Healers Prescribe Tribal Tradition

"The medicine man listened to her and said, 'You live in the white man's world and you have a white man's disease and you need to take the white man's medicine,' " said Dekker, in an interview. The woman agreed to take the drugs.

"If I said, 'Don't go to the medicine man, he has never been to medical school' -- that would alienate 90 percent of my patients," Dekker added.

Reconciling the brain disease model of mental disorders with America's increasingly diverse cultural fabric is more than a matter of gaining patient trust.

A host of small studies has shown that psychiatric drugs do not have the same risks and benefits in every ethnic group: Research showed that Caucasians experience twice the side effects of Hispanics from the antidepressants Prozac and Paxil, said Michael Smith, a psychiatrist at the University of California at Los Angeles. And with an earlier class of antidepressants called tricyclics, Hispanics given half the dose had twice the side effects of Caucasians.

Blacks on some anti-psychotic drugs seem more likely than whites to suffer tardive dyskinesia -- repetitive, involuntary movements. Another study found that Asians who got half the dose of an anti-psychotic drug responded better than Caucasians who received the regular dose.

Some patients have avoidable side effects, Smith said, because "standards were developed in Caucasians and were inappropriately extended to other ethnic groups."

Smith and other advocates for "cultural competence" point out that substantial differences also exist among individuals within each ethnic group. Because of the lack of systematic data about variations in drug effectiveness, Smith advises doctors to tailor drug dosages to individuals:

"Most drug companies don't acknowledge the fact that their medications require individualized dosing, because when you say that, it makes it much more difficult for the average doctor to say one dose fits all."