engendered
DSM5 or 5TR and Misappropriated Culture
In the DSM-5 there is recognition that every disorder is inherently culture-bound. These new guidelines help a social worker to be more sensitive to cultural differences and understand that a client is manifesting symptoms in the way that his or her culture experiences them.
Cultural “syndromes” are clusters of invariant symptoms in a specific cultural group.
Cultural “idioms” of distress are a way of talking about suffering among people in a cultural group, and cultural explanations or perceived causes for symptoms, illness, or distress have been added to assist with casting an acute or forensically endemic SMI diagnosis onto a BIPOC person out of communication,
evaluative and false positive symptomology. What I’m saying in plain English is to be cognizant of everything in your care (e.g., spoken language, interpretive support, body and sensory communication expressions and languages, dialect).
With the DSM-5 or 5-TR, it is vital that combining multicultural theory with lived experience gives meaning to engage culture directly. Experienced Trauma, Race, ethnicity, gender, sexual expression, country of origin and cultural inflections are important to the mix in evaluative behavioral health assessment upon meeting F2F 1:1.
Engaging in practical life on a day to day affords one the opportunity to better understand and correct psychiatrically oppressive “clinically and medically necessary” diagnostic acuity assignments of (BIPOC) people and populations.
Jen Padron, MSW
2022 New York
Celia Brown, NYCPS, Co-Founder | Surviving Race: Intersection of Injustice, Disability and Human Rights
Jennifer Maria Padron, MSW, Co-Founder and Organizer | Surviving Race: Intersection of Injustice, Disability and Human Rights
“First recognized in December 2019, the Coronavirus Disease 2019 (COVID19) was declared a global pandemic by the World Health Organization on March 11, 2020. To date, the most utilized definition of ‘most at risk’ for COVID19 morbidity and mortality has focused on biological susceptibility to the virus. This paper argues that this dominant biomedical definition has neglected the ‘fundamental social causes’ of disease, constraining the effectiveness of prevention and mitigation measures; and exacerbating COVID19 morbidity and mortality for population groups living in marginalizing circumstances. It is clear - even at this early stage of the pandemic - those inequitable social conditions lead to both more infections and worse outcomes.”
‘Most at risk’ for COVID19, Preventive Medicine October 2020
COVID19 is changing our society and challenging how we connect. We long for the time we could touch, feel and hug each other. It has been too hard to settle for new ways of connecting with each other and being in the world. Since COVID19 began in 2020, during this time Surviving Race has offered a social media platform, conference calls, and virtual dialogues, peer support, reframing crisis, advocating for social justice and eliminating police violence and racism toward BIPOC, people with disabilities, LGBTQiA community, people with psychiatric histories, in our society. Our shared experiences and recovery as participants and survivors of the behavioral health systems and surviving health challenges have given us the expertise and tools to support people suffering in social isolation, grief and loss, and trauma. I work in the mental health field and receive regular updates on Covid-19. However, I realized in my conversations with family and neighbors they were receiving misinformation on COVID19 and the vaccine from social media, news sources, websites etc. I want to support my family and neighbors with accurate information so they can make informed health choices/decisions. This COVID19 Self-care guide is an effort to support individuals and their families, friends, neighbors, peers and co-workers with accurate information on COVID19 symptoms, SAR2 and other variants (e.g., Delta, Omicron); how to support people who test positive for COVID19 in their homes. Surviving Race offers expertise and antidotal experiences of home remedies to heal from COVID19, building Co-Immunity, nutritional healing, self-care practices, Emotional-CPR for social connection, building and growing community, hope and love in this time of uncertainty.
In the United States systemic racism and psychiatric oppression (Brown and Padron, 2021) is endemic and requires imminent Declaration of a Public Health Emergency. BIPOC individuals living with disabilities face basic and inherent challenges in addition to being a person of color. In the seminal January 28, 2021, letter from the American Consortia of People with Disabilities and the Consortia for Persons with Disabilities to the United States Department of Health and Human Services, Secretary Designate Xavier Becerra, they state, “Disability is most prevalent in women and in Black, Indigenous, and People of Color. People with disabilities experience poverty at disproportionate rates.”
To exemplify how COVID19 is directly impacting BIPOC people, the Disabilities Consortia further state, “… Two thirds of all coronavirus deaths have been people with disabilities and staff in congregate settings. As we have seen in coronavirus data more broadly, congregate settings that primarily house residents of color, no matter their location, size, or government rating, have experienced deaths due to COVID19 at two to three times the rate as congregate settings that primarily housed white residents”.
Surviving Race: Intersection on Injustice, Disability and Human Rights, Dr. Daniel Fisher, M.D., PhD., Founder and Chair of the National Empowerment Center and Harvey Rosenthal, CEO,
New York Association of Psychiatric Rehabilitation Services stated in our formal recommendation to the President Biden Team, “The pandemic has shone a bright light on racial disparities in health and health care — as Black and Brown Americans have suffered and died from the coronavirus at rates far higher than white Americans. We are seeing a national reckoning on racial justice and the tragic human costs of systemic racism in the murders of Black men, women, and children.”
BIPOC health disparities extends into psychiatric oppression (American Monster, 2021) with firm evidence to the predominance of disparate mistreatment of individuals of color. Psychiatric oppression does not separate BIPOC from the >25+ year earlier morbidity and mortality in the US Public Community Mental Health System (Parks, et al., 2008; World Health Organization, 2020) remains the rule instead of the exception. Surviving Race: Intersection of Injustice, Disabilities and Human Rights’ basic tenet states that systemic racism is an inherent cause for US BIPOC health disparities (Black Lives Matter, 2020; Surviving Race, 2021).
During SARS COVID19, BIPOC individuals are less able to survive barriers in place in the United States. US systemic racism and psychiatric oppression (Brown and Padron, 2021) is endemic and borders on it requiring an imminent Public Health Emergency status (Declaration Act of 2021). BIPOC Americans are dying four times higher than the national average of non- BIPOC populations. There is a dire need for an immediate Health Emergency statement (Louis- Jean, J., Cenat, K., Njoku, C., et al., 2020). This gross impact led to the eventual pairing for our work and call for a Resolution urging the United States Senate to enact the US BIPOC HEALTH DISPARITIES DECLARATION FOR A PUBLIC HEALTH EMERGENCY ACT OF 2021 (Padron, J.M., 2021) submitted to US Senator Raphael Warnock (ATL-D).
Disparities are used in health dialogue referencing racial or ethnic differences in achieved health status. When there is a noticeable, “… greater/lesser outcome between populations,” (US Department of Health and Human Services, 2020) it is considered a disparity1. This is not a recent phenomenon, having been in existence in the US for BIPOC population showing
“Differential health outcomes” for 400 years at least (Hammonds, E., Reverby, S., 2019). There exist many health disparities in the United States, but it is clearly discernable within the US Black, Indigenous People of Color (BIPOC) populations. Healthy People 2020 define a health disparity as “… health difference closely linked with social, economic, and/or environmental disadvantage.”2
US BIPOC people are sustaining centuries of racial oppression3 and historically have experienced poorer health outcomes because of our experienced racial and/or ethnic assignment. Dr. Tanya. M. Luhrmann states, “We argue that above all, it is the experience of “social defeat” that increases the risk and burden of schizophrenia, and that opportunities for social defeat are more abundant in the modern west. And anthropology plays a new role in the science of schizophrenia” and “… where standard psychiatric science cannot tell us what it is about culture that has that impact.” (Luhrmann, T.M., 2016).
Where COVID19 has affected the US BIPOC populations greater than non BIPOC populations from COVID19 (transmission, death) showing the disparities in health care access and treatment, it is solemnly tantamount to the 1918 Spanish Influenza pandemic, for example, in numbers lost to death. Subsequently, into today, the SARS COVID19 pandemic refocuses our attention to BIPOC Americans effected by it. It exemplifies the continued intersection of systemically racist based inequities compounding access to care. It propagates racial health disparities through a “lens of health equity,” (Cooper, L., Krishnan, L., Ogunwole, S., 2020). Obstacles to good (or better) health exist from disparate socioeconomic status, gender, age, mental health, cognitive, sensory, or physical disability, sexual orientation or gender identity, geographic location is closely linked to discrimination and exclusion (US Department of Health and Human Services, 2020).
To better explain health disparities and how it has affected the US BIPOC population, Healthy People 2020 reference the context of the health disparities in this population.4 The Department of Health and Human Services Action Plan to Reduce Racial and Ethnic Health Disparities (2011) prepared the ground for Healthy People 2020 and did outline an action plan to reduce health disparities among BIPOC, “promoting integrated approaches, EBT programs and best practices.”5
Since the Health People 2008 study, Healthy People 2020 bring health equity into focus, taking it to the next step beyond health disparities in Healthy People 2008. Health equity brings health for all people. Achieving health equity requires valuing everyone equally with focused and concentrated effort towards study of equalizing a playing field for achieved health status for US BIPOC people. Healthy People 2020 define health equity as, “… attainment of the highest level of ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.”12
Dr. Ruqaiijah Yearby, J.D., M.P.H., Co-Founder and Executive Director of the Institute for Healing Justice and Equity at Saint Louis University wrote in the September 2020 issue of Journal of Law, Medicine & Ethics “… social factors cause racial inequalities in access to
resources and opportunities (resulting) in racial health disparities,” (Yearby, R., 2020) relational to the US BIPOC population poorer health status; however, Dr. Yearby continues, “this recognition fails to acknowledge the root cause of these social inequalities: structural racism” resulting in health disparities. The current and historically relevant US national division is entrenched in systemic racism towards BIPOC people, “… in economic and social lines (that) have long been and continues to be defining features of American life with health disparities across racial groups considered consequences of these economic and social division.” (Moore, K., 2019).
The US BIPOC population are individuals which includes those living with disabilities facing basic and inherent challenges in addition to being a person of color13. In the seminal January 28, 2021, letter from the American Consortia of People with Disabilities and the Consortia for Persons with Disabilities to the United States Department of Health and Human Services, Secretary Designate Xavier Becerra, they state, “Disability is most prevalent in women and in Black, Indigenous, and People of Color. People with disabilities experience poverty at disproportionate rates.”14
The Disabilities Consortia further state, “… Two thirds of all coronavirus deaths have been BIPOC people with disabilities and staff in congregate settings. As we have seen in coronavirus data more broadly, congregate settings that primarily house residents of color, no matter their location, size, or government rating, have experienced deaths due to COVID19 at two to three times the rate as congregate settings that primarily housed white residents.”16 The US BIPOC populations are no stranger to existing racial crisis. With COVID19, US BIPOC populations face further challenges (Forman, H., Nunez-Smith, M., Tiako, M., 2021). Globally, “… 4 percent of the world’s population in the US accounts for 25 percent of the global number of confirmed COVID19 cases,” (BeLue, R., Chaney, C., Davis, D., 2020). BIPOC Americans have a disproportionate morbidity and mortality due to COVID1917.
To date, the numbers of deaths to COVID19 in the US surmounts to 63 million and 1.5 deaths globally18. BIPOC individuals have a greater susceptibility to contracting COVID19 out of age, a propensity for living with diabetes, hypertension and underlying respiratory and cardiovascular comorbidity associated with an increased risk to the virus (and developing COVID19 mutations) resulting in greater mortality19 for the US BIPOC citizenry. For immediate access to COVID-19 United States Cases by Country, States and Territories, please visit the Johns Hopkins University & Medicine Coronavirus Resource Center located at https://coronavirus.jhu.edu/us-map20.
Within the national context of health disparity, referring to differential health outcomes between BIPOC and Non BIPOC populations, limited access to medical care, resources and supportive services plays a vital role in the interplay between BIPOC higher numbers to morbidity and mortality (e.g., COVID19). COVID19 shows a terrible healthcare crisis in the US for people of color. With Black or African Americans dying nearly four times higher22 than the national average of Non BIPOC populations requires an immediate Health Emergency statement (Louis- Jean, J., Cenat, K., Njoku, C., et al., 2020).
Surviving Race: Intersection on Injustice, Disability and Human Rights stated in their formal recommendations to the President Biden Transition Team 2020-2021 how “The pandemic has shone a bright light on racial disparities in health and health care — as Black and Brown Americans have suffered and died from the coronavirus at rates far higher than white Americans. We are seeing a national reckoning on racial justice and the tragic human costs of systemic racism in the murders of Black men, women, and children.”23 BIPOC individuals’ health disparities extend into psychiatric oppression (Mental American Monster: The Sprawl of American Psychiatry, 2021) with firm evidence to the predominance of disparate mistreatment of individuals of color. Psychiatric oppression, for example, is not separating BIPOC from the >25+ year earlier morbidity and mortality in the US Public Community Mental Health System (Parks, et al., 2006; World Health Organization, 2020) remains the rule instead of the exception.
In the US, Black Americans make up 13.4% (US Census Bureau, 2019); However, mortality numbers for Blacks are 2.2 times greater than the rate for Latino/Hispanic Americans and 2.4 times greater than the rate for Asians, which is 2.6 higher than the rate for White Americans (Belue, R., Chaney, C., Davis, D. 2020). BIPOC racial health disparities propagate hate and ignoble systemic racism and discrimination towards people of color in the US. In what I consider a critical seminal text24, “Eliminating Race-Based Mental Health Disparities: Promoting Equity and Culturally Responsive Care Across Settings,” (Kanter, J., Rosen, D., Williams, M., 2019) the authors craft EBT practice and recommendations for clinicians and educators alike on how to best combat BIPOC health disparities in the behavioral health field utilizing multicultural competency and non-acculturalization of the US BIPOC community for nonbiased Recovery (clinical, medical model included) in general. Effects of the influence of racism and bias on BIPOC cultural behavior reveals a disproportionate number of BIPOC individuals receiving Serious Persistent Mental Illness diagnosis (e.g., Schizophrenia Spectrum Disorders and Psychosis, Bipolar Disorders).
Race-based stress and experienced trauma occur frequently in BIPOC populations and communities. Contextually and historically, BIPOC individuals comprise most of the incarceration and inpatient psychiatric hospitalization (Voluntarily/Involuntarily). It is derivative of archaic systemic racist practice and effected practice for learned assessment, diagnosis and treatment.25 Teachings on race, racism and cultural competence now addresses “… biases,
resistance, egocentrism,” of non BIPOC practitioners and providers (O Kanter, J., Rosen, D., Williams, M., 2019). With COVID19 (SARS-C0V-2) especially, the global pandemic has shown how “racialized” health inequality existing in the US compares to Non BIPOC populations (Louis-Jean, J., Cenat, K., Njoku, C., et al. (2020). BIPOC populations are at greater risk due to the burden of living with a Mental Health diagnosis, history holding a mental health history and now affected by COVID19. People living in high and/or at-risk geolocations are apt to not easily access desperately needed medical attention, care, support and services. BIPOC health disparities did not begin with COVID19 but the virus shows and highlights the pre-existence of racial health inequities experienced by the US BIPOC populations today.
Citations
1 Healthy People 2020, derived from Disparities | Healthy People 2020, March 20, 2021
2 Ibid.
3 Journal of Comparative Family Studies, retrieved March 20, 2020., Vol. 51 Issue 3/4/2020, p. 418.
4 Ibid.
5 “HHS action plan to reduce racial and ethnic health disparities: a nation free of disparities in health and health care,” US Department of Health and Human Services (2011)
6 U.S. Census Bureau, American FactFinder. American Community Survey. 2008 American Community Survey 1-year estimates [Internet]. ACS demographic and housing estimates: 2008 [cited 2010 November 7]. Available from: https://factfinder.census.gov.
[Internet]. ACS demographic and housing estimates: 2008 [cited 2010 November 7]. Available from: https://factfinder.census.gov.
7 Ibid.
8 U.S. Census Bureau, American FactFinder. American Community Survey. 2008 American Community Survey 1-year estimates [Internet]. Selected social characteristics in the United States: 2008 [cited 2010 November 7]. Available
9 U.S. Census Bureau, American FactFinder. American Community Survey. 2008 American Community Survey 1-year estimates [Internet]. B01003.Total population – universe: Total population [cited 2010 November 8]. Available
10 U.S. Census Bureau, American FactFinder. American Community Survey. 2008 American Community Survey 1-year estimates [Internet]. B01003.Total population – universe: Total population [cited 2010 November 8]. Available
11 Mayer KH, Bradford JB, Makadon HJ, et al. Sexual and gender minority health: What we know and what needs to be done. Am J Public Health. 2008;98:989–95. doi:10.2105/AJPH.2007.127811.
12 U.S. Department of Health and Human Services, Office of Minority Health. National Partnership for Action to End Health from: https://www.minorityhealth.hhs.gov/npa/templates/browse.aspx?&lvl=2&lvlid=34.
13 Retrieved February 13, 2021 https://diverseeducation.com/article/203762/
14 AAPD, CCPD Letter to US Secretary Designate Xavier Becerra, January 28, 2021.
15 Retrieved February 13, 2021 The Satcher Health Leadership Institute (SHLI) at Morehouse School of Medicine (MSM)
16 “The Striking Racial Divide in How Covid-19 Has Hit Nursing Homes.” New York Times. (September 2020). Available at Covid-19 and Nursing Homes: A Striking Racial Divide - The New York Times (nytimes.com).
17 Journal of Comparative Family Studies, retrieved March 20, 2020., Vol. 51 Issue 3/4/2020, pp. 417-428.
18 John Hopkins Coronavirus Resource Center, Retrieved March 20, 2021 link.springer.com/article/10.1007/s40615-020- 00938w.
19 Du, R., Liang, L., Yang, C., Wang, W., Cao, T., Li, M., et al., (2020). European Respiratory Journal; 55(5):2000524.
20 Johns Hopkins University & Medicine | Coronavirus Resource Center, retrieved March 20, 2021.
21 Johns Hopkins University & Medicine | Coronavirus Resource Center, Retrieved March 20, 2021 https://coronavirus.jhu.edu/region/us/georgia.
22 Louis-Jean, J., Cenat, K., Njoku, C., et al., “Coronavirus and Racial Disparities: A Perspective Analysis. Journal of Racial and Ethnic Health Disparities 7, 1039-1045 (2020).
23 Surviving Race: Intersection on Injustice, Disability and Human Rights, National Coalition on Mental Health Recovery, New York Association of Psychiatric Rehabilitation President Biden Transition Team BIPOC Recommendations, 2021 (Padron, J.M., Brown, C., Fisher, D., Rosenthal, H., 2021).
24 Kanter, J., Rosen, D., Williams, M. (2019). Eliminating Race-Based Mental Health Disparities: Promoting Equity and Culturally Responsive Care Across Settings, pp. ix-226.
25 Ibid., pp. x-226.