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The Impact of Race and Racism on Mental Health Clients, Practitioners, Organizations, and Delivery Systems – Crossing the Racial Rubicon

Race is the Rubicon we have never crossed in this country. Some claim that race is no longer a factor in the United States. We are “beyond racism.” The opposite is actually the case. Everything in this country is touched by race, from where we live or choose to live, go to school or send our children to school, where we worship and with whom, go to the movies or even walk at night. Nothing escapes race. Our mental and physical health in the United States are both impacted by our relationship to the concept of race.

If you are statused as white in this country, you tend to live longer and reside in neighborhoods where property values are appraised higher. Police in your community are more likely to actually

“protect and serve.” The concept of racial profiling is not a part of your everyday consciousness.

If you are of color in this country, you experience stress levels that affect your personal longevity. Your environments often make you more susceptible to certain diseases. In your community, police often operate as a social control mechanism and racial profiling is employed as a primary operational tactic.

For most of us, living and working within the confines of our particular racial group constitutes normality. Even as we are evermore a multi-racial nation, the vast majority of us are like ships passing in the night. We come close to each other, interact in commerce together, but we are navigating separate channels. We rarely board the other’s vessel.

Race is deeply imbedded in the psyche of this nation. The stereotypical regional splits of North and South, urban versus rural have no saliency within the larger history of systemic and structural racism which is embedded in every facet of American civic consciousness regardless of where we live in the United States. The fear associated with race rears its ugly head in all kinds of places: at town meetings on health care reform, on the front porch of an elite Harvard professor’s home, hourly on the some cable news channels, and in Night Court in any city or town across the country. Our southern border seethes with racial hostility. As a popular white talk show host loses control on air with a fusillade of N—–, N—–. over and over again. Scratch us even a little bit and the prejudices of race well up.

Noted mental health practitioner, Dr. Alan Siskind says: “It is critically important to recognize race-based traumatic stress and not ignore its psychological and emotional impact even though there are numerous pressures to deny or underestimate the impact of it. As David Billings notes, race is so definitive in our lives that it pervasively defines the context in which we live. Mary Pender-Greene has, poignantly, noted that “being a person of color is a full-time job.” The trauma of racial discrimination creates poorer self-image, poorer living conditions, and poorer access to health and mental health services. This is true even as the socio-political and economic context in which people of color live creates greater need for these services. In addition, then, to the well-researched and accepted myriad of health issues created by the traumatic stress of racism, there is strong consensus that there are greater levels of anxiety, depression, suicidality and somatization among those impacted by racism. There is, as well, a wide range of psychological issues that exist as a result of the need to continually adapt to greater deprivations, e.g., poorer services, poorer housing, poorer education, and generally poorer access to those opportunities that get positively defined in our society.” Alan Siskind is the former CEO of the Jewish Board of Family and Children’s Services in New York City. He is now in private practice and a consultant in the field of Mental Health.

The 2008 election of the nation’s first African American president painted a striking and contradictory picture of America’s core fears and attitudes on race. On the one hand, people of all races cheered in an emotional frenzy—a sort of political and national catharsis. For some Obama’s election demonstrated finally that the race demon that had haunted the nation since its beginnings had been exorcised. A shroud had been lifted from the body politic. Obama was the living embodiment of the American dream, proving that we are a nation where hard work and determination pay off and racial limits are no longer real. Racism was a relic of history. After all, the President is a Black man.

For others, the election of a Black president stirred long-submerged fears and rage over whose country is this United States. Gun sales spiked to unparalleled levels. Individual white people appeared with side arms and rifles at presidential events, claiming such actions are protected by the Constitution. Furious Whites stormed discussions of health care policies with blue veins popping and faces contorted in racialized frenzy. Similar behavior took over the national debate on immigration reform: laws were passed militarizing the southern U.S. border and mandating police officers to racially profile those who looked “suspicious.” Political commentator Glen Beck claimed on national television that Barack Obama is a Communist who hates White people (even his own mother, one must surmise). Parents in Texas prohibited their school district from participating in a webinar where the President of the United States urged students to stay in school and make good grades. This is the ruse of race. On the one hand we prize freedom and liberty and the notion that we are all one people. On the other, we are a people scarred by race for so many generations that the thought of equity across race lines brings out the worst in the American character.

Race is a mental health issue. It has been since the nation’s founding. European immigrants seeking greater personal freedoms and promises of possible land ownership, wealth accumulation and participation in the body politic, would find the continent already inhabited. Race would be used as one of the primary reasons that the “Indians” could be removed from their ancestral homes and shunted off to reservations and excluded from the nation’s social contract. These striking dichotomies created a nation fragmented by race categories that tore asunder ideals of equity and democracy. Some of the greatest visionaries of their age or any other age founded the United States of America. Names like Jefferson, Washington, and Franklin symbolize the democratic ideal and the potential of a people to self-govern. Yet, Jefferson and Washington were slave owners. Africans formed the base of their incredible wealth. When Washington married Martha Ball, their combined wealth from the enslavement of Africans made them one of the richest families in the United States. Even Benjamin Franklin, himself not an owner of enslaved Africans, hoped for a country that would exclude Africans and “tawnys” and become a nation of “lovely white.” This contradictory state of mind about race created a mental and moral disconnect that robbed both the persecuted and the persecutor of their humanity. What Gunnar Myrdal called in 1932 the “American Dilemma.” The psychologist Frances Cress Welsing will claim America is race. She will quote her mentor, Neely Fuller, that “in America, if you do not understand racism, what it is and how it is manifested, then all that you think you understand will only tend to confuse you.”

Community activist and anti-racist trainer with The People’s Institute for Survival and Beyond, Margery Freeman reflects on the role of Mental Health services in communities of color: “Mental health care is driving my people crazy!” When I first heard my colleague Barbara Major say that at a health clinic she directed in an African American community in New Orleans 20 years ago, I laughed at the absurdity of the statement. Then I cried over its truth: For it made me realize that we professionals are blinded by a belief in our good intentions. Because we are idealistic, well-meaning, and highly trained, we believe that our efforts are beneficial. Yet the horrific mental health struggles faced by people of color – and white people as well – are only compounded by institutions determined to maintain colorblind policies and practices. As we look squarely at the systemic nature of racism, we can find the courage and conviction to go beyond good intentions to an honest examination of results. With such understanding, we can organize with our clients and colleagues to transform our systems so they no longer “drive us crazy.” Margery Freeman is a trainer/organizer at The People’s Institute for Survival and Beyond.

Race is the founding structural reality of the United States. Every system that constitutes the national infrastructure, from education to law to health care, was constructed by and for White people. This national construct of race and its systemic dimensions still hold true today. The disparate racial outcomes produced by these systems in the twenty-first century are based on the built-in assumptions of the eighteenth-century racial state. Laws have not changed this basic understanding; legislation has not leveled the playing field. Even personal attitudes that for many have lessened the racial fear and phobia characteristic of prior generations, have not shaken the sturdy pillars of this race-constructed nation.

Mental health must be understood in the context of this racial construct. Most Whites live in a state of denial about race or, conversely, think we know all about it. Yet the subject of race rarely comes up in our board rooms or staff meetings unless someone of color raises it. We assume a common “colorblind” understanding and approach. We rarely ask, “What’s Race got to do with it?” Even in public policy debates or data research, the disproportionality of racial impact is missed. Race comes up only when it is the “issue” under discussion. If the topic is not race, it is rarely seen or heard. In contrast, people of color, especially Blacks and Latinos, see race everywhere. There is no topic or arena where race is not a factor. While Whites accuse Blacks of “playing the race card,” Blacks and other people of color see race as impacting every card in the deck.

Today in the field of social services, more and more of our constituencies are people of color. Yet, the professionals who serve them are overwhelmingly white. Without a thorough knowledge of structural racism those of us in the helping professions can do damage.

This issue of Mental Health News is about race and its many dimensions. The authors dissect race from many angles. They analyze the impact of race from both a conceptual and a practical basis. These articles explore how race plays itself out in the therapeutic arena, in policymaking circles, and in direct client interactions. Together they comprise a manual suitable for everyone in the profession.

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