An Acknowledgment of Mental Health Oppression in BIPOC Communities
As a Black woman, mother, grandmother, daughter, wife, 4th-generation entrepreneur, and psychotherapist, I am a resource of healing both personally and professionally. This month is Mental Health Awareness Month, and I have considered it far differently this year than I ever have before. I feel a swelling urgency to deeply change my personal and professional understanding of mental health, particularly as it relates to my Black brothers, sisters, mothers, fathers, and ancestors. I find myself sparing with the very definition of mental health and the context in which it was formed.
Our starting point is fundamentally flawed. Professional mental health providers are taught how to define mental health or “unhealth” through the field’s gospel - the Diagnostic Statistical Manual, or DSM. Its coding is used to determine the state of a person’s mental health, oftentimes a determination that happens after a brief introduction to a client, and that is then typed into an official record and verified by whatever powers that be - in this case the psychotherapist, psychiatrist, or social worker. Before HIPPA was put in place in 1996, there were no laws or limitations protecting the privacy of health information, how it was received, shared, or interpreted. Although clients had no access to their own medical records - unless state law permitted such access, which many patients weren’t even aware of. The person diagnosing the patient knew their “mental health status” and the patient had no grounds to ask for explanation or implication. This system was a continuation of the murky and oppressive ways that psychiatry was particularly weaponized against - or denied to - Black people.
In 1773, the first psychiatric hospital was founded. Initially, patients were not segregated at the facility. Yet decades later, the founders of the American Psychiatric Association made the decision to segregate services and people, arguing that it would improve the quality of care. It’s been said that during this time, some white patients’ bills were paid with enslaved persons. During this period of institutionalized oppression, paired with the stigma and subpar privacy laws around mental health, stereotypes about Black people were formed and spoken of as though they were fact. These stereotypes are the origins of the stereotypes that continue to exist today. Some of the more recognizable one's state that Black people are hostile, lazy and shiftless, intellectually inferior, immature and paint pictures such as the “Angry Black woman” or “scary Black man,” or hissing “Boy” at a fully-grown Black man, “complimenting” Black people by saying “oh my goodness, you’re so articulate (for a black person, they mean)” or wondering why Black people don’t just “pull themselves up by their own bootstraps.”
These stereotypes were historically used to support the validity of the diagnosis of Drapetomania. So what was that diagnosis? It was a name for the collection of symptoms seen in Black Americans who were runaway slaves, seeking freedom. To the APA and society at large, slaves that did not want to be slaves were seen as mentally ill, driven by hostility, proven by the act of running away and being lazy, ungrateful, stupid, and childish. This pattern of the perpetrator further victimizing the victim continues to exist today, and it has both then and now resulted in excruciating deaths and extrajudicial killing of Black people under the guise of their “dangerousness” and “erratic behavior.” These punishments doled out to runaway slaves ring stunningly similar to a Black person hijacked by trauma, triggered by being pursued by police, in a fight-flight response, without a weapon, hands in the air and being granted no mercy or assistance.
In January 2021, The American Psychiatric Association, the same association that launched the first DSM, made a public acknowledgement of their part in laying the foundation of structural racism within the institution of mental health. The APA expressed their “amends for enabling discriminatory and prejudicial actions within the APA and racist practices in psychiatric treatment for Black, Indigenous and People of Color (BIPOC). These actions sadly connect with larger social issues, such as race-based discrimination and racial injustice, that have furthered poverty along with other adverse outcomes. Since the APA's inception, practitioners have at times subjected persons of African descent and Indigenous people who suffered from mental illness to abusive treatment, experimentation, victimization in the name of "scientific evidence," along with racialized theories that attempted to confirm their deficit status. “
Despite this progressive acknowledgment, the stereotypes and institutionalized racism of the mental health field will take much more effort to break down. You can see examples of the systemic racism inherent in the mental health field everywhere. Remember the Chicago Police shooting of LaQuan McDonald, a black teenager killed while acting erratically and holding a knife? What was not as well known was that LaQuan McDonald suffered from PTSD, PTSS (post traumatic slave syndrome), and other “complex mental health problems.” Had he not been seen through the lens of structural racism, his behavior may have been viewed as a mental health episode, at least in part triggered by his lived and inherited trauma. He might’ve been seen as worthy of treatment and help - instead of a dangerous threat that needed to be shot.
Mental Health Awareness Month generally focuses on educating the general population about the signs and symptoms of mental illness, providing resources, maybe even referencing a celebrity as a mental health poster child, offering people the message that if their favorite athlete or singer is addressing their mental health, it is indeed okay for them to also come out of the closet with their own struggles. While educating the general public about mental health is great, I think we need to begin a reverse approach to Mental Health Awareness. Change must happen inside the mental health field, and we as professionals must be dutifully aware of the history of our profession. At a very basic level, this could include a curriculum in graduate school about the true history of structural racism within the institution of Mental Health, and how that racism continues to be propagated today.
There is a current trend of destigmatizing mental health within the BIPOC community, and that’s great - but we cannot destigmatize mental health or raise awareness when we refuse to acknowledge the root causes of stigma and oppression that are pervasive in mental healthcare. Mental-health oppression is the most devastating weapon impeding the liberation of self and community. The work of decolonization in the mental health space requires breaking up the racist foundation so that a new system can be possible. I help both clients and fellow therapists undo the collective socialization of oppression and racism that permeates their wellbeing, and that work is at the core of my mission as a healer.
I take hope in the belief that most therapists have a desire to be a witness engaged in the intimate process of healing, making visible what has been invisible, and reframing story and perspective so that mind, body and heart are connected, oppression is lifted and intergenerational trauma is replaced by intergenerational healing. Our acknowledgment of trauma is the beginning of healing from it, and our acknowledgment of the structural flaws of the mental health field is similarly the beginning of building something better.
“I am an invisible man. No I am not a spook like those who haunted Edgar Allen Poe: Nor am I one of your Hollywood movie ectoplasms. I am a man of substance, of flesh and bone, fiber and liquids, and I might even be said to possess a mind. I am invisible, simply because people refuse to see me.”
― Ralph Ellison, Invisible Man