Feed the Feminine Podcast Episode #7:
Mental Health as a Social Justice Issue
Welcome to Feed the Feminine, a podcast dedicated to reviving archetypal feminine qualities in a masculine-dominated culture. Join me each episode as we talk about the archetypes present in how we eat, express, and relate and what we can do to find meaning and reach balance.
On this episode I’m talking about depression and how the collective repression of the feminine may be influencing depressive ways of being.
As always, before we dive in, a quick disclaimer. The information
provided here is intended to covey general information only and does not intend to replace or infer proper psychological diagnosis. No therapist/client relationship is implied or actualized through any contact with this podcast, website or its creators unless formally agreed upon in a proper clinical setting. And now, without further ado, here's this week's episode of the Feed the Feminine podcast.
Social Justice-Informed Therapy
I want to start this episode by saying I’ve played with the idea of sharing this perspective for a long time but was never entirely sure of the best way to bring it up given the complexities of varying cultural perspectives on therapy, healing, the human condition, and the fact that I’m a white, European American with the systemic privilege of MY “culture” being at the forefront of what’s considered to be right, best, or at the very least, default.
The first time I heard “social justice-informed therapy” was when I was poking around the website of a privately owned therapy practice in Los Angeles, one I’m pleased to announce I now actually work at. At the time, I wasn’t quite sure what that meant – social justice informed therapy - but I knew it struck a chord with me because I know how hard it can be to sit across from a client, as a therapist, and know that what ails them goes way beyond the trauma they experienced as a child and moves into modern, day-to-day marginalization, misrepresentation, systemic abuse, oppression, and neglect. A few episodes ago I talked about how employers like to use the term “burn out” in order to gaslight wavering employees when really they should be taking a look at the organization to ensure it’s not actually creating an environment that offers opportunities for moral injury, NOT burnout. In other words, the systems we’re a part of influence our lives heavily. You don’t live in a bubble, therefore everything that you struggle with is not coming from within. If you’re familiar with systems theory in psychology, you know this. But oftentimes, we only apply that to family systems. We hardly branch out and recognize how work environments, local communities, cultures, and larger societies and its politics dictate our lives, ESPECIALLY if you’re someone living on the “fringe” of any of those systems, in other words you either don’t conform to them, or you’re not accepted by them.
And as therapists, we have to involve that in the therapy room. Being a trauma-informed clinician is not just about the trauma of the past, we have to recognize the ongoing day-to-day trauma our clients experience at the hands of the systems they live in, and that we, ourselves, may actually benefit from.
Younger White Therapist, Older Black Client
My very first client as a therapist was a black woman. And I had so much care for her throughout our time together, but I was always a little intimidated by her. Because I knew I could never truly understand her experiences as a black woman and I felt that having a young white therapist was a disservice to her. And we discussed that often in our therapy. We had to acknowledge when our cultural differences, when our experiential differences, were limiting my ability to serve her the way she needed to be served. And that’s not to say we didn’t work well together. We had a great rapport and we learned a lot from each other, but was there someone better suited for her to allow for deeper work to unfold without the barriers of race, the different experiences we have in this world, and my good, but not always effective, intentions? Moreso, could she have benefited more from a therapist who wasn’t the very face of her oppressor? In other words, no, I’m not a slave owner, my ancestors were not slave owners, I was not alive during the Jim Crow era, I am not currently in a position of power to uphold the systemic racism that remains in our country. And yet I’m the face of the privileged, the descendants of a culture that decided our race was worth more, and I continue to benefit from that system just the same and she continues to be harmed by it, regardless of whether or not I personally believe it should be that way.
Psychotherapy as an Inherently Western Value
We’ll always have differences with our clients. There will always be something we don’t understand about them, experiences we’ve never had that they’ve had and vice versa. So this isn’t to say we all need to be working with our identical twins or no one at all. But I will say that my cultural competence training as a therapist did not quite prepare me for the guilt and doubt I felt in the room with her. Because in western psychology, we view our main principles as the default, and anything outside of that is “other.” Andrew Samuels, who is a British, white, psychotherapist and writer, wrote an essay called “What does it mean to be in ‘the west’?” and he discusses western culture and it’s impact on mental health. He says that in the west, we’re agonizing over our identity and what “the west” means. He notes that Carl Jung himself despaired over the one-sidedness of what the west had become, how it’s overdependent on rationality, materialism, loss of purpose and meaning, and that our minds and bodies are split – this is the masculine excess I talk about. The absence of feminine in the west is palpable.
And if psychotherapy has its roots in a masculine-dominated culture, what does that say about psychotherapy itself as we know it?
In therapeutic training, we are taught the importance of cultural competence, but not much is done to hold us accountable to the depths of what that actually means.
Samuels, in his essay on the west, notes that psychotherapy itself as we know it is a western philosophy. He discusses transcultural therapy, which is to say that in order for therapy to be as culturally competent as it wants to be, it has to traverse other cultures, not just do what we’re sort of trained to do which is wait for different to show up in the room for individual adaptation. In other words, he says that the principles of psychotherapy say that there is “here” and “there,” we are domestic providers and when someone from another cultural background walks in the room, they are now the foreigner. And we have to recognize that difference and then move along with therapy. But just recognizing that difference isn’t enough. And moreover, there is no “here” and “there,” there are myriad cultures with differing, beautiful, nuanced perspectives on the human condition and what heals suffering and that instead of seeing ourselves as domestic and our culturally diverse clients as foreign, we need to see all of us as foreign. We need to individualize our therapeutic approach so much, based on so many details, that you never assume there’s someone walking in the room that you know, culturally. Samuels says to treat every client as though they are “foreign” rather than treat everyone as “domestic” and adapt only when you’ve determined a set of cultural values different from yours.
Even the ethical parameters of our field are informed by western standards. The guidelines that dictate how we interact with clients, what enacts our mandatory reporter status and has us involving CPS or APS in our work, how we assess for and treat suicidality, the appropriateness of our relationship with our clients - all determined by western philosophies and values. And beyond just western perspectives, it's rooted in privileged* western perspectives. Not impoverished western perspectives or eastern traditions, but privileged western perspectives and values, as though that is the standard everyone else should be held to. And that's not to say there isn't value in there, that the goal isn't safety and healing. It is. Of course. But perhaps there are other ways of seeing safety and healing that go beyond the parameters of that privileged western ideology. Being a therapist is about making judgment calls that our individual values, as well as the ethical values of our given license or credential, are informing. There are communities that are not going to fell welcomed, seen, validated, heard, or therefore helped, if we are offering a one-size fits all approach to healing the human soul.
Racial and Socioeconomic Barriers
And even within western culture, there are subcultures. There are cultures informed by socioeconomic status, race, nation of origin, faith, survivalism, and other factors that contribute to different value systems. Not all of them are represented in the ethical or theoretical guidelines of psychotherapy. Safety and legality aside, is it our job to bring them to our cultural values because we've figured out a model that implies high functioning, well adjusted success? Or is it our job to meet them in theirs and help them grow there?
Folks in lower socioeconomic situations may not have access to mental health at all, despite the critical need. But when they do get it, they may be faced with a system that doesn't include them; a system made up of values they don't agree with, a system asking them to conform to one way of living. Do we have room in our profession to help others align with their own values, even if we don't really understand them or feel comfortable with them? And how are we holding ourselves accountable to ensure we are helping our clients live THEIR values out loud, and not ours? That's true cultural competence, and it's not MISSING from psychotherapy, but it is very very easy to overlook or not be able to see objectively.
Intentions Behind Service
And when it comes to working with clients from different backgrounds as yours, Samuels also argues that intention needs to be examined. If we’re white clinicians focusing our work on communities of color, we have to ask ourselves why. And our intentions have to be deeper than “to help,” or “to do good,” or “because I care.” There’s an account I follow on Instagram called @nowhitesaviors and a few months ago they put up a post that read “white folks who work in black/brown/indigenous communities anywhere in the world need to understand blank before attempting to work within our communities.” The ask was for commenters to fill in the blank. Comments include “that your presence is a symptom of colonialism so remain humble” “the power dynamic of your whiteness can bring harm with it” “that you need to do your own work to recognize your privilege before coming into our spaces with all the answers” and “that your way of seeing the world is not the default or only way of seeing it.” There are a lot of really rich comments under that post which I read, and re-read, as a clinician who, at present works with a diverse population of folks, and will always have people coming into my office with experiences I cannot speak to. From the perspective of black, brown, and indigenous people, which by the way I’m not claiming to be an expert on, but I am echoing their comments, is that white people show up in those spaces not truly understanding their cultural values and the problems they’ve endured because of them, and we try to impart our values on them because we’ve figured out some things that have worked, some ideas about the human psyche that may help them out. But we’re not considering that the ideas we have about the human psyche come from western values and is not the only solution.
Now this is not to say that psychotherapy as we know it from its western roots is not for people from other cultural backgrounds. This is not a call to make psychotherapy a white practice where only white people benefit from white ideas. Of course not. Of course not. But this is to say that if we are therapists wanting to help a diverse array of folks, that we have to recognize our perspective is not diverse. That our psychotherapy is rooted in only one framework of ideology and that it’s not necessarily the cure or the solution for all human suffering, especially if it infringes on the cultural values of others. And we must especially be careful of this if we are white or white passing and have experienced the privilege of that. Because part of our privilege meant we never had to consider the other side of things, we never had to experience certain struggles, therefore our “solutions” can only go so far.
Digging into White Privilege
Over the last few years, I’ve really dug into my privilege as a white person in America where I’ve had to move through the discomfort of recognizing how the things aligned with my identity also happened to be the things that were considered successful in Western culture. Take, for a small example, the idea of professionalism. Professionalism means to dress a certain way, communicate a certain way, have a certain kind of body language and persona. We know that to be a rule and we mimic it so that we can get the results we’re hoping for, the successes we want. And so long as we have the financial means, educational opportunities, technological resources, and general ingrained sense of this idea of professionalism, because it comes from the European, colonialist culture I’m bred from, it’s pretty easy to pull off. But what about people in lower socioeconomic communities who don’t have the financial means to afford what we’d considered to be a professional outfit? What about those to whom good education isn’t afforded? What about people from cultural backgrounds beyond European who see professional qualities in a different light but are judged, ridiculed, and demanded to conform, despite the fact that they’ve done nothing wrong other than present a different perspective on what it means to be professional? I read something online the other day, it may have been on Instagram and I’m sorry if I can’t remember who posted it – and I will be sharing really good Instagram accounts that I recommend following at the end of this episode because I learn a lot from people on Instagram – but this article was about a white woman going around helping out young black men by cutting off their dreads so that they could fit in more and have better lives. WHAT? Why are we stripping people of their cultural richness in order to fit in when we should instead be widening what we’re willing to accept? Make his life easier by not treating him like a criminal or a thug because he has dread locks rather than cut off his dread locks.
So when we’re talking about cultural competence as psychotherapists, we have a lot of work to do. And I include myself in that, of course. But before we can do that, we have to truly, really, dig deep into ourselves and recognize, accept, that most of what we subscribe to, even in the best interest of others, is limited. In his essay, Andrew Samuels drops a really powerful line which I think is the starting point to where we go next and that line is:
“In sum, the underlying cultural complex of western psychotherapy is its lack of interest in anything else.”
Chew on that for a bit.
Diversity in the Psychology Workforce
Stats and barriers for diversity among therapists in the U.S. According to the APA, the American Psychological Association, in 2016, 16% of the psychology workforce was comprised of racial/ethnic minorities. Among psychologists, at least, 6% are Hispanic, 4% are black, 3% are asian, 85% are white. So that is a little hard to gauge because not every mental health professional is a psychologist, and psychologists do tend to require PhD-level schooling but we have to ask ourselves what are the barriers to these jobs for non-white people and what does it say that so few non-white people are not entering this field? Is it because they’re not represented in the fabric of it so why echo its teachings? Or are they being cut off from what education is available to them? Or what’s going on?
Marginalizing the Mentally Unwell
Different cultural backgrounds are not the only things that require social-justice-informed therapy. The LGBTQ is chock full of white people who still, despite their white privilege, experience other forms of marginalization, violence, and abuse.
And quite down to it, the mentally ill can be included in that category. Because of what I said at the top of this episode about Carl Jung’s disappointment in the one-sidedness of western culture, because of what I talk about ad nauseum here about how this is a masculine-driven culture with no respect for the feminine or any values beyond what it rigidly holds dear. Anyone outside of that is deemed unacceptable, and when you look at the structure of psychotherapy in the west, it’s essentially asking for conformity. If the roots of psychotherapy are in western ideology, then they are drowning in capitalist ideology where we want the members of our society to be well behaved and productive, contribute to the economy, participate in the work we need to do to keep the culture moving forward. But we’re so worried about moving the culture forward we don’t seem to care about the people we’re leaving on the side of the road, the people who can’t keep up, the people who don’t want to keep up, because we’re moving at a pace not meant for all of humanity. Because some people have certain sensitivities, have different abilities, have different values. The truth is the west wants to tell you what values comprise it, but it doesn’t actually know, so it just keeps moving at lightening speed, perhaps so that it never has to answer the question. So that we can keep producing and keep developing more material excess and rationality while our mind-body split remains and we ditch those who can’t keep up.
Medicating Rock & Roll
Oftentimes, those who can’t keep up, include those who struggle with their mental wellness in a more severe way. I'm going to share a story and I want to be clear that this is not an attempt to moralize anyone's pharmacological choices. Medication is critical for some folks, and it should be a choice individuals get to make with their doctors. However I tell this story from a higher level, a more zoomed-out perspective of recognizing how quick we are on the draw to medicate folks instead of exploring what other things we could do as people heal those who are unwell.
When I was in graduate school, I did this project for my psychopharmacology class – the class about prescription drugs – and I put together a video that I called “Medicating Rock and Roll” and essentially I took 9 songs from various artists, many artists who publicly struggled with their mental health like Kurt Cobain and Jimi Hendrix, and I used their lyrics as their presenting issues, as though they were clients who walked into the office and said “On a Sunday morning sidewalk, I'm wishing Lord that I was stoned, 'Cause there's something in a Sunday, That makes a body feel alone” that’s a Johnny Cash lyric, one that, especially set to the song itself, makes my own heart ache. And so I pretend I’m a psychiatrist and he’s my client and comes in saying that and I have to identify his symptoms and figure out which medication would best solve his problems.
And the truth is, if Johnny Cash was put on an anti-depressant, he’d likely feel happier, but he’d probably have nothing left to say. He’d probably never write another song and if he did, he’d probably grow heartsick over how much of his creativity he lost in the process. And I believe medications can be very helpful for some people, and medications are necessary for some people, this isn’t a rail against pharmacology at all. It has its place. My point is simply to illustrate that our go-to solutions to human suffering are often to suggest some form of conformity – here’s how we get you on board with the rest of society so that your pain goes away. But what if there were other ways to help heal the pain of people? What about inclusion? Acceptance as they are? Disrupting systems that would say because Johnny Cash had a different way of seeing the world, he was broken and needed to be fixed. This doesn’t come in small motions, it doesn’t happen overnight, but as therapists, we can help by expanding our purview of client-centered advocacy and reaching into the collective unconscious, the unconscious mythology of our western culture, that informs the very critical work we do to make sure we’re not blindly following a one-sided set of values that, just by its nature, doesn’t hold space for everyone.
Systems We Don't See as Systems
I spent a lot of time as a therapist working in residential treatment programs and consulting with other professionals who were in the similar environments. Residential treatment programs become a system of their own, not quite a family system, not quite “the” system, but a system nonetheless. And the concept of conformity and the identified patient were rampant there in those environments.
The Identified Patient is a concept in psychology that refers to the person in the family which takes the blame for the dysfunction of the family. So a child may be brought in to see a therapist because he’s acting out in school, getting poor grades, speaking disrespectfully to everyone, and overall displaying signs of distress. So he’s the patient the parents want you to fix. But when you get into the therapy, you start to realize that mom and dad are always fighting and in fact being violent with one another, the family is struggling financially so they don’t always have food to put on the table, and your client has an older brother who bullies him all the time for being different. Now suddenly you’re like “my clients behavior actually makes sense given the environment that he’s in and the fact that he doesn’t have any effective tools for coping with the chaos he’s around.”
Now that’s not to say that client can’t benefit from therapy and gaining some coping skills, processing some emotions, and building their ego strength, but the family also has some work to do in order for the problems to truly resolve. Parents need treatment, big brother needs to get in the room for family sessions, and the family needs resources to help their financial situation and make sure everyone’s getting taken care of at home. But that’s not how your client was presented to you. The parents are having a hard time recognizing their part in it, and it’s not blame, they’re struggling, they need some help, but it certainly isn’t all the kid’s fault. So remember that concept of the Identified Patient because it’s something that happens way more often than just in family therapy.
Going back to my experiences in residential treatment, specifically when I was working with adolescents in a high-crisis treatment environment, when you have a bunch of teenagers with myriad mental illnesses living under the same roof in the same program, there are a lot of rules. A lot of rules. A lot of rules for anyone, much less teenagers, much less teenagers with major depression, anxiety, substance use, suicidal ideation, personality disorders, eating disorder, psychosis, who are actively self-harming, and so on. The rules are meant to maintain safety but they’re also meant to keep order, to remind the kids of who’s in charge, and to apply behavior contingencies that help us train them back into working order, back into productive and effective functioning. But what about the systems they’re in? What about the family system they came from and will return to? And what about the system itself of residential treatment? A system that is imperfect, where some of your employees may be disrespectful or emotionally abusive to the kids, where some of the kids may be bullying each other, or where, at the very least you have a child who is creative, spunky, curious, and by nature of his uniqueness, not going to conform to the rules very well? Or a teenager whose cultural background bumps up against the rules of conformity expected of him? As clinicians, we have to stop thinking that conformity means healing – that once we get someone to behave in an ideal way, all of their problems have gone away. In fact, that tends to only make things worse. And blaming them for behaviors that don’t fit into the norm isn’t therapeutic at all.
Therapists and the Identified Patient
So here’s my thinking, the thing that plagues me as a therapist, the thing I’m working to be conscious of more and more and more every day. We can harm our clients if we act as though their internal pain is theirs and theirs alone. Whether it’s because a client comes from a different set of cultural values as us or because they come from the same cultural values as us they just don’t subscribe to them, we have to recognize this: People experiencing marginalization or oppression are not generating illness from within. Rather they're being poisoned from the outside and then receiving punishment for how they respond to that poison. And if we, as therapists, don't let that part of the conversation into the room, we're going to pathologize the wrong part of the equation. We're going to make our client the "Identified Patient," which is essentially scapegoating them. Calling them the problem when they are very much not the problem. Individual empowerment, accountability, and growth are great things to lead our clients to, recognizing when a situation is beyond their control and their only recourse is to take care of themselves the best they can. That is important and worthy, yes. But client-centered advocacy has to include an understanding of the myriad ways our clients are being harmed from the various systems in which they live and yes, trying to do something about it in some way.
So what do we do? Well I default back to Samuel’s advice that we should frame even our “domestic” clients, the ones we’ve deemed to have the same cultural foundation as us, to be foreigners. That all of our clients are foreigners and we foreigners to them, he says “instead o making the exotic familiar, we render the family exotic, thereby moving each and every therapy in an individuated direction.”
Additionally, especially if you are a white or white-passing clinician, or someone who is rooted in western values personally or professionally, do your work to listen to these communities before you go in to serve them.
So some of the folks that I follow on Instagram and always continue to learn from, I want to share them here so that you can learn from them, too. And I’ll be posting a transcript of this episode soon which will have the list, as well, if that’s easier for you to follow along with. That @nowhitesaviors account is really powerful. @sassylatte often discusses race and body politics and has been dropping a lot of really important pieces of information about the body positive and HAES movement. @rachelcargle is an academic, activist, and writer who is educating folks on racial history in America and the ongoing impacts of it. She recently released a TED Talk which I highly recommend. @decolonizingtherapy is a great account run by a PhD level psychologist who discusses these very things, about the culture of mental health services and how its roots in colonialism act as a disservice to so many. @lilnativeboy is a great account outlining the struggles of America’s indigenous population and how they’ve become absent in the landscape of politics, financial gains, and health. @latinxtherapy is a great account that describes itself as "demystifying mental health stigmas in the Latinx community one myth and conversation at a time." And I’ll be adding other accounts and resources, book suggestions and so on to the transcript of this episode. Meanwhile go follow those folks on Instagram and their other various social media platforms, Patreon pages, etc. And stay tuned to the Hungry Feminine space for more on this, to continue this conversation, for more resources and suggestions. If you have any questions or follow ups on this episode, you can check out my Podcast stories highlight on Instagram where there is a question box for your questions. And thank you, as always, for being here. See you next time.
Other worthy Instagram accounts to follow:
Additional book resources regarding race and privilege can be found on my book list.