Psychology and Policy in Play

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Can We Talk about Privilege in Psychology?

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I wanted to expand on the NPR piece about prisons becoming the new state mental hospital.Until recently, most of my clients were African-American adolescents and adults. Given that my program focused heavily on cultural issues in psychology, professors emphasized the importance of being able to discern between cultural factors  and diagnostic criteria.  Working with other trainees whose programs did not focus heavily on cultural factors in psychology showed me how frequently psychologists, particularly White students and psychologists, over-diagnose or misdiagnose African-Americans.

It’s well-known in psychology that the prevalence rate of psychological disorders among inmates far exceeds the prevalence rates in society.  But in all the literature on this topic, few seem to wonder if over diagnosis of psychological disorders in African-Americans is paying into these high rates. Earlier this year,  a review article by Rich, Wakeman, & Dickman (2011), Medicine and the Epidemic of Incarceration in the United States , discussed the prevalence of mental illness in prisons and jails appeared in the New England Journal of Medicine. You may be wondering what in the world is a “review article.” Well, it’s an article in an academic journal, like the New England Journal of Medicine, that summarizes the current research on a specific topic, and in this case, the rise of psychological disorders in U.S. prisons and jail. According to the article, 22% of state prisoners and 7% of jail inmate are treated for mental health issues while incarcerated. It is a well-known, documented, and maddening fact that racial disparities exist in our prison system, where Latinos and African-Americans are more likely than Whites to be incarcerated. Rich, Wakerman, & Dickman (2011) raised important points about what may be influencing these rates, such as the living conditions, solitary confinement, and substance use and dependence.

Yet in conversations and discussions about this topic, the idea that  perhaps  African-American and Latino inmates are being overdiagnosed and misdiagnosed is infrquently mentioned. Perhaps I am biased given the cultural focus of my program, but it’s quite jarring to me that the importance of cultural factors are often overlooked in this conversation. Numerous studies have shown that psychotic disorders are  more likely to be diagnosed in African-American than White patients, and there is an increased likelihood of Afro-Caribbean immigrants being diagnosed with Schizophrenia and having a psychiatric hospitalization in their lifetime. Over diagnosis of ethnic minority groups does not begin with adults. It starts in childhood. African-American boys are over represented in special education classes.

With African-American more likely to be given a psychiatric diagnoses, it’s very possible that this continues in the prison system. Skills and strategies that Black people developed to live and survive in their community have become seen as a pathology. It is easy to categorize something as a malady when you or anyone you know has never experienced it. As we all know, prisons hold a disproportionate number of people from low-economic backgrounds and ethnic minority groups. Yet, psychologists in prison settings typically don’t share the same background. If they did, they would likely not have obtained a doctorate degree given how social mobility is structured in U.S. society. Much of their connection to these communities comes from working with them in a client-therapist relaitonship. The client-therapist relationship is one with inherent power. A therapist can make a diagnosis that  will reverberate throughout one’s life. It will shape how they view themselves. It can change how their  friends, co-workers, family and strangers view them. It may affect the jobs they get. It could impact who they choose date. To be clear, I am not asserting that you must walk in the same footsteps to understand another person’s problems or life. But when making diagnoses that will be tethered to a person for life, a psychologist cannot use their past client-therapist relationships as their sole reference point in diagnosing folk who grew up in a world that is diametrical to yours.

What I am asking for is raising the possiblity that these prevalence numbers may be inflated due to poor cultural understanding, more specifically unrecognized elements of privilege among psychologists. When much of your values and attitudes are reflected in mainstream culture, it becomes instinctual to view unfamiliar behaviors as pathological.   Yes, it is true that cultural competency classes and multicultural counseling books are becoming more important in graduate psychology programs. But quite frankly, that’s not enough. To truly understand and limit over pathologizing, discussions about privilege at all levels – socio-economic class, sexual orientation, religion, ethnicity, geographical – need to be spoken about. Not only the easy to swallow stuff, such as “I tutored inner-city Black kids in college!” or “What this country did when Katrina happened was awful!” or “I spent 3 months in Africa (because it is a country, you know!) helping cure famine.” The conversation needs to center on privileges that were given to you by luck and how they shaped your route into psychology. Even more, the discussion of privilege in training programs needs to help students explore how one’s values, ideas, attitudes and the meaning placed on these aspects impact clinical and research skills as as well as interests when working with people who you would have never chosen to interact with in your daily life if it was not for your profession.

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Written by G

December 2, 2011 at 12:54 am

Posted in Uncategorized

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