inequalities

The Elephant in the room: Race Representation, Symbolism and Silenced Wounds.

The first time I sat foot on a psychiatric ward was just under 10 years ago.  I was engaged in doing Community Development and Community Research work within Medium Secure Units (MSU) in London.  This was my first day on a MSU and indeed my first time visiting any kind of psychiatric hospital. Following a brief introduction to the all White psychology team by the clinical lead and consultant forensic clinical psychologist (a White man); I was taken round the ward where a multi-ethnic, but still mainly Black staff base, composed the nursing team who was in turn, overseeing the care of a virtually all Black inpatient/clinical population. Upon entering the ward, I was so overwhelmed by the sea of Black faces staring at me in utter stoicism, that I had to work very hard to contain my urge to cry.

The visit felt surreal and oppressive in an almost suffocating way and; this had nothing to do with the (respectful) way I was being treated by staff. At the time, I was not entirely sure why this sight had provoked such a strong response in me.  I had some knowledge of the extent of race inequalities within mental health services and had also been briefed on the clinical population upon my induction. Yet, something happened in my very first few moments on the ward which took me by complete surprise. Although this ‘Elephant’ remained at the back of my mind as I did further work on the Unit, I became somewhat desensitised to its presence, particularly as the subject was hardly ever discussed with colleagues.  Hence, what I set out to do in the present post is to try and make sense of my experience and to consider some potential clinical implications.

The power of symbolism and representation

As human beings we all make use of symbols to categorize, convey and extract meanings from events and social interactions. From a systems perspective, to start with, the staff composition mirrored traditional power distributions so that at the top of the hierarchy was a White man and at the very bottom of the pyramid of power, were of course the Black staff, followed by Black patients. Thus, at team level, there was a representation of social inequalities in relation to income across staff roles.  Further, the Psychologist role is one of authority that socially occupies the sphere of expertise and; in the context of MDUs; as the role encompasses the assessment of patients’ readiness for release, another layer of power is therefore inherent to the role.

The meaning attributed to the role of the patient (or more accurately patient-offender) and that of the Psychologist cannot be interpreted outside of the racial make-up of the ward.  Connotations and associations whether consciously accessible or not; firmly remain when it comes to race dynamics.  Certain images have the power to tap directly onto this rich symbolic heritage.  Indeed, looking through history, one would not have to search for very long for many constructions of Black people as dependent and as psychologically, socially and intellectually deficient to surface (debates around such constructions are to some degree continuing today). Consequently, and in the context described, the sight of a virtually all Black patient population having been assessed as needing treatment, rehabilitation and indeed control cannot but evoke the historical inferiorization and pathologization of Black people.

Projection and Identification

Returning psychoanalytically to what had happened in my ‘here and now’ experience of the ward, Projective Identification may offer an alternative and viable framework to make sense of the dynamics.  In that line of argument, it may be notable that as the detained Black men appeared to display no feeling and emotion, I experienced an overwhelming sadness and a sense of suffocation. Such feelings appear consistent with experiences which may be triggered by compulsory detention, restraint and freedom deprivation. Thus, it could be envisaged that through my experience, I was acting out the patients’ s disowned and/or unacceptable feelings and wishes which had been projected into me.

There is a long psychoanalytical tradition of viewing racism as a mechanism by which dominant groups project intolerable aspects of themselves into racial minorities.  From an internalised racism perspective, those projected qualities can be said to become accepted as one’s own. The imagery evoked by the racial representation clearly echoes the worst things Black people are all too often socialised to believe about themselves. From a psychoanatytical standpoint, the projections from dominant groups. The Ward context may thus evoke the same images that often give rise to many identity difficulties and other internal conflicts amongst some of us. Thus, whilst working toward ‘Recovery’, Black mental health service users may be exposed to the very painful dynamics that may be be part of their parcel of suffering and that may have contributed to bringing about and/or exarcebating their psychological distress.

Working with the Elephant in the room.

Taking on the role of mental health patient, in the current context, may also means psychically, taking on a role which is consistent with racial stereotypes and which may be experienced as buying into the constructed racial hierarchy which naturally part of the self may resist. From that perspective, it may follow that the role of mental health patient may be an extremely conflictual one for many Black men which may bring to the fore feelings of inferiorisation, marginalisation, exclusion, subjugation, distrust and possibly self-loathing. Although I have not come across many Black mental health patients/service users who have described their experience using symbols, systems representation and psychoanalytical concepts as frames of reference, the sense of suffocation and oppression I experienced has recurrently appeared in my sessions with Black service users as did their experience of being stereotyped on psychiatric wards.

There is ample research evidence suggesting that Black mental health service users have the most conflictual relationships with their clinicians, that they are the most dissatisfied group of all mental health service users and that they continue to report experiences of racism (including racism within services) but; despite these well-established findings; it appears that the Elephant in the room remains too overbearing to acknowledge and to work with for many of us. The dearth of discussion, clinical and empirical attention to the extent of the impact of race dynamics in relation to the psychological functioning and the service use, experiences and outcomes of racialized minorities seems to me to be of particular concern.  Not only because it may be part of the reproduction of existing hierarchical structures that perpetuate the invisibility of race and of White privilege, but also because it prevents opportunities for race related wounds and institutional suffering to be seen and addressed. I believe it may well have been these wounds and suffering I was apprehending and reacting to on my first day on the ward.

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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.

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Don’t be scared, it’s only race!

I went to my local DVD store last week and sought to purchase more films that touched upon the issue of race. I searched this relatively large store but could not identify more than a handful of relevant movies, most of which I already owned.  I therefore approached a store person (he was the manager) and asked whether he could recommend some films with race as the subject matter or key theme.  The manager‘s instant utterance was:  ‘ouch…’quickly followed by:  ‘There is not that many… you know… it is such a sensitive subject, not many directors would go near it’.   There was so much in that minute long initial interaction both in terms of verbal and non-verbal communication that I could easily write an essay on it. Fear not! I will refrain.

I did not sense any hostility or racism in the interaction at all. I was dealt with courteously, warmly and, after the somewhat awkward start, the manager was in fact quite helpful.  Nevertheless, I thought about the ‘ouch’ much more than anything else he said.  I reflected on the beauty of its rawness and on what I thought was a genuine and uncensored expression of internal discomfort. I pondered upon what might have been revealed about that White man’s experience of me as a Black woman using the word race. This led me to the current post within which I aim to examine my use of the word race.  It seems to me that race has become a dirty word, arguably for good reasons.  It is a word that, as illustrated above, creates discomfort and controversies.  We are being told to stop using it and to replace it with ethnicity.

Race, ethnicity…does it matter?

Traditionally a distinction is made between race and ethnicity. Whilst race has for long been related to biological factors and physical features, ethnicity on the other hand, aims to highlight cultural factors such as a sense of shared ancestry, history, language, etc… Moreover, some may see race as having ascribed status as opposed to ethnicity which is usually envisaged as self-ascribed. In other words, the objectivity/subjectivity orientation appears to be one underlying but often unrecognized dimension of difference between the two terms.  In reality however, racial classification is both self-defined and externally-ascribed. The problem it seems to me, with the preferential use of the term ethnicity is that it establishes it as a somehow more valid and more significant concept.

I am no expert on social constructionism but one argument I often hear to support the use of the term ethnicity is that race is socially constructed but, isn’t ethnicity also a social construction? It seems to me that both race and ethnicity matter and that today’s insistence on the use of the term ethnicity rather than race, also needs to be socially situated and critically deconstructed. Like the “biological” theories (proved to be scientific fallacies) which were established by dominant groups as social facts to reproduce racial inequalities and perpetuate their privileges, it may be argued that insisting on the use of the term ethnicity today, may help distract from the structural inequalities and institutional oppression that derive from the social construction of race as a ‘social fact’ and thus, also serve to maintain racial hierarchy.  From that perspective it can be said that choosing the word race is also a political act on my part.  I do not believe that the continued use of the word race perpetuates racism.

Facing up to race and its dynamics

My personal view is that the denial of racism and colour blind explanations of inequalities are much more likely to perpetuate racism by leaving it unaddressed. It is because racism exists and continues to affect the lives of millions of people, that some of us prefer to use the word race as opposed to the more palatable and arguably more politically correct term, ethnicity, particularly in relation to inequalities and injustice. When we speak about ethnicity, the legacy of the constructed inferiority of certain groups can be disowned and there is usually no intended reference to continuing structures of hierarchy and power. When we speak about race however, there is- whether explicitly or implicitly. Racialization, in my view simply takes things a little further by placing the emphasis on the dynamic aspects of race and on how the process of categorizing people consciously or unconsciously only really become socially significant in the exercising of power and for creating/perpetuating disadvantage/inequalities. All terms are loaded with meanings, connotations and have inherent flaws.  My choice of term is not fixed.  It is not a ‘till death do us part’ position.  Rather,  at this point of my intellectual journey and life, I feel that the choice I have made word wise, allow me the lenses and framework to make sense of the world but also to advocate for change and equality.  Of course, I may be defined as having a chip on my shoulder and/or be problematized in other ways but, I have decided, that for now at least, this is a small price to pay in comparison to the pain I would inflict myself by remaining silent.

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.