A Mexican American family brings an elderly aunt to the emergency room. The older woman is severely depressed and emaciated. She also appears to be nearly catatonic. She is admitted immediately to the hospital on an emergency commitment. You learn that this woman has been in severe depression for years and wonder why the family waited until things became so serious. Later, when you talk to the aunt, she is somewhat improved. She indicates that her pastor visited her and told her that her depression is due to her lack of religious faith. She tells you she agrees with this assessment. She tells you she believes that if her faith was stronger and she was less sinful, she would not feel like this. 

Look at the culture of each client described in the following scenarios, and decide what might be the underlying issue. What are you thinking about the client as you read each description? What are your first ideas about what constitutes the client’s problem? Do you have a problem personally with the behavior of the client, and if so, in what way? The following brief explanations about cultural behaviors may help you answer the questions when you read the scenarios that follow: 

• In many Asian cultures, members do not talk about family problems, feeling that these are private. They may also pretend that no problems exist. 
• In most Asian cultures, crossing the legs and pointing the toe at another person is considered extremely rude. Because members of Asian cultures like to maintain harmony, they would not be likely to tell you directly that they were offended. In addition, in most Asian cultures, waving at another person or indicating that a person should join you by calling the person over with your hand or a finger is also considered extremely rude. 
• Asians are not likely to make changes in the family or to engage in discussions about the family unless the male head of the household is present or is consulted. Furthermore, they are likely to tell you things are all right in order to maintain harmony. Things may not be all right. They may also tell you that you were helpful to them because they assume that is what you want to hear, not because it is true. Telling you what they believe you want to hear will maintain harmony. 
• In most Asian cultures, group needs and considerations are more important than individual needs and considerations. 
• In most Hispanic families, the man makes the major decisions and expects to be consulted about anything affecting the family. He would not be likely to take his wife’s ideas or concerns into consideration. She would be expected to defer to the husband. 
• Many Hispanic families allow mental health problems to persist for a very long time rather than admit that there is a psychiatric problem. 
• In Hispanic culture, it is often believed that depression is due to a lack of religious faith. 
• In Hispanic culture, mental health problems are often attributed to sin.