More “subtle” forms of racism in psychiatric treatment – looking beyond POC providers as the solution

I have lots to say on this topic but this post was prompted by a specific incident while I was in a partial hospital program for mood and anxiety disorders at one of the best hospitals on the west coast. The way the program was structured was patients were offered a choice of 2 or 3 psycho-education classes every hour. This is similar to group therapy but the focus was on education about a topic & sometimes an exercise & group discussion.

One day a class I attended was on the topic of Resilience. I didn’t really want to be in that class because I’d had a precious negative experience with the therapist leading that class but due to limited choice I was in that class.

For this class, here is the article she chose for us to read as a group:

Now I haven’t read the article again recently since it made me upset the first time. But basically it’s talking about research on resilience. It starts out by talking about how the research has been focused on groups experiencing traumatic events like natural disasters or wars etc. Which fine. But the rest of the article is almost entirely focused on research done in the context of war but, here’s the key, the focus is on the resilience of American soldiers rather than the resilience of the communities they’re harming.

One specific part I remember is talking about how mindfulness techniques were used to help US soldiers fighting in Iraq. Now don’t get me wrong. PTSD & other psychiatric illnesses among soldiers is a major issue that deserves recognition, research & treatment especially since many soldiers come from disadvantaged communities that are preyed upon by military recruiters promising education & career benefits. However, the focus of the research in this article was about how mindfulness was used to increase resilience of US soldiers to make them better at killing Iraqis. IMO this is a heinous application of psychology. What it made me think of was this meme that went around a while ago (which unfortunately I’ve been unable to find) after a movie about an American soldier who had fought in Iraq came out. The meme said something like “Americans will invade your country & then 10 years later make a movie about how invading your country made their soldiers sad”.

IMO feeling sad about participating in an unjust war is a normal & admirable response especially since the US military propaganda machine & predatory recruiting makes it so teenagers joining the military think they’re doing a good thing. Using the science of resilience to counter the conscience of soldiers so they can keep harming Iraqis is an unethical use of psychology.

Moreover, nowhere in the article did it say anything at all about the resilience of the Iraqi people harmed by the US invasion. So even leaving aside whether the research itself was unethical, sharing such an article in a class about resilience in a psychiatric health context is frankly racist and harmful.

Now as I mentioned at the start, I’d already had issues with this therapist so while I was upset I didn’t want to say anything because unfortunately psych health settings are not safe places to express disagreement with treatment strategies. The regimented rules often get one labeled as a problem patient which can lead to pretty bad consequences within the health system. Thankfully I had allies in the room. Another patient spoke up & pointed out the issue that the article would be triggering for people from communities suffering harm at the hands of the US military.

If you’ve read this far, that was all background. Here’s the part I want to focus on: the therapist leading this session was Asian American. You might ask why is that the part you want to focus on? The reason is that I’ve seen a lot of recent focus on how we need more POC therapists & psychiatrists to deal with the issue of racism in psychiatric health. And I agree with that idea in general but it’s not enough. I haven’t seen as much about the importance of interrogating whether the treatment approaches being used are themselves racist. [I’ll write another post soon inshAllah about some widely practiced approaches that are harmful]. The research that many of these treatment programs are based on is still very much based on data from white communities. I have yet another rant to post about how psychology research is not great science in many ways with regards to considering certain behaviours as universal human psych markers rather than considering the huge variations in cultures. White people aren’t the standard human. I don’t think psych science is at the point where they’ve adequately disambiguated biology & culture.

But anyway the main point is just having more POC therapists doesn’t fix the issues of racism in psychiatric healthcare. Everything from the study design for psych studies to choosing what info is appropriate to share in a multicultural group to more “fluffy” aspects of the types of therapeutic activities chosen etc. needs to be analyzed for racist & imperialist biases.

Note that I’m still very much a proponent of scientific approaches to psychiatric health. So for example within my religious community I’m glad to see shifts from telling people to pray away psychiatric illnesses to seeking medical care. However, as a scientist, I’m also very critical of bad science masquerading as good clinical medicine.

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