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Tuesday, October 7, 2008. |
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MIRRORS OR MIRAGES?: HISPANIC
PSYCHIATRY AND SCIENTIFIC MENTORSHIP*
Renato D. Alarcón, M.D., M.P.H.**
* José Arana Lecture and Keynote Speech at the American Society of
Hispanic Psychiatry/Latino Behavioral Health Institute Annual
Conference “Mental Health Care for Hispanics. Challenge in the New
Millennium”. Santa Fe, MM, Nov. 11-13, 1999.
** Professor and Vice Chairman, Department of Psychiatry and
Behavioral Sciences, Emory University School of Medicine and Chief,
Mental Health Service Line, Atlanta VA Medical Center.
SUMMARY
The rapidly growing numbers of Hispanic communities in different
regions of the United States generates an array of mental health needs
and a formidable challenge to policy makers, academic and professional
organizations, and care-providing institutions. Hispanic psychiatry,
in turn, has become more visible in recent decades providing, in
conjunction with other mental health professions, the forum as well as
the support needed in response to the challenges. At the most
essential level, the future of Hispanic psychiatry depends on
mentorship. This paper deals with definitions of mentorship and of is
multidimensional mission. The formative, informative, human relations
and cultural dimensions of mentorship are carefully examined. Both,
the subjective and objective components of this unique relationship,
and examination of current realities about it in the United States
makes evident the need to foster positive and productive relationships
between Hispanic and non-Hispanic mentors. The roles of mentor and
mentee, and the need to enhance mentorship programs in clinical,
educational and research areas within Hispanic psychiatry and Hispanic
mental health are emphasized.
Key Words: Mentorship, Education, Mental Health, Hispanic Psychiatry
Have you ever had a teacher? One who saw you as a raw but precious
thing, a jewel that, with wisdom, could be polished to a proud shine?
If you are lucky enough to find your way to such teachers, you will
always find your way back. Sometimes it is only in your head.
Sometimes it is right alongside their beds.
M. Albom, Tuesdays with Morrie (1997) Some fabulously successful
scientists and clinicians are notoriously poor mentors C.B. Nemeroff,
On Mentoring (1998).
This is a grand occasion for Hispanic psychiatry in the United States.
Called upon by the American Society of Hispanic Psychiatry, a young
and restless organization edging on the transition from adolescence to
adulthood, and encouraged by its partnership with the Latino
Behavioral Health Institute, we all have come to Santa Fe in search of
ourselves, choosing it as another station in our journey to the new
millennium. We have come to celebrate and to meditate, to take account
of our past in order to work for a better future as a community of
professional men and women united by blood, culture, history, duty and
dreams. I am sure that at the end of this meeting and well into the
21st century, we or our children will be proud to say again what my
compatriot César Vallejo, the poet, put so beautifully: “Tengo fe en
que soy/y en que he sido menos – I have faith in that I am/and in that
I have been even less”. This being a scientific meeting, with an
extraordinary scientific program that is a great tribute to José
Cañive’s visionary leadership, I want to talk about a topic that is
crucial to the future development of Hispanic psychiatry if it wants
to become an integral component of the vast canvass of American
psychiatry: mentorship. Mentorship as the safest road to the
realization of potential and promises, mentorship as the most
accomplished reflection of a dyad of which very few talk nowadays –
teacher and student. Mentorship as a gallery of mirrors that can
reflect and magnify but also blind us with occasional lightning's and
deceiving mirages. However, before focusing on mentorship, and because
I said that this is a unique occasion in the journey of Hispanic
psychiatry, a celebration of sorts in the eve of the millennium, let
us do what we Hispanics or Latinos always do when something unusual
unfolds in front of us: we turn a bit nostalgic and always reflective.
It is as if before the rituals of happiness, the strengths of pride,
the warmth of big abrazos, the joy of bailes and canciones, even
beyond the laughter or the tears, we turn our eyes and our minds to
history. Yes, history – even if only for a few minutes.
The Hispanic history of the United States, or better yet the history
of Hispanic communities in the United States is as simple in its human
dimension as it is complex in its actual unfolding. In the fall of
1998, Duke University Press published the preview issue of Hopscotch,
a new cultural magazine whose first Editorial, significantly titled
“Convocation” (1), summarizes in my opinion, the vibrancy,
restlessness, and all so human realities of the Hispanics in the
United States. Let me quote part of such editorial:
Ours is a cardboard world of superficialities, one in which entire
civilizations are routinely reduced to a kit of stereotypes. Our goal
is to explore in depth, and with total honesty and a sense of social responsibility, the complexities of our Hispanic heritage, emphasizing
what we share with others as well a what makes us unique… The 21st
century will be about global heterogeneousness, about new combinations
of cultures and hybridizations, concepts with which Hispanics are
intimately acquainted. After all, our inception occurred at the
crossroads of many other heritages:
Hellenistic, Byzantine, Jewish, Roman, Muslim, Visigothic,
Catholic, African. And our development in the New World involved
marriages (many of them forcible) with additional disparate, ancient
peoples and races. Yet, the result is a still expanding, astonishingly
diverse society that is cosmopolitan, creative, bold, high-spirited,
and deliciously baroque. Its whole principal habitats are Latin
America, the Spanish-speaking Caribbean, the United States, and Spain.
And its languages and dialects include Castillian, Basque, Catalan,
Mayan, Quechua, and other Indian tongues, Haitian Patois, Portuguese,
Ladino, and of course Spanglish, a rapidly growing agglomeration that
promises to be of increasing importance in the near future (p.3). It
is then fair to say that the almost 28 million Hispanics currently
living in the United States, and their ancestors, have many sources of
origin. It was first the Spanish conquistadores taking territories
from Florida to New Orleans, and then coming from Mexico up north to
occupy large areas of what are now California, Oregon, and the
southwestern United States. Over a period of almost two centuries
several streams of Hispanic immigration brought in European
Spanish-speaking men and women, and more and more from Latin America,
particularly Mexico, Central America and the Caribbean. And, this
early in my presentation, I certainly want to emphasize the fact that
Hispanic Americans are not a uniform, homogeneous, monolithic group.
Quite the contrary,
although Mexican-Americans predominate in its composition, the
Hispanic population has different strands that are both a sign of its
own diversity as well as a symbol of its strength. Each subgroup, in
turn, faces dilemmas and demands: Cubans, the joys and pains of full
economic assimilation; Puerto Ricans, the extremes of dual identities;
Mexican and Mexican-Americans, the pressures of legalities and
legalisms; Caribbean's, the unmasked face of blatant racism; South
Americans, the ambiguities of detachment and objectivity. They
reflect, as a whole, the bittersweet reality of being in America.
The United States is the fifth largest Spanish-speaking country in the
world. At the present time, it has the largest Puerto Rican city in
the hemisphere, the second biggest city in the world in terms of its
Spanish-speaking population, the second largest concentration of
Cubans, Salvadorans, Haitians and Jamaicans, and the fourth largest
Mexican metropolis in the world. More than half of the immigrants,
during the decade of the 80’s came from Latin America and the
Caribbean. The country had in 1996 a
Hispanic population of more than 27 million, a dramatic growth of 55%,
compared to 1980, and almost incredible if we remember that 40 years
ago, it was only 4 million (2). It is calculated that towards the year
2050, this population – 75% of which is composed of U.S.-born
Hispanics – will reach 97 millions and will constitute the largest
ethnic minority in the United States, surpassing even the
African-American group (3). This demographic reality is rescuing the
Hispanic legacy of much of what is today the United States, a reality
even present before the arrival of the pilgrims to Plymouth Rock.
Carlos Fuentes reminds us that the United States came into being after
the Hispanic world, not the other way around, taking away territories
in the name of a “Manifest Destiny”. And, to the poetic justice of
having today Spanish names in practically all its regions, the United
States must also add the continuous flux of a culture that is
religious and syncretic, that recognizes the world and the land in
which we inhabit
as sacred places, that teaches respect and attention to the elderly,
that fiercely defends it family unity, and that even practices a
singular way of laughing, enjoying and suffering (4). The same Fuentes
tells us that, in effect, the enchilada can coexist with the hamburger
because cultures flourish only when they are in contact with each
other, because every encounter represents a birth and even more, a
rebirth. It is as Gertrudis Parra, about whom Sandra Cisneros writes
in her book, Woman Hollering Creek (5), leaving at the feet of a
sacred image in a rural church in South Texas, he prayer to the
“mighty poderosos, blessed powerful ones…Santísimo Niño Fidencio,
grand General Pancho Villa, bendito don Pedrito Jaramillo, virtuoso
John F. Kennedy, and blessed Pope Juan Pablo”. It is like the narrator
of “El Aleph” from Jorje Luis Borges, that finds a perfect instant in
time and space, one in which all the places in the world can be seen
at the same time without confusion, from every angle, in perfect and
simultaneous existence We are one, and yet so many, we are one and yet
the same as many. We want to be in the global village and be ourselves
in the global village. Illan Stavans comments on a symbolic poem by
Judith Ortiz Cofer published in 1993 and titled “The Latin Deli,” in
which:
Hispanics north of the border are seen as an amorphous hybrid. Sharing
heterogeneous backgrounds, they are summed up by an archetypal mature
lady. The poet reduces the universe to a king of curative store, a
bodega in which customers look for a medicine to their disheartened
spirit. This Patroness of Exiles, “a woman of no-age who was never
pretty, who spends her days selling canned memories,’ listens to
Puerto Ricans complain about airfares to San Juan, to Cubans
‘perfecting their speech of a
glorious return’ to Havana – where no one has been allowed to die and
nothing to change until then,’ and to Mexicans ‘who pass through,
talking lyrically of dólares to be made in El Norte – all waiting the
comfort of spoken Spanish.’ Latinos, while racially diverse and
historically heterogeneous, an ajiaco (Cuban stew) made of diverse
ingredients, by chance or destiny have all been summed up in the same
grocery store called America. America, where exile becomes home, where
memory is reshaped, reinvented. In the eyes of strangers, our hopes
and nightmares, our energy and desperation, our libido, add up to a
magnified whole. But who are we really? What do we want? Why are we
here? And for how long will thebodega be owned by somebody else?” (7,
p.29) In this magnificent yet poignant context, I submit that Hispanic
psychiatry is an undeniable reality, even if its journey is still
being mapped. There is a Hispanic psychiatry because there is a
growing, vigorous and challenging Hispanic population that in less
than 50 years will reach the already mythical milestone of being “the
largest minority” in the United States. This convergence of Hispanic
families and communities in large and growing urban and rural areas is
creating cultural foci to which health authorities, policy-makers and
planners, mental health professionals, and clinicians of different
persuasions need to pay close attention. There are also psychiatrists
and other mental health professionals of Hispanic background with a
proven interest in dealing with these types of populations, there are
organizations that lend these professionals a setting
and a voice and there is, ultimately, a history that stands behind
this undeniable demographic reality(8).
How can we measure the presence of Hispanic psychiatry in American
psychiatry? Let’s have first some figures. An informal survey
regarding the number of Hispanic psychiatrists in the United States
showed somewhat dissimilar figures from different sources. The APA
membership books indicate a total of 1,232 members who identify
themselves as Hispanic, plus 1,071 non-members for a total of 2,303 or
6.6% of
the total membership. On the other hand, a hand counting of the APA
1998 Membership Director, taken on the basis of names of Hispanic
rots, showed a total of 2,172. Organizations such as the American
Society of Hispanic Psychiatry, and the Interamerican College of
Physicians and Surgeons situate these figures above 3,000,9 close to
10% of the total number of psychiatrists in the country.
Geographically, there are no surprises, with a higher concentration of
Hispanic psychiatrists in cities such as New York, Chicago, Miami,
Houston, Los Angeles and San Francisco (8). Comparatively, the number
of psychologists of Hispanic background in the United States is 1,519
over a total APA membership of 84,426, a 2% (9). The number of
Hispanic social workers is 63,000 out of 749,000, or a 5% (10);
Hispanic nurses number 40,559 out of a total of 2,558,874, a 2% (11).
Finally, 1.8% of the Mental Health Counselors, 0.8% of the marriage
and family therapists, 6.4% of Psychosocial Rehab Technicians, and 26%
of school psychologists are Hispanics. There are four Hispanics who
are Chairman of academic departments of psychiatry out of 152 in the
United States. Four other Hispanics are Vice-Chairmen and
there are six Hispanics elected as Presidents of state psychiatric
societies or District Branch chief officers out of a total of 76 such
organizations (8). Obviously, they have gotten there not because they
are Hispanic, but their ascendance to such prestigious positions
reflects the gradual immersion of Hispanic psychiatrists in mainstream
American psychiatry. Jean Spurlock has recently published a book in
which she discusses the distribution of U.S. psychiatric faculty by
ethnicity, and situates the Hispanic contingent at the 3.7% level
(12). An informal survey I conducted early this year among the
Chairmen of 68 departments of Psychiatry across the country, showed
this figure up to 5.5% with the highest percentage (11%) in the
Southwest. Among psychiatric residents in the United States, the
figures are quite similar. Among IMG psychiatric residents, 57% are of
Hispanic origin. The American Board of Psychiatry and Neurology
unfortunately does not provide information about ethnicity of the
26,000 Board-certified psychiatrists in the United States. On the
other hand, the number of Hispanic medical students has increased
significantly in the last 30 years, from 1 to almost 8% of the total ,
but not as dramatically a that of Asian Americans – 3 to 17% in 20
years. Among the Hispanic medical students,
not unexpectedly Mexican Americans are the most numerous, although
their proportion has diminished to less than half in 30 years (95 to
41%), partly as a result of the growth of other Hispanic
subpopulations that seem to have reached, however, a plateau (8, 13).
In terms of academic productivity, another little survey of original
papers published in two 3-year periods, 30 years apart (1966-68 and
1996-98), in three leading journals in the United States, in which I
looked for authors with Hispanic surnames (admittedly a weak but
somewhat indicative parameter) showed also interesting results. The
journals were the American Journal of Psychiatry, Archives of General
Psychiatry, and Journal of Nervous and Mental Disease. The current
levels oscillate between 9 and 13% of the total but the increase
during the 30-year period is almost 4 – to 5-fold in the three
journals, with most contributions (38% in the 60’s, 62% in the 90’s)
coming from the Northeast (8). Incidentally, only a small percentage
of the articles thus identified dealt directly with Hispanic issues,
as the majority reported about more general, non-ethnic, clinical
research. There are even more evidences of the presence and growing
visibility of Hispanic psychiatry. A number of organizations in
several states, particularly California, Texas, New York and Chicago,
work actively in several areas of Hispanic mental health. Three
journals address themselves specifically to Hispanic mental health
issues, and are published either in New York or California. Their
content reflects a variety of topics from the purely clinical to the
psychotherapeutic, psychopharmacological, psychodynamic, cognitive or
community-oriented. An enormous variety of books
address similar issues in different age groups and clinical
populations. Additionally, books, journals, and book chapters that
deal with cultural psychiatry, social psychiatry, and the interaction
of culture, psychiatry and medicine have a growing component of
Hispanic contributions. The areas of greater impact in research terms
are definitely psychiatric epidemiology and help-seeking patterns.
This follows in the footsteps of pioneering conceptual and
methodological contributions, socio-anthropological research, and
ethno psychopharmacological work. Moreover, research on social and
behavioral approaches to chronic mental illness is as original and
solid as any in similar fields. I will not omit areas such as
community psychiatry, substance abuse, the study of depression in
Hispanic medical patients and of the impact of AIDS in cognition,
families and culture among Hispanic communities (8). The same
scientific commitment characterizes work on neurobiology of affective
disorders, neuroimaging, cultural anthropology, clinical research,
cultural psychotherapy and psychopharmacology, and quality of life
issues. Several young researchers have started to publish in refereed
journals. Finally, there have been, to be sure, Hispanic psychiatrists
as members of teams that have produced significant breakthroughs in
clinical psychopharmacology and psychiatric epidemiology, including
those of the Epidemiological Catchment Area (ECA) survey and the
National Comorbidity Study (NCS). I submit that Hispanic psychiatry in
the United States, nurtured by a variety of cultural currents, is an
extraordinary example of a mestizo entity. Mestization is a totalizing
process that aspires to the creation of new entities, of fruitful
syntheses (14). Hispanic psychiatry is mestiza because society,
population and culture are essentially mestizos. Mestizaje requires
flexibility, adaptability, porosity in order to be stronger and
consistent. The mestizo nature of Hispanic psychiatry is a fundamental
pillar of an identity that is mature, that accepts contributions from
other quarters with an objective, critical eye, and offers in turn its
own findings (8,15). This mestizo identity is also a challenge. On the
one hand, the recognition of our distinctiveness and the implicit duty
to work and investigate what is Hispanic, what is part of our
circumstance, our environment, and our culture. On the other, the
necessity and obligation of being a
harmonious component of the concert of voices in the world which we
inhabit. I submit also that Hispanic psychiatry and Hispanic
communities in the U.S. and other parts of the world can be an
extraordinary natural laboratory for the study of biocultural linkages
in different psychiatric entities. In fact, I envision that these
efforts will be a significant component of research work in the
relatively near future. If researchers of all persuasions are sincere
in their acceptance of the comparable and
complementary pathogenic and therapeutic power of neurobiological and
sociocultural sources, it is clear that the next step in research
would have an integrative seal (16). The biocultural linkages are
those that recognizing and assessing genetic or biochemical basis for
a number of psychopathological states, admit also environmental risk
and protective factors (and environment is in many ways the cultural
context in which these clinical phenomena occur). Such is, in my
opinion, the message of recent work by Kenneth Kendler and his
research group. Environmental factors may account for the difference
of
triggering events for anxiety and depression in spite of the
similarity of genetic factors, and the impact of such factors in the
triggering and perpetuation of symptoms (17). Cultural elements
determine some components of parenting behavior (18), or the role of
religion and beliefs in neutralizing or preventing both depression and
substance abuse (19). They may also delineate levels of genetic
liability toward stressful events. This line of research is not
different from the ethno physiological perspective advocated by Spero
Manson in the study of somatic complaints, or in the definition of
self and loci of
emotion (20). The recognition that they are not only intrapsychic
phenomena, but that they all require neuropsychological integrity and
coherence, adequate assessment of language and semiotics, and the
selective elaboration and cognitive processing of experiences is also
advocated by Kirmayer in his studies of cognitive interpretive
processes (21). Pharmacology and its various outcomes, the social
meaning of physiological mechanisms, and culturally-induced
symptomatic variations are facts in
search of a neurobiological substrate. The same applies to the
psychopathology and creativity model advocated by Jamison (22) and
Schildkraut (23), and numerous studies, such as those by Nemeroff and
other Emory researchers, that attempt to correlate the very personal
experience of stress with a general neuroendocrine response in
different age groups (24). Concepts with enormous cultural meaning
such as resilience, shyness, happiness, fear, selfishness and others
can and should be the matter of neurobiological assessments respectful
of the cultural aspects of such phenomena (16). The controversial but
provocative precepts of Eric Kandel in outlining his “new intellectual
framework for
psychiatry” (25,26), that can be solidly and elegantly rebutted by
Eisenberg’s “seed and soil” metaphor (27). The Hispanic population,
numerous, cohesive, resilient, cooperative and loyal, reach in
cultural legacies and even balanced within a desirable biological
diversity is more than ready to be part of this new chapter of
psychiatric research in America and the world.
But, at the most essential level, the future of Hispanic psychiatry
depends on one type of activity: mentorship. No matter what the scope
of technological progress is, regardless of the number of
scholarships, available institutions, or even sheer volume of
applicants, the progress, growth and development of Hispanic
psychiatry will depend on the development of a strong, vigorous,
committed, and all-encompassing mentorship.
Defined by the Webster’s dictionary as “the influence, guidance or
direction exerted by a mentor”, it seems clear that this activity has
not yet been rigorously delineated in the context of a scientific
enterprise. A mentorship obviously depends on mentors. Mentor (the
name of which comes from the tutor of Telemachus in Homer’s Odyssey)
is “a close, trusted, and experienced counselor or guide”. Right at
this point of the definition, it is also undeniable that mentorship is
above and beyond everything else, a human relationship of unique
characteristics (28). In a recent survey of more tan 1800 faculty
members of medical schools in the United States, Palepu et al (29)
defined mentorship as “a dynamic reciprocal relationship between an
advanced career incumbent (the mentor) and a junior faculty member
(the protegé) aimed at fostering the professional development of the
latter”.
According to J. Tyson Tildon, a recently retired Associate Dean of
Research and Graduate Studies at the University of Maryland School of
Medicine, mentoring “across gender and racial lines can be more
difficult. When there are cultural differences there is bound to be
some opportunity for miscommunication and misread clues”(30). Yet,
Palepu et al’s study found that most of the minority and women faculty
did not feel this to be a problem (29). So, this rather desirable
process should also be based on the realistic assumptions that in the
case of Hispanic psychiatrists it cannot and should not be done only
by senior Hispanic neuroscientists or psychiatrists. Mentorship is a
task to be assumed by every medical educator in the country regardless
of the ethnic or cultural identity of the potential mentees. And
therein resides one of the biggest challenges. More about this, later.
Mentoring is a complex, multidimensional mission. At the base of its
epistemological and ethical nature, the formative dimension of
mentorship reflects a set of values transmitted by example,
inspiration, and everyday work. The informative dimension, as
important as all the others, resides in the amount of knowledge and
technological expertise that the discipline of mentor and mentee has
in store. The sheer
human relations dimension, similar in some of its aspects to the
enduring bond of friendship but also different in depth and meaning,
precedes what I put at the top of the pyramid: the cultural dimension
that has to do with a peculiar vision of the world surrounding the
protagonists of the mentoring relationship. From another perspective,
mentorship owes a set of features also to the nature of the discipline
in which it takes place. It seems clear at this point that in spite of
essential similarities, there are also profound differences if
mentorship is exercised in fields of humanities, arts or letters as
opposed to the vast areas of science. This reminds me of Octavio Paz’
lucid prose describing the differences between poetry and science:
The poet aspires to one image that would resolve in its unity and
uniqueness the plural richness of the world. The poetic images are
like the angels of Catholicism: each one is in itself a species. They
are universal singulars. On the other extreme, the scientist reduces
individuals to series, changes to trends, and trends to laws. For
poetry, repetition is degradation; for science repetition is the
regularity that confirms the hypothesis. The exception is a reward for
the poet and a punishment for the scientist (31, p.68).
Nevertheless, beyond disciplinary constraints, the inspirational and
humanistic essence of mentorship could establish bridges of
understanding. The search for mankind’s well-being is one of those
commonalities. The betterment of the human race in terms of values,
goals, principles, and objectives in the everyday life of communities
and nations responds to the inspirational nature of mentorship.
Hopefully, flexibility, open-mindedness, capacity to dialogue, compare
and confront opposite ideas in a
civilized frame are also levels in which mentorship elevates itself
above discrepancies and useless sectarian battles.
What are the tools that can insure a successful implementation of
mentorship? Unquestionably, the first one is the presence and the
action of good mentors. And what makes a good mentor? Tildon tells us
that it is one who maintains a consistently high level of enthusiasm
for his or her work, what he calls the “wow factor” (30). It also has
to be a man or a woman who is productive in his/her field of work, and
productivity is measured in terms of publications in well-regarded
journals in psychiatry, neuroscience,
general medicine or science (30). Reputation and the respect they get
from colleagues, peers, employees an even clerical personnel are
important ingredients. Palepu et al (29) list commitment, ability to
motivate, methodological skills, and networking capabilities as key
ingredients of a successful mentorship.
Beyond the formal or even bureaucratic requirements to be a good
mentor, beyond even the stability of the mentor’s extramural funding,
there are questions such as whether the chosen mentor should be
directly associated with the subfield that the trainee believes he/she
will eventually choose. Another question is the value that maintaining
a high profile within and outside the university setting itself has
for the mentor (29,30). Here, we are also debating what are the
characteristics of mentoring in teaching and education versus
mentoring for scientific and research careers. While I am trying to be
all-encompassing, I recognize the differences. I certainly want to
focus a bit more on the mentorship of young scientists, particularly
among Hispanic psychiatrists and neuroscientists. There is agreement
in that the nature of the mentor-mentee relationship is crucial. The
intangible elements of affinity, constructive identification, modeling
and motivation, mutual respect and mutual protectiveness of
independence and personal autonomy will vertebrate the scope,
endurance and quality of the relationship. How a mentor should be
sought out is another fairly complex part of the process. Tildon says
that medical schools should not randomly assign people to be mentors.
Charles Nemeroff, the Chairman of my Department at Emory, makes even a
more categorical statement: “Some fabulously successful scientists and
clinicians are notoriously poor mentors” (32). Some people argue that
the potential mentee should look for his or her own match. Others say
that the faculty should actively seek out potential mentees, and even
potential mentors if we talk of junior faculty ranks. A third but not
necessarily incompatible way is that of the institutional or
organizational mechanisms developed to ease the transitions that a
mentorship demands for both mentor and mentee. Mentors should be
familiar with the apprenticeship system, the learning of peer review
and practice at the basis of the experience (30,32). Along the
formative, informative, interpersonal and cultural dimensions outlined
above, the mentors must use their influence to help trainees move to
their next position. In the faculty recruitment and retention
processes, the institutions should make a point of exploring the
mentorship abilities of those individuals, in addition to their
promise in the research field and their capacity to write fundable
grants. Organizations should also entice mentor faculty members to win
awards and even start up funds for new projects. Events in which
mentors and mentees jointly present not only the results of their work
in the laboratory or the clinical units, but also the evolvement of
their own experience would fill a significant need. Last but not
least, the financial compensation for traditionally non-reimbursable
activities such as teaching and mentoring should be actively secured
so that these faculty, overburdened with clinical care and writing
grant applications, may not overlook their mentoring duties (32). This
era of managed care certainly poses a bigger threat not only to
research and the quality of clinical care but also, and sometimes at a
less visible level, to mentorship as the foundation of successful
academic and clinical work (33). I said earlier that in the area of
Hispanic psychiatry one problem may very well be the lack of a
sufficient number of mentors. This realistic understanding will lead
to the need to foster positive and productive relationships with
non-Hispanic mentors who, on the other hand, must be sufficiently
sensitive to the sometimes intangible needs of Hispanic trainees and
mentees. In this area, motivation as to the field and location of
future work, main research objectives with a focus on specific ethnic
and cultural groups or subgroups among the Hispanic population, a
clear understanding that science is not immune, after all, to the
influence of powerful cultural factors, would make this adoption of
non-Hispanic mentors one of the most fascinating exercises in American
academic
medicine. Not that this is not happening already. My plea is towards
increasing these exercises, making them more visible and as exemplary
as they must be to make the reality of a diverse but united American
scientific community more reachable at the turn of the century.
Is enough being done to enhance mentorship in Hispanic psychiatry and
other mental health professions? I am afraid the answer is not enough
at this point. It is clear, however, that at the federal and private
sector levels some organizations and institutions are trying to move
ahead. I have no doubts that this event and the program that we will
enjoy in the next couple of days is a real landmark in this process.
The participants are the who is who in Hispanic psychiatry, clinical
and research endeavors, and the areas which have been chosen reflect
extremely well the realities of American psychiatry in general, and
Hispanic psychiatry in particular. The program, in fact, shows that
Hispanic psychiatry has penetrated practically all areas of this
country’s scientific inquiry in the field at the turn of the 20th
century. It is not only applied or clinical research, outcomes
research, epidemiological and sociocultural areas, but also the basic
sciences that have accepted and benefited from Hispanic contributors.
This is a showcase of what has been done, and a fully confident look
at the future of our field and the future of our psychiatry. We want
the accomplishments to become the luminous landscape of consistent
results throughout the next millennium. I am sure that they are not
mirages because the quality, tenacity, and continuous growth of our
Hispanic scientific community is not a fleeting reality. It responds
to be demographic certainties of the 21st century as well as to the
historical demands of a human group that owned the place not too long
ago. Everyone of us needs a mentor, no matter what stage of our
personal or professional careers we are going through. I would even
say that the more advanced our
career is, the lonelier we may feel at these phases, and the more need
of mentors we may have. We need the mentor’s objectivity that is not
detachment, we need his or her inspiration that is not arrogance, we
want fairness that is not indifference. We need someone who can hold
up a mirror to us and tell us how we are doing. Like Jonathan Kozol,
commenting the book Lanterns, a Memoir of Mentors by Marian Wright
Edelman (34), the founder of the Children’s Defense fund says:
“Mentorship summons up the sense of deep and personal commitments that
each and everyone of us depends upon to keep alive a flame of hope”
Mentorship is the bridge that ties one generation to the next and puts
two individuals, the mentor and the mentee, on a road in which what
each one does for the other becomes a matter of survival and the key
to their success. Much as the mentor should inspire the mentee and let
him/her know they can go higher, the mentee expects from the mentor a
willingness to affirm his or her talents, promises and expectations.
To affirm, in one word, the personhood of the mentee, his or her
self-image.
Marion Wright Edelman tells us too that as mentors we should worry
about disappointing our mentees (34). In the area of Hispanic
psychiatry, I am sure that there are good mentors and I am sure that
they, together with their non-Hispanic colleagues, will help our
future generations to cross the bridges of uncertainty, and increase
the notions of self-respect, consistency, and the “I-can-do-it”
attitude that goes together with the “wow factor” mentioned before.
From a past where ambiguities and injustices alternated with events of
promise and possibilities, Hispanic psychiatry has come to a present
of a strong mestizo identity, traversing towards a future that will be
built on the foundation of a fair and square mentorship. A
professional, a scientist in any field needs to have an “energetic
temperament” determined to achieve the solution of problems, as Peter
Medawar, the Nobel Prize-winning immunologist said (35). He also added
that scientists require commitment to their task and the strength that
can keep them standing against many factors that could put them down.
To be a scientist requires perseverance, a strong rejection to
failure, to giving up, or to admit defeat. Obviously, he or she cannot
do it alone. This reminds me of reading about an interview with a
gifted mentor in a medical school who, when asked how and why she did
all that mentorship, responded: “How could I not?” (30).
BIBLIOGRAPHY
1. Stavans I: Convocation (Editorial) Hopscotch Magazine Preview
Issue, pp. 3-4,
October, 1998.
2. U.S. Bureau of Census. Hispanic Population Nears 30 Million. Census
Bureau
Reports, Public Information Office, CB 98-137, August 7, 1998.
3. Leland J, Chambers V. Generation Ñ. Newsweek Magazine, pp. 18-25,
July 12,
1999.
4. Fuentes C. América: Una utopía de Europa. Oiga, Lima, Octubre,
1983.
5. Cisneros S. Woman Hollering Creek and other stories. 246 pages. New
York:
Random House, 1991.
6. Borges JL. El Aleph. Prosa completa. Volume 2, pp. 112-125.
Barcelona:
Bruguera, 1980.
7. Stavans I. The Hispanic Condition. Reflections on Culture and
Identity in America.
242 pages. New York: Harper Collins, 1995.
8. Alarcón RD. Hispanic Psychiatry: From Margin to Mainstream. Simón
Bolívar
Award Lecture, American Psychiatric Association, Annual Meeting, May
23, 1999,
Washington, DC.
9. American Psychological Association Membership Division Annual
Report.
Washington, DC, 1997.
10. Bureau of Labor and Employment Statistics, National Association of
Social Workers.
Washington, DC, 1998.
11. Bureau of Health Professions, Division of Nursing, Washington, DC,
1996.
12. Spurlock J (ed). Black Psychiatrists and American Psychiatry. 228
pages.
Washington, DC: American Psychiatric Association, 1999.
13. American Association of Medical Colleges. Fall Enrollment
Questionnaire,
Washington, DC, 1997.
14. Lienhard M. De mestizaje, heterogeneidades, hibridismos y otras
quimeras. In,
Mazzotti JA, Zevallos-Aguilar UJ (eds), Asedios a la heterogeneidad
cultural, pp. 57-80. Philadelphia: Asociación Internacional de Peruanistas, 1996.
15. Alarcón RD. La disciplina de los perennes comienzos: Dilemas de la
psiquiatría
contemporánea. (The discipline of perennial beginnings: Dilemmas of
contemporary
psychiatry) In: Desde nuestra propia entraña. (R.D. Alarcón, J. Castro
& E. Cipriani,
Eds.), pp. 117-141. Lima: Editorial P.L. Villanueva, 1992.
16. Alarcón RD. Biocultural Linkages in Psychopathology: The new
research frontier.
Presented at 12th Annual NY State Office of Mental Health Research
Conference.
Albany, NY, Dec. 8, 1999.
17. Kendler K, Karkowski-Shuman L. Stressful life events and genetic
liability to major
depression: Genetic control or exposure to the environment?
Psychological
Medicine, 27:539-547, 1997.
18. Kendler K. Parenting: A Genetic-Epidemiologic Perspective. Am J
Psychiatry
153:11-20, 1996.
19. Kendler K, Gardner CO, Prescott CA. Religion, psychopathology and
substance use
and abuse: A multimeasure, genetic-epidemiologic study. Am J
Psychiatry 154:322-329, 1997.
20. Manson SM. Culture and major depression. Current challenges in the
diagnosis of
mood disorders. Psychiatric Clinics North America 18:487-501, 1995.
21. Kirmayer LJ, Young A, Hayton BC. The cultural context of anxiety
disorders.
Psychiatric Clinics North America 18:503-521, 1995.
22. Jamison KR. Mood disorders, creativity and the artistic
temperament. In,
Schildkraut JJ, Otero A (eds). Depression and the spiritual in modern
art, pp. 15-32.
New York: John Wiley and Sons, 1996.
23. Schildkraut JJ, Hirshfeld AJ. Mind and mood in modern art II:
Depressive disorders,
spirituality and early deaths in the Abstract Expressionist artists of
the New York
School. Am J Psychiatry 151:482-488, 1994.
24. Nemeroff CB. The corticotropin-releasing factor (CRF) hypothesis
of depression:
New findings and new directions. Molecular Psychiatry 1:336-342, 1996.
25. Kandel ER. A new intellectual frame for psychiatry. Am J
Psychiatry 155:457-469,
1998.
26. Kandel ER. Neurobiology and the future of psychoanalysis: A new
intellectual
framework for psychiatry revisited. Am J Psychiatry 156:505-524, 1999.
27. Eisenberg L. Seed or soil: How does our garden grow? (Editorial).
Am J Psychiatry
153: 3-5, 1996.
28. Rhodes GE, Contreras JM, Mangelsdorf SC. Natural mentor
relationships among
Latina adolescent mothers: Psychological adjustment, moderating
processes, and the
role of early parental acceptance. Am J Community Psychology
22:211-227, 1994.
29. Palepu A, Friedman RH, Barnett RC, Carr PL, Ash AS, Szalacha L,
Moskowitz MA.
Junior faculty members’ mentoring relationships and their professional
development
in U.S. medical schools. Acad. Med 73: 318-323, 1998.
30. Academic Physician and Scientist. Making the most of the mentor-mentee
relationship, pp. 5-6, September/October, 1999.
31. Paz O. El laberinto de la soledad. Mexico DF: Fondo de Cultura
Económica, 1950.
32. Nemeroff CB. On mentoring. CNS Spectrums, 3:17-19, 1998.
33. Starr P. The logic of healthcare reform. Transforming American
medicine for the
better. Stanford: Whittle Direct Books, 1992.
34. Edelman MW. Lanterns. A memoir of mentors. Boston: Beacon Press,
1999.
35. Medawar P. The threat and the glory. Oxford: Oxford University
Press, 1990. |
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