Carribbeans - An Under-served Minority
An Advocate's Reflection
By: Loretta Harvey, Graduate Student Troy University-Tampa Bay Site
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Multicultural Competency
A Training Resource
By James J. Messina, Ph.D.
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Historical Perspective on the Carribbean Culture
The history of Caribbean culture dates back to the late fifteenth century that began with the European colonial struggle. Initially, the struggle was with Britain’s involvement with the Caribbean which generated the inclusion of several Africans working in the tobacco industry, cotton, and on sugar plantations (Irespect, 2013). The Caribbean population tripled in Britain, which was derived from the West Indies colonies. Most Africans from the Caribbean during the slave trade period were forced to work on plantations owned by Colonial powers (Irespect, 2013). Many Caribbeans were not recorded in history books as Caribbeans or Africans; they were documented as servants, slaves, Negroes, and colored. Caribbean slaves were named after the colonies they worked for in Britain. Many colonies which were operated by slaves from Africa and the Caribbean were thrown together, thus generating the need for a new language and culture. Several British entities owned property in the Caribbean, so the British forced all the Caribbeans who resided on their colonial properties into slavery (Irespect, 2013). Caribbeans were also brought through the slave ports until 1834, when slavery was abolished in Britain for colored people six years old and under. It was not until 1838 that all slaves were freed. Prior to the abolition of slavery, many earned their freedom by fighting in the British American Independence War. After the end of slavery and when the wars in Britain were over, it became difficult for many native Caribbeans to go back to their native lands because interracial marriages had diluted generations of Caribbeans and Black British.
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In the nineteenth century Britons, Africans, and the Caribbeans created what is known today as the creole societies (Adi, 2007). Creole societies, known as the creolization, derived from the beginning conversations of trans-culturalism, multi-culturalism, post colonialism, and diversity (Adi, 2007). The creolization was woven together from Europe, Africa, and Asia. However, it is perceived not as European, not African, nor Asian; it is known as “Creole” (Adi, 2007). Creole allowed Caribbeans to go beyond slavery and racial issues which exploited them in order to create the Caribbean race, to make their own subculture. The creolization is a unique population in the Caribbean region that consists of Catholicism, French language, Haitian rituals, food, and music that is a combination known today as “Cajun food and Arcadian sounds.” The creole lifestyle is still strong and extremely popular in French quarters of Louisiana today (Spear, 2011). Many Caribbeans today are ostracized because their Caribbean origins were stripped away from them during slavery. Many report they have no identity to classify themselves (Taylor, Nguyen, Sinkewicz, Joe, & Chatters, 2013). Research in the Caribbean region highlights the negative impacts and experiences that devastated the family structure which contributed to the loss of Caribbean identity (Taylor, Nguyen, Sinkewicz, Joe, & Chatters, 2013). The Caribbean population consists of twenty-eight million people, and the regions that contribute to the majority of the populations include Haiti, Jamaica, Puerto Rico, Dominican Republican, and Cuba (Wikipedia, 2015). The Caribbean is a collection of settler nations blended together from Europe’s Eurocentrism values and ideas (Adi, 2007). Colonialism had a big impact on the economic status and political leanings. The influences on the Caribbean culture come from the Europeans. However, the Eurocentric model created a new way of living and thinking because of the oppression of slavery (Adi, 2007). Political leaders such as Marcus Garvey developed ministries and movements among the Caribbeans to help them emancipate themselves from the institutionalized mindset of slavery that is still a threat to the region today (Adi, 2007).
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The economic resources in the Caribbean came from the sugar trade in the twentieth century, but experienced a decline in sales when other countries begin producing sugar (Tomich, 1997). After World War II, the islands became more independent, which resulted in improvements in their educational system, sewage, police stations, and hospitals. This independence made the islands more appealing to tourism, which brought about 25 million visitors to the islands per year and which contributed approximately 49 billion dollars in revenue in 2013. The Caribbean Islands are known as, “the most tourism-dependent region in the world” (Wikepedia, 2015).
The religious beliefs of Caribbeans are predominantly doctrinally Christian. There were two types of Christians in the region in the twentieth century: the “Planters and The Church of the Elite.” The Planters did not discriminate against their fellow neighbors and The Church of the Elite did not believe some of the slaves were smart enough to choose a faith (Wikipedia, 2015). Tourism has had negative effects on the carnival celebrations which originated from the “Holy Trinity.” The Holy Trinity is the belief that the Father, Son and Holy Spirit are three in one (Wikipedia, 2015). Due to tourism, the carnival celebrations have become inauthentic and more commercialized in order to be more attractive to the tourists, which generates even more revenue for the islanders. Voodoo is a religious belief practiced in the Caribbean region and was a result of Africans being a part of the slave trade (Wikipedia, 2015). These beliefs have a direct impact on how mental health disorders are viewed by families in the Caribbean. The other religious beliefs include Islam, agnosticism, atheism, Baha’i Faith, Judaism, Obeah, Rastafarianism, and Santeria (Wikipedia, 2015). The marriages are consummated much as they are according to rituals in the United States, unless the couples have different religious beliefs. The Caribbeans who lived under a different religious belief normally abide by the tenets of their faith (Adi, 2007).
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Mental Health Needs of Carribbeans
Research reports that the mental health issues of Carribeans include substance abuse, depression, mood and anxiety disorders, schizophrenia, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and chronic medical conditions (Taylor, Nguyen, Sinkewicz, Joe, & Chatters, 2012). In the year 2000, “statistics found that 42.8% of sexually active Caribbean children had their first sexual intercourse before the age of ten. By the time a young person reached the ages of 16-18, approximately 29.8% had more than five sexual partners. Many of these were forced sexual encounters” (Wikipedia, 2015). The National Survey of American Life indicated the reason for limited investigations on this population is due to immigration and language barriers. The contributing factors to the mental health disorders come from islanders being displaced from their families and introduced into unfamiliar cultures, which can cause significant pain. (Taylor, Nguyen, Sinkewicz, Joe, & Chatters, 2012). Reports indicate that small groups of immigrants may have less chance of mental illness due to binuclear families who guide and support them (Taylor, Nguyen, Sinkewicz, Joe, & Chatters, 2012). Caribbean women were reportedly less likely to exhibit anxiety disorders, substance abuse disorders, suicidal attempts and were more likely to have mood disorders. Caribbean men were less likely to have anxiety disorders, substance abuse disorders and more likely to have suicidal ideation. Older Caribbean generations are less likely to have anxiety disorders, mood disorders, depression, or attempt suicide. The Caribbean elders are reported to be the healthier subgroup out of the Caribbeans. Younger Caribbeans are more likely to have mood disorders, substance abuse disorders, and depression. They are more likely to have suffered sexual abuse and attempted suicide. However the younger subgroup of Caribbeans is more open to discussing their problems. Research shows that older, native born Caribbeans are less likely ever to develop a mental health disorder (Taylor, Nguyen, Sinkewicz, Joe, &Chatters, 2012). The National Comorbidity Survey Replication, Epidemiological Catchment Area, and the National Survey of American Life reported the disproportionate disparities when it comes to mental health care for Blacks and Caribbeans (Jackson, Neighbors, Torres, Martin, Williams, & Baser, 2007). Data shows all non-Hispanic groups receive psychiatric services at low rates, which is a direct result of “ethnicity, immigration, migration-related factors, within racial categorization, language barriers, cultural incompetence of the therapist, and poverty” (Jackson, Neighbors, Torres, Martin, Williams, & Baser, 2007). Significant data shows that the only way Caribbeans participate in psychiatric services is by force through imprisonment due to immigration issues, incarceration or involuntary commitment to mental health institutions. A sample test conducted on Caribbeans who were diagnosed with PTSD and schizophrenia found that it the conditions appeared to be a result of “post immigration and immigration experiences” (Jackson, Neighbors, Torres, Martin, Williams, & Baser, 2007).
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Proven Effective Theoretical Approaches Used with Carribbeans
Research that pertains to specific types of effective theoretical approaches related to family therapy, couples therapy or sex therapy in the Caribbean culture is limited. Therefore, this writer chose to interview a therapist from the Caribbean islands. Gerard Joseph, who is a native Trinidadian, has a degree in Human Development and is pastor of the Lincoln Boulevard Church of God. He reported the stigma that goes along with Caribbeans seeking a therapist is considered to be “a waste of time.” Joseph reported that many of the Caribbean people do not believe in exposing their personal problems to a complete stranger, so the most common intervention is through church attendance and prayer. According to Joseph, most Caribbeans talk to their pastors when seeking help with problems. The stigma is that if individuals choose to seek help from a therapist, they are considered to be weak. Joseph believes the stigma dates back to times of slavery, because when they chose to trust their neighbors, the British, they ended up becoming their servants. He also reported that many family members only seek help for food and shelter. The Caribbeans ostracize family members who have mental health disorders, which is due to a lack of education about therapeutic interventions. Gerard reported that the Jamaican culture is known for their belief in Rastafarianism. They do not believe in psychotropic medication, only ganja, which is known in America as marijuana. He also reported that most Haitians believe in Voodooism instead of in the existence of mental health disorders. When family members may have a mental health disorder, voodoo practitioners believe that the human body has been possessed by one or more demons that can only be exorcised through rituals which call out to their ancestors (G. Joseph, personal communication, June 30, 2015).
At this time, limited research has been completed in order to determine which therapeutic approaches are best suited to the Caribbean culture. Theoretical approaches still being researched are Transtheoretical Model and Motivational Interviewing (MI) which are believed to be appropriate for treating Africans, Caribbean adolescents, and families who have family members battling with depression disorders (Breland-Noble, Bell, & Nicolas 2006). “The behavioral stage change model consists of five stages: pre-contemplation - unwillingness to change a problematic behavior; contemplation - consideration of changing behavior; preparation - articulating a proximal change; action - engaging in behavior change; and maintenance - continual monitoring of behavior change activities to avoid relapse” (Breland-Noble, Bell, & Nicolas 2006). This theoretical approach was created with the intent to help reduce the negative outlook, stigma and barriers that the African and Caribbean communities have toward therapeutic treatment. Focus groups are typically held in neighborhood churches, since that is where most seek therapy (Breland-Noble, Bell, & Nicolas 2006).
Another study under way is designed to help determine the emotional social patterns and negative interactions that contribute to the stigmatism that Black Americans and Caribbeans hold toward admitting the need for help. The study indicates that Black Americans had more positive emotional closeness than Caribbeans and more emotional closeness with Caribbeans from a higher socioeconomic population. The displacement of “transnational families” is a factor which contributes to the lower level of closeness (Taylor, Brown, H. Taylor, & Chatters, 2013). Data from the National Survey of American Life shows that Caribbeans are unsettled by a symptomatic issue that comes from a dark past. They were viewed as a culture that is known for the fight or flight mentality. Unfortunately, according to accumulated data, they appear to have a frozen mentality due to not being open to therapy and have virtually no coping skills that will result in unfreezing the co-occurring problematic behaviors, which makes them susceptible to depression (Taylor, Brown, Taylor, & Chatters, 2013).
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Training Needs for Counselors and Therapists Working with Carribbeans
Unfortunately for the Caribbeans, they are considered a minority when considering how therapists and lay counselors work with this culture. Researchers have conducted few studies on the non-Hispanic populations. Several more recent studies consider all non-Hispanic groups a priority in order to determine which intervention services and therapeutic approaches will work well. The delay in research is due to lack of training or willingness of therapists to build relationships and learn the ways and needs of the Caribbean culture. Both trainers and trainees must be willing to put aside their biases and fear of the unknown. Unfortunately, the lack of belief in therapeutic services has resulted in native Caribbeans’ seeking educational degrees in fields other than mental health. This stems from the unwillingness to trust therapists and therapists who are unwilling to educate themselves on “ethnic, cultural, racial group membership, and language barriers.” As a result, therapists are neither culturally competent nor perceived as trustworthy. To make matters even worse, some Caribbean natives may fear differential treatment based on their perceived racial background (Anderson, Flora, Ferrari, Tuck, Archie, Kidd, & Kenzie 2015). A recent study, known as the First–Episode Care (FEP) for Blacks, Caribbean’s and European Origins, is designed to dissect and determine the different “socioeconomics, cultures, and history of slavery, and immigration” (Anderson, 2015). Poor educational facilities, poverty, and English as a second language are other barriers that have been researched, which results in limited theoretical approaches that are tailored to Caribbeans and other non-Hispanic cultures. The FEP conclusion was limited in the ability to find out if early intervention services would be effective due to participants’ declining after consenting to being part of the study sample. The results proved that FEP may only work if individuals are referred for FEP services through their primary care physician for any psychological problems.
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Discussion
As was reflected in the study by Anderson, Flora, Ferrari, Tuck, Archie, Kidd, and Kenzie (2015), the lack of research on Caribbean and non-Hispanic population needs is disheartening. As a result, incidents go unreported and the people in need are not being addressed due to biases, barriers, stigma and fears. The perception that seeking outside counsel is a sign of weakness taints today’s thinking which is historically based. Trusting an enormous group of people promising improved lifestyles and economic opportunities (White colonists) in the past resulted in servitude, slavery, and unspeakable atrocities.
The need is to develop and implement systematic data collection and research in order to strengthen the international community of mental health professionals competent to deliver high quality to non-Hispanics and foster trust in those communities.
Reasons why Caribbeans decline therapeutic services are the same as why many other non-White cultures feel they are ostracized. Until therapists, researchers, and physicians open up the lines of communication there will continue to be limited research and the heartbeat of therapy will never be relied upon.
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References
Adi, H. (2007). Combating racism and the issue of reparations. International Journal of African Renaissance Studies, 2(2), 250-254.
Anderson, K. K., Flora, N., Ferrari, M., Tuck, A., Archie, S., Kidd, S., & ... McKenzie, K. (2015). Pathways to first-episode care for psychosis in African-, Caribbean-, and European-origin groups in Ontario. Canadian Journal of Psychiatry, 60(5), 223-231.
Breland-Noble, A. M., Bell, C., & Nicolas, G. (2006). Family first: The development of an evidence-based family intervention for increasing participation in psychiatric clinical care and research in depressed African American adolescents. Family Process, 45(2), 153-169.
IRespect (2013). The African-Caribbean community: An historical perspective. Retrieved on July 2, 2015 from http://www.irespect.net/Untold%20Stories/Caribbean/Community%20History.htm
Jackson, J. S., Neighbors, H. W., Torres, M., Baser, R., Martin, L. A., & Williams, D. R. (2007). Use of mental health services and subjective satisfaction with treatment among black Caribbean immigrants: Results from the national survey of American life. American Journal of Public Health, 97(1), 60-67.
Spear, T. C. (2011). Poles and centers. Contemporary French & Francophone Studies, 15(1), 37-45.
Taylor, R., Forsythe-Brown, I., Taylor, H., & Chatters, L. (2014). Patterns of emotional social support and negative interactions among African American and black Caribbean extended families. Journal of African American Studies, 18(2), 147-163.
Taylor, R., Nguyen, A., Sinkewicz, M., Joe, S., & Chatters, L. (2013). Comorbid mood and anxiety disorders, suicidal behavior, and substance abuse among black Caribbeans in the U.S.A. Journal of African American Studies, 17(4), 409-425.
Tomich, D. (1997). Sugar island slavery in the age of enlightenment: the political economy of the Caribbean world (Book). American Journal of Sociology, 102(5), 1456.
Wikipedia (2015). History of the Caribbean. Retrieved on July 2, 2015 from https://en.wikipedia.org/wiki/History_of_the_Caribbean
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