An Open Letter to Clinical Psychology

By Dr Libby Nugent, First Published Apr 9 2019 08:35AM

I am part of a Facebook group for Clinical Psychologists in private practice. I find it a profoundly helpful group that offers support and reflective space when working in the world without the NHS structure. A few weeks ago, a discussion was being had about resources for women experiencing vaginismus. This discussion was particularly holding in mind women from the Muslim faith. There was described an experience of being able to successfully work towards achieving sexual penetration, but not being able to achieve having the pain stop. At one point someone mentioned that they found working with this group could be challenging, as there seemed to be a push to be goal oriented; they often experienced this group of women as not very psychologically minded. These seemingly gentle observations sent off a panic in my chest. I went to reply, but have since decided to write this letter instead: In some ways I should be the last person to be standing up as a voice on this subject of structural racism. I grew up in a mormon community which has explicitly a vivid white supremacist history. A history I am deeply ashamed of, but it only makes it worse if I deny its existence - seemingly absolving it through silence. However, if I acknowledge my own experience, then perhaps I can ask people of whiteness to think about our own part in perpetuating racist and traumatising cultural narratives. The culture I grew up in was not only racist it was also misogynistic: teenage brides and polygamy being very much a part of the narrative. As a white woman, I learned to be obedient, particularly to white men (of any age post puberty) and to never expose any “not knowing” by them. If I did, it would have been my mistake, and therefore me to be thought accountable. You could be clever and outspoken, but only in service of the white male authority: the neck that turns the head so to speak. To achieve my obedience in a way that didn’t expose the aggression of this, I performed liking my role and displaying gratitude. To be not only a woman, but a woman of colour, was the lowest status of all. It would have been unlikely you would have been chosen as a wife and therefore mother and as such could not be seen as useful or of value. I couldn’t acknowledge or think about this, and so didn’t. At that point I was in denial of my whiteness, my being inherently racist and having any white privilege. I justified my inaction by believing that this was someone else’s fight and that my silence was neutral. I wanted to see myself as just a good person that wanted to be picked. My brothers had a different narrative in our culture. From a young age they were told they were very special and their role was to spiritually care and financially be responsible for the well-being of others who were less capable - namely lower status people. My brothers’ prayers, we were told, had direct communication with god; as such they needed to take this responsibility seriously and invest in their own spiritual development: the closer they were to god the more useful they would be. To maintain their status they needed to be seen to be righteous and not contaminated by wrongdoing - past or present. They also wanted to believe that racism was someone else’s fight and that their silence was neutral. They just wanted to meet their responsibilities. In my late teens I left this community. Part of my leaving was that I knew I needed more from life and I wanted to use my brain and celebrate it. At some point I found clinical psychology - it seemed like a career that I could maybe have it all. I could stretch my academic self and really grow. I ditched god and men and found rationale science and feminism; I had swapped prayers for reflective practice. I thought my psychologist role was solely for good and was about being a responsible caring person, helping other people less fortunate than me with their emotional pain - and in the NHS, where they didn’t need to pay. I was aware not many people of colour were chosen to be in the profession, but I couldn’t bear the thought of thinking about this and so I didn’t. I decided the lack of diversity was probably best dealt with by someone else, as I was aware if I started to speak I might well expose my own racist heritage and I couldn’t afford to be exposed as broken or bad. I just wanted to meet my responsibilities in the least troublesome way possible. Oh dear. You can take the girl out of the Mormon but it’s much harder to take the Mormon out of the girl. My career progressed and I became aware I needed some help to be a better therapist for my clients. I had the answer: go to therapy! You know, for work. In some ways I wasn’t wrong. When I started psychoanalytic therapy I had a shock: I struggled with my therapist that he would not tell me what to do. I struggled that he would not acknowledge how good I am, how nice I am. I was offended when he suggested I might be full of anger and pain. I struggled to notice and connect with my internal world. I struggled to be psychologically minded. Why? Because asking me about my shame was like asking a fish how the water is and their reply is: “What water?”. “Psychological mindedness refers to a person's capacity for self-examination, self-reflection, introspection and personal insight. It includes an ability to recognize meanings that underlie overt words and actions, to appreciate emotional nuance and complexity, to recognize the links between past and present, and insight into one's own and others' motives and intentions.” wikipedia, 03/04/2019 I didn’t ‘know’ when I was drawn to clinical psychology I was replicating a pattern from my traumatic childhood. That I was looking for a new ‘right answer’ on how to live life that didn’t challenge my learned self-image. Now I do, and it has been both a painful and enriching awakening. My lack of insight into my unconscious motivations (my lack of psychological mindedness) to be a clinical psychologist is not unusual. I suppose what is less usual in professions that work at least in part as psychotherapist, is that as a culture psychology has relatively little interest in having these motivations drawn out into the open. Personal or group therapy is not essential to complete training and only a small number of people chose to attend, even fewer are categorised as having ‘lived experience’. Although personal narratives are intellectually regularly acknowledged there is a curious silence surrounding the felt pain of our collective histories and possible subsequent enactments. Intellectually, we know that silence is a form of avoidance and acts to deny pain. We also know that social and cultural groups can hold collective trauma and cultural wounds; they become the building blocks of the social unconscious. When this pain is kept out of consciousness we project our anguish onto others, typically sub groups, and they become the traumatised bad object; the scapegoat who we accordingly determine are just not psychologically minded enough. When I read the Facebook discussion it reminded me of my own and my brothers’ behaviours in the face of the Mormon culture: racism silently active in denial of its context and living with the conviction that there are only kind intentions being exchanged. I suspect anyone in the Facebook discussion group who did have conscious concerns did not express them, for fear of being “ too harsh” and then the abusive gaze being turned back on to them. The profession of clinical psychology is actively both avoiding addressing, and also in its silence perpetuating, structural racism. The Facebook discussion was perpetuating the belief there is an “us and them” and that the models used were not effective because the Muslim women were somehow lacking an ability to “get it”. I am suggesting that the lack of psychological mindedness, (due to unacknowledged trauma) belongs in our culture and does not belong to those subgroups who do not ‘get’ our models. We are just like the Garfield cartoon character who wants to lose weight quickly and so surrounds himself with fat friends. This scapegoat way of thinking does not just extend to the ‘hard to engage clients’. Clinical Psychology is one of the least diverse health care professions in the NHS. As a group, we know this is not an accident; I don’t think many of us view this as acceptable. What do we ask our members with colour to carry in service of the white privilege narrative? We know we need to stop perpetuating the cycle - but how? I believe we need to own our own traumas. We know British culture has a violent history of slavery and that the profession of psychology has acted abusively: IQ testing, Human Nazi experiments and the Aversion Project to name three hideous examples. We need to understand ourselves as a profession trying to survive in treacherous times and bring into consciousness our pain and shame so that we can heal and thrive. We need to make space for people collectively to explore these dynamics, allowing a range of perspectives, not only to acknowledge the cultural abuses and wounds, but also the pain of each group member and for them to be held and attended to. Maybe if as a culture we start to take into account all of our wounds - and not continue to avoid them, we can stop requiring subgroups to be scapegoats for our pain.