Extending the boundaries, bridging the gaps: crafting Mental Health: Culture, Race, and Ethnicity, a Supplement to the Surgeon General's Report on Mental Health.

The August 2001 issuance of Mental Health: Culture, Race, and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General, represents a landmark in the dialogue--political and scientific--regarding health disparities in the United States. This paper offers a critical appraisal of the process and structure of generating these reports, paying particular attention to issues that marked serious epistemological tensions among the participants. These issues revolved around the relative emphasis placed on (1) mental illness and mental health; (2) risk, etiology, and treatment versus prevention and promotion; (3) large-scale, population-based surveys and randomized clinical trials as the standard bearers of scientific evidence; (4) variation related to gender, social class, and culture; (5) ethnicity and culture as dispositional variables or individual glosses as opposed to dynamic, collective phenomena; and (6) the historical forces that shaped the contemporary context for much of this discussion. It describes the sometimes subtle, other times stark differences in assumptions and experience that sprang from disciplinary orientations, investigative methods, institutional affiliations, and personal histories and agendas.