TABLE OF
          	CONTENTS

ABSTRACT

INTRODUCTION

PART 1

Health Locus of Control
Psychosomaticism
Psychosomaticism and Psychoimmunology
HLC and Psychosomaticism

PART 2

Health Reality Models
The (Cultural) Etiology of Illness
Mode of Acculturation
Well-Being and Mode of Acculturation
Mode of Acculturation and HLC
CONCLUSIONS

METHODS

Participants
Materials
Design
Procedure

RESULTS

DISCUSSION

Discussion of Results
Confluence Approach
Cultural Competence
Creativity Amidst Disillusionment
Stress in the 90's
Regaining Control
When Externality is Better
Future Studies

REFERENCES

APPENDIXES

Appendix A Appendix B Appendix C

SPECIAL THANKS

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Discussion

When Externality is the Better Strategy

Other cultures:
For certain cultures where religion is integrated into the view of the self, rather than spirituality being distinct, it might be beneficial to have an external HLC. Believing that a higher power or force has influence over one's health, may not debilitate the person but free the person from stress according to certain frameworks. Collectivist nations may also diverge in the best strategy and favor an external HLC. By the Western standard, anything that is not within our control is a threat to our self-control, and therefore an internal HLC is viewed more favorably/ more favorable to the individuals health.

An exercise in futility:
An internal HLC is by no means a cure all. Disease afflicts individuals with very different personalities and coping strategies. It might even seem that illness feeds upon illness: "The findings also suggest that the existence of health problems contributes, both directly and indirectly, to higher levels of stress and psychological distress" (Tran, Fitzpatrick, Berg, & Wright, 1996, p. 163). And when dealing with terminal illness believing that one has exclusive control over the state of one's health may do more harm than good to the psyche (Vandervoort et al., 1997), an exercise in futility.

Middle ground:
The Serenity Prayer (taken as religious or secular) seems applicable here:

God grant me the serenity,
To accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.

Although I have based this research on the precept that an internal HLC is beneficial to the health of those immersed in mainstream America, perhaps understanding when to moderate these beliefs is the key to psychological and physiological well-being. In this way individuals would not chastize themselves when they are ill, would retain hope of recovery, and exercise methods of improving health whether ill or not.

In an article originally entitled Psychological Factors in Illness: Has the Pendulum Swung Too Far? Benjamin Blich wrote: "Believe it or not, wear and tear, age and time, can actually cause damage to bodily parts and functions. Yet in these psychologically sophisticated times, the insight that illness is affected by the mind has so overwhelmed us that we often forget that it is also physical" (Comer, 1998, p. 360). And illness is very physical. Parting with some wisdom analogous to the serenity prayer, he continues. "When I was a small boy, I loved the story of the little engine that kept telling itself it could and it did," Blich reverberates, "Growing up has taught me that there are times when it can't and maturity demands awareness not only of our abilities, but also of our limits" (Comer, 1998, p.360).

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