Keywords

Introduction

In everyday life, we all encounter instances of prejudice, stereotypes, and racism. This occurs perhaps in most countries where there are different groups of people, of diverse ethnicity, origin, beliefs, appearance, habits and practices, etc. These will be moments where a person would be on the receiving end, or the person might incite an incident of this nature, where bigotry or discrimination is in action, even if doing so unwittingly or passively.

As human beings, we form categories to make sense of the world: the sky is blue, the grass is green, the stove is hot, and the ice is cold. How we perceive ourselves comes from what we have been directly, and indirectly, taught by our families, friends, media, and popular culture. Prejudice is a judgment of that is based in opinion rather than fact (Tatum 1997). Generally, the prejudice leads to dislike or condemnation of an “out group.” The prejudice develops from stereotypes, limited or lack of exposure, or interactions with people outside of our daily lives. This prejudicial belief can be blatant or subtle (Pettigrew and Meertens 1995). The first one is direct and conscious, applied based on a preestablished belief about “other people” and the conviction of knowledge of how they are, what they believe, what they do, etc. In the subtle form, there is a distance and a wish to not know, avoiding getting in contact, and keeping away from “the other people.” In the empirical work of Pettigrew and Meertens on racism and prejudice, “blatant prejudice” is operationally defined with two dimensions: perceived threat from the rejection of the outgroup and opposition to intimate contact with out-group members. The “subtle prejudice” has been defined with three dimensions: defense of traditional values, exaggeration of cultural difference, and denial of positive emotional responses to the out group.

The dislike often is not based even on direct contact with the despised “group of others,” and there is some evidence that direct contact and exposure to “them” may lead to diminished prejudice (Hamberger and Hewston 1997).

Additionally, many people are unaware of the beliefs they hold, having obtained them as a persistent, and unfortunate, consequence of living in a society embedded with system racism. This is because we are each born into a specific set of social identities related to the categories of difference mentioned above, and these social identities predispose us to unequal roles in the dynamic system of oppression. We come to see the diminished status or devaluation of some social groups as acceptable, natural, and unavoidable.

We are then socialized by powerful sources in our worlds to play the roles prescribed by an inequitable social system. This socialization process is pervasive (coming from all sides and sources), consistent (patterned and predictable), circular (self-supporting), self-perpetuating (interdependent), and often invisible (unconscious and unnamed) (Harro 2000, p. 15).

How individuals perceive race and racism can influence how they understand their identity, their actions, and their views on society. In this chapter, we provide an overview of these topics, rather than an in-depth study. It is important to be aware of these concepts when working with all people in a professional setting. Failing to acknowledge how our own privilege, or perceived power, affects how our interactions with clients/patients can negatively impact the effectiveness of the treatment we deliver.

This chapter will view “cultures” in the context of groups that live together in the United States although the information is applicable in any context of an industrialized country when one deals with a “minority” or “underprivileged” client. According to the Office of Immigration Statistics of the Department for Homeland Security in 2015, over one million individuals from other countries were granted lawful permanent residence in the United States (DHS.gov). Individuals from over 70 countries were included in this measurement; the five countries with the most immigrants were Mexico, China, India, the Philippines, and Cuba (DHS.gov). Although this represents a very diverse group of people, this measurement only includes those granted permanent residence and excludes those already residing in the country, naturalized citizens, and undocumented immigrants. These are people from countries all over the world, with their own language, customs, religions, and belief systems living together in one country, a country that was inhabited by Indigenous groups, then colonized by European immigrants. The United States, like many European countries, has become a combination of cultures, beliefs, and languages; any group faces many social injustices.

It is vital for a clinician to recognize and self-reflect on thoughts, actions, and beliefs in regard to people who not only do not share their same privilege identities but also who do not share their own identities. A clinician might endeavor to be able and willing to work with clients from any background and situation. For example, people with mental disabilities face a great deal of stigma, not only from society but also from themselves; consequently, a negative or pessimistic attitude toward these clients from a social worker or mental health professional can create further stigma and augment a negative perception of themselves as well as of receiving care (Harrison and Gill 2010). To avoid this, clinicians might try to be particularly conscious of how their own beliefs, perceptions, and identities affect how they view other people and society as a whole. Clinicians often do not like to face and come to terms with their own privileges and discover they have oppressed another group of people; however, without this revelation and knowledge, change cannot happen, and oppression continues.

Individual, Institutional, and Structural Discrimination

People use schemas to evaluate themselves and the social roles, social groups, social events, and social actors they encounter, in a process known as social cognition. The categories into which they divide up the social world may change over time and evolve with experience, but among mature human beings, they always exist, and people always fall back on them when they interpret objects, events, people, and situations. Humans beings are programmed psychologically to categorize the people they encounter and to use these categories to make social judgements (Massey 2009).

The need to make sense of the world through categorization occurs naturally to humans. Inherently, there is nothing unjust about categorizing people; it is when these categorizations begin to ignore, exclude, or create negative action against those in another “category” that they become discrimination. Discrimination, or the unjust or prejudicial treatment of different categories of people, especially on the grounds of race, age, or sex, is how people are excluded from society. The concept of a dominant group and a minority group indicates the amount of social power or the lack of power held by that group. In the United States, the dominant power has been historically held by people of White European heritage and primarily affluent white males (Pincus 1996). This inequality in power has led to hundreds of years of oppression and racism. In recent years, in an attempt to move toward an equitable racist society, a “color-blind” mentality was developed, as a way to not “see” racism.

The “color-blind” mentality that the United States has largely adopted minimizes the pervasive disparities in access to services due to race, ethnicity, and socioeconomic status, and a “form of lacking awareness in diversity and is associated with lower levels of cultural sensitivity” (Wang et al. 2014, p. 213). The United States, like many other countries in the world, has systems of inequality, systemic oppression, and discrimination. In adopting a “color-blind” ideology, there is the implication that society does not see race. This practice of being aware of race but choosing not to acknowledge its presence makes it nearly impossible to hold organizations or society as a whole accountable for racist systems and conventions (Welton et al. 2015). The United States, like other countries, has experienced colonization, slavery, and systematic oppression of people. Out of this oppression came the concept of race and racism, to categorize people and create a structure of power.

Racism creates a racial structure—a network of social relations at social, political, economic, and ideological levels that shapes the life chances of the various races. This structure is responsible for the production and reproduction of systemic racial advantages for some (the dominant racial group) and disadvantages for others (the subordinated races) creating a sense of “us” versus “them” (Bonilla-Silva 2015, p. 1360).

Seeing all people in a society as different yet equal can create more systemic tension. All humans arrive at each interaction with their own thoughts, wants, needs, and prejudices, which can then in turn lead to behavior driven by ignorance and fear and lead to discrimination.

Sociologist Fred Pincus (1996) explains the three types of discrimination: individual, institutional, and structural.

Individual and institutional discrimination refer to actions and or policies that are intended to have a differential impact on minorities and women. Structural discrimination on the other hand, refers to policies that are race or gender neutral in intent but that have negative effects on women, minorities, or both. (p. 1)

Examples of these types of discrimination can be seen in everyday life in the United States. Individual discrimination is seen through the actions of individuals, or small groups, acting against other individuals due to a particular belief. An example may be a White man who will not purchase items from a store owned by a Muslim family.

Unlike individual discrimination, institutional discrimination is discriminatory behavior embedded in important social institutions. It is usually carried out by a dominant group against minority groups because the dominant groups control social institutions (Pincus 1996). Examples can be seen in US history in school segregation, Jim Crow laws, and how communities are created and who can access them. Because of its nature and the fact that it is embedded into the law, institutional discrimination is often difficult for dominant groups to see or accept. White people may be more willing to acknowledge instances of institutional discrimination carried out against African Americans or other minorities in the past, since in the present it has been “resolved,” such as the case of school segregation and voting rights. Similarly, most men accept that women should be able to vote, now that a century has passed since they won this right. It can be easy for those in the dominant group to assume that the institutional discrimination of the past has been resolved. Given that they are not directly experiencing racism, they may overlook acts of racism and discrimination that may be happening around them. This privileged lens can also convince them that they are not racist, as they would not overtly act in a “racist” manner, but still their behavior is influenced by their examined beliefs (Dovidio et al. 2008, Gee et al. 2016). Systems are difficult to change, and thus individuals continue to be socialized to believe certain things about other people different from themselves. Institutional discrimination can often be uncovered by asking oneself questions such as “Where are new buildings being built? Who is able to access home loans and other types of banking benefits? Who has access to which communities (such as public transportation, home price, affordable house, etc.)? Are those who hold positions of power in a community representative of those living there? How are laws disproportionately affecting certain communities?”

Structural discrimination is defined by Pincus (1996) as being different from institutional discrimination in that it lacks intent. Angermeyer et al. (2014) define structural discrimination as “institutional practices and policies that work to the disadvantage of the stigmatized group, even in the absence of individual discrimination” (p. 61) and distinguish between intended and unintended discrimination.

Intended structural discrimination encompasses rules, policies, and procedures of private and public institutions that purposefully limit rights and opportunities of people…unintended structural discrimination includes major institutions’ policies that are not intended to discriminate but whose consequences nevertheless hinder the options of people. (Angermeyer et al. 2014, p. 61)

Although Pincus and Angermeyer, Matschinger, Link, and Schomerus have some difference in distinctions of discrimination, the fundamental idea is similar that discrimination can occur from an individual interaction to institutional systems.

The following are vignettes to further explore the incidents of discrimination in the United States. Discrimination and racism can be both overt and covert/subtle. This example could occur with an individual from several countries of origin, or ethnic/racial group.

Omar is an immigrant from El Salvador who has recently arrived in a Midwestern city in the United States. He is a high school graduate in El Salvador and is able to read and write in Spanish; his English, however, is weak. His skin is fairly dark, but he would not consider himself Black. Although he has work authorization from theDepartment of Homeland Security, Omar finds work in landscaping alongside mostly undocumented Latinos. In the United States, Omar encounters many people that are of all different races, languages, and cultures. He finds it very different than his home in El Salvador, where everyone he knew was mestizo and shared Salvadoran culture. Omar tries to rent an apartment, and when he finds that many landlords do not return his calls, he decides to live in apartment with other men with whom he works. The men caution him to avoid “los morenos” (African Americans) because several of them have been robbed at gunpoint in front of the store where they cash their paychecks by African Americans.

As a member of a minority group, it is likely that Omar will experience discrimination in his new home that he may not have experienced in El Salvador. It is also likely that as he assimilates into US culture, he will create new categories in his mind that might or might not lead to individual discrimination. Omar feels discriminated against when landlords do not respond to inquiries. The individual landlords are discriminating against Omar, due to his accent or his name. Omar begins to identify and feel a part of the group of Latinos in the United States and in turn also begins to categorize people in a similar way. These categories lead to discrimination being carried out against African Americans, thus perpetuating more stereotypes and racism.

It is also important to note that because one member of one minority is being discriminated by the dominant group does not mean that individual will not also discriminate another member of another minority group, as seen above.

At times discrimination can be observed in a quieter manner.

Lourdes enjoys shopping and finds that this how she likes to release stress. Lourdes grew up in the United States, but her parents immigrated from the Philippines before Lourdes was born. Lourdes recently received a promotion at her company and decided to reward herself with a new wardrobe from a fancy boutique shop in town. Feeling confident and happy in her accomplishments, Lourdes walked into the boutique, without really noticing that she was the only woman of color in the shop. The saleswomen were White, as were the customers. After a few moments of looking at clothes and shoes, Lourdes noticed that no one offered her any help or asked if she needed to see an item. Lourdes saw a few White women come in after her, and they were greeted warmly and asked if they needed help. As Lourdes walked around the shop, she noticed that the saleswomen were following her, without speaking to her or offering help. When Lourdes asked to see a pair of shoes, the saleswoman was short and curt in her responses and treated her differently than the other customers. Lourdes walked out of the shop empty-handed, hurt, and embarrassed but not quite sure why she should feel embarrassment, causing her to also feel angry.

Lourdes was treated as though she was doing something wrong by being in an upscale shop. Although the saleswomen did not say the words that Lourdes was not welcome there, Lourdes was made to feel this way through the sales staff actions of following her and not offering their assistance. One cannot say whether the shop workers were aware of their behaviors, but ultimately, they were discriminating against Lourdes because of the way she looked. Their actions indicate their assumptions that because Lourdes is an ethnic minority, she could not afford what was in their shop and might even steal, thus she needed to be watched, but any further effort would be a waste of their time. As previously mentioned, institutions can perpetuate and reinforce discrimination, racism, and prejudice. For example, when a bank has two applicants for a loan, who, on paper, seem the same—the same income, credit score, etc. the African-American applicant is denied, while the White one is approved. Institutions perpetuate discrimination when service is denied to a Muslim family at a restaurant or an individual is not allowed to vote because she does not have the “correct” form of identification. There are countless examples of individual, institutional, and structural discrimination throughout history and currently.

In the present, some people feel as though society is moving toward a “post-racial” world, in which racism and discrimination are issues of the past. As previously mentioned, changes in laws and regulations to be more “inclusive” and discourage discrimination against ethnic minorities and women are seen as proof of this “post-racial” world. Some individuals cite the election of President Barack Obama in 2008, the first African-American president to be elected in the United States, as a symbol of moving toward a post-racial society.

A focus on post-racial ideology identifies hegemonic ideas and systems of representation that shape the means through which racism itself becomes normalized and concealed, reinforced and reproduced every day in interactions and institutions. Post-racial ideology circulates in situations where various degrees of race- and/or color-blindness, denial of racism and colonialism, and racist sentiment endure alongside persistent, implicit race-consciousness in peoples’ minds and in state policy. Belonging and inclusion become fraught as the avoidance of racial difference in discourse or policy sustains rather than eradicates coloniality… the articulation and re-articulation of race to hierarchies of value/worthlessness, acceptability/disposability…Rather than constituting a contradiction (i.e. race does not exist but has effects and affects), elision is a key means by which racism operates through the absence of intention clearly linked to the concept of ‘race’. The outcome is an apparent disappearance of race without the disappearance of its histories, meanings, and cumulative effects. When deployed as a strategy of power, post-racial ideology seeks to depoliticize race, racism, and difference in ways that demobilize anti-racist politics, substantive cultural recognition, and material redistribution. (Emboaba Da Costa 2016, p. 477)

In an era of global movement, individuals and groups of people who perhaps would have had little interaction 100 years ago are currently able to live side by side. In having a variety of ethnicities, races, and cultures living together, the differences between people are perhaps more apparent but also as time goes on, perhaps more commonplace, leaving less room for overt racism but failing to renounce discrimination or prejudice.

Beyond Cultural Competency: Working Within a Transcultural Framework in a US Context

From the concepts of color-blindness and a post-racial society came the idea of cultural competence. The idea of cultural competence is not like the color-blind concept of not seeing difference but rather requires recognizing differences between individual and using these differences to inform interactions and “working relationships that supersede cultural differences” (Beach et al. 2005). In theory, it can be helpful for one to have some knowledge about another person when having an interaction with them, particularly a professional interaction, but this does not guarantee the absence of prejudice, discrimination, or racism.

Some concerns about cultural competence arise from how individuals learn about cultures and customs and that it could possibly promote more stereotypes, biases, and discrimination (Beach et al. 2005). Stereotypes and biases could be increased when speaking about large groups of people as one, rather than seeing people as human beings and not only as part of one group. Describing the practices of “one group” likely does not accurately describe the practices of all group members. For example, stating that “all Catholics,” or “all Asians,” believe or do something can create stereotypes, which may be partially based in fact but cannot be verified for all group members.

Perception of identity is multifaceted and unique to each individual. For some, their identity may be most strongly tied to their ethnicity, for example, an Italian-American may perceive themselves to be members of an ethnic group, in a largely symbolic manner (Ortiz and Telles 2012). Others may tie their identity to their race, which implies a ranking along a racial hierarchy and which carries palpable social consequences. Based on this group membership, individuals may encounter stereotypes which define how they should behave or who they should be; or they may encounter discrimination where they are treated differently due their group membership (Ortiz and Telles 2012). Not only does the individual from the “minority group” identify in a particular way but so does the person in the “dominant” group. However, those who claim membership in the dominant group are not constantly reminded of how their identity fits into society. The privilege an individual has in a society, present for members of a dominant group, can perpetuate social inequalities, especially if the individual or group is not aware of their privilege (Holm et al. 2017). Not having awareness of one’s own privilege, or approaching race and discrimination with a post-racial ideology, leads to covert forms of discrimination.

Microaggressions are words or actions that may seem more subtle or surreptitious but are still insulting and discriminatory (Fleras 2016). Words in particular can seem innocuous, and the meaning can perhaps be open to interpretation depending on who is speaking and who is receiving the words.

The social context of language, the power of language is not in the words that hurt, but about those patterns of power perpetuated through word play and language use in everyday discourses and daily practices. This assertion alone makes it doubly important to expose how the language of words exemplified by racial micro-aggressions constitute a discourse in defense of dominant ideology. (Fleras 2016, p. 6)

Microaggressions are less blatant to the untrained observer than an obvious insult or harmful action, but they are still harmful and hurtful. Augie Fleras (2016) compiles several examples of racial microaggressions in the following table

Examples of racialized microaggressions

Expression by transgressor

Interpretation by the microaggressed

Where are you really from?

You are a perpetual alien because of appearances

Those people...

“Outing” the other as remote or removed

You speak good English

Who would have thought you could be so articulate, especially since eloquence is beyond the intellectual reach of your kind

You are a credit to your race

Your group is usually not this smart

When I look at you, I don’t see race

Denying identity and people’s lived experiences

There is only one race, the human race

Denying the person as a racial/cultural being

Clutching a purse more tightly

Criminal alert!

Following a customer of color in a store

Acting on stereotypes (“criminalized while shopping”)

Being ignored at a counter

You are less valued/Whites get preferential treatment

Taxi passes a racialized person for a white fare

You are dangerous; you are a second-class citizen

I’m not racist, I have Black friends

Friendships do not exclude microaggressions

As a woman, I know what you are experiencing

I can’t be a racist because I’m like you

Everyone can succeed if they work hard enough

Minorities are lazy or incompetent

It’s a post-racial society

Race is irrelevant to success; accept blame

Asking minority person to settle down; be quiet

Pathologizing communication styles

Mistaking a racialized minority for service worker

Minorities occupy menial jobs

 

(Fleras 2016, p. 7–8)

These are only a few examples of microaggressions; other examples exist that include issues of culture, such as cultural beliefs, religion, and religious practices. Depending on the interactions had by the individuals or groups, these microaggressions can become more escalated and be seen as a more overt act of aggression or discrimination.

The following vignettes illustrate some instances of microaggressions rooted in cultures and traditions.

Leila is a young Muslim woman who wears a headscarf and is active in her Mosque. Leila is usually the only Muslim student in her classes. She finds that her fellow students, and even teachers, turn to her when asking about what all Muslims believe and do. “Is that what Muslims believe?” “Why do Muslims hate women?” “Do all Muslims hate Americans?” Although Leila can generally recognize that these questions come from ignorance and lack of information, she still finds them offensive and hurtful.

Paolo lived in Brazil until his teens, when he moved to the United States to study engineering. Paolo grew up speaking Brazilian Portuguese, although he learned some Spanish in school. Paolo was surprised that his fellow students and friends would often ask him how to say words in Spanish, even though that was not his first language. “You’re from South America! Say something in Spanish!” Paolo would hear. Paolo was often invited to Mexican restaurants, being told that perhaps he would want to eat some “comfort food,” a comment that was not at all comforting.

Sam is a first-year medical student in the United States. Sam grew up in Nigeria and always knew he wanted to be a physician. Sam was surprised to find that in the United States, his fellow students and even professors would turn to him when asked about the minority or the “Black experience” in the United States. Sam replied that he did not grow up in the United States, so he did not have first-hand experience, but others always assumed that he could speak for an entire group of people.

Carmen grew up in the United States and was a third-generation immigrant to the United States. Her family still had strong connections to Mexico, and Carmen still had family members in Mexico. Carmen grew up with a very strong Catholic faith, and this was a very important part of her life. Carmen had been diagnosed with depression in her 20s but didn’t want to share this with anyone in her community, for fear that they would judge her faith. Carmen worried that she would be told she was not praying enough, or that she was losing beliefs, because she was taking medication for depression.

Mi na grew-up in Korea and came to the United States to complete her PhD. Mi na and her husband are expecting their first child and have no family in the United States to support them and have made few friends, so they rely on each other. In one of her OB/GYN appointments, Mi na shared with her nurse that she had experienced several dreams telling her that the baby would be a girl. The nurse became a little worried that Mi na was having visions or hallucinations, but Mi na assured her this was Korean tradition. When asked about her “birth plan,” Mi na stated that she just wanted the baby to be born and that she didn’t want to tell the doctors what to do. The nurse again questioned Mi na, saying that perhaps Mi na was not invested in this pregnancy and worried that Mi na may be depressed or detached from the pregnancy. Mi na did not see the need for a birth plan, because this was not something she had ever heard of, and this was not commonplace in Korea, and she did not want to disrespect the doctor and the medical team by assuming she knew more than they.

Misunderstandings can occur out of insensitivity and lack of knowledge. Many times, humans react out of fear when they are encountered with something unfamiliar—however, rather than reacting out of fear, if we are able to learn from these encounters and grow, we can become kinder and more empathic humans.

Conclusion

Keeping in mind our own privilege, as well as an awareness of how we see ourselves in the world, can help us understand how others see themselves in the world. In a professional setting, it is particularly crucial to recognize the prejudices, biases, and information that we have in our mind, to be able to see them as objectively as possible when encountered with any human interaction. Treating another human with the dignity and respect that any human deserves is ultimately what we strive for in any interaction.

Recognizing that there are differences and similarities in humans, and recognizing the stories and journeys each individual carries within themselves, both personal and historical, is what allows us to work collaboratively with the human in front of us and see their whole integrated self, rather than only pieces of the whole.

Fig. 4.1
Artwork depicts the encounter between different cultures. Two women are present on the left and the right, with a field, animals, and a river between them. The woman on the right stands under a tree.

Encounter of cultures. (Original artwork by Ana-Marcela Maldonado-Morales)

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