Social Injustice

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

Stigma and multiple oppression: Some implications for clinical psychology

A discomforting proposition

I attended a diversity meeting a few weeks ago and although this was not the focus; the on-going underrepresentation of Black and minority ethnic trainees (BME) within the profession was briefly touched upon. I was taken aback and quite disturbed when it was posited that the stigma around mental health issues within BME communities was the reason for the difficulties in recruiting a more representative workforce. This proposition was not elaborated upon and went unchallenged. Instead, it seemed to be taken as a given. It felt wrong. I spent much of the remainder of the meeting considering the proposition and trying to access the logical part of my brain but, such was the level of discomfort I experienced, that I was not able to return to a more rational place and put forward some arguments to challenge the proposition. I chose to remain silent. This post is essentially about articulating a reasoned response to the embodied one.

Could stigma really be a factor?

In all honesty, it was not the first time I had heard stigma put forward as a reason for the lack of diversity within clinical psychology. I have also seen colleagues suggest with much conviction that ‘cultural issues’ were responsible for the lack of Black and Brown faces within the profession. There are various reasons why such notions, which can be stigmatising themselves, may provoke the sort of anxious arousal I experienced within the strategic meeting. It seems those who have put forward the above explanations may not have considered how much of the variance it is suggested, could actually and reasonably be explained by stigma alone, bearing in mind the fact that the acceptance rates for Black and Asian groups are up to thirty times lower than that of White English applicants. Explanations that indirectly put responsibility for inequalities at the feet of disadvantaged groups may act as barriers to curiosity and to more systematic evidence generating.

We have such a wide range of sophisticated research methodologies and much research expertise at our disposal, thus, that so many of us seem quite happy to justify stark and enduring inequalities with reasons that lack precision and/or empirical basis, is in my sense both oppressive and defensive. Indeed this stops us from considering, if only hypothetically, the potential presence and influence of less palatable and more anxiety provoking dynamics such as discrimination (both direct and indirect) and bias (both conscious and unconscious). These processes have after all been widely documented within a wide range of environments and activity sectors. Critically, the above explanations further problematize disadvantaged/marginalized groups.

BME groups are overrepresented in medicine and within branches of the discipline which specialise in mental health such as psychiatric nursing and psychiatry. They also appear over-represented in mental health social work. If stigma (or ‘cultural issues’) were a key variable for such groups’ difficulties in accessing clinical psychology; contact with which is arguably a lot less stigmatising than the above, surely this would not be expected. The ‘Stigma Shout’ survey carried out by Rethink’s research department a few years ago and which is the largest ever survey of people with direct experience of mental health problems on the issue (n=4000), found no ethnic difference on service users’ reports of mental health stigma and discrimination.

Considering the impact of multiple oppression

Of course that is not to say that there is no mental health stigma and discrimination within BME groups, there clearly is. There is mental health stigma within every ethnic group. Thus, like many others, many individuals from BME communities will sadly have negative feelings about mental health services and in addition may show low levels of service awareness. Many will have limited understanding of the signs and manifestations of mental health distress or see psychological difficulties as character flaws. Some would have been influenced by sensationalistic media portrayal of mental health problems and as a result come to believe fallacious associations between mental health problems and dangerosity. It is also true that wihin some sub-sections magico-spiritual explanatory models will be found.

Nonetheless, assuming that stigma may well be a significant factor recruitment wise, it may perhaps be helpful to take our intellectual and reflection efforts further and start being more questioning in this regard, for example, by asking what could we learn from the social context which could be useful in addressing the said inequalities? What practices, at systemic and individual level could perpetuate those inequalities within the profession? How do race, class, and possibly gender oppression (and sexual orientation or trans oppression for some) and the negative stereotypes associated with each subjugated identity, potentially combine and collude with the stigma associated with mental health problems and/or disability?

Maintaining relevance

The above are complex questions but questions we may need to grapple with as trainees/clinical psychologists if we are going to effect and sustain any form of genuine change in relation to access to our profession at both training and service level. Psychology and mental health services have for too long been charged with failing to maintain a sense of relevance to marginalised groups’ lived experiences and worldviews, arguably fuelling suspicion, distrust and anger; leading to both poor uptake and disengagement. Not only does this disengagement may increase the likelihood of more adverse and coercive pathways into mental health services and thus further negative experiences by some marginalised groups, they may perpetuate the stigma and fear that surround mental health problems and services.

Stigma is two-directional. It must be recognised that mental health professionals are not immune to the internalisation of stigma and of other oppressive beliefs. Many people with mental health problems report experiencing stigma and discrimination within health and mental health services, so much so, that the largest anti-stigma campain dedicated part of its activities to tackling such stigma (please see ‘Education not discrimination’ of the ‘Time to Change’ campaign). I was involved in some of these projects as a consultant a few years ago and as part of this, facilitated a range of discussions and training. The latter brought home to me that many myths are still going strong within the mental health sector.

Dealing wih on-going myths

For example, the posited submissiveness of South Asian women and their alleged oppression in their homes or the ‘resistance’ of Black men to experiencing depression and their presumed violence/aggressivity have been repeatedly raised as reasons for race inequalities within the mental health system and difficulties in engaging these groups. Those stigmatising beliefs together with the common denial and/or dismissal of experiences of racism (and the limited cultural competence of services) would naturally deter some BME groups from seeking help from us and from engaging with services; particularly when such contact may be frown upon within one’s environment or community, arguably for good reasons.

Of course too, such dicoursive notions may become internalised and present either social and/or ego threats so that people may understandably consciously reason : ‘I am already facing so much discrimination as a minority in the world, I cannot afford to expose myself to mental health discrimination and stigma’ or ‘I will not give the dominant group the chance to subjugate me some more’. More unconsciously perhaps, some may come to feel : ‘I am inferior/worthless and do not want to evidence or to expose this’. It may be useful to consider potential social and intra-psychic dynamics when discussions around mental health stigma in ethnic minorities are had. Stigma is relational and functional too. At a very basic level, for people to experience or internalize stigma, there needs to be, at least to some degree, others who stigmatize and project. Taking collective responsibility for the on-going stigma and discrimination many face both personally and professionally may help ensure more attention is dedicated to reducing the devastating impact of mental health stigma and discrimination in the lives of people who are often already vulnerable, socially isolated and disempowered. And, that we do not perpetuate stigmatising or othering discourses unintentionally.

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

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.

Want to learn more?

Please see…

Brindle, D. (2013, April 30). Mental health anti-stigma campaign fails to shift health professionals’ attitudes. The Guardian. Retrieved from http://www.theguardian.com/healthcare-network/2013/apr/03/mental-health-anti-stigma-campaign.

Clearing House for Postgraduate Courses in Clinical Psychology http://www.leeds.ac.uk/chpccp. (2013). Equal Opportunities Numbers.

Department of Health (2005). Delivering Race Equality in Mental Health Care. Retrieved on 06/11/2014 from: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4100773

Keynejad, R., (2008). Barriers to seeking help: What stops ethnic minority groups in Redbridge accessing mental health services? London: North East London NHS Foundation Trust.

Littlewood, R., Lipsedge, M. (1982). Aliens & alienists: Ethnic minorities and psychiatry. Routledge London.

SCM (2002) Breaking the circles of fear: A review of the relationship between mental health services and African and Caribbean communities. London: The Sainsbury Centre for Mental Health.

TTC(2008) Stigma Shout: Service user and carer experiences of stigma and discrimination. London: Time to Change.

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The impact of difference PART 1: Personal reflections on clinical psychology training.

The stress of clinical psychology training

The stressful nature of clinical psychology training is well established. The intellectual and emotional demands it places on most trainees cannot be overstated. Nonetheless, there is increasing evidence suggesting that training may be even more challenging for those who are ethnically and/or racially different from the dominant group. Experiences of exclusion and marginalisation for such trainees are not uncommon, as a result, it has been posited that many courses may still be failing to meet the needs of Black and Minority Ethnic (BME) trainees be it in terms of systemic curriculum inclusion of issues of (ethnic) diversity, the management of overt and covert experiences of racism and, the provision of appropriate support to help BME trainees cope with the additional emotional demands which may be placed upon them. This is the first in a series of posts within which I aim to engage in a process of reflection upon my experience of difference within training. I hope to provide some illustrations of some of the ways difference may affect personal behaviours, trainees’ experiences and the training environment (and vice-versa).

How does difference manifest itself in training?

Individuals are, to a large extent, products of their life-experiences. It is well documented that as human beings we tend to have a natural affinity towards other individuals with similar backgrounds. Although some differences are bound to be reflected within training cohorts, those born and raised outside the UK, those who are not British citizens, those who do not speak English as a first language or are otherwise ethnically, culturally and/or racially different from the dominant group; are likely to find themselves in teams of one within their year group. The above cultural factors together with the potential non-traditional professional and/or educational pathways into training (Black and Minority Ethnic trainees seem more likely to be ‘non-traditional’ in terms of pre-training professional experience and education) may have an impact relationally, mean standing out as ‘different’, having to contend with hypervisibility and/or holding epistemological positions which may be at odd with those held by many in training.

Normative influences and expectations in relation to White (English) middle class norms and values abound. If one is neither, conforming, ‘fitting in’ and being open about one’s views can be extremely demanding. As an example, as someone who has stood out for all of the above reasons, my personal perspective into discussions has often been defined as ‘critical’, labeled ‘radical’ and at times as ‘irrelevant’, an isolating and invalidating experience particularly when there has been no intention to challenge. Often, simply speaking about my experience or that other BME groups would be deemed (unduly) challenging or create palpable discomfort. For example, when I questioned the posited collaborative nature of Cognitive Behavioural Therapy for those who do not hold intrapsychic views of mental health distress or individualistic worldviews- a good section, if not the majority, of people of African and African Caribbean descent, amongst others- this was deemed inappropriate or ‘too critical’ for some (the view that such people were simply not suitable for therapy was even put forward). As I failed some coursework in part for being ‘too critical’, passing assignments for me involved conscious attempts at not being perceived as too challenging and thus exercising careful self-censorship. An exhausting process.

I have experienced clashes of worldviews. Many of the beliefs and assumptions that most trainees in my cohort hold as fundamentally true have been at odd with my value system and life experiences (and probably vice-versa) often, the underlying values of concepts and tools which appeared invisible to most around me did violence to me. Naturally, eurocentric notions are more noticeable to those who belong to minority ethnic groups. Because shared cultural, life and professional experiences have been limited, part of my professional socialisation has felt like accepting claims which appear to have entered the professional discourse without question. Such as the view that clinical psychologists make good leaders, that we are good at tolerating anxiety, that our formulations are empowering ect… Many such assumptions (or aspirations?) seem to be banged on about in discussions without much evidence to back them up; questioning truths most closely related to our professional discourse and identity was not the done thing, it seemed.

I quickly learnt that there are some realities that are not to be tempered with, problematized or challenged. Perhaps the more ‘traditional’ applicants had already been socialised into this ‘etiquette’. The reported experiences of marginalisation, racism and eurocentricity within training may deter individuals from BME groups from entering the profession. Further, any theoretical exclusion of race, racism and culture issues may paradoxically (in the context of hypervisibility because of one’s visible difference e.g. skin colour) bring to the fore feelings of invisibility and oppression in BME trainees and in doing so, reproduce social inequalities. It may in addition impact on patients ‘care. Indeed, the overrepresentation of some BME communities within the mental health system and the enduring inequalities in terms of BME people’s access, outcomes and experiences within it have been in part attributed to the lack of cultural competence of mental health professionals. These reported omissions may also have a wide range of potential legal implications encompassing courses ‘duty of care towards BME trainees as well as equality considerations.

Variations in experiences?

There appears to be wide variations in clinical psychology courses’ ability and readiness to work with difference, this may in part explain why the experience of minoritized trainees can be so different and why some BME trainees will report experiencing training as inclusive and welcoming. It must be the case that some courses create less dilemmas for minority trainees and, it is regrettable that more efforts are not made to share examples of good practice in terms of diversity between courses. Of course too, BME trainees ‘sensitivity to such issues vary as do the willingness to engage with them. The defensive or protective stance of ‘see no evil, hear no evil, speak no evil’ holds true for many of us when it comes to difference (yes, even for those who are minoritized). It is certain that many trainees will simply not want to rock the boat. My conversations with other trainees from different minority groups across the country, made me realise that the challenges I had faced were far from unique or idiosyncratic. Sadly, this is evidenced by an increasing number of studies.

Discovering how widespread experiences of marginalisation, inferiorisation and/or of being the ‘Other’ were for minority trainees was both liberating and troubling. What I found the most disturbing was the apparent taboo and silence surrounding such experiences. Perhaps out of shame or fear many minority trainees are reluctant to ‘come out’ about their experience. Given our vulnerability due to the interplay of power with both the trainee role and our race/ethnicity (and for many, other minority characteristics) and; the arduous journeys many would have faced to obtain a training place (last year only about 2% of Black and 3% of Asian applicants were accepted onto the Doctorate comparing to over 60% for White English applicants), this is unsurprising. Of course others have at times been more vocal. There are high personal costs associated with being silent and likely professional ones if one breaks the silence.

For me, the personal costs have often felt too great. I am grateful to have had the support of incredible mentors both within and without the profession who have encouraged and supported me to ‘speak out’ when I felt I needed to -often this felt like self-preservation- this support has allowed me to stay connected to the profession, remain hopeful (this can be unbelievably trying at times) to care for myself in this highly challenging and often alienating context and to develop a professional identity and methodology that are congruent with my worldview and those of marginalised communities. Beyond sustaining me, this energises me and reminds me of the very reasons I started my studies. Without all of this, there is no doubt that I would have exited the profession.

Thank you for reading.

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.

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.

Constantine, M. G., & Sue, D. W. (2007). Perceptions of Racial Micro aggressions among Black Supervisees in Cross-Racial Dyads. Journal of Counselling Psychology, 54(2), 142-153.

Hardy, K.V. (2008). On becoming a GEMM therapist: Work harder, be smarter, and never discuss race. In M. McGoldric & K. V. Hardy (Eds.), Revisioning family therapy: Race, culture, and gender in clinical practice(pp. 461-468). New York, NY. US: The Guilford Press.

Patel, N., Bennett, E., Dennis, M., Dosanjh, N., Mahtani, A., Miller, A., et al. (2000). Clinical psychology, race and culture: A resource pack for trainers. Leicester: BPS Books.

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.

Rajan, L., & Shaw, S. K. (2008). ‘I can only speak for myself’: Some voices from black and minority ethnic clinical psychology trainees. Clinical Psychology Forum, 190, 11-16.

Shah. S. (2010). The Experience of being a trainee clinical psychologist from a Black and minority ethnic group: A Qualitative Study Submitted in partial fulfilment of the requirements of the University of Hertfordshire for the degree of Doctor in Clinical Psychology.

From School Exclusion to Mental Health Hospitalisation: Pathways to Mental Health Care for Black Men?

Mike’s story

Mike* who had just turned 21, was a young man from Africa**. He arrived in the country aged 7 with his family to seek asylum and had lived in London ever since. Mike was expelled from school at age 14 or 15 for truanting. He was convinced the teachers recurrently picked on him because they did not like him.  The day Mike got expelled he did not go back home.  He was scared. Instead, he started staying with friends and quickly became involved in petty crimes and in smoking cannabis.

Mike then got arrested several times for theft and possession of cannabis but was not sent to prison.  Quickly after Mike started smoking cannabis; at about 16, he developed what he called an ‘episode’ (Mike was initially diagnosed with ‘Drug Induced Psychosis’ and later with ‘Paranoid Schizophrenia’).  He was eventually taken to hospital by his mother and was discharged after one month. Once discharged, he stopped taking his medication, was readmitted within days and discharged again within a month.

Mike felt it was too early for him to be out and that he was not well enough. He also felt he lacked insight into his condition (his ‘own’ words) and was suspicious about taking medication. Once home Mike filled the days with smoking cannabis and worked out complex patterns as to when and how much cannabis he could smoke without it affecting his wellbeing. A month after his second hospitalisation, he got into trouble. He claimed to have been stopped and searched by the police 3 times in the same day. He became angry and defiant with the third Officer.  He reported to have been stopped the day before and demanded an explanation from the Police Officer who he said refused to provide one.

Mike ended up in a physical conflict with the Officer and was brought to his local police station where he was eventually charged with common assault.  Once convicted, Mike fell ill in prison and ended up on a Medium Secure Unit (MDU) on a Section 37, 41 of the Mental Health Act (a previous post here considers the potential experiences of Black mental health service users on MSUs).  Mike had been in the Unit for about 3 years when I spoke to him.  When I asked him what could have made a difference in his life he said the teachers ‘they gave up on me too easily’.

Some personal experience of the Education System

I was invited to the first parent-teacher evening to meet with my son’s tutor who taught science at the school. My eldest son had started secondary school a few weeks previously.  As we waited outside her room, I watched parent-child pairs entering the classroom looking slightly anxious but leaving it with a smile. This quietly reassured me.  When our turn arrived we were invited to come in and to sit at a pupil desk where we met a young looking White female teacher.  Upon brief introductions, the teacher buried her head in some kind of record book.  She re-established eye contact with me and then looking directly at my son declared with a beaming smile: ‘based on your current level of achievement, you can expect to achieve a grade C at your GCSEs’.

This statement was not an invitation to discuss potential remedial actions or support. Indeed there was no attempt at creating a dialogue on the mediocre prediction and I did not detect any concern or any indication of disappointment.  Instead, a definite sense of congratulatory determinism.  This was one of those awkward moments when the Psychologist in me has to wrestle with my ghetto side (in my head).  I am not going to lie; a vision of me slapping some sense into her did enter my mind.  Nonetheless, I reciprocated the smile for what seemed a very long time, long enough to compose myself and say to her ‘well that would not be good enough for us, we place a lot of importance on education at home and expect a lot more from him. He’s a very bright boy’. As I kept a smile on my face, I saw the smile on hers morph into an awkward grin betraying her embarrassment.

This was the beginning of year 7.  GCSEs were a few years away. There had been limited opportunities to test children.  I felt there was very little merit in the teacher’s prediction. What caused me the most concern was not the determinism but the sense of celebration which emanated from her voice. To me the subtext of the exchange read something like: grade C is perfectly commendable for a Black boy.  The relationship between school underachievement and social deprivation is well established as is the academic achievement/attainment gap between black boys and their peers (although it is important to remember that White boys coming from similarly socially disadvantaged backgrounds now fare worse academically than Black boys).  The influence of stereotypes and expectations on current educational attainments is receiving increasing attention.  There appears to be a link between low expectations and school exclusions and, although the relationship between school performance and the risk of being diagnosed with schizophrenia has been explored, one aspect that is less scrutinized is the relationship between school disengagement/exclusion and mental health care pathways. This is why Mike‘s story came to mind.

Black Service Users’ lived experiences

One of my research projects a few years ago focused on the pathways to care of Black mental Health Service Users in South London. Mike’s story is derived from this qualitative data analysed using IPA (Interpretative Phenomenological Analysis). The results revealed that for all interviewees (n=16) remaining in education was valued and perceived as important in terms of avoiding contact with mental health services for Black men. The majority of participants cited their dropping out of school or their being expelled as the main factor leading to offending and getting into contact with mental health services.  There was a deep sense of regret and of missing out too which can be perceived in the following quotes from different interviewees:

‘Because I missed quite a bit (of school) I’m suffering the consequences now’

‘I could have done a lot more if I wasn’t truanting from school’

‘Looking back on it, if I could turn back the time I would go back to school’

Schools should not give up on kids too easily’

Of course the above accounts are retrospective and subject to the usual biases. But, perhaps they give us an indication as to where we might start to explore further investigation and/or investment in preventative support? This article is not written as a rant against schools. Many a teacher do a fantastic job in immensely trying circumstances. Some have had a life changing influences on me.  However, like the rest of us, teachers have prejudices and use the same human categorizing and labeling processes. The difficulty is that by virtue of the position of power and trust they hold in relation to children, such processes may well have more potent and further reaching consequences. Incidentally, 3 months after the meeting with the science teacher, mid-year, my son had already achieved all of the year targets in science and was working at grade A level (albeit, after he changed class and science teacher). Similarly, I remember my mother leading many battles against schools where my sisters and I were repeatedly dissuaded from going to university and from studying the subjects we were interested in because we were not deemed ‘academically gifted’ enough for them.  Particularly those of a (hard) scientific nature. These would have been too ‘challenging’ for us (I am sure our gender and social origin also had an influence)…

A decade or two later and after much defiance from my mother, two of my sisters are financial analysts; one is an accountant, one a physicist (the only female in her cohort when she completed her postgraduate studies).  Not bad for a bunch expected to struggle academically. I believe most young people have the capacity to resist low and stereotypical expectations but; this may well be more difficult for those with lower levels of social support and/or with other psychological or social vulnerabilities. Some Black children may only be able to frame what they are experiencing as ‘the teacher picks on me’, ‘the teacher does not like me’. Invariably, some children will be misguided in their interpretation and for some, such views may betray unhelpful thought patterns or other relational difficulties. However, teachers ‘expectations are powerful and many children will de-select themselves from academic pursuits by truanting or otherwise disengaging purely because the message they receive and internalise is, you do not belong here or you are not smart (sorry I meant ‘academically gifted’) enough…

Chicken and egg proposition?

Having spent much time speaking to Black men within the Mental Health System, I noted that difficulties with teachers, particularly exclusions, often seemed to precede their (coercive) pathways into the mental health system and/or contact with the criminal justice system.  School exclusion is strongly correlated with offending. Black boys are at least three times more likely to be excluded than their peers (for similar infringements). The incidence of behavioural difficulties and occupational/school disruption can be associated with various psychiatric diagnoses, including schizophrenia so there may be a potential circular (chicken and egg) dilemma. In any event, if low expectations contribute to underachievement and school exclusions which in turn increase the likelihood of offending (and of being exposed to other stressors or ‘precipitating’ factors for some) and; we know that offending in Black groups is more likely to result in contact with mental health services (and subsequent diagnoses of schizophrenia), isn’t there a potential case to explore how we might better equip schools to support truanting and disengaging Black boys? Might it not also be helpful to pay closer attention and to address the factors leading to school disengagement for this group? In the absence of relevant studies scrutinising life events and adverse pathways to care and assessing the weight of relevant variables; it is difficult to establish relationships and the potential unique influence school exclusions/disengagement may carry in terms of future, and more importantly, type of Mental Health Service use for Black men.

So…What do you think, do schools give up on (some groups of) children too easily?

Have low or high expectations influenced your academic achievements or those of your children?

Do you think that providing more timely support to children who encounter difficulties at school could help reduce inequalities within the Mental Health System, particularly in relation to Black and Minority Ethnic groups?

*Mike is a pseudonym. **I have chosen not to specify the country Mike originates from to minimize risks of him being identified. As part of the research project, consent for wide dissemination and internet publication was sought.

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. 


Want to learn more?

To access The Poverty Site – A UK site for statistics on poverty and social exclusion – ‘s section on school exclusions (click here)

Black Mental Health UK has compiled a range of reports on race inequalities within both criminal justice and mental health systems, to access (Click here)

To speak or not to speak: Can Children From Racialized Groups be Prepared for Racism?

I have wanted to write about this delicate (even by my standards) topic for some time and been doing a bit of digging on the topic but have not identified any evidence based professional guidelines that touched upon how best to prepare children from racialized groups for racist experiences.  This has been a question I have pondered upon for years because of my personal experience.  Being exposed to racism is no unusual experience for those within whom ethnic/racial difference is located. As young children many will learn about people being hostile to them because of their skin colour and/or culture.  Facing incidents of inferiorization, pathologization and/or problematization either directly or indirectly by witnessing racist and discriminatory acts experienced by parents, siblings, friends and/or other members of their communities or; enduring them personally; can have long lasting consequences. In this post, I will present my introduction to racism as I raise a few questions.  This is a topic I am quite tentative about for reasons which may become clear in the article.

Discovering racism…in France

My discovery of racism was quite a brutal one.  I was perhaps 4 or 5 and had been playing with my sister and some of the neighbourhood kids in front of our Parisian cité block as was customary during school holidays or week-ends. There was quite a few of us; 15 perhaps even more.  Children of all backgrounds and creeds.  We were skipping, running around and laughing the summer afternoon away.  A (White) man erupted from a ground floor flat in the tower. After complaining about the noise, he ran directly toward my elder sister and pushed her from behind.  He pushed her so violently that she fell forward and scraped the floor for a few meters. Once immobile, much of the skin at the back of her arms had gone.  A bunch of children quickly ran to our second floor flat to alert my parents.  A few seconds later my mother appeared downstairs to find my sister, me and a few other children in tears and my sister covered in blood.  Within moments she was at the assailant‘s door furious and demanding an explanation.

She was greeted by a barrage of vile racist insults including the N word (of course), followed by ‘go back to your country’ and ‘you lot only ‘lay’ children (sorry, this is a literal translation from the French expression to lay eggs used to refer to women who have many children) for child benefits. Once his monologue over, the man proceeded to punch her on the head with such force that her skin turned blue-black, one of her eye became red with blood and half her face swelled up almost instantly.  Expectedly, all children by this point were crying hysterically; probably with terror.  I am not sure whether it was the sight of my mother‘s grotesque looking face or the hatred in the man’s eyes which caused us the most turmoil.  Things after the punch have blurred in my memory but I can still see my mother standing still after the punch.  Standing tall, defiant and in dignified silence.  Although I do not remember this; perhaps unsurprisingly; I am told the man was apprehended by the police minutes later as he was brandishing a knife threatening to kill her.

My sister’s injuries were in the end only superficial but it took several months for the swelling and hematomas to disappear from my mother’s face and she suffered recurrent headaches for years.  The psychological scars for all those who witnessed the incident, most of us children under 10, probably remained for longer.  I was not spoken to about racism before the assault; or just after, for that matter. In fact the incident was rarely discussed either at home, at school or even amongst people on the block.  No one it seemed could put words to what had happened even as the trial went on (the perpetrator was eventually jailed for ‘racially aggravated’ assault, I believe). Yet, like my mother’s beautiful face (she was a stunning woman) which had been deformed by her injuries, the world had suddenly turned ugly and scary because we were Black.  This was France, inner city Paris to be precise; in the mid/late eighties. It could easily have been anywhere in the ‘western’ world.  It was only several years after this incident that my mother broached of subject of racism. By then I had recurrently experienced it first hand and witnessed its various manifestations.

The impact of the ‘new’ racism

Naturally, racist incidents of that nature are admittedly rarer today. Hence, I thought I had no reason to speak to my son about racism when he was just five,  until he came home from school in tears because he was being called monkey, ‘darkie’ and mocked because he looked ‘too’ African. This was only a few years ago in London.  As he wept in my arms, decades after I had myself sobbed because of racism (and in a different country), I wondered whether I had failed him by not preparing him for the reality of racism and prejudice.  I thought that perhaps, he or I would have been hurt a lot less when first exposed to racism; if we had somehow been prepared or been told of its existence.  The honest answer is I don’t really know if it would have made any difference.  It seems the opinions of those around me are divided.  Although I tend to; almost instinctively; air on the side of talking to the child-and we do discuss racism at home now- I am also mindful of the huge potential to increase a child’s anxiety, unhealthy paranoia and of creating self-fulfilling prophecies.

It is evidently desirable for children to form their own worldviews and experience the world without being unduly influenced by parental expectations and fears.  Nevertheless, there is also ,of course, the real danger of a child becoming seriously disillusioned, for expectations of fairness to be shattered and indeed for deeper psychological wounds to be experienced if the subject is not addressed and experiences of racism ensue, particularly if they occur frequently (I have previously written about young Black men’s experience of the police in a previous post here which may add some insight to the current article).   I realise that the form of racism my son suffered may seem less traumatic. Indeed for most children of colour today when they face racism, there will be no threat to life. There will be no physical injury. It is unlikely the police will be involved.  Still, there will likely be inferiorisation. There may be alienation.  There will most probably be suffering.  As first generations of migrants, my parents’ expectations of justice and equality in their host country were probably low.  Certainly lower than mine and those of my children.  Perhaps this supported my mother’s psychological resilience after the attack.

Thus, I wonder whether racial slights which might have been experienced as minor infringements by first generations may in later generations, become more psychologically damaging because of potential feelings of entitlement to fair treatment, justice and equality. Indeed although racism may have changed its face so that, in the main, more covert and institutional forms of prejudice have replaced behaviours displaying overt prejudice and open racial hostility, some evidence suggests that those exposed to racism‘s ‘new’ manifestations may indeed pay a higher psychological cost.  The children of migrants are much more likely to suffer psychological distress than their parents.  Of course there are various factors that may be at play.  Nevertheless, some have argued that the increase in the incidence of psychological and psychiatric distress in second and possibly third generations of migrants may be in part attributable to the fact that younger generation’s expectations often do not match their reality…

So what to do?

Do we instill lower expectations when it comes to fairness and justice or; do we continue to project an aspirational version of a world? How many may come to painfully experience such a version as a sham, what might the psychological impact be for those who are disillusioned be and, what type of support might be appropriate? Sadly, yet again, such questions have not received much empirical attention and very few Psychotherapists and Clinical Psychologists specialise in this area. As a result, as a parent and as a professional I feel it is difficult to give evidence based guidance. I would be extremely grateful for people to share their views or refer me to relevant guides, articles on the issues.

What do you think? Have I missed something of importance? Have people/professionals done anything to try and prepare children from racial minorities for racism and if so; what type of conversations have people had and when?

Please comment if you feel able to or get in touch to share your views/experiences.

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Unfair stop and search practices and the psychological wellbeing of Black men: Is it time we scrutinized the relationship?

Much has been written about the impact of stop and seaches and racial profiling.  That the unequal use of such powers has far reaching devastating consequences on community relations and in particular, on Black and Minority Ethnic Communities (BME) ‘s relationship with the police has become a truism. One aspect of the debate that has received little attention is the potential effects such practices could have on the psychological wellbeing and mental health of communities disproportionally affected by the practice, particularly on their most vulnerable members.

The Equality and Human Rights Commission (EHRC) has reported that in some areas Black people are 29 times more likely to be stopped and searched with the overall figures nationally documenting that as a group, they are six times more likely to be subjected to these powers, than their white counterparts. In a recent inspection, the EHRC identified that more than a quarter of all stop and searches carried out under the Police and Criminal Evidence Act in (2013) –that is hundreds of thousands, could have been unlawful.  If these findings leave you staggered chances are you’re not a Black inner city young man having to deal with various other social injustices and social stressors (on top of the usual adolescence and young adulthood related stuff) who has been stopped and searched repeatedly for no legitimate reason. Indeed feeling staggered may be a relatively mild emotion for such a person to experience.

Over the years I have come into contact with hundreds of young Black men in community, forensic and clinical settings.  I can say with no hesitation, that young Black men’ s experience of the police has been one of the most virulent and recurrent issue I have been presented with. Expectedly, it was often accompanied by feelings of rage, despair, helplessness, distrust and alienation. Feelings strongly associated with psychological distress. The most resilient and resourceful young Black men may easily manage the slight, indignation anddehumanisation of repeated or unlawful stops and searches without being shaken to the core. However, the longer term impact of such experiences particularly if recurrent, do have to be reflected upon.  But, how about the others?  Those with little or no social support, those with no voice or with a reduced capacity to articulate their experiences?

The level of unmet psychological and mental health needs is high amongst Black men.  I once supported a Black man in his thirties within a forensic unit with a string of offences against the police. He recurrently got into conflict with police officers when he was stopped and searched.  I also remember an extremely bright nineteen year old Black man who had been convicted of assault for punching the fourth or fifth police officer who had wanted to stop and search him in the same day.  These are tragic stories for everyone involved, particularly for the Black men who, shortly after their incarceration became severely distressed and were diagnosed with psychosis.

There is no claim here that the experiences of those two men are representive of those of Black men generally or indeed of those Black men who may have mental health support needs. These stories may be purely anecdotal, nevertheless, it is a fact that Black men are the most likely group to access mental health care through coercive routes and/or through the Criminal Justice System.  It is also a fact that there is little (if, any) empirical evidence scrutinizing the impact of such policing practices on the mental health or psychological wellbeing of Black people and specifically, on that of young Black men.

As a Black woman from an inner city background and a psychologist, these issues disturb me profoundly.  I personally know many people of colour who have been subjected to unfair, discriminatory and even brutal police treatment.  I can recognize the wounds.  And worryingly, at present, I am not sure these invisible injuries can be healed within mainstream mental health services if anything, current provisions may well be exacerbating them either as a result of the traumatic pathways to ‘care’ too many black men are forced to take or, because of the types of intervention(s) they receive. It is too early to say whether Theresa May’s projected overhaul of stop and search powers will have an impact on the experience of Black men in our inner city streets or elsewhere. However,  I personally think it is an overdue step in the right direction that has the potential to foster better psychological health for this group. As for the hundreds of thousands of young Black men who have already been negatively affected by the abusive use of stop and search powers, one can only hope that services will offer these young people appropriate support and a space to process their experience.  And crucially, that the latter will still have enough trust in authority, to accept their offer. 

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All work published on Race Reflections is the intellectual property of its Race Reflections. 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.