Academic journal article American Journal of Psychotherapy

Facing Away: Mental Health Treatment with the Old Order Amish

Academic journal article American Journal of Psychotherapy

Facing Away: Mental Health Treatment with the Old Order Amish

Article excerpt

Mental health treatment of the Old Order Amish is a relatively new phenomenon. Increasingly however, members of this sequestered Christian sect are either voluntarily seeking treatment or finding themselves ordered into treatment. Because they resist acculturation, many of the models of cross-cultural treatment are less than fully applicable; and because their pursuit of counseling is relatively recent, there is little information available to guide the therapist working with these clients. This article provides a practical approach to the more salient experiences and difficulties that arise in treatment of the Old Order Amish.


The Old Order Amish face the paradox of living a sequestered lifestyle in an interlocking modern society. Their reliance on horse and buggy as the primary mode of transportation, their resistance to using external power sources in their homes, an education usually limited to the eighth grade, and their plain form of dress all serve to mark them as "a peculiar people," a label they gladly accept (Hosteller, 1993; Kraybill, 2001). Their rapidly expanding numbers-approximately 175,000 in 28 United States and Canadian provinces, a roughly 200% increase in 25 years (NoIt, 2003)-also brings increasing attention from the very world they attempt to avoid, an unwelcome but necessary acculturation (Berry, 19995).

The Old Order Amish (condensed to "Amish" in this article, although in point of fact, there are several groups of "plain people" who use this generic term) are marketed by the tourist industry as being "frozen in time." In reality, the Amish accept change slowly, and they adapt modern technology to suit their needs. Historically, they have been slow to accept mental health services. The reasons for such resistance vary, both for individuals and for Amish communities (see, for example, Egeland, 1986; Jakubaschk et al., 1994). However, several common concerns predominate in their resistance to mental health care. Concerns about the mental health field itself include perceived cultural biases and misinformation about them among "English" (their term for non-Amish) therapists. Concerns arising from a theological/social perspective include the traditional emphasis on bishops or ministers as the source of counseling (or in some communities, lay Amish who serve in a counseling role) and the possibility that counselors outside the community may hold agnostic or atheistic views. The Amish also emphasize the "untrained mind," placing a premium on humility; "excessive" education or deep thought can become a source of pride and thus is viewed as unnecessary for the simplicity required to live a Christian life. Worse, excessive education may be viewed as an effort to emulate the omniscience of God (Hostetler, 1993; Weyer et al, 2003).

The Amish have long been willing, however, to take from the world that which they consider good, separating themselves from that which is bad (Igou, 1999). For this reason, they seek the services of qualified medical and allied health professionals Witimer, 1995; 2001). Increasingly, they either seek mental health services on their own or sometimes find themselves (or their youth) court ordered into involvement with such services. At the same time, little information is available in the mental health literature about clinical work within the Amish culture. Although detailed, thorough, and excellent sociological studies of this "peculiar people" abound (e.g., Bennett, 2003; Emery, 1996; Kraybill, 2001, 2003; Reiling, 2002; Savells, 2003), a literature review found only one article on mental health needs (Gates & Graham, 2002).

The current article addresses several pragmatic aspects of mental health work with the Amish. Cross-cultural theory and models are a necessary starting point; however, the large majority of these do not address the unique demands of work with a population that neither plans, nor desires, to be assimilated, but intends to remain sequestered. …

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