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Contributors NuhaAbudabbeh,PhD,NAIMFoundation,Washington,DC
AnnaM.Agathangelou,PhD,DepartmentofPoliticalScience,YorkUniversity,Toronto, Ontario,Canada
RheaAlmeida,PhD,LCSW,InstituteforFamilyServices,Somerset,NewJersey;Multicultural FamilyInstitute,HighlandPark,NewJersey
ZaritaAraújo-Lane,MSW,LCSW,CrossCulturalCommunicationSystems,Inc.,Winchester, Massachusetts
GuillermoBernal,PhD,UniversityCenterforPsychologicalServicesandResearchand DepartmentofPsychology,UniversityofPuertoRico,RioPiedras,PuertoRico
LascellesBlack,MSW,privatepractice,NewRochelle,NewYork,andNewYork,NewYork
JamesK.Boehnlein,MD,DepartmentofPsychiatry,OregonHealthandScienceUniversity, Portland,Oregon
NancyBoyd-Franklin,PhD,GraduateSchoolofPsychology,Rutgers,TheStateUniversityof NewJersey,Piscataway,NewJersey
JanetR.Brice-Baker,PhD,DepartmentofPsychology,YeshivaUniversity,Bronx,NewYork
MaryAnneBrokenNose,BA,COPSAInstituteforAlzheimer’sDiseaseandRelatedDisorders, UniversityofMedicineandDentistryofNewJersey–UniversityBehavioralHealthCare, Piscataway,NewJersey
SteveDagirmanjian,PhD,CatskillFamilyInstitute,Kingston,NewYork
SeanD.Davis,PhD,MarriageandFamilyTherapyProgram,DepartmentofFamilyStudies, UniversityofKentucky,Lexington,Kentucky
ConradDeMaster,LCSW,privatepractice,Waldwick,NewJersey
AnnDelVecchio,PhD,AlphaAssessmentAssociates,Albuquerque,NewMexico
JennyDuncan-Rojano,MS,LCSW,School-BasedCenters,HartfordPublicSchools,Hartford, Connecticut
BethM.Erickson,PhD,EricksonConsulting,Edina,Minnesota,andRamsey,Minnesota
x Contributors
CeliaJaesFalicov,PhD,DepartmentofPsychiatry,UniversityofCalifornia,SanDiego,San Diego,California
JohnFolwarski,LCSW,RaritanBayMentalHealthCenter,PerthAmboy,NewJersey
NydiaGarcia-Preto,LCSW,MulticulturalFamilyInstitute,HighlandPark,NewJersey
RitaMaeGazarik,LCSW,privatepractice,NewYork,NewYork;ColumbiaUniversitySchool ofSocialWork,NewYork,NewYork;HunterCollegeSchoolofSocialWork,CityUniversity ofNewYork,NewYork,NewYork
JoeGiordano,MSW,privatepractice,Bronxville,NewYork
MaryAnnDrosGiordano,MSW,privatepractice,Bronxville,NewYork
KarenL.Haboush,PsyD,GraduateSchoolofAppliedandProfessionalPsychology,Rutgers, TheStateUniversityofNewJersey,Piscataway,NewJersey;privatepractice,HighlandPark, NewJersey
MiguelHernandez,LCSW,RobertoClementeCenter,SylviaDelVillardProgram,Gouverneur HealthcareService,NewYork,NewYork;AckermanInstitutefortheFamily,NewYork,New York
PauletteMooreHines,PhD,CenterforHealthySchools,Families,andCommunitiesandOffice ofPreventionServicesandResearch,UniversityofMedicineandDentistryofNewJersey–UniversityBehavioralHealthCare,Piscataway,NewJersey;MulticulturalFamilyInstitute, HighlandPark,NewJersey
VanessaJackson,LCSW,privatepractice,Atlanta,Georgia
BehnazJalali,MD,DepartmentofPsychiary,UniversityofCalifornia,LosAngeles,Los Angeles,California
HugoKamya,PhD,GraduateSchoolofSocialWork,BostonCollege,Boston,Massachusetts
ValliKaleiKanuha,PhD,SchoolofSocialWork,UniversityofHawaii,Honolulu,Hawaii
KyleD.Killian,PhD,DepartmentofFamilyTherapyandPsychology,UniversityofHouston–ClearLake,Houston,Texas
Bok-LimC.Kim,MSW,privatepractice,SanDiego,California
JoanneGuarinoKlages,LCSW,MulticulturalFamilyInstitute,HighlandPark,NewJersey; privatepractice,HighlandPark,NewJersey,andStatenIsland,NewYork
ElianaCatãodeKorin,DiplPsic,DepartmentofFamilyandSocialMedicine,Montefiore MedicalCenter,AlbertEinsteinCollegeofMedicine,Bronx,NewYork
Jo-AnnKrestan,MA,privatepractice,CenterforCreativeChange,Ellsworth,Maine
DanielKusnir,MD,NewCollegeofCaliforniaSchoolofGraduatePsychology,SanFrancisco, California;LaFamiliaCounselingService,Hayward,California;SurvivorsInternational,San Francisco,California
PamelaLangelier,PhD,DepartmentofFamilyMedicine,CollegeofMedicine,Universityof NewEngland,Biddeford,Maine;privatepractice,Saco,Maine
RégisLangelier,PhD,privatepractice,Saco,Maine
TraceyA.Laszloffy,PhD,MarriageandFamilyTherapyProgram,SetonHillUniversity, Greenberg,Pennsylvania
EvelynLee,EdD (deceased),RichmondAreaMultiServices,Inc.,SanFrancisco,California
PaulK.Leung,MD,DepartmentofPsychiatry,OregonHealthandScienceUniversity,Portland, Oregon
CatherineD.M.Limansubroto,MS,privatepractice,Tangerang,Indonesia
VanessaMcAdams-Mahmoud,MSW,privatepracticeandDirectorofCounseling,Spelman College,Atlanta,Georgia
DavidW.McGill,PsyD,CouplesandFamilyCenter,CambridgeHospital,Cambridge, Massachusetts;DepartmentofPsychiatry,HarvardMedicalSchool,Cambridge,Massachusetts
MonicaMcGoldrick,LCSW,PhD(h.c.),MulticulturalFamilyInstitute,HighlandPark,New Jersey;DepartmentofPsychiatry,UniversityofMedicineandDentistryofNewJersey–Robert WoodJohnsonMedicalSchool,Piscataway,NewJersey
LornaMcKenzie-Pollock,MSW,MA,SchoolofSocialWork,BostonUniversity,Boston, Massachusetts;privatepractice,Brookline,Massachusetts
JosianeMenos,PsyD,StatenIslandOfficeofChildrenandFamilyServices,StatenIsland,New York;NewYorkCityDepartmentofEducation,NewYork,NewYork;MulticulturalFamily Institute,HighlandPark,NewJersey
MarshaPravderMirkin,PhD,Women’sStudiesResearchCenter,BrandeisUniversity,Waltham, Massachusetts;LasellCollege,Newton,Massachusetts
MatthewR.Mock,PhD,Family,Youth,Children’sandMulticulturalServices,Berkeley, California;GraduateSchoolofProfessionalPsychology,JohnF.KennedyUniversity,Orinda, California;privatepractice,Berkeley,California
ShivaniNath,MS,DepartmentofProfessionalPsychologyandFamilyTherapy,Collegeof EducationandHumanServices,SetonHallUniversity,SouthOrange,NewJersey;Asian AmericanFederationofNewYork,NewYork
LeonidNewhouse,LCSW,privatepractice,Boston,Massachusetts
BarbaraF.Okun,PhD,DepartmentofCounselingandAppliedPsychology,Northeastern University,Boston,Massachusetts
JohnK.Pearce,MD,PsychiatricGroupoftheNorthShore,Lynn,Massachusetts;Island Counseling,Martha’sVineyard,Massachusetts
SueliS.deCarvalhoPetry,PhD,DepartmentofPsychologyandFamilyTherapy,Collegeof EducationandHumanServices,SetonHallUniversity,SouthOrange,NewJersey;Multicultural FamilyInstitute,HighlandPark,NewJersey
FredP.Piercy,PhD,DepartmentofHumanDevelopment,VirginiaPolytechnicInstituteand StateUniversity,Blacksburg,Virginia
VimalaPillari,DSW,LCSW,GraduateSchoolofSocialWork,DominicanUniversity,River Forest,Illinois
RamónRojano,MD, CityofHartford,Hartford,Connecticut;UniversityofConnecticutSchool ofCommunityMedicine,Storrs,Connecticut;MarriageandFamilyTherapyProgram,Central ConnecticutStateUniversity,NewBritain,Connecticut;InstitutefortheHispanicFamily, Hartford,Connecticut
xii
Contributors
MariaP.P.Root,PhD,privatepractice,Seattle,Washington
ElliottJ.Rosen,EdD,privatepractice,Scarsdale,NewYork
EunjungRyu,LCSW,DepartmentofCouplesandFamilyTherapy,CollegeofNursingand HealthProfessions,DrexelUniversity,Philadelphia,Pennsylvania;privatepractice,Highland Park,NewJersey
EsterShapiro,PhD,DepartmentofPsychology,UniversityofMassachusetts,Boston, Massachusetts
TazukoShibusawa,PhD,ColumbiaUniversitySchoolofSocialWork,NewYork,NewYork
JosephSmolinski,Jr.,MSW,PsychotherapyandSpiritualityInstitute,NewYork,NewYork
AdrianaSoekandar,MS,MandiriSchoolandprivatepractice,Jakarta,Indonesia
CharlesEttaT.Sutton,MSW,LCSW,MulticulturalFamilyInstitute,HighlandPark,NewJersey; privatepractice,Plainfield,NewJersey;TurtleIslandProject,Phoenix,Arizona
NadineTafoya,MSW,privatepractice,Espagnola,NewMexico
MorrisTaggart,PhD,retired,Houston,Texas
CarmenInoaVazquez,PhD,privatepracticeandDepartmentofPsychiatry,NewYork UniversitySchoolofMedicine,NewYork,NewYork
SusanF.Weltman,LCSW,privatepractice,Metuchen,NewJersey
NorbertA.Wetzel,ThD,CenterforFamily,Community,andSocialJustice,Princeton,New Jersey
HindaWinawer,MSW,LCSW,LMFT,CenterforFamily,Community,andSocialJustice, Princeton,NewJersey;AckermanInstitutefortheFamily,NewYork,NewYork
AnatZiv,MSc,privatepractice,Ra’anana,Israel
Acknowledgments Manypeoplehavesupportedusinoureffortstoproducethisthirdeditionof EthnicityandFamilyTherapy,particularlySeniorEditorJimNageotteandthestaffatThe GuilfordPress.FranSnyderandIreneUmbel,attheMulticulturalFamilyInstitute,providedassistancebothdirectandindirecttomakethisbookcometofruition.
I(M.M.)thankmyhusband,SophoclesOrfanidis,fortheongoingemotionaland physicalsupporthehasgivenmeovermorethan35years,whichhavemademyendeavors,includingthismajorlifeeffort,possible.AndIthankmyGreek-Irishson,John,for growingintosuchawonderfulman.
I(J.G.)wanttothankmywife,MaryAnn,whogenerouslyhasgivenherlove,support,andclinicalinsightsinallmyprofessionalandcreativeendeavors.Ialsowantto thankIrvingLevine,mydearestfriendandcolleagueforthepast35years,forhiscontinuedcounsel,andDavidSzonyi,whosehelpineditingthisbookwasinvaluable.And finally,IamgratefultotheMauriceFalkMedicalFundandtheAmericanJewishCommittee,whosefinancialandorganizationalsupportcontributedtothesuccessofthis book.
I(N.G.-P.)wanttothankmychildren,SaraandDavid,forchallengingmyideas aboutculture,gender,andclass,andmyparents,whotaughtmetoloveandtobeproud ofmyPuertoRicanroots.IwouldalsoliketothankalltheLatinAmericanfamilieswho havegivenmetheopportunitytolearnaboutthestrugglesandstrengthsofLatinoimmigrantsinthiscountry.
WearealsodeeplyindebtedtoMaryAnneBrokenNose,whohasformanyyears beenourmajorresearchconsultantonmaterialsforourwork.Wedon’tknowhowthis editionwouldhavecometofruitionwithouther.Herpositiveenergy,intelligence,and skillinfindingrelevantmaterialswereindispensable.
DavidMcGill,awonderfulfriend,camethroughashealwayshas,offeringcounsel andspecificsuggestionsregardingthebook.Hisbehind-the-scenessupportwasamajor factorinmakingthisthirdeditionpossible.
Andwethanktheauthorsforalltheireffortsinprovidingsomuchcreativityand wisdomintheirculturaldescriptions.Someofthemhadtoputupwithourcallsandcritiquesoverandoveragainandwethankthemforpersevering.Weoweaspecialdebtto
Acknowledgments thoseauthorswhohelpedoutinapinchbydeliveringachapterinthenickoftimewhen wewereatourwits’endaboutfillinginthegapformissingmaterial.Wealsothankthe networkoftherapistsandtrainerswhohaveparticipatedintheMulticulturalFamily Institute’sAnnualCultureConferencesovertheyears,fortheunderlyingsupportthey havegiventhatisthesubtextofallourwork.Theyhavegivenusrootsandwingsandwe wouldnotbepublishingthiswithouttheirloyaltyandongoingchallengestoourthinking.
Weareveryproudoftheworkofsomanycolleaguesandhopethereaderswill appreciatetheeffortsmadebysomanypeopletospeakclearlyandpracticallyonasubjectthatissoverycomplex.
Contents 1.Overview:EthnicityandFamilyTherapy1 MonicaMcGoldrick,JoeGiordano,andNydiaGarcia-Preto
I. AMERICANINDIANANDPACIFICISLANDERFAMILIES 2.AmericanIndianFamilies:AnOverview43 CharlesEttaT.SuttonandMaryAnneBrokenNose
3.BacktotheFuture:AnExaminationoftheNativeAmerican HolocaustExperience 55 NadineTafoyaandAnnDelVecchio
4. Na ‘Ohana:NativeHawaiianFamilies64 ValliKaleiKanuha
II. FAMILIESOFAFRICANORIGIN
5.FamiliesofAfricanOrigin:AnOverview77 LascellesBlackandVanessaJackson
6.AfricanAmericanFamilies87 PauletteMooreHinesandNancyBoyd-Franklin
7.AfricanImmigrantFamilies101 HugoKamya
8.BritishWestIndianFamilies117 JanetR.Brice-Baker
9.HaitianFamilies127 JosianeMenos
10.AfricanAmericanMuslimFamilies138 VanessaMcAdams-Mahmoud
III. LATINOFAMILIES 11.LatinoFamilies:AnOverview153 NydiaGarcia-Preto
12.BrazilianFamilies166 ElianaCatãodeKorinandSueliS.deCarvalhoPetry
13.CentralAmericanFamilies178 MiguelHernandez
14.ColombianFamilies192 RamónRojanoandJennyDuncan-Rojano
15.CubanFamilies202 GuillermoBernalandEsterShapiro
16.DominicanFamilies216 CarmenInoaVazquez
17.MexicanFamilies229 CeliaJaesFalicov
18.PuertoRicanFamilies242 NydiaGarcia-Preto
19.SalvadoranFamilies256 DanielKusnir
IV. ASIANFAMILIES 20.AsianFamilies:AnOverview269 EvelynLeeandMatthewR.Mock
21.CambodianFamilies290 LornaMcKenzie-Pollock
22.ChineseFamilies302 EvelynLeeandMatthewR.Mock
23.FilipinoFamilies319 MariaP.P.Root
24.IndonesianFamilies332 FredP.Piercy,AdrianaSoekandar,CatherineD.M.Limansubroto, andSeanD.Davis
25.JapaneseFamilies339 TazukoShibusawa
26.KoreanFamilies349 Bok-LimC.KimandEunjungRyu
27.VietnameseFamilies363 PaulK.LeungandJamesK.Boehnlein
V.
ASIANINDIANANDPAKISTANIFAMILIES
28.AsianIndianFamilies:AnOverview377 RheaAlmeida
29.IndianHinduFamilies395 VimalaPillari
30.PakistaniFamilies407 ShivaniNath
VI. MIDDLEEASTERNFAMILIES
31.ArabFamilies:AnOverview423 NuhaAbudabbeh
32.ArmenianFamilies437 SteveDagirmanjian
33.IranianFamilies451 BehnazJalali
34.LebaneseandSyrianFamilies468 KarenL.Haboush
35.PalestinianFamilies487 NuhaAbudabbeh
VII. FAMILIESOFEUROPEANORIGIN 36.FamiliesofEuropeanOrigin:AnOverview501 JoeGiordanoandMonicaMcGoldrick
37.AmericanFamilieswithEnglishAncestorsfromtheColonialEra: AngloAmericans 520 DavidW.McGillandJohnK.Pearce
38.DutchFamilies534 ConradDeMasterandMaryAnnDrosGiordano
39.FrenchCanadianFamilies545 RégisLangelierandPamelaLangelier
40.GermanFamilies555 HindaWinawerandNorbertA.Wetzel
41.GreekFamilies573 KyleD.KillianandAnnaM.Agathangelou
42.HungarianFamilies586 TraceyA.Laszloffy
43.IrishFamilies595 MonicaMcGoldrick
44.ItalianFamilies616 JoeGiordano,MonicaMcGoldrick,andJoanneGuarinoKlages
45.PortugueseFamilies629 ZaritaAraújo-Lane
46.ScandinavianFamilies:PlainandSimple641 BethM.Erickson
47.Scots-IrishFamilies654 MorrisTaggart
VIII. JEWISHFAMILIES 48.JewishFamilies:AnOverview667 ElliottJ.RosenandSusanF.Weltman
49.IsraeliFamilies680 AnatZiv
50.OrthodoxJewishFamilies689 MarshaPravderMirkinandBarbaraF.Okun
51.RussianJewishFamilies701 LeonidNewhouse
IX. SLAVICFAMILIES 52.SlavicFamilies:AnOverview711 LeonidNewhouse
53.CzechandSlovakFamilies724 Jo-AnnKrestanandRitaMaeGazarik
54.PolishFamilies741 JohnFolwarskiandJosephSmolinskiJr.
CHAPTER1 Overview EthnicityandFamilyTherapy MonicaMcGoldrick JoeGiordano
NydiaGarcia-Preto Thefutureofourearthmaydependontheabilityofall[ofus]toidentifyanddevelop new. . .patternsofrelatingacrossdifference.
—LORDE (1992,p.502)
Whatwoulditbeliketohavenotonlycolorvisionbutculturevision,theabilitytosee themultipleworldsofothers?
—BATESON (1995,p.53)
Culturalidentityhasaprofoundimpactonoursenseofwell-beingwithinoursociety andonourmentalandphysicalhealth.Ourculturalbackgroundreferstoourethnicity, butitisalsoprofoundlyinfluencedbysocialclass,religion,migration,geography,gender oppression,racism,andsexualorientation,aswellasbyfamilydynamics.Allthesefactorsinfluencepeople’ssociallocationinoursociety—theiraccesstoresources,their inclusionindominantdefinitionsof“belonging,”andtheextenttowhichtheywillbe privilegedoroppressedwithinthelargersociety.Thesefactorsalsoinfluencehowfamily membersrelatetotheirculturalheritage,toothersoftheirculturalgroup,andtopreservingculturaltraditions.Furthermore,weliveinasocietyinwhichourhighratesofculturalintermarriagemeanthatcitizensoftheUnitedStatesincreasinglyreflectmultiple culturalbackgrounds.Nevertheless,becauseofoursociety’spolitical,economic,and racialdynamics,ourcountryisstillhighlysegregated;wetendtoliveincommunitiessegregatedcommunitiesbyrace,culture,andclass,whichalsohaveaprofoundinfluenceon oursenseofethnicidentity.
Itisnowmorethantwodecadessincethefirsteditionof EthnicityandFamilyTherapy waspublished;inthesedecadesourawarenessofculturaldiversityinoursocietyand
1.Overview:EthnicityandFamilyTherapy
worldhaschangedprofoundly.WehavewitnessedamazingattemptsattransformingethnicgrouprelationshipsinSouthAfrica,NorthernIreland,theMiddleEast,andtheformerSovietUnion,aswellastragicethnicdevastationintheSudan,Rwanda,Kosovo, Russia,theMiddleEast,andLatinAmerica.Meanwhile,theUnitedStatesisbeingtransformedbyrapidlychangingdemographicsandhasplayedamostethnocentricrolein goingtowarinIraq.Thisisaroleithasunfortunatelyplayedinmanyotherregionsat othertimes,mostespeciallyinCentralandSouthAmerica,insomeoftheCaribbean islandnations,thePhillipines,andVietnam(seeChapters11–19,23,and27).
THEMEANINGOFETHNICITY Whyhaveweasapeoplebeenabletocontinuetoexist?Becauseweknowwherewe comefrom.Byhavingroots,youcanseethedirectioninwhichyouwanttogo.
—JOENIA BATISTEDE CARVAHLO,firstIndianwomanlawyerinBrazil, whoisfightingfortherightsofherpeople.
(NewYorkTimes,November13,2004,p.7)
Havingasenseofbelonging,ofhistoricalcontinuity,andofidentitywithone’sownpeopleisabasicpsychologicalneed.Ethnicity,theconceptofagroup’s“peoplehood,”refers toagroup’scommonalityofancestryandhistory,throughwhichpeoplehaveevolved sharedvaluesandcustomsoverthecenturies.Basedonacombinationofrace,religion, andculturalhistory,ethnicityisretained,whetherornotmembersrealizetheircommonalitieswithoneanother.Itsvaluesaretransmittedovergenerationsbythefamilyand reinforcedbythesurroundingcommunity.Itisapowerfulinfluenceindeterminingidentity.Itpatternsourthinking,feeling,andbehaviorinbothobviousandsubtleways, althoughgenerallywearenotawareofit.Itplaysamajorroleindetermininghowwe eat,work,celebrate,makelove,anddie.
Thesubjectofethnicitytendstoevokedeepfeelings,anddiscussionfrequently becomespolarizedorjudgmental.AsGreeley(1969)hasdescribedit,usingpresumed commonorigintodefine“we”and“they”seemstotouchonsomethingbasicandprimordialinthehumanpsyche.IrvingLevine(personalcommunication,February15, 1981)observed:“Ethnicitycanbeequatedalongwithsexanddeathasasubjectthat touchesoffdeepunconsciousfeelingsinmostpeople.”Whentherehasbeendiscussionof ethnicity,ithastendedtofocusonnondominantgroups’“otherness,”emphasizingtheir deficits,ratherthantheiradaptivestrengthsortheirplaceinthelargersociety,andhow so-called“minorities”differfromthe“dominant”societaldefinitionsof“normality.”
Ourapproachistoemphasizeinsteadthatethnicitypertainstoeveryone,andinfluenceseveryone’svalues,notonlythosewhoareatthemarginsofthissociety.Fromthis perspectiveculturalunderstandingrequiresexaminingeveryone’sethnicassumptions.No onestandsoutsidethecategoryofethnicity,becauseeveryonehasaculturalbackground thatinfluenceshisorhervaluesandbehavior.
ThosebornWhite,whoconformtothedominantsocietalnorms,probablygrewup believingthat“ethnicity”referredtootherswhoweredifferentfromthem.Whiteswere thedefinitionof“regular.”AsTataki(1993,2002)haspointedout,wehavealways tendedtoviewAmericansasEuropeaninancestry.Wewillnotbeculturallycompetent untilweletgoofthatmyth.Manyinourcountryareleftwithasenseofculturalhomelessnessbecausetheirheritageisnotacknowledgedwithinoursociety. 2
Ourverydefinitionsofhumandevelopmentareethnoculturallybased.Easternculturestendtodefinethepersonasasocialbeingandcategorizedevelopmentbygrowthin thehumancapacityforempathyandconnection.ManyWesterncultures,incontrast, beginbypositingtheindividualasapsychologicalbeinganddefinedevelopmentas growthinthecapacityforautonomousfunctioning.Eventhedefinitions“Eastern”and “Western,”aswellasourworldmaps(Kaiser,2001),reflectanethnocentricviewofthe universewithBritainandtheUnitedStatesasthecenter.
AfricanAmericans(seeChapter6;Boyd-Franklin,2003;Carter,1995;Franklin, 2004)haveaverydifferentfoundationfortheirsenseofidentity,expressedasacommunalsenseof“Weare,thereforeIam,”contrastingstarklywiththeindividualisticEuropeanideal:“Ithink,thereforeIam.”IntheUnitedStates,thedominantculturalassumptionshavegenerallybeenderivedfromafewEuropeancultures,primarilyGerman (Chapter40),Dutch(Chapter38),and,aboveall,British(Chapter37),whicharetaken tobetheuniversalstandard.ThevaluesofthesefewEuropeangroupshavetendedtobe viewedas“normal,”andvaluesderivedfromothercultureshavetendedtobeviewedas “ethnic.”Theseothervalueshavetendedtobemarginalized,eventhoughtheyreflectthe traditionalvaluesofthemajorityofthepopulation.
Althoughhumanbehaviorresultsfromintrapsychic,interpersonal,familial,socioeconomic,andculturalforces,thementalhealthfieldhaspaidgreatestattentiontothe firstofthese—thepersonalityfactorsthatshapelifeexperiencesandbehavior.DSM-IV, althoughforthefirsttimeconsideringcultureinassessingandtreatingpatients,allows onetoconducttheentirecourseofdiagnosisandtherapywithnothoughtofthepatient’s cultureatall.Muchoftheauthors’workonculturewasomittedfromthepublished manual,andthe“culture-bound”syndromestheydidmentiontendedto“exoticizethe roleofculture”(Lopez&Guarnaccia,2000).Indeed,theauthorsdecidedtoexcludedisordersseenasprimarilyNorthAmericandisorders(anorexianervosaandchronicfatigue syndrome)fromtheglossaryofculture-boundsyndromesbecausetheywantedtorestrict thetermtoproblemsof“ethnicminorities”(Lopez&Guarnaccia,2000)!
Asthingsstandnow,mostmentalhealthrecord-keepingsystemsdonotevenrecord patients’ethnicbackgrounds,settlingforminimalreferencetoraceastheonlybackgroundmarker.Nootherreferenceisgenerallymadetoimmigrationorheritage.Inthe broadermentalhealthfield,therewasagreatincreaseinattentionpaidtoethnicityinthe 1980s.However,sincethentherehasbeenadistinctretreatfromattentiontocultureas managedcare,pharmaceutical,andinsurancecompaniestookcontrolofmostmental healthservicesandintentionallyminimizedattentiontofamily,context,andevenservice forthosewhocannotaffordtopay.Sincetheearly1990s,thementalhealthprofessions ingeneralpayonlylipservicetotheimportanceofculturalcompetence.Thestudyofculturalinfluencesonhumanemotionalfunctioninghasbeenleftprimarilytothecultural anthropologists.Yettheyhavepreferredtoexploreremoteculturalenclaves,ratherthan examiningculturewithinourowndiversesociety.
Evenmentalhealthprofessionalswhohaveconsideredculturehaveoftenbeenmore interestedinexamininginternational,cross-culturalcomparisonsthaninstudyingthe ethnicgroupswithinourownsociety.Ourtherapeuticmodelsaregenerallypresentedas havinguniversalapplicability.Onlyrecentlyhavewebeguntoconsidertheunderlying culturalassumptionsofourtherapeuticmodelsandofourselvesastherapists.Andeven now,referenceto“culturalcompetence”variesfromcompleteacceptancetooutright derision(Betancourt,2004). 1.Overview:EthnicityandFamilyTherapy
1.Overview:EthnicityandFamilyTherapy
Wemustincorporateculturalacknowledgmentintoourtheoriesandintoourtherapies,sothatclientsnotofthedominantculturewillnothavetofeellost,displaced,or mystified.Workingtowardmulticulturalframeworksinourtheories,research,andclinicalpracticerequiresthatwechallengeoursociety’sdominantuniversalistassumptions,as wemustchallengeourothersocietalinstitutionsaswellinorderfordemocracytosurvive (Dilworth-Anderson,Burton,&Johnson,1993;Hitchcock,2003;Pinderhughes,1989).
Itisunfortunatethatsociety’sruleshavemadeitdifficultforustofocusourvision onourselvesinthisway,butitisessentialifwearetobecomeculturallyeffectiveclinicians.AsBernardLewis(2002)hasputit:
Whenthingsgowronginoursociety,ourresponseisusuallytoplacetheblameonexternalor domesticscapegoats—foreignersabroadorminoritiesathome.Wemightaskadifferentquestion:Whatdidwedowrong?(pp.22–23)
Thisquestion,whichleadsustolookineverysituationtoseewhatwecontributeto misunderstandings,isessentialtoexpandingourculturalawareness.Wemustunderstand wherewehavebeenandtheculturalassumptionsandblindersourownhistoryhasgiven usbeforewecanbegintounderstandthosewhoareculturallydifferentfromus.
Thisbookpresentsakindof“roadmap”forunderstandingfamiliesinrelationto theirethnicheritage.Theparadigmsherearenotpresentedas“truth,”butratherasmaps tosomeaspectsoftheterrain,intendedasaguidefortheexplorerseekingapath.They drawonhistoricaltraits,residuesofwhichlingerinthepsycheoffamiliesmanygenerationsafterimmigration,longafteritsmembershavebecomeoutwardly“Americanized” andceasetoidentifywiththeirethnicbackgrounds.Althoughfamiliesarechangingvery rapidlyintoday’sworld,ourfocushereisonthecontinuities,thewaysinwhichfamilies retaintheculturalcharacteristicsoftheirheritage,oftenwithoutevennoticingthesepatterns.Ofcourse,theclinicalsuggestionsofferedbytheauthorsofthisbookwillnotbe relevantineverycase,buttheywill,itishoped,expandthereaders’waysofthinking abouttheirownclinicalassumptionsandthethinkingofthefamilieswithwhomthey work.Spacelimitationshavemadeitnecessaryforustoemphasizecharacteristicsthat maybeproblematic.Thus,wedonotalwayspresentfamiliesintheirbestlight.Weare wellawarethatthiscanleadtomisunderstandingsandfeednegativestereotypes.We trustthereadertotaketheinformationinthespiritinwhichitismeant—nottolimitour thinking,buttoexpandit.
Therehasbeenagrowingrealizationsincethisbook’sfirsteditionthatapositive senseofethnicandracialidentityisessentialfordevelopingahealthypersonaland groupidentity,andforeffectiveclinicalpractice.Sofar,moreinthefieldofhealthcare thaninmentalhealth,theconceptof“culturalcompetence”hasbeguntobecomean acceptedvalue.Inrecognitionoftheoverwhelmingevidenceofracialandethnicdisparitiesinhealthcare,thereisabeginningacknowledgmentthatwitheveryillnessand onvirtuallyeverymeasureoffunctioning,theculturaldisparitiesinhealthcareare staggeringanditistimetorethinkourculturalattitudesandtoaddresstheserealities. Anewfieldof“culturalcompetence”inhealthcarehasbeenemerging,afieldthat definesthe“culturallycompetenthealthcaresystem”asonethatacknowledgesthe importanceofculturethroughoutthesystemandisvigilantindealingwiththedynamicsthatresultfromculturaldifferences,theexpansionofculturalknowledge,andthe adaptationofservicestomeetculturallyuniqueneeds(Betancourt,Green,Carrillo,& Ananeh-Firempong,2003).
Thisfieldofculturallycompetenthealthcareseekstoidentifysocioculturalbarriers tohealthcareandtoaddressthemateverylevelofthesystem,includingtheculturalcongruityoftheinterventionsprovidedandthedegreetowhichtheleadershipand workforcereflectthediversityofthegeneralpopulation(Betancourtetal.,2003).
Withinthementalhealthfield,recognitionoftheimportanceofculturehasbeenmuch slower.Familytherapy,whichwasrockedtoitsfoundationsbythefeministcritique (Luepnitz,1992;McGoldrick,Anderson,&Walsh,1989;Wheeler,Avis,Miller,&Chaney, 1985),hasbeenmovingtowardanawarenessoftheessentialdimensionofcultureaswellas gender.Unfortunately,mostoftheinstitutionsinthefield,suchasthemajortrainingprograms,thepublications,andtheprofessionalorganizations,stillviewethnicityasan“addon”tofamilytherapy,a“specialtopic,”ratherthanasbasictoalldiscussion.Reactionsto theupsurgein“diversity”presentationsattheannualFamilyTherapyAcademymeetings haveincludedafrequentlyarticulatedrequestbymembersto“getbacktobasics.”Inour viewthereisnosuchthingasmoving“back”tobasics.Rather,wemustre-envisionthe “basics”frommoreinclusiveperspectives,sothattheculturalunderpinningsofalltherapeuticendeavorswillinformourwork,allowingustodealtheoreticallyandclinicallywith all our clients (see the Appendix on cultural clinical assessment).
Formany,theearliereditionsof EthnicityandFamilyTherapy providedan“ah ha!”—arecognitionoftheirownculturalbackgroundorthatofspouses,friends,orclients.Still,whenitwasfirstwritten,wewereallfairlynaiveaboutthemeaningofculture inourcomplexworld.Somefearedthatourbookreinforcedculturalstereotypes,butwe believedthen,andbelievenow,thatexploringculturalpatternsandhypothesesisessentialtoallourclinicalwork.
Wealsorecognizethatethnicityisnottheonlydimensionofculture.Inthisbookwe illustratehowgender,socioeconomicstatus,geography,race,religion,andpoliticshave influencedculturalgroupsinadaptingtoAmericanlife.Knowingthatnosinglebook couldpossiblyprovideclinicianswithalltheyneedtoknowtoworkwiththosewhoare culturallydifferent,wegavetheauthorsofthechaptersthefollowinginstructions:
Wehavebecomeincreasinglyconvincedthatwelearnaboutcultureprimarilynotbylearning the“facts”ofanother’sculture,butratherbychangingourattitude.Ourunderlyingopenness tothosewhoareculturallydifferentisthekeytoexpandingourculturalunderstanding.Thus, culturalparadigmsareusefultotheextentthattheyhelpusrecognizepatternswemayhave onlyvaguelysensedbefore.Theycanchallengeourlong-heldbeliefsabout“thewaythings are.”Thus,weaskyoutowriteyourchapterwiththefollowingaimsinmind:
1.Describetheparticularcharacteristicsandvaluesofthegroupwithsomecontextofhistory,geography,politics,andeconomicsastheyarepertinenttounderstandingthepatternsofthegroup.
2.Emphasizeespeciallyvaluesandpatternsthatarerelevantfortherapy—thoseanuninformedtherapistmightbemostlikelytomisunderstand(e.g,relatedtoproblems,help seeking,andwhatisseenasthe“cure”whenpeopleareintrouble).
3.Describepatternsthatrelatetoclinicalsituations,especiallycouplerelationships;parent–childissues,siblingrelationships,three-generationalrelationships;howfamilies dealwithloss,conflict,affection,homosexuality,andintermarriage.
4.Includerelevantinformationontheimpactofrace,classandclasschange,religion,genderroles,sexualorientation,andmigrationexperiences.
5.Offerguidelinesforinterventiontofacilitateclientwell-being,demonstratingrespect forboththehistoricalcircumstancesandthecurrentadaptiveneedsoffamiliesinthe UnitedStatesatthebeginningofthe2lstcentury. 1.Overview:EthnicityandFamilyTherapy
Cliniciansshouldneverfeelthat,armedwithasmallchapteraboutanothercultural group,theyareadequatelyinformedtodoeffectivetherapy.Thechaptersthatfolloware notintendedasrecipesforrelatingtootherethnicgroups,whichisfarmoreinfluenced byrespect,curiosity,andespeciallyhumility,thanby“information.”Ithasbeensaidthat someindividualsareblessedwithacertainmagicthatenablesthemtobreakdownthe naturalreserveweallfeeltowardthoseofanotherlanguage,anotherculture,another economicstratum.Thisistheblessingwewishtoimparttoourreaders.
THECOMPLEXITYOFETHNICITY Ifwelookcarefullyenough,eachofusisa“hodgepodge.”Developingculturalcompetencerequiresustoquestionthedominantvaluesandexplorethecomplexitiesofcultural identity.Allofusaremigrants,movingbetweenourancestors’traditions,theworldswe inhabit,andtheworldwewillleavetothosewhocomeafterus.Theconsciousnessof ethnicidentityvariesgreatlywithingroupsandfromonegrouptoanother.Manypeople intheUnitedStatesgrowupnotevenknowingtheirethnicityorbeingdescendedfrom manydifferentethnicbackgrounds.Ourclinicalworkofhealingmayentailhelpingclientstolocatethemselvesculturallysothattheycanovercomethesenseofmystification, invalidation,oralienationthatcomesfromnotbeingabletofeelculturallyathomein oursociety.Buteveryonehasaculture.Asfamilytherapists,weworktohelpclientsclarifythemultiplefacetsoftheiridentitytoincreasetheirflexibilitytoadapttoAmerica’s multiculturalsociety.Wehelpthemappreciateandvaluethecomplexwebofconnections withinwhichtheiridentitiesareformedandwhichcushionthemastheymovethrough life.Ourclients’personalcontextsarelargelyshapedbytheethnicculturesfromwhich theyhavedescended.
Formostofus,findingoutwhowearemeansputtingtogetherauniqueinternal combinationofculturalidentities.Ethnicityisacontinuousevolution.Weareallalways inaprocessofchangingethnicidentity,incorporatingancestralinfluenceswhileforging newandemerginggroupidentities,inacomplexinterplayofmembers’relationshipswith eachotherandwithoutsiders.Everyfamily’sbackgroundismulticultural,andallmarriagesare,toadegreeatleast,culturalintermarriages.Notwofamiliesshareexactlythe sameculturalroots.Eachofusbelongstomanygroups.Weneedtofindabalancethat allowsustovalidatethedifferencesbetweenus,whileappreciatingthecommonforces thatbindustogether,becausethesenseofbelongingisvitaltoouridentity.Atthesame time,theprofoundculturaldifferencesbetweenusmustalsobeacknowledged.Itiswhen theexclusionofothersbecomesprimarytogroupidentitythatgroupidentitybecomes negativeanddysfunctional,basedonexclusionofothersthroughmoralsuperiority,such asWhitesupremacygroups,oronelitesocialstatus,suchassecretsocieties.Themultiple partsofourculturalheritageoftendonotfiteasilyintothedescriptionofanyonegroup. Inaddition,todefineoneselfasbelongingtoasingleethnicgroup,suchas“Irish,” “Anglo,”“AfricanAmerican,”istogreatlyoversimplifymatters,inasmuchastheprocess ofculturalevolutionneverstandsstill.Wearealwaysevolvingethnically.Weofferourselvesasillustrations:
Monica:MyIrishancestorshadrootsinCeltictribes,whoprobablycamefromwhat isnowSwitzerland,andVikingcommunitiesinwhatisnowNorway.MyhusbandemigratedfromGreeceatage19,hisfamilyhavinglivedinTurkeyforgenerationsuntilthe
1.Overview:EthnicityandFamilyTherapy
1920s.OursonspeakssomeGreek,butnoGaelic,andhashadtostruggletoput togetherthedifferencesbetweenGreekpatriarchyandIrishmatriarchalvalues.
Joe:MygrandparentscamefromItaly—grandpafromNaplesandgrandmafrom Genoa.(Somewouldsaythatwasamixedmarriage!)ImarriedaPuertoRican-Italian woman;mysecondwife’smotherwasScotsIrish,andherfatherwasborninHollandof aJewishmotherandaProtestantfather.Ialsohavethreegrandchildrenwhosemotheris AfricanAmericanwithrootsintheBaptistSouth.
Nydia:MyancestorswereSpanishcolonizers,Africanslaves,Corsicans,andTaino IndianswhometinBorinquen,theislandknowntodayasPuertoRico.Icamewithmy interracialparentsandbrothertoColumbus,Georgia,in1956,formyfatherwasinthe U.S.Army.Imarriedasecond-generationItalian,andmytwochildrenidentifythemselvesmainlyasPuertoRican.Mygrandson’smotherisAfricanAmerican.
Eachgenerationalcohortalsohasadifferent“culture,”shapedbythehistorical forcesthatdefinedit(theDepression,WorldWarII,Vietnam,etc.),asdopeopleofdifferentgeographicregions,urbanandruralareas,socioeconomiccontexts,andreligious affiliations.Upper-middle-classJewishfamiliesinNortheastcities,middle-classGerman andScandinavianfamiliesonMidwesternfarms,AfricanAmericansandAnglofamilies insmallSoutherntowns,poorMexicanmigrantfarmworkersinruralTexas,andAsian IndianandIranianprofessionalsinCaliforniasuburbsallhavehadverydifferentexperiences.Inaddition,weareallbeinginfluencedbythe“culture”oftheInternetandtelevision,whichisreplacingfamilyandcommunityrelationshipstoaneverincreasingextent.
Sowhenweaskpeopletoidentifythemselvesethnically,wearereallyaskingthemto oversimplify,tohighlightapartoftheiridentityinordertomakecertainthemesofculturalcontinuitymoreapparent.Webelievethatethnicallyrespectfulclinicalworkhelps peopletoevolveasenseofwhomtheybelongto.Thus,therapyinvolveshelpingpeople clarifytheirself-identitiesinrelationtofamily,community,andtheirancestors,whilealso adaptingtochangingcircumstancesastheymoveforwardintime.
Weneedtogobeyondmanyofourculturallabelsanddevelopamoreflexiblelanguagethatallowspeopletodefinethemselvesinwaysthatmoreaccuratelyreflecttheir heritageandculturalpractices.Suchlabelsas“minorities,”“Blacks,”and“Americans,” andoneofthemorerecentadditionstoourlexicon,“non-HispanicWhites,”reflectthe biasesembeddedinoursociety’sdominantbeliefs.Theterm“minority”marginalizes groupswhoseheritageisnotEuropean.Theterm“Black”obliteratestheancestralroots ofAmericansofAfricanheritagealtogetheranddefinesthemonlybytheircolor.Andthe useoftheterm“American”todescribepeopleoftheUnitedStatesmakesinvisibleCanadians,Mexicans,andallotherpeopleoftheWesternHemisphere.Wemightusetheterm “UnitedStatesan,”butwehaveinsteadclaimedonlyforourselvesthedescriptorforpeopleofalltheAmericas.Theterm“non-HispanicWhite”forpeopleofEuropeanorigin forcesthemtodefinethemselvesalwaysinrelationto“Hispanics.”Hispanicsaredefined asaculturalgroup,althoughtheythoughtofthemselvesasaracialgroupinthe2000 census,butwereforcedtodefinethemselvesbyracesthatincludedFilipinoand GuamanianbutnotHispanicorLatino.
Ethnicityis,indeed,acomplexconcept.Jewishethnicity,forexample,isameaningfultermtomillionsofpeople(Chapter48).Yetitreferstopeoplewhohavenosingle countryoforigin,nosinglelanguageoforigin,nosinglesetofreligiouspractices.Jewsin theUnitedStatesmaycomefromArgentina,Russia,Greece,orJapanandhave Ashkenazicroots.OrtheymaybeSephardicJewsfromNorthAfricaorSpain,whohave
verydifferentculturaltraditionsandmigrationpatternswithintheUnitedStates.There aresimilardifficultieswithdefinitionsofArabs(Chapter31),whomaybeEastern OrthodoxSyrians,RomanCatholicLebanese(Chapter34),orTurkish,Jordanian,Egyptian,orPalestinianMuslims(Chapter35).Thereis,however,somesenseofculturalconnectionbetweenthesegroups.Moreover,thesharedethnichistoryoffamiliesofthese backgroundsisnotirrelevanttotheiradaptationintheUnitedStates.
Wemayfeelnegativetoward,orproudandappreciativeof,ourculturalheritage,or wemaybeunawareofwhichculturalgroupsweevenbelongto.Butourrelationshipto ourculturalheritagewillinfluenceourwell-being,aswilloursenseofourrelationshipto thedominantculture.People’ssenseoftheirethnicityisaffectedbytheirrelationship (unaware,negative,proud,appreciative)tothegroupstheycomefrom,andtheirrelationship(asenseofbelonging,feelinglikeanoutsider,orfeelinginferior)tothedominant culture.Arewemembersofit?Arewe“passing”asmembers?Dowefeellike marginalizedoutsiders?Orareweoutsiderswhohavesoabsorbedthedominantculture’snormsandvaluesthatwedonotevenrecognizethatourinternalizedvaluesreflect itsmembers’prejudicesandattemptstosuppressculturaldifference?Individualsshould nothavetosuppresspartsofthemselvesinorderto“pass”fornormalaccordingto someoneelse’sstandards.Being“athome”meanspeoplehavingasenseofbeingatpeace withwhotheyreallyare,notbeingassignedtorigidlydefinedgroupidentities,which strainspeople’sbasicloyalties.MariaRoot(2003)hasdevelopeda“BillofRights”for raciallymixedpeople,whichincludestheright
• toidentifymyselfdifferentlythanstrangersexpect
• toidentifymyselfdifferentlythanmyparentsidentifyme
• toidentifymyselfdifferentlythanmybrothersandsistersidentifyme
• toidentifymyselfdifferentlyindifferentsituations
• tocreateavocabularytocommunicateaboutbeingmultiracial
• tochangemyidentityovermylifetimeandmorethanonce
• tohaveloyaltiesandidentifywithmorethanonegroupofpeople
Asfamilytherapists,webelieveinhelpingclientsunderstandtheirethnicityasa fluid,ever-changingaspectofwhotheyare.LouiseErdrich(Erdrich&Dorris,1991),has describedthecomplexitythisentailsthroughoneofhercharacters:
Ibelongtothelosttribeofmixedbloods,thathodgepodgeamalgamofhueandcrythatdefies easyplacement.WhentheDNAofmyvariousancestors—IrishandCoeurd’AleneandSpanishandNavajoandGodknowswhatelse—combinedtoformme,theresultwasnotsome genteelindecipherablepureethatcomesfromaCuisinart.Youknowwhattheysayontheside oftheBisquickbox,underinstructionsforpancakes?Mixwithfork.Leavelumps.Thatwas me.Thereareadvantagestonotbeingthisorthat.Youhaveamillionstories,oneforevery occasion,andinawaythey’reallliesandinanotherwaythey’realltrue.WhenIndianssayto me,“Whatareyou?”Iknowexactlywhatthey’reaskingandanswerCoeurD’Alene.Idon’t add,“Betweenaquarterandahalf,”becausethat’sinformationtheydon’trequire,firstoff— thoughitmaycomelaterifIscrewupandthey’relookingforreasonswhy.Ifoneofmy Dartmouthcolleagueswonders,“Wheredidyoustudy?”Ipickthebestplace,thehardestone togetinto,inordertoestablishthatIbelong.Ifastrangeronthestreetquestionswhere[my daughter]getsherlightbrownhairanddarkskin,IsaytheOldeSoddeandletthemfigureit out.TherearetimeswhenIcontrolwhoI’llbe,andtimeswhenIletotherpeopledecide.I’m
notallanything,butI’malittlebitofalot.Myrootsspreadineverydirection,andifIwater onesetofthemmoreoftenthanothers,it’sbecausetheyneeditmore.. . .I’vereadanthropologicalpaperswrittenaboutpeoplelikeme.We’recalledmarginal,asifweexistanywherebut onthecenterofthepage.We’reparkedonthebleacherslookingintothearena,neverthe mainplayers,buttherearebonusestoperipheralvision.Outbeyondthenormalbounds,you atleastknowwhereyou’renot.Youescapetheclaustrophobiaofbelonging,andwhat youlackinsecurityyougainbyrealizing—asthoseinsidersneverdo—thatsecurityisan illusion.. . .”Caughtbetweentwoworlds,”isthewaywe’reoftencharacterized,butI’dputit differently.Wearethecatch.(pp.166–167)
Thisbrilliantexpressionofamultifacetedculturalidentity,composedofcomplex heritages,illustratestheimpactofone’ssociallocationontheneedtohighlightoneor anotheraspectofone’sculturalbackgroundinagivencontext,inresponsetoothers’projections.Theillustrationalsopointsoutwhatthosewhobelonghavetolearnfromthose whoaremarginalized.
Mostofusaresomewhatambivalentaboutourethnicidentification.Buteventhose whoappearindifferenttotheirethnicbackgroundwouldbeproudtobeidentifiedwith theirgroupinsomesituationsandembarrassedordefensiveinothers.Thosemost exposedtoprejudiceanddiscriminationaremostlikelytointernalizenegativefeelings abouttheirethnicidentity.Oftenethnicitybecomessuchatoxicissuethatpeopledonot evenwanttomentionit,forfearofsoundingprejudiced,eveninsituationswhereitisprimary.Somefamilieswillholdontotheirethnicidentification,becomingclannishorprejudicedinresponsetoaperceivedthreattotheirintegrity.Othersuseethnicidentification topushforfamilyloyalty.Theymightsay:“Ifyoudothat,you’rebetrayingtheJews.” Forothergroups,forexample,Scots,Irish,orFrenchCanadians,suchanemotional demandforethnicloyaltywouldprobablynotholdmuchweight.
AwarenessofethnicitywithinaUnitedStatescontextisalwaysassociatedwithloss. InthecaseoftheindigenouspeoplesoftheAmericas,theirculturesweredestroyedbythe Europeanimmigrantsorbytheillnessestheybrought,ortheywereuprootedandgreat effortsweremadetodestroythem,sothepreservationoftheirethnicitieshasbeenaprofoundstruggle(Tataki,2002;Zinn,2003).Thosewhocamefromelsewherecame becauseofpoliticalorreligiousoppressionintheiroriginalculture,economicneed,or,as inthecaseofAfricanAmericans,enslavement.Formany,thememoriesandassociations withtheirownculturalgrouporhomelandarefraughtwithpainfortheirancestorsor relativesleftbehindorfortheplightoftheirgroup,whichmayleadthemtodistance themselvesfromthishistoryandperhapsevenhideitfromtheirchildrenandgrandchildren.
StuartHall(1987)hassaidthateveryimmigrantmustfacetwoclassicquestions: “Whyareyouhere?”and“Whenareyougoingbackhome?”
Nomigranteverknowstheanswertothesecondquestionuntilasked.Onlythendoessheor heknowthatreally,inthedeepsense[heorsheis]nevergoingback.Migrationisaone-way trip.Thereisno“home”togobackto.Thereneverwas.(p.44)
WhatHallisreferringtoisthatthosewhocome,especiallyfrompoor,wartorn,or oppressivesituationscanneverreallygoback,becausethecircumstancesinthecultureof originremaindevastating,butalsobecausetheywillneveragainhavethesamerelationshiptothecultureoforigintheyleft;sotheconnectionwiththeirheritagenecessarily
involvespain,andtheirhomelandisaplacewherethatpainoftencontinues.Thus,connectingtoone’sethnicrootshasadifferentmeaning,dependingonthesituationinthe cultureoforigin.TheIrishwhoarenow150yearsawayfromthepovertyanddesperationthatledtotheirmigrationmaylooktotheirethnicrootswithnostalgiaandfindin themasourceofstrengthfortheirancestors’courage,whilefeelingsupportedbyour society’ssocialinstitutionswhentheyneedassistance(Chapter43).ImmigrantsofLatino originrarelyfeelthattheirculturalvaluesaresupportedbythecommunityinstitutions onwhichtheybecomedependentwheninneed.Theirexperienceisoftenofineffective, inadequate,andattimesblatantlyhostile,antifamilysocialservicebureaucracies(Ortiz, Simmons,&Hinton,1999;Chapter11).
Giventheharshcircumstancesmanyimmigrantsface,andthepainful,traumatic historytheyhaveleftbehind,itisnotsurprisingthatmanypeopleignoreordenytheir ethnicitybychangingtheirnamesandrejectingtheirfamiliesandsocialbackgrounds, buttheydosotothedetrimentoftheirsenseofthemselves.Thosewhohaveexperiencedthestigmaofprejudiceandracismmayattemptto“pass”asmembersofthe morehighlyvaluedmajorityculture.Groupsthathaveexperiencedprejudiceanddiscrimination,suchasJews,Latinos,Asians,andAfricanAmericans,mayabsorbthe largersociety’sprejudiceandbecomeconflictedabouttheirownidentities,internalizing racialorethnichatred.
Familymembersmayeventurnagainsteachother,withsometryingto“pass”and othersresentingthemfordoingso.Thosewhoarecloseenoughinappearancetothe dominantgroup’scharacteristicsmayexperienceasenseofchoiceaboutwhatgroupto identifywith,whereasothershavenochoice,becauseoftheirskincolororotherphysical characteristics.Examplesofethnicconflictincludesomegroupmembers’attemptsto changetheirappearancethroughplasticsurgeryorothermeanstoobtain“valued”characteristics.Familiesthatarenotofthedominantculturearealwaysunderpressuretogive uptheirvaluesandconformtothenormsofthemorepowerfulgroup.Intrafamilyconflictsoverthelevelofaccommodationshouldbeviewednotjustasfamilyconflicts,but alsoasreflectingexplicitorimplicitpressurefromthedominantculture.
AfewyearsagoAnnFadimanwroteabookabouttheexperienceofaHmongfamilyinMerced,California,withthehealthcaresystem,whichmayserveasaprimary guidetoculturalcompetenceforfamilytherapistsandotherhealthcareprofessions. Fadiman(1997)showshowanunderstandingofculturechallengesallourassumptions, beginningwithourdecisionsonhowfarbackinhistorywegotoassessthepresenting problem:
IfIwereHmong,ImightfeelthatwhathappenedwhenLiaLeeandherfamilyencountered theAmericanmedicalsystemcouldbeunderstoodfullyonlybybeginningwiththefirstbeginningoftheworld.ButsinceIamnotHmong,Iwillgobackonlyafewhundredgenerationsto thetimewhentheHmongwerelivingintheriverplainsofnorth-centralChina.(p.13)
Here,intwosimplesentences,Fadimanexpressesamostprofoundunderstandingof “culturalcompetence”asshereferstotheastoundingdifferenceinworldviewbetween thedominantculture’smanagedcarevalues,wherebyanimpersonalhealthcareprofessionalisexpectedtodoanassessmentin15to30minutes,focusingalmostexclusivelyon currentsymptoms,whereastheHmongpatient’sframeworkincludesahistorygoing backathousandyears:
1.Overview:EthnicityandFamilyTherapy 11
Foraslongasithasbeenrecorded,thehistoryoftheHmonghasbeenamarathonseriesof bloodyscrimmages,punctuatedbyoccasionalperiodsofpeace,thoughhardlyanyofplenty. Overandoveragain,theHmonghaverespondedtopersecutionandtopressurestoassimilate byeitherfightingormigrating—apatternthathasbeenrepeatedsomanytimes,insomany differenterasandplaces,thatitbeginstoseemalmostagenetictrait,asinevitableinitsrecurrenceastheirstraighthairortheirshort,sturdystature.TheChineseviewedtheHmongas fearless,uncouth,andrecalcitrant.. . .TheHmongneverhadanyinterestinrulingoverthe Chineseoranyoneelse;theywantedmerelytobeleftalone,which,astheirlaterhistorywas alsotoillustrate,maybethemostdifficultrequestanyminoritycanmakeofamajorityculture.(p.14)
Heretooisaprofoundinsightintocross-culturalunderstanding,demonstratingthe mainproblem:howtoseepastourassumptionsinordertounderstandtheexperienceof others.TheLeefamilyexperiencedrepeatedviolationsbywell-meaningbutethnocentric healthcarepersonnelwhosawthislovingfamilyasuncaring,abusive,negligent,and ignorant,onlybecausetheyardsticktheyusedtomeasurethefamily’svaluesandrelationshipswasthatofthedominantU.S.psychologicaltheories.Thehealthcaresystem’s unwittingimpositionofitsownvaluesonthisfamilyshowsushowlimitedourperspectivesare,unlessweaddaculturallenstoourpsychologicalassessments.
SukeyWaller,oneofthefewclinicianswhomanagedtoconnectwiththeLeefamily, demonstratedanamazingnaturalcreativityasaculturebroker:
PsychologicalproblemsdonotexistfortheHmong,becausetheydonotdistinguishbetween mentalandphysicalillness.Everythingisaspiritualproblem.I’vemadeamillionerrors. WhenIcamehereeveryonesaidyoucan’ttouchpeopleonthehead,youcan’ttalktoaman, youcan’tdothis,youcan’tdothat,andIfinallysaid,thisiscrazy!Ican’tberestrictedlike that!SoIjustthrewitallout.NowIhaveonlyonerule.BeforeIdoanythingIask,Isitokay? BecauseI’manAmericanwomanandtheydon’texpectmetoactlikeaHmonganyway,they usuallygivemeplentyofleeway.(quotedinFadiman,1997,p.95)
Waller’sguidelinesurgeopennesstoothersandreflectthecertainknowledgethatwewill makemistakes.Butthedominantculturemakesithardtoopenoneselftothepossibility ofmistakes,ouronlyhopeforincreasingourlearningaboutgroupsthataredifferent. Inthe1990s,RobertMcNamara,defensesecretaryduringtheVietnamWar,met withhisVietnamesecounterpartof30yearsearlier.Hereportsthatitwasinthatconversationthatheforthefirsttimeunderstoodtheculturalmisunderstandingbetweenthe UnitedStatesandtheVietnamese.TheUnitedStatesviewedtheVietnameseaspawnsof theChinesecommunistsintheColdWar.TheVietnameseleadersaidtoMcNamara:
Haven’tyoueverreadahistorybook?Don’tyouknowwe’vebeenfightingtheChinesefor 1,000years?Wesawyouascomingtodominateusaseveryoneelsealwayshadandwere willingtofighttothedeath.(Morris,2002)
Herewasalessoninculturalhumilitythatcorrespondscompletelywiththemessageof thisbookforfamilytherapists:Wemustworktoseethelimitationsofourownviewso wecanopenourmindstotheexperienceofothers.
Culturalmeaningsmaypersistmanygenerationsaftermigrationandafterpeople haveceasedtobeawareoftheirheritage.Indeed,thesuppressionoftheirculturalhistory
1.Overview:EthnicityandFamilyTherapy
mayleadtoculturalpatternstheythemselvesfailtoappreciate.Theymayperceivetheir behaviorasresultingpurelyfromintrapsychicorfamilialfactors,when,infact,itderives fromhiddenculturalhistory.TomHayden,co-founderoftheStudentsforaDemocratic Societyintheearly1960s,afourth-generationIrishAmerican,whobecameacommitted spokespersonforthepowerofthehiddenculturalidentity,discussedtheexperienceofso manyinourcountrywhohavehadtolivewiththeirdeepestculturalhistorydenied:
Whatpricedowepaywhenthosewhopullthecurtainsofhistoryallowustoknowourhistoryonlydimlyorwithshame.[Oursisa]. . .story. . .ofidentityforeverblurredbythe windsofsilenceandthesandsofamnesia.Itisalsoauniversalstoryofbeingrootedin uprootedness.. . .Themesofpersonalidentitybeingthreatenedfirstwithdestructionand laterbyassimilationappearthroughoutourliterature.. . .Themesthatreverberateineach storyarethoseofneardestructionandsurvival,shameandguilt,thelongfuseofunresolved anger,therecoveryofprideandidentity.(1998,pp.8–9)
HaydenhimselfgrewupexperiencinghimselfasCatholic,butnotIrish,thinking thathewas“post-ethnicinanethnicworld,”onlytorealizeyearslaterthathecarriedhis suppressedethnicitywithin:
IhadnohistoricrationaleforwhyIwasrebellingagainstmyparents’achievementofrespectabilityandmiddle-classcomfort.TherewasnooneteachingtheIrishdimensionofmyradical discontent,incontrasttoJewsandblackswhowereinstilledwithvaluesoftheirancestors. . . .TheIrishtradition. . .seemedmorepastthanpresent,moresentimentalthanserious, moreCatholicthanpolitical.(2001,pp.68–69)
ItwasyearsuntilHaydenrealizedthathisfamilyhadsought“respectability”asawayto “pass”forthedominantgroup.Ithadrequiredhisfamily,andindeedhiswholecultural group,toappeartoassimilateintothemeltingpot,butithadcostthemtheirsenseof whotheywere.Feelinghimselfanoutsiderinyoungadulthood,hejoinedthecivilrights movement.HisfirsttaskwastobringfoodtoBlacksharecropperswhohadbeenevicted fromtheirlandsinTennessee.
WasitonlycoincidentalthatIrespondedtoacrisisreminiscentofmyevicted,starvingIrish ancestors?Soeffectivewastheassimilationprocessthatmyparentscouldn’tcomprehendwhy Iwouldriskacareertopreventhunger,evictionandprejudice.IwasIrishontheinside, thoughIcouldn’tnameitatthetime.(2001,p.68)
Haydengrewupmystifiedabouthisidentity.Hisfathertoowasmystifiedaboutwhat madeTomdowhathedid,saying,“Idon’tknowwhatinfluencedhimwhenhewent away,butit’snotthewayhewasraised.”Hayden’sexampleillustratesthemystifying effectthatattemptstodenyorignoreculturalhistoryhaveonpeople’ssenseoftheirown identity.Culturalcompetencerequiresnotacookbookapproachtoculturaldifferences, butanappreciationfortheoftenhiddenculturalaspectsofourpsychological,spiritual, andsocialselves,aprofoundrespectforthelimitationsofourownculturalperspective, andanabilitytodealrespectfullywiththosewhosevaluesdifferfromourown.
MayaAngelou(1986),who,asayoungAfricanAmerican,notsurprisinglyfoundit hardtofeelculturallyathomeintheUnitedStates,wenttoliveinAfrica,hopinginsome waytofindhome.Whatshefoundtherewasthatwhoshewascouldnotbeencompassed bythatimportantpartofherheritage:
