Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality [1 ed.] 9781624176289, 9781624176180

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Copyright © 2013. Nova Science Publishers, Incorporated. All rights reserved. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated, 2013.

Copyright © 2013. Nova Science Publishers, Incorporated. All rights reserved. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

SOCIAL ISSUES, JUSTICE AND STATUS

CROSS-CULTURAL INTERACTION AND UNDERSTANDING

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THEORY, PRACTICE, AND REALITY

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SOCIAL ISSUES, JUSTICE AND STATUS

CROSS-CULTURAL INTERACTION AND UNDERSTANDING THEORY, PRACTICE, AND REALITY

Copyright © 2013. Nova Science Publishers, Incorporated. All rights reserved.

YUMA IANNOTTI TOMES

New York

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Copyright © 2013 by Nova Science Publishers, Inc. All rights reserved. No part of this book may be reproduced, stored in a retrieval system or transmitted in any form or by any means: electronic, electrostatic, magnetic, tape, mechanical photocopying, recording or otherwise without the written permission of the Publisher. For permission to use material from this book please contact us: Telephone 631-231-7269; Fax 631-231-8175 Web Site: http://www.novapublishers.com NOTICE TO THE READER The Publisher has taken reasonable care in the preparation of this book, but makes no expressed or implied warranty of any kind and assumes no responsibility for any errors or omissions. No liability is assumed for incidental or consequential damages in connection with or arising out of information contained in this book. The Publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance upon, this material. Any parts of this book based on government reports are so indicated and copyright is claimed for those parts to the extent applicable to compilations of such works.

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Independent verification should be sought for any data, advice or recommendations contained in this book. In addition, no responsibility is assumed by the publisher for any injury and/or damage to persons or property arising from any methods, products, instructions, ideas or otherwise contained in this publication. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered herein. It is sold with the clear understanding that the Publisher is not engaged in rendering legal or any other professional services. If legal or any other expert assistance is required, the services of a competent person should be sought. FROM A DECLARATION OF PARTICIPANTS JOINTLY ADOPTED BY A COMMITTEE OF THE AMERICAN BAR ASSOCIATION AND A COMMITTEE OF PUBLISHERS. Additional color graphics may be available in the e-book version of this book.

Library of Congress Cataloging-in-Publication Data Cross-cultural interaction and understanding : theory, practice, & reality / editor, Yuma Iannotti Tomes (Masters of Science in School Psychology Program, Philadelphia College of Osteopathic Medicine, Philadelphia, PA , USA). pages cm Includes index. ISBN:  (eBook) 1. Intercultural communication. 2. Cultural pluralism. 3. Social interaction. I. Iannotti Tomes, Yuma. HM1211.C76 2013 303.48'2--dc23 2012048207

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DEDICATION

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To know me is to know my mother. To understand me is to know my God. Most humbly I dedicate this book to my mother, Mary M. Tomes. Thank you for believing in me when I didn‘t believe in myself. Your love through all situations has shown, a ―yes you can spirit‖ and your faith illustrates ―with God all things are possible.‖ And to God, I dedicate this book to you for entrusting me with a gift of sensitivity and allowing it to be manifested daily in my life and throughout this book.

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CONTENTS Preface

ix

Part I. Cross-Cultural Interaction and Understanding: Theory

1

Chapter 1

At a Defining Moment: Cross-Cultural Interaction and Understanding

Chapter 2

Understanding Cultural Appropriateness

25

Chapter 3

Crossing the DSM-IV-TR with Culture

43

Part II. Cross-Cultural Interaction and Understanding: Practice Chapter 4 Chapter 5 Copyright © 2013. Nova Science Publishers, Incorporated. All rights reserved.

3

Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10

63

The African American Perspective to Cross-Cultural Interaction and Understanding

65

The Asian American Perspective to Cross-Cultural Interaction and Understanding

87

The Latino/Hispanic Perspective to Cross-Cultural Interaction and Understanding

107

The Bi/Multi-Ethnic Perspective to Cross-Cultural Interaction and Understanding

127

The Sexual Minority Perspective to Cross-Cultural Interaction and Understanding

145

The Religious/Spiritualist Perspective to Cross-Cultural Interaction and Understanding

179

The Socio-Economic Status to Cross-Cultural Interaction and Understanding

207

Part III. Cross-Cultural Interaction and Understanding: Reality

235

Chapter 11

237

Alien Experiences

Index

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PREFACE

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Despite the unprecedented numbers of immigrants (legal/illegal) and the multicultural explosion experienced in the most diverse country of the world, the United States of America; racist and prejudicial ideology still permeates. In order to thwart the expansion of prejudicial beliefs based on ethnic classification, it is important to create a venue for open, honest, and direct communication about what binds every human. Culture is the backdrop that undergirds life practices. It is through this framework that both thoughts and actions are filtered as individuals go about daily routines. The genesis of "Cross-Cultural Interaction and Understanding: Theory, Practice, and Reality" emphasizes making culture palpable and explainable. Through understanding culture and its relationship to psychological processes, educational attainment, interpersonal interactions, and healthcare practices, the ability to help and serve others is clearly defined.

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PART I. CROSS-CULTURAL INTERACTION AND UNDERSTANDING: THEORY

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Chapter 1

AT A DEFINING MOMENT: CROSS-CULTURAL INTERACTION AND UNDERSTANDING ―The reasonable person adapts himself to the world, while the unreasonable one persists in trying to adapt the world to himself.‖ Author unknown

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ABSTRACT Given the current state of affairs across the United States and numerous other countries, the dialogue across cultural and ethnic groups has become strained. In order to effectively address and redress the concerns, a pathway to cultural understanding and pluralistic sensitivity has to be paved with more than good intentions but conscious actions. This chapter will expose the reader to appropriate terminology when relating to cross-cultural aspects and how words have strong meanings in the face of diversity. Then the need for pivoting from cultural competence to cultural consciousness is offered and ways to achieve it are suggested. Finally, the reader is exposed to the theory of Transculturalism, which encompasses a cultural biopsychosocial approach to understanding cross-cultural beliefs.

INTRODUCTION With the election of the 44th President, Barack Hussein Obama, a half White American and half African male (who identifies as African American), many residents of the United States of America feel we are living in a post-racial society. So, what exactly does post-racial mean? Does it mean, with the election of President Barack Hussein Obama, ―America has completed its evolution into a racial meritocracy,‖ wrote Phillip Morris of the Cleveland Plains Dealer. Our country, according to Jonathan Kay of the National Post, ―has finally become a fundamentally post-racial society,‖ and, Laura Hollis tells us at townhall.com, ―racism is dead‖ (Apollon, 2008). And more drastically, Patrick Buchanan (2011) in Suicide of a Superpower fiercely laments that America is at her weakest state due to the cultural influx of Mexicans and other ethnic groups – yet, this country is in a post-racial period. A true definition of post-racial is undoubtedly hard to come by, as the term and connotations of the term are dubious.

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Yuma Iannotti Tomes Recently, while at a Gay/Lesbian community meeting, a White male (Jack) entered the meeting 30 minutes late, and stated, ―What? Am I Black or something? Is that why you did not tell me about the change of meeting location?‖ After a 5-second pause a comment was made by an African American (Tim), gay male, stating, ―That was extremely offensive and I‘m not happy with your comment.‖ No one else made a comment. The white male quickly said, ―That was intended to be a joke. It was often stated in the 70‘s.‖ Afterwards, the all-white and gay participants came up to the lone black, gay male and said they were offended by Jack‘s comments and were shocked. However, some went on to say he must be stressed with not have any employment and could never have meant what he said. They appeared to almost excuse his behavior. Then the gay, black male turns to his white peers and states, ―If you were so offended, then why didn‘t you say something?‖ The room became silent again. This clip is powerful on many levels. It not only involves different cultural groups, but also different diversities, at one time. What are your initial reactions? This cultural case highlights what will be discussed in this chapter and throughout many others. What is/are the cultural differences presence? What perspective is the white, gay male making in his comment? What perspective is the black, gay male making in his response and later comment? What is the view of the participants? How would you address any concerns with either person or the group?

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Figure 1. Cultural Clip.

Source: http://www.barackobama.com. Figure 2. President Barack H. Obama.

The idea of a post-racial society, in its most basic form, is a society in which race is no longer significant or important (Miles, 2008). While many wish these quotes and definitions of conjecture were true, for many ethnic and cultural groups of color, a racist, culturally insensitive, gender-biased, anti-lower SES society still exists and has become more strident throughout the American culture. Jim Crow is not dead, it just has a different body (Figure 2).

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At a Defining Moment: Cross-Cultural Interaction and Understanding

5

Hurricane Katrina Hurricane Katrina of the 2005 Atlantic hurricane season was the costliest hurricane, as well as one of the five deadliest, in the history of the United States. Among recorded Atlantic hurricanes, it was the sixth strongest overall. It caused severe destruction along the Gulf coast from central Florida to Texas, much of it due to the storm surge. The most severe loss of life and property damage occurred in New Orleans, Louisiana, which flooded as the levee system catastrophically failed, in many cases hours after the storm had moved inland. The federal flood protection system in New Orleans failed at more than fifty places. Nearly every levee in metro New Orleans was breached as Hurricane Katrina passed just east of the city limits. Eventually 80% of the city became flooded and also large tracts of neighboring parishes and the floodwaters lingered for weeks. At least 1,836 people lost their lives in the actual hurricane and in the subsequent floods, making it the deadliest U.S. hurricane since the 1928 Okeechobee hurricane. Why is this a cultural icon? Many Americans, especially African Americans felt the response time by FEMA and the government was extremely delayed due in part to the racial makeup of the severely battered areas such as the 8th Ward of New Orleans, which has a large racial/ethnic minority population. While several thousand residents (all racial and ethnic backgrounds) of southern Louisiana, Mississippi and even Alabama were displaced as far West as Washington (state) and far Northeast as Boston, more African Americans were spread out due to where the levees broke. Additionally, former First Lady Barbara Bush commented, “What I'm hearing, which is sort of scary, is they all want to stay in Texas. Everyone is so overwhelmed by the hospitality. And so many of the people in the arena here, you know, were underprivileged anyway, so this is working very well for them‖ (Emery, 2005, p. 1). These comments conjured many negative thoughts for not only people of color, but also lower socioeconomic individuals. However, it offended many that came from well-to-do homes, neighbors, and communities. So, where were you when Hurricane Katrina hit the Gulf Coast, in particular New Orleans? What were your reactions of the hurricane, residents, government response time, etc.? How have things changed for you in your belief system? What role, if any, do you feel culture had an impact on this situation and your beliefs? Figure 3. Where Were You on August 29, 2005?.

To answer this question it may involve a further examination of the recent past to better understand the future existence of a post racial society. For instance, the displaced residents during Hurricane Katrina, many of whom represented different minority groups, of New Orleans, LA, Gulfport, MS and other gulf cities, would say that racism is very relevant to today‘s society. For many American Indians, whose land was stolen during colonization, and now their land is being purchased to build casinos (i.e., another form of colonization and capitalism) would say that racism still exists. Or maybe countless Spanish-speaking legal immigrants and their children who are ―forced‖ to speak the English language and at times punished because of their native accents would say cultural insensitivity still exists. Also, gay parents who are the biological father or mother are subjected to discriminatory laws as it relates to the parenting of their children. These accounts just represent a small portion of a non-post racial/cultural society.

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With new immigrants (legal/illegal) arriving in significant numbers- coming together with existing minorities and cultural groups within segregated America- an emphasis on multiculturalism and diversity emerged (D‘Angelo and Douglas, 2009). While the United States becomes more diverse, multicultural concerns are affecting a broad spectrum of American institutions extending from the private corporate sector to public education. As a result, this calls into question traditional definitions of race, culture, and ethnicity (Figure 3).

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COMING TO TERMS Culture is defined as the social transmissions of beliefs, values, practices, and behaviors of a group of cognitively-homogeneous individuals (Tomes, 2008). Moreover, culture is not static, but a fluid and dynamic aspect of beliefs and behaviors that have been influenced by new information and new experiences. Matsumoto and Juang (2008) define culture in terms of meaning and information shared by a group and transmitted across generations. Finally, Berry (1992) gives a greater understanding of culture through everyday language. The uses of culture are descriptive, historical, normative, psychological, structural, and genetic. One of the greatest illustrations of culture can be seen through the family. While all families are unique, their culture influences a myriad of unique behaviors (i.e., greetings of one another, foods eaten, etc.). Additionally, many sociocultural factors powerfully affect each family (Hays, 2007). As a result, some researchers feel that culture may be distinguished between narrow and broad definitions. The narrow definition of culture examines simple aspects such as race and ethnicity without much consideration to diversity. The broad definition is much more inclusive of demographic information, affiliations, and other ethnic characteristics that are not limited to race but spans across cultures (Mio, Barker, and Tumambing, 2009). Cross-cultural psychology is important in professional and interpersonal interactions; however, defining cross-cultural psychology is challenging, at best. Many researchers, familiar and unfamiliar to psychological theory, have taken significant strides to explain cross-cultural psychology. According to Cross, Bazron, Dennis, and Isaacs (as cited in Lynch and Hanson, 2004), cross-cultural psychology is defined in terms of behavior, attitudes, and policies that result in effectiveness of cross-cultural situations. Cross culture psychology, a branch of psychology, is the scientific study of how cultural factors influence human behavior and mental processes under diverse conditions. Various definitions of the field are given in Berry, Poortinga, Segall, and Dasen (1992), including ―the scientific study of human behavior and its transmission, taking into account the ways in which behaviors are shaped and influenced by social and cultural forces‖ (p. 1). For this text, cross-culturalism is the scientific understanding of the behaviors and beliefs shaped and influenced by socio-cultural factors transmitted from one culture to another culture. The transmission of information is critical to understanding cross-cultural interaction and communication. Other terms that are used interchangeably with culture, but done so improperly, are ethnicity (ethnic groups) and race. Ethnicity is often confused with culture because it shares tenets, such belief, practices, and patterns of behavior. However, ethnicity also includes traditions that have been shared over a historical period of time by people who have lived and acted together. When one thinks of ethnic groups, immediately Jews and Muslims come to

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At a Defining Moment: Cross-Cultural Interaction and Understanding

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mind. Additionally, for many, ethnicity combines aspects of race and culture, together. Within these ethnic groups an intra-culture rest that may be distinguished by different practices of cultural groups. It is important to note, every ethnicity has a culture, but every culture does not necessarily have an ethnicity. This concept will be discussed later in the book. Ghandi Mohandas Karamchand Gandhi was the pre-eminent political and spiritual leader of India during the Indian independence movement. While he was educated in India and London, it was his experiences in South Africa that transformed a man, a continent, and a world toward social justice. In South Africa, Gandhi involved himself in the Indian‘s community fight to end discrimination against Indians. He drew inspiration from several authors and philosophers and eschewing Western ways of thoughts and cultural which was evidenced by the wearing of loincloth and a shawl. It was in South African that Gandhi organized his first satyagraha (holding the truth), a campaign of civil disobedience expressed in nonviolent resistance to what he regarded as unjust laws. His activities and actions were so successful that he was able to reach an agreement from the South African government that promised the alleviation of anti-Indian discrimination. Gandhi‘s work did not stop on the continent of Africa. He returned to India in 1915 and actively supported the British in World War 1 in the hope of hastening India‘s freedom. During this time he also led agrarian and labor reform demonstrations that embarrassed the British. His program included a free, united India. His efforts were met with some resistance from Indians, but he persevered. He received the title Mahatma, great soul, because his beliefs reflected a personal prestige so high that he could unify the diverse elements of a variety of organizations. In 1942, after rejection of his offer to cooperate with Great Britain in World War II if the British would grant immediate independence to India, Gandhi called for satyagraha and launched the Quit India movement. Six years later when violence broke out between Hindus and Muslims, Gandhi resorted to fasts and tours of disturbed areas to check on various inhabitants. On January 30, 1948, while holding a prayer and pacification meeting at New Delhi, Gandhi was fatally should by a Hindu fanatic who was angered by Gandhi‘s solicitude for the Muslims.

Source: http://www.mkghandi.org. Figure 4. Cultural Icon. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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Race, for many, is a social classification based on physical characteristics/qualities. Race was created as departure to impose superior beliefs of one group over a perceived inferior group. While the history of race dates back the cradle of civilization, it was not elucidated until colonization. There are three concepts of race: biological concept, sociocultural concept, and human concept. Biologically, race is a combination of genetically inherited characteristics, that when manifested through phenotypes distinguish them from other groups. Sociocultural is more contemporary in its approach, because it examines geographic isolation of groups sharing similar physical characteristics. Finally, human perspective simply acknowledges there is one race – the human race. Since homo-sapiens, meaning same species, are distinct amongst the animal kingdom because of the cognitive and affective abilities, we represent one race compared to other mammals/animals such as canines, reptiles, and yes, dinosaurs (Figure 4). Finally, there are two other words that deserve mentioning – diversity and conversity. Diversity is a ubiquitous catchall phrase that embraces broad categorization of many cultural and ethnic discourses. Somewhat similar to the definition of culture, yet, slightly distinct, diversity can be defined simply as respect for differences. These differences may be among groups of people and individuals based on race, ethnicity, socioeconomic status, gender, language, exceptionalities, sexual orientation, religious practices, and geographic locations in which one lives. The concept of diversity promotes the thought of ―otherness‖ which at times can be ―limiting‖ in creating an inclusive community, however, it also showcases different human qualities from one‘s own culture and the outside group to which one belongs but are present in other individuals and groups. Conversity, an offspring of diversity, focuses on examining the similarities between two groups providing less attention to the differences. More poignantly, conversity operates under the notion to minimize ignorance which fuels, positively or negative, the fire for diversity is to explore what homogenously exists between two disparate groups. Here, homogeneity is important becomes it is the binding agent that enunciates the demographic and philosophical similarities among diverse groups.

Cross Cultural vs. Cultural Psychology Cross cultural psychology is differentiated from cultural psychology on two specific levels. Cross-culture tries to bring together such relatively unrelated areas as cultural anthropology and established areas of communication. Its core is to establish and understand how people from different cultures communicate with each other and the culture of a society comprises the shared values, understandings, assumptions, and goals that are learned from earlier generations, imposed by the members of the present day society and passed on to the succeeding generations (Wikianswers, 2009). Even the United States Department of Defense (n.d.) presents a definition of cross-cultural, Cross-cultural competence is the development of knowledge and skill through experience and training that results in a complex schema of cultural differences, perspective-taking skills, and interpersonal skills, all of which an individual can flexibly (or adaptively) apply through the willingness to engage in new environments even in the face of considerable ambiguity, through self-monitoring and through self-regulation to support mission success in a dynamic context. (p. 2)

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Cross cultural psychology includes a search for possible universals in behavior and mental process. Whereas, cultural psychology holds the belief that human behavior is determined by unique individual cultures that can be compared with each other only to a very limited extent. Also, cross cultural psychology surveys two or more cultures using equivalent methods of measurement to determine universality (Hall, 2005). Moreover, Berry, Poortinga, Segall, and Dasen (1992), believe ―there is a relationship between cross cultural psychology and cultural psychology both at the population level and at the individual level (p. 35).‖ Cultural psychology is more focused on specific aspect of one culture with limited attention to its interaction with other cultures. Since cross cultural psychology extends beyond methodological changes in psychology, it is a method interested in understanding a broad range of phenomena related to human behavior applicable to people across different cultural backgrounds.

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Cross Cultural Research Through expanding research methodologies to recognize cultural variance in behavior, language, and meaning, cross cultural psychology seeks to extend, develop, and transform psychology and how it‘s viewed in a global society. According to Matsumoto and Juang (2008), ―cross cultural psychology is a research method that tests the cultural parameters of psychological knowledge‖ (p. 4). Central themes, such as affect, cognition, conceptions of the self, and issues such as psychopathology, anxiety, and depression, are all re-examined in cross-cultural psychology in an attempt to better comprehend the universality of these concepts. While many critics and opponents to cross cultural psychology have pointed to methodological flaws in research, these cultural clashers also claim serious shortcomings in the theoretical basis but the arguments tend to impede rather than help the scientific search for universality (Ho and Wu, 2001). Regardless of these possible concerns, cross cultural research is a scientific study of human behavior and its transmission throughout a variety of cultures. The contribution of cross culture research not only tests where people are similar or different, it also highlights limitations in our knowledge as it relates to universal and culturespecific theories and diagnoses according to the DSM-IV-TR (and upcoming DSM-V). Therefore, it is important to use the DSM-IV-TR in context of a universal language diagnosis tool, but recognizing the limitations this instrument poses in accurately assessing cultural nuances which may present differently from culture to culture.

Cultural Factors There are three main factors that influence culture: ecology, sociology, and biology. Without much detail, it is easy to see how geography and climate impact culture. For example, American Indians who live on reservations may choose to grow and harvest fruits and vegetables, maintain livestock, and till the ground. Moreover, these are traditions of an Agrarian society that values agriculture in the sustenance of life and beliefs. These activities are done out of necessity for preservation of life and cultural values. However,

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interdependence and interrelationships among its members require teamwork fostering certain psychological qualities (i.e., trust, self-esteem, etc.). In order to produce harvest, teamwork is mandatory and a primary focus of daily living. Climate, like geography, plays an important role in cultural influence. Behrensmeyer (2006) chronicles how global changes in climates across history may have affected the evolution of humans. Currently, people indigenous to the artic area are experiencing major cultural changes as icebergs and glaciers continue to melt at a rapid pace. As a result, food supplies begin to change such as less seafood, because cold water fish are dying. Contrast this area to cultures in the tropics or close to the equator may have to suffer through droughts and their food source being depilated due to the droughts. Moreover, Asian cultures tend to struggle when immigrating into other cultures, like the American culture due to food allergies and constraints. Many Asian cultures possess enzymes that make them lactose intolerant, so eating or drinking foods made from diary creates significant problems, thereby, impacting their lifestyle across cultures. Additionally, there may be a lack of quality foods for immigrants. Meaning, seaweed may be prevalent in the American culture, yet, it is not as fresh or lacks some nutrients that may be found in Asian algae. The society in which the culture rests creates another level of important influence. Factors such as population density, type of government, dominant religion, and other sociocultural aspects dictate psychological attributes. It is no secret having access to money and other financial resources impacts children, adults, and families differently than does those who lack adequate funding sources (Matsumoto and Juang, 2008). As a result, lower socioeconomic families are forced to make more challenging decisions compared to their wealthier counterparts. Moreover, as societies reach a level of affluence their dependency on others wanes leaving less affluent societies more dependent on governmental and societal accommodations. This dependence may create psychological characteristics of dependency. The final factor, biology, reflects a lot of the internal states and traits that are less likely to be manifested by the environment or society. While a person‘s genotype is often illustrated through his/her phenotype, the same may be revealed through a culture. For instance, some people refer to Italians as having easy going temperaments, while Germans have a slightly more aggressive culture. These are aspects of a cultural personality. While culture, as Matsumoto and Juang (2008) suggest, influences personalities of it members, the opposite may be manifested as well. When groups of people with similar personality characteristics band together, they have the power to change the culture. Common examples of this is demonstrated when religious regimes are over thrown by other groups that view cultural systems as stagnant and non-progressive. In an effort to further examine these three areas, the biopsychosocial model encapsulates a comprehensive understanding of the cultural context of behavior. According to Mio, Barker, and Tumambing (2009), ―this model grew out of behavioral medicine and health psychology and focuses on an understanding of the psychological, social, and biological factors that contribute to illness and that be can be utilized in the treatment and prevention of illness and the promotion of wellness‖ (p. 14). The three levels take into consideration that at the basic level our behavior is influenced by one‘s genetic makeup, mental processes, and societal relationships. However, the belief by researchers is that at the base of this model is biology and as the culture becomes more involved it reaches into psychological and social issues.

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Etic vs. Emic Different people with different experiences often see the world in quite divergent viewpoints. These perspectives yield worldviews that are reflective of the filtered understanding a person in his/her culture experiences. Moreover, the distinctions between the perspectives are etic or emic, depending on the cross-cultural lens one is looking through on a daily basis. The etic view attempts to build theories of human behavior by examining commonalities across many cultures. Constantine and Sue (2005) believe ―etic refers to the process of trying to find universal behaviors, beliefs, and values across cultures‖ (pg. 134). This approach is commonly used among cultural theorists to explain universal phenomena. Whereas, emic looks internal and examines behaviors, beliefs, and norms within a culture to determine what is valued within that culture. This perspective derives what is meaningful only from within the culture (Mio, et al., 2009). The final area is imposed etics discussed by Berry (1969). When one culture, as an outsider, attempts to impose their viewpoints, beliefs, and practices on another culture leads to imposing etics. While some behaviors or concepts appear to be universal, this is not true for all cultures. For example, the practice of saving money is a strong American value. However, when discussing saving money with a Ugandan, there may be a significant differences. Ugandans tend not to practice saving money as a method to lower inflation rates throughout their country. As a result, many Ugandans spend money frequently on a multitude of products and foods. It is through believing that one should save more, an American imposes his/her values on another culture. This posturing, of sorts, occurs on a frequent basis across cultures and when cultures are newly introduced, such as through an immigrant population. While it is fine to have a worldview, in order to understand and respect similarities and differences, it is important to acknowledge your personal perspective and respect other‘s view. This text will offer a penetrating examination into both the etic and emic perspectives of a variety of cultures. One of the prevalent etic vs. emic perspective tends to be demonstrated in conversations between African Americans and European Americans on the subject of racial-diversity. The picture below and the dialogue that follows perfectly highlights the disparities expressed through etic and emic beliefs (Figure 5).

Source: The Richmond-Times Dispatch. Figure 5. Black and White Dialogue.

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Name That Culture The people of this culture and country have endured great persecution and strife for generations. Political and religious oppression, famine, floods, locusts, and warfare are endemic to this country which covers over one million square miles. While land-wise, this country is massive, it unfortunately is among the poorest countries and its citizens the least literate in the world. The life expectancy of this cultural group is 43 years for men and 44 years for women, which is significantly less than the life expectancy for many cultural groups across the world. There are a number of different types of refugees from this country. The largest number in the United States are refugees from the southern part of the country, composed of various minority ethnic groups fleeing religious and political persecution, warfare, and starvation. While many fled to neighboring countries some ventured further creating a tremendously cultural diverse pocket of individuals. Tribal affinity among many groups is the norm, with frequent intermarriage. Many ethnic languages are not mutually intelligible, although English, and to a lesser extent, Arabic, are the most widespread languages. Linguistically, this cultural/ethnic group is quite diverse, because each tribe has it own language and sometimes several dialects, especially those in the south. Literacy is very low, more so since schooling has been constantly disrupted by chronic warfare and strife. Socially, there are some generalized distinctions between north and south. For the north, which follows Muslim beliefs, when greeting, men shake hands with men, but it is not culturally-appropriate for men to shake hands with women, except within the family. Additionally, respect should always be afforded to the man as the household leader, but typically mothers (in the southern part oft he country) will be more knowledgeable about children‘s health and can be addressed directly. Separation of the sexes is common to the north and homes are divided into male and female areas. Approximately 70 percent of this country‘s population is Muslim, with the remainder practicing Christianity. While the Christians are a small minority, they tend to be the most educated. There is a widespread belief in this culture, especially among southerners, in the spiritual realm and its manifestations on health and illness, although the beliefs vary greatly from one tribe to the next. During periods of epidemics or even individual health crises, oracles are sought out to identify the offended spirits and determine the proper recourse. Frequently an offering is presented or an animal is sacrificed in order to appease or drive away the evil spirit. These spiritual beliefs and practices are observed mostly by non-Christians in the south and are sometimes sources of contention with the Christian community. There are multiple herbal and ―traditional‖ remedies used by this cultural group. For instance, a migraine headache can be cured by applying a chalky compound (clay, leaves, water – combined) rubbed over the head. For malaria, a root (visi ri) is chewed like a stick. For a lot of other aliments, many cures include boiling certain leaves and drinking the liquid mixture. When individuals of this cultural group have resettled to countries such as the United States and United Kingdom, they experience difficulties in accessing medical care. While language and cultural obstacles are obvious barriers, other factors such as lack of previous medical documentation and undiagnosed cases of other disease/disorders confound many encounters. Additionally, it is not uncommon for individuals of this cultural group to discontinue the use of prescribed Western medicine as soon as symptoms resolve rather than completing the full course of treatment. For this cultural group, death is seen as the will of a spirit or God. Burial involves ceremonies meant to appease the spirits so that no more deaths occur. Mourning may last for several months (southerners). For northerners, burial tends to take place as soon as possible. The body is taken to the mosque to be ritually cleaned and blessed by an Imam. The body is then carried to the previouslyprepared grave in a funeral procession. Mourning lasts between three to seven days. This culture is_____________________.

Source: http://www.scribd.com. Figure 6. Name That Culture.

The section above and other countless conversations between cultures continually support the need for cultural sensitivity, compassion and most important – competence (Figure 6). Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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High vs. Low Context High Context and Low Context communication is critical to understanding differences between ethnic groups. Hall (1981) explains that an individual‘s status within a social system also affect what must be attended. To this end, individuals within a culture will pay attention to different things than those outside of the culture. Additionally, those intra-culture persons also have the potential to examine things differently. A high-context culture communicates information either in the physical context or internalized in the person to the point where little information is coded, explicit, or transmitted within the message. Within in the high context culture many things are left unsaid, permitting the culture to explain. Further, words and word choices are important because few words may communicate complex issues. In low context culture information is shared explicitly. As a result, low context cultures do not cater toward in-group, but tends to be more inclusive in practices. For those participants, much more is shared in words and verbalizations, instead of the context of the situation, environment, or person. Through this context of communication much can be extrapolated. High context cultures are often rooted in the past and are very stable, which supports the need for less outward expressions, but minimizes social inclusivity. Whereas, low context cultures are more fluid and less stable leading to more vulnerable actions of society. Since one message can never be strictly identified as a high or low in absolute sense, each message may be part of cultural context continuum (Figure 7).

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NEED FOR CHANGING CULTURAL COMPETENCE TO CULTURAL CONSCIOUSNESS Many students (undergraduate/graduate/medical) often ask me, ―Why is there a need for understanding cultural diversity?‖ At first, I must admit I was indignant regarding this question and similar ones. My politically-correct retort would be, ―Because we must learn how to serve others and no one is too culturally-component.‖ High Context Cultures

Low Context Cultures

China

United States

Arab countries

Israel

Greece

Canada

India

Germany

Spain

Scandinavia

Spectrum from high to low: HIGHER > Japan > China > Arab > Greek >Mexico > Spain > Italy. France > USA > Scandinavia > German > LOWER Created by Y. Tomes (2012) for current publication. Figure 7. High Context vs. Low Context Cultures.

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However, there is a broader issue that has been raised through these lines of questions, and the National Center for Cultural Competence (2009) has identified six salient reasons to having a better cross cultural understanding. 1. To respond to the current and projected demographic changes in the United States Due largely to the immigrant patterns and significant increases among racially, ethnically, culturally, and linguistically diverse populations, the make-up of the United States changes daily. Moreover, organizations that provide mental health care and federal/state/local governments must implement systemic change in order to meet the mental health needs of the growing diverse population. Data from the 2000 census reveal that the number of persons who speak a language besides English at home rose by 50 percent to over 30 million. Of these, just over 45 percent indicated difficulty in speaking English. Further, results from an early 2000‘s survey conducted by the Census Bureau revealed that two out of every ten person in the United States are foreign-born (US Census, 2001). Currently, the US foreign-born population comprises a larger segment than at any time in the past five decades. This trend is expected to continue. More additional data suggest by the year 2010, there will be 5.5 million more Latino children, 2.6 million more African American children, and 1.5 million more children of other races, while white, non-Latino children is expected to decrease by 6.2 million. 2. To eliminate long-standing disparities in the (mental) health status of people of diverse racial, ethnic, and cultural backgrounds Where are the divisions of race, ethnicity, and culture most often drawn? Healthcare. Despite numerous recent progress, and current legislation outlined by President Barack Obama, there are continuing disparities in the incidence of illness and death among numerous ethnic groups. In order to minimize these disparities, especially those in mental health, several areas such as social stigmas, access to healthcare, and cultural empathy must be addressed throughout prevention, diagnosis, and treatment. 3. To improve the quality of services and (mental) health outcomes While we, Americans, are united by similarities there are fundamental differences among populations in the United States based on nationality, ethnicity, culture as well as family background and individual experience. These differences affect the mental health beliefs and behaviors of both patients and providers. For providers, the delivery of high-quality healthcare that is accessible, effective, and cost efficient requires practitioners to have a deeper understanding of the socioeconomic cultural background of patients, their families and the environments in which they live. Research has shown that culturally competent mental health services facilitate clinical encounters with more favorable outcomes, enhance potential for more rewarding interpersonal experience and increase the satisfaction of the individual receiving services. The healthcare setting itself is a culture, one that often excludes patients as outsiders. Language barriers, ethnic background and beliefs, disparities in educational levels, use of folk medicine, discontinuous or uncoordinated care, and many other factors compromise the chances for mutual trust and cooperation in provider-patient relationships (Munoz, 2001). While there are several critical factors that influence culturally competent mental healthcare, four significant areas are: cultural beliefs, culturally-defined health-

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related needs, culturally-based belief systems of the etiology of illness, and patient attitudes regarding mental health. When making a diagnosis, mental health professionals must demonstrate an understanding of cultural beliefs that shape the patient/client‘s approach to mental healthcare. For mental health professionals, knowledge of customs and healing traditions are indispensable to the design of treatment and interventions. It is no secret, mental healthcare services must be received and accepted to be successful. On another note, increasingly, cultural knowledge and understanding are important to personnel responsible for quality assurance programs. Moreover, those who design evaluation methodologies for continual program improvement must address hard questions about the relevance of mental healthcare interventions. Cultural competence, as needed in the United States, will have to be inextricably linked to the definition of specific health outcomes and to an ongoing system of accountability that is committed to reducing the current mental health disparities among racial, ethnic, and cultural groups. 4. To meet legislative, regulatory, and accreditation mandates While not well acknowledged, the federal government has a pivotal role in ensuring culturally component mental healthcare. Title VI of the Civil Rights Act of 1964 mandates that no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance. The Bureau of Primary Healthcare (n.d.) states: Health centers serve culturally and linguistically diverse communities and many serve multiple cultures within one center. Although race and ethnicity are often thought to be dominant elements of culture, health centers should embrace a broader definition to include language, gender, socioeconomic status, housing status and regional differences. 5. To gain competitive edge in the market place The potential for improved services lies in state-managed-care contracts that can increase retention and access to mental healthcare, expand recruitment and increase the satisfaction of individuals seeking mental healthcare services. To reach similar type outcomes, managed care plans must incorporate culturally competent policies, structures and practices to provide services for people from diverse ethnic, racial, cultural and linguistic backgrounds. 6. To decrease the likelihood of liability/malpractice claims It is no secret, especially within the medical field, that the lack of awareness about cultural differences may result in liability under tort principles in several ways. For example, a physician may discover that they are liable for damages as a result of treatment in the absence of informed consent. Moreover, healthcare organizations and programs face potential claims that their failure to understand health beliefs, practices and behavior on the part of providers or patients breaches professional standards of care. The ability to communicate accurately with patients has been shown to be effective in reducing the likelihood of malpractice claims. This further underlines how healthcare organizations and programs must address linguistic competence – insuring for accurate communication of information in language other than English.

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AREAS OF CROSS-CULTURAL APPEAL This book will highlight: identity, interaction, education, and health. It is the belief of the author that the aforementioned areas are not unique to cross-cultural research or psychology, but often forgotten or oversimplified when studied. In order to promote a cultural directedness focus, the book centers on carefully examining these concepts. It is the belief of the author that Identity, Communication, Education, and Health are intricately related throughout the cultural fabric of each individual‘s life.

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Identity Couched within identity is self-identification and social-identification. Self-identity is aptly seen as how an individual defines his/her ethnic or cultural makeup. This perception is solely the responsibility and belief of the individual absent of societal influence. Through this level of identification the individual has achieved a personal ―self actualization‖ of identity. Whereas, social identity involves communicating with others thereby affection an individual‘s identity in that his/her sense of sense is reinforce by how others communicate and view them. More specifically, people enact identities through ascription – the identities that people perceive in others and to which they attribute identities and qualities (Rinderle and Montoya, 2008). For example, transgendered individuals often see themselves at odds with society given that they were born as a male or female, but feel compelled to be switch genders in order to resolve cognitive dissonance. In doing so, he/she confronts a society that is usually unsupportive of this transition, but lacks any form of sensitivity. A transgendered male to female may still be expected to use male restrooms and subjected to be called by his male name even though the name may be legally changed. In this situation, self-identification is that the transgendered male sees himself clearly as a female, unapologetically. However, societal ascription interjects that regardless of how the transgendered defines herself, the individual will always be a male.

Communication/Interaction The ability to communicate is critical to showcasing one‘s culture or ethnicity. Five communication traits, according to Hsu (2010), have been widely applied between various cultural/ethnic groups. The five communication traits are: (1) communication apprehension, (2) willingness to communicate, (3) self-perceived communication competence, (4) argumentativeness, and (5) self-disclosure. In order for cross-culture interaction to be meaningful and less contrite there has to be a willingness to communicate and learn. Communication apprehension details the communication fear or anxiety of an individual within a cultural group as he/she attempts to interact with the host culture. Willingness to communicate describes the general trait of cultural group to initiate communication with others without provocation. In doing so, the cultural group is able to be receptive to what is being shared. Self-perceived communication competence acknowledges one‘s subjective

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assessment of his/her communication ability. There is a skill set to be garnered for an individual to be able to determine the strengths/weaknesses in their patterns of communication. Through patterns, the individual learns how to manipulate cultural ideology and linguistic models. A Conversation between African Americans and European Americans The aforementioned characterizations of two families or social groups – one African American and one European American – adequately qualify a culture to culture dialogue. One, the African American family, tries to understand White America from the perspective of acknowledging but living with any differences, while the European American family desires to ignore the difference and moving forward. How can two different perspectives on one fundamental belief, pluralism, be a stronghold for cultural communication? The key word across these conversations is difference, or better known as DIVERSITY. Differences, individual difference in particular, have been a hallmark of the United States of America. As a result of Africans being forcibly removed from different countries of the African continent and placed in a variety of countries, like the United States and United Kingdom, differences have always been acknowledged. For Africans, later known as African Americans, were taught to abandon any aspect of their African culture and to adopt the better American culture. Meaning, Africans were stripped of their names, children, clothing, food, religion, heritage, and other cultural nuances. Fast forwarding 150 years African Americans are still battling with issues created by White America belief and value in differences. These ideologies perpetuate the cultural conversation of African Americans to understanding, but living with differences, because it has been a part of their American legacy. For European Americans, it‘s a different pathway. While North America was already inhabited by Indigenous and Native Indians, Christopher Columbus was given credit for finding and founding the United States. He was the first to initiate the conversation between Europe and the Americas. Imperialism was at the fore-front of Columbus‘ expedition. Through the art of cultural communication, he had to convince natives that Spanish colonization was best for them and for his native land. This was primarily accomplished through recognizing the similarities between his country and what was to be established in the new land – bringing pre-existing aspects of culture into an uncultured society. Now, moving into the year 2009, the same belief system exists within the European American culture, minimizing differences and showing unity in one. Inherent in this belief system is We are the same (right) so there is no reason to promote the ideal of difference. Again, the acknowledging (or lack thereof) of differences becomes the cultural communication with high and low context value (discussed in chapter 3). The African American‘s belief of understanding and living with differences has been embedded within their lifestyle. As a group, they have been taught to denounce the very existence of which they are, but now with residual effects of slavery, they are determined to live with their difference from white counterparts. This philosophy under girds all aspects of conversations because it exerts the importance of diversity. While European Americans tend to value colorblind statements as a belief that everyone is equal and differences are less important. These cultural conversations between Blacks and Whites occurs everyday in classrooms, courtrooms, business rooms, and prisons. They way learn about cultural conversations is to engage in them, process the information, and learn about the art of communicating, which involves listening. Figure 8. Culture to Culture. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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As mentioned earlier, the amount of information that is communicated through verbal means (low-context) and versus that communicated through nonverbal means or contextual clues (high-context) varies according to culture. In cultures and ethnic groups where there is more use of high-context communication meaning is typically derived through shared experiences, histories, and implicit messages. Whereas, low-context cultures and ethnic groups derive meaning from direct, precise, and logical verbal interchanges (Ortiz and Flanagan, 2002). Communication norms within the context of a practitioner speaking with an individual needing mental health services can often appear to be misunderstood due to low vs. high contextual meanings. For example, individuals from high-context cultures may perceive specific verbal directions, detailed examples, and extensive elaboration as insensitive and mechanistic whereas individuals from low-context cultures feel uncomfortable with personal conversation, silence, obscure phrases and a variety of gestures. Argumentativeness suggests an individual‘s predisposition to either advocate or antagonize verbally cultural positions of others. Finally, self-disclosure, which has direct roots in cultural understanding, examines one‘s ability to comfortably disclose any message about self to others and deal with any possible ramifications. For many, the danger of self-disclosure is making oneself vulnerable to others. (Figure 8)

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Education Having access to education is a right. Yet, when it is restricted to certain segments of population as in many third world countries, it becomes a privilege. Explaining racial and cultural differences in IQ scores has always been a thorny problem. According to previous research, which also tends to be biased toward different ethnic and cultural groups, minority groups tend to perform less well than majority group or host cultures on IQ test and throughout the educational process. Since, in the United States, ethnic groups lag behind educationally than the majority groups, what are the mediating factors? Environmental differences between the groups usually appear at the top of the list. Many racial minorities and ethnic groups have lower incomes than white Americans placing them in poorer parts of cities where schools have smaller budgets, harder time recruiting teachers, and educational support systems that are community generated. Additionally, the cultural background of ethnic and cultural groups is often different than what is taught (and tested) in urban schools throughout the country (Price and Crapo, 2002).

Mental Health The likelihood of ethnic groups to seek mental health assistance is significantly less than their majority counterparts. African Americans are more likely to speak with a pastor or spiritual advisor before soliciting a psychologist/psychiatrist. American Indians and Latinos seek the counsel for healers and Shamans in order to address both mental and physical pain. Asians traditionally implore folk medicine and moxibustion to address maladies and often deny any psychological disturbances. These are all legitimate methods of addressing the health of ethnic groups that contrast those of majority and host cultures. As a result, being

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apprized of appropriate strategies to understand the cultural nuisances to provide sufficient services is necessary.

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TRANS-CULTURALIZED Abraham Maslow, the father of Humanistic Psychology, believed that every person has a desire to not only realize, but more importantly reach his/her full potential – becoming selfactualized. In doing so, he proposed a hierarchy of needs that required fulfillment at each level before ascending the steps to obtain greater fulfillment. Becoming more cultural aware parallels a similar ascension. Trans-culturalized involves an individual progressing through four stages leading to final promotion of being trans-culturalized. Through this cultural evolution different stages of advancement reveal the interactions of biology, psychology, and sociology. While these are not discrete steps void of fluctuation, the individual may easily be in between two stages, before fully embracing the next level. Additionally, while regression is not anticipated, there may be a transition period when a new and different environment is encountered. Regardless, the individual always begins at the base which includes his/her psychological makeup. Psychology envelopes the aspects of cultural that are not necessarily seen to the naked eye – values, beliefs, practices, morals, etc., but solidly is the anchor for personal cultural growth. Values provide an internal reference or moral compass for what is perceived as good, bad, fair, and even appropriate. For many, values appear to be static, but in reality they are perpetually dynamic and uniquely develop over time. Similarly, practices are fairly stable throughout one‘s life (be developed in childhood), but more firmly evolve as the individual determines which practices are germane to daily living. These are the broadest and most salient areas of an individual‘s life and provide the foundation of understanding. As an individual encounters situations, it sets in motion the provocation of one‘s values and practices from two perspectives: defending their personal beliefs or exploring divergent tenets. Core beliefs permit freedom of expression when in homogenous groups; however, the level of expression may change as the lesser known participant enter the conversation. As a result, one begins to perfect his/her psychological persona and appreciation for other cultural differences promoting them to the next level – biological (Figure 9). Biological involves the biological/physiological components of an individual that cannot be altered or changed such as age, sex, ethnicity, race, etc. The reason biology forms the second level is due in part to the physical manifestation of biological aspects (genotype) or the phonetype that one publicly encounters. When an individual encounters a person who is physically different they resort back to the psychological bearings for instructions to relate to the different aspects. Since biological cannot be changed, it forces the individual to deal with reality in its purest form. In order to graduate from this stage the individual identifies a personal benchmark of cultural evolution. Bio-Social marries the biological and social aspects which widens the cultural network in that social peculiarities are integrated into one step. This step involves biological with social constructs, suggesting that these aspects are malleable. Sexuality is centered on biology in that sex, a biological term, can be socialized into gender, a social construct. Gender usually perceived as differences between males and females places sex on a continuum. This continuum has the extremes of femininity and masculinity. As a result, the (biological) sex

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falls somewhere along the (social) gender continuum based upon male/female attributes. This is further proliferated through the XY movement which blurs gender lines even more by challenging male/female gender roles and expectations. The challenge for someone in this step is to recognize and rectify personal biases he/she may have against the biological to the social construct. Biopsychosocial further casts the net over three areas: psychological, biological, and social. Through this approach, biological, psychological, and social play a significant role in human functioning in the context of culture and cultural transmission. The biological component of the biopsychosocial model for trans-culturalization seeks to understand how the unchangeable functions in the personal schemata of the individual‘s cultural beliefs. The psychological component of the biopsychosocial model further examines the potential psychological causes that may thwart advancement in cultural adjustment. The social part of the biopsychosocial model investigates how different social factors influences cultural understanding.

Figure 9. Trans-culturalized.

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Trans-culturalized indicates that one is in harmony with his/her cultural being and his/her cultural surroundings, regardless of the setting or environment. To further illustrate this point, as the environment of the cultural being changes, he/she is quickly able to adapt and accommodate the changes without threatening their cultural identity or those affiliated with a different culture. The trans-culturalized being recognizes his/her worth through cultural transcendence.

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SUMMARY As discussed earlier, ―multicultural psychology is the systematic study of all aspects of human behavior as it occurs where people of different backgrounds encounter one another‖ (Mio, et al., 2009, pg. 32). Defined differently and more germane to the crux of this text is cross-cultural psychology. More specifically, this branch of psychology, examines subjects/perspectives from two or more cultures through equivalent methods of measurement in order to understand limits of general psychology theories and what types of modifications are needed to make these theories more universal. While the difference may appear simple on surface level, they are significant for one critical reason. Researchers may be interested in similarities and/or differences between cultures. Cross-culture interaction allows for understanding through a variable present in one culture, but absent from a similarly investigated culture. These variables may not be easily detectable in examining multicultural principles. The method by which to understand cross-cultural issues continues to evolve due in part to the influences of cultural factors. Viewing issues through a strict quantitative approach fails to fully acknowledge the richness of culture and how it plays out in a person‘s family, social, religious, and/or political life. Equally important is that qualitative research does not capture the statistical significance of cultural on certain aspects of decision-making in a variety of environments. In order to have a balanced approached and meet the needs of various cultures, the National Center of Cultural Competence suggested six areas to better address cultural understanding. These areas not only highlight the need for cultural competence, but also offer practical ways to achieve reasonable professional standard and ethics.

CONCLUSION Peshkin (1992) considers culture a ubiquitous, amorphous, overused, and over-identified term – to the extent that a conception to match nearly any purpose can be found. While culture is universal as Peshkin suggests, it is also specific. Culturally competent is the new mantra of today‘s professional society, especially as it relates to almost every human service field. Yet, public organizations such as school systems and healthcare facilities are still lagging behind in many areas addressing cultural diversity issues. The American school system, like many public social systems, is based on a white, middle-class value system that supports uniqueness and individual characteristics over unity and interdependent. In response to the

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increasing cultural pluralism in elementary and secondary environments, public health clinics, and other facilities, it is urgent that psychologists, psychiatrists, physicians, and the like working in public settings demonstrate cultural responsiveness and sensitivity in their practice. In order to be culturally competent one must present understanding and sensitivity to a variety of cross-cultural bases. To this end APA created Multicultural Guidelines (APA, 2003) with the goal of influencing current and future psychological practice, training, education, and research. Moreover, in the social context of change, structural and functional changes occurred within the psychology profession that affected the development of organizational bodies focused on cultural issues (Constantine and Sue, 2005). Over the years, significant contributions to cross-cultural and multicultural psychology have been made through commitments of mental health practitioners‘ competence in working with persons of color (Constantine, 2002). Further, Sue (2001) has been a leader in developing and understanding multicultural literature as it relates to counseling. Sue and his colleagues developed a tripartite model for counselor which has been expanded by others of the last 15 years. The third revision reflected different emphases in the literature as it related to research in racial/ethnic identity models, included new competencies, and underscored areas of the role of the psychologist in addressing interpersonal/institutional/systemic areas. This book will address as well as challenge some of the issues raised by Sue and colleagues relating to diversity, but more so across culture instead of within cultures, even though emic perspectives will be discussed. It is believed the interaction sustained between cultures allows for a new level of communication that may be inclusive of most multicultural initiatives, but also more specific in high/low context that impacts how practitioners learn about cultures and in exchange work with different cultures. The field of psychology, often perceived as the leader of cross-cultural dialogue, needs continual engagement in culturally relevant practices, education, research, and organizational development. To become more adept at understanding how to work with and service persons of diverse backgrounds, the chapters of this book will provide a cross-cultural experience directly and indirectly challenging the reader to understand his/her own biases, acknowledge them, and pursue an appropriate pathway to help others (Figure 10). I‘ve learned that…     

It is erroneously to use cultural, ethnicity, and race, interchangeably Cross-cultural and multicultural have distinguishable characteristics Both quantitative and qualitative methods present methodological flaws in cross-cultural research Three main factors influence culture: ecology, sociology, biology, and psychology The need for cross-cultural competence is necessary to combat social/psychological/medical ills of society

Figure 10. I‘ve Learned.

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REFERENCES Apollon, D. (2008). How to accept it‘s a post racial society. Retrieved on July 21, 2009. from: http://www.racewire.org. Behrensmeyer, A.K. (2006). Climate change and human evolution. Science, 311, 476-478. Berry, J.W. (1969). On cross-cultural comparability. International Journal of Psychology, 4, 119-128. Berry, J., Poortinga, Y., Segall, M., and Dasen, P. (1992). Cross-cultural psychology: Research and applications. Cambridge: Cambridge University Press. Bureau of Primary Healthcare (n.d.). Retrieved September 6, 2009 from http:// www.bphc.hrsa.gov. Constantine, M. (2002). Predictors of satisfaction with counseling: Racial, and ethnic minority clients‘ attitudes toward counseling and ratings of their counselors‘ general and multicultural counseling competence. Journal of Counseling Psychology, 49, 797-805. Constantine, M.G. and Sue, D.W. (2005). Strategies for building multicultural competence in mental health and educational settings. Hoboken, NJ: John Wiley and Sons, Inc. Cross, T., Nazron, B., Dennis, K., and Isaacs, M. (1989). Towards a culturally competent system of care. (Paper presented at professional conference.). D‘Angelo, R. and Douglas, H. (2009). Taking sides: Clashing views in race and ethnicity (7th Ed.). Boston: McGraw-Hill. Department of Defense (n.d.) Retrieved August 1, 2009, from http://www.defense.gov. Emery, D. (2005). Barbara Bush on hurricane Katrin refugees. Retrieved on August 5, 2012 from http://www.urbanlegends.about.com. Gandhi (n.d.). Retrieved on August 24, 2009, from http://www.referencecenter.com. Goode, T. (1998). The cultural competence continuum. (Paper presented at conference on Culturally Competent Services and Systems: Implications for Children with Special Health Needs, Rio Grande, Puerto Rico.). Hall, E. (1981). Beyond culture. New York: Anchor Books. Hall, L.E. (200). Dictionary of multicultural psychology: Issues, terms, and concepts. Thousand Oaks, CA: Sage Publishers. Hays, P. (2007). Addressing cultural complexities in practice: Assessment, diagnosis, and therapy. Washingon, DC: American Psychological Association. Ho, D.and Wu, M. (2001). Introduction to cross-cultural psychology. In L.L. Adler and U.P. Gielen (Eds.), Cross-cultural topics in psychology (pp. 3-13). Westport, CT: Praeger. Hsu, C. (2010). Acculturation and communication traits: A study of cross-cultural adaptation among Chinese in America. Communication Monographs, 77(3), 414-425. Like, R. (1998). Treating and managing the care of diverse patient populations: Challenges for training and practice. (Paper presented at national conference on Quality Healthcare for Culturally Diverse Populations, New Brunswick, NJ). Lynch, E.W. and Hanson, M.J. (2004). Developing cross-cultural competence: A guide for working with children and their families (3rd ed.). Baltimore: Paul H. Brookes Publishing Company. Mason, J. (1998). Rationale for cultural competence in health and human services. (Paper presented at national conference on Culturally Competent Services and Systems).

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Matsumoto, D. and Juang, L. (2008). Culture and psychology (4th Ed.). Belmont, CA: Thomson Wadsworth. Miles, C.A. (2008). Is America really post racial. Retrieved on July 21, 2009 from: http://www.racism-politics.suite101.com. Mio, J.S., Barker, L.A., and Tuamambing, J. (2009). Multicultural psychology: Understanding our diverse communities (2nd Ed.). New York: McGraw-Hill. Munoz, R.A. (2001). Rethinking ethnicity and healthcare: A sociocultural perspective. The American Journal of Psychology,158, 156-160. National Center for Cultural Competence. Retrieved on July 25, 2009 from: http://www.11.georgetown.edu. Ortiz, S.O. and Flanagan, D.P. (2002). Best practices in working with culturally diverse children and families. In A. Thomas and J. Grimes (Eds.), Best practices in school psychology IV (2 vol.), (pp. 337-351). Bethesda, MD: NASP. Peshkin, A. (1992). The relationship between culture and curriculum: A many fitting thing in P. Jackson (ed.) Handbook of Research on Curriculum, 248-267. New York: Macmillan. Price, W.F. and Crapo, R.H. (2002). Cross-cultural perspectives in introductory psychology (4th ed.). Belmont, CA: Wadsworth Group. Rinderle, S. and Montoya, D. (2008). Hispanic/Latino identity labels: An examination of cultural values and personal experiences. The Howard Journal of Communication, 19, 144-164. Ross, K.G. Toward an operational definition of cross-cultural competence from interview data. Retrieved on July 24, 2009 from: http://www.au.af.mil/au. Sue, D. (2001). Multidimensional facets of cultural competence. Counseling Psychologist, 29, 790-821. Tomes, Y. (2008). Ethnicity, cognitive styles, and math achievement: Variability within African-American post-secondary students. Multicultural Perspectives, 10(1), 17-23. US Census (2001). Retrieved on July 21, 2009 from: http://www.census.gov. WikiAnswers (n.d.) Retrieved on July 24, 2009 from: http://www.wikianswers.com.

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Chapter 2

UNDERSTANDING CULTURAL APPROPRIATENESS ―It is my wish that viewers identify, in these pictures, true existence of struggle below the surface. To see things that are not immediately visible and to understand that what things mean has more to do with you, the observer. To know the meaning of a culture you must recognize the limits and meaning of your own. You can see its facts, but you cannot see it meaning. We share meaning by living it.‖ Ricky Maynard

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ABSTRACT Is it possible to be culturally inappropriate? The answer is a resounding - Yes! For instance, suggesting that a Muslim man should shed his clothes (i.e., Galabiyyas or Jubba) during a 100 degree day and wear ―more appropriate‖ clothing as to not overheat, is not sensitive to the cultural beliefs of Muslims. The decision to impose a value on someone is the advantage many majority cultural groups have had the dubious distinction of doing, historically. In order to address possible cultural inappropriateness, an exploration of Brofenbrenner‘s Ecological System is discussed as the backdrop for the Cultural Ecological System (CES). CES helps to serve how culture overrides and transcends every aspect of human life and how this transcendence is stabilized through a variety of systems (i.e.. education, etc.). Finally, the chapter concludes with further advancing the need for a cultural consciousness model that provokes thoughts transitioning to culturally appropriate actions.

INTRODUCTION The separation of oneself from the culturally-based ethnocentric viewpoints inducted from birth and supported by social interactions throughout life is a virtually impossible task. ―The very essence of what an individual believes, thinks, and does is a product of unique background and developmental experiences that are most often shaped and determined primarily by culture‖ (Ortiz and Flanagan, 2002, p. 337). Moreover, understanding the manner in which culture has a profound imprint on the lives of all humans and the direct correlation with the acquisition of information requires impenetrable conviction and keen insight.

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Is The Emphasis of a Color-Blind Society an Answer to Racism? What does completing an employment application, applying for a credit card, and filing for government assistance have in common? There is always a box to check that asks for your racial declaration. Do the boxes help to fuel or minimize racial tension and move toward a ―color-blind‖ society? Ward Connerly, an African American male who has been a proponent of dismantling affirmative action, wrote an essay titled, ―Don‘t Box Me In‖ in 2001. In his article, Connerly (2001) eloquently pitches an America without race. More specifically, he renounces racial classification by proposing legislation, Racial Privacy Initiative (RPI), to prohibit governmental agencies (in the state of California) from classifying individuals by race, color, ethnicity, or national origin. The belief is, by removing government from the business of classifying its citizens, the country (USA) can move toward becoming one nation. Connerly further concluded that by enacting such policies, the most significant step toward bringing America together has been made. However, how is it possible to have this tremendous degree of racial inequality in a country where most whites claim that race is no longer relevant and African Americans/Latinos see race at the heart of the matter? This ideology may be best explained through Bonilla-Silva‘s (2003) color-blind racism. According to BonillaSilva, contemporary racial inequality is supported through outcomes of nonracial dynamic. Meaning, ―whereas Jim Crow racism explained blacks social standing as the result of their biological and moral inferiority, color-blind racism avoid such facile arguments‖ (D‘Angelo and Douglas, 2009, p. 137). For instances, whites may attribute residential segregation to natural tendencies among group and wanting to be around people who are ―similar‖ and not that many African Americans are shown houses in ―poorer‖ neighborhoods more times than their White counterparts. As a result, it is necessary to uncover the collective practices that serve to reinforce the contemporary racial order. Therefore, color-blind is not a panacea for the race question, but in essence a supplanter of the overt, conspicuous, and blatant racial existence in the United States. Figure 1. Cultural Case Clip.

The reasonable guideline for engaging in best practices and behaviors when dealing with culturally diverse individuals, the foremost principle is – Know Thyself First. The fact that any individual‘s own culture impacts the level of understanding and personal views of others should not be understated. In doing so, it is important to recognize that there will differences that are difficult to comprehend, appreciate, or accept but acknowledge it is merely differences between people and differences between cultures.

BRONFENBRENNER’S ECOLOGICAL SYSTEM Bronfenbrenner’s Structure of Environment Urie Bronfenbrenner‘s Ecological Theory is apropos to advancing the Cultural EcoSystem Model. The Ecological Theory espoused by Urie Bronfenbrenner included five

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environmental systems ranging from fine-grained inputs of direct interactions with social agents to broad-based inputs of culture. It is one of the first early theories that examined the cultural overlay to development of individuals. This theory looks at the child‘s development within the context of the system of relationships that form his/her environment. Bronfenbrenner‘s theory defines complex ―layer‖ of environment, each having an effect on a child‘s development. The interaction between factors in the child‘s maturing biology, his/her immediate family/community environment, and the social landscape fuels and steers his/her development. Changes or conflict in any one layer will ripple throughout other layers. To study one‘s development then, we must look not only at the individual and his/her immediate environment, but also the interaction of the larger environment as well. The five systems are: Microsystem, Mesosystem, Exosystem, Macrosystem, and Chronosystem.

Microsystem

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The microsystem is the layer closest to the child and contains the structures with which the child has direct contact. The microsystem encompasses the relationships and interactions a child has with his/her immediate surroundings. Structures in the microsystem include family, school, neighborhood, or childcare environments. At this level, relationships have impact in two directions – both away and towards the child. Bronfenbrenner calls these bidirectional influences. The interaction of structures within a layer and interactions of structures between layers is key to this theory. At the microsystem level, bi-directional influences are strongest and have the greatest impact on the child. This is where culture becomes entrenched into the lives of children. However, it is equally important to note interactions at outer levels can still impact the inner structures.

Mesosystem This layer provides the connection between the structures of the child‘s microsystem. More importantly, the mesosystem refers to the connections and relationships that exit between two or more microsystems. For example, how a child handles the relationship between his/her parents and his/her teacher. Cultural influences remain strong in this system, but they also may become more fluid as cultural conversations may change between and within the systems with the emergence of new entities.

Exosystem This layer defines the larger society or setting in which the child does not function directly, but still experiences decisions and events that affect him or her indirectly. This structures in this layer impact the child‘s development by interacting with some structure in his/her microsystem. For example, there has been a change in the parent‘s work schedule and this impacts the child because there may be less time for parent-child interaction. The child may not be directly involved at this level, but he/she does feel the positive or negative forces

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involved with the interaction with his/her own system. The child now has an experience with ―invisible‖ cultures that create visible affects on living.

Macrosystem This layer may be considered the outermost layer in a child‘s environment. The macrosystem is the overarching institutions, practices, patterns of beliefs, cultural values, customs, and laws that characterize society as a whole and take the smaller micro-, meso-, and exosystems into account. The effects of larger principles defined by the macrosystem have a cascading influence throughout the interactions of all outer layers. More specifically, if it is the belief of the culture that parents should be solely responsible for raising their children, that culture is less likely to provide resources to help parents. This, in turn, affects the structures in which the parents function. The parents‘ ability or inability to carry out the responsibility toward their child within the context of the child‘s microsystem is likewise affected.

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Chronosystem This system encompasses the dimension of time as it relates to a child‘s environment. Elements within this system can be either external, such as timing of a parent‘s death, or internal, such as the physiological changes that occur with the aging of a child. As children get older, they may react differently to environmental changes and may be more able to determine more how that change will influence them. As this model suggests, the quality and contexts of the child‘s environment is critical to the ongoing development. The complexity of interactions can arise as the child‘s physical and cognitive structures grow and mature.

CULTURAL ECOLOGICAL SYSTEM Cultural Eco-System The author is proposing a Cultural Eco-Systems views culture as the primary system of understanding and the initial base of all experiences, which pivots slightly from the Bronfenbrenner‘s approach. Through this model, culture engages the individual at every system level and it encourages them to respond in a way that supports their cultural knowledge and understanding, until a new paradigm is encountered, which may promote them to a new cultural conscience. Since this is a systems perspective, deficits are not seen as existing within the person as he/she progresses, but the culture continues to offer experiences through one‘s kaleidoscope. For instance, many families of color, particularly those that live in the culture of poverty, experience a number of ecosystem challenges that have negative impacts on children development, rearing practices, and cultural milieu.

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Figure 2. Cultural Eco-System Model.

As a result, the culture indoctrinates the individual through reinforcers/punishers that perpetuate cultural norms until these customs and/or beliefs are threatened (Figure 2).

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Cultural Resilience Couched within the cultural eco-systems is cultural resilience. Resilience has many definitions but it is mostly concerned with individual variations in response to risk and his/her ability to overcome stress and adversity as it relates to life hazards. In one‘s ability to overcome life‘s stressors, there are different types of resilience. Psychological resilience is comprised of internal states of well-being or adapting well to the environment or both (Masten, Best, and Garmezy, 1990). More particularly, children are resilient when ―(a) they receive good and stable care from someone; (b) they are good learners and problem-solvers, (c) they are engaging to other people, and (d) they have an area of competence and perceived efficacy‖ (Masten et al., 1990, p.438). Cultural resilience examines the adversity encountered by a cultural group and the group‘s (individual) ability to negotiate risk variation among themselves. This process-focused approach analyzes and contrasts the dynamic interactions among cultural risk mechanisms and cultural protective factors, mediated by an individual‘s cognitive appraisal of the situation. The presence of potential cultural risk may or may not pose a threat to an individual as risks are defined by individual‘s appraisal, however, those risk may threaten cultural homogeneity evoking cultural resilience. It is the individual‘s appraisal of the risk or situation that becomes the pivotal catalyst in this dynamic process. For cultural resilience to be a staple of any group there must be a confluence of environmental and individual variables that may not be mutually exclusive. Environmental variable such as family discord, presence of malcontent, and lack of readily available resources and external support systems impact coping efforts and the function of any protective factors. When enmeshed in high-risk cultural environments, protective factors

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become extremely critical in helping the cultural group survive and thrive socially and culturally. Additionally, individual factors such as lack of self-efficacy and self-esteem hurt personalize protective mechanisms. ―From the convergence of resiliency theory with ecological systems theory, the profile of a resilience fostering environment emerges as one that fosters high expectations, provides caring, support, and opportunities for participation‖ (Rausch, Lovett, and Walker, 2003, p.574) (Figure 3).

The Clarks Anyone familiar with psychology has at one time or another read or referenced the infamous doll experiments. This research was spawned from the Dr. Mamie Clark‘s (1917-1983) master‘s thesis and it created a national conversation. Dr. Kenneth Clark (1914-2005) was the first African American to earn a PhD in Psychology at Columbia University (1940) and his wife, Dr. Mamie Clark was one of the first African American females to do so the same in 1943. Together, they formed a research team that served to advance racial conversation, especially as it related to the self-perceptions of African American in a segregationist society. The duo published three major papers between 1039-1940 on children‘s self-perception related to race. Their research yielded results that contrasted African American children attending segregated schools versus those in integrated schools. They found that Black adolescents often preferred to play with white dolls over black; that, asked to fill in a human figure with the color of their own skin, they frequently chose a lighter shade than was accurate; and that the adolescents gave the color "white" attributes such as good and pretty, but "black" was qualified as bad and ugly. They viewed the results as evidence that the adolescents had internalized racism caused by being discriminated against and stigmatized by segregation. Their experiments suggested that by its very nature, segregation harms children and by extension, society at large. Their work led them to testify in several legal battles from Briggs v. Elliott and Brown v. Board of Education. Their groundbreaking study has been replicated several times and shockingly with similar results. For more information on the Clarks, please view this link: http://c250.columbia.edu/c250_celebrates/remarkable_columbians/kenneth_mamie _clark.html Source: www.wikipedia.com and www.columbia.edu Figure 3. Cultural Icon.

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Family Systems

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Probably the greatest arena which influences the perpetuation of cultural norms is directly related to the family. For many, a family is viewed as a socialized, basic unit consisting of parents (guardians) and children. While this is a sufficient definition it does little to capture the culture essence. Family, as defined by Tseng and Hsu (1991), is ―the basic socio-cultural unit…the nest for growth of an individual, the resource for social support, and the institution through which culture is transmitted‖ (p. 1). For most, the family represents and sustains a unique culture in and other itself. In order to develop strategies to work with family systems it is important to understand the cultural entities and cultural transmissions and how these areas form knowledge bases to provide needed services. Families, as groups, are likely to come in contact with a variety of mental health and healthcare providers when there is a suspected problem/disease/disability. Depending on previous engagements with the variety of entities and the familiarity with the system some families may transmits positive, negative, or mixed signals to their children or other members. For example, a culturally-sensitive school psychologist may understand that for many Hispanic and Latino families, the typical view of school systems is that they are self-sufficient and capable of handling all situations with their children. Hispanics and Latinos generally seek not to interfere with school business or school staff and when being called upon to assist in a problem with their son/daughter can be confusing if not embarrassing. The level of embarrassment may be exacerbated by the behavior and/or situation, presenting a negative reflection on the family as a whole. Through this example, it is clear that the family is not afraid of the school, but sees those professionals as having a job to do and clear boundaries have to be followed. Further, the child directly/indirectly learns not to draw negative or unwanted attention to the family and the cultural group. These expectations consistently convey the cultural and ethnic beliefs of the group.

Predispositions Systems What we know little about is how genes, culture, and the external environment play upon the brain to produce our behavior (Richerson and Boyd, 2001). The biological makeup of an individual is also influenced by culture, in that culture suggests how one acts upon his/her environment. While many feel that race and culture are indistinguishable, there are technically three major races of humankind: Mongoloid, Negroid, and Caucasoid. These three races present physical traits that appear to be distinct in the ancestral line. Mongoloids are believed to be a straight-haired type, medium in complexion, jaw protrusion, nose-breadth, and inclining probably to round-headedness. Negroids, in general, differ from Caucasoids with flattish nose, flat root of the nose, narrower ears, narrower joints, frontal skull eminences, less hairy, longer eyelashes, and cruciform pattern of second and third molars. Caucasoids traits were recognized by: by thin and narrow nostrils, a small mouths, and slightly angled faces. Additionally, Caucasiods cranial have been considered the largest out of all groups, which as now been disproven by numerous anthropologists (Wikipedia, 2012). These three races strongly suggest that there is a connection between culture and biology and there are ancestral linkages both socially and physically. As a result, human differences may be largely attributed to biological causes.

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Culture, as we know it, is taught by motivated humans, acquired by motivated learners, and stored and manipulated in human brains. Culture is an evolving product of populations of human brains and the expansion of human capital and its relationship to biology. Humans are adapted to learn and manage culture by the way natural selection has arranged our brains. Human social learners in turn arrange features of his/her brain as they learn from others (aka cultural agents and leaders) and the environment (the interaction between the individual and the environment). Hence, if a culture is predisposed towards the manifestation of a particular phenotype, it is most likely to unfold due to preexisting cultural conditions. Culture is a major aspect of what the human brain does, just in the same way as smelling and breathing are what noses do (Richerson and Boyd, 2001). Culture-making brains are the product of more than two million years of more or less gradual increases in brain size and cultural complexity (Richerson and Boyd, 2001). During this evolution, culture must have increased genetic fitness or the psychological capacities for it would not have evolved. Indeed, anthropologists long interpreted much of culture in adaptive terms rather than a neat, narrow boundary between innate and cultural processes that can be characterize by a short list of simple biological constraints on human behavior, we imagine a wide, historically contingent, densely intertwined set of phenomena with causal arrows operating in both directions (Richerson and Boyd, 2001).

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Educational/Social Systems Similar to Bronfenbrenner‘s theory, educational and social systems play an important role in the extension of cultural development and understanding in the Cultural Eco-System Model. The educational system, excluding the family, is the most prominent cultural teacher. Through classrooms, on a daily basis, culture is taught directly and indirectly, thereby, impacting not only what is taught and learned, but how it is applied. Further, if demonstrated in an inappropriate method, the non-conforming aspect may be punished in order to ―correct‖ the behavior. The link between the school and the community further promote appropriate cultural, social dynamics. Through the links and exchanges between educational and social systems, social competence is defined. With social competence, one acquires the ability to understand and relate aspects of their life to their culture. An individual is rewarded when his/her life are aligned to the cultural goals. As a result, culture is perpetuated to everyday dialogue and conversation. For instance, if a cultural group is apprehensive about police presence due to a non-trusting relationship, members of the cultural community teach others to withhold information when speaking to the police as a point to support cultural members (aka, not snitching). To this end, children learn to have distaste for law enforcement not because of their biological makeup but through social exchanges. Here, cultural conformity is not just a way of life, it is survival.

Dyadic Systems The connections between systems are equally important as they further support cultural values and ethnic socialization. Somewhat similar to educational and social systems, dyadic systems envelopes more than just educational or social networks, but reaches in multiple

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aspects of everyday culture. Dyadic systems may incorporate, but not limited to, families, neighborhoods, religion, schools, government, etc. These linkages can be both direct and indirect as they represent the all-encompassing temporal component in which the eco-cultural system is immersed. This level is characterized by the relationship between common belief system, lifestyles, laws, economic and social resources, etc. The relationships offer a cultural blueprint for the culture and any subcultures. For example, a strong dyadic system is government. While many people may never become a politician, the cultural environment of those who serve has far reaching arms into the personal lives of many Americans. Consider the healthcare act recently upheld by the US Supreme Court. Approximately 50 percent of Americans support more of ―universal‖ approach to providing healthcare to all, while the other half feels these policies are intrusive upon personal liberties.

BEST PRACTICES IN WORKING WITH CULTURALLY DIVERSE STUDENTS/FAMILIES

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Cultural Competence in Knowledge Cultural competence is based on ―soft‖ and ―hard‖ skills and partly on a solid knowledge base. The soft skills of cultural competence include the ability to communicate effectively with individuals from varying community. For instance, in recognizing that a family has just relocated to the area and their native tongue is Russian, a school psychologist would seek opportunities to understand more about the educational needs of their children, before conveying school protocol. In doing so, the school psychologist learns more about family and community dynamics that may be impacting the learning environment of the child and creating distal behaviors prior to arriving at school. This opportunity for communal exchange places the parents in less of hierarchal dynamic and more of an equitable partner. Further, soft skills are more challenging to learn as they are interpersonal in nature. Moreover, some cultures may be more receptive and appreciative of the techniques required to make soft skills fluid and necessary. It goes without saying, that if a culture values hard skills or soft skills, even though they should be complimentary of each other, hard skills are more likely to be exercised as the superior skill. The hard skills are those that reflect the mechanics of working within a cultural paradigm. These skills would include obtaining the background information about different culture and using the information plan appropriate courses of actions. This would involve taking theoretical concepts and making them practical realities when addressing cultural concerns of others. Cultural knowledge engages the translation of hard and soft skills into action promoting cultural competence. Of particular interest is where cultural competence has to be exercised. To understand school as a culture unto itself, one has to ask whether the abbreviations RtII, ASD, and IEP have meaning to many ―outsiders.‖ Yet, schools are steeped with more than just verbiage and jargons; they are cultural institutions with its own language, rules, expectations, norms, and values. Schools are independent entities that share commonalities across the country, but also each school is different.

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Yuma Iannotti Tomes How to Gather Culturally-Relevant Information: 1. Establish rapport  Present a non-hierarchal approach to the first meeting. Use the knowledge bases regarding displays of respect, and appropriate greeting behavior and exiting behavior.  Use interpreters/translators as necessary, but make sure they are appropriately trained for the ethnic/cultural group. 2. Build trust  Help the family to feel at ease, respected, and provide the opportunity for family members to fully participate and contribute to the process of service delivery. 3. Identify the presenting problem  Listen carefully to the perspective of the individual (and/or family – if present) and attempt to understand from their viewpoint. This may include the individual feeling as if there is no problem at all.  It is important to determine the individual (or family) past efforts in addressing and handling the problem/disability/disorder. From the information gather, begin to elicit the individual‘s (family‘s) present understanding of new intervention strategies and goals. 4. Learn the family system  It is absolutely necessary to assess and determine the structure of the family system as soon as possible. This includes, but not limited to family composition, family members‘ roles and responsibilities, family‘s hierarchal and interactional patterns, family‘s support systems, family‘s childrearing practices, etc.

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Figure 4. Culturally-relevant Information Gathering.

The difference is not always attributable to the principal but also the community and district the school is situated in. Sadly, as mentioned earlier, politicians have influence in certain schools thereby significantly impacting the learning environment (Figure 4).

Cognitive Styles The work of Jean Piaget has been considered a hallmark for understanding cognitive development, universally. He gave maturational and biological factors of cognition. While researchers such as Jensen (1990) strongly believed that biological aspects play significant roles in cognition, new scholars are acknowledging the importance culture may account for difference among groups. This new era looks at the relationship between one‘s culture and the kinds of cognitive skills one develop (Hale-Benson, 1982). A considerable amount of research has been conducted on international students studying abroad, especially at American institutions of higher learning. These students play an important role in international relations (Hechanova-Alampay, Christiansen, and Van Horn, 2002), in part because they offer a way to decrease misperceptions and increase cultural understanding through extended intercultural contact (Shupe, 2007). Past research has highlighted three approaches to examining international students‘ adjustment: (a) adjustment

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as an independent or predictor variable, (b) adaptation is a dependent or criterion variable determining what predicts successful adaptation, and (c) stress and coping of international students. Conclusive to these students and aligned to cultural adaptation of many groups, international students adapt by acquiring knowledge and skills necessary to fit into new environments. ―Because intercultural adjustment represents a life change accompanied by misunderstandings, uncertainity, and failed expectations, it is typically experienced as quite stressful. Like other stressors, adjustment difficulties can be manifested in a variety of psychological, school-related and social consequences‖ (Shupe, 2007, p. 752). Further, Shupe (2007) follows earlier research by borrowing from the stress and coping literature in conceptualizing adaptation as inherently stressful processes while examining potential predictors of student adaptation. Intercultural conflict as a stressor model helps to illustrate some of the aforementioned points (Figure 5). When considering ethnic information as the backdrop of cognitive styles, examining social settings is crucial. Early research conducted by Witkin and Berry (1975) followed a strategy of comparing group cognitive styles, how social arrangements and standards are conceived, and the relevancy to the development of self and non-self segregation. The hypotheses for most of Witkin‘s cross-racial studies emphasized that societies who practiced heavy conformity would likely be perceived as field-dependent, since stress on conformity discourages the development of separate autonomous functioning, and that they would thus be low in restructuring ability (i.e., assessing their strengths) (Riding and Rayner, 2000). Juxtaposed to this thought is the belief that a field-independent learner would better adjust to a society where there is a greater acceptance of personal autonomy and freedom of expression.

*Adapted from Shupe (2007). Figure 5. Intercultural Conflict as a Stressor Model.

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Additionally, Riding and Rayner (2000) recognized Canfield‘s Learning Style Inventory drawn from Maslow‘s Hierarchy of Needs, cognitive style mapping of Joseph Hill and on different theories of motivation. Similar to other measures of understanding cognitive styles, Canfield (1980) developed scales in four different areas. Conditions of learning, the first scale, includes: (a) affiliation (the student‘s need to develop personal relationships with other students and the instructor), (b) structure (their desire for organization and detail), (c) achievement (their desire for goal setting and independence), and (d) eminence (their orientation toward competition and authority) (Riding and Rayner, 2000).

CULTURAL CONSCIOUSNESS SKILLS

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Personal Awareness Typically, the basis of values indoctrinated by the United States (and other industrialized societies) derived primarily from Western European influences and tend to emphasize: individualism, independence, autonomy, interpersonal competition, mastery, equality, punctuality, materialism, progress, and future orientation. Moreover, these values are supported by those who may even subscribe, culturally, to a different set, but not able to express it comfortably within the American culture. To this end, there are elements of our own culture that values interactions that are less formal, and demonstrate a high regard for personal achievement and fosters pride in direct and assertive interactional communication styles. Psychologists, psychiatrists, and other mental health clinicians who understand the extent to which they identify with each of the American values will be in better position to determine how the values that they adhere to most strongly affect their practice and outlook. The professional will likely appreciate the influence and space of the mainstream culture on culturally diverse students, families, and colleagues (Figure 6). The viewpoint of culture is taken differently by those who examine its contents according to specific criteria. As the definition of culture has been shared early in this book, some would argue differently. The conversation between two ―cultural‖ groups, anthropology and psychology, may have similar interests, but there would contrasts too. For an anthropologist, culture may be viewed in terms of a tool used by society to maintain its adaptation to various permeations that exist. Moreover, recognizing that this ―tool‖ may encompass physical and concrete aspects that perpetuate further the advancement of the culture may be explained through the absence of human genetics. This would explain an evolutionary approach for human capacity to classify and represent things in symbols. But more importantly, this definition highlights the distinct ways culture exists in different societies making they uniquely the same. Psychology has more of a cognitive association to understanding culture that extends beyond physical representation to mental aspects that are transmitted over time. Most psychologiss have couched in his/her definition of culture ideas, behaviors, attitudes, traditions, and thoughts that exist within a group (small/large) by which all adhere to over time. However, culture is transmitted through a collective unconscious that is less highlighted in the anthropologist definition. Figure 6. Culture To Culture. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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This country of origin is the most populous black nation in Africa with an estimated 112 million people. The country is and its inhabitants occupy approximately 356,670 square miles. The country is a federal republic consisting of 30 states and 543 local governments. The country achieved independence from British rule leading to a relatively peaceful and prosperous time. Yet, the large agricultural sector was unable to keep up with the rapid population growth forcing the country to import a lot of food. The people of this country contribute to a complex culture, linguistic differences, and a social mosaic with over 250 ethnic groups speaking many different languages and dialects. Many members are typically concentrated in one area; however, many have migrated to urban areas, thus producing modern cities composed of mixed ethnic groups, with varying problems resulting. Individuals in this cultural group are basically classified into two groups: Nilotic Africans (Arab-type) and Black Africans. There is no state religion, but approximately 50% are Muslim, 40% Christian, 10% other faiths. Culturally and socially, allegiance to family and kinship systems, as well was to village is strong. Marriage often occurs at an early age (at least for females) and childbearing also begins at an early age. Polygamy is legal and practice throughout not just the country, but the ethnic group as well. With this belief, wealthy and/or powerful men tend to have more wives (as many as six or seven which exceeds the limit of four imposed by Islam). Men are dominant among Muslims, Christians, and those who practice traditional religions. It is traditional for families in this ethnic group to live together in one village or area of town. Mothers are the primary caregivers in the family, but receive help from the extended family. In most families men are considered the dominant members and the decision makers. The extended family system and the community have been an important support to parents. This traditional support for families is changing as a result of families moving from rural to urban areas in search of work or educational opportunities. Unfortunately, while in the home country (east side in particularly), significant numbers of children do not go beyond elementary school. While English is the official language of this county and ethnic group, there are over 250 different languages spoken. At least among immigrants and when interacting with westerners, this cultural group is usually soft-spoken. However, people of this cultural group can be very insistent about receiving services to which they feel entitled. Like many other non-westerner cultural groups, traditional healers (sometimes called ―surgeons‖) often focus on maintaining a balance between the invisible world of the deities, ancestral spirits of good and evil, and other beings inhabiting the ―other‖ world. Spirit causation remains a significant part of the traditional medical system and the presence of disease or illness may be seen as a warning sign that there is an imbalance with either the nature or the spiritual world. However, a divide does seem to exist between the east and west inhabitants of the country of origin. East inhabitants tend to use medicinal plants to treat various illnesses. Studies of such plants, including those used for peptic ulcer, asthma, pain, and other problems show significant degrees of efficacy for many treatments. Other treatments, e.g., inducing vomiting or giving cow urine to treat upper respiratory infections are harmful and no longer practiced, in general. Among those that live on the western part of the country, illness and health are seen as biomedical issues and treatment in clinics and hospitals are readily sought. One common belief between to the sides is that epilepsy is considered a communicable disease; hence, person with epilepsy should be avoided. This culture is_____________. Source: http://www.scribd.com. Figure 7. Name That Culture.

There is an art to self-awareness and many fail to master it. In self-awareness, one not only recognizes the differences in one‘s own world view from that of others but seeks to Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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understand those differences as a point of self-education. For example, while the belief of psychologists is to value independence and autonomy in young children or who believe in attaining developmental milestones, may experience considerable dissonance in trying to comprehend why some American Indians and Latino parents appear to possess a relaxed attitude toward their children‘s achievement of self-reliance. This requires the clinician to work within the framework and context of the cultural ideology that is being presented. Moreover, the clinician must find avenues to remain as ―value free‖ in order to serve the needs of the individual. Similarly, those practitioners who tend to believe that source of one‘s disability or disorder lies in the physical ability rather than the spiritual factors will need to work through the thoughts that may result from interactions with individuals committed to spiritual rand than medical/psychological treatments (Figure 7).

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Knowledge of Other Cultures While there may be many ways to learn about other cultures, four primary methods tend to resurface more frequently. The first method, reading of books/materials on other cultures, is probably the most accessible and least threatening technique. While literature provides a window into other cultures it also comes at the expense of someone else‘s viewpoint and perspective, just like this book. Literature can provide diverse views of culture, but should only be used as a means of information gathering. ―Reading provides a broader perspective of cultures while helping the practitioner see the continuum of culture‖ (Miranda, 2002, p. 357). The second area, interacting with people from diverse cultures, offers a true encounter of learning about cultural beliefs, values, and practices. Through cultural mediators, those who help you to explore the culture, provide opportunities to ask questions about what has been read in books, seen on TV, or experienced in real life. ―If it doesn‘t fit, you must acquit‖ (Cochran, 1995). This quote resounded loudly across the backdrop of the United States of America as it pierced the fabric of cultural supremacy and fueled racial hatred. The People of the State of California v. Orenthal James Simpson has been tapped as the case of the century by many standards. American idol, for his footwork on the football field, OJ Simpson was being tried for the murder of his ex-wife Nicole Brown Simpson and her friend Ronald Goldman. While there appeared to be preponderance of evidence mounted against OJ Simpson, the burden of proof still rested with the prosecution. However, the defense attorneys, notable Johnnie Cochran, were able to persuade the jury that reasonable doubt was present and several items were mishandled by the lab scientists and technicians calling into to question DNA results. While OJ Simpson was acquitted for this case on October 3, 1995, he was later sued by the Brown and Goldman families on civil charges. On February 6, 1997, a jury unanimously found there was enough evidence to hold OJ Simpson liable for charges in the wrongful death of Goldman and battery of Brown Simpson. Figure 8. Where Were You October 3, 1995. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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Table 1. Cultural Conscious Interview Outline What is your country of origin? What is your reason for migration? How long have you been in this country? How many of your family members are present in this country? What is their relationship to you? What is the primary language spoken? 

When and where?

What type of family and kinship network do you have? What type of religious beliefs do you practice? Do you have beliefs about causality? How were you reared as a child? Or What are your child-rearing practices? Can you define your sex roles in your culture? Please describe the type of community you lived in within your country of origin? Within your present country? Describe your current living space? How do you seek help from another person? What level of education  

Did you attain in your country of origin Did you attain in your current residence

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What is your current occupation? What is your most recent previous occupation? What has been your experience with rejection? Describe the last time you were rejected. What is your degree of acculturation in your current residence? How many and what types of cultural conflicts have your encountered?

Further, cultural nuances can be explained, clarified, or even refuted by the cultural mediators. The one downfall to having close encounters with someone from one culture is the experience is limited to one person‘s account. To find a true representation of culture, it has to be view beyond one person‘s lens. The third technique, learning the language of the culture, is time-consuming and requires a tremendous commitment. Of which, most working professionals will not do. Language is so critical to developing a working knowledge of culture, as it reflects the verbal/non-verbal exchanges in the ethnic socialization. The final method is an excellent way to increase cross-cultural understanding. Participating in the daily life of another culture is simply carrying out a cultural immersion experience. In doing so, one becomes privy to symbolism, persuasiveness, and the conscious/unconscious awareness and understanding. In order to perform this task, however, requires the individual to take risks by admitting biases, prejudices, and untruths at the expense of learning something new (Figure 8). The landmarks of normal psychological development and the typical signs of psychological developments are different per culture. In order to account for these differences cultural interviews need to be conducted that are sensitive yet comprehensive (Table 1).

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Applying Knowledge While an individual may have good introspection and has gained the prerequisite knowledge, everything is contingent upon how does one apply what has been learning or uncovered. Becoming cross-culturally conscious requires taking emotional and at times physical risks. While it may be uncomfortable and painstaking, at times, it is important discuss issues with those who may present different ideas and experiences. It is through applying the knowledge, an individual has to go back, take a second (or third) look, re-conceptualize, reexamine, rethink, and re-question his/her stance in order to be complete in their cultural reality. If we move beyond, but inclusive of cultural competency, to cultural consciousness, the object of knowledge is not just a series of lists of cultural attributes but what is required challenge our assumptions, values, and biases of injustices to help others. Therefore, the object of knowledge in cultural consciousness is to carry out the social roles and responsibilities as a health practitioner. The manner of experiencing this type of knowledge is different from knowledge required in other areas and courses. Kumagai and Lypson (2009) suggest specific techniques as stories, cognitive disequilibrium, and keeping it current to instill and fulfill the notion of social justice.

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CONCLUSION We use our mind‘s strength through the use of our natural abilities. However, to learn more effectively and efficiently, we must also be able to develop and use abilities beyond our natural styles. Cognitive style-based instruction and processing is intuitively appealing and thus will have a long stay with the educational and psychological areas, especially as high stakes testing proliferates and colleges seek to admit the and retain the brightest students. Cultural appropriateness and cultural consciousness combine mental, biological, and social applications on a daily basis to understand and meet the needs of all diaspora. The Cultural Eco-System helps to illuminate the process and pathway to cultural appropriateness and cultural consciousness. By engaging the culture of the individual with cultural relevance, biology and behaviors help to promote ―system influence change‖ (Figure 9).

    

Cognitive styles are unique to each individual Cultural resilience has both individual and group components There are ―three‖ races Culture and biology do intersect Cultural competence is developed through the translations of hard and soft skills

Figure 9. I‘ve Learned… .

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REFERENCES Bonilla-Silva, E. (2003). Without racists: Color-blind racism and the persistence of racial inequality in the United States. Lanham, MD: Rowman and Littlefield Publishers. Connerly, W. (2001). Don‘t box me in. In R. D‘Angelo and H. Douglas (Eds.), Taking sides, 7th ed., pp. 133-135. New York: McGraw-Hill. Hale-Benson, J.E. (1982). Black children (Rev. ed.). Baltimore: Brigham Young University Press. Hechanova-Alampay, R., Beehr, T.A., Christiansen, N.D., and Van Horn, R.K. (2002). Adjustment and strain among domestic and international student sojourners: A longitudinal study. School Psychology International, 23, 458-474. Jensen, (1990). Brain-based learning. Del Mar, CA: Turning Point Publishing. Kumagai, A.K., and Lypson, M.L. (2009). Beyond cultural competence: Critical consciousness, social justice, and multicultural education. Academic Medicine, 84, 782787. Masten, A.S., Best, K.M., and Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and Psychopathology, 2, 425-444. Miranda, A.H. (2002). Best practices in increasing cross-cultural competence. In A. Thomas and J. Grimes (Eds.), Best practices in school psychology IV (2 vol.), (pp. 353-362). Bethesda, MD: NASP. Ortiz, S.O. and Flanagan, D.P. (2002). Best practices in working with culturally diverse children and families. In A. Thomas and J. Grimes (Eds), Best practices in school psychology IV (2 vol.), (pp. 337-351). Bethesda, MD: NASP. Rausch, J.L., Lovett, C.R., and Walker, C.O. (2003). Indicators of resiliency among urban elementary school students at-risk. The Qualitative Report, 8, 570-590. Richerson, P.J. and Boyd, R. (2001). Culture is part of human biology: Why the superorganic process serves the human sciences badly. In S. Maasen and W. Winterhager (Eds.), Social sciences: Probing the dynamics of scientific knowledge, (pp. 1-20). Davis, CA: UCDvais. Riding, R.J. and Rayner, S.G. (2000). International perspectives on individual differences: Vol. 1. Cognitive styles. Stamford, CT: Ablex Publishing Corporation. Shupe, E.I. (2007). Clashing cultures: A model of international student conflict. Journal of Cross-Cultural Psychology, 38, 750-771. Tseng, W.S. and Hsu, J. (1991). Culture and family: Problems and therapy. New York: Haworth. Wikipedia (2012). Retrieved on July 1, 2012 from http://www.wikipedia.com. Witkin, H.A., and Berry, J. (1975). Psychological differentiation in cross-cultural perspectives. Princeton, NJ: Educational Testing Service.

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Chapter 3

CROSSING THE DSM-IV-TR WITH CULTURE ―As long as you keep a person down, some part of you has to be down, so it means you cannot soar as you otherwise might.‖ Marian Anderson

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ABSTRACT The Diagnostic and Statistical Manual of Mental Disorders – Text Revision (4th Ed) (DSM-IV-TR) (soon-to-be DSM-V) is the Psychologist/Psychiatrist bible. This ―helpful‖ guide to clinical practice has been used for many decades to classify individuals with a myriad of psychological and psychiatric disorders. While many concur with its usefulness, it is not without many detractors, especially those that believe it does not take into account the true significance of culture – enough. The DSM-IV-TR, more than any other edition or version, has dedicated more sensitivity to cultural bound syndromes and examining cultural formulation, but this has not decreased the number of persons of color being diagnosed with certain psychological/psychiatric disorders. This chapter will examine cultural influence and ethnic psychopathology as it relates to what are the strengths and weaknesses of the DSM-IV-TR and where adaptations may be accounted for in diagnosing.

INTRODUCTION Psychological and psychiatric assessments are broad processes that encompass many different approaches to understanding and measuring human actions and adjustments. Psychiatric diagnoses such as mood and personality disorders are sometime more frequently misdiagnosed in people of color or other ethnic/cultural groups. The activities involved in mental health assessment using the DSM-IV-TR represents a categorical classification system with the goal of arriving at a category or categories that most accurately reflect a person‘s adjustment and functioning at present time (House, 2002). This classification is solely dependent on the clinical judgment and decision making of the individual mental health professional, which present ―human‖ challenges.

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Yuma Iannotti Tomes Elyano Tazuki relocated back to Japan from the United Kingdom (UK) after spending 4 years at Oxford working toward her masters‘ degree in English Literature and Humanities. Upon her return to Tokyo, Elyano appeared emotionless and somewhat withdrawn from her immediate family and close friends. While she never wanted to ―hang out‖ with either group she remained steadfast in her work ethic, as Chief Editor of Tokyo‘s national newspaper. A few months later Elyano‘s parents begin to inquire about dating, marriage, and children. Elyano became demonstrative in her response and stated, ―I do not need either to be successful.‖ The parents were stunned with this behavior and felt it was disrespectful and out of character for their once domicile and obedient daughter. The father felt that Elyano had become westernized and lost traditional Japanese values such as deference to authority. Elyano was not sure how to proceed with her future plans so she decided to schedule an appointment with a psychologist, who was educated in the UK. The British psychologist, after a few sessions, diagnosed Eleyano with major depressive disorder due to mood fluctuates, poor adjustment, slow to respond, and indecisiveness. So, does this demonstrate a mood, personality, or adjustment disorder? What are the primary symptoms demonstrated for a mood disorder? What additional information would be helpful? What are possible cultural elements that are being overlooked in this diagnosis?

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Figure 1. Cultural Clip.

Mood disorders, a pattern of illness due to an abnormal mood, exact a dreadful toll on the over 11 million Americans who suffer from them and the nation‘s economy. The most common mood disorder is major depressive disorder, affecting millions of people, regardless of cultural background, monthly. The essential feature of Major Depressive Disorder is the presence a major depressive episode (DSM Criterion A) of which must be present during a 2week period with at least one symptom being a depressed mood or lose of interest/pleasure. The major depressive episode is not better accounted for by another disorder such as Schizoaffective Disorder (Criterion B) and there has never been a Manic Episode (Criterion C). Depressed individuals endure great hardship and discomfort compared to those with a chronic physical illness. According to Badger and Rand (1998), only advanced coronary artery disease results in more days spent in bed and socially, the cost of depression is comparable to that of AIDS, cancer, and heart disease. In several major studies such as National Comorbidity Survey (NCS) and Epidemiologic Catchment Area (ECA) revealed differences in prevalence rates for African Americans, whites, and Latinos. While African Americans tended to have a lower one-year prevalence of major depression than either whites or Latinos, they were more likely to be misdiagnosed with a more severe mood disorder and/or less likely to seek treatment (Badger and Rand, 1998). The potential for variability of rates of mood disorders may be expressed differently in a variety of populations. For instance, in the Japanese, Chinese, and Korean cultures individuals are less likely to express forms of emotions, even if they are severely depressed or present dysthymic symptoms.

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As a result, a psychiatrist/psychologist may be less inclined to believe the patient is suffering from some type of mood disorder and misdiagnosis him/her based on the lack of internal or external expressions of an abnormal mood. Internationally, the United States has the highest prevalence of mood disorders than any other developed country with the highest rates in major depression (Hoskens, 2008). Personality traits are pervasive and enduring patterns of perceiving, relating to, thinking about, and behaving in the environment that are exhibited in a wide range of social and personal contexts (American Psychiatric Association, 2000). While personality traits may reflect how one perceives, thinks about, or acts toward oneself, some behaviors may be considered strange, unusual, or self-punishing by an objective observer (Freeman, Reinecke, and Tomes, 2007). Care must be taken to avoid inappropriate diagnosis applied to socially and culturally different groups. Behavior must deviate significantly from the expectations of the individual‘s culture (American Psychiatric Association, 2000). The essential feature of personality disorder, enduring pattern of inner experience and behavior that deviates from the individual‘s culture, must be manifested in at least two areas: cognition, affectivity, interpersonal functioning, or impulse control (DSM Criterion A). This pattern of behavior is inflexible and pervasive across a broad range of personal and social situations (Criterion B) and leads to clinically significant distress and impairment in multiple areas (Criterion C). Further, the pattern of behavior is stable and long in duration, and the onset may be traced back adolescence or early adulthood (Criterion D). This pattern of behavior is not better accounted for in another mental disorder (Criterion E) and not the direct result of a substance or general medical condition (Criterion F) (Freeman, Reinecke, and Tomes, 2007). The prevalence of personality disorders (PD) diagnoses among women and men have increased steadily over the last decade (Iwanasa, Larrabee, and Merritt, 2000). Proportional to the peak in PD among women and men is that of the diagnoses in adolescents of various ethnic and cultural groups. Unfortunately, this increase may be a result of cultural differences and not a clear indication of a true personality disorder regardless of the developmental stage. Solomon (1992) discussed how applying clinical diagnoses to ethnic minorities may be detrimental because of cultural differences in the expression of symptomatology, use of instruments and evaluations that are culturally invalid and unreliable, clinician bias and prejudice, and institutional racism. These biases make it challenging at best to achieve an accurate representation of an individual due to etic viewpoints often expressed by clinicians. The need to examine the role of ethnicity or culture in psychopathology in general, and in mood and personality disorders specifically, is of particular importance given the ―browning‖ of the United States, especially with the lack of diagnoses, internationally. Moreover, the American Psychological Association adopted ―Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations‖ in 1993, signifying that professional mental health providers must provide effective assessment and treatment interventions to an increasingly diverse population. While progress is currently being made within the development of culture-specific theories of personality and personality disorders, empirical evidence is still lacking (Iwamasa, et al., 2000). Thus, the examination of diagnostic criteria used to diagnose personality disorders among ethnic minorities is important.

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CULTURAL INFLUENCE Cultural Variations We are living in a time of transition with significantly high levels of illegal and legal immigrants moving to North and South Americas and throughout Europe. To maintain consciousness during these periods one has to be willing to embrace discontinuity, ambiguity, and dissimilarities in all facets of life. For many years the United States of America was seen as the melting pot, fusing all cultures and ethnic groups into one gigantic bowl of crosscultural soup. As the country evolved, so did the concepts relating to culture such as cultural identification. Then, the next school of thought described the United States as a toss salad, welcoming individual differences and allowing them to maintain their culture – or at least remnants of their heritage. I propose the United States is a pizza. Like the two previously held beliefs, America is a combination of melting and preserving; I suggest they are done simultaneously. When individuals from other cultures arrive here, they are now able to honor their cultural heritage while blending in with other cultural aspects. According to acculturation models this type of individual would be an integrationist. However, with the acceptance of other cultural values clashes are imminent. These cultural variations have led to clashes in adolescent rearing, schooling, how psychological services are delivered in a variety of mental health settings, because individuals have the freedom to embrace or reject cultural expectations based upon their background and heritage.

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Ethnic Identity Behaviors ―From a cultural constructionist view, all personality models are based on conceptions of personhood and standards of culturally appropriate behavior that have evolved, as a rule, in Anglo-American societies‖ (Allik, 2005, pg. 212). As cultures reflect eclectic behavioral patterns, it has become increasingly more important for clinicians to acknowledge one‘s acquisition of basic ethnic group patterns and how the individual maintains these behaviors. This information really becomes important from the transition of adolescence to adulthood as it relates to psychiatric disorders. A number of authors have explored the value of an adolescent‘s/adult‘s development based upon their ethnicity (Goodman, 1964; Porter, 1971; Clark, 1965). It has been postulated that youth as young as three are aware of aspects of their ethnic identity (Porter, 1971). Even in adolescence, ethnic development continues based upon peer groups and peer perceptions (Canino and Spurlock, 2000). The aforementioned aspects are not the only elements critical to an adolescent‘s ethnic identity, but cognitive functioning is equally important. It is through cognitive functioning adolescents give meaning to their ethnicity and determine how to respond to themselves as well as others outside their group. Their reactions to ethnic stimuli may depend on certain cues emanating in their immediate society. Further, ethnic adolescent/adult reactions may be affective, perceptual, or cognitive. For some ethnic and culturally diverse persons, the way individuals outside of their ethnic

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group perceive them is critically important, compared to other ethnic groups who value intraethnic perception. According to research by Gibbs (1989), black adolescents tend to use other blacks as a comparison group and not their white counterparts even though this research contrasts the historical Clark and Clark doll studies conducted in the 60s. Further, when an adolescent is biracial, a whole different set of norms may arise as he/she affiliates with one race more than the other. Moreover, the identity development of biracial adolescents begins with self-esteem and not racial identification. Then, the adolescent encounters experiences that threaten their self-esteem through racial categorization. It is not until the final stage of integration when the person is then able to embrace all identities that make up his/her ethnic classification. Through this process, the person may be prone to possess a mood or personality disorder as defined by the DSM (and believed by some mental health practitioners), when in essence the adolescent/adult is experiencing normal development as a bi or multiracial person. An adolescent‘s ethnic identity behavior may be more salient depending on the situation. For instance, some situations, depending on the status of the group and the cultural homogeneity/heterogeneity, the adolescent may respond differently as indicated by their referencing point. Changes in an adolescent‘s ethnic awareness may result from changes in cohort or generational groups, varying interactions among influential individuals, and normal developmental changes (Canino, 2000). For example, many third-generation Mexican American adolescents may not know much of their cultural history or their language but may still identify with their ethnic group. This is very important for people from Latino/Hispanic cultures because there is a variety of ethnic classifications one may identify with even if it is not their own cultural group. For instance, a Puerto Rican may be raised in a Mexican environment and culture. As a result of their upbringing and disconnect with Puerto Rican culture, the adolescent has only interacted with and understand their Mexican culture, therefore, they are more likely to identify ethnically with Mexicans.

Linguistic/Language Another aspect of culture is the linguistic skills used by members of various ethnic groups. Language offers not only a means of intra and inter-communication of ethnic groups, but also ―cognitive restructuring‖ of the adolescent/adult‘s world (Hilliard, 1983). However, it has been found that language can be a common problem in assessing a cultural-linguistically different person‘s ability or current (cognitive) functioning. For example, ―Navajo adolescents usually adopt a slow, methodical speech pattern. When the adolescents pause, Anglo-American teachers often regard this as a signal that the student has completed his/her sentence‖ (Canino and Spurlock, 2000). This pattern of speech can present similar problems in personality assessment. In the administration of test such as the Minnesota Multiphasic Personality Inventory-2 (Restructured Form) (MMPI-2-RF), Thematic Apperception Test (TAT), and most intellectual assessments such as the Wechsler Intelligence Scale for Children – IV (WISC-IV), individuals are encouraged to respond within a time frame, in not doing so it may adversely affect their overall score. Further, time constraints of many standardized measures possibly inhibit true abilities while yielding inaccurate results because one‘s culture examines and evaluates time in periods and moments of life and not seconds and minutes of hours in a day.

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Psychosocial Environment for Youth There are two environmental and functioning cultural factors that clinicians must consider when assessing adolescents: 1) social support and 2) interpretation of social stressors. Within the Latino/Hispanic culture, individuals such as the compadre, comadre, and the priest are called upon when the parents of the adolescent are not able to adequately provide for adolescents due to financial reasons (Paniagua, 2001). Similarly, when trials befall African-Americans, research has supported that they are more likely to confer with the minister or community leader for assistance (Boyd-Franklin, 1989). As a result, these individuals become surrogate parents for the adolescents, at times adapting a new mind set. The adolescents, while having parents, may become more receptive to communal and religious expectations overriding societal beliefs. This aspect of community can be seen further within the Asian culture. The extended family holds significance in adolescent-care, bearing financial assistance, and different levels of community support. As the adolescent develops, they encounter more experiences with the ―real world‖ leading them to grapple with multiple perceptions. Clinicians, in order to not reflect perceptions of racial discrimination or stress resulting from this perception, should carefully screen these perceptions. It is important for the clinician to understand that these types of perceptions can be masked as mental disorder symptoms.

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ETHNICITY AND PSYCHOPATHOLOGY The Centers for Disease Control and Prevention (CDC) reported that the psychiatric rate in United States emergency departments (ED) is approximately 3%, which is far below the national psychiatric rate of 20%-28% (U.S. Department of Health and Human Services, 1999). Kunen, Neiderhauser, Smith, Morris, and Marx (2005) discovered that Caucasians, when compared to African Americans, were twice as likely to have a mood disorder as a primary diagnosis. The lower psychiatric rates among African Americans may have resulted for racial differences in symptom complexes for the same disorder. Moreover, previous research (Whaley, 2001) tended to reveal that African Americans were more likely to utilize emergency departments as primary care facility, leading to primary white physicians feeling more comfortable with diagnosing Caucasians with a psychiatric disorder than another ethnic/racial population. The relationship between ethnicity and psychopathology, according to Skeem et al. (2004), is interrelated based on the construct of psychopathology, measure of psychopathology, and levels of psychopathology. When given the Revised Psychopathy Checklist (PCL-R), on laboratory tasks, African Americans who were high in psychopathic traits tended to not manifest the same passive avoidance deficits or affective and information processing deficits as Anglo-Americans (Skeem, 2004). This possibly suggests that psychopathology maybe either more difficult to measure in an ethnic population or influenced by socio-cultural factors of varying ethnic groups. It is these socio-cultural factors that must be understood by attending physicians, psychologists, and other clinicians if minimizing misdiagnosing or limiting over diagnosing of mood and personality disorders. For Latinos, Hispanics, and other immigrants to countries like the United States of America, the issue of immigrant status, known as nativity, is of extreme importance, both in

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terms of policy and needs for service delivery and for a better understanding of the treatment and etiology of mental disorders (Alegria, Canino, Stinson, and Grant, 2005). Even more important, compared with non-Latino whites, U.S.-born Mexican Americans had higher rates of mood, anxiety, and substance use disorders. Because of such findings, there is a greater risk of anxiety and mood disorders for U.S.-born Puerto Ricans compared with foreign-born non-Latino whites, even when adjusting for sociodemographic characteristics. This suggests that there may be key cultural issues or other factors, different within the Latino/Puerto Rican culture (i.e., like reactions to discrimination). According to Alegria et al. (2005), these factors may play a more important role in psychiatric morbidity among Puerto Ricans than Cuban Americans or Mexican Americans. Possibly, different reactions to discrimination and stereotyping may be explained by less tolerance of discrimination on part of Puerto Ricans, whereas Cuban Americans may physically resemble white Americans and likely to be more accepted. Additionally, Cuban Americans may be seen more by clinicians as white and, therefore, no likely to be diagnosed with a DSM-IV classification. (Figure 2) Homosexuality Removed from the DSM

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Robert L. Spitzer, M.D., presented a rationale for the change in language and elimination of homosexuality for the upcoming revised edition of the DSM-II (7th printing). According to Spitzer: For a mental or psychiatric condition to be considered a psychiatric disorder, it must either regularly cause subjective distress, or regularly be associated with some generalized impairment in social effectiveness or functioning. With the exception of homosexuality (and perhaps some of the other sexual deviations when in mild form, such as voyeurism), all of the other mental disorders in DSM-II fulfill either of these two criteria. (While one may argue that personality disorders are an exception, on reflection it is clear that it is inappropriate to make a diagnosis of a personality disorder merely because of the presence of certain typical personality traits which cause no subjective distress or impairment in social functioning. Clearly homosexuality, per se, does not meet the requirements for a psychiatric disorder since it is noted above, many homosexuals are quite satisfied with their sexual orientation and demonstrate no generalized impairment in social effectiveness or functioning (1973, APA Documents).

While many people reading this text may not have been born, this was a significant change in nomenclature for the professional psychology community as well as gay men, lesbians, and bisexuals. Prior to the date, individuals who presented a ―diverse‖ lifestyle as it related to romantic interests were considered as possessing a mental disorder. Further, the revision in the nomenclature provided a finding of homosexuals to be free of psychiatric disorder. So, what are your thoughts regarding the removal of homosexuality from the DSMII? Is homosexuality a personality disorder in the true sense of a mental disorder? If this language (i.e., homosexuals) was in the DSM-IV, how would it impact your current practice and understanding? Figure 2. Where Were You on June 7, 1973?

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Acculturation

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The level of acculturation an adolescent or adult has made to a new country, environment, or even social setting often threatens the culture of the adolescent/adult. While most clinicians acknowledge that transition for an adolescent or adult is difficult, he/she fails to take the level of acculturation into consideration when diagnosing a personality or mood disorder. The process of acculturation may be in itself the focus of clinical attention. Paniagua (2001) suggest several acculturation scales that can be used to assess adolescents, in particular. The Brief Acculturation Scale (BAS) is recommended for clinicians and others who would like to perform a quick assessment of acculturation of adolescents and adults. The dissolution of the Soviet Union led to the creation/re-creation of several eastern European (Balkan states), including this cultural group. The traditional makeup of this cultural group is approximately 40% Serbian, 38% Muslim, and 22% Croatian and believed at one time to a more of religious and ethnic tolerance. From 1991-1992, a national conflict led to this country of origin to declare independence from Yugoslavia. The conflict included an ―ethnic cleansing‖ of Muslims in this country by the military and police. Religion Islamic influences on healthcare beliefs and practices are not as strong as others from rural middle-eastern backgrounds. Women in this cultural group tends to be less intent on maintaining extreme modesty and more willing to report female problems and disorders than women from other groups. Many from this cultural group have relationships with many American Christians. Family Structure The family is significant aspect to health living and most families include both nuclear and extended families. Many of the families have both the husband and wife working outside the home, but men continue to have the greater authority in the household. This cultural continues generally does not practice polygamy, even though it may be practiced per the Quran. Healthcare Beliefs Basic healthcare in this country is similar to many other ―industrialized‖ countries in that it is socialized. There is a greater emphasis on primary care because some sophisticated tests and procedures are not available. While this cultural group suffers from many western conceptions of hypertension, coronary disease, diabetes, and infections, it may be treated different. The biggest health risks are considered to be: nutritional deficit, hepatitis B, and tuberculosis. The most pronounced mental health concerns are residual effects of the war and conflicts: post-traumatic stress disorder (PTSD), combat stress disorder (CSR), depression, and other sequelae of psychological trauma. This cultural group is__________________. Source: http://www.scribd.com. Figure 3. Name That Culture.

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The acculturation stages, as outlined by Berry (1988) include two different but related components. Acculturation, experiences and changes that an individual (or groups) undergoes when they come in contact with a different culture, requires intercultural adaptation and intercultural adjustment. Intercultural adaptation, the method an individual changes his/her behaviors and ways of thinking in a new cultural environment, address the first concern one encounters when being acculturated. The second area focuses on intercultural adjustment. Through this process of acculturation, the individual creates understanding to subjective experiences as he/she begins to adapt their behaviors to the new culture. This information provides clarity to the process by which people adopt a different cultural system. Based on current models of psychosocial functioning in schizophrenia, four dimensions – clinical status, functional status, subjective experiences, and community risk – were examined and compared across African-Americans, Latinos, European-Americans, and KoreanAmericans in a recent study completed by Brekke (2002). While the Korean-Americans were least acculturated, their symptom levels and clinical were highly comparable with those of the other ethnic groups. Further, the Korean-Americans had comparable levels of self-esteem but reported lower satisfaction with life than the other ethnic groups concluding that KoreanAmericans were strongly influenced by their traditional and collectivistic orientation. Acculturation was extremely important because the lower levels of life satisfaction indicated they were experiencing more difficulties to Western societies. This type of acculturation pattern demonstrates that a psychologists/psychiatrists should maintain a collectivistic cultural orientation when delivering mental health services in order to be congruent with Korean-Americans‘ cultural expectations (Figure 3).

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Cultural Deviance in Youth Development Cultural deviance is based out of abnormality of what the culture holds true. Today, especially in American culture and society, there is somewhat of a consensus that psychoses exist among various ethnic and racial cultures (Devereux, 1961). Further, the members of that culture often characterize the manifestations of these disorders differently. The problem facing many societies is how to provide appropriate diagnosis, particularly as it relates to standards of the culture. For example, an American Indian adolescent who is spiritually connected to the earth, may have daily conversations with trees, dirt, and other inanimate objects. By his/her culture‘s standard, they are practicing traditionally held beliefs of being one with the earth and acknowledging the spirits. However, according to Western thought that prevails in the United States of American, this adolescent may appear to have a personality disorder based upon certain symptoms such as hallucinations and may be quickly medicated as to not become a vagrant to society. Unfortunately, without the context of knowing the culture, a misdiagnosis has occurred. Clearly, more than one type of deviance is likely to exist in any culture. As a result, a person may be singled out based upon some uncharacteristic element that distinguishes him/her from the rest of the same-age individuals. The temperament in adolescents is a common focus of attention in the American culture. It is not uncommon to see parents or guardians with infants and toddlers to hush their young children because of the current setting or cultural expectations. In Africa, some tribes such as Zairians infants are encouraged to cry (loudly) regardless of the environment, which is indicative of expressing vocal autonomy of

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their existence. As the culture and/or community evokes this display of emotion, adolescents are further encouraged as they grow to always ―speak their mind.‖ How then does a psychologist determine what is due to a true (personality or mood) disorder or what is simply a result of the person honoring cultural norms? Expectations surrounding adolescent development and rearing practices vary as much as their different cultures throughout the world. No one culture or ethnic group can lay claim on the best method to raise an adolescent. Yet, the expectation is that an adolescent will reflect universal cultural expectations, which initiates the controversy of appropriate diagnosing. Milestones such as vocal expressions, walking without assistance, independence, and mastery of fine and gross motor skills acquire different meanings in different cultures. The level of acculturation of a given family additionally influences cultural norms, even if they are indigenous to the country of interest (Canino and Spurlock, 2000). As a result, language and communication are critical when assessing for any type of disorder. Further, the adolescent must be assessed within the framework of their familial and cultural expectations and not those of the majority culture. While some westernized cultures place high value on early accurate vocalizations, other cultures equally value solitude and language development progressing at a slightly slower pace. Therefore, adolescents coming from a less-verbalized background may present characteristics commonly associated with a personality disorder, but in actuality are reflecting cultural norms (i.e., deference to authority). Non-majority group communication may also signal differences between the majority cultures. Parents of Latino and Caribbean adolescents often teach their adolescents to be physically and emotionally expressive. In doing so, it is expected for them to be creative and excited regardless of the situation or conversation of interest because discriminating between settings is not valued. Further, as they attempt to relate to one another or others outside of their culture, they may break the close proximity rule held by many Americans. Keeping a six feet distance while engaging in a verbal, face-to-face conversation is the expected norm. These expressions may, at times, be viewed as aggressive acts by those unfamiliar with cultural aspects. Further, when these actions are viewed through the lenses of other cultures, an inappropriate diagnosis may be suggested. On the other hand, Asian American adolescents are less likely to be as expressive and may not even make eye contact while communicating with another individual, if this person is one of status. Also, within the American Indian culture, emphasis customarily placed on non-verbal communication. Personal feelings such as anger and content are not openly expressed (Katz, 1981). Based on Asian American cultural stereotypes (i.e., Asians are the model minority group and never become depressed) held by many Americans, clinicians may be less inclined to make a diagnosis. Similar to Latino and Caribbean adolescents, African American adolescents are encouraged to be animated and vocal when expressing the most mundane of events or occurrences. For many, it is a direct link to oral traditions past through African slave ancestry. During this display of exuberance, one‘s voice may reach a high pitch that is often confused with yelling or screaming by westernized standards. As a result, when African American adolescents enter into formal education there are usually several cultural barriers between the school system and the students. As African American adolescents may have been taught to ―speak up,‖ ―speak out,‖ or ―speak to be heard,‖ teachers may expect them to acquiesce to their authority. Further, ADHD has proliferated throughout the school community and most of those students being diagnosed are African American boys, but they are less likely to receive proper treatment for the disorder (Tran, 2007). The disequilibrium that has prevailed

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is simply that of cultural imbalances between teachers‘ expectations and cultural expressions. While growing up, many adolescents are allowed to act upon their motor skills, but then are cajoled into performing actions that will satisfy their needs and that of their parents/guardians. Transitioning this self-regulation into the classroom becomes another step that is usually countered with much correction in the school system. While these concerns have been viewed through youth development, they easily resonate for adult diagnoses as well. In determining true disorders it is important to understand the history of the adult (e.g., childhood experiences, educational level, environmental issues, etc.). This information can be gathered through a detailed cultural interview (mentioned later in this chapter). Through the interview a clinician may obtain acculturation status, developmental issues, and other cultural nuances. Communication and interaction patterns reveal intra and interpersonal difficulties that may be accounted for in cultural expectations or cultural deviances. Further, the inability of one to communicate effectively may yield other concerns related to mental disorders (i.e., traumatic brain injury, etc.). This information, like for the youth, highlights noticeable differences across cultures, yet brings attention to emic perspectives as well.

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ASSESSMENT Personality disorders have the potential to be diagnosed more than any other Axis 1 disorders due to cultural unfairness. ―The potential for bias may be greatest when the mental health professional comes from a different culture from the person being assessed‖ (Blum and Pfohl, 1998, p. 204). The cultural unfairness is not just limited to a mix-match between psychologists/psychiatrists and patient based on cultural background, but also through areas such as assessment measures and techniques. While many assessments utilized by psychologists/psychiatrists/therapists are considered culturally-sensitive because they have representative samples of ethnic groups, these measures are still deficient in understanding cultural norms, expressions, and expectations.

Screeners Diagnostically based interviews for assessing personality disorders in different cultural groups tend to yield fairly consistent information. The reliability for these instruments is complex and varies. According to Zimmerman (1994) interrater reliabilities are higher for joint compared to separate interviews and interrater reliability of highly skilled versus newly trained interviewers are expected to differ. As evidenced by the reliability, clinicians and they like have considerable power in determining the eligibility criteria of a patient presenting a personality or mood disorder based upon less-sufficiently trained individuals. Therefore, if a new psychologist/psychiatrist, less familiar with test instruments or symptoms and unfamiliar with the cultural diversity presented, may increase the likelihood of a misdiagnosis. In order to combat increases in misdiagnoses, training institutions must do a better job in preparing mental health practitioners. The educational activities should not be limited to just classroom lectures and presentations on cultural diversity, but must provide practical access to working

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with individuals from diverse backgrounds through opportunities such as practica, externships, internships, rotations, residencies, etc. An important reason when selecting an instrument for use in diagnosing adolescent(s) with a personality disorder is the interview‘s organization and/or format. When a clinician has evidence that culture maybe a contributing aspect of a mood or personality disorder, he/she should conduct a thorough cultural interview. Once an interview is has been completed then diagnostic measures should be employed. For some instruments, questions may be grouped diagnostically (i.e., DIPD-IV and SCID-II), by topic (e.g., Interpersonal), or by version/format (i.e., Parent version, Student Version, Teacher Version). In creating this categorical system, the personality disorder criteria are purporting manifestations of the given personality disorder. This arrangement helps to accurately estimate whether a particular behavior exemplifies a core characteristic of the target behaviors (Clark and Harrison, 2001). However, this is a potential weakness to this approach, especially as it relates to adolescents in minority groups. If an adolescent appears to be exhibiting more characteristics for the first two criteria (i.e. significantly deviating behavior and pattern of behavior across situations, etc.), the clinician may become less objective and develop a positive persona about classifying the adolescent as having a personality disorder without additional probing. It is through the probing that the clinician may uncover cultural information that supports the adolescent‘s responses to the interview format and not deviance from the majority held beliefs of the dominant population. Similarly, for diagnosing adults with mood or personality disorders, it is equally important to utilize a cultural interview amongst other diagnostic measures (i.e., MMPI-2, Beck Depression Inventory – II, etc.). The cultural interview for an adult should focus on three primary areas: home, work, social (i.e., religion, etc.). These areas are most likely to yield cross-sectional information as it relates to a possible disorder. Further, when evaluating a person who presents a cultural diversity, it is important to consider the following principles outlined by Morrison (1995): 1. Understand the history of the patient 2. Current history is the best, but do not disregard ancient history (especially if one if from a different country) 3. Use collateral information, as necessary 4. Always look for signs while acknowledging symptoms 5. Use objective data and assessment (Figure 4) The accuracy of the clinical assessment and diagnosis of Latinos/Hispanics may be affected by the prominence of Spanish-language use among Latino/Hispanic patients and the scarcity of Spanish-speaking psychologists/psychiatrists/therapists (Minsky et al, 2003). Moreover, there is limited evidence that diagnostic inaccuracies in Latinos/Hispanics may be attributable to language use and cultural factors as different symptomatic expressions and cultural idioms of distress (Peck, 1974). Additionally, the use of Spanish in a diagnostic interview may elicit more personal and revealing information from patients, painting a clearer cultural, clinical picture including psychotic and mood symptoms with the disclosure of more severe forms of psychiatric disorders. The greater the degrees of cultural distance in the patient-practitioner dyad, the greater the potential for clinical error in the diagnosing of a mental disorder, especially a mood or personality disorder (Roger, 1989).

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Crossing the DSM-IV-TR with Culture Home        Work      Social     

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Who do you live with? Are you parents still alive? If so, how old? What is your relationship? Do you have sisters or brothers? Ages? What is your relationship? Describe your family life? Family structure? What are your responsibilities at home? For the family? What are the male roles for the family? Female roles? How many languages do you speak? What is the primary language spoken at home? Are you employed? If so, what type of work do you do? Is this considered an honorable profession in your culture? What type of employment presents a good life in your culture? Are you rewarded for individual or teamwork? Describe how your co-workers respond to you in your place of employment? Respect? Questions work ethic? Etc. What is the primary language spoken at work? Do you have friends that live close to you? What is your relationship with them? What types of activities do you do with your friends? What is the primary language spoken when you are with friends? Do you attend a church/synagogue/mosque/meeting or other form of worship service? Do you have a role in the worship experience? What is the primary language spoken in worship?

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Figure 4. Cultural Interview (Sample Questions).

This level of assessment also folds over into intellectual functioning and other psychopathologies among culturally diverse groups. The DSM-IV-TR suggests ―psychological tests in which the person‘s relevant characteristics are represented in the standardization sample of the test or by employing an examiner familiar with the aspects of the individual ethnic or cultural background‖ (Paniagua, 2001). While this recommendation may be excellent for diagnosis of Intellectual Disability, learning disabilities, etc., there is an inherent problem. Just because a clinician may come from a cultural background similar to the patient it does not mean he/she has complete grasp of the experiences of the individual. It is a flaw to assume that everyone from similar-named backgrounds has the equal cultural expectations or beliefs. Therefore, it may possible that a lower socioeconomic status (SES) white clinician working with a lower SES African American patient may have more in common than a higher SES African American clinician working with a lower SES African American patient.

Over Diagnosis The fear of over diagnosing is real for many culturally diverse individuals. For adolescents, the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) can be seen throughout America‘s school landscape and the epidemic appears to be worsening as teachers and school administrators come into contact

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with multiple ethnic groups and cultures. While it is the belief of the author that the proliferation of ADHD across school populations is a result of cultural clashes between white middle-class teachers and African-American/Latino lower/middle-class students, other influences such as No Child Left Behind (NCLB) have contributed to more students of color being diagnosed. The ―push‖ for accountability has ―punished‖ creative teaching in the classroom and replaced it with ―teaching to the test‖ syndrome. Students no longer experience learning but are ―robotically‖ taught how to monotonously think about singular issues. As a result, clinicians should always be mindful of over diagnosing of any behavioral pattern, disorder, or pathology. There is an unfortunate tendency for clinicians and those that serve a myriad of populations to view pathology in terms of assessment instruments and general lack of understanding (Paniagua, 2005). It is not uncommon to uncover that the assessment instruments used to determine pathology with a culturally diverse group was normed on primarily Anglo-Americans. These instruments lack cross-cultural validity. The second explanation leading to over diagnosing, lack of cultural awareness, is almost inexcusable given the cultural explosion within the United States and other industrialized countries. By having a general lack of understanding and not willing to branch out to discover non-AngloAmerican culture suggests an elitist‘s mentality. Clinicians who are unfamiliar with practices and beliefs of their multicultural clients may incorrectly diagnosis and report a psychopathology or perhaps use inappropriate testing measures, especially projective tests. While there appears to be over diagnoses of ADHD in adolescents, the same is true for diagnoses of psychotic and mood disorders, especially schizophrenia and major depression, in ethnic/racial adult populations. In routine clinical assessments, African Americans were described as having higher rates of diagnosed schizophrenia and lower rates of depression than their European American counterparts (Minsky, Vega, Miskimen, Gara, and Escobar, 2003). A Conversation between a Psychologist and a Psychiatrist (Professional Culture) Psychology has evolved out of academic traditions that values careful development of positions, cautious formulations of hypotheses, and consensual decisions. Whereas, the working perspective in medicine (psychiatry) is an individual practitioner actively assembles relevant data, evaluates the data, arrives at a working diagnoses, and acts upon the diagnoses to provide the appropriate medical intervention. The difference can be illustrated through a psychiatrist supervising a clinical psychologist (intern) and a psychiatry resident within a hospital setting. Psychology interns tend to communicate by carefully stating all the data and the rationales leading up to their final diagnostic conclusion. However, psychiatry residents learned to begin by stating their diagnostic impressions and, if there were questions, following these assertions up with their observations and rationales, which is a contrast to the psychology intern training. In the end, the importance of the DSM-IV is seen in the judgment and decision-making of the professional. So, how can psychologists and psychiatrists capitalize on each other‘s professional strengths? What is the role of the psychologist and psychiatrist when working with each other on a person from a different cultural background? Figure 5. Culture to Culture. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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While it is unclear how practitioners clearly distinguish the presence of psychotic and mood symptoms of a given diagnosis, in that symptoms may appear in both types of disorders. For many, the misdiagnosis may be attributed to unfamiliar cultural expressions. This may be manifested through two sources of potential errors: informational variance and criterion variance (Minsky, et al 2003). Information variance examines the differences between clinicians and researchers in the availability of clinical information recorded by clinicians and used by them to form diagnostic judgment. Criterion variance looks at the differences between clinicians and researchers in the application of diagnostic criteria to the same information, thus leading to discordant diagnoses. Meaning, a clinician may interpret and liken the same experiences of an African American to that as a European American to that as a Laotian and expect exact, if not similar, results. (Figure 5)

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Projective Techniques While projective measures have been used since the early 1930s, their original (and current) use was for members of a familiar culture (Abel, et al., 1987). However, time has revealed that these measures present inaccurate data for less-known groups, or in our case minority populations. Tests such as the Thematic Apperception Test and the Rorschach Inkblot Test provide valid information, yet they these measures do little to account for cultural representation and individual adaptations made even though the norms have been updated (Abel, et al., 1987). Other concerns, as it relates to the Rorschach, highlight the importance of evaluating linguistic equivalence of Rorschach instructions. The brevity and complex nature of the instructions may require a level of abstraction that is itself culture specific (Allen and Dana, 2004). Other tests such as the MMPI-2-RF claim US Census representation, but clinicians feel the test fails to take into account ethnicity and cultural differences when psychologically evaluating Hispanics/Latinos (Blow et al, 2004). It is suggested that when using the MMPI-2-RF, psychologists/psychiatrists must take into consideration the acculturation of the patient and his/her language preference and proficiency realizing that version differences may not be in accordance with the patient‘s country of origin. While the Beck Depression Inventory – II is not a projective measure, it is widely used in the screening and diagnosing depression. Like other self-report measures, the BDI-II may suffer from easily exaggerated or minimized symptoms translating to inaccurate scores. This is especially related to culture in that some culture are either less likely to divulge information as it may be perceived as intrusive behavior on the clinician‘s behalf, whereas other cultures may over-embellish possible symptoms. Further, the problem of interpretation is compounded, as demonstrated in the United States of America, by the enormous amounts of immigrants to the country who must adapt themselves to an unfamiliar role of life. Biases enter as clinicians use their own frame of references as a rubric to make judgments regarding dysfunctional and pathology of adolescents and adults.

Reducing Cultural Bias The DSM-IV-TR made efforts to reduce cultural bias. The first step involves examining the individual in the context of their cultural background. It is important for the clinician to

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consider the culturally diverse person‘s environment, significant relationships, cultural norms outside of ―normal society‖ perspective, etc. When looking at the criteria for schizotypal personality disorder, ―odd‖ is used to describe various behaviors. The ensuing questions should be, ―Is the odd behavior consistent/inconsistent with cultural norms and expectations?‖ ―What are considered odd expressions in your culture?‖ If the behavior reflects traditional background elements, then the individual cannot be diagnosed with this personality disorder.

Dr. Alvin Francis Poussaint is one of the mostly widely know psychiatrist in the United States. Born in East Harlem, New York, Dr. Poussaint matriculated from Columbia in 1956 and earned an MD from Cornell University 4 years later. After interning for two year at the University of California at Los Angeles Neuropsychiatric Institute, he was selected as chief resident in 1965 and led the institute‘s intern training program. During this time period Dr. Poussaint was also active in the Civil Rights Movement as the Southern Field Director of the Medical Committee for Human Rights in Jackson, MS. In 1969 he joined the faculty of Harvard University where he was Director of Student Affairs at Harvard Medical School from 1975-78. Outside of his academic responsibilities, Dr. Poussaint was a script consultant to NBC‘s The Cosby Show and A Different World and continues to consult with the media as an advocate of more responsible programming. He is distinguished life fellow of the American Psychiatric Association, a fellow of the American Association for the Advancement of Science, and a member of the Television and Media Committee of the American Academy of Child and Adolescent Psychiatry. Dr. Poussaint has and continues to receive numerous awards and is the recipient of many honorary degrees. Dr. Poussaint has many publications to his credit, especially dealing with the raising of black children and managing racism, which he dealt with at an early age. Some books are: Come On People: On the Path from Victim to Victor (coauthor Bill Cosby), Lay My Burden Down: Suicide and the Mental Health Crisis Among African-Americans, and Raising Black Children. Source: http://www.harvard.edu. Figure 6. Cultural Icon.

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Likewise, when examining a mood disorder such as Bipolar, an appropriate question as it relates to cultural variance is, ―Is the manic or depressive episode a result of cultural management within a new environment?‖ ―What is the acculturation stage of the individual?‖ These types of questions help to better explain certain behaviors and cultural expectations. The second safeguard included in the DSM-IV-TR deals with the magnitude the possible disorder places on the adolescent or adult. The disorder has to lead ―to clinically significant distress or impairment in social, occupational, or other important areas of functioning‖ (APA, 1994, p.630). The resiliency and adaptability levels of many ethnic minorities in the United States are extremely high. As a result, these individual may employ non-traditional and uncharacteristic functional levels in different environments. While their level of functioning may appear chaotic, eccentric, or uncontrollable, it may not present any clinically significant levels of distress or impairment. While there is no fairy-tale, culturally free assessment, clinicians should make a concerted effort to employ the least biased assessment strategies. Since there is no culturally free test, Paniagua (2001) suggests that clinicians select and use appropriate strategies with African, African American, American Indian, Asian, European, and gay/lesbian/ transgendered, and Latino(a) clients. For example, when diagnosing a person with Dependent Personality Disorder the clinician cannot rely solely on tests (i.e., MMPI-2-RF) to assess the adolescent/adult. The results of this test (and the use of others) could be enhanced with the design of an assessment strategy in which the individual could record actual behavior indicative of ―dependence‖ on another person. Describing the dependent behavior in reference to cultural expectations is necessary. The additional information would help to tease out what may be more of cultural norms than dependence. Furthermore, using tests that have been translated into the native tongue of the patient may possibly yield more conclusive results (Figure 6).

INFLUENCING TREATMENT Overall, selected diagnostic instruments minimally, at best, recognize how cultural factors can influence the expression and definition of ADHD/ADD, schizophrenia, affective and personality disorders. The Research Diagnostic Criteria (RDC) and other interview schedules are commonly used to assess personality disorders and other expressions of psychopathology. An examination of the various diagnostic criteria and interview schedules reveal types of cultural references being made. While some measures account for cultural differences, they do so in a limited basis. The critical point, that influences diagnoses and treatment, is that diagnosticians should make sure that his/her cultural group does not share the patient‘s particular beliefs and perceptual experience. As a result of not following the patterns and traditions of their own group lies the deviance from the norm. Additionally, diagnosticians should exercise caution when assessing formal thought disorder. For some, especially those less familiar with cultural dialects may feel that some speech and thinking patterns are representative of a thought disorder, when in actuality it is normal speech or thinking for some groups (Lopez and Nunez, 1987). For example, indigenous people to the northern part of Australia are more inclined to utilize traditional

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methods for adding and subtracting as it relates to computational problems. This may initiate an interviewer to see the thinking patterns of the individuals as delayed or problematic, when the client is demonstrating a common method of analyzing a math problem. Also, some Eastern Indian tribes do not support their children learning math. As a result, when some Eastern Indian children arrive in Westernized classrooms they may be referred quickly for a psychiatric/psychological (psychoeducational) evaluation, without discussion of cultural norms but to avoid not meeting annual yearly progress according to NCLB. In the diagnosing and treatment of personality and mood disorders and schizophrenia, hallucinations and delusions are often mentioned, but without consideration to cultural influences. The bereavement process is not experienced the same across populations and cultures. Further, the bereaved may not present depressive disorders as commonly believed by many diagnosticians when other cultural members are responding the same in similar circumstances. Also, for many American Indian tribes in the United States, there is a sevenyear bereavement period marked with celebrations and sorrowful moments. It is through these cultural reflections that psychologists/psychiatrists must be made aware in order to avoid unnecessary diagnosing of mood disorders in minority populations.

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CONCLUSION Determining the presence of a personality, mood, or any other DSM-IV-TR classification in an adolescent or adult is a somewhat subjective and daunting task. Even more so, when the individual is from a different population than what the measure was normed on or the cultural background of the clinician provides additional concern about the correct diagnosis. As Paniagua (2001) states, ―Because all behaviors are learned in a cultural context and presented in a cultural context, accurate assessment, meaningful understanding, and appropriate intervention must attend to the cultural context.‖ (pg. 28) It is important for clinicians to incorporate some understanding of acculturation and enculturation process in our thinking as it can only benefits the patients being served (Figure 7).    



Mood and Personality Disorders along with ADHD/ADD have been commonly misdiagnosed in minority cultural groups Ethnic identity, linguistic patterns, and psychosocial development influences cultural variance in possible DSM-IV-TR diagnoses There is no absolute, culturally-free assessment measure possibly leading to over diagnosing of certain disorders A cultural interview should always accompany and DSM-IV-TR diagnosis, when the individual is an immigrant, refugee, or presents different cultural norms. NCLB contributes to overrepresentation of students of color receiving specialized school services

Figure 7. I‘ve Learned… .

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REFERENCES Alegria, M, Canino, G, Stinson, F.S., and Grant, B.R. (2006). Nativity and DSM-IV psychiatric disorders among Puerto Ricans, Cuban American, and Non-Latino Whites in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Journal of Clinical Psychiatry, 67, 56-65. Allen, J., and Dana, R. (2004). Methodological issues in cross-cultural and multicultural Rorschach research. Journal of Personality Assessment, 82(2), 189-206. Allik, J. (2005). Personality dimensions across cultures. Journal of Personality Disorders, 19, 212-232. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA. Badger, L.E. and Rand, E.H. (1998). Advances in mental health research: Implications for practice. Washington, DC: NASW Press. Blow, F.C., Zeber, J.E., McCarthy, J.F., Valenstein, M., Gillon, L., and Bingham, C. (2004). Ethnicity and diagnostic patterns in veterans with psychoses. Social Psychiatry 39, 841851. Blum, N. and Pfohl, B. (1998). Personality disorders. In J. Williams and K. Ell (Eds.), Advances in mental health research (pp.203-216). Washington, DC: NASW Press. Boyd-Franklin, N. (1989). Black family therapy. A multisystems approach. New York: Guilford. Brekke, B. (2002). Characteristics of Korean-American, with schizophrenia: A cross ethnic comparison with African-Americans, Latinos, and Euro-Americans. Schizophrenia Bulletin, 28(3), 703. Clark, K. (1965). Dark ghetto: Dilemmas of social power. New York: Harper and Row. Clark, L.A. and Harrison, J.A. (2001). Assessment instruments. In W.J. Livesley (Ed.), Handbook of personality disorders (pp. 277-306). New York: The Guilford Press. Cooke, D.J., Kosson, D.S., and Michie, C. (2001). Psychopathy and ethnicity: Structural, item, and test generalizability of the Psychopathy Checklist-Revised (PCL-R) in Caucasian and African American participants. Psychological Assessment, 13, 531-542. Devereux, G. (1961). Mohave ethnopsychiatry and suicide: The psychiatric knowledge and psychic disturbances of an Indian tribe. In T.M. Abel, R. Metraux, and S. Roll (Eds.), Psychotherapy and Culture (pp. 40-45). Albuquerque: University of New Mexico. Diller, J.V. (2004). Cultural diversity. (pp. 58-78). Belmont, CA: Brooks/Cole. Freeman, A., Reinecke, A., and Tomes, Y. (2007). Cultural introduction. In A. Freeman and M. Reinecke (Eds.), Personality disorders in childhood adolescence. New York: John Wiley and Sons. Gibbs, J.T. (1989). Biracial adolescents. In J.T. Gibbs, L.N. Huang, and Associates (Eds.), Children of color: Psychological interventions with minority youth (pp. 322-350). San Francisco: Jossey-Bass. Goodman, M.E. (1964). Race awareness in young adolescents (Rev. ed.). New York: Collier. Hale-Benson, J.E. (1982). Black adolescents (Rev. ed.). Baltimore: Brigham Young University Press. Hilliard, A.G. (1983). Psychological factors associated with language in the education of the African-American adolescent. Journal of Negro Education, 52, 24-34.

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Hoskens, C. (2008). Mood disorders and schizophrenia. Retrieved September 11, 2009 from http://www.agape-biblia.org House, A. (2002). DSM-IV diagnosis in the schools. New York: Guilford Press. Iwamasa, G., Larrabee, A. and Merritt, R. (2000). Are personality disorder criteria ethnically biased? A card-sort analysis. Cultural Diversity and Ethnic Minority Psychology, 6(3), 284-296. Katz, P. (1981). Psychotherapy with native adolescents. Canadian Journal of Psychiatry, 26, 455-459. Kunen, S., Neiderhauser, R., Smith, P.O., Morris, J.A., and Marx, B.D. (2005). Race disparities in psychiatric rates in emergency departments. Journal of Consulting and Clinical Psychology, 73(1), 116-126. Lopez, S. and Nunez, J.A. (1987). Cultural factors considered in selected diagnostic criteria and interview schedules. Journal of Abnormal Psychology, 96, 270-272. Minsky, S., Vega, W., Miskimen, T., Gara, M., and Escobar, J. (2003). Diagnostic patterns in Latino, African American, and European American psychiatric patients. Archives of General Psychiatry, 60, 637-644. Morrison, J. (1995). DSM-IV made easy. New York: The Guilford Press. Paniagua, F.A. (2001). Diagnosis in a multicultural context. Thousand Oaks, CA: Sage. Paniagua, F.A. (2005). Assessing and treating culturally diverse clients (3rd ed.). Thousand Oaks, CA: Sage Publications. Peck, E. (1974). The relationship of disease and other stress to second language. International Social Psychiatry, 20, 242-244. Porter, J.D. (1971). Black adolescent, white adolescent: The development of racial attitudes. Cambridge, MA: Harvard University Press. Roger, L., Malgady, R., and Rodriguez, O. (1989). Hispanics and mental health: A framework for research. Malabar, FL: Robert E. Kreiger Publishing Co. Skeem, J.L., Edens, J.F., Camp, J. and Colwell, L.H. (2004). Are there ethnic differences in levels of psychopathy? A meta-analysis. Law and Human Behavior, 28, 505-527. Tomes, Y.I. (2008). Ethnicity, cognitive styles, and math achievement: Variability within African American post-secondary students. Multicultural Perspectives, 10(1), 17-23. Tran, C. (2007). Black kids, girls are less likely than white boys to receive proper treatment. Retrieved July 26, 2009 from: http://www.new.education.ufl.edu U.S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Rockville, MD: Author. Whaley, A. (2001). Cultural mistrust: An important psychological contrast for diagnosis and treatment of African Americans. Professional Psychology: Research and Practice, 32, 555-562. Wilkinson, D. (1993). Family ethnicity in America. In H.P. McAdoo (Ed.), Family ethnicity: Strength in diversity (pp. 15-59). Newbury Park, CA: Sage. Zimmerman, M. (1994). Diagnosing personality disorders: A review of issues and Research methods. Archives of General Psychiatry, 51, 225-245.

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PART II. CROSS-CULTURAL INTERACTION AND UNDERSTANDING: PRACTICE

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Chapter 4

THE AFRICAN AMERICAN PERSPECTIVE TO CROSS-CULTURAL INTERACTION AND UNDERSTANDING ―No Matter Where I Go, I Am Always There!‖ Y. Tomes

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ABSTRACT African Americans have been a heavily researched group for a variety of reasons: historically, psychologically, spiritually, etc. To comprehend the complexity of African Americans cannot be done in a chapter, book, or volume, it would take a lifetime and still episodes would be missing. This chapter offers a glimpse into four perspectives of African Americans lives, while acknowledge these are no cookbook approaches to understanding their identity, education, interaction, and healthcare practices. The identity of many African Americans has been arrested by slavery, yes slavery. One of the purposes of slavery was to strip ―humanity‖ from the African person and build them according to the need of the times. In doing so, men and women were only identified by ―X.‖ This residual effects still remain today for many African Americans and presents challenges for non-African Americans. Additionally, interaction patterns, educational systems, and healthcare trust remain hampered by multiple oppressive systems of change. Through it all, African Americans remain not only resilient, but have thrived in certain area.

INTRODUCTION For those who are Christian, God wrapped Himself in humanity and came to the earth as Jesus to save a dying world. The concept of transitioning from a God to human is almost inconceivable, if not nearly impossible in the eyes of many. Why a God would chose to rid himself of everything to accept the responsibility of a hedonistic society damnable to Hades? Just as this story is almost unsearchable at times, the atrocities of one man to inflict on another, while using the auspicious of religion is ill-conceived at best and unconscionable at worst.

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Yuma Iannotti Tomes Posttraumatic Slave Syndrome (PTSS) is the systematic dehumanization of African slaves and the intergenerational trauma experienced by their descendants which is in the form of emotional and psychological scars on the African American psyche. PTSS offers concrete explanations to how centuries of slavery, followed by systematic oppression, prejudice, and racism have resulted in maladaptive behaviors and poor coping strategies, which have originated in survival strategies. Since that time, Americans of all the ethnic backgrounds have been inculcated, immersed, and enamored in a fabricated (but effective) system of race ―hierarchy,‖ where light complexion privilege still dramatically affects the likelihood of succeeding in American society.

Figure 1. Cultural Clip.

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African Americans, unlike any other ―American‖ group, have endured one of the most horrific pasts known to mankind, to humankind. And crucial to the history of African Americans is the guile of using religion to perpetuate enslavement propaganda, which still permeates many global societies – mentally, physically, and spiritually. As a result of African America men being emasculated of an identity, family, and manhood and the African American women being subjected to rape, floggings, and inhumane acts, the challenge of uncovering the true self has been compromised almost to a point of no return. Identity is a challenging word to define as it encompasses many divergent areas. For the purpose of this book, identity is the psychological formation of one‘s ability to present consistent and stable characteristics when integrating prior experiences with new encounters. While many may feel that identity is static, it is not. Identity continues to evolve as one engages in opportunities that are foreign.

IDENTITY Negative stereotypes of black people abound not only in American societies but many others as well, especially European countries. Overt and covert discrimination coupled with undeniable prejudice and asinine comments have created social and psychological disengagement for many African Americans and those of the African Diaspora. These tragedies endured by African Americans have contributed to forms of self-violence, substance abuses and even death, which is evidenced by high homicide rates committed by African American males on African Americans while only accounting for about 6 percent of the total population. African Americans, in general, are under-represented in multiple American settings such as colleges/universities, senior-level management, and business ownership. More striking are significantly lower levels for African American males, in particular colleges and universities. While African Americans only make up 13.1 percent of total college enrollment approximately less than 34 percent of African American males graduate from college (NCES, 2010). What could possibly attribute to sustained growth of African Americans in predominately White institutions? Understanding Black Identity may offer both cultural and ethnic insight. Black racial identity has been linked with positive psychological well-being for Black men in general (Spurgeon and Myers, 2010), but specifically within predominantly White institutions of learning and employment (Pillay, 2005).

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Probably the most noted racial identity development theory was postulated by William Cross (1971). Cross examined racial identity in context of the individual‘s personal characteristics which were shared across gender, race, ethnicity, cultural norms, and culture that connects groups of people (Spurgeon and Myers, 2010). The development or change of one‘s identity occurred through socialization, meaning how the ―world‖ perceives the individual and the how the individual perceives the ―world‘s‖ reaction. Further, this socialization contributed to identity development through 5 stages: pre-encounter, encounter, immersion-emersion, internalization, internalization-commitment. The five, linear stages represent a cultural pathway to minimizing cognitive dissonance and embracing self-acceptance. Through racial identity development, individuals can, in a positive manner, challenge and address negative life circumstances. Racial identity, believed by many, serves as a paradigm shift to embracing wholeness and wellness which are aspects of positive psychology or in Afrikan terms, Ubuntu Psychology. Ubuntu involves the positive conceptualization of self through divinty, ancestors, and ritualistic practices that serve spiritual wellness. Very few studies have examined positive constructs with African Americans as the deficit model has been the preferred method of peering into the lives of this population leading to bias and prejudicial research. The cultural orientation and identity of many African-Americans are grounded in tenets such as strong religious beliefs, collective social orientation, strong family and kinship bonds, cognitive/academic freedom, oral tradition, open and affective expressiveness, and present time orientation. When these areas of traditional African-American life are unbalanced or denied, problems begin to surface in the identity of whom one is within his/her culture. Specifically speaking, cultural variables such as religiosity, time orientation, and cultural pride may be important factors related to the psychological functioning and general well-being of many African-Americans. Further, these areas also act as a buffer from stress and negative mental health outcomes which impacts, if not predicts one psychological well-being and identity develop. According to Jones (2003), African-Americans deeply entrenched belief in religion can be manifested in a cognitiveemotional structure of perpetual optimism and the ability to recover from adversity. This is most notable in the adjustments African-Americans had to make due to slavery, Jim Crow, segregation, and other degrading practices. While Cross‘ Stages of Identity have been a pillar within the African American communities, there are other avenues by which with African Americans, especially children, become comfortable with there identity. Racial socialization also may lead to African Americans becoming more comfortable in their skin. Racial socialization, the process by which parents teach their children about the significance and meaning of race with their current country of dwelling helps to solidify a stronger identity (Neblett, Chavons, Nguyen, and Sellers, 2009). The process of socializing children about the significance and meaning of race is not complicated, because explicit and non-explicit messages conveyed by parents can be misinterpreted if not explained. Further, parents‘ messages regarding race may act as a buffer against negative racist experiences, while instilling a stronger work ethic leading to an increase in academic motivation and performance. For instance, African American males‘, adolescent boys in particular, physical development during puberty combined with genderedracial stereotyping as aggressive and violent may mislead society to feel that these individuals are unintelligent and threatening (Davis and Jordan, 1994).

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Yuma Iannotti Tomes Racial Pride Messages Racial Barrier Messages

Egalitarian Messages Self-worth Messages

Racial Socialization Behaviors

Messages that emphasizes pride in African American history and culture Messages highlighting the existence of inequalities between African Americans and other racial groups Messages that emphasize equity among races Messages that emphasizes feelings or individual worth within the broader context of being African American Messages that are delivered through parents engaging in race-related activities such as reading African American literature and purchasing African American art.

* Adapted from Neblett et al, 2009. Figure 2. Racial Socialization Themes.

As a result, the ways in which society perceives African Americans (males in particular) may lead to unique, negative interactions around race that not only impacts inter-racial perceptions or intra-racial perceptions. More importantly, is how the African American males feel about themselves. If the males carefully listened to and abided by the perceived stereotypes, the perceptions can be internalized leading to self-hatred. (Figure 2)

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Intra-Identity African Americans have fallen to the second largest minority ethnic group in the United States with individuals from a Latino background surging (Vargas and Kuhl, 2008). Yet, there is a strong hybridization between African Americans and Latinos that is either contentious at times or swept under the rug because both ethnic groups may feel they are competing for similar resources. As the influx of Latinos continues to grow throughout the United States, it begs the question for African Americans regarding their role in the country of immigrants. What can be even more daunting is understanding the challenges of Afro-Latino origin as to where their loyalty lies further complicating what identity means within the African American ethnic group. For many Afro-Latinos, they trace their roots to Africa and Latin America. Further, their physical characteristics mirror African descent, while their ethnic background reflects a different upbringing (Vargas and Kuhl, 2008). Afro-Latino and African American phenotypic affinities place them in a unique position to initiate a dialogue and gain understanding about each other. However, language difficulties and the lack of knowledge of each other‘s history remain a challenge. Not only do Afro-Latinos encounter racial discrimination in American, especially in the American south, they also experience difficulties communicating with their ancestral kin (p. 337).

Instead of rejecting Afro-Latinos as some African American have chosen to do, there is room and opportunity to share in the common bonds that bridge an ethnic divide while Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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highlighting the importance of identity. The unifying element of one‘s identity may coalesce around being in America and not being an American, but being an African. The ancestral linage helps to solidify the enculturation of values, thereby impacting his/her identity.

Identity and Ecological Perspectives

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Urban and rural areas share unfortunate commonalities such as lack of resources, poor accessibility to healthcare, parenting challenges, and psychological/emotional adjustment to the environment. Further, ecological contexts such as family processes, peer influences, and community context among rural African American youth travel a different pathway (Murry, Brody, Simons, Cutrona, and Gibbons, 2008). Parental monitoring for rural, African American single parents revealed four contextual factors: mother‘s education, neighborhood social ties, racial discrimination, and negative life events, help to account of identity among youth. As children were able to see how their single parent dealt with situations, it helped them to navigate the system or acquiesce on some level. The monitoring offered by parents further supported transmitted cultural factors as religious significance. Additionally, as parents encountered negative life events the ability to demonstrate parental warmth was critical to creating a protective factor. Other ecological factors such as a supportive community furthered the cultural values and help to shape the identity of youth. (Figure 3) Trayvon Martin vs. George Zimmerman Trayvon Martin, a 17 year old African American male, was returning home (in a gated-community) when an altercation between he and George Zimmerman, a 28-year old, bi-ethnic male and self-proclaimed neighborhood watch captain, ensued. The altercation eventually led to George Zimmerman fatally shooting Trayvon Martin in the chest. When police arrived George Zimmerman claimed the shooting was in self-defense (which is further complicated by Florida‘s ―stand-your-ground law), even though he reported a suspicious person to the police, which the police instructed George Zimmerman to not pursue the person of interest. Against the request of the police, George Zimmerman followed Trayvon Martin, who alleged to have been talking on the phone with his girlfriend. The police collected little evidence from the crime scene and took George Zimmerman to police headquarter is Sanford, FL. However, George Zimmerman was not charged for a crime which extended over one month. Finally, due to heavy presence of media interest in the case and protestors against the Stand Your Ground Law of Florida, George Zimmerman was officially charged with murder in the second-degree on April 11, 2012. He was released on $150,000 bail on April 23, 2012. This case has caught the interest of the United States and beyond, because it still pulls at issues of race in America. Figure 3. Where were you on February 26, 2012? Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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The Contextualized African American Man Historically, and possibly more prevalent now is the attack on the humanity of the Black male, particularly within the United States. Today, the media and society has constantly defined African American males as drug addicst, unintelligent, violent sexual predators, unemployable, prison dwellers, and brute savages, just to name a few. This assault has forced the African American male to confront not only himself, but maybe more importantly, society‘s image of he is and what he represents. This belief is not relegated to the United States, but other Euro-centric countries as well, as Black men are generally perceived as less than. To further support this belief African American boys often ―receive more messages regarding the existence of racial barriers and fewer messages regarding racial pride than African American girls‖ (Neblett et al, 2009, p. 248). The African American male is national case study of domination, rejection, selection, and survival. Through the perils of slavery to the travesty of institutionalized racism, the African American male has been subjected to it all and yet, resilience has occurred for many. As a result, African American males today are still wrestling with ―Who am I?‖ The personhood of the African American male must be fully engaged to become fully human. Many psychological approaches are commonly used in working with persons of color, but few directly target African American males, especially in the exploration of identity. The Humanistic approach is garnering great support as it allows the African American males psychological functioning to be overlooked within the context of his experiences. ―…a humanistic perspective offers an important corrective to the usual portrayal of African Americans because it allows the focus to be on aspects of their psychological functioning – typically associated with being fully human – that have been overlooked‖ (Johnson, 2006, p. 189). As a result, the African American male may demonstrate one of two possible actions toward understanding his position with an American and global society – active or passive accommodation due to racism. More specifically, Jenkins (1995) explains how African American males, in particular, respond either as a victim or aggressor based upon factors such as discrimination and economic marginalization. In responding passively, African American males may perceive their situations as powerlessness and lacking control of his destiny. Whereas, in responding as the aggressor, African American males present an unintelligent, uncontrollable rage yielding an inability to recognize how to appropriately engage the environment he is apart of on a larger level. In order to better serve African American males in the discovery of his humanity, it is necessary to work with each male in the contexts of his life by providing voice to the circumstances and context to those circumstances while eventually attaining goals. By utilizing a humanistic approach with African American males, it is assumed that the condition will be understood in by both acknowledging the historical reality of racialized hate, oppression, and depression through slavery. This further supports the use of Afro-centric approaches such as Ubuntu Psychology and Ecological Healing. Further, to secure to the powerful earnest competence of the African American male to acknowledge self-esteem, self-worth, and self-dignity. This appreciation for proactive qualities sustains contextual, cultural forces that breed an uncanny humanity of the African American male.

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HEALTH SYSTEMS AND AFRICAN AMERICANS Racism, discrimination, and the lack of identity development can be mental ―cancer‖ for many African Americans, as it consumes all healthy options while leaving infective, rapidly growing and spreading malignant cells. It is important to gain an understanding of how cultural competence affects the mental and medical health care experiences of African Americans. Historically, African Americans have been the recipients of discriminative medical services that included inappropriate diagnoses, abbreviated visits, and poor quality of care. Mays, Cochran and Barnes (2007) argue that the continuation of poor health care for African Americans, despite the many improvements that have been made in their lives over time, is a reason to continue to look at the effects of discrimination. Mays, Cochran, and Barnes, 2007, argue that ―since 1985, racial disparities in health have worsened in many ways‖ (p.202). They argue that the causal link between racial minority status and health disadvantages may lie in the harmful effects of the real and perceived discrimination that African Americans have experienced repeatedly and for long periods of time. Research has suggested that connections among multiple stimuli including poor education, violent conditions, and negative social connections along with exposure to these conditions in early childhood can result in changes in brain functioning and bodily psychophysiological responses (Mays, Cochran, and Barnes, 2007). Health disparities among African Americans have been noted in early mortality rates, disabilities, rates of disease, and injury. Research has also been conducted to show that positive expectations, social interactions, and hopeful outlooks are associated with long-term positive physical and mental health outcomes (Mays, Cochran and Barnes 2007; Frederickson 2000; Ryff and Singer 2000, 2001; Seeman and McEwen 1996; Taylor and Brown 1994; Taylor et al. 1997). African Americans have even been subjected to medical experiments in which they were given diseases, without their knowledge, and left untreated. The Tuskegee Experiment is a prime example of this as African Americans were intentionally given syphilis and lead to believe that they were receiving medical treatment. Eiser and Ellis (2007) suggest that it is important to understand that mistrust is an aspect of the medical care experience for African Americans due to historical experiences such as those previously mentioned. They suggest that bridging cross cultural clinical communication gaps would involve establishing trust, gaining a level of cultural understanding, and being aware that education of illness and health literacy must be available through multiple models. Eiser and Ellis report that 25 percent of doctors in the United States are international medical graduates which results in ethnic distance between patients and their providers (2007). A lack of understanding of the American culture in general, as well as African American culture specifically, results in communication deficits between patients and their doctors. Some aspects of African American culture that Eiser and Ellis (2007) suggest that practitioners should be aware of include religion, distrust and race, home and/or natural remedies, and racial concordance. These are factors, along with insurance and other economic factors, that may determine if African Americans would undergo life saving medical procedures. Physicians should be aware that it is not uncommon for African Americans to try home remedies before seeking medical treatment. This could be a direct result of the historical experience of not having access to quality medical treatment and institutionalized racism. Racial concordance suggests that African Americans are more comfortable with

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African American doctors but there are very few African American medical doctors for physical aliments and psychologists for mental health. Also, physicians/psychologists need to be aware of and acknowledge the religious and cultural beliefs of African Americans as this could lead to mistrust in the relationship. Eiser and Ellis argue that physicians need to be sensitive to patient‘s needs and cultural differences. They also argue that demonstrating cultural humility and mutual concern will help to establish rapport (2007). These are essential in achieving the most efficient cross-cultural clinical encounters for African Americans and their doctors. Previously mentioned, it is not uncommon for African Americans to resist seeking professional help, with the exception of emergency situations. This reluctance is also observed when accessing mental health services. As a result of not seeking professional help, many mental health issues may go undiagnosed, under-diagnosed, or untreated in the African American community. The mental health of African American parents will have a direct effect on their parenting style and the relationships they establish with their children. Symptoms of depression are less likely to be recognized and treated in African American individuals (Davis, Caldwell, Clark andDavis, 2009). Davis et al. (2009) conducted a study to address the health needs of children in the context of family and community. The study involved the association of depressive symptoms in fathers and the level of involvement with their sons when they live in different households. Davis, et al. (2009) reported that 50% of African American children were living in fatherless homes in 2007 (p.1612). They also argue that a lack of involvement with a positive father figure increases the risk of delinquent and adverse physical and mental health behaviors for the child. Involvement was defined in this study as engagement, responsibility and accessibility. Results of the study suggested that the presence of depressive symptoms was associated with a lack of involvement in accessibility and engagement, which has shown to be a protective factor for child and adolescent health behaviors. It should be noted that participants in this study were volunteers, which would suggest that they were actively seeking professional help to improve relationships with their children and symptoms of depression. Considering that African American people have been historically viewed as ―less than human,‖ the approach of those who intend to provide mental health services must be humanistic in nature. More often than not, African American men have been typically dehumanized in popular media and science literature (Johnson, 2006). Johnson suggests that the literature focuses in external forces that act on African Americans not internal forces. This leaves African American men in a position that they are constantly defending their humanity. Johnson (2006) argues that a humanistic approach to counseling could be viewed as a corrective procedure in changing society‘s perception of African American men. Johnson offers four central themes in humanistic counseling approaches: The belief in human capacity for reflective consciousness; humans strive for growth and development rather than maintenance of stability; choice and will are seen as central aspects of human functioning; and person-centeredness: respect and concern for each person engaged in the process (Johnson, 2006, p.188).

Communalism is considered a culture-based socialization activity across all AfricanAmerican groups, but even more so amongst low-income African Americans. The level of communalism not only identifies African-American, it captures the essence of day-to-day Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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realities of the population. Tyler (2005) and other researchers found, ―parents reported communal-based, household socialization activities significantly more than individualistic, vervistic, or competitive activities‖ (p. 302). The study illustrated a complexity of multiple cultural messages found throughout the socialization patters of low-income AfricanAmericans. What remained consistent were the cultural themes shared from conversation, behaviors, and values. However, there were changing dynamics such as the presence of more individualistic principles and tendencies demonstrated by African-Americans to adjust to the mainstream culture (Figure 4). This cultural group resides in a mountainous and densely populated (>7,000,000 people) area with the lowest per capita income in the Western hemisphere. Most of the cultural groups‘ descendants were brought to this country of origin by French colonists. With overpopulation, high unemployment rates (60%), accelerating inflation, high illiteracy rates (55%), victims of natural disasters, and little viable industrial infrastructure, the culture has extraordinary resilience. While many in this cultural group are poorly educated with marginal reading and writing skills, and speak their native language regardless of current location, they can be very future-oriented. Like many people in the United States, this cultural group also views upward mobility through their socioeconomic status, even though a vast majority would be considered in the poverty range based on United States criteria. There is a small middle class and miniscule wealthy class, but little interaction occurs between these levels. Around 80% of this group is Catholic and many of these believe in some extent in Voodoo. As religions continue to infiltrate the country of origin, some have converted to Protestant faiths. Regardless, religion tends to play an integral role in the life of the individual especially during illness or other crisis. Additionally, religion may be seen as akin to magic. For some in the culture, illness may be attributed to natural causes outside the body, such as cold, heat, winds, or humoral imbalance. Changes in eating, living, or other habits may also influence health and illness. Illness may be seen as punishment from God, especially when a person‘s relationship with God is weakened and thus one‘s body also is weakened. Their beliefs about health and illness may also be strongly influenced by life in that country where few people have access to the most basic healthcare (clean water, immunizations, prenatal/obstetric care, antibiotics, etc.). Therefore, a reliance on folk and/or spiritual explanations and treatments for illness may simply be the only option one has. Traditional means of health promotion and disease prevention include: maintaining equilibrium between ―hot‖ and ―cold‖ factors, including ―hot‖ and ―cold‖ or ―light‖ and ―heavy‖ foods help prevent illness, enemas may be given to children for the purpose of cleansing the inner body of impurities, and herbal teas/massages are used to treat illnesses in the early stages (Colin and Paperwalla, 1996). This culture is __________________________. Source: htpp://www.scribd.com. Figure 4. Name that Culture. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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EDUCATION

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Educational Patterns of African Americans Historically in the United States, African Americans have been victims of slavery, discrimination, racism, segregation, and other forms of social injustices and inequities. African Americans have experienced many forms of institutionalized racism and the institute of education has been no exception but the rule. Johnson (2006) states that ―educational institutes and educators have been amongst the most active and effective instruments in the oppression for African-Americans‖ (p. 192). African American children were not allowed access in all-white schools due to legalized segregation and this was based on interpretations of the Constitution. As long as the separate facilities were ―equal,‖ the all-white schools were not obligated to allow African American students access. Access to inclusion in all-white schools was not the only form of educational segregation. In 1899, the case of Cumming v. Richmond (GA) County Board of Education, an injunction was issued that allowed the school board to spend tax money on a white high school at the same time they voted to shut down an African American high school for financial reasons (United States Courts [US Courts]). There have been many other historical cases regarding educational racism across all levels of academia. George McLaurin was an African American admitted to the doctoral program at the University of Oklahoma. Although he was admitted, he was not allowed to sit with the White students in the classroom or in the cafeteria. Changing segregation in the school systems eventually led to the Civil Rights movement and Brown v. Board of Education (Figure 5). Coupled with the educational disadvantages many African American children face in school is the cultural conflicts that arise between teacher and pupil. When a teacher fails to understand or acknowledge the cultural basis of student‘s classroom behavior a cultural conflict or cultural misrepresentation of the student‘s behavior is almost certain to emerge. As a result, teachers are then more inclined to believe the student is an appropriate candidate for special education in order to remedy what is being seen as ―inappropriate‖ behavior for white, middle-class standards. More interesting to note, when African American students have experienced a level of discrimination at early age or in elementary school from teachers, the likely he/she will have lower grades in school as they advance to higher grades. This level of discrimination in the educational system perpetuates a level of inferiority and challenge to teach African American students. ―Undeservingly, this label of difficult-to-teach is often given to students whose classroom behavior, although consistent with cultural norms, is viewed through the eyes of a teacher as disruptive and counterproductive‖ (Siwatu and Polydore, 2010). Suggesting that traditional instructional and classroom management approaches are out of touch and ineffective when addressing academic concerns of diverse students such as African Americans. Whereas, if a teacher/administrator/school presents a culturally responsive education, including teachers and curriculum, that seeks to utilize the cultural practices students bring into the classroom that may influence classroom behavior such as collaborative practices and animated conversing. The further developing of an understanding of the cultural context of classroom behavior may potentially minimize many forms of cultural mistrust and cultural conflict.

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The African American Perspective to Cross-Cultural Interaction … Reverend/Dr. Martin Luther King Jr. Martin Luther King, Jr., was born Michael Luther King Jr. on January 15, 1929, but later changed is name to Martin. While Dr. King attended segregated, public schools in Georgia, he graduated at the age of 15 and enrolled in Morehouse College where he received a BA in … After three years of theological study at Crozer Theological Seminary in Pennsylvania where he was elected president of a predominantly white senior class, he was awarded the B.D. in 1951. With a fellowship won at Crozer, he enrolled in graduate studies at Boston University, completing his residence for the doctorate in 1953 and receiving the degree in 1955. In Boston he met and married Coretta Scott, a young woman of uncommon intellectual and artistic attainments. Two sons and two daughters were born into the family. In 1954, Martin Luther King became pastor of the Dexter Avenue Baptist Church in Montgomery, Alabama. Always a strong worker for civil rights for members of his race, King was, by this time, a member of the executive committee of the National Association for the Advancement of Colored People, the leading organization of its kind in the nation. He was ready, then, early in December, 1955, to accept the leadership of the first great Negro nonviolent demonstration of contemporary times in the United States, the bus boycott described by Gunnar Jahn in his presentation speech in honor of the laureate. The boycott lasted 382 days. On December 21, 1956, after the Supreme Court of the United States had declared unconstitutional the laws requiring segregation on buses, Negroes and whites rode the buses as equals. During these days of boycott, King was arrested, his home was bombed, he was subjected to personal abuse, but at the same time he emerged as a Negro leader of the first rank. In 1957 he was elected president of the Southern Christian Leadership Conference, an organization formed to provide new leadership for the now burgeoning civil rights movement. The ideals for this organization he took from Christianity; its operational techniques from Gandhi. In the eleven-year period between 1957 and 1968, King traveled over six million miles and spoke over twenty-five hundred times, appearing wherever there was injustice, protest, and action; and meanwhile he wrote five books as well as numerous articles. In these years, he led a massive protest in Birmingham, Alabama, that caught the attention of the entire world, providing what he called a coalition of conscience. and inspiring his "Letter from a Birmingham Jail", a manifesto of the Negro revolution; he planned the drives in Alabama for the registration of Negroes as voters; he directed the peaceful march on Washington, D.C., of 250,000 people to whom he delivered his address, "l Have a Dream", he conferred with President John F. Kennedy and campaigned for President Lyndon B. Johnson; he was arrested upwards of twenty times and assaulted at least four times; he was awarded five honorary degrees; was named Man of the Year by Time magazine in 1963; and became not only the symbolic leader of American blacks but also a world figure. At the age of thirty-five, Martin Luther King, Jr., was the youngest man to have received the Nobel Peace Prize. When notified of his selection, he announced that he would turn over the prize money of $54,123 to the furtherance of the civil rights movement. On the evening of April 4, 1968, while standing on the balcony of his motel room in Memphis, Tennessee, where he was to lead a protest march in sympathy with striking garbage workers of that city, he was assassinated.

Source: http://www.wikipedia.com. Figure 5. Cultural Icon. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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Pre-Service Teachers For many pre-service teachers, understanding the inextricable relationship between culture and classroom behavior is a daunting task, as many pre-service programs fail to do an adequate job in preparing future teachers. Further, the lack of understanding of these variables in the learning process may influence whether teachers implement culturally responsive interventions to resolve cultural conflict in the classroom. Siwatu and Polydore (2010) found that a majority of pre-service teachers believed that culturally responsive interventions were necessary, but failed in understanding how to be applicable and invested in the designing. The pre-service teachers felt that engaging African American students in culturally responsive teaching, classroom management, and relevant experiential learning was outside of their repertoire of skills. However, pre-service teachers need to be abreast of these approaches prior to commencing student learning. While African American students may have been afforded the opportunity to attend schools with White students, their intellectual ability was consistently perceived as inferior. More specifically, the perception was that African Americans were intellectually inferior to Whites (Franklin, 2007). In attempt to measure a person‘s level of intelligence, the tests were designed to capture abilities that were suspected to be innate and related to an individual‘s capacity to learn. Historically, social scientists that have conducted research contributing to the Journal of Negro Education have tried to clarify what intelligence tests measure and have attempted to demonstrate that the tests were culturally biased in favor of white, middle-class children (Franklin, 2007). Due to the cultural insensitivity, African American children tended to due more poorly on these tests and as a result were considered innately intellectually inferior. Franklin (2007) argues that ―tests norm-referenced on white children are invalid when determining innate or predicative ability in African American children as a result of cultural bias‖ (p. 217). We need to keep in mind that many children who are identified as ―disabled‖ and in need of specially designed instruction are done so with the results of intelligence testing as a primary factor in making that decision. Researchers have suggested that there are many variables, including socio-environmental and socio-cultural factors that lead to the discrepancies noted between the performance of African American and White children on standardized tests of intelligence. Also, items that are on the tests may mean different things in different cultures which could also result in invalid results (ibid, 2007). The potential for low or invalid results as a product of assessment items that are subjective to multiple interpretations is relatively high. Therefore, the language that is commonly used amongst members of specific cultural groups should be considered when assessing, educating, and planning interventions for members of that group. This consideration should be given to African Americans who speak what has been termed as African American English (AAE). AAE is considered improper Standard American English but is commonly used in both spoken and written language among some African American individuals. Pittman and Ikard (2010) conducted a study on 10th grade African American students who were from a predominantly African American community and attended a school whose population was 60% African American. The purpose of their study was to identify the lack of a dialectic shift between spoken and written language; in other words, they wanted to determine if the children wrote in the manner that they spoke. While they identified four primary features of AAE that typically occurred in spoken and written language, they suggested that this was the place to begin when developing interventions. Research has also

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suggested that teachers and speech and language pathologist who are familiar with the vernacular of AAE will be in a position to help students become more effective with their transition from spoken to written language that is more consistent with standard written English (Pittman and Ikard, 2010). The research of Pittman and Ikard also describes a model to help teachers more accurately assess the written performance of students who speak and write in AAE. Considering that culturally insensitive assessments could produce invalid results, it could be expected that interventions that are produced from those results may be ineffective. Gaining an understanding of the cultural background of African American individuals would lead to more effective interventions in educational settings. Parette, Huer, and Wyatt (2002) suggest that recognizing cultural differences and how they affect assessment and interventions for African American children is a requirement for practitioners. The argument provided by Parette, et.al. is that evaluators need to have some level of knowledge about the culture and values of African American children when they attempt to assess them and provide them services. Another concept that the research suggested is the perception of practitioners by African American people and how that may have an effect on their ability to successfully work with a family. Practitioners need to understand how their communication style and the interventions that they recommend will affect the families level of stress, social stigmas they may be afraid of, and mistrusts that may be perceived by the families (ibid, 2002).

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Special Education The disproportionate number of African American children in special education has been well documented and is considered by many to be pipeline to prison (Artiles, Harry, Reschly, and Chin, 2002; Klinger et al., 2005). As a number of African American males who have been classified with Specific Learning Disability (SLD) fives time more likely to have been incarcerated. The primary reason is low employment rates due to minimal education. There is a negative correlation, the lower or less education the higher the likelihood for jail sentencing or high crime rate. However, an important question to ask is what are the policies and/or procedures that allow for a higher number of African American students to receive special education services? ―With a critical eye focused on what happens in the classroom, researchers contend that African American students are often taught by teachers who do not understand the cultural context of classroom behavior and the role of culture in the teaching and learning process‖ (Siwatu and Polydore, 2010, p. 458). One of the scientific methods scholars have used to support the inferiority of African American children and placement in Special Education services is intelligent tests. The use of intelligence tests has been questioned by many African Americans and others, especially as to the validity of the measurements (Chapman, 1988). More so, many pointed out that initial test such as the Army test scores reflected social and educational training rather than the ―innate‖ intellectual abilities of those tested (Franklin, 2007). As a result, African American children‘s performance on mental tests was more likely due to inferior education. Many noted African Americans, such as Pechstein and Bond, have felt that educational integration of African Americans and Whites accomplished less for African Americans and in fact, may have weakened expectations and the curriculum. While measures such as Williams‘ (1978)

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infamous Black Intelligence Test of Cultural Homogeneity (BITCH) measure attempted to acknowledge culture-specific information usually accessible by African Americans, it never was widely adopted or extremely popular beyond the ethnic group as an appropriate standardized measure. But Sternberg (2007) may have stated it best, ―our explicit theories of intelligence…fail to do justice to people‘s implicit theories of intelligence‖ (p. 152). This further proliferates the concern over the construct of intelligence. The issue of special education and the identification of a disabled student tend to be a difficult process for many parents. While some parents are very receptive to receiving information that their child may have a disability that impacts their ability to perform in the regular education curriculum without specialized supports, others are not. Some researchers have attempted to understand some of the underlying variables of the African American parent‘s involvement in special education. A study conducted by Harry, Allen and McLaughlin (1995) suggested that initially, efforts are made by African American families to support their children who are indentified as requiring special education. However, this support gives way to disappointment because of the lack of opportunity for parental involvement and the separation created by special education placements. The study was conducted over a period of three years and involved the parents of identified preschool children in a large urban school district. The involved families‘ incomes ranged from low to lower middle class. According to Harry, Allen and McLaughlin (1995), parents reported that their level of involvement decreased over the years for a variety of reasons including: classroom environments after preschool that were not warm or inviting, conflicts in the scheduling of meetings, receiving invitations to participate too late, and the feeling that parental involvement was not influential during meetings. While the perception may be that African American parents are not heavily involved in the educational process because of their limited knowledge or varying degrees of trust in the school, consideration should be given to perception of the families. Parents in the Harry et al. (1995) study were under the impression that their children were being placed in special education to catch up. However, they felt that their children were placed in classrooms that were not appropriate, that they were being isolated from other children, not having exposure to the same curriculum, and that they were not informed upfront about classifications and levels of services (1995). Considering the parents perceptions, we are lead to believe that the professionals need to do a more thorough job with communicating with the families in a manner that is more empowering. A study done by Kalyanpur and Rao (1991) found that professionals displayed both empowering and disempowering behaviors which included the focus on the child‘s deficits and the discounting of cultural differences. Professionals need to be more aware of their own behavior and how that may negatively affect the relationship between them and the families that they are intended to provide support. This is supported by the argument that Parette, et al. (2002) provided which suggests that practitioners need to have some level of knowledge of the African American culture when they are attempting to communicate with and provide services to children and their families. The pattern here in education seems to be a reoccurring theme of the need for improved communication between professionals and families, assessments and interventions that are sensitive to the African American culture, and the need to have some understanding of the African American culture. Also, the need to have some background knowledge about the historical experiences of African Americans with institutionalized racism and how that may affect the interpersonal relationship.

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Research efforts that examine the role of culture in educational achievement has yielded three core assumptions (Tyler, Boykin, Boelter, and Dillihunt, 2005). The first posits that public schools in the United States serve a cultural-homogenizing function that is validated through mainstream cultural values and behaviors (Gay, 2000; Hilliard, 2001). The second assumption is that learning is not relegated to just the classroom, but contextual variable that are only shared in the within cultural dialogue has been shunned by traditional public schools (Lee, Spencer, and Harpalani, 2003). Third, the introduction of learning styles and teaching modalities when coalesced with cultural themes can enhance academic performance (Foster, Lewis, and Onafowra, 2003; Tomes, 2010). These assumptions allow culture to have a more prominent role not only with ethnically-diverse students, but more importantly it offers a bridge into communities who may be hesitant of public educators and the educational process. Just as culture is socialized, so is education in the cultural realm. Socialization is the process ―by which people acquire the behaviors and beliefs of the social world or culture in which they live‖ (Tyler, 2005, p. 292). Ethnic socialization further transmits the cultural ancestral and family values to support…The transmission of these values can be done in one of two ways: deliberate socialization and enculturation. According to Levine (1969), explicit and intentional activities utilized by parents to socialize their children are deliberate socialization. These attempts may highlight aspects such as code-switching, when to speak standard American English versus as more comfortable lexicon. However, enculturation, the process of socialization that is carried through content and perspectives of cultural milieu typically showcases the everyday aspects of a student‘s life (Jagers, 1997).

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Education and Technology Technology consumption of African Americans has steadily increased over the past few decades, even when controlling for SES; yet, it remains lower than their white counterparts (Lenhart et al. 2003). In 2003, 45 percent of African American households had at least one computer, but this is 20 percent lower than white households. Later, in 2007, 45.3 percent of African American households had access to the internet via a home computer. However, as the digital divide (ownership of a computer) is moving to a new paradigm, ‗the second digital divide‘ or ‗digital inequality,‘ (ability to access the internet) focus pivots toward the differences in types of internet activities (Graham and Smith, 2011). Graham and Smith (2011) suggest there are four types of internet activities: gathering information, completing daily tasks, communication, and entertainment. While the lines are slightly blurry for AfricanAmerican youth, what has been commonly seen is that African-Americans with a postsecondary institution and under the age of 60 present a homogenous internet user group. More succinctly, African-Americans still lag behind European Americans in the digital divide and increased digital inequality; however, this homogenized group continues to embrace technological advances in different modalities at higher rates than their white counterparts.

Education and Communication John Dewey (1916) once said, humans ―live in a community in virtue of the things which they have in common; and communication is the way in which they come to possess things in

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common‖ (p. 4). The common element that is shared between Africa Americans families and other families is – Education. The miss-communication between African American families or other families, in particular White middle-class families, is – Education. Moreover, according to Brown and Beckett (2007), not only are middle-class White families more involved in schools than disadvantaged African American families, they are so in a variety of different aspects spreading their communication in order to set an educational agenda. When White middle-class parents are engaged in the classroom of urban schools, the agenda specifically focuses on what are the needs of the group at the expense of minimizing the under-privileged African American voices. Barriers to education can often be seen in the communication that crosses ethnic and socioeconomic lines erected on mutual defensiveness and cultural distrust between burgeoning numbers of White, middle-class teachers and increasing numbers of disadvantaged African American students and parents in urban or blighted school districts (Miretzky, 2004). So, where does the ―blame‖ of this mistrust and miss-communication lie, especially since the professional dynamics of who will be teaching students of different backgrounds does not appear to be changing much in the future? It is bidirectional depending on who is sharing their perspective. For many disadvantaged African American parents whose children populate urban school districts believe that teachers blame them for their children‘s poor academic performance and discipline problems and that their children‘s failure in school adversely reflects on the African American community (Spurgeon and Myers, 2007). Whereas, White, middle-class teachers (usually female), ―fear that parents hold them responsible for their students‘ failure, and that their inability to discipline and motivate disadvantaged Black students may reflect a deep-seated and unconscious racism‖ (Spurgeon and Myers, 2007, p. 9). In order to address this level of cultural mistrust and provide a positive and affirming educational environment for all, teachers and parents must be encouraged to work through existing barriers through meaningful communication. Further, research by Ladson-Billings and Tate (1995) point out that critical race theorists believe that disadvantaged African American students are not only overly represented in poor and under-funded schools, but also the schools tend to lack an expansive curriculum with extra-curricular options that are attractive for students and teachers. On surface level this may not appear to be worthy of mentioning, however, these types of schools produce fewer college students further widening the ethnic gap in post-secondary education. Also, subject area gaps and disruptive behaviors tend to increase in poorly-funded schools further creating a chasm between the ―have‖ and the ―have-nots‖ of education. Many times the schools mentioned above are located in predominantly African American communities with a depressed social and economic outlook with little aspirations of school advancement. This mentality becomes steeped in cultural soup that minimizes outside influence to do better and maximizes internal hegemony of ―this is where you are.‖ In order to wake up these troubled, predominantly African American schools multiple strategies must be employed. Paralleling the gap between poor and wealthy schools in achievement is that of parent involvement in these types of schools. Vaden-Kiernan, McManus, and Chapman (2005), examined parents and the level of school involvement based upon socio-economic status. Their results concluded that few parents with high school education or less and fewer parents living below the poverty line attend any type of school function and are less likely to volunteer. However, this study should also be viewed contextually. Many parents of African American students in under-funded schools work on an hourly or wage basis, limiting his/her freedom to attend meetings and functions for the fear of

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losing money or worse, being fired. Yet, this phenomenon is not relegated to the United States, in England, different levels and kinds of parent involvement in education generally reflect the different roles schools play in the lives of lower, middle, and high-class families (Crozier, 2000). Yet, more can be revealed within the cultural context of family lives. For some working-class parents, school may be perceived as work is to the average adult. Meaning, work is something that you have to do to survive but you leave it behind once the day is finished. If this is the culture of the student, he/she may not connect not only with the school, but the value that it is important for later life success. In order for the mentality to change, the cultural context of the environment has to be receptive to a paradigm shift supported by all. The paradigm shift has to involve expectations that extend beyond the ―here and now‖ of the student, but having them engage in ―tomorrow and beyond‖ thought process. Even still, this gap is crucial in understanding how to engage parents in becoming more actively involved in his/her child‘s life through supporting school efforts.

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COMMUNICATION At the core of all interpersonal interactions lies communication. The ability to communicate effectively and respectively with others is a skill that all humans need to develop. It is important to have an understanding of the communication style of African Americans as difficulties with building communicative relationships may stem from a history of mistrust for others who are perceived as outsiders. Learning styles, the willingness to learn, and seeking and accepting help from professionals can all be dependent upon the communication style of the interactive partner. Another effective barrier breaker is the use of cultural brokering. While commonly used with immigrant families, relatively new to a home culture, it can also be used with caste-like or involuntary minorities which compromises African Americans. Cultural brokering is the process of a professional increasing using cultural and academic/social knowledge or research and skills to negotiate with a person of different origin for a beneficial and effective outcome. While cultural brokers can serve many roles and functions, the primary responsibility is to assist the one in greatest need by engaging multiple entities with the cultural community. The National Center for Cultural Competence (2004) lists the following roles of cultural brokers:        

assess and understand their own cultural identities and value systems; recognize the values that guide and mold attitudes and behaviors; understand a community‘s traditional health beliefs, values, and practices and changes that occur through acculturation; communicate in a cross-cultural context; interpret and/or translate information; advocate with and on behalf of children, youth, and families; negotiate health, mental health, and other service delivery systems; mediate and manage conflict

These tenets help to facilitate an open dialogue with and between African Americans and others in the community. (Figure 6) Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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In 1967 U.S. Supreme Court case, Loving v. Virginia challenged and eventually overthrew anti-miscegenation laws. In 1958, Mildred Jeter, a black, Native American woman, married Richard Loving, a white man. They were arrested in 1959 for violating Virginia‘s marriage ban on white and non-whites intermarrying and were forced to leave Virginia. The United States is not the only country to address miscegenation laws. Discrimination against miscegenation mostly followed the mainstream Nazi antiSemitism, which considered the Jews to be a group of people bound by close, so-called genetic (blood) ties to form a unit which one could neither join nor secede from. The influence of Jews had been declared to have detrimental impact on Germany, in order to rectify the discriminations and persecutions of Jews. To be spared, one had to prove one's affiliation with the group of the Aryan race. Although Nazi doctrine stressed the importance of physiognomy and genes in determining race, in practice race was determined only through the religions followed by each individual's ancestors. Individuals were considered non-Aryan (i.e. Jewish) if at least three of four of their grandparents had been enrolled as members of a Jewish congregation; it did not matter if those grandparents had been born to a Jewish family or had converted to Judaism in adulthood. The actual religious beliefs of the individual himself or herself were also immaterial, as was the individual's status under Halachic law. An anti-miscegenation law was enacted by the National Socialist government in September 1935 as part of the Nuremberg Law. With the defeat of Nazi Germany in 1945 the laws banning mixed marriages were lifted again. If couples, who lived together already during the Nazi era, however unmarried due to the legal restrictions, married after the war, their date of marriage had been legally retroactively backdated, if they wished so, to the date they formed a couple. South Africa‘s Prohibition of Mixed Marriage Act passed in 1949 under Apartheid forbade marriages between whites and non-whites. The Population Registration Act (No. 30) of 1950 provided the basis for separating the population of South Africa into different races. Under the terms of this act, all residents of South Africa were to be classified as white, coloured, or native (later called Bantu) people. Indians were included under the category "Asian" in 1959. Also in 1950, the Immorality Act was passed, which criminalized all sexual relations between whites and non-whites. The Immorality Act of 1950 extended an earlier ban on sexual relations between whites and blacks (the Immorality Act [No. 5] of 1927) to a ban on sexual relations between whites and any non-whites. Both Acts were repealed in 1985. Where do you stand? Source: http://www.enotes.com. Figure 6. Cultural to Culture.

CONCLUSION African Americans have and continue to endure a lot within the United States. The residual effects of slavery are still present in 2013. The mere fact that African American struggle with self-identity is just one aspect of the conceptualization of self. Further, these events of trauma spill over into healthcare and education impacting both their physical and mental development. The common thread across identity, health, and education is the ability of African American to communicate effectively which promotes healing (Figure 7).

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  

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The residual effects of slavery has lasting psychological ramifications on the daily functions of many African Americans That racial identity within the African American culture evolves through different aspects but community and religion consistently remains at the forefront for many Educational patterns of African American children are varied from both their cognitive and learning styles Many perceive special education as a ―pipeline to prison‖ Racial socialization messages are not commonly used in African American communities

Figure 7. I‘ve Learned… .

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REFERENCES Artiles, A.J., Harry, B., Reschly, D.J., and Chinn, P.C. (2002). Overidentification of students of color in special education. Multicultural Perspective, 4, 3-10. Brown, L.H. and Beckett, K.S. (2007). Building community in an urban school district: A case study of African American educational leadership. The School Community Journal, 17(1), 7-32. Byrnes, R. (1996), Legislative implementation of apartheid South Africa: A country study, Washington: GPO for the Library of Congress. Chapman, P.D. (1988). School as sorters: Lewis Terman, applied psychology, and the intelligence movement, 1890-1930. Mahwah, NJ: Erlbaum. Colin, J.M. and Paperwalla, G. (1996). Haitians. In J.G. Lipson, S.L. Dibble, and P.A. Minarik (Eds.), Culture and nursing care: A pocket guide (pp. 139-154). San Francisco: UCSF Nursing Press. Cross, W.E. (1971). The Negro-to-Black conversion experience: Toward a psychology of Black liberation. Black World, 20, 13-27. Crozier, G. (1999). Is it a case of ―We know when we‘re not wanted?‖ The parents‘ perspective on parent-teacher roles and relationships. Educational Research, 41(3), 315328. Davis, J.E. and Jordan, W.J. (1994). The effects of school context, structure, and experiences on African American males in middle and high school. The Journal of Negro Education, 63, 570-587. Davis, R.N., Caldwell, C.H., Clark, S.J., Davis, M. (2009). Depressive symptoms in nonresident African American fathers and involvement with their sons. Pediatrics, 124, 6, p.1611-1618. Dewey, J. (1916). Democracy and education: An introduction to the philosophy of education. New York: The Free Press. Eiser, A., Ellis, G. (2007). Cultural competence and the African American experiences with health care: The case for specific content in cross-cultural education. Academic Medicine, 82, 2, p.176-183.

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Foster, M., Lewis, J., and Onafowora, L. (2003). Anthropology, culture and research pm teaching and learning: Appling what we have learned to improve practice. Teachers College Record, 105(2), 261-277. Franklin, V.P (2007). The tests are written for dogs: The journal of Negro education, African American children and the intelligence test movement in historical perspective. The Journal of Negro Education 76, 3, p.216-224. Gay, G. (2000). Culturally responsive teaching. New York: Teachers College Press. Graham, R. and Smith, D.T. (2011). Dividing lines: An empirical examination of technology uses and internet activity among African-Americans. Information, Communication and Society, 13(6), 892-908. Hilliard, A. (2001). ―Race, identity, hegemony, and education: What do we need to know now? In W. Watkins, J. Lewis, and V. Chou (Eds.), Race and education. Boston, Allyn and Bacon. Ikard, R.H., Pittman, R.T. (2002). Examining the writing of adolescent African American English speakers: Suggestions for assessment and intervention. Topics in Language Disorders 30, 3, p.189-204. Jagers, R.J. (1997). Afrocultural integrity and the social development of African-American children: Some conceptual, empirical, and practical considerations. Journal of Prevention and Intervention in the Community, 16, 7-34. Jenkins, A.H. (1995). Turning corners: The psychology of African Americans. Boston: Allyn and Bacon. Johnson, P.D. (2006). Counseling African-American men: A contextualized humanistic perspective. Counseling and Values, 50, p.187-196. Jones, J.M. (2003). TRIOS: a psychological theory of the African legacy in American culture. Journal of Social Issues, 59, 217-242. Klinger, J.K., Artiles, A.J., Kozleski, E., Harry, B., Zion, S., Tate, W. et al. (2005). Addressing the disproportionate representation of culturally and linguistically diverse students in special education through culturally responsive educational systems. Educational Policy Analysis Archives, 13, 1-40. Kjoro-Ljungberg, M., Bussing, R., Williamson, P., Wilder, J., Mills, T. (2008). AfricanAmerican teenagers‘ stories of attention deficit/hyperactivity disorder. The Journal of Child and Family Studies, 17, p. 467-485. Ladson-Billings, G. and Tate, W.F. (1995). Toward a critical race theory of education. Teachers College Record, 97(1), 47-68. Lee, C.D., Spencer, M.B., and Harpalani, V. (2003). ―Every shut eye ain‘t sleep‖: Studying how people live culturally. Educational Researcher, 32(5), 6-13. Lenhart, A., Horrigan, J., Rainie, L., Allen, K., Boyce, A., Madden, M. and O‘Grady, E. (2003). ‗The ever-shifting internet population: a new look at internet access and the digital divide‘, the Pew Internet and American Life Project, April 16 [Online]. Retrieved April 8, 2012, from http://www.pewinternet.org. Levine, R.A. (1969). Culture, personality and socialization: An evoluntionary view. In D. Goslin (Ed.), Handbook of socialization theory and research. Beverly Hills, CA: Sage. Mays, V.M., Cochran, S.D., Barnes, N.W. ( 2007). Race, race-based discrimination, and health outcomes among African Americans. Annual Review of Psychology, 58, p.201225. Retrieved September 27, 2011 from http://www.annualreviews.org.

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Miretzky. D. (2004). The communication requirements of democratic schools: Parent teacher perspectives on their relationships. Teachers College Record 106(4), 814-851. Murry, V.M., Brody, G.H., Simons, R.L., Cutrona, C.E., and Gibbons, F.X. (2008). Disentangling ethnicity and context as predictors of parenting with rural African American families. Applied Developmental Science, 12(4), 202-210. National Center for Cultural Competence. (2004). Cultural brokers help families and providers bridge the cultural divide. Retrieved April 7, 2012, from http:// www.ncc.georgetown.edu. National Center for Educational Statistics. (2010). The condition of education. Washington, DC: US Department of Education. Retrieved March 18, 2012, from http://nces.ed.gov. Neblett, E.W., Chavous, T.M., Nguyen, H.X., and Sellers, R.M. (2009). ―Say it loud-I‘m black and I‘m proud‖: Parents‘ messages about race, racial discrimination, and academic achievement in African American boys. The Journal of Negro Education, 78(3), 246-363. Nobel Prize. (2012). Martin Luther King, Jr. – Bibliography. Retrieved on May 5, 2012 from http://www.Nobelprize.org. Parette, P., Huer, M.B., Wyatt, T. (2002). Young African American children with disabilities and augmentative and alternative communication issues. Early Childhood Education Journal, 29, 3, p.201-207. Pillay, Y. (2005). Racial identity as a predictor of psychological health of African American students at predominantly White university. Journal of Black Psychology, 31, 46-66. Siwatu, K.O. and Polydore, C.L. (2010). Resolving a cultural conflict in the classroom: An exploration of preservice teachers‘ perceptions of effective interventions. The Journal of Negro Education, 79(4), 458-472. Spurgeon, S.L. and Myers, J.E. (2010). African American males: Relationships among racial identity, college type, and wellness. Journal of Black Studies, 40(4), 527-543. Tomes, Y. (2010). Cultural considerations in educational training: A look at multicultural learning modules. In J. Warnick, K. Warnick, and A. Laffoon (Eds.), Educational policy and practice: The good, the bad and the pseudoscience. New York: Nova Science Publishers, Inc. Tyler, K.M., Boydkin, A.W., Boelter, C.M., and Dillihunt, M.L. (2005). Examining mainstream and Afro-cultural value socialization in African American households. Journal of Black Psychology, 31(3), 291-311. United States Courts (n.d.). History of Brown V Board of Education. Retrieved October 25, 2011 from http://www.uscourts.gov/EducationalResources/ ConstitutionResources/ LegalLandmarks/HistoryOfBrownVBoardOfEducation.aspx. Vaden-Kierman, N., McManus, J. and Chapman, C. (2005). Parent and family involvement in education: 2002-03 (NCES-2005-043). U.S. Department of Education, National Center for Education Statistics. Washington, DC: U.S. Government Printing Office. Vargas, M.P. and Kuhl, P.E. (2008). Bridging the communication gap between Afro-Latino and African American individuals. Journal of Hispanic Higher Education, 7(4), 336-345. Williams, R.L. (1978). The testing game. In R.L. Jones (Ed.), Black Psychology (2nd ed., pp. 186-195). New York: Harper and Row.

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Chapter 5

THE ASIAN AMERICAN PERSPECTIVE TO CROSSCULTURAL INTERACTION AND UNDERSTANDING ―And people are always saying he‘s deceptively quick, deceptively athletic, and I don't know if that's just because I'm Asian or what it is, but obviously there's going to be stereotypes that you have to fight.‖ Jeremy Lin

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ABSTRACT Like most ethnic groups in the United States, Asian Americans have endured a decorated past from American concentration camps to vibrant communities. Understanding their success in continuing to grow, develop, and prosper requires a thoroughly knowledge of cultural nuisances that sustain cultural heritage. Asian Americans place a high value on identity and feeling connected to what it means to be Asian, first, and American, second. For many, the choice to keep their language, dress, and food is not really a choice but an expectation. This chapter highlights how identity and acculturation are linked together in defining crucial aspects of Asian American development. Further, expectations of Asian Americans in the school and education systems are discussed as well as to how best serve needs that may be less valued in the majority culture. Finally, traditional aspects to healing are offered and why mental health continues to be seen as shameful is shared.

INTRODUCTION Asian Americans, by many American standards are perceived as the ideal minority group. Asian children ―perform‖ well in schools, parents are well-engaged and family is taken care of by all. As the number of Asian Americans rise they are contributing to the increased diversity in the United States. Geographically, Asian Americans were heavily concentrated in western states such as California and Hawaii, however, migration patterns to the east coast really began in the late 80s and continues today (Min, 2006). The changing locations of the Asian American expands the network of ideas and placement of values, but it also forces different levels of acculturation on family members, possibly impacting identity, education, communication, and health patterns.

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Yuma Iannotti Tomes An unintended conversation between a Chinese mother and a European American mother ensued recently in the neighborhood. Here is some of the conversation:  Chinese mother: Lin (daughter), I expect nothing less than an ―A.‖ I could care less that you made an ―A-― on your paper. You have to do better next time. Let‘s begin to prepare now.  European American mother to Chinese mother: Wow, I think an A- is good for a 5th grader. Do you think you may be placing too many expectations on your daughter too soon? She hasn‘t even hit puberty, yet.  Chinese mother to European American mother: I expect nothing but perfection from my daughter. That‘s the problem with a lot of American parents, you expect mediocrity from your children. In China, we hold our children to high standards and drive this home everyday.  European American mother to Chinese mother: Well I equally expect my children to be successful, but I do it in a manner that allows my daughter to explore who she is instead of demanding her to do it a particular way.  Chinese mother to European American mother: No, demand for our children. That is the problem with American parents, you are too soft when raising your children. Call me a Tiger Mom if you want, but my child will be successful.

Figure 1. Cultural Clip.

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While many Asian Americans may attempt to hold on to strong traditional values, the further they migrate from their ―source‖ and settle, the greater the need to feel comfortable in their environment.

ASIAN AMERICAN IDENTITY The United States is continually identified as being a land of immigrants, meaning that many ethnicities and races make up the culture of this country. It is not uncommon for an American to identify with more than one ethnicity (i.e., bi or multi-ethnic). Society tends to identify the Asian culture as a homogenous group, lumping them into one category. However, the Asian culture is a very heterogeneous group made up of several ethnicities that many people are not aware of or do not consider Asian. The term Asian American represents many groups such as Chinese, Japanese, Filipinos, Koreans, Vietnamese, Laotians, Cambodians, Asian Indians, native Hawaiians, Samoans, Tongans, Fijians, and Chamorro (Fong and Mokuau, 1994). The Asian American culture is the second fastest growing ethnic groups (Mandarin speakers) in the United States; according to Chae and Foley (2010) it is anticipated that the Asian American population will reach up to 40 million by the year 2050. This distinction of groups in the Asian American culture is not well known in literature concerning health services such as social work. Fong and Mokuau (1994) conducted a survey of social work journals related to the direct practice with Asian Americans and Pacific Islanders. They attributed this lack of literature to the misconception that Asian Americans are the ―model minority,‖ not in need of government and social services. Two hundred and thirty

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articles were reviewed in the process, with only 22 noting direct practice themes with Asian American and Pacific Islander populations, 13 of the articles discussed Asian and Pacific Islanders as a collective, non specific ethnic group, which reflects the tendency to see Asian and Pacific Islanders as a single population (Fong and Mokuau, 1994). This study showed there is still a need to distinguish between Asian Americans and Pacific Islanders, separate Asian Americans into separate groups, and acknowledged that Asian Americans and Pacific Islanders and more group oriented than self oriented (Fong and Mokuau, 1994). This helps to shift the focus of using direct practice techniques that involve community based interventions rather than individual interventions.

Ethnic Identity

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The way a person describes himself or herself has a lot to do with their ethnicity and culture. One‘s ethnic identity is a way of feeling part of a group that is like them. Lien, Conway and Wong (2003) conducted a study of how individuals of Asian descent identify themselves in ethnic terms, and the reasoning for their choices. A survey was conducted of individuals of Asian descent who resided in five major metropolitan areas in 2000-2001. Lien et al. 2003, suggests that we come to our individual ethnic identity through a multifaceted process in society. Not only does it come from our ethnic background, but is also influenced by domestic racial and social conditions, transnational events, community organization efforts, U.S. immigration, and racial categorization policies (Lien et al. 2003). All of these factors and others can affect the outcome of how an Asian American comes to the conclusion of identifying themselves. Asians and Asian Americans What is the true relationship between Asians and Asian Americans? First, ―Oriental‖ is rarely used anymore – it has been replaced with term ‗Asian,‘ which designates anyone from East, South, Southeast, or Central Asia. Asian Americans are Americans of Asian descent. The term ‗Asian American‘ was coined in the 1960s along with the creation of Ethnic Studies as a field and the emergence of the Asian American movement. The term suggests that these groups share certain things, including both cultural patterns and particular histories in the U.S. Self-identification as an ‗Asian American‘ is a matter of personal choice. The following terminology denotes the generational understanding immigrants:    

First generation: the generation that emigrated from Asia to the U.S. Second generation: the American-born children of the first-generation immigrants Third generation: the children of the second generation 1.5 generation: someone born in Asia who emigrated to the U.S. as a child or young adult.

Figure 2. Culture to Culture.

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Two thirds of those surveyed identified themselves in ethnic specific terms. Meaning an individual would choose to identify themselves as Chinese American rather than Asian American. One in six of those respondents preferred to be identified as ―Asian American‖ and was accepting of this term. Lien et al. (2003) attributed these findings to primordial ties, prior socialization, culture, social, and political integration. It was concluded that ethnic identity is malleable and dependent on context (Figure 2).

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Identity and Acculturation The process of identifying oneself as American may be due to acculturation. During this process an individual immerses themselves in a culture that is not their own, and begins to identify or pick up the traits of another culture. In today‘s society Asian American children and adolescents tend to be more acculturated compared to their parents. This may be due to the fact that their parents are immigrants and still practice traditional Asian values. Another factor is language, younger Asian Americans who have grown up in the United States may speak little or none of their ethnic language. This may cause a lack of communication between their parents who only speak little English, and cause younger Asian Americans to identify themselves more with the American culture rather than their ethnic country. Further, those of the acculturated generation had to be sensitive to the elders of the community, suggesting that if they are not, they are considered disrespectful. Devos (2006) used the Implicit Association Test (IAT) to examine strength of identification with both American culture and culture of origin among Mexican and Asian American college students. It was hypothesized that Mexican American and Asian American college students would strongly identify with the concept ―American culture‖ when it is contrasted to cultural icons that are not personally relevant (Devos, 2006). It was also predicted that individuals would also display a strong attachment to their culture of origin (Devos, 2006). The study was broken into two separate groups, first comparing Mexican American students and European American college students, and the second comparing Asian American and European American college students. The sample included 51 Asian American students from both first and second and third generation immigrants. A pretest was conducted to select icons representing the concepts ―American culture,‖ ―Asian culture,‖ and ―other culture.‖ Based on these ratings, three sets of seven stimuli were categorized as unambiguous, American culture, or Asian culture. Data indicated that Asian American participants strongly identified with both American and Asian cultures. Devos (2006) concluded that results of the study were highly consistent, participants were able to identify with both cultures, and displayed a pronounced association between self and culture of origin. These findings provide evidence that acculturation may lead younger Asian Americans to be able to identify with both their Asian and American culture. Due to this acculturation young Asian Americans may feel more individualized, rather than collectivist in American society. There have been a number of studies examining the relationship of ethnic identity, acculturation, and psychological well being of Asian Americans, but few studies have looked at these constructs all together (Chae and Foley, 2010). This is due to several limitations such as lack of recruiting participants and the use of these terms interchangeably although they all have different meanings. Chae and Foley (2010) studied the relationship of ethnic identity, acculturation, and psychological functioning among 334 Chinese, Japanese, and Korean

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American participants. These participants were recruited from Asian churches and cultural organizations throughout the United States and their ages ranged from 17 to 55. The Multigroup Ethnic Identity Measure (MEIM) was used to asses ethnic identity, acculturation was measured using the Suinn-Lew Asian Self Identity Acculturation Scale (SL-ASIA). A high score on the SL-ASIA indicates Western identity or high acculturation and a low score indicates Asian identity, or low acculturation. The Depression Happiness Scale (D-H S) was also presented to measure positive and negative emotional states. Packets containing a demographic questionnaire and the measurement instruments and were instructed to complete them. Results of the study showed that ethnic identity and acculturation were associated with psychological well-being, which is consistent with a number of previous studies (Chae and Foley, 2010). Among the Chinese participants, ethnic identity was found to be a strong predictor of psychological well-being, however the Chinese participants were from a Chinese church that strongly embraces their Chinese identity, culture, and heritage (Chae and Foley, 2010). This significant relationship between ethnic identity and psychological well-being may be linked to the family and community settlements of the Chinese (Chae and Foley, 2010). This may be due to the population rise of Chinese in the United States. It is possible that it is easier for the Chinese to establish their own community and feel closer to others of Chinese descent. The positive relationship between ethnic identity and psychological well-being also holds true for the Korean American participants. Chae and Foley (2010) did find a contrast between the Chinese American and Korean American participants due to the fact that Korean ethnic communities are not as well established in the United States as compared to the Chinese Americans. Similarly ethnic identity was a significant predictor of psychological well-being with the Japanese American participants (Chae and Foley, 2010). Those individuals who reported a bicultural acculturation status reported the highest scores on the measure of psychological well-being, this suggests that individuals in this type of bicultural orientation, reported the fewest clinical symptoms and most satisfaction in their lives (Chae and Foley, 2010) (Figure 3).  

20 item test with responses in a Likert Scale format 14 items that assess three aspects of ethnic identity: positive attitude and a sense of belonging towards one‘s group, ethnic Multigroup Ethnic Identity behaviors, and practices and a committed ethnic identity Measure (MEIM)  Measures attitudes toward ethnic groups other than own  Most frequently used measure for assessing Asian ethnic identity  High scores=high acculturation (more Westernized) Suinn-Lew Asian Self Middle scores=bicultural identity Identity Acculturation Scale  Consists of 21 Likert type questions about language, identity, (SL-ASIA) friendship choice, generation/geographic history, and attitudes  25 item self report of positive and negative affective states Depression Happiness Scale  12 items that measure positive indexes of well being (D-H-S)  13 items that measure negative thoughts and feelings * Adapted from Chae and Foley (2010). Figure 3. Measures Used In Examining Relationship of Ethnic Identity, Acculturation, and Psychological Well Being.

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Implications for practice would suggest that when working with East Asian clients, a more successful outcome may be obtained if the counselor has a working knowledge of the different immigration experiences, history of the group‘s experience of institutional and cultural racism, as well as cultural values, traditions, and practices of Chinese, Japanese, and Korean Americans Chae and Chae, 2010 as cited in Chae and Foley, 2010). This recommendation for future counseling practices is helpful in the area of both mental health and education. The knowledge of how a particular culture identifies themselves in critical in many different fields of study today. The Asian American culture is made up of several ethnicities and it is important to be aware of their differences. Most likely, younger Asian Americans can relate to both their Asian and American descent, increasing their psychological well-being. This awareness of cultural identity is vital when working in the health care field today, especially counseling, where the knowledge of a client‘s culture may have direct effects on their psychological health and well being.

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COMMUNICATION STYLES OF ASIAN AMERICANS Communication among Asian Americans tends to differ when compared to Western cultures. Many factors can be attributed to this difference in communication style. Gudydunst (2001) as cited in Park and Kim (2008) found that European Americans report they are more dramatic, open, and precise than Asian Americans, who tend to report they are more indirect. European Americans communication styles are described as low context, while Asian Americans can be described as high context. Gudydunst (2001) describe high context communication styles as being indirect, inferring meaning, interpersonal sensitivity, using feelings to guide behavior, and using silence, while low context styles are described as dominant, animated, relaxed, attentive, open, and friendly. High context communication may be contributed to the belief of Confucianism (Kim and Park, 2008). Confucianism is a widespread belief throughout Asia, which includes the purpose of maintaining harmony within relationships. Pekerti and Thomas (2003) discussed Asian‘s beliefs in maintaining harmony and attributing this to their sociocentric communication styles or orienting towards one‘s social group. Suggesting that Asian American communication style may be heavily link to their Confucianism beliefs is a strong correlate with identity. Examining Asian Americans and their communication interactions with individuals, parents, and teachers intra and inter-culturally suggest some varied interaction patterns. The results of several studies imply that Asian Americans tend to stick to their high context styles of communication, although this style can be altered due to acculturation. Acculturation can be defined as the cognitive and behavioral changes that occur as a result of close contact between different cultures, specifically the adoption of the language and values of the dominant group (Berry, 1990, 1997 as cited in Rhee, Chang, and Rhee 2003). Meaning, these communication styles can be altered when an individual is heavily exposed to a culture different from their own. Therefore an Asian American adolescent may not necessarily develop high context communication styles if they grow up in the United States, as compared to their Asian immigrant parents. While easily adapting low context is not easy for Asian Americans, they are likely to do a fair amount context-communication switching. Meaning as

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they speak in their native tongue with family and friends, they can easily transition to communicating in low context with others.

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Communication Interaction Verbal communication may vary throughout different regions and cultures. For example, in the United States verbal communication is expected to be explicit and unambiguous, in contrast other cultures such as Indonesia and more implicit and ambiguous (Gallois and Cakan, 1997 as cited in Pekerti and Thomas, 2003). Understand the communication style of a particular culture is vital in knowing intercultural communication in business, educational, and personal interactions. Pekerti and Thomas (2003) studied East Asian and Anglo European (Pakeha) participants at a large New Zealand university, in which they completed a consensus decision-making task that required communication with another participant. This task involved a consensus ranking of crimes in their severity, first individually and then in agreement with their partner. To verify cultural groups, each participant completed the Cultural Perspective Questionnaire Version 4 (CPQ4), experiments were videotaped to observe the interactions. Results of the study indicated cultural differences in communication styles through both frequency and intensity of behavior for both cultures (Pekerti and Thomas, 2003). The Pakeha showed an idiocentric communication style, they tended to be more expressive, dominant, aggressive, opinionated, argumentative, initiated action, and attempted more eye contact, demonstrating a low context communication style (Pekerti and Thomas, 2003). In contrast, Asians demonstrated a more sociocentric communication style, exhibiting high context communication traits such as being more accommodative, avoiding arguments, and were more inclined to shift their opinion (Pekerti and Thomas, 2003). These results indicated that participants were more inclined to rely on the dominant behavior styles as opposed to adapting to the styles of their counterpart (Pekerti and Thomas, 2003). Overall, it was concluded that Asians had a propensity to exhibit higher intensities of sociocentric communication behaviors, consistent with fitting into the environment and ―maintaining harmony‖ (Pekerti and Thomas, 2003). Pekerti and Thomas (2003) stated it was clear that interacting with a member of a different culture enhanced individuals‘ dominant communication styles. As a result, when acculturation is taken into consideration, a person may exhibit communication styles similar to their ethnic background, rather than take on the styles of their counterpart remaining true to their ethnicity. As previously noted, Asian Americans communicate differently from other cultural groups based on how they utilize context as a source of information in communication (Park and Kim, 2008). Communication styles can be defined as the way one verbally, nonverbally, and paraverbally interacts to signal how literal meaning should be taken, interpreted, filtered, or understood (Norton, 1983 as cited in Park and Kim 2008). It has been noted that Asian cultures tend to follow the high context communication style, while European cultures tend to follow a low context communication style. These communication styles studied by Park and Kim (2008) examined the relationships between Asian and European cultural values and communication styles among college students. Students completed several surveys regarding demographics, values, and communication. An analysis of the data revealed a higher adherence to emotional self control and lower adherence to European American values which can be attributed to Asian Americans‘ higher use of indirect communication, while higher

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emotional self control explained why Asian Americans use a less open communication style as compared to European Americans (Park and Kim, 2008). It was also found that collectivism was positively related to interpersonal sensitivity style (Park and Kim, 2008). Further, collectivism helps to support the socialization of high context communication style. When the group is forced transmit verbalizations in the same manner without regard to outside sources, the group imposes a strong emic perspective. Similar to Pekerti and Thomas (2003) this study gives further evidence to the principle of high and low context communication styles. It can be further presumed that Asian American communication styles differ from American communication styles, but context of the situation is a factor that may lead to change. A circumstance that may change these communication styles may be interaction in the home. Communication with parents may be strained due to language barriers or acculturation developments of the Asian American child.

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Parental Interaction Rhee et al. (2003) studied the level of acculturation, openness in communication with parents, peers, and self-esteem in Asian and Caucasian American adolescents in the same neighborhood. Rhee et al. (2003) stated that ethnic minority adolescents with immigrant backgrounds tend to face psychosocial issues and have a more difficult time making adjustments. There are significant differences among Asian groups, although many of them share relatively common values, beliefs, and parenting styles that originated from the principles of Confucianism (Rhee et al., 2003). A sample of Asian Americans and Caucasian students at a Los Angeles high school was used to survey data on demographics, self esteem, acculturation, and communication among parents. In general, results indicated Asian adolescents expressed more difficulty discussing problems with their parents compared to Caucasian adolescents (Rhee et al., 2003). Asian students reported they had a tendency to be more careful about what they say to their parents and also indicated more communication problems with their fathers, when compared to their Caucasian peers (Rhee et al., 2003). When further investigating Asian students‘ relationships with their fathers, most indicated that their fathers tend to nag and insult them, and that they are sometimes afraid of asking for what they want (Rhee et al., 2003). Furthermore, Rhee et al. (2003) found that Asian students strongly disagreed with the statement that their fathers are always good listeners. Rhee et al. (2003) attributed this to the suggestion that Asian students had more difficulty communicating with their fathers than their mothers, as expected. These results have a relation to the Asian beliefs of Confucianism. Parents who want to maintain harmony in the household may avoid conflict, thus making it harder for adolescents to communicate with their parents. However, with a contemporary view, some Asian children face similar challenges with mothers, especially ―Tiger mom‖ become heavily discussed societies. Many immigrant parents tend to speak and maintain their fluent language, rather than become fluent in English, compared to their native born children. Boutakidis, Chao, and Rodriguez (2011) examined the loss of native or parental language among adolescents from immigrant families, and the consequences of their relationships with their family. A survey of ninth grade Chinese and Korean adolescents from immigrant families was conducted on native and English language fluency, parental respect, and quality of communication (Boutakidis et al., 2011).

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His Holiness the 14th Dalai Lama, Tenzin Gyatso, is both the head of state and the spiritual leader of Tibet. He was born on 6 July 1935, to a farming family, in a small hamlet located in Taktser, Amdo, northeastern Tibet. At the age of two the child, who was named Lhamo Dhondup at that time was recognized as the reincarnation of the 13th Dalai Lama, Thubten Gyatso. The Dalai Lamas are believed to be manifestations of Avalokiteshvara or Chenrezig, the Bodhisattva of Compassion and patron saint of Tibet. Bodhisattvas are enlightened beings who have postponed their own nirvana and chosen to take rebirth in order to serve humanity. His Holiness began his monastic education at the age of six. The curriculum consisted of five major and five minor subjects. The major subjects were logic, Tibetan art and culture, Sanskrit, medicine, and Buddhist philosophy which was further divided into a further five categories: Prajnaparimita, the perfection of wisdom; Madhyamika, the philosophy of the middle Way; Vinaya, the canon of monastic discipline; Abidharma, metaphysics; and Pramana, logic and epistemology. The five minor subjects were poetry, music and drama, astrology, motre and phrasing, and synonyms. At 23 he sat for his final examination in the Jokhang Temple, Lhasa, during the annual Monlam (prayer) Festival in 1959. He passed with honors and was awarded the Geshe Lharampa degree, the highestlevel degree equivalent to a doctorate of Buddhist philosophy. Leadership Responsibilities In 1950 His Holiness was called upon to assume full political power after China's invasion of Tibet in 1949. In 1954, he went to Beijing for peace talks with Mao Zedong and other Chinese leaders, including Deng Xiaoping and Chou Enlai. But finally, in 1959, with the brutal suppression of the Tibetan national uprising in Lhasa by Chinese troops, His Holiness was forced to escape into exile. Since then he has been living in Dharamsala, northern India, the seat of the Tibetan political administration in exile. Since the Chinese invasion, His Holiness has appealed to the United Nations on the question of Tibet. The General Assembly adopted three resolutions on Tibet in 1959, 1961 and 1965. His Holiness the Dalai Lama is a man of peace. In 1989 he was awarded the Nobel Peace Prize for his non-violent struggle for the liberation of Tibet. He has consistently advocated policies of nonviolence, even in the face of extreme aggression. He also became the first Nobel Laureate to be recognized for his concern for global environmental problems. His Holiness has traveled to more than 62 countries spanning 6 continents. He has met with presidents, prime ministers and crowned rulers of major nations. He has held dialogues with the heads of different religions and many well-known scientists. Since 1959 His Holiness has received over 84 awards, honorary doctorates, prizes, etc., in recognition of his message of peace, non-violence, inter-religious understanding, universal responsibility and compassion. His Holiness has also authored more than 72 books. His Holiness describes himself as a simple Buddhist monk.

Source: http://www.dalailama.com. Figure 4. Cultural Icon. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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It was found that native fluency is significantly and positively correlated with quality of communication with fathers but not with mothers, also quality of communication with both mothers and fathers was significantly positively correlated with respect for mother and father (Boutakidis et al., 2011). These results indicated there is a language gap between first and second-generation adolescents and their parents within these East Asian groups (Boutakidis et al., 2011). However, Boutakidis et al. (2011) suggested the gain in fluency in English comes at the expense of losing parental native language. This loss then compromises the quality of communication with parents, diminish their understanding of the culture, and ultimately decrease the respect adolescents may hold for their parents (Boutakidis et al., 2011). A compromise to the quality of communication between Asian American parents and children can lead to many negative outcomes in the parent-child relationship. Future communication efforts may become compromised which can also lead to psychological and esteem issues (Figure 4).

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ACCULTURATION AND IDENTITY Identity development within the Asian American culture is different to grasp on the surface value due to cultural expectations. For instance, shame and guilt are two prominent areas. In comparison to Caucasians, Asians self-esteem was significantly lower implying a need for provisions to mental health services (Rhee et al., 2003). However, those Asian students who reported communicating with their parents and being more acculturated to US customs/values also had a higher level of self-esteem (Rhee et al., 2003). Asian students who had lesser siblings also gained a higher score in self-esteem (Rhee et al., 2003). It can be inferred that from these findings that children who are more acculturated have a higher positive attitude, also those students who have less siblings may have higher self-esteem due to lack of competition in the household. Asian families place high values on education making it somewhat easier for an Asian student with fewer siblings to do better in school and demonstrate a more positive attitude due to this lack of competition and seeking parental approval. As previously noted, parent-adolescent communication may be altered due to acculturation in Asian American families. Chung et al. (2007) examined whether acculturation is associated with parent-adolescent communication about sex in FilipinoAmerican families. According to Chung et al. (2007) Filipino-Americans in the United States have more adolescent pregnancies and HIV infections than other Asian Pacific Islanders (API). It is unknown whether parent-adolescent communication is affected by acculturation, and high quality parent-adolescent communication about sex has been associated with healthy sexual development (Chung et al., 2007). A survey of 120 pairs of Filipino-American parents and adolescents at were selected to participate answering a questionnaire. Adolescents were asked about their frequency of parent-adolescent communication about sex, adolescent acculturation was measured by disagreement with traditional Asian values and preferential use of English (Chung et al., 2007). Twenty two percent of adolescents reported regularly discussing sex with their parents, 72 percent of agrees with traditional Asian values, and 63 percent preferred using English (Chung et al., 2007). Additionally, it was found that both parents and adolescents agreed that greater acculturation created relationship strains and hampered parent-adolescent communication (Chung et al., 2007). It was concluded that

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acculturation may influence Filipino-American parent-adolescent communication about sex and sexual health (Chung et al., 2007). These findings may indicate that there is a need for sexual health programs to be adaptable to other cultures and forms of acculturation. A system that is tailored to the community may decrease the risk for sexually transmitted diseases and increase adolescents‘ knowledge in the health risks involved. The lack of a system already being in place may simply due to being unaware of the severity as compared to other cultures. Chung et al. (2007) noted the findings of the study do not necessarily apply to all immigrants, however it does play an important role in public health and clinical implications.

EDUCATION Teacher/Consultant Interaction

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Tarver Behring, Cabello, Kushida and Murguia (2000) studied the use of current consultation approaches and modifications among European Americans, African Americans, Asian Americans, and Latino consultants in student interviews, where students were either from the same or different cultural background. The modification that was most reported with teachers of non European American students‘ was helping the teacher with the cultural differences of the class (Tarver Behring et al., 2000). European and non European American consultants with Asian American children and families used a directive approach, showed respect for privacy, used a more formalized relationship with the family, showed respect for stigma of mental health services, and understood the parent‘s high value placed on education (Tarver Behring et al., 2000) (Figure 5).  Find a consultant that speaks the language  Be respectful to the roles of the  mother and father in the home  Allow more time to move through  consultation stages 

Use a directive/expert approach

Use formal interaction styles Respect Asian Customs

       

Lack of communication from parents may be due to language barriers Contacting parents in their native language makes them feel comfortable and more accepting of the situation When visiting the home respect the cultural styles and family roles Language and communication barriers may lead to a lack of understanding Extra time may be needed to explain the consultation process The steps in the process should be expressed in the parents native language Do not emphasize child‘s deficits Explain services needed while understanding high values on educational success Respect stigma for mental health services Avoid asking personal questions Develop a formal relationship with the family Respect privacy At the end of the case a customary gift of gratitude may be given This is a wish as a restitution for a favor

*Adapted fromTarver Behring, S., Cabello, B., Kushida, D., and Murguia, A. (2000). Figure 5. Performing a Consultation of an Asian American family. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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This modification style enhanced the communication among parents, consultants, and students to improve their relationship. Tarver Behring et al. (2000) noted a case involving a Chinese American consultant visiting the home of a Chinese mother whose son was intellectually delayed due to head trauma. The student was in need of a special education evaluation, but there was no response from the parents. A consultant, who spoke Mandarin, conducted several home visits, which gave the parents more time to learn about the consultation stages. The consultant also showed respect for family roles, and used a more expert approach when explaining the services their child needed. However, the consultant did not emphasize the child‘s deficits, to avoid shame, did not ask personal questions, and accepted a gift of gratitude from the family at the end of the case, which is a custom of Asian families to establish restitution for a favor (Tarver Behring et al., 2000). At the end of the consultation, the student was placed in a special education class and successful. This is a strong indication that modifications to communication styles are necessary when consulting with other different cultures. There is a great need to be specifically aware of students‘ cultural backgrounds in order to establish good rapport between the families involved. Levy, Wubbels, Brekelmans, and Morganfield (1997) sought to identify the ways in which culture relates to students‘ perceptions of teachers, and to provide possible interpretations for these perceptions. Levy et al. (1997), believed that a teacher‘s interpersonal actions, in which they maintain a positive classroom atmosphere is vital to the quality of teaching. Student perceptions of teacher communication were analyzed by surveying high school students of mixed ethnicities through questionnaires and interviews. Results showed that students‘ cultural background is significantly related to their perceptions of teacher behavior (Levy et al., 1997). In addition, interviews with teachers indicated that teachers behave differently in class depending upon the cultural composition, and do not appear to be aware of the ways they are perceived by students (Levy et al., 1997). Similarly, the interpersonal relationships of teacher and student ethnic background were studied by den Brok, Levy, Rodriguez, and Wubbels (2002). Perceptions of Asian American and Hispanic American teachers and their students in culturally diverse high schools were again studied through the use of interviews and questionnaires. Results showed teachers had more favorable perceptions of their own behavior than their students (den Brok et al., 2002). Student and ethnic background had a significant impact on students‘ perceptions of their teacher, and data from interviews provided evidence that studies of concepts related to the cultural dimensions of communication are helpful in explaining the relationship between ethnic background and perceptions of students and teachers. These dimensions of communication may include respect from students, closeness, and identification of students with their teachers. In concert with each other, teachers‘ high expectations of their students, especially of Asian descent help to motivate students to achieve. Yet, the achievement of students yielded higher self-esteem and self-efficacy. Students do better because they have high expectations to meet. The reverse has been stated regarding Latinos and African Americans. In regards, to Asian teachers, they revealed a low perception for leadership and a high perception for uncertainty of cultural implications (den Brok et al., 2002). While being interviewed, some Asian teachers revealed they like to be in control because they are supposed to be the source of all classroom knowledge, and this is why they prefer the lecture approach while others discussed being humble as a person, in reference to the

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collectivism/individualism dimension (den Brok et al., 2002). Asian and Hispanic teachers also indicated that students showed more respect when they are from the same ethnic background (den Brok et al., 2002) attributed this to the power distance dimension, because the student feels they have a better understanding of what they are going through and will treat them with more dignity. More importantly, the teacher will have best interest of the student. This was the same argument for many African American parents post-Civil Rights. They felt Black teachers offered the best support systems for their children. Oftentimes, the teachers lived in the communities and therefore had a variety of connections with the students prior to enrolling in school. Also, parents were more likely to trust the decision making of the teachers. Again, contextual variable dictate cultural elements. The results of Levy et al. (1997) and den Brok et al. (2002) revealed similar trends in Asian students‘ and teachers‘ perceptions of one another. These can be attributed to the ideas of a collectivist society, as well as the Asian cultures high standards on education. The literature describes the communication styles of the Asian American culture in today‘s society. Overall, the general understanding of Asian American interaction with others is that they tend to be more introverted compared to their European American counterparts. This is most closely linked to strong beliefs in Confucianism. Maintaining harmony and peace in relationships is what leads Asian Americans to have a higher context communication style. Asian Americans style of communication is not negative, but it is important to know the meaning behind their soft demeanor so it is not taken as offensive. Asian American adolescents tend to have somewhat difficult relationships with their immigrant parents. Lack of communication due to language barriers and sociocentric beliefs may create difficulty during adolescent life. Acculturation tends to clash with parental upbringing; therefore, it is important for teachers and other school consultants to have knowledge of Asian beliefs and communication styles when dealing with adolescent issues such as sexual health, self esteem, and social upbringing. Education is also impacted by contrasting communication styles between Asian Americans and European Americans. Asian Americans hold a high regard for education, therefore if a student is not performing well Asian families may feel it is shameful to their family. It is key for consultants to take the time to explain the needs of the child to the family, and respect their values by interpreting things in a way that will help the family and not make them feel shameful and disrespected. Communication styles tend to be slightly altered when adolescents are acculturated. Barriers in communication still exist between parents and children when acculturation is involved. This needs to be taken into account when dealing with health care and mental health treatment of Asian American adolescents. They may feel like they are unable to speak with their parents on issues that are considered taboo in their society such as sex, therefore these children may need another communication outlet to express these emotions or questions. Overall, the communication styles of Asian Americans are closely related to their beliefs in Confucianism. Asian immigrants have continued these traditional beliefs in their stay in the United States. The collectivist society traditions of Asian Americans are largely what keeps them from changing their style of communicating. The knowledge of beliefs of other cultures is important in today‘s society. The United States is made up of several different cultures which is what makes us unique. Therefore it is important to be aware of others‘ differences so we can all be respectful of one another.

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Expectations Asian Americans tend to have high expectations when it comes to education. Education is highly regarded, and an Asian child is expected to do well in school, as to not shame their family. Shame is a major deterrent for any type of misbehavior as it brings misfortune to the family. So, when I child does not perform at a high level in school or may present a learning disability, the family experiences additional attention from outsiders or ―others.‖ This cultural bias can be attributed to several reasons. One of which may be linked to socioeconomic status (SES). Ginsburg, Lin, Ness, and Seo (2003) examined the cultural and SES differences of four and five year old American and Chinese children‘s mathematical activity during free play. Ginsburg et al. (2003) proposed three questions: 1) Do Chinese and American children display the same types of everyday mathematical behavior in free play? 2) Do Chinese children exhibit a higher frequency or complexity of everyday mathematical behavior? 3) Do possible SES differences exist in frequency and complexity of mathematical activity? Sixty American children (30 lower SES and 30 middle SES) and 24 Chinese children (12 lower and 12 middle SES) participated in the study. American children were selected from four different daycare centers in New York City (Centers A, B, C, D). These centers differed as far as SES and ethnic background, but rooms held little differences as far as arrangement and materials for the children. Chinese children were selected from two different centers in Taipei (Center E and Center F). In order to capture spontaneous mathematical activity, children were observed and video-taped in their natural setting for 15 minutes (Ginsburg et al. 2003). A coding system was developed to capture key aspects of mathematical activity and context (Ginsburg et al. 2003). The six categories included Classification, magnitude, enumeration, dynamics, pattern and shape, and spatial relations. Context codes included location, play objects, social interaction, and play activity. These were intended to describe the environmental conditions associated with children‘s mathematical activity. Children‘s mathematical activities were observed on a minute-based scheme (Ginsburg et al. 2003). Each child‘s videotape was divided into 15 one-minute segments and was coded in terms of content and context. A pair of independent raters coded the American children, and a separate pair of coders rated the Chinese children. Results showed that all 24 Chinese children engaged in at least one mathematical activity during the 15-minute free play session. Fifty-three of the 60 American children engaged in at least one mathematical activity. Chinese middle SES children engaged in a slightly higher average activity compared to low SES Chinese children. However both Chinese SES groups exhibited far more frequent mathematical activity compared to American lower and middle SES children. Results of a 2 (culture) X 2 (SES) ANCOVA showed a significant main effect of culture but a lack of SES main effect or interaction effect of culture and SES (Ginsburg et al. 2003). Even though there was a significant cultural difference there were no differences in SES groups. It was determined that both American and Chinese children showed a significant amount of pattern and shape, magnitude, and enumeration. It was hypothesized that Chinese children engage in more mathematical activity due an Asian biological propensity to mathematical activity; however, this was not fully supported (Ginsburg et al. 2003). There are several plausible explanations, one of which may be due to the environment of Chinese preschools. Relatively few play objects were given to children with a majority of them being Legos and blocks. This may lead to more pattern and shape activity. As a result, Asian students may find this activity less challenging and personally under stimulating. Further, the use of

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characteristics instead of numerals may present cognitively different challenges. In contrast, American preschools had many objects for children to play with. This opportunity for different alternative activities may hinder an American child‘s opportunity to learn and lead them in another direction with many choices there may exist the ineffective ability to master a skill set is always a possibility (Figure 6). Ginsburg‘s (2003) study raises the question as the whether American children are being hindered in their learning environment due to the greater amounts of stimulating toys and activities they are given in the preschool setting compared to Chinese preschools. Preschool environments in America may need to provide more toys and activities that are geared toward learning rather than occupying their time. It should also be noted that SES did not play a major role in children‘s mathematical activity. This removes a label that may be associated with lower SES children, and their lack of intelligence and learning ability. Attitudes toward education and academics can differ among ethnicities when cultural group place value in education that promotes it differently than those that may view it as a ―privilege.‖ Knudson (1993) studied student attitudes toward writing in grades 4-8. A 19-item survey was administered to 1798 students throughout 10 schools in California.

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The 2011 Tohoku earthquake and tsunami ravaged the coast and inland of Japan. Japan was devastated by 8.9 magnitude earthquake unleashing 13 foot tsunami that swept boats, cars, buildings and tons of debris miles inland and prompting a "nuclear emergency.‖ This is the fourth largest earthquake in the world and the largest in Japan since instrumental recordings began in 1900. The earthquake generated the deadliest tsunami since the 2004 magnitude 9.1 Sumatra earthquake and tsunami caused nearly 230,000 deaths and $10 billion in damage. This is the most devastating earthquake to occur in Japan since the 1995 Kobe earthquake caused over 5,500 deaths and the deadliest tsunami since the 1993 Hokkaido earthquake generated a tsunami which was responsible for over 200 deaths.

Source: http://www.wikipedia.com. Figure 6. Where Were You on March 11, 2011? Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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The Knudson Writing Attitude Survey for Children was a 19-item survey consisting of questions that were to be answered on a Likert scale from ―Almost Always‖ (1 point) to ―Almost Never‖ (5 points). The student population consisted of 958 Anglo-Americans, 601 Hispanic, 136 African American, and 103 Asian totaling 920 boys and 878 girls. Results indicated no significant effect of ethnicity on total score, but there were significant main effects for grade and gender (Knudson 1993). Follow up tests showed older students had higher scores than younger ones, which suggests their attitudes are less positive (Knudson 1993). This suggests that writing is not viewed favorably but there are some reasons as to why: 1) critical thinking must accompany writing, 2) writing to synthesis material, 3) learning writing nuances, and 4) significant amount of writing assignments. Girls had lower scores than boys suggesting their attitudes toward writing are more positive. Patterns indicated African American and Asian students had higher (less positive) scores at each grade (Knudson 1993). There was also a lack of gender differences between these two ethnicities. Education also plays an important role in facilitating communication between generations. Lin, Suyemoto, and Kiang (2009) describe the influences on intergenerational communication within refugee families about socio-cultural trauma. Lin et al. (2009) suggests that education may positively affect this communication process. Qualitative research and theory based on a larger study concerning intergenerational effects about trauma in Cambodian-American refugee families was used to draw their conclusions. Similarly, this may be helpful in facilitating communication for others whose families experienced refugee trauma such as those who fled from Vietnam, Somalia, and Bosnia (Figure 7). Lin et al. (2009) stated that following a socio-cultural trauma such as genocide, silence is not only surrounding by the survivors but spreads to their families, communities, and larger society. Refugee survivors often resist talking about their experiences, even with their own children (Lin et al. 2009). Students who were refugees themselves and whom refugees raised typically have not communicated about the meaning of trauma in their family. Educators can facilitate this opportunity for their students by teaching them to understand more clearly that their family life contexts are relevant to their personal, intellectual, and professional growth (Lin et al. 2009). Speaking intensely about personal tragedy is discouraged by Cambodian and other Asian cultures which may minimize the struggle. In order to be respectfully but bridge emotional gaps educators may be given the opportunity to teach Asian American students about the struggles of their culture and bridge the emotional gap between Asian parents and their children. Educators can provide context and structures that enable students to concrete new meanings for what it is to be Cambodian and what it means to be a survivor (Lin et al. 2009). Lin et al. (2009) conducted interviews with several Cambodian American students, who expressed a positive psychosocial development and a strengthened bond between themselves and their families after taking an Asian American studies class and addressing the Cambodian genocide, along with other significant events in history. This open communication may lead to families seeking outside support to deal with their emotions, and it strengthens the bond between generations. The goal of Lin‘s article was to highlight ways that education is a catalyst to open communication within Asian American families affected by trauma. The reasoning behind the lack of communication is due in part to cultural ties and beliefs. However, educating children opens up the barriers of communication and helps those affected by tragedy.

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The home country of this cultural/ethnic group is landlocked by China, Vietnam, Cambodia, and Thailand. From its beginnings in the 6th century A.D., this country and it inhabitants have been ruled by competing kings and foreign powers until full independence was achieved in 1954. Survival more years of turmoil forced many refugees fleeing to neighboring countries and to the United States with many settling in California, Iowa, Minnesota, Texas, and Washington. This ethnic group tends to be a tightly knit community to greater extent of other refugees. In several of the states in the US, they in live traditional, mutually assisting social structures that support family values and practices. Religion Many individuals apart of this ethnic group practice Theravada Buddhism. While there are regional variations according to the area one originated from, the influence of Buddhism is extremely strong, so much so it is not uncommon to see a mix of Buddhism and Brahmanism practiced. In their practice, it may be common to see shrines: inside the home is reserved for the Buddhist shrine; outside may have a spirit house (Phi). The central canon remains what a person does in his/her life instead of what they believe. Additionally, there may be strong animism among this ethnic group. It is believed there are Four Noble Truths of this ethnic group‘s religion: To live is to suffer (dukkha) – all sentiments being suffer, The cause of suffering is desire, e.g., for happiness, for life, for permanence, for cessation of suffering, and so on, To cease to suffer, one must cease to desire Cessation of desire (enlightenment or nirvana) may occur by following the Eightfold Path of right thought, right resolve, right speech, right action, right livelihood, right effort, right mindfulness, and right concentration To follow this path to enlightenment, it is necessary to become and remain a member of the sangha. It is important to note, the Buddhist temples or Wats are not to worshipped, but the teachings should be followed. Healthcare Healthcare beliefs and practices are significantly related to Brahmanistic and animistic beliefs. An illness may be attributed to the loss of one of the thirty-two spirits thought to inhabit the body and maintain health. The loss of spirit may occur in a random fashion such as being startled while walking alone. As with other similar ethnic groups, ―winds‖ play a major role in health and illness and bringing the winds into balance restores health or well-being. Additionally, physical and mental wellness may be tied to one‘s ability to sleep and eat without difficulty. Usually it is viewed that only the poor or strict vegetarians consume large amounts of vegetables, otherwise, the wealth purchases beef to eat. Common barriers to healthcare are: language issues, cultural misunderstanding of problems, and transportation. There are a variety of healing practices for this ethnic group. Khout lom involves using coins and mentholated medicine to rub certain parts of the body in one direction to release the ―wind.‖ Pinching may be used to relieve a headache and cupping may be performed to further draw the wind from the body. Additionally, there are spiritual healing practices such as involvement of acharn or the wearing of a katha. In general, as with people of all cultures – health care providers should be aware that traditional practices and beliefs of this ethnic group are dynamic an changing. Regarding social issues with this ethnic group, respect remains at the forefront. Respect includes being polite and encompasses privacy for individuals and their families. When personal questions are asked, they should be prefaced with ―This is between you and me. I will not talk about this with anyone else.‖ Home and family is health the husband or oldest man, with elders of both sexes given respect. When visiting this ethnic group at home, shoes should be removed even if told ―never mind.‖ It is common to sit below the oldest person present. Effusiveness and expression of strong feelings is discouraged. Raving over children and complementing them is not good form. This culture is______________.

Source: http://www.scribd.com. Figure 7. Name That Culture. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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The following literature displays the importance of education in Asian society. Asian children show higher levels of mathematic activity during early childhood, however SES does not make a differences in either culture. Attitudes toward writing skills are slightly different among American and Asian American school children, although further research should be conducted to find more distinct results. Education can also be used to bridge the gap in communication in Asian American culture. Young Asian Americans can take what they have learned in the classroom about Asian history and help their family cope with tragic events that may have never been spoken about. The overall importance of education in Asian American society is very apparent today.

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CONCLUSION Asian Americans are truly a unique yet diverse ethnic group. Similar to Latinos, there is a variety of different ethnic and cultural groups under the Asian umbrella. As a result, there is no one shoe fits all formula to work with this population. Since the passing of the Immigration and Nationality Act of 1965, the Asian American population has seen a dramatic growth in number (Kim, Wong, and Maffini, 2010). With this growth emerges the transference of cultural ideology that includes areas such as: collectivism and filial piety. This transference normal occurs in aspects such as ethnic socialization; however, Asian American youth may who are born/raised in the United States may be swayed to part from some of their traditional roots (Park, Vo, Tsong, 2009). These Asian-value gaps may lead to forms of psychological distress, but cultural shame/guilt does not allow for much in flexibility of treatment. This is not only a conceptual consequence of the way in which all communications depend on context, but also in a more straightforward way in which communications between Asian Americans and healthcare providers or even educators bring to the fore issues of cultural belonging and understanding which are often hidden (Ali, Atkin, Neal, 2006). The overall role of culture has to be understood in the Asian American context in order to better assess the need and determine and appropriate outcome. Being reflective demonstrates a willingness to acknowledge of a variety of embedded cultural practices that provide necessary background to any cultural consultation (Figure 8).

    

The Asian Diaspora is made up of may ethnic groups beyond Japanese, Chinese, Korean, and Vietnamese Intense emotion is not favored across may Asian ethnic groups A lot of Asian culture use high context communication skills Shame and guilt are to be avoided at all times Asian students may not present an initial affinity to mathematical concepts as many have stereotyped

Figure 8. I‘ve learned… .

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REFERENCES Ali, N., Atkin, K., Neal, R. (2006). The role of culture in the general practice consultation process. Ethnicity and Health, 11, 389-408. Boutakidis, I. P., Chao, R. K., and Rodriguez, J. L. (2011). The role of adolescents' native language fluency on quality of communication and respect for parents in Chinese and Korean immigrant families. Asian American Journal of Psychology, 2(2), 128-139. doi:10.1037/a0023606 Chae, M. H., and Foley, P. F. (2010). Relationship of ethnic identity, acculturation, and psychological well-being among Chinese, Japanese, and Korean Americans. Journal of Counseling and Development, 88(4), 466-476. Chung, P. J., Travis, R. r., Kilpatrick, S. D., Elliott, M. N., Lui, C., Khandwala, S. B., and ... Schuster, M. A. (2007). Acculturation and parent-adolescent communication about sex in Filipino-American families: A community-based participatory research study. Journal of Adolescent Health, 40(6), 543-550. doi:10.1016/j.jadohealth.2007.01.004. den Brok, P. J., Levy, J., Rodriguez, R., and Wubbels, T. (2002). Perceptions of Asian American and Hispanic American teachers and their students on teacher interpersonal communication style. Teaching And Teacher Education, 18(4), 447-467. doi:10.1016/ S0742-051X(02)00009-4. Devos, T. (2006). Implicit bicultural identity among Mexican American and Asian American college students. Cultural Diversity and Ethnic Minority Psychology, 12, 381-402. Fong, R., and Mokuau, N. (1994). Not simply 'Asian Americans': Periodical literature review on Asians and Pacific Islanders. Social Work, 39(3), 298-305. Ginsburg, H. P., Lin, C., Ness, D., and Seo, K. (2003). Young American and Chinese Children's Everyday Mathematical Activity. Mathematical Thinking And Learning, 5(4), 235-258. doi:10.1207/S15327833MTL0504_01. Kim, B.S., Wong, J.W., Maffini, C.S. (2010). Annual review of Asian American psychology, 2009. Asian American Journal of Psychology, 1, 227-260. Knudson, R. E. (1993). Effects of ethnicity in attitudes toward writing. Psychological Reports, 72(1), 39-45. Lien, P., Margaret Conway, M. M., and Wong, J. (2003). The Contours and Sources of Ethnic Identity Choices Among Asian Americans. Social Science Quarterly, 84(2), 461-481. doi:10.1111/1540-6237.8402015. Levy, J., Wubbels, T., Brekelmans, M., and Morganfield, B. (1997). Language and cultural factors in students' perceptions of teacher communication style. International Journal of Intercultural Relations, 21(1), 29-56. doi:10.1016/S0147-1767(96)00005-3. Lin, N. J., Suyemoto, K. L., and Kiang, P. (2009). Education as catalyst for intergenerational refugee family communication about war and trauma. Communication Disorders Quarterly, 30(4), 195-207. doi:10.1177/1525740108329234. Min, P.G. (2006). Asian Americans: Contemporary trends and issues (2nd ed.). Thousand Oaks, CA: Pine Forge Press. Park, Y. S., and Kim, B. K. (2008). Asian and European American cultural values and communication styles among Asian American and European American college students. Cultural Diversity and Ethnic Minority Psychology, 14(1), 47-56. doi:10.1037/10999809.14.1.47.

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Park, Y.S., Vo, L.P., Tsong, Y. (2009). Family protection as a protective factor against the negative effects of perceived Asian value gaps on the parent-child relationship for Asian American male and female college students. Cultural Diversity and Ethnic Minority Psychology, 15, 18-26. Pekerti, A. A., and Thomas, D. C. (2003). Communication in intercultural interaction: An empirical investigation of idiocentric and sociocentric communication styles. Journal Of Cross-Cultural Psychology, 34(2), 139-154. doi:10.1177/0022022102250724. Rhee, S., Chang, J., and Rhee, J. (2003). Acculturation, Communication Patterns, and SelfEsteem Among Asian and Caucasian American Adolescents. Adolescence, 38(152), 749-768. Tarver Behring, S., Cabello, B., Kushida, D., and Murguia, A. (2000). Culturalmodifications to current school-based consultation approaches reported by culturally diverse beginning consultants. School Psychology Review, 29(3), 354-367.

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Chapter 6

THE LATINO/HISPANIC PERSPECTIVE TO CROSS-CULTURAL INTERACTION AND UNDERSTANDING ―A buen entendedor, pocas palabras bastan.‖ - Unknown (To someone with good understanding, only a few words are necessary)

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ABSTRACT The expansion of Spanish speakers into the United States and Canada has lead to a variety of identity crises for Latinos (Hispanics), Americans, and Canadians. As of 2010, Latinos/Hispanics accounted for 16 percent of the United States population, making it the second largest ethnic group (Wikipedia, 2012). With these changes in cultural and ethnic dynamics, come perspectives that challenge the known or traditional systems, more importantly awakening previous undisturbed feelings of what it means to be an American. Further complicated in the burgeoning growth, is the referencing or identification of Spanish speakers. This chapter offers a clear explanation as to what is the preferred term in identifying Spanish speakers and why this important for healthcare, communication, and educational practices. Closely married to the Latinos identity is the belief in familism and its importance to a healthy life. Further, the chapter introduces contextual variables in understanding Latinos/Hispanics and how the media communication serves to misrepresent cultural nuances that expand beyond just language barriers. Finally, the chapter introduces a less known term, Hispano/a, as they most encompassing ethnic identification.

INTRODUCTION To date, immigrants, documented and undocumented, remain a hotbed issue not only for the United States, but for many countries throughout the world. Maybe more so in the United States, the issue of immigration becomes heatly-contested as a political football allowing many politicians to do a fourth quarter fumble in an effort of achieving an appropriate pathway to citizenship.

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Mexican vs. Puerto Rican Both ethnic groups have their origins from Spain a result of Christopher Columbus' comissioned discovery of the New World. Spanish Conquistadores gained control of both formerly-called Borikén andMéxico-Tenochtitlan, which are presently known as Puerto Rico and Mexico. Puerto Rico's ethnic history is curiously a miniature scale of that of the United States mainland's, but not entirely. Europeans brought along African slaves to supplement the almost-extinct Taino Indian population. Their main goal was to excavate and take the island's gold back to Europe, which can be currently found in its lavish cathedrals. Eventual inter-marriages among the indigenous Tainos, Europeans and African slaves led to the very varied mixture of races that is commonly found on the island as well as in the United States. Therefore, there is no typical Puerto Rican per se. The people can range from blonde-haired, blue-eyed to mid-range colored skin, or to actual Black in color. Contrary to Puerto Rico, Mexico did not participate in the importation of African slaves into their ancestral origins. They did, however, have a group of indigenous people called the Aztec Indians, which intermingled with the European races. The majority of Mexicans have strong indigenous physical features such as straight hair, brown skin, and Asiatic eye shapes. For many years now, there have been feuds between Mexicans and Puerto Ricans. Much of it stems from a sense of right and entitlement that each group acclaims. There are resentments due to illegal immigration, crimes, gangs and collective prejudice from non-Latinos that assume both ethnicities are the same. When President Obama appointed Sonia Sotomayor, of Puerto Rican descent, for the United States Supreme Court, many Mexican-Americans were in an uproar as they felt it should have been one of their own so as to better understand the immigration issues of the country. Figure 1. Cultural Clip.

Casas (2009) believes such issues were heightened with the passages of federal laws, anti-immigration acts, and resolutions such as: the 1882 Chinese Exclusion Act, the 1965 Immigration Act, the ―on‖ and ―off‖ bracero acts, and California‘s Proposition 187 in 1994. Yet, there are other laws and ordinances that pre-dated these geared to involuntarily dehumanizing people that were taken from their native land and brought here such as African slaves. One such law was the ―3/5th‖ law in that slaves were count as a one-third human in order to minimize overpopulation, which initiates the conversation of immigration.

IDENTITY The Hispanic/Latino American population of the United States has been growing steadily over the last four decades and recent census statistics indicated that over 50 million Americans identify themselves as Hispanic or Latino, with a 43 percent growth from 2000 – 2010 (Casas, Vasquez, and Ruiz de Esparza, 2002; U.S. Census Bureau, 2010). This group of individuals represents a diverse mixture of individuals from various ethnicities, languages,

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and cultures who trace their origins to several nations. According to Casas (2010), ―Measured in raw numbers, the modern Latin-American dominated immigration wave is by far the largest in US history‖ (p. 2). This mentioned earlier, this number continues to exponentially grow as nearly 40 million immigrants from Latin American-dominated countries have come to the United States since 1965. (Figure 2) The prevalent trend of the last 10-12 years has been that the inflow of undocumented immigrants exceeded arrivals of legal permanent residents. However, Passel and Cohn (2008) note that the inflow of undocumented immigrants has slowed significantly since 2005 and now trails the pace of legal immigration. This decreased rate may be attributed to not only immigration laws in the U.S., but more potential immigrants tending to stay in their native land. Moreover, Hispanics/Latinos who are undocumented are trending to concentrate in places with existing large immigrant communities, increasingly such immigrants are settling throughout the rest of the county (Passel, 2005). Somewhat begrudgingly, as immigrants settle in non-traditional demographic pockets, the U.S. finds itself confronting new and complex social, cultural, ethnic, and political issues such as economic disparities and increased individuals unable to afford healthcare. As these issue become more complex and comprehensive while the United States population grows, the direct and indirect effects of immigration will continue to provoke visceral reactions from different populations. A Hispanic or Latino‘s identity rests on the notion that people from Latin American sharing a common history, language, and culture. Moreover, those common characteristics bind those who share them and distinguish them from those who do not. However, one of the most common criticisms of the idea of pan-ethnic identity is that it eliminates the diversity inherent in the populations it intends to represent. Latin America is a region of many languages (from native languages to Spanish), many cultures, and many religions. For some, a label that attempts to encompass this diversity only misrepresents its peoples‘ heterogeneity. Even a cursory understanding of Spanish colonial rule in the America‘s is important for navigating the strict an rigid aspects of the Spanish system, which involved racial, religious, and class hierarchies demarcated by social, economic, and political status. Thus, is it justified to use the culture of a system so characterized by inequality to represent individuals whose ancestors experienced it so differently? Moreover, doesn‘t utilizing the term ―Hispanic‖ justify and even glorify the Spanish conquest? While these criticisms are valid for several people, it only stokes the embers of a cultural and ethnic fire for others.

Undocumented

Documented

Country of Origin Mexico Latin America South/Southeast Asia Mexico Latin America Asia Western Europe Africa

Percentages 56 22 5 30 35 26 14 8

Figure 2. Most Documented/Undocumented Immigrant Populations. Percentages of Document and Undocumented Immigrants in the US. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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As a result, many have begun to embrace the term ―Hispano/a‖ as a label of pride in their Spanish cultural heritage and discounting any inappropriateness in the use of pan-ethnic terms (Baia, 2000). There is more to pan-ethnic identification than just perceived shared Spanish culture. From the table it can be gleaned that Pan-ethnic identity, as reported by Jones-Correa (1998) does not have a profound effect on how respondents perceive cultural commonalities. Therefore, the social constructionist view may offer the most useful explanation of Hispanic/Latino identity. (Table 1) The evolving and emerging identities of individuals who identify and/or describe themselves as Hispanic or Latino are the by-product of four coalesced areas: state promotion, transplanted identities, immigrant experiences, and the multi-context (Baia, 2000). Every immigrant to any foreign country brings with him/her a set of values, beliefs, traditions, languages, etc. which helps to define them according to state‘s categorization system. Further, the experiences of adapting to new environments are involved in the process of ongoing identity development and construction. This may further be demonstrated through how immigrants chose to assimilate, accept, reject, or distance themselves from either their country of origin or the current country. Inherent in this construction, is the belief that has Hispanics/Latinos are becoming ―more of something‖ they are also leaving ―something behind.‖ However, according to Baia (2000), for Hispanics/Latinos, ―adopting pan-ethnicity does not necessitate a denial or rejection of other identities, particularly national identities‖ (p. 10). Quite the contrary, Hispanic and/or Latino identity functions as one among multiple situationally-specific identities. Differing levels of identification and adoption of norms and values of the culture of ones ethnic group and the greater society may result in discrepancies how one acculturates. One group that may be particularly influenced by the impact of acculturation, especially within the United States of America, is Hispanic/Latino Americans. The U.S. Census Bureau (2010) defined persons of Hispanic origin as people who claim their ancestry as being Cuban, Mexican, Puerto Rican, Argentinean, Colombian, Dominican, Central American, or South American origin. For the purpose of this book, Latinos(as) will be defined by the aforementioned definition with the inclusion of other Spanish speaking countries. Additionally, Hispanic Americans have the birth rates in the country and currently are the largest ―minority‖ population, eclipsing African Americans two years ago. At the current pace, it is estimated that one out of each three children in a public school will be Hispanic within the next 10 years. This growth and expansive of the Hispanic population has forced the United States into uncharted waters as to how to respond. Table 1. Shared Culture and Self-Identification. 3 Categories of Shared Culture and Self-Identification

Survey Respondents Agree No Opinion Disagree Total N=214. Source: (Baia, 2000).

Self-Identification National Origin National Origin and Hispano or Latino 18/9% 14.6% 8.3% 41.7% 17.6% 5.9% 18.2% 15.4%

Hispano or Latino 66.5% 50% 76.5% 66.4%

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Familism

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In order to preserve the identity of future generations, many Hispanic/Latinos practice familism. Familism can be defined as a social pattern whereby individual interests, decisions, and actions are conditioned by a network of relatives thought in many ways to take priority over the individual (Steidel and Contreras, 2003). From 1511 to 1898 this cultural group‘s homeland was a Spanish colony populated largely by Spanish and black African slaves, even though slavery was abolished in 1886. Despite significant corruption and repression under the rules of some strong dictators in the countries early beginning, it managed to establish a relatively large middle and professional class. Communist changes in government and society led to shifts (but no lessening) in repression, increased literacy rates, changes in land ownership, and increased access to basic health care. It is difficult to characterize this culture as differences exist according to social class, background, ethnicity, and other factors. Although many immigrants and refugees of this culture are from urban backgrounds, significant numbers will have lived in the city for less than one generation, hence may have more rural than urban outlook on life. Through communication, conversations tend to be animated, fast, and may seem loud. Usually direct contact between family members is extremely warm and affectionate with genuine concern for each other. Direct eye contact is often made through all interactions. In general, men greet one another with a firm handshake and women often embrace. When expressing themselves to other outside of their ethnic group, they tend to be passionate and express themselves in a way that seems demanding to others. In relation to health, the culture believes that mind, body, and spirit are inextricably yoked. Health is viewed as a sense of well-being, freedom from discomfort, and a robust appearance, which may be seen as unhealthy in other cultures. Traditionally, it is not uncommon for this culture to understand moderate obesity indicative of good health and thinness equated to poor health. While biomedical or allopathic medical practices are widespread in the country of origin and germ theory is accepted and understood by many, traditional and other theories of illness causality are also incorporated in health beliefs and practices. Stress is thought to cause a variety of physical and mental health problems. Further, supernatural forces or a lack of balance are thought by some, especially the less educated to cause or contribute to physical and mental health problems. Overall life expectancy at birth for the period of 1990-1995 was 76.1 years vs. 75.4 years in the U.S. overall. Persons who are sick within this country and cultural group tend to take on a passive and dependent role. Self-care is poorly understood and often ―rejected.‖ A person perceived as providing medical/psychological assistance is revered and it is considered more of a directive than partnership role. Decision making, as it relates to health issues, usually include older and/or more respected family members. Discerning the truth about the country is difficult. The government‘s iron and repressive control over the lives of its people are still prevalent. This culture is _______________. Source: http://www.scribd.com. Figure 3. Name That Culture. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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Familism is an important component of Hispanic/Latino cultures and it serves as a protective factor with regard to making the decision to engage inappropriate behavior as it transmits important values. At the attitudinal level, Hispanic/Latino adults and adolescents value interdependence, as well as family support and obligations, more than Whites (Fuligni et al., 1999). At the behavioral level, Hispanics/Latinos report higher degrees of familial cohesion and intimacy than Whites and influence and assist family members in instrumental ways more so than Whites (Sarkisian et al., 2006). And at the structural level, Hispanics/Latinos live in larger and denser kinship networks than Whites which leads to a stronger family/community influences. Hispanic/Latino familism may help to mitigate the social influences involved in decision-making that may have negative consequences such as abusing alcohol, especially if seeking the advisement of family beforehand (Figure 3).

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COMMUNICATION Bridging the gaps intra-culturally is challenging but between different cultures it is nearly impossible without effective communication patterns. The question that remains then is, how do we learn to effectively communicate with those not of our own cultural or ethnic group? The first step toward becoming multiculturally-sensitive is developing a competent level of understanding. Latinos have, as any cultures will, particular ways of communicating. Each region (i.e., Mexico, Paraguay, Spain, etc.) may even have its own idiosyncrasies. Confusing the issue further are the stereotypes which emerge once that culture begins to mix with another. Not only is a lack of understanding of the Latino culture and language harmful when trying to carve out a cultural identity in the context of another dominant culture, but it can create barriers to acculturation, education, and obtaining healthcare. Stereotyping is inevitable. We use it to manage information and make inferences about subjects in which we have a gap in understanding or a lack of experience. The problem arises when we don‘t gain insight of our inaccurate perceptions or use these stereotypes to segregate or exclude.

School Communication and Expectation The consequences for refusing to find common ground can be dire. An unfortunate example of the ways ineffective communication can hinder progress was described in a case study by Williams and Garza (2006). They recount monthly meetings with the Dallas School Board, which is a heavily African-American and Hispanic-American district that had recently been riddled with scandal and corruption, creating especially high tension. They explain how the differences in communication techniques were received and responded to by both cultures. The Hispanic-Americans were, in general, very respectful even when criticizing a member of the board, and exhibited ―patriotism.‖ The African-Americans were significantly more passionate and animated and, as a result were either not taken seriously or not allowed to continue speaking. They describe how, in some cases, the meetings were not formally adjourned, but ended in chaos and the audience storming out. Assumedly, little was resolved because no equal or common ground could be found, and problems will persist with little assistance for the students (2006). For many Latinos, schools are considered strictly learning

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environments where their children are professionally attended to on a regular basis that includes minimal contact with the home. However, many African Americas perceive school as an extension of home, thereby, creating a different interactional patter with teachers. As a result, both groups care about what is happening to their children/community, it is done through different communication patterns. Further, if these differences are not acknowledged various cultural stereotypes may emerge impacting teachers‘ perceptions of students and their families. While stereotyping has the potential to be harmful in the overall population, it is infinitely more so when it occurs in schools. A lack of cultural understanding can be the barrier that prevents or inhibits a student from reaching their full potential in school. For example, Spanish-speaking or bilingual students may confront language myths in composition studies. In her examination of language attitudes, Kells (2002) describes this as a deficit theory. The seeming inability of these students to perform at the standard level is viewed either as an innate deficit or as a deficit in upbringing. She explains the language myths which permeate these classrooms, which include dialect misconception, English bias, language purity myth, literacy myth and misconception of oral performance. Another hindrance comes from the student when he/she responds to these myths, they have a lack of confidence in their language ability and thus it becomes a cycle.

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Communication Through Media The media is arguably the most important and potent vehicle for disbursing information. In many cases, information regarding the Latino culture is presented through the medium of television and news, which at times fails to due diligence in reflecting positive attributes about the culture.. Of course, the media, especially advertising, will generalize in order to appeal to the majority. However, many Latinos feel these attempts to reach them are grounded more in generalizations than in an effort to understand them and their beliefs, and that when an effort is made to show respect for their culture, public relations materials tend to be more affective. Perez (2002) examines how the atmosphere of public relations is changing. Latinos felt that there has been progress made in the direction of cultural understanding, but feel the U.S. has far to go. Some of the strategies for reaching the Hispanic culture were to become familiar with the audience and their culture, use accurate language especially in translation, and do not assume that knowing ethnicity is the same as understanding cultural literacy. Of particular importance is the news media, due to the assumed legitimacy of the information. When people watch the news or read a newspaper, they believe it to be researched and proven. However, there are many examples of how the news has been biased and promoted stereotypes of its own. When Elian Gonzalez came to America in 2000, his mother drowned during the journey, and he was placed with relatives in the U.S. The media played out the controversy almost constantly, portraying the mother as a woman with the American dream who was repressed in her own country. When Elian was ordered to be returned to his Cuban father, many in the country had strong, polarized opinions of the decision with limited information given by the media. Another example of how the media plays a role in the portrayal of Latinos is explained by Correa (2010). Correa (2010) specifically examined how women are portrayed in Spanish and English newspapers in

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Florida. Surprisingly, she found that both newspapers used generalizations, although they used different frames. This may be the case because, while the Spanish newspaper was written by those who are ―in-group‖ members, they are still in America and the media is still run by the dominant culture. Also, they may feel that, as members of the culture, they may be given slack for upholding a pan-ethnic identity. The Spanish newspaper highlighted attributes that reflected a strong commitment to family and emphasized their sensuality. The English newspaper, however, focused on achievements and viewed them as a new market and underserved minority. Although neither of these stereotypes is particularly negative, the author argues that any overgeneralization is harmful simply because it homogenizes a minority group and ignores their unique qualities.

HEALTHCARE

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Healthcare Cultural Barriers Another area where a lack of cultural understanding is not simply an annoyance but a potential threat is communication in healthcare. Patients who are not able to understand instructions or explanations of a condition, or who are unable to effectively express questions are at risk of poor quality of care and outcomes, as well as potential dangers of misunderstandings, such as an inappropriate use of medicine and reduce follow up. Healthcare providers who are unable to fully understand their patients and their histories may misdiagnose or order an excessive amount of tests, making a visit to the doctor even more expensive. Collins, Villagranand Sparks (2008) describe some of the structural and cultural barriers of Hispanics in getting quality healthcare. Structural barriers include poverty, language or illiteracy issues, and inability to commute to treatments. Another example of a cultural barrier is religion. Many Latinos are Catholic, and may put more importance on religion and the will of God. However, this may lead to more practicing Catholics but less church attendees. Some Hispanics are followers of non-Judaic religions and may place more importance on folk remedies and spells. Suggested mitigation for this problem includes the presence of a qualified interpreter, teaching medical Spanish to those who provide direct care to patients, and educating providers about the health beliefs of their patients (Morales, Cunningham, Brown, and Liu, 1999). Not surprisingly, Latino patients are more satisfied with healthcare providers who are more culturally competent. Physicians who speak Spanish are more likely to elicit cooperation and responsiveness from patients, and are able to more fully treat their physical issues while fully comprehending their problems and concerns. Culturally competent providers are necessary in order to improve the care of diverse populations (Fernandez, Schillinger, Grumbach, Rosenthal, Stewart, Wang, and Perez-Stable, 2004). Seamus (2009) said, ―Keep constantly in mind in how many things you yourself have witnessed changes already. The universe is change, life is understanding.‖ (p. 429) Change is universal and inevitable, as are similarities and differences. Becoming sensitive and aware of other cultures and respecting them is a way of adapting to an ever changing world.

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Mental Health Services Socio-psychological problems and issues of mental health can occur prior to, during, and after Hispanics/Latinos‘ arrival in their host country regardless of age. These problems that may arise can have immediate and long-term implications for the psychological and social well being of individuals and families which can be especially traumatic for undocumented children and families (Casas, 2010). Regarding children and youth, the immigrant experience may adversely affect physical, mental, and spiritual growth and development. As a result, Hispanic/Latino children‘s acculturation may impact their self-concept/self-esteem, ability to trust, sense of security and belongingness and other socio-cultural elements. It is not uncommon for undocumented immigrant children and youth to be subjected to traumatic experiences ranging from racial/ethnic discrimination to racial profiling to being separated from their families and deportation. These traumatic challenges can produce a range psychological/psychiatric problems including but not limited to: post-traumatic stress disorder, acculturative stress, and intergenerational conflict, general anxiety, depression, difficulties in school performance, and loss of motivation (Capps et al., 2007; Suarez-Orozco, 2007; Kohatsu, Concepcion, and Perez, 2010). With all these problems and a host of others, it would appear that services would be readily available to address any potential problems if not proactively seeking opportunities; however, this is not the case. Systemic problems continue to adversely impact the provision of mental health care services to low-immigrant and undocumented immigrants. And probably the greatest travesty in attempting to providing service is the mental health/health provider‘s treatment of mental disorders rather than placing their clients within a broader ecological context. The United States continues to learn that the risk for some potential problems for immigrant youth can significantly impact the sociopolitical climate between the U.S. and Latin American countries. Alcohol abuse has become a major concern with many Latinos. The Hispanic American Baseline Alcohol Survey (HABLAS) examined data on alcohol use by Hispanics/Latinos living in five major metropolitan areas and uncovered Hispanics/Latinos have higher rates of alcohol abuse and dependence compared to their white counterparts (Caetano, Ramisetty, and Rodriguez, 2008). More alarming, as rates for Whites decline, the rates of Hispanics/Latinos present a negative correlation, especially with heavy drinking. Ethnic identity is a particularly salient protective mechanism against the various contextual risk factors of alcohol and drug abuse which Hispanics/Latinos are disproportionately exposed. As mentioned earlier, key components of ethnic identity include common ancestral origin, common language, common religion, the use of ethnic media, membership in ethnic voluntary organizations, participation in ethnic social networks, and an attachment of affinity to the ethnic group to which an individual belongs. Studies of generational differences in ethnic identity have consistently shown greater acculturation marked by a decline in group identification in subsequent generations following immigration. Here, conformity is appreciated as it furthers the common cultural mantra of collectivism, which represents a form of protective factors. Additional factors contributing to weaker ethnic identity among immigrant populations include exposure to the new culture at a younger age and for a longer period of time (Phinney, 1989). Moreover, it is typically adolescents who tend to be more bicultural than their adult counterparts and may more easily and readily adopt the norms of the culture of settlement (Sam and Berry, 1995). Lower ethnic identity, that is, a higher degree of acculturation, has been linked to higher alcohol consumption rates among Hispanics/Latinos. When examining

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the relationship between ethnic identity and health concerns such as alcohol/substance abuse, it is easy to understand how acculturation is a key mediator. As acculturation is a process where individuals take on attitudes, values, and norms on the host society, Hispanics/Latinos who value their ethnicity and cultural identity have lower rates of alcohol use (Umana-Taylor, Diversi, and Fine, 2002). Although the specific impacts of acculturation vary by sex, age, and birthplace, the general effect of acculturation on Hispanics/Latinos has been to liberalize their drinking (Wallace, 1999). More specifically, highly acculturated Hispanics/Latinos have more liberal attitudes and norms toward alcohol use than do those who are less acculturated, and more likely to drink more heavily than their less acculturated counterparts who remain steadfast to their cultural norms, values, and beliefs. The less liberal and less acculturated continue to adhere more strictly to cultural expectations as a way to remain connected to their home country. Furthermore, the strongest support for a relationship between assimilation to the American culture and substances use comes from studies that consistently find a positive relationship between English language preference and proficiency and higher rates of alcohol and drug use, abuse, and dependence among Hispanic/Latino Americans (Kohatsu, Concepcion, and Perez, 2010). In terms of functional relationship, it appears that as the level of acculturation increases, the use and abuse of alcohol increases.

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Community/Contextual Factors Affecting Health There are significant differences in the social contexts and community environments in which different races and ethnicities live. In addition to being more likely than White families to be poor, Hispanic/Latino families are significantly more likely to live in rural and urban areas of concentrated poverty-communities in which at least 20 percent of the residents are living in poverty (Umana-Taylor, Diversi, and Fine, 2002). For many Mexican Immigrants to the United States living rural or sparsely populated areas has facilitated migrant work, but as Mexicans and other Spanish-speaking immigrant enter the country additional opportunities await them beyond rural areas. However, location has been linked to factors affecting health. Research on contextual risk factors for substance abuse, such as community-level indicators of poverty, laws and norms that encourage use and high levels of drug availability, clearly indicate that Hispanic/Latino Americans are at a higher risk than Whites based on community dynamics. In addition, Hispanic/Latino drinkers in poor neighborhoods reported higher numbers of alcohol-related problems than did White drinkers in poor neighborhoods. When further examining aspects of community factors, Scheier et al (1999) believed personal life events and neighborhood stress were determinants of alcohol use among Hispanic/Latino adolescents. Personal events included disruptive and beneficial life experiences, whereas neighborhood stress assessed gang involvement and perceived neighborhood toughness. Analyses were conducted to examine the ability of several key measures of psychosocial functioning to moderate relations between life events, neighborhood stress, and alcohol use. Positive outcomes (e.g., family communication) and internal health locus of control buffered the effects of neighborhood stress on alcohol use. Both positive and negative life events and neighborhood stress uniquely predicted alcohol use controlling for risk, gender, and ethnicity. More importantly from community psychology perspective, for Hispanics/Latinos, these outcomes suggest the prevalence of ecological stress and environmental press. The neighborhood values may be acrimonious with the values and/or expectations believed by

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some Hispanics/Latinos, especially if there are few same ethnic individuals; thereby, creating environmental press and challenges to fully adapt to the location. The inability of the individual to adapt the principles may lead to greater distress and the likelihood of indulging in behaviors less accepted in the culture of origin. Canino et al. (1992) found that the prevalence of alcohol use, the degree to which alcohol is readily available, maybe somewhat higher in neighborhoods with a high concentration of Hispanics/Latinos. This further supports the association between environmental conditions and increased rates of alcohol abuse among Hispanic/Latino adolescents. Studies of billboard content have found that Hispanic/Latino communities have significantly more billboards and other print media that feature alcohol products that do predominantly White communities (Wallace, 1999). Similar finding exist in regard to predominantly African American communities. The social availability of alcohol in the Hispanic/Latino community extends beyond billboard and magazine advertisements. Producers of alcoholic beverages give their products high levels of social availability through their support of Hispanic/Latino-oriented charities, cultural activities, and community service efforts in comparison to other private industries. In addition to its social availability, alcohol‘s economic availability is also important to consider. Cheap wine and malt liquors are widely available and heavily advertised in Hispanic/Latino, as well as African American, communities. Additionally, relative to White adolescents, Hispanic/Latino adolescents report seeing people who are drunk in their community more often (Figure 4). Recently, while watching CNN, there was a story about a small town in southern Texas where historically the largest minority group was African Americans, but now Mexicans (Mexican Americans) are moving in, outnumbering the African American, and forcing many Blacks out of jobs they held for years. The usual response is that Mexicans are hard working and they are willing to be dedicated to completing the job. Whereas, the assumption must then be that Blacks are lazy, but that is never mentioned. For years, those of us on the ―Right‖ knew that eventually there would be conflict over jobs between Blacks and Mexicans, but the minority leadership was staunch in trying to keep ―people of color‖ united against Whites. Now that united front is starting to fall apart: Mexican gangs fighting Black gangs over drug turfs, territory, and machismo; Blacks being displaced in the workforce by Mexicans (who may work longer for less money), and Mexicans expanding their presence in the media, in academic agendas, etc. A similar conflict has been ongoing between Jews and Blacks. But Jews are much more successful in general, are only 2% of the population versus 13% for Blacks, so the conflict never really became public. Now, Mexican/Black conflict will increase as the percentage of Mexicans increases. Why this is important is that it may precipitate a split among ―people of color.‖ Increasingly it will be African Americans versus Mexicans using affirmative action— with dwindling returns. Eventually would the conversation change to African Americans demanding that affirmative action should only be used for Blacks due to the sufferings from slavery and Jim Crow. Or will Mexicans say they should be entitled to privileges as it relates to immigration status? Conflict is the best opportunity for a change in people‘s attitudes. Figure 4. Culture to Culture. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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Lack of Treatment Hispanics/Latinos who abuse alcohol generally do not seek treatment as the same rate of Whites due in part to the stigma associate, which is in concert with many other ethnic populations. Hispanic/Latino males, in particular, may not want to admit that they have a problem due to fear of being seen as a failure to their family and peers. Additionally, many may feel the treatments offered will not align to traditional values of their home country. When this is the case, those more closely acculturated may accept the current culture‘s beliefs and practices further distancing them from their homeland

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EDUCATION The wave of Latin American immigration to the United States began around 1965. As with other immigrant waves in the early 20th century, Latinos reported optimism about their future, which include a belief in the importance of education and hard work to achieving the American dream. However, they are also more likely to drop out of school, become teenage parents, and live in poverty (Pew Hispanic Center, 2009). These attitudes and challenges continue today in Latin American youth. The difference is that today, the majority of Hispanic/Latino youth, approximately two-thirds, are not immigrants, they are native-born, and that percentage continues to climb (Pew Hispanic Center, 2009). In 2007, 25% of newborns in the United States were born to Hispanic mothers (Hamilton, Martin, and Ventura, 2009). The numbers show that the Hispanic population is the youngest and largest minority group in the United States. In 2009, President Obama set the ―2020 Goal‖ for the country, aiming to have the highest percentage of people with a college education. We are unlikely to reach such a goal without participation of the Hispanic population. Further, it is estimated that in 2025, 25% of the people in the workforce will be Latino (White House Initiative, 2010). Therefore, it is of the utmost importance to make preparing them for adulthood and the job market a high priority. Although many Hispanics consider education to be important, a persistent education gap has been maintained across generations and dropout rates continue to be higher among this group than any other minority, almost twice that of African American youth. In March of 2009, approximately 50% of Hispanics age 16-24 were not enrolled in high school or college (Pew Hispanic Center, 2009). The list of causes and interventions of this gap is understandably long and complex. The government has attempted to address many of these barriers by issuing policies at national and state levels. The White House Initiative on Educational Excellence for Hispanic Americans, which was established in 1990, was intended to provide guidance to the secretary of education regarding education issues and opportunities for Hispanics. This initiative continues, and in 2010 it held the National Education Summit and Call to Action, which included 300 participants from national Hispanic education, community and business leaders as well as Education Department and Administration officials. During this summit, discussions were held regarding many barriers Latinos face in education on every level, from bridging language gaps between parents and educators to increasing grants, loans, programs and other resources to retain Latino enrollment in high school and college and increase graduation rates (White House Initiative, 2010) (Table 2).

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Table 2. School Enrollment of Youths Age 16 to 24. Race and Ethnicity of School Enrollment for 16-24 Years of Age (%) All Youth

Hispanics

Whites

Blacks

Asians

30.2 97.8 2.2 28.2 85.3 14.7

30.6 96.1 3.9 20.5 76.3 23.7

29.3 98.2 1.8 30.4 87.6 12.4

33.9 97.9 2.1 24.5 80.6 19.4

28.5 99.0 1.0 44.4 90.1 9.9

Not Enrolled 41.6 Source: Pew Hispanic Center (2009).

48.9

40.4

41.5

27.1

Enrolled in High School Full time Part time Enrolled in College Full time Part time

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One of the biggest barriers to Latinos in navigating a successful education path is lowered expectation. A contradiction exists in the Hispanic community regarding educational expectations. While an overwhelming majority of Hispanic youths and their parents believe that a college education is important, these numbers are not matched by their personal expectations of advancement. Although nearly 97% of young Latinos feel college is important, only 48% say they expect to get a college degree. The main reason given for this expectation is a need to support a family (Pew Hispanic Center, 2009). Many feel they need to work to contribute to their parent‘s home, others feel pressure to send money back to the country of origin. A major factor in family support is the prevalence of young motherhood. In 2007, 29% of immigrant Latinos and 17% of native-born Latinos between the ages of 16 and 25 were mothers, compared with 12% of white females (Pew Hispanic Center, 2009). These financial obligations leave Hispanics with less ability to pursue educational goals. (Table 3) Table 3. A Difficult Passage to Adulthood for Latinos(as) Females age 19 who are mothers Ethnicity Latinas/Hispanics African Americans Whites Asians High School Dropout Rates Latinos/Hispanics African Americans Whites Asians Living in Poverty Latinos/Hispanics African Americans Whites Asians Source: Pew Hispanic Center (2009).

Percentage 26 22 11 6 17 9 6 4 23 28 13 18

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Much of the research points to parental involvement as one of the most significant factors in educational success. Parental participation and positive peer networks influence strong school attachment and can be stronger predictors of academic success than ethnicity or SES (LeCroy and Krysik, 2008). In order to create an environment where school professionals and parents can collaborate effectively to promote academic success, an atmosphere of communication and understanding needs to be in place. Teachers may become frustrated with parents and perceive a lack of participation as a lack of interest in their child‘s education. Likewise, parents can become dismayed and discouraged by the behavior of school professionals. Ramirez (2003) provides an illuminating perspective on the misunderstandings and misinterpretations that can undermine a relationship between school professionals and parents and have a negative effect on students‘ success. Parents accustomed to different roles and customs of education can be left feeling isolated and shut out of the education process if the school personnel are not aware of or sensitive to the cultural differences. Teachers may assume parents just know to contact them if a child is having problems, but Latino parents may not feel comfortable initiating contact and believe that a personal invitation is necessary from the school. They may not feel that it is their place to address the teacher regarding education. Parents may not fully comprehend their rights or responsibilities if they cannot understand English or their culture considers the teacher to be in charge of the education (Langdon, 2009). Further, parents expressed that teachers express a negative or uncaring attitude to their participation when they did attempt communication. Flyers and word of mouth are often not sufficient, and the extra step from the school to personally contact the family is very helpful, and often results in a better response. Due to the language barrier, flyers or mailings that are not bilingual may not be understood. Considerations may also need to be in place for those parents who work unconventional hours. They expressed concern over the impression that teachers may assume they just don‘t care enough to show up, when the reality is that they may not be able to make open houses or meetings because they work or just haven‘t been informed. When they are able to attend open houses or meetings, no interpreter was available to help them understand the information being given. One school‘s solution was to assign parents of seniors to act as mentors to the incoming students parents. Another school made the parents an active partner in policymaking, and asked them what they hoped for regarding their child‘s education. To address time and transportation issues, Northrop High School in Fort Wayne, Indiana initiated a program called ―On Your Turf,‖ which seeks to involve parents in the Parent-Teacher-Student Association by having neighborhood meetings (Ramirez, 2003). Parent classes, child care support, and time flexibility can help increase the parents‘ ability to become involved and build relationships between school professionals and families. The attitude of school personnel goes a long way as well. Parents expressed concern that the teachers gave their children lower level courses because they were bilingual without really getting the opportunity to know the child. This behavior continues the perpetuation of negative and detrimental stereotypes. They also felt at times as though they were being spoken to in a very condescending tone during meetings and school visits. Finally, they showed frustration over the seeming indifference of cultural differences. The Hispanic/Latino population is a heterogeneous group, originating from many countries. Some parents felt that the teachers believed all Spanish-speaking students‘ parents came from Mexico, or that Mexico was the same as El Salvador or Guatemala in customs and culture (Ramirez, 2003). In the classroom, teachers may assume the student is being rude by not looking directly at

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them when they are speaking, which is an American custom, whereas it is considered defiant and rude in some Hispanic cultures for a student to look at an adult when being addressed (Langdon, 2009). Multicultural education courses for school professionals can bridge the cultural gap that persists in so many Hispanic serving institutions. These examples show how parents who have a desire to get involved with their children‘s education can get lost in the confusion, but with some understanding and organization, and a little effort, they can be an integral part of the education system. This is vitally important because parental involvement is one of the strongest predictors of a student‘s success in school. At the very least, the parents expressed a desire to simply be respected and included, and to feel like the school professionals cared. On February 24, 2009, President Obama announced his goal in a Joint Session of Congress to have the highest proportion of college graduates in the world. He recognized that, in order to reach this goal, particular focus would have to be on the fastest growing and youngest minority group in America: Hispanic Americans. In October, 2010, he renewed the White House Initiative on Educational Excellence for Hispanics. In it, one of the major pitfalls in the education of the Hispanic community is addressed: low income levels. Greater support for parents so they can be more attentive to their school-aged children is suggested, as well as opening up funding for student aid and ensuring students‘ access to technology. Some states and individual colleges also have funding and programs available to achieve equity in postsecondary schools, such as the Bright Futures Scholarship Program and the Talented 20 Program in Florida, the Texas Ten Percent Plan, and the UT Longhorn Scholars program (Figure 5). The Development, Relief, and Education for Alien Minors (DREAM Act) is an American legislative proposal first introduced in the Senate on August 1, 2001 by U.S. Senators Dick Durbin and Orrin Hatch. According to this bill, conditional permanent residency to certain illegal individuals of good moral character who graduate from U.S. high schools, arrived in the United States as minors, and lived in the country continuously for at least five years prior to the bill's enactment. If they were to complete two years in the military or two years at a four-year institution of higher learning, they would obtain temporary residency for a six-year period. Within the six-year period, they may qualify for permanent residency if they have "acquired a degree from an institution of higher education in the United States or [have] completed at least 2 years, in good standing, in a program for a bachelor's degree or higher degree in the United States" or have "served in the armed services for at least 2 years and, if discharged, [have] received an honorable discharge.‖ Military enlistment contracts require an eight-year commitment, with active duty commitments typically between four and six years, but as low as two years. "Any alien whose permanent resident status is terminated... shall return to the immigration status the alien had immediately prior to receiving conditional permanent resident status under this Act." This bill would have included illegal immigrants as old as 35 years of age. Recently, President Obama‘s beliefs of the DREAM Act evolved by making children who were brought here illegally free from deportation and making them eligible for work permits. This decision impacts over 800,000 children and young adults, but it does not offer a path to citizenships. Additionally, there are requirements that must be met by those who chose to operate under this Act. Figure 5. Where were you August 1, 2001. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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Sonia Sotomayor is an Associate Justice of the Supreme Court of the United States. President Barack Obama nominated her on May 26, 2009 and she was confirmed by the United States Senate three months later on August 6, 2009. Justice Sotomayor has two distinctions; she is only the third woman to serve the Supreme Court and the first Hispanic Justice. Born in New York, NY to Puerto Rican parents, Justice Sotomayor grew up in a bilingual household, but did not learn to speak English until the passing of her father. Justice Sotomayor graduated summa cum laude from Princeton University with a bachelor‘s degree in History in 1976 and was awarded the Juris Doctor degree in 1979 from Yale Law School. Her professional career has included: Assistant District Attorney (New York), private practice, Federal District Judge, and United States Court of Appeal for the Second Circuit Judge.

Reference: http://www.judgepedia.org.

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Figure 6. Cultural Icon.

Although the initiative gives attention to all levels of education, such as funding early childhood programs with parent education built in, much of the initiative focuses on getting Hispanics into college and keeping them there. They recommend organizing parent visits to colleges, providing more counseling and funding, and Federal TRIO Programs which are outreach services to identify and assist those from disadvantaged backgrounds, to encourage Hispanic students to complete college. The need for proper preparation cannot be overstated. In a survey to Hispanic Serving Institutions (HSI‘s), poor student preparedness was named as the second largest challenge facing the colleges, the first being funding. These respondents state that many of the students who come to their institutions need remedial math or English work in order to keep up (de los Santos and Cuamea, 2010). While change can be painfully slow, there is evidence that improvement is being made. In a report from the Pew Hispanic Center, the Hispanic college enrollment spiked 24% from 2009 to 2010. Although the numbers of Hispanics in college still fall short of other groups, this spike narrowed the gap between them (Pew, 2011). (Figure 6)

CONCLUSION Reading a chapter on Hispanics and Latino and defining the best and most effective practices brings us to a final question, which term ―Hispanic‖ or ―Latino/a‖ is best to represent this identity and use in practice? While many, regardless of the setting, tend to use the terms interchangeable, more of the scholarship on the topic and on the community, in general favor the use of the ―Latino/a.‖

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There is a difference between how Spanish-speakers identify their cultural and ethnic heritage Hispanola is the emerging term of identification Less acculturation strengthens country of origin bonds Latinos/Hispanics have a strong professional expectation for teachers Familism is a strong ethnic aspect

Figure 7. I‘ve Learned… .

For many, this term encompass all Latin American nationalities while being inclusive of the not just immigrants but their descendants, who in some cases have lived in countries such as the United States for several generations. However, Baia (2000) feels that her research merits more consideration for breaking from the either primary term to embracing Hispano/a, as it envelopes a pan-ethnic preference for the Spanish language, culture, and traditions uniting many in the United States. What matters more than understanding the identity is getting to know the person first. Person-first language helps to clarify how the person perceives and showcases his/her ethnic identity. Therefore, healthcare providers should never project (i.e., racial socializing) an identity on the individual, but allow the individual to share who he/she is and how he/she identifies themselves. (Figure 7)

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REFERENCES Baia, L. (2000). “Hispanic” – “Latino”: True representation of an emerging identity. Retrieved on May 31, 2012 from http://www.lasa.international.pitt.edu. Canino, G.J., Burnam, A., and Caetano, R. (1992). The prevalence of alcohol abuse and/or dependence in two Hispanic communities. In J.E. Helzer and G.J. Canino (Eds). Alcoholism in North America, Europe, and Asia. New York: Oxford University Press. Capps, R., Castaneda, R. Chaudry, A. and Santos, R. (2007). Paying the price: The impact of immigrations raids on America’s children. Retrieved on May 27, 2012 from http://www.urban.org. Casas, J.M., Vasquez, M.J.T., and Ruiz de Esparza, C.A. (2002). Counseling the Latina(o): A guiding framework for a diverse population. In P.B. Pedersen, J.G. Draguns, W.J. Lonner, and J.E. Trimble (Eds.), Counseling across cultures (5th ed., pp. 133-160). Honolulu, HI: University of Hawaii Press. Casas, J.M. (2009). The 1998 APA resolution on children, youth, and families: A time to revisit and revitalize. Retrieved on May 1, 2012 from http://www.apa.org/pi.families/ resources/newsletter/2009/11/fall.pdf. Casas, J.M. (2010). Confronting immigration challenges in nation of immigrants: A call for APA action. Retrieved on May 26, 2012 from http://www.apa.org/pi/oema/resources. Collins, Dorothy, VillagranMelinda M., andSparks, Lisa. (2008). Crossing borders, crossing cultures: Barriers to communication about cancer prevention and treatment along the U.S./Mexico border. Patient Education And Counseling, 71(Translational Communitybased Health Communication Interventions to Promote Cancer Prevention and Control for Vulnerable Audiences), 333-339.

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Correa, T. (2010).Framing Latinas: Hispanic women through the lenses of Spanish-language and English-language news media. Journalism, 11(4), 425. de los Santos, A. G., and Cuamea, K. (2010). Challenges Facing Hispanic-Serving Institutions in the First Decade of the 21st Century. Journal Of Latinos and Education, 9(2), 90-107. Fernandez, A., Schillinger, D., Grumbach, K., Rosenthal, A., Stewart, A., Wang, F., and Pérez-Stable, E. (2004).Physician language ability and cultural competence.An exploratory study of communication with Spanish-speaking patients.Journal Of General Internal Medicine, 19(2), 167-174. Fuligni, A. and May, L. (1999). Attitudes toward family obligations among American adolescents with Asian, Latin, and European backgrounds. Child Development, 70, 10301044. Hamilton, B., Martin, J., Ventura, S., Births: Preliminary data for 2007. National vital statistics reports, Web release; vol 57 no 12. Hyattsville, MD: National Center for Health Statistics. Released March 18, 2009. Jones-Correa, M (1998). Between two nations: The political predicament of Latinos in New York City. Ithaca: Cornell University Press. Kells, M. (2002). Linguistic Contact Zones in the College Writing Classroom: An Examination of Ethnolinguistic Identity and Language Attitudes. Written Communication, 19(1), 5-43. Kohatsu, E.L., Concepcion, W.R., and Perez, P. (2010). Incorporating levels of acculturation in counseling practice. In J. Ponterotto, J. Casas, L. Suzuki, and C. Alexander (Eds.), Handbook of multicultural counseling. (3rd ed.), pps. 343-356. Thousand Oaks, CA: Sage. Langdon, H. W. (2009). Providing Optimal Special Education Services to Hispanic Children and Their Families. Communication Disorders Quarterly, 30(2), 83-96. LeCroy, C., and Krysik, J. (2008). Predictors of Academic Achievement and School Attachment among Hispanic Adolescents. Children and Schools, 30(4), 197-209. Morales, L. S., Cunningham, W. E., Brown, J. A., Liu, H., and Hays, R. D. (1999). Are Latinos Less Satisfied with Communication by Health Care Providers?.JGIM: Journal Of General Internal Medicine, 14(7), 409-417. doi:10.1046/j.1525-1497.1999.06198.x. Moving America Forward: President Obama‘s Agenda and the Latino Community, http://ed.gov/about/inits/list/hispanic-initiative/obama-agenda.pdf. Passel, J.S. (2005). Unauthorized migrants: Numbers and characteristics. Retrieved on May 27, 2012 from http://pewhispanic.org. Passel, J.S. and Cohn, D. (2008). Trends in unauthorized immigration: Undocumented inflow now trails legal inflow. Retrieved on May 27, 2012 from http://pewhispanic.org. Pérez, F. G. (2002). Effectively Targeting Hispanics in the Southwest: Views from Public Relations Professionals in a Border City.Public Relations Quarterly, 47(1), 18-21. Perna, L. W., Li, C., Walsh, E., and Raible, S. (2010). The Status of Equity for Hispanics in Public Higher Education in Florida and Texas. Journal Of Hispanic Higher Education, 9(2), 145-166. Pew Hispanic Center. ―Between Two Worlds: How Young Latinos Come of Age in America,‖ Washington, D.C. (December 11, 2009). Pew Hispanic Center. ―Hispanic College Enrollment Spikes, Narrowing Gaps with Other Groups,‖ Washington, D.C. (August 25, 2011).

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Phinney, J.S. (1989). Stages of ethnic identity development in minority group adolescents. Journal of Early Adolescence, 9, 34-49. Ramirez, A. (2003). Dismay and Disappointment: Parental Involvement of Latino Immigrant Parents. Urban Review, 35(2), 93. Sam, D.L. and Berry, J.W. (1995). Acculturative stress among young immigrants in Norway. Scandinavian Journal of Psychology, 36, 10-24. Sarkisian, N., Gerena, M., and Gerstel, N. (2006). Extended family ties among Mexicans, Puerto Ricans, and Whites: Superintegration or disintegration? Family Relations, 55, 331-344. Scheier, L., Botvin, G.J., and Miller, N.L. (1999). Life events, neighborhood stress, psychosocial functioning, and alcohol use among urban minority youth. Journal of Child and Adolescent Substance Abuse, 9(1), 19-50. Seamus, M. (2009). ‗Wrestle to be the man philosophy wished to make you‘: Marcus Aurelius, reflective practitioner. Reflective Practice, 10, 429-436. Steidel, A., and Contreras, J. (2003). A new familism scale for use with Latino populations. Hispanic Journal of Behavioral Sciences, 25, 312-330. Suarez-Orozco, C. (2007). Commentary: The challenges of immigrant families. Communique, 3, 6-14, Umana-Taylor, A.J., Diversi, M., and Fine, M.A. (2002). Ethnic identity and self-esteem among Latino adolescents: Distinctions among the Latino populations. Journal of Adolescent Research, 17, 303-327. U.S. Census (2010). Hispanic population of the United States current population survey definition and background. Retrieved September 18, 2011, from http://www.census.gov. Wallace, J. (1999). The social ecology of addiction: Race, risk, and resilience. Pediatrics, 102(2), 693-695. White House Initiative on Educational Excellence for Hispanics, 2010. http://ed.gov/print/ about/inits/list/hispanic-initiative/index.html. Wikipedia. (2012). Hispanic and Latino Americans. Retrieved on August 10, 2012 from http: www.wikipedia.com. Williams, J. E., and Garza, L. (2006). A Case Study in Change and Conflict: The Dallas Independent School District. Urban Education, 41(5), 459-481.

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Chapter 7

THE BI/MULTI-ETHNIC PERSPECTIVE TO CROSSCULTURAL INTERACTION AND UNDERSTANDING ―One day our descendants will think it incredible that we paid so much attention to things like the amount of melanin in our skin or the shape of our eyes or our gender instead of the unique identities of each of us as complex human beings.‖ Franklin Thomas

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ABSTRACT Imagine getting nestled into your airplane seat and have someone peering at you wondering if you were Black, Mixed, Latino, or Irish. This is a common experience for bi/multi-ethnic persons. A lesser discussed group when mentioning a cross-cultural text is individuals who identify as bi/multi-ethnic, not bi-racial. While there have been theories espoused by a variety of researchers (e.g., Poston, Kerry, and Root), many textbook continues to omit or minimize the amount of coverage, suggesting there is a challenge in representing accurately these individuals. Since society provides bi/multi-ethnic individuals with no easy answer about where he/she belongs in terms of identification, many are forced to determine their own trajectory. This chapter will introduce the reader to a succinct perspective of identity development and how biology and contextual variable play a critical role understanding the role of ethnicity. Additionally, mental health concerns will be discussed that may impact bi/multi-ethnic identity development and the appropriate pathways to resolve intra-conflict will be suggested.

INTRODUCTION Increased national attention and interest in multicultural research has risen in the past few decades due to several factors. The multiracial population is one of the fastest growing minority groups in the United States today. This is partly because marriages between people of differing racial backgrounds are occurring more frequently and becoming more accepted by society after the legalization of interracial marriages in 1967 (Shih and Sanchez, 2009; Rockquemore, Brunsma, and Delgado, 2009).

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The act or practice of passing, identifying and presenting oneself as one ―race‖ while denying ancestry of another, has been around since slavery. Historically speaking, many slave masters/owners raped their African American female slaves leading to many unwanted pregnancies that produced ―biracial‖ children. As these children grew up, their pigmentation may have been significantly lighter than the African American mother, allowing them to ―pass‖ as white in social circles and receive benefits not afforded to their darker siblings. As a result, today many persons of color who identify as ―black‖ but may still pass as ―white‖ when it is convenient. However, what happens if we pursue the other direction and have ―white‖ pass as ―blacks.‖ Is it possible? What is there to gain being ―black‖ in an ―white‖ American society?

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Figure 1. Cultural Clip.

In 1945, more than half of the states enforced laws against interracial marriage and in 1966, 19 of those states still had active laws banning interracial marriage (Parker 1999, as cited in Harris, 2002).Farley (2001) suggests that by the year 2050, one in five Americans will identify as multiracial due to the increased mixing of racial and ethnic diversity (Shih and Sanchez, 2009). Being apart of one ethnic group is challenging enough for many, but what happens when you are bi-ethnic (aka bi-racial). Balancing two or more ethnic identities is not impossible to manage, but must be approached with a healthy dose of self-acceptance, self-perseverance, and self-understanding. Poston (1990) proposed five stages regarding the identity development of multiracial children. In order to navigate the challenges, Poston (1990) suggested that multiracial children start off with a personal identity (Stage 1) void of a racial preference group. As a result, they do not show any allegiance to a racial categorization. It is not until personal factors (Stage 2) such as appearance and cultural knowledge that forces the child to choose a cultural group to associate more with partially based upon society‘s viewpoint (Renn, 2008). In Stage 3 the child may experience guilt by not being able to identity with all of his/her cultural heritage and either over indulges in one group and denies the other creating an emotional conundrum. As the individual broadens their racial understanding by expanding their cultural knowledge they begin to identify with others in the less accepted group (Stage 4). Finally, integration (Stage 5) represents a multicultural existence whereby the individual values all of his/hers ethnic identities (Renn, 2008).

IDENTITY It is important to distinguish between racial categories, racial identity, and racial identification. Rockquemore, Brunsma, and Delgado (2009) suggest that researchers must differentiate between these terms instead of using race as a comprehensive construct in order to accurately understand identity in bi-ethnic individuals. The researchers note that while these three constructs are highly correlated for groups of a single race, they are not so highly correlated for mixed-race groups. The constructs might also overlap in ways that have not been previously studied. Racial identity refers to an individual‘s self-understood identity. More importantly, how does the bi-ethnic individual perceives themselves absent of others

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viewpoint, recognizing that this is a fluid situation. As one continues to evolve, they may come into a greater understanding of their heritage, their culture, and more importantly themselves. Racial identification refers to how others perceive and categorize the individual. This is based on ―outcomes‖ of society‘s viewpoint, which can be flawed and harmful if not exercised with respect. Lastly, racial categorization refers to the racial identities that are available and chosen by multiracial individuals. For example, the previous US Census format allowed only for one race to be checked off. This forced option clashed with individuals‘ racial identity and perhaps racial identification as well. Racial identification determines how others understand multiracial individuals. However, racial identity can change depending on the social context. The change in racial categorization of the US Census in 2000 also contributed to the rising interest in multiracial populations (Rockquemore, Brunsma, and Delgado, 2009). Bonilla-Silva (2003) indicated that the Census debate over racial categorization recognized race as a social construct and not as a reflection of one‘s biology (as cited in Rockquemore, Brunsma, and Delgado, 2009; Shih and Sanchez, 2009). The identity perception by mixedrace individuals of themselves and the identification of mixed-race individuals by society influenced the discussion of whether people of mixed backgrounds should check one comprehensive multiracial category or check multiple racial categories on the Census. Some Civil Rights activists argued that identification for the purposes of monitoring population inequalities and discrimination outweighed the desire for mixed-race individuals to identify themselvesin a category of their choosing (Rockquemore, Brunsma, and Delgado, 2009). As a result of this dispute, mixed-race individuals can now check all responses that apply to their racial backgrounds instead of being constrained to just one racial category defined by society (Rockquemore, Brunsma, and Delgado, 2009).

*Adapted from Rockquemore, K.A., Brunsma, D.L., and Delgado, D.J. (2009). Figure 2. Rethinking Racial Identity, Racial Identification, and Racial Category. Cross-Cultural Interaction and Understanding: Theory, Practice, & Reality : Theory, Practice, and Reality, Nova Science Publishers, Incorporated,

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Researchers interested in studying the matter of identity in those individuals of mixedrace now have more demographic information to draw from. Also, multiracial identity is understood as a more complex issue than just checking off one category. While the 2000 Census enlightened society and researchers about the growing multiracial population, attempting to define a cohesive group of individuals belonging to more than one race is still a complicated endeavor (Figure 2). Shih and Sanchez (2009) discuss two important issues when defining the term multiracial: 1) racial category construction (the concept of race and how society creates racial categories), and 2) racial identification (the process by which society determines the categories that others belong to after those racial categories have been created). Stocking (1994) notes that previously, people believed that race was related to differences in blood-line and heritage while Gould (1994) stated that racial categories were designated by racial ―types‖ and separated by physical appearance like skull size and skin color (Shih and Sanchez, 2009).

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Biology and Bi-Ethnic Identity Currently, race is viewed as a social construct as opposed to biological differences among races. Goodman (2000) discussed six reasons why race is an insufficient and even harmful way to think about biological differences between humans, basing his argument on historical, theoretical, and biological tenants. Regarding biological differences, Goodman points out that within-group genetic differences are much greater than differences among races. Lewontin (1972) collected data on common blood types from different racial groups and found that blood group variation among these groups only explained 6% of the total variation. If an individual is to identify oneself with a particular racial identity, it must also be understood that one‘s biological race only explains a small amount of the variation between other groups, which is better explained by geographic proximity (as cited in Goodman, 2000). Racial category construction is alsoinfluenced by society, history, and variability within racial groups (Shih and Sanchez, 2009). Shih and Sanchez (2009) note several ways in which racial identification occurs regarding societal perception and self-perception. The US 2000 Census was an example of introducing a societal perception of the multiracial population. To quell arguments that identifying only with one race would deny parts of the individual‘s true identity and that a separate multiracial category would diminish political influence of minority populations, multiracial individuals could check off more than one racial category. A way to identify one‘s race due to their own self-perception would be to create their racial identify themselves instead of selecting from already existing categories. This method would allow the individual to identify oneself according to the individual‘s own view and limit the influence of society‘s definition of race and the biological component of heritage. For the purpose of Shih and Sanchez‘s (2009) research, multiracial refers to people who identify with two or more racial heritages that are influenced by societal standards. Previously, researchers viewed identity development among multiracial individuals as a unidirectional process that only focused on innate, psychological factors and their influence on development. While these theories deemphasized the importance of context and societal influence, these factors are now being given the appropriate attention in order to see how the

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whole picture affects one‘s multiracial identity development. Literature today replaces old, rigid frameworks with a more fluid and dynamic understanding of identity. Now that context and societal influence is emphasized as having a prominent influence on identity development, researchers have a more comprehensive understanding of how social interactions affect identity development in multiracial individuals. Jackson (2009) explored factors that influence cultural identity of multiracial individuals and reported three major categories that support the structure of these new identity theories. Direct and indirect experiences of racism and discrimination (perception by others in society) affect the multiracial individual‘s self-perception. Interviewed multiracial individuals reported that they realized they were different because of how they appeared to other people. The often ethnically ambiguous appearance led others to question the multiracial individual about identity. Jackson (2009) also reported that social influences such as family and peers affected the multiracial individual‘s sense of worth and independence. Similar to Crawford and Alaggia‘s (2008) findings, Jackson (2009) reported that parents influenced their children‘s selfperception of identity in negative and positive ways. Some parents neglected to talk about identity and race or directly discriminated against their own child‘s appearance or chosen racial identity. These interactions often fostered feelings of isolation, confusion, and disconnection between the child and parents. While some individuals experience this discrepancy between family perception and self- perception, most multiracial youth reported positive interactions with family members regarding identity. Family members often explained values, norms, and beliefs of the different ethnic backgrounds and fostered feelings of self-worth and independence. Lastly, Jackson (2009) reported that environmental context is significant in contributing to the understanding of one‘s multiracial identity. Interviewed multiracial individuals explained that the racial and cultural composition of the surrounding community and racial attitudes that were expressed by this community was the environmental variable that contributed the most to their self-perceived identity. The results demonstrated that societal perceptions of multiracial individuals must be considered when attempting to understand one‘s self-perception. It forces the multiethnic person to define him/herself in agreement with society or disillusioned by society. This opinion also justifies the theoretical shift from only considering innate factors that contribute to identity development to including societal and contextual factors.

Contextual/Environmental Jackson (2009) reported that the neighborhood and school environments provided the most memorable experiences to shape identity development. Some individuals directly experienced living amidst a multicultural environment and some did not. However, all of the participants reported experiencing a general value to living in an environment surrounded by a diverse population. The school environment is where most participants reported their first experience of racism and discrimination. As such, school faculty, teachers, and administration should be aware of this identity exploration phase. For many, college represented a positive experience as individuals who did not feel accepted by peers previously, attended schools that represented many cultures as well as their own.

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Understanding racial identity development is a complex process. One biracial (half Filipino and half Anglo-American) cross-cultural psychotherapist applied Carl Rogers‘ concept of the structure of self to her own understanding of racial identity development. Rogers believed that the creation of one‘s identity results from interacting with one‘s environment, specifically one‘s interaction with others (Hill, 2010). Hill (2010) used her own experiences and reactions to her environment as a biracial individual to more fully comprehend her own clients and build a better, more intimate rapport with them. Even though she did not always identify with the same races as her biracial clients, Hill (2010) connected with her clients through their shared experiences of navigating life as a biracial individual. This connection seems to be dependent on the client‘s acceptance of the therapeutic process. However, the connection seems to be independent of whether the client‘s racial background matched Hill‘s racial background. In one case, Hill details counseling an Ethiopian man with academic and identity issues. Grandparents of different races raised both client and counselor and it was through their relationships with family that each learned about identity, culture, and values. Through this shared connection, Hill helped her client of a differing racial background to understand his identity in terms of religion. In another case, Hill (2010) counseled a young Filipina girl who had fallen in love with a married Anglo-American man. The girl‘s parents would not approve of such a match even if he was not married and her age. Identity in the Philippine culture translates the girl‘s shame as her family‘s shame and must be healed by returning to an obedient state. Hill bonded with the girl through their shared gender and language of Tagalog, understanding of Philippine culture, and experiences as first-generation American born individuals. While Hill appeared White to the girl, her shared understanding of the Philippine culture and familial expectations allowed Hill to help the girl return to an obedient state by restoring the familial relationship and maintaining a positive self-identity. This case study exemplifies how self-identification is influenced by societal interactions with others, how others view that biracial individual, and how the biracial individual evaluates these interactions. Rockquemore, Brunsma, and Delgado (2009) identified four patterns regarding identity development within the multiracial population. First, racial identity varies among people of mixed races. Some individuals identify with one of their races, some identify with both of their races, some shift between identifying with one race or the other depending on the type of interaction and who they are interacting with, and some individuals prefer not to identify with any race. Second, racial identity does not remain constant and may change over an individual‘s lifetime. Hitlin, Brown, and Elder (2006) found that youth identifying as multiracial are 4 times more likely to change their racial identity than to report the same racial identify over a period of five years. Researchers (Hiltin et al., 2006) found that youth were less likely to switch identification when associated with a higher socioeconomic background and higher self-esteem. They may have wanted to be perceived differently than their original identification or classification as a protective factor or cultural evolution. Also, higher intelligence was associated with increased tendency to switch racial identification. This might suggest that some adolescents are able to fluidly adapt to the ―cognitively complex issue of self-identification in a racially contested society‖ (p. 1306). Ultimately, familiarity may have been sought regardless of age. Hitlin, Brown, and Elder (2006) also suggest that altering one‘s self-identification over time might be the result of its use in society. Some Native Americans changed their initial

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self-identification status from White to White/Native American while the majority of biracial White/Native Americans reported identifying as only White. Researchers (Gatson, 2003) theorized that both processes of identity development might be related to the perceived use of either identifying with the majority culture or also claiming minority group membership. Blacks were found more likely to diversify than other groups but reasons as to why are less clear. The researchers (Renn, 2006) implore future research to study the degree to which these identification processes are related to individual beliefs and others‘ judgments of the youths‘ skin color and culture. Gatson (2003), Hitlin, Brown, and Elder (2006), and Wallace (2001) have supported the notion that racial identity changes in multiracial individuals are related to social, cultural, economic, and institutional influences (Rockqumore, Brunsma, and Delgado, 2009). These studies also illustrate the third pattern of multiracial identity development in which identity is not a predictable process with only one result (Rockquemore, Brunsma, and Delgado, 2009). Essentially, there is no right or wrong way for an individual to identify oneself and the process for this racial identification is different for each individual. Lastly, context is extremely important to consider when discussing identity development among mixed-race people as the definition of race is influenced by society, culture, and political means (Rockquemore, Brunsma, and Delgado, 2009).

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Insider/Outsider Research Mohan and Venzant Chambers (2009) explored how to better conduct multiracial research and how insider/outsider status of researchers affected the quality of research. Insider research is defined as research conducted by and with individuals who share a common sociopolitical identity. Mohan is a White/Indian biracial woman and interviewed self-identified multiethnic high school students while Venzant Chambers is a Black/White woman who interviewed Black/White multiracial undergraduate students. While some participants viewed the researchers as those with ―insider‖ status, others did not seem to view race as a concern regarding identity, identifying simply as ―human,‖ and did not connect with the researcher over shared biraciality. Mohan believed that her multiethnic identity enabled her to establish better rapport with the participants and allowed her to gain more quality insight into the participant‘s identity formation process. Venzant Chambers believed the students trusted her more because of her ―insider‖ status. Each researcher concluded that their personal experiences helped them to more intimately identify and communicate with the participants, possibly allowing for higher quality research (Mohan andVenzant Chambers, 2009). As a result of this research, Mohan and Venzant Chambers (2010) provide an argument against a single multiracial category that encompasses all individuals belonging to more than one race. After interviewing students who identified as multiracial to more fully understand their racial construction processes and experiences as multiracial students, Mohan and Venzant Chambers (2010) found that all students possessed different definitions of what it meant for them to be multiracial. Some students identified as mono-racial and others identified as multiracial or multiethnic. Still for other students, being multiracial and identifying with one racial category was not a concern for them as they identified merely as ―human.‖

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Yuma Iannotti Tomes Table 1 Culture to Culture. Korean vs. American Values

American Mainstream Value Family Values Family-oriented Individualistic Interdependent Autonomy/Self-sufficient Family Loyalty Separation and Individualism Life Philosophy Collectivism Individualism Reciprocity and Obligation Avoidance of Obligation Holistic Living in Harmony w/ Nature Controlling Nature Communication Style Subtle, nonverbal, body language Verbal Language Required Control of Feelings Free Expression of Feelings Self-effacing Self-promoting Responsive Assertive Little Eye-to-Eye Contact Eye Contract Important

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Korean Traditional Values

Also, it was found that students identified with each other not because of a shared sense of common identity in being multiracial, but due to the similarities in experiences they shared as multiracial students (Mohan, Venzant Chambers, 2010). This study suggests that individuals of multiracial populations do not identify with one single, cohesive multiracial category and that the definition of the term multiracial is very complex, but context plays a critical role. Being multiracial means something slightly different for each person. A person‘s life experiences shape one‘s identity and might not always fit into someone else‘s definition of multiracial. For instance, two individuals might appear White and come from similar mixed backgrounds, but due beliefs and experiences related to individual, familial, and societal influences, might identify themselves differently. It is so important to study how multiracial individuals perceive themselves due to these individual differences (Table 1).

Self-Concept and the Bi-Ethnic Experience Lou, Lalonde, and Wilson (2011) investigated self-concepts and experiences of individuals identifying as multiracial across mixed-race groups (Black/White and Asian/White) while using a multidimensional framework. The definition of multiracial includes both identifying with a category and the social context of whether or not the individual‘s identity is accepted by others. This acceptance by others can influence the multiracial individual‘s perspective of self. Shelton and Sellers (2000) suggested that views of race and the multiracial category may influence the degree to which the racial identity is central to one‘s view of identity (Lou, Lalonde, and Wilson, 2011). The multiracial individual may also view multiple social identities as ―compatible or oppositional to one another‖ (Lou, Lalonde, and Wilson, 2011, p. 80). Rockquemore‘s (1999) multidimensional framework allows for biracial individuals to report changes in identity depending on the situation, to have numerous identities at one time, as well as to view oneself as not belonging to any particular racial group at all (Lou, Lalonde,

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and Wilson, 2011). The four options for biracial identity include: 1) the singularity identity option where a biracial individual chooses to identify with one race, 2) the border identity option in which the biracial individual chooses to identify with both races (this identity could be validated or not validated by others), 3) the protean identity option where individuals see themselves as shifting between racial identities depending on the situation, and 4) the transcendent identity option in which the individual identifies as ―human‖, transcending race and choose not to identify with any particular racial group (Figure 3). Lou, Lalonde, and Wilson (2011) found that Black/White and Asian/White biracial individuals reported significant variability in self-reported racial identity. When individuals viewed their identities as not being validated or accepted by others, they believed their racial identity conflicted with itself, whereas individuals who felt others validated their identity did not experience opposition between their chosen identities.

Adapted from Rockquemore, Brunsma, and Delgado (1999).

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Figure 3. Biracial identity options for Black and White Individual.

*Adapted from Rockquemore, Brunsma, and Delgado (2009). Figure 4. Example of a Biracial Individual‘s Identity Choices.

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Black/White and Asian/White individuals reported different patterns of racial identification. Asian/White individuals were more likely to identify with the protean option than Black/White individuals who were more likely to identify with the validated border identity option. Black/White individuals were also more likely than Asian/Whites to identify with the unvalidated border identity. This means that Black/White individuals viewed themselves as biracial but felt others viewed them as Black. Researchers suggest that this result occurred because of the historical connection to the ―one-drop‖ rule, which stated that an individual with any Black heritage was automatically considered Black even if they identified themselves as biracial individuals. Society imposes restrictions on biracial individuals, affecting the identification process by causing conflict between the individual‘s preferred self-identification and society‘s imposed identification. The Asian population experienced different historical roots in America and therefore was less likely to identify with the invalidated border identity. Also, Asian society places more importance on interdependence as it relates to self-definition, whereas western societies emphasize independence. This disparity between cultures may explain the greater tendency for Asians to define themselves in terms of relationships, allowing for the adoption of fluid (protean) identities in which they can shift identities depending on context (Lou, Lalonde, and Wilson, 2011) (Figure 4). There was a strong, positive correlation between identity integration and self-concept clarity (r= .61, p