Ethnic and gender differences in mental health utilization: the case of Muslim Jordanian and Moroccan Jewish Israeli out-patient psychiatric patients.

A sample of 148 (87 Jordanian [61 male, 26 female] and 61 Israeli [26 male, 35 female]) was selected from a psychiatric clinic in Ashdod Israel and Zarka Jordan, using convenience sampling methodology over a 12 month period in late 1997 and early 1998. A revised Hopkins Symptom Checklist: A Self-Report Symptom Inventory (HSCL) was translated into Arabic and Hebrew and distributed to subjects; additional questions explored demographic characteristics, forms of received treatment, patient perceptions of treatment efficacy, patient use of traditional healers, and patient explanation of etiology. Data revealed that there were differences in dimensions between the 2 groups based on nationality and gender. More Jordanians than Israelis expected medications as the main treatment, and unlike Israelis, no Jordanian patients received individual psychotherapy. Israelis expected medications, advice, directions, and instructions from psychiatrists. Both ethnic groups consulted a wide array of traditional healers, although precise types of healers varied according to gender and ethnicity. Israeli subjects gave more diverse explanations of mental health etiologies: physical, family, divorce, economic, unemployment; whereas Jordanians tended to emphasize divine and spiritual sources. Implications for psychiatric practice are discussed.

Psychological responses to blood vengeance among Arab adolescents.

OBJECTIVE: The goal of this study was to investigate the well being of Arab adolescents who live under the threat of ongoing blood vengeance, and to assess the impact of socio-demographic characteristics, cultural context, and family functioning as a mediators factors. METHOD: The sample consisted of 100 adolescents in grades 6-8. Self-reported standardized measures were used to assess the participants' level of self-esteem (Rosenberg's scale), mental health (the Brief Symptom Inventory BSI), and perceived family functioning (the McMaster Family Assessment Device FAD). RESULTS: The participants of this study demonstrated higher levels of distress and symptomatic behavior as compared to the Israeli norms. In a series of multiple regression, General Family Functioning emerged as the major predictor associated with mental health. Female participants reported a higher anxiety level than their male counterparts. Male participants, on the other hand, were more willing to continue the feud of blood vengeance. CONCLUSION: The findings suggest that there are similarities among children and adolescents who live in war zones and those who live under a threatening blood vengeance. Family functioning appears as the major mediator of well being. Implications for practice are discussed.

Gendered utilization differences of mental health services in Jordan.

A revised Hopkins Symptom Checklist (HSCL), translated into Arabic, was distributed to a sample of 87 nonpsychotic mental health out-patients in Zarka, Jordan (male = 61, female = 26). Findings revealed no significant gendered differences, but higher responses among women in all dimensions. Regardless of gender, patients also expected and were satisfied with medicinal treatment; explained etiologies as having supernatural origins; and utilized informal community traditional healing and religious healing systems. The supernatural explanations and community healing systems varied by gender. Findings emphasize future treatment and programme development strategies that take into account the biomedical/traditional interface, culturally appropriate treatment modalities, different gendered patient needs, and the potential stigma of professional treatment.

Learning achievement, social adjustment, and family conflict among Bedouin-Arab children from polygamous and monogamous families.

A sample of 146 Bedouin-Arab pupils from polygamous and monogamous families participated in this study, which was conducted in a Bedouin-Arab village in the Negev, Israel. The authors compared learning achievement, social adjustment, and family conflict. Data revealed differences between the two groups: The children from monogamous families had higher levels of learning achievement than did the children from polygamous families; in addition, those from monogamous families adjusted to the school framework better than did those from polygamous families. The mean conflict rating of children from polygamous families was higher than that of their counterparts from monogamous families. The father's level of education tended to be inversely correlated with family size in terms of both number of children and number of wives.

Culturally sensitive social work practice with Arab clients in mental health settings.

Several culturally specific practical considerations should inform social work interventions with ethnic Arab peoples in Arab countries or in Western nations. These include taking into account gender relations, individuals' places in their families and communities, patterns of mental health services use, and, for practice in Western nations, the client's level of acculturation. Such aspects provide the basis for specific guidelines in working with ethnic Arab mental health clients. These include an emphasis on short-term, directive treatment; communication patterns that are passive and informal; patients' understanding of external loci of control and their use of ethnospecific idioms of distress; and, where appropriate, the integration of modern and traditional healing systems.

Explanations of mental health symptoms by the Bedouin-Arabs of the Negev.

Sixty Bedouin-Arab patients (36 females, 24 males) referred to the psychiatric clinic of the Soroka Medical Centre in the Negev, Israel were interviewed before they met with the psychiatrists and again two weeks later. An open-ended questionnaire was administered during three month period, to examine the patients' explanations of their mental health symptoms. Findings revealed that all patients, male and female alike, perceived and explained their symptoms as being caused by supernatural powers. There were gender differences, however, regarding the perceived nature of, and behaviour of, these supernatural powers. Males explained their symptoms as caused by God's will, whether directly through Him, or indirectly through evil-spirits. In both instances, human behaviour was not a primary concern. In contrast, 97% of the female patients explained their symptoms as a result of sorcery, a phenomenon which integrates human behaviour with supernatural powers. Cultural and language differences between the patients and psychiatrists were also found to cause miscommunications and inappropriate treatment, with the result that 50% of the sample terminated psychiatric treatment after two sessions.

Gender and biomedical/traditional mental health utilization among the Bedouin-Arabs of the Negev.

Twenty Bedouin-Arab non-psychotic subjects in Israel (10 male, 10 female) utilized biomedical and traditional healing mental health care systems. Common patterns of utilization were observed: first to family/friends, then to a general practitioner, next to a traditional healer, and finally to a psychiatrist. Men were more familiar with the biomedical system, and women with the traditional. Women, more than men, made group utilization decisions; men, more than women, saw traditional healers outsider their home communities. Gender differences were found in symptomatology and in patient construction of etiology. The biomedical system successfully addressed physical symptoms. The traditional system struck a stronger therapeutic alliance, tended to diagnose more comprehensibly, and was perceived by many patients as being more clinically beneficial. Biomedical practitioners can learn from traditional healers how to read a client's ecological map, incorporate the family/community in treatment, and communicate in the patient's cultural idiom. In their search for models of traditional/biomedical system integration, scholars should turn to patients themselves, who are currently living such integration.

Social work intervention with Bedouin-Arab children in the context of blood vengeance.

Blood vengeance is a culturally specific phenomenon that can place Bedouin-Arab children at high risk of neglect. This case study examines the psychological and social implications of vengeance on children, the children's coping strategies, and the role of social work. The social work function includes nonauthoritarianism, strategies for forming a positive helping alliance, and various forms of culturally sensitive assessment and intervention. The study therefore yields insight into bridging the emic-etic gap in conceptualizing and responding to child neglect in a non-Western society.

Attitudes toward and perceived psychosocial impact of female circumcision as practiced among the Bedouin-Arabs of the Negev.

The present pilot study examines attitudes toward and the perceived psychosocial impact of circumcision as practiced among the Bedouin-Arabs of the Negev, Israel. A convenience sample of 24 women participated in the study: 12 who had experienced the ritual, and 12 who had not, but who had witnessed or been told about the practice of the ritual on women in their extended families. Two research instruments were used: a structured questionnaire, and a semi-structured open-ended interview. Data showed differences in subject responses depending on the research tools. The structured questionnaire revealed that women who had experienced the circumcision gave legitimization and cognitive rationalization to it. In contrast, the semi-structured interview revealed that these same subjects reported insult: traumatization, direct negative influences, and narcissistic insult, and described emotional difficulties during the research interviews. The findings indicated that they had difficulties in mother-daughter relationships and trust. Implications of the ritual on the continuity of polygamy and marital/sexual problems are discussed.

Family therapy with a multiparental/multispousal family.

This article examines therapy with a Bedouin-Arab family from the Negev, Israel, which consisted of 69 members: a husband, 8 wives, and 60 siblings. The husband, who lived with his youngest wife, paid little attention to his other wives and their children. There was considerable competition, hostility, and jealousy among the wives; no communication between the co-wives or the children of different wives; and a variety of behavioral and psychosocial problems among family members. I describe the varied strategies and systems involved in family therapy. The main strategies were to establish good relationships among the co-wives and to build a coalition among them, including the youngest wife, through group therapy in a medical clinic. A secondary strategy was using the children's problems to get the husband involved in the therapy. With improvement of the children's functioning, and with reduced intra-subfamily hostility, the husband's relationships with his children and wives improved.

The healing significance of the Negev's Bedouin Dervish.

Among the Bedouins of the Negev desert, Israel, there are Dervish healers specializing in what are now called psychiatric disorders. Five Dervish (three male, two female) were interviewed and observed with reference to concepts of etiology, symptom classification, diagnosis, stages of treatment, and aftercare. The conclusion examines reasons why Bedouins might want to seek treatment from a Dervish, rather than a modern health care practitioner.

When a man encounters a woman, Satan is also present: clinical relationships in Bedouin society.

Professional encounters in Bedouin society between male therapists and their female clients are discussed in terms of the conflict between clinical precepts and Bedouin codes of social conduct. The effects of the conflict on the transference relationship are examined by means of case presentations, and rules of conduct acceptable in both the professional realm and Bedouin society are proposed as an avenue toward resolution.