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

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

Part II; Culture and Health

Anecdote: A psychiatrist once told me about a Mormon woman who came to him deeply distressed because, 20 years and four children into her second marriage, she realized that she would be spending eternity with her first husband, a man who had died 6 months after their wedding. Mormon couples can be married both for this life and for 'eternity,' and she and her first husband had chosen to be linked in both ways. Now her husband was a stranger to her, and she desperately wanted to spend her afterlife with her present husband and children. To his credit, the psychiatrist realized that he could not help this patient. He called a Mormon colleague who quickly linked the patient with a bishop of the Mormon church. In a single visit, the Bishop helped the woman straighten out her fears about the afterlife. Why could the first psychiatrist not help the patient himself? He did not share her reality model. Instead of telling her not to be silly, he took a logical and compassionate step, and linked the sick woman with health care workers who did share her reality model. -Cassidy, 1996, p.10.

A health professional must work within the auspices of her culture and paradigm's disease models: "A health practitioner who attempts to deal with human suffering, whether medical doctor, shaman, priest, therapist, or healer, begins the work of healing in a specific cultural and social setting embedded in personal history and experience" (Shulman, 1997, p. 14). The anecdote above illustrates a case in which this situation is acknowledged. Unfortunately, those very biases which render our understandings culture bound are too often taken for granted or not acknowledged when making cross-cultural inquiries or treating individuals who are not of the same frame of reference. The supposition: "The cultural biases and subjectivity of the staff are not assumed to have importance" (Shulman, 1997, p. 15) is an even worse scenario as it assumes that these biases are known of and then disregarded. Shulman (1997) suggests that a strategy of 'reflexivity' be adopted wherein one becomes aware of the effects of one's observations on what/ who is being observed as according to the cultural context, and claims that this would encourage a cultural dialogue. This discussion acquires threefold importance:

When iatrogenic forces enter into illness (any given person's diagnosis is liable to be altered when we move from one conceptual framework to another).

When a person's frame of reference influences how they perceive changes in their mind and body.

When researchers make assumptions regarding individuals who may have frames of reference distinct from their own.

Western medical models:
In order to restore the homeostasis which health affords, "our culture has declared a war on biology" (Morris, 1998, p. 2). This is evident in the terminology used by Western medical paradigms: those of battles and counterattacks (Morris, 1998). The Western model has made a great number of advancements using this frame of reference (my stepfather remembers the mass phobia children and their mothers experienced over contracting polio, a fear eliminated today by vaccination), but it has its flaws as well.

One flaw is derived from an over-reliance on reductionism. Reductionism is a Western tendency which views the world in terms of a conglomerate of simpler processes. It has birthed many advancements in the field of health:

This reductionist approach proved extremely effective in increasing scientific understanding of disease. When the complexity of the body was reduced to simple processes, it became possible to measure these processes. Measurement of bodily function thus became central to scientific medical thinking. -Watkins, 1996, p. 52.

Western thought, however, tends to rely too heavily on separating (reducing) phenomenon into disciplines and sub-processes, further fragmenting the problems at hand. Reductionism neglects the interaction between the phenomenon which it reduces. It appears that science has gotten very familiar with the xylem and the phloem of the trees, but has no conception that they once belonged to the forest. This problem in the health field is explained: there is "too little attempt to cross disciplinary boundaries in order to form a coherent picture" (Shulman, 1997, p. 115). What results is disciplinary closure or relativism which is resorted to when disparate findings arise between paradigms. Physiopsychologists and psychoimmunologists are attempting to cross disciplinary boundaries, but there is a lack of integration of their findings in our health care system.

This act of separating phenomenon has also resulted in the dichotomous treatment of the mind and body in Western academic thought. (Even with the emergence of fields like physiopsychology, they are usually treated as separate entities). The dichotomy perpetuated by this culture between the mind and the body is evident in the fact that we have doctors for the head, doctors for the mind, and doctors for the soul. This tale began when shaman divided into herbalist (physical, mechanistic) and priest/ magician or traditionalist (spiritual, vitalistic) (Watkins, 1996). The herbalist eventually subdivided into modern day MD., nurse, medical researcher, and pharmacologist, etc., while priest and traditionalist were subjugated into the class of non-science by Western mentality. My guess is that psychologists occupied a position somewhere in the middle (and science still treats the field of psychology with a bit of suspicion). While the positive role of these professions should not be underestimated, it is possible that a person may grow to feel fragmented. If it takes x number of professionals to help a person, they may feel like x many distinct facets reside within them. Chopra (1997) writes, the Western self is "a mysterious fusion of ego, personality, and memory that everyone amasses between infancy and early childhood" (p. 13). We must these unite these disparate people living within ourselves, or come up with some sort of living arrangement for them. In addition, our own human intuition has been 'dismissed': "Individual experience, which could not be measured, diminished further and the intuitive wisdom of healers was dismissed as anecdotal." (Watkins, 1996, p. 52).

Western science displays a very low tolerance for ambiguity, which may have something to do with this devaluation of intuition. Western medicine, specifically, is in constant search for the universal diagnosis and treatment option with little attention to the individual and his or her specific needs. The diagnoses themselves may serve to plague the individual (especially with agencies like Managed Care around) as attention is placed on the malady and its symptoms rather than on how to restore good health/ remove the cause of the problem. Shulman (1997) recognizes the fault in the medical profession: there is a greater concern with "watching, recording, diagnosing" than with "relating", and expresses alarm over the notion that we are to grow and heal amidst a destructive, isolating and medicating environment. Not being able to tolerate the ambiguous nature of the individual patients themselves has led the health profession astray from their original intention: helping people. I concentrate mainly on the faults of the Western biomedical model, partly because they are pervasive, but also because these are the areas which individuals from different frames of reference find most contention with.

Other medical models:
The use of distinct medical models, while blatantly obvious across country and continental borders, is also pronounced within the borders of the United States: "An example of a culturally shaped belief is the extensive use of traditional herbal medicines by blacks, Asians, and Hispanics living in the U.S." (Levy & Hawks, 1996). Many systems of health maintenance exist aside from the conventional biomedical model, although they overlap on a number of grounds. Chinese Medicine, Curaderismo, Herbalism, and Homeopathy are among a few. Most models differ from the bio-medical model specifically in their emphasis on spirituality and/ or the mind-body continuum. Many also advocate that life is more than a collection of chemical reactions or a sum of its parts as the mechanistic view would have us believe. Even folk knowledge (wive's tales) may be considered to be a medical model: "An apple a day keeps the doctor away"; "Don't run with scissors"; "Beer before liquor never sicker, liquor before beer, never fear"; "Feed a cold, starve a fever". These statements may seem almost silly, but they subsist in a sea of pop-cultural medical knowledge which extends through to our cooking practices, and other daily health routines/ beliefs. According to Bodeker (1994), "Traditional medical knowledge typically is encoded into household cooking practices, home remedies and health prevention and health maintenance beliefs and routines" (p. 281). And although 'traditional' is used in reference to ways aside from allopathy, these statements apply to allopathy as well. Sometimes we forget that the bio-medical model, as 'modern' and 'verifiable' as it is, is just as dependant on cultural tradition;as are the others.

Impact of these models:
What these disparate models foster are distinct patterns of health across cultures and their sub-cultures. Cultures of the world acquire physiological and psychological illnesses at different rates and to different degrees, having as much to do with bacterial, viral, and human evolution in these areas as with psycho-social forces emerging in these communities. As I am not in the profession of cataloguing the infectious/ viral agents or genetic predispositions, I will concentrate on those psychosocial variables which carry weight. Cultural differentiation is propagated by environmental and sociopolitical dynamics, which not only impart different stressors, but different appraisals of those stressors and their effects on the body: "Thus symptoms and signs are interpreted differently depending on the underlying culture of each society" (Watkins, 1996, p. 51).

I started out my introduction by giving a recount of some common story lines emerging in the health care industry of the US. These issues influence the health of (and are influenced by) the majority of people in the US. They impart or reflect their entire conceptual framework, just as other models interact with those who subscribe to them. I will now turn to evidence which supports the notion that different cultures within the US might diverge in health outcomes, as based on varied beliefs, environments, and life stressors.