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Can We “Treat” Racism in our Clinical Practices?
from Division Review
by Steven BOTTICELLI
In a recent talk, Steve Portugues (2021) called on white psychoanalysts “to learn how to explore race and treat racism within ourselves and our patients and to do so with compassion for the racist in us all.” He urged that analysts set aside a false idea of neutrality in the interest of identifying oppressive ideologies that distort our and our patients lives, presumably in order to demystify and expunge them.
Portugues’s call is in the spirit of a growing turn in psychoanalytic practice to attend to the social dimension of our patients’ lives and is given more urgency following the murder of George Floyd and burgeoning Black Lives Matter movement. Racism hurts us all, dividing Black from white, keeping us from joining in common interest, and in this way contributes to the largest context of whatever problems in living our patients present to us. Racism is at once an omnipresent feature of our social world, and an easy thing for many white people to ignore. I admire the intention behind Portugues’s project, as well as its ambition. As Beverly Burch (2020) notes, white people’s privileged ability to avoid dealing with race leaves us ill-prepared to talk about it; Portugues seems up for the challenge.
The idea that we might use the clinical space to explore and perhaps challenge racism raises many conceptual and technical questions. For instance, outside of the rare circumstance in which a patient seeks therapy to address their racism, how to raise the issue when it doesn’t arise quote-unquote “organically.” Do we wait for some relevant context to bring it up, and what does it mean, to us and the patient, if we deviate from our usual practice of following the patient to raise it ourselves.
The idea that in our clinical work we might set about “treating” racism—by which I take Portugues to mean identifying racist attitudes with the aim of changing them— needs to be subject to psychoanalytic scrutiny. My reservations about this undertaking break down roughly into three areas: The question of motive; the role of the analyst’s authority; and the effect of such an undertaking on the dynamics of the therapy process and the analytic couple. I’ll consider how these factors might pertain in a white-on-white therapy dyad, the configuration in which the issue of racism is perhaps least likely to come up explicitly.
In the first place, let’s hold in mind all we’ve been learning about the systemic nature of racism, that is, how racism in our era operates largely “behind our backs,” an aspect of ideology, rather than as a result of the actions of individual racists. Attacking structural racism takes the committed work of conscious antiracists, as well as smaller actions on the part of everyone. But thinking about racism in its systemic aspects should cause us to approach with modesty the scope of what it will be possible to achieve in addressing racism on the individual level.
Thinking psychoanalytically, we can’t assume our motives are transparent to us. We may believe we’re aiming to uncover underlying racist ideologies in the service of the patient’s and society’s enhanced well-being, but there could be more to it. Do we identify and explore and perhaps challenge the patient, as a way of managing our anxiety and discomfort at listening to racist speech? To attempt to relieve our own guilt about racism? Jane Calflisch (2020) has written of the unbearable burden of guilt white people may experience about historical and current racism given the magnitude of injury inflicted on Black people over centuries, injuries so great that in her words reparation may well be felt to be impossible. We may want to be seen as and experience ourselves as good for addressing racism with a patient, or to reassure ourselves that we are free of, or in the process of freeing ourselves, of the contamination of racism.
Might our intention to treat racism be a way of managing our disappointment at the ordinary results of our clinical work? Lynne Layton (2006) has written that too often our work only seems to produce “happier, healthier versions of narcissism” (p. 107); those of us with a developed political consciousness might wish to achieve something more. While the impulse to make our clinical work politically relevant is understandable, might we thereby inflate it with more significance than it can really bear?
Then there’s the matter of the analyst’s authority. As analysts, we are not innocent of power. We analyze, but also participate in, power. If we are to set about analyzing power, including the social conditions and psychological operations that perpetuate racism in our patients and ourselves, we need to consider the sources and effects of the power that inheres in our professional roles. It’s easy as solo practitioners sitting in our private offices to feel that we encounter our patients simply one individual to another, but in fact we operate as representatives of an entire mental health industrial complex that depends for its functioning on a complex system of referring entities, insurance companies and professional and governmental bodies that condition the terms of our practice. These forces must certainly shape our personal politics in ways we are not fully aware of, but that are in the room with us, influencing our relationship to and feelings about power. And this is only to gesture at the power differential between analyst and patient, the democratizing thrust of recent developments in psychoanalysis notwithstanding. Can we conceive of the patient who would have the gumption to tell their analyst who raises the topic of racism, I don’t feel like talking about this.
Irwin Hoffman (1996) writes of the intimate and ironic authority of the analyst, the numinous power we retain as mentor-like figures capable of exerting a special form of influence on our patients, even in these postmodern days when most forms of authority have been discredited. Is the promulgation of antiracism (implicit in an exploration of racism) an appropriate use of our analytic authority? I don’t think this problem is much alleviated by a position that allows that the analyst’s racism is also open for consideration.
Regarding ideology, what makes us think we’re in a privileged position to identify and critique it? How do we avoid occupying the position of the one who knows, itself a piece of mystification that our field has slowly been emerging from. Let’s recall also the critique of psychoanalysis as a regulatory practice. However modestly approached, an analyst-initiated inquiry into racism cannot but suggest antiracism as an implicit value, perhaps replacing heterosexuality, Oedipality and other regulatory ideals that have held sway over the history of psychoanalysis. As Jessica Benjamin (1997) reminds us, that history has shown how oppressive ideals that when recognized as such may give rise to counter-ideals, which can become just as excluding, punitive, encouraging of conformity and intolerant of difference as the original ones—perhaps even if the ideal is as laudatory as antiracism.
Any psychoanalytic therapy balances a dialectic between the real world and its anxieties and the anxieties of the symbolic or intrapsychic world. An analytic approach that aims to take on racism needs to be careful to not come down too hard on the side of “reality,” and be mindful of the risk of losing the “as if” quality of the analytic experience. For all of us, patients and therapists alike, the world is too much with us. We need to preserve a space for reverie, refuge, retreat, to be able to regard race and racism as ugly facts about the world as well as fantasy and phantasm. I think for example of Joel Kovel’s discussion in his book White Racism (1970) of the role that images and ideas about race can play as a vehicle for representing the abject and deni- grated, obviously related to yet still separable from “real world” referents.
Consider too the boundless transitiveness of unconscious life, the ubiquity of displacement, the principle of multiple function (Waelder, 2007). In therapy we can’t assume racist speech is only, or necessarily at all, an expression of racism. I think of a heterosexual white male patient who would sometimes in sessions with me make disparaging remarks about Black coworkers. Whatever the content of this man’s ideas about Black people, I sensed that these remarks were primarily intended as jabs at the presumed sensibility of his therapist. At some point this man had come to know that I was gay; I wondered how much his racist remarks might be displaced expressions of homophobia. Before I took the opportunity to explore this possibility with him, he asked me directly what I felt when he made denigrating comments about Black people. I told him, directly, that I was offended by them, and he stopped making them.
For the analyst aiming to challenge ideological distortions, why stop at racism? What about sexism, homophobia, antisemitism, Islamophobia? For the analyst so oriented, what is the fate of freely hovering attention? And for their patient, of free association—once they tune in to their analyst’s attention to such matters. In a climate where people are sensitized to the unacceptability of racism, the analyst’s attention to the matter risks stimulating shame and perhaps concealment, or perhaps defensive idealization of the analyst who unlike the patient seems to be free of racist attitudes. Such a patient might be moved to take up a complementary role in the hope of being reflected back to themselves in a similarly idealized fashion (cf. Calflisch, 2020).
In a recent article the white analyst Beverly Burch (2021) presented an example of how she addressed a white patient’s and her own racism, not out of programmatic intent on her part but rather as a spontaneous expression of her own subjectivity—which may be no more or less than what the exploration of racism in the clinical situation can ever be. That is, the analyst may believe they are talking about racism as a thing out in the world, but all that’s for sure is that the patient will understand that racism is something this analyst cares about.
In Burch’s case she found herself repeating the comment her patient had made complaining about her daughter’s rejection from an elite college, “probably because she was white.” This not quite intentional underlining of the patient’s racially tinged remark unsettled each of them, causing the patient to feel chagrined and prompting Burch to ponder what had moved her to speak. Upon reflection, Burch’s speech act helped cue her to the significance of her patient’s racial entitlement as a prop to her shaky self-esteem, as it also moved her to consider her conflicted feelings about her own racial entitlement.
This patient had dated men of color, which provided one entry point in the treatment for an explicit consideration of race and its meanings. As the therapy unfolded Burch was moved to reflect on her countertransference experience of devaluation at her patient’s hands. She noticed her shifting identification and disidentification with her patient’s sense of privilege, and was led to consider how whiteness—hers and the patient’s—functioned as rationalizations for their capacity to hurt each other and other people. Selective parts of these reflections became part of the clinical conversation.
Burch grappled with the question of when her introduction of content that directly addressed the political dimension of rac- ism was intrusive, rather than facilitative, of the therapeutic process. Retrospectively she understood her repeating her patient’s comment about her daughter as an enactment, an unconscious expression of the conflict between the wish to disown her own white privilege and her identification with the patient’s sense of superiority and entitlement she also enjoyed as a white person. All of this having been set in motion without any conscious agenda on Burch’s part, she was left to observe what followed: “Then I watched this enactment give direction to the subsequent therapy” (2021, p.36). The reader is left with the sense that patient and analyst were each left productively unsettled by their encounter with their own racism.
I find Burch’s work here exemplary of how at its best a therapeutic process that includes a consideration of race might be engaged, precisely because she did not set out to do so, the absence of programmatic intent on her part. I think one risk of inviting discussions of racism in our practices when this does not emerge within a naturally unfolding process led by the patient is that it may permit for the therapist an “I gave at the office” mentality regarding fighting racism, when perhaps the most important thing those of us who are white can do about racism is to stay uncomfortable about it. Here I think of the early political Freudians (cf. Jacoby, 1983), who conducted their work with patients along the classical lines they themselves were helping to develop, while keeping their political activities quite separate. Following their example, and simply put, I think our efforts to fight racism are best engaged outside of our therapy offices, as we have been called to do by the BLM movement. As Ibram X. Kendi (2019) argues in How to Be an Antiracist, our lives present us with many opportunities to act to oppose racism. Let’s take them.
References
Benjamin, J. (1997) Psychoanalysis as a Vocation. Psychoanalytic Dialogues 7:781-802.
Burch, B. (2021) Engaging the Whitewashed Countertransference: Race Unexpectedly Appears for Therapy. Psychoanalytic Dialogues 31:28-37
Caflisch, J. (2020) “When Reparation Is Felt to Be Impossible”: Persecutory Guilt and Breakdowns in Thinking and Dialogue about Race. Psychoanalytic Dialogues 30:578-594.
Hoffman, I. Z. (1996) The Intimate and Ironic Authority of The Psychoanalyst’s Presence. Psychoanalytic Quarterly 65:102-136
Jacoby, R. (1983), The repression of psychoanalysis : Otto Fenichel and the political Freudians. New York: Basic Books.
Kendi, I.X. (2019), How to be an Antiracist. New York: One World.
Kovel, J. (1970), White Racism: A Psychohistory. New York: Pantheon Books.
Layton, L. (2006), Attacks on linking: The unconscious pull to dissociate individuals from their social context. In Layton, L., Hollander, N., Gutwill, S. (Eds) Psychoanalysis, class and politics : encounters in the clinical setting. New York: Routledge. Pp. 107-117.
Portugues, S. (2021), Neutrality as a White Lie. Paper presentation at the 2021 National Meeting of the American Psychoanalytic Association, February 10.
Waelder, R. (2007) The Principle of Multiple Function: Observations on Over-Determination. Psychoanalytic Quarterly 76:75-92
