Manual Voices of Diversity: Multi-culturalism in America (Clinical Sociology: Research and Practice)

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Racial bias is no longer overt: it is widespread, but unconscious. Unconscious bias explains the gaps in education, housing, income, employment, health, and social mobility generally. Moreover, it is the microaggressions of daily life, committed by even the most well-intentioned, that is the source of the inequality. The concept of microaggressions was put forth by academics, so it is no surprise that the primary search for microaggressions takes place on the college campus.

The concept is not new. Harvard professor of education and psychiatry Chester M. Pierce created the term in to describe the countless slights, denigrations, and dismissive behaviors inflicted upon black Americans by others every day. Only in the s, however, has the concept spread rapidly across higher education.

Multi-culturalism in America

Bollinger and Grutter v. Texas in support of the University of Texas. Throughout the years, Sue and his colleagues have developed a list of racial microaggressions, [9] for example:. Microaggression theory has, of course, expanded beyond race to include women, LGBT individuals, the disabled, and multiple-identity groups e. There are many problems with studies of microaggressions, technical and conceptual. To start, its advocates are informed by the academic tradition of critical theory. Critical theory as applied to race i. Pervasive in the dominant white culture, racism is ubiquitous and explains social phenomena in terms of white privilege and white power, and oppression of people who are not white:.

Such storytelling enables the implementation of a highly politicized agenda and places a social change agenda above objective social science research. Most important, the critical race paradigm logically and unreflectively results in a one-way analysis pervasive in these studies, which all start with this premise: that microaggressions can only be perceived by non-whites but are only committed by whites.

This one-way racial framework accounts for the serious technical shortcomings in critical race theory studies—biased interview questions, reliance on narrative and small numbers of respondents, problems of reliability, issues of replicability, and ignoring alternative explanations.

I discuss each of these issues below. Biased interview questions. Conventional protocol is for the researcher to be unbiased in conducting the interview by properly phrasing questions. These race researchers have no problem making it perfectly clear what they intend to show. In their interview protocol, for example, Sue et al. How have others subtly expressed their stereotypical beliefs about you? After such prompting by the interviewer, respondents would be more likely to find what the researcher is looking for, i. Very small number of study respondents. In general, microaggressions studies are based on very small qualitative focus groups or one-on-one interviews.

While such small studies using focus groups or interviews are often necessary when developing a new theory in the social sciences, they are not typically viewed as sufficient evidence for accepted science, much less for policy. In the study of microaggressions, there are only a few recent studies using samples of or more and relying on current quantitative methods discussed later in this article. Bias and opinion conformity w hen using only focus groups.

Focus group research also runs the risk of introducing bias through peer and authority pressure and conformity of response. All focus groups are researcher-created artificial gatherings, subjected to small-group dynamics of peer pressure, the need to please the authority figure usually the interviewer , and the conscious and unconscious biases of the researcher. One or two participants may end up controlling the whole group. In these race-based focus groups, bias contamination would pose even more of a problem, since the groups deal openly with the difficult topic of race and the guiding hypothesis that whites routinely inflict microaggressions on non-whites.

The focus group structure, given the controversial topic of race, would inherently stifle dissent. Administration policy as constraint to speak freely. Microaggression focus group studies are conducted overwhelmingly on campus. As such, the stories and comments are further contaminated by administration policy. Those who believe in this model of cultural competence may not think that clinicians can deliver culturally-competent care when patient and clinician backgrounds and identities differ. This tendency emerged among administrators who recommended patient-clinician matching by perceived cultural similarities as a model for cultural competence.

Clinicians and administrators typically define patient identities by making assumptions about physical appearance based on racial or ethnic backgrounds rather than asking patients directly about their cultural identities Aggarwal In our focus groups, participants assigned deviations from expected clinical norms for trust, eye contact, family structures, or therapeutic disclosure to racial or ethnic differences. Since all administrators and clinicians are trained in these policies, it is unclear if the group-based model for cultural competence is due to insufficient training or disagreement with policies.

In contrast, person-centered definitions focused on customizing care for each individual. This understanding is consistent with the patient-centered movement across the health disciplines since the s that has prioritized respect for patient wishes in clinical interactions Saha et al. That most patients and clinicians responded in this way suggests that these stakeholders may see cultural competence as integral to treatment through direct patient interactions compared to administrators working at systemic and organizational levels.

Discrepancies between hospital policies and actual practice raise questions over how to align priorities around cultural competence. For example, current policies do not specify best practices for clinicians on how to conduct a comprehensive cultural assessment. Some clinicians and administrators undergoing hospital training may have espoused group-based models of cultural competence based on their personal experiences of delivering cross-cultural care rather than implementing an institutionally-endorsed alternative.

One solution is to train staff in specific models of cultural assessment. The CFI simultaneously affirms the value of group-based and individually constructed identities in its eighth and ninth questions, preceded by a prompt:. By background or identity, I mean, for example, the communities you belong to, the languages you speak, where you or your family are from, your race or ethnic background, your gender or sexual orientation, or your faith or religion. Are there any aspects of your background or identity that make a difference to your problem?

American Psychiatric Association The CFI recognizes that culture emerges from the communities to which one belongs, i. The CFI also encourages clinicians to personalize care by asking patients which aspects are most crucial while seeking care for a mental problem. All groups also mentioned that clinicians should share similarities with patients as techniques for achieving cultural competence, but patients and clinicians wanted clinicians to relate personal experiences whereas an administrator warned against professional boundary violations.

Role expectations may explain differences. Administrators supervising clinicians may want to avoid breaking institutional rules whereas clinicians may be willing to experiment with different forms of interactions with patients since they ultimately are responsible for treatment. Psychologists have shown that US racial and ethnic minorities respond positively to therapist self-disclosures related to cultural identities Burkard et al. Indeed, many anthropological studies on cultural competence have been conducted with psychiatric trainees who have resisted instructor-led discussions of culture and difference since many trainees have their own negative experiences with cultural differences that are often unacknowledged Willen and Carpenter-Song In contrast, our clinician sample openly discussed strategies to bridge cultural differences even when they departed from hospital policies.

It is possible that differences in sample characteristics underlie our findings: we enrolled clinicians beyond only psychiatrists, independent practitioners rather than residents in training, and clinicians in a diverse community where working through cultural differences is necessary to provide services. Future work could examine perceptions of cultural competence across different types of clinicians, at various stages of practice, and in a variety of institutions such as academic, community, and for-profit hospitals.

All groups also mentioned that clinicians should explain more options to patients, but only patients and some clinicians prioritized respecting patient wishes. Patients wanted to be treated as equal partners in treatment planning whereas clinicians and administrators viewed explanations as opportunities for psychoeducation.

The growth of managed care since the s has led to patients seeing themselves as consumers and clinicians as consultants rather than older models of clinicians as omniscient and omnipotent Kronenfeld Limits on the consultation model appear during acute illness when clinicians may need to treat patients against their preferences Aggarwal One solution may be to ask patients how they wish to be treated during times of acute illness such that patient preferences and the range of clinician responses are discussed in advance of clinical emergencies.

All groups also discussed patient challenges to culturally competent care, though only administrators mentioned clinician challenges. This cultural understanding stigmatizes mental illness and may lead to treatment non-adherence Vargas et al. Lastly, all groups mentioned time and technological pressures as institutional challenges. The use of quality assurance and utilization management procedures throughout medicine since the s has linked good clinical treatment to long-term cost controls as person-centered care has transitioned to population-based algorithms Donald Our participants equated time constraints to decreased quality, noting that patients did not receive quality care when treated like hundreds of others.

Time pressures have also been named to avoid implementing cultural competence initiatives Aggarwal et al.

Impact of Cultural Diversity and Multiculturalism on Teaching and Learning

Others have warned that changes in clinician knowledge, attitudes, and skills may not actually change clinician behaviors if the institutional structure of health care delivery is also not changed Kirmayer We see time management and quality assurance as distinct domains: clinicians can individualize care in short appointments or treat people algorithmically even without time constraints. Hospital clinicians used personal time to satisfy institutional requirements, but may benefit from recognizing time management and quality assurance as distinct.

Administrators could also designate one billable appointment for a cultural assessment such that patients and clinicians do not feel as if individual patient preferences are excluded, a tactic that has successfully made the business case for cultural competence in community settings Bassiri and Soriano Our results should be interpreted in light of several limitations. First, this study was conducted in a single hospital, potentially limiting the generalizability of findings. This is a limitation common to all single-site studies, qualitative and quantitative.

The goal of qualitative research is to advance social theory by designing research rigorously that accounts for the unique perspectives of subjects and researchers through robust data analysis, not to posit cause-effect relationships as in statistically-based quantitative research Mays and Pope We situate our work within this tradition by presenting the range of stakeholder opinions on cultural competence at one community hospital.

At the same time, we have striven for representativeness by enrolling all relevant stakeholders. Intervention studies that are intended to change human behavior often narrowly select participants and apply narrowly specified strategies that can limit the representativeness of results Glasgow et al. Our study aimed for representativeness by broadly enrolling patients, clinicians, and administrators with minimal exclusion criteria and encouraging them to brainstorm strategies for changing human behavior rather than asking them to apply strategies determined by the researchers beforehand.

Future qualitative research could explore whether our findings on cultural competence converge or diverge from findings in other clinics. Second, existing relationships among clinicians and administrators could have influenced interactions. Although no single participant dominated any group, perceptions of influence may have encouraged some to participate more than others. Third, we followed methodologists in using theoretical sampling to achieve data saturation. There is no consensus among focus group methodologists on the numbers of participants needed to achieve data saturation among methodologists Carlsen and Glenton We believe that our findings exhibit candor and exhaust the range of responses, including contradictions among participants, indicating that we have achieved data saturation.

This study offers future research, policy, and practice directions related to cultural competence. The discrepancy between employee responses and hospital policies raises several possibilities. Employees may benefit from role-specific training as administrators or clinicians that is relevant to professional responsibilities and more frequent training than an initial orientation followed by an annual session.

Techniques to achieve cultural competence can also be specified within hospital policies in an ongoing fashion so that clinicians who understand policies also have actionable procedures to accomplish goals. In addition, hospital leaders could incorporate patients, clinicians, and administrators in writing policies since culturally-competent care affects multiple stakeholders.

Finally, patients and clinicians could initiate discussions on how to respect patient wishes and explain treatment options in advance of treating acute illnesses. More research is needed on how clinicians should ascertain and act as consultants or as educators to patients since patients have their own models of mental health illnesses and services that do not necessarily correspond with those of providers.

Our study demonstrates the value of qualitative research methods in hospitals. The hospital in our study represents the challenges of a broader American society struggling to redress injustices for historically disadvantaged minorities, provide services for diverse immigrants, and balance market efficiency with consumer satisfaction. Staff meetings, employee orientations, and other hospital settings can illuminate how multiple stakeholders create and debate everyday knowledge and practice that may diverge with institutional standards.

Social science research in health care settings can illuminate our understanding of how people construct institutional culture by comparing what people say with what they think they do Lambert and McKevitt We have adopted this orientation in analyzing how patients, clinicians, and administrators construct the institutional culture of one hospital by comparing their perspectives on cultural competence what they say as stakeholders against actual hospital policies what they think they do to improve clinical practice.

NKA designed the study, acquired and analyzed the data, and drafted the initial manuscript. KC acquired and analyzed the data and was involved in drafting the initial manuscript. All authors read and approved the final manuscript. The study was supported by a grant from the National Institute of Mental Health to the first author. The funding body had no role in the design, collection, analysis, and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

Neil Krishan Aggarwal, Phone: , Email: ude. Peter Guarnaccia, Email: ude. Arthur Kleinman, Email: ude. National Center for Biotechnology Information , U. Published online Mar Author information Article notes Copyright and License information Disclaimer. Corresponding author.

Received Jan 27; Accepted Mar This article has been cited by other articles in PMC. Abstract Cultural competence training is mandatory in the United States of America to alleviate minority health disparities though few studies have examined perceptions across stakeholders. Keywords: Cultural competence, Cultural sensitivity, Cultural psychiatry, Cross-cultural psychiatry, Transcultural psychiatry, Focus groups, Document analysis, Policy analysis. Background The Office of the U. Methods Design We stratified participants through theoretical sampling into separate focus groups for patients, clinicians, and administrators.

Please tell us what types of services you receive as patients. Please tell us what types of services you manage as administrators. Please also tell us what cultural competence means to you Cultural competence between patients and clinicians How can a clinician demonstrate cultural competence to patients? Based on your experiences receiving care, for what types of patients is cultural competence necessary and why? We want to hear about your specific experiences in providing treatment. Based on your experiences with providing care, for what types of patients is cultural competence necessary and why?

We want to hear about your specific experiences as administrators. Based on your experiences managing clinicians, for what types of patients is cultural competence necessary and why? Cultural competence and patient treatment expectations Does culture affect what types of treatment you want or how long you want to be treated?

If so, how? Does culture affect what types of treatment patients want or how long they want to be treated? If you had a chance to give advice on cultural competence to your clinical director, what advice would you give? Open in a separate window. Analytical strategy All recordings were sent for professional transcription. P patients, C clinicians, A administrators. CCC definitions All participants defined culturally competent care as 1 acknowledging group-based demographic traits of patients, or 2 delivering person-centered care based on individual characteristics, though clear differences emerged by stakeholder.

Clinician techniques for CCC Patients, clinicians, and administrators identified clinician techniques for culturally competent care. Clinician 2: Or empathize. Moderator: What kind of example specifically? Patient challenges to CCC All groups agreed that patients bring challenges to culturally competent care. Clinician challenges to CCC Two patients and three administrators—but no clinicians—identified explicit and implicit clinician biases as challenges to CCC.

Moderator: She wanted to talk about your culture? Patient 1: Yeah, and my hair and my eyes. Patient 2: Your therapist wanted to do that? Patient 1: And she would do it at every session.


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Institutional challenges to CCC Respondents in all groups reported that time and technological pressures threatened culturally competent care. Patient 2: I get upset sometimes. Clinician 1: You walk fast. Clinician 2: Walk and talk. Patient 2: The computer. The policies include this definition for cultural competence: Diversity is much more than skin color, gender, age, religion or background. Discussion This article has analyzed cultural competence meanings and practices through focus groups at a diverse New York City hospital.

For you, what are the most important aspects of your background or identity? Conclusions Our study demonstrates the value of qualitative research methods in hospitals. Acknowledgements The study was supported by a grant from the National Institute of Mental Health to the first author.

Competing interests The authors declare that they have no competing interests. References Aggarwal NK. Intersubjectivity, transference, and the cultural third. Contemp Psychoanal. The psychiatric cultural formulation: translating medical anthropology into clinical practice. J Psychiatr Pract. Among black hip-hop fans, the word "nigga" can sometimes be considered a friendly greeting, but when used by whites, it is usually viewed as offensive. The term is sometimes used in a racist manner, by other white people to belittle the person perceived as "acting black", but it is also widely used by African Americans like 50 Cent offended by the wigga or wanksta 's demeaning of black people and culture.


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The phenomenon of white people adopting elements of black culture has been prevalent at least since slavery was abolished in the Western world. The concept has been documented in the United States, Canada, the United Kingdom, Australia, and other white-majority countries. An early form of this was the white negro in the jazz and swing music scenes of the s and s, as examined in the Norman Mailer essay " The White Negro ". It was later seen in the zoot suiter of the s and s, the hipster of the s, the beatnik of the s—s, the blue-eyed soul of the s, and the hip hop of the s and s.

In , an article in the UK newspaper The Independent described the phenomenon of white, middle-class kids who were "wannabe Blacks". Robert A. Clift's documentary examines "racial and cultural ownership and authenticity -- a path that begins with the stolen blackness seen in the success of Stephen Foster , Al Jolson , Benny Goodman , Elvis Presley , the Rolling Stones -- all the way up to Vanilla Ice popular music's ur-wigger The term "blackfishing" was popularised in by writer Wanna Thompson, describing female white social media influencers who adopt a look perceived to be black or mixed race — including braided hair, dark skin from tanning or make-up, full lips, and large thighs.

National Association of Scholars - The Pseudo-Science of Microaggressions by Althea Nagai

Critics argue they take attention and opportunities from black influencers by appropriating their aesthetic and have likened the trend to blackface. Among critics, the misuse and misrepresentation of indigenous culture is seen as an exploitative form of colonialism, and one step in the destruction of indigenous cultures. The results of this use of indigenous knowledge have led some tribes, and the United Nations General Assembly , to issue several declarations on the subject.

We assert a posture of zero-tolerance for any "white man's shaman" who rises from within our own communities to "authorize" the expropriation of our ceremonial ways by non-Indians; all such " plastic medicine men " are enemies of the Lakota, Dakota and Nakota people. Indigenous peoples have the right to maintain, control, protect and develop their cultural heritage, traditional knowledge and traditional cultural expressions, as well as the manifestations of their sciences, technologies and cultures, including human and genetic resources, seeds, medicines, knowledge of the properties of fauna and flora, oral traditions, literatures, designs, sports and traditional games and visual and performing arts.

They also have the right to maintain, control, protect and develop their intellectual property over such cultural heritage, traditional knowledge, and traditional cultural expressions. In , a group of Native American academics and writers issued a statement against the Rainbow Family members whose acts of "cultural exploitation In writing about Indigenous intellectual property for the Native American Rights Fund NARF , board member Professor Rebecca Tsosie stresses the importance of these property rights being held collectively, not by individuals:. The long-term goal is to actually have a legal system, and certainly a treaty could do that, that acknowledges two things.

Number one, it acknowledges that indigenous peoples are peoples with a right to self-determination that includes governance rights over all property belonging to the indigenous people. And, number two, it acknowledges that indigenous cultural expressions are a form of intellectual property and that traditional knowledge is a form of intellectual property, but they are collective resources — so not any one individual can give away the rights to those resources. The tribal nations actually own them collectively. Use of minority languages is also cited as cultural appropriation when non-speakers of Scottish Gaelic or Irish get tattoos in those languages.

Since the early s, it has become increasingly popular for people not of Asian descent, to get tattoos of Indian devanagari , Korean letters or Han characters traditional , simplified or Japanese , often without knowing the actual meaning of the symbols being used. However, they are given only one percent of lead roles in film. White actors account for In , Ghost in the Shell , which is based on the seinen manga Ghost in the Shell by Masamune Shirow , provoked disputes over whitewashing. Scarlett Johansson , a white actress, took the role of Motoko Kusanagi , a Japanese character.

During Halloween , some people buy, wear, and sell Halloween costumes based on cultural or racial stereotypes. Day and Black History Month.

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Deloria refers to the Koshare Indian Museum and Dancers as an example of "object hobbyists" who adopt the material culture of indigenous peoples of the past "the vanishing Indian" while failing to engage with contemporary native peoples or acknowledge the history of conquest and dispossession. The objections from some Native Americans towards such dance teams center on the idea that the dance performances are a form of cultural appropriation which place dance and costumes in inappropriate contexts devoid of their true meaning, sometimes mixing elements from different tribes.

Some people in the transgender community have protested against the casting of straight, cis-gender actors in trans acting roles, such as when Eddie Redmayne played the role of artist Lili Elbe in the film The Danish Girl and when Jared Leto played the role of a trans woman named Rayon in Dallas Buyers Club.

In some cases, a culture usually viewed as the target of cultural appropriation can be accused of appropriation, particularly after colonization and an extensive period re-organization of that culture under the nation-state system. For example, the government of Ghana has been accused of cultural appropriation in adopting the Caribbean Emancipation Day and marketing it to African American tourists as an "African festival". For some members of the South-Asian community, the wearing of a bindi dot as a decorative item, by a non- Hindu , [] or by a woman who is not South Asian, is considered cultural appropriation.

A common term among Irish people for someone who imitates or misrepresents Irish culture is Plastic Paddy. In , Prince Harry of the British royal family used Indigenous Australian art motifs in a painting for a school project. One Aboriginal group labelled it "misappropriation of our culture", saying that to Aboriginal people, the motifs have symbolic meanings "indicative of our spiritualism", whereas when non-Aborigines use the motifs they are simply "painting a pretty picture".

In the Victoria's Secret Fashion Show , former Victoria's Secret model Karlie Kloss donned a Native American -style feathered headdress with leather bra and panties and high-heeled moccasins. The outfit was supposed to represent November, and thus "Thanksgiving", in the "Calendar Girls" segment. The outfit met with backlash and criticism as an appropriation of Native American culture and tradition. Victoria's Secret pulled it from the broadcast and apologized for its use.

Kloss also commented on the decision by tweeting "I am deeply sorry if what I wore during the VS Show offended anyone. I support VS's decision to remove the outfit from the broadcast. Avril Lavigne was cited by some [ who? The song and music video depict Asian women dressed up in matching outfits and Lavigne eating Asian food while dressed in a pink tutu. I flew to Tokyo to shoot this video When Selena Gomez wore the bindi during a performance, there was debate on her reasoning behind wearing the culture specific piece.

Some viewed this as "casting her vote for Team India" but it was also viewed as misuse of the symbol as Selena was seen as not supporting or relating the Bindi to its origin of Hinduism, but furthering her own self-expression. Actress Amandla Stenberg made a school-related video called "Don't Cash Crop on My Cornrows" about the use of black hairstyles and black culture by non-black people, accusing Katy Perry and Iggy Azalea of using "black culture as a way of being edgy and gaining attention".

Rachel Dolezal made headlines in when it was discovered that she was not African-American , as she had claimed. She is an American former civil rights activist known for being exposed as Caucasian while falsely claiming to be a black woman. Dolezal was president of the National Association for the Advancement of Colored People NAACP chapter in Spokane, Washington , from February 7, until June 15, when she resigned amid suspicion she had lied about nine alleged hate crimes against her.

In , in an interview with Billboard magazine regarding her new image, Miley Cyrus criticized what she considered to be overly vulgar aspects of Hip Hop culture while expressing her admiration for the song " Humble " by Kendrick Lamar. This was met with backlash from people who felt Cyrus has a history of appropriating hip hop culture.

In , a group of students at Ohio University started a poster campaign denouncing the use of cultural stereotypes as costumes. The campaign features people of color alongside their respective stereotypes with slogans such as "This is not who I am and this is not okay. At the Coachella festival one of the most noted fashion trends was the bindi , a traditional Hindu head mark.

John McWhorter , a professor at Columbia University , has criticized the concept, arguing that cultural borrowing and cross-fertilization is a generally positive thing, and is something which is usually done out of admiration, and with no intent to harm, the cultures being imitated; he also argued that the specific term "appropriation", which can mean theft, is misleading when applied to something like culture that is not seen by all as a limited resource: unlike appropriating a physical object, others imitating an idea taken from one group's culture don't inherently deprive that originating group of its use.

If we embrace narrow group-based identities too fiercely, we cling to the very cages in which others would seek to trap us. Referring to a case in which U. Yet that's what we're paid to do, isn't it? Step into other people's shoes, and try on their hats. There's no difference between cultural appropriation and learning from each other. They're the same thing. Now, that doesn't mean that there's no theft between people; there is. And it doesn't mean that once you encounter someone else's ideas, you have an absolute right to those ideas as if they're your own. But the idea that manifesting some element of another culture in your own behavior is immoral is insane.

It's actually one of the bases of peace. Others criticize it as a stumbling block for the adaptation of differing cultural elements or even discussion for fear of being labeled "racist" or "ignorant". From Wikipedia, the free encyclopedia. The adoption of elements of a minority culture by members of a dominant culture. See also: Native American mascot controversy and List of sports team names and mascots derived from indigenous peoples.

Main article: Whitewashing in film. Crossover music Cultural diffusion Cultural imperialism Enculturation Fusion cuisine Indigenous intellectual property Syncretism Westernisation Xenocentrism. Part 2. For The Guardian. Accessed 24 Nov The Age. Archived from the original on Retrieved February 1, Cultural Appropriation and the Arts.

Retrieved July 22, African Americans, Asian Americans, Native Americans, and indigenous peoples generally tend to emerge as the groups targeted for cultural appropriation.

Mobilizing social science for the public good.

Black music and dance, Native American fashions, decoration, and cultural symbols, and Asian martial arts and dress have all fallen prey to cultural appropriation. Who Owns Culture? Rutgers University Press. Taking intellectual property, traditional knowledge, cultural expressions, or artifacts from someone else's culture without permission.

This can include unauthorized use of another culture's dance, dress, music, language, folklore, cuisine, traditional medicine, religious symbols, etc. It is most likely to be harmful when the source community is a minority group that has been oppressed or exploited in other ways or when the object of appropriation is particularly sensitive, e. Accessed 18 April World Bank, Washington, DC. Native American Rights Fund.

Retrieved April 17, Rainforest Aboriginal Network.