Social Injustice

Key social issues/phenomenon disproportionately impacting on Black and Minority Ethnic communities.

Trauma Informed Care & people of colour

“If you are silent about your pain, they’ll kill you and say you enjoyed it”

Zora Neale Hurston

There are different kinds of wounds. Not all pain is deemed legitimate. Oppression causes trauma. Amidst the (fairly) obvious, debates around what really constitutes trauma as laid out in criterion A of the Diagnostic Statistical Manual (DSM)’s diagnosis for Post Traumatic Stress Disorder (PTSD); are alive and well. Criterion A now requires that an individual has been ‘confronted with: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence’ in order to qualify as having experienced trauma. In contrast with the DSM-IV and previous versions, the DSM-V notably includes sexual violence but not racial violence…troublingly evoking the fight for racial justice.

Looking back in history, (white) women’s rights have always taken precedence over the rights of people of colour. For example, in the US white women were afforded the right to vote in both state and federal elections in 1920 but, it was only in 1954 that people of Asian heritage could vote and; well into the 60s that measures specifically designed to bar African Americans from voting (e.g. voting taxes, literacy tests or intimidation) were rendered unlawful. The recognition of racial violence and injustice historically takes much longer than the recognition of sexual violence. It is important to bear that in mind. With some luck, we may get some intersectional thinking within mainstream mental health systems within 50 years.

Still…many of us continue to exist under the weight of racial (and intersectional) violence and more critically; continue to be affected by smaller, less extreme but repeated traumatic experiences. They rarely involve threat to life or to the integrity of our body but, they nonetheless create threat to livelihood, affect life course and limit life chances. They may not cause us to be confronted with overt violence, all the same, they create unsafeness and insecurity, pain and, a sense of futility and resignation or helplessness. Often too, they lead to internalised silencing or self-censorship due to repeated experiences of denial, invalidation or minimisation.

I am amongst those who believe in speaking of our pain.  As marginalised people when we are silent when violence is done to us, we offer a hiding place to perpetrators and to oppressive systems. Oppression and abuse often create a felt sense of shame. And, shame thrives in silence. This is also how oppressive systems reproduce themselves, they locate the pathology, dysfunction or anomaly within those they harm. We do the master’s work when we internalise these (projective) beliefs. Moreover, when one cannot speak of the violence they experience or have experienced, they are done violence all over again. Silence is violence. Often.

Insidious trauma

There is nothing new in considering oppression as a traumatic agent, nothing new at all. Feminist scholars have long critiqued DSM conceptualisations of trauma. Many have advocated for a theoritical expansion so as to locate the experience of trauma within socio-political contexts. The concept of insiduous trauma is born out of this scholarship. Insidious traumatisation (Root, 1992) is centred on the daily ‘subthreshold’ traumatic stressors marginalised people experience which, when taken cumulatively, amounts to trauma because they are constant reminders of one’s precariousness and unsafeness in the world. Some feminists have sought to include insidious trauma within PTSD criteria or put forward conceptualisations of oppression-related psychiatric disorders.

Understanding insidious traumatisation is vital. Nevertheless, I am not sure that some sort of pathologisation parity is required or would be helpful. Nor that pathologising responses to trauma more generally is desirable. This is not because I uphold a hierarchy of suffering or injustice or, because I think, insidious trauma necessarily produces dissimilar physical or psychological reactions to more ‘classic’ traumatic events or experiences. I am simply not convinced that the legitimisation of the psychological harm of racial violence should be via an extension of the DSM/psychiatric classification systems; systems that are based on alleged ‘deviation’ from unpacked and unproblematised norms (and let’s be real which themselves have a long history of doing violence to marginalised groups and indeed may easily be charged with actively living up to that legacy) when being deemed ‘abnormal’ and treated as such in the world is, by definition, the root cause of insidious trauma.

Trauma Informed Care?

When a traumatic event is extreme or when we are able to identify a specific event, it is easier to see and recognise the need for support and care. When the damage is done covertly or more subtly over months, years or decades or; when it is part of the fabric of society culturally or ideologically, it can be much more difficult to attend to our suffering or to legitimise the need for support; even to ourselves. Such violence becomes the norm and our responses the pathology, our inability to cope. Smaller but repeated acts of denigration, of discrimination, of othering; constant reminders of structural inequalities and injustices do culminate into significant psychological distress. The evidence is there. There is nothing abnormal or deviant in survivors. The deviance lays in the violence.

There has been a global push towards what is often referred to as Trauma Informed Care (TIC). Various definitions of Trauma Informed Approaches (TIA) exist; all have at their core, a will to configure services and/or care around the developmental impact of trauma on all level of human functioning including on the psychological, neurological and on social development. TIA, further; seeks to ensure all social systems understand the impact of trauma on families, groups, communities and other social systems. TIC may be less stigmatising and, there are many benefits to understanding how trauma can affect attachment, worldviews and more generally people’s experience of the world and thus how structures can retraumatise.

I remain cautious though, when it comes to uncritically embracing the approach. I am not sure there is a huge conceptual difference between envisaging people as traumatised rather than as ‘mentally ill’.  For starters, most proponents of the medical model would probably argue that both propositions are not mutually exclusive. Indeed, it is precisely what has been proposed of late ‘there is something wrong with you… (in your brain, your emotional responses, your personality, your perceptions, your cognitive or relational processes etc…) because of what you have been through’. Thus, saying or implying, you are damaged because of trauma is no more humanising as a narrative, to me, than saying or implying you are damaged because of faulty brain structures.

Both explanatory models locate the disturbance or pathology within the individual.  In other words, you are still saying to me that there is something wrong with me as opposed to, there is something wrong with the way that I have been treated and everything ‘right’ in the way I have responded to try to survive. Further, and more importantly, the main focus remains on ‘treatment’ rather than on prevention, at least not on holding structures of power to account.  I have seen very little of this within TIA. ‘What has happened to you’ is infinitely more compassionate than ‘what is wrong with you’ no doubt, better still is asking ‘what has happened to you’ then, turning to oppressive systems and those with more social power; to ask ‘what are you doing to stop harming people’ or ‘how are you abusing your power’. Much more difficult questions of course but, necessary ones to balance the focus here and not lay our gaze exclusively or even primarily, onto individuals who survived violence or try to survive the harm done onto them but onto those who abuse their power, individuals and systems.

Trauma Informed Care and oppression

Psychiatry and mental health systems do not own distress or trauma. Or how it is defined. Or how it is or should be experienced. Trauma is not patented by the American Psychiatric Association (APA). Our experience of the world does not cease to exist simply because a group of white American men at the APA, or dominant systems more generally have decided, the daily violence we suffer is not that traumatic or worthy of a name or of a mention in their (conceptually and empirically flawed) book. Or because mental health systems, by and large, continue to struggle to make themselves relevant to so many of us.

I note that despite the recognition that racism constitutes trauma within most TIA I have come across and, the expressed link between trauma and historical and cultural contexts as one the principles of TIC,  I am still to see a single intervention within the framework specifically addressing the damage of whiteness within any mainstream mental health system in the UK. This, I find quite ironic. Racism reproduced at cultural-symbolic level is a source of trauma too. This invisibilisation or disinterest is consequently quite rich.  There is thus no evidence that TIC would be more relevant and/or more centred on people of colour’s needs or experience. Although the potential that it could is certainly there.

Although I am still ambivalent but open about TIC in relation to people of colour and their experience of oppression particularly, I do believe that we could benefit from using insidious trauma to make sense of our lived experience and to render visible and legitimate, the psychological effects of racial oppression. Although here too, the danger of individualising social trauma by narrowing analytical lenses looms very near indeed, constant efforts are required to avoid this process. Sill, by claiming the term, irrespective of dominant groups or systems’ approval, we are choosing self-definition. We are too, asserting our right and power to define reality. We are choosing to centre our experience of the world and hopefully to orientate ourselves towards self-care. And, to be clear, self-care in my book absolutely entails organising and resisting. History, teaches us that it makes little sense, to seek social approval for our struggles before taking action. Eventually, we tend to be proved right.  TIC and particularly, oppression-focused TIA may well prevent more debilitating manifestations of oppression-related or insidious trauma in people of colour, but the evidence base is simply not there and, I cannot say I have seen a rush for it.

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.)

Root M. P. (1992). Reconstructing the impact of trauma on personality. In Brown L. S., Ballou M. (Eds.), Personality and psychopathology: Feminist reappraisals (pp. 229-265). New York: Guilford.

Thank you for reading.

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Our dreams are political too: individual tears, collective wounds

I don’t often remember the content of my dreams but on occasions I do, vividly. When I do, certainly rarely, if ever, do I remember the specific dates when I had particular dreams. I don’t keep a dream diary, maybe I should… But, there is a date that has stuck in my mind and a dream that has not faded from my memory. Despite sharing some initial thought on this dream and making it available for interpretations via social media as you do… (and via psychotherapy, of course), I feel quite self-conscious about writing this piece. It feels somewhat more personal than usual. More exposing. Perhaps something worth returning to. I had that dream in the early hours of December 29th 2015.

The tears of a friend

My dream was set in France. In the neighbourhood I grew up in. As I walked about, I bumped into an old friend of mine. It actually felt as though he walked into me. I remember him as one of the cool kids. He was also strikingly beautiful both in my dream and in my recollection. He is of Senegalese descent and one might say, a picture of virility. Tall, statuesque, ebony like dark skin, deep voiced and overflowing with charisma and confidence. I had not seen him since we were both teens but we instantly recognised one another. I asked how he was almost confused by the unexpected meeting and he told me his partner, who I also knew had died. Bow-headed, he started sobbing and never uttered another word. He was crying so profusely I felt completely disarmed. Utterly grief stricken.  That is what he was. I put my arms around him and he sobbed and sobbed there. We were in the middle of the street but there was no one else around. He sobbed until I woke up. Shaken.

Making sense of dreams…

The consideration of dreams in therapy has fallen out of fashion, arguably for good reasons. Perhaps this explains my feelings of discomfort too… And, when dreams are considered the political is often overlooked. Perhaps this is unsurprising given the epistemological bases within which dreams tend to be considered in the mental health field. In traditional psychoanalytical theory, dreams are thought to be ‘wish fulfilment’, representation of childhood material or of unresolved conflict which we cannot consciously tolerate. They consequently inform the dreamer and/or her analyst of repressed, unacceptable parts of the self which are to be discovered, decrypted, decoded. Their more public nature is rendered almost irrelevant, if not non-existent. As a result, some have likened dream work to colonialism. With western analysts, discovering the new territories of the unconscious and characterising their local inhabitants as too primitive to inform public or political matters.

Thus, those who may be analytically inclined may focus their curiosity on understanding who my friend might have been representing in the dream. Given that in our dreams we are believed to often see our own desires reflected in others, the most obvious interpretation might be that I was crying through him. That I was processing some unresolved personal grief or trauma, something related to my relationship with my mother, perhaps. Nightmares indeed commonly follow traumatic experiences. They can be a sign that one is struggling to make sense of a situation where our psychological or physical integrity might have been threatened or compromised. As there was nothing which was race or oppression related in the actual (literal) content, an apolitical and decontextualised interpretation of the dream may choose to omit these aspects.

The political content of dreams 

Worth noting however… On December 28th 2015, Officer Loehmann, was cleared of any criminal wrongdoing in the shooting of Tamir Rice. Loehmann was a white police officer in training who fatally shot Tamir on November 22nd 2014 in Cleveland. Tamir was a 12-year-old Black boy. When he was killed, he was playing in a local playground with a toy gun which was mistaken for a real firearm, within seconds of the police arriving at the scene. A wave of outrage, condemnation and protests at what was widely held to be an unreasonable and hasty use of deadly force, ensued. Primarily in the United States but also across the world. On December 28th 2015, Tamir’s death was essentially officially declared to have been caused by his own actions. This was despite the video of the killing and police records evidencing a range of failings and miscommunication. Also worth noting…Tamir reminded me of my middle son, not only because they were the same age, I also thought they looked strikingly alike.

Dream content is affected by the dreamer’s culture and more importantly, by the socio-political context. Consequently, it has a collective a dimension. Existing power relations are a precursor of our dreams and, our dreams are imbedded in power relations. When a woman dreams of being raped, for example, we might interpret that unacceptable repressed sexual impulses might have become fulfilled in her dream. Alternatively, we might consider that her dream may be an attempt by her psyche at trying to process the rape culture within which her life must be lived. Similarly, when we recurrently dream of public humiliation, one might suggest the audience in such dreams to be the dreamer’s own ‘super-ego’, an inner critic signalling disapproval of certain aspects of the dreamer’s life. Or, we might focus on how our collective need for self-esteem is deeply anchored in capitalism and its deriving need for competition. And, consider the latter dream to be a manifestation of the resulting psychological tension.

Like many dreams, mine was one of a meeting.  It was both personal and public. Personal in terms of the intimacy of the physical contact and the fact that no one else could be seen in the dream, and public because we were in the streets. My friend’s physicality sharply contrasted with his emotional state challenging constructions of masculinity and particularly of Black virility. A political issue. The underlying theme was death and associated feelings of grief, sadness, despair but also emotional overwhelm. Those feelings of loss were juxtaposed onto a context of racial injustice. Another political issue. In the material context of the dream, impunity seems to be the most likely response when Black people die at the hands of the state. Some of the people killed are bound to look like our sons and daughters or our sisters or brothers or fathers or mothers or friends… In the material world, the expectation of Black strength and of invulnerability kills and the collective trauma inflicted upon people of African descent is erased yet continually re-enacted so that we are not allowed to grieve and fully experience the injustices done onto us.  The personal does not cease to be political when we start dreaming. Social wounds do get imbedded onto our unconscious. Sometimes we relive them in our sleep and they may connect us to experiences that are more collective.  Perhaps, dream analysis needs to more routinely consider more political interpretations. 

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Beauty as resistance: On marginalisation, style & self-love

 

‘Does my sexiness upset you?

Does it come as a surprise?

That I dance like I’ve got diamonds

At the meeting of my thighs?’

Maya Angelou, Sill I rise.

 

On fashion

I have, for much of my life got attention for the way that I dress. To some degree, this continues today.  I love clothes. This is no secret. I love playing with what the different fabrics, colour and styles can do to the female body form and correspondingly to our psyche and sense of self. I have for long treasured the fantasy of designing clothes. Maybe someday… I learnt quite early and by accident, that there was much power in beauty and in elegance. My days in high school, even during teachers’ meetings were filled with conversations about the clothes I wore. On one occasion, the teachers’ feedback I received from the class representative about my academic performance was: ‘they said you think you’re on the runway’. That had been the only information provided to me about how to improve my grades on this particular term.

Even as a fourteen or fifteen year old, I knew there was something both fascinating and disturbing at play here. Something being contested. There was certainly violence and objectification in the interest so many white adults, primarily females, were paying to my body. But, I could not articulate what is was. Nothing I wore was extravagant. I have never got in trouble for wearing clothes which were deemed too ‘provocative’ or otherwise inappropriate, for example (French schools are non-uniformed generally). I think I just dressed beautifully. Even as a teenager -yes, I am going to say so myself.  And, that this went against expectations. Although I was an unremarkable student on balance, I did well in philosophy and literature and, excelled in English. But this did not capture the imagination the way the dresses I wore did.

The socio-political and historical context

It is interesting to look back at these memories through intersectional lenses and to relate them to the colonial gaze. My high school years were in the late nineties, in the banlieue of Paris. A time and place where many people felt challenged in their identity. Where new generations of French people of colour were starting to assert themselves, demanding space and visibility. This was a time when the social order was much more racialised with migrants and people of colour, by and large, confined to the poverty ridden banlieues and viewed as second class citizen, if at all citizens. And though to date, still, the notion of Black elegance/beauty continues to be controversial, it would have been much more of a challenge to social hierarchies then, particularly in a country that holds elegance and sophistication quite dear to its national national sense of self.

Colonial discourses and its associated voyeuristic fantasised representations of the Other have long promoted the consumption, devaluation and denigration of the black body. Their white supremacist and capitalist agenda spread the view that white people were superior (more intelligent, more socially adept, more civilised, & generally more sophisticated) than ‘indigenous’ populations. The promotion of white-cis-hetero-patriarchy has been central to the binary construction of femininity with, on opposite poles of the ideology, purity, grace and beauty arbitrarily accorded to white women and at the other extreme end, depravity, bestiality, androgyny fixed onto constructions of black womanhood. The ante-femininity. And, of course, conceptualisations of femininity only arose out of the need to assert (toxic) masculinity and manhood and to reinforce white men’s power.

Colonialism is directly engaged here. We are essentially talking about dynamics which occurred during the migration and settlement of populations from former French colonies and their children. The arrival of the colonial Other…Though colonial ideologies may seem absurd to most of us today, their legacy can still be felt. Constructions of beauty and femininity are intrinsically linked and, such constructions have always been central to systems of domination and marginalisation. They are strongly linked to privilege and can facilitate or deny access to structures of power. It is not coincidental that ‘low rank’ women (and people more generally) have been socially constructed as less beautiful, graceful and that correspondingly, elegance and style have for long been characteristics reserved for the more socially powerful groups.

Beauty as the ultimate resistance?

And so, the alleged lack of femininity of disabled women, Trans women, poor women, elderly women and women of colour continues to be used to dehumanise and marginalise. Watch how, for example, women with the above identities and who challenge implicit notions of ugliness eg. Beyoncé and Caitlyn Jenner, are acclaimed or over-consumed. Marginalised women reclaiming beauty may be dismissed as vain, self-centred or as manifestation of internalised oppression by those whose appearance more closely resemble Eurocentric beauty standards and who are privileged enough to see themselves represented and in mainstream media, folklore, literary, artistic manifestations and outlets. Such analyses are nevertheless reductionist. Black scholars including Maya Angelou have written about the importance of style and beauty as means of defiance and self-actualisation.

In Still I rise, she powerfully articulates her capacity to connect with her beauty and her eroticism. Qualities which despite violent erasure attempts, remain.  Maya Angelou evokes the misogyny and racism, contemporarily and historically, that she and generations of Black women before her, have endured. Yet her poem is one of triumph: they have survived. Indeed, not only have we survived, we are thriving and gaining strength, beauty and power not despite but because of racial adversity. Though this may challenge common wisdom around the hierachisation and posited pyramids of human needs, there is a long history of marginalised people seeking affirmation through beauty. Black artists and others, for example have used fashion and style as means to resist oppression, for centuries. From the slaves who took particular pride in their appearance and beauty by dressing in their Sunday best, to the dandies of the Harlem Renaissance and the Sapeurs, of central Africa during and after colonisation.

These efforts were never simply about vanity, narcissism or emulating the master. They have always been about politics, about challenging colonial narratives about self-affirmation and self-definition. I have recently heard about the work of a human right activist who described how Muslim women in war torn Bosnia used beauty to resist war.  Wearing lipstick during the conflict had become a way for them to assert their humanity. This activist recounted the story of such a woman who had spoken about how important it was for her to die beautiful and that if she was to be killed by a sniper, she wanted her killer to know that he was putting to death a beautiful woman. Few domains exist where marginalised women can feel valued and take control of how they are represented. The subornation of our needs is socially expected and as part of that, self-negation and self-hatred are viewed as standard.

Marginalised women are bombarded with messages that explicitly or implicitly state that they have little to no value and that they are worthless.  This breeds feelings of helplessness and resignation in the face of injustice and, thus serves the status-quo.  To love oneself as a Black woman is ‘to love blackness’. This, according many theorists including bell hooks, is dangerous and threatening in a white supremacist culture.  bell hooks refers to self-love for Black women as a ‘serious breach in the fabric of the social order’. The ultimate power for any marginalised woman and indeed any woman of colour may accordingly be to reclaim beauty. Doing so has always been central to liberation praxes. It buffers the impact of racial injustices and of marginalisation. At its most fundamental, caring about the way we look, is caring about our body and by extension, our life. It is rejecting notions of inferiority and inadequacy. It is proclaiming I believe I am entitled to love and thus, to justice and equality. It is quietly saying I am a human being. Like you.  Perhaps, this is what so many, have a hard time accepting.

 

Maya Angelou

 

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Clinical Psychology and The Equality Act: The potential case for indirect discrimination (PART1)

Indirect discrimination and the Equality Act

Employing NHS trusts and (university based) clinical psychology courses share the legal responsibility to ensure that no unlawful discrimination occurs at any stage of the training process, this includes indirect discrimination (the present article will focus on race). Further, clinical psychology training arrangements are covered by employment and higher education jurisdictions both of which are subject to the Equality Act (2010) also referred to as ‘The Act’.  According to the Equality and Human Right Commission (EHRC, 2011), indirect discrimination exists when a provision, criteria or practice which is applied similarly across groups has the effect of putting individuals with a protected characteristic at a particular disadvantage and that criteria, provision or practice cannot be justified as a ‘proportionate means of achieving a legitimate aim’.

Although ‘disadvantage’ is not defined in law, the EHRC proposes that anything that a reasonable person would consider to be a disadvantage would be deemed disadvantageous in court/tribunal.  As examples, the commission lists the following as disadvantages: the denial of opportunities or of choices, deterrence, rejection or exclusion.  Similarly, ‘provision’, ‘criterion’ or ‘practice’ are undefined within The Act but, it is suggested that they should be interpreted widely so as to include both formal and informal arrangements and may thus cover admission onto courses, courses’ arrangements and their delivery.

Once disadvantage has been established, the provision, practice or criteria can only be deemed justified if they are not otherwise discriminatory and represent a real and objective consideration.  In the context of clinical psychology training, examples of legitimate aims might include the need to maintain academic standards or to ensure the health and safety and/or welfare of students and/or service users.  Nevertheless, even if an aim is legitimate, the means of achieving it must still remain proportionate (EHRC, 2011). Proportionate in this context means ‘appropriate and necessary’.  ‘Necessary’ however, does not mean that the provision, criterion or practice is the only possible way of achieving the legitimate aim.  In summary, the EHRC helpfully concludes that the more serious the disadvantage caused by a discriminatory provision, criterion or practice, the more convincing the justification must be for a defense to succeed.

Some potential implications for recruitment and selection

The potential for indirect discrimination on the ground of ‘race’ may become clearer by following the key steps which may need to be taken for such a claim to succeed.  The first step would be to clearly identify the provision(s), criteria/criterion or practice(s) equally applied to all relevant students/trainees or applicants.  The next, would entail establishing that the provision(s), criteria/criterion or practice(s) put students sharing a protected characteristic (e.g. applicants from specific minority ethnic groups or from the general BME population) at a particular disadvantage in comparison to those who do not share that characteristic (e.g. White British applicants or applicants from other minority ethnic groups). Naturally, in court/tribunal any claimant would also need to demonstrate that they have suffered the disadvantage in question. Crucially, the final step would be to establish that the said provision(s), criteria/criterion or practice(s) cannot be justified objectively.

There is no question that some on-going practices in terms of selection to clinical psychology training may disadvantage BME applicants as a group (or some sections of it).  For example, there are strict restrictions on the degree class applicants must achieve to be eligible to apply for training so that those with a 2.2 or low 2.1 are not generally considered. It has been argued that although distinguishing between applicants of similar aptitudes may challenge the fairness of the recruitment process at interview stage, at earlier stages of the shortlisting process the reliability of recruitment methods may be more robust. Others have attempted to justify the minimum criterion of the a 2.1 standard on the basis that clinical psychology training entails the undertaking of academically demanding studies and the completion of a doctorate degree. These arguments do appear to have face validity.

Nevertheless, as far as is known, there is currently no published empirical study or statistical information to support the predictive validity of such criteria in terms of both training and practice outcomes once qualified. Yet, there is a strong and growing body of evidence documenting real disparities in degree classification attained between different ethnic (and socio-demographic) groups with some groups of BME students considerably less likely to obtain first class and upper second class degrees, ‘the attainment gap’. Consequently, it is highly likely that the academic criteria described above would indirectly discriminate against some BME groups. Could such potential discrimination be held legitimate?

Minimum criteria may indeed need to be set to manage the vast number of applications however, in relation to the responsibilities imposed by The Act; one wonders whether this practical consideration may objectively pass the proportionality test.  Further, although there is no doubt that recruiting applicants who are able to sustain the demands of training and become competent clinical psychologists would constitute a legitimate aim, some difficulties may be encountered if we cannot objectively demonstrate that a real difference in terms of abilities to complete training and to fulfil the role of a Clinical Psychologist exists between applicants who may have achieved a 2.1 and applicants with a 2.2, and/or between those who have achieved a low 2.1 and those who achieved mid 2.1; particularly as class differences between degree attainments can depend on less than one percent difference.

For these criteria to be deemed essential and for the objectivity test to be met in court/tribunal, a real rather than a perceived difference may need to be established. Differences amongst courses in terms of academic entry requirements, (although those have reduced notably over the years), may further problematise the reported objectivity or necessity of these criteria and the defence that they help to maintain academic standards. Entry tests for all candidates who meet the “minimum” entry criteria are increasingly being used as part of the selection process.  These tests do have the potential to reduce the risk of indirectly discriminating against some groups of applicants provided that they have robust validity and reliability. Further, they may only be justified legally if they possess sound psychometric properties with scores clearly related to subsequent performance on a training programme, and indeed more problematically, once qualified, to work performance (naturally criteria used to select who is invited to sit such tests also need to be justified…)

Some research suggests that in comparison to their White counterparts; BME applicants are less likely to meet the ‘relevant experience’ criteria.  Additional evidence suggests that BME applicants may be less likely to have held Assistant Psychologist or Research Assistant posts, yet, it seems relatively common for such experience to be deemed ‘more relevant’ on the premise that it will give potential applicants more realistic views of the demands of clinical psychology training. This may be an interpretation of the competency-based assessment, which requires applicants to demonstrate developmental “readiness”. It is proposed that the same reasoning in terms of indirect discrimination could be applied to this practice/criteria whether formally or informally applied and; that it may fall foul of the Equality Act (2010), unless of course it can be objectively justified as a genuine requirement to perform the clinical psychologist role.  Again, inconsistencies across courses as to what experiences may be deemed more valuable/acceptable and the fact that there is yet no evidence suggesting that applicants who have held more ‘traditional’ roles fare better in training and in employment may also indicate that such criteria is not essential and thus that scoring those who can demonstrate it higher/or not shortlisting those who do not meet it, may be unjustified.

Conclusion

The validity and reliability of assessment methods is a serious challenge that the profession faces, not only in relation to selection, but also in terms of course assessment procedures.  Although arguably the latter may be less problematic as long as assessment tasks are properly mapped to the HCPC Standards of Proficiency, the legal framework for registering as a clinical psychologist, the influence of racial bias and indeed indirect discrimination may present real risks here too. To help establish that current practices are ‘justified’ it may be helpful for the Clearing House to systematically monitor applicants’ prior experiences in relation to ethnicity and ‘race’ (and other protected characteristics), for courses to document training outcomes in relation to degree classifications and prior experiences and, for the psychometric properties of entry tests to be established unequivocally. That there is currently limited data on which to base meaningful national analyses may well increase the risk of successful claims for indirect discrimination.

DISCLAIMER

This piece presents a lay person‘s reasoning and perspective. I am NOT legally qualified and do not intend the present article to constitute legal advice.

Acknowledgement

Simply to acknowledge the late Professor Malcolm Adams for his comments and support in writing the article which inspired this post.

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Psychiatric diagnoses: does forcing a medical framework onto people problematise informed consent?

Informed consent and clinical psychology

 

Informed consent underpins everything we do as psychologists.  It is an essential ethical principle.  Whether we assess, formulate, intervene, evaluate or carry out research. Irrespective of our skills or level of experience ethical dilemmas will arise and, resolving them defensibly, to the best of our abilities, is a central part of our practice.  Regardless of the setting, client population or type of intervention, we are bound to have to make decisions engaging multiple and conflicting ethical principles often, not easily reconcilable.

 

Seeking meaningful consent involves informing potential or actual clients of the basis for our intervention and its rationale. Sharing theoretical and empirical underpinnings and, explaining the anticipated process and possible challenges. Though we may not routinely explore challenges to the core assumptions underlying our practice most of us would, hopefully, routinely explain to clients that our model or our way of working is one of many ways of deriving meaning and of supporting people.  

 

As such, we are in a very privileged position.  We are not wedded to any school of thought/therapy or worldview. In theory. This allows us to work with clients using their own explanatory model (s) and attribution style and to some degree, adapt our practice accordingly.  Further, because we (usually) use formulations rather than diagnoses to co-construct the meaning of the experiences that have led people to our doors and to make sense of their distress, we can work from multiple epistemologies. In theory.

 

Outside the therapy room, things are less malleable. For example, if someone is diagnosed with psychosis, it won’t matter much how they formulate or make sense of their distress when they are out in the real world.  In the real world, this diagnosis will be documented onto their medical notes.  Their personal explanatory model (s) or story may matter even less to the people who hold the most social power. Their psychiatric label will likely take precedence over much else.  This is because in the real world, bio-medical explanations are still considered real and are the norms through which human experiences of distress are categorised. Still.

 

Meanwhile in the real world…

 

Thus, it matters very little that one might have been and continues to be oppressed or that one might have been repeatedly abused. This is background or additional information to the core issue that one ‘has’ depression, psychosis, a personality disorder or any other psychiatric diagnosis.  So, when looking for a job, most potential employers will ask ‘have you suffered from/received treatment for any psychiatric illness’ or something along these lines. Such occupational health questions would typically be closed, inviting a ‘yes’ or ‘no’ answer. There may be space to elaborate or to even enclose a formulation done in therapy but, it would not stop many employers considering those who answered  ‘yes’ potential liabilities in terms of sickness absence and think twice about making/confirming an offer of employment (though this may be unlawful).

 

Nothing of course forces anyone to disclose a psychiatric diagnosis but, failure to do so may not only deprive people of potentially valuable support, it may leave vulnerable individuals succeptible to accusations of breach of trust and confidence and/or of dishonesty; should it later emerge that  information related to their psychiatric ‘history’ was withheld.  In addition, of course, the additional stress generated by having to worry about the ‘truth’ coming out needs bearing in mind. I became sorely aware of the limits of informed consent when I was asked to sign a discharge before my son could have surgery.

 

Informed consent and adverse events/consequences

 

The discharge listed the main risks and potential complications from the surgical intervention. It made clear that I was consenting to the possibility of adverse events both short and longer term by signing the discharge and allowing my son to have surgery.  The discharge made no mention of the risks associated with the other options available or of any cost-benefit analysis in relation to the alternative interventions. However, there had been some pre-operative discussions around alternative treatments and the no treatment option upon which the surgical team was relying when presenting me with the information focussing on the intervention at hand. This experience got me thinking.

 

True informed consent can only be given if clients can compare the risks and benefits of each and every course of action available to them and consider them in the short, medium and long term. Typically, when people access our services they have already been diagnosed or are suspected of having some form of mental ‘illness’ (suspicion alone carries consequences, especially if recorded). This is documented onto their medical notes as a matter of course. But does this practice not amount to forcing a medical framework onto people’s experiences? And if so, does it not problematise informed consent; if patients are not made aware of the of the risks and likely adverse consequences associated with having such a diagnosis?

 

Though by the time people get to us their health records have already been amended, they may not necessarily have been made aware of the (medium to long term) impact of being diagnosed with a psychiatric ‘illness’ particularly those seen as more ‘serious’ or ‘enduring’.  They may never have even heard of alternatives to diagnoses or been made aware of their significant empirical and theoretical limitations. How might we argue then that those diagnosed have given their full informed consent?  Isn’t it odd that patients are often given the choice as to whether they want their health records to reflect that they have had a pregnancy termination, sexually transmitted diseases or other stigmatising conditions/interventions but that such consideration is not routinely given to those with mental health problems?

 

On consenting for stigma

 

Given the very real, serious and debilitating consequences of stigma and discrimination, isn’t it ethical to seek fuller consent and as part of that, to give patients a choice as to how they make sense of their distress; including within their own health records? In the mist of our distress we may not have the headspace to consider such questions and of course some people may simply not have the capacity to assimilate this information or to decide.  However, upon recovery, for the majority who did/could, the reality of having been diagnosed with a psychiatric ‘illness’ may hit home.  People may well find that the psychiatric diagnosis they were given matters. That it matters enormously.  At which point of course giving informed consent will no longer be an option.

 

Thank you for reading.

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When the oppressed turn into oppressors: Parenting & internalised racism

The privilege of being lighter skinned

I am a lighter skinned Black woman. I am light enough to benefit from shadism but dark enough to still be accepted as Black. A uniquely privileged position. Throughout my upbringing I have received messages in my environment that this made me more desirable, more worthy, and/or more significant than my darker skinned counterparts. These messages were both covert and overt and articulated in the home and outside the home, at school, in the media etc… Pretty much everywhere.  There is no doubt that I was, at times, spoken to in kinder voices or treated with more patience than my darker skinned peers or sisters by both people of colour and by White people, all things being equal.  In time, I have learnt that my femininity and womanhood would be more easily accepted.

That my humanity would be slightly less frequently questioned.  Giving birth to a darker skinned girl forced me to revisit some of these unearned privileges. It brought home to me that because I was and would be treated with more consideration; my daughter would invariably be treated in more problematic ways, more often.  I had to grieve over the fact that whatever little respite and refuge my lighter skin had afforded me, it would not be enjoyed by her, that I had not transmitted these privileges to her. This was painful. It was scary too. The thought of her going through even more hardship because of the darker shade of her skin was difficult to come to terms with.   It led me to wonder about the role of parents in the process of internalisation of racism.  It also made me confront my own internalised racism.

Parenting and internalised racism

Some see internalised racism as one of the most common yet least studied feature of racism.  The subject is fraught with taboo, shame and avoidance leading to many misconceptions and unmet psychological needs. Most people of colour would have grown up in houses within which the narratives of ‘working harder’, ‘being smarter’, were repeatedly enacted. ‘You have to be twice as good as your White equivalent to simply be deemed good enough to stand underneath him/her’ or words to that effect will likely resonate with many non-Whites.   Similarly, it is not unusual for Black parents to mirror (consciously or otherwise) the harsh treatment society befalls onto Blacks males. To respond with punishing harshness to any lapse in conduct or behaviour, particularly those associated with racial prejudices. Out of fear that negative societal expectations and the dreaded stereotypes may materialise.

I have on occasions caught myself looking at my sons’ behaviour through the contemptuous gaze of society.  Perhaps too I have in these moments responded more harshly than necessary in an effort to help ensure my boys would not fall victim of others’ prejudices. I have seen young children whose skin had been lightened. In some families, children may be socialised to avoid partnering with darker skinned individuals or taught to distance themselves from their minoritised or cultural identities or to put the needs and experiences of White people above their own.  Though in good faith, the violence contained within such parenting practices is worth reflecting upon. In essence in our efforts to compensate for racism, we socialise children into injustice, compliance and complicity and instil a sense of inferiority in them. In doing so we may limit children’s scope to be themselves. We may reduce our capacity to respond to them with compassion and kindness. We may attend to stereotypes of what our children could be or could be seen as, rather than attending to them as unique beings. In a nutshell, we may contribute to racism’s self-fulfilling prophecies, perpetuate racial inequalities and more worryingly, may increase their risk of psychological  distress.

The perpetuation of oppression is everyone’s business

Nevertheless, it would be ridiculous to blame or demonise parents for their wanting to increase the survival chances, privileges and life opportunities of their children or to prepare them for the racism they will encounter so as to minimise its effects. Internalising racism is adaptive.  It is no pathology.  It is no personality, genetic or biological flaw. Nor is it the consequence or evidence of inferiority in the oppressed.  So where does it originate from and what function might it serve?  Foucault proposed that the construction of reality through the production of ideologies or knowledge is controlled by the dominant group and circulated throughout society. This construction is posited to inform social norms, common sense and all aspects of organisational and structural life.

The fundamental consequence of such knowledge transmission is that the interests of the oppressors are presented as actually reflecting everyone’s best interests so that those who are oppressed come to internalise the dominant group’s interests as their own.  The ‘double bind’ experience has been used to make sense of internalised racism. It refers to the illusionary and implicit promise by the dominant group that oppressed groups can escape the consequences of their otherness by disowning their ‘difference’.  It lures racial minorities into agreeing to the very rules which Other them. In essence, the double bind exclaim: ‘become more like us and you too will have access to structures of power, you will become one of us’.  A tempting proposition for anyone, particularly for racialised parents eager to shelter children from the impact of racism.  The trouble however is, that achieving the promise of the double bind is impossible. This is because the construction of a superior class is dependent upon the existence of an inferior one.

Making internalised racism and its manifestations the problem of racialised groups is a further act of violence. This  equates not only to victim-blaming but also to erasing the very fact that the dominant group remains both the primary beneficiary and source of such internalisation. It is akin to saying ‘you need to be like us to be human or not to be Other’ whilst similarly positing ‘trying to be like us is evidence that you are not human or that you are Other’.  A ‘lose lose’ tautologically absurd proposition.  Being a parent is the toughest job on the planet.  Parenting in the mist of oppression and marginalisation is even harder.  Perhaps it is time that we collectively stopped shying away from internalised racism and gave it the clinical and empirical attention it deserves.  For mental health professionals this would naturally entail sharing a little bit of power and giving away some privileges. The privileges of not knowing, of not understanding or perhaps of not wanting to understand.

Thank you for reading.

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By challenging racism: could we actually be perpetuating it?

The Function of racism

‘The function, the very serious function of racism is distraction. It keeps you from doing your work. It keeps you explaining, over and over again, your reason for being. Somebody says you have no language and you spend twenty years proving that you do. Somebody says your head isn’t shaped properly so you have scientists working on the fact that it is. Somebody says you have no art, so you dredge that up. Somebody says you have no kingdoms, so you dredge that up. None of this is necessary. There will always be one more thing.’ Toni Morrison

There seems to be two different kinds of people when it comes to dealing with experiences of racism or at least two main types of response.  On the one hand, we may react; indeed we may make it a point to react. People who react tend to be those who argue, who wish to demonstrate the folly of racial prejudice to those who utter offending comments. These may be principled people, conscious people, and/or rational or reasonable people.  People who may feel that they have an ethical or liberatory obligation to respond, to correct, to evidence or to have their voice and experience heard.

On the other hand, there are those who seemingly chose not to engage, those who ignore the offensive or bigoted comments or theories or who seem to turn a blind eye to them. They either appear to take no notice or seem not to care.  Naturally, most of us oscillate between these two poles and may spend much time somewhere in the middle.  Many believe that speaking out is an intrinsic part of the liberatory process.  That it is absolutely necessary and indeed that being silent amounts to complicity, to letting people off the hook and in doing so, to contributing to the perpetuation of oppression.  Not everyone however, is aware of the emotional demands of both challenging and being silent.

Reinforcing racism

Though mindful of the courage both positions require and of the potential material risks and perils associated with challenging racism, it has always felt as though there were higher psychological costs to being silent.  I had too been certain that in the longer term, gains in terms of equality and dignity could only be achieved if we spoke individually and collectively. Thus, for long, speaking out seemed a pre-condition to tackling racism. Tony Morrison’s quote somewhat challenges this position.  It proposes that such actions serve the function of racism.  Whilst she posits that distraction is the core function of racism and we may or may not agree, one issue I will reflect upon here is whether responding intellectually or emotionally to racism may be in the interest of those directly impacted upon by racism.

So, what if actually, some or all of our actions to combat racism actually perpetuated it, inadvertently?  I am aware that this is often a defensive premise which may be advanced by those with social power who are unwilling to contemplate the thorniness of the subject matter or to sit with their own racism or privilege. But do bear with me… As is plain to see from the above quote, Toni Morrison does not believe that expanding energy rationally disproving racist claims is necessary. Doing so according to her is futile because there will always be one more claim to disprove. I believe doing so is also a lost cause because racism does not belong to the realm of the rational. Critically, challenging racism may also be unhelpful if not harmful…Firstly, from a behaviourist perspective, every human behaviour serves a function.  Behaviours can naturally have multiple functions, some (or all) of which may well be obscure.

The core issue here is that when the function of a particular behaviour is served, then that behaviour will likely remain.  It would have been reinforced thus, maintained.  This is a fundamental behaviourist principle. This simple tenet may have significant implications for how we tackle racism. For example, if the function (or one of the functions) of racist ideologies is to inferiorize people of colour and, people of colour as a result of such ideologies internalise this inferiority, this function would have been fulfilled and racist ‘ideologizing’ reinforced thus likely to be perpetuated. Or, if a function of racist language is to offend or to hurt and, such language does get to us, then behaviourists would argue, the likelihood or such language being used again would have been increased.

Self-care and boundaries 

I am aware the above propositions have the potential of being seen as victim blaming. This is far from my intention. The responsibility for racist and discriminatory acts, in my book, remains firmly in the hands of perpetrator(s). However, if it is or can be within our control to reduce the occurrence or the impact of racism on us, then, we may start to reclaim some of the power oppression robs us of. It is clear to me that the impact (or consequences) of racism feeds into its existence, it is what gives it its potency.  Though I realise this may betray the dim view I have on humanity, my sense is, in a nutshell, that as long as racism works or hurts, it will invariably continue to exist.

This may help explain why in spite of major gains made in terms of race equality, it is quite evident that processes of othering and marginalisation remain and seem the most difficult to address.  Perhaps this is because the hostility, contempt and fear we have for the Other now manifest in more subtle and covert ways. So, if much racial bias and prejudice find their refuge in our unconscious and, become externalised without our awareness, could it be hypothesised some equally unhelpful processes may become triggered outside our awareness, as racial minorities, when we respond, argue, defend, and evidence our humanity, again and again?

Could it not be hypothesised that arguing our way out of racist encounters and discourses may actually also allow something in? And that perhaps, our psychic integrity or boundaries may somehow become compromised?  To challenge a proposition entails a degree of internalisation since we need to hold it in mind to consider it.  When such propositions are hate based and carry with them projections, trauma and violence one may be rightly concerned about potential impact of such repeated internalisation (in addition of course to the more observable psychological and health consequences).  Even though this internalisation may only be momentary, perhaps its potential impact on our psyche, on the struggle for liberation and also on the possible unconscious needs or processes which may get fed ( in those who other us) may need more attention.

Thank you for reading.

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The cycle of oppression: A psycho-socio-cultural formulation (DRAFT 1).

Bringing the social and psychological together

A common critique of mainstream psychotherapy models is that they take little account of social and cultural forces and of their effect upon psychological structures and relational processes. This is a significant limitation in terms of culture competence. Many minority and marginalised groups continue to see mainstream therapy and mental health services as irrelevant.  More concerning is that some may come to experience the therapeutic process as one which exposes and weakens them into powerlessness and; which renders invisible the power of the social context and its related wounds and traumas. It is not unusual for therapists and other helping professionals to feel overwhelmed and helpless in relation to the idea of actively working with social and cultural forces within the therapeutic encounter.

However, any genuinely emancipatory and culturally competent approach to therapy must strive to make visible the impact of oppression and help support service users’ efforts to free themselves from its destructive power relations. Relations that exist structurally, socially and psychologically for people who continue to be othered, marginalised and oppressed.  More culturally and socially informed formulations may therefore offer tools to validate marginalised groups’ experience of the world and thus contribute to change.  Although extremely useful, I have personally been frustrated by purely social formulations which have not commonly highlighted deriving psychological correlates and thus have located themselves within a level of analysis and intervention which may arguably be outside the remit of mainstream psychotherapeutic practice. This post is an attempt at bridging the gap. It provides an introduction to a preliminary psycho-socio-cultural formulation framework (figure A), its rationale and some possible questions to aid reflection.

Figure A:  Draft diagrammatical formulation of the cycle of oppression.

photo (1)

Description of the formulation framework: The cycle of oppression.

At the centre of the draft formulation is a cycle of oppression.  This cycle is made of four interrelated components varying in proximity to the present or to the ‘here and now’.  Those components are: discrimination and oppression, inequality/access to material resources, proximal images/discourses and, distal and intergenerational narratives and events. The oppression cycle is posited to impact on both worldviews and on psychological functioning so that another cycle of psychological correlates is located outside it. The proposed deriving psychological processes are status anxiety and evaluative stress, the internalisation and replication of oppression, the (cognitive) salience of historical traumatic narratives/events and finally the sense of cultural mistrust or paranoia and (affective) distance to the dominant culture. The formulation thus firmly puts the influences of the social and cultural at the centre of psychological functioning.

Discrimination, oppression and cultural mistrust

Perception and experiences of oppression such as discrimination and harassment in the workplace (or in other life domains) are commonly reported amongst all members of minority groups. The link between such experiences and chronic stress, poor psychological wellbeing and ill physical health are well established. Perceived and actual discrimination can elicit what has been termed cultural paranoia, a healthy and adaptive response to experiences of oppression. Nonetheless, cultural paranoia can give rise to feelings of hopelessness, helplessness and bias against members of the dominant groups. It can also produce hyper-vigilance and fear.

It is thus likely that those who are experiencing it to a high level, will be in some form of distress. From the therapeutic perspective it may be helpful to consider how cultural paranoia may impact on trust and on the working alliance. Mental health services are a microcosm that, it can be argued, represents the social world. A service user who expects that he/she will be discriminated against within services or by therapists and/or that his/her account of such experiences will be dismissed, silenced or pathologized will understandably be guarded and reluctant to disclose relevant difficulties. A degree of hostility may become apparent if the therapist is seen as a representative of the dominant culture, the state and/or authority.

How does the Service User (S.U). locate himself/herself, his/her immediate family and distant family culturally and historically?

How does the S. U. define oppression and discrimination?

To what extent has the S.U. experienced oppression and discrimination?

How is sense made of the above?

What part do such experiences play/played in current/past psychological distress?

What has the S.U. found useful in managing such experiences?

What is the S.U. experience of power and powerlessness?

Social/material inequality, status anxiety and evaluative stress

Social inequalities have a significant impact on our psychological wellbeing. On a basic level they perpetuate the uneven distribution of protective factors and of stressful life events. Evidence suggests that more unequal societies tend to suffer from poorer mental health. England is one of the most unequal countries in the world. As consumerism is reaching new heights, the gap between the rich and poor is increasing. The relationship between mental health distress and social inequalities is bi-directional so that each has the potential to exacerbate the other. Additionally, although causality and directionality is not always clear, most marginalized groups tend to be socio-economically disadvantaged.

The psychological consequences of inequalities are central to the psychological functioning of those who are economically and materially disadvantaged. Wilkinson and Pickett (2009) argue that the impact of income inequality is psychologically mediated by ‘status anxiety’ in that inequality creates social hierarchies which increase status competition, stress and thus poor psychological health. Yet, another psychological mechanism that seems relevant is social-evaluative threat (SET). SET is believed to occur when a central component of our identity is, or could be, negatively evaluated so that we fear rejection. Within such potentially rejecting situations our fundamental need for social acceptance is threatened and a discrepancy between our actual and our ideal self is created giving rise to feelings of worthlessness, reduced relational value and/or shame.

How is respect and disrespect framed and conceptualized?

Are there significant debts?

To what extent does the S. U. feel pressure to conform to consumerism?

Is there a discrepancy between the actual economic situation and the idealized one?

Is there access to well established friendships and social support networks?

Is there shame and stigma associated with the socio-economic situation?

Images, discourses and the internalisation/replication of oppression

Unsurprisingly a proportion of minoritized individuals will internalize oppression. Internalized oppression can affect relationships within and between minority groups and between minority group members and those who are from the dominant group. This internalisation may manifest in mistrust toward the in-group, idealisation of the dominant culture, distancing from minoritized identities or the holding of stereotypical views about members of the in-group. Further, internalised oppression can, In extreme cases, lead to low self-esteem, self-hatred and even violence towards members of the in-group.

Assessing internalised oppression can be difficult because it is associated with high levels of shame and stigma and may therefore not be readily disclosed nonetheless; careful questioning may elicit such processes. Thus, any recurrent negative statements made about the in-group(s) may need further probing as may any negative emotion evoked by questions about the subjugated identity.   Various standardised questionnaires exist to assess internalised oppression which may be useful when the therapeutic relationship is firmly established. Acculturation and stages of identity development may also influence the relationship with the dominant group (in addition to the one which may be formed with the therapist) and whether the therapeutic values and norms may be acceptable.

What community/group(s) does the S.U. feel most affiliated with?

Are there difficulties with fitting-in or with belonging?

What is the relationship with members of the in-group(s)/out-group(s) like?

Are there weak/strong cultural or other ties with members of other minority identities?

Is there a history of immigration or displacement?

Is there evidence of shame and stigma associated with the culture of origin?

Historical and intergenerational context and distal narratives and events

Many theorists have put forward concepts that aim to capture the psychological impact of historical trauma on oppressed groups. For example, Alleyne (2004) has proposed the concept of ‘The internal oppressor’. The internal oppressor is theorized to be a psychic part of the self which can become activated when members of oppressed groups are confronted with oppressive situations in their day to day lives so that painful and emotionally charged historical events gain salience in their awareness. Examples of such painful historical events/processes may include the Holocaust for people of Jewish origin, imperialist processes (eg. slavery, colonisation) for other members of minority ethnic groups or the pathologization of homosexuality for some sexual minorities. In essence, the ’internal oppressor’ triggers a process of interpretation of contemporary oppression in light of historical trauma and injustice. This amplifies the distress experienced.

Experiences of oppression can also be reinforced or triggered by public images and media portrayals. Marginalized groups’ representations in the media tend to be distorted. Some groups are particularly prone to misrepresentation e.g. Black males, those who claim benefits, travellers, those with mental health problems and Muslims. A number of studies have identified patterns in media representations of marginalised groups including an overall underrepresentation, an over-emphasis on negative associations (e.g. criminality, unemployment…) whilst at the same time relatively few positive associations. Consequently, public portrayal of minorities tend be one-dimensional, negatively framed or problem focussed. Biased representations leave out significant aspects of minoritized communities’ lives, contributions and experiences.

What historical and contemporary narratives has the individual been exposed to?

What impact have such narratives have/have had?

Are there alternative/competing stories?

How are negative images/discourses managed?

Has there been exposure to positive role models from the subjugated identity group?

Is there shame and stigma associated with negative images/narratives?

Conclusion

This post is a first attempt at putting together a formulation framework that is based on a social explanatory model but which also identifies possible deriving psychological processes upon which potential psychological interventions may be based. The framework is not married to any school of psychotherapy. It simply aims to offer a possible starting point to reflect and consider relevant socio-cultural forces, their possible psychological impact and potential interactions.  I do not see praxis and social change based epistemologies as incompatible with psychological interventions particularly if they are located within a social model of psychological distress. In fact I believe that both are necessary to facilitate resistance and liberatory efforts. The diagrammatic formulation is based on common themes and theories related to oppression and inequality as well as some relevant empirical findings.  Although the framework may be most useful when applied to racialized minorities, it may equally be helpful to support other marginalised groups. I welcome comments and feedback which will allow the improvement and further development of the tool.

Thank you for reading.

If you have found this article useful or interesting, please spread the word.

All work published on Race Reflections is the intellectual property of its writers. Please do not reproduce, republish or repost any content from this site without express written permission from Race Reflections.  If you wish to repost this article, please see the contact section for further details.

 

What to learn more? Please see…

Alleyne, A. (2004). Black identity and workplace oppression. Counselling and Psychotherapy Research, 4(1), 4 – 8.

Dickerson, S. S., Gruenewald, T. L., & Kemeny, M. E. (2004). When the social self is threatened: Shame, physiology, and health. Journal of Personality, 72, 1191–1216.

Hutchinson, E. O. (1996). The Assassination of the Black Male Image. New York, New York: Touchstone.

Rowlingson, K. (2011). Does income inequality cause health and social problems? York: Joseph Rowntree Foundation.

Wilkinson, R. and Pickett, K. (2009). The Spirit Level: Why More Equal Societies Almost Always Do Better. London: Penguin.

Wilkinson, R. and Pickett, K. (2010). The Spirit Level: Why Equality Is Better For Everyone. London: Penguin.

The impact of difference PART 2: The silent influence of Cultural Capital.

A renewed momentum?

I have made no secret of the fact that clinical psychology training has been fraught with challenges, many unexpected and most related to difference. The Division of Clinical Psychology is currently drafting its first ever Equality & Diversity strategy which emphasises the necessity to increase cultural competence within clinical psychology. It seems quite topical then to further the reflections first laid out (here) within the first part of this article and to start to explore some potential mechanisms which may bear an influence on professional processes. In the next few posts of this series, I will ask the reader to consider more implicit or tacit variables and their potential impact in terms of difference. I start here with cultural capital.

The influence of prior experience

Having 6-12 month relevant experience prior to applying for training is an essential criterion for all clinical psychology courses. In reality however, due to the competitive nature of the recruitment process and for most, the resulting need to apply more than once before obtaining a training place, most successful applicants would have worked a number of years prior to being accepted onto the doctoral course. Forming realistic views of the demands of clinical psychology training and of clinical psychology as a career prior to embarking onto its demanding (and costly) studies is naturally of crucial importance to applicants, recruiters and funders alike.

Nonetheless, some inequalities have been noted in the acquisition of relevant experience. In comparison to their White counterparts for example, BME applicants appear less likely to meet the ‘relevant experience’ requirement. Some evidence also suggests that applicants belonging to minority groups may face some additional difficulties securing assistant psychologists (AP) and research assistant (RA) posts, a key barrier, it seems, in terms of training accessibility for such groups. It still appears that those who have followed more traditional routes in terms of ‘relevant experience’ remain more likely to be accepted onto training.

Although there could be various mediating variables involved (including differences related to reference, degree classification, supervision, previous experience of psychologically informed clinical work etc.), there seems to have been no systematic study scrutinising the impact of past professional experience. I have therefore been curious about the potential influence of less visible, softer but possibly more insidious factors related to the above and, been wondering about the possible impact applicants and trainees ‘prior professional experience may bear upon their professional socialisation and in term of recruitment and assessment outcomes.

Professional socialisation and cultural expectations

Becoming a clinical psychologist necessarily entails the assimilation of in-group worldviews and the adoption of certain ways of thinking, speaking and ultimately being. For applicants and trainees who have held traditional roles, this professional socialisation would have been initiated well before their application for training. On the other hand, those who may have acquired their ‘relevant experience’ outside clinical psychology teams may not have or not have to the same degree, been socialised into presenting, communicating and indeed thinking the way clinical psychologists do (or at the very least as they are expected to).

But, is such socialisation necessary for candidates to successfully complete clinical psychology training or in other words, are there essential attributes that are acquired or believed to be acquired, during this socialisation? Could it contribute to perfectly well qualified applicants being assessed as less suitable for training? Is sufficient attention presently paid to differences in presentation which may be related to past professional socialisation and which may be further complicated by candidates’ cultural and social origins? There is currently no empirical basis upon which to base firm answers to the above questions.

However, there is an extensive body of empirical evidence demonstrating that we are more likely to like, to recruit and to support people who we perceive as being ‘similar to us’. As someone from a ‘different’ cultural and social background and with a relatively unusual professional profile, I have experienced first-hand the violence of normative expectations within training. It has been incredibly difficult to draw a line between such cultural norms and the assessment of some competencies. I have secretly harboured the hope of becoming able to distinguish with certainty the essence of clinical competence from the ‘fluff’ of cultural norms and expectations although; I recurrently question the feasibility of such a task.

Cultural Capital

Bourdieu and Passeron’s concept of cultural capital may be helpful to consider the potential difficulties which may come to light in assessing those who are ‘different’. Cultural Capital refers to the collection of symbolic elements such as tastes, posture, dress sense, mannerisms, etiquette etc. that one acquires through being part of a particular social group. Sharing similar forms of cultural capital with others such as the same taste in music or the same worldview is believed to create a collective identity and a group position in relation to others. Critically, differences in cultural capital are believed to be a major source of inequality in that they can help or hinder one’s social mobility.

This is because some forms of cultural capital are valued over others and in particular the possession of the dominant culture as capital often translates into access to wealth and to structures of power. In that sense, it can be said that the more familiar one is with the dominant culture, the more cultural capital one has. The education system is posited to assume that pupils possess the same cultural capital (as those from upper and middle ‘classes’). This is one of the reasons children from lower socio-demographics backgrounds may face particular disadvantages to succeed in the education system.

The relevance of cultural capital

Bourdieu has at times been criticised for the lack of precision of some of his concepts, nonetheless, his emphasis on the non-material/economic resources possessed by socially privileged groups is noteworthy and has generated much theoretical and empirical literature within education and occupational fields. I am not aware that the framework has formed the basis of any empirical studies within professional psychology nonetheless; differences in cultural capital may be important to reflect upon in relation to current inequalities of access to the profession.

The concept invites selectors and assessors to be on the look out for ways in which dominant capital (here White and middleclass) may become normalised at systems level and therefore expected during recruitment and assessment. The framework is not only useful to consider the ways non-traditional applicants may be disadvantaged through not having acquired the expected (professional) cultural capital on their pathway to training, it also encourages us to consider the tacit knowledge which may escape those who diverge from the typical White English middle class clinical psychologist (who also tends to be female, heterosexual, and able bodied).

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Want to learn more?

Please see…

Bourdieu, P. & Passeron, J. C.(1990). Reproduction in Education, Society and Culture. London: Sage Publications.

Division of Clinical Psychology (2014). The Alternative Handbook for Postgraduate Training Courses in Clinical Psychology: 2014 Entry. Leicester: British Psychological Society.

Hemmings, R., & Simpson, J. (2008). Investigating the predictive validity of the Lancaster DClinPsy written shortlisting test on subsequent trainee performance: Final Report to the Clearing House. Doctorate in Clinical Psychology: Lancaster University.

Phillips, A., Hatton, C., & Gray, I. (2004). Factors predicting the short-listing and selection of trainee clinical psychologists: A prospective national cohort study. Clinical Psychology and Psychotherapy, 11, 111–125.

Scior, K., Bradley, C. E., Potts, H. W. W., Woolf, K. and Williams, A. C. (2014). What predicts performance during clinical psychology training?. British Journal of Clinical Psychology, 53: 194–212.

There is no racism in clinical psychology: Personal reflections from another Black trainee.

This article asks whether the majority ethnic group may have a tendency to dismiss experiences of racism. Considering my lived experience, I reflect on some processes which may become engaged when racism is evoked and propose some potential implications for clinical psychology.

Subjective realities and embodied experiences

When individuals speak about their experiences of racism, they are often challenged about their interpretations and encouraged to consider more ‘objective’ reasons which may account for the behaviours or words that caused offense or hurt. Invariably, as there are multiple ways to interpret events, particularly in the realm of human interactions, experiences of prejudice and of discrimination can easily be discounted. Such dynamics are well documented and I, like other Black and minority ethnic (BME) trainees have encountered them in Training. Navigating a racist society may equip individuals from racialized minorities with the ability to recognize subtle pre-verbal and para-verbal cues of racism.

This embodied apprehension of prejudice may be the result of inner adaptations to the external reality of racism yet, it can easily be dismissed as it may not lead us to easily verbalise our experiences. There have been repeated calls for increased cultural competence within clinical psychology but, trainees continue to be socialised into rhetorics of social and power awareness. Diversity indeed commonly features within our professional discourse. A ‘better than’ position may be adopted whereby racism and discrimination become minimised and eventually envisaged as being ‘out there’ rather than ‘in here’. Being able to remain oblivious to the experiences of those who are racially subjugated and deny responsibility for racism may be the hallmarks of White privilege.

Expectedly, following experiences of racism from a supervisor, I painfully reflected upon my experience before alleging that the supervisor was prejudiced and racially offensive. When my concerns were raised, they were instantly discounted. I was interrupted in my account then coached into considering other possible motives for the conduct. The differential treatment and offending words did not provide ‘evidence’ of discriminatory intentions. Nevertheless, when the same supervisor questioned areas of my competence and intelligence without evidence, an epistemological shift occurred so that the supervisor’s perspective and judgement alone became sufficiently evidential. Meeting a positivist threshold was no longer necessary.

Managing cognitive dissonance

It is well documented that people tend to use prior beliefs to interpret personal experiences. This is the essence of Cognitive Dissonance Theory. Festinger (1957) posited that powerful motives to maintain cognitive consistency often give rise to irrational or unhelpful behaviours and that when excessive dissonance is produced intellectual defences can be triggered. Such defences may manifest in the refusal to accept the discomforting information, or in unduly questioning its validity. Refusing to consider the possibility that racial prejudice may indeed have been involved within the supervisory relationship, may help protect the safety of existing assumptions and truths whilst unabling a reflexive consideration of privilege. More disturbing perhaps, may be the implications that the purported competence/intelligence deficiencies seem to have been accepted in the absence of supporting evidence. Cognitive Dissonance Theory would posit that prior beliefs or worldviews were therefore not disturbed in this instance.

The denial of racism

Behaviours displaying overt prejudice are now relatively rare. They have been replaced by more covert forms of racism. Such behaviours although more subtle have been posited to betray deeply rooted prejudices. When BME trainees have spoken about their experiences of training, experiences of both overt and covert racism have been documented. The latter may be met with more scepticism however, when potentially painful and/or anxiety provoking information is instantly rejected, one may suspect that some level of denial may be at play. Denying racism may indeed serve multiple functions. Institutionally, and it may help avoid liability for potentially unlawful acts. Socially, it may be part of a strategy of positive in-group presentation and demonstrate adherence to social norms and values. Moreover, such self-presentation, may also serve to defend the in-group as a whole or its dominant discourse.

Thus, the failure to fully hear, document and investigate race related concerns may be interpreted as reiteration of the professional consensus and public discourse: ‘there is no racism in clinical psychology’ or ‘we are not racists’. This social denial has been theorised to also fulfil an individual defence. ‘She is not racist’ may therefore mean ‘I am not racist’ whereby staff rather than empathising with the trainee’s distraught come to identify with the supervisor accused of racism. This interaction between the institutional, social, and individual may make accusations of racism highly discomforting. Possibly more so than the potentially discriminatory acts complained of. To discharge such discomfort; counter-accusations are usually made e.g. ‘playing the race card’, ‘having a chip on the shoulder’, ‘being paranoid’, ‘being oversensitive’ or indeed ‘jumping to conclusions’.

Individual and/or institutional racism?

In the mist of scepticism and cognitive ‘reframing’ attempts, my distress became invisible. I was left with little support. Engaging with the pain might have shifted ‘the gaze’. Perhaps I was being punished unconsciously. Trainees, who challenge racism may be at risk of being ostracised, dismissed or penalised. The McPherson enquiry uncovered institutional racism within the police force which it defined as:

‘The collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racial stereotyping’. (McPherson, 1999, 6.34)

Although this definition is not without problems, it does offer a framework to reflect on how systemic and unintentional discrimination may become manifest within institutions. The independent enquiry into the death of David Bennett found institutional racism within the psychiatric system, including persisting race inequalities, the widespread use of stereotypes and of particular relevance here, failures to take allegations of racism seriously. Its recommendations led to the ‘Delivering Race Equality in Mental Health’ programme. The action plan came to an end in 2010 thus; race inequalities may have fallen down the political agenda. However, they remain. In this context of suffering and alienation, BME service users’ experiences of racism continue to receive little empirical and clinical attention. Perhaps parallels may be drawn.

Final Reflections

Although multiple versions of events and reality can and do co-exist, the most privileged amongst us may have vested interests in maintaining oppressive biases which locate truth where power is and assure that only those with power can define reality. The inter-connection between agency and systemic structures may mean trainees from racialized minorities are at risk of being silenced and dismissed in their experiences. It was to help ensure that they have a voice that I created ‘The Minorities in clinical psychology Training Group’. Indeed, in the context of continuing challenges in recruiting a more representative workforce and enduring difficulties in adequately serving BME communities; a failure to pay close attention to such voices may not only deprive the profession of opportunities to better understand and meet the needs of service users from traditionally marginalised groups, it may leave clinical psychology vulnerable to accusations of institutional racism.

Thank you for reading. If you have found this article helpful or interesting, please share it with others.

Want to learn more?

Please see…

Adetimole, F., Afuape, T., & Vara, V. (2005). The impact of racism on the experience of training on a clinical psychology course: Reflections from three Black trainees. Clinical Psychology Forum, 48, 11-15. 6.

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Department of Health (2005). Delivering Race Equality in Mental Health Care, Department of Health: London.

Fanon, F. (1967). Black Skin, White Masks. London: Pluto Press.

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Patel, N. (2004). Difference and Power in Supervision: The case of culture and racism. In Fleming, I. & Steen, L. (Eds.), Supervision and Clinical Psychology: Theory, Practice and Perspectives. Hove: Brunner-Routledge.

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Van Dijk, T. A. (1992). Elite Discourse and Racism. Discourse and Society 3(1): 87-118.