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Appalachian Mental Health

Appalachian Mental Health

Copyright Date: 1988
Pages: 264
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  • Book Info
    Appalachian Mental Health
    Book Description:

    This volume is the first to explore broadly many important theoretical and applied issues concerning the mental health of Appalachians. The authors -- anthropologists, psychologists, social workers and others -- overturn many assumptions held by earlier writers, who have tended to see Appalachia and its people as being dominated by a culture of poverty.

    While the heterogeneity of the region is acknowledged in the diversity of sub-areas and populations discussed, dominant themes emerge concerning Appalachia as a whole. The result of the authors' varied approaches is a cumulative portrait of a strong regional culture with native support systems based on family, community, and religion.

    Some of the contributors examine therapeutic approaches, including family therapy, that consider the implications of the cultural context. Others explore the impact of Appalachian culture on the impact of Appalachian culture on the development of mental health problems and coping skills and the resulting potential for conflict between Appalachian clients and non-Appalachian health providers. Still others examine cultural considerations in therapeutic encounters and mental health service delivery. The book is rich in case studies and empirical data. The practical, applied nature of the essays will enhance their value for practitioners seeking ways to improve mental health care in the region.

    eISBN: 978-0-8131-5877-8
    Subjects: Psychology, Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Lists of Tables and Figures
    (pp. vii-viii)
  4. Preface
    (pp. ix-x)
  5. Introduction
    (pp. 1-12)

    This collection of articles addresses mental health issues in Southern Appalachia. There are two very good reasons for such a book. In the first place, the Appalachian region suffers from significant problems and deficiencies in the delivery of mental health services. Appalachia is underserved by mental health professionals and services, as are most rural areas in the United States (see Efird, Chapter 9); but because Appalachia covers one of the largest and poorest rural populations in the country, its need is intensified. Moreover, the mental health facilities that do serve the region tend to be located in urban centers, creating...


    • 1 Appalachian Cultural Systems, Past and Present.
      (pp. 15-23)

      Appalachia is a distinct region of the United States, set apart not only by geography but also by history. An understanding of the historical experience is essential for any interpretation of modern-day problems and prospects in the region. This essay presents a brief historical overview of Appalachia and considers the implications for mental health services.

      Settlement of the southern Appalachian region was well under way by the late eighteenth contury. Progressive waves of Scotch-Irish and German settlers, coming first down the great valley of Virginian into the piedmont areas of the eastern states, and later through southern ports, were joined...

    • 2 Appalachian Family Ties.
      (pp. 24-35)

      No ethnography of Appalachians fails to speak of them as familistic. The family is the central unit of rural Appalachian social organization. It is the basis of an individual’s identity. In many cases, kinship is described as the only basis for social relationships among rural mountaineers; neighbors and friends in some way always overlap with kin. We know most about rural Appalachian family organization at this point and so this paper is focused on it.

      Of course, kinship is the basis for social organization in any society, including mainstream American society in general. However, the meaning of kinship and its...

    • 3 Religion in Southern Appalachia.
      (pp. 36-48)

      Quite commonly, religion in Appalachia is greatly misunderstood or misrepresented. The traditional religion of Appalachia has been under attack since the 1880s by missionaries, teachers, and mainstream America through the mass media and state and federal agencies and programs. Mental health professionals have not been an exception to the rule. For the most part, psychologists as well as missionaries and teachers have not seriously attempted to understand the southern Appalachian people’s religion. This is all the more unfortunate considering that the one aspect on which scholars, social workers, and the Appalachian people generally agree is that Appalachian religion today is...


    • 4 Adaptive Socialization Values of Low-Income Appalachian Mothers.
      (pp. 51-65)

      The values that parents would like their children to adopt are significant influences in the parent-child relationship. An important focus of the research on this topic has been concerned with the links between aspects of the larger social structure (i.e., social class and culture) and parental socialization values (Ellis, Lee, and Peterson 1978; Gecas 1979; Inkeles 1969; Kohn 1977; Lee 1977; Pearlin 1971; Peterson, Lee, and Ellis 1982; Scheck and Emerick 1976; Wright and Wright 1976). That is, socioeconomic and subcultural groups differ in terms of the socialization values that parents convey to their offspring.

      There are several reasons why...

    • 5 Gender, Class and Self-Image.
      (pp. 66-80)

      Little systematic attention has been given to the importance of gender in determining the individual life course in Appalachia (Tickamyer and Tickamyer 1987; Walls and Billings 1977). Little data is available on female-headed households and there is a paucity of statistical data regarding Appalachian women in general (Weeks 1980). Analyses of social structure in Appalachian communities frequently define women’s lives solely in relation to their position or role functions within the traditional family group (Photiadis 1986; Stephenson 1968; Schwarzweller, Brown, and Mangalam 1971).

      Low-status Appalachian women, in particular, have been typically represented by stereotypical images not only in the media...

    • 6 The Social Context of “Nerves” in Eastern Kentucky.
      (pp. 81-100)

      Are you a woman? Do you understand the meaning of “shattered nerves?” Are you tortured with every form of suffering? Aches in the back and side and head? Do you get nearly beside yourself over trifles? Does your face grow thin and haggard? Are you completely discouraged and tired of life?¹

      The history of women’s health chronicles the cultural construction of illness after illness—neurasthenia, hysteria, nervous prostration, and chlorosis to name just a few—that embodied the conflicts and contradictions experienced by women as they strove to make their place in the changing family and society of the late...

    • 7 Social Support Networks of Families with Handicapped Children.
      (pp. 101-122)

      This paper presents findings from a study examining the mediating effects of social support on the personal and familial well-being of parents of handicapped children. The study was conducted in rural western North Carolina, in an area that includes eight Appalachian and four non-Appalachian counties (Appalachian Regional Commission 1977; Ergood 1976).¹

      Social system theory (Bronfenbrenner 1977, 1979; Caplan 1976; Cochran and Brassard 1979; Holahan 1977; Mitchell and Trickett 1980) was used to generate predictions regarding the relationships between social support networks and well-being. Our main hypothesis was that availability of social support would be inversely related to physical and emotional...


    • 8 Factors Affecting the Use of Mental Health Services: A Review.
      (pp. 125-134)

      Factors affecting mental health service utilization are diverse and complex. Investigation of these factors has received considerable attention, especially with regard to disadvantaged groups, including ethnic minorities, the poor, and rural residents (e.g., Barrera 1978; Garrison 1975; Kaplan and Roman 1973; Miller 1966). For Appalachians, however, few such studies exist. The purpose of this paper is to briefly review relevant factors affecting mountaineers’ use of mental health services and to conclude with recommendations for the improvement of mental health service delivery.

      One of the difficulties in reviewing what has been written about Appalachians and mental health is determining the extent...

    • 9 Enhancing the Use of Mental Health Services.
      (pp. 135-144)

      Appalachia’s unique social and cultural heritage plays a significant role in the illness behavior of its residents, especially in their decisions to utilize mental health care services. It should play an equally important role in the way mental health care providers plan and deliver mental health services. Too often, mental health personnel fail to consider this unique context and, as a result, find that services are not utilized to the fullest extent possible by the people they are intended to serve.

      To enhance the utilization of mental health services in Appalachia, mental health programs themselves must be offered in ways...

    • 10 An Exploratory Study of Mental Health Service Utilization by Appalachians and Non-Appalachians.
      (pp. 145-158)

      Mental health services in Appalachia must serve more and more diverse populations. No longer is the region a hinterland where traditional life endures relatively unchanged, made up of more or less homogeneous face-to-face communities. Nor has Appalachia remained a region of economic decline and out-migration. On the contrary, southern Appalachia’s population grew by 19 percent between 1970-1980 (Pickard 1981). Growth was particularly significant in those parts of southern Appalachia with economies based primarily on tourism and recreation, vacation homes, and retirement populations. Those moving into the region include return migrants and newcomers from all parts of the United States, even...


    • 11 Cross-Cultural Conflict between Providers and Clients and Staff Members.
      (pp. 161-174)

      In mental health work we are often reminded that one ought to “start where the client is.” Experience suggests, however, that this is not so easy to do; that, as sensitive as we might try to be, culture runs deeper than the awareness we carry in everyday life. The ways we move, talk, listen, dress, stand and sit, and make decisions are all symbols to be interpreted by others around us. In the social world of the urban professional, there seems to be a broad consensus as to the meaning of gesture and symbols that form a part of our...

    • 12 Appalachian Family Therapy.
      (pp. 175-187)

      There has been a growing interest among therapists in considering the cultural context when practicing family therapy (McGoldrick, Pearce, and Giordano 1982). During the early 1960s, several family therapists found that a given intervention approach was more or less effective depending on a family’s socioeconomic status (Hoffman 1981). This realization led to the development of several different “schools” of therapy that took into account the ecological setting in which the family was embedded. Gradually, the notion of ecological setting was refined to include not only income level and education but also ethnicity (Haley 1973).

      Although there is at least minimal...

    • 13 Hospitalized Appalachian Adolescents.
      (pp. 188-206)

      One morning, early, my mother took me to her and told me she needed me to stay home and be at her side. I was happy. I said I was glad to do anything she wanted. She held me close and said thanks. I remember feeling really good the rest of the day. But at night, in bed, I felt sad and my eyes became all filled up, and I didn’t know why.[Coles and Coles 1978, p. 77]

      This paper focuses upon relationships among rural to urban migration patterns, changing gender roles, and transformations in family structure as factors...


    • 14 Conscience and Convenience in Eastern Kentucky.
      (pp. 209-222)

      At the turn of the century, the Progressive movement began in an attempt to reform society’s dealings with the criminal, the delinquent, and the mental patient. According to Rothman (1980), the movement was largely a failure. The major result in mental health was a cosmetic gesture in which the asylum of the nineteenth century became the hospital of the twentieth century. The inclusion of the inmates of asylums under the medical model—with the implication of disease, treatment, and cure—did not change the policies of incarceration and coercive custodial care. However, under the new banner, old policies could be...

    • 15 Mental Health Professionals in Appalachia.
      (pp. 223-239)

      This essay addresses the role of health care professionals in Appalachia, focusing on the delivery of mental health care by psychiatric social workers in Appalachian community mental health clinics. Of particular concern is the relevance of Appalachian studies and clinical anthropology to the practical knowledge utilized by primary therapists in the patient-practitioner encounters that make up a large part of the therapists’ clinical day. My purpose is to illustrate the need for a body of literature applicable to health care delivery in Appalachia. Addressing this need involves a refocused perspective on regional professionals, understanding them as individuals whose appropriate education...

  11. Conclusion
    (pp. 240-245)

    This volume covers a wide range of topics and findings concerning the mental health of people in Appalachia. As such, it is not easy to summarize the material covered. In fact, it might be more useful to consider the collection as it bears on the question: How can the people of Appalachia be better served by mental health practitioners and services? The contributors to this volume offer a host of suggestions based on their work in the region. It is significant that despite the disciplinary differences among the authors, there is little disagreement in the kinds of suggestions they make....

  12. Contributors
    (pp. 246-247)
  13. Index
    (pp. 248-254)