The insult

The incident

The narrator tells us:

“I was going to start my 4 month´s internship in the psychiatric hospital Sct. Hans in the Capital area. As part of the preparation, I was going to attend a number of encounters with the supervisors:

Firstly, I would attend an introductory meeting in the form of a group session with the clinical supervisor from the hospital and my practical supervisor from my school.

Secondly, I would attend a follow-up meeting with the clinical supervisor shortly after the first meeting. In this meeting we were going to clarify the mutual expectations for the internship.

Thirdly, after 2 months, I was going to have a group meeting with the two supervisors in order to conduct an interim evaluation of my internship.

When I arrived to the first meeting, the clinical supervisor at the very first presentation asked me, if the local employment or social authorities in my municipality had put pressure on me to conduct this internship. I was surprised and almost speechless, when confronted with this kind of question. But I answered politely and insisted on presenting myself and my background as an engaged and dedicated healthcare student, who had chosen the healthcare education on a totally voluntary basis. I also stressed that I was looking very much forward to fulfilling my internship in the psychiatric sector. However, I got the feeling that she was deliberately provoking me and trying to push me to be irritated – thereby putting my internship at risk. No other trainees were asked similar questions.

Shortly after, I went to conduct my second meeting in order to talk about my expectations. This time, the clinical supervisor opened the meeting by asking, if I had a criminal background. Again, I was struck by surprise. I had to mobilize all my resources in order to answer her question politely. I calmly responded that like all other citizens in Denmark I have a criminal record, and it is totally clean. She would be very welcome to investigate this matter further. Thus, I succeeded in keeping a cool head, not getting emotional about this intimidating interview.

Then after 2 months of internship, I was going to have a third meeting. This would serve as a preparatory meeting shortly before the interim assessment meeting. The third meeting was planned by the clinical supervisor in cooperation with my practical supervisor, who was also present.

He and I had a good relationship, and we had been talking ahead of the meeting about a lot of positive experience from the internship, which was now to be presented to the clinical supervisor.

However, instead of focusing on the actual experience from the internship, the clinical supervisor focused on a completely different subject. She told me that she made research on psychiatric diagnoses for a great many years. She wondered if I may have a diagnosis, apparently such as ADHD (Attention Deficit Hyperactivity Disorder). She asked me, if I had a personal mentor or a good GP who could possibly make a diagnostic investigation.

This time I sat silent for 20 seconds, completely speechless and taken by surprise. Then I tried to consider what would be a wrong response and how to control my anger. I was so incredibly hurt, and I totally failed to understand what she was plotting with these stigmatising and intimidating statements. But then I replied by telling her that this was far too off. How could she possibly have any basis for asking such a question, since we hardly knew each other?

I had avoided to respond at the previous meetings, but this time I became so emotional and frustrated about being categorized and stigmatised as a sick person without any basis in reality.

But, at the same time, I was also very nervous for the reactions, still having 2 more months left to complete my internship. This was, in fact, also crucial for the completion of my entire education. I knew it would be nearly impossible to change the internship. Thus, I decided not to pursue the incident with a complaint. Doing so, I would most probably make a hell for myself in the daily collegiate environment, where complaints and pending cases cause questions, uneasiness and uncertainty. Being in the bottom of the hierarchy, I feared to be blamed and excluded.

In the situation, my practical supervisor also responded to this most unexpected attack, by gently asking the clinical – and superior – supervisor to focus on the positive experience and professional results from my internship. Afterwards, he advised me not to pursue the matter.

Finally, to the interim assessment meeting, she appeared more neutral and positive, even praising my professional efforts and results…”

1. Identities of the actors in the situation

The narrator is a healthcare student, being educated to the Danish healthcare education called Healthcare Assistant. This education has a duration of 3 years and is part of the vocational education system in Denmark. At the time of the incident, the narrator is on his third year and close to completing his education after an internship.

The narrator is 21 years old.

The narrator was born in Denmark of migrant parents. His parents are originally Palestinian refugees, who lived in Denmark for approx. 30-35 years.  Thus, the narrator grew up in Denmark in the second largest city in an area with a huge migrant population. Later he moved to the Capital area, where he is living nowadays and where he conducts his education. He speaks Danish fluently, and he can be described as a very reflective person, being highly engaged in life and events around him.

The narrator is also engaged in issues of equality, antidiscrimination and diversity. Apart from his healthcare education, he is educated as a so called Young Agent/Counselor in the City of Copenhagen. The Young Counselors constitute a corps of young people advocating for antidiscrimination in the vocational training system. Consequently, the narrator is very observant about situations where he experiences discrimination, injustice and lack of equal opportunities.

Apart from the narrator, two other persons were present:

A Danish female clinical supervisor who has overall responsibility for all internships and trainees at the psychiatric hospital in the Capital area, where the incident takes place. The clinical supervisor worked as a trained nurse for many years in the psychiatric system – and possibly also in other fields of the healthcare system. She is presumed to be in her late fifties when the incident takes place, in autumn 2015. From the perspective of the incident, her attitudes towards other cultures and religions seem to be marked by negative presumptions and even prejudices, bordering on discrimination.

Her own cultural-religious reference framework would presumably be that of the ordinary Danish Christian-protestant Church. But a formal attachment to the Christian religion would say nothing about her religious practice in a highly secularised society such as Denmark. Her ethical standpoint and attitudes towards other cultures and religions will sooner be marked by her profession and her social-economical and socio-cultural background.

A male practical supervisor being responsible for the practical and current training of 1-2 healthcare trainees – in this case the narrator. The practical supervisor is also a professional nurse. We do not know about his age, but apparently he is not very old, probably in his thirties. Like the female clinical supervisor, the younger male practical supervisor has Danish origins.

The narrator and the practical supervisor know each other well before the meetings about the internship. We don’t know if the practical supervisor has been in contact with the clinical supervisor in relation to previous internships for other students. This would certainly be a possibility, because institutions for internships are much in demand.

2. Context of the situation

This incident takes place in the office of a clinical supervisor, being in charge of the local internships for healthcare students in a psychiatric hospital in the Capital area. In fact, the incident develops over a series of consecutive meetings in this office.

3. Emotional reaction

The narrator´s most basic feeling and emotional reaction is that he will be judged and “boxed” from general preconceptions and prejudices about young men from ethnic minorities.

He will not be assessed and recognised as an individual human being with hopes, ambitions, resources and capabilities.

He also experiences that no matter how talented and committed he is, he is still assessed from general prejudices and not on his actual performance.

He is experiencing at firsthand how the ethnic-cultural background weighs heavier than the individual human being and the individuality. He is in other words subjected to a strong example of culturalisation.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock

The norms and values of equal treatment and equal opportunities

First and foremost, the reactions of the clinical supervisor affect the narrator’s values ​​of equality, recognition and respect regardless of the individual background. This also implies the value of equal opportunities: when you commit yourself and work seriously and ambitiously to achieve a goal – in this case an education – you should have equal opportunities to pursue your goals regardless of your social, economic and cultural background. Instead of praising the narrator for his commitment to complete an education, the clinical supervisor doubts his commitment and motivation from the very start.

The norms and values of antidiscrimination and room for diversity

The narrator is very observant about situations where he experiences discrimination, injustice and lack of equal opportunities. Based on his ethnicity and upbringing in a ghetto-like area, he has personally learned from childhood that with an ethno-cultural minority background you are, generally, vulnerable to discriminatory behaviour. This also includes the ways of indirect discrimination, where some people meet you with  negative pre assumptions and expectations, even though they do not know you personally. The encounter with the clinical supervisor exposes this vulnerability.

The norms and values of education and contribution to the welfare of society.

The narrator has strongly internalised the welfare state values of providing as best to your abilities and capacities, thus contributing to the general welfare and support yourself and your family etc. it surprises him completely when an authority from the educational system takes his good intentions and ambitions in doubt – thus trying to discourage him instead of supporting and encouraging him in his educational plans and aspirations.

The norms and values of self-control and sober dialogue with antagonists.

Apparently, the narrator learned the academic and dialogical lesson that for previous experience that in arguments you should not get too emotional and lose your temper, if you want to be heard, and if you want to obtain the other person’s respect and recognition. You should keep calm and sober in your speech, even when you are treated unfairly and feel insulted.

However, in this case he is confronted with an opponent acting in opposition of what he expects. Apparently, she takes no account of his good manners.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The impression is that the clinical supervisor is guilty of:

  • Injustice and demotivating behaviour.
  • Negative pre assumptions and prejudices.
  • Stigmatisation and generalisations of ethnic minorities and especially young male immigrants.
  • Indirect discrimination.
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator

Norms, values and reference framework of the clinical supervisor

The clinical supervisor seems to be raised and socialised in the old and more authoritative school, especially the traditional hierarchy of the healthcare system. As one example, she prefers the trainees to give yes/no answers to her assessment questions. Apparently she is provoked by the narrator´s communicative form and attitude, which is characterised by more nuanced and complex answers, where he is also using many explanatory words etc. She rejects his way of reflection and communication by calling him abstract, imprecise and blurry.

Furthermore, her initial questions about his motives for being a healthcare student as well as her questions about his criminal records tends to be offensive, prejudiced and even discriminatory. It seems that she asks questions and makes hypothesis which probably is not common in such conversations with students and trainees as a prelude to an internship.

However, although her behaviour cannot be excused, she may refer to the common experience that the employment service and social authorities in many cases are using the healthcare sector as a “parking place” for long-term unemployed people. This in particular applies to migrants, while the healthcare system also includes short-term education. It is well-known within the healthcare sector that many students in the short-term education are not particularly dedicated to the healthcare professions, being actually forced by authorities in order to keep their social benefits etc.

Apparently, the narrator is confusing the clinical supervisor, while she on one side tends to categorise him from his migrant origins – but on the other side cannot fit him into her general picture of young male ethnic immigrants. According to this pre assumption, he would be living on welfare, criminalised, linguistically restricted etc.

Norms and values of the practical supervisor

The practical supervisor is trying to act as a mediator between his superior, the clinical supervisor, and the narrator, his quite talented trainee. There are reasons to believe that he actually dissociates from the clinical supervisor´s opposition to the narrator. But he chooses to act pragmatically and also pass pragmatic advice to the narrator, probably to spare him from being thrown out of the internship. However, by acting so, he is tacitly maintaining a system, where prejudices and even discrimination can pass without consequences.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

This incident took place recently. Thus, the incident reflects how we would still meet culturalisation in both attitudes and practices in the healthcare system.

This should be seen in the light of the fact that over quite many years the healthcare sector focused on the values of cultural differences and diversity in the sector – and consequently implemented a lot of training among both managers and employees. It is disappointing and alarming to witness that these efforts are still so strongly needed.

Recent research about drop-out among Danish students in the Healthcare educational sector confirms that the lack of motivation only applies to a small group of students. Most of the students are motivated to complete the educational program. However, many of them may not have a realistic picture of what the education entails. The professional, empathic and realistic guidance is strongly needed. The same needs apply to the mandatory internships, where a warm welcome, positive attention and a thorough introduction to tasks and professional expectations are crucial for a successful study.  Especially the personal and relational competences of the clinical supervisors have shown to be of great importance.

Respondents at all levels in this research (both teachers, educational counselors, clinical supervisors and students etc) have emphasised the importance of thorough introductions through preliminary meetings in order to clarify the trainees’ personal issues, skills and need for individual support etc. Truly, this was the mission of the clinical supervisor in the incident. There seems to be a need for good practice instructions for conducting such preliminary meetings.