Another missed opportunity for clinical psychology to challenge racism

[Taiwo A]

Recent films ‘Long walk to freedom’ ‘12 years a slave’ and ‘Selma’, tell stories about Black people’s struggle and resistance. These stories, although important, promote the idea that Black people have been liberated from racism through successful legal reform. These are also stories of a time so far away we can be excused for leaving our discomfort and righteous indignation at the brutality of yesterday, in the auditorium, so we might go about our daily lives in the comfort of today. Unless, of course, we are an ethnic minority; in which case we leave the cinema knowing our fight is not over.

 

Ever since I began a career in clinical psychology in 1999, my disappointment, as a Black woman of working class origin, in the profession’s lack of serious attention to Black people’s experiences has not assuaged. Racism seems to be something we address in Britain, and yet for many Black and ethnic minorities, it is rarely spoken about by the majority population with the ease, depth and level of complexity it requires. As a result, much in the Black experience is invisible to the British majority. Even among some of my friends the full extent of my everyday experience would be astounding. Despite anti-discrimination legislation racism is alive and well; living a more pernicious existence, particularly evident in our mental health institutions. Every decade that passes since Cochrane’s 1977 research into rates of psychiatric hospital admission, the picture remains the same – ‘Depression’ in ethnic minority groups is up to 60% higher than in the white population; Young Asian women are three times as likely to kill themselves as young White women; Black people are more likely to be diagnosed with schizophrenia, perceived as being potentially dangerous, detained under the Mental Health Act, given physical treatments, such as medication and ECT, and prescribed higher doses of medication and less likely to be offered ‘talking treatments’, than their White counterparts (Mental Health Foundation, 2007).

 

It was with continued disappointment that I read the new report published at the end of November 2014, by the Division of Clinical Psychology (DCP), ‘Understanding Psychosis and Schizophrenia’, which describes a psychological approach to psychosis. Despite the impressive list of contributors, psychologists who have dedicated their careers to highlighting the impact of racism on wellbeing – such as Nimisha Patel, Iyabo Fatimilehin, Angela Byrne, Ann Miller, Derek Hook and Aruna Mahtani – were not among them. On first reading, Understanding Psychosis is laudable in its attempt to demedicalise experiences that attract the schizophrenia or psychosis label, by suggesting, we move beyond the medical model as an explanation; hearing voices or feeling paranoid is common and understandable in the context of people’s lives and that psychological interventions can enable people to make sense of their experiences.  A number of talking therapies are briefly described, but attention is focused on Cognitive Behaviour Therapy (CBT). According to this approach, it is not voice-hearing or unusual beliefs that cause distress, but the person’s relationship with these experiences. That is, there is a problem with the way the person interprets information (their ‘thinking styles’) and how they act with others (‘what they do in their interaction’), which ‘keeps a problem going’. 

 

If our interventions are still based on the idea that something has gone wrong inside the individual, are they not just a rehashing of the medical model rather than a radical departure from it? Despite arguing for a safer, fairer and less prejudiced society, Understanding Psychosis upholds the focus in clinical psychology on using techniques to change individual people’s responses to harm and make them ‘more rational’. Locating distress within minds in this way places responsibility for recovery on individuals despite social circumstances.

 

Although it contains many pertinent points about the continuum of experience, and the unhelpfulness of viewing distress as an illness, Understanding Psychosis could have gone much further. Just as films focused on ‘looking back’ at racism, position us in relation to what was, Understanding Psychosis reinforces the view that psychiatric ‘symptoms’ ‘are survival strategies which were essential at the time but which have outgrown their usefulness’ (p.59). In so doing, an opportunity is missed to focus us on what is: psychosocial difficulties (often termed “mental health problems”), as valid, meaningful responses to ongoing, and not just past, adversity. 

 

When the over-representation of Black people in the mental health system is briefly mentioned, the suggestion is that the risk factors are ‘social disadvantage’, ‘deprivation and the experience of living in dense, urban environments’. Despite mentioning the impact of economic inequality, relationships and family environment, racism is only mentioned when describing why we might find it ‘hard to trust people’ (p.47) and the need to combat discrimination and promote ‘a more tolerant and accepting society’(p.114). That Black people can be ‘accepted’ but still treated as lesser-than, is missed. Images of gross racism (violently wielded batons and brutal slavers) that any tolerant and accepting person would be repulsed by, might, ironically, mask rather than highlight the subtle ways in which Black people are excluded, dehumanised, violated, misrepresented, exoticised and oppressed.

 

Understanding Psychosis is brave enough to call out the skewed agenda of pharmaceutical companies, who have a vested interest in promoting the idea that schizophrenia is a brain disease, but is not brave enough to give the experience of Black people the space and analysis it deserves.

 

At times it reads as though there are ‘people with mental health problems’ and ‘Black people’; further masking the experiences of Black people who use mental health services. Page 33 reads: ‘we have moved beyond blaming all Black people for the actions of the odd Black criminal, yet we still punish all the mentally ill for the violence of a few’; and page 115, concludes: ‘We hope that this report will prove to be part of an ongoing major shift in public attitudes that sees prejudice against people with mental health problems become as unacceptable as racism or sexism’. The fact that racism – including Islamophobia, anti-Semitism, and xenophobia – is increasingly acceptable is ignored. Understanding Psychosis chimes with notions of racism as a twisted relic and dinosaurian clumsiness that does not dare rear its ugly head in polite, educated and civilised company. We have moved on from racism and need to bring other forms of prejudice and oppression, such as discrimination against ‘people who have mental health problems’, out of the shadows to be banished back into them. 

 

Understanding Psychosis does not mention psychological frameworks that reject the idea that distress is kept alive in the mind and address what people say about their on-going experiences, such as community psychology or liberation psychology that view psychosocial difficulties as, not so much an effect of social abuse, but a response and resistance to it.

  

As a Black psychologist, I am saddened by the so called ‘psychology of psychosis’ that is apparently, ‘transforming mental health services’. Despite this self-congratulatory tone, it will not surprise me if in decades to come Black and ethnic minority people continue to be over-represented within the mental health system and our struggles and forms of resistance, continue, unnoticed and unacknowledged.