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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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Part I; Belief and Health

Psychosomaticism

Psychosomaticism demystified:
Have you ever gotten a headache after an argument? Have you ever noticed that there are virtual epidemics of colds on campus during exam times? Have you ever broken out in hives because you were nervous about something? Has your heart ever skipped a beat because you were shocked, or had an intense emotional reaction? All involve complex pathways of the autonomic and neuroendocrine systems of the Central Nervous System (CNS) which respond to internal and external stimuli. The above examples illustrate how the mind and body interact and incite influence over each other in this process.

Psychosomatic refers to the interaction between mind and body illustrated above. The term psychosomatic, however, has taken on a variety of definitions since its inception. It is thus important to specify which interpretation of the term is being used for this analysis. Heinroth coined the term in 1818 from the Greek 'psyche' (soul or to breath) and soma (body) to "emphasize multicausality and . . . interaction between the mind and body", and to help eliminate the lack of integration between the medical and behavioral sciences (Fleming-Courts & Bartol, 1996). Bartol and Eakes (1995) attempted to determine what the term means to individuals within the health care industry. There were four major tenets:

    [imaginary] an imagined physical disorder.

    [structural] a physical structure disturbance mediated by emotional tension.

    [functional] a disturbance of the function of an organ mediated by emotional tension.

    [holistic] an approach to any state of the body taking into consideration psychic factors in physical conditions and physical factors in psychic conditions.
-adapted from Bartol and Eakes, 1995.
The bidirectional, holistic (4) definition is consistent with the original definition and is the one I use (even though psychic conditions are not addressed in the current discussion). Unfortunately, Bartol and Eakes (1995) found that even individuals in the health care field espouse inaccurate unidirectional (2 or 3), or imaginary (1) definitions, but that level of education moderated this. The DSM-IV now refers to psychosomatic as 'psychological factors affecting medical condition', also exhibiting a unidirectional bias. Likewise, unidirectional or imaginary assumptions of the term are assumed by non-medical experts, which Fleming-Courts and Bartol (1996) believe is reflective of the conceptions of their caregivers. The alternative term psychophysiological has emerged, which perhaps carries less of the societal stigma (ie., as imaginary) attached to the word psychosomatic.

'Holistic', in the sense that the World Health Organization described it (1978), is consistent with how this paper views psychosomaticism:

that of viewing a man in his totality within a wide ecological spectrum, and of emphasizing the view that ill health or disease is brought about by an imbalance, or disequilibrium, of man in his total ecological system and not only by the causative agent and pathogenic evolution. -Bodeker, 1994, 279-80.
This adheres to the diathesis stress model, which explains dysfunction (ie. schizophrenia) according to biological, psychological, and sociocultural factors (Comer, 1998). Health is a natural state. Illness is an imbalance in homeostasis. Both are mediated by physical/ psychosocial causes.

Psychosomatic is not psychogenic:
I would like to emphatically caution the reader against the assumption that the mind has sole control over the manifestation of our (ill) health. It is far from my intention to imply that all physical afflictions are derived solely or even mainly from psychic forces ('it's all in your head'/ psychogenic). Such a belief system is demonstrated in the following stigmatization of the victim: the impression that the "person chose to be ill, perhaps to get attention, or that the person could become well simply by making a choice for health and giving up the benefits its illness affords" (Bartol & Eakes, 1995, p. 28). This may lead caregivers to regret or disparage their patients (Bartol & Eakes, 1995). Feeling "discounted, labeled or ignored", furthermore, has detrimental effects on the level of self-esteem/ hope of these individuals, possibly discouraging them from seeking care when needed (Bartol & Eakes, 1995; Fleming-Courts & Bartol, 1996). Just because the mind exerts influence over our physical body, does not negate the fact that physical factors are involved in every aspect of health. Factitious or somatoform disorders, which do rely more heavily on psychic forces, will not be addressed in this study. What I am considering is that the mind and body are not autonomous, mutually exclusive systems.

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