V De Maynard
V De Maynard. Philosophy, 'Race' and Mental Health: Another Existential Perspective. The Internet Journal of World Health and Societal Politics. 2005 Volume 3 Number 1.
Black and minority ethnic people are still over-represented in our mental institutions and recent qualitative research conducted by myself would indicate that Western preference for some forms of philosophy, and the exclusion of others, continues to have grave consequences for the psychological treatment offered to Black and minority ethnic people in the UK. None of the participants interviewed were receiving psychological interventions and yet their narratives suggested that some description and clarification of their experiences to date may have helped and supported them in their moment of crisis (De Maynard, 2005).
In this article, a critical approach to the literature pertaining to the human condition from a European perspective was undertaken to determine whether something of the "black human condition" revealed itself. It was found that similarities could be made between the Jewish experience of detention in prison camps during the war, and that of the black man's detention within prisons and mental health institutions, today. Like the Jew, the black man too appears imprisoned within his own embodiment, and through his narratives something of the black human condition today revealed itself.
In conclusion, it would seem that much of the emotional distress experienced by black men is related to the difficulty they have coping with the negativity directed at that within which they are embodied. Like the Jew, the black man is separated out, but he is never made independent. To gain some understanding of the black human condition, mental health workers should abandon the safety and security of symptom control and consider the possibility that no amount of psychiatric drugs will ever resolve the issues of adequacy, failure, racial discrimination, powerlessness, and hopelessness.
The over-representation of African and African Caribbean men within the Mental Health System is well documented (Bhugra, et al., 1997; Singh, et al., 1998; Hickling, et al., 1999; Bhui and Bhugra 2002; Morgan, et al., 2004), and need not be reiterated here, however very little help and support beyond the administration of antipsychotics and antidepressants appears to be offered to people of black African and African Caribbean descent detained under the Mental Health Act in the UK Participants spoke of ‘how' their actions in the world repeatedly failed, and how the evolution of powerlessness gave rise to occasions when they even doubted the permanence of their own sexuality (De Maynard, 2005). If, we might assume that their expression of emotional distress is meditated by psychological processes representing issues that need to be discovered, clarified, and addressed, it must be asked ‘how' are black people ever going to resolve their issues and concerns within the context of their everyday life without access to appropriate psychological interventions?
The issue of whether African and African Caribbean people were suitable for psychological interventions has long been discussed within the literature (Dryden and Feltham, 1995), but little change has taken place (Curry, 1964; Vontress, 1979; Littlewood and Lipsedge, 1982; Kareem, 1992). Afrocentrists like Molefi Asante (1987), Na'im Akbar (1984), Maulana Karenga, and Dona Richards (1988) and Amos Wilson, (1993) have begun to argue that the treatment conferred on people of African descent within British institutions of mental health care represents a form of ‘institutional racism' that binds the black man in state of chronic dependency. Akbar (1984) appears to reiterate Rousseau's deviation from the racist views of his contemporaries by arguing that European views are inherently deficient for human development: ethnocentrism, individualism, rationalism, and materialism, tending to immoralities pervasive in European societies; whereas African values of collectivism, spirituality, affectivity/symbolism and humanism which apparently detract from the pursuit of immoral behaviour and lewd acts. Aristotle, Kant, Hegel, and Nietzsche advocate the superiority of one culture over another by virtue of perceived ‘natural characteristics'. People's who appeared ‘docile, lacked intelligence, and the “god-less” were considered ‘natural slaves'; and hence, there was nothing immoral about the enslavement of one people on grounds of cultural difference.
Many writers argue that the legacy of enslavement and dispossession undermines the mental health of black people of African and African Caribbean descent peoples in the West. The evidence it is claimed is to be found in the narratives of Black and minority ethnic people engaged in counselling (Cross, 1971; Vontress, 1988; Helms, 1990; Kareem, 1992; Carter, 1995; Dupont Joshua, 1996; Rose, 1997). These writers have articulated some of the difficulties that can arise during therapeutic encounters indicating that black people are responsive to appropriate administered psychological intervention; and yet during an investigation into the pathways to care that African and African Caribbean men appear to pass through before being detained under the Mental Health Act, none of the participants had been offered any form of psychological intervention whatsoever (De Maynard, 2005).
‘Race and racial discrimination', as social constructs primarily determined by skin colour, continues to divide British society. This social division also persists within Mental Health care system, and was brought sharply into focus when researching the pathway to care for many men from African Caribbean backgrounds (black men) (De Maynard, 2005). By ‘pathway to care', I am referring to the events and situations that precipitated detention under the Mental Health Act. The qualitative study undertook to uncover the events/situations leading up to detention under the Mental Health Act in two different South London hospitals revealed the two things. Firstly, that excessive difficulty in achieving success in black men's actions in the world, and in their interpersonal relations, is traumatic; and secondly that semi-structured indepth interviews elicited narratives as phenomena that were never addressed by mental health care professionals, psychologically. It was striking to note ‘how' different the treatment options offered to all patients supposedly suffering from the same mental illness, (i.e. schizophrenia). None of the interviewees were offered an assessment of their psychological health state, nor consequently were any psychological interventions offered; except those participants from Mauritius. The participants themselves did not accept that their illness experience was indicative of any disease process, and felt that they were being detained as a part of state systematic oppression against all Black men (Sivanandan, 1991; Moodley and Perkins, 1991). For the participants, their emotional problems arose as a consequence of the guilt and shame experienced in not being to provide, and act in what they believe is an appropriate way for a man to be have. Their everyday experience of discrimination and failure seemed to reinforce feelings of persecution and oppression (Alleyne, 2004), and participants found it difficult to communicate to their families because the participants felt that they should be able to deal with this perceived oppression themselves.
To all intents and purposes, when presented with what appear to be symptoms of paranoia, delusion, depression, and confusion, family, friends and health professionals can but conclude that mental disease is the cause of the participant's illness experience, and offer treatment for this ‘disease' in accordance with proscribed wisdom. But I would argue that these presenting symptoms, when taken out of context, loose their meaning, and therefore any treatment offered can not address the cause of the apparent mental illness because as yet the
Existential counselling and psychotherapy, like most other Eurocentric approaches to counselling and psychotherapy, is grounded in Eurocentric worldview where the ‘Negro' had been virtually invisible (Littlewood and Lipsedge, 1982; Kareem, 1992; Carter, 1993). Training in this approach involves intensive exposure to all those philosophers who have written about the human condition; but what of the all those philosophers who are not-White? Existential counselling and psychotherapy 'favours open exploration of individual difficulties and experiences; taking into account the cultural, social, political, and ideological context of a person's existence' (Van Deurzen, 2001, p32). The aim, Prof. van Deurzen tells us, is to enable a person to live more deliberately within these contexts of his/her own existence. This requires that we accept the limitations and contradictions that of life within these contexts. I would like to address some of these precepts from my own perspective as ‘a Black man'; not least, of all, because there some limitations and contradictions in everyday life that are not acceptable to me, as a Black man.
To begin with, for me, the term ‘Black man' is problematic. It immediately objectifies me in the world; irrespective of dimension, without giving my form, subjectivity. ). We speak of ‘Black' ‘Brown' or ‘Yellow' people as if they were finite, fixed/immutable definite objects, when really all we have done is reduce the person before us to the status of object-for-us (Sartre, 1943; Guthrie, 1976; Smedley, 1993). Nietzsche (1982) wrote:
As a black man, I have a physicality that appears to call to the world in which I exist, and that in-itself is very rarely addressed within Existential counselling and psychotherapy. Sartre argues that this standpoint is in-itself – sadistic: the denial that I am embodied and that I have a perspective on the world that can be seen by others - is sadistic. Conversely, the denial that I exist beyond my physicality; my objectivity, is masochistic. We have now created for ourselves an object-subject dichotomy where we are situated somewhere along its continuum: never being completely an object, nor completely subject, for the other in actuality: always, either the black man making the ‘Look' of the victim (masochist), or the ‘Look' of the victimiser (sadist), within a given context.
Sartre (1945) argues that we can not be more than the sum of our actions (Sartre, 1943), but black man in relation with the white world is all too often nothing more than the sum of our actions or entirety of his physical body – an object for the other. Jean Améry writing about his experiences in the Nazi concentrations camps described how he became
(Ibid, 1980, p91)
Sartre argues that this in-itself, (i.e. our physicality), is an illusion; that we create others and the world-around for ourselves. From another's perspective, these same objects may take on a different description and meaning. Améry draws our attention to the way he became aware of himself in-relation, and of life itself,
For me, Améry's descriptions of the way in which he became suddenly more aware of his physical body when he was punched is telling. In response, he punched his assailant. The opportunity to engage in dialogue, to express oneself and one human being to another (Buber, 1923), was denied in-relation with the other. To communicate with him, the other punched him, he replied with a punch. He had become ‘an object' to be used in the only way you can interact with an object. Consequently, Améry responded as ‘an object'; using the language of ‘an object'; he returned the punch. In becoming violent, he once again became more than just a mere object. He became an object struggling to regain his subjectivity in relation to his oppressors; he became violent. He acknowledged the other in-relation in becoming somebody in-relation other than a mere object. He writes:
In this moment of persecution, he demanded that his body, the object of his existence, assume subjectivity in-relation with the other. His demands were accepted, and the punch was returned. He writes:
Characteristic in the discourse is the view that, Jean Améry could escape from his Jewish-ness. He was a Jew from himself, and for others, and that Jewish-ness was realised in-relation by his experiencing body. In the context he found himself in, he could not choose not to be a Jew; he was reminded of this fact within the course of everyday life – in violent ways. This aspect of his physicality will not change with time, or space. It is fixed, and immutable in much the same ways, as a black man, I, too, can not escape nor avoid another person's actions-in-the-world that may draw attention to this aspect of my person. ‘I think, therefore, I am' draws attention to that content of my thoughts which must consider the object and the objects ability to be observed doing something'. That something seems dependent on the physical attributes of the object, and
As a young man, I was often confounded by the way; other people behaved in-relation with me. Others seemed to behave in ways that were not obvious to me, when I was a child. I attempted to make direct correlations between what I had said and done, and what had been said and done by others, but found there was none. For instance, I would walk casually down the road towards an approaching person, only to find the oncoming person had crossed the road and continued walking; something that I had not experienced as a child. I had done nothing that might prompt such behaviour, (i.e., behave in a threatening way); except, be ‘this black man walking down the road'. My attention is, now, drawn to that aspect of my embodiment that is - physical. My subjectivity has been set aside, and I have assumed a position of objectivity in-relation with the world. Prof van Deurzen (2001, p32) argues that: ‘angst (existential doubt) or anxiety is the basic ingredient to vitality'. If, a person of colour expresses anxiety about the way he perceives himself in-relation as a person of colour, how might s/he learn how to be anxious in the right way? What is the right way to be anxious; and, experience others in this way as a person of colour? How anxious should Stephen Lawrence have been when he stood waiting for a bus? I do not suppose he was anxious at all; at least, not until it was too late.
Clearly, our physical features do matter; and we are overly concerned with what we look like; rather than what we say and do, because we draw attention to these features in-relation whether we want to or not. Here, I am reminded of the way, as a child, I was required to put my hand in the air and wait to be address/spoken to, by the teacher. I am sure many children in schools share this experience, today. I, the object, wait to be called upon to give utterance to my thoughts. I wait my turn. It is not enough to wait until the other person has finished speaking, no I must be given permission to speak. The teacher grants the permission. She alone has the power to grant such permission. I wait to be called into subjectivity. For Améry, he waited until he was punched before he responded. Relying purely on what we do, and say, ignores the fact that our physicality presents limitations for our existence in ways that are not addressed in the existential psychotherapeutic literature. If, we look at the writings of those philosophers who wrote about the human condition, we see that they lived in times and place which were specific to those time and place. Nietzsche wrote extensively on the position of the German, and his relation with others within he mocked the way in which the German had de-valued himself in relation, and mourned for this loss; becoming angry as he considered what this might mean for him. Heidegger (1927) in his book, ‘Being and time', suggested that ‘we are ‘thrown' into a world that is already there to start with', and that ‘these limitation situations have to be accepted and worked with: we cannot avoid nor escape from them'. To this end, we are reminded of our own finiteness, and that all things must come to an end as a consequence of the contexts in which we live (ibid, 33). This may be ‘why' Heidegger, when confronted with Nazism and nationalism, opted to change his way of being-in-the-world such that any anxiety he experienced would be minimised. He wore the emblems of the National Socialist Party (Swastika), and in so doing, appeared to support the ruling hegemony, but said nothing neither in support not against the ‘Jewish Question' (Young, 1997, p214).
We are embedded contextually in
It makes no sense whatsoever to talk about
I would argue that this is not possible, and the reasons are made quite clear in Sartre's Play ‘The Respectful Prostitute' (1955). In this play is about a prominent white family's attempts to defend a nephew, ‘Thomas', who is accused of killing a black man on a train. The accused man's family coerce ‘Lizzie McKay', a white prostitute, who had also been riding on the train, into signing a statement that suggests that Thomas' had killed the black man whilst defending Lizzie from an attempted rape. Another black man, mistaken as an accomplice, has already been lynched for the alleged rape. Most striking for me about this whole play is the namelessness of the black man pleading for his life. Sartre reduces the black man to an “it”; an object, within this play, and makes no apologies for his. Sartre writes eloquently about the way this black man's fate is sealed by the conspiracy that is weaved in-relation with him by those in a position of power, and the black man's reluctance (‘bad faith') to become anything else an object for himself, and everybody else. Lizzie, estranged by her choice of profession, covets a sense of belonging to the dominant race, and signs the statement. For her, this sense of belonging calls to her soul far more strongly than any existential guilt she might harbour in betraying the black man. She appears to apportion no value her own social status over, and above that of the black man's life: in-relation he has been reduced to an object; an object to be used and abused, and discarded as you might so do with any other object. What are we to make of these relative positions of power? Are these positions given over to us? How do we take up such positions within the course of our daily lives? I am uncertain.
Van Deurzen suggests that we recreate ourselves each and everyday, that we never really reach our full potential as how we are, and these things in themselves invoke existential guilt within us (ibid, 33). The Black man recreates the power relation between him and his lived-world each day, and never really reaches his full potential within the time allotted to him. Therefore, he must be consumed by Existential guilt because more often that not he has failed in this respect; particularly at the end of his life, when there is no time left. Van Deurzen goes on to suggest that, ‘Existential counselling and psychotherapy helps put all these current issues into perspective'. There is also scope to help and support the person ‘to find a satisfactory direction for their future life with full recognition of the contradictions and dilemmas that to be faced in this process' (ibid, p33). Courage and humility is required in this endeavour (Tillich, 1952).
For me, this is a tall order. The black man is required to confront the world everyday with courage and humility; even though he feels himself to be an object-for-others. What direction should he choose for himself in such a lived-world where he is objectified by the virtue of his skin colour? Natanson wrote:
Natanson ascribes to the Sartrean view of ‘‘bad faith'‘ by arguing that, ‘‘bad faith' consists of the individual's moving from subject to object in social roles which have congealed consciousness into routine expectancy impact and which have made of intersubjectivity a masked and masking reality' (ibid p45). For Natanson, and Sartre, ‘‘bad faith'‘ is a means by which the individual can absolve him/herself of freedom to be, and the responsibility that goes with that having chosen to be in either this way or that. So, in ‘‘bad faith'‘ I know that others can see my blackness and I perform in such a way as to deny my own freedom to choose, and in thus doing, absolve myself of any responsibility for my own actions. In accepting my fate, I acknowledge that freedom is relational. I am not free to act in the same way as I see others do, and therefore the choices I can make for myself are severely limited. This for me is the ultimate limit situation, and society tells me that I must be glad with my lot in life. “I am not free in the relational sense, and therefore I can not be held responsible for my own actions”, the Black man proclaims. To act in ‘bad faith' then reflects an acceptance of a prevailing situation from which the Black man finds difficult to escape or avoid in the course of his everyday life. I am either purely an object for the other, or purely a subject for the other; the object-subject dichotomy reveals itself and I am fragmented.
Clearly, there are limits to freedom, and the extent to which the individual can realise my full potential. These limitations are dictated by the society within which we all live, and the extent to which we as individuals or as groups are able to exert power within our social relations. The black body in particular, and the social construct ‘race', continue to present to a number of limit situations, from which the black person can neither escape nor avoidance. To discover themselves in-relation with others, Black people must confront the apparent prejudices of others within the context of my everyday life, in ways that reflect the experienced frustrations in relation to the demands put upon them. Hence, the black person must acknowledge the changes in facial expression of the shop assistant as s/he turns to her/him and set the aside to ensure that s/he is able to purchase whatever it is that s/he wanted to purchase. Stephen Lawrence must wait the bus stop or he would have had difficulty getting to his destination. As a black man, I too must endure the jeers, crass comments and sly remarks of the racist, or I would never leave the house. Everyday, the black person is required to summon up the courage to be in-relation with the racist society, and endure the uncertainty of living in time where the immediate past prohibits his/her actions in the future with serenity.
I can only conclude that, more often than not, others have what I want, and/or need. This presents me with a dilemma. Being-in-the-world fills other with dread whether I am observed doing something or not. Everyday, I am confronted with the possibility that that which I covet may never be realised. Deciding what must be done to get what I want and/or need requires courage and humility in the face of adversity. To deny myself the freedom to be courageous and humble in-relation, is to deny the responsibility that goes with that freedom. To exist in ‘‘bad faith'‘ is too great a sacrifice for me. There is no reason to expect others to meet the demands I make on them when I am not prepared to meet the demands they appear to make on me. I must, therefore, ask myself to what extent am I to assume the
Prof. R. Littlewood & Prof. T. Leiba
V. De Maynard, London South Bank University, Faculty of Health and Social Care, Borough Road, London, SE1 0AA (e-mail: firstname.lastname@example.org).