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Mental Health Professionals, Minorities and the PoorReview - Mental Health Professionals, Minorities and the Poor
by Michael E. Illovsky
Brunner-Routledge, 2002
Review by Jack R. Anderson, M.D.
Jun 10th 2004 (Volume 8, Issue 24)

What shines most brightly through the pages of Illovsky's book is the deep compassion he feels for all of the unfortunates in this world. Not only does he share the suffering of children, the weak, the very old, the disadvantaged, the alienated, the sociocultural minorities, the sad and the poor—he is determined to do everything he can to relieve their suffering. To this end he has devoted years of hard work acquiring and organizing the material in this unusually rich and informative volume.

The author divides Americans into several groups. The dominant group he calls "European Americans." This group, also called "Whites," controls the U.S. through economic, political, social and military power. The other groups: "African Americans;" "Hispanic Americans;" "Asian Americans;" and "Native Americans" make up the minorities. When—as is often the case—the mental health professional is European American and his client is from one of the minorities, the difference in their sociocultural backgrounds interferes with the therapeutic process.

Some Western-bound cultural values that may conflict with those of non-European Americans are:

1.      Focus on the individual rather than the family or community. If a non-European client does not focus on himself, he may be described as dependent or immature.

2.      Verbal expression of emotions. A non-European American client who is not verbal or articulate may be described as inhibited, repressed or uninvolved.

3.       Openness and intimacy. If a non-European American client does not engage in self-disclosure because of cultural prohibitions, he may be described as suspicious, guarded or paranoid.

4.      Insight. Some non-European cultures, e.g. Chinese, do not regard insight as a necessary component of therapy, but a non-European American client who does not demonstrate insight might be considered resistant.

5.      Competition versus cooperation. Although European Americans value competition, cooperation is more important to many non-European American cultures. A non-European client who does not meet his therapist's expectations with regard to competitiveness is apt to be called passive or lacking in assertiveness.

6.      Linear-static time emphasis. In some non-European American cultures, time is considered to be circular, flowing, harmonious and marked by events rather than by clocks. If a non-European American violates his therapist's linear-static time perception by being late for a session, he is apt to be classified as resistant, irresponsible or passive-aggressive.

7.      Nuclear versus extended family. Most European American therapists' concepts of family are based on the nuclear concept, while their non-European American clients' families might include ancestors, aunts, uncles, etc.

8.      Scientific empiricism. Although the European American mental health professionals' therapeutic process is based on symbolic logic, cause and effect, and linear, rationalistic or reductionist analyses of phenomena, his non-European American client might have a nonlinear, wholistic view and approach to the world. 

Illovsky offers European American therapists and counselors a variety of solutions to the problems of cross-cultural communication with their clients. He recommends they follow the lead of marketing specialists, who carefully study various ethnic groups and vary their posters, email, newspaper ads, etc. in order to successfully communicate with each group and thus sell their products. He suggests therapists do careful self-assessments and question their own basic assumptions. If a non-European American client fails to respond to the treatment program, perhaps it's the therapist's fault rather than the client's. Therapists should develop valid and reliable assessment tools for their non-European American clients, learn better techniques to empower them, and study each of the different cultures to become familiar with the various signs of comfort and discomfort,  threatening and non-threatening gestures and behaviors, and meaningful methods of reassurance and caring.

Illovsky also recommends that mental health professionals spend some of their time and effort in programs of social activism. He points out the effects that social, economic and political conditions can have on mental health, and believes that professional ethics require counselors and therapists to speak out against the evils of institutional racism and other forms of discrimination, and to intervene with proper authorities when they see injustices involving their clients. Professionals are also asked to examine their own motives with respect to the dynamics of power. Do they hold their positions because of their professional competence, or because they share ethnicity and socioeconomic backgrounds with the executives—the power holders—of their institutions? Are their activities directed toward organizational or therapeutic needs?

Illovsky writes: "One can make a case that counselors and therapists perpetuate the economic, political, and social effects that American society, in general, has on minority communities. That is, the relationship is an exploitive (sic), mercantile, and imperialistic one. It is more concerned with maintaining the status quo than it is with dealing with the real issues that pertain to the mental health of ethnic minorities."

Throughout the book, the author attributes the inequities and injustices suffered by the minorities and the poor to the selfish and materialistic attitudes and behaviors of the dominant European Americans. He explains that not only the politicians' but also the mental health professionals' political activities are usually directed toward self-aggrandizement and that professional organizations, while pretending that they protect and help the public, really work to increase the clout and benefits of their members.

The title of Chapter 7 is "World Mental Health—It isn't the Fault of the Minorities and the Poor." In this chapter, Illovsky gives a list of possible reasons why the poor exist and why some social groups are defined as minorities. One possible reason listed is that a capitalistic society requires a large pool of poor unemployed to remind workers of their vulnerability if they don't work hard to hold their jobs. Another reason posited is that "Minorities exist to validate the values of the ruling group (a sociological perspective)."

As the title of Chapter 7 suggests, Illovsky does not believe the minorities and the poor can do much about their conditions through their own efforts. Members of the dominant group, he writes, use the concept of "free will" to prove that they obtained their positions of power through their own efforts rather than through institutional racism, ethnic privilege or similar circumstances. They can also explain the lack of power and resources of the poor and the minorities by characterizing them as lazy and lacking in will power. Although the author does believe in the concept of "free will," be thinks it is wrong to attribute the plight of the poor and minorities to a lack of will power. As explained above, he attributes their economic and social inequities to the materialism and selfishness of the dominant European Americans. 

Illovsky does not just discuss the mental health problems of the minorities and the poor; he also spends a large portion of his book discussing solutions. He has done a lot of research and presents a multitude of well-thought-out suggestions from a multitude of documented sources—too many to be discussed in this short review.  For example he cites the World Bank's Development Reports (World Bank, 1993), as advocating for further investments into health care and reduction of poverty because of the impact social environments have on mental health. The United States Surgeon General's report (1999b) found that certain mental health services were in consistently short supply and recommended that steps be taken to ensure the supply of mental health services and providers.

Unfortunately, hell will probably freeze over before Illovsky's thoughtful and compassionate remedies are adopted to redress the inequities and injustices suffered by the minorities and the poor. With our burgeoning federal deficit and the rapidly escalating costs of health care, the gap between care provided the haves and that provided the have- nots will in all probability continue to grow, rather than shrink, in the foreseeable future.                   

Nevertheless, the good doctor deserves our thanks and applause for his hard work and courage for bringing these problems to our attention. Because of his efforts, we European Americans, if we take time to read his masterpiece, might be spurred by pangs of conscience (if, indeed, we still have a conscience) to do something about our responsibilities to the less fortunate citizens of our world.


© 2004 Jack R. Anderson



    Jack R. Anderson, M.D. is a retired psychiatrist living in Lincoln, Nebraska


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