|What do you think has caused your problem?|
|Why do you think it started when it did?|
|What do you think your sickness does to you? How does it work?|
|How bad (severe) do you think your illness is? Do you think it will last a long time, or will be better soon in your opinion?|
|What kind of treatment would you like to have?|
|What are the most important results you hope to get from treatment?|
|What are the chief problems your illness has caused you?|
|What do you fear most about your sickness? (p. 29)|
If patients' answers suggest that they are not traditional in their health beliefs, then the strategies suggested here are not necessary.
The previous suggestions are only a few of the many changes in the content and process of delivering interventions to minorities thatare needed. Other changes are contingent on the specific ethnic minority group to whom services are to be delivered, and may require new assessment procedures to (for example) address fears of loss of lien and reticence to disclose symptoms. Each of these recommended strategies is, in a sense, simple insofar as it is readily accommodated by standard, biomedical practice. Simultaneously, however, culturally tailoring programs to minorities in the ways outlined here is not as simple as it might at first seem. This is because the biomedical view of what an illness is (a reified entity housed within an individual) and the sociocentric, holistic concept of illness (a process located everywhere but manifested in an individual) are diametrically opposed understandings. Biomedical health education and disease prevention programs, no matter how culturally tailored and sensitive, necessarily reflect and communicate their underlying, dualistic assumptions, and these are destructive to minority cultural life. As Fabrega (1974) put it:
the spread of modern medicine should be seen, not as a process that simply erodes and takes the place of native views and practices, but rather as a pervasive undermining (with consequent disarticulation) of established modes of thinking, feeling, and behaving. In [sociocentric cultures] conceptions about disease, indeed experiences of and with disease, are isomorphic with those that articulate one's personal identity and also give meaning to social relations. What is more, all of these form the fabric of what we may term “medical care.” It is not surprising, then, that the intrusion of Western medicine into such a setting brings with it more than decreased infant mortality and rates of infectious diseases; it brings with it the destruction of the previously mentioned unity in social relations, body and self. Insofar as it operates through specialized occupational and suboccupational surgeons, etc.), medicine tends to segmentalize the person in various ways. Each of these groups has a perspective that is organized by separate premises, obligations, and explanations, all of which are in conflict with native understandings. Problems are somewhat arbitrarily divided into “mental” versus “physical, ” “social” versus “medical, ” disarticulations. In other words, what to [sociocentric people] is a single crisis having broad ramifications is in this new system or view a heterogeneous collection of “problems, ” each of which has a separate cause and locus. In this process of differentiation and specialization, Western medicine …fragments and undermines the native cultural system. (pp. 246–247)
The difficult task faced by health psychology and related disciplines in this increasingly multicultural society then is not so much that of culturally tailoring interventions for minorities, nor even of creating cooperative systems of care that include both biomedical and indigenous healers and cures. Rather, it is to do so without disrupting the holism that undergirds minority understandings of health, and also provides the web that ties people to each other, and to their environment and their gods. Holism is not a view about health, but rather is a view of life and the universe that is merely reflected in health beliefs and practices. It is holism as a metaphor people live by that we must take care to protect.
Supported by funds provided by the California Tobacco- Related Disease Research Program Grant Numbers 6RT-0081 and 8RT-0013, and by the California Department of Health Services, Tobacco Control Section Grant Number 94–20962.
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(nurses, internists, psychiatrists, “Natural”