“Shattering Culture is a fine book, organized around a tightly constructed theme but taking advantage of the authors’ widely varying perspectives and professions. It carefully examines the mantra of ‘cultural competence.’ While valuing different cultural frameworks and emphasizing the need to understand patients from their own perspective, the authors show how some elements of respect for diversity must be rethought in the face of hard realities of running a health care system. The message is sensitive, sensible, and energizingly bold.”
—JENNIFER L. HOCHSCHILD, Harvard University

“Shattering Culture humanizes the struggle to provide culturally-grounded health care to a patient population that refuses to fit neatly into our tidy conceptual boxes. Drawing from their own insider and outsider perspectives, the editors and authors deliver an unusually empathic yet critical analysis of the various players and practices that interact to shape patient care—for better and for worse. Beautifully written, and brimming with rich, ethnographic details, this volume explodes static formulations of cultural competence, and shows us just how much more work we have to do. A remarkable achievement.”
—DORIS F. CHANG, New School for Social Research

“This volume shines a fresh and brilliant light on contemporary culture and American healthcare. Shattering Culture is essential reading for the social and medical sciences and particularly for the fields of global health, medical anthropology/sociology, internal medicine, psychiatry, psychology, and public health. The immediacy of the problems tackled here (precisely how does culture ‘count’?) is demonstrated with compelling qualitative materials that empirically display intimate clinician-patient encounters under the press of ‘checkbox medicine/psychiatry.’ This book takes an utterly fearless look into the chasm of cultural complexity and provides the foundation for innovation in the provision of healthcare.”
—JANIS H. JENKINS, University of California, San Diego

"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.

MARY-JO DELVECCHIO GOODis professor of social medicine at Harvard Medical School and teaches in the Department of Sociology at Harvard University, in addition to being a faculty affiliate of the Asia Center, the Center for Middle Eastern Studies, and the Weatherhead Center for International Affairs.

SARAH S. WILLEN is assistant professor of anthropology at the University of Connecticut.

SETH DONAL HANNAH is lecturer on sociology at Harvard University.

KEN VICKERY is director of external fellowships at the University of Illinois, Urbana-Champaign.

LAWRENCE TAESENG PARK assistant professor of psychiatry at Massachusetts General Hospital.

CONTRIBUTORS: Antonio Bullon, Joseph D. Calabrese,  Elizabeth Carpenter-Song,  Sadeq Rahimi, Lisa Stevenson, Marina Yaroshenko.  

A Volume in the American Sociological Association’s Rose Series in Sociology

Winner of the 2012 Outstanding Book Award of the Theory Section of the Society for the Study of Social Problems (SSSP)

In the long history of warfare and cultural and ethnic violence, the twentieth century was exceptional for producing institutions charged with seeking accountability or redress for violent offenses and human rights abuses across the globe, often forcing nations to confront the consequences of past atrocities. The Holocaust ended with trials at Nuremberg, apartheid in South Africa concluded with the Truth and Reconciliation Commission, and the Gacaca courts continue to strive for closure in the wake of the Rwandan genocide. Despite this global trend toward accountability, American collective memory appears distinct in that it tends to glorify the nation’s past, celebrating triumphs while eliding darker episodes in its history. In American Memories, sociologists Joachim Savelsberg and Ryan King rigorously examine how the United States remembers its own and others’ atrocities and how institutional responses to such crimes, including trials and tribunals, may help shape memories and perhaps impede future violence.

American Memories uses historical and media accounts, court records, and survey research to examine a number of atrocities from the nation’s past, including the massacres of civilians by U.S. military in My Lai, Vietnam, and Haditha, Iraq. The book shows that when states initiate responses to such violence—via criminal trials, tribunals, or reconciliation hearings—they lay important groundwork for how such atrocities are viewed in the future. Trials can serve to delegitimize violence—even by a nation’s military— by creating a public record of grave offenses. But the law is filtered by and must also compete with other institutions, such as the media and historical texts, in shaping American memory. Savelsberg and King show, for example, how the My Lai slayings of women, children, and elderly men by U.S. soldiers have been largely eliminated from or misrepresented in American textbooks, and the army’s reputation survived the episode untarnished. The American media nevertheless evoked the killings at My Lai in response to the murder of twenty-four civilian Iraqis in Haditha, during the war in Iraq. Since only one conviction was obtained for the My Lai massacre, and convictions for the killings in Haditha seem increasingly unlikely, Savelsberg and King argue that Haditha in the near past is now bound inextricably to My Lai in the distant past. With virtually no criminal convictions, and none of higher ranks for either massacre, both events will continue to be misrepresented in American memory. In contrast, the book examines American representations of atrocities committed by foreign powers during the Balkan wars, which entailed the prosecution of ranking military and political leaders. The authors analyze news accounts of the war’s events and show how articles based on diplomatic sources initially cast Serbian President Slobodan Milosevic in a less negative light, but court-based accounts increasingly portrayed Milosevic as a criminal, solidifying his image for the public record.

American Memories provocatively suggests that a nation’s memories don’t just develop as a rejoinder to events—they are largely shaped by institutions. In the wake of atrocities, how a state responds has an enduring effect and provides a moral framework for whether and how we remember violent transgressions. Savelsberg and King deftly show that such responses can be instructive for how to deal with large-scale violence in the future, and hopefully how to deter it.

JOACHIM J. SAVELSBERG is professor of sociology at the University of Minnesota.

RYAN D. KING is associate professor of sociology at the University at Albany, State University of New York.

An insightful examination of why we compare ourselves to those above and below us.

“Fiske makes a strong argument for the cognitive and emotional processes that underlie everyday inequalities and their social consequences. . . . Readers who have wondered why the Tea Party is angry, why Harvard students avoid ‘dropping the H-bomb,’ or why John Kerry’s presidential campaign was over after he was photographed windsurfing may find the answers from psychology fascinating. . . . I would recommend Envy Up, Scorn Down to any social worker, policy-maker, or politician attempting to understand the persistent struggles between people, groups, or nations that, in one way or another, are not equal.”
—Science 

“Of all the seven deadly sins, envy is the one that nobody ever boasts about. In this fascinating and important book, Susan Fiske explores this taboo topic, explaining the universal human obsession with status. She shows how our complex feelings towards those above us and below us can be adaptive and beneficial; they can motivate us as individuals and bind us together as groups. Or they can make us miserable, tearing apart families and communities, and fueling hatred and war. This is an engaging book by a great scientist and a deep thinker.”
—PAUL BLOOM, professor of psychology, Yale University 

“This book is a masterful examination of the causes and consequences of our powerful compulsion to compare ourselves to others. Lucid and learned, witty and wise, this book will be the authoritative standard that readers will love and social scientists will envy.”
—DANIEL GILBERT, professor of psychology, Harvard University

The United States was founded on the principle of equal opportunity for all, and this ethos continues to inform the nation’s collective identity. In reality, however, absolute equality is elusive. The gap between rich and poor has widened in recent decades, and the United States has the highest level of economic inequality of any developed country. Social class and other differences in status reverberate throughout American life, and prejudice based on another’s perceived status persists among individuals and groups. In Envy Up, Scorn Down, noted social psychologist Susan Fiske examines the psychological underpinnings of interpersonal and intergroup comparisons, exploring why we compare ourselves to those both above and below us and analyzing the social consequences of such comparisons in day-to-day life.

What motivates individuals, groups, and cultures to envy the status of some and scorn the status of others? Who experiences envy and scorn most? Envy Up, Scorn Down marshals a wealth of recent psychological studies as well as findings based on years of Fiske’s own research to address such questions. She shows that both envy and scorn have distinctive biological, emotional, cognitive, and behavioral characteristics. And though we are all “wired” for comparison, some individuals are more vulnerable to these motives than others. Dominant personalities, for example, express envy toward high-status groups such as the wealthy and well-educated, and insecurity can lead others to scorn those perceived to have lower status, such as women, minorities, or the disabled. Fiske shows that one’s race or ethnicity, gender, and education all correlate with perceived status. Regardless of whether one is accorded higher or lower status, however, all groups rank their members, and all societies rank the various groups within them. We rate each group as either friend or foe, able or unable, and accordingly assign them the traits of warmth or competence. The majority of groups in the United States are ranked either warm or competent but not both, with extreme exceptions: the homeless or the very poor are considered neither warm nor competent. Societies across the globe view older people as warm but incompetent. Conversely, the very rich are generally considered cold but highly competent. Envy Up, Scorn Down explores the nuances of status hierarchies and their consequences and shows that such prejudice in its most virulent form dehumanizes and can lead to devastating outcomes—from the scornful neglect of the homeless to the envious anger historically directed at Tutsis in Rwanda or Jews in Europe.

Individuals, groups, and even cultures will always make comparisons between and among themselves. Envy Up, Scorn Down is an accessible and insightful examination of drives we all share and the prejudice that can accompany comparison. The book deftly shows that understanding envy and scorn—and seeking to mitigate their effects—can prove invaluable to our lives, our relationships, and our society.

SUSAN T. FISKE is Eugene Higgins Professor of Psychology at Princeton University.

An interview with Fiske can be read here.

An in-depth look at the challenges undocumented immigrants face as they raise children in the U.S.

“Making It Work combines the precision of scientific experiments with the breadth of ethnographic methods to yield a penetrating picture of low-income mothers working at low-wage jobs while struggling to raise their children. Here we find the specific job-related factors, including work schedules and wage levels and changes that have impacts on both the mother’s and children’s well-being. The implications for public policy are enormous.”
—RON HASKINS, Brookings Institution

“Making It Work provides a much needed examination of the role that parents' employment plays in the developmental pathways of children in working poor households. It shows us that the working poor are a diverse group that experiences many different trajectories through the labor market, each of which imposes different pressures (and positive impacts) on kids. For parents who see upward mobility that is stable, the news is fundamentally good, particularly if child care is consistent and high quality. But parents who cannot provide a stable environment for their children see the opposite outcome: their kids are troubled in school and at home. No one dimension of work supports or family characteristics explains these outcomes. Instead, the authors show convincingly that ‘it takes a web’ of supports to pull children through in good shape, the kind of supports that the New Hope experiment provided in Milwaukee. This volume is an eye-opening examination of the nexus of work and child-rearing. The careful research design, the combination of survey data and ethnographic observation, and the judicious treatment of the research results combine to make it required reading for anyone who is serious about the long-term prospects for the children of the poor.”
—KATHERINE S. NEWMAN, Princeton University

“In the wake of welfare reform, many low-income mothers have gone to work. Making It Work provides numerous insights, based on both quantitative and qualitative evidence, into the circumstances under which work does or does not benefit low-income mothers and their children. It suggests that with the right supports—wage supplements, child care, and reliable transportation in particular—many of these mothers can be successful with positive benefits for their children as well. What is needed is a national commitment to provide the kind of supports that these mothers had as voluntary participants in a carefully evaluated demonstration program in Milwaukee during the 1990s.”
—ISABEL V. SAWHILL, Brookings Institution
 

There are now nearly four million children born in the United States who have undocumented immigrant parents. In the current debates around immigration reform, policymakers often view immigrants as an economic or labor market problem to be solved, but the issue has a very real human dimension. Immigrant parents without legal status are raising their citizen children under stressful work and financial conditions, with the constant threat of discovery and deportation that may narrow social contacts and limit participation in public programs that might benefit their children. Immigrants Raising Citizens offers a compelling description of the everyday experiences of these parents, their very young children, and the consequences these experiences have on their children’s development.

Immigrants Raising Citizens challenges conventional wisdom about undocumented immigrants, viewing them not as lawbreakers or victims, but as the parents of citizens whose adult productivity will be essential to the nation’s future. The book’s findings are based on data from a three-year study of 380 infants from Dominican, Mexican, Chinese, and African American families, which included in-depth interviews, in-home child assessments, and parent surveys. The book shows that undocumented parents share three sets of experiences that distinguish them from legal-status parents and may adversely influence their children’s development: avoidance of programs and authorities, isolated social networks, and poor work conditions. Fearing deportation, undocumented parents often avoid accessing valuable resources that could help their children’s development—such as access to public programs and agencies providing child care and food subsidies. At the same time, many of these parents are forced to interact with illegal entities such as smugglers or loan sharks out of financial necessity. Undocumented immigrants also tend to have fewer reliable social ties to assist with child care or share information on child-rearing. Compared to legal-status parents, undocumented parents experience significantly more exploitive work conditions, including long hours, inadequate pay and raises, few job benefits, and limited autonomy in job duties. These conditions can result in ongoing parental stress, economic hardship, and avoidance of center-based child care—which is directly correlated with early skill development in children. The result is poorly developed cognitive skills, recognizable in children as young as two years old, which can negatively impact their future school performance and, eventually, their job prospects.

Immigrants Raising Citizens has important implications for immigration policy, labor law enforcement, and the structure of community services for immigrant families. In addition to low income and educational levels, undocumented parents experience hardships due to their status that have potentially lifelong consequences for their children. With nothing less than the future contributions of these children at stake, the book presents a rigorous and sobering argument that the price for ignoring this reality may be too high to pay.

HIROKAZU YOSHIKAWA is professor of education in Harvard University’s Graduate School of Education.

Read an RSF interview with Yoshikawa here.

“Choosing Ethnicity, Negotiating Race contributes mightily to our understanding of important issues that we ignored for too long, and still understand too little about. It is vital reading.”
—ADAM PERTMAN, Evan B. Donaldson Adoption Institute 

“Choosing Ethnicity, Negotiating Race by Mia Tuan and Jiannbin Lee Shiao gives critical insights into the unique experience of Korean adoptees. This book provides depth of detail and background, making it one of the most complete resources available on this subject. As a first-generation Korean adoptee, much of what is described by adoptees in this book resonates with me. Tuan and Shiao have done an excellent job of providing supporting information and research, but let the voices of the adoptees tell their own stories of navigating the nuances of being a Korean American adoptee. The result is a profoundly good read.”
—SUSAN SOON-KEUM COX, Holt International 

“Choosing Ethnicity, Negotiating Race by Mia Tuan and Jiannbin Lee Shiao is a must read for scholars in the specialized field of transnational and transracial adoption studies and the larger field of ethnic and racial studies, as well as for all parties involved in international adoption practices, including birth and adoptive families, adoption agencies, and mental health service providers. Using in-depth interviews, Tuan and Shiao reveal the ways in which ethnicity, race, and culture overlap, intersect, and remain distinct in the everyday lives of adopted Korean Americans. They also expertly frame these experiences within H. David Kirk’s theory of shared fate, complemented by current sociological and psychological theory and research on adoption, ethnicity, and race. Equally, if not more, important, Tuan and Shiao make public the personal voices and narratives of adopted Korean American adults whose stories have long been appropriated by adoptive parents and adoption agencies.”
—RICHARD M. LEE, University of Minnesota 

“In Choosing Ethnicity, Negotiating Race, Mia Tuan and Jiannbin Lee Shiao give us a fresh and compelling analysis of how race can shape social experience even in the seemingly mos integrated places. With rich new interview material on Korean adoptees—the single largest category of foreign-born adoptees in the United States—Tuan and Shiao show how a racialized social order penetrates even the most intimate realms of identity and family. Rather than transracial adoption proving the irrelevance of race today, they show that it creates new and complex terrain on which matters of ethnic identity and socially imposed racial boundaries and hierarchies get renegotiated. This book makes a major contribution and is a must read for anyone interested in transracial adoption or the larger contemporary dynamics of race.”
—LAWRENCE D. BOBO, Harvard University

Transnational adoption was once a rarity in the United States, but Americans have been choosing to adopt children from abroad with increasing frequency since the mid-twentieth century. Korean adoptees make up the largest share of international adoptions—25 percent of all children adopted from outside the United States—but they remain understudied among Asian American groups. What kind of identities do adoptees develop as members of American families and in a cultural climate that often views them as foreigners? Choosing Ethnicity, Negotiating Race is the only study of this unique population to collect in-depth interviews with a multigenerational, random sample of adult Korean adoptees. The book examines how Korean adoptees form their social identities and compares them to native-born Asian Americans who are not adopted.

How do American stereotypes influence the ways Korean adoptees identify themselves? Does the need to explore a Korean cultural identity—or the absence of this need—shift according to life stage or circumstance? In Choosing Ethnicity, Negotiating Race, sixty-one adult Korean adoptees—representing different genders, social classes, and communities—reflect on early childhood, young adulthood, their current lives, and how they experience others’ perceptions of them. The authors find that most adoptees do not identify themselves strongly in ethnic terms, although they will at times identify as Korean or Asian American in order to deflect questions from outsiders about their cultural backgrounds. Indeed, Korean adoptees are far less likely than their non-adopted Asian American peers to explore their ethnic backgrounds by joining ethnic organizations or social networks. Adoptees who do not explore their ethnic identity early in life are less likely ever to do so—citing such causes as general aversion, lack of opportunity, or the personal insignificance of race, ethnicity, and adoption in their lives. Nonetheless, the choice of many adoptees not to identify as Korean or Asian American does not diminish the salience of racial stereotypes in their lives. Korean adoptees must continually navigate society’s assumptions about Asian Americans regardless of whether they chose to identify ethnically.

Choosing Ethnicity, Negotiating Race is a crucial examination of this little-studied American population and will make informative reading for adoptive families, adoption agencies, and policymakers. The authors demonstrate that while race is a social construct, its influence on daily life is real. This book provides an insightful analysis of how potent this influence can be—for transnational adoptees and all Americans.

MIA TUAN is professor of education studies, director of the Center on Diversity and Community, and associate dean of the graduate school at the University of Oregon.

JIANNBIN LEE SHIAO is associate professor of sociology at the University of Oregon.