Unit 3.1 db: implicit bias test

There are four important points to be made initially about racism:

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.

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.

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.

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.

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

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.

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.

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.

4-3dCultural Racism

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.

· 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.

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).

4-5White Racial Attitude Types

4-5

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).

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.

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

· 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

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.

4-6cBecoming White

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.

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.)

4-6dFinding Sangha

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.

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).

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

Chapter: 8

8-1The Impact of Social, Political, and Racial Attitudes

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There is a vast body of research in social psychology that shows how attitudes can unconsciously affect behavior. Some examples include the following:

· 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.

· 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

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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).

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

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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.

· 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

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· 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.

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)

· 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.

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.

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

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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:

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.

· 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.

· 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)

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

· 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.

· 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

· 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.

· 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