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Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations.
BOOK REVIEWS
duced and explained. The strengths and weaknesses of each type of study are clearly reviewed, as are other relevant methodological issues. Informative examples from the literature are discussed. This chapter provides the reader with sufficient knowledge and insight to be able to read, understand, and evaluate published studies of psychiatric epidemiology. If in the research field, a reader could also use this information as a basis to design and carry out a thoughtful study. Chapter 3 covers causal and clinical heterogeneity and their genetic basis. Spectrum disorders are addressed from the genetic perspective, and the authors discuss how this knowledge can enhance delivery of clinical care. How neurobiology and neuropsychology enter psychiatric genetics is also made clear in this chapter. The authors discuss step-by-step how an initial finding related to neuropsychological function in patients with schizophrenia, their family members, and controls shaped follow-up studies which, in turn, led to brain imaging studies, each study designed to ask (and answer) questions derived from the previous study. This section also gives the reader insight into how science proceeds from study to study and, more interestingly perhaps, how scientists think from study to study. The latter part of this chapter contains a detailed discussion of one author’s (S.V.F.) research on ADHD and associated comorbidity. This section is rich in content (but, again, easy to read) and is well suited for those readers who grapple with ADHD and its attendant heterogeneity and comorbid conditions. Mathematical models and their use in studying modes of inheritance are explained in chapter 4. Chapter 5 covers molecular genetics. This chapter includes a thorough, but not lengthy, explanation of linkage analysis (lod score analysis and affected pedigree member methods) and, for those who need a primer, appropriate background information on basic biology, genetics, and DNA. The explanation of how to interpret linkage results is clear, as is the discussion of levels of significance. This section concludes with an example of genetic linkage analysis done in Alzheimer disease and how this ultimately led to gene discovery (psychiatric genetics at its best.) Family-based association studies and the nature and analysis of gene mutations are also covered. While at first glance these two chapters may seem farthest from a clinical practice, in fact, they are composed such that their relevance is clear. These chapters show the reader the elegance and limitations of molecular genetic research while making it intellectually accessible. With that accomplished, readers will have a more thorough grasp and critical understanding of genetics articles that come their way (through either lay or academic presses). In the current genetics-focused society, this will serve us all well. The last two chapters center on the clinical applications of psychiatric genetics and the future of psychiatric genetics. Genetic counseling for psychiatric disorders is thoroughly reviewed. This chapter provides the principles to help clini-
J . A M . AC A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 0 : 10 , O C TO B E R 2 0 0 1
cians clearly communicate genetic risks to patients and their families. Two case studies augment this section by fleshing out the principles of genetic counseling to actual clinical practice. Contained in this section is a hands-on approach to explain statistical probability that makes this concept concrete and accessible. The book concludes with a discussion on the impact of psychiatric genetics on clinical nosology, presymptomatic genetic testing, and ethical issues for the science and practice of psychiatric genetics. I was glad to have read this book. The text was very informative across a wide range of topics while being accessible and timely. Psychiatric genetics is a rapidly developing field, and this book captures where the field has come from, its current state, and its promising future. Dorothy E. Grice, M.D. Center for Neurobiology and Behavior Department of Psychiatry University of Pennsylvania, Philadelphia
Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations. Edited by Israel Cuellar and Freddy A. Paniagua. San Diego, CA: Academic Press, 2000, 486 pp., $79.95 (hardcover). The premise of this book is that psychiatry is currently dominated by a biological and medical approach to mental illness. It suggests that biomedicine is prevalent because the North American and Western European cultures that endorse it are the dominant economic and political powers in the world today. It calls for the study and treatment of mental illness to be placed, not simply within the context of an individual’s biology, but in an encompassing ecological framework. This would involve an attempt to understand mental illness as the result of a complex interaction of many domains including biology, culture, economics, politics, and psychology. My own recent experiences suggest that the editors’ observations about psychiatry in general are also true even for our more contextually oriented discipline of child and adolescent psychiatry. Several days ago I reviewed an evaluation and treatment plan prepared in the clinic of a child and adolescent psychiatrist. Its centerpiece was a single photon emission computed tomography (SPECT) imaging study describing the deficits found in the child’s brain functioning and a recommendation for two medications that would ostensibly address those deficits. Similarly, in a recent discussion with child and adolescent psychiatry residents I was told that “what we really need to learn [in our training] is psychopharmacology. That is what employers out there want to pay us to do.” And finally, in a conversation with the chairman of a psychiatry department, I was told, “If we wanted to have a [child psychiatry] researcher we would have hired a neuroimager.” 1239
BOOK REVIEWS
Assuming that my perceptions and those of the editors and authors of Multicultural Mental Health are correct, then this book provides an excellent corrective intellectual experience for those mental health professionals wishing to broaden their horizons beyond the realm of an individual’s biology. It argues persuasively that in an increasingly multicultural America, mental health practitioners must be trained to be culturally competent and capable of dealing effectively and empathetically with patients from ethnic groups other than their own. Culture should not be relegated to the role of a bit player in the biopsychosocial model, but should be center stage along with other main characters such as biology and psychology. The book is divided into four main parts, with each part subdivided into chapters written by different expert authors. Part I provides an overview of cross-cultural theories and models as well as a summary of projected growth trends among the four major ethnic minority populations of the United States: African Americans, American Indians, Asian Americans, and Hispanic Americans. Part II addresses methodological issues in crosscultural personality assessment and research. Part III discusses cross-cultural assessment and treatment including separate chapters focused on the shared features of the many ethnic peoples subsumed within each of the major ethnic minority groups. Part IV describes the issues and teaching strategies involved in training mental health professionals to be culturally competent practitioners. While the book is written primarily with adult ethnic minority patients in mind, its concepts and techniques are quite applicable to work in child and adolescent psychiatry. There is also an excellent chapter on “Depression and Suicidal Behaviors Among Adolescents: The Role of Ethnicity” by Robert E. Roberts, a contributor of important articles on cross-cultural mental health to this Journal. I was especially interested in the early conceptual and theoretical chapters on “Culture and Mental Health: An Introduction and Overview of Foundations, Concepts, and Issues”; “Cultural Models of Health and Illness”; and “Acculturation and Mental Health: Ecological Transactional Relations of Adjustment.” These chapters provide the framework and rationale for the rest of the book and pose a constructive challenge to the present dominance of biology in American psychi-
1240
atry. As a researcher in cross-cultural child and adolescent psychiatry, I also found the two chapters addressing issues of methodology illuminating and helpful. The final chapter in the book, “Responding to the Challenge: Preparing Mental Health Professionals for the New Millennium,” provides a useful technique for helping trainees to better appreciate their own strengths and weaknesses in understanding and assisting patients from ethnic groups other than their own. For those of us who have been in the field of child and adolescent psychiatry for a number of years and who have witnessed the waxing and waning of different theoretical and empirical perspectives, this book is both refreshing and reassuring. It helps us to see that we, as professionals, also live in a practice and research culture that changes with time and that unfortunately trends toward exclusivity rather than integration. Like other ethnocentric assumptions, our professional world view needs to be challenged continuously and broadened to include other ways of understanding the children, adolescents, and families we serve. There are many ways of being human, and there are also many diverse and complementary ways to assess and treat the mental illnesses that afflict our children. No one approach holds all the truth or all the healing. This book helps us to appreciate that fact and encourages us to adopt an ecological approach in our work with child and adolescent mental illness. I would especially recommend this book to training directors who are looking for a text to buttress the seminars and practice experiences they offer to residents on cross-cultural child and adolescent psychiatry. I would also recommend it to those practitioners and researchers who work with cross-cultural populations. It provides both a thorough introduction to and a good reference for work with ethnic minority populations. Robert S. McKelvey, M.D. Professor and Director of Child and Adolescent Psychiatry Oregon Health Sciences University, Portland Note to Publishers: Books for review should be sent to Christopher Thomas, M.D., UTMB Department of Psychiatry, 301 University Boulevard, Galveston, TX 77555-0193.
J . A M . AC A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 0 : 10 , O C TO B E R 2 0 0 1
duced and explained. The strengths and weaknesses of each type of study are clearly reviewed, as are other relevant methodological issues. Informative examples from the literature are discussed. This chapter provides the reader with sufficient knowledge and insight to be able to read, understand, and evaluate published studies of psychiatric epidemiology. If in the research field, a reader could also use this information as a basis to design and carry out a thoughtful study. Chapter 3 covers causal and clinical heterogeneity and their genetic basis. Spectrum disorders are addressed from the genetic perspective, and the authors discuss how this knowledge can enhance delivery of clinical care. How neurobiology and neuropsychology enter psychiatric genetics is also made clear in this chapter. The authors discuss step-by-step how an initial finding related to neuropsychological function in patients with schizophrenia, their family members, and controls shaped follow-up studies which, in turn, led to brain imaging studies, each study designed to ask (and answer) questions derived from the previous study. This section also gives the reader insight into how science proceeds from study to study and, more interestingly perhaps, how scientists think from study to study. The latter part of this chapter contains a detailed discussion of one author’s (S.V.F.) research on ADHD and associated comorbidity. This section is rich in content (but, again, easy to read) and is well suited for those readers who grapple with ADHD and its attendant heterogeneity and comorbid conditions. Mathematical models and their use in studying modes of inheritance are explained in chapter 4. Chapter 5 covers molecular genetics. This chapter includes a thorough, but not lengthy, explanation of linkage analysis (lod score analysis and affected pedigree member methods) and, for those who need a primer, appropriate background information on basic biology, genetics, and DNA. The explanation of how to interpret linkage results is clear, as is the discussion of levels of significance. This section concludes with an example of genetic linkage analysis done in Alzheimer disease and how this ultimately led to gene discovery (psychiatric genetics at its best.) Family-based association studies and the nature and analysis of gene mutations are also covered. While at first glance these two chapters may seem farthest from a clinical practice, in fact, they are composed such that their relevance is clear. These chapters show the reader the elegance and limitations of molecular genetic research while making it intellectually accessible. With that accomplished, readers will have a more thorough grasp and critical understanding of genetics articles that come their way (through either lay or academic presses). In the current genetics-focused society, this will serve us all well. The last two chapters center on the clinical applications of psychiatric genetics and the future of psychiatric genetics. Genetic counseling for psychiatric disorders is thoroughly reviewed. This chapter provides the principles to help clini-
J . A M . AC A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 0 : 10 , O C TO B E R 2 0 0 1
cians clearly communicate genetic risks to patients and their families. Two case studies augment this section by fleshing out the principles of genetic counseling to actual clinical practice. Contained in this section is a hands-on approach to explain statistical probability that makes this concept concrete and accessible. The book concludes with a discussion on the impact of psychiatric genetics on clinical nosology, presymptomatic genetic testing, and ethical issues for the science and practice of psychiatric genetics. I was glad to have read this book. The text was very informative across a wide range of topics while being accessible and timely. Psychiatric genetics is a rapidly developing field, and this book captures where the field has come from, its current state, and its promising future. Dorothy E. Grice, M.D. Center for Neurobiology and Behavior Department of Psychiatry University of Pennsylvania, Philadelphia
Handbook of Multicultural Mental Health: Assessment and Treatment of Diverse Populations. Edited by Israel Cuellar and Freddy A. Paniagua. San Diego, CA: Academic Press, 2000, 486 pp., $79.95 (hardcover). The premise of this book is that psychiatry is currently dominated by a biological and medical approach to mental illness. It suggests that biomedicine is prevalent because the North American and Western European cultures that endorse it are the dominant economic and political powers in the world today. It calls for the study and treatment of mental illness to be placed, not simply within the context of an individual’s biology, but in an encompassing ecological framework. This would involve an attempt to understand mental illness as the result of a complex interaction of many domains including biology, culture, economics, politics, and psychology. My own recent experiences suggest that the editors’ observations about psychiatry in general are also true even for our more contextually oriented discipline of child and adolescent psychiatry. Several days ago I reviewed an evaluation and treatment plan prepared in the clinic of a child and adolescent psychiatrist. Its centerpiece was a single photon emission computed tomography (SPECT) imaging study describing the deficits found in the child’s brain functioning and a recommendation for two medications that would ostensibly address those deficits. Similarly, in a recent discussion with child and adolescent psychiatry residents I was told that “what we really need to learn [in our training] is psychopharmacology. That is what employers out there want to pay us to do.” And finally, in a conversation with the chairman of a psychiatry department, I was told, “If we wanted to have a [child psychiatry] researcher we would have hired a neuroimager.” 1239
BOOK REVIEWS
Assuming that my perceptions and those of the editors and authors of Multicultural Mental Health are correct, then this book provides an excellent corrective intellectual experience for those mental health professionals wishing to broaden their horizons beyond the realm of an individual’s biology. It argues persuasively that in an increasingly multicultural America, mental health practitioners must be trained to be culturally competent and capable of dealing effectively and empathetically with patients from ethnic groups other than their own. Culture should not be relegated to the role of a bit player in the biopsychosocial model, but should be center stage along with other main characters such as biology and psychology. The book is divided into four main parts, with each part subdivided into chapters written by different expert authors. Part I provides an overview of cross-cultural theories and models as well as a summary of projected growth trends among the four major ethnic minority populations of the United States: African Americans, American Indians, Asian Americans, and Hispanic Americans. Part II addresses methodological issues in crosscultural personality assessment and research. Part III discusses cross-cultural assessment and treatment including separate chapters focused on the shared features of the many ethnic peoples subsumed within each of the major ethnic minority groups. Part IV describes the issues and teaching strategies involved in training mental health professionals to be culturally competent practitioners. While the book is written primarily with adult ethnic minority patients in mind, its concepts and techniques are quite applicable to work in child and adolescent psychiatry. There is also an excellent chapter on “Depression and Suicidal Behaviors Among Adolescents: The Role of Ethnicity” by Robert E. Roberts, a contributor of important articles on cross-cultural mental health to this Journal. I was especially interested in the early conceptual and theoretical chapters on “Culture and Mental Health: An Introduction and Overview of Foundations, Concepts, and Issues”; “Cultural Models of Health and Illness”; and “Acculturation and Mental Health: Ecological Transactional Relations of Adjustment.” These chapters provide the framework and rationale for the rest of the book and pose a constructive challenge to the present dominance of biology in American psychi-
1240
atry. As a researcher in cross-cultural child and adolescent psychiatry, I also found the two chapters addressing issues of methodology illuminating and helpful. The final chapter in the book, “Responding to the Challenge: Preparing Mental Health Professionals for the New Millennium,” provides a useful technique for helping trainees to better appreciate their own strengths and weaknesses in understanding and assisting patients from ethnic groups other than their own. For those of us who have been in the field of child and adolescent psychiatry for a number of years and who have witnessed the waxing and waning of different theoretical and empirical perspectives, this book is both refreshing and reassuring. It helps us to see that we, as professionals, also live in a practice and research culture that changes with time and that unfortunately trends toward exclusivity rather than integration. Like other ethnocentric assumptions, our professional world view needs to be challenged continuously and broadened to include other ways of understanding the children, adolescents, and families we serve. There are many ways of being human, and there are also many diverse and complementary ways to assess and treat the mental illnesses that afflict our children. No one approach holds all the truth or all the healing. This book helps us to appreciate that fact and encourages us to adopt an ecological approach in our work with child and adolescent mental illness. I would especially recommend this book to training directors who are looking for a text to buttress the seminars and practice experiences they offer to residents on cross-cultural child and adolescent psychiatry. I would also recommend it to those practitioners and researchers who work with cross-cultural populations. It provides both a thorough introduction to and a good reference for work with ethnic minority populations. Robert S. McKelvey, M.D. Professor and Director of Child and Adolescent Psychiatry Oregon Health Sciences University, Portland Note to Publishers: Books for review should be sent to Christopher Thomas, M.D., UTMB Department of Psychiatry, 301 University Boulevard, Galveston, TX 77555-0193.
J . A M . AC A D . C H I L D A D O L E S C . P S YC H I AT RY, 4 0 : 10 , O C TO B E R 2 0 0 1