Category Archives: race and mental health

Systemic Racism and Mental Health

Currently participating in the Maryland Psychological Association(MPA) annual Ethics Conference. I was able to speak about systemic racism and mental health. With clients: nurturing diversity awareness gently, but also insisting on it.

Takeaways from Dr. Siddique:

  • It is our obligation as mental health professionals to speak about systemic oppression, environmental context, and racism as an integral part of our intake process and treatment planning. This is a required need of our ethical guidelines, as recently endorsed by the American Psychological Association.
  • Microaggressions by clinicians can be a negative part of the psychotherapy process, without training and awareness. The research shows that BIPOC patients who experience their therapist as invalidating generally do not return to treatment. Ever.
  • We must get supervision from peers, consultants, and our own therapy in order to help others and to get a true understanding. Don’t assume that you know.
  • Developing psychological rapport and alliance is the most important way for us to work with our clients, as shown by psychotherapy research.

Resources
Coping with Racial Trauma
BlackLine provides a space for peer support and counseling, reporting of mistreatment, and affirming the lived experiences to folxs who are most impacted by systematic oppression with an LGBTQ+ Black Femme Lens.

My Personal Readings to Challenge Oppression.
DiAngelo, Robin (2018). White Fragility: Why It’s So Hard for White People to Talk About Racism Beacon Press: Reprint Edition.
Helms, Janet E. (2019). A Race is A Nice Thing to Have: A Guide to Being a White Person or Understanding the White Persons in Your Life. Cognella Academic Publishing.
Kendi, Ibram X. (2019.) How to Be an Antiracist. One World Publications.
Nadal, Kevin L. (2018). Microaggressions and Traumatic Stress: Theory, Research, and Clinical Treatment. American Psychological Association.

A Tribute to Psychologist Dr. Mamie Phipps Clark

Dr. Mamie Phipps Clark was born in Arkansas to a physician father and a homemaker mother who also ran the office practice. She was an exemplary student, and graduated with honors, winning scholarships to Howard University and Fisk University. She attended Howard University in Washington DC, where she majored in math and physics, before she fell in love with psychology.

Primarily, Dr. Clark investigated and analyzed the development of racial identification in black children and how that relates to self-esteem. After completing her undergraduate studies, and influenced by her work with children in an all-Black nursery school, Clark completed her master’s thesis, “The Development of Consciousness of Self in Negro Pre-School Children.”

Essentially, she wondered when and how children develop the idea that they are Black, and what that means to them on a personal level and social level.

She moved to New York with her husband, the psychologist Dr. Kenneth Clark, where she started her doctoral studies at Columbia University. Their combined research resulted in the famous “doll experiments.”

The Doll Experiments and Black Psychology
Dr. Clark completed the doll experiments with her husband, research which played a key role in the Brown v. Board of Education Supreme Court decision.  It was also the first psychology research to be submitted as hard evidence in the Supreme Court’s history.

The study used four dolls identical in all ways except skin color and asked 260 Black children, ages 3 to 7, to rate them for liking and overall attractiveness. Over two thirds of the participants indicated a preference for the white doll, saying it was the ‘best’.  Further, 60 % of the participants indicated that the brown doll “looks bad.” The tendency to believe that the brown dolls were inferior was consistent, even in three-year old children. The study showed that segregation had significant negative mental health effects on the self-esteem and self-perception of black children.

She gave back to her community
Inspired by her volunteer work at the Riverdale Home for Children, where she conducted psychological testing with homeless Black girls, Dr. Phipps Clark founded the Northside Center for Child Development, in NYC, in February 1946. Launched with a $946 personal loan by her father, the Center was housed in the basement of the Paul Lawrence Dunbar apartments, where her family lived. The first of its kind, the Center provided therapy for children in Harlem, parent training and consultation, and provided support to families needing housing assistance. Dr. Phipps Clark remained active as the director of the Center until she retired in 1979. Today, it continues to support the community with remedial reading and math tutoring services, nutritional workshops, and psycho educational programs. The Clarks also collaborated on various other community projects, including the Harlem Youth Opportunities Unlimited project (HARYOU), to provide job training and employment opportunities for Black youth.

She faced racism head-on
Dr. Phipps Clark earned her Ph.D. in psychology in 1943 from Columbia University. Her doctoral dissertation advisor was Dr. Henry Garrett, an openly racist professor and social scientist, outspoken in his writing and lectures. Dr. Clark later testified against him in a prominent Virginia desegregation case, rebutting his support of inherent racial differences in the ability and cognition of Blacks. Dr. Clark wrote extensively about experiencing pervasive frustration in her career. She attributed this to the “unwanted anomaly” of a Black female presence in a field dominated by White males.

Also see The Pioneers and Black History Month.

The Pioneers: Psychology and Black History Month

FRANCIS CECIL SUMNER (1895-1954)
Dr. Sumner was the first African American to receive his Ph.D. in Psychology. He was a founder of the psychology department at Howard University,  the first renowned department at a historically black college. Dr. Sumner completed a vast amount of research which delineated racism and bias in psychological studies of African Americans, including in research, testing, and clinical work. Some of his students went on to becoming leading psychologists in their own right, including Dr. Kenneth Clark (below).

INEZ BEVERLY PROSSER (1891-1934)
Dr. Prosser was the first African American woman to receive her Ph.D. Her dissertation examined the academic development of African American children in mixed and segregated schools. Her findings showed that African American children fared better socially and academically in segregated schools. Specifically, she found that African American children from integrated schools experienced more social maladjustment and more bullying, and felt less secure, a barrier to their learning.  Her research findings were used in the Brown versus Board of Education Supreme Court ruling, in 1954. She spent the last seven years of her life teaching at historical Black colleges, before she was killed in a car accident in Louisiana, in 1934.

KENNETH BANCROFT CLARK (1914-2005)
Supremely gifted psychologist, Department of Psychology, at Howard University in Washington DC. In the famous “Bobo Doll Study” he studied the responses of Black children who were given a choice of white or brown dolls. His findings illustrated that children showed preference for white dolls from as early as three years old. He concluded segregation was psychologically damaging, which played a role in the Supreme Court decision in outlawing segregation. He was also the first black president of the American Psychological Association (APA).

MAMIE PHIPPS CLARK (1917-1983)
Dr. Clark graduated from her segregated high school in Arkansas, at age 17, with honors. She subsequently attended Howard University in Washington DC, where she originally intended to major in math. It was at Howard that Mamie Phipps would meet her future husband, Kenneth Clark, in 1934 (they married four years later).  After struggling with misogyny in the math department, she was persuaded by Kenneth Clark to join the psychology department.

After completing undergraduate and Master’s studies at Howard University, the couple enrolled in the psychology doctorate program at Columbia University, where Clark challenged herself by studying under Henry E. Garrett, a prominent statistician, and unabashed racist and eugenicist. Despite his discouragement, she completed her doctoral thesis work on intellectual development in children. She and her husband became the first black recipients of psychology doctorates at Columbia University, in 1943.

Her work with children showed that African American children became aware of their racial identity as early as three years old. Many of the children she studied began to reflect and internalize the views that society held about them. These findings lead to the later Bobo doll studies conducted with Dr. Kenneth Clark, where both black and white children significantly preferred white dolls over dolls of color, rating them as more attractive and intelligent.

Mental Health and Black Patients: Survival and Stigma

The Black community suffers from a high rate of mental health concerns, including anxiety, PTSD, and depression. Black people experience direct traumatic stressors (including being heavily policed or being the victims of physical and verbal attacks), indirect stressors (such as the effects of viewing the video of the killing of George Floyd and others), and intergeneration-ally transmitted stressors (from traumatic stress passed from one generation to the next).

Access and availability of mental health care
Despite these challenges, however, Black people are far less likely to seek care. Statistics show us that about 25% of African Americans seek mental health care, compared to 40% of white Americans. Unequal access to health care is one major contributor to this disparity. The lack of cultural sensitivity by health care professionals, feeling marginalized, and the reliance on family, community, and spiritual support instead of medical or psychiatric treatment are others.

The incidence of psychological difficulties in the Black community is related to the lack of availability and access to appropriate and culturally responsive mental health care, prejudice and racism inherent in the daily environment of Black individuals, and historical trauma enacted on the Black community by the medical field. Moreover, given that the Black community exists at the intersection of racism, classism, and health inequity, mental health needs are often exacerbated and mostly unaddressed and unfulfilled.

History of exploitation and stigma
In Black communities, reluctance to seek both physical and mental health care can often be attributed to a general distrust of the medical establishment. This distrust is not without merit: historically, African Americans have been misdiagnosed at higher rates than white patients, and black communities have been exploited by the U.S. government and medical community in the name of medical research. Seeking mental health care is often viewed as a weakness, running counter to possibly a survivalist mentality born from systemic oppression and chronic racism.

Dr. Martin Luther King, Jr. suffered from bouts of severe depression from his teenage years throughout adulthood. He attempted suicide three times, but refused to go into long-term treatment, even though urged to do so by his inner circle of friends and advisers. He stated that he did not want the Civil Rights movement and his work to be tainted by the stigma of mental health problems. Today, the mental health stigma remains.
Culturally responsive mental health treatment

Culturally responsive mental health treatment is one way of addressing the disparities in psychological wellbeing in the Black community. Culture, a person’s belief, norms, values, and language, plays a vital role in every aspect of our lives, including mental health. Being culturally responsive is a mental health provider’s ability to recognize and understand the role of culture, both the client and clinician’s and the ability to adapt the treatment to meet the client’s needs within their cultural framework.

When meeting with mental and medical health providers, it is essential for clients to ask questions to gain a sense of their level of cultural sensitivity. Many people often feel nervous or guilty about asking these hard questions, but providers usually expect and welcome questions as this helps them better understand the patient and what’s important to them. If they become defensive, that provides important information as well. 

Here are tips Black clients could do to seek out culturally responsive providers:
Experience and training
Ask the provider questions about their treatment approach and if they provide care that is culturally sensitive.

Awareness of intersections
Seek attention from someone who is aware and affirming of your intersecting identities (social categorizations such as race, class, and gender, that are overlapping and interdependent systems of discrimination or disadvantage) and your cultural background.

Ability of the provider to ask questions and be mindful of their own gaps in knowledge and experience

Sidebar: I have to note another statistic that I frequently discuss when I am teaching seminars on this topic. The stats are that Black clients enter therapy with a sense of optimism. Microaggressions can occur in the very context of the therapeutic space. If they remain unaddressed, most often clients will just go away rather than complain. Research also shows that people who drop out of therapy are much less likely to go back.

Additional information on research on developmental psychology and microaggressions can be found here.

(Stats included are from Department of HHS 2017; APA 2019; Mental Health America).

Is extreme racism a form of mental disorder?

This question was recently sent to me via one of my psychology blogs:

Is extreme racism a form of mental disorder? 

My answer:
The American Psychological Association has never officially recognized extreme racism as a mental health problem, although the issue was raised more than 30 years ago. After several racist killings in the civil rights era, a group of black psychiatrists sought to have extreme bigotry classified as a mental disorder. At that time, the question was posed to the American Psychiatric Association, a related medical association that is separate from mental health counseling/psychology.

This professional association rejected the recommendation, arguing ‘that because so many Americans are racist, even extreme racism in this country is normative; a cultural problem rather than an indication of psychopathology’.

The psychiatric profession’s primary index for diagnosing psychiatric symptoms, the Diagnostic and Statistical Manual of Mental Disorders (DSM), does not include racism, prejudice, or bigotry in its text or index.

Therefore, there is currently no statistical support for including extreme racism under any diagnostic category. This leads psychiatrists to think that it cannot and should not be treated in their patients.

Others in the profession have argued that to continue perceiving extreme racism as normative and not pathologic is to lend it legitimacy. Clearly, anyone who scapegoats whole groups of people and seeks to eliminate them to potentially resolve internal conflicts meets criteria for a delusional disorder, a major psychiatric symptom of illness.

Extreme racists’ violence could be examined in the context of behavior described by clinical psychologist Gordon Allport in the classic text, The Nature of Prejudice.

Allport’s 5-point scale categorizes increasingly dangerous acts: It begins with verbal expression of antagonism, progresses to avoidance of members of disliked groups, then to active discrimination including segregation, financial, and, social; to physical attack, and finally to extermination (lynchings, massacres, genocide).

Based on these theories, using the DSM’s structure of diagnostic criteria for a diagnosis of delusional disorder, the following subtype of delusional disorder has been suggested:

Delusional Disorder, Prejudice type: A delusion whose theme is that a group of individuals, who share a defining characteristic have a particular and unusual significance to the (psychiatric) patient. These delusions are usually of a negative or pejorative nature, but also may be grandiose in content. When these delusions are extreme, the person may act out by attempting to harm, and even murder, members of the despised group(s). Based on our Allport’s work, individuals suffering delusions usually also have overall serious social dysfunction that impairs their ability to work with others, have healthy interpersonal relationships, and maintain employment.

While psychiatric classification may be a useful tool, other researchers believe behaviors stemming from prejudice/hatred may not necessarily be pathological, and these acts are certainly not generic. Where is the line between societal ‘normal,’ and not? If racism has normative foundations, is it a disease, or an internalization of expectations? Is racism part of intergenerational trauma, as suggested by James Baldwin?

In my forensic work, intent, perceived goals, ability to understand right and wrong, cognitive ability, overall comprehension, and consequences, are all considered when somebody is deemed mentally incompetent. If somebody is aware of all of these factors and fully cognizant of their behavior, is it a mental illness?

We have a lot to study. And we must.

Dr. King and Mental Health

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” – Dr. Martin Luther King, Jr.

As an adult, Dr. King experienced bouts of severe depression. From childhood, he experienced highs and lows. A brilliant student and writer, he skipped his freshman and senior years of high school before enrolling at Morehouse College at the age of 15. During this same period, following the death of his beloved grandmother, he also attempted suicide twice. The stigma against individuals with mental illness, still very much alive today, was even more pronounced in the 1950s and 1960s. Concerned that people opposed to the Civil Rights Movement would use it as a way to try to discredit him, his incidents of depression remained a closely held secret among family, friends, and his inner circle during his lifetime.

Dr. King was jailed 29 times for peaceful civil disobedience or protests (one charge was for walking on the grass). He spent the last 13 years of his life under constant threat of physical harm. He survived an assassination attempt in 1958, where a stabbing narrowly missed his aorta. He constantly worried about the health and safety of his children and wife. If he were seen by a mental health professional today, it is most likely he would have been diagnosed with PTSD, in addition to long-standing clinical depression.

The stigma that forced Dr. King to keep secret his experience with depression still negatively affects millions of people throughout the United States. An increasing body of research in neuropsychology and clinical psychology is demonstrating PTSD like symptoms from a young age for black youth exposed to microaggressions, vicarious traumatization, and systemic discrimination. [see also, Minority Mental Health: Everyday Traumas and Microaggressions.

Additionally, while rates of behavioral health disorders may not significantly differ from the general population, Black Americans have substantially lower access to mental health and substance-use treatment services. (Graph, SAMSHA, 2020).

Part of the legacy of Dr. King is: Mental Health is for All.

Indigenous Americans, youth, and mental health.

Indigenous/tribal communities face significant behavioral health challenges and disparities. For Indigenous Americans, multiple factors influence health outcomes, including historical trauma and a range of social, policy, and economic conditions such as poverty, under-employment, lack of access to health care, lower educational attainment, housing problems, and violence.

These disparities have important consequences. Suicide is the second leading cause of death among Native American youth ages 8 to 24. Also, while there is general awareness that Native Americans experience higher rates of alcohol and substance use, the scope of these behavioral health problems is not fully understood.

With 564 federally recognized American Indian and Alaska Native (AI/AN, is the designation currently used by the Census Bureau) tribes, 100 state recognized tribes, and over 200 languages, there is a great need for the development of mental health programs aimed at AI/ANs that center culture as a dominant aspect of treatment. The deficit in culturally relevant treatment programs aimed at Indigenous Americans people living with mental illness is glaring. These communities cope with intergenerational trauma which has a historical context, occurring when exposure to trauma takes place in an earlier generation and continues to affect subsequent generations. The stress of intergenerational trauma contributes to the erosion of family structure, tribal structure and even spiritual ties. It can affect one’s identity, relationship skills, personal behavior, transmission of traditions and values, and attitudes and beliefs about the future. The stress of these traumas combined with the complex and ongoing mistreatment of AI/AN citizens contributes to the rates of mental illness in AI/AN communities and can manifest in a high rate of substance abuse disorder, PTSD, anxiety and depression.

Additional stressors such as a lack of access to health insurance, pervasive poverty and unemployment, and higher suicide rates exacerbate these issues.

I have compiled this list of resources for indigenous clients. Please note that the hours of availability may have changed, but they are all in service at the present time.

Mental Health Resources For Native And Indigenous Communities:
–  Indigenous Story Studio creates illustrations, posters, videos, and comic books on health and social issues for youth.

–  Suicide prevention.
–  National Alliance on Mental Illness.
–  One Sky Center: The American Indian/Alaska Native National Resource Center for Health, Education, and Research; mission is to improve prevention and treatment of mental health and substance use problems and services among Native people.
–  WeRNative: a comprehensive health resource for Native youth by Native youth, promoting holistic health and positive growth in local communities.
–  Ask Auntie: similar to an advice column – type in your question and it will pull up similar ones; if none answer what you’re asking, Auntie Amanda will write up an answer and notify you when it is posted.
–  StrongHearts Native Helpline: The StrongHearts Native Helpline (1-844-762-8483) is a confidential and anonymous culturally-appropriate domestic violence and dating violence helpline for Native Americans, available every day from 7 a.m. to 10 p.m. CT.

#WorldMentalHealthDay

Today is #WorldMentalHealth day.

I grew up in a South Asian family that didn’t believe in mental health, even with numerous family members with generally undiagnosed eating disorders, depression, anxiety, ADHD, personality disorders, suicides, and PTSD.  Intergenerational trauma is a term that describes how oppressive events that impacted one generation and remain unaddressed are carried over to later generations.

BIPOC Individuals are much less likely to receive support for mental health awareness and treatment. Racism, stigma, financial hardship, unfamiliarity, and lack of trust make it much harder for people of color to receive or even seek mental health services. As a community dedicated to mental health, we must persevere to change this. #EmboldenPsychology is dedicated to making mental health more accessible. 

Black Americans have higher rates of depression, anxiety, learning differences, and sleep and digestive problems, studies have found. Racially discriminatory events have led Black people to be in a state of high arousal — which means a heightened level of situational awareness and vigilance. This hypervigilance is harmful, medically and psychologically, and has very similar effects as studies on PTSD on brain and developmental functioning.

Asian Americans are discriminated against for their looks, languages and culture. They also face a great amount of family and social stress by having to represent their family and embody two cultures: that of their heritage and being “American” in the US. Depression and anxiety have skyrocketed in the community. 
Native American communities are often geographically disconnected and are significantly underserved, with a disproportionate level of substance abuse, depression, anxiety, sexual assault, and domestic abuse.
Microaggressions for BIPOC individuals cumulatively take their toll, and so do emotional and physical responses to vicarious and direct experiences with racial violence and racism. In the mental health industry, there is a significant lack of education, availability, and research regarding serving people of color. In a 2015 national survey of the mental health professions, close to 90% of all therapists were white. Very few training programs integrate diversity training as part of their broad curriculum.

In this time period of COVID-19, a significant national uptick in mental disorders, and great unrest, mental health awareness is more important than ever.

How to help a loved one who is having mental health problems

We all go through tough times and people help us through them. Other times we have been worried about other people’s mental health. Whether they are a friend, family member, significant other, neighbor, or colleague, there are many ways to support somebody you care about.

1 in 6 people experienced a common mental health problem such as anxiety or depression in the past week.

Talking about mental health
If you are worried about someone it can be difficult to know what to do. When you are aware there is an issue, it is important not to wait. One of the saddest components of depression is that it is immobilizing. You can simultaneously know that you desperately need help, and have absolutely no energy or desire to seek it.

Waiting and hoping others will come to you for help might lose valuable time in getting them support. Openly talking with someone is often the first step to take when you know they are going through a hard time. This way you can find out what is troubling them and what you can do to help.

Eight tips for talking about mental health:

  1. Set time aside with no distractions. It is important to provide an open and non-judgemental space.
  2. Let them share as much or as little as they want to. Let them lead the discussion at their own pace. Don’t put pressure on them to tell you anything they aren’t ready to talk about. Talking can take a lot of trust and courage. You might be the first person they have been able to talk to about this.
  3. Don’t try to diagnose or second guess their feelings. You probably aren’t a medical expert and, while you may be happy to talk and offer support, you aren’t a trained counsellor. Try not to make assumptions about what is wrong or jump in too quickly with your own diagnosis or solutions.
  4. Keep questions open ended. Say “Why don’t you tell me how you are feeling?” rather than “I can see you are feeling very low”. Try to keep your language neutral. Give the person time to answer and try not to grill them with too many questions.
  5. Talk about wellbeing. Exercise, having a healthy diet and taking a break can help protect mental health and sustain wellbeing. Talk about ways of de-stressing and ask if they find anything helpful.
  6. Listen carefully to what they tell you. Repeat what they have said back to them to ensure you have understood it. You don’t have to agree with what they are saying, but by showing you understand how they feel, you are letting them know you respect their feelings.
  7. Offer them help in seeking professional support and provide information on ways to do this.
  8. Know your limits. If you believe they are in immediate danger or they have incurred injuries that need medical attention, you need to take action to make sure they are safe. More details on dealing in a crisis can be found below.

How do I respond in a crisis?

People with mental health problems sometimes experience a crisis, such as breaking down in tears, having a panic attack, feeling suicidal, or experiencing a different sense of reality (dissociation). This may include even losing a sense of time and place. You may feel a sense of crisis too, in response, but it’s important to stay calm yourself.

There are some general strategies that you can use to help:

    • Listen without making judgements and concentrate on their needs in that moment.
    • Ask them what would help them.
    • Reassure and help point them to practical information or resources.
    • Avoid confrontation.
    • Ask if there is someone they would like you to contact.
    • Encourage them to seek appropriate professional help.
    • If they have hurt themselves, make sure they get the first aid they need.

Seeing, hearing or believing things that no-one else does can be the symptom of a mental health problem. It can be frightening and upsetting. Gently remind the person who you are and why you are there. Under extreme stress, people can dissociate. Don’t reinforce or dismiss their experiences, but acknowledge how the symptoms are making them feel.

How do I respond if someone is suicidal?
If someone tells you they are feeling suicidal or can’t go on, or if you suspect they are thinking of taking their own life, it is very important to encourage them to get help.

National Suicide Prevention Lifeline
Hours: Available 24 hours. Languages: English and Spanish
1-800-273-8255

Mental Health and John Lewis

In 2014, APA President Dr. Nadine Kaslow, presented Rep. John Lewis with a presidential citation honoring the congressman as a truly effective champion of the application of psychology to promote human rights, health, well-being and dignity.

He epitomized the American Psychological Association’s values to strive for social justice, diversity and inclusion, from his early days as a heroic young Freedom Rider, and fighting a long, hard struggle to end racial discrimination and segregation throughout our nation.

Little Known Facts:
Lewis fought to improve the child welfare system, eliminate pay disparities for women, further LGBT rights, and aid disadvantaged families, among many other accomplishments. He supported biomedical and behavioral research at the National Institutes of Health, which helped to advance research to enhance health and well-being by including attention to behavioral factors, such as unhealthy diet and lack of exercise, that play a significant role in cancer, heart disease, and many other serious disorders, especially in people of color. Truly a hero in every way. 

Embolden Psychology
Embolden

Embolden offers the ADOS-2, the gold standard assessment for kids on the spectrum.

Combined with psychoeducational testing, it helps provide comprehensive information and recommendations to help children and teens six and up.

Thank you for contacting us.