“And I have been trying to smash her frankness so that she should reserve opinion until she is sure of mine.”
Sigmund Freud about his wife Martha
“The Life & Work of Sigmund Freud” by Ernest Jones (1953)
Imagine this: You start to experience mental health problems so serious you know you need help. Fortunately your circumstances enable you to meet a mental health practitioner of the talking therapies and you take up the opportunity to get the help you need. However, as your talking unfolds, your practitioner begins to frame your experiences within cultural definitions that bear no resemblance to your own experiences of life. What do you imagine this might do to you, on top of your own problems, and what impact is it likely to have on your recovery?
These are important questions. Before many mental health practitioners protest that, in their work, they simply listen to their clients/patients, I would ask another question: how can you be so sure? None of us are unaffected by the culture we come from. Our personal cultural assumptions are the bedrock of ego formation and never really leave us, no matter how much we might transform other aspects of ourselves. So when a client first comes into therapy and the practitioner takes their history, the practitioners’ own history is just as important. For example: what if the history of the practitioner’s professional training looked like this?
The cultural history of the global mental health movement has its roots firmly in White culture, along with all its assumed privileges. Ask MH practitioners where they would pinpoint the root of their profession and most would point to Freud. There is, however. a problem with Freud: when faced with a choice between his patient’s truth and professional pressure to recant, he recanted. although not everyone agrees with this analysis. It interests me that those who defend the Freudian status quo seem to be predominately male and are probably themselves products of white culture. I point this out simply because women working in the profession recognised Freud’s alleged behaviour from their own experiences of life. Indeed, the issue of a white man’s view of women’s sexuality seems remarkably unchanged, even today, so much so that sometimes satire gives a far more incisive take on the problem.
Whilst women have challenged the assumptions of a white male view of mental health, cultural challenges seem to be far fewer. The result means that people of colour or from differing cultures who become ‘service-users’ of a system requiring self-reflection in patients are ‘treated’ by those who stoutly refuse to engage in the same process. Little wonder that such patients develop little or no trust in practitioners of mental health services. True; this might make interesting conference or research material for existing practitioners in the field but it does absolutely nothing to help those actually experiencing mental health problems. For them, all that seems available is more of the same stuff that is the likely cause of their mental health problems to begin with.
So what to do?
If I return to the history of mental health ‘services’, whilst we may begin with Freud (who was a product of his own culture and time), we continue with those who broke away from his ideas. Jung broke with Freud but, like his mentor, he was also a product of his culture and time – there have been numerous analyses of the inherent racism in some of his ideas. Following on were others who developed their own models of psychotherapeutic assistance: Ferenczi, Perls and Rogers to name but a few. In the 1970/80’s, we saw women like Susie Orbach and Luise Eichenbaum wrest psychotherapy from the hands of men. One of the most significant contributions these women made – and still make – is to frame women’s mental health problems within the context of a patriarchal society. To me, it is this that might offer solutions to the problem of racism and cultural bigotry within existing mental health services.
If mental health is to ever truly mean what it says on the tin, existing white cultural assumptions and presumptions on the subject need to be wrested away from the ‘establishment’ by those who are actually experiencing these problems. We need to break with the idea of ‘professions’ because the history of mental health ‘professionalism’ is littered with unspeakable cruelties and abuses towards all those who are non-white or non-male. For white practitioners (like me), it’s time we began to acknowledge the invalidity of many of our assumptions and started down our own road to greater self-awareness because, from what I see in myself alone, much of what we have been doing is directly harmful to those we are hypocritically claiming to assist. For those who have problems with that notion, I would simply say this: if your patient/client were displaying the behaviour you are about to display in response, what would your professional interpretation be?
Sometimes a client’s resistance to psychotherapeutic intervention is absolutely appropriate.
“If a patient doesn’t fit the book, throw away the book and listen to the patient”
Unnamed Freudian-trained analyst quoted in “The Feminine Mystique” by Betty Friedan