Culture, Identity, and Mental Health

This chapter presents conclusions and future directions on culture, identity, and mental health, including the importance of identity and culture, separations and mourning as an important part of the immigrant experience, immigration-related separations, understanding acculturation, transnational identities, pilgrimages, and return migrations, understanding and treating refugees and special populations, criminality among immigrants to the United States, immigration and race, American narratives and immigrant narratives, treatment of immigrants and the children of immigrants, alternative futures for cultural identity – intercultural future and tribalistic future.

Treatment Interventions for Immigrants, Refugees, and Their Families

The chapter on treatment interventions for immigrants, refugees, and their families describes the importance for clinicians to familiarize themselves with how to treat these populations given the changing demographics in the United States. It explains the cultural competence model, the cultural sensibility model, and the community systems of care model, as well as other variations of treatment that take into account cultural nuances. The chapter outlines specific recommendations to treat child, adolescent, and adult immigrants and refugees based on the Practice Parameter on Child and Adolescent Psychiatric Culturally Competent Care by the American Academy of Child and Adolescent Psychiatry and other sources. These include how to overcome barriers to mental health treatment, the role of language barriers and how to overcome them, the generational challenges in treating the family, awareness of cultural biases and how to address them, understanding cultural idioms of distress in diagnosis and formulation, the need to assess and treat immigration-related losses and traumas and to evaluate acculturation-related family conflicts, identification of key family members in the treatment, and the need to design treatment interventions that are consonant with the cultural values and beliefs of the immigrant family. The need to provide evidence-based pharmacological treatments and to consider ethnopharmacological factors is addressed. Other evidence-based treatments such as cognitive behavioral therapy for post-traumatic stress disorder, testimonial psychotherapy, narrative exposure therapy, eye movement desensitization and reprocessing, and others are discussed.

The Immigrant Narrative

The chapter on the immigrant narrative explains the role of human narratives in identity development and explains the origins, meanings, and importance of the quintessential American narrative, which is known as the narrative of the redemptive self. It explains how understanding the dynamics of this particular narrative facilitates the understanding of the American cultural experience and how many aspects of this narrative parallel the immigrant experience. It discusses the concepts of historical truth and narrative truth. It explains how the use of narratives can serve as a useful therapeutic tool to help the immigrant work through the traumas and losses associated with migration and to negotiate the different stages of transformation of the immigrant’s identity. This chapter also explains the neurobiology of memory formation and the distortions of memory and narrative that may result from psychological trauma. It discusses how psychotherapy involves the creation of new, more adaptive narratives that can provide healing and personal growth and its relevance in the immigrant experience. It also discusses immigrant narratives in contemporary literature and how these can be used as a therapeutic tool with the younger generations of immigrants. The chapter is illustrated with various clinical cases.

Immigration Trends in the United States

The chapter on immigration trends describes the current legal and illegal paths of immigration to the United States; a historical perspective of the reasons for migration; the past and current numbers of immigrants who have arrived in the United States and their demographic profile; which countries contribute immigrants and which states receive them; the changing race and ethnicity of the immigrants throughout the country’s history; the immigrants’ levels of education, skill sets, and financial attainment at the time of arrival and after the second generation. A demographic profile of the illegal immigrants, their vulnerability for exploitation, and their financial importance to the country’s economy is presented. The composition of immigrant families, some of the psychological effects of geographical separations and deportations on the family, factors that facilitate or impede assimilation and adaptation, the intergroup relations, values, and political orientation of the different immigrant groups, and the immigrants’ financial contributions to the United States are discussed.

Culture, Identity, and Psycho-social Development

The chapter on culture and identity defines the current use of these terms and discusses how culture influences identity formation from a developmental perspective, starting in early childhood and throughout the life span. It also introduces new neurobiological findings related to theory of mind, neural mapping, object representation, and emotional reactivity and how these exert an influence on culture and identity formation. It covers a historical perspective that includes the contributions of pioneers such as Freud, Vigotsky, Montessori, Bandura, Mead, and Erikson. It also discusses ethnicity and race and the social and biological origins of prejudice and explains the meaning of ethnic-racial socialization messages, the dynamics of biracial identities, the importance of language in the development of the American identity and the role of culture and identity in psycho-social functioning and resiliency, including such variables as religion and spirituality. It also describes the influences of globalization and the diminishing importance of national boundaries on cultural identity for both minority and majority group members. Some of the concepts are illustrated and explained with clinical cases.

Acculturation

The chapter on acculturation describes the possible reactions of the immigrant to the encounter with the new host culture and describes the history and meaning of the term acculturation, the strategies used by immigrants in order to adapt to the new host culture, the styles and models of acculturation, and the distance or proximity in which they place themselves with respect to the new culture that surrounds them. It explains the concepts of acculturation stress—the risk factors and protective factors and other variables that facilitate or slow down acculturation—and the concept of acculturative family distancing, which occurs when different members of the family acculturate at different rates and the conflicts that are generated by this phenomenon. The chapter also explains the role of the acquisition of a new language and how acculturation is measured, the epidemiological findings brought by acculturation on the different generations of the immigrant family, and how individual, family, and community factors influence acculturation. It also explains the role of acculturation in nonimmigrant historical minorities who have resided in the country but do not partake of the mainstream culture. Treatment interventions are discussed, and the chapter is further illustrated with case studies.

Criminality Among Immigrants to the United States

The chapter on criminality among immigrants seeks to dispel the myths and to clarify the true statistics of criminality among the immigrant population in the United States. It provides a historical perspective of criminality and immigration and describes the anti-immigrant currents and rhetoric that have emerged throughout the history of the country. It describes the crime rates and socioeconomic factors that generate criminality among legal and undocumented immigrants, providing an in-depth analysis of the three principal federal, state, and local justice system U.S. government databases in order to clarify the true statistics on immigrant criminality. It discusses the variables that affect the levels of criminality, including immigration, class, and race and the statistics and factors affecting criminality among second-generation immigrants and beyond. It describes what constitutes a cultural crime and the plight of immigrants as victims, including border crossings, human trafficking, violence, and exploitation and the contribution of post-traumatic stress disorder as a cause of criminality and as a result of victimization. Ultimately, it discusses the dilemma of immigration as an issue of national security.

Immigration and Race

The chapter on Immigration and Race describes the history of race relations and the present and future and the rapidly changing racial topography of the United States. It explains these changes are based on the high rates of ethnic-racial intermarriage that have appeared in the last two decades. It analyzes the complexity of ethnic-racial self-identification, taking into account the tensions that appear between the identification imposed by the majority culture, in contrast with the person’s individual self-concept of ethnicity and race, especially in the face of the increasing multi-ethnic and multi-racial American population. It addresses the history of racism and discrimination experienced by minority populations and immigrants of color and the psychological effects of discrimination and racism on these populations. It describes the risk factors and protective factors that come into play when individuals are faced with experiences of discrimination and racism. It describes the process of ethnic-racial identity development and the different styles of ethnic-racial socialization and cultural orientation. Ultimately, it discussed the importance of ethnicity and race in the psycho-therapeutic encounter and offers treatment recommendations on how to approach and discuss issues of ethnicity and race in psychotherapy.

Transnational Identities, Pilgrimages, and Return Migrations

The chapter on transnational identities, pilgrimages, and return migrations explains the concept and importance of the term transnationalism and the new socioeconomic dynamics that take place between immigrants to the United States and the flow of cultural exchange and monetary remittances to the relatives in the country of origin. It expands on how the use of new communication technologies and more accessible air transportation have contributed to globalization and how this globalization has changed the immigrant experience, leading to a process of interculturation. It expands on the particular immigrant experience of Puerto Ricans and also discusses the dynamics of those whose stay behind in the country of origin. This chapter explains the psychodynamic meaning of nostalgia and discusses the reasons and motivations that generate return migrations to the country of origin. It also discusses the socioeconomic and psychodynamic issues of those who chose to return and how the transfer of newly acquired skills and knowledge impacts the country of origin, as well as the psychodynamic and socioeconomic issues that result in the encounter between those who chose to stay and those who return. This chapter also discusses the meaning of pilgrimages to the lands, not of the immigrants’ birth, of their ancestral family histories and how these pilgrimages serve as intrapsychic organizers that lead to the integration and enrichment of the person’s cultural identity and may promote personal growth. The topics are explained and illustrated with various case studies.

Refugees and Special Populations

The chapter on refugees and special populations defines what constitutes a refugee and describes the demographics and sociopolitical causes of the refugee problem worldwide. It describes the different types of circumstances that produce forced migrations and the sociocultural and psychodynamic phases of the refugee experience, beginning with the departure from the country of origin and ending in the arrival and adaptation into the host country. It discusses the plight of unaccompanied child and adolescent refugees and the case of child soldiers. It describes the epidemiological findings among the different refugee populations worldwide and the controversies that exist in various countries in validating and granting a person refugee status, as well as the controversies of understanding the refugee experiences from a pathological–traumatic perspective in contrast with a resiliency perspective. It describes the mental health assessment and screening of refugees, access to care, treatment interventions, the treatment process, the existing evidence-based treatments and preventive interventions, as well as implications for policy, practice, and research. It also illustrates the controversies with a clinical case.