14 HISPANIC ADOLESCENTS AND THEIR FAMILIES: SOCIOCULTURAL FACTORS AND TREATMENT CONSIDERATIONS

Adolescent Psychiatry,  2004  by Rothe, Eugenio M

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The United States is now an ethnically complex society. The demographic changes that have taken place in America during the past five decades have given rise to a country where cultural and ethnic diversity is becoming the rule, rather than the exception. These changes are also evident in the field of mental health, where psychiatrists and other practitioners are finding that "a patient-therapist cross-cultural dyad now constitutes the modal unit" (Arce, 1993). Psychiatrists treating recent immigrants should always ask themselves the following questions: To what part of the United States has the person immigrated? Which racial, cultural, socioeconomic, or climactic variables has the immigrant encountered and how do these differ from his or her own?

Hispanics are the largest and fastest-growing minority group in the United States, and Hispanic adolescents are the largest and fastestgrowing minority in this particular age group. This chapter reviews the available psychiatric literature on Hispanic American adolescents and their families. It focuses on issues such as the experience of migrating to the United States, the experience of being a Hispanic adolescent refugee, the process of acculturation, and the transformations of identity experienced by Hispanic adolescents in the United States. In addition, the effects of poverty, substance abuse, risk of HIV, and other social Stressors on Hispanic adolescents and their families are discussed.

Finally, this chapter outlines treatment considerations that allow the non-Hispanic psychiatrist to better understand issues of transference and countertransference and to design treatment interventions that are culturally sensitive and that facilitate the successful engagement of the Hispanic adolescent and his or her family in the treatment relationship.

THE NEW DEMOGRAPHICS OF HISPANIC AMERICANS

The term Hispanic first came into common use in the United States in the 1980s, when demographers began utilizing the term to define a fast-growing but heterogeneous segment of the U.S. population (SuarezOrozco and Suarez-Orozco, 2001). It has been used loosely to define individuals who descend culturally from the inhabitants of Spain, regardless of their race.

There are presently 35.2 million Hispanics in the United States, constituting 12% of the country's total population. It is expected that by the year 2050, their number of will triple to 98 million, and that Hispanics will then constitute one-fourth of the U.S. population. Hispanics have the highest fertility rate of any U.S. ethnic group, growing at a pace that is three times faster than any other U.S. ethnic group. They also have the lowest divorce rate and the highest marriage rate of any ethnic group in the United States.

With a mean age of 26 years, Hispanics are the youngest ethnic group in the United States-almost a decade younger than the rest of the U.S. population (35.3 years). The largest subgroups by percentage of the U.S. population are Mexican Americans (65%), people of South American heritage (14%), Puerto Ricans (10%), people of Central American heritage (7%), and Cuban Americans (4%).

One out of every two Hispanic Americans was born in Latin America. The population of Latin America also grew to 500 million in the last decade (between 1990 and 2000) constituting 8.2% of the world population. Immigration from Latin America to the United States represented an important factor in the population growth of Hispanics in the United States. The largest number of immigrants in the last decade came from Mexico, Cuba, the Dominican Republic, and El Salvador (U.S. Census Bureau, 2003).

Less than 20% of the world population lives in wealthy countries, and the majority of Hispanics immigrate to the United States to escape poverty. Poverty is usually interrelated with war and political unrest. Because poverty is likely to continue to affect many Latin American countries into the twenty-first century, Latin American immigrants will probably continue to arrive in the United States in large numbers (Central Intelligence Agency, 2001).

THE IMMIGRANT EXPERIENCE

Immigration is one of the most stressful events a family can undergo. It removes the family members from many of their relationships: friends, neighbors, and members of the extended family (Suarez-Orozco and Suarez-Orozco, 2001). It also removes the family from their community, jobs, schools, customs, and sometimes language, placing them in a strange and unpredictable environment (Ticho, 1971). These changes are disorienting and inevitably lead to a sense of loss.

Immigration destabilizes the family in a variety of ways. Suarez-Orozco and Suarez-Orozco (2001) suggest that the journey of Hispanic immigrants to the United States is a highly fractured, phase specific process that results in psychologically complex patterns of family fragmentation and reunification. Children and adolescents are often left behind in the care of grandparents or other relatives and may not reunite with their parents for years to come. Immigrant parents sometimes have to make a Faustian bargain, gambling with the dream of having a better life at the risk of undermining family cohesion and their parental authority and the risk of losing their children to the new culture.