Caribbean Psychology: Indigenous Contributions to a Global Discipline 9781433820649, 1433820641

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CARIBBEAN PSYCHOLOGY

CARIBBEAN PSYCHOLOGY Indigenous Contributi ons to a Global Discipline Edited by JAI PAU L L. ROOPNARI NE and DE RE K C HADE E

AME R I C A N

PS YC H O LO G I CAL WA S H I N G TO N,

AS S O CI ATI O N

D C

Copyright © 2016 by the American Psychological Association. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning and digitization, or stored in a database or retrieval system, without the prior written permission of the publisher. Published by American Psychological Association 750 First Street, NE Washington, DC 20002 www.apa.org

To order APA Order Department P.O. Box 92984 Washington, DC 20090-2984 Tel: (800) 374-2721; Direct: (202) 336-5510 Fax: (202) 336-5502; TDD/TTY: (202) 336-6123 Online: www.apa.org/pubs/books E-mail: [email protected]

In the U.K., Europe, Africa, and the Middle East, copies may be ordered from American Psychological Association 3 Henrietta Street Covent Garden, London WC2E 8LU England Typeset in Goudy by Circle Graphics, Inc., Columbia, MD Printer: Bang Printing, Brainerd, MN Cover Designer: Berg Design, Albany, NY The opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American Psychological Association. Library of Congress Cataloging-in-Publication Data Roopnarine, Jaipaul L. Caribbean psychology : indigenous contributions to a global discipline / Jaipaul L. Roopnarine and Derek Chadee. pages cm Includes bibliographical references and index. ISBN 978-1-4338-2064-9 — ISBN 1-4338-2064-1 1. Psychology—Caribbean Area. I. Chadee, Derek. II. Title. BF108.C27R66 2016 155.8'9729—dc23 2015012398 British Library Cataloguing-in-Publication Data A CIP record is available from the British Library. Printed in the United States of America First Edition http://dx.doi.org/10.1037/14753-000

CONTENTS

Contributors.................................................................................................   ix Acknowledgments.......................................................................................   xi Introduction: Caribbean Psychology—More Than ..................................... 3 a Regional Discipline Jaipaul L. Roopnarine and Derek Chadee I.  Conceptual Issues......................................................................... 13 Chapter 1. Toward a Caribbean Psychology: Context, Imperatives, and Future Directions................................. 15 Ava D. Thompson Chapter 2. Global, Indigenous, and Regional Perspectives on International Psychology........................................... 45 John Berry

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II.  Developmental Psychology.......................................................... 69 Chapter 3. Family Socialization Practices and Childhood Development in Caribbean Cultural Communities....... 71 Jaipaul L. Roopnarine and Bora Jin Chapter 4.

Remote Acculturation and the Birth of an Americanized Caribbean Youth Identity on the Islands........................ 97 Gail M. Ferguson

Chapter 5.

Caribbean Research on Human Development in Adolescence and Adulthood: Progress and Recommended Directions...................................... 119 Ishtar O. Govia, Vanessa Paisley-Clare, and Tiffany Palmer

III.  Health and Community Psychology.......................................... 147 Chapter 6.

Current State of Health and Health Outcomes in Caribbean Societies.................................................. 149 Lutchmie Narine

Chapter 7.

Contextualizing the Health Behavior of Caribbean Men......................................................... 171 Andrew D. Case and Derrick M. Gordon

Chapter 8.

Interpersonal Violence in the Caribbean: Etiology, Prevalence, and Impact.................................. 205 Gillian E. Mason and Nicola Satchell

IV.  Social Psychology..................................................................... 233 Chapter 9.

Copycat Crime Behavior: Implications for Research in the Caribbean........................................................... 235 Ray Surette, Mary Chadee, and Derek Chadee

Chapter 10.

Fear of Crime: The Influence of Community and Ethnicity................................................................. 259 Mary Chadee and Derek Chadee

Chapter 11.

HIV/AIDS Stigmatization in the Caribbean: Implications for Health Care........................................ 281 Jannel Philip, Rosana Yearwood, and Derek Chadee

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V.  Clinical Psychology....................................................................  303 Chapter 12.

Mental Health in the Caribbean.................................. 305 Jacqueline Sharpe and Samuel Shafe

Chapter 13.

Metamorphosing Euro American Psychological Assessment Instruments to Measures Developed by and for English-Speaking Caribbean People............ 327 Michael Canute Lambert, Whitney C. Sewell, and Alison H. Levitch

Chapter 14.

Innovations in Clinical Psychology With Caribbean Peoples......................................................... 357 Rita Dudley-Grant

Index......................................................................................................... 387 About the Editors..................................................................................... 401

contents     

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CONTRIBUTORS

John Berry, PhD, Department of Psychology, Queen’s University, Kingston, Ontario, Canada Andrew D. Case, PhD, Duke Global Health Institute, Duke University, Durham, NC Derek Chadee, PhD, Department of Behavioral Sciences, The University of the West Indies at St. Augustine, Trinidad and Tobago Mary Chadee, MS, Department of Behavioral Sciences, The University of the West Indies at St. Augustine, Trinidad and Tobago Rita Dudley-Grant, PhD, MPH, Virgin Islands Behavioral Services, St. Croix, U.S. Virgin Islands Gail M. Ferguson, PhD, Department of Human and Community Development, University of Illinois at Urbana-Champaign Derrick M. Gordon, PhD, Yale University School of Medicine, New Haven, CT Ishtar O. Govia, PhD, Department of Sociology, Psychology and Social Work, The University of the West Indies at Mona, Jamaica Bora Jin, PhD, Department of Child and Family Studies, Syracuse University, Syracuse, NY

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Michael Canute Lambert, PhD, School of Social Work, University of North Carolina at Chapel Hill Alison H. Levitch, PhD, Department of Psychology, Bloomsburg University, Bloomsburg, PA Gillian E. Mason, PhD, Department of Sociology, Psychology and Social Work, The University of the West Indies at Mona, Jamaica Lutchmie Narine, PhD, Department of Public Health, Food Studies, and Nutrition, Syracuse University, Syracuse, NY Vanessa Paisley-Clare, MS, Independent Practice, Clinical and Consulting Psychology, Kingston, Jamaica Tiffany Palmer, MS, Independent Practice, Clinical and Consulting Psychology, Kingston, Jamaica Jannel Philip, PhD, Department of Behavioral Sciences, The University of the West Indies at St. Augustine, Trinidad and Tobago Jaipaul L. Roopnarine, PhD, Department of Child and Family Studies, Syracuse University, Syracuse, NY Nicola Satchell, MA, Department of Government, The University of the West Indies at Mona, Jamaica Whitney C. Sewell, MSW, School of Social Work, University of North Carolina at Chapel Hill Samuel Shafe, MD, MS, North West Regional Health Authority, Eric Williams Medical Sciences Complex, The University of the West Indies Medical School at St. Augustine, Trinidad and Tobago Jacqueline Sharpe, MBBS, MRCPsych, North West Regional Health Authority, Eric Williams Medical Sciences Complex, The University of the West Indies Medical School at St. Augustine, Trinidad and Tobago Ray Surette, PhD, School of Health and Public Affairs, Criminal Justice and Legal Studies, University of Central Florida, Orlando Ava D. Thompson, PhD, Department of Psychology, College of The Bahamas, Nassau Rosana Yearwood, PhD, Department of Behavioral Sciences, The University of the West Indies at St. Augustine, Trinidad and Tobago

x       contributors

ACKNOWLEDGMENTS

This volume grew out of our joint interest in delineating the role of different branches of the psychological sciences in addressing the human needs of Caribbean peoples from diverse backgrounds. It marks a commitment between Syracuse University and The University of the West Indies, St. Augustine, to work collaboratively to enhance research and training in different areas of psycho­logy in the Caribbean region. We are deeply indebted to John Berry and Merry Bullock, who assisted us with the book prospectus, and we appreciate the feedback provided on the different chapters by Thomas Achenbach, Camille Alexis-Garsee, Janet Brown, Barbara Landon, Ramaswami Mahalingam, Patricia Mohammed, Ross Parke, and Louise Silverstein. To our colleagues in the Caribbean and in the diaspora, we thank you for your support and research efforts that made this volume possible. We extend our sincere gratitude to our respective families for their understanding during the preparation of this volume. Elif Dede Yildirim assisted with the preparation of the manuscript.

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CARIBBEAN PSYCHOLOGY

INTRODUCTION: CARIBBEAN PSYCHOLOGY—MORE THAN A REGIONAL DISCIPLINE JAIPAUL L. ROOPNARINE AND DEREK CHADEE

Its history firmly planted in North American and European cultural settings and traditions, psychology as a discipline is becoming increasingly global. This no doubt is due to the greater recognition of the role of psychology in understanding behavioral processes and addressing human needs in an increasingly complex, interconnected world community that is marked by ever-changing political, social, and economic conditions. At the same time, several local, regional, and international organizations have called for psychological processes and human development to be defined from a pancultural or universalist perspective. Essentially, this would speak to behavioral patterns and processes and their underlying etiology and neurological underpinnings—those that are shared among human beings and those that are culture specific. The latter entail considerations of local customs, beliefs, and practices and physical factors within the geography and ecology of settings that influence pathways to human development, the indigenous view. http://dx.doi.org/10.1037/14753-001 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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The indigenous view does not discount the cross-comparative approach to studying psychological processes (Berry, 2013). However, it does subscribe to a philosophy of the generation of scientific information from within the culture as a basis for laying the foundation for a larger, integrated psychological science field. In this vein, cultural, cross-cultural, and indigenous psychological approaches to mapping human development and functioning across cultural communities have been instructive. Employing these different approaches, researchers have placed cultural communities along dimensions of individualism and collectivism with regard to the self, interpersonal relationships, attribution style, and well-being (see Oyserman, Coon, Kemmelmeier, 2002, for a discussion); examined parenting styles (e.g., levels of warmth, sensitivity, control) and the nature and quality of parent–child attachment relationships (see reviews by Ahmed, Rohner, Khaleque, & Gielen, in press; Khaleque & Rohner, 2012); determined rates of adult depression and depressive symptoms (see Pan American Health Organization, 2011, for an assessment of Caribbean countries); developed scales to measure childhood behavioral difficulties (Achenbach, in press); and used common conceptual models to catalog psychological adjustment to new cultural communities in several societies around the world (e.g., Berry, 2008; Sam & Berry, 2015). In these and other efforts (see Roopnarine, 2015; Gielen & Roopnarine, in press), researchers, including those in the Caribbean and Caribbean diaspora, have been able to carefully document common properties that are basic to human functioning across cultural settings. However, in some cases they have also noted cultural variations in the manifestations of behaviors and cultural pathways to outcomes that exhibit country-level or regional variations. This volume was conceived in the spirit of understanding and defining the particularities and complexities of a regional psychology of Caribbean peoples with an eye toward the shared meaning of psychological principles within a larger global context. Why the need for a focus on Caribbean psychology? For one thing, as Ava D. Thompson (Chapter 1, this volume) puts it, despite attempts to develop an indigenous view of psychology, the psychological stories of Caribbean peoples have been missing from the broader international discourses in the psychological sciences. This missing link is not limited to Caribbean psychology. The same may also be said for human development in other regions such as Africa, the Middle East, Asia, and Latin America. Obviously, psychological principles that are not inclusive of other cultural groups around the world are inherently limited and fail to utilize the two-way flow and integration of scientific information from the majority to the developed world. The bidirectional flow and exchange of information could be of use in validating exiting theories and constructing new ones, in shaping research agendas, in 4       roopnarine and chadee

encouraging collaborations and cross-fertilization of ideas, and in strengthening clinical practice and service delivery systems in attending to human needs more broadly. Given their different histories of oppression, experiences with colonialism, and identity confusion, a psychology of Caribbean peoples has relevance beyond its local borders. The large Caribbean diaspora in North America and Europe (e.g., Great Britain, the Netherlands) and ethnic and cultural groups in other postcolonial societies in Africa and other parts of the world may profit from knowledge systems developed in the Caribbean. Because Caribbean ethnic groups (e.g., African Caribbeans, Indo Caribbeans) in the diaspora are twice-removed from the ancestral cultures, a focus on them may offer insights into cultural continuity and discontinuity in patterns of psychological functioning and development. Not apart from the abovementioned issues is the development of a regional understanding of a Caribbean psychology that considers the multiple needs and realities of life in the Caribbean itself. The Caribbean is a vast region, with diverse ethnic groups who speak different languages (e.g., Spanish, French, Kreyól, English, Hindi, Arabic, Dutch, different patois); have ancestral ties to Africa, Asia, Europe, and the Middle East; are indigenous to the area (e.g., Amerindians in Guyana); and who are of Mixed-Ethnic ancestry (e.g., African Caribs). The unique geography and ecologies of these small nation states that stretch from northern South America to the eastern coast of the United States and west to Central America represent a rich and diverse cultural tapestry of life and subsistence and economic patterns. Within this diversity of ecological settings and life conditions, how individuals define the self and meet the demands of everyday life varies, often greatly, within and among countries. For example, although there may be similarities in human responses to the earthquake in Haiti, the volcanic eruption in Montserrat, the frequent floods in Guyana, and the hurricanes in Jamaica, important differences exist in how people in these small nation states approach and cope with disasters, depending on economic resources, gender ideologies, ethnicity and race, health belief systems, the availability of mental health services, and the ability of governments to act swiftly to deal with psychological distress. Until recently, these independent nation states have not been able to cooperate on the training of psychologists or in outlining the psychological needs of Caribbean peoples. Relatedly, any approach to psychological issues in the Caribbean must take into account the unique histories and behavioral patterns of different Caribbean ethnic groups. These postcolonial societies have endured the transplantation and loss of cultural traditions through slavery and indentured servitude, invasion of the cultural psyche of individuals, political and social hegemony, and experiences with violence during slavery and colonization. Framing psychological issues in the context of oppression, resistance, and introduction     

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adaptation can enhance understanding of family structures, child-rearing patterns, gender roles and gender disparities in socialization practices and interpersonal relationships, identity formation, health belief systems, views on accessing mental health services, stigma and stereotyping, attribution styles, and other aspects of everyday life in different ethnic groups and communities across the Caribbean. However, simply integrating sociohistorical experiences into articulating contemporary psychological issues is clearly not sufficient. As Thompson (see Chapter 1, this volume) and the Caribbean Alliance of National Psychological Associations (CANPA) have outlined, greater consideration is needed for the worldviews and cultural patterns of living of Caribbean ethnic groups—the unique features and attributes of their cultural lives, behavioral patterns, modes and ways of thinking, and regional and within country factors—that promote and impede well-being and human capital development. Moreover, psychological theories, clinical practice, and policies that are relevant to psychological functioning should emanate from within Caribbean societies. This volume is an effort toward that end: We pre­ sent a more unified view of contemporary psychological issues of Caribbean peoples that will better inform training and research efforts in the region and the diaspora and at the same time add to the overall universal body of knowledge on psychology. THE CONTENTS OF THE BOOK Conceptualizing a psychology of Caribbean peoples has not been an easy journey. The lack of training infrastructure, systematic mental health policies, and plans within and across countries, as well as the influence of and adherence to dominant psychological theories, clinical practices, and research findings from North America and Europe, have at times undermined the best laid plans to develop a psychological science of Caribbean peoples. Our focus on developmental, health, social, and clinical areas of psychology aligns well with the current needs of Caribbean peoples as identified by social scientists, policymakers, civil society groups, nongovernmental organizations, government agencies across countries, regional bodies (e.g., the PanAmerican Health Organization, CANPA), and international organizations (e.g., World Health Organization [WHO] and the United Nations Development Program [UNDP]). These different organizations and groups have based their recommendations on large-scale, multiple country analysis and individual studies in formulating their recommendations as to the most pressing issues affecting Caribbean peoples. For instance, in working with the United Nations Children’s Fund and the Bernard van Leer Foundation, child development and early childhood education experts within the Caribbean 6       roopnarine and chadee

have targeted early parent–child relationships as important for setting the life trajectories of young children as they navigate their way through difficult home and neighborhood environments. Likewise, the WHO has provided a macrolevel view of mental health issues and systems, and the UNDP has provided some alarming statistics on crime and citizen insecurity across Caribbean countries (United Nations Development Program, 2012). In addition, the developmental, health, social, and clinical areas of psychology have generated the most scholarship by researchers within the Caribbean region and the diaspora. To outline and lay bare some of the psychological information accrued so far within the four areas of psychology considered in this volume, we drew from a distinguished group of scholars (e.g., clinical psychologists, cultural psychologists, child developmentalists, community psychologists, psychiatrists, social psychologists, public health researchers). They are mainly from within the Caribbean and the Caribbean diaspora and were trained in North America, Europe, and in the Caribbean. Their different expertise converges to provide rich accounts of culturally situated human development within the Caribbean context. To set the stage for a regional understanding of psychological science in the Caribbean, authors of chapters in Part I, Conceptual Issues, of this book provide arguments in support of a regional psychology of Caribbean peoples and its role within the international arena. In Chapter 1, Thompson chronicles the development of a regional understanding of psychological principles, from the early efforts by Bahamian and Jamaican psychologists to attend to mental health needs within the context of Caribbean lived experiences and realities to recent developments to establish a regional infrastructure for training psychologists and formulating research priorities, clinical practices, and policies that advance the well-being of Caribbean peoples. She also highlights the contributions of Caribbean researchers and professionals in the psychological sciences to the development of a growing body of knowledge in seminal areas of human functioning. This is followed by John Berry’s chapter, which offers compelling reasons for a more extended, global view of psychology. Berry points to the ethnocentrism of North American psychology and proposes three major approaches to interpret culture–behavior links: the culture-comparative, the cultural, and the indigenous perspectives. He makes a strong case for an integration of Caribbean peoples at the political, social, and economic levels that will permit a common identity. Noting factors such as family structural arrangements, socialization patterns, remote acculturation, cultural belief systems, and economic and social conditions, the authors of the three chapters in Part II, Developmental Psychology, present a lifespan view of development patterns in Caribbean groups. In Chapter 3, which focuses on family socialization, Jaipaul L. introduction     

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Roopnarine and Bora Jin provide a comprehensive overview of parenting styles; religious, ethnic, and academic socialization; and childhood outcomes across Caribbean countries (e.g., Guyana, Trinidad and Tobago, Barbados, Jamaica). To offer continuity, the other two chapters in this section focus on adolescent and adult development. In Chapter 4, on remote acculturation, orientation to one’s own culture, and a remote culture, Gail M. Ferguson covers cutting-edge research on the effects of intercultural contact and exposure on adolescent identity and child-rearing. This chapter has broad implications for the impact of cultural contact through tourism, trade, and the media in most regions of the world. Chapter 5 builds on the theme of developmental outcomes, and Ishtar O. Govia, Vanessa Paisley-Clare, and Tiffany Palmer use rigorous selection criteria to highlight factors that aid and abet adolescent and adult development. In all three chapters in this section, the authors discuss theoretical frameworks that are best suited for research on Caribbean ethnic groups. Part III, Health and Community Psychology, begins with Chapter 6, by Lutchmie Narine, and is an overall survey of health conditions in different Caribbean countries and ethnic groups. This overview brings to the fore age and gender differences in the types of major diseases that affect Caribbean groups. Data are presented on communicable and noncommunicable diseases and the risk factors associated with their onset. Regional differences are evident in cardiovascular disease, diabetes mellitus, suicides, tobacco and alcohol use, and vehicular accidents—all on the increase in a region with under­ developed medical care systems. It also touches on the role of psychologists in assisting to stem the tide against such health issues as obesity, alcoholism, inactivity, and disability due to health statuses that have strong behavioral components. We chose, among the diverse health psychology issues that exist in the Caribbean, to include a chapter on Caribbean men’s health. Chapter 7’s focus on a range of theories on health behaviors and cultural scripts in no way implies that the health concerns and needs of Caribbean women are less important. In fact, the theories Andrew D. Case and Derrick M. Gordon explore in this chapter have implications for women’s health issues, and they refer to bodies of work on women’s health. In Chapter 8, Gillian E. Mason and Nicola Satchell delve into one component of health that is of central importance to women’s and children’s safety and well-being: interpersonal violence. Given the importance of eradicating interpersonal violence worldwide, this chapter calls attention to the history of violence that Caribbean ethnic groups have been subjected to and the socialization and acceptance of violence as possibly normative in child rearing and interpersonal relationships. It is not surprising, as is the case in other parts of the world, that the negative consequences of interpersonal violence on individuals, 8       roopnarine and chadee

families, and children are dire, its effects cascading into other institutions in the community. Acknowledging increasing concerns about crime and citizen insecurity and a body of work on criminology based in the southern Caribbean, the authors in Part IV (Social Psychology) focus on copycat behavior (Chapter 9; Ray Surette, Mary Chadee, and Derek Chadee), fear of crime (Chapter 10; Mary Chadee and Derek Chadee), and stigmatization (Chapter 11; Jannel Philip, Rosana Yearwood, and Derek Chadee). Although copycat behavior has not been well documented in the Caribbean, it certainly has implications for bullying and for addressing violence at the societal and regional levels. Fear of crime is palpable in a number of Caribbean countries, as families, individuals, and communities retreat from participation in mainstream life and grapple with the role of ethnicity, income, and their own interpretations of incivility and fear of crime. Chapter 11, on stigmatization caps off this section. A social psychological understanding of HIV/AIDS stigmatization has broad applications in terms of health care access and delivery. The underlying social cognitive structures of stigmatization may be applicable to other areas of discrimination and prejudice, such as ingroup and outgroup relationships, fear of crime, and so on, in the more culturally diverse nations of Guyana and Trinidad and Tobago. The authors of chapters in the final section of the book, Part V, Clinical Psychology, discuss the prevalence of mental health disorders, their possible etiologies, and the relevance of well-established instruments for assessing mental health in the Caribbean. After providing a brief history of the evolution of mental health systems and treatment in the Caribbean, Jacqueline Sharpe and Samuel Shafe (Chapter 12) discuss prevalence rates of schizophrenia, affective disorders, personality disorders, substance abuse, and suicides and attempted suicides, and make recommendations for new research and the implementation of mental health plans and policies. Of course, in the domain of intervention strategies, one should be concerned about the cultural appropriateness and validity of instruments, mostly developed in North America, for assessing human functioning in Caribbean ethnic groups. In Chapter 13, Michael Canute Lambert, Whitney C. Sewell, and Alison H. Levitch engage in an extensive discussion of how different instruments (e.g., Brief Symptom Inventory [Derogatis & Spencer, 1993], Child Behavior Checklist [Lambert, Essau, Schmitt, & Samms-Vaughan, 2007]) fare in terms of their psychometric properties when used with Caribbean groups, a discussion that enables the reader to determine the cultural validity of assessment batteries. More important, Lambert and his colleagues carefully analyze instruments (e.g., Caribbean Symptom Checklist; Lambert et al., 2013) that were modified or developed for use with Caribbean adults and children. Of course, in the domain of intervention strategies, concerns include the cultural appropriateness and validity of introduction     

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instruments, mostly developed in North America, for assessing human functioning in Caribbean ethnic groups. In Chapter 14, Rita Dudley-Grant identifies crucial mental health issues, sociocultural factors (e.g., stigmatization, immigration, gender disparity in accessing services), and diverse mechanisms surrounding clinical psychology and practice (e.g., role of spirituality), and introduces diverse intervention strategies (individual, group, family therapy) and their efficacy in working with groups in Caribbean countries. This volume brings together major bodies of work in four areas of the psychological sciences that are pertinent to Caribbean ethnic groups. A regional focus on Caribbean psychology will not only assist in further determining and attending to the needs of Caribbean ethnic groups but will also serve as a platform for building bridges and collaborations with other regional and international organizations to enhance the development of a global psychology. This volume serves as a resource for all those concerned with the well-being of Caribbean ethnic groups and the development of the region. It should be of interest to upper level undergraduates and graduate students interested in cultural psychology, cross-cultural psychology, and ethnic studies within the Caribbean and more broadly across the world; those in the Caribbean and the Caribbean diaspora who focus on the applied, clinical, and research areas of psychology and psychiatry; other professionals, such as social workers, child development and early childhood specialists, and anthropologists; and criminologists, health professionals, policymakers, and government officials within the Caribbean and in other developing societies who focus on human development. REFERENCES Achenbach, T. (in press). Developmental approaches to psychopathology: Multi­ cultural challenges, findings, and applications. In U. P. Gielen & J. L. Roopnarine (Eds.), Childhood and adolescence: Cross-cultural perspectives and applications (2nd ed.). Westport, CT: Praeger. Ahmed, R. A., Rohner, R., Khaleque, A., & Gielen, U. P. (in press). Parental acceptance and rejection in the Arab world: How do they influence children’s development? In U. P. Gielen & J. L. Roopnarine (Eds.), Childhood and adolescence: Cross-cultural perspectives and applications (2nd ed.). Westport, CT: Praeger. Berry, J. W. (2008). Globalisation and acculturation. International Journal of Intercultural Relations, 32, 328–336. http://dx.doi.org/10.1016/j.ijintrel.2008.04.001 Berry, J. W. (2013). Achieving a global psychology. Canadian Psychology/Psychologie Canadienne, 54, 55–61. http://dx.doi.org/10.1037/a0031246 Derogatis, L. R., & Spencer, P. M. (1993). Brief Symptom Inventory: BSI. Upper Saddle River, NJ: Pearson.

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Gielen, U. P., & Roopnarine, J. L. (Ed.). (in press). Childhood and adolescence: Crosscultural perspectives and applications (2nd ed.). Westport, CT: Praeger. Khaleque, A., & Rohner, R. P. (2012). Pancultural associations between perceived parental acceptance-rejection and psychological adjustment of children and adults: A meta-analytic review of worldwide research. Journal of Cross-Cultural Psychology, 43, 784–800. http://dx.doi.org/10.1177/0022022111406120 Lambert, M. C., Essau, C. A., Schmitt, N., & Samms-Vaughan, M. E. (2007). Dimensionality and psychometric invariance of the Youth Self-Report Form of the Child Behavior Checklist in cross-national settings. Assessment, 14, 231–245. http://dx.doi.org/10.1177/1073191107302036 Lambert, M. C., Lambert, C. T. M., Hickling, F., Mount, D., Le Franc, E., SammsVaughan, M., . . . Levitch, A. (2013). Two decades of quantitative research on Jamaican children and current empirical studies on Caribbean adult functioning. Caribbean Journal of Psychology, 5, 14–39. Oyserman, D., Coon, H. M., & Kemmelmeier, M. (2002). Rethinking individualism and collectivism: Evaluation of theoretical assumptions and meta-analyses. Psychological Bulletin, 128, 3–72. Pan American Health Organization. (2011). WHO-AIMS: Report on mental health systems in Latin America and the Caribbean. Gatineau, Quebec, Canada: Canadian International Development Agency. Retrieved from http://www.who.int/ mental_health/evidence/mh_systems_caribbeans_en.pdf Roopnarine, J. L. (Ed.). (2015). Fathers across cultures: The importance, roles, and diverse practices of dads. New York, NY: Praeger. Sam, D. L., & Berry, J. W. (2015). Cambridge handbook of acculturation psychology (2nd ed.). Cambridge, England: Cambridge University Press. United Nations Development Program. (2012). Caribbean human development report 2012: Human development and the shift to better citizen security. Retrieved from http://hdr-caribbean.regionalcentrelac-undp.org/download-report

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I CONCEPTUAL ISSUES

1 TOWARD A CARIBBEAN PSYCHOLOGY: CONTEXT, IMPERATIVES, AND FUTURE DIRECTIONS AVA D. THOMPSON

Modern scientific psychology, by virtue of its origin, theoretical contributions, overall research production, and influence in the global context, is predominantly a Euro American discipline that has been exported as the universal model for understanding and promoting human psychological functioning. There is now growing acceptance of its conceptualization as a culturally bound discipline (i.e., grounded in a singular cultural/tradition), the validity of decades of criticisms about its limited application in the global context and calls for a culturally relevant science (Adair & Ka˘gitçibas¸i, 1995; Azuma, 1984; Diaz-Guerrero, 1993; Henrich, Heine, & Norenzayan, 2010; Moghaddam & Taylor, 1986; Owusu-Bempah & Howitt, 2000; Smith, Rodríguez, & Bernal, 2011; Watts, 1992). These persistent critiques, together with a range of geopolitical, economic, and technological developments, have contributed to mainstream psychology’s emerging evolution.

http://dx.doi.org/10.1037/14753-002 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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Psychology is gradually expanding (Adair & Huynh, 2012; Adair, Unik, & Huynh, 2010; Henrich et al., 2010) beyond its narrow Euro American representation of humanity and developing as a culturally based discipline that is more representative of, and relevant to, the diversity in the 21st-century global community. This promising paradigmatic shift is evidenced in broadened psychological content, research methodology, application models, and the growth of perspectives for capturing the centrality of culture. Specific developments in the last category include global psychology, international psychology, and various examples of cross-cultural psychology, such as cultural, cross-comparative, and indigenous psychologies (Berry, Poortinga, Breugelmans, Chasiotis, & Sam, 2011; see also Chapter 2, this volume). Although the cross-comparative approach (previously known as the crosscultural approach) is most widely recognized, it is possible that the indigenous approach, which predates the cross-comparative approach (Brock, 2006) and has grown exponentially in the past 40 years, has made the greatest contribution to an increasingly culturally based psychology. Indigenous psychology (IP), also called alternative psychology and population-specific psychology (Watts, 1992), is primarily the area in which psychologists from the majority world (i.e., countries that are also considered developing or low income; Ka˘gitçibas¸i, 1996), who have historically represented the periphery of the discipline, have made the most significant impact. This diverse and burgeoning body of literature represents the intentional effort of psychologists to “domesticate psychology” (see Nsamenang’s contribution in Allwood & Berry, 2006) as a critical component of the postcolonial development agenda and to develop an approach to psychology that is relevant to the social, political, and cultural character of their national contexts (Allwood & Berry, 2006). Global IP leaders note the critical contributions of majorityworld luminaries from virtually all continents: Virgilio Enriquez, Uichol Kim, Jai B. Sinha, and Fathalia Moghaddam from Asia; Rogelio Diaz-Guerrero from North America; Rubén Ardilla from South America; and Bame Nsamenang and Michael Durojaiye from Africa (Allwood & Berry, 2006; Kim & Berry, 1993; Kim & Park, 2007). However, the seminal work of “minority” psychologists—that is, African American, Hispanic American, and Asian American psychologists, including Na’im Akbar, Cynthia García Coll, Aletha Huston, David Matsumoto, Vonnie Mcloyd, Wade Nobles, Amado Padilla, and Roderick Watts (Gershoff, Mistry, & Crosby, 2013; Watts, 1992)—has also contributed substantially to the development of IP. Collectively, their work has challenged mainstream psychology and inspired other psychologists who have continued to interrogate their own psychological traditions (Brock, 2006), develop and measure concepts that more meaningfully reflect the realities of peoples in their contexts, promote multihemispheric exchange of psychological science, reduce the cultural and intellectual 16       ava d. thompson

dependence on mainstream psychology, and seek to address the power imbalance in the discipline. In addition, the sustained efforts to critically examine and promote psychology’s engagement with society address social challenges that are often neglected in mainstream psychology (Azuma, 1984) and promote national development in countries that continue to experience dramatic social, political, and economic changes. As a result, indigenous psychologists have contributed to reinvigorated psychological growth in the global community (Stevens, 2007) and substantively enhanced psychology’s representation, relevance, and capacity to improve human functioning and well-being in all contexts. Although global IP leaders typically recognize the cultural specificity of their IP approach (e.g., conceptualizations, research findings) and eschew a priori statements of generalizability or universality to peoples of other cultures, they recognize similarities in the contextual factors, including the intellectual hegemony of Euro American psychology, that have contributed to the development of IP in the global context and highlight other points of convergence (e.g., themes, issues, areas of focus, challenges) across the IP literature (Allwood & Berry, 2006). These similarities extend to countries and regions that have not traditionally been featured in the history of psychology. The Caribbean region is included among those parts of the global community whose psychology stories are conspicuously missing from the discipline’s historiography (Alvarez Salgado, 2000), despite its own history of indigenization. This chapter represents an attempt to address this issue but with the recognition that a comprehensive story of Caribbean psychologists’ indigenizing efforts requires collaboration with colleagues from across the region and the diaspora. In this chapter, I first highlight the indigenous contributions of select Caribbean psychologists, provide a historical context for collective efforts to advance the discipline, and outline critical contemporary organizational developments to promote the development of a Caribbean psychology. In the following sections, I present features of psychologists’ vision for a Caribbean psychology and then describe a framework that integrates the various components. In the last section, I offer several sets of recommendations for establishing a Caribbean psychology, drawing on the extant literature on Caribbean psychology; the developments in other regions of the majority world; and organizations in the Caribbean’s intellectual, health, and human development landscape. Consistent with the views of regional colleagues (Alvarez Salgado, 2000; Amuleru-Marshall, 2013), I use the singular term Caribbean psychology for ease of communication but recognize that the term Caribbean psychologies likely more accurately reflects the realities of the region and the actual direction of the field. toward a caribbean psychology     

17

THE NEED FOR A PSYCHOLOGY OF HUMAN DIVERSITY: CARIBBEAN RESPONSES Although the achievement of Caribbean psychologists is less wellknown internationally (Thompson, 2011, 2013), they have also struggled with the application of an “alien framework” (Sinha, 2010) in their community and national contexts. Thompson (2011, 2013) has outlined the multiple ways that regional psychological scholars, educators, and practitioners have highlighted the limitations of an imported psychology and illuminated its negative impact on the development of culturally appropriate application and perceptions of progress in national contexts. Similar to scholars elsewhere in the global community (Adair, 1995; Allwood, 2005; Moghaddam, 1997; Nsamenang, 1992, 2004) and other mental health professionals in the region (e.g., Hickling, 2007), regional psychologists have also examined mainstream psychology’s effects on thinking patterns, values, and behaviors of the Caribbean peoples and explored how the overreliance on an imported science limits public and policymakers’ confidence in and acceptance and use of the discipline and essentially can retard, rather than facilitate, national development (Hickling, Doobar, et al., 2008). Pioneering psychological scholars across the various islands and territories of the Caribbean region, who by necessity were trained outside of their country of origin, endeavored (albeit to varying degrees) to apply psychology in a manner that was relevant to their local cultures and needs. The professional achievements of Bahamian psychology pioneers exemplify this approach. Timothy McCartney, the father of Bahamian psychology, earned his PhD from the University of Strasbourg, France, in 1967 and returned to The Bahamas, then a British colony, and developed an approach to psychology that was particularly responsive to the Bahamian context. McCartney (1971) cited the need to “throw to the wind any traditional text-book approach or accepted procedure in order to cater to the specific needs of an unorthodox i.e., Bahamian situation” (p. 2). He proceeded to integrate Bahamian “actualities” (p. 3), for example, traditional healing practices (i.e., bush medicine), spirituality, beliefs, ways of thinking, political and social realities, and ethical standards into individual and group practice, psychoeducational activities, and the numerous organizations and associations established under his leadership and/or with his participation. His early publications (e.g., Neuroses in the Sun, 1971; Ten, Ten the Bible Ten: Obeah in the Bahamas, 1976) also reflected his commitment to developing a psychological approach that was grounded in the Bahamian and Caribbean historical and cultural realities. McCartney’s efforts were complemented by those of Corolyn Hanna and Mizpah Tertullien, who worked in different sectors of the Bahamian community. Tertullien’s lecture series, “Psychologically Speaking,” first aired in 1973 as a component of the 18       ava d. thompson

Independence Project (the year of Bahamian independence) on the only radio station in the country. The series was produced with the goal of “effecting positive psycho-social change” (p. 4) and in 1976, three years after independence, Tertullien (1976) published a book (Psychologically Speaking: Attitudes and Cultural Patterns in the Bahamas) that she hoped would ultimately contribute to national development. Despite the paucity of information on the history of psychology and the accomplishments of regional psychology pioneers, a similar indigenizing philosophy is evident in contributions of select pioneering psychologists in other Caribbean contexts: Eldra Shulterbrandt in the U.S. Virgin Islands (Todman, 2000) and Peter Weller, Audrey Pottinger, and Rosemarie Johnson (Ward & Hickling, 2005), who fostered psychology’s growth to meet the sociopsychological needs of the Jamaican society (Frey & Black, 2011). Bernal (1985) outlined the work of philosophers/psychologists in Cuba whose work was critical to the emergence of scientific contemporary psychology, highlighted the social consciousness of psychologists during the colonial period, and described the priority they placed on developing a solutions-based approach to psychology that met the needs of the community. Alphonso Bernal del Reisgo, a key figure in Cuban psychology, wrote textbooks in psychology (rather than translate English language books) and sought to address tertiary educational reform and child rearing as critical components in developing an approach to psychology that reflected the sociocultural and economic realities of Cuban society (Bernal, 1985). Although some pioneers focused their indigenizing efforts on a single Caribbean context, others were more intentional in addressing issues of universality and diversity across Caribbean contexts in their scholarship. One such scholar is Ramesh Deosaran, who although formally trained as a criminologist, is regarded by many as a pioneer in Caribbean social psychology with his extensive scholarship in Trinidad and Tobago and comparative work across several Caribbean countries. He lamented the “invasion of the Caribbean psyche” (Deosaran, 1992, p. 19) by European and European American influences and called for scholarship that combines liberation theology with humanistic psychology to empower the Caribbean people, that is, to transcend their external conditions and recognize their capacity to determine their well-being. This “social psychology of self-discovery” (Deosaran, 1992, p. 20) and other components of his work demonstrated that although the methods and theories of Euro American social sciences have some application within the region, adaptation is required (Raven, 1992). He also promoted the growth of an IP through the work of The ANSA McAL Psychological Research Center (located on the St. Augustine’s Campus of The University of the West Indies), establishing The Caribbean Journal of Criminology and Social Psychology and fostering linkages between regional and international scholars (Deosaran, 1992). toward a caribbean psychology     

19

Arthur Richardson, an Anguillan psychologist based at The University of the West Indies, Cave Hill, also focused more broadly on the Caribbean, but in the area of developmental psychology. Beginning in the early 1980s, he collaborated with regional colleagues (e.g., Mary Richardson, Monica A. Payne) on a range of topics to address the limited knowledge about Caribbean youth and published a collection of his seminal work almost two decades ago (Richardson, 1999). Although he did not explicitly articulate a vision for a Caribbean psychology, Richardson’s focus on comparative studies, emphasis on collaborative research as a strategy to address the limited resources in Caribbean societies, and focus on the particularities of Caribbean youth are consistent with a vision for an indigenous regional approach to psychology. This indigenizing focus was also evident in the achievements of Caribbean psychologists who worked simultaneously in the region and diaspora: Carlos Albizu-Miranda, Sharon Gopaul-McNichol, and Jaipaul Roopnarine. AlbizuMiranda called for a Puerto Rican model of psychology and promoted the development and adaptation of training models and techniques to meet the sociocultural needs of Hispanic clients in Puerto Rico and the continental United States (Quinones, 2009). He founded the Instituto Psicologica de Puerto Rico in 1966, the first independent professional school of psychology to provide culturally appropriate training in clinical psychology (Padilla & Olmedo, 2009). With the opening of a second institution, Caribbean Center for Advanced Studies in Miami, Albizu-Miranda provided culturally relevant training for Latinos and other students from the Caribbean. Gopaul-McNichol’s (1993) work is more recent and focused primarily on Caribbean people of African descent. She used her early experiences in Trinidad and Tobago to incorporate West Indian world views into psycho­ therapy, clinical supervision and training, and publications to promote appropriate knowledge about and intervention for West Indian families in the United States, Canada, and Great Britain. Roopnarine, a Guyaneseborn child developmentalist, based in New York and Trinidad and Tobago, acknowledged that socialization patterns in Caribbean families was typically absent in his psychological studies and noted his efforts to rectify this situation (Roopnarine & Brown, 1997). In addition to his extensive international scholarship on diversity in parent–child relationships, childhood friendship, and play (e.g., Gielen & Roopnarine, 2004), Roopnarine developed collaborative projects with regional and diasporic scholars to understand the dynamics of Afro and Indo Caribbean family organization and functioning, fathering, and early childhood education across several countries, including Jamaica, Trinidad and Tobago, and Guyana (Gielen & Roopnarine, 2004; Roopnarine, 1997; Roopnarine, Wang, Krishnakumar, & Davidson, 2013). Overall, these early efforts to develop a culturally relevant psychology in specific nation states and in some cases, across national boundaries, laid 20       ava d. thompson

the foundation for an indigenization process that continues and is having the regional and international impact envisioned by pioneers (Gopaul-McNichol, 1993; Raven, 1992; Richardson, 1999). In Cuba, the postrevolutionary work of Cuban psychology pioneers that initially involved developing curricula for physicians has led to a preventive and community-oriented approach to health psychology that is fully integrated into the primary health care system and is a model for the regional and international communities (Kristiansen & Soderstrom, 1991). Similarly, the impact of Deosaran’s efforts to promote the development of psychology is evident in the research output and policy documents from ANSA McAL Psychological Research Center on a range of topics, including HIV/AIDS stigmatization, work and environmental attitudes, crime, and social norms (University of the West Indies at St. Augustine, Trinidad and Tobago, n.d.). Deosaran served as the mentor to its current director, Derek Chadee, who continues the legacy of scholarship with books that internationalize the discipline of social psychology with diversity in topics and contributors (e.g., Chadee & Young, 2006). Numerous available examples enumerate the full range of contemporary indigenizing efforts via research, intervention, policy development, advocacy and teaching with regards to specific national or community contexts in the Caribbean is beyond the scope of this chapter. This chapter focuses on collective or Pan-Caribbean efforts to develop an indigenous Caribbean psychology; in the next section, I provide an overview of work to establish a Caribbean organization to achieve this goal. AN HISTORICAL PERSPECTIVE ON CARIBBEAN PSYCHOLOGY: A REGIONAL ORGANIZATION In 1976, regional pioneers of psychology created the Association of Caribbean Psychologists, and in their first conference in Haiti, colleagues from several countries (e.g., The Bahamas, Haiti, Puerto Rico) presented papers related to the theme “Psychotherapy: What Works in the Caribbean” (Lefley & Bestman, 1977). In debating the cultural relevance of mainstream psychotherapy, particularly psychodynamic theories and techniques, the participants explored a myriad of issues related to the specific sociocultural context of the region, including the legacies of enslavement and colonialism, the multiracial population that was predominantly of African descent, and economic development in the region. More specific to psychotherapy, the psychologists and other mental health professionals (e.g., psychiatrists) examined the appropriateness of facilitating adaptation from traditional to modern worldviews via psychotherapy, the role of spirituality in acceptance and relevance of psychotherapy, culture-specific criteria for psychopathology, integration of psychotherapy with traditional healing systems, and indigenous toward a caribbean psychology     

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forms of psychotherapy (Lefley & Bestman, 1977; T. McCartney, personal communication, March 24, 2012). Although the association’s existence was short-lived, the conference and resulting summary report with recommendations marked the first Pan-Caribbean effort to interrogate issues specific to the development of a Caribbean scientific psychology. Contemporary Caribbean psychologists have made noteworthy individual, group, and interisland achievements but remained committed to the development of a Caribbean organization of psychology to increase psychology’s relevance and role in transforming Caribbean societies. This effort continued with formal and informal dialogue at national psychology conferences, networks, project meetings, and multidisciplinary fora with Pan-Caribbean organizations (e.g., Pan-Caribbean Partnership Against HIV/AIDS) throughout the years across various countries. However, it was almost 30 years before the next regional conference in psychology was held. In 2002, Victor Lina and colleagues hosted the 1st Meeting of Psychology in the Caribbean in Martinique under the theme “Diversity of Approaches and Practices in Psychology in the Caribbean.” The organizers emphasized intraregional similarities but also recognized the diversity in their call for collective action (e.g., mutual exchange of conceptualizations, research, application) by psychologists in the region to address the psychological needs of the diverse ethnic groups in the Caribbean. The organizers noted the necessity for Caribbean psychologists to find an “original route,” rather than rely on the work emanating from the European or American centers of psychology. In addition, they suggested that regional psychologists view the Caribbean as the proverbial center and disseminate their work to the periphery, that is, the global psychological community. More than 40 participants from eight Caribbean countries and France attended this meeting with presentations on the cultural relevance of psychotherapy, the evolution of the discipline in the region, state of psychological research, and the roles and activities of psychologists in various sectors of society. The topics of the presentations, which also included the multiethnic and multicultural nature of specific Caribbean countries, appropriate social models for the Caribbean, and mental health policies, overlapped significantly with those addressed at the 1976 conference in Haiti. However, it is likely that a multiplicity of factors, including long-standing linguistic and logistical challenges with communication, networking, and exchange that have hampered Caribbean collaboration contributed to the small number of psychologists who attended this meeting and organizers’ lack of awareness about the first meeting in Haiti. These challenges, many of which are still present, are likely to have contributed to the dissolution of the first Caribbean organization of psychology. Although the specific outcomes of the 2002 conference are unknown, the organizers and attendees provided invaluable input and participated fully 22       ava d. thompson

in the most recent regional conference: Caribbean Regional Conference of Psychology 2011 (CRCP 2011), which was held in Nassau, The Bahamas. CRCP 2011 was hosted by the Bahamas Psychological Association, but the role of its dedicated regional conference committees and invaluable international support (see Thompson et al., 2013, for additional information about the conference) cannot be understated. In many ways, the synergy experienced in the process of organizing the conference is an apt reflection of the conference theme: “Psychological Science and Well-Being: Building Bridges for Tomorrow.” CRCP 2011, envisioned as a capacity-building and networking opportunity, was ultimately a catalyst for the creation of a Caribbean organization of psychology. As a result of the stimulating presentations and discussions during the various conference sessions, particularly the capacitybuilding workshop with leaders of national associations and psychology education programs, conference organizers prepared a statement that reflected their commitment to developing a Caribbean organization of psychology to advance psychology. The full text of The Nassau Declaration (International Union of Psychological Science, 2011) that was signed by regional and international CRCP 2011 participants is provided below: Recognizing the potential for psychology to serve as a critical instrument for building bridges across cultures, time discipline, regions, research, areas, and communities Recognizing the critical role of psychology in policy development, advocacy, education, publication and teaching Recognizing the strength of psychology as an agent for change, development and empowerment of individuals and communities Recognizing the value of collaborative regional organizations to work towards these goals Therefore: We the undersigned, having attended the Caribbean Regional Conference of Psychology 2011 in Nassau, Bahamas, November 2011, agree in principle to establish a Caribbean Psychology Organization to promote the development of psychology as a science and practice. (International Union of Psychological Science, 2011)

The Caribbean Organization of Psychology Steering Committee (COPSC) established immediately to provide temporary leadership in Caribbean psychology and to develop a Caribbean organization of psychology, held its first meeting after the CRCP 2011 Closing Session. The committee was composed of the members of the CRCP 2011 COPSC, psychologists appointed by their national organizations (academics and practitioners), and distinguished regional and international psychologists who served in an advisory capacity. Following 18 months of planning, consultation, and meetings, the Caribbean Alliance of National Psychological Associations (CANPA) was launched in June 2013 at the Caribbean Studies Association Conference in Grenada, toward a caribbean psychology     

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and as of December 31, 2013, had 12 national members from the English-, French-, Spanish- and Dutch-speaking Caribbean countries. Through its committees (e.g., Psychology Education and Training, Presidents and Elders Council, Website and Communication, Professional Practice and Standards), CANPA executives and national members have completed initial steps in crystallizing the collective vision for Caribbean psychology. CRCP 2014 was held in Paramaribo, Suriname, and represented the next major milestone for Caribbean psychology. The theme for this conference, “Caribbean Psychology: Unmasking the Past and Claiming Our Future,” spoke directly to the issue of constructing psychological models that reflect the historical, sociocultural, linguistic, and political realities of Caribbean people. Specifically, it communicated the necessity for a regional psychological perspective that can “give voice” to the past; present experiences of Caribbean peoples; and contribute more meaningfully to individual, community, national, and regional development agendas that reflect aspirations for self-determination and overall well-being. Finally, it provided further opportunities for engagement with the global psychology community in a manner that allowed for mutual exchange of knowledge that facilitate the development of a global psychological science that is representative of all humanity. A CARIBBEAN PSYCHOLOGY: IMPERATIVES, ISSUES, AND FEATURES Despite early indigenization efforts, mainstream psychology is still the dominant approach in the Caribbean. However, contemporary developments in psychology suggest that Caribbean psychologists—researchers, practitioners, and teachers—overwhelmingly support the development of a Caribbean approach to psychology, and many assert that it is a regional imperative. This position arose from a shared view of the Caribbean region’s distinctiveness (Benitez-Rojo, 2006); the shared historical and contemporary sociopolitical, economic, and cultural experiences of its peoples (Hickling, Matthies, Morgan, & Gibson, 2008); and the complex interconnectedness and dynamic Caribbeanness experienced by its people. The dissimilarities, although evident in many areas and important to Caribbean peoples’ sense of identity and other aspects of psychological functioning, might not be perceived as more significant than Caribbean people’s view of themselves as one people and the collective capacity to shape their world, that is, participate meaningfully in achieving the Caribbean shared vision of a quality life (Browne, 2013). Regional psychologists have also become increasingly aware of the limitations of the hegemonic Euro American perspectives of psychology and have been encouraged by the models of indigenization within (e.g., 24       ava d. thompson

Hickling, Matthies, et al., 2008) and outside the Caribbean. Nobles’s (2013) position that the only valid psychological perspective (i.e., knowledge and research) is one that reflects the culture of the people that it represents resonates with Caribbean psychologists’ call for a regional approach to psychology. The now widely accepted position that the psychology that emerges from each context is embedded in a specific cultural reality (see Chapter 2, this volume) and the extant Caribbean psychological literature on the distinctiveness of Caribbean psychological phenomena also affirms the necessity of a psychology that is directly relevant to experiences of Caribbean peoples. In addition, the work from international colleagues on the role of psychology in promoting national development (e.g., Carr & Schumaker, 1994; MacLachlan & Carr, 1994) and scholarship elucidating contextual factors, constructs, and phenomena previously absent from the psychological literature (e.g., Okazaki, David, & Abelmann, 2008) are equally supportive of the Caribbean pioneering efforts to create culturally appropriate psychologies. These developments have been embraced by contemporary psychologists and have strengthened their call for a Caribbean psychology. The practical benefits of a Caribbean psychology cannot be discounted, particularly given the multiplicity of factors (e.g., size, geography, educational infrastructure, economic realities, human resources) that limit each country’s/ territory’s capacity to adequately address the endemic and emerging human and societal challenges. This reality, along with the region’s strong history of collaboration in a range of disciplines (e.g., education, history, social work, medicine, nursing), Pan-Caribbean development initiatives (e.g., Caribbean Cooperation in Health Initiative), and organizations, undoubtedly provides strong impetus for the development of a Caribbean psychology. Paradoxically, so does the failure to progress on key integration issues (e.g., Caribbean Single Market and Economy), along with perceptions of increasing isolation between countries (Patterson, 2010). Finally, it is likely that the regional growth of psychology (i.e., the critical mass), increasing recognition of factors that limit the growth of psychology and enormous technological advances have enhanced the willingness and opportunities for collective action. Such developments facilitate the creation of a regional psychological infrastructure necessary to promote collaboration and collective effort to advance the discipline. Regional psychologists are now in the position to participate in what Shridath Ramphal (1992) described as intellectuals’ “vigorous articulation of an indigenous perspective in the study of the region’s affairs” (p. ix) to increase psychology’s role in promoting well-being and affecting societal transformation. This readiness is reflected in contemporary scholarship from across the region on the development of psychology in the Caribbean. In the inaugural issue of the Caribbean Journal of Psychology, Branche, Minor, and Ramkissoon (2004) bemoaned the fact that although regional social theorists toward a caribbean psychology     

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have developed psychological formulations and articulated the psychological phenomena in Caribbean life, a distinctive “scientific” psychology remains unarticulated. They cited Gopaul-McNichol (1993), who attributed psychology’s slow regional development to a number of factors, including regional psychologists’ overreliance on North American assessment tools, theoretical formulations, standards, research approaches, and applications. According to Gopaul-McNichol, it was incumbent for Caribbean psychologists to integrate the Caribbean reality in clinical practice. Alvarez Salgado (2000), in her historical review of psychology in the region, also highlighted the dependence on extraregional countries as sources of knowledge and direction of the discipline and the impact on the discipline and societies at large. She too was explicit in encouraging Caribbean psychologists to look to each other as main partners to develop an IP to serve the region’s needs but also recognized Caribbean psychologists’ potential to have a greater impact in the international community. More recently, Jamaican psychologists (Hickling, Matthies, et al., 2008) collaborated with psychiatrists in editing the book Perspectives in Caribbean Psychology. With a primary focus on Jamaica, they provided a historical overview of the discipline, discussed factors that influenced the development of the discipline, showcased Caribbean scholarship in support of their position that there is a Caribbean psychology, and provided recommendations to promote even further growth of the science and profession. Sutherland (2011) provided a view from the diaspora in her position that the psychological examination of the cultural, philosophical, and linguistic foundations of Caribbean societies is required for the development of appropriate theoretical and research frameworks to address the Caribbean realities. She argued that the African retentions are still evident in the worldviews, social theories, and behavioral patterns of Caribbean people of African descent and proposed an African-centered approach to Caribbean psychology to address the many individual and collective challenges (e.g., identity, violence, poverty, parenting styles) that people of African descent experience in the Caribbean. Although significant for its scope, Sutherland’s approach represents a singular perspective, which will by necessity coexist with alternative approaches that address the lived experiences of other racial, ethnic, and cultural groups in the Caribbean, for instance, Indo Caribbean, indigenous peoples of the region (e.g., in Guyana, Grenada, St. Vincent and the Grenadines), Asian Caribbean, Middle East Caribbean, European Caribbean, and those of mixed ethnic or racial ancestry. These differing perspectives can potentially contribute to the development of a more inclusive Caribbean psychology that encompasses the full range of Caribbean diversity, including within-group differences that reflect the intersection with other aspects of Caribbean reality (e.g., class, gender, religion). 26       ava d. thompson

Ramkissoon (2010), Thompson (2011, 2013), and Amuleru-Marshall (2013) are other contemporary Caribbean psychologists who have expressed the paramount importance of Caribbean psychological conceptualizations. Regional psychologists have called for a historically grounded psychology that highlights the role of sociopolitical, historical, religiospiritual, economic, and ecological factors, past and present, that affect the psychological reality of the Caribbean people, inclusive of the regional universalities and particularities. Despite the overwhelming consensus on the need for a historically grounded Caribbean psychology that enhances psychologists’ capacity to engage meaningfully in the region and allows for mutual exchange of information with the global community, less unanimity exists on issues related to the developmental agenda of Caribbean psychology. Key issues include the characteristics, content, methodology, prioritization, and temporal sequencing of the strategic action. Greater divergence is also anticipated in regional discourse on appropriate approaches or frameworks. This diversity in perspective, already evident in articulated visions of a Caribbean psychology, will also be critical in cultivating the evolution of a regional approach to psychological thought within the different branches/subdisciplines of psychology. Although Gopaul-McNichol (1997, as cited by Branche et al., 2004) highlighted the need for increased research capacity, Alvarez Salgado (2000) raised the alarm about psychology’s rapid growth without appropriate regulations and placed an emphasis on collaborative efforts in academics, practice, and research across disciplines to build a Caribbean psychology. Veronica Salter (2000), an Irish social psychologist who relocated to Jamaica in the 1970s, prioritized regional standards in her assertion that development of a Caribbean psychology should proceed using “no other yardstick than our own” (p. 218). Ramkissoon (2010) extended this focus with her call for a regional framework to systematically assess the development of psychology and guide its further development. She recognized the limitations of centralization but concluded that a generalized organizing body was a necessity for the level of cooperation required to advance the field. Amuleru-Marshall (2011, 2013) was also cognizant of the gargantuan complexities and challenges associated with integrating the multiple cultural contexts and psychological traditions in the Caribbean but maintained the view that a statutory regional professional organization was imperative to establish and harmonize standards for training, licensing and professional practice (including ethics). Psychologists’ lamentations about the impact of limited educational resources on psychology’s development (Thompson, 2011) and their concerns about and involvement in psychology education and training (PET) quality-control activities (Aire, 2012; Alvarez Salgado, 2000; Evans, 2012; Hickling, Doobar, et al., 2008) suggest an understanding of PET’s role in the development of a culturally relevant approach to psychology. Despite toward a caribbean psychology     

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the growth of psychology programs and courses with Caribbean content in national contexts, only recently has PET as a strategy in developing a Caribbean psychology, at least in the English-speaking Caribbean, been explicitly prioritized. Thompson (2013) outlined the components of the bachelor’s program in psychology at the College of The Bahamas that is distinctive in its socioconstructionist framework; metadisciplinary focus; tripartite integration of Bahamian, Caribbean, and international content (see Figure 1.1); and emphasis on historical and cultural psychicentrality as a core component and foundation in the psychology of human diversity. These features of the program were designed to “contribute to the development of an indigenous approach to psychology to address the needs of the Bahamian and Caribbean contexts” (College of The Bahamas Psychology Program, 2005, p. 7). The emphasis on adapting Euro American or international educational standards, models, and content to indigenize PET is also evident in the proposed graduate programs at St. George’s University (Grenada) and The University of the West Indies (Jamaica and Trinidad and Tobago campuses). The latter programs were designed to facilitate national and regional development and to address local and Pan-Caribbean psychological health priorities

International

Regional

Local & National

Figure 1.1.  College of The Bahamas’ tripartite undergraduate psychology model.

28       ava d. thompson

via research and application, and they all feature distinctively Caribbean interdisciplinary content and resources. These priority areas identified by Caribbean psychologists indicate that a metadisciplinary framework and comprehensive strategic planning are prerequisites for the development of an indigenous psychological approach for people who, despite their shared historical and cultural experiences, do not have a homogenizing reality (Alvarez Salgado, 2000). The various components, encapsulated in Figure 1.2, are interconnected critical components in a framework that can be used to develop and later characterize a Caribbean psychology. For example, regionally developed training, licensing, and professional standards (including ethical guidelines) are expected to have a direct impact on both PET and application/intervention. On the other hand, the PET innovations, models, and constraints will affect regional standards, scholarship, application/intervention, and policy implications. The journey to develop a Caribbean psychology is undoubtedly a long process that requires comprehensive systematic planning with attention to critical processes and mechanisms, prioritization, and a commitment to gradualism to ensure sustainability (Amuleru-Marshall, 2013; Thompson, 2013).

Caribbean Organization of Psychology

Psychology Education and Training

Standards for Training, Licensing, and Professional Practice

Caribbean Historical PsychosocialLinguistic-SocialCultural Reality

Culturally Appropriate Theoretical and Application Models

Research Infrastructure and Output Regional Model for the Assessment of the Discipline

Figure 1.2.  Components of a meta-disciplinary framework for a Caribbean psychology. toward a caribbean psychology     

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In addition to the priority areas just identified, other defining aspects of a Caribbean psychology will require considerable reflection. Although regional psychologists agree on the overarching goal to develop a regional psychological science that is grounded in the specific historical, cultural, social, and linguistic traditions of the Caribbean, multiple goals are associated with this task that need to be delineated. As Hwang asserted in his contribution in Allwood and Berry (2006), simply accumulating research findings is insufficient to justify an IP, as it makes little contribution to the advancement of social sciences (e.g., challenging the intellectual and psychology hegemony of mainstream psychology while expanding the understanding of human functioning). Specific goals of a Caribbean psychology include the following: 77 77

77 77

77 77

documenting the worldviews, beliefs, and ways of living of Caribbean peoples; identifying the unique features of functioning in the Caribbean, from the Caribbean people’s perspective, that is, giving voice to the past and present; promoting an understanding of Caribbean cultural heritage, traditions, and worldviews; exploring Caribbean-specific thinking and behavioral patterns and developing appropriate conceptualizations and theories to account for these experiences; examining similarities/differences across communities and nations; and designing and evaluating solutions to individual, community, national, and regional problems, as well as promoting overall health and well-being and contributing to national and regional development agendas.

To achieve these more specific goals, an emphasis on empirical research is critical, as is attention to theoretical construction, neither of which can be achieved without significant philosophical reflection about the nature of knowledge, knowledge construction, appropriate subject matter, and methods of inquiry. Hickling, Matthies, et al. (2008) implored regional mental health professionals to challenge the episteme, and Thompson (2013) discussed the importance of positioning on issues of epistemology (e.g., positivism vs. constructivism), research perspectives (e.g., cross-cultural, cross-comparison/ national studies), and associated relevant methodologies (e.g., quantitative and/or qualitative, mixed methods) that are appropriate in the Caribbean context. Particularly important to the Caribbean context are methodologies to examine the nature of being/existence during the various periods in the history of Caribbean peoples—the ancestral past of indigenous peoples, persons of African descent (e.g., pre-enslavement, enslavement, colonial), Europeans, 30       ava d. thompson

and Indo Caribbeans. Analyses of the individual and collective present realities, as well as future aspirations, are equally important. Central to these issues are conceptualizations about the nature of culture, including its operationalization and the degree to which it can be separated from the individual. It is important to examine the extent to which Caribbean psychologists move beyond the reductionistic approach of mainstream psychology and capture the complexity of human behavior that often reflects multiple cultural traditions, and distinguish between “culture” and the adaptive responses to oppression (Watts, 1992). The interconnectedness of the components in the framework and the variety of issues to be addressed in developing a Caribbean psychology indicate considerable collaboration between psychologists from different specialties and roles in Caribbean societies and with distinctive views about the discipline and profession. Regional psychologists (Alvarez Salgado, 2000; Ramkissoon, 2010; Sutherland, 2011) have consistently expressed the importance of psychological partnership in enhancing regional efforts to promote the development of Caribbean peoples. The value for collaboration, when combined with other values that undergird the planning for the CRCP conferences, will be pivotal in transcending specific obstacles (e.g., complex intraregional and extraregional affinities and loyalties) that separate the various subregions of the Caribbean and limit the capacity of the subregional associations to contribute to a pan-regional perspective. Conference organizers embraced a diversity–inclusion agenda that involved valuing the diversity in the Caribbean cultural tapestry and endeavored to ensure regional representation of diverse cultural, economic, political, linguistic, and psychological realities. Psychologists’ preference for a broader definition of the Caribbean in the development of the regional infrastructure is another example of this commitment and the potential to overcome barriers that were erected centuries ago. The diversity–inclusion agenda also extended to the discipline of psychology, as CRCP and CANPA organizational structures reflect diversity in level of psychology infrastructure present in the region. Although many participants represent large communities of psychology practitioners, researchers, and educators, others represent newly established psychological communities with low per capita professional presence (Amuleru-Marshall, 2013) and limited tertiary education opportunities. THE WAY FORWARD Pioneering and contemporary Caribbean psychologists have consistently articulated a vision for a regional psychological perspective, illuminating critical areas of focus and indispensable values and principles that can toward a caribbean psychology     

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guide the developmental process. However, psychological scholars (Alvarez Salgado, 2000; Amuleru-Marshall, 2013; Sutherland, 2011; Thompson, 2011), like other Caribbean intellectuals, are cognizant of the multiple barriers associated with regional coordination and harmonization. Sociologist Ramphal (1992) posited that “making integration a reality is the greatest challenge” (p. 9) of Caribbean intellectuals, and despite psychologists’ profound knowledge about human behavior, the obstacles that affect other disciplines and Caribbean integration efforts will likely have similar effects on current efforts. The complexity of this task is heightened by the colonial legacies in philosophical and educational systems (Ramphal, 1992) and the absence of a framework for developing an indigenous regional psychological science. The development of a Caribbean psychology will require the active participation of psychologists from across the region, from different professional settings, and with different areas of expertise to develop the blueprint, identify critical milestones, and evaluate progress. It will become a reality when regional psychologists think nationally, regionally, and globally about the discipline’s responsibility to society and act to integrate these three levels of functioning in all aspects of their professional lives in a manner that is most meaningful to them (see Figure 1.1). The five sets of recommendations outlined next are preliminary steps that would allow psychologists to capitalize on current developments in regional psychology and continue formal discussions on the same. Expand the Caribbean Alliance of National Psychological Associations The regional organization of psychology is a critical mechanism for the development of psychology as a science and is equally important in nurturing the gestation of a Caribbean approach to psychology. CANPA executives and various committee members are endeavoring to build the regional infrastructural capacity (e.g., professional standards committee) that regional scholars view as integral to Caribbean psychology. In addition, they are striving to achieve the CRCP 2011 conference outcomes that will be instrumental in fostering a Caribbean psychology. The additional outcomes still to be achieved are as follows: 77 77 77 77

building and sustaining psychology leadership in the Caribbean; establishing a Caribbean student network; developing a directory of Caribbean psychologists and psychology organizations; developing a Caribbean resource bank of 1.  educational programs, 2.  psychological scholarship (publications, presentations),

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3.  educational resources (curriculum, syllabi, programs), and 4.  internship sites; and linking Caribbean psychologists throughout the diaspora.

It is incumbent upon CANPA and its general assembly to establish a task force to foster the development of a Caribbean psychology at both the local and regional levels. With a broad membership base (i.e., across contexts, type of professional engagement, and specialties), this task force can be charged with responsibilities such as: 77 77 77 77

assessing the state of Caribbean psychology; developing the framework, blueprint, and strategic plan for the development of Caribbean psychology; building regional capacity for a Caribbean psychology via lectures, seminars, and workshops; and fostering relationship with IP experts in the global psychological community.

Advance Culturally Focused Theoretical, Research, and Application Scholarship The increasing number of national psychology workshops and conferences, along with presentations at international venues and publications in journals and books, indicates a burgeoning Caribbean scholarship. In the most recent assessment of Caribbean-based psychology publications, Govia and Bernal (2013) reported overall progress in the region but considerable variability between countries. This pattern of results is consistent with other findings on psychology’s uneven development in the region (Alvarez Salgado, 2000; Ward & Hickling, 2005) and suggests that an increased research-capacity-building agenda between countries/territories is required. Despite the multiple examples of intercountry collaboration, the opportunities are growing for psychologists from countries with greater research infrastructure and for those in the diaspora to extend their impact beyond their country of origin by providing training and engaging psychologists from other countries with considerably fewer resources. Govia and Bernal (2013) also recommended a mapping exercise (including content analysis) on available information in the Caribbean for different language groups as a step in developing, documenting, and sharing knowledge. However, a focus on IP (theoretical, conceptual, and research methodology) can be added to gauge the degree to which Caribbean people are producing culturally based scholarship and challenging the episteme, rather than building a body of imitative and replicative empirical work. Relevant

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indicators of culturally focused scholarship include the extent to which scholarship 77

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documents the traditional and contemporary worldviews, beliefs, and ways of living of Caribbean people (i.e., gives voice to the realities of the Caribbean people); identifies culture-specific phenomena and provides culturally adapted and/or original theoretical conceptualizations; operationalizes the range of contextual factors that affect the psychosociocultural reality of the Caribbean people and explores their interrelationship and connection to psychological functioning in the region; integrates Caribbean intellectual and psychological traditions; reflects Pan-Caribbean research and application to identify similarities and differences across contexts; extends research focus beyond narrow reductionistic approaches and captures the complexities of Caribbean and human psychological functioning; focuses on current Caribbean challenges/issues and eschews projects that are only peripherally relevant to promoting the wellbeing of Caribbean peoples; tests the applicability of existing mainstream constructs, theories, and empirical findings; expands disciplinary focus beyond the individual level of analysis to macrolevel issues; and explores cross-indigenous psychology issues and relevance for a global psychology.

Increase Regional Publications Caribbean psychologists view enhanced dissemination of regionally based psychological scholarship as vital to the development of the discipline and have taken key steps to increase accessibility via publications in academic outlets. The establishment of the Publication Committee in CANPA’s organizational structure, the publications emanating from CRCP 2011, and the position that Caribbean psychologists should assume leadership roles in scholarship about and/or for the region are all examples of critical developments. The commitment to incorporate multiple linguistic and psychological traditions in Caribbean psychology publications, despite the challenges associated with the same, is another illustration of progress in the area of research. However, strengthening publication-related infrastructure and mechanisms to ensure sustainability is an urgent need. The few psychology journals (e.g., Journal of Cuban Psychology, Dominican Journal of Psychology, Caribbean 34       ava d. thompson

Journal of Psychology) based in the region have been discontinued, have had interruptions in publications, and/or are not indexed in PsycINFO (Govia & Bernal, 2013); as a result, they are not widely accessible within the region as both sources of Caribbean scholarship or possible publication outlets. This situation increases the appeal of publishing in international publications and can enhance international awareness of Caribbean psychology, but at the expense of regional scholarly exchange and ultimately retards regional psychology development. It is thus imperative that regional psychologists 77 77 77 77 77 77

commit to publishing in regional journals, expand awareness about and increase access to existing journals, explore the challenges associated with journal publication in the region, undertake a strategic plan to ensure the sustainability of existing journals, advocate to ensure indexing in international databases (e.g., PsycINFO), and facilitate the development of additional journals for the region.

Similar action is also required with respect to the publication of books in the region. It is vital that regional psychologists work in partnership with regional publishers to increase the interest in publishing psychological resources, permit publications in the languages of the Caribbean, and foster publication projects across countries. Expand Caribbean-Focused Education and Training Culturally relevant pedagogy has been relatively neglected in contemporary discourse on development of a Caribbean psychology but is a crucial mechanism for addressing many challenges associated with indigenizing psychology (Thompson, 2013). Through PET, regional psychologists have an opportunity to build the critical mass of psychologists who understand the complexities of Caribbean realities, hold cultural and ideological views, demonstrate the psychicentrality, and have the requisite psychological skills and competences to contribute optimally to transforming Caribbean societies (Thompson, 2013). Regional pioneering efforts, along with contemporary developments in individual Caribbean contexts have provided a foundation for indigenizing psychology education training. Critical steps to facilitate the necessary developments in Caribbean PET include 77

prioritizing the development of Caribbean psychology as a goal in undergraduate and undergraduate programs, with concomitant realignment of objectives, course content, and pedagogical strategies; toward a caribbean psychology     

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integrating components on psychology of human diversity (e.g., global and regional historiography, philosophies, theoretical, research issues); developing models for incorporating Caribbean and global cultures in curricula; emphasizing multispecialty models that include areas (e.g., neuropsychology, developmental psychology) that broaden the range of psychological science expertise in the region; developing regional guidelines for PET, including content, skills and competencies, quality assurance mechanisms, and outcome assessment; systematically integrating Caribbean cultural, social, and psychological realities (e.g., history, spirituality, musicology/festivals, literature, health care, governance, language) into Caribbean psychology courses; incorporating Caribbean psychology (e.g., history, developments, similarities, differences, pioneers and contemporaries, features, research, theoretical developments) into all courses; prioritizing national and Caribbean human development, macro­ level indicators of societal development and societal changes (e.g., population statistics, health care needs and resources, mental health issues, rates of violence and costs to society, disability issues, demographic shifts, unemployment in youth) and strategic planning as appropriate frames of reference in the curriculum; integrating Caribbean intellectual traditions (e.g., Fanon, Marti, Lamming, Rodney, Walcott, Cesaire, Guillen, Brathwaite, Hall) with psychological thought and empiricism; and developing PET resources (i.e., textbooks) to reduce dependence on Euro American material that ultimately contribute to “remote acculturation” (Ferguson & Bornstein, 2012).

Multispecialty, Multidisciplinary, Multiorganizational, and Multisectoral Collaboration The sustained and systematic collaboration across the region, the diaspora, and the global psychological community that is axiomatic for the development of Caribbean psychology must also be extended across specialties, disciplines, organizations, and sectors of society to address those diverse, multi­ layered, and increasingly complex issues that appear to most seriously undermine human and social development. Caribbean psychologists have noted its import for addressing mental health, early childhood development, poverty, violence, HIV/AIDS, chronic noncommunicable disease, crime, education, 36       ava d. thompson

and so on (e.g., Amuleru-Marshall, 2011), but they have collectively been absent in efforts to address these challenges. Psychology’s less common specialties (e.g., developmental psychology, cognitive psychology, neuropsychology) are particularly relevant to several of these areas but can also make considerable contributions to efforts to other human development issues that have only recently become regional priorities, including neurological disorders, aging, and associated cognitive deficits (Ward, 2008). Psychologists are also conspicuous in their relative absence from the discourse on national and regional development, in which multidisciplinary and eventually interdisciplinary approaches are required to construct, implement, and evaluate appropriate development models and agendas. The enduring challenge of Caribbean integration that has featured heavily in regional scholarship for decades is a critical example of an area where psychological science has a particularly important role. To realize psychology’s potential impact in the region, psychologists must extend the pioneering and contemporary endeavors of individual partnerships with mental health professionals and other professionals, work in multiple sectors (e.g., human development, health and national security), and collectively engage with national and Pan-Caribbean organizations. As Powell (2009) noted with specific reference to Jamaica, economic and social policy models are naively adopted without adequately accounting for the cultural and behavioral assumptions of the population and fail to gain traction and effect the change intended. An indigenous Caribbean psychology has the potential to contribute to the success of such macrolevel interventions with the systematic measurement of psychocultural factors, that is, worldviews, perceptions, and behavioral traditions, that can interrogate existing paradigms of development and inform the adaptation and development of appropriate development models. To increase psychology’s more meaningful integration into the Caribbean’s intellectual, social change and development landscape (i.e., expand sphere of influence and facilitate the development of a Caribbean psychology), the following recommendations for psychologists are offered: 77

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participate consistently in multidisciplinary organizations and conferences at the national and regional levels (e.g., Haitian Studies Association, Caribbean Studies Association); initiate memoranda of collaboration with national and regional professional, health, human development, and governmental organizations (e.g., Association of Caribbean Social Work Educators, Association of Caribbean Historians); engage with Pan-Caribbean health and human development organizations (e.g., Pan American Health Organization, toward a caribbean psychology     

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Caribbean Community and its Council for Human and Social Development, The Caribbean Public Health Agency); integrate cross-disciplinary scholarship in psychological conceptualizations, research, and projects; incorporate cross-disciplinary scholarship, information about mission, and work of national and Pan-Caribbean organizations into psychology courses; foster multidisciplinary research, projects, and programs; expand individual psychologist’s work with Pan-Caribbean and international organizations across countries/territories; and commit to an interdisciplinary framework for developing a Caribbean psychology and the transformation of Caribbean societies at the national and regional levels. CONCLUDING THOUGHTS

Since the introduction of psychology to the Caribbean, regional psychologists have engaged in indigenization efforts at individual and national levels and have also collectively explored issues of cultural relevance. They have also sought to develop a regional psychological organization to facilitate the growth of psychology in, of, and for the Caribbean (Govia & Bernal, 2013). However, as a result of the many challenges associated with developing the necessary psychological infrastructure in the region, which undoubtedly contributed to the indiscriminant and persistent importation of psychological products (including theories, research findings, applications, and resources), psychology in the region has continued to be dominated by Euro American perspectives. Although pockets of indigenization exist throughout the region, there is no comprehensive, systematic Caribbean psychological framework with theories that reflect the psychological realities of the Caribbean people (Hickling, Matthies, et al., 2008); research that seeks to document, understand, and affirm Caribbean worldviews; and applications that incorporate the cultural particularities of the Caribbean people. However, regional psychologists have recently committed collectively to address this void with The Nassau Declaration (International Union of Psychological Science, 2011) and have made significant strides to further the growth and development of a culturally relevant psychology through establishing a regional psychology organization. Regional psychologists remain cognizant of the enormity of the task and have individually identified critical components of a framework to foster a Caribbean psychology that embraces the diversity in the Caribbean psychosocial– linguistic–cultural tapestry but recognizes and builds on the considerable historical, social, cultural, and geographical similarities and connections across 38       ava d. thompson

the region. In this chapter I have integrated these various features into preliminary model that will stimulate discussion and further advance collective action. With these developments, regional psychologists are formally joining psychologists from the global community who have developed indigenizing models and have initiated meaningful engagement that will enhance reciprocal knowledge exchange, collaboration, and greater exploration of the universalities and particularities and the eventual establishment of a negotiated global psychological science that is truly representative of all humanity. Caribbean psychology is poised for further growth as a science and profession, greater national and regional relevance in the story of Caribbean peoples and societies, and contributions to humanity’s psychological narrative that will maintain the diversity required for survival (Marsella, 2005). REFERENCES Adair, J. G. (1995). The research environment in developing countries: Contributions to the national development of the discipline. International Journal of Psychology, 30, 643–662. http://dx.doi.org/10.1080/00207599508246592 Adair, J. G., & Huynh, C. L. (2012). Internationalization of psychological research: Publications and collaborations in the United States and other leading countries. International Perspectives in Psychology: Research, Practice, Consultation, 1, 252–267. Adair, J. G., & Ka˘gitçibas¸i, Ç. (1995). Development of psychology in developing countries: Factors facilitating and impeding its progress. International Journal of Psychology, 30, 633–641. http://dx.doi.org/10.1080/00207599508246591 Adair, J. G., Unik, L. M., & Huynh, C. L. (2010). Psychology through international congresses: Differences between regions, countries, and congresses. International Journal of Psychology, 45, 155–162. http://dx.doi.org/10.1080/ 00207590903157221 Aire, J. (2012, July). Local and regional issues in the training of Grenadian psychologists. Paper presented at the 30th International Congress of Psychology, Cape Town, South Africa. Allwood, C. M. (2005). Psychology in a global world: Locally relevant . . . but globally ignored? The Psychologist, 2, 84–87. Allwood, C. M., & Berry, J. W. (2006). Origins and development of indigenous psychologies: An international analysis. International Journal of Psychology, 41, 243–268. http://dx.doi.org/10.1080/00207590544000013 Alvarez Salgado, A. I. (2000). A history of psychology in the Insular Caribbean. Revista Interamericana de Psicología, 34, 235–256. Amuleru-Marshall, O. (2011, November). Toward a wholistic or multi-specialty psychology: The challenge of history, culture and global health. Paper presented at the Caribbean Regional Conference of Psychology, Nassau, The Bahamas. toward a caribbean psychology     

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Raven, B. H. (1992). Foreword. In R. Deosaran (Ed.), Social psychology in the Caribbean: Directions for research and theory (pp. 9–14). San Juan, Trinidad and Tobago: Longman Trinidad. Richardson, A. G. (1999). Caribbean adolescents and youth: Contemporary issues in personality development and behaviour. Brooklyn, NY: Caribbean Diaspora Press. Roopnarine, J. L. (1997). Fathers in the English-speaking Caribbean: Not so marginal. World Psychology, 3, 191–210. Roopnarine, J. L., & Brown, J. (Eds.). (1997). Caribbean families: Diversity among ethnic groups. Greenwich, CT: Ablex. Roopnarine, J. L., Wang, Y., Krishnakumar, A., & Davidson, K. (2013). Parenting practices in Guyana and Trinidad and Tobago: Connections to preschoolers’ social and cognitive skills. Interamerican Journal of Psychology, 47, 313–327. Salter, V. (2000). The status of psychology in the Commonwealth Caribbean: Emphasis on Jamaica. Interamerican Journal of Psychology, 34, 211–221. Sinha, J. B. P. (2010). Living and doing psychology. Psychology and Developing Societies, 22, 95–120. http://dx.doi.org/10.1177/097133360902200104 Smith, T. B., Rodríguez, M. D., & Bernal, G. (2011). Culture. Journal of Clinical Psychology, 67, 166–175. http://dx.doi.org/10.1002/jclp.20757 Stevens, M. J. (2007). Orientation to a global psychology. In M. J. Stevens & U. P. Gielen (Eds.), Toward a global psychology: Theory, research, intervention and pedagogy (pp. 333–365). Mahwah, NJ: Erlbaum. Sutherland, M. E. (2011). Toward a Caribbean psychology: An African-centered approach. Journal of Black Studies, 42, 1175–1194. http://dx.doi.org/10.1177/ 0021934711410547 Tertullien, M. (1976). Psychologically speaking: Attitudes and cultural patterns in The Bahamas. Nassau, The Bahamas: Media Publishing. Thompson, A., Bernal, G., Dudley-Grant, R., Govia, I., Nicolas, G., Bullock, M., & Gauthier, J. (2013). Regional conferences—A capacity-building mandate: Report on CRCP2011—Building Bridges and Building a Regional Structure. International Journal of Psychology, 48, 1321–1331. http://dx.doi.org/10.1080/ 00207594.2013.840964 Thompson, A. D. (2011, November). Fulfilling psychology’s promise: A model of undergraduate psychology education. Paper presented at the Caribbean Regional Conference of Psychology, Nassau, The Bahamas. Thompson, A. D. (2013). Fulfilling psychology’s promise: A model of undergraduate psychology education. Interamerican Journal of Psychology, 47, 277–285. Todman, P. R. (2000). Eldra Shulterbrandt and the development of public mental health services in the U.S. Virgin Islands. Interamerican Journal of Psychology, 34, 11–26. University of the West Indies at St. Augustine, Trinidad and Tobago. (n.d.). ANSA McAL Psychological Research Centre. Retrieved from http://sta.uwi.edu/ AnsaMcAlPsychologyResearchCentre.asp toward a caribbean psychology     

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Ward, T. (2008). Neuropsychological assessment in the Caribbean. In F. W. Hickling, B. K. Matthies, K. Morgan, & R. C. Gibson (Eds.), Perspectives in Caribbean psychology (pp. 332–359). Mona, Jamaica: CARIMENSA, University of the West Indies at Mona. Ward, T., & Hickling, F. (2005). Psychology in the English-speaking Caribbean. The Psychologist, 17, 442–444. Watts, R. J. (1992). Elements of a psychology of human diversity. Journal of Community Psychology, 20, 116–131. http://dx.doi.org/10.1002/1520-6629 (199204)20:23.0.CO;2-S

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2 GLOBAL, INDIGENOUS, AND REGIONAL PERSPECTIVES ON INTERNATIONAL PSYCHOLOGY JOHN BERRY

In my view, the core challenge facing psychological science and practice at present is how to understand the development and display of human behavior in relation to the vast array of cultural and intercultural experiences of individuals. Clearly, human societies provide variable contexts for human development. Just as clearly, these contexts are undergoing change as a result of intercultural influences. The fundamental challenge is to understand these culture–behavior relationships, not only within each society but also internationally to achieve a truly global psychology. This chapter extends two previous examinations of these issues. The first was a talk at the conference in Chile in 2001 of the Sociedad Interamericana de Psicologia (SIP) when I received the Interamerican Prize for Contributions to Psychology. The second was an article that followed from my award from the Canadian Psychological Association for Contributions to the International Advancement of Psychology (Berry, 2013). I continue here with these themes http://dx.doi.org/10.1037/14753-003 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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by first critically examining some of the features of contemporary international psychology. I then look at some possible ways of dealing with these problems, using the fields of cross-cultural and intercultural psychology as a guide. Within the field of cross-cultural psychology, I include three perspectives on how to study and interpret culture–behavior links: the culturecomparative, the cultural, and the indigenous perspectives. Within the field of intercultural psychology, I examine the various ways that individuals and societies may respond to domination from outside their own cultural region. Finally, I consider the possible role of regional psychologies as one further way to understand human behavior in cultural and intercultural contexts, and as a step toward achieving a global psychology. INTERNATIONAL PSYCHOLOGY: A CRITIQUE The discipline and practice of psychology have long histories in only a few countries of the world. Initially developed in Europe, then further in the United States, these histories have close ties to the cultural traditions of those particular societies. Although more and more taught, studied, and practiced in other parts of the world, psychology remains largely culture bound (Berry, Poortinga, Segall, & Dasen 1992; Henrich, Heine, & Norenzayan, 2010), being limited in its origins, concepts, and empirical findings to only a small portion of the world. And although the concept of culture has been recognized as a core variable in psychology in a book that documents the origin and development of 15 key psychological concepts (Berry & Triandis, 2006), the discipline has remained culture blind, largely ignoring the influence of the role of culture in shaping the development and display of human behavior (Cole, 1996; Rogoff, 2003). As a result of these limitations, missing from the international scene are the insights and knowledge of psychology from the largest, most complex, and in many ways the earliest developed societies of the world. In particular, the psychological contributions from China, India, and the Arab world are largely unknown to Western psychology. Similarly missing are those from societies in Africa, the Caribbean, indigenous North and South America, and the Pacific region. It should be mentioned that some attempts have been made to understand human behaviors from other regions of the world by psychologists and human development researchers (e.g., Chapter 5, this volume; Cole, 1996; Rogoff & Gauvain, 1984; Ramadan & Gielen, 1998). The core question is, If human beings are all one people, belonging to one species, how can a discipline that thinks of itself as the science of human behavior not be based on an understanding of all human experience and knowledge? Why has psychology lagged so far behind other human and social 46       john berry

sciences in seeking the development of a global science? Why do we not have a global science that permits the understanding of human behavior, and the practice of psychology, that is truly panhuman? One reason for this myopia is that the discipline and the profession of psychology are overwhelmingly rooted in, and practiced in, one small part of the world: Western Euro American societies. This psychology is clearly an indigenous psychology of this region. The problems with this culture-bound and culture-blind character of psychology were echoed by Sutherland (2014) for the Caribbean region: “The evidence is patently clear that Western psychological theories and methods cannot adequately explain the social and psychological functioning of African descendants, nor can this discipline provide useful and sustainable remedies for the region’s problems” (p. 1). Moreover, populations of the world beyond the Euro American enclave has been assumed to be only consumers or subjects, and psychology is sold to or tried out on other peoples. This is a form of scientific colonialism. I argue that to deal with these limitations and impositions, psychology needs to sample all human diversity and examine it in all its variety, as a basis for discerning what may be common to all human behavior. This strategy would follow the examples of cultural anthropology, in which centuries of studying the universals that underlie the surface variation in customs have yielded a number of cultural universals (e.g., Munroe & Munroe, 1997; Murdock, 1975). From this enterprise, it has been well established that all cultures share numerous basic attributes (e.g., social structures, norms, ways of dealing with their habitat); similarly, all languages share core features (such as semantics and syntax). In both these examples, the discovery of these underlying similarities was possible only after substantial study of variations across cultures and languages. In my earlier examination of these problems (Berry, 2001), I deliberately provoked a reaction by calling my talk to SIP “Interamerican or Unteramerican: Trafficking in International Psychology.” My title did indeed startle and provoke many in attendance, but it has led to a discussion on the imbalance in the supply and demand of psychology internationally. Of course, it was a play on words. Inter implies that relationships between communities of psychologists take place among equal-status parties, involving two-way communication, sharing, and cooperation. Unter implies relationships among unequal parties, involving dominance and subservience. Similarly, American has two possible meanings. First, it can refer to all the peoples of the Americas (which is the use of the term in SIP). But it can also refer to the people of one country, which often refers to itself simply as “America” (i.e., the United States). The subtitle refers to trade in commodities (e.g., consumer goods, illicit drugs). There are two implications to the concept of trafficking. The first is to the notion of dumping, in which a commodity that is in great supply in one country is dumped into other societies, thereby overwhelming the other global, indigenous, and regional perspectives     

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societies; it may also be delivered at a lower cost than in the original society. The second reference is to the trading of commodities, in which the product may not be of any value or may even be harmful to people in other societies. The commodity being referred to is, of course, psychology, including concepts, empirical findings, journals, textbooks, and membership in psychological associations. Specifically, the reference is to psychology that is produced in the Western world (particularly in the United States) and that is made available in large quantities and relatively cheaply to the rest of the world. There are two sides to this trade: the supply side and the demand side. The supply side is well documented: Overwhelmingly, psychology is produced in Western societies and distributed to others (see, e.g., Danziger, 1990). With respect to the Americas, it is worth remembering the Monroe Doctrine, which was announced by the U.S. President James Monroe in 1823. It argued that no other country should presume to become involved in the societies of the Western hemisphere, which was reserved as the sphere of influence of the United States. Although initially conceived as a way of preventing European powers from being further involved in their former colonies, it became synonymous with the exercise of U.S. power and dominance in the whole of the Americas. For many societies, the Monroe Doctrine has come to be perceived as a form of U.S. interventionism and imperialism. With respect to the prospects for the development of a Caribbean regional psychology, the core question is whether a Monroe Doctrine for psychology will see the continuing domination of the science and practice from outside the region. It can be argued that the large and powerful presence of the American Psychological Association (APA) and its many divisions in the Western hemisphere (indeed in the whole world) actually represents an extension of the Monroe Doctrine from the political, economic, and military domains into the scientific domain of psychology. Some may argue that APA has attempted to assist the development of psychology in the rest of the Americas through its various activities and committees, such as Ethnic Minority Affairs, Multicultural Education, and Division of International Psychology (Bullock, 2011). However, in these activities, ample evidence shows a view of psychology that is rooted in that one society. The concern in U.S. psychology with minorities poses a problem for many of us who see culture and behavior as closely linked; rather than being seen as cultural groups that have a culture, the use of the term minority emphasizes their small size and implies that they are not only small numerically but also insignificant in the population as a whole. For example, in the APA (2003) “Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists,” the U.S. population is described as being diverse, made up of various minorities. And the very name of the Committee on Ethnic Minority Affairs places the concept of minority front and center. 48       john berry

Moreover, APA adopts U.S. Census categories such as “Asian and Pacific Islander, Sub-Saharan Black African, Latino/Hispanic, and Native American/American Indian.” Do these broad categories have any ethnographic reality even in the United States? When APA extends its reach into other societies, these categories make no sense at all. For example, when psychologists from other societies seek to publish in APA journals, they are often asked to describe their samples in terms of these U.S. census categories. Similarly when APA provides accreditation in other societies (as it has done until recently in Canada), their domestic criteria are placed upon the training and practice there. APA also presumes to hold their annual conferences outside their own society (as it did again in Canada in 2015). When this is done, there are some negative impacts on the national psychological society. When holding their annual meetings outside their own national range, the attendance at the Canadian Psychological Association has tended to fall off. What possible justification can there be for these colonial actions? Perhaps the most blatant example of APA’s involvement in the psychological space of other societies occurred at the first Caribbean Regional Conference of Psychology in 2012. At this conference, tables were supplied by the conference organizers for publishers to display their publications. By my estimate, the display of APA publications took up over 80% of the table space. This overwhelming presence of APA publications was inconsistent with the goals of a conference that sought to have a chance to create a Caribbean regional psychology. This supply-side problem is accompanied by a demand-side problem, which is equally problematic for the attainment of a regional or global psychology. Psychologists in many parts of the world seek to be involved in these activities, often being encouraged to join APA, to read and to publish in APA journals, and to participate in their conferences. When so many psychologists in other countries take Western (particularly U.S.) psychology as their reference group, key issues of local psychological, social, and cultural concern may be missed or even misrepresented both conceptually and empirically. In addition to the absence of attention to these issues, the growth and sharing of a locally relevant psychology, both as a discipline and as practice, may be retarded by such easy access to Western psychology. I now consider some possible ways to deal with this imbalance in international psychology, beginning with an examination of the goal of achieving a global psychology through the concepts and methods that have been developed in the field of cross-cultural psychology. I then consider indigenous and regional psychologies as alternative ways to deal with the problems. global, indigenous, and regional perspectives     

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GLOBAL PSYCHOLOGY One way to achieve a global psychology is through the field of crosscultural psychology (e.g., Berry, Poortinga, Breugelmans, Chasiotis, & Sam, 2011; Segall, Dasen, Berry & Poortinga, 1999). This field has sought to establish links between cultural context and experience and the development and display of human behavior. Over the years, this field has gradually moved from an examination of differences in human behavior across cultures to a search for what may be common to human behavior in all cultures. The examination of these culture–behavior links has also taken into account changes in life experiences that have resulted from intercultural contact and the resultant process of acculturation (Sam & Berry, 2015). In parallel with cross-cultural psychology, intercultural psychology is also searching for some common principles that may allow for the understanding of the role of culture change in psychological development. Together, intercultural psychology and cross-cultural psychology seek to develop a global psychology, one that permits both the comparison of behaviors across cultures and the development of effective intercultural relationships, on the basis of these underlying commonalities. In this view (Berry et al., 2011), cross-cultural psychology is a comprehensive approach that incorporates many other ways of examining the links between cultural context and human behavior. One view is that we researchers need to examine the ecological and cultural settings for human psychological development in many settings and then compare them; this the culture-comparative approach. That is, we need to strategically sample cultures and individuals from a variety of settings, assess their cultural contexts and behaviors, and make comparisons of them across cultures. A second approach is that of cultural psychology (Cole, 1996; Shweder, 1991). Initially, this approach examined only one cultural context and sought to understand the behaviors of individuals that emerged in that context. However, over the past few years, it has become increasingly comparative, and it now resembles the culture-comparative approach. A third view is that of indigenous psychologies, in which the historical and philosophical roots of a society are examined to define and interpret the (possibly) unique features of the psychology of people in that society (Allwood & Berry, 2006; Kim & Berry, 1993). As for cultural psychology, the indigenous approach has also become more comparative, and now resembles the culture-comparative way of examining the links between cultural context and behavior. Thus, in this chapter, I consider these three approaches to now be rather similar in their wish to understand the links between cultural context and human behavioral development: They all examine cultural context; they all assess individual behavior; and they all do comparatively, searching for systematic 50       john berry

relationships between culture and behavior. Hence, I subsume them all under the comprehensive term cross-cultural psychology (Berry, 2000). Over the years, I have been pondering, researching, and teaching about many aspects of the relationship between cultural context and the development and display of human behavior. My own approach to culture-comparative research has been guided by an ecocultural framework (Berry, 1976, 2008; Berry et al., 2011).This approach combines ethnographic and ecological research (rooted in the disciplines of anthropology and human ecology) with the concepts and tools of psychology. Similar approaches have been taken by other researchers: the ecological (Bronfenbrenner, 1979), the developmental niche (Super & Harkness, 1986), and the psychocultural (Whiting & Whiting, 1975). These approaches all use the comparative method to discover relationships between ecological and cultural contexts on the one hand, and the development and display of human behavior, possibly leading to the emergence of a global psychology, on the other. The very possibility of achieving a global psychology must be based on some vision of what we all share as members of humanity. As noted above, this vision has emerged over the years, accompanying the gradual shift in interest away from what is different between cultural groups and the behavior of their individual members to what is similar among them. Although the interest has remained on what differentiates individuals and groups from each other across cultures, there is now a much greater interest in what we share as members of one human community (Poortinga, 2011). Somewhat paradoxically, this search for what is common to human behavior around the world requires the examination of behavioral diversity. It also requires the introduction of the concept of cultural and psychological universals, the cultural and psychological features of human life that are found in all cultural populations, even though they may be expressed in very different ways. The concept of universals is linked to the distinctions among three core features of psychological life: process, competence, and performance. Psychological processes are posited to be shared features of all human beings. Competence is the outcome of psychological development rooted in these shared processes and is posited to be variable across individuals and cultures. Performance is the expression of competence in appropriate social and cultural contexts and settings, and is also posited to be variable across individuals and cultures. To illustrate, processes are those psychological features of individuals that are the fundamental ways in which people deal with their day-to-day experiences, such as perception, learning, and categorization. Competencies are those features of individuals that develop as a result of cultural experience, such as abilities, attitudes and values. They are developed on the basis of the interaction between the basic underlying processes and peoples’ global, indigenous, and regional perspectives     

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encounters with the outside world. Performances are those activities of individuals that are expressed as behavior, such as skilled work, carrying out projects, or engaging in social or political action. Performances are those expressions of competencies that are appropriate to, or are triggered by, the need to act in a suitable way in a particular social context. The actual performance will depend not only on the competence but also on a host of situational factors. For example, all individuals have the basic processes required to learn a language (or multiple languages). Which language(s) will be learned (competencies) depends on the cultural context in which the individual develops. And in a situation in which one has a choice of language, the performance will depend on the language of the interlocutor and the requirement to speak a particular language in any specific social situation (e.g., work, one’s cultural community). Understanding these three psychological phenomena is a prerequisite for interpreting the theoretical position of universalism as a basis for achieving a global psychology. One can only observe performances, in all their variety and in all their cultural and intercultural contexts. Competencies can only be inferred from patterns of regularities in these performances (whether exhibited in naturalistic settings or under controlled test conditions). And most removed from observable human behaviors are the underlying processes; these also require the making of inferences from these patterns. Within cross-cultural psychology, some strategies have been proposed to deal with the current problems in international psychology and to move toward a more global psychology. The first is prevention strategies; the second is acculturation strategies. Prevention Strategies Borrowing concepts from the field of health, I discuss three forms of prevention that may be used to reduce the demand for Western psychology. First is primary prevention: For members of nondominant cultural communities, the strategy is simply to not expose oneself to the dominant Western psychology; do not subscribe to or read the material on offer. It also means not submitting work carried out in, or that is of primary relevance to one’s own society, to the national journals of another society. All this means turning away from and not using the dominant psychology as one’s reference group. Instead, it involves deliberately avoiding the external source and turning to the examination of issues in one’s own society, using local concepts and methods. For the dominant psychology community, primary prevention means not dumping their psychology onto nondominant psychological communities, standing back, and allowing them space and time to develop their own cultural and regional perspectives. 52       john berry

Secondary prevention for nondominant psychologists involves seeking to limit the impact of the external influence once exposure has already occurred. If the materials are readily available (e.g., journals and textbooks in the library, the basis for discussions with colleagues), ignore them, criticize them, and do not use them automatically in teaching or research. This is difficult to do in a world in which the work of Western psychology floods every Internet search. However, it is always possible to read, and dismiss as irrelevant, the dumped material, rather than accept it as gospel. For the dominant Western psychology, any reduction of the impact is difficult to achieve, given the widespread availability of telecommunications and the Internet. And once it is made widely available, it is difficult to take back. However, restraint (e.g., in dominating book displays at conferences at which the goal is to find an alternative psychology) is still an option for dominant Western psychological communities. Given these difficulties, primary prevention is of utmost importance. The third prevention strategy for nondominant psychology is to counteract the influence of Western psychology by criticizing it and providing alternative materials (e.g., locally relevant research concepts, empirical findings, and teaching materials) that will be more useful in the local society. These strategies have given rise to the development of indigenous psychologies (discussed below). For the dominant Western psychology, tertiary prevention may take the form of not dismissing or negating the development of indigenous approaches but being open to such alternative conceptions of human behavior. A related approach has been termed indigenizing (Sinha, 1997); it accepts this Western psychology as a starting point to understand behavior in another culture and engages in a process of conceptual and methodological change that increasingly matches the local realities (cf. the concept if integration, in Acculturation Strategies section, below). This sequence resembles the imposed-etic–emic-derived-etic set of steps I have advocated (Berry, 1969, 1989) for many years. These three prevention strategies may help in dealing with the demand side of the problem. However, the supply side will remain a problem as long as the dominant Western psychology continues to be disseminated (even dumped) into the world psychology market. Acculturation Strategies In the field of intercultural psychology, the concept of acculturation has been examined for decades (Sam & Berry, 2006). This process involves the cultural and behavioral changes that result from contact between groups and individuals who have different cultural backgrounds. Understanding the process of acculturation is relevant here because the impact of Western psychology on other societies may be considered a form of scientific acculturation, global, indigenous, and regional perspectives     

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especially assimilation, and has some resultant challenges. This issue has been highlighted by Sutherland (2014) for the Caribbean region: A Pan-Caribbean Psychology will need to explain the impact of Western influences on the psychological functioning of African Caribbeans and African descendants in Latin America. For instance, what are the psychological implications for people of African descent having to simultaneously deal with these contradictory influences of African culture and heritage and European culture and heritage, and other non-African cultural influences? (p. 8)

As part of this research on acculturation, the concept of acculturation strategies has been advanced (Berry, 1980). This term refers to the various ways that groups and individuals seek to engage the acculturation process. Knowledge of these variations has increased substantially in recent years, challenging the widespread assumption that everyone would assimilate and become absorbed into the dominant group. The search for a global psychology naturally brings to mind the concept of globalization. I have argued previously (Berry, 2008) that globalization does not lead inevitably to a linear change from being engaged in one’s heritage culture to accepting the more dominant one. If this is so, then multidimensional conceptions of the outcomes of intercultural contact are required. One way to examine these various possible outcomes of intercultural contact in plural societies is to consider the intercultural strategies framework that I developed (Berry, 1980), which has three dimensions. The first is the relative preference for maintaining one’s heritage culture and identity. The second is the relative preference for having intercultural contact with, and participating in, the larger society along with other ethnocultural groups. The third is the relative power of the groups in contact, particularly the role played by the larger society (its policies and institutions) in allowing or constraining these first two preferences by the nondominant individuals and groups. These three issues can be responded to on attitudinal dimensions, ranging from generally positive or negative orientations to these issues; their intersection defines eight strategies. There are four orientations from the point of view of nondominant ethnocultural peoples (both individuals and groups); and four views (public policies and attitudes) held by the dominant larger society. It has now been well demonstrated that these dimensions are empirically, as well as conceptually, independent from each other (e.g., Donà & Berry, 1994; Ryder, Alden, & Paulhus, 2000; Sabatier & Berry, 2008). For nondominant ethnocultural groups, orientations to these issues intersect to define the four acculturation strategies of assimilation, separation, marginalization, and integration. When individuals do not wish to maintain their cultural identity and seek daily interaction with other cultures, it is referred to as the assimilation strategy. In contrast, when individuals place a value on holding on to their original culture, and at the same time wish to avoid interaction 54       john berry

with others, then it is the separation alternative. Marginalization is when people have little possibility or interest in cultural maintenance (often for reasons of enforced cultural loss) and have little interest in having relations with others (often for reasons of exclusion or discrimination). Finally, integration strategy is when individuals have an interest in maintaining one’s original culture while participating in daily interactions with other groups. In this case, some degree of cultural integrity is maintained, while seeking, as a member of an ethnocultural group, participation as an integral part of the larger society. Note that integration has a very specific meaning within this framework: It is clearly different from assimilation (because of substantial cultural maintenance with integration), and it is not a generic term referring to just any kind of long-term presence, or involvement, of an immigrant group in a society of settlement. The original definition of acculturation in anthropology clearly established that both groups in contact would change during the acculturation process (Redfield, Linton, & Herskovits, 1936). Hence, conceptualizing the views of the dominant group in influencing the way in which mutual acculturation would take place is needed. Assimilation, when sought by the dominant group, is termed the melting pot. When separation is forced by the dominant group, it is segregation. Marginalization, when imposed by the dominant group, is exclusion. Finally, for integration, when diversity is a widely accepted and valued feature of the society as a whole, including by all the various ethnocultural groups, it is called multiculturalism. I argue that the dominance of Western psychology has resulted in a form of scientific assimilation. It has influenced the development of psychology in other societies, indeed the whole of international psychology (how it is conceived, researched, and practiced) in the rest of the world. Not only has this resulted in scientific assimilation of the discipline, it has also led to the personal and social assimilation of psychologists when they turn away from networks in their own society and orient themselves to the national organizations in other countries. For example, as discussed above, when a national psychological society accepts a foreign association to hold a congress within their national borders, or to provide accreditation for their graduate programs (usually with the acceptance of foreign criteria), the national society engages in the acceptance of such scientific assimilation. As a result, it is possible that national psychological communities may become marginal to the needs and concerns of their own society. One solution is for psychologists to initially adopt a separation strategy by turning their backs on the dominant psychology and having a close look at the culture–behavior links in their own societies. This amounts to using the approach of indigenous psychologies (to be outlined next). However, to achieve a global psychology, the integration strategy would then need to be used by taking all the indigenous psychologies that have been developed and global, indigenous, and regional perspectives     

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bringing them together to discover patterns of similarities and differences around the world (Berry, 1993). INDIGENOUS PSYCHOLOGIES Consistent with the use of the separation strategy, a second way to deal with the current problems in international psychology is the promotion of the development of indigenous psychologies. By indigenous psychologies, I mean a set of approaches to understanding human behavior within the cultural contexts in which they have developed and are currently displayed. They can also be seen as attempts to root psychological research in the conceptual systems that are indigenous to a culture, including the philosophical, theological, and scientific ideas that are part of the historical and contemporary lives of people and their institutions. (Allwood & Berry, 2006, p. 241; see also Kim & Berry, 1993)

Indigenous psychology has sought to examine the specific links between the historical, philosophical, and cultural features of a cultural community and the behavior that is evident there. In a way, this approach has mirrored the localization movement that has sought to counter the process of globalization (Berry, 2008). The indigenous perspective has tended to emphasize the unique features of behavior in specific cultural contexts (e.g., Sinha, 1986). However, the search for commonalities has also been advocated (Enriquez, 1990, 1993) through the use of the cross-indigenous method, in which indigenous psychologies are brought together using the comparative method. This corresponds to the integration strategy outlined above. The indigenous approach may be seen as a reaction to the dominance of Western psychology around the world. This dominance is problematic because there may be a serious mismatch between what is available from Western psychology and what is needed in other societies (Moghaddam, Erneling, Montero, & Lee, 2007). Allwood (1998) and Danziger (2006) have argued that Western psychology is actually an indigenous psychology, which is rooted in one particular time and place. That is, the psychology that most of us know and practice (and that is sometimes thought to be universal) is actually just an indigenous psychology of the West. An international survey of indigenous psychologists that examined the current state of indigenous psychologies was carried out by Allwood and Berry (2006). Analysis of respondents’ views noted some core features to the approach, including the widespread recognition of the importance of the historical and philosophical notions in their cultures, and the contemporary characteristics of their societies, in achieving a relevant indigenous 56       john berry

psychology. The view was widely shared that indigenous psychologies could advance psychology in two ways: They create a more valid and useful local psychology, and they are contributions in the pursuit of a global psychology through the use of the comparative cross-indigenous method. They also noted some other qualities of indigenous psychologies, including that they are seen as a postcolonial reaction to the dominance of concepts, methods, and findings of Western psychology. These imported psychologies could not usually be applied to the development needs of their societies. Many also reported that there was a reaction to their work on indigenous psychology by local and international colleagues, where doing indigenous psychological research was claimed to be undermining their academic careers, as well as the status of psychology as a science. An important issue found in the survey was the contrasting views that may be described as indigenous versus indigenizing. Is the starting point in developing indigenous psychologies to be rooted exclusively in one’s own history, society, and culture, or is it in the importation followed by the modification of Western psychology? This issue was raised by Sinha (1997), who saw theses paths as complementary, rather than contradictory. The process of indigenization was the route; this could be by way of first examining local cultural themes and then drawing on Western psychology. The product was the attainment of indigenous psychologies and, eventually, through the use of the comparative method, the achievement of a global psychology. This approach resembles the integration acculturation strategy discussed here. Sinha (1986) has presented a systematic account of this process in many parts of the majority world. His main position is composed of two complementary assertions. First is the need to embed every psychology in a specific cultural context. Second is the need to establish the universality of the empirical basis and principles of psychology. In his view, “indigenization is considered to be a vital step towards a universal psychology” (Sinha, 1997, p. 131). This view is shared by Yang (2000) and corresponds to the goal of achieving a global psychology. My view is that a balance has to be found (Berry, 2000). On the one hand, it does not make sense to completely ignore the achievements of Western psychology. On the other hand, the ethnocentrism of Western psychology makes it necessary to take other cultural viewpoints on human behavior into account if we are ever to achieve a global psychology. Probably the integration strategy will prove to be the most appropriate way forward (Berry, 1993). As argued throughout this chapter, one of the goals of cross-cultural psychology is the eventual development of a global psychology that incorporates all indigenous (including Western) psychologies. If we continue to use only Western concepts and tools, researchers will never know whether all diverse psychological data and cultural points of view have been incorporated into the eventual universal psychology. global, indigenous, and regional perspectives     

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The philosopher of science Eddington (1939) noted that we can only catch fish that are able to be caught with the type of net that we use. In keeping with this metaphor, we should at least cast our net as widely as possible, and with culturally appropriate concepts and tools, to gather all the relevant psychological information that is available around the world. REGIONAL PSYCHOLOGIES A third way to deal with the problems in international psychology is to develop regional psychologies. Many have argued (e.g., Craton, 1997) that the Caribbean does form a region because of its common history of colonization, slavery, and eventual independence from European powers. This regional way forward has recently been pursued in various parts of the world, including the Caribbean region. As Sutherland (2014) noted for the Caribbean region: Another task for this discipline is to correct the errors of Western Psychology, and if possible, reconstruct Western Psychology to more appropriately address the needs of Caribbean populations, while being cognizant of the fact that reconstruction processes might be fraught with difficulties in view of the cultural differences of people living in the region and those living in Western countries. The developers of a PanCaribbean psychology will define the theoretical parameters, socially relevant research themes, and methodological approaches. Theoretical frameworks related to applied work in the areas of employment, health, education, conflict management, and in other life domains must also be a priority of Caribbean psychologists. (pp. 16–17)

However, a legacy of earlier work can be built upon: A Pan-Caribbean psychology, if it is to succeed, must be built by the efforts of those psychologists living in the Caribbean and in Latin America. These psychologists must be fully dedicated to defining the culturally relevant theoretical frameworks and applied work in the areas of justice, employment, health, education, conflict management, and in other life domains. There must be an uncompromising commitment to prioritize the psychological concerns of people of African descent. This will be a difficult task in a region that defines itself as creole, multiracial, and so forth. Pan-Caribbean Psychology’s mission, I argue, is to make African descendants culturally whole again for personal and national development. In healing African descendants, we contribute to the healing of our global world order. (Sutherland, 2014, pp. 16–17)

This regional perspective is one that in many ways is located between the global and the indigenous levels of analysis. It is based on the notion that there are culture areas of the world that share some cultural features in 58       john berry

common, including ecological, linguistic, and historical qualities (Murdock, 1975). Murdock (1975) proposed that there are six culture areas: Africa, Asia, Circum-Mediterranean, Oceania, North America, and South America. The concept of culture areas has been used for a variety of purposes. One is to ensure that all cultural variation is sampled equitably when carrying out cross-cultural research. For example, the standard cross-cultural sample (Naroll, Michik, & Naroll, 1980) has representation from all these cultures to achieve good representation of cultural variation in any comparative study. Another use has been in the organizational structure of the International Association for Cross-Cultural Psychology, with a board made up of representatives from each of these regions, so that no one region has more influence in the running of the Association than any another region (despite different numbers of members in each region). The question is whether these cultural regions may serve as a basis for the development of regional psychologies. On the one hand, Poortinga (1999) argued that developing indigenous psychologies can lead to a proliferation of numerous local psychologies that may not well serve the goal of achieving a global psychology—causing too many, too small, psychologies. On the other hand, the six cultural regions proposed by Murdock (1975) may be too encompassing of important differences within a region and, hence, miss examining the details of cultural and behavioral variation within the area. One activity that appears to support the importance of regions in the development of psychology is the holding of regional conferences of psychology by various organizations over the past 40 years. For example, the International Association for Cross-Cultural Psychology (IACCP) has held 14 regional conferences of psychology since 1975, covering the regions of Africa, Asia, Europe, and North America (see Appendix 2.1 for a list). In addition, the International Union for Psychological Science (IUPsyS) and the International Association for Applied Psychology (IAAP) have held nine regional conferences since 1995, sometimes cosponsored by IACCP. These conferences have sought to provide an intellectual basis for the development of regional perspectives on psychology that may be rooted in a particular culture area. An example that is particularly relevant to this chapter is the Caribbean Regional Conference of Psychology held in the Bahamas, November 15–18, 2011. It was hosted by the Bahamas Psychological Association and supported by three international psychological organizations: IUPsyS, IAAP, and IACCP. The conference addressed issues of paramount importance to the Caribbean community of psychologists as they strive to attend to local needs while connecting with the global community of psychologists. The theme of the conference was “Psychological Science and Well-Being: Building Bridges for Tomorrow.” The conference was attended by more than 350 persons, from 37 countries, of which 20 nations/territories were in the Caribbean. At the global, indigenous, and regional perspectives     

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end of the conference delegates signed the Nassau Declaration, in which they made a commitment to form a Caribbean psychology organization, which was formalized in 2013 as the Caribbean Alliance of National Psychological Associations (CANPA), to promote the national and regional development of psychology as a science and practice. The organization will significantly enhance the capacity of psychologists in the region to use psychological science to improve the well-being of the Caribbean people. Following this inaugural meeting, a second conference was held in Suriname in 2014, with a third conference being planned for Haiti in 2016 (see Chapter 1, this volume). An early example of a psychology association with a regional focus is the Asian Association of Social Psychology (n.d.). It was founded in 1995, with the goal of providing scholars in Asia and the Pacific with a collaborative forum for the discussion, promotion, capabilities building, and publication of their research. It promotes research on Asian traditions, philosophies, and ideas that have scientific merit and practical applications, and expands the boundary, substance, and direction of social psychology by supplementing and integrating Western psychology’s focus on intraindividual processes with a broader and more holistic view from culture and society. (Association of Social Psychology, n.d.)

This association has its own journal and meets every 2 years in various countries in the Asia-Pacific region. A third step in the development of a regional psychology was the recent declaration advanced at the International Congress of Psychology in Capetown in 2012. This declaration was motivated by the energy created by delegates from many parts of Africa meeting each other at the congress, and was inspired by the Nassau Declaration. The Capetown Declaration proposed to establish the Pan African Psychology Union. Representatives of 11 African countries came together to discuss possibilities for developing a stronger focus for the role of psychology within Africa, under the initiative of the ICP2012 Secretariat and IUPsyS. The first meeting was held in 2014, with 14 countries being represented. The goals of the Pan African Psychology Union are to address the following challenges: The need to develop the uniquely African voice of psychology; the need to demonstrate the relevance of the discipline on the continent and improve its visibility and status; the importance of including, generating and disseminating African-centred psychological knowledge; harmonization and development of continental curricular that are contextually and culturally relevant, and include indigenous theories, knowledge and practices; research to inform and strengthen a contextualized approach to teaching and practice; enhanced access to knowledge (e.g., creation of

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an African psychology journal, and continental research data bases and archives to facilitate this); networking and exchange (e.g., student and staff exchange). (2nd & 3rd Pan-African Psychology Union Workshop, 2013, p. 2)

These three examples of regional initiatives testify to the perceived need and viability of the regional approach to the development of psychology. These may well serve as building blocks in an eventual global psychology. I now raise the basic social, cultural, and political question, What constitutes a “region”? As I discussed above, Murdock (1975) proposed the concept of culture area, with six cultural regions being defined. Are these areas appropriate for the development of regional psychologies, or are they too large? In particular, one may ask, Is the Caribbean a “cultural region,” and what may be achieved for psychology by considering it to be so, as we pursue the development of a Caribbean psychology? The issue of viewing the Caribbean as one cultural region that shares some common features has been discussed and debated for centuries (e.g., Boxhill, 1997; Hall, 2000). Some disciplines clearly view the Caribbean as a region, without explicitly defining its parameters (e.g., see the volume Caribbean Sociology, edited by Barrow & Reddock, 2001). These authors implicitly accept that a shared geography and a history of colonization by European powers (and more recently by the United States), as well as the shared institutions of slavery and indentured labor, may be the core features of the region. More explicitly, Lewis (1968) argued that the sweep of historical forces since the discovery has shaped the archipelago—colonization, slavery, the plantation system, sugar, Emancipation has shaped the West Indian society. The particular impact has naturally been different in each island society, since the region’s anomalous decentralization has worked to isolate island from island, island-group from island-group. That explains still, the absence of any real pan-Caribbean consciousness and the continuing balkanization of the area. (p. 4)

This lack of a regional consciousness or identity raises a core psychological issue. As Boxhill (1997) noted, “Caribbean society evolved with stronger identification with countries outside of the region than with those inside, notwithstanding intra-regional relations developed through migration and political unions” (p. 4). Boxhill’s analysis has been supported by Michael Manley, who wrote on the cover of Boxhill’s book, “I agree one hundred percent with the basic contention . . . that it is the absence of an ideology of regionalism which explains the weakness of integration.” This lack of a common identity has been made even more explicit by Thomas-Hope (1984): “The failures of Caribbean integration are chiefly ascribed to the lack of a sense of identity” (p. 2). global, indigenous, and regional perspectives     

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Of course, this regional issue for psychology is closely tied to the broader issue of Caribbean regional integration at other levels (cultural, economic and political). Forbes Burnham (1970) argued that without such integration, either we weld ourselves into a regional grouping serving primarily Caribbean needs, or lacking a common positive policy, have our various territories and nations drawn hither and thither into, and by, other large territories, where the peculiar problems of the Caribbean are lost and where we become objects of neocolonialist exploitation, and achieve the pitiable status of international mendicants . . . either we integrate or perish, unwept, unhonoured. (pp. 246–247)

In the section on acculturation strategies, I defined integration as being simultaneously oriented toward one’s own heritage culture and involved with a larger social and cultural community. It is this conception of integration that may well serve the process of developing a regional Caribbean psychology: Each society maintains and develops its own psychological conceptions, practices, and organizations that meet their own local needs, while becoming a participant in the wider Caribbean community and its institutions. This approach provides a win–win situation for psychologists: No local community of psychologists need feel diminished, and opportunities are provided for expanding each community’s activities at the regional and international levels. A second advantage is a now well-established relationship between the integration acculturation strategy and well-being, at both the individual and group levels (Berry, 1997; Berry et al., 2006; Nguyen & Benet-Martinez, 2013). These findings on the relationship between acculturation strategies (how people acculturate) and well-being (how well they adapt) have shown that those who are engaged in more than one sociocultural community achieve greater well-being than those who orient themselves to only one group (by way of assimilation or separation) and are especially better adapted than those who are marginal to the process of intercultural contact. The regional integration of psychological communities is likely to follow this path toward an enhanced capacity for achieving their goals and a greater sense of well-being as well. What are the core issues for the Caribbean region with respect to the development of regional integration of psychology and achieving a successful regional association? As noted in my analysis of the problems with contemporary international psychology, and as alluded to by commentators on the Caribbean situation, two aspects need to be addressed simultaneously. One is the lack of a common identity among all the communities in the region. So much variation in language (resulting from colonization by different powers) and ethnicity (from the historical pattern of indigenous and migrant settlement) has resulted in a lack of sociocultural commonality on which a shared identity could be based. These are issues that are now being 62       john berry

addressed by psychologists in the region (e.g., Chapters 1 and 5, this volume; Sutherland, 2014). The other issue is the established and continuing links with psychology in societies that are outside the region (rather than with other psychologists in the Caribbean region). As noted above, these have resulted in identification with, membership in, and professional and research involvement with these other national (indigenous) psychologies. And as observed in my discussion of the increasing role of U.S. psychology in the region, we have seen the development of a kind of Monroe Doctrine for psychology. The supply side has been overwhelming, and the demand side has been difficult to limit. CONCLUSION In this chapter, I have presented some criticisms of international psychology, particularly of the dominant Western and U.S. indigenous psychologies. I have proposed that the achievement of a more global psychology may be within reach if some concepts and methods now available in psychology from both these dominant Western sources and from those working in the rest of the world are used. A global psychology would be based on a sampling of behaviors in many cultures, using indigenous concepts and methods, and then examining them for their commonalities. The perspectives to be used include drawing on the distinction among process, competence, and performance; prevention strategies to avoid domination by Western psychology; the intercultural strategies of separation and integration (while avoiding assimilation and marginalization); and the development of indigenous and regional psychologies around the world. A global psychology may eventually be discerned from the patterns and similarities among these various indigenous and regional psychologies. It is a truism that all forms of domination eventually come to an end— empire or scientific paradigm, nothing lasts forever. In my view, the time is ripe to question the presumed universality of the Western indigenous psychology, to challenge its dominance in international psychology, and to develop alternative psychologies through the use of more indigenous and regional approaches. Whether these various psychologies will eventuate in the emergence of a global psychology remains a major challenge. However, in my view, now sufficient evidence indicates a basis for developing a global psychology, one that is rooted in common shared psychological processes. This view is sustained because no cross-cultural research has yet established the presence of a basic psychological process in one culture that is absent in another culture. Despite the obvious fact that behavior is developed and displayed in culturally variable ways, there appears to be no conceptual or methodological impediment to searching for their underlying commonalities. global, indigenous, and regional perspectives     

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APPENDIX 2.1 REGIONAL PSYCHOLOGY CONFERENCES REGIONAL CONFERENCES OF THE INTERNATIONAL ASSOCIATION FOR CROSS-CULTURAL PSYCHOLOGY

Year

Region

Location

1977 1983 1985 1987 1989 1991 1995 2001 2003 2005 2009 2011 2013 2015

North America Asia Europe North America Europe Europe North America Europe Europe Europe Africa Europe North America Central America

Kingston, Ontario, Canada Kuala Lumpur, Malaysia Malmo, Sweden Kingston, Ontario, Canada Amsterdam, the Netherlands Debrecen, Hungary Hermosillo, Mexico Winchester, United Kingdom Budapest, Hungary San Sebastian, Spain Buea, Cameroon Istanbul, Turkey Los Angeles, California, United States San Cristobal, Mexico

REGIONAL CONFERENCES OF THE INTERNATIONAL UNION FOR PSYCHOLOGICAL SCIENCE AND THE INTERNATIONAL ASSOCIATION OF APPLIED PSYCHOLOGY

Year

Conference

2013 2011 2009

African Regional Conference Caribbean Regional Conference of Psychology South East Europe Regional Conference of Psychology Second Middle East and North Africa Regional Conference of Psychology Asian Applied Psychology International– Regional Conference Middle East and North Africa Regional Conference of Psychology: Psychology and Sustainable Development and Peace Southeast Asia Regional Conference on Science and Applied Psychology: Enhancing Human Potential First Africa Congress of Psychology First Asian Regional Conference

2007 2005 2003 2001 1999 1995

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Location Kampala, Uganda Nassau, The Bahamas Sofia, Bulgaria Amman, Jordan Bangkok, Thailand Dubai, United Arab Emirates Mumbai, India Durban, South Africa Guangzhou, China

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Berry, J. W., Poortinga, Y. H., Breugelmans, S. M., Chasiotis, A., & Sam, D. L. (2011). Cross-cultural psychology: Research and applications (3rd ed.). Cambridge, England: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511974274 Berry, J. W., Poortinga, Y. H., Segall, M. H., & Dasen, P. R. (1992). Cross-cultural psychology: Research and applications (1st ed.). Cambridge, England: Cambridge University Press. Berry, J. W., & Triandis, H. C. (2006). Culture. In K. Pawlik & G. d’Ydewalle (Eds.), Psychological concepts: An international historical perspective (pp. 47–62). Hove, England: Psychology Press. Boxhill, I. (1997). Ideology and Caribbean integration. Kingston, Jamaica: Consortium Graduate School of Social Sciences. Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press. Bullock, M. (2011, November). APA’s international responsibility. Monitor on Psychology, 42(10), 9. Burnham, F. (1970). A destiny to mould: Selected discourses by the Prime Minister of Guyana. London, England: Longman Caribbean. Cole, M. (1996). Cultural psychology: A once and future discipline. Cambridge, MA: Belknap. Craton, M. (1997). Empire, enslavement, and freedom in the Caribbean. Kingston, Jamaica: Ian Randle. Danziger, K. (1990). Constructing the subject: Historical origins of psychological research. New York, NY: Cambridge University Press. http://dx.doi.org/10.1017/ CBO9780511524059 Danziger, K. (2006). Universalism and indigenization in the history of modern psychology. In A. Brock (Ed.), Internationalizing the history of psychology (pp. 208–225). New York, NY: New York University Press. Donà, G., & Berry, J. W. (1994). Acculturation attitudes and acculturative stress of Central American refugees in Canada. International Journal of Psychology, 29, 57–70. http://dx.doi.org/10.1080/00207599408246532 Eddington, A. (1939). Philosophy of science. Cambridge, England: Cambridge University Press. Enriquez, V. G. (Ed.). (1990). Indigenous psychologies. Quezon City, Republic of the Philippines: Psychology Research and Training House. Enriquez, V. G. (1993). Developing a Filipino psychology. In U. Kim & J. W. Berry (Eds.), Indigenous psychologies: Research and experience in cultural context (pp. 152–169). Newbury Park, CA: Sage. Hall, K. (Ed.). (2000). Integrate or perish: Perspective of leaders of the integration movement 1993–1999. Mona, Jamaica: University of the West Indies Press. Henrich, J., Heine, S. J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 33, 61–83. http://dx.doi.org/10.1017/ S0140525X0999152X

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Kim, U., & Berry, J. W. (Eds.). (1993). Indigenous psychologies: Research and experience in cultural context. Newbury Park, CA: Sage. Lewis, G. K. (1968). The growth of the modern West Indies. New York, NY: Monthly Review Press. Moghaddam, F., Erneling, C., Montero, M., & Lee, N. (2007). Toward a conceptual foundation for a global psychology. In M. Stevens & U. Gielen (Eds), Toward a global psychology: Theory, research, and pedagogy (pp. 179–206). Mahwah, NJ: Erlbaum. Munroe, R. L., & Munroe, R. H. (1997). A comparative anthropological perspective. In J. W. Berry, Y. H. Poortinga, & J. Pandey (Eds.), Handbook of cross-cultural psychology: Vol. 1. Theory and method (pp. 171–213). Boston, MA: Allyn & Bacon. Murdock, G. P. (1975). Outline of world cultures (5th ed.). New Haven, CT: Human Relations Area Files. Naroll, R., Michik, G., & Naroll, F. (1980). Holocultural research methods. In H. C. Triandis & J. W. Berry (Eds.), Handbook of cross-cultural psychology: Vol. II. Methodology (pp. 479–521). Boston, MA: Allyn & Bacon. Nguyen, A. M. T. D., & Benet-Martinez, V. (2013). Biculturalism and adjustment: A meta-analysis. Journal of Cross-Cultural Psychology, 44, 122–159. http://dx.doi. org/10.1177/0022022111435097 Poortinga, Y. H. (1999). Do differences in behaviour imply a need for different psychologies? Applied Psychology, 48, 419–432. Poortinga, Y. H. (2011). Research on behavior-and-culture: Current ideas and future projections. In F. J. R. Van de Vijver, A. Chasiotis, & S. M. Breugelmans (Eds.), Fundamental questions in cross-cultural psychology (pp. 545–578). Cambridge, England: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511974090.022 Ramadan, A., & Gielen, U. (Eds.). (1998). Psychology in the Arab countries. Cairo, Egypt: Menoufla Press. Redfield, R., Linton, R., & Herskovits, M. J. (1936). Memorandum on the study of acculturation. American Anthropologist, 38, 149–152. Rogoff, B. (2003). The cultural nature of human development. Oxford, England: Oxford University Press. Rogoff, B., & Gauvain, M. (1984). The cognitive consequences of specific experiences: Weaving vs. schooling among the Navajo. Journal of Cross-Cultural Psychology, 15, 453–475. http://dx.doi.org/10.1177/0022002184015004005 Ryder, A. G., Alden, L. E., & Paulhus, D. L. (2000). Is acculturation unidimensional or bidimensional? A head-to-head comparison in the prediction of personality, self-identity, and adjustment. Journal of Personality and Social Psychology, 79, 49–65. http://dx.doi.org/10.1037/0022-3514.79.1.49 Sabatier, C., & Berry, J. W. (2008). The role of family acculturation, parental style, and perceived discrimination in the adaptation of second-generation immigrant youth in France and Canada. European Journal of Developmental Psychology, 5, 159–185. http://dx.doi.org/10.1080/17405620701608739 global, indigenous, and regional perspectives     

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Sam, D. L., & Berry, J. W. (Eds.). (2006). The Cambridge handbook of acculturation psychology. Cambridge, England: Cambridge University Press. Sam, D. L., & Berry, J. W. (2015). The Cambridge handbook of acculturation psychology (2nd ed.). Cambridge, England: Cambridge University Press. 2nd & 3rd Pan-African Psychology Union Workshop. (2013, November). The IUPsyS Monthly Bulletin. Retrieved from http://www.iupsys.net/dotAsset/42df5111-07b8404f-8ab5-b7ea68e8a974.pdf Segall, M. H., Dasen, P. R., Berry, J. W., & Poortinga, Y. H. (Eds.). (1999). Human behavior in global perspective: An introduction to cross-cultural psychology (2nd ed.). Boston, MA: Allyn & Bacon. Shweder, R. A. (1991). Thinking through cultures: Expeditions in cultural psychology. Cambridge, MA: Harvard University Press. Sinha, D. (1986). Psychology in a Third World country: The Indian experience. New Delhi, India: Sage. Sinha, D. (1997). Indigenizing psychology. In J. W. Berry, Y. H. Poortinga, & J. Pandey (Eds.), Handbook of cross-cultural psychology: Vol. 1. Theory and method (2nd ed., pp. 129–169). Boston, MA: Allyn & Bacon. Super, C. M., & Harkness, S. (1986). The developmental niche: A conceptualization at the interface of child and culture. International Journal of Behavioral Development, 9, 545–569. http://dx.doi.org/10.1177/016502548600900409 Sutherland, M. E. (2014, November) Pan-Caribbean psychology: A tool for Caribbean regional development. Paper presented at Second Conference of the Caribbean Regional Conference of Psychology, Republic of Paramaribo, Suriname. Thomas-Hope, E. (1984). Perspectives on Caribbean regional identity. Liverpool, England: University of Liverpool Press. Whiting, B. B., & Whiting, J. W. M. (1975). Children of six cultures: A psychocultural analysis. Cambridge, MA: Harvard University Press. http://dx.doi.org/10.4159/ harvard.9780674593770 Yang, K.-S. (2000). Monocultural and cross-cultural indigenous approaches: The royal road to the development of a balanced global psychology. Asian Journal of Social Psychology, 3, 241–263. http://dx.doi.org/10.1111/1467-839X.00067

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II DEVELOPMENTAL PSYCHOLOGY

3 FAMILY SOCIALIZATION PRACTICES AND CHILDHOOD DEVELOPMENT IN CARIBBEAN CULTURAL COMMUNITIES JAIPAUL L. ROOPNARINE AND BORA JIN

Family socialization practices in Caribbean cultural communities occur in diverse mating and marital systems, often under harsh economic conditions and in neighborhoods of poor quality. Within this context, several factors have helped to shape current socialization practices and childhood outcomes across Caribbean nations. Among them are sociohistorical experiences (e.g., slavery, indentured servitude, colonialism), ancestral cultural practices, internal working models about gender roles and child-rearing, educational attainment, economic ascendancy, contact with adjacent groups, and migration within and external to the Caribbean. In this chapter, we discuss family structural organization patterns for child-rearing, psychocultural beliefs about child-rearing, parenting styles, practices, and goals, and childhood outcomes in English-speaking Caribbean countries. We focus on early socialization processes in two ethnic groups: African Caribbeans who were brought as slaves to the region and Indo Caribbeans http://dx.doi.org/10.1037/14753-004 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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who were brought as indentured servants to fill labor shortages after slavery was abolished. The largest concentrations of Indo Caribbeans are in Guyana, Trinidad and Tobago, and Suriname. Although the numbers of individuals of Mixed-Ethnic parentage are increasing in Caribbean societies (e.g., Trinidad and Tobago, Guyana), studies on them are rare. The same can be said for research on indigenous groups (e.g., Amerindians in Guyana) and individuals with indigenous ancestry (e.g., Black Caribs in Dominica). THEORETICAL CONSIDERATIONS As indicated in other chapters in this volume, sociohistorical experiences form the nexus of understanding developmental patterns in individuals, families, and children in the Caribbean. Because Caribbean countries were variously affected by colonization, slavery, and indentured servitude, the transition to independent nation states invited a good deal of introspection on the development of personal and collective identities at the community and societal levels as individual countries moved to establish political, social, educational, and legal institutions during the postcolonial period. The colonial experience has received increasing attention in interpreting psychological identity, socialization patterns, and the sociocultural and cognitive aspects of human development. However, it is worth mentioning that beyond acknowledging the overall destructive power of colonization, researchers have attempted to construct a metatheoretical, postcolonial perspective that speaks to the essence of identities and developmental patterns in multiethnic Caribbean communities. That is, amidst competing and often conflicting social and cultural forces that existed between the colonial experience and natal beliefs and practices, Caribbean peoples have historically faced the challenge of fashioning a sense of self, establishing families, and rearing children within diverse experiences—oppressive and nonoppressive. While Caribbean identities are likely more nuanced today, it is regularly argued that the legacy of the violent and oppressive colonial experience still figures prominently in family structural arrangements, child-rearing patterns, and identity development (see Barrow, 1998). Using literary, sociological, and historical analysis, Escayg (2014) delineated some major components of the anticolonial Caribbean perspective: transplantation, violence, and loss within the context of resistance; the con­ flicting processes of identity formation that draw upon ancestral cultural traditions and European hegemony, not to mention the assimilation of cultural practices and beliefs from adjacent cultural groups in the Caribbean; color and class; and childhood socialization, family processes, and development rooted in a colonial past and current social and economic challenges. 72       roopnarine and jin

Basically, the anticolonial perspective considers the unequal power structures that existed in economic activities and human relationships during periods of domination by different colonial powers and the myriad of ways in which Caribbean people have resisted colonization. The resistance strategies underscore the adaptations that have occurred in personal identities due to dominance (e.g., psychological invasion of the natal psyche), loss of ancestral cultural practices (e.g., relationship structures), transplantation (e.g., relaxation in conservative views about gender roles among Indo Caribbeans), and relationships between different ethnic groups that share a common cultural space (see Patterson, 1967). Connecting the impact of the colonial past of destruction and resistance and the sociohistorical experiences embedded in colonialism with the current state of families and children is not the goal here. Rather, within the frameworks of cultural, cross-cultural, and indigenous perspectives in psychology, we want to call attention to the emphasis placed on what anthropologists call sociohistorical factors. For the purpose of this chapter, anticolonial theory has relevance for interpreting family structural arrangements and child-rearing patterns in harsh ecological niches. To be sure, vestiges of colonialism are still evident in the educational, judicial, and other governmental and societal institutions in Caribbean societies today. Moreover, practices such as mate shifting and mother-headed households among Caribbean families may have evolved out of the destructive practices of slavery. Likewise, religious and ethnic socialization may have been introduced to combat harsh treatment and marginalization. Attempts have been made by several writers and scholars to explain the colonial experience and the Caribbean psyche (e.g., Fanon, 1967; Patterson, 1967), and some have chronicled ancestral connections to presentday family life (e.g., Roopnarine, 2004). Yet it remains a challenge for those in the psychological sciences to more clearly define pathways and intersections between the sociohistorical experiences of Caribbean peoples, ancestral ties to natal cultures as demonstrated through beliefs and practices (e.g., herbal treatments for children, spiritual journeys), and developmental patterns in families and children. Other frameworks such as colorism and critical race theory have been used to interpret developmental patterns of historically oppressed groups in the United States (Burton, Bonilla-Silva, Ray, Buckelew, & Freeman, 2010). In working toward a pancultural or panhuman understanding of family socialization processes and their meanings for childhood development, cultural and cross-cultural psychologists (Greenfield, Keller, Fuligni, & Maynard, 2003; Whiting & Whiting, 1975) have utilized ecological models in framing their work. A model proposed by Whiting and Whiting (1975) in the Six Culture Study has been influential in this regard. It considers challenges/ opportunities within the near environment, the history of people, subsistence family socialization practices and childhood development     

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patterns and modes of production, the learning environment of the child (e.g., settings, caregivers), behavioral tendencies and beliefs of adults, and projective-expressive systems (e.g., religion and ideology). Staying close to the basic tenets of the ecological frameworks, the developmental niche model focuses on parental psychologies or ethnotheories about child-rearing, customs and practices, and the physical setting (Super & Harkness, 1997), and the model of hierarchical parental functions emphasizes the prioritization of child-rearing goals relative to the conditions and demands of the immediate environment (LeVine, 1970, 2004). Modes of subsistence, household density, and resources can often determine the emphasis placed on growth and learning (Bock, 2002). In view of economic conditions, parental belief systems, alloparenting, histories of oppression, and diverse ideological belief systems in Caribbean cultural communities, cultural ecological models appear pertinent for cataloging early socialization patterns among families. Though questioned, parenting frameworks such as those developed by Baumrind (1967) and Rohner (1986; Rohner & Khaleque, 2005) have been examined in different cultural communities around the world and thus have broad appeal for addressing socialization patterns in the Caribbean. In both frameworks, levels of warmth and control are used to determine optimal parenting. Baumrind’s (1967) framework stipulates parenting typologies (authoritative, authoritarian, and permissive), and Rohner’s interpersonal acceptance–rejection theory (IPARTheory, formerly known as PARTheory) suggests that across cultures children experience varying levels of parental warmth and control that fall along a continuum— from acceptance (warmth, care, comfort) at one end to rejection (absence of and withdrawal of feelings of affection and care) at the other (Rohner, 1986; Rohner & Khaleque, 2005). IPARTheory proposes that the impact of parental control (psychological, physical, and behavioral) displayed in the form of rejection depends on children’s perception and interpretation of the event. There is some consensus that too little (e.g., lack of structure, low limit setting) or too much (e.g., overprotective) control affects children’s behaviors negatively (Aunola & Nurmi, 2005; Barber, Stolz, & Olsen, 2005; Chen, Liu, & Li, 2000). Although parental sensitivity is a universally important construct for gauging optimal parenting, the nature and use of parental control across cultures is less clear. In some cultural settings (e.g., India, China), parental control may be viewed as “care” offered by parents (Saraswathi & Dutta, 2010), and authoritarian strategies have been used in conjunction with warmth in child training in some ethnic groups (Chao, 1994, 2001). Because of their prominence in guiding research on parenting practices and childhood outcomes, assessments of their behavioral properties in plural cultural settings (Rohner & Khaleque, 2012), and their demonstrated relevance for 74       roopnarine and jin

childhood development (see Sorkhabi, 2005), Baumrind’s parenting framework (Baumrind, 1967), Rohner’s (1986) IPARTheory, and the developmental niche model (Super & Harkness, 1997) form the basis of the discussion that follows. In the employment of these frameworks, it is prudent to consider cultural continuity in parenting practices and how sharing cultural space with adjacent ethnic groups in the Caribbean may have influenced socialization practices over time—the creolization thesis. FAMILY STRUCTURAL DYNAMICS AND THE IMMEDIATE ENVIRONMENT Family Structure Caribbean countries are made up of different ethnic groups. Among them are African Caribbeans with ancestral roots in Africa, the predominant group in most English-speaking countries; Indo Caribbeans with ancestral ties to India are mainly confined to Trinidad and Tobago and Guyana; individuals of European ancestry; Syrians; Black Caribs who have African and native Caribbean ancestry and reside in countries such as Dominica and Belize; Amerindians who are indigenous to certain geographic locations such as Guyana; individuals of Mixed-Ethnic ancestry who are the offspring of interethnic marriages; and Chinese Caribbean among smaller numbers of recent migrants. The average life expectancy at birth across the Caribbean nations for the period 2005–2010 was 72 years for men and 77 years for women (United Nations Statistics Division, 2010). Table 3.1 presents other sociodemographic characteristics for different Caribbean countries. In addition to economic conditions, family structural arrangements, the stability of these arrangements, and the adaptations that occur within them exert a profound impact on the health and well-being of families and the social and cognitive development of children (see Samms-Vaughan, 2005). The early work of anthropologists such as Clarke (1957) and Smith (1957) revealed different marital and mating systems in Caribbean cultural communities. While Clarke’s seminal work (My Mother Who Fathered Me) laid the foundation for understanding the role of the father in children’s development in Jamaica, Smith’s analysis of family mating unions in Guyana identified a dual-marriage system. More specifically, Smith described several characteristics that reflect the social-structural organization of African Caribbean families, which includes matrifocal organization, emphasis on conjugal ties, nonlegal unions among lower income women, relationships that are not easily defined within a “household” system, and roles that are demarcated by gender but permit greater flexibility for women to seek occupational activities. Smith family socialization practices and childhood development     

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TABLE 3.1 Sociodemographic Characteristics of Caribbean Countries

Countries Antigua and Barbuda Aruba The Bahamas Barbados Belize Bermuda Dominica Grenada Guyana Haiti Jamaica St. Kitts and Nevis St. Lucia St. Vincent and The Grenadines Suriname Trinidad and Tobago Turks and Caicos Islands

Total populationsa (thousands)

Urban populationsa (%)

Population under 15a (%)

Adult (+15) illiteracy ratea (%)

Per capita GDPb (U.S.$)

Predominant ethnic composition groupc (%)

2013

2013

2013

1970–2012

2012

2000–2012

90 102.9 377.4 284.6 331.9 65 72 105.9 799.6 10,317.5 2,715 54.2 182.3 109.4

30 47 85 45 44 100 67 40 29 56 52 32 16 50

25 19 21 19 34 — — 27 36 35 27 — 24 25

1 3 4.4 0.3 23.1 2 6 4 15 51 13 2.2 9.9 4

13,405 — 21,908 14,917 4,853 — 6,915 7,598 3,585 772 5,343 13,659 7,289 6,349

Black (91) Dutch (82.1) Black (90.6) — Mestizo (48.7) Black (53.8) Black (86.8) Black (82) East Indian (43.5) Black (95) Black (92.1) — Black (82.5) —

539.3 1,341.2 33.1

71 14 94

27 21 —

5 1 —

9,182 17,365 —

East Indian (37) East Indian (35.4) Black (87.6)

World Development Indicators (WDI) from The World Bank Group. bStatistics and Indicators in CEPALSTAT from Economic Commission for Latin American and the Caribbean (ECLAC). cThe World Factbook of the Central Intelligence Agency (CIA). GDP = Gross Domestic Product.

a

and others (e.g., Simey, 1946) recognized early on that a significant number of African Caribbean families did not resemble the nuclear family structure that is based on marriage. Instead, childbearing and child-rearing occurred in a variety of unions: nonresidential visiting unions and coresidential unions that may be based on marriage or common-law relationships. Later work by sociologists confirmed these different familial arrangements. For instance, in her work on men in four communities (N = 1,142) in Jamaica, Anderson (2007) found that only 20.5% of fathers below 35 years of age were married. As men aged and attained better economic standing, about 44.8% of men over 35 were married. Similar family social organizational structures were observed in Trinidad and Tobago by child development researchers. In a national representative sample of the three major ethnic groups in Trinidad and Tobago, the marriage rate among individuals of Mixed-Ethnic ancestry was 27.2%, Indo Caribbeans was 69.3%, and among African Caribbeans was 21.7%. Common-law unions were prevalent among African (28%) and MixedEthnic Caribbean (32.2%) groups and on the increase among Indo Caribbeans (23.3%). In both Jamaica and Trinidad and Tobago, nonresidential fatherhood and fathering was common. In the Jamaican sample, only 41.2% of the respondents lived with both parents at age 12 and the Survey of Living Conditions in Jamaica (2004) showed that 47% of children lived with their mothers. Thus, entrance into childbearing in Caribbean cultural communities occurs in different mating/marital systems. For most African Caribbean families, marriage is not a prerequisite for childbearing and child-rearing. Usually, child-rearing begins in nonmarital mating relationships and progress to other unions where men and women engage in “mate shifting” and have children from different “baby mothers” and “baby fathers” (Leo-Rhynie & Brown, 2013). Initially, men and women have children in “visiting relationships” in which they meet and have sexual relationships. They do not reside together and may seek economic and child care support from relatives. In Anderson’s study, 53.9% of men had one baby mother, 25.8% had two baby mothers, and 10.6% had three baby mothers. After having children in visiting relationships, men and women may then move on to common-law relationships with other mating partners where they share a residence and have other offspring. Between 12% and 48% of relationship unions were considered common-law in different study samples in Jamaica (Anderson, 2007; Brown, Newland, Anderson, & Chevannes, 1997; Samms-Vaughan, 2005). With increasing economic security, couples enter marital relationships. For men who begin childbearing in a marital relationship, having “outside children” is not uncommon. Jealousy, scarce economic resources, migration, mate shifting, and child shifting seem to undermine parental involvement during progressive mating. Paternal absence and family instability are major concerns in these different mating relationships. family socialization practices and childhood development     

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By comparison, for Indo Caribbean families, marriage generally marks entry into parenthood. The cultural scripts regarding marriage and husband/ wife roles that accompany East Indian families on the journey to indentureship are quite conservative, steeped in religious edicts outlined in ancient texts (e.g., the Ramayana). Though these cultural scripts set by traditions are rarely achieved, they are reinforced through epics that personify the devoted son and good wife and mother (e.g., Ram and Sita in the Ramayana). Historically, relationships were arranged hierarchically by gender and age. Even today, older men and males are accorded greater status than women. Men have close social ties with their father (Shravan Kumar) and brothers. Within the traditional script women are expected to be subservient (pativrata; Kakar & Kakar, 2007). Although this traditional role dichotomy is changing with better educational attainment and employment opportunities for women, men continue to assume dominant roles within the family in Guyana and Trinidad and Tobago (Brown et al., 1997; Roopnarine et al., 1995). For most Indo Caribbean families, the structural dimensions for bearing and rearing children fall within a mixture of the traditional, extended, and contemporary nuclear family structure. In both African and Indo Caribbean families, alloparenting is prevalent. Whether this is an outgrowth of ancestral practices, slavery/indentureship, or mating patterns, women consistently form social alliances with other kinship and nonkinship members to raise children. Among families in northern Trinidad, Flinn (1992) found that while mothers devoted most of the care interactions to children, sibling (16.3%) and grandparent care interactions (17.6%) were integral to child-rearing. For a majority of families in both ethnic groups some form of structural (e.g., intergenerational families sharing a residence, brothers and sisters sharing living quarters or living in close proximity to each other) or emotional extendedness exists. At the very least, family members have frequent social contacts with kinship members. With increasing migration of Caribbean families to North America and Europe, parents also rely on relatives and friends to care for children who remain in the Caribbean. The extendedness that exists for the socialization of children in Caribbean families is similar to what has been observed in India (Desai et al., 2010) and in African cultural communities (see Marlowe, 2005, for care among the Hadza of Tanzania and Fouts, 2013, for care among the Bofi of the Central African Republic). Home and Community Environment With some exceptions, economic conditions and access to health care have improved in the Caribbean (see Chapter 6, this volume). Nevertheless, significant numbers of families are economically strapped by poor material 78       roopnarine and jin

resources and live in neighborhoods that are affected by high rates of crime and violence (United Nations Development Programme, 2012). Poverty, ignorance about the benefits of early parent–child stimulation, and a lack of play- and literacy-related materials severely hamper early parental input into children’s development. Studies of socialization patterns in Trinidad, Dominica, and Jamaica (Barrow & Ince, 2008; Grantham-McGregor, Landman, & Desai, 1983; Samms-Vaughan, 2006) found that there were few books and toys for engagement in play among poor families, and when present, toys were viewed as expensive items and offered only under adult supervision (Barrow & Ince, 2008). Additionally, 46% of rural Dominican mothers had very little information on the early stimulation process (Charles, 2004) and most caregivers had limited knowledge of child development (Charles & Williams, 2007). Low levels of play stimulation were observed among low-income Jamaican mothers and children with poor nutritional status (Wachs, Chang, Walker, & Meeks Gardner, 2007). Neighborhood quality, particularly disintegration (disorder, resource deprivation, economic adversity, physical setting), can challenge parents’ abilities to meet children’s social and cognitive needs. Sadly, violence in the home (interpartner violence), community (gang violence), and school is witnessed daily by Caribbean children in urban environments. Samms-Vaughan (2005) found that among children in Jamaica, 70% saw someone being beaten up, 54% had heard gunshots, and 48% had seen someone arrested by the police. Leo-Rhynie and Brown (2013) put it this way: Increasing numbers of young children lose family members to gun and knife violence, imprisonment, and arson. The threat of arson as a tool of reprisal for all sorts of perceived or actual offences also results in a lack of shelter security. Instability in the microsystem and the trauma of the loss of significant persons can have repercussions for children in the form of severe psychological damage and emotional scarring and can also upset the chronosystem resulting in setbacks to the optimal development of children. (p. 38)

Obviously, under these conditions, parents must devote more energy toward the protection and safety of children. CONCEPTUALIZING EARLY SOCIALIZATION: BELIEFS, PRACTICES, AND STYLES Developmental and cultural psychologists have identified three important factors that embody early socialization: parental/caregivers’ beliefs about child-rearing, parenting practices, and parenting styles (see Darling & Steinberg, 1993). Briefly, parental beliefs constitute the internal working family socialization practices and childhood development     

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models or cultural schemas (schematic, unaware) or depends on events of which the person is quite cognizant (Bugental & Johnston, 2000; Super & Harkness, 1997, 2002). These belief systems are generally acknowledged by cultural communities as accepted methods of child-rearing and child training, but they vary tremendously by ethnic or cultural group, gender, and socio­ economic status (e.g., Bornstein & Cote, 2004). Cultural belief systems about child-rearing often drive the structuring of cognitive and social activities for children and help define when caregivers expect certain developmental milestones to emerge or unfold in children. Parenting practices constitute the daily routines that parents engage in to meet the needs of young children; they are context specific. Parenting style has been variously defined within constructs such as nurturance and control, acceptance and rejection, warmth and hostility, demandingness and responsiveness, permissiveness and restrictiveness, detachment and involvement, and dominance and submission (see the review by Darling & Steinberg, 1993). According to Darling and Steinberg (1993), parenting style conveys to the child, through behavioral practices and interactions, an emotional attitude (e.g., harsh tone during communication, bad temper). It is an attitude that cuts across behavioral practices and interactions. These three dimensions of early socialization are examined in more detail next. Core Beliefs About Gender Roles and Child Training As stated previously, parenting beliefs and practices vary widely across societies by educational attainment and income (Goodnow & Collins, 1990). While this is also true for Caribbean cultural communities, a few parental beliefs regarding maternal and paternal roles and child training are present across the region regardless of ethnicity, educational attainment, and income. To appreciate the potential role of belief systems in parental investment and training of children, mothers’ and fathers’ ideas about gender roles and responsibilities and a few seminal beliefs about child-rearing are considered herein. Despite changes in women’s roles in Caribbean societies, men and women across ethnic groups have largely traditional conceptions of gender roles and caregiving: Motherhood is synonymous with caregiving and fatherhood with economic provision and protection (Brown et al., 1997; Leo-Rhynie & Brown, 2013). However, given the diverse mating patterns in Caribbean cultural communities, fatherhood and concomitant responsibilities are a bit more difficult to define. Rooted in beliefs about virility (early and frequent hetero­sexual activity), protector, and head, men find self-definition through biological fatherhood. This could possibly indicate that there is a common conceptual base to Caribbean fatherhood in which men’s beliefs about being the head of the family, masculinity, and economic activities work in concert 80       roopnarine and jin

to define manhood. However, some have argued that African Caribbean men see a separation between fatherhood and pair-bond stability. In other words, men may be good fathers outside of a strong commitment to a mating partner or a prior baby mother (Anderson, 2007). A similar pattern is possible for Indo Caribbean men, whose beliefs about dominance, emotional ties to kinship, and nonkinship males are intimately tied to paternal investment in children. Within a gender-demarcated home and community environment, mothers and fathers in a number of Caribbean countries (e.g., Jamaica, Barbados, Saint Kitts, Guyana, Trinidad and Tobago) expect young children to be obedient, compliant, and tidy (Barrow & Ince, 2008; Brown & Johnson, 2008; Roopnarine, Jin, & Krishnakumar, 2013; Wilson, Wilson, & Berkeley-Caines, 2003). Children who fail to meet parental expectations regarding these behavioral demands are labeled “hardened” (stubborn), rude/talk back to adults (Ka raisonne), troublesome (A-betant), or lazy (Durbrow, 1999). Caribbean parents believe in early academic training for children (Leo-Rhynie et al., 2009), are strong advocates of religious and ethnic socialization (Anderson, 2007; Roopnarine, Krishnakumar, Narine, Logie, & Ramlal, 2012), and subscribe to gender-typed socialization of young children (Barrow & Ince, 2008). Ethnic, religious, and academic socialization are considered in more detail later in the chapter. Behavioral Investment and Socialization Practices Undoubtedly, in challenging ecological niches there are factors that tend to undermine mothers’ and fathers’ efforts to shape their children’s lives in a productive manner. The inability to provide economic support was a major source of dissatisfaction in men’s roles as fathers (Anderson, 2007). Lower income Jamaican men were more likely to have more baby mothers and more children, and to use violence during partner conflicts, than their more affluent counterparts. It is also true that poor economic resources and limited knowledge about parenting and childhood development are associated with poor childhood outcomes (Samms-Vaughan, 2005). So how involved are Caribbean parents in the socialization of children? Taking into account economic conditions and parenting stress, both qualitative and quantitative studies paint a more positive picture of parental involvement and practices among ethnic groups in Caribbean cultural communities today compared with those carried out in previous decades. After introducing general levels of involvement, the discussion turns to three practices that are at the heart of early childhood socialization in Caribbean cultural communities: disciplinary practices, academic socialization, and ethnic and religious socialization. family socialization practices and childhood development     

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Levels of Involvement A national survey (Ricketts & Anderson, 2009) of parents in Jamaica present some insights into the daily activities between parents and children: Eighty percent of parents said that they talked with their young children daily or almost daily about their feelings and interests, about 10% said they did this only a few times a month or never, while a little over 10% said they had these conversations a few times a week. Thirty-two percent indicated that they often shared recreational activities with children, 43% said they did this sometimes, and 25% said that they rarely or almost never did as a family. A majority (62%) of parents used praise, hugging, and kissing as forms of affection; 24% used hugging and kissing; 12% used praise alone; and 3.5% mentioned that they rarely showed affection to their children. Families on the lower end of the economic scale were less likely to engage in these activities than those who were better off economically. In related work on Jamaican families (Roopnarine et al., 1995), mothers in dual-earner families spent 3.53 hours holding/playing with infants (fathers spent 2.95), 2.00 hours feeding infants (fathers 1.08 hours), and 1.80 hours in cleaning/washing infants (fathers .75 hour). Moderate to low rates of paternal involvement in caregiving and leisure activities with children were determined for Guyanese families (Wilson et al., 2003), and extremely low levels of paternal social interactions were observed among the Black Caribs of Belize (Munroe & Munroe, 1992). The variability in rates of paternal involvement with young children is similar to those of fathers in other cultural settings (see discussions of father involvement across cultures in Shwalb, Shwalb, & Lamb, 2013). Disciplinary Practices A significant threat to children’s safety and well-being, physical punishment is used regularly to address childhood behavioral transgression across ethnic groups in the Caribbean and is endorsed by adults and children alike (Payne, 1989). Although there are minor signs that physical punishment may be on the decrease in Trinidad and Dominica (Barrow & Ince, 2008), a recent cross-national study involving 34 countries (Cappa & Khan, 2011) found that a majority of mothers in Jamaica, Belize, Trinidad and Tobago, Guyana, and Suriname reported using physical punishment on children between 2 and 12 years of age (Cappa & Khan, 2011). In the case of Guyana and Barbados, physical punishment involved hitting with a belt or stick, shoving/pushing, having the child kneel, punching, and other forms of physical control (Anderson & Payne, 1994; Roopnarine, Jin, & Krishnakumar, 2013). Despite claims about the differential treatment of children by Caribbean mothers and fathers (LeoRhynie, 1997; Leo-Rhynie & Brown, 2013), rural Guyanese mothers used physical punishment more than did fathers (Pant, Roopnarine, & Krishnakumar, 82       roopnarine and jin

2008), and there was no difference in the use of physical punishment between rural and urban mothers (Cappa & Khan, 2011). The greater use of physical punishment by mothers may be an artifact of the greater amount of time they spend with children in which they have many more opportunities to address childhood behavioral difficulties compared with fathers. However, Ricketts and Anderson (2008) found that younger Jamaican children received more physical punishment than older ones and boys received harsher physical punishment than girls. Reasons offered by adults for the use of harsh discipline varied and included: biblical injunctions (e.g., “To spare the rod is to spoil the child”); not wanting to relinquish parental control over children; not being aware or know of alternatives that work well; receiving similar treatment as children; fighting, breaking things, requests for food, and taking too long to complete tasks; and to achieve higher rates of compliance among children to attain the socialization goals of obedience and loyalty (Brown & Johnson, 2008; Leo-Rhynie & Brown, 2013; Payne, 1989). Needless to say, these approaches to controlling children’s behaviors were seen by children as problematic in enhancing parent–child relationships. When 7- to 12-year-old middle-class Jamaican children were asked about their perceptions about parent–child relationships, they acknowledged that parents did engage in positive interactions with them. But negative interactions (harsh discipline, lecturing children) were more prevalent than positive exchanges. Children mentioned that parents were rarely interested in their feelings and thoughts, and few would approach their parents for guidance with difficulties in their lives (Brown & Johnson, 2008). The discussion turns next to three practices that are more positive in nature: academic, religious, and ethnic socialization. Academic Socialization Academic socialization represents one aspect of cognitive caregiving that involves direct engagement in activities with children at home intended to boost their intellectual functioning. It was associated with better linguistic and intellectual outcomes in young children of Caribbean immigrants in the United States (Roopnarine, Krishnakumar, Metindogan, & Evans, 2006). Within Caribbean countries there is a heavy endorsement of academic training in the early childhood years (Logie, 2013). A comparative analysis of maternal beliefs about what children should learn in preschool indicated that most mothers in Guyana, Jamaica, and St. Vincent and the Grenadines were very explicit about the need for children to be exposed to early academic training—learning number, letter, and word concepts—in preschool (LeoRhynie et al., 2009). In the national study of families in Trinidad and Tobago introduced above, mothers were asked to estimate the extent to which both family socialization practices and childhood development     

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they and fathers engaged in academic socialization with young children at home. Three general areas that were explored were engagement in reading, writing, and working with number activities; engagement in literacybased activities, such as reading to the child; and telling stories to the child. Across ethnic groups, parents engaged in high levels of academic socialization with children in the preschool years. Furthermore, mothers engaged in higher levels of academic socialization than did fathers across ethnic groups (Roopnarine, 2013). The findings on overall levels of academic socialization in Trinidad and Tobago are congruent with the prevailing beliefs about early academic training noted for other Caribbean countries (see Leo-Rhynie et al., 2009). The gender differences that emerged for parents are probably due to mothers’ greater involvement with children in general. Ethnic and Religious Socialization Researchers increasingly point to the importance of ethnic and religious socialization as mediators and moderators of the negative consequences of poor parenting and poor neighborhood quality on childhood development (Caughy, Nettles, O’Campo, & Lohrfink, 2006; Evans, 2006). These constructs have particular relevance for Caribbean communities given the high poverty rates in some countries and the degree to which adults embrace religion as a central component of their daily lives (Anderson, 2007; Roopnarine et al., 2012). Ethnic or cultural socialization is defined in the larger parenting literature as verbal and behavioral messages (e.g., ethnic pride, ethnic heritage) that are shaped by parents, the community, social circumstances, and diverse institutions within a culture (Hughes et al., 2006). It is often associated with parental warmth and sensitivity (see Hughes et al., 2006, for a review), enables children to develop ingroup and outgroup social preferences (Marks, Szalacha, Lamarre, Boyd, & Garcia Coll, 2007), and can boost children’s cognitive skills in neighborhoods with differing social capital (Caughy et al., 2006; Supple, Ghazarian, Frabutt, Plunkett, & Sands, 2006). In the same vein, religiosity and spirituality can exert a significant influence on parenting practices. It has been argued that these two constructs may have an interdependent conceptual base. Nonetheless, the form, content, and functions of religiousness and spirituality have been delineated by several scholars and writers (see Oser, Scarlett, & Bucher, 2006, for a discussion of these issues). Assessments have shown that both constructs have implications for maternal and child well-being. For instance, mothers’ participation in religious activities was related to positive views about the mother–child relationship (Pearce & Axinn, 1998), and mothers’ religiousness was related to greater self-esteem and lower levels of aggressiveness and delinquency in children after considering maternal intelligence, socioeconomic status, stress, 84       roopnarine and jin

and maternal support (Carothers, Borkowski, Lefever, & Whitman, 2005). Church attendance was positively associated with paternal supervision and involvement in youth-related activities (Bartkowski & Xu, 2000; Wilcox, 2002), and spirituality was associated with the greater use of authoritative parenting practices (Letiecq, 2007). Not unlike other cultural communities, ethnic socialization, as measured by items that assess messages of ethnic pride, heritage, and cultural artifacts, appears to be a central aspect of family life in Trinidad and Tobago. Indo Caribbean, African Caribbean, and families from Mixed-Ethnic parentage indicated engaging in high levels of ethnic socialization with preschool- and kindergarten-age children. Indo Caribbean caregivers engaged in significantly more ethnic socialization than African and Mixed-Ethnic Caribbean caregivers. Likewise, religious socialization that is expressed through the teachings and beliefs of diverse religions (e.g., Orisha, Hinduism, Islam, different Christian denominations), sacred texts (e.g., Qur´an, Bible, Bhagavat Gita), revivals, and broadcasts on TV and radio, and celebration and observation of religious holidays/events are woven into many aspects of child-rearing (Houk, 1995; Vervotec, 1995). Religious socialization was reportedly high among Indo, African, and Mixed-Ethnic Caribbean families in Trinidad and Tobago (Roopnarine et al., 2012). It is not clear whether families in neighborhoods marred by economic and social woes turn to ethnic and religious socialization more so than families who have more material resources and live in neighborhood environments that are in good repair and are more cohesive. Parenting Styles Whether Caribbean parents use excessive control (behavioral, psychological, and physical) as one component of child-rearing has come under increasing scrutiny. It is often asserted that Caribbean parents use a combination of warmth and indulgence and high physical control during everyday socialization practices (Leo-Rhynie, 1997). Data from recent studies on parenting practices and styles partially confirm this claim. However, parenting practices in Caribbean societies are a bit more complex than has been previously described. Beginning with Ramkissoon’s (2002) study on secondary school children’s perceptions of parenting practices in Jamaican families, most fathers were viewed as adopting an authoritative style of parenting. Another study of parenting practices among families in Barbados also indicated that there were higher levels of nurturance in families who were in skilled occupations and had adequate material resources than in those who were less skilled and less privileged materially (Anderson & Payne, 1994). Related work across four Caribbean countries support a more diverse pattern of parental practices as well. Lipps et al. (2012) examined parenting styles among families in family socialization practices and childhood development     

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Jamaica, the Bahamas, St. Kitts and Nevis, and St. Vincent and found that the most prevalent parenting styles were authoritative (32.6%) and neglectful (28.4%). About 20.3% of children across countries experienced an authoritarian and 18.7% experienced a permissive parenting style. By comparison, in St. Vincent, the predominant parenting style was neglectful (Lipps et al., 2012). These latter findings suggest that most parents used parenting styles that would be considered less optimal for child-rearing in developed societies. Assessments (Roopnarine, Krishnakumar, Narine, Logie, & Lape, 2013; Roopnarine, Wang, Krishnakumar, & Davidson, 2013) of parenting practices among families in Guyana and Trinidad and Tobago shed further light on the use of warmth and harsh socialization practices. Among rural Indo Guyanese families, cluster analysis revealed that mothers could be classified into two categories: those who were high in warmth and low in behavioral control and those who were high in warmth and high in behavioral control. An identical pattern was obtained for a diverse ethnic sample of Trinidadian mothers and fathers. Interestingly, levels of warmth displayed during parenting in both countries were comparable with those in other developing, recently developed, and developing societies (e.g., Jordan, Italy, China; Putnick et al., 2012). What these data suggest is that parents in Caribbean societies use a combination of warmth with different modes of control (behavioral, psychological, and physical) in parenting young children. Further evidence of the use of positive and harsh practices was evident among a national representative sample of African Caribbean, Indo Caribbean, and families of Mixed-Ethnic heritage in Trinidad and Tobago (Roopnarine, Krishnakumar, et al., 2013). Positive and harsh modes of parenting were relatively high across ethnic groups. Indo and Mixed-Ethnic families engaged in more positive parenting than did African Caribbean families and Indo Caribbean families engaged in less harsh parenting than African Caribbean and Mixed-Ethnic Caribbean families. Overall, Indo Caribbean and MixedEthnic Caribbean families were quite similar in parenting practices, possibly due to a greater integration of Indo Caribbean child-rearing tendencies and beliefs among Mixed-Ethnic families—a phenomenon that is not unusual in plural societies. A majority of the Mixed-Ethnic Caribbean families were of Indo African Caribbean ancestry. Is there homogeny in parenting styles between Caribbean mothers and fathers? One of the few studies to examine similarities in parenting patterns (Roopnarine, Wang, Krishnakumar, & Davidson, 2013) revealed that there was good congruence in the parenting styles of mothers and fathers; 71% had similar parenting patterns. The most consistent pattern was mothers and fathers with high warmth and low behavioral control (55%). The rest of the couples fell into the following categories: mothers and fathers with high warmth and moderately high behavioral control (16%), mothers with 86       roopnarine and jin

high warmth and low behavioral control and fathers with high warmth and moderately high behavioral control (14%), and mothers with high warmth and moderately high behavioral control and fathers with high warmth and low behavioral control (13%). These levels of congruence/incongruence are similar to those found in a study of supportive parenting (60% of mothers and fathers were deemed supportive) among families in the United States (Martin, Ryan, & Brooks-Gunn, 2007). Parenting and Childhood Outcomes According to Baumrind’s (1967, 1996) parenting styles framework and Rohner’s (Rohner & Khaleque, 2005) interpersonal acceptance rejection theory, parental warmth and sensitivity and appropriate levels of control (e.g., limit setting, offering structure) are considered optimal for child-rearing. Similarly, attachment theory stresses the importance of warmth and responsiveness for the development of attachment bonds between children and mothers and fathers (Ainsworth, 1989). In most cultures studied to date, the authoritative parenting style appears to be associated with instrumental competence in children—that is, parental warmth and sensitivity promotes the development of intellectual and social skills (see the meta-analysis by Rohner & Khaleque, 2012). In contrast, high levels of parental physical (e.g., physical punishment, physically restricting child), psychological (e.g., making the child feel guilty or worthless), and behavioral (e.g., limit setting, restriction, structure, clear and consistent rules) control are linked to internalizing and externalizing behaviors in children (see meta-analyses by Gershoff, 2002; Rohner & Khaleque, 2012). The associations between child-rearing beliefs and practices and childhood outcomes in Caribbean families have been minimally explored. A few studies (e.g., Samms-Vaughan, 2005) have begun to draw links between family structural arrangements, family processes, and parenting styles and developmental outcomes in children. With respect to social and cognitive outcomes, poor economic resources, crowded living conditions, and instability in living arrangements had a negative impact on Jamaican preschool-age children’s cognitive scores. More specifically, children in married households performed better academically and had better cognitive scores than children in other family arrangements, and child shifting and multiple father figures were associated with behavioral difficulties in children (e.g., social withdrawal). Children who lived with biological fathers and surrogate mothers also had academic and behavioral difficulties, possibly due to the lack of trust in forming relationships with temporary caregiving figures. Maternal and paternal educational attainment levels were positively related to children’s cognitive performance (Samms-Vaughan, 2005). family socialization practices and childhood development     

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Data on the links between family processes and parenting styles and children’s social and cognitive skills are also instructive. Family functioning (cohesion and adaptability) was associated with better cognitive performance in young children (Samms-Vaughan, 2005) and to lower health risks (e.g., suicides and emotional distress) in older children (Halcón et al., 2003). Turning to parenting styles, children in the Bahamas, Jamaica, St. Kitts and Nevis, and St. Vincent who experienced an authoritative parenting style at home showed less depressive symptoms, whereas those exposed to the authoritarian and neglectful styles showed more depressive symptoms. Among Guyanese, but not Trinidadian families, preschoolers who were exposed to high levels of parental warmth and low levels of behavioral control fared better academically and socially than those who were exposed to high levels of warmth and high levels of behavioral control (Roopnarine, Wang, et al., 2013). Contrary to several other studies (see Khaleque & Rohner, 2012, for a summary), paternal warmth and affection did not show a significant association with children’s social or cognitive skills in a diverse sample of Trinidadian families (Roopnarine, Wang, et al., 2013). In contrast, harsh parenting in Indo, African, and Mixed-Ethnic families had more direct associations with negative behaviors. Another study on rural Indo Guyanese mothers confirmed a direct, negative association between harshness in physical punishment and decreasing prosocial behaviors in children (Roopnarine, Krishnakumar, et al., 2013). These findings suggest that the prevalence of harsh parenting has direct, negative consequences for the development of Caribbean children across ethnic groups and that parental warmth in particular may not moderate such associations (see Roopnarine, Krishnakumar, et al., 2013). It would be informative for future researchers to link harsh parental treatment and neurological development in children during infancy, toddler, and preschool years. It was intimated earlier that ethnic socialization and religiosity may mediate the associations between harsh parenting and childhood outcomes in difficult ecological niches. Ethnic socialization mediated the association between maternal parenting practices and children’s prosocial behaviors and behavioral difficulties differently in Indo, African, and Mixed-Ethnic families in Trinidad and Tobago (Roopnarine, Krishnakumar, et al., 2013). While among Indo and Mixed-Ethnic Caribbean families, the association between positive parenting and prosocial behaviors was partially mediated via ethnic socialization, this was not the case for African Caribbean families. For the latter group, positive parenting had a more direct link to prosocial behaviors in children. Although there are no studies of the mediating or moderating role of religiosity on the association between parenting practices and childhood outcomes in Caribbean countries, Anderson (2007) found that religiosity, as measured by church membership and church attendance, was associated with greater commitment to fathering and with less stereotyped 88       roopnarine and jin

views about masculinity among Jamaican men. According to these findings, the importance of religiosity for child-rearing in the Caribbean may extend beyond childhood outcomes to views about parental roles and investment in parenting itself. SUMMARY AND FUTURE DIRECTIONS At the moment, Caribbean parenting practices are steeped in both positive and negative parental behaviors across ethnic groups. Whether these sets of behaviors are used as an adaptive strategy to raise children in harsh ecological niches or are an outgrowth of the harsh treatment and oppressive conditions that families endured during, slavery, indentured servitude, and colonialism is mere speculation at this point. As in developed societies, family process variables such as cohesion, ethnic socialization, and academic socialization seem to impart positive influences on childhood development either directly or in conjunction with other parenting practices and sociodemographic factors. Harsh treatment seems to have more direct negative effects on childhood social skills, and because it is pervasive in Caribbean communities, it should be a major focus of parenting and early education programs. Because of the emphasis on human capital development in Caribbean societies, there is an obvious need to determine mothers’, fathers’, and other caregivers’ and children’s conceptions of control and its effects on social and cognitive development in different ethnic groups in the Caribbean. Likewise, Caribbean parenting styles and practices need to be codified from an emic perspective using more sophisticated conceptual models that consider mediating and moderating variables and homogamy in parenting practices across different family constellations and ethnic groups. A much-ignored area is the associations between parental practices and harsh neighborhood environments and neurological development in young children. REFERENCES Ainsworth, M. D. (1989). Attachments beyond infancy. American Psychologist, 44, 709–716. http://dx.doi.org/10.1037/0003-066X.44.4.709 Anderson, P. (2007). The changing roles of fathers in the context of Jamaican family life. Kingston, Jamaica: Planning Institute of Jamaica and The University of the West Indies. Anderson, S., & Payne, M. A. (1994). Corporal punishment in elementary education: Views of Barbadian schoolchildren. Child Abuse & Neglect, 18, 377–386. http://dx.doi.org/10.1016/0145-2134(94)90040-X family socialization practices and childhood development     

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Pearce, L. D., & Axinn, W. G. (1998). The impact of family religious life on the quality of mother-child relations. American Sociological Review, 63, 810–828. http://dx.doi.org/10.2307/2657503 Putnick, D., Bornstein, M. H., Lansford, J. E., Chang, L., Deater-Deckard, K., Di Giunta, L., . . . Bombi, A. S. (2012). Agreement in mother and father acceptance-rejection, warmth, and hostility/rejection/neglect of children across nine cultures. Cross-Cultural Research: The Journal of Comparative Social Science, 46, 191–223. http://dx.doi.org/10.1177/1069397112440931 Ramkissoon, M. W. (2002). The psychology of fathering in the Caribbean: An investigation of the physical and psychological presence of the Jamaican father. Unpublished master’s thesis, The University of West Indies, Mona, Jamaica. Ricketts, H., & Anderson, P. (2008). The impact of poverty and stress on the inter­ action of Jamaican caregivers with young children. International Journal of Early Years Education, 16, 61–74. http://dx.doi.org/10.1080/09669760801892276 Ricketts, H., & Anderson, P. (2009). Parenting in Jamaica (Working Paper 09). Kingston: Planning Institute of Jamaica, Policy Research Unit. Rohner, R. P. (1986). The warmth dimension: Foundations of parental acceptance-rejection theory. Beverly Hills, CA: Sage. Rohner, R. P., & Khaleque, A. (Eds.). (2005). Handbook for the study of parental acceptance and rejection. Storrs, CT: Rohner Research. Rohner, R. P., & Khaleque, A. (2012). Essentials of parenting: Parental warmth, behavioral control, and discipline. In K. D. Keith (Ed.), The encyclopedia of cross-cultural psychology. Malden, MA: Wiley-Blackwell. Roopnarine, J. L. (2004). African American and African Caribbean fathers: Levels, quality, and meaning of involvement. In M. E. Lamb (Ed.), The role of the father in child development (pp. 58–97). New York, NY: Wiley. Roopnarine, J. L. (2013). Fathers in Caribbean cultural communities. In D. Shwalb, B. Shwalb, & M. E. Lamb (Eds.), Fathers in cultural perspectives (pp. 203–227). New York, NY: Rutledge. Roopnarine, J. L., Brown, J., Snell-White, P., Riegraf, N. B., Crossley, D., Hossain, Z., & Webb, W. (1995). Father involvement in child care and household work in common-law dual-earner and single-earner families. Journal of Applied Developmental Psychology, 16, 35–52. http://dx.doi.org/10.1016/0193-3973 (95)90015-2 Roopnarine, J. L., Jin, B., & Krishnakumar, A. (2013). Do Guyanese mothers’ levels of warmth moderate the association between harshness and justness of physical punishment and children’s prosocial behavior and anger in preschool? International Journal of Psychology. Advance online publication. Retrieved from http:// www.ncbi.nlm.nih.gov/pubmed/24990638 Roopnarine, J. L., Krishnakumar, A., Metindogan, A., & Evans, M. (2006). Links among parenting styles, academic socialization, and the early academic and

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social skills of pre-kindergarten and kindergarten-age children of Englishspeaking Caribbean immigrants. Early Childhood Research Quarterly, 21, 238– 252. http://dx.doi.org/10.1016/j.ecresq.2006.04.007 Roopnarine, J. L., Krishnakumar, A., Narine, L., Logie, C., & Lape, M. E. (2013). Relationships between parenting practices and preschoolers’ social skills in African, Indo, and Mixed-ethnic families in Trinidad and Tobago: The mediating role of ethnic socialization. Journal of Cross-Cultural Psychology. Advance online publication. http://dx.doi.org/10.1177/0022022113509884 Roopnarine, J. L., Krishnakumar, A., Narine, L., Logie, C., & Ramlal, B. (2012). Child-rearing beliefs and practices and childhood development in Trinidad and Tobago. Ministry of Education and University of the West Indies, Trinidad and Tobago. Roopnarine, J. L., Wang, Y., Krishnakumar, A., & Davidson, K. (2013). Parenting practices in Guyana and Trinidad and Tobago: Connections to preschoolers’ social and cognitive skills. Revista Interamericana de Psicología, 47, 313–328. Samms-Vaughan, M. (2005). The Jamaican pre-school child: The status of early childhood development in Jamaica. Kingston, Jamaica: Planning Institute of Jamaica. Samms-Vaughan, M. E. (2006). Screening, early intervention and referral for health, developmental and behavioural disorders in Jamaica: A summary. Journal of the Children’s Issues Coalition, 1, 163–173. Saraswathi, T. S., & Dutta, R. (2010). India. In M. Bornstein (Ed.), Handbook of cultural developmental science (pp. 465–483). New York, NY: Psychology Press. Shwalb, D. W., Shwalb, B. J., & Lamb, M. E. (Eds.). (2013). Fathers in cultural context. New York, NY: Routledge. Simey, T. S. (1946). Welfare and planning in the West Indies. London, England: Oxford University Press. Smith, R. (1957). The Negro family in British Guiana. London, England: Routledge and Kegan Paul. Sorkhabi, N. (2005). Applicability of Baumrind’s parent typology to collective cultures: Analysis of cultural explanations of parent socialization effects. International Journal of Behavioral Development, 29, 552–563. http://dx.doi.org/10.1177/ 01650250500172640 Super, C., & Harkness, S. (1997). The cultural structuring of child development. In J. Berry, P. Dasen, & T. Saraswathi (Eds.), Handbook of cross-cultural psychology: Vol. 2. Basic processes and human development (pp. 1–39). Needham, MA: Allyn & Bacon. Super, C., & Harkness, S. (2002). Culture structures the environment for development. Human Development, 45, 270–274. http://dx.doi.org/10.1159/000064988 Supple, A.  J., Ghazarian, S.  R., Frabutt, J.  M., Plunkett, S.  W., & Sands, T. (2006). Contextual influences on Latino adolescent ethnic identity and academic outcomes. Child Development, 77, 1427–1433. http://dx.doi.org/10.1111/j.1467-8624. 2006.00945.x

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Survey of Living Conditions in Jamaica. (2004). Planning Institute of Jamaica and Statistical Institute of Jamaica. 2004. Jamaica survey of living conditions. Kingston: Planning Institute of Jamaica. United Nations Development Programme (UNDP). (2012). Human development and the shift to better citizen security. Retrieved from http://hdr-caribbean.regional centrelac-undp.org/files/caribbean_hdr2012.pdf United Nations Statistics Division. (2010). The world’s women 2010: Trends and statistics. Retrieved from http://unstats.un.org/unsd/demographic/products/Worlds women/WW_full%20report_color.pdf Vervotec, S. (1995). Hindus in Trinidad and Britain: Ethnic religion, reification, and the politics of public space. In P. van der Veer (Ed.), Nation and migration: The politics of space in the South Indian diaspora (pp. 132–156). Philadelphia: University of Pennsylvania Press. Wachs, T. D., Chang, S. M., Walker, S. P., & Meeks Gardner, J. M. M. (2007). Relation of birth weight, maternal intelligence and mother–child interactions to cognitive and play competence of Jamaican two-year old children. Intelligence, 35, 605–622. http://dx.doi.org/10.1016/j.intell.2006.11.005 Whiting, B. B., & Whiting, J. W. (1975). Children of six cultures: A psychocultural analysis. Cambridge, MA: Harvard University Press. http://dx.doi.org/10.4159/ harvard.9780674593770 Wilcox, W. (2002). Religion, convention, and paternal involvement. Journal of Marriage and Family, 64, 780–792. http://dx.doi.org/10.1111/j.1741-3737.2002.00780.x Wilson, L. C., Wilson, C. M., & Berkeley-Caines, L. (2003). Age, gender and socioeconomic differences in parental socialization preferences in Guyana. Journal of Comparative Family Studies, 34, 213–227.

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4 REMOTE ACCULTURATION AND THE BIRTH OF AN AMERICANIZED CARIBBEAN YOUTH IDENTITY ON THE ISLANDS GAIL M. FERGUSON

Today, few societies are beyond the reach of globalization. Although external cultural influence is not a new phenomenon (given the inglorious human history of conquest and colonization) and third culture children are on the rise, there is an unprecedented level of voluntary culture sharing in the 21st century due to modern forms of globalization. Technological advances beginning at the end of the 20th century have facilitated instantaneous access to and interaction among people from once-distant lands. In the case of the Caribbean, there is a well-established bidirectional exchange with the United States, the country that sends the most tourists to the Caribbean and receives the most migrants from the Caribbean (Caribbean Tourism Organization, 2013a; Thomas-Hope, 2002). As the Caribbean Community (CARICOM) acknowledges in its 2010 Commission on Youth Development report, the United States has an unmistakable presence in modern life on the Caribbean islands, especially http://dx.doi.org/10.1037/14753-005 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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for youth. The amicable coexistence of Caribbean and American societal elements in Caribbean cities today evidences the hybridization of the two cultures in public spaces. For example, in Half Way Tree, the capital of St. Andrew, Jamaica, teenagers can shop for rasta-handmade Jamaican leather sandals and imported Ralph Lauren jeans from local vendors, eat a “Spicy Chick’n Crisp Sandwich” at Burger King consisting of a Jamaican chicken patty dressed with typical burger toppings in a sesame seed bun, and watch the latest Hollywood blockbuster preceded by the Jamaican national anthem in a nearby cinema, all the while exchanging texts with cousins living in Miami. This hybridized Caribbean culture on the islands raises an important question: How has modern societal “Americanization” affected the psychosocial development of youth in the Caribbean, specifically their identity, values, and behavior?1 Recent scholarship on remote acculturation has begun to answer that question. Remote acculturation, which was first documented in Jamaica, is a 21stcentury form of acculturation in which geographically remote cultures are brought by globalization into the local environment, allowing nonmigrants indirect and/or intermittent exposure, and for some, resulting in a new type of bicultural profile (Ferguson & Bornstein, 2012). The purpose of this chapter is to introduce and describe remote acculturation in the larger context of Caribbean migration, transnationalism, and industry; discuss pertinent theoretical/conceptual frameworks underpinning remote acculturation; review research findings on remote acculturation in the Caribbean; and outline policy implications and future research directions. Although a few Caribbean countries are U.S. territories in which residents are official U.S. citizens (i.e., Puerto Rico, U.S. Virgin Islands), this chapter excludes those countries because U.S. citizenship and free movement between those islands and the United States means that American culture is not remote for those islanders. REMOTE ACCULTURATION Acculturation refers broadly to changes that come about when culturally different groups or individuals interact (Sam & Berry, 2006). Psychological acculturation pertains to the intrapersonal and interpersonal aspects of these changes (e.g., in behavior, values, and identity: Graves, 1967; Schwartz, Unger, Zamboanga, & Szapocznik, 2010) and is the focus of this chapter unless otherwise noted. The very definition of globalization as the “multidirectional flows The term American(ization) in this chapter pertains to the United States to be consistent with common usage in the Caribbean. Because most Caribbean countries are islands, the term island is used interchangeably with countries. 1

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of goods, people, and ideas” (Jensen, Arnett, & McKenzie, 2011, p. 258) indicates why it is considered “the starting point for acculturation” (Berry, 2008, p. 332). The traditional conceptualization of acculturation applies most readily in the context of migration in which the movement of people from one place to another prompts intercultural interaction (Redfield, Linton, & Herskovits, 1936). However, the traditional conceptualization does not account for cultural and psychological change following the flow of goods and ideas across borders in the absence of migration, nor does it account for short-term travel, all of which are contemporary realities. For this reason, remote acculturation was recently introduced as a modern form of nonmigrant acculturation prompted by indirect and/or intermittent intercultural contact via newer forms of globalization such as information and communication technologies (ICTs; e.g., cell phones, cable television, Internet) and multinational fast food companies (Ferguson & Bornstein, 2012). Taken together, acculturation can now be considered as “what happens when groups or individuals of different cultures come into contact—whether continuous or intermittent, first-hand or indirect—with subsequent changes in the original culture patterns of one or more parties” (Ferguson, 2013, p. 249). Over time, various ideas have been advanced about how acculturating individuals deal with their experience of more than one culture. Although it was originally thought that the acquisition of a second culture competed with maintaining a connection to the first (unidimensional model), there is now a realization that the second culture is its own dimension of experience (bidimensional model; see Berry, 1980, 1997). According to this bidimensional view, an individual can have a strong orientation to both cultures (integration), to one’s first culture only (separation), to one’s second culture only (assimilation), or to neither (marginalization). Integration or biculturalism is the most common acculturation strategy among immigrant youth based on a large study of immigrant youth across 13 societies, the International Comparative Study of Ethnocultural Youth (ICSEY; Berry, Phinney, Sam, & Vedder, 2006). Like traditional immigrant acculturation, globalization-based remote acculturation can take multiple forms depending on the strength of one’s orientation to the culture of origin and the remote culture (Berry, 2008; Ferguson, 2013). Moreover, Arnett (2002) predicted that biculturalism would become predominant among 21st-century nonmigrant youth because they are immersed in global culture in addition to their local culture. According to Jensen et al. (2011), globalization-based assimilation is evident when young rural Chinese women who migrate to the city for work swap global values for traditional rural ones (Chang, 2008, as cited in Jensen et al., 2011). Separation is demonstrated in the revival of traditional Samoan tattooing among adolescent boys after being eclipsed by global cultural norms. Integration can be seen among youth in India who remain committed to arranged marriage remote acculturation     

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despite being immersed in high-tech global culture (Côté, 1994, and Verma & Saraswathi, 2002, respectively, as cited in Jensen et al., 2011). And marginalization is embodied by the rejection of traditional local culture and unattainable global culture by some Nepali youth (Leichty, 1995, as cited in Jensen et al., 2011). Transnationalism and cosmopolitanism are also useful lenses through which to view the impact of globalization on local youth identities. Glick Schiller and colleagues’ work on these two concepts pertains primarily to the experiences and identities of migrants who straddle the home and host nations or who are both rooted in their own nations and open to the world (see Glick-Schiller, Basch, & Blanc-Szanton, 1992; Glick Schiller, Darieva, & Gruner-Domic, 2011). However, these theoretical conceptualizations are ripe for application to nonmigrant youth undergoing remote acculturation. Caribbean youth may develop a type of transnational or cosmopolitan identity due to close social, monetary, and practical connections to family and friends in the United States and elsewhere. Viewing remote acculturation through the lenses of transnationalism and cosmopolitanism also reveals a certain dynamism to the experience and resulting youth identities that can be overlooked by the acculturation lens. GLOCALIZED CARIBBEAN CONTEXT Acculturation processes in the Caribbean date back at least to Christopher Columbus’s arrival in the 15th century and perhaps earlier if distinct indigenous groups interacted as they co-occupied the islands. The arrival of new cultural groups over the centuries via the slave trade (Western Europeans and West Africans mainly), indentured labor agreements (e.g., from India), voluntary immigration (e.g., China, Nigeria, other Caribbean islands), and within-Caribbean migration (e.g., Indo Caribbeans from Guyana to Barbados) has since fueled acculturation processes in the Caribbean (see Senior, 2003). Today, permanent migration of nonnatives into the Caribbean has by-and-large been supplanted by short-term tourism. Cultural influences, especially from the United States, also arrive on the islands’ shores through merchandise, food, and ICT. However, these remote cultural elements are not always practiced in their original forms; islanders often put their own stamp on them. For example, reggae and soca versions of hit U.S. pop songs are popular on the islands, and Burger King and KFC in Jamaica serve meat seasoned to the Jamaican palate (in fact, the KFC “barbecue” chicken recipe is a favorite in Jamaica but does not exist in the United States, where the company originates). Thus, glocalization—“the co-presence . . . of both universalizing [global] and particularizing [local] tendencies” (Robertson, 1997)—rather than 100       gail m. ferguson

mere globalization, best describes the impact of U.S. culture on local Caribbean communities. There are at least three major mechanisms by which the glocalized Caribbean context sets the stage for remote acculturation of youth: (a) migration and transnationalism; (b) tourism and imported goods; and (c) monetary, practical, and social remittances. Migration and Transnationalism Caribbean people are highly migratory. In fact, the Caribbean has the highest out-migration propensity in the world, driven largely by the incapacity of the labor market to provide sustainable employment, particularly for skilled and highly skilled workers. Annual out-migration rates range from 12.1% of the population in the Bahamas to 43.3% in Suriname (Pienkos, 2006). Beginning in the 1960s, the United States (#1) and Canada (#2) eclipsed the United Kingdom as the top destinations for Caribbean emigrants (Thomas-Hope, 2002), and Caribbean Blacks now represent over half of the U.S. foreign-born Black population (Greico, 2010). See Table 4.1 for outmigration rates of Caribbean-born individuals to the United States in the most recent 2010 census (note that Jamaica has the highest rate). Consequently, there is now a widespread diaspora of Caribbean emigrants who have settled and built communities in other world regions. However, back-and-forth migration may be even more characteristic of the Caribbean TABLE 4.1

Rates of Out-Migration From Select Caribbean Countries to the United States

Country Caribbean Cuba Dominican Republic Jamaica Haiti Other Caribbeanb

Number of Caribbean-born individuals recorded in the U.S. 2010 Censusa

Caribbean region and island populations based on most recent national estimates

Percentage of Caribbean population in U.S. 2010 Censusi

3,731,000 1,105,000 879,000 660,000 587,000 500,000

41,624,000 (2010)c 11,162,934 (2012)d   9,445,281 (2010)e   2,717,991 (2013)f 10,413,211 (2012)g  7,884,583h

 9% 10%  9% 24%  6%  6%

Adapted from “The foreign born from Latin America and the Caribbean: 2010,” by Y. D. Acosta and G. P. de la Cruz, 2011, U.S. Census Bureau, American Community Survey Briefs, ACSBR/10-15, p. 3. In the public domain. b“Other Caribbean” countries = Anguilla, Antigua and Barbuda, Aruba, Bahamas, Barbados, British Virgin Islands, Cayman Islands, Dominica, Grenada, the former country of Guadeloupe (including St. Barthélemy and Saint-Martin), Martinique, Montserrat, the former country of the Netherlands Antilles (including Bonaire, Curaçao, Saba, Sint Eustatius, and Sint Maarten), St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Trinidad and Tobago, and Turks and Caicos Islands. cData from “Caribbean 2010” (n.d.). dData from National Office of Statistics and Information (n.d.). eData from National Office of Statistics (n.d.). fData from Statistical Institute of Jamaica (2015). gData from Haitian Institute of Statistics and Information (2007). h“Other Caribbean” population derived by subtracting the four listed country populations from the “Caribbean” population. iPercentage of Island Population in U.S. 2010 Census computed for each row. a

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than is permanent emigration from the islands (Thomas-Hope, 2002). This has given rise to a certain transnationalism wherein Caribbean “transmigrants” actively maintain social networks in both their heritage and destination countries (Glick Schiller et al., 1992). Seasonal farm workers and temporary domestic workers often spend months at a time in each location, as do informal commercial importers whose livelihood is to accumulate goods to bring back to the islands to sell (Durant-Gonzalez, 1983). Serial family migration is also common wherein a parent, usually the mother, emigrates months to years ahead of the children to establish herself before “sending for” them to join her (Pottinger, Stair, & Brown, 2008). As a result, Caribbean islanders, perhaps especially youth, have developed a collective mental image of migration destinations, according to Thomas-Hope’s (2002) cross-national study. This mental image is corroborated by the selective positive information transmitted back to the homeland by migrants and facilitates remote acculturation on the islands as some youth begin to imagine the eventuality of emigration, even if it is never realized. Due to the transnationalism of the Caribbean diaspora, those living outside of the region keep close ties with those within the region in tangible ways that allow islanders appreciable exposure to remote cultures. For example, Caribbean associations in the United States often engage in community development initiatives back home, such as sponsoring students’ education, building community centers, offering medical, social, and religious services, and donating emergency vehicles (Glick Schiller et al., 1992; http://chicagoconcerned jamaicans.com). These collaborative transnational projects not only strengthen the mental image of migration among nonmigrant island youth but also bring these youth into contact with migrants living in the desired locations. Islanders also play an active role in connecting to those in the diaspora to the island pulse through radio and television programs (e.g., “Jamaican Diaspora Live” call-in radio program on Power 106 in Jamaica; 102.7 FM in Trinidad and Tobago) and bargain international calling plans to North America and Europe (e.g., Digicel Jamaica’s $1,500—approximately US$13—for 1,000 minutes). Recently, the banding together of Jamaicans in the Caribbean and in the diaspora in support of Jamaican national Tessanne Chin, who was the fall 2013 winner of the televised American vocal competition “The Voice,” perfectly illustrates how Caribbean transnationalism may facilitate remote acculturation by allowing the average nonmigrant island youngster to observe and participate in U.S. culture. Tourism and Imported Goods In relation to the United States, the Caribbean is both consumed (via tourism) and consumer (via imported goods). Tourism is clearly one of the Caribbean’s best assets and represents a prime industry for many islands. 102       gail m. ferguson

Tropical beaches that promise fun in the sun in easygoing island style lure large numbers of tourists to the Caribbean each year, growing from approximately four million in 1970 to nearly 25 million in 2012 (Caribbean Tourism Organization, 2013b; Nicholson-Doty, 2013). The economic benefit of tourism to the Caribbean is clear—Caribbean visitors spent US$27.5 billion in 2012. U.S. residents comprise the largest proportion of visitors to the Caribbean both historically and currently (Caribbean Tourism Organization, 2013b, 2013a) ahead of Canada, Europe, and other world regions. Many, if not most, Caribbean youth have brief and sporadic contact with U.S. tourists, which may over time predispose them to remote acculturation. The Caribbean also consumes a great number of American products, including entertainment (e.g., cable television, movies, music), apparel (e.g., name-brand clothing), electronics (e.g., game consoles), and food (e.g., U.S. fast food/restaurant chains). According to the 13-country CARICOM Commission on Youth Development (2010) study, ICT is considered the primary means by which Caribbean youth on the islands consume American cultural products. For example, Forbes’s (2012) ethnography demonstrated that Facebook is a dominant interface used by youth in Jamaica for social connections with others on the island and abroad. Monetary, Practical, and Social Remittances Members of the Caribbean diaspora also keep strong ties with family members through remittances: monetary, practical, and social. Monetary and practical remittances are staples of Caribbean life; family members in the United States send money via services such as Western Union and ship goods to family members on the islands. Monetary remittances to the Caribbean from the United States grew exponentially from approximately US$2 billion in 1988 to US$12.5 billion in 2000, and research confirms that the total remittances returned to the islands is a function of the number of Caribbean immigrants admitted into the United States (Sampson & Branch-Vital, 2013). In addition, there is a tradition of shipping barrels of clothing and other goods from the United States to family members, especially intended for children whose parents have emigrated ahead of them (“barrel children”; CrawfordBrown & Rattray, 2002). Although Caribbean shipping businesses in Florida took a financial hit due to the recent global recession, the practice is still alive and well (“Caribbean Families Still Lean on Barrel Shipments From Overseas,” 2012). Social remittances have been defined as the “ideas, behaviors, identities, and social capital that flow from receiving-[country] to sending-country communities” between individuals who know each other (Levitt, 1998, p. 927). Social remittances use a variety of mechanisms, including migrants’ temporary remote acculturation     

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or permanent trips back to the homeland, nonmigrants’ trips to the diaspora, and telephone/video/written exchanges. For example, migrants from a town called Miraflores in the Dominican Republic residing in wintery Boston send boots and long-sleeved shirts back to Miraflores as gifts for relatives, resulting in a new hybrid fashion of wearing winter boots with shorts in tropical Miraflores. These transnational migrants also consciously and unconsciously model new behaviors and attitudes for island youth, slowly changing some local norms and values (e.g., increasing value placed on gender equality, which challenges maledominated norms in the Caribbean; Levitt, 1998, pp. 933–934). Research Findings on Remote Acculturation Among Youth in the Caribbean The back-and-forth migratory patterns of the Caribbean diaspora, the ebb and flow of U.S. tourists, and the steadily increasing consumption of U.S.produced ICT, goods, and remittance flows into the islands create an interesting cultural context in which today’s Caribbean youth come of age (Ferguson, 2013). Traditionally, Jamaican and other Caribbean children are socialized to value family and community and socialized to respect and obey parents and other adults (Richardson, 1999). Parents favor strict discipline, although it can be applied inconsistently and differently for boys and girls (Bailey, Branche, McGarrity, & Stuart, 1998; Evans & Davies, 1997). Jamaican teenagers describe average peers as fun-loving, motivated to fit in, fashion conscious, and into media (Ferguson & Iturbide, 2013). Developmentally speaking, adolescents are also focused on the task of self-definition by trying on identities, values, and behaviors (Erikson, 1968), including ethnic and cultural self-definition (Phinney, 1990). The modern glocalized Caribbean context, therefore, predisposes island youth to remote acculturation toward U.S. culture(s) by bringing into their locale different sets of values (e.g., family values) and behaviors (e.g., fashions) via media and other mechanisms. A bicultural Americanized Caribbean identity is the most likely outcome of remote acculturation based on acculturation research findings with immigrant youth (Berry et al., 2006) and on predictions for nonmigrant youth acculturating in response to modern globalization (Arnett, 2002). The Culture and Family Life Study has now demonstrated the presence of such a bicultural Americanized Caribbean identity among some urban adolescents in the Caribbean (Ferguson & Bornstein, 2012, 2015). In the inaugural study, Ferguson and Bornstein (2012) administered questionnaires to approximately 250 adolescents (mean age = 13.27) and their mothers in Kingston, Jamaica, measuring acculturation using a three-pronged approach recommended by Schwartz and colleagues (i.e., acculturation behaviors, values, identity; Schwartz et al., 2010). Behavioral and identity acculturation were measured using the Acculturation Rating Scale for Jamaican Americans 104       gail m. ferguson

(ARSJA; Ferguson, Bornstein, & Pottinger, 2012), a measure adapted from the Acculturation Rating Scale for Mexican Americans (ARSMA-II Scale I; Cuéllar, Arnold, & Maldonado, 1995). The ARSJA assesses respondents’ orientation to Jamaican culture, European American culture, and African American culture separately by inquiring about the degree to which an individual participates in or enjoys aspects of each culture including entertainment (e.g., TV shows from each culture), social contact (e.g., friendships with individuals in each culture), and language (i.e., Jamaican Patois). Further, ARSJA respondents indicate the degree to which they identify as a member of each cultural group. Values acculturation was measured using the Family Values Scale (Berry et al., 2006), which assesses values regarding obligations that adolescents should have toward parents and family, and rights adolescents should have in the family. American adolescents, European Americans in particular, have been shown to have lower family obligations and higher adolescent rights compared with acculturating immigrant adolescent from Latin America (Phinney, Ong, & Madden, 2000). Finally, parent–adolescent discrepancies in family obligations and rights were calculated and parent–adolescent conflict was measured (Robin & Foster, 1989) because acculturating immigrant families often report larger intergenerational discrepancies (Phinney & Vedder, 2006) and more parent– adolescent conflict than do nonimmigrant families (Birman, 2006). Cluster analyses identified one cluster of youth with a bicultural profile (33% of sample) based on scores on multiple acculturation indicators measured (Ferguson & Bornstein, 2012). “Americanized Jamaicans,” as this cluster was labeled, reported high orientation to Jamaican culture as well as relatively high orientation to European American culture, lower family obligations, higher intergenerational obligations discrepancies, and higher parent–adolescent conflict compared with a second cluster of culturally “traditional Jamaicans” (i.e., 67% of the sample: high Jamaican orientation, low European American orientation, high family obligations, lower intergenerational obligations discrepancies, and low parent–adolescent conflict). However, Americanized Jamaican adolescents did not differ from traditional peers in orientation to African American culture (adolescents in both clusters had fairly strong orientation to African American culture). See Figure 4.1 for a graphical representation of the characteristics of Americanized Jamaican versus traditional Jamaican adolescents. Parent–adolescent conflict was associated with the acculturation gap: Dyads mismatched in remote acculturation (i.e., one partner was traditional Jamaican, whereas the other was “Americanized” Jamaican) reported significantly higher conflict than did matched dyads. Remote acculturation of Jamaican islanders resembled traditional acculturation among Jamaican immigrants in the United States. Americanized Jamaican adolescents’ orientation to European American culture was similar to that of Jamaican immigrant adolescents living in the United States, remote acculturation     

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Americanized Jamaican

Traditional Jamaican

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Jamaican Orientation* 1.40 1.20 1.00 Parent–Adolescent Conflict*

0.80

African American Orientation

0.60 0.40 0.20 0.00 –0.20 –0.40 Parent–Adolescent Rights Discrepancy

–0.60

European American Orientation*

Family Obligations*

Parent–Adolescent Obligations Discrepancy*

Adolescent Rights

Figure 4.1.  Remote acculturation clusters among adolescents in Jamaica. From “Remote Acculturation: The ‘Americanization’ of Jamaican Islanders,” by G. M. Ferguson and M. H. Bornstein, 2012, International Journal of Behavioral Development, 36, pp. 167–177. Copyright 2012 by SAGE. Adapted with permission. Standardized scores are used, thus positive scores in this figure reflect raw scores above the mean and negative Z scores in this figure reflect raw scores below the mean. Asterisks (*) mark acculturation indicators in which there were significant differences between Americanized Jamaican and Traditional Jamaican youth.

and fell in between those of traditional Jamaicans and a comparison sample of U.S.-born European American adolescents. Americanized Jamaican adolescents were even more similar to European American adolescents than to Jamaican immigrant adolescents in terms of having relatively low family obligations. They also had much higher conflict with mothers than any other group, including Jamaican immigrant adolescents. The person–context fit perspective (Lerner, 1982) sheds some light on the latter finding in that a bicultural Americanized Jamaican adolescent will be more poorly matched to the values and expectations of his/her culturally traditional mother and environment in Jamaica compared with a Jamaican immigrant adolescent in the United States whose mother is, like her, embedded in the American cultural context. Mothers in the Culture and Family Life Study (Ferguson & Bornstein, 2012) also showed evidence of remote acculturation, although a smaller percentage (11%) demonstrated the bicultural Americanized Jamaican profile compared with adolescents (33%). Compared with two traditional Jamaican clusters, Americanized Jamaican mothers reported the highest European American orientation, obligations discrepancies, and parent–adolescent conflict. These original remote acculturation findings were replicated in a second cohort of over 220 early adolescents (mean age = 12.08)2 in Kingston, Jamaica, using the same methods, variables, and analyses, except that mothers were not included and parent–adolescent discrepancy scores were, therefore, not used (Ferguson & Bornstein, 2012). Findings from this study also revealed that one set of adolescents was grouped into an Americanized Jamaican cluster, the remaining being traditional Jamaican. These replicated findings confirmed that remote acculturation was, indeed, occurring (i.e., findings from the original study were not an artifact or cohort effect) and could be reliably detected. Ferguson and Bornstein’s 2015 follow-up study went beyond replication and also investigated some potential mechanisms by which Jamaican island youth come in contact with U.S. culture, or “vehicles” of remote acculturation. These potential vehicles included interactions with U.S. tourists, communication with U.S. individuals and receipt of various kinds of remittances, and consumption of U.S. goods and media. Results showed that adolescents who consumed more U.S. TV (girls) and less local TV (both genders) had higher odds of falling into the Americanized Jamaican cluster. In addition, consumption of U.S. food, contact with U.S. tourists on the island, internet/ phone communication with family/friends/acquaintances in the United States, and receipt of gifts from U.S. relatives/friends were all positively correlated with European American Orientation. The number of days visiting the United States on vacation was not related to remote acculturation; The only meaningful difference between the original remote acculturation study and the replication study was that mothers were not included in this study because very few mothers were Americanized Jamaicans (11%) compared with adolescents (33%). Thus, parent–adolescent discrepancies were not used as remote acculturation indicators in this study. 2

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thus, traditional immigrant acculturation was an unlikely explanation for these adolescents’ biculturalism. Parental education was measured as a proxy for socioeconomic status in both the original and replication studies and it was unrelated to remote acculturation in both cohorts. Thus, Americanized Jamaican youth are not just the privileged who can afford a cable subscription or to eat American fast food on a regular basis. This may be due to the fact that Caribbean youth from all walks of life have a stable mental image of migration, which is sustained by positive information communicated by relatives in the United States (Thomas-Hope, 2002). Following an explanatory sequential design, focus group interviews were also conducted with a subsample of Jamaican boys from the Culture and Family Life Study to gain a more in-depth understanding of remote biculturalism.3 Focus group questions first explored boys’ construals of their local Jamaican culture and American culture (“Describe what Jamaican teenagers are like today” and “Describe what American teenagers are like today”; Ferguson & Iturbide, 2013). Exploring how Jamaican adolescents perceive Jamaican culture and European American culture is important to fully understand key aspects of biculturalism of Americanized Jamaicans. Next, questions explored the perceived advantages and disadvantages of being an Americanized Jamaican teenager in Jamaica (Ferguson, Kumar, Iturbide, & Simpson, 2013). Fifteen boys who participated in all other aspects of the study participated in focus group interviews. Thematic analysis by a team of three coders (Jamaican on the island, Jamaican in the United States, Latina American in the United States) revealed first that when referencing American culture, Jamaican adolescents do think primarily of White Americans of European descent rather than African Americans. Overall, boys perceived some similarities (e.g., adolescent autonomy) and some differences (e.g., parenting style) between Jamaican and European American cultures. They construed Jamaican culture as aggressive, antigay, and fashion-focused, which reflected aspects of Jamaican dancehall culture’s4 view of masculinity. By contrast, boys’ construal of American culture centered on spoiled and crazy teens who “rule” their permissive parents (Ferguson & Iturbide, 2013; see Figure 4.2). Moreover, boys saw both advantages (e.g., preparation for travel abroad, cultural flexibility in peer relations) and disadvantages (e.g., targeted for bullying, procedural confusion—using cultural strategies in the wrong context) to being a bicultural Americanized Jamaican living on the island (Ferguson, Kumar, Iturbide, & Simpson, 2013). Ferguson and colleagues noted that youths’ construals of Girls were not included because the nature of gendered socialization in the Caribbean suggested that they would have a very different construal of local Jamaican culture, and it was not feasible at the time to conduct separate focus groups for girls. 4 Dancehall culture refers to the values, rituals, lifestyles, and identities associated with dancehall music, a popular subgenre of reggae music, which largely originated in inner-city Kingston in the 1980s but now boasts a large fan base across socioeconomic classes in Jamaica and in other countries such as Japan. (See Hope, 2012, for more details). 3

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Figure 4.2.  Thematic map of Jamaican adolescent boys’ construals of Jamaican and American cultures. From “Jamaican Boys’ Construals of Jamaican and American Teenagers,” by G. M. Ferguson and M. I. Iturbide, 2013, Caribbean Journal of Psychology, 5(1), p. 71. Copyright 2013 by the University of the West Indies, Mona. Reprinted with permission.

both American and Caribbean cultures are stereotypical, having been heavily influenced by popular media representations in both countries (U.S. cable television and Jamaican dancehall music, respectively). This caricaturization indicates an oversimplification of both cultures in adolescents’ minds but nonetheless sheds light on dimensions of attitude and behavior that may be impacted by their remote acculturation toward European American culture. A study in rural Haiti, which has limited ICT and less access to U.S. tourists and goods, suggests that remote acculturation is not pervasive across all Caribbean settings, however (Ferguson, Désir, & Bornstein, 2014). Just over 100 early adolescents (mean age = 12.87) completed questionnaires in Haitian Kreyól in Northern Haiti. Findings revealed strong orientation to Haitian culture and very high family obligations (in boys especially) but very low U.S. orientation. However, adolescents who interacted more frequently with U.S. tourists and those who consumed more U.S. fast food had higher U.S. culture orientation. This suggests that if rural areas of the Caribbean become more exposed to U.S. culture, rural adolescents may begin to experience remote acculturation similar to urban peers. To summarize, both quantitative and qualitative empirical research in the Caribbean reveals that remote acculturation in the form of Americanization is occurring among urban adolescents. Americanized Jamaican youth resemble Jamaican immigrant youth in the United States in terms of their orientation toward European American culture, although Americanized Jamaicans have higher conflict with their mothers than do immigrants. Higher conflict in remotely acculturating families relative to immigrant families may be related to the fact that mothers do not expect their Jamaican teenagers on the island to be acculturating to the United States. The qualitative findings that Jamaican adolescents perceive European American teenagers to be rebellious against permissive parents who grant them autonomy earlier (compared with Jamaican families; Ferguson & Iturbide, 2013) help to explain why Americanized Jamaican adolescents, who have higher European American orientation than do Traditional Jamaicans, are also distinguished by lower family obligations, higher adolescent–mother obligations discrepancies, and much higher adolescent–mother conflict (Ferguson & Bornstein, 2012). POLICY AND PRACTICE IMPLICATIONS Family and Health Policy Remote acculturation has implications for both policy and practice in the Caribbean given the findings that bicultural Americanized Jamaican adolescents experience significantly more conflict with parents than do culturally 110       gail m. ferguson

traditional adolescents. Ferguson and Bornstein (2012) found that this conflict was related to the acculturation gap with parents. Although parents of nonmigrant Jamaican youth are generally aware of adolescents’ gravitation toward the United States and its products, they generally do not expect them to internalize U.S. cultural behaviors and values via remote acculturation, creating a culture gap between them. This situation predisposes mothers of Americanized Jamaican adolescents to have more conflict with their teenagers. Professionals working with Americanized Jamaican youth and families should be aware that the normative parent–adolescent conflicts are being exacerbated by parent–adolescent gaps in remote acculturation (Ferguson & Bornstein, 2012). Professionals may be able to utilize literature on counseling immigrant families settling in industrialized countries to work with these nonmigrant families (see Ka˘gitçibas¸i, 2007). In addition, basic psychoeducation regarding remote acculturation among parents, guidance counselors, and educators may be an important step. Youth Policy According to the CARICOM Commission on Youth Development report (2010), Caribbean youth on the islands say they gravitate toward U.S. and other foreign cultures because they are seeking development opportunities they do not have in their local Caribbean communities. The Culture and Family Life focus group data lend strong support to CARICOM findings: Boys reported frustration at the lack of opportunities to develop personal skills such as leadership and self-care and admired the fact that American teenagers had these options in their schools (Ferguson & Iturbide, 2013). Similarly, boys reported having difficulty relating to locally produced shows, partly because they perpetuate negative stereotypical representations of Caribbean people, whereas they are seeking something more positive and growth-inducing. As one 14-year-old Jamaican boy explained, “Miss but like Jamaican shows dem jus’ have like one ting about people from di ghetto an dis ahn dat . . . Yes Miss like gun, who go shirtless, ahn who a rob, and who a sell weed and dem stuff deh Miss” [English Translation: Miss, but Jamaican shows just have one theme about people from the ghetto and this and that . . . yes Miss, like guns, who goes shirtless, and who robs, and who sells weed (marijuana) and those things]. (Ferguson & Iturbide, 2013, p. 73)

While it is not possible for developing Caribbean nations to produce the volume or variety of local television programs to match those available on U.S. cable, cable television content can be used to spark intentional conversations at home and at school regarding personal development in remote acculturation     

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the local Caribbean context (e.g., how to make wise decisions regarding substance use). Tourism and Migration Policy Remote acculturation has its liabilities for family life, but it may be an asset for keeping the Caribbean on the leading edge of the global tourism industry in terms of innovation and tourist experience. Americanized Jamaican youth have a deeper understanding of the culture, values, and lifestyles of their peers in the United States, who will be tomorrow’s tourists. If Americanized Jamaican youths’ biculturalism can be recognized as a marketable skill, they can play a significant role in securing the future of this prime industry for the region. Indeed, Glick Schiller and colleagues (2011) proposed “cosmopolitan sociability” as a unique social competence and communication skill facilitating globally open and inclusive social relations. Another potential asset is smoother adaptation to the United States should Americanized Jamaican adolescents emigrate in the future, which is of benefit both to those on the island (e.g., remittances), and to those in the United States (e.g., good ambassadors for the Caribbean). FUTURE DIRECTIONS FOR ACCULTURATION RESEARCH IN THE CARIBBEAN AND DIASPORA Remote Acculturation Remote acculturation should be investigated across other Caribbean islands, in terms of both Americanization and the influence of other remote cultures. More than two cultures may be relevant in some Caribbean settings; for example, Trinidad has Afro Trinidadian and Indo Trinidadian cultures in addition to its significant U.S. culture influence. Canada, Quebec in particular, may be another important remote destination culture for Haitians. Additionally, observations suggest that Jamaican or Trinidadian cultures may exert some influence on other islands by way of their music (reggae, soca, respectively) and products (e.g., food). Longitudinal and creative experimental research is needed to investigate, respectively, remote acculturation as a potential precursor to immigrant acculturation and to inform our understanding of the direction of remote acculturation effects (i.e., does engagement with identified vehicles of remote acculturation drive “Americanization” or vice versa or both?). Longitudinal research will also be valuable in understanding the process of psychological and developmental change experienced by remotely acculturating Caribbean youth. Researchers should also pay 112       gail m. ferguson

attention to parents’ experience of the remote acculturation of their teenagers. Although conflictual relationships are a challenge facing mothers of Americanized Jamaican adolescents, Jensen and colleagues (2011) hypothesized that such parents may nonetheless welcome these adolescents’ preparedness for today’s world. Caribbean Immigrant Acculturation Within the Caribbean Region There is a high level of intraregional short- and medium-term migration in the Caribbean for study and work (Thomas-Hope, 2002; Pienkos, 2006). The University of the West Indies (UWI), for example, has campuses spread across several islands, and Cuba’s medical schools attract students from across the Caribbean. Acculturation based on intraregional migration deserves scholarly attention to understand how Caribbean young adults acculturate when exposed to neighboring Caribbean cultures (e.g., whether biculturalism is also most common for them) and to assess the association between these acculturation strategies and students’ psychological and sociocultural adaptation to their new country. Many intraregional foreign students experience acculturative stress, and some present at university counseling centers to seek support. Research in this area would inform the work of university clinicians and would provide the basis for preventive psychoeducational interventions targeting foreign students. CONCLUSION The Caribbean is a unique and dynamic region and diaspora in which remote acculturation has produced a new generation of urban bicultural Americanized Caribbean youth on the islands. Americanization of Caribbean youth is not a rejection of Caribbean culture but an internalization of the hybrid Americanized Caribbean society that has evolved in Caribbean cities over decades due to migration and transnationalism, tourism and industry, and remittances of various kinds. Rather than ignore or deny the implications this new cultural reality has for Caribbean youth identities, it behooves Caribbean society to seek to understand it and work to maximize its assets while minimizing its liabilities. REFERENCES Acosta, Y. D., & de la Cruz, G. P. (2011). The foreign born from Latin America and the Caribbean: 2010 (ACSBR/10-15). Retrieved from http://www.census.gov/ prod/2011pubs/acsbr10-15.pdf remote acculturation     

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Arnett, J. J. (2002). The psychology of globalization. American Psychologist, 57, 774–783. http://dx.doi.org/10.1037/0003-066X.57.10.774 Bailey, W., Branche, C., McGarrity, G., & Stuart, S. (1998). Family and the quality of gender relations in the Caribbean. Kingston, Jamaica: Institute of Social and Economic Research. Berry, J. W. (1980). Acculturation as varieties of adaptation. In A. Padilla (Ed.), Acculturation: Theory, models and some new findings (pp. 9–25). Boulder, CO: Westview. Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology: An International Review, 46(1), 5–34. Berry, J. W. (2008). Globalisation and acculturation. International Journal of Intercultural Relations, 32, 328–336. http://dx.doi.org/10.1016/j.ijintrel.2008.04.001 Berry, J. W., Phinney, J. S., Sam, D. L., & Vedder, P. (Eds.). (2006). Immigrant youth in cultural transition: Acculturation, identity, and adaptation across national contexts. Mahwah, NJ: Erlbaum. Birman, D. (2006). Measurement of the “acculturation gap” in immigrant families and implications for parent–child relationships. In M. H. Bornstein & L. R. Cote (Eds.), Acculturation and parent–child relationships: Measurement and development (pp. 113–134). Mahwah, NJ: Erlbaum. Caribbean families still lean on barrel shipments from overseas. Caribbean Today. (2012, October 8). Retrieved from http://caribbeantoday.com/index.php? option=com_content&view=article&id=3142:caribbean-families-still-leanon-barrel-shipping-from-overseas&catid=96:feature Caribbean Tourism Organization. (2013a). International and Caribbean tourist arrivals: 1970–2004. Retrieved from http://www.onecaribbean.org/content/files/ intlcbbntouristarrivals1970to2004.pdf Caribbean Tourism Organization. (2013b). Latest statistics 2012. Retrieved from the website of the Caribbean Tourism Organization. Retrieved from http://www. onecaribbean.org/wp-content/uploads/June142013Lattab2012.pdf Caribbean 2010. (n.d.). Retrieved from http://populationpyramid.net/caribbean CARICOM Commission on Youth Development. (2010). Eye on the future: Investing in youth now for tomorrow’s community. Georgetown, Guyana: CARICOM Secretariat. Retrieved from http://www.caricom.org/jsp/community_organs/ cohsod_youth/eye_on_the_future_ccyd_report.pdf Crawford-Brown, C., & Rattray, J. M. (2002). Parent-child relationships in Caribbean families. In N. Boyd Webb &. D. Lum (Eds.), Culturally diverse parent-child and family relationships (pp. 107–130). New York, NY: Columbia University Press. Cuéllar, I., Arnold, B., & Maldonado, R. (1995). Acculturation Rating Scale for Mexican Americans-II: A revision of the original ARSMA scale. Hispanic Journal of Behavioral Sciences, 17, 275–304. http://dx.doi.org/10.1177/07399863950173001 Durant-Gonzalez, V. (1983). The occupation of higglering. Jamaica Journal, 16, 2–12.

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Erikson, E. (1968). Identity, youth, and crisis. New York, NY: Norton. Evans, H., & Davies, R. (1997). Overview of issues in child socialization in the Caribbean. In J. Roopnarine & J. Brown (Eds.), Caribbean families: Diversity among ethnic groups (pp. 1–24). Greenwich, CT: Ablex. Ferguson, G. M. (2013). The big difference a small island can make: How Jamaican adolescents are advancing acculturation science. Child Development Perspectives, 7, 248–254. http://dx.doi.org/10.1111/cdep.12051 Ferguson, G. M., & Bornstein, M. H. (2012). Remote acculturation: The “Americanization” of Jamaican islanders. International Journal of Behavioral Development, 36, 167–177. http://dx.doi.org/10.1177/0165025412437066 Ferguson, G. M., & Bornstein, M. H. (2015). Remote acculturation of early adolescents in Jamaica towards European American culture: A replication and extension. International Journal of Intercultural Relations, 45, 24–35. http://dx.doi. org/10.1016/j.ijintrel.2014.12.007 Ferguson, G. M., Bornstein, M. H., & Pottinger, A. M. (2012). Tridimensional acculturation and adaptation among Jamaican adolescent-mother dyads in the United States. Child Development, 83, 1486–1493. http://dx.doi.org/10.1111/ j.1467-8624.2012.01787.x Ferguson, G. M., Désir, C., & Bornstein, M. H. (2014). “Ayiti Cheri”: Cultural orientation of early adolescents in rural Haiti. The Journal of Early Adolescence, 34, 621–637. http://dx.doi.org/10.1177/0272431613503214 Ferguson, G. M., & Iturbide, M. I. (2013). Jamaican boys’ construals of Jamaican and American teenagers. Caribbean Journal of Psychology, 5(1), 65–84. Retrieved from http://ojs.mona.uwi.edu/index.php/cjpsy/article/viewFile/3823/3232 Ferguson, G. M., Kumar, A. K., Iturbide, M. I., & Simpson, J. (2013, April). Bicultural adolescent boys in Jamaica: Exploring remote acculturation up close and over time. In L. Juang (Chair), Acculturation and enculturation across the globe: Examining individual and family processes among immigrants and considering implications for adjustment. Symposium conducted at the Society for Research in Child Development Biennial Meeting, Seattle, WA. Forbes, M. A. (2012). Streaming: #Social media, mobile lifestyles. Kingston, Jamaica: Phase Three Productions. Glick Schiller, N., Basch, L., & Blanc-Szanton, C. (1992). Transnationalism: A new analytic framework for understanding migration. Annals of the New York Academy of Science, 645, 1–24. http://dx.doi.org/10.1111/j.1749-6632.1992.tb33484.x Glick Schiller, N., Darieva, T., & Gruner-Domic, S. (2011). Defining cosmopolitan sociability in a transnational age. An introduction. Ethnic and Racial Studies, 34, 399–418. http://dx.doi.org/10.1080/01419870.2011.533781 Graves, T. D. (1967). Psychological acculturation in a tri-ethnic community. Southwestern Journal of Anthropology, 23, 337–350. Greico, E. M. (2010). Race and Hispanic origin of the foreign-born population in the United States: 2007 (ACS-11). Retrieved from http://www.census.gov/prod/2010pubs/ acs-11.pdf remote acculturation     

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Haitian Institute of Statistics and Information. (2007). Statistiques démographiques et sociales: Informations sur les conditions de vie de la population vue dans sa réalité socio-démographique [Demographic and social statistics: The living conditions of the population information seen in its socio-demographic reality]. Retrieved from http://www.ihsi.ht/produit_demo_soc.htm Hope, D. P. (2012). Man vibes: Masculinities in the Jamaican dancehall. Kingston, Jamaica: Ian Randle. Jensen, L. A., Arnett, J. J., & McKenzie, J. (2011). Globalization and cultural identity. In S. J. Schwartz, K. Luyckx, & V. L. Vignoles (Eds.), Handbook of identity theory and research: Vol. 1. Structures and processes (pp. 285–301). New York, NY: Springer Science+Business Media. http://dx.doi.org/10.1007/978-1-4419-7988-9_13 Kag˘itçibas¸i, Ç. (2007). Family, self and human development across cultures: Theory and applications (Rev. 2nd ed.). Hillsdale, NJ: Erlbaum. Lerner, R. M. (1982). Children and adolescents as producers of their own development. Developmental Review, 2, 342–370. http://dx.doi.org/10.1016/0273-2297 (82)90018-1 Levitt, P. (1998). Social remittances: Migration driven local-level forms of cultural diffusion. International Migration Review, 32, 926–948. http://dx.doi.org/10.2307/ 2547666 National Office of Statistics. (n.d.). Retrieved from http://www.one.gov.do/ categoria?categoriaid=5&vista=1 National Office of Statistics and Information. (n.d.). Resultados preliminares [Preliminary results]. Retrieved from http://www.one.cu/publicaciones/cepde/cpv20 12/20121212cifraspreliminares/resultados%20preliminares.pdf Nicholson-Doty, B. (2013). State of the industry report. Retrieved from http://www. onecaribbean.org/content/files/StateofIndustryFeb2013.pdf Phinney, J. S. (1990). Ethnic identity in adolescents and adults: Review of research. Psychological Bulletin, 108, 499–514. http://dx.doi.org/10.1037/0033-2909.108.3.499 Phinney, J. S., Ong, A., & Madden, T. (2000). Cultural values and intergenerational value discrepancies in immigrant and nonimmigrant families. Child Development, 71, 528–539. http://dx.doi.org/10.1111/1467-8624.00162 Phinney, J. S., & Vedder, P. (2006). Family relationship values of adolescents and parents: Intergenerational discrepancies and adaptation. In J. W. Berry, J. S. Phinney, D. L. Sam, & P. Vedder (Eds.), Immigrant youth in cultural transition: Acculturation, identity, and adaptation across national contexts (pp. 167–184). Mahwah, NJ: Erlbaum. Pienkos, A. (2006). Caribbean labour migration: Minimizing losses and optimizing benefits. Port of Spain, Trinidad: International Labour Organization. Retrieved from http://www.ilo.org/wcmsp5/groups/public/---americas/---ro-lima/---sroport_of_spain/documents/meetingdocument/wcms_306289.pdf Pottinger, A. M., Stair, A. G., & Brown, S. W. (2008). A counselling framework for Caribbean children and families who have experienced migratory separation

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and reunion. International Journal for the Advancement of Counselling, 30, 15–24. http://dx.doi.org/10.1007/s10447-007-9041-x Redfield, R., Linton, R., & Herskovits, M. J. (1936). Memorandum for the study of acculturation. American Anthropologist, 38, 149–152. http://dx.doi.org/10.1525/ aa.1936.38.1.02a00330 Richardson, M. F. (1999). The identity profile of Jamaican adolescents. In A. G. Richardson (Ed.), Caribbean adolescence and youth: Contemporary issues and personality development and behavior (pp. 11–32). Brooklyn, NY: Caribbean Diaspora Press. Robertson, R. (1997). Comments on the “Global Triad” and “Glocalization.” Paper presented at the Globalization and Indigenous Culture Conference, Institute for Japanese Culture and Classics, Kokugakuin University, Tokyo, Japan. Robin, A. L., & Foster, S. L. (1989). Negotiating parent–adolescent conflict: A behavioral family systems approach. New York, NY: Guilford Press. Sam, D. L., & Berry, J. W. (Eds.). (2006). Cambridge handbook of acculturation psychology. Cambridge, England: Cambridge University Press. http://dx.doi.org/ 10.1017/CBO9780511489891 Sampson, S. S., & Branch-Vital, A. (2013). U.S. remittances to the Caribbean, Jamaica and Trinidad & Tobago. International Migration (Geneva, Switzerland), 51(s1), e70–e83. http://dx.doi.org/10.1111/imig.12018 Schwartz, S. J., Unger, J. B., Zamboanga, B. L., & Szapocznik, J. (2010). Rethinking the concept of acculturation: Implications for theory and research. American Psychologist, 65, 237–251. http://dx.doi.org/10.1037/a0019330 Senior, O. (2003). Encyclopedia of Jamaican heritage. St. Andrew, Jamaica: Twin Guinep. Statistical Institute of Jamaica. (2015). Population by sex: 2002–2013. Retrieved from http://statinja.gov.jm/Demo_SocialStats/population.aspx Thomas-Hope, E. (2002). Caribbean migration. Kingston, Jamaica: University of the West Indies.

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5 CARIBBEAN RESEARCH ON HUMAN DEVELOPMENT IN ADOLESCENCE AND ADULTHOOD: PROGRESS AND RECOMMENDED DIRECTIONS ISHTAR O. GOVIA, VANESSA PAISLEY-CLARE, AND TIFFANY PALMER

This chapter provides a selective review of the Caribbean-based empirical literature on adolescent and adult development, with a focus on studies published from January 2000 to November 2013. Our purpose for this review is to clarify current Caribbean emphases in developmental psychology, particularly the themes, topics, research questions, research designs, and strategies used; countries and subpopulations studied; and related findings relevant to human development at the adolescent, early and middle adulthood, and late adulthood stages in the lifespan. During the 2000 to 2013 period, two reviews relevant to English-speaking Caribbean adolescents’ development were published. The first explored health risk behaviors (Maharaj, Nunes, & Renwick, 2009); the other examined adolescent mental and physical health (Pilgrim & Blum, 2012). This chapter can be considered a supplement to these reviews because it includes studies on adolescent development in the areas of mental and physical health and http://dx.doi.org/10.1037/14753-006 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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health behaviors published since then or during that time but not included in those reviews; because it includes studies that were conducted in the French-, Spanish-, and Dutch-speaking Caribbean; and because it includes a focus on the early and middle adulthood and late adulthood stages of human development. The review is restricted to empirical research published in peer-reviewed journals—the gold standard in the advancement of behavioral science. For quantitative research, we present the nature of associations between various predictors and outcomes for each developmental stage of focus. For qualitative studies, we present the research aim or questions and related findings, and we discuss common themes and gaps. Before presenting the findings for each of the three developmental periods, we briefly identify key topical foci in the broader psychological literature on the specific developmental stage, including work conducted in majority world countries (such as those in the Caribbean region) and work from other regions and countries. The research foci are mainly in the physical, cognitive, social, and personality developmental domains. These overviews are intended to be summaries rather than exhaustive representations of topical foci. We end the chapter with suggested future directions for the advancement of a coordinated program of research for developmental psychology in the Caribbean with a focus on the human lifespan. THEORETICAL PERSPECTIVES USED IN LIFESPAN DEVELOPMENT Although innumerable theories and conceptual frameworks can be used, and have been used, in the study of lifespan development, many find their roots in one of the following six theoretical orientations, or in some combination thereof: psychodynamic, behavioral, cognitive, humanistic, contextual, and evolutionary. Several of these perspectives on human development over the lifespan have different emphases and assumptions and are discussed in detail elsewhere (e.g., Bornstein & Lamb, 2011), and their components are not considered herein. Much research on specific developmental stages or on change and continuity across developmental stages use these theories or some derivative of one or more of their tenets. Across contexts, the extensive body of work in developmental psychology suggests that no one perspective provides a complete explanation for any given phenomenon. Rather, they provide different information that can be considered as complementary and/or as addressing distinct facets of the phenomenon. The contextual perspective suggests that each individual’s development must be considered in relation to the social and cultural world in which she or he is embedded. It posits that human development occurs through relatively 120       govia, paisley-clare, and palmer

enduring, complex interactions between individuals and their immediate environments (i.e., proximal processes) and that the extent of the effect of these processes depends on the characteristics of the individual and/or the environment in which the interactions are taking place. Bronfenbrenner (1994), in his bioecological model, suggests that five levels of the environment (microsystems, mesosystems, exosystems, macrosystems, chronosystems) need to be appreciated to understand human development across the lifespan. Vygotsky (1978), in his sociocultural theory and with a focus on children, suggests that there is a reciprocal interaction between people and their environment. These two approaches have particular relevance for the studies considered below. Other theoretical frameworks are woven into the discussion where appropriate. CRITERIA FOR SELECTION OF RESEARCH REVIEWED We used PubMed, PsycINFO, and Google Scholar to search for empirical studies with adolescent or adult Caribbean-based samples, published between 2000 and 2013, with key words “adolescent, adolescence, youth” or “adult” or “aging, elderly” and “Caribbean” and country-specific names in Boolean searches. We also used the references in some studies to determine other studies that might be relevant to the present review. The inclusion and exclusion criteria for this review required studies to (a) be empirical; (b) focus on Caribbean-based samples (vs. Caribbean immigrant and immigrant ancestry samples in contexts outside the Caribbean, e.g., United States, United Kingdom, Canada); (c) include information about the age of the participants and for the youngest age to be 11 years; (d) focus on research questions, and in the case of quantitative studies, predictors or outcomes, that were relevant to development at any of the three life stages of focus: adolescence, early and middle adulthood, and late adulthood; and (e) not be books, chapters in books, conference presentations and/or conference abstracts, dissertations or theses, reports (e.g., those commissioned by or published by nongovernmental organizations), editorials, review articles, letters to the editor, or strictly psychometric investigations (because the purpose was to establish substantive, and not strictly methodological, areas for coordinated research effort). Once studies met these criteria, we further examined them to determine whether the journals in which they were published were predatory journals, as indexed in Beall’s (2012) listing of predatory, open-access journals. We also assessed whether they indicated the research design and methods used for data collection, including information on sample selection, recruitment, and study procedures. For instance, one article was omitted because it did not provide a description of how participants were recruited or indicate the number of participants and sample characteristics. caribbean research on human development     

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We read in detail the studies that met selection criteria to further assess their relevance to human development at the three developmental periods of focus. We determined this either by using statements in the works themselves that explicitly clarified such relevance in the context of a specific developmental psychology framework or theory, or when such statements were not provided, by agreement (between all three coauthors) on the ways in which the study could inform psychological investigation of adolescent or adult development. This was particularly necessary for articles that were not published in psychological journals and which were strictly descriptive. At that point, we also omitted articles if their focus was strictly educational, sociological, demographic, or medical, with no relevance for understanding the experience and/or context of development of persons during adolescence or adulthood.1 All authors reviewed studies that came under question for inclusion. Once the final assessment was made, we read and extracted data from all studies that met criteria, focusing specifically on developmental period, authorship, year of publication, Caribbean country or countries in which data were collected, sample size and description, predictor and outcome variables (for quantitative studies), research aims (for qualitative studies), and findings. We included 22 studies in this selective review. These represented 11 Caribbean countries, which were mostly English-speaking but included one study that represented the French-speaking Caribbean (Haiti) and another that collected data in Dutch-speaking Suriname. Table 5.1 provides a summary of these and other features of the studies reviewed. OVERVIEW OF RELEVANT LITERATURE AND SUMMARY OF EMPIRICAL RESEARCH FINDINGS Adolescence Topical Foci in International Literature Key areas of focus in the international psychology literature include puberty-related physical changes that adolescents experience; nutrition, food, and eating disorders; cognition and language expression; learning inside For this review, we considered adolescence as between ages 11 and 18, early and middle adulthood as between ages 18 and 55, and late adulthood as ages 55 and older. A few notes on this classification are in order. First, because of the few studies on both early adulthood and middle adulthood, we group these life stages together for practical purposes, whereas they are usually treated as distinct life stages in the psychological literature. Second, we acknowledge that beginning the late adulthood period with age 55 is different from the trend in broader psychological literature to consider 65 and older as the ages of consideration. Here, too, we opted for this age-stage categorization for pragmatic purposes—specifically, the number of studies focused on late adulthood were minimal, and those that did focus on late adulthood tended to have samples with an earlier age boundary. 1

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TABLE 5.1 Characteristics of Caribbean-Based, Peer-Reviewed, Published Quantitative and Qualitative Studies on Adolescent, Early and Middle, and Older Adult Development

Characteristic Disciplinary orientation of journal   Psychology   Public health   Medicine   Education   Interdisciplinary Years of publication   2000–2005   2006–2010   2011–2013 Years of data collection   1997–2000   2001–2004   2005–2009   Not specified Research design    Quantitative (cross-sectional survey or  correlational)   Qualitative   Mixed Sampling   Probability   Convenience   Purposeful Sample size   n < 100   n = 101–500   n = 501–1,000   n = 1,000–5,000 Single or multiple country sample   Single   Multiple Country studied   Barbados   Bermuda   Guyana   Haiti   Jamaica   St. Lucia    Trinidad and Tobago    Bahamas, Barbados, Guyana, Jamaica,    Suriname, Trinidad and Tobago    Barbados, Jamaica, Trinidad and   Tobago    Jamaica, Bahamas, St. Kitts and   Nevis, St. Vincent Sex    Male and female   Male only a

Includes ethnographic study.

Adolescent (N = 9)

Early and middle (N = 7)

Older (N = 6)

n

n

n

1

2 1 1 1 2

8 2 7

2 7 8

4 3

2 2 3 1

5

1 2 1 2

7

4

2

1 1 7 1

1 3

1 1 4 3

4

3 1 2 3

4 1 1

2a 1 3

8 1

6 1

5 1

1

2

1

6

2 1 2

1

1

2 1 1 1

1 1 8 1

7

5 1

and outside academic contexts; brain development and impulse control; rituals for the transition between childhood and adulthood; violence, poverty, and other risk factors to their health and well-being; identity; peer and family relationships; dating, sexual behavior, and teenage pregnancy. Summary of Review Findings We reviewed a total of nine studies. Eight studies used quantitative data; one used qualitative data. Eight studies included both male and female adolescents; one focused exclusively on male adolescents. Seven studies examined negative outcomes; two studies explored more positive outcomes. In the one multi-country study, data were collected from adolescents in Jamaica, Bahamas, Federation of St. Kitts and Nevis, and St. Vincent. Other countries represented included Trinidad and Tobago and Bermuda (Le Franc, SammsVaughan, Hambleton, Fox, & Brown, 2008). Jamaica was the country most represented (n = 8 studies). The majority of the studies were descriptive, with only one study exploring a mediating mechanism (Steely & Rohner, 2006). Seven of the nine studies used a self-administered questionnaire mode for data collection, mainly at the adolescents’ schools (one exception was Steely & Rohner, 2006, in which data were collected from child guidance clinics). The other modes for data collection were interviewer-administered questionnaires (McFarlane, Younger, Francis, Gordon-Strachan, & Wilks, 2014) and interviewer-led structured interviews (Jethwani-Keyser, Mincy, & Haldane, 2013). The year of data collection was mentioned in only two of the studies (Lipps et al., 2012; McFarlane et al., 2014). Table 5.2 presents a summary of the sample, methods, and findings of these nine studies. The main outcome of focus in these nine studies was well-being. The only prevalence study included here (i.e., McFarlane et al., 2014, because it was not included in the previously mentioned reviews on adolescent physical and mental health [Pilgrim & Blum, 2012] and health risk behaviors [Maharaj et al., 2009]) reported findings consistent with the published reviews. Specifically, using a community-based, nationally representative sample, the study examined risk behaviors and depression among Jamaican adolescents. It found a proportion of adolescents classified as depressed (15.5%) that was similar to the proportion reported in the Lipps et al.’s (2012) school-based sample of Jamaican adolescents (14.4%). Consistent with studies presented in the aforementioned reviews, the study also found that female adolescents were more likely than male adolescents to report depressive symptoms, and that risk factors related to sexual behavior, substance use, and violence were associated with an increased likelihood of being depressed. Most of the studies examined adolescents’ perceptions of adult-related factors (parenting-related factors, violence and aggression among adults in the household and in close proximity) and their associations with adolescents’ 124       govia, paisley-clare, and palmer

TABLE 5.2 Reviewed Studies on Adolescence Study

Caribbean country

Ferguson (2013)

Jamaica

Jethwani-Keyser et al. (2013)

Bermuda

Lipps et al. (2012)

Jamaica, Bahamas, St. Kitts and Nevis, St. Vincent

Findings a. Scale scores show well-adjusted adolescents and parents. b. Ideals for family obligations were highest in nuclear families and lowest in single-parent families. c. Adolescents had strong familistic values; stronger value transmission occurred in early adolescence. d. Adolescents’ family prioritization (FP) was as high as their parents’ ideals for them. e. Adolescents’ high FP was associated with parents feeling efficacious and satisfied with parenting role. f. Relational discrepancies between adolescents’ FP and parents’ ideals were beneficial and not predictive of emotional problems. a. Family members and teachers encouraged commitment to education. b. Lack of knowledge about college application procedure relevant to educational goals. c. Almost all participants had educational goals for the future; all believed college facilitated professional and income goals. d. Preference for going to college overseas. e. Almost all participants lived with biological mother. f. Biological mother reported as most influential on educational and career decisions, staying in school, and maintaining the belief that education will lead to a better life. g. Belief that fathers care about education and prefer college overseas to avoid getting into trouble in Bermuda. h. Almost all participants identified at least one adult mentor at school for guidance, encouragement, and advice about after high school. a. 52% of sample reported mild depressive symptoms; 29%, moderate to severe. b. Prevalence of moderate to severe symptoms highest in Jamaica, followed by St. Vincent, St. Kitts and Nevis, and Bahamas. c. Authoritative and neglectful parenting used most; the former more with girls and latter with boys. d. Authoritarian and neglectful parenting styles were most associated with depressive symptoms in all four countries. e. Relationship of parenting styles to depression scores not consistent across countries. (continues)

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TABLE 5.2 Reviewed Studies on Adolescence  (Continued) Study

Caribbean country

McFarlane et al. (2014)

Jamaica

Mello & Worrell (2008)

Trinidad and Tobago

Smith & Moore (2013a)

Jamaica

Findings a. 15.5% classified as depressed; more prevalent for young women than young men. b. 59% sexually active by 14 years old; significantly more males were sexually active and had more than one partner in past 3 months. c. Participants who ever had sex, had been pregnant or got someone pregnant, had more than one partner, used substances, were involved in violence, and/or had a forced sexual encounter were more likely to be classified as depressed. a. 85% participated in at least one extracurricular activity (EA); males, in more athletic activities, and females, in more artistic activities. b. Athletic and intellectual EA participation were positively associated with academic achievement. c. Perceived life chances (PLC) were positively associated with EA and academic achievement but were lower in males participating in fewer artistic activities than females and males participating in more artistic activities. d. Age was inversely associated with perceived life chances. e. Academic achievement was a stronger predictor of PLC than gender and EA but did not moderate the relationship between EA and PLC. a. 62% received corporal punishment (more males); 90% experienced familial verbal aggression; 43.9% witnessed interadult (IA) physical violence; 81.3%, IA verbal aggression. b. Higher levels of corporal punishment, verbal aggression, and IA violence were independently associated with adolescents’ negative outcomes. c. Parent–child verbal aggression had greatest negative effect; corporal punishment had no negative effect. d. IA verbal aggression predicted psychological problems, except alcohol/drug use and conduct problems, and IA violence was correlated with alcohol/drug use. e. Aggressive and violent behaviors combined were better predictors of negative adolescent outcomes than each individually.

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TABLE 5.2 Reviewed Studies on Adolescence  (Continued) Study

Caribbean country

Smith & Moore (2013b)

Jamaica

Smith et al. (2011)

Jamaica

Steely & Rohner (2006)

Jamaica

Findings a. Authoritarian parenting was positively associated with anger, depression, suicide ideation, and conduct problems in children. b. Boys reported significantly higher scores on anger, depression, suicide ideation, and conduct, and greater conduct problems with higher levels of authoritarian parenting. c. High levels of authoritarian parenting and disagreement with parents’ behavior increased likelihood of adolescent anger, depression, and conduct problems. a. 77.6% of sample reported physical punishment at home; no differences by socioeconomic status or gender. b. 65.2% of sample had one or more behavior problems; more males reported conduct problems. c. Males and females reported suicidal ideation most frequently, followed by depression and anxiety, somatic complaints, anger and irritability, and alcohol or drug use. d. Physical punishment was more likely to be associated with mental health and behavioral problems. e. Those often punished had significantly lower self-esteem scores. a. 97% of sample received physical punishment; 95% by mothers, and 81% by fathers. b. All felt reasonably well loved by parents despite perceiving parental punishment as being slightly harsh and fairly unjust. c. Perceptions of maternal harshness were correlated with self-reported psychological maladjustment and perceptions of maternal rejection. d. Perceived maternal rejection partially mediated the relationship between harshness of maternal punishment and psychological maladjustment. e. Perceptions of paternal harshness were correlated with perceived paternal rejection. f. Younger children reported harsher maternal punishment and maladjustment. g. Perceived maternal acceptance–rejection almost completely mediated the relation between perceived harshness of maternal punishment and psychological adjustment.

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psychosocial well-being. The main well-being outcomes examined were depressive symptoms, psychosocial adjustment, life satisfaction, and selfesteem. Consistently, adolescents’ perception of parenting approaches that were authoritarian, neglectful, or harsh was associated with poorer psychological well-being (Lipps et al., 2012; Smith & Moore, 2013b; Smith, Springer, & Barrett, 2011; Steely & Rohner, 2006). In addition, some studies suggested that aggressive and violent interactions and exchanges were associated with poor psychosocial well-being, particularly with externalizing and behavioral problems (e.g., drug/alcohol abuse) and lower self-esteem. The one study that examined a possible mechanism linking parenting-specific interactions with adolescent outcomes suggested that these negative interactions with adults, and particularly with parents, may precipitate poor psychological outcomes because they may increase adolescents’ feeling of being rejected by these key caregivers (Steely & Rohner, 2006). Three studies focused on factors that promoted psychological health and well-being. One study (Ferguson, 2013) examined a sense of intergenerational obligations and psychosocial well-being among adolescents. It pointed to the potentially beneficial function for the adolescent when she or he prioritized familial relationships in a way different from the way their parents prioritized relationships. Another study (Mello & Worrell, 2008) illustrated that artistic and athletic activity involvement predicted expectancies for positive life chances, for both adolescent boys and girls in Trinidad. Using a qualitative data collection strategy with a sample of 17- to 19-year-old young men in Bermuda, a third study (Jethwani-Keyser et al., 2013) echoed the important role that family members, particularly mothers, played in adolescent professional and educational aspirations. Overall, these studies present a picture of adolescent development in the English-speaking Caribbean, and particularly in Jamaica, that is consistent with broader psychological literature on the role of parenting and adult interaction factors on adolescents’ psychosocial well-being. Authoritarian, neglectful, and violent interactions with adults are risk factors for poor psycho­social well-being. That the studies focused on these risk factors speaks to the important role that researchers perceive these factors to play in Caribbean contexts. Adolescents are understood to be developing in challenging contexts, over and above the typical physiological and emotional challenges they endure. Chapter 3 in this volume addresses socialization practices around parenting and so those are not discussed in detail here. Noticeably absent from the body of empirical research were studies in developmental psychology topics common to the period of adolescent development: cognitive and neurological development, language and learning, 128       govia, paisley-clare, and palmer

moral development, peer relations, friendship patterns, delinquency, and school achievement. Theories were used in five of these nine studies: relational discrepancy theory (Ferguson, 2013), Bronfenbrenner’s (1994) ecological theory (Jethwani-Keyser et al., 2013; Smith & Moore, 2013a, 2013b), and Baumrind’s (1991, 2005) typological approach to parenting effects on child outcomes (Lipps et al., 2012). Used in the Ferguson (2013) study, relational discrepancy theory (Boldero et al., 2009) proposes that individuals compare themselves with others with whom they have relationships. The degree of perceived similarity between two people with regard to aspirations and obligations is a powerful determinant of how likely they are to have positive or negative emotional outcomes. Applied to family relations, it is suggested that smaller discrepancies in the child/adolescent–parent dyad in obligation ideals lead to better psychologically adjusted adolescents. However, for collectivist cultures that emphasize hierarchical family relationships (i.e., “authority ranking” or “leader–follower”) and in which the lower ranking partner expects, accepts, and adjusts for the relational differences, discrepancies are not hypothesized to be associated with poor adjustments in adolescents. In the Ferguson (2013) study, which focused on Jamaica, this was indeed the case. The author stated that the parenting style typically emphasizes parental authority, strict discipline, and high behavioral and educational expectations, which is matched by adolescents’ holding parents as primary role models and prioritizing family in their self-identity over several life domains. She found support for her hypotheses that there would be discrepancies in parent–child obligation ideals but that these discrepancies would not operate as an emotional liability as they tend to in societies that are more individualistic and egalitarian than Jamaica. It would be interesting to explore whether these findings replicate across social class groups in Jamaica, as well as in comparative studies between Jamaica and other Caribbean societies. The Jethwani-Keyser et al. (2013) study, as well as the two Smith and Moore (2013a, 2013b) studies, drew heavily on Bronfenbrenner’s (1994) bioecological model summarized earlier in this chapter. The integrative theory for the study of development in minority populations (García Coll et al., 1996) was used as an adjunct to Bronfenbrenner’s (1994) human ecology model in the study of the interaction between home, educational, and cultural messages/environments and the interaction’s impact on the educational goals of Bermudan adolescent boys (Jethwani-Keyser et al., 2013). The integrative theory adds to other ecological models by considering social position and social stratification constructs salient in the developmental processes of minority populations (García Coll et al., 1996). The theory purports eight major constructs hypothesized to influence developmental processes for children of color: (a) social position variables (race, social class, ethnicity, and caribbean research on human development     

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gender) that are defined by the society’s social stratification system; (b) social stratification mechanisms (racism, prejudice, discrimination, oppression); (c) residential, economic, and/or social and psychological segregation that operate at the macrosystem level to mediate between social position and other contexts that may more directly affect developmental outcome; (d) promoting or inhibiting environments (e.g., schools, neighborhoods, health care systems); (e) adaptive culture, resulting from a group’s collective history and current contextual demands posed by the promoting and inhibiting environments (includes survival strategies/culturally defined coping mechanisms developed from these interacting factors); (f) child characteristics, particularly age and temperament, health status, maturational timing, and racial features; (g) family context, including its structure and roles, beliefs, values, goals, racial socialization, and socioeconomic status and resources; and (h) developmental competencies (i.e., functional/adaptive competencies and developing [cognitive, social, emotional, and linguistic] skills of children; García Coll et al., 1996). The authors’ use of this theory helped them understand the ways in which the disenfranchisement and marginalization that Bermudian young men experienced against a historical backdrop of institutional racism likely informed their sense of limited social mobility and educational options. Lipps et al. (2012) framed their study within Baumrind’s (1991, 2005) work on parenting styles and how they influence the health and well-being of children. In her work, Baumrind (1991, 2005) proposed three main parenting styles as a function of responsiveness (warmth, supportiveness) and demandingness (behavioral control): authoritative, authoritarian, permissive, and neglectful. The Lipps et al. (2012) study suggested that across the four Caribbean countries from which school-based student samples were gathered, authoritative and neglectful parenting were the most prevalent. They also noted that the relationship between parenting styles and depression was inconsistent across the countries. Early and Middle Adulthood Topical Foci in International Literature Studies on early adulthood in the international psychological literature share many of the aforementioned topical foci as those discussed on adolescence: in particular, stress and coping; life events and cognitive development; factors that promote or dissuade successful college participation; relationships, specifically friendships, intimacy, and love; attachment styles; marriage, divorce, and parenthood; and work and career. Studies on these topics are also concerned with sex- and gender-based differences. The topics on which the literature on middle adulthood focuses are in many ways the same as those from the prior stages. In addition, the foci are on 130       govia, paisley-clare, and palmer

gradual changes in the body’s capabilities; the senses, reaction time; sexuality and middle age; menopause and andropause; wellness and illness specific to middle age; intelligence (whether it declines at this stage); memory; and the development of expertise. For this period, literature on social and personality development has explored the two competing perspectives on adult personality development: the normative crisis versus life events. In the first, agerelated crises, occurring in a prespecified linear order, are intricately linked to personality development in each of the life periods, of which middle age is but one. In the second, life events, rather than age is what determines personality development. Summary of Review Findings A total of seven published empirical studies were located; all were quantitative and included both male and female adults (see Table 5.3). In the one multicountry study (Le Franc et al., 2008), data were collected from adults in Barbados, Jamaica, and Trinidad and Tobago. Apart from that multi­country study, Haiti and Guyana were the two other countries represented. Jamaica was once again the country most represented, although this time only in three studies. All the studies were descriptive. Five of the seven studies used an interviewer-administered questionnaire mode for data collection. The year of data collection was mentioned in only two of the studies (i.e., Martsolf, 2004; Ricketts & Anderson, 2008). Four main categories of outcomes were presented in these studies: those related to parenting (n = 3), heterosexual relationship patterns (n = 1), mental health (n = 1), and violence and aggression (n = 2). All three of the studies on parenting outcomes used national probability samples. The two studies from Guyana (C. M. Wilson, Wilson, & Fox, 2002; L. C. Wilson, Wilson, & Berkeley-Caines, 2003) used a social science household survey, which from the commonalities in sampling design and authorship, could have been based on the same data set, although it is difficult to ascertain because neither the study name nor the year of data collection was stated. The one from Jamaica (Ricketts & Anderson, 2008) used data from a government-initiated annual household survey tool used to monitor the impact of social policies and programs in Jamaica, one that used an adapted version of the World Bank’s Living Standards Measurement Survey (Grosh & Munoz, 1996). These three studies on parenting in the early and middle adulthood developmental periods focused on disciplinary strategies used, and other types of interactions with their children, as well as general perceptions of their children. As in the broader psychological literature, associations between stress and poorer quality or intensity of interaction with children were reported. Parents who reported higher stress exposure (e.g., were at or below poverty level) reported less interaction with their children (Ricketts & Anderson, 2008). Those caribbean research on human development     

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TABLE 5.3 Reviewed Studies on Early and Middle Adulthood Study

Caribbean country

Gaines et al. (2003)

Jamaica

Griffith et al. (2006)

Trinidad

Le Franc et al. (2008)

Barbados, Jamaica, Trinidad and Tobago

Martsolf (2004)

Haiti

Findings a. Mean scores on cultural value orientations and responses to accommodative dilemmas scales did not differ significantly based on race. b. No significant association between group orientation and accommodation. c. Self-orientation was negatively associated with accommodation. a. U.S. participants had less tolerance for domestic violence (DV). Age accounted for these differences; the younger Trinidadians were, the less tolerant they were of DV. b. Women, across groups, had lower levels of tolerance for DV. c. No group differences in willingness to intervene when DV involved family members or coworkers; U.S. participants were more likely than Trinidadians to intervene when DV involved a friend or neighbor. d. Unwillingness to intervene in DV with a friend or coworker mostly attributed to it being “none of [the participant’s] business” and not feeling close enough to the victim. e. Ethnicity not significantly related to tolerance for DV across groups but was associated with Trinidadians’ willingness to intervene with coworkers. f. More Trinidadians than U.S. participants experienced DV in childhood families. a. 63.1%–72.5% of men and 65.1%–83.1% of women reported being victims of violence. b. Violence against women was highest in Jamaica and lowest in Trinidad but was almost equally as high in Jamaica and Trinidad for men. c. Violence perpetrated by a partner in a relationship was most common. d. Women were more likely to be victims of any type of violence, sexual coercion specifically; sexual coercion was highest in Jamaica. e. Violence generally decreased with age, except physical violence by strangers or acquaintances, which increased with age. f. More women reported being perpetrators of physical violence. a. 60% of women and 86% of men reported at least one form of moderate to severe childhood maltreatment; physical neglect was highest rated childhood maltreatment. b. 54% of the sample had scores indicating major depression. c. Childhood maltreatment correlated positively with physical symptoms and depression, and negatively with quality of life.

TABLE 5.3 Reviewed Studies on Early and Middle Adulthood  (Continued) Study

Caribbean country

Ricketts & Anderson (2008)

Jamaica

C. M. Wilson et al. (2002)

Guyana

L. C. Wilson et al. (2003)

Guyana

Findings d. Age, religion, marital status, number of children, level of education, and work status correlated with childhood maltreatment, physical health outcomes, and depression. e. Men reported more childhood maltreatment and higher levels of depression. a. 95% of caregivers felt that they parented well/ very well; 47% reported being unable to cope at times; and 25% felt trapped or controlled by demands of parenting. b. High parent–child interaction were reported in general except for poor families, in which 25% reported few or no joint family recreational activities. c. 49% of all parents and 73% of poor parents reported moderate to high parental stress. d. Level of parenting stress was negatively correlated with level of interaction. e. Caregivers slapped children regardless of level of interaction, but noncorporal punishments were more likely used among parents with higher interaction levels. a. Mothers were more likely than fathers to use physical punishment and verbal threats, particularly with boys. b. Reasoning was most frequently used and physical punishment was least used, regardless of gender of parent or child. c. Boys were more frequently disciplined and more likely to receive physical punishment and threats. d. Perceived parental strain was associated with higher use of verbal threats and physical punishment but not with frequency of reasoning. e. Discipline techniques did not vary by race, family, and level of economic hardships. a. Most desirable characteristics in children were obedience, honesty, mannerly conduct; least desirable were being considerate, neat and clean, getting along with others. b. Success and good sense and judgment were ranked higher for older children. c. Mannerly conduct, obedience, responsible behavior, good sense and judgment, and getting along with others ranked equally for gender and all age groups. d. Desire for success and good sense and judgment increased with age; success, specifically for boys. e. Desire for education was important for boys regardless of age but was less important for girls, especially as they aged. f. Socioeconomic variations were inconsistent for socialization preferences.

who reported greater subjective parenting strain (C. M. Wilson et al., 2002) reported more use of physical punishment and verbal threats. The two studies on violence and aggression (Griffith, Negy, & Chadee, 2006; Le Franc et al., 2008) explored attitudes toward, and experiences of, these. Although the study on attitudes toward domestic violence (Griffith et al., 2006) was comparative (with a U.S.-based student sample in Florida), it is included in this review because the Caribbean-based sample addresses the attitudes toward domestic violence of university students in Trinidad and Tobago. Using a convenience sample, the study suggested that ethnic differences existed in willingness to intervene in domestic violence involving coworkers, with those from East Indian backgrounds being more willing to intervene than those from African or mixed backgrounds. Sex differences emerged in tolerance for domestic violence, with women, as expected, reporting lower tolerance. High prevalence rates (over 63%) of being victims of domestic violence—both women and men—were presented in a study that used a multicountry household probability survey conducted in Barbados, Jamaica, and Trinidad and Tobago (Le Franc et al., 2008). This study also suggested country differences in violence perpetuated against women (highest in Jamaica and lowest in Trinidad and Tobago) but no country differences in violence perpetuated against men. A surprising finding from this study was that more women than men reported being perpetrators of domestic violence. The extent to which this is an artifact of self-presentation and social-desirability–influenced reporting biases remains to be examined. The one study on mental health was from a convenience, clinic-based sample from Haiti and presented both expected associations and counterintuitive findings (Martsolf, 2004). This clinic-based sample reported high prevalence rates of moderate to severe childhood maltreatment was within the threshold for depression; maltreatment earlier in life was correlated with the manifestation of both poor physical and mental health. Counterintuitive findings related particularly to sex differences in maltreatment exposure and levels of depression: More men than women seemed to have been exposed to childhood maltreatment, and men also reported higher levels of depression. The one study that explored heterosexual relationships (Gaines, Ramkissoon, & Matthies, 2003) explored the associations between group orientations, which they termed cultural value orientations, and reactions in dilemmas with partners. The researchers found that individualism (as opposed to what they termed group orientations and which included collectivism, familism, romanticism, and spirituality) was negatively associated with reports of accommodation in relationships. Taken together, these studies on persons in the early and middle adulthood developmental periods suggest a focus on parenting and romantic/ intimate/sexual partnerships. Missing from the literature were studies that 134       govia, paisley-clare, and palmer

examined other themes presented in empirical psychological literature on persons in the early and middle adulthood phases of development. No studies were located that explored issues related to work–life balance, and although hinted at in various studies, there were no explicit theoretically or conceptually guided examinations of psychosocial development; personality changes and consistencies during this developmental period; and gender schemas, roles, or socialization. Nor were there studies that explored the psychological development and experiences of marginalized populations, such as adults who are lesbian, gay, bisexual, or transgender; adults who are differently abled, or people who are homeless. Theories or conceptual frameworks were used or referenced in four of these seven studies. Interdependence theory of social relations (H. H. Kelley & Thibaut, 1978) and cultural value orientations (Triandis, 1995) were used in the Gaines et al. (2003) article. In two studies, although not used for explicit hypothesis testing, theories were mentioned. Specifically, an ecological model was referenced in the Martsolf (2004) study, harkening to the contextual perspectives discussed earlier, and in the Ricketts and Anderson (2008) study, the authors referenced attachment theory (John Bowlby and Mary Ainsworth). One study (C. M. Wilson et al., 2002) presented six theoretical perspectives, although the authors did not use any for hypothesis testing. Late Adulthood Topical Foci in International Literature Psychological research on late adulthood tends to be presented in the context of the shifting demographics of aging societies as a function of longer life expectancies and the resultant challenges and opportunities. Increasing focus is being placed on debunking myths that older persons are not productive, contributing members of society, and on cross-cultural and in-depth examinations of the psychological consequences of longer lifespans. Popular topics include ageism; chronological versus biological aging; changes in reaction time and the senses (particularly sight, sound, taste, smell); sexuality in old age; physical, mental, and cognitive disorders and their comorbidity; the nature of intelligence in older people, with a special focus on the notion of plasticity (the degree to which a developing structure or behavior is susceptible to experience); memory changes; learning, education, and technological pursuits in later adulthood; continuity and change in personality; coping with aging; how culture shapes the way people are treated in late adulthood; successful aging (a term introduced nearly 30 years ago to encourage a focus on productive functioning and growth with aging; see O’Neill & Pruchno, 2015); living arrangements (living at home vs. alternative arrangements); financial caribbean research on human development     

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issues; work and retirement in late adulthood (age discrimination, retirement); and relationships, especially widowhood, friendships, family relationships, and negative relationship dimensions, such as abuse of older people. Summary of Review Findings A total of six studies on late adulthood were located. In only one of these (Rawlins, Simeon, Ramdath, & Chadee, 2008) did the age range of focus for late adulthood reflect the 65 years of age and older that is used to define this period in the broader psychological literature. Four studies used quantitative data (Bourne, 2008; Hambleton et al., 2005; Morris, James, Laws, & Eldemire-Shearer, 2011; Rawlins et al., 2008); two used qualitative data (Cloos et al., 2010; L. S. Kelley, 2005). Five of the six studies included both men and women; one quantitative study focused exclusively on men (Morris et al., 2011; see Table 5.4). From these four quantitative investigations, health and psychosocial well-being was the common theme. These studies were from the disciplines of public health or epidemiology, and demography rather than psychology, and as such, they provided mainly descriptive findings. All four were single site countries, with data collected in Jamaica (n = 2), Barbados (n = 1), and Trinidad and Tobago (n = 1) using household surveys. Three of the four studies were original data collection efforts, with the mode being intervieweradministered questionnaires. The other quantitative study used secondary data analysis of public data from government-initiated annual household survey mentioned earlier in the section on early and middle adulthood. A common picture across these four quantitative studies was that of older adults being vulnerable and at risk in terms of their physical health (high prevalence rates for chronic noncommunicable disease) and psychosocial well-being (low levels of well-being, high levels of loneliness, high rates of cognitive impairment). The one study in these four that was informed by an a priori specified conceptual framework and related hypotheses found support for the prediction that current lifestyle and disease experience of older persons were key mechanisms that linked their past socioeconomic status and their current health status (Hambleton et al., 2005). Findings in all four studies suggested that social networks and social support were linked to the health and wellbeing of the older adults in their samples. The two qualitative studies provided textured information about the formal and informal systems of care in place for older people in the Caribbean countries studied. One of the qualitative studies focused on a single country site, namely, St. Lucia (L. S. Kelley, 2005). The other was a multicountry study, with data collected in the Bahamas, Barbados, Guyana, Jamaica, Suriname, and Trinidad and Tobago (Cloos et al., 2010). The two qualitative studies 136       govia, paisley-clare, and palmer

TABLE 5.4 Reviewed Studies on Late Adulthood Study

Caribbean country

Bourne (2008)

Jamaica

Cloos et al. (2010)

Bahamas, Barbados, Guyana, Jamaica, Suriname, Trinidad and Tobago

Hambleton et al. (2005)

Barbados

Findings a. On average, well-being was low. b. Factors with greatest impact on well-being were marital status, social support, average occupancy per room, area of residence, education, physical environment, age, gender, property ownership, cost of health care, and psychological conditions. c. Perceived social support was the most positively influential factor on well-being, followed by average number of people occupying a room. d. Well-being was predicted more by negative than positive affective conditions. a. Coherent, multisector, comprehensive responses to population aging are lacking in Caribbean region. b. Geographical location and socioeconomic status shape health inequalities in all countries studied. c. Services perceived as curative and lack consistency, scope, and resources (e.g., equipment, infrastructure, services, trained physicians and nurses). d. Multigenerational households were less prevalent, reducing the social/familial support for older adults. e. Less socially advantaged persons and those with disabilities were more vulnerable to social exclusion. f. Pensions were not available or were not enough to cover the costs of basic necessities. a. Persons reporting better health had more siblings and finances to meet daily needs. b. Odds of reporting good health status were lowered by obesity, undernourishment, and inadequate exercise (lifestyle risk factors). c. Indicators of disease were the strongest predictor of health status. d. Historical socioeconomic indicators were likely to have a smaller effect on health status over time and were partly mediated through current lifestyle and disease experience. (continues)

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TABLE 5.4 Reviewed Studies on Late Adulthood  (Continued) Study

Caribbean country

Kelley (2005)

St. Lucia

Morris et al. (2011)

Jamaica

Rawlins et al. (2008)

Trinidad and Tobago

Findings a. Being viewed as old was based on capacity to independently carry out daily activities. b. Only 32% of children wanted to get old, because they did not want to be teased or treated badly. c. Most of the people who were older occupied a low social status. d. Villagers were unable to identify an older person who was respected or revered. e. Little evidence of stable family support or a respected position for older people, especially those who were functionally or cognitively impaired and in need of assistance. a. Characteristics of sample of men: less than 1% living alone, 51% married, 88% head of household, over 80% having basic or all-age school-level education, 74% retired or not working, 85% fully independent re: daily living. b. 78.0%, cognitively functional; 74.0% reported good or excellent health; 51.0% reported having a chronic disease; 17.6% had mild to significant depression. c. Depression was associated with lack of participation in social clubs and/or church. d. 67.6% had not visited a doctor/health facility in the previous year due to absence of illness (44%), use of home remedies (29%), or not being able to afford care (22%); 50% did not seek treatment even when ill. e. 68.2% reported some form of exercise and 38.0% exercised regularly. a. More women than men had no schooling and fewer were skilled laborers. Only 2% of the sample was currently employed. b. Good/very good health was reported by 44% and bad/very bad by 11%. More men than women reported good health. c. At least one chronic disease reported by 80% of sample. d. Sources of income: old age pension, national insurance, private government pensions, savings and relatives; 0.6% reported no income. e. 16% of sample lived alone, but 33% reported loneliness, mainly because of living alone or because family and friends were too busy. More men reported being lonely despite being more likely to live with a spouse.

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examined familial and broader societal norms and resources for the care of older people. A multicountry study that primarily used focus groups revealed a lack of coordinated, comprehensive, and multisector responses to population aging across the Caribbean contexts studied and that the ripple effects of this were starkly apparent in the lack of preventative approaches to health care and social services in place for older people (Cloos et al., 2010). Similarly, an ethnographic study of one community in St. Lucia suggested that assumptions that older people are well-supported—either by familial or community infrastructures or by broader systems—are misguided. Given the demographic shift expected to be manifesting, even in Caribbean countries, toward a larger percentage of older adults, both the quantitative and qualitative studies paint a picture of the psychosocial needs of older people and aging as areas for urgent research focus. Research on these needs as well as on the formal and informal systems of care in place or needed for older people seem particularly necessary to stem the tide of expected age-related disease and disability. No studies we located examined working, retirement, generativity, or successful aging. Whether this is because these topics are not perceived as relevant or pressing in many Caribbean contexts in which a considerable proportion of the population is part of informal work economies or because of other factors was not clear and is deserving of further attention. It is also noteworthy (although perhaps not surprising, given the public health, epidemiology, or demography focus of the studies) that, for the most part, these studies were not framed by theories or conceptual frameworks commonly used in the psychological study of older adults. No theories were used or explicitly referenced in any of the above six studies. However, some studies reference the concept of need fulfillment, a psychodynamic construct, in one study (i.e., Bourne, 2008). In another study (Hambleton et al., 2005), the framework used incorporated a consideration of the impact of early life experiences on later health; this seems aligned with the contextual perspectives described earlier. DISCUSSION Common Issues and Gaps Human development is a dynamic and lifelong process. Developmental psychology as a field has traditionally focused on development from infancy through early adulthood, perhaps because it is such a crucial period for the mind and social development. As a result, the study of developmental changes throughout adulthood is relatively recent. Research in the Caribbean is no exception. In addition to the already existing review articles on adolescents caribbean research on human development     

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described earlier in this chapter, much more published work has been on adolescence as opposed to development in middle and later adulthood. Given this dearth of research, it is therefore difficult to critically synthesize the studies reviewed in terms of the key themes common to developmental psychology: nature versus nurture, continuous versus discontinuous development, and stability versus plasticity (both in general development and across and within various domains, e.g., cognitive, social, emotional, physical). Alternatively, the studies reviewed suggest that research on adolescence and adulthood is deeply rooted in the theme of development in socio­cultural context. Although not explicitly presented as a guiding theme in many of the studies reviewed, the country comparisons and the development of study rationales suggest that sociocultural context is important to Caribbean-focused research in develop­ mental psychology. Few studies referenced or incorporated a life course perspective that linked early life exposures, experiences, and vulnerabilities with later life experiences and outcomes. Two studies were located that adopted lifespan development approaches (Alea, Ali, & Arneaud, 2012; Hutchinson et al., 2004). These two studies suggested particularly rich areas for future investigation. They noted, for example, that levels of mental and physical health, as well as psychosocial well-being, varied across the lifespan and, to some extent, varied for men versus women. Furthermore, as the studies presented earlier indicated, the role of socioeconomic and social relations factors was apparent across the life stages represented in these two studies. Another consistency across the studies is that they were largely descriptive, data driven, and by extension, not guided by conceptual frameworks in general or by developmental psychology theories and frameworks commonly used in the field. This is perhaps necessary in emic approaches to empirical work that seeks to inductively present the experiences and realities of specific groups that have not been a focus of study in psychology. In this spirit, if theories and concepts endemic to the Caribbean are being developed, researchers can facilitate the building of programs of research in those areas by explicitly describing the components of these theories and frameworks. At the same time, to ascertain where Caribbean-based research in human development across the lifespan falls in the broader developmental psychology literature, it may be helpful to use and evaluate the usefulness of traditional developmental psychology frameworks, such as those described earlier. Our review of empirical research on adolescence and adulthood also indicated that the majority of studies represent the realities of persons from English-speaking Caribbean countries. Given the diversity among Caribbean countries, to understand the similarities and dissimilarities across various markers of difference, it would be helpful if more research were published that was representative of the experiences of adolescents and adults in the Dutch-speaking, 140       govia, paisley-clare, and palmer

French-speaking, and Spanish-speaking Caribbean. Furthermore, it will be important to present profiles of adolescent and adult development in Englishspeaking Caribbean countries that are understudied and, perhaps even more underresourced, such as small island states. Few studies examined within-country variability in adolescent and adult developmental trajectories and outcomes. Although this was hinted at in many of the studies, it was not presented as questions or hypotheses to be explicitly tested. In programs of research focused on these developmental periods, it will be important to examine the extent to which socioeconomic factors create different developmental contexts, which in turn may be linked to differential outcomes. In this program of research, it will be important to explore not only adolescents and adults in contexts that are perceived as resource deprived but also those in resource-rich environments. Only in this way will we have a clearer and more accurate picture of adolescent development and related outcomes in Caribbean contexts. Limitations This review has four main limitations. First, studies that were not indexed in the databases used were, to a large extent, not included. Second, specific types of articles and empirical studies were not included; it did not, for example, include studies that strictly focused on psychometric evaluations. Arguably, understanding the psychometric validity of tools and measures is useful, parti­ cularly for learning and education outcomes, for example, with adolescents and with persons throughout the lifespan who may be cognitively impaired. However, because of our emphasis on discerning areas for substantive research, such studies were not included. Third, the review focused only on articles published in peer-reviewed journals. Some of the suggested areas for future research may therefore seem redundant if studies in the gray literature examine those issues. However, to advance the discipline and the specific field of developmental psychology in the Caribbean published research is essential, and particularly research published in reputable academic sources. Fourth, the review did not include empirical studies published before 2000. Although the inclusion of such studies may have assisted with the evaluation of larger bodies of work and in assessing areas for future emphases, it is crucial to gauge the current state of empirical research. Suggested Topic Areas, Methodological Approaches, and Capacity-Building Strategies Given the emphases in the reviewed research on adolescent development, it will be helpful to build the burgeoning body of empirical research caribbean research on human development     

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on adolescent self and identity, as well as the coping of children, adolescents, and young adults in the context of relationships with parents, teachers, and peers. It may also be helpful to expand on these applied foci and look more closely at issues of motivation, self and identity, moral development, language development, cognitive development (especially age-related changes in cognitive and neurobiological development), education and learning, and topics in the psychosocial development of adolescents that are understudied in the Caribbean context (e.g., bullying). In these potentially newer areas of investigation, and in the areas in which scholarship already exists and is growing, it will be important to continue to examine adolescent development within the specific social, physical, and cultural contexts between and within Caribbean countries. Because the research on middle and late adulthood of people in the Caribbean is scant, this developmental period would be a good place for researchers to make a strong contribution—and it is also an area in which psychological research is essential. Along with the areas outlined in other places in this chapter, the counterintuitive findings on sex differences, particularly for health and well-being for aging and persons who are older, is also an important area of investigation. At least two studies (Le Franc et al., 2008; Martsolf, 2004) reported counterintuitive findings (e.g., higher exposure to childhood maltreatment among men, higher levels of depression among men, more perpetration of domestic violence by women). These need to be further investigated using rigorous research designs, data collection, and analytic strategies that are informed by life course perspectives focused on early life exposures and vulnerabilities and the ways in which these may be linked to outcomes throughout the lifespan. One key area for future research is positive developmental psychology. Research on various developmental periods has tended to examine challenges and pathologies, which may have the inadvertent effect of overly emphasizing negative aspects of human development in Caribbean contexts. Although it is important to speak to the specific contextual challenges that adolescents and adults face, it is also important to profile and examine their positive psychological experiences and processes. Strengths- and assets-based approaches may help ascertain contextually specific, and perhaps more universally applicable, strategies for healthy development throughout adolescence and adulthood. Failing to incorporate such approaches may inadvertently encourage a tradition of regarding the Caribbean region and its populations as Other, and pathological. Developmental psychology in the Caribbean would also be well served to incorporate additional research designs and strategies. In quantitative studies, although cross-sectional data from household surveys facilitate greater generalizability, they are also limited in the ability to make the types of causal inferences possible when using experimental designs (which are used frequently in 142       govia, paisley-clare, and palmer

identity and well-being research with adolescents, for example) or longitudinal designs. Cohort-sequential designs and panel designs are alternatives that may help with understanding human development, particularly among aging populations, in ways that are sensitive to period and cohort effects. Equally important is the use of other strategies, such as observation (used frequently in the broader developmental literature on attachment, for example) and biomarker data (which is now being used in interdisciplinary research that examines human development across the lifespan and the ways in which early life conditions can get under the skin and manifest in health inequities). CONCLUSION Without coordinated programs of research and the publication of these bodies of research in peer-reviewed empirical journals, the potential ways in which Caribbean perspectives in adolescent and adult development can inform broader developmental psychology may remain invisible. Although there must be a balance between publishing in high impact factor journals and publishing in local and regional venues to strengthen publication infrastructures, the discipline assesses contributions to empirical scholarship by representation in mainstream publication outlets. The promotion of robust research within Caribbean contexts that is relevant, comparative, and critical of research, trends, and theoretical formulations developed outside of the region or with other populations in mind is crucial to the expansion and promotion of Caribbean perspectives in psychology. It is important to reiterate that without systematic programs of research in which findings are replicated within and between various Caribbean sub­ groups, it is not possible to speak in global terms about adolescent and adult development in the Caribbean. For example, with there being so little published empirical research from the French-speaking, Spanish-speaking, and Dutch-speaking Caribbean, or from smaller English-speaking Caribbean nations, it would be misleading to make conclusions about phenomenon, experiences, and trends in adolescent and adult development and to label them as illustrative of all adolescent and adult populations in the Caribbean. Caribbean research in developmental psychology has focused on human development within the specific social, cultural, and historical contexts of the various Caribbean countries studied. As programs of research in developmental psychology move forward in the region, it will be important to maintain these emphases. However, it will also be important that the field develops in a systematic way, one that is not ad hoc or simply reactionary. The question that developmental psychologists in the region must confront is how to grow the field so that it plays a key role in developing evidence-informed practice that benefits Caribbean persons at various points across the lifespan. caribbean research on human development     

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Grosh, M. E., & Munoz, J. (1996). A manual for planning and implementing the Living Standards Measurement Study Survey (Working Paper No. LSM 126). Washington, DC: World Bank. Retrieved from http://documents.worldbank. org/curated/en/1996/05/438573/manual-planning-implementing-livingstandards-measurement-study-survey Hambleton, I. R., Clarke, K., Broome, H. L., Fraser, H. S., Brathwaite, F., & Hennis, A. J. (2005). Historical and current predictors of self-reported health status among elderly persons in Barbados. Revista Panamericana de Salud Pública, 17, 342–352. http://dx.doi.org/10.1590/S1020-49892005000500006 Hutchinson, G., Simeon, D. T., Bain, B. C., Wyatt, G. E., Tucker, M. B., & Le Franc, E. (2004). Social and health determinants of well-being and life satisfaction in Jamaica. International Journal of Social Psychiatry, 50, 43–53. http://dx.doi.org/10.1177/0020764004040952 Jethwani-Keyser, M., Mincy, R., & Haldane, E. (2013). We’re graduating, what’s next? Relational contribution to the educational attainment of Black Bermudian adolescent boys. Journal of Black Psychology, 39, 455–485. http://dx.doi. org/10.1177/0095798412457177 Kelley, H. H., & Thibaut, J. W. (1978). Interpersonal relations: A theory of interdependence. New York, NY: Wiley. Kelley, L. S. (2005). Growing old in St. Lucia: Expectations and experiences in a Caribbean village. Journal of Cross-Cultural Gerontology, 20, 67–78. http://dx.doi. org/10.1007/s10823-005-3799-2 Le Franc, E., Samms-Vaughan, M., Hambleton, I., Fox, K., & Brown, D. (2008). Interpersonal violence in three Caribbean countries: Barbados, Jamaica, and Trinidad and Tobago. Revista Panamericana de Salud Pública, 24, 409–421. http:// dx.doi.org/10.1590/S1020-49892008001200005 Lipps, G., Lowe, G. A., Gibson, R. C., Halliday, S., Morris, A., Clarke, N., & Wilson, R. N. (2012). Parenting and depressive symptoms among adolescents in four Caribbean societies. Child and Adolescent Psychiatry and Mental Health, 6, 31–42. http://dx.doi.org/10.1186/1753-2000-6-31 Maharaj, R. G., Nunes, P., & Renwick, S. (2009). Health risk behaviours among adolescents in the English-speaking Caribbean: A review. Child and Adolescent Psychiatry and Mental Health, 3, 10–21. http://dx.doi.org/10.1186/1753-2000-3-10 Martsolf, D. S. (2004). Childhood maltreatment and mental and physical health in Haitian adults. Journal of Nursing Scholarship, 36, 293–299. http://dx.doi. org/10.1111/j.1547-5069.2004.04054.x McFarlane, S., Younger, N., Francis, D., Gordon-Strachan, G., & Wilks, R. (2014). Risk behaviours and adolescent depression in Jamaica. International Journal of Adolescence and Youth, 19, 458–467. Mello, Z. R., & Worrell, F. C. (2008). Gender variation in extracurricular activity participation and perceived life chances in Trinidad and Tobago adolescents. Psykhe: Revista de la Escuela de Psicología, 17, 91–102. http://dx.doi.org/10.4067/ S0718-22282008000200008 caribbean research on human development     

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Morris, C., James, K., Laws, H., & Eldemire-Shearer, D. (2011). Health status and health-seeking behaviour of Jamaican men fifty-five years and over. The West Indian Medical Journal, 60, 322–329. O’Neill, G., & Pruchno, R. (Eds.). (2015). 2015 White House Conference on Aging [Special issue]. The Gerontologist, 55(2). Pilgrim, N. A., & Blum, R. W. (2012). Adolescent mental and physical health in the English-speaking Caribbean. Revista Panamericana de Salud Pública, 32, 62–69. http://dx.doi.org/10.1590/S1020-49892012000700010 Rawlins, J. M., Simeon, D. T., Ramdath, D. D., & Chadee, D. D. (2008). The elderly in Trinidad: Health, social, and economic status and issues of loneliness. The West Indian Medical Journal, 57, 589–595. Ricketts, H., & Anderson, P. (2008). The impact of poverty and stress on the interaction of Jamaican caregivers with young children. International Journal of Early Years Education, 16, 61–74. http://dx.doi.org/10.1080/09669760801892276 Smith, D. E., & Moore, T. M. (2013a). Family violence and aggression and their associations with psychosocial functioning in Jamaican adolescents. Journal of Family Issues, 34, 745–767. http://dx.doi.org/10.1177/0192513X12450841 Smith, D. E., & Moore, T. M. (2013b). Parenting style and psychosocial outcomes in a sample of Jamaican adolescents. International Journal of Adolescence and Youth, 18, 176–190. http://dx.doi.org/10.1080/02673843.2012.682593 Smith, D. E., Springer, C. M., & Barrett, S. (2011). Physical discipline and socioemotional adjustment among Jamaican Adolescents. Journal of Family Violence, 26, 51–61. http://dx.doi.org/10.1007/s10896-010-9341-5 Steely, A. C., & Rohner, R. P. (2006). Relations among corporal punishment, perceived parental acceptance, and psychological adjustment in Jamaican youths. Cross-Cultural Research: Journal of Comparative Social Science, 40, 268–286. http://dx.doi.org/10.1177/1069397105284397 Triandis, H. C. (1995). Individualism and collectivism. Boulder, CO: Westview. Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press. Wilson, C. M., Wilson, L. C., & Fox, C. A. (2002). Structural and personal contexts of discipline orientations of Guyanese parents: Theoretic and empirical considerations. Journal of Comparative Family Studies, 33, 1–13. Wilson, L. C., Wilson, C. M., & Berkeley-Caines, L. (2003). Age, gender, and socioeconomic differences in parental socialization preferences in Guyana. Journal of Comparative Family Studies, 34, 213–227.

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III HEALTH AND COMMUNITY PSYCHOLOGY

6 CURRENT STATE OF HEALTH AND HEALTH OUTCOMES IN CARIBBEAN SOCIETIES LUTCHMIE NARINE

Psychological issues and processes are important to the experience of health and health outcomes in Caribbean societies, given that many of the leading causes of illness are the result of behaviors that are amenable to change, and even when the disease is not a result of behavioral sequelae, psychology often has a role in how the disease is experienced, how it may be treated, and how it might be prevented. The focus of this chapter is to outline the current state of health and health outcomes in Caribbean societies in a few key areas and to highlight, where relevant, individual, social, and structural factors that are associated with health outcomes. The data provided below on mortality outcomes were in the majority of cases obtained from Pan American Health Organization’s (PAHO) databases and specifically from its Regional Core Health Data Initiative (PAHO, 2010). Socioeconomic factors, such as population aging, urbanization, economic development, and globalization of consumer markets, are said to be http://dx.doi.org/10.1037/14753-007 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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the ultimate drivers in the increase of major diseases, in particular, chronic diseases around the world (Leon, 2008). The Caribbean, like other world regions, has been affected by these influences; because of the openness, proximity to large metropolitan centers, and the relatively small size of many nations, they may be more acutely affected. These macro-level factors bring with them associated risks, such as more crowded living conditions, congested traffic, noise, environmental pollution, loss of traditional family structure and support, abandonment of traditional food sources, and increased emotional stress. How people deal with these and other risk factors and how they come to affect their health are where psychological theories and models become important. Over the years, a number of models have sought to explain the complexities of health behavior. Some of these seminal theories and models, such as social cognitive, reasoned action and planned behavior, and transtheoretical models, are discussed in the next chapter of this volume and are not given further attention here (Albarracín, Johnson, Fishbein, & Muellerleile, 2001; Bandura, 1977, 1986; Prochaska & DiClemente, 1983). Other theories have focused on stress and coping as they relate to health-related behaviors and outcomes. For example, stress response theory (Seyle, 1976) has sought to show the pathways between the experience of stress and how people’s physiological reactions can wear them down to the extent of adversely affecting health. Other theories and models explain how some negative behaviors, such as the excessive use of alcohol and tobacco, can be interpreted as attempts to cope with the stresses of daily living, whereas engagement in violent behavior can be seen as a consequence of stressful and overcrowded living conditions (Beck, 1992). Health belief models attempt to identify why people do not engage in behaviors to prevent or detect disease early, whereas resiliency models focus on accounting for why some individuals are not as affected by health risk factors as much as others, and the stages of change. Transtheoretical models highlight that individuals vary in their readiness to change from engaging in risky behaviors and what is involved in moving people toward changing their risky behaviors (Institute of Medicine Committee on Health and Behavior, 2001; Prochaska & DiClemente, 1983). Psychological approaches to the understanding and treatment of health conditions take on increased significance in the context of the Caribbean because, as I discuss, the leading causes of death in the region are now attributable to noncommunicable diseases. PAHO (n.d.) has indicated that most of these noncommunicable diseases are the result of four specific behaviors: the harmful use of alcohol, unhealthy diets, lack of physical activity, and tobacco use. I first discuss the dimensions of the leading causes of death. Then, I cover the extent to which the four behavioral risk factors prevail in the Caribbean in the context of the quality of life experienced by people in the region. The risk factor of unhealthy diets is discussed with respect to 150       lutchmie narine

its behavioral consequence currently most relevant to the leading causes of death: increases in the number of people who are significantly overweight or obese in the Caribbean. Inasmuch as health behavior models and theories help explain human behaviors and motivations behind engaging in behaviors that are considered unhealthy, it is first necessary to understand the prevalence of health-related issues in the Caribbean. MORTALITY OUTCOMES Overall, the Caribbean countries have made important progress in improving the health condition of their populations. As seen in Figure 6.1, the life expectancy in years from birth has increased from the 1990s, through 2000, and continuing more recently to 2012. This follows a similar pattern for countries in all the other regional groupings of the Americas. This has largely been the result of improvements in sanitation, health infrastructure, and advances in the treatment of disease, especially in the case of infectious disease. Over the decades from the 1990s to the 2000s, the profile of conditions that affect the life expectancy of people in Caribbean countries has changed somewhat. An analysis of leading causes of death in the past two decades reveals some interesting trends. Diseases associated with the heart and circulatory

Life Expectancy at Birth (Years)

90 80 70 60 50 40

Life expectancy at birth [Years] 1990

30

Life expectancy at birth [Years] 2000

20 10

Life expectancy at birth [Years] 2012

0

Region

Figure 6.1.  Life expectancy at birth (years). Data from Pan American Health Organization (2010). current state of health in caribbean societies     

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system, such as ischemic heart disease, cerebrovascular disease, and hypertensive diseases, rank as some of the greatest contributors to death in the population. Diabetes mellitus, which is a major contributor to heart and circulatory diseases, remained the third leading cause of death in the Caribbean. In the 2000s, three new conditions appeared as significant causes of death: homicide, suicides and intentional self-injury, and chronic lower respiratory disease. Some communicable diseases, such as HIV/AIDS, influenza, and pneumonia, continue to be among the leading causes of mortality, but generally the importance of communicable diseases has declined. This is reflected, for example, in the fact that intestinal infectious diseases ranked as the 16th leading cause of death in the 1995 to 1999 period, whereas it is not among the leading causes of death in the 2005 to 2009 period. The mortality rate for communicable diseases in Caribbean countries dropped significantly in the 10-year period from 2000 to 2009. This reduction is similar to what has taken place for other regions in the Americas, with the exception that rates in the Andean, Central America, Brazil, and Mexico regions increased from 2000 to 2009 and remained about the same for countries in the South Cone region. It is important to emphasize that this general drop in mortality rates for communicable diseases should not distract from an appreciation of the importance of HIV/AIDS as a leading contributor to morbidity and mortality in the Caribbean region. The incidence of AIDS cases increased dramatically from 1990 to 2000 in the Caribbean region but in more recent years has declined. In 1990, the incidence rate for AIDS was 15.32 per 100,000; it increased to 40.3 per 100,000 in 2000; and it declined to 18 per 100,000 by 2009. However, the Caribbean remains among the regions in the Americas with relatively high incidence rates for HIV/AIDS. As can be seen in Table 6.1, the types of diseases that affect the people of the Caribbean vary by age and gender. The leading causes of death among children 0 to 4 years old include disorders after birth; malformation and abnormalities; and communicable diseases, such as influenza, pneumonia, intestinal infections, and HIV/AIDS (primarily occurring as transmission from mother to child). For children 5 to 14 years old, the two top leading causes of death involve accidents either from land transportation or from drowning. In contrast, another notable leading cause of death among this age group is due to intended actions, that is, suicides and intentionally inflicted injury. The 15 to 24- and 25 to 44-year-old age groups have similar leading causes of death, with homicide joining land transportation accidents and suicides and intentionally inflicted injury as leading causes of death. However, for 25- to 44-year-olds HIV/AIDS was the leading cause of death, whereas homicide was the leading cause for 15- to 24-year-olds. For the 25- to 44-year-old group, the appearance of circulatory/heart related problems are major causes of death in the form of ischemic heart disease and cerebrovascular disease. 152       lutchmie narine

TABLE 6.1 Leading Causes of Death by Age and Gender, 2005–2009 0–4 years old • Perinatal disorders • Malformations, abnormalities • Influenza, pneumonia • Intestinal infectious diseases • Septicemia • HIV/AIDS

5–14 years old • Land transport accidents • Accidental drowning, submersion • Cancer of lymphoid, hematopoietic tissue • Suicides, intentionally inflicted injury • Undetermined events • Influenza, pneumonia

15–24 years old • Homicide • Land transport accidents • Suicides, intentionally inflicted injury • HIV/AIDS • Accidental drowning, submersion • Undetermined events

25–44 years old • HIV/AIDS • Homicide • Land transport accidents • Suicides, intentionally inflicted injury • Ischemic heart disease • Cerebrovascular disease

45–64 years old • Ischemic heart disease • Diabetes mellitus • Cerebrovascular disease • Hypertensive diseases • HIV/AIDS • Cirrhosis, other liver diseases

65–84 years old • Cerebrovascular disease • Ischemic heart disease • Diabetes mellitus • Hypertensive diseases • Prostate cancer • Heart failure

85–95 years old • Cerebrovascular disease • Ischemic heart disease • Diabetes mellitus • Influenza, pneumonia • Heart failure • Prostate cancer

Women • Diabetes mellitus • Cerebrovascular disease • Ischemic heart disease • Hypertensive diseases • Breast cancer • Influenza, pneumonia

Men • Ischemic heart disease • Cerebrovascular disease • Diabetes mellitus • Prostate cancer • Hypertensive diseases • HIV/AIDS

For the age groups 45 to 64, 65 to 84, and 85 to 95, diseases of the heart and circulation system dominate as the leading causes of death. Diabetes mellitus appears as a major cause of death for the 45-to-64 age group and remained as a leading cause of death for all older age groups. When separated out by gender and taking all age groups into consideration, one can see that the leading causes of mortality are diseases of the heart and circulatory system. This is the case even considering that diabetes mellitus is a major cause of death and is associated with comorbid conditions, such as hypertension and high cholesterol that contribute to the development of heart and circulatory diseases (Ford, 2005). The separation by gender does reveal cancer as a leading cause of death. This is understandable, given that the cancers that are most dominant are those that tend to be specific to women (breast cancer) and men (prostate cancer). It is also noteworthy that the sixth leading cause current state of health in caribbean societies     

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of death for both genders is a communicable disease: influenza and pneumonia for women and HIV/AIDS for men. The main risk factors for the three leading causes of death are obesity, physical inactivity, and unhealthy diets, and each of these risks may be modified by interventions to change unhealthy lifestyles. Psychological approaches can be useful in helping to prevent such unhealthy lifestyles and to intervene in effecting change where unhealthy lifestyles have already been established. In the following section, I take a closer look at selected leading causes of death affecting people in Caribbean countries, where they are of most importance among individual Caribbean nations, and in some cases how they compare in impact relative to other regional groupings in the Americas. Ischemic Heart Disease The leading cause of death overall in Caribbean countries is ischemic heart disease. The Caribbean is the third most affected region by this disease as measured by mortality rates. North America, which has a rapidly aging population, is the region in the Americas with the highest rates of death from ischemic heart disease (133.8 deaths per 100,000 population in 2009). In the Caribbean, the rates of death from ischemic heart disease increased in the early 2000s relative to that obtained from the 1990s, and although it has dropped in the late 2000s, the mortality rate is still higher than that experienced in the 1990s. The most recent PAHO data indicate that the Caribbean country with the highest ischemic heart disease mortality rate is Trinidad and Tobago, with 121.2 deaths per 100,000 people. The other four leading countries with ischemic heart disease are, in order, the U.S. Virgin Islands (102.3), Montserrat (98.1), Saint Vincent and the Grenadines (87), and Guyana (79). The country with the lowest mortality rate for ischemic heart disease is the Turks and Caicos Islands (17.4). Note that the values cited here and for the other diseases are for the most recent data collected over the 5-year period of 2005 to 2009; unfortunately, data for this period were generally not available for the Netherlands Antilles. Cerebrovascular Disease The second leading cause of death among Caribbean countries is cerebro­ vascular disease. In the 1990s and early 2000s, Caribbean countries were second only to countries in the South Cone of the Americas with deaths from cerebrovascular disease. However, by the late 2000s, both the South Cone and Caribbean countries had seen reductions in cerebrovascular deaths, with the South Cone region currently experiencing slightly higher mortality rates than that of the Caribbean region (62.1 vs. 57.6 deaths, respectively, per 154       lutchmie narine

100,000 in 2009). The Caribbean country with the highest cerebrovascular disease mortality rate is Montserrat, with 117.7 deaths per 100,000 people. The other four leading countries with cerebrovascular disease are, in order, Dominica (95), Saint Kitts and Nevis (90.9), Guyana (79.3), and Saint Vincent and the Grenadines (75.1). The country with the lowest mortality rate for cerebrovascular disease is the Cayman Islands (8.2). Diabetes Mellitus

Deaths From Diabetes Mellitus (per 100,000 pop.)

Diabetes mellitus ranks as the third most important cause of mortality in the Caribbean in its own right. However, its importance is further enhanced when one considers that it is linked to a variety of cardiac/circulatory disorders, including four other conditions that are among the list of the top causes of mortality in the Caribbean: ischemic heart disease, cerebrovascular disease, heart failure, and hypertensive disease. As shown in Figure 6.2, the Caribbean region led in deaths from diabetes mellitus among the countries in the Americas in the 1990s and early 2000s. However, the late 2000s has seen a significant drop in deaths from the disease (49 per 100,000 in 2009). This is in contrast to what is taking place in Brazil and Mexico, where there has been a recent increase in the rates of death from diabetes mellitus. Along with Brazil and Mexico, the Caribbean region has the highest mortality from diabetes mellitus. The Caribbean country with the highest diabetes mellitus mortality rate is Montserrat, with 137.3 deaths per 100,000 people. The other four leading countries with diabetes mellitus are, in order, Trinidad and Tobago (106.7), Barbados (98.7), Grenada (77.0), and Saint Kitts and Nevis (74.8). The

70 60 50 40 30

1990

20

2000

10

2009

0 North America

Central America

Lan Caribbean

Andean Area

Brazil & Mexico

South Cone

Non-Lan Caribbean

Region

Figure 6.2.  Mortality rate from diabetes mellitus (per 100,000 people). Data from World Health Organization (2011) and Pan American Health Organization (2012). current state of health in caribbean societies     

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country with the lowest mortality rate for diabetes mellitus is the Turks and Caicos Islands (4.4). Homicide Crime has become a growing problem for some regions in the Americas, including Caribbean countries, and as crime has increased, so has mortality from homicides. In the Caribbean, deaths from homicide have increased significantly from the 1990s into the early and late 2000s (3.67 per 100,000 in 1990 to 11.5 per 100,000 in 2009). However, mortality from homicide continues to be higher in the Central American, Andean, and Brazil and Mexico regions (33.5, 29.0, and 23.5 deaths, respectively, per 100,000 in 2009). The United Nations Office on Drugs and Crime (UNODC; 2011), through its global study on homicide, estimated that 468,000 of global deaths in 2010 were due to homicide; 31% of these deaths occurred in the Americas. The mortality rate for homicides in the Americas, at 15.6 per 100,000 population, is more than double that of the global average of 6.9 per 100,000. The Caribbean—comprising both Latin and non-Latin Caribbean countries— ranks fourth among the world’s regions with respect to deaths from homicide. The regions with the three highest rates of mortality due to homicide, in order of rank, are South Africa, Central America, and South America. According to UNODC data within the Caribbean region, the country with the highest homicide mortality rate is Jamaica (52.1 deaths per 100,000 people). The other four leading countries with deaths due to homicide are, in order, the U.S. Virgin Islands (39.2), Saint Kitts and Nevis (38.2), Trinidad and Tobago (35.2), and the Bahamas (28). The country with the lowest mortality rate due to homicide is Turks and Caicos Islands (8.9). The factors that are said to mostly contribute to the increased risk for crime in the Caribbean are drug trafficking, as Caribbean countries serve as important trans-shipment points between South and North America, the draw of gangs and organized crime which is itself in part associated with the surge in drug trafficking, lack of capacity to deal with crime in the criminal justice and police services, and economic inequalities in communities as significant variation in economic conditions exist within and among countries (United Nations Development Programme [UNDP]; 2012). Economic inequalities give rise to large numbers of young Caribbean men who are unemployed or underemployed. Stress due to economic instability can lead to changes in family structures and functions, as men and women migrate within and between countries to find better economic opportunities (Harriott, 2002) or become involved in gang activities or drug trafficking (UNDP, 2012). Interpartner violence has also contributed to homicides (see Chapter 8, this volume).

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Land Transportation Accidents Deaths from land transportation accidents are the 10th leading cause of death in the Caribbean region. The highest numbers of land transportation accidents death are among the younger section of the population (5–44 years). Land transportation accidents are the highest-ranked cause of death among people 5 to 14 years old, second among 15 to 24 years old, and third among adults 25 to 44 years old. Within the Caribbean region, the country with the highest mortality rates from land transportation accidents is Anguilla with 27.7 deaths per 100,000 population. The other four countries that lead in mortality from land transportation accidents are Suriname (21.4), Trinidad and Tobago (20.4), Turks and Caicos Islands (17.4), and Aruba (16). These deaths are attributed to the small size of Caribbean countries, increased urbanization, and modernization, factors that, in turn, contribute to increased volume of traffic and use of motorized vehicles on roads that cannot handle significant shifts in volumes and speed. At the same time, increased urbanization brings with it greater numbers of pedestrians, who must share the road with motorized vehicles and other types of traffic. Another factor is failure to take precautions to prevent having an accident or reduce the severity of injury when accidents do occur. These include obeying speed limits, traffic lights, practicing safe driving, and using protective gear (e.g., seat belts, helmets; World Health Organization [WHO], 2004). These latter factors can benefit from psychological and community interventions that encourage the use of preventive measures and to educate drivers and pedestrians about traffic safety requirements. Suicides and Intentional Self-Injury Epidemiological data on, and the risk factors associated with, suicide and attempted suicide are discussed in Chapter 12. Here, I present some general data on suicides and self-injury. Death from suicides and self-inflicted injury is the 14th most important cause of death in the Caribbean region. However, as is the case for deaths from land transportation accidents, suicide deaths rank very high among the younger segments of the population. It is the fourth-ranked cause of death among 15- to 24-year-olds and third-ranked for 25- to 44-yearolds. The country with the highest mortality rate from suicides and self-inflicted injuries is Suriname, with 25.2 deaths per 100,000 population. The other four leading countries for suicides and self-inflicted injuries, in rank order, are Guyana (20.8), Trinidad and Tobago (15.0), U.S. Virgin Islands (8.2), and the Cayman Islands (6.6). The country with the lowest suicide and self-inflicted injury mortality rate is Barbados (0.4). Data were not available for the 2005 to

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2009 period for the Anguilla, Jamaica, Montserrat, Netherlands Antilles, and the British Virgin Islands. Thoughts of suicide were highest among adolescents in Guyana (23.2%), followed in rank order by Grenada (21.3%), Dominica (20.6%), and Anguilla (19.4%). The country where adolescents had the least amount of thoughts of suicide is Suriname (13.9%). QUALITY OF LIFE In this section, I discuss some of the health conditions that detract from the quality of life of people in the Caribbean, focusing on those issues that are most likely to benefit from psychologists working in the medical field. In most of the cases, the conditions discussed (e.g., alcohol use, low physical activity, being overweight or obese, thoughts about suicide, tobacco use) are largely a result of behaviors. These behavioral risk factors contribute to a number of the leading causes of death in the Caribbean. They are often amenable to psychological and social psychological interventions that can bring about improvement in the health and quality of life of Caribbean people. In this section, I also discuss the situation of disabilities in the Caribbean region, not because it is a risk factor but because it can often be a secondary outcome associated with the experience of the leading causes of death or behavioral risk factors and because it can have serious impacts on the quality of life experienced by sections of the Caribbean population. In the majority of cases, the data presented were obtained from the Health Situation in the Americas: Basic Indicators 2012 report (PAHO, 2012). Alcohol Use The harmful use of alcohol worldwide results in 2.5 million deaths annually. Indeed, alcohol is estimated to be the world’s third-largest risk factor for disease and disability. It is a particularly acute risk factor for death among men, for whom alcohol use can result in deaths due to injuries, violence, and cardiovascular disease, all of which are among the leading causes of death in the Caribbean (WHO, 2011). Figure 6.3 shows the use of alcohol in various Caribbean countries for people 15 years and older. The pattern of alcohol use as measured by total consumption in liters of pure alcohol per capita is presented for each country for which data are available. Adjustments were made for countries with high populations of tourists, who may account for a portion of recorded alcohol consumption in the country. In addition, data are presented on the percentage of males and females who engage in binge drinking in each Caribbean country. Binge drinking is a key drinking behavior, as it is particularly associated with the occurrence of injuries (WHO, 2011). 158       lutchmie narine

Liters of Alcohol Consumed Per Capita, and Percent of People Who Binge Drink

70 60 50 40 30 Liters Per Capita

20

% Male Binge Drinkers

10

% Female Binge Drinkers

0

Country

Figure 6.3.  Per capita alcohol consumption and percentage of binge drinking. Data from World Health Organization (2011) and Pan American Health Organization (2012).

As seen in Figure 6.3, the Caribbean country with the highest rate of alcohol use is Saint Lucia (11.4 L per capita), followed by Grenada (9.9 L) and Saint Kitts and Nevis (8.9 L). Consistent with trends in the rest of the world, binge drinking is more of a problem for men than women in all countries for which data were available. Aruba had the highest rates of binge drinking among both men and women, followed by Suriname, Saint Kitts and Nevis, British Virgin Islands, and Dominica. Disability Although it is not a major cause of death in the Caribbean, disability is an important health outcome. More than one billion individuals worldwide face some form of disability and 85% of these persons live in developing countries, such as the nations in the Caribbean region (WHO/World Bank, 2011). Rates of persons with disabilities around the world are growing as a result of chronic health conditions, aging populations, and changes in technology. Indeed, disabilities can occur as a result of the experience of many of the conditions identified as leading causes of death in the region, such as ischemic heart disease, cerebrovascular disease, diabetes mellitus, land transportation accidents, and cancers. The work of psychologists and other mental health professionals can help to address issues associated with the experience current state of health in caribbean societies     

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of disabilities. Psychologists can assist with promoting the psychological welfare of people with disabilities, devising ways to better manage disability limitations, and offer psychological services that are responsive to the needs of individuals with disabilities. Moreover, psychologists can provide therapy and programs that help reduce the risk for conditions that can result in disabilities among members of the population. For example, they could intervene to address mental health issues that might give rise to suicides and self-inflicted injuries, which is a leading cause of death in the Caribbean region. Figure 6.4 shows the estimates of the percentage of the population with disabilities for 13 Caribbean countries, on the basis of 2000 census data for these countries. As can be seen in the figure, the five countries with the greatest share of the population with disabilities are the Netherlands Antilles (8.5%), followed by Guyana (6.4%), Jamaica (6.3%), Belize (5.9%), and Aruba (5.6%). The country with the lowest percentage share of the population with disabilities is Barbados (4%). The average percentage of persons with disabilities for the 13 Caribbean countries is 5.1%. Across the Caribbean countries, the most common type of disabilities in order of percentage share of the disabled population are disabilities associated with loss of sight (28.07%), problems with lower Netherlands An
lles Guyana Jamaica Belize Aruba An
gua and Barbuda Country

Saint Lucia Bri
sh Virgin Islands Montserrat

% Persons with Disabili
es

Bermuda Saint Vincent and the… Grenada Cayman Islands Bahamas Trinidad and Tobago Barbados 0

5

10

Percentage of People With Disabili es

Figure 6.4.  Percentage of people with disabilities, on the basis of 2000 census data. Data from the Economic Commission for Latin America and the Caribbean (2011).

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limb mobility (19.3), hearing loss (8.77), behavioral and mental problems (8.77%), and learning and intellectual function disabilities (7.02%). Being Overweight or Obese

Percentage of Adults Who Are Overweight

The WHO estimated that in 2004 more than a billion people worldwide were overweight (i.e., body mass index [BMI] ≥ 25) and more than 300 million people were obese (BMI ≥ 30). Average BMI rates were highest for the regions of the Americas, Europe, and the Eastern Mediterranean (WHO, 2009). High body mass levels are known to be a significant risk factor for some of the leading causes of death, such as ischemic heart disease, cerebrovascular disease, diabetes, and some cancers, in the non–Latin Caribbean. Furthermore, being chronically overweight or being overweight for a prolonged time can contribute to osteoarthritis, which is a major cause of disability. The WHO (2009) estimated that in 2005, being overweight or obese accounted globally for 44% of the burden of diabetes, 23% of ischemic heart disease burden, and between 7% and 41% for various cancer burdens. As Figure 6.5 demonstrates, the Caribbean countries that have the greatest prevalence of being overweight among adults, as measured by BMIs between 25.0 and 29.9 are, in rank order, Trinidad and Tobago (64.7%), 80 70 60 50 40 30 Both Sexes

20

Male

10

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0

Country

Figure 6.5.  Prevalence percentage of people who are overweight (body mass index = 25.0–29.9) among adults. Data from Trinidad and Tobago Ministry of Health/Pan American Health Organization (2012) and Pan American Health Organization (2012). current state of health in caribbean societies     

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Antigua and Barbuda (59.0%), Suriname (58.4%), Saint Vincent and the Grenadines (57.8%), and Saint Lucia (54.2%). The Caribbean country with the lowest levels of being overweight among the adult population is Dominica, with 24.9% of the adult population being overweight. Generally, for most countries, being overweight was more of a problem for women than men. This was particularly the case for Trinidad and Tobago (69.6%), Suriname (64.8%), Saint Vincent and the Grenadines (63.7%), Saint Lucia (63.6%), and Antigua and Barbuda (63.3%). Figure 6.6 shows that the situation with respect to obesity (BMI ≥ 30) is somewhat different in that the country with the largest percentage of adults categorized as obese is Aruba (40.8%), and then in order of highest rank, British Virgin Islands (35.5%), Trinidad and Tobago (30%), and the U.S. Virgin Islands (29.6%). As was the case with being overweight, females were generally more obese than males in the various Caribbean countries. This was particularly so for the Bahamas (60.5%), Saint Kitts and Nevis (52.5%), Trinidad and Tobago (38.8%), and Jamaica (37.7%). Physical Inactivity Growing urbanization and sedentary lifestyles in Caribbean countries have given rise to the problem of physical inactivity. Low physical activity

Percentage of Adults Who Are Obese

70 60 50 40 30 Both Sexes

20

Male

10

Female

0

Country

Figure 6.6.  Prevalence percentage of obesity (body mass index ≥ 30) among adults. Data from Trinidad and Tobago Ministry of Health/Pan American Health Organization (2012) and Pan American Health Organization (2012).

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Percentage of Adults With Low Physical Ac vity Levels

levels are characterized as engaging in less than 600 metabolic equivalent minutes (MET) over the course of a week. One MET is defined as the energy costs of sitting quietly and is the equivalent of caloric consumption of 1 kcal/ kg/hour (Trinidad and Tobago Ministry of Health/PAHO, 2012). Physical inactivity can increase the risk for leading causes of cardiovascular deaths, some cancers, and diabetes mellitus. It can negatively affect the control of body weight, musculoskeletal health, symptoms of depression, and contribute to weight gain. The WHO (2009) estimated that in 2004 physical inactivity contributed globally to 30% of ischemic heart disease burden, 27% of diabetes, and 21% to 25% of breast and colon cancer. Figure 6.7 data show the level of physical inactivity for seven Caribbean countries for which data are available. The data for Trinidad and Tobago were obtained from a report produced by that country’s Ministry of Health (Trinidad and Tobago Ministry of Health/PAHO, 2012), and data for the other countries were obtained from the Health Situation in the Americas: Basic Indicators 2012 report (PAHO, 2012). As is displayed in Figure 6.7, the Caribbean countries whose adult populations have the lowest levels of physical activity are, in rank order, Barbados (51.3%), Aruba (45.8%), and Trinidad and Tobago (45.4%). The Caribbean country with the smallest percentage of people who have low activity levels is Jamaica (15.7%). Also of

70 60 50 40 30 20

Both Sexes

10

Male Female

0

Country

Figure 6.7.  Prevalence percentage of low physical activity (less than 600 metabolic equivalent minutes) for adults. Data from Trinidad and Tobago Ministry of Health/ Pan American Health Organization (2012) and Pan American Health Organization (2012). current state of health in caribbean societies     

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note is that in all seven countries for which data are available, it is clear that females have substantially lower levels of physical activity than men. Tobacco Use

Percentage of Adults Currently Using Tobacco

Smoking and the use of tobacco products increases the risk of death from a variety of diseases, including lung cancers, chronic respiratory disease, stroke, and heart disease. In 2004, smoking around the globe was said to cause 71% of lung cancers, 42% of chronic respiratory disease, and 10% of cardiovascular disease. Overall, tobacco use caused an estimated 5.1 million deaths accounting for one in every eight deaths among adults age 30 and older globally in 2004 (WHO, 2009). Estimates using 2000 data indicate that at least 20% of the general population in Caribbean countries used tobacco at some point in their lifetime and through its impact on multiple diseases account for close to 10% of deaths in the Caribbean region (PAHO/WHO, 2001). In Figure 6.8, data are presented on the prevalence of current users of tobacco in Caribbean countries. As is apparent from Figure 6.8, the Bahamas has the largest percentage of the adult population who are current smokers (43%) followed, in rank order, by Suriname (27.0%), Saint Lucia (18.6%), and Aruba (16.2%). The Caribbean country with the lowest percentage of current smokers based on the available data is the U.S. Virgin Islands (6.4%). Figure 6.8 also reveals that by

60 50 40 30 20

Both Sexes Male

10

Female

0

Country

Figure 6.8.  Percentage of current adult users of tobacco. Data from World Health Organization (2011) and Pan American Health Organization (2012).

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far males were the larger group of current smokers among the nine countries for which tobacco use data were available. A breakdown of current smokers by gender was not available for Suriname. Cross-Country Health Variations The countries of the Caribbean share many of the same health problems, but the analysis also shows substantive variations in the experience of these problems. Cross county differences in health conditions can result from a variety of causes, such as differences in resources devoted to health care, the existence and nature of health-promoting policies, sociodemographic forces, and cultural differences. The economic resources of Caribbean countries clearly differ, especially related to size; for instance, larger territories have greater abundance of resources and so have the capacity to offer enhanced access to health care services. Regional institutions, such as PAHO, have articulated potentially effective health policies, but because of lack of resources or focus, they are implemented in differing degrees across countries, thus affecting the expression of disease states across the region. The stresses of modernization and urbanization have already been mentioned as important sociodemographic determinants of health conditions in the Caribbean, especially with respect to chronic diseases. Another potentially important sociodemographic factor that contributes to regional health differences is the varying ethnic composition of Caribbean nations, in particular the large Indo Caribbean populations in Trinidad and Tobago, Guyana, and Suriname. For example, significant differences in the occurrence of problems or engagement of risky health behaviors have been noted among African and Indo Caribbean groups. Adolescents of East Indian background in Trinidad and Guyana are more likely to attempt suicides than are their counterparts of African origin (Dookhan, 1997; Neehall & Beharry, 1994). Preferences for the abuse of harmful substances also manifest differently among ethnic groups. Afro Trinidadian adolescents are more likely to use marijuana, whereas their peers of Indian origin are more likely to abuse alcohol (Singh, Maharaj, & Shipp, 1991). Another potentially important variable that may contribute to regional variation in health conditions are cultural differences. The Caribbean contains a rich mix of cultural groups as a result of its long colonial history and location along one of the world’s major crossroads. Cultural factors can often influence beliefs about how health problems are to be treated, how individuals cope with health challenges, attitudes about seeking professional help for illnesses, and even beliefs about whether a condition represents a threat to one’s health. For example, cultural constructions of masculinity and femininity can impose constraints and obligations among some Caribbean cultural groups to engage in sexual practices that put them at greater risk for current state of health in caribbean societies     

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contracting HIV/AIDS (Bombereau & Allen, 2008). Among some groups, being overweight may be seen as an attractive quality in women and not as a potential health risk. A number of cultural groups make use of healers and medicines that draw from religious traditions and practices outside the formal health system and apart from mainstream faith traditions. Improved understanding of these cultural considerations can help Caribbean health providers to better address the health challenges faced by indigenous groups across the Caribbean. CONCLUSION A clear epidemiological transition has shifted the major causes of death or risk factors from communicable diseases to noncommunicable diseases among Caribbean countries. Although HIV/AIDS continues to be a significant cause of death in Caribbean countries overall, the region faces a declining threat from communicable diseases. The top causes of death are all from noncommunicable diseases, such as ischemic heart disease, cerebrovascular disease, and diabetes mellitus. The epidemiological transition being experienced by Caribbean countries is in part because of the progress made in preventing and treating communicable diseases and is also driven by demographic trends. In particular, the increased life expectancy in the region has resulted in increases in the lifespan in the population and, hence, the emergence of problems associated with aging and associated chronic disease. As Caribbean countries modernize and develop economically, they are becoming increasingly urbanized. However, urbanization brings with it a variety of health risks from, for example, more crowded living conditions, traffic congestion, noise, environmental pollution, increased emotional stress, and loss of traditional family structure—all of which can have profound negative impacts on health (Leon, 2008). The role of behavioral factors in mortality in the Caribbean region presents important opportunities for Caribbean psychology and psychologists. Many of the noncommunicable diseases affecting the region can likely be prevented or their impacts mitigated through behavioral interventions that psychologists can help develop, design, and implement. Indeed, even for diseases not considered to be due to lifestyle reasons, behavior plays an important part. For example, the rise of HIV/AIDS is in part due to unsafe sexual practices. Interventions that seek to change people’s attitudes toward, and knowledge about, the dangers of smoking, having poor eating habits, and leading a sedentary lifestyle can also be extremely helpful. For a recent review of successful psychological interventions in tobacco cessation, see Schlam and Baker (2013); for obesity, see Brennan, Murphy, Shaw, and Mckenzie 166       lutchmie narine

(2014); and for workplace interventions for physical activity, see Malik, Blake, and Suggs (2014). The consistent identification of psychological risk factors for suicide and suicidal behavior suggests that psychological interventions can help in the development of programs to address these problems. See Christensen et al. (2104) for a useful database of clinical trials focusing on psychosocial interventions for suicidal ideation, plans, and attempts. Similarly, brief interventions to reduce high-risk drinking at the individual level through educational sessions and psychosocial counseling could potentially reduce alcohol consumption among some of the most high-risk drinkers. See Regan (2012) for a review of the research evidence for brief alcohol interventions. To lower the burden of disease in the region, Caribbean psychologists need to go beyond their traditional involvement in small-scale community prevention projects and become more engaged in workplace health promotion efforts and collaboration with schools to develop and deliver effective school health programs. Psychologists can also help with the development of credible and evidence-based health promotion messages that target entire national populations to promote healthy lifestyles. Along with these primary prevention efforts, Caribbean psychologists can play a key role in secondary prevention through the development and delivery of clinical intervention programs to identify high-risk individuals at the point of service delivery in the health and social welfare systems. Intervention and follow-up are essential to address individuals in the early stages of acquiring behavioral risk factors to prevent incapacity or disability, deterioration, and eventually death. Indeed, growing evidence indicates the effectiveness of psychological and behavioral interventions in modifying a variety of negative health conditions (Jepson, Harris, Platt, & Tannahill, 2010).

REFERENCES Albarracín, D., Johnson, B. T., Fishbein, M., & Muellerleile, P. A. (2001). Theories of reasoned action and planned behavior as models of condom use: A metaanalysis. Psychological Bulletin, 127, 142–161. http://dx.doi.org/10.1037/00332909.127.1.142 Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215. http://dx.doi.org/10.1037/0033-295X.84.2.191 Bandura, A. (1986). The explanatory and predictive scope of self-efficacy theory. Journal of Social and Clinical Psychology, 4, 359–373. http://dx.doi.org/10.1521/ jscp.1986.4.3.359 Beck, U. (1992). Risk society: Towards a new modernity. Thousand Oaks, CA: Sage. current state of health in caribbean societies     

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Bombereau, G., & Allen, C. F. (2008). Social and cultural factors driving the HIV epidemic in the Caribbean. St. Augustine, Trinidad and Tobago: Caribbean Health Research Council. Brennan, L., Murphy, K. D., Shaw, K. A., & McKenzie, J. E. (2014). Psychological interventions for overweight or obesity. Cochrane Database of Systematic Reviews, 5, CD003818. Christensen, H., Calear, A. L., Van Spijker, B., Gosling, J., Petrie, K., Donker, T., & Fenton, K. (2014). Psychosocial interventions for suicidal ideation, plans, and attempts: A database of randomised controlled trials. BMC Psychiatry, 14, 86–91. http://dx.doi.org/10.1186/1471-244X-14-86. Dookhan, D. A. (1997). Self-poisoning in the adolescent and adult population at the Georgetown Hospital, Guyana. West Indian Medical Journal, 46, 45. Economic Commission for Latin America and the Caribbean. (2011). Availability, collection and use of data on disability in the Caribbean subregion. Retrieved from http://archivo.cepal.org/pdfs/2011/S2011011.pdf Ford, E. S. (2005). Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome: A summary of the evidence. Diabetes Care, 28, 1769–1778. http://dx.doi.org/10.2337/diacare.28.7.1769 Harriott, A. (2002). Crime trends in the Caribbean and responses. Vienna, Austria: United Nations Office on Drugs and Crime. Institute of Medicine Committee on Health and Behavior. (2001). Health and behavior: The interplay of biological, behavioral, and societal influences. Washington, DC: National Academies Press. Jepson, R. G., Harris, F. M., Platt, S., & Tannahill, C. (2010). The effectiveness of interventions to change six health behaviours: A review of reviews. BMC Public Health, 10, 538–553. http://dx.doi.org/10.1186/1471-2458-10-538 Leon, D. A. (2008). Cities, urbanization, and health. International Journal of Epidemiology, 37, 4–8. http://dx.doi.org/10.1093/ije/dym271 Malik, S. H., Blake, H., & Suggs, S. L. (2014). A systematic review of workplace health promotion interventions for increasing physical activity. British Journal of Health Psychology, 19, 149–180. Neehall, J., & Beharry, N. (1994). Demographic and clinical features of adolescent parasuicides. The West Indian Medical Journal, 43, 123–126. Pan American Health Organization. (2010). Health information and analysis project. Regional core health data initiative. Washington, DC: Author. Pan American Health Organization. (2012). Health situations in the Americas: Basic indicators 2012. Washington, DC: Author. Retrieved from http://ais.paho.org/ chi/brochures/2012/BI_2012_ENG.pdf Pan American Health Organization. (n.d.). Regional health observatory. Retrieved from http://www.paho.org/hq/index.php?option=com_content&view=article& id=5967&Itemid=2391

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Pan American Health Organization/World Health Organization. (2001). Tobacco use in the English speaking Caribbean. Retrieved from http://www1.paho.org/english/ sha/be_v22n2-tabacco.htm Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390–395. http://dx.doi.org/10.1037/0022-006X.51.3.390 Regan, D. (2012). The brief alcohol intervention. The Psychologist, 25, 286–289. Schlam, T. R., & Baker, T. B. (2013). Interventions for tobacco smoking. Annual Review of Clinical Psychology, 9, 675–702. http://dx.doi.org/10.1146/annurevclinpsy-050212-185602 Seyle, H. (1976). Stress in health and disease. Reading, MA: Butterworth. Singh, H., Maharaj, H. D., & Shipp, M. (1991). Pattern of substance abuse among secondary school students in Trinidad and Tobago. Public Health, 105, 435–441. http://dx.doi.org/10.1016/S0033-3506(05)80613-4 Trinidad and Tobago Ministry of Health/Pan American Health Organization. (2012). Trinidad and Tobago chronic non-communicable disease risk factor survey (Pan American STEPS). Port of Spain, Trinidad: Trinidad and Tobago Ministry of Health. United Nations Development Programme. (2012). Caribbean human development report 2012: Human development and the shift to better citizen security. New York, NY: Author. United Nations Office on Drugs and Crime. (2011). 2011 global study on homicide: Trends, context, data. Vienna, Austria: Author. Retrieved from http://www. unodc.org/documents/data-and-analysis/statistics/Homicide/Globa_study_on_ homicide_2011_web.pdf World Health Organization. (2004). World report on road traffic injury prevention: Summary. Geneva, Switzerland: WHO Press. World Health Organization. (2009). Global health risks: Mortality and burden of disease attributable to selected major risks. Geneva, Switzerland: WHO Press. World Health Organization. (2011). Global status report on alcohol and health. Geneva, Switzerland: WHO Press. World Health Organization/World Bank. (2011). World report on disability. Geneva, Switzerland: WHO Press.

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7 CONTEXTUALIZING THE HEALTH BEHAVIOR OF CARIBBEAN MEN ANDREW D. CASE AND DERRICK M. GORDON

The need to identify those factors that promote or undermine the health of men in the Caribbean diaspora (i.e., men of Caribbean descent living in regions such as the West Indies, North America, Europe) has never been more critical. Rising rates of sexually transmitted infections, diabetes, and other health conditions not only threaten the well-being of these men but also introduce hardships to their families and communities (Hennis & Fraser, 2004; Inciardi, Syvertsen, & Surratt, 2005). In understanding the determinants of health, research has consistently suggested that the onset and prevention of many health conditions are influenced by the actions of individuals. Consequently, the past 50 years has seen a proliferation of theories and models that explain health-related behaviors and their role in disease prevention and health promotion (Glanz, Rimer, & Viswanath, 2008; Noar, 2005). Despite the advancement in understanding of health-related behavior generally, greater precision in the understanding of the health behavior of http://dx.doi.org/10.1037/14753-008 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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men in the Caribbean diaspora (hereinafter referred to simply as Caribbean men) is needed. Because health-related behavior occurs within the context of social and cultural factors idiosyncratic to a given population (Glanz et al., 2008), it is necessary to identify the unique contributions of context to the health-related behavior of Caribbean men. With such an understanding, researchers will be better able to develop effective interventions to promote the health of Caribbean men. In this chapter, we acknowledge that an emphasis that singularly considers the health of Caribbean men neglects the health and well-being of Caribbean women. Although some of the constructs and ideas presented are consistent across gender, considering the health and well-being of Caribbean women is important and merits specific attention (Blackman et al., 2014; D. R. Williams & Mohammed, 2009; Wilson et al., 2008; Zunzunegui, Alvarado, Béland, & Vissandjee, 2009). Given the focus of this chapter, that consideration falls outside of this analysis. However, important references and research underscore the strengths and risks experienced by women of Caribbean descent across the diaspora residing in the West Indies, America, and Europe (Blackman et al., 2014; N. Brown et al., 2006; Consedine, Tuck, Ragin, & Spencer, 2014; Draughon et al., 2014; Edge, Baker, & Rogers, 2004; Miller, Rafanan, Keihany, & Reyes-Ortiz, 2015; Tull et al., 1999; D. R. Williams, González, et al., 2007; D. R. Williams, Haile, et al., 2007; D. R. Williams & Mohammed, 2009; Wilson et al., 2008; Zunzunegui et al., 2009). We refer readers to some of these and strongly encourage more attention and focus on the unique health needs and challenges experienced by women of Caribbean descent. This chapter elucidates unique sociocultural underpinnings of health behavior in Caribbean men. We begin by defining health behavior and describing different types of health behavior enacted by Caribbean men. This is followed by a review of prominent theories that have guided how health scholars understand health behavior. Our goal is to then bring added precision to these understandings by contextualizing the health behavior of Caribbean men. Specifically, we examine the roles Caribbean masculinities and masculine scripts may play in the initiation and maintenance of health behavior. We conclude with the general implications of an analysis of Caribbean masculinity for theory refinement and efforts to promote the health of Caribbean men. HEALTH BEHAVIOR Most human behaviors can be described as health-related because of their associated health consequences. Health behavior, however, refers specifically to those actions taken by an individual, group, or organization related 172       case and gordon

to health maintenance, restoration, or enhancement (Glanz et al., 2008; Gochman, 1997). Health behavior is a complex phenomenon resulting from individual, social, and structural factors, including access to health-related services, cultural norms, and individual attitudes toward health (Noar, 2005). Accounting for this complexity has been no easy task. Glanz et al. (2008), in a review of health-related research published from 2000 to 2005, identified more than 50 distinct theories and models. Despite the proliferation of health behavior frameworks, a select few theories have dominated research, education, and intervention (Noar, 2005). We summarize these theories, highlighting their contribution to an understanding of health behavior in Caribbean men while suggesting areas of research and theorizing around the unique ways Caribbean men’s health behaviors are shaped. Types of Health Behavior Before discussing prominent health theories and models, it is worth noting the types of health behavior that are the subject of these frameworks. Health scholars generally agree on three overarching types of health behavior, distinguishable by their perceived goals or desired outcomes (Maddux, 1993). Preventive, or protective, behaviors are used to reduce the risk of future health problems. For example, one may choose not to smoke as a way to reduce the probability of acquiring smoking-related diseases (e.g., lung cancer) later in life. Promotive behaviors (also known as health enhancement) are engaged in as a way to maintain or improve current health. For instance, one may exercise regularly to keep in shape or to have more energy. Detection behaviors (also referred to as illness behaviors; Kasl & Cobb, 1966a) are initiated to provide information about the presence or absence of health-related conditions. Having physical exams, mammograms, blood pressure checks, and HIV screenings are all examples of common detection behaviors. A fourth type of behavior not included in this typology but nevertheless critical to health is help-seeking, or sick-role, behaviors (Kasl & Cobb, 1966b). Unlike preventive or promotive behaviors, which occur in the absence of an adverse health condition, help-seeking behaviors are enacted when the individual suspects or is aware of a health-related condition. These behaviors, meant to return the individual to a more optimal state of functioning, include going to the doctor when ill or seeking out social supports or professional helpers when distressed. Although this typology is useful for understanding types of health behavior, it is of limited use for predicting the conditions under which Caribbean men will engage in health behavior. This is so because behavior results from a confluence of many variables, including individual factors (e.g., preferences, attitudes) and contextual considerations (e.g., access to health services, cultural norms around help-seeking; Glanz et al., 2008; Noar, 2005). The evidence contextualizing the health behavior of caribbean men     

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for this lies in the fact that not all individuals who suspect they have an adverse health condition seek help. Similarly, despite a general awareness of the benefits of diet and exercise, not all individuals engage in these promotive behaviors. To understand specific determinants of health behavior, we must turn our attention to health behavior theories and models; these specify individual and environmental factors proximally associated with the initiation of and adherence to health behaviors. Health Behavior Theories and Models Four theories account for the majority of current research, education, and intervention efforts associated with health behavior (Glanz et al., 2008; Noar, 2005): the theory of reasoned action (TRA), which was later expanded into the theory of planned behavior (TPB); social cognitive theory (SCT); and the transtheoretical model (TTM). These theories were developed in response to ongoing questions concerning the factors that help to predict, describe, and support health behaviors in individuals (Glanz et al., 2008; Maddux, 1993). It is important to note that some scholars have questioned the cross-cultural applicability of these theories, pointing to economic, gendered, and cultural determinants of health behaviors that may not be adequately addressed by these frameworks (Ashing-Giwa, 1999; Cochran & Mays, 1993). However, a growing corpus of research across different racial, gender, cultural, and socioeconomic groups suggests these theories have cross-cultural use (e.g., Di Noia, Schinke, Prochaska, & Contento, 2006; Hinkle, Johnson, Gilbert, Jackson, & Lollis, 1992; Jemmott et al., 1992). Additionally, the fact that these theories have been used to predict numerous health behaviors from exercise and smoking to drunk driving and safe sex (see Noar, 2005, and Maddux, 1993) suggests that they can help inform researchers’ understanding of health behavior among Caribbean men. Although the four theories differ in what they consider to be the significant determinants of behavior and the pathways to behavior change, they do share a core assumption that bears noting for the purposes of this chapter. These theories are based on an individual perspective of heath behavior (Noar, 2005; Noar & Zimmerman, 2005), whereby health behavior is conceived as arising primarily from intrapersonal factors and processes (e.g., beliefs, attitudes, motivations, cognitions). Notably absent from these theories is an articulation of the range of ways that health behavior is shaped by extra-individual factors, such as cultural norms, access to resources and social–environmental barriers (Noar, 2005). Granted, these theories posit environmental influences on behavior; however, that influence is conceptualized as being mediated or filtered through individual-level factors, such as perception (Noar, 2005). Despite this limitation, the theories have 174       case and gordon

contributed much to our understanding of individual-level factors implicated in health behaviors across diverse groups of individuals. The forerunner of these theories is the TRA. Theories of Reasoned Action and Planned Behavior The TRA (Fishbein & Ajzen, 1975) was founded on research findings that suggested that attitudes only weakly predicted behaviors (see Wicker, 1969). In explaining these counterintuitive findings, Fishbein and Ajzen (1975) argued that attitudes toward an object are distinct from attitudes toward behaviors to the object, and as a result, attitudes toward an object is an inadequate predictor of behaviors associated with the object (Montaño & Kasprzyk, 2008). This line of research and emerging theory began to underscore the crucial role motivational factors play in behavior (Ajzen, 1991). The central explanatory concept in the TRA is behavioral intention (see Figure 7.1), which can be understood as “indications of how hard people are willing to try, or how much of an effort they are planning to exert, in order to perform the behavior” (Ajzen, 1991, p. 181). It is assumed to capture the motivational factors that lead to behavior (Ajzen, 1991). Behavioral intention comprises attitudes toward the behavior and subjective norms. Attitudes toward the behavior are the beliefs individuals hold about the outcomes of engaging in a behavior coupled with an evaluative weighting of those outcomes. Thus, an individual who believes wearing a seat belt results in safety and who values safety will have positive attitudes toward wearing a seat belt. Subjective norms refer to the extent to which a person believes that important others will approve of the behavior and the person’s willingness to comply with the expectations of others. Simply stated, if an individual believes others approve of his or her wearing seat belts and he or she values these opinions, he or she can be described as having positive subjective norms toward wearing seat belts (Montaño & Kasprzyk, 2008).

Attitudes toward the behavior Behavioral Intention

Health Behavior

Subjective norms about the behavior

Figure 7.1.  Theory of reasoned action. contextualizing the health behavior of caribbean men     

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Empirical support for the TRA’s major construct, behavioral intention, has come by way of research studies and meta-analyses on health behaviors from exercise to smoking to substance use to condom use (Albarracín, Johnson, Fishbein, & Muellerleile, 2001; Armitage & Conner, 2001; Schlegel, D’Avernas, Zanna, DeCourville, & Manske, 1992; Sheeran & Orbell, 1998). These findings indicate that behavioral intention has use in predicting health behavior (Duff, 2010). Although there has been support for the use of the TRA, it is important to note that these observations are valid only for behaviors over which the individual has complete volition or control. In other words, it is only suitable for predicting behavior when the only factor needed to initiate behavior is the person’s intention to do so. Given the current social, resource, and contextual factors that influence many health-related behaviors, some attention needs to be paid to whether a given individual possesses the requisite resources, skills, and opportunities to enact health behavior. For example, the intent to enact a behavior may not result in the successful execution of it, because one lacks some critical asset that is required for the behavior to occur. In addition, despite one’s positive attitudes and subjective norms toward a behavior, one may also not initiate the behavior out of concern that the associated effort will not result in the successful execution of the act. Thus, behavior is often the result of the interplay between intention and access to the resources to make the behavior happen. This realization was the impetus behind the expansion of the TRA. That is, acknowledging the limitation of the TRA, Ajzen and Madden (1986) proposed the TPB. The goal of this new and expanded theory was to address the predictive limitations that arise when people do not have complete volition over their behaviors. In the TPB, another significant determinant of behavior is proposed: perceived behavioral control. The TPB posits that perceived behavioral control is an important contributor to health-related action, above and beyond behavioral intention (Ajzen, 1991; see Figure 7.2). Perceived behavioral control refers to one’s assessment of his or her ability to execute a behavior. Perceived behavioral control accounts for the impact of perceptions of external factors (e.g., resources, barriers) that may impede one’s ability to engage in a behavior despite positive attitudes toward it and subjective norms reinforcing it. Perceived behavioral control is composed of beliefs about factors that facilitate or hinder behaviors (i.e., control beliefs) and an evaluative weighting of the extent to which these factors influence behavior (i.e., perceived power). Similar to the TRA, the TPB has been supported empirically across racial-, cultural-, ethnic-, and health-related behaviors (Albarracín et al., 2001; Blue, 1995; Craig, Goldberg, & Dietz, 1996; Godin & Kok, 1996). Moreover, it appears that the inclusion of perceived behavioral control 176       case and gordon

Attitudes toward the behavior Behavioral Intention Subjective norms about the behavior Health Behavior

Control beliefs Perceived Behavioral Control Perceived power

Figure 7.2.  Theory of planned behavior.

increases the general predictive power of the initial model (Madden, Ellen, & Ajzen, 1992). Areas of health where perceived behavioral control, as part of the larger TPB, has gained significant traction include HIV, condom use, and mammography screening (Ajzen, 1991; Albarracín et al., 2001; Montaño, Thompson, Taylor, & Mahloch, 1997). The TRA and the TPB have been crucial in highlighting the role of motivational factors and perceptions of control in health behaviors. Some researchers, however, have identified one major limitation experienced in the application of these theories: a failure to articulate and account for the relationships between environmental factors and health behavior (Noar, 2005). Bandura’s (1977) SCT has sought to highlight and address this limitation by articulating the interaction between environment and behavior. Social Cognitive Theory SCT (Bandura, 1977, 1986) posits that health behavior results from the dynamic interplay between intrapersonal and environmental factors (see Figure 7.3). This theory is influenced by a number of fields, including cognitive psychology, with its emphasis on how information processing and cognitive biases impact behaviors; humanistic psychology and its emphasis on self-determination; and sociology, with its orientation toward collective action (McAlister, Perry, & Parcel, 2008). Although SCT posits that environment influences behavior, the focus of the theory is on how individuals contextualizing the health behavior of caribbean men     

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Health Behavior

Person

Environment

Figure 7.3.  Reciprocal determinism in social cognitive theory.

shape environments to suit their own perceived needs through behaviors (McAlister et al., 2008). SCT is composed of several concepts, reciprocal determination, outcome expectations, self- and collective-efficacy, observational learning, incentive motivation, facilitation, self-regulation, and moral disengagement (McAlister et al., 2008). One concept heavily emphasized in SCT is reciprocal determinism, which is the position that individuals shape their environments and their environments, in turn, shape them. Another important concept is outcome expectation, which is the individual’s estimate of the likelihood that a particular behavior will result in a particular consequence and the value attached to that consequence. A third major concept is self-efficacy, which is composed of beliefs about one’s capacity to successfully enact behaviors that result in desired outcomes. Because many desired outcomes require coordinated, collective action, Bandura (1998) expanded the concept of selfefficacy to include collective efficacy. The principle assumption of SCT is that the greater a person’s self-efficacy or a group’s collective efficacy related to a particular behavior, the greater the probability that that behavior will be successfully enacted. For example, this principle may explain Black boys’ interest in pursuing sports careers. Because of the observed predominance of Black men in some professional sports, Black boys strongly believe (selfefficacy) they can be successful at these sports and thus pursue sports careers (Hawkins & Cooper, 2014; Majors, 1998). Self-efficacy, the most proximal determinant of behavior according to SCT, has been the most researched concept associated with this theory (Noar, 2005). It has also been incorporated into several models and theories of health behaviors (see for example Ajzen, 1991, for a discussion of the conceptual overlap between perceived behavioral control and self-efficacy). 178       case and gordon

Across studies, self-efficacy has been shown to be a significant predictor of health behaviors and behavioral intention (Albarracín et al., 2004; Armitage & Conner, 2001; Hagger & Chatzisarantis, 2009; Milne, Sheeran, & Orbell, 2000; Rodgers, Conner, & Murray, 2008). Behavioral intention and self-efficacy highlight an important factor in health behavior initiation: the process associated with moving from appraisal to intention to action. Further, the notion that a process undergirds behavior initiation and change signifies that health action does not occur discretely but unfolds over time (J. O. Prochaska & DiClemente, 1983). The transtheoretical model of health behaviors emerged as a means to conceptualize and describe the process of behavioral change. The Transtheoretical Model The TTM (J. O. Prochaska & DiClemente, 1983) articulates important stages and principles of behavior change (see Figure 7.4). The TTM and its theory emerged in the context of its developers trying to better understand how individuals engaged in addictive behaviors (e.g., substance abuse) change their behaviors with or without the assistance of psychotherapy (J. O. Prochaska & DiClemente, 1983; J. O. Prochaska & Norcross, 2010). After a careful review of the leading theories of psychotherapeutic and behavioral change, J. O. Prochaska (1984) proposed the TTM in an effort to reconcile numerous theories of psychotherapy change. The model itself articulates four constructs important for understanding behavioral change: stages of change, processes of change, decisional balance, and self-efficacy. Overall, the TTM has been used to investigate and predict numerous health behaviors across and within racial and cultural populations, including smoking cessation, diet and exercise, and condom use (Aveyard et al., 1999; Noar, Benac, & Harris, 2007; J. M. Prochaska et al., 2004).

Maintenance Readiness to change behavior

Action Preparation Contemplation Precontemplation

Figure 7.4.  Stages of change in transtheoretical model. contextualizing the health behavior of caribbean men     

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Stages of Change According to the TTM, any health behavior change progresses through a series of six stages indicative of the individual’s readiness to change: precontemplation, contemplation, preparation, action, maintenance, and termination. Progress through these stages is not always linear. Although individuals move sequentially through the stages, they may also revert to previous stages (J. M. Prochaska et al., 2004). The precontemplation stage signifies a state in which the individual does not intend to initiate health behavior change. He or she likely does not recognize that he or she has a need for behavior change and/or are not aware or fully aware of the consequences of their current behavior. In the contemplation stage, the individual intends to initiate behavior change in the near future. In comparison with precontemplators, contemplators are more aware of the consequences of their behaviors but are ambivalent about changing, as they are in the process of weighing the pros and cons of health behavioral change. During the preparation stage, the individual intends to change his or her behaviors and takes steps toward that goal. Here, they have a plan that they intend to execute. For example, purchasing a gym membership with the intention of using it to exercise to lose weight would characterize someone in the preparation stage. In the action stage, the individual engages in modifications in behavior. For example, after purchasing the gym membership beginning a 3-day-a-week workout routine. Maintenance is the stage where one has made modifications in behavior and does not need to exert as much effort to maintain change. The focus of this stage is on preventing relapse because of the greater sense of efficacy around behavior change and less temptation to relapse. In this stage, the focus is also on continuing to engage in the positive health behavior change that results in more positive health outcomes. The final stage, termination, is one in which the individual experiences no temptation and have a complete sense of control or volition. At this point, the practiced health behavior is considered “automatic.” Processes of Change Individuals progress through the stages of change as a result of change processes, which are “overt and covert strategies and techniques used to modify problem behaviors” (J. O. Prochaska, Redding, Harlow, Rossi, & Velicer, 1994, p. 476). J. O. Prochaska et al. (1994) identified 10 processes of change common to a range of problem behaviors: consciousness raising, dramatic relief, self-liberation, self-reevaluation, environment evaluation, helping relationships, social liberation, stimulus control, counterconditioning, and reinforcement management. A review of each of these processes is outside of the scope of this chapter, in which we outline three methods that might be 180       case and gordon

implicated in the health behaviors of Caribbean men, given their seeming universality. The three processes we focus on are consciousness raising, self-liberation, and social liberation. First, consciousness raising refers to an increased level of awareness that leads to behavioral change. It often takes the form of the individual realizing the ways in which current behaviors place her or him at risk for unfavorable outcomes. For example, one might begin to take notice of one’s risky sexual practice and seek information and resources to alter those practices in ways that reduce the risk of unfavorable health outcomes. Self-liberation constitutes one’s belief in their ability to change and one’s commitment to change. This is akin to self-efficacy. The individual believes that he or she can engage in, for instance, safer sexual practices and makes a commitment to do so. Social liberation refers to noticing social or cultural changes that support personal changes. For instance, one might observe social campaigns around safe sex practices that increase one’s resolve to alter risky sexual behaviors. Ultimately, these and other processes serve as catalysts that move individuals from one stage of change to the other. Decisional Balance and Self-Efficacy In addition to stages of change and change processes, the TTM specifies two constructs that are important to change: decisional balance and selfefficacy (J. O. Prochaska et al., 1994). Decisional balance refers to the assessing of gains (pros) and losses (cons) associated with the consequences of behaviors. Past research has found that decisional balance is associated with stages of change such that in precontemplation, the cons related to initiating a healthpromoting behavior often outweigh the pros; in contemplation, pros and cons are of equal weight; and in the preparation, action, and maintenance stages, the pros outweigh the cons (J. O. Prochaska et al., 1994). Self-efficacy, as previously defined, is the degree to which an individual believes that he or she can enact behaviors that lead to projected outcomes. It is important to note that in the TTM, self-efficacy is composed of (a) confidence to enact and sustain behavioral change and (b) situational temptation. The inclusion of situational temptation, adapted from Bandura’s (1977) self-efficacy model, is important. This construct is used to assess the intensity of the urge to engage in maladaptive behaviors in difficult situations and the confidence to avoid engaging in these behaviors in difficult situations. These two constructs have been identified as critical mediators and have been incorporated into interventions (Abraham & Michie, 2008; Downs & Hausenblas, 2005; Schwarzer, 2008; Sillice et al., 2014). Collectively, the TRA, the TPB, SCT, and the TTM have empirical support for their use in predicting health behaviors and changes in health contextualizing the health behavior of caribbean men     

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behaviors across racial, cultural, and ethnic groups. Although important, they still function in context. For the purpose of this chapter, this context involves being a man living in the West Indian diaspora. Understanding the reality this entails, the ways in which gender affects the health and health behavior of men of Caribbean descent must be considered. The importance of this consideration rests in the observation that gender, and more specifically, gender socialization, impacts the health and health practices of men (Addis & Mahalik, 2003; Courtenay, 2000). MASCULINITY One dynamic factor that impacts the health behavior of men is their masculinity or gender role socialization (Addis & Mahalik, 2003). Masculinity refers to a collection of cognitions, attitudes, and behaviors that is informed by a cultural belief system or ideology around how men ought to understand and interface with the world (Addis & Mahalik, 2003; Courtenay, 2000). Gender socialization is the shaping process through which values, customs, and behavioral norms are transmitted (Chevannes, 2001). Although the biological underpinning are currently not explicit and described, masculinity may be best understood as a self- and other-constituted phenomenon situated within time and place (Beckles, 2004; Courtenay, 2000; Evans, Frank, Oliffe, & Gregory, 2011). However, the implications of masculinity are far-reaching for the lives of men. As Peterson (1997) argued, masculinity “is not only out there structuring activities and institutions, and ‘in our heads’ structuring discourse and ideologies; it is also ‘in here’—in our hearts and bodies—structuring our intimate desires, our sexuality, our self-esteem, and our dreams” (p. 199). These observations support Chevannes’s (2001) viewpoint that masculine gender socialization is as much a study of meaning as it is the way people construct it (masculine gender; see p. 34). Research has supported the idea that the endorsement of masculinity— specifically hegemonic masculinity, which emphasizes toughness, self-reliance, and constricted emotionality—can negatively impact how men perceive their health, cope with adversity, and access health care (Addis & Mahalik, 2003; Courtenay, 2000; Hong, 2000; Oyserman, Fryberg, & Yoder, 2007). Men who adhere to the ideals of masculinity are at heightened risk for a range of healthrelated problems, such as alcohol abuse, physical aggression, difficulties with anger, and not engaging in health-promoting behaviors (e.g., help-seeking; Addis & Mahalik, 2003; Gast & Peak, 2011; Gordon, Hawes, Perez-Cabello, et al., 2013; Gordon, Hawes, Reid, et al., 2013; Mahalik, Burns, & Syzdek, 2007; Mahalik, Lagan, & Morrison, 2006). Therefore, masculinity can shape the health behavior of men at a very fundamental level. 182       case and gordon

Very little has been written on how masculinity influences the health behavior of Caribbean men. This observation is both surprising and troubling for the following reasons. First, ample research suggests that masculinity plays a significant role in the health behavior of men, regardless of ethnicity and race (Addis & Mahalik, 2003; Courtenay, 2000). Thus, for Caribbean men, there seems to have been a missed opportunity to examine the unique contributions of masculinity on the health problems facing this group. Second, what we know about how masculinity influences the health behavior of men of other ethnicities cannot be wholly transferred to Caribbean men (Chevannes, 2001), as masculinity reflects contextual and temporal realities. Research has shown that the masculinities that subgroups of men (e.g., Black men) have historically been able to access are often devoid of some of the privileges associated with the masculinities of other groups of men, especially White men (e.g., power, wealth, status; Chevannes, 2001; Evans et al., 2011; Tannenbaum & Frank, 2011). Thus, understanding how masculinity relates to the health behavior of Caribbean men requires a nuanced understanding of Caribbean masculinity within its historical context, ways of being, privileges, and constraints. Current thinking about Caribbean masculinity has been informed primarily by qualitative methods that try to describe and understand the cultural scripts that define masculinity in these subgroups. Understanding masculinities through the examination of the scripts that constitute a particular masculinity is important. Scripts can be understood as outgrowths of gender role socialization that specify how men ought to respond in various situations (Mahalik, Good, & Englar-Carlson, 2003; O’Neil, 2015). Mahalik et al. (2003), for example, found that certain scripts negatively impacted men’s seeking of professional psychological help. These included the strong-and-silent script, which restricts the extent to which men are willing to talk about the challenges they are experiencing; the tough-guy script, which asserts that men are invulnerable and should not need help; the playboy script, which endorses the idea that men should be sexually adventurous but averse to intimacy; and the homophobic script, which teaches men to avoid behaviors that may be perceived as feminine or homosexual (e.g., crying, displaying emotion). Gordon and others (Gordon, Hawes, Perez-Cabello, et al., 2013; Gordon, Hawes, Reid, et al., 2013; Iwamoto et al., 2012) have also been able to show that these scripts have implications for the health behaviors and actions of subpopulations of men (e.g., young fathers, formerly incarcerated men). Specifically, Gordon and colleagues observed that some masculine scripts were health undermining (e.g., toughness, antifemininity), whereas others were health promoting (e.g., status). These observations are consistent with research findings that suggest, in general, that masculinity and adherence to masculine scripts simultaneously confer risk and protective forces in the health context (Addis & Mahalik, 2003; Burns & Mahalik, contextualizing the health behavior of caribbean men     

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2007; Mahalik et al., 2003; O’Neil, 2015). We argue that unique analogs to these scripts exist within Caribbean masculinities and impact the health behaviors of Caribbean men. On the basis of an analysis of Caribbean cultures and a perusal of the literature on masculinities in a Caribbean context, we review the identified scripts and discuss our hypotheses about how they are likely to influence the health behaviors of Caribbean men. We also integrate these scripts into our aforementioned health behavior models. Caribbean Culture and Masculinity Scripts The most crucial influences on gender socialization and relations in the Caribbean region have been slavery, indentured servitude, and migration and globalization (Beckles, 2004; Hall, 2011; Howard, 2004; see also Chapter 3, this volume). These factors have to be considered independently and collectively because of their complex implications for the cultural and racial dimensions of Caribbean life. They also have helped to shape family life, a critical factor in the socialization that occurs, as boys are socialized into their social roles as men (Chevannes, 2001). The ancestors of Caribbean individuals were introduced to the region in divergent ways, and their incorporation and acculturation into Caribbean society reflect these distinctions. Caribbean masculinities have been shaped by these larger historical trends and the relationships they created between specific groups of men and Caribbean societies across the diaspora (Beckles, 2004). As Chevannes (2001) explained, increased understanding of masculinity necessitates an acknowledgement that it does not mean the same thing everywhere. Moreover, Chevannes (2001) has been able to show that masculinity within these contexts tends to fall within the broader parameters of gender role preferences, space and identity, sexuality, and provider. In these larger “contexts” in which the male gender is shaped and enacted, no analysis of the Caribbean experience is complete without some consideration of, and attention to, the ways that slavery, indentured servitude, and migration and globalization have shaped the cultural and social context that currently exists around masculinity and its expression. In addition to establishing hierarchies of race in the Caribbean, slavery had a significant hand in contouring how Caribbean men and women interacted with each other, the roles they took in relation to one another, and Caribbean men’s experience of their maleness (Howard, 2004). For enslaved African men in the Caribbean, there was a contradiction of sorts related to masculinity. On the one hand, patriarchy—as a form of hegemonic masculinity— was superimposed onto the system of slavery. Here, the White slave owner had, by right, unfettered sexual access to enslaved African women as well as power over his White wife. Therefore, there was a model of hegemonic masculinity that male slaves could emulate. On the other hand, because of the 184       case and gordon

social structure of slavery, African men were unable to fully achieve that ideal of masculinity. This viewpoint is based on the observation that although enslaved African men may have strived for this masculine ideal, their status made it almost impossible for them to actually assume the hegemonic masculine role. That is, enslaved males could not wield the influence and status of White men, nor did they possess the resources and assets to support a natural position of power and agency (Beckles, 2004; Mohammed, 2004). Moreover, any attempt by enslaved males to assert hegemonic masculinity was met with swift reprisal. For example, it was not uncommon for enslaved men to identify female partners with the understanding that this selection was only valid if it suited their White slave owners. Further, business decisions associated with the sale and/or trading of slaves were not predicated on the relationship status of said slaves. Also blurring the lines (at least from a Eurocentric perspective) on what was fundamentally constitutive of masculinity and femininity was the reality of few, if any, gender divisions in work roles among enslaved males and females (Nurse, 2004). The context of slavery is said to have had an impact on contemporary gender relations in the Caribbean in two notable ways. First, it gave rise to a marginalized masculinity among Caribbean men, with vestiges that can be observed today. Currently, many Caribbean men still do not have access to what would be considered the privileges of masculinity: power, money, and esteem (Nurse, 2004). For men who endorse a hegemonic conception of masculinity, this is a particularly salient issue. Second, the lack of work role differentiation is said to have contributed to female autonomy in the postslavery era (Howard, 2004; Nurse, 2004). In the aftermath of slavery, Caribbean women resisted the gender roles modeled by White men and women to pursue opportunities for social and economic advancement through participation in the labor market. Today, Caribbean women outperform men in academics and are making significant strides in the political and economic arenas (Nurse, 2004). Thus, Caribbean masculinity, in part, can be understood as a quest to define and assert maleness in this unique social milieu of gender relations in the Caribbean. Moreover, the masculinity scripts held by Caribbean men reflect this ongoing tension. Although slavery and its impact on masculinity have received some attention, also relevant to Caribbean masculinity is the role of indentured servitude. Slavery has been described as an involuntary participation in a system that subjugated one group under another (Beckles, 2004; Mohammed, 2004). Indentured servitude has been described by some as the “voluntary” participation in a system where for passage or to settle some other debt, an individual agreed to work for a specified time. Once meeting the obligation delineated in the agreement, one was then free to do as she or he pleased. In Caribbean life, the introduction of indentured servants to a system already rooted in slavery contextualizing the health behavior of caribbean men     

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introduced another challenging and tiered system. In this context, individuals migrating or who “were brought” to the Caribbean from India, China, and West Africa created an intermediary hierarchy between that of enslaved Africans brought here involuntarily and the former slave owners. This experience also impacted the notions of masculine ideals available. It required the established gender-based system to reconsider and adjust to this new class of individuals that needed to be socially accommodated (Beckles, 2004). Considering the accommodation that was needed to integrate this new class of Caribbean residents, one must pay attention to the resulting impact on the masculine ideals that the men within this class had to enact to continue to move forward. First, as with slavery, indentured servitude shaped gender relations in the Caribbean. For example, Howard (2004) noted that in the aftermath of slavery in Trinidad and Tobago, two thirds of the women emigrating from India forewent marriage to develop economic and political power, which ultimately led to increased female autonomy in contemporary Caribbean society. Second, indentured servitude opened pathways to different performances of masculinity. Although true, it is clear that for individuals who entered Caribbean life through this path, critical challenges continue to exist as they face, understand, and construct their gender identities (Chevannes, 2001). The masculinities Caribbean men have access to are in part determined by their historical entryway and assimilation into Caribbean life. For example, the preceding section highlighted the vicissitudes of a marginalized masculinity contoured by the dynamics of slavery and racial violence. It is a masculinity that is contemporarily accessed and negotiated by the descendants of enslaved African males (Nurse, 2004). In a similar fashion, the masculinities accessible to males of other ethnicities, such as Indians, will naturally reflect a unique historical experience related to that group. For Indian men, it reflects the experience of indentured servitude and the historical relationship between these men and the opportunity structure, as it existed and now exists in the Caribbean. However, the last notable influences on Caribbean masculinity, migration and globalization, are nonlocalized trends that are both historical and contemporary, and dynamic in nature. Masculine ideals are not only being promulgated by social forces in the Caribbean but by forces in other locales (Matthei & Smith, 2004; see also Chapter 4, this volume). Through the processes of migration and globalization, Caribbean men are exposed to familiar an unfamiliar performances of masculinity (Hall, 2011; Matthei & Smith, 2004). Men emigrating to the United States and Europe, as part of their acculturation to those contexts, may encounter masculinities that are not available in the Caribbean. A similar process occurs for Caribbean men who remain in the Caribbean but are exposed to American and European cultures. Globalization forces in the 186       case and gordon

forms of literature and media are creating new avenues for intercultural contact. The adoption of masculinity ideals through globalization may be especially true for younger men. Ferguson and Bornstein (2012, 2014) have argued that Caribbean adolescents are increasingly engaged in a process of remote acculturation or Americanization whereby they adopt American cultural ideals through distant exposure to these ideals. Thus, in addition to the local and historical influences on Caribbean masculinities in the form of slavery and indentured servitude, contemporary and nonlocalized influences include migration and globalization. The preceding discussion suggests that Caribbean masculinities are multifaceted and dynamic in nature. However, because of their roots in the Caribbean context, we argue that they share distinct elements reflective of the ethos of Caribbean culture. In other words, focusing on masculinity scripts is a good starting point for understanding the health behavior of Caribbean men. The masculine scripts that may be enacted by Caribbean men have been described in literary and social science writings and help to begin to frame the connection between these ideas of masculinity and men’s societal role. On the basis of our review of the pertinent literature, we contend that the following are commonly enacted scripts within Caribbean masculinities: breadwinner, stalworth, gallis, and rudebwoy. We discuss these in turns below. One script held by Caribbean men is that of breadwinner. This script asserts that having a job and earning a good income is part and parcel of maleness (J. Brown & Chevannes, 2001; Nurse, 2004). As such, Caribbean men determine their self-worth as men by the extent to which they can provide for their families and are willing to make personal sacrifices in service to that role (Mohammed, 2004). Another script is the stalworth, which encourages men to be physically and mentally strong, to be emotionally inhibited, and to avoid displaying signs of weakness (Anderson, 2007; de Moya, 2004). Similar to the playboy script found among American men, the gallis script among Caribbean men extols having multiple sexual partners and displaying sexual prowess as evidence of masculinity (J. Brown & Chevannes, 2001; Chevannes, 1993). Moreover, that the Patois term gallis includes gal (“woman”) clearly highlights heterosexual sexual relations as the de facto proscription for Caribbean masculinity. Last, is the rudebwoy script often associated with street or urban culture. It emphasizes a rugged self-reliance, independence, self-determination, and resourcefulness that often transgress into illicit and illegal behavior (Hall, 2011). These masculinity scripts, by virtue of their far-reaching implications for men, are likely to impact the health behavior of Caribbean men. The health implications of social forces (slavery, indentured servitude, migration/globalization) toward masculinity not only limit the breadth of options available to men from the Caribbean diaspora (McKeown, Nelson, contextualizing the health behavior of caribbean men     

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Anderson, Low, & Elford, 2010) but also confer both risks and protection in terms of health outcomes. Although some researchers have been able to demonstrate that men from the Caribbean diaspora report better overall health (Lucas, Barr-Anderson, & Kington, 2003), significant evidence indicates that the legacy of these histories negatively impacts their health care experiences (D. R. Williams, 2012; R. A. Williams, 2007, 2009), increases the morbidity and mortality experienced when compared with Whites (Ben-Shlomo et al., 2008; Chinegwundoh et al., 2006; Gonzalez, Consedine, McKiernan, & Spencer, 2008; Nielsen & Krasnik, 2010; Odedina et al., 2009; Rebbeck et al., 2013; D. R. Williams, González, et al. 2007), and may lead them to have greater risks than those experienced by their African American counterparts (D. R. Williams, Haile, et al., 2007). Further, barriers impede their access to health care, including health screenings (Lee, Consedine, & Spencer, 2011). Examples here include insurance status (Lucas et al., 2003), access and use of preventive and indicated care (Atallah et al., 2007; Hammond et al., 2011), poor management of health-related concerns (Atallah et al., 2007; Jackson et al., 2007), social stressors (Morgan & Hutchinson, 2010), comorbid conditions (Zaninotto, Mindell, & Hirani, 2007), and fear (Lee et al., 2011). These barriers then impact the health behaviors of Caribbean men across the diaspora. Implications of Masculinity Scripts for Formulations of Caribbean Men’s Health Behavior As previously mentioned, understanding the health behaviors of Carib­ bean men requires attention to the unique sociocultural context in which these behaviors have emerged. A salient part of that context are the conceptions of masculinity Caribbean men adhere to, and more specifically, the masculine scripts that guide their health behaviors. Accounting for the influence of these scripts on health behavior requires careful consideration of the extent to which the relationships between masculinity and health behavior can be understood through the lens of prominent health behavior theories and models. Further, any expression of these masculine scripts has to be understood through the migration lens of the ethnic and racial groups of interest. Specifically, some consideration must be given to the influence of the cultural legacy of Caribbean men and how that legacy is shaped by the historical context that influenced their introduction into the Caribbean milieu and the reverberation of that introduction across generations. The health behavior theories and models reviewed in this chapter make allowances, to differing extents, for sociocultural influences on health behavior. Thus, the task is to identify the pertinent factors and pathways by which these models and theories might “capture” masculine scripts and their relationship 188       case and gordon

to health behavior. In the TRA and the TPB, for example, masculinity scripts likely inform subjective norms around health behaviors. Scholars note that men, compared with women, feel heightened pressure to conform to gender expectations (Addis & Mahalik, 2003; Courtenay, 2000). Thus, the belief that Caribbean men have around whether others would approve of their health behaviors given their identities as men is likely to influence their decision to engage in a health behavior. In other words, if wearing seat belts, having protected sexual encounters, and seeking out help are somehow seen as nonmasculine by important others, men may decide not to engage in these behaviors. Masculine scripts may also inform Caribbean men’s own personal attitudes, absent the opinions of important others. Masculinity is inextricably linked to the self-concepts of men (Peterson, 1997). Thus, behaviors that transgress masculine norms might be experienced as an affront to the ways Caribbean men think about and experience themselves (McKeown et al., 2010). Addis and Mahalik (2003) noted that the very act of seeking help requires a surrendering of power, control, autonomy, and self-reliance—all of which are hallmarks of traditional masculinities. Further, these hallmarks are part and parcel of the stalwart script that many Caribbean men enact. In SCT, masculinity scripts can have a prominent place in the principle of reciprocal determinism. Specifically, the sociocultural environment of the Caribbean in terms of conceptions of masculinity influences what becomes the normative behavior of Caribbean men. This social influence helps to perpetuate certain ideals and expectations concerning how Caribbean men ought to behave. For example, the breadwinner script emphasizes hard work and self-sacrifice that might lead men to work long hours, sacrificing health. This behavior pattern then becomes the expectation for other men. Masculine scripts may also figure in outcome expectations. If the expectation among Caribbean men is that engaging in a particular health behavior does not result in a valued outcome congruent with their gendered sense of self, they are less likely to engage in that behavior. As it pertains to the TTM, an important consideration for how masculinity scripts affect health behavior is the impact they have on readiness to change. The degree to which Caribbean men endorse these scripts may be an important indicator of their readiness to change. So, for example, the more a man adheres to the gallis script, the more likely he might be to display ambivalence about safe sex practices, suggesting he is at the contemplative stage of behavior change. This ambivalence could be resolved through processes of change, such as consciousness raising. Specifically, the man in question would come to recognize the negative outcomes associated with risky sex practices and subsequently move from contemplation to preparation to change his sexual practices. Similarly, the more a man endorses the breadwinner script, the less likely he is to see a lack of self-care and preventive practices as a contextualizing the health behavior of caribbean men     

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problem. However, through his growing recognition of limited self-care and preventive practices as problematic, he moves from contemplating behavior change to preparing for it and executing it. The preceding discussion suggests much promise for integrating an understanding of masculinity scripts among Caribbean men into prominent health behavior theories. In doing so, researchers can begin to contextualize the health behavior of Caribbean men in ways that enhance understanding of the facilitators and barriers to health for this population. Further, masculinity scripts can be a foundation on which one may be able to build and inform culturally anchored health-promoting interventions. Implications of Masculinity Scripts for Intervention With Caribbean Men Identifying the masculine scripts endorsed and performed by Caribbean men represents a unique opportunity to understand the social and cultural underpinnings of the health behavior of this population. Using behavior theories and models like the ones reviewed in this chapter, researchers can begin to postulate the precise relationships between masculine scripts and health behavior. Moreover, understanding how these scripts function as either barriers or facilitators of health behavior has promise for the policy and intervention work of health educators and public health practitioners. Below, we mention some key considerations for the practical applications of an understanding of Caribbean masculinity scripts and their relationship to health behavior. As previously discussed, masculinity is a fluid and dynamic phenomenon that is subject to contextual influences. Globalization, migration, and acculturation are all shaping and reshaping what it means to be a man in the Caribbean (Hall, 2011; Matthei & Smith, 2004). Health educators, public health practitioners, and other allied health professionals can play a vital role in shaping masculine scripts in ways that promote, instead of undermine, health behavior in Caribbean men. In this regard, a universal prevention approach that targets all Caribbean men might be in order. For instance, the masculinity script of Breadwinner extols the virtue of providing for one’s family, even at the expense of one’s well-being (Lewis, 2004; Nurse, 2004). This script can be challenged/reframed through a social campaign (e.g., public service announcements, posters, electronic messaging) that argues that ensuring one’s health (through regular physician checkups and appropriate screenings) is one way to ensure that one’s family is provided for. In addition, this approach may also reinforce the value that men add to the health and functioning of families. This is particularly important when considering the intersection between this script in relationship to the significant others involved in their lives 190       case and gordon

(e.g., wives, children, extended family members). Similarly, the gallis script can be challenged to reduce the incidence of sexually transmitted infections if masculinity is equated with responsibility and responsibility is equated with safe sexual practices (e.g., condom use, monogamy). Gordon, Hawes, Reid, et al.’s (2013) research has shown that some masculine scripts can be protective. Using the scripts that could be health promoting (e.g., breadwinner) may by virtue of their primacy in the consciousness of Caribbean men decrease more maladaptive scripts that may be health undermining (e.g., gallis). Changes in the way that Caribbean men relate to the masculine scripts may also have real implications for the women and children attached to them. Increases in healthy physical, social, emotional, and relational functioning may promote stronger interpersonal relationships between them and their partners, thus reducing incidence of intimate partner violence and associated sexually transmitted infections that may arise from promiscuity and adultery. They may also increase the parenting capacity of both individuals. This observation is based on research that suggests that healthy, connected male partners have a positive impact on the parenting practices of their female partners and on their own parenting interventions (Paulson, Dauber, & Leiferman, 2006). Given the dynamic nature of masculinity, masculine scripts are a critical site of intervention for promoting the health and vitality of Caribbean men. In addition to a universal approach to challenge masculinity scripts that undermine health behavior, a grassroots or community-based approach to promoting health behaviors of Caribbean men may also be effective. This could involve using natural helpers, or cultural brokers, who are trained and educated to deliver these services (Brownstein, Cheal, Ackermann, Bassford, & Campos-Outcalt, 1992; Eng, Rhodes, & Parker, 2009; Singh, McKay, & Singh, 1999). These are respected laypersons, such as ministers and barbers, to whom men could turn to for support and who could work directly with men to promote health behaviors and connect them to health resources in the community. In essence, these individuals would function as repositories of knowledge and be trusted advice givers who would help connect men with the resources and information that will help them make informed decisions about their health. This could be transmitted in forms that are congruent with their communication patterns and shaped through these exchanges. One example is humor and its effort of bringing levity and direction in one palatable swoop (R. A. Williams, 2009). The advantage of a cultural-broker approach is as follows. First, it provides a model for a different kind of masculinity, one in which men are proactive in the promotion of their health. Here, the cultural brokers, respected men in their own right, are talking about health and encouraging health-promoting behaviors. This may give other men a certain license or freedom to talk, and joke, about health and through contextualizing the health behavior of caribbean men     

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this exchange pursue health-related resources. Second, the use of natural helpers and cultural brokers capitalizes on community resources and creates a sustainable infrastructure for the continuation of an on-the-ground approach to promoting health behavior in men (Eng, Rhodes, & Parker, 2009). It also begins to assist in the rewriting of the masculine scripts available by providing a model of how to integrate this developing approach to one’s masculine script into practice. Ultimately, this approach brings the discussion of health to men and it does so in a way that is perhaps more relevant and impactful than other means. Finally, to support universal and specific approaches to health promotion, health-friendly policies are needed at the governmental and healthsystem levels. Here, trained psychologists, other mental health professionals, and public health practitioners in partnership with the medical establishment and policy makers are critically needed to review and revise regulations and controls that target the health needs of Caribbean men across the diaspora. These professionals, using their diverse skill-sets—research, experience in program evaluation and development, psychological interventions to address needs at multiple level (e.g., family, community, individual)—may bring important, but missing, avenues that facilitate change. As these efforts progress, critical consideration must not only be given to the role that masculinity plays in undermining Caribbean men’s health but also to the extent that societies and systems erect barriers to health. Chief among such considerations are health care costs. Is health a viable option for all men across the socioeconomic strata? Affordable health care, in many ways, is a prerequisite to any health-promoting approach or strategy. Policies that reduce health care costs will create the conditions for men to engage in preventative strategies, instead of waiting until a health concern is acutely impairing. This discussion brings to the fore the interplay between the intra-/interindividual and system factors that impact health. Another policy consideration involves how to incentivize or, at the least, not penalize men for engaging in health behaviors. This could include ensuring adequate sick days or a reduction in health care premiums for having regular checkups, exercising, and engaging in preventative medicine. In short, a policy-driven approach to promoting health behavior among Caribbean men is needed to create the structural facilitators of health promotion for them. CONCLUSION The health behaviors of individuals are a critical determinant of health, and what is known about health behavior and its antecedents has increased almost exponentially over the past 50 years (Glanz et al., 2008). However, 192       case and gordon

rising rates of preventable diseases and illness among Caribbean men (Hennis & Fraser, 2004; Inciardi et al., 2005; Chapter 6, this volume) necessitate a critical examination of the unique social and cultural contributors to the health of this population. Through this chapter, we sought to contextualize the health behavior of Caribbean men by drawing much needed attention to the role of masculinity in this phenomenon. We reviewed prominent theories of health behavior and the literature on masculinity and its relationship to the health of Caribbean men. We then showed how Caribbean masculinity can be understood through popular health behavior frameworks and detailed some practical implications for an understanding of Caribbean masculinity and health behavior. As has been argued, masculinity pervades the life experiences and spaces of men so completely that it is of critical importance to understand the ways it promotes and undermines health behavior. Such an understanding is important not only to further research on this topic but also to inform efforts to promote men’s health. Given that at any moment, men have multiple, dynamic masculinities available to them that are shaped by the social and cultural dimensions of society, it behooves us as psychologists and researchers to be contextual and nuanced in our analyses of masculinity and its impact on health behavior. For Caribbean men—a group that has been understudied in this regard— a multitude of simultaneous and even competing forces shape and reshape their sense of manhood. From the legacies of slavery and indentured servitude to the contemporary processes of migration, globalization, and acculturation, the forces that contribute to Caribbean masculinity are many and varied. Moreover, these social and cultural factors have implications for the health behavior of Caribbean men vis-à-vis their role in creating masculine scripts that inform the ways they understand themselves and interact with the world. Although the focus of this chapter is on Caribbean men and their health, we also call for research and analyses that examine the overlapping and unique health challenges faced by Caribbean women across the diaspora. This call is fueled by a concern for, and understanding of, the interconnectedness and unique nature of the gendered health experiences of men and women. It is also shaped by research that suggests this type of analysis is warranted and important to increase the health and well-being of both genders across the Caribbean diaspora (Blackman et al., 2014; D. R. Williams & Mohammed, 2009; Wilson et al., 2008; Zunzunegui et al., 2009). The task now faced by researchers and public health professionals regarding Caribbean masculine scripts is to further understand these scripts and their impact on health behaviors, while devising ways to leverage them so that they promote and not undermine the health of Caribbean men, their families, and their communities. contextualizing the health behavior of caribbean men     

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8 INTERPERSONAL VIOLENCE IN THE CARIBBEAN: ETIOLOGY, PREVALENCE, AND IMPACT GILLIAN E. MASON AND NICOLA SATCHELL

The Latin American and Caribbean region is considered one of the most violent areas in the world (Small Arms Survey, 2012). In 2005, the Caribbean had the highest, and Latin America the fifth highest, murder rate out of 15 regions in the world (United Nations Office on Drug and Crime [UNODC] & Latin America and the Caribbean Region of the World Bank [LAC World Bank], 2007). Unlike Latin America, in the Caribbean, most of the violence is social (Geneva Declaration Secretariat, 2011). Needless to say, government agencies, social scientists, and policymakers within the Caribbean are quite concerned with the high levels of interpersonal violence and its impact on families and children and on society as a whole (Harriott, 2008a). Accordingly, significant resources have been poured into trying to fully understand this level of violence and into formulating policies to effectively address violence within communities, schools, and families.

http://dx.doi.org/10.1037/14753-009 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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Caribbean researchers from different disciplines have examined the problem of violence from varying theoretical and methodological perspectives. For example, social workers (e.g., Crawford-Brown, 2010), criminol­ogists (e.g., Harriott, 2008a), medical professionals (e.g., Meeks Gardner, Powell, Thomas, & Millard, 2003), anthropologists (e.g., Gayle, Grant, Bryan, Yee Shui, & Taylor, 2004), and economists (e.g., Francis, Gibbison, Harriott, & Kirton, 2009) have examined the diverse impact violence can have on Caribbean societies. The psychological sciences can contribute much to the effort, but some would argue that their input thus far has been relatively minimal. As can be seen from the chapters in this volume, within the Caribbean, diverse areas of the psychological sciences are more widely recognized, and researchers have suggested both developing and increasing the training of psychologists in the region to address wide-ranging human needs (Ramkissoon, 2011; Ward & Hickling, 2004). In this chapter, we integrate literature from across several disciplines to document the prevalence of interpersonal violence and its etiology in the Caribbean context; discuss theoretical perspectives on interpersonal violence; and examine attitudes toward, and the impact of experiencing, interpersonal violence. In the concluding section, we discuss the role of Caribbean psychologists in studying and developing programs to reduce interpersonal violence. Because violence falls into different categories based on who is inflicting physical injury on whom (Krug, Mercy, Dahlberg, & Zwi, 2002), the focus of this chapter is on interpersonal violence. Such behavior occurs between people “acting in their private lives with no regard to occupational roles or formal institutions” (Barak, 2003, p. 23) and is facilitated by societal structures and poor public policy. Our discussion therefore centers on family violence, specifically intimate partner violence and child maltreatment. In keeping with Bronfenbrenner’s (1977) ecological model, we recognize the need to consider violence wherever it happens as being part of a multilevel system involving both proximal and distal processes. The overlap of the individual, the family, the community and its institutions, and the society cannot be ignored, as the occurrence of violence at any of these levels affects, in some way, the other levels. Given the central role that the situational context plays in interpersonal violence, the chapter begins with a discussion of aspects of the Caribbean society we view as being most relevant to the occurrence of interpersonal violence. THE CONTEXT OF INTERPERSONAL VIOLENCE IN THE CARIBBEAN The etiology of violence is difficult to identify, given the complex nature of this phenomenon (Smith & Green, 2007). We argue that violence in the Caribbean is directly linked to a number of factors, including but not 206       mason and satchell

limited to the region’s violent history, sociopolitical activities following independence from colonial rulers, poor economic conditions and associated illegal activities, and international migration. Beginning with sociohistorical experiences, the colonial encounter included an extended period of trading and enslavement of Africans and, later, the introduction of East Indians as indentured laborers. According to Hutton (1996), “violence was the instrument of impregnation, gestation, birth, and development of the plantation system” (p. 1). Violence was used to perpetuate complete control over the enslaved Africans and was especially evident through punishment, which was often extremely violent, with little to no accountability if death occurred (Hutton, 1996). Punishment was frequently delivered in public, engendering a general air of fear. Violence toward the enslaved was not limited to the physical format. Many enslaved females were sexually assaulted by colonizers, and in some instances they were hired out to perform sexual services (Barrow, 1996; Beckles, 1989). These experiences of physical and sexual domination by enslavers are believed to have created significant trauma affecting individuals, the nature of the Africans’ intimate relationships and their family structures, and the overall collective (Barrow, 1996; Ward & Hickling, 2004). Indentured servitude introduced its own set of social exclusion and gender relations. Most people brought as laborers to the Caribbean, primarily to Guyana and Trinidad and Tobago, were males, resulting in gender imbalance (Barrow, 1996; see discussion of gender roles in Chapter 3). On top of the effect of the traditional patriarchal gender role ideology, the smaller number of women present in the laboring communities introduced fierce competition for mates and encouraged violence against women and in some cases death (Sharma, 1986). The gender imbalance and violence toward women would persist far into the postindentureship period (after 1917) when legal marriages became recognized. Following these eras, the region endured a prolonged period of dependence as colonies of European powers (Fanon, 1963). Nicolas and Wheatley (2013) asserted that the period of colonization has an indirect influence on many current Caribbean phenomena, which would likely include interpersonal violence. Fanon (1963) proposed that the trauma experienced during the colonial period resulted in a sense of powerlessness, which is manifested by Caribbean persons showing dominance over one another. However, people of the region are also affected by their historical resistant efforts against enslavement and colonization. As stated by Nicolas and Wheatley, “The psychological impact of fighting for freedom can have a significant impact on the psyche of the individual . . . which is not easily eradicated by the passage of time alone” (p. 172). Indeed, experiences with oppression and violence extended throughout the period of state dependence on European colonizers and continued interpersonal violence in the caribbean     

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after Caribbean nation states gained independence. The process of acquiring nationhood was not a seamless or easy one (United Nations Development Program [UNDP] Caribbean Human Development Report, 2012a). Young political parties seeking power and control of their country’s resources encouraged fierce competition among supporters, which has had the long-term result of fragmenting communities in many Caribbean countries along political party lines and in some cases ethnic lines, as in Guyana and Trinidad and Tobago (Mars, 2001; Premdas, 2007; Sives, 2003; UNDP Caribbean Human Development Report, 2012a). Ellis (1987) argued that criminal violence in the region could be seen as an adaptive survival strategy to counter existing socioeconomic and political conditions. For instance, in Jamaica, political competition as well as societal displacement of the masses transformed the character of many urban areas, resulting in the formation of garrison communities. These communities exemplify the patron–client relationship and the strong motivation behind violent confrontations, which has implications for other forms of violence. Probably not as severe as in Jamaica, political rivalry in other Caribbean territories, such as Grenada, Guyana, Suriname, and Trinidad and Tobago contribute to the incidence of violence, whether directly or through experiences of social displacement. Three issues related to socioeconomic conditions are also connected to the occurrence of violence. First, poor economic conditions are connected to violence by encouraging illegal money-earning activities (Small Arms Survey, 2012). Violence as a by-product of drug or human trafficking is quite common, and with increased drug activity feuds between and within drug gangs often increase. The use of firearms and other weapons and their exchange for drugs also contribute to overall levels of violence in the Caribbean (United Nations Children’s Fund [UNICEF], 2006; Small Arms Survey 2012). Second, weak gender relations exacerbated by economic pressure contri­ bute to violence toward women and children (Le Franc & Rock, 2001). Gender relations in the Caribbean are affected by attitudes about partner relationships situated in male dominance and issues of male identity (DeShong, 2011; Jewkes, 2002). Feelings of machismo and beliefs that men are the head of households are quite prevalent across Caribbean communities even though women are the chief economic providers in a significant number of households (P. Anderson, 2007; Le Franc & Rock, 2001). A possible conceptual separation between men’s roles as fathers and companions to mating partners or spouses (P. Anderson, 2007) can lead to gender mistrust wherein men can become abusive if questioned about their social ties and activities with other men. Mistrust and dominance become exacerbated in the face of poor economic conditions, family instability, and the need to define manhood through biological fatherhood with many mating partners (Le Franc & Rock, 2001; Roopnarine, 2013). 208       mason and satchell

Finally, international migration, which is often driven by a search for greater opportunities and economic benefits, places children at increased risk for experiencing violence either directly or as witnesses (Blank, 2007). Caribbean parents who engage in serial migration, which occurs more frequently within the working class, leave children behind in sometimes precarious caregiving situations. Children may be placed with relatives, such as grandparents and aunts and uncles, who may be ill-equipped to psychologically and economically care for young children and adolescents (Pottinger & Williams Brown, 2006; Sharpe & Mohammed, 2013). Coupled with the common practice of child shifting (Ramkissoon, 2006), parental separation due to migration increases children’s vulnerability to abuse (Crawford-Brown, 2002) and social difficulties in school and community settings (CrawfordBrown, 2002; Pottinger & Williams Brown, 2006). Although these children receive the benefit of material goods from their parents in North America and Europe, their feelings of abandonment and loss can lead them to anti­ social behaviors and activities that involve violence (Crawford-Brown, 2002; Pottinger & Williams Brown, 2006). Not examined in the Caribbean literature, intergenerational conflict (e.g., between migrated parents and children still at home, between migrated parents and children’s caregivers in the country of origin) might be another by-product of Caribbean citizens leaving the region for economic gain (Foner & Dreby, 2011) and might be an area worth examining for Caribbean families. The sociohistorical, economic, and political perspectives just outlined provide the context within which interpersonal violence in the Caribbean occurs. It is our contention that having more psychological analyses of issues related to interpersonal violence would meaningfully contribute to reduction efforts. In particular, an examination of attitudes toward violence, coping factors, and institutional responses would do much to inform policies and clinical practice. We turn next to the prevalence of interpersonal violence in Caribbean countries. Prevalence of Interpersonal Violence In 2005, the murder rate in the Caribbean of 30 murders per 100,000 population was higher than any other region in the world (UNODC & LAC World Bank 2007). This level of violence is not uniform across Caribbean countries, nor do all countries have problems with the same types of violent activities. The most recent report on human development in the Caribbean showed that the percentage of respondents who reported being victimized in the preceding decade ranged from 17.4% in Jamaica to 26.6% in Barbados, and the 2010 police-reported rates for homicide per 100,000 citizens ranged from a low of three in St. Lucia to 50 in Jamaica (UNDP Caribbean Human interpersonal violence in the caribbean     

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Development Report, 2012a1). In contrast, St. Lucia had the highest reported level of rape in 2010 (40 per 100,000 persons), and Barbados had the lowest (18 per 100,000 persons; UNDP Caribbean Human Development Report, 2012a). Despite variations across territories, over the past 20 years most countries have seen an increase in their homicide rates; the exceptions are Suriname, for which data were provided only for the past 10 years, and Barbados (UNDP Caribbean Human Development Report, 2012a). The rates for violent crimes in which death occurs are accessible through police documentation. However, relying on police documentation of family violence with nonfatal outcomes may grossly underestimate the problem (Le Franc, 2001; National Family Planning Board [NFPB], 2010; Sharpe, 1997). Although most, if not all, Caribbean countries have official channels that allow the reporting of crimes including intimate partner violence and child maltreatment, the usually private nature in which these incidents occur provides victims and witnesses with the opportunity of choosing when and whether to make a report (Krug et al., 2002). Fear of reprisal from the perpetrator, beliefs that family matters are private, and economic reliance on the perpetrator all contribute to the delay in and underreporting of these crimes (Cabral & Speek-Warnery, 2004; Schmeitz, 2006; UNICEF, 2006). In general, data for nonfatal violent acts from Jamaica, Barbados, and Trinidad and Tobago are more readily available than those from other Caribbean countries. However, even within those locales, limited prevalence research has been done at the national level. In addition, challenges in gathering data and variations in methodologies result in the surveys producing inconsistent reports. For instance, if the researchers rely on official police statistics, the data may be affected by the reporting issues mentioned earlier; in other instances discrepancies may arise because of differences in the parameters used to define violence (Blank, 2007; Gopaul, Morgan, & Reddock, 1996; Schmeitz, 2006; Zellerer, 2000). The result is that uncertainty remains regarding prevalence rates. A comparison of three recent intimate partner violence reports for Caribbean countries illustrates this problem. These reports are a three-country sample (Barbados, Jamaica, and Trinidad and Tobago) of 3,401 adolescents and young adults between the ages of 15 and 30 years (Le Franc, Samms-Vaughan, Hambleton, Fox, & Brown, 2008); a Jamaican national survey of 7,222 women between the ages of 15 and 49 years (NFPB, 2010); and a report from 11,155 randomly selected adults (i.e., 18 years old and older) from Antigua and Barbuda, Barbados, Guyana, Jamaica, Saint Lucia, Suriname, and Trinidad and Tobago

This report covered seven Caribbean countries: Antigua and Barbuda, Barbados, Guyana, Jamaica, Saint Lucia, Suriname, and Trinidad and Tobago. 1

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(UNDP Caribbean Human Development Report, 2012a, 2012b). All three reports created their samples so the distribution by gender and by urban/ rural residence (NFPB, 2010) or by country of residence (UNDP Caribbean Human Development Report, 2012a) was proportionate, but Le Franc et al. (2008) appears to also have stratified by age. The real differences among the three methods emerge in their parameters for measuring violence. First, although all three reports asked respondents about experiences with current and/or former partners, they differ in the period covered. Both Le Franc et al. (2008) and NFPB (2010) provided lifetime rates, whereas the UNDP Caribbean Human Development Report (2012a) considered relied on respondents’ experiences from the preceding 12 months. It is therefore not surprising that the rates from the UNDP Caribbean Human Development Report (2012b) are lower than those for the other two reports (see Table 8.1). The second major distinction was with the definition of physical violence, and this distinction was twofold. Both the NFPB (2010) and the Le Franc et al. (2008) studies used multiple physical violence items, whereas the UNDP Caribbean Human Development Report (2012a) survey included just one item (i.e., instances when a partner/ex-partner used violence against the respondent). It is also noteworthy that although the items from the two former studies came from the Revised Conflict Tactics Scale (CTS2; Straus, Hamby, Boney-McCoy, & Sugarman, 1996) the NFPB study used only six adapted items, whereas Le Franc et al. used all 12 CTS2 items; this variation helps to explain some of the difference between their reported rates

TABLE 8.1 Comparison of Percentage Rates of Physical Intimate Partner Violence for Nationally Based Samples Country Barbados Source Le Franc et al. (2008)a (N = 3,401) NFPB (2010)a (N = 7,222) UNDP (2012b)b,c (N = 5,012)

Jamaica

Trinidad and Tobago

Women %

Men %

Women %

Men %

Women %

Men %

50.0

44.7

45.3

40.4

45.2

47.7

17.2

—

9.2

5.4

7.9

Note.  A dash indicates data were not obtained (i.e., only women were asked about victimization). NFPB = National Family Planning Board; UNDP = United Nations Development Program. aRates for lifetime experiences of physical violence by an intimate partner or ex-partner. bRates for being physically injured by an intimate partner or ex-partner in the last year. cRates were not disaggregated by gender.

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(see Table 8.1). Further, the UNDP Caribbean Human Development Report (2012a) survey asked only about instances in which the respondent had been injured whereas neither Le Franc et al. nor NFPB made such a distinction. The final difficulty among the three reports concerned how the genders were included. Le Franc et al. (2008) asked victimization questions of both genders, whereas only Jamaican women were asked about those experiences for the NFPB (2010) study. The UNDP Caribbean Human Development Report (2012b) survey asked victimization questions of both genders but only included aggregated data in their report. Differences were also observed in their reports for psychological violence. For example, on the basis of eight items from the CTS2, Le Franc et al. reported a 69% lifetime rate for psychological aggression for Jamaican women, whereas the NFPB survey used only two items and reported a lifetime rate that was just below 31%. Again, the UNDP Caribbean Human Development Report (2012b) survey asked about experiences in only the last 12 months and had one item (i.e., respondent being sworn at or insulted); their reported rate for Jamaicans (males and females) was 15%. Although the three approaches are valid, the variation in definitions and reporting strategies makes it difficult to be sure of the level of intimate partner violence occurring in the region. Not having a good grasp on prevalence rates makes it additionally challenging to adequately address the phenomenon. The discrepancies suggest a need for consensus in definitions and methods of data collection, especially for crimes such as these, for which underreporting by victims makes it difficult to rely on official statistics. Despite the differences in reported rates, the data across the three studies were in line with worldwide reports. That is, Caribbean lifetime rates of physical violence fall within the reported rates for other territories of 10% to 50% (Watts & Zimmerman, 2002), and in all cases the rates for psychological or verbal violence were higher than that for physical violence (Krug et al., 2002; Le Franc et al., 2008; NFPB, 2010; UNDP Caribbean Human Development Report, 2012a). Violence Against Children Caribbean children are exposed to various forms of violence in a range of settings. However, on the basis of existing research, it is safe to say that most of this violence occurs within family settings, with family members being the main perpetrators of child abuse (Meeks Gardner et al., 2006). Within the family, children experience various forms of violence, such as child abuse (sexual, physical, and/or psychological) and neglect, as well as witnessing instances of family violence (Joseph, 2001). Over the past 30 years, children’s rights and protection issues have received significant attention in the Caribbean. This shift has largely been due to the introduction and ratification of the Convention on the Rights of the Child (UNICEF, 2005), which 212       mason and satchell

Le Franc (2001) described as “one of the high points of the growing awareness of the unfortunate and disadvantaged position of large numbers of children” (p. 285). The increased attention to the rights and welfare of children notwithstanding, Kirton (2011) reported that a large number of children within the Caribbean are victimized and neglected. Recent regional reports conclude that both the rates and variability in incidence of abuse and neglect across Caribbean countries are high (UNICEF, 2006; 2012). For instance, sexual abuse is the most prevalent form of reported child abuse in Jamaica and Dominica, whereas general neglect is the most dominant form in Belize and Barbados; in Grenada, abandonment (a specific form of neglect) and neglect are most problematic (UNICEF, 2006). Another regional study also found significant levels of child abuse in Caribbean nations. The Caribbean Youth Health Survey composed of a sample of 10- to 18-year-olds (n =15,695) from nine Anglophone Caribbean countries (i.e., Antigua, Bahamas, Barbados, British Virgin Islands, Dominica, Grenada, Guyana, Jamaica, St. Lucia). As also reported in subsequent chapters in this volume (see Chapter 12), 16% of the sample reported having been physically abused; 10% had been sexually abused; 5% experienced both forms of abuse (Halcón et al., 2003). Another form of child sexual abuse, transactional sexual exchanges or “sex for gain,” is growing in the region (UNICEF; 2012; Williams, 2002). These exchanges can be for children to gain either basic-needs items or nonessential items, such as designer clothes, that parents cannot afford to purchase (Dunn, 2002; Pan Caribbean Partnership against HIV and AIDS [PANCAP] & Caribbean Community [CARICOM] Secretariat, 2009). Prevalence rates for this form of abuse are unavailable, as most of the studies done on transactional sex in the Caribbean are qualitative and only describe the nature of the activity (PANCAP & CARICOM, 2009). This type of abuse is seen in all social classes, but anecdotal information suggests that heads of economically challenged households may encourage or even initiate their children into such relationships to gain resources for the family, making these instances of abuse open secrets (UNDP Caribbean Human Development Report, 2012a; UNICEF; 2012). In such situations, this is a form of family violence against children. Within the Caribbean, children at all levels of society appear to be susceptible to experiencing abuse. However, regional reports indicate that physical and sexual abuse are more often reported for families who are of low socioeconomic status; those in which the parental figures have alcohol or drug abuse problems (UNICEF, 2006; 2012); and among children from minority indigenous groups, such as found in Suriname, St. Vincent and the Grenadines, and Guyana (Danns, 2001; Joseph, 2001; Terborg, 2001). Higher rates for abuse are also found among children with disabilities and those whose birth parents are absent or have died (Cabral & Speek-Warnery, interpersonal violence in the caribbean     

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2004). UNICEF (2012) has expressed special concern for migrant children for whom language barriers and fear of engaging with formal institutions may result in high rates of underreporting. Boys and girls are equally as likely to experience physical abuse but reports suggest that girls are more vulnerable to being sexually abused than boys (Milbourne, 1994, as cited in Rock, 2001; UNICEF, 2012). Some questions surround whether a gender difference really exists, as it may be that less attention is paid to sexual abuse against boys, especially when committed by women (UNICEF, 2012). The physical abuse of children can be viewed as a special category of maltreatment in the Caribbean because of the general acceptance of corporal punishment in the region (Cappa & Khan, 2011; Roopnarine, Jin, & Krishnakumar, 2014). Corporal punishment, often used as a form of dis­ cipline (Cappa & Khan, 2011; Chaffin, 2006; Joseph, 2001; Le Franc, 2001), sometimes results in nonaccidental physical injury, reflecting the UNICEF (2006) definition for physical abuse. In a few cases, the most extreme form of child physical abuse, homicide, occurs. Data accessed from the Trinidad and Tobago Police Service indicated 45 instances of homicide of children 15 years and under between the years 2000 and 2005. The method of homicide for these cases suggests that only a few of them may have been purely accidental, as most of the children were beaten to death, shot, burnt, stabbed, or chopped (St. Bernard, 2006). Unfortunately, little progress to date has been made in prohibiting the use of corporal punishment in the home, which is key if the practice is to be reversed (Global Initiative to End All Corporal Punishment of Children, 2012). On a positive note, most Caribbean territories have legislation or official policy that outlaws and/or discourages corporal punishment of children in settings outside the home. However, the same report indicates that the vast majority of Caribbean states still permit corporal punishment in penal institutions and several allow the court to sentence child offenders to corporal punishment (Global Initiative to End All Corporal Punishment of Children, 2012). One subset of child abuse that has received relatively little attention is child neglect, or behaviors that result in “negligent treatment or maltreatment of a child by a parent or caretaker under circumstances indicating harm or threatened harm to the child’s health and welfare” (Wallace, 2002, p. 90). The absence of research on this form of abuse contrasts with its reportedly high prevalence rates in countries such as Belize, Barbados, Dominica, Grenada, Jamaica, and St. Vincent and the Grenadines (Child Development Agency, Jamaica, 2008; Meeks Gardner et al., 2006; Rock, 2001; Thompson-Ahye, 1999). Given that children under 15 years of age constitute approximately 30% of the Caribbean’s population (Henry-Lee, 2006), it is imperative that their vulnerabilities receive wider attention from researchers and practitioners. 214       mason and satchell

Violence Among Youth It is vital that the occurrence and impact of violence against children by adults be examined, given the social and legal expectations of protection and the relatively high prevalence rates of such violence. However, the occurrence of violence from one child to another also needs to be examined. Across the Caribbean, as elsewhere, there is clear evidence that children perpetuate violence against other children (Abdirahman, Bah, Shrestha, & Jacobsen, 2012; Meeks Gardner et al., 2003; Pottinger, 2012). Such violence includes peer harassment, such as verbal and physical bullying, and interpersonal violence between children involved in intimate relationships (Abdirahman et al., 2012; Pottinger, 2012). With the increasing access to mobile telephones and the Internet, an additional growing phenomenon is Internet-, or cyber-, bullying (Eljach, 2011). Although the research in the Caribbean on bullying and adolescent intimate partner violence is limited, enough evidence exists to suggest that primary and secondary school children have these experiences. Recent studies in different Caribbean countries indicate that around 20% of students have been bullied or physically assaulted (Abdirahman et al., 2012; Meeks Gardner et al., 2003).We found no research on cyberbullying in the Caribbean, but anecdotal evidence as reported in national newspapers (e.g., Douglas, 2010; Neaves, 2013) documents its existence. This is an area ripe for research as researchers strive to determine the prevalence and effects of these types of behaviors. To effectively ventilate the issue of prevalence to understand and ultimately to provide successful treatment, researchers must identify theories that explain why violence occurs. Above, we discussed sociological and historical factors that contribute to interpersonal violence in the Caribbean. In the next section, we focus on some of the more common theories used to understand this phenomenon within Caribbean societies. These theories have been developed in North America and Europe where the social dynamics are quite different from our own. Nevertheless, the theoretical postulations are useful in guiding both theory and praxis in the field. SOCIAL PSYCHOLOGICAL THEORIES OF INTERPERSONAL VIOLENCE Theories used to explain the occurrence of violence fall into two general camps: those that target factors within the individual perpetrator of the violence and those that target factors outside of the individual, namely, elements within social networks and structures. Together, these approaches parallel interpersonal violence in the caribbean     

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the emphasis placed by ecological models on societal, family, and individual factors and processes. In line with Bronfenbrenner’s (1977) ecological model, researchers seek to identify factors at the various levels (i.e., individual level, microlevel, mesolevel, macrolevel) that are believed to contribute to the occurrence of violence (Krug et al., 2002). An ecological approach also seems more productive in view of the contradictory findings observed when any singular class of theory (i.e., biological, individual, social psychological) is used to explain violence (Kruh, Frick, & Clements, 2005). Although acknowledging that more individual-focused theories, such as psychoanalytic and personality theories, are relevant for understanding the occurrence of interpersonal violence, Caribbean researchers generally examine violence and crime within the context of the social conditions of the region. This is congruent with the social structural approach wherein crime is seen as a social phenomenon best understood through reference to the social and economic environment in which it occurs. Nonetheless, despite this dominance in Caribbean research, minimizing the role that individuallevel factors play in the occurrence of violence would be a mistake, given the implications for policy development and clinical interventions. This is particularly true of settings with high rates of violence where traumatic experiences have the potential to overwhelm traditional response systems designed to give victims a sense of security and control (Herman, 1997). SOCIAL LEARNING AND RELATED THEORIES Several social theories and frameworks can be used to explain violence, for example, social learning theory (Bandura, 1977), social contagion (Fagan, Wilkinson, & Davies, 2007), and intergenerational explanations for violence (Mihalic & Elliott, 1997). A common thread across them is that people learn to be violent and to accept violence on the basis of what they learn from significant others. Most important, this learning can be vicarious, with individuals learning to use and accept violence just from observing significant others’ behaviors and the responses they receive for performing such deeds (Bandura, 1977). The social learning theoretical approach is particularly relevant when trying to explain youth violence, as it purports that youth learn that violent responses are appropriate and effective from observing the adults in their lives. Moreover, the lack of negative consequences from engaging in these behaviors reinforces for the youth the value of performing such violent acts (Ellis, 1987). This perspective considers that the intergenerational transmission of violence occurs through learning mechanisms (Mihalic & Elliott, 1997). Social contagion shifts the focus from learning from adults to learning from one’s peers but still maintains the idea of violence (as a concept and 216       mason and satchell

a behavior) spreading like a virus among people (Burt, 1987; Fagan et al., 2007). The social contagion theory aligns well with examinations of adolescent delinquent behavior and to gang violence, given its focus on the need for a shared social network where persons are structurally equivalent (Burt, 1987). An offshoot of the social contagion theory is the idea that violence is spread via “most fit” memes, which are those ideas that most easily selfreplicate (Fagan et al., 2007). These replicated memes then develop into cognitive scripts to which members of a culture refer when necessary, suggesting an avenue by which violence becomes inculcated into a culture (Fagan et al., 2007). This helps to explain why and how certain manifestations of violence, such as intimate partner violence, may have become normalized over time for many Caribbean nations. The media in all its forms (e.g., television, video games, radio, cellular telephones, Internet) are often mentioned as contributing to the development of a culture of violence. Research consistently demonstrates that exposure to media violence results in short-term and long-term expressions of aggression (C. A. Anderson et al., 2003). It is believed that both short- and long-term effects are due to observational learning and priming, but other processes, such as desensitization and physiological arousal, also play a role (C. A. Anderson et al., 2003; Huesmann, 2007). The rapidly changing and easily accessible technology provides greater opportunities for exposure, and researchers are especially concerned for the youth who spend copious amounts of time with these forms of entertainment. Given the current advent, in which video games permit more direct involvement (i.e., players perform “kills”) and are structured to be played simultaneously with peers through multiplayer games, theoretical and research-based examinations are needed to understand the potential ramifications of these additional layers of contact with violence (Huesmann, 2007). Along with the social psychological theories just described, it should be noted that due to prevailing beliefs about gender role ideologies in the region, scholars often use the feminist theory when discussing intimate partner violence in Caribbean communities (DeShong, 2011; Pargass & Clarke, 2003). Perspectives emanating from this theory emphasize the role of male dominance as a causative factor for intimate partner violence (McPhail, Busch, Kulkarni, & Rice, 2007). Emerging from the 1970s, feminist theory posits that male privilege dominant in patriarchal societies, along with rigid gender roles, results in males feeling entitled to abuse their female partners (Muturi & Donald, 2006). Recent examinations of feminist frameworks, such as the integrative feminist model (McPhail et al., 2007), have expanded the focus from being solely social to incorporating contributory individual factors. Therefore, although still maintaining male privilege as central to the occurrence of intimate partner violence, such models recognize the combined effect of personal interpersonal violence in the caribbean     

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elements (e.g., physiological factors, attachment disorders, psychopathology, difficult personality traits) and social elements (e.g., intergenerational transmission of violence, the social construct of maleness; McPhail et al., 2007). This intermingling of elements from different structural levels further reinforces the point made above about the need to consider violence within an ecological context. As outlined above, violence has a far-reaching impact in many societal spheres, and exposure can produce a range of physical and psychological responses in individuals. We discuss such responses in the next section, focusing on the psychological impact. However, in keeping with our ecological perspective, our discussion is not limited to the individual but also examines the impact on institutions and society at large as well. THE PSYCHOLOGICAL IMPACT OF VIOLENCE The impact of interpersonal violence, whether in its physical or psychological form, penetrates all ecological levels. At the individual level, psychological repercussions result from direct and indirect experiences with violence. Typical reactions include feeling anxious; an inability to react with emotion; demonstrations of dissociative symptoms and/or personality changes; and victims performing deviant behaviors, such as perpetuating criminal and/or violent acts (Follingstad, 2009; Kirton, 2011; Meeks Gardner, Powell, & Grantham-McGregor, 2007; Smith & Green, 2007; Waszak Geary, Wedderburn, McCarraher, Cuthbertson, & Pottinger, 2006). Receiving physical injuries also has the potential to cause psychological distress. Concern should lie not only with those who are direct victims of violence but also with people who are indirectly exposed, given the serious harm that can occur. For instance, Kitzmann, Gaylord, Holt, and Kenny’s (2003) meta-analysis of studies of child witnesses of domestic violence showed no differences in psychosocial responses between them and physically abused children. This is an area of significant concern as the “intentional, repetitive, and personally directed” nature of violence in the home creates significant levels of trauma for children even if such violence is not aimed at them (Cohen, Mannarino, Murray, & Igelman, 2006, p. 738). The impact for children exposed to violence deserves special mention, given their developmental and social status. Research strongly indicates that the negative outcomes for young children are both immediate and long lasting (Margolin & Gordis, 2000), making this an issue of concern for psychologists. Findings from Caribbean research document possible longer term effects. For example, analyses of data from the 1997 Caribbean Youth Health Survey found that youths ages 10 to 18 years who experienced either sexual and/or 218       mason and satchell

physical abuse were much more likely to report suicide attempts, depression, and feeling like killing someone, even though these instances of abuse may have occurred several years before (Blum et al., 2003). Also of concern to psychologists is the likelihood that maladaptive coping strategies children develop in response to violent experiences will extend into adulthood, creating a victimization–criminalization continuum. To address these two concerns, researchers should better understand the intricacies of children’s response mechanism that integrates anatomy, physiology, and psychopathology. Although much research focuses on psychological outcomes, there has also been a growing interest in learning about children’s neurobiological responses, as evidence indicates that some of these effects, such as dysregulated hypothalamic–pituitary–adrenal axis activity, may help explain the development of psychological problems, such as depression and anxiety (Bevans, Cerbone, & Overstreet, 2005). Understanding how these mechanisms work is one aspect of the overall move to conduct more process-oriented analyses in which researchers seek to identify causative, rather than correlational, factors in the patterns of children’s response to violence exposure (Cummings & Davies, 2002). Process-oriented research also provides a framework for explaining the dynamic processes that contribute to these responses while accounting for the complexities of the situational context and children’s developmental stage (Cummings & Davies, 2002). The more researchers can fully understand how violence affects children’s development—their biological, emotional/psychological, and social development—the faster they will be able to stymie its impact on them. Violence in the community, especially if it occurs frequently, can harm citizens’ general psychological state, as it produces anxiety, depression, post­ traumatic stress disorder, and a universal fear of crime (Cooley-Quille, Boyd, Frantz, & Walsh, 2001; Morrison, 2000; UNDP Caribbean Human Development Report, 2012b). This has been observed in Jamaica where political rivalry has created high levels of violence and fragmentation within communities that leave all members of the society vulnerable to psychological harm (Bailey 2010; Harriott, 2008b). In an attempt to protect their children, parents may send them to stay in safer communities, disrupting the household and causing additional psychological distress to all involved (Pottinger, 2005). Within the micro- and mesosystems, entities such as families, schools and workplaces experience repercussions if a member is a victim of violence or if the entity itself experiences violence. These systems are adversely affected in societies where violence occurs frequently. For instance, it shapes how players in the setting interact and establish guidelines to protect members. The psychological impact of violence at the societal level is a conglomeration of the effects at all other levels of the ecology. In addition, the potential for psychological damage to individuals and smaller systems can result from interpersonal violence in the caribbean     

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negative interactions with social institutions, such as the police and the legal system, that should provide support to victims of violence (UNDP Caribbean Human Development Report, 2012a). This confirms the pervasive nature of violence, so that even industrial and organizational psychologists have cause for professional concern. Researchers also should not ignore the perpetrators, as they are an important component of understanding violence at the individual level. Often, these perpetrators were survivors of violent experiences and having those victimization experiences may have contributed to their becoming perpetrators (Kamphuis & Emmelkamp, 2005). Addressing the psychological concerns of perpetrators should therefore decrease the incidence of violence. Special mention must also be made of the need for greater understanding of psychological violence. Although there has been some research in this area in North America (e.g., Follingstad, 2009), not much has been done in the Caribbean, and it appears that this form of abuse is “downplayed by victims, policy makers and the media” (UNDP Caribbean Human Development Report, 2012a, p. 30). Minimizing such abuse undoubtedly affects the nature of attitudes concerning psychological violence generated within the society. In examining the impact of violence, psychologists should not only be concerned with assessing effect but also with the tools used for measurement, and it is also important that researchers identify individual and situation-specific characteristics that serve as protective factors (Cooley-Quille et al., 2001; Kamphuis & Emmelkamp, 2005). Recently, a few attempts have been made to validate clinical measures used in assessing Caribbean people’s emotional response to interpersonal violence (e.g., Lambert, Essau, Schmitt, & Samms-Vaughan, 2007), but much more can and should be done. Work of this nature must be encouraged, as getting an accurate understanding of the impact violence has on the individual and the factors that attenuate such impact is important when trying to determine effective ways to help his or her recovery. ADDRESSING VIOLENCE: CHALLENGING ATTITUDES THAT SUPPORT INTERPERSONAL VIOLENCE An important aspect of addressing violence is to understand and challenge prevailing supportive attitudes and the rationalizations and social processes that facilitate their replication. Attitudes speak to the “learned, global evaluation of an object (person, place, or issue)” (Perloff, 2008, p. 59), and it is well established that one’s attitude influences one’s beliefs and behavior (Erwin, 2001; Perloff, 2008). Likewise, cultural schemas, or ethnotheories, about socialization practices (e.g., physical punishment) can influence the implementation of behaviors and activities to achieve socialization goals 220       mason and satchell

(Super & Harkness, 2002). Society-level attitudes that support violence can create environments wherein victims can feel further victimized, can deter them from acknowledging and reporting violent incidents, and can discourage prosocial responses (i.e., helping behavior, empathy; Griffith, Negy, & Chadee, 2006; Krahé, Bieneck, & Möller, 2005). In addition, these attitudes may suggest to the citizenry that perpetuating such behaviors is feasible and normative. Thus, the cultural context and prevailing societal attitudes that are supportive of violence, having been identified, should be vigorously and effectively challenged (Gracia & Herrero, 2006; Meeks Gardner et al., 2003). Caribbean writings speak of a culture that condones and even encourages violence (Ellis, 1987). The widespread acceptance and use of corporal punishment in home and school (Brown & Johnson, 2008; Cappa & Khan, 2011; Roopnarine, 2013; UNICEF, 2006; Zellerer, 2000) and the prevailing belief that domestic violence is a private matter foster a high level of tolerance for such behaviors and lend support to this assertion (Blank, 2007; Schmeitz, 2006; Zellerer, 2000). The desire to control others seems to be the rationalization behind these attitudes. For parents, the justification behind corporal punishment is that children belong to them, and to thwart behavioral transgressions, they need to beat the “badness” out of the child and use harsh punishment to build character (Brown & Johnson, 2008; Leo-Rhynie & Brown, 2013). For intimate partner violence, a seemingly shared view is that the woman should be under the control of her male partner, which is tied into the traditional view that the man is the head of the household and that each gender has distinct roles to play in the home (Brown & Chevannes; 1998; Le Franc & Rock, 2001). Despite the apparent normalization of intimate partner violence across the region, Le Franc and Rock (2001) highlighted that the majority of citizens do not engage in this behavior. Similarly, national reports demonstrate relatively low levels of agreement with beliefs which anecdotally may be assumed to be the dominant viewpoint (e.g., NFPB, 2010; Statistical Institute of Belize [SIB] & UNICEF, 2012). The rates of agreement by women from Guyana, Belize, Suriname, and Jamaica that it was all right for men to hit their wives under particular circumstances (e.g., refusing sex, mishandling food, having sex with another man) were all under 15% (Ministry of Social Affairs and Housing & Bureau of Statistics, 2012; NFPB, 2010; SIB & UNICEF, 2012). Although the rates were higher for young Jamaican men who were asked the same questions, the rates of agreement were still below 25% (NFPB, 2010). Data collected from East Indian Guyanese women in the late 1980s suggested greater support of men’s right to abuse women (Danns & Parsad, 1989, as cited in Cain, 2001), so these more recently reported rates may reflect that a change in attitudes toward intimate partner violence is occurring. Ideally, no one should agree with such statements, but interpersonal violence in the caribbean     

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the relatively low rates supporting intimate partner violence is encouraging for the fight to change social norms. Attempts to change attitudes and beliefs (and by extension institutional responses) about interpersonal violence have largely been through legislative reform, such as requiring mandatory reporting, which has been fueled by international laws (Economic Commission for Latin America and the Caribbean & United Nations Development Fund for Women, 2003; Meeks Gardner et al., 2006; UNICEF, 2005, 2012). Although these changes by state institutions have likely resulted in greater awareness among the populace concerning the rights of women and children, new tensions may have been created with citizens being resistant to the new paradigms. Such situations can produce additional opportunities for violence, and ways to monitor and counter this must be considered. Some have postulated that in the Caribbean the supportive culture of violence is more responsible for the high levels of violence than the psychological processes (Ellis, 1987; Harriott, 2009). Although the accuracy of such a claim can be questioned, it nonetheless draws attention to the underlying role of cultural attitudes and beliefs in the occurrence of violence. We have mentioned only a few attitudes and beliefs relevant to interpersonal violence; further research is needed to comprehensively identify belief systems that contribute to the apparent normalization and acceptance of this behavior (Dudley-Grant, 2013). THE WAY FORWARD: CHALLENGES AND OPPORTUNITIES This review of the prevalence of interpersonal violence and its sequelae demonstrates several roles for psychologists. To be able to make any headway in decreasing the level of violence, the region must first be aware of the level of violence that exists. In this regard, psychologists should follow the example of interdisciplinary measurement teams in other regions who have been successful in formulating relevant definitions and establishing prevalence rates (Orpinas & de los Ríos, 1999). This approach better informs specificity in the types and amount of resources needed to tackle the problem. Simultaneously, given the demography of the region, more attention should be given to studying all forms of interpersonal violence, including the much neglected area of child maltreatment. Researchers and practitioners in the psychological sciences can do much to attend to the scourge of violence that has significantly undermined human capital development and increased citizen insecurity in the Caribbean region. The following may assist in advancing our scientific and applied understanding of the diverse dimensions of interpersonal violence. 222       mason and satchell

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Reduce insularity to improve communication among psychologists and other social science and mental health disciplines across the Caribbean. Cross-country and cross-disciplinary discussions would permit psychologists with different skill sets to work with each other and with other mental health and social service delivery professionals. This has the potential of improving training and mobilizing service resources at the regional level (see Chapters 1 and 2, this volume; Meeks Gardner et al., 2006; UNICEF, 2006). No doubt, the Caribbean Alliance of National Psychological Associations will provide a platform for the discussion of regional human development needs (see Chapter 1, this volume). The Internet and other technological media have already made a difference in sharing research information and in other dissemination efforts. Improve the quality and accessibility of research conducted in the region. Although an emerging body of work focuses on violence in the Caribbean, some have concerns about the use and usefulness of the research findings. Studies that are couched within the preventative science framework and use more complex models to examine direct and indirect associations between violence and psychological outcomes would isolate both risk and protective factors that aid/abet the impact of interpersonal violence. Clearly, more complex multifactor designs and analytic techniques (e.g., structural equation modeling) would enable an examination of causal mechanisms. Validate research and clinical instruments in the area of violence for use with Caribbean populations. This need is discussed in Chapters 13 and 14 in this volume, but the area of violence presents new challenges with respect to diagnostic and research tools. More refined definitions and assessment criteria for establishing the prevalence of different modes of violence are necessary to accurately determine the gravity of the situation in the Caribbean. Help change attitudes and beliefs about interpersonal violence at the individual, institutional, and societal levels. Too often, agencies within governmental systems (e.g., police and court systems) disparage and insult victims of violence and delay justice. This has the potential of conveying to the Caribbean populace that violence is a justified behavior. Policies that speak to these issues within reporting agencies and the legal system are sorely needed.

Much more can be learned about the multitude of factors associated with interpersonal violence in the Caribbean region: for instance, sociocultural, interpersonal violence in the caribbean     

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distal and proximal family processes, institutional, and societal beliefs and practices. Although pragmatic and academic exchanges in individual sub­ areas, such as health, peace, and clinical psychology, would be of benefit, an ecological approach could be particularly useful in coordinating crossdisciplinary research and regional response efforts. It will take a strong commitment on the part of government agencies, social scientists, and practitioners to reduce the prevalence and impact of interpersonal violence on human and economic development in the Caribbean. REFERENCES Abdirahman, H. A., Bah, T. T., Shrestha, H. L., & Jacobsen, K. H. (2012). Bullying, mental health, and parental involvement among adolescents in the Caribbean. The West Indian Medical Journal, 61, 504–508. http://dx.doi.org/10.7727/ wimj.2012.212 Anderson, C. A., Berkowitz, L., Donnerstein, E., Huesmann, L. R., Johnson, J. D., Linz, D., . . . Wartella, E. (2003). The influence of media violence on youth. Psychological Science in the Public Interest, 4, 81–110. Anderson, P. (2007). The changing roles of fathers in the context of Jamaican family life. Kingston, Jamaica: Planning Institute of Jamaica and The University of the West Indies. Bailey, C. (2010). Social protection in communities vulnerable to criminal activity. Social and Economic Studies, 55, 211–242. Bandura, A. (1977). Social learning theory. Oxford, England: Prentice-Hall. Barak, G. (2003). Violence and non-violence: Pathways to understanding. Thousand Oaks, CA: Sage. Barrow, C. (1996). Family in the Caribbean: Themes and perspectives. Kingston, Jamaica: Ian Randle. Beckles, H. (1989). Natural rebels: A social history of enslaved Black women in Barbados. London: Zed Books. Bevans, K., Cerbone, A. B., & Overstreet, S. (2005). Advances and future directions in the study of children’s neurobiological responses to trauma and violence exposure. Journal of Interpersonal Violence, 20, 418–425. http://dx.doi.org/10.1177/ 0886260504269484 Blank, L. (2007). Situation analysis of children and women in the Eastern Caribbean. Bridgetown, Barbados: UNICEF Eastern Caribbean Office. Blum, R. W., Halcón, L., Beuhring, T., Pate, E., Campell-Forrester, S., & Venema, A. (2003). Adolescent health in the Caribbean: Risk and protective factors. American Journal of Public Health, 93, 456–460. http://dx.doi.org/10.2105/AJPH.93.3.456 Bronfenbrenner, U. (1977). Toward an experimental ecology of human development. American Psychologist, 32, 513–531. http://dx.doi.org/10.1037/0003-066X.32.7.513

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IV SOCIAL PSYCHOLOGY

9 COPYCAT CRIME BEHAVIOR: IMPLICATIONS FOR RESEARCH IN THE CARIBBEAN RAY SURETTE, MARY CHADEE, AND DEREK CHADEE

In 2002, a 17-year-old teenager duped a security guard at an international school in Trinidad, entered the compound of the school with his father’s 9mm gun, shot a security guard, and held a student hostage in a computer room. The teenager was fatally shot by the police. Later, a suicidal note was discovered that suggested that the teenager was also strongly prejudicial to people whose sexual orientation and ethnic background were different from his. Over the following weeks, the police were concerned with copycat crimes on prestigious schools in the country. Although shootings of these kinds are rare even outside of the Caribbean, other kinds of less news-grabbing criminal behavior includes bullying, shooting, and robberies that may be academically defined as copycat behavior and worthy of studying. In this chapter, we recognize the limitation of copycat research in the Caribbean and make a case for developing an active research agenda on this topic.

http://dx.doi.org/10.1037/14753-010 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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Almost three decades ago, Jones-Hendrickson (1985; as cited by DudleyGrant, 2001) argued that increased exposure to the media and telecommunications was an important explanatory factor for understanding crime in the Caribbean. In the Caribbean and elsewhere, male youths commit most of the violent crimes, and having early violent experiences is a strong predictor of risk of committing violence (Dahlberg, 1998; Willman & Marcelin, 2010). The availability of guns and other weapons within Caribbean territories creates opportunities to pursue criminal activities, which can be observed via the media. Caribbean researchers have intuitively associated negative media images and media idealization of criminal behavior as one core explanation for juvenile crimes. For example, Mustapha (2013), in recognizing the dominance of negative media images, especially violent images, in Caribbean programs, recommended depictions of positive moral values in the media. In the case of the Caribbean, Buvinic, Morrison, and Shifter (1999) noted that the media also influences the level of violence by providing often prized models of violent behavior that viewers learn and emulate; these, in turn, tend to stimulate and fuel aggressive behavior. Repeated exposure to rewarded violence in the media is consistently associated with increased incidence of aggression, especially in children (Huesmann & Eron, 1986). The violent media is a situational trigger for aggressive behavior. Other situational triggers include the easy availability of guns, as well as environmental conditions that facilitate crime, such as the lack of privacy in homes and the absence of streetlights. (p. 28)

Writing about Central America, Imbusch, Misse, and Carrión (2011) concluded that the media (e.g., reports, television programs) substantially construct the perceptions about violence in the society; these findings have implications for the Caribbean because the media exposure content across geographical areas are similar. The diversity of the media, from music and dance to social media, television, and Hollywood movies, supplies vulnerable youths in the Caribbean with techniques to commit copycat crime, and gangsta culture in Caribbean societies may be partially be explained by the copycat media effect (Ayling, 2011). Because of the Caribbean’s unique history and contemporary exposure to Western mass media, it is important to consider the unique copycat crime dynamic that may operate in that region. WHAT IS COPYCAT BEHAVIOR? The labeling of some social behavior as copycat became popular in the late 1800s (Siegelberg, 2011), and today it is widely accepted that the media generates copycat crime. As media technology has evolved so that a mediated experience has come to approach that of a real-world experience, concerns 236       surette, chadee, and chadee

with emulation of media-modeled behaviors have grown. For a crime to be considered copycat, not only is an aspect of the original crime incorporated in its undertaking (e.g., the choice of victim, motive, or technique) but also, more significantly, key elements of media publicity and exposure to the media content must be the yoking mechanism between the crimes (Surette, 2015). That is, the key implied element of a copycat crime is that, beyond mere similarities, the copycat crime would not exist in its current form without the copycat offender’s exposure to intervening media content. The nature of copycat crime makes it inherently difficult to study. Mis­ identification of copycat crimes can occur when true copycat events go unrecognized and unreported because the initial crime that generated media happened in the distant past or because the copycat crime occurred in a geographically distant location. In addition, the study of copycat crime is hindered by the danger of false positives, in which crimes that share elements with prior media content occur and are incorrectly linked together and labeled as copycats. The American film Money Train (Canton, Peters, & Ruben, 1995), for example, was inaccurately credited as the model for the arson/robbery/ homicide of a New York subway clerk (Cohen, 1999; Perez-Pena, 1995) and the Virginia Tech massacre (April 16, 2007) shooter was initially credited as a copier of a South Korean action movie (Kim & Park, 2003; Streets, 2007). Thus, unlike crimes such as bank robbery or homicide, for which determining which crimes fit within the category and which ones do not is relatively straightforward (to be categorized as a bank robbery, a bank must be robbed; to be a categorized as a homicide requires that a person be killed), determining whether a pair of crimes are a copycat pair is more difficult because it requires proving that the crimes are connected through the media. Another reason for the limited copycat research is the difficulty in examining copycat crime levels. Whereas other crimes are relatively straightforward to quantify and are routinely tallied in official law enforcement statistics, copycat crimes are not counted in any systematic way; therefore, whether a substantial copycat effect operates is controversial (Clarke & McGrath, 1992; Stack, 1987, 2000). THE IMPORTANCE OF COPYCAT CRIME RESEARCH Although copycat crimes are difficult to identify, given that the intentions of a criminal act has to be ascertained, the criminal kidnapping industry in Trinidad and Tobago has been described as emulative of external terrorist groups (Williams, 2005), and surveys of incarcerated juveniles and high school students in Trinidad report substantial levels of self-reported copycat crimes (Chadee, Surette, Chadee, & Brewster, 2015; Surette 2013b). As media technology has evolved so that a mediated experience has come to approach copycat crime behavior     

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that of a real-world experience, concerns about emulation of media-modeled behaviors have grown (Helfgott, 2008). Waves of fads and fashions have established that people lift behavior models from the media, and this connection has been extrapolated to include the mimicking of media-portrayed criminal acts (Miller, 2000). Recent research suggests that copycat crime is a common part of many offenders’ criminal histories, with approximately one in four reporting a copycat attempt (Surette, 2013b). Historically, copycat research has concentrated not on crime but on two other types of behavior: suicide and terrorism. The first to receive serious research attention concerned imitative suicides, termed a Werther effect, after a fictional hero who committed suicide in a Johann Goethe 18th-century novel. As a result of this type of research, the impact of media reporting and portrayals of suicide incidents on suicide behavior has been widely recognized (O’Carroll & Potter, 1994; Phillips, Lesyna, & Paight, 1992; Stack, 1987). Further supporting the impact of copycat crime, within the research literature about terrorism few doubt the media’s ability to motivate copycat terrorist acts, and much anecdotal evidence suggests that terrorist events, such as kidnappings, bank robberies with hostages, airline hijackings, suicide bombings, and online beheadings, occur in media-linked clusters (Poland, 1988; Tuman, 2010). The consensus regarding copycat terrorism is that it is especially strong following a well-publicized, successful act using a novel approach (Surette, 2015). From these research streams, the study of copycat crime has slowly developed. One of the early points made by Pease and Love (1984a) regarding copycat crime research was the necessity of determining the correlates of copycat crime in terms of criminogenic media content, the characteristics of copycat criminals, and the settings in which copycat crime occurs to develop useful theory. CHARACTERISTICS OF MEDIA CONTENT CORRELATED WITH COPYCAT CRIME Regarding the types of media content that have been correlated with copycat crime, three areas emerge: characteristics of the portrayed crimes, the portrayal of punishment, and the characteristics of the portrayed criminals. Crimes that are portrayed as successful, rewarded, unpunished, and justified have been flagged as increasing the likelihood of emulation. In addition, crimes that are shown as realistic, humorous, exciting, and enjoyable will generate more copycats, as will content that contain neutralizations of the harm caused by crime and explicit crime instructions (Doley, Ferguson, & Surette, 2013; Wilson, Colvin, & Smith, 2002). A content factor that has been particularly singled out is the media portrayal of the punishment that 238       surette, chadee, and chadee

follows committing a crime. The portrayal of a final punishment for crime at the end of a media portrait has long been assumed to mitigate the criminogenic effects of prior successful crime portraits (Hays, 1932). However, the assumption of punishment as an effective counterbalance to pernicious effects from previously portrayed successful crimes should be questioned. Depicted punishments can be seen as informative regarding ways of avoiding similar mistakes, and because of a common error in overestimating their odds of success, potential copycats sometimes act on the belief that with slight modification of tactics, they can gain the benefits of crime without suffering the costs (Bandura, 1973, citing Claster, 1967). In addition to how crime is portrayed, how criminals are painted in media content is also important. A match between media crime model and real-world copier on age, race, and gender has been found to enhance imitation (Gould & Shaffer, 1986; Pirkis & Blood, 2001; Stack, 2000). Media models who commit crime due to positive socially supported motives or that are shown as competent and heroic increase copycat effects (Bandura, 1995; Wilson et al., 2002). Immediate or inferred rewards to the model also influence imitative behavior, with the social and material success of the media criminal model important factors regarding copycat generation (Bandura, 1973). Although some media content has been found to be associated with copycat crime, characteristics of copycat offenders have also been identified. Along these lines, research in the Caribbean needs to also focus on characteristics of the portrayed crimes, the portrayal of punishment, and the characteristics of the portrayed criminals to determine whether similar relationships exist between media content and offender imitation. CHARACTERISTICS OF COPYCAT OFFENDERS CORRELATED WITH COPYCAT CRIME The most consistent copycat offender characteristics are being young and male (Hassan, 1995; O’Carroll & Potter, 1994; Surette, 2002, 2013a)— findings that are consistent with research on juvenile delinquency undertaken in the Caribbean. For example, Deosaran and Chadee (1997) found that juveniles in a detention center were more likely to be males from urban dissolved or single family structures with lower socioeconomic status. It is interesting to note that copycat research undertaken at this same institution 12 years later found that a higher percentage of youths in this detention center were likely to copycat than youths outside of the institution (Chadee et al., 2015). DudleyGrant (2001) pointed out a strong link between (a) poor parental role models and lack of adequate parental supervision and (b) juvenile delinquency in the U.S. Virgin Islands. Moreover, research in the Caribbean has shown a relationship between parental ambiguity or tolerance on issues related to antisocial copycat crime behavior     

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behavior and the propensity for child gun ownership (Maguire, 2013). As the copycat literature suggests, risk and vulnerability to commit crimes are consistently associated with copycat propensity, but future research needs to directly test these relations across geographic regions (Surette, 2013c). Beyond basic demographics, exposure to real-world crime is indicated as one of the more predictive copycat factors (Heller & Polsky, 1976; Pease & Love, 1984a). A history of criminal behavior is felt to increase the perception of one’s ability to successfully copy a crime (Bandura, 1995). Established offenders who see media-modeled crimes as good means of obtaining material goods or social prestige are hypothesized to more often copy if given the opportunity (Rogers, 2003). Exposure to real-world crime can also come from criminal friends and family, especially parents (Bandura & Walters, 1963; Mazur, 2006). Even if they preach law abiding and punish law breaking, criminal family members provide strong criminogenic models that supplement the media-provided ones (Surette, 2013a). A particular set of attitudes is seen as increasing the risk for committing copycat crimes. Persons who see the media as strongly influential on social behavior and as useful information sources about crime are more prone to be copycat offenders (Heller & Polsky, 1976; Pease & Love, 1984a, 1984b; Surette, 2002, 2013a). Also, copycat crime would be more attractive to those who do not see law-abiding behavior as likely to be rewarded (Akers, 1998; Bandura, 1973; Rogers, 2003) and who enjoy seeing laws broken or those in authority defied (Bryant & Miron, 2002). Additional personality traits that have been linked to copycat propensities include low self-control (Akers, 1998), high criminal innovativeness (Rogers, 2003; Surette & Maze, 2014), and disinhibition and sensation seeking (Haridakis, 2002). When combined with a high interest in guns and a history of encounters with law enforcement, perceptions of delusion have been expressly flagged as a copycat crime correlate (Bandura, 1973). In the Caribbean, social and psychological factors associated with conduct disorders and offending adolescents include “poverty; abuse; exposure to violence; disrupted family structure; poor parent–child bonding and affection; poor parental monitoring, poor supervision, and poor disciplinary practices; family discord and conflict; and parental deviance in behavior and attitude” (Dudley-Grant, 2001, p. 52). The antecedents and predisposing psychological and sociological factors associated with copycat behavior may create a vulnerability such that when at-risk youth are exposed to negative media role images, they are more likely to attempt copycat behavior (Chadee et al., 2015). Where risk vulnerability factors associated with copiers have been identified in Caribbean literature, future research related to these factors and copycat behavior will provide useful programmatic directions for structured engagement in the identification and early intervention to prevent copycatting. A cross-cultural research agenda would be pragmatically valuable in 240       surette, chadee, and chadee

understanding multiple dimensions of copycat behavior and the dynamic association with the media. CHARACTERISTICS OF THE COPIER’S RELATIONSHIP WITH MEDIA CORRELATED WITH COPYCAT CRIME Beyond content and copier characteristics, elements of the nature of the relationship between the copier and their media have been found to be significant. Predictive characteristics related to how copycats interact with media include media immersion, high interest in crime content, and seeing the media as a good source of crime and justice information (Surette, 2002, 2013a, 2013c). Immersion refers to media use that reflects a concentration on a single media source to the exclusion of other media and interpersonal contacts (Akers, 1998; Rogers, 2003). Offenders who immerse themselves in a criminogenic niche media (e.g., watching criminogenic excerpts from a single piece of media repeatedly) and are weakly networked into law-abiding groups and strongly networked into deviant groups are at greater risk (Meloy & Mohandie, 2001; Rogers, 2003). The likelihood of media immersion increases as peers and family decrease in importance (Akers, 1998), and by extension, individuals who are deeply immersed in popular culture and are media dependent are also believed to show an increased copycat propensity (Rogers, 2003). The speculation is that individuals with less to lose in the real world more often choose copycat crime, as these individuals rely more on media for positive social reinforcement (Akers, 1998). Because media-immersed consumers are not necessarily heavy consumers in terms of total hours but may tend to form parasocial relationships with media personalities, media-immersed individuals who also identify with media-portrayed criminals may be more likely to copy the media portrayed offenses (Mazur, 2006, citing Dowrick & Raeburn, 1995). When media immersion is combined with a high interest in crime content, the copycat effect is heightened, particularly when a decision to commit a crime is already in place (Fisch, 2002; Rubin, 2002). Last, individuals who judge the media as helpful and informative regarding crime are more at risk for copycat crime (Akers, 1998). In general, a positive view of the media increases copycat crime propensities so that individuals who see media personalities as opinion leaders and as friends are more copycat crime at-risk candidates (Mundorf & Laird, 2002; Rogers, 2003). To date, no research has been published on media immersion, crimino­ genic niche media, media consumption of juveniles, identification with media personality and media-portrayed criminals, the perception of media as helpful and informative, and high interest in crime content in the Caribbean context. Copycat research is important to undertake within the Caribbean setting, copycat crime behavior     

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rather than extrapolating from North American studies, because of the cultural, social, economic, and ethnodemographic differences; individualistic versus collectivistic value differences; smallness of society; and other factors. Policies and practices should be informed by studying both copycat and related media factors to create a greater sensitivity to the needs of institutions responsible for engaging juveniles in well-being practices and to inform caregivers of important variables that may influence juveniles who are potential copiers. CHARACTERISTICS OF THE COPIER’S ENVIRONMENT CORRELATED WITH COPYCAT CRIME A number of family, community, and cultural environment factors have been linked to copycat crime (Surette, 2013c). As noted earlier, exposure to real-world crime models has been flagged as significant, and criminogenic media effects are further enhanced by racial strife, income disparities, and detrimental social conditions that expand the pools of-risk copycat offenders (Fisher, 1980). Media that are saturated with pervasive criminogenic content also support criminogenic cultures, neighborhoods, and families by normalizing crime and violence, which in turn increases the capability of the media to generate copycat crime (Akers, 1998). Settings of idleness, social isolation, and deterioration in socioeconomic functions accompanied by perceptions of persecution and resentment, when present with delusion, have collectively been forwarded as predictors of violent copycat acts (Bandura, 1973; Meloy & Mohandie, 2001). Overall, the amount of copycat crime in a society is the result of the interaction of four factors: characteristics of media-portrayed generator crimes and criminals, characteristics of potential copycat criminals, how atrisk individuals interact with media, and the broader social context in which the consumer and media interactions reside (Surette, 2015). Select, usually successful, highly engaging crimes shown in popular entertainment or news stories emerge as the prime candidates for copying. Unless media attention was the goal, what is expected to happen by the copycat offender in the real-world determines subsequent imitation. In the end, whether a copycat crime is committed by a particular individual depends on the interaction of the content of a particular media product (the characterizations of crime and punishment in the copycat generator crime), the individual’s traits and predispositions toward crime (personal criminal history, family, environmental factors), and the media’s social context (preexisting cultural norms supporting crime, opportunities to commit crime, the pervasiveness and credibility of the media; Surette, 2015). 242       surette, chadee, and chadee

Both situational and personality factors have been found to assist in understanding the development of vulnerability to aggressive stimuli. However, once aggressive behavior is present, the social environment and the aggressor are in a reciprocal relationship that leads to changes in social interaction, with reduced interactions with positive models and gravitation to deviant peers (Anderson & Dill, 2000). In the same vein, copycat research in the Caribbean and elsewhere must take into consideration the culturally based social and psychological factors, including unique situation, personality variables, exposure to aggressive stimuli, the associative cognitive network, media immersion, need for identification, and exposure to copycat models that are at work to produce such behavior. Although a number of at-risk factors are known, neither their relative importance nor how predictive they are for copycat offending have been determined in the Caribbean or elsewhere. However, four conceptual mechanisms by which copycat crime comes into existence have been described in the literature: priming, script acquisition, observational learning, and narrative persuasion. COPYCAT CRIME MECHANISMS The first mechanism is priming, which occurs when the portrayals of behaviors in the media activate a cluster of associated ideas within the potential copycat offender that increase the likelihood that similar, but not necessarily identical, behavior will occur (Dijksterhuis & Bargh, 2001; Roskos-Ewoldsen, Roskos-Ewoldsen, & Carpentier, 2002). Priming is understood as establishing a set of ideas and beliefs that construct a social reality that is supportive of copycat crime—the perception that the nature of the world is such that a particular crime is likely to be successful (Berkowitz, 1984; Berkowitz & Rogers, 1986). The second mechanism is script acquisition, from cognitive theory and the field of communication (Huesmann, 1986), which is the idea that criminal scripts can be acquired by observing criminogenic media during fantasy role-playing, a part of normal child development (Surette, 2013c). Role playing encourages the acquisition of generalized scripts for social roles—the roleplaying child, for example, acquires a role persona and subsequently acts like he or she thinks a doctor, athlete, or gangster would act in various situations beyond the ones specifically modeled in the observed media content (Claxton, 2005; Goldman, 2005; Huesmann, 1986). Cues, such as the presence of a gun, first observed in the media and later encountered in the real world, increase the likelihood of the activation of previously acquired criminal scripts and the enactment of copycat behavior (Huesmann, 1986, p. 130). Conceptually linked to priming when applied to copycat crime, scripts are thought to be copycat crime behavior     

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primed by media content, such as the image of a gun priming an individual’s script for violence (Huesmann, 1986). Scripts are conceived as pre-established directions that individuals hold in their memories and scroll up to direct their actions as needed. Cognitive scripts serve as guides for behavior by laying out the sequence of events that one believes are likely to happen and the behaviors that one believes are appropriate in particular situations (Huesmann, 1998). The process of script acquisition is most commonly conceived as occurring via observational learning, the third copycat mechanism. Factors that enhance observational learning include consumer attentiveness to the behavior model, the mental rehearsal of the modeled behavior, and an expectation of reinforcement for copying the behavior (Bandura, 1973). Observational learning currently stands as the current leading mechanism for copycat crime (Surette, 2015). Supplementing observational learning, elements of social cognition theory have been linked to two paths to copycat crime (Surette, 2013c). One path is through a systematic central path and requires a copycat offender to consciously evaluate media-provided information. This path has been linked to instrumental, planned copycat crimes, such as bank robberies (Petty, Priester, & Brinol, 2002). The second path is a heuristic peripheral route that is quickly traveled by a copycat offender who conducts a minimum evaluation of media-supplied information (Petty et al., 2002; Shrum, 2002). It is linked to emotional spontaneous copycat crime, such as impulsive assaults or hate crimes (Surette, 2013c). The fourth and final copycat crime mechanism is through narrative persuasion. Most media consumed is narrative- or storytelling-based, and consumer interaction with narrative media is qualitatively different from the first two paths. The terms transportation, engagement, and absorption have been used to describe this type of media interaction. The narrative persuasion path enables influence-resistant media consumers to be affected by story characters who model both attitude and behavior change (Green, Garst, Brock, & Chung, 2006; Polichak & Gerrig, 2002; Slater & Rouner, 2002). Narrative persuasion describes how most people use and interact with most media, seeking entertainment, not explicit instructions (Green & Brock, 2000; Slater & Rouner, 2002; Strange, 2002). When engagement with criminogenic content is high, transformation or absorption results, and the consumer is transported to a world in which criminal behavior is justified, rewarded, and unlikely to be punished (Green & Brock, 2000). As narrative persuasion describes the most common use of media, this path is speculated to be the most significant copycat crime path (Slater & Rouner, 2002). Although the copycat crime paths are believed to operate universally, it is expected that societies will differ between themselves and over time in their copycat crime rates (Surette, 2015). Some societies are expected to generate more criminogenic content,

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more at-risk copycat offenders, and more opportunities and cultural support for applying copycat crime models. Understanding the mechanisms of priming, cognitive scripts, observational learning processes, cognitive processing of information, and narrative persuasion will assist researchers in developing a copycat crime theory. However, cross-cultural research and competing explanations provide for the opportunity to test the universality of a theory while identifying specificities that operate within unique cultural settings, such as in the Caribbean.

COMPETING EXPLANATIONS OF COPYCAT CRIME Currently, two competing models offer explanations of copycat crime: media as trigger and media as catalyst. In the first, exposure to criminogenic media content is seen as a direct cause of crime; in the second, the media are viewed as crime catalysts that shape, rather than generate, criminality. The first model is represented by the general aggression model (GAM) advocated by Anderson, Gentile, and Buckley (2007). In the GAM, the media trigger individuals to commit crimes, as well as criminalize those who would otherwise be law-abiding citizens. In this manner, media portrayals of crimes increase the numbers of offenders and increase their motivation to offend. In the alternate, media-as-catalyst model, criminally disposed individuals driven by preexisting motives perform a search of the media for crime instructions (Ferguson et al., 2008). In this model, the expectation is that removing media exposure would not eliminate crimes, as different forms of crime would still be committed. Media-provided crime models thus play significantly different roles in the two competing perspectives. In the first, exposure to crime models cause individuals to commit crimes that they would not otherwise commit. In the second, media exposure shapes criminal behavior that would have occurred in some fashion regardless. Recent research has tended to support the media-as-catalyst model over the GAM explanation (Ferguson et al., 2008; Ferguson, San Miguel, Garza, & Jerabeck, 2012; Ferguson, San Miguel, & Hartley, 2009; Grimes, Anderson, & Bergen, 2008; Surette, 2013a). The catalyst model has been supported in surveys of offenders in which the media has been credited as a source of crime techniques but not as a source of criminal motivation (Pease & Love, 1984b; Surette, 2002). Exposure to media crime models and criminal behavior has been more often viewed as instructional sources, as crime catalysts and rudders, rather than as crime-generating triggers (Surette, 2015, p. 93).

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NON–TRINIDAD AND TRINIDAD RESEARCH Much of the research on copycat behavior is based on the hypothetical extrapolation of findings from research not on copycat crime itself but on imitation of other types of behaviors and other types of media effects (Surette, 2015). In addition, the bulk of the research is based on non-Caribbean populations. As such, it is speculative, and a definitive model of copycat crime remains elusive. Likewise, the validity of generalizing the limited external finding to the Caribbean can be questioned. The current working hypothesis based on non-Caribbean populations is that copycat criminals are more likely to be career criminals involved in property offenses than first or violent offenders (Surette, 2013c). If there is a consensus regarding the nature of copycat crime, it is that a media criminogenic influence will concentrate in preexisting criminal populations (Helfgott, 2008; Pease & Love, 1984a; Surette, 2015; Surette & Maze, 2014). In the non-Caribbean anecdotal case histories, most of the individuals who mimic media crimes have prior criminal records or histories of violence, suggesting that the copycat effect of the media is more likely qualitative (affecting criminal behavior) than quantitative (affecting the number of criminals; Pease & Love 1984a, Surette, 2015). The research indicates a pragmatic use of the media by offenders, with borrowing media crime techniques as the most common practice (Surette, 2013a). Copycat offenders usually have the criminal intent to commit a particular crime before they copy a media-based technique (Pease & Love 1984b). Distilling the research conducted outside of the Caribbean, if the dynamics of copycat crime in the Caribbean are similar (Chadee et al., 2015; and no research evidence indicates that it is not), the most criminogenic content is where innovative and successful crimes are justified; are explicitly rewarded; go unpunished; are stripped of negative consequences; involve guns; are realistic or humorous; and contain criminal models who commit crimes with positive prosocial motives, who are heroic, and who are demographically similar to the consumer (Bandura, 1973; Surette, 2002, 2013c). Such content, combined with consumer multiple viewings, emotional reaction to the content, and the opportunity for real-world rehearsal, will maximize contentrelated copycat effects (Bandura, 1973). Copycat effects are maximized when one has a criminal history, has made a decision to commit a crime, and has preexisting perceptions of the use of media-supplied criminogenic content (Surette, 2013c). Research in the Caribbean is limited to one study conducted in Trinidad (Chadee et al., 2015). The study assessed youths selected from three institutions reflecting three different categories of male respondents (14–18 years old): seriously involved in crime category and in a juvenile detention center (n = 15), in a high-risk group (n = 107), and in a low-risk group (n = 115). 246       surette, chadee, and chadee

Part of the study assessed the propensity to commit future crime, and the interplay of media on crime was measured by asking respondents their likeliness of committing an illegal act learned from the media. The findings suggest that people from the detention center were more likely to copycat. For example, when asked, “After watching a movie or hearing a song, have you gone out and looked for a fight?” 37% of respondents from the detention center said yes, compared with 12% of those in the high-risk group and 15% of those in the low-risk group. On the question of wanting a gun after seeing a gun used in a TV program or movie, 52% of respondents from the detention center said yes, compared with 25% of those in the high-risk and 31% in the low-risk groups. Of the youths in the detention center, 17% indicated that they wanted a knife after seeing a knife used in a TV program or movie, compared with 11% of those in the high-risk group and 14% in the low-risk group. When asked, “Can you remember ever having learned something in the media that was against the law and thought about trying to do something similar?” 60% of youths in the detention center, 48% in the high-risk group, and 42% in the low-risk group said yes. However, when asked if they had actually tried to do something against the law that they learned about from the media, 46% in the detention center said yes, compared with 28% in the high-risk group and 13% in the low-risk groups. These Trinidad findings suggest that although youths may think about a criminal act, those who are low risk are less likely to actually commit the act they saw in the media. EMPHASIS OF FUTURE RESEARCH AND IMPLICATIONS FOR THE CARIBBEAN Much of the entertainment media available in Trinidad comes from the United States or the United Kingdom. News about major crimes committed in the developed countries intermixes with local crime news in the Caribbean. Research is needed on how this mix affects the perceptions of crime and justice in the Caribbean and influence the level and processes of copycat crime. The specific association between media coverage and the generation of crime and the social and psychological context factors that are most important to such an association are largely unknown. Needless to say, the associations between crime and the media in the Caribbean context need further exploration because of an unstated and untested assumption in the prior literature that copycat crime research and dynamics transfer seamlessly to non-Western cultures. The Caribbean countries provide a natural field laboratory for studying what is generalizable about copycat crime and what is unique about crime generation. The following are some suggested copycat crime behavior     

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directions for future research. These recommendations are relevant to both North America and the Caribbean. Research is needed to understand factors resulting in the launch of the short-term and periodical bursts of high-profile criminogenic copying. An understanding of these bursts and the dynamics of copycat crime waves such as have been seen in product tampering, airline hijacking, and suicide bombings awaits further research and may provide useful comparable data (Borowitz, 1983; Gupta & Mundra, 2005; Holden, 1986; Pape, 2003). Of importance to Caribbean communities in this regard is the delineation of how the media interact with cycles of ransom kidnappings and the growth of terrorist groups. Moreover, copycat theorization has been dependent on self-reported data. Researchers are needed to validate the self-report estimates largely obtained elsewhere for Caribbean nations and to substantiate local survey rendered estimates via interviews with identified copycat offenders. Specifically, the theories and models used will have greater scientific strength with validation of specific dates, details, and dynamics concerning the reported copycat events. Copycat crime research in the Caribbean has thus far been limited to Trinidadian youths and concentrated on low-risk, nonincarcerated, non­ offender populations. An important unexplored research question involves hypothesized differences between offenders reporting past copycat criminality and offenders without such activity (Lindberg, Sailas, & KaltialaHeino, 2012). Are there general factors that discriminate copycat offenders from noncopycat offenders? And are coexisting unique Caribbean cultural factors playing a copycat crime role? An understanding of which factors are explained by cultural, demographic, or psychological differences would help determine which elements are possibly cross-cultural in nature and which are idiosyncratic to the Caribbean. The resulting prevention and intervention strategies could be tailored to reflect both local and universal dynamics. One area of research that requires sensitivity to local and general processes is that of the role of video games in copycat crime. Research questions generated from the interactions between a respondent’s interest in media crime content and their video game play, Internet and social media use, having a jailed relative, and seeing the media as criminogenically helpful have been initially examined (Surette & Maze, 2014). Studies of video game effects, much like research on media in general, have concentrated on European and North American subjects, and it remains an open question whether the gamer experience is similar across cultures. The globalization of the world via media, especially social media, provides similar negative criminogenic media stimuli to otherwise unique and distinct societies. The limited research literature begs the question of whether a significant difference in copycat crime prevalence 248       surette, chadee, and chadee

between countries and cultures exists. A systematic cross-cultural research agenda will begin to answer some of these questions. Copycat behavior is a common element of a substantial proportion of offenders in the United States, and seminal studies suggest that copycat crime exists at greater levels in Trinidad and Tobago (Chadee et al., 2015). It follows that the incarcerated population should be the focus of criminaljustice-related policy attention in the Caribbean. The copying of criminal behavior lays at the crux of negative media-generated social effects, and comprehending the relationship of copycat crime offenders to criminogenic media should be a pressing Caribbean criminal justice policy concern. NonCaribbean research indicates that an understanding of copycat crime dynamics is necessary for developing a number of related criminal justice and media social policies (Surette & Maze, 2014). For example, determining whether the characteristics of crime-related media content are found to be less important than the social context in which exposure occurs in the generation of copycat crime is crucial for criminal justice policy focus. Accordingly, Caribbean nations may wish to more closely consider what media they import. If the social exposure contexts and characteristics of media users are more important, then access by at-risk individuals to criminogenic programs should be the policy focus, and efforts to influence local values and worldviews would make sense. Emergent findings suggest that copycat crime activity tends to occur early in criminal careers (Surette & Maze, 2014). Framing the study of copycat crime in a developmental life-course perspective of delinquency would be beneficial. If the copying of a media-modeled offense is a common pathway into initial delinquency for many youth, then the study of copycat crime would be revealing regarding who enters into, and perhaps stays on, career criminal trajectories. Teasing out the antecedent factors that lead to the emergence of copycat behavior—whether these factors reside in the family or community and whether they are associated with exposure to specific media content or to beliefs about the role of violence, and so on—should improve both copycat research and Caribbean policy. Beyond the Caribbean, the study of copycat crime has relevance for a number of criminological and psychological theoretical perspectives, most obviously social learning theory (see, e.g., Akers, 1998) but also for subculture, cross-cultural, and life-course theories of crime (see, e.g., Surette, 2013c). Social learning theorists have improved the understanding of the role of media-supplied behavior models (Lilly, Cullen, & Ball, 2014). These models provide additional insight into the social and psychological dynamics involved in broader noncriminal social learning processes. As new social media platforms, such as Facebook, Twitter, Instagram, and instant messaging services (e.g., WhatsApp, Kik), allow social interactions, personal copycat crime behavior     

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relationships, and communities to develop in new virtual ways, understanding how negative social behaviors diffuse via social media would provide another window into contemporary general social learning processes. Among the questions for researchers to examine are, To what extent does the use of the Internet social media differ within culture and across societies, and what impact does use have on criminogenic exposure? Within a broader theoretical research endeavor, the similarities and differences between regions such as the Caribbean and America would add worth for understanding the general phenomena of copycat crime and its’ emergence in various settings. Along these lines, knowledge of the dynamics of copying crime for urban minority youth compared with suburban Anglo youth, or for Caribbean compared with non-Caribbean youth, would advance the understanding of regional and subcultural delinquency variance. Similarly, the study of copycat crime rates internationally and comparing high-crime-media/lowcopycat-crime cultures with low-crime-media/high-copycat-crime cultures would advance the knowledge of both copycat crime and cultural differences in crime rates. If, as suggested by Caribbean-based self-reports, copycat crime is more prevalent in the region, the importance of such research is heightened (Surette, 2013b). Research on copycat crime would also be useful for disciplines that do not study crime and justice, such as those that study media and communication. The decision to commit a copycat crime involves the cognitive processing of media supplied information.1 Research on copycat crime can further understanding of the social cognitive processes involved in contextualizing criminogenic media content and subsequent criminological crime data. Further, the study of copycat crime would be helpful for understanding the importance of immersion in violent and criminogenic media narratives via new media platforms, such as video games and social media (Surette, 2013c). Caribbean-based research on copycat crime would also benefit regional criminal justice systems by assisting law enforcement agencies in understanding, recognizing, and predicting shifts in crime trends and the emergence of crime clusters, such as kidnappings. Rigorous research could promote the recognition of falsely labeled copycat crimes, reducing fear of crime levels when news media coverage incorrectly declares a “crime wave” (Sacco, 2005). The inordinate levels of fear of kidnapping in Trinidad serve as examples (see Chadee, 2001, 2003a, 2003b; Chadee, Austen, & Ditton, 2007; Chadee & Ditton, 2003; Ditton, Chadee, & Khan, 2005). Since 2001, studies in Trinidad have

1 For overviews of cognitive process and the media, see Kahneman (2011), Petty et al. (2002), and Shrum (2002).

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introduced fear of kidnapping as an item on fear-of-crime scale measures (see Chadee, 2001, 2003a, 2003b; Chadee & Ditton, 2003; Chadee et al., 2007; Ditton et al., 2005). In the judicial system, evidence of a copycat crime would be useful for prosecuting attorneys looking to establish premeditation or for defense attorneys seeking mitigating factors in cases in which pathological media immersion might be operating. Understanding of the mind-set of a Caribbean copycat defendant would help to improve sentencing and treatment decisions. For instance, restrictions on access to specific media content and Internet sites would be a logical application from knowledge that a particular offender is at risk of committing a copycat crime. Debunking of idiosyncratic cultural views and beliefs that interact with criminogenic media would also be useful. Regarding corrections, regional copycat crime research would assist in developing Caribbean-based treatment and rehabilitation programs. Identifying the most significant local copycat crime risk factors in juveniles would enable the development of school-based curriculum programs tailored to Caribbean settings that could debunk the attractiveness, utility, and impact of media-provided criminal models. Correctional programs could be developed to de-prime the behavioral effects of criminogenic media on crime decision-making. Knowledge regarding what crime-related content is most likely to generate copycat crime locally would reduce the need for broad content restrictions on the media, as well as encourage the timely release of nonproblematic crime information by authorities to the news media (Dill, Redding, Smith, Surette, & Cornell, 2011). CONCLUSION In this chapter, we discussed the importance of copycat research in general and in the Caribbean specifically. Recognizing the lacuna in Caribbeanbased research on the topic, we believe that increasing attention in a number of areas has implications for regional criminal justice systems and rehabilitative programmatic interventions and has strong justification. As media criminogenic influences are likely to be culturally sensitive, research in the Caribbean can establish to what degree media research findings and theories can be generalized across cultures. In a globalizing world, criminogenic media content is available to previously insulated societies. Care should be taken to determine what media-related behaviors, such as copycat crime, appear to be universal and which ones are substantially modified by local factors. An understanding of copycat behavior from a multidisciplinary, multicultural perspective is an important component for comprehending the larger relationship between media, crime, and justice. copycat crime behavior     

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Sacco, V. (2005). When crime waves. Thousand Oaks, CA: Sage. http://dx.doi.org/10.4135/ 9781483328799 Shrum, L. J. (2002). Media consumption and perceptions of social reality: Effects and underlying processes. In J. Bryant & D. Zillmann (Eds.), Media effects: Advances in theory and research (pp. 69–95). Mahwah, NJ: Erlbaum. Siegelberg, B. (2011, August). Copycat: Where does the term come from? Slate. http://www.slate.com/articles/news_and_politics/explainer/2011/08/what_a_ copycat.html Slater, M., & Rouner, D. (2002). Entertainment education and the persuasive impact of narratives. In M. Green, J. Strange, & T. Brock (Eds.), Narrative impact (pp. 157–181). Mahwah, NJ: Erlbaum. Stack, S. (1987). Celebrities and suicide: A taxonomy and analysis, 1948–1983. American Sociological Review, 52, 401–412. http://dx.doi.org/10.2307/2095359 Stack, S. (2000). Media impacts on suicide: A quantitative review of 293 finings. Social Science Quarterly, 81, 957–972. Strange, J. (2002). How fictional tales wag real-world beliefs. In M. Green, J. Strange, & T. Brock (Eds.), Narrative impact (pp. 263–286). Mahwah, NJ: Erlbaum. Streets, N. (2007, April 20). Cho Seung-Hui and Oldboy: Killer may have re-enacted violent film. The National Ledger. Retrieved from http://www.nationalledger.com/ pop-culture-news/cho-seung-hui-amp-oldboy-ki-206623.shtml#.VzM4_vIViko Surette, R. (2002). Self-reported copycat crime among a population of serious and violent juvenile offenders. Crime and Delinquency, 48, 46–69. http://dx.doi. org/10.1177/0011128702048001002 Surette, R. (2013a). Cause or catalyst: The interaction of real world and media crime models. American Journal of Criminal Justice, 38, 392–409. http://dx.doi. org/10.1007/s12103-012-9177-z Surette, R. (2013b). Estimating the prevalence of copycat crime: A research note. Criminal Justice Policy Review. Advance online publication. http://dx.doi. org/10.1177/0887403413499579 Surette, R. (2013c). Pathways to copycat crime. In J. Helfgott (Ed.), Criminal psycho­ logy: Vol. 2. Typologies, mental disorders, and profiles (pp. 251–273). Santa Barbara, CA: Praeger. Surette, R. (2015). Media, crime and criminal justice: Images, realities and policies (5th ed.). Stamford, CT: Cengage. Surette, R., & Maze, A. (2014). Video game play and copycat crime: An exploratory analysis of an inmate population. Psychology of Popular Media Culture. Advance online publication. http://dx.doi.org/10.1037/ppm0000050 Tuman, J. (2010). Communicating terror. Thousand Oaks, CA: Sage. Williams, C. (2005, March 13). Island’s abduction rate is second in the world. Caribbean Voice: The Voice of the Caribbean at Home and Abroad. Retrieved from http:// caribvoice.org/island-s-abduction-rate.html copycat crime behavior     

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Willman, A., & Marcelin, L. H. (2010). “If they could make us disappear, they would!” Youth and violence in Cité Soleil, Haiti. Journal of Community Psychology, 38, 515–531. http://dx.doi.org/10.1002/jcop.20379 Wilson, B., Colvin, C., & Smith, S. (2002, March). Engaging in violence on American television: A comparison of child, teen, and adult perpetrators. Journal of Communication, 36–60.

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10 FEAR OF CRIME: THE INFLUENCE OF COMMUNITY AND ETHNICITY MARY CHADEE AND DEREK CHADEE

Crime and security is one of the priority areas of concern in the Caribbean. Research in criminology and psychology at The University of the West Indies in Trinidad and Tobago underscores this concern (Chadee & Ng Ying, 2013; Deosaran, 2007; Harriott, 2003; Seepersad, 2013; Seepersad & Bissessar, 2013). Increases in crime in many highly socially cohesive territories within the region have created a disquiet resonance within and across several Caribbean societies. The reverberation of crime concern at the citizen and political levels often does not reflect the reality of actual crime occurrence at the community level. A disconnect between the reality of crime and perceptions of the occurrence of crime, on the one hand, and estimation of being a victim of crime, on the other hand, persistently influences the level of citizens’ fear of crime. The literature quite often defines fear of crime as “an emotional response of dread or anxiety to crime or symbols that a person associates with crime” (Ferraro, 1995, p. 4). The sociological and criminological http://dx.doi.org/10.1037/14753-011 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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explanations for the fear of crime are innumerable. However, less adopted in the literature is a mesoperspective bridging the gap between micropsychological and macrocriminological/sociological factors in our understanding of the variance in fear of crime. Fear of crime is a social psychological construct with its genesis in the criminological literature and its occurrence explained by both macrofactors and microfactors, including risk assessment (Acuña-Rivera, Brown, & Uzzell, 2014; Chadee, 2003a; Jackson, 2006); levels of general fear (Chadee & Ng Ying, 2013); community factors (Chadee, 2003a); and the association of demographic variables, including perceptions of ethnicity (Chadee, 2003b), with commitment of criminal activity. Although fear of crime is not inherently negative, excessive rumination, discourse, and concern over the possibility of being a victim of crime generate anxiety, stress, stereotyping, prejudice, and social responses, including political debates and media hype—all of which may create a collective thrust that negatively affects individual and community life. Many Caribbean communities comprise diverse ethnic groups. The wider ethnic relationships within these societies can have an impact on the perception of issues related to fear of crime and perceptions of victimization. This chapter focuses on the influence of community and ethnicity on fear of crime, drawing on the limited Caribbean literature and assessing parallels with studies undertaken in countries outside of the region and offering directions for future research. Although the Caribbean is unique, with important idiosyncrasies that justify culture-specific research, extrapolating from research outside this region is just as significant for contextualizing and creating the international connectedness in integrating Caribbean literature into an international scientific community. In other words, we are not an isolated region but an international player, and neither is psychology a regionally isolated discipline. CRIMES IN TRINIDAD Seepersad (2015) reported that during the first decade of the 21st century, the average murder rate across the Caribbean was 20.9 per 100,000, compared with Trinidad and Tobago, with an average murder rate of 25.1. From 1990 to 2013, the annual average numbers of murders in Trinidad was 242. However, the annual average number of homicides increased by 181 murders to 423 murders per year for the period 2009 to 2013, with the highest number of murders (547) recorded in 2008. Within the period 2009 to 2013 the crime statistics were unusually high, with an annual average of 594 woundings and shootings; 512 incidents of possession of arms and ammunition; 482 incidents of malicious wounding; 4,445 robberies; and 718 rapes, incest, and other sexual 260       chadee and chadee

offenses (apart from serious indecency and indecent assault; see Seepersad, 2015). In 2013, the crime rate (per 100,000 inhabitants) for the following crimes in Trinidad and Tobago were: 221.2, robbery; 40.5, woundings and shootings; 30.4, murders; 25.3, incest and other sexual offenses; 15.9, rape; 8.7, kidnappings; 5.2, serious indecency; 221.8, burglaries and break-ins; 23.0, fraud; and 27.7 larceny in dwelling houses (see Seepersad, 2015). For the period 1990 to 2013, the average detection in percentages were 67.8% for serious indecency; 63.2% for rapes, incest, and sexual offenses; 48.3% for kidnappings, 42.3% for wounding and shootings; 32.0% for murder; and under 20.0% for robberies, larcenies in dwelling houses, burglaries, and break-ins and general larceny and larceny of motor vehicles. But data suggest that detection rates in 2013 were below the previous two decades’ averages, with less than 25.0% detection for larcenies and larceny of motor vehicles, burglaries and break-ins, larcenies in dwelling houses, robberies, murder and woundings, and shootings. Percentage detection also fell for rapes, incest, and sexual offenses to 40.5% in 2013. Detection does not mean conviction but that an alleged perpetrator has been identified (Seepersad, 2015). Crime victimization data and surveys with other perceptual measures are useful in measuring not only actual victimization but also the extent to which a population’s perceptions fit the crime reality. Such perceptions are real and influence social interactions and cohesion within communities (Chadee, 2003b; Chadee & Ditton, 2003, 2005). In a 2003 study undertaken for the Ford Foundation, Chadee (2003a) found that fear of crime was high in areas where crime victimization was relatively low. In fact, as an aggregate, levels of fear were even higher in low-crime than in high-crime areas. The major concern is not only the reality of actual crime victimization but also the social psychological reality of fear of criminal victimization and the consequences fear can have on social and interpersonal life. Attempting to reduce the “fear” of crime is becoming an important part of government policy. It is in this context of high crimes in a multicultural society that an understanding of fear of crime becomes important. Although crime is particularly high in Trinidad, the distribution of crime is skewed with a propensity toward hot spots located in the Northeastern areas/east–west corridor of the island. COMMUNITY AND FEAR OF CRIME Fear of crime affects a community in many negative ways, including creating internal migration within the community, decreasing economic activities, and influencing increases in crime resulting from a breakdown in the informal social control mechanisms (Chadee, 2003a; Woldoff, 2006). Social disorganization theories assist in providing some mesostructure to fear of crime     

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understand the social psychological dynamics of the community effects on fear of crime (Bursik, 1988; Kornhauser, 1978; Sampson & Groves, 1989; Shaw & McKay, 1942). Communities are unique, but common features exist across societies, and socially disorganized communities share parallels across different cultures. North American research, therefore, on fear of crime and community disorder has provided some insights into fear of crime in the Caribbean. For example, Parkes, Kearns, and Atkinson (2002) found that residents of less affluent areas were more sensitive to unfriendliness in their neighborhood, an indication of low community solidarity, and were more likely to indicate neighborhood dissatisfaction. Likewise, Reisig and Cancino (2004) suggested that persons living in economically challenging geographical areas have a greater propensity to identify negative elements (e.g., incivilities) within their environment. However, they also found that persons living in residential units with high collective community efficacy identified fewer incivilities and community efficacy was an important mediating factor intervening between economic background and community assessment. Skogan (1990) reinforced and qualified this point in observing that economically disadvantaged urban neighborhoods displayed greater incivilities, both socially and physically. Incivilities within a community lead to increases in residents’ fear levels, and such fear reaction to crime predisposes a community to further victimization because criminal elements are aware of the community’s inhibitions in responding to violations (Skogan, 1990; Wilson & Kelling, 1982). One interpretation of these findings suggests a nondeterministic economic influence on fear of crime, with efficacy and control assuming a strong mediating role. This interpretation suggests programmatic interventions that encourage the role of community organizations and other interventions to build community efficacy in an attempt to reduce, among other concerns, fear of criminal victimization. This is of particular importance for economically deprived Caribbean communities in which village councils and community organizations influence and guide social activities. Research in the Caribbean has examined the relations between perceptions of incivility, sense of safety, risk sensitivity, and fear of crime levels (Chadee, 2003a, 2003b; Chadee, Austen, & Ditton, 2007; Ditton & Chadee, 2006). However, the impact of incivility on fear of crime in the Caribbean context may be better understood by assessing the reduction of community bonds and the sense of mutual trust within neighborhoods. The weakening of these important bonds negatively affects informal social control mechanisms, causing members of the community to lose their efficacy within these neighborhoods and often leading to higher levels of violent crimes (Sampson, Raudenbush, & Earls, 1997). Sampson and Raudenbush (1999) defined collective efficacy as “the linkage of cohesion and mutual trust with shared 262       chadee and chadee

expectations for intervening in support of neighborhood social control” (pp. 612–613). As a result of their small size, many Caribbean communities are stereotypically known for their internal connectedness and collectivism compared with industrialized developed countries that are characterized by their high individualistic values (Becker et al., 2012; Schwartz & Bilsky, 1987; Urzúa, Miranda-Castillo, Caqueo-Urízar, & Mascayano, 2013). Studies have found that communities with functional interactions among neighbors create stronger informal social control mechanisms and trust, lowering the levels of crimes (e.g., Bellair, 1997). These findings are symptomatic of Caribbean societies that are in the process of transition to modernity. Modernity affects many aspects of a society, including the family structure. The traditional Caribbean extended families emerged as a result of economic and social necessities. However, over the years, these traditional structures have evolved into nuclear structures, driven by the individualistic demands of Western modernity, particularly the dominant North American economic and cultural values. The social psychological consequences of this transition is a less collectivist culture and the breaking down of substantive social control mechanisms for both within (family) and without (community). The cyclical reciprocal relationship between breakdown in community solidarity and fear of crime may also be a result of modernity— a speculation that is worthy of investigation in the Caribbean context. Merry (1981) put it thus when she described the effects of community breakdown on levels of fear: Fear of crime actually contributes to the incidence of crime, that fear of crime breaks down neighborhood cohesion, undermines neighborly sociability and concern for others, and instills distrust and suspicion in their place. As community solidarity weakens, informal social control atrophy. Residents are less willing to intervene to stop a crime, to help a stranger, or to question and drive out intruders. They become more afraid to venture from their homes. As a result, there are fewer people on the streets, less surveillance of street life, and less chance of effective intervention. (p. 5)

Merry went on to present the following argument, citing Wilson (1975, p. 21): By disrupting the delicate nexus of ties, formal and informal, by which we are linked with our neighbors, crime atomizes society and makes of its members mere individual calculators estimating their own advantage, especially their own chances for survival amidst their fellows. Common undertakings become difficult or impossible, except for those motivated by a shared desire for protection. (as cited in Merry, 1981, p. 5)

Merry’s findings are instructive in understanding the social psychological dynamics of incivility and sense of safety. Her findings resonate in the context of Caribbean society. fear of crime     

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In their classic work, Shaw and McKay (1942) pointed out that impoverished ethnically diverse communities were more likely to have weak social organization compared with economically stable homogeneous communities. These weakly socially organized communities have problems in obtaining social solidarity and cohesiveness on shared values and are unable to monitor and control the behavior of residents (Kornhauser, 1978; Sampson & Raudenbush, 1999). Community deprivations and fear of crime are circular in their effects on Caribbean societies inhibiting the development of collective efficacy, which provides the community with the sense of confidence to address important problems. It is as though the community problems militate against the collective conscience of the community from reflecting and providing solutions. Adler’s (1927) concept of Gemeinschaftsgefühl is instructive when applied to the Caribbean context. Adler discussed the needs of people to express empathy and compassion for others and by extension for the welfare of the general community. He referred to this as developing a sense of “social/community feelings.” Low levels of Gemeinschaftsgefühl, Adler argued, lead to maladaptive behavior. High levels of Gemeinschaftsgefühl contribute to prosocial activities. People have an innate need for social connectedness. From very early, children have a strong motivation to connect with others and seek out affection. This is a direct result of the way in which self emerges within a social context. As Mead (1934) saw it, self is a social entity. Our consciousness emerges within the social context and, therefore, can only develop a sense of purpose within this context. Our thoughts are social because they involve the use of symbols that are socially constructed. Adler argued that people are often aware of the responsibilities they have toward their community and the groups to which they are closely tied. The worthiness of behavior is calibrated on the degree of public good achieved by the behavior. Social empathy develops within the individual and is influenced by the level of Gemeinschaftsgefühl within the community. Social efficacy, by comparison, is influenced by the motivation to become of value to one’s community. The higher this value, the greater the levels of social efficacy (Bandura, 2000; Fernández-Ballesteros, Díez-Nicolás, Caprara, Barbaranelli, & Bandura, 2002). The internal connectedness among residents and sense of vulnerability and risk are negatively influenced by community incivility and disorder affect. Sampson et al. (1997) found an inverse association between collective efficacy and perceptions of violence and crime victimization in neighborhoods. Collective efficacy and structural conditions are strong explanatory factors for community disorder and perceived victimization (Morenoff, Sampson, & Raudenbush, 2001; Sampson & Raudenbush, 1999). Disorder as an explanatory variable is greatest in the urban setting (Perkins & Taylor, 1996; Sacco, Johnson, & Arnold, 1993). However, as Conklin (1975) argued 264       chadee and chadee

many years ago, and as reinforced by Merry (1981) in her classic work on fear of crime, the collective self-efficacy of a neighborhood or community can be eroded by crime and the perception of crime: The indirect cost of crime includes the changes in attitude and behavior by people who fear their own victimization. They stay off the street at night and lock their doors. If they go out, they walk only in groups and avoid certain areas in the city. They use taxi or cars to protect themselves from street crime. If they have to drive through high-crime areas in the city, they roll up their car windows and lock their doors. To avoid possible victimization, people do not use library and educational facilities at night, they stay away from meetings of social groups and organizations, and they keep out of parks and recreational areas. Some forfeit additional income by refusing overtime work which would force them to go home after dark. Some even carry firearms or knives. Many take security measures to protect their homes—additional locks on doors and bars on windows, brighter light on porches and in the yards, burglar-alarm systems, and watchdogs. Judging by the types of precautions that people take, they seem to fear personal attacks more than the loss of property through theft. One extreme but fairly common reaction to both personal and property crimes is a desire to move, to escape from the community where crime poses such great threat. (Conklin, 1975, p. 6)

Although these observations are in the American context, they have relevance for Caribbean societies today (Chadee, 2003b). Further, Caribbean research on community and fear of crime can also be guided by the following research. Using structural equation modeling, Gibson, Zhao, Lovrich, and Gaffney (2002) tested two major hypotheses: (a) residents who feel socially integrated into their neighborhoods are more likely than those who do not to express positive perceptions of collective efficacy, and (b) social integration is indirectly related to fear of crime through perceptions of collective efficacy. Social integration was mediated by collective efficacy in explaining fear of crime. Sampson and Raudenbush (2001) suggested that residents’ feelings of collective efficacy, their feelings of social cohesion, and having trustworthy neighbors are mediating factors in understanding residents’ assertiveness to establish informal social control, try to control crime, and feel safe (see also Morenoff et al., 2001). Other research on collective efficacy reveals that persons who are poor, who are members of minority groups, and who are not socially linked to their community have lower levels of collective efficacy (Sampson et al., 1997). By contrast, persons who participate in community groups have strong friendship and familial bonds and are more likely to demonstrate collective efficacy (Morenoff et al., 2001). The findings have been inconsistent on individual affiliation with community associations and their perception of fear and risk fear of crime     

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of criminal victimization (Gibson et al., 2002; Hartnagel, 1979; McGarrell, Giacomazzi, & Thurman, 1997; Taylor, Gottfredson, & Brower, 1984; Rountree & Land, 1996). The association between fear and community integration is still not conclusive and may be the result of the operationalization of the variable community integration (Bursik & Grasmick, 1993; Gibson et al., 2002). These are considerations that Caribbean researchers need to refine in their studies by taking into account the idiosyncrasies within and across the region. Although Caribbean societies do not have a metropolitan environment compared with developed countries, research on rural areas may also provide some further parallels. In the nonmetropolitan environment, studies have shown that social disorganization leads to similar fear of crime and criminal victimization consequences as in metropolitan areas (Osgood & Chambers, 2000). Reisig and Cancino (2004) argued that metropolitan and nonmetropolitan settings have structural differences, including stronger family ties in the rural setting, a phenomenon that also exists in the transitioning Caribbean countries where urban residents are more physically distant from their relatives and have stronger friend bonds. As noted already, in many areas within Caribbean societies, the greater collectivism means that inter­action and commitments are more likely to be seen as obligations rather than a freedom of choice. Taylor and Shumaker’s (1990) hazards model indicates that residents can be inoculated and develop a psychological immunity and adaptive behavior to deal with threatening stimuli brought about by certain crimes and incivilities. Being alone in an urban environment even in the Caribbean setting can lead to a heightened feeling of fear, a fear that may be unfocused, general, formless (Farrall, Bannister, Ditton, & Gilchrist, 1997; Warr, 1990). In fact, the general urban uneasiness of crime often supersedes its specificity (Garofalo & Laub, 1978). Such general urban uneasiness creates ambiguity, heightening fear levels, leading to uncertainty, and opening the human imagination to speculation and quick absorption of media sensational presentation of crime news. These dated findings should be tested within Caribbean societies, as they have implications not only for tourism but also for policies aimed at increasing a sense of safety. Incivilities within a community also interact with the general psychological ambiguities and the urban uneasiness. Community incivilities are signs and symbols within the community that interact with both residents’ and nonresidents’ stereotypes about crime and can lead to fear and provoke defensive and protective practices that often damage the already delicate forms of social control within the community (Lewis & Salem, 1986; Skogan, 1990). At the same time, the findings of Carvalho and Lewis (2003) and Taylor and Shumaker (1990) seem to suggest that residents in areas of high incivility accommodate the incivility stimuli, decreasing the strength of the association between fear and incivilities. 266       chadee and chadee

Woldoff (2006) linked the lack of community social control and anomie (Cloward, 1959; Durkheim, 1897/1979; Merton, 1968) to fear. The inconsistencies associated with living in a high-crime neighborhood and ignoring the reality of crimes to psychologically function effectively lead to the creation of anomie (Madriz, 1997b). Such dissonance (Festinger, 1957) situations are not uncommon in many urban and suburban Caribbean areas. Anomie breaks down community collectivism, resulting in individualistic survival responses to threatening stimuli. This leads to withdrawal from public interaction, creating a vulnerability and susceptibility within the community. These explanations can assist in helping to understand Caribbean research findings, which suggest that persons in high-crime areas were less likely to be fearful than persons living in low-crime areas (Chadee, 2003b; Chadee & Ng Ying, 2013). Within and across Caribbean societies, the diversity of communities would be determined, among other factors, by the degree of solidarity and efficacy. Findings from a study conducted in North America lend some insight into the association between diversity and efficacy and fear of crime in the Caribbean. Using a sample of 587 respondents between 19 and 49 years old residing in Chicago, Carvalho and Lewis (2003) assessed the community’s reaction to crime and incivility. They identified four types of residence: violent crime neighborhoods, nonviolent crime neighborhoods with frequent illegal activities with sporadic violence, uncivil neighborhoods, and quiet neighborhoods. Being afraid and living in problematic areas or areas of incivility did not correspond. The study also showed that incivility and crimes do not directly impact fear, safety, and anger. However, fear, safety, and anger are influenced by the interaction with perceived/actual danger and the physical distance from crime areas (see also Taylor & Shumaker, 1990). The findings of Carvalho and Lewis (2003) demonstrated a strong altruistic fear among respondents, that is, respondents were more concerned about family members, relatives, and neighbors being victims. About 75% of the sample felt safe even in the face of incivility or local crime. The authors inferred from the data that fear of crime was neither a politically uniting force nor the most popular reaction to crime. Those who felt afraid were influenced by the actual local crimes and incivilities within the community or by the perceptual inaccuracy that they were vulnerable. Those who felt most unsafe, compared with those who were angry, had lived on average for a shorter period in the community. Of those respondents who were angry, 100% were employed, and 56% of those who felt safe and 60% of those who felt unsafe were employed. Also, those who felt safe were least likely to be on welfare. Further, Carvalho and Lewis (2003) found that those who felt safe used protective measures routinely as part of their daily lives. Fearful persons constrained their behavior excessively, being highly motivated to leave their area. These persons were more likely to participate in defensive and protective fear of crime     

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strategies and in some cases excessive strategies such as the use of furniture to secure doors. Angry respondents’ protective strategies were similar to those displayed by persons who felt safe and seem to be driven by a rational basis for trying to target the sources of danger. However, Ferraro (1995) cautioned that where constrained behavioral strategies do in fact reduce victimization, they may not reduce fear over time. Many Caribbean communities adopt protective practices to reduce the potential risk of victimization and by extension decrease the fear of crime. Future research should evaluate the extent to which these practices do in fact reduce perception of vulnerability to victimization and how they differ from those used outside of the region. Between the community’s social structure and crime occurrence is the fear of crime, which has a mediating effect (Skogan, 1990; Woldoff, 2006). Woldoff (2006) noted that fear of crime creates a feedback loop, a mediating role that has the potential to have a spiral effect between fear and community crime. Fear creates community susceptibility. As Skogan (1990) and Ferraro (1995) proposed with the incivility thesis, the response is not so much to actual crime but to indicators of incivility and disorganization in the community. However, fear of crime inhibits community members’ engagement in both individual and collective crime reduction activities. Caribbean communities need to be cognizant of the delicate social psychological dynamics among the variables discussed (i.e., crime victimization, collective efficacy, incivility). ETHNICITY AND FEAR OF CRIME Ethnicity has been a major factor associated with fear of crime in many societies, including some ethnically diverse Caribbean communities. However, as an explanatory factor, it has always been subject to controversy and debate. Ethnic groups and races are often stereotyped, and these stereotypes affect crime perceptions related to ethnic and race groupings and sometimes lead to the stigmatization and negative labeling of those groups and their members (Hurwitz & Peffley, 1997; Stephan & Rosenfield, 1982). Research from outside of the Caribbean can again inform understanding of the social psycho­ logical dynamics of racial stereotyping and crime. A number of studies (Devine, 1989; Devine & Elliot, 1995; Hacker, 1995; Krueger, 1996; Peffley, Hurwitz, & Sniderman, 1997) have shown that Whites are more likely to assess African Americans negatively and are more likely to perceive members of this ethnic group as violent and criminally oriented. Furthermore, research has also shown that similar behavior displayed by different ethnic groups is interpreted differently in the criminal justice system. Specifically, African Americans are perceived as being more likely to be guilty and antagonistic than Whites (Bodenhausen, 268       chadee and chadee

1988; Hurwitz & Peffley, 1997; Rector, Bagby, & Nicholson, 1993). Other studies have shown that African American men were often associated with crime and fear of crime (Anderson, 1995). The perceptions of living physically close to African Americans provoke fear (Moeller, 1989; Skogan, 1995). Are the findings in the Caribbean parallel? Research on fear of crime in ethnically diverse Trinidad has consistently shown a relationship between ethnicity and fear of crime. The population is made up of a number of ethnic groupings, with approximately 40% of African origin; 40% of East Indian origin; 19% mixed persons (an official category); and Whites, Syrians, Chinese, and other groups constituting about 1% of the population. Surette, Chadee, Heath, and Young (2011) found a strong bivariate correlation in respondent’s ethnicity as Indo Trinidadians’ responses concerning criminal justice policy support were significantly different from those of African origin respondents. Indo Trinidadians were significantly more supportive of punitive policies than African Trinidadians. Those in low-crime areas showed higher levels of endorsement of criminal policy than those in high-crime areas. Similar research in the United States found that the attitudes of African American and Whites greatly differ among many issues, including those related to the criminal justice system (Hagan & Albonetti, 1982; Sigelman & Welch, 1991). Both groups also experience crime differently. Secret and Johnson (1989) opined that for many African Americans, crime is a reality, whereas for many Whites, crime is quite often abstract. Are these perceptual differences a reflection of historical and political antecedents in Trinidad, as they are in the United States, and how do these antecedents affect the way in which fear of crime may be experienced? Another recent study conducted in Trinidad (with some of the findings reported in Chadee & Ng Ying, 2013) found that fear of crime was significantly correlated with risk of victimization and general fear for all major ethnic groups in the sample—African Trinidadian, Indo Trinidadian, and mixed persons. General fear refers to fear toward noncrime stimuli. Analysis showed that levels of fear of crime and general fear were significantly different across ethnic groups, with Indo Trinidadians showing higher levels of fear of crime and general fear than other ethnic groups. Further, regression analyses also identified general crime, not risk of victimization, as the major predictor of fear of crime. This finding was consistent across all ethnic groups, with Indo Trinidadians showing the highest levels of general fear. Chadee and Ng Ying (2013) speculated that cultural practice and the influences of significant members of one’s social and cultural group can transform a formerly innocuous stimulus to one that evokes a fear response. It is possible then that fear acquisition among Indo-Trinidadians has been more extensive given certain ontogenetic and environmental factors. The present research findings, therefore, offer fear of crime     

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a viable preliminary explanation for these group differences, and lend support to the possibility that GF has roots in both person and state factors. (p. 1901)

Woldoff (2006) provided some insights that may shed some light on the ethnic dimension to fear of crime victimization. Using social learning theory, he suggested that differential socialization and learning processes result in differential assessment and coping strategies among ethnic groups. Fear of crime, therefore, is an outcome of differential socialization. In a multicultural society such as Trinidad, this explanation may provide some direction in understanding the consistent findings in the differential fear of crime experiences in the two major ethnic groups. In the United States, Madriz (1997b) showed that fear of crime is high among many ethnic minority groups and relatively high in Latino teenagers in both urban and suburban settings. Using vulnerability as an explanatory factor, the author noted that Latinos are vulnerable to victimization because they are more likely to live in areas that are higher in incivility and being poor economically, making them susceptible to crimes both inside and outside of their homes (Gove, Hughes, & Galle, 1983; Ringheim, 1993). Latinos were victims of crimes, including domestic violence, rape, assaults, and burglaries (Madriz, 1997a). Internal migration to suburban areas by Latinos still did not reduce their fear of crime levels, because they also experienced crime victimization in these areas. Madriz (1997b) further argued that the strong concern for family members leads to altruistic fear (also see Warr, 1992) more than fear for self. These findings are in accord with those of Carvalho and Lewis (2003) on altruistic fear. Protective and defensive behaviors, such as seeking protectors and initiating membership in gangs, help to make some Latinos feel a greater sense of psychological comfort against victimization and fear of crime. Additionally, Madriz (1997b) argued that the interactions between the police and Latinos do not facilitate a sense of trust and only reinforce the wider discrimination that they feel from interactions in the workplace, schools, and on the street. These findings can lend insights into understanding the relations between fear of crime and gang membership in the English-speaking and non–Englishspeaking Caribbean. In fact, Parker, McMorris, Smith, and Murty (1993) found that Hispanics/ Latinos displayed higher levels of fear of crime than African Americans. They indicated that fear of crime is also a pervasive factor present among different non-White groups. Underprivileged and poor African Americans are more vulnerable to victimization and have higher fear of crime levels than high-income White Americans (Parker et al., 1993; Skogan & Maxfield, 1981). Some studies have shown that African Americans’ levels of fear of crime are higher than those of Whites (Covington & Taylor, 1991; Yin, 1980). Eron, Gentry, and Schlegel (1994) argued that African Americans were at an increased level 270       chadee and chadee

of victimization, whereas Hammond and Yung (1993) found that African Americans were more likely to be victimized in the inner city. Social vulnerability is an important explanatory factor in understanding why Latinos are more likely to be fearful than African Americans and Whites (Rohe & Burby, 1988; Skogan & Maxfield, 1981). Madriz’s (1997b) results suggest that socioeconomic class was an important mediating variable in that those in the lower socioeconomic backgrounds were more likely to be fearful. This point has been reinforced when the fear of crime levels of socially vulnerable groups are assessed (Maxfield, 1984; Ortega & Myles, 1987). Those who exist in some kind of economic/resource (education and income) marginality are more likely to report vulnerability to fear of crime against person (Keane, 1998). These North American findings are different from the Trinidad findings on ethnicity and possibly explainable by cultural differences. However, vulnerability is an important factor that may be a common thread in fear of crime across societies, and future studies in the Caribbean may consider exploring this line of work. Chiricos, Hogan, and Gertz (1997) assessed the relations between fear of crime and neighborhood racial composition. The authors were interested in investigating respondents’ fear of crime levels as a function of the actual and perceived increases of African Americans in the neighborhood. Findings suggest that the racial composition did not influence fear of crime. But perceived racial composition impacted the fear of crime of Whites in that they were more likely to be fearful; this was not the case for African Americans. When Whites felt that they were a minority within an area, their fear levels were higher. Risk of victimization was found to be an intervening factor. Controlling for being a victim, perception of crime in one’s neighborhood, age, income, and sex, and perception of racial composition had a significant effect on fear of crime. Chiricos et al.’s (1997) findings are consistent with those of Covington and Taylor (1991) and Liska, Lawrence, and Sanchirico (1982). Chiricos et al. (1997) proposed that the impact of racial composition on fear of crime has to be assessed both spatially and temporally; in measuring the perception of racial composition, they asked the following question: “I would like to ask you about the neighborhood you live in: If you think of the people living within a mile of your house, what percentage of the people living there are White/Black/Latino?” Ward, LaGory, and Sherman (1986) found that African American presence was related to perceptions of safety particularly among those who experienced some kind of insecurity, specifically, health or “mastery” problems. Chiricos, McEntire, and Gertz (2001), building on the Chiricos et al. (1997) findings, assessed the impact of racial and ethnic composition of neighborhood on perception of risk. The study used the survey method with a sample size of 3,000 respondents. Perceptions of race and ethnic composition fear of crime     

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were measured by asking the question, “If you think about your neighborhood and the people living within a mile of your house—what percent of those people would you say are White, African American, Hispanic, other?” Results support the position that persons feel at risk of victimization when living in proximity to other ethnic groups. Respondents’ perception of African Americans or Hispanics living nearby heightened feelings of risk. Chiricos et al. (2001) posited that the perceptions of crime threats are ethnic coded and race coded but may have a greater impact on minority groups rather than Whites. Among the other relevant findings were that Hispanics, African American, and women had a higher perceived risk. Those who thought that crimes were on the increase in their area or in the nation or were recent victims also had a higher level of perceived risk. Lower levels of perceived risk were recorded for those who had higher income and higher educational attainment. An early study found that Whites were more likely to feel high levels of fear of crime when they interacted with unknown African Americans compared with unknown Whites (St. John & Heald-Moore, 1996). The extrapolations for these findings are relevant for understanding the effects of ethnic diversity in some Caribbean communities. CONCLUSION Fear of crime is a phenomenon that has been explored with some depth in the North American and European criminology literature but sparsely in the psychology literature. However, a fuller understanding of fear of criminal victimization, the actual risk of becoming a victim, and the antecedents to fear of crime will assist in directing interventions to reduce unwarranted fear of crime. Considering the sociocultural context of people in the Caribbean countries, including the organization of community life, demographic distributions, and ethnic relationships, will move research and policy in the direction of an indigenous understanding of the crime–fear problem and may complement, refute, or provide unique insights to research in other regions. One of the more pernicious effects of crime is its impact on citizens’ quality of life and their reactions to politicians and government policies addressing security. Crime victimization studies that emphasize fear of crime will assist in identifying unreported victimization, as well as the root of many misperceptions about the incidence of crime. Such identification may enable the development of police and other governmental interventions that can more effectively address issues of victimization and defuse unfounded fears about criminal activity while ensuring that citizens are provided with effective means for addressing their security. Lack of feelings of security not only is socially, economically, and politically destabilizing but also affects citizens’ psychological and physical well-being. 272       chadee and chadee

Future research on fear of crime should consider investigating psychological constructs, such as time perspective, psychological reactance, attribution, religiosity, and general fears, as they relate to perceptions of crime victimization and citizens’ perceptions of security. In view of increasing crime rates and citizen insecurity in Caribbean nation states, goals of this chapter were to raise the issue of fear of crime, the sparseness of its literature in the Caribbean, and the need to investigate this issue from a social psychological perspective. REFERENCES Acuña-Rivera, M., Brown, J., & Uzzell, D. (2014). Risk perception as mediator in perceptions of neighbourhood disorder and safety about victimisation. Jour­ nal of Environmental Psychology, 40, 64–75. http://dx.doi.org/10.1016/j.jenvp. 2014.05.002 Adler, A. (1927). Individual psychology. Journal of Abnormal and Social Psychology, 22, 116–122. http://dx.doi.org/10.1037/h0072190 Anderson, D. C. (1995). Crime and the politics of hysteria: How the Willie Horton story changed American justice. New York, NY: Random House. Bandura, A. (2000). Exercise of human agency through collective efficacy. Current Directions in Psychological Science, 9, 75–80. http://dx.doi.org/10.1111/14678721.00064 Becker, M., Vignoles, V. L., Owe, E., Brown, R., Smith, P. B., Easterbrook, M., . . . Yamakog˘lu, N. (2012). Culture and the distinctiveness motive: Constructing identity in individualistic and collectivistic contexts. Journal of Personality and Social Psychology, 102, 833–855. Bellair, P. E. (1997). Social interaction and community crime: Examining the importance of neighbor networks. Criminology, 35, 677–704. http://dx.doi.org/10.1111/ j.1745-9125.1997.tb01235.x Bodenhausen, G. V. (1988). Stereotypic biases in social decision making and memory: Testing process models of stereotype use. Journal of Personality and Social Psycho­l­ ogy, 55, 726–737. http://dx.doi.org/10.1037/0022-3514.55.5.726 Bursik, R. J., Jr. (1988). Social disorganization and theories of crime and delinquency: Problems and prospects. Criminology, 26, 519–552. http://dx.doi.org/ 10.1111/j.1745-9125.1988.tb00854.x Bursik, R. J., Jr., & Grasmick, H. G. (1993). Economic deprivation and neighborhood crime rates, 1960–1980. Law & Society Review, 27, 263–284. http://dx.doi. org/10.2307/3053937 Carvalho, I., & Lewis, D. A. (2003). Beyond community: Reactions to crime and disorder among inner-city residents. Criminology, 41, 779–812. http://dx.doi. org/10.1111/j.1745-9125.2003.tb01004.x fear of crime     

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11 HIV/AIDS STIGMATIZATION IN THE CARIBBEAN: IMPLICATIONS FOR HEALTH CARE JANNEL PHILIP, ROSANA YEARWOOD, AND DEREK CHADEE

Over the past three decades, AIDS has been one of the most severe problems facing public health. The disease AIDS, and HIV, the virus that causes it, continue to have a profound impact on medical education and clinical care (McDaniel, Carlson, Thompson, & Purcell, 1995; UNAIDS, 2009, 2010). Worldwide, it is estimated that 34 million individuals are living with HIV/ AIDS (UNAIDS, 2012). After sub-Saharan Africa, the Caribbean Basin has the highest rate of HIV in the world (Inciardi, Syvertsen, & Surratt, 2005; UNAIDS, 2009, 2010, 2012). HIV/AIDS has had a profound impact on the Caribbean region and is the prevailing cause of death among 15- to 44-yearolds in the region (UNAIDS, 2005, 2010).

http://dx.doi.org/10.1037/14753-012 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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THE HIV/AIDS EPIDEMIC IN THE CARIBBEAN The first cases of AIDS in the Caribbean marked the official beginning of the epidemic in the region and were recorded in Haiti in 1981 (UNAIDS, 2010, p. 1). Other cases were later reported in Jamaica and Bermuda in 1982 and by 1987, all Caribbean countries had reported at least one case (George & Richards, 2012). In 2007, the island of Hispaniola recorded the highest number of persons living with HIV (PLHIV), which is 182,000 and accounts for about 70% of PLHIV in the Caribbean (UNAIDS, 2010, p. 2). For the same year, in the English-speaking Caribbean, Jamaica had the largest number of PLHIV, followed by Trinidad and Tobago, with an estimated 27,000 and 14,000, respectively. At the end of 2011, an estimated 22,000 persons were reported living with HIV/AIDS in Trinidad and Tobago (UNAIDS, 2012). Adult HIV prevalence rates remain above 1.5% in The Bahamas, Jamaica, Haiti, and Trinidad and Tobago. Increased access to antiretroviral treatment in the region has contributed to a decrease in the AIDS mortality rate. Since 2001, mortality associated with AIDS in the Caribbean has declined 48% (UNAIDS, 2012), and 51% of persons who need treatment can access it (UNAIDS, 2010). This is very significant because access to treatment redound to longer, healthier, and productive lives for PLHIV. The number of new cases in the region has significantly decreased, as 2011 saw a 42% decline in new infections since 2001 (UNAIDS, 2012). The HIV/AIDS epidemic in the Caribbean is said to be both generalized and sustained, reflecting mainly heterosexual sexual transmission (UNAIDS, 2012). Women are especially vulnerable to HIV, and the number of women affected has increased since the start of the epidemic. In 1990, 35% of PLHIV in the region were women; by 2008, women represented 50% of all PLHIV in the Caribbean (UNAIDS, 2010; UNAIDS, 2012). The prevalence is, however, much higher, in men who have sex with men, female commercial sex workers, prisoners, and crack cocaine users (UNAIDS, 2012). Gender inequality, poverty, stigma, and discrimination are some of the social drivers of the HIV/AIDS epidemic in the Caribbean (UNAIDS, 2010, 2012). Stigma and discrimination are two major challenges for PLHIV in the region. Stigmatization is widespread in the workplace, in communities, and in the health sector (UNAIDS, 2010). Stigma and discrimination have been implicated in the reduction of CD4 count in men with HIV at a centralized AIDS treatment delivery facility in Barbados (Kumar, Fonde, & Roach, 2010). Their access to treatment may have been delayed because of the stigma attached to the facility. In Trinidad and Tobago, “stigma and discrimination remains pervasive particularly against persons living with AIDS and most atrisk groups and thus create barriers to accessing testing and treatment services” (UNAIDS, 2008, p. 5). 282       philip, yearwood, and chadee

HIV/AIDS Stigmatization and Health Care HIV stigmatization and discrimination take place at the individual, societal, and institutional levels and are said to be the major obstacles to effective HIV/AIDS prevention and care (UNAIDS, 2000). Stigma impedes PLHIV’s access to treatment and care and thus reduces their life chances by hindering their access to economic and social resources (Aggleton & Parker, 2002; Castro & Farmer, 2005; Herek, 1990; Link & Phelan, 2001). According to Reidpath and Chan (2005), stigmatization is “the process of marking individuals and groups judged as unworthy of social investment” (p. 425). In the literature, researchers have applied the stigma concept to many instances, including mental illness (Corrigan & Penn, 1999; Phelan, Link, Stueve, & Pescosolido, 2000), cancer (Fife & Wright, 2000), and leprosy (Opala & Boillot, 1996). For all these instances of stigma, stigmatization may involve dehumanization, threat, aversion, and sometimes the depersonalization of others into stereotypic figures (Dovidio, Major, & Crocker, 2000). The consequences of HIV/AIDS stigmatization has the potential to be very damaging, and its effects could be more severe depending on the role of the stigmatizer in the life of the stigmatized (Varas-Díaz & Marzán-Rodríguez, 2007). Health care providers play a critical role in the lives of PLHIV because they are the first point of contact for HIV/AIDS care and treatment. Researchers (Cohen, Romberg, Grace, & Barnes, 2005; Li et al., 2007; Reis et al., 2005; Varas-Díaz & Marzán-Rodríguez, 2007) have found that a considerable number of health care professionals and health care students hold stigmatizing attitudes that have a negative impact on their willingness to care for and interact with PLHIV. Actions such as withholding health care and segregating PLHIV from others represent stigmatizing attitudes from health care providers (Caribbean Health Research Council [CHRC], 2007). PLHIV and those who think that they might be infected share concerns about stigmatization and discrimination from health services, and consequently refrain from accessing the necessary services for treatment and care (Kaplan, Scheyett, & Golin, 2005; Madura, 2003; Ogden & Nyblade, 2005; Weiser et al., 2006). The stigma that is attached to AIDS, therefore, presents a significant barrier to the prevention of HIV/AIDS and the care of patients with HIV/AIDS. HIV stigmatization has had a detrimental impact on people living with HIV/AIDS, their families, and public health. A Social Psychological Understanding of HIV/AIDS Stigmatization The social nature of HIV/AIDS incorporates issues linked to moral behaviors with implications for controllability of contracting the HIV virus. Implicit in HIV/AIDS stigmatization is attribution of blame and, as such, hiv/aids stigmatization in the caribbean     

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attribution theories offer a framework for understanding stigma toward PLHIV. Furthermore, attribution theories are fundamental in understanding and explaining stereotypes, prejudice, and discrimination, which are interrelated components of stigma. HIV stigmatization is manifested in social behavior during the interaction between stigmatizer and the stigmatized. It is, therefore, critical to take into consideration the elements that bear upon the interaction process. A thorough investigation of HIV stigmatization would take into account the social and psychological factors that influence the lives of the stigmatized and the stigmatizer. A useful approach, therefore, would be one that can be used to understand the phenomenon from the perspective of both parties. The social cognitive framework provides such an approach. It is the approach that is widely used by social psychologists in understanding behaviors such as HIV/ AIDS stigmatization, and it is a very useful one for understanding HIV stigmatization in the Caribbean (Philip, Chadee, & Yearwood, 2014). In addition, the social construction of an illness like HIV must be taken into consideration to fully comprehend its impact in the Caribbean region. The Social Cognitive Approach Fiske and Taylor (1984) referred to social cognition as “the study of how people make sense of other people and themselves” (p. 1). The information that people receive about others and themselves is first interpreted or given meaning by factors such as the social context, past experiences, and cultural values (Pennington, 2000). When social information is analyzed the initial interpretation is subject to adjustment, change, or rejection. The social information is then stored in memory, where it may be retrieved (Pennington, 2000). Pennington (2000) noted that in the definitions of social cognition, the term social world refers to both other people and oneself. The social cognitive approach therefore takes account of self and other and, most important, the self in interaction with other people (Pennington, 2000). Overall, the social cognitive approach is in keeping with the general social psychological process. Social psychology’s attempt to “understand and explain how the thought, feeling, and behavior of individuals is influenced by the actual, imagined or implied presence of others” (Allport, 1954, p. 3) augurs well for the content and concerns of social cognition. The social cognitive approach does not rely on any one theory but has as its objective concerns about “how people make sense of other people and themselves” (Fiske &Taylor, 1984, p. 12). Some theories that fall within the social cognitive framework are attribution theory and appraisal theory of emotions (Hareli, 2014; Kelley & Michela, 1980; Scherer, 1999; Weiner, 2014). The social cognitive approach is relevant to the study of person perception, stereotyping, and attitudes. 284       philip, yearwood, and chadee

The Social Construction of Stigma Illness is defined by a process that requires a series of social interactions, from the point of observation of symptoms through to the categorization and formulation of a cure (Herek, 1990). In commenting on the process through which illness is defined, Herek (1990) noted that “during this definitional process, the culture imbues the disease with meanings by integrating it into a larger ontology” (p. 5). Behaviors and attitudes concerning health and illness are very contextual, and researchers must consider the sociocultural context surrounding the individuals of interest (see Chapter 6, this volume). Culture largely determines the construction of illness and, therefore, as with stigma, illness is socially constructed. Culture plays a major role in the construction of stigma. The combined effect of the role of culture in the construction of illness and stigma holds important implications for understanding HIV/AIDS stigmatization. In an investigation of HIV/AIDS stigma, it is therefore relevant to recognize the social and cultural idiosyncrasies of the society, as well as the specific populations being studied. Thus, to understand the phenomena of HIV stigma in the Caribbean, it is imperative to take into consideration the social and cultural peculiarities of the Caribbean society. Additionally, although studies have shown that attitudes of health care providers toward PLHIV are similar to that of the general population, it is important to recognize the structural and systemic context of the workplace that influences that social interaction between health care providers and PLHIV. Antecedents of Stigmatizing Attitudes Negative reactions toward PLHIV and people living with AIDS have been observed generally and also among health care professionals (Abed & Neira-Munoz, 1990; Farmer & Greenwood, 2001; Melby, Boore, & Murray, 1992). PLHIV also express feelings of devalued social identity resulting from their interaction with health care practitioners. How stigma is manifested in the general society is an extension and an indication of how it is manifested institutionally (Aggleton, Wood, Malcolm, & Parker, 2005). The Caribbean region is not immune to the consequences of stigma related to HIV/AIDS. Caribbean researchers (e.g., Mahdi et al., 2005; Norman & Carr, 2005; Norman, Carr, & Jiménez, 2006; White & Carr, 2005) have reported the pervasiveness of HIV stigma in the Caribbean region. Confronted with the statistics presented above, regional leaders, local leaders, and stakeholders are seeking every means to address the epidemic and its attendant challenges. In the Caribbean region, HIV/AIDS stigma and discrimination are said to be widespread among health care providers (Brown, Macintyre, & Trujillo, hiv/aids stigmatization in the caribbean     

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2003). Health care providers were reported as “overworked, scared, and ill prepared to deal with the disease” (Foreman, Lyra, & Breinbauer, 2003, p. 36). Experiences related by patients include delay and withholding of treatment, premature discharge from hospitals, HIV testing without consent, and breach of confidentiality within the health care system (Brown et al., 2003). Furthermore, a study by the CHRC reported negative and stigmatizing attitudes toward PLHIV by health care workers. Patients reported that they were segregated from other people and were asked to use different utensils and toilets from other patients (CHRC, 2007). They also reported negligence in their hygiene needs and that the health care workers used protective clothing unnecessarily when treating them (CHRC, 2007). These findings are indicative of the social exclusion inherent in the treatment of PLHIV and people living with AIDS. Health care practitioners’ unwillingness to interact with and treat PLHIV is a major indication of their negative reactions toward PLHIV. Research findings have revealed that onset controllability is a key determinant of stigma towards PLHIV. That is, whether the condition (HIV) is perceived as beyond control of the affected person or the PLHIV’s responsibility. In other words the question is asked, Is the individual’s illness caused by his or her behavior? Moreover, controllability often involves moral judgments of PLHIV, linked with preexisting stigmas attached to PLHIV (e.g., homosexuality, drug abuse, and sexual promiscuity; Norman & Carr, 2005; Nyblade et al., 2003; Pryor, Reeder, Vinacco, & Kott, 1989; Visser, Makin, & Lehobye, 2006). Behavioral Causation and HIV Stigmatization HIV/AIDS is typically regarded as a behaviorally caused illness. It is usually believed that the HIV-positive individual did something wrong or behaved in a manner that allowed him or her to contract the virus (Herek, 1999). In other words, people infer or make judgments about the cause of the individual’s HIV-positive status. Assignment of controllability, responsibility, and blame to PLHIV may be further influenced by their membership in groups that are already stigmatized. HIV stigmatization is more complex because of its associations with preexisting stigmas, such as being a gay man, being promiscuous, using drugs, and engaging in commercial sex work. Persons who are members of these groups are seen as having control over their membership in the group or choosing to be part of the group, thus eliciting further causal inferences. HIV stigmatizing attitudes may therefore be additionally influenced by prejudices against these groups. Ladany, Stern, and Inman (1998) found that medical students tended to rate an HIV-infected male patient who contracted his illness via blood transfusion as more responsible for the cause and solution to his problems when the patient was additionally described as being gay. Moreover, male medical 286       philip, yearwood, and chadee

students who were privy to information about a patient who acquired HIV via blood transfusion were significantly more willing to provide treatment to that patient if he was straight rather than gay. In the Caribbean, studies show a widespread intolerance toward people who are not straight (Mahdi et al., 2005; Norman & Carr, 2005; Norman, Carr, & Jiménez, 2006; Norman, Carr, & Uche, 2006; White & Carr, 2005). It is instructive to know whether this apparent intolerance influences the care and treatment for PLHIV in the Caribbean. Emotional Expression and Causal Attribution Psychological and behavioral reactions such as HIV stigmatization have multiple inputs or predictors. These inputs may interact to have moderating, intervening, and mediating effects in their contribution to behavioral reactions. Weiner (1995, p. 3), for instance, asserted that judgment of personal responsibility generates certain emotions, such as anger and sympathy and these emotions in turn direct social behaviors such as stigmatization. In an attribution–emotion model of stigmatization, Weiner, Perry, and Magnusson (1988) suggested that reactions to stigmas such as HIV are amenable to attribution analysis. The HIV virus represents negative outcomes, and both the stigmatized and the observer search to find out the origin of the stigma. HIV implies a cause and thus negates the need to actively search for a cause. For instance, HIV and AIDS may automatically be associated with being gay, being promiscuous, or using intravenous drugs. These associations infer causality and personal responsibility, and are fraught with emotional undertones inherent in morals and the expectations and feelings of how society ought to be (Weiner, 1995). Attribution theory posits that these perceived causes of the stigma will influence affective responses, such as anger and pity toward the stigmatized person (Weiner, 1995). The perceived cause will also affect future expectations concerning the person and behavioral intentions toward him or her (Weiner et al., 1988). The perception that one’s HIV status is due to promiscuous behavior may give rise to anger or resentment, and, as a result, the observer would be less willing to engage in positive behavioral interaction with the infected person (Weiner, 1995). Weiner (1980, 1993, 1995) and Weiner et al. (1988) further proposed that emotions such as anger and sympathy may result from attributions of onset controllability and influence participant helping intentions and willingness to interact with persons with stigmatized conditions. The mediational role proposed by Weiner (1993, 1995) implies that emotion is a necessary pathway from attributions of responsibility to behavior. In other words, the direct determinant of the stigmatizing behavior is the emotion that was elicited after attributing personal responsibility for the outcome. Perceived controllability, responsibility, and blame, therefore, have indirect hiv/aids stigmatization in the caribbean     

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paths to stigmatizing behavior, and these paths are through emotions. The combination of the above-mentioned factors gives AIDS a special status as an elicitor of multiple affective reactions (Weiner, 1995, p. 109). These reactions have a great influence on the treatment and care of PLHIV. Weiner’s (1995) attribution–emotion motivational sequence can further be expanded to incorporate the instance of HIV stigmatization or negative social reactions toward PLHIV. The sequence in Figure 11.1 demonstrates how the causal perceptions specific to HIV work through emotions to result in the eventual social reaction to the PLHIV. Social Psychological Explanations of HIV Stigmatization— The Caribbean Context To what extent can Weiner’s (1995) model be used to explain reactions to persons with HIV/AIDS in the Caribbean context? What are the implications of this motivational sequence on health care in the Caribbean? These issues were investigated by Philip et al. (2014), and much insight was gained with respect to HIV/AIDS-related stigmatization in the Caribbean and its influence on health care in the region. The research sampled health care students from a teaching hospital on the island of Trinidad and examined the students’ reactions toward PLHIV. The following discussion presents a social psychological explanation of HIV stigmatization in the Caribbean context.

Figure 11.1.  Motivational sequence of reactions toward persons with HIV/AIDS. From Judgments of Responsibility: A Foundation for a Theory of Social Conduct (p. 108), by B. Weiner, 1995, New York, NY: Guilford Press. Copyright 1995 by Guilford Press. Adapted with permission.

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HIV-Onset Controllability The investigations revealed that patients’ mode of HIV transmission had a significant effect on all student reactions examined, with the exception of fear (see Table 11.1). Negative reactions (i.e., disgust, blame, prejudicial evaluations) were significantly greater, as were less positive reactions (i.e., empathy, willingness to interact) toward patients who were deemed to have caused their illnesses (high HIV-onset control). These results indicate that health care students’ general reactions toward PLHIV are dependent on their evaluation of the patient’s mode of acquiring HIV. Health care students responded more negatively to the PLHIV when he or she contracted HIV through unprotected promiscuous sex. These results concur with the findings of previous studies (e.g., Cohen et al., 2005; Herek, 2002; Seacat et al., 2007). The association of HIV with preexisting stigmas, such as promiscuity, is therefore evident in the results of this Caribbean research. Promiscuity can be classified as a blemish on one’s individual character, as stated by Goffman (1963) in his typology of stigma. This blemish of individual character leads to the devaluing and discrediting of the stigma bearer. Individual character is judged on the basis of what is expected and acceptable. In other words, departure from social norms elicits negative evaluations and emotions about the PLHIV and also inhibits social interaction with him or her. Society has become furnished with a wealth of information to assist in understanding the transmission and effects of HIV, and although this may serve to attenuate some of the visible forms of stigma, the problem of prejudice or prejudicial evaluation still exists. Goffman (1963) cautioned that “familiarity need not reduce contempt” (p. 70). In making any social cognitive inference we, as social beings, first gather relevant information. However, the selection of information we deem relevant is guided by preexisting expectations and theories (Howard, 1995). According to the social cognitive approach, TABLE 11.1 Main Effects of HIV Onset Controllability on Participant Reactions

Reaction Attribution of blame Empathy Disgust Fear Willingness to interact Prejudicial evaluation

High-onset control

Low-onset control

M

SD

M

SD

F(1, 337)

hp2

MSE

15.28 11.62 7.22 5.18 46.25 25.30

4.37 3.69 3.17 2.46 11.55 6.59

8.87 14.61 6.13 4.71 48.90 19.56

4.48 3.34 3.92 2.38 11.23 6.06

177.44*** 61.10*** 10.95** 3.26 4.58* 69.56***

.35 .15 .03 .01 .01 .17

19.62 12.40 9.30 5.86 129.75 40.10

*p < .05. **p < .01. ***p < .001.

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people are selective in gathering information in an effort to maintain cognitive efficiency (Fiske & Taylor, 1984; Heider, 1958; Howard, 1995). As social beings, people’s preconceptions about social groups and social processes influence the information they gather, the inferences they make, and attitudes they engage in (Howard, 1995). In this study, the inferences made about the patient and the resultant reactions toward him may have been guided by health care students’ perceptions and expectations of “acceptable” or “right” lifestyles. The investigations also looked into whether the sexual orientation of PLHIV would significantly influence health care students’ reactions toward the patient. No significant differences were found between reactions toward straight men and gay men (Philip et al., 2014). But this finding is contrary to the findings of many studies (Cohen et al., 2005; Kelly, St. Lawrence, Smith, Hood, & Cook, 1988; Ladany et al., 1998), which indicated that health care providers were less willing to interact with PLHIV who were gay. Intolerance toward people who are not straight is widespread in the Caribbean (Mahdi et al., 2005; Norman & Carr, 2005; Norman, Carr, & Jiménez, 2006; Norman, Carr, & Uche, 2006; White & Carr, 2005). Sexual prejudice has proven to be a major impediment to health care, with increasing efforts to reduce biases in health care (Drench, Noonan, Sharby, & Ventura, 2003). The absence of explicit negative reactions toward PLHIV who are gay in this study is therefore promising, as it may demonstrate acceptance of gay men and lesbians and consequently a reduction in negative attitudes and undesirable behavior toward them. At the onset of HIV/AIDS 30 years ago, the disease was closely linked to being gay because it was more prevalent among gay men. AIDS was, therefore, called the “gay plague” and was first named “gay-related immune deficiency syndrome” (Altman, 1982; Brennan & Durack, 1981; Herek, 1991; R. Smith, 2001). The immense negative reactions included violence toward gay men regardless of their HIV/AIDS status (Herek, 2000; Pryor, Reeder, & Landau, 1999). Presently, in many parts of the world, including the Caribbean, HIV/ AIDS is more prevalent among people who are straight, and AIDS is essentially a heterosexually transmitted disease (Inciardi et al., 2005; UNAIDS, 2010). As Clark (1994) suggested, affective associations held by individuals may reflect their “cultural and idiosyncratic experiences” (p. 256). The peculiar experience of the Caribbean in relation to the transmission of HIV has been largely through unprotected heterosexual intercourse (Inciardi et al., 2005; UNAIDS, 2010). This specific experience of the Caribbean, therefore, creates a different collection of associations with HIV and may provide an explanation for the results obtained. Many societies have not accepted being a gay man or lesbian as normal and hence are prejudicial toward these people (White & Carr, 2005). 290       philip, yearwood, and chadee

However, now in many countries people who are gay or lesbian are increasingly accepted (T. W. Smith, 1999). This increased acceptance is evident in the proliferation of television programs that present gay and lesbian relationships as typical and acceptable and in the fact that gay men and lesbians are in prominent public positions. The post–HIV-onset generation, that is, individuals 30 years old or younger, is therefore exposed to less negative representations of gay men (and lesbians) and their associations with HIV. The apparent acceptance of gay men and lesbians may be in part due to the youthful age (M = 25 years old) of the health care students examined in the Caribbean study referenced here (Philip et al., 2014). Cognitive and Affective Predictors of Willingness to Interact With People With HIV The research further examined some cognitive and affective factors to observe their combined effect on students’ willingness to interact with PLHIV. The factors in combination significantly predicted participants’ willingness to interact with PLHIV (see Table 11.2). This finding is in keeping with the social cognitive approach. Innumerable factors contribute to health care students’ interaction with PLHIV. The limited factors presented in this research explain or contribute to over a third of the variability in participants’ willingness to interact with HIV/AIDS patients. This demonstrates the significance of the cognitive and affective variables in determining and directing behavior of health care students in the Caribbean.

TABLE 11.2 Standard Multiple Regression of Cognitive and Affective Factors on Participants’ Willingness to Interact With Persons Living With HIV Outcome variable: Willingness to interact with PLHIV (N = 339) Predictor variable Attribution of control Attribution of responsibility Attribution of blame Empathy Disgust Anger Fear Prejudicial evaluation Perception of occupational risk

B

SE B

b

sr 2

.15 -.08 .16 .64 -1.00 .62 -1.27 -.54 .03

.16 .18 .16 .18 .22 .20 .24 .10 .05

.09 -.04 .08 .21*** -.27*** .20** -.27*** -.33*** -.03

.00 .00 .00 .02 .04 .02 .05 .05 .00

Note.  R 2 = .39; DR 2 = .38. Unique variability for the full regression model is .18. **p < .01. ***p < .001.

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A look into the individual impact of the cognitive and affective factors on willingness to interact with PLHIV provides further insight into the tripartite view of HIV/AIDS stigmatization. Dovidio et al. (2000) suggested that stigmatization reflects a combination of cognitive, affective, and behavioral processes and their interactions. The results suggest that greater willingness to interact with the patient is significantly influenced by increased empathy toward PLHIV and less fear, disgust, and prejudicial evaluation of them. Among these four factors, however, fear and prejudicial evaluation are more significant predictors of willingness to interact than other variables, as indicated. Fear is affective in nature, and prejudicial evaluations include both cognitive and affective elements. Researchers (e.g., Dijker, Kok, & Koomen, 1996; Kelly, St. Lawrence, Hood, & Cook, 1987) have consistently demonstrated the impact of fear and prejudicial evaluation on health care practitioners’ inter­ action with PLHIV. It is therefore being demonstrated that fear and prejudicial evaluation are major determinants of stigmatizing reactions in the Caribbean context (Philip et al., 2014). The advanced stage of AIDS is very telling of its fatality and destruction to the human body: The emaciated appearance, the overwhelming presence of bodily lesions, and the frail physical appearance of the person with AIDS combine to present a picture of death. Among the many fears that humans may experience is the fear of death, and anything that presents a threat to human existence brings forth a strong emotion of fear. The physical manifestations of AIDS not only elicit fear but also disrupt social interaction with persons living with HIV/AIDS (Herek, 1999; Herek & Capitanio, 1998). Some people avoid PLHIV because AIDS is perceived as repellent, ugly, upsetting, and dangerous (Herek & Capitanio, 1998). The instrumental fear of AIDS as an illness, therefore, lends explanation to the significant impact of fear on health care students’ willingness to interact with PLHIV. By contrast, prejudicial evaluation is indicative of the symbolic associations between AIDS and groups identified with the disease (Herek, 1999; Herek & Capitanio, 1998; Reidpath & Chan, 2005)—that is, they result from the social meanings attached to HIV/AIDS. It represents attitudes toward groups associated with the behaviors that are perceived to transmit HIV; these behaviors include promiscuity, homosexuality, drug use, and commercial sex work (Pryor et al., 1989; Reidpath & Chan, 2005). The significant influence of prejudicial evaluation on health care students’ willingness to interact with PLHIV could, therefore, imply a symbolic prejudice toward groups commonly associated with HIV and may be indicative of the influence of the social meanings attached to HIV/AIDS. Emotions as Mediators Finally, the investigations probed into the mediational role of emotions. The findings clearly demonstrated that emotions occupy a mediating 292       philip, yearwood, and chadee

role in the relationship between attributions and willingness to interact with PLHIV. This means that health care students’ perceptions about patients’ controllability, responsibility, and blame for contracting HIV give rise to empathy, fear, anger, and disgust. Consequently, empathy, fear, anger, and disgust influence their willingness to interact with PLHIV. These findings are consistent with Weiner’s (1986, 1995) attribution– emotion model for understanding reactions to stigmatized conditions. This investigation tested all aspects of Weiner’s sequential model among health care students. The findings support the literature that suggests emotions affect every aspect of human life (Frijda & Mesquita, 1994; Varas-Díaz & MarzanRodríguez, 2007). Specifically, emotions guide behaviors, which influence other people and cause reactions to events and action of others (Frijda & Mesquita, 1994). Emotional experiences of the health care students seem to serve as a guide for their social interaction with PLHIV. Empathy fully mediated attributions of control, responsibility, and blame. This is noteworthy, as it indicates that in this model, empathy has total control of the path between these attributions and people’s willingness to interact with PLHIV. Health care students’ perceptions of the patients’ control, responsibility, and blame for contracting HIV do not directly influence willingness to interact with PLHIV. Rather, empathy is the route through which these attributions have an effect on willingness to interact with PLHIV. We can, therefore, infer that empathy has a considerable influence on health care students’ reactions toward PLHIV. The research that tested the full model among health care providers is limited. Hence, this study lends to the body of literature that emphasizes the importance of the mediating function of emotions in understanding health care providers’ interactions with patients living with HIV/AIDS. In the Caribbean, little research has investigated the role of emotions in health care providers’ reactions to PLHIV. Abell, Rutledge, McCann, and Padmore (2007) suggested the need for further research into how emotions are implicated in health care providers’ attitudes toward PLHIV in the Caribbean. This present investigation took this suggestion and demonstrated the significant function of emotions in health care practitioners’ HIV/AIDS-related attitudes. Weiner’s (1986, 1995) attribution–emotion model thus stands as an applicable theoretical model to understand health care students’ willingness to interact with PLHIV in the Caribbean context. Implications for Health Care and Practice Now, with more insight into social psychology of HIV stigmatization in the Caribbean context, it is imperative to consider the implications for health care. In particular, the findings above have implications for clinical hiv/aids stigmatization in the caribbean     

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encounters and practice of health care students. I discuss these implications next, along with recommendations for best practice. Self-Awareness of Potential Biases and Prejudices The significant influence of prejudicial evaluation highlights a need for self-awareness of biases and prejudices among health care students. Awareness of personal biases and prejudices is critical in regulating behavioral interactions. The blame directed at the PLHIV with high HIV-onset controllability is instrumental in inciting these biases and prejudices in health care students. Health care students should therefore refrain from blaming patients for their illness and focus on helping them. To achieve self-awareness of personal biases, the psychosocial abilities of health care students need to be developed. These psychosocial skills and abilities should focus on an understanding of human behavior and interaction from the perspective of self (provider) and other (patient). Health care curricula should therefore focus on supplying students with evidence-based medical knowledge, as well as helping students to develop psychosocial competence. Awareness of Emotions Emotions assume a significant role in determining health care students’ behavioral reactions to PLHIV. Caring for PLHIV is a highly emotionally charged event for health care students. It is therefore important that they are aware of the emotions that they experience when interacting with these patients. An appreciation of the influence of emotions in determining the quality of HIV care and treatment should therefore be factored into the design of training programs and curricula for health care students. As suggested by this research, cognitive and affective aspects of HIV must be addressed in an attempt to reduce HIV stigma in health care settings. Personal and institutional assessment of barriers to effective HIV care and treatment are also necessary for understanding the emotional implications for providers’ interaction with PLHIV. The research discussed in this chapter is not without limitations. The sample of medical and health students from Caribbean islands may not allow for the generalization of the results to medical students in other regions of the world. Another limitation of the study is the usage of quasi-experimental design and vignettes methodology. Although such a design increases internal validity, it may reduce external validity of the study because actual patients were not used. Recommendations for Future Research and Conclusion The research discussed in this chapter has by no means exhausted all the factors that influence health care students’ willingness to interact with 294       philip, yearwood, and chadee

PLHIV in the Caribbean. It does, however, highlight some areas worthy of further investigation. The overwhelming influence of emotions on students’ reactions to PLHIV signals a need to investigate further the role of emotions as well as emotional regulation. Future studies should focus on the information processing of health care providers and how it affects cognitive inferences about PLHIV. The studies should take into consideration, for instance, the cognitive reasoning and processing involved in making internal and external attributions about PLHIV. Health care practitioners play a pivotal role in society and in the care and treatment of PLHIV. Health care providers have a key role in effecting an enabling environment for PLHIV. They have much power to either facilitate or hamper social dialogue concerning HIV and AIDS, simply because they are “gatekeepers for medical treatment and prevention programming” (Rutledge, Abell, Padmore, & McCann, 2009, p. 19). Because of this significant role, health care providers—students or professionals—can make a significant contribution to reversing stigma and discrimination. HIV stigmatization hinders society’s ability to effectively respond to the HIV/AIDS epidemic; comprehending and reducing stigma will, therefore, remain an important goal of public health for years to come. Social and psychological research such as this study can play an instrumental role in providing the information necessary to develop effective programs to address HIV/AIDS stigma among health care practitioners. Evidence-based research is critical to inform stigma-reducing interventions in health care. Theory and scientific evidence assume a significant function in health promotion interventions that are necessary especially for the HIV epidemic (Glanz, Rimer, & Lewis, 2002). The present study provides a conceptual and theoretical framework, namely, the social cognitive theoretical framework for understanding health care students’ willingness to interact with patients living with HIV/AIDS. The social cognitive framework highlights the cognitive, affective, and behavioral aspects related to HIV stigma. This research, therefore, contributes significant theoretical and scientific evidence toward health promotion and the reduction of HIV/AIDS stigma in health care settings in the Caribbean. REFERENCES Abed, R., & Neira-Munoz, E. (1990). A survey of general practitioners’ opinions and attitudes to drug addicts and addiction. British Journal of Addiction, 85, 131–136. Abell, N., Rutledge, S.  E., McCann, T.  J., & Padmore, J. (2007). Examining HIV/AIDS provider stigma: Assessing regional concerns in the islands of the Eastern Caribbean. AIDS Care, 19, 242–247. http://dx.doi.org/10.1080/09540120600774297 hiv/aids stigmatization in the caribbean     

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Aggleton, P., & Parker, R. (2002). A conceptual framework and basis for action: HIV/ AIDS stigma and discrimination. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS. Aggleton, P., Wood, K., Malcolm, A., & Parker, R. (2005). HIV-related stigma, discrimination, and human rights violations: Case studies of successful programmes. Geneva, Switzerland: UNAIDS Best Practice Collection. Allport, G. W. (1954). The historical background of social psychology. In G. Lindzey & E. Aronson (Eds.), Handbook of social psychology (Vol. 1, pp. 1–46). New York, NY: Random House. Altman, L. K. (1982, May 11). New homosexual disorder worries health officials. The New York Times. Retrieved from http://www.nytimes.com/1982/05/11/science/ new-homosexual-disorder-worries-health-officials.html Brennan, R. O., & Durack, D. T. (1981). Gay compromise syndrome. The Lancet, 2, 1338–1339. Brown, L., Macintyre, K., & Trujillo, L. (2003). Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention, 15, 49–69. http://dx.doi.org/10.1521/aeap.15.1.49.23844 Caribbean Health Research Council. (2007). Caribbean Health Research Council (CHRC)/CRN+ study Quality of Life of People Living With HIV/AIDS in the Caribbean. Port of Spain, Trinidad and Tobago: Author. Castro, A., & Farmer, P. (2005). Understanding and addressing AIDS-related stigma: From anthropological theory to clinical practice in Haiti. American Journal of Public Health, 95, 53–59. http://dx.doi.org/10.2105/AJPH.2003.028563 Clark, L. F. (1994). Social cognition in health psychology. In R. S. Wyer & T. K. Srull (Eds.), Handbook of social cognitions: Applications (pp. 239–288). Hillsdale, NJ: Erlbaum. Cohen, L. A., Romberg, E., Grace, E. G., & Barnes, D. M. (2005). Attitudes of advanced dental education students toward individuals with AIDS. Journal of Dental Education, 69, 896–900. http://dx.doi.org/10.4103/2141-9248.138020 Corrigan, P. W., & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54, 765–776. http://dx.doi. org/10.1037/0003-066X.54.9.765 Dijker, A. J., Kok, G., & Koomen, W. (1996). Emotional reactions to people with AIDS. Journal of Applied Social Psychology, 26, 731–748. http://dx.doi. org/10.1111/j.1559-1816.1996.tb02741.x Dovidio, J. F., Major, B., & Crocker, J. (2000). Stigma: introduction and overview. In T. F. Heatherton, R. E. Kleck, M. R. Hebl, & J. G. Hall (Eds.), The social psychology of stigma (pp. 1–13). New York, NY: Guilford Press. Drench, M. E., Noonan, A. C., Sharby, N., & Ventura, S. H. (2003). Psychosocial aspects of health care. Upper Saddle River, NJ: Pearson. Farmer, R., & Greenwood, N. (2001). General practitioners’ management of problem drinkers: Attitudes, knowledge, and practice. Drugs: Education, Prevention, and Policy, 8, 119–129. http://dx.doi.org/10.1080/096876301300101843

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Weiner, B. (1995). Judgments of responsibility: A foundation for a theory of social conduct. New York, NY: Guilford Press. Weiner, B. (2014). The attribution approach to emotion and motivation: History, hypotheses, home runs, headaches/heartaches. Emotion Review, 6, 353–361. http://dx.doi.org/10.1177/1754073914534502 Weiner, B., Perry, R. P., & Magnusson, J. (1988). An attributional analysis of reactions to stigmas. Journal of Personality and Social Psychology, 55, 738–748. http://dx.doi. org/10.1037/0022-3514.55.5.738 Weiser, S. D., Heisler, M., Leiter, K., Percy-de Korte, F., Tlou, S., DeMonner, S., . . . Iacopino, V. (2006). Routine HIV testing in Botswana: A population-based study on attitudes, practices, and human rights concerns. PLoS Medicine, 3, e261. http:// dx.doi.org/10.1371/journal.pmed.0030261 (Correction published October 31, 2006, PLoS Medicine, 3, e395) White, R. C., & Carr, R. (2005). Homosexuality and HIV/AIDS stigma in Jamaica. Culture, Health & Sexuality, 7, 347–359. http://dx.doi.org/10.1080/136910505 00100799

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V CLINICAL PSYCHOLOGY

12 MENTAL HEALTH IN THE CARIBBEAN JACQUELINE SHARPE AND SAMUEL SHAFE

Mental health issues in the Caribbean have, as elsewhere, been major contributors to the global burden of disease. The lifetime prevalence of mental disorders globally has been estimated to be between 12% and 47% (Kessler et al., 2007). Mental and substance use disorders are the leading global cause of all nonfatal burden of disease and account for 22.9% of total years lived with disability (Whiteford et al., 2013). Because of high chronicity, early age of onset, and the serious impairment that may result, mental health disorders pose serious challenges to developing societies. In general, mental health remains a low-priority health issue for most Caribbean countries. Usually, a health problem gains political priority when three specific conditions are met: (a) country political leaders, as well as international leaders, publicly (and privately) express support for an issue;

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(b) policies are enacted that address the problems; and (c) resources appropriate to the disease burden are allocated to the issue (Tomlinson & Lund, 2012). In the Caribbean, neither the first nor the third condition applies, and although some countries have developed mental health policies and others have developed mental health plans, enactment of the plans on the basis of a policy framework lags behind the formulation of the policies, as we demonstrate later in this chapter. Insufficient resources inequitably distributed, and at times inefficiently used, have led to a treatment gap (percentage of individuals who need treatment and who do not receive treatment) in mental health disorders of more than 75% that exists in low-income and lower-middle-income countries (World Health Organization [WHO], n.d.). About a decade ago, the treatment gap for Latin America and the Caribbean was 58.9% for depression, 64.0% for bipolar disorder, and 75.0% for alcohol-associated disorders (Kohn, Saxena, Levav, & Saraceno, 2004). Despite this situation, there is overall recognition that “there is no health without mental health” (WHO/Pan American Health Organization [PAHO]). Countries throughout the Caribbean do provide some level of mental health services and care and have participated in mental health evaluation exercises (e.g., WHO, 2011). Moreover, Caribbean countries have also made commitments in the Panama Consensus of the PAHO/ WHO to allocate more resources to addressing mental health issues. These commitments include, inter alia, to increase the allocation of resources to mental health programs and services and ensure appropriate, equitable distribution of these resources, so that they are adequate to the growing burden of mental and substance use disorders, in the understanding that investing in mental health means contributing to overall health and well-being, as well as to the social and economic development of countries. (PAHO, 2010)

Another commitment was to ensure a “hemisphere with no insane asylums in 2020” (PAHO, 2010). It is in the context of these issues that we explore the history of the development of psychiatric services and the state of mental health in the 15 Caribbean Community Countries (CARICOM). We examine some of the epidemiology of mental health disorders and current research on mental health in the region. Finally, we discuss legislation, policy, and plans that inform mental health care and services in the Caribbean. Because mental health issues traditionally fell primarily within psychiatry in Caribbean countries, we provide a brief historical account of the evolution of the treatment of the mentally ill before discussing the epidemiology of mental illness and policy. Chapter 14 in this volume outlines related attempts within psychology to address mental health issues in the Caribbean. 306       sharpe and shafe

HISTORICAL ROOTS OF TREATING THE MENTALLY ILL In writing about the history of psychiatry in the Caribbean, Beaubrun et al. (1976) recalled the treatment of the mentally ill as described by the Spanish monk De Las Casas in 1542. Among the indigenous Taino people in Jamaica, the community took responsibility for the mental health of its members. Treatment of the mentally ill “involved the use of unguents and salves, herbs blended with foods for those they called ‘mind-riven’ who were allowed to wander at large. The Spanish colonizers attributed the excellent results achieved by these indigenous treatments to sorcery” (Hickling & Gibson, 2012, p. 438). The mass deaths of the indigenous population due to genocide and infectious diseases ushered in the period of chattel slavery. As noted in several chapters in this volume (see, e.g., Chapters 3 and 14), slaves were brought from West and South West Africa across the middle passage to the Caribbean to labor on the sugar cane plantations. After emancipation, indentured laborers were brought from India to continue to work the plantations in some countries, particularly Trinidad and Tobago, the Guianas, Jamaica, and Martinique. Slaves who were mentally ill met cruel treatment at the hands of their masters. De Las Casas records that suicide was a common response to European colonization. Most slaves who were mentally ill were incarcerated, and institutionalization would become a common practice during the colonial period (Beaubrun et al., 1976). The first lunatic asylum in Jamaica was established in 1776 as a component of the Kingston Public Hospital (KPH; Hickling & Gibson, 2012). Between 1850 and 1900, asylums for the mentally ill were established in many of the Caribbean islands following similar developments in Britain. The first mental asylum was established in Trinidad and Tobago in 1858 and in Barbados in 1893. In Jamaica, Bellevue Hospital was set up and started taking patients from KPH in 1862. In the Windward Islands, mentally ill people were sent to the asylum opened in Grenada in 1879, and those from the Leeward Islands were sent to the asylum in Antigua starting in 1871. The early part of the 20th century saw the first Black Caribbean physicians being trained in the United Kingdom, the United States, and Canada. The first Black psychiatrist in the Caribbean was Dr. Hopetoun Edward Bond, who began practicing in Jamaica in 1914 (Hickling & Gibson, 2012). Along with Dr. Bond, later pioneers in psychiatry in the Caribbean were Dr. L. F. E. Lewis, who was based at St. Ann’s Hospital in Trinidad, and Dr. Robert Lloyd-Still, a British national who made his home in Barbados and pioneered the concept of open wards at the psychiatric hospital there. In other islands, district medical officers and other physicians performed the role of psychiatrist, meeting the needs of people who were mentally ill. Interisland transfer of patients from locations without qualified psychiatrists to hospitals with mental health in the caribbean     

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psychiatrists occurred when necessary. With the establishment of the faculty of medicine at The University of the West Indies (UWI) at Mona, Jamaica, in 1947, the stage was set for the training of mental health professionals in the region. DEVELOPMENT OF MENTAL HEALTH SERVICE AND DELIVERY By 1965, the department of psychiatry was established at UWI in Jamaica and led by Professor Michael Beaubrun. It started with six beds situated in one ward of a general hospital, namely, the University Hospital: six beds on a dermatology ward. . . . In contrast, Bellevue, a large mental hospital in downtown Kingston, had some 3,000 beds . . . we determined on a policy of trying to treat all patients with no limitations for the type of patient accepted, returning the patients to the community as soon as possible and trying to send no one to the mental hospital. For the first few years we actually succeeded in doing this. (Beaubrun, 1991)

Before establishing the Department of Psychiatry at UWI, Beaubrun was also instrumental in the development of a psychiatric unit at the Port of Spain General Hospital in Trinidad and Tobago. The emergence of the department of psychiatry at the faculty of medicine at UWI marked in many ways the beginning of a Caribbean mental health philosophy. The most significant change was the beginnings of deinstitutionalization of psychiatric care and the early movement to community mental health care. The university also pioneered the establishment of mental health clinics in the community. Building psychiatric units in general hospitals in other Caribbean nations was often resisted by the general medical establishment, even though liaison psychiatry services were an important part of treatment provided by psychiatrists to hospitals with no inpatient treatment facilities. Today, a general hospital psychiatric unit and community mental health services have become the basis for mental health care in some Caribbean countries. The WHO Assessment Instrument for Mental Health Systems (WHO-AIMS) survey indicated 11 subregional mental health hospitals, 278 outpatient mental health clinics (from two in Guyana and Anguilla to 139 in Jamaica), 15 day treatment facilities, 18 inpatient psychiatric units, and 39 residential treatment centers across the region (WHO, 2011). During his tenure as head of psychiatry at UWI, Beaubrun created undergraduate and postgraduate programs in psychiatry that have resulted in the training of hundreds of Caribbean health professionals in mental health care and community mental health services. The postgraduate training in psychiatry began in 1965 in Jamaica through two pathways: 4 years of residency training 308       sharpe and shafe

for psychiatrists and 2 years of diploma training for doctors in other specialties or general practice who needed to manage patients living in countries without a psychiatrist. The doctors in training were required to spend time in a community setting. This was in line with a Caribbean Federation of Mental Health resolution that patients should be treated near their homes. One component of the residency program was a student exchange with a university in the United Kingdom, with the clear goal of enhancing training in another setting. Having started in Jamaica, the residency program has evolved so that training now takes place fully at the other campuses of the UWI located in Trinidad and Tobago, Barbados, and The Bahamas. UWI now also offers degree programs in psychology including a master’s level program in Clinical Psychology at Mount Hope Medical School in Trinidad and Tobago (discussed in Chapter 14, this volume). The deinstitutionalization thrust that started in the 1960s continued with the help of Dr. Ken Royes, Dr. Frederick Hickling, and their colleagues from PAHO. They transformed systems of isolation and institutionalization of the severely mentally ill, “custodialization,” to rehabilitation and community treatment (Hickling & Gibson, 2012). Important elements of the transformation were the implementation of the concept of the therapeutic community (Jones, 1956) and the introduction of vocational therapy, as well as family reintegration of patients (Hickling & Gibson, 2012). Further, Hickling was the first to use cultural therapy at Bellevue hospital in Jamaica, which culminated in the establishment of the Cultural Therapy Centre in 1978. Key therapeutic approaches at the center were sociodrama and an innovative technique called psychohistoriography. In the main, sociodrama used the combined cultural and artistic expressions of the patients and staff members. Psychohistoriography, which grew out of the meetings between patients and staff, involved “a fusion of historiography, dialectics and psychotherapy involving the examination of the psychological implications of a timeline of historical anecdotes and phenomena” (Hickling & Gibson, 2012, p. 439). Community-based treatment of the mentally ill has been a major feature of the mental health service development across the Caribbean. At the fifth conference of Health Ministers held in Dominica in 1973, recommendations were made to revise legislation to integrate mental health into general health care, to establish acute units in general hospitals, and to develop drug and alcohol programs (Caribbean Community, 1973). Implementation of these recommendations, the success rates of reducing the numbers of institutionalized patients, and the true integration of mental health treatment into primary and secondary care facilities have varied a good deal across Caribbean nations. In some situations, the model has not resulted in a reduction of the numbers of patients in central psychiatric hospitals, but even in those countries in which this is true, the community mental health systems are being mental health in the caribbean     

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developed and the role of the mental health officer (MHO) has been crucial to this process. MHOs are psychiatric nurses, who in addition to having strong psychiatric nursing skills have been trained in social work and community health. In countries in which nurse practitioners are recognized for their professional skills, they are able to prescribe psychotropic medication. They are in many ways the lynchpin of community mental health services. In Jamaica, MHO training is undertaken by the Ministry of Health and includes courses in general medicine, psychiatry, and social work, as well as psychopharmacology, psychology, and patient management (McKenzie, 2008). The training is designed to permit the MHO to function in the community in dealing with most psychiatric referrals. The MHO may advise primary care and hospital physicians on how to treat individuals with mental health problems and offer crisis intervention as well. In Trinidad and Tobago, MHOs function as part of the multidisciplinary community mental health team, providing community mental health services at community mental health centers and community-based clinics. They have a significant role in (a) follow-up of patients discharged from in-patient treatment; (b) supporting the patient, his/her family, and the community in maintaining treatment regimens, including psychopharmacological treatment; and (c) actively promoting community mental health and psychoeducation. In addition, MHOs functioning within the Child Guidance Clinics in the child and adolescent psychiatry services in Trinidad and Tobago work with schools in various capacities. For children who are patients at Child Guidance Clinics, MHOs conduct assessments of the school environment from multiple perspectives: physical health and nursing, psychosocial, and psychoeducational. MHOs assist school teachers to understand information provided by the psychologist or psychiatrist about a particular child, and in consultation with the psychologist, help teachers with managing behavior in school, in and out of the classroom. A benefit that often emerges in this partnership between MHOs and schools is increased awareness and attention to mental health issues in children in school settings. In several of the smaller islands of the Caribbean without psychiatric hospitals, such as Anguilla, British Virgin Islands, Dominica, Montserrat, St. Kitts and Nevis, the mental health service development has been community based; psychiatric units in general hospitals provide the inpatient treatment, and community mental health teams, including psychiatric nurse practitioners, provide outpatient care and follow-up. Similarly, the success of the Belize government’s work in establishing a community mental health care system, in which mental health care is fully integrated into primary health care, has been recognized (PAHO, 2013). Belize decided to close its single psychiatric hospital. It integrated mental health care into the system of community 310       sharpe and shafe

health centers and also built community rehabilitation centers to provide support and follow-up care for individuals with severe mental illness. The service is staffed mainly by trained psychiatric nurses, and the complement of required nurses is at this time 62% achieved. Between 2001 and 2007, the number of mental health consultations increased from 4,500 to 16,000 (see the WHO-AIMS report [WHO, 2011] for the distribution of mental health professionals per 100,000). EPIDEMIOLOGY OF MENTAL ILLNESS IN THE CARIBBEAN It is widely acknowledged that the epidemiological data on mental illness in the Caribbean are limited and that most of the efforts in the research arena have been led by individuals in different fields of research. Thus, the focus often reflected individual interest in different aspects of mental health care. This notwithstanding, some studies have addressed the epidemiology of the major disorders in the Caribbean that constitute the main burden of mental illness, namely schizophrenia, affective disorders, and substance abuse disorders. Less information is available on the epidemiology of anxiety dis­ order and personality disorder. Substance Abuse Although substance abuse is a major concern in the Caribbean (WHO, 2011) and the Caribbean remains an important transshipment area for the illegal drug trade, few surveys have been aimed at understanding the epidemiology of substance use in the region. In 2001, the Caribbean Drug Information Network was established to be a formal body to afford a uniform system of data collection. However, infrastructure inadequacies and lack of funding have hindered national population studies. For the most part, there have been small-scale studies focusing on risk behavior among adolescents in some English-speaking countries. These studies have found that a high percentage of adolescents in the Caribbean use cigarettes and marijuana, but these rates are lower than those found in the United States (Maharaj, Nunes, & Renwick, 2009). In the Caribbean, lifetime use of alcohol was 52%; marijuana, 17%; and cocaine, 2%. One study showed that, in the past month, Indo Trinidadian adolescents were more likely to use alcohol and African Trinidad adolescents were more likely to use marijuana. Risk factors associated with substance use were being male, being children of professionals, absence of religious involvement, poor grades, skipping school, having more spending money, and rage (Maharaj et al., 2009). Several decades ago, Beaubrun (1967) reported that the incidence of alcoholism varied widely, from 47.6% of mental hospital admissions in Nassau, mental health in the caribbean     

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The Bahamas, to 53.0% in Martinique, to 0.3% in Jamaica. In a subsequent study, Beaubrun and Mahy (1980) reported that 47% of all male admissions and 6% of all female admissions to medical wards in the Port Spain General Hospital in Trinidad and Tobago were alcohol related. Again, larger numbers of Indo Trinidadians were in the alcoholic group compared with other ethnic groups. Subsequent findings from genetic studies (Montane-Jaime et al., 2006) showed that the ADH1C*2 allele was significantly associated with alcohol dependence in people of Indo Trinidadian ancestry but not associated with current alcohol consumption. In exploring issues related to substance abuse, including alcoholism (e.g., the clinical course of alcoholism in Trinidad and Tobago), Montane-Jaime et al. (2008) could not identify any differences in the progression to alcoholism between Indo Caribbeans and other ethnic groups. However, in comparison to the U.S. population, progression to alcoholism was significantly slower in both groups of the Trinidad and Tobago cohort. Schizophrenia Interest in the epidemiology of schizophrenia in the Caribbean was fueled by findings of an increased risk for both schizophrenia and mania in the African Caribbean population in the United Kingdom. It was reported that second-generation people of African Caribbean descent had significantly higher admission rates for schizophrenia than their parents or than the White British population (Littlewood & Lipsedge, 1988; Sugarman & Craufurd, 1994). Because the studies discussed next indicate that the incidence of schizophrenia in the countries from which these immigrants originated is not unduly high and the rates reported were sometimes as much as six times higher, it is possible that social factors, such as deprivation, adversity, and racism may have contributed to the findings (Saraceno, Levav, & Kohn, 2005). These assertions have been explored in research studies on Caribbean populations since the increased risk for schizophrenia was identified (Bhugra et al., 1997; Hickling & Hutchinson, 2012; Hutchinson et al., 1996) Studies in the Caribbean have clearly shown that first-contact incidence rates of schizophrenia in several countries are not elevated and are well within the range noted internationally by WHO. For example, Hickling and RodgersJohnson (1995) found the incidence to be 2.09 per 10,000 in Jamaica; Mahy, Mallett, Leff, and Bhugra (1999) reported a first-contact incidence rate of 3.2 per 10,000 in Barbados; and Bhugra et al. (1996) found the first-contact incidence rate of 2.2 per 10,000 in Trinidad and Tobago. However, as the WHO-AIMS report suggests, schizophrenia was the major diagnosis for users of outpatient services across the Caribbean region (WHO, 2011). 312       sharpe and shafe

Affective Disorders In a global study, Ferrari et al. (2013) identified depressive disorders and dysthymia as leading causes of the burden of disease. Ferrari et al. (2013) determined that major depressive disorder accounted for 8.2 % and dysthymia accounted for 1.4% of global years lived with disability. Data from international studies also point to high comorbidity of major depression and other psychiatric disorders with diabetes mellitus (Katon, 2008); other studies have shown a clear relationship between depression and ischemic heart disease (Davidson, 2012). In the Caribbean, Martin, Neita, and Gibson (2012) reported that 19.9% of patients (N = 201) with cardiovascular illness in University Hospital of the West Indies (UWI, Jamaica) had depressive symptoms. Epidemiological studies of rates of depression across Caribbean countries vary widely, and as a result generalization is difficult. In a nationally representative sample of women (N = 1,102) in Trinidad and Tobago, Krishnakumar, Narine, Roopnarine, and Logie (2014) found that rates of clinical depression were lowest among Indo Caribbean women (2.8%) compared with African Caribbean (4.2%) and women of Mixed-Ethnic background (6.9%). Maternal health, pain in carrying out household activities, and early experience of domestic violence were significantly related to depression across groups. Among samples of patients from chronic disease clinics in Trinidad and Tobago, Maharaj et al. (2005) found that 28.3% of participants were depressed. Those who were 50 years and older, were female, had lower than secondary school education, were housewives, were unemployed, were unskilled workers, and had a greater number of chronic diseases sowed a higher risk of being depressed. A different report indicated that the period prevalence rate for mania and manic depressive psychosis was 0.16 per 1,000, and the age corrected (15–55 years) prevalence rate was 0.23 per 1,000 (Hickling, 2005). These rates are within those found in the WHO World Mental Health Survey Consortium (2004) using the Composite International Diagnostic Interview in 14 countries (six less developed, eight developed). In that study, rates of mood disorders (Bipolar I and II disorders, dysthymia, and major depressive disorders) ranged from 0.8% in Nigeria to 9.6% in the United States. Shafe et al. (2009) found an association between select affective and anxiety disorders in patients presenting at substance abuse centers in Trinidad and Tobago. About 41% of Indo Trinidadians and 37% of African Trinidadians with anxiety disorder had comorbid major depressive disorders independent of alcohol or drug use. The depressive illness was induced by alcohol use in 39% of Indo Trinidadians and 37% of African Trinidadians. Among adolescents in the Caribbean, a school-based survey in Jamaica of 3,003 adolescents, 10 to 15 years old (47% males), indicated depressive symptoms in 134 (4.5%; 5.9% females and 2.9% males) of the participants mental health in the caribbean     

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(Abel, Bailey-Davidson, et al., 2012). Factors associated with depression were negative community attributes, alcohol use in the family, attending low-status schools, protective factors within the home (prayers, religious socialization, family structure), gender, and learning difficulties (Abel, Bailey-Davidson, et al., 2012; Maharaj et al., 2009). Using the Reynolds Adolescent Depression Scale on a stratified random sample of 1,845 students in 24 schools in Trinidad and Tobago, it was found that 14% of the sample was depressed and that girls were 2.18 times more likely to be depressed than boys (17.9% girls to 8.2% boys); no ethnic differences in the depression rates were identified (Maharajh, Ali, & Konings, 2006). In a subsequent study of adolescents in Jamaica, The Bahamas, St. Kitts and Nevis, and St. Vincent, half of the participants across countries (52.1%) reported mild to severe symptoms of depression and 29.1% reported moderate to severe symptoms of depression (Lipps et al., 2012). However, the prevalence of depression scores was not uniform across countries. Forty-one percent of adolescents in Jamaica, 31% in St. Vincent, 25% in St Kitts and Nevis, and 23% in The Bahamas reported moderate to severe symptoms of depression. Nondemocratic modes of parenting (e.g., authoritarian) were strongly associated with depression (Lipps et al., 2012). Suicide and Attempted Suicide Deliberate self-harm and suicidal behavior have become increasingly common forms of morbidity in the developing world, and suicidal behavior is a major public health problem in Trinidad and Tobago (Hutchinson, Bruce, & Simmons, 2008; see also Chapter 6, this volume). In a preliminary retrospective epidemiological report on suicide by poisoning in the Port of Spain General Hospital in Trinidad and Tobago, Hutchinson, Daisley, Simmons, and Gordon (1991) examined data gathered over a 15-year period (1976–1990) on 270 patients who died at the hospital. They discovered that the maleto-female ratio for suicide was 2.7:1, and 54.4% were Indo Trinidadians and 42.0% were African Trinidadians, with 3% from Mixed-Ethnic backgrounds. The 11- to 34-year-old age group accounted for 52.6% of cases. In further work, Hutchinson and Simeon (1996) also determined that suicide rates for men in Trinidad and Tobago had increased from 4.6 per 100,000 in 1978 to 20.76 per 100,000 in 1992, whereas the rate for women was fairly constant at below 8 per 100,000 for the same time period. Poisoning by paraquat ingestion was a significant problem in Trinidad and Tobago compared with other Caribbean countries; young Indo Trinidadians seem particularly likely to attempt suicide by this means than other ethnic groups. A similar trend was observed in a later study (Hutchinson et al., 2008). Between October 2001 and October 2002, suicides increased fourfold compared with data from a study completed in 1974. Suicide among males 314       sharpe and shafe

greatly increased, such that the female-to-male ratio declined considerably. Men tended to be older in mid-adulthood and to use more violent methods, whereas women tended to be in young adulthood and drank bleach or overdose on medication. By comparison, the suicide rate in Jamaica has not changed between 2002 and 2010 (Abel, James, et al., 2012), remaining at an overall annual incidence of 2.1 per 100,000 of population. Ninety-five percent were males, and the highest rates were in the 25 to 34 years old and over 75 age groups. Seventy-six percent of suicides were due to hanging. The data from Trinidad and Tobago were gleaned from hospital records, whereas the annual incidence in Jamaica was obtained from police records, which may account for some of the differences between countries. In one of the most extensive studies of mental health among adolescents in nine Caribbean countries (Antigua, The Bahamas, Barbados, British Virgin Islands, Dominica, Grenada, Guyana, Jamaica, and St. Lucia), Blum et al. (2003) found that 12% of adolescents reported ever having attempted suicide. Across all age groups, girls were consistently more likely than boys to report suicide attempts. Sexual abuse played a major role in attempts to commit suicide; although 9.1% of young people who did not indicate an experience of sexual abuse reported ever having made a suicide attempt, 23.1% who had experienced sexual abuse reported ever having attempted suicide. A similar relationship was evident between physical abuse and suicide attempt. Along the same lines, research conducted on 1,845 high school students (12–20 years old) in Trinidad and Tobago also indicated a strong gender difference in suicide ideation and attempts (Ali & Maharajh, 2005). Females had significantly higher rates of both behaviors than males. Adolescents with a family history of alcohol abuse were twice as likely to have suicidal ideation and 2.5 times more likely to have attempted suicide. Personality Disorders Research on personality disorders in the CARICOM countries is sparse. In a case-control study involving 351 patients from a private psychiatric practice in Kingston, Jamaica, Hickling, Martin, et al. (2013) found that the most common diagnosis was dependent personality disorder. Patients diagnosed with a personality disorder also exhibited depression (38.5%), had substance abuse disorder (17.9%), anxiety state (19.1%), and psychosis (6%). In similar work, Hickling and Walcott (2013), who used the Jamaican Personality Disorder Inventory (JPDI) on a representative sample of 1,506 Jamaicans between 18 and 64 years of age, reported that 42% of the sample scored above the scale’s cutoff point, indicating a diagnosis of personality disorder ranging from mild to severe. Persons with personality disorder were significantly more likely to be single, men between the ages 18 and 44 years, and of a lower mental health in the caribbean     

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socioeconomic status. Although accepting methodological limitations in the study’s design, such as data obtained from a single individual report and no comparisons using another internationally recognized personality disorder instrument, Hickling and Walcott (2013) nonetheless concluded that the reported elevated levels of personality disorder in Jamaica have far reaching implications for this country and the Caribbean, and should not be ignored or rejected but instead critically evaluated and monitored for the identification and development of appropriate treatment interventions. (p. 447)

Indeed, these findings need to be replicated, given the struggle that many Caribbean nations are now experiencing with increased crime and murder rates (United Nations Development Programme, 2012). In another study involving 100 consecutively admitted patients (16–64 years old and a majority African Caribbean) to general medical wards at the University Hospital of the West Indies in Jamaica, personality dis­ order was assessed via three methods: the JPDI, the International Personality Disorder Examination Screening questionnaire, and a consultant psychiatrist assessment based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000; Martin, Walcott, Clarke, Barton, & Hickling, 2013). Fifty-nine patients had been treated previously by a general practitioner. The major presenting complaints were interpersonal conflict (35%), anxiety (21%), and depressed mood (20%). The Axis I diagnosis revealed that 30% of the patients had major depression; 18%, substance abuse disorder; and 13%, generalized anxiety disorder. Significantly more females had depression and significantly more males had substance abuse. The DSM–IV–TR Axis II personality disorder was as follows: females were more likely to exhibit histrionic personality disorder (38%), avoidant personality disorder (15%), and obsessive–compulsive personality disorder (8%), whereas males exhibited avoidant personality disorder (20%) and narcissistic personality disorder (8%; Hickling & Walcott, 2013). The prevalence rates of personality disorder in Jamaica are higher than those of Canada, United States, New Zealand, and Europe (15%–18%). According to Hickling and Walcott (2013), this may be due to differences in the method and cutoff scores used to determine personality disorder in Jamaica and internationally. Developments on the Research Front In investigating research priorities in mental health in low and middle income countries, Sharan et al. (2009) found a broad consensus across stakeholders and researchers about the need for epidemiological studies on 316       sharpe and shafe

risk factors and the burden of disease. Depression, anxiety, substance abuse, and psychosis were prioritized among disorders, and children, adolescents, women, and people exposed to violence and trauma were given equally high priority. Parallel priorities emerged in published articles and commentaries on mental health in Caribbean countries. But other areas of interest have been identified as well that have relevance for contemporary Caribbean life: the decolonization of psychiatric public policy, innovative treatment approaches, deinstitutionalization, HIV and depression, resilience and social capital, and community and policy responses to mental health issues within transcultural experiences related to migration (De La Haye et al., 2010; Hickling, Gibson, & Hutchinson, 2013; Hickling & Walcott, 2013). Because of the steady flow of outward migration from the Caribbean to North America and Europe, greater emphasis has been placed on immigrant adjustment patterns in their new cultural communities, issues of remote acculturation, and the separation and reunification of children and parents during the migration process. For instance, Livingston, Neita, Riviere, and Livingston (2007) found a positive relationship between personal problems and depression among Caribbean immigrants in the United States, and Jones, Sharpe, and Sogren (2004) found that children separated from their parents because of migration were twice as likely to have emotional problems even though their economic situation may have improved. Likewise, in focusing on the mental health of children who were left behind in Jamaica because of parental migration, Pottinger (2005) found that those who were separated from their parents were at greater risk for developing mental health and school difficulties compared with children whose parents did not migrate. Significant contributions to evaluation in mental health service delivery have also been made by investigators who have validated depression scales for use with Caribbean populations. For example, Lipps, Lowe, and Young (2007) validated the Beck Depression Inventory—II (BDI–II) in a Jamaican student cohort (N = 690; 77% female, mean age 23.4 years). The BDI–II had good internal consistency (Cronbach’s a = .90) and moderately good concurrent validity as seen in its relationship with the Center for Epidemiologic Studies—Depression Scale (r = .71) and Brief Screen for Depression (r = .74) and acceptable discriminant validity as evident from its relationship with the UCLA Loneliness Scale (r = .50). Campbell, Maynard, Roberti, and Emmanuel (2012) compared the Zung Self-Rating Depression Scale (Zung SDS) and the BDI–II in a Barbados university student cohort (N = 415; 75% female and 25% male; age M = 25.2 years) and found that head-to-head comparison of the Zung SDS and the BDI–II indicated that the BDI–II had slightly better psychometric properties. The correlation between the two scales was moderately high (r = .67). Overall analyses suggested that modified versions of the Zung SDS merits further research consideration. mental health in the caribbean     

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Likewise, in an effort to develop indigenous assessment instruments, the JPDI has been used and validated in several studies on Caribbean mental health (e.g., Hickling, Martin, et al., 2013). Mental Health Legislation, Policies, and Plans There is general acknowledgement that “all people with mental disorders have the right to receive high quality treatment and care delivered through responsive health care services. They should be protected against any form of inhuman treatment and discrimination” (WHO, 2003, p. viii). People with mental disorders are vulnerable members of the population; they face stigma and discrimination in most societies and frequently experience economic marginalization and social exclusion. In an ideal world, mental health legislation should codify the values and principles of human rights, which would then be embedded in the country’s mental health policy. The policy would be the basis on which mental health plans would be developed. WHO (2003) legislation and human rights guidance suggests that mental health policies might be most effective when consolidated in a single piece of legislation and also dispersed in different laws. Most of the Caribbean laws for the mentally ill are consolidated mental health acts and many of the Caribbean countries currently operate with mental health acts that have not been updated since their passage into law in the 1950s or before. These acts were partly shaped by the influence of the colonial powers at the time, with minor changes in a few instances that reflect current thinking about mental illness (see WHO, 2011, for the years legislation was passed in different Caribbean countries). Although the mental health acts of the various countries may be similar in their content, minor differences may influence how patients are admitted into and discharged from psychiatric facility. Amended mental health acts as they now exist in many Caribbean countries are in dire need of review. One aspect of mental health legislation that is of particular interest is the area of involuntary admission to a mental health facility as the principle of the least restrictive alternative requires that persons are always offered treatment in settings that have the least possible effect on their personal freedom. WHO guidelines recommend that in mental health legislation treatment without consent (involuntary treatment) should be permitted only under exceptional circumstances (which must be outlined). The legislation should incorporate adequate procedural mechanisms that protect the rights of persons with mental disorders who are being treated involuntarily. In Jamaica and Trinidad and Tobago, the MHO is granted permission to remove people with mental illnesses and have them admitted into a psychiatric facility for assessment and treatment. There are differences in the letter of the law on 318       sharpe and shafe

how these functions are implemented. For example, the MHO in Jamaica is allowed to enter private and government property with reasonable suspicion and remove somebody who is deemed mentally ill (The Mental Health Act of Jamaica, 2009). In Trinidad and Tobago, MHOs can only intervene if the mentally ill creates a disturbance in public space (Mental Health Act, 1975). A good policy framework provides a mechanism through which countries define the vision for mental health, establish priorities and plans, and coordinate all programs and services to improve mental health and reduce the burden (Abel, Kestel, Eldemire-Shearer, Sewell, & Whitehorne-Smith, 2012). Policy about mental health care delivery was the major focus at the PAHO mental health conference in Caracas, Venezuela, in 1990 (Levav, Restrepo, & Guerra de Macedo, 1994). Since then, Caribbean countries have been developing mental health policies, and at the time of the WHO-AIMS report (WHO, 2011), mental health policies had been formally approved in Anguilla, Barbados, Jamaica, St. Lucia, Suriname, and the Turks and Caicos. A mental health plan has been formally approved in Belize, Jamaica, Montserrat, Suriname, Trinidad and Tobago, and the Turks and Caicos. Only Jamaica, Suriname, and the Turks and Caicos Islands have both a mental health policy and a plan that have been developed in the past 5 years. The policy efforts have focused on mental health care in the community, the treatment of the mentally ill in general hospitals, and the provision of psychotropic drugs. Implementation of policy is low in many Caribbean countries because of financial constraints. However, on average, the Caribbean dedicates 3.8% of the government health budget to mental health, with considerable differences among countries (e.g., 4% in Antigua and Barbuda, 4% in Trinidad and Tobago, and 7% in Barbados; Abel, Kestel, et al., 2012). This average is higher than the one emerging from a cross-national analysis of WHO-AIMS, where the average indicated of health expenditure to mental health was 2% (WHO, 2011). It would be interesting to see how new billing criteria for mental health services (e.g., assessments using the International Classification of Diseases and DSM) established by organizations elsewhere in the world influence both funding and access to mental care in the Caribbean. At the moment, the DSM is widely used within the Caribbean.

CONCLUSION In this chapter, we provided a brief history of the development of psychiatric services, discussed the prevalence of mental health disorders, and outlined the current state of mental health plan and policies primarily in the English-speaking Caribbean. Mental disorders are highly prevalent mental health in the caribbean     

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throughout the world and are major contributors to morbidity, disability, and premature mortality. The complex relationship between physical health and mental health needs to be recognized. Mental disorders increase the risk of communicable disease and noncommunicable disease and accidental and nonaccidental injuries. Further, many physical illnesses increase the risk of mental disorder. Even as the Caribbean states confront difficult economic times, they must also be aware that ensuring good mental health and providing mental health services and care will reduce the burden of disease and hence enhance the gross domestic product. The Caribbean must continue to pursue creative and innovative approaches to service delivery and treatment that are rooted in a Caribbean ethos. These approaches must focus on negating stigma and discrimination, and a move toward true community-based, clientcentered, integrated physical and mental health care across the lifespan. REFERENCES Abel, W. D., Bailey-Davidson, Y., Gibson, R. C., Martin, J. S., Sewell, C. A., James, S., & Fox, K. (2012). Depressive symptoms in adolescents in Jamaica. The West Indian Medical Journal, 61, 494–498. http://dx.doi.org/10.7727/wimj.2012.179 Abel, W. D., James, K., Bridgelal-Nagassar, R., Holder-Nevins, D., Eldemire, H., Thompson, E., & Sewell, C. (2012). The epidemiology of suicide in Jamaica 2002–2010: Rates and patterns. The West Indian Medical Journal, 61, 509–515. http://dx.doi.org/10.7727/wimj.2011.121 Abel, W. D., Kestel, D., Eldemire-Shearer, D., Sewell, C., & Whitehorne-Smith, P. (2012). Mental health policy and service system development in the Englishspeaking Caribbean. The West Indian Medical Journal, 61, 475–482. http:// dx.doi.org/10.7727/wimj.2012.308 Ali, A., & Maharajh, H. D. (2005). Social predictors of suicidal behaviour in adolescents in Trinidad and Tobago. Social Psychiatry and Psychiatric Epidemiology, 40, 186–191. http://dx.doi.org/10.1007/s00127-005-0846-9 American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author. Beaubrun, M. H. (1967). Treatment of alcoholism in Trinidad and Tobago, 1956–65. The British Journal of Psychiatry, 113, 643–658. http://dx.doi.org/10.1192/ bjp.113.499.643 Beaubrun, M. H. (1991, May). Caribbean psychiatry, yesterday today and tomorrow. Closing address at the joint American Psychiatric Association/Caribbean Psychiatric Association Meeting, Sam Lord’s Castle, Barbados. Beaubrun, M. H., Bannister, P., Lewis, L. F. E., Mahy, G., Royes, K. C., Smith, P., & Wisinger, Z. (1976). The West Indies. In J. G. Howells (Ed.), World history of psychiatry (pp. 507–527). New York, NY: Brunnel/Mazel.

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Beaubrun, M. H., & Mahy, G. (1980, April). Position paper on drug use and abuse in the Caribbean Community. Paper presented at Conference of Ministers Responsible for Health, St. George’s, Grenada. Bhugra, D., Hilwig, M., Hossein, B., Marceau, H., Neehall, J., Leff, J., . . . Der, G. (1996). First-contact incidence rates of schizophrenia in Trinidad and one-year follow-up. The British Journal of Psychiatry, 169, 587–592. http://dx.doi.org/10.1192/ bjp.169.5.587 Bhugra, D., Leff, J., Mallett, R., Der, G., Corridan, B., & Rudge, S. (1997). Incidence and outcome of schizophrenia in Whites, African-Caribbeans, and Asians in London. Psychological Medicine, 27, 791–798. http://dx.doi.org/10.1017/ S0033291797005369 Blum, R. W., Halcón, L., Beuhring, T., Pate, E., Campell-Forrester, S., & Venema, A. (2003). Adolescent health in the Caribbean: Risk and protective factors. American Journal of Public Health, 93, 456–460. http://dx.doi.org/10.2105/AJPH.93.3.456 Campbell, M. H., Maynard, D., Roberti, J. W., & Emmanuel, M. K. (2012). A comparison of the psychometric strengths of the public-domain Zung self-rating depression scale with the proprietary Beck Depression Inventory—II in Barbados. The West Indian Medical Journal, 61, 483–488. http://dx.doi.org/10.7727/wimj.2010.145 Caribbean Community. (1973, February). Final report. Fifth meeting of the Caribbean Health Ministers Conference, Roseau, Dominica. Georgetown, Guyana: Author. Davidson, K. W. (2012). Depression and coronary heart disease. ISRN Cardiology, 2012, 1–18. http://dx.doi.org/10.5402/2012/743813 De La Haye, W., Clarke, T. R., Lipps, G., Lowe, G. A., Longman-Mills, S., Barton, E. N., & Bains, B. (2010). Patterns of depressive symptoms among patients with HIV infection. The West Indian Medical Journal, 59, 380–385. Ferrari, A. J., Charlson, F. J., Norman, R. E., Patten, S. B., Freedman, G., Murray, C. J., . . . Whiteford, H. A. (2013). Burden of depressive disorders by country, sex, age, and year: Findings from the global burden of disease study 2010. PLoS Medicine, 10, e1001547. http://dx.doi.org/10.1371/journal.pmed.1001547 Hickling, F. W. (2005). The epidemiology of schizophrenia and other common mental health disorders in the English-speaking Caribbean. Revista Panamericana de Salud Pública/Pan. American Journal of Public Health, 18, 256–262. Hickling, F. W., & Gibson, R. C. (2012). Decolonization of psychiatric public policy in Jamaica. The West Indian Medical Journal, 61, 437–441. http://dx.doi.org/10.7727/ wimj.2012.127 Hickling, F. W., Gibson, R. C., & Hutchinson, G. (2013). Current research on transcultural psychiatry in the Anglophone Caribbean: Epistemological, public policy, and epidemiological challenges. Transcultural Psychiatry, 50, 858–875. http://dx.doi.org/10.1177/1363461513508806 Hickling, F. W., & Hutchinson, G. (2012). Caribbean contributions to contemporary psychiatric psychopathology. The West Indian Medical Journal, 61, 442–446. http://dx.doi.org/10.7727/wimj.2012.128 mental health in the caribbean     

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Hickling, F. W., Martin, J., Walcott, G., Paisley, V., Hutchinson, N., Clarke, T., & Barton, E. N. (2013). The creation and validation of the Jamaica Personality Disorder Inventory. The West Indian Medical Journal, 62, 389–396. Hickling, F. W., & Rodgers-Johnson, P. (1995). The incidence of first contact schizophrenia in Jamaica. The British Journal of Psychiatry, 167, 193–196. http://dx.doi. org/10.1192/bjp.167.2.193 Hickling, F. W., & Walcott, G. (2013). Prevalence and correlates of personality disorder in the Jamaican population. The West Indian Medical Journal, 62, 443–447. Hutchinson, G., Bruce, C., & Simmons, V. (2008). Increasing incidence of admissions to a general hospital for deliberate self-harm in Trinidad. The West Indian Medical Journal, 57, 346–351. Hutchinson, G., Takei, N., Fahy, T. A., Bhugra, D., Gilvarry, C., Moran, P., . . . Murray, R. M. (1996). Morbid risk of schizophrenia in first-degree relatives of White and African-Caribbean patients with psychosis. The British Journal of Psychiatry, 169, 776–780. http://dx.doi.org/10.1192/bjp.169.6.776 Hutchinson, G. A., Daisley, H., Simmons, V., & Gordon, A. (1991). Suicide by poisoning: A preliminary epidemiological report. The West Indian Medical Journal, 40, 56. Hutchinson, G. A., & Simeon, D. T. (1996). Suicides in Trinidad and Tobago: Associations with unemployment, crime, and emigration. The West Indian Medical Journal, 45, 20. Jones, A., Sharpe, J., & Sogren, M. (2004). Children’s experience of separation from parents as a consequence of migration. The Caribbean Journal of Social Work, 3, 89–100. Jones, M. (1956). The concept of a therapeutic community. The American Journal of Psychiatry, 112, 647–650. http://dx.doi.org/10.1176/ajp.112.8.647 Katon, W. J. (2008). The comorbidity of diabetes mellitus and depression. The American Journal of Medicine, 121(11, Suppl. 2), S8–S15. http://dx.doi.org/10.1016/ j.amjmed.2008.09.008 Kessler, R. C., Angermeyer, M., Anthony, J. C., DE Graaf, R., Demyttenaere, K., Gasquet, I., . . . Ustün, T. B. (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry, 6, 168–176. Kohn, R., Saxena, S., Levav, I., & Sarceno, B. (2004). The treatment gap in mental health care. Bulletin of the World Health Organisation, 82, 858–866. Krishnakumar, A., Narine, L., Roopnarine, C., & Logie, C. (2014). Prevalence and sociocultural predictors of mental health disorders among mothers in Trinidad and Tobago: Examining ethnic variations. Manuscript submitted for publication. Levav, I., Restrepo, H., & Guerra de Macedo, C. (1994). The restructuring of psychiatric care in Latin America: A new policy for mental health services. Journal of Public Health Policy, 15, 71–85. http://dx.doi.org/10.2307/3342608

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Lipps, G., Lowe, G. A., Gibson, R. C., Halliday, S., Morris, A., Clarke, N., & Wilson, R. N. (2012). Parenting and depressive symptoms among adolescents in four Caribbean societies. Child and Adolescent Psychiatry and Mental Health, 6, 31. http://dx.doi.org/10.1186/1753-2000-6-31 Lipps, G. E., Lowe, G. A., & Young, R. (2007). Validation of the Beck Depression Inventory—II in a Jamaican university student cohort. The West Indian Medical Journal, 56, 404–408. Littlewood, R., & Lipsedge, M. (1988). Psychiatric illness among British AfroCaribbeans. British Medical Journal, 297, 135–136. Livingston, I. L., Neita, M., Riviere, L., & Livingston, S. L. (2007). Gender, acculturative stress and Caribbean immigrants’ health in the United States of America: An exploratory study. The West Indian Medical Journal, 56, 213–222. http://dx.doi. org/10.1590/S0043-31442007000300004 Maharaj, R. G., Nunes, P., & Renwick, S. (2009). Health risk behaviours among adolescents in the English-speaking Caribbean: A review. Child and Adolescent Psychiatry and Mental Health, 3, 10. http://dx.doi.org/10.1186/1753-2000-3-10 Maharaj, R. G., Reid, S. D., Misir, A., & Simeon, D. T. (2005). Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad. West Indian Medical Journal, 54, 369–374. Maharajh, H. D., Ali, A., & Konings, M. (2006). Adolescent depression in Trinidad and Tobago. European Child & Adolescent Psychiatry, 15, 30–37. http://dx.doi. org/10.1007/s00787-006-0501-3 Mahy, G. E., Mallett, R., Leff, J., & Bhugra, D. (1999). First-contact incidence rate of schizophrenia on Barbados. The British Journal of Psychiatry, 175, 28–33. http:// dx.doi.org/10.1192/bjp.175.1.28 Martin, J., Walcott, G., Clarke, T. R., Barton, E. N., & Hickling, F. W. (2013). The prevalence of personality disorder in a general medical hospital population in Jamaica. The West Indian Medical Journal, 62, 463–467. Martin, J. S., Neita, S. M., & Gibson, R. C. (2012). Depression among cardio­ vascular disease patients on a consultation-liaison service at a general hospital in Jamaica. The West Indian Medical Journal, 61, 499–503. http://dx.doi.org/10.7727/ wimj.2012.178 McKenzie, K. (2008). Jamaica: Community mental health services. In J. M. Caldas de Almeida & A. Cohen (Eds.), Innovative mental health programs in Latin America & the Caribbean (79–92). Washington, DC: Pan American Health Organization. The Mental Health Act. (1975). Laws of Trinidad and Tobago, Chapter 28:02. Retrieved from http://rgd.legalaffairs.gov.tt/laws2/alphabetical_list/lawspdfs/28.02.pdf The Mental Health Act of Jamaica. (2009). Section 16-1, Part II: Admissions, treatment and discharge of patients. Retrieved from http://www.moh.gov.jm/ laws/mental-health-act

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Montane-Jaime, K., Moore, S., Shafe, S., Joseph, R., Crooks, H., Carr, L., & Ehlers, C. L. (2006). ADH1C*2 allele is associated with alcohol dependence and elevated liver enzymes in Trinidad and Tobago. Alcohol, 39, 81–86. http://dx.doi. org/10.1016/j.alcohol.2006.08.002 Montane-Jaime, L. K., Shafe, S., Joseph, R., Moore, S., Gilder, D. A., Crooks, H., . . . Ehlers, C. L. (2008). The clinical course of alcoholism in Trinidad and Tobago. Journal of Studies on Alcohol and Drugs, 69, 834–839. http://dx.doi.org/10.15288/ jsad.2008.69.834 Pan American Health Organization. (2010). Panama consensus. Consensus of the Regional Conference on Mental Health, Panama City, Panama. Retrieved from http://new.paho.org/hq/dmdocuments/2010/Panama%20Consensus.pdf Pan American Health Organization. (2013). Belize: A wider doorway to mental health. Retrieved from http://www.paho.org/hq/index.php?option=com_content&view= article&id=9247%3Abelice-una-puerta-mas-amplia-a-la-salud-mental&catid=1443%3Anews-front-page-items&lang=en&Itemid=1926 Pottinger, A. M. (2005). Children’s experience of loss by parental migration in innercity Jamaica. American Journal of Orthopsychiatry, 75, 485–496. Saraceno, B., Levav, I., & Kohn, R. (2005). The public mental health significance of research on socio-economic factors in schizophrenia and major depression. World Psychiatry, 4, 181–185. Shafe, S., Gilder, D. A., Montane-Jaime, L. K., Josephs, R., Moore, S., Crooks, H., . . . Ehler, C. L. (2009). Co-morbidity of alcohol dependence and select affective and anxiety disorders among individuals of East Indian and African ancestry in Trinidad and Tobago. The West Indian Medical Journal, 58, 164–172. Sharan, P., Gallo, C., Gureje, O., Lamberte, E., Mari, J. J., Mazzotti, G., . . . Saxena, S. (2009). Mental health research priorities in low- and middle-income countries of Africa, Asia, Latin America and the Caribbean. The British Journal of Psychiatry, 195, 354–363. http://dx.doi.org/10.1192/bjp.bp.108.050187 Sugarman, P. A., & Craufurd, D. (1994). Schizophrenia in the Afro-Caribbean community. The British Journal of Psychiatry, 164, 474–480. http://dx.doi.org/ 10.1192/bjp.164.4.474 Tomlinson, M., & Lund, C. (2012). Why does mental health not get the attention it deserves? An application of the Shiffman and Smith framework. PLoS Medicine, 9, e1001178. http://dx.doi.org/10.1371/journal.pmed.1001178 United Nations Development Programme. (2012). Caribbean Human Development Report 2012: Human development and the shift to better citizen security. New York, NY: Author Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., . . . Vos, T. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the Global Burden of Disease Study 2010. The Lancet, 382, 1575–1586. http://dx.doi.org/10.1016/S0140-6736(13)61611-6

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WHO World Mental Health Survey Consortium. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA, 291, 2581–2590. http://dx.doi.org/10.1001/ jama.291.21.2581. World Health Organization. (2003). Mental health legislation & human rights. Geneva, Switzerland: Author. Retrieved from http://www.who.int/mental_health/resources/ en/Legislation.pdf World Health Organization. (2011). WHO-AIMS report on mental health systems in the Caribbean region. Geneva, Switzerland: Author. Retrieved from http://www.who. int/mental_health/evidence/mh_systems_caribbeans_en.pdf World Health Organization. (n.d.). Mental Health Gap Action Programme (mhGAP). Retrieved from http://www.who.int/mental_health/mhgap/en

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13 METAMORPHOSING EURO AMERICAN PSYCHOLOGICAL ASSESSMENT INSTRUMENTS TO MEASURES DEVELOPED BY AND FOR ENGLISH-SPEAKING CARIBBEAN PEOPLE MICHAEL CANUTE LAMBERT, WHITNEY C. SEWELL, AND ALISON H. LEVITCH

Psychological measures (a term we use interchangeably in this chapter with psychological tests, assessment instruments, and scales) that are reliable and valid are critical for conducting research, engaging in clinical practice, and evaluating programs. Hence, the burden is on professionals who conduct research or engage in clinical practice in any world region to ensure that the psychological tests they use have appropriate reliability and validity for the groups from whom they obtain clinical and research data (Kendall, Butcher, & Holmbeck, 1999; Lambert, Rowan, Rowan, & Mount, 2014). Use of psychological tests with questionable reliability and validity can be one of the weakest links in research (Kline, 2005). Such tests make the task of drawing appropriate clinical and research inferences virtually impossible. Because research and clinical practice inform one another, inaccurate testrelated research findings can negatively affect the accuracy of information social scientists use to guide practice and research. http://dx.doi.org/10.1037/14753-014 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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QUALITIES OF PSYCHOMETRICALLY SOUND MEASURES Psychometricians—professionals who develop and study psychological tests—believe that measures are psychometrically sound (i.e., their scores are trustworthy) if they are valid and reliable. Medoff (2003) stated that a test is valid if it measures what it purports to measure. Hence, validity refers to how accurate the test is. Reliability, he stated, is the constancy and stability of test results. Thissen and Wainer (2001) noted that colloquially speaking, validity is “measuring the right thing” (i.e., construct) and reliability is “measuring the thing right” (p. 11). Kline (2005) cautioned that a test in and of itself is not valid or reliable and that reliability and validity refer to whether one can have sufficient confidence in a test to draw appropriate inferences from its scores. Various psychometricians (e.g., Haynes, Richard, & Kubany, 1995) have stated that estimating the psychometric properties of a measure is an iterative process, meaning that although tremendous psychometric work must be done before the publication of a test, this work merely represents the beginning of the process of amassing evidence to show that the scores from such measures possess adequate reliability and validity (Kendall et al., 1999). Thus, multiple studies are required to provide enough evidence that such test scores possess these qualities. Reliability In “measuring the right thing,” researchers have delineated multiple forms of reliability and developed multiple procedures to provide converging evidence that a test is reliable. Interrater reliability is one type. Interrater reliability is achieved when scores from a test administered by two different professionals to the same individual are highly correlated (Medoff, 2003). In the absence of test score changes due to treatment, maturation, or other phenomena, test–retest reliability implies that the scores from the same measure administered to the same person two or more times should be highly correlated (Medoff, 2003). Higher correlations allow the researcher to infer that test scores are stable across time. A more costly approach, sometimes used when examining test score changes over time, is alternate form reliability: Hence, an individual might receive one form of a test at Time 1 and another form at Time 2, as well as at additional data collection points. If scores from the two or more forms of a test have alternate form reliability, their scores should be highly correlated (Kline, 2005). Internal consistency is an index of whether scores from items within a test are highly correlated. Multiple measures of internal consistency exist, including split-half reliability, in which items in a database are split into two groups 328       lambert, sewell, and levitch

and correlations from their scores are compared. If the correlation coefficient across scores derived from both halves of the test are high, then internal consistency is believed to be present. Cronbach’s coefficient alpha is the most widely used form of internal consistency index. Here, all possible permutations of splitting the tests are compared and calculated. The coefficient alpha is ubiquitous in statistical packages (e.g., SAS, SPSS) and, thus, easily calculated. Kline (2005) noted that its use is so pervasive that some researchers have mistakenly considered it as “reliability” and not just a measure of internal consistency or intercorrelations among items in a test. Cronbach and Shavelson (2004) cautioned that it should be considered as part of a larger system of reliability analyses. Hence, the coefficient alpha is not reliability in and of itself, as many authors often report it. Validity “Measuring the right thing” includes testing multiple forms of validity. Medoff (2003) stated that external validity refers to how well test scores generalize to groups on which it is used. That is if a test has external validity, persons who are assessed using such a test should be well represented in the sample that the test’s psychometric indices (e.g., reliability and validity) were estimated. Convergent validity suggests that a score from a new and a previously existing test measuring a similar construct should be at least moderately correlated (Campbell & Fiske, 1959; Nunnally & Bernstein, 1994). Divergent validity suggests that if individuals complete a new test and an existing measure whose construct is different from those measured by the new measure, correlations between scores across such measures should be virtually non­ existent (Campbell & Fiske, 1959; Nunnally & Bernstein, 1994). Criterionrelated validity indicates that the measure is capable of predicting what it purports to predict (Kendall et al., 1999). Haynes et al. (1995) stated that content validity is the magnitude to which components of a test are related to the psychological construct the test is designed to measure. Noting that construct validity subsumes all forms of validity, these authors further stated that because content validity provides foundational evidence for the extent to which items on a test are relevant and representative of the construct being measured, it is inextricably linked to construct validity. Although we agree with Haynes et al. (1995) that content validity is critical, we are also aware that appropriate content validity cannot be achieved without conceptual and cultural validity (King, Khan, LeBlanc, & Quan, 2011). These two types of validity are infrequently addressed in the existing literature base. Yet, researchers should be especially mindful of them when designing new tests or using existing tests to measure functioning in persons metamorphosing euro american psychological assessment     

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from specific cultural groups. Conceptual validity refers to how a population conceptualizes the psychological constructs being measured (see King et al., 2011; Olsen, Jensen, Tesfaye, & Holm, 2013). For example, although depression might be universal, socioethnic groups within the Caribbean might conceptualize this construct and what composes it in a very different manner than those in the United States or European nations, such as Great Britain (Lambert, Lambert, et al., 2013). Related to conceptual and content validity is cultural validity. A test is considered to be culturally valid for specific groups if it consists of items that represent behaviors individuals from the population targeted for assessment exhibit. Items from culturally valid measures also reflect idiomatic expressions members of target populations use (see Lambert, Essau, Schmitt, & SammsVaughan, 2007). Findings from tests that lack content, conceptual, and cultural validity for the population studied can adversely affect how well a test measures the construct it purports to measure. Such tests are likely to yield inaccurate findings (Gross et al., 2007; Koro-Ljungberg, Bussing, Williamson, Wilder, & Mills, 2008). Because they have greater access to measures with scores that have satisfactory reliability and validity indices, it is somewhat less difficult for professionals in Europe and North America who use psychological assessment instruments to confidently draw plausible and well-supported clinical and research-related inferences from these tests. Yet, even in countries in North America and Europe, findings from most psychological tests are mostly applicable to members of the White majority group. This problem emerges because minorities are often excluded from studies from which psychometric parameters are estimated or because their numbers are low— that is, while the sample sizes might reflect minority group representation in the population, the numbers are too small to permit meaningful and trustworthy analyses (Kouyoumdjian, Zamboanga, & Hansen, 2003; Lambert et al., 2013). Moreover, most of these measures were written by middle-class, White professionals to reflect the functioning, reality, and language of middle-class Whites in North America or Europe. Therefore, they might have limited language and conceptual appropriateness for other socioethnic groups within or outside these regions (see Lambert, Markle, & Bellas, 2001; Lambert et al., 2005, 2014). Despite these limitations, such measures are used to obtain test data not only from individuals from minority groups in the United States but also from people in other world regions, including the Caribbean Basin (Lambert et al., 2013). This is often done without modification to make the measure more culturally appropriate for the socioethnic groups who are assessed. In addition, psychometric studies that support their use in such populations is typically nonexistent. Thus, clinicians using these measures risk 330       lambert, sewell, and levitch

violating ethical guidelines provided by many professional organizations that set the standards for psychological testing. CULTURAL ISSUES IN TESTING AND ASSESSMENT Professional Standards The Association for Assessment in Counseling and Education (AACE) a division of the American Counseling Association, has cautioned test users to review all test information to ensure that the group on which a given test is normed is appropriate for intended test takers (Code of Fair Testing Practices in Education; Joint Committee on Testing Practices, 2004). The AACE also cautioned that when characteristics, including ethnic and cultural background, influence test takers’ responses, the information derived from tests is usually invalid—and possibly harmful to members of such groups. The AACE produced another document on multicultural assessment standards that cautions their members to understand how ethnicity and culture may impact the manifestation of psychological disorders (Association for Assessment in Counseling, 2003). Moreover, these standards also warn that if a test is culturally inappropriate for multicultural populations, clinical decisions informed by its findings could be inappropriate. In its Ethical Principles of Psychologists and Code of Conduct, the American Psychological Association (2010) clearly stated that psychologists should use assessment instruments that have been validated on people in the population from which the test taker is a member. This professional body adopted the Code of Fair Testing Practices in Education (2004). Among other guidelines, this document placed the responsibility on professionals to provide, as well as to use, tests that are fair to the test taker regardless of age gender, race, ethnicity, and national origin. It is against this backdrop that we review how measures have been employed when research is conducted in the Caribbean region. How Measures Are Used in Clinical Research Conducted in English-Speaking Caribbean Countries Although we are aware that many measures used for research conducted in English-speaking Caribbean nations (hereinafter referred to as Caribbean) are also used in clinical work, this brief review focuses primarily on research and then briefly addresses the use of tests in clinical settings. We also acknowledge that research has been conducted in the Caribbean for several decades and that the past 20 years has seen an explosion in the number of studies metamorphosing euro american psychological assessment     

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conducted there. Because we are interested in understanding contemporary trends in how recent studies have addressed measurement-related issues, this review focuses more specifically on recent research conducted in the 21st century that was published in juried journals. In our review, we consulted literature databases, such as PsycINFO, ERIC, MEDLINE, and PubMed. To ensure that we included all Caribbean nations, we used terms such as Caribbean and West Indies. In addition, we included the name of each Caribbean nation in the search terms. To capture research that might not be included in these databases, we did an online search for publications in the Caribbean Journal of Psychology (CJP) and the The West Indian Medical Journal. In searching the CJP, we also reviewed available paper copies published before the CJP was published online. Table 13.1 summarizes results from more than three dozen studies. As noted in the table, these studies focused on children, adolescents, adults, and families, and covered a wide range of topics, including depression, suicidal ideation, delinquent behavior, self-esteem/self-concept—such as their effects on skin bleaching, attitudes regarding abortion, masculinity, and behavioral and emotional functioning in children and adolescents. Few of these studies addressed measurement-related issues, and even fewer focused on determining whether the measures they used had suitable psychometric properties for the Caribbean region or the nations in which the study was conducted. Almost none focused on constructing measures that have appropriate conceptual, content, cultural, and other forms of validity for the populations from which the samples were drawn. Table 13.1 shows multiple studies that were conducted in several Caribbean nations, such as Barbados, Jamaica, and Trinidad and Tobago. Of the 35 studies reviewed, 20 used Jamaican samples. The remaining 15 studies included six in populations from Trinidad and Tobago, and nine studies were of Caribbean populations in general. The larger number of Jamaican studies in comparison with all other Caribbean populations is the result of a greater prevalence of peer-reviewed Jamaican studies in the recent research literature. Table 13.1 further shows that some studies provided no information on reliability or validity for the measures used for their Caribbean samples (e.g., Maharaj et al., 2008; Pottinger, La Hee, & Asmus, 2009; Pottinger et al., 2006; Wissart, Parshad, & Kulkarni, 2005). Other studies only reported Cronbach’s coefficient alphas, and some stated that this index shows that the measures are “reliable” (e.g., Campbell, Maynard, Roberti, & Emmanuel, 2012; Lipps & Lowe, 2006; Maharajh, Ali, & Konings, 2006). These studies engaged in what Schmitt (1996) described as “abuse of coefficient alpha.” Cronbach and Shavelson (2004) stated Cronbach’s alpha coefficient “covers only a small perspective of the range of measurement uses for which reliability information is needed” (p. 391). Rogers, Schmitt, and Mullins (2002) noted that coefficient alphas are calculated based on the assumption that 332       lambert, sewell, and levitch

metamorphosing euro american psychological assessment     

TABLE 13.1 Caribbean Psychological Studies Reviewed From 2000 to 2013

Reference Abdirahman et al. (2012) Abel, Bailey-Davidson, et al. (2012)

333

Brief description

Measure

Psychometric studies

Bullying and parental involvement in Caribbean adolescents Depression in Jamaican adolescents

WHO Global Health Surveya

No psychometric analyses conducted None referenced and none reported for sample None referenced or reported for sample None referenced and none reported for sample Pretesting and use of principal components None reported

No

Validity but sample(s) estimated unclear “Good existing reliability” reported but not reported for Trinidadians a original scale and for current sample a for scale and current sample a provided based on the original sample a both original scale and for the current sample

No

WHO Global Health Surveya Healthy Lifestyles Surveyc Aggression Scaleb

Abel, Sewell, et al. (2012) Alea et al. (2010)

Suicidal ideation in Jamaican youth Childhood memories and depression in Trinidadian adults

Interviewer administeredd Background and Health Questionnairea AMCQa CES–Da

Ali & Toner (2001)

Ali & Maharajh (2005) Asnani et al. (2010)

Psychometric limitations mentioned

Depression in Caribbean and Caribbean Canadian women

BDIa

Suicidality in Trinidadian and Tobagonian adolescents Depression in Jamaicans with sickle cell

SIQa

Silencing the Self Scalea

BDI–IIa

No No No No No

No No No No Yes (continues)

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TABLE 13.1 Caribbean Psychological Studies Reviewed From 2000 to 2013  (Continued)

Reference Buckley et al. (2013) Campbell et al. (2012)

Brief description Parental control in Jamaicans with delinquent behavior Comparison of BDI–II with SDS

Measure

Psychometric studies

Family Relationship Scalea

a (original scale and current sample) “Strong” reliability, including as in U.S. samples Item total correlations alphas; correlations with BDI–II, EFA, and CFA Referenced earlier use in the Caribbean and CFA as in existing studies and in current sample as in psychometric and the current study as for current study as for current study as for current study None reported

No

a both original scale and for the current sample None provided a (unclear for psychometric or study samples) a (unclear for psychometric or study samples)

Yes

SDSa STAI-Ta BDI–II, STAI-Aa Perceived Stress Scalea Ego Resiliency-89a

Charles (2010)

Skin bleaching in Jamaica

Edge et al. (2004)

Pre- and postpartum depression in Black Caribbean women Depression in Jamaican adolescents Self-representation in Jamaican adolescents

Ekundayo et al. (2007) Ferguson & Dubow (2007)

Psychometric limitations mentioned

RSEa CES–Da Racial Self-Esteema Edinburgh Postnatal   Depression Scalea BDI–IIa Identity Pied RSEa CES–Da

Yes Yes Yes No No No No No

No No No

metamorphosing euro american psychological assessment     

Johnson & Dockery (2005) Lambert, Puig, et al. (2001) Lambert et al. (2003)

Symptoms of Jamaican sexual abuse survivors Multimethod (i.e., TRF, DOF) study of child problems in Jamaican classrooms Invariance of the PRF, TRF, and YSR for Jamaican youth

BDI–IIa TRFa PRF, TRF, YSRa

Lambert, SammsVaughan, & Achenbach (2006) Lambert, SammsVaughan, Schmitt, & An (2006)

Problems in Jamaican and African American children

PRF, TRF, YSRa

Factor model FACES II

FACES IIa

Lambert et al. (2007)

Dimensionality and invariance of YSR across Jamaican and German youth

YSRa

Lambert et al. (2013)

Masculinity beliefs and Jamaican adults’ psychopathology and CSC development

Male Role Norm Inventorya

Toronto Alexithymia Scalea

BSIa

335

Psychometric indices for North American samples None reported

Yes

CFA for configural and metric invariance within and across informants None reported, cited earlier studies addressing cultural equivalence CFA (configural invariance), EFA on derivation-, and CFA on cross-validation samples, gender invariance test IRT factor analysis and DIF to study invariance across groups and estimate item parameters CFA on existing model, EFA on a derivation sample, and CFA on cross-validation sample CFA on existing model, EFA on a derivation sample, and CFA on cross-validation sample Used factors established as psychometrically sound (Mount et al., 2011)

Yes

Yes

Yes Yes

Yes

Yes

Yes

Yes

(continues)

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TABLE 13.1 Caribbean Psychological Studies Reviewed From 2000 to 2013  (Continued)

Reference

Brief description

Measure FACES IIa

Yes

BDI–IIa

Used factors established as psychometrically sound (Lambert et al., 2013) Cultural and content validity, IRT estimates psychometric indices EFAs for Barbados, Jamaica, Trinidad and Tobago None reported as for original validation and current samples as

Parenting Practice Scalea

as

No

BDI–IIa

Yes

RADSa

Language equivalence modifications as from measure, none for study a

BSIa

as, CFA, IRT-DIF

Yes

CSCb Caribbean Strengths Scaleb Lipps et al. (2010) Lipps et al. (2012)

Maharaj et al. (2008) Maharajh & Ali (2006) Maharajh et al. (2006) Mount et al. (2011)

Tracking and depression in Jamaican adolescents Depressive symptoms in Jamaican, St. Vincent, St. Kitts and Nevis students Parenting and depressive symptoms among Caribbean adolescents Depression among adolescents in Trinidad Suicide in Trinidad and Tobago Depression in Trinidadian and Tobagonian adolescents Using IRT (evaluate BSI for Jamaicans and Europeans)

Psychometric studies

Psychometric limitations mentioned

DOFa BDI–Ia

SIQa

Yes Yes Yes Yes No

No Yes

Patrick (2013) metamorphosing euro american psychological assessment     

Jamaican Women’s social status and abortion attitudes

337

No

General Health Questionnaire—28a

as reported for original measure but no indices for sample as for original measure but no indices reported for sample as for the current study sample

43-item checklistb

None reported

No

McCarthy Scales of Children’s Abilitya

Noted previous research use; no psychometric indices for Jamaica Test–retest reliability for psychometric sample, no indices for Jamaica Literature-based modifications via adding items a (reported) Stated “good test–retest” reliability but on Turkish sample, a calculated for Jamaican sample a for the current study sample a for psychometric sample and the current study sample Alpha and test–retest reliability for psycho­ metric sample

No

Attitudes Towards Women Scalea RCIa

Pottinger et al. (2006) Pottinger et al. (2009) Pottinger & Palmer (2013)

Infertility coping among couples counseled for in vitro fertilization University students with “hidden disabilities” Parenting anxiety in Jamaica families with or without in vitro fertilization

Vineland Social and Adaptive Scalesa Adaptive Parenting Behaviorsa Impact on Family Scalea

Rollocks et al. (2007)

Self-esteem across Indo and Afro Trinidadians

Smith et al. (2011)

Physical discipline adjustment among Jamaican adolescents

Dyadic Adjustment Scale (Short Form)a Self-Esteem Indexa MAYSI 2a

No No

No No No

No No No

(continues)

338       lambert, sewell, and levitch

TABLE 13.1 Caribbean Psychological Studies Reviewed From 2000 to 2013  (Continued)

Reference

Brief description

Measure Behavior problem measureb RSEa

Thomas & Lipps (2011)

Well-being in Jamaican adults with sickle cell disease

Two-item physical punishment measureb Generic Quality of Life Indexa

Positive and Negative Affect Schedule Ward et al. (2005)

Psychometrics of WAIS–III in Jamaican adults

WAIS–IIIa

Wissart et al. (2005)

Pre- and postpartum depression in Jamaican women

SDSa

Psychometric studies

Psychometric limitations mentioned

None reported

No

a reported for psychometric and Jamaican samples None reported

No

Test–retest reliability psychometric sample, none for Jamaica Test–retest reliability psychometric sample, none for Jamaica Standardized scaled scores generated for Jamaican sample None reported

No

No

No Yes No

Note. WHO = World Health Organization; a = coefficient alpha; AMCQ = Autobiographical Memory Characteristics Questionnaire; BDI–III = Beck Depression Inventory—III; BSI = Brief Symptom Inventory; CES–D = Center for Epidemiological Studies—Depression Scale; CSC = Caribbean Symptom Checklist; CFA = confirmatory factor analyses; DIF = differential item functioning; DOF, PRF, TRF, and YSR = the Direct Observation Form, Parent Report Form, Teacher Report Form and Youth Self-Report Form of the Child Behavior Checklist; EFA = exploratory factor analyses; FACES II = Family Adaptability and Cohesion Evaluation Scale; IRT = item response theory; MAYSI 2 = Massachusetts Youth Screening Instrument; RADS = Reynolds’s Adolescent Depression Scale; RCI = Religious Commitment Inventory; RSE = Rosenberg Self-Esteem Scale; SDS = Zung Self-Rating Depression Scale; SIQ = Suicidal Ideation Questionnaire; STAI-T = State–Trait Anxiety Inventory, Trait version; WAIS–III = Wechsler Adult Intelligence Scale—Third Edition. aExisting measure. bMeasure created for study. cUnknown. dUnclear.

unidimensionality has been established for constructs used in research. That is, previously conducted statistical procedures should have been conducted to verify that the constructs of interest were essentially unidimensional. Calculating coefficient alphas without knowing whether essential unidimensionality exists could lead to inaccurate alpha values. Because few studies (e.g., Mount, Lambert, Essau, Samms-Vaughan, & Bokszczanin, 2011) reviewed address dimensionality issues in the Caribbean region, it remains unknown whether dimensions on measures established outside this region are appropriate for samples drawn from Caribbean populations. Absence of this information makes it difficult to interpret the alpha values researchers often report. Rogers et al. (2002) provided the following guidelines for using coefficient alphas. First, use confirmatory factor analysis (CFA) to assess the uni­ dimensionality of the factor model. If the CFA provides a comparative fit index less than .80, one can proceed to calculating coefficient alpha. If not, then one should perform an exploratory factor analysis (EFA) to identify item clusters. Thereafter, one might calculate coefficient alphas for each item cluster. Rogers et al. (2002) also provided guidelines to correct for attenuation if composite scores are desired. We suggest taking these steps even further by following the standards described by Floyd and Widaman (1995). They stated that if CFA reveals that the data do not fit the established factor model, and the sample is large enough, then an EFA should be conducted on a portion of the (derivation) sample, followed by a CFA to cross-validate the findings from the EFA on the other (cross-validation) portion. In the next section, we provide examples of how factor structure established for measures widely used in North America and different parts of the world are examined in the Caribbean region. Factorial Validity of Measures Used in the Caribbean Factor analysis is a critical component of test construction and validation (see Kline, 2005). This set of methodological procedures helps researchers in finding evidence that a test measures one or more constructs (McLeod, Swygert, & Thissen, 2001). Some psychometricians believe that factor analyses provide a better measure of internal consistency than do coefficient alphas (see Rogers et al., 2002; Schmitt, 1996). Factor analysis helps the researcher determine whether a group of items might cluster according to single or multiple constructs (McLeod et al., 2001; Nunnally & Bernstein, 1994). The information in Table 13.1 indicates that most studies conducted in the Caribbean assume that the factor models for constructs derived from data analyses conducted on North American samples are appropriate for persons studied in the Caribbean (see, e.g., Lambert, Ferguson, & Rowan, in press). This is often not the case, however, because an identical measure that produced a factor model metamorphosing euro american psychological assessment     

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in samples from one population might produce different factor solutions in samples from another (Lambert & Ferguson, 2011). In the past few years, a few studies have addressed the factorial validity of existing measures in the Caribbean region. Mount et al. (2011) used a modern measurement theory–guided approach to estimate the psychometric properties of the Brief Symptom Inventory (BSI; Derogatis & Melisaratos, 1983; Derogatis & Spencer, 1993) across Jamaica and Germany. This study examined the factorial validity of each BSI dimension in both nations and used item response theory (IRT) to address whether bias existed across responses given by adults from both nations. We believe that this study could not only have addressed the psychometric properties of this measure but also could be used as a teaching tool for researchers who wish to conduct similar studies in the region. However, this article was published in the form of a brief report in the CJP, where such information was truncated. A similar study that focused on Jamaican and German youth (see Lambert et al., 2007) addressed whether the factor structure of the Achenbach System of Empirically Based Assessments (ASEBA) Youth Self-Report Form (YSR) of the Child Behavior Checklist (CBCL) was present and metrically invariant across the two nations. Although this study was published as a full-length article in Assessment, it might not reach the audience of Caribbean professionals. Nonetheless, Lambert et al. (2007) showed that using the CBCL factors established in North America to assess German and Jamaican youth could be misguided. Similar to the findings from the YSR study, a CFA conducted on the Family Adaptability and Cohesion Evaluation Scale II (FACES II) showed that the four-factor model was not evident for Jamaican families (Lambert, Samms-Vaughan, Schmitt, & An, 2006). An EFA conducted on half the sample and cross-validated via CFA on the remaining half revealed a twofactor solution, labeled Cohesion and Distance. Similar findings were evident for the 20-item Toronto Alexithymia Scale (Taylor, 1994) and the Male Role Norm Inventory (see Levant et al., 2003), where the factor models for these measures established on North American samples were not replicated in Jamaica (see Lambert et al., 2013). These findings have serious implications because, if the constructs (i.e., factors) identified for these measures are not replicated in the Caribbean region, it might be inappropriate to use them to test individuals in clinical and research settings there. Homegrown Measures and Modification of Measures As Table 13.1 shows, some researchers (e.g., Abel, Bailey-Davidson, et al., 2012; Abel, Sewell, Martin, Bailey-Davidson, & Fox, 2012; Pottinger et al., 2009; Smith, Springer, & Barrett, 2011) have developed their own 340       lambert, sewell, and levitch

measures for their study. It is unfortunate that these researchers reported no psychometric indices for any of these measures. This practice is troubling because without indices documenting their psychometric properties, it is difficult to determine what such surveys measured or to interpret findings from the research that used them. Other researchers (e.g., Lambert, Knight, Taylor, & Achenbach 1994; Lambert, Lyubansky, & Achenbach, 1998; Pottinger & Palmer, 2013) have modified existing measures to reflect idiomatic expression of people in the Caribbean, and some (e.g., Lambert, Knight, Taylor, & Newell, 1993; Pottinger & Palmer, 2013) have added items to existing measures. Pottinger and Palmer (2013), for example, added items based on the literature but did not state whether this was the Caribbean literature or a broader literature base. Lambert et al. (1998) added items to the parent, teacher, and adolescent forms of the CBCL. These items were derived from a search of presenting problems caregivers reported when they referred children and adolescents for mental health services in Jamaica. However, it is unfortunate that most of the studies these authors published did not include these additional items, and only recently have they begun to conduct any psychometric studies that include these items (Lambert & Ferguson, 2011). We believe that Caribbean researchers’ efforts to modify measures to fit the Caribbean nations in which they have conducted studies represent an important step in ensuring that measures become more conceptually and culturally valid for the populations on which they are used. Yet, we also question whether this might be the most appropriate way of addressing such validity concerns. That is, despite these efforts, such measures could miss not only how mental health problems are conceptualized by persons of Caribbean heritage but also important content that could be critical for assessment of psychological functioning throughout the Caribbean region. It is in this context that we next address the use of measures in clinical settings. Use of Measures in Caribbean Clinics The research reviewed thus far has focused on the use of standardized measures designed mostly in North America and Europe to study functioning in persons of Caribbean heritage. Although it is difficult to determine how many of these measures are used in clinical work in the region, we are aware that such instruments are occasionally used to measure functioning in clinicreferred persons within the Caribbean. For example, we have observed clinics in various parts of one of the largest Caribbean islands. From our experience, especially outside this nation’s capital, it was clear that few, if any, standardized or even unstandardized measures were used in assessment. Virtually all clinical data were collected via clinical interviews. metamorphosing euro american psychological assessment     

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We are aware that clinical interviews can be invaluable in clinical assessment, but we are also cognizant that a tremendous amount of clinical data can be gathered economically and efficiently through the use of standardized tests (Achenbach & McConaughy, 2003). For example, within less than half an hour, adolescents, their caregivers, and teachers can provide critical information from multiple perspectives about the adolescents’ functioning via standardized checklists that measure behavioral and emotional adjustment. Information on younger children can also be gathered from adult caregivers and teachers (see Lambert et al., 1998). Such informants can also provide information about the context in which the child and adolescent behavior occurs. This information can assist clinicians in quickly generating and testing hypotheses regarding child and adolescent functioning. For example, if multiple informants’ responses show clinical levels of problems with conduct in a single setting or across multiple settings, clinicians can focus further data gathering and treatment planning in one or more settings as appropriate. In some Caribbean clinics, such as those described in the preceding paragraphs, clinicians have created their own questionnaires to collect clinical data. We know that such questionnaires can be useful, but nonexistent psychometric studies make it is extremely difficult to know what constructs are being measured. Even if the constructs are known, it is virtually impossible to provide a comparative yardstick for scores obtained from two or more respondents. Hence, appropriately identifying borderline or clinical levels of the constructs being measured and, thus, knowing what the scores mean can also be challenging. We are also aware that professionals use standardized measures developed in the United States and Great Britain to measure functioning of persons seen in clinics within the Caribbean region. For example, we have observed clinicians using intelligence tests, such as the Wechsler Intelligence Scales (Wechsler, 2003), the Kauffman Assessment Battery for Children (Kaufman & Kaufman, 2004), the Wide Range Achievement Tests (Jastak & Wilkinson, 1984), the Woodcock–Johnson III Tests (Woodcock, McGrew, & Mather, 2001), and the ASEBA forms (Achenbach & Rescorla, 2001) of behavioral and emotional functioning. Most of these measures were used within a teaching hospital context in the nation’s clinics we observed, but they were not used in most satellite clinics nationwide. Although these measures can provide useful clinical information, they have questionable content and cultural validity, and little is known about their psychometric properties for the region. In our own research, we discovered that, from a psychometric standpoint, items composing some measures designed outside the Caribbean behave significantly differently across Caribbean and even some European nations (Lambert et al., 2007). In some cases, items on North American and European measures 342       lambert, sewell, and levitch

provide limited information for groups in specific Caribbean nations (see Lambert et al., 2013). The dearth of measures designed by researchers of Caribbean heritage, with input from Caribbean people, can negatively impact the accuracy of research findings and clinical data gathered throughout the region, which is a major problem for Caribbean researchers and clinicians (Lambert & Ferguson, 2011). Measurement development requires significant economic investment and psychometric expertise, and even in industrialized nations the number of researchers conducting such work is comparatively small (Merenda, 2007). It is, therefore, extremely important that ministries of health from all Caribbean nations begin to invest in training researchers in psychometrics and fund, as well as encourage, clinicians to collaborate with psychometricians within and outside the Caribbean region to develop culturally valid tests. We now provide two examples of how such work might occur. The Caribbean Symptom Checklist We developed the Caribbean Symptom Checklist (CSC) based on procedures used in the Behavioral Assessment for Children of African Heritage (BACAH; Lambert et al., 2005, 2013). To ensure cultural validity for the region, we conducted multiple focus groups in rural and urban Jamaican regions. In these focus groups, adults were asked how they would describe strengths in persons on the island and what types of psychological problems they observed in persons throughout their country. In addition, we searched 597 clinic records throughout the island to identify problems for which adults 18 and older were referred for mental health services. Information from the focus groups was analyzed to produce items of behavioral and emotional strengths for Caribbean adults. We used qualitative data from the focus groups and quantitative data from the clinic records to create a 147-item self- and third-party report of emotional and behavioral problems for adults in the region. Although all item content of the CSC will be revealed in an upcoming publication (Lambert, Levitch, Hickling, & Garwood, 2015), we note that a significant amount of item content was unique to the region and not evident in widely used North American measures, such as the BSI, that other researchers and clinicians have used in the region. Such regionally unique items include “brandishing a machete”; “acting like other (police)”; feeling like one’s “head is heavy” or that it is “opening and closing”; feeling “like someone is touching . . . [one in one’s] sleep”; and “jumping out of . . . [one’s] sleep.” As the content of these items show, measures imported from Europe and North America are missing content that could be critical to the assessment of people in the region. metamorphosing euro american psychological assessment     

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After creating the CSC prototype, we asked Caribbean clinicians to review items on the measure, as well as the instructions written on it, and to suggest changes to enhance its clarity. We then asked them to add additional items or suggest items that might be dropped. Clinicians suggested no additional items for the CSC and made no mention of items that should be dropped, but they suggested revising some items and the instructions for clarity. We revised the CSC accordingly (see Lambert et al., 2013). We note that in Barbados, as well as Trinidad and Tobago, items were reviewed by researchers from these nations and were virtually translated and back-translated to match the idiomatic expression of potential informants in these nations. Establishing the Caribbean Symptom Checklist Psychometric Properties Having attempted to ensure appropriate cultural and content validity for the CSC, we used Lengua, Sadwowski, Friedrich, and Fisher’s (2001) rational and mathematical (e.g., CFA) approach and again relied on the expertise of clinicians of Caribbean heritage to identify dimensions of psychopathology in the region. Three psychologists, one social worker, and seven psychiatrists reviewed all items and were asked to place each item under the broad categories of Aggressive Behavior, Antisocial Behavior, Anxiety, Attention Deficit, Depression, Mania (see Table 13.2), Psychosis, and SelfDestructive Behavior. We placed items under their respective dimensions if five or more professionals placed them accordingly (or if five or more were not in consensus, we placed that item in the category that the majority of professionals placed it in). To mathematically establish that each set of items is essentially unidimensional, we conducted CFAs on data collected from 239 clinic-referred and 456 nonreferred adults. All such analyses revealed good data to model fit (see Lambert et al., 2013). To provide more estimates of the psychometric properties of the selfreport CSC, we administered it to clinic-referred and nonreferred adults (N = 695). We combined data from both sets of adults because they provided the variance necessary to obtain stable measurement parameter estimates (Embretson & Reise, 2000). We used IRT to estimate the parameters of the CSC. Summarized elsewhere (see Lambert et al., 2013), IRT represents a set of theoretical models and procedures that have been argued to provide more measurement precision than traditional test theories and procedures. Implying the existence of one or more traits (i.e., factors, constructs, or dimensions), IRT models estimate the interaction between test items and respondents’ responses to them (Embretson & Reise, 2000). Hence, IRT models calculate the probability of respondents giving responses to items that measure specific trait (in this case psychopathology) levels labeled q.

344       lambert, sewell, and levitch

TABLE 13.2 Caribbean Symptom Checklist Examples of Items on Mania Dimension Nonreferred Brief item description 16.  Superior powers 19. Boisterous/raucous 34. Disruptive/annoying 39.  Elated energetic 40.  Excessive singing 45.  Out of control 60. Giving away belongings 78.  Fast mood changes 86.  Too religious 92. Uncontrollable 99.  Quarreling often 100.  Racing thoughts

Referred

a

b1

b2

a

b1

b2

1.70 2.43 2.16 0.69 1.21 1.78 1.50 1.29 1.33 2.17 1.80 1.66

0.76 0.28 0.22 -2.24 -1.08 0.35 -0.26 -0.49 0.67 0.29 -0.13 -0.12

1.50 1.25 1.24 1.71 0.40 1.30 1.27 1.17 2.13 1.37 1.02 1.24

1.70 2.14 2.16 0.98 1.21 1.78 1.90 1.29 1.33 2.17 1.80 1.66

0.76 -0.17 -0.31 -0.29 0.01 -0.29 -0.22 -0.49 0.11 0.11 -0.52 -0.12

1.50 0.58 0.34 1.77 1.10 0.54 0.99 1.17 1.29 0.93 0.61 1.24

Note.  Bolded parameter estimates are identical and show that no significant differential item functioning emerged (i.e., the item is considered invariant) across nonreferred and referred groups. a = discrimination parameter estimate, measuring how well each item discriminates between the level of function of its location (b) parameter estimates measure versus other levels; b1 = estimated level of functioning the lowest point (boundary) on the 3-point scale measures; b2 = the estimated highest point on the 3-point scale measures— calculation of the middle point is the subtraction of the b1 parameter estimate from that of b2.

For CSC items measuring Mania/Hypomania, IRT estimates the probability that individuals would respond positively to items that match their levels of functioning on this dimension and negatively to other items that do not measure such functioning levels. Hence, individuals with lower levels of psychopathology should endorse items measuring mild problem levels, whereas the converse should be true for higher levels. It is important to note that items on dimensions whose parameters are estimated using IRT methods are seldom summed. Typically, IRT and testing software that uses IRT parameters and scoring algorithms examine the patterns of response and provide scores based on such patterns (see Lambert et al., 2013). IRT is useful in determining not only the levels of functioning items are capable of measuring but also how well each item discriminates between the levels of functioning it estimates versus other levels of functioning on the measurement continuum (typically ranging from 3 standard deviations below to 3 standard deviations above mean). Further, it is capable of determining whether bias exists for one or more items across groups (e.g., male vs. female, across different Caribbean islands, and across individuals referred for services vs. those who are not)—that is, whether one or more groups overreport or underreport their psychopathology on an item or an entire dimension, or

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whether an item provides better discrimination for one group versus the next. For example, one group might fully understand the item content whereas others might not, leading to differences in how well the item discriminates for one group versus the next. IRT also permits psychological test items to be linked across two or more demographic groups or across two or more subtests that measure an identical construct. Linking permits unbiased assessment across groups who are administered some identical items, whereas other items might be unique to each group. For example, some items on a dimension might be culturally appropriate for Trinidad and Tobago but not for the Bahamas. IRT linking can place groups of items that are unique for each group of respondents, as well as those that overlap across groups on the same scale, thus permitting unbiased assessment across groups. Linking can also reduce bias for some items that might be biased for one group. It also allows researchers to add items to a dimension without having to collect new data on all existing and new items. Finally, IRT lends itself to computerized adaptive testing (CAT) where only items matching the individual’s levels of functioning are measured—hence, maximizing measurement precision—whereas items reflecting higher or lower levels of functioning are not administered. Yet, because all items in the CAT item bank are precalibrated, scores can be compared across individuals who might receive different sets of items. A crude example is the administration of most IQ subtests: No one receives all items on the subtest, yet scores are comparable across individuals. Caribbean Symptom Checklist Mania/Hypomania Scale We use the CSC’s Mania/Hypomania dimension as an example of how we used IRT to estimate its psychometric properties. Because we found bias across individuals who were referred for services versus those who were not, we used IRT linking to place items on this dimension on an identical metric for referred and nonreferred Caribbean adults. Table 13.2 gives examples of items on this dimension. The first column under the Referred heading has values (a) that tell how well an item discriminates across the levels of functioning it measures. Typically, values higher than 1 are thought to have discrimination. The second and third columns have b1 and b2 values where the lower value represents the lower boundary that the items are capable of measuring and the upper value represents the higher boundary—hence, 0 (not true) and 2 (very true or often true) on the Likert scale. Obtaining the value of the 1 (sometimes/somewhat true), one merely subtracts the lowest from the highest. Because CSC test administration software record scores in standard score units, they can easily be transformed to T scores, percentiles, raw scores, or other values the professional requires. 346       lambert, sewell, and levitch

The Behavioral and Emotional Assessment for Children of Caribbean Heritage The Behavioral and Emotional Assessment for Children of Caribbean Heritage (BEACCH) is also patterned after the BACAH forms. Hence, it consists of 61 items that match the BACAH and 34 items derived from a clinic record search of children referred for mental health services in urban and rural Jamaica. We developed BEACCH using similar procedures that were applied to the BACAH and the CSC, where professionals grouped items according to Attention Deficit, Anxiety, Atypical Thoughts, Probable Conduct Problems, Depression, Oppositional Defiant, and Somatization. We subjected these item groupings to CFA that was conducted separately for reports given by 1,898 parents (of children ages 4–18), 1,352 teachers (of children and adolescents ages 6–18), and 1,014 adolescents (ages 11–18). All analyses revealed that these dimensions were essentially unidimensional. We then subjected items on each dimension to IRT analyses to identify the levels of functioning each item measured; to determine how well each item discriminated between such levels versus others; and to link items across parent, teacher, and self-reports to permit unbiased comparisons across informants. Table 13.3 shows an example of the item parameter estimates that were calculated for Conduct Problems for nonreferred adolescents. These items show that they measure functioning as low as the mean to more than TABLE 13.3 Behavioral and Emotional Assessment for Children of Caribbean Heritage Self-Report Conduct Problem Examples Brief item 21.  Destroy others’ property 57.  Attack people 90.  Curse bad words 96.  Think about sex too much 97.  Threaten others 101. Truancy 105. Alcohol/drugs 114.  Deliberately annoy others 120.  Put self in dangerous situation 121.  Do not respond to punishment 124.  Rude to others 130.  Stone people 132.  Throw stones at objects 133.  Beg at home or on street 137. Gossip

a

b1

b2

1.39 1.42 1.39 0.83 1.96 1.15 0.98 1.41 1.63 0.98 2.17 1.53 1.13 1.12 0.83

1.48 1.50 0.00 1.31 0.66 1.15 2.37 0.30 1.22 0.39 0.18 1.18 0.37 1.74 1.37

3.16 2.93 2.00 3.28 2.00 3.04 3.89 2.24 2.50 2.37 1.94 2.69 2.23 3.74 4.29

Note.  a = discrimination parameter estimate, measuring how well each item discriminates between the level of function of its location (b) parameter estimates measure versus other levels of functioning; b1 = estimated level of functioning the lowest point (boundary) on the 3-point scale measures; b2 = estimated highest point on the 3-point scale measures—calculation of the middle point is the subtraction of the b1 parameter estimate from that of b2.

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three standard deviations above the mean. Considering that conduct problems are believed to be extremely serious within child psychopathology, it is not surprising that respondents’ positive responses to any of these items reflect severe psychopathology. It is also noteworthy that items such as “stoning people,” “begging at home or on the streets,” and “gossiping” from the clinic record survey are part of this scale and reflect levels of functioning reported by caregivers regarding children who were referred for mental health services. These items are, however, absent from measures such as the ASEBA forms that we and others have used in research and clinical assessment in the Caribbean region. Thus, we advocate the development of reliable and valid measures of multiple psychological constructs for various sociocultural groups throughout the Caribbean and worldwide. Such measures should replace those of questionable cultural, conceptual, and content validity for such groups. Professionals who conduct international research might argue that creating psychological measures for specific nations might pose a challenge for international or other cross-group research and might even endorse the use of an identical set of measures cross-nationally. We counter this argument by first noting that not only is it unethical to use measures on groups for which they were not designed but that findings from such research might be rife with errors due to poor conceptual, cultural, and content validity (King et al., 2011; Olsen et al., 2013). Furthermore, we have shown both in this chapter and in our earlier work (Lambert & Ferguson, 2011) that linking groups of items that are specific to each of two or more groups with items that are identical/equivalent across groups can reduce cross-group bias and allow appropriate cultural and conceptual validity. SUMMARY AND CONCLUSION Research and clinical assessments require the availability of psychological tests that are reliable and valid. When used with persons from diverse backgrounds, including those who reside in the Caribbean basin, the burden on professionals to use psychometrically sound measures becomes even greater, because such measures must have appropriate conceptual, cultural, and content validity. Yet, there are almost no measures used in Caribbean clinical practice and research that meet these criteria. The vast majority of research conducted in the region uses tests that are designed by White European or North American researchers. Few studies have been conducted that test whether these measures are culturally, conceptually, and mathematically appropriate for persons in the Caribbean region. Some researchers (e.g., Lambert, Puig, et al. 2001) have attempted to address this concern by modifying existing measures to be more culturally appropriate for use in 348       lambert, sewell, and levitch

this region. However, very few studies have been conducted to determine whether these modified measures, or even existing measures in their original form, are culturally reliable and valid. At best, most researchers have calculated coefficient alphas for internal consistency and have mistakenly labeled it as “reliability.” Some professionals have invented their own tests for use in clinical and research settings, but few psychometric studies have been done. Lack of psychometric information makes it extremely difficult to be confident about findings and inferences drawn from such research or clinical data. To address these concerns, we have presented two examples where the content of the measures was derived from focus groups with persons from the general population in rural and urban Jamaica, clinic record surveys, and input from professionals who practice and conduct research in Jamaica. Data from these studies have led to the development of region-specific items. Moreover, by seeking the expertise of professionals who have experience practicing in the Caribbean, we have attempted to ensure conceptual validity based on how they grouped items on these measures. The application of mathematical principles and practice (e.g., IRT, CFA) has confirmed that these professionals have done a remarkable job of placing such items in essentially unidimensional constructs. Thus, we believe that it is possible to create and begin to establish measures with culturally appropriate items and scores that are scientifically verified as reliable and valid. We are aware that it takes a significant amount of psychometric expertise to take the necessary steps we have taken. For that reason, we believe that governments throughout the Caribbean Basin must begin to invest resources in training professionals to become psychometricians. In the interim, we strongly suggest that they encourage researchers and clinicians in the area to begin collaborating with psychometricians of Caribbean heritage outside the region. Without such investment, developing measures designed by and for Caribbean people will be elusive or be very difficult to accomplish. Having a set of flexible measures, such as the BEACCH and the CSC, researchers can begin to contribute to assessments in research and clinical practice that produce more reliable and valid test scores from Caribbean people’s responses. It is our hope that further psychometric work throughout the Caribbean Basin can use the results of our efforts to develop other culturally reliable and valid assessment tools for the Caribbean region.

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Lambert, M. C., Lyubansky, M., & Achenbach, T. M. (1998). Behavior and emotional problems among adolescents of Jamaica and the United States: Parent-, teacherand self-reports for ages 12–18. Journal of Emotional and Behavioral Disorders, 6, 180–187. http://dx.doi.org/10.1177/106342669800600306 Lambert, M. C., Markle, F., & Bellas, V. F. (2001). Psychopathology and assessment in African American children and families: A historical, ecological, and strengthbased perspective. In A. Neal-Barnett, J. Contreras, & K. A. Kerns (Eds.), Forging links: A clinical developmental understanding of African American children (pp. 1–26). Westport, CT: Prager. Lambert, M. C., Puig, M., Lyubansky, M., Rowan, G. T., Hill, M., Milburn, B., & Hannah, S. D. (2001). Child behavior and emotional problems in Jamaican classrooms: A multimethod study using direct observations and teacher reports for ages 6–11. International Journal of Intercultural Relations, 25, 545–562. http:// dx.doi.org/10.1016/S0147-1767(01)00022-0 Lambert, M. C., Rowan, G. T., Kim, S., Rowan, S. A., An, J. S., Kirsh, E. A., & Williams, O. (2005). Assessment of behavioral and emotional strengths in Black children: Development of the Behavioral Assessment for Children of African Heritage (BACAH). Journal of Black Psychology, 31, 321–351. http:// dx.doi.org/10.1177/0095798405278409 Lambert, M. C., Rowan, G. T., Rowan, S. A., & Mount, D. L. (2014). Behavioral and emotional problem scales of the behavioral assessment for children of African heritage (BACAH): Culturally valid measurement of psychological functioning in black children. Journal of Black Psychology, 40, 451–482. http://dx.doi. org/10.1177/0095798413497512 Lambert, M. C., Samms-Vaughan, M. E., & Achenbach, T. M. (2006). An international survey of behavior and emotional problems among clinic and nonclinic children of the African Diaspora: Parent and teacher reports for African American and Jamaican children ages 6 to 11. Caribbean Journal of Psychology, 2, 50–70. Lambert, M. C., Samms-Vaughan, M. E., Schmitt, N., & An, J. S. (2006). Psychometric properties of the Family Cohesion and Adaptability Scale II for Jamaicans. Caribbean Journal of Psychology, 2, 4–22. Lambert, M. C., Schmitt, N., Samms-Vaughan, M. E., An, J. S., Fairclough, M., & Nutter, C. A. (2003). Is it prudent to administer all items for each Child Behavior Checklist cross-informant syndrome? Evaluating the psychometric properties of the Youth Self-Report dimensions with confirmatory factor analysis and item response theory. Psychological Assessment, 15, 550–568. Lengua, L. J., Sadwowski, C. A., Friedrich, W. N., & Fisher, J. (2001). Rationally and empirically derived dimensions of children’s symptomatology: Expert ratings and confirmatory factor analyses of the CBCL. Journal of Consulting and Clinical Psychology, 60, 683–698. http://dx.doi.org/10.1037/0022-006X.69.4.683. Levant, R. F., Richmond, K., Majors, R. G., Inclan, J. E., Rossello, J. M., Heesacker, M., . . . Sellers, A. (2003). A multicultural investigation of masculinity ideology metamorphosing euro american psychological assessment     

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and alexithymia. Psychology of Men & Masculinity, 4, 91–99. http://dx.doi. org/10.1037/1524-9220.4.2.91 Lipps, G., Lowe, G. A., Gibson, R. C., Halliday, S., Morris, A., Clarke, N., & Wilson, R. N. (2012). Parenting and depressive symptoms among adolescents in four Caribbean societies. Child and Adolescent Psychiatry and Mental Health, 6, 31–31. http://dx.doi.org/10.1186/1753-2000-6-31 Lipps, G., Lowe, G. A., Halliday, S., Morris-Patterson, A., Clarke, N., & Wilson, R. N. (2010). A brief report on the association of academic tracking with depressive symptoms in high school students in Jamaica. Journal of Black Psychology, 36, 369–380. http://dx.doi.org/10.1177/0095798409353752 Lipps, G. E., & Lowe, G. A. (2006). Validation of the brief screen for depression in a Jamaican cohort. The West Indian Medical Journal, 55, 425–429. http://dx.doi. org/10.1590/S0043-31442006000600011 Maharaj, R. G., Alli, F., Cumberbatch, K., Laloo, P., Mohammed, S., Ramesar, A., . . . Ramtahal, I. (2008). Depression among adolescents, aged 13–19 years, attending secondary schools in Trinidad: Prevalence and associated factors. The West Indian Medical Journal, 57, 352–359. Maharajh, H. D., Ali, A., & Konings, M. (2006). Adolescent depression in Trinidad and Tobago. European Child & Adolescent Psychiatry, 15, 30–37. http://dx.doi. org/10.1007/s00787-006-0501-3 McLeod, L. D., Swygert, K. A., & Thissen, D. (2001). Factor analysis for items scored in two categories. In D. Thissen & H. Wainer (Eds.), Test scoring (pp. 189–216). Mahwah, NJ: Erlbaum. Medoff, D. (2003). The scientific basis of psychological testing. Family Court Review, 41, 199–213. http://dx.doi.org/10.1177/1531244503251482 Merenda, P. F. (2007). Psychometrics and psychometricians in the 20th and 21st centuries: How it was in the 20th century and how it is now. Perceptual and Motor Skills, 104, 3–20. http://dx.doi.org/10.2466/pms.104.1.3-20 Mount, D. L., Lambert, M. C., Essau, C. A., Samms-Vaughan, M. E., & Bokszczanin, A. (2011). Using IRT-DIF methodology in detecting and evaluating Brief Symptom Inventory item response differences among Afro-Caribbean and European adults. Caribbean Journal Psychology, 4, 29–42. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York, NY: McGraw-Hill. Olsen, M., Jensen, N. K., Tesfaye, M., & Holm, L. (2013). Conceptual equivalence of WHOQOL-HIV among people living with HIV in Ethiopia. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care, and Rehabilitation, 22, 361–367. http://dx.doi.org/10.1007/s11136-012-0141-7 Patrick, G. K. (2013). The relationship between social status and attitudes towards abortion. Caribbean Journal of Psychology, 5, 52–64. Pottinger, A. M., La Hee, F., & Asmus, K. (2009). Students admitted to university who fail: Hidden disabilities affecting students’ performance. The West Indian Medical Journal, 58, 99–105.

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14 INNOVATIONS IN CLINICAL PSYCHOLOGY WITH CARIBBEAN PEOPLES RITA DUDLEY-GRANT

The practice of psychology in the Caribbean is a reflection of the society of the Caribbean itself, with its interplay and melding of cultures, practices, structures, and belief systems. Similarly, clinical practice is provided by a mixture of psychologists, using the training they received frequently from America or Great Britain, with multiple theoretical orientations with limited research on their efficacy with Caribbean populations (Hutchinson & Sutherland, 2013; Johnson, Weller, Williams Brown, & Pottinger, 2008). The practicing psychologist is challenged to provide culturally competent and effective services to these ethnically diverse and complex communities (Bernal & Domenech Rodríguez, 2012; La Roche, 2013; McGoldrick, Giordano, & Pearce, 1996). Innovations abound in every aspect of their work, including settings that are preferably community-based; collaboration with professional and nonprofessional healers; and the use of context, such as therapeutic dinners, to inform interventions (e.g., family therapy). http://dx.doi.org/10.1037/14753-015 Caribbean Psychology: Indigenous Contributions to a Global Discipline, J. L. Roopnarine and D. Chadee (Editors) Copyright © 2016 by the American Psychological Association. All rights reserved.

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Regardless of the clinical specialty, Caribbean psychologists are called upon to be generalists, as they frequently are one of one, or one of a few, psychologists available in these small nations (Hickling et al., 2008; Hutchinson & Sutherland, 2013). Mental health service delivery in the region faces many obstacles while simultaneously being presented with rich opportunities. It challenges the clinician to stretch his or her knowledge and to test, modify and research new approaches, but frequently in isolated settings with clients who are unfamiliar with talk therapies, as well as averse to mental health counseling (Nicolas & Schwartz, 2012). From family therapy under the Tamarind tree in the backyard of a client’s home, to geriatric competency evaluations in the back bedroom of a small apartment attached to the main house, from crisis intervention when a shooting or death has occurred at one’s child’s school, to group therapy and group family counseling in a church parish hall; from seeking out clients after a devastating hurricane to crisis counseling after a bank robbery or explosion in a refinery—therapy in the Caribbean tests the ability of the practicing psychologist to be flexible and creative, while confronting ethical dilemmas and maintaining boundaries and cognizance of ethical standards, culturally competent skills, and evidence-based practices (Barnard & Rothgeb, 2000; Hickling et al., 2008). In this chapter, I look at the challenges inherent in clinical psychology practice in the Caribbean. I present an epidemiological overview of mental health service needs, access to psychology services, and availability of providers to meet those needs. I review community attitudes toward mental health services, psychological treatments, and available research on treatment outcomes, including a model of treatment and training in operation at Virgin Islands Behavioral Services (VIBS) in the U.S. Virgin Islands. Finally, I pre­ sent the current state of clinical training in Caribbean countries and future directions for improving clinical training—all in the context of culturally competent practice. OVERVIEW OF CLINICAL PSYCHOLOGY AND MENTAL HEALTH NEEDS IN THE CARIBBEAN Definition of Psychology in the Caribbean: Caribbean Alliance of National Psychological Associations Traditionally, psychology in the Caribbean has tended to focus on one or another of the three primary subcultures, such as the Englishspeaking Caribbean (ESC; Hickling & Sorel, 2005), the Spanish-speaking Caribbean (Bernal & Shapiro, 2005; Consoli & Morgan Consoli, 2012; 358       rita dudley-grant

Consoli, Morgan Consoli, & Klappenbach, 2013), or the French-speaking Caribbean, primarily Haiti (Nicolas, Jean-Jacques, & Wheatley, 2012). This chapter is more inclusive, using the definition of the Caribbean most recently adopted by the newly formed Caribbean Alliance of National Psychological Associations (CANPA; launched June 5, 2013): the insular Caribbean, the nations/territories of Belize, Guyana, French Guiana, and Suriname. Eleven Caribbean psychological associations have signed as CANPA founding members: The Bahamas, Barbados, Grenada, Haiti, Martinique, Suriname, Trinidad and Tobago, U.S. Virgin Islands, Puerto Rico, Jamaica, and Cuba. CANPA intends to provide a structure to bring a unifying voice and mission to the activities of psychologists from the region, the Caribbean diaspora, and its supporters, including creation of standards for training and practice of psychology in the Caribbean (see Chapter 1, this volume). Clinical practice herein is broadly defined to include all psychological service provider subspecialties within the region, including clinical, counseling, school, crisis intervention, consultation, and related services. Practice includes interventions at the microlevel of individual and family services as well macroservices, such as consultation and interventions within institutions, both government and private, or communitywide interventions required for disaster mental health interventions and training needs for same. In this way, consultants can positively influence community health, from HIV to trauma reduction (Francis & Bishay, 2013; Ramkissoon, GopaulMcNicol, Davidson, Matthies, & Brown-Earle, 2008). The “psychology of Caribbean people” lacks an easily definable singularity. Although principles of culturally competent practice are an essential aspect of successful clinical interventions, psychotherapists are cautioned to be aware of the potential for the use of psychotherapy in the service of several methods of population control, including assimilation, acculturation, and enculturation, where the therapy consciously or transferentially inculcates beliefs, attitudes, and values from the dominant one (Bernal & Domenech Rodríguez, 2012; see also Chapter 4, this volume, for a discussion of remote acculturation). In this instance, the “dominant culture” could be seen as the particular culture in which the psychologist is trained (e.g., the United Kingdom, France, the United States), as well as the theoretical orientation espoused by their university. Thompson (2011) in her plenary session address sounded an extremely positive note. Her abstract states, “The growth of culturally based scholarship emerging from the global psychology community indicates that the end of acontextual, ahistorical, and acultural psychology is imminent” (Thompson, 2011, p. 43). Similar changes in psychotherapeutic practice also appear to hold promise for the practice of psychology in the Caribbean. innovations in clinical psychology with caribbean peoples     

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Brief Historical Overview of the Caribbean Clinical practice in the Caribbean has been shaped by cultural realities, both past and present, of the region and its people. The history of slavery and colonialism has played an integral role in the collective identity of persons of Caribbean birth (Morgan & O’Garo, 2008; Willock, 1995). The melding of cultures in these tiny locations, representing virtually every ethnicity in the world (African, Asian, Indian, and European), has formed the basis of the Caribbean society of today and produced a fascinating mosaic that is reflected in the food, music, and rhythms, as well as the family systems, child-rearing patterns and ubiquitous tensions of the region. Some researchers and clinicians have posited a long-term negative impact on the sense of self and of community (Charles, 2003; Hutchinson, 2005), whereas others see this history as contributing to the resilience, warmth, and openness, which are a key component of the success of tourism, the primary industry in the region (Robertson-Hickling, 2008; Young, 1993). To be effective, the psychologist must consider all aspects of this history while attempting interventions that respect the tragedies, as well as the triumphs, of the Caribbean psyche over the history of oppression. Epidemiological Overview of Current Major Mental Health Issues The Pan American Health Organization (PAHO)/World Health Orga­ nization (WHO) and Caribbean Community Secretariat (CARICOM; 2006) provide valuable information on the incidence and prevalence of health and mental health in the region. They report a steady increase from 1990, when psychiatric and neurological disorders were estimated to account for 8.8% of the disability-adjusted life years in Latin America and the Caribbean, to 21% by 2004, with more than half remaining untreated. Lack of funding and resources for the treatment of mental health problems is a primary factor in the underserved population (PAHO/WHO & CARICOM, 2006). In addition, affective disorders and alcoholism have the highest prevalence rates in the Caribbean and Latin American (Kohn et al., 2004). Hutchinson and Sutherland (2013) in their chapter on counseling and therapy in the ESC reported similar epidemiological statistics. They challenged the profession, however, to look more closely at the etiology of these illnesses. Rather than symptoms of dysfunction, anxiety and depression complaints may be a somewhat normalized response to the real-life challenges of trauma, violence, and substance abuse, which abound in the society. Moreover, these individual, family, and community challenges may indicate a disturbing sense that Caribbean societies are unraveling, highlighting the need for a Caribbean-oriented psychology. The call for a self-defined Caribbean psychology was frequently restated by psychologists from across the Caribbean 360       rita dudley-grant

who presented at the Caribbean Regional Conference of Psychology (CRCP) 2011 (Thompson et al., 2013). In summary, increasing capacity to provide the greatly needed services in effective ways remains the challenge. SOCIOCULTURAL ISSUES, CLINICAL PSYCHOLOGY, AND PRACTICE IN CARIBBEAN COUNTRIES Psychology in the Caribbean: Practice and Psyche The culture and psyche of Caribbean people result from centuries of colonialization, along with the many accommodations necessary to survive when the colonizers were vastly outnumbered by the enslaved and/or indentured populations. The dehumanization of African captives was used to justify generational enslavement (DeGruy, 2010). Additionally, a white-collar, mulatto, educated class was consciously created from frequent slave–master unions, which were promoted to dominate the field hands and increase the balance of power on islands that were 10% to 20% White and the rest African and Indian. The colonial minority used education and privilege to expand the identification with the aggressor of persons of “mixed” heritage to maintain socioeconomic control of these tiny, but extremely lucrative, economies. Postslavery, indentured immigration from the Indo Asian countries added cultural complexity with further layers of oppression. Hickling and Hutchinson (1999, 2000) have written extensively about the impact of this history on the psyche of Caribbean people. Hickling and Hutchinson (1999, 2000) termed it “the roast breadfruit syndrome”: Black persons identifying as White, which contributes to identity confusion and a lack of self-definition in terms of the character of Caribbean peoples (see, e.g., Hickling & Hutchinson, 1999, p. 132). Lequay (2011) suggested, in his plenary on sense making, that identity difficulties also stem from the fact that Caribbean people have been written about for centuries through the lens of the European colonizers. These early writers described first the native Indian cultures, such as Taino and Kaoliang (Carib), and then the African slaves in deleterious terms, imposing their culture and values (Morgan & O’Garo, 2008). Negative stereotypes continue to this day, imbuing Caribbean persons with standards of productivity, work pace, and family structure, to name a few, that frequently do not adhere to the Euro American cultural norm. Pejorative terms include “the mañana mentality” and male-dominant machismo of the Latino society, the laissez-faire of the French Caribbean, the “emasculating” matriarchal and unstable family structure of the ESC, or the patriarchal “female oppression” practiced by the Indian community, as well as the “laziness” of the entire regional population. Euro American values continue to abound in the demeaning descriptive analysis of Caribbean innovations in clinical psychology with caribbean peoples     

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behaviors and family structures (Maharajh & Abdool, 2005; Morgan & O’Garo, 2008). The challenge lies in redefining Caribbean people and culture exclusive of the Euro American hegemony (see Chapters 1 and 2). Lequay (2010) asserted that meeting this challenge of self-definition, “postslave, indentureship, and colonial experiences is a requirement for ‘mental health’” (p. 11). Although identity confusion, poor self-esteem, and difficulties in attachment can result from the history of oppression, great strengths have also emerged in terms of strong yet flexible extended family structures, tremendous resilience, and inherent self-confidence, particularly when immigrating away from the Caribbean (Joseph, Watson, Wang, Case, & Hunter, 2013; Tormala & Deaux, 2006). The people of the Caribbean are also known for their warmth, creativity, and openness (Robertson-Hickling, 2008). Nevertheless, psychological troubles in paradise abound and remain largely untreated because of minimal resources, misinformation, and stigma regarding mental illness, and systems poorly designed to meet mental health needs. Attitudes Toward Mental Illness in the Caribbean: Stigma Along with the ubiquitous funding shortages for treatment, which exist worldwide, perhaps the greatest challenge to treatment for mental illness is the misinformation and fear that contributes to stigma and discrimination. Results of recent studies conducted on attitudes toward mental illness in the Caribbean confirm that the negative attitudes persist (Neckles, AlvarezJimenez, Martinez, Vernezobre, & Cortina, 2012). Other studies (Hickling, Robertson-Hickling, & Paisley, 2011; Peluso & Blay, 2004) have reported significant reductions in negative attitudes toward the mentally ill since the 1980s, which Hickling et al. (2011) attributed to the movement toward deinstitutionalization, notably in Jamaica. Peluso and Blay (2004) and Neckles et al. (2012) both conducted in-depth reviews of the literature on Caribbean attitudes toward mental illness, but only Neckles et al. (2012) confirmed the persistence of stigma, which includes the belief that mental illness results from an external demonic source now resident within the individual (DudleyGrant, 2006; Gopaul-McNicol, 1997); that mental illness is narrowly defined to be primarily major psychosis, most often schizophrenia (Peluso & Blay, 2004; PAHO, 2011); and the ever-present fear of not only what a mentally ill person might do but also the subsequent stigma and discrimination that would transfer to family members (Arthur et al., 2008). These attitudes have the unfortunate consequence of delaying help-seeking behavior, as well as minimizing the long-term impact on the individual. Several approaches to reducing and eventually eliminating stigma in community acceptance of mental illness and support of treatment have proven effective. Hickling et al. (2011) conducted a qualitative study of 362       rita dudley-grant

deinstitutionalization in Jamaica. They reported findings of reduced discrimination in communities in which the mentally ill clients resided in the neighborhoods versus being in an institution for extended periods of time. The Disability Rights Center of the Virgin Islands (2008) reported efficacy in stigma reduction by increasing knowledge and awareness in the younger population through youth essay contests conducted annually for 3 years. Hundreds of students submitted essays on the needs of the mentally ill, community attitudes toward mental illness, and recommendations for change, thereby increasing their own knowledge of the issues. Similarly, the Glasgow Anti Stigma Partnership (2007) found success by targeting the whole population with a program aimed at increased understanding of multicultural belief systems. Successful community engagement to reduce stigma then must promote an inclusive definition of mental illness that includes the spiritual as well as the physical dimensions of mental health and well-being. Role of Spirituality in Mental Health Treatment Much has been written about the role of spirituality in the mental health of Caribbean communities (Amuleru-Marshall, Gomez, & Neckles, 2013; Caldwell-Colbert, Henderson-Daniel, & Dudley-Grant, 2003; GopaulMcNicol, 1997; James & Peltzer, 2012). The American Psychological Association (APA) Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists (APA, 2003) recommend that competent multicultural practice include the importance of including the client’s spiritual life, beliefs, and practices in treatment. Effective therapists seek to learn about, and respect, both the beliefs of those they serve and the healers, shamans, priests, priestesses, and other spiritual practitioners who can provide an extremely important part of the entire psychotherapeutic and mental health healing process (Sutherland, Moodley, & Chevannes, 2013). Successful integration can extend from a respectful desire to understand, up to and including the native healer as an equal part of the treatment team (Dudley-Grant, 2006; Gopaul-McNicol, 1997; Wedenoja & Anderson, 2013). Most important is the necessity for practitioners to be clear in their beliefs while maintaining awareness of the importance of not imposing those values on others. Johnson et al. (2008) encourages the clinician to be aware of the cultural differences that can arise within the therapeutic interaction when the therapist, who may come from a different culture or socioeconomic class, may not share the same traditional beliefs and practices as the client and may even hold negative attitudes toward, for example, Voodoo and other native healing practices, seeing them as evil rather than healing. Neckles et al. (2012) identified Protestant, Catholic, Christianity, and Judaism as the most commonly identified major world religions. Other religious practices innovations in clinical psychology with caribbean peoples     

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were identified as Voodoo, Santeria, Obeah, and Espiritismo. These spiritual practices, along with other Eastern religions, were found to have equal prevalence with those who self-identified as Christian. It is clear that consideration of traditional healers is critical in the treatment of the Caribbean population. Family Systems and Psychological Interventions The Caribbean presents a complex system of child and family dynamics, which undergirds the culture and the varying behavior of its members at home and in the diaspora (Anderson, 2007; Gopaul-McNicol, 1993; Roopnarine & Brown, 1997; Roopnarine & Shin, 2003; Roopnarine, Yang, Krishnakumar, & Davidson, 2013; see also Chapter 3, this volume). These relationships affect services to families with members who are mentally ill. The extended family is consistent across subcultures. Conversely, attitudes toward children are as varied as the cultures existing in the region. Although some cultures focus on the child as central, others maintain the practice that children are to be “seen and not heard.” These cultures expect courtesy and respect to one’s elders, especially within the extended family, along with the preeminence of their opinion regarding all matters related to the family (Wilson, Wilson, & Berkeley-Caines, 2003). These attitudes affect the help-seeking behavior of families. To be effective, the clinician must take into account the culture’s attitudes not only toward mental health services but also toward parental, child, and extended family roles in the health of the family (Ramkissoon et al., 2008). In addition, services need to be accessible and culturally compatible. Milbourn, Sharpe, and Samms-Vaughan (2005) described the child guidance clinic model, which they identify as the main model for the provision of outpatient mental health services throughout the ESC. These facilities tend to be staffed with a multidisciplinary team relying on social service workers who can provide community-based counseling services in homes, schools, and other locations, which are consonant with the multisystem, multidisciplinary, locally provided family interventions proven to be effective with this population. Family connections have been found to be focal in the mental health and resilience of the individual, a significance that is consistent across regional subcultures and is based on the communal nature of Caribbean communities (Roopnarine & Brown, 1997). An example of the importance of these social networks for Haitian immigrants was documented by Nicolas, DeSilva, and Donnelly (2011), who found that the household composition in Haiti, consisting of both kin and non-kin family members, was replicated in immigrant communities in the United States. They studied the relationship between the Haitian family variables of family support, family stress, and family contact. Data analysis suggested that Haitians were more vulnerable to depressive symptoms when worried about family members. 364       rita dudley-grant

Roopnarine, Krishnakumar, and Xu (2009) used a Creolization conceptual framework to study beliefs about paternal and maternal roles within the home among 60 Indo Caribbean immigrant couples with young children. They found that family structure, roles, and responsibilities did not change to reflect the behaviors of the new country but rather remained stable in the roles and structures of the home country. Thus, exposure to egalitarian roles and greater economic opportunities for women in the United States did not appear to influence Indo Caribbean couples’ ideological beliefs about maternal and paternal roles, which were retained along a traditional continuum: Fathers as providers and models and mothers as caregivers. Moreover, family structures in the new country maintained the same extended-family and smallcommunity orientation that was reported by Nicolas et al. (2011). These results once again demonstrate the resilience and primacy of these relationships to emotional well-being across subcultures in the region. Gender Disparities and Psychotherapy Use Although the extended family is a central focus and strong source of support in Caribbean cultures, gender inequality in families, as reported by Roopnarine (2013) and others (Barriteau, 2003; Bell, 2010; Dudley-Grant, Nicolas, & Thompson, 2014; Roopnarine et al., 2009), continues to serve as a potential source of stress and oppression, yet has been less well addressed within Caribbean psychology. The Caribbean struggle for liberation is replete with examples of strong women taking leadership roles. From Cecile Fatiman, who helped lead a ceremony in 1792 to launch the Haitian war of independence against the French slave owners, to Queen Mary in St. Croix, U.S. Virgin Islands, who led the Fire Burn March fighting for labor rights in the early 1900s, women have fought alongside men in leadership positions for liberation of Caribbean peoples (Dudley-Grant et al., 2014). However, the lingering perception of women’s inferiority to men and the resulting economic, social, and academic disparities remain true to the present. Reddock (2007) identified how as early as 1890s, Afro Caribbean feminist activists, such as Catherine McKenzie, secretary of the Kingston Branch of the Pan African Association of Jamaica and a member of the People’s Convention, were clearly concerned about race and also expressed strong concerns about sexual discrimination. In the mid- to late-20th century, organizations such as The Caribbean Association for Feminist Research and Action emerged from a scholarship on the gendered nature of “race” and ethnic difference (BakshSoodeen, 1998). The attempt to redefine feminism from a Pan-Caribbean perspective was hampered by the need to address the differential barriers based on culture. Specifically for the Indo Trinidadian women, claiming the feminist identity has been, and continues to be, seen as rejecting an Indo innovations in clinical psychology with caribbean peoples     

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Trinidadian identity because a key aspect of that identity includes a gender hierarchy implicit within the family structure (R. Durvasula, personal communication, July 12, 2014; Wells, 2000). Thus, the intersectionalities of identity for Caribbean women—single head of household, liberators, advocates, victims of violence; gender bias in all forms; its link to lower income and educational opportunities—all contribute to health and mental health concerns (Sianko, 2011; S. Smith, 1995). As it is for women in other parts of the world, Caribbean women in lower classes are at greater risk for mental health issues and might benefit from culturally appropriate clinical services are least likely to seek therapy (PAHO/WHO & CARICOM, 2006). At the International Family Therapy Association’s 21st World Family Therapy Congress, Reynolds (2013) identified gender inequality as one of the issues or barriers to Caribbean Couples use of family therapy. The unequal status of women is reflected in her findings that Caribbean couples may have sought spiritual guidance, denied for many years the existence of a challenge, or lived in fear of emotional rejection from their partner should they seek to acquire therapeutic services. Moreover, the need for women to support their men to combat the legacy of slavery (Afro Caribbean), while not rejecting their cultural values (Indo Caribbean), with the widespread stigma-born belief that traditional therapy destroys relationships and families are deeply held values that must be addressed to eliminate this barrier to the success of psychotherapy in the Caribbean (Dudley-Grant et al., 2014). Immigration, Family Systems, and Family Therapy in the Caribbean To further understand the emotional issues in Caribbean extended families, one needs to consider the role of immigration in the mental well-being of children left behind. It is frequently stated that the population of people of Caribbean descent residing in the diaspora greatly outnumber those currently living in the Caribbean. Colloquial references to “Little Havana” (Cuba) or “Kingston 21” (an extension of the postal subdivisions in Jamaica) speak to the large number of Cubans or Jamaicans, respectively, residing in major cities such as Miami or New York. Researchers have studied the impact on the family and children, both those who leave and those who remain (Baptiste, Hardy, & Lewis, 1997; Ramkissoon et al., 2008). Immigration for a better life can bring benefit to the individual and to those who are afforded opportunity to migrate, as well as access to the resources sent to those in the home country (Joseph et al., 2013), and socialization through remote acculturation (see Chapter 4, this volume). The Interamerican Development Bank Multilateral Investment Fund (2006) documented that a significant portion of the economy of Latin America and Caribbean is dependent on the monthly remittances from family abroad to family in the Caribbean, which reached more than $60 billion in 366       rita dudley-grant

2006, supporting more than 2 million households. Moreover the intellectual capital, much of which was lost during significant periods of migration, has not been entirely lost to the region. Rather, these individuals have remained connected and served as a resource for understanding the sociopsychological functioning of Caribbean people in the region and in the diaspora in structures such as the Caribbean Studies Association (see http://www.caribbeanstudies association.org/), whose annual conferences have made major contributions to the scholarly body of knowledge about the region. Thus, the impact on the Caribbean of migration can be both positive and negative. Immigration and the practice of leaving one’s child behind can negatively impact the bonding of families contributing to attachment disorders and sibling rivalry (Jones, Sharpe, & Sogren, 2004). Children who may be victims of abuse or who have cognitive, emotional, or behavioral difficulties are further traumatized when moved at latency or adolescence to parents they no longer feel emotionally connected to nor feel is their primary caretaker. Integration into the new family disrupts relationships and positions held by siblings who were born in the new location. Problems are further exacerbated by the move to unfamiliar cultures and academic systems, which can worsen existing learning difficulties or undermine a wellfunctioning student’s self-esteem and consequent motivation (S. J. Parrilla, personal communication, November 21, 2013; Pottinger, 2005; A. Smith, Lalonde, & Johnson, 2004). Effective family therapy uses a multidisciplinary approach to have social service providers include original family members in the therapeutic process. Teleconferences or, more recently, visual social media technology, can give caretakers left in the home country the opportunity to describe the behaviors and issues that may be contributing to the current presenting problems while maintaining emotional support for the youngster. The following inter­ ventions have been found to be effective in helping the family to reestablish and/or maintain bonds essential to the healthy functioning of the family structure: multi­cultural/multimodal/multisystems (Gopaul-McNicol, 1997); multi­systems family therapy (Boyd-Franklin, Cleek, Wofsy, & Mundy, 2013); and evidence-based interventions, such as CAPAS (Criando con Amor: Promoviendo Armonía y Superación) and parent management training–Oregon, a culturally adapted parenting intervention program for parents of children 5 to 9 years of age, which is successfully being implemented with Latino families in the United States (Domenech Rodríguez, Baumann, & Schwartz, 2011) and researched for implementation in Puerto Rico (M. Domenech Rodríguez, personal communication, March 15, 2012). Thus, successful long-term treatment for Caribbean children and families involves treatment of the whole system, with an understanding of those present and those exerting critical influence from other physical locations. innovations in clinical psychology with caribbean peoples     

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MENTAL HEALTH SERVICE DELIVERY SYSTEMS In the Caribbean, the small numbers of psychologists and heavy reliance on the medical model of office- and facility-based service delivery prove to be significant barriers to adequate provision of psychological services (Hutchinson & Sutherland, 2013; PAHO/WHO & CARICOM, 2006). The PAHO/WHO and CARICOM (2006) study documented the forward move to community-based mental health services aided by psychotherapeutic treatments and psychiatric pharmacotherapy in the 1980s and 1990s, then reversing course to more institutional care because of funding shortages. Structures of Provision Mental health services are provided primarily in inpatient settings. Throughout the Caribbean, women are the majority of users of both inpatient and in community-based clinics. Private practice is minimal and primarily provided to class- and education-defined populations (Hickling et al., 2008). A particularly underserved group is the children and adolescents of the Caribbean, who make a significant portion of the population of the region but use only 1% to 10% of mental health services (PAHO, 2011). The WHOAIMS report (PAHO, 2011) further indicated that an inpatient unit solely dedicated to pediatric mental health does not exist in the Caribbean. The U.S. Virgin Islands has attempted to address this lack by creating a system of care through a public–private partnership with the U.S. Department of Health and Human Services. A brief description follows. Mental Health Service Delivery: Virgin Islands Behavioral Services VIBS is a system of care created in a public private partnership between the U.S. Virgin Islands and a private American health care company created for the sole purpose of residential and outpatient care for government clients. VIBS has successfully afforded close to 1,000 youngsters between the ages of 5 and 18 culturally consonant treatment in the territory, with access to familyand community-based normalizing experiences (Dudley-Grant, 2001; Virgin Islands Behavioral Services, 2011). The population of the U.S. Virgin Islands is about 110,000, with Black and Hispanics making up about 87% of the population. Other sub­cultures include East Indians and Middle Eastern and Filipino immigrants. The child and adolescent population has declined, with a 21% drop from 2000 to 2010. Those under 18 years old now make up about 21% of the population. Forty-eight percent live in female-headed households and 38% live below the poverty line (Mather & Jarosy, 2014). The territory benefits from American financial resources but consequently has experienced an ongoing erosion of its Caribbean cultural identity. Despite having a larger 368       rita dudley-grant

cohort of mental health professionals than many of their same-size island nation neighbors, the territory still lacks the cadre of mental health professionals necessary to address the needs of the population (Disability Rights Center of the Virgin Islands, 2008). The VIBS system of care includes residential and outpatient services, representing a graduated system of care. From crisis center to group homes, from residential- to community-based alternative to incarceration services, youngsters can be easily moved to the level of care best suited to meet their emotional and behavioral needs. Consonant with the multicultural clients, therapeutic and residential counselors are trained to provide treatment that includes factors such as differing family structures, frequently female-headed; the role of the father with multiple families, sometimes in multiple islands; and the traditional, as well as native, spiritual belief systems. Treatment plans for youngsters focus on behavior change using a range of interventions, including solutionfocused reality therapy, cognitive behavior therapy, and trauma-focused treatment. Successful implementation of multisystems family therapy has been previously documented (Dudley-Grant, 2001). All interventions center on healthy relationships. The most common diagnoses are oppositional defiant disorder, dysthymia or major depression, posttraumatic stress disorder, anxiety disorder, conduct disorder, and learning disabilities. Substance abuse is higher among males and sexual abuse victimization is higher among females. In addition, attachment disorder is frequent, with a greater incidence appearing in clients from non–U.S. Virgin Islands cultures. This disorder appears as a frequent underlying factor in the disorders of the youth (VIBS Annual Reports, 2011). Families respond to the integrated approach that involves professionals from the agency, human services, and education. However, severely compromised family structures require extensive intervention. Two unique homebased approaches to family engagement successfully implemented by VIBS master’s level counselors are “Family Dinners,” initiated by Martha Tyler, MA, and “Family Therapy Under the Tamarind Tree,” initiated by Sophia Parrilla, MS (VIBS Annual Reports, 2011). Family Dinners allow the therapist to conduct family therapy using the structural approach while partaking in dinner in the family home, normalizing the intervention and reducing the stigma. The success was so remarkable that the intervention began to be written into the court-ordered treatment plans. Similarly, Family Therapy Under the Tamarind Tree was provided in the Juvenile Intensive Outpatient Program by the family therapist to decrease absenteeism. It was found that conducting sessions on Saturdays in the backyard of the family home (often under a Tamarind or similarly large sheltering tree), with structured interactions, such as questionnaires and drawings, greatly enhanced extended family participation, including engaging fathers who had previously avoided innovations in clinical psychology with caribbean peoples     

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family sessions, an essential component of successful family interventions (McGoldrick et al., 1996). Formal research is needed to document the experientially observed positive outcome of these interventions with mindfulness of boundaries and focus in such innovative interventions, as the Caribbean client may wish to move the relationship away from the professional to the more social chitchat of the family friend. Awareness of potential boundary concerns was regularly discussed in weekly supervisions and was maintained by the therapist’s consistent focus on therapeutic family goals. VIBS has also served as a training site for almost 40 practicum, pre- and postdoctoral internship, and psychiatry subspecialty residency physicians. Weekly supervision and clinical team participation, staff in-service training, and case conference presentations are components of the training program, along with individual, group, and family therapy. Emphasis was placed on interdisciplinary team building and cultural competence. Six- and 12-month outcome measures showed significant reduction in recidivism and out-ofhome placements. VIBS and its community-based partners have focused on strengthening the youth and their families and promoting use of communitybased resources to build long-term success (VIBS Annual Report, 2011). MAJOR MENTAL HEALTH NEEDS AND INTERVENTION STRATEGIES Mental Health and Substance Abuse Mental disorders, defined as schizophrenia, mood disorders, and substance abuse, are the three most prevalent mental illnesses among primary users treated in mental health outpatient facilities in the subregion (PAHO, 2011). Substance abuse treatment is most frequently provided in very-short-term hospital settings or outpatient programs, with high recidivism rates. Newer interventions, such as motivational interviewing, are being promoted but await efficacy studies. Drugs contribute even more significantly to mental illness and delinquency in the juvenile population, as well as undermining parental ability to provide adequate care for their children (Blum & Ireland, 2004; D’Amico, Edelen, Miles, & Morral, 2008; Dudley-Grant, Williams, & Hunt, 2000). Violence Violence in the Caribbean is woven into its colonial history and continues to manifest among all segments of the population. It is unfortunate that violence appears to be on the rise across all of the island nations. From the large Jamaica, frequently considered one of the most violent of the island 370       rita dudley-grant

communities (Matthies, Meeks Gardner, Daley, & Crawford-Brown, 2008), to the tiny U.S. Virgin Islands, reported as having one of the highest percapita crime rates in the United States, violence in all forms continues to devastate Caribbean communities (Parrilla, 2012; UNDP Caribbean Human Development Report, 2012). Domestic violence is an issue that has drawn particular attention in Carib communities, as its impact on the entire family, so integral to Caribbean well-being, is generational with cultural components (Griffith, Negy, & Chadee, 2006; Jeffers, 2010; Le Franc & Rock, 2002; Mio et al., 2003; Parrilla, 2012). Children exposed to this violence can then become perpetrators themselves, from bullying in childhood to abusing as adults (Loeber & Hay, 1997; see also Chapter 8, this volume). Effective interventions, therefore, must be multifaceted, addressing all aspects in homes, schools, and the community, with therapy buttressed by support groups. Therapy for victims of violence is most often provided in shelters or other intervention settings. The small communities are a major deterrent to helpseeking, with ongoing community education used (Parrilla, 2012). The recent rise in violence against gay men or lesbian in the Caribbean, and by self-admission particularly in Jamaican society, requires separate comment (Matthies et al., 2008; Quinn, 2013; White & Carr, 2005). Although Jamaica was named by Time Magazine in 2006 as having the highest rate of homophobia in the world (Padgett, 2006), it is also acknowledged that the Caribbean in general is known for strong antigay, homophobic sentiments. Matthies et al. (2008) reported that the rates of homosexuality in the Caribbean are comparable with those in the developed world, but the violence against gay men and lesbian continues to rise. Strong religious and cultural beliefs may underlie this excessive violent response, which continues to turn deadly and tends to target males far more than females, suggesting fears of emasculation. Providers in the Caribbean must ensure that their own conscious or subconscious attitudes and beliefs do not prevent positive psycho­ therapeutic interventions both for gay clients and for straight clients who express violent tendencies toward this population. Child Sexual Abuse Child sexual abuse is one of the largest underaddressed sources of lifelong emotional trauma throughout the Caribbean, as reported in the UNICEF/ Eastern Caribbean Country Study, 2008–2009 (Jones & Jemmott, 2009). The report indicates that the Caribbean has the earliest age of sexual debut in the world, with many young people being initiated into sexual behavior as a consequence of child abuse as early as 10 years or even earlier. Recent research positively correlates early sexual initiation with child sexual abuse and suggests that boys and girls, especially those in poverty, once initiated by the innovations in clinical psychology with caribbean peoples     

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abuser are increasingly using sex as a source of economic exchange, exchanging sex for money or material goods. Young girls are especially at risk of being solicited for child prostitution. Some of the most devastating outcomes are the increased risk for HIV/AIDS, as well as the high rates of teen pregnancy, which is one of the factors most highly correlated with maintaining a family in poverty, perhaps the single most pervasive and damaging factor underlying the major behavioral mental health issues found throughout the Caribbean (Mills, 1998). Jones and Jemmott’s (2009) survey in six Eastern Caribbean countries of incidence, prevalence, and attitudes among a cross-section of the population, including government leaders and adult survivors, revealed attitudes particularly among men that defined the end of childhood as between 13 and 16 years of age rendering these young persons as legitimate sexual targets once they reach their teens. Furthermore, they are deemed “consenting” and thus no longer defined as victims of sexual abuse. Family and close friends were found to be the main perpetrators, with frequent complicity by other family members who benefit materially by the activity (see Chapter 8, this volume). Jones and Jemmott (2009) recommended clarification of the definition of sexual abuse, introducing two additional phrases: “harmful sexual behavior” and “behavior that contributes to the sexual harming of children.” They noted the severe shortage of skilled sexual abuse treatment persons needed to provide appropriate trauma services. Another issue is the complicity of professionals who are aware of abuse but do not act to report it or to protect the child victims. Jones and Jemmott recommended expansion of statutory and support agencies as a partial solution to the overall scourge of child sexual abuse. Suicide Suicide rates around the Caribbean are quite low compared with the rest of the world, with the notable exception of Guyana, which has been found to be in the top 10 countries in the world in incidence of suicide per capita (Emmanuel & Campbell, 2012). Recent reports indicate that 75% of completed suicides annually are males who are primarily of East Indian descent. Suicide is the leading cause of death in young people between the ages of 15 and 24 and is the third leading cause of death in those between 25 and 44 years of age (Rooplall, 2012). Abel and Martin (2008) identified multiple risk factors for suicide: increasing age, being male, lacking social support, being unmarried, and having a mental disorder which accounts for 90% of suicide. Trinidad has the second highest incidence rate, again with an overrepresentation of the Indo Trinidadian population. Maharajh and Abdool (2005) suggested that renunciation of the old culture without assimilation of the new predisposes individuals to behavioral disturbances such as suicide; however, family history of suicide was the significantly greatest predictor of suicide, independent of 372       rita dudley-grant

severe mental disorder (Runeson & Asberg, 2003). Interventions appear to rely on the traditional encouragement to seek help and identified the support of family and friends as key protective factors in suicide prevention. Maharajh and Abdool (2005) concluded, “In the management of suicidal behavior, a system of therapeutic re-culturation is needed, with an emphasis on ethnohistiography, psychospiritual, and culture therapy” (p. 744). Trauma Trauma in the Caribbean occurs on many levels. Trauma in the individual results from personal harm or attack, such as physical, sexual, or emotional abuse. It can also occur at the community level, with extended exposure to high levels of violence. Trauma also results from the repeated exposures to disasters, most particularly hurricanes occurring annually throughout the region, as well as volcanic eruptions, such as in Montserrat. Trauma-informed care is a practice framework that helps providers understand and treat clients who have experienced trauma(s). Several approaches to trauma treatment, from eye movement desensitization and reprocessing to behavioral health debriefing, have been successfully implemented in the Caribbean and were reported on at the Disaster Mental Health workshop at CRCP 2011 (Copemann, Dudley-Grant, Moore, & Richards, 2011). Nevertheless, implementation requires awareness of the cultural issues in the Caribbean (Dudley-Grant & Etheridge, 2008). Evidencebased treatment approaches abound within the field and are frequently implemented in the Caribbean after natural disasters. However, no single approach has proven effective across the region. Kutcher, Chehil, and Roberts (2005) implemented a postdisaster train-the-trainer mental health program developed by the International Section of the Department of Psychiatry at Dalhousie University (Halifax, Canada) and delivered in Grenada after Hurricane Ivan struck the country in September 2004. The program used an integrated community health model to train local health care providers in the identification, and evidenced-based treatment, of mental disorders occurring after a natural disaster, which the researchers contended is more effective than the traditional whole population debriefing methods. Conversely, Copemann et al. (2011) effectively implemented the debriefing model after Hurricane Hugo, with significant positive outcomes. More research is needed to match the most effective interventions to the type of trauma and disaster, rather than suggesting a particular model of effectiveness for the entire Caribbean. Effective Treatment Modalities The psychotherapeutic psychologist has dual considerations: the many cultures existing in the region and the manifest and hidden impact of innovations in clinical psychology with caribbean peoples     

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interventions. The concern is that the treatment models are largely designed for, and validated with, cultures different from the Caribbean and that they may have been the past instruments of oppression. The outcome has been psychological structures within the individual that undermine the well-being of Caribbean society. Johnson et al. (2008) suggested that the therapist, unwittingly, may also be promoting acceptance of the status quo without awareness of the larger sociological factors contextualizing psychological well-being. Therein lies the dilemma that psychologists in the Caribbean can face when using treatments that may be adding to the problem that they seek to alleviate. Clinical Practice Individual and Group No single individual therapeutic modality has been proven to be more efficacious with this population, in part because of the limited amount of research that has been conducted on the effectiveness of approaches to therapy with Caribbean people. In the United States, evidence-based techniques—including psychoeducation, motivational interviewing, cognitive behavior therapy, mindfulness and acceptance-based therapies, and relapse prevention—continue to gain prominence and have been used with multicultural populations (Boyd-Franklin et al., 2013). However, individual treatment modalities are as varied as the schools where psychologists have been trained. Although it appears that relationship- and solution-focused therapies tend to be more culturally consonant in the Caribbean, La Roche (2013) recommended that focusing on understanding individuals within their culture should be central to culturally competent psychotherapy. Other than the small number of clients who seek individual counseling for the benefit of personal growth, or a current crisis, most clients tend to access therapy through a clinic or hospital with first encounter through extended family or pastoral counseling. Use of medication is still viewed with suspicion and resisted in many cases. Unlike the more industrialized nations, in which medication for depression and other health concerns is widely accepted and promoted in part by the ever-growing pharmaceutical industry, poorer island nations neither have access to nor funding for medicines that are not linked with survival. In addition, the use of “herbs,” legal or otherwise, continues to be more acceptable as a “natural” remedy than the expensive pharmaceuticals that may have uncomfortable side effects, as well as heightened stigma. Family Family therapy has been suggested as the intervention that is more closely aligned with the culture of the Caribbean. Regardless of the model, successful implementation of family therapy attempts to remove the barriers 374       rita dudley-grant

to care, including provision of home- and community-based services, transportation, child care, and food. In addition to the well-researched and previously reviewed multisystemic family therapy models, other approaches include those that focus on combinations of parent training and role clarification. It must be noted again that the therapies most often used in the subculture (i.e., American, British, French, Dutch) tend to reflect that used in the dominant culture, at best, with cultural accommodations to improve “fit and fidelity” (Hutchinson & Sutherland, 2013). Given the extensive agreement within practitioners in the region of the consonance of this approach, it is important to note that individual therapy still tends to be the primary mode of psychotherapeutic intervention, another factor which requires realignment with the Caribbean interrelationships. Consultation Weller (2011) and others have demonstrated the effectiveness of consultation on a variety of community-based concerns with psychological components. Weller’s seminal work on HIV/AIDS throughout the Caribbean seeks to reduce the pandemic in the region through education. Similarly, Francis and Bishay (2013) conducted a community seminar in the U.S. Virgin Islands, affording new understanding of trauma and its psychological effects to law enforcement and government and nonprofit organizations. Psychologists are active providers of services to employee assistance programs and serve as consultants with military, large companies, governments, crisis interventions, and school crisis teams.

RESEARCH FINDINGS ON THERAPEUTIC CULTURAL EFFICACY AND CONSONANCE La Roche’s (2013) cultural psychotherapy appears to provide promise for clinicians who necessarily must work across cultures in the region. He suggested that all effective clinicians use the three most relevant sets of psychotherapeutic paradigms—individualistic, relational, and contextual/ ecological approaches—as aspects of the cultural psychotherapy paradigm centering on the needs of the client. Bernal and Domenech-Rodríguez (2012) assessed evidence-based treatments with Caribbean clients using cultural adaptation paradigms. Cultural adaptation encourages the practitioner to consider three major areas: whether to adapt treatments, general considerations in cultural adaptation, and action steps once the decision to adapt a particular treatment is made. Additional challenges arise in culturally adapting interventions across languages. Bernal, Jean-Jacques, and Ortiz-Torres innovations in clinical psychology with caribbean peoples     

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(2011) identified the importance of la familia, or the family, in rendering the adolescent depression treatment intervention effective in Puerto Rican adolescents. Nicolas and Schwartz (2012) highlighted some of the difficulties in adaptation in their study on Black Caribbean youth when attempting to culturally adapt the Adolescent Coping With Depression Course with Haitian adolescents. The study population was all English speakers living in the United States. Nevertheless, concerns with language-, culture-, and generation-bound analogies were quite evident. The researchers determined that despite efficacy of the intervention, partnering with the community of the population of interest, culturally sensitive training for the researchers, and using a culturally sensitive framework was essential to adequately evaluate the selected evidence-based treatment. The area of test construction for Caribbean populations is in its infancy. At the CRCP 2011, several presentations addressed recent studies that have attempted to modify existing tests, as well as promote newly created ones. An example of scale modification was presented by Khan and Venneri (2011), from the United Kingdom. Their validation study of the Mini Mental Status Examination (Stewart, Johnson, Richards, Brayne, & Mann, 2002) for Caribbean people, resulted in validation adjusted scores showing a 35% decrease in false positive rates when the scores were adjusted for ethnicity and education. Padilla-Martinez, Perez-Mercado, Mantos-Ramos, and Sayers Montalvo (2011) presented on their construction and validation of a new culturally consonant Compassion Fatigue Scale for Puerto Rican professional helpers affected by working with trauma victims. The Behavioral Assessment for Children of African Heritage (Lambert & Rowan, 2003) and Caribbean Symptom Checklist (Lambert et al., 2013) were found to show promise as a valid and reliable measure of psychological functioning in the African diaspora. It appeared to have equivalent validity in assessing pathology within island nations, as well as among Caribbean immigrants living abroad (see Chapter 13 for a discussion of assessments). CLINICAL TRAINING IN CARIBBEAN COUNTRIES: CURRENT STATE AND FUTURE DIRECTIONS Training in the Caribbean has many challenges. The WHO-AIMS study (PAHO, 2011), which reviewed opportunities for training in 16 mostly Eastern Caribbean countries, found that most countries, with the exception of Jamaica, were quite lacking in mental health training resources, and individuals. More important, the definition of a “psychologist” ranges dramatically according to the culture, the resources, and the standard. Although the APA is the largest in the world and along with the European Union sets the 376       rita dudley-grant

standard for the developing world, the largest number of “psychologists” is found in South America, recognized at the master’s level. APA defines the professional psychologist as one who has a doctoral degree in psychology from an organized, sequential program in a regionally accredited university or professional school. The American protectorates in the region—the Commonwealth of Puerto Rico and the U.S. Virgin Islands—are governed by this standard. Puerto Rico is the only entity training “psychologists” in its several doctoral programs and has the only APAaccredited internship center in the Caribbean, one that functions within the Veterans Administration training system (VA Caribbean Healthcare System, 2011). Starting in 2011, the University of the Virgin Islands offers a master’s in counseling psychology. This degree is not license eligible but affords graduates the opportunity to work in institutional settings, both public and private. Hutchinson and Sutherland (2013) reported that training resources in Eastern Caribbean island nations are more plentiful and readily accessible, although less well developed, than in Cuba, Guadeloupe, or Martinique, with clearly established programs. The University of the West Indies has five master’s level programs in clinical psychology and two in counseling psychology. Again, the master’s degree is sufficient to practice as a psychologist because of lack of license or legislation and the small numbers of trained practitioners relative to service, supervision, or internship training sites. Survey findings of leaders of psychology conducted before CRCP 2011 recommended accrediting distance learning programs using local standards and requirements supplemented with coursework on Caribbean psychology, accrediting and supporting local internship experiences, and reconsidering the issues of credentialing at the master’s level. Other suggestions included creating a visiting professors program, developing and enhancing international partnerships, and forging alliances between graduate programs, all of which would present unique approaches to enhancing the limited resources found in smaller, island academic institutions. The issue of practice and standards is a key term of reference for CANPA, which has identified it as an urgent need for the region. CONCLUSION The practice of psychology in the Caribbean presents an ongoing array of challenges and opportunities. This unique region, with its local communities and cosmopolitan attitudes, can inform the global community regarding psychological attitudes and competencies necessary to thrive in a multi­ cultural global world. Increasing the clinical services provided by culturally competent providers is needed to address the mental health problems experienced by individuals, families, and communities. Moreover, services must innovations in clinical psychology with caribbean peoples     

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be provided in ways that respect and build on the strengths of Caribbean peoples and the internal and societal structures. Training opportunities for psychologists must be offered to early career psychologists without requirement that they uproot themselves and their families to be trained in other cultures to meet licensure requirements created outside of the region. Rather, it is incumbent upon psychologists to create opportunities throughout the English-, Dutch-, French-, and Spanish-speaking Caribbean for those who have the desire and the talent to obtain well rounded training that will move our profession forward. Finally, along with the mandate of CANPA, psychology in the Caribbean must address the need for self-definition, including standards of practice that reflect the realities of culture and need, while holding to the highest standards of ethical competence within the profession. We as psychologists and researchers from the Caribbean owe nothing less to this beautiful region that we are fortunate to call home.

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INDEX American Psychological Association (APA), 48–49, 331, 363, 376–377 Amuleru-Marshall, O., 27 Anderson, C. A., 245 Anderson, P., 77, 83, 88 Anguilla, 158, 310, 319 ANSA McAL Psychological Research Center, 19 Anticolonial perspectives, 72–73 Antigua health outcomes in, 162 interpersonal violence in, 210 mental asylums in, 307 Antisocial behavior, 239–240 Anxiety disorders, 313, 369 APA. See American Psychological Association Arnett, J. J., 99 ARSJA (Acculturation Rating Scale for Jamaican Americans), 104–105 ARSMA-II Scale I (Acculturation Rating Scale for Mexican Americans), 105 Aruba, 160, 163 ASEBA (Achenbach System of Empirically Based Assessments), 340, 342 Asian Association of Social Psychology, 60 Assessment, psychological. See Psychological assessment instruments Assimilation, 54–55, 99. See also Acculturation Association for Assessment in Counseling and Education (AACE), 331 Association of Caribbean Psychologists, 21–22 Asylums, 308–309 Atkinson, R., 262 Attachment disorder, 369 Attribution–emotion motivational sequence, 288, 293 Attribution theory, 287

AACE (Association for Assessment in Counseling and Education), 331 Abdool, P. S., 372–373 Abel, W. D., 372 Abell, N., 293 Academic socialization, 83–84 Acculturation definitions of, 55 with emigration, 186 and masculinity, 190 remote. See Remote acculturation of Americanized youth scientific, 53–54 strategies for, 53–56 Acculturation Rating Scale for Jamaican Americans (ARSJA), 104–105 Acculturation Rating Scale for Mexican Americans (ARSMA-II Scale I), 105 Achenbach System of Empirically Based Assessments (ASEBA), 340, 342 Adler, A., 264 Adolescence and adulthood developmental research on. See Developmental research remote acculturation in. See Remote acculturation of Caribbean youth Affective disorders, 313–314 African Americans, 268–271 Aggression, 124, 128, 134 AIDS stigmatization. See HIV/AIDS stigmatization Ajzen, I., 175, 176 Albizu-Miranda, Carlos, 20 Alcohol use, 158–159. See also Substance use Allwood, C. M., 30, 56 Alternate form reliability, 328 Alternative psychology. See Indigenous psychologies Americanization of Caribbean youth. See Remote acculturation of Caribbean youth

387

BACAH (Behavioral Assessment for Children of African Heritage), 343, 347, 376 Bahamas affective disorder rates in, 314 childhood outcomes in, 88 clinical training in, 309 health outcomes in, 156, 162 HIV/AIDS in, 282 mental health services in, 312 out-migration in, 101 parenting styles in, 86 psychology pioneers in, 18 research on adolescence in, 124 research on late adulthood in, 136, 137 Bandura, A., 178, 181 Barbados clinical training in, 309 early and middle adulthood research in, 131, 132, 134 health outcomes in, 155, 160, 163 HIV/AIDS in, 282 interpersonal violence in, 210, 213 late adulthood research in, 136, 137 mental asylums in, 307 mental health services in, 319 parental disciplinary practices in, 82 psychological assessment research in, 332 rates of violence in, 209–210 Barbuda health outcomes in, 162 interpersonal violence in, 210 Baumrind, D., 74, 75, 87, 129, 130 Beall, J., 121 Beaubrun, M. H., 307, 308, 311–312 Behavioral and Emotional Assessment for Children of Caribbean Heritage (BEACCH), 347 Behavioral Assessment for Children of African Heritage (BACAH), 343, 347, 376 Behavioral intention, 175 Belize health outcomes in, 160 interpersonal violence in, 213, 221 mental health services in, 310, 319 parental disciplinary practices in, 82

388       index

Bermuda, 124, 125 Bernal, G., 19, 33, 375 Bernal del Reisgo, Alphonso, 19 Berry, J. W., 30, 56 Bhugra, D., 312 Biculturalism, 99, 107 Bioecological model of development, 121, 129 Bishay, M., 375 Blay, S. L., 362 Blum, R. W., 315 Bond, Hopetoun Edward, 307 Bornstein, M. H., 104, 107, 111, 187 Boxhill, I., 61 Branche, C., 25–26 British Virgin Islands health outcomes in, 158, 159, 162 mental health services in, 310 Bronfenbrenner, U., 121, 129, 216 Brown, J., 79 Buckley, K., 245 Bullying, 215 Burnham, Forbes, 62 Buvinic, M., 236 Canadian Psychological Association, 45, 49 Cancer, 153, 161, 163 Cancino, J. M., 262, 266 CAPAS (Criando con Amor: Promo­ viendo Armonía Superación), 367 Capetown Declaration, 60 Caribbean Alliance of National Psychological Associations (CANPA) Caribbean region defined by, 359 history of, 23–24 and Nassau Declaration, 60 proposed expansion of, 32–33 Publication Committee, 34 structure of, 31 Caribbean Center for Advanced Studies, 20 Caribbean Community Secretariat (CARICOM), 97–98, 103, 360, 368 Caribbean Drug Information Network, 311 Caribbean Federation of Mental Health, 309

The Caribbean Journal of Criminology and Social Psychology, 19 Caribbean Journal of Psychology (CJP), 25–26, 331, 340 Caribbean Organization of Psychology Steering Committee (COPSC), 23 Caribbean psychology, 15–39. See also specific headings approaches to, 3–6 contemporary scholarship in, 25–27 development of, 24–25 educational resources in, 27–29 future directions in, 31–38 historical perspective on, 21–24 and indigenous psychology. See Indigenous psychologies need for, 18–21 practical benefits of, 25 priority areas in, 30–31 terminology in, 17 Caribbean Regional Conferences of Psychology (CRCP) APA presence at, 49 history of, 23–24 and innovations in clinical psychology, 361 issues addressed in, 59–60 planning of, 31, 32 publications emerging from, 34. See also specific publications and test construction, 376 Caribbean Symptom Checklist (CSC), 343–348 Caribbean Youth Health Survey, 213, 218–219 CARICOM. See Caribbean Community Secretariat Carvalho, I., 267, 270 CAT (computerized adaptive testing), 346 Cayman Islands, 155, 157 CBCL (Child Behavior Checklist), 340 Cerebrovascular disease, 152, 154–155 CFA (confirmatory factor analysis), 339, 340, 344 Chadee, D., 20, 239, 261, 269–270 Chan, K. Y, 283 Chehil, S., 373 Chevannes, B., 182, 184 Child Behavior Checklist (CBCL), 340

Child guidance clinic model, 364 Child maltreatment and abuse, 209, 212–214, 218–219, 367, 371–372 Child training, 80–81 Chin, Tessanne, 102 Chiricos, T., 271–272 Christianity, 363 Chronic lower respiratory disease, 152 Circulatory system, 151, 152 CJP (Caribbean Journal of Psychology), 25–26, 331, 340 Clark, L. F., 290 Clarke, E., 75 Clinical Caribbean psychology, 357–378. See also Mental health; Psychological assessment instruments and Caribbean history, 360–362 common mental health needs in, 370–375 and current major mental health issues, 360–361 and delivery of mental health, 368–370 family systems approaches in, 364–365 gender disparities in, 365–366 and immigration, 366–367 incorporation of spirituality in, 363–364 and mental illness stigma, 362–363 overview, 358–359 therapeutic cultural efficacy in, 375–376 training in, 309, 376–377 Code of Fair Testing Practices in Education, 331 Cognitive behavior therapy, 369 Cognitive psychology, 177 Cognitive scripts (copycat crime), 243–244 Cognitive theory, 243 Collective efficacy, 262–266 Collectivist cultures, 129, 262–266 College of The Bahamas, 28 Colonialism psychological and sociocultural effects of, 72, 207 and regional psychologies, 58 scientific, 47 sociohistorical factors in, 73

index     

389

Colorism, 73 Communication field, 243 Community environment, 78–79 Community violence, 79 Compassion Fatigue Scale, 376 Competence, 51–52 Computerized adaptive testing (CAT), 346 Conceptual validity, 330 Conduct disorder, 369 Conferences, regional, 59–60. See also specific conferences Confirmatory factor analysis (CFA), 339, 340, 344 Conklin, J. E., 264–265 Consciousness raising (processes of change), 180–181 Content validity, 329 Control beliefs, 176–177 Convention on the Rights of the Child, 212–213 Convergent validity, 329 Copemann, C., 373 COPSC (Caribbean Organization of Psychology Steering Committee), 23 Copycat crime, 235–251 and characteristics of copier’s environment, 242–243 and characteristics of offenders, 239–241 future directions for research on, 247–251 importance of research on, 237–238 mechanisms of, 243–245 media content correlated, 238–239 models of, 245 non-Caribbean research on, 246–247 overview, 236–237 Copycat crime behavior, 235–251 Corporal punishment, 82–83, 88, 214, 221. See also Child maltreatment and abuse Cosmopolitanism, 100 Counterconditioning (processes of change), 180–181 CRCP. See Caribbean Regional Conferences of Psychology

390       index

Criando con Amor: Promoviendo Armonía Superación (CAPAS), 367 Crime copycat. See Copycat crime behavior fear of. See Fear of crime Criterion-related validity, 329 Critical race theory, 73 Cronbach, L. J., 329, 332 Cronbach’s coefficient alpha, 329, 332–333 Cross-cultural psychology, 50–51 CSC. See Caribbean Symptom Checklist Cuban psychology, 19 Cultural belief systems, 80 Cultural brokers, 191–192 Cultural ecological models, 74 Culturally-based scholarship, 33–34 Cultural psychology, 50–51. See also Cross-cultural psychology Cultural schemas, 220–221 Cultural validity, 330 Cultural value orientations, 134 Culture, 31. See also Cross-cultural psychology Culture and Family Life Study, 104–107 Daisley, H., 314 Dalhousie University, 373 Danziger, K., 56 Darling, N., 80 Decisional balance, 181–182 Deinstitutionalization, 309, 363 Deosaran, R., 19, 21, 239 Depression, 124, 128, 313–314, 369 De Silva, A., 364 Detection health behaviors, 173 Developmental issues. See Adolescence and adulthood Developmental niche model, 74, 75 Developmental psychology. See also specific headings Developmental research, 119–143 on adolescence, 122–130 common issues in, 139–141 on early and middle adulthood, 130–135 future directions for, 141–143

gaps in, 139–141 on late adulthood, 135–139 theoretical perspectives in, 120–121 Diabetes mellitus, 152, 155–156, 163 Disability, 159–161 Disability Rights Center of the Virgin Islands, 363 Disciplinary practices, parental, 82–83 Divergent validity, 329 Domenech-Rodríguez, M. M., 375 Dominica children’s play stimulation in, 79 health outcomes in, 155, 158, 159, 162 interpersonal violence in, 213 mental health services in, 310 parental disciplinary practices in, 82 Dominican Republic, 104 Donnelly, S., 364 Dovidio, J. F., 292 Dramatic relief (processes of change), 180–181 Drug trafficking, 208 Drug use, 286, 287, 292 Dysthymia, 369 Early and middle adulthood research, 130–135 Ecocultural framework, 51 Ecological theory, 129, 216 Eddington, A., 58 Educational institutions, 83–84 Educational resources, 27–29. See also Psychology education and training EFA (exploratory factor analysis), 339, 340 Ellis, H., 208 Emotions, 287–288, 292–294 Environment evaluation (processes of change), 180–181 Epistemology, 30 Eron, L. D., 270–271 Escayg, K.-A., 72 Espiritismo, 363 Ethical Principles of Psychologists and Code of Conduct (American Psychological Association), 331 Ethnicity, 75, 268–272 Ethnic socialization, 84–85 Ethnotheories, 220–221

Euro American psychology adaptation of, 28, 57 adaptation of assessments used in. See Psychological assessment instruments intellectual hegemony of, 17, 47–48 limitations of, 24–25 reducing demand for, 52–53 Event-dependent schemas, 80 Exploratory factor analysis (EFA), 339, 340 Factor analysis, 339–340 Family Adaptability and Cohesion Evaluation Scale II (FACES II), 340 Family Dinners intervention, 369–370 Family policy, 110–111 Family socialization practices, 71–89 and behavioral investment, 81–85 and childhood outcomes, 87–89 and family structure, 75–78 of gender roles and child training, 80–81 in home and community environment, 78–79 and parenting styles, 80, 85–87 theoretical perspectives on, 72–75 Family structure, 75–78 Family systems approaches, 364–365 Family therapy, 366–367, 374–375 Family Values Scale, 105 Fanon, F., 207 Fatiman, Cecile, 365 Fear of crime, 259–273 community effects of, 261–268 and crimes in Trinidad, 260–261 and ethnicity, 268–272 mesoperspective on, 260 Fear of death, 292 Feminism, 217–218, 365–366 Ferguson, G. M. and relational discrepancy theory, 129 and remote acculturation, 104, 107, 108, 110, 111, 187 Ferrari, A. J., 313 Ferraro, K. E., 268 Fishbein, M., 175 Fisher, J., 344 Fiske, S. T., 284

index     

391

Floyd, F. J., 339 Forbes, M. A., 103 Francis, S., 375 Friedrich, W. N., 344 Gaffney, M. J., 265 GAM (general aggression model), 245 Gangs and copycat crime, 236 drug, 208 and family socialization, 79 and fear of crime, 270 and health, 156 and social contagion theory, 217 Gay and lesbian populations, 286–287, 290–292, 371 Gaylord, N. K., 218 Gemeinschaftsgefühl (social connectedness), 264 Gender inequality, 282, 365–366 Gender roles core beliefs about, 80–81 in family systems, 365 and health outcomes, 165–166 and interpersonal violence, 208, 217–218. See also Interpersonal violence in relationships, 75, 78 Gender socialization, 182 General aggression model (GAM), 245 Gentile, D., 245 Gentry, J. H., 270–271 Gertz, M., 271–272 Gibson, C. L., 265 Glasgow Anti Stigma Partnership, 363 Glick-Schiller, N. 100, 112 Globalization defined, 98–99 and masculinity, 186–187, 190 reach of, 97 Global psychology, 50–56 and acculturation, 53–56 and cross-cultural psychology, 50–51 prevention strategies in, 52–53 Glocalization, 100–110 defined, 100–101 and remittances, 103–104 and research on remote acculturation, 104–110

392       index

role of migration and transnationalism in, 101–102 role of tourism and imported goods in, 102–103 Goffman, E., 289 Gopaul-McNichol, Sharon, 20, 26, 27 Gordon, A., 314 Gordon, D. M., 183, 191 Govia, I. O., 33 Grenada health outcomes in, 155, 158, 159 interpersonal violence in, 213 mental asylums in, 307 political climate of, 208 trauma interventions in, 373 Grenadines academic socialization in, 83 affective disorder rates in, 314 health outcomes in, 154, 155, 162 Group orientations, 134 Group therapy, 374 Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists, 363 Guyana academic socialization in, 83 childhood outcomes in, 88 family roles in, 78 health outcomes in, 155, 157, 158, 160, 163 indentured servitude in, 207 Indo Caribbeans in, 72 interpersonal violence in, 210, 221 parental disciplinary practices in, 82 parenting styles in, 86 political climate of, 208 research on early and middle adulthood in, 131, 133 research on late adulthood in, 136, 137 Haiti family systems in, 364 HIV/AIDS in, 282 remote acculturation of youth in, 110 research on early and middle adulthood in, 131, 132, 134 Hammond, W. R., 271

Hanna, Corolyn, 18–19 Hawes, S. W., 191 Haynes, S. N., 329 Health and health outcomes, 149–167 alcohol use, 158–159 cross-country variations in, 165–166 with disability, 159–161 factors in, 149–150 of men. See Men’s health behavior mortality outcomes, 151–158 physical inactivity, 162–164 tobacco use, 164–165 weight issues, 161–162 Health belief models, 150 Health care, 78, 283, 293–294 Health policy, 110–111, 192 Health Situation in the Americas: Basic Indicators (report), 158, 163 Heart diseases, 151, 152, 163 Heath, L., 269 Hegemonic masculinity, 182, 185 Helping relationships (processes of change), 180–181 Help-seeking behaviors, 173–174, 362, 364 Herek, G. M., 285 Hickling, F. W., 39, 312, 315, 316, 362–363 Hickling, Frederick, 309 Hispanics, 270–272 Hispaniola, 282 HIV/AIDS and child abuse, 372 mortality rates with, 152 reduction of, 375 HIV/AIDS stigmatization, 281–295 antecedents of, 285–288 future directions for research on, 294–295 and health care, 283, 293–294 and history of HIV/AIDS epidemic, 282 social psychological explanations of, 283–285, 288–293 Hogan, M., 271 Holt, A. R., 218 Home environment, 78–79 Homegrown psychological assessment instruments, 340–341

Homicide, 152, 156, 205, 209 Homosexuality, 286–287, 290–292, 371 Human ecology model, 129 Humanistic psychology, 177 Human trafficking, 208 Hutchinson, G., 360, 377 Hutchinson, G. A., 314 Hutton, C., 207 Hypertension, 152 IAAP (International Association for Applied Psychology), 59 IACCP (International Association for Cross-Cultural Psychology), 59 ICSEY (International Comparative Study of Ethnocultural Youth), 99 Identity anticolonial perspectives on, 72–73 collective, 360 postcolonial perspectives on, 72 youth. See Remote acculturation of Caribbean youth Illness behaviors, 173 Immigration, 366–367 Imported goods, 102–103 Indentured servitude as context of psychological behaviors, 5 and family socialization practices, 72, 73 and gender socialization, 184–186 and regional psychologies, 61 and transition to nation states, 72 and violence, 207 Indigenous psychologies (IP) and culturally-based scholarship, 33–34 defined, 16, 56 development of, 16–17 overview, 56–58 Indo Caribbean families, 78 Inman, A. G., 286 Instituto Psicologica de Puerto Rico, 20 Integration (acculturation), 55–58, 62, 99 Integrative theory, 129–130 Interamerican Development Bank Multi­ lateral Investment Fund, 366 Intercultural psychology, 50 Intergenerational violence, 216

index     

393

Internal consistency, 328 International Association for Applied Psychology (IAAP), 59 International Association for CrossCultural Psychology (IACCP), 59 International Comparative Study of Ethnocultural Youth (ICSEY), 99 International Congress of Psychology, 60 International Family Therapy Association, 366 International psychology, 45–49 International Union for Psychological Science (IUPsyS), 59 Interpersonal acceptance–rejection theory (IPARTheory), 74–75, 371 Interpersonal violence, 205–224 among youth, 215 challenging attitudes supporting, 220–222 against children, 209, 212–214, 218–219, 367 etiology of, 206–209 future directions for researchers and practitioners, 222–224 homicides resulting from, 156 and masculinity, 191 prevalence of, 79, 209–212 psychological impact of, 218–220 research on, 134 social learning and related theories of, 216–218 social psychological theories of, 215–216 Intimate partner violence. See Inter­ personal violence IP. See Indigenous psychologies IPARTheory (interpersonal acceptance– rejection theory), 74–75, 371 IRT. See Item response theory Ischemic heart disease, 152, 154 Item response theory (IRT), 340, 344–346 IUPsyS (International Union for Psychological Science), 59 Jamaica academic socialization in, 83 adolescence research in, 124–129 affective disorder rates in, 313–314 childhood outcomes in, 88

394       index

children’s play stimulation in, 79 deinstitutionalization in, 363 early and middle adulthood research in, 131–134 economic and social policy in, 37 familiar arrangements in, 77 health outcomes in, 158, 160, 162, 163 HIV/AIDS in, 282 homophobia, 371 interpersonal violence in, 210, 213, 221 late adulthood research in, 136–138 mental asylums in, 307 mental health policies in, 318–319 mental health services in, 310, 312, 319 parental disciplinary practices in, 82 parenting styles in, 86 political climate of, 208, 219 psychological assessment research in, 332 rates of violence in, 209–210 remote acculturation of youth in, 104–110 schizophrenia rates in, 312 suicide rate in, 315 Jamaican psychology, 26 Jamaica Personality Disorder Inventory (JPDI), 315 Jean-Jacques, R., 375 Jemmott, E. T., 372 Jensen, L. A., 99 Jethwani-Keyser, M., 129 Johnson, R., 363, 374 Johnson, Rosemarie, 19 Jones, A., 372 Jones-Hendrickson, S. B., 236 Journals, regional, 34–35. See also specific journals JPDI (Jamaica Personality Disorder Inventory), 315 Judaism, 363 Kauffman Assessment Battery for Children, 342 Kearns, A., 262 Kenny, E. D., 218 Kidnapping, 237 Kirton, B. E., 213

Kitzmann, K. M., 218 Kline, T., 328, 329 Krishnakumar, A., 313, 365 Kutcher, S., 373 Ladany, N., 286 Lambert, M. C., 340, 341 La Roche, M., 374, 375 Late adulthood, 135–139 Latinos, 270–272 Learning disabilities, 369 Leeward Islands, 307 Leff, J., 312 Le Franc, E., 211–213, 221 Legal mental health issues, 318–319 Lengua, L. J., 344 Leo-Rhynie, E., 79 Lequay, K., 361 Lesbian populations. See Gay and lesbian populations Lewis, D. A., 267, 270 Lewis, L. F. E., 307 Life expectancy, 75, 151–152 Lifespan development, 120–121 Lin, Victor, 22 Lipps, G., 85–86, 124, 130, 317 Living Standards Measurement Survey, 131 Livingston, I. L., 317 Livingston, S. L., 317 Lloyd-Still, Robert, 307 Logie, C., 313 Love, C., 238 Lovrich, N. P., 265 Lowe, G. A., 317 Madden, T. J., 176 Madriz, E. I., 270, 271 Magnusson, J., 287 Mahalik, J. R., 183 Maharaj, R. G., 313 Maharajh, H. D., 372–373 Mahy, G., 312 Mahy, G. E., 312 Mallett, R., 312 Mania, 313 Mantos-Ramos, J., 376 Marginalization, 55, 100 Marriage, 75, 77–78

Martin, J., 315 Martin, J. S., 372 Martinique, 312 Masculinity, 182–192 Caribbean contexts of, 184–188 hegemonic, 182, 185 and interventions with Caribbean men, 190–192 relationship between health behaviors and, 188–190 Mating systems, 75 Matrifocal organization, 75 Matthies, B. K., 39, 371 McCann, T. J., 293 McCartney, Timothy, 18 McEntire, R., 271–272 McKaye, H. D., 264 McKenzie, Catherine, 365 McMorris, B. J., 270 Mead, G. H., 264 Measurement, psychological. See Psychological assessment instruments Media and copycat crime. See Copycat crime social, 249–250 and violence, 216 Medication, 374 Medoff, D., 328, 329 Men’s health behavior, 171–193 and masculinity, 182–192 and social cognitive theory, 177–179, 189 and theories of reasoned action and planned behavior, 175–177, 189 and transtheoretical model of change, 179–182, 189–190 types of, 173–174 Mental asylums, 308–309 Mental health, 305–320. See also Clinical Caribbean psychology affective disorders, 313–314 development of services for, 308–311 developments in research on, 316–318 history of Caribbean approaches to, 307–308 legal issues surrounding, 318–319 personality disorders, 315–316 schizophrenia, 312

index     

395

Mental health, continued substance abuse disorders, 305, 311–312, 369, 370 suicide and suicide attempts, 314–315 systems for delivery of, 368–370 Mental health officers (MHOs), 310, 318–319 Merry, S. E., 263, 265 Mesoperspective (fear of crime), 260 MHOs (mental health officers), 310, 318–319 Migration and glocalization, 101–102 and interpersonal violence, 209 and masculinity, 190 and remote acculturation, 101–102, 112 Milbourn, P., 364 Mini Mental Status Examination, 376 Minor, S., 25–26 Monetary remittances, 103 Money Train (film), 237 Monroe Doctrine, 48, 63 Montane-Jaime, K., 312 Montserrat health outcomes in, 154, 155, 158 mental health services in, 310, 319 Morrison, A., 236 Mortality outcomes, 151–158 Mount, D. L., 340 Mullins, M. E., 332, 339 Multicultural family systems, 367 Multidisciplinary collaboration, 36–38 Multisystems family therapy, 369 Murdock, G. P., 59, 61 Murty, K. S., 270 Mustapha, N., 236 Narine, L., 313 Narrative persuasion (copycat crime), 243 Nassau, 311 The Nassau Declaration, 23, 60 National Family Planning Board (NFPB), 211–212 Natural helpers, 191–192 Neckles, K., 362, 363 Neita, M., 317 Netherlands Antilles, 158, 160 Ng Ying, N. K., 269–270

396       index

Nicolas, G., 207, 364, 365, 376 Nobles, W. W., 25 Nonlegal unions, 75, 77 Obeah, 363 Obesity, 161–162 Observational learning, 243 Oppositional defiant disorder, 369 Ortiz-Torres, B., 375 Outcome expectation, 178 Padilla-Martinez, V., 376 Padmore, J., 293 Pan African Psychology Union, 60–61 Pan American Health Organization (PAHO), 149, 154, 360, 368 Pan-Caribbean organizations, 37–38 Panculturalism, 73 Panhumanism, 73 Parental beliefs, 79–80 Parenting practices, 74 Parenting styles, 80, 85–87, 129–130. See also Family socialization practices Parent management training–Oregon, 367 Parker, K. D., 270 Parkes, A., 262 Parrilla, Sophia, 369 Pease, S., 238 Peluso, E. P., 362 Perceived behavioral control, 176–177 Perceived power, 176–177 Perez-Mercado, F., 376 Performance (global psychology), 51–52 Perry, R. P., 287 Personality disorders, 315–316 Persons living with HIV (PLHIV). See HIV/AIDS stigmatization PET. See Psychology education and training Peterson, V. S., 182 Physical inactivity, 162–164 Physical punishment of children. See Corporal punishment PLHIV (persons living with HIV). See HIV/AIDS stigmatization Poortinga, Y. H., 59 Population-specific psychology. See Indigenous psychologies

Positive developmental psychology, 142 Postcolonialism, 5, 16, 57, 72 Posttraumatic stress disorder, 369 Pottinger, A. M., 19, 317 Poverty and HIV/AIDS, 282 and human development, 124 prevalence of, 78–79 and socialization, 84 Powell, L. A., 37 Practical remittances, 103 Preventive health behaviors, 173 Primary prevention, 52 Priming (copycat crime), 243–244 Prochaska, J. O., 179, 180 Promiscuity, 286, 287, 289, 292 Promotive health behaviors, 173 Protective health behaviors, 173 Psychoeducation, 111, 373 Psychohistiography, 309 Psychological acculturation, 98 Psychological assessment instruments, 327–349 in Caribbean clinics, 341–343 Caribbean modifications of EuroAmerican, 340–341 Caribbean Symptom Checklist. See Caribbean Symptom Checklist in clinical research in Englishspeaking Caribbean countries, 331–339 construction of, 376 homegrown, 340–341 professional standards for, 331 reliability of, 328–329 validity of, 329–331, 339–340 Psychology education and training (PET) Caribbean adaptation of, 28–29 expansion of, 35–36 role of, 27–28 Psychotherapy. See Clinical Caribbean psychology Puerto Rican psychology, 20 Racial stereotyping, 268–269 Ramkissoon, M., 25–27, 85 Ramphal, Shridath, 25 Raudenbush, S. W., 262–263, 265 Reciprocal determinism, 178

Regional conferences, 59–60. See also specific conferences Regional psychologies, 58–63 conferences in, 59–60 and defining regions, 61–62 levels of analysis in, 58–59 Regional publications, 34–35 Reid, A. E., 191 Reidpath, D., 283 Reinforcement management (processes of change), 180–181 Reisig, M. D., 262, 266 Relational discrepancy theory, 129 Reliability (psychological assessment instruments), 328–329 Religion, 84, 363–364 Remittances, 103–104 Remote acculturation of Caribbean youth, 97–113 future directions for research on, 112–113 and glocalization. See Glocalization and masculinity, 187 and migration, 101–102 policy and practice implications of, 110–112 recent research on, 104–110 and remittances, 103–104 and terminology, 98–100 and tourism, 102–103 Research methodologies, 30–31 Reynolds Adolescent Depression, 314 Richardson, Arthur, 20 Ricketts, H., 83 Riviere, L., 317 Roberts, T., 373 Rock, L., 221 Rodgers-Johnson, P., 312 Rogers, W. M., 332, 339 Rohner, R. P., 74, 75 Role-playing (copycat crime), 243 Roopnarine, C., 313 Roopnarine, J. L., 20, 365 Royes, Ken, 309 Rutledge, S. E., 293 Sadwowski, C. A., 344 Salgado, Alvarez, 26, 27 Salter, Veronica, 27

index     

397

Samms-Vaughan, M. E., 79, 364 Sampson, R. J., 262–265 Santeria, 363 Sayers Montalvo, S., 376 Scales, psychological. See Psychological assessment instruments Schizophrenia, 312, 362 Schlegel, P. E., 270–271 Schmitt, N., 332, 339 Schwartz, B., 376 Schwartz, S. J., 104 Scientific acculturation, 53–54 Scientific colonialism, 47 Script acquisition (copycat crime), 243–244 SCT. See Social cognitive theory Secondary prevention, 53 Self-efficacy, 178, 181–182 Self-injury, 152, 157–158 Self-liberation (processes of change), 180–181 Self-reevaluation (processes of change), 180–181 Separation strategies (acculturation), 55, 99 Sexual abuse, child, 213, 214, 218–219, 371–372 Sexually transmitted infections, 191 Sex work, 286, 292 Sharan, P., 316–317, 364 Sharpe, J., 364 Shavelson, R. J., 329, 332 Shaw, C. R., 264 Shifter, M., 236 Shulterbrandt, Eldra, 19 Shumaker, S. A., 266 Sick-role behaviors, 173–174 Simmons, V., 314 Sinha, D., 57 SIP (Sociedad Interamericana de Psicologia), 45 Skogan, W. G., 262, 268 Slavery and collective identity, 360 as context of psychological behaviors, 5 and dehumanization, 361 and family socialization practices, 72, 73

398       index

and gender socialization, 184–185 and mental illness, 307 and regional psychologies, 58, 61 and violence, 207 Smith, E., 270 Smith, R., 75 Social cognitive theory (SCT), 177–179, 189, 284, 289, 290 Social contagion theory, 216–217 Social disorganization theories, 261–262 Social efficacy, 264 Socialization practices, 20. See also Family socialization practices Social learning theory, 216–218, 249–250 Social liberation (processes of change), 180–181 Social media, 249–250 Social remittances, 103–104 Sociedad Interamericana de Psicologia (SIP), 45 Sociohistorical factors in colonialism, 73 Sociology, 177 Solution-focused reality therapy, 369 Spirituality, 363–364 Split-half reliability, 328–329 St. George’s University (Grenada), 28 St. Kitts and Nevis affective disorder rates in, 314 childhood outcomes in, 88 health outcomes in, 155, 156, 159 mental health services in, 310 parenting styles in, 86 research on adolescence in, 124, 125 St. Lucia health outcomes in, 159, 162, 163 interpersonal violence in, 210 mental health services in, 319 rates of violence in, 209–210 research on late adulthood in, 136, 138, 139 St. Vincent academic socialization in, 83 affective disorder rates in, 314 health outcomes in, 154, 155, 162 parenting styles in, 86 research on adolescence in, 124, 125 Steinberg, L., 80 Stereotyping, racial, 268–269 Stern, M., 286

Stigma HIV/AIDS. See HIV/AIDS stigmatization mental illness, 362–363 Stimulus control (processes of change), 180–181 Stress response theory, 150 Subjective norms, 175 Substance abuse disorders, 305, 311–312, 369, 370 Substance use, 286, 287, 292 Suicide, 152, 157–158, 314–315, 372–373 Surette, R., 269 Suriname health outcomes in, 157, 159, 162, 163 Indo Caribbeans in, 72 interpersonal violence in, 210, 221 late adulthood research in, 136, 137 mental health services in, 319 out-migration in, 101 parental disciplinary practices in, 82 political climate of, 208 rates of violence in, 210 Sutherland, M. E., 26, 47, 54, 58 Sutherland, P., 360, 377 Taylor, R. B., 266 Taylor, S. E., 284 Technology, 97 Tertullien, Mizpah, 18–19 Test–retest reliability, 328 Tests, psychological. See Psychological assessment instruments Theories of planned behavior (TPB), 174–177, 189 Theories of reasoned action (TRA), 175–177, 189 Therapy. See Clinical Caribbean psychology Thissen, D., 328 Thomas-Hope, E., 102 Thompson, A., 359 Thompson, A. D. and epistemology, 30 and limitations of mainstream psychology, 18 and need for focus on Caribbean psychology, 4

pioneering work of, 27 and psychology education and training, 28 Tobacco use, 164–165 Tourism, 102–103, 112 TPB (theories of planned behavior), 174–177, 189 TRA (theories of reasoned action), 175–177, 189 Transnationalism, 100, 101–102 Transplantation, 72 Transportation accidents, 157 Transtheoretical model (TTM) of change, 179–182, 189–190 Trauma-focused treatment, 369, 373 Trinidad and Tobago academic socialization in, 84 adolescence research in, 124, 126 affective disorder rates in, 313 childhood outcomes in, 88 children’s play stimulation in, 79 clinical training in, 309 copycat crime in, 246–247, 249–251 crime and violence rates in, 210, 260–261 early and middle adulthood research in, 131, 132, 134 ethnic socialization in, 85 family roles in, 77, 78 fear of crime in, 269 health outcomes in, 155–157, 161–163 HIV/AIDS in, 282 indentured servitude in, 207 Indo Caribbeans in, 72 interpersonal violence in, 210 kidnapping in, 237, 250–251 late adulthood research in, 136–138 mental asylums in, 307 mental health policies in, 318–319 mental health services in, 310, 312 parental disciplinary practices in, 82 parenting styles in, 86 political climate of, 208 psychological assessment research in, 332 schizophrenia rates in, 312 suicide rate in, 314, 372 TTM (transtheoretical model) of change, 179–182, 189–190

index     

399

Turks and Caicos Islands health outcomes in, 154, 156, 157 mental health services in, 319 Tyler, Martha, 369 Typological approach to parenting effects on child outcomes, 129 United Nations Development Programme (UNDP) Caribbean Human Development Report, 211–212 United Nations Office on Drugs and Crime (UNODC), 156 Universality, 51 University of the Virgin Islands, 377 University of West Indies (UWI), 28, 113, 259, 308–309 U.S. Virgin Islands health outcomes in, 154, 156, 157 juvenile delinquency in, 239 mental health service delivery in, 358, 368–370 Validity (psychological assessment instruments), 329–331, 339–340 Videogames, 248–249 Violence, 72, 134, 370–371. See also Interpersonal violence Virgin Islands Behavioral Services (VIBS), 358, 368–370 Visiting relationships, 77 Voodoo, 363, 364 Vygotsky, L., 121 Wainer, H., 328 Walcott, G., 315, 316

400       index

Wechsler Intelligence Scales, 342 Weight issues, 161–162 Weiner, B., 287, 288, 293 Weller, P. D., 375 Weller, Peter, 19 Werther effect, 238 Western psychology. See Euro American psychology The West Indian Medical Journal, 331 Wheatley, A., 207 Whiting, B. B., 73–74 Whiting, J. W., 73–74 WHO Assessment Instrument for Mental Health Systems (WHO-AIMS), 308, 319, 368, 376–377 Widamin, K. F., 339 Wide Range Achievement Tests, 342 Windward Islands, 307 Woldoff, R. A., 267, 268, 270 Women. See also Gender inequality health behavior of, 172 leadership by, 365–366 and masculinity scripts, 191 Woodcock–Johnson III Tests, 342 Xu, Y., 365 Young, J. R., 269 Young, R., 317 Youth identity. See Remote acculturation of Caribbean youth Youth policy, 111–112 Yung, B., 271 Zhao, J., 265

ABOUT THE EDITORS

Jaipaul L. Roopnarine, PhD, received his doctorate from the University of Wisconsin. He is Jack Reilly Professor of Child and Family Studies at Syracuse University in Syracuse, New York. He has taught at several universities in the United States and internationally and has conducted observational and survey studies around the world on father involvement and childhood development in India, Malaysia, Taiwan, Brazil, the United States, Jamaica, Trinidad and Tobago, and Thailand. Dr. Roopnarine was a consultant to the Roving Caregiver Program implemented in several Caribbean countries and assisted in revising the Guyanese national early childhood curriculum. He was Fulbright scholar to The University of the West Indies, was awarded a Distinguished Visiting Nehru Chair at M. S. Baroda University, Gujarat, India, is the editor of the journal Fathering, and has published extensively in the areas of family relationships, childhood development, and early childhood education across cultures. His recent volumes include International Perspectives on Children’s Play (with Patte, Johnson, and Kuschner) and Fathers Across Cultures: The Importance, Roles, and Diverse Practices of Dads. Derek Chadee, PhD, received his doctorate from the Department of Behavioural Sciences, The University of the West Indies (UWI). He is a 401

professor of psychology in the Department of Behavioural Sciences, The University of the West Indies, St. Augustine Campus. He is also director of the ANSA McAL Psychological Research Centre at UWI. Dr. Chadee has edited several volumes, including Theories in Social Psychology and Social Psychological Dynamics (with Aleksandra Kostic). He has written several articles on the social psychology of fear of crime trying to bridge criminological issues with social psychological theories. His current research interests are fear of crime, HIV/AIDS stigmatization, and antecedents of emotions. Dr. Chadee was a Fulbright scholar at Hunter College, City University of New York, and the University of Central Florida in Orlando.

402       about the editors