Healthcare professionals must consider the unique array of diverse identities that are represented within each individual encountered in each therapeutic relationship. The complexity embodied within each patient affects the way that the patient understands and views the healthcare professional and the professional relationship, just as the complexity of the healthcare provider’s diversity dimensions affects the way that the healthcare professional understands and views each patient. It is impossible to provide information that allows healthcare professionals to gain knowledge about categories
of people and how they behave or view the world, because not only is the variation within individual ethnicities and races endless, but the variation within each individual also is endless. Instead, healthcare professionals should aim to understand the societal landscape that privileges and oppresses individuals. The experiences of oppression experienced by various diverse groups are likely to provide them with a unique perspective on both the larger society and on their relationship with healthcare professionals.
OPPRESSION, PRIVILEGE, AND MARGINALIZATION
Understanding the concepts of oppression, privilege, and marginalization is essential for practicing with cultural humility. There are various aspects of individual identities that oppress or privilege people vis-a-vis their marginalization or empowerment. Oppression is a commonly referenced term in many of the mental and behavioral health disciplines. Because the term has several definitions, or in some instances, the term is left undefined, there can be confusion regarding its meaning in a therapeutic context. Oppression can be defined as “unjust or cruel exercise of authority or power” (Merriam-Webster, 2021), but a more expansive description is that oppression consists of the barriers present as a result of cultural and sociopolitical forces that serve to prevent certain populations of people, based on group characteristics (e.g., LGBTQ, impoverished, African American, Muslim), from accessing resources and/or opportunities that are readily available to others (Frye, 2019; Seethaler, 2014; Van Soest, 2013). Barriers include restricted access to resources and opportunities such as high-quality public education and stable, well-paying jobs. Oppression is a pervasive system. It has its foundation in history and is maintained via individual and institutional systematic discrimination, personal bias, bigotry, and social prejudice. Oppression leads to a condition of privilege for the person or the group that is the oppressor(s) (NCC, 2021). Oppression is expressed in a systematic manner and enforced by cultural ideology and the threat of violence (Van Soest, 2013). It is not accidental, and it is not avoidable by the populations that experience it. It is meant to maintain the current societal status quo (Seethaler, 2014). It is important to understand “the unavoidability of oppressive forces for many groups” (Seethaler, 2014, p. 43). Oppression is not something individuals can work their way out of or avoid by changing their behavior. In the context of counseling, it is essential to recognize and address the systemic nature of oppression and the role it plays in clients’ and counselors’ lives. In individual counseling sessions the power dynamic within the counseling relationship needs to be identified. Attention needs to be paid to equalizing the relationship and to entering into a partnership with clients; it must be recognized that both the counselor and client bring essential knowledge to the relationship (Sue & Sue, 2021). As part of practicing with cultural humility, mental and behavioral health professionals are called on to take an active role in addressing issues of oppression outside the office on institutional levels and to make efforts to reduce any power differentials that affect the client within the service environment or other areas within the client’s life. Privilege is a central concept for mental and behavioral healthcare professions in their work to address oppression and marginalization of certain groups and the resulting privileging of other groups. The concept of White privilege and male privilege were clearly articulated and widely disseminated through McIntosh’s work in the 1980s. McIntosh articulated White male privilege as “an invisible package of unearned assets which he can count on cashing in each day, but about which he was ‘meant’ to remain oblivious. White privilege is like an invisible weightless knapsack of special provisions, assurance, tools, maps, guides, codebooks, passports, visas, clothes, compass, emergency gear, and blank checks” (McIntosh,
1998, p. 1). Privileging is “a process where chances or odds of being offered an opportunity are altered or skewed to the advantage of members of certain groups” (Minarik, 2017, p. 55). Essentially, privilege functions by providing some groups of individuals (e.g., White, male, heterosexual, abled, middle class) with preferred treatment in the form of special opportunities and advantages, while withholding that preference from other individuals (e.g., African American, female, LGBTQ, disabled). Privilege can include many advantages, including being given the benefit of the doubt and feeling a sense of belongingness (Minarik, 2017). Individuals who are not privileged experience the opposite—such as being an automatic suspect or having to prove belonging (Minarik, 2017). Privilege is not a guarantee of success for those groups who receive it; however, it is an advantage that other groups do not receive and allows for opportunities that others are denied (Minarik, 2017). A final key aspect regarding privilege is that it is not necessarily visible to those who receive it. The invisibility of privilege is the key component that allows it to continue. More simply, when those who receive privilege do not recognize it, they are unable to take actions to change it. Once people become aware of privilege, they may choose to use the benefits of privilege to advocate for marginalized populations. Self-Assessment Quiz Question #5 When discussing oppression and privilege, healthcare professionals should know that: a. Privilege is the commission of an unjust or cruel exercise of authority or power. b. Privilege is a guarantee of success for groups receiving it. c. Oppression’s foundation is in the “me too” movement. d. Oppression leads to a condition of privilege for the person or the group that is the oppressor(s). Marginalization is an important concept in the delivery of patient care. In the context of oppression, privilege, cultural humility, and social justice, marginalization is the pushing aside and exclusion of certain groups (e.g., ethnic and racial minorities, immigrants, LGBTQ population, individuals with disability, and individuals who are economically disadvantaged) from full participation in a society’s mainstream social, economic, cultural, and political structures (Cooke-Jackson, et al., 2021). Some experts have identified the following three themes of marginalization (Baah et al., 2019): ● Creation of margins : Margins act as barriers and connections between a person and the environment. Margins construct physical, emotional, and psychological boundaries that people experience during interactions with society. Enforcement and maintenance of boundaries divide political and socioeconomic resources in an uneven fashion. This also facilitates the unbalanced distribution of critical resources such as healthcare (Baah et al., 2019). This illustrates the concept of social determinants of health (SDH), which is defined as “the circumstances in which people are born, live, work and age and the systems put in place to deal with illness” (World Health Organization [WHO], 2010).
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