Client Ethnography:

Bonnie Schell interviews Maria Maceira

Reprinted from April 1998 Cal Net Gazette

Q. Maria, when we were sitting in the rain on the hotel patio at the Alternatives Conference, you spoke of there being a Client "Culture." That one idea was magnetic for me. By that I mean experiences, phrases, and observations began to attach to that idea. Can you define what Client Culture is?
Maria: In my opinion, there is a definable/observable set of congruent behaviors, attitudes, beliefs, values, history, habits and customs shared by people in the mental health client communities.
Q. Is that why a mental health client from one state can meet up with one from another state, maybe both with different language, religious backgrounds, yet find themselves bonded?
Maria: Yes, definitely! We are a group of people who by and large at one or more times in our lives have been subjected to heavy doses of neuro-biological medication. So we share the devastation and survival of heavy medication. It affected me in many ways. . .
lack of purpose shame hopelessness
helplessness low self-esteem poor hygiene/poor diet
lack of exercise drug addiction/abuse mental, physical and sexual abuse
Q. Are you suggesting that if I invited you to come speak at our drop-in center about cultural competency, that the important information wouldn't be your ethnic background?
Maria: Please don’t get me wrong. I do believe we have to be equally sensitive to a persons ethnicity and primary language. DMH’s Cultural Competency plan is attempting to address this. I just feel when you are heavily medicated, homeless, experiencing voices, and the other barriers we are faced with, that translating or interpreting language and defining ethnicity will not necessarily bring about safe and secure housing, healing treatment, meaningful employment and/or community education. Our "quality of life" issues must not be ignored, they must be incorporated into the mental health plan in a significant and meaningful way. This is the missing link to Cultural Competency! When I was taking 35 mg of Trilifon, I did not think about the color of my skin. Actually I felt invisible. Truthfully, I could just barely feed myself, or take a bath at that time. I just wanted a safe place to be. . .I was under heavy meds and felt very vulnerable. . . lot of helplessness and hopelessness. I felt that my psych Dr and therapist just had no clue about how this medicine was affecting me. They were content with my just getting by. . . and would assure me that I would get used to it and eventually get better. Did they realize how numb I felt? How much fear I felt? I did not tell them either. I just wanted the basics, a place to sleep, food, and no heavy decisions to make.
Q. Did you not tell them about feeling vulnerable and helpless because you are a woman or because you are.....?
Maria: I did not tell them because I did not understand what was happening to me. I was scared, confused and felt tremendous shame for feeling different. I really don't know if the fear, helplessness and hopelessness was just from the deep process I was in, the heavy medication or both. I do remember the Fog though.
Q. To a cultural anthropologist the whole ritual of being labeled and diagnosed and forced to admit to it and get used to it while in the Fog might look like an initiation into a tribe. The Powerful give you the flat mask, followed by ill fitting layers of clothing over a bloated body, yank your teeth on MediCal, send you out to survive where your watch and identification will surely be taken.
Maria: You are describing our rites of passage into the client culture which I believe are two-fold. First from the devastation due to medication and second from the labels imposed upon us by society. The labels imposed upon us may be potent due to its immediate effect upon our beliefs, attitudes and thoughts about being different. If we are told we are different, we begin to believe it, internalize it, accept it and act it. Medication affects the way we behave and thus the way we think. Both ultimately produce the same effect. Personally, I believe if we expect less, we receive less from society, our community, the mental health system, and from ourselves. These are the ties that bind us together. Through our shared experiences in the culture we have come to see that we are not so different. We are able to better understand ourselves and act as role models in recovery. We know what we need from society and are in a good position to advocate for ourselves and others. But as a person who has been labeled with a mental illness, I personally expect sensitivity, tolerance, acceptance, appreciation, accountability and respect.
Q. So cut to the quick. How would you apply recognition of client cultural competency to service delivery?
Maria: Again it is my opinion that the culture we live with everyday is what the mental health plan should focus on. . . The mental health block grants should be spent on our real issues...
  • homelessness/housing
  • sedation/forced treatment/seclusion/restraints
  • income/nutrition/poverty
  • alternatives that heal without disabling
  • unemployment/meaningful employment
  • discrimination/segregation
  • community education/stigma
  • violence/physical, mental and sexual abuse
  • voices/paranoia/visual&physical&mood hallucinations
just to name a few.
Q. How would our lives be if these issues were really dealt with in a meaningful way?
Maria: Imagine having a home you can afford, not having to worry about the rent, imagine having enough money to buy food for the whole month, imagine having a "real" job that allows all this to be realized, and imagine having treatment you choose and believe in, just imagine. . . .
Q. So is it that social services need to respond to client culture first?
Maria: Yes. I’ll eat the foods that my grandmother taught me are healing if I have a stove and a chair and table. Telling me in my primary language that you can only offer me medication management is not culturally competent, or even competent. Giving me a prescription to take on a full stomach when I have no food is worse than incompetent.