Mental(izing) Health
Newsletter #8
My last newsletter culminated with this question: Is now a time, when confronting anti-Black racism and white supremacy must be incorporated into our work, not occasionally, but insistently and relentlessly? In this newsletter, I shall pursue discussion of various issues around this question and end up with the response: yes, with a few caveats.
For African Americans, and people of color in general, identifying the dominant culture in the US as white supremacist is no revelation. It is mainly white people who have undergone a transformation in the way they think about white supremacy. For many white people, myself included, the existence of white supremacy has long registered, but tended to be associated with extremism, terrorism, and people who live out west in far-flung, desolate places, among endless fields of over-fertilized white potatoes. It is convenient to see white supremacy as about them, not about you.
Some white people recoil at the notion of white supremacy, experiencing it as a personal affront to find themselves placed in this category. Clearly, there are degrees of inhabiting white supremacy. Perhaps one does not have to avow the superiority of white people in a literal way in order to be a white supremacist. Perhaps white supremacy can be defined in terms of the wish to live monoculturally, that is, amongst people whom you see as like yourself.[i] Some have argued additionally that white supremacy is borne from white people’s reaction that their power is in decline, suggesting that underlying the guise of being better is a fear of falling behind.[ii] I do not find that to be so persuasive because it gives license simply to disregard the fate of African Americans, whose lives are even more challenged on economic (and most other) measures.
A second crucial point about white supremacy is that it does not have to be a conscious attitude. It might well be split off from awareness, residing deep in the recesses of the individual and social unconscious. The notion of aversive racism captures how a person might prefer not to think of him/her/their self as racist, yet still manifest racist beliefs and behaviors. I doubt anyone can manage to avoid being racist, if such a person exists contentedly in a monocultural world.
Like many others, the persistent, horrific examples of police violence against African Americans are significant factors in convincing me that white supremacy is real, mainstream, and a peril to the nation.[iii] Efforts to warn us about this have existed from James Baldwin to numerous contemporary authors. By last summer, it felt that something shifted, where many more white people were beginning to make the journey, to acknowledge their complicity in a system that pretends but really refuses to change. A line was crossed, where it was unavoidable to face that neo-liberalism has resulted in worsening inequality, and that new paths forward were needed, where we would no longer avert our eyes to anti-Black racism, and where we would squarely confront the extent to which white people have been self-servingly comfortable ignoring the meaning of whiteness.
If you agree, more or less, with my formulation of recent history, it must be on your mind, too, to wonder what the implications are for clinical practice. Let’s start slowly: just about everyone will agree that it is not desirable to force patients to talk about race nor is it helpful to ignore the topic, if and when it comes up. The next step is equally non-controversial: that if race is in the air—a patient refers to race indirectly, or mentions something that happened to someone else, or comments on a recent event in the news—that some effort should be made to explore the patient’s willingness to speak more explicitly about it. Although it is obvious, we might add that a clinician cannot go wrong in inquiring whether race is on a patient’s mind or not.
Nevertheless, I would be reluctant to endorse an unqualified stance, like that if there is a racial difference between the dyad, it is the job of the therapist to insist that it be discussed. Clinical tact cannot go out the window: a therapist must be mindful of the power differential with patients and be wary of imposing beliefs onto them. Here’s my effort to put the point perspicuously: a therapist should feel free to be able to introduce race, where it has not been mentioned by the patient, as long as the therapist imagines that it will contribute to the patient’s meaning-making. In other words, it may not be enough to introduce race ex nihilo, just because it happens to be on your mind. I am not at all supposing that it is realistic for politics to be excluded from the room; it’s there whether we like it or not. However, it is possible for politics to be deployed defensively and intrusively, either by patient or therapist, or colluding together.
While I am advocating this caution, I also would like to stress that a therapy that never addresses race is lacking in some ultimate way. I realize that therapies that do not emphasize the relationship might well be satisfied with the results, where, if the patient is suffering less, everyone goes home pleased. But if your ambition is to transform a patient’s life, it will be necessary to articulate and fathom the respective identities of both parties, which includes but might not be defined by race.
Ready to move now in a more controversial direction? Where the dyad is a black therapist and a black patient, it is impossible to imagine that race will not be discussed. Where the dyad is a POC therapist and a POC patient, it is extremely likely that race will be discussed, even if the dyad differs, say, a Black therapist and an Asian patient. Yet, intuition tells us that a dyad of a white therapist and a white patient might or might not discuss race. The explanation, as I have already implied, is that whiteness traditionally is taken for granted, especially in the privileged environment of private practice. It remains in the background, easily preempted by other aspects of identity. A kind of hypocrisy is betrayed in uncritically assuming that a white therapist with a black patient might not encourage the patient to talk about race, whereas we imagine that a black therapist with a white patient would wish the patient to talk about race.
Unreflective beliefs, which casually verge on generalizations, if not stereotypes, deserve scrutiny. I have given short shrift to within group differences, not to mention neglecting to take account of social class. In order to deepen my inquiry, I would like to turn to Kirkland Vaughan’s work, which provides insight about these dynamics and also illuminates the foundation of white supremacy.[iv] Vaughan postulates that white people fail to mentalize black people. Black people are not seen or recognized; they do not really exist in the same capacity as white people. This is why a white therapist might ignore race with a black patient and a black therapist is unlikely to do so. The white therapist runs the risk of operating with the assumption that the black patient, like him/her/them, has the option of thinking about race, whereas the black therapist would be unlikely to suffer such a conceit. White people are underexposed to the experience of black people, blind to the inescapability of race, guilty of pretending that their experience is universal. Dialogues about race are all well and good, but it is time for white people to do more listening. I was reminded of this recently in watching the documentary film, Time, directed by Garrett Bradley, which depicts a black woman’s struggle to hold her family together as she fights for the release of her husband from jail (https://www.imdb.com/title/tt11416746/). The portrayal of every black person in the film showed detailed, loving attention: we see each member of the family sensitively, a harsh contrast to the kind of images that we see of black people in Hollywood films or the mainstream media.
What is at stake with white people not mentalizing black people? If white people made the effort to see black people, they would have to take in how they are seen by black people, and this produces avoidance, shame, and resentment. As long as I am free not to think about my whiteness, I can be free not to think about your blackness—the cycle is shut and repeated over and over again. This offers a further glimpse about why a white therapist with a black patient might not want to go there, whereas a black therapist with a white patient will see no alternative.
It is fraught for any dyad of different races to find a way to speak honestly and productively about race. In welcoming patients to express how they feel, therapists might hear things that are not flattering. The issue of how much therapists show say about race or how much detail to give in responding to questions from patients is a matter of discretion. It is legitimate not to say more than one is comfortable divulging, although this has to come up against patients’ wish to know and how self-disclosure can abet trust. Courage is required, a willingness to take a stand against the regression that we have witnessed in public discourse and conduct that rewards thin-skinned reactivity. It seems like a long time ago when microaggressions were defined in terms of replacing macroaggressions, given that our society no longer tolerated them. Our pathetic reality is that macroaggressions are back and that microaggressions have hardly disappeared. They even occur, implausibly, together, at the same time. The resurgence of anti-Asian racism is further indication of a snowball effect of white supremacy.
Therapists who see their work as dependent upon the quality of the relationship that they form with patients have a special obligation to discuss race. The reason is that getting to know each other is bound to incorporate a focus on race as one part of self-identity. Race cannot slip into the optional category, and it should not be discussed in mere factual terms. Race is, as Kim Leary, has observed inescapably has elements both of being real and being a fantasy.[v] Hearing patients’ feelings, thoughts, and associations about race is an intrinsic way to get to know that person. This is as relevant for similar dyads as it is for different dyads. More specifically, working with white patients, white therapists must be alert to race, and be prepared to encourage discussion of race, and to consider how this links to the patient’s self-knowledge and self-interest. I recall one (white) patient who expressed racist views, which we pursued in endlessly frustrating ways, until he began to see how much they were projections of his own sense of being victimized in his family; he left treatment no longer expressing anti-Black racism. Sadly, I also recognize times that I have often failed to confront racism constructively.
White therapists have an obligation to be allies, and this does not exclusively pertain to what happens in their interaction with black patients. Of course, a piece of this has to do with the well-trodden notion of owning privilege. However, the highest priority should be considering what comes next after one acknowledges privilege. A recent panel at the spring conference of Division 39 of the APA provided an extraordinary example: three white therapists reflecting on their own experiences of whiteness—including recognition of objective shame, awareness of seeing oneself through the eyes of how others see you (interpreting the play Fairfield), and contemplating a complex, disturbing case of a white woman where race emerged as a crucial factor.[vi] We need more of these presentations.
White psychologists need to recognize the extent to which the history of psychology in the US is a narrative of WEIRD people, who differ fundamentally from others around the globe.[vii] Research on whiteness that is aware of being about whiteness is welcome, especially as it serves to alleviate the burden on ethnic minorities to be the ones who have and are concerned with race.
Our field remain inamicable to black people—to black patients whose iatrophobia in medical environments has a long history, and to black therapists.[viii] Another panel at Division 39 was with 8 African American graduate students and early career professionals, all of whom had an association with George Washington University, which provided ample documentation of feeling oppressed by white supremacy and how unprepared white educators were to understand their experience.[ix] To be honest, I believe that doctoral students at my graduate program (CUNY) have had similar experiences. At the moment, we are all in affinity groups, attempting to face ourselves and to work through some of the microaggressions that have occurred. It is remarkable to confront that even at institutions that strive to be diverse that alienation persists. This confirms how much more work there is to do to rid ourselves of white supremacy, all the more so given that I would guess that many clinical psychology doctoral programs might even be less supportive of ethnic minority students.
Are we going to hold onto the momentum that the Black Lives Matter movement has inspired? It’s tempting to feel heartened by the election of Biden and Harris. Since last summer, though, we can already sense in the environment some regression to the mean, regardless that the stakes are so high. If we do not sustain the fight against white supremacy and anti-Black racism (as well as all forms of racism) with vigor and passion, how can we feel hopeful about the future of mental healthcare or our country?
[i] See B. Stoute’s Racial Socialization and Thwarted Mentalization: Psychoanalytic Reflections from the Lived Experience of James Baldwin’s America, American Imago, 76(3): 335-357, and Cross, W. (1983). The Ecology of Human Development for Black and White Children: Implications for Predicting Racial Preference Patterns. Critical Perspectives of Third World Americas, (1)1: 177-189.
[ii]For media reflections on the term “white supremacy,” see V. Newkirk’s “The Language of White Supremacy” in the Atlantic, October 6, 2017; S. Kantrowitz’s “White Supremacy Has Always Been Mainstream” in the Boston Review, July 23, 2018; C. Blow’s “Call A Thing A Thing” in the New York Times, July 8, 2020; and J. Asare’s “4 Myths About White Supremacy That Allow It to Continue” in Forbes, January 14, 2021.
[iii] K. Belew’s (2019) Bringing the War Back Home (Cambridge: Harvard) traces the most recent manifestation of white racism to soldiers returning from the Vietnam war, who felt betrayed by the government’s lack of support. The movement grew steadily and stealthily, with deliberate efforts to remain decentralized in order not to be easily detected. Belew emphasizes the complicity of the media, for example, in buying the story of the Oklahoma bomber, Timothy McVeigh, who committed the single most violent terrorist action on US soil, as a loner, whereas he had visited a white racist community just before the bombing and was likely supported by like-minded people.
[iv] Vaughan, K. and Harris, L. (2016). The Police, Black, and Hispanic Boys: A Dangerous Inability to Mentalize, Journal of Infant, Child, and Adolescent Psychotherapy, 15(3): 171-178. Also see Vaughans’ terrific edited volume, which was not reviewed in any psychoanalytic journals, as far as I could tell: Vaughans, K. and Spielberg, W. (2015), Eds. The Psychology of Black Boys and Adolescents, Vol. 1. Santa Barbara: Praeger.
[v] Leary, K. (2012). Race as an adaptive challenge: Working with diversity in the clinical consulting room. Psychoanalytic Psychology, 29(3): 279-291.
[vi] The panel was entitled “Having and Hiding: Reckoning with the Lived Experience of Privilege,” Stephen Anen, Jane Caflisch, Danielle Frank as speakers and Mary Kim Brewster as Discussant (Division 39, APA, Spring conference, March 14, 2021)
[vii] See my last newsletter (#7) regarding the WEIRD (Western, Educated, Industrialized, Rich, and Democratic). While a provocative construct, its lack of attention to race is troubling.
[viii] Washington, H. (2006). Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. New York: Anchor (Random House). Washington provides a comprehensive account of the fear of the medical profession that African Americans have justifiably experienced, warning against dwelling on the Tuskegee experiment as an exception, rather than the norm.
[ix] This special event at the conference was entitled “The Encounter Between Black Student Clinicians & the Racial Reckoning” with the following panelists: Pamela Blackwell, Victoria Todd, Kelly Banks, Aiyanna Archer, Andolyn Medina, Justin Hopkins, Ashland Thompson, and Jesse Walker as the moderator. I learned a lot from this panel and look forward to imagining how they will change the field (Division 39, APA, Spring conference, March 14, 2021).