This important book combines history, sociology and the author's own experiences to illuminate how racial and cultural prejudice have affected the theory and practice of psychiatry and clinical psychology. Chapters 2 and 3 describe how the modern forms of both ‘psy’ professions originated in the Enlightenment period in Europe and the New World colonies. This was a time when economic growth in these areas was underpinned by colonial exploitation and slavery, which promoted development of theories of racial and cultural superiority of White people over others that particularly affected both professions. Theories of racial superiority inevitably led to poor-quality research ‘proving’ White people's superiority. Concepts such as psychological theories about instincts and intelligence were created on the basis of local norms and it was assumed that these could be extrapolated to people of different backgrounds and cultural frameworks of understanding. Psychiatry uses descriptive diagnostic constructs that are mostly based on clinical traditions dating from 19th- and 20th-century Europe that may not be suitable to describe people of different cultural backgrounds. Finally, important figures in the development of the ‘psy’ professions, such as Kraepelin, Jung and Sir Aubrey Lewis, often displayed features of ‘race thinking’ and prejudice.
Chapters 4–9 discuss how racism over the past 50 years has shifted from overt to more covert forms and describe how hopes of serene progress to a ‘post-racial’ world have been rudely shattered recently. Useful definitions of concepts such as ‘race’ and ‘institutional racism’ are provided. Fernando argues that UK psychiatric services are racist, given the well-documented poorer outcomes of Black people diagnosed with psychosis, such as higher rates of detention.
There are some weaknesses in this book, such as Fernando's view that mental health science is not a proper science as it is not totally objective – more recent philosophy of science recognises the role of values and subjectivity in science, but in mental health divergence of values is more likely among people of different cultural backgrounds. Psychiatric diagnostic constructs can be reliably ascertained in different populations by clinicians of similar cultural background even if not optimally configured. Fernando omits the relevant discussion that, although psychiatry has a very ethnically diverse workforce, clinical psychology by contrast has selection procedures that discriminate against Black and minority ethnic people and is therefore less ethnically diverse than the general population.
In summary, this book makes the case that race thinking and attendant prejudices have affected the theoretical background and practice in both psychiatry and clinical psychology and highlights the need to address this problem to better serve today's ethnically diverse population and acknowledge the injustices of the past.
eLetters
No eLetters have been published for this article.