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Book Review   |    
Humberto Marin
Psychiatric Services 2008; doi:
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by Mark M. Leach, Ph.D.; Philadelphia, Haworth Press, 2006, 258 pages, $49.95

Dr. Marin is assistant professor, Division of Clinical Psychopharmacology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway.

We are increasingly aware that the largest and most frequently used ethnocultural denominations refer to heterogeneous groups. African Americans show significant intragroup differences between recent and more established African immigrants, males and females, straight and gay persons, people from central and southern Africa, and so on. We know that individuals in umbrella groups such as "Hispanic" or "Asian" include several populations that may differ in terms of factors that influence mental health and the treatment of mental disorders, such as language, fluency, acculturation, religion, education, economic level, health insurance, mental health literacy, and attitudes toward mental illness and its treatment.

A knee-jerk reaction of some theoreticians and politicians is to propose an end to using these classifications. However, the suggestion of clinical providers and researchers is precisely the opposite: we need to multiply ethnocultural classifications. Using the term "Hispanic" is not only insufficient but to some extent misleading when we are discussing the mental condition of a black, Pentecostal, professional, bilingual, Hispanic male from the Caribbean who has sex with other men and has become severely depressed upon finding that he is HIV positive.

Jean Paul Sartre said that the Arab or the Worker—with capital letters—do not exist, but there exist many arabs or workers. This is not true for sociologists, economists, or market researchers. For them, the "17—24 year-old male" or the "over 55 widowed female" is as real as penicillin is for a physician. But for clinicians, Sartre's affirmation is gospel. The more definitions we can have of our patients the better, but none of them should obscure the unique individual who is the target of our efforts.

The long title of this book, with multiple points of emphasis, suggests that the author is a clinician. The preface starts by declaring, "This book is intended for clinicians and researchers who want to increase their consideration of cultural issues when working with or researching suicidal clients." After an introductory chapter on the relationship between culture and suicide, the book deals in separate parts with European, African, Asian, Hispanic, and Native Americans. It includes a section on gender or sexual orientation for each of these groups and when most relevant, some group-specific issues, such as views of death, suicide, and religion.

The book's limitations reflect the state of the field. Some of the authors' conclusions may be debatable, but that is not a significant drawback in a field in which we need plenty of debate. My hope is that Cultural Diversity and Suicide gets the attention it deserves.

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