How clinical psychology fails minority groups

Overt racism is what most often comes to mind when people think of racism, where individuals actively discriminate against historically oppressed cultural and ethnic groups. But other forms of racism are also prevalent and recognised within social psychology and other academic fields, such as covert racism where discrimination is never blatantly identified or admitted to, examples of which include not hiring someone based on their ethnicity but never stating that as a reason. This can sometimes manifest as discrimination based on prejudices an individual may not be aware they hold (i.e. implicit racism). For example, multiple studies have found applicants with “black names” are less likely to get follow-up interviews.

Systemic racism occurs as a consequence of rules or practices within a larger social system that result in a disproportionate disadvantage to particular racial groups. This can happen even when they make no overt mention of race. Identifying it can be exceptionally difficult, as these systems pervade our lives and are often engaged with passively in our daily lives. As such it is essential that we spend the time and effort in examining them.

Though clinical psychologists aim to improve the wellbeing of their patients, they risk propagating racism and bringing about poor outcomes for minority groups if they are unable to address how their field contributes to systemic racism. One of the first lessons of any abnormal psychology class is a discussion of the classification of clinical disorders, summarised through the three Ds: deviance, dysfunction, and distress. If a behaviour is experienced by a small number of people, limits one’s ability to function within a society, and leads to distress, then this behaviour is potentially eligible for classification as disordered or abnormal. This is a seemingly innocent set of guidelines, however this thinking has resulted in legitimate and serious harm. This approach does not consider external factors such as how accepting or discriminatory a society may be, and instead considers issues of dysfunction as being due purely to the behaviour and emotional state of the individual. 

This speaks to the general problem of individualism in clinical psychology, which can be seen in the most popular and commonly used therapies such as cognitive behavioural therapy (CBT). CBT is based on the theory that a person’s thoughts can act as a source of harm and distress, or that a suffering person struggles to regulate their own emotions. As such, it assumes that issues which cause clinical disorders can be found within the mind of the person who is suffering. For example, a patient has depression, it is not the world or their circumstances which are depressing. This leaves little room to consider external factors, and makes it increasingly difficult for psychologists to recognise and incorporate them into mental health treatments. External events can be taken into account when they are isolated and easily identifiable (such as distress due to the passing of a loved one), however when issues are ongoing and a common feature of everyday life, it is far more difficult to take them into consideration. When we consider pervasive distressing events with external causes, such as discrimination, we can see how this system may fail to identify the causes of the suffering of people from minority groups.

The classification of homosexuality as a clinical disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM; the main resource and tool for clinicians in both the USA and Australia) until 1973 is a prime example of this. If we run through those three Ds once more we can gain an insight into how this occurred. Psychologists of that era identified homosexuality as not being experienced by the majority, and to be correlated with difficulties in functioning within a society and overwhelming distress. What this classification ignored was the social consequences of bigotry, discrimination, and abuse, and the inevitable distress and difficulties resulting from functioning within a bigoted society. Instead, a diagnosis was placed on an entire group of people, and in doing so justified continued discrimination and violent abuse, including the presentation of conversion therapies as clinical and scientific. Homosexuality was ultimately removed from the DSM, though far too late and after much damage had already been done. This was not due to a radical alteration in the methods and practices of clinical psychology, but due to a gaining of recognition outside of them. As such, few — if any — safeguards were introduced to consider the experiences of minority groups or to acknowledge the impacts of a discriminatory society, and these issues can now be identified in terms of systemic racism.

Those who experience ongoing discrimination have a much greater chance of being diagnosed with a clinical disorder due to the significant impacts it can have on wellbeing. The disproportionate misdiagnosis of minority groups with clinical disorders is also an example of how past discrimination is perpetuated, and so explains how systemic racism can be compounded. Individual psychologists may hold no explicit prejudice, but the insensitivity of common practices of clinical psychology to external and social factors of minority groups are left worse off than their majority group counterparts.

The underlying issue is the framing of psychological diagnoses as a patient requiring treatment for a problem within themselves, and the failure to acknowledge social circumstances that may have contributed to it. This results in those who experience racism and discrimination being treated through expensive therapy sessions, psychiatrist-prescribed medications, and, in extreme cases, institutionalisation. The blame, cost, and location of the problem are shifted on to individuals and away from those who discriminate and propagate racism.

Even with correct diagnosis, therapies developed in western cultures (as most are) are often less effective in treating those from non-western cultures. What these issues speak to is a growing need for recognition of systemic racism and marginalisation of minorities within psychology, as well as acknowledgement of culture-specific diseases and treatments. This is captured in the movement to decolonise psychology which intends to move away from considering the individual in isolation, and begin to meaningfully consider social contexts. 

The example of clinical psychology is not a unique case, but is instead an example to highlight that marginalisation and systemic racism is present everywhere. If you are reading this, you are likely a university student who is already engaging with large systems and through continued education may be finding themselves in increasing positions of power within them. Through an increased awareness of the systemic issues that pervade these systems, we can hope to be part of the solution rather than the problem.