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Learning Objectives
• Describe the epidemiology of PTSD.
• Describe the epidemiology of acute stress disorder.
• Describe the epidemiology of adjustment disorders.
• Describe the epidemiology of prolonged grief disorder.
PTSD
The national lifetime prevalence rate for PTSD using DSM-IV criteria is 6.8% for U.S. adults and 5.0% to 8.1% for U.S. adolescents. There are currently no definitive, comprehensive population-based data using DSM-5 though studies are beginning to emerge (APA, 2022). It should not come as a surprise that the rates of PTSD are higher among veterans and others who work in fields with high traumatic experiences (i.e., firefighters, police, EMTs, emergency room providers). In fact, PTSD rates for combat veterans are estimated to be as high as 30% (NcNally, 2012). Between one-third and one-half of all PTSD cases consist of rape survivors, military combat and captivity, and ethnically or politically motivated genocide (APA, 2022).
Concerning gender, PTSD is more prevalent among females (8% to 11%) than males (4.1% to 5.4%), likely due to their higher occurrence of exposure to traumatic experiences such as childhood sexual abuse, rape, domestic abuse, and other forms of interpersonal violence. Women also experience PTSD for a longer duration. (APA, 2022). Gender differences are not found in populations where both males and females are exposed to significant stressors suggesting that both genders are equally predisposed to developing PTSD. Prevalence rates vary slightly across cultural groups, which may reflect differences in exposure to traumatic events. More specifically, prevalence rates of PTSD are highest for African Americans, followed by Latinx Americans and European Americans, and lowest for Asian Americans (Hinton & Lewis-Fernandez, 2011). According to the DSM-5-TR, there are higher rates of PTSD among Latinx, African-Americans, and American Indians compared to whites, and likely due to exposure to past adversity and racism and discrimination (APA, 2022).
Acute Stress Disorder
The prevalence rate for acute stress disorder varies across the country and by traumatic event. Accurate prevalence rates for acute stress disorder are difficult to determine as patients must seek treatment within 30 days of the traumatic event. Despite that, it is estimated that anywhere between 7-30% of individuals experiencing a traumatic event will develop acute stress disorder (National Center for PTSD). While acute stress disorder is not a good predictor of who will develop PTSD, approximately 50% of those with acute stress disorder do eventually develop PTSD (Bryant, 2010; Bryant, Friedman, Speigel, Ursano, & Strain, 2010).
As with PTSD, acute stress disorder is more common in females than males; however, unlike PTSD, there may be some neurobiological differences in the stress response, gender differences in the emotional and cognitive processing of trauma, and sociocultural factors that contribute to females developing acute stress disorder more often than males (APA, 2022). With that said, the increased exposure to traumatic events among females may also be a strong reason why women are more likely to develop acute stress disorder.
Adjustment Disorder
Adjustment disorders are relatively common as they describe individuals who are having difficulty adjusting to life after a significant stressor. In psychiatric hospitals in the U.S., Australia, Canada, and Israel, adjustment disorders accounted for roughly 50% of the admissions in the 1990s. It is estimated that anywhere from 5-20% of individuals in outpatient mental health treatment facilities have an adjustment disorder as their principal diagnosis. Adjustment disorder has been found to be higher in women than men (APA, 2022).
Prolonged Grief Disorder
As this is a new disorder, the prevalence of DSM-5 prolonged grief disorder is currently unknown. Using a different definition of the disorder a meta-analysis of studies across four continents suggests a pooled prevalence of 9.8%. It should be noted that these studies could only be loosely compared with one another making the reported prevalence rate questionable.
Key Takeaways
You should have learned the following in this section:
• Regarding PTSD, rates are highest among people who are likely to be exposed to high traumatic events, women, and minorities.
• As for acute stress disorder, prevalence rates are hard to determine since patients must seek medical treatment within 30 days, but females are more likely to develop the disorder.
• Adjustment disorders are relatively common since they occur in individuals having trouble adjusting to a significant stressor, though women tend to receive a diagnosis more than men.
Review Questions
1. Compare and contrast the prevalence rates among the trauma and stress-related disorders.
2. What do we know about the prevalence rate for prolonged grief disorder and why? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/02%3A_Part_II._Mental_Disorders__Block_1/05%3A_Trauma-_and_Stressor-Related_Disorders/5.03%3A_Trauma-_and_Stressor-Rel.txt |
Learning Objectives
• Describe the comorbidity of PTSD.
• Describe the comorbidity of acute stress disorder.
• Describe the comorbidity of adjustment disorder.
• Describe the comorbidity of prolonged grief disorder.
PTSD
Given the traumatic nature of the disorder, it should not be surprising that there is a high comorbidity rate between PTSD and other psychological disorders. Individuals with PTSD are more likely than those without PTSD to report clinically significant levels of depressive, bipolar, anxiety, or substance abuse-related symptoms (APA, 2022). There is also a strong relationship between PTSD and major neurocognitive disorders, which may be due to the overlapping symptoms between these disorders (Neurocognitive Disorders will be covered in Module 14).
Acute Stress Disorder
Because 30 days after the traumatic event, acute stress disorder becomes PTSD (or the symptoms remit), the comorbidity of acute stress disorder with other psychological disorders has not been studied. While acute stress disorder and PTSD cannot be comorbid disorders, several studies have explored the relationship between the disorders to identify individuals most at risk for developing PTSD. The literature indicates roughly 80% of motor vehicle accident survivors, as well as assault victims, who met the criteria for acute stress disorder went on to develop PTSD (Brewin, Andrews, Rose, & Kirk, 1999; Bryant & Harvey, 1998; Harvey & Bryant, 1998). While some researchers indicated acute stress disorder is a good predictor of PTSD, others argue further research between the two and confounding variables should be explored to establish more consistent findings.
Adjustment Disorder
Unlike most of the disorders we have reviewed thus far, adjustment disorders have a high comorbidity rate with various other medical conditions (APA, 2022). Often following a critical or terminal medical diagnosis, an individual will meet the criteria for adjustment disorder as they process the news about their health and the impact their new medical diagnosis will have on their life. Other psychological disorders are also diagnosed with adjustment disorder; however, symptoms of adjustment disorder must be met independently of the other psychological condition. For example, an individual with adjustment disorder with depressive mood must not meet the criteria for a major depressive episode; otherwise, the diagnosis of MDD should be made over adjustment disorder. As the DSM-5-TR says, “adjustment disorders are common accompaniments of medical illness and may be the major psychological response to a medical condition” (APA, 2022).
Prolonged Grief Disorder
Prolonged grief disorder is commonly comorbid with MDD, PTSD if the death occurred in violent or accidental circumstances, substance use disorders, and separation anxiety disorder.
Key Takeaways
You should have learned the following in this section:
• PTSD has a high comorbidity rate with psychological and neurocognitive disorders while this rate is hard to establish with acute stress disorder since it becomes PTSD after 30 days.
• Adjustment disorder has a high comorbidity rate with other medical conditions as people process news about their health and what the impact of a new medical diagnosis will be on their life.
• Prolonged grief disorder has a high comorbidity with PTSD, MDD, separation anxiety disorder, and substance use disorders.
Review Questions
1. What are the most common comorbidities among trauma and stress-related disorders?
2. Why is it hard to establish comorbidities for acute stress disorder? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/02%3A_Part_II._Mental_Disorders__Block_1/05%3A_Trauma-_and_Stressor-Related_Disorders/5.04%3A_Trauma-_and_Stressor-Rel.txt |
Learning Objectives
• Describe the biological causes of trauma- and stressor-related disorders.
• Describe the cognitive causes of trauma- and stressor-related disorders.
• Describe the social causes of trauma- and stressor-related disorders.
• Describe the sociocultural causes of trauma- and stressor-related disorders.
Biological
HPA axis. One theory for the development of trauma and stress-related disorders is the over-involvement of the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis is involved in the fear-producing response, and some speculate that dysfunction within this axis is to blame for the development of trauma symptoms. Within the brain, the amygdala serves as the integrative system that inherently elicits the physiological response to a traumatic/stressful environmental situation. The amygdala sends this response to the HPA axis to prepare the body for “fight or flight.” The HPA axis then releases hormones—epinephrine and cortisol—to help the body to prepare to respond to a dangerous situation (Stahl & Wise, 2008). While epinephrine is known to cause physiological symptoms such as increased blood pressure, increased heart rate, increased alertness, and increased muscle tension, to name a few, cortisol is responsible for returning the body to homeostasis once the dangerous situation is resolved.
Researchers have studied the amygdala and HPA axis in individuals with PTSD, and have identified heightened amygdala reactivity in stressful situations, as well as excessive responsiveness to stimuli that is related to one’s specific traumatic event (Sherin & Nemeroff, 2011). Additionally, studies have indicated that individuals with PTSD also show a diminished fear extinction, suggesting an overall higher level of stress during non-stressful times. These findings may explain why individuals with PTSD experience an increased startle response and exaggerated sensitivity to stimuli associated with their trauma (Schmidt, Kaltwasser, & Wotjak, 2013).
Cognitive
Preexisting conditions of depression or anxiety may predispose an individual to develop PTSD or other stress disorders. One theory is that these individuals may ruminate or over-analyze the traumatic event, thus bringing more attention to the traumatic event and leading to the development of stress-related symptoms. Furthermore, negative cognitive styles or maladjusted thoughts about themselves and the environment may also contribute to PTSD symptoms. For example, individuals who identify life events as “out of their control” report more severe stress symptoms than those who feel as though they have some control over their lives (Catanesi et al., 2013).
Social
While this may hold for many psychological disorders, social and family support have been identified as protective factors for individuals prone to develop PTSD. More specifically, rape victims who are loved and cared for by their friends and family members as opposed to being judged for their actions before the rape, report fewer trauma symptoms and faster psychological improvement (Street et al., 2011).
Sociocultural
As was mentioned previously, different ethnicities report different prevalence rates of PTSD. While this may be due to increased exposure to traumatic events, there is some evidence to suggest that cultural groups also interpret traumatic events differently, and therefore, may be more vulnerable to the disorder. Hispanic Americans have routinely been identified as a cultural group that experiences a higher rate of PTSD. Studies ranging from combat-related PTSD to on-duty police officer stress, as well as stress from a natural disaster, all identify Hispanic Americans as the cultural group experiencing the most traumatic symptoms (Kaczkurkin et al., 2016; Perilla et al., 2002; Pole et al., 2001).
Women also report a higher incidence of PTSD symptoms than men. Some possible explanations for this discrepancy are stigmas related to seeking psychological treatment, as well as a greater risk of exposure to traumatic events that are associated with PTSD (Kubiak, 2006). Studies exploring rates of PTSD symptoms for military and police veterans have failed to report a significant gender difference in the diagnosis rate of PTSD suggesting that there is not a difference in the rate of occurrence of PTSD in males and females in these settings (Maguen, Luxton, Skopp, & Madden, 2012).
Key Takeaways
You should have learned the following in this section:
• In terms of causes for trauma- and stressor-related disorders, an over-involvement of the hypothalamic-pituitary-adrenal (HPA) axis has been cited as a biological cause, with rumination and negative coping styles or maladjusted thoughts emerging as cognitive causes.
• Culture may lead to different interpretations of traumatic events thus causing higher rates among Hispanic Americans.
• Social and family support have been found to be protective factors for individuals most likely to develop PTSD.
Review Questions
1. Discuss the four etiological models of the trauma- and stressor-related disorders. Which model best explains the maintenance of trauma/stress symptoms? Which identifies protective factors for the individual? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/02%3A_Part_II._Mental_Disorders__Block_1/05%3A_Trauma-_and_Stressor-Related_Disorders/5.05%3A_Trauma-_and_Stressor-Rel.txt |
Learning Objectives
• Describe the treatment approach of the psychological debriefing.
• Describe the treatment approach of exposure therapy.
• Describe the treatment approach of CBT.
• Describe the treatment approach of Eye Movement Desensitization and Reprocessing (EMDR).
• Describe the use of psychopharmacological treatment.
Psychological Debriefing
One way to negate the potential development of PTSD symptoms is thorough psychological debriefing. Psychological debriefing is considered a type of crisis intervention that requires individuals who have recently experienced a traumatic event to discuss or process their thoughts and feelings related to the traumatic event, typically within 72 hours of the event (Kinchin, 2007). While there are a few different methods to a psychological debriefing, they all follow the same general format:
1. Identifying the facts (what happened?)
2. Evaluating the individual’s thoughts and emotional reaction to the events leading up to the event, during the event, and then immediately following
3. Normalizing the individual’s reaction to the event
4. Discussing how to cope with these thoughts and feelings, as well as creating a designated social support system (Kinchin, 2007).
Throughout the last few decades, there has been a debate on the effectiveness of psychological debriefing. Those within the field argue that psychological debriefing is not a means to cure or prevent PTSD, but rather, psychological debriefing is a means to assist individuals with a faster recovery time posttraumatic event (Kinchin, 2007). Research across a variety of traumatic events (i.e., natural disasters, burns, war) routinely suggests that psychological debriefing is not helpful in either the reduction of posttraumatic symptoms nor the recovery time of those with PTSD (Tuckey & Scott, 2014). One theory is these early interventions may encourage patients to ruminate on their symptoms or the event itself, thus maintaining PTSD symptoms (McNally, 2004). In efforts to combat these negative findings of psychological debriefing, there has been a large movement to provide more structure and training for professionals employing psychological debriefing, thus ensuring that those who are providing treatment are properly trained to do so.
Exposure Therapy
While exposure therapy is predominately used in anxiety disorders, it has also shown great success in treating PTSD-related symptoms as it helps individuals extinguish fears associated with the traumatic event. There are several different types of exposure techniques—imaginal, in vivo, and flooding are among the most common types (Cahill, Rothbaum, Resick, & Follette, 2009).
In imaginal exposure, the individual mentally re-creates specific details of the traumatic event. The patient is then asked to repeatedly discuss the event in increasing detail, providing more information regarding their thoughts and feelings at each step of the event. During in vivo exposure, the individual is reminded of the traumatic event through the use of videos, images, or other tangible objects related to the traumatic event that induces a heightened arousal response. While the patient is re-experiencing cognitions, emotions, and physiological symptoms related to the traumatic experience, they are encouraged to utilize positive coping strategies, such as relaxation techniques, to reduce their overall level of anxiety.
Imaginal exposure and in vivo exposure are generally done in a gradual process, with imaginal exposure beginning with fewer details of the event, and slowly gaining information over time. In vivo starts with images or videos that elicit lower levels of anxiety, and then the patient slowly works their way up a fear hierarchy, until they are able to be exposed to the most distressing images. Another type of exposure therapy, flooding, involves disregard for the fear hierarchy, presenting the most distressing memories or images at the beginning of treatment. While some argue that this is a more effective method, it is also the most distressing and places patients at risk for dropping out of treatment (Resick, Monson, & Rizvi, 2008).
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy, as discussed in the mood disorders chapter, has been proven to be an effective form of treatment for trauma/stress-related disorders. It is believed that this type of treatment is effective in reducing trauma-related symptoms due to its ability to identify and challenge the negative cognitions surrounding the traumatic event, and replace them with positive, more adaptive cognitions (Foa et al., 2005).
Trauma-focused cognitive-behavioral therapy (TF-CBT) is an adaptation of CBT that utilizes both CBT techniques and trauma-sensitive principles to address the trauma-related symptoms. According to the Child Welfare Information Gateway (CWIG; 2012), TF-CBT can be summarized via the acronym PRACTICE:
• P: Psycho-education about the traumatic event. This includes discussion about the event itself, as well as typical emotional and/or behavioral responses to the event.
• R: Relaxation Training. Teaching the patient how to engage in various types of relaxation techniques such as deep breathing and progressive muscle relaxation.
• A: Affect. Discussing ways for the patient to effectively express their emotions/fearsrelated to the traumatic event.
• C: Correcting negative or maladaptive thoughts.
• T: Trauma Narrative. This involves having the patient relive the traumatic event (verbally or written), including as many specific details as possible.
• I: In vivo exposure (see above).
• C: Co-joint family session. This provides the patient with strong social support and a sense of security. It also allows family members to learn about the treatment so that they are able to assist the patient if necessary.
• E: Enhancing Security. Patients are encouraged to practice the coping strategies they learn in TF-CBT to prepare for when they experience these triggers out in the real world, as well as any future challenges that may come their way.
Eye Movement Desensitization and Reprocessing (EMDR)
In the late 1980s, psychologist Francine Shapiro found that by focusing her eyes on the waving leaves during her daily walk, her troubling thoughts resolved on their own. From this observation, she concluded that lateral eye movements facilitate the cognitive processing of traumatic thoughts (Shapiro, 1989).
While EMDR has evolved somewhat since Shapiro’s first claims, the basic components of EMDR consist of lateral eye movement induced by the therapist moving their index finger back and forth, approximately 35 cm from the client’s face, as well as components of cognitive-behavioral therapy and exposure therapy. The following 8-step approach is the standard treatment approach of EMDR (Shapiro & Maxfield, 2002):
1. Patient History and Treatment Planning – Identify trauma symptoms and potential barriers to treatment.
2. Preparation – Psychoeducation of trauma and treatment.
3. Assessment – Careful and detailed evaluation of the traumatic event. Patient identifies images, cognitions, and emotions related to the traumatic event, as well as trauma-related physiological symptoms.
4. Desensitization and Reprocessing – Holding the trauma image, cognition, and emotion in mind, while simultaneously assessing their physiological symptoms, the patient must track the clinician’s finger movement for approximately 20 seconds. At this time, the patient must “blank it out” and let go of the memory.
5. Installation of Positive Cognitions – Once the negative image, cognition, and emotions are reduced, the patient must hold onto a positive image or thought while again tracking the clinician’s finger movement for approximately 20 seconds.
6. Body Scan – Patient must identify any lingering bodily sensations while again tracking the clinician’s fingers for a third time to discard any remaining trauma symptoms.
7. Closure – Patient is provided with positive coping strategies and relaxation techniques to assist with any recurrent cognitions or emotions related to the traumatic experience.
8. Reevaluation – Clinician assesses if treatment goals were met. If not, schedules another treatment session and identifies remaining symptoms.
As you can see from above, only steps 4-6 are specific to EMDR; the remaining treatment is essentially a combination of exposure therapy and cognitive-behavioral techniques. Because of the high overlap between treatment techniques, there have been quite a few studies comparing the treatment efficacy of EMDR to TF-CBT and exposure therapy. While research initially failed to identify a superior treatment, often citing EMDR and TF-CBT as equally efficacious in treating PTSD symptoms (Seidler & Wagner, 2006), more recent studies have found that EMDR may be superior to that of TF-CBT, particularly in psycho-oncology patients (Capezzani et al., 2013; Chen, Zang, Hu & Liang, 2015). While meta-analytic studies continue to debate which treatment is the most effective in treating PTSD symptoms, the World Health Organization’s (2013) publication on the Guidelines for the Management of Conditions Specifically Related to Stress, identified TF-CBT and EMDR as the only recommended treatment for individuals with PTSD.
The National Institute for Health and Care Excellence (NICE) says to consider EMDR for adults with a diagnosis of PTSD and who presented between 1 and 3 months after a non-combat related trauma if the person shows a preference for EMDR and to offer it to adults with a diagnosis of PTSD who have presented more than three months after a non-combat related trauma. They state that EMDR for adults should (cited directly from their website):
• be based on a validated manual
• typically be provided over 8 to 12 sessions, but more if clinically indicated, for example if they have experienced multiple traumas
• be delivered by trained practitioners with ongoing supervision
• be delivered in a phased manner and include psychoeducation about reactions to trauma; managing distressing memories and situations; identifying and treating target memories (often visual images); and promoting alternative positive beliefs about the self
• use repeated in-session bilateral stimulation (normally with eye movements but use other methods, including taps and tones, if preferred or more appropriate, such as for people who are visually impaired) for specific target memories until the memories are no longer distressing
• include the teaching of self-calming techniques and techniques for managing flashbacks, for use within and between sessions.
For more on NICE’s PTSD guidance (2018) as it relates to EMDR, please see Sections 1.6.18 to 1.6.20: https://www.nice.org.uk/guidance/ng116/chapter/Recommendations
Psychopharmacological Treatment
While psychopharmacological interventions have been shown to provide some relief, particularly to veterans with PTSD, most clinicians agree that resolution of symptoms cannot be accomplished without implementing exposure and/or cognitive techniques that target the physiological and maladjusted thoughts maintaining the trauma symptoms. With that said, clinicians agree that psychopharmacology interventions are an effective second line of treatment, particularly when psychotherapy alone does not produce relief from symptoms.
Among the most common types of medications used to treat PTSD symptoms are selective serotonin reuptake inhibitors (SSRIs; Bernardy & Friedman, 2015). As previously discussed in the depression chapter, SSRIs work by increasing the amount of serotonin available to neurotransmitters. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are also recommended as second-line treatments. Their effectiveness is most often observed in individuals who report co-occurring major depressive disorder symptoms, as well as those who do not respond to SSRIs (Forbes et al., 2010). Unfortunately, due to the effective CBT and EMDR treatment options, research on psychopharmacological interventions has been limited. Future studies exploring other medication options are needed to determine if there are alternative medication options for stress/trauma disorder patients.
Key Takeaways
You should have learned the following in this section:
• Several treatment approaches are available to clinicians to alleviate the symptoms of trauma- and stressor-related disorders.
• The first approach, psychological debriefing, has individuals who have recently experienced a traumatic event discuss or process their thoughts related to the event and within 72 hours.
• Another approach is to expose the individual to a fear hierarchy and then have them use positive coping strategies such as relaxation techniques to reduce their anxiety or to toss the fear hierarchy out and have the person experience the most distressing memories or images at the beginning of treatment.
• The third approach is Cognitive Behavioral Therapy (CBT) and attempts to identify and challenge the negative cognitions surrounding the traumatic event and replace them with positive, more adaptive cognitions.
• The fourth approach, called EMDR, involves an 8-step approach and the tracking of a clinician’s fingers which induces lateral eye movements and aids with the cognitive processing of traumatic thoughts.
• Finally, when psychotherapy does not produce relief from symptoms, psychopharmacology interventions are an effective second line of treatment and may include SSRIs, TCAs, and MAOIs.
Review Questions
1. Identify the different treatment options for trauma and stress-related disorders. Which treatment options are most effective? Which are least effective?
Module Recap
In Module 5, we discussed trauma- and stressor-related disorders to include PTSD, acute stress disorder, adjustment disorder, and prolonged stress disorder. We defined what stressors were and then explained how these disorders present. In addition, we clarified the epidemiology, comorbidity, and etiology of each disorder. Finally, we discussed potential treatment options for trauma- and stressor-related disorders. Our discussion in Module 6 moves to dissociative disorders. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/02%3A_Part_II._Mental_Disorders__Block_1/05%3A_Trauma-_and_Stressor-Related_Disorders/5.06%3A_Trauma-_and_Stressor-Rel.txt |
Learning Objectives
• Describe how dissociative disorders present.
• Describe the epidemiology of dissociative disorders.
• Describe comorbidity in relation to dissociative disorders.
• Describe the etiology of dissociative disorders.
• Describe treatment options for dissociative disorders.
In Module 6, we will discuss matters related to dissociative disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will consist of dissociative identity disorder, dissociative amnesia, and depersonalization/ derealization. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of models to explain psychopathology (Module 2), and descriptions of the various therapies (Module 3).
06: Dissociative Disorders
Learning Objectives
• Describe dissociative disorders.
• Describe how dissociative identity disorder presents.
• Describe how dissociative amnesia presents.
• Describe how depersonalization/derealization presents.
Dissociative disorders are a group of disorders characterized by symptoms of disruption and/or discontinuity in consciousness, memory, identity, emotion, body representation, perception, motor control, and behavior (APA, 2022). These symptoms are likely to appear following a significant stressor or years of ongoing stress (i.e., abuse; Maldonadao & Spiegel, 2014). Occasionally, one may experience temporary dissociative symptoms due to lack of sleep or ingestion of a substance; however, these would not qualify as a dissociative disorder due to the lack of impairment in functioning. Furthermore, individuals who suffer from acute stress disorder and PTSD often experience dissociative symptoms, such as amnesia, numbing, flashbacks, and depersonalization/derealization. However, because of the identifiable stressor (and lack of additional symptoms listed below), they meet diagnostic criteria for a stress disorder as opposed to a dissociative disorder.
There are three main types of dissociative disorders: dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder.
Dissociative Identity Disorder (DID)
The key diagnostic criteria for dissociative identity disorder is the presence of two or more distinct personality states or an experience of possession (Criteria A). How overt or covert the personality states are depends on psychological motivation, stress level, cultural context, emotional resilience, and internal conflicts and dynamics (APA, 2022), and severe or prolonged stress may result in sustained periods of identify confusion/alteration. Those presenting as being possessed by spirits or demons and for a small proportion of non-possession-form cases, the alternate identifies are readily observable. Generally, though, the identities in non-possession-form dissociative identity disorder are not overtly displayed or only subtly displayed and when they are, it is just in a minority of individuals and manifests as different names, hairstyles, handwritings, wardrobes, accents, etc. If the alternate identities are not observable, their presence is identified through sudden alterations or discontinuities in the individual’s sense of self and sense of agency, as well as recurrent dissociative amnesias (see the second criteria below; APA, 2022).
The second main diagnostic criteria (Criteria B) for dissociative identity disorder is that there must be a gap in the recall of events, information, or trauma due to the switching of personalities. These gaps are more excessive than typical forgetting one may experience due to a lack of attention. The dissociative amnesia presents as gaps in autobiographical memory, lapses in memory of well-learned skills or recent events, and discovering possessions for which there is no recollection of ever owning, and can involve everyday events and not just events that are stressful or traumatic.
It should be noted that most possession states occurring around the world are part of broadly accepted cultural or religious practice and should not be diagnosed as dissociative identity disorder (Criteria D). The possession-form identities in dissociative identity disorder manifest most often as a spirit or supernatural being taking control and the individual speaking or acting in a distinctly different way. These identities present recurrently, are involuntary and unwanted, and cause significant distress or impairment (Criteria C). Impairment varies in adults from minimal (i.e., high functioning professionals) to profound. For those minimally affected, marital, family, relational, and parenting functions are more likely to be impaired by symptoms of dissociative identity disorder rather than their occupational and professional life.
While personalities can present at any time, there is generally a dominant or primary personality that is present most of the time. From there, an individual may have several subpersonalities. Although it is hard to identify how many subpersonalities an individual may have at one time, it is believed that there are on average 15 subpersonalities for women and 8 for men (APA, 2000).
The switching or shifting between personalities varies among individuals and can range from merely appearing to fall asleep, to very dramatic, involving excessive bodily movements, though for most, the change is subtle and may occur with only subtle changes in overt presentation. When sudden and unexpected, switching is generally precipitated by a significant stressor, as the subpersonality best equipped to handle the current stressor will present. The relationship between subpersonalities varies between individuals, with some individuals reporting knowledge of other subpersonalities while others have a one-way amnesic relationship with subpersonalities, meaning they are not aware of other personalities (Barlow & Chu, 2014). These individuals will experience episodes of “amnesia” when the primary personality is not present.
Dissociative Amnesia
Dissociative amnesia is identified by the inability to recall important autobiographical information, usually of a traumatic or stressful nature. It often consists of selective amnesia for a specific event or events or generalized amnesia for identity and life history. This type of amnesia is different from what one would consider permanent amnesia in that the information was successfully stored in memory but cannot be freely recollected. It is conceptualized as possibly being a reversible memory retrieval deficit. Additionally, individuals experiencing permanent amnesia often have a neurobiological cause, whereas dissociative amnesia does not (APA, 2022).
There are a few types of amnesia within dissociative amnesia. Localized amnesia, the most common type, is the inability to recall events during a specific period. The length of time within a localized amnesia episode can vary—it can be as short as the time immediately surrounding a traumatic event, to months or years, should the traumatic event occur that long (as commonly seen in abuse and combat situations). Selective amnesia is, in a sense, a component of localized amnesia in that the individual can recall some, but not all, of the details during a specific period. For example, a soldier may experience dissociative amnesia during the time they were deployed, yet still have some memories of positive experiences such as celebrating Thanksgiving or Christmas dinner with the members of their unit. Systematized amnesia occurs when an individual fails to recall a specific category of information such as not recalling a specific room in their childhood home.
Conversely, some individuals experience generalized dissociative amnesia in which they have a complete loss of memory for most or all of their life history, including their own identity, previous knowledge about the world, and/or well-learned skills. Individuals who experience this amnesia experience deficits in both semantic and procedural knowledge. This means that individuals have no common knowledge of (i.e., cannot identify letters, colors, numbers) nor can they engage in learned skills (i.e., typing shoes, driving car). While generalized dissociative amnesia is extremely rare, it is also extremely frightening. The onset is acute, and the individual is often found wandering in a state of disorientation. Many times, these individuals are brought into emergency rooms by law enforcement following a dangerous situation such as an individual wandering on a busy road.
The distress and impairment suffered by those with dissociative amnesia resulting from childhood/adolescent traumatization varies. Some are chronically impaired in their ability to form and sustain satisfactory attachments while others are highly successful in their occupation due to compulsive overwork. And finally, a substantial subgroup of those afflicted by generalized dissociative amnesia develop a highly impairing, chronic autobiographical memory deficit that is not ameliorated by relearning their life history, resulting in poor overall functioning in most life domains (APA, 2022).
Depersonalization/Derealization Disorder
Depersonalization/derealization disorder is categorized by recurrent episodes of depersonalization and/or derealization. Depersonalization can be defined as a feeling of unreality or detachment from oneself. Individuals describe this feeling as an out-of-body experience where you are an observer of your thoughts, feelings, and physical being. Furthermore, some patients report feeling as though they lack speech or motor control, thus feeling at times like a robot. Distortions of one’s physical body have also been reported, with various body parts appearing enlarged or shrunken. Emotionally, one may feel detached from their feelings, lacking the ability to feel emotions despite knowing they have them.
Symptoms of derealization include feelings of unreality or detachment from the world—whether it be individuals, objects, or their surroundings. For example, an individual may feel as though they are unfamiliar with their surroundings, even though they are in a place they have been to many times before. Feeling emotionally disconnected from close friends or family members whom they have strong feelings for is another common symptom experienced during derealization episodes. Sensory changes have also been reported, such as feeling as though your environment is distorted, blurry, or even artificial. Distortions of time, distance, and size/shape of objects may also occur.
These episodes can last anywhere from a few hours to days, weeks, or even months. The onset is generally sudden, and like the other dissociative disorders, is often triggered by intense stress or trauma. Many individuals describe feeling like they are “crazy” or “going crazy” and fear they have irreversible brain damage. They experience an altered sense of time and may be obsessed about whether they really exist.
As one can imagine, depersonalization/derealization disorder can cause significant emotional distress, as well as impairment in one’s daily functioning. The disorder is associated with major morbidity and impairment occurs in both interpersonal and occupational spheres due to “…the hypoemotionality with others, subjective difficulty in focusing and retaining information, and a general sense of disconnectedness form life” (APA, 2022).
Key Takeaways
You should have learned the following in this section:
• Dissociative disorders are characterized by disruption in consciousness, memory, identity, emotion, perception, motor control, or behavior. They include dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder.
• Dissociative identity disorder is the presence of two or more distinct personality states or an experience of possession.
• Dissociative amnesia is characterized by the inability to recall important autobiographical information, whether during a specific period (localized) or one’s entire life (generalized).
• Depersonalization/derealization disorder includes a feeling of unreality or detachment from oneself (depersonalization) and feelings of unreality or detachment from the world (derealization).
Review Questions
1. Identify the diagnostic criteria for each of the three dissociative disorders. How are they similar? How are they different?
2. What are the types of amnesia within dissociative amnesia?
3. What is the difference between depersonalization and derealization? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/02%3A_Part_II._Mental_Disorders__Block_1/06%3A_Dissociative_Disorders/6.01%3A_Dissociative_Disorders_-_Clinical_Presen.txt |
Learning Objectives
• Describe the epidemiology of dissociative disorders.
Dissociative disorders were once believed to be extremely rare; however, more recent research suggests that they may be more present in the general population than once thought. Estimates for the prevalence of dissociative identity disorder in U.S. adults is 1.5%, with women predominating in adult clinical settings. Symptom profiles, clinical history, and childhood trauma history show few gender differences though women have higher rates of somatization. Research shows that dissociative amnesia occurs in approximately 1.8% of the U.S. population. It is estimated that about one-half of all adults have experienced at least one episode of depersonalization/derealization during their life, however, symptomatology that meets full criteria for the disorder is markedly less common than these transient symptoms. A one-month prevalence of about 1-2% was reported in the United Kingodm (APA, 2022).
The onset of dissociative disorders is generally late adolescence to early adulthood, with the exception of dissociative identity disorder. Due to the high comorbidity between childhood abuse and dissociative identity disorder, it is believed that symptoms begin in early childhood following the repeated exposure to abuse; however, the full onset of the disorder is not observed (or noticed by others) until adolescence (Sar et al., 2014).
Key Takeaways
You should have learned the following in this section:
• Dissociative identity disorder has a prevalence of 1.5% and dissociative amnesia occurs in approximately 1.8% of the U.S. population.
• Estimates for depersonalization/derealization disorder are unknown, though it is believed that about half of all adults have experienced at least one episode during their life (i.e. transient symptoms and not full criteria).
Review Questions
1. What are the prevalence rates for dissociative disorders? What are some identified barriers in determining prevalence rates of these disorders?
6.03: Dissociative Disorders - Comorbidity
Learning Objectives
• Describe the comorbidity of dissociative disorders.
Given that a traumatic experience often precipitates dissociative disorders, it should not be surprising that there is a high comorbidity between most dissociative disorders and PTSD (comorbidity of depersonalization/derealization disorder with PTSD is low). Similarly, depressive disorders are also commonly found in combination with dissociative disorders, likely due to the impact the disorders have on social and emotional functioning. In individuals with dissociative amnesia, a wide range of emotions related to their inability to recall memories during the episode often present once the amnesia episode is in remission (APA, 2022). These emotions frequently contribute to the development of a depressive episode.
There has been some evidence of comorbid somatic symptom disorder and conversion disorder, particularly for those who experience dissociative amnesia. Furthermore, dependent, obsessive-compulsive, avoidant, and borderline personality traits/disorders are comorbid and for dissociative identity disorder and dissociative amnesia there is evidence of comorbid substance-related and feeding and eating disorders. Anxiety disorders are common for depersonalization/derealization disorder, and often individuals concurrently have unipolar depressive disorder.
Key Takeaways
You should have learned the following in this section:
• Many dissociative disorders have been found to have a high comorbidity with PTSD and depressive disorders.
• Somatic symptom and conversion disorders, as well as some personality disorders, have also been found to be comorbid.
Review Questions
1. What are the common comorbid diagnoses for individuals with dissociative disorders? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/02%3A_Part_II._Mental_Disorders__Block_1/06%3A_Dissociative_Disorders/6.02%3A_Dissociative_Disorders_-_Epidemiology.txt |
Learning Objectives
• Describe the biological causes of dissociative disorders.
• Describe the cognitive causes of dissociative disorders.
• Describe the sociocultural causes of dissociative disorders.
• Describe the psychodynamic causes of dissociative disorders.
Biological
While studies on the involvement of genetic underpinnings need additional research, there is some suggestion that heritability rates for dissociation rage from 50-60% (Pieper, Out, Bakermans-Kranenburg, Van Ijzendoorn, 2011). However, it is suggested that the combination of genetic and environmental factors may play a larger role in the development of dissociative disorders than genetics alone (Pieper, Out, Bakermans-Kranenburg, Van Ijzendoorn, 2011).
Cognitive
One proposed cognitive theory of dissociative disorders, particularly dissociative amnesia, is a memory retrieval deficit. More specifically, Kopelman (2000) theorizes that the combination of psychological stress and various other biopsychosocial predispositions affects the frontal lobes executive system’s ability to retrieve autobiographical memories (Picard et al., 2013). Neuroimaging studies have supported this theory by showing deficits to several prefrontal regions, which is one area responsible for memory retrieval (Picard et al., 2013). Despite these findings, there is still some debate over which specific brain regions within the executive system are responsible for the retrieval difficulties, as research studies have reported mixed findings.
Specific to dissociative identity disorder, neuroimaging studies have shown differences in hippocampus activation between subpersonalities (Tsai, Condie, Wu & Chang, 1999). As you may recall, the hippocampus is responsible for storing information from short-term to long-term memory. It is hypothesized that this brain region is responsible for the generation of dissociative states and amnesia (Staniloiu & Markowitsch, 2010).
Sociocultural
The sociocultural model of dissociative disorders has been primarily influenced by Lilienfeld and colleagues (1999) who argue that the influence of mass media and its publications of dissociative disorders, provide a model for individuals to not only learn about dissociative disorders but also engage in similar dissociative behaviors. This theory has been supported by the significant increase in dissociative identity disorder cases after the publication of Sybil, a documentation of a woman’s 16 subpersonalities (Goff & Simms, 1993).
These mass media productions are not just suggestive to patients. It has been suggested that mass media also influences the way clinicians gather information regarding dissociative symptoms of patients. For example, therapists may unconsciously use questions or techniques in session that evoke dissociative types of problems in their patient following exposure to a media source discussing dissociative disorders.
Psychodynamic
The psychodynamic theory of dissociative disorders assumes that dissociative disorders are caused by an individual’s repressed thoughts and feelings related to an unpleasant or traumatic event (Richardson, 1998). In blocking these thoughts and feelings, the individual is subconsciously protecting himself from painful memories.
While a single incidence of repression may explain dissociative amnesia, psychodynamic theorists believe that dissociative identity disorder results from repeated exposure to traumatic experiences, such as childhood abuse, neglect, or abandonment (Dalenberg et al., 2012). According to the psychodynamic perspective, children who experience repeated traumatic events such as physical abuse or parental neglect lack the support and resources to cope with these experiences. To escape from their current situation, children develop different personalities to essentially flee the dangerous situation they are in. While there is limited scientific evidence to support this theory, the nature of severe childhood psychological trauma is consistent with this theory, as individuals with dissociative identity disorder have the highest rate of childhood psychological trauma compared to all other psychiatric disorders (Sar, 2011).
Key Takeaways
You should have learned the following in this section:
• Though there is some evidence for a genetic component to dissociative disorders, a combination of genes and environment are thought to play a larger role.
• A cognitive explanation assumes a memory retrieval deficit, particularly related to dissociative amnesia, and differential hippocampus activation between subpersonalities in dissociative identity disorder.
• Mass media is also purported to have caused a rise in dissociative disorders due to the attention it gives these disorders in its publications and movies such as Sybil.
• Finally, repressed thoughts and feelings are thought to be the cause of dissociative disorders in the psychodynamic theory.
Review Questions
1. How do the biological, cognitive, sociocultural, and psychodynamic perspectives differ in their explanation of the development of dissociative disorders? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/02%3A_Part_II._Mental_Disorders__Block_1/06%3A_Dissociative_Disorders/6.04%3A_Dissociative_Disorders_-_Etiology.txt |
Learning Objectives
• Clarify why treatment for dissociative disorders is limited.
• Describe treatment options for dissociative identity disorder.
• Describe treatment options for dissociative amnesia.
• Describe treatment options for depersonalization/derealization disorder.
Treatment for dissociative disorders is limited for a few reasons. First, with respect to dissociative amnesia, many individuals recover on their own without any intervention. Occasionally treatment is sought out after recovery due to the traumatic nature of memory loss. Second, the rarity of these disorders has offered limited opportunities for research on both the development and effectiveness of treatment methods. Due to the differences between dissociative disorders, treatment options will be discussed specific to each disorder.
Dissociative Identity Disorder
The ultimate treatment goal for dissociative identity disorder is the integration of subpersonalities to the point of final fusion (Chu et al., 2011). Integration refers to the ongoing process of merging subpersonalities into one personality. Psychoeducation is paramount for integration, as the individual must understand their disorder, as well as acknowledge their subpersonalities. As mentioned above, many individuals have a one-way amnesic relationship with the subpersonalities, meaning they are not aware of one another. Therefore, the clinician must first make the individual aware of the various subpersonalities that present across different situations.
Achieving integration requires several steps. First, the clinician needs to build a relationship and strong rapport with the primary personality. From there, the clinician can begin to encourage communication and coordination between the subpersonalities gradually. Making the subpersonalities aware of one another, as well as addressing their conflicts, is an essential component of the integration of subpersonalities, and the core of dissociative identity disorder treatment (Chu et al., 2011).
Once the individual is aware of their personalities, treatment can continue with the goal of fusion. Fusion occurs when two or more alternate identities join (Chu et al., 2011). When this happens, there is a complete loss of separateness. Depending on the number of subpersonalities, this process can take quite a while. Once all subpersonalities are fused and the individual identifies themselves as one unified self, it is believed the patient has reached final fusion.
It should be noted that final fusion is difficult to obtain. As you can imagine, some patients do not find final fusion a desirable outcome, particularly those with harrowing histories; chronic, severe stressors; advanced age; and comorbid medical and psychiatric disorders, to name a few. For individuals where final fusion is not the treatment goal, the clinician may work toward resolution or sufficient integration and coordination of subpersonalities that allows the individual to function independently (Chu et al., 2011). Unfortunately, individuals that do not achieve final fusion are at greater risk for relapse of symptoms, particularly those with whose dissociative identity disorder appears to stem from traumatic experiences.
Once an individual reaches final fusion, ongoing treatment is essential to maintain this status. In general, treatment focuses on social and positive coping skills. These skills are particularly helpful for individuals with a history of traumatic events, as it can help them process these events, as well as help prevent future relapses.
Dissociative Amnesia
As previously mentioned, many individuals regain memory without the need for treatment; however, there is a small population that does require additional treatment. While there is no evidenced-based treatment for dissociative amnesia, both hypnosis and phasic therapy have been shown to produce some positive effects in patients with dissociative amnesia.
6.5.2.1. Hypnosis. One theory of dissociative amnesia is that it is a form of self-hypnosis and that individuals hypnotize themselves to forget information or events that are unpleasant (Dell, 2010). Because of this theory, one type of treatment that has routinely been implemented for individuals with dissociative amnesia is hypnosis. Through hypnosis, the clinician can help the individual contain, modulate, and reduce the intensity of the amnesia symptoms, thus allowing them to process the traumatic or unpleasant events underlying the amnesia episode (Maldonadao & Spiegel, 2014). To do this, the clinician will encourage the patient to think of memories just before the amnesic episode as though it was the present time. The clinician will then slowly walk them through the events during the amnesic period to reorient the individual to experience these events. This technique is essentially a way to encourage a controlled recall of dissociated memories, something that is particularly helpful when the memories include traumatic experiences (Maldonadao & Spiegel, 2014).
Another form of “hypnosis” is the use of barbiturates, also known as “truth serums,” to help relax the individual and free their inhibitions. Although not always effective, the theory is that these drugs reduce the anxiety surrounding the unpleasant events enough to allow the individual to recall and process these memories in a safe environment (Ahern et al., 2000).
Depersonalization/Derealization Disorder
Depersonalization/derealization disorder symptoms generally occur for an extensive period before the individual seeks out treatment. Because of this, there is some evidence to support that the diagnosis alone is effective in reducing symptom intensity, as it also relieves the individual’s anxiety surrounding the baffling nature of the symptoms (Medford, Sierra, Baker, & David, 2005).
Due to the high comorbidity of depersonalization/derealization disorder with anxiety and depression, the goal of treatment is often alleviating these secondary mental health symptoms related to the depersonalization/derealization symptoms. While there has been some evidence to suggest treatment with an SSRI is effective in improving mood, the evidence for a combined treatment method of psychopharmacological and psychological treatment is even more compelling (Medford, Sierra, Baker, & David, 2005). The psychological treatment of preference is cognitive-behavioral therapy as it addresses the negative attributions and appraisals contributing to the depersonalization/derealization symptoms (Medford, Sierra, Baker, & David, 2005). By challenging these catastrophic attributions in response to stressful situations, the individual can reduce overall anxiety levels, which consequently reduces depersonalization/ derealization symptoms.
Key Takeaways
You should have learned the following in this section:
• Treatment for dissociative identity disorder involves the integration of subpersonalities to the point of final fusion and takes several steps to achieve.
• For some patients, this is not possible as they do not find final fusion to be a desirable outcome.
• Instead, the clinician will work to achieve resolution or sufficient integration and coordination of the subpersonalities to allow the person to function independently.
• For dissociative amnesia, hypnosis and phasic therapy are used, as well as barbiturates known as “truth serums.”
• Finally, diagnosis alone is sometimes enough to reduce the intensity of symptoms related to depersonalization/derealization disorder and due to the high comorbidity with anxiety and depression, alleviation of these secondary symptoms is often the goal of treatment.
Review Questions
1. What is the treatment goal for dissociative identity disorder? How is it achieved?
2. What are the treatment options for dissociative amnesia and depersonalization/depersonalization disorder?
Module Recap
In this module, we discussed the dissociative disorders of Dissociative Identity Disorder, Dissociative Amnesia, and Depersonalization/Derealization Disorder in terms of their clinical presentation, epidemiology, comorbidity, etiology, and treatment approaches. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/02%3A_Part_II._Mental_Disorders__Block_1/06%3A_Dissociative_Disorders/6.05%3A_Dissociative_Disorders_-_Treatment.txt |
Learning Objectives
• Describe how anxiety disorders present.
• Describe the epidemiology of anxiety disorders.
• Describe comorbidity in relation to anxiety disorders.
• Describe the etiology of anxiety disorders.
• Describe treatment options for anxiety disorders.
In Module 7, we will discuss matters related to anxiety disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will include generalized anxiety disorder, specific phobia, agoraphobia, social anxiety disorder, and panic disorder. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of the various therapies (Module 3).
07: Anxiety Disorders
Learning Objectives
• Describe how generalized anxiety disorder presents.
• Describe how specific phobia presents.
• Describe how agoraphobia presents.
• Describe how social anxiety disorder presents.
• Describe how panic disorder presents.
The hallmark symptoms of anxiety-related disorders are excessive fear and anxiety and related behavioral disturbances. How do we distinguish fear from anxiety? The DSM says that fear is an emotional response to a real or perceived imminent threat which leads to “…surges of autonomic arousal necessary for flight or flight, thoughts of immediate danger, and escape behaviors.” Anxiety, on the other hand, is the anticipation of a future threat leading to, “…muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors” (APA, 2022, pg. 215). The anxiety disorders differ from one another in the types of objects or situations that lead to fear, anxiety, or avoidance behavior. We will cover generalized anxiety disorder, specific phobia, agoraphobia, social anxiety disorder, and panic disorder.
Generalized Anxiety Disorder
Generalized anxiety disorder is characterized by an underlying excessive anxiety and worry related to a wide range of events or activities and lasting for more days than not for at least six months. While many individuals experience some degree of worry throughout the day, individuals with generalized anxiety disorder experience worry of greater intensity and for longer periods than the average person (APA, 2022). Additionally, they are often unable to control their worry through various coping strategies, which directly interferes with their ability to engage in daily social and occupational tasks. To receive a diagnosis of generalized anxiety disorder, three or more of the following somatic symptoms must be present in adults as well: restlessness, fatigue, difficultly concentrating, irritability, muscle tension, and problems sleeping (APA, 2022; Gelenberg, 2000).
Specific Phobia
Specific phobia is distinguished by fear or anxiety specific to an object or a situation. While the amount of fear or anxiety related to the specific object or situation varies among individuals, it also varies related to the proximity of the object or situation. When individuals are face-to-face with their specific phobia, immediate fear is present, and the phobic object or situation is actively avoided or endured. It should also be noted that these fears are excessive and irrational, often severely impacting one’s daily functioning. The fear, anxiety, or avoidance is persistent, lasting at least six months (APA, 2022).
Individuals can experience multiple specific phobias at the same time. In fact, nearly 75% of individuals with a specific phobia report fear of more than one object and the average individual fears three or more objects or situations (APA, 2022). When making a diagnosis of specific phobia, it is important to identify the stimulus. Among the most diagnosed specific phobias are animals, natural environment (height, storms, water), blood-injection-injury (needles, invasive medical procedures), or situational (airplanes, elevators, enclosed places). In terms of gender differences, women predominantly experience animal, natural environment, and situational specific phobias while blood-injection-injury phobia is experienced by both men and women equally (APA, 2022).
Agoraphobia
Agoraphobia is defined as intense fear or anxiety triggered by two or more of the following: using public transportation such as planes, trains, ships, buses; being in large, open spaces such as parking lots or on bridges; being in enclosed spaces like stores or movie theaters; being in a crowd or standing in line; or being outside of the home alone. The individual fears or avoids these situations because they believe something terrible may occur and due to concern over not being able to escape or help not being available (APA, 2022). Active avoidance of the situations occurs and can be behavioral such as changing daily routines or using delivery to avoid entering a restaurant or cognitive such as using distraction to bear with an agoraphobic situation. The avoidance can result in the person being homebound. The fear or anxiety is out of proportion to the actual danger they pose and has been present for at least six months.
Social Anxiety Disorder
For social anxiety disorder, the anxiety or fear relates to social situations, particularly those in which an individual can be evaluated by others. More specifically, the individual is worried that they will be judged negatively and viewed as stupid, anxious, crazy, boring, or unlikeable, to name a few. Some individuals report feeling concerned that their anxiety symptoms will be obvious to others via blushing, stuttering, sweating, trembling, etc. These fears severely limit an individual’s behavior in social settings and have occurred for six months or more.
To explain social anxiety in greater detail, let’s review the story of Mary. Mary reported the onset of her social anxiety disorder in early elementary school when teachers would call on students to read parts of their textbook aloud. Mary stated that she was fearful of making mistakes while reading and to alleviate this anxiety, she would read several sections ahead of the class to prepare for her turn to read aloud. Despite her preparedness, one day in 5th grade, Mary was called to read, and she stumbled on a few words. While none of her classmates realized her mistake, Mary was extremely embarrassed and reported higher levels of anxiety during future read aloud moments in school. In fact, when she was called upon, Mary stated she would completely freeze up and not talk at all. After a few moments of not speaking, her teacher would skip Mary and ask another student to read her section. It took several years and a very supportive teacher for Mary to begin reading aloud in class again.
Like Mary, individuals with social anxiety disorder report that all or nearly all social situations provoke this intense fear. Some individuals even report significant anticipatory fear days or weeks before a social event is to occur. This anticipatory fear often leads to avoidance of social events in some individuals; others will attend social events with a marked fear of possible threats. Because of these fears, there is a significant impact on one’s social and occupational functioning.
It is important to note that the cognitive interpretation of these social events is often excessive and out of proportion to the actual risk of being negatively evaluated. As we saw in Mary’s case, when she stumbled upon her words while reading to the class, none of her peers even noticed her mistake. Situations in which individuals experience anxiety toward a real threat, such as bullying or ostracizing, would not be diagnosed with social anxiety disorder as the negative evaluation and threat are real.
Panic Disorder
Panic disorder consists of a series of recurrent, unexpected panic attacks coupled with the fear of future panic attacks. A panic attack is defined as a sudden or abrupt surge of fear or impending doom along with at least four physical or cognitive symptoms. Physical symptoms include heart palpitations, sweating, trembling or shaking, shortness of breath, feeling as though they are being choked, chest pain, nausea, dizziness, chills or heat sensations, and numbness/tingling. Cognitive symptoms may consist of feelings of derealization (feelings of unreality) or depersonalization (feelings of being detached from oneself), the fear of losing control or ‘going crazy,’ or the fear of dying (APA, 2022). While symptoms generally peak within a few minutes, it seems much longer for the individual experiencing the panic attack.
There are two key components to panic disorder—the attacks are unexpected, meaning there is nothing that triggers them, and they are recurrent, meaning they occur multiple times. Because these panic attacks occur frequently and are primarily “out of the blue,” they cause significant worry or anxiety in the individual as they are unsure of when the next attack will happen. In contrast to unexpected there are also expected panic attacks, or those that have an obvious trigger. The DSM-5-TR states that presence of expected panic attacks does not rule out the diagnosis of panic disorder as about half of individuals diagnosed with the disorder in the United States and Europe have both types of attacks (APA, 2022).
In some individuals, significant behavioral changes such as fear of leaving their home or attending large events occur as the individual is fearful an attack will happen in one of these situations, causing embarrassment. Additionally, individuals report worry that others will think they are “going crazy” or losing control if they were to observe an individual experiencing a panic attack. Occasionally, an additional diagnosis of agoraphobia is given to an individual with panic disorder if their behaviors meet diagnostic criteria for this disorder as well.
The frequency and intensity of these panic attacks vary widely among individuals. Some people report panic attacks occurring once a week for months on end, others report more frequent attacks multiple times a day, but then experience weeks or months without any attacks. The intensity of symptoms also varies among individuals, with some patients experiencing four or more symptoms (full-symptom) or less than four (limited-symptom. Furthermore, individuals report variability within their panic attack symptoms, with some panic attacks presenting with more symptoms than others. To be diagnosed with panic disorder, the individual must present with more than one unexpected full-symptom panic attack (APA, 2022).
Key Takeaways
You should have learned the following in this section:
• All anxiety disorders share the hallmark symptoms of excessive fear or worry related to behavioral disturbances.
• Generalized anxiety disorder is characterized by an underlying excessive worry related to a wide range of events or activities and an inability to control their worry through coping strategies.
• Specific phobia is characterized by fear or anxiety specific to an object or a situation and individuals can experience fear of more than one object.
• Agoraphobia is characterized by intense fear related to situations in which the individual is in public situations where escape may be difficult and help may not be able to come.
• Social anxiety disorder is characterized by fear or anxiety related to social situations, especially when evaluation by others is possible.
• Panic disorder is characterized by a series of recurrent, unexpected panic attacks coupled with the fear of future panic attacks.
Review Questions
1. What is the difference between fear and anxiety?
2. What are the key differences between generalized anxiety disorder and agoraphobia?
3. Individuals with social anxiety disorder will experience both physical and cognitive symptoms, particularly when presented with social interactions. What are these symptoms?
4. What are the common types of specific phobias?
5. What are the physical and cognitive symptoms observed during panic disorder?
6. What are the key components of panic disorder? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/07%3A_Anxiety_Disorders/7.01%3A_Anxiety_Disorders_-_Clinical_Presentation.txt |
Learning Objectives
• Describe the epidemiology of generalized anxiety disorder.
• Describe the epidemiology of specific phobia.
• Describe the epidemiology of agoraphobia.
• Describe the epidemiology of social anxiety disorder.
• Describe the epidemiology of panic disorder.
Generalized Anxiety Disorder
The 12-month prevalence for generalized anxiety disorder is estimated to be 2.9% of the adult general population of the United States while the mean 12-month prevalence around the world is 1.3% (with a range of 0.2% to 4.3%). The disorder occurs more frequently in women and adolescent girls, those of European descent, and those living in high-income countries (APA, 2022).
Specific Phobia
The prevalence rate for specific phobia is 8-12% in the United States and about 6% in European countries. There is a 2:1 ratio of females to males diagnosed with specific phobia. Prevalence rates are lower in older individuals and those from Asia, Africa, and Latin America.
Agoraphobia
The prevalence rate of agoraphobia worldwide for adolescents and adults is 1% to 1.7%. As with other anxiety disorders, women are twice as likely to be diagnosed with it. Older adults in the United States (aged 65 and up) have a 12-month prevalence of 0.4% and for older adults aged 55 and up in Europe and North America, the prevalence is 0.5%.
Social Anxiety Disorder
The overall prevalence rate of social anxiety disorder is significantly higher in the United States than in other countries, with an estimated 7% of the U.S. population diagnosed with social anxiety disorder, compared to 0.5% to 2.0% worldwide (median prevalence in Europe is 2.3%). A decrease in the diagnosis of social anxiety disorder among older individuals, aged 65 years and older, has been found. Regarding gender, there is a higher diagnosis rate in females than males. This gender discrepancy is greater among adolescents and young adults. Finally, non-Hispanic whites in the United States have a higher prevalence rate than Asian, Latinx, African American, and Caribbean Black descent (APA, 2022).
Panic Disorder
The 12-month prevalence for panic disorder in the general population is estimated at around 2-3% in adults and adolescents across the United States and several European countries. Higher rates of panic disorder are found in American Indians and non-Latinx whites. Females are more commonly diagnosed than males with a 2:1 diagnosis rate. Prevalence declines from about 1.2% in adults older than 55 to 0.7% in adults aged 64 and up.
Key Takeaways
You should have learned the following in this section:
• Prevalence rates for anxiety disorders range from 1.0% for agoraphobia up to 12% for specific phobia.
• For most anxiety disorders, females are twice as likely to be diagnosed.
Review Questions
1. Create a table of the prevalence rates across the various anxiety related disorders. What are the differences between the disorders?
2. How do prevalence rates vary as a function of gender, race, nationality, and age?
7.03: Anxiety Disorders - Comorbidity
Learning Objectives
• Describe the comorbidity of generalized anxiety disorder.
• Describe the comorbidity of specific phobia.
• Describe the comorbidity of agoraphobia.
• Describe the comorbidity of social anxiety disorder.
• Describe the comorbidity of panic disorder.
Generalized anxiety disorder
There is a high comorbidity between generalized anxiety disorder and the other anxiety-related disorders, as well as unipolar depressive disorders. Comorbidity with substance use, neurodevelopmental, neurocognitive, psychotic, and conduct disorders is less common for those afflicted with generalized anxiety disorder. Generalized anxiety disorder is associated with higher levels of suicidal ideation and behavior and psychological autopsy studies reveal it is the most frequent anxiety disorder diagnosed in suicides (APA, 2022).
Specific phobia
Other anxiety disorders, depressive and bipolar disorders, substance-related disorders, and somatic symptom disorder are typically comorbid with specific phobia. Additionally, personality disorders, in particular dependent personality disorder, are comorbid. Specific phobia is associated with the transition from suicidal ideation to attempt (APA, 2022).
Agoraphobia
As with other anxiety disorders, common comorbid mental disorders include other anxiety disorders and depressive disorders. Agoraphobia is also comorbid with PTSD and alcohol use disorder. For those with comorbid major depressive disorder, the agoraphobia is more treatment-resistant compared to those with agoraphobia alone. About 15% of patients diagnosed with agoraphobia report suicidal thoughts or behavior (APA, 2022).
Social Anxiety Disorder
Among the most common comorbid diagnoses with a social anxiety disorder are other anxiety-related disorders, major depressive disorder, and substance-related disorders. The high comorbidity rate among anxiety-related disorders and substance-related disorders is likely connected to the efforts of self-medicating to deal with social fears. For example, an individual with social anxiety disorder may consume more alcohol in social settings in efforts to alleviate the anxiety of the social situation. The comorbidity with major depressive disorder may be due to the chronic social isolation associated with social anxiety disorder. Comorbidity has also been found with body dysmorphic disorder and avoidant personality disorder.
Panic disorder
Panic disorder rarely occurs in isolation, as 80% of individuals report symptoms of other anxiety disorders, major depressive disorder, bipolar I and bipolar II disorder, and possibly mild alcohol use disorder. Some individuals diagnosed with panic disorder also develop a substance-related disorder, likely as an attempt to treat their anxiety with alcohol or other substances. About 25% of patients report suicidal thoughts and the disorder may increase the risk for future suicidal behaviors but not deaths. (APA, 2022).
Unlike some of the other anxiety disorders, there is a high comorbidity with general medical symptoms. More specifically, individuals with panic disorder are more likely to report somatic symptoms such as dizziness, cardiac arrhythmias, COPD, asthma, irritable bowel syndrome, and hyperthyroidism (APA, 2022). The relationship between panic symptoms and these conditions is unclear.
Key Takeaways
You should have learned the following in this section:
• Many anxiety disorders are comorbid with one another.
• Other common comorbid disorders include depressive disorders and substance-related disorders.
• Agoraphobia has a high comorbidity with PTSD and panic disorder with general medical symptoms.
• Most anxiety disorders are associated with suicidal thoughts and behaviors, but not always deaths.
Review Questions
1. What other disorders commonly occur with specific anxiety related disorders and why?
2. What anxiety-related disorder has a high comorbidity with medical symptoms?
3. What is the relationship of the disorders with suicidal ideation and attempts/behaviors? Be specific. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/07%3A_Anxiety_Disorders/7.02%3A_Anxiety_Disorders_-_Epidemiology.txt |
Learning Objectives
• Describe the biological causes of anxiety disorders.
• Describe the psychological causes of anxiety disorders.
• Describe the sociocultural causes of anxiety disorders.
Biological
7.4.1.1. Biological – Genetic influences. While genetics have been known to contribute to the presentation of anxiety symptoms, the interaction between genetics and stressful environmental influences appears to account for more anxiety disorders than genetics alone (Bienvenu, Davydow, & Kendler, 2011). The quest to identify specific genes that may predispose individuals to develop anxiety disorders has led researchers to the serotonin transporter gene (5-HTTLPR). Mutation of the 5-HTTLPR gene is related to a reduction in serotonin activity and an increase in anxiety-related personality traits (Munafo, Brown, & Hairiri, 2008).
7.4.1.2. Biological – Neurobiological structures. Researchers have identified several brain structures and pathways that are likely responsible for anxiety responses. Among those structures is the amygdala, the area of the brain that is responsible for storing memories related to emotional events (Gorman, Kent, Sullivan, & Coplan, 2000). When presented with a fearful situation, the amygdala initiates a reaction to ready the body for a response. First, the amygdala triggers the hypothalamic-pituitary-adrenal (HPA) axis to prepare for immediate action— either to fight or flight. The second pathway is activated by the feared stimulus itself, by sending a sensory signal to the hippocampus and prefrontal cortex, to determine if the threat is real or imagined. If it is determined that no threat is present, the amygdala sends a calming response to the HPA axis, thus reducing the level of fear. If a threat is present, the amygdala is activated, producing a fear response.
Specific to panic disorder is the implication of the locus coeruleus, the brain structure that serves as an “on-off” switch for norepinephrine neurotransmitters. It is believed that increased activation of the locus coeruleus results in panic-like symptoms; therefore, individuals with panic disorder may have a hyperactive locus coeruleus, leaving them more susceptible to experience more intense and frequent physiological arousal than the general public (Gorman, Kent, Sullivan, & Coplan, 2000). This theory is supported by studies in which individuals experienced increased panic symptoms following the injection of norepinephrine (Bourin, Malinge, & Guitton, 1995).
Unfortunately, norepinephrine and the locus coeruleus fail to fully explain the development of panic disorder, as treatment would be much easier if only norepinephrine was implicated. Therefore, researchers argue that a more complex neuropathway is likely responsible for the development of panic disorder. More specifically, the corticostriatal-thalamocortical (CSTC)circuit, also known as the fear-specific circuit, is theorized as a major contributor to panic symptoms (Gutman, Gorman, & Hirsch, 2004). When an individual is presented with a frightening object or situation, the amygdala is activated, sending a fear response to the anterior cingulate cortex and the orbitofrontal cortex. Additional projection from the amygdala to the hypothalamus activates endocrinologic responses to fear, releasing adrenaline and cortisol to help prepare the body to fight or flight (Gutman, Gorman, & Hirsch, 2004). This complex pathway supports the theory that panic disorder is mediated by several neuroanatomical structures and their associated neurotransmitters.
Psychological
7.4.2.1. Psychological – Cognitive. The cognitive perspective on the development of anxiety related disorders centers around dysfunctional thought patterns. As seen in depression, maladaptive assumptions are routinely observed in individuals with anxiety-related disorders, as they often engage in interpreting events as dangerous or overreacting to potentially stressful events, which contributes to an overall heightened anxiety level. These negative appraisals, in combination with a biological predisposition to anxiety, likely contribute to the development of anxiety symptoms (Gallagher et al., 2013).
Sensitivity to physiological arousal not only contributes to anxiety disorders in general, but also for panic disorder where individuals experience various physiological sensations and misinterpret them as catastrophic. One explanation for this theory is that individuals with panic disorder are more susceptible to more frequent and intensive physiological symptoms than the general public (Nillni, Rohan, & Zvolensky, 2012). Others argue that these individuals have had more trauma-related experiences in the past, and therefore, are quick to misevaluate their symptoms as a potential threat. This misevaluation of symptoms as impending disaster likely maintain symptoms as the cognitive misinterpretations to physiological arousal creates a negative feedback loop, leading to more physiological changes.
Social anxiety is also primarily explained by cognitive theorists. Individuals with social anxiety disorder tend to hold unattainable or extremely high social beliefs and expectations. Furthermore, they often engage in preconceived maladaptive assumptions that they will behave incompetently in social situations and that their behaviors will lead to terrible consequences. Because of these beliefs, they anticipate social disasters will occur and, therefore, avoid social encounters (or limit them to close friends/family members) in efforts to prevent the disaster (Moscovitch et al., 2013). Unfortunately, these cognitive appraisals are not only isolated to before and during the event. Individuals with social anxiety disorder will also evaluate the social event after it has taken place, often obsessively reviewing the details. This overestimation of social performance negatively reinforces future avoidance of social situations.
7.4.2.2. Psychological – Behavioral. The behavioral explanation for the development of anxiety disorders is mainly reserved for phobias—both specific and social phobia. More precisely, behavioral theorists focus on respondent conditioning – when two events that occur close together become strongly associated with one another, despite their lack of causal relationship (see Module 2 for an explanation of respondent conditioning). Watson and Rayner’s (1920) infamous Little Albert experiment is an example of how respondent conditioning can be used to induce fear through associations. In this study, Little Albert developed a fear of white rats by pairing a white rat with a loud sound. This experiment, although lacking ethical standards, was groundbreaking in the development of learned behaviors. Over time, researchers have been able to replicate these findings (in more ethically sound ways) to provide further evidence of the role of respondent conditioning in the development of phobias.
7.4.2.3. Psychological – Modeling is another behavioral explanation of the development of specific and social phobias. In modeling, an individual acquires a fear though observation and imitation (Bandura & Rosenthal, 1966). For example, when a young child observes their parent display irrational fear of an animal, the child may then begin to display similar behavior. Similarly, seeing another individual being ridiculed in a social setting may increase the chances of developing social anxiety, as the individual may become fearful that they would experience a similar situation in the future. It is speculated that the maintenance of these phobias is due to the avoidance of the feared item or social setting, thus preventing the individual from learning that the object or situation is not something that should be feared.
While modeling and respondent conditioning largely explain the development of phobias, there is some speculation that the accumulation of many these learned fears will develop into generalized anxiety disorder. Through stimulus generalization, or the tendency for the conditioned stimulus to evoke similar responses to other stimuli, a fear of one stimulus (such as the dog) may become generalized to other items (such as all animals). As these fears begin to grow, a more generalized anxiety will present, as opposed to a specific phobia.
Sociocultural
Seeing how prominent the biological and psychological constructs are in explaining the development of anxiety-related disorders, we also need to review the social constructs that contribute and maintain anxiety disorders. While characteristics such as living in poverty, experiencing significant daily stressors, and increased exposure to traumatic events are all identified as significant contributors to anxiety disorders, additional sociocultural influences such as gender and discrimination have also received considerable attention, mainly due to the epidemiological nature of the disorder.
Gender has largely been researched within anxiety disorders due to the consistent discrepancy in the diagnosis rate between men and women. As previously discussed, women are routinely diagnosed with anxiety disorders more often than men, a trend that is observed throughout the entire lifespan. One potential explanation for this discrepancy is the influence of social pressures on women. Women are more susceptible to experience traumatic experiences throughout their life, which may contribute to anxious appraisals of future events. Furthermore, women are more likely to use emotion-focused coping, which is less effective in reducing distress than problem-focused coping (McLean & Anderson, 2009). These factors may increase levels of stress hormones within women that leave them susceptible to develop symptoms of anxiety. Therefore, it appears a combination of genetic, environmental, and social factors may explain why women tend to be diagnosed more often with anxiety-related disorders.
Exposure to discrimination and prejudice, particularly relevant to ethnic minorities and other marginalized groups, can also impact an individual’s anxiety level. Discrimination and prejudice contribute to negative interactions, which is directly related to negative affect and an overall decline in mental health (Gibbons et al., 2014). The repeated exposure to discrimination and prejudice over time can lead to fear responses in individuals, along with subsequent avoidance of social situations in efforts to protect themselves emotionally.
Key Takeaways
You should have learned the following in this section:
• Biological causes of anxiety disorders include the serotonin transporter gene (5-HTTLPR); brain structures to include the amygdala, hippocampus, and prefrontal cortex; and the locus coeruleus and corticostriatal-thalamocortical (CSTC) circuit in relation to panic disorder.
• Psychological causes of anxiety disorders include maladaptive assumptions, the linking of events through respondent conditioning, modeling, and stimulus generalization as it relates to generalized anxiety disorder.
• Sociocultural causes of anxiety disorders include social pressures leading to a higher rate of diagnosis for women and discrimination and prejudice which affects ethnic minorities and other marginalized groups.
Review Questions
1. Discuss the biological etiology of panic disorders. What brain structures and neurotransmitters are involved?
2. How does the cognitive model explain the development and maintenance of anxiety related disorders?
3. What is the difference between emotion-focused and problem-focused coping strategies? How do these two coping strategies explain differences in anxiety related disorders?
4. What are the effects of prejudice and discrimination on the development of anxiety disorders? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/07%3A_Anxiety_Disorders/7.04%3A_Anxiety_Disorders_-_Etiology.txt |
Learning Objectives
• Describe treatment options for generalized anxiety disorder.
• Describe treatment options for specific phobia.
• Describe treatment options for agoraphobia.
• Describe treatment options for social anxiety disorder.
• Describe treatment options for panic disorder.
Generalized Anxiety Disorder
7.5.1.1. Psychopharmacology. Benzodiazepines, a class of sedative-hypnotic drugs that will be discussed in more detail in the substance abuse module, originally replaced barbiturates as the leading anti-anxiety medication due to their less addictive nature, yet equally effective ability to calm individuals at low dosages. Unfortunately, as more research was done on benzodiazepines, serious side effects, as well as physical dependence of benzodiazepines at large dosages, has routinely been documented (NIMH, 2013). Due to these negative effects, selective serotonin-reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are generally considered to be first-line medication options for those with generalized anxiety disorder. Findings indicate a 30-50% positive response rate to these psychopharmacological interventions (Reinhold & Rickels, 2015). Unfortunately, none of these medications continue to provide any benefit once they are stopped; therefore, other effective treatment options such as CBT, relaxation training, and biofeedback are often encouraged before the use of pharmacological interventions.
7.5.1.2. Rational-Emotive therapy. Albert Ellis developed rational emotive therapy in the mid-1950s as one of the first forms of cognitive-behavioral therapy. Ellis proposed that individuals were not aware of the effect their negative thoughts had on their behaviors and various relationships, and thus, established a treatment to address these thoughts and provide relief to those suffering from anxiety and depression. The goal of rational emotive therapy is to identify irrational, self-defeating assumptions, challenge the rationality of those assumptions, and to replace them with new, more productive thoughts and feelings. By identifying and replacing these assumptions, the individual will experience relief of generalized anxiety disorder symptoms (Ellis, 2014).
7.5.1.3. Cognitive Behavioral Therapy (CBT). CBT is discussed in detail in the Mood Disorder Module; however, it is also among the most effective treatment options for a variety of anxiety disorders, including generalized anxiety disorder. Findings suggest 60 percent of individuals report a significant reduction/elimination in anxious thoughts one-year post treatment (Hanrahan, Field, Jones, & Davy, 2013). The fundamental goal of CBT is a combination of cognitive and behavioral strategies aimed to identify and restructure maladaptive thoughts while also providing opportunities to utilize these more effective thought patterns through exposure-based experiences. Through repetition, the individual will be able to identify and replace anxious thoughts outside of therapy sessions, ultimately reducing their overall anxiety levels (Borkovec, & Ruscio, 2001).
7.5.1.4. Biofeedback. Biofeedback provides a visual representation of a patient’s physiological arousal. To achieve this feedback, a patient is connected to a computer that provides continuous information on their physiological states. There are several ways a patient can connect to the computer. Among the most common is electromyography (EMG). EMG measures the amount of muscle activity currently experienced by the individual. An electrode is placed on a patient’s skin just above a major muscle group, usually the forearm or the forehead. Other common areas of measurement are electroencephalography (EEG), which measures the neurofeedback or brain activity; heart rate variability (HRV), which measures autonomic activity such as heart rate or blood pressure; and galvanic skin response (GSR) which measures sweat.
Once the patient is connected to the biofeedback machine, the clinician can walk the patient through a series of relaxation scripts or techniques as the computer simultaneously measures the changes in muscle tension. The theory behind biofeedback is that in providing a patient with a visual representation of changes in their physiological state, they become more skilled at voluntarily reducing their physiological arousal, and thus, their overall sense of anxiety or stress. While research has identified only a modest effect of biofeedback on anxiety levels, patients do report a positive experience with the treatment due to the visual feedback of their physiological arousal (Brambrink, 2004).
Specific Phobias
7.5.2.1. Exposure treatments. While there are many treatment options for specific phobias, research routinely supports the behavioral techniques as the most effective treatment strategies. Seeing as the behavioral theory suggests phobias develop via respondent conditioning, the treatment approach revolves around breaking the maladaptive association between the object and fear. This is generally accomplished through exposure treatments. As the name implies, the individual is exposed to their feared stimuli. This can be done in several different approaches: systematic desensitization, flooding, and modeling.
Systematic desensitization is an exposure technique that utilizes relaxation strategies to help calm the individual as they are presented with the fearful object. The notion behind this technique is that both fear and relaxation cannot exist at the same time; therefore, the individual learns how to replace their fearful reaction with a calm, relaxing reaction.
To begin, the patient, with assistance from the clinician, will identify a fear hierarchy, or a list of feared objects/situations ordered from least fearful to most fearful. After teaching several different types of relaxation techniques, the clinician will present items from the fear hierarchy, starting from the least fearful object/subject, while the patient practices using the learned relaxation techniques. The presentation of the feared object/situation can be in person—in vivo exposure—or it can be imagined—imaginal exposure. Imaginal exposure tends to be less intensive than in vivo exposure; however, it is less effective than in vivo exposure in eliminating the phobia. Depending on the phobia, in vivo exposure may not be an option, such as with a fear of a tornado. Once the patient can effectively employ relaxation techniques to reduce their anxiety to a manageable level, the clinician will slowly move up the fear hierarchy until the individual does not experience excessive fear of all objects on the list.
Flooding is another exposure technique in which the clinician does not utilize a fear hierarchy, but rather repeatedly exposes the individual to their most feared object or situation. Similar to systematic desensitization, flooding can be done in either in vivo or imaginal exposure. Clearly, this technique is more intensive than systematic or gradual exposure to feared objects. Because of this, patients are at a greater likelihood of dropping out of treatment, thus not successfully overcoming their phobias.
Modeling is another common technique used to treat phobias (Kelly, Barker, Field, Wilson, & Reynolds, 2010). In this technique, the clinician approaches the feared object/subject while the patient observes. As the name implies, the clinician models appropriate behaviors when exposed to the feared stimulus, showing that the phobia is irrational. After modeling several times, the clinician encourages the patient to confront the feared stimulus with the clinician, and then ultimately, without the clinician.
Agoraphobia
Similar to the treatment approaches for specific phobias, exposure-based techniques are among the most effective treatment options for individuals with agoraphobia. However, unlike the high success rate in specific phobias, exposure treatment for agoraphobia has been less effective in providing complete relief from the disorder. The success rate may be impacted by the high comorbidity rate of agoraphobia and panic disorder. Because of the additional presentation of panic symptoms, exposure treatments alone are not the most effective in eliminating symptoms as residual panic symptoms often remain (Craske & Barlow, 2014). Therefore, the best treatment approach for those with agoraphobia and panic disorder is a combination of exposure and CBT techniques (see panic disorder treatment).
For individuals with agoraphobia without panic symptoms, the use of group therapy in combination with individual exposure therapy has been identified as a successful treatment option. The group therapy format allows the individual to engage in exposure-based field trips to various community locations, while also maintaining a sense of support and security from a group of individuals whom they know. Research indicates that this type of treatment provides improvement for nearly 60 to 80 percent of patients with agoraphobia; however, there is a relatively high rate of partial relapse, suggesting that long-term treatment or booster sessions should continue for several years at minimum (Craske & Barlow, 2014).
Social Anxiety Disorder
7.5.4.1. Exposure. A hallmark treatment approach for all anxiety disorders is exposure. Specific to social anxiety disorder, the individual is encouraged to engage in social situations where they are likely to experience increased anxiety. Initially, the clinician will role-play various social situations with the patient so they can practice social interactions in a safe, controlled environment (Rodebaugh, Holaway, & Heimberg, 2004). As the patient becomes habituated to the interaction with the clinician, the clinician and patient may venture outside of the treatment room and engage in social situations with random strangers at various locations such as fast-food restaurants, local stores, libraries, etc. The patient is encouraged to continue with these exposures outside of treatment to help reduce anxiety related to social situations.
7.5.4.2. Social skills training. This treatment is specific to social anxiety disorder as it focuses on the patient’s skill deficits or inadequate social interactions that contribute to their negative social experiences and anxiety. During a session, the clinician may use a combination of skills such as modeling, corrective feedback, and positive reinforcement to provide feedback and encouragement to the patient regarding their behavioral interactions (Rodebaugh, Holaway, & Heimberg, 2004). By incorporating the clinician’s feedback into their social repertoire, the patient can engage in positive social behaviors outside of the treatment room and improve their overall social interactions while reducing ongoing social anxiety.
7.5.4.3. Cognitive restructuring. While exposure and social skills training are suitable treatment options, research routinely supports the need to incorporate cognitive restructuring as an additive component in treatment to provide substantial symptom reduction. Like cognitive restructuring previously discussed in the Mood Disorder module, the clinician will work with the therapist to identify negative, automatic thoughts that contribute to the distress in social situations. The clinician can then help the patient establish new, positive thoughts to replace these negative thoughts. Research indicates that implementing cognitive restructuring techniques before, during, and after exposure sessions enhances the overall effects of treatment of social anxiety disorder (Heimberg & Becker, 2002).
Panic Disorder
7.5.5.1. Cognitive Behavioral Therapy(CBT). CBT is the most effective treatment option for individuals with panic disorder as the focus is on correcting misinterpretations of bodily sensations (Craske & Barlow, 2014). Nearly 80 percent of people with panic disorder report complete remission of symptoms after mastering the following five components of CBT for panic disorder (Craske & Barlow, 2014).
Psychoeducation. Treatment begins by educating the patient on the nature of panic disorder, the underlying causes of panic disorder, as well as the mechanisms that maintain the disorder such as the physical, cognitive, and behavioral response systems (Craske & Barlow, 2014). This part of treatment is fundamental in correcting any myths or misconceptions about panic symptoms, as they often contribute to the exacerbation of panic symptoms.
Self-monitoring. Self-monitoring, or the act of self-observation, is essential to the CBT treatment process for panic disorder. In this part of treatment, the individual is taught to identify the physiological cues immediately leading up to and during a panic attack. Then, the patient is encouraged to recognize and document the thoughts and behaviors associated with these physiological symptoms. By bringing awareness to the symptoms, as well as the relationship between physical arousal and cognitive-behavioral responses, the patient learns the fundamental processes with which they can manage their panic symptoms (Craske & Barlow, 2014).
Relaxation training. Similar to that in exposure-based treatment for phobias, prior to engaging in exposure training, the individual must learn relaxation techniques to apply during onset of panic attacks. Though breathing training was once included as the relaxation training technique of choice for panic disorder more recent research has failed to support this technique as effective in the use of panic disorder due to the high incidence of hyperventilation during panic attacks (Schmidt et al., 2000). Findings suggest that breathing retraining is more commonly misused as a safety behavior or means for avoiding physical symptoms as opposed to an effective physiological response to stress (Craske & Barlow, 2014).
Progressive muscle relaxation. To replace the breathing retraining, Craske & Barlow (2014) suggest progressive muscle relaxation (PMR). In PMR, the patient learns to tense and relax various large muscle groups throughout the body. The patient is encouraged to start at either the head or the feet, and gradually work their way through the entire body, holding the tension for roughly 10 seconds before relaxing. The theory behind PMR is that in tensing the muscles for a prolonged period, the individual exhausts those muscles, forcing them (and eventually) the entire body to engage in relaxation (McCallie, Blum, & Hood, 2006).
Cognitive restructuring. Cognitive restructuring, or the ability to recognize cognitive errors and replace them with alternate, more appropriate thoughts, is likely the most powerful part of CBT treatment for panic disorder, aside from the exposure part. As noted previously, cognitive restructuring involves identifying the role of thoughts in generating and maintaining emotions. The clinician encourages the patient to view these thoughts as “hypotheses” as opposed to fact, which allows the beliefs to be questioned and challenged. This is where the detailed recordings produced by self-monitoring are helpful. By discussing what the patient has recorded for the relationship between physiological arousal and thoughts/behaviors, the clinician can help the patient restructure the maladaptive thought processes to more positive thought processes, which in return, helps to reduce fear and anxiety.
Exposure. As discussed in detail in the specific phobia section, the patient is next encouraged to engage in a variety of exposure techniques such as in vivo exposure and interoceptive exposure, while also incorporating the cognitive restructuring and relaxation techniques previously learned to reduce and eliminate ongoing distress. Interoceptive exposure involves inducing panic-specific symptoms to the individual repeatedly for a prolonged period, so that maladaptive thoughts about the sensations can be disconfirmed and conditional anxiety responses are extinguished (Craske & Barlow, 2014). Some examples of these exposure techniques include spinning a patient repeatedly in a chair to induce dizziness and breathing in a paper bag to cause hyperventilation. These treatment approaches can be presented gradually; however, the patient must endure the physiological sensations for at least 30 seconds to 1 minute to ensure adequate time for applying cognitive strategies to misappraisal of cognitive symptoms (Craske & Barlow, 2014).
Interoceptive exposure is continued both in and outside of treatment until panic symptoms remit. Over time, the habituation of fear within an exposure session ultimately leads to habituation across treatment and long-term remission of panic symptoms (Foa & McNally, 1996). Occasionally, panic symptoms will return in individuals who report complete remission of panic disorder. Follow-up booster sessions reviewing the steps above are generally effective in eliminating symptoms again.
7.5.5.2. Pharmacological interventions. According to Craske & Barlow (2014), nearly half of patients with panic disorder present to psychotherapy already on medication, likely prescribed by their primary care physician. Some researchers argue that anti-anxiety medications impede the progress of CBT treatment as the individual is not able to fully experience the physiological sensations during exposure sessions, thus limiting their ability to modify maladaptive thoughts and maintaining the panic symptoms. Results from large clinical trials suggest no advantage during or immediately after treatment of combining CBT and medication (Craske & Barlow, 2014). Additionally, when the medication was discontinued post-treatment, the CBT+ medication groups fared worse than the CBT treatment-only groups, thus supporting the theory that immersion in interoceptive exposure is limited due to the use of medication. Therefore, it is suggested that medications be reserved for those who do not respond to CBT therapy alone (Kampman, Keijers, Hoogduin & Hendriks, 2002).
Key Takeaways
You should have learned the following in this section:
• Treatment options for generalized anxiety disorder include benzodiazepines, rational-emotive therapy, CBT, and biofeedback.
• Treatment options for specific phobias include exposure treatments such as systematic desensitization, flooding, and modeling.
• Treatment options for agoraphobia include exposure and CBT techniques.
• Treatment options for social anxiety disorder include exposure treatment, social skills training, and cognitive restructuring.
• Treatment options for panic disorder include CBT, psychoeducation, self-monitoring, relaxation training, cognitive restructuring, exposure, and pharmacological interventions.
Review Questions
1. Discuss the types of exposure treatments for individuals with anxiety disorders? Which are most effective? What have been some concerns with exposure treatment?
2. What is biofeedback? How is biofeedback used to treat anxiety related disorders?
3. What are the concerns with using pharmacological interventions in the treatment of anxiety disorders? Is there a time when it is helpful to use this treatment method?
Module Recap
Module 7, the first module of Unit 3, covered the topic of anxiety disorders. This discussion included generalized anxiety disorder, specific phobias, agoraphobia, social anxiety disorder, and panic disorder. As with other modules in this book, we discussed the clinical presentation, epidemiology, comorbidity, and etiology of the anxiety disorders. Treatment options included biological, psychological, and sociocultural options. In Module 8, we will discuss somatic symptom and related disorders. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/07%3A_Anxiety_Disorders/7.05%3A_Anxiety_Disorders_-_Treatment.txt |
Learning Objectives
• Describe how somatic symptom disorders present.
• Describe the epidemiology of somatic symptom disorders.
• Describe comorbidity in relation to somatic symptom disorders.
• Describe the etiology of somatic symptom disorders.
• Describe treatment options for somatic symptom disorders.
• Describe psychological factors affecting other medical conditions in terms of their clinical presentation, diagnostic criteria, common types of psychophysiological disorders, and treatment.
In Module 8, we will discuss matters related to somatic symptom disorders to include the clinical presentation, epidemiology, comorbidity, etiology, and treatment options for somatic symptom disorder, illness anxiety disorder, functional neurological symptom (conversion) disorder , and factitious disorder. We also will discuss psychological factors affecting other medication conditions in relation to their clinical presentation, diagnostic criteria, common types of psychophysiological disorders, and treatment. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of therapies (Module 3).
08: Somatic Symptom and Related Disorders
Learning Objectives
• Describe somatic symptom and related disorders.
• Describe how somatic symptom disorder presents.
• Describe how illness anxiety disorder presents.
• Describe how functional neurological symptom (conversion) disorder presents.
• Describe how factitious disorder presents.
Psychological disorders that feature somatic symptoms are often challenging to diagnose due to the internalizing nature of the disorder, meaning there is no real way for a clinician to measure the somatic symptom. Furthermore, the somatic symptoms could take on many forms. For example, the individual may be faking the physical symptoms, imagining the symptoms, exaggerating the symptoms, or they could be real and triggered by external factors such as stress or other psychological disorders. The symptoms also may be part of a real medical illness or disorder, and therefore, the symptoms should be treated medicinally.
All the disorders within this chapter share a common feature: there is a presence of somatic symptoms and/or illness anxiety associated with significant distress or impairment. Oftentimes, individuals with a somatic disorder will present to their primary care physician with their physical complaints. Occasionally, they will be referred to clinical psychologists after an extensive medical evaluation concludes that a medical diagnosis cannot explain their current symptoms. As you will see, despite their similarities, there are key features that distinguish the disorders in this class from one another.
Somatic Symptom Disorder
Individuals with somatic symptom disorder often present with multiple somatic symptoms at one time. These symptoms are significant enough to impact their daily functioning, such as preventing them from attending school, work, or family obligations. The symptoms can be localized (i.e., in one spot) or diffused (i.e., entire body), and can be specific or nonspecific (e.g., fatigue). Individuals with somatic symptom disorder often report excessive thoughts, feelings, or behaviors surrounding their somatic symptoms (APA, 2022). For example, individuals with somatic symptom disorder may spend an excessive amount of time or energy evaluating their symptoms, as well as the potential seriousness of their symptoms. A lack of medical explanation is not needed for a diagnosis of somatic symptom disorder, as it is assumed that the individual’s suffering is authentic. Somatic symptom disorder is often diagnosed when another medical condition is present, as these two diagnoses are not mutually exclusive.
Somatic symptom disorder patients generally present with significant worry about their illness. Their interpretation of symptoms is often viewed as threatening, harmful, or troublesome (APA, 2022). Because of their negative appraisals, they fear that their medical status is more serious than it typically is, and high levels of distress are often reported. Oftentimes these patients will “shop” at different physician offices to confirm the seriousness of their symptoms.
Illness Anxiety Disorder
Illness anxiety disorder, previously known as hypochondriasis, involves an excessive preoccupation with having or acquiring a serious medical illness. The key distinction between illness anxiety disorder and somatic symptom disorder is that an individual with illness anxiety disorder does not typically present with any somatic symptoms. Occasionally an individual will present with a somatic symptom; however, the intensity of the symptom is mild and does not drive the anxiety. Acquiring a serious illness drives concerns and they will even avoid visiting a sick relative or friend for fear of jeopardizing their own health.
Individuals with illness anxiety disorder generally are cleared medically; however, some individuals are diagnosed with a medical illness. In this case, their anxiety surrounding the severity of their disorder is excessive or disproportionate to their actual medical diagnosis. While an individual’s concern for an illness may be due to a physical sign or sensation, most individual’s concerns are derived not from a physical complaint, but their actual anxiety related to a suspected medical disorder. This excessive worry often expands to general anxiety regarding one’s health and disease. Unfortunately, this anxiety does not decrease even after reassurance from a medical provider or negative test results, even when provided by multiple physicians and diagnostic tests.
As one can imagine, the preoccupation and anxiety associated with attaining a medical illness severely impacts daily functioning. The individual will often spend copious amounts of time scanning and analyzing their body for “clues” of potential ailments. Additionally, an excessive amount of time is often spent on internet searches related to symptoms and rare illnesses. Illness becomes a central feature of the person’s identity and self-image. Although extreme, some cases of invalidism have been reported due to illness anxiety disorder (APA, 2022).
Making Sense of the Disorders
In relation to somatic symptom and related disorders, note the following:
• For somatic symptom disorder …… the patient presents with multiple somatic symptoms at one time that are significant enough to impact their daily functioning
• For illness anxiety disorder … the patient does not typically present with any somatic symptoms but if they do, the symptoms are just mild in intensity
Functional Neurological Symptom Disorder (Conversion Disorder)
Functional neurological symptom (conversion) disorder occurs when an individual presents with one or more symptoms of altered voluntary motor or sensory function (APA, 2022). Common motor symptoms include weakness or paralysis, abnormal movements (e.g., tremors), and gait abnormalities (i.e., limping). Sensory symptoms include altered, reduced, or absent skin sensation, vision, or hearing. Less commonly seen are epileptic seizures and episodes of unresponsiveness resembling fainting or coma (Marshall et al., 2013). The disorder was called “conversion disorder” in prior versions of the DSM and in the psychiatric literature. As noted, “The term “conversion” originated in psychoanalytic theory, which proposes that unconscious psychic conflict is “converted” into physical symptoms” (APA, 2022).
The most challenging aspect of functional neurological symptom disorder is the complex relationship with a medical evaluation. While a diagnosis of conversion disorder requires that the symptoms not be explained by a neurological disease, just because a medical provider fails to provide evidence that it is not a specific medical disorder is not sufficient. Therefore, there must be evidence of an incompatibility of the medical disorder and the symptoms. For example, an individual experiencing a seizure would require a normal simultaneous electroencephalogram (EEG), indicating that there is not epileptic activity during what was previously thought of as an epileptic seizure.
Factitious Disorder
Factitious disorder differs from the three previously discussed somatic disorders in that there is deliberate falsification of medical or psychological symptoms imposed on oneself or on another, with the overall intention of deception. While a medical condition may be present, the severity of impairment related to the medical condition is more excessive due to the individual’s need to deceive those around them. Even more alarming is that this disorder is not only observed in the individual leading the deception— it can also be present in another individual, often a child or an individual with a compromised mental status who is not aware of the deception behind their illness.
Some examples of factitious disorder behaviors include, but are not limited to, altering a urine or blood test, falsifying medical records, ingesting a substance that would indicate abnormal laboratory results, physically injuring oneself, and inducing illness by injecting or ingesting a harmful substance. Although most individuals with factitious disorder seek treatment from health care professionals, some choose to mislead community members either in person or online about the illness or injury (APA, 2022). While it is unclear why an individual would want to fake their own (or someone else’s) physical illness, there is some evidence suggesting that factors such as depression, lack of parental support during childhood, or an excessive need for social support may contribute to this disorder (McDermott, Leamon, Feldman, & Scott, 2012; Ozden & Canat, 1999; Feldman & Feldman, 1995).
Individuals with factitious disorder are at risk for experiencing psychological distress or functional impairment causing harm to themselves and others such as family, friends, heath care professionals, and faith leaders. The DSM-5-TR states, “Whereas some aspects of factitious disorders might represent criminal behavior, such criminal behavior and mental illness are not mutually exclusive” (APA, 2022, pg. 368).
Key Takeaways
You should have learned the following in this section:
• Somatic symptom disorder is characterized by the presence of multiple somatic symptoms, whether localized or diffused and specific or nonspecific, at one time which impact daily functioning.
• Illness anxiety disorder is characterized by concern over having or acquiring a serious illness, and not the actual presence of somatic symptoms. Individuals spend a great deal of time scanning and analyzing their body for “clues” of potential ailments.
• Functional neurological symptom disorder is characterized by one or more symptoms of voluntary motor or sensory function.
• Factitious disorder is characterized by deliberate falsification of medical or psychological symptoms of oneself or another, with the overall intention of deception.
Review Questions
1. What are some commonly shared features of somatic disorders?
2. Which somatic disorder usually accompanies a medical diagnosis?
3. What are the key distinctions between illness anxiety disorder and somatic symptom disorder?
4. What are the key differences between factitious disorder and the other somatic disorders? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/08%3A_Somatic_Symptom_and_Related_Disorders/8.01%3A__Somatic_Symptom_and_Rel.txt |
Learning Objectives
• Describe the epidemiology of somatic disorders.
The prevalence rates for somatic disorders are often difficult to determine; however, overall estimates of somatic symptom disorder are around 4-6%. There is a trend that females report more somatic symptoms than males; thus, more females are diagnosed with somatic symptom disorder than males (APA, 2022).
Seeing as illness anxiety disorder is a newer diagnosis (replacing hypochondriasis), prevalence rates are largely based on the previous disorder. Previous findings suggest that illness anxiety disorder occurs in 1.3% to 10% of the general population and is equal among males and females.
Prevalence rates of factitious disorder are largely unknown, likely due to the use of deception in individuals diagnosed with the disorder. Additionally, health care professionals infrequently record the diagnosis, even in recognized cases (APA, 2022).
And like the other somatic symptom disorders, the prevalence of functional neurological symptom disorder is unknown, even though transient functional neurological symptoms are common. In the United States and northern Europe, research shows that the incidence of individual persistent functional neurological symptoms to be around 4-12 of every 100,000 annually (APA, 2022).
Key Takeaways
You should have learned the following in this section:
• Though prevalence rates for somatic symptom disorders are hard to determine, it is believed that between 1 and 10% of the population suffer from one of these disorders.
• Females are more like to be diagnosed with somatic symptom disorder and are as likely as males to be diagnosed with illness anxiety disorder.
Review Questions
1. Create a table of the prevalence rates across the various somatic disorders. What are the differences between the disorders?
2. What gender differences are evident in the disorders, if any?
8.03: Somatic Symptom and Rel
Learning Objectives
• Describe the comorbidity of somatic disorders.
Given that half of psychiatric patients also have an additional medical disorder, 35% have an undiagnosed medical condition, and approximately 20% reported medical problems caused their mental condition, it should not come as a surprise that somatic disorders, in general, have high comorbidity with other psychological disorders (Felker, Yazel, & Short, 1996). More specifically, anxiety and depressive disorders are among the most commonly co-diagnosed disorders for somatic disorders. While there is not a lot of information regarding specific comorbidities among somatic symptom and related disorders, there is some evidence to suggest that those with illness anxiety disorder are at risk of developing OCD and personality disorders. Similarly, personality disorders are more common in individuals with functional neurological symptom disorder than the general public. Somatic symptom disorder is also comorbid with PTSD and OCD. (APA, 2022). No comorbidity information is given for factitious disorder.
There is also high comorbidity between somatic disorders and other physical disorders classified as central sensitivity syndromes (CSSs), due to their common central sensitization symptoms, yet medically unexplained symptoms (McGeary, Harzell, McGeary, & Gatchel, 2016). Disorders included in this group are fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome. Comorbidity rates are estimated at 60% for these functional syndromes and somatic pain disorder (Egloff et al., 2014).
Key Takeaways
You should have learned the following in this section:
• Anxiety and depression have a high comorbidity with somatic symptom and related disorders.
• Functional neurological symptom disorder and illness anxiety disorder frequently occur with personality disorders.
• PTSD and OCD are comorbid with somatic symptom disorder.
• Central sensitivity syndrome also has high comorbidity with somatic disorders.
Review Questions
1. In general, what other disorders often occur with somatic disorders?
2. Which disorder do we not know anything about? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/08%3A_Somatic_Symptom_and_Related_Disorders/8.02%3A_Somatic_Symptom_and_Rela.txt |
Learning Objectives
• Describe the psychodynamic causes of somatic disorders.
• Describe the cognitive causes of somatic disorders.
• Describe the behavioral causes of somatic disorders.
• Describe the sociocultural causes of somatic disorders.
Psychodynamic
Psychodynamic theory suggests that somatic symptoms present as a response against unconscious emotional issues. Two factors initiate and maintain somatic symptoms: primary gain and secondary gain. Primary gains produce internal motivators, whereas secondary gains produce external motivators (Jones, Carmel & Ball, 2008). When you relate this to somatic disorders, the primary gain, according to psychodynamic theorists, provides protection from the anxiety or emotional symptoms and/or conflicts. This need for protection is expressed via a physical symptom such as pain, headache, etc. The secondary gain, the external experiences from the physical symptoms that maintain these physical symptoms, can range from attention and sympathy to missed work, obtaining financial assistance, or psychiatric disability, to name a few.
Cognitive
Cognitive theorists often believe that somatic disorders are a result of negative beliefs or exaggerated fears of physiological sensations. Individuals with somatic related disorders may have a heightened sensitivity to bodily sensations. This sensitivity, combined with their maladaptive thought patterns, may lead individuals to overanalyze and interpret their physiological symptoms in a negative light.
For example, an individual with a headache may catastrophize the symptoms and believe that their headache is the direct result of a brain tumor, as opposed to stress or other inoculate reasons. When their medical provider does not confirm this diagnosis, the individual may then catastrophize even further, believing they have an extremely rare disorder that requires an evaluation from a specialist.
Behavioral
Keeping true with the behavioral approach to psychological disorders, behaviorists propose that somatic disorders are developed and maintained by reinforcers. More specifically, individuals experiencing significant somatic symptoms are often rewarded by gaining attention from other people (Witthoft & Hiller, 2010). These rewards may also extend to more significant factors, such as receiving disability payments.
While the behavioral theory of somatic disorders appears to be like the psychodynamic theory of secondary gains, there is a clear distinction between the two – behaviorists view these gains as the primary reason for the development and maintenance of the disorder, whereas psychodynamic theorists view these gains as secondary, only after the underlying conflicts create the disorder.
Sociocultural
There are a couple of different ways that sociocultural factors contribute to somatic related disorders. First, there is the social factor of familial influence that likely plays a significant role in the attention to somatic symptoms. Individuals with somatic symptom disorder are more likely to have a family member or close friend who is overly attentive to their somatic symptoms or report high anxiety related to their health (Watt, O’Connor, Stewart, Moon, & Terry, 2008; Schulte, Petermann, & Noeker, 2010).
Culturally, Western countries express less of a focus on somatic complaints compared to those in the Eastern part of the world. This may be explained by the different evaluations of the relationship between mind and body. For example, Westerners tend to have a view that psychological symptoms sometimes influence somatic symptoms, whereas Easterners focus more heavily on the mind-body relationship and how psychological and somatic symptoms interact with one another. These different cultural beliefs are routinely seen in research where Asian populations are more likely to report the physical symptoms related to stress than the cognitive or emotional problems that many in the United States report (Sue & Sue, 2016).
Key Takeaways
You should have learned the following in this section:
• Psychodynamic causes of somatic disorders include primary and secondary gains.
• Cognitive causes of somatic disorders include negative beliefs or exaggerated fears of physiological sensations.
• Behavioral causes of somatic disorders include reinforcers such as attention gained from others or receiving disability.
• Sociocultural causes of somatic disorders include familial influence and culture.
Review Questions
1. How does catastrophizing contribute to the development and maintenance of somatic disorders?
2. How do somatic disorders develop according to behavioral theorists? Does this theory also explain how the symptoms are maintained? Explain.
3. What does the sociocultural model suggest regarding somatic disorders across cultures? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/08%3A_Somatic_Symptom_and_Related_Disorders/8.04%3A_Somatic_Symptom_and_Rela.txt |
Learning Objectives
• Describe treatment options for somatic disorders.
Treatment for these disorders is often difficult as individuals see their problems as completely medical, and therefore, do not think psychological intervention is necessary (Lahmann, Henningsen, & Noll-Hussong, 2010). Once an individual does not find relief from their symptoms after meeting with several different physicians, they often do willingly engage in psychotherapy, psychopharmacology, or both (Raj et al., 2014).
Among the most effective treatment approaches is the biopsychosocial model of treatment. This approach considers the various biological, psychological, and social factors that influence the illness and presenting symptoms (Gatchel et al., 2007). This treatment is often achieved through a multidisciplinary approach where the symptoms are managed by many providers, usually including a physician, psychiatrist, and psychologist. The interdisciplinary approach involves a higher level of care as the multiple disciplines interact with one another and identify a treatment goal (Gatchel et al., 2007). This approach, although more difficult to find, particularly in more rural settings, is presumed to be more effective due to the integration of health care providers and their ability to work together to treat the patient uniformly.
Psychotherapy
8.5.1.1. Psychodynamic. Interpersonal psychotherapy, a type of psychodynamic therapy, has been found to be efficacious in treating somatic disorders. Interpersonal psychotherapy focuses on the relationship between self-experience and the unconscious, and how these factors contribute to body dysfunction. This type of treatment has been shown to reduce anxiety, depression, and improve the overall quality of life immediately following treatment; however, effects appear to diminish over time (Abass et al., 2014; Steinert et al., 2015).
8.5.1.2. CBT. Traditional cognitive-behavioral therapies (CBT) have been employed to address the cognitive attributions and maladaptive coping strategies that are responsible for the development and maintenance of the disorder. The most common misattribution for these disorders is catastrophic thinking, or the rumination about worst-case scenario outcomes. Additionally, goals of CBT treatment are the acceptance of the medical condition, addressing avoidance behaviors, and mediating expectations of treatment (Gatchel et al., 2014).
8.5.1.3. Behavioral. Behavioral therapies have also been shown to effectively manage complex chronic somatic symptoms, particularly pain. The behavioral approach involves bringing attention to physiological symptoms, the individual’s attribution to those symptoms, and the subsequent anxiety produced by the negative attributions (Looper & Kirmayer, 2002).
Psychopharmacology
Psychopharmacological interventions are rarely used due to possible side effects and unknown efficacy. Given that these individuals already have a heightened reaction to their physiological symptoms, there is a high likelihood that the side effects of medication would produce more harm than help. With that said, psychopharmacological interventions may be helpful for those individuals who have comorbid psychological disorders such as depression or anxiety, which may negatively impact their ability to engage in psychotherapy (McGeary, Harzell, McGeary, & Gatchel, 2016).
Key Takeaways
You should have learned the following in this section:
• The biopsychosocial model of treatment is one of the most effective for somatic disorders as it considers the various biological, psychological, and social factors that influence the illness and presenting symptoms and includes a multidisciplinary approach.
• Psychotherapy options include interpersonal psychotherapy, CBT, and behavioral.
• Psychopharmacological interventions are rarely used for somatic disorders due to the side effects of the medication producing more harm than good. When used, they deal with comorbid disorders such as depression or anxiety.
Review Questions
1. Discuss the difference between multidisciplinary and interdisciplinary approaches to treatment of somatic disorders.
2. What is the biopsychosocial model for treatment of somatic disorders? What are the three main components of this treatment?
3. Are there any treatments that are not effective in treating somatic disorders? If so, why? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/08%3A_Somatic_Symptom_and_Related_Disorders/8.05%3A_Somatic_Symptom_and_Rela.txt |
Learning Objectives
• Describe how psychological factors affecting other medical conditions presents.
• List and describe the most common types of psychophysiological disorders.
• Describe treatment options for psychological factors affecting other medical conditions.
Although previously known as psychosomatic disorders, the DSM-5-TR has identified physical illnesses that are caused or exacerbated by biopsychosocial factors as psychological factors affecting other medical conditions. This disorder is different than all the previously mentioned somatic related disorders as the primary focus of the disorder is not the mental disorder, but rather the physical disorder. Psychological or behavioral factors adversely affect the medical condition by, “…influencing its course or treatment, by constituting an additional well-established health risk factor, or by influencing the underlying pathophysiology to precipitate or exacerbate symptoms or to necessitate medical attention” (APA, 2022, pg. 365). It is believed that a lack of positive coping strategies, psychological distress, or maladaptive health behaviors exacerbate these physical symptoms (McGeary, Harzell, McGeary, & Gatchel, 2016).
Psychophysiological Disorders
The most common types of psychophysiological disorders are headaches (migraines and tension), gastrointestinal (ulcer and irritable bowel), insomnia, and cardiovascular-related disorders (coronary heart disease and hypertension). We will briefly review these disorders and discuss the associated psychological features believed to exacerbate symptoms.
8.6.1.1. Headaches. Among the most common types of headaches are migraines and tension headaches (Williamson, 1981). Migraine headaches are often more severe and are explained by a throbbing pain localized to one side of the head, frequently accompanied by nausea, vomiting, sensitivity to light, and vertigo. It is believed that migraines are caused by the blood vessels in the brain narrowing, thus reducing the blood flow to various parts of the brain, followed by the same vessels later expanding, thus rapidly changing the blood flow. It is estimated that 23 million people in the U.S. alone suffer from migraines (Williamson, Barker, Veron-Guidry, 1994).
Tension headaches are often described as a dull, constant ache localized to one part of the head or neck; however, it can co-occur in multiple places at one time. Unlike migraines, nausea, vomiting, and sensitivity to light do not often occur with tension headaches. Tension headaches, as well as migraines, are believed to be primarily caused by stress as they are in response to sustained muscle contraction that is often exhibited by those under extreme stress or emotion (Williamson, Barker, Veron-Guidry, 1994). In efforts to reduce the frequency and intensity of both migraines and tension headaches, individuals have found relief in relaxation techniques, as well as the use of biofeedback training to help encourage the relaxation of muscles.
8.6.1.2. Gastrointestinal. Among the two most common types of gastrointestinal psychophysiological disorders are ulcers and irritable bowel syndrome (IBS). Ulcers, or painful sores in the stomach lining, occur when mucus from digestive juices are reduced, allowing digestive acids to burn a hole into the stomach lining. Among the most common type of ulcers are peptic ulcers, which are caused by the bacteria H. pylori (Sung, Kuipers, El-Serag, 2009). While there is evidence to support the involvement of stress in the development of dyspeptic symptoms, the evidence linking stress and peptic ulcers is slowly growing. (Purdy, 2013). Researchers believe that while H. pylori must be present for a peptic ulcer to develop, increased stress levels may impact the amount of digestive acid present in the stomach lining, thus increasing the frequency and intensity of symptoms (Sung, Kuipers, El-Serag, 2009).
IBS is a chronic, functional disorder of the gastrointestinal tract. Common symptoms of IBS include abdominal pain and extreme bowel habits (diarrhea or constipation). It affects up to a quarter of the population and is responsible for nearly half of all referrals to gastroenterologists (Sandler, 1990).
Because IBS is a functional disorder, there are no known structural, chemical, or physiological abnormalities responsible for the symptoms. However, there is conclusive evidence that IBS symptoms are related to psychological distress, particularly in those with anxiety or depression. Although more research is needed to pinpoint the timing between the onset of IBS and psychological disorders, preliminary evidence suggests that psychological distress is present before IBS symptoms. Therefore, IBS may be best explained as a somatic expression of associated psychological problems (Sykes, Blanchard, Lackner, Keefer, & Krasner, 2003).
8.6.1.3. Insomnia. Insomnia, the difficulty falling or staying asleep, occurs in more than one-third of the U.S. population, with approximately 10% of patients reporting chronic insomnia (Perlis & Gehrman, 2013). While exact pathways of chronic psychophysiological insomnia are unclear, there is evidence of some biopsychosocial factors that may predispose an individual to develop insomnia such as anxiety, depression, and overactive arousal systems (Trauer et al., 2015). Part of the difficulty with insomnia is the fact that these psychological symptoms can impact one’s ability to fall asleep; however, we also know that lack of adequate sleep also predisposes individuals to increased psychological distress. Due to this cyclic nature of psychological distress and insomnia, intervention for both sleep issues as well as psychological issues is vital to managing symptoms.
8.6.1.4. Cardiovascular. Heart disease has been the leading cause of death in the United States for the past several decades. Costs related to disability, medical procedures, and societal burdens are estimated to be \$444 billion a year (Purdy, 2013). With this large financial burden, there have been considerable efforts to identify risk and protective factors in predicting cardiovascular mortality.
Researchers have identified that depression is a predictor of early-onset coronary heart disease (Ketterer, Knysk, Khanal, & Hudson, 2006). More specifically, there is a five-fold increase of depression in those with coronary heart disease than the general population (Ketterer, Knysk, Khanal, & Hudson, 2006). Additionally, anxiety and anger have also been identified as an early predictor of cardiac events, suggesting psychological interventions aimed at reducing anxiety and establishing positive coping strategies for anger management may be effective in reducing future cardiac events (Ketterer, Knysk, Khanal, & Hudson, 2006).
8.6.1.5. Hypertension. Also called or chronically elevated blood pressure, is also found to be affected by psychological factors. More specifically, constant stress, anxiety, and depression have all been found to impact the likelihood of a cardiac event due to their impact on vasoconstriction (Purdy, 2013). Elevated inflammatory markers such as C-reactive protein, which is indicative of plaque instability, has been found in chronically depressed individuals, thus predisposing them to potential heart attacks (Ketterer, Knysk, Khanal, & Hudson, 2006).
Treatments for Psychological Factors Affecting Other Medical Conditions
As more information regarding contributing factors to psychophysiological disorders is discovered, more psychological treatment approaches have been developed and applied to these medical problems. The most common types of treatments include relaxation training, biofeedback, hypnosis, traditional CBT treatments, group therapy, as well as a combination of the previous treatments.
8.6.2.1. Relaxation training. Relaxation training essentially teaches individuals how to relax their muscles on command. While relaxation is used in combination with other psychological interventions to reduce anxiety (as seen in PTSD and various anxiety disorders), it has also been shown to be effective in treating physical symptoms such as headaches, chronic pain, as well as pain related to specific causes (e.g., injection sites, side effects of medications; McKenna et al., 2015).
8.6.2.2. Biofeedback. Biofeedback is a unique psychological treatment in which an individual is connected to a machine (usually a computer) that allows for continuous monitoring of involuntary physiological reactions. Measurements that can be obtained are heart rate, galvanic skin response, respiration, muscle tension, and body temperature, to name a few.
There are a few different ways in which biofeedback can be administered. The first is clinician-led. The clinician will actively guide the patient through a relaxation monologue, encouraging the patient to relax muscles associated near the pain region (or within the entire body). While going through the monologue, the clinician is provided with real-time feedback about the patient’s physiological response. Research studies have routinely supported the use of biofeedback, particularly for those with pain and headaches that have not been responsive to pharmacological interventions (McKenna et al., 2015).
Another option of biofeedback is through computer programs developed by psychologists. The most common, a program called Wild Devine (now Unyte) is an integrative relaxation program that encourages the use of breathing techniques while simultaneously measuring the patient’s physiological responses. This type of programming is especially helpful for younger patients as there are various “games” the child can play that requires the awareness and control of their thoughts, feelings, and emotions.
8.6.2.3. Hypnosis. Hypnosis, which some argue is just an extreme sense of relaxation, has been effective in reducing pain and managing anxiety symptoms associated with medical procedures (Lang et al., 2000). Through extensive training, an individual can learn to engage in self-hypnosis or obtain recorded hypnosis monologues to assist with the management of physiological symptoms outside of hypnosis sessions. While additional research is still needed within the field of hypnosis, studies have indicated that hypnosis is effective in not only treating chronic pain, but also assists with a reduction in anxiety, improved sleep, and improved overall quality of life (Jensen et al., 2006).
8.6.2.4. Group Therapy. Group therapy is another effective treatment option for individuals with psychological distress related to physical disorders. These groups not only aim to reduce the negative emotions associated with chronic illnesses, but they also provide support from other group members that are experiencing the same physical and psychological symptoms. These groups are typically CBT based and utilize cognitive and behavioral strategies in a group setting to encourage acceptance of disease while also addressing maladaptive coping strategies.
Key Takeaways
You should have learned the following in this section:
• Psychological factors affecting other medical conditions has as its primary focus the physical disorder, and not the mental disorder.
• The most common types of psychophysiological disorders include headaches to include migraines and tension, gastrointestinal to include ulcers and IBS, insomnia, coronary heart disease, and hypertension.
• Common treatments for these other medical conditions include relaxation training, biofeedback, hypnosis, traditional CBT treatments, and group therapy.
Review Questions
1. What are the most common types of psychophysiological disorders?
2. Discuss the differences between the different types of headaches.
3. What is the difference between ulcers and irritable bowel syndrome?
4. What are the identified predictors to coronary heart disease and other cardiac events?
5. What are the most effective treatment options for psychophysiological disorders?
Module Recap
In Module 8, we discussed somatic disorders in terms of their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Somatic disorders included somatic symptom disorder, illness anxiety disorder, functional neurological symptom (conversion) disorder , and factitious disorder. We also discussed psychological factors affecting other medication conditions in relation to their clinical presentation, common types of psychophysiological disorders, and treatment. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/08%3A_Somatic_Symptom_and_Related_Disorders/8.06%3A_Somatic_Symptom_and_Rela.txt |
Learning Objectives
• Describe how obsessive-compulsive disorders present.
• Describe the epidemiology of obsessive-compulsive disorders.
• Describe comorbidity in relation to obsessive-compulsive disorders.
• Describe the etiology of obsessive-compulsive disorders.
• Describe treatment options for obsessive-compulsive disorders.
In Module 9, we will discuss matters related to obsessive-compulsive and related disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will include obsessive compulsive disorder (OCD), body dysmorphic disorder (BDD), and hoarding. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of the therapies (Module 3).
09: Obsessive-Compulsive and Related Disorders
Learning Objectives
• Describe how obsessive compulsive disorder presents.
• Describe how body dysmorphic disorder presents.
• Describe how hoarding disorder presents.
Obsessive-Compulsive Disorder
Obsessive-compulsive disorder, more commonly known as OCD, requires the presence of obsessions, compulsions, or both. Obsessions are defined as repetitive and persistent thoughts, urges, or images. These obsessions are intrusive, time-consuming (i.e., take more than an hour a day), and unwanted, often causing significant distress or impairment in an individual’s daily functioning. Common obsessions are contamination (dirt on self or objects), errors of uncertainty regarding daily behaviors (locking the door, turning off appliances), thoughts of physical harm or violence, and orderliness, to name a few (Cisler, Adams, et al., 2011; Yadin & Foa, 2009). Often the individual will try to ignore these thoughts, urges, or images. When they are unable to ignore them, the individual will engage in compulsory behaviors to gain temporary relief from the distress or anxiety.
Compulsions are time-consuming, repetitive behaviors or mental acts that an individual performs in response to an obsession. Common examples of compulsions are checking (e.g., repeatedly checking if the stove is turned off even though the first four-times they checked it was), counting (e.g., flicking the lights off and on exactly five times), hand washing, symmetry, fears of harm to self or others, or repeating specific words (APA, 2022). These compulsive behaviors essentially alleviate the anxiety associated with the obsessive thoughts. For example, an individual may feel as though their hands are dirty after using utensils at a restaurant. They may obsess over this thought for some time, impacting their ability to interact with others or complete a specific task. This obsession will ultimately lead to the individual performing a compulsion where they will wash their hands with extremely hot water to rid all the germs, or even wash their hands a specified number of times if they also have a counting compulsion. At this point, the individual’s anxiety should be temporarily relieved.
These obsessions and compulsions are more excessive than the typical “cleanliness” as they consume a large part of the individual’s day. Additionally, they cause significant impairment in one’s daily functioning. Given the example above, an individual with a fear of contamination may refuse to eat at restaurants, or they may bring their utensils from home. The frequency and severity of the obsessions and compulsions varies by patient, with some having mild to moderate symptoms and only spending 1-3 hours a day obsessing or engaging in compulsive behaviors, while other patients present with severe symptoms and have nearly constant intrusive thoughts or compulsions that can become incapacitating (APA, 2022).
Body Dysmorphic Disorder
Body dysmorphic disorder is another obsessive disorder; however, the focus of the obsessions is with perceived defects or flaws in one’s physical appearance. A key feature of these obsessions is that they are not observable or appear slight to others. An individual who has a congenital facial defect or a burn victim who is concerned about their scars are not examples of an individual with body dysmorphic disorder. The obsessions related to one’s appearance can run the spectrum from feeling “unattractive” to “looking hideous.” While any part of the body can be a concern for an individual with body dysmorphic disorder, the most commonly reported areas are skin (acne, wrinkles, skin color), hair (particularly thinning or excessive body hair), and nose (size or shape; APA, 2022). Interestingly, the disorder can occur by proxy meaning the individual is not concerned with their own defects but those of another person, often a spouse or partner but at times, a parent, child, sibling, or stranger.
Due to the distressing nature of the obsessions regarding one’s body, individuals with body dysmorphic disorder also engage in compulsive behaviors that take up a considerable amount of time in their day. For example, they may repeatedly compare their body to other people’s bodies in the general public; frequently look at themselves in the mirror; engage in excessive grooming, which includes using make-up to modify their appearance. Some individuals with body dysmorphic disorder will go as far as having numerous plastic surgeries in attempts to obtain their “perfect” appearance.
While most of us are guilty of engaging in some of these behaviors, to meet criteria for body dysmorphic disorder, one must spend a considerable amount of time preoccupied with their appearance (i.e., on average 3-8 hours a day), as well as display significant impairment in social, occupational, or other areas of functioning. Some individuals excessively tan, change their clothes repeatedly, or compulsively shop such as for beauty products. Camouflaging perceived defects is a common behavior and could involve applying makeup, adjusting a hat or one’s clothes, or covering the forehead or eyes with one’s hair, all to hide or cover the perceived defect or problem area (APA, 2022).
As the DSM-5-TR notes, body dysmorphic disorder has been associated with, “abnormalities in emotion recognition, attention, and executive function, as well as information-processing biases and inaccuracies in interpretation of information and social situations” (APA, 2022, pg. 273). These individuals tend to express a bias for negative and threatening interpretations of facial expressions and situations that would be classified as ambiguous, for instance.
9.1.2.1. Muscle dysmorphia. While muscle dysmorphia is not a formal diagnosis, it is a common type of BDD, particularly within the male population. Muscle dysmorphia refers to the belief that one’s body is too small or lacks the appropriate amount of muscle definition (Ahmed, Cook, Genen & Schwartz, 2014). While the severity of BDD between individuals with and without muscle dysmorphia appears to be the same, some studies have found higher use of substance abuse (i.e., steroid use), poorer quality of life, and increased reports of suicide attempts in those with muscle dysmorphia (Pope, Pope, Menard, Fay Olivardia, & Philips, 2005). The DSM-5-TR instructs clinicians to specify if body dysmorphic disorder occurs with muscle dysmorphia.
9.1.2.2. Insight specifiers. Those diagnosed with body dysmorphic disorder vary in the degree of insight they have about the accuracy of their body dysmorphic disorder beliefs, ranging from good to absent/delusional. On average, insight is poor and at least one-third of those diagnosed with the disorder display absent/delusional insight. Mental health professionals would indicate the degree of insight regarding body dysmorphic disorder beliefs using with good or fair insight, with poor insight, or with absent insight/delusional beliefs. See page 272 of the DSM-5-TR for more information. Note that the insight specifier is used with OCD and hoarding disorders as well.
Hoarding Disorder
In hoarding disorder, the key feature is the persistent over-accumulation of possessions (APA, 2022). While we all obtain items throughout life, individuals with hoarding disorder continue to accumulate items without discarding possessions, regardless of their value or sentiment. This lack of discarding occurs over a long period and is not explained by a recent significant stressor (e.g., lost house in fire, so now keeps everything). For example, last week’s newspaper would likely have no relevance to you or possibly any historical value, but those with hoarding disorder would keep this newspaper despite the lack of value or sentiment.
The most commonly hoarded items are newspapers, magazines, clothes, bags, books, mail, and paperwork (APA, 2022). While these items may be stored in attics and garages, individuals with a hoarding disorder also have these items cluttering their living space, sometimes to the extent that they are unable to utilize their furniture because it is covered in stuff. Cognitive factors contributing to the need to hold onto these non-sentimental items are fear of losing valuable information and fear of being wasteful. When asked to “clean out” their house or get rid of these items, individuals with hoarding disorder experience significant distress. Individuals with hoarding disorder display indecisiveness, avoidance, procrastination, perfectionism, difficulty planning and organizing tasks, and are easily distractible.
One’s hoarding behaviors also impacts their daily functioning and causes impairment in social and occupational functioning. It can lead to low quality of life and in extreme cases, place the individual at risk for figure, falling, poor sanitation, and other health risks. Family relationships are often strained and conflict with neighbors and local authorities is common (APA, 2022).
Key Takeaways
You should have learned the following in this section:
• As part of OCD, obsessions are repetitive and persistent thoughts, urges, or images while compulsions are repetitive behaviors or mental acts that an individual performs in response to an obsession.
• Body dysmorphic disorder is characterized by obsessions over perceived defects or flaws in one’s physical appearance.
• Muscle dysmorphia refers to the belief that one’s body is too small or lacks the appropriate amount of muscle definition and is a type of body dysmorphic disorder common to men.
• Hoarding disorder is characterized by accumulating items without discarding possessions, regardless of their value or sentiment.
Review Questions
1. Define obsessions and compulsions. Provide a list of examples of each thought/behavior.
2. What is body dysmorphic disorder? Give examples of characteristics that would not be consistent with a body dysmorphic disorder diagnosis.
3. Many of us save items throughout our lifetime that remind us of specific events. How is this different from hoarding? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/09%3A_Obsessive-Compulsive_and_Related_Disorders/9.01%3A_Obsessive-Compulsiv.txt |
Learning Objectives
• Describe the epidemiology of OCD.
• Describe the epidemiology of body dysmorphic disorder.
• Describe the epidemiology of hoarding disorder.
OCD
The prevalence rate for OCD is approximately 1.2% both in the U.S. and worldwide (APA, 2022). Women are diagnosed with OCD more often than males; however, in childhood, boys are diagnosed more frequently than girls (APA, 2022). With respect to gender and symptoms, females are more likely to be diagnosed with cleaning related obsessions and compulsions. In contrast, males are more likely to display symptoms related to forbidden thoughts and symmetry (APA, 2022). The DSM-5-TR reports that the mean age of onset of OCD is 19.5 years with a quarter of cases starting by 14 years of age. Additionally, males have an earlier age of onset (5-15 yrs.) compared to females (20-24 yrs.; Rasmussen & Eisen, 1990).
Body Dysmorphic Disorder
The point prevalence rate for body dysmorphic disorder among U.S. adults is 2.4% while outside the U.S., the point prevalence is 1.7% to 2.9%. Gender-based prevalence rates indicate that women are more likely to be diagnosed with body dysmorphic disorder than men, though muscle dysmorphia is diagnosed more frequently in men. Additionally, women are more likely to be preoccupied with weight, breasts, buttocks, legs, hips, and excessive body or facial hair while men have preoccupations with their genitals, body build, and thinning hair (APA, 2022).
Hoarding Disorder
While national studies on the prevalence rate of hoarding within the U.S. and internationally are not available, community surveys estimate clinically significant hoarding as occurring in 1.5% to 6.0% of the population (APA, 2022; Gilliam & Tolin, 2010). Clinical samples are more highly represented by females than males and older individuals (over the age of 65 years) are three times more likely to be diagnosed with hoarding disorder than younger adults.
Key Takeaways
You should have learned the following in this section:
• The prevalence rate for OCD is about 1.2% while body dysmorphic disorder is 2.4% and hoarding is estimated at 1.5% to 6%.
• In terms of gender, females are more likely to be diagnosed with the three disorders, though in terms of body dysmorphic disorder, males receive the muscle dysmorphia specifier more than females.
• Gender differences are also present for symptom presentation in OCD and the area of the body focused on in body dysmorphic disorder.
Review Questions
1. What are the key gender differences related to OCD and body dysmorphic disorder?
2. How do the prevalence rate of the three disorders compare?
9.03: Obsessive-Compulsiv
Learning Objectives
• Describe the comorbidity of OCD.
• Describe the comorbidity of body dysmorphic disorder.
• Describe the comorbidity of hoarding disorder.
OCD
There is a high comorbidity between OCD and other anxiety disorders. Nearly 76% of individuals with OCD will be diagnosed with another anxiety disorder, most commonly panic disorder, social anxiety disorder, generalized anxiety disorder, or a specific phobia. Additionally, due to the nature of OCD and its symptoms, nearly 41% of those with OCD will also be diagnosed with a depressive or bipolar disorder (APA, 2022).
There is a high comorbidity between OCD and tic disorder, particularly in males with an onset of OCD in childhood. Children presenting with early-onset OCD typically have a different presentation of symptoms than traditional OCD. Research has also indicated a strong triad of OCD, tic disorder, and ADHD in children. Due to this psychological disorder triad, it is believed there is a neurobiological mechanism at fault for the development and maintenance of the disorders.
It should be noted that there are several disorders—schizophrenia, bipolar disorder, eating disorders, body dysmorphic disorder, and Tourette’s disorder – that OCD is much more common in. Therefore, clinicians who have a patient diagnosed with one of the disorders should also routinely assess patients for OCD (APA, 2022).
Finally, OCD has a mean rate of lifetime suicide attempts of 14.2%, a mean rate of lifetime suicidal ideation of 44.1%, and a mean rate of current suicidal ideation of 25.9%. Severity of OCD, the symptom dimension of unacceptable thoughts, a history of suicidality, and severity of comorbid depressive and anxiety symptoms are predictors of greater suicide risk (APA, 2022).
Body Dysmorphic Disorder
Major depressive disorder is the most common comorbid psychological disorder with body dysmorphic disorder and typically occurs after the onset of body dysmorphic disorder. Additionally, there are some reports of social anxiety disorder, OCD, and substance-related disorders (likely related to muscle enhancement; APA, 2022). Those with body dysmorphic disorder are four times more likely to have experienced suicidal thoughts and 2.6 times more likely to have made suicide attempts compared to healthy control subjects and those diagnosed with eating disorders, OCD, or any anxiety disorder.
Hoarding Disorder
Of those diagnosed with hoarding disorder, about 75% have a comorbid mood or anxiety disorder with major depressive disorder, social anxiety disorder, and generalized anxiety disorder being the most common comorbid conditions. Additionally, nearly 20% also meet the criteria for OCD (APA, 2022).
Key Takeaways
You should have learned the following in this section:
• OCD is shown to have a high comorbidity with anxiety and depressive disorders as well as tic disorder and ADHD in children.
• Body dysmorphic disorder has a high comorbidity with major depressive disorder.
• Hoarding disorder has a high comorbidity with mood and anxiety disorders.
Review Questions
1. What are the most common comorbidities for OCD? Be specific.
2. This section discussed the OCD triad in children. What two other disorders complete this triad?
3. Which disorder is body dysmorphic disorder most comorbid with?
4. What can we say about comorbidities with hoarding disorder? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/09%3A_Obsessive-Compulsive_and_Related_Disorders/9.02%3A_Obsessive-Compulsiv.txt |
Learning Objectives
• Describe the biological causes of obsessive-compulsive disorders.
• Describe the cognitive causes of obsessive-compulsive disorders.
• Describe the behavioral causes of obsessive-compulsive disorders.
Biological
There are a few biological explanations for obsessive-compulsive related disorders, including hereditary transmission, neurotransmitter deficits, and abnormal functioning in brain structures.
9.4.1.1. Hereditary transmission. With regards to heritability studies, twin studies routinely support the role of genetics in the development of obsessive-compulsive behaviors, as monozygotic twins have a substantially greater concordance rate (80-87%) than dizygotic twins (47-50%; Carey & Gottesman, 1981; van Grootheest, Cath, Beekman, & Boomsma, 2005). Additionally, first degree relatives of patients diagnosed with OCD are at a 5-fold increase to develop OCD at some point throughout their lifespan (Nestadt, et al., 2000).
Interestingly, a study conducted by Nestadt and colleagues (2000) exploring the familial role in the development of obsessive-compulsive disorder found that family members of individuals with OCD had higher rates of both obsessions and compulsions than control families; however, the familial relationship with regards to obsessions were stronger than that of compulsions suggesting that there is a stronger heritability association for obsessions than compulsions.
This study also found a relationship between age of onset of OCD symptoms and family heritability. Individuals who experienced an earlier age of onset, particularly before age 17, were found to have more first-degree relatives diagnosed with OCD. In fact, after the age of 17, there was no relationship between family diagnoses, suggesting those who develop OCD at an older age may have a different diagnostic origin (Nestadt, et al., 2000).
Initial studies exploring genetic factors for BDD and hoarding also indicate a hereditary influence; however, environmental factors appear to play a more significant role in the development of these disorders than that of OCD (Ahmed, et al., 2014; Lervolino et al., 2009).
9.4.1.2. Neurotransmitters. Neurotransmitters, particularly serotonin, have been identified as a contributing factor to obsessive and compulsive behaviors. This discovery was made accidentally, when individuals with depression and comorbid OCD were given antidepressant medications clomipramine and fluoxetine—both of which increase levels of serotonin—to mediate symptoms of depression. Not only did these patients report a significant reduction in their depressive symptoms, but also a substantial improvement in their OCD symptoms (Bokor & Anderson, 2014). Antidepressant medications that do not affect serotonin levels are not effective in managing obsessive and compulsive symptoms, thus offering additional support for deficits of serotonin levels as an explanation of obsessive and compulsive behaviors (Sinopoli, Burton, Kronenberg, & Arnold, 2017; Bokor & Anderson, 2014). More recently, there has been some research implicating the involvement of additional neurotransmitters—glutamate, GABA, and dopamine—in the development and maintenance of OCD, although future studies are still needed to draw definitive conclusions (Marinova, Chuang, & Fineberg, 2017).
9.4.1.3. Brain structures. Seeing as neurotransmitters have direct involvement in the development of obsessive-compulsive behaviors, it’s only logical that brain structures that house these neurotransmitters also likely play a role in symptom development. Neuroimaging studies implicate the brain structures and circuits in the frontal lobe, more specifically, the orbitofrontal cortex, which is located just above each eye (Marsh et al., 2014). This brain region is responsible for mediating strong emotional responses and converts them into behavioral responses. Once the orbitofrontal cortex receives sensory/emotional information via sensory inputs, it transmits this information through impulses. These impulses are then passed on to the caudate nuclei, which filters through the many impulses received, passing along only the strongest impulses to the thalamus. Once the impulses reach the thalamus, the individual essentially reassesses the emotional response and decides whether to act (Beucke et al., 2013). It is believed that individuals with obsessive compulsive behaviors experience overactivity of the orbitofrontal cortex and a lack of filtering in the caudate nuclei, thus causing too many impulses to transfer to the thalamus (Endrass et al., 2011). Further support for this theory has been shown when individuals with OCD experience brain damage to the orbitofrontal cortex or caudate nuclei and experience remission of OCD symptoms (Hofer et al., 2013).
Cognitive
Cognitive theorists believe that OCD behaviors occur due to an individual’s distorted thinking and negative cognitive biases. More specifically, individuals with OCD are more likely to overestimate the probability of harm, loss of control, or uncertainty in their life, thus leading them to over-interpret potential negative outcomes of events. Additionally, some research has indicated that those with OCD also experience disconfirmation bias, which causes the individual to seek out evidence of their failure to perform the ritual or compensatory behavior correctly (Sue, Sue, Sue, & Sue, 2017). Finally, individuals with OCD often report the inability to trust themselves and their instincts, and therefore, feel the need to repeat the compulsive behavior multiple times to ensure it is done correctly. These cognitive biases are supported throughout research studies that repeatedly find individuals with OCD experience more intrusive thoughts than those without OCD (Jacob, Larson, & Storch, 2014).
We have shown that individuals with OCD experience cognitive biases and that these biases contribute to the obsessive and compulsive behaviors, but why do these cognitive biases occur so often? Everyone has times when they have repetitive or intrusive thoughts such as: “Did I shut the oven off after cooking dinner?” or “Did I remember to lock the door before I left home?” Fortunately, most individuals are able to either concede to their thoughts once, or even forgo acknowledging their thoughts after they confidently talk themselves through their actions, ensuring that the behavior in question was or was not completed. Unfortunately, individuals with OCD are unable to neutralize these thoughts without performing a ritual as a way to put themselves at ease. As you will see in more detail in the behavioral section below, the behaviors (compulsions) used to neutralize the thoughts (obsessions) provide temporary relief to the individual. As the individual is continually exposed to the obsession and repeatedly engages in the compulsive behaviors to neutralize their anxiety, the behavior is repeatedly reinforced, thus becoming a compulsion. This theory is supported by studies where individuals with OCD report using more neutralizing strategies and report significant reductions in anxiety after employing these neutralizing techniques (Jacob, Larson, & Storch, 2014; Salkovskis et al., 2003).
Behavioral
The behavioral explanation of obsessive compulsive-related disorders focuses on compulsions rather than obsessions. Behaviorists believe that these compulsions begin with and are maintained through operant conditioning. How so? Well, an individual with OCD may experience negative thoughts or anxieties related to an unpleasant event (obsession; the event is a stimulus). These thoughts/anxieties cause significant distress to the individual, and therefore, they seek out some behavior (compulsion; the response) to alleviate these threats (i.e., escape behavior associated with negative reinforcement). This provides temporary relief to the individual, thus reinforcing the compulsive behaviors used to lessen the threat. Over time, the compulsive behaviors are reinforced due to the repeated exposure of the obsession and the temporary relief that comes with engaging in these compulsive behaviors (escape behavior).
Strong support for this theory is the fact that the behavioral treatment option for OCD- exposure and response prevention, is among the most effective treatments for these disorders. As you will read below, this treatment essentially breaks the patient’s operant conditioning associated with the obsessions and compulsions by preventing the individual from engaging in the compulsive behavior until anxiety is reduced.
Key Takeaways
You should have learned the following in this section:
• Biological causes of obsessive-compulsive disorders include hereditary transmission, neurotransmitter deficits particularly in relation to serotonin, and abnormal functioning in brain structures.
• Cognitive causes of obsessive-compulsive disorders include distorted thinking such as overestimating the probability of harm, loss of control, or uncertainty in their life, and negative cognitive biases such as disconfirmation bias.
• Behavioral causes of obsessive-compulsive disorders include operant conditioning.
Review Questions
1. What are the biological implications regarding the etiology of OCD and related disorders? What brain structures have been linked to these disorders?
2. Discuss identified cognitive biases that are related to the development and maintenance of OCD and related disorders?
3. The behavioral model discusses how respondent conditioning may explain the development and maintenance of these disorders. What type of reinforcement is at work and how? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/09%3A_Obsessive-Compulsive_and_Related_Disorders/9.04%3A_Obsessive-Compulsiv.txt |
Learning Objectives
• Describe treatment options for OCD.
• Describe treatment options for body dysmorphic disorder.
• Describe treatment options for hoarding disorder.
OCD
9.5.1.1. Exposure and Response Prevention (ERP). Treatment of OCD has come a long way in recent years. Among the most effective treatment options is exposure and response prevention (March, Frances, Kahn, & Carpenter, 1997). First developed by psychiatrist Victor Meyer (1966), as you might infer from the name, individuals are repeatedly exposed to their obsession, thus causing anxiety/fears, while simultaneously prevented from engaging in their compulsive behaviors. Exposure sessions are often done in vivo (in real life), via videos, or even imaginary, depending on the type of obsession. For example, a fear that one’s house would burn down if their compulsion was not carried out would obviously be done via imaginary exposure, as it would not be ethical to have a person burn their house down.
Prior to beginning the exposure and response prevention exercises, the clinician must teach the patient relaxation techniques for them to engage in during the distress of being exposed to the obsession. Once relaxation techniques are taught, the clinician and patient will develop a hierarchy of obsessions. Treatment will start at those with the lowest amount of distress to ensure the patient has success with treatment, as well as preventing withdrawal of treatment.
Within the hierarchy of obsessions, the individual is also gradually exposed to their obsession. For example, an individual obsessed with germs, may first watch a person sneeze on the computer in session. Once anxiety is managed and compulsions refrain at this level of exposure, the individual would move on to being present in the same room as a sick individual, to eventually shaking hands with someone obviously sick, each time preventing them from engaging in their compulsive behavior. Once this level of their hierarchy was managed, they would move on to the next obsession and so forth until the entire list was complete.
Treatment outcome for exposure and response prevention is very effective in treating individuals with OCD. In fact, some studies suggest up to an 86% response rate when treatment is completed (Foa et al., 2005). Combination treatments such as ERP with family counseling (utilizing CBT techniques) may increase this response rate even higher (Bolleau, 2011; Krebs & Heyman, 2015). Like most OCD related treatments, the largest barrier to treatment is getting patients to commit to treatment, as the repeated exposures and prevention of compulsive behaviors can be extremely distressing to patients.
9.5.1.2. Psychopharmacology. There has been minimal support for the treatment of OCD with medication alone. This is likely due to the temporary resolution of symptoms during medication use. Among the most effective medications are those that inhibit the reuptake of serotonin, clomipramine and SSRIs. Reportedly, up to 60% of patients show improvement in symptoms while taking these medications; however, symptoms are quick to return when medications are discontinued (Dougherty, Rauch, & Jenike, 2002). While there has been some promise in a combined treatment option of exposure and response prevention and SSRIs, these findings were not superior to exposure and response prevention alone, suggesting that the inclusion of medication in treatment does not provide an added benefit (Foa et al., 2005).
Body Dysmorphic Disorder
Seeing as though there are strong similarities between OCD and body dysmorphic disorder, it should not come as a surprise that the only two effective treatments for body dysmorphic disorder are those that are effective in OCD. Exposure and response prevention has been successful in treating symptoms of body dysmorphic disorder, as patients are repeatedly exposed to their body imperfections/obsessions and prevented from engaging in compulsions used to reduce their anxiety. (Veale, Gournay, et al., 1996; Wilhelm, Otto, Lohr, & Deckersbach, 1999). The other treatment option, psychopharmacology, has also been shown to reduce symptoms in patients with body dysmorphic disorder. Similar to OCD, medications such as clomipramine and SSRIs are generally prescribed. While these are effective in reducing body dysmorphic disorder symptoms, once medication is discontinued, symptoms resume nearly immediately suggesting this is not an effective long-term treatment option for those with body dysmorphic disorder.
Treatment of body dysmorphic disorder appears to be difficult, with one study finding that only 9% of participants had full remission at a 1-year follow-up, and 21% reported partial remission (Phillips, Pagano, Menard & Stout, 2006). A more recent finding reported more promising findings, with 76% of participants reporting full remission over 8 years (Bjornsson, Dyck, et al., 2011).
9.5.2.1. Plastic surgery and medical treatments. Many individuals with body dysmorphic disorder seek out plastic surgery to attempt to correct their deficits. Phillips and colleagues (2001) evaluated treatments of patients with body dysmorphic disorder and found that 76.4% of the patients reported some form of plastic surgery or medical treatment, with dermatology treatment the most reported (45%) followed by plastic surgery (23%). The problem with this type of treatment is that the individual is rarely satisfied with the outcome of the procedure, thus leading them to seek out additional surgeries on the same defect (Phillips et al., 2001). Therefore, it is important that medical professionals thoroughly screen patients for psychological distress before completing any medical treatment.
Hoarding Disorder
Recent research has concluded that unlike OCD, many individuals with hoarding disorder do not experience intrusive thoughts, nor do they experience urges to perform rituals. Because of this difference, treatment for hoarding disorder has moved away from exposure and response prevention, and more toward a traditional cognitive-behavioral approach.
Frost and Hartl (1996) believed that individuals with hoarding disorder engage in complex decision-making processes, overanalyzing the value and worth of possessions, thus leading to hoarding the object as opposed to discarding it. Therefore, in addition to having the individual engage in exposure treatment, an added component of cognitive restructuring and motivational interviewing are added to address the complex-decision making that is involved in maintaining unnecessary possessions. By discussing motives for keeping items, as well as fears that may be associated with discarding items, clinicians can assist patients in their cognitive processes to ultimately determine the item’s actual worth (Williams & Viscusi, 2016). Unfortunately, due to the distressing nature of having to discard their possessions, many individuals in treatment for hoarding disorder prematurely end treatment, thus never reaching remission of symptoms (Mancebo, Eisen, Sibrava, Dyck, & Rasmussen, 2011).
Key Takeaways
You should have learned the following in this section:
• Treatment options for OCD include exposure and response prevention, as well as SSRIs though the drug does not provide an added benefit in treatment.
• Treatment options for body dysmorphic disorder include exposure and response prevention and drugs clomipramine and SSRIs.
• Treatment options for hoarding disorder include exposure treatment, cognitive restructuring, and motivational interviewing.
Review Questions
1. Discuss the various types of treatments for OCD. Which treatment option has the best outcome?
2. What are the different components of Exposure and Response Prevention? How do they work together to reduce OCD symptoms?
3. What are the most effective treatment approaches for body dysmorphic disorder?
4. According to Frost and Hartl (1996) what are the main components that contribute to the maintenance of hoarding disorder?
Module Recap
As in all modules past, we have discussed the clinical presentation, epidemiology, comorbidity, etiology, and treatment options for a specific class of disorders – obsessive compulsive and related disorders. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/03%3A_Part_III._Mental_Disorders__Block_2/09%3A_Obsessive-Compulsive_and_Related_Disorders/9.05%3A_Obsessive-Compulsiv.txt |
Learning Objectives
• Describe how feeding and eating disorders present.
• Describe the epidemiology of feeding and eating disorders.
• Describe comorbidity in relation to feeding and eating disorders.
• Describe the etiology of feeding and eating disorders.
• Describe treatment options for feeding and eating disorders.
In Module 10, we will discuss matters related to feeding and eating disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will include anorexia nervosa, bulimia nervosa, and binge eating disorder. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of the therapies (Module 3).
10: Feeding and Eating Disorders
Learning Objectives
• Describe how anorexia nervosa presents.
• Describe how bulimia nervosa presents.
• Describe how binge-eating disorder (BED) presents.
Feeding and eating disorders are “…characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning” (APA, 2022, pg. 371). They are very serious, yet relatively common mental health disorders, particularly in Western society, where there is a heavy emphasis on thinness and physical appearance. In fact, 13% of adolescents will be diagnosed with at least one eating disorder by their 20th birthday (Stice, Marti, & Rohde, 2013). Furthermore, a large number of adolescents will engage in significant disordered eating behaviors just below the clinical threshold (Culbert, Burt, McGue, Iacono & Klump, 2009). While there is no exact cause for eating disorders, the combination of biological, psychological, and sociocultural factors has been identified as major contributors in both the development and maintenance of eating disorders.
Within the DSM 5-TR (APA, 2022), six disorders are classified under the Feeding and Eating Disorders chapter: pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa, and binge-eating disorder. In this book, we will cover the latter three whose diagnostic criteria are mutually exclusive, meaning that only one of these diagnoses can be assigned at any given time due to substantial differences in their clinical course, outcome, and treatment needs, despite a number of common psychological and behavioral features.
For more on eating disorders in general, please visit the National Eating Disorders Association website below:
www.nationaleatingdisorders.org/what-are-eating-disorders
10.1.1. Anorexia Nervosa
Anorexia nervosa involves the restriction of energy intake, which leads to significantly low body weight relative to the individual’s age, sex, and development. This restriction is often secondary to an intense fear of gaining weight or becoming fat, despite the individual’s low body weight. Altered perception of self and an over-evaluation of one’s body weight and shape contribute to this disturbance of body size.
Typical warning signs and symptoms are divided into two different categories: emotional/behavioral and physical. Some emotional and behavioral symptoms include dramatic weight loss; preoccupation with food, weight, calories, etc.; frequent comments about feeling “fat;” eating a restricted range of foods; making excuses to avoid mealtimes; and not eating in public. Physical changes may include dizziness, difficulty concentrating, feeling cold, sleep problems, thinning hair/hair loss, and muscle weakness, to name a few. When the individual loses weight, they view this as an impressive achievement and a sign of extraordinary discipline, while weight gain is seen as an unacceptable failure of self-control (APA, 2022).
The onset of the disorder typically begins with mild dietary restrictions such as eliminating carbs or specific fatty foods. As weight loss is achieved, the dietary restrictions progress to more severe, e.g., under 500 calories/day. Symptoms present in adolescence or young adulthood and rarely before puberty or after age 40. The onset of the disorder typically is preceded by a stressful life event such as leaving home for college.
For more on anorexia nervosa, please visit the National Eating Disorders Association website below:
www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia
Bulimia Nervosa
Unlike anorexia nervosa where there is solely restriction of food, bulimia nervosa involves a pattern of recurrent binge eating behaviors. Binge eating can be defined as a discrete period of time where the amount of food consumed is significantly more than most people would eat during a similar time period. Individuals with bulimia nervosa often report a sense of lack of control over-eating during these binge-eating episodes. While not always the case, these binge-eating episodes are followed by a feeling of disgust with oneself, which leads to a compensatory behavior to rid the body of the excessive calories. These compensatory behaviors include vomiting, use of laxatives, fasting (or severe restriction), diuretics or other medications, or excessive exercise. This cycle of binge eating and compensatory behaviors occurs on average, at least once a week for three months (National Eating Disorder Association website; APA, 2022).
It is important to note that while there are periods of severe calorie restriction like anorexia, the two disorders cannot be diagnosed simultaneously. Therefore, it is important to determine if an individual engages in a binge-eating episode—if they do, they do not meet the criteria for anorexia nervosa.
Signs and symptoms of bulimia nervosa are similar to anorexia nervosa. These symptoms include but are not limited to hiding food wrappers or containers after a bingeing episode, feeling uncomfortable eating in public, developing food rituals, limited diet, disappearing to the bathroom after eating a meal, and drinking excessive amounts of water or non-caloric beverages. Additional physical changes include weight fluctuations both up and down, difficulty concentrating, dizziness, sleep disturbance, and possible dental problems due to purging post binge eating episode.
Making Sense of the Disorders
Though anorexia and bulimia share some common features, they differ as follows:
• Diagnosis anorexia …… if severe calorie restriction occurs alone
• Diagnosis bulimia … if severe calorie restriction occurs AND there is a binge-eating episode
Symptoms of bulimia nervosa typically present later in development – adolescence or early adulthood. Like anorexia nervosa, bulimia nervosa initially presents with mild restrictive dietary behaviors; however, episodes of binge eating interrupt the dietary restriction, causing bodyweight to rise around normal levels. In response to weight gain, patients engage in compensatory behaviors or purging episodes to reduce body weight. This cycle of restriction, binge eating, and calorie reduction often occurs for years before seeking help.
Additionally, those with bulimia are often ashamed of their eating problems and attempt to hide the symptoms. The binge eating occurs in secrecy or as inconspicuously as possible. Common antecedents of binge eating include negative affect; interpersonal stressors; dietary restraint; boredom; and negative feelings linked to body weight, shape, and food.
For more on bulimia nervosa, please visit the National Eating Disorders Association website below:
www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia
Binge-Eating Disorder (BED)
Binge-eating disorder is similar to bulimia nervosa in that it involves recurrent binge eating episodes along with feelings of lack of control during the binge-eating episode. The binge-eating episodes are associated with at least three of the following: eating quicker than usual, eating until uncomfortably full, eating large amounts even if not hungry, eating alone, and feeling disgust with oneself or being depressed. Despite the feelings of shame and guilt post-binge, individuals with BED will not engage in vomiting, excessive exercise, or other compensatory behaviors. These binge eating episodes occur on average, at least once a week for 3 months.
Because these binge-eating episodes occur without compensatory behaviors, individuals with BED are at risk for obesity and related health disorders. Individuals with BED report feelings of embarrassment at the quantity of food consumed, and thus will often refuse to eat in public. Due to the restriction of eating around others, individuals with BED often engage in secret binge eating episodes in private, followed by discrete disposal of wrappers and containers.
Making Sense of the Disorders
Though bulimia and BED are similar, they differ as follows:
• Diagnosis BED …… if binge eating occurs alone
• Diagnosis bulimia … if binge eating occurs AND there are compensatory behaviors to prevent weight gain
While much is still being researched about binge-eating disorder, current research indicates that the onset of BED is adolescence to early adulthood but can begin later in life. Those who seek treatment tend to be older than those with either bulimia or anorexia. Binge eating has been found to be common in adolescent and college-age samples and for all, is associated with social role adjustment issues, impaired health-related quality of life and life satisfaction, and increased medical morbidity and mortality (APA, 2022).
For more on binge eating disorder, please visit the National Eating Disorders Association website below:
www.nationaleatingdisorders.org/learn/by-eating-disorder/bed
Key Takeaways
You should have learned the following in this section:
• Anorexia nervosa involves the restriction of food, which leads to significantly low body weight relative to the individual’s age, sex, and development, and an intense fear of gaining weight or becoming fat.
• Bulimia nervosa is characterized by a pattern of recurrent binge eating behaviors followed by compensatory behaviors.
• Binge-eating disorder is characterized by recurrent binge eating episodes along with a feeling of lack of control but no compensatory behavior to rid the body of the calories.
Review Questions
1. What does mutually exclusive mean? What does it mean with respect to eating disorders?
2. What are the key differences in diagnostic criteria for anorexia, bulimia, and binge eating disorder?
3. Define compensatory behavior. What disorder is this found in? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/04%3A_Part_IV._Mental_Disorders__Block_3/10%3A_Feeding_and_Eating_Disorders/10.01%3A_Feeding_and_Eating_Disorders_-_Cl.txt |
Learning Objectives
• Describe the epidemiology of anorexia nervosa.
• Describe the epidemiology of bulimia nervosa.
• Describe the epidemiology of binge eating disorder.
Anorexia Nervosa
According to the National Eating Disorder Alliance (NEDA) website, at any point in time more women (0.3-0.4%) than men (0.1%) will be diagnosed with anorexia. Anorexia nervosa is most prevalent in postindustrialized, high-income countries such as the United States, Australia, New Zealand, Japan, and many European countries. In the U.S., prevalence is lower among Latinx and non-Latinx Black Americans than non-Latinx Whites (APA, 2022).
Bulimia Nervosa
According to the NEDA website, at any point in time, 1.0% of women and 0.1% of men will meet the diagnostic criteria for bulimia nervosa. A study by Stice and Bohon (2012) found that between 1.1% and 4.6% of females and 0.1% to 0.5% of males will develop bulimia and that subthreshold bulimia occurs in 2.0% to 5.4% of adolescent females. The DSM reports that the 12-month prevalence ranges from 0.14% to 0.3% with higher rates in females and high-income countries. Rates are similar across ethnoracial groups across the U.S. (APA, 2022).
Binge Eating Disorder
Hudson et al. (2007) reports that BED is three times more common than anorexia and bulimia and is more common than breast cancer, HIV, and schizophrenia. It has also been found that between 0.2% and 3.5% of females and 0.9% and 2.0% of males will develop binge eating disorder with subthreshold binge eating disorder occurring in 1.6% of adolescent females (Stice & Bohon, 2012). The DSM reports a 12-month prevalence of 0.44% to 1.2% with rates 2-3 times higher in women, similar rates across ethnoracial groups in the United States and between most high-income industrialized countries (APA, 2022).
For more on statistics and research related to feeding and eating disorders, please visit the National Eating Disorders Association website below:
www.nationaleatingdisorders.org/statistics-research-eating-disorders
Key Takeaways
You should have learned the following in this section:
• BED is three times more common than anorexia and bulimia.
• All feeding and eating disorders are more common in women and high-income, industrialized countries.
• Only anorexia shows differences across ethnoracial groups in the United States.
Review Questions
1. Which feeding and eating disorder is most common?
2. What gender differences occur with regards to the eating disorders?
3. Are there any other noteworthy similarities or differences in the prevalence rates of the three disorders?
10.03: Feeding and Eating Disorders - Co
Learning Objectives
• Describe the comorbidity of anorexia nervosa.
• Describe the comorbidity of bulimia nervosa.
• Describe the comorbidity of BED.
Anorexia Nervosa
Anorexia is rarely a single diagnosis. High rates of bipolar, depressive, and anxiety disorders are common among individuals with anorexia nervosa. Obsessive-compulsive disorder is more often seen in those with the restricting type of anorexia nervosa, whereas alcohol use disorder and other substance use disorders are more commonly seen in those with anorexia who engage in binge-eating/purging behaviors. Unfortunately, there is also a high rate of suicidality, with rates reported to be 18 times greater than in an age- and gender-matched comparison group. It is also estimated that between 9% and 25% of individuals with anorexia have attempted suicide (APA, 2022).
Bulimia Nervosa
The majority of individuals diagnosed with bulimia nervosa also present with at least one other mental disorder. Similar to anorexia nervosa, there is a high frequency of depressive symptoms (i.e., low self-esteem), as well as bipolar and depressive disorders. While some experience mood fluctuations because of their eating pattern (occurring at the same time or following the development of bulimia), some individuals will identify mood symptoms prior to the onset of bulimia nervosa (APA, 2022).
Anxiety, particularly social anxiety, is often present in those with bulimia nervosa. However, most mood and anxiety symptoms resolve once an effective treatment of bulimia is established. Substance use disorder, and in particular alcohol use disorder, is also prevalent in those with bulimia, with about a 30% prevalence among those with bulimia. The substance abuse begins as a compensatory behavior (e.g., stimulant use is used to control appetite and weight) and over time, as the eating disorder progresses, so does the substance abuse. There is also a percentage of individuals with bulimia nervosa who display personality features that meet the criteria for at least one personality disorder, most often borderline personality disorder. Finally, about one-quarter to one-third of individuals with bulimia have had suicidal ideation and a comparable amount have attempted suicide.
BED
Research shows that BED shares similar comorbidities with anorexia nervosa and bulimia nervosa. Common comorbidities include major depressive disorder and alcohol use disorder. About 25% of those with BED have shown suicidal ideation (APA, 2022).
Key Takeaways
You should have learned the following in this section:
• Anorexia has a high comorbidity with bipolar, depressive, and anxiety disorders. OCD and alcohol use disorder are also comorbid but depend on the type of anorexia (restricting or binge-eating/purging).
• Bulimia has a high comorbidity with bipolar disorder, depressive symptoms and disorders, social anxiety, and substance use disorder.
• BED is highly comorbid with MDD and alcohol use disorder.
• There is a high rate of suicidal ideation with all three disorders.
Review Questions
1. Discuss the comorbidity rates among the three main eating disorders. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/04%3A_Part_IV._Mental_Disorders__Block_3/10%3A_Feeding_and_Eating_Disorders/10.02%3A_Feeding_and_Eating_Disorders_-_Ep.txt |
Learning Objectives
• Describe the biological causes of feeding and eating disorders.
• Describe the cognitive causes of feeding and eating disorders.
• Describe the sociocultural causes of feeding and eating disorders.
• Describe how personality traits are the cause of feeding and eating disorders.
What causes eating disorders? While researchers have yet to identify a specific cause of eating disorders, the most compelling argument to date is that eating disorders are multidimensional disorders. This means many contributing factors lead to the development of an eating disorder. While there is likely a genetic predisposition, there are also environmental, or external factors, such as family dynamics and cultural influences that impact their presentation. Research supporting these influences is well documented for anorexia nervosa and bulimia nervosa; however, seeing as BED has only just recently been established as a formal diagnosis, research on the evolvement of BED is ongoing.
Biological
There is some evidence of a genetic predisposition for eating disorders, with relatives of those diagnosed with an eating disorder being up to six times more likely than other individuals to be diagnosed also. Twin concordance studies also support the gene theory. If an identical twin is diagnosed with anorexia, there is a 70% percent chance the other twin will develop anorexia in their lifetime. The concordance rate for fraternal twins (who share less genes) is 20%. While not as strong for bulimia, identical twins still display a 23% concordance rate, compared to the 9% rate for fraternal twins.
In addition to hereditary causes, disruption in the neuroendocrine system is common in those with eating disorders (Culbert, Racine, & Klump, 2015). Unfortunately, it’s difficult for researchers to determine if these disruptions caused the disorder or have been caused by the disorder, as manipulation of eating patterns is known to trigger changes in hormone production. With that said, researchers have explored the hypothalamus as a potential contributing factor. The hypothalamus is responsible for regulating body functions, particularly hunger and thirst (Fetissov & Mequid, 2010). Within the hypothalamus, the lateral hypothalamus is responsible for initiating hunger cues that cause the organism to eat, whereas the ventromedial hypothalamus is responsible for sending signals of satiation, telling the organism to stop eating. Clearly, a disruption in either of these structures could explain why an individual may not take in enough calories or experience periods of overeating.
Cognitive
Some argue that eating disorders are, in fact, a variant of obsessive-compulsive disorder (OCD). The obsession with body shape and weight—the hallmark of an eating disorder—is likely a driving factor in anorexia nervosa. Distorted thought patterns and an over-evaluation of body size likely contribute to this obsession and one’s desire for thinness. Research has identified high levels of impulsivity, particularly in those with binge eating episodes, suggesting a temporary lack of control is responsible for these episodes. Post binge-eating episode, many individuals report feelings of disgust or even thoughts of failure. These strong cognitive factors are indicative as to why cognitive-behavioral therapy is the preferred treatment for eating disorders.
Sociocultural
Eating disorders are overwhelmingly found in Western countries where there is a heavy emphasis on thinness—a core feature of eating disorders. It is also found in countries where food is in abundance, as in places of deprivation, round figures are viewed as more desirable (Polivy & Herman, 2002). While eating disorders were once thought of as disorders of higher SES, recent research suggests that as our country becomes more homogenized, the more universal eating disorders become.
10.4.3.1. Media. One commonly discussed contributor to eating disorders is the media. The idealization of thin models and actresses sends the message to young women (and adolescents) that to be popular and attractive, you must be thin. These images are not isolated to magazines, but are also seen in television shows, movies, commercials, and large advertisements on billboards and hanging in store windows. With the emergence of social media (e.g., Facebook, Snapchat, Instagram), exposure to media images and celebrities is even easier. Couple this with the ability to alter images to make individuals even thinner, it is no wonder many young people become dissatisfied with their body (Polivy & Herman, 2004).
10.4.3.2. Ethnicity. While eating disorders are not solely a “white woman” disorder, there are significant discrepancies when it comes to race, especially for anorexia nervosa. Why is this? Research indicates that black men prefer heavier women than do white men (Greenberg & Laporte, 1996). Given this preference, it should not be surprising that black women and children have larger ideal physiques than their white peers (Polivy & Herman, 2000). Since black women are less driven to thinness, black women would appear to be less likely to develop anorexia; however, findings suggest this is not the case. Caldwell and colleagues (1997) found that high-income black women were equally as dissatisfied as high-income white women with their physique, suggesting body image issues may be more closely related to SES than that of race. The race discrepancies are also less significant in BED, where the prominent feature of the eating disorder is not thinness (Polivy & Herman, 2002).
10.4.3.3. Gender. Males account for only a small percentage of eating disorders. While it is unclear as to why there is such a discrepancy, it is likely somewhat related to cultural desires of women being “thin” and men being “muscular” or “strong.”
Of men diagnosed with an eating disorder, the overwhelming percentage of them identified a job or sport as the primary reason for their eating behaviors (Strother, Lemberg, Stanford, & Turberville, 2012). Jockeys, distance runners, wrestlers, and bodybuilders are some of the professions identified as most restrictive regarding body weight.
There is some speculation that males are not diagnosed as frequently as women due to the stigma attached to eating disorders. Eating disorders have routinely been characterized as a “white, adolescent female” problem. Due to this bias, young men may not seek help for their eating disorder in efforts to prevent labeling (Raevuoni, Keski-Rahkonen & Hoek, 2014).
10.4.3.4. Family. Family influences are one of the strongest external contributors to maintaining eating disorders. Often family members are praised for their slenderness. Think about the last time you saw a family member or close friend- how often have you said, “You look great!” or commented on their appearance in some way? The odds are likely high. While the intent of the family member is not to maintain maladaptive eating behaviors by praising the physical appearance of someone struggling with an eating disorder, they are indirectly perpetuating the disorder.
While family involvement can help maintain the disorder, it can also contribute to the development of an eating disorder. Families that emphasize thinness or place a large emphasis on physical appearance are more likely to have a child diagnosed with an eating disorder (Zerbe, 2008). In fact, mothers with eating disorders are more likely to have children who develop a feeding/eating disorder than mothers without eating disorders (Whelan & Cooper, 2000). Additional family characteristics that are common among patients receiving treatment for eating disorders are enmeshed, intrusive, critical, hostile, or overly concerned with parenting (Polivy & Herman, 2002). While there has been some correlation between these family dynamics and eating disorders, they are not evident in all families of people with eating disorders.
Personality
There are many personality characteristics that are common in individuals with eating disorders. While it is unknown if these characteristics are inherent in the individual’s personality or a product of personal experiences, the thought is eating disorders develop due to the combination of the two.
10.4.4.1. Perfectionism. It should come as no surprise that perfectionism, or the belief that one must be perfect, is a contributing factor to disorders related to eating, weight, and body shape (particularly anorexia nervosa). While an exact mechanism is unknown, it is believed that perfectionism magnifies normal body imperfections, leading an individual to go to extreme (i.e., restrictive) behaviors to remedy the flaw (Hewitt, Flett & Ediger, 1995).
10.4.4.2. Self-Esteem. Self-esteem, or one’s belief in their worth or ability, has routinely been identified as a moderator of many psychological disorders, and eating disorders are no exception. Low self-esteem not only contributes to the development of an eating disorder but is also likely involved in the maintenance of the disorder. One theory, the transdiagnostic model of eating disorders, suggests that overall low self-esteem increases the risk for over-evaluation of body, which in turn, leads to negative eating behaviors that could lead to an eating disorder (Fairburn, Cooper & Shafran, 2003).
Key Takeaways
You should have learned the following in this section:
• Biological causes of eating disorders include a genetic predisposition and disruption in the neuroendocrine system.
• Cognitive causes of eating disorders include distorted thought patterns and an over-evaluation of body size.
• Sociocultural causes of eating disorders include the idealization of thin models and actresses by the media, SES, gender, and family involvement.
• The personality trait of perfectionism and low self-esteem are contributing factors to disorders related to eating, weight, and body shape.
Review Questions
1. Define multidimensional disorders?
2. What evidence is there to suggest eating disorders are biologically driven?
3. According to the cognitive theory, eating disorders may be a variant of what other disorder?
4. Discuss the four sociocultural subgroups that explains development of eating disorders.
5. What are the two personality traits most commonly used to describe behaviors associated with eating disorders? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/04%3A_Part_IV._Mental_Disorders__Block_3/10%3A_Feeding_and_Eating_Disorders/10.04%3A_Feeding_and_Eating_Disorders_-_Et.txt |
Learning Objectives
• Describe treatment options for anorexia nervosa.
• Describe treatment options for bulimia nervosa.
• Describe treatment options for binge eating disorder.
• Discuss the outcome of treatment for feeding and eating disorders.
Anorexia Nervosa
The immediate goal for the treatment of anorexia nervosa is weight gain and recovery from malnourishment. This is often established via an intensive outpatient program, or if needed, through an inpatient hospitalization program where caloric intake can be managed and controlled. Both the inpatient and outpatient programs use a combination of therapies and support to help restore proper eating habits. Of the most common (and successful) treatments are Cognitive-Behavioral Therapy (CBT) and Family-Based Therapy (FBT).
10.5.1.1. CBT. Because anorexia nervosa requires changes to both eating behaviors as well as thought patterns, CBT strategies have been very effective in producing lasting changes to those suffering from anorexia nervosa. Some of the behavioral strategies include recording eating behaviors—hunger pains, quality and quantity of food—and emotional behaviors—feelings related to the food. In addition to these behavioral strategies, it is also important to address the maladaptive thought patterns associated with their negative body image and desire to control their physical characteristics. Changing the fear related to gaining weight is essential in recovery.
10.5.1.2. Family based therapy (FBT). FBT is also an effective treatment approach, often used as a component of individual CBT, especially for children and adolescents with the disorder. FBT has been shown to elicit 50-60% of weight restoration in one year, as well as weight maintenance 2-4 years post-treatment (Campbell & Peebles, 2014; LeGrange, Lock, Accurso, Agras, Darcy, Forsberg, et al, 2014). Additionally, FBT has been shown to improve rapid weight gain, produce fewer hospitalizations, and is more cost-effective than other types of therapies with family involvement (Agras, Lock, Brandt, Bryson, Dodge, Halmi, et al., 2014).
FBT typically involves 16-18 sessions which are divided into 3 phases: (1) Parents take charge of weight restoration, (2) client’s gradual control of overeating, and (3) addressing developmental issues including fostering autonomy from parents (Chen, et al., 2016). While FBT has shown to be effective in treating adolescents with anorexia nervosa, the application for older eating patients (i.e., college-aged students and above) is still undetermined. As with adolescents, the goal for a family-based treatment program should center around helping the patient separate their feelings and needs from that of their family.
Bulimia Nervosa
Just as anorexia nervosa treatment initially focuses on weight gain, the first goal of bulimia nervosa treatment is to eliminate binge eating episodes and compensatory behaviors. The aim is to replace both negative behaviors with positive eating habits. One of the most effective ways to establish this is through Cognitive Behavioral Therapy (CBT).
10.5.2.1. CBT. Similar to anorexia nervosa, individuals with bulimia nervosa are expected to keep a journal of their eating habits; however, with bulimia nervosa, it is also important that the journal include changes in sensations of hunger and fullness, as well as other feelings surrounding their eating patterns in efforts to identify triggers to their binging episodes (Agras, Fitzsimmons-Craft & Wilfley, 2017). Once these triggers are identified, psychologists will utilize specific behavioral or cognitive techniques to prevent the individual from engaging in binge episodes or compensatory behaviors.
One method for modifying behaviors is through Exposure and Response Prevention. As previously discussed in the OCD chapter, this treatment is very effective in helping individuals stop performing their compulsive behaviors by literally preventing them from engaging in the action, while simultaneously using relaxation strategies to reduce anxiety associated with not engaging in the negative behavior. Therefore, to prevent an individual from purging post-binge episodes, the individual would be encouraged to partake in an activity that directly competes with their ability to purge, e.g., write their thoughts and feelings in a journal at the kitchen table. Research has indicated that this treatment is particularly helpful for individuals suffering from comorbid anxiety disorders (particularly OCD; Agras, Fitzsimmons-Craft & Wilfley, 2017).
In addition to changing behaviors, it is also important to change the maladaptive thoughts toward food, eating, weight, and shape. Negative thoughts such as “I am fat” and “I can’t stop eating when I start” can be modified into more appropriate thoughts such as “My body is healthy” or “I can control my eating habits.” By replacing these negative thoughts with more appropriate, positive thought patterns, individuals begin to control their feelings, which in return, can help them manage their behaviors.
10.5.2.2. Interpersonal Psychotherapy (IPT). IPT has also been established as an effective treatment for those with bulimia nervosa, particularly if an individual has not been successful with CBT treatment. The goal of IPT is to improve interpersonal functioning in those with eating disorders. Originally a treatment for depression, IPT-E was adapted to address the social isolation and self-esteem problems that contribute to the maintenance of negative eating behaviors.
IPT-E has 3 phases typically covered in weekly sessions over 4-5 months. Phase One consists of engaging the patient in treatment and providing psychoeducation about their disease and the treatment program. This phase also includes identifying interpersonal problems that are maintaining the disease.
Phase Two is the main treatment component. In this phase, the primary focus is on problem-solving interpersonal issues. The most common types of interpersonal issues are lack of intimacy and interpersonal deficits, interpersonal role disputes, role transitions, grief, and life goals. Once the main interpersonal problem is identified, the clinician supports the patient in their pursuit to identify ways to change. A key component of IPT-E is the supportive role of the clinician, as opposed to the teaching role in other treatments. The idea is that by having the patient make changes, they can better understand their problems, and as a result, make more profound changes (Murphy, Straebler, Basden, Cooper, & Fairburn, 2012).
Phase Three is the final stage. The goals of this phase are to ensure that the changes made in Phase two are maintained. To achieve this, treatment sessions are spaced out, allowing patients more time to engage in their changed behavior. Additionally, relapse prevention (i.e., problem-solving ways not to relapse) is also discussed to ensure long term results. In doing this, the patient reviews the progress they have made throughout treatment, as well as identifying potential interpersonal issues that may arise, and how their treatment can be adapted to address those issues.
Support for IPT-E is limited; however, two extensive studies suggest that IPT-E is effective in treating bulimia nervosa, and possibly BED. While treatment is initially slower than CBT, it is equally effective in long-term follow-up and maintenance of disorder (Fairburn, Marcus, & Wilson, 1993).
Binge Eating Disorder
Given the similar presentations of BED and bulimia nervosa, it should not be surprising that the most effective treatments for BED are similar to that of bulimia nervosa. CBT, along with antidepressant medications, are among the most effective in treating BED. Interpersonal therapy, as well as dialectical behavioral therapy, have also been effective in reducing binge-eating episodes; however, they have not been effective in weight loss (Guerdjikova, Mori, Casuto, & McElroy, 2017). Goals of treatment are, of course, to eliminate binge eating episodes, as well as reduce body weight as most individuals with BED are overweight. Seeing as BED has only recently been established as a separate eating disorder, treatment research specific to this disorder is expected to grow.
10.5.3.1. Antidepressant medications. Given the high comorbidity between eating disorders and depressive symptoms, antidepressants have been a primary method of treatment for years. While they have been shown to improve depressive symptoms, which may help individuals make gains in their eating disorder treatment, research has not supported antidepressants as an effective treatment strategy for treating the eating disorder itself.
Outcome of Treatment
Now that we have discussed treatments for eating disorders, how effective are they? Research has indicated favorable prognostic features for anorexia nervosa are early age of onset and a short history of the disorder. Conversely, unfavorable features are a long history of symptoms prior to treatment, severe weight loss, and binge eating and vomiting. The mortality rate over the first 10 years from presentation is about 10%. Most of these deaths are from medical complications due to the disorder or suicide.
Unfortunately, research has not identified any consistent predictors of positive outcomes for bulimia nervosa. However, there is some speculation that individuals with childhood obesity, low self-esteem, and those with a personality disorder have worse treatment outcomes. While treatment outcome for BED is still in its infancy, initial findings suggest that remission rates of BED are much higher than that for anorexia nervosa and bulimia nervosa.
Key Takeaways
You should have learned the following in this section:
• Treatment options for anorexia nervosa include CBT and FBT.
• Treatment options for bulimia nervosa include CBT, exposure and response prevention, and the three phases of interpersonal psychotherapy.
• Treatment options for BED include the taking of antidepressants to manage depressive symptoms, CBT, and interpersonal therapy.
Review Questions
1. What is the initial (main) goal of treatment for anorexia?
2. What are the three phases of family-based treatment?
3. What is the goal for interpersonal psychotherapy? Discuss the three phases of IPT.
4. What is the overall treatment effectiveness of eating disorders?
Module Recap
Module 10 covered eating disorders in terms of their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. In Module 11, we will discuss substance-related and addictive disorders, which will conclude this part. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/04%3A_Part_IV._Mental_Disorders__Block_3/10%3A_Feeding_and_Eating_Disorders/10.05%3A_Feeding_and_Eating_Disorders_-_Tr.txt |
Learning Objectives
• Describe how substance-related and addictive disorders present.
• Describe the epidemiology of substance-related and addictive disorders.
• Describe comorbidity in relation to substance-related and addictive disorders.
• Describe the etiology of substance-related and addictive disorders.
• Describe treatment options for substance-related and addictive disorders.
Module 11 will cover matters related to substance-related and addictive disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will include substance intoxication, substance use disorder, and substance withdrawal. We also list substances people can become addicted to. Be sure you refer to Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of the therapies (Module 3).
11: Substance-Related and Addictive Disorders
Learning Objectives
• Define substances and substance abuse.
• Describe properties of substance abuse.
• Describe how substance use disorder presents.
• Describe how substance intoxication presents.
• Describe how substance withdrawal presents.
• Define depressants and describe types.
• Define stimulants and describe types.
• Define hallucinogens/cannabis/combination and describe types.
Defining Terms and Adding Context
Substance-related and addictive disorders are among the most prevalent psychological disorders, with roughly 100 million people in the United States reporting the use of an illegal substance sometime throughout their life (SAMHSA, 2014). It is worth noting that the DSM-5 shifted terminology from drug addiction to substance use disorder, “…to describe the wide range of the disorder, from a mild form to a severe state of chronically relapsing, compulsive pattern of drug taking.” The DSM-5 acknowledges that many clinicians will use the term drug addiction to describe more severe presentations, but it is omitted from the DSM-5 due to “…its uncertain definition and its potentially negative connotation” (APA, 2022, pg. 543).
What are substances? Substances are any ingested materials that cause temporary cognitive, behavioral, or physiological symptoms within the individual. The DSM uses 10 classes of substances: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, stimulants, tobacco, and other (or unknown).
Repeated use of these substances or frequent substance intoxication can develop into a long-term problem known as substance abuse. Abuse occurs when an individual consumes the substance for an extended period or must ingest large amounts of the substance to get the same effect a substance provided previously. The need to continually increase the amount of ingested substance is known as tolerance. As tolerance builds, additional physical and psychological symptoms present, often causing significant disturbances in an individual’s personal and professional life. Individuals with substance abuse often spend a significant amount of time engaging in activities that revolve around their substance use, thus spending less time in recreational activities that once consumed their time.
Sometimes, there is a desire to reduce or abstain from substance use; however, cravings and withdrawal symptoms often prohibit this from occurring. Common withdrawal symptoms include, but are not limited to, cramps, anxiety attacks, sweating, nausea, tremors, and hallucinations. Depending on the substance and the tolerance level, most withdrawal symptoms last anywhere from a few days to a week. For those with extensive substance abuse or abuse of multiple substances, withdrawal should be closely monitored in a hospital setting to avoid severe consequences such as seizures, stroke, or even death.
According to the DSM-5-TR (APA, 2022), the substance-related disorders are divided into two groups: substance use disorders and substance-induced disorders which include substance intoxication and substance withdrawal. While there are some subtle differences in symptoms, particularly psychological, physical, and behavioral symptoms, the general diagnostic criteria for substance use disorder, substance intoxication, and substance withdrawal remains the same across substances. These criteria are reviewed below, with more specific details of psychological, physical, and behavioral symptoms in the Section 11.1.5.: Types of Substances Abused.
Substance Use Disorder
The essential feature of substance use disorder, is a “…cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems” (APA, 2022, pg. 544) and can be diagnosed for all ten substance classes except for caffeine. Distress or impairment can be described as any of the following: inability to complete or lack of participation in work, school or home activities; increased time spent on activities obtaining, using, or recovering from substance use; impairment in social or interpersonal relationships; use of a substance in a potentially hazardous situation; psychological problems due to recurrent substance abuse; craving the substance; an increase in the amount of substance used over time (i.e., tolerance); difficulty reducing the amount of substance used despite a desire to reduce/stop using; and/or withdrawal symptoms (APA, 2022). While the number of these symptoms may vary among individuals, only two symptoms are required for a diagnosis of substance use disorder.
Substance Intoxication
For a diagnosis of substance intoxication, the individual must have recently ingested a substanc. Immediately following the ingestion of this substance, significant behavioral and/or psychological change is observed. In addition, physical and physiological symptoms present as a direct result of the substance ingested. As stated above, these behavioral, physical, and physiological symptoms are dependent on the type of substance that is ingested and, therefore, discussed in more detail within each substance category (i.e., depressants, stimulants, hallucinogens/cannabis/combination). This said, the most common changes involve disturbances of perception, wakefulness, attention, thinking, psychomotor behavior, interpersonal behavior, and judgment (APA, 2022).
Substance Withdrawal
Finally, substance withdrawal is diagnosed when there is cessation or reduction of a substance that has been used for a long period of time. Individuals undergoing substance withdrawal will experience physiological and psychological symptoms within a few hours after cessation/reduction. These symptoms cause significant distress or impairment in daily functioning (APA, 2022). As with substance intoxication, physiological and psychological symptoms during substance withdrawal are often specific to the substance abused and are discussed in more detail within each substance category later in the module.
Types of Substances Abused
For our purposes, the most abused substances will be divided into three categories based on how they impact one’s physiological state: depressants, stimulants, and hallucinogens/cannabis/combination.
11.1.5.1. Depressants. Depressants include alcohol, sedative-hypnotic drugs, and opioids are known to have an inhibiting effect on one’s central nervous system; therefore, they are often used to alleviate tension and stress. Unfortunately, when used in large amounts, they can also impair an individual’s judgment and motor activity.
While alcohol is one of the only legal (over-the-counter) substances we will discuss, it is also the most commonly consumed substance. According to the 2015 National Survey on Drug Use and Health, approximately 70% of individuals drank an alcoholic beverage in the last year, and nearly 56% of individuals drank an alcoholic beverage in the past month (SAMHSA, 2015). While the legal age of consumption in the United States is 21, approximately 78% of teens report that they drank alcohol at some point in their life (SAMHSA, 2013).
Despite the legal age of consumption, many college-aged students engage in binge or heavy drinking. In fact, 45% of college-aged students report engaging in binge drinking, with 14% binge drinking at least 5 days per month (SAMHSA, 2013). In addition to these high levels of alcohol consumption, students also engage in other behaviors such as skipping meals, which can impact the rate of alcohol intoxication and place them at risk for dehydration, blacking out, and developing alcohol-induced seizures (Piazza-Gardner & Barry, 2013).
The “active” substance of alcohol, ethyl alcohol, is a chemical that is absorbed quickly into the blood via the lining of the stomach and intestine. Once in the bloodstream, ethyl alcohol travels to the central nervous system (i.e., brain and spinal cord) and produces depressive symptoms such as impaired reaction time, disorientation, and slurred speech. These symptoms are produced due to the ethyl alcohol binding to GABA receptors, thus preventing GABA from providing inhibitory messages and allowing the individual to relax (Filip et al., 2015).
The effect of ethyl alcohol in moderation allows for an individual to relax, engage more readily in conversation, and in general, produce a confident and happy personality. However, when consumption is increased or excessive, the central nervous system is unable to metabolize the ethyl alcohol adequately, and adverse effects begin to present. Symptoms such as blurred vision, difficulty walking, slurred speech, slowed reaction time, and sometimes, aggressive behaviors are observed.
The extent to which these symptoms present are directly related to the concentration of ethyl alcohol within the body, as well as the individual’s ability to metabolize the ethyl alcohol. There are a lot of factors that contribute to how quickly one’s body can metabolize ethyl alcohol. Food, gender, body weight, and medications are among the most common factors that affect alcohol absorption (NIAAA,1997). More specifically, recent consumption of food, particularly those high in fat and carbohydrates, slow the absorption rate of ethyl alcohol, thus reducing its effects. Regarding gender, women absorb and metabolize alcohol differently than men, likely due to the smaller amount of body water and the lower activity of an alcohol metabolizing enzyme in the stomach. Another factor related to gender is weight—with individuals with more body mass metabolizing the alcohol at a slower rate than those who weigh less. Finally, various medications, both over the counter and prescription, can impact the liver’s ability to metabolize alcohol, thus affecting the severity of symptoms that present (NIAAA, 1997).
Sedative-Hypnotic drugs, more commonly known as anxiolytic drugs, have a calming and relaxing effect on individuals. When used at a clinically appropriate dosage, they can have a sedative effect, thus making them a suitable drug for treating anxiety-related disorders. In the early 1900s, barbiturates were introduced as the main sedative and hypnotic drug; however, due to their addictive nature, as well as respiratory distress when consumed in large amounts, they have been largely replaced by benzodiazepines which are considered a safer alternative as they have less addictive qualities (Filip et al., 2014).
Commonly prescribed benzodiazepines— Xanax, Ativan, and Valium—have a similar effect to alcohol as they too bind to the GABA receptors and increase GABA activity (Filip et al., 2014). This increase in GABA produces a sedative and calming effect. Benzodiazepines can be prescribed for both temporary relief (pre-flight or before surgery) or long-term use (generalized anxiety disorder). While they do not produce respiratory distress in large dosages like barbiturates, they can cause intoxication and addictive behaviors due to their effects on tolerance.
Opioids are naturally occurring, derived from the sap of the opium poppy. In the early 1800s, morphine was isolated from opium by German chemist Friedrich Wilhelm Adam Serturner. Due to its analgesic effect, it was named after the Greek god of dreams, Morpheus (Brownstein, 1993). Its popularity grew during the American Civil War as it was the primary medication given to soldiers with battle injuries. Unfortunately, this is also when the addictive nature of the medication was discovered, as many soldiers developed “Soldier’s Disease” as a response to tolerance of the drug (Casey, 1978).
In an effort to alleviate the addictive nature of morphine, heroin was synthesized by the German chemical company Bayer in 1898 and was offered in a cough suppressant (Yes, Bayer promoted heroin). For years, heroin remained in cough suppressants as well as other pain reducers until it was discovered that heroin was more addictive than morphine. In 1917, Congress stated that all drugs derived from opium were addictive, thus banning the use of opioids in over-the-counter medications.
Opioids are unique in that they provide both euphoria and drowsiness. Tolerance to these drugs builds quickly, thus resulting in an increased need of the medication to produce desired effects. This rapid tolerance is also likely responsible for opioids’ highly addictive nature. Opioid withdrawal symptoms can range from restlessness, muscle pain, fatigue, anxiety, and insomnia. Unfortunately, these withdrawal symptoms, as well as intense cravings for the drug, can persist for several months, with some reports up to years. Because of the intensity and longevity of these withdrawal symptoms, many individuals struggle to remain abstinent, and accidental overdoses are common (CDC, 2013).
The rise of abuse and misuse of opioid products in the early-to-mid 2000s is a direct result of the increased number of opioid prescription medications containing oxycodone and hydrocodone (Jayawant & Balkrishnana, 2005). The 2015 report estimated 12.5 million Americans had abused prescription narcotic pain relievers in the past year (SAMHSA, 2016). In an effort to reduce such abuse, the FDA developed programs to educate prescribers about the risks of misuse and abuse of opioid medications.
11.1.5.2. Stimulants. The two most common types of stimulants abused are cocaine and amphetamines. Unlike depressants that reduce the activity of the central nervous system, stimulants have the opposite effect, increasing the activity in the central nervous system. Physiological changes that occur with stimulants are increased blood pressure, heart rate, pressured thinking/speaking, and rapid, often jerky behaviors. Because of these symptoms, stimulants are commonly used for their feelings of euphoria, to reduce appetite, and prevent sleep.
Similar to opioids, cocaine is extracted from a South American plant—the coca plant—and produces feelings of energy and euphoria. It is the most potent natural stimulant known to date (Acosta et al., 2011). Low doses can produce feelings of excitement, talkativeness, and euphoria; however, as the amount of ingested cocaine increases, physiological changes such as rapid breathing, increased blood pressure, and excessive arousal can be observed. The psychological and physiological effects of cocaine are due to an increase of dopamine, norepinephrine, and serotonin in various brain structures (Hart & Ksir, 2014; Haile, 2012).
One key feature of cocaine use is the rapid high of cocaine intoxication, followed by the quick depletion, or crashing, as the drug diminishes within the body. During the euphoric intoxication, individuals will experience poor muscle coordination, grandiosity, compulsive behavior, aggression, and possible hallucinations and delusions (Haile, 2012). Conversely, as the drug leaves the system, the individual will experience adverse effects such as headaches, dizziness, and fainting (Acosta et al., 2011). These negative feelings often produce a negative feedback loop, encouraging individuals to ingest more cocaine to alleviate the negative symptoms. This also increases the chance of accidental overdose.
Cocaine is unique in that it can be ingested in various ways. While cocaine was initially snorted via the nasal cavity, individuals found that if the drug was smoked or injected, its effects were more potent and longer-lasting (Haile, 2012). The most common way cocaine is currently ingested is via freebasing, which involves heating cocaine with ammonia to extract the cocaine base. This method produces a form of cocaine that is almost 100% pure. Due to its low melting point, freebased cocaine is easy to smoke via a glass pipe. Inhaled cocaine is absorbed into the bloodstream and brain within 10-15 seconds suggesting its effects are felt almost immediately (Addiction Centers of America).
Crack is a derivative of cocaine that is formed by combining cocaine with water and another substance (commonly baking soda) to create a solid structure that is then broken into smaller pieces. Because of this process, it requires very little cocaine to make crack, thus making it a more affordable drug. Coined for the crackling sound that is produced when it is smoked, it is also highly addictive, likely due to the fast-acting nature of the drug. While the effects of cocaine peak in 20-30 minutes and last for about 1-2 hours, the effects of crack peak in 3-5 minutes and last only for up to 60 minutes (Addiction Centers of America).
Amphetamines are manufactured in a laboratory setting. Currently, the most common amphetamines are prescription medications such as Ritalin, Adderall, and Dexedrine (prescribed for sleep disorders). These medications produce an increase in energy and alertness and reduce appetite when taken at clinical levels. However, when consumed at larger dosages, they can produce intoxication similar to psychosis, including violent behaviors. Due to the increased energy levels and appetite suppressant qualities, these medications are often abused by students studying for exams, athletes needing extra energy, and individuals seeking weight loss (Haile, 2012). Biologically, similar to cocaine, amphetamines affect the central nervous system by increasing the amount of dopamine, norepinephrine, and serotonin in the brain (Haile, 2012).
Methamphetamine, a derivative of amphetamine, is often abused due to its low cost and feelings of euphoria and confidence; however, it can have serious health consequences such as heart and lung damage (Hauer, 2010). Most commonly used intravenously or nasally, methamphetamine can also be eaten or heated to a temperature in which it can be smoked. The most notable effects of methamphetamine use are the drastic physical changes to one’s appearance, including significant teeth damage and facial lesions (Rusyniak, 2011).
While we are sure you are well aware of how caffeine is consumed, you may be surprised to learn that in addition to coffee, energy drinks, and soft drinks, caffeine can also be found in chocolate and tea. Because of the vast use of caffeine, it is the most widely consumed substance in the world, with approximately 90% of Americans consuming some form of caffeine each day (Fulgoni, Keast, & Lieberman, 2015). While caffeine is often consumed in moderate dosages, caffeine intoxication and withdrawal can occur. In fact, an increase in caffeine intoxication and withdrawal have been observed with the simultaneous popularity of energy drinks. Common energy drinks such as Monster and RedBull have nearly double the amount of caffeine of tea and coke (Bigard, 2010). While adults commonly consume these drinks, a startling 30% of middle and high schoolers also report regular consumption of energy drinks to assist with academic and athletic responsibilities (Terry-McElrath, O’Malley, & Johnston, 2014). The rapid increase in caffeinated beverages has led to a rise in ER visits due to the intoxication effects (SAMHSA, 2013).
11.1.5.3. Hallucinogens/Cannabis/Combination. The final category includes both hallucinogens and cannabis- both of which produce sensory changes after ingestion. While hallucinogens are known for their ability to produce more severe delusions and hallucinations, cannabis also has the capability of producing delusions or hallucinations; however, this typically occurs only when large amounts of cannabis are ingested. More commonly, cannabis has been known to have stimulant and depressive effects, thus classifying itself in a group of its own due to the many different effects of the substance.
Hallucinogens come from natural sources and have been involved in cultural and religious ceremonies for thousands of years. Synthetic forms of hallucinogens have also been created—most common of which are PCP, Ketamine, LSD, and Ecstasy. In general, hallucinogens produce powerful changes in sensory perception. Depending on the type of drug ingested, effects can range from hallucinations, changes in color perception, or distortion of objects. Additionally, some individuals report enhanced auditory, as well as changes in physical perception such as tingling or numbness of limbs and interchanging hot and cold sensations (Weaver & Schnoll, 2008). Interestingly, the effect of hallucinogens can vary both between individuals, as well as within the same individual. This means that the same amount of the same drug may produce a positive experience one time, but a negative experience the next time.
Overall, hallucinogens do not have addictive qualities; however, individuals can build a tolerance, thus needing larger quantities to produce similar effects (Wu, Ringwalt, Weiss, & Blazer, 2009). Furthermore, there is some evidence that long-term use of these drugs results in psychosis, mood, or anxiety disorders due to the neurobiological changes after using hallucinogens (Weaver & Schnoll, 2008).
Similar to hallucinogens and a few other substances, cannabis is also derived from a natural plant—the hemp plant. While the most powerful of hemp plants is hashish, the most commonly known type of cannabis, marijuana, is a mixture of hemp leaves, buds, and the tops of plants (SAMHSA, 2014). Many external factors impact the potency of cannabis, such as the climate it was grown in, the method of preparation, and the duration of storage. Of the active chemicals within cannabis, tetrahydrocannabinol (THC) appears to be the single component that determines the potent nature of the drug. Various strains of marijuana have varying amounts of THC; hashish contains a high concentration of THC, while marijuana has a small concentration.
THC binds to cannabinoid receptors in the brain, which produces psychoactive effects. These effects vary depending on both an individual’s body chemistry, as well as various strains and concentrations of THC. Most commonly, people report feelings of calm and peace, relaxation, increased hunger, and pain relief. Occasionally, negative symptoms such as increased anxiety or paranoia, dizziness, and increased heart rate also occur. In rare cases, individuals develop psychotic symptoms or schizophrenia following cannabis use (Donoghue et al., 2014).
While nearly 20 million Americans report regular use of marijuana, only 10% of these individuals will develop a dependence on the drug (SAMHSA, 2013). Of particular concern is the number of adolescents engaging in cannabis use. One in eight 8th graders, one in four 10th graders, and one in three 12th graders reported use of marijuana in the past year (American Academy of Child and Adolescent Psychiatry, 2013). Individuals who begin cannabis abuse during adolescence are at an increased risk of developing cognitive effects from the drug due to the critical period of brain development during adolescence (Gruber, Sagar, Dahlgren, Racine, & Lukas, 2012). Increased discussion about the effects of marijuana use, as well as psychoeducation about substance abuse in general, is important in preventing marijuana use during adolescence.
It is not uncommon for substance abusers to consume more than one type of substance at a time. This combination of substance use can have dangerous results depending on the interactions between substances. For example, if multiple depressant drugs (i.e., alcohol, benzodiazepines, and/or opiates) are consumed at one time, an individual is at risk for severe respiratory distress or even death due to the compounding depressive effects on the central nervous system. Additionally, when an individual is under the influence of one substance, judgment may be impaired, and ingestion of a larger amount of another drug may lead to an accidental overdose. Finally, the use of one drug to counteract the effects of another drug—taking a depressant to combat the effects of a stimulant—is equally as dangerous as the body is unable to regulate homeostasis.
Key Takeaways
You should have learned the following in this section:
• An individual is diagnosed with substance use disorder, substance intoxication, or substance withdrawal specific to the substance or substances being ingested though the symptoms remain generally the same across substances.
• Substance use disorder occurs when a person experiences significant impairment or distress for 12 months due to the use of a substance.
• Substance intoxication occurs when a person has recently ingested a substance leading to significant behavioral and/or psychological changes.
• Substance withdrawal occurs when there is a cessation or reduction of a substance that has been used for a long period of time.
• Depressants include alcohol, sedative-hypnotic drugs, and opioids.
• Stimulants include cocaine and amphetamines, but caffeine as well.
• Hallucinogens come from natural sources and produce powerful changes in sensory perception.
• Cannabis is also derived from a natural plant and produces psychoactive effects.
• Many drugs are taken by users in combination which can have dangerous results depending on the interactions between the substances.
Review Questions
1. What is a substance?
2. What is the difference between substance intoxication and substance abuse?
3. What is the difference between tolerance and withdrawal?
4. Create a table listing the three types of substances abused, as well as the specific substances within each category.
5. What are the common factors that affect alcohol absorption?
6. What are the effects of sedative-hypnotic drugs?
7. What receptors are responsible for increasing activity in alcohol and benzodiazepines?
8. What is responsible for the addictive nature of opioids?
9. Which neurotransmitters are implicated in cocaine use?
10. What are the different ways cocaine can be ingested?
11. List the common types of amphetamines. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/04%3A_Part_IV._Mental_Disorders__Block_3/11%3A_Substance-Related_and_Addictive_Disorders/11.01%3A_Substance-Related_an.txt |
Learning Objectives
• Describe the epidemiology of depressants.
• Describe the epidemiology of stimulants.
• Describe the epidemiology of hallucinogens.
It has been estimated that nearly 9% of teens and adults in the United States have a substance abuse disorder (SAMHSA, 2014). Asian/Pacific Islanders, Hispanics, and African Americans are less likely to develop a lifetime substance abuse disorder compared to non-Hispanic white individuals (Grant et al., 2016). Native Americans have the highest rate of substance abuse at nearly 22 percent (NSDUH, 2013). Additional demographic variables also suggest that overall substance abuse is greater in men than women, younger versus older individuals, unmarried/divorced individuals than married, and in those with an education level of a high school degree or lower (Grant et al., 2016). With regards to specific types of substances, the highest prevalence rates of substances abused are cannabis, opioids, and cocaine, respectively (Grant et al., 2016).
Depressants
Concerning depressant substances, men outnumber women in alcohol abuse 2 to 1 (Johnston et al., 2014). Ethnically, Native Americans have highest rate of alcoholism, followed by White, Hispanic, African, and Asian Americans. With regards to opioid use, roughly 1% of the population has this disorder, with 80% of those being addicted to pain-reliever opioids such as oxycodone or morphine; the remaining 20% are heroin (SAMHSA, 2014).
Stimulants
Nearly 1.1% of all high school seniors have used cocaine within the past month (Johnston et al., 2014). Due to the high cost of cocaine, it is more commonly found in suburban neighborhoods where consumers have the financial means to purchase the drugs. Methamphetamine is used by men and women equally. It is popular among biker gangs, rural America, and urban gay communities, as well as in clubs and all-night dance parties (aka raves; Hopfer, 2011).
A growing concern is the abuse of stimulant medication among college students as 17% of college students reported abusing stimulant medications. Greek organization membership, academic performance, and other substance use were the most highly correlated variables related to stimulant medication abuse.
Hallucinogens
Up to 14% of the general population have used LSD or another hallucinogen. Nearly 20 million adults and adolescents report current use of marijuana. Men report more than women. Sixty-five percent of individuals report their first drug of use was marijuana—labeling it as a gateway drug to other illicit substances (APA, 2022). Due to the increased research and positive effects of medicinal marijuana, the movement to legalize recreational marijuana has gained momentum, particularly in the Pacific Northwest of the United States.
Key Takeaways
You should have learned the following in this section:
• More men and Native Americans are addicted to depressants.
• Cocaine is more prevalent in suburban neighborhoods due to its cost and methamphetamine is used equally by men and women.
• Hallucinogens are used by up to 14% of the general population.
Review Questions
1. Identify the gender and ethnicity differences of substance abuse across the three substance categories.
2. Are these substances abused by other unique groups of people?
11.03: Substance-Related an
Learning Objectives
• Describe the comorbidity of substance-related and addictive disorders.
Substance abuse, in general, has a high comorbidity within itself (meaning abuse of multiple different substances), as well as with other mental health disorders. Researchers believe that substance abuse disorders are often secondary to another mental health disorder, as the substance abuse develops as a means to “self-medicate” the underlying psychological disorder. In fact, several large surveys identified alcohol and drug dependence to be twice as more likely in individuals with anxiety, affective, and psychotic disorders than the general public (Hartz et al., 2014). While it is difficult to identify exact estimates of the relationship between substance abuse and serious mental health disorders, the consensus among researchers is that there is a strong relationship between substance abuse and mood, anxiety, PTSD, and personality disorders (Grant et al., 2016).
Key Takeaways
You should have learned the following in this section:
• Substance abuse has a high comorbidity within itself and with mental health disorders such as mood, anxiety, PTSD, and personality disorders.
Review Questions
• With what other conditions are substance-related and addictive disorders highly comorbid? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/04%3A_Part_IV._Mental_Disorders__Block_3/11%3A_Substance-Related_and_Addictive_Disorders/11.02%3A_Substance-Related_an.txt |
Learning Objectives
• Describe the biological causes of substance-related and addictive disorders.
• Describe the cognitive causes of substance-related and addictive disorders.
• Describe the behavioral causes of substance-related and addictive disorders.
• Describe the sociocultural causes of substance-related and addictive disorders.
Biological
11.4.1.1. Genetics. Similar to other mental health disorders, substance abuse is genetically influenced. With that said, it is different than other mental health disorders in that if the individual is not exposed to the substance, they will not develop substance abuse.
Heritability of alcohol abuse is among the most well studied substances, likely because it is the only legal substance (except cannabis in some states). Twin studies have indicated a range of 50-60% heritability risk for alcohol disorder (Kendler et al., 1997). Studies exploring the heritability of other substance abuse, particularly drug use, suggests there may be a stronger heritability link than previously thought (Jang, Livesley, & Vernon, 1995). Twin studies indicate that the genetic component of drug abuse is stronger than drug use in general, meaning that genetic factors are more significant for abuse of a substance over nonproblematic use (Tsuang et al., 1996). Merikangas and colleagues (1998) found an 8-fold increased risk for developing a substance abuse disorder across a wide range of substances.
Unique to substance abuse is the fact that both genetic and familial influence are both at play. What does this mean? Well, biologically, the individual may be genetically predisposed to substance abuse; additionally, the individual may also be at risk due to their familial environment where their parents or siblings are also engaging in substance abuse. Individuals whose parents abuse substances may have a greater opportunity to ingest substances, thus promoting drug-seeking behaviors. Furthermore, families with a history of substance abuse may have a more accepting attitude of drug use than families with no history of substance abuse (Leventhal & Schmitz, 2006).
11.4.1.2. Neurobiological. A longstanding belief about how drug abuse begins and is maintained is the brain reward system. A reward can be defined as any event that increases the likelihood of a response and has a pleasurable effect. Most of the research on the brain reward system has focused on the mesocorticolimbic dopamine system, as it appears this area is the primary reward system of most substances that are abused. As research has evolved in the field of substance abuse, five additional neurotransmitters have also been implicated in the reinforcing effect of addiction: dopamine, opioid peptides, GABA, serotonin, and endocannabinoids. More specifically, dopamine is less involved in opioid, alcohol, and cannabis. Alcohol and benzodiazepines lower the production of GABA, while cocaine and amphetamines decrease dopamine. Cannabis has been shown to reduce the production of endocannabinoids.
Cognitive
Cognitive theorists have focused on the beliefs regarding the anticipated effects of substance use. Defined as the expectancy effect, drug-seeking behavior is presumably motivated by the desire to attain a particular outcome by ingesting a substance. The expectancy effect can be defined in both positive and negative forms. Positive expectations are thought to increase drug-seeking behavior, while negative experiences would decrease substance use (Oei & Morawska, 2004). Several studies have examined the expectancy effect on the use of alcohol. Those with alcohol abuse reported expectations of tension reduction, enhanced sexual experiences, and improved social pleasure (Brown, 1985). Additionally, observing positive experiences, both in person and through television or social media, also shapes our drug use expectancies.
While some studies have explored the impact of negative expectancy to eliminate substance abuse, research has failed to continually support this theory, suggesting that positive experiences and expectations are a more powerful motivator of substance abuse than the negative experiences (Jones, Corbin, Fromme, 2001).
Behavioral
Operant conditioning has been implicated in the role of developing substance use disorders. As you may remember, operant conditioning refers to the increase or decrease of a behavior, due to reinforcement or punishment. Since we are talking about increasing substance use, behavioral theorists suggest that substance abuse is positively and negatively reinforced due to the effects of a substance.
Positive reinforcement occurs when substance use is increased due to the positive or pleasurable experiences of the substance. More specifically, the rewarding effect or pleasurable experiences while under the influence of various substances directly impacts the likelihood that the individual will use the substance again. Studies of substance use on animals routinely support this theory as animals will work to receive injections of various drugs (Wise & Koob, 2013).
Negative reinforcement, or the increase of a given behavior due to the removal of a negative effect, also plays a role in substance abuse in two different ways. First, many people ingest a substance as an escape from their unpleasant life—whether it be physical pain, stress, or anxiety, to name a few. Therefore, the substance temporarily provides relief from a negative environment, thus reinforcing future substance abuse (Wise & Koob, 2013). Secondly, negative reinforcement is involved in symptoms of withdrawal. As previously mentioned, withdrawal from a substance often produces significant negative symptoms such as nausea, vomiting, uncontrollable shaking, etc. To eliminate these symptoms, an individual will consume more of the substance, thus again escaping the negative symptoms and enjoying the “highs” of the substance.
Sociocultural
Arguably, one of the strongest influences of substance abuse is the impact of one’s friends and the immediate environment. Peer attitudes, perception of others’ drug use, pressure from peers to use substances, and beliefs about substance use are among the strongest predictors of drug use patterns (Leventhal & Schmitz, 2006). This is particularly concerning during adolescence when patterns of substance use typically begin.
Additionally, research continually supports a strong relationship between second-generation substance abusers (Wilens et al., 2014). The increased possibility of family members’ substance abuse is likely related to both a genetic predisposition, as well as the accepting attitude of the familial environment (Chung et al., 2014). Not only does a child have early exposure to these substances if their parent has a substance abuse problem, but they are also less likely to have parental supervision, which may impact their decision related to substance use (Wagner et al., 2010). One potential protective factor against substance use is religiosity. More specifically, families that promote religiosity may reduce substance use by promoting negative experiences (Galen & Rogers, 2004).
Another sociocultural view on substance abuse is stressful life events, particularly those related to financial stability. Prevalence rates of substance abuse are higher among poorer people (SAMHSA, 2014). Furthermore, additional stressors such as childhood abuse and trauma, negative work environments, as well as discrimination are also believed to contribute to the development of a substance use disorder (Hurd, Varner, Caldwell, & Zimmerman, 2014; McCabe, Wilsnack, West, & Boyd, 2010; Unger et al., 2014).
Key Takeaways
You should have learned the following in this section:
• Biological causes of substance-related and addictive disorders include the brain reward system and a genetic predisposition, though if the individual is not exposed to the substance they will not develop the substance abuse.
• Cognitive causes of substance-related and addictive disorders include the expectancy effect, and research provides stronger support for positive expectancy over negative expectancy.
• Behavioral causes of substance-related and addictive disorders include positive and negative reinforcement.
• Sociocultural causes of substance-related and addictive disorders include friends and the immediate environment.
Review Questions
1. Discuss the brain reward system. What neurobiological regions are implicated within this system?
2. Define the expectancy effect. How does this explain the development and maintenance of substance abuse?
3. Discuss operant conditioning in the context of substance abuse. What are the reinforcers?
4. How does the sociocultural model explain substance abuse? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/04%3A_Part_IV._Mental_Disorders__Block_3/11%3A_Substance-Related_and_Addictive_Disorders/11.04%3A_Substance-Related_an.txt |
Learning Objectives
• Describe biological treatment options for substance-related and addictive disorders.
• Describe behavioral treatment options for substance-related and addictive disorders.
• Describe cognitive-behavioral treatment options for substance-related and addictive disorders.
• Describe sociocultural treatment options for substance-related and addictive disorders.
Given the large number of the population affected by substance abuse, it is not surprising that there are many different approaches to treat substance use disorder. Overall, treatments for substance-related disorders are only mildly effective, likely due in large part to the addictive qualities in many of these substances (Belendiuk & Riggs, 2014).
Biological
11.5.1.1. Detoxification. Detoxification refers to the medical supervision of withdrawal from a specified drug. While most detoxification programs are inpatient for increased monitoring, some programs allow for outpatient detoxification, particularly if the addiction is not as severe. There are two main theories of detoxification—gradually decreasing the amount of the substance until the individual is off the drug completely, or eliminating the substance entirely while providing additional medications to manage withdrawal symptoms (Bisaga et al., 2015). Unfortunately, relapse rates are high for those engaging in detoxification programs, particularly if they lack any follow-up psychological treatment.
11.5.1.2. Agonist drugs. As researchers continue to learn more about both the mechanisms of substances commonly abused, as well as the mechanisms in which the body processes these substances, alternative medications are created to essentially replace the drug in which the individual is dependent on. These agonist drugs provide the individual with a “safe” drug that has a similar chemical make-up to the addicted drug. One common example of this is methadone, an opiate agonist that is often used in the reduction of heroin use (Schwartz, Brooner, Montoya, Currens, & Hayes, 2010). Unfortunately, because methadone reacts to the same neurotransmitter receptors as heroin, the individual essentially replaces their addiction to heroin with an addiction to methadone. While this is not ideal, methadone treatment is highly regulated under safe medical supervision. Furthermore, it is taken by mouth, thus eliminating the potential adverse effects of unsterilized needles in heroin use. While some argue that methadone maintenance programs are not an effective treatment because it simply replaces one drug for another, others claim that the combination of methadone with education and psychotherapy can successfully help individuals off both illicit drugs and methadone medications (Jhanjee, 2014).
11.5.1.3. Antagonist drugs. Unlike agonist drugs, antagonist drugs block or change the effects of the addictive drug. The most commonly prescribed antagonist drugs are Disulfiram and Naloxone. Disulfiram is often given to individuals trying to abstain from alcohol as it produces significant negative effects (i.e., nausea, vomiting, increased heart rate, and dizziness) when coupled with alcohol consumption. While this can be an effective treatment to eliminate alcohol use, the individual must be motivated to take the medication as prescribed (Diclemente et al., 2008).
Similar to Disulfiram, Naloxone is used for individuals with opioid abuse. Naloxone acts by binding to endorphin receptors, thus preventing the opioids from having the intended euphoric effect. In theory, this treatment appears promising, but it is extremely dangerous as it can send the individual into immediate, severe withdrawal symptoms (Alter, 2014). This type of treatment requires appropriate medical supervision to ensure the safety of the patient.
Behavioral
11.5.2.1. Aversion therapy. Based on respondent conditioning principles, aversion therapy is a form of treatment for substance abuse that pairs the stimulus with some type of negative or aversive stimulus. For example, an individual may be given a shock every time they think about or attempt to drink alcohol. By pairing this aversive stimulus to the abused substance, the individual will begin to independently pair the substance with an aversive thought, thus reducing their craving/desire for the substance. Some view the use of agonist and antagonist drugs as a form of aversion therapy as these medications utilize the same treatment strategy as traditional aversion therapy.
11.5.2.2. Contingency management. Contingency management is a treatment approach that emphasizes operant conditioning—increasing sobriety and adherence to treatment programs through rewards. Originally developed to increase adherence to medication and reinforce opiate abstinence in methadone patients, contingency management has been adapted to increase abstinence in many different substance abuse treatment programs. In general, patients are “rewarded” with vouchers or prizes in exchange for abstinence from substance use (Hartzler, Lash, & Roll, 2012). These vouchers allow individuals to gain incentives specific to their interests, thus increasing the chances of abstinence. Common vouchers include movie tickets, sports equipment, or even cash (Mignon, 2014).
Contingency management has been proven to be effective in treating various types of substance abuse, particularly alcohol and cocaine (Lewis & Petry, 2005). Not only has it been effective in reducing substance use in addicts, but it has also been effective in increasing the amount of time patients remain in treatment as well as compliance with the treatment program (Mignon, 2014). Despite its success, dissemination of this type of treatment has been rare. To rectify this, the federal government has provided financial resources through SAMHSA for the development, implementation, and evaluation of contingency management as a treatment to reduce alcohol and drug use (Mignon, 2014).
Cognitive-Behavioral
11.5.3.1. Relapse prevention training. Relapse prevention training is essentially what it sounds like—identifying potentially high-risk situations for relapse and then learning behavioral skills and cognitive interventions to prevent the occurrence of a relapse. Early in treatment, the clinician guides the patient to identify any interpersonal, intrapersonal, environmental, and physiological risks for relapse. Once these triggers are identified, the clinician works with the patient on cognitive and behavioral strategies such as learning effective coping strategies, enhancing self-efficacy, and encouraging mastery of outcomes. Additionally, psychoeducation about how substance abuse is maintained, as well as identifying maladaptive thoughts and learning cognitive restructuring techniques, helps the patient make informed choices during high-risk situations. Finally, role-playing these high-risk situations in session allows patients to become comfortable engaging in these effective coping strategies that enhance their self-efficacy and ultimately reducing the chances of a relapse. Research for relapse prevention training appears to be somewhat effective for individuals with substance-related disorders (Marlatt & Donovan, 2005).
Sociocultural
11.5.4.1. Self-help. In 1935, two men suffering from alcohol abuse met and discussed their treatment options. Slowly, the group grew, and by 1946, this group was known as Alcoholics Anonymous (AA). The two founders, along with other early members, developed the Twelve Step Traditions to help guide members in spiritual and character development. Due to the popularity of the treatment program, other programs such as Narcotics Anonymous and Cocaine Anonymous, adopted and adapted the Twelve Steps for their respective substance abuse. Similarly, Al-Anon and Alateen are two support groups that offer support for families and teenagers of individuals struggling with alcohol abuse.
The overarching goal of AA is abstinence from alcohol. To achieve this, the participants are encouraged to “take one day at a time.” In using the 12 steps, participants are emboldened to admit that they have a disease, that they are powerless over this disease, and that their disease is more powerful than any person. Therefore, participants turn their addiction over to God and ask for help to right their wrongs and remove their negative character defects and shortcomings. The final steps include identifying and making amends to those who they have wronged during their alcohol abuse.
While studies examining the effectiveness of AA programs are inconclusive, AA’s membership indicates that 27% of its members have been sober less than one year, 24% have been sober 1-5 years, 13% have been sober 5-10 years, 14% have been sober 10-20 years, and more than 22% have been sober over 20 years (Alcoholics Anonymous, 2014). Some argue that this type of treatment is most effective for those who are willing and able to abstain from alcohol as opposed to those who can control their drinking to moderate levels.
11.5.4.2. Residential treatment centers. Another type of treatment similar to self-help is residential treatment programs. In this placement, individuals are completely removed from their environment and live, work, and socialize within a drug-free community while also attending regular individual, group, and family therapy. The types of treatment used within a residential program varies from program to program, with most focusing on cognitive-behavioral and behavioral techniques. Several also incorporate 12-step programs into treatment, as many patients transition from a residential treatment center to a 12-step program post discharge. As one would expect, the residential treatment goal is abstinence, and any evidence of substance abuse during the program is grounds for immediate termination.
Studies examining the effectiveness of residential treatment centers suggest that these programs are useful in treating a variety of substance abuse disorders; however, many of these programs are very costly, thus limiting the availability of this treatment to the general public (Bender, 2004; Galanter, 2014). Additionally, many individuals are not able to completely remove themselves from their daily responsibilities for several weeks to months, particularly those with families. Therefore, while this treatment option is very effective, it is also not an option for most individuals struggling with substance abuse.
11.5.4.3. Community reinforcement. The goal for community reinforcement treatment is for patients to abstain from substance use by replacing the positive reinforcements of the substance with that of sobriety. This is done through several different techniques such as motivational interviewing, learning adaptive coping strategies, and encouraging family support (Mignon, 2014). Essentially, the community around the patient reinforces the positive choices of abstaining from substance use.
Community reinforcement has been found to be effective in both an inpatient and outpatient setting (Meyers & Squires, 2001). It is believed that the intrinsic motivation and the effective coping skills, in combination with the support of an individual’s immediate community (friends and family) is responsible for the long-term positive treatment effects of community reinforcement.
Key Takeaways
You should have learned the following in this section:
• Biological treatment options for substance-related and addictive disorders include detoxification programs, agonist drugs, and antagonist drugs.
• Behavioral treatment options for substance-related and addictive disorders include aversion therapy and contingency management.
• Cognitive-behavioral treatment options for substance-related and addictive disorders include relapse prevention training.
• Sociocultural treatment options for substance-related and addictive disorders include Alcoholics Anonymous, residential treatment centers, and community reinforcement.
Review Questions
1. Discuss the differences between agonist and antagonist drugs. Give examples of both.
2. What are the two behavioral treatments discussed in this module? Discuss their effectiveness.
3. What are the main components of the 12-step programs? How effective are they in substance abuse treatment?
Module Recap
And that concludes Part IV of the book and Block 3 of mental disorders. In this module, we discussed substance-related and addictive disorders to include substance use disorder, substance intoxication, and substance withdrawal. Substances include depressants, sedative-hypnotic drugs, opioids, stimulants, and hallucinogens. As in past modules, we discussed the clinical presentation, epidemiology, comorbidity, and etiology of the disorders. We then also discussed the biological, behavioral, cognitive-behavioral, and sociocultural treatment approaches. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/04%3A_Part_IV._Mental_Disorders__Block_3/11%3A_Substance-Related_and_Addictive_Disorders/11.05%3A_Substance-Related_an.txt |
• Describe how schizophrenia spectrum disorders present.
• Describe the epidemiology of schizophrenia spectrum disorders.
• Describe comorbidity in relation to schizophrenia spectrum disorders.
• Describe the etiology of schizophrenia spectrum disorders.
• Describe treatment options for schizophrenia spectrum disorders.
In Module 12, we will discuss matters related to schizophrenia spectrum disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will consist of schizophrenia, schizophreniform disorder, schizoaffective disorder, and delusional disorder. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of the therapies (Module 3).
12: Schizophrenia Spectrum and Other Psychotic Disorders
Learning Objectives
• List and describe distinguishing features that make up the clinical presentation of schizophrenia spectrum disorders.
• Describe how schizophrenia presents.
• Describe how schizophreniform disorder presents.
• Describe how schizoaffective disorder presents.
• Describe how delusional disorder presents.
The Clinical Presentation of Schizophrenia Spectrum Disorders
The schizophrenia spectrum and other psychotic disorders are defined by one of the following main symptoms: delusions, hallucinations, disorganized thinking (speech), disorganized or abnormal motor behavior, and negative symptoms. Individuals diagnosed with a schizophrenia spectrum disorder experience psychosis, which is defined as a loss of contact with reality. Psychosis episodes make it difficult for individuals to perceive and respond to environmental stimuli, causing a significant disturbance in everyday functioning. While there are a vast number of symptoms displayed in schizophrenia spectrum disorders, presentation of symptoms varies greatly among individuals, as there are rarely two cases similar in presentation, triggers, course, or responsiveness to treatment.
12.1.1.1. Delusions. Delusions are “fixed beliefs that are not amenable to change in light of conflicting evidence” (APA, 2022, pp. 101). This means that despite evidence contradicting one’s thoughts, the individual is unable to distinguish their thoughts from reality. The inability to identify thoughts as delusional is likely likely due to a lack of insight. There are a wide range of delusions that are seen in the schizophrenia related disorders to include:
• Delusions of grandeurbelief they have exceptional abilities, wealth, or fame; belief they are God or other religious saviors
• Delusions of control– belief that others control their thoughts/feelings/actions
• Delusions of thought broadcasting– belief that one’s thoughts are transparent and everyone knows what they are thinking
• Delusions of persecution– belief they are going to be harmed, harassed, plotted or discriminated against by either an individual or an institution; it is the most common delusion (Arango & Carpenter, 2010)
• Delusions of reference– belief that specific gestures, comments, or even larger environmental cues are directed directly to them
• Delusions of thought withdrawal– belief that one’s thoughts have been removed by another source
It is believed that the presentation of the delusion is primarily related to the social, emotional, educational, and cultural background of the individual (Arango & Carpenter, 2010). For example, an individual with schizophrenia who comes from a highly religious family is more likely to experience religious delusions (delusions of grandeur) than another type of delusion.
12.1.1.2. Hallucinations. Hallucinations are “perception-like experiences that occur without an external stimulus” (APA, 2022, pg. 102). They can occur in any of the five senses: hearing (auditory hallucinations), seeing (visual hallucinations), smelling (olfactory hallucinations), touching (tactile hallucinations), and tasting (gustatory hallucinations). Additionally, they can occur in a single modality or present across a combination of modalities (e.g., having auditory and visual hallucinations). For the most part, individuals recognize that their hallucinations are not real and attempt to engage in normal behavior while simultaneously combating ongoing hallucinations.
According to various research studies, nearly half of all patients with schizophrenia report auditory hallucinations, 15% report visual hallucinations, and 5% report tactile hallucinations (DeLeon, Cuesta, & Peralta, 1993). Among the most common types of auditory hallucinations are voices talking to the patient or various voices talking to one another. Generally, these hallucinations are not attributable to any one person that the individual knows. They are usually clear, objective, and definite (Arango & Carpenter, 2010). Additionally, the auditory hallucinations can be pleasurable, providing comfort to the patient; however, in other individuals, the auditory hallucinations can be unsettling as they produce commands or malicious intent.
12.1.1.3. Disorganized thinking (Speech). Among the most common cognitive impairments displayed in patients with schizophrenia are disorganized thoughts, communication, and speech. More specifically, thoughts and speech patterns may appear to be circumstantial or tangential. For example, patients may give unnecessary details in response to a question before they finally produce the desired response. While the question is eventually answered in circumstantial speech patterns, in tangential speech patterns the patient never reaches the point. Another common cognitive symptom is speech incoherence or word salad, where speech is “nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization” (APA, 2022, pg. 102). Derailment, or the illogical connection in a chain of thoughts, is another common type of disorganized thinking. Although not always, derailment is often seen in illogicality, or the tendency to provide bizarre explanations for things.
These types of distorted thought patterns are often related to concrete thinking. That is, the individual is focused on one aspect of a concept or thing and neglects all other aspects. This type of thinking makes treatment difficult as individuals lack insight into their illness and symptoms.
12.1.1.4. Disorganized/abnormal motor behavior. These symptoms manifest as childlike “silliness” to unpredictable agitation. Catatonic behavior, the decreased or complete lack of reactivity to the environment, is among the most commonly seen grossly disorganized motor behavior in schizophrenia. There runs a range of catatonic behaviors from negativism (resistance to instruction); mutism or stupor (complete lack of verbal and motor responses); rigidity (maintaining a rigid or upright posture while resisting efforts to be moved); or posturing (holding odd, awkward postures for long periods). There is one type of catatonic behavior, catatonic excitement, where the individual experiences hyperactivity of motor behavior, in a seemingly excited or delirious way. Other features include repeated stereotyped movements, staring, grimacing, and the echoing of speech (APA, 2022, pg. 102).
12.1.1.5. Negative symptoms. Up until this point, all the symptoms can be categorized as positive symptoms, or symptoms that are an over-exaggeration of normal brain processes; these symptoms are also new to the individual. The final diagnostic criterion is negative symptoms, which are defined as the inability or decreased ability to initiate actions, speech, express emotion, or feel pleasure (Barch, 2013). Negative symptoms often present before positive symptoms and remain once positive symptoms remit. Because of their prevalence through the course of the disorder, they are also more indicative of prognosis, with more negative symptoms suggesting a poorer prognosis. The poorer prognosis may be explained by the lack of effectiveness antipsychotic medications have in addressing negative symptoms (Kirkpatrick, Fenton, Carpenter, & Marder, 2006). There are six main types of negative symptoms seen in patients with schizophrenia. Such symptoms include:
• Diminished emotional expression – Reduction in emotional expression; reduced display of emotional expression
• Alogia – Poverty of speech or speech content
• Anhedonia – Inability to experience pleasure
• Asociality – Lack of interest in social relationships
• Avolition – Lack of motivation for goal-directed behavior
Schizophrenia
As stated above, the hallmark symptoms of schizophrenia include the presentation of at least two of the following during a one month period: delusions, hallucinations, disorganized speech, disorganized/abnormal behavior, or negative symptoms. These symptoms create significant impairment in an individual’s ability to engage in normal daily functioning such as work, school, relationships with others, or self-care, and continuous signs of the disturbance persist for at least 6 months. It should be noted that the presentation of schizophrenia varies significantly among individuals, as it is a heterogeneous clinical syndrome (APA, 2022).
While the presence of symptoms must persist for a minimum of 6 months to meet the criteria for a schizophrenia diagnosis, it is not uncommon to have prodromal symptoms that precede the active phase of the disorder and residual symptoms that follow it. These prodromal and residual symptoms are “subthreshold” forms of psychotic symptoms that do not cause significant impairment in functioning, with the exception of negative symptoms (Lieberman et al., 2001). Due to the severity of psychotic symptoms, mood disorder symptoms are also common among individuals with schizophrenia; however, these mood symptoms are distinct from a mood disorder diagnosis in that psychotic features will exist beyond the remission of depressive symptoms.
Schizophreniform Disorder
Schizophreniform disorder is similar to schizophrenia, except for the length of presentation of symptoms. Schizophreniform disorder is considered an “intermediate” disorder between schizophrenia and brief psychotic disorder as the symptoms are present for at least one month but not longer than six months. Schizophrenia symptoms must be present for at least six months and a brief psychotic disorder is diagnosed when symptoms are present for less than one month. Approximately two-thirds of individuals who are initially diagnosed with schizophreniform disorder will have symptoms that last longer than six months, at which time their diagnosis is changed to schizophrenia (APA, 2022).
Another key distinguishing feature of schizophreniform disorder is the lack of criteria related to impaired functioning. While many individuals with schizophreniform disorder do display impaired functioning, it is not essential for diagnosis. Finally, any major mood episodes—either depressive or manic— that are present concurrently with the psychotic features must only be present for a short time, otherwise a diagnosis of schizoaffective disorder may be more appropriate (APA, 2022).
Making Sense of the Disorders
In relation to schizophrenia spectrum and other psychotic disorders, note the following:
• Diagnosis brief psychotic disorder …… if symptoms have been present for less than one month
• Diagnosis schizophreniform disorder …… if symptoms have been present for at least one month but not longer than six months
• Diagnosis schizophrenia … if the symptoms have been present for at least six months
Schizoaffective Disorder
Schizoaffective disorder is characterized by the psychotic symptoms included in schizophrenia and a concurrent uninterrupted period of a major mood episode—either a major depressive or manic episode. It should be noted that because the loss of interest in pleasurable activities is a common symptom of schizophrenia, to meet the criteria for a depressive episode within schizoaffective disorder, the individual must present with a pervasive depressed mood (APA, 2022). While schizophrenia and schizophreniform disorder do not have a significant mood component, schizoaffective disorder requires the presence of a depressive or manic episode for the majority, if not the total duration of the disorder. While psychotic symptoms are sometimes present in depressive episodes, they often remit once the depressive episode is resolved. For individuals with schizoaffective disorder, psychotic symptoms should continue for at least two weeks in the absence of a major mood disorder (APA, 2022). This is the key distinguishing feature between schizoaffective disorder and major depressive disorder with psychotic features.
Delusional Disorder
As suggestive of its title, delusional disorder requires the presence of at least one delusion that lasts for at least one month in duration. It is important to note that if an individual experiences hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms—in addition to delusions—they should not be diagnosed with delusional disorder as their symptoms are more aligned with a schizophrenia diagnosis. Unlike most other schizophrenia-related disorders, daily functioning is not overly impacted due to the delusions. Additionally, if symptoms of depressive or manic episodes present during delusions, they are typically brief compared to the duration of the delusions.
The DSM-V-TR (APA, 2022) has identified five main subtypes of delusional disorder to better categorize the symptoms of the individual’s disorder. When making a diagnosis of delusional disorder, one of the following modifiers (in addition to mixed presentation) is included. Erotomanic delusion occurs when an individual reports a delusion of another person being in love with them. Generally speaking, the individual whom the convictions are about is of higher status, such as a celebrity. Grandiose delusion involves the conviction of having great talent or insight. Occasionally, patients will report they have made an important discovery that benefits the general public. Grandiose delusions may also take on religious affiliation, as people believe they are prophets or even God. Jealous delusion revolves around the conviction that one’s spouse or partner is/has been unfaithful. While many individuals may have this suspicion at some point in their relationship, a jealous delusion is much more extensive and generally based on incorrect inferences that lack evidence. Persecutory delusion involves the individual believing that they are being conspired against, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in pursuit of their long-term goals (APA, 2022). Of all subtypes of delusional disorder, those experiencing persecutory delusions are the most at risk of becoming aggressive or hostile, likely due to the persecutory nature of their distorted beliefs. Finally, somatic delusion involves delusions regarding bodily functions or sensations. While these delusions can vary significantly, the most common beliefs are that the individual emits a foul odor despite attempts to rectify the smell; there is an infestation of insects on the skin; or that they have an internal parasite (APA, 2022). If no one delusion predominates, the mixed type specifier is used and if the dominant delusional belief cannot be clearly determined, use the unspecified type specifier. A separate specifier is used when the content of the delusions are deemed bizarre or implausible, not understandable, and not derived from ordinary life experience.
Key Takeaways
You should have learned the following in this section:
• Schizophrenia spectrum disorders are characterized by delusions, hallucinations, disorganized thinking (speech), disorganized or abnormal motor behavior, and negative symptoms.
• Delusions are beliefs that do not change even when conflicting evidence is presented and can be of grandeur, control, thought broadcasting, persecution, reference, and thought withdrawal.
• Hallucinations occur in any sense modality and most individuals recognize that they are not real.
• Disorganized thinking, abnormal motor behavior, catatonic behavior, and negative symptoms such as affective flattening, alogia, anhedonia, asociality, and avolition are also common to schizophrenia spectrum disorders.
• Schizophrenia is characterized by delusions, hallucinations, disorganized speech, disorganized/abnormal behavior, or negative symptoms lasting six months.
• Schizophreniform disorder is considered an “intermediate” disorder between schizophrenia and brief psychotic disorder as the symptoms are present for at least one month but not longer than six months.
• Schizoaffective disorder is characterized by the psychotic symptoms included in schizophrenia and a concurrent uninterrupted period of a major mood episode—either a depressive or manic episode.
• Delusional disorder requires the presence of at least one delusion that lasts for at least one month in duration to include erotomanic, grandiose, jealous, persecutory, and somatic.
Review Questions
1. What are the four positive symptoms identified in a schizophrenia diagnosis? Define and identify their difference.
2. What is meant by negative symptoms? What are the negative symptoms observed in schizophrenia related disorders?
3. Identify diagnostic differences between schizophrenia, schizophreniform, schizoaffective, and delusional disorders. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/12%3A_Schizophrenia_Spectrum_and_Other_Psychotic_Disorders/12.01%3A_Schizophre.txt |
Learning Objectives
• Describe the epidemiology of schizophrenia spectrum disorders.
Schizophrenia occurs in approximately 0.3%-0.7% of the general population (APA, 2022). There is some discrepancy in rates of diagnosis between genders; these differences appear to be related to the emphasis of various symptoms. For example, men typically present with more negative symptoms, whereas women present with more affect-laden symptoms. Despite gender differences in the presentation of symptoms, there appears to be an equal risk for both genders to develop the disorder.
Schizophrenia typically occurs between late teens and mid-30s, with the onset of the disorder slightly earlier for males than females (APA, 2022). Earlier onset of the disorder is generally predictive of a worse overall prognosis. Onset of symptoms is typically gradual, with initial symptoms presenting similarly to depressive disorders; however, some individuals will present with an abrupt presentation of the disorder. Negative symptoms appear to be more predictive of prognosis than other symptoms. This may be due to negative symptoms being the most persistent, and therefore, most difficult to treat. Overall, an estimated 13.5% of individuals diagnosed with schizophrenia meet recovery criteria, according to one meta-analysis of 50 studies of individuals with broadly defined schizophrenia (APA, 2022).
Schizoaffective disorder, schizophreniform disorder, and delusional disorder prevalence rates are all significantly less than that of schizophrenia, occurring in 0.2% to 0.3% of the general population. While schizoaffective disorder is diagnosed more in females than males (similar to schizophrenia but using the less stringent DSM-IV criteria), schizophreniform and delusional disorder appear to be diagnosed equally between genders (APA, 2022).
Key Takeaways
You should have learned the following in this section:
• Less than 1% of the general population is diagnosed with schizophrenia and 13.5% of these people fully recovery from the disorder.
• Both genders have an equal risk of developing schizophrenia while men typically display more negative symptoms while women present with more affect-laden symptoms.
• Schizoaffective disorder, schizophreniform disorder, and delusional disorder have prevalence rates between 0.2 to 0.3%.
Review Questions
1. Discuss the different prevalence rates across the schizophrenia related disorders. Are there differences among the disorders? Between genders?
2. Are there differences in prevalence rates depending on symptom presentations? If so, what?
12.03: Schizophre
Learning Objectives
• Describe the comorbidity of schizophrenia spectrum disorders.
There is a high comorbidity between schizophrenia and substance abuse disorder and there is some evidence to suggest that the use of various substances (particularly marijuana) may place an individual at an increased risk of developing schizophrenia if the genetic predisposition is also present (see diathesis-stress model below; Corcoran et al., 2003). Additionally, there appears to be comorbidity with anxiety-related disorders, specifically panic disorder, and obsessive-compulsive disorder, among individuals with schizophrenia than compared to the general public. Schizotypal or paranoid personality disorder sometimes precede the onset of schizophrenia. About 5-6% of individuals diagnosed with schizophrenia die by suicide, about 20% have attempted suicide on at least one occasion, and many more have significant suicidal ideation.
It should also be noted that individuals diagnosed with a schizophrenia-related disorder are also at an increased risk for associated medical conditions such as weight gain, diabetes, metabolic syndrome, and cardiovascular and pulmonary disease (APA, 2022). This predisposition to various medical conditions is likely related to medications and poor lifestyle choices, and also place individuals at risk for a reduced life expectancy.
Schizoaffective disorder is comorbid with substance use disorders and anxiety disorders. Metabolic syndrome occurs at a higher rate than for the general population as well.
Cormorbidity information is not given for delusional disorder or schizophreniform disorder.
Key Takeaways
You should have learned the following in this section:
• Schizophrenia has a high comorbidity with substance abuse disorders, anxiety-related disorders, OCD, and some medical conditions.
• Schizoaffective disorder is comorbid with substance use disorders, anxiety disorder, and metabolic syndrome.
Review Questions
1. What comorbidities exist between schizophrenia spectrum and other psychotic disorders? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/12%3A_Schizophrenia_Spectrum_and_Other_Psychotic_Disorders/12.02%3A_Schizophre.txt |
Learning Objectives
• Describe the biological causes of schizophrenia spectrum disorders.
• Describe the psychological causes of schizophrenia spectrum disorders.
• Describe the sociocultural causes of schizophrenia spectrum disorders.
Biological
12.4.1.1. Genetic/Family studies. Twin and family studies consistently support the biological theory. More specifically, if one identical twin develops schizophrenia, there is a 48% chance that the other will also develop the disorder within their lifetime (Coon & Mitter, 2007). This percentage drops to 17% in fraternal twins. Similarly, family studies have also found similarities in brain abnormalities among individuals with schizophrenia and their relatives; the more similarities, the higher the likelihood that the family member also developed schizophrenia (Scognamiglio & Houenou, 2014).
12.4.1.2. Neurobiological. There is consistent and reliable evidence of a neurobiological component in the transmission of schizophrenia. More specifically, neuroimaging studies have found a significant reduction in overall and specific brain region volumes, as well as tissue density of individuals with schizophrenia compared to healthy controls (Brugger, & Howes, 2017). Additionally, there has been evidence of ventricle enlargement as well as volume reductions in the medial temporal lobe. As you may recall, structures such as the amygdala (involved in emotion regulation), the hippocampus (involved in memory), as well as the neocortical surface of the temporal lobes (processing of auditory information) are all structures within the medial temporal lobe (Kurtz, 2015). Additional studies also indicate a reduction in the orbitofrontal regions of the brain, a part of the frontal lobe that is responsible for response inhibition (Kurtz, 2015).
12.4.1.3. Stress cascade. The stress-vulnerability model suggests that individuals have a genetic or biological predisposition to develop the disorder; however, symptoms will not present unless there is a stressful precipitating factor that elicits the onset of the disorder. Researchers have identified the HPA axis and its consequential neurological effects as the likely responsible neurobiological component responsible for this stress cascade.
The HPA axis is one of the main neurobiological structures that mediate stress. It involves the regulation of three chemical messengers (corticotropin-releasing hormone [CRH], adrenocorticotropic hormone [ACTH], and glucocorticoids) as they respond to a stressful situation (Corcoran et al., 2003). Glucocorticoids, more commonly referred to as cortisol, is the final neurotransmitter released which is responsible for the physiological change that accompanies stress to prepare the body to “fight” or “flight.”
It is hypothesized that in combination with abnormal brain structures, persistently increased levels of glucocorticoids in brain structures may be the key to the onset of psychosis in prodromal patients (Corcoran et al., 2003). More specifically, stress exposure (and increased glucocorticoids) affects the neurotransmitter system and exacerbates psychotic symptoms due to changes in dopamine activity (Walker & Diforio, 1997). While research continues to explore the relationship between stress and onset of the disorder, evidence for the implication of stress and symptom relapse is strong. More specifically, schizophrenia patients experience more stressful life events leading up to a relapse of symptoms. Similarly, it is hypothesized that the worsening or exacerbation of symptoms is also a source of stress as they interfere with daily functioning (Walker & Diforio, 1997). This stress alone may be enough to initiate the onset of a relapse.
Psychological
12.4.2.1. Cognitive. The cognitive model utilizes some of the aspects of the diathesis-stress model in that it proposes that premorbid neurocognitive impairment places individuals at risk for aversive work/academic/interpersonal experiences. These experiences, in turn, lead to dysfunctional beliefs and cognitive appraisals, ultimately leading to maladaptive behaviors such as delusions/hallucinations (Beck & Rector, 2005). Beck proposed the following diathesis-stress model for how schizophrenia develops (Fee Figure 12.1).
Figure 12.1. Diathesis-Stress Model of the Development of Schizophrenia
Adapted from Beck & Rector, 2005, pg. 580
Based on this theory, an underlying neurocognitive impairment (as discussed above) makes an individual more vulnerable to experience aversive life events such as homelessness, conflict within the family, etc. Individuals with schizophrenia are more likely to evaluate these aversive life events with a dysfunctional attitude and maladaptive cognitive distortions. The combination of the aversive events and negative interpretations produces a stress response in the individual, thus igniting hyperactivation of the HPA axis. According to Beck and Rector (2005), it is the culmination of these events leads to the development of schizophrenia.
Sociocultural
12.4.3.1. Expressed emotion. Research regarding supportive family environments suggests that families high in expressed emotion, meaning families that have high hostile, critical, or overinvolved family members, are predictors of relapse (Bebbington & Kuipers, 2011). In fact, individuals who return post-hospitalization to families with high criticism and emotional involvement are twice as likely to relapse compared to those who return to families with low expressed emotion (Corcoran et al., 2003). Several meta-analyses have concluded that family atmosphere is causally related to relapse in patients with schizophrenia, and that these outcomes can be improved when the family environment is improved (Bebbington & Kuipers, 2011). Therefore, one major treatment goal in families of patients with schizophrenia is to reduce expressed emotion within family interactions.
12.4.3.2. Family dysfunction. Even for families with low levels of expressed emotion, there is often an increase in family stress due to the secondary effects of schizophrenia. Having a family member with schizophrenia increases the likelihood of a disruptive family environment due to managing the patient’s symptoms and ensuring their safety while they are home (Friedrich et al., 2015). Because of the severity of symptoms, families with a loved one diagnosed with schizophrenia often report more conflict in the home as well as more difficulty communicating with one another (Kurtz, 2015).
Key Takeaways
You should have learned the following in this section:
• Biological causes of schizophrenia spectrum and other psychotic disorders include genetics, several brain structures, and the HPA axis.
• Psychological causes of schizophrenia spectrum disorders include the diathesis-stress model.
• Sociocultural causes of schizophrenia spectrum disorders include families high in expressed emotion and family dysfunction.
Review Questions
1. What evidence is there to support a biological model with respect to explaining the development and maintenance of the schizophrenia spectrum and other psychotic disorders?
2. Discuss the stress-vulnerability model with respect to schizophrenia spectrum and other psychotic disorders.
3. How does the sociocultural model explain the maintenance (and relapse) of schizophrenia related symptoms? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/12%3A_Schizophrenia_Spectrum_and_Other_Psychotic_Disorders/12.04%3A_Schizophre.txt |
Learning Objectives
• Describe psychopharmacological treatment options for schizophrenia spectrum and other psychotic disorders.
• Describe psychological treatment options for schizophrenia spectrum and other psychotic disorders.
• Describe family interventions for schizophrenia spectrum and other psychotic disorders.
While a combination of psychopharmacological, psychological, and family interventions is the most effective treatment in managing schizophrenia symptoms, rarely do these treatments restore a patient to premorbid levels of functioning (Kurtz, 2015; Penn et al., 2004). Although more recent advancements in treatment for schizophrenia appear promising, the disease itself is still viewed as one that requires lifelong treatment and care.
12.5.1. Psychopharmacological
Among the first antipsychotic medications used for the treatment of schizophrenia was Thorazine. Developed as a derivative of antihistamines, Thorazine was the first line of treatment that produced a calming effect on even the most severely agitated patients and allowed for the organization of thoughts. Despite their effectiveness in managing psychotic symptoms, conventional antipsychotics (such as Thorazine and Chlorpromazine) also produced significant side effects similar to that of neurological disorders. Therefore, psychotic symptoms were replaced with muscle tremors, involuntary movements, and muscle rigidity. Additionally, these conventional antipsychotics also produced tardive dyskinesia in patients, which included involuntary movements isolated to the tongue, mouth, and face (Tenback et al., 2006). While only 10% of patients reported the development of tardive dyskinesia, this percentage increased the longer patients were on the medication, as well as the higher the dose (Achalia, Chaturvedi, Desai, Rao, & Prakash, 2014). In efforts to avoid these symptoms, clinicians have been cognizant of not exceeding the clinically effective dose of conventional antipsychotic medications. If the management of psychotic symptoms cannot be resolved at this level, alternative medications are often added to produce a synergistic effect (Roh et al., 2014).
Due to the harsh side effects of conventional antipsychotic drugs, newer, arguably more effective second-generation or atypical antipsychotic drugs have been developed. The atypical antipsychotic drugs appear to act on both dopamine and serotonin receptors, as opposed to only dopamine receptors in the conventional antipsychotics. Because of this, common medications such as clozapine (Clozaril), risperidone (Risperdal), and aripiprazole (Abilify), appear to be more effective in managing both positive and negative symptoms. While there continues to be a risk of developing side effects such as tardive dyskinesia, recent studies suggest it is much lower than that of the conventional antipsychotics (Leucht, Heres, Kissling, & Davis, 2011). Thus, due to their effectiveness and minimal side effects, atypical antipsychotic medications are typically the first line of treatment for schizophrenia (Barnes & Marder, 2011).
It should be noted that because of the harsh side effects of antipsychotic medications in general, many individuals, nearly one half to three-quarters of patients, discontinue the use of antipsychotic drugs (Leucht, Heres, Kissling, & Davis, 2011). Because of this, it is also important to incorporate psychological interventions along with psychopharmacological treatment to both address medication adherence, as well as provide additional support for symptom management.
12.5.2. Psychological Interventions
12.5.2.1.Cognitive Behavioral Therapy (CBT). As discussed in previous chapters, the goal of treatment is to identify the negative biases and attributions that influence an individual’s interpretations of events and the subsequent consequences of these thoughts and behaviors. For schizophrenia, CBT focuses on the maladaptive emotional and behavioral responses to psychotic experiences, which is directly related to distress and disability. Therefore, the goal of CBT is not on symptom reduction, but rather to improve the interpretations and understandings of these symptoms (and experiences) which will reduce associated distress (Kurtz, 2015). Common features of CBT for schizophrenia patients include psychoeducation about their disease and the course of their symptoms (i.e., ways to identify coming and going of delusions/hallucinations), challenging and replacing the negative thoughts/behaviors associated with their delusions/hallucinations to more positive thoughts/behaviors, and finally, learning positive coping strategies to deal with their unpleasant symptoms (Veiga-Martinez, Perez-Alvarez, & Garcia-Montes, 2008).
Findings from studies exploring CBT as a supportive treatment have been promising. One study conducted by Aaron Beck (the founder of CBT) and colleagues (Grant, Huh, Perivoliotis, Stolar, & Beck, 2011) found that recovery-oriented CBT produced a marked improvement in overall functioning as well as symptom reduction in patients diagnosed with schizophrenia. This study suggests that by focusing on targeted goals such as independent living, securing employment, and improving social relationships, patients were able to slowly move closer to these targeted goals. By also including a variety of CBT strategies such as role-playing, scheduling community outings, and addressing negative cognitions, individuals were also able to address cognitive and social skill deficits.
12.5.3. Family Interventions
The diathesis-stress model of schizophrenia has primarily influenced family interventions. As previously discussed, the emergence of the disorder and exacerbation of symptoms is likely related to environmental stressors and psychological factors. While the degree in which environmental stress stimulates an exacerbation of symptoms varies among individuals, there is significant evidence to conclude that stress does impact illness presentation (Haddock & Spaulding, 2011). Therefore, the overall goal of family interventions is to reduce the stress on the individual that is likely to elicit the onset of symptoms.
Unlike many other psychological interventions, there is not a specific outline for family-based interventions related to schizophrenia. However, the majority of programs include the following components: psychoeducation, problem-solving skills, and cognitive-behavioral therapy.
Psychoeducation is important for both the patient and family members as it is reported that more than half of those recovering from a psychotic episode reside with their family (Haddock & Spaulding, 2011). Therefore, educating families on the course of the illness, as well as ways to recognize onset of psychotic symptoms, is important to ensure optimal recovery.
Problem-solving is a crucial component in the family intervention model. Seeing as family conflict can increase stress within the home, which in return can lead to worsening of psychotic symptoms, family members benefit from learning effective methods of problem-solving to address family conflicts. Additionally, teaching positive coping strategies for dealing with the symptoms of mental illness and its direct effect on the family environment may also alleviate some friction within the home
The third component, CBT, is similar to that described above. The goal of family-based CBT is to reduce negativity among family member interactions, as well as help family members adjust to living with someone with psychotic symptoms. These three components within the family intervention program have been shown to reduce re-hospitalization rates, as well as slow the worsening of schizophrenia-related symptoms (Pitschel-Walz, Leucht, Baumi, Kissling, & Engel, 2001).
12.5.3.1.Social skills training. Given the poor interpersonal functioning among individuals with schizophrenia, social skills training is another type of treatment commonly suggested to improve psychosocial functioning. Research has indicated that poor interpersonal skills not only predate the onset of the disorder but also remain significant even with the management of symptoms via antipsychotic medications. Impaired ability to interact with individuals in a social, occupational, or recreational setting is related to poorer psychological adjustment (Bellack, Morrison, Wixted, & Mueser, 1990). This can lead to greater isolation and reduced social support among individuals with schizophrenia. As previously discussed, social support has been identified as a protective factor of symptom exacerbation, as it buffers psychosocial stressors that are often responsible for the exacerbation of symptoms. Learning how to interact with others appropriately (e.g., establish eye contact, engage in reciprocal conversations, etc.) through role-play in a group therapy setting is one effective way to teach positive social skills.
12.5.3.2.Inpatient Hospitalizations. More commonly viewed as community-based treatments, inpatient hospitalization programs are essential in stabilizing patients in psychotic episodes. Generally speaking, patients will be treated on an outpatient basis; however, there are times when their symptoms exceed the needs of an outpatient service. Short-term hospitalizations are used to modify antipsychotic medications and implement additional psychological treatments so that a patient can safely return to their home. These hospitalizations generally last for a few weeks as opposed to a long-term treatment option that would last months or years (Craig & Power, 2010).
In addition to short-term hospitalizations, there are also partial hospitalizations where an individual enrolls in a full-day program but returns home for the evening. These programs provide individuals with intensive therapy, organized activities, and group therapy programs that enhance social skills training. Research supports the use of partial hospitalizations as individuals enrolled in these programs tend to do better than those who enter outpatient care (Bales et al., 2014).
Key Takeaways
You should have learned the following in this section:
• Psychopharmacological treatment options for schizophrenia spectrum disorders include antipsychotic drugs such as Thorazine, Chlorpromazine, Clozaril, Risperdal, and Abilify.
• Psychological treatment options for schizophrenia spectrum disorders include CBT, the goal of which is to improve the interpretations and understandings of symptoms (and experiences) which will reduce associated distress.
• Family interventions for schizophrenia spectrum disorders include psychoeducation, problem-solving skills, cognitive-behavioral therapy (CBT), social skills training, and inpatient/partial hospitalizations.
Review Questions
1. Define tardive dyskinesia.
2. What pharmacological interventions have been effective in managing schizophrenia related disorder symptoms?
3. What is the main goal of family interventions? How is this achieved?
Module Recap
In our first module of Part V – Block 4, we discussed the schizophrenia spectrum and other psychotic disorders to include schizophrenia, schizophreniform disorder, schizoaffective disorder, and delusional disorder. We started by describing their common features, such as delusions, hallucinations, disorganized thinking, disorganized/abnormal motor behavior, and negative symptoms. This led to a discussion of the epidemiology, comorbidity, etiology, and treatment options for the disorders. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/12%3A_Schizophrenia_Spectrum_and_Other_Psychotic_Disorders/12.05%3A_Schizophre.txt |
Learning Objectives
• Describe how personality disorders present.
• Describe the epidemiology of personality disorders.
• Describe comorbidity in relation to personality disorders.
• Describe the etiology of personality disorders.
• Describe treatment options for personality disorders.
In Module 13, we will cover matters related to personality disorders to include their clinical presentation, epidemiology, comorbidity, etiology, and treatment options. Our discussion will include Cluster A disorders of paranoid, schizoid, and schizotypal; Cluster B disorders of antisocial, borderline, histrionic, and narcissistic; and Cluster C personality disorders of avoidant, dependent, and obsessive-compulsive. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of the therapies (Module 3).
13: Personality Disorders
Learning Objectives
• Define personality trait.
• Define personality disorder.
• List the defining features of personality disorders.
• Describe the three clusters.
• Describe how paranoid personality disorder presents.
• Describe how schizoid personality disorder presents.
• Describe how schizotypal personality disorder presents.
• Describe how antisocial personality disorder presents.
• Describe how borderline personality disorder presents.
• Describe how histrionic personality disorder presents.
• Describe how narcissistic personality disorder presents.
• Describe how avoidant personality disorder presents.
• Describe how dependent personality disorder presents.
• Describe how obsessive-compulsive personality disorder presents.
Overview of Personality Disorders
According to the DSM-5-TR, personality traits are “…enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personality contexts while a personality disorder “…is an enduring pattern of inner experience and behavior that deviates markedly from the norms and expectations of the individual’s culture, is pervasive and inflexible, and has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment” (APA, 2022, pg. 733). Personality disorders have four defining features, which include distorted thinking patterns, problematic emotional responses, over- or under-regulated impulse control, and interpersonal difficulties. While these four core features are universal among all ten personality disorders, the DSM-5-TR divides the personality disorders into three different clusters based on symptom similarities.
Cluster A is described as the odd or eccentric cluster and consists of paranoid, schizoid, and schizotypal personality disorders. The common feature between these three disorders is social awkwardness and social withdrawal. Often these behaviors are similar to those seen in schizophrenia; however, they tend to be not as extensive or impactful on daily functioning as seen in schizophrenia. In fact, there is a strong relationship between Cluster A personality disorders among individuals who have a relative diagnosed with schizophrenia (Chemerinksi & Siever, 2011).
Cluster B is the dramatic, emotional, or erratic cluster and consists of antisocial, borderline, histrionic, and narcissistic personality disorders. Individuals with these personality disorders often experience problems with impulse control and emotional regulation. Due to the dramatic, emotional, and erratic nature of these disorders, it is nearly impossible for individuals to establish healthy relationships with others.
And finally, Cluster C is the anxious or fearful cluster and consists of avoidant, dependent, and obsessive-compulsive personality disorders. As you read through the descriptions of the disorders, you will see an overlap with symptoms from the anxiety and depressive disorders. Cluster C disorders have the most treatment options of all the personality disorders, likely because the overlapping anxiety and depressive disorders have well-established treatment options.
To meet the criteria for any personality disorder, the individual must display the pattern of behaviors in adulthood. Children cannot be diagnosed with a personality disorder. Some children may present with similar symptoms, such as poor peer relationships, odd or eccentric behaviors, or peculiar thoughts and language; however, a formal personality disorder diagnosis cannot be made until the age of 18. The DSM-5-TR reports that median prevalence across several countries is 3.6% for Cluster A disorders, 4.5% for Cluster B, 2.8% for Cluster C, and 10.5% for any personality disorder.
It is also noted that the clustering approach used in the DSM has not been consistently validated and has some serious limitations. As written, “An alternative to the categorical approach is the dimensional perspective that personality disorders represent maladaptive variants of personality traits that merge imperceptibly into normality and into one another” (APA, 2022, pg. 734). Interested readers should consult Section III of the DSM (beginning on page 881) for a full description of the dimensional model for personality disorders and an alternative model for personality disorders that utilizes a hybrid dimensional-categorical model approach.
Cluster A
13.1.2.1. Paranoid personality disorder. Paranoid personality disorder is characterized by a marked distrust or suspicion of others. Individuals interpret and believe that other’s motives and interactions are intended to harm them, and therefore, they are skeptical about establishing close relationships outside of family members—although, at times, even family members’ actions are also believed to be malevolent (APA, 2022). Individuals with paranoid personality disorder often feel as though they have been deeply and irreversibly hurt by others even though they lack evidence to support that these others intended to or did hurt them. Because of these persistent suspicions, they will doubt relationships that show true loyalty or trustworthiness. Compliments are misinterpreted and they may view an offer of help as a criticism that they are not doing a good enough job on their own.
Individuals with paranoid personality disorder are also hesitant to share any personal information or confide in others as they fear the information will be used against them. Additionally, benign remarks or events are often viewed as demeaning or threatening. For example, if an individual with paranoid personality disorder was accidentally bumped into at the store, they would interpret this action as intentional, with the purpose of causing them injury. Because of this, individuals with paranoid personality disorder are quick to hold grudges and unwilling to forgive insults or injuries- whether intentional or not. They are known to quickly and angrily counterattack, either verbally or physically, in situations where they feel they were insulted (APA, 2022).
13.1.2.2. Schizoid personality disorder. Individuals with schizoid personality disorder display a persistent pattern of avoidance of social relationships, along with a limited range of emotional expression in interpersonal settings (APA, 2022). Similar to those with paranoid personality disorder, individuals with schizoid personality disorder do not have many close relationships; however, unlike paranoid personality disorder, this lack of connection is not due to suspicious feelings, but rather, the lack of desire to engage with others and the preference to engage in solitary behaviors. Individuals with schizoid personality disorder are often viewed as “loners” and prefer activities where they do not have to engage with others (APA, 2022). Established relationships rarely extend outside that of the family as they make no effort to start or maintain friendships. This lack of establishing social relationships also extends to sexual behaviors, as these individuals report a lack of interest in engaging in sexual experiences with others.
Regarding the limited range of emotion, individuals with schizoid personality disorder are often indifferent to criticisms or praises of others and appear not to be affected by what others think of them. Individuals will rarely show any feelings or expressions of emotion and are often described as having a “bland” exterior (APA, 2022). In fact, individuals with schizoid personality disorder rarely reciprocate facial expressions or gestures typically displayed in normal conversations such as smiles or nods. Because of this lack of emotion, there is a limited need for attention or acceptance.
13.1.2.3. Schizotypal personality disorder. Schizotypal personality disorder is characterized by a range of impairment in social and interpersonal relationships due to discomfort in relationships, along with odd cognitive or perceptual distortions and eccentric behaviors (APA, 2022). Similar to those with schizoid personality disorder, individuals also seek isolation and have few, if any established relationships outside of family members.
One of the most prominent features of schizotypal personality disorder is ideas of reference, or the belief that unrelated events pertain to them in a particular and unusual way. Ideas of reference also lead to superstitious behaviors or preoccupation with paranormal activities that are not generally accepted in their culture (APA, 2022). The perception of special or magical powers, such as the ability to mind-read or control other’s thoughts, has also been documented in individuals with schizotypal personality disorder. Similar to schizophrenia, unusual perceptual experiences such as auditory hallucinations, as well as unusual speech patterns of derailment or incoherence, are also present.
Like the other personality disorders within cluster A, there is a component of paranoia or suspiciousness of other’s motives. Additionally, individuals with schizotypal personality disorder display inappropriate or restricted affect, thus impacting their ability to appropriately interact with others in a social context. Significant social anxiety is often also present in social situations, particularly in those involving unfamiliar people. The combination of limited affect and social anxiety contributes to their inability to establish and maintain personal relationships; most individuals with schizotypal personality disorder prefer to keep to themselves to reduce this anxiety.
Cluster B
13.1.3.1. Antisocial personality disorder. The essential feature of antisocial personality disorder is the persistent pattern of disregard for, and violation of, the rights of others. This pattern of behavior begins in late childhood or early adolescence and continues throughout adulthood. While this behavior presents before age 15, the individual cannot be diagnosed with antisocial personality disorder until the age of 18. Prior to age 18, the individual would be diagnosed with conduct disorder. Although not discussed in this book as it is a disorder of childhood, conduct disorder involves a repetitive and persistent pattern of behaviors that violate the rights of others or major age-appropriate norms. Common behaviors of individuals with conduct disorder that go on to develop antisocial personality disorder are aggression toward people or animals, destruction of property, deceitfulness or theft, or serious violation of rules (APA, 2022).
While commonly referred to as “psychopaths” or “sociopaths,” individuals with antisocial personality disorder fail to conform to social norms. This also includes legal rules as individuals with antisocial personality disorder are often repeatedly arrested for property destruction, harassing/assaulting others, or stealing (APA, 2022). Deceitfulness is another hallmark symptom of antisocial personality disorder as individuals often lie repeatedly, generally to gain profit or pleasure. There is also a pattern of impulsivity—decisions made in the moment without forethought of personal consequences or consideration for others (Lang et al., 2015). This impulsivity also contributes to their inability to hold jobs as they are more likely to impulsively quit their jobs (Hengartner et al., 2014). Employment instability, along with impulsivity, also impacts their ability to manage finances; it is not uncommon to see individuals with antisocial personality disorder with large debts that they are unable to pay (Derefinko & Widiger, 2016).
While also likely related to impulsivity, individuals with antisocial personality disorder tend to be extremely irritable and aggressive, repeatedly getting into fights. The marked disregard for their safety, as well as the safety of others, is also observed in reckless behavior such as speeding, driving under the influence, and engaging in sexual and substance abuse behavior that may put themselves at risk (APA, 2022).
Of course, the most known and devastating symptom of antisocial personality disorder is the lack of remorse for the consequences of their actions, regardless of how severe they may be. Individuals often rationalize their actions as the fault of the victim, minimize the harmfulness of the consequences of their behaviors, or display indifference (APA, 2022). Overall, individuals with antisocial personality disorder have limited personal relationships due to their selfish desire and lack of moral conscience.
13.1.3.2. Borderline personality disorder. Individuals with borderline personality disorder display a pervasive pattern of instability in interpersonal relationships, self-image, and affect (APA, 2022). The combination of these symptoms causes significant impairment in establishing and maintaining personal relationships. They will often go to great lengths to avoid real or imagined abandonment. Fears related to abandonment can lead to inappropriate anger as they often interpret the abandonment as a reflection of their own behavior. It is not uncommon to experience intense fluctuations in mood, often observed as volatile interactions with family and friends (Herpertz & Bertsch, 2014). Those with borderline personality disorder may be friendly one day and hostile the next.
To prevent abandonment, individuals with borderline personality disorder will often exhibit impulsive behaviors such as self-harm and suicidal behavior. In fact, individuals with borderline personality disorder engage in more suicide attempts, and completion of suicide is higher among these individuals than the general public (Linehan et al., 2015). Other impulsive behaviors, such as non-suicidal self-injury (cutting) and sexual promiscuity, are frequently seen within this population, typically occurring during high-stress periods (Sansone & Sansone, 2012). They often have chronic feelings of emptiness along with painful feelings of aloneness. Occasionally, hallucinations and delusions are present, particularly of a paranoid nature; however, these symptoms are often transient and recognized as unacceptable by the individual (Sieswerda & Arntz, 2007).
13.1.3.3. Histrionic personality disorder. Histrionic personality disorder is the first personality disorder that addresses pervasive and excessive emotionality and attention-seeking. These individuals are usually uncomfortable in social settings unless they are the center of attention. To help gain attention, the individual is often vivacious and dramatic, using physical gestures and mannerisms along with grandiose language. These behaviors are initially very charming to their audience; however, they begin to wear due to the constant need for attention to be on them. If the theatrical nature does not gain the attention they desire, they may go to great lengths to draw attention, such as using a fictitious story or creating a dramatic scene.
To ensure they gain the attention they desire, individuals with histrionic personality disorder frequently dress and engage in sexually seductive or provocative ways. These sexually charged behaviors are not only directed at those in which they have a sexual or romantic interest but to the general public as well (APA, 2022). They often spend a significant amount of time on their physical appearance to gain the attention they desire.
Individuals with histrionic personality disorder are easily suggestible. Their opinions and feelings are influenced by not only their friends but also by current fads (APA, 2022). They also tend to exaggerate relationships, considering casual acquaintanceships as more intimate than they are.
13.1.3.4. Narcissistic personality disorder. Like histrionic personality disorder, narcissistic personality disorder also centers around the individual; however, with narcissistic personality disorder, individuals display a pattern of grandiosity along with a lack of empathy for others (APA, 2022). The grandiose sense of self leads to an overvaluation of their abilities and accomplishments. They often come across as boastful and pretentious, repeatedly proclaiming their superior achievements. These proclamations may also be fantasized to enhance their success or power. Oftentimes they identify themselves as “special” and will only interact with others of high status.
Given the grandiose sense of self, it is not surprising that individuals with narcissistic personality disorder need excessive admiration from others. While it appears that their self-esteem is hugely inflated, it is very fragile and dependent on how others perceive them (APA, 2022). Because of this, they may constantly seek out compliments and expect favorable treatment from others. When this sense of entitlement is not upheld, they can become irritated or angry that their needs are not met.
A lack of empathy is also displayed in individuals with narcissistic personality disorder as they often struggle to (or choose not to) recognize the desires or needs of others. This lack of empathy also leads to exploitation of interpersonal relationships, as they are unable to understand other’s feelings (Marcoux et al., 2014). They often become envious of others who achieve greater success or possessions than them. Conversely, they believe everyone should be envious of their achievements, regardless of how small they may be.
Cluster C
13.1.4.1. Avoidant personality disorder. Individuals with avoidant personality disorder display a pervasive pattern of social inhibition due to feelings of inadequacy and increased sensitivity to negative evaluations (APA, 2022). The fear of being rejected drives their reluctance to engage in social situations so that they may prevent others from evaluating them negatively. This fear extends so far that it prevents individuals from maintaining employment due to their intense fear of negative evaluation or rejection.
Socially, they have very few if any friends, despite their desire to establish social relationships. They actively avoid social situations in which they can develop new friendships out of the fear of being disliked or ridiculed. Similarly, they are cautious of new activities or relationships as they often exaggerate the potential negative consequences and embarrassment that may occur; this is likely a result of their ongoing preoccupation with being criticized or rejected by others. Within intimate relationships, their fear of being shamed or ridiculed leads to restraint, and they view themselves as socially inept (APA, 2022).
Making Sense of the Disorders
As you read the clinical description of avoidant personality disorder, did you think it sounded a lot like social anxiety disorder? You likely did as there is a great deal of overlap between the two disorders. So, how do they differ if they are to be regarded as separate diagnostic categories in the DSM? This difference is linked to self-concept. How so?
• In social anxiety disorder the negative self-concept is unstable and less pervasive and entrenched.
• In avoidant personality disorder, the negative self-concept is more stable as an enduring and pervasive pattern, typical of personality traits.
Additionally, avoidant personality disorder frequently occurs in the absence of social anxiety disorder and some separate risk factors have been identified for the two.
13.1.4.2. Dependent personality disorder. Dependent personality disorder is characterized by pervasive and excessive need to be taken care of by others (APA, 2022). This intense need leads to submissive and clinging behaviors as they fear they will be abandoned or separated from their parent, spouse, or another person with whom they are in a dependent relationship. They are so dependent on this other individual that they cannot make even the smallest decisions without first consulting with them and gaining their approval or reassurance. They often allow others to assume complete responsibility for their life, making decisions in nearly all aspects of their lives. Rarely will they challenge these decisions as their fear of losing this relationship greatly outweighs their desire to express their own opinion. Should the relationship end, the individual experiences significant feelings of helplessness and quickly seeks out another relationship to replace the old one (APA, 2022).
When they are on their own, individuals with dependent personality disorder express difficulty initiating and engaging in tasks on their own. They lack self-confidence and feel helpless when they are left to care for themselves or engage in tasks on their own. So that they do not have to engage in tasks alone, individuals will go to great lengths to seek out support of others, often volunteering for unpleasant tasks if it means they will get the reassurance they need (APA, 2022).
13.1.4.3. Obsessive-compulsive personality disorder (OCPD). OCPD is defined by an individual’s preoccupation with orderliness, perfectionism, and ability to control situations that they lose flexibility, openness, and efficiency in everyday life (APA, 2022). One’s preoccupation with details, rules, lists, order, organization, or schedules overshadows the larger picture of the task or activity. In fact, the need to complete the task or activity is significantly impacted by the individual’s self-imposed high standards and need to complete the task perfectly, that the task often does not get completed. The desire to complete the task perfectly often causes the individual to spend an excessive amount of time on the task, occasionally repeating it until it is to their standard. Due to repetition and attention to fine detail, the individual often does not have time to engage in leisure activities or engage in social relationships. Despite the excessive amount of time spent on activities or tasks, individuals with OCPD will not seek help from others, as they are convinced that the others are incompetent and will not complete the task up to their standard.
Personally, individuals with OCD are rigid and stubborn, particularly with their morals, ethics, and values. Not only do they hold these standards for themselves, but they also expect others to have similarly high standards, thus causing significant disruption to their social interactions. The rigid and stubborn behaviors are also seen in their financial status, as they are known to live significantly below their means to prepare financially for a potential catastrophe (APA, 2022). Similarly, they may have difficulty discarding worn-out or worthless items, despite their lack of sentimental value.
Though on the surface it may appear that OCPD and OCD are one and the same, there is a distinct difference as the personality disorder lacks definitive obsessions and compulsions (APA, 2022). In fact, most individuals with OCD do not have a pattern of behavior that meets criteria for this personality disorder.
Key Takeaways
You should have learned the following in this section:
• Personality disorders share the features of distorted thinking patterns, problematic emotional responses, over- or under-regulated impulse control, and interpersonal difficulties and divide into three clusters.
• Cluster A personality disorders are described as the odd/eccentric cluster and share as the common feature social awkwardness and social withdrawal. It consists of paranoid, schizoid, and schizotypal personality disorders.
• Cluster B personality disorders are described as the dramatic, emotional, or erratic cluster and consists of antisocial, borderline, histrionic, and narcissistic personality disorders.
• Cluster C is the anxious/fearful cluster and consists of avoidant, dependent, and obsessive-compulsive personality disorders.
• Paranoid personality disorder is characterized by a marked distrust or suspicion of others.
• Schizoid personality disorder is characterized by a persistent pattern of avoidance of social relationships, along with a limited range of emotion among social relationships.
• Schizotypal personality disorder is characterized by a range of impairment in social and interpersonal relationships due to discomfort in relationships, along with odd cognitive or perceptual distortions and eccentric behaviors.
• Antisocial personality disorder is characterized by a persistent pattern of disregard for, and violation of, the rights of others. They show no remorse for their behavior
• Borderline personality disorder is characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affect.
• Histrionic personality disorder is characterized by pervasive and excessive emotionality and attention-seeking.
• Narcissistic personality disorder is characterized by a pattern of grandiosity along with a lack of empathy for others.
• Avoidant personality disorder is characterized by a pervasive pattern of social anxiety due to feelings of inadequacy and increased sensitivity to negative evaluations.
• Dependent personality disorder is characterized by pervasive and excessive need to be taken care of by others.
• OCPD is characterized by an individual’s preoccupation with orderliness, perfectionism, and the ability to control situations that they lose flexibility, openness, and efficiency in everyday life.
Review Questions
1. What are personality traits and how do they lead to personality disorders?
2. What are the three clusters? How are disorders grouped into these three clusters? Discuss the differences in symptom presentation between the three personality clusters.
3. Create a chart identifying each of the disorders among the three clusters. Be sure to include personality characteristics of each disorder. It is important to find characteristics unique to each personality disorder to aid in their identification. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.01%3A_Personality_Disorders_-_Clinical_Presenta.txt |
Learning Objectives
• Describe the epidemiology of Cluster A personality disorders.
• Describe the epidemiology of Cluster B personality disorders.
• Describe the epidemiology of Cluster C personality disorders.
Cluster A
Disorders within Cluster A have a prevalence rate of around 2-5%. More specifically, according to Part II of the National Comorbidity Survey Replication, the estimated prevalence of paranoid personality disorder was 2.3%, schizoid personality disorder was 4.9%, and schizotypal personality disorder was 3.3%. Schizotypal personality disorder has been found to be more common in men while research on schizoid personality disorder leans to no gender difference in prevalence. As for paranoid personality disorder, it appears to be more common in men though the National Epidemiologic Survey on Alcohol and Related conditions found it to be more common in women (APA, 2022).
Cluster B
Using Part II of the National Comorbidity Survey Replication, it was found that for Cluster B personality disorders prevalence rates were: 0.6% for antisocial, 1.4% for borderline, 0.0% for histrionic, and 0.0% for narcissistic. It should be noted that the prevalence of histrionic personality disorder was 1.8% and narcissistic was 6.2% in the National Epidemiologic Survey on Alcohol and Related Conditions.
As for sex-and gender-related differences, antisocial personality disorder is three times more common in men and they present with irritability/aggression and reckless disregard for the safety of others more often than women. Borderline personality disorder is more common among women in clinical samples while community samples show no difference in prevalence, likely due to the tendency of women to seek help leading them to clinical settings. Histrionic personality disorder is more predominant in females in clinical settings, though some studies using structured assessments point to no difference in prevalence rates across the genders. Narcissistic personality disorder occurs more in men than women.
Cluster C
Using Part II of the National Comorbidity Survey Replication, it was found that for Cluster C personality disorders prevalence rates were: 5.2% for avoidant, 0.6% for dependent, and 2.4% for OCPD. Women are more likely to be diagnosed with avoidant and dependent personality disorders while OCPD appears to be equally prevalent in women and men.
For expanded information on the prevalence of the various personality disorders from the DSM-5-TR, please see Table 13. 1 below.
Key Takeaways
You should have learned the following in this section:
• Prevalence rates of Cluster A personality disorders range from 2% to 5% with schizotypal being more common in men and there being no difference in schizoid and conflicting evidence for paranoid.
• Prevalence rates of Cluster B personality disorders range from 0.0% to 1.4% and antisocial and narcissistic are more common in men with borderline and histrionic being more common in women, in general.
• Prevalence rates of Cluster C personality disorders range from 0.6% to 5.2% with women being more likely to be diagnosed with avoidant and dependent personality disorders and OCPD appearing to be equally prevalent in women and men.
Review Questions
1. What is the difference in prevalence rates across the three clusters? Are there any trends among gender?
2. Identify the most commonly occurring personality disorder. Which is the least common?
13.03: Personality Disorders - Comorbidity
Learning Objectives
• Describe the comorbidity of personality disorders.
Among the most common comorbid diagnoses with personality disorders are mood disorders, anxiety disorders, and substance abuse disorders (Lenzenweger, Lane, Loranger, & Kessler, 2007). A large meta-analysis exploring the data on the comorbidity of major depressive disorder and personality disorders indicated a high diagnosis of major depressive disorder, bipolar disorder, and dysthymia (Friborg, Martinsen, Martinussen, Kaiser, Overgard, & Rosenvinge, 2014). Further exploration of major depressive disorder suggested the lowest rate of diagnosis in Cluster A disorders, higher rate in Cluster B disorders, and the highest rate in Cluster C disorders. While the relationship between bipolar disorder and personality disorders has not been consistently clear, the most recent findings report a high comorbidity between Cluster B personality disorders, with the exception of OCPD (which is in Cluster C), which had the highest comorbidity rate than any other personality disorder. Overall analysis of dysthymia suggested that it is the most diagnosed depressive disorder among all personality disorders.
A more detailed analysis exploring the prevalence rates of the four main anxiety disorders (generalized anxiety disorder, specific phobia, social phobia, and panic disorder) among individuals with various personality disorders found a clear relationship specific to personality disorders and anxiety disorders (Skodol, Geier, Grant, & Hasin, 2014). More specifically, individuals diagnosed with borderline and schizotypal personality disorders were found to have an additional diagnosis of one of the four main anxiety disorders. Individuals with narcissistic personality disorder were more likely to be diagnosed with generalized anxiety disorder and panic disorder; schizoid and avoidant personality disorders reported significant rates of generalized anxiety disorder; avoidant personality disorder had a higher diagnosis rate of social phobia. Substance use disorders occur less frequently across the ten personality disorders but are most common in individuals diagnosed with antisocial, borderline, and schizotypal personality disorders (Grant et al., 2015). Schizotypal personality disorder is also comorbid with brief psychotic disorder, schizophreniform disorder, delusional disorder, and schizophrenia while borderline is additionally comorbid with eating disorders, PTSD, and ADHD (APA, 2022).
Key Takeaways
You should have learned the following in this section:
• Mood disorders, anxiety disorders, and substance abuse disorders have a high comorbidity with personality disorders.
• Substance abuse disorders occur less frequently across the ten personality disorders but when they do, are comorbid with antisocial, borderline, and schizotypal personality disorders.
Review Questions
1. With what other disorders are personality disorders comorbid? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.02%3A_Personality_Disorders_-_Epidemiology.txt |
Learning Objectives
• Describe the biological causes of personality disorders.
• Describe the psychological causes of personality disorders.
• Describe the social causes of personality disorders.
Research regarding the development of personality disorders is limited compared to that of other mental health disorders. The following is a general overview of contributing factors to personality disorders. While there is some research lending itself to specific causes of specific personality disorders, the overall contribution of biological, psychological, and social factors will be reviewed.
Biological
Research across the personality disorders suggests some underlying biological or genetic component; however, identification of specific mechanisms have not been identified in most disorders, except for those below. Because of this lack of concrete evidence, researchers argue that it is difficult to determine what role genetics plays into the development of these disorders compared to that of environmental influences. Therefore, while there is likely a biological predisposition to personality disorders, exact causes cannot be determined at this time.
Research on the development of schizotypal personality disorder has identified similar biological causes to that of schizophrenia—high activity of dopamine and enlarged brain ventricles (Lener et al., 2015). Similar differences in neuroanatomy may explain the high similarity of behaviors in both schizophrenia and schizotypal personality disorder.
Surprisingly, antisocial personality disorder and borderline personality disorder also have similar neurological changes. More specifically, individuals with both disorders reportedly show deficits in serotonin activity (Thompson, Ramos, & Willett, 2014). These low levels of serotonin activity in combination with deficient functioning of the frontal lobes—particularly the prefrontal cortex which is used in planning, self-control, and decision making—as well as an overly reactive amygdala, may explain the impulsive and aggressive nature of both antisocial and borderline personality disorder (Stone, 2014).
Psychological
Psychodynamic, cognitive, and behavioral theories are among the most common psychological models used to explain the development of personality disorders. Although much is still speculation, the following are general etiological views with regards to each specific theory.
13.4.2.1. Psychodynamic. The psychodynamic theory places a large emphasis on negative early childhood experiences and how these experiences impact an individual’s inability to establish healthy relationships in adulthood. More specifically, individuals with personality disorders report higher levels of childhood stress, such as living in impoverished environments, exposure to domestic violence, and experiencing repeated maltreatment (Kumari et al., 2014). Additionally, high levels of childhood neglect and parental rejection are also observed in personality disorder patients, with early parental loss and rejection leading to fears of abandonment throughout an individual’s life (Newnham & Janca, 2014; Roepke & Varter, 2014; Caligor & Clarkin, 2010).
Psychodynamic theorists believe that maltreatment in early childhood has the potential to negatively affect an individual’s sense of self and their perception of others, leading to the development of a personality disorder. For example, an individual who was neglected as a young child and deprived of love may report a lack of trust in others as an adult, a characteristic of antisocial personality disorder (Meloy & Yakeley, 2010). Difficulty trusting others or beliefs that they are unable to be loved may also impact one’s ability or desire to establish social relationships, as seen in many personality disorders, particularly schizoid. Because of these early childhood deficits, individuals may also overcompensate in their relationships to convince themselves that they are worthy of love and affection (Celani, 2014). Conversely, individuals may respond to their early childhood experiences by becoming emotionally distant, using relationships as a sense of power and destructiveness.
13.4.2.2. Cognitive. While psychodynamic theory emphasizes early childhood experiences, cognitive theorists focus on the maladaptive thought patterns and cognitive distortions displayed by those with personality disorders. Overall deficiencies in thinking can lead individuals with personality disorders to develop inaccurate perceptions of others (Beck, 2015). These dysfunctional beliefs likely originate from the interaction between a biological predisposition and undesirable environmental experiences. Maladaptive thought patterns and strategies are strengthened during aversive life events as a protective mechanism and ultimately come together to form patterns of behavior displayed in personality disorders (Beck, 2015).
Cognitive distortions such as dichotomous thinking, also known as all-or-nothing thinking, are observed in several personality disorders. More specifically, dichotomous thinking explains rigidity and perfectionism in OCPD, and the lack of self-sufficiency among individuals with dependent and borderline personality disorders (Weishaar & Beck, 2006). Discounting the positive also explains the underlying mechanisms for avoidant personality disorder (Weishaar & Beck, 2006). For example, individuals who have been routinely criticized or rejected during childhood may have difficulty accepting positive feedback from others, expecting only to receive rejection and harsh criticism. In fact, they may employ these misattributions to positive feedback to support their ongoing theory that they are constantly rejected and criticized by others.
13.4.2.3. Behavioral. Behavioral theorists apply three major theories to explain the development of personality disorders: modeling, reinforcement, and lack of social skills. In modeling, an individual learns maladaptive social patterns and behaviors by directly observing family members engaging in similar behaviors (Gaynor & Baird, 2007). While we cannot discredit the biological component of the familial influence, research does support an additive modeling or imitating component to the development of personality disorders, especially antisocial personality disorder (APA, 2022).
Reinforcement, or rewarding of maladaptive behaviors is also observed in the development of many personality disorders. Parents may unintentionally reward aggressive behaviors by giving in to a child’s desires to cease the situation or prevent escalation of behaviors. When this is done repeatedly over time, children (and later as adults) continue with these maladaptive behaviors as they are effective in gaining their needs and wants. On the other side, there is some speculation that excessive reinforcement or praise during childhood may contribute to the grandiose sense of self observed in individuals with narcissistic personality disorder (Millon, 2011).
Finally, failure to develop normal social skills may explain the development of some personality disorders, such as avoidant personality disorder (Kantor, 2010).
Social
13.4.3.1. Family dysfunction. High levels of psychological and social dysfunction within families have also been identified as contributing factors to the development of personality disorders. High levels of poverty, unemployment, family separation, and witnessing domestic violence are routinely observed in individuals diagnosed with personality disorders (Paris, 1996). While formalized research has yet to explore the relationship between SES and personality disorders fully, correlational studies suggest a link between poverty, unemployment, and poor academic achievement with increased levels of personality disorder diagnoses (Alwin, 2006).
13.4.3.2. Childhood maltreatment. Childhood maltreatment is among the most influential argument for the development of personality disorders in adulthood. Individuals with personality disorders often struggle with a sense of self and the ability to relate to others—something that is generally developed during the first four to six years of a child’s life, and it is affected by the emotional environment in which that child was raised. This sense of self is the mechanism in which individuals view themselves within their social context, while also informing attitudes and expectations of others. A child who experiences significant maltreatment, whether it be through neglect or physical, emotional, or sexual abuse, is at-risk for an underdeveloped or absent sense of self. Due to the lack of affection, discipline, or autonomy during childhood, these individuals are unable to engage in appropriate relationships as adults as seen across the spectrum of personality disorders.
Another way childhood maltreatment contributes to personality disorders is through the emotional bonds or attachments developed with primary caregivers. John Bowlby thoroughly researched the relationship between attachment and emotional development as he explored the need for affection in Harlow monkeys (Bowlby, 1998). Based on Bowlby’s research, four attachment styles have been identified: secure, anxious, ambivalent, and disorganized. While securely attached children generally do not develop personality disorders, those with anxious, ambivalent, and disorganized attachment are at an increased risk of developing various disorders. More specifically, those with an anxious attachment are at-risk for developing internalizing disorders, ambivalent are at-risk for developing externalizing disorders, and disorganized are at-risk for dissociative symptoms and personality-related disorders (Alwin, 2006).
Key Takeaways
You should have learned the following in this section:
• Biological causes of personality disorders have not been identified in most disorders, the exception being schizotypal which has similar biological causes as schizophrenia and antisocial and borderline personality disorders which have similar neurological changes.
• Psychological causes of personality disorders include negative early childhood experiences; maladaptive thought patterns and cognitive distortions; and modeling, reinforcement, and lack of social skills.
• Social causes of personality disorders include high levels of psychological and social dysfunction within families and maltreatment.
Review Questions
1. What personality disorders are most explained by the biological model?
2. How does the psychodynamic model explain the development of personality disorders?
3. What cognitive distortions are most discussed with respect to personality disorders?
4. What are the three behavioral theories used to explain the development of personality disorders?
5. Discuss the roll of attachment and how theorists have used it to explain the development of personality disorders. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.04%3A_Personality_Disorders_-_Etiology.txt |
Learning Objectives
• Describe treatment options for personality disorders.
Cluster A
Individuals with personality disorders within Cluster A often do not seek out treatment as they do not identify themselves as someone who needs help (Millon, 2011). Of those that do seek treatment, the majority do not enter it willingly. Furthermore, due to the nature of these disorders, individuals in treatment often struggle to trust the clinician as they are suspicious of the clinician’s intentions (paranoid and schizotypal personality disorder) or are emotionally distant from the clinician as they do not have a desire to engage in treatment due to lack of overall emotion (schizoid personality disorder; Kellett & Hardy, 2014, Colli, Tanzilli, Dimaggio, & Lingiardi, 2014). Because of this, treatment is known to move very slowly, with many patients dropping out before any resolution of symptoms.
When patients are enrolled in treatment, cognitive-behavioral strategies are most commonly used with the primary intention of reducing anxiety-related symptoms. Additionally, attempts at cognitive restructuring—both identifying and changing maladaptive thought patterns—are also helpful in addressing the misinterpretations of other’s words and actions, particularly for individuals with paranoid personality disorder (Kellett & Hardy, 2014). Schizoid personality disorder patients may engage in CBT techniques to help experience more positive emotions and more satisfying social experiences, whereas the goal of CBT for schizotypal personality disorder is to evaluate unusual thoughts or perceptions objectively and to ignore the inappropriate thoughts (Beck & Weishaar, 2011). Finally, behavioral techniques such as social-skills training may also be implemented to address ongoing interpersonal problems displayed in the disorders.
Cluster B
13.5.2.1. Antisocial personality disorder. Treatment options for antisocial personality disorder are limited and generally not effective (Black, 2015). Like Cluster A disorders, many individuals are forced to participate in treatment, thus impacting their ability to engage in and continue with treatment. Cognitive therapists have attempted to address the lack of morality and encourage patients to think about the needs of others (Beck & Weishaar, 2011).
13.5.2.2. Borderline personality disorder. Borderline personality disorder is the one personality disorder with an effective treatment option—Dialectical Behavioral Therapy (DBT). DBT is a form of cognitive-behavioral therapy developed by Marsha Linehan (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991). There are four main goals of DBT: reduce suicidal behavior, reduce therapy interfering behavior, improve quality of life, and reduce post-traumatic stress symptoms.
Within DBT, five main treatment components collectively help to reduce harmful behaviors (i.e., self-mutilation and suicidal behaviors) and replace them with practical, life-enhancing behaviors (Gonidakis, 2014). The first component is skills training. Generally performed in a group therapy setting, individuals engage in mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation. Second, individuals focus on enhancing motivation and applying skills learned in the previous component to specific challenges and events in their everyday life. The third, and often the most distinctive aspect of DBT, is the use of telephone and in vivo coaching for DBT patients from the DBT clinical team. It is not uncommon for patients to have the cell phone number of their clinician for 24/7 availability of in-the-moment support. The fourth component, case management, consists of allowing the patient to become their own “case manager” and effectively use the learned DBT techniques to problem-solve ongoing issues. Within this component, the clinician will only intervene when absolutely necessary. Finally, the consultation team, is a service for the clinicians providing the DBT treatment. Due to the high demands of borderline personality disorder patients, the consultation team offers support to the providers in their work to ensure they remain motivated and competent in DBT principles to provide the best treatment possible.
Support for the effectiveness of DBT in borderline personality disorder patients has been implicated in several randomized control trials (Harned, Korslund, & Linehan, 2014; Neacsiu, Eberle, Kramer, Wisemeann, & Linehan, 2014). More specifically, DBT has shown to significantly reduce suicidality and self-harm behaviors in those with borderline personality disorders. Additionally, the drop-out rates for treatment are extremely low, suggesting that patients value the treatment components and find them useful in managing symptoms.
13.5.2.3. Histrionic personality disorder. Individuals with histrionic personality disorder are more likely to seek out treatment than other personality disorder patients. Unfortunately, due to the nature of the disorder, they are very difficult patients to treat as they are quick to employ their demands and seductiveness within the treatment setting. The overall goal for the treatment of histrionic personality disorder is to help the patient identify their dependency and become more self-reliant. Cognitive therapists utilize techniques to help patients change their helpless beliefs and improve problem-solving skills (Beck & Weishaar, 2011).
13.5.2.4. Narcissistic personality disorder. Of all the personality disorders, narcissistic personality disorder is among the most difficult to treat (with maybe the exception of antisocial personality disorder). Most individuals with narcissistic personality disorder only seek out treatment for those disorders secondary to their personality disorder, such as depression (APA, 2022). The focus of treatment is to address the grandiose, self-centered thinking, while also trying to teach patients how to empathize with others (Beck & Weishaar, 2014).
Cluster C
While many individuals within avoidant and OCPD personality disorders seek out treatment to address their anxiety or depressive symptoms, it is often difficult to keep them in treatment due to distrust or fear of rejection from the clinician. Treatment goals for avoidant personality disorder are similar to that of social anxiety disorder. CBT techniques, such as identifying and challenging distressing thoughts, have been effective in reducing anxiety-related symptoms (Weishaar & Beck, 2006). Specific to OCPD, cognitive techniques aimed at changing dichotomous thinking, perfectionism, and chronic worrying help manage symptoms of OCPD. Behavioral treatments such as gradual exposure to various social settings, along with a combination of social skills training, have been shown to improve individuals’ confidence prior to engaging in social outings when treating avoidant personality disorder (Herbert, 2007). Antianxiety and antidepressant medications commonly used to treat anxiety disorders have also been used with minimal efficacy; furthermore, symptoms resume as soon as the medication is discontinued.
Unlike other personality disorders where individuals are skeptical of the clinician, individuals with dependent personality disorder try to place obligations of their treatment on the clinician. Therefore, one of the main treatment goals for dependent personality disorder patients is to teach them to accept responsibility for themselves, both in and outside of treatment (Colli, Tanzilli, Dimaggio, & Lingiardi, 2014). Cognitive strategies such as challenging and changing thoughts on helplessness and inability to care for oneself have been minimally effective in establishing independence. Additionally, behavioral techniques such as assertiveness training have also shown some promise in teaching individuals how to express themselves within a relationship. Some argue that family or couples therapy would be particularly helpful for those with dependent personality disorder due to the relationship between the patient and another person being the primary issue; however, research on this treatment method has not yielded consistently positive results (Nichols, 2013).
Key Takeaways
You should have learned the following in this section:
• Individuals with a Cluster A personality disorder do not often seek treatment and when they do, struggle to trust the clinician (paranoid and schizotypal) or are emotionally distant from the clinician (schizoid). When in treatment, cognitive restructuring and cognitive behavioral strategies are used.
• In terms of Cluster B, treatment options for antisocial are limited and generally not effective, borderline responds well to dialectical behavioral therapy (DBT), histrionic patients seek out help but are difficult to work with, and finally narcissistic are the most difficult to treat.
• For Cluster C, cognitive techniques aid with OCPD while gradual exposure to various social settings and social skills training help with avoidant. Clinicians use cognitive strategies to challenge thoughts on helplessness in patients with dependent personality disorder.
Review Questions
1. What is the process in Dialectical Behavioral Therapy (DBT)? What does the treatment entail? What disorders are treated with DBT?
2. Given the difference in personality characteristics between the three clusters, how are the suggested treatment options different between cluster A, B, and C?
Module Recap
Module 13 covered three clusters of personality disorders: Cluster A, which includes paranoid, schizoid, and schizotypal; Cluster B, which includes antisocial, borderline, histrionic, and narcissistic; and Cluster C which includes avoidant, dependent, and obsessive-compulsive. We also covered the clinical description, epidemiology, comorbidity, etiology, and treatment of personality disorders. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/05%3A_Part_V._Mental_Disorders__Block_4/13%3A_Personality_Disorders/13.05%3A_Personality_Disorders_-_Treatment.txt |
Learning Objectives
• Describe how neurocognitive disorders present.
• Describe the epidemiology of neurocognitive disorders.
• Describe the etiology of neurocognitive disorders.
• Describe treatment options for neurocognitive disorders.
In Module 14, we will cover matters related to neurocognitive disorders (NCDs) to include their clinical presentation, epidemiology, etiology, and treatment options. Our discussion will include delirium, major neurocognitive disorder, and mild neurocognitive disorder. We also discuss nine subtypes to include: Alzheimer’s disease, traumatic brain injury (TBI), vascular disorder, substance/medication induced, dementia with Lewy bodies, frontotemporal NCD, Parkinson’s disease, Huntington’s disease, and HIV infection. Be sure you refer Modules 1-3 for explanations of key terms (Module 1), an overview of the various models to explain psychopathology (Module 2), and descriptions of the therapies (Module 3).
14: Neurocognitive Disorders
Learning Objectives
• Describe how delirium presents.
• Describe how major neurocognitive disorder presents.
• Describe how mild neurocognitive disorder presents.
Unlike many of the disorders we have discussed thus far, neurocognitive disorders often result from disease processes or medical conditions. Therefore, it is important that individuals presenting with these symptoms complete a medical assessment to better determine the etiology behind the disorder.
There are three main categories of neurocognitive disorders—delirium, major neurocognitive disorder, and mild neurocognitive disorder. Within major and minor neurocognitive disorders are several subtypes due to the etiology of the disorder. For this book, we will review diagnostic criteria for both major and minor neurocognitive disorders, followed by a brief description of the various disease subtypes in the etiology section.
It is important to note as well that the criteria for the various NCDs are based on defined cognitive domains. These include the following, with a brief explanation of what it is:
1. Complex attention – Sustained, divided, or selective attention and processing speed
2. Executive function – planning, decision-making, overriding habits, mental flexibility, and responding to feedback/error correction
3. Learning and memory – includes cued recall, immediate or long-term memory, and implicit learning
4. Language – Includes expressive language and receptive language
5. Perceptual-motor – Includes any abilities related to visual perception, gnosis, perceptual-motor praxis, or visuo-constructional
6. Social cognition – Includes recognition of emotions and theory of mind
Delirium
Delirium is characterized by a notable disturbance in attention along with reduced awareness of the environment. The disturbance develops over a short period of time, representing a change from baseline attention and awareness, and fluctuates in severity during the day. There is also a disturbance in cognitive performance that is significantly altered from one’s usual behavior. Disturbances in attention are often manifested as difficulty sustaining, shifting, or focusing attention. Additionally, an individual experiencing an episode of delirium will have a disruption in cognition, including confusion of where they are. Disorganized thinking, incoherent speech, and hallucinations and delusions may also be observed during periods of delirium.
Delirium is associated with increased functional decline and risk of being placed in an institution. That said, most people with delirium recover fully with or without treatment, especially if not elderly, but if undetected or the underlying cause is untreated, it may progress to stupor, coma, seizures, or death (APA, 2022).
Major Neurocognitive Disorder
Individuals with major neurocognitive disorder show a significant decline in both overall cognitive functioning (see the previously listed six domains) as well as the ability to independently meet the demands of daily living such as paying bills, taking medications, or caring for oneself (APA, 2022). While it is not necessary, it is helpful to have documentation of the cognitive decline via neuropsychological testing within a controlled, standardized testing environment. Information from close family members or caregivers is also important in documenting the decline and impairment in areas of functioning.
Within the umbrella of major neurocognitive disorder is dementia, a striking decline in cognition and self-help skills due to a neurocognitive disorder. The DSM-5-TR (APA, 2022) refrained from using this term in diagnostic categories as it is often used to describe the natural decline in degenerative dementias that affect older adults; whereas neurocognitive disorder is the preferred term used to describe conditions affecting younger individuals such as impairment due to traumatic brain injuries or other medical conditions. Therefore, while dementia is accurate in describing those experiencing major neurocognitive disorder due to age, it is not reflective of those experiencing neurocognitive issues secondary to an injury or illness.
Mild Neurocognitive Disorder
Individuals with mild neurocognitive disorder demonstrate a modest decline in one of the listed cognitive domains. The decline in functioning is not as extensive as that seen in major neurocognitive disorder, and the individual does not experience difficulty independently engaging in daily activities. However, they may require assistance or extra time to complete these tasks, particularly if the cognitive decline continues to progress.
It should be noted that the primary difference between major and mild neurocognitive disorder is the severity of the decline and independent functioning. Some argue that the two are earlier and later stages of the same disease process (Blaze, 2013). Conversely, individuals can go from major to mild neurocognitive disorder following recovery from a stroke or traumatic brain injury (Petersen, 2011). The DSM-5-TR describes major and mild NCD as existing on a spectrum of cognitive and functional impairment (APA, 2022, pg. 685).
Key Takeaways
You should have learned the following in this section:
• The criteria for the various NCDs are based on the cognitive domains of complex attention, executive function, learning and memory, language, perceptual-motor, and social cognition.
• Delirium is characterized by a notable disturbance in attention or awareness and cognitive performance that is significantly altered from one’s usual behavior.
• Major neurocognitive disorder is characterized by a significant decline in both overall cognitive functioning as well as the ability to independently meet the demands of daily living.
• Mild neurocognitive disorder is characterized by a modest decline in one of the listed cognitive areas with no interference in one’s ability to complete daily activities.
Review Questions
1. What are the six cognitive domains the diagnostic criteria for NCDs are based on?
2. Define delirium. How does this differ from mild and major neurocognitive disorders?
3. What are the main differences between mild and major neurocognitive disorders?
14.02: Neurocognitive Disorders - Epidemiolo
Learning Objectives
• Describe the epidemiology of neurocognitive disorders.
Delirium
The prevalence of delirium in the general community is relatively low at 1% to 2% based on data from the United States and Finland. For older individuals presenting to North American emergency departments, the rate is 8% to 17%. Prevalence rates for those admitted to the hospital range from 18% to 35%. For those in nursing homes or post-acute care settings prevalence is 20 to 22% and 88% for individuals with terminal illnesses at the end of life. Prevalence rates are lower for younger African Americans compared to White individuals of similar age.
Major and Mild NCD
Major and mild neurocognitive disorder prevalence rates vary widely depending on the etiological nature of the disorder and overall prevalence estimates are generally only available for older populations. Internationally, dementia occurs in 1-2% of individuals at age 65, and up to 30% of individuals by age 85. The female gender is associated with higher prevalence of dementia overall. Estimates for mild NCD among older individuals range from 2% to 10% at age 65 and 5% to 25% at age 85. In the U.S., incidence is highest in African Americans followed by American Indians/Alaska Natives, Latinx, Pacific Islanders, non-Latinx Whites, and Asian Americans.
Major and Mild NCD Subtypes
Alzheimer’s disease, the most commonly diagnosed neurocognitive disorder, is observed in nearly 5.5 million Americans (Alzheimer’s Association, 2017a), with 11% of those aged 65 and older and 32% older than 85 having dementia due to Alzheimer’s disease. It should also be noted that somewhere between 60-90% of dementias are attributable to Alzheimer’s disease, depending on the setting and diagnostic criteria. In terms of ethnoracial background in the U.S. the highest prevalence rates have been found among African Americans and Latinx of Caribbean origin (APA, 2022).
Over 2.87 million traumatic brain injuries (TBIs) happen each year within the United States, with men being 40% more likely to experience a TBI compared with women. The most common causes of TBI, in order of occurrence, are falls followed by collision with a moving or stationary object, automobile accidents, and assaults. It has also become increasingly recognized that concussion in sport causes mild TBI (APA, 2022).
Key Takeaways
You should have learned the following in this section:
• As individuals age, the rate of occurrence of delirium and dementia increases dramatically.
• Estimates for mild NCD among older individuals range from 2% to 10% at age 65 and 5% to 25% at age 85.
• As for Alzheimer’s disease, prevalence rates are 11% of those aged 65 and older and 32% of those older than 85.
• Men are more likely to experience a TBI than women.
Review Questions
1. What is the rate of occurrence of the neurocognitive disorders? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/06%3A_Part_VI._Mental_Disorders__Block_5/14%3A_Neurocognitive_Disorders/14.01%3A_Neurocognitive_Disorders_-_Clinical_P.txt |
Learning Objectives
• Define degenerative.
• Describe the symptoms and causes of Alzheimer’s disease.
• Describe the symptoms and causes of traumatic brain injury (TBI).
• Describe the symptoms and causes of vascular disorders.
• Describe the symptoms and causes of substance/medication-induced major or mild NCD .
• Describe the symptoms and causes of dementia with Lewy bodies.
• Describe the symptoms and causes of frontotemporal NCD.
• Describe the symptoms and causes of Parkinson’s disease.
• Describe the symptoms and causes of Huntington’s disease.
• Describe the symptoms and causes of HIV infection.
Neurocognitive disorders occur due to a wide variety of medical conditions or injury to the brain. Therefore, this section will focus on a brief description of the nine different etiologies of neurocognitive disorders per the DSM-5-TR (APA, 2022). As you will see, most of these neurocognitive disorders are both degenerative, meaning the symptoms and cognitive deficits become worse over time, as well as related to a medical condition or disease.
Per the DSM-5-TR (APA, 2022), an individual will meet diagnostic criteria for either mild or major neurocognitive disorder as listed above. In order to specify the type of neurocognitive disorder, additional diagnostic criteria specific to one of the following subtypes must be met.
Alzheimer’s Disease
Alzheimer’s disease is the most prevalent neurodegenerative disorder. While the primary symptom of Alzheimer’s disease is the gradual progression of impairment in cognition, it is also important to identify concrete evidence of cognitive decline. This can be done in one of two ways: via genetic testing of the individual or a documented family history of the disease, or, through clear evidence of cognitive decline over time by repeated standardized neuropsychological evaluations (APA, 2022). It is crucial to identify these markers in making the diagnosis of Alzheimer’s disease as some individuals present with memory impairment but eventually show a reversal of symptoms; this is not the case for individuals with Alzheimer’s disease.
14.3.1.1. Causes of Alzheimer’s disease. Autopsies of individuals diagnosed with Alzheimer’s disease identify two abnormal brain structures— beta-amyloid plaques and neurofibrillary tangles— both of which are responsible for neuron death, inflammation, and loss of cellular connections (Lazarov, Mattson, Peterson, Pimplika, & van Praag, 2010). It is believed that beta-amyloid plaques, large bundles of plaque that develop between neurons, appear before the development of dementia symptoms. As these plaque bundles increase in size and number, cognitive symptoms and impaired daily functioning become evident to close family members. Neurofibrillary tangles are believed to appear after the onset of dementia symptoms and are found inside of cells, affecting the protein that helps transport nutrients in healthy cells. Both beta-amyloid plaques and neurofibrillary tangles impact the health of neurons within the hippocampus, amygdala, and the cerebral cortex, areas associated with memory and cognition (Spires-Jones & Hyman, 2014).
Researchers have identified additional genetic and environmental influences in the development of Alzheimer’s disorder. Genetically, the apolipoprotein E (ApoE) gene that helps to eliminate beta-amyloid by-products from the brain, has been implicated in the development of Alzheimer’s disorder. One of the three variants of this gene, the e4 allele, appears to reduce the production of ApoE, thus increasing the number of beta-amyloid plaques within the brain. However, not all individuals with the e4 allele develop Alzheimer’s disease; therefore, this explanation may better explain a vulnerability to Alzheimer’s disease as opposed to the cause of the disease.
Various brain regions have also been implicated in the development of Alzheimer’s disease. More specifically, neurons shrinking or dying within the hypothalamus, thalamus, and the locus ceruleus have been linked to declining cognition (Selkoe, 2011, 1992). Acetylcholine-secreting neurons within the basal forebrain also appear to shrink or die, contributing to Alzheimer’s disease symptoms (Hsu et al., 2015).
Environmental toxins such as high levels of zinc and lead may also contribute to the development of Alzheimer’s disease. More precisely, zinc has been linked to the clumping of beta-amyloid proteins throughout the brain. Although lead has largely been phased out of environmental toxins due to negative health consequences, current elderly individuals were exposed to these toxic levels of lead in gasoline and paint as young children. There is some speculation that lead and other pollutants may impact cognitive functioning in older adults (Richardson et al., 2014).
14.3.1.2. Onset of Alzheimer’s disease. Alzheimer’s disease is defined by the onset of symptoms. Early-onset Alzheimer’s disease occurs before the age of 65. While only a small percentage of individuals experience early onset of the disease, those that do experience early disease progression appear to have a more genetically influenced condition and a higher rate of family members with the disease.
Late-onset Alzheimer’s disease occurs after the age of 65 and has less of a familial influence. This onset appears to occur due to a combination of biological, environmental, and lifestyle factors (Chin-Chan, Navarro-Yepes, & Quintanilla-Vega, 2015). Nearly 30% of individuals within this class of diagnosis have the ApoE gene that fails to eliminate the beta-amyloid proteins from various brain structures. It is believed that the combination of the presence of this gene along with environmental toxins and lifestyle choices (i.e., more stress) impact the development of Alzheimer’s disease.
Traumatic Brain Injury (TBI)
TBIs occur when an individual experiences significant trauma or damage to the head. Neurocognitive disorder due to TBI is diagnosed when persistent cognitive impairment is observed immediately following the head injury, along with one or more of the following symptoms: loss of consciousness, posttraumatic amnesia, disorientation and confusion, or neurological impairment (APA, 2022).
The presentation of symptoms varies among individuals and depends largely on the location of the injury and the intensity of the trauma. Furthermore, the effects of a TBI can be temporary or permanent. Symptoms generally range from headaches, disorientation, confusion, irritability, fatigue, poor concentration, and emotional and behavioral changes. More severe injuries can result in more significant neurological symptoms such as seizures, paralysis, and visual disturbances.
Major or mild NCD due to TBI may be comorbid with specified or unspecified depressive, anxiety, or personality disorders and PTSD. Rates of suicidal ideation are as high as 10% with rates of suicide attempt hovering around 0.8% to 1.7% (APA, 2022).
The most common type of TBI is a concussion. A concussion occurs when there is a significant blow to the head, followed by changes in brain functioning. It often causes immediate disorientation or loss of consciousness, along with headaches, dizziness, nausea, and sensitivity to light (Alla, Sullivan, & McCrory, 2012). While symptoms of a concussion are usually temporary, there can be more permanent damage due to repeated concussions, particularly if they are close in time. The media has brought considerable attention to this with the recent discussions of chronic traumatic encephalopathy (CTE) which is a progressive, degenerative condition due to repeated head trauma. CTEs are most commonly seen in athletes (i.e., football players) and military personnel (Baugh et al., 2012). In addition to the neurological symptoms, psychological symptoms such as depression and poor impulse control have been observed in individuals with CTE. These individuals also appear to be at greater risk for the development of dementia (McKee et al., 2013).
Vascular Disorders
Neurocognitive disorders due to vascular disorders can occur from a one-time event such as a stroke or ongoing subtle disruptions of blood flow within the brain (APA, 2022). The occurrence of these vascular disorders general begins with atherosclerosis, or the clogging of arteries due to a build-up of plaque. The plaque builds up over time, eventually causing the artery to narrow, thus reducing the amount of blood able to pass through to other parts of the body. When these arteries within the brain become entirely obstructed, a stroke occurs. The lack of blood flow during a stroke results in the death of neurons and loss of brain function. There are two types of strokes—a hemorrhagic stroke that occurs when a blood vessel bursts within the brain and an ischemic stroke, which is when a blood clot blocks the blood flow in an artery within the brain (American Stroke Association, 2017).
While strokes can occur at any age, the majority of strokes occur after age 65 (Hall, Levant, & DeFrances, 2012). A wide range of cognitive, behavioral, and emotional changes occur following a stroke. Symptoms are generally dependent on the location of the stroke within the brain as well as the extensiveness of damage to those brain regions (Poels et al., 2012). For example, strokes that occur on the left side of the brain tend to cause problems with speech and language, as well as physical movement on the right side of the body; whereas strokes that occur on the right side of the brain tend to cause problems with impulsivity and impaired judgement, short-term memory loss, and physical movement on the left side of the body (Hedna et al., 2013).
After Alzheimer’s disease, vascular disease is the second most common cause of NCD and population prevalence estimates are 0.98% for those between the ages of 71-79 years, 4.09% for individuals aged 80-89 years, and 6.19% for those aged 90 years and up. Within three months of a stroke, 20%-30% of people are diagnosed with dementia. Finally, stroke is more common in men up to age 65 and after that, it shifts to women. Vascular disease is frequently comorbid with major or mild NCD due to Alzheimer’s disease and depression.
Substance/Medication-Induced Major or Mild NCD
Significant cognitive changes occur due to repetitive drug and alcohol abuse. Delirium can be observed in individuals with extreme substance intoxication, withdrawal, or even when multiple substances have been used within a close period (APA, 2022). While delirium symptoms are often transient during these states, mild neurocognitive impairment due to heavy substance abuse may remain until a significant period of abstinence is observed (Stavro, Pelletier, & Potvin, 2013).
Dementia with Lewy Bodies
Symptoms associated with neurocognitive disorder due to Lewy bodies include significant fluctuations in attention and alertness; recurrent visual hallucinations; impaired mobility; and sleep disturbances such as rapid eye movement sleep behavior disorder (APA, 2022). While the trajectory of the illness develops more rapidly than Alzheimer’s disease, the survival period is similar in that most individuals do not survive longer than eight years post-diagnosis (Lewy Body Dementia Association, 2017).
Lewy bodies are irregular brain cells that result from the buildup of abnormal proteins in the nuclei of neurons. These brain cells deplete the cortex of acetylcholine, which causes the behavioral and cognitive symptoms observed in both dementia with Lewy bodies and Parkinson’s disease. The motor symptoms seen in both these disorders occur from the depletion of dopamine by the Lewy body nerve cells that accumulate in the brain stem.
Major or Mild Frontotemporal NCD
Frontotemporal NCD causes “progressive development of behavioral and personality change and/or language impairment” (APA, 2022, pg. 696). For the behavioral variant, individuals display at least three of the following: behavioral disinhibition, apathy or inertia, loss of sympathy or empathy, preservative or compulsive behavior, or hyperorality and dietary changes. For the language variant, they show prominent decline in language ability (i.e., speech production, word finding, object naming, grammar, or word comprehension). There is relative sparing of learning and memory and perceptual-motor functioning. Individuals with frontotemporal NCD commonly present in their 50s though the age of onset has a range of age 20 to 80 years. The median survival is 6-11 years after symptom onset and 3-4 years after diagnosis (APA, 2022).
Parkinson’s Disease
The awareness of Parkinson’s disease has increased in recent years due in large part to Michael J. Fox’s early diagnosis in 1991. It affects approximately 630,000 individuals (Kowal, Dall, Chakrabarti, Storm, & Jain, 2013). While many are aware of the tremors of hands, arms, legs, and face, the other three main symptoms of Parkinson’s disease are rigidity of the limbs and trunk; slowness in initiating movement; and drooping posture or impaired balance and coordination (National Institute of Neurological Disorders and Stroke, 2017). These motor symptoms are generally present at least one year prior to the beginning of cognitive decline, although severity and progression of symptoms vary significantly from person to person.
Onset of Parkinson’s disease is typically from age 50 to 89 years. Mild NCD develops early in the course of Parkinson’s disease while Major NCD does not occur until individuals are much older. The prevalence of Parkinson’s disease in the U.S. increases with age and is more common in men than women. The disease is comorbid with Alzheimer’s disease and cerebrovascular disease. Depression, psychosis, REM sleep behavior disorder, apathy, and motor symptoms can make functional impairment worse (APA, 2022).
Huntington’s Disease
Huntington’s disease is a rare genetic disorder that involves involuntary movement, progressive dementia, and emotional instability. Due to the degenerative nature of the disorder, there is a shortened life-expectancy as death typically occurs 15-20 years post-onset of symptoms (Clabough, 2013). Although symptoms can present at any time, the average age of symptom presentation is during middle adulthood (between ages 35 and 45 years; APA, 2022). Symptoms generally begin with neurocognitive decline, particularly in executive function, along with changes in mood and personality. As symptoms progress, more physical symptoms present, such as facial grimaces, difficulty speaking, and repetitive movements. Because there is no treatment for Huntington’s disease, the severity of the cognitive and physical impairments ultimately leads to complete dependency and the need for full-time care. Suicide is among the leading causes of death in Huntington’s disease (APA, 2022).
HIV Infection
Not many people are aware that cognitive impairment is sometimes the first symptom of untreated HIV. While symptoms vary among individuals, slower mental processing, impaired executive function, problems with more demanding attentional tasks, and difficulty learning new information are among the most common early signs (APA, 2022). When HIV becomes active in the brain, significant alterations of mental processes occur, thus leading to a diagnosis of neurocognitive disorder due to HIV infection. Significant impairment can also occur due to HIV-infection related inflammation throughout the central nervous system.
Fortunately, antiretroviral therapies used in treating HIV have been effective in reducing and preventing the onset of severe cognitive impairments; however, HIV-related brain changes still occur in nearly half of all patients on antiretroviral medication. There is hope that once antiretroviral therapies can cross the blood-brain barrier in the central nervous system, there will be a significant improvement in the prevalence of HIV-related neurocognitive disorder (Vassallo et al., 2014).
Key Takeaways
You should have learned the following in this section:
• Most neurocognitive disorders are degenerative meaning they become worse over time.
• Alzheimer’s disease is characterized by the gradual progression of impairment in cognition as well as the presence of beta-amyloid plaques and neurofibrillary tangles.
• TBIs occur when an individual experiences significant trauma or damage to the head with the most common type being a concussion.
• Vascular disorders generally begin with atherosclerosis which leads to a stroke.
• Significant cognitive changes occur due to repetitive drug and alcohol abuse such as delirium.
• Dementia with Lewy bodies is characterized by significant fluctuations in attention and alertness; recurrent visual hallucinations; impaired mobility; and sleep disturbance.
• Frontotemporal NCD causes progressive declines in language or behavior due to the degeneration in the frontal and temporal lobes of the brain.
• Parkinson’s disease is characterized by tremors of hands, arms, legs, or face; rigidity of the limbs and trunk; slowness in initiating movement; and drooping posture or impaired balance and coordination.
• Huntington’s disease involves involuntary movement, progressive dementia, and emotional instability.
• HIV infection begins with slower mental processing, impaired executive function, problems with more demanding attentional tasks, and difficulty learning new information.
Review Questions
1. Define degenerative. What disorders discussed in this module are considered degenerative?
2. Identify the biological causes of Alzheimer’s disease.
3. What is a TBI?
4. How do vascular disorders occur?
5. What are Lewy bodies? How does dementia with Lewy bodies differ from Alzheimer’s disease?
6. What are the main symptoms of Parkinson’s disease? Huntington’s disease? | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/06%3A_Part_VI._Mental_Disorders__Block_5/14%3A_Neurocognitive_Disorders/14.03%3A_Neurocognitive_Disorders_-_Etiology.txt |
Learning Objectives
• Describe treatment options for neurocognitive disorders.
Treatment options for those with neurocognitive disorders are minimal at best, with most attempting to treat secondary symptoms as opposed to the neurocognitive disorder itself. Furthermore, the degenerative nature of these disorders also makes it difficult to treat, as many diseases will progress regardless of the treatment options.
Pharmacological
Pharmacological interventions, and more specifically medications designed to target acetylcholine and glutamate, have been the most effective treatment options in alleviating symptoms and reducing the speed of cognitive decline within individuals diagnosed with Alzheimer’s disease. Specific medications such as donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne), and memantine (Namenda) are among the most commonly prescribed (Alzheimer’s Association, 2017a). Due to possible negative side effects of the medications, these drugs are prescribed to individuals in the early or middle stages of Alzheimer’s as opposed to those with advanced disease. Researchers have also explored treatment options aimed at preventing the build-up of beta-amyloid and neurofibrillary tangles; however, this research is still in its infancy (Alzheimer’s Association, 2017a)
Parkinson’s disease has also found success in pharmacological treatment options. The medication levodopa increases dopamine availability, which provides relief of both physical and cognitive symptoms. Unfortunately, there are also significant side effects such as hallucinations and psychotic symptoms; therefore, the medication is often only used when the benefits outweigh the negatives of the potential risks (Poletti & Bonuccelli, 2013).
Psychological
Among the most effective psychological treatment options for individuals with neurocognitive disorders are the use of cognitive and behavioral strategies. More specifically, engaging in various cognitive activities such as computer-based cognitive stimulation programs, reading books, and following the news, have been identified as effective strategies in preventing or delaying the onset of Alzheimer’s disease (Szalavits, 2013; Wilson, Segawa, Boyle, & Bennett, 2012).
Engaging in social skills and self-care training are additional behavioral strategies used to help improve functioning in individuals with neurocognitive deficits. For example, by breaking down complex tasks into smaller, more attainable goals, as well as simplifying the environment (i.e., labeling location of items, removing clutter), individuals can successfully engage in more independent living activities.
Support for Caregivers
Supporting caregivers is an important treatment option to include as the emotional and physical toll on caring for an individual with a neurocognitive disorder is often underestimated. According to the Alzheimer’s Association (2017b), nearly 90% of all individuals with Alzheimer’s disease are cared for by a relative. The emotional and physical demands on caring for a family member who continues to decline cognitively and physically can lead to increased anger and depression in a caregiver (Kang et al. 2014). It is important that medical providers routinely assess caregivers’ psychosocial functioning, and encourage caregivers to participate in caregiver support groups, or individual psychotherapy to address their own emotional needs.
Key Takeaways
You should have learned the following in this section:
• Pharmacological interventions for Alzheimer’s disease target the neurotransmitters acetylcholine and glutamate and newer research is focused on the build-up of beta-amyloid and neurofibrillary tangles.
• Psychological treatments include cognitive and behavioral strategies such as playing board games, reading books, or social skills training.
• Caregivers need to join support groups to help them manage their own anger and depression, especially since 90% of such caregivers are relatives of the afflicted.
Review Questions
1. Review the listed treatment options for neurocognitive disorders. What are the main goals of these treatments?
Module Recap
Our discussion in Module 14 turned to neurocognitive disorders to include the categories of delirium, major neurocognitive disorder, and Mild neurocognitive disorder. We also discussed the subtypes of Alzheimer’s disease, traumatic brain injury (TBI), vascular disorder, substance/medication induced, dementia with Lewy bodies, frontotemporal NCD, Parkinson’s disease, Huntington’s disease, and HIV infection. The clinical description, epidemiology, etiology, and treatment options for neurocognitive disorders were discussed. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/06%3A_Part_VI._Mental_Disorders__Block_5/14%3A_Neurocognitive_Disorders/14.04%3A_Neurocognitive_Disorders_-_Treatment.txt |
Learning Objectives
• Describe how clinical psychology interacts with law.
• Describe issues related to civil commitment.
• Describe issues related to criminal commitment.
• Outline patient’s rights.
• Clarify concerns related to the therapist-client relationship.
In our final module, we will tackle the issue of how clinical psychology interacts with law. Our discussion will include topics related to civil and criminal commitment, patient’s rights, and the patient-therapist relationship. We end on an interesting note and discuss whether gaming can be addictive. Enjoy.
15: Contemporary Issues in Psychopathology
Learning Objectives
• Define forensic psychology/psychiatry.
• Describe potential roles a forensic psychologist might have.
• Define civil commitment.
• Identify criteria for civil commitment.
• Describe dangerousness.
• Outline procedures in civil commitment.
• Define criminal commitment.
• Define NGRI.
• Describe pivotal rules/acts/etc. in relation to the concept of insanity.
• Define GBMI.
• Clarify what it means to be competent to stand trial.
Forensic Psychology/Psychiatry
According to the American Psychological Association, forensic psychology/psychiatry is when clinical psychology is applied to the legal arena in terms of assessment, treatment, and evaluation. Forensic psychology can also include the application of research from other subfields in psychology to include cognitive and social psychology. Training includes law and forensic psychology, and solid clinical skills are a must. According to APA, a forensic psychologist might “perform such tasks as threat assessment for schools, child custody evaluations, competency evaluations of criminal defendants and of the elderly, counseling services to victims of crime, death notification procedures, screening and selection of law enforcement applicants, the assessment of post-traumatic stress disorder and the delivery and evaluation of intervention and treatment programs for juvenile and adult offenders.” A key issue investigated by forensic psychologists includes mens rea or the insanity plea. We will discuss this shortly.
To learn more about forensic psychology, or to investigate the article mentioned above, please visit:
www.apa.org/ed/precollege/psn/2013/09/forensic-psychology.aspx
Civil Commitment
15.1.2.1. What is civil commitment? When individuals with mental illness behave in erratic or potentially dangerous ways, to either themselves or others, then something must be done. The responsibility to act falls on the government through what is called parens patriae or “father of the country” or “country as parent.” Action, in this case, involves involuntary commitment in a hospital or mental health facility and is done to protect the individual and express concern over their well-being, much like a parent would do for their child. An individual can voluntarily admit themselves to a mental health facility, and upon doing so, staff will determine whether treatment and extended stay are needed.
15.1.2.2. Criteria for civil commitment. Though states vary in the criteria used to establish the need for civil commitment, some requirements are common across states. First, the individual must present a clear danger to either themselves or others. Second, the individual demonstrates that they are unable to care for themself or make decisions about whether treatment or hospitalization is necessary. Finally, the individual believes they are about to lose control, and so, needs treatment or care in a mental health facility.
15.1.2.3. Assessment of “dangerousness.” Dangerousness can best be defined as the person’s capacity or likelihood of harming themselves or others. Most people believe that those who are mentally ill are more dangerous than those free of mental illness, especially when espousing self-reported conservatism and RWA (Right-Wing Authoritarianism; Gonzales, Chan, and Yanos, 2017; DeLuca and Yanos, 2015) or after tragic events such as a mass shooting (Metzl & MacLeish, 2015). The media plays a role in this, and as McGinty et al. (2014) found, 70% of news coverage of serious mental illness (SMI) and gun violence over a 16-year period (1997 to 2012) focused on extreme events and described specific shootings by persons with SMI. The authors wrote, “Even in thematic news coverage focused on describing the general problem of SMI and gun violence, the majority of news stories did not mention that most people with SMI are not violent or that we lack tools capable of accurately identifying persons with SMI who are at heightened risk of committing future violence.” They concluded that media coverage of persons with SMI as violent might contribute to negative public attitudes.
Rozel & Mulvey (2017) showed that mental illness is a weak risk factor for violence though this is not to say that the mentally ill do not commit violent acts. The authors write, “…it has been documented repeatedly that people who report diagnosable levels of psychiatric symptoms also report more involvement in acts of violence toward others than the general population reports.” Approximately 4% of criminal violence can be attributed to the mentally ill (Metzl & MacLeish, 2015), while those with mental illness are three times more likely to be targets and not perpetrators of violence (Choe et al., 2008).
Regardless of this, we do attempt to identify the level of dangerousness a person may exhibit or have the potential to exhibit. How easy is it to make this prediction? As you might think, it can be very difficult. First, the definition of dangerousness is vague. It implies physical harm, but what about psychological abuse or the destruction of property? Second, past criminal activity is a good predictor of future dangerousness but is often not admissible in court. Third, context is critical; in some situations, the person is perfectly fine, but in other circumstances, like having to wait in line at your local Department of Motor Vehicles, the person experiences considerable frustration and eventually anger or rage.
15.1.2.4. Procedures in civil commitment. The process for civil commitment does vary somewhat state-to-state, but some procedures are held in common. First, a family member, mental health professional, or primary care practitioner, may request that the court order an examination of an individual. If the judge agrees, two professionals, such as a mental health professional or physician, are appointed to examine the person in terms of their ability for self-care, need for treatment, psychological condition, and likelihood to inflict harm on self or others. Next, a formal hearing gives the examiners a chance to testify as to what they found. Testimonials may also be provided by family and friends, or by the individual him/herself. Once testimonies conclude, the judge renders judgment about whether confinement is necessary and, if so, for how long. Typical confinements last from 6 months to 1 year, but an indefinite period can be specified too. In the latter case, the individual has periodic reviews and assessments. In emergencies, the process stated above can be skipped and short-term commitment made, especially if the person is an imminent threat to themself or others.
Before we move on, consider for a minute that a person who is accused of a crime is innocent until proven guilty, has a trial, and if found guilty beyond a reasonable doubt (or almost complete certainty) is only then incarcerated. This is not true for the mentally ill, who may be committed to a facility without ever having committed a crime or having a trial, but simply because they were judged as having the potential to do so (or was seen as dangerous). This potential means that there must be “clear and convincing” proof, which the U.S. Supreme Court defines as 75% certainty. The standard to commit is much different for those accused of criminal acts and those who are mentally ill.
Criminal Commitment
When people are accused of crimes but found to be mentally unstable, they are usually sent to a mental health institution for treatment. This is called criminal commitment. Individuals may plead not guilty by reason of insanity (NGRI) or as it is also called, the insanity plea. When a defendant pleads NGRI they are acknowledging their guilt for the crime (actus rea) but wish to be seen as not guilty since they were mentally ill at the time (mens rea).
The origins of the modern definition of insanity go back to Daniel M’Naghten in 1843 England. He murdered the secretary to British Prime Minister, Robert Peel, during an attempted assassination of the Prime Minister. He was found to be not guilty due to delusions of persecution, which outraged the public and led to calls for a more precise definition of insanity. The M’Naghten rule states that having a mental disorder at the time of a crime does not mean the person was insane. The individual also had to be unable to know right from wrong or comprehend the act as wrong. But how do you know what the person’s level of awareness was when the crime was committed?
Dissatisfaction with the M’Haghten rule led some state and federal courts in the U.S. to adopt instead the irresistible impulse test (1887), which focused on the inability of a person to control their behaviors. The issue with this rule is in distinguishing when a person is unable to maintain control rather than choosing not to exert control over their behavior. This meant there were two choices in the U.S. in terms of how insanity was defined – the M’Haghten rule and the irresistible impulse test. A third test emerged in 1954 from the Durham v. United States case, though it was short-lived. The Durham test, or products test, stated that a person was not criminally responsible if their crime was a product of a mental illness or defect. It offered some degree of flexibility for the courts but was viewed as too flexible. Since almost anything can cause something else, the term product is too vague.
In 1962, the American Law Institute (ALI) offered a compromise to the three precepts in use at the time. The American Law Institute standard stated that people are not criminally responsible for their actions if, at the time of their crime, they had a mental disorder or defect that did not allow them to distinguish right from wrong and to obey the law. Though this became the standard, it also became controversial when defense attorneys used it as the basis to have John Hinckley, accused of attempting to assassinate President Ronald Regan, found not guilty by reason of insanity in 1982.
Public uproar led the American Psychiatric Association to reiterate the stance of the M’Naghten test and assert people were only insane if they did not know right from wrong when they committed their crime. The Federal Insanity Defense Reform ACT (IDRA) of 1984 “was the first comprehensive federal legislation governing the insanity defense and the disposition of individuals suffering from a mental disease or defect who are involved in the criminal justice system.” The ACT included the following provisions:
• significantly modified the standard for insanity previously applied in the federal courts
• placed the burden of proof on the defendant to establish the defense by clear and convincing evidence
• limited the scope of expert testimony on ultimate legal issues
• eliminated the defense of diminished capacity, created a special verdict of “not guilty only by reason of insanity,” which triggers a commitment proceeding
• provided for federal commitment of persons who become insane after having been found guilty or while serving a federal prison sentence.
Source: https://www.justice.gov/usam/criminal-resource-manual-634-insanity-defense-reform-act-1984
This is the current standard in all federal courts and about half of all state courts, with Idaho, Kansas, Montana, and Utah choosing to get rid of the insanity plea altogether.
For more on the insanity plea, please visit:
https://www.npr.org/sections/health-shots/2016/08/05/487909967/with-no-insanity-defense-seriously-ill-people-end-up-in-prison
Another possibility is for the jury to deliver a verdict of guilty but mentally ill (GBMI), effectively acknowledging that the person did have a mental disorder when committing a crime, but the illness was not responsible for the crime itself. The jurors can then convict the accused and suggest they receive treatment. Though this looks like an excellent alternative, jurors are often confused by it (Melville & Naimark, 2002), NGRI verdicts have not been reduced, and all prisoners have access to mental health care anyway. Hence it differs from a guilty verdict in name only (Slovenko, 2011; 2009).
A final concept critical to this discussion is whether the defendant is competent to stand trial and refers to the accused’s mental state at the time of psychiatric examination after arrest and before going to trial. To be deemed competent, federal law dictates that the defendant must have a rational and factual understanding of the proceedings and be able to rationally consult with counsel when presenting their defense (Mossman et al., 2007; Fitch, 2007). This condition guarantees criminal and civil rights and ensures the accused understands what is going on during the trial and can aid in their defense. If they are not fit or competent, then they can be hospitalized until their mental state improves.
Key Takeaways
You should have learned the following in this section:
• Forensic psychology is when clinical psychology is applied to the legal arena in terms of assessment, treatment, and evaluation, though it can include research from other subfields to include cognitive and social psychology.
• Civil commitment occurs when a person acts in potentially dangerous ways to themselves or others and can be initiated by the person or the government.
• Dangerousness is defined as the person’s capacity of harming themselves or others and implies physical harm but not necessarily psychological abuse or the destruction of property.
• Criminal commitment occurs when a person is accused of a crime but found to be mentally unstable.
• Several rules or tests have been attempted to determine if a person is responsible for their actions at the time a crime was committed. These include the M’Naghten rule, irresistible impulse test, Durham test, and the American Law Institute standard.
Review Questions
1. Describe the subfield of forensic psychology.
2. What is civil commitment and what criteria is used when establishing its need?
3. What does the concept of dangerousness mean?
4. What is criminal commitment?
5. Outline the various rules/tests used to determine if someone is responsible for their actions at the time of a crime.
6. Contrast the insanity plea with the concept of being competent to stand trial. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/06%3A_Part_VI._Mental_Disorders__Block_5/15%3A_Contemporary_Issues_in_Psychopathology/15.01%3A_Legal_Issues_Related_to.txt |
Learning Objectives
• Describe rights patients with mental illness have and identify key court cases.
The following are several rights that patients with mental illness have. They include:
• Right to Treatment – In the 1966 case of Rouse v. Cameron, the D.C. District court said that the right to treatment is a constitutional right, and failure to provide resources cannot be justified due to insufficient resources. In the 1972 case of Wyatt v. Stickney, a federal court ruled that the state of Alabama was constitutionally obligated to provide all people who were committed to institutions with adequate treatment and had to offer more therapists, privacy, exercise, social interactions, and better living conditions for patients. In the case of O’Connor v. Donaldson (1975), the court ruled that patient’s cases had to be reviewed periodically to see if they could be released. As well, if they are not a danger and are able to survive on their own or with help from family or friends, that they be released.
• Right to Refuse Treatment – As patients have the right to request treatment, they too have the right to refuse treatment such as biological treatment, psychotropic medications (Riggins v. Nevada, 1992), and electroconvulsive therapy.
• Right to Less Restrictive Treatment – In Dixon v. Weinberger (1975), a U.S. District Court ruled that individuals have a right to receive treatment in facilities less restrictive than mental institutions. The only patients who can be committed to hospitals are those unable to care for themselves.
• Right to Live in a Community – The 1974 U.S. District Court case, Staff v. Miller, ruled that state mental hospital patients had a right to live in adult homes in their communities.
Key Takeaways
You should have learned the following in this section:
• Patients with a mental illness have a right to treatment, to refuse treatment, to have less restrictive treatment, and to live in a community.
Review Questions
1. What rights do patients with mental illness have and what court cases were pivotal to their establishment?
15.03: The Therapist-Client Re
Learning Objectives
• Describe three concerns related to the therapist-client relationship.
Three concerns are of paramount importance in terms of the therapist-client relationship. These include the following:
• Confidentiality – As you might have learned in your introductory psychology course, confidentiality guarantees that information about you is not disseminated without your consent. This applies to students participating in research studies as well as patients seeing a therapist.
• Privileged communication – Confidentiality is an ethical principle while privileged communication is a legal one, and states that confidential communications cannot be disseminated without the patient’s permission. There are a few exceptions to this which include the client being younger than 16, when they are a dependent elderly person and a victim of a crime, or when the patient is a danger to him or herself or others, to name a few.
• Duty to Warn – In the 1976 Tarasoff v. the Board of Regents of the University of California ruling, the California Supreme Court said that a patient’s right to confidentiality ends when there is a danger to the public, and that if a therapist determines that such a danger exists, they are obligated to warn the potential victim. Tatiana Tarasoff, a student at UC, was stabbed to death by graduate student, Prosenjit Poddar in 1969, when she rejected his romantic overtures, and despite warnings by Poddar’s therapist that he was an imminent threat. The case highlights the fact that therapists have a legal and ethical obligation to their clients but, at the same time, a legal obligation to society. How exactly should they balance these competing obligations, especially when they are vague? The 1980 case of Thompson v. County of Alameda ruled that a therapist does not have a duty to warn if the threat is nonspecific.
Key Takeaways
You should have learned the following in this section:
• There are three concerns which are important where the therapist-client relationship is concerned – confidentiality, privileged communication, and the duty to warn.
Review Questions
1. What are the three concerns related to the therapist-client relationship? Describe each and state any relevant court rulings relevant to them.
Check This Out
Can you play video games so much, that it becomes addictive? Does this mean that it is a diagnosable mental illness to be listed in the DSM 5-TR? Currently, the disorder is only listed in the DSM 5-TR as a condition for further study and is called internet gaming disorder. It is thought to include symptoms such as:
• Preoccupation with Internet games
• Withdrawal symptoms when not playing Internet games
• The person has tried to stop or curb playing Internet games, but has failed to do so
• The need to spend increasing amounts of time engage in Internet gaming
• A person has had continued overuse of Internet games even with the knowledge of how much they impact a person’s life
• The person uses Internet games to relieve anxiety or guilt or to escape
• Loss of interests in previous hobbies and entertainment except for internet gaming
Interestingly, the DSM-5-TR says the mean prevalence of 12-month Internet gaming disorder is approximately 4.7% across multiple countries and is similar in Asian and Western countries. It is more common in males than females. It is comorbid with major depressive disorder, OCD, and ADHD.
And, the ICD now includes gaming disorder in its 11th edition.
For more on this “disorder,” check out the following articles:
What do you think?
Module Recap
And that’s it. Our final module explored some concepts that transcend any one mental disorder but affect people with mental illness in general. This included civil and criminal commitment and issues such as NGRI or the insanity plea, what makes someone dangerous and what we should do about it, and determining competency to stand trial. We then moved to patient rights, such as the right to treatment and, conversely, the right to refuse treatment. Finally, we ended by discussing the patient-therapist relationship and specifically, when the patient’s right to confidentiality and privileged communication ends, and the therapist has a moral and legal obligation to warn. We hope you find these topics interesting and explore the issues further through the links that were provided and peer-reviewed articles that were cited. | textbooks/socialsci/Psychology/Psychological_Disorders/Fundamentals_of_Psychological_Disorders_3e_(Bridley_and_Daffin)/06%3A_Part_VI._Mental_Disorders__Block_5/15%3A_Contemporary_Issues_in_Psychopathology/15.02%3A_Patients_Rights.txt |
“Not everything that is faced can be changed, but nothing can be changed until it is faced”
- James Baldwin
Higher education is a place where many of us call home. It has opened our minds, given us valuable life lessons, led to pathways that have been transformative, and given us hope for a better tomorrow. It is truly a place where magic happens. It is also a product of the larger social structure and as such rife with a shameful past and problematic present that cannot go unnamed. Structural racism has shaped all social institutions in the creation of these United States. A legacy of disparity that has existed since its founding must be acknowledged in order to progress towards dismantling structures that have perpetuated ongoing discrimination and inequality. Decades of historical whitewashing and pretending lived opportunities are equal for everyone has led to a boiling point which has once again exposed the massive inequalities we face as a culture. Although the criminalization and targeting of young Black men are definitely not new, with the increase in social media, the ongoing police murders of unarmed Black people in the US, coupled with a global pandemic,have seemingly ignited a new flame of anger in some individuals and a resolve to create a more perfect union.
Higher Education was built to serve wealthy white men (The lin, et al. 2021). It was not originally intended to educate the masses nor to create a level playing field with upward social mobility for everyone. Structural racism in the form of Anti-literacy laws like the Alabama Slave Code of 1833 denied Black Americans access to reading and writing (Literacy as Freedom, n.d.).Despite this, enslaved Africans taught themselves to read and write in the dark of night, all the while knowing if they were caught by their white enslavers there would be violent repercussions including death and dismemberment (Cornelius, 1983).
This unfortunate truth is something we do not often discuss in the halls of higher education. Instead, we imagine that we have simply moved on from or are above issues surrounding racial and gender biases and that we are the good guys so to speak. While these efforts may be well intentioned, we are in desperate need of some truth telling. The goal of this Open Educational Resource (OER) is to briefly introduce the reader to the role structural racism plays in each of the academic disciplines discussed throughout it, with the caveat that there is much more to tell.The goal of this book is not to tell the whole story, merely to invite further investigation, as a primer is intended to do. It is also not meant to serve as an introduction to each discipline. There have been a multitude of books dedicated to that purpose and we imagine as subject area experts that would be the role of the reader. We will briefly define each discipline and move into a sampling of the impact structural racism has had on that specific area. We hope the reader will take it upon themselves in a true OER philosophical approach to build on, remix and reuse this content to serve their educational needs (Butcher, 2011). This is by no means meant to be all encompassing as we cannot claim that authority, nor is there space here to do so. While much of this book is historical, it also looks at present day effects and sadly, incidents of individual and structural racism that are still happening today. In some cases we also highlight great thinkers of color, LGBTQIA+, or women who were overlooked, or ways in which individual academic fields are confronting this historical legacy in hopes of changing it. Unfortunately, for now it seems that structural racism in academia will continue to occur long after this book is published. However, we hope that with this potentially new knowledge, a push for policy changes, and a recognition of the value of different perspectives and ways of thinking a truly inclusive higher educational system in the United States can soon be realized. As this is an Open Educational Resource (OER) it is available free of charge and the reader is welcome to reuse, retain, revise, remix and redistribute as they see fit. We hope this primer serves as an opportunity to take a deeper dive into various academic disciplines and explore how higher education excluded some groups and individuals who sought an opportunity to be included.
As the reader examines their respective sections, certain content and information may seem like common knowledge depending on each individual’s educational background.However, we believe that knowing the historical development of your chosen field and its failure to be inclusive matters. Placing ourselves as individuals into the field of study can also in your field of expertise dictates or informs the information and content you provide to your students. Do they understand the implications of an unlevel playing field? If the answer is no,we challenge you to reflect on why it is omitted from what is otherwise most likely an outstanding course. We believe that students might appreciate this level of transparency, and the opportunity for innovation within academic courses or classrooms is only strengthened by honest discourse. Great social change, technological discoveries, and policy shifts are often born in the classroom. “The classroom remains the most radical space of possibility in the academy” (hooks, 1994,12). The role of the teacher in the classroom and beyond can be one that excites and encourages critical thinking and a love of learning.
If it is hard to conceptualize how this information may be inserted into your course or if you are questioning whether or not you are capable of doing a good job teaching it, please reach out to people on your campus who are doing diversity, equity and inclusion (DEI) work.There are various resources dedicated to helping faculty teach difficult topics that can help create an effective pedagogical model.
As previously mentioned, this reader is being put together during a time of great social upheaval. We are in the midst of a global pandemic the likes of which most people currently living have not experienced. We have been required to adjust much of our lives and the suffering and ever changing landscape has not left anyone untouched. However, people of color have been especially hit hard as the pandemic has further highlighted the structural racism in areas like healthcare, politics, and education (Maxwell, & Solomon, 2020). Structural racism goes beyond individual prejudice. As defined by the Aspen Institute, structural racism is:
a system in which public policies, institutional practices,cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity. It identifies dimensions of our history and culture that have allowed privileges associated with“whiteness” and disadvantages associated with “color” to endure and adapt over time. Structural racism is not something that a few people or institutions choose to practice. Instead it has been a feature of the social,economic and political systems in which we all exist (The Aspen Institute, 2016).
As a feature of social structure, racism at the structural level reveals itself in a variety of ways. Recent police murders of Black men, women and children became highly visible to many White Americans who, for years, did not consider the ways in which law enforcement’s underlying racist procedures disproportionately killed Black and Brown people, and they were forced to examine the realities of the system. How is it that police can kill Black people so freely and not be held accountable? What is inherent in the system that allows for this genocide to go unchecked? How do systemic policies in policing permit such use of force? How does racism play a role? If we can answer questions like this with an eye to right what has been so devastatingly wrong, we can start to unpack and examine how we as a society got to this point and what, if anything can be done (Smelser, Wilson, & Mitchel, 2011).
Institutions of higher education can serve as a place for these types of dialogues to take place with actionable outcomes. First we must acknowledge and address our own hidden biases within the walls of the academy. Transgressing status quo conventions in academia is a foundational requisite of an effective, and equitable pedagogy. By uncovering the ways in which structural racism is deeply embedded in higher education and learning ways to create amore equitable institution, the potential for healing, innovation and change is possible. As educators, we are charged with teaching the next generation of thinkers, to help them become self-actualized members of society. What we have the potential to do goes far beyond the walls of the academy. “Professors who embrace the challenge of self-actualization will be better able to create pedagogical practices that engage students, providing them with ways of knowing that enhance their capacity to live fully and deeply” (hooks, 1994 p 22). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/01%3A_Introduction/1.01%3A_Introduction.txt |
The murder of George Floyd in May of 2020 served as a perfect storm. Highly visible police actions that were clearly racially motivated, excessively forceful, and criminal, along with a populace forced to shelter in place often with more time on their hands to follow popular culture and react to it. The reaction was overwhelming outrage. People were moved to speak out and demand justice against a legal system steeped in systemic racism. Cries were heard to defund the police, demolish the broken carceral system, and recognize that Black lives do matter in the hopes of creating a nation where all people have the same rights, protection under the law, and access to opportunities.
In this time where much of the world has acknowledged that structural racism provides advantages to some and disadvantages to others, we have an opportunity to contribute to this ongoing conversation. We are working to share examples of how structural racism shapes the function and form of higher education and actively take steps to build equity in our hallowed halls. In a 2021 interview conducted by Sarah Brown in the Chronicles of Higher Education, Professor of History at Georgetown University, Marcia Chatelain describes the unique positionality of the university and its role:
The university can be two things at the same time. First, it is a place in which leaders have to be held accountable for their decisions by a larger public—not just students,parents, and donors, but the larger public that often subsidizes the university and feels the consequences of its choices. Second, universities are uniquely situated because of their pursuit of knowledge. So what role do they play in terms of racial justice? They should be held accountable in the same ways that we hold government entities, banks, and private businesses accountable. Their responsibilities to repair are vast, because they’ve been able to exploit certain types of inequality in our society.We can’t just be observers, saying, “There are all these movements happening, that’s interesting or novel.” We are always indicted in these cycles of history (Chatelain,2021).
However, like many social movements of the past, the urgency and attention wanes with the next attention grabbing headline. As prevalent the need for structural change is in many minds throughout America, we have begun to see diminishing support in the culture at large for the Black Lives Matter (BLM) movement and a desire to “get back to normal.” In fact, support for BLM is lower now than it was prior to the 2020 murder of George Floyd (Chudy, & Jefferson,2021). So if this book feels like an urgent call for radical change, that’s because it is.
There have been multiple moments in history where it felt as if real change would come,only to find that momentum had died off and white supremacy and patriarchal social structures had once again prevailed. Humanity only has a finite amount of time on this planet. We are being called by nature to be better stewards of the Earth if we wish to make our time here habitable. But holistically, what does that look like? What are the changes we wish to see and who will benefit from them? Once we reckon with our past, we can start to put those pieces in place in order to make academia a place where we all have a comfortable seat at the table.
1.03: Acknowledgements
A big thank you is due to the faculty, students and experts who served as consultants, lent their support, allyship and shared resources.
With appreciation:Erica Abke, Kelsey Bensky, Bonnie Bornstein PhD, Chris Boyd, PhD, Juan Camara-Pech, YashicaCrawford, PhD, Zoe Davis, ShaquamEdwards, Emily Fox PhD, Patricia French, PhD, Dave KingPhD, Sheila McKnight, PhD, Colleen Mihal PhD, Steve Newton PhD, Dayna Quick, PhD, NadiaSanko, PhD, and Carmen Works, PhD. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/01%3A_Introduction/1.02%3A_A_Tipping_Point.txt |
Studying Administration of Justice can lead to a career in law, law enforcement, or corrections. Students at the college where this book was written who are considering this field are asked, “Are you committed to upholding justice?” Administration of Justice includes how laws and the legal system help provide public safety and maintain order (College of Marin, n.d.).Due to the problematic history of law enforcement, this field is prone to be tainted by the structural racism that was built into the original goal of policing in the United States. This field is also known as Criminal Justice or Criminology, both of which lead students into fields that deal with issues connected to the legal system.
The first criminal justice program was established at the University of California, Berkeley, by Berkeley Police Chief August Vollmer, in 1916.In the 1920s, criminal justice emerged as an academic discipline. The criminal justice system includes three distinct components: (1) Law enforcement; (2) The Judiciary; and (3) Corrections. All of these parts operate independently as well as together under the Rule of Law(City of Berkeley police, n.d.).
To study this system effectively, a student must know the racialized history of the creation of the United States as a decreed democracy. Without this knowledge, the tasks surrounding the administration of justice cannot be carried out effectively. The history of policing in the United States developed unique characteristics specific to the institution of chattel slavery via the creation of rules and punishments to maintain racial segregation. Its roots can be traced to some of the earliest forms of white supremacy, in the enforcement of rules and punishments associated with slavery by the use of slave patrols (Lepore, 2020). During the mid 1800s to the early 1900s, police were white men armed with guns who used their power to kill Blacks,Asians, indigenous Indians and Mexicans in the name of their laws (Lepore, 2020). Policing as an institution was created to maintain the structural order of white supremacy and some may argue that nothing much has changed since its inception. The use of the law as a tool of oppression applies to the other fields under which Administration of Justices falls as well, the legal system and corrections. In her book,The New Jim Crow: Mass Incarceration in the Age of Color blindness, Michelle Alexander, 2010 discusses the ways in which the system is designed to trap people of color in a cycle of legal battles that strips their ability to participate fully in the democratic system their white counterparts thrive in. Our legal system is historically rooted in these slave patrols and the creation of this nation was built in the enforcement of this hierarchy. As most versions of American history point out, slavery formally ended just over one hundred and fifty years ago except as stated in the Thirteenth Amendment, as punishment forcrime.We then moved into the Jim Crow era which purported separate but equal which it never was. After the Civil Rights movements, Professor Alexander identifies the New Jim Crow era as mass incarceration, yet another iteration of the Administration of Justice (Alexander,2010). As students flocked to these fields that promised safety for their communities and a good paying job, they often failed to learn the racialized history of the field. Alexander’s work became a prominent read for those studying the sociological branch of criminology and further discussions of this information can be found in certain fields within Administration of Justice,yet there still remains a deep financial tie to the roots of government funded U.S. policing once known as slave patrols.“Academic criminology became more sociological while applied criminology became more administrative. Criminal justice university programs increasingly grew by the middle 1960s because of federal monies from the Law Enforcement Assistance Administration” (Morn, 1980). Understanding this backdrop allows us to identify ways in which programs centered around public safety are also tied to upholding racial bias.
A glance at U.S. incarceration rates as compared to the U.S. population at large demonstrates that there is a disproportionate amount of Black and Brown people incarcerated and the lasting effects of a criminal record make pursuit of the American dream nearly impossible. As a tool for oppression, the law serves to sustain racial hierarchies.“No area in American life is more volatile than the point at which charges of racial injustice intersect with the administration of criminal law” (Smelser, Wilson, & Mitchell, 2001). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.01%3A_Administration_of_Justice.txt |
Anthropology is defined as the “study of humanity,” (Östör, 1998). It is commonly concerned with aspects such as the biological history and evolution of human beings and their ancestors, archeology and fossil records, as well as the societies, cultures, and traditions of humans and their ancestors. When viewing, researching, and analyzing different cultures and social norms, it is important to do so with an open mind and an effort to remain objective. Core concepts learned in introductory courses are Ethnocentrism, a belief that one’s own culture is superior, and a judgment of other cultures in comparison to the anthropologist’s own culture (Ethnocentrism, nd). and Cultural Relativism which views the study of culture through its respective lens and on its own terms, rather than making judgements or using the standards of one’s own culture (Cultural Relativism, nd).Both help those studying anthropology consider how a researcher's cultural beliefs can shape how they undertake their study with some recommendations about the importance of understanding culture with greatercontext.Unfortunately, this expectation often falls short and Anthropologists may fall victim to their own ethnocentrism. Since academia is a Western dominated field, ethnocentrism causes other non-European societies and cultures to be viewed through a white, Eurocentric lens. Those other cultures are viewed as foreign, strange, or at their worst, subhuman.
In its nascent stages, the field of Cultural Anthropology frequently viewed the world through differences, and anthropologists were always North American or European in these early years of the discipline. Societies that did not mimic patterns of modernization like Western Europe and the United States were commonly labeled with terms such as tribal, traditional, preliterate, savage, or primitive (Mercier, 1999). These labels were applied frequently to small,non white populations, and allowed for the justification of the dehumanization of countless peoples, which led to further atrocities and genocides.
However, as time has progressed, society as a whole tends to view itself as more accepting and open. Anthropology prides itself as a field that practices Cultural Relativism. It is the premise that all cultures are equal and need to be viewed through their own unique perspective (Lewis, 2020). However, when accounting for factors such as Implicit Bias, this viewpoint is virtually impossible. As human beings will have unconscious ideas without being able to see that they help influence and guide our perspectives and studies. Furthermore,ethnocentric beliefs, prejudices and biases that are not uncovered and acknowledged by researchers appear to simplify the nuanced and intricate differences between cultures. This often leads to micro aggressions and other indignations through ignorance and a lack of social and cultural awareness.
This reader highlights in various sections how the disregard for BIPOC bodies on the part of academics has allowed for study, interrogation, and disregard of Black and Brown lives. A most grievous example of racism in the field is the study and use of Black, Indigenous, People of Color’s (BIPOC) bones without consent in Physical Anthropology courses. As an example, in 2021 both Princeton University and University of Pennsylvania were found to be using bones from a 1985 police fire bomb of a home that killed a Black child. These bones were used as material for courses at both institutions but these bones were essentially stolen from police property and used without consent from the family of the victim. University of Pennsylvania Anthropologist, Alan Mann was asked to help with the police identify remains from the 1985 fire and kept the bones for use in his courses and for some at Princeton University (Pilkington,2021). Princeton University has since issues this apology:
As anthropologists we acknowledge that American physical anthropology began as a racist science marked by support for,and participation in, eugenics. It defended slavery, played a role in supporting restrictive immigration laws, and was used to justify segregation,oppression and violence in the USA and beyond,” the department said in a statement. Physical anthropology has used, abused and disrespected bodies, bones and lives of indigenous and racialized communities under the guise of research and scholarship. We have a long way to go toward ensuring anthropology bends towards justice(Princeton University, 2021).
This type of cultural appropriation of human remains exemplifies the ways in which many anthropologists throughout history saw BIPOC as specimens to be examined and studied rather than seeing their humanity and treating them with dignity and respect.
Another example of how structural racism lives within Anthropology occurred in 2018,at the American Ethnological Society Conference. Keynote speaker Sherry Ortner had previously focused her work on questions of class, specifically among her predominantly white, Jewish peers in Newark, New Jersey (Parikh, 2018).In this presentation, Ortner presented her findings after studying police violence. Her research also led her to the idea of Purity and Danger, a concept first introduced by anthropologist Mary Douglas in her 1966 book of the same title. Per this concept, Douglas identifies a concern for purity lies at the heart of every society and that in white western societies, cis-gendered, able bodied, heterosexual white men are the template for purity in the United States, and all who deviate are impure others (Douglas, 1966, p.23).Ortner argued that a primarily white, primarily male police force perpetuates a law enforcement system that uses violence and abuse on women, people of color, LGBTQ people and people with disabilities to uphold the binary system of pure and impure described by Douglas. This allows for the oppression and mistreatment of those seen as impure.
Ortner primarily cited Douglas’ work, as well as Didier Fassin’s research on policing in urban France.However, when presenting a lecture on policing, race, gender, and patriarchy,Ortner failed to cite a single black scholar, nor did she cite any intersectional feminist research or literature. Her presentation even included the use of racial slurs and epithets while citing documents. When asked about how class may have a role to play, Ortner faltered and stumbled, stating that the possibilities were overwhelming her (Parikh, 2018).
Historically, Anthropology viewed race as a biological construct. Until the 1900’s,research was conducted through a white supremacist lens, and racial hierarchies were the norm. This began to transition when Franz Boas, a German American professor, began to teach and argue that race is a social construct, rather a biological one. Boas is commonly known as the father of modern Anthropology and Cultural Relativism (NPR, 2019). Despite Boas’ efforts in the 1900’s, ethnocentrism still runs rampant in Anthropology, as displayed by Ortner. Ortner continued using racial epithets throughout her presentation. Her choice of words and delivery often shocked and disturbed younger scholars, while older academics sat largely unfazed.Ortner was book ended by two speakers of color, and was followed by a roundtable discussion on social justice in anthropology. The discussion panel was focused on gender and racial inequality in education and strategies for “pursuing social justices in workplaces and research”(Parikh, 2018). The final keynote concluded with a speaker who quoted W. E. B. DuBois, who stated, “how does it feel to be a problem?” (Parikh, 2018).
Within the field of Anthropology, being concerned with differences between varying societies and cultures may be the starting off point, but there should also be a commitment to racial justice. Anthropology (and all disciplines for that matter), can shift focus to include an anti-racist lens as a means to strengthen their work. Rather than focus on free speech as a justification for offensive comments, a speaker may choose to focus on ethical and equitable speech. Rather than try to provoke students or audiences with provocative language and ideas,one can opt to be a purposeful educator. Institutions can seek to represent scholars of color as well as other underrepresented demographics in their hiring practices, and hold one another accountable for problematic behaviors and actions. Remember that in spite of the best intentions, there is still potential for a negative impact, and good intentions do not negate the effects of problematic actions. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.02%3A__Anthropology.txt |
Architecture is a combination of art and science, combining the imagination and creativity of the human mind with the science and mathematics needed to create secure and stable structures. Through studying architecture, one may expect to work in fields such as urban planning, interior or spatial design, architecture, or other occupations related to the built environment. In one way or another an architect works with the foundations and structures people interact with on a daily basis (Collier, 2021). There are always cultural connotations involved with the architecture of a given society, civilization, and time period.Britannicadifferentiates between architecture and other similar fields such as construction, by comparing architecture to an art form of designing and building, rather than the skills required for construction. Architecture can also serve practical utility, providing shelter and other use, while also being aesthetically appealing, and an expression of the architect and their creative imagination (Collins, nd). The architecture and design of a society will vary based on environmental factors, such as climate, and weather, while also reflecting the history and traditions of the civilization. New innovations will frequently be included or reflected, and architecture serves as a lasting monument to the past.
In 2021, the New York Museum of Modern Art (MOMA) had an exhibit titled,"Reconstructions: Architecture and Blackness in America". This exhibit featured the ways in which structural racism is intentionally built into our physical environment. Throughout history, design has cemented our prejudices by expelling the oppressed to undesirable structures and neighborhoods. This exhibit highlights the ways in which Black Americans were denied housing options White’s had access to, from early slave quarters, to present day housing projects or low income neighborhoods (Sanderson, 2021). Redlining of neighborhoods in the 1950’s and the GI bill that put White GI’s into homes and Black GIs (who all fought in the same war) into housing projects further cemented housing segregation and the disproportionality of home ownership between Blacks and Whites. Gentrification over time further complicates this with wealthy(mostly White) people moving into poorer neighborhoods, displacing Blacks and other people of color, forcing them to relocate often further away from their jobs or their children’s schools.
As the designers of civilization, architects play a key role in shaping the world around them as well as the built environment that everyone is required to interact with on a daily basis. In a world and more specifically, a nation that was built on the backs of discrimination,racism, and the exploitation of labor, no industry or academic discipline can claim that they have a truly inclusive and accepting communityandhistory.TheArchitects’ Journal conducted a Race Diversity Survey in 2018 which demonstrates that architecture is no exception to this fact.In a survey of 1,000 architects, technologists, and students, results actually showed that racism has gotten worse for BAME (Black, Asian and Minority Ethnic) individuals. When comparing results from the 2018 survey to the 2020 edition, the results indicated greater experiences of discrimination and racism. 33% of respondents said that racism was widespread in architecture, and 27% of respondents agreed with the statement, “I have been the victim of racism at my place of work” (Architecture and Racism, 2020). Among individuals who identify as Black,African, and Caribbean, the percentage of people who reported that racism was widely prevalent was 43%. All of these metrics were higher compared to the 2018 edition of the survey.
From an academic perspective, there is a level of faculty acknowledgement regarding architecture and its inequities. An article that recorded a panel conversation between architecture faculty, historians, and individuals working within the field elaborated on such inequalities. Louis Nelson, professor of architectural history, as well as the vice provost for academic outreach at the University of Virginia, stated that, “Because architecture is part of the Western tradition of power,it is not a cultural but white” (Architecture and Racism, 2020). Another panelist, Dianne Harris cited a statistic that over the past 40 years, racial demographics within the profession and architectural offices have remained relatively stagnant and unchanged (Architecture and Racism, 2020). White men still dominate the field, especially within leadership roles.
By excluding people of color from this educational pathway and corresponding career paths, people of color are also excluded and unrepresented in the creation of the built environment. How neighborhoods are designed, structures of houses and city layouts all impact people of color, and disenfranchised people of color are more likely to inhabit less desirable spaces of the built environment. By allowing for greater representation for people of color,there may be a path to reconciliation which may also help rectify injustices such as housing inequality and environmental racism. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.03%3A_Architecture.txt |
Dance as a discipline in higher education serves to educate students in becoming, “an artist/citizen with a depth of expertise in the physical forms as well as the historical, cultural,political and scientific aspects of dance” (Romita & Romita, 2018). An abstract of systemic racism in dance education begins with acknowledging that most schools in the U.S. require rigorous study of Western forms of dance. This would not be an issue, as most developed countries center their own forms of dance as well; however, as the population of America has shifted over time to incorporate many other racial identities, the curricula remain strictly Western-based, with cultural appropriation of hip hop on the side. The ways in which dance education has been historically systemically racist towards people of color is by invisibility or not prioritizing anything other than Western dances, by appropriating cultural dances overtime, and by not offering financial aid to students of color, thereby creating unequal access. Not to mention the cost of developing skills through classes and coaching at a younger age, which is not accessible to all students at all K-12 schools nationally, thus making those who can pay for lessons a leg up on those who cannot.
Going back further in time, prior to European colonizers arriving in Virginia, Indigenous people used dance education as a meaningful and sacred practice to share culture, medicine,and spirituality. During the 17th and 18th centuries before the Civil War, African American,Asian, and Indigenous enslaved people danced only in secret, perhaps at reported late night hidden social gatherings. They also used food and song to keep each other’s spirits up; and even held dance competitions, all of which could be viewed as applied dance education amongst themselves.
Dance was first introduced into the education system as a form of physical education and in 1926, the first dance major was approved in the Women’s Physical Education Department at the University of Wisconsin/Madison (National Dance Educational Organization,n.d.). At around the same time, legislation such as Title IX in 1972 and Equal Educational Opportunity in 1974 passed, which caused PE to focus on coeducational sports, thus dance artists were encouraged to get degrees in teaching dance (National Dance Educational Organization, n.d.). This is what led dance to become a respected formal collegial program now defined as a fine and performing art.
However, the resurgence for decolonizing has led to Black Indigenous People Of Color(BIPOC) dancers speaking up about their shared experiences in the age of social media and blogging. For BIPOC dancers in the dance education world,interactions with microaggressions can include inability to be casted based on race, not being allowed into class based on skin color due to the teacher’s need for “symmetry,” and refusing to hire teachers of color (Mullikin,2020). For example, refusing to hire a hip-hop teacher at a university because they do not have a master’s in dance when hip hop is not offered broadly at a collegiate level and certainly not ata master’s level-is a systematic set up to keep BIPOC folks and their dance forms out of colleges and to continue to invalidate their contributions to the dance world (Mullikin, 2020).Many contemporary dance educators refer to Western dances as “technique” in a way that assumes every other genre of dance does not require formal training, skill, or technique; and placing white European cis males at the center of expertise (Mullikin, 2020). Many young BIPOC ballerinas join the same classical companies as their white counterparts but are faced with the unfair reality that the path isn't equally set. Frequently, they're pushed to consider non-ballet dance options. Preston Miller, a Master ballet teacher, says, “I regularly have to hold uncomfortable conversations with my students of color...If you are ever in a predicament where you feel resistance in a classical ballet setting due to the color of your skin, speak from your perspective exclusively and express how you feel. You may not change your director's beliefs,but you will change their thought process" (Spears, 2020). Dance departments across universities in the United States can embrace a more inclusive system by devising curricula that do not validate any particular dance form over another. Instead these departments can demonstrate a commitment to exploring and understanding the many forms of dance worldwide, some belonging to their diverse students whose culture has had a hand in shaping the history of dance. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.04%3A_Art_-_Dance.txt |
Earning a degree in Drama prepares students to become actors, art consultants, set designers, visual artists, and scriptwriters, along with other professional theatre skills (Foster,2011).Students studying performing arts learn multiple forms of performative creativity such as drama, music, and dance. In providing a framework for understanding the relationship between the performing arts and white supremacy, we must examine how racism operates and how racial hierarchies are constructed within the arts and in theater education in the United States.To make the case for understanding the arts as white supremacy property, a dual-lensed framework that defines “the performing arts” as both an inclusive and exclusive educational experience based largely on student testimonies can be analyzed. From the top down,performing arts institutions are largely private not-for-profit and this privatization makes it all the more difficult to hold these approximately 473 United States institutions accountable(“General Drama and Theater Arts”, n.d.). New York University awards the most degrees in General Drama & Theater Arts in the US, but Portland Actors Conservatory and American Academy of Dramatic Arts-Los Angeles have the highest percentage of degrees awarded in General Drama & Theater Arts (“General Drama and Theater Arts”, n.d.). Tuition costs per term for General Drama & Theater Arts majors are, on average, \$7,070 for in-state public colleges,and \$36,680 for out-of-state private colleges. (“General Drama and Theater Arts”, n.d.).
An abstract of systemic racism in theatre begins with the origins of stage drama, traced back to the slave trade and colonization period. The cultural appropriation of Middle Eastern,Asian, African, and Native American performance traditions was dominated by white European writers, directors, and actors. In the early years of the slave trade, Black, Indigenous, People of Color (BIPOC) were only able to put on private performances at plantations and the homes of the slave owners (L, 2019). The first characters of color to appear on stage in the 17th and 18th centuries were white people wearing ‘blackface’ makeup, appearing at intervals in white productions as comic relief, usually playing dim-witted servants (L, 2019). The use of blackface characters grew in popularity in the early 1800’s, with BIPOC characters portrayed as racist caricatures: lazy, buffoonish, superstitious and slow (L, 2019). The performances were typically burlesque and aimed at a low-brow audience, but they soon infiltrated the opera house, first as entr’actes and eventually taking over completely to become America’s first national art form (L,2019).
According to Howard University, people of color have been an integral part of theatre and drama since its beginnings in colonial America, with the first American production of a play taking place during the middle of the seventeenth century (Howard University, n.d.). The play,Prince of Parthia, patterned its form from neoclassicism which entailed rigorous adherence to decorum and grandiose spectacle, as all theatre in America would until the Minstrelsy period beginning in the early 19th century. The minstrel show was an exploitative form of theatre that belittled and made light of the Black experience and was performed primarily by white actor swearing what was commonly known as black face (Howard University, n.d.). A West Indian slave played a character known as Mungo who was a profane clown of little authenticity in the 1769 play,Padlock(Howard University, n.d.). In early productions featuring Black actors, they were given two options: accept the comical, minstrel type role or create their own theatre(Howard University, n.d.).
The first professional Black theatre group in America, founded by Mr. Brown (who’s first name is said to be unknown) in 1820-1821, was the African Company, and their theatre was the African Grove, located in lower Manhattan (Howard University, n.d). The African Company's repertoire was primarily made up of Shakespearean dramas, but they also showcased the first play written by African Americans called King Shotaway, while performing for diverse audiences(Howard University, n.d.). Unfortunately, The African Grove closed in 1823 after it was vandalized by white hoodlums, so Black actors had to resort back to minstrelsy (Howard University, n.d.). During this time there were still Black theatre companies being formed and finally, in the 1900’s Black actors completely stopped performing minstrelsy (Howard University, n.d.).
The growth of theatre by other ethnic groups has been primarily a product of the 20th century in the United States. Asian-American theatre did not surface until the 1960s and has grown to around forty groups today. Early productions often had Asian themes or settings; "yellow face" was a common medium for displaying the perceived exoticism of the East in American performance (Morgan, 2018). Professors Sidoni Lopez and Hanane Benali write that Native Americans were largely left out of the theatre industry, despite their rich history of storytelling until the later 20th century. The stories that inspire Native American Theatre have been around for hundreds of years but did not gain formal recognition by colonial America until Lynn Riggs, a playwright of Cherokee descent, brought Native theatre into the spotlight through the Six Nations Reserve Forest Theatre in Ontario in the 1930’s (Lopez & Benali, 2016). Through these events, Native Theatre has been introduced to mainstream society and contemporary Native American Theater was born. Arab-American theatre dates to 1909, growing out of a small repertoire (Ali, 2017). The events of 9/11 and their ramifications have largely shaped Arab American theatre, with the current political climate further galvanizing it by reinstating a “clash of civilization” discourse (Ali, 2017).
In 2020 some light was shed on the history of performing arts colleges, with many students coming forward to tell their stories. As many institutions attempted to make vague statements about supporting the Black Lives Matter movement, students called out these hypocrisies, demanding real change. Contemporarily, students of color continue to face hostility and rejection from the people in power at performing arts universities. In a 2020 article written by Erica Batres, a theatre major student, she recounts first-hand knowledge of how the musical theatre and acting BFA audition process is set up to keep low-income students from auditioning in a series of calculated steps. First, to receive a callback, students must film a high quality prescreen audition in which some students invest hundreds of dollars in studio and audition coaches. Students who are privileged to have attended private performing arts high schools have an upper hand in this process because of the training they received and access to space and technology needed to produce the submission materials. Secondly, there are fees attached to audition submissions on top of the school application fees. The last step of auditioning requires students who have received a call back to have an in-person audition, in many cases this requires last minute airfare which isn’t always feasible for students who are not upper-middle class (Batres, 2020).Today, schools across the country vary in quality of resources due to the location and area of where they are placed, and racial segregation has played a destructive role. In predominantly BIPOC neighborhoods, there is a significant lack of funding within extracurriculars and even classroom supplies (Batres, 2020). This directly affects theatre education, forit is common practice that theatre be the first to go when budget cuts are proposed (Batres, 2020). Many theatre programs exist with no facility or budget, with students left up to fend for themselves to get fundraising, a teacher to donate their time, and request to use the cafeteria after school (Batres, 2020). The problem of access leads to less and less BIPOC performers auditioning for college theatre programs. As if access and preparation doesn’t set them back, the audition hurdle of getting accepted almost certainly will (Batres, 2020).
Not surprisingly, lack of representation is an issue for the field. The population of the United States is 63 percent white, yet 81 percent of performing arts graduates are white(“Artists Report Back”, 2014). The population of the United States is 12 percent Black, yet only 4 percent of performing arts graduates are Black (“Artists Report Back”, 2014). Every theatre department in every institution of higher education should be reckoning with the discussion of how to create a more diverse, equitable and inclusive community for students while recognizing that work on these issues is far from finished.
When BIPOC students do make it into the program and onto the stage, they often receive microaggressions and discrimination from the faculty, via Stereotyping in casting and difficulty accessing coaching. One African American student in Syracuse University’s theatre program was told she “passed the ‘paper bag test,’” an infamous measure that upholds colorism by excluding those whose skin tone is darker than the color of a brown paper bag (Diane, 2020).
It is commonly said that “if you want to be the best you must train with the best,” but what happens when the “best” is virtually impossible to access (Batres, 2020)? Training schools influence what our Broadway stages look like. To advocate for diversity in the theatre industry,actionable steps must be taken, such as supporting nonprofit organizations like The Fund for College Auditions (TFCA) (Batres, 2020). TFCA provides information and support to students and parents, funds for workshops and camps, grants for traveling fees, and much more (Batres,2020). Another step to be taken is to organize free theatre performances and workshops in low-income communities to create an accessible industry (Batres, 2020). There are many directions that can be taken to implement change within the theatre and drama industry, and those in powerful positions in the field have an opportunity to start demanding them. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.05%3A_Art_-_Drama.txt |
A studio arts major will apply creativity, problem-solving, and design-based solutions to different forms of media, including sculpture, ceramics, painting, and jewelry (art, n.d.).Every person possesses creativity and the act of making art is available to all of humanity. It is when an artist seeks validation for their creative work that cultural standards of beauty and value come into play. Whether this creativity gets nurtured or judged is steeped in structural racism. Racism in art takes place in the public forum, via evaluative practices in art schools and universities that are focused on a Eurocentric aesthetic, which dictates what makes something artistically appealing. Is beauty in the eye of the beholder or is there something larger at play that serves as a tool to critique art based on an industry standard? Often it is white folks in the academy, gallerists, and art critics who set the barometer to dictate what is classified as art inU.S. Art departments and schools, and in the culture at large. Traditionally the frame is Eurocentric if something is to be considered classic artwork. A historical lens focusing on Art from Europe as the premier form shapes how Art faculty teach students to draw, paint and sculpt. When there is instruction on styles or methods that originate from non-Euro/North of Mexico cultures, it is often labeled “primitive art” which basically translates to anything non-white (Primitive Art, 2021).
Financial barriers that preclude students in other types of art discussed in previous sections serve to perpetuate western, upper class, imperialism by limiting access for those who cannot pay. Art school, materials and portfolio curation are all expensive which keeps many from pursuing this field. The capitalist ethic is also closely tied to whether or not something is considered art. While art as a creative endeavor is possessed by all humanity in one form or another, in Western culture, art is something that sells. There is a belief that someone who makes art is not an artist if their art is not generating capital. Museums and galleries are the landing points for artists who wish to gain exposure and gaining access to those places is not available to all. Street artists whose work is not found in galleries face a big barrier towards a career as an artist by not being featured in galleries. If it is not in a gallery it is not art. Poet and author Rene Ricard wrote,The Radiant Child,highlighting up and coming street artists, in 1981 in which he states, “to support oneself by the work is the absolute distinction between the amateur and the pro” (Ricard, 1981).Real artists don’t need side jobs and art as a way to level up is something that is part of the appeal.
What’s with art anyway, that/We give it such precedence?Most basic is the common respect,the popular respect for living off one’s vision. My experience has shown me that the artist is a person much respected by the poor because they have circumvented the need to exert the body, even of time,to live off what appears to be the simplest bodily act. This is an honest way to rise out of the slum, using one’s sheer self as the medium, the money earned rather a proof pure and simple of the value of that individual, The Artist. This is abasic class distinction in the perception of art where a picture your son did in jail hangs on your wall as a proof that beauty is possible even in the most wretched; that someone who can make a beautiful thing can’t be all bad; and that beauty has an ability to lift people as a Vermeer copy done in a tenement is surely the same as the greatest mural by some MFA. An object of art is an honest way of making a living, and this is much a different idea from the fancier notion that art is a scam and a ripoff. The bourgeoisie have,after all, made it a scam. But you could never explain to someone who uses God’s gift to enslave that you have used God’s gift to be free (Ricard, 1981).
While Ricard’s sentiment regarding art as a pure form and a way to uplift is inspiring, he is keenly aware that the commodification of the art and the artist cannot be removed from this analysis or the industry itself. Art appreciation and curation is a way for a person to exhibit their cultural capital to others. Those who can purchase and display, or donate art are often of the privileged class, and their aesthetic dictates who can profit from their labor. Work done by the individual artist in the studios and classrooms are evaluated by Art teachers and institutions of higher education who, in large part, decide what makes a creation, art.
Perhaps even more complicated but still rooted in structural racism is the identity of an artist, their type of art and their links to the legacy of cultural appropriation in their work. While art outside of Euro/North of Mexico America is labeled “primitive,” it is also a source of inspiration for many Euro/North of Mexico American artists. So when a Banksy pops up in East Anglia it is all the rage but when an unnamed Black or Brown youth turns a dark alleyway into a colorful landscape it is a crime. Hip-hop culture in the 1980’s grew in response to racism in New York, and the onset of graffiti art as a valuable commodity was found there. Prior to validation received by art critics, graffiti art was not always recognized as art and there are still discrepancies as to what is labeled art and what is labeled vandalism, and in many cases, it boils down to the artist's skin color. Once the art world validated its merit as an art form, a rebrand of graffiti took place but the racial, classist hierarchies still remain. Activists employ art to send a message as a medium for change. Whether it is a Palestinian activist creating a message on the separation wall in the occupied Palestinian territory or a street artist tagging a box car somewhere along the Southern Pacific Railway, these acts do not often merit the label art. It is only when more notable often white artists mimic this type of street art that it becomes worthy of the label. Banksy’s rogue socially just artwork comes with a hefty price tag but affords the buyer the great cultural capital of owning such a piece affording them “woke” status. While technically anonymous, Banksy is presumed to be a white male, and thus is afforded the privilege of being labeled a radical and not a criminal. One painful irony of Banksy’s ability to be in such high demand is on full display at The Walled Off Hotel mere feet away from the separation wall in the occupied West Bank town of Bethlehem where the wall serves as a canvas for oppressed Palestinians to speak their truth with little recognition. This type of cultural appropriation of street art is just another way structural racism plays a key role in Art as a field.
While there remains a huge hierarchy regarding art that is held in high esteem by those who have the privilege to make those values judgements, Art is created by much of humanity for various reasons. Art and activism (artivism) have always co-existed. Many artists use their platform to speak truth to power on varying social issues, and artivism has been central to social movements and cultural critique.
Perhaps one of the most famous examples of market driven valuation of activist street art can be seen in the life and work of John Michelle Basquiat. His value as an artist relied at first onto kenism (Jean-Michel Basquiat, 2021, Schnabel, 1996). His rise to fame came in 1981 when Rene Ricard wrote his famous piece,The Radiant Child. Were it not for this validation of sorts,this prolific artist who created over 3000 paintings and drawings may have gone unacclaimed(Jean-Michel Basquiat, 2021). Posthumously his work has increased in value which sadly also highlights the commodification of pain in the art world (Jean-Michel Basquiat, 2021).Basquiat’s work was artivism in that his pieces spoke to the foundational issues of racism. He was keenly aware of the art community's reaction to him, knowing that those reactions were based in their own preconceived notion of who they thought he was (Jean-Michel Basquiat, 2021, Schnabel,1996). The connection between racism of all forms in American history and art was clear to him and his work like so many others reflected it. In describing this connection, Ricard writes:
To Whites every Black holds a potential knife behind the back, and to every Black the White is concealing a whip. We were born into this dialogue and to deny it is fatuous. Our responsibility is to overcome the sins and fears of our ancestors and drop the whip, drop the knife (Ricard, 1981).
An honest assessment of history will do nothing but strengthen and diversify the art world.Decentering whiteness and the white gaze from the recognition of something being defined as art is in practice by many, but the dominant evaluative measure still lies in a white Eurocentric aesthetic. While the rise to fame of Basquiat is predominantly posthumously, there is an opportunity (as in all of the other fields described in this reader) to spotlight, recognize and learn from artists of color and less visible artists whose art is not featured in galleries or museums. Art teachers introduce their students to the act of art and reference those who came before them. They can play a pivotal role in the creation of their students as artists and the cultural valuation of diverse forms of art.
An example of shining a light on artists who have not been heralded as an acclaimed artist is Pearl Fryer, topiary artist and sculptor who brought international attention to his depressed South Carolina hometown, Bishopville with his incredible topiary work. Fryar is a self-taught artist, most known for topiary artistry and sculpture who uses everyday “junk” and discarded plants from local nurseries. Not only has he put Bishopville on the map with his amazing 3 acretopiary garden visited by thousands annually, he serves as teacher and mentor to South Carolina students both young and old. Fryar is an artist in residence at Coker College, a small liberal arts college in South Carolina (Pierson and Galloway,2006). This gives these students an invaluable opportunity to learn from an acclaimed artist and demonstrates to the predominantly white students there that the artistic community, at least at that institution, values his artistry. Fryar has been commissioned to create gardens similar to his own in spaces in South Carolina, including the McKissick Museum in the capital city of Columbia. Additionally, Fryar has donated many topiary pieces to various museums and the Bishopville city government (Pearl Fryar, 2021).His topiaries are featured on main street in Bishopville as part of their “Streetscape” project. Preservationists are looking for a way to preserve his garden well into the future. As of this writing, Pearl is 81 and still going strong. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.06%3A_Art_-_Visual.txt |
Art history is the study of objects of art considered within their time period. Art historians analyze visual arts’ meaning (painting, sculpture, architecture) at the time they were created (International studies in history and business of art & culture 2021). For many who take what is considered a survey course as an introduction to Art History, they would likely be exposed to art and artists who come from or resided in Europe and Euro-America. Positioning what is often called western art as normative and placing other art in relation to it is another form of privilege that sets the standard for valuing certain types of art, humans, and cultures,over others. Scholars such as Edward Said have long argued that the term non-western itself is pejorative (Said, 1979). Additionally the term “western” in regard to art when discussing a geographic region is inaccurate. In most survey art history courses, a study of “western” art would include European and Euro-American artists which leaves out much of the geographical west which includes multiple indigenous western people (Kerin & Lepage, 2016). Many scholars in the field of Art History are grappling with this centering of whiteness and seek to move the discipline in a different direction. There is a move to create what is called a multi-survey model (MSM) approach. This would decenter what has historically been taught in the standard general education (GE) art history classes and instead offer multiple art history courses that focus on different geographic regions and highlight the type of art historically created there (Kerin & Lepage, 2016). Considerations for transitioning to this model would depend on the size of a school and departmental faculty trained in these areas of art history.Departmental hirings and future course creations can also be part of a move in a direction to de-center white art as the only art of historical significance. While the traditional survey art history course is one piece of the history of Art as an academic discipline, it is not the entire history. Positioning European and Euro-American art works as the standard content of what is art worth appreciating in the GE course college, means that students learn about the history of art which privileges white art over all others. Yale University has decided to revise the traditional course taught there on art history. They made this move based in large part on student response to what they saw as an idealized“Western canon, a product of an overwhelmingly white, straight, European and male cadre of artists”(Hedeman & Kristoffersen,2020).While there are critics of a less Euro-centric approach to art history, the Art History faculty see this as a way to be more expansive and less reductive (Greenberger, 2020).Adding to the complexity of what is considered historically significant to the world of art, is the art historians themselves and how they hold beliefs about what was seen as artistically pleasing to early artists. Case in point is early Greek and Roman sculptures often highlighted as artistic greatness and as a window into what was held as beauty for the people of those eras. When learning about these sculptures, we are often presented with stark white images sculpted out of stone. Archeological discoveries of statues in ancient Greece reveal that in fact, many of these sculptures were painted to reflect features such as red lips or black coils of hair. These findings change the way art historians interpret perceptions of worth and beauty, and according to Mark Abbe, professor of Art History at the University of Georgia, the notion that pure white sculptures were used to represent the human form were the ideal artifacts of the time“is the most common misconception about Western aesthetics in the history of Westernart.” It is, he said, “a lie we all hold dear” (Talbot, 2018).The notion of whiteness equating beauty and purity has led to an act of what he sees as collective blindness which leads historians to tend towards understanding art through a lens which privileges art that aligns with whiteness as beauty and even misidentifies how ancient sculptors meant for their pieces to be seen. A process to resurrect what some art actually looked like can serve as a tool to debunk this notion that whiteness was the standard of beauty and that in fact, polychromy, the art of painting or sculpting in many colors, was used in much of ancient artist rendering of beauty.This clip shows the resurrection process on the Treu Head, a Roman sculpture:
https://www.youtube.com/watch?v=gRMPYh2QdSM&feature=youtu.be
The art history department at Yale is not alone in its thinking regarding representation; a move to decolonize higher education is also taking place in many art departments nationwide and there is a great deal of art being done by BIPOC artists both in the US and abroad that deserve study and recognition. By searching for those who are not found in many standard art history texts, Art History teachers have the ability to introduce students to a wide variety of up and coming artists as well as those historical artists who did not get a place in the standard history books yet whose work is no less significant. Students can also engage in the process of finding new artists they are excited about and share with their classmates. Access to information is so prevalent at this point, students can easily access artists they find compelling and assignments can be tailored to encourage searches that find diverse artists. One artist of note is Irene Antonia Diane Reece https://www.irenereece.com. A self-described intersectional womanist visual activist, her use of art as both message and catharsis bring voice to the often voiceless.Her celebration of “Black Everything” is a welcomed reprieve in an art world filled with a predominance of white voices dominating art history.
2.08: Astronomy
Astronomy is the study of everything in the universe beyond Earth's atmosphere. That includes objects we can see with our naked eyes, like the Sun, the Moon, the planets, and the stars. It also includes objects we can only see with telescopes or other instruments, like faraway galaxies and tiny particles (What is Astronomy?, n.d.). This discipline, like many others, has had a problem with inclusivity. Currently, astronomers are 90 percent white, about 1 percent black,about 1 percent Latino and 0 percent Native American. Students of color do not see themselves represented in Astronomy faculty and that is one reason for most students of color who enter as Astronomy majors to change their major. Like other fields of study, some of the issues creating this lack of diversity in faculty include representation in the field at large, and a long path to tenure. (McCrea, 2020)The Banneker Institute, named after Benjamin Banneker,creator of the Farmer’s Almanac,and the first Black Astronomer,was formed for undergraduate students of color to pursue graduate programs in astronomy, focusing on research, graduate coursework, and social science education. In their summer workshop they work to train astronomers of color in currently white dominated fields while simultaneously addressing social issues surrounding racism and social justice. Effective approaches to a focus on both Astronomy as a field and an emphasis on social issues involve asking questions as simple as, how are planets formed, and where are all the Black people in the field (Sokol, 2016)?The program was started by John Johnson who left a position at Caltech due to the institution's disinterest in diversifying the field.
There are countless unanswered questions in the field of Astronomy, and there are underrepresented groups such as women and minorities, who would be valuable additions in attempting to answer those questions.The institute seeks to help students find a sense of community in the field. In addition to a lack of inclusivity, sexual harassment has also plagued the field further marginalizing students. The governing body for the field, American Astronomical Society (AAS) failed to make a statement in support of Black Lives Matter which appeared disrespectful to its Black astronomers. It has also not as of yet, added a social justice focus to its charge which is something many see as a failing. There have been conversations to address these and other issues of discrimination. Advice from these discussions for white astronomers in the field who wish to ally in creating a more diverse field is to “calm down, it’s been bad for a long time, this isn’t new phenomenon even if it is new to you, [sic] listen to their colleagues of color, and learn about the discipline’s racist history”(McCrea, 2020). Actions to attract and retain more students of color are happening with a goal of diversifying the field.Both the Banneker Institute and a program at Vanderbilt University have taken the charge to do so. Vanderbilt has been identifying promising students in HBCUs and supporting them entering the doctoral program at Vanderbilt. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.07%3A_Art_History.txt |
Biology is the study of life. There is much to be learned from this discipline, and so many advances we have made as a nation are traced back to work done in the Biology laboratories on college campuses. Despite this, the roots of biology are deeply intertwined with structural racism. From experimentation on enslaved Africans to experimentation on Black bodies post slavery, Biology has a past steeped in racist ideologies that led to gross misconduct and exploitation of African Americans (Nurridan, Mooney, & White, 2020; Savitt, 1982). In response to this history, there is severe distrust of scientist’s motives by Black Americans present day,which may explain why some African Americans have decided not to receive the COVID-19 vaccination. The troubled history is not lost on many Black Americans who, when surveyed, as a group are the least inclined to express an interest in getting the vaccine and this hesitancy is born out of a history of being betrayed by science (Jones, 2021). Examples of abuse and exploitation range from well known Tuskegee and lesser known Guatemala syphilis studies by now defamed physician John Charles Cutler,to the harvesting of body parts for scientific exploration without informed consent (Centers for Disease Control, n.d.; Park, 2017; Rever by,2012; Rodriguez et al., 2013). In 1951, a full four years after the Nuremberg code, Henrietta Lacks, a Black woman from Baltimore MD with cervical cancer, had cells taken from a tumor that could be grown easily in the lab and proved to be transformative to the field of cell biology.Numerous institutions profited financially through use of her cells. The cells were taken without consent and Ms. Lacks and her family were not informed or compensated in any way (Beskow,2016; Nature, 2020). The exploitation of persons who have been devalued by white culture is a theme throughout history. Indigenous peoples on this continent were also used as science experiments and treated less humanely than animals for slaughter. Lifesaving medicine was used as a bargaining chip for more compliant tribes during the smallpox pandemic.
Similarly in terms of access to present day life-saving COVID-19 vaccines, it is clear whose lives matter most and what populations had to wait to get access to lifesaving testing and vaccines (Hampton, 2020). The mere fact that the United States Government and Big Pharma were debating whether or not to remove the patents that could get more vaccines out quicker worldwide highlights the inhumanity we face when medicine for profit over people is the national model. Use of public funds for research that then turns private companies into multi-billion dollar enterprises while pricing out those most vulnerable of life saving medication is something we should be taking a hard look at.
No more devalued in this culture presently are the millions of incarcerated people held hidden from view. In Acres of skin: human experiments at Holmesburg Prison. A true story of abuse and exploitation in the name of medical science,Tom Wilkie writes of the medical experimentation on 75 Black prisoners in Holmesburg prison (Wilkie, 2000). From 1951-1974, also well after the Nuremberg ethical code had been established, these studies tested the effects of a known contaminant, dioxin, without the informed consent of the 75 men (Wilkie, 2000).
Biology has also been used as a tool to justify racial hierarchies. Scientific racism has been employed as a tool for white supremacy. From the 4 races of man in the mid-1700’s to the Eugenics movement of the early 1900s, both put forth the claim that there were distinct differences in humans based on race (Timeline of Scientific Racism, n.d.). The Eugenics movement laid bare the dangers of using a false scientific rationale to justify the superiority of a race (Miller, 2014). This use of science to justify unequal treatment has been employed by leaders of nations in order to fight the abolition of slavery, to commit genocide, to forceibly steralize the mentally ill and incarcerated men and women to this day, and to defend unequal cultural practices (Manian, 2020; Stern, 2020).
Despite the understanding that Eugenics is a pseudoscience, we still find remnants of it in the scientific data; highlighting the fact that science is not without its failings and that sometimes data is inaccurate and used to support an agenda that is not scientifically valid(Bhopal, 2007; Eigen, 2005; Kevles, 2011; Michael, 2017). The justification of differential treatment based on biological traits has contributed to unequal access to resources including medical care. One example is the differential of prescribed pain medication for Black patients by doctors of all races under the assumption that they “feel less pain” than their white counterparts (See also the section on Human Sexuality for a discussion of presumed racial pain differential) (Hoffman, Trawalter, Axt, et al., 2016). Structural racism plays a role in federal,state and local funding for housing, healthy food, and protection of clean water, all items needed for our biological well-being (Bank, 1996; Branson, 2017; Miller, 1994; Williams & Eberhardt, 2008). Implicit bias on the part of practitioners (also discussed in the section on Health Education) and governmental leaders coupled with years of structural racism has led us to a place where the lived experience of (specifically) Black Americans, but also other people of color in the United States is vastly different from Whites (Mende-Siedlecki et al., 2019; Metzl,2009; Oliver et al., (2014).
Similarly, the Indian Vaccination Act of 1832 has an eerily familiar theme to the Tuskegee and Guatemala studies (Reverby, 2012). While nowhere in the literature does it state that the vaccine trials caused Native deaths, many Native Americans recount the history about how the government forced the trials on them with this act, and kept a list of all the Natives who were vaccinated. The belief is that the shots they were given did not vaccinate from Smallpox as it was claimed to do, but instead gave Native Americans the disease and was akin to murder. It is not hard to imagine this taking place based on the attempted smallpox transmission via blankets handed out to Native Americans during forced relocation as a form of genocide(Brands, 2005). According to tribal elders, the list of names of those who received the smallpox vaccine was lost some time ago so tracing these claims has proven impossible. It is interesting that many academic papers discuss the smallpox genocide was caused by not being given the vaccine, when another argument is that it was caused by the vaccine itself (Pearson, 2003).Because of a well-documented track record of unethical practices on the part of white scientists and practitioners, a severe mistrust of white medicine further exacerbates equitable access to care for many Black, Indigenous and other People of Color in the United States.
The irony behind the amount of ways in which Biology has been used to maintain structural racism and exploit people of color is it is also the key to identifying the truth about race (Kevles, 2011). As a social construction, race and its consequences are quite real but there is no biological basis in racial differences (The Biology of Skin Color, 2015; Public Broadcasting Service, n.d.). Just as in other academic disciplines, the diversification of scholars in the field likely will lead to a more robust anti-biased field. The current numbers still are on par with other STEM fields in terms of diversity of students and faculty but are gaining ground in terms of representation. Although biology boasts a higher number of non-white doctorates awarded,it is still not representative of the population at large so there is much work to be done(National Center for Science and Engineering Statistics, 2017). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.09%3A_Biology.txt |
A business is an organization that strives for a profit by providing goods and services desired by its customers (Gitman et al., 2018).The administration of a business includes the performance or management of business operations and decision-making, as well as the efficient organization of people and other resources to direct activities towards common goals and objectives (Thuis & Stuive, 2019). Business students learn about leadership, management,financial knowledge, communication, collaboration, and marketing skills through studies in business administration and can also receive hands-on training to start their own venture through courses in business entrepreneurship (Business, n.d.).In a society organized under capitalism, business students learn to operate businesses within the capitalist system. Inherent in capitalism is racism. In an effort to identify and address this, there is a growing demand for business students of color to call out the racist systems in the discipline. In the current era where white supremacist policy are subordinating people of color, things will not change unless they are called out and dismantled. In their 2020 article,The Business School Is Racist: Act up!,Dar et. al. explain that business schools per se do not acknowledge race as a salient factor in understanding business, “In the Business School specifically, knowledge production has erased race from business scholarship, resulting in the continued omission of the roles of Indigenous genocide, extractive settler-colonialism and Black chattel slavery in contemporary capital accumulation and wealth disparity”(Dar et al., 2020).Scholars of color must survive in educational environments where their knowledge is seen as not worth knowing. The emotional toll this takes on students of color makes thriving in school differently difficult than of their white counterparts. Finding activist scholar spaces helps students of color identify the systemic racism they face in business schools and create a space for healing. The physical and emotional toll the present system places on students of color are vast and unacknowledged.
In a global marketplace the business school must rise to the challenge of teaching effective business processes beyond borders. There is an absolute need to work alongside scholars in the global south and seek out diversity of voice in innovation. An expansion is overdue on the narrow understanding of a discipline that has left so many out of idea production and solutions generation in order to move towards a business model that re-imagines success and questions the status quo (Dar et al., 2020). In a globalized marketplace,diverse knowledge about commerce, trade and consumerism can only strengthen the field.
2.11: Career Counseling
Career Counseling is a process that helps an individual know and understand themselves, and the world of work in order to make career, educational, and life decisions. Oftentimes, this type of work is done in the college setting for students who are trying to decide on both their college and career pathways so career counselors in an academic setting have great influence on students. They are usually part of an institution's student servicesdepartment.Career Centers/Career Services support students (and sometimes alumni) in their career development process. The career development process includes self-exploration/reflection, career & major decision making, and support with everything needed to obtain post-graduation goals: resume/cover letter/interview support, internship and job search strategies, and support.
The field of career services/career counseling in higher education is deeply entrenched in white supremacy and patriarchy. The field as a whole is only beginning to consider the ways in which those in it perpetuate systemic & individualized oppression. One example of how students are counseled centers around student’s presentation of self. Many college career centers state their aim is to support their students in becoming what is often termed“professional.” Research into the use of the focus on professionalism has demonstrated that the idea of professionalism itself is a white, western, patriarchal ideal, which when employed perpetuates unequal access to opportunity for students of color (Gray, 2019).
Additionally, beyond the goals and aims of a career center, they are one of the departments on campus that has access to employers who hire students.Because of their access to employers, counselors have the opportunity to help level the playing field in a mindful and positive way.This unique role creates a huge opportunity for true student advocacy focused on dismantling systemic issues. At present, there are clear and identified hiring practices that are harmful and/or discriminatory to people of color, specifically Black individuals(Rios, 2015).
Many career centers and career counselors state that they believe in and prioritize diversity, inclusion, and equity,however, the focus is mainly on creating resources and best practices for working with diverse students. This positions these students in relation to whiteness which in and of itself keeps structures in place (Gerdman, 2017). These types of policies or advocacy statements do little to actually advocate/educate employers on how their hiring practices may be racist or discriminatory. Many in the field of career counseling, have started getting requests for access to “diverse students” (Anderson, 2020). The purpose of this may be an attempt at equity, but it also begs the question of how universities and career centers are protecting their students and ensuring those workplaces are actually inclusive, as opposed to doing further harm by sending them into environments that are at best, tokenizing,and at worst, racist and discriminatory (Dali, 2018). Decentering whiteness as the norm for gauging professionalism in students can be done intentionally by career center staff and faculty without tokenizing, if staff commits to self-reflectivity and ongoing anti-bias work (Anderson,2020).
2.12: Career Technology Education (CTE)
Career and Technical Education (CTE) prepares students for career pathways in the global marketplace by offering experiential learning, post-secondary credits and industry certifications.
CTE Students gain technical and high-level academic skills,equipping them to be lifelong learners. CTE provides each student with the opportunity to develop and refine skills and applications necessary to be productive citizens. The mission of CTE is to provide industry linked programs and services that enable all individuals to reach their career goals in order to achieve economic self-sufficiency,compete in the global marketplace, and contribute to a Nation's economic prosperity (WHAT IS CAREER TECHNICAL EDUCATION?, n.d.).
These certificate based programs are often thought to be equity measures to help students find a path that can provide them with sustainable skills that will garner them steady employment without high cost enrollment fees associated with some for profit CTE programs. Community Colleges nationwide offer a variety of programs to certificate students.
Career Technology Education (CTE) may include a diverse selection of certificate programs that allow the certificated person access to employment opportunities that require specific credentials. Because this field is so large and diverse, it is difficult to describe it as one succinct field. We have chosen to discuss just three specific fields offered at many community college CTE programs: Fire Technology, Graphic Design and Multimedia Studies. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.10%3A__Business.txt |
A certification of completion in Fire Technology is designed for those who wish to make the fire service a career but do not intend to pursue a 4-year degree. Fire Technology Certificate Programs prepare students for careers in the fire service, either public or private. A basic understanding in fire protection, prevention, combustion and behavior, fire company organization and procedures, and wild land fire behavior among other areas are the basis for the curriculum (College of the Canyons, n.d.). The role of a firefighter in society is critical for maintaining public safety. Those in the field take risks most others do not, and their life saving jobs are a critical part of a smooth functioning community. While they are rightfully heralded as heroes for their bravery and dedication, the field of firefighting has a past and present steeped in racism that also deserves acknowledging. To include perspective, institutional racism is just as prevalent within the fire service as it is within law enforcement. As an academy, agency, and industry that operates under paramilitary rules and regulations, fire departments and individual firefighters work hand-in-hand with law enforcement as “first responders.” Historically, the fire service was constructed out of a place of need. The earliest evidence available marks the first female firefighter as African-American woman Molly Williams, who was held under slavery by a New York City firefighter in the 1780's. Devastating fires occurred frequently and fingers were being pointed in every community across the nation. Action was taken by the local governing bodies to officially organize people (Milligan & Ballew, n.d.). White Fire Commissioners were appointed to take charge at any fire and to conscript any and all bystanders and assign them to service, both free and slave. In 1833 New Orleans, four companies were documented:Volunteer No.1, Mississippi No.2, Lafayette No.3 and Washington No.4. It was noted in the government documentation that Lafayette and Washington were made up of "two squads of Negroes, with a colored man named Johnson at their head” and it also noted that new equipment had been purchased and placed in use by the Lafayette and Washington companies(Milligan & Ballew, n.d.).The other two companies led by whites felt they should have received the new equipment and were jealous of the black companies and filed a complaint with the city. Throughout the 1800s, people of color were documented as firefighters enlisted to white fire companies, requiring twice the amount of training time required for white firefighters. Post Civil War, firefighters of color were treated like second-class citizens and were not afforded the same opportunities as their white counterparts, despite their proven ability to outperform them (Milligan & Ballew, n.d.). In 1886 Philadelphia did hire its first black firefighter, but it was not until 1974, when Club Valiants, an organization for Philadelphia's black firefighters, sued the city in federal court for more proportional representation that Black firefighters gained access to what historically had been a white-dominated organization. Firefighters of color remained segregated until the 1960’s, and once integration was in place, documented acts of racism against firefighters of color have been numerous. Firefighters of color have had to endure micro aggressions and life-threatening racist acts across the country, such as finding that their oxygen tank has been mysteriously emptied.
In 1970 the International Association of Black Professional Firefighters was founded and as a result, first-time hires and promotions for firefighters of color were well documented across the country throughout the 80s and 90s (Milligan & Ballew, n.d.). Despite the rise in numbers of Black firefighters, racism against these heroes continued.Even as recently as 2018,a black firefighter found a noose in his locker at work. It was reported and was an expose to the New York Times followed with the headline, “I Was a Firefighter for 35 Years. Racism Today Is as Bad as Ever” (Stewart, 2018).
Today, fire academy students can find abundant racism resource pages published by fire departments across the United States, including news about how racism has been demonstrated in the fire service, as well as lawsuits and disciplinary actions related to alleged racist behaviors by fire service personnel. Racism in the fire service will be destroyed when men and women of character, devotion, and courage sit down and talk about issues that are hard to talk about. Company officers who are willing to put their crews on notice that intolerance has no place in their firehouse are more likely to successfully navigate the minefield of a race issue (Seicol, 2020).Company officers first should educate themselves about the challenges associated with taking on a discussion about race and then gather the troops around the kitchen table and actually have the conversation. Unchecked hate and discrimination obliterate essential trust that first responders need and ultimately, unchecked racism puts all firefighters in great danger. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.13%3A_CTE_-_Fire_Technology.txt |
Graphic Design Certificates at Community Colleges prepare individuals to apply artistic and computer techniques to the interpretation of technical and commercial concepts, in preparation to design websites from concept to completion. This may include basic design principles, website architecture and promotion, graphic design, web animation, audio and video production, instruction in computer-assisted art and design, printmaking, concepts sketching,technical drawing, color theory, imaging, studio technique, still and life modeling, multimedia applications, communication skills and commercial art business operations. (Cuesta College 2018).
According to the 2019 design census created by American Institute of Graphic Arts, Black people make up just 3% of the graphic design industry, while White people make up 71%. Native Americans make up 0.2%, Asian Americans 9%, and Multi-Racial reported 5%. (GRAPHIC DESIGNER Demographics And Statistics In The US, 2021).To place these numbers in perspective,note that in the 1960s only 1% to 2% of designers were Black, and that number has only increased by 1% as of 2019 data. In 1991, a landmark symposium titled, “Why is graphic design 93% White?” by the Professional Association for Design began to ask difficult questions regarding racial disparities. (The Black Experience in Graphic Design: 1968 and 2020, 2020).When we look at upper level leadership in the graphic arts industry and academies those numbers dwindle even more. In line with our country’s culture for the past 250 years, the history of graphic design stems from one dominant and white supremacist voice. The inability to bridge the gap is a failure of equity across educational institutions, industry organizations,and the design profession as a whole. To break the cycle, we need a more diverse mix of industry gatekeepers. Leaders must address the structural racism abound, in order to support disenfranchised youth who are facing these ongoing difficulties yet still have the will to succeed. The continued psychological trauma of always feeling as though they are being tied down and constantly suppressed by teachers, colleagues, clients, and the media makes their ability to create that much harder. The history of graphic design is frequently traced from the onset of moveable-type printing in the 15th century, yet earlier developments and technologies related to writing and printing can be considered as parts of the longer history of communication. After the Second World War, with the emergence of new color printing technology and particularly the introduction of computers, the art of poster-making underwent a new revolutionary phase. Unfortunately, the high costs associated with sophisticated printing processes can only be afforded largely by government entities and elite corporations, which means communities with less wealth, often those of color, have been left out of the graphic design industry altogether. While people can create color posters on their laptop computers and create color prints at a relatively low cost, the costs associated with paper, printer, ink, and design software are still considered expensive for students living on limited incomes. With the emergence of social media and the internet,the role of the infographic in conveying information among groups of ethnicities has played history-changing roles in movements like Black Lives Matter (#BLM) and Missing and Murdered Indigenous Women (#MMIW). By searching hashtags like, #SocialJustice or#MeToo, a wealth of online creators of all ethnicities are freely sharing their work on social media for the first time in history. Graphic design has become a part of daily life for people of color who engage with each other online and seek to work toward common goals. Websites like Patreon offer graphic designers a place to sell their artwork and custom created content to the general public for nominal fees, allowing a small side income to be established for artists. However, K-12 education is still based on levels of resources available, and many students of color do not have access to computers which became evident when the 2020 COVID-19 pandemic forced students to continue their education remotely. Graphic design software companies like Adobe Inc. and Canva charge fees and make money from each user. Adobe Incorporated is owned by an Indian American, and Canva is owned by an Australian woman, and both companies promote the idea that graphic design should be accessible to everyone.
Graphic design is about communication. It is about access to information. To get more information to more people, we need a greater understanding about making that happen in an equitable fashion (Korsunskiy, 2020). We need the communicators, the designers, to better represent the people they’re talking to. “Better representation means better communication,which means information is more equitably shared and knowledge is power” (Korsunskiy, 2020). The makeup of the industry needs to better reflect the makeup of our country. We need disenfranchised youth to get involved and we need design writers to seek out more inclusive stories and to help script the new equitable narrative. We need awards shows to open up entries, open up judging, and celebrate craft in all its many permutations (Korsunskiy, 2020).Ultimately, we need the people that do the hiring of agencies and companies to do the work of seeking out representation at every level of design. Contemporarily, white graphic designers appropriating designers of color with phrases like “bae” and “on fleek” is rampant across the graphic design industry as brands attempt to stay relevant to the growing racially-mixed population (Korsunskiy, 2020). As the recent #BLM protests have put more pressure on civil authorities and white-owned companies to acknowledge humanity towards people of color,this is the time for white graphic designers in influential positions to reach out to look inward to seek to address their own racial biases that prevent young designers of color from proceeding further. The people who make up the graphic design industry need to better reflect the makeup of the United States population. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.14%3A_CTE_-_Graphic_Design.txt |
Multimedia expression involves storytelling at its most advanced, whether it be for Hollywood big screens, apps on our smartphones or shiny and bright online advertising, a multimedia studies certificate affords a student entry into the world of cultural creation.According to the College of Marin Career Technical Education website,
Multimedia Entertainment Designers use design skills,equipment and technology to produce audio/video content, visual effects, 2D and 3D animations for use in video production, video games, presentations, marketing materials and educational training. They create moving visuals that excite, explain and entertain.Multimedia Entertainment Designers may work in the entertainment industry in video production, modeling or visual effect creation for movie, television, and game development. Or, they may work for schools,corporations or organizations to create eye-catching motion graphics and animations for use in presentations,marketing materials and educational training.(Multimedia–Entertainment, n.d.)
The variety and scope of what a certificate in Multimedia studies can lead to is clearly vast and highly relevant in our ever more digitally accessed world. Often, the type of imagery and storytelling afforded those who create media can and do fall prey to the tropes and stereotypes that so often perpetuate racist, sexist and heteronormative narratives. A 2015 study by Kassia E. Kulaszewicz at the School of Social Work at St. Catherine University and the University of St.Thomas St. Paul, Minnesota discusses just this and how the media influences perceptions on racism and racial biases. Historically, people of color (POC) were largely unable to portray themselves in the media. POC representations were not first-hand accounts of their own stories, beliefs, opinions, culture, or identities, rather an imagined creation by those who controlled the industry. The media was, and in most parts, still is, controlled by white elites at the head of media corporations, who have been able to solely dictate how people of color were portrayed in films, the news, literature, and other forms of media. The research done by Kulaszewicz also incorporates Bandura’s Learning Theory to understand how media messages can influence beliefs and values in the same way Bandura (and many others) postulates that social behaviors can be learned through others. (Kulaszewicz, 2015).
It is important to know what information is available to media consumers, and how the information consumed shapes, influences, and impacts individual agency, as well as thoughts,beliefs, and behaviors towards people of color. Kulaszewicz specifically focuses on the perceptions, stereotypes, racial micro aggressions, and perceived racial differences of African American males and finds that the skewed or limited information provided by media about a group a viewer otherwise does not have contact with leaves them only with what is provided in the media they consume which is often partial and filled with racial stereotypes (Kulaszewicz,2015).
Language or word choice is also of significance in terms of how stereotypes and racists beliefs are constructed in the media. The use of identifier word patterns, using the words “black” and“white” to depict things either seen as positive or negative help shape racialized beliefs.Onaverage, the word “black” is used three times more than the word “white” in the news. The constant usage of the word “black” in a negative connotation can extend into a micro aggression, as it conditions and socializes the mind to correlate the word to negative thoughts and ideas (Kulaszewicz, 2015). Black men are often criminalized in the media, and the research revealed patterns of criminalization and justification for this criminalization in the stories we are told. In contrast, in the case of police brutality, when a White officer shoots or commits other excessive and unnecessary acts of violence against a Black man, the officer and their actions are supported regardless of their own criminality. The research suggests that a correlation exists between the media and racism; specifically, media that reinforces racism and perpetuates racial stereotypes, thus exacerbating systemic inequality and racism (Kulaszewicz,2015). As multimedia students and scholars undertake re-imaging imagery and storytelling, they have an obligation to commit to changing the narrative so often found in mainstream media. Only then can we move past the damaging ways in which our systems of media have solidified the structures of racial and gendered inequality. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.15%3A_CTE_-_Multimedia_Studies.txt |
Chemistry is the branch of science that deals with matter and how it changes. This includes the identification of substances composed of matter, the investigation of atomic and molecular properties and the ways in which they interact, combine, and change, as well as the use of these processes to form new substances. The field of Chemistry, as with the majority of the Science, Technology, Engineering and Math (STEM) fields, is permeated with an historical legacy of structural racism.
In 2020, a conversation took place during #BlackInChem week about the lack of representation in the field and micro aggressions felt by Black Chemistry students. Looking at ways to address this involved surveying students of color in the field of chemistry about their experiences and what steps they perceived would be helpful. Many students cited a need for effective mentorship not just from faculty, but peer mentorship as well. They also stressed the need for greater financial support to allow them to devote time studying rather than working side jobs in order to survive. When students come from families that do not have prior experience with higher education, perhaps they are first generation college students, they also need help navigating the educational system (Remmel, 2020 12:15). Mentorship can come from internships in industry or research with faculty members in their academic labs. There has been funding put in place to target diversity in STEM via both of these types of Mentorships. Also knowing about scientists of color is empowering for students. Teachers have an opportunity to highlight those individuals as a part of their curriculum. The Marberger STEM Center at Lawrence Technological University (https://www.ltu.edu/stem-center/) is a great resource for STEM faculty wishing to make their teaching more inclusive. It is important to note that the responsibility of diversifying the field cannot just fall on the Black scientists but rather a united effort on the part of all scientifically minded educators and researchers.
What will become clear as you read through this primer is that representation matters. It is important both for students of color and women to see themselves in their fields of study, so hiring practices in chemistry should reflect that goal. Additionally, for those faculty who do not represent the demographic of their students, it is important to highlight prominent thinkers in their field that are not just white men. In an effort to learn more about the history of Black Chemists here we highlight the first African American to earn a PhD in Chemistry.
Born in Louisville, Kentucky in 1884, Saint Elmo Brady became the first African American to earn a Ph.D. in the field of chemistry when he completed his graduate studies at the University of Illinois in 1916. Brady studied chemistry at Fisk University in Nashville, Tennessee and earned hisB.S. degree in 1908. After graduation he accepted a faculty position at Tuskegee Normal and Industrial Institute (now known as Tuskegee University) and was mentored by George Washington Carver and Booker T. Washington,President of Tuskegee. He began graduate studies in the Department of Chemistry at the University of Illinois in 1912, earning his M.S. degree in 1914 and completing his doctorate in 1916.
As a graduate student at Illinois, Brady’s research focused on the characterization of organic acids. Brady eventually published three abstracts focused on his graduate work in Science, a prestigious peer-reviewed journal.After completing his doctorate, Brady returned to Tuskegee and continued teaching until 1920. He also served as chair and faculty of the Department of Chemistry at Howard University and Fisk University. (Collins, 2007).
In the summer of 2020, the president of the American Chemical Society (ACS) issued a statement in response to the killing of George Floyd. As one of the world's largest scientific organizations they felt the use of their platform to connect the field of chemistry to social justice and structural racism was important (Echegoyen, 2020). There is an acknowledgement on the part of the American Chemical Society (ACS) that their publications do not represent enough diversity of voice and they released this statement denouncing racial violence. They, like other academic organizations, have committed to a number of first action steps including a commitment to diversity of journal contributors as a part of the evaluation of the Editor in Chief(Advancing ACS’, nd). Placing the task of ensuring diverse representation in the publication they edit as a part of their job performance ensures accountability and the outcome is easily measurable. In order to do so, it will be important to circle back to see how this equity work shifts the demographics of the field. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.16%3A_Chemistry.txt |
The study of communication in academia examines the process of human communication cutting across socio-economic, political, and cultural contexts, dealing with how meaning is generated in different communication settings (“What is Communication Studies”,n.d.). Racial inequalities and the colonial legacies of white supremacy permeate scholarly and public discussions in the field of communications (Chakravartty et al., 2018). As part of an ongoing movement to decenter white masculinity as the normative core of media and communications, white women were once considered the only diverse component on American TV screens.
In analyzing the demographics of who graduated with communications degrees in 2019, about 56.1% of degrees were awarded to Whites, 15.7% to Hispanics, 11.6% to Blacks, 4.19% to Asians, 0.318% to Native Americans, and 4% reported mixed racial identity (“Communications”, n.d.). Given the central role of universities in social reproduction, and in the creation and legitimation of knowledge, equity and its place in higher education are a subject of significant interest in both social movements and scholarly critique across the United States. However, not only do the demographics of educational degrees not represent our country as a whole, the publication of authors and scholars of color is also vastly disproportionate. By coding and analyzing the racial composition of primary authors of both articles and citations in journals between 1990–2016, one study found that non-white scholars continue to be underrepresented in publication rates, citation rates, and editorial positions in communication studies (Chakravartty et al., 2018).
White supremacy has a habit of finding opportunity in new innovations in media, technology,and communications. In the shift from the print-only-era to the Internet era we see the distinct advantage wealthy whites had over students and faculty of color. White supremacists understood this period of innovation early on, and saw ways to exploit it to further their ideological goals (Daniels, 2019). The 1915 film Birth of a Nation,directed by D.W. Griffith,premiered, giving white supremacists an opportunity to parade outside the theatre in celebration of their group’s rise after their defeat in the Civil War (Daniels, 2019). Griffith also premiered his film at the White House for Woodrow Wilson, who is quoted in the film and stated that it is,“history writ with lightning” (Daniels, 2019). With these new avenues of publication for their ideologies, the KKK began to create film companies and produced more films to be screened at events, churches, and schools, obtaining an estimated five million members by the mid 1920’s (Daniels, 2019).
Almost a century later, another generation saw the same potential to spread white supremacy in digital technologies. As Derek Black, son of Don Black (founder of Stormfront, a white supremacist website), said in a recent interview with Michael Barbaro on The Daily podcast,reflecting on his childhood in the 1990s, they were a family of early tech adopters, always looking for innovations that they could exploit for the cause of racism:
Pioneering white nationalism on the web was my dad’s goal. That was what drove him from the early 90's, from the beginning of the web. We had the latest computers,we were the first people in the neighborhood to have broadband because we had to keep Storm front running,and so technology and connecting people on the website,long before social media. ...When I was a little kid, I would get on chat rooms in the evening ... and I had friends in Australia who I would talk to at a certain hour ... I had friends in Serbia I would talk to at a certain hour (Barbaro, 2017).
Stormfront’s successful global reach initiated more online white supremacist sites such as, The Daily Stormer, now the largest global neo-Nazi website with servers based in the U.S., run by Andrew Anglin and Andrew Auerbheimer (Daniels, 2019). In the years of early Internet, there were no gatekeepers as there were in broadcast news and print media, so the new virtual world acted as the perfect platform for white supremacists to create and disseminate racist propaganda (Daniels, 2019). For example, Stormfront’s motto stated, “white pride worldwide”(Daniels, 2019).
However, as communications is not limited to the internet, we must take a look at the leaders of linguistics, such as it’s governing body, the Modern Language Association, (MLA). It is prevalent in America today that masses of people harbor negative assumptions about the different ways other people speak.
Before the eighteenth-century speakers like Chaucer and Shakespeare used double negatives commonly, but they are now socially unacceptable (Luu, 2020). African Americans who speak in what is known as African American or Black Vernacular English (AAVE or BVE)have been stigmatized as uneducated by using double negatives and other grammar not typically used in standard American English (Luu, 2020).People who speak dialects that are not considered standard, or mainstream face several challenges like, renting an apartment, getting job interviews, and interacting with police because many people harbor negative assumptions based on how one may speak (See also the section on English for a discussion on this) (Luu,2020). Western linguistics, particularly its study of Eurasian languages, arose against a background of Eurocentrism, colonial racism, nationalism, and related theories, later espoused by Nazism and other White Supremacy movements. Significant traces of this racism remain in contemporary western linguistics, casting a dark shadow over how the world is viewed by those educated by the American educational institutions.
In 2021, the MLA held two panels titled “Decentering Whiteness,” with one panel for scholars of color and another panel for scholars of white heritage (Flaherty, 2020). Several postcolonial literary theorists have drawn a link between linguistic discrimination and the oppression of indigenous cultures. Prominent Kenyan author Ngugi wa Thiong'o argues in his book "Decolonizing the Mind" that language is both a medium of communication, as well as a carrier of culture (Kamoche, 1987). As a result, linguistic discrimination resulting from colonization has facilitated the erasure of pre-colonial histories and identities (Kamoche, 1987). If we are to achieve true equity in the United States, we must rewrite the relationship between race,language, and racism, which plays such a key role in reflecting and defining the way our society is structured. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.17%3A_Communication_Film_Speech.txt |
Computer Science is the study of computation, algorithms, and technologies, as well as their impacts on society and applied uses. In an ever evolving world, Computer Science is one of the main theses of the STEM argument that technological innovation sets the basis for the rest of society. The use of technologies such as facial recognition technology, artificial intelligence, and automation, have potential for vast changes in society. However, it is not guaranteed that these changes will prove positive for society.
In June 2020, introspection and reflection arose with fervor in the wake of the murder of George Floyd. This held true throughout academia, including the field of computer science. A cohort of Black computer scientists, including professors from the University of Michigan, wrote an open letter calling to combat and end racism within the discipline, in which they discussed the history of inequity, and asked for a role in establishing fairness and equal opportunity, as well as equal partnership and representation within the leadership in the field (McAlpine,2020). In a nation that was built on discrimination and white supremacy, no facet of the society is spared, and this includes Computer Science and the increasingly advanced technological innovations. Artificial intelligence and Big Data continue the cycle of inequality and specifically target historically marginalized people of color. While technology is praised as a tool of societal advancement, these same technologies marginalize and disrupt communities of color with racial profiling. The letter articulates multiple offenses in Computer Science education. From micro aggressions such as black students being harassed and followed while accessing research and computer labs, to being told they do not fit industry culture, students face challenges on the basis of their race in addition to all the other everyday challenges of higher education. (An Open Letter, 2020).
Innovations such as AI (Artificial Intelligence) and Big Data are continuing to target historically marginalized communities. Algorithms systemically segregate decisions such as admissions, housing, hiring for jobs, and more. Facial recognition technology and machine learning label Black people as criminals, leading to automated racial profiling. There is a historic connotation of police and law enforcement labeling and stereotyping Black people as criminals and outsiders who do not belong. This has held true over the decades, even at universities. Many colleges have looked to automate their methods to determine who belongs on campus,and who does not and may be a criminal.
The University of California, Los Angeles (UCLA), one of the first colleges to utilize facial recognition, decided to use the technology to identify people in the view of the cameras dispersed all throughout campus. The nonprofit organization, Fight for the Future, decided to mirror UCLA’s actions, and found harrowing results. The organization used Amazon facial recognition software Recognition, and compared over 400 members of the community,including faculty members and student athletes to mugshots from a large scale database. This test returned 58 false positive results, connecting students and faculty with people who were identified as criminals in the mugshot database. The most common misattribution occurred with people of color, and many times, two people with nothing in common beyond race were identified as the same person with “100% certainty” (Jones, 2020).
Furthermore, Daniel Neill and Will Gorr, two researchers at Carnegie Mellon University,developed a software tool named CrimeScan. CrimeScan was designed to be a crime-predicting aid (Rieland, 2018). The pair asserted that crime can have a “gateway effect,” and that smaller scale crimes serve as a predictor for more serious crimes in the future. These programs also frequently rely on past police data. By using historical police data that is built on racial biases,further feedback loops are built that continue the same cycles of race based policing. Certain neighborhoods are deemed as “good” and “bad,” and this causes arrests and policing based on Artificial Intelligence to be even more at risk of bias, as they are based on police decisions, not actual crimes (Rieland, 2018).
Another ethical query arises: if a tool raises more expectations for crime in a neighborhood, will this in turn increase police aggression in said neighborhood? And if this is the case, will this give more data that confirms the current AI bias? Several organizations, such as the Brennan Center and the ACLU, have also posed questions about flaws in the AI systems,and biases being programmed into the system.
Timnit Gebru is a computer scientist who specializes in artificial intelligence, and the former co-lead of Google’s ethical AI team, until she reported being forced out. Gebru coauthored a revolutionary article that discussed that facial recognition was significantly less accurate at identifying women and people of color, which can lead to discrimination against them (Hao, 2020). Based on records including articles, tweets, and emails, Gebru’s article was met with disdain from her colleagues, specifically, Jeff Dean, the head of AI. According to Dean,the paper failed to meet the expectations set for publication.At least 1,400 Google staffers and 1,900 others have signed letters of protest, and several other prominent AI and ethics figures argued that Google forced her out because of her role in raising queries on the ethical application of artificial intelligence, and other forms of advanced technological innovation.
The discriminatory aspects of technology exist in subsects beyond artificial intelligence,such as machine learning, hiring algorithms, and even healthcare. The organization, Black in Computing listed several actionable items to promote change and equality in the field. These items include, but are not limited to supporting underrepresented students, improving workplace and academic environments, and changing outdated policies and procedures (Action Item List, nd). Technology is ever evolving, yet it must also evolve in an equitable and just direction, or else society risks falling into a dystopian world like those found in science fiction. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.18%3A_Computer_Science.txt |
Early childhood education (ECE) consists of activities and/or experiences that are intended to support developmental growth in children prior to their entry into elementary school (“Early Childhood Education”, n.d.). The discipline helps educators who are entering the field have an understanding of the developmental stages of children and their lived experiences. It explores the various stages and how childhood experiences, both positive and negative, affect development. In many ECE degree programs, students take courses dedicated to some type of diversity awareness; however, current biases towards young children of color in ECE programs remain. Lack of cultural competency on the part of scholars and educators in the field have created a situation in which very young children are being sanctioned for not fitting the mold put forth by educational standards and policies. Children who act out, fail to use their words, or demonstrate what is often developmentally appropriate but unpleasant behavior, are being treated in a developmentally inappropriate way. Early childhood educators are tasked with scaffolding skill building to students who are just beginning their engagement with society, and the teacher’s role to guide them is a powerful one. We are witnessing children not receiving nurturing guidance but rather, punitive interventions that do not help them learn from their actions. An example of this is suspension and expulsion of children as young as 3 years old.
An opinion paper by Dr. Dolores Steglin, Senior Fellow at The Institute for Child Success and Professor Emerita at Clemson University, examines this alarming trend and the problems associated with it (Stegelin & Emerita, 2018). At present over half the states allow for expulsion of preschool aged children. However, “recent legislative efforts to address school discipline policies have focused on: restricting expulsion and suspension by grade level and infraction;limiting the length of exclusion; implementing and enhancing reporting mechanisms; and strategies to re-engage the student and family” (Rafa, 2018). The use of suspension and expulsion at the preschool level is higher than K-12 and over 40% of those expelled are African-American boys (Dobbs, 2005). These early experiences in the educational system affect how students fare in school going forward so this practice has long lasting consequences. So why are these practices taking place at such a high rate and why are they disproportionately affecting very young (3-4 year olds) students of color, in particular Black boys? A tool used in ECE, Early Childhood Discipline Policy Essentials Checklist (ECDPEC) found “that most early childhood program discipline policies fail to sufficiently address those essential features known to contribute to reducing challenging behavior and promoting pro-social behavior in youngchildren.” (Longstreth, Brady, & Kay, 2013). The authors of the study go on to provide a framework for decreasing the uses of suspension and expulsion which can be attained by teacher practices of cuing into socio-emotional development. In fact the role of the teacher was shown to be key in student success.
This study provided helpful information on specific practices within preschool classrooms that are likely to lead to decreased or increased rates of preschool expulsion and suspension. This study also confirmed the importance of environmental factors and positive teacher-child interactions in reducing rates of preschool expulsion. This study serves to validate the importance of providing program support in the areas of social and emotional development as well as focused interventions for children with special needs and/or mental health issues (Longstreth,Brady, & Kay, 2013).
Implicit racial bias on the part of teachers also plays a role in the treatment of their students based on their race or ethnicity and the levels to which they will address what can be considered discipline worthy behavior. A way to offset this is to train culturally competent teachers working in classes that are not overcrowded and underfunded. Early Childhood Educators (ECEs) are often the first non-familial adults to interact with the children in their care. This is a pivotal time for students to learn social norms and practice behaviors. Research conducted using the Adverse Childhood Experiences (ACES) measurement scale suggests that the impact of preschool expulsion and suspension can lead to:
Early trauma on the child’s later development and the relationships between early trauma and associated health conditions, both physical and mental. As such, expulsion and suspension practices in early childhood settings–two very stressful and negative experiences young children and their families may encounter in early childhood programs–should be prevented, severely limited, and eventually eliminated. (Felitti et al., 1998; U.S. Department of Health & Human Services, n.d.).
Policy work is being done both within certain states and on a national level to reduce or remove the use of expulsion and suspension as a tool for ECEs while also helping young children develop their socio-emotional skills effectively. This involves implementing policies without bias, involving families, hiring a highly skilled workforce, transparently stating goals, and collecting data to measure success (Stegelin & Emerita, 2018) Children are apt to stumble along the way and the role of the teacher is to guide and redirect, not punish and disregard them. By doing this, a child is forever wary of a system that was supposed to teach them but instead failed them. Rather than expulsion or suspension, ECE’s can look for ways to reach children in an effective way that helps them navigate social rules and norms. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.19%3A_Early_Childhood_Education.txt |
Economics is a social science concerned with the production, distribution, and consumption of goods and services. It studies how individuals, businesses, governments, and nations make choices about how to allocate resources. Allocation of resources for national prosperity and growth sets a foundation for the nation's success (Hayes, 2020). Ethos like rugged individualism and ironically, pulling yourself up by your bootstraps, which is of course impossible, serve to enforce a myth of meritocracy that allows for judegment to be cast for those who do not fit the societal perception of “success,” and make it harder to identify the ways in which this myth is harmful to individuals and the larger society. When only some of a nation’s population are economically secure, the entirety of the nation and its future is at risk.
The United States has a particular problem with income inequality and the ways in which economists address these matters. In most fields of study, disaggregation, the breaking down of differing variables of data, is needed in order to see patterns often masked by aggregate data. Traditionally, the focus of economic measures has been on aggregate success/failure of the economy, but when you disaggregate you get to see a clearer picture of who is economically successful and comfortable and who is not. Disaggregation shows that economic prosperity and hardship falls down racial lines. Using this data to create economic policy is where the most economic impact can happen if programs are then targeted based on the data. Typically, neoliberal approaches seem to still permeate the field of economics. The notion that“a rising tide lifts all boats,” has not proven to be the case. Inequities of employment, income, and wealth persist for Black Americans no matter their educational attainment. In, How Economic Assumptions Uphold Racist Systems, Gamble (2020) writes, “Even if economic growth lifts all baseline living standards, persistent inequity, even at a higher standard, is still unjust”(Gamble, 2020). According to Gamble, there is a need to interrogate assumptions made about economic research and pedagogy in order to address racial wealth disparities, specifically:
●The assumption that value equals price. Taking the example of essential workers under Covid-19 times. While classified as such, they are often underpaid by comparison and predominantly made up of people of color. Market power of employers, outdated labor standards. and lack of union organizing all contribute to this. As a result, “the wealth gap between Black and white families is as wide now as it was in 1968. And extreme wealth, which is overwhelmingly white,has increasingly more control over political agendas as inequality increases.”
●The assumption that behavior represents the independent and rational preferences of individuals. This assumption does not sufficiently consider history, power and institutions in the shaping of behavior (Gamble, 2020).
These lived understandings of economics and the ways in which inequality plays out are missing in the neoliberal approach. Economists Anna Gifty Opoku-Agyeman and Fanta Traore wanted to know the percentage of Black women in the field. What they found is that it has been declining since 1995 and there are very few, 4% of all Economics BAs and 0.5% of all PhDs are earned by Black women. There is only 1 Black woman economist at the federal reserve out of a total of 409 economists, which raises questions regarding economic and fiscal policy making(Weingarten, 2020). This lack of representation prompted Opoku-Agyeman and Traore to form The Sadie Collective, an organization which works to get more Black women into economics related fields by illuminating the many roadblocks they face and attempting to remove those barriers. They cite structural racism in the field as the reason the discipline is so white. A future with more economists of color will have major implications on the lives of Black and Brown people. These future economists will be part of the financial decision making and have a voice and role regarding future fiscal policies. In the past, this has not been the case, and recessions have hurt marginalized communities at a significantly greater rate. By placing Black women in positions of prevalence and authority, our society begins to allow for representation of voices that are typically left out of economic policy discussions (Weingarten, 2020).
A White Paper was created by The Sadie Collective to address the need to diversify the field. This white paper addresses how to use financial commitments from high profile corporations and the newfound awareness of the racial inequity to upend systemic racism and improve access for underrepresented groups. Education statistics show that Black women in particular are underrepresented in the fields of math, economics, accounting and finance.There must be a commitment to cultivate a pipeline for Black women that begins earlier than their college careers to expose them to opportunities in these fields and support them along the way (The Sadie Collective, 2020). As there are few Black women majoring in these fields, in turn, there are few of them working in the corresponding professions. The global pandemic disproportionately hurt Black women who now sit at over 12% unemployment rate, much higher than the national average(Weingarten, 2020). Add on structural racism being evidenced lately by police killings of Black women further disadvantages them. The corporate world is at acritical juncture as it seeks to find ways to bring Black women into the field.The paper cites specific barriers to Black women’s entry into the field:
● Access to Information
● Discrimination in the Field
● Lack of role models
The Sadie Collection is a valuable resource for changing this. They offer a network of over 1000 Black women and allies in the field, offer mentorship, host conferences and create and partner on other vital outreach measures.
They offer two key ways to address the pipeline problem:
● Adopting the Black Women Best Framework
● Allocating Annual Funding for Black Women Led Initiatives That Support The Pipeline
The corporate world is at a turning point along with much of the nation and The Sadie Collective seeks to center Black women as a part of the change (The Sadie Collective, 2020). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.20%3A__Economics.txt |
Engineering is the applied use of mathematics and sciences, including chemistry and physics, in order to complete tasks such as building structures, parts,infrastructures, and machines. In a society like the United States, where constant growth, innovation, and improvement is expected, Engineering is nearly always promoted to students, especially those with interest or aptitude in math and science classes.In large part, this has led to the “STEM or Starve” narrative, where majors included in the STEM fields (Science, Technology, Engineering,and Mathematics) are viewed as superior, as they are those fields with the most applicable and profitable value. This mindset is dangerous for several reasons, including its exclusion of other disciplines such as social sciences (which, despite being sciences, are not included in STEM), less applied forms of traditional sciences, and the arts.
Engineering design and build has a direct impact on the structure of the world. Like other disciplines, Engineering is also a predominantly white male driven industry and field of study,and there is little representation of women or a variety of ethnic minority groups. Over the last 30 years, the overall number of bachelor’s degrees awarded to Black scholars has increased. However, in engineering disciplines, the proportion of Black students who receive degrees has maintained a consistent rate of roughly 4% (Patel, 2021). An article by the Hechinger report provides additional information and statistics. The National Science Foundation, (NSF) found that from a 15 year window spanning from 2001 to 2016, Bachelor of Science (BS) degrees in engineering earned by Black students declined from 5% to 4%, and mathematics degrees earned by black students decreased from 7% to 4% (Newsome, 2021). Despite the supposed demand and need for massive increase in STEM educated students, the disciplines seem to be regressing in their mission for diverse inclusion.
Microaggressions also are a frequent occurrence for ethnic and racial minority STEM students. Amida Koroma entered the University of Maryland as a Bioengineering student, and was a regular recipient of honors such as the Dean’s list. She reported that often, white students would undermine her, and rather than allow her to take on hands-on roles, assign her to tasks such as typing and recording. This cycle eventually led her to become so frustrated that she decided to change her major to Psychology, thus turning away from Bioengineering.(Newsome, 2021) An article published in the International Journal of STEM Education further described these racial microaggressions (RMAs) within the disciplines. The research involved a survey of 4800 students of color, with a STEM subsect of 1688 students of color. The study found that on a campus, academic, and peer level, microaggressions were a significant factor in the lack of students of color within the STEM majors. Students in the survey also reported that being the only, or one of the only students of color within STEM classrooms led to feelings of isolation, loneliness, and invalidation. This creates a self-fulfilling prophecy, and because STEM students of color feel alone, they are less likely to enroll in and stay within the field, which leads to lower levels of representation and increased feelings of isolation and non representation (Lee, Collins, et. al, 2020). College enrollment as a whole for Black students was on the decline as well. As of Fall 2021, Black freshman enrollment was down 7.5%, and their decline in enrollment was greatest at two year, public colleges, or community colleges, which are often heralded as great equalizers due to their affordability and accessibility (Lee, Collins, et. al,2020).
Beyond bachelor degrees, advanced degrees in engineering are also riddled with inequity and environments of hostility. Brian Burt is an assistant professor at Iowa State in the School of Education, as well as the lead author of a research article which describes a graduate engineering degree for Black men as “riding out a storm” (Hunt, 2020). The metaphorical storm, as Brian Burt describes it, represents the tensions and struggles these young men face as a result of structural inequalities, and faculty who are largely either unwilling or unable to support these underrepresented students through the storm (Hunt, 2020). On a societal level,there is a belief that success and failure are representations of individual character, and so there is a belief that students who drop out of an engineering program do so because they are not smart enough or are otherwise incapable of success. However, that explanation relies on individual flaws, when actually and the main challenges that students faced were systemic and structural, not individual, and thus out of their control.
Marcus, a third year student in the program stated, “People are naturally going to want to be around people who look like them,” and that, “As a Black man in engineering, I don’t have that camaraderie. So, I am forced to immediately look outside of my comfort zone in order to find people who I can study with, talk with, and have overall support” (Hunt, 2020). This lack of camaraderie from peers with similar experiences can exacerbate feelings of isolation and feeling a lack of belonging. Some students even reported that they considered leaving their programs due to this feeling and a lack of support. Students further reported receiving discouraging messages from advisors, which ranged from passive aggressive slights to explicit challenges about the student’s ability to conduct doctoral level work and research.
The disparity in engineering does not end in the classrooms. From a salary perspective,pay inequality is rampant. On average, a white worker with a bachelor’s in engineering earns\$90,000 a year, while Black workers with graduate degrees earn an average of \$87,000 (Patel,2021). In order to improve equity in the discipline, there are several actions which can be taken.First, universities can improve recruitment by admitting more Black students, and take steps to improve retention. For example, establishing learning communities for underrepresented students provides a sense of belonging and support for underrepresented students. Universities and individual departments can also help students learn to be culturally sensitive and aware. Free college is also a fair and, given the value of education, realistic suggestion.
Underrepresented students, especially first generation students, do not have the familial and generational resources to attend college on their parents' dime. This forces students to combine working part time or even full time jobs in addition to being a full time student, while also trying to pursue personal and career experiences. This can create near insurmountable amounts of pressure, and make it more difficult to secure internships and career opportunities. Service learning and paid internships may also prove beneficial, as they would provide for cultural capital and financial relief for students. Engineering, like the larger entity of higher education, has a need to improve equity and opportunity for all students. The future of our nation and innovation may depend on it. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.21%3A_Engineering.txt |
English is the study and delivery of the English language in context. It is a required gateway all must pass in pursuit of higher education in the United States. The discipline is meant to standardize language and writing of students so that their work may be evaluated in relation to what is considered English as defined and maintained by those in the field. This is oftentimes where problems arise. In many of the sections in this reader, a discussion about who controls the creation and maintenance of knowledge and thus what becomes standard is being described. In this particular field, racist ideas about what standard English is have dominated the field since its inception. Many academics in the field are making the connection between language and white supremist ideals of “proper” English. Those academics seek to dismantle and re-examine current rules about what is acceptable in an effort to include a larger swath of language used in the United States (Baker-Bell, 2020).
In the wake of the murder of George Floyd, an unarmed Black man by Minnesota Police Officer Derek Chauvin who placed his knee on Mr. Floyd’s neck, killing him in front of witnesses and filmed by a courageous bystander for the whole world to see, an awakening took place by those who were previously unaware of the ways in which structural and individual racism plague the lives of Black, Indigenous, people of color nationwide. While many more named and unnamed individuals have also been killed by law enforcement, his death served as a rallying cry for justice. As stated throughout this document, academia is also guilty of racism and is rooted in white supremacy. Many academic disciplines felt moved to respond to this and commit to do better. English, like other areas of study, always had within it, faculty who were long time spokespeople to shift this norm and have been having conversations about how to address this. Now that racial justice is in the spotlight, many are demanding change.
A position statement by the Conference on College Composition & Communication (part of the National Council for Teachers of English, considered by many the most significant professional organization for faculty in English) identifies specific ways in which structural racism has been built into the teaching of the English language. The authors provide a list of demands that need to be considered in an attempt to facilitate Black Linguistic Justice in the wake of the Black Lives Matter (BLM) Movement. Included in this list are: issues surrounding framing academic,“standard” English as the norm, and acknowledging that this is a social construction which is entrenched in white supremacy and which forces many Black students to code switch. Also adding more authors of color to curriculum, and insisting that academia address anti-Blackness as endemic to how language functions. Lastly, an examination is required of how English/education has been historically situated, and how college writing has been actively constructed.
It is a call to faculty in English to stop positioning White language as the standard English and to do much better in their own self-work in order to challenge the multiple institutional structures of anti-Black racism used to shape language politics (Baker-Bell, 2020). This type of engaged pedagogy that employs a variety of acceptable language including Black Vernacular English (BVE) can be liberatory for students and faculty who are so often marginalized.
An unbroken connection exists between the broken English of the displaced, enslaved African and the diverse black vernacular speech black folks use today. In both cases, the rupture of standard English enabled and enables rebellion and resistance. By transforming the oppressors' language, making a culture of resistance, black people created an intimate speech that could say far more than was permissible within the boundaries of standard English. The power of this speech is not simply that it enables resistance to white supremacy, but that it also forges a space for alternative cultural production and alternative epistemologies-different ways of thinking and knowing that were crucial to creating a counter-hegemonic worldview. (hooks, 1994 p.171).
In reality, much of our pop culture and political slogans originated from BVE. For example, “Stay Woke,” which has been changed to “Woke,” which has been in turn co-opted into a negative term by more conservative groups.
The English Department at Loyola University released a response to the killing of George Floyd and their commitment to do better. Their statement summarizes the connection of literary canons to whiteness and the English discipline’s roots in imperialism and Eurocentrism. They list 5 affirmations:
• Black lives matter.
• Racism is based in white supremacy.
• Literature and literary canons have been used to validate white supremacy.
• All spaces at the university, including our classrooms, should be inclusive and welcoming to all BIPOC students, staff, and faculty.
• Systemic inequity exists, and confronting racism requires that we actively facilitate conversations about it in the classroom (English Department's Commitment, nd).
They go on to explain how they will keep this commitment including reinstating a tenure-track faculty position in African American literature and continuing educating themselves about anti-racism and engaging as a department in discernment (English Department's Commitment, nd). The University of Chicago affirms a commitment to BLM and states they will only admit graduate students specializing in Black Studies for 2020-2021. Further, they acknowledge that, “English as a discipline has a long history of providing aesthetic rationalizations for colonization, exploitation, extraction, and anti-Blackness” (Faculty Statement, 2020).
Although indirectly tied to English as a discipline, the publishing industry is closely connected to creative writing programs, which typically fall under English. Those programs have proliferated immensely in the past few decades, particularly in graduate programs, but the realities of the publishing world mean creative writers of color are less likely to find equity in the process of getting published (So, 2020).
Publishing is mass marketed to white audiences more than people of color. This continues in academia, as English faculty feel obligated to only “ teach the classics,” and not highlighting important creative writers of color. This leaves English students with a false understanding of who the great English thinkers and writers are. In efforts to offset this, there are writers of color workshops, meet ups and Instagram sites like "black girls read", Voices of Our Nations Arts Foundation (VONA), and The Root, which highlight writers of color (Wabuke, 2015). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.22%3A_English.txt |
English as a Second Language (ESL), courses at U.S. institutions are designed to help non-native English speakers learn English. At many colleges they are split into credit bearing and non-credit bearing units students take. Beginning to advanced noncredit ESL classes take an integrated skills approach, practicing the fundamentals of grammar and vocabulary for everyday and employment situations through listening, speaking, reading and writing activities. These classes help students improve their English so that they can communicate in their everyday life. These classes are often offered for free. The intermediate and advanced level classes which are credit and cost bearing are more skills-focused and relating to employment and academic scenarios. Offerings include separate classes for grammar and writing, reading and vocabulary, listening and speaking, and pronunciation (ABOUT ESL PROGRAM, 2021).
Without a mastery of some level of English, survival in the U.S. is more difficult. While there are many aspects of social structure that have information available in multiple languages, there are situations in which without a basic understanding of English, navigation becomes difficult. The decision to learn English for many non-native speakers often involves subtle ways in which these students are forced to give up some of their native culture in order to assimilate into American society. Managing two cultures can be difficult and this is why for students whose home culture matches what we might call dominant U.S. culture (tracing its roots from White Anglo-Saxon Protestantism) college curriculum has always been more reflective of what they already know.
Having to pivot from your home culture to the one most prominent in higher education is extra work that middle and upper class white students do not have to do. Additionally,perceptions surrounding a failure to integrate and navigate society "properly" (per expectations) can lead to ostracization and discrimination. Along with that, extra learning also sometimes comes with a value judgment that non-native speakers often feel as new students.ESL teachers who are not culturally competent can, whether intentionally or not, impose their cultural bias on their students, making them feel like their culture is not as important as the dominant white culture. Experts in the field stress the importance of having ESL students express values,beliefs, and norms from their home culture as well as trying to adapt into American society. Oftentimes, there is an assumption that immigrants need to assimilate into their new society to be accepted. However, forced assimilation is not the best practice for English language learners. Assimilation should not be the end game if it means losing one’s roots.
ESL classes and the work that come along with them is a process that many non-native English speakers must go through in order to have the possibility of being accepted by society. ESL classes play a vital role in the assimilation process that many immigrants undergo in order to live their lives and even when doing so they still may not be accepted and sometimes face discrimination. Rather than demanding that ESL students change to fit into the culture, it is important to help new students learn English, while also honoring valuable knowledge that they carry with them from their home countries. Some recommendations for ESL teachers are to engage in open dialogue, invite student’s families into their educational life, as well as embrace and validate their cultures. It is critical for students to feel that every part of them is being accepted. Students shouldn’t feel that they must assimilate and lose part of themselves just to be able to obtain acceptance into U.S. society. The role of ESL classes cannot be just to assimilate people into society. Instead, it must also incorporate the many beautiful things that students in ESL classes bring from their home cultures. Society at large is richer with the embracement of the diversity of a nation of immigrants and the varied cultural bricolage that have developed. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.23%3A_English_as_a_Second_Language.txt |
Environmental Science is defined as an “interdisciplinary academic field that draws on Ecology, Geology, Meteorology, Biology, Chemistry, Engineering, and Physics to study environmental problems and human impacts on the environment” (Kte’pi, 2014).Environmental Science provides knowledge and learning across several disciplines to create amore holistic understanding of human interaction with the planet and atmosphere.Environmental Science is a field with an inherent impact of the intersection between society,the environment, and human survival. In fact, in the face of an impending environmental crisis,Environmental Conservation and Innovation are among the most needed fields for overall species survival.
In spite of this fact, Environmental Science is one of the least diverse STEM fields. While African American account for 13.6% of the U.S. population, they received just 2.8% of Environmental Science degrees awarded in 2016 (Ruf, 2020). This disparity and underrepresentation has been questioned multiple times, and rather than recruit minority students, or conduct research to find insights on why this disparity exists, universities, faculty,and administration choose another explanation, stating that “People of color are not interested in the environment” (Ruf, 2020). This narrative is a generalization and oversimplification that fails to accurately convey reality.
In 2018, the Proceedings of the National Academy of Sciences (PNAS) concluded that both white people and people of color associate the term “environmentalist” with a white face,and that both demographics also underestimate the environmental concern felt by racial and ethnic minorities. Despite being perceived as the least environmentally sensitive, all survey edminority groups (Native Americans, African Americans, Latinxs, and Asian Americans) reported greater levels of environmental concern than white people (Ruf, 2020). This evidence is further supported by the disproportionate effects of climate change on communities of color. In a 2020 article entitled, People of Color Experience Climate Grief More Deeply Than White People, published by Vice, Nylah Burton writes that people of color experience greater trauma surrounding the climate crisis. This occurs in large part due to environmental racism, which causes people of color to be affected by the negative effects of climate change at greater rates.This applies to negative effects such as greater levels of displacement, having greater risk of experiencing natural disasters, exposure to pollution, and negative health effects (Burton,2020).
The article also discusses differences in how people of color react to climate change.Because they feel the negative effects on a harsher level, there is a greater call to action and sense of urgency. Mary Heglar, who is a Black climate justice essayist and writer at Columbia University, believes that the climate community in its current iteration relies on hope too often,which causes inaction. She is quoted saying that, “Hope is ‘such a white concept,’ You're supposed to have the courage first, then you have the action, then you have the hope” (Burton,2020). Heglar finds that the underrepresentation of people of color, who face more negative consequences from climate change, leads to an unrealistic and over optimistic perspective toward climate change due to skewed data.
A 2018 report from the Environmental Protection Agency, or EPA, also reported that race is the greatest determining factor for particulate matter exposure, even more so than class or socioeconomic standing. The researchers discovered that Black Americans were exposed to 1.54 times more of a particulate matter known as PM 2.5, which is associated with heart disease, lung disease, and a shortened life expectancy. PM 2.5 primarily is found through burning fossil fuels. When comparing other demographics, people classified as ‘poor’ were exposed to 1.35 times more pollution than white people, and people of color as a whole were exposed to 1.28 times more PM 2.5 (McKenna, 2018). Environmental racism is a real phenomenon, and although minorities are affected by environmental damage at higher degrees of severity, they are still seen as less concerned about the environment.
Dr. Dorceta Taylor, a Professor of environmental justice and environmental sociology at the University of Michigan, cited several barriers to minorities in Environmental Science. The greatest barrier she cited was cost, which particularly affects people of color because they fear being able to find a job after graduating. This is an even greater burden on people of color who lack resources in juxtaposition to whites, both financially and socially (Ruf, 2020). People of color have less access to a wide network and social capital, and they may often be the first in their family to attend college.
Minorities overall are underrepresented in environmental sciences as compared even to other STEM fields; a 2014 report detailed that while 40% of employees and 17% of executives in tech were people of color, only 25% of staff and 4% of executives and senior staff were reported as people of color (Ruf, 2020). Some hypotheses as to why from a student’s perspective environmental science may be less appealing are that environmental based curriculum does not focus on environmental issues relevant to people of color, issues such as increased access to green spaces, rerouting interstates out of minority dense neighborhoods, and reducing the amount of toxic waste spaces in communities of color (Ruf, 2020). Further, “Black and Brown people experience environmental hazards and crises first and worst but are not the ones in the environmental fields making the decisions that are going to mitigate these issues”(Ruf, 2020). Despite pursuing a graduate degree in nature, society, and environmental governance at Oxford, Dr. Taylor says she was not an environmentalist as a child. She grew up perceiving environmentalists only as white people who climbed mountains and advocated only wildlife protection(Ruf, 2020).
“Traditional or mainstream environmentalism doesn’t tend to center its scholarship on things like the protection and experiences of people of color and indigenous folks. That scholarship is sidelined and seen as an environmental justice issue rather than centered within what is considered mainstream environmental scholarship or advocacy”(Ruf, 2020).
As academics and as people of color in environmental science, many describe having been met with racism from their peers and colleagues. On one occasion, Dr. Taylor was not allowed by a receptionist to check into a conference where she was the keynote speaker (Ruf, 2020). Incidents of discrimination and microaggressions and feeling like the only person of color amongst an ocean of white academics can lead to a feeling of isolation and for some they may question whether they even belong in the field at all.
One program seeking to offset this is the Doris Duke Conservation Scholars’, which unites underrepresented students in its program in hopes of providing a safe space for students of color. However, it is important to note that efforts to alleviate racism and implicit biases in academia should not fall on people of color alone. Programs and departments “ should invest resources to educate White students, White faculty and White staff to understand where their biases are coming from, where their ignorance is... Because the assumption is that they are knowledgeable, nothing needs to be done and it’s for the people of color to make all of the adjustments” (Ruf, 2020). Dorceta Taylor emphasized that white people should not see people of color engaging in nature as an anomaly, while also recognizing how American history has restricted their access to nature spaces and environmental activism (Ruf, 2020).
As a suggestion for white people, Taylor mentioned attending Climate Conventions at HBCUs across America, as this would demonstrate that people of color are not simply“disinterested” in the environment. At these Climate Conventions at HBCUs there are hundreds of environmentalists of color who are making an impact. In the immediate need for environmental innovation, action, and activism, it is imperative that higher education facilitate the learning of marginalized communities of color, especially in the wake of possible climate disasters in the coming future. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.24%3A_Environmental_Science.txt |
Ethnic Studies, in the United States, is the interdisciplinary study of ascribed differences such as race and ethnicity, but can also include sexuality and gender, as they relate to power(Hu-DeHart,1993).
Ethnic Studies first emerged in higher education as an interdisciplinary field in 1967 at San Francisco State University in response to student protests (Molefi, 2005). The social climate at the time was undergoing major reformation as liberation movements progressed. As a result,there were many student protests all over the country fighting to implement Black Studies in higher education. This movement paved the way for other ethnic groups’ histories to be studied as well. During this time Native American Studies, Latino Studies, and Asian American Studies were beginning to be offered at some colleges and universities.
Ethnic Studies plays a crucial role in higher education. For students whose ethnic background is the focus, it gives them a sense of belonging and further understanding of their roots and history in American society. Ethnic Studies is also highly beneficial when other students learn about other cultures' history and contributions in American history. An important goal in Ethnic Studies is to enlighten students’ cultural understandings and end prejudices and racial conflicts (Ward, 2019).
What differentiates Ethnic Studies from other social sciences and humanities is how it took root as an academic discipline. In many ways it began in response to charges that traditional social science and humanities disciplines were conceived from a Eurocentric perspective (Chapman 2013).
Ethnic Studies departments face challenges such as underfunding, high turnover rates, understaffing and lack of autonomy. For example, Northwestern University has a 100 percent turnover rate due to not offering tenure to Ethnic Studies professors that do not commit to sharing appointments in another department, a tenure home, essentially double the work (Baskar, 2019). In August 2020, California Governor Gavin Newsom signed the bill AB 1460,that requires all undergraduates attending California State Universities to enroll in an Ethnic Studies course to graduate (McKenzie, 2020). With this new requirement in California, it will prove difficult for universities to try to dismantle the discipline, which has been an issue in the past. Despite its origins, Ethnic Studies is not immune to structural racism. For example, at CSU Long Beach, administrators failed to hire professors for the Department of Africana Studies for 8 years, then strategically suggested replacing the department with only an Africana studies program falling under another department, claiming that the department did not have sufficient tenured faculty (McKenzie, 2020). Departments allow faculty to coordinate to make decisions such as hiring, so by dismantling a department, there would be no faculty organization of the discipline, contributing to less hiring and promotion. This is a common tactic used by universities to reduce the autonomy of Ethnic studies departments, as well as other departments (McKenzie, 2020).
The study of Critical Race Theory (CRT) has recently come under scrutiny, mainly from the conservative right wing claiming the study perpetuates divisiveness. The benefit of studying CRT is not to delve into individuals who may be racist, but to better understand racial disparities in the institutions and systems within the United States that persist and cause harm (Fortin, 2020). Derek Bell, the late Harvard professor known as the father of critical race theory, developed the course after trying to understand how race and American law interact (Harris,2021). In 1981, Kimberlé Crenshaw was enrolled at Harvard Law but felt there was avoid after Bell, the only Black professor at the time, resigned when he discovered the institution's discriminatory hiring practices (Harris, 2021). Crenshaw and other students asked 12 scholars of color to lead discussions about Bell’s book,Race, Racism, and American Law after they realized the Harvard Law administration did not understand the importance of race and law (Harris,2021). This was the beginning of CRT, examining how our “nation’s sordid history of slavery,segregation, and discrimination is embedded in our laws, and continues to play a central role in preventing Black Americans and other marginalized groups from living lives untouched by racism” (Harris, 2021). CRT does not teach young Americans to hate America or promote divisiveness, but to explore how inequality today is rooted in our past foundations. Ethnic Studies continues to evolve and shift perspectives, so it’s time other disciplines do the same to implement an effective, inclusive curriculum. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.25%3A_Ethnic_Studies.txt |
Geography is the study of the physical and spatial world. The discipline studies the Earth and its different surfaces, including landmasses such as continents, and the oceans that span across the planet. Geography also entails human relations and interactions with the natural environment around them. The term, “Geography” originates from the ancient Greek civilizations, who used the word to describe the maps and written records which recorded what they learned about the world. “Geo” means Earth and “graphy” means to write (Geography, nd). Given the global history of European colonization, the geographic records created throughout the centuries of exploration and subjugation are directly connected to the mistreatment and exploitation of populations all over the globe. These geographic records,such as maps, are still used as guides and bases for modern geographic innovation and labor. Geography as a discipline is also a predominantly white one. As stated by a 2013 study researching geography and diversity, one possible explanation for the demographics of the field was a lack of two year level colleges which offer degrees in Geography and similar subjects, as two year community colleges are often affordable and accessible options for diverse student populations (Adams, 2013).
Geography and race have been connected for centuries, as historic geographical discoveries were made due to physical exploration and exposure to racially and culturally diverse groups of people. Modern geography is said to have been founded in the late 19th and early 20th centuries, an era in which race was viewed as a biological construct rather than asocial construct (Tyner, 2017). The idea of race signifying biological superiority allowed for the justification of colonization and European imperialism. As imperialism spread throughout Asia,Africa, and the Americas, there was a need to justify the global conquest and subjugation of the newly “discovered” and colonized populations (Tyner, 2017). Part of this justification was religious, it was the Christian tenet of converting others to their faith, as well as a possible predecessor of Manifest Destiny, or the American idea of expanding westward.
Mona Domosh, geographer and professor, questions why whiteness is so synonymous with the field of Geography. Despite including materials focusing on anti-colonial and anti-racist scholarship and practices, and despite addressing the social construction of race, Domosh argues that what is taught and disseminated is what she terms “white geography,” which is described as a seeing, learning about, and understanding the world through a white Eurocentric lens built on colonialism and racism (Domosh, 2015). The American Association of Geographers (AAG) website has a dedicated list of recorded actions to promote diversity and inclusion, including statements made regarding racism toward African Americans and Asian Americans. The website also includes a list of members, multi-year plans for improving diversity and actions taken, such as providing funding for geographic software(s) to minority serving institutions (Diversity & Inclusion, nd).
Despite the shift from viewing race as a biological construct to now viewing race as asocial construct, racism still exists in a spatial context. Several scholars have researched the spatial contexts of race and racism, and it is important to highlight and study these scholars and their contributions (Tyner, 2017). The geographic recording of ethnic enclaves within cities,maps detailing paths of colonization and forced migrations should be recorded and taught about, to promote diverse thought within geography. Geography also plays a role within environmental racism, as the discipline studies human interactions with nature, mapping, and urban planning.
A statistic from the AAG found that in 2012, just 4.38% of AAG members identified as Hispanic and 3.15% identified as African American (Domosh, 2015). Laura Pulido is a geographer and Chicanx professor, who articulated the challenges of being the only person of color in geographic academic and career spaces. Pulido asserts the need for diversification in the field, in order to foster outreach within the field and make geography more relevant in marginalized communities (Pulido, 2002).
Pulido also describes how greater representation of people of color would enhance the field, as they would introduce a new lens of thought and scholarship, as well as tie the discipline to others such as Ethnic Studies, providing a more well-rounded, interdisciplinary method of thinking (Pulido, 2002). It would also prove beneficial to study topics including, but not limited to racial residential segregation, racialization of immigrants, and intersections between geography and space between race, gender, sexuality and class (Domosh, 2015). However, the discipline also should continue to take steps on educating scholars on the discipline’s problematic origins. In taking such steps, the discipline of Geography can begin to be more inclusive of oppressed and marginalized groups, as well as incorporate a more holistic and equitable future for the path of study. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.26%3A_Geography.txt |
Geology examines questions about the earth and other planets, utilizes the fundamental principles of physics and chemistry, and employs a broad palette of tools, including isotopes,field observations, the fossil record, lab experiments recreating extreme conditions, and remote sensing. The field is rich in scope and opportunity, ranging from ample fieldwork occupations to research and classroom teaching, which allows for many options for those who pursue a degree in Geology and other Earth Sciences. But like many other fields, there is a problem with a lack of diversity of the people studying and employed in the Earth Sciences (for more on this, see our section on Environmental Science). Less than 10% of geoscience PhDs go to people of color. This limits the diversity and quality of research and is the single largest cultural problem the geoscience currently face. The study of planet Earth, its oceans, its atmosphere and its interactions with human society only has approximately 4% of its tenured employees identifying as persons of color and this has not changed in over four decades (Goldberg, 2019). A pipeline problem has been cited, in that there are not as many people of color studying earth science. This was discussed in more detail in the Environmental Science section can be partially attributed to the treatment Black people have received when enjoying nature. Robert Stanton,the first Black director of the National Park Service, who says that“black folks don’t like parks” has become a “self-fulfilling prophecy”(Bernard & Copper dock,2018). Another factor may be limited exposure to nature in earlier schooling due to schools' lack of resources which makes field trips to experience and learn about nature limited.A lack of representation by the very people who live in areas where the most drastic effects of climate change limits the strength of the discipline. Further this limits Geology’s ability to effectively address climate change. Lorelei Curtin, a fifth-yearPh.D. student at Columbia University calls attention to the importance of highlighting indigenous and people of color’s voices who may be deeply connected to the land. She began a book club that brings Geoscientists together for discussions of race and white privilege. The Geoscientists were not used to this kind of work, but it helped facilitate much needed discussions surrounding racism and discrimination in the field. As a result of the findings mentioned in this piece, the diversity director of the institution has written an article in Nature Geoscience entitled, “Race and Racism in the Geosciences,” that was so popular that the journal’s editors removed its paywall.It describes the differing ways white people and people of color view racism. The director also hosted a discussion, which was standing room only.The less diverse a field is, the less inviting it is to students of color, and a greater percentage of students of color end up leaving the field in comparison to white students.
The notion of a colorblind approach to the work of Geoscience reinforces race being defaulted to white and practitioners often engage in racist behavior despite not being overtly racist. This same diversity officer for the school’s Geosciences department has observed that white faculty consider race as incidental, while students of color see it as a large part of their identity. They do not however wish to discuss issues of race with their white colleagues, as they worry it may create tension, and in many circumstances, students of color worry about jeopardizing their job security. Implicit racism in the society writ large also can be applied to Geosciences. It is hard for White Geoscientists to see how they are privileged and perhaps do not see the systemic racism that renders them so. Talking about this may make them uncomfortable as they do not like the implication that they contribute to this, especially when they have other ways in which they may have been disadvantaged. The author additionally states, “when it is the norm to be White, maintaining the comfort of White people becomes part of the unwritten code of a culture, a code that people of colour often follow.” (Dutt, 2019).Part of the privilege that White Geoscientists have is the ability to be oblivious to their counterparts of color. If the goal is a Geosciences where all are welcomed, dominant groups need to take ownership in the culture shift rather than having the Geoscientists of color bear the responsibility. In general, people who do not experience a certain type of discrimination tend to dismiss it as not real. In the case of students in the Geosciences, this can drive students of color away from the field. In order for diversity and inclusion to take place, everyone must feel a sense of belonging. Some suggestions for White Geoscientists the author suggests are as follows:
• Separate the fact that you do benefit from white privilege and you are a good person.
• Read and learn about people of color
• Talk about this with White colleagues
The author also points out that affinity bias, or the tendency to get along with or seek out others who are like us, is a problem at the institutional level and higher education in general needs to appoint more people of color in leadership and put resources into faculty and students of color. Diversity and inclusion needs to be prioritized on par with scientific professional development. A massive shift has to occur to move the Geosciences past passively non-racist to actively anti-racist (Dutt, 2019).
Another important step in supporting students of color in the Earth Sciences is to address safety issues surrounding field work. Field work can evoke justifiable fears in students of color and present actual danger. An account of feeling unsafe and experiencing racism from a Black Fieldwork student in a recent youtube video demonstrates this. The student describes their experiences and offers suggestions for White field supervisors/faculty on how to help keep students of color safe while in the field. (Black Thoughts, 2020). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.27%3A_Geology.txt |
Health education is a broad amalgamation of several different majors and career pathways. It may be related to paths of study such as Biology, Chemistry, Kinesiology, Pre-Medical pathways, and Nursing. Health related educational pathways are typically concerned with physical human health. Due to the variety of inequalities and instances of racism within healthcare, it is reasonable to find potential correlations between health education and healthcare careers. Not only is this reasonable, it will likely prove to be life-saving, as improved education will lead to improved health outcomes for marginalized groups.
Healthcare providers are required to take the Hippocratic Oath, as a sign of their dedication to patient care and their profession. One of the core tenets of this oath is to treat all patients with care to one’s best ability, and to remain an active member of the society they live and practice in (Marks, 2021). Following the murder of George Floyd, all facets of society practiced introspection and reflection on what needs to be improved. This introspection was also practiced by healthcare professionals whose ability to treat all patients with care according to their oath has been compromised by systemic racism. Practicing this introspection is the first step in rectifying systemic inequalities and prejudices within the field, such as a lack of education regarding people of color. In a majority of learning experiences, the patient type used is white which can be detrimental when attempting to treat skin conditions. One example is a condition known as Erythema Migrans, which is a sign of early stages of Lyme Disease. Students learning about the rash in textbooks or in labs most frequently see it displayed on white skin, and this shortcoming makes it difficult to identify the condition in darker skin tones with greater levels of melanin (Khan and Mian, 2020).
This lack of education regarding different racial demographics can often lead to diagnostic errors and improper treatment of patients of color. In turn, such errors can have drastic health concerns. When analyzing the previous example, there is often a delayed Lyme disease diagnosis in black patients, and a higher proportion of these diagnoses are made at later stages of the disease, and this later diagnosis leading to greater rates of arthritis than white patients (Khan and Mian, 2020).
BMI is an acronym which stands for Body Mass Index, and is a value calculated by dividing an individual’s weight by their height. BMI uses this proportion to measure levels of body fat, and is frequently used in medical settings to track health. However, BMI as a metric maybe more flawed and dated than most perceive. The BMI metric was first introduced by Adolphe Quetelet almost 200 years ago. Quetelet was an academic in Sociology, Astronomy, Statistics, and Mathematics; however, he was not a medical practitioner nor a physician. Quetelet was most known for his work into studying “L’homme moyen,” or rather, the average man, who Quetelet viewed as the ideal form of man (Friend, 2019). Much like Sir Francis Galton, who will be discussed in the Psychology and Statistics sections of this book, Quetelet’s work led to further justification for the eugenics movement.
Furthermore, even Quetelet did not see BMI as a measure of individual health; for him,it was a way of measuring populations for statistics, not to measure individual health (Friend,2019). BMI also fails to detect cases of obesity with high levels of accuracy. In Black, White, and Hispanic women, the BMI detected under 50% of obesity cases, and the BMI overestimates health risks for Black people, while also underestimating health risks for Asian people (Friend,2019). These inaccuracies have large scale negative consequences on their respective demographics, such as misdiagnosis and improper health care based on said misdiagnosis.
Medical education can also reaffirm preexisting stereotypes and preconceived beliefs that take physical shape during clinical visits. Before appointments, it is standard to complete medical questionnaires, which include and begin with questions involving race, age, and gender. It is not uncommon for practitioners to diagnose and prescribe specific conditions based on racial stereotypes. One example is when a Black child reports bone pain. A Black child reporting bone pain is often associated with sickle cell disease (Khan and Mian, 2020). Even if such stereotypes are based on historical disease prevalence, it is dangerous to make assumptions based on this history. This can lead to drastic consequences such as misdiagnosis and possible malpractice. It is imperative to consider all possible causes and to ensure that stereotyping does not further increase unconscious biases.
Nurses are a critical part of the healthcare system, as they typically have more time with patients than doctors. However, nursing education is not immune to and perpetuates the same structural inequality that permeates other healthcare disciplines. Nursing actually began as an occupation dependent on the exploitation of enslaved labor. In the early 1800’s, enslaved African American women provided the majority of nursing aid on plantations (Nursing has along History, 2021). Disparity and unjust treatment still runs rampant today, both when pursuing education and after graduation in professional work. Some forms of these offenses include dissuasion from the field, assumed incompetence, wage gaps, stolen credit for accomplishments by peers, and denial of advancement opportunities (Nursing has a long History, 2021). This does not even begin to address offenses such as microaggressions and overt racism from fellow colleagues and even patients that nurses of color are tasked to heal(Shah, 2020).
Just like the profession of nursing, nursing programs in academia face the same lack of diversity. Nursing educators are also predominantly white, as less than 1% of deans and chief nursing officers are from racially diverse backgrounds (Leading Nursing Organizations, 2021). Similar to the majority of a neoliberal society, color blindness is preached as a core tenet within healthcare education. However, rather than respect and accept the unique intricacies of diverse ethnic and racial populations, color blind philosophies instead ignore the uniqueness and differences of people of color. According to Blythe Bell, 2020, ideals such as color blindness and perceived equal treatment also exist in nursing students’ perceptions and beliefs. Bell also noted that such narratives are present in her recently graduated nursing cohorts, a group of predominantly white women in their early twenties (Bell, 2020). Furthermore, rather than address potential problematic behavior that occurs based on color and race, color blindness helps society ignore and even deny racism, colorism, and other structural inequalities. Within healthcare and nursing, this is portrayed as treating everyone “the same” and with “equal respect” (Bell, 2020). However, this ignores the effects of primary socialization, the effects of living in a racist society, and thoughts and behaviors such as implicit bias and racial microaggressions. And like other blanketed statements, this serves to hide and erase race,racism, gender, class, and other characteristics that have historically led to disparity in marginalized groups.
Without filling the gaps in healthcare education with regard to a legacy of structural racism, and without providing in-depth holistic learning and equal representation, inequalities within health-care training experiences, treatments, and outcomes will only continue. As healthcare is such a broad and important field of occupation, education, and society, it would be possible to write another book solely on structural racism within healthcare and health education. Therefore, we encourage further research into specific occupational and educational pathways to further supplement this introduction into the discipline. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.28%3A_Health_Education.txt |
History is an evolving record of human emotions, aspirations, successes, and failures.Historians deal with the goals, fears, interests, and prejudices of people in the past, and the impact of their thoughts and actions on the people of today and tomorrow. Whether we acknowledge it or not, historical acts are the building blocks of present-day society, and the historian must reckon with the sins of our past when teaching the next generation of students about the events that occurred before them. It has been a great failing of historians who teach in classrooms across this nation, at all grade levels, and those who write history books who tell the story of the United States, to omit critical pieces of history that are painful or embarrassing. Revisionist history is commonplace in most curriculums, especially at the K-12 level. It is often only if a student reaches a college-level history class where the professor is committed to undoing some of these revisions that they will get a more accurate, representative view of the history of the United States.
As the title of this book may suggest, we write this with an acknowledgement to a great historian who did just that. Howard Zinn’s 2005,A People's History of the United States: 1492-Present remains a building block for speaking truth to power. His work spans centuries and tells the side of history Zinn calls a “people’s history”, something that is frank and critical of the status quo as a means of empowering readers with tools to critically evaluate what has been and is being done in the name of freedom in the United States. Zinn spoke of his rationale for writing “people’s history:”
I think that it’s extremely important for young people to learn a different history that will make them skeptical of what they hear from authority. I think if young people knew, for instance, the history of lies and violence that have accompanied American foreign policy, they would not be enticed into joining the armed forces (Zinn, 2005).
It can also be said that it is as much about what is being excluded from history that is problematic. Much of this reader is filled with examples of things many of us just did not know because it was not taught to us at any point in our academic career. As Zinn and so many other historians would point out, history is crafted by the victor and so in the United States, the historical narrative highlights the greatness of European white settlers from a white patriarchal frame. White washing history, as it is perhaps best labeled, allows the development of the United States to appear righteous and divine when in fact it is far more complicated, painful and brutal than that. But omission serves to make historical events invisible, events that many believe need to be visible. While the claim of absolute objectivity is a fallacy, there is a way in which history can be taught as a means for equity and social justice.
But there is no such thing as a pure fact innocent of interpretation. Behind every fact presented to the world-by a teacher, a writer, anyone-is a judgement. The judgement that has been made that this fact is important, and that other facts omitted are not important (Zinn, 1980).
Zinn is not alone by far in his assessment. Historical omissions serve to move forward cultural narratives that serve those in power. By minimizing historical atrocities committed by white colonizers on enslaved Africans, indigenous Indians or other migrants, we lack perspective into the intergenerational trauma that affects families to this day. Understanding the ways in which our history is steeped in structural racism is important for us to understand much of the social ills of the present day. The actual history of African-Americans has been erased from history textbooks. The inefficiency of our educational system to convey an equal representation of history has made it so that Black, Indigenous, people of color, (BIPOC) voices and experiences are not recognized. This fairy tale is exemplified in curricula across the U.S. from very early on:
A Connecticut fourth grade social studies textbook falsely claimed that slaves were treated just like “family.” A Texas geography textbook referred to enslaved Africans as “workers.” In Alabama, up until the 1970s, fourth graders learned in a textbook called "Know Alabama" that slave life on a plantation was "one of the happiest ways of life." In contrast, historians and educators point out, many children in the U.S.education system are not taught about major Black historical events, such as the Tulsa Race Massacre or Juneteenth, the June 19 commemoration of the end of slavery in the United States (Silva, 2020).
The suppression of the complete history of our country has made it easier for systemic racism and white supremacy to reign over the reality of our history. When BIPOC voices and contributions are not acknowledged, it makes that community invisible to the whole of society.There have been many inventors that were BIPOC, yet we do not know their names.“So when people say you can’t erase history, it's like, what are you talking about? If you crack open a textbook from the mid-20th century, there are no minorities in those textbooks”(Silva, 2020). The contributions of BIPOC citizens have been undermined, and educators are now being calledupon to work hard to show these contributions that have remained hidden for a very long time. Sadly, when academics do take on revisionism and attempt to shine a light, it does not always sit well with those in powerful positions.Speaking truth to power, questioning the status quo,and asking for answers can get you in a lot of trouble. There areso many historians who over the years have fearlessly challenged the dominant narrative in efforts to tell a more accurate tale of history and resultant U.S. policy who then are at risk of failed tenure, termination, and threats to their safety just so that the story could remain the same. Muckrakers the likes of Howard Zinn, Cornel West, Steve Salida, Ilan Pappé, and more recently, Nikole Hannah-Jones and Garrett Felber have all felt the wrath of those determined to perpetuate the supremacist patriarchal status quo (Middleton, 2020).Historians today stand on the shoulders of giants.They are charged with telling a more complete story which can help move academia towards greater equity. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.29%3A_History.txt |
Human Sexuality as an academic field studies the ways in which humans express themselves as sexual beings. This epistemology is interdisciplinary in nature utilizing biology,medical research, sociology and psychology. The science of human sexuality approaches understanding as multilayered. Pulling from these varying disciplines, the field is able to look at sexuality from multiple lenses. While there have been many approaches to the study, its foundation lies in the heteronormative white male perspective. As exclusionary as its roots are,there is an ongoing demand from scholars in the field and much has been written about the need to be more expansive. Understanding Human Sexuality in its totality demands a wider lens.
Whether it was biology or medical research or any of the disciplines that fall under the wide umbrella of an interdisciplinary approach to Human Sexuality, there is a tendency towards an explanation of human sexuality in terms of a false binary that informs the creation of knowledge in the field which is often scientifically inaccurate. Repercussions of this result in varying levels of invalidation of lived experiences of students in the field to highly abusive practices in research and medicine. Historically, the field of Human Sexuality int he United States has been chronically underfunded due to the puritanical roots inherent in the White Anglo-Saxon Protestant (WASP) foundation. Particularly, the study of female or non-binary bodied persons and research findings, stated conclusions, and best practices about sexuality have often been determined with a white, misogynistic, heteronormative lens.
There have been well documented examples of ethical violations that stem from both individual and structural racism reaching back to the development of the field up until present day. We begin this section with the case of enslaved woman, Sara Baartman. Today she is seen by many as the epitome of colonial exploitation and racism, of the ridicule and commodification of Black bodies. Sarah Baartman was brought to Europe seemingly on false pretenses by a British doctor, stage-named the "Hottentot Venus." She was paraded around "freak shows" in London and Paris, with crowds invited to look at her large buttocks. Baartman died on 29 December 1815, but her exhibition continued. Her brain, skeleton and sexual organs remained on display in a Paris museum until 1974. Her remains weren't repatriated and buried until 2002(Parkinson, 2016).
Dr. J. Marion Sims has been heralded as the father of modern gynecology. It has long been asserted that Dr. Sims perfected the first consistently successful operation for the cure of“vesicovaginal fistula, a catastrophic complication of childbirth in which a hole develops between a woman's bladder and her vagina and leads to constant, unremitting, and uncontrollable urinary incontinence” (Wall, 2006). He did so by practicing on slave women without the use of anesthesia which clearly raises questions regarding Dr. Sim’s medical ethics and his perceptions surrounding the human rights of enslaved persons. During Simm's tenure, women suffered horribly from this condition and a race for the cure was critical. Dr Sims' use of slave women was well documented historically. By the very nature of their enslavement, these women were unable to consent. He performed surgery on them as test cases, and then performed more surgeries later on some white women without anesthesia.
The use of anesthesia was new during this time, and anesthesia did not become commonplace until he was routinely performing this procedure on white women. (Wall, 2006).He later described white women complaining of pain while enslaved Black women did not, and used this anecdotal evidence to make assumptions about differing pain thresholds as inherently based on race,rather than other possible factors for their differing responses, such as enslaved women’s likely fear of punishment for expressing said pain. Some argue it is not because Dr.Sims was racist, but rather that anesthesia was not widely used; however, whatever biases Simms had about pain thresholds and racial identity allowed him to make assumptions about how the women he worked on experienced the procedures.
There is much controversy surrounding the practices of Dr. Sims and the ethical considerations factoring in despite the invention’s historical significance. A Vesicovaginal Fistula (VVF), rendered women greatly incapacitated during the time Dr. Sims was in practice. It was considered a fate worse than death for many. Prior to Dr. Sims’s breakthrough there had been no consistently effective procedure to repair the fistula and there was not a field of gynecology per se at the time; in fact, examining women’s organs was considered repugnant by male doctors. From 1845-1849, Dr. Sims performed experimental surgery on 7 enslaved Black women in his small backyard hospital (Ojanuga, 1993). He performed his experimental surgery on his first patient Lucy in front of 12 male doctors watching as she crouched on her hands and knees and endured the hour long procedure without anesthesia. The surgery was a failure and she almost died. Another patient, an enslaved woman named Anarcha endured 13 operations without anesthesia with limited success (Ojanuga, 1993). Dr. Sims attempted his procedure on white women but as previously mentioned, found that they could not endure the pain. In the minds of many who look at the history of this particular doctor and his practices, Dr. Sims was not merely a product of his time but rather his infliction of pain on Black women was unethical,cruel and callous.
Sadly, the pattern of white male doctors who callously practice unethical procedures on women and people of color does not end with Dr. Simms. Well into the 21st century, forced sterilization of women in California correctional institutions was a consistent practice (Jindia,2020).
A state audit and prison records reveal nearly 1,400 sterilizations between 1997 and 2013. In addition to people sterilized during labor, an unknown number of cis women and trans people were sterilized during other abdominal procedures (Jindia, 2020).
These sterilizations took place without consent or under coercive circumstances. Despite ethical mandates and procedural efforts to make sure research participants are protected, there remain recent examples of gross violations. As we take a look at these,we often find that marginalized populations are the ones most at risk. There seems to almost be permission to test on incarcerated people like they are lab rats. From high risk cancer treatments, to testing skin cream and cosmetics, they have been used for non-consensual medical testing as if their human rights are not valid. These forced sterilizations of incarcerated women in California prisons are the topic of the new documentary, BELLY OF THE BEAST. This film highlights the ways in which the lives of incarcerated people are not their own, and basic human rights to choose and autonomy of their bodies were grossly disregarded. But it is not just the incarcerated, the institutionalized as well have been sterilized against their will. A recent expose highlighted the decades long practice of forced sterilization and castration of men and women who were living in the Sonoma home, one of many homes for the mentally ill/disabled that practiced this type of forced medical intervention (Barber, 2021). The decisions by medical directors to undertake these sterilizations were based solely on their prejudiced attitudes towards the people whose care they were charged with. The unfortunate truth is that white supremacy, sexism and ableism were deeply entrenched in the mindsets of the medical community that made these decisions without consent and this influences the science and decision making practices of the medical community to this day.
Just as the enslaved women could not consent, incarcerated and institutionalized people face similar lack of rights and threat of increased sentences if they fail to comply with authority. The legacy of structural racism, sexism and heteronormativity are part and parcel of the field of Human Sexuality. It is the hopes of this author that a deeper dive will be undertaken by the readers to explore the ways in which what is otherwise a rich field that’s value stretches far beyond the walls of the academy has to reckon with it’s problematic past and present. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.30%3A_Human_Sexuality.txt |
In the United States, language learning is taught both inside and outside of the academy. An opportunity to learn a new language allows students to expand their horizons and increase their marketability in the workforce. Languages worldwide however, are more numerous than the selection that is represented by most community college offerings. It is a choice made by each institution to offer certain languages over others, which centers some as more valuable. While some of that has to do with the need for bilingual speakers in the workforce, particularly Spanish, there are numerous European languages taught more frequently than languages such as Cantonese or Arabic, demonstrating a Eurocentric prioritizing of language learning. Spanish and French are the most commonly taught languages in U.S.schools, privileging those as the preferred options for U.S. students. And even within these two dominant language offerings, we see a preference towards a preferred type of Spanish or French taught in schools rooted in the form spoken in Europe. In pragmatic terms this has more to do with where it came from than its practical application to those who may be speaking it.For the billions of Spanish speakers living in the Americas, their dialect is seen as not proper and instead what is known as Spain Spanish is the form of Spanish regarded by many instructors,professors, and educators as the more prestigious or appropriate Spanish to teach to language learners. For many indigenous Spanish speakers in the US, this type of Spanish is not what they speak at home. In many ways there is a hierarchy to the type of Spanish which is seen as better and it correlates directly to race, region, and ethnicity and the stigma surrounding the vernacular is evident. The closer the dialect is to the European Spanish brought to the Americas by the colonizers, the better.
So if you really want to hurt me, talk badly about my language. Ethnic Identity is twin skinned to linguistic identity-I am my language. Until I can take pride in my language, I cannot take pride in myself. Until I can accept as legitimate Chicano Texas Spanish, Tex-Mex and all the other languages I speak, I cannot accept the legitimacy of myself. Until I am free to write bilingually and to switch codes without having always to translate, while I still have to speak English or Spanish, when I would rather speak Spanglish, as long as I have to accommodate the English speakers rather than having them accommodate me, my tongue will be illegitimate (Anzaldúa, 2012 p. 81).
Disregarding dialects and linguistic difference as not the right way to speak is a form of privileging language to resemble that of the conquerors. Because of this, we see some of the more European nations in South America being privileged over the more indigenous ones.Argentinian Spanish is a close second to Spain’s Spanish in terms of favorability, but nations like Guatemala or various Caribbean nations whose Spanish departs from the conqueror’s Spanish in its usage is not often taught in US schools. Perhaps not coincidentally, these nations also have a majority population that is ethnically non-anglo-European. French too becomes privileged if it is rooted in the nation of France, while other colonized nations that France is spoken in are less valuable. So those who study French in school whose roots are Creole or from various African nations like Morocco, Algeria, or Senegal may not recognize what they are learning as what they know at home.
The United States was created as an English speaking country on land that already had inhabitants who spoke other languages. Despite this, there are almost no institutions of higher learning that offer any languages indigenous to the Americas such as Náhutal, Quechua, or Quichéas apart of their “foreign languages” offering. Some schools do offer introductions to select indigenous dialects through their school’s Native American Studies departments though they are few.
Students enter higher education with varied exposure to speaking and learning a second language in their earlier schooling. A student's experience with foreign language classes has alot to do with their race and social class, and the school system in which their K-12 education took place. “Black students at the K–12 level are more likely to attend schools or be tracked into programs in which foreign languages are not available” (Anya & Randolph, 2019). If a student is not offered an opportunity to learn early on, as they move into higher education,that area of learning often becomes more of an intimidating obligation, rather than something to get excited to learn more about. It also creates yet another field in higher education that is lacking representation. According to Musu-Gillete, et al., 2017, Black students in the U.S.“complete the least number of high school credits in this subject; they earn only 4% of bachelor’s degrees conferred in the field of foreign languages; and Black teachers comprise just 6% of instructors in the humanities and a mere 3% of postsecondary foreign language faculty” (Musu-Gillete, et al., 2017; U.S. Department of Education, 2016).
These statistics are not due to a low interest or lack of motivation on the part of Black students to learn language; rather, it can be traced back to past and current segregation, inequitable distribution of resources, and the systemic exclusion and marginalization of African Americans in U.S. schools (Glynn, 2012). Further, teacher perceptions of their students have long been shown to contribute to student success so when a teacher harbors unconscious bias favoring white students over students of color, the result is that students of color disproportionately suffer. In a 2012 study of “79 students analyzing experiences in foreign language study, and perceptions of the low enrollment of African-American students in foreign language classes,findings reflected that teachers and fellow students harbored negative perceptions and stereotypes of African-American students” (Glynn, 2012).
Using whiteness as a standard for imagery and teaching culture to students has also proven to be a way to leave swaths of students out. Representation matters and languages like Spanish are spoken all over the globe by people from many different ethnic backgrounds. Leaving those representations out of the teaching clearly hinders student success.
Black students could not see themselves in mainstream Spanish teaching materials. The images found in instructional materials were overwhelmingly of White Spanish speakers worldwide. The visuals omitted Afro-Hispanic history and Afro-Latinx presence not to mention the absence of other marginalized groups like the large Spanish-speaking Indigenous populations. After all, it may be easier for Black students to see themselves speaking Spanish if they see, hear, and learn about Afro-Cubans, the Spanish speakers of Equatorial Guinea, and multicultural Puerto Ricans, among others. My Black students helped me to dig deeper to develop and publish more inclusive and thought-provoking instructional materials to use with all of my students (Spaine Long, 2020).
So much of language learning is designed for non-native speakers. Perhaps until native speakers from nations that do not have the specific preferred form of their language traditionally taught in the US began studying language, there was not as much pushback on the fact that this preference exists, but for those who see their particular culture disregarded as insufficient, it becomes problematic.
The majority of language teaching in US schools comes with outrageously expensive textbooks, which many students just cannot afford. There is a reckoning with this in terms of some faculty decrying the prohibitive costs, and as mentioned above, privileging of languages of the conquerors, but roots run deep and change comes slow (Hines-Gaither, 2020). In fact,the American Council on the Teaching of Foreign Languages (ACTFL) has put together a list of Resources that Address Issues of Race,Diversity, and Social Justice, in order to address the need for change. ACTFL began in “1967 as a small offshoot of the Modern Language Association(MLA), and has set industry standards, established proficiency guidelines, advocated for language and education funding,” so like many of other discipline specific organizations, the ACTFL acted in response to the highly visible police murders of George Floyd, Breonna Taylor and so many unnamed other Black and Brown people in recent years (Resources that Address Issues of Race, Diversity, and Social Justice, n.d.). What comes from this depends on those in the field continuing to shine a light on the present inequity. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.31%3A_Languages.txt |
Librarians who work in colleges and universities provide access to information for their academic institutions and teach library users about accessing, using, and citing information.Gathering information is the bedrock for any research undertaken by students, and the role of the librarian is critical for student success. Librarianship as a field has a rich and complicated past. Its charge of helping people find information struggles against the influence of structural racism and sexism woven into how information gets privileged. Library systems that organize how information is gathered have been fraught with a slant towards a White Anglo-Saxon Protestant bias that has shaped its growth and development. One such example of this bias is perhaps the most famous librarian, Melvil Dewey. Melvil Dewey, has been called the "Father of American Librarianship" and creator of the Dewey Decimal System (DDC). Dewey's famous system has been critiqued for the way it emphasizes certain categories of knowledge and de-emphasizes others, and Dewey himself has been accused and charged with sexual harassment and was an outspoken segregationist.
Emily Drabinski, a librarian at the Mina Rees Library at the Graduate Center, City University of New York describes Dewey’s classification structure by stating, “It’s all about white Christian power that has spread around the globe.” (Lindell, 2019).It stands to reason that Dewey’s beliefs that guided his creation of the DDC also guided his personal life. He was racist,anti-Semitic, and he sexually harassed women (Lindell, 2019). These have been fairly well-known character traits of Dewey both at the time he was alive and working, and posthumously,yet the organizations that guide librarianship have taken more than a century to acknowledge his wrongdoings and speak truth to power. Even by the standards of his times, Dewey was found guilty of sexually harassing women, and in 1927, Dewey was also successfully sued by one of his victims. Dewey's legacy is complicated; while mostly fraught with structural and individual racism and sexism,he did create a system that, with modifications to address its enmeshment with white supremacy, still is a highly utilized tool in librarianship. To complicate his legacy further, Dewey stood up to Columbia University to help women get librarian education, all the while declaring that they should be paid less than men, in addition to other sexist ideations about women in the workplace generally (Lindell, 2019).
Librarians nationwide are keenly aware of the history of their field and current practices that enforce hierarchical information gathering, citing and validation.Violet Fox, Dewey editor with the Online Computer Library Center, which owns the rights to the DDC, said the system is continuously updated, and editors are now “focusing on gender identity and sexual orientation as well as providing new options for classifying works about Indigenous peoples” (Lindell, 2019). Some librarians aspire to be especially committed to historically oppressed library users,although academic librarians are typically not representative of the students they serve. Librarians tend to be white, as 86.7% of librarians are white (Henke and Rosa, 2017). Among library professionals and library students, non-whites are one-third less present in librarianship than in the general public (Barlow and Jaeger, 2017). This is a persistent problem that has not changed over time and it mirrors higher education overall (Vinopal, 2016). A lack of representation in library staff impacts a library’s ability to provide appropriate resources and services. “In an overwhelmingly white (and heterosexual, cisgender, and patriarchal) organization, it is important to recognize that the data we collect represents primarily the worldview of the dominant culture and will be shaped by its limitations and biases” (Vinopal,2016). Information curated and gathered by only one demographic leads to a narrower collection at individual institutions across the nation. Furthermore, when potential library sciences students do not see themselves represented in the field, recruiting diverse students becomes harder.
There is work being done to address structural racism and diversify the field precisely because much of what librarians are called to do reflects a strong commitment to social justice. The American Library Association’s Task Force on Diversity, Equity, and Inclusion (DEI) calls for continuing the work of making the issue more visible (“Fina Report,” 2016). The American Library Association, co-founded by Melvil Dewey and the world’s largest professional body for librarianship, includes individuals and groups working tirelessly to create a more representative field. Their “Bill of Rights” and the commitment to equitable access to all has led Library Information Science professionals and institutions to take many important roles in supporting inclusion and justice in their local communities and in society as a whole (Barlow and Jaeger, 2017). Going forward,there are identifiable steps discussed in reports like those mentioned here, to be taken in order to support a more diverse body of librarians in varied sizes and types of libraries nationwide. The ALA Task Force on Equity, Diversity, and Inclusion and Jennifer Vinopal,author of In the Library with the Lead Pipe,have made recommendations that include:
• Bias Awareness and Valuing Difference
• Naming the Problem
• Mission and Follow-through
• Data Collection
• Recruiting
• Mentoring
• Pay for Work
(Read the expanded version of these suggestions here)
Not unlike suggestions made by other discipline specific governing bodies across academia,these steps are widely thought of as an equitable path forward. Many in the field seek to shift the way in which librarianship is made available and representative of the population at large. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.32%3A_Library_and_Information_Science.txt |
Mathematics is the science and study of quality, structure, space, and change.Mathematicians seek out patterns, formulate new conjectures, and establish truth by rigorous deduction from appropriately chosen axioms and definitions (What is Mathematics?, 2021). Aside from being incomplete, inconsistent, and undecidable, math is a long standing tool for knowledge. Despite this, there is a hole in the bottom of math, in that we will never know anything with absolute certainty (Veritasium, 2021). What we can assert with certainty is that math as a requisite part of a general education pathway has proven to be a very difficult hurdle,and the conversation about how to address this has been ongoing, disharmonious and nowhere near resolved. Math holds the distinction of being one of the scariest subjects for a great deal of students. Math anxiety is actually a recognized phobia:
People who experience feelings of stress when faced with math-related situations may be experiencing what is called“math anxiety.” Math anxiety affects many people and is related to poor math ability in school and later during adulthood (Sokolowski & Ansari, 2017).
This type of anxiety that many regardless of identity experience may also be compounded by structural racism in a number of ways. Statistical Data, a mathematical tool in itself has been used to illustrate a persistent underperformance in math by Black, Latino and Indigenous youth. While findings such as this are a part of the equation they are not the entire story, there is more underlying in the ways in which these findings get used to shape perceptions which affect those student’s outcomes. A 2016 study in the Journal of Urban Mathematics Education,
disrupts those narratives by examining an unaddressed element of the equation—namely, the ways in which “whiteness” in math education reproduces racial advantages for white students and disadvantages historically marginalized students of color (Anderson,2017).
The study concludes that there is little discussion about the role of whiteness in how math is taught. “Naming White institutional spaces, as well as the mechanisms that oppress students,can provide those who work in the field of mathematics education with specific ideas about combating these racist structures” (Battey, & Leyva, 2016). The role of the teacher then becomes critical here in order to move in the direction of higher success and retention rates for students. As mentioned in other sections of this reader, a growth mindset is needed for educators wishing to combat these structures, instead of a fixed set of perceptions that does not allow a teacher to see a mathematical scholar in a student who does not fit their perceived mold. Any math educator can work in the direction of equity minded teaching by recognizing their own biases and acknowledging the structures in place that have marginalized so many students. There are many in the field working in this direction currently. (Those) “Educators say that incorporating anti-racism into math education involves providing students with context about how math has been used to perpetuate racism and giving students an opportunity to apply math in real-life scenarios that encourage equity” (Okwuosa, 2021).
2.34: Mathematics - Statistics
The subfield of statistics within mathematics has been used widely among virtually all academic fields.Statistics is the science concerned with developing and studying methods for collecting, analyzing, interpreting and presenting empirical data (What is Statistics?, 2021). Data is a critical piece of academic research but it’s use and misuse to perpetuate inequality have deep historical roots. Some of the early work in the field of Statistics was done by Sir Francis Galton and it is important to understand the historical role, structural racism played in it’s development. Sir Francis Galton was a prominent researcher in several fields, including Psychology, Biology, Anthropology, Sociology, and Statistics. Some of his most relevant contributions were the correlation statistic, regression, psychometrics, and behavior genetics. However, Galton, the younger cousin of Charles Darwin, was also the father of a more insidious subject: Eugenics. Eugenics is described as a racist and misogynistic pseudoscience, and served as justification for oppression and injustices of anyone deemed undesirable or less desirable. Specifically, Eugenics called for the oppression of any person who was not a wealthy and able bodied white man, and for demographics seen as especially undesirable, Eugenics argued for their forced sterilization. Galton and his followers, including Karl Pearson, argued that the British Race was deteriorating due to unfavorable genes being inherited and passed down. Whereas Charles Darwin developed his theories on evolution, Darwin did not believe that those theories justified superiority of specific races. Rather, Darwin asserted that any human alive today is successfully adapted, and by extension, just as perfect as the other people around them (Hanley, 2020).
In Galton’s efforts to sow inequality, he created the Anthropomorphic Laboratory, which worked to prove how humans were subject to natural selection, just as plants and animals.Eugenic arguments were consistently disproven. Case in point, a 1904 Interdepartmental Committee on Physical Deterioration argued that syphilis and insanity are the only two inheritable genetic degenerative conditions, and that other conditions were a result of poor nutrition, sanitation, and other environmental consequences. Despite clear inaccuracies in the pseudoscience, eugenicists inspired by Galton persisted in their argument that poor genetics were undermining the British population. The 1907 Eugenics society was incorporated in 1907,and they played instrumental roles in legislation such as the 1905 Aliens Act and the 1913 Mental Deficiency Act, which strengthened anti immigration policies and were in favor of institutionalizing people seen as “mentally defective” (Gunderman, 2021).
Unlike the United States and many European nations, England did not participate in mass forced sterilization. However, eugenicists such as Marie Stopes argued that working class families were too large and that there was a need for contraception (birth control) to stop the working class from reproducing faster than the “more desirable” middle class. Eugenicist assumed that the working class and less fortunate were in their social position due to genetics; working classes were seen as lazy and unchaste on a genetic level. Eugenicists argued that this was a gene which could and would spread if the working class were allowed to have children,and the spreading of those traits would lead to racial decline and collapse.
It is important to recognize scientific accomplishments, while also acknowledging the scientist’s problematic behaviors, thoughts, and beliefs. In contemporary society, scientists are too often lauded and praised limitlessly; their flaws and problematic ideas are ignored or even hidden. This white washing of history perpetuates the system of inequality, and by failing to learn about horrors such as Eugenics, society may one day be doomed to relive it. In current society, although the majority of society’s members admit that prejudices are unfair and immoral, assumptions about natural racial and gender based differences still persist (Gunderman, 2021). Galton may have been responsible for scientific contributions and statistical discoveries such as correlation and regression, but he was also responsible for atrocities against humanities through his pursuit of Eugenics. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.33%3A_Mathematics.txt |
From classical and jazz, to rock and pop music, a degree in music offers a sophisticated knowledge of the theory, history, and performance standards of all fields of music (Music, n.d.). That definition of the field has not proven to be quite accurate. The study of music theory in particular is not fully inclusive of all styles of music, but rather,framed in a white supremacist lens at various levels of the field, which dictates the styles of music studied and valued.An abstract of music education in the United States begins in the 1700’s, with music theory in American popular culture only referring to the white racially framed style of European musicians.
Music theory is white. According to the Society for Music Theory’s “Annual Report on Membership Demographics ”for 2018, 84.2% of the society’s membership is white 90.4% of all full-time employees in music theory are white (8), and 93.9% of associate and full professors in music theory are white (9). Aside from this literal version, there exists a figurative and even more deep-seated whiteness in music theory. This is the whiteness—which manifests itself in the composers we choose to represent our field inside and outside of the classroom, and in the music theorists that we elevate to the top of our discipline—that one must practice,regardless of one’s own personal racial identity, in order to call oneself a music theorist (Brown, 2018, Ewell, 2020).
There is a vast and diverse musical tradition globally and in the U.S. that many music majors are not introduced to. Indigenous spiritual music played purposefully by Natives already living in North America was viewed as “inferior” and even “horrifying” by European religious colonizers who moved in with Quaker, Catholic, and Christian hymns(Winston, 2019). The migration of people southward led to the settling of the Appalachian Mountains where many poor Europeans inhabited and brought country blues and fiddling styles. African Slaves came to the United States and introduced the music world to instruments like the xylophone and banjo. The diverse music of the United States comes from the diverse type of people who first colonized this country, however music “scholars” in the field of education have long maintained white-centric curricula by labeling music from other cultures as “less than” with other names like “folk” and“ethnic” music (Ewell, 2020).According to musicologist Dr. Ewell,
Our white racial frame believes that the music and music theories of white persons represent the best framework for music theory. Music theory can be seen as a racial ideology in which the views and ideas of white persons are held to be more significant than the views and ideas of nonwhites (Ewell, 2020).
America also proved how music education can be a mechanism of cultural genocide. In the 1800’s, Congress elected to assimilate the remaining Indigenous population, chartering boarding schools where thousands of Native American children suffered, often died, and most notably were denied the right to sing, dance, or play their ancestral music. Thus,they were unable to experience, know, or pass on their culture, thereby killing hundreds of individual tribal cultures. For American students in the 1900’s, class and wealth gaps in the United States economy have defined generational ability to own any instrument,attend music lessons, or proceed to a music institution. This means racial segregation played a major role in lack of access and opportunity.
It wasn’t until the 1950’s that the American Orff-Schulwerk Association (AOSA) popularized, and simultaneously, mass production factories granted the ability to make and deliver plastic recorders to children across the country. Recorders have dominated public education for the past 70 years or so, and every citizen can likely say they’ve played a recorder in school as a child. AOSA is fully responsible for the popularity of the recorder and the mass elementary music education curricula, yet many are unaware that Carl Orff,the man who created AOSA, was the most celebrated Nazi musician of the Third Reich. Orff’s affiliation with the Nazi regime has not prompted the AOSA to consider a name change despite their website’s commitment to diversity and inclusion (Diversity, Equity, and Inclusion, 2021).
The recorder is not the only element within the field of music with an insidious background, as many popular rhymes have racist roots. “Eeny meeny miny mo” is one of those rhymes that’s ingrained in our cultural limbic system,yet its racist references predate the end of the civil war and enslavement. The song lyrics were constructed sometime in the 17th century with the “n” word in the second line, and even had later versions popularized in Europe before it was officially published in 1935 with the “n” word still encrypted, less than one hundred years ago (Simchayoff, 2021).
Decolonizing the music educational experience from toddler to senior starts with centering Black, Brown, Indigenous, and Asian voices, knowledge, and experiences to challenge the historical dominance of white Western European and American music,narratives, and practices that have resulted in minimization and erasure throughout the music field. Solutions lie in expanding curricula to include nonwestern and nonwhite forms of music theory. This change would not erase Western tonality, rather, it would make space in the curricula for music theories of nonwestern cultures to be included. By decentering whiteness and reframing the totality of the world of music, the music theories of nonwestern cultures would enrich musical offerings in our music institutions (Ewell,2020). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.35%3A_Music.txt |
While the culture and perception around music is seen to be inclusive and accepting, there are countless instances of exclusion and cultural appropriation within music. Berklee College of Music wrote about cultural appropriation within music, first defining the term as “The adoption of an element or elements of one culture by members of another culture. This can be controversial when members of a dominant culture appropriate from disadvantaged minority cultures” (White, nd).
Elvis Presley, the man titled the ‘King of Rock,’ has a controversial relationship with Black musicians and culture. Presley fully admitted his relationship and admiration with Black music, even stating, “But rock 'n' roll was here a long time before I came along. Nobody can sing that kind of music like colored people” (Ward, 2017). In Presley’s era,which coincided with racial segregation, Black music and its creators would not be given a radio presence or spotlight, and Presley’s recognition and admiration of Black music and culture is something we cannot overlook. Furthermore, Elvis’ Black contemporaries, such as Little Richard and B.B. King, praise Elvis. B.B. King stated that he did not think Elvis ripped off black music, and that “They did not make a mistake when they called him The King” (Young, 2020).
However, we also cannot overlook the fact that Elvis has annual earnings of \$2,000,000, while Black contemporary Fats Domino earned \$700,000; Elvis himself even admitted that he could not sing like Domino (Ward, 2017). Elvis’ history and relationship to Black culture and musicians was a complicated one, and it is important to view it from all aspects, from his praise toward Black musicians, but also from the income disparity, and we must also acknowledge and recognize the validity of those who say Elvis stole and appropriated Black culture, whether it was intentional or not. It is important to also critically analyze the role of the music industry and executives, as although Elvis may have embraced Black artists, the industry and executives did not. As the gatekeepers of music and popularity, they would not allow Black artists to enjoy the fruits of their labor, instead unfairly gifting them to white artists.
Even in the contemporary era, cultural appropriation has not ceased. There are countless instances across genres, and it would be impossible to note every instance of cultural appropriation in the past decades. Some examples include Iggy Azalea, a white Australian musician, who recorded a music video in an Indian neighborhood, wearing asari, traditional wedding attire, and a bindi, while rapping in a style akin to Black artists in Atlanta (White, nd). Madonna has faced claims of also stealing Indian and Black culture, as well as Latin American and LGBTQ culture (Nittle, 2020). Other artists include Justin Bieber, Robin Thicke, Pharell Williams, Ariana Grande, Miley Cyrus, and Katy Perry (Kameir, 2020).
As a collective, shared experience, and due to its pervasive impact on culture, it is difficult to say when music is being appreciated and incorporated or when it is being appropriated and stolen. However, when music theory is written from a white and Western perspective, it undermines the validity of other forms of music, such as indigenous, Asian, and African music, and can even give these forms of music an image of inferiority. When a white artist incorporates these forms of music and introduces them to the popular culture, it does a disservice to the societies, communities, and musicians who originally played and created their form of music. Those original artists are instead often shunned or seen as less valid. White artists also have the privilege of profiting from marginalized cultures as they see fit for as long as they want to, in addition to the default white culture. These are luxuries that are not afforded to marginalized artists. Music has the unique ability of uniting people across barriers, but it can also be misused to exclude marginalized people, and further inequalities.
It is suggested that the reader further their own research on the ways in which the music industry is entrenched in structural racism. One possible starting point is the film “The Five Heartbeats,” which explores the experiences of Black musicians and how white executives took advantage of Black musicians and their work, and used them as products for the use of white artists. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.36%3A_Music_Musical_Performance_ers.txt |
The love of wisdom, aka Philosophy,seeks to study the fundamental nature of knowledge, reality, and existence, especially when considered as an academic discipline. People can learn fundamental truths about themselves, the world in which they live, and their relationships to both the world and to each other. While Philosophy is a foundational building block for all other academic disciplines, it has been shaped by structural racism, and this shaping has had an effect on its growth, development and its demographic. From the early work of Immanuel Kant in 1781, who famously began his work describing the superiority of Whites over Blacks and Indigenous Peoples, philosophy rests in that foundation (Rutledge,2019). It is important to establish that racism has broad implications for how the entire field of philosophy is practiced.
At present, all members of the discipline should be on notice that racism has historically impacted, and continues to impact their field. Philosophy is highly utilized, built upon and central to the growth and development of other disciplines. An honest analysis of race and racism can make all schools of philosophy, including ethics, political philosophy, and abstract debates of metaphysics, philosophy of mind, and epistemology, all richer fields. For race theorists, philosophy is highly significant for their work, however it has been observed that contemporary philosophy continues to evade a discussion of racism in the field and, as a result,often helps to promote it. At the same time, anti-racist theorists in many disciplines regularly draw on crucial notions of objectivity, rationality, agency, individualism, and truth without adequate knowledge of philosophical analyses of these very concepts (Cook, 2003). Evidently there remains a disconnect.
There remains alack of diversity in the use and recognition of Black, Indigenous, people of color (BIPOC) Philosophers in most college level Philosophy classes. For new students studying the field, this leaves them with a misunderstanding of who has contributed to the field. From very early on, Philosophers came from all parts of the globe and had differing epistemologies, that if taken as a whole would create a wider philosophical lens for students to gaze through (Rutledge, 2019).
2.38: Physics
Physics is the science of matter and how matter interacts. Matter is any physical material in the universe. Everything is made of matter.Physicsis used to describe the physical universe around us, and to predict how it will behave. This epistemology has been seen as the science that sees the world so accurately and in such great detail. This reputation has been unchallenged and in fact has contributed to the limited scope and lack of diversity in the field.
“White empiricism is the practice of allowing social discourse to insert itself into empirical reasoning about physics, and it actively harms the development of comprehensive understandings of the natural world by precluding putting provincial European ideas about science, which have become dominant through colonial force into conversation with ideas that are more strongly associated with “indegneity,” whether it is African indigeneity or another” (Prescod-Weinstein, 2019).
As in other disciplines, a lack of diverse thought and representation limits the contributions in the field to what is seen as the right way to do physics. A recent statement by Dartmouth University admits complacency in their practices over the years in regard to supporting students of color. They issued a statement addressing this and announced its support of the Black Lives Matter Movement. Dartmouth is committing themselves to concrete actions in a 6 part plan that includes making the department of physics more welcoming to students of color by highlighting work in the field by Black, Indigenous, people of color (BIPOC), and revisiting biased admission exams that women and students of color historically do poor on, thus putting them at a disadvantage to their white male peers. This statement was influenced by the American Institute of Physics TEAM-UP report (Dartmouth Department of Physics and Astronomy, 2020).
The American Institute of Physics TEAM-UP report is a report regarding the status of racism in Physics with an eye to increase the number of African American students pursuing degrees in Physics. The team conducted site visits at 5 U.S. colleges, one Historically Black Colleges and Universities, (Morev house), two Predominantly Black Institutions (Chicago State and Georgia State), and two Predominantly White Institutions (University of Maryland and Henderson State University) and made recommendations (TEAM UP, 2020). The team was made up of social scientists,astronomers and physicists called TEAM-UP. The inclusion of social scientists was because “TEAM-UP members firmly believe that scientists cannot solve the problem of African American underrepresentation using methods common to physics and astronomy; new thinking and new language are needed. TEAM-UP identified five factors responsible for the success or failure of African American students in physics and astronomy: Belonging, Physics Identity, Academic Support, Personal Support, and Leadership and Structures” (TEAM UP, 2020). African American students are as capable as any other students,but these identified barriers are what the research, based on student interviews, 5 site visits,and department head interviews found. These barriers have a strong correlation to the lack of diversity and representation in the field, and addressing and removing these barriers is crucial for future improvement. Fostering inclusion and belonging is an important piece to recruiting more students but this will require a shift in faculty mindset.
Students need to see themselves as physicists, and can do so by participating in research and conferences and through faculty recognition, so mentoring, access to opportunity,and support from faculty and institutions is important. Schools need to hire more Black faculty and diversify STEM departments overall. Beyond diversifying faculty, students do better with caring faculty of any race/gender who can guide students to all types of support services they need so a focus on this type of faculty skill building is also in order. For students who are having financial problems, there should be resources for them to get aid whether it be cash,food, housing, etc. TEAM UP’s report provides detailed recommendations to the problems outlined and is centered around a theory of change using sense making and shared leadership in this process (TEAM UP, 2020). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.37%3A_Philosophy.txt |
Astrophysics is a branch of space science that applies the laws of physics and chemistry to explain the birth, life and death of stars, planets, galaxies, nebulae and other objects in the universe. It has two sibling sciences, astronomy and cosmology, and the lines between them blur (Balter, 2017). Like its counterpart, Astronomy, it is a predominantly white field (AIP Report, 2021). While racism is not rocket science, rocket science suffers from it when it comes to representation in the field. A notable exception is Dr. George Carruthers, who was an Astrophysicist, acclaimed scientist, and inventor who died in December of 2020. His telescope enabled astronauts on Apollo 16 to obtain photos while on the moon in 1973.
One of the leading and few Black astrophysicists in his field, Carruthers built his first telescope at age 10. He responded to a 1969 call from NASA to design experiments for Apollo space flights. Four months later, Dr. Carruthers received a patent for an “Image Converter for Detecting Electromagnetic Radiation Especially in Short Wavelengths.” He was unique in that he was the conceptual scientist behind the invention but also the practical engineer. He and a team created a telescope that “electronically amplify [sic] images from space through a series of lenses, prism [sic] and mirror [sic], just three inches in diameter. Then, by converting photons to electrons,the images could be recorded on film” (Shudel, 2020).The telescope was also sturdy enough to handle space travel and was easy enough for astronauts to maneuver in their space gear. It was like a planetary observatory, which was the first of its kind to be used in space. He went on to develop more telescopes in his tenure. Dr. Carruthers was one of four children. He completed his education in a very short time period. He was very shy but gave wonderful lectures. In a 1971 interview, he mentioned that in his 7 year career at the naval research laboratory, he worked 14 hour days, had never taken a vacation, and had no hobbies as this work felt like a hobby. In the 1980s, he began to work extensively in science outreach programs particularly in Black schools. After retiring in 2002, he taught Earth and Space science at Howard University (Shudel, 2020).
In a 1992 Interview with Dr. George Carruthers, he discussed Project SMART,Science and Mathematics Achievement through Research Training(SMART) which was a group started by Valarie Thomas, who works at the National Space Science Data Center in Goddard Space Flight Center. The project was created to advise on science and technology issues of importance to the Black community. The initial goal of the project was to increase literacy in the fields of science and technology among the Black community regardless if they make a career out of it and it has expanded its charge over time. Dr. Carruthers explained that there are other organizations working on similar causes that he also works with. When asked if it was different working to recruit African American students into his field as opposed to white students, he responded,
“I don't think there is anything different in nature. There may be some difference in the degree because of environment and background. Certainly I don't think there is anything inherent to race that's involved. It's just that most of the African American students come from less well-to-do backgrounds, inner city backgrounds, and aren't exposed to science and technology to the degree that some of the other students are. But the other question about how we get them interested is something that we're really trying to find out and develop” (Carruthers, 1992).
He spoke to the idea of being a role model and the importance of the youth to see someone like them doing the work (DeVorkin, 1992). He mentioned the obstacles but argued that there were fewer of them at the time of the interview (1993) than in the 1950s and 1960s. Dr.Carruthers discussed his father who worked in the same field, and he also had an uncle with a PhD who taught at Howard University. Getting a science fiction comic book from his grandmother is what got him interested in science. He built his first telescope shortly after. In high school he competed in science fairs and continued to build telescopes. There he started going to the Adler planetarium and connected with astronomers. He read an article in the 1950s that suggested astronomy should be done in outer space, and this idea was in sharp contrast to what many astronomers felt the charge of astronomy was and that in fact it should be done on Earth (DeVorkin, 1992). His teachers were supportive of him in high school but he was really over their head in terms of his intellect and ambition. At Adler, he was part of a telescope making group; in the group, it was up to the inventors to purchase their own supplies which Carruthers was capable of doing. He was not poor, but did not have as many resources as some of his contemporaries. Carruthers stated that, “Since the astronomers at the Adler Planetarium told me that space flight was nonsense, I wanted to sort of counter that by studying aerospace engineering and making space astronomy a reality,” so he pursued that area of inquiry at the university. He cited books growing up serving as role models for him (DeVorkin, 1992). In college the shift academically was hard. He went from As to Cs and Ds, and he credits these grades in part due to not enough high level math classes offered to him at his mostly Black high school. In his first year of grad school, Dr. Carruthers took a summer job at Aerojet in Sacramento, California, which was his first exposure to what engineers do. It helped him refine what he did not want to do but he learned a lot. He wanted to work for the Naval Research Laboratory (NRL) from early on and secured a NASA postdoc with that goal.
The ability to do one's own engineering and building wasn't common practice of scientists at NASA, so many found Carruthers odd, and some engineers felt he was stepping on their toes. In 1967, he had his first rocket success and was able to get aerial images from space with a telescope. After the postdoc, he moved to NRL and was able to focus on the work he found meaningful. In this regard he could be involved in all aspects of the inventing, building, testing, and observing which is the way he wanted to work. In this work he saw an opportunity to act as a role model for those aspiring to do similar work. His groundbreaking telescope project came as a call for experiments to be brought on the Apollo 16 launch. His proposal was accepted and he was asked to partner with Thornton Page whose proposal was similar. The telescope was engineered by Carruthers and it launched with Apollo 16. After Apollo technology changed, Carruthers research interest shifted to his work with Project SMART. He saw classroom teaching as not engaging, and asserted that there needed to be supplemental hands-on opportunities for summer programs that perform first hand science experiments and activities to engage youth (DeVorkin, 1992). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.39%3A_Physics_-_Astrophysics.txt |
"The soul of our politics is the commitment to ending domination"
-bell hooks
The United States was born out of a desire to end what the founders saw as a tyrannical monarchy. Political Science is the study of systems of government, covering both the functions of government and theoretical approaches that guide those functions. Within the United States, The field is typically broken up into political theory, American politics, comparative politics, and international relations. Structural Racism is ingrained in the field by both the “founding scholars” of political science and the actions that the field is used to excuse.
Throughout the history of political science as a field, the role of race was not studied, in the way that it has been in other social sciences. However, Roger Smith, Professor of Political Science, argues that racism has been entrenched in the field since its beginnings.The Wealth of Nations by Adam Smith is known as the “bible of capitalism,” and has been referenced by politicians and political scientists when forming policy and framing research throughout our nation’s history (Smith, 1997). Adam Smith writes about the necessary political and economic structure of nations to succeed. His ideal nations, or the wealthy nations of Europe, were described as “civilized” with people who are “industrious”, leading to the success of the country. On the other hand, Smith describes “savage” nations with people who are “miserable poor”, alluding to nations outside of Europe (Cannan (Ed.), 2019).Along with capitalism, our nation’s liberal values also stem from the teachings of John Locke. John Locke, known as the father of liberalism, wrote in the “Second Treatise of Government”about the role of government and the influence it should have on the people. He famously writes that it is the government's role to protect the natural rights of people, also known as life, liberty, and property (Locke,1773). The founding fathers relied on his teachings in drafting the declaration of independence and our constitution, even describing the people’s “unalienable rights” to “life, liberty, and the pursuit of happiness,” a direct reference to John Locke. However, John Locke was a beneficiary of slavery, owning stock in the Royal African Company, and assisting in drafting Carolina’s constitution, a document that allowed slavery. While his teachings reference slavery, it is clear that he condoned slavery, and when he discussed man’s right to property, Black slaves were considered as such (Brewer, 2018). It is clear that both Adam Smith and John Locke, two of the most regarded figures in political science, were racist, and their racist ideas are ingrained in the field of political science and in American Politics.
The U.S. political machine operates in part through the democratic process of voting. We vote in our elected officials who then work on behalf of the people and we vote for or against policy changes that affect all aspects of human life. The right to vote is seen as sacred,and it is a right that people have fought and died for throughout history. The history of voting in the United States is fraught with gerrymandering, suppression, lack of access, and inequality. More of the population than not were denied the right to vote until fairly recently. Women were not granted the right to vote until 1920. The fifteenth amendment was put in place in 1870 to allow Black men to vote but voter suppression the likes of literacy laws and poll taxes effectively denied them their right to vote. The reality is that it was not until the voting rights act of 1965 that Black Americans were somewhat freely able to vote. Present day, there are still varying ways that voter suppression, especially for people of color, takes place. A push by many Republican policy makers in states like Texas to restrict voting rights via closing polls entirely in certain areas, restricting voting by mail, and poll watchers is actively taking place right now(Ura, 2021). Gerrymandering is frequently employed as a way for a political party to maintain political power,but it flies in the face of what a true democracy actually is. In 2021, false claims of election fraud as a means to overturn a presidential election brought the US to the brink of civil war.
Historically, there have been numerous attempts at power grabs by using the political system to advantage one political agenda over another. In 1787, the 3/5th compromise allowed slave owners to count each of their slaves as 3/5th of a person, in order to increase overall population in slave owning states. The compromise gave disproportionate congressional representation without giving slaves the right to vote. Many liken mass incarceration to modern day slavery, and those incarcerated find their bodies similarly used to create a political advantage. Since the 1790 census, incarcerated people who reside in institutions have been counted to boost the population of the region where the prison is located, regardless of where their actual home is located. Simultaneously, barring a few exceptions, these incarcerated people are not allowed those people the right to vote (Felon Voting Rights, 2021). This continuation of the 3/5th compromise has been called prison gerrymandering.
That little-known practice involves determining the areas elected officials represent with census numbers that count prisoners as residents of where they are incarcerated.With those tallies, some redistricting officials have created local voting districts filled mostly with people who are locked behind bars and, in most states, cannot vote (Lo Wang, 2021).
Currently, only 11 states in the nation are moving to eliminate this practice. The ways in which districts get drawn, people get counted, and the historical legacy of voter suppression has had a lasting impact on who we elect to public office. It raises the question of what our political leaders would look like if every American had always possessed the right and opportunity to vote.
As demonstrated, the field of Political Science has often been used to justify racist policies and actions. Racist policies and actions have harmed Black and Brown people throughout history, but did not receive widespread acknowledgement until recently. In the wake of the highly visible police murders of George Floyd and many other Black and Brown people, a multitude of academic fields have issued statements in support of Black lives and decrying their field's contribution to the perpetuation of structural racism. Political science is no exception. A recent statement by Gettysburg college in part reads,
If politics is the struggle of who gets what, when, and how, we–as political scientists–need to directly address how national, state, and local institutions have perpetuated a system whereby the outcomes of that struggle are neither equal nor just (Department Statement on Structural Racism. 2020).
Gettysburg College has committed to actionable steps that will create a less racist learning environment, focused on specific steps that create more inclusion, speak truth to power and identify past problems in their field that contribute to structural racism in the society at large via political action. A complete list of their action steps can be found in their Departmental Statement on Structural Racism-Political Science.
In and of itself, silence is a political act, and for those in the field of political science, their silence regarding the legacy of structural racism in the field speaks volumes. Students need to be empowered with the knowledge of how the political apparatus works as well as how it has been used for both good and evil. For educators, making space in their curriculum to address structural racism is part of effectively teaching Political Science. As a white supremacist nation built on the backs of non-white people, this aspect of the culture is important for a true understanding of our political system. Failing to do so would betray the very purpose the study of Political Science is intended to serve (Department Statement on Structural Racism. 2020). | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.40%3A_Political_Science.txt |
Psychology is the science of human processes within the mind, such as thoughts,feelings, and behavior. Psychology can be viewed through a multitude of subsects, such as Abnormal, Biological, Clinical, Cognitive, Developmental, Forensic, Industrial, and Social Psychology (Cherry, 2020). Psychology is interested in the way the human mind operates, and how external stimuli may affect or impair various psychological processes. In a society built on a foundation of structural racism, the impacts of racism on psychological well being cannot be overstated. However, it is imperative to question whether Psychology is riddled with the same prejudices that impact higher education across disciplines, as well as society as a whole. On October 29, 2021, American Psychological Association (APA), admitted to failing to lead the discipline of Psychology against racism and systemic inequities, and apologized for their actions and inactions toward people of color and combating systemic racism (Apology to People, 2021). Accepting the consequences of the failures and discrimination that was perpetuated by the discipline is the first step toward improvement; however, it is imperative to view the discipline holistically, starting from a historical perspective.
Historically, Psychology has been responsible for the creation of several racist,primordial beliefs, such as claims about the relationship between intelligence, race, and nationality. Intelligence Quotients, also known as IQ tests, have long been viewed as a resource for judging and gauging one’s intelligence. However, IQ tests are inherently problematic, as they overgeneralize intelligence, which can exist in multiple ways, including those that are not measured in quantifiable or obvious metrics. Dr. Adrian Owen stated that there is no such thing as a single measure of general intelligence, and that a single number cannot explain the differences between people. IQ tests also overlook factors such as age, use of substances such as tobacco, or conditions such as anxiety (Castillo, 2012). IQ tests have been used to argue for racial hierarchies in the past as well. In 1916, Lewis Terman, American Psychologist and education researcher, made the assertion that intellectual deficiencies in Indigenous, Hispanic,and Black people were genetic and based on race. Terman even went so far as to state that, “Their dullness seems to be racial, or at least inherent in the family stocks from which they come ... Children of this group should be segregated into separate classes ... They cannot master abstractions but they can often be made into efficient workers ... from a eugenic point of view they constitute a grave problem because of their unusually prolific breeding” (Martschenko, 2017).
Arguments such as these were the basis of Eugenics supporters, who pressured for the mistreatment and forced sterilization of groups such as people of color, people with varying levels of physical and mental ability, immigrants, poor and impoverished people, and other demographics that were deemed as unfit. The Eugenics movement called for the oppression of any person who was not a wealthy and able bodied white man, and for demographics seen as especially undesirable, Eugenics argued for their forced sterilization (Martschenko, 2017).
The role psychologists contributed to this movement was by using IQ scores through army testing in World War I noting racial differences. This allowed supporters to make connections between the “socially unfit” and “racially unfit”, and use the field of psychology to promote and propose eugenicists programs (Guthrie, 2004).
One of the most significant figures in the eugenics movement was Sir Francis Galton whose story was previously detailed in the Mathematics-Statistics section. Galton was a researcher in several different academic disciplines, such as Anthropology, Biology, Psychology, Sociology, and Statistics. As psychological research is largely dependent on statistics, his contributions are even more connected to the discipline. He was also Charles Darwin’s younger cousin, but was also a father of Eugenics (Gunderman, 2021). Galton and his followers,including Karl Pearson, argued that the British Race was deteriorating due to unfavorable genes being inherited and passed down. Whereas Charles Darwin developed his theories on evolution, Darwin did not believe that those theories justified superiority of specific races.Rather, Darwin asserted that any human alive today is successfully adapted, and by extension,just as perfect as the other people around them.
Today, Galton is most known for his contributions to the field of statistics, and statistical concepts such as the standard deviation, correlation and regression toward the mean (McColl, 2012). However, he is also responsible for the oppression, forced sterilization, and even death of countless people, and by failing to acknowledge these crimes against humanity, higher education will always have a blemish. While Galton’s work in other disciplines, especially statistics, has value, and should continue to be used, a complete history should include Galton’s darker side, as well as the problematic history of psychology as a discipline. Otherwise, we may find that we are doomed to repeat history at some point in the future.
Psychological research also has an inherently white bias.A study conducted by Professor Steven O. Roberts inspected academic journals and the demographics of their contributors. Out of 60 identified editors, 83% were white, 5% were people of color, and 12% were unidentifiable. When looking at writers, the research provided the following data: 63% of the publication’s “first authors” were white, 23% were people of color, and 14% were unidentifiable. However, there was no distinct difference in quality of research by race, as there was no difference in citation count for scholars based on race. Furthermore, in lower tier journals, there were less white researchers than POC, demonstrating that there is not simply a greater amount of white researchers (De Witte, 2020).
Structural racism can help to explain this phenomena; because white psychologists dominate psychological journals and research, they control what is included and excluded from scientific records. The possibility of white fragility, and a hesitance, if not refusal to face one’s own prejudices, can cause race based research or research by psychologists of color to not receive publication. Roberts also addressed several possible solutions and equitable practices to incorporate. The first is communicating a top-down commitment to diversity, where the journal explicitly states whether it publishes research sensitive to and regarding race, and whether the journal values the editing, writing, and participation of racially diverse researchers. Authors should also be expected to articulate the racial demographics of their studies (De Witte, 2020).
In admitting their role in perpetuating and allowing for structural racism and inequality in the field of Psychology, the APA has taken the first steps toward promoting equity and change within the study of Psychology and the fields of Psychological research and clinical mental health. However, this is not a solution as of yet, and the dangers of past misinformation has effects to this day. In 2013, Jason Richwine faced controversy and ultimately resigned from his then position for his Harvard PhD dissertation, in which he claimed that Hispanic and Black Americans are less intelligent than white counterparts, making it more difficult for them to assimilate into white American society. Richwine attributed this to genetic factors, harkening back to the problematic history of Eugenics and IQ tests (Lindsey, 2013). Moin Syed, a Professor at the University of Minnesota, discusses the need for Psychology to address its racist past and its effects on the future. Syed mentions the dangers of awards named after scholars of the past who promoted dangerous and discriminatory ideas, and that it is possible to separate citing and crediting research from granting awards in the name of such problematic figures. Syed further asserts the need to educate on how statistical models and techniques can and have been used in conjunction with racism (Syed, 2020). Despite a variety of psychology research and practice being dedicated to concepts such as culture, discrimination, identity, mental illness in differing racial and ethnic demographics, and more, there is still a need to learn about the past. Students are mature enough and deserve to learn about and discuss topics such as Eugenics and structural racism in their discipline, and failure to do so is a discredit to them and the psychological community as a whole. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.41%3A_Psychology.txt |
Sociology is the study of society, and the ways in which humans interact with it and one another to create, and remake social structure. Through an understanding of culture, social institutions and structures, and social interactions, we can begin to make sense of humans in a greater societal context. Sociology grew out of a desire to understand human phenomena scientifically. While the discipline has morphed over the years to understand that the human requires a different type of study than inanimate objects such as a leaf, it still battles with a desire to be seen as a science, and to acknowledge that an objective/value free study of the human as a rational creature has its limitations. One of the first U.S. schools to highlight this point was a Historically Black College and University (HBCU), the Atlanta Sociological Laboratory at Atlanta University, whose most noted Sociologist was W.E.B. DuBois.The Atlanta Sociological Laboratory (ASL) is the first American school of sociology and the first to acknowledge limitations to value free study in its publication. Despite this, most professional sociologists know little about ASL. Instead, the Chicago School became credited as the first American sociological school. Albion Small, who was a founding sociologist at the Chicago School, failed to mention ASL in his seminal 1916 article describing the rise of American sociology over the previous 50 years. He made no mention of W.E.B. Dubois or his contribution to the discipline.ASL was completely ignored, as was Dubois until 1951 in American Sociology: The Story of Sociology in the United States through 1950 by Howard Odum, who credits the work of Dubois as contributing to the areas of “race/ethnic/group/folk” but fails to describe the work he did in many other areas of sociology (Odum, 1951).
An argument can be made that work done at ASL ought to be taught in introductory courses, however it is generally not.In 2012, Sociologist Earl Wright made recommendations on how to add this content into an Introduction to Sociology course, and highlighted the missed opportunity of standard introductory textbooks to include this information. Wright’s work examined the 5 most commonly assigned introductory texts and found only cursory mention of Dubois and almost no mention of ASL. The author suggests areas where the Atlanta Sociological Laboratory can be infused into specific chapters and sections of introductory courses, including the history of the discipline, research methods, religion, and race/ethnicity. The article includes appendices that provide resources to further students learning about ASL including readings and assignments to incorporate into introductory coursework (Wright, 2012).
Sadly, despite the work of Wright and others, Sociology and white supremacy are bound through elitism, power and racism. Sociology is neither objective nor value free in that the researcher is always implicated in their work. White scholarship practices erasure and it’s methods and practices are considered the mainstream while Black sociology is seen in contrast.Sociology reproduces the culture at large through its positioning white thinkers as noted experts, both the peer review and publishing practices, and creating a hierarchy of thought. In order to bring sociology into a place where it is more inclusive to all scholars, research and writings by sociologists of color must be incorporated better into the discipline’s recognized body of work (Shotwell, 2019).
There is a rising call to action to address the issue of white supremacy and racism inherent in Sociology. The epistemological framework of sociology is steeped in racism, just like all other fields, but this understanding has long been acknowledged in the field and many sociologists have spoken out in attempts to address this for over 100 years. An attempt to end the “possessive investment in white sociology,” which “continues to plague the discipline and its potential,” (Brunsma & Padilla Wyse, 2019)is a moral imperative, and ending this inequity will also make the discipline more relevant to 21st century students. In the field of Sociology,like the rest of society, whites benefit from the privilege of being the normative cultural definers, while others are seen in relation to whiteness. According to C. Wright Mills, “Whether signatories of this deal or not, all whites benefit from this” (Mills, 1959). It is important to understand the parallel development of the field in white institutions and HBCUs and just how differently each is received. The birth of both schools, the Sociology department at the University of Chicago (1892) and the Atlanta Sociological Laboratory (1895) both created a great deal to the field and deserve an equal place in the history books.
By conceptualizing Black sociology, hegemonic white sociology became visible. Black Sociology was seen as the sociology of liberation and adopted a culturally relative approach. White Sociology’s belief in objective knowledge via positivism did not consider the Eurocentric worldview that defined their reality. “Scholars explain that the racialized segregation of knowledge as structured by white supremacy reproduces a ‘white ignorance,’ which is ‘not confined to only white people’” (Brunsma & Padilla Wyse, 2019). Despite the discipline being organized around an understanding of humanity, many of the contributions of Black sociologists are not in the standard required elements of a sociology curriculum, whether at the undergraduate or graduate level, which limits the relevance of the field. More often than not,students of color do not see themselves reflected in the work.
We are not graduating sociologists of color, who then go on to teach at the rate we could be, and this is a symptom of this investment we have made in white sociology. Our organizing body (ASA) is a part of the problem as well. The structure and the ways in which one obtains a seat at the table is historically bound in the peer review process, and in a style of writing that is required to become published. When whiteness is normalized into institutional and disciplinary fabric, instances of micro affirmations, micro recognitions, micro validations, micro transformations, and micro protections become commonplace (Brunsma & Padilla Wyse, 2019).
A sociology of knowledge approach is needed to make clear the ways in which the investment in white sociology has shaped the discipline, and it also offers a way forward. By empowering our understanding of the discipline’s racialized history, we also empower the decolonization of our sociological imaginations. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.42%3A_Sociology.txt |
Zoology is the scientific study of the behavior, structure, physiology, classification, and distribution of animals. It further divides into various branches including Mammalogy,Herpetology and Ornithology. Classification as a form of understanding is part and parcel to the scientific process; however, moving from the non-human world to the species of humans is where historically and presently classification has led to some policies, ideas, and consequences of difference that are deeply rooted in structural racism.
In his 2020 book, How Zoologists Organize Things: the Art of Classification, author David Bainbridge describes how“an inherent human obsession with biological classification has left a pervasive, ugly legacy: many people still believe some “races” to be more primitive than, or inferior to, others” (Bainbridge, 2020). He describes this as a result of a hierarchical classification in the natural world that dates back to the 14th century. Philosopher Ramom Llulllikens this hierarchy to a staircase from lowest to highest life forms ordained by god.The way in which animal life was classified in ancient times included humans, which led Aristotle to reference Ramon Llull’s hierarchy of animals to include humans.Sadly, this organization was also attributed to homo sapiens as a species, which while in scientific terms is unsound, was a basis for understanding human difference, even until the present day in some scientific circles.Bainbridge notes that, the science of Zoology was inaccurately cataloged by a “human urge to organize animals most outstripped our actual understanding of those animals” (Bainbridge,2020).
Perhaps one of the most well-known Zoologists is Ornithologist, Naturalist, and Painter, John James Audubon (April 26, 1785–January 27, 1851). He is the namesake of the Audubon Society, founded in 1905. The society has worked for over 100 years in the effort of Conservation of birds, other wildlife and healthy ecosystems.His rise to prominence came with his groundbreaking effort to document all types of American birds which included detailed illustrations that depicted birds in their natural habitats in his book, The Birds of America (1827-1839). The classic book is considered one of the finest ornithological works ever completed(Audubon, 1827). As great as his work was to craft a scientific marvel still in use today, he left additional legacies as a part of who he was. His belief in the merits of slavery and his outspoken anti-abolitionist views cloud the very society that is his namesake.
In the wake of demands to acknowledge previously unacknowledged effects structural racism has had on various aspects of social life as well as a push to rename organizations clouded by troubled pasts, the Audubon Society is being asked to rebrand itself. An acknowledgment that he was a slaveholder and staunch opponent of abolition also comes with the revelation that he may not be the best namesake for an organization dedicated to conservation of the planet. Whether that rebranding involves an organizational name change,more aggressive efforts to serve underserved communities through conservation efforts, or to diversify leadership to be more representative, is still being worked through (Marcelo, 2021).Ultimately, racial justice must be a charge that goes hand in hand with conservation efforts of a healthy ecosystem if the organization is to fulfill its stated mission. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/02%3A_A_Look_at_Structural_Racism_by_Discipline/2.43%3A_Zoology.txt |
"The master's tools will never dismantle the master's house"
-Audre Lorde
Overview
As illustrated in the preceding sections, higher education is not free of the social ills that plague society at large. To assume that the strictures of culture would not be a contributing factor to the development and evolution of our higher educational systems would be at best,naive. While education has long been central to the promise of this nation, our system has never been designed to promote equitable opportunities that all of us deserve (Cantor et al.,2021). Reckoning with this past does not leave us without recourse for our future; however, nor does it diminish the incredible accomplishments made in pursuit of higher learning. It merely gives us an opportunity to grow and improve from where we are now. We have a chance to design an academy that affords all of its participants equitable access. In these times of great social upheaval, we are required to make radical change on multiple fronts, including as a nation and as a planet, thus, the commitment to restructure higher education is only one piece of a larger evolution.
In the United States, privileged whites have historically been able to take time to pursue educational endeavors in part due to having servants or slaves to perform all other activities of daily life. These folks went about creating an educational structure for their own children,without regard for the slaves and their families who were maintaining their households. Since we’ve made strides elsewhere in the culture and announced our commitment to include Black and other marginalized people in the educational system, we’ve done little to actually address the educational structure in its current form. In practice, there has been a lack of overall diversity and very little representation of the lived experience and contributions of non-white male thinkers. So for many students of color the message conveyed is akin to, “ok we’ll let you learn about us and how great we are and you should just be glad to have been invited.” This is not only disingenuous, but it makes wanting to be a part of a system that was never intended for you less than attractive to many.
It is time for an honest assessment about how far we have come since Brown v. Board of Education. How appealing was it to be integrated into a school where people who didn’t want you there taught you about how great they were and ignored contributions of non-white people or flat out disrespected your culture? A narrow curriculum focused on, and taught for the comfort of white students leaves little space for others. In higher education, it is the norm to be white, and “when it is the norm to be White, maintaining the comfort of White people becomes part of the unwritten code of a culture, a code that people of colour often follow.” (Dutt, 2019).
Beyond just comfort, in many instances we also must acknowledge the fact that the renaissance of thought perceived to come from white western thinkers was stolen from enslaved Africans, poor women and people of color, or earlier civilizations and repackaged with a white face on it (Johnson,2017).
The Academy in its present form is about certifying what is socially defined as significant and reproducing knowledge about what is of importance. It is meant to maintain the stratification of power in society. What is especially frustrating about the well documented lack of inclusion of historically marginalized groups from academic discourse is that there is this mitigated acknowledgement of the exclusion, and so only small concessions are made by the powers that be in an effort to appease the marginalized. The minimal appeasement allows for the maintenance of as close to the existing structures of power inherent in higher education and in the larger society as possible. This is insufficient. There is a need to come to terms with the fact that the history of higher education is steeped in structural racism, and it has not been modified enough to create a learning environment that is inclusive of the diversity of the United States population. Only when acknowledged, can we move to change it and become the premiere nation of innovation and technology we once were. If we are to do so, we must ask ourselves some hard questions. Why is knowledge always centered around whiteness? Who gets to say what it means to be smart? What types of knowledge and brain function is really assessed in IQ testing, and how do factors such as social class, race and gender shape what is being tested rather than “intelligence”.
As a result of higher education’s continued prioritization of whiteness above all else, we see sharp decline in enrollments and more separation of students of color. In order to learn about the totality of American history, which includes truth about a shamefully racist past and present, to great non-white or non-male thinkers, inventors, and educators, many find a better option for their educational pursuits to be in Historically Black, Colleges and Universities (HBCUs). Created at first to educate when white institutions would not admit Black students,they still serve the purpose of providing a safe place to learn and critically evaluate the human condition long after colleges and universities have integrated.
How we’ve missed the mark and what is at stake
In researching this book, we identified some of the ways in which lack of inclusion in higher education has hurt the progression of society writ large by ignoring great ideas and not funding research by women and people of color. Academia is often the birthplace for scientific inventions that have saved lives via medical discoveries. Innovations in technology and brain science are made in the labs of R1 institutions and we evolve culturally, economically and environmentally thanks to the work being done in institutions of higher education. Discovering new ideas that lead to cultural shifts is the way this happens, but the processes in place limit the opportunity for everyone to put their innovations into practice. Less innovation is not the preferred outcome of maintaining the status quo, our cultural scripts are written such that we as a society value technology, innovation and freedom of thought and yet, due to the historical legacy of privilege and bias, many innovators are left unrecognized.
If we limit who gets access to research grants or internships, we limit the potential for new life changing ideas and innovations, which does a disservice to the society at large.Historically, opportunities to work toward innovation via schooling and access to patents were withheld from Black inventors. When Black inventors did create and innovate, especially during the era of slavery, their work was stolen from them by their white enslavers. Black inventors have been ignored and exploited for a very large portion of our country’s history. Black inventors have made many different contributions to our society, yet they have not been awarded the credit that they rightfully deserve. In part, this is because even though the patent law in the U.S. was said to be colorblind, rates of patents granted have disproportionately advantaged white inventors. This was very damaging to Black and Brown innovators, because without a patent it was difficult to make any legitimate money from their inventions. Many Black inventors found themselves having to partner with a white man and share the profit of their invention so that they could get the patent, and be able to reap some of the wealth from the inventions they made (Johnson, 2017).
Throughout this book, we have argued that academia lacks diversity both in students completing programs and faculty representation. This presents problems in terms of the knowledge creation that comes from these institutions. Diversifying the field of knowledge creation would allow for new innovations that may otherwise not be discovered. The process of obtaining funding for a research project is something academics who conduct research must undertake in order to conduct their research. Often that pipeline is controlled by white men,who may have unconscious biases about what makes for a “good researcher” and research worth funding.
As we begin to emerge from a global pandemic the likes of which most of the current living population on earth has never seen, we all waited with bated breath for a vaccine that would bring an end to life under quarantine. R1 institutions and pharmaceutical companies went to work to try to create a vaccine. What came of this work was a fairly new type of vaccine that worked with mRNA. What many are not actually aware of however is that this type of vaccine was in the works for over 20 years, but due to lack of funding, the finished product that could have been tested and ready to use before the death toll skyrocketed was not created. Hungarian researcher Katalin Karikó struggled to obtain funding for her pioneering work on mRNA. “Katalin Karikó spent the 1990s collecting rejections. Her work, attempting to harness the power of mRNA to fight disease, was too far-fetched for government grants,corporate funding, and even support from her own colleagues” (Garde & Saltzman, 2020). Her grant proposals were rejected over and over and she was demoted at University of Pennsylvania. It was only when a white male colleague signed on to her research that she received funding. While we cannot know for certain that lives would have been saved, one has to wonder what would be different if this type of vaccine used for COVID 19 was tested and vetted years ago. What if the medical field listened to a woman scientist? Would it have saved lives?
Racism in the STEM fields has been explored in earlier sections of this book and discussed widely among many institutions of higher learning. These discussions are robustly taking place, which is a sign that change can happen. There is a pressing need to acknowledge what is at stake for the overall field of science, technology, engineering, and math, both as academic pursuits and as fields of innovation that make our nation strong, if we fail to fund and train women and people of color. A failure to diversify any field limits what we can learn, and this in many ways has been the downfall of the United States in educational and innovation leadership.
There is a lower rate of funding of National Institutes of Health R01 applications submitted by African-American/Black scientists relative to white scientists(Hoppe et al, 2018). Efforts to close the funding gap need to be robustly focused on encouraging a more diverse applicant pool, and developing and implementing mentoring programs.In efforts to move the conversation forward with regard to a historical past and recent incidents of structural racism interfering with innovation, Harvard has put together an open list of Racial Bias in ScientificFields | Anti-Racism Resources to help educators both teach students the history of racism intheir fields, and help move forward a shift.
Microaggressions, racial bias and prejudice are all at play in the microcosm of people working in higher education. We advocate here for institutional changes to address the structural racism at play in higher education but there is also individual faculty perception and bias that contribute to student success or failure based on said bias.In,STEM faculty who believe ability is fixed have larger racial achievement gaps and inspire less student motivation in their classes, Canning et al describe the ways in which STEM faculty who believe a person’s ability is fixed have larger racial achievement gaps and inspire less student motivation in their classes which disproportionately affect outcomes for their students of color (Canning et al,2019).
A multitude of studies have attempted to understand why retention and persistence rates of students of color are consistently lower than white students. Findings suggest that teacher perception of their students contributes to the students' success in their class. Faculty who have a fixed mindset toward their students’ ability, as well as their potential to learn, are found to be less effective or willing to teach students who they have negative connotations towards. This roadblock can be dealt with by helping faculty to develop a growth mindset towards these students, but this involves those faculty deciding to do the work. “Faculty-centered interventions may have the unprecedented potential to change STEM culture from a fixed mindset culture of genius to a growth mindset culture of development while narrowing STEM racial achievement gaps at scale” (Canning et al, 2019).
Adding an honest discussion of the history of structural racism is part and parcel to effectively engaging all students, but especially those who have historically been marginalized. Critical Race Theory is an approach that recognizes the historical legacy of race based hierarchies and the resultant inequalities our society is faced with. Rather than shying away from an honest conversation about the racialized past of the United States, Critical Race Theory helps to explain race as a social construct, and that racism is not merely an individual bias but rather embedded in legal systems and policies that shape social structure. As each preceding section demonstrated, a racialized past has contributed to the growth and development of all fields within higher education.
Telling the historical story goes a long way for a deeper understanding of our current predicament. Asking students to connect the dots between historical oppression and present day reality is a necessary exercise in critical thinking. Each discipline carries with it a history and as stewards of our respective fields, we have an obligation to teach our students how our discipline came to be. This applies to all fields. Many in the fields of anti-racist pedagogy have for years recommended that teaching about a history of structural racism and how to move the needle towards an anti-racist field is as important as learning the field itself. In 1994, the late great bell hooks in Teaching to Transgress spoke to the importance of multiculturalism as engaged pedagogy:
Multiculturalism compels educators to recognize the narrow boundaries that have shaped the way knowledge is shared in the classroom. It forces us all to recognize our complicity in accepting and perpetuating biases of any kind. Students are eager to break through barriers to knowing. They are willing to surrender to the wonder of re-learning and learning ways of knowing that go against the grain. When we, as educators, allow our pedagogy to be radically changed by our recognition of a multicultural world, we can give students the education they desire and deserve. We can teach in ways that transform consciousness, creating a climate of free expression that is the essence of a truly libratory liberal arts education (hooks, 1994 p. 44).
An acknowledgement on the part of all in academia of the ways in which structural racism is embedded into our higher education system goes a long way to include students who have felt alienated. “Colorblind” approaches to teaching STEM for example, fall short specifically because there is an aspect of denial in that approach (Sheth, 2018).
If higher education is to truly be a place for all thinkers, there is work to be done in terms of access to materials and supplies. This book is being published under an open license in order for it to be free and accessible to all. Open Educational Resources (OERs) dismantle economic barriers to student success by being freely available to everyone. Additionally, there is a strong movement within the OER community of educators to speak to an additional barrier students often find in commercial textbooks. What we know is that under-representation of diverse views in texts and other course materials hampers the progress of science and leaves students feeling left out of the field. A recent examination of biology textbooks revealed the following.
Charles Darwin. Carolus Linnaeus. Gregor Mendel. They’re all men. They’re all white. And their names appear in every biology book included in a new analysis of college textbooks. According to the survey, mentions of white men still dominate biology textbooks despite growing recognition in other media of the scientific contributions of women and people of color. The good news, the researchers say: Scientists in textbooks are getting more diverse. The bad news: If diversification continues at its current pace, it will take another 500 years for mentions of Black/African American scientists to accurately reflect the number of Black college biology students (Brookshire,2020).
Textbooks whose authors, stories, and images feature white, male focused, heteronormative imagery in any field remind those who do not fit that image that they do not belong. Many new OERs like this one feature collaborations between students and faculty,cross-racially, and not monogendered, but instead, are inclusive of multiple identities. It takes a concerted effort to update texts and materials to represent the students they are serving, but it is possible. Faculty using materials that are not representative can supplement their content to add diversity.Publishers can also do better, and if faculty are committed to working with specific publishers,they can demand it from them. Better yet, all faculty can convert their materials to OERs, which can easily be modified and created to be more representative, without any sort of prohibitive costs to students (Daly & Sebesta, 2021).
Another needed area of improvement lies in the hiring and retention via the tenure process of a diverse faculty, specifically those least represented in the academy. A recent article from Inside Higher Ed cited found that “just 2.7 percent of all academic job placements in 2019 were of Black women with Phds’” (Rucks-Ahidiana, 2021). What this looks like overall among the 1438 colleges and universities studied nationwide is that, “of all the colleges and universities in this searchable data table as many as 573 (39 percent) had no tenured Black women faculty” (Rucks-Ahidiana, 2021).
If commitments to increasing faculty diversity are more than symbolic gestures, colleges and universities should address the systemic issues creating these racialized and gendered inequities. That is the only way to increase the number of tenured Black women in our colleges and universities (Rucks-Ahidiana, 2021).
Beyond hiring and retaining faculty of color as a means of eradicating racist structures in academia, faculty can decide to take the additional step of looking to diverse author’s research and writings as sources for their own work, as well as what they ask their students to learn about. “The next project you start, do not start with the most cited, most engaged with, most validated scholarship; start with scholarship from journals that support explicitly the work of nonwhite intellectual activists and subordinated knowledges.” (Brunsma & Padilla Wyse, 2019).
By highlighting the work of less cited authors and researchers of color and women we are enriching our fields and allowing their work to rise to the level of notoriety of the predominantly white male scholarship that is most often cited.
In all honesty, higher education in the United States was not created for all people. It was created for and by white men to serve the purpose of strengthening their domination. With this in mind, there are real concerns about what a modification of a system marred by structural racism should look like. Appeasing the guilt of many in higher education, an Ethnic Studies course was added to many school’s graduation requirements nationwide. But is that enough? Many would argue it is not. If a system is broken, do we decide to patch it up in hopes that it will still function? Or do we decide to eliminate it and rebuild something new, using the previous foundation to create something that resembles what we once knew but with new focus and goals? To be for the people, higher education must also be by the people. A new academia that meets the needs of 21st century students in the United States must be representative of their students. And what is at stake if we do not change with the times and acknowledge that for many, there were no good old days, but rather a racist, white supremacist, patriarchal past that was not designed for most of us? It is hard to say, but if the mass exodus from higher education is any indication, then we may be in grave trouble. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/03%3A_Conclusion/3.01%3A_Conclusion.txt |
Growing up in Marin County asa biracial woman is certainly a unique experience. As many biracial individuals describe, we don’t simply fit into any one group, and the expectation for us to pick a side is problematic. I grew up in over seven rental homes throughout Marin by the age of 17, which gave me another unique experience as I became extremely adaptable having to switch schools frequently. It was at a new school in 8th grade that I was called a racial slur. I later had to ask my mother for the meaning. In high school, it was not uncommon that police officers would be stationed out front, sometimes even detaining students. Another vivid remembrance from high school was that it was common knowledge amongst African American students that if we were in a certain Spanish teacher’s class, we would undoubtedly be assigned to sit in the front row. I didn’t believe it until it happened to me, 2nd period Spanish was a sight to see. With this brief introduction of a few of my early experiences with education, my goal is to remind you that there are still racial prejudices students face day to day. We should continue to ask, understand, hear, and really hear the lived experiences of all people of color if we truly want to do better.
Near the end of 2020 I decided to return to college and fulfill my dream of becoming the first in my family to graduate from college. I had been working at the same organization for 9 years and early in my career I experienced burnout, another gift from the pandemic. My first semester at College of Marin I enrolled in Dr. Susan Rahman’s Gender and Society course, and after completion she invited me to contribute to this piece. Her course was the first Zero Textbook Cost course I had taken, and I enjoyed every bit of it. One thing I am grateful for in returning to college as an adult is that I am more dedicated and have a stronger passion to learn. Going over each week’s material, I could tell how much effort was put into creating content that is relevant and inclusive. OERs and Zero Textbook Cost courses also give students an opportunity to learn about work created by people of color that may not have otherwise been featured in mainstream textbooks. Dr. Rahman has a talent for asking questions that get students thinking outside of our societal norms.
I joined this project later on, yet Dr. Rahman still provided me with spaces to have a voice. Throughout this work, I have gained experience, learned a great deal, and had the chance to work with an incredible team who share a vision. I want to give Dr. Rahman a huge shout out and thank you for challenging the academic system, pushing for us to create a better future,and shedding light on this topic. I am accustomed to being in environments dominated by whiteness, especially academically, and I often don’t question or feel comfortable in questioning certain ideas and teachings. In the past, when I thought I was in a safe space to share a few of the microaggressions thrown at me, I was told I was too sensitive, not believed,and my favorite, “it’s their generation, what are they going to do.” My hope with this book is that while we are pushing for more marginalized, underrepresented BIPOC to further their education and become future leaders, we can also provide them with inclusive material to learn from, and diverse, informed educators guiding them. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/03%3A_Conclusion/3.02%3A_Reflections_from_the_Authors_-_Dahmitra_Jackson.txt |
As a first generation student, a child of immigrant parents, and a person of color, I have witnessed, experienced, and felt the effects of racism in a myriad of ways. Because of these experiences, and an intrinsic feeling of empathy and justice for all, I have always felt a call to speak out against injustices. However, this feeling has often been stifled in favor of preserving the pre existing norms, in favor of conformity, and in favor of not “rocking the boat.” However,after laboring over this project,I have felt the uplifting feeling of raising awareness to injustices,in addition to the discomfort and struggle of doing so.
When I first began working on this project, I was unsure what to expect. This book was my first hands-on venture into a large scale research project beyond the classroom environment. This project came in the wake of the killing of George Floyd, and in the midst of the COVID-19 pandemic, both events which sparked great levels of introspection and self-reflection, from myself as well as society as a whole. Working with Professor Rahman has been a privilege, as she encouraged me to work independently, while also providing support as needed, allowing me to gain hands-on learning experience. I also learned that the uncomfortable conversations that this book inspired are not appreciated by all, as even some individuals who affiliate and speak for social justice rose up in protest against the work.
As a first generation student, I have immense respect for Open Education Resources (OERs), as the movement aims to alleviate financial pressure off of students. This is especially beneficial for students from lower income households and/or first generation students, which are both demographics that typically balance education with working. I am one of these students. I have worked since I was 14, and consistently balanced working and financial obligations with my education.
Working with Susan on this book was the first time that my work was connected to my future aspirations, as I conducted research in hopes of raising awareness for a better future.This book allowed me to confront my Imposter Syndrome, another byproduct of life as a first generation student. Despite applying, and being accepted to several universities in high school,due to financial need and a lack of knowledge of the college system, I found myself first attending community college, which in retrospect has been a blessing, as it allowed me to work on this project and transfer. Impostor Syndrome is another symptom of inequality within college that is often overlooked, and one that relates to the inequalities of the higher education industry as well. I am grateful to have the opportunity to develop confidence in myself as a student and a researcher, and to have helped create this living document, which will evolve to reflect changes in higher education.
I would like to conclude this self-reflection with a call to action. First, to the college admissions committees: it is urgent to view extracurriculars and activities through a new lens. Rather than only viewing mission trips and backpacking trips as signs of an applicant’s strength,we must also acknowledge and celebrate the students who do not enjoy such privilege. We must appreciate the student who translates for their parents, and the student who works afterschool. We should not idolize experiences that are enabled by a parent’s wealth, rather, we should admire the student who perseveres and succeeds through the adversity around them.Finally, I would like to call for greater access and financial access to all aspects of education. As Gretchen Jewett wrote, income level is correlated to academic attrition and persistence. For every \$10,000 increase in family income, persistence increases by 2%. Every \$1,000 increase in grant aid increases persistence by 2.7%, and every \$1,000 increase in Work Study increases persistence by 6.4% (Jewett, 2008). This last statistic is particularly revealing, as work studies integrate students into the campus community, and a lack of campus inclusion was a recurring theme revealed throughout this project. While it is not possible for colleges to change parental income, it is absolutely possible and even necessary to increase aid to students, in order to create an equitable and just academic system. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/03%3A_Conclusion/3.03%3A_Reflections_from_the_Authors_-_Prateek_Sunder.txt |
As they say, the personal is political. This statement evokes in me the fact that my mere existence and what I do on this planet is a political statement. In some ways that is a lot of pressure but in others, it's a call to action. As a first generation Palestinian woman, my existence has been about resistance. Resistance to patriarchy, resistance to false narratives about my homeland, resistance to white supremacy, all the while knowing that the path of least resistance would have made things alot smoother. And I admit, sometimes I took that path,blended in, and participated in maintaining the status quo, all the while knowing I was complicit in something that felt wrong. As I matured, became more rooted in my social justice agenda,and was privileged to earn more occupational security, I began to feel obligated to make racial justice front and center in my teaching, activism and scholarship.
This book is a lifetime of thoughts and ideas generated by the authors and other anti-racist scholars who have been screaming from the rooftops that their existence must be seen, and that the disciplines they have developed an expertise in and a love for, need to show up for them. Scholars like the late great bell hooks taught me that it is ok to both be critical of and care for something, that’s the human condition, and it’s complicated.
When deciding to work on this reader, a lot was going through my mind. I love being an educator, I love working with students, and I feel compelled to create a space where students can critique culture and push for change. I am fortunate that Sociology affords me the latitude to talk about issues surrounding structural racism, and that students have the chance to share their lived experiences with me about being othered by faculty. I wrongly imagined that since I am having these types of conversations, others across disciplines were as well. It turns out that it is not the norm to do so and that both faculty and the resources they employ often fail to address the effect of structural racism on their fields, or acknowledge what students of color are experiencing.
The discovery of Open Educational Resources (OERs) for me began as a financial equity measure. The idea that we could eliminate a financial barrier for our students was something I really felt drawn to. So I began my Open journey. Attending conferences, writing grants, trying to build a community of faculty that believed in this and wanted to build the availability of classes using open content. As I dug deeper, I saw various other reasons for why OERs could solve other equity issues present in higher education. The dynamism of the content, and the overall philosophy of OER eliminated some of the issues I found with many traditional publications. The lack of diversity in traditional authorship was one barrier I saw for students connecting with content. Let’s face it, when most texts are written from the white male perspective, it leaves a lot of others out of the creation of knowledge. I see the potential of OERs to add others to the conversation as a huge benefit. As discussed throughout this book,this shift in voice is a powerful tool in diversifying academic fields.
I want to share my experiences with you here, because when I began this project I failed to consider pushback. Sometimes my Northern California higher education bubble prevents me from realizing what is at stake to some people, who may not feel like there is any benefit of diversifying fields or speaking truth to power. I realized early on that my identity has an impact on every project I work on, rather than the simple merit of that project and that in and of itself is a gate that needs not be kept.
As a part of this book project, I began inviting peer editors. I selected 8 colleagues at my institution to begin with and asked them if they would be willing to read their discipline’s section for accuracy. I explained that these sections were drafts written by myself and students, and none of us were experts in the fields so please fact check us and help us get it right. I sent off the email and within 5 minutes I got a response from one faculty very eager to help. I sent the section to them explaining the project. Again within minutes a pretty unkind email was sent back to me unclear about the purpose of the book or the expanding so much about the Black scholars discussed in the sections sent. The faculty member asked not to be associated with the publication. I explained the purpose of the book again and assured this faculty that they would not be associated with the book. This faculty then sent an email to a selected portion of the faculty in the original email I sent out. Below is the email edited to leave out identifying details:
I read what has been sent to me by Susan about and I found it lacking a lot of fundamentals and knowledge of the fields, but also very limited in providing a comprehensive picture of how anti-racism efforts have grown to overcome past wrongdoings.
I would be more than happy to chat with any of you on this because I do not see any value in such work as has been presented to me.
I provided references, comments and critics on the 2-pages.But maybe is me [sic]....or maybe is my[sic] grading...
There was no editorial critique included, which was what I was seeking in the first place. Rather than help produce content that would be a good addition to their field, they chose to attack the project and me. As stated above, the personal is political. Aside from having my work summarily discounted as not worthy of this faculty member's attention, I have been called audacious for wanting to take on projects that some felt were above my pay grade. This is not the first time I’ve been dismissed or minimized because of who I am by men in higher education who think they know more than me. It left me wondering, how many stories like this have prevented important research from being done? The end result for me is that I continue to do the work I feel must be done, in order to see a better future in higher education for the many who continue to be marginalized by the status quo. My audacity and desire to be outside of the lane given to me has allowed me the fortitude to apply for and receive multiple grants and ultimately fund this project. So for all of us who have felt left out, audacious or not,we are not staying in our lane. | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/03%3A_Conclusion/3.04%3A_Reflections_from_the_Authors_-_Susan_Rahman.txt |
3 Hiring Practices that Disadvantage Black Students. (n.d.). In Handshake. Retrieved from
https://joinhandshake.com/blog/employers/3-hiring-practices-that-disadvantage-black-students/
ABOUT ESL PROGRAM. (2021). In College of Marin-English as a Second Language.
Retrieved from https://esl.marin.edu/about-esl-program
Action Item List (n.d.). Retrieved from https://blackincomputing.org/action-item-list/
Adams, J., Solís, P., & McKendry, J. (2013, January 8). The Landscape of Diversity in U.S.
Higher Education Geography. Retrieved from
https://www.tandfonline.com/doi/abs/10.1080/00330124.2012.735935
Advancing ACS' Core Value of Diversity, Equity, Inclusion & Respect (n.d.). Retrieved from
https://www.acs.org/content/acs/en/about/diversity.html
AIP National Taskforce to Elevate African-American Representation in Undergraduate Physics and Astronomy (TEAM UP). (2020). The Time is Now: Systemic Changes to
Increase African Americans with Bachelor's Degrees in Physics and Astronomy. In Making Black Women Scientists Under White Empiricism: The Racialization of
Epistemology in Physics (pp. 25-71). College Park, MD: American Institute of Physics. Retrieved from
https://www.aip.org/sites/default/files/aipcorp/files/teamup-full-report.pdf
Alexander, M. (2010).The new Jim Crow: Mass incarceration in the age of colorblindness. New Press.
Ali, R. (2017). The arab-american theatre: Still a struggle to be seen. Al Jadid. Retrieved April 4, 2021, from https://www.aljadid.com/node/2079
Amado, A., Conlon Perugini, D., Lindstrom, S. (2020. June 2). Enacting Social Justice in Early Language Classrooms through Critical Cultural Awareness. [Video]. You Tube.
https://youtu.be/-6m5IdUWT2o
An Open Letter & Call to Action to the Computing Community from Black in Computing and Our Allies (2020, June 8). Retrieved from https://blackincomputing.org/
Anderson, G. (2020, September 10). Analysis: Students of Color Less Likely to Have Paid Internships. In Inside Higher Ed. Retrieved from
https://www.insidehighered.com/quicktakes/2020/09/10/analysis-students-color-less-likely-have-paid-internships
Anderson, M. D. (2017, April 25). How Does Race Affect a Student's Math Education? The Atlantic. Retrieved from
https://www.theatlantic.com/education/archive/2017/04/racist-math-education/524199/
Anya, U., &Randolph Jr., L. J. (2019, October). Diversifying Language Educators and Learners. The Language Educator, 23-27. Retrieved from
https://www.actfl.org/sites/default/files/tle/TLE_OctNov19_Article.pdf
Anzaldúa, G. (2012). Borderlands La Frontera: The New Mestiza (fourth ed., pp. 75-86). San Francisco, CA: Aunt Lute.
Apology to People of Color for APA’s Role in Promoting, Perpetuating, and Failing to Challenge Racism, Racial Discrimination, and Human Hierarchy in U.S (2021, October 29).
Retrieved from https://www.apa.org/about/policy/racism-apology
Architecture and Racism: A Conversation (2020, October 22). Retrieved from https://www.architecturalrecord.com/articles/14844-architecture-and-racism-a-conversation
Art. (n.d.). In College of Marin. Retrieved from https://academics.marin.edu/program/art
Artists report back. BFAMFAPhD. (2014). Retrieved April 7, 2021, from http://bfamfaphd.com/wp-content/uploads/2016/05/BFAMFAPhD_ArtistsReportBack2014-10.pdf
Audubon, J. J. (1827).The Birds of America(pp. 4-5). London, England: Natural History Museum.Bainbridge, D. (2020). How Zoologists Organize Things. London, United
Kingdom: Frances Lincoln. Baker-Bell, A. (2020, July). This Ain’t Another Statement! This is a DEMAND for Black Linguistic Justice!. Retrieved from
https://cccc.ncte.org/cccc/demand-for-black-linguistic-justice
Balter, A. (2017, December). What is Astrophysics?. In Space.com. Retrieved from
https://www.space.com/26218-astrophysics.html
Bank, A. (1996). Of “Native Skulls” and “Noble Caucasians”: Phrenology in Colonial South Africa. Journal of Southern African Studies,22(3), 387–403.
http://www.jstor.org/stable/2637310
Barbaro, M. (2017, August 22).'The Daily': A conversation with a former white nationalist. The New York Times. Retrieved October 19, 2021, from
https://www.nytimes.com/2017/08/22/podcasts/the-daily/former-white-nationalist-derek-black.html
Barber, P. (2021, November 4). How Sonoma County became the dark center of America’s forced sterilization movement. The Press Democrat.
https://www.pressdemocrat.com/article/news/how-sonoma-county-became-the-dark-center-of-americas-forced-sterilization/
Barlow, D.L. & Jaeger, P.T. (2017). Celebrating the James Partridge Award: Essays toward the development of a more diverse, inclusive, and equitable field of library and
information science. Emerald Group Publishing Limited.
Baskar, P. (2019, May 30). Doing double: Ethnic studies programs-suffering funding and faculty dearth, high turnover rates, intense working conditions-demand structure
reform. The Daily Northwestern. Retrieved November 10, 2021, from https://dailynorthwestern.com/2019/05/30/campus/doing-double-ethnic-studies-programs-suffering
funding-and-faculty-dearth-high-turnover-rates-intense-working-conditions-demand-structure-reform/
Batres, E. (2020, June 16). Why your dream theater school is systemically racist.TheEnsemblist. Retrieved April 7, 2021, from
http://www.theensemblist.com/blog/2020/6/16/why-your-dream-theater-school-is-systemically-racist
Battey, D.,& Leyva, L. A. (2016). A Framework for Understanding Whiteness in Mathematics Education. Journal of Urban Mathematics Education,9(2).
https://doi.org/10.21423/jume-v9i2a294
Bell, B. (2020, July 28). White dominance in nursing education: a target for anti-racist efforts. Retrieved from https://onlinelibrary.wiley.com/doi/epdf/10.1111/nin.12379
Bernard, R. E., & Copperdock, E. G. (2018, April 30). No progress on diversity in 40 years. Nature Geoscience,11, 292-295. Retrieved from https://rdcu.be/cyN2k
Bernasconi, R., & Cook, S. (Eds.). (2003). Race and Racism in Continental Philosophy (pp.1-328). Bloomington, IN: Indiana University Press.
Beskow, L. M. (2016). Lessons from hela Cells: The ethics and policy OF BIOSPECIMENS. Annual Review of Genomics and Human Genetics, 17(1), 395–417.
https://doi.org/10.1146/annurev-genom-083115-022536
Bhopal R. (2007, December 20). The beautiful skull and Blumenbach's errors: the birth of the scientific concept of race. BMJ (Clinical research ed.), 335(7633), 1308–1309.
https://doi.org/10.1136/bmj.39413.463958.80
Black Thoughts. (2020. June 21). Hazards of Field Work While Black.[Video]. You Tube. https://www.youtube.com/watch?v=W0B7xwGkl00&feature=youtu.be
Brands, H. W. (2005, November 20). 'Andrew Jackson'. The New York Times. Retrieved September 13, 2021, from
https://www.nytimes.com/2005/11/20/books/chapters/andrew-jackson.html
Branson, S. (2017). Phrenology and the Science of Race in Antebellum America. Early American Studies: An Interdisciplinary Journal 15(1), 164-193.doi:
10.1353/eam.2017.0005
Brewer, H. (2018, September 12). Slavery-entangled philosophy. In Aeon. Retrieved from
https://aeon.co/essays/does-lockes-entanglement-with-slavery-undermine-his-philosophy
Brookshire, B. (2020, July 17). College biology textbooks still portray a world of white scientists. In Science News. Retrieved from
https://www.sciencenews.org/article/college-biology-textbooks-representation-white-men
Brown, J. (2018). “Annual Report on Membership Demographics.” The Society for Music Theory, October, 2018.
https://societymusictheory.org/sites/default/files/demographics/smt-demographics-report-2018.pdf
Brown, S. (2021, December 3). Chronicles of Higher Education. In How Should Universities Respond to Racism? Randall Kennedy and Marcia Chatelain debate
history,accountability, and free speech. Retrieved from https://www.chronicle.com/article/how-should-universities-respond-to-racism?cid=gen_sign_in
Brunsma, D. L., & Padilla Wyse, J. (2019, January). The Possessive Investment in White Sociology. Sociology of Race and Ethnicity,5(1), 1-10. Retrieved from
https://journals.sagepub.com/doi/10.1177/2332649218809968
Burton, N. (2020, May 14). People of Color Experience Climate Grief More Deeply Than White People. Retrieved from
https://www.vice.com/en/article/v7ggqx/people-of-color-experience-climate-grief-more-deeply-than-white-people
Business. (n.d.). In College of Marin. Retrieved from https://academics.marin.edu/program/bus
Butcher, N. (2011). A Basic Guide to Open Educational Resources (OER). In A. Kanwar & S.Uvalić-Trumbić (Eds.). Vancouver, British Columbia, Canada: Commonwealth of
Learning/UNESCO. Retrieved from https://oasis.col.org/colserver/api/core/bitstreams/a96264c7-db65-4b52-8e69-7ebee62ef188/content
Cannan, E. (Ed.). (2019). The Wealth of Nations Adam Smith (pp. 3-144). Minneola, NY: IxiaPress.
Canning, E., Muenks, K., Green, D., & Murphy, M. (2019, February 15). STEM faculty who believe ability is fixed have larger racial achievement gaps and inspire less student
motivation in their classes. SCIENCE ADVANCES,5(2), 3-144. Retrieved from https://www.science.org/doi/10.1126/sciadv.aau4734
Cantor, Pamela, Lerner, Richard M., Pittman, Karen J., Chase, Paul A., and Gomperts, Nora.(2021). Whole-Child Development, Learning and Thriving: A Dynamic Systems
Approach (pp. 21-22). Cambridge, MA:Cambridge University Press
Castillo, M. (2012, December 21). IQ scores not accurate marker of intelligence, study shows. Retrieved from
https://www.cbsnews.com/news/iq-scores-not-accurate-marker-of-intelligence-study-shows/
Centers for Disease Control and Prevention. (n.d.).The Tuskegee Timeline. Centers for Disease Control and Prevention. Retrieved September 12, 2021, from
https://www.cdc.gov/tuskegee/timeline.htm
Chakravartty, P., Kuo, R., Grubbs, V., & McIlwain, C. (2018). #communicationsowhite. Journal of Communication, 68(2), 254–266.
https://academic.oup.com/joc/article-abstract/68/2/254/4958972?redirectedFrom=fulltext
Chapman, Roger (2013). Culture Wars in America: An Encyclopedia of Issues, Viewpoints, and Voices. London, UK: Routledge. ISBN 9780765683021
Cherry, K. (2020, June 10). What Is Psychology?. Retrieved from http://www.calvin.edu/library/knightcite/index.php
Chudy, J., & Jefferson, H. (2021, May 23). Support for Black Lives Matter Surged Last Year. Did It Last? New York Times.
https://www.nytimes.com/2021/05/22/opinion/blm-movement-protests-support.html?searchResultPosition=1
City of Berkeley police department history the earliest YEARS 1905-1925 "first in policing". City of Berkeley. (n.d.). Retrieved September 13, 2021, from
https://www.cityofberkeley.info/Police/Home/History_The_Earliest_Years_1905-1925.aspx
College of Marin. (n.d.).Administration of justice. Academics. Retrieved September 13, 2021, from http://academics.marin.edu/program/aj
Collier, S. (2021, September). What Can You Do With An Architecture Degree. Retrieved from
https://www.topuniversities.com/student-info/careers-advice/what-can-you-do-architecture-degree
Collins, P. (n.d.). Architecture. Retrieved from https://www.britannica.com/topic/architecture
Collins, S. (2007, October 5). Saint Elmo Brady (1884-1966). Retrieved from https://www.blackpast.org/african-american-history/brady-saint-elmo-1884-1966/
Communications. Data USA. (n.d.). Retrieved April 5, 2021, from https://datausa.io/profile/cip/communications
Cornelius, J. (1983). “We Slipped and Learned to Read:” Slave Accounts of the Literacy Process,1830-1865. Phylon (1960-), 44(3), 171–186. https://doi.org/10.2307/274930
Cuesta College. (2018). Program: Graphic Design. In CAREER TECHNICAL EDUCATION (CTE) TWO-YEAR PROGRAM REVIEW 2017-2018(p. 5). Retrieved from
https://www.cuesta.edu/about/documents/inst_research/GraphicCTER_2017_2018.pdf
Cultural Relativism (n.d.). In Lumen. Retrieved from https://courses.lumenlearning.com/culturalanthropology/chapter/cultural-relativism/
Dali, K. (2018). "Culture Fit" as "Anti-Diversity": Avoiding Human Resources Decisions that Disadvantage the Brightest. The International Journal of Information, Diversity, &
Inclusion, 2(4), 1-8. Retrieved from https://jps.library.utoronto.ca/index.php/ijidi/article/view/32199/24588
Daly, U., & Sebesta, J. (2021, November 28). Time for OER. In Community College Daily. Retrieved from https://www.ccdaily.com/2021/11/time-for-oer/
Daniels, J. (2019, January 7). Racism in Modern Information and Communication Technologies.Keynote Address and Paper. CUNY Academic Works Publication and Research,
3-26. Retrieved from https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1529&context=hc_pubs
Dar, S., Liu, H., Martinez Dy, A., & Brewis, D. N. (2020). The Business School Is Racist: Actup! Organization, 28(4), 695–706. https://doi.org/10.1177/1350508420928521
Data on Underrepresented Groups among PhD recipients. (2021, December). In American Institute of Physics. Retrieved from https://www.aip.org/statistics/minorities/phds
De Witte, M. (2020, June 24). Psychological research has a racism problem, Stanford scholar says. Retrieved from
https://news.stanford.edu/2020/06/24/psychological-research-racism-problem-stanford-scholar-says/
Department of Physics and Astronomy Statement on Black Lives Matter. (2020, June). In Dartmouth Department of Physics and Astronomy. Retrieved from
https://physics.dartmouth.edu/news/2020/06/department-physics-and-astronomy-statement-black-lives-matter
Department Statement on Structural Racism. (2020). In Gettysburg College. Retrieved from https://www.gettysburg.edu/academic-programs/political-science/structural-racism/
DeVorkin, D. (1992, August 18). Interview of George Carruthers. Niels Bohr Library & Archives, American Institute of Physics, College Park, MD USA.
www.aip.org/history-programs/niels-bohr-library/oral-histories/32485
Diane, C. (2020,August 5). When the students have notes for the teachers. AMERICAN THEATRE. Retrieved from
https://www.americantheatre.org/2020/08/05/when-the-students-have-notes-for-the-teachers/
Digital Collections-Today in History. (n.d.). In Library of Congress. Retrieved from https://www.loc.gov/item/today-in-history/november-09/
Diversity & Inclusion at AAG (n.d.). Retrieved from http://www3.aag.org/cs/programs/diversity
Diversity, Equity, and Inclusion. (2021). In American-Orff Schulwek Association. Retrieved from
https://member.aosa.org/member/professional-development/diversity-equity-and-inclusion
Dobbs, M. (2005, May 17). Youngest students most likely to be expelled. The Washington Post.Retrieved September 12, 2021, from
https://www.washingtonpost.com/wp-dyn/content/article/2005/05/16/AR2005051601201.html
Domosh, M. (2015, June 1). Why is our Geography Curriculum so White?. Retrieved from http://news.aag.org/2015/06/why-is-our-geography-curriculum-so-white/
Douglas, M. (1966). Purity and Danger: An Analysis of Concepts of Pollution and Taboo (Vol. II,pp. 1-87). New York, NY: Routledge.
Dutt, K. (2019, December 16). Race and racism in the geosciences. Nature Geoscience,13, 3-292. Retrieved from https://doi.org/10.1038/s41561-019-0519-z
Early childhood education. Encyclopedia of Children’s Health. (n.d.). Retrieved September 11,2021, from http://www.healthofchildren.com/E-F/Early-Childhood-Education.html
Echegoyen, L. (2020, June 4). ACS Statement on the Killing of George Floyd. Retrieved from
https://www.acs.org/content/acs/en/about/acs-statement-on-the-killing-of-george-floyd.html
Eigen, S. (2005). Self, Race, and Species: J. F. Blumenbach’s Atlas Experiment. The German Quarterly, 78(3), 277–298. http://www.jstor.org/stable/30039411
English Department's Commitment to Anti-Racism (n.d.). Retrieved from https://www.loyola.edu/academics/english/en-dept-anti-racism-stmt
Equity, Diversity, and Inclusion.(n.d.). American Library Association. https://www.ala.org/advocacy/diversity
Ethnocentrism: The Cultural Superiority Complex (n.d.). In Culture Plus Consulting. Retrieved from https://cultureplusconsulting.com/2015/06/04/ethnocentrism/
Ewell, Philip. “MTO 26.2: Ewell, Music Theory and the White Racial Frame.” Journal of The Society For Music Theory, 1 Sept. 2020,
https://mtosmt.org/issues/mto.20.26.2/mto.20.26.2.ewell.html
Faculty Statement. (2020). In University of Chicago Division of the Humanities English. Retrieved from https://english.uchicago.edu/news-events/news
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M.P., & Marks, J. S. (1998). Relationship of childhood abuse and household
dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine,14(4), 245–258.
https://www.ajpmonline.org/article/S0749-3797(98)00017-8/fulltext
Felon Voting Rights. (2021, June 28). In National Conference of State Legislatures. Retrieved from
https://www.ncsl.org/research/elections-and-campaigns/felon-voting-rights.aspx
Final Report of the ALA Task Force on Equity, Diversity, and Inclusion June 2016. (2016). American Library Association. Retrieved from
https://www.ala.org/aboutala/sites/ala.org.aboutala/files/content/TFEDIFinalReport_ALA_CONNECT.pdf
Fire Technology. (n.d.). In College of the Canyons. Retrieved from https://www.canyons.edu/academics/fire/index.php
Fitzgerald, W. (2009, February 1). “Carl Orff, beyond Nazi Music.” Open Democracy. Retrieved from https://www.opendemocracy.net/en/carl-orff-beyond-nazi-music/
Flaherty, C. (2020, March 4). Separate but equal at the MLA? Inside Higher Ed. Retrieved April 5, 2021, from
https://www.insidehighered.com/news/2020/03/04/separate-equal-mla
Fortin, J. (2021, July 27). Critical race theory: A brief history. The New York Times. https://www.nytimes.com/article/what-is-critical-race-theory.html?searchResultPosition=46
Fortin, J. (2021, November 5). An intractable problem.New York Times. Retrieved from https://santarosapressdemocrat-ca-app.newsmemory.com/?publink=3561d2603_1345fc5
Foster, A. (2011). What to do with a degree in drama studies. The Guardian. Retrieved October 18, 2021, from
https://www.theguardian.com/money/2011/may/14/dramastudies-degree
Friend, Y. F. (2019, October 15). The Bizarre and Racist History of the BMI. Retrieved from
https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb
Gamble, J. (2020, June 9). How Economic Assumptions Uphold Racist Systems. Dissent, 3-292. Retrieved from
https://www.dissentmagazine.org/online_articles/how-economic-assumptions-uphold-racist-systems
Garde, D., & Saltzman, J. (2020, November 10). The story of mRNA: How a once-dismissed idea became a leading technology in the Covid vaccine race. Stat News. Retrieved
General Drama & Theater Arts. Data USA. (n.d.). Retrieved October 18, 2021, from https://datausa.io/profile/cip/general-drama-theater-arts
Geography (n.d.). Retrieved from https://www.nationalgeographic.org/encyclopedia/geography/
Gerdeman, D. (2017, May 17). Minorities Who 'Whiten' Job Resumes Get More Interviews. Harvard Business School's Working Knowledge. Retrieved from
https://hbswk.hbs.edu/item/minorities-who-whiten-job-resumes-get-more-interviews
Gitman, L. J., McDaniel, C. D., Shah, A., Reece, M., Koffel, L., Talsma, B., & Hyatt, J. C.(2018). Introduction to business. XanEdu. An Openstax ally.
Glynn, C. (2012). The role of ethnicity in the foreign language classroom: Perspectives on African American students’ enrollment, experiences, and identity (Unpublished
doctoral dissertation). University of Minnesota, Minneapolis, MN. https://conservancy.umn.edu/bitstream/handle/11299/143200/1/Glynn_umn_0130E_13329.pdf
Goldberg, E. (2019, December 23). Earth Science has a Whiteness Problem. New York Times. Retrieved from
https://ezproxy.marin.edu:2263/blogs-podcasts-websites/earth-science-has-whiteness-problem/docview/2329690808/se-2?accountid=10215
GRAPHIC DESIGNER Demographics And Statistics In The US. (2021, September). In Zippia. Retrieved from https://www.zippia.com/graphic-designer-jobs/demographics/
Gray, A. (2019, June). The Bias of ‘Professionalism’ Standards. Stanford Social Innovation Review. Retrieved from
https://ssir.org/articles/entry/the_bias_of_professionalism_standards
Greenberger, A. (2020, February 24). Yale Art History Department Addresses Controversial Decision to Eliminate Traditional Survey Course: ‘Art History Is a Global Discipline’.
ART news. Retrieved from https://www.artnews.com/art-news/news/yale-art-history-survey-controversy-statement-1202677092/
Gunderman, R. (2021, January). Francis Galton pioneered scientific advances in many fields–but also founded the racist pseudoscience of eugenics. In The Conversation.
Guthrie, R. V. (2004). Even the rat was white (second). Allyn and Bacon.
Hall, N. (2015, October 15). Assimilated or Acculturated? Helping Students Navigate Two Worlds. In tesol international association. Retrieved from
http://blog.tesol.org/assimilated-or-acculturated-helping-students-navigate-two-worlds/
Hampton, S. C. (2020, May 20). How Andrew Jackson used the smallpox vaccine against Native Americans: A cautionary tale of politics and disease. Memories of the People.
Retrieved September 13, 2021, from https://memoriesofthepeople.wordpress.com/2020/05/20/how-andrew-jackson-used-the-smallpox-vaccine-against-native-americans
a-cautionary-tale-of-politics-and-disease/
Hanley, A. (2020, February 22). Lies, damned lies, and racist statistics. In History Workshop. Retrieved from
https://www.historyworkshop.org.uk/lies-damned-lies-and-racist-statistics/
Hao, K. (2020, December 4). We read the paper that forced Timnit Gebru out of Google. Here’s what it says. Retrieved from
https://www.technologyreview.com/2020/12/04/1013294/google-ai-ethics-research-paper-forced-out-timnit-gebru
Harris, A. (2021, May 7). The GOP's 'critical race theory' obsession. The Atlantic. Retrieved November 10, 2021, from
https://www.theatlantic.com/politics/archive/2021/05/gops-critical-race-theory-fixation-explained/618828/
Hayes, A. (2020, December 29). Guide to Economics. In Investopedia. Retrieved from https://www.investopedia.com/terms/e/economics.asp
Hedeman, M., & Kristoffersen, M. (2020, January 24). Art History Department to scrap survey course. Yale Daily News. Retrieved from
https://yaledailynews.com/blog/2020/01/24/art-history-department-to-scrap-survey-course/
Hines-Gaither, K. (2020, July 21). Anti-Racism in the World Language Classroom. In Concordia Language Villages. Retrieved from
http://www.concordialanguagevillages.org/blog/villages/anti-racism-in-the-world-language-classroom#.YX8S8S2cY0o
Hochschild J.“Why Now? What Next? Constitutional Crisis in American Politics,”. In: Mark Tushnet, Sanford Levinson, and Mark Graber, eds. Constitutional Democracy in Crisis?
Oxford University Press ; 2018. pp. 85-102.
Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences
between blacks and whites. Proceedings of the National Academy of Sciences of the United States of America, 113(16), 4296–4301.
https://doi.org/10.1073/pnas.1516047113
hooks, b. (1994). Teaching to Transgress: Education as the Practice of Freedom. Oxfordshire,England UK: Routledge.
Hoppe, T., Litovitz, A., Willis, K., Meseroll, R., Perkins, M., Hutchins, I., ... Santangello, G.(2018, September 12). Topic choice contributes to the lower rate of NIH awards to
African-American/black scientists. SCIENCE ADVANCES,5(10), 3-144.
Retrieved from https://www.science.org/doi/10.1126/sciadv.aaw7238
How One Anthropologist Reshaped How Social Scientists Think About Race (2019, August). In NPR.
Howard University. (n.d.). Black Theatre History. Retrieved April 4, 2020, from https://theatrearts.howard.edu/about/black-theatre-history
Hu-DeHart, E. (1993). The History, Development, and Future of Ethnic Studies. The Phi Delta Kappan, 75(1), 50-54. Retrieved August 26, 2021,
http://www.jstor.org/stable/20405023
Hunt, A. (2018, April11). These factors drive black men out of engineering school. Retrieved from https://www.futurity.org/black-men-in-engineering-stem-1728412-2/
Jean-Michel Basquiat. (2021). In The Broad. Retrieved from https://www.thebroad.org/art/jean-michel-basquiat
Jewett, G. (2008, April 22). College persistence stories of low income, first-generation students. In Scholar's Archive@OSU. Retrieved from
https://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/p2676x507
Jindia, S. (2020, June). Belly of the Beast: California's dark history of forced sterilizations. The Guardian. Retrieved from
https://www.theguardian.com/us-news/2020/jun/30/california-prisons-forced-sterilizations-belly-beast
Johnson, S. (2017, February 19). America’s always had black inventors–even when the patent system explicitly excluded them. In The Conversation. Retrieved from
https://theconversation.com/americas-always-had-black-inventors-even-when-the-patent-system-explicitly-excluded-them-72619
Jones, E. (2021, February 24). Many black Americans aren't rushing to get the COVID-19 VACCINE–a long history of medical abuse suggests why. The Conversation.
Retrieved September 12, 2021, from https://theconversation.com/many-black-americans-arent-rushing-to-get-the-covid-19-vaccine-a-long-history-of-medical-abuse
suggests-why-152368
Jones, W. (2020, February 24). Racial Profiling Goes High Tech With Facial Recognition.
Kameir, R. (2020, October 19). Rethinking Appropriation and Wokeness in Pop Music. In Pitchfork. Retrieved from
https://pitchfork.com/features/article/rethinking-appropriation-and-wokeness-in-pop-music/
Kamoche, J. G. (1987). [Review of Decolonising the Mind: The Politics of Language in African Literature, by N. wa Thiong’o]. World Literature Today, 61(2), 339–339.
https://doi.org/10.2307/40143257
Kerin, M. R., & Lepage, A. (2016). De-Centering “The” Survey: The Value of Multiple Introductory Surveys to Art History. Multiple Introductory Surveys to Art History.",
1(1),1-15. Retrieved from https://academicworks.cuny.edu/ahpp/vol1/iss1/3
Kevles, D. J. (2011). From eugenics to patents: Genetics, law, and human rights. Annals of Human Genetics, 75(3), 326–333.
https://doi.org/10.1111/j.1469-1809.2011.00648.x
Khan, S., & Mian, A. (2020, September 1). Racism and medical education. In The Lancet.
Korsunskiy, E. (2020, September 1). Dismantling White Supremacy in Design Classrooms: My Conversation With Design Guru Cheryl D. Miller. In Medium. Retrieved from
https://medium.com/future-of-design-in-higher-education/dismantling-white-supremacy-in-design-classrooms-my-conversation-with-design-guru-cheryl-d-miller
5dc9c48b15e4#id_token=eyJhbGciOiJSUzI1NiIsImtp
Kte'pi, B. (2014, April 12). Environmental Science. Retrieved from https://www.britannica.com/science/environmental-science/additional-info#history
Kulaszewicz, K. E. (2015, May). Racism and the Media: A Textual Analysis. Sophia, the St.Catherine University repository website. Retrieved from
https://sophia.stkate.edu/cgi/viewcontent.cgi?article=1478&=&context=msw_papers&=&sei
redir=1&referer=https%253A%252F%252Fwww.google.com%252Furl%253Fq%253Dhttps%253A%252F%252Fsophia.stkate.edu%252Fcgi
L, B. (2019, July 24). History of black theater in America. SeatUp. Retrieved from https://seatup.com/blog/history-of-black-theater-in-america/
Leading Nursing Organizations Launch the National Commission to Address Racism in Nursing (2021, January 25). Retrieved from
https://www.nursingworld.org/news/news-releases/2021/leading-nursing-organizations-launch-the-national-commission-to-address-racism-in-nursing/
Lee, M., & Collins, J. (2020, September 14). “If you aren’t White, Asian or Indian, you aren’t an engineer”: racial microaggressions in STEM education.
International Journal of STEM Education.
Legacies of Violence and Complicity. (2021, August 31). In Princeton University. Retrieved from
https://anthropology.princeton.edu/news/legacies-violence-and-complicity-current-policies-and-guidelines
Lepore, J. (2020, July 13). The invention of the police. The New Yorker. Retrieved September 13, 2021, from
https://www.newyorker.com/magazine/2020/07/20/the-invention-of-the-police
Lewis, E. (2020, December). Franz Boas, Father of American Anthropology. In ThoughtCo.. Retrieved from https://www.thoughtco.com/franz-boas-4582034
Lindell, K. (2019, September 27). The name "Dewey" is synonymous with libraries. So why did librarians strike it from an award? Slate Magazine. Retrieved from
https://slate.com/human-interest/2019/09/melvil-dewey-american-library-association-award-name-change.html
Lindsey, B. (2013, May 15). Why People Keep Misunderstanding the 'Connection' Between Race and IQ. Retrieved from
https://www.theatlantic.com/national/archive/2013/05/why-people-keep-misunderstanding-the-connection-between-race-and-iq/275876/
Literacy as Freedom. (n.d.). In Smithsonian American Art Museum. Retrieved from https://americanexperience.si.edu/wp-content/uploads/2014/09/Literacy-as-Freedom.pdf
Lo Wang, H. (Host). (2021,September 26). Most Prisoners Can't Vote, But They're Still Counted In Voting Districts [Audio podcast episode]. In All Things Considered. NPR.
https://www.npr.org/2021/09/22/1039643346/redistricting-prison-gerrymandering-definition-census-congressional-legislative
Locke, J. (1773). An essay concerning the true original extent and end of civil government.
Boston: Edes and Gill, in Queen-Street.
Longstreth, S., Brady, S., & Kay, A. (2013). Discipline policies in early childhood care and education programs: Building an infrastructure for social and academic success.
Early Education & Development, 24(2), 253–271. https://doi.org/10.1080/10409289.2011.647608
Lopez, S., Benali, H. (2016). Native American theater: a concise history. Miscelanea: A Journal of English and American Studies, 54, 93-111.
https://www.miscelaneajournal.net/index.php/misc/article/view/330/160
Luu, C. (2020, February 12). Black english matters. JSTOR Daily. Retrieved April 4, 2021, from https://daily.jstor.org/black-english-matters/
MacInnes, P. (2021, August 24). Ellie Simmonds: ‘I’ve found the expectations harder as I’ve got older.’ The Guardian.
https://www.theguardian.com/sport/2021/aug/24/ellie-simmonds-expectations-tokyo-paralympics-interview
Manian, M. (2020, September 29). Immigration Detention and Coerced Sterilization: History Tragically Repeats Itself. American Civil Liberties Union.
Retrieved September 13, 2021, from https://www.aclu.org/news/immigrants-rights/immigration-detention-and-coerced-sterilization-history-tragically-repeats-itself/
Marcelo, P. (2021, July 15). How Audubon societies are grappling with a racist past. In The Christian Science Monitor. Retrieved from
https://www.csmonitor.com/Environment/2021/0715/How-Audubon-societies-are-grappling-with-a-racist-past
Marks, J. (2021, June 3). Medical Definition of Hippocratic Oath. Retrieved from https://www.medicinenet.com/hippocratic_oath/definition.htm
Martschenko, D. (2017, October 11). IQ tests have a dark, controversial history—but they're finally being used for good.
Maxwell, C., & Solomon, D. (2020, April 14). The Economic Fallout of the Coronavirus for People of Color. In Center for American Progress. Retrieved from
https://www.americanprogress.org/issues/race/news/2020/04/14/483125/economic-fallout-coronavirus-people-color/
McAlpine, K. (2020, June 15). Black computer scientists, including U-M professors, call to dismantle racism in the field. Retrieved from
https://cse.engin.umich.edu/stories/black-computer-scientists-including-u-m-professors-call-to-dismantle-racism-in-the-field
McColl, L. (n.d.). Regression to the Mean: as relevant today as it was in the 1900s. Retrieved from
https://select-statistics.co.uk/blog/regression-to-the-mean-as-relevant-today-as-it-was-in-the-1900s/
McCrea, M. (2020). First, Do No Harm: Thinking about Racism in Astronomy. Rose City Astronomers. Retrieved from
https://www.rosecityastronomers.net/newsletter-content/2020/7/presidents-message
McKenna, P. (2018, March 2). Retrieved from https://insideclimatenews.org/news/02032018/air-pollution-data-african-american-race-health-epa-research/
McKenzie, Lindsay. (2020, October 22). Is It Time for All Students to Take Ethnic Studies? Inside Higher Ed.
https://www.insidehighered.com/news/2020/10/22/adding-ethnic-studies-college-curricula-has-long-been-controversial-moment-different
Mende-Siedlecki, P., Qu-Lee, J., Backer, R., & Van Bavel, J. J. (2019). Perceptual contributions to racial bias in pain recognition. Journal of experimental psychology. General,
148(5), 863–889. https://doi.org/10.1037/xge0000600
Mercier, P. (1999). Cultural Anthropology. In Britannica. Retrieved from https://www.britannica.com/science/cultural-anthropology
Metzl, J. M. (2009).The protest psychosis: How schizophrenia became a black disease. BeaconPress. Michael, J.S. (2017, July 25). Nuance Lost in Translation. N.T.M.
25, 281–309. https://doi.org/10.1007/s00048-017-0173-8
Middleton, C. (2020, December 15). UM Fires History Professor Who Criticizes ‘Powerful,Racist Donors’ And ‘Carceral State’. In Mississippi Free Press. Retrieved from
https://www.mississippifreepress.org/7518/um-fires-history-professor-who-criticizes-powerful-racist-donors-and-carceral-state/
Miller S. M. (2014). The role of Eugenics in research misconduct. Missouri medicine, 111(5), 386–390.
Miller, A. (1994). The Pioneer Fund: Bankrolling the Professors of Hate. The Journal of Blacks in Higher Education, 6, 58–61. https://doi.org/10.2307/2962466
Milligan, C., & Ballew, R. (n.d.). History of Black Firefighters. In legeros.com. Retrieved from https://www.legeros.com/history/ebf/national.shtml
Mills, C. (1959). The Sociological Imagination (pp. 15-63). New York, NY: Oxford University Press.
Molefi Kete Asante, & Ama Mazama. (2005). Encyclopedia of Black Studies. SAGE Publications, Inc.
https://ezproxy.marin.edu:2729/eds/ebookviewer/ebook?sid=4dc6e055-dede-431e-b511-67b06f2125b0%40pdc-v-sessmgr01&ppid=pp_xxv&vid=0&format=EB
Morgan, T. (2018, August 20). How Hollywood cast white actors in caricatured Asian roles. History. Retrieved April 4, 2021, from
https://www.history.com/news/yellowface-whitewashing-in-film-america
Morn, F. T. (1980, April). Academic disciplines and debates: An essay on criminal justice and criminology as professions in higher education. ERIC.
Retrieved September 13, 2021,from https://eric.ed.gov/?q=criminology&pg=6&id=ED207397
Mullikin, A. (2020, June 19). Recognizing systemic racism in dance. Seattle Dances. Retrieved October 3, 2021, from
http://seattledances.com/2020/06/recognizing-systemic-racism-in-dance/
Multimedia–Entertainment. (n.d.). In College of Marin-Career Education. Retrieved from http://workforce.marin.edu/cte_course/multimedia-entertainment/
Music. (n.d.). In College of Marin. Retrieved from https://academics.marin.edu/program/mus
Musu-Gillette, L., de Brey, C., McFarland, J., Hussar, W., Sonnenberg, W., Wilkinson-Flicker, S. (2017). Status and Trends in the Education of Racial and Ethnic Groups
2017 (NCES 2017-051). U.S. Department of Education, National Center for Education Statistics.Washington, DC. Retrieved from
https://nces.ed.gov/pubs2017/2017051.pdf
National Center for Science and Engineering Statistics. (2017). Who earns a U.S. doctorate? National Science Foundation. Retrieved September 13, 2021,from
https://www.nsf.gov/statistics/2017/nsf17306/report/who-earns-a-us-doctorate/race-and-ethnicity.cfm
National Dance Education Organization. (n.d.). Evolution of dance in arts education. NDEO. Retrieved October 3, 2021, from
https://www.ndeo.org/content.aspx?page_id=22&club_id=893257&module_id=51380
Nature. (2020, September 1). Henrietta lacks: Science must right a historical wrong. Nature News. Retrieved September 12, 2021, from
https://www.nature.com/articles/d41586-020-02494-z
Newsome, M. (2021, April 12). Even as colleges pledge to improve, share of engineering and math graduates who are Black declines. Retrieved from
https://hechingerreport.org/even-as-colleges-pledge-to-improve-share-of-engineering-graduates-who-are-black-declines/
Nittle, N. K. (2020, December 14). Cultural Appropriation in Music: From Madonna to Miley Cyrus. In ThoughtCo.. Retrieved from
https://www.thoughtco.com/cultural-appropriation-in-music-2834650
Nuriddin, A., Mooney, G., & White, A. I. (2020). Reckoning with histories of MEDICAL racism and violence in the USA. The Lancet, 396 (10256), 949–951.
https://doi.org/10.1016/s0140-6736(20)32032-8
Nursing Has a Long History of Racism. Now Is the Time to Overcome It (2021, September 9). Retrieved from
https://voice.ons.org/conferences/nursing-has-a-long-history-of-racism-now-is-the-time-to-overcome-it
Odum, H. W. (1951). American Sociology: The Story of Sociology in the United States through 1950 (p. 378). London: Greenwood.
Ojanuga, D. “The medical ethics of the 'father of gynaecology', Dr J Marion Sims.” Journal of medical ethics vol. 19,1 (1993): 28-31. doi:10.1136/jme.19.1.28
Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1376165/
Okwuosa, A. (2021, August 9). What does an anti-racist math class look like?. Intvo. Retrieved from
https://www.tvo.org/article/what-does-an-anti-racist-math-class-look-like
Oliver, M. N., Wells, K. M., Joy-Gaba, J. A., Hawkins, C. B., & Nosek, B. A. (2014). Do physicians' implicit views of African Americans affect clinical decision making?.
Journal of the American Board of Family Medicine : JABFM, 27(2), 177–188. https://www.jabfm.org/content/27/2/177
Östör, k. (1998). Anthropology. In Britannica. Retrieved from https://www.britannica.com/science/anthropology
Parikh, A. (2018, April 9). Race is still a Problem in Anthropology. In Anthrodendum. Retrieved from
https://anthrodendum.org/2018/04/09/race-is-still-a-problem-in-anthropology/
Park, J. (2017). Historical origins of the tuskegee experiment: The Dilemma of Public Health in the United States. Korean Journal of Medical History, 26(3), 545–578.
https://doi.org/10.13081/kjmh.2017.26.545
Parkinson, J. (2016, January 7). The significance of Sarah Baartman. In BBC News. Retrieved from https://www.bbc.com/news/magazine-35240987
Patel, V. (2021, June 15). Race on Campus: Engineering Has a Diversity Problem. Colleges Can Help. Retrieved from
https://www.chronicle.com/newsletter/race-on-campus/2021-06-15
Pearl Fryar. (2021). In South Carolina African American History Calendar. Retrieved from https://scafricanamerican.com/honorees/pearl-fryar/
Pearson, J.D. (2003). Lewis Cass and the politics of disease: The Indian Vaccination act of 1832. Wicazo Sa Review 18(2), 9-35. https://doi.org/10.1353/wic.2003.0017
Pierson, B. and Galloway, S.(2006). A Man Named Pearl [Film; DVD].Tentmakers Entertainment.
Pilkington, E. (2021, April 29). Ivy League colleges apologize for ‘serious error’ in using bones of Black child for teaching. In The Guardian.
Prescod-Weinstein, C. (2019). Making Black Women Scientists under White Empiricism: The Racialization of Epistemology in Physics. Signs: Journal of Women in Culture and
Society, 45(2), 421-447. Retrieved from https://www.journals.uchicago.edu/doi/pdfplus/10.1086/704991
Primitive Art. (2021). In Museum of Modern Art. Retrieved from https://www.moma.org/collection/terms/primitive-art
Public Broadcasting Service. (n.d.). Race-the power of an illusion. PBS. Retrieved September 21, 2021, from https://www.pbs.org/race/000_About/002_04-teachers.htm
Pulido, L. (2002). Reflections on a white discipline. Retrieved from https://atrium.lib.uoguelph.ca/xmlui/bitstream/handle/10214/1803/7-Pulido.pdf?sequence=1&isAllowed=y
Rafa, A. (2018). (rep.). Suspension and Expulsion (pp. 1–6). Denver, CO: Education Commission of the States. Retrieved September 11, 2021, from
https://www.ecs.org/suspension-and-expulsion/
Remmel, A . (Host). (2020, September 23). On Being #BlackInChem (No. 33) [Audio podcast episode]. In Stereo Chemistry. Open Berkeley.
https://chemistry.berkeley.edu/news/black-chemists-discuss-strategies-dismantling-systemic-racism-science
Resources that Address Issues of Race, Diversity, and Social Justice . (n.d.). In ACTFL Language Connects.
Reverby, S. M. (2012). Ethical failures and History Lessons: The U.S. public Health service research studies in Tuskegee and Guatemala. Public Health Reviews, 34(1), 1–18.
https://doi.org/10.1007/bf03391665
Ricard, R. (1981, December). The Radiant Child. Artforum, 20(4), 35-43. Retrieved from https://www.artforum.com/print/198110/the-radiant-child-35643
Rieland, R. (2018, March). Artificial Intelligence Is Now Used to Predict Crime. But Is It Biased?.
Rios,C. (2015, February 15). You Call It Professionalism; I Call It Oppression in a Three-Piece Suit. Everyday Feminism. Retrieved from You Call It Professionalism; I Call It
Oppression in a Three-Piece Suit https://everydayfeminism.com/2015/02/professionalism-and-oppression/
Rodriguez, M. A., & García, R. (2013). First, do No Harm: The US sexually transmitted Disease experiments in Guatemala. American Journal of Public Health,
103(12), 2122–2126. https://doi.org/10.2105/ajph.2013.301520
Romita, A., & Romita, N. (2018, October 26). Why major in dance? A case for dance as a field of study in universities in 2018. OUPblog. Retrieved October 5, 2021, from
https://blog.oup.com/2018/10/dance-field-of-study-in-universities/
Rosa, K. and Henke, K. (2017).2017 ALA Demographic Study Report. In American Library Association: Office for Research and Statistics. Retrieved from
https://www.ala.org/tools/sites/ala.org.tools/files/content/Draft%20of%20Member%20Demographics%20Survey%2001-11-2017.pdf
Rucks-Ahidiana, Z. (2021, July 16). The Systemic Scarcity of Tenured Black Women. In Inside Higher Ed. Retrieved from
https://www.insidehighered.com/advice/2021/07/16/black-women-face-many-obstacles-their-efforts-win-tenure-opinion
Ruf, J. (2020, February 16). Why Environmental Studies is Among the Least Diverse Fields in STEM. Retrieved from
https://www.diverseeducation.com/institutions/hbcus/article/15106248/why-environmental-studies-is-among-the-least-diverse-fields-in-stem
Rutledge, D. (20, November 9). Racist attitudes 'whitewashed' modern philosophy. What can be done to change it?. Retrieved from
https://www.abc.net.au/news/2019-11-10/modern-philosophical-canon-has-always-been-pretty-whitewashed/11678314
Said, E. (1979). Orientalism (First ed., pp. 1-6). New York, NY: Vintage Books. Sanderson, S. (2021, February 22). MoMA examines role of architecture in systemic racism.
Savitt, T. L. (1982). The use of blacks for medical experimentation and demonstration in the Old South. The Journal of Southern History, 48(3), 331–348.
https://doi.org/10.2307/2207450
Schnabel, J. (1996).Basquiat[Film, DVD]. Miramax Films.
Seicol, A. (2020, June 8). Institutional racism in the fire service: ‘We must admit that it exists in our house’. In FireRescue1 by Lexipol. Retrieved from
https://www.firerescue1.com/fire-department-management/articles/institutional-racism-in-the-fire-service-we-must-admit-that-it-exists-in-our-house-cV2Tmq26ufggM89Z/
Shah, M. (2020, October 9). What It Feels Like to Be a Nurse of Color. Retrieved from https://voice.ons.org/stories/what-it-feels-like-to-be-a-nurse-of-color
Sheth, M. J. (2018, May 22). Grappling with racism as foundational practice of science teaching. Wiley Online Library. doi: https://doi.org/10.1002/sce.21450
Shotwell, J. (2019, June 18). Yes, sociology is racist, too. Contexts:Sociology for the Public: Cite Black Women!. Retrieved from
https://contexts.org/articles/yes-sociology-is-racist-too/
Shudel, M. (2020, December 31). George R. Carruthers, scientist who designed telescope that went to the moon, dies at 81.Washington Post. Retrieved from
https://www.washingtonpost.com/local/obituaries/george-carruthers-dead/2020/12/31/ca5a366e-4acc-11eb-a9d9-1e3ec4a928b9_story.html
Silva, D. (2020, June 18). From Juneteenth to the Tulsa massacre: What isn't taught in classrooms has a profound impact. In NBC News. Retrieved from
https://www.nbcnews.com/news/us-news/juneteenth-tulsa-massacre-what-isn-t-taught-classrooms-has-profound-n1231442
Simchayoff, E. (2021, January 24). The Racist Origin of ‘Eeny, Meeny, Miny, Moe’. In Medium.com. Retrieved from
https://aninjusticemag.com/the-racist-origin-of-eeny-meeny-miny-moe-411e2d4815ac
Smelser, N., Wilson, W., & Mitchel, F. (Eds.). (2011). America Becoming Racial Trends and Their Consequences (First ed., Vol. II, pp. 3-8). Washington, DC: The National
Research Council. Retrieved from https://doi.org/10.17226/9719
Smith, R. M. (1997). Still Blowing in the Wind: The American Quest for a Democratic, Scientific Political Science. Daedalus, 126(1), 253–287.
http://www.jstor.org/stable/20027417
So, R. J., & Wezerek, G. (2020, December 11). Just How White Is the Book Industry?. Retrieved from
https://www.nytimes.com/interactive/2020/12/11/opinion/culture/diversity-publishing-industry.html?searchResultPosition=3
Sokol, J. (2016, August 23). Why the Universe Needs More Black and Latino Astronomers. Smithsonian Magazine. Retrieved from
https://www.smithsonianmag.com/science-nature/how-can-we-give-black-and-latino-astronomers-foundation-reach-stars-180960213/
Sokolowski, H., & Ansari, D. (2017, October 17). Who Is Afraid of Math? What Is Math Anxiety? And What Can You Do About It?. In Frontiers for Young Minds Main.
Spaine Long, S. (2020, July 22). Race and Language Teaching. Language Magazine. Retrieved from
https://www.languagemagazine.com/2020/07/22/race-and-language-teaching/
Spears, C. C. (2020, June 10). How dance students can confront racism and implicit bias in the studio. Dance Spirit. Retrieved October 3, 2021, from
http://www.dancespirit.com/students-confront-racism-2646167153.html?rebelltitem=10#rebelltitem10
Stegelin, D.A., & Emerita. (2018, December). Preschool suspension and expulsion: Defining the issues. Institute for Child Success. Retrieved September 12, 2021, from
https://www.instituteforchildsuccess.org/publication/preschool-suspension-and-expulsion-defining-the-issues/
Stern, A. (2020, September 23). Forced sterilization policies in the US targeted minorities and those with disabilities–and lasted into the 21st century. Institute for Healthcare
Policy & Innovation. Retrieved September 13, 2021, from
https://ihpi.umich.edu/news/forced-sterilization-policies-us-targeted-minorities-and-those-disabilities-and-lasted-21st
Stewart, A. (2018, September 13). “Opinion | I Was a Firefighter for 35 Years. Racism Today Isas Bad as Ever.”. The New York Times. Retrieved from
www.nytimes.com/2018/09/12/opinion/the-racism-inside-fire-departments.html
Syed, M. (2020, August 28). Psychology Must Reckon with its Racist Past—and Present. Retrieved from
https://cla.umn.edu/psychology/story/psychology-must-reckon-its-racist-past-and-present
Talbot, M. (2018, October 22). The Myth of Whiteness in Classical Sculpture. The New Yorker. Retrieved from
https://www.newyorker.com/magazine/2018/10/29/the-myth-of-whiteness-in-classical-sculpture
The Aspen Institute. (2016). Roundtable on Community Change. In Glossary for Understanding the Dismantling Structural Racism/Promoting Racial Equity Analysis (pp. 1-2).
Aspen, CO:Author. Retrieved from https://www.aspeninstitute.org/wp-content/uploads/files/content/docs/rcc/RCC-Structural-Racism-Glossary.pdf
The Biology of Skin Color. (2015). HHMI BioInteractive. Retrieved September 21, 2021, from https://www.biointeractive.org/classroom-resources/biology-skin-color
The Black Experience in Graphic Design: 1968 and 2020. (2020, July 8). In Letterform Archive. Retrieved from
https://letterformarchive.org/news/view/the-black-experience-in-graphic-design-1968-and-2020
The Sadie Collective. (2020, November 11). Why are Black Women Missing from Corporate Leadership?. In Medium.com. Retrieved from
https://sadiecollective.medium.com/black-women-missing-from-corporate-1a6524314ca7
Thelin, J., Edwards, J., Moyen, E., Berger,J., & Vita Calkins, M. (2021). Higher Education in the United States HISTORICAL DEVELOPMENT, SYSTEM . In State university.com.
Thuis, P., & Stuive, R. (2019). Business administration. Routledge. Timeline of scientific racism. Haunted Files APA NYU. (n.d.). Retrieved September 13, 2021, from
https://apa.nyu.edu/hauntedfiles/about/timeline/
Tyner, J. (2017, May 19). Race and Racism. Retrieved from https://www.oxfordbibliographies.com/view/document/obo-9780199874002/obo-9780199874002-0124.xml
U.S. Department of Education (2016). National Teacher and Principal Survery. National Center for Education Statistics. Washington, DC. Retrieved from
https://nces.ed.gov/surveys/ntps/index.asp
U.S. Department of Health & Human Services. (n.d.). Understanding child trauma. SAMHSA. Retrieved September 21, 2021, from
https://www.samhsa.gov/child-trauma/understanding-child-trauma
Ura, A. (2021, August 23). The hard-fought Texas voting bill is poised to become law. Here's what it does. Texas Tribune. Retrieved from
https://www.texastribune.org/2021/08/30/texas-voting-restrictions-bill/
Veritasium.(2021, May 22). Math Has a Fatal Flaw. [Video]. You Tube. https://www.youtube.com/watch?v=HeQX2HjkcNo
Vinopal, J. (2016, January 13). The Quest for Diversity in Library Staffing: From Awareness to Action. In In the Library with the Lead Pipe. Retrieved from
https://www.inthelibrarywiththeleadpipe.org/2016/quest-for-diversity/
Wabuke, H. (2015, April 16). 20 Black Poets You Should Know (and Love). Retrieved from https://www.theroot.com/20-black-poets-you-should-know-and-love-1790868612
Wall, L L. “The medical ethics of Dr J Marion Sims: a fresh look at the historical record.” Journal of medical ethics vol. 32,6 (2006): 346-50. doi:10.1136/jme.2005.012559
Ward, A.M. (2019). Ethnic studies programs. Salem Press Encyclopedia.
http://ezproxy.marin.edu:2048/login?url=https://ezproxy.marin.edu:2472/login.aspx?direct=true&db=ers&AN=96397324&site=eds-live
Ward, B. (2017, August 17). Elvis Presley 40 Years Later: Was the King of Rock 'n' Roll Guilty of Appropriating Black Music?. Retrieved from
https://www.newsweek.com/elvis-presley-40-years-later-was-king-rock-n-roll-guilty-appropriating-black-651911
Weingarten, E. (2020, June). Why Economics Needs More Black Women. Behavioral Scientist. Retrieved from
http://behavioralscientist.org/why-economics-needs-more-black-women/
What is art history?. (2021). In International studies in history and business of art & culture. Retrieved from https://www.iesa.edu/paris/news-events/art-history
What is Astronomy?. (n.d.). In American Museum of Natural History. Retrieved from https://www.amnh.org/explore/ology/astronomy/what-is-astronomy
WHAT IS CAREER TECHNICAL EDUCATION?. (n.d.). In Career Technical Educational Foundation. Retrieved from
https://ctesonomacounty.org/what-is-career-technical-education/
What is communication studies? Masters in Communications. (n.d.). Retrieved October 18,2021, from
https://www.mastersincommunications.com/faqs/what-is-communication-studies
What is Mathematics?. (2021). In Tennessee Tech. Retrieved from https://www.tntech.edu/cas/math/what-is-mathematics.php
What is Statistics?. (2021). In Department of Statistics-Donald Bren School of Information & Computer Sciences. Retrieved from https://www.stat.uci.edu/what-is-statistics/
White, R. H. (n.d.). Cultural Appropriation in Music. In Berklee Online. Retrieved from https://online.berklee.edu/takenote/cultural-appropriation-in-music/
Wikimedia Foundation. (n.d.). Linguistic discrimination. Wikipedia. Retrieved April 4, 2021, from https://en.Wikipedia.org/wiki/Linguistic_discrimination
Wilkie T. (2000). Acres of skin: human experiments at Holmesburg Prison. A true story of abuse and exploitation in the name of medical science.
Medical History, 44(1), 132–133.
Williams, M. J., & Eberhardt, J. L. (2008). Biological conceptions of race and the motivation to cross racial boundaries. Journal of Personality and Social Psychology,
94(6), 1033–1047. https://doi.org/10.1037/0022-3514.94.6.1033
Winston, Abigail C. (2019) "The Role of Music in Assimilation of Students at the Carlisle Indian Industrial School," The Gettysburg Historical Journal: Vol. 18 , Article 9.
Available at: https://cupola.gettysburg.edu/ghj/vol18/iss1/9
Wright, E. (2012). Why, Where, and How to Infuse the Atlanta Sociological Laboratory into the Sociology Curriculum. Teaching Sociology, 40(3), 257-270.
doi:10.1177/0092055X12444107
Young, T. (2020, February 12). Retrieved from https://elvisbiography.net/2020/02/12/elvis-presley-and-the-black-community-dispelling-the-myths/
Zinn, H. (1980, 2005). A People's History of the United States: 1492-Present (pp. 5-323, 684, 13). New York, NY: Harper Perennial Modern Classics.
A People’s History of Structural Racism in Academia: From A(dministration of Justice) to Z(oology) © 2022 by Susan Rahman is licensed under CC BY 4.0. To view a copy of this license,visit http://creativecommons.org/licenses/by/4.0/
The contents of this book were developed under an Open Textbooks Pilot grant from the Fund for the Improvement of Postsecondary Education (FIPSE), U.S. Department of Education. However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.
3.06: A List of Resources For Further Exploration
A List of Resources For Further Exploration | textbooks/socialsci/Social_Justice_Studies/A_Peoples_History_of_Structural_Racism_in_Academia%3A_From_A(dministration_of_Justice)_to_Z(oology)/03%3A_Conclusion/3.05%3A_References.txt |
Immigration Policy
Purposes of Immigration Policy
There are five primary purposes of immigration policy (US English Foundation, 2014; Fix & Passel, 1994).
1. Social: Unify citizens and legal residents with their families.
2. Economic: Increase productivity and standard of living.
3. Cultural: Encourage diversity, increasing pluralism and a variety of skills.
4. Moral: Promote and protect human rights, largely through protecting those feeling persecution.
5. Security: Control undocumented immigration and protect national security.
Tug-of-War in Immigration Policy
There are many ideological differences among the stakeholders in immigration policy, and many different priorities. In order to meet the purposes listed above, policy-makers must balance the following goals against one another.
Provide refuge to all versus recruit the best. Some stakeholders desire to provide refuge for the displaced (Permanently stamped on the Statue of Liberty are the words, “Give me your tired, your poor, your huddled masses yearning to breathe free”). These stakeholders seek to welcome all who are separated from their families or face economic, political, or safety concerns in their current locations. Others aim to recruit those best qualified to add to the economy.
Meet labor force needs versus protect current citizen employment. Immigrant workers are expected to make up 30-50% of the growth in the United States labor force in the coming decades (Lowell, Gelatt, & Batalova, 2006). In general, immigrants provide needed employment and do not impact the wages of the current workforce. However, there are situations (i.e., during economic downturns) where immigration can threaten the current work force’s conditions or wages.
Enforce policy versus minimize regulatory burden and intrusion on privacy. In order to enforce immigration policy away from the border, the government must access residents’ documents. However, this threatens citizens’ privacy. When employers are required to access these documents, it also increases regulatory burden for the employers.
BBC World Service – Border fence – CC BY-NC 2.0.
Key Stakeholders in Policy
There are many groups who are deeply invested in immigration and immigrant policy; their fortunes rise or fall with the policies set. These groups are called “stakeholders.” Key stakeholders in immigration and immigrant policy in the United States include the federal government, state governments, voluntary agencies, employers, families, current workers, local communities, states, and the nation as a whole.
Families. As we described in the introduction, one of the most common motivations for immigration is to provide a better quality of life for one’s family, either by sending money to family in another country or by bringing family to the United States (Solheim, Rojas-Garcia, Olson, & Zuiker, 2012). Immigration policy impacts these families’ abilities to migrate to access safer living conditions and seek economic stability. Further, immigration policy impacts a family’s opportunity for reunification. Reunification means that immigrants with legal status in the United States can apply for visas to bring family members to join them. Approximately two-thirds of the immigrants in the United States were sponsored by family members who migrated first and became permanent residents (Kandel, 2014).
“My goals are to offer my family a decent life and economic stability, to guarantee them a future without serious problems, with a house, a means of transport… things that sometimes you can’t achieve in Mexico. Our goal must be for our family’s welfare, as much for my family here as for my family back there” – Mexican Immigrant, Solheim et al., 2012 p. 247.
Federal government. The federal government is currently solely responsible for the creation of immigration policies (Weissbrodt & Danielson, 2004). In the past, each state determined its own immigration policy according to the Articles of Confederation because it was unclear whether the United States Constitution gave the federal government power to regulate immigration (Weissbrodt & Danielson, 2011). A series of Supreme Court cases beginning in the 1850s upheld the federal government’s right to create immigration policies, arguing that the federal government must have the power to exclude non-citizens to protect the national public interest (Weissbrodt & Danielson, 2004). The Supreme Court has determined that the power to admit and to remove immigrants to the United States belongs solely to the federal government (using as precedents the uniform rule of Naturalization, Article 1.8.4, and the commerce clause, Article 1.8.3). In fact, there is no area where the legislative power of Congress is more complete (Weissbrodt & Danielson, 2004).
Immigration responsibilities were originally housed in the Treasury Department and the Department of Labor, due to its connection to foreign commerce. In the 1940s, the immigration office (now called the “INS”) was moved to the United States Department of Justice due to its connection to protecting national public interest (USCIS, 2010). The federal departments and agencies that implement immigration laws and policies have changed significantly since the terrorist attacks of 2001. In 2001, the United States Commission on National Security created the Department of Homeland Security (DHS), which absorbed and assumed the duties of Immigration and Naturalization Services (INS).
Three key agencies within DHS enforce immigration and immigrant policy (see Figure 1):
• United States Citizenship and Immigration Services (USCIS): USCIS provides immigration services, including processing immigrant visa requests, naturalization petitions, and asylum/refugee requests. Its offices are divided into four national regions: (1) Burlington, Vermont (Northeast); (2) Dallas, Texas (Central); (3) Laguna Niguel, California (West); and (4) Orlando, Florida (Southeast). The director of USCIS reports directly to the Deputy Secretary of Homeland Security. It is important to note that immigration officers, who traditionally hold law degrees, have broad discretion in deciding whether an application is complete and accurate (Weissbrodt & Danielson, 2011).
• Immigration and Customs Enforcement (ICE): ICE is primarily tasked with enforcing immigration laws once immigrants are inside the United States’ ICE is responsible for identifying and fixing problems in the nation’s security. This is accomplished through five operational divisions: (1) immigration investigations; (2) detention and removal; (3) Federal Protective Service; (4) international affairs; and (5) intelligence.
• United States Customs and Border Protection (CBP): USCBP includes the Border Patrol, which is responsible for identifying and preventing undocumented aliens, terrorists, and weapons from entering the country. In addition to these responsibilities, USCBP is responsible for regulating customs and international trade to intercept drugs, illicit currency, fraudulent documents or products with intellectual property rights violations, and materials for quarantine.
Figure 1: Federal Immigration Organizations
State governments. Although states have no power to create immigration policy, the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA, 1996) enabled the Secretary of Homeland Security to enter into agreements with states to implement the administration and enforcement of federal immigration laws. States are also responsible for policy regarding immigrant and refugee integration. There is wide variation in how states pursue integration. Not all policies are welcoming. For example, several have passed legislation that limits access of public services to undocumented immigrants (e.g., Alabama, Georgia, Indiana, South Carolina, and Utah). In contrast, states such as Minnesota, have sought to expand immigrant access to public services. These drastically different approaches have promoted consideration of this critical important task at the federal level. In late 2014, President Obama formed the “White House Task Force on New Americans” whose primary purpose is to “create welcoming communities and fully integrating immigrants and refugees” (White House, 2014). This is the first time in United States history that the executive branch of the government has undertaken such an effort.
Employers. Employers have high stakes in policy that impact immigration, particularly as it impacts their available labor force. United States employers who recruit highly skilled workers from abroad typically sponsor their employees for permanent residence. Other employers who need a large labor force, particularly for low-skill work, often look to immigrants to fill positions.
Employers are also impacted by requirements to monitor the immigrant status of employees. Following the Immigration Reform and Control Act (IRCA) of 1986, it became illegal to knowingly employ undocumented immigrants. Many employers are now required by state law or federal contract to use the e-verify program to confirm that prospective employees are not undocumented immigrants. Such requirements aim to reduce incentives for undocumented immigration, but also pose burdens of liability and reduced labor availability for employers. The National Council of Farmer Cooperatives (2015) and the American Farm Bureau Federation oppose measures that could constrict immigration such as the E-Verify program, stating that it could have a detrimental impact on the country’s agriculture.
Migrant worker.
Bread for the World – Migrant Worker and Cucumbers, Blackwater, VA – CC BY-NC-ND 2.0.
Current workforce. Overall, research demonstrates that immigration increases wages for United States-born workers (Ottaviano & Peri, 2008; Ottaviano & Peri, 2012; Cortes, 2008; Peri, 2010). Estimated increases in wages from immigration range from .1 to .6% (Borjas & Katz, 2007; Ottaviano & Peri, 2008; Shierholz, 2010). However, these wage increases are not unilaterally and consistently distributed across time, skill and education levels of workers. Some researchers have found that low-education workers have experienced wage decreases due to immigration, as large as 4.8% (Borjas & Katz, 2007). However, other researchers have found that among those without a high school diploma, wages decreased by approximately 1% in the short run (Shierholz, 2010; Ottaviano & Peri, 2012) but were increased slightly in the long run (Ottaviano & Peri, 2012).
Immigration generally does not decrease job opportunities for United States-born workers, and may slightly increase them (Peri, 2010). However, during economic downturns when job growth is slowed, immigration may have short-term negative effects on job availability and wages for the current workforce (Peri, 2010). Immigrants create growth in community businesses (see Textbox 1, “Did you know”). It is nonetheless important to emphasize that the fear of non-citizens taking away employment opportunities from citizens is a primary driver for immigration laws (Weissbrodt & Danielson, 2011).
Communities. United States communities must provide education and health care regardless of immigration status (i.e., Plyer v. Doe, 1982). In areas with rapidly increasing numbers of immigrant workers and their families, this can tax local communities that are already overburdened (Meissner, Meyers, Papademetriou & Fix, 2006). The Congressional Budget Office found that most state and local governments provide services to unauthorized immigrants that cost more than those immigrants generate in taxes (2007). However, studies have found that immigrants may also infuse new growth in communities and sustain current levels of living for residents (Meissner, Meyers, Papademetriou & Fix, 2006).
Country. Immigrants provide many benefits at a national level. Overall, immigrants create more jobs than they fill, both through demand for goods and service and entrepreneurship. Foreign labor allows growth in the labor force and sustained standard of living (Meissner, Meyers, Papademetriou & Fix, 2006). Even though immigrants cost more in services than they provide in taxes at a state and local governments level, immigrants pay far more in taxes than they cost in services at a national level. In particular, immigrants (both documented and undocumented) contribute billions more to Medicare through payroll taxes than they use in medical services (Zallman, Woolhandler, Himmelstein, Bor & McCormick, 2013). Additionally, many undocumented immigrants obtain social security cards that are not in their name and thereby contribute to social security, from which they will not be authorized to benefit. The Social security administration estimates that \$12 billion dollars were paid into social security in 2010 alone (Goss et al., 2013).
Textbox 1
Did you know?
While immigrants make up 16% of the labor force, they make up 18% of the business owners
Between 2000 and 2013, immigrants accounted for nearly half of overall growth of business ownership in the United States (Fiscal Policy insitute, 2015). | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/01%3A_Immigration_and_Immigrant_Policy-_Barriers_and_Opportunities_for_Families/1.01%3A_Immigration_Policy.txt |
Current Immigration Policy
Although the decision to migrate is generally made and motivated by families, immigration policy generally focuses on the individual. For example, visas are granted to individuals, not families. In this section, we will describe the immigration policies that are most influential for today’s families. For an overview of all immigration policies and their historical context, please see Appendices 1-4 (The History of Documented Immigration Policy 1850s-1920s, 1920s-1950s, 1950s to Present, and the History of Undocumented Immigration Policy, respectively).
In the landmark decision of Arizona et al. v. United States (2012), Associate Justice Anthony Kennedy remarked that “The history of the United States is in part made of the stories, talents, and lasting contributions of those who crossed oceans and deserts to come here.”
1952 McCarran-Walter Act: This act and its amendments remains the basic body of immigration law. It opened immigration to all countries, establishing quotas for each (US English Foundation, 2014). This act instituted a priority system for admitting family members of current citizens. Admission preference was given to: (1) unmarried adult sons and daughters of United States citizens; (2) spouses and unmarried sons and daughters of United States citizens; (3) professionals, scientists, and artists of exceptional ability; and (4) married adult sons and daughters of United States citizens. This meant that more families from more countries had the opportunity to reunite in the United States.
1965 Hart-Celler Immigration Act or Immigration and Nationality Act and 1978 Amendments. In this act, the national ethnicity quotas were repealed. Instead, a cap was set for each hemisphere. Once again, priority was given to family reunification and employment skills. This act also expanded the original four admission preferences to seven, adding: (5) siblings of United States citizens; (6) workers, skilled and unskilled, in occupations for which labor was in short supply in the United States; and (7) refugees from Communist-dominated countries or those affected by natural disasters. This expanded the opportunities for family members to reunite in the United States.
1990 Immigration Act. This act eased the limits on family-based immigration (US English Foundation, 2014). It ultimately led to a 40% increase in total admissions (Fix & Passel, 1994).
Deferred Action for Childhood Arrivals. The Dream Act, proposed in the Senate in 2001, would allow for conditional permanent residency to immigrants who arrived in the United States as minors and have long-standing United States residency. While this bill has not been signed into law, the Obama administration has created renewable two-year work permits for those who meet these standards. This has the largest impact on undocumented families. Many children travel to the United States without documents to be with their families, and then spend most of their lives in the United States. If the bill passed, these children would have new opportunities to pursue higher education and jobs in the land they think of as home, without fear of deportation.
2000 Life Act and Section 245(i). This allowed undocumented immigrants present in the United Sttes to adjust their status to permanent resident, if they had family or employers to sponsor them (US English Foundation, 2014).
2001 Patriot Act: The sociopolitical climate after the September 11, 2001 terrorist attacks drastically changed immigrant policies in the United States. This act created Immigration and Customs Enforcement (ICE) and Citizenship and Immigration Services (CIS), greatly enhancing immigration enforcement.
2005 Bill. The House of Representatives passed a bill that increased enforcement at the borders, focusing on national security rather than family or economic influences (Meissner, Meyers, Papademetriou & Fix, 2006).
2006 Bill. The Senate passed a bill that expanded legal immigration, in order to decrease undocumented immigration (Meissner, Meyers, Papademetriou & Fix, 2006).
As these policies indicate, it is currently very difficult to enter the United States without documentation. There are few supports available to those who do make it across the border (see Table 1). However, the 2000 Life Act and the Dream Act provide some provisions for families who live in the United States to obtain documentation to remain together, at least temporarily.
For families who want to immigrate with documentation, current policy prioritizes family reunification. Visas are available for family members of current permanent residents, and there are no quotas on family reunification visas (See Textbox 2, “Process for Becoming a Citizen). Even when family members of a current permanent resident are granted a visa, they are a long way from residency. They must wait for their priority date and process extensive paperwork. If a family wants to immigrate to the United States but does not have a family member who is a current permanent resident or a sponsoring employer, options for documented immigration are very limited.
Table 1
Supports available to documented and undocumented immigrants
Taken from US Citizenship and Immigration Services, 2010
Textbox 2
Process of Becoming a Citizen, also called “Naturalization”
File a petition for an immigrant visa. The first step of documented immigration is obtaining an immigrant visa. There are a number of ways this can occur:
• For family members. A citizen or lawful permanent resident in the United States can file an immigrant visa petition for their immediate family members in other countries. In some cases, they can file a petition for a fiancé or adopted child.
• For sponsored employees. United States employers sometimes recruit skilled workers who will be hired for permanent jobs. These employers can file a visa petition for the workers.
• For immigrants from countries with low rates of immigration. The Diversity Visa Lottery program accepts applications from individuals in countries with low rates of immigration. These individuals can file an application, and visas are awarded based on random selection.
If prospective immigrants do not fall into one of these categories, their avenues for documented immigration are quite limited. For prospective immigrants who fall within one of these categories, their petition must be approved by USCIS and consular officers. However, they are still a long way from residency.
Wait for priority date. There is an annual limit to the number of available visas in most categories. Petitions are filed chronologically, and each prospective immigrant is given a “priority date.” The prospective immigrant must then wait until there is an available visa, based on their priority date.
Process paperwork. While waiting for the priority date, prospective immigrants can begin to process the paperwork. They must pay processing fees, submit a visa application form, and compile extensive additional documentation (such as evidence of income, proof of relationship, proof of United States status, birth certificates, military records, etc.) They must then complete an interview at the United States. Embassy or Consulate and complete a medical exam. Once all of these steps are complete, the prospective immigrant received an immigrant visa. They can travel to the United States with a green card and enter as a lawful permanent resident (US Visas, n.d.).
A lawful permanent resident is entitled to many of the supports of legal residents, including free public education, authorization to work in the United States, and travel documents to leave and return to the United States (Refugee Council USA, 2014). However, permanent resident aliens remain citizens of their home country, must maintain residence in the United States in order to maintain their status, must renew their status every 10 years, and cannot vote in federal elections (USCIS, 2015).
Apply for citizenship. Generally, immigrants are eligible to apply for citizenship when they have been a permanent resident for at least five years, or three years if they are married to a citizen. Prospective citizens must complete an application, be fingerprinted and have a background check, complete an interview with a USCIS officer, and take an English and civics test. They must then take an Oath of Allegiance (USCIS, 2012). | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/01%3A_Immigration_and_Immigrant_Policy-_Barriers_and_Opportunities_for_Families/1.02%3A_Current_Immigration_Policy.txt |
Opportunities and Barriers for Immigrant Families
The United States gives priority to family reunification, and has made great efforts to make the process of reunification accessible to immigrants. This provides new opportunities and security for immigrant families. However, there are still substantial challenges and barriers to families. In the sections below, we will describe the opportunities and barriers available to families in different configurations, including families seeking reunification, families living together in the United States without documentation, and couples in international marriages.
Reunification
As we outlined in the policy section, United States policy prioritizes family reunification, and immigrant and refugees’ spouses and children are eligible to immigrate without visa quotas. The majority of current immigrants are family members being reunited with United States citizens or permanent residents.
USCIS providing answers about citizenship and immigration for soldiers and families at Army Community Services in Seoul.
US Army Garrison Red Cloud – U.S. Embassy answers immigration questions – CC BY-NC-ND 2.0.
In addition to these policies that promote family reunification, there are now more accepting policies to support reunification of gay citizens and their immigrant spouses. Historically, United States immigration policy has denied immigration to same-sex orientation applicants. Under the 1917 Immigration Act, homosexuality was grounds for exclusion from immigration. In 1965, Congress argued that gay immigrants were included in a ban on “sexual deviation” (Dunton, 2012). The ban against gay immigrants continued until 1990, when the Immigration and National Act was amended, removing the homosexual exclusion. Moreover, asylum has been granted for persecution due to sexual orientation (Dunton, 2012). Until 2013, immigrants and refugees could apply for residency or visas for their opposite-sex spouses. There was no provision made for same-sex partners. Following the overturn of the Defense of Marriage Act (DOMA), citizens and permanent residents can now sponsor their same-sex spouses for visas. United States citizens can also sponsor a same-sex fiancé for a visa (USCIS, 2014).
Despite these advances, there are two large challenges faced by immigrants seeking reunification. First, it requires substantial time and resources, including legal counsel, to navigate the visa system. Adults can petition for permanent resident visas for themselves and their minor children, but processing such applications can take years. Currently, children of permanent residents can face seven-year wait times to be accepted as legal immigrants (Meissner, Meyers, Papademetriou & Fix, 2006).
In some cases, children can age out of eligibility by the time the application is processed and the visa is granted. Such children then go to the end of the waiting list for adult visa processing (Brown, 2014). The 2002 Child Status Protection Act is designed to protect children against aging out of visa eligibility when the child is the primary applicant for a visa, but the act does not state if it applies if a parent was applying on behalf of their family (Brown, 2014). In the 2014 ruling to Cuellar de Osorio v. Mayorkas, the Supreme Court found that the child status protection act does not apply for children when a parent is applying on behalf of their family. Such young adults have already generally been separated from family for many years, and will now be separated for years or decades more.
Undocumented Families
For families who do not have a sponsoring family member, have a sponsoring employer, or originate from a country with few immigrants, the options for legal immigration to the United States are very limited. Those families who choose to travel to the United States face substantial barriers, including a perilous trip across the border, few resources, and constant threat of deportation.
One of the most dangerous times for undocumented families is the risky trip across the border. In order to avoid border patrol, undocumented immigrants take very dangerous routes across the United States border. The vast majority of all apprehensions of undocumented immigrants are on the border (while the remainder is apprehended through interior enforcement). For example, in 2014 ICE conducted 315,943 removals, 67% of which were apprehended at the border (nearly always by the Border Patrol), and 33% of which were apprehended in the interior (ICE, 2014). The trip and efforts to avoid Border Patrol can be physically dangerous and in some cases, deadly. The acronym ICE symbolizes the fear that immigrants feel about capture and deportation. A deportee in Exile Nation: The Plastic People (2014), a documentary that follows United States deportees in Tijuana, Mexico, stated that ICE was chosen as the acronym for the Immigration and Customs Enforcement agency because it “freezes the blood of the most vulnerable.”
Even after arrival at the interior of the United States, undocumented immigrants feel stress and anxiety relating to the fear of deportation by ICE (Chavez et al., 2012). This impacts their daily life activities. Undocumented parents sometimes fear interacting with school, health care systems, and police, for fear of revealing their own undocumented status (Chavez et al., 2012; Menjivar, 2012). They may also avoid driving, as they are not eligible for a driver’s license.
Since 2014, the Department of Homeland Security has placed a new emphasis on deporting undocumented immigrants. Department efforts generally prioritize apprehending convicted criminals and threats to public safety, but recent operations have taken a broader approach. In the opening weeks of 2016, ICE coordinated a nationwide operation to apprehend and deport undocumented adults who entered the country with their children, taking 121 people into custody in a single weekend. The majority of these individuals were families who applied for asylum, but whose cases were denied. Similar enforcement operations are planned (DHS press office, 2016). In many cases, the parents’ largest concern is that immigration enforcement will break up the family. Over 5,000 children have been turned over to the foster care system when parents were deported or detained. This can occur in three ways:
• when parents are taken into custody by ICE, the child welfare system can reassign custody rights for the child,
• when a parent is accused of child abuse or neglect and there are simultaneous custody and deportation proceedings, and
• when a parent who already has a case open in a child welfare system is detained or deported (Enriquez, 2015; Rogerson, 2012).
“One of my greatest fears right now is for anybody to take me away from my baby, and that I cannot provide for my baby. Growing up as a child without a father [as I did], it’s very painful… I felt like there was no male to protect them.” – Mexican Immigrant describing how his fear of deportation grew after his baby daughter was born (Enriquez, 2015, p. 944)
Although the perilous trip and threat of deportation are significant challenges for undocumented immigrant families, there are two recent policy changes that offer new opportunities and protections for undocumented families. First, some states have sought to expand the educational supports available to undocumented immigrants. The State of Minnesota, for example, enacted the “Dream Act” into law (2013). This unique act, which is also known as the “Minnesota Prosperity Act,” makes undocumented students eligible for State financial aid (State of Minnesota, 2014; Chapter 99, Article 4, Section 1).
Protesting for immigration reform.
Peoplesworld – CC BY-NC 2.0.
Second, there are now greater protections for unaccompanied children. In some cases, children travel across the border alone, without their families. They may be travelling to join parents already in the United States, or their parents may send them ahead to try to obtain greater opportunities for them. As a result of human rights activism, unaccompanied and separated immigrant children are now placed in a child welfare framework by licensed facilities under the care of the Office of Refugee Replacement (Somers, 2011). They provide for education, health care, and psychological support until they can be released to family or a community (Somers, 2011). Each year, 8,000 unaccompanied immigrant children receive care from the ORR (Somers, 2011).
Mixed Status Families
Some members of the family may have documentation, while the others do not. There may be cases where a United States citizen has applied for a visa for his family members, but they live without documentation while they wait for their priority date. Alternatively, there may be children who are born in the United States to undocumented parents. These children are entitled to benefits that their undocumented parents are not, such as welfare benefits (Peterson Institute for International Economics, 2005).
Children are subject to “multigenerational punishment,” where they are disadvantaged because of their parents’ undocumented status (Enriquez, 2015). As in undocumented families, parents fear interacting with school, health care, or police (Chavez et al., 2012; Menjivar, 2012).These children have limited opportunities to travel domestically (due to risks of driving without a license) or internationally (due to lack of travel papers) (Enriquez, 2015). When parents’ employment opportunities are limited due to their lack of documentation, the children share in the economic instability (Enriquez, 2015).
“I’m still [supposed to be] perceived as this male provider… [but] we lost our place [after my job found out about my status], and now I’m [living] with my in-laws, and it’s hard to find a great-paying job… It makes you feel like [people are saying]. ‘How dare you do that to a little child.’ It’s hard because you do feel guilty, you feel that you’re punishing someone that shouldn’t be punished.” –Mexican immigrant (Enriquez, 2015, p. 949)
International Marriages
Spouses of United States service members in Italy take the oath of allegiance to become United States citizens.
felicito rustique, jr. – CC BY 2.0.
In our increasingly global world, more couples are meeting and courting across national borders. Many of these couples ultimately seek to live together in the same country. In some cases, an immigrant travels to the United States and obtains citizenship, but still hopes to marry someone from their home country and culture. Under current United States policy, there are visas available for fiancés to immigrate to the United States. However, these relationships are screened. There are strict requirements to prove that the marriage is “bonafide.” If a marriage is considered “fraudulent,” the immigrant spouse can be detained and the native spouse can be fined. There are also limits to how many fiancé visas can be filed within a certain time frame, so that the same person cannot repeatedly apply for a fiancé visa with different partners (USCIS, 2005).
Regulations are in place to protect the non-citizen fiancés. In some cases, the United States citizen has much greater power than the non-citizen fiancé, and may exploit their lack of knowledge of English, local customs, and culture. The United States Government is required to give non-citizen fiancés information about their rights and resources, in an effort to prevent or intervene in cases of intimate partner violence (USCIS, 2005). A citizen can use an international marriage broker (IMB) to connect with a partner from their home country or another desired country. The International Marriage Broker Regulation Act of 2005 (IMBRA) states that the government must conduct criminal background checks on prospective citizen clients, in order to protect the welfare of the fiancés who will enter the United States (USCIS, 2005). | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/01%3A_Immigration_and_Immigrant_Policy-_Barriers_and_Opportunities_for_Families/1.03%3A_Opportunities_and_Barriers_for_Immigrant_Fami.txt |
Future Directions
There are two shifts in immigration policy that are critical for the well-being of families. First, policy should shift to accelerate family reunification for those families whose visas have been accepted. Families are currently separated from their children for years, caught in a holding pattern of waiting. This leads to stress, grief, and difficulty building relationships during key developmental times in a child’s life. Accelerating processing applications and shorter wait times would facilitate greater family well-being.
Second, policy could provide greater protection for vulnerable children in undocumented or mixed-status families. In cases where a parent is deported, the child’s welfare should be carefully considered in whether to leave the child in the care of a local caregiver or provide the option to send the child to the home country with their parent.
1.05: Conclusion
Conclusion
Though there are substantial barriers to family reunification and well-being, there are also great opportunities. Never before has policy been so inclusive or aimed so intensely on family reunification. The case studies below outline different paths to immigration and family reunification. They demonstrate the opportunities and assistance which are available, as well as the challenges faced.
Case Study 1: Becoming a Citizen
Mr. and Mrs. Addisu, both in their early 70s, immigrated to the United States from Ethiopia nearly 15 years ago with sponsorship from their daughter and her United States-born husband. The couple was eager to learn English and embrace the different cultural values, which meant becoming citizens. They wanted to join the country that their child and grandchildren called home.
After filing the appropriate documentation, paying related fees, and waiting for several years, both Mr. and Mrs. Addisu were scheduled for their naturalization test. The Addisu’s daughter helped them study the material. They particularly hoped that their parents could obtain citizenship so that the Addisus could take a long trip home to see their friends in Ethiopia, which they had not been able to do since moving to the United States with strict residency requirements.
But it quickly became apparent that Mr. Addisu had trouble learning English, which was primarily age-related. With assistance from a local church, Mr. Addisu applied for an English Language Exemption. This enabled him to exempt from the English language requirement and take the civics test in Oromo with the assistance of an interpreter.
Case Study 2: Family Reunification
Matias, a United States citizen, filed a petition to request a green card for his daughter Victoria who still lived in Mexico. Victoria had a 15-year old son and a 14-year daughter, who were listed on the petition as “derivative beneficiaries”, eligible to receive a visa if their mother received one. Their petition was approved, and they waited for their priority date. Victoria and her son and daughter continued living in Mexico, they lived on a low income and in a violent neighborhood. They communicated regularly with Matias, and Victoria repeatedly expressed how excited she was to see her dad again, and to be able to provide a better life for her kids. She regularly checked on her application and the priority date, excited for its arrival.
The priority date arrived 7 years later. Victoria’s children were now 22 and 21, and so they were no longer eligible to be derivative beneficiaries on Victoria’s visa. When Victoria learned, she was distraught. She talked to every advocacy group she could find, but there were no options. There would have been services available to expedite their petition as the children approached adulthood, but she and Matias had been unaware.
Victoria talked with her children about the options; they could all remain together in Mexico, or she could travel to the United States and apply for them to join her. One of her children as now working, and the other was attending a technical school. They decided together that it would be best for Victoria to go on to the United States. Once she arrived and became a lawful permanent resident, she filed a petition for her kids to get a visa. It was approved. Once again, the family waited for their priority date. Now, Victoria was with her father, but separated from her kids. It was now her kids she was calling, saying, “I miss you, I am excited to see you, I hope we can be together soon, soon, soon.” After 8 years, the priority date arrived. Victoria’s children, now ages 29 and 30, joined their mother in the United States.
Discussion Questions
1. Think back on your own family history. If you had family immigrate to the United States, what policies were in place when they arrived?
2. What would motivate a family to immigrate without documentation? What might make them decide against it?
3. What challenges does a child face if their parents do not have documentation?
4. What are the arguments for making family reunification quicker and more accessible? What are the arguments against it?
5. What barriers did the families in the case studies have to reunification? What supports did they receive?
Helpful Links
Migration Policy Institute
• http://www.migrationpolicy.org/
• The Migration Policy Institute is “an independent, nonpartisan, nonprofit think tank in Washington, DC dedicated to analysis of the movement of people worldwide”. They have regular publications and press releases about trends in migration, both to the United States and internationally.
Statue of Liberty Oral History
• www.libertyellisfoundation.org/oral-history-library
• The Statue of Liberty – Ellis Island Foundation, Inc. keeps a database of oral histories of immigrants who came through Ellis Island during their migration to America between 1892 to 1954. | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/01%3A_Immigration_and_Immigrant_Policy-_Barriers_and_Opportunities_for_Families/1.04%3A_Future_Directions.txt |
Borjas, G. J., & Katz, L. F. (2007). The evolution of the Mexican-born workforce in the United States. National Bureau of Economic research: Mexican immigration to the United States. Retrieved from: http://www.nber.org/chapters/c0098.pdf
Brown, K. J. (2014). The long journey home: Cuellar de Osario v. Mayorkas and the importance of meaningful judicial review in protecting immigrant rights. Boston College Journal Of Law & Social Justice, 34(3), 1-13.
Chavez, J. M., Lopez, A., Englebrecht, C. M., & Viramontez Anguiano, R. P. (2012). Sufren Los Niños: Exploring the Impact of Unauthorized Immigration Status on Children’s Well-Being Sufren Los Niños: Exploring the Impact of Unauthorized Immigration Status on Children’s Well-Being. Family Court Review, 50(4), 638-649. doi:10.1111/j.1744-1617.2012.01482.x
Congressional Budget Office. (2007). The impact of unauthorized immigrants on the budgets of state and local governments. Retrieved from: https://www.cbo.gov/sites/default/files/110th-congress-2007-2008/reports/12-6-immigration.pdf
Cortes, (2008). The effect of low-skilled immigration on U.S. prices: Evidence from CPI data. Journal of Political Economy, 116(3), p. doi: 0022-3808/2008/11603-0004.
Department of Homeland Security Press Office. (2016). Statement by Secretary Jeh C. Johnson on Southwest Border Security[Press release]. Retrieved from: www.dhs.gov/news/2016/01/04/statement-secretary-jeh-c-johnson-southwest-border-securityDunton, E. S. (2012). Same sex, different rights: Amending U.S. immigration law to recognize same-sex partners of refugees and asylees. Family Court Review, 50(2), 357-371. doi:10.1111/j.1744-1617.2012.01441.x
Enriquez, L. E. (2015). Multigenerational punishment: Shared experiences of undocumented immigration status within mixed-status families. Journal of Marriage and Family, 77, 939-953. doi: 10.1111/jomf.12196
Fiscal Policy Institute. 2015. How immigrant small businesses help local economies grow. Retrieved from www.fiscalpolicy.org.
Fix, M. E. & Passel, J. S. (1994). Immigration and immigrants: Setting and record straight. Urban Institute. Retrieved from: http://www.urban.org/publications/305184.html#II
Garner, B.A. (Ed.). (2014). Black’s law dictionary. Eagan, MN: West Publishing.
Goss, S., Wade, A., Skirvin, J.P., Morris, M., Bye, D. M., & Huston, D. (2013) Effects of Unauthorized Immigration on the Actuarial Status of the Social Security Trust Funds. Acturial Note No. 151. Social Security Administration, Office of the Chief Actuary.
Immigration and Customs Enforcement (ICE). (2014). FY 2014 ICE Immigration Removals. Retrieved from: www.ice.gov/removal-statistics/
Kandel, W. A. (2014). U.S. family-based immigration policy. Congressional Research Service Report for Congress. Retrieved from: fas.org/sgp/crs/homesec/R43145.pdf
Lowell, B. L., Gelatt, J., & Batalova, J. (2006). Immigrants and labor force trends: The future, past, and present. Insight, 17. Retrieved from: http://www.migrationpolicy.org/research/immigrants-and-labor-force-trends-future-past-and-present
Mandeel, E. W. (2014). The Bracero program 1942-1964. American international Journal of Contemporary Research, 4(1), p. 171-184. Retrieved from: http://www.aijcrnet.com/journals/Vol_4_No_1_January_2014/17.pdf
Meissner, D., Meyers, D. W., Papademetriou, D. G., & Fix, M. (2006). Immigration and America’s Future: A new chapter. Migration Policy Institute. Retrieved from: http://www.migrationpolicy.org/research/immigration-and-americas-future-new-chapter
Menjívar, C. (2012). Transnational Parenting and Immigration Law: Central Americans in the United States. Journal of Ethnic & Migration Studies, 38(2), 301-322. doi:10.1080/1369183X.2011.646423
Nadadur, R. (2009). Illegal immigration: A positive economic contribution to the United States. Journal of Ethnic and Migration Studies, 35(6), doi: 10.1080/13691830902057775
National Council of Farmer Cooperatives. (2015). E-verify. Retrieved from: http://ncfc.org/build/issues/labor-and-infrastructure/e-verify/
Ottaviano, G. I. P., & Peri, G. (2012). Rethinking the effect of immigration on wages. Journal of the European Economic Association, 10, 152-197.
Ottaviano, G., & Peri, G. (2008). Immigration and National Wages: Clarifying the Theory and the Empirics. NBER Working Papers, 14188. National Bureau of Economic Research, Cambridge Ma.
Passel, J. S. & Cohn, D. (2011). Unauthorized immigrant population: National and state trends, 2010. Retrieved from: http://www.pewhispanic.org/2011/02/01/unauthorized-immigrant-population-brnational-and-state-trends-2010/
Peri, G. (2010). The impact of immigrants in recession and economic expansion. Migration Policy Institute. Retrieved from: http://www.migrationpolicy.org/research/impact-immigrants-recession-and-economic-expansion
Peterson Institute for International Economics. (2005). US immigration policy and recent immigration trends. Retrieved from: www.iie.com/publications/chapters_preview/4000/02iie4000.pdf
Rogerson, S. (2012). Unintended and Unavoidable: The Failure to Protect Rule and Its Consequences for Undocumented Parents and Their Children. Family Court Review, 50(4), 580-593. doi:10.1111/j.1744-1617.2012.01477.x
Shierholz, H. (2010). Immigration and Wages: Methodological Advancements Confirm Modest Gains for Native Workers. Economic Policy Institute Briefing Paper #255.
Solheim, C.A., Rojas-Garcia, G., Olson, P.D., & Zuiker, V.S. (March/April, 2012). Family Influences on Goals, Remittance Use, and Settlement of Mexican Immigrant Agricultural Workers in Minnesota. Journal of Comparative Family Studies, 43(2).
Somers, A. (2011). Voice, agency and vulnerability: The immigration of children through systems of protection and enforcement. International Migration, 49(5), 3-14.
United States Border Patrol (USBP). (2014). Nationwide illegal alien apprehensions fiscal years 1925-2014. Retrieved from: www.cbp.gov/sites/default/files/documents/BP%20Total%20Apps%20
FY1925-FY2014_0.pdf.
US Citizenship and Immigration Services. (2005). Information on the legal rights available to immigrant victims of domestic violence in the United States and facts about immigrating on a marriage-based visa. Retrieved from: http://www.uscis.gov/sites/default/files/USCIS/Humanitarian/Battered
%20Spouse%2C%20Children%20%26%20Parents/IMBRA%20Pamphlet%
20Final%2001-07-2011%20for%20Web%20Posting.pdf
US Citizenship and Immigration Services. (2010). Welcome to the United States: A Guide for New Immigrants. Retrieved from: http://www.uscis.gov/sites/default/files/files/nativedocuments/M-618.pdf
US Citizenship and Immigration Services. (2012). A guide to Naturalization. Retrieved from: http://www.uscis.gov/sites/default/files/files/article/M-476.pdf
US English Foundation, Inc. (2014). American immigration – An overview. Retrieved from: usefoundation.org/userdata/file/Research/Chapter2.PDF
U.S. Visas. (n.d.). The Immigrant Visa Process. Retrieved from: travel.state.gov/content/visas/english/immigrate/immigrant-process/petition.html
Weissbrodt, D., & Danielson, L. (2004). The source and scope of the federal power to regulate immigration and naturalization. University of Minnesota Human Rights Library. Retrieved from: http://www1.umn.edu/humanrts/immigrationlaw/chapter2.html
Weissbrodt, D. & Danielson, L. (2011). Immigration law and procedure in a nut shell (6th ed.). Eagan, MN: West Publishing Company.
White House. (2014). Presidential memorandum: Creating welcoming communities and fully integrating immigrants and refugees. Retrieved from: https://www.whitehouse.gov/the-press-office/2014/11/21/presidential-memorandum-creating-welcoming-communities-and-fully-integra
Zallman, L., Woolhandler, S., Himmelstein, D., Bor, D., & McCormick, D. (2013). Immigrants contributed an estimated \$115.2 billion more to the medicare trust fund than they took out in 2002-2009. Health Affairs, 32(6), 1153-1160. Doi: 10.1377/hlthaff.2012.1223 | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/01%3A_Immigration_and_Immigrant_Policy-_Barriers_and_Opportunities_for_Families/1.06%3A_References.txt |
Appendix 1
History of Documented Immigration Policy: the Qualitative Restrictions Phase (1850s to 1920s)
In the mid-1800s, the United States began a phase of qualitative restrictions. There was a labor shortage during the 1840s, and many Chinese men and families had immigrated to fill this gap. During the recession that followed, stigma against the Chinese grew. Western states complained that wages were lowering due to Chinese immigration. Immigration policy during this time aimed to exclude “undesirable” immigrants based on country of origin (notably China), skills, and criminal background.
• 1868 14th Amendment: This amendment granted citizenship rights to all people born in the United States. Not all immigrants were considered equally eligible, however; aliens of African descent were eligible for naturalization, while Asians were not (US English Foundation, 2014).
• The Act of 1882: This act is considered the first federal immigration act, which barred (1) convicts; (2) prostitutes; (3) lunatics; (4) idiots; and (5) those likely to become public charges (dependent for support) from immigrating.
• 1882 Chinese Exclusion Act: Immigration of all Chinese laborers was banned. Current Chinese immigrants were denied naturalization, and undocumented immigrants could now be deported (Fix & Passel, 1994). The ban was not repealed until 1943 (US English Foundation, 2014).
• 1881: This Act added the (1) diseased; (2) paupers,” and “polygamists” to the list of people excluded from immigrating to the United States.
• 1903: And this act added (1) epileptics; (2) insane; (3) beggars; and (4) anarchists.
• 1906 Naturalization Act: Naturalization required the ability to speak and understand English (US English Foundation, 2014). This was implemented in an effort to discourage “inferior” immigrants from applying (Weissbrodt & Danielson, 2011).
• 1917 Immigration Act or Asiatic Barred Zone Act: Congress barred immigrants from most of Asia (US English Foundation, 2014). They also added a literacy test for naturalization and banned immigrants with “perceived mental inferiority”, which included homosexuality (Dunton, 2012).
Appendix 2
History of Documented Immigration Policy: the Quantitative Restrictions Phase (1920s to 1950s)
In the early 1900s, the United States began a phase of quantitative immigration restrictions. The United States was again in a recession, and citizens feared that immigrants could reduce employment opportunities. Immigration policy now instituted quotas to restrict immigration.
• 1921 Quota law: Each national origin was given a quota limit. For example, immigrants from each European country could not exceed 3% of the national census of people from that country currently living in the United States. Quotas favored western and northern Europeans, and most Asian countries continued to be excluded (US English Foundation, 2014).
• 1924 Immigration and Naturalization Act, also known as Johnson-Reed Act: This restricted the annual quota to 2% for each country, substantially reducing total immigration. The system favored Southern and Eastern European immigrants, and immigrants from most Asian countries were prohibited (US English Foundation, 2014).
• 1952 McCarran-Walter Act: This act, and the amendments below, remains the basic body of immigration law. It opened immigration for many countries, establishing quotas for all countries (US English Foundation, 2014). It also established a quota for immigrants whose skills were needed in the labor force (Fix & Passel, 1994). The act also implemented a four admission preferences: (1) unmarried adult sons and daughters of United States citizens; (2) spouses and unmarried sons and daughters of United States citizens; (3) professionals, scientists, and artists of exceptional ability; and (4) married adult sons and daughters of United States citizens.
Appendix 3
History of Documented Immigration Policy: the Inclusive Phase (1950s to Present)
President Kennedy denounced the national origins quota system (“Immigrant policy should be generous; it should be fair; it should be flexible. With such a policy we can turn the world, and our own past, with clean hands and a clear conscience.”). The civil rights movement gave further additional power to a more inclusionary policy system. Immigration policy began to eliminate racial, national, and ethnic biases (Fix & Passel, 1994).
• 1965 Hart-Celler Immigration Act or Immigration and Nationality Act and 1978 Amendments. In this act, the national ethnicity quotas were repealed. Instead, a cap was set for each hemisphere. Priority was given to family reunification and employment skills. This shifted away from a priority on European Immigration (Fix & Passel, 2004), and led to a substantial increase in documented immigration (Peterson Institute for International Economics, 2005). This act also expanded the original four admission preferences to seven, adding: (5) siblings of United States citizens; (6) workers, skilled and unskilled, in occupations for which labor was in short supply in the United States; and (7) refugees from Communist-dominated countries or those affected by natural disasters.
• 1990 Immigration Act: This act increased the ceiling for employment-based immigration and eased the limits on family-based immigration (US English Foundation, 2014). It was created as a compromise between exclusionary and inclusionary policies (see undocumented immigration section below), but ultimately led to a 40% increase in total admissions (Fix & Passel, 1994). It also created a Diversity Immigrant Visa Program, known as the “Green Card Lottery,” increasing the focus on diversity in admissions. Each year, the Attorney General issues visas through this program to regions that sent few immigrants to the United States.
• 2000 Legal Immigration Family Equity (LIFE) Act: This act temporarily revived a section of the Immigration Act, allowing qualified immigrants to obtain permanent residency, even if they entered without documents.
• 2001 Patriot Act: This act allowed for the indefinite detention of immigrants
• Deferred Action for Childhood Arrivals: The Dream Act, proposed in the Senate in 2001, would allow for conditional permanent residency to immigrants who arrived in the US as minors and have long-standing US residency. While this bill has not been signed into law, the Obama administration has created renewable two-year work permits for those who meet these standards.
Appendix 4
History of Undocumented Immigration Policy
Before the mid-1900s, there were few policies that regulated the identification and deportation of undocumented immigrants. The Immigration Act of 1891 introduced undocumented immigration policy by establishing the Bureau of immigration, responsible for deportation of undocumented immigrants. In 1940, the Alien Registration Act allowed for all previously undocumented immigrants to obtain legal recognition. All residents who were not US citizens were required to register with the government. They were given a receipt card (AR-3) as proof of compliance. After World War II, this became part of the immigration procedure. Immigrants were now given a visitors form, temporary foreign laborer card, or a permanent resident card (“green card”; US English Foundation, 2014).
Policies became much more stringent beginning in the mid-1900s. Immigration rates dropped during the Great Depression resulting in a labor shortage. The government established the Bracero program in 1942 to actively recruit temporary agricultural laborers from Mexico. Over 4 million Mexican laborers were recruited over the next twenty years (Mandeel, 2014). Through this program, Mexican immigrants began to establish homes and social networks in the United States, and in turn, helped friends and family to come to the United States both legally and illegally.
There was controversy over the Bracero program. As a result, the INS implemented “Operation Wetback” that targeted and deported Mexican immigrants between 1954 and 1964. When the Bracero program ended in 1964, there was an influx in undocumented immigration (Mandeel, 2014; Nadadur, 2009). Legislation after this point has aimed to reduce undocumented immigration.
• 1986 Immigration Reform and Control Act: This act was implemented in response to criticism of the United States being unable to control the flow of undocumented immigrants. The act made it illegal to hire undocumented workers, and created sanctions. It required that states verify immigration status of applicants for welfare (Fix & Passel, 1994). It expanded border enforcement (Peterson Institute for International Economics, 2005; Fix & Passel, 1994). These provisions were meant to reduce enticements to immigrate without documentation, and to enforce immigration policy. However, it also granted amnesty to all people living without documents prior to 1982, and to their immediate families in other countries (US English Foundation, 2014). This led to the legalization of more than one percent of the United States population (Fix & Passel, 1994). In order to reduce financial burdens of this declaration of amnesty, the act also provided funds for states to provide health care, public assistance, and English education (Meissner, Meyers, Papademetriou & Fix, 2006), but barred most previously undocumented immigrants from receiving federal public welfare assistance for five years (Weissbrodt & Danielson, 2011).
• 1996 Undocumented Immigration Reform and Immigrant Responsibility Act: This act aimed to reduce undocumented immigration. It reduced benefits for legal immigrants, such as food stamps and welfare. It increased border control and expedited deportation of undocumented immigrants and increased required documentation for employment (US English Foundation, 2014).
• 1996 Anti-Terrorism and Effective Death Penalty Act: This act expedited the removal of foreigners convicted of felonies, or who do not have proper documentation. The felony bar remains today and is an important determinant of immigrants being deported, even if they arrived in the United States legally.
• 2000 Life Act and Section 245(i): This allowed undocumented immigrants present in the United States to adjust their status to permanent resident, if they had family or employers to sponsor them (US English Foundation, 2014).
• 2001 Patriot Act: The sociopolitical climate post-September 11, 2001 drastically changed immigrant policies in the United States. The Department of Homeland Security (DHS) was formed in 2002 and absorbed Immigration and Naturalization Services (INS). This act created two other agencies: Immigration and Customs Enforcement (ICE) and Citizenship and Immigration Services (CIS). This act also enhanced immigration enforcement, and barred immigrants with potential terrorist links (US English Foundation, 2014).
• 2005: The House of Representatives passed a bill that increased enforcement at the borders, focusing on national security rather than family or economic influences (Meissner, Meyers, Papademetriou & Fix, 2006).
• 2005 REAL ID Act: This act required that before states issue a driver’s license or identification care, they must verify the applicant’s legal status.
• 2006: The Senate passed a bill that expanded legal immigration, in order to decrease undocumented immigration (Meissner, Meyers, Papademetriou & Fix, 2006). | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/01%3A_Immigration_and_Immigrant_Policy-_Barriers_and_Opportunities_for_Families/1.07%3A_Appendices.txt |
Fleeing Persecution and Separation from Family
During those times everyone was afraid, and we taught the children very young to be afraid, so at the age of one or two, they already learned to be afraid and did not cry either.
-Mai Vang Thao, Hmong refugee
All refugees have experiences of loss and/or exposure to traumatic events, either personally or within their communities. Such experiences might include systematic discrimination and intimidation, civil war, ongoing military conflicts, forceful government expulsion from the country, ethnic cleansing, and even genocide. Families living in these contexts often experience violence, or they hear about it in their communities and have reason to fear it. Families’ top priority is to find safety. However, even after they relocate, some families will experience the long-term effects from the traumatic stress they have experienced.
Kosovar refugees fleeing their homeland. [Blace area, The former Yugoslav Republic of Macedonia]
United Nations Photo – Kosovo refugees – CC BY-NC-ND 2.0.
“[The children’s father] was hardly with us. He went off with the men and left us hiding in the jungles. In fact he had prepared that in the event that we could no longer stay, he would leave to Thailand, and the children and I, if captured by the communists, would stay behind since the communist soldiers would not kill us because we are only women and children.”
-Mai Vang Thao, Hmong refugee
The conflicts and situations that cause people to flee their home countries often separate families. Families can become separated in the midst of a conflict or during the process of fleeing or migrating (families can also be separated during the resettlement process, see below). Even if parents and children are kept together through this arduous process, resettlement of an entire family unit (in many cultures, the family unit includes grandparents, aunts and uncles and their families) would rarely occur.
Separation from family members can be a source of guilt, loss, and added pressure. These losses of family ties and community support can often be characterized as ambiguous (Boss, 2006). When a family member dies, the loss is concrete, and the family can mourn. When family members are separated, there can be great ambiguity. Separated loved ones are physically absent but very present in the minds of their family members. Families have difficulty determining who is in the family, and what roles they play. This ambiguity can add to the stress of an already stressful migration. For example, youth separated from their parents during civil war wondered if their families had survived the fighting or had died. They described feelings of loneliness and intense depression. One child described, “The kids were most thinking – Are they alive or are they not alive?” (Luster, Qin, Bates, Johnson, & Rana, 2008, p. 449).
Wondering whether certain family members are alive or dead can cause individuals and families to become stuck with mixed feelings of hope, loss, guilt, and grief. These ambiguous losses compound the concrete losses of homes and family members. The impact of loss and traumatic events can be seen at both the individual and family level. In fact, one study found that the statistical relationships between traumatic events, grief, depression, and PTSD are stronger at the family level than they are at the individual level (Nickerson et al., 2011). Separated individuals must find ways to accept and live with the ambiguity. As one child said of his separation from his parents, “It happened. I did not have any control over it. I just think I wish it did not happen. But it did and I could not do anything about it” (Luster et al., 2008, p. 449).
When refugees are able to remain with close family members, it can ease the strains of relocation and coping with the traumas experienced in the home country. In a study of refugees in Norway, Lie, Lavik, and Laake (2001) found that the presence of close family in Norway had a positive impact on mental health symptoms, especially for those with higher exposure to traumatic events. McMichael, Gifford, and Correa-Velez (2011) similarly found that family connection is particularly important for youth early in the resettlement process.
2.02: Travel to Temporary Refuge
Travel to Temporary Refuge
“When it became so unsafe we could not stay anymore. Some of the men who had returned [from Thailand] were my uncles, and they said that if we wanted to go with them to Thailand they would help us out, so that is why we decided to leave for Thailand… I still remember lots of things about living in camp, such as the sicknesses, not enough water to drink, the very hot weather, and not enough food…Everything about it was bad. We were living on the Thai people’s land, so they treated us any way they wanted. When the Hmong went to the flea market, they were beaten.”
-Mai Vang Thao, Hmong refugee
In order to be a refugee, families must have traveled to a new country in order to escape persecution. Families generally cross the border into another country where they have heard that some aid is available. Charity or government organizations will set up refugee camps, which provide some shelter, medical care, and food.
Refugee camps are set up in response to a sudden and great need. Consequently, there are rarely enough resources for all of the families. Women are particularly at risk after a disaster. They may struggle to compete with men for resources (Viswanath et al., 2013). Post-disaster resources tend to have little sensitivity to needs of women, such as sanitary towels, diapers, or privacy or protection near restroom facilities (Viswanath et al., 2013; Fisher, 2010). Women experience increased sexual violence and domestic abuse following a disaster (Luft, 2008; Neumayer & Plumper, 2007; Anastario, Larrance, & Lawry, 2008; Viswanath et al., 2013).
Families can sometimes be separated during this stage of relocation. For example, children are sometimes sent ahead to another camp that is thought to be safer, leading to separation from their parents (Luster, Qin, Bates, Johnson, & Rana, 2008). This can lead to both vulnerability and feelings of loss.
Figure 1. Camp for Pakistani Refugees.
Al Jazeera English – Refugee camp – CC BY-SA 2.0. | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/02%3A_From_There_to_Here-_The_Journey_of_Refugee_Families_to_the_United_States/2.01%3A_Fleeing_Persecution_and_Separation_from_Family.txt |
Family Admittance to the United States
Once refugees have entered a new country, they can begin the road to refugee or asylee status in the United States. This process can be arduous and often takes over a year. The first step is a Refugee Status Determination, or RSD. An authorized official from the United Nations High Commissioner for Refugees will determine if an individual is considered a refugee under international, regional, or national law. The official will then determine if the person should return to their home country, resettle in the neighboring country, or resettle in a third country (such as the United States). Less than 1% of refugees worldwide are ever resettled in a third country (UNHCR, 2015).
How do you define “refugee”?
UNHCR: The UNHCR held a Council in 1951 on the Status of Refugees, and they created a definition of refugee. Their definition is summarized in this chapter, but the full text is included on page 14 of the Council notes: http://www.unhcr.org/3b66c2aa10.html.
United States: The full definition of refugee adopted by the U.S. government comes from the UNHCR definition. You can see the U.S. definition in Section 101(a)(42) of the U.S. Immigration and Nationality Act.
United States Policies about Refugee Admittance
The UNHCR or an authorized NGO can refer a refugee for admission to the United States. Each year, the United States prioritizes particular groups to be eligible for refugee status. The current priorities are:
• Priority 1: Cases that are identified and referred to the program by the United Nations High Commissioner for Refugees (UNHCR), a United States Embassy, or a designated non-governmental organization (NGO).
• Priority 2: Groups of special humanitarian concern identified by the U.S. refugee program.
• Priority 3: Family reunification cases (spouses, unmarried children under 21, and parents of persons lawfully admitted to the United States as refugees or asylees or permanent residents (green card holders) or United States citizens who previously had refugee or asylum status; PRM, 2014).
The United States President sets a refugee ceiling each year that identifies the number of refugees who can be granted refuge in the country (see the appendix for a brief history of United States Refugee policy). Limits for refugees allowed from particular world regions are also set. Asylees are not included in this number. These limits can be influenced by national security threats and political will. As an example, the number of admitted refugees across all refugee groups dropped from 68,925 to 26,788 following the terrorist attacks on September 11th, 2001 (Refugee Council, 2012). In recent years, the ceiling has been set at 70,000-80,000. In 2012 the refugee ceiling was set at 76,000 and a total 58,179 refugees came to the United States (Burt & Batalova, 2014). For the most up-to-date numbers of United States-admitted refugees and their countries of origin, see www.state.gov/j/prm/releases/statistics/
People who receive a referral for refugee status (not asylum seekers) work with a Resettlement Support Center to prepare their application. They then are interviewed by an officer from the United States Citizen and Immigration Services. Applying is free and applications can include a spouse, unmarried children, and occasionally other family members. All individuals approved as refugees are medically screened for infectious diseases, which could prevent entry to the United States. For a case example of this process, please see Ester’s Story.
In contrast, asylum seekers apply for asylum at a port of entry to the United States or apply within one year of arriving in the United States. There are two methods of seeking asylum: affirmative and defensive. In the affirmative asylum process, individuals file an application for asylum to the United States Citizenship and Immigration Services (USCIS). These individuals are free to live in the United States while their case is processed. In this past, a decision was required to be made within 180 days. However, due to expanding case loads, USCIS is currently unable to predict how long the process will take (USCIS, 2015). During the application processing time or the first 180 days after filing the application (whichever is shorter), these individuals are not authorized to work. In the defensive asylum process, an immigrant who is in the process of being removed from the United States may request asylum as a form of relief. This process can happen when an immigrant 1) was apprehended in or entering the United States without documentation or 2) was denied asylum after applying to USCIS asylum officers. If an immigrant requests asylum as a defense against removal from the United States, they conduct removal proceedings in the immigrant court with the Excutive Office for Immigration Review. An Immigration Judge hears these cases and makes a final decision about eligibility for asylum (United States Immigration, 2011).
Many defensive asylum seekers are held in jails or detainment centers until they are paroled or a decision is made about asylum. They typically wear prison uniforms and are separated from opposite gendered family. This practice has been discouraged by the UNHCR and criticized by Human Rights First (Human Rights First, 2012). After an asylee declares a desire for asylum, he or she is interviewed to determine the credibility of the danger threat in their home country. If officials determine that there is a credible threat, there is still a process that must be followed before they are granted asylee status. | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/02%3A_From_There_to_Here-_The_Journey_of_Refugee_Families_to_the_United_States/2.03%3A_Family_Admittance_to_the_United_States.txt |
Entering the United States
“In my opinion this country is even harder to adjust to, harder to live in because… because there are lots of rules and laws that bind us here. It is much harder to do things in this country. I came at an old age already, and learning English does not come easy. Everything is much harder for me.”
-Mai Vang Thao, Hmong refugee
Formal Supports
When refugees have been accepted for admittance to the United States, they are provided with a cultural orientation that can include information and education on basic English phrases, how to shake hands, interviewing for a job, using a western toilet, or the experience of flying on a plane. The International Organization for Migration provides a loan to refugees to cover their airplane ticket expenses from the United States government; they must repay this loan once they are resettled in the country.
Once they arrive, the Office of Refugee Resettlement assigns a voluntary agency (VOLAG) to offer them help (see “Key Organizations in Refugee Admissions and Integration” for a full description of agencies involved in refugee resettlement and policy). These VOLAGs often meet the refugee at the airport and arrange for housing and basic furnishings. They teach the refugees how to purchase groceries and use transportation, and connect them with resources for employment and education. These services are only available for 30-90 days. Across organizations and across states, there is no consistent process for these relocation/integration services, and availability of and applications for resources may vary. In some states, refugees are also eligible for cash assistance or medical assistance beyond this 90 day period (Refugee Council USA, 2014).
Key Organizations in Refugee Admissions and Integration
The following organizations enforce refugee policy and/or help with refugee integration:
• Bureau of Population, Refugees, and Migration (PRM): PRM is a bureau under the U.S. Department of State, and it works internationally to develop human solutions to displacement. They provide funding to and work with international organizations such as the U.N. that operate refugee camps. The director of PRM also serves as the U.S. Coordinator for Refugee Affairs, and is responsible to the president to help develop policy relating to refugees, including admission ceilings and priorities.
• Office of Refugee Resettlement (ORR): ORR is an office within the Department of Health and Human Services. It works with state governments and provides funding for voluntary agencies to facilitate economic and social support to refugees.
• Resettlement Support Centers (RSC): These international organizations help prepare files and store data for those applying for refugee status.
• U.S. Citizenship and Immigration Services (USCIS) and Customs and Border Protections (CBP): USCIS evaluates applications for refugee status, and the CBP screens refugees when they arrive.
• Voluntary Agencies (VOLAGs). Voluntary agencies, such as Catholic Charities and Lutheran Immigrations and Refugee Services, have agreements with the State Department to provide reception and placement services for refugees. These agencies are funded through the State Department’s Bureau of Population, Refugees, and Migration. VOLAGs often contract with the ORR to provide resettlement-related services.
The VOLAG works with sponsoring relatives when applicable, and will sometimes find an individual, church, or other private group that can assist with sponsorship if there is no sponsoring relative (Refugee Council USA, 2014). Refugees are eligible for all welfare benefits offered to citizens, such as Temporary Assistance for Needy Families and Medicaid.
Congolese Family being met at the airport by their case worker.
World Relief Spokane – Welcome to Spokane – CC BY-NC-ND 2.0.
An Overwhelming Transition
Imagine waking up, and finding that everything in your life has changed. Your bed is a different size, shared with a different number of people, and in a different location. You wake up to a new sound, and it is a different temperature than you expect. You get up, and find that the only foods available are foreign to you. You try to go shopping, but you do not know how to navigate the transportation system. When you get there, the food all seem unfamiliar. You do not know how to pay for your food – the currency seems odd, and you also have a “money card” that you don’t understand how to use. You cannot talk to anyone well. You come home and someone has put a piece of paper on the door, which you cannot read and do not know how to have translated.
After relocation, families must navigate a new completely new culture. Everything is new. Often, a family faces changes in every aspect of life. Betancourt, Abdi, Ito, Lilienthal, Agalab, & Ellis (2014) documented major shifts in the experiences of Somali refugee families in Boston, including:
• These Somali families lost resources during the flight from their home country, and arrived to the United States in poverty regardless of their previous status.
• Parents lost employment status, as their previous employment credentials were not accepted in the United States.
• Children were exposed to drugs, violence, and gain activity in the neighborhoods in which they were located.
• Despite this strained economic standing, families felt responsible to send money back to extended family in Somalia.
• Parent-Child authority structures shifted. Children who were more fluent in English withheld information about their situations at school.
• Children faced discrimination based on their nationality. Families were separated from extended support (Betancourt et al., 2014).
These changes, combined with encountering a completely new culture, would shake any family’s coping skills. Unfortunately, the social supports available to refugees are difficult to access. Parents lack knowledge of how to navigate school systems and the health care system, and are further isolated from services by lack of transportation and financial resources (Isik-Ercan, 2012; Navuluri et al., 2014). Mental health services are frequently not culturally sensitive or geared towards refugees (Shannon et al., 2014; Weine, 2011).
After arriving in the United States, many states require or recommend that refugees receive a physical screening. In spite of the inherent exposure to potentially traumatic events, no states currently require mental health screenings. Some argue that screenings would be unethical without a referral infrastructure in place while others suggest that this is part of the process of addressing mental health concerns and working toward an infrastructure (for additional information about mental health among refugees, please see Chapter 5). After conducting focus groups with refugees about mental health needs, Shannon and her colleagues argue that existing infrastructures could be trained to be responsive to refugee needs. “Health care providers might require more training about how work collaboratively with new populations of refugees to assess the mental health effects of war” (2014, p. 13).
“Understanding and healing the symptoms of political oppression starts in the initial assessment with validating the ways that political trauma has rendered refugees ‘voiceless.’ Listening, documenting, and witnessing individual and community stories of exposure to human rights violations is credited as an essential component of restoring human dignity.”
-Shannon, Wieling, Simmelink, & Becher, 2014, p. 11.
Applying for Citizenship
Refugee status is granted for one year. After that time, refugees are required to apply to become a permanent resident alien, which provides them with the commonly known ‘green card’ (Refugee Council, 2014). Asylees are also eligible to apply for permanent resident alien status, although it is not required. A permanent resident alien is entitled to many of the same supports as citizens, including free public education, authorization to work in the United States, and travel documents to leave and return to the United States (Refugee Council USA, 2014). However, permanent resident aliens remain citizens of their home country, must maintain residence in the United States in order to maintain their status, must renew their status every 10 years, and cannot vote in federal elections (USCIS, 2015). After being a permanent resident for five years, refugees and asylees can apply for citizenship (PRM, 2013).
Family Reunification
Once resettled, refugees are able to apply to bring certain family members to join them in the United States if they were not able to come together. In order to bring additional family members to the United States, refugees must apply within two years of being granted refugee or asylee status. Refugees are able to apply to bring a spouse or children who are unmarried, under 21 years old, and conceived before leaving. Only anchor or “principal applicant” refugees are allowed to apply to bring family members. A principal applicant is generally the first refugee from a family to arrive in the United States. These principal applicants then apply to bring their immediate family members. However, the family members coming to join a principle refugee will not be able to apply to bring additional family members (Refugee Council USA, 2014). For example, a refugee could apply to bring his/her parents, his/her wife, and their children to the United States. After they arrive, the wife/husband is not eligible to apply to bring her/his parents. This means that some refugees will continue to feel separated and isolated from loved ones.
The process for family reunification is onerous. Refugees currently residing in their host country and their family members awaiting permission to join them must both work through cumbersome systems in their respective countries. The anchor or principal applicant in the United States must file an application with USCIS, and must provide proof of their relationship to the family members (through birth or marriage certificates, receipts of remittances sent home, photographs, etc.). The family members in the home country must then complete visa interviews, medical examination, security background checks, and DNA testing (in the case of children).
At any stage along this process, the official can deny the application if they suspect fraud. If an adjudicator suspects fraud in the anchor refugee’s application, they can request stronger evidence of the relationship. If they remain unconvinced that the refugee is telling the truth, they can deny the application. If officers suspect fraud during the visa interview process, they will decline the issue the visa. They may also decline visas for health reasons or for past criminal behavior. There are waivers available, but not all potential refugees are aware of the waivers. Denials require a written rebuttal, the processing of which can take many months. If the rebuttal is approved, the family members in the home country must complete the interviews again. Many lack the education or the resources to tackle these processes. Refugees may not even be aware that they are eligible for reunification, as there is no systematic way of informing them. Currently it is not clear how many family members eligible for reunification are able to complete the process and submit a full application (Haile, 2015).
There are supports available to help refugees through this process. The VOLAGs who assist with refugee resettlement generally have services available to assist in applications for family reunification. Local community organizations often also offer services to help prepare and complete applications. In Minnesota, for example, the Minnesota Council of Churches hosts weekly information sessions about family reunification eligibility and the application process.
Support from Afar
In cases where families cannot be or choose not to be reunited, refugees still find ways to provide support to one another. Refugees may support family and friends through remittances or may spend time and money trying to locate and bring family members to the United States. In other cases, some may forgo long terms gains, such as job training or college, to be able to immediately help others (Betancourt et al., 2014). While this may cause emotional distress for some, it can also be the source of motivation to make the most of their opportunities. Transnational family connections help refugees retain a sense of identity within their culture and family (Lim, 2009).
Resilience
Refugees are inherently survivors. They have experienced loss and traumatic events but have found ways to survive. For example, Somali refugee families in Boston used religious faith, healthy family communication, support networks, and peer talks to make new lives for themselves (Betancourt et al., 2014). Refugee youth take on new responsibilities after migration, including interpreting, providing financial support, and helping parents navigate services (Hynie, Guruge, & Shakya, 2012). The ways refugee individuals, families, and communities find and create support differ greatly. They draw on family and community resilience to find ways to continue to survive and, in many cases, thrive.
Refugee resilience is seen when they rebuild community networks in the cities to which they relocate. Others have formed organizations to protect and lobby for their communities, and others have been elected to public offices.
Keith Ellison – Congressman Ellison with Minnesota State Senator Mee Moua – CC BY 2.0.
Mee Moua: Senator Mee Moua is the first Hmong American woman to become a Minnesota State Senator. Moua came to the U.S. with her family in 1978 and has since worked her way up from the public housing projects of Appleton, Wisconsin to the State Capitol in St. Paul, Minnesota. Moua is also an accomplished attorney who lives with her mother, her husband, and their two children.
“The issue is not whether the Asian American politicians are ready, it’s really whether America is ready.”
For a complete interview about her path to the U.S., go to: www.pbs.org/searching/aap_mmoua.html. | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/02%3A_From_There_to_Here-_The_Journey_of_Refugee_Families_to_the_United_States/2.04%3A_Entering_the_United_States.txt |
Future Directions in Policy and Refugee Family Support
The United States is taking steps forward in its support of refugee families. For example, there previously has been no unified approach to relocating and supporting refugees. Procedures vary by state and by VOLAG. However, President Obama recently created the White House Task Force on New Americans specifically to create unified plans to “create welcoming communities and fully integrating immigrants and refugees” (White House, 2014).
However, there are more steps left to take. One international concern is the lack of protection for internally displaced persons. Those seeking a referral for refugee status complete the process from within the country to which they have fled. Internally displaced persons are not eligible for refugee status unless specifically identified by the President to be approved for refugee status. Additional steps may be necessary to protect those who face persecution but cannot, for whatever reason, flee to another country.
2.06: Conclusion
Conclusion
Refugee Stories: Policy in Practice
In this chapter, we have described the policies and processes that drive refugee resettlement. In order to have a complete picture, it is important to see how these policies and processes impact the real families who experience them. The case study highlighted throughout this chapter and the case study below provide examples of the opportunities and barriers they face during their transition.
Case Study
“Ester, a refugee from the Democratic Republic of the Congo, was forcibly separated from five of her children during civil conflict in the early 2000s. She spent years in a refugee camp and was eventually resettled to North Carolina without her children. Upon arrival in the United States, she petitioned the USCIS to bring her children here. USCIS required that Esther provide birth certificates to prove her relationship to her children, all minors, but these documents did not exist. Incurring months of extra delay, Esther contacted relatives in the Congo who procured retroactive documentation of the relationship. USCIS then approved the petition and transferred the file to the United States Embassy in Kinshasa, Congo’s capital. In order to continue processing, the children had to travel to Kinshasa for visa interviews. But the children lived on the other side of the country, hundreds of miles away, and the journey to Kinshasa was extremely dangerous. Esther had no choice, however, and raised money from her church to fly them to the capital in a small plane…. On the day of their interview, they were turned away from the embassy because they lacked the requisite paperwork, which was in the United States with Esther. Rescheduling the interview took months. During this time, the youngest child, Florence, went missing. She is presumed kidnapped or dead, and did not accompany her siblings to the United States to be reunited with their mother. When the remaining four children received a new interview…. Their visas were approved – nearly two years after Esther filed the petition.”
-“Esther’s Story” describes a true story presented in Haile, 2015.
Discussion Questions
1. Imagine you and your family were suddenly unsafe in the United States and feared for your life. What would you do? If you would leave the country, where would you go? How would you get there? How would you provide for your family in the meantime? How do you think you would be received there?
2. Why should a country receive refugee families?
3. What helps refugee families’ well-being during relocation?
4. Where did Ester run into problems with the resettlement process?
5. What examples of resilience to you see in Ester’s story? What is your reaction to the story’s ending?
6. How might this have been avoided during the process of family reunification?
7. Are there policy recommendations you can see?
Helpful Links
Stories of Recent Immigrants and Refugees
• http://education.mnhs.org/immigration/
• This website, created by the Minnesota Historical Society, is a database of oral histories of recent immigrants. They have stories from Asian Indian, Filipino, Hmong, Khmer, Latino, Somali and Tibetan refugees and immigrants.
UNHCR Website
• http://www.unhcr.org/
• This is the website of the UN Refugee Agency. It has up-to-date news on refugee crises, needs, and resources.
USCIS United States Refugee Admissions Program Consultation & Worldwide Processing Priorities | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/02%3A_From_There_to_Here-_The_Journey_of_Refugee_Families_to_the_United_States/2.05%3A_Future_Directions_in_Policy_and_Refugee_Family.txt |
Anastario, M. P., Larrance, R., & Lawry, L. (2008). Using mental health indicators to identify postdisaster gender-based violence among women displaced by Hurricane Katrina. Journal of Women’s Health, 17(9), 1437–1444.
Betancourt, T. S., Abdi, S., Ito, B. S., Lilienthal, G. M., & Agalab, N. (2014). We left one war and came to another: Resource loss, acculturative stress, and caregiver-child relationships in Somali refugee families. Cultural Diversity and Ethnic Minority Psychology, 21(1), 114-125. doi: 10.1037/a0037538
Bureau of Population, Refugees, and Migration (PRM). (2013). U.S. refugee admissions program FAQs. Retrieved from: www.state.gov/j/prm/releases/factsheets/2013/210135.htm
Bureau of Population, Refugees and Migration (PRM). (2014). Proposed refugee admissions for fiscal year 2015. Retrieved from: www.state.gov/j/prm/releases/docsforcongress/231817.htm
Boss, P. (2006). Loss, Trauma, and Resilience. New York: W.W. Norton.
Burt, L. & Batalova, J. (2014). Refugees and Asylees in the United States. Migration Policy Institute. Retrieved from: http://www.migrationpolicy.org/article/refugees-and-asylees-united-states
Fisher, S. (2010). Violence against women and natural disasters: Findings from post-tsunami Sri Lanka. Violence Against Women,16(8), 902-918. doi:10.1177/1077801210377649
Fix, M. E. & Passel, J. S. (1994). Immigration and immigrants: Setting and record straight. Urban Institute. Retrieved from: http://www.urban.org/publications/305184.html#II
Haile, A. (2015). The scandal of refugee family reunification. Boston College Law Review, 56(1). Retrieved from: http://lawdigitalcommons.bc.edu/bclr/vol56/iss1/7/
Haines, D. W. (2010). Safe Haven? A history of refugees in America. West Hartford, CT: Kumarian Press.
Human Rights First. (2012). How to repair the U.S. Asylum and Refugee Resettlement Systems. Retrieved from: www.humanrightsfirst.org/wp-content/uploads/pdf/asylum_blueprint.pdf
Hynie, M., Guruge, S., & Shakya, Y. B. (2012). Family Relationships of Afghan, Karen and Sudanese Refugee Youth. Canadian Ethnic Studies, 44(3), 11-28.
Isik-Ercan, Z. (2012). In Pursuit of a New Perspective in the Education of Children of the Refugees: Advocacy for the “Family”. Educational Sciences: Theory & Practice, 12, 3025-3038. doi:10.1111/1475-3588.00286
Lie, B., Lavik, N. J., & Laake, P. (2001). Traumatic events and psychological symptoms in a non-clinical refugee population in Norway. Journal of Refugee Studies, 14(3), 276-294. doi: 10.1093/jrs/14.3.276
Lim, S. (2009). Loss of connections is death: Transnational family ties among Sudanese refugee families resettling in the United States. Journal of Cross-Cultural Psychology, 40(6), 1028-1040. doi: 10.1177/0022022109346955
Luft, R. E. (2008). Looking for common ground: Relief work in post-Katrina New Orleans as an American parable of race and gender violence. Feminist Formations, 20(3), 5–31.
Luster, t. Qin, D. B., Bates, L., Johnson, D. J., Rana, M. (2008). The lost boys of Sudan: Ambiguous loss,search for family, and reestablishing relationships with family members. Family Relations, 57, 444-456.
McMichael, C., Gifford, S, M., & Correa-Velez, I. (2011). Negotiating family, navigating resettlement: Family connectedness among resettled youth with refugee backgrounds living in Melbourne, Australia. Journal of Youth Studies, 14(2), 179-195. doi: 10.1080/13676261.2010.506529
Minnesota Historical Society. (2001). Hmong Women’s Action Team Oral History Project: Interview with Mai V. Thao. Retrieved from: http://collections.mnhs.org/cms/largerimage.php?irn=10040206&catirn=10446858
Navuluri, N., Haring, A., Smithson-Riniker, K., Sosland, R., Vivanco, R., Berggren, R., & Rosenfeld, J. (2014). Assessing Barriers to Healthcare Access Among Refugees Living in San Antonio, Texas. Texas Public Health Journal, 66(3), 5-9.
Neumayer, E., & Plumper, T. (2007). The gendered nature of natural disasters: The impact of catastrophic events on the gender gap in life expectancy, 1981–2002. Annals of the Association of American Geographers, 97(3), 551–566.
Nickerson, A., Bryant, R., Brooks, R. T., Steel, Z., Silove, D., & Chen, J. (2011). The familial influence of loss and trauma on refugee mental health: A multilevel path analysis. Journal of Traumatic Stress, 24(1), 25-33. doi: 10.1002/jts.20608
Refugee Council USA. (2013). Refugee Admissions Figures. Retrieved from: www.rcusa.org/refugee-admissions-figures
Refugee Council USA. (2014). Post arrival assistance and benefits. Retrieved from: http://www.rcusa.org/?page=post-arrival-assistance-and-benefits
Shannon, P. J., Wieling, E., Simmelink, J., & Becher, E. (2014). Exploring the mental health effects of political trauma with newly arrived refugees. Qualitative Health Research, 1-15. Doi: 10.117/104973231454975
US English Foundation, Inc. (2014). American immigration – An overview. Retrieved from: usefoundation.org/userdata/file/Research/Chapter2.PDF
U. S. Citizenship and Immigration Services. (2015). Untitled. Retrieved from: www.uscis.gov/humanitarian/refugees-asylum/asylum/faq/how-long-does-process-take
United Nations Office of the High Commissioner on Refugees. (2014). Worldwide displacement hits all-time high as war and persecution increase. Retrieved from: http://www.unhcr.org/558193896.html
United States Immigration. (2011). The United States asylum program. Retrieved from: unitedstatesimmigration.info/asylum.html
Viswanath, B., Maroky, A. S., Math, S. B., John, J. P., Cherian, A. V., Girimaji, S. C., & … Chaturvedi, S. K. (2013). Gender differences in the psychological impact of tsunami. International Journal of Social Psychiatry, 59(2), 130-136. doi:10.1177/0020764011423469
Weine, S. M. (2011). Developing preventive mental health interventions for refugee families in resettlement. Family Process, 50(3), 410-430. doi:10.1111/j.1545-5300.2011.01366.x
White House. (2014). Presidential memorandum: Creating welcoming communities and fully integrating immigrants and refugees. Retrieved from: https://www.whitehouse.gov/the-press-office/2014/11/21/presidential-memorandum-creating-welcoming-communities-and-fully-integra
2.08: Appendix
Appendix: Refugee Policy: A Brief History
Until the mid-1900s, there was no separate policy for refugee admittance to the U.S. All immigrants admitted, including refugees, needed to fall within the established quotas. During World War II, the government began making shifts in order to provide haven for those in need (US English Foundation, 2014).
• 1948 Displaced Persons Act: This was the first U.S. policy for refugees. It allowed Europeans to enter the U.S., establishing a quota for the number of persons fleeing persecution after World War II who would be permitted to enter (US English Foundation, 2014).
• 1953 Refugee Relief Act: This act authorized admission of hundreds of thousands of refugees, escapees, or expellees from Europe and Communist-dominated countries, outside the limits of the established quota (US English Foundation, 2014).
• 1967 Protocol. In 1951, the Office of the United Nations High Commissioner for Refugees (UNHCR) held the Conventional Relating to the Status of Refugees, creating the definition of refugee in Textbox 1. It was amended later with the 1967 Protocol. The 1967 Protocol was ratified by the United States in 1968. This ratification began to move U.S. policy on refugees from individual legislative decisions about whether or not to provide refuge to a particular group, to developing a more comprehensive plan in line with the UNHCR (UNHCR, 2014).
• 1965 Hart-Celler Immigration Act and 1978 Immigration and Nationality Act Amendments. These acts repealed the exclusionary national ethnicity quotas. It introduced the current process of setting refugee admittance ceilings each year (Center for Immigration Studies, 1995).
• 1980 Refugee Act: This act defined refugee and asylee, attempting to follow the United Nations Criteria, and established a process for their admittance (Fix & Passel, 1994; US English Foundation, 2014). It also created the Office of Refugee Resettlement and established a process of resettlement, including providing economic, medical, and social support (Fix & Passel, 1994).
• 1990 Immigration Act: This act granted temporary protected status to refugees from war-torn countries (US English Foundation, 2014).
• 2001 Patriot Act: This act provided humanitarian assistance and special immigrant status for family members of those attacked in 9/11 (US English Foundation, 2014)
The American experience with refugees over the past seventy years has ranged from acceptance to rejection, from well-wrought program efforts to botched policy decisions, from humanitarian concerns to crass politics. The U.S. Department of State has been both the fabricator of paper walls to exclude refugees and the locus of intense efforts to move them quickly into the United States. Religious and secular voluntary agencies have been lauded for their efforts on behalf of refugees and chided for providing inconsistent services. Refugees themselves have been characterized as true American success stories and criticized as overly dependent on public welfare. The American people, in turn, have often been impressively generous in their welcome of refugees but at other times neglectful, disinterested, and sometimes hostile.
David Haines, in Safe Haven? A History of Refugees in America. | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/02%3A_From_There_to_Here-_The_Journey_of_Refugee_Families_to_the_United_States/2.07%3A_References.txt |
What are Human Rights?
António Guterres, the United Nations High Commissioner for Human Rights (UNHCR), wrote that the “…UNHCR has never had to address so much human misery in its 64-year history” (Project Syndicate, 2015). This maxim guides the importance of understanding and exploring the intricacies of human rights. The foundational definition of human rights, according to the UNHCR, encompasses “…inherent rights to all human beings, whatever the nationality, place of residence, sex, national or ethnic origin, color, religion, language, or any other status.” This definition is critical to understanding how and why the international community endeavors to define and protect these rights. A complete understanding of human rights includes moral values, ethical and philosophical norms such as autonomy, justice, beneficence and non-maleficence. All of these characteristics factor into the creation of a particular paradigm of rights for human beings that has been specifically and gradually shaped into international law since the United Nations was founded in 1945.
While human rights are based on moral values, it is important to recognize that values are fundamentally different from rights. The concept of values addresses what is important whereas human rights address social practices that seek to empower human beings. A right is not merely a benefit, since having a right also gives a person a significant legitimacy within the system of governmental authority. According to Donnelly (2003), “…a human rights conception of human dignity and political legitimacy rests on the fact that human beings have an essential, irreducible moral worth and dignity irrespective of the social groups to which they belong” (p. 27). This means that universal human rights, for the purpose of this discussion, are rights that have been codified (i.e., incorporated into a legal code) by the international community.
Early version of the Universal Declaration of Human Rights.
United Nations Photo by Greg Kinch – public domain.
While human rights are based on an ideal, they also provide a social means of ensuring that nation-states grant to all human beings the opportunity to lead a life of human dignity; a life worthy for a human being. The specifics of exactly what human rights should entail have been enshrined in documents such as the Universal Declaration of Human Rights (UDHR, 1993), which conceptualizes the idea of human rights as a “self-fulfilling moral prophecy” (Donnelly, 2003, p 15). The UDHR has led to several international treaties, such as the International Covenant on Civil and Political Rights and the International Covenant on Economic Social, and Cultural Rights. These statutes and treaties are created by societies coming together in order to codify global requirements for the kind of human behavior that will support the thriving of all. Thus the notion of human rights as a social practice is integral to the process of understanding the impact on immigrant and refugee families.
3.02: The Universal Declaration of Human Rights
The Universal Declaration of Human Rights
In response to the gross human rights violations following the Second World War, the UDHR was chartered by the United Nations in an attempt to prevent such atrocities from being committed again. The UDHR’s preamble states unequivocally “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world” (OHCHR; Office of the High Commissioner for Human Rights, 1948). Following the preamble are 30 Articles, which lay out in detail the specific rights to which all human beings should be entitled. According to the UNHCR, there are 389 different translations of this document.
Poster depicting the Universal Declaration of Human Rights, English Version.
United Nations Photo – public domain.
The UDHR encompasses both negative (i.e., the right to not be tortured, imprisoned without cause, or enslaved) as well as positive (i.e., the right to own property, the right to freedom of thought, and the right to marry) rights. It also enumerates, for the first time, the core principles of human rights, which are: universality, interdependence and indivisibility, equality and non-discrimination. The UDHR states further that human rights are not merely an entitlement, they also include rights and obligations. In other words, having a right brings with it a particular obligation as well. If we are to enjoy our rights as humans, then we need to respect these same rights for others. These concepts have been reiterated in many subsequent international human rights treaties, declarations, and conventions. This document (UDHR), along with the International Covenant on Civil and Political Rights (ICCPR) and the International Covenant on Economic, Social, and Cultural Rights (ICESCR), are considered to be the foundational pillars of international human rights law and the legal basis for all subsequent human right norms, standards, and rules. | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/03%3A_Human_Rights/3.01%3A_What_are_Human_Rights.txt |
The Status of Human Rights in the United States
While human rights have in large part been internationalized, they have to be implemented at the domestic level. According to Donnelly (2003), this dichotomy permits countries to fulfill dual and seemingly incompatible roles: essential protector and principle violator. In the United States, this duality can be seen in the difference between the laws upon which the country was founded and the implementation of these laws in an equitable fashion.
The Bill of Rights, as codified in the United States Constitution, lays out specific human rights that parallel those to which the majority of international human rights regimes adhere. Thus, the founding myths of this country are grounded in the central place of human rights (Donnelly, 2003). In fact, many if not most liberal democracies share these constitutive principles. As Koopmans (2012) points out, “internal constitutive principles – such as the right to exercise one’s religion…imply that the granting of rights to individuals and groups will be more similar across democracies than it will be between them and non-democracies” (p 25). And yet, there remain significant areas where United States domestic policy can be seen to violate various rights of various portions of the population at any given time.
Original Bill of Rights, United States.
Archives.org – public domain.
Political Issues
The most pressing human rights issues in the United States revolve around immigrant and refugee families. The strategic priorities outlined by the UNHCR include: (a) countering discrimination; (b) combating impunity and strengthening accountability; (c) pursing economic, social and cultural rights and combating poverty; (d) protecting human rights in the context of migration; (e) protecting human rights during armed conflict, violence and insecurity; and (f) strengthening international human rights mechanisms and the progressive development of international human rights law. Priorities (a), (c) and (d) make up the elements most germane to the human rights situation in the United States today. The difficulties faced by immigrant and refugee families include classism, racism, sexism, and discrimination on the basis of religion as well as uncertain economic circumstances.
Secretary-General of the United Nations, Ban Ki-moon, meets President of the United States, Barack Obama.
UN.org – public domain.
The United States voted in favor of the UDHR but it did not ratify (i.e., sign) the document. While various theories attempt to explain relevant reasons, numerous rights enshrined in the UDHR are in the Constitution and Bill of Rights (AHR; Advocates for Human Rights, n.d.) The United States’ apparent sense of exceptionalism to international standards and norms has been evidenced over time in two main ways: the ongoing torture of Guantanamo Bay detainees and the revelation that American social scientists were involved in reverse engineering torture techniques for the government. While the United States may at times act outside of the limitations established by the international community (and specifically the UDHR) this stance is not the focus of this chapter. As the UNCHR notes, “national and local politicians have sought to mobilize electoral support by promoting xenophobic sentiments, exaggerating the negative impact of hosting refugees while ignoring the fact that refugees can actually attract international assistance and investment to an area, creating new jobs and trading opportunities” (2006, p 32). In this way the refugee situation has often been used as a political football in United States political culture.
Legal Issues
The current legal climate in the United States is negatively skewed against international human rights, particularly as it pertains to the legal status of displaced persons (persons who are forced to leave their home country due to war, persecution or natural disasters). There are many reasons to be pessimistic about successfully using international human rights arguments as a way of advancing displaced person’s rights in the United States (Chilton, 2014; Cole, 2006; ICHR; International Council on Human Rights, 2008). According to Cole (2006), in spite of its history as a nation of immigrants, the United States remains deeply nationalist and quite parochial; the law reflects that parochialism. Furthermore, “International human rights arguments are often seen as the advocates’ last refuge pulled out only when there is no other authority to cite” (Cole, 2006, p. 628).
Poster entitled, “It is our right to seek and enjoy in other countries asylum from persecution.”
UN Photo – public domain.
However, this trend seems to be moving the national towards the transnational in terms of how human rights law is perceived and implemented in the legal system and culture of the United States. This means that increased globalization and interdependence has had the effect of strengthening the influence of international human rights standards in the United States. The hope is that these standards may “command greater respect from our own domestic institutions” (Cole, 2006, p 643). Cole further posits that the paradigm shift in the United States from national to transnational, merging the national and the international, parallels the shift in the United States from state to federal power that occurred with the advent of the New Deal in the 1930s. In other words, there is reason to hope that gradual change is coming within the legal system in the United States with regards to its acceptance of the international human rights regimes norms and standards.
Refugee families and asylum seekers. The terms of refugee and asylum seeker are often used interchangeably, but there are important legal differences between them. These differences not only determine which resources they are eligible for once arriving in the United States, but also in which phase of the legal process they are currently.
Refugees and displaced persons in South-East Asia; Cambodia, Vietnam, and Laos.
United Nations Photo – Coping with Disaster – CC BY-NC-ND 2.0.
Refugees. An estimated 51.2 million people were displaced since 2013 as a direct result of persecution, war, violence, and human rights atrocities (UNHCR, 2013). In 2013, the United States Department of Justice (DOJ, 2014) received 36,674 asylum applications but only approved 9,993. The remaining applications were abandoned (1,439), withdrawn (6,400), or simply unaccounted for (11,391). Being that the recent United States population estimate is 318 million people, refugees make up less than 1% of the population. The families seeking asylum from their home countries often have significant traumatic histories and thus can loom larger in the public sphere than other types of immigrants. Most of these families are fleeing extreme injustices in their home country, such as war, political instability, genocide and severe oppression. Because of the uncertainty of their original situation, it remains quite difficult for the Department of Homeland Security (DHS) to determine who is legitimately eligible for asylum.
Asylum seekers. A further complication for government agencies lies in trying to determine when and how to return rejected asylum seekers to their home countries (Koser 2007). Within the domain of international migration studies there has been traditionally a differentiation made between refugees (involuntary migration) and labor seekers (voluntary migration). While the former group represents the political outcome of global systems and interactions and the latter group represents the economic outcome, nonetheless, it is quite clear that people migrate for a whole complex series of reasons, including social ones (Koser, 2007). If an asylum-seeker’s claim for asylum is denied, they are placed in deportation proceedings. During this process, an immigration judge (IJ) works with the asylum-seekers’ attorney to determine the removal process. It is important to note that displaced persons are rarely detained and/or immediately placed on the next flight to their country of origin.
Women and Children’s Rights
The UNHCR has, within the last decade, specifically recognized gender as a fundamental human rights issue. The policy on refugee women is based on the recognition that becoming a refugee affects men and women differently: “… even where there is no armed conflict, women and children continue to be subject to serious human rights violations resulting from discrimination and/or violence against them due to their gender…” (Zeiss Stange, Oyster, & Sloan, 2012). Many of the human rights issues that involve women and children obviously impact families in a very deep way. This category of violation stems from historical perceptions of women and children as property or “chattel.”
International Women’s Day March for Gender Equality and Women’s Rights.
UN Photo – public domain.
Domestic violence. The issue of domestic violence, for example, is one that disproportionately affects women and children. In immigrant families from more patriarchal societies, the home is still considered the woman’s domain whereas earning is considered the man’s, even when both work for pay outside the home. This particular division of labor can increase the power imbalance in these relationships, which can create a setting within which domestic violence may be more likely to occur (Perilla, 1999). This imbalance can become particularly problematic when the power hierarchy between parents and children is inverted once they arrive to the United States. Since wage-earning immigrant women often gain autonomy and greater gender equity, while men tend to lose ground, this adds further threats to male self-esteem that is already being eroded by classism, racism and legal status (Mahler & Pessar, 2006).
Children’s issues. Children are disproportionately impacted in other ways as well. Children of displaced families, asylum-seekers in particular, are more likely to be without health insurance and have less access to public programs across nationalities (Blewett, Johnson, & Mach, 2010). This is due to their legal designation of being persons who are ineligible for public services (i.e., health insurance). The literature suggests that traumatic events impact each family member regardless of whether they were directly or indirectly exposed. This is important because traumatic stress, loss and grief extend beyond individual family members and influence the entire family (Nickerson, Bryant, Brooks, Silove, Steel, & Chen, 2011). Detention and deportation in particular pull families apart and make it much more difficult for parents and other caregivers to access necessary resources for their children. This is true for many immigrant families because there are many different legal statuses within families due to, for example, children being born to undocumented parents in the United States. Thus the tendency is for these families to be more careful and anxious about seeking out services that they might qualify for because of the fear of being reported to immigration authorities.
Female genital mutilation. Female genital mutilation (FGM), also known as female genital cutting, is a human rights issue of growing importance due to the increasing number of refugees arriving in the United States from East and West Africa. This practice, sometimes also known as female circumcision, is a long-standing cultural tradition in some communities. Although FGM is generally practiced in Muslim communities, there is no actual religious mandate for it (Cook, Dickens, & Fathalla, 2002). While the practice is deeply cultural, it is illegal in many African nations. However, regardless of legality, the practice is widespread. Fatima, for example, from the opening story, told the first author, “The president’s daughter has been circumcised – how will he enforce this law? Are they going to put him in jail? Hah!” (Personal communication, 2011).
Angélique Kidio and Concer Sponsors Brief on Efforts to End FGM.
UN Photo – public domain.
According to Mather and Feldman-Jacobs (2015), over 500,000 girls and women have undergone genital mutilation in the United States. FGM is regarded as a human rights issue for women because it can cause severe health sequelae. Even though the family of the child may consent to the procedure, this does not make it a legal practice as consenting to a physical mutilation can never be legal (Cook, et al., 2002) However, recommendations include more education and counseling of women as opposed to the firmer application of the law in cases like these. This practice remains illegal in the United States, which may have the effect of pushing those refugees wishing to practice this even further underground. In other words, shame and stigma often accompany FGM. And though it can be presented as a convincing claim for asylum in the United States, many women do not feel comfortable doing so and instead pursue other means (USCIS; United States Citizenship and Immigration Services, 2015).
In 2012, the United Nations issued an interagency resolution calling for the elimination of FGM worldwide. The resolution states unequivocally that “seen from a human rights perspective, the practice reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women” (WHO; World Health Organization, n.d.). The hope is that this ban will speed the process of eliminating this dangerous and painful practice worldwide.
Sex Trafficking and Human Trafficking
The United Nations Protocol to Prevent, Suppress, and Punish Trafficking in Persons, Especially Women and Children, defines trafficking as the “…recruitment, transfer, harboring or receipt of persons, by any means of threat or force…for the purpose of exploitation.” This crime is globally categorized as either sex trafficking or labor trafficking. According to the DOJ (2006), there have been an estimated 100,000 to 150,000 sex trafficking victims in the United States since 2001. Furthermore, estimates of persons currently in situations of forced labor or sexual servitude in the United States range from 40,000 to 50,000.
The leading countries of origin for foreign victims in fiscal year (FY) 2011 were Mexico, Philippines, Thailand, Guatemala, Honduras, and India (DOJ, 2012). In 2011, “notable prosecutions included those of sex and labor traffickers who used threats of deportation, violence, and sexual abuse to compel young, undocumented Central American women and girls into hostess jobs and forced prostitution in bars and nightclubs on Long Island, New York” (DOS, 2012). According to the International Labor Organization (ILO, 2016), globally an estimated 4.5 million women, men, and children are sexually exploited. While there is some legal benefit (a self-petitioned visa in the United States) in place for those who cooperate in prosecuting their traffickers; with this visa victims can receive four years of legal status. Unfortunately, far fewer receive immigration aid than are identified as victims of sex trafficking, (DOS, 2012).
Human trafficking is another area where issues of physical safety and sexual exploitation of immigrant and refugee women and children come to the forefront as a human rights issue. Contrary to popular thought, sex trafficking is an ongoing and insidious activity that also includes young boys, and the prevalence of human and sex trafficking in the United States disproportionately affects the more vulnerable, under-resourced populations such as immigrant and refugee families (DOS, 2012).
Mixed Status (Deportation) and Separation of Families
One of the most pressing human rights issues for displaced persons in the United States today is the mixed-status families (i.e., documented and undocumented). These are families whose members hold different levels of legal status in the country. Some members of the family may be documented persons (such as asylum-seeker, permanent resident or citizen) while others have undocumented status. Though the children born to undocumented migrants typically receive citizenship by birth, this does not change their parents’ legal status. The exception, however, is when undocumented parents return to their country of origin and wait until that child is 18 years of age; at that point the young adult child can sponsor them in becoming United States citizens. When families consist of members whose legal status is documented as well as undocumented, this uncertain distal context can set the stage for significant vulnerabilities within the family.
Brabeck and Xu (2010), who studied of the effects of detention and deportation on children of Latino/a immigrants, found that the legal vulnerability of Latino/a parents, as measured by immigration status and detention and deportation experience, predicted child well-being. In other words, the children suffer when they cannot be sure whether their parents will be able to stay and live with them in United States on a day-to-day basis. Kanstroom (2010) writes that although “international law recognizes the power of the state to deport noncitizens, international human rights law has also long recognized the importance of procedural regularity, family unity, and proportionality. When such norms are violated the State may well be obligated to provide a remedy” (p. 222). Once again the paradox of international human rights norms conflicting with the actual social and political practices of the United States; as of this writing the issue remains a political football in the United States.
Detention Without Trial
In 2011, United States Congress passed the National Defense Authorization Act (NDAA) that codified, for the first time since the McCarthy era, indefinite detention without charge or trial. Subjecting refugees to detention induces unnecessary psychological fear and harm. Furthermore, it does not uphold the fundamental human rights principles set out in the ICCPR preamble (Prasow, 2012). The notion that people, whether citizens, documented or undocumented immigrants, could be held by the government indefinitely without access to the protections enshrined in the United States Constitution is a clear violation of international human rights law and anathema to human rights and civil liberties groups. As of late 2012, members of Congress proposed to have it repealed or amended. As noted by Senator Dianne Feinstein of California, “Just think of it. If someone is of the wrong race and they are in a place where there is a terrorist attack, they could be picked up, they could be held without charge or trial for month after month, year after year. That is wrong” (Prasow, 2012). The amendment that Senator Feinstein proposed, however, would protect only citizens and lawful residents; undocumented immigrants would still be subject to this odious practice. | textbooks/socialsci/Social_Justice_Studies/Immigrant_and_Refugee_Families_(Ballard_Wieling_and_Solheim)/03%3A_Human_Rights/3.03%3A_The_Status_of_Human_in_the_United_States.txt |
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