Yale Psychiatry Grand Rounds: January 27, 2023

January 27, 2023

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Karasu Psychosocial Lecture: "Decolonizing Psychoanalytic Theory and Practice"

Pratyusha Tummala-Narra, PhD, Research Professor in the Department of Psychological and Brain Sciences; Director of Community-Based Education, Albert and Jessie Danielsen Institute, Boston University

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00:00Much. Thank you so much Doctor Steinfeld
00:04and Doctor Crystal for these introductions.
00:06I really appreciate it.
00:09I am really honored to join all of you today
00:13on this very significant and meaningful day,
00:17the Holocaust Remembrance Day.
00:20I I also am especially grateful to to
00:26provide this lecture that honors Dr.
00:29T Byram Karasu, and I'll tell you a
00:32very short story about why actually,
00:35Doctor Karasu has meaning in my life I.
00:39Actually had a very dear supervisor of mine,
00:42Robert Webber and at Cambridge Health
00:44Alliance when I was a psychology intern.
00:47And back in 1996 when I completed
00:50my psychology internship,
00:51my supervisor gave me a book by an author and
00:56it is Doctor Karasu and he gave me a book.
00:59It was a parting gift and it was called
01:02wisdom in the practice of psychotherapy,
01:04which was published in
01:061992 and I have to say.
01:09I have cherished this book and
01:11it's wisdom over the years and
01:13find it very meaningful to deliver
01:15a lecture honoring this author.
01:17And I want to share something that
01:19he wrote in this book that I found
01:22especially relevant to my talk today
01:24in a in a chapter that he titled
01:27Diagnosis and psychotherapy means
01:29understanding human conditions that
01:31are both unique and universal.
01:34That was the IT was really a sentence,
01:36but that was the the title of the chapter.
01:39And he wrote the following in this chapter,
01:41he said accentuating neurotic or
01:44psychotic symptomology takes the
01:46psychotherapist away from a broader
01:48and deeper look at the individual,
01:50which is necessarily more flexible
01:53and demanding.
01:54Moreover,
01:55because such a stance is skewed towards
01:58towards preconceived categories or
02:00prototypic standards of behavior,
02:02it can be dehumanizing to the
02:04extent that it fails to regard the
02:07complex and subtle nuances of the
02:09whole person whose psychodynamics
02:11are intricate and infant.
02:13Infant.
02:13I can never say this word,
02:15but infinitesimal on one level,
02:18broad and boundless on another,
02:21and you'll see why this particular.
02:25Excerpt from the book is relevant to
02:27what I'm about to share with you today.
02:30So this topic of decolonizing a
02:32theory and practice like analytic
02:34theory and practice is so broad.
02:36My focus is going to be particularly
02:38in the area of race and culture,
02:40and I come to this talk as a researcher,
02:43as a clinician and as an educator,
02:45and as an immigrant,
02:46as an Indian American immigrant.
02:48My family and I immigrated to the United
02:51States when I was seven years old in 1977.
02:54We lived.
02:54We first arrived to New York City.
02:57We lived in the Bronx.
02:58We moved around to New York,
03:00from New York to New Jersey to Michigan and,
03:04you know,
03:05other places since then as an adult.
03:08But I want to start with a personal anecdote,
03:11and I'm going to be shifting
03:13sort of from the personal to the
03:15academic and to the clinical.
03:17So please bear with me as you see me
03:19sort of move through these different
03:21spheres throughout my talk today.
03:23But let me begin with a personal. Anecdote.
03:25After immigrating to the United States,
03:28it was striking how my family and I had
03:31so quickly begun to absorb American
03:34cultural norms and expectations,
03:36most often unconsciously.
03:381 Evening a few months after
03:41we arrived to New York,
03:43we had been eating our dinner,
03:45which almost always consisted of
03:47traditional South Indian curries and rice.
03:50We mix the rice with the curries,
03:53the delicious curries that my
03:54mother would make, and.
03:56Ate the food with our hands.
03:58This is customary.
04:00We had not learned to eat our Indian
04:02meals with Western utensils until we
04:04moved to the US that particular evening.
04:07The doorbell to our apartment rang and all
04:10four of us immediately got up from the table,
04:14washed our hands at the sink
04:16before my father opened the door.
04:18No one had instructed us to
04:20get up and wash our hands.
04:23Nevertheless, we knew to do so.
04:25We never spoke about this afterward.
04:28And since that time,
04:30I've thought about how we each
04:32knew to wash our hands without ever
04:34having a conversation about it.
04:36I was aware, however,
04:37that people at school and on TV
04:40would comment that's gross when
04:42they saw anyone eat food with their
04:44hands other than sort of pizza or
04:46a hamburger or something like that.
04:49This notion of eating with one's
04:51hands as gross was difficult for me
04:53to reconcile with the reality that
04:56eating Indian food with my hand was
04:59essential. To how the food tasted.
05:01To me it doesn't taste the same
05:03when I eat with a fork. Or a spoon.
05:07These memories raise questions
05:08about what we learned implicitly
05:10and explicitly about the presumed
05:13superiority of a culture and a
05:15nation that both allowed you to enter
05:18and demanded that you leave parts
05:20of yourself somewhere in transit.
05:22Enters.
05:23Interestingly,
05:23in more recent times,
05:25eating Indian food with one's
05:27hands has shifted towards a blend
05:29of acceptance and exoticizing,
05:31as many non South Asian people now
05:34enjoy eating Indian food with their hands.
05:37The change in attitudes in at least
05:39some regions of US or some parts
05:42of US culture raises questions
05:44of who decides which practices
05:46shaping development are acceptable,
05:48desire desirable and civilized.
05:52Narratives on what's normal and what's
05:55pathological are steeped in early childhood,
05:57within families,
05:58Community Schools,
05:59social media,
06:00and just the broader context that
06:02we all live in.
06:03These narratives persist even while
06:06we're exposed to new conceptualizations
06:08of normality and abnormality.
06:10And in my view,
06:12colonization strives to strip
06:14subjectivity of the colonized
06:15and requires a narrative written
06:18and spoken by the colonizer to
06:20be fixed and unchanging.
06:22For racial minorities in the US,
06:24our narratives are too often defined
06:27and codified without our presence.
06:29Existing psychological and
06:31psychoanalytic theories of development
06:34and psychopathology most often
06:36rely on fantasies of who we are,
06:38who racial minorities are,
06:40rather than our diverse and
06:42complex subjectivities.
06:44These theories also have
06:46profound implications for people
06:48within and beyond the clinic.
06:50Juxtaposed against mainstream psychological
06:52theories are postcolonial theories
06:55that counter theoretical concepts
06:57rooted in Euro American context.
07:00These theories aim to decolonize
07:03psycho psychological theories by
07:05reclaiming the subjectivity of
07:07colonized people and their descendants.
07:10So in this presentation today,
07:12what I do is I will explore
07:14the the juxtaposition between
07:16psychoanalytic and postcolonial
07:18perspectives concerning development.
07:20And I will focus specifically on the
07:24concept of dependency and why I think
07:27that's such a core issue and concept
07:29in our theories of psychopathology
07:33and our psychotherapy approaches.
07:35So let me begin with city of
07:38psychoanalysis and colonized approaches
07:39to development and then describe some
07:42this issue of dependency and postcolonial
07:45perspectives that challenge these views.
07:48And I will wrap up today by sharing
07:51with you some some of my ideas
07:54on on how we might begin to move
07:57towards decolonizing theory,
07:59practice and training.
08:02Umm so first,
08:04colonization within psychoanalytic theory.
08:06Dian Powell recently has written about how
08:09psychoanalysis and clinical psychology
08:11have contributed to racism in the US.
08:13She specifically points to the problematic
08:17use of psychological terminology like,
08:19for example,
08:21drapetomania,
08:21which is literally translates
08:24to flight from home madness.
08:26This concept or this term was
08:28used to describe an affliction of
08:30slaves who attempted to run away
08:32from their masters to gain freedom.
08:35This type of terminology illustrates
08:37how analysts and psychologists use
08:40pseudoscience to subjugate people of color.
08:43She further notes the importance of
08:45recognizing the insidious quality
08:47of racism in early psychoanalysis,
08:49beginning with Freud,
08:50who referred to people of African
08:53descent as primitive and less
08:55and less evolved and ongoing.
08:56And also the ongoing reluctance
08:58to fully engage with race and
09:01psychoanalytic institutes and circles.
09:03As Freud aimed for his meta psychological
09:06conceptions of development and
09:08psychopathology to be universal,
09:10he dismissed the the sociocultural
09:13particulars of human experience,
09:15especially when they contradicted
09:17what he understood as more evolved
09:19behavior or civilized behavior.
09:21His correspondence with Gurinder
09:23Shekhar Bose illustrates this point.
09:26Gurinder Shekhar Boaz was an Indian
09:28psychiatrist who received the first
09:31doctoral degree in psychology in 1921.
09:33The first ever to be awarded
09:36in British occupied India.
09:38In 1921.
09:39Both began a correspondence which with Freud,
09:43which would last until 1937.
09:47And while the tone of the
09:49correspondence was polite,
09:50Freud would largely dismiss the cultural
09:52particulars of of the psychoanalytic
09:54theory that Bose had presented to him.
09:57Both,
09:57in fact,
09:58had been developing psychoanalytic
10:00ideas that integrated Hindu and
10:03Indian philosophy with Western
10:05understandings of the unconscious.
10:07For example, for both,
10:08the delineation between the masculine
10:11and feminine were far less rigid,
10:13as he wrote about boys unconscious
10:15desire to be female,
10:17in contrast to Freud's conceptions
10:19of castration,
10:20fear among boys and penis envy among
10:24girls in honor of Freud's 75th birthday.
10:27Both sent Freud an ivory statue of Vishnu,
10:31who is the God,
10:32the Hindu God who is known as
10:34the preserver of life.
10:36And Freud responded to to boast
10:38by writing the following as long
10:41as I can enjoy life,
10:43it will recall to my mind the progress
10:46of psychoanalysis and the proud conquest
10:48it has made in foreign countries.
10:51Freud's response clearly marks
10:52a curiosity of the foreign,
10:54but one that's embedded within
10:56and constrained by the wish to
10:59to align with the colonizer.
11:01He seemed more interested in other
11:03words and contrast in conquering
11:05the minds of foreigners than an
11:08understanding their experience.
11:09Paradoxically,
11:10it's been widely recognized that
11:12Freud himself was an outsider in
11:15an anti-Semitic Viennese society.
11:17anti-Semitism among Europeans
11:19promulgated notions of Jews as castrated,
11:23oriental, black, racially,
11:25socially and psychologically
11:27inferior and primitive.
11:29And a major consequence of the colonial
11:32underpinnings of psychoanalytic
11:33theory was the separation of
11:35the psychic and the social,
11:37and even more aptly,
11:38the dissociation of the social
11:40from the psyche.
11:41And I would argue that the most traumatic
11:44aspect of the social remain the most
11:47associated in our theories even today.
11:49The effects of split and dissociation
11:51can be seen in psychotherapy
11:52approaches to racial minorities
11:54in the US and in the applications
11:56of psychoanalytic theory,
11:58and I would say broadly
11:59psychological theories.
12:00To development across the world.
12:02So for example,
12:03cross cultural approaches have most
12:06often framed psychological experiences
12:07of people and quote developing
12:10countries by separating the east from
12:13the West and uncritically imposing
12:15psychoanalytic concepts like the
12:17Oedipus complex rather than asking
12:20people what they actually think and feel.
12:23I remember growing up with Hindu myths
12:26in my home and the myth of Ganesha,
12:29the elephant headed God in Hinduism
12:32and he is known to be the remover
12:35of obstacles and how that story,
12:37which has deep spiritual significance,
12:40has been interpreted in psychology
12:43and psychoanalysis by many authors
12:46as akin to the Oedipus complex with
12:49no real research into how Hindus.
12:53Actually feel about this myth.
12:55So there's this history that we
12:57have around imposing these ideas.
13:00And together with disciplines
13:02such as personality,
13:04cognitive and developmental psychology,
13:06psychoanalysis has had a global
13:08impact on conceptualizations of
13:11development and psychopathology.
13:13Let me give you another example.
13:15And this was brought forth in a
13:17in a beautiful paper written by
13:19Sunil Bhatia and Kumar Priya,
13:20they explored Erik Erikson's theory
13:23of identity to illustrate the use
13:26of theory to mark certain cultural
13:28groups as less evolved in particular.
13:31Erikson's theory of identity formation
13:33and wide you're American adolescence as
13:36assuming responsibility in maintaining
13:38a nation's growth contrasted with his
13:41views of nonwhite adolescence as passive,
13:44dependent,
13:44and submissive.
13:45Kumar Priya noted Erickson further
13:48maintains that non whites are
13:50doomed to have a submissive identity
13:53because their parents corporeal
13:55and bodily socialization practices
13:57prime the child to develop a
14:00set of primary sensory behaviors
14:02reflected in the child's language
14:04and interpersonal interactions.
14:06And as we know,
14:08Erikson's theory of identity has
14:10deep influence in our understandings
14:13of development and identity.
14:16The emphasis of the cultural
14:18assumptions of psychoanalysis that
14:20are consciously and unconsciously
14:22absorbed and yet unintegrated by
14:24non white people and communities
14:26also cannot be overstated.
14:28So let me share with you a personal anecdote
14:31that provides an illustration of this issue.
14:34Just before I began my doctoral program,
14:37I had shadowed an Indian
14:39psychiatrist who trained as a
14:41psychoanalyst in the United Kingdom.
14:44He he this was in India.
14:46So I had taken a summer um and gone to India
14:49between college and and Graduate School,
14:52and I had shadowed him this summer.
14:55He had been he had finished his training
14:58in the UK, and then he led a very busy,
15:01psychoanalytically oriented practice
15:02in a in in Hyderabad in India.
15:05That's where I'm I was born.
15:08One of the first patients whom I observed in
15:11this practice was a woman in her early 20s.
15:14And the suchiate Christ had
15:16diagnosed with diagnosed her with
15:18obsessive compulsive disorder.
15:20The patient had been washing her
15:22hands compulsively for over three
15:24years and she coped with her
15:26intense anxiety through prayer.
15:28The psychiatrist prescribed medication to
15:29help her with her hand washing compulsion,
15:33but in private shared with me that
15:35he found it difficult to conduct
15:37psychotherapy with her as he was not
15:40able to understand her religiosity
15:42and he commented that.
15:44She's a product of Indian society that is
15:47quote hyper religious and quote backward.
15:50And he went on to tell me that her
15:53parents had poisoned her mind by
15:55telling her that if she prays enough
15:57that she would find a good husband.
15:59So when I asked him to tell me
16:01more about the patient's family,
16:02he said the family was from a low
16:05income and low caste background.
16:07Later that same day,
16:09just a few hours later,
16:10the psychiatrist told me how much he missed
16:14living in India while he was in the UK.
16:16He spoke about how he missed the
16:19landscape and climate of India,
16:20the beautiful colorful clothing,
16:22and the bustling noises of Indian cities.
16:26And I left these interactions on one hand.
16:29Very confused.
16:30And on the other hand,
16:32also I would say at the same
16:33time kind of apprehensive about
16:35psychology and psychoanalysis.
16:36I thought to myself,
16:38I have no idea what I've gotten myself into,
16:41you know,
16:41as I was anticipating starting a doctoral
16:45program just a month or two later.
16:47And at the time I didn't understand.
16:51His contradictory statements about India
16:53or his negative views of the patients
16:55and her family's religious beliefs,
16:57especially since these beliefs are
16:59not uncommon in Indian society,
17:01not to mention within my family.
17:04Since then,
17:04I've learned more about the impact
17:06of colonized thinking that's
17:08that's integral to Euro American
17:10psychology and psychoanalysis,
17:12and how the internalization of
17:14a colonial mentality leaves us,
17:17those of us whose ancestors were colonized,
17:19in despair.
17:20In particular,
17:21many people who are victimized by
17:24colonization questioned their own
17:26cultural or indigenous narratives
17:28as legitimate and powerful,
17:30even while we deeply value our.
17:33Emotional connection to our families,
17:36cultural,
17:36religious communities and heritage culture.
17:40Notably,
17:40this ambivalence makes us question
17:43whose narrative,
17:44that of the colonizer or that
17:46of the colonized,
17:47is in fact the legitimate 1.
17:49Which, of course, has important implications
17:52for the therapeutic relationship.
17:54Maybe even more significant on a
17:56global scale is the impact of this
17:59ambivalence on who holds power
18:01in developing and disseminating
18:03theoretical concepts of development,
18:05health and psychopathology.
18:07Within the US, this ambivalence and despair
18:10are evident in mental healthcare systems,
18:13as racial minorities continue to
18:15struggle with how much of their stories,
18:17indigenous to their families, communities,
18:19and at times countries of origin
18:22will be legitimate and considered
18:24civilized in the mind of the therapist.
18:27For example, my my patient Jacqueline,
18:30who's an African American sis woman.
18:32She's in her 40s.
18:35She had told me in one in
18:37actually in our first session,
18:38that she's not sure how
18:40psychotherapy could help her.
18:41She had met briefly with a
18:43therapist prior to working with me,
18:45and she said that while she
18:47expected her white therapist to
18:49not fully understand her family,
18:50she was disappointed by having to
18:52pay to see a therapist who doesn't
18:54really know what it's like to be
18:56black in one of her sessions when
18:59she described a family gathering.
19:01To this therapist,
19:04the family gathering included her
19:06former husband and his children and.
19:09And so the client, Jacqueline,
19:11was describing this family
19:13gathering and session.
19:15That therapist remarked that she
19:17needed to have better boundaries
19:18from her former husband.
19:20And Jacqueline then told me that
19:22she was not concerned about the
19:23presence of her former husband or
19:25his children at the Gathering,
19:27but that what had upset her at
19:29the gathering was that she missed
19:30the presence of her mother,
19:32who had died the previous year,
19:34Jacqueline said.
19:35I just stopped going to see her
19:38because I didn't want to have to
19:40explain black families to her.
19:42Jacqueline,
19:42in conveying this in this
19:44particular incident to me,
19:46was of course implicitly asking me if
19:49I too could understand black families.
19:53So let me shift a bit here to talking
19:57about post colonial challenges
19:59to some of this colonization,
20:02the colonized pieces that I'm talking about.
20:06In an effort to challenge the imposition
20:09of traditional paradigms on people of color,
20:11the discipline of psychology since
20:13the 1980s has supported unique
20:15therapeutic approaches for racial
20:17and ethnic minority patients.
20:19These efforts have resulted in a
20:21growing visibility of experiences
20:23of people of color.
20:24However, expanding the visibility of culture,
20:29race and other social locations and
20:31oppression faced by racial minorities,
20:33in my view,
20:34has not culminated in a deeper
20:37understanding of heterogeneity
20:38within racial minority groups or
20:41more complete understandings of
20:43subjectivity of racial minorities.
20:45The effort to expand psychological
20:48theories towards multiculturalism has
20:50inadvertently dismissed the importance
20:52of exploring individual subjectivity.
20:55As shaped by multiple social contexts and
20:58by conscious and unconscious dynamics,
21:01more recently,
21:02culture has been increasingly
21:04recognized as dynamic,
21:06contextual and transnational.
21:09Some postcolonial scholars have
21:11interestingly turned to using
21:13psychoanalytic concepts to
21:15challenge colonized thinking about
21:17development and psychopathology.
21:19In other words,
21:20psychoanalysis has been used as a framework
21:22for understanding the colonial mind and the
21:25effects of colonization on people of color.
21:27So let me share with you.
21:31Some some more depth around this concept
21:35of dependency which I mentioned earlier.
21:38The concept of dependency is a critical
21:41feature of psychological theories of
21:43development and typically dependency
21:44is seen as a subjective experience that
21:47one we sort of gradually move away
21:50from in the course of development,
21:51as as noted in ideas like separation
21:56and individuation.
21:57Now, while it's certainly the case
21:58that in many cultural contexts,
22:00psychological separation is a very
22:02typical process in development,
22:04the ways in which dependency and
22:07separation and individuation are
22:08constructed vary across contexts.
22:13There there's been a growing criticism
22:15in fact, over the last two decades of
22:18how euroamerican ideas around attachment
22:20and separation individuation have
22:22been applied non discriminately to
22:25non euro American cultural contexts.
22:27And and and there's also been a
22:30call for Indigenous studies that
22:32focus on local observations.
22:34In particular,
22:35these criticisms underscored the
22:37the the variations in parenting
22:39behaviors and that these variations.
22:42Don't necessarily mark a quality
22:44of relationship and attachment
22:46between a caregiver and a child,
22:49or how much a parent or a
22:51caregiver loves a child.
22:53But despite these criticisms,
22:55family dynamics that diverge from what
22:58I would say is is a Euro American middle
23:01class value system continue to be viewed,
23:04either consciously or unconsciously,
23:07as pathological or underdeveloped.
23:10So let me draw in Frantz Fanon's work here.
23:13Umm Fanon,
23:14in his landmark book black Skin,
23:16white masks,
23:17and which was published in 1952,
23:20challenged the notion of the dependency
23:23complex that was thought to compose the
23:26unconscious mind of colonized people.
23:28And specifically,
23:30he critiqued the work of Oktav Manoni,
23:35a French psychoanalyst who lived
23:37in Madagascar for about 20 years,
23:39over 20 years.
23:41Manoni's drawing on Adler's concept
23:44of the inferiority complex concluded
23:47that a dependency complex existed
23:49among the Malagasy prior to the
23:52French colonizing Madagascar.
23:54Because their culture was supposedly
23:56centered on the worship of
23:58ancestors and patriarchy,
24:00So what Manoni did was he he assumed
24:02that that the submissiveness of the
24:05Malagasy was a trait inherent to
24:08their culture that was redirected to
24:10new paternal rule of the Europeans.
24:14Fanone proposed an alternative to
24:16this idea of the dependency complex.
24:19That is the colonies,
24:21colonization and racist structures are
24:23the things that produce inferiority.
24:26And he stated inferior lization is
24:29the native correlative correlative to
24:32the Europeans feeling of superiority.
24:35Let's have the courage to say it is the
24:38racist who creates the interiorized.
24:40So in phenoms view,
24:42psychoanalysis should address
24:43the real source of conflict.
24:45That drives feelings of inferiority,
24:47which is the social structure.
24:50In the US today,
24:51we can certainly see how this colonial
24:54mentality is enacted in rhetoric and
24:57violence against racial minorities,
24:59immigrants and indigenous people.
25:01In my view,
25:02it's unconscionable that we have a
25:05well established understanding of the
25:07importance of secure attachment and
25:09yet we've allowed migrant children
25:11to be separated from their parents,
25:13be placed in cages.
25:14This is not a new thing, of course.
25:17In U.S.
25:18history,
25:18the separation of children has been
25:21used over and over again as a form
25:24of violence against people of color.
25:26Only a colonial mentality,
25:28though, can justify that.
25:30Secure attachment is only a valid human
25:33right for some children and not others.
25:36Along with the disregard for the humanity
25:39and subjectivity of the colonized,
25:41there's a prevalent belief that
25:43the colonized wannabe white.
25:45For example,
25:46we hear repeatedly that immigrants
25:48are dying to come to the US and
25:51not just take what we have,
25:53but also want to be like us.
25:55And so it's important to clarify
25:58what racial minority immigrants
25:59actually want, and that is the rights
26:02that whites have bestowed to themselves.
26:04We don't want to be white.
26:06We simply want the right
26:08to resources and humanity,
26:09which whites have consciously
26:12and unconsciously assumed belongs
26:14primarily or solely to them.
26:16Additionally,
26:17expressions of justified anger
26:19and outrage against racism and
26:22xenophobia within a colonized
26:24framework are often perceived to be
26:26further indications of pathology.
26:29So dependency and colonial mentality
26:31mentality is complicated in that it not
26:34only requires the superior racial group.
26:37The so-called Superior Racial Group
26:39to provide protection for those
26:41so-called inferior racial group,
26:43but also the belief that any
26:45autonomy asserted by the colonized
26:47is an attack on the colonizer.
26:52So I want to say a few things about the
26:57impact of colonized colonization and
27:00racial trauma on racial minorities.
27:05Dependency and inferiority are attributes not
27:07just projected towards racial minorities,
27:10but they also become internalized
27:13psychic experiences.
27:14Umm and so, like, for example,
27:18there's a high prevalence of skin
27:20bleaching and lightening creams and
27:23skin products both among racial minority
27:25groups in the US and in African,
27:27Asian, South Asian countries.
27:31And all of these,
27:32if you look across diaspora,
27:34this has become not a a problem that's
27:38declining but actually increasing and
27:40industries making a lot of money off of this.
27:44And to me, when you look at this,
27:46you know, simple, very simple but
27:48powerful example of these skin bleaching,
27:51lightening products and procedures,
27:53intravenous interventions to
27:54lighten your skin, which is,
27:56you know, becoming more and more
27:58prevalent around the world.
28:00To me, this is one way,
28:02one reflection of an internalization
28:04of white beauty ideals.
28:06It's worth noting,
28:07however,
28:08that many people of color internalize
28:10these kinds of white beauty ideals,
28:13and at the same time.
28:14Proudly identify with cultural values and
28:17norms distinct from euroamerican values.
28:20This type of paradox embedded in
28:23colonial mentality is a common experience
28:25where there's both an adaptation
28:28to the demands of white society
28:31and a rejection of white society.
28:33Therefore,
28:34projections of dependency and inferiority
28:36are met with ambivalence and resistance.
28:41Nonetheless, the devaluation of indigenous
28:44narratives on development has significant,
28:46lasting effects on intrapsychic life.
28:50Including psychological alienation,
28:52ambivalence, distortions about the self,
28:55sense of trust, safety and belonging.
28:59Colonial mentality among some people of
29:02color largely develops unconsciously,
29:04resulting in a sense of cultural inferiority.
29:07Also an uncritical rejection of a
29:09heritage culture in some cases,
29:11and discrimination among members
29:14of 1's own sociocultural group.
29:17There's a analyst,
29:19Chris Yee in Los Angeles,
29:21who's written very beautifully and has
29:24described a concept called cultural
29:27dissociation, and this is when an.
29:29Immigrant or racial minority
29:31person is traumatized within one's
29:33family and community,
29:34and traumatic stress and one's heritage,
29:37culture or community are merged.
29:39In this case,
29:41one distances oneself from heritage,
29:43culture, traditions,
29:44and language and similar ethnic people and
29:47feels more connected with mainstream norms.
29:50Yet the experience of cultural
29:53dissociation is actually a disruption
29:55in one's ability to stand in the spaces
29:59between disconnected or dissociated.
30:01Health states,
30:02reflecting heritage and mainstream cultures.
30:05So Chris would say that this,
30:10this experience of cultural dissociation
30:12poses an impossible dilemma for racial
30:15minorities coping with both traumatic
30:17stress within their families and our
30:20communities and at the same time,
30:22racism outside of their families
30:25and communities.
30:26Umm,
30:27the development of it.
30:30When we think about this issue of colonial
30:33mentality and cultural dissociation,
30:35it's also important to me to consider
30:39our existing diagnostics systems is
30:42there's a way in which racial trauma
30:45and colonization have remained largely
30:48disassociated from our diagnostic thinking.
30:51So our diagnostic systems like
30:53the DSM and I CD,
30:55still do not recognize racial
30:57trauma as a precipitant to PTSD,
30:59falsely suggesting that there's not
31:01enough empirical evidence for the
31:03negative psychological effects of racism.
31:06We have ample evidence in in
31:09several fields at this point of
31:12this the impact of racism.
31:14Cycle analytic formulations of psychic
31:17trauma have also not included racial and
31:20sociocultural traumas as precipitants.
31:22I would argue that it's now a critical
31:25time to explicitly recognize racial
31:26trauma as a form of psychic trauma.
31:29In doing so,
31:30we can finally recognize the ongoing
31:32traumatic effects of colonization and
31:35begin working through our dissociation
31:37from the effects of colonization
31:39on our theories of development and
31:41psychopathology and our practice.
31:46So I want to just move towards.
31:50Maybe a very last section of what I want
31:55to share how do we sort of move from?
31:59This colonization,
32:00the position of colonization towards
32:03a decolonized theory and practice,
32:06and this is again a very large topic
32:09and and I do believe that the task
32:12of decolonizing theory and practice
32:14requires multiple perspectives
32:17and interdisciplinary work.
32:19But I want to just ask us
32:22to consider four areas.
32:23One has to do with humanizing
32:27versus colonizing.
32:28Decolonizing theory and practice
32:30requires humanizing cultural narratives.
32:33Knowing and seeing a whole person,
32:35with all of the intertwined complexity
32:38of intrapsychic, interpersonal,
32:40and sociocultural aspects of life
32:43is 1 antidote to colonize theory.
32:46Specifically,
32:47we can reexamine our understandings
32:49of attachment and dependency as
32:52experiences that are fluid across
32:54and within sociocultural groups.
32:56We can expand our analysis of attachment.
32:59Beyond caregiving relationships or
33:01romantic or sexual relationships,
33:04integrating relational life
33:06involving friendships, social media,
33:08broader communities, schools, and workplaces.
33:13Let me give you a brief example of this.
33:16There's typically we in psychology.
33:19We ask many,
33:21many questions in our intakes
33:23around developmental history
33:25about a person's family.
33:27Which of course is very critical,
33:29but very seldom do we ask,
33:31as a part of our developmental
33:34history experiences that relate
33:36to sociocultural traumas.
33:38Like, for example,
33:38what was it like to go to school?
33:41What was it like to live
33:43in your neighborhood?
33:43Tell me about the social
33:45media platforms you use.
33:47What's going on in there?
33:49What's the composition,
33:50the racial composition,
33:51the religious composition of
33:52people who you grew up around?
33:55These are the kinds of
33:56questions that are critical.
33:58Corolla Suarez Orozco,
33:59who is a phenomenal researcher
34:02of immigrant children.
34:03She has she back in the early 2000s.
34:08Conducted a series of.
34:12I would say it's very
34:14psychoanalytically oriented research,
34:15but she conducted a studies with 3rd and
34:184th grade students who are immigrant
34:21children from Mexican American,
34:23Haitian American and Chinese
34:26American backgrounds.
34:27And she gave them sentence completion tasks.
34:30And so I'll give you a couple
34:33of examples of the sentences.
34:35The first sentence would read people
34:37in my family think that I'm blank.
34:40The second would read most
34:42Americans think that I am blank.
34:44And the kids, these are,
34:46you know, 9 year olds,
34:48typically 8910 year olds,
34:51they would,
34:52they would respond to the first sentence.
34:54People in my family think that I am funny.
34:57People in my family think that I'm silly.
34:59People in my family think that I'm smart.
35:02You know,
35:02all the kinds of descriptors you
35:05might imagine children to say about
35:07what their families think of them.
35:11The second sentence most
35:12Americans think that I'm blank.
35:14The children would say things like.
35:17Most Americans think that I am bad,
35:20that I am stupid,
35:22that I'm lazy, that I smell.
35:27All of the descriptors that these
35:30kids shared exactly matched with the
35:32stereotypes of their racial groups,
35:34their ethnic groups.
35:37So what she does then,
35:40Corolla, is she develops.
35:42She extends Winnicott's concept
35:44of mirroring in the in the
35:47caregiving relationship to the
35:48concept of social mirroring,
35:49the importance of understanding
35:51what is happening in the House and
35:54outside the House for children.
35:56Starting the moment they leave the House,
35:59preschool and beyond.
36:02So this is a critical step in
36:05what I'm talking about when I
36:08say humanizing versus colonizing.
36:10Relating to the whole self of the
36:13patient is inherent to humanizing.
36:15In contrast to relating to a partial
36:19object that characterizes colonizing.
36:21So here's another example.
36:23My patient,
36:24rose is a second generation
36:27Chinese American SIS woman.
36:29She came to therapy to to cope with
36:32her depressed mood and isolation,
36:34she told me in one session.
36:37People don't know me at work,
36:38or really most places.
36:39They see a Chinese person and think,
36:42oh, she must be smart,
36:43but you can't trust her.
36:45So I guess I show them what they expect.
36:48This way I don't have to deal with them.
36:51Rose is speaking here.
36:53To her colleagues perception of her
36:55as a partial object 1 steeped in
36:59colonized perceptions of Chinese
37:01and Chinese American people.
37:03She proceeded in the session to
37:05tell me that no one in her workplace
37:07really knows anything about the
37:09kind of music or food she enjoys,
37:10even though these are frequent topics
37:13of conversation among her colleagues.
37:16And she said no one sees how I suffer,
37:19only what I can offer them.
37:21They don't know that I lost
37:23a relative recently.
37:24And in the context of the pandemic,
37:26she's made even more efforts to
37:28keep herself hidden from others
37:30while bearing microaggressions.
37:32As some white colleagues comment on how
37:34the pandemic was spread by Asians, rose,
37:37feeling resigned in another session,
37:39shared.
37:40They will never really know me or my family,
37:42and they don't care.
37:44The powerlessness that rose experiences
37:48is unfortunately not uncommon.
37:50However,
37:50in psychotherapy she starts to
37:52reveal other aspects of herself,
37:54including what she loves and despises
37:57about her Chinese American family,
37:59her Chinese American church,
38:01the Chinese government,
38:02and the United States.
38:05Psychotherapy becomes a space in which
38:07she can re examine stereotypes and
38:09assumptions projected towards her and
38:11the ones that she has internalized
38:13and directed towards people of other
38:15racial and cultural backgrounds.
38:16In the session later in our work together,
38:19she said it's strange that
38:21seeing a therapist,
38:22such a white thing to do is
38:24what has been helping me,
38:25but it doesn't feel like a white thing,
38:27you know? It's like my own thing.
38:30Understanding.
38:31When I think about Rose's comments,
38:33I think about this shift where
38:36she was moving away from being
38:39experienced only as a partial object.
38:42Umm,
38:43a second area of consideration
38:44has to do with humility and psych.
38:47And I know that cultural humility
38:49has been written about and talked
38:51about quite a bit.
38:52And I think about what does
38:54it mean in in psychoanalytic
38:56psychotherapy in particular and
38:58and I I think part of it I loved.
39:01There was a paper written by Salman
39:03Akhtar that came out in 2018,
39:05which I highly recommend on
39:08psychoanalytic humility.
39:09But one of the things he talks about.
39:12Is listening with Attunement for
39:14multiple determinants of all psychic
39:16material and being comfortable
39:18with diverse theoretical models.
39:20This shows humility.
39:22The the ability to recognize one's
39:25mistakes and apologize for mistakes,
39:27and understanding that mistakes with
39:30our patients are are inevitable.
39:32This is another component of humility.
39:35Umm.
39:37Trying to think about what what we
39:40feel fragile emotionally about what
39:43what what is our type of what do?
39:46What do we feel discomfort with?
39:48Which aspects of our identities
39:50or other people's identity make
39:52us feel uncomfortable?
39:54This is all humility.
39:55The concept of cultural humility has
39:58actually been questioned in the case of
40:01racial minority therapists specifically,
40:03Sarah Moon and Steve Sandige called for
40:05an elaboration of cultural humility.
40:07Was asking racial minority therapists
40:10to be culturally humble might contribute
40:12to their own retraumatization.
40:14And so they ask an important question.
40:16They say,
40:17how does the therapist of color
40:19express ones authentic feelings of
40:21anger without shaming the patient?
40:23And they're pointing out that
40:25even while concepts like humility
40:27are critical for decolonizing,
40:29these concepts can hold significantly
40:32different meanings and implications for
40:35minority and majority status therapists,
40:37whatever that.
40:38Positionality might be whether we're
40:40talking about race or sexuality,
40:42gender, disability, and so on.
40:46Umm,
40:46I'll quickly mention the last
40:49couple of considerations.
40:50One the the third I want to
40:53mention has to do with working
40:55in the depressive position.
40:57Glasser Levi suggested that reparation
41:00involves a movement from a paranoid
41:02schizoid position to a depressive position.
41:05And he noted that it's in the
41:08depressive position that objects
41:09which have been split into good
41:11and bad may be united as whole
41:13objects that maintain the qualities
41:15of goodness and badness.
41:16So in other words,
41:18the depressive position allows for
41:20mourning a necessary process for a
41:23racial reparation and decolonization.
41:26Anna Ornstein has written
41:27beautifully about this,
41:28too.
41:28The essential step in mourning
41:30involves the capacity of the
41:33therapist and patient to remember
41:35past collective traumas and engage
41:37with ongoing collective traumas.
41:39So part of the working in the
41:42depressive position also includes a
41:44capacity to recognize the limits of our
41:47relationship with our our our patients,
41:50our own frustrations.
41:51Our own limitations of
41:53therapy sits alongside.
41:55Our desire to want to do good and
41:58feel good with regard to injustice.
42:02Lastly. And I think about decolonizing.
42:06I think about training and
42:07sort of where we begin.
42:09And I mentioned to you some things
42:12relevant in my own training earlier.
42:15But there's a way in which we can
42:17think about troye's elaboration of
42:19melancholia to better understand
42:20the ambivalence that we might have
42:23around structural change in our
42:25current psychotherapy training.
42:26Melancholia was described by
42:27Freud as a form of
42:30pathological unresolved warning
42:31where a person is unable to.
42:34Resolve their ambivalence towards a
42:37lost loved object and therefore has
42:40trouble investing in new relationships.
42:43So maybe that concept could help
42:46us understand our own collective
42:48reluctance and sometimes refusal to
42:51engage in narratives that hold multiple
42:54truths regarding race and culture.
42:56So I think there's a way.
42:59What I do want to emphasize here is that
43:02rethinking what we do does not mean that
43:05we erase euroamerican models of development,
43:08but rather that we identify common
43:10ground and distinctions across
43:12cultural narratives of development
43:15and recognize each perspective as
43:17equally valuable and relevant.
43:20So in my view, this is a call to move away
43:23from all or none thinking with regard to the.
43:26The inclusion and exclusion of people in
43:30dialogues about race and colonization,
43:33so I'm going to stop there.
43:37And um. Happy to.
43:39Hear from all of you.
43:41I've been talking for a very long time.