Reducing Mental Health Disparities

Cultural Conflicts Are Barriers to Treatment and Training

First, let’s look at this video in which Dr. Joy Degruy explains the historically grown psychological disorders which run rampant in the U.S. Her book about Post Traumatic Slavery Syndrome is a masterpiece that gives a clear idea about the past, present, and future of slavery and discrimination-related issues.

Dynamic cultural conflicts are when two cultural styles are operating at the same time but in contradiction to one another. Dynamic cultural conflicts should be identified and addressed.
American workers are taught to separate work, professional and personal lives.
Yet to become culturally competent it is necessary to understand one’s personal cultural experience. A cultural conflict. We are not accustomed to revealing our selves in professional settings
The more aware one is of his or her cultural norms, values, communication styles, the easier it is to consider and grasp another persons’ culture.

Racial Identity, Culture, and Psychological Variation

In American society, race has been and is treated as a marker for culture. Typically as a socio-demographic characteristic. Racial groups are identified on the basis of skin color, physical features, and language. But what do we actually know about people of Color? I advocate a point of view that says – race should be understood as racial identity, not “race identity”. Racial identity ego statuses are psychological orientations to one’s racial group.

Racial Identity Statuses
For instance, possible racial identity resolutions across racial groups (e.g., White, Asian, Black) includes:
Color-blind perspectives where race is not salient for self or others;
Confusion about whether and how race is significant;
Realization of the role of race while working to internalize the culture of one’s racial group;
Integration of race and its meaning into one’s personality, world-view, and emotional life;
An understanding of one’s race that is positive and valued as non-oppressive.

Racial Identity

The processes I describe are like the social transformation of the 1960s. People today referred to as African-American transformed their social and cultural identity from an imposed label of Colored, Negroes to people who self-identified as Black and Proud.
Thus, a person may have a distinct psychological resolution (i.e., racial identity ego status) regarding his or racial group. The resulting resolutions correspond to different constellations of thoughts, behaviors, attitudes, values, and emotions.
I contend that a new arena for understanding racial and cultural factors and the traumatic stress in so many communities of color in the development of health and mental health is psychological variation in people’s group memberships.

Need for Broader Assessment Criteria

I count myself among other scholars (e.g., Norris, Herman, Carlson) who argue that DSM-IV-TR diagnostic criteria are too narrow and limited to adequately or accurately capture the reactions of people of Color.
Broader and non-pathological categories are needed to understand the life-events and the effects of various aspects of daily living (i.e., stress) that might contribute to mental health status and reactions of people of Color.

  • I noted that people of Color (both citizens and war veterans) have higher rates of PTSD and traumatic stress reactions than do Whites. See also Dr. DeGruy on PTSS.
  • And they had prior histories of life-event(s) traumatic stress.
  • Thus, researchers contend that people of Color are confronted with racism, neglect, and hostility which may heighten the effect of life event crises.
  • Also, assessment using strict DSM guidelines underestimate or do not consider systematic sources of stress that may lead to trauma

What do we Need to Know About Racism?

  • We know that it is associated with poor physical and mental health for people who are targets of racism.
  • I have argued that racism should be unpacked by distinguishing between racial discrimination (avoidance) and racial harassment (hostility).
  • I have found that for people of Color racial discrimination and harassment are related to symptoms of traumatic stress as defined broadly (i.e., avoidance, intrusion etc.).
  • Moreover, racial harassment was more frequent and related to more severe psychological and emotional injury than discrimination was. See also this post about Dr. Joy DeGruy and her book about Post Traumatic Slave Syndrome, or PTSS. 

In Summary To Prevent Mental Health Disparities

    • We need to understand dynamic cultural conflicts as barriers to training for cultural competence.
    • We need to move beyond socio-demographic race and adopt racial identity ego status models to capture the full complexity of race and culture for all racial groups.
    • We need broader non-pathological diagnostic criteria and treatment strategies that are racially-culturally based and not limited.
    • We need to define racism as harassment (hostility) and discrimination (avoidance) and study the differential effects on mental health.
    • Together I think these preventive steps could increase equity, access and positive outcome for people of Color.