At The American's Fall Meeting in New York, a public forum on racism was presented, co-sponsored by the American Psychoanalytic Foundation and the Social Issues Committee. The title of the forum was “Creation of a Self: Color and Trauma in the Life of a Child.”
The overall theme of the forum was an exploration of how psychoanalysis has been largely disconnected from social problems in general and from racism in particular. Two areas of concern emerged from the presentation and discussion: the role of psychoanalytic thinking and theory in the understanding and treatment of children exposed to severe trauma, and the difficulty in outreach to African-American patients and candidates.
In introducing the panel, Mark Smaller, co-chair of the Committee on Social Issues, noted the need to know and respect social context, especially when working with patients whose racial and social backgrounds may differ from the therapist's. He pointed out that African-Americans were also subject to a type of holocaust, which has a conscious and unconscious impact on the psychoanalytic situation. In many inner cities, children grow up under a plague of poverty and violence, leading to a dehumanizing repetition of violence and trauma.
Carl Bell, president and CEO of the Community Mental Health Council in Chicago, was the first panelist. He has long been interested in the value of psychoanalytic theory to public health issues. He spoke of the high prevalence of children exposed to violence in certain inner-city neighborhoods. They witness violence in the family and in the community, they witness shootings and murder, and they are familiar with the direct effects of physical and sexual abuse, rape and assault. This leads to a cycle of acute and chronic traumatic stress reactions. In acute situations, more classic symptoms of anxiety, depression, and hyperarousal are seen. When the trauma is chronic and repeated, classic symptoms are not seen; a more complex behavioral syndrome of academic failure, social disturbances, and drug abuse arises.
Bell presented two cases of PTSD in preadolescence, both of which presented as academic failure years after a major trauma. Only when the psychodynamic meaning of the trauma in the child's current developmental stage was understood and interpreted was there lasting behavioral improvement. Bell stressed the importance of early intervention to prevent the “hard wiring” of the brain in chronic organization of traumatic events.
Gloria Johnson-Powell was the second panelist. She is a professor of psychiatry at the Harvard Medical School and consultant at the Judge Baker Center for Children in Boston. She spoke movingly of her own experience of racism as a child. She was labeled white by her black aunt because she was quiet and studious, while her siblings were labeled black because they weren't as good and smart. Though this was gratifying, it caused great tension, both within her own identity and with her siblings.
Johnson-Powell believes that the black-white model of racism may be too narrow for the multicultural milieu of today. In the inner cities, whites have largely left and the racial tensions exist more between various non-white races. African-American children growing up in the ghetto may have little overt experience of racism, as they may rarely leave their neighborhood and have little contact with whites. This too may have its limited gratifications but can lead to core identity conflicts, a need for multiple identities in different social contexts, and feeling invisible as a thinking, feeling person to the dominant white culture.
Stephen Kurtz was the third panelist. He is the founder and director of the Harlem Family Institute, a training facility for psychotherapists who work with inner-city patients. He cited Harry Belafonte, the singer, as an example of racial splits in identity. Belafonte grew up in a mixed Harlem neighborhood, with a mother who was not maternal to any of her children, a father who preferred Belafonte's lighter-skinned brother, and a white Jamaican grandmother who was most loving to him. As an adult, Belafonte had a complex private identity, but his public identity was determined by the color of his skin. When confronted by Southern racism, he went into psychoanalysis to heal the private aspects of his identity.
Kurtz, like Johnson-Powell, emphasized that racism in the ghetto is pervasive but located nowhere in particular. The only direct exposure to white racism for many children is police brutality. Because of both social barriers and lack of integration of social constructs as children, entire groups are being written off and marginalized. Kurtz presented the case of an adult patient who had a multigenerational history of abuse and neglect. Kurtz stressed the need for flexibility and openness in working with such patients. The development of trust and the feeling that no subject is off limits were the two most important principles of treatment, he said.
Steven Marans, the fourth panelist, is a professor of psychiatry at the Child Study Center at Yale University and the director of the Program on Child Development and Community Policing in New Haven. He spoke of the cycle in children of witnessing violence, being the victim of violence, and becoming the perpetrator of violence. The Police Project, which is federally funded in a number of cities, is one answer to Bell's call for acute treatment of PTSD in children. The project attempts to identify children at the time of exposure to trauma and offer immediate intervention and treatment.
Marans presented three cases in different developmental stages wherein the child either witnessed murder or was the victim of an assault. Uncovering the complex meaning of the trauma for the child and paying attention to the regressive trend toward infantile dependency were both important for the recovery process.
Robert S. White, M.D., is a member of the Western New England Psychoanalytic Society and an assistant professor of psychiatry at Yale University.
During the discussion, in addition to questions and comments about the clinical material, participants made several points about institutional psychoanalysis. Until now, the American Psychoanalytic Association, its societies, and its institutes have been largely silent about these issues. In The American, there have been examples of overt racism toward patients and a much larger institutional racism toward African-American candidates and their training. Several African-American candidates from the audience spoke of this and how most African-Americans have been written off as potential psychoanalytic patients.
There is now a growing African-American middle class whose members have not been exposed to severe trauma but suffer from more subtle aspects of racism and lesser aggressions against identity; they could benefit from psychoanalytic treatment. Two trends move away from the silence: a small but growing scientific literature on the effects of race in treatment, and the projects and discussions described in the recent public forum. One member of the audience said, “This was the most moving and stimulating panel The American has ever put on.”