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Review

Malcolm MacLachlan, Culture and HealthChichester, UK: John Wiley and Sons, 1997,316 pp.£15.99/US$39.95 (Pbk);ISBN 0-471-096626-6.

ISSUES OF CULTURE and diversity are impor-tant in all areas of psychology and the health

professions today. As such, students,. educators,and practitioners alike are all c1amo?ng for ~hemost pertinent and most relevant mformallonand resources on various topics in the healthprofessions with regard to the influence ofculture. Unfortunately, despite the widespreadrecognition of the importance of this topic, andthe influence it has in everyday life and inprofessional work, there is a glaring void in theliterature that professionals and educators canaccess.

It is within this backdrop that this book,Culture and Health, is a welcome addition. It

attempts to glean the relevant and most pertinentliterature related to cultural influences on bothmental and physical health into a single resourcefor the health practitioner. As one of the first,and perhaps to date only, book resource to do

so, it attempts to fill an important gap in ourknowledge, and provide an important service tothose who work with cultural issues in theireveryday professional practices, as well as tothose who teach in these areas.

The structure and outline of the book aresolid. The first chapter, 'Culture and health',serves as an introduction for the reader, definingculture, discussing the links between culture andboth the physical and mental aspects of health.The second chapter, 'Understanding culturaldifferences', serves a similar pUrpose, providingreaders with a frame of reference with which tounderstand cultural differences in health andtreatment approaches.

Chapters 3 through 7 discuss culture boundsyndromes, mental health, physical health, treat-ment, and health services, respectively, andrepresent more of a review of the available

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Journal of Heolrh Psychology

Copyright @ 1999 SAGE PublicationsLondon, Thousand Oaks and New Delhi.

[] 359-1053(1999O])4:]1Vol 4(1) 109-110; 006664

literature in each of these areas with regard tothe scientific and scholarly information relatedto each. The book doses adequately with a final

chapter on health promotion and disease preven-tion across cultures.

One of the greatest strengths of this book, Ifound, was the compilation of the availableliterature in each of the areas in chapters 3through 7. In chapter 3, for example, the authornot only focuses the reader on two culture-bound syndromes (koro and latah) in depth, butalso briefly discusses 10 others within the scopeof the origins of such syndromes within eachcultural milieu. The author then discusses mod-els concerning how culture contributes to thedevelopment of such syndromes.

Likewise, in chapter 5 on culture and physicalhealth, the author provides a convincing reviewof the role of social factors in health promotionor disease etiology, and introduces and discussesthe relevant literature with regard to culturaldifferences in physical health outcomes, includ-ing recent work on pain and mv IAIDS.

Another strength of the book is in the inclu-

sion of guidelines for professional practicewhich are included at the end of each chapter.These serve as important, concise, bullet state-ment-like summaries of the material presentedin the chapter, and in many cases go beyond thematerial to provide summative recommenda-tions to health professionals who deal with suchissues daily in their working lives. Thus, theniche of the book in tenns of targeting mentaland physical health professionals, as well as

educators in these fields, is well served by suchan inclusion.

One of the main weaknesses of the book,however, was its lack of a clear and concisedefinition of culture, especially in chapters I and2. The author failed to draw on much relevantliterature that is available over the past 50+years in definitions and conceptualizations ofculture, and how they impact on behaviors,psychology, and ultimately, health. 1l1is lit-erature exists, and the exclusion of such a

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literature gave me the impression at the outsetthat the book was not very scholarly in itswriting. Although I believe the author did amuch better job of including the relevant lit-erature in later chapters, I found the material inchapter 1 painstakingly lacking in this regard.

One result of this lack of attention to the

scholarly literature on culture definitions was thelack of a clear distinction between culture, race,and ethnicity. Indeed, most serious students ofculture would argue that there are importantdistinctions between these, each having its ownunique perspective on health issues that couldhave been fleshed out in the remainder of thebook. Unfortunately, however~ most of the bookwas written as if the word 'culture' encom-

passed all the terms. I believe that there areimportant differences between them, each ofwhich has different consequences and ramifi-cations for our unders"tanding of health out-come's.

The lack of discussion concerning the defini-tion of culture in the beginning of the book alsoresulted in the lack of a coherent messagethroughout the book concerning exactly whatculture's influence is on mental and physicalhealth, and treatment, diagnosis, and prevention.Rather, the material in chapters 3 and on, despitehaving the advantage of representing the avail-able literature in each respective area, did nothold well together as a coherent whole. Instead,the material read as if it was a series of shortessays and discussions on various topics thathappened to be grouped according to the generaltopic dealt with. The lack of a coherent thread ormessage running through the entire text servedas a great disservice to the material, and left mesearching for ways in my own mind as to how toput the literature together. Instead, it shouldhave been the author who presented his ideas to

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the readers about what culture means and how itinfluences health, and then he should have thoseideas in all subsequent chapters.

To be sure, this problem exists in large part inthe field. That is, it is the field that has not satback and considered how culture influences

health, incorporating all of the available evi-dence into a single, coherent picture. The fielditself has a long way to go not only in terms ofresearch but also in terms of the development oftheoretical models that can help incorporate andintegrate research findings from as broad a rangeof areas as possible. Thus, the book's lack inthis regard can also be seen as a reflection of thisgreat lack in the field. On one hand, while theauthor has contributed substantially to compil-ing much of the relevant literature into a singleresource, on the other hand, he has not pushedour knowledge much beyond the mere compila-tion of facts, and in so doing, has missed theopportunity to make a far greater potentialcontribution.

The best professional books are those that arescholarly in their approach, yet accessible andmeaningful to those who need to apply thatinformation in their professional lives. While thebook does have some strengths as mentionedabove, it also falls short in addressing theexisting scholarly literature on culture and itsinfluences on behavior, and in using that knowl-edge to integrate much of the knowledge pre-sented. While the book definitely addresses avoid in the literature, it also falls short ofservicing the professional audience it intends toserve in this regard.

DA VlD MATSUMOTOCulture and Emotion Research LaboratorySan Francisco State UniversitySan Francisco, CA, USA