Mental Health Professionals, Minorities and The Poor.

By Michael E. Illovsky, PhD
Brunner Routledge, New York, 2003
ISBN 0-415-93576-8

Perhaps the most important work to come out in 2003 in the discipline of cross-cultural relations, this work is as comprehensive and thoughtful as one could hope for, or, depending from what perspective one is reading - fear. In its very first pages, Illovsky, a licensed clinical psychologist and counselor who also teaches at Western Illinois University, re-examines the concepts that help us to categorize each other into handy categories and classes. One of the first ideas he challenges is free will "a very expedient concept for the dominant group to accept and propagate." The members of the group who propagate this idea can easily believe they hold their positions thanks to their own work, when institutional racism, or ethnic privilege, may have more or all to do with their positions: political, economic, social, or academic. Illovsky is not obsessed with power, but he does not let it go for a single page of his the book.

Throughout his work, the author lists problems in a handy point form format, and then provides proposed solutions and recommendations based on his own or others’ practice. While the title of the work indicates mental health will be examined, more of the book is dedicated to manners in which to approach culture, and the gaps between ethnic groups, and the very definitions we have tried to provide for "ethnic." Illovsky man-handles the very vocabulary of the professions and the concepts of "patient," "client" "disease" and "professional" are tested for solidity. Not quite an obstacle course, the reading of this book requires pause. In fact, the mental health portion of the work, while significant, seems almost an afterthought for Illovsky, whose chief concern is bridging the gap between "professional" and "client," minority and majority, established and poor, category and perceptions.

Every page of the work is studded with numerous – at least half a dozen per page - academic and professional references, dating back to the 70s, 80s, and 90s. International institutions such as the World Health Organization, as well as American benchmarking organizations, such as the Surgeons Generals’ Office, the Census Bureau and several others are cited more to reveal the scope of research already done than to argue a point. In fact I would say that Illovsky is far more concerned with bringing his reader information than making a point – an increasingly rare endeavor.

For example, in the first chapter titled "Providing Services to Cross-Cultural Persons," Illovsky cites a United Nations Commission of Human Rights report which itself used Amnesty International information denouncing U.S. violations of human rights of its people of color: Africans, Asians and Latinos. Racism, an analyst wrote, is pervasive in North America - that would include Canada - and the rights of people of color are insidiously violated in the medical health systems. Racism and stress, and ultimately disease are increasingly cause-related for African Americans, several studies show. . Furthermore, Illovsky attacks his own professions, arguing that smiles and civility are often a façade of professional friendliness which, in turn, serves a number of what may be termed "self-serving" purposes, but do little to assist the patient or client. In fact , smiles and friendliness – when mimicked are among the best told to facilitate business relations, not a patient relationship. In more than one culture, not only are these business techniques transparent, but a smile can be misunderstood to a surprising degree. Illosvky need not ask the question at this stage: it is clear that North American Europeans, who manage the health care system here – are those responsible for smiling-services.

The question Illovsky makes you ask yourself, is not, of course, whether we ought to stop smiling – although you may when you start to read this book – but rather, I think, whether it is sufficient to smile?

Citing a Surgeon Generals report from 1999, Illovsky explains how recent research has uncovered a multitude of ethnic and cultural variations and trends to drugs and their uses. The field of ethnopsychopharmacology – not in your computer’s spellchecker - is a "specialty that concentrates on the study of responses to drug metabolism, generic variations, and the effects of tradition, culture and endogenous drugs. For instance, research reveals that 33% of African Americans, and 37% of Asians are slow metabolizers of several antipsychotic medications and antidepressants. The significance of this is that pharmacy-automated prescriptions may very well result in over-medication, or even in over-dose in certain cases. Other key findings include relationships on smoking, suicide, alcohol, suicide mortality (success) rates, and eating disorders, classified by ethnic or minority groups. Asian Americans, for example, on the whole, eat better than and are more healthy than Whites. Native Americans learn best privately, not publicly, and use mental images, rather than verbal ones, to understand words and concepts. Schizophrenia has a higher recovery rate in less developed countries than in developed ones, raising the question of what factors might mitigate the course of schizophrenia ? More insidiously, Europeans have been able to leave their countries and spread throughout the world because of their superior technology and weaponry, and while this may once have been a monopoly, recent events prove this hold on technology has been broken. Finally, what we are terming "aberrant" behavior is not necessarily a clinical disorder, but may frequently be an indiosyncratic expression, whose definitions may grow, depending on whether we are willing to learn more from other cultures.

Several subchapters are titled "contributions of other cultures" where iIllovsky points towards non European-American sources of information, knowledge, and wisdom. His motive for these investigations is that the status quo – ethnocentrism – limits our learning from other cultures. African and Chinese cultures have existed for thousands of years and have fashioned "relationship patterns that have lasted centuries – if not millennia." These are in contrast to the relatively short-lived European systems that we have adopted in North America. Illovsky states the obvious, but it’s a wonder it is not stated more frequently in academic works and research projects concerned with cross-cultural relations.

Furthermore, this psychologist argues, our own research, where we would re-interpret, for the umpteenth time, our European roots, and we where we assiduously desiccate the works Karl Marx, Max Weber and C. Wright Mills, may not yield any more insights, since it is only our own culture that we are delving in. These thinkers viewed "power dynamics…usually from the perspective of White males interacting with females, but their analyses might provide insight into those who control the systems in this society that affect minorities – and how we react to them."

In the portion where he deals with minority mental health research, the researcher examines data generated by the World Health Organization in the mid 1990s. What he notes here is that what started out as a well-defined scientific objective ended up churning out far more conceptual problems and questions than envisaged. As a result, dozens of writers have since re-launched their energies into sub-fields of research which now have gained far more of attention. Several papers on transcultural psychiatry were generated and, as he points out, you often need only type in the author’s name when logged on to the Internet to obtain a copy of their work. Significantly, the authors and scientists who were tasked to launch the WHO research ended up criticizing methods and results: one of the most intriguing criticisms was that many syndromes and disorders such as anorexia and chronic fatigue were excluded from the glossary of "culture bound syndromes." The reason? Many scientists view these and other disorders as chiefly North American psychological phenomena The result, Illosvky writes, is that while it proclaims to be an objective study of mental health world-wide, research is often "a manual of heavily loaded …culture-bound values, perceptions, definitions and syndromes."

Another study titled "World Mental Health Report" was also heavily criticized because of the statistical approaches and pitfalls it failed to avoid. For example, and not surprisingly, many nations in the study have different numbers of psychologists available to deliver programs and client services, so that the patient-doctor ratio fluctuated radically from state to nation to nation. As a result, a single psychologist may well have much higher numbers than a similar professional in another state. While seemingly obvious, these and other warnings fill Illovsky’s book. He also dedicates several pages to the inequities of university minority and equity programs: many administrations, he writes, use numbers to "play the game" and one of the favorites is to use white women – who are a form of minority, to fill in the colored minority quotas. Grant programs, this author writes, are an abuse of minorities, where cash is granted to allegedly "minority-owned business", and whites easily use minorities as fronts to circumvent government regulations, or make their business more competitive. Ultimately, the minority is only a tool in the larger objective: profit generation. "No matter what the purpose of the grant, he writes, " the net result is usually to provide support to the person administering the grant. The function of grants should be to develop endogenous, self-perpetuating…services and systems. The eventual goal of grants should be to have community members assume responsibility for all the roles and functions of service providers." But this is not what is happening.

If this author has an agenda, he aptly uses others' research to make his point. Unsatisfied with the current definitions of "ethnic", Illovsky cites and summarizes the work of close to a dozen authors who are working on a new model, where world views are used to indicate a person's ethnicity. Instrumentation has already been worked out, and tested, as the first steps in this direction back in the 1970s. Gender, race and religion neutral, world views and perceptions of the world around us would permit scientists to escape the color barriers so evident in an interview or poll where whites ask blacks how they feel about certain subjects. Whites, Illosvky argues succinctly are not color-blind, nor are they attuned to the barriers, stereotypes and prejudices that have placed them where they are in relation to the majority of blacks, and other colored peoples. Prisons, jobs, health, economic standards, residential rental area are among a myriad of factors that increasingly show there is a classification problem in our way to approach each other.

Another chapter explains evolutionary psychology and its cross-cultural applications. In one of the more riveting sections of this chapter, Illovsky cites recent work in what can be termed "brain research." In a nutshell, different areas of the brain have a number of specific functions, each containing different learning mechanisms, cognitive structures and computational devices, including what is referred to in research by Spriggs (1998) as "Darwinian algorithmic mechanisms." While locating precisely where these are in the brain is still several years away, it is clear that they will also reveal much about an individual’s environment and culture, and where people have found themselves in certain periods of their cultural and personal development. Furthermore, ethology – the study of behaviors – has also been applied to cross-cultural behaviors, showing, inter alia, that variability exists among all species, that this variability can be moved along generations, and that individuals differ in their survival and reproduction techniques and success. Illosvky then uses the example that while blood is a bright red, its alarming color is only a "spandrel" (a unique function) that is secondary to its other vital uses: carrying oxygen, repairing open wounds etc. So, Illovsky argues, we appear to be only at the entrance of vast forests of data about the spandrels of our behaviors as humans.

Put differently, there are vast amounts of behaviors, well catalogued and frequently mis-labeled that are perfectly human functions, but which we may frown upon because of the stereotypes we have taped to them. Homosexuality, inappropriate dancing, screaming and facial grimaces may well be some of these useful spandrels that we are on the cusp of explaining/accepting. And for skeptics, Illovsky has questions: "Within the controls of White American values, should one deprive the body of food and lose weight to obtain more status, or should one cater to this biological drive, eat, gain weight, and lose status? Another example: should a woman stay in the security of a familiar environment and put up with an abusing spouse, or leave and enter an unfamiliar environment for the protection of her safety.

The writer also spends several pages explaining racism, and significantly this is done under the same chapter : evolutionary psychology. Here we find that Nazism and movements such as the Klu Klux Klan may well have had roots in economic distress and protective, tribal instincts. The KKK enrolled more participants when economic times were poor. While this finding alone is not new, the analysis that Illovsky provides afterward is. Some 50 pages are dedicated to what he calls "special populations" those with sexual orientations different from the "norm", the disabled, children, women and older persons. There are several pages on the uses and applications of modern technology and computer programs that bypass hard-wired stereotypes by asking appropriate, neutral questions in polling and surveys.

The most compelling pages of the book are Illovsky’s call to action and a demand to go beyond article writing and grant searches. He writes: "those of us who are in the professions that purport to help others often use the public and people to suffer as a means to obtain grants and to obtain funds and resources for ourselves and for the agencies we work for – we engage in self-aggrandizing altruism." Institutions such as democracy and the church have marginalized minorities and the poor to such an extent that they now "occupy a tangential part of our consciousness and activities." Surely, Illovsky argues, we can do more than offer platitudes and special issues of journals , to develop services that have a measurable impact on improving those who suffer and are ostracized. There are ways: "multicultural counseling and therapy – which has an acronym in the book – MCT – and the approaches developed for working with cross-cultural populations deserve serious consideration," he concludes.

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