The Puerto Rican Patient: Some Historical, Cultural and Psychological Aspects

At least 5% of the population of the United States are people from Spanish-speaking cultures. Included in this group are over 2 million Puerto Ricans, most of whom reside in the New York, New Jersey and Connecticut metropolitan area. In contrast to the Spanish-speaking individuals from certain other Spanish cultures (Cuban, South American, Spanish), many of whom came from the middle and upper classes, the Puerto Ricans are mostly

from the economically deprived lower classes who have migrated from an economically deprived island (Meyer, 1977). They bring with them a mixture of identities (Spanish, African, Indian), skin colors, and cultural attitudes which may be important, sometimes crucial, influences on the development and treatment of psychiatric illness. Without appreciation of these sociocultural determinants, a therapeutic working alliance may not be successfully developed, resulting in avoidance, premature termination or failure of treatment.

Because of the extreme degree of underrepresentation of Puerto Rican psychiatrists and other mental health professionals in relation to the growing numbers of Puerto Ricans on the mainland, most Puerto Rican patients in the United States will be treated by non-Puerto Rican, non-Spanish-speaking therapists, either through an interpreter or in the English language. It is, therefore, essential that non-Puerto Rican psychiatrists have as complete an awareness and understanding as possible of the sociocultural matrix of the Puerto Rican–American patient. It is especially necessary that those in the greater New York metropolitan area be given the opportunity in their training to work with Puerto Rican patients under supervision. The need for education about and sensitivity toward these frequently misunderstood patients has motivated us to write this paper. Whereas we, the authors, have all had extensive, professional involvement w