Is Cultural Sensitivity Undermining Mental Health Treatment?

There is an epidemic of mental illness in Japan called hikikomori. It is an extreme form of social isolation that was thought to affect mostly men until recently. Yet in the United States, anyone with the same symptoms of apathy and social withdrawal might be diagnosed with depression, agoraphobia, severe anxiety, or even avoidant personality disorder. In the US sex differences are considered less of a factor as well.

Why is that? Unlike heart disease or lung cancer, which can be identified under a microscope, what is considered mental illness and mental health are shaped by the culture in which they are identified. A group's beliefs, norms, and values shape the meaning that people ascribe to their symptoms. Even the language someone speaks can determine how symptoms are described to healthcare professionals.

That’s why cross-cultural studies can help zero in on common conditions. Evidence that a condition exists in many cultures means those symptoms can be more thoroughly understood in different contexts. This should ultimately lead to better treatments.

But what happens when a culture becomes confused? When norms break down and people are divided into different groups that receive radically different treatment even as they are living side by side?

This is what is called multiculturalism.

Unfortunately, that is what is happening and it’s the psychology sciences that are creating and transmitting this confusion.

Since at least the 1980’s the mental health fields of psychology, social work, psychiatry, and counseling have come under the sway of an ideology built on critical theories, retooled Marxism, bigotry, and multiculturalism.

In the first of several mega meetings of the field, counseling in particular decided to promote multiculturalism as a value that practitioners must adopt and they in turn must push on their clients. Demanding anyone adopt a belief is unethical, but that wasn’t noted. The field pressed on.

Since that time the mental health associations and graduate programs have created cultural sensitivity trainings and standards that amount to indoctrination. They have done this without adequately exploring the possible consequences and side effects of this ideology.

It should be no surprise that this has coincided with a replication crisis which has seen up to half of psychology-based studies fail standards of proof. A lack of standards in one place often leads to a loosening of standards elsewhere.

The crisis is so bad that the majority of 2000 psychologists asked to respond to a methodology study admitted to using at least one questionable research practice.

When you put these together, what you have is a profound deficit of professional integrity. 

To see what this looks like in textbooks we can go to the new revision of Counseling the Culturally Diverse Theory and Practice.  As early as the preface we find this politicized passage:

We consider it a serious omission not to discuss counseling diverse populations without acknowledging and dissecting the issues of marginality, oppression, and the current sociopolitical climate on mental health practice. For example, the horrendous murder of George Floyd on May 25, 2020, and the historic and continuing killing of unarmed Black Americans…

While addressing things like “marginality and oppression” may seem a well-meaning sentiment, full of compassion and concern, these terms and ideas can’t be quantified. As for the killing of unarmed Black Americans we need only to look at the work of one of the most exceptional black scholars working today, Roland Fryer.

In an empirical study, Dr. Fryer found that there was not only no racial bias in police shootings, but blacks were shot 20% less than whites. He even went so far as to repeat the study to confirm the results. Despite Fryer’s work being completed before 2019, three years before this textbook was published, his study isn’t cited anywhere in the 432 pages.

This kind of disingenuous instruction material has an impact.

Rather than take the tack that a counselor in the U.S. should work to help clients adapt to mainstream U.S. culture or a receptive subculture, this book teaches that to be a culturally competent counselor to a young Asian male who didn’t want to leave the house, one would have to know about and be able to treat hikikomori.

Such super-specialized care might be reasonable to deliver for just one situation. But it would be dependent on the Asian man being Japanese, having a connection to Japanese culture strong enough despite living in the US that he could have hikikomori and actually having hikikomori.

Even if a counselor went to such extreme measures, that’s not the same as having evidence that this kind of care is necessary for effective treatment, or that it would be effective treatment. This is just cultural relativism.

Cultural relativism in therapeutic treatment is not only impractical but when taken in mass over all world cultures and subcultures, it leads to an incoherent understanding of what makes for abnormal behaviors.

Consider a counselor treating a client with a background where women were expected to be sexually offered to visitors. Would the counselor help the woman learn coping strategies to better accept this treatment? What about foot binding, were that to make a comeback? Would that be considered child abuse that must be reported, or accepted as a cultural preference?

What does diagnosis even mean in that kind of environment?

In this methodology, values like individualism, scientific empiricism, and emotional expressiveness get thrown under the bus in favor of things like ancestral sin.

A more concerning result is that the field of psychology ceases to be a science that explores human nature and becomes a force demanding compliance with the new accepted standards of behavior.

Perhaps the most damning evidence that these cultural competency trainings are divorced from real science can be found in this quote from the same book:

We believe that ethnocentric monoculturalism is dysfunctional in a pluralistic society such as that of the United States.

Please tell me, at what point did it become ok to prescribe vast cultural subversion and changes in an applied science field based on a belief rather than evidence?

I’ll wait.

About

Diogenes in Exile began after I returned to grad school to pursue a degree in Clinical Mental Health Counseling at the University of Tennessee. What I encountered, however, was a program deeply entrenched in Critical Theories ideology. During my time there, I experienced significant resistance, particularly for my Buddhist practice, which was labeled as invalidating to other identities. After careful reflection, I chose to leave the program, believing the curriculum being taught would ultimately harm clients and lead to unethical practices in the field.

Since then, I’ve dedicated myself to investigating, writing, and speaking out about the troubling direction of psychology, higher education, and other institutions that seem to have lost their way. When I’m not working on these issues, you’ll find me in the garden, creating art, walking my dog, or guiding my kids toward adulthood.

You can also find my work at Minding the Campus

Diogenes in Exile is reader-supported. If you find value in this work, please consider becoming a paid subscriber or buying Thought Criminal merch to keep this mission alive.