Paper presented as part of a Symposium on Cross-cultural Counseling Research at the American Personnel and Guidance Association Annual Meeting: Washington, D.C. - March 23, 1983.
*Author was Psychologist III with Rural Clinics Community Counseling Center in Ely, Nevada at the time. This was part of the State of Nevada Rural Clinics system.
There has been increasing interest in recent years in the development of comprehensive mental health programs. This interest has been world-wide (Draguns, 1981). In a pluralistic society like the United States, successful intervention will quite often depend on how well the therapist knows and understands the client's cultural or ethnic group (Draguns, 1981). Rural areas of the western United States add still another dimension, with sometimes large geographical areas populated with diverse ethnic and cultural groups.
The American west has been portrayed in song, story, speech, myth, legend and films. From the classic tales of Mark Twain (Hill, 1982) to the legends of Butch Cassidy (Steckmesser, 1982) to Native Americans (Boyer, 1982) to films about western women, schoolmarms and prostitutes (Jefchak, 1982) to the major epic dramas of United States history, the American west has held a fascination for people from many cultures. The west, though, has a reality of its own (Jordan, 1982). The myths and legends were created, but the reality doesn't always fit the myth or legend - or even the general concept of what the west may be like. The modern west is changing as man seeks to use and/or change the environment.
The physical aspects of our environment are a large part of an individual's experience. They have an impact on the individual and the amount of stress and anxiety experienced. One aspect of the physical environment, population density, appears to have negative effects on feelings of personal security (Buchanan and Cantril, 1953) and on affiliative and other social responses to individuals or groups (Munroe and Munroe, 1972; Bass and Franke, 1972).
There has been relatively little research on crowding which has focused on individual and cross-cultural differences. Evans (1978) found evidence that young children may be more adversely affected by crowding than older persons. However, this may only be indicative of western cultures. Children in Kung society (Draper, 1974) apparently do not suffer any ill effects from crowding. Studies of crowding in Chicago (Galle, Gove and MacPherson, 1972) support the hypothesis that pathology tends to increase as the population density increases. This relationship appears to work the other way in the Netherlands (Levy and Herzog, 1974). In a study done in Hong Kong (Mitchell, 1971) no adverse effects were found as the result of high population density.
The environment is the source of many stressors which can initiate a variety of reactions. These reactions may range from endocrine secretions to such things as complicated appraisals and evaluations of the sources. These reactions to stressors may be physiological (Selye, 1956/1976) and/or psychological (Lazarus, 1966; Lazarus and Cohen, 1977; Lazarus and Launier, 1978). Few investigators have attempted to study all aspects of the stress process simultaneously.
Stressful responses can be evoked by the changes and challenges one experiences in daily life. They can be caused by the disruption of one's habits (e.g. unpredictable noise or crowding). Malfunctioning of social systems which place obstacles in one's path, deprivation, losses and culturally-governed mores may also contribute to stressful responses. Stressors may be intrusive, physical and universally threatening (e.g. natural disasters). Others may be more culturally determined, less universal and more psychosocial in nature. Aiello and Thompson (1980) and Hall (1966) found that varying intensities of crowding and proximities in spatial invasion are specific to cultural norms and meanings.
The obvious lack of relative crowding and the presence of generous open space in western rural areas would seem to offer escape from the stressors generally associated with urban areas. The lessening of noise factors, crowding and other variables associated with stress production would seem to enhance the quality of life. In fact, these have been some of the traditional reasons why people have sought out rural areas for rest, relaxation and vacations.
Ranchers and farmers have tended to form small close communities which have supported their way of life and provided for mutual support. Depending on their cultural heritage, they have developed and maintained values and attitudes congruent with their way of life. Other groups (e.g. Mexican Americans) have been generally successful in preserving their cultural heritages while attempt- ing to adapt and adjust to changes in United States society. Others (e.g. Native American groups) have maintained their culture in varying degrees and, in many cases, in relative isolation from the mainstream of U.S. society.
Much of the history of the United States is concerned with the westward expansion of a civilization that had its beginnings on the eastern shores of the North American continent. The Spaniards were the first men of European origins to penetrate the vast regions between the Rocky Mountains and the Pacific Ocean. As late as the 1820's, very little exploring had been done in the far west. In many cases, the terrain was found to be rough and rugged and resources were scarce in the beginning. Communities were separated by great distances and travel was difficult, at best, by today's standards (Hulse, 1981).
Today, in many areas of the western United States, rural towns and communities may be separated by as much as 100 miles or more. Many of these towns are farm and ranch centers or mining towns. There is often a shortage of physicians, psychiatrists and psychologists as well as other mental health related services and trained personnel. An increase in population in a number of areas within the past 10-15 years has placed a tremendous strain on many local resources. The need for effective community counseling programs in rural areas of the western United States has been increasing. This is at least partially due to stressors placed on old timers and newcomers alike. The rapid growth in some areas is exacerbated by rapidly fluctuating economic changes. As more people enter an area, they tend to overwhelm old timers who quite often are left bewildered and lost in a community which once was theirs. Newcomers have difficulties dealing with scarce or non-existent services and resources as well as a lack of adequate housing. Tensions develop over these areas as well as from a clash of values. There is a need for adequate and effective community counseling centers to address these problem areas.
Human services in any community cover a broad area, In addition to mental health services, such services may include law enforcement, legal services, social services, public health, recreation, youth services, local government, educational services, and services for senior citizens. These services have generally been provided informally or through institutions. When rapid community growth occurs, the size of the local population may increase at a rate which causes people problems to increase tremendously with a resultant strain on existing community resources.
In areas of rapid development, there tends to be a rapidly developing shortage of adequate and reasonably-priced housing. Rentals become high and crowding develops (Uhlmann, Doherty and Hill, 1977). Recreation presents other problems. Citizens of rural communities in the west have traditionally engaged in recreational activities such as camping, fishing and hunting. Newcomers tend to have a different set of interests ( e.g. bowling alleys, theaters, swimming pools, and handball courts). Communities which can't provide these types of activities may find newcomers taking advantage of more easily available diversions such as drinking, gambling and prostitution (Uhlmann, 1977).
Uhlmann (1977) has pointed out a number of significant problem areas in her analysis of the delivery of human services in Wyoming boom towns. A review of her report points out the potential sources of stress and other mental health related problems encountered in western rural communities experiencing rapid growth. She found that mental health problems in rapidly developing communities include an increased incidence of depressed women and a rising rate of alcoholism among males. She also found an increase in family crises and that children and adolescents are at risk for an increased incidence of behavior disorders and social maladjustments. Newly arrived young adults (18-26) were found to face problems as a result of few, if any, solid interpersonal relationships. They frequently became involved in drug and alcohol abuse. Uhlmann found that public assistance through social services was drastically reduced and that there was frequently a lack of adequate medical personnel available. She found that schools experienced difficulties as a result of a rapid growth in student population. At the high school level, the drop-out rate tended to increase as young people were attracted and drawn off by employment opportunities in the area.
She suggested that law enforcement personnel in rapidly developing communities may have to deal with problems they have not encountered before and may be hampered by inadequate training, low salaries and a high turnover of personnel. Poor and/or inadequate facilities (e.g. jails, juvenile detention, and foster homes) were seen as making the job of law enforcement more difficult.
Uhlmann suggests that local governments in small rural communities may not have the administrative structure necessary to deal with the new and critical demands placed on them by a rapidly growing population.
In the past, rural communities in the western United States were frequently characterized by a large population of senior citizens. Uhlmann suggests this occurred because young people left the community to seek better employment elsewhere. However, it seems that when a rapid increase in population due to development occurs, this process is partially reversed. Senior citizens may be forced to leave the community due to a rising cost of living. Such a process of demographic change was observed in three Wyoming communities (Uhlmann, Kimble and Throgmorton, 1976; Uhlmann, Doherty and Hill, 1977).
Other problems associated with rapid population growth include a sense of a decreasing "quality of life". Rapid growth brings rapid change. Many impacted communities have stressed decline and loss. The negative effects such accounts point out usually include: a speeded-up pace of life; congestion and over- crowding; inflation in prices; fear of change in life style for present residents; lack of activities and sense of belonging for newcomer families; alcoholism and mental health problems (HUD Program Guide, 1976). Increased incidents of severe depressions and alienation of both oldtimers and new- comers may result in "we-they" conflicts (Miller, 1978).
Traditional agencies and persons who have dealt with the above problem areas may not even exist in such communities. Many of these small rural communities have long been used to everyone taking care of themselves. Existing agencies may find their caseloads overwhelming. Communities which are impacted need help in defining future problems, predicting the magnitude of such problems and designing and implementing programs and mechanisms to alleviate the problems (Miller, 1978).
Uhlmann (1977) suggests that most of these problems develop because communities don't have the time to develop financial resource bases and local attitudinal support for needed services. She also suggests that problems occur due to the changing composition of local populations. She points out that all of the factors reviewed above bring about increased demands for human services in impacted communities. The remainder of her report focuses on a description of the Wyoming Human Services Project and it approaches to dealing with these problems.
STRESS AND RURAL AREAS
Nevada has a history of boom and bust dating back to the middle of the nineteenth century (Hulse, 1981). As a state, it has managed to grow and expand its interests. Although geographically rugged and sparsely populated, it has maintained a rich culture and a pluralistic society. Basque sheep- herders in the north, cattle ranchers, miners, Mexaican Americans, Chinese Americans, Japanese Americans, Shoshone, Washo and Paiute Indians, and many other groups add to the color and richness of Nevada culture.
In recent years, an expanded effort has been made to develop and maintain mental health services in rural areas (Doherty, 1984). Fluctuations in the economy have stressful effects on the small rural communities. Growth and decline of communities have a psychological impact on those directly affected. People experience this stress and anxiety differently, depending on a number of factors.
One method of studying perceived stress and anxiety is to use a self-report indicator such as Speilberger's (1970) State-Trait Anxiety Inventory (STAI). Speilberger (1970) states that Trait anxiety tends to be relatively stable and indicates a tendency to respond to situations perceived as threatening with elevations on the State scale. Atkinson (1964) suggests that trait anxiety has the characteristics of a class of constructs which he terms "motives". He defines these as dispositions which remain latent until they are activated by cues in different situations. Campbell (1963) calls these "acquired behavioral dispositions". According to him, they involve residues of past experiences which tend to predispose individuals to view the world in a particular way. They also tend to predispose an individual to manifest what he calls "object consistent" response tendencies.
In other words, trait anxiety is like potential energy. It suggests differences between people in the disposition to respond to stressful situations with varying amounts of state anxiety (Speilberger, 1970). Persons with high levels of trait anxiety tend to be more likely to respond with an increase in state anxiety intensity in situations that hold a threat to their self-esteem (Speilberger, 1970). Whether persons who differ in trait anxiety differ in a similar way for state anxiety depends on the extent they perceive a specific as being threatening or dangerous. This is strongly influenced by their past experience.
Attitudes toward the sources of stress tend to mediate the responses. If an individual or a group believe that a stressor will cause no permanent harm, the response will probably be less extreme than if the danger poses the threat of lasting harm. Psychologically, the perceptions of control, social support and other characteristics of individuals exposed to stressors will affect their evaluation of different stressors (Baum, Singer and Baum, 1981; Epstein, 1981). Perceived control can be a powerful mediator of stress. That is, it can provide the individual, or group, with a sense of being able to cope more effectively, to predict events and to determine what will happen.
The following study was designed to look at State and Trait anxiety levels experienced by a sample of individuals from two rural counties in Nevada and a small Native American Reservation, also in Nevada.
Speilberger's State-Trait Anxiety Inventory (STAI) was administered to 28 Subjects from two rural counties and one small Native American Reservation in Nevada. Eleven subjects were from each of the two rural counties and six were from the Reservation.
Five assistants were trained in how to administer the STAI, both orally and written. Four residents from the two rural counties were chosen to administer the STAI. In one county, there was a small group of Filipino Nurses in residence. One of them was trained as one of the five assistants and was asked to administer it to the nurses. The fifth assistant was a Western Shoshone Indian who works as an Outreach Worker for a Community Counseling Center. This assistant was trained and asked to translate items into the Shoshone language orally for those who had difficulty with English or to present the inventory orally for those who could not read. This assistant administered the STAI to members of the Western Shoshone Tribe in Nevada. Similar instructions on how to administer the STAI orally and written were given to all five assistants. In addition, each assistant was administered the STAI and the accompanying brief questionnaire prior to their training.
A one page questionnaire with independent variables (age, sex, etc.) and the STAI were administered to the 28 subjects by the five assistants. Standard- ized instructions were given to fill out the brief questionnaire. Instructions for administering the STAI were those provided on the inventory. These were either read orally for those with a reading problem or translated into the Shoshone language if necessary or the subject was asked to read them. Responses were recorded by the subject or by the assistant if given orally. When a subject had difficulty understanding an item, the assistant would help to clarify the meaning by instructing the subject to respond according to what the item meant to him/her.
Ss were 28 people from two rural counties and a small Native American Reservation in Nevada. Twenty of the ss were female and eight were male. The mean age for all Ss was 40.21 with an age range from 23-71. Three Ss were single, 20 were married and five were divorced. Seventeen of the Ss were employed full-time, seven were employed part-time, one was a homemaker, two were retired and one was a self-employed rancher. Twenty-two Ss were high school graduates. Of these, nine were college graduates.
Eleven Ss came from each of two counties. Three of the Ss in one county were Filipino Nurses employed by a rural hospital. In addition to these 22 Ss, six Ss were members of the Western Shoshone Tribe in Nevada. Ss were chosen by the assistants so as to represent as close as possible the population areas from which they came in terms of independent variables such as age, marital status, education, etc.
Populations of both counties are approximately 10,000 and 3500 respectively. The Western Shoshone Reservation population is approximately 150.
Independent variables are listed in Table 1.The mean age was 40.21 for all Ss. Ss from County A had a mean age of 39.09, from County B a mean age of 41.18 and from the Reservation a mean age of 40.50. The mean age of the three Filipino Nurses was 29.70. Other characteristics of Ss are discussed in the Subjects section above.
Ss were asked to respond to the following question prior to administration of the STAI: "When you have a personal or a family problem, where do you go first to get help?" The results are listed in Table 2. Twelve of the Ss (42.85%) preferred to solve these problems themselves. Seven (25%) preferred to seek the help of a friend. Five (17.85%) preferred to seek help from a relative. The remaining four Ss (14.28%) preferred a variety of other people, including a neighbor, physician, spouse and prayer.
Two of the six Shoshone Ss preferred to solve problems themselves as did two of the three Filipino Nurses. Six of the 11 Ss in County A and two of the 11 Ss in County B preferred to solve problems by themselves. Four of the 11 Ss in County B preferred to seek help from a friend whereas only two of the 11Ss in County A preferred to do so. One of the six Shoshone Ss preferred to seek help from a friend. Two of the six Shoshone Ss preferred to seek help from a relative.
The results of the administration of the STAI for the State scale are listed for all three groups (County A, County B and Reservation) in Table 3. T-tests were used to compare the means of all three groups with each other (Kirk, 1968). There was no significant difference between Ss in County A and in County B (.05 level). There was a significant difference between County A Ss and Reservation Ss (.05 level). The Reservation Ss scored significantly lower on State anxiety than did Ss from County A. There was no significant difference (.05 level) between Reservation Ss and County B Ss. Reservation Ss rated their present levels of anxiety lowest of all three groups, but this was only significant when compared with County A.
The results of the Trait scale of the STAI are listed in Table 4. Again, T-tests were used to compare all mean scores (Kirk, 1968). There were no significant differences between groups on any of the comparisons (.05 level).
Table 5 lists the State and Trait means for all three groups and the total means for the State and Trait scales. There are significant differences between the State and Trait scales for all three groups (.05 level). There is also a significant difference between the State and Trait scales for the total of all groups (.05 level). In all cases, the Trait scale was significantly higher thant the State scale.
It is interesting to note that 12 of the 28 Ss (42.85%) chose to solve personal or family problems by themselves. An additional 13 (46.43%) seek help from a friend, neighbor or relative first. Only one S indicated that he/she would seek help from a professional (physician) first. This is similar to Miller's (1978) finding that many small rural communities in the west have long been used to taking care of themselves.
Speilberger (1970) defines State anxiety "as a transitional emotional state or condition of the human organism that is characterized by subjective, consciously perceived feelings of tension and apprehension, and heightened autonomic nervous system activity". He suggests that these anxiety states vary in intensity and fluctuate over time. The significant difference between Ss from County A and Ss from the Reservation suggests that State anxiety levels were generally lower for the Ss on the Reservation at the time the STAI was administered.
The amount of difference in standard deviations between County A (13.36) and Reservation Ss (13.56) is very small. The difference between County A (13.36) and County B (5.97) is larger. This suggests that the County B group is more homogeneous. There was no significant difference between Ss from County A and those from County B. One conclusion is that, at the time of administration of the STAI, Reservation Ss were subjectively less tense and apprehensive and may have been experiencing lower autonomic nervous system activity (Speilberger, 1970). Another reason which may account for this is that the Reservation is more isolated and relatively more rural. It is about 50 miles from other population centers and has a population of around 150. County A Ss come from a population center of County A which has a population of around 7000. It is difficult to say what, if any, cultural factors may have had any effect on the results. More detailed study of cultural differences, attitudes, values and expectations is needed to answer this question.
The result which shows that the Trait means for all three groups are significantly higher than the State means is not what might be generally expected. It suggests that all three groups have a potential to experience higher levels of State anxiety when placed in stressful situations. One could logically expect, given the constructs of the STAI, that a perceived threat to personal well-being and/or self-esteem would result in elevations on the State scale for all three groups. One example of such a perceived threat may be a rapid increase in population with the potential of changing the characteristics of the community. Such a change would probably have more potential for disruption of traditional ways on the Reservation than in areas of County A or County B. However, depending upon the size of the increase as well as the ability of all three areas to assimilate and provide services to newcomers, each group will be affected. Attitudes of both newcomers and of oldtimers will have an effect.
Doherty (1984) describes a rural mental health program in Nevada which attempts to deal with community problems by emphasizing concepts such as preventive interventions, multi-faceted approaches, effects of the community environment on individuals, and utilization of client advocacy and activist approaches to affect the community as a whole. The report describes a community counsel- ing program which serves a three county area of the state of Nevada and is part of a state-wide system of rural mental health clinics. The program attempts to provide a comprehensive range of mental health treatment, consultation, education and referral services to all ages and a broadly diverse population within the areas it serves. It attempts to do this in as close a coordination as possible with other health and social services. Treatment is provided in the least restrictive manner possible and efforts are made to maintain the dignity of the individual through a community based program which attempts to be responsive to the needs of the community. The program utilizes an interdisciplinary approach which takes advantage of the expertise of social workers, psychologists, and consulting psychiatrists. An outreach worker, who is also a member of the Western Shoshone Tribe, works with the Native American population both on and off the Reservation. She also partakes in staffings, training sessions, and other staff activities. The program is state owned and maintains a community advisory board.
Adequate needs assessments, community planning and allocation of available human resources can help prevent and alleviate potential problems and stressors associated with rapidly growing rural communities. Such activities can give communities perceived and actual control over their futures and can contribute to the well-being and mental health of the whole community.
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