Asian Self-Identity Acculturation Scale———17

Marín, G., Sabogal, F., VanOss Marín, B., Otero-Sabogal, R., United States, self-reported ethnic identity, attitudes & Pérez-Stable, E. J. (1987). Development of a Short toward counseling, willingness to see a counselor, and Acculturation Scale for Hispanics. Hispanic Journal of counselor ratings. Suinn and colleagues found the Behavioral Sciences, 9, 183–205. SL-ASIA items to be influenced by five underlying factors: (1) reading, writing, and cultural preference; (2) ethnic interaction; (3) affinity for ethnic identity ACCULTURATION SCALES: and pride; (4) generational identity; and (5) food preference. This five-factor model of the SL-ASIA has SUINN-LEW ASIAN SELF-IDENTITY been validated in both exploratory and confirmatory ACCULTURATION SCALE factor analytic investigations. Miller and colleagues also found evidence suggesting the SL-ASIA mea- Developed to gauge acculturation in Asian Americans, sures acculturation in an equivalent fashion for both the Suinn-Lew Asian Self-Identity Acculturation women and men. Together, these pieces of evidence Scale (SL-ASIA) assesses the cognitive, behavioral, suggest the SL-ASIA produces reliable and valid and attitudinal aspects of acculturation. The SL-ASIA scores of acculturation for Asian Americans. is the most widely used measure of acculturation in Asian American populations. The SL-ASIA is based UTILITY OF THE SL-ASIA on a unilinear conceptualization of acculturation, which suggests that increased adherence to main- Because the SL-ASIA is a relatively brief, clear-cut stream culture results in the reduction of adherence to instrument, it can be an effective piece of formal or infor- the person’s culture of origin. mal assessment in clinical practice. As an assessment The SL-ASIA is a paper-and-pencil self-report tool, the SL-ASIA supplies information about an indi- scale that consists of 21 multiple-choice items, each vidual’s ethnic interaction, ethnic identity, language use, of which is rated on a five-point scale. Items assess and social networks. By obtaining a deeper cultural and language, identity, friendship choice, behaviors, gen- ethnic understanding of the individual, clinicians can eration and geographic history, and attitudes, and they begin to understand the phenomenological experience of are worded so as to be relevant to various Asian sub- the Asian American individual. In addition, because of groups (e.g., Korean, Chinese, and Japanese). Scores the wording of the SL-ASIA items, the measure can be are obtained by summing the answers for all 21 items used with a wide range of Asian American subgroups. and dividing the sum of scores by 21 to derive the final acculturation score. Acculturation scores can LIMITATIONS range from 1.00 (low acculturation) to 5.00 (high acculturation). An acculturation score of 3.00 repre- When using the SL-ASIA, it is important to recog- sents a bicultural experience. Higher acculturation nize that the majority of items assess the behavioral scores infer a greater degree of Western identification. dimension of acculturation (e.g., language preference). In addition to total score analysis, one item allows the Recently, multidimensional conceptualizations of participant to rate himself or herself as either “very acculturation, which suggest that acculturation occurs Asian,” “bicultural,” or “very anglicized.” on multiple dimensions (e.g., values and behavior), have been postulated. Therefore, it is helpful to understand that the SL-ASIA may not address other dimen- PSYCHOMETRIC PROPERTIES sions of the acculturation process. There is much evidence to suggest that the SL-ASIA —Matthew J. Miller is capable of producing reliable scores (e.g., see —Suzette L. Speight Ponterotto, Baluch, & Carielli, 1998). Scores on the SL-ASIA have generated internal consistency esti- See also Acculturation; Acculturation Measures mates ranging from .68 to .88 but typically fall in the mid .80s. In addition, there is much evidence that speaks to the construct validity of the SL-ASIA. For FURTHER READING example, relationships have been found between SL- Miller, M. J., Abe-Kim, J., Li, J., & Bryant, F. B. (2006). ASIA scores and generational status, residency in the A multisample confirmatory analysis examining the A-Jackson.qxd 7/12/2006 2:10 PM Page 18

18———Acculturative Stress

equivalence of the SL-ASIA across sex. Manuscript American college students, acculturative stress is submitted for publication. associated with racial identity and racial socialization. Ponterotto, J. G., Baluch, S., & Carielli, D. (1998). The Suinn- For Latinos, acculturative stress is related to the effi- Lew Asian Self-Identity Acculturation Scale (SL-ASIA): cacy of stress-coping resources, degree of accultura- Critique and research recommendations. Measurement and Evaluation in Counseling and Development, 31, 109–124. tion, cohesion of the family, language use, and length Suinn, R. M., Ahuna, C., & Khoo G. (1992). The Suinn-Lew of residence in the United States. Asian Self-Identity Acculturation Scale: Concurrent and Not surprisingly, acculturative stress has been factorial validation. Educational and Psychological linked to academic performance and negative mental Measurement, 52, 1041–1046. health consequences. For example, acculturative stress has been positively associated with lower academic performance, lower quality of life in general, excessive alcohol intake, body dissatisfaction and ACCULTURATIVE STRESS bulimia, identity confusion, anxiety, psychosomatic symptoms, depression, and suicidal ideation. More- Acculturation refers to a process of cultural change that over, during the past five years, research related to occurs when two or more cultural groups come into acculturative stress has begun to identify variables that contact for an extended time, particularly when indi- might mediate or moderate the relationship between viduals in minority groups move into a new culture acculturative stress and depression. For example, it or host society. This is a complex, dynamic change has been found that maladaptive perfectionism mod- process whereby individuals continuously negotiate erates the relationship between acculturative stress among accepting, adapting to, or denying the charac- and depression in international students. Similarly, teristics of a majority culture, as well as retaining, perceived social support from friends has been shown changing, or rejecting certain components of their own to have a buffering effect between acculturative stress culture. Psychological acculturation involves an adap- and depression for Korean adolescents from immi- tation or change in attitudes, behaviors, values, and grant families in the United States. Likewise, family identity. closeness, hopefulness for the future, and financial As people undergo the process of cultural change, resources have been found to provide a buffer against they often encounter difficulties or challenges in the negative effects of acculturative stress experi- adapting to a new set of cultural customs and behav- enced by Mexican immigrants. Thus, the relationship ioral rules in a nonnative society, where they may lack between acculturative stress and mental health in not resources and support from their native culture. necessarily a simple linear relationship but can be Acculturative stress is defined as stress related to buffered by a range of personality variables, social moving from one’s culture of origin to another cul- support, and financial resources. ture. Although the traditional view held that accul- —P. Paul Heppner turation inevitably brings tremendous stress, the —Hyun-joo Park contemporary view attempts to understand accultura- —Mei-fen Wei tive stress through a lens of a stress-coping model. This model postulates that (1) acculturative stress may See also Acculturation; Cultural Barriers occur when the external and internal demands of the acculturation process exceed the individual’s coping FURTHER READING ability or resources, and (2) the level of acculturative Berry, J. W. (1990). Psychology of acculturation: Under- stress depends on multiple factors, such as the mode standing individuals moving between cultures. In R. W. of acculturation, nature of the acculturating group, Brislin (Ed.), Applied cross-cultural psychology (pp. 232– characteristics of the host culture, and demographic 253). Newbury Park, CA: Sage. variables (e.g., age, gender). Rodriquez, N., Meyers, H. F., Mira, C. B., Flores, T., & Garcia- For example, it has been found that among inter- Hernandez, L. (2002). Development of the Multidimensional Acculturative Stress Inventory for adults of Mexican origin. national students in the United States, acculturative Psychological Assessment, 14, 451–461. stress is associated with English fluency, satisfaction Williams, C. L., & Berry, J. W. (1991). Primary prevention with social support, social connectedness, the need for of acculturative stress among refugees. American Psychol- approval, and maladaptive perfectionism. For African ogist, 46, 632–641. A-Jackson.qxd 7/12/2006 2:10 PM Page 19

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Given the persistence of gender and racial discrim- AFFIRMATIVE ACTION ination, organizations have a choice: They can deal with discrimination retroactively after a complaint is Few governmental policies have been as controversial made, or they can adopt an affirmative action policy to as affirmative action. During the last several years, stave off complaints and to ensure that women and battles over affirmative action captured the public’s minorities are indeed receiving opportunities equal to attention as two cases—Gratz v. Bollinger and Grutter those of Caucasian men. Many organizations voluntar- v. Bollinger—were heard by the Supreme Court. ily opt for affirmative action to minimize the chances of Generally heralded as successes for affirmative action, having to clean up a problem after the fact. the two Supreme Court decisions, handed down in Affirmative action aims to assure true equality of June 2003, have not stopped anti–affirmative efforts. opportunity. Yet affirmative action can also be distin- Part of the reason for the continued controversy is guished from the ideal of equal opportunity. Affirma- that affirmative action is not well understood. Often tive action takes a proactive stance on ensuring misrepresented as quotas or reverse discrimination, fairness and diversity in employment and education. affirmative action is actually a system whose purpose In other words, rather than assuming that equal oppor- is to detect and correct systematic institutionalized tunity exists, affirmative action takes into account that discrimination. Affirmative action aims to ensure, not equal opportunity is flawed because of institutional- to undercut, true equality of opportunity for all eth- ized racism and sexism. nicities and both genders. AFFIRMATIVE ACTION IN EMPLOYMENT WHAT IS AFFIRMATIVE ACTION? All federal organizations are required to comply with The American Psychological Association defines the policy of affirmative action. Private organizations affirmative action as occurring when an organization with more than 50 employees that contract with the expends energy to make sure that there is no discrim- federal government for amounts greater than $50,000 ination in employment or education and to ensure that are also required to act as affirmative action employ- equal opportunity exists. The United States received ers. They are required, in other words, to develop and its first governmental mandate to initiate affirmative maintain an affirmative action plan in the workplace. action by way of Executive Order 11246, issued by At the core of any affirmative action plan for fed- Lyndon Johnson in 1965. The order required all eral contractors is a monitoring system. Organizations governmental agencies, as well as organizations that must make sure that the ratio of minorities and women contract with the federal government, to enact proac- to Caucasian men in their labor force is equal to that tive measures to ensure that the diversity within their of the qualified labor pool. Similarly, federal contrac- organizations matches the diversity in the pool of tors must monitor their promotions. qualified labor. Sometimes the monitoring process reveals substan- Ideally, hiring in the workplace and admissions tive differences—for example, that the proportion of in educational organizations would result in diversity women in the organization’s labor force is lower than within businesses and schools equal to that in society. the proportion of qualified women in the available Yet research shows that this is not the case. Regardless labor pool. When differences appear, corrective of the value of equal opportunity, it is clear that equal actions must be identified and undertaken. opportunity does not always exist in practice within The Office of Federal Contract Compliance organizations in the United States. Because of old Program (OFCCP) is the governmental agency charged habits of thought and behavior that create racial with oversight of businesses that have contracts with and gender insensitivity, as well as blatant and subtle the federal government. Although the majority of racism and sexism, Caucasian men still enjoy private organizations self-monitor their own hiring unearned privileges in American society. They can statistics, the OFCCP does run 3,000 to 5,000 compli- find and keep employment more easily than others ance reviews on privately owned businesses per year. who are similarly qualified. They obtain better mort- If an organization is found to be in noncompliance, gage rates, car deals, housing, and health care than the OFCCP helps the organization adhere to the rules. others. Organizations that are flagrant offenders of the rules A-Jackson.qxd 7/12/2006 2:10 PM Page 20

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can be disbarred from holding federal contracts for a In recent years, the University of Michigan has period of time. been more in the public’s eye than the University of California. In 1997, Jennifer Gratz and Patrick Hamacher, two European American students, chal- AFFIRMATIVE ACTION IN EDUCATION lenged the race-sensitive admissions program of the Affirmative action in education functions much as it undergraduate college at the University of Michigan. does in employment. Typically, universities compile They had been rejected, whereas applicants of color records from the admissions office that track the ethnic- with lower scores and grades had been accepted. Two ity and gender of applicants and students. The university months after the Gratz case was filed in federal court, uses these records to compare the diversity of the appli- Barbara Grutter, another rejected European American cant pool to that of the accepted students, as well as applicant, brought suit against the University of to track the retention of students to make sure that all Michigan Law School. On June 23, 2003, the ethnicities and genders are being treated equally. If a Supreme Court announced its decisions. It declared problem is detected, the university can examine why the that race could not be used in formulaic approaches to discrepancy exists and move to remedy the problem. admissions, but the Court also recognized diversity in The state of California has a master plan for higher higher education as a compelling state interest. Race- education that guarantees admission to the University sensitive policies, the Court concluded, are not ipso of California to the top 12.5% of high school gradu- facto unconstitutional. ates. By monitoring the ethnicity and gender of the top students, the university noted that there were more WHY DO WE NEED AFFIRMATIVE ACTION? Latino students available for admission than were being admitted. The problem was found to be the Affirmative action is only one method of correcting result of some specific factors. Latino high school injustices. More reactive means, such as bringing a students were less likely than others to be counseled lawsuit, are sometimes thought to be more fair and by guidance staff to take the core class requirements effective than affirmative action. There are three main to gain admission. In addition, Latino students were reasons why affirmative action may be a more effec- less able to take advantage of advanced placement tive and less costly way of assuring fairness and sta- courses than Caucasian students. To address these bility than the reactive (lawsuit) approach. First, problems, the university has exempted the top tier of copious research in the social sciences has shown that, applicants (those who graduated in the top 4%) from many times, the victims of discrimination “have the course requirements, and it is in the process of blinders on,” refusing to acknowledge discrimination making advanced placement courses available online. until the situation is dire. Second, even fair-minded These changes represent alternative paths to increas- outside observers who have not themselves been ing diversity that aim to increase the eligibility of the victims of discrimination have a hard time detect- underrepresented students rather then giving prefer- ing imbalances without the help of systematically ence to minority applicants. arranged aggregate data. Most affirmative action plans In 1996, the voters of California passed Proposition provide observers with aggregated data and thus allow 209 by a very narrow majority. In addition, the Regents them to detect patterns of fairness or unfairness that of the University of California, under the prodding they would otherwise miss. Third, lawsuits are of Regent Ward Connerly, enacted two resolutions that extremely costly for individuals and for organizations. removed the consideration of race, religion, sex, color, Proactive measures that allow organizations to moni- ethnicity, or country of origin as criteria for admission tor their situations and to correct minor problems to the university as well as faculty and staff hiring. As before they engender a lawsuit usually prove to be a result of this policy change, the percentage of under- excellent investments. represented group members admitted to the university dropped considerably in the following years. In 2001, DOES AFFIRMATIVE ACTION WORK? the Regents unanimously voted to repeal the 1995 ban on race-conscious admission; however, because of the Affirmative action plans in education have been passage of Proposition 209, the ban is still in effect at shown to increase the presence and the success of the state level. hitherto underrepresented minorities. Indeed, without A-Jackson.qxd 7/12/2006 2:10 PM Page 21

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race-sensitive admissions plans, imperfections in the admissions criteria would result in student bodies AFRICAN AMERICANS more Caucasian than at present. In our multiethnic AND MENTAL HEALTH society, the state has a compelling interest in achieving diverse student bodies, according to the U.S. PREVALENCE OF MENTAL ILLNESS Supreme Court. AMONG AFRICAN AMERICANS In industry, affirmative action has also proven to be effective. Cost–benefit analyses have found that, in Mental disorders are highly prevalent across all material terms, companies that use affirmative action populations, regardless of race or ethnicity. Within the benefit not only from avoiding costly lawsuits but also United States, overall rates of mental disorders for from the diversity in their workforce. Meanwhile, ethnic most minority groups are largely similar to those for minority workers and Caucasian women benefit from Caucasians. However, ethnic and racial minorities in the reduction in barriers that affirmative action brings. the United States face a social and economic environ- Some opponents of affirmative action claim that ment of inequality that includes greater exposure to the policy undermines the confidence of its intended racism and discrimination, violence, and poverty—all beneficiaries. Certainly, people do not like to believe of which take a toll on mental health. In some surveys, that they may have obtained positive outcomes as a African Americans have been found to have higher result of special privilege. Notwithstanding stereo- levels of lifetime (or current) mental disorders than types to the contrary, only a handful of ethnic minor- Caucasians. However, when differences in age, gen- ity individuals and Caucasian women mistake der, marital status, and socioeconomic status are taken affirmative action for special privilege. Careful sur- into account, the racial difference is eliminated. veys show that the majority of direct beneficiaries see In most major epidemiological surveys, the overall the policy not as one that gives them special privilege, rates of mental illness for African Americans living but rather as one that reduces the previously unques- in a community appear to be similar to those of non- tioned special privileges of Caucasian males. Hispanic Caucasians. However, differences do arise In sum, affirmative action is a policy that attempts when assessing the prevalence of specific illnesses. to make the ideal of equal opportunity an actuality. In For example, African Americans are less likely to suf- employment and education, it entails careful monitor- fer from major depression and more likely to suffer ing of information so that subtle patterns of discrimi- from phobias than Caucasians. Although somatization nation can be detected and imbalances can be is more common among African Americans than corrected. Affirmative action promotes diversity. among Caucasians, rates of suicide for young men in Rather than simply giving lip service to the values of both ethnic groups are similar. Researchers have also fairness, justice, and diversity, affirmative action helps found lower lifetime rates among African Americans to ensure that these values are fulfilled in our society. for several other major mental disorders, including —Kristina R. Schmukler panic disorder, social phobia, and generalized anxiety disorder. In contrast, African Americans have higher See also Equal Opportunity Employment; Institutional Racism rates of posttraumatic stress disorder and substance abuse than Afro-Caribbeans or Caucasian Americans. The general conclusion regarding the lack of racial FURTHER READING differences in rates of mental illness does not apply to American Psychological Association. (1996). Affirmative vulnerable, high-need subgroups such as the homeless action: Who benefits? Washington, DC: Author. or the incarcerated, who have higher rates of mental Bowen, W. G., & Bok, D. C. (1998). The shape of the river: illness and are often not captured in community sur- Long-term consequences of considering race in college veys. African Americans are overrepresented in these and university admissions. Princeton, NJ: Princeton high-need populations. Although they represent only University Press. 12% of the U.S. population, African Americans make Crosby, F. J. (2004). Affirmative action is dead: Long live affirmative action. New Haven, CT: Yale University Press. up about 40% of the homeless. The ratio is similar for Crosby, F. J., Iyer, A., Clayton, S., & Downing, R. (2003). people who are incarcerated: Nearly half of all pris- Affirmative action: Psychological data and the policy oners in state and federal jails and almost 40% of debates. American Psychologist, 58, 93–115. juveniles in legal custody are African American. One A-Jackson.qxd 7/12/2006 2:10 PM Page 22

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explanation for African Americans’ higher rates of other ethnic minority group. As recently as 1990, certain mental health problems is the stressful condi- 29% of Caucasians viewed most African Americans tions created by racism, discrimination, and poverty. as unintelligent, 44% believed that most are lazy, Whether racism and discrimination by themselves 56% endorsed the view that most prefer to live on can cause these disorders is not clear, but there does welfare, and 51% indicated that most are prone to vio- appear to be a significant association between poverty lence. There seems to be broad support for egalitarian and incidences of mental illness. attitudes toward African Americans, but this coexists with a desire to maintain at least some social distance from African Americans and a limited commitment to THE EFFECTS OF RACISM policies to eradicate entrenched inequalities. ON MENTAL HEALTH Racism exists on both an individual and an institu- There is no question that racism exists in the United tional level. Historically, beliefs about the inferiority States and that African Americans have been the pri- of African Americans were translated into policies mary recipients of negative stereotypes and discrimi- that restricted their access to education, employment, nation. There are numerous definitions of racism health care, and residential opportunities. These present in the research literature. For the purposes of restrictions led to disparities in essential resources, this discussion, the term racism is used to refer to any resulting in significant residential segregation and behavior or pattern of behavior that tends to systemat- poverty within African American communities. ically deny access to opportunities or privileges to Today, institutional racism is evidenced by the fact members of one racial group while perpetuating that the median income for Caucasian American access to opportunities and privileges to members of households is almost 1.7 times higher than that of another racial group. African Americans. Nearly 40% of African American It has been argued that racism has a pervasive, children under the age of 18 are growing up poor, adverse influence on the health and well-being of compared with 11% of their Caucasian peers. Racism racial and ethnic minority populations in the United can also be seen in less obvious differences, such as States. There are three general ways that racism may the economic benefits of educational attainment. In jeopardize the mental health of minorities: (1) Racial 1998, the U.S. Census Bureau noted that a household stereotypes and negative images may be internalized, with an African American male college graduate denigrating individuals’ self-worth and adversely earned 80 cents for every dollar earned by a compara- affecting their social and psychological functioning; ble Caucasian household. The difference is even more (2) racism and discrimination by societal institutions marked for African American households with a have resulted in minorities’ lower socioeconomic female college graduate, whose median income is status and poorer living conditions, in which poverty, 74% of that of comparable Caucasians. crime, and violence are persistent stressors that can These differences in socioeconomic status and affect mental health; and (3) racism and discrimina- educational attainment have important consequences tion are stressful events that can directly lead to for mental health. Research has found that persons psychological distress and physiological changes in the lowest categories of both income and educa- affecting mental health. tion (who are disproportionately African Americans) Racial attitudes toward African Americans have are twice as likely as those at the highest levels shifted over time. During the early 1940s, survey (who are disproportionately Caucasian Americans) research found that most Caucasians supported poli- to meet the criteria for one of the major psychiatric cies and practices that limited interracial contact in disorders. schools, neighborhoods, and marriages. By the 1990s, Racism is also thought to adversely affect mental these attitudes had shifted, and a majority of health status through the subjective experience of dis- Caucasians endorsed such practices as integrated crimination. However, there are inconsistent results schools and interracial marriages. Although there have regarding the connection between racial discrimina- been changes in the attitudes of Caucasian Americans tion and psychological distress. Some studies have toward African Americans, negative stereotypes of found that exposure to racial discrimination is posi- African Americans persist. In general, Caucasians tively related to physical risk factors such as elevated view African Americans more negatively than any levels of blood pressure and elevated levels of A-Jackson.qxd 7/12/2006 2:10 PM Page 23

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psychological distress. Other studies have found the negative attitudes about mental health services and opposite or no racial differences in rates of psycho- report being less likely to use them in the future than logical distress in African Americans compared with are Caucasians with comparable needs and usage. Caucasians. Some have hypothesized that this pattern may reflect the presence of coping strategies within BARRIERS TO MENTAL HEALTH SERVICES the African American population that may mitigate some of the psychological consequences of exposure A number of variables have been suggested to explain to racism. The link between perceived discrimination the racial disparity in the use of mental health ser- and mental health appears to be complex, and under- vices. Barriers to mental health care occur at three standing the variables that moderate this relationship levels: individual, environmental, and institutional. is a relatively new area of empirical research. Individual barriers reflect factors that originate from within the individual, such as culture-specific beliefs and knowledge about mental illness that may influ- USE OF MENTAL HEALTH SERVICES ence help-seeking behavior. Disparities in access to and use of mental health Mistrust of mental health services is as a major services persist across racial and ethnic groups in barrier for ethnic minorities seeking treatment, and the United States. These disparities vary, however, it is widely accepted as pervasive among African depending on geographical location, socioeconomic Americans. It arises from both historical persecution status, and type of service. In general, racial and and present-day struggles with racism and discrimina- ethnic minorities use fewer mental health services than tion. Mistrust also arises from documented abuses and do Caucasians with comparable distress and problems perceived mistreatment, both in the past and more and have less access to mental health services than do recently, by medical and mental health professionals. non-Hispanic Caucasians. Considering that the inci- It has been found that 12% of African Americans and dence of mental illness is similar across racial and eth- 15% of Latinos—compared with 1% of Caucasians— nic groups, minority individuals who require mental feel that a doctor or health provider judged them health services carry a greater burden from unmet unfairly or treated them with disrespect because of mental health needs. Studies have shown that African their race or ethnic background. Americans are less likely than Caucasians to seek help Individuals who are more mistrustful of Caucasian from therapists in private practice, mental health cen- providers are less willing to seek mental health treat- ters, and physicians. Yet African Americans prove no ment and expect less satisfaction from such therapeu- different from Caucasians in their use of public-sector tic encounters. Given the low numbers of ethnic therapists, and they are more likely than Caucasians to minorities trained to deliver mental health services, use inpatient services and the emergency room for many systems are unable to deliver racially matched mental health care. African Americans who have providers. African American clients who must rely on undergone treatment for mental health problems are racially different providers may face clinicians who also more likely than Caucasians to be confined to are culturally insensitive, and this experience may jails, prisons, and mental hospitals and more likely to negatively influence their attitudes toward mental become homeless at some point. These findings high- health services. light the vulnerability of African Americans who are For some African Americans, limitations in under- mentally ill and their high degree of social fragility. standing the problem and in their awareness of possi- African Americans, both those in the general pop- ble solutions, strategies, and resources are obstacles ulation and those who have been diagnosed with a to seeking mental health services. When experiencing mental illness, display more positive attitudes toward problems, many African Americans perceive that they seeking mental health care than Caucasians, yet they are having a normal response to a difficult life situa- use fewer services. It is interesting to note that prior tion and believe that they should keep trying to man- to their actual use of services, African Americans’ atti- age their difficulties on their own. As their problems tudes toward seeking mental health services are com- increase or reoccur and begin to interfere with their parable to—and in some instances more favorable ability to function, African Americans are more likely than—those of Caucasians. Once they have used ser- to rely on informal support from friends, family mem- vices, however, African Americans tend to hold more bers, and clergy to try to deal with the situation rather A-Jackson.qxd 7/12/2006 2:10 PM Page 24

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than seek formalized mental health services. It has Institutional barriers are factors related to the been noted that about 43% of African Americans rely ability of the individual seeking services to actually exclusively on informal help, 44% use both informal access mental health care. The surgeon general’s and formal providers, and less than 5% turn exclusively report on culture, race, and ethnicity identified access to formal sources of help when they are experiencing to care as a major issue involved in mental health ser- personal difficulties. This approach to handling prob- vice disparities among African Americans. The report lems seems to be supported by family members, sig- identified numerous institutional barriers to mental nificant others, and influential African American health services, including a lack of or inadequate community members. insurance coverage, disjointed services, and the loca- Certain cultural beliefs, such as the need to resolve tion of culturally specific services. There are few family concerns within the family and the expectation high-quality mental health services located in low- that African Americans should always demonstrate income communities, where the majority of African strength in the face of problems, inhibit individuals Americans reside. Twenty years ago, many more ser- from seeking mental health services. There is a cul- vices were provided in these communities through tural expectation that life is difficult and that African federal and private funding. These services are no Americans as a cultural group should be able to effec- longer available because of increasing budget cuts and tively cope with adversity. Another cultural factor that shifts in priorities for government spending and pri- may influence the use of mental health services is vate philanthropy. African Americans seeking mental one’s beliefs about the causes of mental illness. health services must often travel relatively long dis- Individuals who identify causes that are consistent tances to find available, affordable care. They often with those espoused by mental health professionals experience problems with transportation, inflexible (such as the importance of early experiences in fami- job schedules, and limited resource knowledge, all of lies and the effect of trauma on development) are which serve as barriers to care. more likely to seek mental health services than those The cost of mental health services has also been who endorse more discrepant views. Ethnic minority noted as a significant barrier to seeking mental health populations more strongly endorse folk beliefs—for treatment. African Americans, the majority of whom example, that imbalances in natural forces cause ill- live in poverty, frequently lack adequate insurance to ness or that supernatural, spiritual, or mystical forces cover mental health services. Hourly fees for treat- cause illness. They also believe that a lack of modera- ment are perceived as excessive and are considered a tion or willpower and weakness of character cause luxury in the face of basic needs and ongoing finan- illness. It is unlikely that individuals who hold such cial challenges. Even for African Americans who beliefs about the causes of mental illness will seek receive Medicaid benefits, bias is experienced because formal approaches to mental health treatment. medication is often the recommended treatment. More Environmental barriers reflect factors that occur often than not, psychotherapy and counseling are not within the external environment and inhibit attempts offered as treatment options. With the further margin- or increase the difficulty of efforts to seek help. Mental alization of African Americans by managed care and illness and mental health treatment continue to be other insurance companies, access to quality mental plagued by a stigma that adversely affects help-seeking health services has become more difficult and costly. behavior. Stigma refers to a cluster of negative attitudes Although there is considerable evidence that mental and beliefs that motivate the general public to fear, health service needs are high within the African reject, avoid, and discriminate against people with American community, the service shortfall that exists mental illness. Stigma is widespread in the United precludes access, thereby exacerbating the emotional States and other Western nations. Research conducted strain on African Americans as individuals and as a during the 1980s found that African Americans held cultural group. more negative views of mental illness than Caucasians. Misdiagnosis is a further barrier to African In more recent studies, however, it has been found that Americans and other ethnic minorities receiving ade- African Americans hold less stigmatized views of men- quate mental health care. Minority patients are among tal health services than in the past. But there continues those at greatest risk for nondetection of mental disor- to be a belief that mental health services are only for ders in primary care. Missed or incorrect diagnoses those who are seriously mentally ill. carry severe consequences if individuals are given A-Jackson.qxd 7/12/2006 2:10 PM Page 25

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inappropriate or possibly harmful treatments, leaving sensitive to clients’ cultural idiosyncrasies. The devel- their underlying mental disorder untreated. Institu- opment of a therapeutic or conceptual orientation is an tional racism was evident over a century ago in the ongoing process, and mental health providers must be form of separate and often inadequate mental health willing to continue this developmental process well services for African Americans. It continues today in beyond their graduate school education. To be most the form of medical practices for diagnosis, treatment, effective in their work with African Americans, mental prescription of medications, and referrals. There is health providers must accept that different worldviews ample evidence that African Americans are overdiag- can coexist and adapt their skills and abilities so they nosed for schizophrenia and underdiagnosed for bipo- are applicable to other cultures. lar disorder, depression, and anxiety as a result of An abundance of literature on African Americans providers’ stereotypical attitudes and beliefs. To date, and their culture is available to mental health providers there has been limited research on the extent of bias who are committed to enhancing their cultural sensitiv- and stereotyping of African Americans among mental ity and awareness of this ethnic minority group. It is not health providers; therefore, the role that stereotyping possible to review this literature in detail, but a brief plays in the racial disparities in mental health service discussion of some of the newer theoretical approaches utilization and effectiveness remains unclear. to working with African Americans can provide examples of new trends in the field. One new approach is the multicultural assessment- CULTURE-SPECIFIC APPROACHES intervention process (MAIP) model. This model TO ASSESSMENT, DIAGNOSIS, requires the mental health provider to employ a sys- AND INTERVENTION tematic approach to assessment and intervention that African American psychologists recognize that tradi- uses cultural information to inform service delivery tional psychology is limited in its understanding of and improve the quality of services provided to people of color and that much of the history of the field African Americans. Questions are addressed at vari- has reflected bias and discriminatory attitudes and ous points in the assessment-intervention process to beliefs about African American individuals, families, emphasize the relevance of assessment instruments, and communities. Today, many ethnic minority increase the reliability and accuracy of clinical diag- researchers and scholars are recommending that mental noses, and foster the use of more credible and benefi- health providers become more culturally sensitive in an cial intervention services. In the MAIP model, there is effort to enhance the effectiveness of their intervention a recognition that cultural and racial differences are efforts with African American clients. It has been sug- essential in the understanding of the self and impor- gested that providers should take a multifaceted thera- tant in the delivery of mental health services to ethnic peutic approach, one that (1) identifies the therapist’s minorities. It requires a willingness to address prob- own attitudes and beliefs about the world based on lems on the basis of these differences during assess- developmental and sociocultural influences; (2) exam- ment, diagnosis, and treatment and a commitment on ines how the therapist’s background and worldview the part of mental health providers to undergo the may differ from the client’s and may hinder the thera- necessary training to become culturally competent. peutic process; (3) strikes a balance between the thera- A second approach that seems to hold promise for pist’s need to learn from the client about his or her enhancing access to mental health services calls for experiences and the use of community and interagency collaboration between the field of psychology and resources to help understand the client’s background; the African American church. The African American and (4) stresses a therapeutic approach that incorpo- church in general and the clergy in particular have rates multicultural theories and practices. traditionally played important roles in providing sup- Understanding African Americans from a multicul- portive resources to the African American community. tural perspective requires that mental health providers Although there are a number of African-centered really listen to clients and try to understand clients from models of psychotherapy in which spiritual develop- within their cultural context. Adopting this approach to ment is understood as central to human development, working with African American clients will help few mental health providers have actively collaborated providers become more adaptable in their theoretical with the African American church. There are several orientation, flexible with their skills and strategies, and barriers that impede collaborative efforts between A-Jackson.qxd 7/12/2006 2:10 PM Page 26

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psychologists and the church: Few academic depart- become the accepted standard of care in the field, ments require training for mental health providers there is hope that existing racial disparities will be in religious or spiritual issues, and mental health significantly reduced or eliminated in the future. providers have limited understanding of the traditions of the different denominations that make up the CONCLUSIONS African American church. To overcome these barriers, providers need to examine their own beliefs regarding The mental health needs of African Americans have religion and spirituality and obtain additional training been well documented in the psychological literature, in religious or biblical counseling. Increasing the col- and over the last decade, there has been a serious effort laboration between the African American church and to incorporate race, ethnicity, and culture into our mental health providers will make it possible to pro- understanding of mental health and mental illness. vide culturally relevant mental health services to Although gains have been made in developing more many African Americans who currently do not use culturally sensitive treatment interventions, there con- traditional mental health delivery systems. tinues to be evidence of bias in the assessment and A third recommended treatment approach for work- diagnosis of mental disorders among African ing with African Americans focuses on cultural Americans. There are also multiple barriers that have strengths within the African American community and a negative impact on African American clients’ access factors that promote resilience. Resilience refers to the to high-quality mental health services and effective notion that some people are able to succeed in the face utilization. There are a number of areas for future of adversity. It involves factors and processes that inter- research, such as the need to better understand the help- rupt the trajectory from risk to problem behavior or seeking attitudes and behaviors of African Americans psychopathy. A resilience perspective highlights the in the utilization of mental health services and the role development of competencies, assets, and strengths in that stigma plays in this process. A final question that individuals’ lives, and it includes the maintenance of will need to be examined more thoroughly in the future healthy development despite the presence of a threat or relates to the effects of cumulative stress on the emer- recovery from trauma. These psychosocial resources gence and progression of mental health problems and resilience factors can insulate the individual from experienced by African Americans. such significant stressors as racism or provide coping Focusing on cultural strengths and resilience is mechanisms to reduce the negative effects of stress. clearly an important direction for the future; however, Well-established psychosocial resources, such as we should not lose sight of the fact that promoting indi- supportive social ties, perceptions of mastery or con- vidual (or collective) resilience is not a substitute for trol, and self-esteem, have been shown to serve as pro- systemic, institutional change. There is compelling evi- tective factors for individuals coping with stress and dence that African Americans and other racial and eth- adversity. In addition, research suggests that other cul- nic minorities experience a disproportionately high turally specific resources seem to enhance coping disability burden from unmet mental health needs. The among African Americans. These include religious racism, discrimination, and economic deprivation that beliefs and behavior, ethnic-group identity and con- plague much of the African American community sciousness, and racial socialization experiences. The require system-level change. Ultimately, reducing dis- term racial socialization refers to the process of com- parities in the mental health treatment of African municating behaviors and messages to children for the Americans will require a societal commitment to social purpose of enhancing their sense of racial or ethnic justice and equity. identity, partially in preparation for racially hostile —Elizabeth E. Sparks encounters. The association between African Americans’ perceptions of racial discrimination and mental health See also African/Black Psychology; Africentric; Association is moderated by experiences with racial socialization of Black Psychologists; Black Racial Identity Scale in families and by levels of self-esteem. These newer approaches to understanding and FURTHER READING promoting mental health in African Americans hold Dana, R. H. (2002). Mental health services for African promise for the development of mental health services Americans: A cultural/racial perspective. Cultural Diversity that are culturally appropriate and effective. As they and Ethnic Minority Psychology, 8(1), 3–18. A-Jackson.qxd 7/12/2006 2:10 PM Page 27

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U.S. Department of Health and Human Services. (2001). In response to discontent with the American Mental health: Culture, race, and ethnicity (Suppl. to Psychological Association, the Association of Black Mental health: A report of the surgeon general). Rockville, Psychologists (ABP) was established in 1968 with an MD: Author. agenda to address issues of race, culture, and oppres- Williams, D. R., & Williams-Morris, R. (2000). Racism and mental health: The African American experience. Ethnicity sion as they concern African/Black persons and to and Health, 5(3/4), 243–268. promote the refutation of cultural-deficit models and comparative studies that portray African/Black persons as deviant. The ABP is credited with three con- tributions to the field of African/Black psychology. AFRICAN/BLACK PSYCHOLOGY The first is the reemergence of African psychology based on an African cosmology; second, the develop- African/Black psychology is a system of knowledge ment of the Journal of Black Psychology; and finally, grounded in the perspectives of African-descent the Annual International ABP convention, at which persons and designed to describe their personalities, African/Black psychologists throughout the diaspora attitudes, emotions, and behaviors. This system of collaborate and learn from one another while building knowledge is based on an African cosmology and cor- an African/Black psychological community. responds to African conceptions of the social uni- In 1972, Wade Nobles’s literary contribution, verse. Essentially, it is a science of exploring the lives African Philosophy: Foundations for Black of African-descent persons from a perspective that is Psychology, was the final development to clearly link centered on their experiences. ancient African philosophical thought to the psychol- Although African psychologists acknowledge the ogy of African/Black people. Following the establish- existence of an African/Black psychology derived ment of the ABP, three camps developed among from the development of early African civilizations in African/Black psychologists: Eurocentric, Black, and Egypt and Ethiopia, formal study and articulation of African. Eurocentric psychologists are of African African psychological concepts, theories, and models descent and employ Eurocentric theory and research have only recently begun to take shape. This formal in their work with African-descent persons. Black psy- development is marked by three pivotal moments in chologists are described as reacting to White suprema- history: (1) the work of Francis Cecil Sumner, (2) the cist notions and racist formulations promoted by founding of the Association of Black Psychologists, Eurocentric psychological theory and research. and (3) Wade Nobles’s publication on the philosophi- Finally, African psychologists are described as being cal basis of African psychology in 1986. proactive in the development of African/Black psy- In 1992 and 1996, Chancellor Williams and Daudi chological research and theory, which is centered on Ajani ya Azibo, respectively, discussed how the the experiences of African/Black people and con- destruction of Black African civilization, beginning as nected to an African system of knowledge (i.e., cos- early as 4500 BCE and continuing through the present mology, ontology, axiology, worldview, ideology, and day, has arrested the development and ownership of ethos). Nobles’s essay was the first published work to African-centered conceptions of the human experi- articulate the African philosophical basis of African ence. Historically, Eurocentric psychological explana- psychology—a seminal piece that initiated the propa- tions have been the primary mode of understanding gation of proactive African/ Black psychological the behaviors of African/Black persons. In response research orientation, theory, and practice. to this approach, Dr. Francis Cecil Sumner, the first African American to receive a PhD in psychology in AFRICAN/BLACK PSYCHOLOGICAL the United States (in 1920), began a program of inves- DEVELOPMENTS tigation to refute racist and pejorative theory and research that argued for African/Black inferiority. African/Black psychological research orientation, the- Sumner was named the “father of Black American ory development, and practice are significantly guided psychologists,” and his work is considered an initial by the Afrocentric school of thought founded by response to Eurocentric psychology, which has been Molefi Asante during the late 20th century. Asante used to validate the mistreatment of African-descent coined the term Africalogy—the Afrocentric study of persons. phenomena, events, ideas, and personalities related A-Jackson.qxd 7/12/2006 2:10 PM Page 28

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to Africa—to describe the generation of theory and racially hostile and oppressive environment. Continu- practice across all disciplines (including psychology) ing this work, Azibo developed an African-centered centered on Africa and African descendants. A review nosology of Black personality disorders that system- of developments in African/Black research orienta- atized 18 disorders of the African personality. Several tion, theory, and practice follows. studies have substantiated the integrity of Azibo’s nosology. Like Akbar and Azibo, Linda Meyers presented the framework of optimal psychology to Research Orientation explain the manifestation of the African worldview in There are four tenets of the Afrocentric method the psychology of African/Black persons. by which Africalogists (i.e., researchers of Africa and Developmental psychological theory has focused African-descent persons) are guided. First, researchers on the redefinition of normative growth and develop- examine themselves in the process of examining the ment of African/Black children. The work of Amos subject of study, thus maintaining a practice of intro- Wilson is noteworthy. Wilson’s work concentrated spection and retrospection throughout the course of on the developmental psychology of African/Black study. Second, the Afrocentric research method children and the development of culturally responsive requires cultural and social immersion and discour- child-rearing and learning environments that would ages traditional scientific distance in the study of promote their optimal development. In this vein, African and African-descent persons. Third, the Neferkare Abena Stewart focused her work on the Afrocentric method requires the researcher to have early development of African/Black infants across the familiarity with the history, language, philosophy, and world to generate developmental milestone norms myths of the people under study. Fourth, the Afrocen- (e.g., average age for sitting up, walking, talking, etc.) tric method views research as a vehicle by which to for these children. humanize research participants and, ultimately, the Racial identity theory has also witnessed tremen- world. Later theorists elaborated the Afrocentric dous growth over the last 30 years. In 1970, William research method, explicating and concretizing con- Cross introduced formidable work on “Nigrescence” cepts offered by Asante’s initial work. (i.e., the Negro-to-Black conversion) that investigated the process by which African/Black persons develop an integrated identity with regard to race. Cross’s Theory initial work influenced subsequent developments in African/Black psychological theory has been gender and racial identity development theory. developed to explain the personalities, attitudes, emotions, and behaviors of African-descent persons from Practice a perspective that is centered on their experiences. Personality and developmental psychological theories The practice of African/Black psychology has only have experienced the most growth. Additionally, iden- recently been formally presented as a cohesive system tity theory has witnessed further growth and develop- of treatment, although African-centered approaches to ment. In her groundbreaking work, Dr. Frances Cress treatment in social services, educational, and mental Welsing (1970) presented the Cress theory of color health settings have been employed for some time. confrontation and racism, which explains the hostile In 1990, Frederick Phillips presented an Afrocentric treatment of African-descent persons by those of approach to psychotherapy. This approach is spiritu- European descent. Other personality theories that ally based, focusing on achieving balance and align- explain African-descent persons have been offered by ment within persons and systems. Basic principles of African/Black psychologists such as Na’im Akbar, Afrocentric therapy—harmony, balance, interconnect- Daudi Ajani ya Azibo, and Linda Meyers. edness, cultural awareness, and authenticity—are Akbar’s early conceptualizations of African/Black guided by the African worldview. psychology sought to redefine normalcy for African- descent persons by considering their logical reactions CONCLUSION to an oppressive social environment. He coined terms such as misorientation and mentacide, which describe The field of African/Black psychology continues to African-descent persons’ psychological response to a develop, reclaiming and elaborating on the African A-Jackson.qxd 7/12/2006 2:10 PM Page 29

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historical and cultural legacy. As growth in the field civilizations of the Nile Valley. This revisionist view persists, several developments are anticipated. The of world history and antiquity counters the dominant expansion of existing theories and the development perspective of African people, which commences with of new theoretical conceptualizations and practical European conquest. approaches are expected, as the existing theories and The second aim focuses on how individuals make models are at least three decades old. Additionally, meaning of the world within an Africentric cultural psychological studies grounded in Afrocentric theory context. Africentric scholars argue that because the that demonstrate the effectiveness of African/Black Western framework represents African people as psychological interventions and their generalizability deviant from the European ideal, it is futile to attempt among African/Black persons in diverse settings and to understand the behaviors of African people within contexts are needed. Finally, as a concerted effort a Eurocentric framework. takes hold among African/Black psychologists to meet the mental health needs of African-descent per- AFRICENTRIC PSYCHOLOGY sons throughout the diaspora, the development, imple- mentation, and evaluation of theory and interventions Connectedness is a primary tenet of the Africentric for African-descent persons outside the United States worldview. Contrary to the Western or Eurocentric per- will most likely be expanded. spective, which vales objectivity, the Africentric world- —Wendi S. Williams view recognizes the interconnectedness of the affective —Julie R. Ancis (feeling), cognitive (knowing), and behavioral (acting) domains. The African Self-Consciousness Scale is a See also Association of Black Psychologists measure that encompasses dimensions related to an individual’s awareness of a collective sense of relationship to African people and resistance to forces of FURTHER READING oppression. African self-consciousness is related to cul- Azibo, D. A. (1996). African psychology in historical perspec- tural and racial socialization among African Americans. tive and related commentary. Trenton, NJ: Africa World In the Africentric paradigm, the consequences of Press. oppression manifest in the psyche of African people and Helms, J. E. (1990). Black and White racial identity: Theory, research, and practice. Westport, CT: Greenwood Press. are evident in behavior. The Africentric psychologist Nobles, W. (1986). African psychology: Toward its reclama- views cultural orientation as related to well-being. When tion, reascension, and revitalization. Oakland, CA: Black African people adopt a foreign or Eurocentric worldview, Family Institute. maladaptive behaviors and psychopathology result. Thus, an Africentric framework explains the often-cited disparities between European Americans and African Americans in educational, health, or mental health out- AFRICENTRIC comes as a consequence of oppression and detachment from the cultural source. Africentric psychologists and The term Africentric, and the more commonly used educators have designed culturally relevant interven- term Afrocentric, describe a worldview in which tions, such as youth rites of passage programs, to help African people and culture are the central unit of counter the impact of racial oppression. analysis, with a focus on social and historical context. There are two critical aims in the framework of CHALLENGES TO AFRICENTRIC THEORY Africentric scholarship: (1) the reclamation and revision of the history of African people, who share com- One major challenge to Africentric theory is that mon ancestral origins but are spread throughout the within this framework, race is constructed as an essen- world (this international population represents the tial characteristic. Africentric scholars have been African diaspora) and (2) the resistance of European critiqued for focusing on racial classification as cultural hegemony and oppression. deterministic rather than acknowledging the dynamic The first aim is to transform scholarship. In partic- aspects of culture and the diversity of individual ular, Africentric scholars have studied the impact expressions of ethnicity. Some scholars of European of Black African civilizations, such as the ancient classicism have challenged the veracity of some of the A-Jackson.qxd 7/12/2006 2:10 PM Page 30

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claims made within the revised analysis of African and mental health professionals. Although the Alaska people in ancient civilizations throughout the African Native community constitutes a small percentage diaspora. Other critiques address some Africentric of the U.S. population, an incredible diversity exists scholarship that makes arguably sexist or homophobic among its people. For example, differences among assertions about interpersonal relationships in an Alaska Native peoples can be found in geographical authentic African cultural context. location, language, customs, beliefs, religion, family structures, and social structures. The degree of diversity among the Alaska Native peoples has important CONCLUSIONS implications for psychological research and mental This entry offers a brief review of Africentric per- health treatment. spectives on knowledge production, meaning making, and behavior. Although Africentric theory has gained GENERAL INFORMATION more attention in recent years, this intellectual tradition is evident historically throughout Black scholar- Though there is no single definition of Alaska Native, ship in the diaspora. Africentric theory in psychology this term is typically used to describe the indigenous provides a framework for understanding the context of people of what is now the state of Alaska. Specifi- human behavior liberated from Western cultural cally, Alaska Natives are generally thought to include biases regarding mental health. An Africentric para- Eskimo, Indian, and Aleutian peoples. Nearly half of digm transforms the analysis of how cultural world- all Alaska Natives are Eskimo, which includes the view affects micro- and macro-level outcomes. Inupiat, Yup’ik, and Cup’ik peoples. About one-third —Zaje A. T. Harrell of Alaska Natives are Indians, which encompasses the Athabascan, Eyak, Tlingit, Tsimshian, and Haida See also African/Black Psychology; Association of Black peoples. Finally, the Aleut people constitute approxi- Psychologists; Culture mately 15% of Alaska Natives. The Alaska Native population is geographically dis- persed throughout the state of Alaska, which is approx- FURTHER READING imately one-fifth the size of the continental United Ani, M. (1994). Yurugu: An African-centered critique of States. In general, the majority of Alaska Natives reside European cultural thought and behavior. Trenton, NJ: outside the larger Alaska cities in villages of 2,500 Africa World Press. people or fewer. Anchorage, the most populated city Asante, M. K. (1998). The Afrocentric idea. Philadelphia: in the state, is home to approximately 14,000 Alaska Temple University Press. Kambon, K. K. (1992). The African personality in America: Natives. Altogether, Alaska Native groups compose An African-centered framework. Tallahassee, FL: Nubian approximately 16% of the state’s population. Not only National Publications. are there geographical differences; linguistic and cultural differences can also be found among the Alaska Native peoples. For example, Alaska Natives speak 20 different languages, live in all major areas of Alaska, ALASKA NATIVES and vary in degrees of acculturation. The Inupiaq live in the northern and northwestern Mental health is important to an individual’s general region of Alaska, where they still live a subsistence health, family relationships, and relationships within lifestyle. Two major dialects, which resemble the the community. A number of factors can contribute to dialects of Canadian and Greenlandic Eskimos, are mental health status, including biological, social, and spoken by the Inupiaq. The Inupiaq believe in the psychological phenomena. Mental illness can have a reincarnation of both animal and human spirits. This significant negative impact on individuals, families, belief is often expressed in the ceremonial treatment and communities. To effectively prevent or ameliorate of animals that are killed during a hunt and the naming mental health–related problems, current research and of children after deceased relatives. practice focus on these contributors to mental health. Distinguishable by their different dialects, the Specifically, the role of culture on mental health has Yup’ik and Cup’ik are concentrated in southwestern become an important area of interest for researchers Alaska. Also hunters and gatherers, the Yup’ik and A-Jackson.qxd 7/12/2006 2:10 PM Page 31

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Cup’ik were once a mobile people following the Finally, the Aleut and Alutiiq peoples live in migration of the game they hunted. Historically, social southern and southwestern Alaska, including the chain hierarchies among the Yup’ik and Cup’ik were based of islands off the Alaskan coast known as the Aleutian on gender, and men and women often lived in separate Islands. The Aleutian Islands are known for having dwellings. Elders played an important role in the some of the harshest weather in the world. The three socialization of younger members of the group and major groups of the Aleut and Alutiiq peoples speak were responsible for passing on cultural beliefs two different languages. The Aleut and Alutiiq also through storytelling. incorporate the Russian language into their everyday Historically, the Athabascan people were concen- speech. This reflects the early contact between trated around river ways in the Alaskan interior (central Russian fur traders and the Aleut and Alutiiq peoples. Alaska), where they would hunt, fish, and trap. Today, Like many of the others Alaska Native groups, the Athabascans live throughout the state of Alaska. Eleven Aleut and Alutiiq peoples place a strong emphasis on languages are spoken by the Athabascan people. kinship and sharing. Although there are exceptions, the majority of The Russian discovery of Alaska in 1741 brought Athabascan clans follow a matrilineal social structure. significant changes to the indigenous Alaska Native In the past, this matrilineal system influenced hunting population. Russian fur traders concentrated hunting practices, living arrangements, and the socialization efforts on much of the Alaskan coast in search of sea of children. Among the many values the Athabascan otter pelts, often trading with the Alaska Natives. By people hold, sharing and respect for all living things are 1772, a permanent Russian settlement had been estab- especially important. lished in Unalaska. In 1795, Russian missionaries The Eyak, Tlingit, Tsimshian, and Haida peoples established the first Russian Orthodox Church on inhabit the southeastern portion of Alaska, known as Kodiak Island. Although not all Alaska Native groups the Alaska panhandle, and use a matrilineal system of were negatively affected by the Russian fur trade, the moieties, phratries, and clans. A moiety includes two mistreatment of the Aleuts is well documented. In par- subdivisions that can be broken down into several ticular, the Aleut people were enslaved and forced to clans. A phratry is similar to a moiety but has four hunt sea otters for the Russia fur traders. Eventually, divisions instead of two. Like moieties, phratries interest in Alaska subsided when sea otters had been include a specific number of clans. The matrilineal hunted to near extinction. In 1867, the United States social system determines family name, inheritance, purchased Alaska from Russia for 7.2 million U.S. hunting practices, and living arrangements. The Eyak dollars. once occupied the southeastern corner of south- Outside interest in Alaska was rekindled when gold central Alaska and included two moieties. Currently, was discovered near Juneau in 1880 and again in the the Eyak people are concentrated on the Copper River Klondike region in 1897. When vast quantities of gold Delta in Alaska, where they continue to live a subsis- were found in the Nome region in 1898, the Alaska tence lifestyle. As with the Eyak, Tlingit subsistence gold rush began. This brought the arrival of numerous comes primarily from fishing but also includes the non-Natives to Alaska in a very short period of time. gathering of plants and hunting of game. Considered A booming commercial fishing and canning industry, one of the most complex cultures of the North in addition to a growing population of military per- American Natives, Tlingit culture uses a social classifi- sonnel, created a significant population increase cation system that defines social norms and strata. during the early 1900s. By 1959, Alaska’s population Although one common language is shared by the had grown enough to qualify for statehood. With the Tsimshian people, four separate dialects are spoken discovery of oil and natural gas reserves on Alaska’s depending on geographical location. Currently, the North Slope, the influx of people to the state has Tsimshian people are concentrated on Annette Island continued to increase. off the southeastern coast of Alaska. The Haida originally lived among the Queen Charlotte Islands in CUSTOMS AND BELIEFS Canada, eventually settling on Prince of Wales Island off the southeastern coast of Alaska. Unlike the Tlingit The cultural values and ways of life of the different and Tsimshian peoples, the Haida speak a language that Alaska Native groups have been permanently affected is unrelated to the other Alaska Native languages. by the introduction of Western society. For example, A-Jackson.qxd 7/12/2006 2:10 PM Page 32

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non-Native people brought diseases, racial discrimi- identifying which taboo has been broken and advising nation, and modern industry to Alaska. These things the individual or the members of the community on have, in some cases, led to a loss of the traditional methods for remedying the problem. This process typ- ways of the Alaska Native peoples. However, tradi- ically involves the shaman entering a trance-like state tional beliefs still persist among Alaska Natives. to improve his or her ability to perceive supernatural Today, spirituality remains an important aspect of phenomena that are important to the healing process. Alaska Native culture, and the traditional belief that The reason for the illness or problem is then identified humans, animals, and the earth share a relationship in an attempt to prevent future problems for the indi- is fundamental to the modern belief system of Alaska vidual and the community. Natives. With the introduction of organized religion Alaska Natives believe that the underlying cause of to Alaska, some Alaska Natives have come to view an illness can be either natural or supernatural; the their spirituality concurrently through traditional source of the problem determines the method of inter- Native customs and non-Native religious perspectives vention. The healing ceremonies that follow involve (e.g., shamanism, Christianity). reestablishing community harmony. For example, In addition to beliefs about the relationship prayers, songs, and other activities are used to create between animals, humans, and the earth, Alaska an atmosphere that facilitates a healing environment. Native culture emphasizes harmony among an indi- During these ceremonies, participants sometimes vidual’s mind, body, and soul. This is considered wear masks or ornate costumes, dance, play musical important to preserving overall health. Disharmony instruments, and use images depicting the spirits they between mind, body, and soul, therefore, can result in intend to attract. mental and physical deterioration. In addition to its holistic view of life, Alaska Native culture places an HEALTH DISPARITIES emphasis on helping within the Native community. This can be seen in the continuance of the subsistence Because Alaska Natives and American Indians tend lifestyle of many of the modern Alaska Native groups. to be grouped together when it comes to health issues, Each individual has a role in the daily functioning of it can be difficult to determine the specific mental and the community. For example, elders among the clan physical health problems Alaska Natives face. are considered an important source of wisdom and However, some information does exist about the men- advice among Alaska Native peoples. tal and physical health problems of Alaska Natives. Although not all Alaska Native cultures believe in Some of the leading causes of death among Alaska shamanism, the idea that an individual can possess the Natives are cancer, unintentional injury, power to see and influence spirits does exist in some suicide, and homicide. Although cancer rates are Alaska Native groups. Among these groups, a shaman decreasing among the general population in the is sometimes considered the spiritual leader of the United States, cancer rates among Alaska Natives are clan. In other instances, the shaman is seen strictly as increasing. Compared with their non-Native counter- a healer or an individual who influences the luck of parts, Alaska Natives are less likely to survive once the community. they are diagnosed with cancer. The most common In the case of mental or physical illness, the types of cancer among Alaska Natives are colorectal shaman’s duties include determining the causes of cancer and lung cancer. The high rates of lung cancer the illness and deciding how to treat the underlying among Alaska Natives may be related to the high causes of that illness. For example, many physical or smoking rates among Alaska Native groups. mental problems are considered to be the result of a Additionally, because tobacco sales to minors are broken taboo. A taboo is an inhibition or ban on spe- common, Alaska Natives tend to start smoking at a cific behaviors or even thoughts based on Native cus- younger age. toms and beliefs (e.g., not hunting the animal of your Death as a result of unintentional injury among clan name). Many taboos are related to preventing ill- Alaska Natives has been estimated to be almost four ness or the promotion of a healthy lifestyle. A broken times that of the general population in the United taboo disrupts the harmony between mind, body, and States. Additionally, unintentional injury is the leading spirit, not only for the individual but also for the com- cause of death among Alaska Native children. Risk munity as a whole. The shaman is responsible for factors related to unintentional injury include poverty, A-Jackson.qxd 7/12/2006 2:10 PM Page 33

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substance abuse, poor housing, lack of access to Board has developed tobacco-prevention programs to adequate medical treatment, and geographic isolation. assist Alaska Native communities in reducing tobacco Suicide rates among Alaska Natives have been use. These prevention programs focus on discourag- estimated to be twice the national average. Suicide ing tobacco use and preventing tobacco-related ill- rates are particularly high among Alaska Native males nesses that ultimately lead to death. These programs in their late teens and early twenties who live in are also intended to target Alaska Native youth to nonurban areas of Alaska (i.e., villages). Though no prevent early tobacco use. one can say for sure, suicide is often the result of a lack of treatment for depression and substance abuse. Suicide These risk factors appear to be more common among the Alaska Native population. Barriers related to the The Department of Health and Social Services utilization of appropriate mental health services may Division of the Alcohol and Drug Abuse Community- be a secondary contributor to suicide among Alaska Based Suicide Prevention Program provides support Natives who suffer from depression and addiction. for Alaska Native communities to create prevention Some estimates show that Alaska Natives are four programs aimed at reducing suicide. This resource is times more likely to die from homicide than their non- particularly appealing because it allows communities Native counterparts. In fact, nearly half of all deaths to develop prevention programs to meet the specific among Alaska Natives are a result of suicide or homi- needs of the community. In addition to these services, cide. Again, alcoholism is considered by many to play a number of agencies and organizations proactively a significant role in the high homicide rates within the initiate programs for the purpose of educating the Alaska Native community. Alaska Native community about suicide risk factors, Alaska Natives also have higher rates of incarcera- preventing suicides, and providing a forum for dis- tion, homelessness, poverty, and alcohol and drug cussing concerns related to suicide. problems. Statistics on homelessness and poverty can For example, the Western Athabascan Natural be difficult to interpret because of the extreme varia- Helpers Program is a school-based program that tar- tion in living circumstances among Alaska Natives gets at-risk schools for suicide prevention. Addition- groups. Several theories exist to explain the high ally, the Zuni Life-Skills Development Curriculum, prevalence of alcohol abuse among Alaska Natives. the Wind River Behavioral Health Program, the Some believe that the altered state induced by alcohol Tohono O’odham Psychology Service, and the Indian consumption was initially considered a valued spiri- Suicide Prevention Center are prevention programs tual experience among the Alaska Native peoples. developed for American Indian populations. Although Others postulate that the binge drinking of early these programs are not designed specifically for Russian and American fur traders and trappers led to Alaska Natives, they may provide useful information a skewed socialization of appropriate alcohol con- about tailoring suicide-prevention programs to sumption. Finally, some believe that the problems include Native customs and beliefs. many Alaska Natives face are the result of negative events experienced by their ancestors (e.g., racism, Unintentional Injury discrimination). These stressors are consequently passed down to each successive generation. Regardless The Alaska Injury Surveillance and Prevention of the reason for the high rates of alcoholism among Program (ISAPP) currently provides resources for Alaska Natives, most agree that this problem is a preventing unintentional injuries among Alaska significant one. Native peoples. These programs work to improve environmental surroundings (e.g., by installing child car seats), encourage safety law compliance (e.g., TREATMENT AND PREVENTION EFFORTS child car seat use), and provide safety-related education (e.g., proper use of child car seats). The ISAPP Smoking Prevention uses a community-level approach that focuses on A number of prevention programs have been devel- establishing specific programs that target the prob- oped to address the high rates of tobacco use among lems a particular community is facing (e.g., car Alaska Natives. For example, the Alaska Native Health seat–related accidents). A-Jackson.qxd 7/12/2006 2:10 PM Page 34

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Homicide mental health services to Alaska Natives. This system of health service providers aims to improve the phys- In addition to programs designed to prevent unin- ical and mental health of Alaska Natives. tentional injury, resources exist for the purpose of The National Center for American Indian and reducing and preventing intentional injury within Alaska Native Mental Health Research is a research Alaska Native communities (i.e., homicide). An organization affiliated with the University of Colorado’s example of such an organization is the Alaska Injury Department of Psychiatry. This program is sponsored Prevention Center, which works to increase general by the National Institutes of Mental Health. The community safety. The center works with Alaska law center focuses its research efforts exclusively on enforcement and community agencies to reduce the American Indian and Alaska Native peoples. This incidence of homicide through education, public ser- organization was developed to improve understanding vice announcements, and community-based programs. of psychological issues among American Indian and Alaska Native populations. Alcoholism The Center for Alaska Native Health Research is a research organization that conducts research among Although a number of substance abuse programs Alaska Native populations. Sponsored by grants from are available in Alaska, few incorporate Native the National Institutes of Health and the National beliefs into treatment protocol. However, recent Center for Research Resources to the University of efforts have been made by such organizations as the Alaska– Fairbanks, the center collects health-related Department of Health and Human Services to pro- information (e.g., nutritional information) among mote culturally sensitive treatment programs for Alaska Native people. Utilizing both scientific and Alaska Natives. Also, Internet resources have been cultural approaches to examining health issues, the used by this organization to overcome barriers that Center for Alaska Native Health Research looks to often result from the geographic dispersion of Native improve the health of Alaska Natives. communities.

MENTAL HEALTH SERVICE UTILIZATION ALASKA NATIVE ORGANIZATIONS It is common knowledge that ethnic and racial minori- In addition to prevention programs and organizations, a ties in general are less likely to use mental health number of groups exist to provide services to Alaska services. Although the specific rates of mental health Natives. For example, the Alaska Native Health Board service utilization among Alaska Natives have not provides a forum for discussing Alaska Native health been carefully examined thus far, the use of these issues. The purpose of this organization is to promote resources appears to be particularly low in this popu- the overall well-being of the Alaska Native community. lation. Alaska Natives face barriers that are common The Alaska Native Knowledge Network is an orga- to other ethnic groups, but they also face obstacles nization that compiles and exchanges information that are unique to the cultural, social, and geographic related to Alaska Native culture. It was developed to characteristics of their way of life. Negative past expe- provide federal agencies, private organizations, edu- riences with non-Native peoples (i.e., racism, discrim- cators, and the public with insight into the Alaska ination, segregation) may result in a general mistrust Native way of life. Additionally, this network provides of mental health professionals. This, coupled with a Alaska Natives with a method for preserving informa- relative lack of mental health professionals of Alaska tion about their customs and beliefs. The Alaska Native descent, may help explain the underutilization Native Knowledge Network also has resources for of psychological services. Another barrier to the use educators who are developing curricula for Alaska of mental health services is cost. Fortunately, the Native children and adolescents. Indian Health Service (IHS) is a federally funded The Alaska Native Tribal Health Consortium is an agency that provides affordable health care, including organization that is owned by the Alaska Native tribal mental health services, to Native populations. government and various Alaska Native health services However, geographic isolation can make it difficult to organizations. The consortium is part of the Alaska access IHS-designated clinics that offer mental health Tribal Health System, which provides medical and services to Alaska Natives. A-Jackson.qxd 7/12/2006 2:10 PM Page 35

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RECOMMENDATIONS FOR RESEARCH As in some American Native cultures, Alaska Natives speech may proceed at a slower rate than for other There is still a great deal that is unknown about the people. Silence, pauses, and a lack of eye contact may be mental health issues faced by Alaska Native peoples. common during conversations and should not be per- In general, future research efforts that focus on con- ceived as avoidance or disrespect. Additionally, exten- ducting culture-centered research among Alaska ding mental health treatment to include family members, Natives would help us better understand the psycho- respected elders from the community, or other commu- logical needs of this population. The influence of cul- nity members may help to facilitate the treatment tural beliefs on psychological phenomena may process. Alaska Natives may have different perceptions improve our understanding of the suicide, uninten- of disability and illness. For example, Alaska Natives tional injury, homicide, and alcoholism rates in this sometimes believe that mental illness stems from a spir- population. Ethical research conducted among spe- itual rather than a psychological or biological cause. cific Alaska Native groups that highlights differences Inquiring about an individual’s perceptions of the con- among these groups could be improved. For example, tributors to mental health can help improve the develop- when reporting treatment research methods and ment of an effective treatment plan. For example, design in an Alaska Native sample, researchers should including traditional Alaska Native treatments in addi- include information related to the specific group tion to more conventional psychological methods may assessed in the study (e.g., Tlingit, Aleut). This would improve treatment adherence. Improved adherence to improve our understanding of the generalizability of treatment recommendations will therefore improve treat- treatment results, which could, in turn, aid in the ment outcomes. Again, the holistic view of health shared translation of research into effective treatments. by many Alaska Native peoples should be considered This is not to say that research has not been con- when explaining and treating psychological issues. ducted among Alaska Native groups; however, addi- In addition to client and patient factors, mental tional research is necessary. Specifically, further health professionals should be aware of their own research should focus on the effects of non-Native ver- beliefs and cultural background. Because mental sus Native mental health professionals on the health professionals are also products of their own client–therapist relationship, different utilization rates culture, they should be aware of attitudes and beliefs of mental health services among specific Alaska Native that may influence their perceptions of Alaska groups, and the effectiveness of incorporating cultural Natives. Consistently monitoring one’s own beliefs values and beliefs into the treatment process. Research and preconceived notions about Alaska Native peo- that answers these questions will enable mental health ples can improve a mental health professional’s abil- professionals to more effectively address the mental ity to function effectively in cross-cultural situations. health needs of their Alaska Native clients. —Michael M. Steele RECOMMENDATIONS FOR PRACTICE See also Native Americans

Assumptions should never be made about any indi- FURTHER READING vidual based on his or her ethnicity or race. However, Herring, R. D. (1999). Counseling with Native American an understanding of specific cultural values and Indians and Alaska Natives: Strategies for helping profes- beliefs can be an important factor in establishing an sionals. Thousand Oaks, CA: Sage. effective therapeutic relationship. For example, some U.S. Department of Health and Human Services. (1999). Alaska Native cultures display a reserved communi- Mental health: A report of the surgeon general. Retrieved cation style, which is sometimes viewed as unfriendly January 28, 2006, from http://www.mentalhealth.org/cmhs/ by non-Natives. Additionally, in some Alaska Native surgeongeneral/surgeongeneralrpt.asp cultures, sharing information related to personal problems or complaints is not encouraged by the Native community. In these circumstances, trust becomes ALCOHOL/SUBSTANCE crucial to the therapeutic relationship. A lack of trust USE AND ABUSE in the context of cross-cultural mental health treatment and suspicion of mental health professionals Alcohol and illicit drug problems are not unique to the may not be uncommon. majority culture of the United States. They also exist A-Jackson.qxd 7/12/2006 2:10 PM Page 36

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throughout the many cultural groups that compose the term substance misuse is a general term that describes nation’s ethnic minority population. Within the ethnic people who suffer from either a substance abuse or minority population, alcohol and illicit drug problems substance dependence disorder. span age, gender, educational background, occupa- Colloquially, the term substance abuse is used to tion, and socioeconomic status. What follows is an refer to any degree of substance use, ranging from overview of alcohol and illicit drug use and misuse as one-time use of an illicit drug to severe addiction. it pertains to the ethnic minority population of the Its definition among medical and mental health pro- United States. This overview is divided into discus- fessionals, however, and its use here, refers to a sub- sions of (1) the distinction between substance use and stance abuse disorder marked by habitual use of a forms of substance misuse, (2) the role of cultural substance in a manner that is harmful to self or others norms and acculturation in substance use, (3) the but without strong signs of physical dependence or prevalence of substance use and misuse among ethnic significant psychosocial negative consequences. For minority groups, (4) interventions for substance use example, a man may drink heavily at bars on some and misuse in ethnic minority groups, and (5) the weekends and then drive home in a state of intoxica- impact of drug-control policies on ethnic minority tion. His behavior is dangerous because he is placing groups. This overview does not address alcohol and himself and others at risk of injury or death, but the drug problems outside the United States, but it is role of alcohol in his life may not be so central as to important to note that substance problems are promi- reach the level of addiction. nent in other nations and have a negative impact on Among medical and mental health professionals, a cultural groups around the globe. Neither will this substance dependence disorder describes an addiction overview address nicotine and prescription drug prob- to a substance, marked signs of tolerance and with- lems, both of which are also prominent domestic and drawal, and a number of negative consequences asso- international concerns. ciated with the substance use, but continued use of the substance despite these consequences. Terms such as alcoholic, junkie, and crackhead are colloquialisms DISTINGUISHING BETWEEN SUBSTANCE USE used to describe people who suffer from abuse of or AND SUBSTANCE MISUSE dependence on alcohol, heroin, and crack cocaine. Understanding the nature of alcohol and illicit drug use and misuse among ethnic minority groups must THE ROLE OF CULTURAL NORMS AND begin by distinguishing among substance use, sub- ACCULTURATION IN SUBSTANCE USE stance misuse, substance abuse, and substance dependence (ordinarily referred to as addiction or chemical Each culture has a set of norms regarding the sub- dependence). Clarification of the terminology is impor- stance use of its members. Individuals within a given tant because patients, researchers, policymakers, law cultural group will vary in the extent to which their enforcement, and the media often use these terms personal attitudes and behavior toward substances are interchangeably, and the definitions may be at odds consistent with these norms. Thus, the substance use with those of the mental health and medical profes- of some individuals will closely follow their cultural sionals who are responsible for diagnosing and treat- norms, whereas the substance use of others will be at ing alcohol and drug problems. For example, a man odds with their cultural norms. Despite these individ- arrested for smoking marijuana at a concert may con- ual differences, cultural norms have been found to sider himself a substance user, but the criminal justice have a profound and multifaceted impact on the sub- system may label him a substance abuser and him to stance use of group members. They influence the drug treatment, where he may be diagnosed with a sub- particular drugs that are deemed acceptable for use, stance dependence disorder (such as a cannabis depen- how and when drugs are used, and even the kinds of dence) by a psychologist. reactions that the drug produces in the user. A person engaging in substance use can be One facet of the relationship between cultural described as using a substance without any identified norms and substance use concerns the delineation problem associated with such use. For example, a between substances that are acceptable and unaccept- teenager may experiment with marijuana, experience able for use. The tolerance of some substances and the no adverse effects, and refrain from further use. The prohibition of others is a reflection of a cultural norm A-Jackson.qxd 7/12/2006 2:10 PM Page 37

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that varies from culture to culture. For example, in the sanctions a high degree of alcohol use will likely United States, where drinking is a traditional part of decrease their alcohol use as they become more accul- many social customs and practices, alcohol use is turated to an adopted culture that has strong prohibi- legal for those above a certain age. In contrast, alco- tions on alcohol use. hol use is illegal in many Middle Eastern cultures, Research on the relationship between acculturation where alcohol use is regarded as sinful. and substance use has not been so straightforward A second facet of the relationship between cultural or consistent. In fact, the effects of acculturation on norms and substance use concerns how a particular substance use have been found to vary by age, gender, substance is used. A substance that is ingested in one and cultural group. For example, research has linked form in one culture may be ingested very differently increased levels of acculturation with less drinking by another culture. For example, in parts of South among middle-aged Mexican American men and America, indigenous cultures ingest cocaine by chew- more drinking with other groups of Hispanic men. ing coca leaves rather than by snorting or injecting powder cocaine or smoking crack cocaine. In contrast, THE PREVALENCE OF SUBSTANCE USE, cocaine users in the United States snort or inject pow- ABUSE, AND DEPENDENCE AMONG ETHNIC der cocaine or smoke crack cocaine but do not chew MINORITY GROUPS IN THE UNITED STATES coca leaves. A third facet of the relationship between cultural The measurement of substance use in the United norms and substance use concerns the delineation States is constrained because of limitations in the of appropriate versus inappropriate contexts for sub- research methodology. For example, researchers have stance use. The use of a substance may be tolerated in used disparate measuring strategies in alcohol and one context but prohibited in another. For example, drug use surveys. This inconsistency in measurement members of the Native American church regard the technique has led to difficulty comparing findings use of peyote in the context of worship as a sacra- across studies. In addition, researchers attempting to mental act, one that allows the believer communion measure alcohol and illicit drug use in the population with God. Peyote’s use during Native American wor- are always faced with people’s reluctance to admit to ship ceremonies has persisted for several centuries. substance use. The measurement of substance abuse However, the use of the drug outside the ceremonial and substance dependence disorders is more complex context is not culturally proscribed. than simply measuring substance use because of the Finally, cultural norms have a role in the kinds of added burden of assessing both the quantities of sub- effects a drug has on its user. For example, researchers stance use and the negative consequences associated investigating marijuana use in Jamaica during the with such use. Therefore, estimating the prevalence of 1970s found that marijuana users reported strength, substance abuse and dependence disorders is impre- endurance, and quickness from their drug use. These cise. The best research available provides only a rough findings provide a sharp contrast to the amotivational estimate of the percentage of Americans who drink, syndrome marked by lowered drive, lack of ambition, use drugs, and suffer from substance abuse or depen- and poor concentration that researchers have found dence disorders. among marijuana users in the United States. Estimates of alcohol and illicit drug use among Acculturation reflects the extent to which an indi- ethnic minority groups are even more subject to error vidual has adapted to or acquired the beliefs of the because of additional problems associated with ethnic majority culture. At first glance, the relationship minority research methodology. One such problem is between acculturation and substance use might appear that most of the research on ethnic minority substance straightforward. That is, the level of acculturation use employs umbrella labels for disparate cultural should yield predictable patterns of substance use, so groups. For example, labels such as Hispanic, Asian, that a minority group’s substance use should come to and American Indian/Alaska Native are common closely resemble that of the majority culture as its ethnic minority categories in the research literature. degree of acculturation increases. This would inten- These terms, though descriptively useful in many sify or lessen substance use depending on the culture’s ways, mask an array of distinct cultural groups con- unique sanctions and prohibitions regarding substance tained within these groups. The label Hispanic use. For example, immigrants from a culture that encompasses people with origins in Cuba, Puerto A-Jackson.qxd 7/12/2006 2:10 PM Page 38

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Rico, Mexico, South America, and other Central differences remains to be fully explored. However, American and Caribbean nations. The label Asian research has thus far revealed differences among encompasses people with origins in China, Japan, Hispanic cultural groups. For example, Mexican Korea, Hawaii, and other Pacific Islands. The label American men report a higher rate of frequent heavy American Indian/Alaska Native encompasses several drinking than do Puerto Rican and Cuban American hundred tribal groups, people who live on reserva- men. Mexican American and Puerto Rican men are tions, people who live off reservations, and people more likely to report a period of heavy drinking dur- with varying degrees of tribal exposure. ing their lifetime than Cuban American men. Cuban The use of these labels would not be a problem if American women report less alcohol use than rates of substance use among the various cultural Mexican American and Puerto Rican women. In a groups within the label were equivalent. Unfortunately, similar vein, studies of drinking differences among it has become apparent that there are significant differ- Asian cultural groups have identified more alcohol ences among the various cultural groups contained abstainers than alcohol users in Filipino American and within these umbrella labels. For example, rates of Korean American samples and more alcohol users alcohol use differ significantly among Native American than abstainers in Japanese American and Chinese tribes. In addition, it has become apparent that sub- American samples. stance use rates differ among ethnic minority members who were born in the United States versus those who ILLICIT DRUG USE have immigrated more recently. For example, rates of abstinence from alcohol are significantly higher among The 2002 National Survey on Drug Use and Health Mexican American immigrant women than among found that 8.3% of the population 12 years and older third-generation Mexican American women. had used an illicit drug during the month prior to the survey. Rates of drug use varied by cultural group. Respondents reporting heritage from two or more ALCOHOL USE races had the highest rate of past-month drug use at The results of the most recent large-scale government 11.4%. American Indian/Alaska Natives had the survey on alcohol use, the 2002 National Survey on second-highest rate of past month drug use at 10.1%, Drug Use and Health conducted by the Substance followed by African Americans at 9.7%, Caucasians Abuse and Mental Health Services Administration, at 8.5%, Hispanics at 7.2%, and Asian Americans at found that 51% of Americans over the age of 12 3.5%. There were significantly different rates of drug reported current use of alcohol. Overall, the survey use among those who fell under the umbrella label of found differences in rates of alcohol use among the Hispanic. Puerto Ricans had the highest prevalence nation’s largest cultural groups. For example, 55% of rate at 10%, followed by Mexican Americans at 7.3%, Caucasians reported consuming at least one drink in Cuban Americans at 6.5%, and people of Central and the 30 days prior to the survey. Respondents reporting South American origin at 5%. There were also signif- heritage from two or more races had the second- icantly different rates of drug use among those who highest rate of past-month alcohol use at 49.9%, fol- fell under the umbrella label of Asian. For example, lowed by 44.7% among American Indian/Alaska past-month drug use among Korean Americans was Natives, 42.8% among Hispanics, 39.9% among 7%, whereas the rate was 5% among Japanese African Americans, and 37.1% among Asians. The rate Americans and 1% among Chinese Americans. of past-month binge drinking (defined as consuming five or more drinks in one sitting during the past 30 SUBSTANCE ABUSE AND DEPENDENCE days) was highest among American Indian/Alaska Natives at 27.9%, followed by 25.2% among Native The 2002 National Survey on Drug Use and Health Hawaiians and other Pacific Islanders, 24.8% among estimated the prevalence rates of substance abuse Hispanics, 23.4% among Caucasians, 21% among and dependence disorders by asking respondents African Americans, and 12.4% among Asians. questions that reflect the criteria established by the Rates of alcohol use can vary significantly within American Psychiatric Association for the diagnosis of the cultural groups that make up the umbrella labels these disorders. For example, questions pertaining to commonly used in survey research. The extent of such substance abuse disorders probed for problems with A-Jackson.qxd 7/12/2006 2:10 PM Page 39

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the law, work, friends, family, or school as a result drug-related deaths among Caucasians and Hispanics of alcohol or illicit drug use. Questions pertaining (mentioned in 41% of cases involving Caucasian dece- to substance dependence disorders probed for phys- dents and 47% of Hispanic decedents). In contrast, iological signs of tolerance and withdrawal and cocaine is the most commonly implicated substance continued use of the substance despite the negative in drug-related deaths among African Americans, consequences associated with its use. mentioned in 64% of cases. In the sample, 4.5% of the population reported symptoms consistent with a diagnosis of a substance INTERVENTION abuse disorder. The same percentage reported symptoms consistent with a diagnosis of a substance depen- Interventions in the area of substance use and misuse dence disorder. Alcohol was the most commonly can be broadly grouped into prevention programs, reported substance problem, followed by marijuana, screening and assessment techniques, and treatment cocaine, and prescription pain relievers. American programs. Prevention programs are typically targeted Indians and Alaska Natives had the highest rate of toward adolescents or other individuals at high risk for abuse or dependence at 14.1%, followed by persons substance use and misuse. The aim of prevention pro- from two or more races at 13%, Hispanics at 10.4%, grams is to prevent or prolong the initiation of sub- African Americans at 9.5%, Caucasians at 9.3%, and stance use and to minimize the substance use of those Asians at 4.2%. who begin. Screening and assessment techniques are The high rates of abuse and dependence among used to aid the identification and diagnosis of substance American Indians and Alaska Natives may explain the abuse and dependence disorders. Treatment programs high rates of substance-related health and social prob- are targeted toward individuals who have already been lems in this ethnic minority group. The death rate identified as having a substance abuse or substance related to alcohol misuse is higher among American dependence disorder, typically a population that is Indians and Alaska Natives than among the general older than the audience of prevention programs. The population. For example, death from chronic liver dis- aim of treatment programs is usually abstinence from ease and cirrhosis (consequences of heavy drinking) is substances; however, some programs seek moderation four times more common among American Indians and of substance use rather than abstinence. Traditionally, Alaska Natives than in the rest of the U.S. population. interventions have been provided to ethnic minority Fatal alcohol-related motor vehicle accidents are three group members without considering the compatibility times more common. Alcohol-related suicide and homi- of the intervention with the values, beliefs, and prac- cide are also more common among American Indians tices of the ethnic minority group. Over the past few and Alaska Natives than in the general population. decades, awareness has grown in the field of clinical Negative consequences associated with substance psychology and other helping professions that an indi- abuse and dependence are overrepresented among vidual’s cultural values and beliefs about substances African Americans and Hispanics. African Americans influence his or her response to substance use and mis- compose 10% to 12% of the U.S. population, and use interventions. Hispanics compose about 10% of the population. Yet This awareness has led to the modification of some recent estimates indicate that African Americans and existing prevention programs and the creation of new Hispanics make up 50% of new AIDS diagnoses prevention programs to increase their sensitivity to the (often a consequence of injection drug use). African cultural backgrounds of the ethnic minority groups Americans represent 51% of marijuana-related emer- attending the programs. One example is Life Skills gency room visits and 34% of cocaine-related emer- Training, a program developed to help adolescents suc- gency room visits. Overall, African Americans make cessfully resist peer pressure to use alcohol, tobacco, up 21% of drug-related emergency room visits. and illicit drugs. Researchers modified the program to Hispanics represent 15% of methamphetamine-related enhance its sensitivity to the cultural background of emergency room visits and 11% of overall drug- African American and Hispanic adolescents, and they related emergency room visits. found greater reduction in alcohol consumption among Cultural differences are also evident in drug-related the Hispanic and African American adolescents who deaths. Recent estimates place heroin and morphine attended the culturally sensitive version of the program as the most commonly implicated substances in compared with those who attended the standard version. A-Jackson.qxd 7/12/2006 2:10 PM Page 40

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Awareness of the relevance of cultural differences use traditional cultural healing practices that fall has also informed the practice of screening and assess- outside mainstream psychological practices. For ment. Screening and assessment techniques in the field example, traditional cultural folktales have been incor- of addictions, and mental health in general, were often porated into substance abuse treatment with Hispanic developed and standardized on Caucasian clients, with and Native Americans clients; peyote rituals and sweat little regard for how the instrument or technique would lodges have been incorporated into treatment for Native perform with ethnic minority clients. Applying a American clients; and a public apology technique has screening or assessment instrument developed on one been developed for Asian American clients. However, cultural group to a different cultural group without first the use of such treatments is the exception rather than testing its adequacy is problematic. For example, if a the norm with ethnic minority clients. screening instrument inquires about a set of alcohol problem warning signs that are uniquely manifested in DRUG CONTROL POLICY a particular cultural group, the successful screening of alcohol problems in a different cultural group will be Historically, U.S. drug control policy has been associ- questionable. ated with tension between majority group members Attempts to improve the multicultural utility of and ethnic minority group members. Restrictions on screening and assessment instruments have occurred alcohol, cocaine, opiates, and marijuana have all been through several avenues. One avenue is exemplified linked with prejudices toward ethnic minority groups. by the development of the Alcohol Use Disorders For example, fear and intolerance of a new and grow- Identification Test. This popular alcohol screening ing immigrant group during the 19th century, the instrument was developed on clients from many cul- Irish, extended to their drinking habits and provided tures on several continents to ensure that the test items an impetus for the nation’s first temperance move- would be appropriate for different cultural groups. ment. As a result of this movement, a third of Other avenues to improve the multicultural utility of American states were under alcohol prohibition by the screening and assessment instruments have included end of the 1850s. Cocaine was a legal drug in the translating instruments into foreign languages and col- United States during the 19th century, used for a vari- lecting normative data on ethnic minority populations. ety of recreational and medicinal purposes. Efforts to Improvements in the assessment process have also been prohibit cocaine were prompted by claims that the made by training counselors to be sensitive to the eth- drug provided African American men with super- nic minority groups they serve and to assess an ethnic human strength and caused them to commit acts of vio- minority group member’s language preference, degree lence against Caucasians, including raping Caucasian of acculturation, and ethnic identity. women. Awareness of the relevance of cultural differences Opiate drugs such as opium, morphine, and heroin has led to concerns about the adequacy of existing also enjoyed widespread recreational and medicinal treatment programs for ethnic minority clients. The use during the 19th century. Opium smoking in par- dominant modality of substance abuse treatment in ticular was a common pastime of Chinese immigrants. the United States has been the “Minnesota model” Efforts to control opiates began as their addictive of treatment, which was developed from the principles nature became more widely understood and were of Alcoholics Anonymous. Alternative forms of sub- prompted by fear and intolerance toward the Chinese. stance abuse treatment based on cognitive-behavioral Not surprisingly, prohibitions on smoking opium were therapy and motivational enhancement therapy have enacted before prohibitions on morphine and heroin. become popular as well. The utility of these treat- Marijuana was used as a medicinal drug in the United ments with ethnic minority clients has not been fully States from the 19th century until the 1930s, and evaluated. Attempts to improve treatment outcomes recreational marijuana smoking was a common pas- among ethnic minority clients have led to the devel- time of Mexican immigrants. Similar to beliefs about opment of culturally sensitive and culturally specific African Americans and cocaine was the belief that treatments. Culturally sensitive treatments modify marijuana could lead Mexicans to acts of violence and existing treatment programs to make them more com- other forms of crime. These claims aided the estab- patible with the beliefs and values of the ethnic minor- lishment of legislation that ultimately led to the drug’s ity clients being served. Culturally specific treatments prohibition. A-Jackson.qxd 7/12/2006 2:10 PM Page 41

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Some have argued that contemporary drug control culture influences drug control policy to the extent that policy in the United States is discriminatory toward eth- such policies reflect the formalization of the majority nic minority group members because they are more culture’s views on legal and illicit substance use. prone to the negative consequences of drug control —Damon Mitchell policies than Caucasians. Compared with Caucasians, —D. J. Angelone African Americans are more likely to be arrested for a drug-related offense, their drug-related arrests are more See also Drug Abuse Prevention in Ethnic Minority Youth likely to result in conviction, they are more likely to be incarcerated after a drug-related conviction, and they serve longer prison terms for drug-related offenses. FURTHER READING The majority of individuals incarcerated for federal Aponte, J. F., & Wohl, J. (Eds.). (2000). Psychological inter- drug-related crimes are African American or Hispanic. vention and cultural diversity (2nd ed.). Boston: Allyn & Approximately 40% of incarcerated federal drug Bacon. offenders are Hispanic, 30% are African American, and Kazarian, S. S., & Evans, D. R. (Eds.). (1998). Cultural clinical psychology. New York: Oxford University Press. 25% are Caucasian. These numbers are well out of Straussner, S. L., & Ekrenkranz, S. M. (Eds.). (2001). proportion to the percentage of each cultural group in Ethnocultural factors in substance abuse treatment. New the general population, and they are even more strik- York: Guilford Press. ing when one considers that rates of drug use among Hispanics, African Americans, and Caucasians are relatively similar. Perhaps the most controversial topic concerning AMERICAN COUNSELING contemporary drug policy and ethnic minority groups ASSOCIATION concerns the federal mandatory minimum sentencing guidelines for crack and powder cocaine. The Anti–Drug In 1952, four independent associations convened at Abuse Act of 1986 established vastly different manda- a joint convention to form the American Personnel tory minimum penalties for powder versus crack cocaine and Guidance Association. In 1983, this organization violations. For example, a first-time offender in posses- changed its name to the American Association of sion of 5 grams of crack cocaine faces a mandatory min- Counseling and Development, and 10 years later short- imum of five years’ incarceration; however, a first-time ened its name to the American Counseling Association powder cocaine offender would not face a five-year (ACA). Headquartered in Alexandria, Virginia, the minimum penalty unless he or she were in possession ACA sees its role as promoting public confidence in of 500 grams of the drug. This discrepancy in the amount the counseling profession. With members in the United of crack versus powder cocaine required for a mandatory States and 50 other countries, the ACA maintains a net- minimum has been called the “100:1 penalty.” It has work of 56 branches and 18 divisions. been argued that this sentencing guideline is especially discriminatory toward African Americans because approximately 85% of individuals convicted of crack MISSION STATEMENT cocaine offenses are African American. In summary, cultural differences are a relevant The ACA’s brief mission statement underscores its variable in many aspects of psychoactive substance commitment to respecting human diversity: to use. Cultural sanctions and prohibitions influence enhance the quality of life in society by promoting the prevalence rates of substance use and misuse and development of professional counselors, advancing explain differences in the rates of substance use the counseling profession, and using the profession among ethnic minority groups. The responses of eth- and practice of counseling to promote respect for nic minority group members to prevention and treat- human dignity and diversity. ment programs is mediated by their cultural beliefs and values; positive and negative responses to pro- CODE OF ETHICS grams may be related to the extent the intervention programs are congruent with culturally proscribed Consistent with its mission statement, The ACA’s means of conceptualizing such problems. Finally, code of ethics refers to the importance of respecting A-Jackson.qxd 7/12/2006 2:10 PM Page 42

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human diversity in virtually every major section of the the Multicultural Counseling Competencies,” and code. Indeed, the preamble states that association “Dimensions of Personal Identity.” members recognize societal diversity and support the —G. Scott Sparrow individual’s rights and development. Under the section of the code titled “The Counseling See also Multicultural Counseling; Multicultural Counseling Relationship,” ACA members are expected to strive to Competencies understand the diverse cultural backgrounds of the clients with whom they work and to develop a clear understanding of how the counselor’s own cultural, eth- AMERICAN PSYCHOLOGICAL nic, and racial identity influences his or her values and ASSOCIATION beliefs about the counseling process. An emphasis on cultural competency extends to The American Psychological Association (APA), head- other areas of the ACA’s code of ethics. In the process quartered in Washington, D.C., is the largest scientific of diagnosing their clients, for example, counselors and professional organization representing psychology are expected to recognize cultural influences on the in the United States and the world’s largest association definition of clients’ problems and consider socioeco- of psychologists. The APA’s membership includes more nomic and cultural experiences before arriving at than 150,000 researchers, educators, clinicians, consul- diagnoses. tants, and students. Through its divisions in 53 subfields When it comes to testing, the ACA code warns that of psychology and affiliations with 60 state, territorial, counselors should be cautious in administering tests and Canadian provincial associations, the APA works to among culturally diverse populations, whose social- advance psychology as a science, as a profession, and ized behavioral and cognitive patterns may fall out- as a means of promoting health, education, and human side the range of the test’s applicability and validity. welfare. The association’s annual convention, held in late Furthermore, counselors are advised to observe cau- summer, is the world’s largest meeting of psychologists. tion in interpreting the data of populations that differ The APA members sit on association boards, com- from the norm group on which the test was standard- mittees, and task forces and work with colleagues to ized and to remain forever cognizant of the possible shape policies for the association and to develop stan- impact of a range of factors (age, color, culture, etc.) dards regarding psychological research, practice, on test administration and interpretation. education, and the application of psychology and Counselor educators are also expected to introduce psychological research to social issues. material related to human diversity into all courses The APA supports membership interests through and workshops that are designed to promote the devel- its central offices and four directorates—Practice, opment of professional counselors. Science, Education, and Public Interest—as well as through its meetings, journals (the APA publishes 46 journals), newsletters, books, e-products, continu- MULTICULTURAL COMPETENCIES ing education programs, training, and accrediting activ- One of the 18 divisions of the ACA is the Association ities. Members also benefit from the APA’s federal for Multicultural Counseling and Development legislative and regulatory advocacy and media rela- (AMCD). Chartered in 1972, the AMCD was origi- tions, as well as an ethics education program. nally called the Association of Non-White Concerns The Science Directorate is the focal point of the in Personnel and Guidance. The AMCD endeavors APA’s efforts to enhance psychological science and to advance cultural, ethnic, and racial understanding expand the recognition of its achievements. This to improve and maintain personal development. directorate develops and manages programs serving In 1992, an article was simultaneously published APA members involved in academe and research and in the Journal of Counseling and Development and consolidates the APA’s science activities. the AMCD’s Journal of Multicultural Counseling and The Practice Directorate promotes the practice Development. The multicultural competencies that were of psychology and the availability and accessibility outlined in that article have become part of the canon of psychological services for health care consumers of the counseling literature. They are available from through its national public education campaign, the ACA as three separate documents: “Cross-Cultural advocacy and legislative efforts, and work with state Competencies and Objectives,” “Operationalization of psychological associations. A-Jackson.qxd 7/12/2006 2:10 PM Page 43

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The Public Interest Directorate promotes the The goal of the ADA is equal rights for persons science and practice of psychology by contributing to with disabilities and their full inclusion and participa- the improvement of the public’s health and well- tion in society. The ADA brings a civil rights approach being. It works to inform social policies based on psy- to persons with disabilities and moves away from chology’s unique expertise in human behavior. seeing persons with disabilities as beneficiaries of The Education Directorate works to advance the charity. education and training of psychologists, the teaching The ADA specifically addresses employment dis- of psychology, and the application of psychology to crimination, discriminatory access to local and state education and teaching. governments, public accommodations, access to Other functions of the association include the establishments such as restaurants and supermarkets, Research Office, the Office of Public Affairs, and the pub- and telecommunications availability (primarily for lication Monitor on Psychology. The primary mission of persons who are deaf and hard of hearing). the Research Office is to collect, analyze, and disseminate information relevant to psychology’s labor force and edu- PRECURSORS OF THE ADA cational system. The Office of Public Affairs provides a link between the news media and the expertise of APA The Architectural Barriers Act of 1968, which was members. The Monitor on Psychology, the APA’s official concerned with access to federal and federally financed monthly magazine, informs readers of the latest advances buildings for persons with disabilities, and Sections 501, in the field and the activities of the APA. 503, and 504 of the Rehabilitation Act Amendments of The APA is a nonprofit corporation chartered in 1973, which mandated programmatic access of persons Washington, D.C. In accordance with its bylaws and with disabilities to organizations receiving federal the association rules, the APA is governed by a council funds, were precursors of the ADA. The Education for of representatives with elected representatives from its All Handicapped Children Act of 1975 entitled children divisions and affiliated psychological associations. The with disabilities to a free, appropriate education and APA’s central office is guided by a board of directors reinforced inclusiveness by the U.S. government. The and administered by a chief executive officer. need for specific legislation protecting persons with dis- —Diane Willis abilities from discrimination was bolstered by a report titled “Toward Independence,” issued by the National See also Committee/Office on Ethnic Minority Affairs, Council on Disability in 1986. American Psychological Association; Council of National The ADA’s passage into law is significant because it Psychological Associations for the Advancement of Ethnic involved many people working together to bring about Minority Interests change. The final passage of the ADA occurred because people with many different kinds of disabilities—from FURTHER READING people who were blind to those with developmental American Psychological Association. (2003). Making APA work disabilities, along with families and advocates— for you: A guide for members. Washington, DC: Author. worked together in ways that were unprecedented in American disability history. AMERICANS WITH DISABILITIES ACT DISABILITY DEFINED The ADA defines persons with disabilities as persons The Americans With Disabilities Act (ADA) of 1990 is who have a physical or mental impairment that sub- a civil rights act protecting persons with disabilities stantially limits one or more of their major life activi- from discrimination. The ADA follows earlier civil ties; who have a record of such impairment; or who rights legislation that provided similar protections are regarded as having such an impairment. against discrimination on the basis of race, gender, age, The ADA says that persons with disabilities may and national origin. The ADA is especially significant not be discriminated against in employment on the for ethnic and racial minorities with disabilities, whose basis of their disability; however, they must be quali- experience has been described as a “double whammy” fied for the job, with the requisite work, experience, of having to cope with reactions to both race and education, and other requirements of the position, and disability. must, with or without reasonable accommodation, be A-Jackson.qxd 7/12/2006 2:10 PM Page 44

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able to perform the essential functions of the position. genocide. Scholars have outlined seven categories At the same time, there is an inherent obligation of of anti-Semitism: (1) religious (e.g., Jews’ “refusal” to employers to remove barriers and to provide “reason- embrace Jesus); (2) social (e.g., limiting Jews’ occu- able accommodation.” pational choices); (3) political (e.g., blaming Jews for The ADA also extends the antidiscrimination communism); (4) economic (e.g., the myth that all mandate to local and state governments and to organi- Jews are rich); (5) psychological (e.g., the majority zations in the public arena, such as banks, supermar- culture’s desire to assimilate Jews is projected onto kets, retailers, and restaurants. Government and Jews so that they are seen as wanting to take over the businesses must remove barriers that are “readily world); (6) sexual (e.g., Jewish women are stereo- achievable” and are not an “undue hardship” for them. typed as being both teases and prudes simultane- —Paul Leung ously); and (7) racial (e.g., Jews are seen as biologically inferior). See also Disabilities; Racism and Discrimination Other examples of anti-Semitism include question- ing the Jewish identity of nonreligious Jews, violence FURTHER READING against Jews at the individual and community levels, denying the occurrence of the Holocaust, and bashing Americans With Disabilities Act of 1990, 42 U.S.C.A. § 12101 the state of Israel. et seq. Retrieved January 19, 2006, from http://www.usdoj Why does anti-Semitism persist? Three factors .gov/crt/ada/pubs/ada.txt appear to be responsible. The first and foremost is Bruyere, S. M., & O’Keeffe, J. O. (1994). Implications of the Americans With Disabilities Act for psychology. Christian anti-Semitism. With the creation and main- Washington, DC: American Psychological Association. tenance of Christian state power, the deicide myth Shapiro, J. P. (1993). No pity. New York: Random House. (i.e., the erroneous belief that the Jews killed Jesus), the blood libel myth (i.e., the belief that Jews killed Christian children for religious ceremonies), and the New Testament’s depiction of Judaism (e.g., ANTI-SEMITISM Christianity superseding the Hebrew covenant with God) became institutionalized. This made anti- Anti-Semitism refers to hostility toward Jews as a reli- Semitism a state- and church-sanctioned activity, last- gious, ethnic, or racial group that is manifested on an ing for hundreds of years. In the United States, this led individual, institutional, or societal level. This defini- to the creation of an invisible yet powerful anti- tion highlights one of the major difficulties of defining Semitic system that provides unearned privileges to anti-Semitism accurately—that is, Jews often confound Christians in a process parallel to the way racism established notions of ethnic, racial, and religious iden- benefits Caucasians. This Christian dominance is just tity. Unfortunately, many people see Judaism only as a beginning to be deconstructed. religion, and others see Jews as Caucasian; the latter Second, Jews historically served as a middle class designation is particularly problematic for Jews of whom those in power used as an intermediary color. These categorizations are overly simplistic and between the oppressed and the oppressors. As a state- do not fully describe the diversity of Jews. For example, less people, Jews were permitted to enter countries in there are Jewish ethnic differences (i.e., Ashkenazim, exchange for serving those in power; simultaneously, Sephardim, and Mizrachim) and different Jewish a continuous low-level, unofficial campaign of anti- movements (i.e., Orthodox, Hasidic, Reform, Conser- Jewish propaganda was kept alive among the vative, Reconstructionist, and Renewal). Hence, anti- oppressed majority. In times of threatened revolt Semitism is more than simple religious bias. It is among the oppressed, violent, official anti-Jewish important to note that many scholars no longer hyphen- propaganda emerged. Pogroms, massacres, and expul- ate the term anti-Semitism in order to cease the co- sions were organized to turn the resentments of the opting of this word for anything other than what it truly oppressed majority, prepared to revolt against the means: Jew hatred. oppressors, toward the Jews as scapegoats. This strat- Anti-Semitism has been documented for more than egy has been used throughout the last 2,000 years, 2,000 years and comes in many forms, including and scholars contend that Jews are difficult to catego- oppression, discrimination, segregation, pogroms, and rize because this intermediary status has made them A-Jackson.qxd 7/12/2006 2:10 PM Page 45

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simultaneously part of both the dominant and subor- so they are somewhat arbitrary and do not entirely dinate groups. portray the cross-national status of some indigenous The third factor is the invisibility of Jewish identity. Hispanic and Native American groups. Given the The long history of oppression experienced by Jews, scope of this entry, information concerning the assess- culminating in the Shoah (Holocaust), caused many ment and treatment of anxiety disorders in ethnic Jews to hide or shed their Jewish identity in a desperate minority groups is not included. Rather, attention is attempt to assimilate. Though many Caucasian Jews focused on known, unique aspects of anxiety dis- used their privileged skin color to “pass,” the costs orders in ethnic minorities, as well as specific culture- were severe (e.g., losing their Jewish culture). The suc- bound disorders. cess of Jewish American assimilation allowed anti- Semitism to persist because Jews became Caucasian UNIQUE SYMPTOM EXPRESSION and because their invisibility legitimized the denial of AMONG RACIAL AND ETHNIC GROUPS anti-Semitism. —Lewis Z. Schlosser The important role of culture in anxiety has been highlighted by developments in emotion theory. What consti- See also Racism and Discrimination tutes anxiety varies by culture, and cultural variables may affect the way an individual describes his or her FURTHER READING symptoms. For example, it may be more acceptable in certain cultures to express psychological distress through Feldman, S. M. (1997). Please don’t wish me a merry Christmas: A critical history of the separation of church physical symptoms, such as a headache, as opposed to and state. New York: New York University Press. “feeling depressed.” For further information on the som- Langman, P. F. (1999). Jewish issues in multiculturalism: A atization versus psychologization of descriptors for anx- handbook for educators and clinicians. Northvale, NJ: iety and depression, including idioms of distress, readers Jason Aronson. are referred to Laurence Kirmayer’s review of differ- Schlosser, L. Z. (2003). Christian privilege: Breaking a sacred ences in anxiety symptomatology by culture. taboo. Journal of Multicultural Counseling and Develop- Thoughts, feelings, and bodily experiences are ment, 31, 44–51. not necessarily seen as separate in many cultures. Therefore, in certain cultures, even serious anxiety symptomatology may not be brought to the attention of a health care professional. Additionally, the cultural ANXIETY DISORDERS expressions used to describe anxiety may overlap with IN ETHNIC MINORITIES traditional descriptors of affective, somatoform, and dissociative disorders, further complicating the clini- Of the major diagnostic groups of mental disorders, cal presentation. As a result, anxiety disorders in anxiety disorders have one of the highest—if not the ethnic minorities may be misdiagnosed, perhaps more highest—reported prevalence rates in the United often than in the general population. States. Anxiety is the most common mental disorder There are many examples of differences in the among women and the second most common among symptom expression of anxiety across cultures. In men. This entry provides a brief overview of the cur- Hispanic cultures, for example, anxiety may present rent literature on anxiety disorders in racial and ethnic itself as ataques de nervios, a condition that involves minority groups, particularly among the four principal attacks of anger, screaming, and other symptoms that racial and ethnic minority groups in the United States: may not be seen as panic or anxiety from other per- African Americans, Asian Americans, Hispanic spectives. Steven Friedman noted that, for men in some Americans, and American Indians/Alaska Natives. South Asian cultures, anxiety may be communicated Although these descriptors are necessary for ease of as losing semen in urine. Qualitative ethnographic reading, it is critical to bear in mind the diversity within research has suggested that culture may affect the expe- each category. Racial and ethnic groups are multifac- rience and presentation of anxiety among African eted rather than unidimensional, with many cultures Americans in a unique way, as described by Suzanne existing within each group. Furthermore, these distinc- Heurtin-Roberts and collaborators. For example, tions are based on U.S. national boundaries, and African Americans may express anxiety through A-Jackson.qxd 7/12/2006 2:10 PM Page 46

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expressions such as “high-pertension,” “high blood,” disorder prevalence, symptoms, or impairment between “nerves,” and “falling out” rather than traditional psy- African American and Caucasian patients in a primary chological nomenclature, and they may report somatic medical setting. Taken together, the disagreement in symptoms related to problems with their blood. In their prevalence rate findings for anxiety disorders across review of ethnographic research, Heurtin-Roberts and racial and ethnic groups is not surprising, considering colleagues concluded that many African Americans the wide range of anxiety symptomatology. Therefore, describe anxiety primarily through somatic terms. future epidemiological research on anxiety within ethnic minorities is needed. RISK FACTORS UNIQUE MANIFESTATIONS Risk factors for developing anxiety include discrimi- OF ANXIETY DISORDERS AMONG nation and racism experienced both by the individual RACIAL AND ETHNIC GROUPS and vicariously through a legacy of historical trauma. Additional factors (noted by Gayle Iwamasa and Variations in the expression and experience of anxiety Shilpa Pai) that may influence the development of symptoms exist across ethnic and racial minority anxiety and other psychological disorders are racial groups. One important caveat to consider is the hetero- identity, ethnic identity, and acculturation level. These geneity inherent within ethnic groups. For this reason, three culturally related aspects are unique to each an idiographic approach is essential to understanding individual; therefore, they may act as protective fac- anxiety disorders. Aside from the culture-bound syn- tors or as risk factors in the development and possible dromes, there is an unfortunate dearth of information continuation of anxiety. Many ethnic minorities in the on unique manifestations of the major anxiety disorders United States face increased social stressors when among ethnic and racial minority groups. Currently, the compared with the Caucasian majority. For example, African American experience of anxiety has the most minorities are more likely to live in substandard hous- literature, particularly on panic disorder, although the ing, be unemployed, and have no health insurance. amount of research is still largely inadequate. For all ethnic minority groups, racism and poverty are risk factors for psychopathology. African Americans Information regarding the epidemiology of anxiety EPIDEMIOLOGY AND PREVALENCE disorders in African Americans currently is available Although relatively few cross-cultural studies have for panic disorder and obsessive-compulsive disorder. examined the epidemiology of anxiety disorders, those conducted thus far have reported similar rates of Panic Disorder anxiety disorders across the world. Prevalence rates of anxiety disorders across racial and ethnic groups Although research is limited, studies have sug- within the United States, however, are inconsistent. gested several factors that may influence the presenta- The Epidemiologic Catchment Area (ECA) studies, tion of panic disorder (PD) among African Americans conducted by the National Institute of Mental Health and differentiate it from PD among Caucasians, par- from 1980 to 1985, determined the lifetime preva- ticularly hypertension and isolated sleep paralysis. lence of specific phobias and agoraphobia to be higher Isolated sleep paralysis (ISP) is a condition that in African Americans than in Caucasians and Hispanic occurs while one is falling asleep or awakening; the Americans at every level of education. Research has person cannot move and may experience hypnagogic also indicated that rates of phobias, panic disorder, or hypnopompic hallucinations, tachycardia, hyper- and sleep paralysis are higher in African Americans ventilation, and fear. Different from a nocturnal panic than in the general population. attack, ISP has been described by the phrase “the However, in a subsequent examination of anxiety witch is riding you.” In a study of Caucasian and disorder prevalence, the National Comorbidity Survey African American anxiety patients from clinical and of 1989, no racial differences were found in the preva- community samples, African Americans with PD had lence of any anxiety disorders. Furthermore, Charlotte by far the greatest incidence of recurrent ISP (59.6%), Brown and collaborators found no differences in anxiety leading Steven Friedman and colleagues to conclude A-Jackson.qxd 7/12/2006 2:10 PM Page 47

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that recurrent ISP may be a feature of PD that is unusually high amount of shame and a sense of being unique to African Americans. alone in the presentation of the disorder compared In an analysis of ECA data by Ewald Horwath and with Caucasian patients. Additional clinical issues for collaborators, African Americans and Caucasians had African American women with OCD included fears of similar clinical features of panic disorder, although going crazy (i.e., fear that their obsessions and compul- African Americans reported more tingling in the sions indicated that they had “lost their mind”) and, extremities and “hot and cold flashes” during panic typical of OCD cases, obsessions that were influenced attacks. African Americans with panic disorder by their cultural belief systems. Specifically, one obses- described greater tingling and numbing of the extremi- sion involved a fear of being cast under a spell if the ties during panic attacks, as well as stronger fears of client touched a spot previously touched by another, dying or going crazy, in studies by Steven Friedman and which she explained could “put the root” on her. The Cheryl Paradis and by Lisa Smith and collaborators. authors noted the normalcy of a belief in root magic in Finally, in work by these same investigators, some cultural groups, including those with Caribbean greater rates of comorbid posttraumatic stress and backgrounds. As noted by Peter Guarnaccia, clinicians depression were noted among African Americans than should be cautioned against misdiagnosing patients’ among Caucasian panic disorder patients. These concerns about “root work,” harmful magic, or super- studies also revealed that the two groups employed natural forces as indicative of psychosis rather than different coping strategies; specifically, African anxiety. Americans displayed less self-blame and used strategies involving religion, spirituality, and gratitude for Asian Americans one’s good fortunes more than Caucasians. The Asian American population comprises a number of ethnic groups, including Asian Indians, Obsessive-Compulsive Disorder Cambodians, Chinese, Filipinos, Japanese, Koreans, The inclusion of African Americans in clinical and Vietnamese, among others. Like other racial and research on obsessive-compulsive disorder (OCD) has ethnic groups, the extensive heterogeneity within this been vastly inadequate despite the suggestion in the population proscribes broad assumptions concerning ECA data that the prevalence of OCD may be slightly the cultural expressions of anxiety that are unique to higher in African Americans than in Caucasians. Asian Americans. Research has indicated, however, a Current research has found little to distinguish the higher prevalence of certain anxiety disorders within African American experience of OCD from that of subpopulations of Asian Americans. In particular, other racial and ethnic groups. In a naturalistic treat- refugees of Southeast Asia are at increased risk for ment outcome study of African American, Caribbean posttraumatic stress disorder (PTSD). This finding is American, and Caucasian OCD patients, Steven consistent with the experience of brutal environmental Friedman and colleagues found no differences in the strains such as habitation in refugee camps, combat, type of OCD symptoms displayed, symptom severity, and torture. In addition, Asian American college or treatment outcome across the three ethnic groups. students reported higher levels of social anxiety rela- Furthermore, no differences in religious symptoma- tive to Caucasians. tology were found. Interestingly, although symptom According to Derald Sue and David Sue, Asian severity was equivalent between Caucasians and Americans often express emotional and psychological African Americans, African Americans were less stress through physical complaints, which are more likely to report obsessive-compulsive symptoms ini- culturally accepted. This tendency to communicate tially and often revealed them only after the establish- anxiety through somatic complaints was echoed by ment of rapport. This hesitancy to disclose one’s Dosheen Toarmino and Chi-Ah Chun in their guide- symptoms or distress may speak to the greater levels lines for counseling Korean Americans; specifically, of shame found in African American compared with they noted that complaints about appetite, sleep dis- Caucasian OCD sufferers, as reported by Elaine turbances, fatigue, headache, and restlessness often Williams, Dianne Chambless, and Gail Steketee. are expressed rather than descriptors such as “anxi- In case studies of African American women with ety” or “depression.” Sue and Sue noted that this OCD, Elaine Williams and colleagues described an emphasis on somatic complaints may result from a A-Jackson.qxd 7/12/2006 2:10 PM Page 48

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belief that emotional distress is caused by physical peoples of North America, American Indians and ailments and that it will cease upon proper medical Alaska Natives have endured hundreds of years of treatment for the physical problem. onslaught by other dominating cultural groups. The cultural stressors involved in this forced acculturation are numerous and include the loss of ancestral lands Hispanic Americans and forcible relocation to inhospitable or culturally In recent years, the Hispanic population in the foreign areas, systematic attempts to eliminate reli- United States has seen rapid growth and diversifica- gion and language, imposed outside governance, tion, including individuals from Mexico, Puerto Rico, treaty violations, mandated education in boarding Cuba, and other Central and South American coun- schools, exposure to non-Native diseases and prac- tries. Like other minority groups, Hispanic Americans tices with disastrous health consequences, and even often underutilize mental health care services for a genocide. variety of reasons, such as poor financial circum- Given these historical and contemporary stressors, stances or preferences for family support. Although it is not surprising that many American Indians and there is an unfortunate paucity of information con- Alaska Natives experience culturally specific anxi- cerning the experience of the major anxiety disorders eties. Such anxieties, spanning social involvement among Hispanic Americans, information is available with Native Americans and cultural knowledge, eco- on unique idioms of distress that may be used to nomic issues, and social involvement with the major- describe anxiety (e.g., ataques de nervios) and culture- ity culture, have been identified by Daniel McNeil and bound syndromes (e.g., nervios). Peter Guarnaccia colleagues using the Native American Cultural and others have suggested that culturally related Involvement and Detachment Anxiety Questionnaire. anxiety disorders among Hispanic Americans, such as Consistent with this idea of unique historically and ataques de nervios, may be a culturally shaped response environmentally based influences on the anxiety of to extreme stress because they often elicit family or American Indians and Alaska Natives, J. Douglas other social support and usually occur at family con- McDonald, Thomas Jackson, and Arthur McDonald flicts, funerals, or accidents. have suggested that Native American college students One culture-bound syndrome among Hispanic who leave home to pursue their education may expe- Americans, susto, may be an expression of PTSD or rience greater generalized anxiety than both their non- acute stress disorder. Resulting from a distressing or Native counterparts and reservation-based Native frightening event, susto may involve complaints of American students who stay near home at a reserva- sadness, troubled eating or sleeping, and reduced esti- tion-based college. In addition to such culturally spe- mation of self-worth, as well as various physical ail- cific anxieties, other disorders that are culturally ments, such as stomachaches. Certain symptoms of bound (e.g., kayak angst) or culturally related (e.g., susto, such as disturbing dreams, are consistent with the intergenerational PTSD) may affect the indigenous PTSD criterion related to the reexperiencing of a trau- peoples of North America. matic event. Although susto may also indicate depressive or somatoform disorders, its resemblance to PTSD CULTURALLY SPECIFIC and acute stress disorder merit its consideration as an ANXIETY DISORDERS anxiety disorder. The following disorders, listed alphabetically, are unique to various cultural groups. Many of them are American Indians and Alaska Natives described in greater detail in other entries in this Although psychological disorders such as depres- volume. This list is not exhaustive. Furthermore, sion and substance abuse are believed to be more although culturally specific disorders with a strong common among American Indians and Alaska Natives, anxiety component are included, the majority of the problems with anxiety are increasingly being recog- syndromes described here do not map exactly onto the nized among these groups. There are also culturally diagnostic categories of the Diagnostic and Statistical specific anxieties and anxiety disorders that appear Manual of Mental Disorders, 4th edition (DSM- to uniquely affect Native Americans. As indigenous IV-TR). Presentations may resemble adjustment, A-Jackson.qxd 7/12/2006 2:10 PM Page 49

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depressive, dissociative, somatic, or psychotic disorders. avoidance behaviors related to cold (e.g., compulsive Many, but not all, of the disorders described here are wearing of heavy clothing, even in warm temperatures). included in the glossary of culture-bound disorders in the DSM-IV-TR. Intergenerational Posttraumatic Stress Disorder (Many Racial Ataque de Nervios (Hispanic Americans) and Ethnic Minority Groups) Ataque de nervios (attack of nerves) is described Posttraumatic stress disorder is an anxiety disorder in the DSM-IV-TR as an expression most closely that has unique considerations for ethnic minority related to panic attacks and commonly recognized members because of potential cumulative trauma among Latin American and Latin Mediterranean and the possible transmission of traumatic events to groups. Common symptoms include shaking, palpita- individuals of subsequent generations. For example, tions, numbness, and a sense of heat rising to the head. work by Sandra Choney and colleagues has sug- Peter Guarnaccia noted “screaming uncontrollably” gested that intergenerational PTSD may occur in as the most common symptom reported, followed by Native Americans in response to historical trauma. “attacks of crying.” Robert Robin and collaborators described the impact of community trauma on the psychological health of American Indian individuals, a consideration that is Brain Fag (African Americans) consistent with the collectivist, extended-family ori- Brain fag is a phrase indicating fatigue or exhaus- entation and oral traditions within American Indian tion from intense thinking in many cultures. Difficulty and Alaska Native cultures. Therefore, the develop- thinking and concentrating is a common symptom, ment and presentation of PTSD in Native American and somatic complaints have also been reported. individuals may involve additional clinical considera- Brain fag syndrome is most prevalent in rural areas; it tions. Similar ethnocultural historical effects may be may be a form of anxiety or depression disparate from risk factors for PTSD for a variety of racial and ethnic traditional North American psychological terms. groups. For a comprehensive reference concerning PTSD among African Americans, American Indians, Asian Americans, and Hispanic Americans, the work Dhat (Asian Americans) of Anthony Marsella and colleagues is recommended. Syndromes with presentations similar to dhat include jiryan in India, sukra prameha in Sri Lanka, Hwa-byung (Asian Americans) and shen-k’uei in China. Inherent in these cultures is an ancient belief that a man’s vital energy resides in Hwa-byung, or wool-hwa-byung, refers to “anger his semen. Dhat refers to feelings of extreme anxiety syndrome” in Korean folk culture. Presenting symp- related to a supposed discharge of semen, usually toms include panic, fear of imminent death, fatigue, thought to be passed through the urine, and an accom- and insomnia, as well as somatic symptoms of indi- panying whitish discoloration of the urine. Numerous gestion, anorexia, general aches, and feeling a lump in somatic symptoms often accompany the complaint of the front of the abdomen. semen loss; weakness and exhaustion are commonly associated with dhat. Kayak Angst (Native Americans) Kayak angst, a condition that has been historically Frigophobia (Asian Americans) identified among the Inuit of Greenland, bears a strik- Frigophobia, also known as pa-leng and wei han ing resemblance to panic disorder. Kayak angst has zheng, is a condition characterized by a severe fear of been described as a discrete condition of severe anxi- cold and winds, which are believed to cause fatigue, ety that overcomes seal hunters while fishing in impotence, or death. Frigophobia, a disorder that is well- one-man boats. A loss of direction, helpless feelings, known in Chinese mental health practice, often involves and psychophysiological responsivity are characteris- somatic complaints (e.g., headaches, numbness) and tic. An intense fear of drowning that decreases by A-Jackson.qxd 7/12/2006 2:10 PM Page 50

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returning to land or by the presence of other hunters which anxiety is communicated by ethnic and racial has also been reported. Kayak angst shares many fea- minority clients may vary according to the cultural tures of panic disorder, including unexpected onset acceptability of psychological descriptors of distress and and subsequent avoidance behavior (e.g., avoiding the ways in which emotional states are described within future hunting opportunities). the client’s culture. An understanding of this cultural complexity is a step toward removing semantic and other barriers to valid assessment and treatment. Koro (Asian Americans) Despite the high prevalence of anxiety disorders in Koro, a diagnosis included in the Chinese Classifi- the population, limited epidemiological data are avail- cation of Mental Disorders, is a syndrome known in able for racial and ethnic minorities. Therefore, more Southeast Asia. Koro manifests as extreme anxiety systematic research is needed to identify idioms of dis- that one’s genitals will retract into the body, perhaps tress and anxiety symptomatology that may characterize resulting in death, or that one’s genitals have been the experience of anxiety for different cultural groups. stolen. Reports of koro have ranged from single cases Recognition of the significant overlap of anxiety disor- to epidemics. Koro also is similar to shen-k’uei, or ders with other clinical syndromes—particularly affec- anxiety relating to a perceived loss of semen. tive, somatoform, and dissociative disorders—is critical. Finally, guidelines for clinicians in regard to anxiety and its relationship to culture are required to move toward an Nervios (Hispanic Americans) understanding of anxiety across ethnic and racial groups. Nervios is a frequently described expression of —Rebecca K. Widoe distress among Hispanic Americans. Nervios ranges —Renata K. Martins from a small subset of symptoms to presentations —Daniel W. McNeil resembling full disorders, and it includes broad categories of somatic symptoms, difficulty functioning, and See also Cross-Cultural Psychology; Culture-Bound Syn- emotional distress. Headaches, stomach problems, dromes: Ataque de Nervios; Culture-Bound Syndromes: sleep disturbances, feelings of nervousness, dizziness, Brain Fag; Culture-Bound Syndromes: Dhat; Culture-Bound tearfulness, trembling, and tingling sensations are com- Syndromes: Hwa-byung; Culture-Bound Syndromes: Koro; monly reported symptoms. Culture-Bound Syndromes: Nervios; Culture-Bound Syndromes:TaijinKyofusho;PosttraumaticStressDisorder Taijin-Kyofu-Sho (Japanese Americans) Taijin-kyofu-sho, or taijin kyofusho, is often seen as FURTHER READING a Japanese form of social phobia. Rather than intense Brown, C. B., Shear, M. K., Schulberg, H. C., & Madonia, M. J. fear of embarrassment or negative evaluation, as in the (1999). Anxiety disorders among African-American and Western conceptualization of social anxiety disorder, White primary medical care patients. Psychiatric Services, this syndrome is characterized by anxiety resulting 50, 407–409. from a fear of offending others through one’s body, Choney, S. K., Berryhill-Paapke, E., & Robbins, R. R. (1995). The acculturation of American Indians: Developing frame- appearance, odor, or movements. works for research and practice. In J. G. Ponterotto, J. M. Casas, L. A. Suzuki, & C. M. Alexander (Eds.), Handbook CONCLUSIONS of multicultural counseling (pp. 73–92). Thousand Oaks, CA: Sage. Anxiety disorders are some of the most common psy- Friedman, S. (Ed.). (1994). Anxiety disorders in African chological difficulties. As the population of the United Americans. New York: Springer. States becomes increasingly more diverse, there is need Friedman, S. (Ed.). (1997). Cultural issues in the treatment of for a greater understanding of anxiety disorders within anxiety. New York: Guilford Press. ethnic and racial minority groups. Because one’s Friedman, S., & Paradis, C. (2002). Panic disorder in African- Americans: Symptomatology and isolated sleep paralysis. expression and manifestation of anxiety may vary Culture, Medicine and Psychiatry, 26, 179–198. depending on one’s cultural background, it is important Friedman, S., Smith, L. C., Halpern, B., Levine, C., Paradis, for clinicians to understand each patient’s conceptual- C., Viswanathan, R., Trappler, B., & Ackerman, R. (2003). ization of his or her symptoms. In this vein, the ways in Obsessive-compulsive disorder in a multi-ethnic urban A-Jackson.qxd 7/12/2006 2:10 PM Page 51

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outpatient clinic: Initial presentation and treatment Williams, K. E., Chambless, D. L., & Steketee, G. (1998). outcome with exposure and ritual prevention. Behavior Behavioral treatment of obsessive-compulsive disorder in Therapy, 34, 397–410. African Americans: Clinical issues. Journal of Behavior Guarnaccia, P. J. (1997). A cross-cultural perspective on anxi- Therapy and Experimental Psychiatry, 29, 163–170. ety disorders. In S. Friedman (Ed.), Cultural issues in the treatment of anxiety (pp. 3–20). New York: Guilford Press. Guarnaccia, P. J., Rubio-Stipec, M., & Canino, G. J. (1989). Ataques de nervios in the Puerto Rican Diagnostic Interview Schedule: The impact of cultural categories ASIAN AMERICAN on psychiatric epidemiology. Culture, Medicine and Psychiatry, 13, 275–295. PSYCHOLOGICAL ASSOCIATION Heurtin-Roberts, S., Snowden, L., & Miller, L. (1997). Expressions of anxiety in African Americans: Ethnography The Asian American Psychological Association and the Epidemiological Catchment Area studies. Culture, (AAPA) was founded in 1972 as a group effort spear- Medicine and Psychiatry, 21, 337–363. headed by a small but dedicated and influential hand- Horwath, E., Johnson, J., & Hornig, C. D. (1993). ful of Asian American psychologists such as Derald Epidemiology of panic disorder in African-Americans. American Journal of Psychiatry, 150, 465–468. Sue, Stanley Sue, Roger Lum, Marion Tin Loy, Reiko Iwamasa, G. Y., & Pai, S. M. (2003). Anxiety disorders among True, and Tina Yong Yee. What began as informal ethnic minority groups. In G. Bernal, J. E. Trimble, A. K. meetings to stay connected and offer an exchange of Burlew, & F. T. L. Leong (Eds.), Handbook of racial and information and support among this select group in ethnic minority psychology (pp. 429–447). Thousand Oaks, the San Francisco Bay Area has become a major eth- CA: Sage. nic minority psychological association with more than Kirmayer, L. J. (2001). Cultural variations in the clinical pre- 400 members. The growth of the AAPA as an influen- sentation of depression and anxiety: Implications for diag- tial force within psychology reflects the growing nosis and treatment. Journal of Clinical Psychiatry, 62(Suppl. 13), 22–28. needs and demands of the Asian American population, Marsella, A. J., Friedman, M. J., Gerrity, E. T., & Scurfield, R. M. which is currently the fastest growing ethnic minority (Eds.). (1996). Ethnocultural aspects of posttraumatic group in the United States. stress disorder. Washington, DC: American Psychological Since its inception in the 1970s, the AAPA has Association. grown and struggled to overcome many barriers to McDonald, J. D., Jackson, T. L., & McDonald, A. L. (1991). become a highly visible organization with many Perceived anxiety differences among reservation and non- objectives, the focus of which are the mental and psy- reservation Native American and majority culture students. chosocial health issues of Asian Americans. Some of Journal of Indigenous Studies, 2, 71–79. McNeil, D. W., Porter, C. A., Zvolensky, M. J., Chaney, J. M., these goals include advocating for Asian Americans & Kee, M. (2000). Assessment of culturally related anxiety and promoting Asian American psychology in the in American Indians and Alaska Natives. Behavior form of research, policies, and practices. Other key Therapy, 31, 301–325. objectives of the organization include the training and Robin, R. W., Chester, B., & Goldman, D. (1996). Cumulative education of Asian American mental health profes- trauma and PTSD in American Indian communities. In sionals. Important AAPA initiatives have included A. J. Marsella, M. J. Friedman, E. T. Gerrity, & R. M. lobbying the U.S. Census Bureau to recognize and Scurfield (Eds.), Ethnocultural aspects of posttraumatic stress disorder (pp. 239–253). Washington, DC: American include Asian American subgroups in census data, Psychological Association. presenting state-of-the-art information on Asian Smith, L. C., Friedman, S., & Nevid, J. (1999). Clinical and Americans to various presidential commissions and sociocultural differences inAfricanAmerican and European surgeon general’s reports, and promoting Asian American patients with panic disorder and agoraphobia. American perspectives within organized psychology. Journal of Nervous and Mental Disease, 187, 549–560. Many journals, books, and newsletters focus on Sue, D. W., & Sue, D. (2003). Counseling the culturally Asian American psychology and advocacy of service diverse: Theory and practice (4th ed.). New York: Wiley. delivery to this population. From Stanley Sue’s pioneer- Toarmino, D., & Chun, C. A. (1997). The issues and strategies in counseling for Korean Americans. In C. C. Lee (Ed.), ing Mental Health of Asian Americans to the landmark Multicultural issues in counseling: New approaches to Handbook of Asian American Psychology, each of these diversity (pp. 368–394). Alexandria, VA: American works have helped to lay the groundwork for develop- Counseling Association. ment of the field of Asian American psychology. A-Jackson.qxd 7/12/2006 2:10 PM Page 52

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The AAPA operates through an elected executive of Asia; however, this is an underestimate of the committee that serves a two-year term and consists of a global population of Asian and Pacific Islanders (API) board of directors, which includes a president, vice pres- because numerous API reside outside Asia. In the ident, past president, membership and financial affairs United States alone, Asian and Pacific Islander officer, secretary/historian, and four board members. As Americans (APIA) represent one of the fastest-growing the AAPA began to form an established identity, it began minority populations. Nonetheless, they remain to publish an official newsletter, the Asian American overwhelmingly underrepresented in psychological Psychologist, which eventually evolved into a journal. research. Currently, the AAPA has returned to the newsletter format, which is published on a regular basis, three times ASIAN AND PACIFIC ISLANDER annually. It consists of topics revolving around AAPA AMERICANS IN THE UNITED STATES news, events, advertisements, accomplishments, and issues pertaining to Asian American psychology. The Chinese were among the first API immigrants The AAPA holds a national annual convention the to the United States. The increasing rate of Chinese day before the American Psychological Association immigration, initially fueled by the gold rush, was convention. The national convention features programs rapidly stifled with the passage of the Chinese relatedtoAsianAmericanpsychology,training,research, Exclusion Act of 1882. As the number of immigrants policies, and education. The convention is designed to from other API nations (e.g., Japan, Korea, and India) optimize interactions between the presenters and the began to steadily increase, a number of parallel leg- participants so that levels of intimacy, learning, men- islative acts were passed during the early 1900s to toring, and comradeship are established. The AAPA restrict their immigration as well. As a result, API also maintains a Web site (www.aapaonline.org) and an immigration slowed to a trickle until the enactment of active Listserv for discussion. The current executive the 1965 Immigration Act, which eased restriction committee of the AAPA has initiated a Digital History on immigration from API nations, catalyzing a resur- Project for the association, and soon, digital copies of gence of API immigration. Although the majority of the historical record will be available on its Web site. APIA arrived after 1965, there are substantial num- The future of the AAPA seems clear: to continue its bers of APIA refugees and American-born APIA. efforts to promote the well-being of Asian Americans Current data suggest that there are more than through training, research, and service and to serve as 12.5 million APIA residing in the United States, rep- the primary professional organization for Asian resenting nearly 4.5% of the nation’s population. The American psychologists. majority of APIA have taken residence in the western —Frederick T. L. Leong United States (51%), and the remainder are spread —Arpana Gupta throughout the South and Northeast (19% each), as well as the Midwest (12%). It is estimated that there See also Asian/Pacific Islanders are approximately 43 different ethnicities represented by API in the United States, displaying a tremendous FURTHER READING diversity in terms of language, culture, religion, level Leong, F. T. L. (1995). History of Asian American psychology of education, and socioeconomic status. (Asian American Psychological Association Monograph Series, Vol. 1). Phoenix, AZ: Asian American Psycho- ISSUES IN THE RESEARCH CONCERNING logical Association. ASIAN AND PACIFIC ISLANDER AMERICANS Leong, F. T. L., Inman, A., Elares, A., Yang, L., Kinoshita, L., & Fu, M (Eds.). (2006). Handbook of Asian American Although significant advances have been made within Psychology (2nd ed.). the last 20 years in regard to ethnic minority research, research within the field of psychology using APIA participants remains sparse, and the literature that does ASIAN/PACIFIC ISLANDERS exist is often inconclusive. There have been numerous attempts to illuminate the reasons for the paucity of Estimates suggest that, at the present time, just over research, as well as the inconsistencies within the exist- 60% of the global population resides on the continent ing literature, involving this group of people. A-Jackson.qxd 7/12/2006 2:10 PM Page 53

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Some researchers argue that the discriminatory and Asian descent, for example, those of Cambodian, exclusionary tactics aimed at APIA tend to be greater Chinese, Japanese, Philippine, or Vietnamese back- than those directed at other ethnic minority groups. ground. However, when the term Oriental was These biases are believed to stem from the fact that deemed no longer appropriate for use in reference to API decided to immigrate to the United States, unlike individuals, it was replaced by the much broader and other minorities, who had little choice. Thus, the sen- more nebulous term Asian. Thus, all the people of the timent suggests that APIA do not deserve to be stud- vast Asian continent were grouped together under one ied until other groups have been given their due umbrella term. No attention was given or attempt attention. Although some may consider this a rather made to distinguish the vastly heterogeneous peoples extreme point of view, it should not be too quickly dis- of this immense continent. There are undoubtedly missed, regarded as an extremist position, or viewed numerous significant differences among the cultures, as an impossibility. It is quite possible that at some customs, and fundamental beliefs of individuals orig- level, these erroneous beliefs have the power to influ- inating from the different regions of Asia and the ence or even tarnish one’s view of various ethnic Pacific Islands, yet they are often treated as one group. groups, hence reducing interest in the conduction of Thus, the preponderance of research using “Asian” research on those groups. participants lacks a truly representative sample of Additionally, many researchers have suggested that APIA participants. Omissions in the literature become common (mis)perceptions of APIA as professionally apparent as the Chinese and Japanese appear to be the and financially successful may lead to a lack of interest predominantly addressed cultures. in research on this population. Such perceptions may This leads back to the question of defining the API contribute to a mistaken belief that these enhanced population, both globally and within the United States. financial resources are accompanied by superior psy- The importance of differentiating various API popula- chological resources, thus better equipping these indi- tions, such as South Asians from East Asians from viduals to combat the stresses typically associated with Pacific Islanders, appears to stem naturally from the immigration and acculturation. Such unsubstantiated basic principles of scientific methodology and repre- thinking may lead to the unfounded belief that APIA, sentative sampling. Psychological research has long because of their financial success, simply do not suffer been criticized for its overwhelming lack of sampling from psychological distress, or if they do, they are in diversity and representativeness. The majority of our possession of superior coping resources that allow them current psychological principles and theories are biased to better deal with distress. Thus, their status as “worth- by research conducted primarily on middle-aged, while” and “important” subjects for research is further Caucasian males or undergraduate psychology students. made subordinate. Such concerns have been echoed by a number of One reason the research on APIA is so inconclu- researchers within the psychological community. sive may stem from the astonishing diversity of the The field of psychology, in its relentless pursuit people suggested for inclusion in this broadly defined of internal validity, has neglected the importance of group. The APIA represent one of the most diverse external validity. It appears that this neglect has served ethnic groups in the United States. However, the term as a fault in a good deal of the current literature. The Asian is ill defined and often leads to mis- balance between external and internal validity is a understanding and ambiguity. difficult matter for virtually all psychological research. The definition of APIA currently used by the U.S. Additionally, the lack of operational definitions to Census Bureau, though comprehensive, is not without identify various groups has proven to be a disconcert- its own complexities. Although it identifies several ing conundrum. At what point do we consider a subcontinents and provides examples of the identified people “a group” necessitating differentiation and sep- groups therein, its seeming “broad stroke” grouping aration as its own population? Many suggest that such a of these minorities creates room for perceptions of question opens up a never-ending Pandora’s box. In cultural homogeneity among the distinct groups. fact, it appears that there is no definitive point at Within recent decades, social etiquette and politi- which a particular group of people is identified as a cal correctness have encouraged the discontinuation unique people, “deserving” of distinction and individ- of the use of the term Oriental. Previously, this term uation from other groups. Such distinctions are poten- was used primarily to describe individuals of East tially quite subjective, but they must be arrived at, A-Jackson.qxd 7/12/2006 2:10 PM Page 54

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operationally defined, and employed by the community Caucasian Americans, whereas others studies indicate of researchers in a way that is relevant to the research no such trend. A few of these studies have gone so far question under investigation and that allows the as to hypothesize that many of the symptoms associ- research to be more consistent and comparable across ated with depression—as it is currently conceptual- studies. ized by the majority of the Western world—are rare and perhaps even nonexistent for individuals with backgrounds that are not rooted in Western societies. PSYCHOLOGICAL DISTRESS A number of factors may be implicated in the dis- Psychological distress is an expansive term that parate findings within the literature. Given the array encompasses factors such as depression, anxiety, and of distinct cultures that fall under the APIA umbrella, other conditions. As our world continues to grow into the confounding of classification may lead to erro- a more unified and global community, constructs such neous results. Also, the measures used in the collec- as depression and anxiety require reevaluation and tion of data may not be appropriately normed or revision. Such constructs, as they currently exist, have standardized for use within the various populations, been defined within a context of limited cultural and effectively making the results uninterpretable or contextual variability. Cross-cultural variations in the invalid. The age range of the participants may also manifestation of symptomatology associated with play a role as an additional confound, as there is rea- psychological disorders may render our current diag- sonable evidence suggesting that an individual’s age nostic and classificatory systems inadequate and inac- may vary symptom presentation and manifestation. curate as we begin to consider such constructs in a Although it is important to bear in mind that these cross-cultural context. confounds have been obstacles to research on minori- Numerous authors have commented on the role of ties in general, there are other factors that one must culture in psychological illness, stressing the concerns consider when attempting to integrate the contrasting of culturally specific perceptions of illness and the research findings concerning APIA in particular. consequential responses. Thus, it may be posited that From the lay perspective, many APIA are often cultural context affects the ways in which biological referred to and viewed as the “model minority,” based on changes within the body as well as psychological phe- perceptions and stereotypes of APIA as educationally, nomena are manifested. An individual’s manifestation professionally, and financially successful. Therefore, one of psychological distress is thus undoubtedly affected might then be tempted to explain research findings with by his or her given culture’s expectations, taboos, and hypotheses that are influenced by these stereotypical beliefs regarding etiology. beliefs. For example, one might suggest that studies It has been suggested that cultural influence on reporting elevated levels of symptomatology stem from symptom manifestation affects the account of illness the use of inappropriate assessment devices that have led provided to the clinician. In other words, a construct to inaccurate and unsubstantiated elevations, or that such as depression may exist cross-culturally, yet its observed elevations are the result of variations in culture. manifestations may vary in accordance with cultural Another example is that studies suggesting lower levels variations and differences. Such disparity in the man- of depression may be viewed as indicating a lack of ifestations of psychological symptomatology may depressive symptomatology in APIA populations and lead to difficulty in precise diagnoses. This may fur- thus greater psychological adjustment and superior cop- ther result in the prescription of inappropriate, unsuit- ing faculties. These hypotheses, which are potentially able, and thus ineffective treatments. influenced by stereotypical beliefs regarding this population, are made to be consistent with popular belief. PSYCHOLOGICAL DISTRESS IN ASIAN AND PACIFIC ISLANDER FACTORS THAT SUGGEST AMERICAN POPULATIONS INCREASED PSYCHOLOGICAL DISTRESS IN ASIAN AND PACIFIC A great deal of research has been conducted on dis- ISLANDER AMERICAN POPULATIONS tress manifestation in APIA populations; however, the findings have been equivocal. Some studies indicate In contrast to the mixed results of the APIA studies on a lower manifestation of depressive symptoms than in depression, consistent results have been observed A-Jackson.qxd 7/12/2006 2:10 PM Page 55

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when one considers the concept of psychological African Americans are perceived as being an distress from a much broader, and consequently more oppressed people, having been brought to this conti- ill-defined, perspective. There are many indications nent under the chains of slavery, against their will. that Asian Americans experience as much, if not Latino Americans are viewed as the original inhabi- more, emotional difficulty and psychological distress tants of this land or as a colonized people. Among this as Caucasians. The level of stress is attributed to landscape of immigrants, APIA may be perceived as increased experience of psychological stressors that lacking a distinctive role in relation to other people are directly related to acculturative stress or to diffi- who are here. This may adversely affect APIA ethnic culties associated with the process of immigration. identity formation during the process of acculturation, For example, immigrants are often faced with a vari- leading to even greater experience of psychological ety of changes related to climate, the nature of their distress. residence, and the characteristics of the community in which they reside. They also face changes in diet, per- MANIFESTATION OF haps because of the unavailability of foods and ingre- PSYCHOLOGICAL DISTRESS dients to which they are accustomed, and dangers associated with exposure to new and different dis- One significant issue when studying ethnic minorities eases, which their immune systems may not be used is that studies may use measures that do not focus on to. Social changes also abound: Immigrants are often relevant manifestations of psychological distress in a faced with the trauma of separation from family and given minority population. For example, a measure that friends, which is compounded by the lack of a social assesses the social and emotional components of support system in their new environment. Finally— depression would be insensitive and inappropriate if a though quite significantly—changes associated with particular ethnic group manifests depression in a more the general attitudes, values, and religious beliefs of somatic manner. Thus, attempting to assess depression the culture in which immigrants now find themselves with an inappropriate or insensitive device may lead to may contribute to acculturative stress as well. overlooked diagnoses. Conversely, the use of an inap- Immigrants face these challenges on a daily basis. propriate assessment device may lead to superfluous They are continually inundated with aspects of their diagnosis or an overestimation of the severity of a dis- new culture, and although this process places pressure order. For example, consistent elevations were found in on both the immigrant and the host culture, the immi- Minnesota Multiphasic Personality Inventory scores on grant bears the brunt of the pressure to accommodate. Scale 2 (Depression) and Scale 8 (Schizophrenia) in a Given these challenges and in light of the ingrained sample of Hong Kong students. Such observations roles and values immigrants often arrive with, accul- could lead one to believe that individuals from this turation is often experienced as a difficult and at times population suffer from elevated levels of depression- and a painful process. Some studies have proposed corre- schizophrenia-related symptomatology. Furthermore, lates associated with APIA immigrants’ experience what is considered to be withdrawn behavior—and of acculturative stress. Some general trends in this thus viewed as disturbed behavior among Caucasian research suggest that women exhibit greater accultur- Americans—may be the norm for Hong Kong Chinese. ative stress than men and that immigrants who have Similar problems with profile elevations have been chosen to migrate and plan to remain permanently observed in a variety of other ethnic minority groups. express more positive attitudes about their new host It is difficult to make a global statement about the culture and exhibit better overall mental health. mental well-being of the APIA population because of Furthermore, it has been suggested that APIA are the heterogeneity of the group. Although somatization seen as lacking a distinct position among the people has been indicated in groups such as South and East and immigrants in the United States; they are often Asians, there is little evidence to suggest a similar viewed simply as the “other” group, not quite fitting trend within the Pacific Islander groups. Additional within other U.S. minorities. Many people of other distinctions may be noted in the culture-specific dis- ethnicities who have immigrated have a historical role orders through which psychological distress is mani- that, to some extent, defines their place as an immi- fested. The Japanese, for example, conceptualize a grant group. European Americans may be conceptual- disorder called taijin kyofusho as a multityped syn- ized as the conquerors from a historical perspective. drome that encompasses some aspects of the Western A-Jackson.qxd 7/12/2006 2:10 PM Page 56

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personality, delusional, body dysmorphic, and anxiety United States, Asian and Pacific Islander populations disorders. The Korean hwa-byung, which may be exhibit lower rates of both inpatient stays and employ- grossly identified as a mixture of anxiety and depres- ment of psychiatric services than any other cultural sion, has distinct features (e.g., pain in the epigas- group. trium) that are not found in depressive manifestations One reason for the disparate rates may lie in the of other cultures.And koro and dhat, anxiety expressed perception of the mind–body relationship. Western through concern for genital function, are distinctly cultures tend to take a dualistic approach to the mind– Asian Indian–bound disorders. This variance in symp- body relationship, whereas Eastern cultures take a tom presentation, as well as the uniqueness of culture- more holistic stance. This means that, although those bound disorders, creates an obstacle to generalization of Western thought can make a distinction between across the different groups. somatic and psychological ailments, such a distinction Regarding the construct or theoretical identifica- can only be made with great difficulty and high inaccu- tion of depression, it is quite possible that the manner racy for those of a holistic perspective. The implication in which it is conceptualized in the Western world is of such variance has bearing on the language used in not culturally relevant to this population. Thus, it is symptom description, as well as the cause attributed to possible that the construct of depression may be con- their manifestation. Linguistic barriers, too, have been ceptualized and manifested in an entirely different cited as a source of diagnostic problems, particularly in manner. If this is the case, the instruments we cur- cases in which translation is used. Because translation rently use to assess that construct may not be valid is unable to coherently employ word-for-word equiva- with this population. lence between two languages, terms that are particular One consistent finding that lends support to this to a culture may fall by the wayside, effectively con- notion is the utilization of somatization as a means founding the message’s meaning. Perceptions of pain, of expressing psychological distress among APIA. for example, may be presented differently by those of Somatization, or the physical manifestation of psycho- the Asian culture, with psychological distress expressed logical stress, often includes the presentation of fatigue, as somatized pain. When faced with ambiguous symp- dizziness, angina, and other body sensations. Though tom presentation, general practitioners and psychia- advances have been made in the battle against the neg- trists may be unable to classify the disorder. Research ative stigmatization of mental illness and mental health on the topic appears to support this conjecture and indi- concerns, these prejudices remain firmly seated within cates that the Western construct of depression allows our society, as well as within many of the world’s cul- for only a subsyndrome in many evaluations of Asian tures. In this respect, API cultures are in no way exempt individuals. This underdiagnosis and nontreatment from these biases against mental illness. In fact, it may effectively reinforces the tendency to seek aid from be argued that intolerance of mental illness is exagger- nontraditional medicine. ated in the eastern cultures of the API. These cultures Another fact that might account for the low treatment adhere to a more collectivistic tradition rather than the rates is the perceived need for psychiatric assistance. individualistic tradition observed in Western cultures. Beyond the treatment efforts exerted for somatic As a result, the expression of emotion and mental ill- symptoms, specific cultural views on the cause of the ness is discouraged in these societies in an effort to disorder often spur individuals to seek treatment from maintain a given social status and to “save face” in their natural healers and other nontraditional medical per- community. Thus, it is often more readily acceptable to sonnel. Supernatural causes such as magic curses or display psychological distress through somatic mani- the Djinn have been cited as reasons why such ser- festations, as has often been observed among individu- vices have been employed. als of API ancestry. When psychiatric disorders are diagnosed, the A number of researchers have suggested that APIA cultural barriers affecting the utilization of psychi- have different help-seeking preferences that result atric services may also retard treatment progress. The from this alternative expression of symptom manifes- patient’s perception of his or her ailment and its cause tation. Studies suggest that APIA rarely present emo- has a great impact on the efforts of the psychologist. tional or interpersonal problems on occasions when Because a good patient–clinician alliance is an inte- they do seek out professional treatment. Rather, they gral part of any treatment, addressing culturally spe- tend to focus on concerns regarding their occupation, cific concerns (e.g., reporting style, spiritual beliefs, somatic complaints, and educational concerns. In the etc.), behavioral norms (e.g., direct eye contact), and A-Jackson.qxd 7/12/2006 2:10 PM Page 57

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therapeutic approaches has a great influence on the Ibrahim, F., Ohnishi, H., & Sandhu, D. S. (1997). Asian therapeutic outcome. American identity development: A culture-specific model for South Asian Americans. Journal of Multicultural Counseling and Development, 25, 34–50. CONCLUSION Kaplan, G.A., Hong, G. K., &Weinhold,C. (1984). Epidemiology of depressive symptomatology in adolescents. Journal of the As the population of the United States grows and American Academy of Child Psychiatry, 23, 91–98. increases and its makeup becomes more diverse, greater Kim, W., & Rew, L. (1994). Ethnic identity, role integration, understanding of cultural differences is a matter of quality of life, and depression in Korean-American women. increasing precedence. Though the body of literature on Archives of Psychiatric Nursing, 6, 348–356. the APIA is increasing, the rate at which progress is Krishnan, A., & Berry, J. W. (1992). Acculturative stress and accul- being made is insufficient. Methodological and categor- turation attitudes among Indian immigrants to the United States. Psychology and Developing Societies, 4(2), 187–212. ical issues impede the progress of research, and they are Lee, S. M. (1998). Asian Americans: Diverse and growing. further complicated by erroneous “model minority” per- Population Bulletin, 53(2), 2–40. ceptions that often surround these groups. What may be Rahman, R. O., & Akamatsu, T. J. (2000, November). Depres- abstracted from the literature is that the APIA are as vul- sive symptomatology in Asian Indians. Poster presentation nerable to psychological distress as any other culture. In at the Association for the Advancement of Behavior fact, the process of acculturation may exacerbate this Therapy Annual Convention, New Orleans, LA. vulnerability through elevated stress levels. The mani- Reeves, T., & Bennett, C. (2003). The Asian and Pacific festation of distress as a psychological disorder interacts Islander population in the United States: March 2002. Current population reports (Series P20, No. 540). with cultural background, affecting syndrome detection Washington, DC: U.S. Census Bureau. and inaccurately depicting these groups. If psychology Sue, S. (1999). Science, ethnicity, and bias: Where have we is to disabuse itself of such misconceptualizations, mis- gone wrong? American Psychologist, 54, 1070–1077. perceptions, miscalculations, and mistreatments, cultur- United Nations Population Division. (2003). World population ally specific manifestations and diagnostic criteria need prospects: The 2002 revision (highlights). New York: to be addressed in the diagnosis, treatment, and research United Nations. of individuals within these groups. U.S. Census Bureau. (2001). The Asian and Pacific Islander population in the United States: March 2000 (update) —Reece O. Rahman (PPL-146). Washington, DC: U.S. Census Bureau. —Ilya Yaroslavsky Zane, N. W. S., Sue, S., Hu, L., & Kwon, J. (1991). Asian- American assertion: A social learning analysis of cultural See also Asian Values Scale; Chinese Americans; Filipino differences. Journal of Counseling Psychology, 38, 1–8. Americans; Japanese Americans; Korean Americans; Model Minority Myth

FURTHER READING ASSOCIATION OF Cheung, F. (1985). Cross-cultural consideration for the translation and adaptation of the Chinese MMPI in Hong Kong. BLACK PSYCHOLOGISTS In J. N. Butcher & C. D. Spielberger (Eds.), Advances in personality assessment (Vol. 4, pp. 95–130). Hillsdale, NJ: The Association of Black Psychologists (ABP) was Lawrence Erlbaum. founded in 1968 in San Francisco, California, by 28 Doerfler, L. A., Felner, R. A., Rowlinson, R. T., Raley, P. A., & Evans, E. (1988). Depression in children and adolescents: psychologists of African descent. This was the first A comparative analysis of the utility and construct validity national organization to be established by and for psy- of two assessment measures. Journal of Consulting and chologists of African descent. Its establishment was Clinical Psychology, 56, 769–772. based on the unique history of African descent, espe- Durvasula, R. S., & Mylvaganam, G. A. (1994). Mental health cially enslavement and its social, economic, and of Asian Indians: Relevant issues and community implica- psychological effects on people of African descent tions. Journal of Community Psychology, 22, 97–108. worldwide. These founding members called for spe- Furnham, A., & Malik, R. (1994). Cross-cultural beliefs about cialized training and expertise in addressing the psycho- “depression.” International Journal of Social Psychiatry, 40, 106–123. logical well-being of the African community locally, Huang, L. N. (1994). An integrative approach to clinical nationally, and internationally. assessment and intervention with Asian American adoles- The founding members also desired to develop an cents. Journal of Clinical Child Psychology, 23, 21–31. approach to psychology consistent with the experience A-Jackson.qxd 7/12/2006 2:10 PM Page 58

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of people of African descent. They envisioned that the deviant, including but not limited to the inferiority, newly formed organization would promote and deficiency, or disadvantaged models, the goals of the advance the profession of African psychology, influ- association became not only to enhance the psycho- ence and affect social change, and develop programs logical well-being of people of African descent but whereby psychologists of African descent could help also to promote constructive understanding through to solve the problems of people of African descent and positive approaches to research. These research goals other ethnic and racial groups. expanded to include the development of psychological concepts and standards consistent with African or African American culture, the development of support FOUNDING MEMBERS systems for psychology students, and the promotion The 28 founding members of the ABP were Joseph of values that support well-being. Association mem- Awkard, Aubrey Escoffery, Florence Farley, Wiley bers were also encouraged to foster relationships with Bolden, Jane Fort, George Franklin, Alvis Caliman, local, state, national, and international policymakers Avlin Goings, Robert Green, Norman Chambers, to better influence the mental health and community Robert Guthrie, William Harvey, Harold Dent, Leslie needs of the African-descent community. Several Hicks, Thomas Hilliard, Anna Jackson, Walter Jacobs, annual awards are granted each year, including an Adelbert Jenkins, Reginald Jones, Melvin King, award to support student research and an award for Lonnie Mitchell, Wade Nobles, David Terrell, Dalmas service, scholarship, and community service. Taylor, Charles Thomas, Ernestine Thomas, Robert Williams, and Joseph White. ORGANIZATIONAL STRUCTURE Members of this group represented a myriad of psychological disciplines, professions, and locations The organization elects a president to a two-year term. across the United States. The board of directors consists of a past president, president, and president-elect, along with a secretary, treasurer, four regional representatives, presiding FIRST ACTIONS—RESPONSES elder, and parliamentarian. The formative group of founding members submitted seven petitions of concerns proposing that the COMMITTEE STRUCTURE American Psychological Association (1) officially endorse the Kerner Commission’s Report of Civil Committees are structured into three main clusters: Disorders; (2) develop or implement policies related advancing knowledge, community, and organizational to the African American community; (3) bring its maintenance. Located within the advancing knowl- resources to finding solutions to the problems of racism edge cluster are professional development, the and poverty; (4) establish a committee to study the Committee to Advance African Psychology, the misuse of standardized psychological instruments; (5) African Psychology Institute, Black Mental Health reevaluate the adequacy of certified training programs Month, and the Leadership Institute. The community in clinical and counseling training programs in terms cluster supports social action, testing and education, of their relevance to social problems; (6) recommend legislative education, health, and the African American to each psychology department steps to be taken to Family Preservation and Revitalization committee. increase the number of African American students in The final cluster comprises membership, the Committee their graduate program; and (7) implement and evaluate on International Relations, chapter development, stu- the progress of the foregoing recommendations in dent affairs, and information technology. Additionally, consultation with representatives from the ABP. The there are seven standing committees: Ethics, Rules, requests were received and reviewed by the American National Convention, Personnel, Fiscal Affairs, Publi- Psychological Association, but they were not fulfilled. cations, and Reparations.

CURRENT ASSOCIATION GOALS PUBLICATIONS By examining approaches to research that had tradi- The Association of Black Psychologists has tionally represented people of African descent as three regular publications: PSYCHDiscourse; ABPsi A-Jackson.qxd 7/12/2006 2:10 PM Page 59

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NewsJournal, a monthly or bimonthly newsletter; and of gender, race, ethnicity, culture, and socioeconomic the Journal of Black Psychology, a professional quar- status. terly journal of qualitative and quantitative research. —Harvette Armonda Grey CAUSES AND MAJOR CHARACTERISTICS

See also African/Black Psychology; African Americans Comprehensive considerations of race, ethnicity, gender, and culture have generally been overlooked in the understanding of ADHD. Among individuals with FURTHER READING ADHD, the core symptoms, such as distractibility or Azibo, D. (2003). African-centered psychology: Culture- inattentiveness, are biologically influenced. There is focusing for multicultural competence. Durham, NC: no single known cause of ADHD. It occurs more fre- Carolina Academic Press. quently in individuals who have a family history of Williams, B. (1997). Coming together: The founding of the the disorder and more frequently in children who are Association of Black Psychologists. Unpublished doctoral dissertation, St. Louis University. exposed to prenatal insult, obstetrical complications, Williams, R. (1974). A history of the Association of Black or high levels of lead. The disorder was once viewed Psychologists: Early formation and development. Journal as a neurological condition primarily involving atten- of Black Psychology, 1, 9–24. tion, but it is now understood as a neurological condition primarily involving self-control and behavioral inhibition. Cultural environment is important because it determines how well or how poorly an individual ATTENTION-DEFICIT/ functions, and it influences how behavior will be HYPERACTIVITY DISORDER understood and treated. Parenting styles and educational methods do not cause ADHD, but they often Attention-deficit/hyperactivity disorder (ADHD) is one play a role in effective treatment. of the most frequently diagnosed disorders among Studies examining the prevalence of ADHD or the children and adolescents. It is a lifelong condition that proportion of individuals with ADHD in specific eth- is estimated to affect 3% to 5% of school-age children. nic groups have reported conflicting results. The use The disorder is characterized by core symptoms that of different assessment instruments and methods of include age-inappropriate levels of concentration, diagnosis may account for the conflicting findings as attention, distractibility, and impulsive behavior. For much as any true differences in the rate of ADHD example, affected children seem unable to sit still, among ethnic groups. For example, rates of ADHD always appear to be daydreaming, or cannot focus on based on teacher ratings of children’s behavior indi- tasks long enough to finish. Children may exhibit a cate higher rates among African American and range of characteristics and varying levels of severity. Hispanic American children compared with European Behaviors associated with ADHD are classified into American and Asian American children. However, the three subtypes: predominantly inattentive, predomi- observer’s judgment about the quality of the child’s nantly hyperactive-impulsive, and combined. Because behavior has been shown to be influenced by ethnic- ADHD often affects functioning in multiple settings, ity, socioeconomic status, and student and teacher such as home, school, and peer relations, it may have a expectations. negative, long-term impact on academic and vocational Attention-deficit/hyperactivity disorder is a life- performance and on social-emotional development. long condition that is identified more often in boys. A number of controversies surround ADHD: It is estimated that boys are three times more likely to whether it exists as a distinct disorder, whether it can be affected than girls, although ADHD may not be as be accurately identified, and what the most effective easily recognized in girls. Boys are more likely to treatments are. For people of color, there are also con- demonstrate disruptive and impulsive behavior that cerns about stigma associated with diagnostic labels, gets the attention of parents and teachers. Girls are the rate at which ethnic groups are identified with more likely to demonstrate inattentiveness, depres- ADHD, and access to appropriate treatment. Extant sion, and academic problems that may be overlooked. research focuses primarily on Caucasian, male, and Consequently, girls are more likely to be identified middle-class populations, with limited consideration later than boys and less likely to receive treatment. A-Jackson.qxd 7/12/2006 2:10 PM Page 60

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Until recently, ADHD was most often diagnosed by how well the scales and tests have been designed during childhood. It is now known that ADHD continues for use with racial and ethnic groups and by possible into adulthood, although symptoms can change from rater or examiner bias. Rating scales that focus on childhood to adulthood. Hyperactivity, aggressiveness, specific core symptoms are helpful in identifying the impulsive behavior, and distractibility are more common child’s behavior in different settings. Rating scales among children. In older adolescents and adults, inatten- that focus on a wide range of behavior, attitudes, and tiveness, impatience, and restlessness are more common feelings are helpful in making an accurate diagnosis with lessened hyperactivity, partly because of coping and determining whether there are other coexisting strategies that are learned with life experience. problems. As a group, African American children are Attention-deficit/hyperactivity disorder frequently often rated with more ADHD behaviors and with more coexists with other disorders, including disruptive severe symptoms, which may be the result of bias or behavioral disorders, specific learning disabilities, actual behavioral differences from other groups. anxiety, depression, and tic disorders. A large propor- Although psychological and educational tests are tion of adults with ADHD may also experience helpful in identifying academic and learning disabili- depression, anxiety, and major mood disorders. When ties, their appropriate use with ethnic and racial ADHD goes untreated, substance abuse occurs in groups requires an understanding of possible bias in nearly half the people affected. test construction and interpretation.

ASSESSMENT TREATMENT Criteria for a diagnosis of ADHD includes the onset or There are three basic types of treatment for ADHD: beginning of symptoms before age seven, the presence medication, behavioral intervention, and combined or of at least six inattentive or six hyperactive symptoms multimodal intervention. Medications such as Ritalin for at least six months, and significantly lowered per- are considered by medical professionals to be the formance in two or more areas of the child’s life (e.g., most effective treatment for the core symptoms of difficulty at home and at school). Children may be mis- ADHD. The use of medication is controversial because takenly identified with ADHD because many of the key of concerns about the abuse and misuse of these drugs characteristics are typical for children of certain ages, and because little is known about their long-term and a diagnosis may be made based on poor informa- effect (i.e., longer than 14 months) on development. tion after a brief assessment. In addition, culture influ- Possible racial and ethnic differences in how these ences the expectations and behavioral norms of family, medications are processed by the body have not been schools, and communities. What is acceptable and conclusively demonstrated. adaptive behavior from one cultural or ethnic group to Behavioral or psychosocial interventions include another varies. People from different cultural and eth- parent education, social skills training, structured posi- nic groups may also have different beliefs and attitudes tive reinforcement for appropriate behavior in school about illness, helping professions, and trust in large and at home, and counseling for organizational and institutions, as well as preferred community supports socialization strategies. These treatments are more and healers. effective than medication in improving academic, There is no single psychological, educational, or vocational, and social functioning, but they are not as medical test for ADHD. To accurately identify ADHD, effective as medication in reducing the core ADHD a multisource (information obtained from multiple symptoms. Ethnic groups may prefer psychosocial individuals) and multimethod (information obtained interventions over medication. Ethnicity and socioeco- using many methods) process is necessary. Information nomic status may influence the motivation for various from the child, parents, teachers, and others familiar treatments. with the child in different settings helps to assess the Multimodal approaches combine medication and child’s behavior compared with other children of the behavioral treatments to address ADHD symptoms same developmental stage and cultural context. and academic and social problems. Combined Methods used in assessment may include interviews, approaches work best when family, teachers, and behavior rating scales, and psychological testing. The other professionals coordinate their efforts to ensure use of rating scales and psychological tests is limited consistency from one setting to another. A-Jackson.qxd 7/12/2006 2:10 PM Page 61

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Although ADHD is not specifically designated characteristics that are internal and stable to them under the Individuals With Disabilities Education Act, (e.g., positive personality characteristics), whereas some children and adolescents may be eligible for they tend to deflect blame for failure outcomes by special education services depending on the severity making attributions that reflect external elements of of their symptoms and the presence of specific learn- the situation or context (e.g., the task was too hard). ing disabilities. Many families of color are suspicious These self-serving attributions are important because of in-school services because of stigma and because they have been linked to psychological and physical of the disproportionate representation of African health indexes such as self-esteem and immune func- American and Hispanic youth, especially males, in tioning. Moreover, these self-serving attributions, special education. Youth and adults may be eligible though prevalent in all cultural groups, are typically for school and workplace accommodations under stronger in Western (versus Eastern) cultures. Section 504 of the Rehabilitation Act and under the In explaining outcomes that happen to others, more Americans With Disabilities Act. pronounced cultural differences are found, particu- —Cheryl C. Munday larly for failure outcomes. Individuals from Western cultures tend to make dispositional attributions to explain the unsuccessful outcomes of others (e.g., FURTHER READING “She didn’t get the job because she is not smart Barkley, R. (1998). Attention deficit hyperactivity disorder: A enough”), whereas individuals from Eastern cultures handbook for diagnosis and treatment (2nd ed.). New York: tend to make attributions that reflect situational con- Guilford Press. straints or pressures (e.g., “She was late for the meet- Gingerich, K. J., Turnock, P., Litfin, J. K., & Rosen, L. A. ing because she was caring for an ailing parent”). (1998). Diversity and attention deficit hyperactivity disor- These social attributions are important because they der. Journal of Clinical Psychology, 54(4), 415–426. can lead to stereotyping and discrimination when indi- LaRosse, M. (2004, November). Ideas for accommodating viduals, particularly those from Western cultures, individuals with ADD/ADHD in postsecondary training and college. Retrieved from the Job Accommodation make attributions within a multicultural society. Network Web site: http://www.jan.wvu.edu Livingston, R. (1999). Cultural issues in diagnosis and treat- SELF-ATTRIBUTIONS ment of ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 38(12), 1591–1594. Self-attributions can be classified according to three U.S. Department of Education, Office of Special Education dimensions: internality, stability, and globality. Inter- and Rehabilitative Services, Office of Special Education nality is present when an outcome is an attribute of Programs. (2003). Identifying and treating attention deficit the self (e.g., ability, effort) rather than outside the self hyperactivity disorder: A resource for home and school. Washington, DC: Author. (e.g., difficulty of task, other people). Stability is Weiss, G., & Hechtman, L. (1993). Hyperactive children present when an outcome is consistently present (e.g., grown up: ADHD in children, adolescents, and adults. an immutable personality trait) rather than temporary New York: Guilford Press. (e.g., effort). Globality is present when an outcome is cross-situational (i.e., occurs on many situations) rather than situation specific (i.e., occurs only in the target situation). Attributing negative or failure out- ATTRIBUTION comes to internal, stable, and global causes (e.g., one’s own personality) is referred to as a depressive or Attributions involve making causal explanations for pessimistic attributional style. events or outcomes, particularly the behaviors that led Because the underlying attributions suggest the to those events or outcomes. These explanations may cause will be present in a multitude of situations in be made by the individuals who experienced the the future, individuals will experience feelings of events directly (self-attributions), or explanations may helplessness, lowered self-esteem, and expectations be given for why events or outcomes happened to that future failures are likely to reoccur. In contrast, other individuals (social attributions). attributing negative outcomes to internal, unstable, Individuals tend to take personal credit for suc- and specific causes (e.g., lack of effort) suggests that cessful outcomes by making attributions that reflect one’s behavior can be altered to eliminate or reduce A-Jackson.qxd 7/12/2006 2:10 PM Page 62

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the negative outcome (e.g., if one just works harder). from Eastern cultures have a tendency to emphasize Conversely, attributing positive outcomes to internal, attributions as tempered by situational or contextual stable, and global causes (e.g., one’s own personality) influences, such as the social-role obligations and is referred to as an optimistic or stress-buffering attri- social pressures that an individual is experiencing. butional style. This attributional style (also referred to Cultural differences in attributional thinking do not as having “positive illusions”) is generally associated appear because there is an absence of dispositional with heightened self-esteem and expectations that thinking in Eastern cultures. However, Eastern cul- successful outcomes are likely to reoccur in the future. tures view dispositions as more malleable, and they Cross-cultural differences in attributional styles are more sensitive to the fact that individuals behave are explained by a cultural emphasis on individualism differently under different circumstances. versus collectivism. Because individuals in Western Attributions that individuals make about the behav- cultures focus on the person as the source of negative ior of members from other groups (specifically, and positive outcomes, one would expect these individ- different cultural groups) are important because they uals to make more dispositional than situational attri- can foster stereotypes and lead to discrimination. butions for their own behavior. Because individuals in Attributions made by an individual (referred to as the Eastern cultures focus on the individual as rooted in the judge) from a specific cultural group (referred to as social environment, one would expect these individuals the in-group) about the negative outcomes experi- to make more situational than dispositional attributions enced by members (referred to as the target) of a for their own behavior. Research has shown that a self- different cultural group (referred to as the out-group) serving attributional bias is relatively universal, though typically reflect negative personality characteristics it is weaker in Eastern cultures. and engender feelings of anger. For example, a There is a tendency, however, for some minority Caucasian juror may attribute the criminal behavior of group members within the United States to experience an African American defendant to the aggressive attributional ambiguity for outcomes. This occurs when nature of the target individual. Conversely, attribu- a minority group member is unsure whether an out- tions made for the behavior of a fellow in-group mem- come is the result of his or her own personal character- ber are more likely to be situationally based and istics or group membership. For successful outcomes, engender feelings of sympathy. For example, a such as being hired for a job, individuals might wonder Caucasian juror is more likely to attribute the criminal whether they were hired because of their perceived behavior (e.g., robbery) of a Caucasian defendant abilities (e.g., an internal, stable attribution) or because to extenuating circumstances, such as financial need. of perceived affirmative action policies (e.g., an exter- The implications of these attributions can be profound nal attribution). For unsuccessful outcomes, such as not in the courtroom and beyond. The assignment of per- being hired for a job, individuals might wonder whether sonality attributions for behavior is more strongly they were not hired because they were unqualified (i.e., associated with judgments of guilt and retaliatory they did not have the abilities for the job) or because behaviors than the assignment of situationally based “they are African American.” Thus, no clear self-serving attributions for behavior. attributions are made. Attributions provide an expectation about behavior. Behaviors leading to negative outcomes that are consistent with existing stereotypes are attributed to internal, SOCIAL ATTRIBUTIONS stable, and global causes (e.g., negative personality Similar cultural theories of individualism and collec- traits). Behaviors leading to positive outcomes that are tivism can be used to explain cultural differences in not consistent with existing stereotypes are attributed the attributions that individuals make about the behav- to external, unstable, and situation-specific causes ior of others. Differences in social attributions are (e.g., luck) or to internal, unstable, and situation-specific largely a function of where individuals focus their causes (e.g., “they [African Americans] happened to attention. Individuals from Western cultures have a work hard in this one instance”). It has been found, tendency to emphasize the traits and abilities of others for example, that the perceived successes of African at the expense of situational characteristics (e.g., how Americans (and women, for that matter) are attributed hard a task was) when making attributions for behav- more to luck and task ease than the perceived successes ior, particularly for negative outcomes. 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A model of the effect of stereotypes on social student holds the stereotype that Hispanics are hard- judgments can be proposed to explain these social working, the same target behavior will be viewed as attributions. A target individual’s behavior is first consistent with the stereotype and attributed to the compared with a salient group stereotype that the ability of the target Hispanic. Thus, the attributions judge (or the individual perceiving the behavior) has. that individuals have—and ultimately, the discrimina- Next, the target behavior is determined to be either tory behaviors that individuals may engage in as a consistent or inconsistent with the prevailing group consequence of these attributions—begin with stereo- stereotype. An observed behavior that is consistent types. Nowhere is this more prominent than int the with the group stereotype will lead to attributions that stereotypes that individuals hold about different are ability or personality based. A behavior that is cultural groups. inconsistent with the group stereotype will lead to —Scott C. Roesch attributions that largely reflect luck or task ease. —Allison A. Vaughn For example, assume that a Caucasian high school student (the judge) has just learned that a fellow FURTHER READING Hispanic classmate (the target) has been admitted to Harvard University (the target behavior or outcome). Choi, I., Nisbett, R. E., & Norenzayan, A. (1999). Causal attri- Further, assume that the Caucasian student holds bution across cultures: Variation and universality. the stereotype that Hispanics are lazy. Because the Psychological Bulletin, 125, 47–63. Mezulis, A. H., Abramson, L. Y., Hyde, J. S., & Hankin, B. L. Hispanic student’s target behavior is inconsistent with (2004). Is there a universal positivity bias in attributions? the Caucasian student’s group stereotype, the latter A meta-analytic review of individual, developmental, and will largely attribute the behavior to causes such as cultural differences in the self-serving attributional bias. luck or affirmative action. However, if this Caucasian Psychological Bulletin, 130, 711–747. A-Jackson.qxd 7/12/2006 2:10 PM Page 64