Of Mice and Minds- race and mental health.
In a recent copy of openmind magazine (the magazine of the Mind mental health organisation) is a story about a Somali woman who having complained to her psychiatrist that she was hearing mice in her accommodation was diagnosed with 'hallucinations' and was compulsory detained in hospital.
"This particular women had said she could hear, see and feel mice in her bed at night. And a visit to her accommodation showed that there were mice. When I went to visit her in hospital she told me of course that she could no longer hear mice. What she actually needed was socially based support. Many people from other cultures will also say they hear their ancestors talking to them. It is not necessary a sign of schizophrenia. Instead it is something that can be comforting to that person."(1)
It is clear that the psychiatrist has made a serious error of judgement because he has failed to really listen to what the Somali woman is telling him. He clearly cannot relate to her and demonstrates his racism by assuming that the black woman before him is mad. He is not listening to her. Rather he is listening to his learnt method, which tells him that to hear voices and sounds, is delusional and a symptom of mental illness. His identity as a psychiatrist with its many years of medical training and with its skill of analysing and abstracting the words spoken to him, lead him to a wrong psychological place. He fails to communicate with his own consciousness, as he fails to connect with hers, so in the end it is he, and not his client, who hallucinates. By listening to his method he does not hear anything of value and cannot hear the reality, which she communicates.
Research into the issues around the mental health of minorities makes for dismal reading. Black women, black men, the Irish, the Chinese and the Vietnamese; as well gays and lesbians are suffering deeply within white mainstream society. At the same time it is these very people who are unable to access the support and services they require.
For instance black people, especially black men are between 10-15 times more likely to be sectioned, detained in hospital, diagnosed with schizophrenia, given high doses of medication rather than being offered other less invasive treatments like counselling. Black people are subject to stereotyping within the mental health system- black men are viewed as big, black, bad and dangerous, while black women are seen as angry and suffer from sexism and class disadvantage. The relationship between the white practitioner and black client is devoid of any understanding of racial and cultural bias, which continually undermines the psychological well being of black people, who are quite naturally reluctant and suspicious of those services. Franz Fanon saw the paucity of this relationship as a colonial legacy of master/slave, which may well explain the high incidence of schizophrenia amongst African Caribbeans.
A similar depressing tale is told about the Chinese and the Vietnamese who suffer from a lack of support and understanding. It is reported that Chinese women often suffer a lonely and isolated existence, which is restricted by language and culture. Chinese men are prone on the other hand to schizophrenia, racism and social stigma.
The Irish have the highest rates of admission to mental hospital. They are discriminated against while not being considered to be in need of cultural sensitive services. Irish people are more likely to be disadvantaged and experience a high level of physical and mental health problems and are grossly overepresented in the mental health system. The same appalling statistics are present for Asians, Bangladeshi, Pakistani and Sri Lankans where high unemployment, low incomes, racism, discrimination and poor housing all contribute to poor mental health and poor delivery of mental health services. It would seem that to be from an ethnic minority in white society is to disadvantaged and too often to be denied a place from which to live and conduct one's life. (2)
In an article entitled The Same Difference Suman Fernando tells us how deeply racism is embedded in western culture and western psychological theories and how western culture needs to come to terms with its own racism. He considers the importance of self-knowledge and advocates the study of consciousness in such a way that altered states of consciousness and suffering would not be viewed from a place of objectivity. Promoting mental health, he says must be seen to be applicable to all people and communities and through their relationships with each other and change must come through social equity.
"Throughout the past three hundred years racism has distorted Western thinking about other people and their cultures...underlying these views were racist assumptions about black people, their cultures and their place in society; civilisation was associated with white races and primitives with others." (3)
Racism is itself a distortion of thinking that arises out of the mind's capacity to regard itself as an object. This very separation of mind from body separates the civilised from the uncivilised, the rational from the irrational, me from you. Suman Fernando makes an appeal for psychiatry to study consciousness, but it would seem that white culture already has a monopoly on consciousness. In the field of mental health this is most evident where the white man through his identity expresses his culture by separating himself from those that are different and fails to see that what he observes is a mirror of himself. Same and difference are held apart, psychologically, and this way of thinking manifests in the fragmentation of every part of life.
I was in conversation with a white psychiatrist who regularly works in India, and has an interest in these issues. ‘Of course, I have never been in a minority,’ he said, I don’t know what it’s like.’ He was sitting in a room with two black women, and was on his way to the airport to fly to India, but he saw no contradiction. White is never a minority just as royalty are never a minority - the royal ‘we’ of power, by definition outnumbering mere numbers of bodies.
In response to the crisis of confidence in the mental health system, the government has initiated new policies to deal with racial prejudice, discrimination and inequality which occurs in the field of mental health, as throughout society.(4) Transcultural studies and courses in cultural competence introduce practitioners to cultural knowledge and aim to promote cultural sensitivity. However it is unlikely that effective policies and attitudes will be developed without understanding the root of the problem of racism, which is psychological. Before starting to look at other cultures’ concepts, of spirituality or possession, maya or satori, there is a certain circularity and hollowness of our own starting place to be dealt with. In every aspect of life, the white man divides up his culture and rules it in his own image. He makes himself God. His guiding rules are my authority, my country, my religion and conformity is his way of life. What is good is his schools, his government, his economy and his woman.
Mental illness doesn't arise in a vacuum, nor is it inherently biological: rather it is created through the social milieu in which we live. Mental distress arises out of a failure of relationship and communication. In the case of the Somali woman this is manifestly the case, and it is power relations which determine who is mad. This isn't an isolated case but one that is symptomatic of white society and culture. The pathology of an individual who is mentally distressed or ill is the pathology of society, since what is sane and what is insane relate to each other without division.
"Hardly any of the "symptoms" of psychological distress may be correctly seen as medical matters. The so-called 'neuroses,' the 'psychoses' and related forms of suffering are nothing to do with faulty biology; nor indeed are they the outcome of individual moral weakness or other personal failing. They are the creation of the social world in which we live, and the world is structured by power."
(David Smail) (5)
What is it about white society then that 'creates' pathology and distress? What is it about the identity of the white man?
White identity is above all an expression of power, of authority, both personally and politically, where processes of cultural identification raise the profile of differences, and communication separates rather than joins. People from ethnic minorities are seen as different and it is this quality of difference, rather than equality, that is being institutionlised. This racial profiling focuses on separation by racial group and identity. Not only does this policy increase marginalisation it makes it abundantly clear who has the dominant identity.
"What one would not like to see again is the consolidation of peoples on the basis of their colour. But as long as we in the west place on colour the value that we do, we make it impossible for the great unwashed to consolidate themselves according to any other principle…colour is not a human or a personal reality: it is a political reality." (6) James Baldwin.

What dominates is not skin colour but thought itself. The white man rules and oppresses through his very way of thinking and through the image he has of himself as is expressed through his ideas and language. Audre Lorde defines racism thus:
"The belief in the inherent superiority of one race over another and thereby the right to dominance." (7)
White western society likes to believe it is tolerant and that it is innocent of oppression but in the case of ethnic minorities this is clearly not the case. Society is fragmented; self-interest is considered normal as well as exploitation, conformity and competition. To be successful in white society means that you have accepted these rules. To find yourself poor and distressed means that you only have yourself to blame and the failure is both mental and moral.
Politicians seek to maintain an image of a happy society by creating an image of confidence and to being seen to be doing something about them who are the problem. This is the essence of the illusion of progress, which lulls an accepting populace into a frenetic passivity in the knowledge that the government is always in charge of things and has authority over social problems. And the mental health of ethnic minorities is a social problem. In this way politicians would have society believe that there is progress that we are getting to the illusory there, when in fact the pressure is always to stay the same.
Stable government is maintained through a way of thinking, which maintains homeostasis in which we all agree to certain basic assumptions. Safety, simplicity and so called sanity are achieved by these basic codes of distorted thinking that the feelings of the body are to be kept separated from the mind and that human weakness and vulnerability are to be overwhelmingly managed and controlled.
The white man and his way of thinking makes him the arbiter of sanity of the culture and it is he who draws the line as to what is acceptable and legitimate behaviour. To challenge these boundaries and 'leave' this artificial framework is to risk being called mad. It is interesting to note that western psychiatry grew up historically along with slavery. For a slave to run away from a plantation was known as drapedomania and its cure was the removal of toes. Slaves were also seen as suffering from a disease called 'negritude,' the cure for which was physical punishment. Homeostasis is what must prevail in families and society and thus 'slavery' is still with us in many ways. Nothing fundamental has changed; society reinvents itself again and again in the same way. To be from an ethnic minority means a continual loss of self from birth to grave, and to live a life bound by the white man who must progress by creating ever more boundaries (plantations) to protect himself and his vision of white society.
For instance in the late 19th century when a woman's activity was based in the home the common diseases were hysteria, nymphomania and pregnancy. These were the main mental illnesses of women and cause for concern in society. Today, women's illnesses relate to them being seen as sex objects, so that anorexia, bulimia and self-harm are the modern diseases. Pathology is written on the body of a woman in much the same way as on the body of a black man.
A slave who ran away from the plantation was seen as mad; no doubt being a slave was for his own good and in a society governed by individualism, human greed and self interest, the people that suffer distress or who do run away - psychologically, are viewed as mentally ill. The white patriarchal image is the very foundation of capitalism and anyone who doesn't adhere to this image is seen as different or dangerous and a threat to a 'civilised' society. In order to maintain white credibility, to maintain identity, to continually replicate power and authority, a distance must be created between 'them', and 'us.' If there is no distance there is no power and there is no authority. Same and difference therefore must never merge into one. If the safety of conventional thinking were merged with the torment of mental uncertainty then that would bring an end to white colonial rule.
It is difficult to comprehend the enormous and oppressive force of this style of thinking which in every way personally socially and institutionally favours the white male. Into this mythic hall of mirrors where image is everything and where 'the real man' dominates, ethnic minorities are always at a disadvantage. Despite the fact that this image is an illusion, it apportions all meaning to itself from every human interaction. The white man while robbing his own body of feeling denies the feelings of others. His power and control is always directed downwards, always scrutinising those others, which are not he. The white man rules through his discourse and thought, which he makes material. The Word is God and He is the Word.
"The white fathers told us: I think therefore I am...The head will save us. The brain alone will set us free...For within living structures defined by profit, by linear power, institutional dehumanisation, our feelings were not meant to survive." (8) Audre Lorde: Sister Outsider.
In Richard Webster’s essay The Politics of the Body and the Body Politic(9), he carefully traces the historical origin of the liberal democracy of the west as a conflict born out of religion and the rise of secular thinking. What we know as rational thinking was created in the monastery where young men in their desire for purity and Christian piety chastised their bodies in order to subdue the 'natural man'. The image of white patriarchy as god's emissary evolved out of a rigid and authoritarian Puritanism. The body and its feelings were to be controlled and punished into submission. Having established his particular brand of rationality as the supreme expression, and having subdued his body, all that remained, as in any good religion, was to do the same to others. This process made the perfect rationale to pursue slavery in good faith.
The enslavement to thought is the condition of our lives as we live in a social context, which is itself created by thought. And in no other area is the body so subdued as in the arena of mental health. The term mental health itself makes a distinction between the mind and the body. Race and mental health are two extremely contentious issues, which must be seen together because racism begins in the mind because thought always locates reality outside of itself. Eldridge Cleaver's passionate Soul on Ice (10) tells us that the white man has claimed the 'head' of society and established himself in the 'front office.' In society the white man sees himself as the brain and he wants the black man to be the body. In order to claim his cultural identity he claims rationality for himself, a rationality that is unquestionable. Cleaver skilfully describes the mechanics of the myth of white society as a body fragmented in terms of race gender and class. He attributes characteristics to the white man, the black man and the black woman, reminding us that these images are not real but are based on fear and our perceived distance from the apex of society that is the white man.
Unable to harness this 'administrative function or image which has been claimed by white patriarchy and which represents the authentic energy within ourselves to resource our own lives, we see this psychological component outside ourselves and one that we must always strive for. This is the nature of thought. In Cleaver's essay the white man is 'markedly feminine' searching for (and no doubt simultaneously rejecting) his alienated weak body in order to affirm his omnipotence. He despises weakness, which he projects outside himself, separating his superior objective thinking from his subdued 'natural man.' Any movement away from this image is seen as threatening and the beginning of pathology, so that anyone whose image, race or culture does not fit with this view of what is normal is different and represents an inferior image. Distorted thinking and the body/mind split are at the root of the crisis of race and mental health.
The government's attempts to rectify the prejudices and biases within the mental health system reveal that at the same time as their new directives on policy and training are being produced, the New Mental Health Bill (11) is being introduced. This new legislation will extend the boundary of the meaning of mentally ill to include the concept of ‘dangerousness’ as the chief reason for being sectioned and treated. Given that ethnic minorities, especially black people, are over represented within the system, it's very likely that the new legislation once more will grossly disadvantage ethnic minorities.
Thought alone cannot bring about change. Counselling and psychiatry are very much a white western institution. Students learn through the authority of others and the pain and the distress of the individual is not at the centre of the interaction despite its apparent focus. The client may quickly realise that she is not getting paid to be in this relationship, and that behind the counsellor or psychiatrist is a whole hierarchy, a whole support system with books and libraries and university departments created by thought and maintained by power. There is a stark division between her distressed life and that supported by therapy and psychological services. She may even be aware that her psychiatrist doesn't live in her world, though she has to live in his. James Baldwin discussing the American situation says:
"I am far from convinced that being released from the African witch doctor was worthwhile if I am now – in order to support the moral contradictions and the spiritual aridity of my life – expected to become dependent on the American psychiatrist. It is a bargain I refuse…" (12)
The psychiatrist is wrong in his analyses of the words of the Somali woman and he cannot comprehend the true nature of the lived reality of being a particular human being. Language and thought may be an expression of life but are not life, so that their communication is in fact non-existent. Thought says I am a psychiatrist, I have the history of analytical thinking on my side…She is a Somali, she says something that fits neatly into my learning, and therefore she must be 'distressed,' where distress is by definition a delusion in capitalist heaven.
Words always separate one thing from another, one human being from another and there is no way out of that since that is their nature. This is the civilising force of western patriarchy. The psychiatrist's assessment is second hand and refers to something that has already happened in the past. He brings his knowledge to bear on the lived life of the Somali woman. Thought, memory, knowledge and ideology are thus part of the problem, not part of the solution. When a client goes to see a white practitioner may well be feeling bad, depressed or anxious. She enters an environment that is controlled by thought, that is by the past. The ways of seating, the methods of talking, the skills and resources prepare the practitioner for the job. It may be comfortable, thoughtful – literally, and very much designed with body in mind.
She may be vulnerable, confused and conflicted and is literally a 'slave' in the world of thought. Her master speaks another language, organises the environment, scrutinises and records her every word, observes the body of her world and her feelings. Her master gets paid because she is in distress. If the client is black or from an ethnic minority, his treatment will be seen as white, her pathology black. The practitioner is taught to be genuine, culturally sensitive, tolerant and to treat everyone the same. He must, with tenacity, hold on to his mask to protect himself from his own feelings and negativity; he must create, through thought, another person to the one he is in order to protect himself from her. This 'other' is his professional attitude.
The role that the psychiatrist brings to the client separates him from himself so that very little communication is possible. Armed with all the paraphernalia of a white civilisation there is a problem at the outset brought on by the past. Alienation begins with the human body because the rational mind falsely locates the problem outside of itself and endlessly causes confusion and miscommunication. Rather than being an issue of race per se it is an issue of the predominance of thought, where the violence of the white culture is imposed.
Racism is the outcome of wrong thinking which separates the shame of the body from the thinking mind. Everyone is somebody's other and the struggle for power is a struggle to impose my phantasy over yours. Nothing will really change in white culture until people start to see themselves as they really are, in relation to those others.
The root of the problem and its solution lies in the not-identity of our inner selves, where there is an empty space where thought does not dominate. Through shame we cannot express this and all our identifications are designed to cover it. In the uncertainty and ambiguity of ourselves, in the spaces between thought, and in the very weakness and shyness of not knowing, lies the key to the problem of the races. Mental pain leads to awareness and with it the possibility of true communication, psychological freedom and creativity.
"The white man's unadmitted - and apparently, to him, unspeakable- private fears and longings are projected on to the Negro. The only way he can be released from the Negro's tyrannical power over him is to consent, in effect to become black himself..." (13)
(1) Openmind magazine. From 'Having an Open Mind.' Jan/Feb 2005
(2) Mind Factsheets. Statistics 3.
(3)Suman Fernando. From The Same Difference. New Internationalist, issue 209-July 1990.
(4)Delivering Race Equality in Mental Health Care - an action plan for reform inside and outside services. Department of Health
(5) David Smail's website.
(6) James Baldwin. The Fire Next Time. Penguin
(7) Audre Lorde. Sister Outsider, in The Audre Lorde Compendium. Pandora.
(8) Audre Lorde. Ibid.
(9) The Body Politic and the Politics of the Body. Richard Webster’s website.
(10) Soul on Ice. Eldridge Cleaver. Cape paperback 1969.
(11)Proposed New Mental Health Bill. Mind Website.
(12) James Baldwin ibid.
(13) James Baldwin ibid.
Isabel Adonis.
June 2005.