Clinical Care in Environments of Hyperdiversity: Race, Culture, and Ethnicity in a Post Pentad World

I investigate how staff members and patients in psychiatric clinics understand and invoke notions of race, culture and ethnicity, and how these understandings are affected by institutional forces such as the culture of medicine and demographic forces such as immigration and increasing racial, ethnic, and cultural diversity. I argue that in many social settings, a different, more complicated form of diversity exists that goes beyond the U.S. Census-based pentad of racial and ethnic categories. These settings are composed of members of all major racial/ethnic groups (white, black, Hispanic/Latino, Asian, Native American), but are increasingly composed of individuals with a variety of other meaningful identities that don't easily match up with the official American system of racial and ethnic classification. I refer to these settings as "cultural environments of hyperdiversity.";Theoretical models in sociology have assumed that race and ethnicity would strongly figure in such "hyperdiverse" social environments, and particularly in health care settings where racial and ethnic disparities in care are thought to at least partially be a function of discrimination. More recent scholarship has challenged this view, showing that other forms of boundaries can be important modes of social distinction. My findings support this view. In the clinics where I studied, race and ethnicity were not always the most important mode of classification. Instead, institutional factors such as the culture of medicine and the political economy of care combined with the particular exigencies of daily practice to form a series of micro-emergent cultural categories such as "rowdy-one," "street-type patient," or "druggie patient" that became prominent modes of classification. This was reinforced by the complex social diversity among the patient and staff populations. With so many different groups present, the lines between them increasing blurred, and the cultural diversity among individuals within groups, racial and ethnic boundaries were harder to maintain, allowing alternative patterns of distinction to emerge.;I develop this argument on the basis of 192 qualitative interviews with staff members and 50 interviews with patients in five psychiatric hospitals in Greater Boston. I also rely on ethnographic observations during fieldwork in two inpatient and one outpatient psychiatric clinic.