CHAPTER TWO: LITERATURE REVIEW
In this review of literature, I discuss the uniqueness of the African American population as a racial/ethnic minority group. Then, I discuss the observed underutilization of mental health services by African Americans and its significance for this population in regard to the perceived need of services. Lastly, I discuss the patterns of African American utilization and variables that influence continuation or discontinuation of services.
African Americans as a Racial/Ethnic Minority
African American Reference Labels
This paper uses the label, African American, to refer to all people of African descent, who are also referred to as Blacks or Afro-Americans in the literature reviewed. The term, Black, usually includes people of color from the Caribbean and Latin America (Goldberg, 1993). The term, African American, usually does not include these people of color. As Hill (1993), points out, there are 14 subcultures among Blacks in the United States, including those that are Afro-English, Afro-Spanish, and Afro-French. Although the concern of this thesis is with persons of African decent and with a history of slavery in the United States, the literature review discussed African Americans without distinction of whether or not the group included those of African descent with or without a history of slavery in the United States. However, much of the literature also uses the terms African American, Afro-American, and Blacks interchangeably. Thus, this literature review will use the term African American as an overarching category for the reference of African Americans, Afro-Americans, or Blacks in the literature reviewed.
African Americans are considered an ethnic minority (Ho, 1987; McGoldrick, Giordano, & Pearce, 1996). McGoldrick, et al. (1996) states that “the concept of a group’s ‘peoplehood’ is based on a combination of race, religion, and cultural history and is retained, whether or not members realize their commonalities with one another” (p.1). Ethnicity connotes a “common ancestry through which individuals have evolved shared values and customs.” It is also implies cultural uniqueness (Ho, 1987). African Americans share a common African ancestry and legacy of slavery in America, from which values and customs have evolved.
African American people are also viewed as a cultural group (Surgeon General, 1999). Culture refers to a shared heritage, beliefs, norms, and value system. There have been several African American cultural values that have been identified (Ho, 1987). These include: strong kinship bonds, strong education and work achievement orientation, flexibility in family roles, commitment to religious values and church participation, humanistic orientation, and endurance of suffering.
Simultaneously with being a unique cultural and ethnic group, African Americans are minorities in America. The term “minority” denotes a group of people who view themselves as economically and politically relatively powerless, with a history of unfair and discriminatory treatment (Ho, 1987). As with other minority groups, African Americans continue to struggle against discrimination in America.
Although African Americans constitute a distinct ethnic minority group in America, they also have a common racial distinction. Race is an important characteristic in the African American experience in America (Boyd-Franklin, 1989). Race refers to similarities in physical characteristics, such as skin color, hair texture, appearance, and implies a shared heritage and origin (Boyd-Franklin, 1993). However, it is a socially contrived category that assumes group homogeneity (Celious & Oyserman, 2001) and carries meaning in regard to status and privilege (Delgado & Stefancic, 2001). It is believed to serve the purpose of lumping a group of people into the same social status regardless of socioeconomic status to allow for the political oppression of the defined group (McGoldrick, et al, 1996). Thus, it is also imperative that African Americans are explored as a racial group, as well as an ethnic group to prevent the marginalization of the experience of race in America (Hardy & Laszloffy, 1994; cited in Leslie, 1995).
African Americans are a racial/ethnic minority group in America with a distinct culture (Boyd-Franklin, 1989). Thus, African Americans are discussed as racial minorities, ethnic minorities, and as a cultural group. Much of the literature has addressed African Americans under these terms. Thus, these concepts are discussed in this thesis in reference to African American people.
Much of the literature that discusses African Americans as a group, treated African Americans and African American families as a homogenous group. However, the entity referred to as the Black family does not exist (Allen, 1995; Boyd-Franklin, 1989). Treating African Americans as a homogeneous entity has functioned as a vehicle to distinguish African Americans from other racial/ethnic groups. However, African Americans are diverse in values, characteristics and lifestyles based on gender, age, skin tone, socioeconomic status, regional background, education, religious background, and level of acculturation (Allen, 1995; Boyd-Franklin, 1989; Celious & Oyserman, 2001). Unfortunately, making blanket statements about the Black family has been unproductive, resulting in an inaccurate view of the African American population (Boyd-Franklin, 1989).
Generalizations about African American people produce stereotypes (Allen, 1995). Stereotypes serve the purpose of reducing large and complicated information to manageable smaller categories; however, truth and the intricacies of African American family life are lost in blanket statements about African Americans. These stereotypes promote images of African American life that are perpetuated in the media, academia, and politics, which have negative consequences for all African Americans (Celious & Oyserman, 2001). These consequences differ based on characteristics such as socioeconomic status, gender, and skin tone of the individual African American.
Many of the generalizations about African Americans are referenced against White Americans, with White Americans representing the norm (Willie, 1988). Research literature abounds with Black-White dichotomies (Allen, 1995; Celious & Oyserman, 2001). The tradition has been to describe African American behavior and lifestyle against White Americans, as the ideal (Willie, 1988). Thus, there is a call for research to show the heterogeneity of the African American population in America (Allen, 1995; Celious & Oyserman, 2001; Willie, 1988). This heterogeneous view of African Americans should also be considered in the collection and interpretation of results in the research of African American mental health service use.
Researchers also suggest that race and class are not separated in evaluation of minorities (Boyd-Franklin, 1989; Snowden, 1999). McGoldrick & Giordano (1996) suggest that ethnicity is closely tied to economics and class. Some believe that class is more predictable of people’s behavior than ethnicity. This relationship of ethnicity and class is described as “ethclass” (McAdoo, 1993). Hence, it is proposed that the lives of minorities are examined by class and ethnicity status. There are distinct behavioral responses at the intersection of ethnicity and class (McAdoo, 1993). In addition, BoydFranklin (1989) argues that class distinctions within African Americans are not parallel to society’s distinction of class differences.
Some clinicians suggest that class is more important than race (Hill, 1993). However, some clinicians and researchers also challenge the “class not race” myth (Boyd-Franklin, 1989). They explain that this idea promotes an “illusion of color blindness.” Color blindness is the belief that a person should treat all persons the same regardless of race (Delgado & Stefancic, 2001). Boyd-Franklin (1989) suggests that it ignores racial and cultural differences. Some therapists may fear that seeing the color of a client’s skin as synonymous with discrimination (Hardy & Laszloffy, 1998). However, Delgado and Stefancic (2001) contend that the perception hinders the eradication of racism in American society because the discriminatory experiences based on race become marginalized. There are African American clients that have been raised in an all-White atmosphere that may advocate being “color blind” (Boyd-Franklin, 1989). However, despite differing perceptions of race in the African American community, race continues to influence African American advancement (Hill, 1993) and it is related to African American psychological well being (Boyd-Franklin, 1989)
Differing perceptions of race in the African American community is related to racial identity. Racial identity refers to the extent to which race influences a person’s self-concept and consequent behavior (Rowley, Sellers, Chavous, & Smith, 1998). In the African American population, racial identity is heterogeneous (Celious & Oyserman, 2001). It is affected by socioeconomic status and situational context. Rowley, et al. (1998) explains that all African Americans are able to articulate their feelings about being African American due to the significance placed on race in America. However, individuals differ on the degree to which those feelings influence the self-concept and are based on the meaning that they give to race.
Models of racial identity have been developed to conceptualize healthy racial identity (Sellers, et al., 1998). However, there have been different opinions of what constitutes healthy racial identity development for African Americans. In the beginning, researchers viewed African American racial identity within the context of oppression in America, without consideration of the influence of African American culture in the daily lives of African American people. The conceptualization of racial identity in these terms is called the mainstream approach. The mainstream approach focuses on a universal process of ethnic identity development and the significance of this to individuals. It also views African American racial identity as involving a damaged self-concept as a result of stigma in America.
Another group of researchers later began to espouse a new conceptualization of racial identity that incorporated the influence of African American culture on African American racial identity. This group’s collections of theories are called the underground approach. The underground approach examines the unique experience of African Americans in the context of culture and oppression. It also acknowledges the effect of stigma on the self-identity on African Americans but, in addition, it recognizes the positive impact of African American culture on ego development. Some researchers in the underground approach conceptualize African American racial identity as a continuum, with the values of the dominant society on the opposite end of African American cultural values. They suggested that healthy African American identity would lie on the end of the continuum that is closer to African American values, referring to a preference for own-group values. While others, such as Cross’s Nigrescence model, conceptualizes healthy identity development as five stages that culminate in the ability to view the positives and negatives of the Black race and the White race.
However, Sellers, et al. (1998) has integrated components of both the mainstream approach and the underground approach to African American racial identity. It is called the Multidimensional Model of Racial Identity (MMRI). According to these theorists, racial identity in African Americans is the “significance and qualitative meaning that individuals attribute to their membership within the Black racial group within their self-concept” (p.23). The theory does not determine if an individual’s racial identity is healthy or unhealthy, nor does it judge it as right or wrong. It is based on four assumptions and specifies four dimensions that are important in the examination of racial identity.
The first assumption is that identities are stable and situational dependent components of an individual (Sellers, et al., 1998). The self-concept is influenced by contextual cues and allows the stable components of the identity to influence the behavior at the specific event. The significance and qualitative meaning given to race by the individual represent the stable components of the identity. However, these stable components can gradually change over an individual’s lifetime, as the individual remains affected by social and developmental forces.
The second assumption is that individuals have many identities that are hierarchically ordered by the individual (Sellers, et al., 1998). The MMRI is concerned with how important race is to the individual’s self-identity. This assumption allows the MMRI to explore race within the context of other significant identities of an individual. The relative significance of other identities has implications for the significance of racial identity, as an African American.
The third assumption says that an individual’s view of their own racial identity is the best and most valid indicator of their identity (Sellers, et al., 1998). The MMRI recognizes that society influences the development of self but chooses to focus on the individual’s perception of their racial identity. It takes a phenomenological approach to racial identity. Although the focus is on the self-perception of racial identity, they also expect that behavior of the individual will be reflective of the racial identity characteristics perceived. However, the MMRI recognizes that contextual factors influence the relevance of race, thus behavior in a specific context may be more closely related to another salient identity.
The fourth assumption states that the MMRI is primarily concerned with the status of a person’s racial identity rather than the development (Sellers, et al., 1998). The MMRI chooses to emphasize the significance and nature of a person’s racial identity at a specific moment of time. It does not place individuals within a stage of development. It, however, acknowledges that a person’s perception of their racial identity will change over the lifetime.
The first dimension of the MMRI is called racial salience (Sellers, et al., 1998). It refers to the “extent to which one’s race is a relevant part of one’s self-concept at a particular moment or in a particular situation” (p.24). Salience examines the situation and the associated situational cues, and is related to the degree of significance given to race by the individual. Differences in individual racial salience become more apparent within ambiguous situations and are determined by the stable properties of race in the individual’s self-concept (Centrality). Racial salience, thus, is a mediator between the stable properties of racial identity and the behavior chosen within a given situation.
The second dimension is called racial centrality (Sellers, et al., 1998). It refers to the “extent to which a person normatively defines himself or herself with regard to race “(p. 25). It is considered to be a relatively stable dimension with different contexts. The unit if analysis is the perception of racial identity that remains more constant across different situations. Racial centrality also implies that individuals have identities that are hierarchically ordered.
The third dimension to be discussed is called racial regard (Sellers, et al., 1998). It refers to a “person’s affective and evaluative judgment of her or his race in terms of positive-negative valence” (p. 26). It addresses how positively or negatively an individual views their race. Regard has two components, private regard and public regard. Private regard is specifically relates to how negatively or positively one feels toward African Americans and being African American. Public regard is concerned with the extent that the individual believes others outside the African American race view African Americans positively or negatively.
The fourth dimension is called racial ideology (Sellers, et al., 1998). It deals with the individual’s beliefs, opinions, and attitudes about how African Americans should behave. Racial ideology addresses the individual’s perception of how African Americans should live and interact with the broader society. Four proscribed ideologies, nationalist ideology, oppressed minority ideology, assimilation ideology, and humanist ideology, have been suggested as representative of the beliefs of African Americans in respect to believed standards of African American behavior.
The nationalist ideology suggests that being Black is a unique experience (Sellers, et al., 1998). Those who espouse a nationalist ideology assert that African Americans should be in control of the group’s destiny, without regard to the opinions of other groups. They have an increased propensity to socialize within predominately African American contexts and be active in African American organizations. Nationalists may also view African American status as being marginalized and have a greater appreciation for the uniqueness of African American culture.
The oppressed minority ideology is concerned with the marginalization of African Americans (Sellers, et al., 1998). However, it is also concerned with the marginalization and oppression of other groups. Those who espouse oppressed minority beliefs are more likely to support social strategies of change that involve the cooperation of other groups.
Oppressed minority ideologists are also more likely to focus on the forces of oppression in general
CHAPTER ONE: INTRODUCTION
Statement of the Problem
Rationale of the Study
Critical Race Theory
The Multidimensional Model of Racial Identity
Purpose of the Study
CHAPTER TWO: LITERATURE REVIEW
African Americans as a Racial/Ethnic Minority
African American Reference Labels
African American Experience in America
Mental Health Services for Racial and Ethnic Minorities
African American Underutilization
CHAPTER THREE: METHODS
Design of the Study
Session Evaluation Questionnaire (SEQ)
Multidimensional Inventory of Black Identity (MIBI)
CHAPTER FOUR: RESULTS
Black and White Participants
Sample Description of Interview Participants
Multidimensional Inventory of Black Identity
Regina and David
CHAPTER FIVE: DISCUSSION
Summary of the Findings
Black and White Clients
Sample Description Similarities
Limitations of the Study
Implications for Future Research
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