If you take a look again at the weekly resources it is located there under ” Articles, Websites, and Videos:” – It appears like this.
This is Harvard’s Implicit Bias test where you will be able to test your own unconscious biases of various groups. Project Implicit. (2011). Harvard.
After you take two of the Implicit Bias tests share your results here using the following questions:
- Which tests did you take? Why? What intrigued you about the test?
- What were your results? Analyze your results using concepts from this unit and/or previous units.
- Where you surprised by your results? Did they altar how you viewed yourself and your beliefs? Why or why not? Explain position.
- What can you take away from these results? How might these result impact interactions with your clients or future clients? How might our implicit biases impact our clients or communities? Find one resource to suggest next steps for reducing bias.Chapter: 4
Understanding Racism, Prejudice, and White Privilege
4-1Defining and Contextualizing Racism
Hoyt Jr. (2012) defines racism as “a particular form of prejudice defined by preconceived erroneous beliefs about race and members of racial groups.” It is supported simultaneously by individuals, the institutional practices of society, and dominant cultural values and norms. Racism is a universal phenomenon that exists across cultures and tends to emerge wherever ethnic diversity and perceived or real differences in group characteristics become part of a struggle for social power. In the case of the United States, African Americans, Latinos/as, Native Americans, and Asian Americans—groups that we have been referring to as people of color—have been systematically subordinated by the white majority.
There are four important points to be made initially about racism:
· Prejudice and racism are not the same thing. Prejudice is a negative, inaccurate, rigid, and unfair way of thinking about members of another group. All human beings hold prejudices. This is true for people of color, as well as for majority group members. But there is a crucial difference between the prejudices held by whites and those held by people of color. whites have more power to enact their prejudices and therefore negatively impact the lives of people of color than vice versa. The term racism is used in relation to the racial attitudes and behavior of majority group members. Similar attitudes and behaviors on the part of people of color are referred to as prejudice and discrimination (a term commonly used to mean actions taken on the basis of one’s prejudices). Another way of describing this relationship is that prejudice plus power equals racism.
· Racism is a broad and all-pervasive social phenomenon that is mutually reinforced at all levels of society.
· Institutional racism involves the manipulation of societal institutions to give preferences and advantages to whites and at the same time restrict the choices, rights, mobility, and access of people of color.
· Cultural racism is the belief that the cultural ways of one group are superior to those of another. Cultural racism can be found both in individuals and in institutions. In the former, it is often referred to as ethnocentrism. Jones (2000) mentioned that historical insults, societal norms, unearned privilege, and structural barriers are all aspects of institutional racism.
· People tend to deny, rationalize, and avoid discussing their feelings and beliefs about race and ethnicity. Often, these feelings remain unconscious and are brought to awareness only with great difficulty.
· When young children hear the stories of people of color, they tend to feel deeply and sincerely with the storyteller. “I’m really sorry that you had to go through that” is the most common reaction of a child. By the time one reaches adulthood, however, the empathy is often gone. Instead, reactions tend to involve minimizing, justifying, rationalizing, or other forms of emotional blocking. Human service providers are no less susceptible to such defensive behavior, but they must force themselves to look inward if they are sincere in their commitment to work effectively cross-culturally. For this reason, this chapter concludes with a set of activities and exercises aimed at stimulating self-awareness.
4-1aIndividual Racism and Prejudice
The burning question that arises when one tries to understand the dynamics of individual racism is: Why is it so easy for individuals to develop and retain racial prejudices? As suggested earlier, racism seems to be a universal phenomenon that transcends geography and culture. Human groups have always exhibited it, and, if human history is any lesson, they always will. The answer lies within the fact that people tend to feel most comfortable with those who are like them and are suspicious of those who are different. They tend to think categorically, to generalize, and to oversimplify their views of others. They tend to develop beliefs that support their values and basic feelings and avoid those that contradict or challenge them. Also, they tend to scapegoat those who are most vulnerable and subsequently rationalize their racist behavior. In short, it is out of these simple human traits and tendencies that racism grows.
4-1bTraits and Tendencies Supporting Racism and Prejudice
The idea of in-group and out-group behavior is a good place to begin any discussion of racism. There seems to be a natural tendency among all human beings to stick to their own kind and to separate themselves from those who are different. One need not attribute this fact to any nefarious motives; it is just easier and more comfortable to do so. Ironically, inherent in this tendency to love and be most comfortable with one’s own are the very seeds of racial hatred. Thus, what is different can always be and often is perceived as a threat. The tendency to separate oneself from those who are different only intensifies the threat because separation limits communication and thus heightens the possibility of misunderstanding. With separation, knowledge of the other also grows vague. This vagueness seems to invite distortion, the creation of myths about members of other groups, and the attribution of negative characteristics and intentions to the other.
Prejudice is also stimulated by the human proclivity for categorical thinking. It is a basic and necessary part of the way people think to organize perceptions into cognitive categories and to experience life through these categories. As one grows and matures, certain categories become very detailed and complex; others remain simplistic. Some become charged with emotion; others remain factual. Individuals and groups of people are also sorted into categories. These “people” categories can become charged with emotion and vary greatly in complexity and accuracy. On the basis of these categories, human beings make decisions about how they will act toward others.
For example, I have the category “Mexican.” As a child, I remember seeing brown-skinned people in an old car at a stoplight and being curious about who and what they were. As we drove by, my father mumbled, “Dirty, lazy Mexicans,” and my mother rolled up the window and locked her door. This and a variety of subsequent experiences, both direct and indirect (e.g., comments by others, the media, what I read), are filed away as part of my “Mexican” category and shape the way I think about, feel, and act toward Mexicans.
But it is even more complicated than this because categorical thinking, by its very nature, leads to oversimplification and prejudgment. Once a person has been identified as a member of an ethnic group, he or she is experienced as possessing all the categorical traits and emotions internally associated with that group. I may believe, for instance, that Asian Americans are very good at mathematics and that I hate them because of it. If I meet individuals whom I identify as Asian American, I will both assume that they are good at mathematics and find myself feeling negative toward them.
The concept of stereotype is related. Weinstein and Mellen (1997) define stereotype as “an undifferentiated, simplistic attribution that involves a judgment of habits, traits, abilities, or expectations … assigned as a characteristic of all members of a group” (p. 175). For instance, Jews are short, smart, and money-hungry; Native Americans are stoic and violent and abuse alcohol. Implied in these stereotypes is that all Jews are the same and all Native Americans are the same (i.e., share all characteristics). Ethnic stereotypes are learned as part of normal socialization and are amazingly consistent in their content. As a classroom exercise, I ask students to list the traits they associate with a given ethnic group. Consistently, the lists that they generate contain the same characteristics, down to minute details, and are overwhelmingly negative. One cannot help but marvel at society’s ability to transmit the subtlety and detail of these distorted ethnic caricatures. Not only does stereotyping lead to oversimplification in thinking about ethnic group members, but it also provides justification for the exploitation and ill treatment of those who are racially and culturally diverse. Because of their negative traits, they deserve what they get. Because they are seen as less than human, it is easy to rationalize ill treatment of them. Categorical thinking and stereotyping also tend to be inflexible, self-perpetuating, and highly resistant to change. Human beings go to great lengths to avoid new evidence that is contrary to existing beliefs and prejudices.
Psychologists, such as Gordon Allport, suggest that the factors just discussed—in-group and out-group behavior, categorical thinking and stereotyping, avoidance, and selective perception—together set the stage for the emergence of racism. But without the existence of some form of internal motivation, an individual’s potential for racism remains largely dormant. Perry, Murphy, and Dovidio (2015) suggested that the awareness of one’s biases is a major factor in the reduction of prejudice. Various theories have been offered regarding the psychological motivation behind prejudice and racism. In reality, there does not seem to be a single theory that can explain the impetus toward racism adequately in all individuals. More likely, there is some truth in all the theories that follow, and in the case of any given individual, one or more of them may be at work. (The summary of theories that follows derives largely from Allport, 1954; Rutland, Killen, & Abrams, 2010; Melamed & North, 2010; Poteat & Anderson, 2012; Carr, Dweck, & Pauker, 2012; Perry, Murphy & Dovidio, 2015.)
· Self-regulation of prejudice : When a low-prejudiced person has a negative implicit evaluation of an outgroup member (of which he or she may or may not be aware), this evaluation leads to the recognition of a discrepancy between his or her egalitarian goals and his or her negative behavior toward the outgroup.
· Frustration-aggression-displacement hypothesis: This theory holds that as people move through life, they do not always get what they want or need, and as a result, experience varying amounts of frustration. Frustration, in turn, creates aggression and hostility, which can be alternately directed at the original cause of frustration, directed inward at the self, or displaced onto a more accessible target. Thus, if my boss reprimands me, I go home and take it out on my wife, who, in turn, yells at the kids, who then kick the dog. Such displacement, according to the theory, is the source of racism.
· Authoritarian personality : This theory holds that prejudice is part of a broader, global personality type. The classical example is the work of Adorno, Frenkel-Brunswik, Levinson, and Sanford (1950). Adorno and his colleagues postulated the existence of a global bigoted personality type manifesting a variety of traits revolving around personal insecurity and a basic fear of everything and everyone different. Such individuals are believed to be highly repressed and insecure and to experience low self-esteem and high alienation. In addition, they tend to be highly moralistic, nationalistic, and authoritarian; to think in terms of black and white; to have a high need for order and structure; to view problems as external rather than psychological; and to feel anger and resentment against members of all ethnic groups.
· Tajfel’s Social Identity Theory: This maintains that individuals have a natural propensity to strive toward a positive self-image, and social identity is enhanced by categorizing people into in-groups and out-groups.
· Rankism , offered by Fuller (2003), is the persistent abuse and discrimination based on power differences in rank or hierarchy. The experience of being ranked above or below others, which Fuller refers to as being a somebody or a nobody, exists throughout our social system and persists “in the presence of an underlying difference of rank signifying power.” Somebodies receive recognition and experience self-satisfaction and pride in themselves; on the other hand, nobodies face derision and experience indignity and humiliation. Somebodies use the power associated with their rank to improve or secure their situation to the disadvantage of the nobodies below them. Fuller argues that a person’s self-esteem and identity are based on the recognition and appreciation that he or she receives and that a lack of recognition can have serious mental health consequences.
All these theories share the idea that through racist beliefs and actions, individuals meet important psychological and emotional needs; to the extent that this process is successful, their hatred remains energized and reinforced. Within such a model, the reduction of prejudice and racism can occur only when alternative ways of meeting emotional needs are found.
4-2aMicroaggressions and Implicit Bias
In more recent studies, researchers have increasingly argued that overt racist acts and hate crimes do not do as much damage to people of color as subtler microaggressions and implicit biases that tend to be unconscious, invisible, and thus more insidious forms of attack (Constantine and Sue, 2007). Racial microaggressions “are brief and commonplace daily verbal, behavioral, and environmental indignities … that communicate hostile, derogatory, or negative racial slights and insults to the target person or group” (Sue et al., 2007, p. 273). Jones (2008) summarizes an emerging picture of implicit bias ; that is, negative, cognitive racial attributions held unconsciously, interacting with brain activity at the core of white racism:
The implicit measures of racial attitudes have proven to be powerful detectors of racial biases. Moreover, we have utilized social neuroscience to show that racial biases are often “hard-wired.” For example, we have learned that the amygdala region of the brain, commonly associated with fear responses, is activated when the faces of out-group members are detected. Implicit measures of racial attitude such as the Implicit Association Test (IAT) have demonstrated strong connections between positive concepts (heaven, ice cream) and negative concepts (devil, death) and Blacks. (p. XXVIII)
Thus, it seems that the small and repetitive racial slights, misconceptions, and diminutions routinely experienced by people of color are no less destructive and, in many ways, more debilitating than more overt forms of racism. Microaggressions were discussed in Chapter 3 in relation to their traumatizing impact on people of color and will be discussed further in Chapter 8 in regard to unconscious racial slights and biases within therapy.
4-2bImplications for Providers
What does all this information about individual racism have to do with human service providers? Put most directly, it is the source or at least a contributing factor to many problems for which culturally diverse clients seek help. Some clients present problems that revolve around dealing with racism directly; they live with it on a daily basis. Relating to the racism that they encounter in a healthy and non-self-destructive manner, therefore, is a major challenge. To be the continual object of someone else’s hatred, as well as that of an entire social system, is a source of enormous stress, and such stress takes its psychological toll. It is no accident, for example, that African American men suffer from and are at particularly high risk for stress-related physical illnesses.
Other clients present with problems that are more indirect consequences of racism. A disproportionate number of people of color find themselves poor and with limited resources and skills for competing in a white-dominated marketplace. The stress caused by poverty places people at high psychological risk. More affluent people of color are no less susceptible to the far-reaching consequences of racism. Life’s goals and aspirations are likely blocked (or at least made more difficult) because of the color of their skin. There is a saying among professionals of color that one has to be twice as good as one’s white counterpart to make it. This is also a source of inner tension, as are the doubts that a professional of color may have as to whether he or she received a job or promotion because of his or her ability, or because of skin color.
It is critical that providers become aware of the prejudices that they hold as individuals. (Exercises at the end of this chapter, if undertaken with honesty and seriousness, can provide valuable insight into your feelings and beliefs about other racial and ethnic groups.) Without such awareness, it is all too easy for providers to confound their work with their prejudices. For example, if I think stereotypically about clients of color, it is very likely that I will define their potential too narrowly, miss important aspects of their individuality, and even unwittingly guide them in the direction of taking on the very stereotyped characteristics I hold about them. My own narrowness of thought will limit the success that I can have working with culturally diverse clients. It is critical to remember that prejudice often works at an unconscious level and that professionals are susceptible to its dynamics. It is also critical to be aware that, after a lifetime of experience in a racist world, clients of color are highly sensitized to the nuances of prejudice and racism and can identify it very quickly. Finally, it is important to re-emphasize that professional codes of conduct consider it unethical to work with a client with whom one has a serious value conflict. Prejudice and racism are such value conflicts.
Consider the following statistics from various sources about African Americans in the United States:
· Of the prisoners in the United States in 2014, 34 percent are African Americans (NAACP).
· In 2015, the U.S. Census Bureau reported that 25.4 percent of African Americans, in comparison to 10.4 percent of non-Hispanic whites, were living at the poverty level (U.S. Department of Health and Human Services, Office of Minority Health).
· The death rate for African Americans was generally higher than whites for heart diseases, stroke, cancer, asthma, influenza and pneumonia, diabetes, HIV/AIDS, and homicide (U.S. Department of Health and Human Services, Office of Minority Health).
· According to a 2015 Census Bureau report, the average African American household median income was $36,515 in comparison to $61,394 for non-Hispanic white households (U.S. Department of Health and Human Services, Office of Minority Health).
· In 2015, the unemployment rate for African Americans was twice that for non-Hispanic whites (11.4 percent and 5.0 percent, respectively). This finding was consistent for both men and women (U.S. Department of Health and Human Services, Office of Minority Health).
· African Americans are overrepresented in low-pay service occupations (e.g., nursing aides and orderlies, 30.7 percent) and underrepresented among professionals (e.g., architects, 0.9 percent) (Hacker, 1992).
· In 2015, as compared to non-Hispanic whites 25 years and over, a lower percentage of African Americans had earned at least a high school diploma (84.8 percent and 92.3 percent, respectively); 20.2 percent of African Americans have a bachelor’s degree or higher, as compared with 34.2 percent of non-Hispanic whites (U.S. Department of Health and Human Services, Office of Minority Health).
These are the consequences of institutional racism: the manipulation of societal institutions to give preferences and advantages to whites and at the same time restrict the choices, rights, mobility, and access of people of color. In each of these varied instances, African Americans are seen at a decided disadvantage or at greater risk compared to whites. The term institution refers to “established societal networks that covertly or overtly control the allocation of resources to individuals and social groups” (Wijeyesinghe, Griffin, and Love, 1997, p. 93). Included are the media, the police, courts and jails, banks, schools, organizations that deal with employment and education, the health system, and religious, family, civil, and governmental organizations. Something within the fabric of these institutions causes discrepancies, such as those just listed, to occur on a regular and systematic basis. Jones (2000) explained that institutional racism can manifest in two conditions: material and access to power. The author added that examples of material conditions include housing, employment, education, and appropriate medical facilities. Example of access to power include access to information, presence in government, and financial resources.
In many ways, institutional racism is far more insidious than individual racism because it is embedded in bylaws, rules, practices, procedures, and organizational culture. Thus, it appears to have a life of its own and seems easier for those involved in the daily running of institutions to disavow any responsibility for it.
4-3aDetermining Institutional Racism
How does one go about determining the existence of institutional racism? The most obvious manner is through the reports of victims themselves—those who regularly feel its effects, encounter differential treatment, and are given only limited access to resources. But such firsthand reports are often held suspect and are too easily countered by explanations of “sour grapes” or “they just need to pull themselves up by their own bootstraps” by those who may not, for a variety of reasons, want to look too closely at the workings of racism.
A more objective strategy is to compare the frequency or incidence of a phenomenon within a group to the frequency within the general population. One would expect, for example, that a group that comprises 10 percent of this country’s population would provide 10 percent of its doctors or be responsible for 10 percent of its crimes. When there is a sizable disparity between these two numbers (i.e., when the expected percentages do not line up, especially when they are very discrepant), it is likely that some broader social force, such as institutional racism, is intervening.
One might alternatively argue that something about members of the group itself is responsible for the statistical discrepancy, rather than institutional racism. Such explanations, however—with the one exception of cultural differences (to be described later in this chapter)—must be assessed very carefully because they are frequently based on prejudicial and stereotypical thinking. For instance, members of Group X consistently score lower on intelligence tests than do dominant group members. One explanation may be that members of Group X are intellectually inferior. However, there has long been debate over the scientific merit of taking such a position that has yet to prove anything more than the fact that proponents who argue on the side of racial inferiority in intelligence tend to enjoy the publicity they inevitably receive. An alternative and more scientifically compelling explanation is that intelligence tests themselves are culturally biased and, in addition, favor individuals whose first language is English.
There are indeed aspects of a group’s collective experience that predispose its members to behave or exhibit characteristics in a manner different from what would be expected statistically. For instance, because of ritualistic practices, Jews tend to experience relatively low rates of alcoholism. Therefore, it is not surprising to find that the percentage of Jews suffering from alcohol abuse is disproportionately lower than their representation in the general population.
Such differences, however, tend to be cultural rather than biological.
4-3bConsciousness, Intent, and Denial
Institutional racist practices can be conscious or unconscious and intended or unintended. “Conscious or unconscious” refers to the fact that people working in a system may or may not be aware of the practices’ existence and impact. “Intended or unintended” means the practices may or may not have been purposely created, but they nevertheless exist and substantially affect the lives of people of color. A similar distinction was made early in the Civil Rights Movement between de jure and de facto segregation. The former term refers to segregation that was legally sanctioned and the existence of actual laws dictating racial separation. De jure segregation was, thus, both conscious and intended. De facto segregation, on the other hand, implies separation that exists in actuality or after the fact, but may not have been created consciously for racial or other purposes.
It is important to distinguish among consciousness, intent, and accountability. I may have been unaware that telling an ethnic joke could be hurtful, and I might not have intended any harm; however, I am still responsible for the consequences of my actions and the hurt that may result. Similarly, someone I know works in an organization that unknowingly excludes people of color from receiving services, and it was never his or her intention to do so. But, again, intention does not justify consequences, and as an employee of that institution, he or she should be aware of its actions. Thus, lack of intent or awareness should never be regarded as justification for the existence of or compliance with institutional or individual racism.
Although denial is an essential part of all forms of racism, it seems especially difficult for individuals to take personal responsibility for institutional racism, for the following reasons:
· First, institutional practices tend to have a history of their own that may precede the individual’s tenure in the organization. To challenge or question such practices may be presumptuous and beyond one’s power or status. Alternatively, one might feel that he or she is merely following the prescribed employee practices or a superior’s dictates and, thus, cannot fairly be held responsible for them. Similar logic is offered in discussions of slavery and white responsibility:
· Second, people tend to feel powerless in relation to large organizations and institutions. Sentiments such as “You can’t fight City Hall” and “What can one person do?” seem to prevail. The distribution of tasks and power and the perception that decisions come down “from above” contribute further to feelings of powerlessness and alienation.
· Third, institutions are by nature conservative and oriented toward keeping the status quo. Change requires far more energy and is generally considered only during times of serious crisis and challenge. Specific procedures for effecting change are seldom spelled out, and important practices tend to be subtly yet powerfully protected.
· Fourth, the practices of an institution that supports institutional racism (i.e., that keeps people of color out) are multiple, complicated, mutually reinforcing, and, therefore, all the more insidious. Even if one were to undertake sincere efforts to change, it is often difficult to know exactly where to begin.
To provide a better sense of the complexity with which institutional racism asserts itself, I would like to share three very different case studies.
Case Study 1
The first case is an excerpt from a cultural evaluation of Agency X focusing on staffing patterns. The purpose of the project was to assess the organization’s ability to provide culturally sensitive services to its clients and to make recommendations as to how it might become more culturally competent. Although the report does not point directly to instances of institutional racism in staffing practices, they become obvious as one reads through the text and its recommendations.
Currently, People of Color are underrepresented on the staff of Agency X. In the units under study, only two workers are of Color: a Latino and an African American male. Neither are supervisors. In the entire office, only seven staff members are of Color: two Latino/as, one African American, and three Asian Americans. Two of the Asian Americans are supervisors. There are no People of Color in higher levels of management. An often-cited problem is the fact that there are few minority candidates on the state list from which hiring is done. To compensate requires special and proactive recruitment efforts to get People of Color on the lists, as well as the creation of special positions and other strategies for circumventing such lists. At a systems level, attention must be given to screening practices that may inadvertently and unfairly reject qualified minority candidates. While parity in numbers of Staff of Color to population demographics should be an important goal, holding to strict quotas misses the point of cultural competence. The idea is to strive for making the entire organization, all management and staff, more culturally competent, that is, able to work effectively with those clients who are culturally different. Nor is it reasonable to assume that all Staff of Color will be culturally competent. While attempting to add more Staff of Color, it is highly useful to fill the vacuum through the use of community resources and professionals hired specifically to provide cultural expertise.
In general, the staff interviewed were found to be in need of cultural competence training. This would include awareness of broader issues of culture and cross-cultural communication, history and cultural patterns of specific minority cultures, and implications of cultural differences for the provision of client services. Especially relevant was knowledge of normal vs. dysfunctional family patterns within different cultural groups so that culturally sensitive and accurate assessments might be carried out. In moving toward a family support model within the agency, as was indicated by several staff members during our interviews, it is critical to understand family dynamics of a given family from the perspective of its culture of origin as opposed to a singular, monocultural Euro-American perspective. Also evident was a basic conflict within the organization between treatment and corrections models of providing services. Staff adhering to the latter tended to devalue the importance of cultural differences in working with Clients of Color and tended to see Youth of Color as using racism and cultural differences as an excuse for not taking responsibility for their own behavior.
White staff members report the following needs and concerns in regard to working with Children of Color: need help in identifying culturally appropriate resources and placements; discomfort in dealing with issues of race; don’t know the right questions to ask; families often unwilling to discuss or acknowledge race as an issue; the need for more and better training; lack of knowledge about biracial children; and the need for a better understanding of the role of culture in the service model they use.
Staff of Color did not report any experiences of overt discrimination and felt respected by their colleagues. They believed that Agency X was, in fact, trying to deal with the problem of cultural diversity, but that this interest was of rather recent vintage and motivated primarily by political and legal concerns. They also suggested that the liberal climate of the organization did much to justify a pervasive attitude that “we treat everyone the same” and “I know good service provision and can deal with anyone.” Together, such attitudes often served as an excuse for not dealing directly with cultural differences in clients. They also stated that cultural diversity was experienced by some coworkers as an extra burden, requiring extra work from them. As in most work situations, the Staff of Color did experience some distance from coworkers. The onus of keeping up good relations was often felt to be on the Person of Color to put their White coworkers at ease. Staff of Color we interviewed were subject to especially high burnout potential and needed their own resources and support outside the organization. We found both Staff of Color in the units under investigation to be especially strong and competent individuals who were particularly stretched thin between their regular duties and their roles within the organization as cultural experts.
The recent hiring of a Latino professional by Agency X, as a means of dealing with a growing Spanish-speaking population, deserves some comment. The need to provide services to this population has been well documented by the demand that has already arisen for his services. We are concerned, however, that the way in which the position was created will eventually lead to burnout and failure and that much more support for the position must be consciously and systematically provided. We perceive an expectation from within and from outside the organization that this individual will be able to “do it all”—help organize an advisory board and provide services to it, do outreach to the Latino/a community, be an in-house cultural expert, be an advocate with other agencies and a referral source for all Latino/a members of the community, and carry a full caseload of Latino/a and non-Latino/a families. The work demands are already cutting into personal time, and as he deals with other agencies and realizes the lack of culturally relevant services available elsewhere, he becomes even further burdened.
Providing culturally competent services to the Latino/a community, as Agency X is now trying to do, will merely open the floodgates of additional demands for services. The current position holder suggested: “The agency doesn’t realize that this is only the tip of the iceberg.” It is likely that Agency X will soon be faced with adding bicultural, bilingual staff to meet the growing need. In this regard, two caveats should be offered. First, culturally sensitive workers and those assigned caseloads of individuals from non-Euro-American cultures tend to work most effectively and creatively when they are allowed maximum flexibility, leeway, and discretion in how they carry out their duties. Rules and policies established in the context of serving Euro-American clients may be of little help and possibly obstructive to working with culturally different groups. Second, the existence of a defined cultural expert in an organization should not be viewed in any way as a justification for not actively pursuing the cultural competence of the agency in general and its staff.
Case Study 2
The second case study, drawn from the work of Oakland psychiatrist Terry A. Kupers, deals with prisons, mental health, and institutional racism. Kupers (1999) argues that a disproportionate number of mentally ill individuals reside in prison, receive limited or no treatment, and decompensate as a result of the trauma and stress of life behind bars. These same conditions cause previously normal inmates to regularly experience “disabling psychiatric symptoms as well” (p. xvii). Especially dramatic is the impact of these conditions on Prisoners of Color.
According to Kupers (1999), “Racism permeates the criminal justice system” (p. 94). People of Color are more likely than Whites to be stopped, searched, arrested, represented by public defenders, and receive harsh sentences. Incarceration rates are badly distorted, as 50 percent of the current prison population is African American, 15 percent is Latino/a, and Native Americans are dramatically overrepresented in relation to their numbers in the general population. It is estimated that by the year 2020, one third of African Americans and one quarter of Hispanics aged 18 to 34 years will be in the criminal justice system. The numbers grow even more disproportionate as the level of incarceration becomes more severe. For example, minimum security units are primarily White, “whereas the super-maximum-security units contain up to 90 or 95% blacks and Latinos” (Kupers, 1999, p. 95).
The prisons themselves are replete with racial tension, and “racial lines are drawn sharply” within the institutions (p. 93). For their own protection, prisoners self-segregate along racial lines and gangs dominate the political landscape. When tensions rise in the prison yard, inmates “quickly join the largest group of their own race they can reach” (p. 96). Some analysts suggest that racial tensions are kept alive within the system as a means of social control, and that there are many little things that keep Blacks and Whites angry at each other. The bottom line, according to Kupers, is that “race matters very much, to everyone” (p. 96).
Located primarily in rural settings, a majority of prison staff is White, as are those who sit on hearing and appeals panels. In general, they lack experience and knowledge of People of Color and tend to view racially different prisoners in stereotypical ways. Complaints of racial discrimination among guards are rampant. Jobs, supervisory positions, and training tend to be doled out along racial lines, with the more prestigious and better paying ones going to White inmates. At times, practices are just plain cruel. Kupers tells the story of an African American inmate who was “confined in a cell covered with racist graffiti” (p. 98). Although there are “good” guards, inmates complain that codes “among correctional officers” make it difficult “to interfere when a ‘bad cop’ is harassing or brutalizing a prisoner” (pp. 98–99). There are even accusations of guards inciting interracial and gang violence.
Prison life cannot help but remind Prisoners of Color of the injustices and discriminations they have experienced in the outside world. Kupers feels that there is good reason for Prisoners of Color to fear being abused because of race behind bars and that such fear “creates psychiatric symptoms” (p. 103). Stable prisoners are traumatized, and those with histories of mental illness tend to deteriorate and become self-destructive. When victimized by racism, the former report feeling frustrated and full of rage, despair, and powerless. If they cannot hold on to sanity by remaining in contact with family and community or planning for release, the result is often lethargy and/or acting out in fits of defiance. Kupers reports observing significant “anxiety, depression, panic attacks, phobias, nightmares, flashbacks, and uncontrollable rage reactions” in these prisoners (pp. 104–105). The plight of less stable Prisoners of Color is even more precarious.
In the face of persistent and significant racism, they decompensate. Especially frequent are two patterns of emotional breakdown, depending on the prisoner’s mental history. Some are driven to clinical depression due to increasing cycles of hopelessness and despair. Others, in the grip of ever-increasing rage, move toward ego disintegration and psychosis. In both cases, the breakdown tends to be progressive as the correctional staff responds to the increasingly symptomatic behavior with more oppressive measures. Finally, in relation to treatment, Prisoners of Color are more likely to be labeled “paranoid” and “disruptive,” punished by being sent to “lockup” rather than treated, and medicated as opposed to receiving psychotherapy or admittance to prison mental health programs. Kupers summarizes his findings vis-à-vis institutional racism in prison as follows: “Prisoners of Color are doubly affected by racial discrimination behind bars. Racism plays a big part in the evolution and exacerbation of their psychiatric symptomology, and they are more likely than whites to be denied adequate mental health services” (p. 111).
Case Study 3
The third case study is drawn from observations made by the author about issues of race, mental health, and psychology training in South Africa during a two-month stay in Cape Town. During that time, he served as a visiting faculty member in the psychology department of Stellenbosch University, as well as a facilitator for the Institute for Healing of Memories, Cape Town (see Chapter 10).
Stellenbosch is a small university town in the beautiful wine-growing region of the Western Cape known as the Garden Route, an hour’s drive from Cape Town. Beneath its seemingly sleepy exterior, however, lies a most interesting—and at times—chilling history. It is a traditional area of Afrikaner culture, and Afrikaans is still the language in which most undergraduate courses are taught. I would learn that during the World War II era, several members of the psychology department had been among the intellectual architects of the apartheid. In fact, the building in which the psychology department is located was named after a social scientist who had carried out many studies of racial differences in intelligence between Blacks and Whites. It was nothing short of ironic, then, that I would find, housed in that building, by far the most racially balanced and integrated, culturally sensitive, and community-oriented psychology program I had ever come across. Once I had come to know several of the faculty members, I would kid them about the “amount of karma they still had to work off.” In time, I realized just how true that was—how South Africa’s history of colonialism, apartheid, and the pursuit of social justice permeated all aspects of life, including its psychology world.
The lingering symptoms of the past were obvious in many of the community counseling programs I visited. At my first “Healing of Memories” workshop, I watched in amazement as a White facilitator—a very kindly person whom I had previously met—lead a group of almost exclusively Black and Colored participants in a very authoritarian and at times even belittling manner. When asked about the style, I was told that that was all that seemed to work. During visits to several innovative high school “life skills” classrooms, I found similar “tough love” to be the rule rather than the exception. When asked about the use of psychotherapy and individual counseling, I was told that they found it necessary to stay away from that kind of individual work. “Too likely to open these kids up,” I was told. American students in South Africa whom I had supervised also reported being discouraged from and steered away from any kind of dynamic work. They too were cautioned that “we need to keep a lid on these kids’ emotions.”
I am also aware that in the Youth Program at the Institute for Healing of Memories, their work focuses on teaching children South African history rather than direct psychological intervention. Like many second-generation survivors of historic trauma, these children know nothing of what their parents faced during apartheid and the revolution because of their parents’ traumatic silence. I also learned about internalized oppression, South African style. I was introduced to the work of Steven Biko, who was hounded and eventually killed by the apartheid government for his preaching of “black consciousness,” and the importance of psychological liberation from self-hatred and the internalization of colonialism. There was certainly no lack of insight and knowledge about their country’s psychological past. In fact, I found high school and undergraduate students to be far more culturally and racially sophisticated than their American counterparts. The problem is lack of psychological resources. I learned that there was one psychologist for every 100,000 people in South Africa.
In my travels and the various institutions I visited, I was particularly struck by the openness and candor with which South Africans—Black, White, and Colored—spoke about racism and apartheid. In a guided visit to one of the townships, the young Black man who was our guide brought us into the home of his granny, a respected elder of her clan, who, sitting regally in her best finery in an overstuffed chair, proceeded to tell us about her life in intimate detail and the coming of apartheid, the forced migrations, the identity cards, and the death of her husband. There was no hesitation or concern for personal boundaries. I also spent three days sharing a house with two other Healing of Memories facilitators on the grounds of a maximum-security prison, where we did a workshop for high-risk prisoners. Both were colored, experienced educators and shared freely about their families and experiences growing up in South Africa. Especially powerful was watching a TV documentary about the forced relocation of a community under apartheid with the commentary of one of my housemates who had lived through that actual experience. The stories he told were chilling. The Whites I met were equally forthcoming. I particularly remember conversations with South Africans, both of Afrikaans descent, who served as guide and bus driver on a trip through Namibia. The driver had been a career soldier and spoke at length with open candor over a couple of beers about fighting in the war with Angola, South Africa’s protectorate of Namibia, his theories of race superiority, and the uselessness of the Truth and Reconciliation Committee. He was extremely prideful of his past and the history of Afrikaners in South Africa and in no way apologetic about the excesses of the past. “We did what we had to do,” he kept repeating. Our guide, a woman in her forties with a grown family, spoke most openly about the impact—mostly negative—that the democratization of South Africa had had on her world. She complained about how “things,” meaning public services, were not running as well as they had when they were run by Whites. She also talked about how her children in their mid- to late-twenties could not find employment in South Africa and were considering leaving the country to find work. She said that such jobs were going to Blacks and Colored young people. She hesitated for a moment and then added: “I guess that is the way it should be, but it sure has been hard on us. But we are a Christian country, and the changeover probably needed to happen, and we need to just forgive and look for the best in it all.” And, finally, I am reminded of the Healing of Memories workshop that we did for the students in psychology at Stellenbosch, mostly of Afrikaans descent, who shared very honestly about the problems that the apartheid and the political changeover had created in their families. More liberal and well-educated than their parents, they tended to hold very different ideas about apartheid, race relations, and the past. This had caused much tension at home, and they spoke of this sadly and with great pain. They also spoke of their feelings of pride about being Afrikaners—but of trying to forge a new identity, not based on race relations. In hearing them, I was reminded of the German youth and their anger at their parents’ generation over World War II and what Germany had done.
Each time, I listened to the frank and straightforward manner in which South Africans openly spoke about racial politics and the specifics of the apartheid years. I could not help but compare it to the difficulty with which we engage our own racial history in the United States. We speak of it only haltingly, if at all, and almost exclusively in our racially separate communities. We teach a course called “Multicultural Awareness” at The Wright Institute, in which we help students explore their own attitudes toward diversity and multiculturalism, and every year, there is widespread and palpable anxiety among the students who are required to take this course. I believe the differences lie in the nature of race relations in the two countries. Apartheid—no doubt one of the most heinous forms of racism ever conceived—did not hide or conceal itself. Actually, it was openly celebrated. It was acknowledged as a legal reality. It was not hidden from view but was proudly acknowledged by the perpetrators, who saw it as “God’s Way.” The beliefs in racial differences and inequality were built into the social structure and openly celebrated by most Whites and mourned as well as challenged with increasing ferocity by those they repressed. South Africa was not a democracy and in no way pretended its values were egalitarian. Apartheid was the law and structured into the legal system of the country. And, eventually, South Africa fought a bloody revolution for change, and once democracy had been introduced, it undertook a process of public healing—the Truth and Reconciliation Committee—that sought to acknowledge what had occurred under apartheid and the bloody war for independence and to create together an honest and objective narrative and make what reparations were possible to its victims so the country might go on in peace. In the United States, quite the opposite has occurred. Race and race relations have always remained mystified and hidden. As a nation, we have neither acknowledged nor sought to make amends for the destructive acts or the various forms of individual, institutional, or cultural racism we have visited on our minorities throughout our history. Its White majority are largely unaware of their privilege and the hidden forms of institutional racism that exists systemically. Its minorities, which will in less than forty years become a majority, are mystified and enraged by the lack of willingness to acknowledge what they know to be an ever-present reality within their daily lives. The psychic consequences of these two alternative approaches to racism is very different, especially in the way that anger is managed and processed within the psyches of the respective victim populations.
Finally, I would like to speak about the psychology department at Stellenbosch. What I encountered there—much to my surprise—was a very different kind of psychology than typically practiced here in the United States. I found it to be communal rather than individualistic, and self-critical and self-reflective rather than organized around themes of managed care and the medicalization of treatment. What they called “critical psychology” was a central theme in their orientation and work, and by this, they meant addressing the social problems their society now faced—postapartheid and a bloody revolution. According to Painter and Blanche (2004), it represents efforts to address the manner in which mainstream psychology “has positioned itself vis-à-vis neo-colonialism, racism, capitalist exploitation, and neo-liberal market ideologies”; that is, perpetuated the dehumanizing tenets of the broader society in general. I was amazed by the number of research projects being carried out by the faculty in the townships of the Cape Town area. These interventions actively addressed the dysfunctions and healing of a population traumatized by a long history of racism and war. Much of the work was focused on children and youth—their hope for the future. I was also struck by their emphasis on communal themes. Although students (and I worked primarily with their Honors students) were exposed to a broad range of individualistic psychological theories and interventions, these were never isolated from either their community or cultural contexts. I had repeatedly found the word “community” reverberating through my previous visits to South Africa.
During my first visit, I especially remember being taken for a tour of a township and the reaction of several women on our tour who did not want to participate for fear of being depressed by the squalid living conditions they had seen running for miles along the road from the airport. My reaction was something quite different. Even though we were tourists, the residents that showed us around and welcomed us into their homes did so with great sincerity and pride in showing off their community, humble though it was in physical terms. I was also aware of a sense of inner peace and joy—of people being comfortable in one’s own skin—that I’ve seldom seen in the more “developed” world. South Africa has myriad and staggering social problems, and the trauma they have experienced has certainly left its mark. But who one was did not seem to be defined exclusively by the lack of affluence and possessions, but also—and perhaps more centrally—by a palpable sense of one’s community and connection. The psychology department was itself a similar community. I was especially struck by the kindly and thoughtful manner in which I was welcomed into their midst and how so many extended themselves to make sure that I was made to feel comfortable. It was also clear that they sincerely cared about each other and were friends as well as colleagues. In many ways, it reminded me of how I envisioned university life in the United States fifty years ago. Faculty socialized with each other, knew of each other’s lives intimately, gathered regularly to discuss and argue ideas (including every morning over tea and coffee), and presented colloquia on their research for the broader university. And I was invited to do the same. In the United States, we speak of community but live primarily fragmented and individualized lives. I found something very different—to which I was very drawn—in South Africa.
4-3cImplications for Providers
What, then, are the implications of institutional racism for human service providers? First and foremost, the vast majority of providers work in agencies and organizations that may suffer in varying degrees from institutional racism, to the extent that the general structure, practices, and climate of an agency make it impossible for clients of color to receive culturally competent services, the efforts of individual providers, no matter how skilled, are drastically compromised.
It is just not possible to divorce what happens between a provider and clients from the larger context of the agency. Culturally diverse clients may avoid seeking services from a discriminatory agency once they are familiar with its practices. (Such information travels very quickly within a community.) If they must go there, their willingness to trust and enter a working relationship with the individual provider to whom they are assigned is seriously diminished.
Again, their work with individual staff members is affected by how clients perceive and experience the agency as a whole. In their eyes, the provider is always a part of the agency and perceived as responsible for what it does. Finally, the ability to do what is necessary to meet the needs of a culturally diverse clientele may be limited by the rules and atmosphere of the workplace. Are there support, resources, and knowledgeable supervision for working with culturally diverse clients? Is the provider afforded enough flexibility to adapt services to the cultural demands of clients from various cultural groups? If the answer to either of these questions is no, then the provider must be willing to try to initiate changes in how the organization functions—its structure, practices, climate—so it can be supportive of efforts to provide more culturally competent services.
Closely associated with institutional racism is cultural racism—the belief that the cultural ways of one group are superior to those of another. Whenever I think of cultural racism, I remember a Latino student once telling a class about painful early experiences in predominantly white schools:
One day, a teacher was giving us a lesson on nutrition. She asked us to tell the class what we had eaten for dinner the night before. When it was my turn, I proudly listed beans, rice, tortillas. Her response was that my dinner had not included all of the four major food groups and, therefore, was not sufficiently nutritious. The students giggled. How could she say that? Those foods were nutritious to me.
Institutions, like ethnic groups, have their own cultures: languages, ways of doing things, values, attitudes toward time, standards of appropriate behavior, and so on. As participants in institutions, people are expected to adopt, share, and exhibit these cultural patterns. If they do not or cannot, they are likely to be censured and made to feel uncomfortable in a variety of ways. In the United States, the cultural form that has been adopted by and dominates all social institutions is white Northern European culture. The established norms and ways of doing things in this country are dictated by the various dimensions of this dominant culture. Behavior outside its parameters is judged as bad, inappropriate, different, or abnormal. Thus, the eating habits with which my student was raised in his Latino home—in that they differed from what white culture considers nutritious—were judged unhealthy, and he was made to feel bad and ashamed because of it. Herein lies the real insidiousness of cultural racism—those who are culturally diverse must either give up their own ways, and thus a part of themselves, and take on the ways of majority culture or remain perpetual outsiders. (Some people believe that it is possible to be bicultural—that is, to learn the majority culture’s ways and also to function comfortably in two very different cultures. This idea is discussed in Chapter 7.) Institutional and cultural racism are thus two sides of the same coin. Institutional racism keeps people of color on the outside of society’s institutions by structurally limiting their access. Cultural racism makes them uncomfortable if they do manage to gain entry. Its ways are foreign to them, and they know that their own cultural traits are judged harshly.
· Holidays and celebrations: Thanksgiving and Christmas are acknowledged officially on calendars. “Traditional” holiday meals, usually comprising foods that represent the dominant culture, have become the norm for everyone. Holidays associated with non-European cultures are given little attention in American culture.
· Personal traits: Characteristics such as independence, assertiveness, and modesty are valued differently in different cultures.
· Language: “Standard English” usage is expected in most institutions in the United States. Other languages are sometimes expressly prohibited or tacitly disapproved of.
· Standards of dress: If a student or faculty member dresses in clothing or hairstyles unique to his or her culture, he or she is described as “being ethnic,” whereas the clothing or hairstyles of Europeans are viewed as “normal.”
· Standards of beauty: The prevailing ideals of eye color, hair color, hair texture, body size, and shape in the United States exclude most people of color. For instance, black women who have won the Miss America beauty pageant have closely approximated white European looks.
· Cultural icons: Jesus, Mary, Santa Claus, and other cultural figures are portrayed as white. The devil and Judas Iscariot, however, are often portrayed as black (p. 94).
4-3eImplications for Providers
Cultural racism has relevance for human service providers in several ways. First, it is important that providers be aware of the cultural values that they, as professionals, bring to the counseling session and acknowledge that these values may be different from, and even at odds with, those of their clients. This is especially true for white providers working with clients of color. It is not unusual for clients of color to react to white professionals as symbols of the dominant culture and to initially act out their frustrations with a society that so systematically negates their cultural ways.
Second, all helping across cultures must involve some degree of negotiation around the values that define the helping relationship. Most importantly, therapeutic goals and the general style of interaction must make sense to the client. Yet, at the same time, they must fall within the broad parameters of what the provider conceives as therapeutic. Most likely, the provider will have to make significant adaptations to standard methods of helping to fit the needs of the culturally diverse client.
Third is the realization that traditional training as helping professionals and the models that inform this training are themselves culture-bound and have their roots in dominant Northern European culture. As such, what exactly are the values and cultural imperatives that providers bring to the helping relationship? And what relevance do these have for clients whose cultural worldview might be very different? Cultures differ greatly in how they view healing and how they conceive of the helping process. The notion of seeking professional help from strangers makes little sense in many cultures. Similarly, questions of what healthy behavior is and how one treats dysfunction vary greatly across cultures. Given all this cultural variation and the ethnocentricity of traditional helping models and methods, helping professionals must answer for themselves a number of very knotty questions. Is it possible, for example, to expand culture-bound models so they can become universally applicable (i.e., appropriately applied multiculturally)? If so, what would such a model look like? Or is there, perhaps, some truth to the contention of many minority professionals that something in the Northern European dominant paradigm is inherently destructive to traditional culture and that radically different approaches to helping must be forged for each ethnic population? These questions are addressed in Chapter 5.
4-4Racial Consciousness Among Whites and White Privilege
In a very heated classroom discussion of diversity a few years ago, several white male students complained bitterly: “It has gotten to a point where there’s no place we can just be ourselves and not have to watch what we say or do all the time.” The rest of the class—women and ethnic minorities—responded in unison: “Hey, welcome to the world. The rest of us have been doing that kind of self-monitoring all of our lives.” What these men were feeling was a threat to their privilege as men and as whites, and they did not like it one bit. Put simply, white privilege encompasses the benefits that are automatically accrued to European Americans just on the basis of their skin color. Most insidious is that to most whites, it is all but invisible. For them, it is so much a basic part of daily experience and existence and so available to everyone in their “world” that it is never acknowledged or even given a second thought. Or at least it seems that way.
If one digs a little deeper, however, there is a strong element of defensiveness and denial. Whites tend to see themselves as individuals, just “regular people,” part of the human race but not members of any particular racial group. They are, in fact, shocked when others relate to them racially (i.e., as “white”). In a society that gives serious lip service to ideas of equality and equal access to resources (“With enough hard work, anyone can succeed in America” or “Any child can nurture the dream of someday being president”), it is difficult to acknowledge one’s “unearned power,” to borrow the description from McIntosh (1989).
It is also easier to deny one’s white racial heritage and see oneself as colorless than to allow oneself to experience the full brunt of what has been done to people of color in this country in the name of white superiority. Such awareness demands some kind of personal responsibility. If I am white and truly understand what white privilege means socially, economically, and politically, then I cannot help but bear some of the guilt for what has happened historically and what continues to occur. If I were to truly “get it,” then I would have no choice but to give up my complacency, try to do something about rectifying racial disparity, and ultimately find myself with the same kind of discomfort and feelings as the men in my class did. No one gives up power and privilege without a struggle.
It is easy, as whites, to feel relatively powerless in relation to others who garner more power than they do because of gender, class, age, and so forth, and thereby deny that they hold any privilege. As Kendall (2002) points out, one need only look at statistics regarding managers in American industry to find out otherwise. While white males constitute 43 percent of the workforce, they hold 95 percent of senior management jobs. White women hold 40 percent of middle management positions compared to black women and men, who hold 5 percent and 4 percent, respectively. Having said all this, it is equally important to acknowledge that as invisible as white privilege is to most European Americans, that is how clearly visible it is to people of color. To them, we are white, clearly racial beings, and we obviously possess privilege in this society. The idea that we do not realize this obvious fact is, in fact, mind-boggling to most people of color because to them, race and racial inequity are ever-present realities. To deny them must seem either deeply cunning or bordering on the verge of psychosis.
At a broader level, white privilege is infused into the very fabric of American society, and even if they wish to do so, whites cannot really give it up. Kendall (2002) enumerates some reasons for this:
· It is “an institutional (rather than personal) set of benefits.”
· It belongs to “all of us, who are white, by race.”
· It bears no relationship to whether we are “good people” or not.
· It tends to be both “intentional” and “malicious.”
· It is “bestowed prenatally.”
· It allows us to believe “that we do not have to take the issues of racism seriously.”
· It involves the “ability to make decisions that affect everyone without taking others into account.”
· It allows us to overlook race in ourselves and to be angry at those who do not.
· It lets me “decide whether I am going to listen or hear others or neither” (pp. 1–5).
What can be done about white privilege? Mainly, individuals can become aware of its existence and the role that it plays in their lives. It cannot be given away. Denying its reality or refusing to identify as white, according to Kendall (2002), merely leaves us “all the more blind to our silencing of people of color” (p. 6). By remaining self-aware and challenging its insidiousness within oneself, in others, and in societal institutions, it is possible to begin to address the denial and invisibility that comprise its most powerful foundation. Like becoming culturally competent, fighting racism and white privilege—both internally and externally—is a lifelong developmental task.
4-5White Racial Attitude Types
Rowe, Behrens, and Leach (1995) offer a framework for understanding how white European Americans think about race and racial differences. Their research has generated seven attitude structures or types that whites can adopt vis-à-vis race and people of color.
The authors describe the first three types (avoidant, dependent, dissonant) as unachieved and the remaining four (dominative, conflictive, integrative, reactive) as achieved. The distinction between unachieved and achieved refers to the extent to which racial attitude is “securely integrated” into the person’s general belief structure—in other words, how firmly it is held versus how easily it can be changed.
· Avoidant types: Tend to ignore, minimize, or deny the importance of race in relation to both their own ethnicity and that of non-whites. Whether out of fear or just convenience, they merely avoid the topic.
· Dependent types: Hold a position but merely have adopted it from significant others (often from as far back as childhood). Therefore, it remains unreflected, superficial, and easily changeable.
· Dissonant type: Held by individuals who are uncertain about what they believe. They lack commitment to their position and are, in fact, open to new information, even if it is dissonant. Their position may result from a lack of experience or knowledge, may indicate incongruity between new information and a previously held position, or may reflect a transition between positions.
Rowe, Behrens, and Leach (1995) next define four types of racial attitudes that they consider as having reached an achieved status (i.e., sufficiently explored, committed to, and integrated into the individual’s general belief system).
· Dominative attitudes : Involve the belief that majority group members should be allowed to dominate those who are culturally diverse. They tend to be held by people who are ethnocentric, use European American culture as a standard for judging the rightness of others’ behavior, and devalue and feel uncomfortable with non-whites, especially in closer personal relationships.
· Conflictive attitude : Held by individuals who, although they would not support outright racism or discrimination, oppose efforts to ameliorate the effects of discrimination, such as affirmative action. They are conflicted around the competing values of fairness, which requires significant change, and retaining the status quo, which says, “I am very content with the way things are.”
· Integrative attitudes : Tend to be pragmatic in their approach to race relations. They have a sense of their own identity as whites and at the same time favor interracial contact and harmony. They further believe racism can be eradicated through goodwill and rationality.
· Reactive attitudes : Involves a rather militant stand against racism. Such individuals tend to identify with people of color, may feel guilty about being white, and may romanticize the racial drama. They are, in addition, very sensitive to situations involving discrimination and react strongly to the inequities that exist in society.
According to the authors, these are the most frequently observed forms of white attitudes toward race and race relations. The unachieved types are most changeable; by definition, they have not been truly integrated into the person’s worldview. The four achieved forms are more difficult to change, but under sufficient contrary information or experience, they can be altered. When that does occur, it usually involves a process of change during which the individual looks a lot like those who are in the dissonant mode. A summary of Rowe, Behrens, and Leach (1995) can be found in Table 4-1.
Racial Attitude Types and Statuses
Types Status Summary Avoidant Unachieved Ignore, minimize, or deny race Dependent Unachieved Adopt positions of significant others Dissonant Unachieved Lack commitment and change position easily Dominative Achieved Adopt classic bigotry Conflictive Achieved Oppose efforts at social justice Integrative Achieved Open to change through goodwill and rationality Reactive Achieved Stand militantly against racism
4-5aA Model of White Racial Identity Development
Helms (1995) offers a somewhat different approach to understanding how whites experience and relate to race in the United States through her model of white racial identity development. Rather than suggest a series of independent attitude statuses, as do Rowe, Behrens, and Leach (1995), she envisions a developmental process (defined by a series of stages or statuses) through which whites can move to recognize and abandon their privilege. According to Helms, each status or stage is supported by a unique pattern of psychological defense and means of processing racial experience. A statement typical of someone at that developmental level follows the description of each stage.
The first stage, contact status, begins with the individual’s internalization of the majority culture’s view of people of color, as well as the advantages of privilege. Whites at this level of awareness have developed a defense that Helms calls “obliviousness” to keep the issue of race out of consciousness. Bollin and Finkel (1995) describe contact status as the “naive belief that race does not really make a difference” (p. 25).
I’m a White woman. When my grandfather came to this country, he was discriminated against, too. But he didn’t blame Black people for his misfortune. He educated himself and got a job; that’s what Blacks ought to do. (Helms, 1995, p. 185)
The second stage, disintegration status, involves “disorientation and anxiety provoked by unresolved racial moral dilemmas that force one to choose between own-group loyalty and humanism” (Helms, 1995, p. 185). It is supported by the defenses of suppression and ambivalence. At this stage, the person has encountered information or has had experiences that led him or her to realize that race in fact does make a difference. The result is a growing awareness of and discomfort with white privilege.
I myself tried to set a nonracist example (for other Whites) by speaking up when someone said something blatantly prejudiced—how to do this without alienating people so that they would no longer take me seriously was always tricky—and by my friendships with Mexicans and Blacks who were actually the people with whom I felt most comfortable. (Helms, 1995, p. 185)
Reintegration status, the third stage, is defined by an idealization of one’s racial group and a concurrent rejection and intolerance for other groups. It depends on the defenses of selective perception and negative out-group distortion for its evolution.
Here, the white individual attempts to deal with the discomfort by emphasizing the superiority of white culture and the natural deficits in cultures of color.
So what if my great-grandfather owned slaves. He didn’t mistreat them, and besides, I wasn’t even here then. I never owned slaves. So, I don’t know why Blacks expect me to feel guilty for something that happened before I was born. Nowadays, reverse racism hurts Whites more than slavery hurts Blacks. At least they got three square (meals) a day. But my brother can’t even get a job with the police department because they have to hire less qualified Blacks. That (expletive) happens to Whites all the time. (Helms, 1995, p. 185)
The fourth stage, pseudoindependence status, involves an “intellectualized commitment to one’s own socioracial group and deceptive tolerance of other groups” (Helms, 1995, p. 185). It is grounded in the processes of reshaping reality and selective perception. The individual has, at this point, developed an intellectual acceptance of racial differences and espouses a liberal ideology of social justice but has not truly integrated either emotionally.
Was I the only person left in America who believed that the sexual mingling of the races was a good thing, that it would erase cultural barriers and leave us all a lovely shade of tan? … Racial blending is inevitable. At least, it may be the only solution to our dilemmas of race. (Helms, 1995, p. 185)
A person functioning in the immersion/emersion status, fifth along the continuum, is searching for a personal understanding of racism, as well as insight into how he or she benefits from it. As a part of this process, which has as its psychological base hypervigilance and reshaping, there is an effort to redefine one’s whiteness. Entry into this stage may have been precipitated by being rejected by individuals of color and often includes isolation within one’s own group in order to work through the powerful feelings that have been stimulated.
It’s true that I personally did not participate in the horror of slavery, and I don’t even know whether my ancestors owned slaves. But I know that because I am White, I continue to benefit from a racist system which stems from the slavery era. I believe that if White people are ever going to understand our role in perpetuating racism, then we must begin to ask ourselves some hard questions and be willing to consider our role in maintaining a hurtful system. Then, we must try to do something to change it. (Helms, 1995, p. 185)
The final stage, autonomy status, involves “informed positive socioracial-group commitment, use of internal standards for self-definition, and capacity to relinquish the privileges of racism” (Helms, 1995, p. 185). It is supported by the psychological processes of flexibility and complexity. Here, the person has come to peace with his or her whiteness, separating it from a sense of privilege, and is able to approach those who are culturally diverse without prejudice.
I live in an integrated (Black-White) neighborhood and I read Black literature and popular magazines. So, I understand that the media presents a very stereotypical view of Black culture. I believe that if more of us White people made more than a superficial effort to obtain accurate information about racial groups other than our own, then we could help make this country a better place for all people. (Helms, 1995, p. 185)
Helms’s model of white identity development parallels models of racial identity development for people of color that are introduced in Chapter 6. Both involve consciousness raising; that is, becoming aware of and working through unconscious feelings and beliefs about one’s connection to race and ethnicity. However, the goal of identity development in each group is different.
For people of color, it involves a cumulative process of “surmounting internalized racism in its various manifestations,” while for whites, it has to do with the “abandonment of entitlement” (Helms, 1995, p. 184). What the two models share is a process wherein the person (whether of color or white) sheds internalized racial attitudes and social conditioning and replaces them with greater openness and appreciation for racial and cultural identity, as well as cultural differences.
4-5bIdentity Development in the Classroom
Ponterotto (1988), drawing parallels with the earlier work of both Helms (1985) and Cross (1971), describes “the racial identity and consciousness development process” of white participants in a multicultural learning environment, an educational setting that may well be similar to that in which you may find yourself. Ponterotto identifies four stages through which students proceed:
In the pre-exposure stage, the student “has given little thought to multicultural issues or to his or her role as a white person in a racist and oppressive society” (p. 151). In the exposure stage, students are routinely confronted with minority individuals and issues. They are exposed to the realities of racism and the mistreatment of people of color, examine their own cultural values and how they pervade society, and discover that the “mistreatment extends into the counseling process” and “the counseling profession is ethnocentrically biased and subtly racist” (p. 152). These realizations tend to stimulate both anger and guilt—anger because they had been taught that counseling was “value free and truly fair and objective” and guilt because holding such assumptions had probably led them to perpetuate this subtle racism themselves.
In the zealot-defensive stage, students tend to react in one of two ways—either overidentifying with ethnic minorities and the issues they are studying or distancing themselves from them. The former tend to develop a strong “pro-minority perspective” (p. 152) and through it are able to manage and resolve some of the guilty feelings. The latter, on the other hand, tend to take the criticism very personally and withdraw from the topic as a defense mechanism, becoming “passive recipients” (p. 153) of multicultural information. In the real world, such a reaction leads to avoidance of interracial contact and escape into same-race associations. In classes, however, where students are a “captive audience,” there is greater likelihood that the defensive feelings will be processed and worked through as the class proceeds.
In the final stage, integration, the extreme reactions of the previous stage tend to decrease in intensity. Zealous reactions subside, and those students become more balanced in their views. Defensiveness is slowly transformed, and students tend to acquire a “renewed interest, respect, and appreciation for cultural differences” (p. 153). Ponterotto, however, is quick to point out that there is no guarantee that all students will pass through all four stages, and some can remain stuck in any of the stages.
4-6Becoming a Cultural Ally
After participating in a class or workshop on cultural diversity, white students often ask how they can support people of color in addressing racism and moving toward greater social justice. Relevant here is the concept of becoming a cultural ally . Bell (1997) suggests that whites “have an important role to play in challenging oppression and creating alternatives. Throughout our history, there have always been people from dominant groups who use their power to actively fight against systems of oppression … Dominants can expose the social, moral, and personal costs of maintaining privilege so as to develop an investment in changing the system by which they benefit, but for which they also pay a price” (p. 13). Wijeyesinghe, Griffin, and Love (1997) define an ally as a white person who actively works to eliminate racism. Melton (2018) expresses a more general definition of allyship as “a person, group, or nation that is associated with another or others for some common cause or purpose” (p. 2). “This person may be motivated by self-interest in ending racism, a sense of moral obligation, or a commitment to foster social justice, as opposed to a patronizing agenda of ‘wanting to help those poor People of Color’” (p. 98). Melton goes on to describe four steps to best address the role of becoming an ally:
awareness of oneself as a cultural being,
choose a plan and act,
take professional and personal responsibility for our actions and decisions, and
These authors, along with Thompson (2005), describe a more detailed list of the characteristics of a cultural ally. This person:
· Acknowledges the privilege that he or she receives as a member of the culturally dominant group
· Listens and believes the experiences of marginalized group members without diminishing, dismissing, normalizing, or making their experience invisible
· Is humble and does not act as an expert in the marginalized group culture
· Is willing to be confronted about his or her own behavior and attitudes and consider change
· Takes a stand against oppression even when no marginalized-group person is present
· Believes he or she can make a difference by acting and speaking out against social injustice
· Knows how to cultivate support from other allies
· Works to understand his or her own privilege and does not burden the marginalized group to provide continual education
4-6aDoing the White Thing
I would like to end this section on white privilege, identity, and consciousness with a firsthand account of one woman’s personal journey of discovery into her own whiteness and its meaning.
The author, Swan Keyes, is a psychotherapist, consultant, writer, and racial justice educator dedicated to dismantling white supremacy and other forms of oppression. She delivers trainings, lectures, and workshops specializing in helping white people investigate their racial conditioning to become more effective at interrupting oppression, building healthy communities, and advocating for social change.
· As we pull into our driveway, I notice a young Black man walking down the sidewalk toward us, a brown paper bag full of flowers in his hands. I can see that he wants to engage and I am tired and don’t want to deal with anyone.
I step out of the car to hear him say hello. He extends his hand and introduces himself. Mustering up all the friendliness I can, I offer a weak smile and ask him if he is selling flowers.
“Uh, no,” he says, looking surprised. “I’m here to see Alicia.” Alicia is my neighbor of many years.
Ah. Now I notice that this young man is wearing a nice suit. I realize that instead of seeing him, I just projected an image of one of the many Black men who approach me downtown selling the local homeless newspaper or asking for change for the bus. Considering that I’ve never actually met a homeless person selling newspapers in my neighborhood up in the Oakland foothills, I wonder, how is it that instead of seeing this sharply dressed young man bringing flowers for his date, I am seeing some kind of salesman or beggar?
I start to backpedal, fast, hoping he has no idea what has just passed through my mind.
He looks embarrassed (probably for me) and asks if I want some from his bag.
“Oh, no, no, give them to Alicia. Thank you so much. It’s really great to meet you.” We shake hands and quickly part.
My friend Kenji, who has witnessed the interaction, says hi to the man, and we walk into our house.
“Damn!” is all I can say.
“Yeah,” Kenji says, shaking his head, clearly displeased with what he has just observed.
Such a vivid illustration of how my mind has been trained to see a stereotype, rather than a person. Does this young man see how quickly I projected the image of a homeless person onto him? If so, is he hurt or angry, or just laughing it off? Is he used to this kind of projection?
I want to pretend this incident has no impact and could have happened to anyone.
I didn’t mean any harm, and perhaps he had no idea what was going on for me. But if it’s no big deal, why is my stomach in knots? I feel like a jerk, anxious and ashamed. I want to purge the image of the beggar from my mind, eliminate the part of me that can see this young man in that way—the entwined racial and class training embedded in my psyche.
But I know that my white conditioning isn’t just going to evaporate due to my good intentions. So disappointing. I wish intention was everything. Unfortunately, my actions can have harmful effects even when my intentions are great. And in this case, there was another person impacted by the interaction. My friend, Kenji, who witnessed the interaction, is a man of Asian American descent, and daily faces a multitude of stereotypes projected on him from white people and others.
So my practice is to try to put positive intentions into action to learn as much as possible about the origins and impacts of stereotypes and racial conditioning and how they affect people of whiteness and people of color. Although I may not eliminate the mental conditioning that paints a young Black man as a nuisance, I can develop awareness of it and eventually learn to respond in better ways and hopefully work to shift the power imbalance that maintains these stereotypes (the same system that holds Black people on the whole in economic bondage, on the bottom of the social ladder, even in a country that can elect a Black man president).
4-6bBut I’m Not Racist
I like to think of myself as a very open person, dedicated to social justice. Yet I see that when that incident occurred with my neighbor’s date, there were very few African Americans in my life. I had plenty of acquaintances of color whom I proudly called friends, but very few truly intimate relationships. Living in one of the most diverse regions in the country, I socialized mostly with white people—at work, at home, at school, at my meditation center, at parties. At all of these places I can expect the majority of people to look like me.
My lack of close relationships with people of color meant that I rarely had to confront my racial conditioning. This is one of the privileges of being white in U.S. society. For the most part, I can choose whether and when to acknowledge or address racism. I choose not to think about race a good deal of the time. I enjoy films, books, and other media that focus almost entirely on white characters without having to think of this as a racial experience. I go to restaurants, night clubs, and beaches that are predominantly white without thinking about why it is that some spots remain so exclusive. I can just see myself and other white people as the norm (as “human”) and see race only when it comes to people outside of that norm. And I can live in a way where I rarely have to engage the “other.”
So what is this white racial conditioning, or training, and how does it work in the U.S. today? White training is how people are taught to be what we call white. People of all different European ethnicities come to the U.S. and through a process of assimilation, accrue unearned benefits due to light skin color and other features that allow them to be considered “white.” People often give up their ethnic identities to blend in to the mainstream white culture. To be successful requires one to blend in and seek economic privilege and independence within the system. This white training tells us what it means to be “civilized,” professional, beautiful, intelligent, responsible, successful, and such. The training tells us who is outside of this norm and bombards us daily with images of the Other, as strange, deviant, criminal, etc. The stereotypes are often negative and sometimes positive as well (soulful, spiritual, musical, etc.), but always a projection of the parts not recognized within the norm of the dominant culture.
As a child when my hippie father took me to visit his working-class family, descendants of English Protestant early colonial settlers, I knew I did not fit in. Growing up on a commune with a Jewish mother, I was embarrassed at not knowing the social customs of this “normal” family. I knew my father had stepped outside of the bounds of conventional whiteness (though I didn’t yet think of it in racial terms), both in his counterculture lifestyle and in marrying my mother, who was too loud, too emotional, too intellectual, too opinionated, too expressive, too sexual, too much for a white Christian family to have any idea what to do with.
I learned that to fit in (to become like them—culturally white) meant to make myself very small. So, I became a very nice girl. I spoke softly, observed their table manners, didn’t talk about politics, religion, or sex, and generally left most of myself at the door in order to gain entrance to this world that I saw on TV, the world I craved so much to be part of.
Along with the benefits of light skin, there are also many hidden costs to white conditioning. Just as I have learned that to be Jewish is to be “too much” for many other light-skinned people to deal with, I have also taken on a feeling that there is some inadequacy in me because I am white. I used to feel terribly insecure in racially mixed groups, always afraid of doing or saying the wrong thing, or else wanting to say something radical to prove my worth.
I have been immobilized at times, feeling so much shame at the legacy of racism that I couldn’t stand up against racism when I should have. I felt too small, too weak, too incompetent, which is what happens when we are not taught to see our racial conditioning and understand our place in the racial hierarchy. So, I let racist comments go by. I remember once as a teenager meeting an elderly African American man coming out of the health food store in the rural town of Shelburne Falls, Massachusetts, where I grew up. I saw that the man was upset and asked if he was okay. He told me he had just been informed by another customer that Blacks weren’t welcome here. I felt so bad all I could do was tell him how sorry I was. In retrospect, I wish I had confronted the customer or the owner of the store, rather than sink into a sense of helplessness. At the time, I had no idea what to say or do, so I did what I had learned to do: nothing. And the cost was guilt, fear, and alienation. I had connected to this man in my grief and sense of injustice, but the connection ended in my feeling stuck and ashamed, and I wonder if there might have been a reluctance on my part to engage with African Americans afterward, wanting to avoid that feeling of inadequacy I experienced.
The legacy of assimilation has also cost me a sense of connection to my cultural and spiritual roots, so that I have looked to the traditions of others—Native Americans, Africans, Asians, South Americans—for spirituality and culture, wanting to take on something of theirs to fill the void in myself. (I believe this is a major part of why “tribal” tattoos, jewelry, and clothing are so popular in the U.S. today, why we can so easily become culture vultures.)
When I finally decided that I wanted to learn about racism and racial conditioning, I had no idea where to begin. I wanted a place where I could speak honestly and ask some really basic questions. I had already seen that in mixed-race groups, it wasn’t always a good idea for me to speak my mind, partly because I was coming from a pre-school level of understanding of race (like most white people) and required people of color in the group to be continually teaching and speaking to my level—exhausting and often quite unpleasant for them (not that all people of color have awareness of these issues, but I do believe that all are targeted by racism and stereotyping to varying degrees, with varying results). I wanted to sit down with some other white people and lay my questions and stereotypes on the table.
Such a group is extraordinarily hard to come by. Yet as soon as I put out this intention, Kenji found a flyer from a local library advertising the “UNtraining,” a program for white people to explore what it means to be white and how we unconsciously participate in a system that keeps white people in positions of power. I called and talked for hours with the founder, Robert Horton.
Robert’s work was founded on the approach of Rita Shimmin, a woman of African American and Filipina descent who he met at a weeklong international Process Work seminar with Arnold Mindell in the early 90s. People of color at the seminar repeatedly requested that the white folks in the room get together and look at whiteness, rather than asking people of color to teach them about racism. At one point, Robert asked, “Why don’t white people get together and do this?” to which Rita replied, “Why don’t you?” Fortunately for him, she was willing to mentor him while he formed such a group, and remains his teacher to this day, due to his demonstrated commitment to the work.
In the UNtraining, we work with the parts of ourselves we most want to disown, including the areas where we see our racial training. Just as we learn in meditation to observe our thoughts, feelings, and physical states as they rise and pass, so too we can become familiar with how our racial training works. It takes study, long-term commitment, and community, as we learn to overcome the individualistic white training that tells us that we can “fix it” all on our own.
4-6eWays I Avoid Dealing with Racism (and Piss Off People of Color in My Life)
One of the things I discovered early on in the work was the way I was thinking about racism held me back from doing any real work around it. I thought there were two separate kinds of people: good people and racists. I didn’t feel hatred toward people of color, so I didn’t consider myself racist. I was one of those people who might innocently (and not altogether truthfully) state, “Some of my best friends are Black.”
As Robert Horton pointed out, this fallacy that there are two types of people—the racist and the nonracist—is counterproductive. By acknowledging that all people (including so-called people of color) have racial conditioning, and no one chooses it, we stop trying to prove that we are the “right” type of person and we free up energy to develop nonblaming awareness of the stereotypes, fears, and unconscious prejudices we have learned. Also, we begin to see that racism is more than just unconscious attitudes and prejudices, which anyone can have, but it is also a system that holds some people in a position of structural power over others (when one group dominates a society’s economic, government, education, health, and other systems of power, then psychological conditioning is important to understand not just to shift attitudes, but to shift structural imbalance and increase justice and connection between groups).
I also had to give up any attempts at colorblindness. Growing up in a hippie commune where we considered ourselves all one on a spiritual level, I had learned to use spiritual bypass to avoid dealing with social issues. We believed that just because we were caring people, we were somehow immune to social conditioning. We thought that our love was enough to free us from any accountability for the ills of society. Unfortunately, ignorance of issues doesn’t make them go away.
Over the years, examining racism, sexism, heterosexism, class oppression, and other-isms that keep people apart, alliance building became my primary spiritual practice. As with my meditation practice, the ability to develop compassionate awareness became a great source of liberation. Today, it is such a relief when I can see my racial conditioning and not hit myself over the head with it, but instead take the opportunity to go a little deeper in inquiry and make more conscious choices about how to respond to it.
Bias in Service Delivery
8-1The Impact of Social, Political, and Racial Attitudes
There is a vast body of research in social psychology that shows how attitudes can unconsciously affect behavior. Some examples include the following:
· Rosenthal and Jacobson (1968) looked at the relationship between teacher expectations and student performance. Teachers were told at the beginning of the school year that half the students in their class were high performers and the other half were low. In actuality, there were no differences among the students. By the end of the year, however, there were significant differences in how the two groups performed. Those who were expected to do well did so, and vice versa. In another experiment, Rosenthal (1976) assigned beginning psychology students rats to train. Some were told that their rats came from very bright strains; others were told that their rats were genetically low in intelligence. The rats were, in actuality, all from the same litter. By the end of the training period, each group of rats was performing in keeping with their “heredity.” In these two experiments, what the teachers and the psychology students believed and expected were translated into differential behavior, which in turn, became what Rosenthal called a “self-fulfilling prophecy.” In other words, what we believe (i.e., the attitudes that we hold) about people shapes our treatment of them. Freud called this phenomenon countertransference when it occurred in the clinical setting. The following types of similar dynamics have also been demonstrated in relation to helping professionals.
· In another classic study, Broverman et al. (1970) looked at gender stereotyping and definitions of mental health. They asked a group of psychiatrists, psychologists, and social workers to describe characteristics that they would attribute to healthy adult men, healthy adult women, and healthy adults with gender not specified. There was high agreement among subjects, and there were no differences between male and female clinicians. As a group, the clinicians enunciated very different standards of health for women and men; that is, a healthy woman was described in very different terms than was a healthy man. The concept of a healthy adult man and that of a healthy adult of unspecified sex did not differ significantly, whereas that of a healthy adult man and a healthy adult woman did. Compared to men, healthy adult women were seen as more submissive, less independent, less adventuresome, more easily influenced, less aggressive, less competitive, more excitable in minor crises, more easily hurt, more emotional, less objective, and more concerned with appearance. It is probably fair to say that such beliefs about gender differences cannot help but translate into the ways that these clinicians work with their male and female clients.
· In yet another study, researchers looked at the effect of political attitudes on the diagnosis of mental disorders (Wechsler, Solomon, and Kramer, 1970). Clinicians in the study were asked to rate clients on the severity of their symptoms based on videotaped interviews. All clinicians were shown the same videotapes, in which the clients described their symptoms. The only difference was what the clinicians were told about the political activities of the clients. Clients described as being more extreme politically were regularly rated as having more severe symptoms (i.e., as being “sicker” than those who were presented as more conservative). Similarly, when clinicians were told that some subjects advocated violent means of bringing about political change, they, too, were rated as having more severe symptoms, as were those who were described as having very critical attitudes toward the field of mental health. Again, it is a short step to suggesting that the political attitudes and prejudices of providers can color their perception and treatment of politically diverse clients.
· Although there is less empirical data on the effect of racial attitudes on provider behavior (probably because of the desire to appear “politically correct” and, therefore, the difficulty in accurately measuring and identifying racist attitudes), some exemplary studies do exist. Jones and Seagull (1983), for example, asked African American and White clinicians to evaluate the level of adjustment of African American therapy clients. He found that White clinicians tended to rate African American clients as more disturbed than did the African American therapists, especially in relation to how seriously they viewed external symptoms and their assessment of the quality of family relations. Other studies show that counselors and trainees tend to think in terms of stereotypes when working with culturally diverse clients (Atkinson, Casas, and Wampold, 1981; Wampold, Casas, and Atkinson, 1982).
· In addition, there is much research that shows dramatic differences in the kinds of services that White and non-White clients receive. For example, African Americans are more likely to receive custodial care and medications and are offered psychotherapy less often than are Whites (Hollingshead and Redlich, 1958). And even when they are offered psychotherapy, it tends to be short-term therapy or crisis intervention, as opposed to long-term therapy (Turner, 1985). Similarly, African Americans are overrepresented in public psychiatric hospitals (Kramer, Rosen, and Willis, 1972), and African Americans, Latinos/as, and Asian Americans are all more likely to receive supportive vs. intensive psychological treatment and to be discharged more rapidly than whites (Yamamoto, James, and Palley, 1968).
In short, there is no reason to believe that racial attitudes are any less likely to affect the perception and treatment of clients than social or political ones.
8-2Who Are the Providers? Under-Representation in the Professions
It is well documented that clients prefer helpers from their own ethnic group (Cabral and Smith, 2011). The sense of familiarity and safety that this affords cannot be underestimated. However, present statistics do not bode well for potential clients of color; the reality is that people of color are sadly underrepresented among the ranks of helping professionals. This serious lack of non-white providers is often cited as one of the reasons for the underuse of mental health services by people of color.
A study of membership in the American Psychological Association (APA) in 1979, for example, showed that only 3 percent of the members were non-white (Russo et al., 1981). Of more than 4,000 practitioners who claimed their specialty to be in counseling psychology, fewer than 100 were of color. A more recent study showed little change, with members of color representing only 4 percent of the APA membership (Bernal and Castro, 1994).
Nor does the situation improve noticeably when one looks at enrollment figures for graduate training programs. As Atkinson et al. (1996) point out, “the key to achieving ethnic parity among practicing psychologists rests on the profession’s ability to achieve equity in training programs” (p. 231). Statistics collected by Kohout and Wicherski (1993) show that African Americans make up only 5 percent, Latinos/as 5 percent, Asian Americans 4 percent, and Native Americans 1 percent of students enrolled in doctoral psychology programs. These figures represent a decrease for African American students and only a slight increase for the other three groups over the previous 25 years (Kohout and Pion, 1990). Over the course of training, however, disproportionate dropout rates for students of color bring their number at graduation close to the 3 percent or 4 percent reported for APA membership. Recent research from the APA suggest that there was an increase in racial/ethnic minority students in psychology departments—the largest increases were seen by students who considered themselves multi-ethnic.
While much lip service is paid to the need for recruiting more students and faculty of color, the numbers say it all: they have remained consistently low over time. In addition to cost, a major deterrent keeping non-White students out of college (and contributing to their dropout rate when they do go) is the Northern European cultural climate that predominates in such settings. It is not only difficult for students of color (especially those who are not highly acculturated) to navigate the complex application and entry procedures that training programs typically require, but it is also hard to feel comfortable, safe, and welcome in a monocultural environment that is not their own.
An equally critical factor is the number of faculty of color within these programs. These statistics also continue to be quite low. Atkinson et al. (1996) note that within doctoral training programs in clinical, counseling, and school psychology, African Americans make up 5 percent of the faculty, Latinos/as 2 percent, and Asian Americans and Native Americans 1 percent each. These authors succinctly summarize the current situation as follows: “Although ethnic minorities make up approximately 25 percent of the current U.S. population, with dramatic increases ahead, they constitute less than 15 percent of the student enrollment and less than 9 percent of the full-time faculty in applied psychology programs” (p. 231).
8-2aDissatisfaction Among Providers of Color
These numbers will not change until significant diversity is introduced in the helping professions, as well as in their training facilities. At present, both remain overwhelmingly White. Cabral and Smith (2011) expressed that “to improve mental health services for people of color, professionals have emphasized the need for cultural congruence between therapists and clients” (p. 3). D’Andrea (1992) documents this fact by pointing to “some of the ways in which individual and institutional racism imbues the profession.” He offers the following seven examples:
· Less than 1 percent of the chairpersons of graduate counseling training programs in the United States come from non-White groups (89 percent of all chairpersons in counseling training programs are White males).
· No Hispanic American, Asian American, or Native American person has ever been elected president of either the American Counseling Association (ACA) or the APA.
· Only one African American person has been elected president of the APA; that was Kenneth Clark, in 1971.
· A computerized literature review of journal articles found in social science periodicals over a 12-year period (1980–1992) indicated that only 6 of 308 articles published during this time period that examined the impact of racism on one’s mental health and psychological development were published in the three leading professional counseling journals (The Counseling Psychologist, the Journal of Counseling and Development, and the Journal of Counseling Psychology).
· All the editors of the journals sponsored by the ACA and the APA (excluding one African American editor with the Journal of Multicultural Counseling and Development) are White.
· Despite more than 15 years of efforts invested in designing a comprehensive set of multicultural counseling competencies and standards, the organizational governing bodies of both the ACA and the APA have consistently refused to adopt them formally as guidelines for professional training and development.
It is not difficult to read between the lines of D’Andrea’s examples and sense the enormous frustration of providers of color with the seeming slowness with which the professional counseling establishment has moved toward actively embracing and implementing its verbalized commitment to multiculturalism. D’Andrea and Daniels (1995) summarize these feelings as follows:
Although persons from diverse racial/cultural/ethnic backgrounds must continue to lead the way in promoting the spirit and principles of multiculturalism in the profession, it is imperative that White counseling professionals take a more active stand in advocating for the removal of barriers that impede progress in this area. Together we can transform the profession, or together we will suffer the consequences of becoming an increasingly irrelevant entity in the national mental health care delivery system. (p. 32)
Similar sentiments are offered by Parham (1992):
To make the types of changes that are necessary in order that the counseling profession will be able to meet the needs of an increasing number of clients from diverse cultural and racial backgrounds, the profession in general and its two national associations—the American Psychological Association and the American Counseling Association—in particular, will have to learn to share more of its power and resources with persons who have traditionally been excluded from policy-making and training opportunities. (pp. 22–23)
8-2bThe Use of Paraprofessionals
One strategy that held great promise for dramatically increasing the number of providers of color was the use of indigenous paraprofessionals. Stimulated by a visionary book by Arthur Pearl and Frank Reisman (1965) entitled New Careers for the Poor, the National Institutes of Mental Health (NIH) committed extensive resources to educating mental health facilities in the use of ethnic paraprofessionals.
The idea was a rather simple one. Individuals who were natural leaders within ethnic communities were given training in the rudiments of service delivery (basic assessment, interviewing skills, knowledge of psychopathology) and then hired to act both as liaisons and outreach workers to the community and as adjunct providers working under the direction of professional staff. Often, special satellite centers were established in ethnic communities and staffed by these local paraprofessionals. The concept worked exceptionally well for over ten years. Community members were more willing to bring their problems to paraprofessionals who were already known, respected, and able to understand their culture and lifestyle.
Paraprofessional involvement in mainstream agencies, in turn, gave them a certain credibility that was not afforded when the staff was all White. The strategy also served to inject a large number of entry-level ethnic paraprofessionals into the system. Many, in fact, chose to return to school and became professionals. Ironically, this strategy was ultimately undermined by the development of a number of academic paraprofessional training programs. Viewing the paraprofessional role, not so much as a means of creating more indigenous providers but rather as a new entry point into mental health jobs, these programs attracted primarily White middle- to upper-middle-class students. Agencies, in turn, received increased pressure to hire these “professional nonprofessionals.” The ultimate result was that indigenous providers were slowly but systematically replaced by trained paraprofessionals, and a very functional approach to infusing ethnic community members into the mental health delivery system was undermined.
8-3The Use of Traditional Healers
Another potentially useful strategy for overcoming the lack of ethnic helping professionals is the involvement of traditional healers—that is, indigenous practitioners from within traditional ethnic cultures—as part of a mental health organization’s treatment team, either on staff or in a consultative role. This is not only a mark of cultural respect, but it is also an invitation to less acculturated community members who would not normally avail themselves of mainstream services to view mental health services (thus more broadly defined) as a resource for them as well. Barriers to including traditional healers usually come from Western professionals who see the use of shamanic healers as unscientific, superstitious, and regressive. Their hesitancies come from conflicting worldviews, although Torrey (1986), for one, has argued that Western mental health approaches work structurally in much the same way as do indigenous healing systems. Both, for example, are afforded high status and power and also depend on clients sharing the same worldview. Torrey suggests that both be incorporated under the broad multicultural rubric of healer.
Lee and Armstrong (1995), however, enumerate a number of content differences:
· Traditional healing views human capacities holistically, whereas Western providers typically distinguish among physical, spiritual, and mental well-being.
· Western healing stresses cause and effect; traditional approaches emphasize circularity and multidimensional sources in etiology.
· In Western psychology, helping occurs through cognitive and emotional change. In traditional healing, there is also a spiritual basis to health and well-being.
· In Western psychology, helpers tend to be passive in their interventions; indigenous healers are more active and take a major role and responsibility in the healing process itself.
In spite of such differences, the only reason for not pursuing cooperation and consultation is ethnocentrism. Such narrow thinking typically goes hand in hand with cultural insensitivity in Western providers because the very spirituality and religiosity of which they are generally critical play a central role in the worldview of most culturally diverse clients.
One last point needs to be made regarding increasing the number of ethnic helpers. Just because providers have certain racial or cultural roots does not guarantee their cultural competence or ability to work effectively with clients from their group of origin. Making an extra effort to hire providers of color sends an important social and political message. But to do so without careful consideration of a candidate’s experience, skills, training, and cultural competence is merely racism in reverse. No agency would think of randomly selecting White candidates regardless of their credentials and assume that they will be competent to work successfully with a broad spectrum of White clients. However, on a much more frequent basis, agencies do assume that hiring a person of color will resolve problems of racism and cross-cultural service delivery automatically.
As has been continually stressed throughout this book, ethnic groups encompass enormous diversity, and it is dangerous to make assumptions about the characteristics that a given individual possesses merely on the basis of group membership. For example, an agency has within its service jurisdiction a small but growing Latino/a population and wishes to hire someone of Latino/a descent to help provide services. Some of the following questions may prove useful in making informed and culturally sensitive choices among possible candidates:
· Is the person bilingual and fluent in both English and Spanish, written and verbal?
· Is the person bicultural—that is, familiar with the traditional as well as the dominant culture?
· With what specific ethnic subgroups within the broad category of Latino/a culture is the candidate familiar and knowledgeable?
· What is this person’s knowledge of class, gender, and regional differences in the Latino/a community?
· Where was the person born, and how acculturated was the family of origin?
· Does the candidate have firsthand experience with the migration process?
· What is the nature of his or her own ethnic identity?
· With what other ethnic populations has this person worked?
· How culturally competent is this person?
8-4Cultural Aspects of Mental Health Service Delivery
So far, this chapter has looked into sources of bias related to the provider. There are, in addition, aspects of the helping process per se that limit its relevance to clients of color. In general, these relate to the fact that current mental health theory and practice are defined in terms of dominant Northern European cultural values and norms and therefore limit the ability of providers to address and serve the needs of non-White populations adequately. Chapter 5 includes a description of four characteristics of the helping process (as it is currently constituted) that directly conflict with the worldview of communities of color.
Research has shown that African Americans, Hispanics, and Asian mental health is similar or better than whites. Hearld, Budhwani, and Chavez-Yenter (2015) explained that “even with a health advantage, some studies have found discrimination to negatively affect certain mental health outcomes” (p. 107). Here, we explore additional sources of this cultural mismatch, as well as describe ways in which the current helping model portrays clients of color in a negative light, highlights their “weaknesses,” and assumes pathology even when it does not necessarily exist. An extreme example is the case study of Bill, a supposedly psychotic Navajo, with which this chapter opens. His behavior, when viewed through the lens of Navajo culture, looked quite normal, but from the perspective of Western psychology, it reflected a deep disturbance and psychopathology.
8-5Bias in Conceptualizing Ethnic Populations
There is a long history in Western science of portraying ethnic populations as biologically inferior. Highlights include the following:
· Beginning with the work of luminaries such as Charles Darwin, Sir Francis Galton, and G. Stanley Hall, one can trace what Sue and Sue (1990) call the “genetic deficiency model” of racial minorities into the present, continued by research psychologists such as Jensen (1972).
· Similarly, Jews have been vilified under the guise of psychological analysis. Jung (1934), for example, wrote the following comparison of Jewish and Aryan psychologies: “Jews have this peculiarity in common with women, being physically weaker, they have to aim at the chinks in the armor of their adversary, and thanks to this technique … the Jews themselves are best protected where others are most vulnerable” (pp. 165–166). Jung, who also wrote disparagingly of the African American psyche, found his ideas on national and racial character warmly received by the Nazi regime.
· McDougall (1977), an early American psychologist, offers similar sentiments against Jews in his analysis of Freud’s work: “It looks as though this theory which to me and to most men of my sort seems to be strange, bizarre and fantastic, may be approximately true of the Jewish race” (p. 127).
As biological theories of genetic inferiority lost intellectual credibility, they were quickly replaced in social science circles by notions of “cultural inferiority” or “deficit theories.” While political correctness would not allow practitioners with negative racial attitudes to continue to embrace the idea of genetic inferiority, they could easily attach themselves to theories that assumed “that a community subject to poverty and oppression is a disorganized community, and this disorganization expresses itself in various forms of psychological deficit ranging from intellectual performance … to personality functioning … and psychopathology” (Jones and Korchin, 1982, p. 19). These new models took two forms: cultural deprivation and cultural disadvantage. In relation to the former, non-whites were seen as deprived (i.e., lacking substantive culture).
The word disadvantaged—a supposed improvement over the term deprived—implies that although ethnic group members do possess culture, it is a culture that has grown deficient and distorted by the ravages of racism. More recent and acceptable are the terms culturally diverse and culturally distinct. But as Atkinson, Morten, and Sue (1993) point out, even these can “carry negative connotations when they are used to imply that a person’s culture is at variance (out of step) with the dominant (accepted) culture” (p. 9).
Psychological research on ethnic populations has also tended to be skewed in the direction of finding and focusing on deficits and shortcomings. This body of research, which Jones and Korchin (1982) refer to as part of a “psychology of race differences tradition,” has been widely criticized for faulty methodology. Jones and Korchin explain: Studies typically involved the comparison of ethnic and white groups on measures standardized on white, middle-class samples, administered by examiners of like background, intended to assess variables conceptualized on the basic U.S. population (p. 19). Turner and Kramer (2016) further this point by stating “in mental health settings the use of diagnostic criteria that fail to take into account major cultural and social class differences between African American and whites lead to invalid conclusions” (p. 9). But even more insidious have been two additional tendencies:
· Researchers have chosen to study and compare whites and people of color based on characteristics that culturally favor dominant group members. Thus, intelligence is assessed by measuring verbal reasoning, or schoolchildren are compared on their ability to compete or take personal initiative. In other words, research variables portray white subjects in a more favorable light and simultaneously create a negative impression of the abilities and resources of minority ethnic subjects.
· Where differences have been found between whites and people of color, they tend to be interpreted as reflecting weaknesses or pathology in ethnic culture or character. Looking at such studies, various researchers have asked why alternative interpretations stressing the creative adaptiveness or strengths inherent in ethnic personality or culture might not just as easily have been sought. Turner and Kramer (2016) suggest that “one needs to emphasize the uniqueness of persons and evaluate psychological status from the individual’s particular perspective” (p. 9). These negative portrayals and stereotypes of people of color serve to justify the status quo of oppression and unfair treatment, and thus they serve political as well as psychological purposes.
An interesting and provocative example of the psychological mystification of ethnic culture and cultural traits is offered by Tong (2005). Tong argues that the psychological representation of Chinese Americans as the model minority—that is, ingratiating and passive—is more a survival reaction to American racism than a true reflection of traditional Chinese character. He goes on to suggest that there is within traditional culture a “heroic tradition” that portrays the Chinese in a manner very different from the uncomplaining model minority: “Coexistent with the Conventional Tradition was the ‘heroic,’ which exalted a time-honored Cantonese sense of self: the fierce, arrogant, independent individual beholden to no one and loyal only to those deemed worthy of undying respect, on that individual’s terms” (p. 15). Tong calls to task fellow Chinese American psychologists for perpetuating the myth through their research and writings, and thus for confusing psychopathology with culture:
Timid and docile behavior is indicative of emotional disorder. If Chinese Americans seem to be that way by virtue of cultural “background,” it is the case only to the extent that white racism, in combination with our heritage of Confusion [sic] repression, made it so. The early Chinamans [sic] consistently shaped themselves and justified their acts according to the fundamental vision of the Heroic Tradition. Their stupendous feats of daring and courage, however, remain buried beneath a gargantuan mound of white movies, popular fiction, newspaper cartoons, dissertations, political tracts, religious meeting minutes, and now psychological studies that teach us to look upon ourselves as perpetual aliens living only for white acceptance. (p. 20)
Tong calls this mystification of the Chinese American psyche “iatrogenic.” Iatrogenesis is a medical term that means sickness or pathology that results from medical or psychological intervention and treatment.
A final difficulty with contemporary psychology’s model of helping is its theoretical narrowness and inability to acknowledge different cultural ways of looking at and conceptualizing mental health as valid. I once worked as part of a team whose task was to create a mental health service delivery system for recent southeast Asian refugees. This is an at-risk population that has suffered serious emotional trauma as a result of war, migration, and rapid acculturation in the United States. The first problem that we encountered was that there was no concept within their culture for mental health per se, nor was there a distinction between physical and mental health. Problems were not dichotomized, and as we were to learn later, what we considered mental health problems generally presented in the form of physical symptoms.
In time, however, it was possible to discern certain patterns of physical complaints that seemed to indicate emotional difficulties, such as depression and post-traumatic stress disorder (PTSD). But the symptom patterns for these disorders within Southeast Asian populations looked very different from those presented in the DSM-5, which is “normed” primarily on Northern European clients. In addition, the Western concept of helping (i.e., seeking advice, help, or support from a professional stranger) made no sense to our Southeast Asian clients. In most Asian cultures, one does not go outside the family for help, let alone to strangers. The acknowledgment of emotional difficulties brings shame on the family. It is expected that individuals accept their conditions quietly. From a Western perspective, this is considered denial or avoidance.
As a general strategy for intervention, we decided to train paraprofessionals from the community to serve as outreach and referral workers. Not only did our paraprofessionals (who were young adults and among the most acculturated individuals in the community) have great difficulty grasping, understanding, and using the mental health concepts and simple diagnostic procedures we tried to teach them, but there was also a problem in their being accepted by older community members as legitimate health providers. This was largely because of age. So long as we approached the community from a Northern European perspective, we were destined to fail. We had pushed the model of training with which we were familiar as far as it could be stretched, and we were still unable to accommodate major aspects of Southeast Asian culture.
What does one do when the very concept of mental health makes little sense within a culture, or when the very notion of helping as conceived in Western terms is irrelevant because it is considered shameful to share one’s problems with complete strangers? I came away from that experience realizing that if we were to continue, we would have to start from scratch and create a new helping model that was not merely an adaptation of mainstream helping practices, but rather was specifically tailored to the cultural needs of Southeast Asians. (You might want to review Chapter 5 and its discussion of conflicting strategies of cross-cultural service delivery.)
8-5aBias in Assessment
In no other area of clinical work has there been more concern raised about the possibility of cultural bias than in relation to psychological assessment and testing. This is because people of color have for many years watched their children being placed in remedial classrooms or tracked as retarded on the basis of IQ testing and seen loved ones diagnosed as suffering from serious mental disorders because of their performance on various personality tests. Serious life decisions are regularly made on the basis of these tests, and it is reasonable to expect that they be “culture-free”; that is, they should be scored based on what is being measured and not differentially affected by the cultural background of the test taker. In reality, there probably is no such thing as a culture-free test, and it has been suggested—and supported by some research—that ethnic group members tend to be overpathologized by personality measures and have their abilities underestimated by intelligence tests (Snowden and Todman, 1982; Suzuki and Kugler, 1995).
Reynolds and Suzuki (2003) list several factors that can contribute to cultural bias in testing:
· Test items and procedures may reflect dominant cultural values.
· A test may not have been standardized on populations of color, only on middle-class whites.
· Language differences and unfamiliarity or discomfort with the client’s culture can cause a tester to misjudge them or have difficulty establishing rapport.
· The experience of racism and oppression may lead to groupwide deficits in performance on tests that have nothing to do with native ability.
· A test may measure different characteristics when administered to members of diverse cultural groups.
· Differences in experience taking tests may put non-White clients at a disadvantage in testing situations.
In short, it is very difficult to ensure fairness in psychological testing across cultures, and practitioners should exert real care in drawing conclusions based exclusively on test scores (Kim and Zabelina, 2015). As a matter of validation, they should gain as much non-testing collaborative data as possible, especially when the outcome of the assessment may have real-life consequences for the future of the client. They should also be willing not to test a client if it is believed that the procedure will not give useful and fair data.
Having raised all these cautions, the fact remains that a great deal of culturally questionable testing still takes place. Clinicians tend to be overly attached to psychological tests as a means of gaining client information. When they do try to take into account cultural differences, it is done not by creating new instruments, but rather by modifying existing ones—adjusting scores, rewriting items, or translating them into a second language. In general, this merely creates new problems in the place of old ones. The Minnesota Multiphasic Personality Inventory (MMPI) and Thematic Apperception Test (TAT), probably the two most widely used personality assessment techniques, provide excellent examples.
The MMPI is by far the most widely used instrument to measure psychopathology. Historically, it has been administered without reservation to racial and ethnic minorities:
· Concerns about cultural bias were raised for two reasons: first, because it had been normed (i.e., standardized as far as cutoff scores reflecting normal vs. psychopathological behavior) exclusively on White subjects; and second, because it was being used extensively to make decisions about hospitalizing patients, a disproportionate percentage of whom were people of color.
· Cultural differences and the possibility of bias are most evident in differential scoring patterns. African American test takers (from normal, psychiatric, and inmate populations alike), for example, consistently score higher than whites on three scales: F (a measure of validity), 8 (a measure of schizophrenia), and 9 (a measure of mania).
· In addition, 39 percent of the items are answered differently by African American subjects than by white subjects. Of these, a third are not clinical scale items, which implies that differences are related to culture as opposed to pathology.
· There is also evidence that MMPI items are neither conceptually nor functionally equivalent for African Americans and whites; this suggests that they neither mean the same thing nor fulfill a similar psychological purpose for the two groups.
As a means of dealing with these problems, Costello (1977) developed a Black-White Scale that adjusted African American scores so they might be interpreted similarly to white scores. But Snowden and Todman (1982) are critical of this procedure:
The Black-White Scale may be useful in the short term for making interpretive adjustments to allow for known differences, however, must be seen as a stopgap measure. In the long run, it leaves unanswered all the pertinent questions raised by both cross-cultural and environmental psychologists alike … The Costello Black-White Scale does not ask these questions; it merely corrects for them. The logical extension of this scale could very well be the following: If one subtracts a factor of x from the score of a black male, his profile is then “as good” as if it were of a white. One can conclude with confidence that the MMPI has never established its validity as a diagnostic or assessment instrument with blacks. (pp. 210–211)
The MMPI-2, a revision of its predecessor, was tested initially on both African American and Native American sample populations. The resulting research has been so confusing, however, that Dana (1988) and Graham (1987) both conclude that it is best not to use the test with ethnic group members.
The TAT and the Rorschach are the most widely used projective tests for assessing personality and psychopathology. The TAT involves showing clients drawings of people in various situations and asking them to tell a story about the picture. Scoring involves both the kinds of themes that are generated and the style of responding:
· Questions about its use with non-White populations were raised early because the stimulus figures on the cards were White, and there was the obvious question of whether African American clients, for example, could identify with these figures or rather would inhibit self-disclosure because of them. To test this, Thompson (1949) developed the same cards redrawn with African American figures and used them with African American clients. Although he showed that his cards generated more responses than did the original White cards, all the questions about cultural comparability raised by Reynolds and Kaiser (1990) remain unanswered.
· TAT scoring generates impressions about unmet needs within the client. Who is to say that such needs or motivations are equivalent across cultural groups or that the stimulus pictures, regardless of the race of the figures, have equivalent cultural meanings?
· Finally, there is a question about the use of projection with non-White groups. Generally, it has been found that blacks are less responsive, less willing to self-disclose, and more guarded about their participation in the TAT testing than members of other groups. Snowden and Todman (1982) suggest that this guardedness may be culturally determined and the result of a long history of dealing with racist institutions.
In spite of all these questions about the cultural validity of the TAT, it continues to be used cross-culturally. There is, in fact, now a Latino/a version, as well as one specifically designed for children, which has cards showing animal characters instead of people.
8-5bBias in Diagnosis
Culture shapes and affects the very essence of how clinical work is done (Neighbors, Trierweiler, Ford, and Muroff, 2003). According to Gaw (1993), it colors the following areas:
· How problems are reported and how help is sought
· The nature and configuration of symptoms
· How problems are traditionally solved
· How the origin of presenting problems is understood
· What appropriate interventions involve
· How the helping relationship is maintained over time
In short, each culture has its own paradigm of how these processes occur, and there is enormous variation. Difficulties emerge, however, when practitioners superimpose their cultural worldviews onto the life experience of culturally diverse clients and then make clinical assumptions or judgments from that perspective. This is where things stand today vis-à-vis Western mental health service delivery and the desire to serve other cultural groups. Ricci-Cabello, Ruiz-Pérez, Labry-Lima, and Márquez-Calderón (2010) stated “the relevance of inequalities in terms of health-care is especially evident among patients suffering from chronic or long-term illnesses” (p. 572). Most practitioners tend to be far too narrow and ethnocentric in their thinking to acknowledge and accept other versions of clinical reality. Rather than try to redesign the “puzzle” and broadening their perspective, providers keep trying to force the “round piece” into the “square hole,” and the “hole” keeps objecting. This method could cause serious issues when helping culturally diverse individuals.
8-6Cultural Variations in Psychopathology
Nowhere is the limited thinking of Western psychology more challenged by cultural variation than around the question of what psychopathology is and how it is diagnosed. This is also where misdiagnosis of those who are culturally diverse most regularly occurs. Jones and Korchin (1982) summarize the issue as follows:
Most mental health workers proceed on the assumption of the pancultural (i.e., etic) generality of categories, criteria, and theories of psychopathology originated in Western cultures. Minority clinicians have long objected that standard psychiatric nomenclature does not recognize cultural variation in symptomology. This position is quite consistent with a growing view among cross-cultural psychologists that problems of identifying cases of psychopathology in clients from different cultures and comparing incidence and forms of psychopathology across cultures need to be reconsidered. (pp. 26–27)
8-6aCultural Attitudes toward Mental Health
Cultures differ dramatically in their orientation and attitude toward mental disorders, as well as in their understanding of personality dynamics, what is considered therapeutic, and how help is to be sought. Cultural responses to these issues are shaped by certain key themes that contribute a distinctive Gestalt to how each culture relates to the problem of mental illness. Jang, Chiriboga, Herrera, Martinez, Tyson, and Schonfeld (2011) expressed that there needs to be more research on mental health among ethnic and racial minorities. More research could identify misconceptions, personal beliefs, and cultural attitudes related toward mental health. Regarding past research on cultural attitudes toward mental health, I will summarize the early research of Lum (1982) on mental health attitudes among Chinese Americans, whose clinical worldview differs substantially from that of Western psychology. Within the Chinese American culture, mental health and mental illness are two sides of the same coin.
· According to Lum, individuals are considered mentally healthy if they possess the capacity for self-discipline and the willpower to resist conducting oneself or thinking in ways that are not socially or culturally sanctioned; a sense of security and self-assurance stemming from support and guidance from significant others; relative freedom from unpleasant, morbid thoughts, emotional conflicts, and personality disorders; and the absence of organic dysfunctions, such as epilepsy or other neurological disorders. Similarly, mental illness involves the opposite: a loss of discipline, preoccupation with morbid thoughts, insecurity because of the absence of social support, and distress stemming from external factors.
· Consistent with this, Chinese Americans tend to externalize blame for mental illness, thus setting the stage for avoidance of unwanted thoughts and feelings. Traditional Chinese wisdom sees value in learning to inhibit and control one’s emotions. Defensively, according to Hsu (1949), Chinese tend to use suppression as opposed to repression, which is more common among European Americans. Suppression tends to have an obsessional quality because to use it effectively, one must rationalize, justify, or use other intellectual strategies to blunt the anxiety. Using it, in turn, tends to encourage obsessive-compulsive qualities, including extreme conscientiousness, meticulousness, acquiescence, rigidity, and a preference for thinking over feeling.
· As patients, Chinese Americans prefer helpers who are authoritarian, directive, and fatherly in their approach. They expect, in turn, to be taught how to occupy their minds to avoid unwanted thoughts and feelings. Insight approaches tend to have limited meaning, and generally, therapy does not seem to affect Chinese Americans characterologically.
· Finally, help-seeking is limited because within the Chinese community, there is a stigma and shame around mental illness. Shame often leads to minimizing the seriousness and frequency of a problem. Patients often feel “ashamed and ambivalent about their illness” and are reluctant to tell others about their emotional difficulties. In sum, the threads that run through the Chinese American worldview of mental health and illness are the importance of controlling emotions and thoughts and their avoidance when they become too intrusive or distracting, the necessity of social support as a precondition for healthy mental functioning, the submerging of the self as a means of deferring to family and authority, and mental illness as a stigma that requires the individual to tolerate disturbing symptoms rather than bring shame on the family. These themes translate basic cultural values into behavioral prescriptions for living that, in turn, reinforce basic cultural values.
8-6bCultural Differences in Symptoms, Disorders, and Pathology
Cultures also differ as to what disorders are most typically observed, how symptom pictures are construed, and even what is considered pathological:
· Some disorders (e.g., schizophrenia and substance abuse) appear to be universal, although the exact content is culture specific. Hallucinations, for example, tend to contain familiar cultural material, such as voices speaking to the person in his or her native language or visions infused with cultural symbols and motifs. Other disorders (e.g., depression) can be observed across cultures, but they vary dramatically in relation to specific symptoms. In Western clients, for example, depression is diagnosed on the basis of a combination of psychological and physical symptoms, whereas among southeast Asian clients, physical symptoms such as headaches and fatigue are more prevalent indicators.
· There are also culture-specific syndromes or disorders that appear only among members of a single cultural group. Jones and Korchin (1982) point to two—ataque, found only among Puerto Ricans, is a hysterical seizure reaction in which patients fall to the ground, scream, and flail their limbs. Largely unfamiliar to majority practitioners, it tends to be misdiagnosed as a more serious seizure disorder. A similar disorder, called “falling out” disease, is found only among rural southern African Americans and West Indian refugees and is regularly misdiagnosed as epilepsy or a transient psychotic episode.
· The same symptom can have very different meanings depending on the cultural context in which it appears. Mexican Americans, for instance, view hallucinations as far less pathological and more within the realm of everyday (normal) experience than do whites. Hearing voices, thus, is more culturally sanctioned and often associated with deep religious experiences. Meadow (1982) shows that hospitalized Mexican American patients report significantly more hallucinations, both visual and auditory, than do whites. These variations in experiencing raise the important question of exactly where culture ends and psychopathology begins. Meadow (1982) attempts to sort it out as follows:
Some Mexican-American hallucinatory experiences may simply reflect a cultural belief and occur in persons completely free of psychopathology. In other cases, Mexican-American hallucinations may have the same significance as those reported by Anglo-American patients. There exists an intermediate group of Mexican-American patients in which the hallucination may be interpreted as a symbolic expression of a wish fulfillment or as a sign of a warded-off superego criticism. For these patients, the hallucination is a symptom of psychopathology, but it does not signify the serious break with reality that would be implied if it occurred in an Anglo-American case. (p. 333)
8-6cThe Globalization of Treatment Modalities
Equally disturbing is the recent trend toward the globalization and exportation of Western conceptions of mental health and their associated treatment modalities, especially in relation to Third World cultures. In his recent book, Crazy Like Us: The Globalization of the American Psyche, Ethan Watters (2010) warns of the enormous and unintended cultural consequences of such practices among Western mental health providers:
Over the past thirty years, we Americans have been industriously exporting our ideas of mental illness. Our definitions and treatments have become the international standards. Although this has often been done with the best of intentions, we’ve failed to foresee the full impact of these efforts. It turns out that how a people think about mental illness—how they categorize and prioritize the symptoms, attempt to heal them, and set expectations for their course and outcome—influences the diseases themselves. In teaching the rest of the world to think like us, we have been, for better or worse, homogenizing the way the world goes mad. (p. 2)
Watters goes on to warn that as a result of the exportation of Western training in mental health, the use of the DSM as a standard for diagnosis and definition of various categories of mental illness, the worldwide distribution of Western-oriented professional journals and training conferences, and the enormous funding of research and marketing of medication for mental illness, “the remarkable diversity once seen among different cultures’ conceptions of madness is rapidly disappearing” (p. 3).
Underlying this standardization of Western ideas of the mind and mental health is an enormous sense of hubris and ethnocentrism, not to mention drug company profit motives, that totally disregards the importance and value of culture and cultural variation and its critical role in the expression and healing of mental illnesses. However:
Cross-cultural researchers and anthropologists… have shown that the experience of mental illness cannot be separated from culture. We can become psychologically unhinged for many reasons… Whatever the cause, we invariably rely on cultural beliefs and stories to understand what is happening. Those stories, whether they tell of spirit possession or serotonin depletion, shape the experience of the illness in surprisingly dramatic and often counterintuitive ways. In the end, all mental illness, including such seemingly obvious categories such as depression, PTSD, and even schizophrenia, are every bit as shaped and influenced by cultural beliefs and expectation… as any other mental illness ever experienced in the history of human madness. The cultural influence on the mind of a mentally ill person is always a local and intimate phenomenon.” (p. 6)
As an example, Watters offers four in-depth examples of the Westernization and importation of mental illness in four different cultures: the rise of anorexia in Hong Kong, the wave that brought PTSD to Sri Lanka, the shifting mask of schizophrenia in Zanzibar, and the mega-marketing of depression in Japan. Watters ends his critique of the exportation of our own mental health concepts with a telling question: “Given the level of contentment and psychological health our cultural beliefs about the mind have brought us, perhaps it’s time that we rethink our generosity” (p. 255).
8-6dThe Case of Suicide
The same mental health problem can be configured very differently in terms of both its sources (etiology) and its frequency (incidence) across cultures. A classic example is suicide. According to the Group for the Advancement of Psychiatry Committee on Cultural Psychiatry (1984), suicide rates differ substantially across ethnic groups in the United States, as follows:
· By far, the highest aggregate suicide rate (i.e., for all ages and genders combined) is found among Native Americans.
· The next highest is among European Americans, followed by Chinese Americans and Japanese Americans.
· The lowest aggregate rates are found among African Americans and Latinos/as.
Practitioners are often surprised by the relatively low rates of suicide among people of color. Why? Because, stereotypically, many equate non-whites with violence. It is also useful to note, as pointed out previously, that as ethnic groups assimilate, their relative position in the hierarchy increasingly comes to approximate that of European Americans. Thus, with acculturation, it is expected that African Americans, Latinos/as, and Asian Americans will increase their aggregate suicide rates.
Looking at peak rates across ethnic groups provides even further insights, especially because it is reasonable to assume that suicide rates reflect periods of optimal stress in a group’s life cycle:
· For European Americans, suicides tend to occur three times as often for men as for women. In addition, peak rates tend to increase with age. For men, the highest rates are in those over 65, and for women, rates are highest in their early 50s.
· The picture is very different for communities of color. First, suicide occurs most frequently among young males in African American, Native American, and Latin cultures. Japanese Americans show a similar trend, but it is less pronounced. Chinese American young males are a notable exception (Group for Advancement, 1989). These high rates most likely result from the fact that young, non-White males are usually “the point men” for acculturative stress. They tend to be the ones who have the closest, most sustained contact and least positive interactions with White institutions, usually through school and then work. High rates of unemployment and underemployment are certainly contributing factors. Research has also shown that young men of color who have consolidated a positive ethnic identity and attachment to tradition are less likely to be at risk of suicide than those who have become marginalized from their culture. The same is true for other self-destructive behaviors, such as substance abuse and violence.
· A second major finding of the 1989 study is the extremely low suicide rates among African American, Native American, and Latina women when compared with ethnic males and majority group members combined. The one exception was Chinese American women, who showed a peak incidence of it in later life. There seem to be two reasons for these low rates. First, because of traditional sex roles, ethnic women have less exposure to the stressful effects of acculturation. In addition, they tend to experience much lower rates of unemployment and underemployment and can also derive personal satisfaction from alternative roles in the home. The higher suicide rate among older Chinese women is probably because of the interaction of several factors. They tend to remain closer to their cultural tradition and, as such, are separatist in their orientation toward majority culture. As they lose their nurturing role in the family with age and as their children acculturate, they tend to grow even more isolated and lack support for their traditional orientation. In addition, many experience poverty without support from their family, and they are unable or unwilling to seek help from majority social agencies.
· Finally, there are especially low rates of suicide among older African Americans, Native Americans, and Latinos/as in comparison to younger ethnic group members and majority group members combined (Group for Advancement, 1989). It is likely that these individuals have learned to cope with the acculturative stress. They tend to be revered in their communities and supported by strong community institutions that they likely helped found. The fact that older Asian Americans were not included in this statistic may reflect the effects of greater acculturation, which would lead to greater isolation of the elderly, as is more common in mainstream culture.
Given such cultural relativity in defining mental health and psychopathology, an interesting question arises as to the appropriate criteria to be used in assessing psychopathology. From what cultural perspective should deviant behavior be judged? And within any particular cultural perspective, what makes a behavior deviant or psychopathological? The problem is made difficult by the fact that ethnic group cultures exist within a broader framework than is usually identified and is defined culturally as Northern European. From a clinical standpoint, individuals’ behavior must be judged in accordance with the values and criteria of their own group’s culture (Garlow, Purselle, and Heninger, 2005). Thus, “to justify an interpretation of behavior as an instance of psychopathology, it must be established that there is intersubjective agreement among members of the culture that the behavior in question represents an exaggeration or distortion of a culturally acceptable behavior or belief” (Jones and Korchin, 1982, p. 27). If one applies this maxim to Bill, the institutionalized Navajo whose case is discussed at the start of this chapter, it is clear that he was acting within the bounds of culturally acceptable Navajo behavior and that his diagnosis as catatonic, his assessment as psychopathological from a Western psychological perspective, and his institutionalization were all inappropriate.
8-6eRacial Microaggressions and the Therapeutic Relationship
Bias can also be unintentionally introduced into the therapeutic relationship through the unexamined attitudes of the human service provider. In Chapter 2, I introduced the notion that a central tenet of cultural competence is the self-awareness of one’s racial attitudes and the negative impact they might have in forming a bond with culturally diverse clients. In Chapter 3, I briefly discussed the topic of implicit bias and racial microaggressions. Here, we will explore how these largely unconscious aspects of the therapist’s worldview can be introduced into the helping relationship and also how they might be addressed and eliminated.
According to Sue et al. (2007), microaggressions are “unconsciously delivered in the form of subtle snubs or dismissive looks, gestures, and tones. These exchanges are so pervasive and automatic in daily conversations and interactions that they are often dismissed and glossed over as being innocent and innocuous” (p. 273). They further argue that they are counterproductive to therapeutic efforts because they can be “detrimental to persons of color because they impair performance in a multitude of settings by sapping the psychic and spiritual energy of recipients by creating inequalities.” They are also not limited to human interactions but can reside within various environments that by their nature expose people of color to assaults against their racial identities, often by the lack of familiar racial content.
The authors define three forms of microaggressions. Microassaults are verbal and nonverbal attacks intended with varying degrees of conscious awareness to hurt a person of color through name-calling, avoidance, or other forms of discriminatory behavior and insensitivity. Microinsults are communications that “convey rudeness and demean a person’s racial heritage or identity.” Microinvalidations are communications that exclude, negate, or nullify psychological thoughts, feelings, or experiential reality of people of color. All three types, especially the latter two, can be observed frequently in the therapeutic interaction between therapist and client, particularly among White mental health practitioners. Sue et al. have identified nine categories of microaggression with distinct themes. Table 8-1 provides examples of racial microaggressions in therapeutic practice and their accompanying hidden assumptions and messages.
Examples of Racial Microaggressions in Therapeutic Practice
Theme Microaggression Message Alien in Own Land When Asian Americans and Latin Americans are assumed to be foreign-born A White client does not want to work with an Asian American therapist because “she will not understand my problem.”
A White therapist tells an American-born Latino client that he should seek a Spanish-speaking therapist.
You are not American. Ascription of Intelligence Assigning a degree of intelligence to a person of color on the basis of their race A school counselor reacts with surprise when an Asian American student had trouble on the math portion of a standardized test.
A career counselor asks a black or Latino/a student, “Do you think you’re ready for college?”
All Asians are smart and good at math.
It is unusual for people of color to succeed.
Color Blindness Statements that indicate that a White person does not want to acknowledge race When a client of color attempts to discuss her feelings about being the only person of color at her job and feeling alienated and dismissed by her coworkers, a therapist says “I think you are being too paranoid. We should emphasize similarities, not people’s differences.” A client of color expresses concern in discussing racial issues with her therapist. Her therapist replies with, “When I see you, I don’t see color.” Race and culture are not important variables that affect people’s lives. Your racial experiences are not valid. Criminality/Assumption of Criminal Status A person of color being presumed to be dangerous, criminal, or deviant on the basis of their race When a black client shares that she was accused of stealing from work, the therapist encourages the client to explore how she might have contributed to her employer’s mistrust of her. A therapist takes great care to ask all substance abuse questions in an intake with a Native American client and is suspicious when the client says he has no history with using substances. You are a criminal. You are deviant. Denial of Individual Racism A statement made when whites renounce their racial biases A client of color asks his or her therapist about how race affects their working relationship. The therapist replies, “Race does not affect the way I treat you.” Your racial or ethnic experience is not important. A client of color expresses hesitancy in discussing racial issues with his White female therapist. She replies “I understand. As a woman, I face discrimination also.” Your racial oppression is no different than my gender oppression. Myth of Meritocracy Statements that assert that race does not play a role in succeeding in career advancement or education A school counselor tells a black student that “if you work hard, you can succeed like everyone else.” A career counselor is working with a client of color who is concerned about not being promoted at work despite being qualified. The counselor suggests, “Maybe if you work harder, you can succeed like your peers.” People of color are lazy and/or incompetent and need to work harder. If you don’t succeed, you have only yourself to blame (blaming the victim). Pathologizing Cultural Values/Communication Styles The notion that the values and communication styles of the dominant or white culture are ideal A black client is loud, emotional, and confrontational in a counseling session; the therapist diagnoses her with borderline personality disorder. A client of Asian or Native American descent has trouble maintaining eye contact with his therapist; the therapist diagnoses him with a social anxiety disorder. Advising a client, “Do you really think your problem stems from racism?” Assimilate to the dominant culture. Leave your cultural baggage outside. Second-class Citizen Occurs when a white person is given preferential treatment as a consumer over a person of color A counselor limits the amount of long-term therapy provided at a college counseling center; she chooses all white clients over clients of color. Clients of color are not welcomed or acknowledged by receptionists. Whites are more valued than people of color. White clients are more valued than clients of color. Environmental Microaggressions Macro-level microaggressions, which are more apparent on a systemic level A waiting room office has pictures of American U.S. presidents. Every counselor at a mental health clinic is white. You don’t belong or only white people can succeed. You are an outsider. You don’t exist.
Source: Based on Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., and Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, Vol. 62, No. 4, 271–286.
Microaggressions are particularly insidious because of their invisibility to the perpetrator and often the recipient as well. Most whites tend to view themselves as “good, moral, and decent” and find it difficult to see themselves as racially biased or engaging in discriminatory behavior. In addition, such acts can “usually be explained away by seemingly non-biased and valid reasons.” For the recipient, on the other hand, there is always the “nagging question” of what really occurred. It has been reported that in such situations, people of color often experience a vague feeling of having been attacked, disrespected, or that something is just not right. Sue et al. further identity four psychological dilemmas that microaggressions pose for both white perpetrators and the people of color involved in such encounters. These include:
· A clash in racial realities in which whites tend to underestimate the existence and impact of racism and discrimination as well as their capacity for bias and racism, and people of color view whites as racially insensitive, superior, needing to be in control, and actively discriminatory.
· An invisibility of unintentional expressions of bias on the part of whites, who tend to be stunned by the accusation of bias, feel betrayed by what they perceive as their good intentions in the interaction, or are consciously unaware when they respond differentially on the basis of race or automatically because of cultural conditioning. In other words, how does one prove that a microaggression has occurred?
· A perception on the part of whites that minimal harm has resulted from the alleged microaggression, accompanied by a belief that the person of color “has overreacted and is being overly sensitive and/or petty.”
· A Catch-22 for people of color as to how to respond when a microaggression occurs and the conflicting questions that it raises. Did a microaggression really occur? If so, what is the best way to respond? What are the consequences of deciding that responding will do no good, engaging in self-deception and denial, and getting angry when that likely will engender negative consequences? In other words: damned if you do, and damned if you don’t.
In turning to the situation of counseling and psychotherapy, the authors suggest that “the therapeutic alliance is likely to be weakened or terminated when clients of color perceive white therapists as biased, prejudiced, or unlikely to understand them as racial/cultural beings” (p. 280). This, in turn, will lead to clients of color not receiving the help they need and, because of premature termination, possibly feeling worse than they did before seeking help. What, then, can be done to address the negative impact of unintentional, racial microaggressions in the therapeutic relationship? Sue et al. offer a number of suggestions, all having to do with therapist training and education about race in general and microaggressions in particular. These include:
· Overcoming trainee resistance to talk about race in the context of safe and productive learning environments
· Challenging trainees to explore their own racial identities, as well as their feelings about other racial groups, and to learn to tolerate the discomfort and vulnerability that doing so will likely produce
· White trainees addressing “what it means to be white,” becoming aware of their own white racial identity development and how it may have a negative impact on clients of color
· Increasing trainees’ skill in identifying microaggressions in general, but particularly in their own behavior
· Understanding how microaggressions, especially their own, negatively affect and alienate clients of color
· Learning to accept responsibility for becoming aware of and overcoming racial bias
Finally, it is important to point out that the negative impact of racial microaggressions is not limited to white therapists and clients of color only. Future research should include the existence of microaggressions between therapists of color and white clients, interethnic racial dyads, and microaggressions that occur in relation to other cultural identities and minorities, such as gender, sexual orientation, and disability.