Shattering Culture

"Culture counts" has long been a rallying cry among health advocates and policymakers concerned with racial disparities in health care. A generation ago, the women's health movement led to a host of changes that also benefited racial minorities, including more culturally aware medical staff, enhanced health education, and the mandated inclusion of women and minorities in federally funded research. Many health professionals would now agree that cultural competence is important in clinical settings, but in what ways? Shattering Culture provides an insightful view of medicine and psychiatry as they are practiced in today's culturally diverse clinical settings. The book offers a compelling account of the many ways culture shapes how doctors conduct their practices and how patients feel about the care they receive. Based on interviews with clinicians, health care staff, and patients, Shattering Culture shows the human face of health care in America. Building on over a decade of research led by Mary-Jo Good, the book delves into the cultural backgrounds of patients and their health care providers, as well as the institutional cultures of clinical settings, to illuminate how these many cultures interact and shape the quality of patient care. Sarah Willen explores the controversial practice of matching doctors and patients based on a shared race, ethnicity, or language and finds a spectrum of arguments challenging its usefulness, including patients who may fear being judged negatively by providers from the same culture. Seth Hannah introduces the concept of cultural environments of hyperdiversity describing complex cultural identities. Antonio Bullon and Mary-Jo Good demonstrate how regulations meant to standardize the caregiving process—such as the use of templates and check boxes instead of narrative notes—have steadily limited clinician flexibility, autonomy, and the time they can dedicate to caring for patients. Elizabeth Carpenter-Song looks at positive doctor-patient relationships in mental health care settings and finds that the most successful of these are based on mutual "recognition"—patients who can express their concerns and clinicians who validate them. In the book's final essay, Hannah, Good, and Park show how navigating the maze of insurance regulations, financial arrangements, and paperwork compromises the effectiveness of mental health professionals seeking to provide quality care to minority and poor patients. Rapidly increasing diversity on one hand and bureaucratic regulations on the other are two realities that have made providing culturally sensitive care even more challenging for doctors. Few opportunities exist to go inside the world of medical and mental health clinics and see how these realities are influencing patient care. Shattering Culture provides a rare look at the day-to-day experiences of psychiatrists and other clinicians and offers multiple perspectives on what culture means to doctors, staff, and patients and how it shapes the practice of medicine and psychiatry.

In this insightful and look at the practical challenges and possibilities for Christian life in the global age, Schweiker investigates Christianity’s current relevance and discusses how the life of faith can be oriented. Explores the big religious themes of modern life, including religious identity in global times, the role of conscience, integrity, and versions of religious humanism Written by an author who is internationally recognized as one of the world’s leading theologians Draws on the work of some prominent contemporary philosophers and theologians to clarify the nature of faith Unique in its appreciation of the ambiguity of religion – in its representations of the highest human achievements as well as the very worst of human actions – using a balanced and engaged approach to discusses contentious theological and intellectual issues

Through rich ethnographic narrative, Becoming Gods examines how a cohort of doctors-in-training in the Mexican city of Puebla learn to become doctors. Smith-Oka draws from compelling fieldwork, ethnography, and interviews with interns, residents, and doctors that tell the story of how medical trainees learn to wield new tools, language, and technology and how their white coat, stethoscope, and newfound technical, linguistic, and sensory skills lend them an authority that they cultivate with each practice, transforming their sense of self. Becoming Gods illustrates the messy, complex, and nuanced nature of medical training, where trainees not only have to acquire a monumental number of skills but do so against a backdrop of strict hospital hierarchy and a crumbling national medical system that deeply shape who they are.

An intimate account of rural New England families living on the edge of homelessness, as well as the practices and policies of care that fail them. Families on the Edge is an ethnographic portrait of families in rural and small-town New England who are often undercut by the very systems that are set up to help them. In this book, author and medical anthropologist Elizabeth Carpenter-Song draws on a decade of ethnographic research to chart the struggles of a cohort of families she met in a Vermont family shelter in 2009, as they contend with housing insecurity, mental illness, and substance use. Few other works have attempted to take such a long-term view of how vulnerability to homelessness unfolds over time or to engage so fully with existing scholarship in the fields of anthropology and health services. Research on homelessness in the United States has been overwhelmingly conducted in urban settings, so much less is known about its trajectory in rural areas and small towns. Carpenter-Song’s book identifies how specific aspects of rural New England—including scarce affordable housing stock, extremely limited transportation, and cultural expectations of self-reliance—come together to thwart opportunities for families despite their continual striving to “make it” in this environment. Carpenter-Song shines a light on the many high-stakes consequences that occur when systems of care fail and offers a way forward for clinicians, health researchers, and policymakers seeking practical solutions.

The radically humanistic essays in Arc of Interference refigure our sense of the real, the ethical, and the political in the face of mounting social and planetary upheavals. Creatively assembled around Arthur Kleinman’s medical anthropological arc and eschewing hegemonic modes of intervention, the essays advance the notion of a care-ful ethnographic praxis of interference. To interfere is to dislodge ideals of naturalness, blast enduring binaries (human/nonhuman, self/other, us/them), and redirect technocratic agendas while summoning relational knowledge and the will to create community. The book’s multiple ethnographic arcs of interference provide a vital conceptual toolkit for today’s world and a badly needed moral perch from which to peer toward just horizons. Contributors. Vincanne Adams, João Biehl, Davíd Carrasco, Lawrence Cohen, Jean Comaroff, Robert Desjarlais, Paul Farmer, Marcia Inhorn, Janis H. Jenkins, David S. Jones, Salmaan Keshavjee, Arthur Kleinman, Margaret Lock, Adriana Petryna

Explores experiences with disability and aging for immigrant survivors of domestic violence across the life course Across the United States, one in three women experiences violence in their intimate relationships. More resources are now being devoted to providing these women with immediate care; but what happens to survivors, especially those from marginalized communities, as they grow older and grapple with the long-term effects? In Violence Never Heals, Allison Bloom presents a life-course perspective on the disabling experience of violence in Latina immigrant communities. Drawing on extensive ethnographic fieldwork performed in a Latina program at an Intimate Partner Violence (IPV) crisis center, Bloom offers insights into the long-term effects of systemic and gender-based violence, revealing that these experiences become subtly disabling long before old age. Drawing from her own background as a practitioner, Bloom further details how current IPV services fail to acknowledge and accommodate such effects, in large part because of their disproportionate focus on younger survivors and the particular development of the domestic violence services field. She offers both scholars and practitioners concrete strategies for how they can alter their approaches to better treat and mitigate the lifelong effects of domestic violence. Violence Never Heals addresses a glaring omission in IPV scholarship, providing both an aging-focused perspective on IPV as well as laying out concrete steps for how to implement this perspective in pursuit of more comprehensive treatment.

The focus on Latinos in the United States has generally overlooked key social-economic-political dimensions that are not only growing in importance, but may ultimately hold an important key to how well this group does in the immediate and distant future in the country. The approximate ten-year period since this text's initial publication has witnessed an increase in scholarship and new social-political-economic developments regarding this population group. Social Work with Latinos, Second Edition captures these advances and adds to the existing body of work in this area. In particular, this revised edition provides an up-to-date demographic profile; identifies the rewards and challenges for the development of social work interventions focused on Latinos; includes a conceptual foundation from which to develop social work strategies for outreach, engagement, service-provision, and evaluation; features a series of case illustrations to highlight how cultural competency/humility can unfold to better reach this population group; grounds the Latino experience within a social, economic, cultural, and political context; and provides recommendations for social work education, research and practice.