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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

© 2004 Jack R. Anderson

 

 

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

Categories: Ethics, MentalHealth