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Book Reviews   |    
The Mental Health of Refugees: Ecological Approaches to Healing and Adaptation
Reviewed by Jeffrey Stovall, M.D.
Psychiatric Services 2005; doi: 10.1176/appi.ps.56.6.765
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edited by Kenneth E. Miller and Lisa M. Rasco; Mahwah, New Jersey, Lawrence Erlbaum Associates, 2004, 429 pages, $49.95

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When I began to read The Mental Health of Refugees: Ecological Approaches to Healing and Adaptation, I doubted that I would find it useful. The title was esoteric. I dreaded a book with multiple authors and two editors, expecting a lack of focus and cohesion. I suspected a book laden with theory and of limited value to clinicians working in nonspecialized programs. I was mistaken.

The Mental Health of Refugees discusses an ecological, or community-based, approach to treating refugees and their communities. With a mix of theoretical discussion and examples of work with refugee communities, the authors challenge the commonly used clinic-based approach to working with refugees. They cite several arguments to advocate a community-based approach: the relative scarcity of clinical resources, particularly in non-Western and nonurban areas, makes it unlikely that most refugees will have access to care; the multiple needs of refugees will not be addressed in clinic-based treatment; and the psychological and disease-based approaches that are common in Western mental health treatment are likely culturally foreign to most refugees. Instead, the authors build on principles of community psychology and propose that services enhance refugees' capacity to adapt to the existing communities in which they live. Interventions should reflect the priorities of the community, emphasize preventive care, target individual treatment, develop culturally appropriate services, and be integrated into community settings.

The editors effectively provide the authors of individual chapters with a blueprint for discussing their work in order to avoid the repetition and disconnection that often befall collected works. The authors describe experiences with refugee groups from and in Bosnia, Angola, Cambodia, Colombia, and other countries. All the efforts are recent and reflect the current political climate and clinical approach. The authors are clinicians who have worked extensively in these communities, experience that is reflected in their discussions of both the successes and failures of their work.

The editors minimize the debate over the validity of Western diagnoses in a cross-cultural population. While providing brief statements on both sides of the discussion of the validity of the diagnosis of posttraumatic stress disorder, the authors instead focus the text on more immediate issues. The reader benefits from this approach, with the advantage of avoiding entangling arguments that might create a diversion from more central arguments.

This book will benefit any clinician who is working in a community setting in which refugees need services. Concrete details provided in the various chapters may be unique to certain communities. However, the central concept of viewing and treating the individual within the context of his or her community is an instructive method for anyone working with refugees or for those in administrative or funding-level positions. As is always the case for those of us working in community settings, it is easy to read about specialized programs and lament the fragmented nature of community-based care. However, even the clinician who is working in the most strapped community setting will benefit from reading The Mental Health of Refugees.

Dr. Stovall is assistant professor of psychiatry and of family medicine and community health at the University of Massachusetts Medical School in Worcester.




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