The mental health benefits and costs of critical consciousness: A longitudinal investigation of the co-occurring positive and negative effects of critical consciousness among sexual minorities

Critical consciousness is a powerful tool for individuals from marginalized groups to transcend their oppressive conditions through engagement in critical reflection, motivation, and action. Nonetheless, the mental health benefits and costs of critical consciousness have received limited research attention. The present study utilized a longitudinal research design to explore the positive and negative relationships between critical consciousness and mental health among sexual minority individuals in different developmental stages. A total of 636 sexual minority individuals were involved in the baseline study and were asked to complete a follow-up questionnaire after one year. The results demonstrated a co-occurrence of positive and negative effects of critical consciousness on mental health among sexual minority individuals across time. On the one hand, critical consciousness was associated with better mental health outcomes through the mediation of internalized oppression and community connectedness. Specifically, critical consciousness was associated with reduced internalized oppression, which in turn was linked to lower levels of emotional distress. Critical consciousness was also associated with heightened levels of community connectedness, which in turn was associated with improved well-being. On the other hand, the results revealed a positive direct effect of critical consciousness on emotional distress, after controlling for internalized oppression and community connectedness. Notably, developmental stage moderated the relationship between critical consciousness and well-being. A negative association between critical consciousness and well-being was observed among sexual minority youth, whereas no such association was found among sexual minority adults. While the study highlights that critical consciousness can be a pedagogical and therapeutic tool for the liberation and empowerment of sexual minority individuals, it is equally important to acknowledge the potential risks associated with critical consciousness. Striking a balance between critical consciousness and self-care is crucial for sustaining meaningful engagement in the pursuit of social change.

Oppression and internalized oppression as an emerging theme in accessing healthcare: findings from a qualitative study assessing first-language related barriers among the Kurds in Turkey

BACKGROUND

Language has been well documented to be a key determinant of accessing healthcare. Most of the literature about language barrier in accessing healthcare is in the context of miscommunication. However, it is critical to consider the historical and political contexts and power dynamics underlying actions. The literature in this matter is short. In this paper we aimed to find out how first-language affects access to healthcare for people who do not speak the official language, with a particular focus on language oppression.

METHODS

We conducted this qualitative study based on patient-reported experiences of the Kurds in Turkey, which is a century-long oppressed population. We conducted 12 in-depth interviews (all ethnically Kurdish, non-Turkish speaking) in Şırnak, Turkey, in 2018-2019 using maximum variation strategy. We used Levesque's 'Patient-Centred Access to Healthcare' framework which addresses individual and structural dimensions to access.

RESULTS

We found that Kurds who do not speak the official language face multiple first-language related barriers in accessing healthcare. Poor access to health information, poor patient-provider relationship, delay in seeking health care, dependence on others in accessing healthcare, low adherence to treatments, dissatisfaction with services, and inability to follow health rights were main issues. As an unusual outcome, we discovered that the barrier processes in accessing healthcare are particularly complicated in the context of oppression and its internalization. Internalized oppression, as we found in our study, impairs access to healthcare with creating a sense of reluctance to seek healthcare, and impairs their individual and collective agency to struggle for change.

CONCLUSIONS

A human-rights-based top-down policy shift, and a bottom-up community empowerment approach is needed. At the system level, official recognition of oppressed populations, acknowledgement of the determinants of their health; and incorporating their language in official capacities (particularly education and healthcare) is crucial. Interventions should include raising awareness among relevant professions and stakeholders that internalized oppression is an issue in accessing healthcare to be considered. Given that internalized oppression can be in other forms than language or ethnicity, future research aimed at examining other aspects of access to healthcare should pay a special attention to internalized oppression.

"Don't you care about the well-being of your race?": African American couples discuss racial differences involving criticisms of other Black people

African American couples have unique racial stress and high relationship instability, although few studies have examined the role of racial stressors in their relationships. This qualitative study used grounded theory to examine 10 African American couples' disagreements about criticisms of other Black people. Each couple completed a standard couple problem-solving task modified to focus solely on racial differences between the partners. Two models of couple relationships framed the approach; the general vulnerability-stress-adaptation model (Karney & Bradbury, Psychol. Bull., 118, 1995, 3) was combined with a comprehensive race-focused model (Bryant et al., J. Fam. Theory Rev., 2, 2010, 157). The goal was to understand racial stress faced by African Americans, including its context, how and why it is stressful, how they cope, and its consequences in their relationship. A tentative model emerged, suggesting that some African Americans have early race-related experiences that make them vulnerable to concerns about how Black people are seen by others. This may result in a unique minority status stressor that appears indicative of internalized stereotypes and may often include gendered criticisms of their partners. Partners seem to adapt by looking to other African Americans to take personal responsibility for their behavior and defending their racial group. Black male-female gender role issues appear to emerge as a consequence of racial stress that also seems salient across all aspects of the model. Future studies can further examine culturally specific models involving African Americans' criticisms of other Black people and identify successful couple-level strategies to overcome internalized oppression.

Liberating and Empowering Effects of Critical Reflection on Collective Action in LGBT and Cisgender Heterosexual Individuals

Critical consciousness represents the transformation from a passive target of oppression to an active actor with an increased capacity to analyze and negotiate conditions of oppression. It is considered as an antidote for oppression that can liberate people from oppressive ideologies and empower them to resist social injustice. Building on the theory of critical consciousness and the Social Identity Model of Collective Action, this paper examined the liberating and empowering effects of critical reflection on collective action for minority rights. Results of a cross-sectional study in 1,050 LGBT individuals (Study 1) showed that critical reflection was associated with lower levels of internalized oppression and higher levels of collective efficacy, which in turn were associated with greater intentions to undertake collective action for LGBT rights. Findings from a prospective longitudinal study in 428 cisgender heterosexual individuals (Study 2) indicated that critical reflection was associated with lower levels of internalized domination and heightened levels of efficacious beliefs, which positively predicted actual participation in collective action at a subsequent wave. The findings supported the effects of critical reflection on collective action mobilization and offered leads for future research and praxis on how to orient different sectors of society to work toward social equity.

Structural equation modeling of the effects of racism, LGBTQ discrimination, and internalized oppression on illicit drug use in LGBTQ people of color

BACKGROUND

Experiences with lesbian, gay, bisexual, transgender, or queer (LGBTQ) discrimination and racism have both been associated with mental health problems and illicit drug use. However, the cumulative effects of both forms of discrimination--and resulting internalized oppression--on illicit drug use in LGBTQ people of color (POC) has not been examined in the research literature.

METHODS

Using online questionnaires, this study collected self-report data from 200 LGBTQ POC about their experiences with racism, LGBTQ discrimination, internalized racism, internalized LGBTQ discrimination, and illicit drug use.

RESULTS

Two structural equation models yielded adequate fit indices in which experiences with racism and LGBTQ discrimination led to more internalized oppression, which then led to greater illicit drug use magnitude. LGBTQ discrimination was directly related to increased internalized oppression, which was positively associated with illicit drug use magnitude; the relationship between LGBTQ discrimination and illicit drug use magnitude was mediated by internalized oppression in both models. However, racism and the interaction between racism and LGBTQ discrimination did not show valid direct effects on internalized oppression or indirect effects on illicit drug use magnitude.

CONCLUSIONS

LGBTQ POC can be the targets of both racism and LGBTQ discrimination, although the current study found that the most psychologically damaging effects may come from LGBTQ discrimination. Interventions meant to decrease or prevent illicit drug use in LGBTQ POC may benefit from helping participants examine the links among LGBTQ discrimination, internalized oppression, and illicit drug use as a coping strategy, focusing on substituting more adaptive coping.