Post by Mel on Dec 29, 2005 14:58:34 GMT -5
OC Multi-Cultural Issues
By Angela M. Neal-Barnett, Ph.D.
Little information is available about obsessive-compulsive disorder (OCD) and its related disorders among people of color in the United States. The lack of knowledge has led many to questions whether OCD is manifested differently in various ethnic minority groups. The epidemiological data indicate that the prevalence of OCD among American ethnic minority groups is equal if not greater than that of Whites. Differences do not appear to exist in symptoms. Yet, ethnic minorities with OCD continue to go untreated. Why? What can people committed to helping OCD sufferers do within their communities, support groups, treatment and research centers to reach out to ethnic minorities with OCD?
The purpose of this section of the OC Foundation Web Site is to provide readers with information that will assist them in developing awareness and treatment programs for people of color. Information has been arranged for easy access and readability. The information provided in this section is intended to serve only as a brief guide. The reader is encouraged to access the resources listed at the end of this section to gain an in-depth understanding of multi-cultural issues in OCD.
BARRIERS --
Numerous barriers exist that limit awareness and treatment of OCD among various American ethnic minority groups. It is extremely important that individuals who want to develop OCD awareness programs in communities of color have knowledge of these barriers. Three major barriers are highlighted in the tables below.
Barrier 1: Cultural Mistrust
African Americans: Historically, psychological and psychiatric research has been used to support notions of Black inferiority. In addition, there has been a strong tendency to misdiagnosis African American psychopathology. For these reasons, many African Americans mistrust mental health professionals.
American Indians: American Indians' reasons for mistrust are similar to those of African Americans.
Asian Americans: In Asian American cultures, mistrust is characterized by the belief that outsiders should not be involved in personal matters. Within some Asian communities, particularly Chinese and Japanese Americans, emotional and affective needs are met within the family. To go outside the family, (i.e. to consult with a psychiatrist or psychologist) is viewed as bringing shame or dishonor upon the family.
Latinos/Latinas: Cultural mistrust appears to be affected by acculturation. Acculturation is defined as the process of adopting the values and customs of the dominant society. In the United States, this means adapting the values and customs of White society. Higher levels of acculturation are associated with use of mental health professionals. However, it is important to understand that for some people, acculturation may come at a heavy price, cutting them off from family and their respective communities thereby producing more anxiety.
Barrier 2: Help-Seeking Behavior
African Americans: Research indicates that African Americans are more likely to seek help at natural help-giving institutions within the Black community. These include Black churches, beauty salons, and barbershops. Advice and counsel is also sought from elders in the community who are valued for their wisdom and life experience.
American Indians: Many American Indian communities have an acknowledged healer (medicine man/medicine woman) who is consulted on mental health issues.
Asian Americans: Asian American help-seeking is directly related to their cultural mistrust. Problems are handled within the family and outside assistance is actively discouraged. Among more recent Asian immigrants (e.g. Vietnamese, Laotians) the close-knit community functions as an extended family and help is sought among community members.
Latino/Latinas: Help-seeking varies depending on the region and the country of origin. Some states may have cultural specific mental health agencies with bilingual therapists. When these services are available, Latinos/Latinas appear to utilize them. In other parts of the United States, Latinos may either seek help from a spiritualist or a traditional mental health provider.
Barrier 3: Medication Issues
African Americans: Medication is a volatile issue for many Africans Americans. Certain segments of the Black community view medication as a way to make Blacks, particular men, docile and as a form of genocide. The cost of medication is often prohibitive especially for low-income individuals and the elderly. The prohibitive cost of medication may lead people to cut their pills in half or only take them when the behavior is at its worse. It has been suggested that recruiting poor ethnic minorities for clinical trials and research studies are ways to eliminate the medication price issue. However, this suggestion fails to take into account the cultural mistrust exhibited by many African American towards research. Some drugs that are effective in White American populations are ineffective in African American populations. For example, beta-blockers appear to be relatively ineffective in treating hypertension in African Americans.
American Indians: No information is available.
Asian Americans: Differences appear to exist in the way Asian American groups metabolize drugs. For example, Benzodiazepines, a category of drugs used in the treatment of anxiety disorders, appear to metabolize slower in Asian Americans than in Caucasians. Among more recent Asian immigrants (Vietnamese, Laotian) to the United States, medication compliance appears to be an issue.
Latinos/Latinas: Research suggests that, in general, Latinos may be more receptive to medication than African Americans. However, they may be less likely to understand how to take the medication. Research has shown Latinos may take the medication on an as need basis or when the anxiety becomes overwhelming, but stop when they begin to feel a little better. Latinos appear more likely to hoard their medication for fear of not being able to obtain more of it. This fear may result in the individual purchasing extra quantities of the drug when they or family members travel back to their homeland.
OCD Medications: At this time, no information is available specifically about ethnic minorities and OCD medications.
OVERCOMING BARRIERS --
There are many steps one can take to overcome the barriers that prevent ethnic minority communities from receiving information about Obsessive Compulsive Disorder. Several basic steps are outlined below.
1. First and foremost, believe in your ability to reach and teach people of color with OCD and their extended families.
2. Increase your knowledge and understanding about OCD and other anxiety disorders among people of color.
Read Books or attend workshops that focus on multi-cultural issues in general and multi-cultural issues in anxiety.
Recommended Resources:
a. Dr. Angela Neal-Barnett's Web Site: www.personal.kent.edu/~aneal/amnbhp.html
b. Cultural issues in the treatment of anxiety edited by Steven Friedman: Guilford Press.
c. Counseling the Culturally Different by Derald Wing Sue and David Sue: John Wiley and Sons.
3. Work At Overcoming Cultural Mistrust.
Demonstrate a consistent commitment to raising awareness/treatment issues in your target community of color.
a. Change may not happen overnight. Persistence and patience is essential.
Collaborate with churches, community centers, civic organizations, fraternities and sororities in the target community to develop an OCD awareness program.
a. An awareness program should include either an OCD sufferer of color, an OCD expert of color, or a program moderator of color.
b. A treatment program should include either treatment team members of color, or examples that are relevant to people of color with OCD.
c. When using an interpreter or bilingual presenter makes sure they speak the same or similar dialect as the members of your audience. Misunderstandings can occur when for example, a Spanish speaker from Puerto Rico speaks to an audience of Mexican Spanish speakers.
Especially For Ethnic Minority OCD Sufferers And Their Families --
If you suffer from OCD and are a person of color, you may feel as if you are the only one. After all, how many other members of your particular ethnic group do you know who have OCD? Because we rarely see or hear about people of color with OCD, many people mistakenly believe it is a white disease. This is not true. OCD affects people of all races, classes, and genders. In many ethnic minority communities, mental health issues are not discussed. This can make it difficult for you to seek and receive help. Many of your family members and friends may be at a lost as to how to help you. Some may suggest that you are crazy.
YOU ARE NOT CRAZY.
OCD is a disorder that can be treated and managed. The important thing is to find the appropriate help. Reading the information on this Web Site is a good start. The OC Foundation has a list of people and groups in your area that can help. The OC Foundation can also suggest groups and books for your family to help them understand what is happening and how to help Call, write, or e-mail them. If you are uncomfortable about seeking help from the OC Foundation, there are people and places within your community that can help. Traditional healers and counseling ministries within churches are a good place to start. Wherever you go, print out this page and take it with you.
REMEMBER, YOU ARE NOT ALONE!
By Angela M. Neal-Barnett, Ph.D.
Little information is available about obsessive-compulsive disorder (OCD) and its related disorders among people of color in the United States. The lack of knowledge has led many to questions whether OCD is manifested differently in various ethnic minority groups. The epidemiological data indicate that the prevalence of OCD among American ethnic minority groups is equal if not greater than that of Whites. Differences do not appear to exist in symptoms. Yet, ethnic minorities with OCD continue to go untreated. Why? What can people committed to helping OCD sufferers do within their communities, support groups, treatment and research centers to reach out to ethnic minorities with OCD?
The purpose of this section of the OC Foundation Web Site is to provide readers with information that will assist them in developing awareness and treatment programs for people of color. Information has been arranged for easy access and readability. The information provided in this section is intended to serve only as a brief guide. The reader is encouraged to access the resources listed at the end of this section to gain an in-depth understanding of multi-cultural issues in OCD.
BARRIERS --
Numerous barriers exist that limit awareness and treatment of OCD among various American ethnic minority groups. It is extremely important that individuals who want to develop OCD awareness programs in communities of color have knowledge of these barriers. Three major barriers are highlighted in the tables below.
Barrier 1: Cultural Mistrust
African Americans: Historically, psychological and psychiatric research has been used to support notions of Black inferiority. In addition, there has been a strong tendency to misdiagnosis African American psychopathology. For these reasons, many African Americans mistrust mental health professionals.
American Indians: American Indians' reasons for mistrust are similar to those of African Americans.
Asian Americans: In Asian American cultures, mistrust is characterized by the belief that outsiders should not be involved in personal matters. Within some Asian communities, particularly Chinese and Japanese Americans, emotional and affective needs are met within the family. To go outside the family, (i.e. to consult with a psychiatrist or psychologist) is viewed as bringing shame or dishonor upon the family.
Latinos/Latinas: Cultural mistrust appears to be affected by acculturation. Acculturation is defined as the process of adopting the values and customs of the dominant society. In the United States, this means adapting the values and customs of White society. Higher levels of acculturation are associated with use of mental health professionals. However, it is important to understand that for some people, acculturation may come at a heavy price, cutting them off from family and their respective communities thereby producing more anxiety.
Barrier 2: Help-Seeking Behavior
African Americans: Research indicates that African Americans are more likely to seek help at natural help-giving institutions within the Black community. These include Black churches, beauty salons, and barbershops. Advice and counsel is also sought from elders in the community who are valued for their wisdom and life experience.
American Indians: Many American Indian communities have an acknowledged healer (medicine man/medicine woman) who is consulted on mental health issues.
Asian Americans: Asian American help-seeking is directly related to their cultural mistrust. Problems are handled within the family and outside assistance is actively discouraged. Among more recent Asian immigrants (e.g. Vietnamese, Laotians) the close-knit community functions as an extended family and help is sought among community members.
Latino/Latinas: Help-seeking varies depending on the region and the country of origin. Some states may have cultural specific mental health agencies with bilingual therapists. When these services are available, Latinos/Latinas appear to utilize them. In other parts of the United States, Latinos may either seek help from a spiritualist or a traditional mental health provider.
Barrier 3: Medication Issues
African Americans: Medication is a volatile issue for many Africans Americans. Certain segments of the Black community view medication as a way to make Blacks, particular men, docile and as a form of genocide. The cost of medication is often prohibitive especially for low-income individuals and the elderly. The prohibitive cost of medication may lead people to cut their pills in half or only take them when the behavior is at its worse. It has been suggested that recruiting poor ethnic minorities for clinical trials and research studies are ways to eliminate the medication price issue. However, this suggestion fails to take into account the cultural mistrust exhibited by many African American towards research. Some drugs that are effective in White American populations are ineffective in African American populations. For example, beta-blockers appear to be relatively ineffective in treating hypertension in African Americans.
American Indians: No information is available.
Asian Americans: Differences appear to exist in the way Asian American groups metabolize drugs. For example, Benzodiazepines, a category of drugs used in the treatment of anxiety disorders, appear to metabolize slower in Asian Americans than in Caucasians. Among more recent Asian immigrants (Vietnamese, Laotian) to the United States, medication compliance appears to be an issue.
Latinos/Latinas: Research suggests that, in general, Latinos may be more receptive to medication than African Americans. However, they may be less likely to understand how to take the medication. Research has shown Latinos may take the medication on an as need basis or when the anxiety becomes overwhelming, but stop when they begin to feel a little better. Latinos appear more likely to hoard their medication for fear of not being able to obtain more of it. This fear may result in the individual purchasing extra quantities of the drug when they or family members travel back to their homeland.
OCD Medications: At this time, no information is available specifically about ethnic minorities and OCD medications.
OVERCOMING BARRIERS --
There are many steps one can take to overcome the barriers that prevent ethnic minority communities from receiving information about Obsessive Compulsive Disorder. Several basic steps are outlined below.
1. First and foremost, believe in your ability to reach and teach people of color with OCD and their extended families.
2. Increase your knowledge and understanding about OCD and other anxiety disorders among people of color.
Read Books or attend workshops that focus on multi-cultural issues in general and multi-cultural issues in anxiety.
Recommended Resources:
a. Dr. Angela Neal-Barnett's Web Site: www.personal.kent.edu/~aneal/amnbhp.html
b. Cultural issues in the treatment of anxiety edited by Steven Friedman: Guilford Press.
c. Counseling the Culturally Different by Derald Wing Sue and David Sue: John Wiley and Sons.
3. Work At Overcoming Cultural Mistrust.
Demonstrate a consistent commitment to raising awareness/treatment issues in your target community of color.
a. Change may not happen overnight. Persistence and patience is essential.
Collaborate with churches, community centers, civic organizations, fraternities and sororities in the target community to develop an OCD awareness program.
a. An awareness program should include either an OCD sufferer of color, an OCD expert of color, or a program moderator of color.
b. A treatment program should include either treatment team members of color, or examples that are relevant to people of color with OCD.
c. When using an interpreter or bilingual presenter makes sure they speak the same or similar dialect as the members of your audience. Misunderstandings can occur when for example, a Spanish speaker from Puerto Rico speaks to an audience of Mexican Spanish speakers.
Especially For Ethnic Minority OCD Sufferers And Their Families --
If you suffer from OCD and are a person of color, you may feel as if you are the only one. After all, how many other members of your particular ethnic group do you know who have OCD? Because we rarely see or hear about people of color with OCD, many people mistakenly believe it is a white disease. This is not true. OCD affects people of all races, classes, and genders. In many ethnic minority communities, mental health issues are not discussed. This can make it difficult for you to seek and receive help. Many of your family members and friends may be at a lost as to how to help you. Some may suggest that you are crazy.
YOU ARE NOT CRAZY.
OCD is a disorder that can be treated and managed. The important thing is to find the appropriate help. Reading the information on this Web Site is a good start. The OC Foundation has a list of people and groups in your area that can help. The OC Foundation can also suggest groups and books for your family to help them understand what is happening and how to help Call, write, or e-mail them. If you are uncomfortable about seeking help from the OC Foundation, there are people and places within your community that can help. Traditional healers and counseling ministries within churches are a good place to start. Wherever you go, print out this page and take it with you.
REMEMBER, YOU ARE NOT ALONE!