Institutional racism in psychiatry and clinical psychology race matters in mental health

222 Pages·2017·2.787 MB·English

by  Fernando, Suman

CONTEMPORARY BLACK HISTORY
I NCISLNITN IPTI CSUAYTCLI O HPNISAAYTLCR RHYAO ACLNOI SDGM Y
RACE MATTERS IN MENTAL HEALTH
SUMAN FERNANDO
Contemporary Black History
Series editors
Peniel E. Joseph
Department of History
Tufts University
Medford, MA, USA
Yohuru Williams
Department of History
Fairfield University
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Suman Fernando
Institutional Racism
in Psychiatry
and Clinical
Psychology
Race Matters in Mental Health
SumanFernando
London MetropolitanUniversity
London, UK
ContemporaryBlack History
ISBN978-3-319-62727-4 ISBN978-3-319-62728-1 (eBook)
DOI 10.1007/978-3-319-62728-1
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To the memory of Darcus Howe, broadcaster and campaigner
for the rights of black people in the UK, who died on Saturday
1 April, 2017, just as I was finishing this book.
I never knew Darcus personally, but admired him for his
straighttalkingandgrass-roots activism. Mayhe rest inpeace.
P
REFACE
This book is somewhat personal in that it reflects many of my own expe-
riencesandviews,bothgenerallyaboutracemattersinBritishsociety,and
aboutracism(mixed upwithculturalbias) inthefieldofmentalhealth,in
particular the practice of psychiatry and clinical psychology.
In the 1960s I embarked on psychiatric training, hoping to build my
career as a psychiatrist in the (British) National Health Service (NHS). I
decided not to apply for a training post at the so-called centres of excel-
lence in London—I had heard that most prestigious centres followed an
old-fashioned institutional approach to patients while some mental hospi-
tals (still very much asylums) were sometimes more forward looking. I
opted to work in training posts in mental hospitals in Epsom while
attending lectures and seminars at the Institute of Psychiatry. Once I had
the diploma in psychological medicine awarded by the Royal
Medico-Psychological Association (RMPA), I faced the hurdle of obtain-
ingaseniorregistrarjob,theprelude(afterthreeorfouryears)toapplying
for consultant posts in the NHS.
In the 1950s and most of the 1960s, there was a strict racial, and
less-strict gender glass ceiling for senior registrar (SR) posts, especially
when they were based at teaching hospitals in London. At this point I
struck lucky—a Jewish consultant I had worked under looking after
inpatientsatthebasehospitalinEpsomandhelpingwithoutpatientclinics
at the London Jewish Hospital in East London, recommended me to a
colleague and friend at the London Hospital. I was appointed SR at the
LondonHospital,andlearnedlaterthatthisparticularconsultant,whohad
vii
viii PREFACE
clearly spoke up for me at the appointments committee, had himself been
the first Jewish doctor to be appointed as a consultant there. This job
suitedmeperfectlybecauseIcametobequiteattachedtotheareathatthe
patients came from, but also because I was able to get funding (through
contactsImade)tobeginaresearchstudyIhadplannedonsocio-cultural
aspects of depression among Jewish people in East London. Later, in the
1960s, I worked at Claybury Hospital in Woodford, Essex (where some
of the admission wards were organised along the lines of therapeutic
community principles); and finally at Chase Farm Hospital (a general
hospital) in Enfield, Middlesex.
Many psychiatric institutes in London were operating a race-based
glass-ceiling in the 1960s and early 1970s in terms of senior staff
appointments; and there were indications that black patients were dissat-
isfied with the services they received, too. In the late 1970s I became
involved in the work of the Transcultural Psychiatry Society (TCPS) in
campaigning against racism in mental health services (see ‘Transcultural
psychiatryintheUK’inChap.6),bothintermsofthedifficultiesfacedby
non-white professionals and by black and brown-skinned users of the
mental health services. In the late 1970s, senior posts in psychiatry were
gradually opened up to non-white people as legal measures against racial
discrimination in employment practices came into effect, but even then
black or brown-skinned consultants were a rarity. The race-based glass
ceilingattheIOPwasnotbrokenuntilthemid-to-late1990s,wheninthe
course of a few years, three senior posts were filled by two psychiatrists of
Asian origin and one of African-Caribbean origin. Significantly, none
of them had participated in the work of the TCPS—it is likely that they
would not have attained their posts at the IOP if they had done so—but
theirgoodfortunemaywellhavehadsomethingtodowiththeworkdone
by the TCPS. In fact one of these psychiatrists told me much laterthat he
thought the work of the TCPS opened doors for him.
In 1986, I was invited to serve on the Mental Health Act Commission
(MHAC), a government inspectorate established under progressive new
mental health legislation in 1983. There I met and worked with several
white people to highlight issues of discrimination and injustice in the
mental health services; and I discovered how black professionals who
reached higher levels in the mental health field often preferred not to get
involvedinsuchactivities—mainlybecausetheywereafraidfortheircareer
prospects.Iwasfortunatetobecomechairmanofthecommission’s(then)
influential standing committee on race and culture, which devised its first
PREFACE ix
policyonracefollowingepisodesofovertracismthathadactuallyoccurred
within the MHAC itself (see ‘Illustrations of institutional racism’ in
Chap. 6). Unfortunately, when we discovered serious problems in patient
care, all that we could do in the MHAC was to report the matter to the
managers of the hospital for action to be taken, and then make general
recommendations for improvement, or hope for top-down action to be
implemented as a result of our including suitable comments in the annual
reports that were delivered directly to Parliament. I learned a lot from my
service on the MHAC about how psychiatry was experienced by people
who were caught up in the system, especially if they were black—some-
thingthatinformedtherestofmytimeinthediscipline.OnethingIfound
difficult to understand was why and how racism has persisted in Western
cultureforsolong;andinparticularhowitwasthatpsychiatryandclinical
psychology, the disciplines that informed the mental health system, a
supposedly medical system, had come to be as they were—that they were
sooftenexperiencedasracistbypeoplewhousetheseservices.So,whileI
did the best I could in alleviating the oppression that people using the
mental health services felt (which was not much because for much of the
time I had to adhere to what I felt was a flawed system), I read about its
origins and background, integrating what I found out with my observa-
tionsandpersonalexperiencesofthesystemitself.Thisbookisanattempt
to share my thoughts in the form of a historical account.
London, UK Suman Fernando
A
CKNOWLEDGEMENTS
I am indebted to works of scholarship in the fields of history, psychology,
psychiatry,religionandsociology,especiallythoseworksthattakeacritical
approachtopsychologyandpsychiatryandindeedtoraceandculture;and
those that cut across disciplines. In particular I would like to express my
appreciation of some classics in the field of race and culture, namely the
works of Frantz Fanon, Stuart Hall, Edward Said and Homi Bhabha; and
the book that first led me to examine the background to racism in
psychiatry—AlexanderThomasandSamuelSillen’sRacismandPsychiatry,
the Black Patient—Separate and Unequal, published in 1972.
I have included in my book a few personal accounts and true stories in
ordertoillustratethewaysinwhichthepersonalispoliticalandviceversa;
and I wish to acknowledge the support and advice I received from col-
leaguesandfriendsduringsomeoftheincidentsthatIdescribe.Allinall,I
have had the support throughout my writing career of numerous col-
leagues and friends, especially people I worked with in the Transcultural
Psychiatry Society (UK) for over twenty years until it was disbanded by
mutual agreement in 2008. And I am grateful to many colleagues in the
fieldofmentalhealthfortheirencouragementwhilstwritingthisbook—in
particular I wish to mention the support of Roy Moodley and Martha
Ocampo of Toronto. Finally, I am grateful to Megan Laddusaw,
Commissioning Editor and Christine Pardue, Editorial Assistant at
Palgrave Macmillan for their patience, advice and help in taking this book
to completion, and to my wife Frances and daughter Siri for their support
and encouragement during its writing.
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