Cultural Issues in the Treatment of Anxiety.

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Friedman, Steven, Ed. Cultural Issues in the Treatment of Anxiety. New York, NY: The Guilford Press, 1997. xviii + 261 pp. $32.00.Even as cultural influences on mental health are starting to receive more attention at a national level, well-designed clinical research on anxiety disorders in ethnically diverse groups in the U.S. remains scarce. This book is derived from presentations given at a 1995 symposium "Recognizing and Treating Anxiety Disorders Across Cultures" held at the State University of New York Health Science Center in Brooklyn. It is divided into three major sections.Part I, General Issues in the Cross-Cultural Treatment of Anxiety Disorders, consists of overviews of topics relevant for a mental health professional's understanding of this emerging area. Peter Guarnaccia presents a thoughtful overview of cross-cultural issues in anxiety and anxiety disorders research. Ewald Horwath and Myrna Weissman then define and discuss the epidemiology of individual anxiety disorders, and how these may vary cross-culturally in the U.S. and abroad. The final chapter, written by Lawrence Welkowitz and Jack Gorman, offers a brief review of the treatment of anxiety disorders based on a model of treating panic disorder.Part II, Issues in the Treatment of Specific Ethnic Groups in the United States, is devoted to anxiety disorders in a number of ethnic groups including Hispanic Americans, Caribbean Americans, Asian Americans, Orthodox Jews, African Americans, and Asian-Indian Americans, with a different researcher or group authoring each chapter. Most are clearly written and on the whole provide useful and up-to-date information about anxiety disorders in the different ethnic groups. It is left unclear, however, how the individual ethnic groups were selected, and as is true for many symposium compilations, the considerable variation in theoretical orientation, writing style, and informational content of individual chapters could have benefitted from a more uniform format and occsionally tighter editing. For example, the chapter on "Caribbean Americans" defines this population as immigrants from "English-speaking islands" who comprise a "subgroup of the African American population." This idiosyncratic description excludes Caribbean immigrants who self-identify as being of mixed-race, Hispanic, native Caribe/Indian, or Caucasian heritage. Later, immigrants from non-English speaking Cuba and Haiti are also mentioned, leading me to conclude that the chapter's topic is actually Afro-Caribbean immigrants.Although their scope varies substantially, each ethnic group chapter supplies some clinically relevant material. Gayle Iwamasa's chapter provides a particularly comprehensive approach to the treatment of Asian Americans. An unusual and interesting chapter on Orthodox Jews offers numerous insights and treatment suggestions for this small minority of the U.S. Jewish population, which may, the authors suggest, also be applicable to the larger context of other devoutly religious ethnic minorities.The last section of the book starts with a good general overview of ethnocultural psychopharmacology written by members of the Harbor-UCLA Psychobiology of Ethnicity group. Somewhat more attention to anxiety and anxiety disorders-perhaps relating ethnocultural variation in psychotropic response to specific anxiety disorders discussed in earlier chapters-would have enriched this chapter. The book closes with a very thoughtful discussion of future clinical and research directions by Laurence Kirmayer.Cultural Issues in the Treatment of Anxiety is a welcome reference for both students and clinicians, and I strongly recommend it to anyone with interest in cultural aspects of anxiety or in the psychiatric treatment of anxiety disorders.Frederick M. Jacobsen, M.D., M.P.H.

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