Norman Kim, PhD.; Understanding the Needs of Multicultural Populations in Behavioral Healthcare

Montare Media presents Season 2, episode 22 of the Discover U Podcast with JD Kalmenson:  Understanding the Needs of Multicultural Populations in Behavioral Healthcare, with Dr. Norman Kim, PhD.

Learn More about Montare Behavioral Health: https://montarebehavioralhealth.com/about/digital-library/

JD Kalmenson’s  interviews Dr. Norman Kim, the co-founder of the Institute for Antiracism and Equity, as well as the Diversity chair of the Columbia University Department of Psychiatry, to discover how innate biases in the healthcare system compromise both the quality and quantity of care provided to marginalized communities. Dr. Kim explains how a deeper understanding of cultural differences, and an increased sensitivity to diverse cultural norms, leads to better outcomes for everyone suffering with mental health challenges.

Dr. Kim is the inaugural Diversity, Equity, and Inclusion Officer for the Center for Practice Innovation at Columbia University Department of Psychiatry and the NY State Office of Mental Health, and the co-founder of the Institute for Antiracism and Equity, a social justice-focused consultancy. He completed his B.A. at Yale and his Ph.D. in Psychology at UCLA. Norman has developed an expertise in psychiatrically complex populations, and his primary areas of interest are the application of a transdiagnostic framework for eating disorders, taking an evolutionary approach to shame and anxiety, and minority mental health. He is a regular national and international speaker, educator, and passionate advocate with a particular focus on minority status and barriers to mental health care in marginalized communities. He was the founding co-chair of the Black, Indigenous, and People of Color Committee of IAEDP, on the inaugural Behavioral Health Taskforce for the Gay and Lesbian Medical Association, former board member of the Eating Disorders Coalition, and serves on numerous advisory boards. Most recently Norman was the Deputy Director of Ayana Therapy, a tech startup focused on providing culturally intelligent, adapted, and accessible care to marginalized communities, and was the co-founder of Reasons Eating Disorder Center.

Host Kalmenson is the CEO/Founder of Renewal Health Group, a family of addiction treatment centers, and Montare Behavioral Health, a comprehensive brand of mental health treatment facilities in Southern California. Kalmenson is a Yale Chabad Scholar, a skilled facilitator, teacher, counselor, and speaker, who has provided chaplain services to prisons, local groups and remote villages throughout the world. His diverse experience as a rabbi, chaplain, and CEO has inspired his passion and deep understanding of the necessity for effective mental health treatment and long-term sobriety.

Follow JD at JDKalmenson.com

Transcript

JD Kalmenson:

Welcome to another episode of Discover U, our podcast exploring innovative solutions to issues in behavioral health. I'm JD Kalmenson, CEO of Montare Behavioral Health, a family of dynamic mental health treatment centers in Southern California. I am so honored and excited to introduce you to our wonderful guest today, Dr. Norman Kim. Norman is the inaugural Diversity, equity and Inclusion Officer for the Center of Practice Innovation at Columbia University Department of Psychiatry and the New York State Office of Mental Health. He's the co-founder of the Institute for Anti-Racism Inequity, a social justice focus consultancy. He completed his BA at Yale and his PhD in psychology at UCLA. Norman has developed an expertise in psychiatrically complex populations, and his primary areas of interest are the application of a trans diagnostic framework for eating disorders, taking an evolutionary approach to shame and anxiety, and minority mental health. He is a regular national and international speaker educator, and passionate advocate with a particular focus on minority status and barriers to mental health care in marginalized communities. He was the founding co-chair of the Black, Indigenous and People of Color Committee of IAEDP, on the inaugural Behavioral Health Task Force for the Gay and Lesbian Medical Association, former Board of the Eating Disorders Coalition, and serves on numerous advisory boards. 

JD Kalmenson:

Welcome, Norman. So happy to have you with us today. Thank you for taking the time to talk with us.

Norman Kim:

Oh, it's my pleasure. Thanks so much for having me.

JD Kalmenson:

You have such a deep background in both delivering behavioral healthcare to minority populations and in treating eating disorders. We're opening up an eating disorder facility for adolescents in LA and plan to open up more in the near future. So we obviously have a particular interest in all aspects of this complex illness and would love to benefit from your insight. And at Montare, we place a great importance on developing diverse teams of clinicians and support staff so that they can bring their cultural backgrounds and life experiences into the treatment room. So we focus on helping our clients not just really heal from the symptoms of the crisis or the mental and behavioral issue, but rather to use it as a catalyst than a springboard to find a meaning and purpose in their life. And they walk away from that episode and that experience with a new spunk, a new spring in their step and with a greater enhanced sense of self-awareness. Now, meaning and purpose looks different for every individual, and I'm sure we can learn a lot from you about the nuances of delivering care to marginalized groups. So let's start, maybe if you can share with us the basic criteria of how you would define a marginalized community. 

Norman Kim: 

Yeah, that's such an important question and, you know before I answer, I wanna, I just wanna acknowledge that I think what you said about the way, that you all are approaching eating disorder care is so important and actually, unfortunately not, not where people tend to come from. You know, we do tend to be very focused on symptoms and just sort of treatment without much sense of a greater sense of mission in terms of, you know, there, there are the symptoms of this illness, but then it's all happening in a larger context. And that so much of what I've spent, you know, probably more of my, more of my life thinking about more than anything else. So when you talk about, you know, it's not just getting them physically better or even getting them psychologically better in terms of the illness, but rather helping, helping our patients and, and helping anybody struggling with this illness really reconnect to something bigger than themselves. Reconnect to a larger sense of meaning and purpose. So I really applaud you having that as, as kind of a guiding principle. I think that's terribly important. 

You know, to, to go back to your question, it's not a straightforward answer to that question. Anybody who's experienced discrimination, harassment, whether it's based, whether it's based on the color of your skin, whether it's based on where you come from, whether it's based on your religion, based on your sexual orientation, your gender identity, et cetera. There are any number of identity dimensions. But what's more important is the fact that there's been a systemic level of discrimination that you've experienced. And it's that kind of marginalization that really hits us at our core as human beings as an experience. And there's, there's a reason why that's so impactful. And you know, this might go a little bit beyond the question you're asking, but you know, if you think about our evolutionary history, the reason we're the apex predator, the reason that we're the top of the food chain isn't because we're the fastest or the strongest, cuz we're not, you know, you're plenty of other animals who, who are much faster, stronger than we are.

It's because we evolve the capacity to work together, to have communities, and to work together in groups. That's why we've survived. And so because of that, anything that threatens our social styles is something that's gonna hit us. Really in this very primal place, though, there's almost nothing more threatening to us as a species than something that threatens your standing socially. 

JD Kalmenson:

So what I'm hearing from you is, first and foremost, the idea of a marginalized community or group is really any time one might experience discrimination bias and that sort of resistance, that sort of toxicity and negativity has nothing to do with them as an individual, but everything to do with the community that they're a part of, the religion, that they're a part of, the race that they're a part of. And the reason why it sounds like it could be so deeply harmful is because it almost cuts to the very core of their existential sort of status and says, it doesn't make a difference about how talented or how good of a person you are or what you, you know, or, or, or what you as an individual look like. The very fact that you belong to something puts you at a lower and more inferior status.

And that's, that's deeply traumatizing. And you know, it's so important to identify this in the domain of behavioral health, first and foremost, to help identify where the specific trauma might be coming from. 

 It's really important to hone in, identify that as what, what exactly the underlying issue is. But also, I'm assuming that it's gonna be enormously impactful when it comes time to crafting the master treatment plan so that the integration and the application of whatever the treatment is, will be in line and will be synergistically you know compatible with their culture, with their community, with their group, you know, making sure that that it's, it is a tight fit that will, that will resonate with them as an individual.

Norman Kim:

Absolutely. I mean, you know, really, even before we get to the point of thinking about treatment and a master treatment plan, it's are the assessment tools, are the questions that we learn to ask as clinicians, are those necessarily appropriate across the board or equally appropriate across the board for anybody regardless of their background. That's at a very basic level. I think that's an open question. There's a next level question of are the clinical phenomena that we're interested in trying to assess, does that look different or does it look the same whether you come from X group or Y group? And I think that's also an open question and there's that can differ from one thing to another. But certainly, the way that any kind of distress is manifested by somebody can have a lot of cultural variation.

And if we're not sensitive on our side as clinicians to the variations, we run the risk of either under attributing cultural factors or over attributing sometimes.  And way, we're not gonna be doing a good job as clinicians. I'll give, you an example from the news a couple of weeks ago, from The Journal of the American Medical Association released this study that you know, those infrared thermometers that have been ubiquitous, especially over the last couple of years. You know, any that we use to check temperature for, you know, evaluating covid risk, for example. But it's a very basic medical marker, and we've just researchers have just found out that there're significantly less accurate on, on black people. In other words, that the, the, their, the degree of a variation in the, in the readings are gonna be less is gonna be greater and therefore less accurate in some people versus others.

Now, this is something that has wide ranging implications for the kind of care that we do. This is a very basic, basic sort of tool that we use all the time, and it's just that we, no one's really bothered to ask the question before that, that we just assumed that it was equally appropriate and equally accurate across the board. And that tends to be the case with, with most things, especially when we get to things as nuanced and as complicated as you said, as behavioral health issues. Yes. you know, there, there are many more places where there can be variation in, where there can be subtleties that just aren't picked up if you're not set up to looking for them. And if you're not sort of primed as a clinician to think about those kinds of questions…

JD Kalmenson:

It makes so much sense. And, and you know, this is one area where behavioral health is really different in a, in a critical aspect than general health or general medical health. Because when some two people come to a hospital and they're really presenting with identical symptoms, there's a, there's a great chance that they're going to be suffering from a similar condition of similar issue. Whereas here, identical symptoms really have zero indication that the underlying issue is gonna have an identical source. So you really have to put on the investigative cap and approach this with a fresh set of eyes 

So, you have two separate areas of expertise, at least two, but two that we're talking about today, which is your expertise in eating disorder and in treating minority populations. First of all, I'd love to get to know if you perhaps could share, is there anything personal that you've experienced in your life that may have led you to have this part, you know, this interest in these two particular domains and healthcare? And is there a connection between these two? 

Norman Kim:

Yeah, yeah. That's a, that's a great question. I mean, certainly in, in terms of minority mental health and thinking about the impact of, of health or, or thinking about aspects of health equity you know, I'm a first, first and a half generation immigrant. I was born in South Korea. My family immigrated when I was about five years old. So certainly the, the experience of growing up here on the one hand, extremely acculturated. You know, I'm 51 years old, so the vast majority of my life has been spent here. I feel as American as anything as I feel anything else. It's you know, it's a deep part of how just I grew up all of my education, et cetera. On the other hand, you know, especially sort of being, being from Korea I was always visibly, I'm obviously visibly not sort of American in the way that most people think about what American is.

 So that my sense of my experience as somebody who was always treated kind of as a foreigner regardless of my facility with English, or regardless of the fact that I've basically grown up here that made a profound impact on me. So as I started thinking about career choices and thinking about psychology in particular I knew that that was gonna be a focus. So I went to UCLA for my PhD, and UCLA historically has always been a hotbed of research on minority mental health. And so there's a big part of the reason why I wanted to go there to study. And it was, it made a significant impact on me in terms of obviously what I did for the rest of my career.

The eating disorders unit was down the hall from my office when I was getting my postdoc, and so is the easiest place for me to sort of see patients. And but in, in starting to do that work, there was something about it that did really resonate with me and that did really connect with me. And, and I think that's sort of the linkage between the two, the two sets of expertise I think I've developed. You know, part of, part of the experience of having an eating disorder is rooted in that same sort of in that same almost primal anxiety that that has a, such a significant impact on how we view the world, how we view other people, how we view ourselves.

And so, you know, there's certainly a linkage in, in that respect. As I started to do more work within the eating this sort of world, and especially I think as I myself came into positions of leadership within the eating disorder world, it became quite clear that there were just weren't very many other people who looked like me or looked like anybody who wasn't, you know, who wasn't who wasn't basically white. And that, that was troubling on a number of levels, especially as I saw the patient population being as diverse as America is diverse. And yet as clinicians, we didn't reflect that kind of diversity.

JD Kalmenson: 

So that's amazing how you're able to take those two areas. I mean, your, your long-time passion of really working you know, with marginalized communities and seeing how the fact that they might have had the discrimination issues impact the, that their access to mental health and the quality of the mental health and the eating disorder world. So, it's nice that you were able to unify the two. Can you share with us any sort of generalizations about how minority groups or a particular minority group as a whole experience psychological issues differently than the rest of the population, for instance, anxiety and depression? Are they experienced differently in some cultures versus, you know, over other cultures? 

Norman Kim:

I think as far as we know, there is some universal experience that most people would recognize as an anxiety or depression, you know, and the specifics of it might look a little bit different, but there is some core of that experience that I think most people can relate to, regardless of where you come from, the ways that it might manifest is certainly gonna be different.

So, for example, this myself as somebody from, from East Asian background, you know, I think the stereotype, which is the stereotype is that Asian people are less emotional, that we are less expressive with our emotions, et cetera. And, you know, to some extent that's true, but I think it's a little bit more nuanced than that. It's not so much that we necessarily experience emotions differently, but there are social, you know, many of the social rules that exist in Asian cultures about with whom and how it's appropriate to express distress are quite different. And so, for example, one of the, one of the significance of cultural barriers for many for many Asian people who are especially Asian people in the West who are experiencing mental health issues or any kind of behavioral health problem, is that, you know, in as much as behavioral health issues have a stigma attached to them for anybody who's experiencing them, there's an additional stigma for somebody who might come from a culture where there's a high level of high level of ancestor shame as part of that culture. So, you know, for somebody who's coming from an Asian culture, it's not just that those behaviors might reflect poorly on you as an individual, it's very much and very directly, directly that those behaviors reflect poorly on you, but also more importantly, they reflect poorly on your family and on your ancestors and on your community as a whole. And so, when you have that in the background, you know, the, the level of comfort that you might have in discussing those issues is gonna be very different. 

JD Kalmenson:

Wow, that's so much to carry on one's shoulders when one's trying to get better for them, you know, and engage in in a pursuit of healing. 

JD Kalmenson:

So what do you think the best way to reduce the stigma so that people in these minority cultures will have to deal with not only the shame that they experience as individuals, but ancestor shame? How do we help them feel confident, courageous enough to seek out the help that they desperately need?

Norman Kim:

Yeah. And that's such an important thing that we're, I think as clinicians, we really are struggling with. When I train clinicians, for example, I talk about it as like, your primary job in that room is for the other person sitting across from you to feel like you get them on some fundamental level that you'd get them, you get their experience, you get what their struggle is. And I think this is part of that too, that, you know, based on the kinds of questions that you ask based on the fact that you're asking about this, for example, as something that might be a part of someone's experience, I think that in and of itself can be extremely validating.

And, and that level of validation is gonna be terribly important to get somebody over that, that hump of feeling that level of shame. Because if somebody else can kind of see you in that and somebody else can kind of understand what you might be struggling with that is, you know, that level of being seen is, is just terribly important. You know what, there's, there is there are some really, really good people around the world working on, you know, what sort of is the antidote to shame. And Kristen Neff here in the United States, for example, talks a lot about self-compassion as, as an antidote for shame. And I think that's about as good of a, of a construct as I've come across.  You know, if you think about shame in, even in like a classical sense, there's, there, is shame is about sort of how some perceived others looks at you, right?

And what kinds of judgements they might be making about you. Well, if, if that sort of other, is kind of what shame means, and the opposite of that, the answer to that has to be has to be some level of feeling compassion towards yourself, giving yourself, you know, grace, for lack of a better word, right? For what you might be struggling with. And that's, you know, if you think about sort of our culture at large, that's not really a message we get too much of. We don't get too much of a message about to treat yourself well as a, as a good as a, as a value. You know, treating yourself well is something we tend to actually sort of minimize, especially I think in, in America, especially in western culture, it's not something we, we tend to, we tend to put at the, at the top of lists.

Now, I will say that I think what gives me a little bit of hope in much of this is that younger generations, especially those, you know, young folks going into the workforce now, and we've seen this really over the last two years. I think this younger generation has been, first of all, much more much more open and much more vocal and much more showing much more vulnerability and talking about their own their own, especially mental health issues and mental health struggles. I think seeing a lot of, sort of, a lot of like, you know, musicians and, and athletes also talking about this, where of the younger generation has made a big impact. But I'm hoping there's a cultural shift happening where we start to, we start to, we do start to prioritize self care, and we do start to prioritize, you know, just treating ourselves better than we have been and not sort of you know, I I imagine sort of certainly my generation of, of messages that we were getting about, you know, you kind of work yourself as hard as you can work yourself, but that there's virtue in doing that.

Yeah. There's virtue in sort of doing hard things for the sake of doing hard things. And not to say, say that those aren't good things to do in some cases, but I think part of that messaging has also been that, you know, prioritizing yourself, prioritizing your own mental health, prioritizing, taking care of yourself has taken a back seat, I think, to our detriment. 

JD Kalmenson:

Yes. And I couldn't agree with you more. I mean, the, like you said, the good news and the reason why we ought to be cautiously optimistic and hopeful is because the truth is that the fact that in mainstream society, mental health is being de-stigmatized and people in great positions of power and influence for the first time being open and vulnerable about it, it will have an impact even in these smaller ethnic communities. Because the way I see it, at least within the Jewish community, it is that, you know, whatever happens in the world at large, it just takes a longer period of time, but slowly it does begin to infiltrate and change mindsets and public opinion and, and general cultural trends. It just takes longer for a it to seep through. And I would assume that would probably be like that in, in a lot of minority communities that, you know, it just takes a little bit longer, but it ultimately does have, its, its effect. 

You know the idea of normal functioning or optimized living and, and using that as a baseline for what, you know what we ought to strive for. And then the polar opposite of that being, you know, a lack of norm normative living, you know, dysfunctional behavioral lifestyle. Do you find in your research that those parameters or those posts are different based on different cultures and, and, and different, you know, community’s perception of what normal and what not normal really looks like?

Norman Kim:

Absolutely. I mean, I mean, normal is, normal is always relative, right? There is not there's, I I think it's more nuanced, certainly if nothing else in, in minority communities, just because you have, you know, we all get sort of the same message from the majority community about what normal and what the default ought to be and what, what that ought to look like. And then, you know, if you belong to a community that's not part of that, that majority community or whatever that might mean in a particular case your own community then also has rules for what's considered normal, like what the goals ought to be, how people are ought to be. 

JD Kalmenson:

Any examples come to mind?

Norman Kim:

Sure. even the first thing that comes to mind is, so, you know, most Western cultures, for example, most Western European culture you know, are cultures that we would characterize as being individualistic in their focus, right? So, all of the developmental psychology that I learned, the be all end all of development is individuation. It's in, you know, everything sort of values, things like independence, you know, especially in America where, where like the pick yourself up by your bootstraps, kind of, that's the whole frontier spirit and the founding of our country, you know? So I would say that's a big cultural value in certainly Western European societies and, and certainly in America. I think people who come from many other cultures certainly, you know, Asian cultures, African cultures but I think, you know, many Jewish communities as well, where there is a much more collectivistic notion of how one ought to be and how one ought to exist, where there's much more you ought to, you ought to put the needs of your community first as opposed to yourself.

You ought to put the needs of your family or your neighbors or, you know, whatever that community might mean, that's supposed to come first. And if you have to if you have to put your own needs aside in order for that to happen, then that's what you need to do. And I think there are, obviously, there's no, there's no one way that's, that's best in any kind of absolute sense. I do think there's a tremendous amount of value to both, you know, you see, you see innovation being driven by an individualistic kind of culture. But, you know, I think there's a certain lack of maybe empathy that's also part of that individualistic focus. 

And so, there is the flip side of that, of collectivism sometimes can be a little sort of closed offness where everything then needs to happen within your community. And that certainly happens with mental health issues. Like there are many, many collectivistic cultures where you're not supposed to go outside of your community to talk about mental health struggles. You're supposed to keep it within your group. And oftentimes that that limits the kind of, you know, treatment options someone might need. If there isn't somebody within their community, or if, you know, there are many problems for which, like, you know, community leaders aren't necessarily equipped to help you. You really need a professional to help you. But if that's not something that's okay, based on the rules of a particular community, that's a big reason why so many people tend not to get tend not to go seek treatment. 

JD Kalmenson:

That's so true. And it, and it's so important to keep that in mind in the treatment process, you know, knowing that whether they belong to a more individualistic culture than the treatment plan and what the standards of, you know, of, of functionality and living have to be reflected in very much within their individual lifestyle versus, you know, on a collectivist level you know, bringing those factors into the treatment can really help and lend a degree of efficacy, understanding the unique needs of, of the client that's in, that's in front of us. You know, and, and so, so I guess the, the, the, the, the real question that comes to mind as a follow up is when we talk about diagnoses and interventions, so will interventions really vary based on the specific culture? In other words, whether we're treating depression or trauma, or whether we're treating bipolar, would you say that certain interventions work in a more effective way for certain populations, you know, as opposed to others? Or would you say that as a whole the interventions are gonna have similarity, it's just how you present it, how you package it, and how you integrate it with that specific client's narrative and storyline?

Norman Kim:

Yeah. I, I think it's much more the latter. I think it's much more that for a number of important reasons. I think first of all, it's an open question whether all of these interventions that we routinely use, especially in, you know, things like eating disorders, things like addictions or, you know, many behavioral health issues, there are, there are sort of a you know, there's sort of a set of interventions that most people use and you tailor it to a given individual. But you know, it's, it's a, from one program to the next, most of the sort of menu of options that we draw from tend to be relatively similar. But, you know, the applicability of all of that to all groups or the, whether all of those interventions are equally effective for all groups is an open question, because we don't have the data to tell us one way or the other.

I think what that tells us is that you know, given that there's no sort of one thing that everyone does better on or everyone does better with, it does come down to how we apply it and the ways in which we apply it, and all of the other non-specific aspects of therapy that, and we have decades of research that tells us that all of the non-specific aspects of treatment are extremely important.

We just don't tend to spend as much time thinking about those aspects. We get kind of locked into, you know, we're gonna do X, Y, and Z, and, you know, you see this disorder, we're gonna do this approach, et cetera. Because that's how we're trained to think about things. I think it's, it's much more time consuming, obviously, to try to take a person, not just as an individual, as a patient, but as an individual, as a patient in the context of like what symptoms they're exhibiting, but also thinking about them in the context of culture and thinking about them in the context of, you know, their life and their family and their broader community. And those are, in many ways, the more important questions that we ought to be asking ourselves as clinicians.

JD Kalmenson:

Yes. Yeah. I mean, one of our, an example that comes to mind of what we're talking about is one of our past podcast guests that told us about how schizophrenia is dealt with in some African cultures. And I have not verified this independently, but he said that it's seen as an intrusive spirit that needs to be extracted. And many times, after a ritual exorcism is performed, the person feels cured of the disease. So, if somebody with that belief system, which in the western world, we don't currently have a definitive cure for schizophrenia, where to be treated in the US they would probably be prescribed you know, with medication to help deal with the symptoms now.

Norman Kim:

Absolutely.

JD Kalmenson:

How would you, you know, what would, in your opinion, what would be the optimal way of, of, of treating somebody who comes from a culture with a very different set of beliefs than ours, and that set of beliefs may actually help them in their healing path and process that sort of contradicts what our views of contemporary science have to say about the issue? You know, what would, what would be your take on a, a scenario like that?

Norman Kim:

Yeah, yeah, that's a great example. And, you know, you could see that going either way. Like you could really see it being, you know, here, here's a culture that doesn't recognize something like schizophrenia. So they do this approach instead. And you know, and maybe it works or maybe it doesn't. But the other way that you could think about that scenario is that you know, it's either, maybe it is some sort of culturally defined syndrome that we're just not used to seeing in the West, or we're not, we're not used to assessing in the West. And this is a perfectly valid intervention because if the person feels better, they feel better. I, I think it comes down to so much of it comes down to knowing what you don't know, and based on, based on that sort of introspection, and based on that understanding of your own biases and your own sort of your own where you might be lacking and in knowledge or experience, then, you know, if you know that you don't know something, then it, it becomes a course of what are the relevant questions to ask?

Do you, you know, do you have to find somebody who has an expertise in that particular African culture, for example, to help provide you with some context for these behaviors? But if you don't start from some standpoint of humility, of understanding, I, you know, I'm, I only know what I know, and there's this whole world of experiences that I don't know, that I don't know about. Then, you know, of course the obvious thing is I need to go seek information from somebody who is an expert in that, in that area, or that particular culture. I can guarantee you the vast majority of clinicians don't do anything close to that. Most of us will try to fit it into, and I say us because I truly mean us. I mean, I'm, this is how I've been trained as well. Most of us try very hard to fit it into what we already know, and then, you know, sort of proceed from there, which is why so many people end up being misdiagnosed mistreated in many cases in, in large part because of these kinds of cultural mismatches. 

JD Kalmenson: 

Yeah, that makes a lot of sense. You know, we in our organization, so we have one, a dedicated towards addiction treatment, and another one towards primary mental health. And you know, what I've, an interesting thing that I've seen in the addiction treatment space is that a lot of clients who come even with very strong cultural backgrounds and for minority communities, because they're facing death and looking at it in the face, there's a certain universality to the human condition that they feel very comfortable tackling in the addiction space. Whereas with the primary mental health, they're really trying to figure out how to elevate their normative living, which invariably is going to include trends and you know, prevalent themes and sentiments of their culture. So, it's almost like in the addiction space, I feel that there's a certain willingness for even folks who are coming with very strong cultural biases and, and perspectives to put that all aside because they see this, this is life and death, and people really connect and bond over that within the treatment space. It's a fascinating phenomenon that I've seen. 

Norman Kim:

I do think there's a universality, at least as far as we understand it, there is a universality to you know, I think all of us desperately need a connection to something bigger, whatever that might mean to you. And, and a connection and, and some sense of purpose, some sense of meaning to what we're, why we're doing what we're doing. And when that's absent, it's an extremely painful way to exist. So, you know, if, if anything we can do to help somebody get connected to that I think we're, we're certainly doing them a service. You know, you bring up an interesting contrast because I, and, and I know what you're saying. I think something that's happened extremely well in the substance abuse community is that the way that, that the substance abuse treatment has kind of evolved.

It's, it, you know, I think because of the influence of 12 step programs and the nature of 12 step programs, there's sort of this automatic kind of communal nature to that struggle. You're right, the whole idea of identifying yourself as an addict, the whole idea about seeking support from peers, having sponsors, et cetera it's, it's not something that really exists to the same degree with, with most other mental health issues or most other mental health all syndromes. And, and I think there's a tremendous power to that because it taps into that sort of, that profound socialness that we have as a species, and it, it feeds something positive in that it can certainly feed it in a negative way as well. But in general, I think it feeds something positive in that. And you know, there's an automatic sort of identity that comes along with it. There's an automatic sense of at least belonging to this community of other people who are struggling with addiction. And it's, it's not something we've really managed to replicate in too many other spheres. And it's, it's one of the things that I've always been impressed with in a, in a substance abuse world.

JD Kalmenson:

Right. Right. That's so interesting. Let's, let's just turn to eating disorders for a moment because we, we, I would love to talk all day, but we do have limits on the time. So regarding that, you know, your experiences in the eating disorder of community. Have you seen certain communities in certain you know, cultures impacted by the rising rates of eating disorder? Have you seen that more prevalent in some over others?

Norman Kim:

Absolutely. So, you know, historically, and this isn't like that far in history. I mean, we, this is, that's the way that I was trained in grad school for most of my professional life. You know, we looked at eating disorders, those disorders that primarily impacted upon, you know, relatively privileged young white women. You know, that that is, that is the picture of who has an eating disorder. We didn't necessarily think it impacted on women of color, for example, or other groups. Now, in the last, I would say 10 years or so, we've gotten much better, at least within the eating disorder community, in raising awareness about the fact that eating disorders certainly can look different from one person to the next. That it's not just sort of the, you know, thin, young white woman kind of picture that we might have. We've gotten good at understanding that eating disorders impact upon people from all sorts of communities, eating disorders, impact upon men, the eating disorders impact people living in larger bodies.

There are all sorts of ways in which the stereotype just doesn't fit. And that's all backed with, with epidemiologic data that we have. I think what's not caught up with that is, are, are a couple of things. One the understanding that even disorders impact on, for example, on women of color at the same or greater rates than they do in among their white peers. You know, that's important for a number of reasons. One is that means that we need you know, we ought to have more appropriate assessment measures, more appropriate treatment approaches, more appropriate treatment programs with that understanding. And we don't, it ought to mean that we have more clinicians who come from varied backgrounds so that they might be able to better, better be likely to work with, with clients from diverse backgrounds. And we don't have that.

it also means that there are all of these sort of more societal inequities that get magnified when we talk about treatment. You know, eating disorder treatment, it tends to be extremely expensive. It tends to be extremely, extremely involved involves multiple disciplines, you know, multiple, and much of it often is not always covered by insurance. So all of the societal inequities that we have that disproportionately impact upon communities of color are then magnified with something like an eating disorder. So you have, you know, black and brown women, for example, who are struggling with this illness at the same or greater rates than their white peers, and yet they have significantly less access to services. And even when they get access to services, those services are not necessarily gonna be culturally adapted or appropriate for them. So it's a significant systemic barrier, systemic set of barriers that that people face. And so, you know, from that standpoint, you know, many communities of color are, are not, not nearly getting, getting the services that they need or the or the or, or the state-of-the-art kinds of services that they need.

JD Kalmenson:

Yeah. Gosh, I wish more people would, would hear you speak, because this would really help so many of these communities that are not having ac the correct amount of the correct access to the services that they desperately need, and in general, that the treatment is not, is not nearly as effective as it could be given these sort of the wide array of cultural components. I mean, even if there was just a greater sense of education in the you know, in the, in the formal process of acquiring your, your licensure as a clinician, as a doctor, that would I'm sure help so much giving a little bit of a of a background on that. But I wanna thank you for sharing your expertise with us and taking the time today, Norman, it was thought provoking and immensely enjoyable. Thank you for joining us on today's episode of the Discovery U Podcast. How can people, people find out more about the work that you do?

Norman Kim:

They can certainly contact me at the institute websites. It's anti-racismandequity.com, and they can find out more about the kind of consulting education work that we do there. 

JD Kalmenson:

Great!  

And thank you audience for joining us today. I hope you enjoyed today's episode of Discover U, and that it gave you new food for thought. At Montare, we want you to know that you're not alone on your journey. And to find out more about our innovative treatment programs, you could find us at montarebh.com, and you can listen to our podcast on iTunes, Spotify, or wherever you get your podcasts. Wishing all of you vibrant health and a safe and peaceful day. See you next time.