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First published online July 5, 2010

Ethno-Cultural Variations in the Experience and Meaning of Mental Illness and Treatment: Implications for Access and Utilization

Abstract

We conducted a study to investigate how understandings of mental illness and responses to mental health services vary along ethno-racial lines. Participants were 25 African American, Latino, and Euro-American inner-city residents in Hartford Connecticut diagnosed with severe mental illness and currently enrolled in a larger study of a community mental health center. Data were collected through 18 months of ethnographic work in the community. Overall, Euro-Americans participants were most aligned with professional disease-oriented perspectives on severe mental illness and sought the advice and counsel of mental health professionals. African-American and Latino participants emphasized non-biomedical interpretations of behavioral, emotional, and cognitive problems and were critical of mental health services. Participants across the sample expressed expectations and experiences of psychiatric stigma. Although Euro-Americans were aware of the risk of social rejection because of mental illness, psychiatric stigma did not form a core focus of their narrative accounts. By contrast, stigma was a prominent theme in the narrative accounts of African Americans, for whom severe mental illness was considered to constitute private “family business.” For Latino participants, the cultural category of nervios appeared to hold little stigma, whereas psychiatric clinical labels were potentially very socially damaging. Our findings provide further empirical support for differences in symptom interpretation and definitions of illness among persons from diverse ethno-racial backgrounds. First-person perspectives on contemporary mental health discourses and practices hold implications for differential acceptability of mental health care that may inform variations in access and utilization of services in diverse populations.

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1.
1. Racial/ethnic corresponds to current terminology of the U.S. Census Bureau. We stress that these categories are social constructions, taking on significance in the context of social interactions.
2.
2. The categories, “Hispanic/Latino,” “Black/African American,” and “White” reflect the terminology of the U.S. Census Bureau. According to the U.S. Census Bureau, “‘White’ refers to people having origins in any of the original peoples of Europe, the Middle East, or North Africa. It includes people who indicated their race or races as ‘White’ or wrote in entries such as Irish, German, Italian, Lebanese, Near Easterner, Arab, or Polish. ‘Black or African American’ refers to people having origins in any of the Black racial groups of Africa. It includes people who indicated their race or races as ‘Black, African American, or Negro,’ or wrote in entries such as African American, Afro American, Nigerian, or Haitian. Hispanic/Latino is defined as ‘a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race’” (Grieco & Cassidy, 2001).

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Published In

Article first published online: July 5, 2010
Issue published: April 2010

Keywords

  1. ethnicity
  2. explanatory models
  3. illness stories
  4. race
  5. severe mental illness
  6. US

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© The Author(s), 2010.
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History

Issue published: April 2010
Published online: July 5, 2010
PubMed: 20603387

Authors

Affiliations

Elizabeth Carpenter-Song
Dartmouth Psychiatric Research Center & Dartmouth College, [email protected]
Edward Chu
Dartmouth Psychiatric Research Center & Dartmouth College, [email protected]
Robert E. Drake
Dartmouth Psychiatric Research Center & Dartmouth College, [email protected]
Mieka Ritsema
Dartmouth Psychiatric Research Center & Dartmouth College, [email protected]
Beverly Smith
Dartmouth Psychiatric Research Center & Dartmouth College
Hoyt Alverson
Dartmouth Psychiatric Research Center & Dartmouth College, [email protected]

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