Cultural mistrust: An important psychological construct for diagnosis and treatment of African Americans.

Abstract

Although clinicians are encouraged to be more sensitive to cultural factors in the diagnosis and treatment of mental disorders, as evidenced by the significant changes in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994), little information is provided to help them determine which aspects of culture are important to the mental health of African Americans. This article discusses the importance of cultural mistrust as a psychological construct in the lives of African Americans. The origins of the construct, the research it has generated over the past 2 decades, and implications for improving interventions with Black clients seeking mental health care are discussed. The need for greater cultural sensitivity in psychological interventions with African Americans often places mental health clinicians in a double bind. On the one hand, they are told to acknowledge and respect cultural differences. On the other hand, they are warned about relying on stereotypes and generalizations in working with people of African descent who are in need of psychological services. One way to avoid this apparent contradiction is to review the literature and identify cultural themes or issues that have been shown to have direct relevance to the mental health treatment of African Americans. Psychologists interested in cultural variables often fail to identify the specific aspects of culture that are thought to influence behavior (Betancourt & Lopez, 1993). Prevalence studies indicate that paranoid schizophrenia is the most frequent diagnosis given to African Americans (Collins, Rickman, & Mathura, 1980; Mukherjee, Shukla, Woodle, Rosen, & Olarte, 1983; Toch, Adams, & Greene, 1987). This finding has been explained by some in terms of clinicians' insensitivity to different cultural norms for paranoid ideations in the Black population (Adebimpe, 1981; Grier & Cobbs, 1968; Jones & Gray, 1986; Ridley, 1984). However, this explanation remains an unARTHUR L. WHALEY received his PhD in clinical psychology from Rutgers