Transcript Cultural Diversity: A Primer for the Human Services

Cultural Diversity:
A Primer for the
Human Services
{ By Jerry V. Diller
Chapter 8
{
Bias in Service
Delivery
Case Study 1
Bill, a 26-year-old Navajo man was
hospitalized as psychotic in a mental
hospital for 18 months, diagnosed as
schizophrenic
 Diagnosis occurred without knowledge of
Bill’s ethnic identity, and without the use of
a interpreter

Case Study 1
Bill was misidentified as Mexican, then
Filipino, and when a Navajo interpreter was
finally utilized, it became apparent that Bill
had been misdiagnosed
 Doctors assumed a diagnosis, and then
searched for evidence for their assumption
 Insight into Navajo culture made apparent
the many mistakes that had been made by
the doctors who saw Bill

Impact of Social, Political,
And Racial Attitudes
Attitudes can unconsciously affect behavior
 Examples:

Teachers expectations were seen to shape the
way students performed (Rosenthal and
Jacobson, 1968)
 Differing standards of health were held for men
and women (Broverman et al., 1970)

Impact of Social, Political,
And Racial Attitudes
Attitudes can unconsciously affect behavior
 Examples:

Effects of political attitude increased the report
of severe symptoms by providers (Wecshler,
Solomon, and Kramer, 1970)
 The race of the provider and of the client impact
the severity of mental health diagnosis, and the
kinds of services provided (Multiple studies)

Under-Representation
In The Professions
In doctoral psychology programs,
enrollment rates are less than 5 percent for
students of color
 Numbers have remained consistently low



The major deterrent being the Northern
European cultural climate that predominates in
such settings
Numbers for faculty of color are also
disproportionately low
Dissatisfaction Among
Providers of Color

D’Andrea (1992) documents 7 ways
individual and institutional racism is
present in the profession, including:
No Hispanic American, Asian American, or
Native American has been elected president of
the ACA or APA
 Only one African American has been elected
president of the APA

Dissatisfaction Among
Providers of Color

D’Andrea (1992) documents 7 ways
individual and institutional racism is
present in the profession, including:

None of the 5 most commonly used textbooks in
counselor training programs in the U.S. lists
“racism” as an area of attention
The Use of
Paraprofessionals

One suggestion for increasing the number of
providers of color is the use of indigenous
paraprofessionals


Individuals who were already leaders in their
community were given training on basic service
delivery and hired to act as outreach workers
and adjunct professionals
Many paraprofessionals chose to return to
school and become professionals
The Use of
Paraprofessionals
As academic paraprofessional training
programs were created, they were seen as
entry points into mental health jobs and
attracted primarily white students
 Indigenous providers were replaced by
trained paraprofessionals and the functional
approach to bringing ethnic community
members into mental health was
undermined

The Use of
Traditional Healers

Another strategy includes the involvement
of traditional healers as part of a mental
health organization treatment team, either
as staff or as consultants
Differences in Traditional
and Western Healing
Traditional healing is holistic; Western
distinguishes between physical, spiritual,
and mental well-being
 Western healing stresses cause and effect;
traditional healing emphasizes circularity
and multidimensional sources
 Western healing occurs through cognitive
and emotional change; traditional healing
has a spiritual basis to heath and well-being

The Use of
Traditional Healers

Hiring providers of color sends an
important message to the community, but
should not be done without consideration of
experience, skills, or training
The Use of
Traditional Healers

Helpful questions include:
Is the person bilingual and fluent in both written
and verbal forms?
 Is the person bicultural? Is the person familiar
with both dominant and traditional culture?
 What specific ethnic subgroups is the candidate
familiar with and knowledgeable of?
 Does the candidate have firsthand experience of
the migration process?
 How culturally competent is this person?

Bias in Conceptualizing
Ethnic Populations

Historically, Western science has portrayed
ethnic populations as biologically inferior

Over time, this notion has shifted to notions of
“cultural inferiority” or “deficit theories.” These
models have two forms:


Cultural deprivation: Non-whites are seen as derived
of substantive culture
Cultural disadvantage: Non-whites are seen as having
a culture that has become deficient due to racism
Bias in Conceptualizing
Ethnic Populations

Biases in research on ethnic population
tends to be skewed toward findings of
deficit and shortcomings, including:
The comparison of whites and people of color on
characteristics that culturally favor whites
 Interpretation of differences between whites and
people of color as reflecting weaknesses in ethnic
culture

Bias in Conceptualizing
Ethnic Populations

Biases in research on ethnic population
tends to be skewed toward findings of
deficit and shortcomings, including:

Theoretical narrowness and inability to
acknowledge different cultural ways of
conceptualizing mental health as valid
Biases in Assessment

Patients of color tend to be overpathologized by personality measurement
tools and have their intellectual abilities
underestimated by intelligence testing
Biases in Assessment

Barriers include:
Test items and procedures that reflect dominant
values, are not standardized to populations of
color, and use culturally unfair criteria to
validate tests
 Language differences between testers and clients
 Differences in experience taking tests

Biases in Assessment

Example: Minnesota Multiphasic
Personality Inventory (MMPI)
Normed exclusively on white subjects, leading to
a disproportionate number of patients of color
being hospitalized based on results
 Studies show differentials in scoring patterns
between African Americans and whites to the
extent that the functionality of the test is not
equivalent between groups

Biases in Diagnosis

Culture affects the core aspects of clinical
work and diagnosis, including:
How problems are reported and how help is
sought
 Nature and configuration of symptoms
 How problems are traditionally solved
 How the origin of presenting problems is
understood
 What appropriate interventions involve

Cultural Attitudes
Toward Mental Health

Attitudes toward mental health vary with
regard to appropriate personality dynamics,
definitions of therapy, and how help is
sought
Cultural Attitudes
Toward Mental Health

Chinese American example (Lum, 1982):

Mental illness as a loss of discipline,
preoccupation with morbid thoughts, insecurity
due to absence of social support, and distress
from external factors

Mental health is the opposite of these traits (i.e.,
capacity for self discipline, freedom from morbid
thoughts, etc.)
Externalization of blame for mental illness
 Preference for authoritarian, directive, fatherly
helpers

Differences in Symptoms,
Disorders, and Pathology

Cultures differ in what disorders are
typically observed, how symptom pictures
are construed, and what is considered
pathological

Some disorders appear to be universal, though
the exact content is culture specific; other
disorders are observed across cultures but vary
dramatically in their specific symptoms
Differences in Symptoms,
Disorders, and Pathology

Cultures differ in what disorders are
typically observed, how symptom pictures
are construed, and what is considered
pathological
Culture-specific symptoms exist and are found
only among members of a single cultural group
 Symptoms can have different meanings
depending on the cultural context in which they
appear

Globalization of
Treatment Modalities
Conceptions of mental illness constructed
and influenced by cultural beliefs
 Watters (2010) offers four cultural examples
of the spread of Western descriptions and
categorizations of mental illness

Anorexia in Hong Kong, China
 PTSD in Sri Lanka
 Schizophrenia in Zanibar
 Depression in Japan

The Case of Suicide

Differences in etiology and frequency of
specific mental health problems exist crossculturally

Suicide is a prime example of differences

Highest suicide rates are found among Native
Americans; lowest are found among African Americans
and Latinos/as
The Case of Suicide

Differences in etiology and frequency of
specific mental health problems exist crossculturally

Suicide is a prime example of differences



European American males experience suicide rates 3X
higher than European American women; occurs most
frequently with those over 50
In communities of color, suicide occurs most frequently
in young men
Suicide rates are extremely low in African American,
Native American, and Latina women
Racial Microaggressions &
Therapeutic Relationship

Microaggressions


Unconsciously delivered race-related subs,
dismissive looks, gestures, and tones
Microassaults

Verbal and non-verbal attacks with varying
degrees of intention to hurt a person of color
through name-calling, avoidance, or other forms
Racial Microaggressions &
Therapeutic Relationship

Microinsults


Communication that conveys rudeness and
insensitivity to demean a person’s racial heritage
and identity
Microinvalidations

Communication that negates, nullifies, or
excludes a person’s thoughts or feelings as a
person of color
Racial Microaggressions &
Therapeutic Relationship
Microaggressions are particularly
counterproductive when they enter the
therapeutic session between a white
provider and a client of color
 Frequent dilemmas include:


Whites underestimating capacity for bias and
racism, while people of color view whites as
actively discriminatory
Racial Microaggressions &
Therapeutic Relationship

Frequent dilemmas include:

Whites are often unaware of microaggressions
and are stunned by the accusation of bias


Perceive people of color as overly sensitive
People of color have a difficult time determining
how to react to microaggression when no
reaction appears to lead to a positive change