Race and Culture
in Mental Health
Our cultural context (race, ethnic
group, gender, religion, language, social class and so forth)
influences how we understand health and mental fitness.
Our culture also determines what is considered normal and
The circumstances in society, such as access to work, shelter,
and health care, also influences our understanding of our
experience and how we function in our communities and in society.
Anthropological and cross-cultural studies show that
cultural beliefs about what mental illness is, affects its
course and treatment
Researchers agree that cultural bias operates in diagnoses
since many clinicians (irrespective of racial-cultural group
membership) are socialized and taught during professional
development to see people of Color as more disturbed then
Symptoms of disturbance may be experienced and expressed
differently by members of distinct cultural groups.
Health professionals have found in many studies that people
who are exposed to various types of life-events may find such
events as stressful or traumatic.
Definitions of Trauma
There are two ways to understand and identify extreme stress
One is to use DSM diagnostic criteria of post-traumatic stress
disorder (PTSD) or Acute Stress Reactions (ASR) or other diagnoses.
The other way to understand traumatic stress would be to
use broader criteria and to consider the person’s evaluation
of the event to determine whether it was traumatic.
DSM - Post-Traumatic Stress Disorder -
An event is life threatening and results in a reaction of
intense fear or helplessness or horror, and leads to impairment
of functioning (also needed are Criteria B, C, D, E and F).
The criterion uses an exposure or dose response model. Relying
on external factors and less on subjective evaluation.
Need for broader model of trauma
The criterion for PTSD focuses on the reactions to threatening
life events. Some life events may not be seen as life threatening
but may produce a traumatic stress reaction.
Because the DSM framework for understanding stress reactions
is based on the rather narrow criteria for diagnosis of PTSD
or Acute Stress Reactions.
Research on Traumatic Stress in summary:
Some people who are exposed to life events experience the
event as traumatic and have stress that leads to psychological
The general rates of developing PTSD after exposure to life
events are about 5-10%.
People of Color experienced higher rates of PTSD after exposure
to traumatic events (rates above 10% between 15% & 40%)
and their symptoms were more severe.
Veterans of Color have higher rates of PTSD and other psychological
symptom of distress not explained by the specific exposure
to war related trauma.
Some of the higher rates of symptoms by People of color are
explained by exposure to race-related stress in the form of
discrimination and racism
It is suggested that People of Color are confronted with hostility
neglect and racism that may heighten the effect of life event
Features of Traumatic Stress – Summary
Traumatic stress involves a reaction to an event that is
perceived as negative, sudden and uncontrollable. It may be
a form of on-going physical and/or psychological threat that
produces fear, anxiety, depression, helplessness and/or PTSD
The threat and stress associated with recent disasters is
a source of constant worry for people in communities of Color.
The concern may lower self-worth and increase feeling of being
Thus, institutional policies and procedures can communicate
danger as well as lack of attention to a group’s current
Traumatic stress is real and may be affecting people without
their awareness. Many people of Color are at high risk for
symptoms of traumatic stress given prior histories of trauma
in their community.
What is needed are procedures to help organizations deal
with traumatic stress, broader diagnostic criteria to assess
stress reactions, and treatment strategies that are racially-culturally
effective for reducing the symptoms of traumatic stress.
Treatment and Training
The training associated with responding to traumatic stress
in communities of Color must be grounded in the worldview
and cultural patterns of that community.
Crisis Response Operations.
In training people to respond to communities of Color after
a disaster the training must
consider and address how people in the respective communities
were treated prior to the
What is their receptiveness to the people and agencies involved
in the first response?
Has the community reported feelings of distrust and fear as
have many community members and organizations have indicated?
Action should be underway to reduce such feelings so as
to enhance disaster response to communities of Color.