Otherizing: Implications for Mental Health Practice and Policy

1. Otherizing: Implications for Mental Health Practice and Policy Mental Health Task Force Summit September 21, 2010 Sheri Johnson, Ph.D., Assistant Professor Department of Pediatrics Center for Advancement of Underserved Children Medical College of Wisconin

2. Objectives • Develop understanding of C. Jones’ model of levels of racism • Explore the relationships between racism and health • Consider cultural humility as a framework for improving delivery of care

3. US Declaration of Independence • “We hold these truths to be self evident, that all men are created equal. That they are endowed by their creator with certain inalienable rights. And that among these are life, liberty and the pursuit of happiness”

4. What about these other groups? AND What if you’re in more than one of these other groups? • “Race” • Ethnicity • Gender • Nativity • Sexual Orientation • Ability Status

5. “Race” is a pigment of our imagination (Ruben Rumbaut) • The “one drop” rule • Mother’s “race” determines the race of the child on US birth certificates • US Census data is self report • Nearly 40% of African Americans say that blacks cannot be thought of as a single “race” (Pew 2007)

6. So What’s “Race” Got to Do With It? • “Race” has been socially constructed • “Race” serves a strategy to hierarchically organize groups of people • Racismmediates access to goods, services and opportunities that are associated with health.

7. Racism • Institutionalized • defined as the structures, policies, practices, and norms resulting in differential access to the goods, services, and opportunities of society by “race.” Institutionalized racism is normative, sometimes legalized, and often manifests as inherited disadvantage. • Personally Mediated • Internalized Jones CP.  Confronting Institutionalized Racism.  Phylon 2003;50(1-2):7-22.

8. Rev. Dr. Martin Luther King Jr. 1967 Address to APA: • Mental health is contingent upon society’s ability to afford opportunity and justice for its citizens • Social scientists must study and support strategies to create health equity • Social scientists must use research to confront racism

9. Rev. Dr. Martin Luther King Jr. 1967 Address to APA: Internalized Racism • “Negroes have been oppressed for centuries, not merely by bonds of economic and political servitude...the worst aspect of their oppression was their inability to question and defy the fundamental precepts of the larger society

10. Doll Study Revisited http://www.youtube.com/watch?v=ybDa0gSuAcg&feature=related

11. Reflections • What are the implications of being chronically devalued? • Vulnerability to stereotype threats • What are the implications of being chronically overvalued? • Xenophobia

12. Rev. Dr. Martin Luther King Jr. Comments on: Interpersonal Racism “All too many white Americans are horrified not with conditions of Negro life, but with the product of these conditions - the Negro himself”

13. Being the “other” has negative health effects • Drawing on previous studies hypothesizing that experiences of discrimination increase the risk of pre-term birth and low birth weight • California birth certificate data used to determine the relative risk of poor birth outcomes by race, ethnicity and nativity for women who gave birth in the 6 months post 911 compared to the same six month period one year earlier. • The relative risk of poor birth outcomes was significantly increased for Arabic named women but not for any other groups Lauderdale, DS Demography , Volume 43-Number 1, February 2006: 185–201

14. See Baby Discriminate • Simpson, BV (2007) “Exploring the Influences of Educational Television and Parent-Child Discussions On Improving Children’s Racial Attitudes” • 93 White children, age 5-7 and parents • Utilized the Black/White Evaluative Trait Scale and Prediction of Parental Attitudes Scale • Sample questions: • How many white people are mean? • Do your parents like black people? • Fourteen percent of children responded, "No, my parents don't like black people” Newseek Magazine, October 2009

15. Social Psychology Has the Answer! • Why Do Interracial Interactions Impair Executive Function? A Resource Depletion Account (Richeson and Trawalter, 2005) • The Impact of Multiculturalism vs Color-blindness on Racial Bias (Richeson and Nussbaum, 2003) • The Threat of Appearing Prejudiced and Race-Based Attentional Biases (Richeson and Trawalter, 2008) • Negotiating Interracial Interactions: Cost, Consequences and Possibilities (Richeson and Shelton, 2007)

16. Situational Factors Interaction roles, goals, scripts discussion topic evaluation potential (Public vs. private) Intrapersonal outcomes Self-regulatory failure Cognitive depletion Executive attentional capacity Individual difference predictors Racial attitudes Previous contact experience Concern about appearing prejudiced (W) Race-based rejection sensitivity (RM) Self -regulation Activated interracial contact concerns Negative affect Whites Appearing prejudiced Racial Minorities Experiencing prejudice Confirming stereotypes Interpersonal outcomes Partner liking Partner affect Rapport Affective reactions Physiological arousal anxiety Working Process Model of Interracial Contact

17. Laboratory Results For Minorities and Whites Show Effects on Executive Functioning • Individuals performed more poorly on the Stroop task after contact with a different “race” experimenter than they did after contact with a same “race” experimenter and this was magnified by level of implicit racial bias

18. In other experiments: For Whites • Self regulation or effortful self control has positive and negative consequences. • If suppression and vigilance are the primary cognitive strategies primed (prevention), the result is cognitive depletion more than when a condition of goal attainment (promotion) is primed.

19. For Minorities • Self regulation is in the service of avoiding being the target of prejudice. • When primed with racial prejudice, racial minorities put forth more interpersonal effort during interaction with White partners than when primed with a non racial prejudice condition. • Racial prejudice priming was associated with negative affect toward White research lab partners and less feeling of authenticity and genuineness.

20. Rev. Dr. Martin Luther King Jr. 1967 APA AddressStructural Racism • “When we ask Negroes to abide by the law, let us also demand that the white man abide by the law in the ghettos… He violates welfare laws to deprive the poor of their meager allotments; he flagrantly violates building codes and regulations; his police make a mockery of law; and he violates laws on equal employment and education and the provisions for civic services”

21. Pull yourself up by your bootstraps?

22. US Policy and Race: Affirmative Action • Started in 1641: colonies begin to specify in law that rights to property, ownership of goods and services and to vote were restricted by race and gender. • Expanded in 1790: restriction to citizenship via naturalization was applied only to “whites” and was not overturned until 1952. • Affirmative action has been in place for whites for 360 years, and 50 years for racial/ethnic minorities Brown, M, Carnoy, M, Currie, E. Duster, T. Oppenheimer, B.,Schultz,,MM Wellman, D Whitewashing Race: The Myth of a Color Blind Society 2003 University of California Press, Berkeley

23. Reality Check (Source: http://www.census.gov/prod/2007pubs/p60-233.pdf)

24. Race, Incarceration, and Employment Without criminal record With criminal record Without criminal record With criminal record Source: Pager 2003

25. Race: The Power of An Illusion The Story We Tell

26. Part 3:Cultural Humility Hunh?

27. Future Obama

28. Cultural Humility • Refers to a life long process of self evaluation and self critique. • Requires reflection on power imbalances that exist. • Does not discount the value of knowing as much as possible about the health care practices of communities that we serve. Tervalon and Murray-Garcia (1996)

29. Cultural Humility Recognizes That • An isolated increase in knowledge without parallel changes in attitude and behavior is limited in value. • Patient focused interviewing reduces the need for complete mastery of every groups’ health beliefs because the patient is encouraged to communicate how little or much culture has to do with the situation. Tervalon and Murray-Garcia (1996)

30. Provider level changes • Enhance Provider Understanding of the Psychological Basis of Bias • Enhance Providers’ Confidence in their Ability to Successfully Interact with Socially Dissimilar Patients by promoting contact • Enhance Emotional Regulation skills specific to Promoting Positive Emotions • Increase Providers Perspective Taking and Affective Empathy • Improve Providers Ability to Build Partnerships with Patients Burgeess D, van Ryn, M, Dovidio, J and Saha, S (2007)

31. Conclusions • Our “child and youth problem” is not a child and youth problem, it is a profound adult problem, as our children do what they see us adults doing in our personal, professional and public lives...False “either/ors” between personal, family, community and societal responsibility for children need to stop” • Marian Wright Edelman, Cradle to Prison Pipeline Children’s Defense Fund

32. Simply put… • Love is patient; love is kind; love is not envious or boastful or arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice in wrongdoing, but rejoices in the truth. It bears all things, believes all things, hopes all things, endures all things, love never fails. (1 Corinthians 13: 4-7)

33. HAPPY PEOPLE • Have better health habits • Have lower blood pressure • Have more robust immune systems • Are more productive on the job • Have higher incomes • Are able to tolerate more pain • Live longer than average Dannerr (2001) and Diener Seligman (2002)