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Article Excerpt
The last century has seen an increase in the population of Americans of Arab and Chaldean descent. In recent decades, clinicians have articulated the goal of enhancing their knowledge of cultural diversity for the purpose of improving their appreciation for diversity and the quality of their mental health interventions with diverse populations. However, there is currently little systematic empirical research regarding the counseling of Arab and Chaldean Americans, although awareness of the need for such research among mental health professionals has started to emerge. The purpose of this paper is to provide an integrative review of the values and socio-cultural forces that are relevant to the counseling of this population in North America, and to provide some culturally sensitive recommendations for working with American families of Arab and Chaldean ethnicity. In particular, we propose that effective interventions with clients of Arab and Chaldean ethnic backgrounds will need to be informed by an understanding of the everyday sociopolitical contextual background of target clients and the impact of values and acculturation processes on the family network.
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In recent years, Western scholars have developed an appreciation for "diversity" and "multiculturalism," resulting in increasing attempts to learn about various ethnic groups, including those of Arab and Chaldean descent, and to incorporate this understanding into their culturally sensitive psychotherapy with families (e.g., McGoldrick, Giordano, & Pearce, 1996; McGoldrick, Giordano, & Garcia-Preto, 2005). Like the terms often used for other groups such as Hispanic, European, Asian, Native and African American, the term "Arab American" encompasses many different groups whose heterogeneity stands in contrast to the much promulgated notion of cultures as unique and homogeneous (Miller, 1997). The term Arab is used to refer to Arabic speaking people from the Middle East. Because the modern Middle East represents diverse nationalities and peoples, cultures within cultures often develop with variations occurring according to specific language, religion, and village or tribal subcultures. Not all people from the region commonly referred to as the Middle East speak Arabic and thus not all are considered to be Arabs. For example, Iranians speak Farsi, Israeli Jews speak Hebrew, and Turks speak Turkish. Even though most Iranians, Arabs, and Turks in the Middle East are of the Islamic faith, some are of the Christian or Jewish faith (Shabbas & Al-Qazzaz, 1989).
The Chaldeans are one large subgroup of immigrants to the United States from the Middle East. They are Iraqi Catholic Christians who speak a dialect of Aramaic, although Arabic may be spoken as well (Kamoo, 1999). Because of the use of the Aramaic language (not just the Arabic language) and the formation of community enclaves within North American, Chaldean Americans are considered to be a separate but closely related subgroup to the broader category known as Arab Americans. Because of the intertwined culture, the two groups are often considered together.
The Arab American and Chaldean Council of Southeastern Michigan (ACC; 2007) reports that Americans of Arab and Chaldean descent have historically been underserved with respect to mental health services. There are at least two possible reasons that this population has been underserved. First, there is stigma attached to mental disorders and shame that reflects upon the family in Arabic culture (e.g., Abudabbeh & Aseel, 1999). For this reason, many less acculturated immigrants from the Middle East are reluctant to seek mental health services for themselves and their family members; thus, outreach efforts have been initiated by some community mental health organizations such as ACC. Second, because of the influx of refugees from the Middle East in recent decades, the overall population of Arab and Chaldean Americans has increased without a concomitant increase in culturally relevant services that are backed by empirical research (e.g., Haboush, 2007).
Although the U. S. Census Bureau has only recently begun to acquire statistics on individuals of Arab and Chaldean descent, it is currently estimated that these individuals number over 3.5 million in the United States (Arab American Institute, 2007). The largest concentration of Americans of Arab and Chaldean descent in the United States is in the Metropolitan Detroit area of Southeastern Michigan due to early immigration patterns and employment opportunities in the automobile industry in the late 19th and early 20th centuries. Among the more recent reasons for immigration is the need for refuge from the political unrest in the Middle East (ACC, 2007). Based on U.S. Census data, recent estimates from the Arab American Institute (2007) suggest that the current population of Arab Americans in Southeastern Michigan is approximately 490,000. However, Arab Americans are located throughout the United States with additional large urban concentrations in California, New York, New Jersey, Illinois, and Washingon, DC. Culturally relevant mental health issues for Arab and Chaldean Americans that may be encountered by counselors and other health professionals involve acculturation issues and traumatic histories related to immigration, current world events, and political unrest in the Middle East.
The purpose of this review is to provide mental health counselors with background information and recommendations to inform the culturally sensitive treatment of families and individuals with an Arab or Chaldean ethnic background. Understanding the family unit, whether treating one or multiple family members, is especially important in counseling Americans of Arab and Chaldean background because of the complex interplay of cultural and religious values within family life.
CULTURAL BACKGROUND AND VALUES
Large scale Arab and Chaldean immigration to North America began in the late 19th century and proceeded in three major waves (Abudabbeh, 1996, 2005a). Earlier waves of immigrants were more likely to be Christian and less educated, while later waves tended to have more Muslim immigrants, more refugees, and more individuals with higher education (e.g., Abudabbeh & Hays, 2006; Shabbas & Al-Qazzaz, 1989). The goal of ethnic preservation in more recent waves of Arab Americans has fostered family trends of intra-ethnic marriage, cultivating larger families than average in America, continued use of the mother tongue, and the valuing of Arab traditions (Zogby, 2001). Thus, while the goal of the earlier immigrants (from the 1890s into the early 20th century) was assimilation to the dominant host culture over and above ethnic identification (Zogby, 1990), later waves of immigrants in the late 20th century often focused on maintaining their ethnic identity and cultural traditions (Abudabbeh & Hays, 2006).
Each new wave of immigrants in the Arab and Chaldean communities has likely struggled with how to reconcile old-world values and those of the surrounding Western, mainstream culture. Like Asian and Hispanic cultures among others, Middle Eastern societies are often described as being collectivistic where independent thinking and individual needs, feelings, and thoughts are discouraged in favor of a submissive approach to the will of the family and larger social group (Dwairy, 1999). Western values, in contrast, favor the development of an individualistic orientation in which the rights and needs of the individual take priority over those of the social group. As with other collectivistic ethnic groups, there is often a stressful tension between the old world collectivistic values and the individualistic values of contemporary American life in Arab and Chaldean American families.
Arab and Chaldean families also often function according to a set of paternalistic values, where men are viewed as having more power in general than women, especially in matters outside of the family sphere (Feather, 2004; Glick & Fiske, 2001). With paternalism, men are viewed as needing to protect and provide for women who are expected to uphold conventional roles including a maternalistic view of nurturing men's emotional and domestic needs.
Arabic tradition and heritage incorporates both collectivistic and paternalistic values (Hakim-Larson & Nassar-McMillan, in press) and these are reinforced by the extended family, a unit cherished as the foundation in almost all Middle Eastern societies regardless of religion or nationality (Nydell, 1987, 2006). Judaism, Christianity, and Islam are all considered to be Abrahamic religions. That is, Abraham of the Old Testament is considered to be an ancestor common to followers of all three religions (Esposito, 2003). Thus, the collectivistic and family values in the ancient scriptures provide a common base for followers of these three major world religions in the Middle East. Family unity, closeness, and solidarity are valued over and above friendships and work life, and in return extended families offer emotional support and financial security in Arab families (Nydell, 1987, 2006). Individuals have limited freedom within their extended families, and the families typically have a multigenerational patriarchal structure marked by authoritarian attitudes and explicit limits placed...
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