Racism in Mental Health Prejudice and Suffering

Discussion of racism and psychiatry were quite prominent in the 1970’s, fuelled in part by the greater racial awareness and sensitivity following the peak of the civil rights movement, and increased attention to the impact of social issues on the psychopathology and upon the care of psychiatric patients, at the interpersonal as well as the systemic levels. Race was discussed as a contributor to psychopathology and to psychic distress, by its contribution to the individuals’ subjective experience of the world, and by the way the world/society related to the individual. It was also discussed in terms of its clinical impact at the levels of assessment and diagnosis, the therapeutic process, and the systemic levels of planning and the delivery of care. Racism was seldom linked to immigration status and to culture, (in the sense of Western versus other cultures), but it was more linked to ethnicity and social class, with the primary dichotomy being white versus black. The current book is an edited text of chapters in which eight chapters were fully written and one co-authored by the editor and almost all by UK psychiatrists, writing from the perspective of their knowledge and experience of the issues in mental health among Britain’s immigrant minorities of non-European backgrounds. In the opening chapter entitled “Feeling for Racism,” the author outlines how his ‘raw’ personal experiences of being misidentified and of being the direct victim of racism, stimulated his interest in his topic and led to his writing of this book. This is quite a revealing look into the subjective experience and insight of a very sensitive and reflective person. He comes to recognition of the “violence” of racism, in which, he “soon learnt that whatever I thought my substance to be, whoever I thought I was, this was always quite different from the ascription to which others invested me” and that, “It was easier to be who I was perceived to be, rather than who I was/am.” This condenses a seminal experience of racism. The subsequent five chapters are devoted to the discussion of important theoretical and conceptual issues about: racial discourse; the nature of prejudicial beliefs; psychosocial and psycho political aspects of racism; the legacy of Frantz Franon, and the contemporary representation of racism and mind. Four chapters, including, one by a patient, focus on the individual experiences of racism in the mental health system from both the patient and the clinician perspective. The patients’ discussions and suggestions are particularly poignant. A chapter on the provision of mental health services for London’s ethnic minorities provides a good case study with identification of important issues and suggestions from lessons learnt. The book concludes on a reflective note, about contemporary dilemmas and wise suggestions regarding essential elements that should be included in the future of mental health care, particularly as it relates to a serving of ethnic minorities. The content strongly reflects the importance of racial issues at all levels of serving the mental health needs of the major ethno cultural groups, including the South Asians, Afro-Caribbean’s, Africans, and the Chinese, as well as the outcome of various studies and service delivery approaches to serving these populations. Over all it is a mature and serious reflection on racism as a factor in mental health, that critically examines the British experience, informed by the American experience during the socio-cultural revolution of the civil rights movement and beyond…as well as by careful consideration of relevant ideas from sociology, psychology, and psychoanalysis. It tackles difficult questions such as the definition of ethnicity, race, and racism (which are often thought with demagoguery and circularity). It does not shy away from difficult issues such as the difficulty of justifying the claim of racism and whether the victim may contribute to his own experience of racism. It also addresses the reason for the clinician’s involvement in the process of taking action against racism. In the struggle with these issues and questions, the authors’ very poignantly convey the frustration of the clinicians in dealing with racism in practice. We identify with them, and agree that the elimination of racism may be unachievable. That rather than being a reflection of psychopathology…it maybe a natural human proclivity to divide the world into the other and us, that this has historically dangerous consequences and therefore needs to be raised to a level of awareness and very actively resisted. The current approaches to working with ethnic minorities of “cultural awareness” and “cultural competence,” are seen by the author as a corporate trick to reduce the extra efforts and the resources required to deal effectively with racism in mental health. The strengths of this book include the inclusion of the patients’ perspective. One potential weakness is that there is some unevenness in the level of scholarship among the chapters. But this was less than I anticipated in a multi-authored text on this topic. The book will be of interest, and easily read by anyone working with a multi-ethnic clientele and should be required reading for anyone in the field of mental health. It was gratifying to see that the British have devoted significant resources and effort to this issue, at all levels, including to serious academic study. All Canadian physicians, including child psychiatrists, even though it is not child focused, should read the book. As a highly multicultural and multiethnic society, racial insensitivity, racial prejudice and frank racism in mental health will increasingly surface and demand more open attention. This insight into the British experience might be helpful in this regard.

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