Prudent Nicole, Johnson Peggy, Carroll Jennifer, Culpepper Larry
Boston University School of Medicine, Massachusetts, USA.
Prim Care Companion J Clin Psychiatry. 2005;7(4):190-7. doi: 10.4088/pcc.v07n0409.
A case study of a young Haitian American is presented that is illustrative of cultural issues that influence care of those with attention-deficit/hyperactivity disorder (ADHD). Medications are the preferred treatment for ADHD and can be combined with psychological intervention. However, many Haitians and Haitian Americans see psychoactive medications as leading to substance abuse or mental illness. Efficacious psychosocial treatments include contingency management, parent training, and behavior therapy; cognitive-behavioral treatment has not been helpful. Complementary and alternative medicine might have appeal; primary care physicians can help families to assess such treatments and not to be enticed by expensive ones of little benefit. A determinant of the treatment a family pursues is their perception of the cause of the ADHD behaviors. While there is no term for ADHD in the Haitian-Creole language, in the Haitian culture the behaviors consistent with the diagnosis might be interpreted as indicating a poorly raised child whose behavior could be modified by parental discipline, an intentionally bad child, or a psychically victimized child suffering from an "unnatural" condition. "Natural" ailments are attributed to natural forces (e.g., wind, temperature), while "unnatural" ones are attributed to bad spirits or punishment by God. Families may "lift their feet" (Leve pye nou: to see a Hougan or voodoo priest) to determine the unnatural cause. Haitian Americans often combine therapeutic foods that are considered cold in nature, natural sedatives and purgatives from herbal medicine, religious treatments, and Western medicine. Immigrants often lack support of extended families in an environment not supportive of their interpretation of child behaviors and traditionally accepted parental disciplinary style. Stigma, language, cultural conceptions, concerns about governmental agencies, and physician bias can all be barriers to care for immigrant families. Primary care and behavioral integration are useful in managing families from other cultures.
本文介绍了一位年轻海地裔美国人的案例研究，该案例说明了影响注意力缺陷多动障碍（ADHD）患者护理的文化问题。药物治疗是ADHD的首选治疗方法，可与心理干预相结合。然而，许多海地人和海地裔美国人认为精神活性药物会导致药物滥用或精神疾病。有效的心理社会治疗方法包括应急管理、家长培训和行为疗法；认知行为疗法并无帮助。补充和替代医学可能有吸引力；初级保健医生可以帮助家庭评估此类治疗方法，避免被昂贵但益处不大的疗法所吸引。家庭所寻求的治疗方法的一个决定因素是他们对ADHD行为原因的看法。虽然海地克里奥尔语中没有ADHD这个词，但在海地文化中，与该诊断相符的行为可能被解释为表明孩子养育不当，其行为可通过父母管教得到改善，或者是故意调皮的孩子，或者是患有“非自然”疾病的精神受折磨的孩子。“自然”疾病归因于自然力量（如风、温度），而“非自然”疾病则归因于恶灵或上帝的惩罚。家庭可能会“抬脚”（Leve pye nou：去看伏都教巫师）以确定非自然原因。海地裔美国人通常会将性质寒凉的治疗性食物、来自草药的天然镇静剂和泻药、宗教疗法以及西医结合起来。在一个不支持他们对儿童行为的理解和传统上认可的父母管教方式的环境中，移民往往缺乏大家庭的支持。耻辱感、语言、文化观念、对政府机构的担忧以及医生的偏见都可能成为移民家庭获得护理的障碍。初级保健和行为整合有助于管理来自其他文化的家庭。
