mental health

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. 

Thank you for reading.

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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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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.

Care Quality Commission and National Mental Health Development Unit (2010). ‘Count Me In 2009 – Results of the 2009 national census of inpatients and patients on supervised community treatment in mental health and learning disability services in England and Wales’. Care Quality Commission: London.

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.

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.

Festinger, L. (1957). A Theory of Cognitive Dissonance. Stanford, CA: Stanford University Press.

Hardy, K, V. (2001). Family therapy: Exploring the fields past, present and possible futures. Adelaide: Dulwich Centre Publication.

Hook, D. (2006). ‘Pre-discursive’ racism. Journal of Community and Applied Social Psychology. 16, 207-232.

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.

Macpherson, W. (1999). The Stephen Lawrence Inquiry: report of an inquiry by Sir William Macpherson of Cluny. London. Home Office Cm 4262-I.

NSCSHA (2003). Independent Inquiry into the death of David Bennett. An Independent Inquiry set up under HSG (94)27. Norfolk, Suffolk and Cambridgeshire Strategic Health Authority: Cambridge.

Tan, R., & Campion, G. (2007). Losing yourself in the moment: The socialisation process of clinical psychology training. Clinical Psychology Forum (180), 13-16.

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

Unspoken challenges of clinical psychology training? A view from inside. PART 1

Becoming a clinical psychologist has been likened to a process by which a new identity is incorporated into an existing sense of self whereby unique physical and mental experience, attributes, and a position within social roles, relationships and discourses is transformed. This process, although rewarding in the main, is not experienced without challenges and pain. What one might struggle with on the professional pathway is to some degree personal and idiosyncratic nevertheless, some processes may become engaged and/or significant for many. Further, often it is the things we do not expect to find difficult that come and pose the most challenges. This post aims to present some of the processes and dynamics which can become challenging for trainees within the professional socialization process. Those who are aspiring clinical psychologists or new trainees may find reflecting on some of the issues it highlights helpful. Hopefully too, it will be of some use to those with supervision responsibilities.

Feeling deskilled

Feeling deskilled at the start of training or learning journeys is a common experience. However, in the context of clinical psychology training such feelings may well become amplified. The demand for clinical psychology training places has always outstripped the supply. The possible difficulties trainees may have faced to gain places due to the inherently competitive nature of the recruitment process may bear an influence on the professional socialisation process. Trainees may feel pressured to ‘prove’ that they are deserving of a training place or that they are good enough. Unsurprisingly, many will come to experience self-doubt, some loss of confidence and even ‘impostor syndrome’ during the training journey.

The Conscious Competence Ladder model (Burch, 1972) may provide a helpful framework to better understand and reflect on how trainees may respond to learning processes and activities. This model essentially posits that two factors: consciousness and competence, affect our thinking and emotions as we acquire a new skill. According to the model, we move through four different levels or phases as we build competence. The initial level: ‘unconsciously unskilled’, occurs when we do not know that we are not competent. We then move onto the ‘consciously unskilled’ phase as we realise the limitation of our competence.

Thirdly, it is posited that we become ‘consciously skilled’ when we are aware that we have acquired the skills/ competence required (though conscious effort is still required). Finally, the ‘unconsciously skilled’ level is reached when the said skills and competence have become so assimilated that they demand little or no conscious awareness to be practiced. This model is not linear and we may for instance after having become unconsciously skilled, revert to feeling consciously unskilled for instance because we fail an assignment. Of particular relevance, training wise, may be the fact that trainees are required to complete placements in different specialized areas and thus may recurrently find themselves in the consciously unskilled phase, the most emotionally demanding position; as they develop their competencies.

Managing power imbalances

We all have peculiar relationships with power and authority based on various factors including: our personal history, our cultural and social backgrounds and to some degree our social positioning. In addition, how we may deal with potential feelings of disempowerement and powerlessness can also be related to professional experiences and in particular, the level of past autonomy, responsibilities and/or organisational cultures accustomed to prior to starting training. Whilst for most ‘traditional’ applicants gaining a training place will entail an increase in status and with it an improvement in terms of employment and work conditions, for those who held relatively senior posts and worked autonomously before starting training, the training environment and trainee role may take some adjusting to and indeed involve a decrease in status and in autonomy.

Trainees can often (though mostly tacitly) be positioned as naïve, dependent and/or passive. Such implicit infantilisation can occasionally become explicit. On one occasion, for example, the positive feedback from a placement review I received included ‘doing as I am told’. Clearly, the supervisory relationship is not an equal one as clinical supervisors hold evaluation and marking responsibilities and thus have actual power (to pass or to fail) over the trainee. An unusual dynamic may be created when trainees because of their past experiences/responsibilities, qualifications and/or behaviours may not meet some supervisors’ potential expectations of dependency. Whilst actual power may not be disrupted, for some, perceived power may well be.

Power dynamics are of course further complicated when trainees belong to minority and/or marginalised groups. Their presence in the training arena alone can challenge or evoke social/personal expectations and stereotyped notions. Self-fulfilling hyper-vigilance may thus become an issue for such trainees who may become anxious about the (real) possibility of being discriminated against or of facing prejudicial attitudes. On the other hand, difference may also impact on some supervisors who may not have prior experience of working with ‘non-traditional’ trainees and who may be unsure about how and whether or not to raise issues of difference within the supervisory relationship and/or be unduly preoccupied with the (also real) eventuality of being perceived or experienced as prejudiced.

The challenge of adopting a questioning attitude

Clinical psychology trainees hold dual statuses as trainees thus, employees of specific NHS trusts which usually provide an employment contract, associated terms and conditions and the placements within which practical skills are developed and; as students within universities which host the courses, deliver the academic components of the training programme and thus the student identity. With the professionalization of the discipline, the adoption of the trainee role over that of the student one seems to have been preferred. Such preference would appear to give higher status to the trainee role.

However, the exclusion or reduction of the student identity may set particular dynamics and impact on how trainees see themselves, their learning and how they are perceived. Whilst students may be actively encouraged to be questioning and irreverent toward prior practices, theories and of taken for granted wisdom, such a stance may not be specifically sought after or strongly emphasized within the trainee role, arguably necessarily so. Indeed training is, by definition, centred on applying and demonstrating practical competence often by copying or mirroring others.

Given the unbalanced power distribution and the potential high risks of getting into conflict with those who hold a responsibility for assessing you, it is perhaps unsurprising that trainees often simply decide to ‘go along’ with theories and models of working that are experienced as oppressive, are incongruent/incompatible with their worldviews or appear to lack empirical support. Additionally, people in cohesive groups typically experience greater pressure to conform than those in non-cohesive groups. Consequently, homogeneity and conformity may not only present challenges for trainees, they may problematize innovation and creativity within the profession (more on that in due course).

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.

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.

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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. 


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)

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.

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.

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. 

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.