Appalachian Mental Health

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.

This thoughtful, compassionate book makes a major contribution to our understanding of the Southern Appalachian child—his mental disorders and his adaptive strengths. Drawing upon his extensive fieldwork as a clinical child psychiatrist in Eastern Kentucky, Dr. Looff suggests means by which these children can be helped to bridge the gap between their subculture and the mainstream of American life today. The children described in this book, the author points out, are in a real sense not "all children." Since no child grows up in a vacuum, the children of Eastern Kentucky cannot be understood apart from the historical, geographic, and socioeconomic characteristics of the area in which they grow. Knowledge of the children requires some knowledge of the lives of parent, teachers, and the many others upon whom they are dependent. That is to say, mental disorder—or mental health—is embedded in a social matrix. Dr. Looff therefore examines the milieu of these Southern Appalachian children, their future as adults, and how they can achieve their potential—whether in their native or an urban setting. In viewing the children within their own cultural framework, Dr. Looff shows how they develop toward mental health or psychopathology, suggesting supportive techniques that build upon the strengths inherent in each child. These strengths, he suggests, rise out of the same culture that burdens the child with handicaps. Dr. Looff's position is one of guarded optimism, based on the successes of the techniques he has used and observed in seven years of work in Appalachian field clinics. Although he details instances of mental disorder in children, and instances of failure in family functioning, he notes at the same time family strengths and sees these strengths as sources of hope. Although this book is based on fieldwork techniques within a specific area and culture, it is paradigmatically suggestive of wider application. Dr. Looff demonstrates effectively and clearly the profound need for increased concern about what is happening to the rising generation—the children of Eastern Kentucky, the children of the Southern Appalachian region, and the children of the rural south.

The analysis of the developmental experiences and resulting personality patterns of Southern Appalachian children is based upon fieldwork in psychiatric clinics in eastern Kentucky, where diagnostic evaluation and treatment were provided for emotionally disturbed children. Observations on the mental health, or mental disorder, of the children are made concurrently with and in the light of observations on the ways in which eastern Kentucky families raise their children and on the kinds of adjustments to life that these children make. The historical, geographic, and socioeconomic characteristics of the region, in addition to characteristic family life styles and child rearing practices, are presented as the necessary context for understanding the children's mental health problems. Mental disorders are viewed largely as social phenomena and mental health or disorder is seen as firmly embedded in the social matrix. The study of family structure and interrelationships reveals three prominent themes influential in child development - emphasis on infancy of the children and family closeness, poor development of verbal skills, and the consideration of sexual maturation and functioning as a tabooed topic. Instances of emotional disturbance discussed are grouped accordingly: dependency themes, communication patterns, and psychosexual themes. (Kw).

Health and human service practitioners who work in Appalachia know that the typical “textbook” methods for dealing with clients often have little relevance in the context of Appalachian culture. Despite confronting behavior and values different from those of mainstream America, these professionals may be instructed to follow organizational mandates that are ineffective in mountain communities, subsequently drawing criticism from their clients for practices that are deemed insensitive or controversial. In Appalachian Cultural Competency, Susan E. Keefe has assembled fifteen essays by a multidisciplinary set of scholars and professionals, many nationally renowned for their work in the field of Appalachian studies. Together, these authors argue for the development of a cultural model of practice based on respect for local knowledge, the value of community diversity, and collaboration between professionals and local communities, groups, and individuals. The essays address issues of both practical and theoretical interest, from understanding rural mountain speech to tailoring mental health therapies for Appalachian clients. Other topics include employee assistance programs for Appalachian working-class women, ways of promoting wellness among the Eastern Cherokees, and understanding Appalachian death practices.Keefe advocates an approach to delivering health and social services that both acknowledges and responds to regional differences without casting judgments or creating damaging stereotypes and hierarchies. Often, she observes, the “reflexive” approach she advocates runs counter to formal professional training that is more suited to urban and non-Appalachian contexts. Health care professionals, mental health therapists, social workers, ministers, and others in social services will benefit from the specific cultural knowledge offered by contributors, illustrated by case studies in a myriad of fields and situations. Grounded in real, tested strategies—and illustrated clearly through the authors’ experiences—Appalachian Cultural Competency is an invaluable sourcebook, stressing the importance of cultural understanding between professionals and the Appalachian people they serve.

Appalachians have been characterized as a population with numerous disparities in health and limited access to medical services and infrastructures, leading to inaccurate generalizations that inhibit their healthcare progress. Appalachians face significant challenges in obtaining effective care, and the public lacks information about both their healthcare needs and about the resources communities have developed to meet those needs. In Appalachian Health and Well-Being, editors Robert L. Ludke and Phillip J. Obermiller bring together leading researchers and practitioners to provide a much-needed compilation of data- and research-driven perspectives, broadening our understanding of strategies to decrease the health inequalities affecting both rural and urban Appalachians. The contributors propose specific recommendations for necessary research, suggest practical solutions for health policy, and present best practices models for effective health intervention. This in-depth analysis offers new insights for students, health practitioners, and policy makers, promoting a greater understanding of the factors affecting Appalachian health and effective responses to those needs.

Appalachian Americans: Issues and Concerns for Counseling and Psychotherapy, an edited book, by Drs. Daya Singh Sandhu, Jeffrey Parsons, and Quentin Hunter, has recently made debut in the fields of multicultural and cross-cultural scholarship and practice as sui generis, a unique book of its kind in many ways. This is perhaps one of the few books that brings counseling needs and mental health problems of the Appalachian people at the forefront for the first time. Generally, Appalachian Americans have been neglected, overlooked, or just forgotten in the past.Since the Civil Rights Act of 1964, when culturally different, racially diverse, and people of color started getting attention as an integral part of the American society, multiculturalism became one of the major research interests of social scientists. As a result, most of the multicultural scholarship focused on the cultural identity, cultural worldviews, cultural values of five major racial groups which included, European Americans, African Americans, Latina/Latino Americans, Asian Americans, and Native Americans.Appalachian Americans: Issues and Concerns for Counseling and Psychotherapy is very different, unique, and distinct from most of the previous multicultural publications. This book is not based on the racial or cultural identity of the Appalachian people, it is distinctly based on the issues relating to social marginalization, economic and social injustices, and inequities. It focuses much of its attention on the impact of the oppression and social marginalization on Appalachian people's lives.In its very first and rare attempt, this powerful book explores and discusses the effects of geography on the personality and special rules for living on the Appalachian Americans. Appalachian trails, also called trails of tears, have been sadly neglected by the multicultural scholarship and institutions of higher learning. While people in the other parts of the country enjoy beautiful sceneries of mountains and their ranges, but people from Appalachia living on the same mountains call their challenges of life as mountains of problems.The contributors of this book are commended for opening new vistas and visions for the Appalachian people to tread proudly and fearlessly on many unbeaten paths of their lives without worrying about becoming prisoners of mountains.More than ethnic, cultural, and racial conflicts, Appalachian people face more economical and environmental racism and discriminations mostly caused by the big corporations who are hungry for coal from the Appalachia. Many authors have discussed issues relating to social, psychological, and environmental needs of the Appalachian people and offered strategies of social justice and advocacy to deal with poverty, injustices, and social marginalization that is so prevalent in the Appalachian Land.The aim of this textbook is to address the mental health problems and counseling needs of the Appalachian people and it is indispensable for mental health professionals, professional counselors, psychologists, social workers, psychiatrists, and all other people interested in the physical, emotional, and spiritual well-being of the Appalachian people. I hope it will adorn your home library soon.Daya Singh SandhuAugust 29, 2019