Tag Archives: Multiculturalism & Diversity

Multiculturalism & Diversity

Unmasking White supremacy and racism in the counseling profession

By Patricia Arredondo, Michael D’Andrea and Courtland Lee September 10, 2020

Our country has been roiling through two major pandemics. The first, COVID-19, is still relatively new, and with a vaccine, the incidences of this miserable disease should decrease and diminish over time. In contrast, the pandemic of White racism and White supremacy has long been at the heart of the persistent psychological, emotional and behavioral racial tensions and injustices that we face in the United States. The senseless killing of George Floyd and other Black citizens has raised awareness once again of the violence of White racism and police brutality in many sectors of society.

The National Institute of Mental Health recently published a report indicating that between 17 million and 22 million adults in the United States are in need of professional mental health services each year. It was further determined that only 41% of these individuals receive such services. The fact that a majority of adults in need of mental health services do not receive this important care represents an ongoing health care crisis in our country. And, of course, COVID-19 stressors are only compounding mental health distress.

When researchers focused on the racial disparities linked to this pandemic, those from African, Asian, Latinx and Indigenous backgrounds were found to be substantially overrepresented among those adults not receiving or not having access to mental health care. This finding reflects what supporters of the Black Lives Matter movement and many social justice advocates in general are talking about when they point to disparities resulting from systemic racism and White privilege in this country.

Institutional racism in the profession

In 1982, nearly 40 years ago, Derald Wing Sue wrote, “Counseling is the handmaiden of the status quo.” This phrase relates to the ways that many counselor educators, practitioners, supervisors and students are inextricably linked to perpetuating White racism and White supremacy by remaining silent, noncommittal and inactive in the face of so many forms of structural and institutional racism.

Sadly, this situation is still a reality as unintentional and covert forms of racial injustice continue to be manifested in counselor training, research and practice. For example, how prepared are counseling students to work with those who speak English as a second language, those who are recipients under the Deferred Action for Childhood Arrivals program, families in poverty and so forth? When are counselor training programs requiring community service to link to social justice principles and competencies endorsed by the American Counseling Association? How do counselor training programs prepare students to talk about racism with clients? If counselor educators and counseling programs were to take on these three queries, they would find opportunities to unmask racism and decrease their behavior as a “handmaiden of the status quo.”

Professionals and students alike must commit themselves to move toward bold, courageous and morally grounded actions. We must go beyond our favorite mode of operating, which often involves the overuse of intellectual analysis of these social pathologies. As we critically analyze the mental health impacts of these injustices on our clients’ lives, let us be reminded that Martin Luther King Jr. warned us that an overemphasis on such intellectualization without substantial social justice actions too often results in the paralysis of analysis.

Challenging the counseling status quo

In 1992, Michael D’Andrea, one of the co-authors of this article, wrote a column in Counseling Today (then named The Guidepost) titled “The violence of our silence: Some thoughts about racism, counseling and human development.” In that column, he asserted that if they continued to operate as witnesses and bystanders to various forms of institutional, societal and cultural racism, counseling professionals and students would become guilty of being racists themselves through their silent complicity.

Some progress has been made as a result of a minority of counselor educators, practitioners, supervisors and students taking courageous action to boldly and routinely describe the ways that White supremacy and White racism adversely affect the counseling profession and the racially diverse clients we serve. However, it is apparent that much more needs to be done in these areas. Today, there are education and training programs guiding professionals in moving away from bystander behavior and toward action. The #EquityFlattensTheCurve initiative is offering a Bystander Anti-Racism Project.

Identifying areas of urgency in the counseling profession is also part of unmasking racism. Just take note of the contemporary counseling profession. In doing so, you are likely to see the following: counselor educators, graduate students, supervisors in counseling centers, textbook authors, the theories studied, the research methodology applied in studies, CACREP site visitors, and the leadership in ACA, the Association for Counselor Education and Supervision and other professional associations all seeming to have a homogeneous identity.

Little has substantially changed over the past 50 years. A majority of White counseling students continues to be taught by a majority of White professors. Multicultural counseling is still a one-semester course. Theories of counseling, career development and human development are Eurocentric in nature and dated. Furthermore, counseling research has not advanced knowledge about racism, White supremacy and the well-being of people of color. Samples of convenience continue to be normative, with many research participants coming from White, Western European, English-speaking and often Christian backgrounds.

All of this leads us to assert that the counseling profession has stagnated. This perpetuation of persistent Eurocentric conformity will soon be irrelevant and contribute to greater inequities in the preparation of counselors and the delivery of mental health care. This professional irrelevance will occur as a result of the unprecedented demographic transformation occurring in our nation. As one example, in 2013, for the first time, the percentage of Latinx high school graduates going on to college was higher than that of any other group, as reported by the Hispanic Research Center, and this representation in colleges continues. How many counselors are aware of this demographic shift?

Moving to action: Applying the MCCs 

In 2003, the ACA Governing Council approved the Multicultural Counseling Competencies (MCC), originally published in 1992 by Derald Wing Sue, Patricia Arredondo (one of the co-authors of this article) and Roderick McDavis. The awareness, knowledge and skills paradigm remains as vital today as it was in 1992 when the MCC were published and in 1964 when the Civil Rights Act was passed. The MCC, the subsequent document on operationalization of the competencies that promotes intersecting identities in sociohistorical contexts (1996), and the Multicultural and Social Justice Counseling Competencies (2015) remain anchors to lean on during these times for needed change, increased awareness, more expansive knowledge and bold actions in the counseling profession. The 1992 competencies addressing racism are cited here for further application.

  • Culturally competent counselors possess knowledge and understand about how oppression, racism, discrimination and stereotyping affect them personally and in their work. This allows them to acknowledge their own racist attitudes, beliefs and feelings. Although this standard applies to all groups, for White counselors it may mean that they understand how they may have directly or indirectly benefited from individual, institutional and cultural racism.
  • Culturally competent counselors are constantly seeking to understand themselves as racial-cultural beings and actively strive to develop a nonracist identity.
  • Culturally competent counselors are knowledgeable of sociopolitical influences that impinge upon the life of racial and ethnic minorities. Immigration issues, poverty, racism, stereotyping and powerlessness all leave major scars that may influence the counseling process.
  • Culturally competent counselors become actively involved with [ethnic/racial] minority individuals outside the counseling setting (via community events, social and political functions, celebrations, friendships, neighborhood groups and so forth) so that their perspective of minorities is more than an academic or helping exercise.
  • Culturally competent counselors strive to eliminate biases, prejudices and discriminatory practices. They should be cognizant of clients’ sociopolitical contexts when conducting evaluations and providing interventions. They also continually attempt to develop greater sensitivity to issues of oppression, sexism and racism especially as they affect their clients’ lives.

Racial reckoning: If not now, when?

The country has entered a period of racial reckoning. New incidents of racism and anti-Black behavior are reported on a daily basis on city streets, on college campuses and in stores. The challenge to not be bystanders persists, and as counselors committed to advancing diversity, equity and inclusion, we must be activists and advocates for social justice. We must rise to the task of unmasking White supremacy and White racism in both our professional training and practice as professional counselors.

We need to ask ourselves, if not now, when will we take these actions? If not us, who will make the changes to have the counseling profession move beyond the “violence of our silence” and the role many educators, supervisors and students play as “handmaidens of the status quo”?

 

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Patricia Arredondo is a past president of the American Counseling Association and the Association for Multicultural Counseling and Development and a founding member of Counselors for Social Justice. She partners with organizations to address diversity, equity and inclusion initiatives through the Arredondo Advisory Group. Contact her at parredondo@arredondoadvisorygroup.com.

Michael D’Andrea is an associate professor at Springfield College in Springfield, Massachusetts. He is one of the founders of Counselors for Social Justice. Contact him at michaeldandrea1@gmail.com.

Courtland Lee is a past president of the American Counseling Association and the Association for Multicultural Counseling and Development. He is a professor in the counselor education program at the Washington, D.C. campus of the Chicago School of Professional Psychology. Contact him at clee@thechicagoschool.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Encountering and addressing racism as a multiracial counselor

By Michelle Fielder and Lisa Compton August 11, 2020

It was a simple question, “How are you doing?” that started us on a path of discovery. I (Lisa) wanted to check in with Michelle, my teaching assistant, after racial tensions consumed the news. George Floyd had just been killed, and the media were focused on his death, the shooting death of Ahmaud Arbery, and the outcry for justice for the African American community.

Michelle was initially numb, unsure of how to articulate the different thoughts and feelings the recent events had triggered for her. I could tell she needed a break from our usual academic work, so I assigned a reflective activity to give her space for introspection.

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The events brought to my (Michelle’s) mind a comment that actor Will Smith had previously made on a late-night television show: “Racism is not getting worse; it’s getting filmed.”

As my ideas began to crystallize, Lisa and I began to share our perspectives on the sobering current events. The result was a rich dialogue between us — raw, authentic and refreshingly open.

What follows is an excerpt from our discussion. We hope that it will stimulate other discussions and encourage counselors to not fear engaging in dialogue about race. We believe that such open communication will help us to better understand one another and the reality of systemic issues, to identify our blind spots and areas for growth, to improve our care for clients and to move our profession forward.

Racism at first glance

Lisa: Michelle, you told me how triggering the recent acts of racism in America and subsequent protests have been for you. Could you share some of your background?

Michelle: I was born to an African American father and a Japanese mother around the civil unrest and well-publicized riots of 1968. The United States was embroiled in an unpopular war in Vietnam, and racial tensions at home were an additional black eye on our status as a world leader. It is sobering to consider that the institutionalized racism which led to the widespread violence and destruction of many cities, including Washington, Chicago and Baltimore, has not been eliminated over my lifetime.

My first understanding of racism occurred when I was in the first grade. My mother would meet me after school each day to walk the mile or so back to our house. One day, a white pickup truck pulled alongside us, and two Caucasian men started yelling racial epithets and throwing beer bottles at us. My mother grabbed me and ran into a nearby park where they could not follow in their vehicle.

My mother reported the incident to the police, but it was not investigated, and the matter was dropped. It was not until several years later that I understood what transpired that day and the reality that the very notion of my existence was abhorrent to someone simply based on how I looked.

The path to becoming a counselor

Lisa: That must have been a terrifying experience for you. What impact did your childhood have on your career path as a professional counselor?

Michelle: I became driven to prove my value and worth to society through academic and athletic achievement. When it came time to apply to college, I wanted to mark the “other” box because, back then, “multiracial” was not an option.

My mother surprisingly challenged my decision: “Michelle, whether you like it or not, the world is going to look at the color of your skin and decide that you’re African American. Why not show them you are also kind, driven, intelligent and talented? It doesn’t have to be either-or.”

My mother’s advice empowered me to look beyond my neighborhood and the typical path of my peers, which was community college or service and retail jobs. I applied to the United States Naval Academy and was accepted into the 10th class that allowed women. As a midshipman, it was not lost on me that there were few black or brown faces, and I was often reminded that there were 20 other applicants for everyone who was accepted, so I had to make my presence count.

I found my follow-on experience in the Marine Corps to be a great example of inclusion, as we all worked together toward a common mission. There were not black, white, brown or yellow Marines — we were all “green.” As an intelligence officer, I became adept at understanding the human nature of our enemies and advising appropriate responses to conflict. This intuitiveness and desire to bring healing to suffering led me straight to my next career as a professional counselor.

Experiencing racism with clients

Lisa: Have you experienced racism in your interactions with clients and, if so, how have you managed it?

Michelle: Depending on how I wear my hair, it has apparently been difficult for others to determine my race. Over my lifetime, I have been mistaken for Filipino, Puerto Rican, Thai/Burmese, South Korean and Samoan.

As a licensed professional counselor, I have had clients decline to meet with me because I was not pale enough for their liking or not dark enough “to understand their experience.” Several clients have made racially disparaging comments about African Americans or Asian groups in my presence because they were unaware of my multiracial background. One Caucasian client made the flip comment, “She [a Hispanic friend] is so stupid. What did she expect dating a Black guy? They’re all dogs and can’t keep a job!”

Those comments were spoken so casually that it is not hard to imagine that worse was being said in other settings. It is a sad reminder that racial prejudice and stereotyping are still at the forefront of some people’s minds. Sad because such views prevent the speaker from seeing the potential good aspects of another race and benefiting from their culture. Sad because such divisiveness prevents unity that could make us stronger as neighbors, co-workers or fellow journeyers on this path through life. My identity is not the “little mongrel” girl who had to hide in a park, nor are those individuals being described the sum of those demeaning or devaluing statements. We can and need to do better.

Early in my career, I had a Caucasian client tell me he hated “Black people.” I was quite surprised, and it must have shown on my face because he immediately added, “But you’re all right. You’re not like the other ones I’ve met.”

As you can imagine, I was angry at his audacity and saddened by his views, but I knew based on where he was in treatment that it was not the time to get into a heated debate about his racial beliefs. However, I realized that his sharing of those ideas with me indicated that he felt safe to do so in my presence and that I had been entrusted with a variable that I had not known about him previously. While I was offended by his remark, I remember thinking, “Stay focused on the client. This is not about me; it’s about the client.”

I am going to be judged, fairly and unfairly, but I choose to live in a manner to be a credit to my race rather than a detractor. I also recognize that every instance of racism is a learning opportunity — for me to better understand how the other person came to their beliefs and for clients to perhaps expand their views to see past a person’s appearance to their character. We are all a product of our genetics, nurturing, environment and experience. A client’s life may have taught them to hate, but if we, as counselors, do not believe in the potential for people to change and grow, we are in the wrong profession.

Racism can come in many forms. It can be overt or covert, generational or situational, and institutional or individual. As counselors, we need to be prepared for however it manifests and to recognize that some people are not even aware of how hurtful their beliefs are until they are uttered out loud and someone checks them on it. When working with clients, I have come to recognize that racism is often based on fear, and the more information the client is willing to learn about the object of their fear, the less impact it has. Working with a client’s racist remarks takes the same unconditional positive regard that you would give any client, and it is an opportunity to model healthy self-concept and emotional regulation.

So, take the client I mentioned previously who stated that he hated Black people. For this interview, I will call him “John.” When John made that statement, I did not react to his remarks, but I was able to work with him later in therapy surrounding some of his distorted schemas when he was ready. The following are some practical suggestions for working with clients who show signs of racism:

1) It’s not about you. (Do not personalize clients’ racist remarks).

Me: “It sounds like there are anger and pain behind that statement. Tell me about the Black people you’ve previously met.”

John: “Well, they make me sick. They’re lazy. They lie around doing drugs and collecting a welfare check while I bust my butt working all the time.”

2) Gently challenge any overgeneralizations.

Me: “Who are ‘they’? Are you talking about specific people you know?”

John: “No, you know what I mean. Just Black people.”

Me: “I know some Black people, but they don’t do drugs and they have jobs.”

John: “I know they’re not all like that. Like I said, you’re all right because I know you work for a living.”

Me: “So you don’t hate all Black people, just the Black people who are uneducated or unemployed?”

John: “Yeah, I guess.”

3) Help clients clarify their feelings.

Me: “Some might take your response as jealousy rather than hatred. You work hard, but they get by without working. Would you consider jealousy to be a better word?”

John: “No! I’m not jealous of those Black people. Shoot, I’m way better than them. I’m financially secure with a good job and a house. There’s nothing to be jealous of.”

Me: “You do work hard and have a lot going for you. So, why are you comparing yourself to them?”

John: “I’m not! They’re a drain on society. They could be doing as well as I am if they would just apply themselves.”

Me: “So, help me understand. If there is no comparison in your eyes, why do you even care?”

John: “Because my taxpayer dollars are going to finance their lifestyle.”

Me: “Actually, your and my tax dollars are going to finance a lot of things, like the military, Social Security and the national debt. Do you hate them too?”

John: “No, that’s just stupid. Of course I don’t hate the military. They’re necessary for our nation’s defense. It’s just our precious resources should only be used on important things that benefit all of society.”

Me: “If hate is too strong, or not the right word, what is a better way to describe how you feel?”

John: “I guess you could say I’m frustrated.”

4) Help clients clarify their beliefs.

Me: “OK, you are frustrated with some uneducated or unemployed Black people.”

John: “Yeah, because they’re on welfare.”

Me: “I also know a lot of people on welfare — White, Black, Hispanic, etc. Are you frustrated with them as well?”

John [staring at me]: “I know what you’re doing. No, I’m not frustrated with all of them. You are just twisting things around.”

5) Follow up with psychoeducation.

Me: “I’m just trying to understand what you believe and why you believe it. Words matter, and I hope you can see there is a big difference between ‘I hate Black people’ and ‘I’m frustrated with what I believe is the misuse of taxpayer money.’

Some people are where they are due to a lack of nurturing, growing up in an unsafe environment or even traumatic experiences. But when you are hindered by those things, which are outside of your control, and the color of your skin habitually prevents others from seeing you as a person or recognizing your worth, it is hard to have hope of living any other way.

We all have biases — because of our genetics, nurturing, environment and experiences — that can incite our emotions and distort our thinking. Racism occurs when we start believing those distortions about an entire group of people without considering individual differences. It may be easy to blame an entire group of people in a situation, but it is much more helpful to honestly examine why we feel the way we do and, when in our power, to do something about it.

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Having an open conversation about race with a client is possible, but counselors must consider the client’s readiness and make sure the discussion is integral to the context of the client’s presenting issue. The counseling office is not a bully pulpit, nor is it a place for counselors to get their own emotional needs met. However, when a client is ready and open to discuss the subject, counselors should be ready to “go there” while maintaining empathy and without allowing countertransference to interfere with their effectiveness.

Experiencing racism within the profession

Lisa: Thank you for sharing your experiences and such practical suggestions for working with clients. I think we are often caught off guard by comments made during sessions, and it is very helpful to think ahead of time about what to do in those situations. In addition to interactions with clients, have you experienced racism within our professional field?

Michelle: Sure. I once had a colleague tell me that she was no longer going to take Medicaid clients because they were “all Black, unemployed and unmarried with a gang of kids.” Another colleague commented that the Black clients brought their kids in for testing for attention-deficit/hyperactivity disorder “just so they can get a check.” These were seasoned professionals who had been seeing clients for many years.

Lisa: How disappointing to hear such comments from your peers. As a Caucasian, I have noticed that many of my White colleagues feel content in knowing that they do not personally hold prejudiced feelings against others. However, I realize that a lack of personal hate does not do enough to confront systemic racism. What can we do as a profession to make progress and move forward in this area?

Michelle: The first thing is to stop apologizing. I cannot speak for all people of color, but we are not looking for apologies. Now, let me caveat that: I always advise my clients to “own what’s yours.” If you personally contributed in any way to the oppression of a person of color, then apologize to that person. Otherwise, a blanket apology often indicates that someone does not understand the nature of institutional racism.

Secondly, ask, listen, learn and act. We will never solve the problem if we do not understand the nature of the problem. Ask people of color about their experiences. You may be surprised how many instances of racism — such as inappropriate comments or jokes in the workplace — individuals have had to push aside or ignore. Question formal processes at work that have been in place for a long time because “that’s the way we’ve always done things” attitudes can indicate tacit approval of an oppressive infrastructure (e.g., not taking Medicaid clients because it does not pay as well as commercial insurance).

Listen to the conversations being held when people of color are not in the room. They may be an indication of an undercurrent of racism (e.g., gossip or complaining regarding people of color) that needs to be exposed.

Learn by reading books, listening to podcasts or subscribing to YouTube channels by people of color.

Act by speaking up when you hear racist comments or when you see acts of discrimination. Be willing to get involved with faith organizations, social justice movements and causes of people of color (e.g., speaking at a city council meeting about trauma-informed care for African American neighborhoods or joining a peaceful march). Lastly, help affect the future of the counseling profession. Become a supervisor and share the wisdom you learn about institutional racism and the need to work with people of color to fix the system.

Thirdly, for supervisors, it is important to recognize that our supervisees are coming from different backgrounds and are at different levels of multicultural competence. I hold an initial interview with my supervisees to get a sense of their goals, strengths and weaknesses. Included in this interview is a question about their ethnicity, nurturing, environment and experience as it pertains to working with race and other marginalized groups. The answer is usually, “I had a multicultural awareness class as part of my master’s degree.” I take that to mean that they do not know what they do not know, so the onus is then on the supervisor to prepare counselors-in-training in this area of competency.

I take a developmental approach with supervision and challenge supervisees to take multicultural considerations into account as they approach each client and their diagnosis. Our discussions also include case studies tailored to increase their ability to recognize their own biases and blind spots.

These past weeks, with all of the media coverage of the racial unrest, have offered a rich environment for my supervisees to learn about institutional racism and to ask questions about social justice for their clients. It is not just a multicultural issue but also an ethical one. So, I try to ensure that my supervisees are not only comfortable working with people of diverse backgrounds but also willing to admit their own areas of cultural ignorance and work toward increasing their knowledge.

Connecting multicultural competency and trauma-informed care

Lisa: Is there any other area where we can look for change?

Michelle: All professional counseling organizations have submitted statements of support to the current nonviolent protests and offered ways to help support the victims of racial trauma. This is a great start to addressing the issue. However, if we want to make a difference, we need to reevaluate the profession’s approach to multicultural and trauma-informed education because they go hand in hand.

Most counseling programs have one mandatory multicultural class and may offer some trauma electives. However, multicultural competency should be infused throughout the program, and trauma-informed care should be a required part of every curriculum. Recognizing that the design of the master’s programs is toward clinical competency as determined by face-to-face hours, how well do practicum and internships expose and evaluate multicultural and trauma care competencies? Your new book, Preparing for Trauma Work in Clinical Mental Health, addresses concepts such as historical trauma, disenfranchised grief, advocacy and ethnic identity strength and would really fill this curriculum void.

For provisional and licensed counselors, in the same way that ethics continuing education is required every year, multicultural and trauma refresher training should be required on an annual basis to ensure that counselors are maintaining the best practices. To obtain licensure, counselors should demonstrate competency in working with diverse clients and various trauma backgrounds. In addition, all professional counselors should take an active role in advocacy work on behalf of their clients and in their communities.

Just as the color of my skin is going to be subconsciously noted by the people I meet, similar experiences are happening to our clients of color, most of whom have lived with some form of oppression during their lifetime. Counselors need to be prepared to approach multicultural considerations in trauma-informed care to understand how to appropriately establish strong therapeutic alliances with clients and enhance safety and stabilization. This is a herald’s call for counselors to change the way we approach the effects of institutionalized racism if we truly want to be agents of change.

 

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Michelle Fielder is a licensed professional counselor and approved clinical supervisor in private practice. She is also a doctoral candidate in the counselor education and supervision program at Regent University. Contact her at michfi3@mail.regent.edu.

Lisa Compton is a certified trauma treatment specialist and full-time faculty at Regent University. Contact her at lisacom@regent.edu.

 

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Black mental health matters

By Lindsey Phillips July 27, 2020

Racial violence and discrimination are woven into the fabric of the United States. The way policies and laws are implemented. The weaponization of Whiteness and privilege. Disparities in education and health care. The horrible and senseless killings of Black people throughout our nation’s history and into the present day.

How do daily acts of racial violence, injustice and discrimination affect the mental health of Black Americans? What is it like to work and live beside people who don’t value you as a human being? What is it like to live in a country where your rights are frequently threatened?

Dominique Hammonds, an assistant professor and testing coordinator in the Department of Human Development and Psychological Counseling at Appalachian State University, provides a quick glimpse into the complexities of being a Black woman and counselor in a racist society. Hammonds, wearing a shirt that read “Black and Educated,” was shopping in Walmart recently when a White woman passed by her and casually said, “You’re disgusting.” In that moment, Hammonds felt powerless. She feared the consequences of saying or doing anything in response.

Hammonds left the store and shortly thereafter went into a counseling session where her client recounted feeling powerless, angry and upset because of injustices they were experiencing in their life. Hammonds had to compartmentalize her own feelings of powerlessness to help the client.

Counselors play an important role in helping Black Americans cope with and heal from racial stress and trauma, but they can do more. Namely, they can also take steps toward changing an unjust and racist system that powerfully and negatively affects the mental health of Black Americans.

A distrust of mental health

Research indicates that Black Americans are 20% more likely to report serious psychological distress than are White Americans, yet they are less likely to use mental health services.

Loni Crumb and Janeé Avent Harris, who are both assistant professors of counselor education at East Carolina University (ECU), examined, along with two of their colleagues, the negative perceptions of mental illness and treatment among Black Americans. They found that stigma, a lack of trust in mental health care and a mislabeling of Black people’s presenting concerns make this group more apprehensive to seek counseling. Financial constraints and a lack of access to culturally responsive mental health care are additional barriers, explains Crumb, a research and innovation associate with the Rural Education Institute in the College of Education at ECU. (See their article “African Americans’ perceptions of mental illness and preferences for treatment” in the Journal of Counselor Practice for a more detailed discussion of their findings.)

This distrust is not unfounded. Black Americans have been misdiagnosed and overdiagnosed with schizophrenia for decades, for example. (For more, read “The historical roots of racial disparities in the mental health system” by Tahmi Perzichilli at CT Online.)

Angie D. Cartwright, an associate professor of counseling at the University of North Texas (UNT), stresses the importance of looking at how and why the mistrust of mental health began in the Black community. “Institutional and systemic racism is the foundation of a lot of our medical treatments, including mental health counseling,” Cartwright says. “And, historically, when [Black people] invite others into [their] homes and communities, then problems happen.”

Sitting with discomfort

Counselors, not clients, should be the first to broach issues of racism. This isn’t necessarily easy or comfortable.

Counselors often conflate comfort and safety, but they are two different things, insists Cartwright, a licensed professional counselor and licensed sex offender treatment provider who is the clinical director and owner of North Texas Counseling and Wellness.

As she explains, being comfortable enough to broach the topic does not mean the topic itself will be comfortable. “It’s not comfortable to say, ‘I was discriminated against,’ ‘I had a gun pulled on me’ or ‘I was fired because my boss is racist,’” she continues. “There are some conversations we will always feel some discomfort talking about. And that’s OK.” But clients should feel safe enough to share their experiences — ones that will often be uncomfortable for counselors to hear, she adds.

“You have to get comfortable with being uncomfortable,” says Hammonds, a licensed clinical mental health counselor (LCMHC) in North Carolina. “Part of the [counseling] skill set is learning how to have these discussions in a way that feels comfortable.” For example, can counselors say the word Black, acknowledge their own ethnic identities or discuss racism knowledgeably? If not, then clients know they won’t be able to go beyond a surface-level discussion with them, Hammonds explains.

What counselors say doesn’t even have to be overly complicated, notes Hammonds, an American Counseling Association member. They can simply say, “I just want to check in. There’s a lot going on around us right now. What’s that been like for you?” or “I’m curious how you as a Black American might be affected by racial violence and oppression.”

Being open and brave about this topic will likely result in some missteps. That’s part of the process, says Hammonds, who encourages counselors to use those mistakes as opportunities to learn.

One misstep may be getting defensive when clients express anger, distrust or sadness about their experiences. “If you find yourself getting defensive — trying to explain away the client’s experiences or identifying with client experiences and feeling like you have to apologize … on behalf of the system — don’t,” Hammonds says. “All you’re doing [in getting defensive] is communicating to the client that you’re still not comfortable and haven’t done your own personal work around this.” And apologizing just puts clients in a position where they feel obligated to say, “Oh, it’s OK,” she adds.

Instead, she advises counselors to reflect on their own internal experience and to tune in to what might be prompting that response. Perhaps it’s a case of the counselor wanting to protect their own ego, or maybe they are masking their own discomfort or lack of knowledge. If counselors find themselves becoming defensive in session, they can tell the client, “I feel like I’m reacting to something right now, and I recognize that I need to do some self-reflection. But I don’t want to heap that on you.” But do this briefly, Hammonds says, or else the session becomes about the counselor rather than the client.

Building trust and rapport also becomes critical to creating a sense of safety for these clients. Too often, counselors jump to diagnosis and treatment because the mental health system encourages them to have a solid plan and work toward a goal fairly early in treatment, Hammonds points out. She encourages counselors to slow down and first invest time in establishing good relationships with their Black clients.

Context matters

As Avent Harris, an ACA member, points out, counselors won’t be aware of needing to broach the topic of racism unless they understand its historical and political context. Put simply, they have to know what to look for and ask about.

“You don’t learn this context or gain this cultural awareness by just reading the DSM [Diagnostic and Statistical Manual of Mental Disorders],” says Avent Harris, who specializes in multicultural considerations in counselor education and the role of spirituality in Black mental health help-seeking behaviors. She advises counselors to move beyond reading only counseling texts to explore the works of Black scholars, theologians and authors.

Counselors may also need to adjust a technique or approach to better fit with their clients’ experiences. For example, the thought of going for a run in the evening sounds straightforward, but for many Black people, and Black men in particular, it can evoke a sense of fear. They question whether they will be safe or if their choice to run could cost them their life.

If a client brings this fear up in session, it could be dangerous for the counselor to use a thought-stopping technique, with the aim of interrupting, removing and replacing the client’s “problematic thoughts,” Hammonds explains. Suggesting that the client simply stop thinking that running could harm them ignores their experiences and the existence of the racism embedded in society, she says.

Instead, Hammonds, president-elect of the North Carolina Counseling Association, says the counselor should consider the context around the client’s fear of running alone at night. Where does that fear come from? How does society contribute to or perpetuate this client’s fear and anxiety?

“Those are the types of discussions that we need to be making space for,” she says.

Self-awareness and honesty about biases

Hammonds stresses the importance of counselors reflecting — honestly — on their own experiences and biases. As she points out, counselors often like to think, “I took this multicultural course, or I’ve worked with clients from diverse backgrounds, so I’m doing OK.” But it may not mean that at all, she emphasizes.

This self-awareness starts with counselor training. Working with diverse clients is the best way to learn to appreciate differences and to examine one’s own biases and beliefs, says Crumb, an LCMHC in North Carolina.

This diversity should also extend to counselors’ consultation groups. Avent Harris, an LCMHC associate in North Carolina, looks for colleagues who will provide honest feedback and challenge her own thoughts and beliefs. She says that if she has an uncomfortable moment in session, these colleagues would ask, “So, what made you uncomfortable in that moment? What questions do you need to ask yourself to reflect on that moment?” They wouldn’t just echo her thoughts or tell her “not to worry about it,” Avent Harris says.

Hammonds recommends that counselors continue to record and watch themselves in session just as they did during graduate school and supervision. “There’s so much value in replaying your words and listening from that outsider’s perspective,” she says. The process affords counselors a chance to (re)consider their words, think about the purpose of their statements or actions, and evaluate whether they really listened to and heard their clients.

Counselors should also get their own counselor. “Some of this stuff is deep-rooted. It takes time to dig up those roots, to understand them, to untangle them and to repot them,” Cartwright says.

She jokes that her mother always told her, “Never trust a beautician with bad hair.” This same principle applies to counselors, she says. They have to make sure they take care of their own mental health before working with clients on their well-being. “And clients will be able to tell if you … have done your work,” she adds.

Cartwright, the project director for UNT Classic (a program that addresses disparities in mental health services for Black and Hispanic populations in the Dallas-Fort Worth metro areas) and UNT ICBH Project (a program that supports graduate students during clinical training), suggests that her colleagues, especially those who hold identities associated with privilege, work with a counselor who identifies with a marginalized group or with intersections with which the privileged colleague struggles.

They should also intentionally put themselves in a position in which they are the minority, continues Cartwright, a member of the ACA Advocacy Task Force and president of the International Association of Addictions and Offender Counselors, a division of ACA. For example, she suggests that White counselors attend a Black church one Sunday. “If you are uncomfortable for that short time that you’re there, imagine what your Black clients feel like on a daily basis when they are constantly in spaces dominated by White people,” she observes.   

Finding voice and value

Black clients report to counseling with the same common presenting concerns that other clients have. But in addition, Hammonds says, they often seek counseling because of issues of “voice and value.” They have experiences that either minimize their voice or communicate — overtly or covertly — that their ideas, opinions and problems don’t matter or don’t matter as much as those of others, she explains. Feeling undervalued, dismissed and unheard can lead to anxiety, depression and other mental health issues, she adds.

Cartwright specializes in underserved populations in counseling and counselor education, mentorship in counselor education, and offender and addictions counseling issues. She once worked with a client who was experiencing racism and discrimination at her job. The former client was the only Black woman on a large corporate team, and she noticed that meeting times would suddenly change without anyone alerting her. She also got the sense that her co-workers were talking about her behind her back. At first, she internalized this discrimination and started thinking that she must be bad at her job. She felt like an impostor.

But after another colleague confirmed the woman’s suspicions of racial discrimination, the former client filed a lawsuit and won. The win came at a cost, however. She learned that co-workers had purposely changed meeting times without letting her know. Other colleagues whom she had thought were well-intentioned had made racist and hurtful remarks about her that were uncovered during the lawsuit and investigation.

As a result, the client began to question her judgment and worth. Cartwright helped the client learn to feel valued and trust herself again. They worked on challenging the client’s thoughts that she wasn’t good enough. For instance, they used self-affirming techniques such as daily affirmations and “I” statements that allowed the client to identify and acknowledge her strength and resilience.

Even if counselors can’t relate to being discriminated against at work, they probably can identify with feeling like their voice hasn’t been heard, Hammonds says. With that perspective, counselors can take intentional steps to empower these clients in session.

For example, Black clients often feel like they can’t or shouldn’t tell counselors if they didn’t like the way the counselor phrased something or if a moment in session made them uncomfortable, Hammonds notes. But they should be made to feel comfortable voicing those thoughts, she continues, and it’s up to counselors to create a space that invites that feedback.

Hidden struggles

A May 31 article in the Washington Post reporting on protests in the wake of the killing of George Floyd described a less visible impact of racial violence: “the private weariness and anguish felt by many [B]lack people in the country.” In other words, many Black people are exhausted.

Emotional exhaustion is another reason that Black individuals often seek counseling, Hammonds says. Besides being fatigued from the discrimination and injustices that they experience daily, they often find it necessary to code-switch — changing the way they talk and express themselves when they are outside of their homes and Black communities.

To help explain this concept, Hammonds uses the analogy of counseling professionals switching their “hats” or roles. They may go from teaching to supervision to having a counseling session with a client and back to teaching again, all in the same day, which can be taxing.

“Switching roles, having to constantly pause and reconsider how much you can share and what is your role in this new context, and always being aware of what you can and can’t say and what you can and can’t do is exhausting,” Hammonds says. “And that’s an emotional labor that many White Americans aren’t required to do.”

Black women often face an extra burden. As Avent Harris explains, “Black women are expected both inside and outside their community to not be vulnerable, to not share emotions and to carry the weight of everything on their shoulders.”

This unrealistic expectation can take a toll on mental health. In fact, many of Cartwright’s clients struggle with the “Black superwoman syndrome” — the myth that Black women are impermeable. They feel pressure to do it all and to do it well. Although this isn’t really a syndrome, it does help explain the chronic stress these women endure while trying to juggle multiple roles and keep up with the daily demands placed on them by family, work and community.

Cartwright’s clients often discuss feeling misunderstood at work and how co-workers minimize their experiences. Cartwright normalizes these experiences for her clients, but she also expresses how sad it is that this is their “normal.”

The trauma of racial violence

Instances of brutality and violence against Black people are not new, and neither are the racial disparities that regularly confront them. The main difference today is the ability to easily document such instances, says Hammonds, whose research interests include technology in counseling, multicultural counseling and community determinants of mental health. Almost everyone today has a smartphone in their pockets, and more people are using them to record acts of race-based violence and to demand justice and accountability.

These videos also continually expose others to these traumatic and heinous acts. This can be particularly traumatizing for Black people, who often internalize the traumas they witness because they know it could have easily happened to them, Hammonds says.

The disparaging comments on social media can also be traumatizing and triggering for Black Americans, Crumb adds. For instance, they may read a racist comment made by a supervisor or colleague. Then they have to return to work and sit beside that person, knowing how that person really feels about them.

“And so often, [Black people] are expected to move through the world, to hear all this, to see all this, and have no emotional reaction or response,” Avent Harris says. Counselors can help change this by validating clients’ emotional reactions to racial violence and discriminatory remarks, she adds. This involves letting them know that it’s OK to feel disappointed, sad, angry, scared, anxious or whatever else they are feeling.

The trauma of being exposed to racial violence and remarks also has a collective effect. “Collective trauma is exposure to stressful events that threatened a sense of safety on a group level,” Hammonds explains.

On a recent episode of The Thoughtful Counselor podcast, Hammonds described how repeated exposure to racial violence and discrimination operates like a wound that won’t heal: “That spot’s been nicked so many times. We can go about the process of healing, but before you know it, there is another nick. Then you’re walking around doing your best to cope, shielding that spot, anticipating situations that might nick you again. … You are always on edge. You’re withdrawing. Your trust is slow to build in other people and situations. You feel angry and sad. And you start to think, ‘Is there something wrong with me? Why can’t I get out of this cycle?’”

This collective trauma correlates with symptoms of depression and posttraumatic stress disorder such as avoidance, reexperiencing, numbing and hyperarousal, she adds.

If a community experiences stress together, then counseling approaches that draw on the power of relationships are helpful, Hammonds says. These approaches include relational therapies, psychodrama, drama therapies, creative approaches and group therapy.

Hammonds often incorporates music into her sessions with clients. She describes music as being akin to a picture book because it connects people to a certain memory, place, emotion or experience in their life.

When clients can’t easily describe their thoughts, feelings or perceptions in their own words, she asks them to think of a song that best captures their emotions or that represents what they see around them. She then pulls up the song and plays it in session, asking the client, “What is powerful about this song? How do the lyrics or beat affect you?”

Impacts on Black children

In the summer of 2016, Philando Castile was fatally shot in his car by a Minnesota police officer during a traffic stop. Castile wasn’t alone. His girlfriend, Diamond Reynolds, and her 4-year-old daughter witnessed the entire incident.

After the shooting, Reynolds, who was now in handcuffs, was understandably distraught and emotional. Her daughter tried to comfort her, exclaiming, “Mom, please stop saying cusses and screaming ’cause I don’t want you to get shooted.” A few minutes later, the girl said, “I wish this town was safer. … I don’t want it to be like this anymore.”

The girl’s words illustrate how racism and racial violence affect children even at a young age. “Black youth are just as affected as their Black parents are by systemic racism and injustices,” says Crumb, an ACA member whose research interests include rural and school-based mental health services. Black children are affected directly and indirectly. They witness racial violence and discrimination themselves, and they hear adults talking about it at the kitchen table. “Then, they assume these thoughts, these fears … [and] this distrust,” Crumb adds.

Again, counselors should take the initiative to broach the topic of racism with these youth. Crumbs calls it “taking the temperature of the room” because counselors can check in to see how children are doing. For example, a counselor could say, “This has been a tough summer with COVID-19 and a lot of people getting harmed and dying. How are you feeling?”

Then counselors should let the children guide the conversations, Crumb says. Some may verbalize their feelings. Others may use play or draw a picture to express their emotions.

Crumb points out that school settings are often the only access that some Black communities have to counselors. But because of mistrust and fear, they may not view counselors and schools as “safe spaces.” Crumb advises counselors to be mindful of current and historical racial inequities within school systems and to alter their approaches accordingly in attempting to connect with these children.

Younger children may not have the vocabulary to easily communicate their feelings. They often “speak” through play and toys. So, Cartwright recommends that counselors keep an assortment of toys, dolls and activities that will allow children to communicate in the way in which they feel most comfortable. If they want to use a brown doll, counselors should make sure it is available to them, she adds.

But as Reynold’s 4-year-old daughter demonstrated, some Black children possess an early awareness of racism and a vocabulary to discuss it. They often have little choice. Black children will be exposed to inequities earlier than their White peers because of their parents’ lived experiences and the conversations they overhear, Avent Harris explains.

Crumb encourages counselors, especially school-based counselors, to be courageous in advocating for Black youth. Black youth are often overlooked academically and are disproportionately suspended, she says. Counselors can be vocal in questioning why that is the reality. Likewise, if diagnoses of attention deficit/hyperactivity disorder and conduct disorders are disproportionate toward one ethnicity, counselors can ask questions and press for answers.

More than that, counselors can do something about such disparities. For example, they can lead professional development trainings for teachers, Crumb says.

Partnering with the Black community

Black people may rely on informal networks of support such as family, friends and their church communities when it comes to issues having to do with their mental health, Crumb says. She add that counselors should encourage clients to continue using these supportive networks because it is imperative that they have trusted individuals to whom they can turn to discuss their experiences of race-based trauma.

Counselors should also reach out and form relationships with stakeholders in Black communities. Crumb and Avent Harris recommend partnering with community organizers, historically Black Greek-letter organizations, those involved with the juvenile justice system, law enforcement personnel and faith leaders.

Faith leaders are often both spiritual and political leaders in the Black community, Avent Harris says, so collaboration with them is crucial. “A lot of times, how [Black Americans] conceptualize events, crises, pain and suffering is coming from [their] spiritual beliefs systems,” she adds.

In an article written for CT Online after the 2015 church shooting in Charleston, South Carolina, that took the lives of nine Black people, Avent Harris suggested that counselors could meet with Black pastors and offer to speak in their Sunday morning services, co-sponsor a mental health day or provide referral resources.

Counselors should also think of these partnerships as a preventive measure. Counselors need to be invested and involved with Black communities before crises happen, Avent Harris stresses. She challenges her colleagues to name five contacts they have a working relationship with in the Black community and could reach out to immediately. If they can’t name five, she says, then they have some work to do.

Less talk, more action

The words diversity and inclusion have steadily gained prominence in the counseling profession, but Avent Harris believes this has allowed counselors to largely become complacent and not move past thinking of “change” as simply including and hiring diverse individuals.

“It’s not just diversity and inclusion. It’s how we’re doing equity work, how we are doing anti-racism work,” she emphasizes. “What are our actions behind the words that we say? And do our actions align with what we say and who we say we are as a profession?”

Avent Harris, like many other Black people, is exhausted from having the same conversation over and over again about what the Black experience is like. “It’s time to move beyond that talk and really implement action,” she says.

Taking action doesn’t mean that all counselors have to hit the streets and protest, but they can commit to influencing the spaces they are in, Crumb says. Maybe that’s writing an article. Maybe that’s offering a training. Maybe it’s working to inform policy. Maybe it involves working toward making positive change in their communities or within themselves.

Cartwright also suggests one small step counselors could take that would have a huge impact: making their services more accessible to communities of color by offering one pro bono slot a week or having a sliding scale.

Although 2020 hasn’t been the year we wanted, it may be the one we need. Every day, we hear the global rallying cry, “Black Lives Matter.” Behind that cry are Black people who are suffering and dying because of systemic racism. We hear the refrain: Trayvon Martin, Tamir Rice, Eric Garner, Philando Castile, Charleena Lyles, Atatiana Jefferson, Breonna Taylor, Ahmaud Arbery, George Floyd, Tony McDade, Rayshard Brooks, and countless others who have died.

These are the tragic killings that make the news. But how many others die daily without drawing widespread attention? How many more face daily injustices or discrimination?

Yes, their lives matter. And their mental health does too.

 

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On June 22, the ACA Governing Council issued a statement on anti-racism. As this article was being written, ACA leadership was listening to a cross section of members and volunteers to develop an action plan that would give life to the statement. For more, see tinyurl.com/ACAAntiRacism.

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

ACA anti-racism statement

June 22, 2020

 

After discussion and discernment, the ACA Governing Council has issued the following statement on anti-racism. The ACA leadership is listening to a cross section of members and volunteers in order to develop an action plan that will give life to this statement.

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ACA Anti-Racism Statement

Racism, police brutality, systemic violence, and the dehumanizing forces of oppression, powerlessness, and White supremacy have eroded the very fabric of humanity which ideally binds our society together. Macrolevel systemic racism extends to disparities in institutional policies and procedures in physical and mental healthcare, education, the judicial system, employment, sports and entertainment, and the brutal violence of law enforcement. These larger societal oppressions lead to inaccessibility to resources and social marginalization, which descend finally to individual racist attitudes, implicit biases, stereotypes, microaggressions, and even death. The ongoing and historical injustices are not acknowledged by those who want to be in power or protect their entitlements. Some who do acknowledge, do so reactively, temporarily, or superficially and thus, no meaningful change occurs. Anti-Black racism is often reframed as accidental, an unfortunate incident, or as the criminality of the victim.

Words cannot truly capture our feelings. We are angry, exhausted, grieving, suffering, furious, and in despair. The American Counseling Association is pained by the murders of George Floyd, Rayshard Brooks, Ahmaud Arbery, Breonna Taylor, Tamir Rice, Eric Garner, Sandra Bland, Michael Brown, and countless other Black/African Americans who unfortunately remain nameless. We stand in solidarity with our Black siblings in denouncing the historical legacy and destruction caused by institutionalized racism and violence against Black people, perpetuated at the hands of law enforcement, the hatred bred of White supremacy, the deafening silence of dehumanizing and complicit inaction to address these systemic ills within our society. As counselors, we listen, we empathize, and agree with protestors that when absolute justice is established, peace will follow. Enough is enough, we cannot continue to watch fellow Black Americans being murdered, as the very life force is suffocated out of them.

The American Counseling Association is built on enduring values and a mission that promotes: human dignity and diversity, respect, the attainment of a quality of life for all, empowerment, integrity, social justice advocacy, equity, and inclusion. If we remain silent, and do not promote racial justice, these words become harmful and meaningless for our members and the counseling community. Given the rapidly evolving double pandemic of COVID-19 and the continued exposure of Black people to institutionalized racism, ACA wants to be clear about where we stand and the ongoing actions we will take. As proactive leaders, counselors, mentors, supervisors, scholars, and trainers we will break away from this structure of racism trauma, and the violence born on the necks of Black people.

Our stance is: Black Lives Matter. We have a moral and professional obligation to deconstruct institutions which have historically been designed to benefit White America. These systems must be dismantled in order to level the playing field for Black communities. Allyship is not enough. We strive to create liberated spaces in the fight against White supremacy and the dehumanization of Black people. The burden of transgenerational trauma should not be shouldered by Black Americans even though they have remained resilient.

All ACA members must be willing to challenge these systems, but also confront one’s own biases, stereotypes, and racial worldview. Moving forward, our actions will be based on input from our members and the voices of others. We are committed to change.

 

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Learn more

ACA has compiled a number of resources focused on cultural competencies and combating racism: https://bit.ly/2BuNZ1Y

 

The historical roots of racial disparities in the mental health system

By Tahmi Perzichilli May 7, 2020

Racial disparities, or unfair differences, within the system of mental health are well documented. Research indicates that compared with people who are white, black, indigenous and people of color (BIPOC) are:

  • Less likely to have access to mental health services
  • Less likely to seek out services
  • Less likely to receive needed care
  • More likely to receive poor quality of care
  • More likely to end services prematurely

Regarding racial disparities in misdiagnosis, black men, for example, are overdiagnosed with schizophrenia (four times more likely than white men to be diagnosed), while underdiagnosed with posttraumatic stress disorder and mood disorders. Additionally, concerns are compounded by the fact that for BIPOC, mental health care is often provided in prisons, which infers a multitude of issues.

BIPOC are overrepresented in the criminal justice system, as the system overlays race with criminality. Statistics show that over 50% of those incarcerated have mental health concerns. This suggests that rather than receiving treatment for mental illness, BIPOC end up incarcerated because of their symptoms. In jails and prisons, the standard of care for mental health treatment is generally low, and prison practices themselves are often traumatic.

The vast majority of mental health treatment providers in the United States are white. For example, approximately 86% of psychologists are white, and less than 2% of American Psychological Association members are African American. Some research has demonstrated that provider bias and stereotyping are relevant factors in health disparities. For nearly four decades, the mental health field has been called to focus on increasing cultural competency training, which has focused on the examination of provider attitudes/beliefs and increasing cultural awareness, knowledge and skills.

Despite such efforts, racial disparities still exist even after controlling for factors such as income, insurance status, age, and symptom presentation.Established barriers for BIPOC are the following:

  • Different cultural perceptions about mental illness, help-seeking behaviors and well-being
  • Racism and discrimination
  • Greater vulnerability to being uninsured, access barriers, and communication barriers
  • Fear and mistrust of treatment

In addition to emphasizing culturally competent services, other recommendations to bridging the gaps and addressing barriers have largely focused on diversifying workforces and reducing stigma of mental illness in communities of color.

One area not often noted is the historical (and traumatic) context of systemic racism within the institution of mental health, although it is well known that race and insanity share a long and troubled past. This focus may begin to account for how racial differences shape treatment encounters, or a lack thereof, even when barriers are controlled for and the explicit races of the provider and client are not at issue.

Historical context

In the United States, scientific racism was used to justify slavery to appease the moral opposition to the Atlantic slave trade. Black men were described as having “primitive psychological organization,” making them “uniquely fitted for bondage.”

Benjamin Rush, often referred to as the “father of American psychiatry” and a signer of the Declaration of Independence, described “Negroes as suffering from an affliction called Negritude.” This “disorder” was thought to be a mild form of leprosy in which the only cure was to become white. Ironically Rush was a leading mental health reformer and co-founder of the first anti-slavery society in America. Rush did observe, however, that “the Africans become insane, we are told, in some instances, soon after they enter upon the toils of perpetual slavery in the West Indies.”

In 1851, prominent American physician Samuel Cartwright defined “drapetomania” as a treatable mental illness that caused black slaves to flee captivity. He stated that the disorder was a consequence of slave masters who “made themselves too familiar with the slaves, treating them as equals.” Cartwright used the Bible as support for his position, stating that slaves needed to be kept in a submissive state and treated like children to both prevent and cure them from running away. Treatment included “whipping the devil out of them” as a preventative measure if the warning sign of “sulky and dissatisfied without cause” was present. Remedy included the removal of big toes to make running a physical impossibility.

Cartwright also described “dysaethesia aethiopica,” an alleged mental illness that was the proposed cause of laziness, “rascality” and “disrespect for the master’s property” among slaves. Cartwright claimed that the disorder was characterized by symptoms of lesions or insensitivity of the skin and “so great a hebetude [mental dullness or lethargy] of the intellectual faculties, as to be like a person half asleep.” Undoubtedly, whipping was prescribed as treatment. Furthermore, according to Cartwright dysaethesia aethiopica was more prevalent among “free negroes.”

The claim that those who were free suffered mental illness at higher rates than those who were enslaved was not unique to Cartwright. The U.S. census made the same claim, and this was used as a political weapon against abolitionists, although the claim was found to be based on flawed statistics.

Even at the turn of the 20th century, leading academic psychiatrists claimed that “negroes” were “psychologically unfit” for freedom. And as late as 1914, drapetomania was listed in the Practical Medical Dictionary.

Furthermore, after slavery was abolished, Southern states embraced the criminal justice system as a means of racial control. “Black codes” led to the imprisonment of unprecedented numbers of black men, women and children, who were returned to slavery-like conditions through forced labor and convict leasing that lasted well into the 20th century.

Scientific racism early on indicates motives of control and containment for profitability. Leading health professionals propagated the idea that blacks were “less than” to justify exploitation and experimentation. The mislabeling of behavior, such as escaping slavery, as a byproduct of mental illness did not stop there. Significant transformations in defining mental illness also occurred in the civil rights era, suggesting that institutional racism becomes more powerful in the context of moments of heightened racial tensions in the collective social consciousness.

Prior to the civil rights movement, schizophrenia was described as a largely white, docile and generally harmless condition. Mainstream magazines from the 1920s to the 1950s connected schizophrenia to neurosis and, as a result, attached the term to middle-class housewives.

Assumptions about the race, gender and temperament of schizophrenia changed beginning in the 1960s. The American public and the scientific community began to increasingly describe schizophrenia as a violent social disease, even as psychiatry took its first steps toward defining schizophrenia as a disorder of biological brain function. Growing numbers of research articles asserted that the disorder manifested by rage, volatility and aggression, and was a condition that afflicted “Negro men.” The cause of urban violence was now due to “brain dysfunction,” and the use of psychosurgery to prevent outbreaks of violence was recommended by leading neuroscientists.

Researchers further conflated the symptoms of black individuals with perceived schizophrenia of civil rights protests. In a 1968 article in the esteemed Archives of General Psychiatry, schizophrenia was described as a “protest psychosis” in which black men developed “hostile and aggressive feelings” and “delusional anti-whiteness” after listening to or aligning with activist groups such as Black Power, the Black Panthers or the Nation of Islam. The authors wrote that psychiatric treatment was required because symptoms threatened black men’s own sanity as well as the social order of white America.

Advertisements for new pharmacological treatments for schizophrenia in the 1960s and 1970s reflected similar themes. An ad for the antipsychotic Haldol depicted angry black men with clenched fists in urban scenes with the headline: “Assaultive and belligerent?” At the same time, mainstream white media was describing schizophrenia as a condition of angry black masculinity or warning of crazed black schizophrenic killers on the loose. A category of paranoid schizophrenia for black males was created, while casting women, neurotics and other nonthreatening individuals into other expanded categories of mood disorders.

The black psyche was increasingly portrayed as unwell, immoral and inherently criminal. This helped justify the need for police brutality in the civil rights movement, Jim Crow laws, and mass incarceration in prisons and psychiatric hospitals, which at times was an exceedingly thin line. In general, attempts to rehabilitate took a back seat to structural attempts to control. Some state hospitals, presided over by white male superintendents, employed unlicensed doctors to administer massive amounts of electroshock and chemical “therapies,” and put patients to work in the fields. Deplorable conditions went unchallenged as late as 1969 in some states.

Deinstitutionalization, a government policy of closing state psychiatric hospitals and instead funding community mental health centers, began in 1955. Over the next four decades, most state hospitals were closed, discharging those with mental illness and permanently reducing the availability of long-term inpatient care facilities. Currently, there are more than three times as many people with serious mental illnesses in jails and prisons than in hospitals. The shifts in defining what constitutes mental health reflects the reality that the definition is shaped by social, political and, ultimately, institutional factors in addition to chemical or biological ones.

Conclusion

Looking at the historical and systemic context of the mental health system may provide insight into why racial disparities continue to exist and why these disparities have been resistant to interventions such as cultural competency training and standardized diagnostic tools. Focusing primarily on the race of the provider and the client, while valid, is an approach that does not consider the system itself, the functions of the diagnosis, and its structurally developed links to protest, resistance, racism and other associations that work against the therapeutic connection.

Racial concerns, including overt racism at times, were written into the mental health system in ways that are invisible to us now. Understanding the past enables new ways of addressing current implications and identified barriers, including how schizophrenia became a “black disease,” why prisons emerged where hospitals once stood, and how racial disparities continue to exist in the mental health system today.

 

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Additional resources

 

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Tahmi Perzichilli is a licensed professional clinical counselor and licensed alcohol and drug counselor working as a psychotherapist in private practice in Minneapolis. Contact her through her website at www.tahmiperzichilli.com.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.