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How does a child know what race they are? And where do they get the idea that one race is better than another? Today, Dr. Beverly Stoute looks into the unconscious origins of racial bias.
Duration: 12 minutes, 11 seconds
CHRIS AIKEN: Beverly Stoute looks at how racial identity develops and how racial stereotypes take root in the unconscious.
KELLIE NEWSOME: Welcome to the Carlat Psychiatry Podcast, keeping psychiatry honest since 2003.
CHRIS AIKEN: I’m Chris Aiken, the editor in chief of the Carlat Report.
KELLIE NEWSOME: And I’m Kellie Newsome, a psychiatric NP and a dedicated reader of every issue.
DOLORES MORRIS: I can go back as far as when I was. I was three years old, and there was a woman in the neighborhood that looked very different to me, and I asked my mother who she was. And my mother responded, "she's white". I'd never heard that term before, white. I said, "oh, white? Are you white? Am I white?" And then I start skipping around saying, "She's white, I'm white, you're white." And I make a little game out of it. My mother was obviously very embarrassed and she shook me to be quiet. I came to understand that I'm black and she's white. And that to me, talk about it in a way that I was playing with it was a source of embarrassment.
CHRIS AIKEN: Last year, a group of psychoanalysts chaired by Dorothy Holmes published the Holmes Commission on Racial Equality in American Psychoanalysis. It's an historic report that turned the analytic lens on psychoanalysis itself. Today, we speak with Dr. Beverly Stoute, who co-chaired the commission, along with psychoanalysts Anton Hart, PhD and Dionne Powell, MD.
KELLIE NEWSOME: The extra clips you'll hear are from the documentary Black Psychoanalysts Speak. Which you can watch in full at blackpsychoanalystspeak.org or on YouTube.
CHRIS AIKEN: In our opening clip was Dr. Dolores Morris, and in our last episode we left off the credits for two clips which featured Drs. Michael Moskowitz and Anton Hart.
What is systemic or structural racism?
BEVERLY STOUTE: Well, I'll back up because I think the idea that something is systemic and structural has a few antecedent points. So, I always say that when I say I have candidates is that if we're going to talk about racism, then you actually have to invoke psychoanalytic thinking, right? Because there has to be an unconscious. Most people do not knowingly want to be harmful, especially, you know, I'm a physician. You are as well. So, in mental health care, most people go into mental health care wanting to do something positive. So, how do we want to do something positive and end up replicating a system that's injurious? The only way to do that is if there's something that you're not aware of. The second thing is that the bias related to racism begins early and developmentally, and most people really aren't aware of it. And when clinicians began to sort of think, how do we talk about this? Most people were unprepared. How do you deal with that? So, by three or four years of age, you already become aware of racial bias, by four years of age you know that white skin is preferred to black, by five years of age, you know, that not only is white preferred, but black is less preferred, and by six, which was the age of a lot of the kids in the famous Clark doll experiments, black kids would choose the white doll as the good doll. And if you watch the Google rendition of it, they cried as they did it, almost as if they knew there was something that didn't sit right. So, think about that. So, by the time you get to middle childhood, age seven or eight, you know that you belong to a racial group. Depending on where you grow up, you may or may not have had much experience with people of another group. So, if you already encode those ideas from the surrounding culture, regardless of who your mom and dad are, you're already set up to have ideas. Systemic racism posits that we have a system that advantages one dominant group, and necessarily oppresses a non-dominant group, but it operates unconsciously in the psyche of the people and in the structure of the organization or the society. And I always say that one way of looking at racism is when a bunch of people get together who want to be good and in a system end up doing harmful things.
DOROTHY HOLMES: I have a certain wariness and skepticism about white people who don't think of themselves in racial terms. In a sense, the society is set up that they don't have to even more deep, I think, is they don't dare to because if they do, then they would have to acknowledge certain practices and attitudes and beliefs. And you know, according to psychoanalytic principles, anything you become really aware of, then it's subject to change.
CHRIS AIKEN: Dorothy Holmes, PhD, Black Psychoanalyst, speak.
BEVERLY STOUTE: And so in order to understand that there must be unconscious motivations, unconscious ideas, unconscious fears that lead us to stratify according to what our ideas tell us about race. And in our culture, there are race fantasies encoded in the culture. You can't make it to adulthood in America without being exposed to media. And 1970, Joel Covell was the first analyst to look at racism from a psycho historical perspective. And he said that there are race fantasies in the culture. If we sit here and think about what black means and how they're encoded, we're all exposed to it. So, we start there.
CHRIS AIKEN: What sort of fantasies did he uncover back then?
BEVERLY STOUTE: Well, he talked about things like, for example, if you think about how the word black is used. Back in that time, theory was the main gig in psychoanalysis, so we didn't have more modern ideas. So the idea about racism was that one had to project, and one had to project onto black people. In the early slave culture, the black slaves were the ones on whom we projected all the negative, and reserved the pure idea of whiteness and white, white mothers as not having that. So, he said, if that happens, then how did that come about? I am from New York and I live in Georgia now. So there are religious ideas that say there are reasons why some people were black. You can rely on the idea of the Bible, which some people do rely on. And if you don't, it's still part of the culture. There are fantasies about what blacker people are, sexual fantasies and violent fantasies that are encoded. Jonathan Mitchell's book on protest psychosis. He went back into the literature on psychiatric hospitals and actually traced how the idea about black men being diagnosed with schizophrenia more frequently than bipolar disorder was actually encoded in the historical record as they began to move forward. He spent, I think, seven or eight years researching, and he showed you that some people, white people, and more often women tended to get bipolar disorder. Diagnoses and black men got schizophrenia and he showed you how it became a fantasy and related to this idea that black men are dangerous. I don't think that everybody consciously thinks that, but in the moments when one is afraid their neurobiological studies that show if you show a white person black faces, the fear center in the amygdala will light up. I don't think that people are consciously wanting that. I think there are cultural ways in which we are conditioned that those patterns develop. And most of us are unaware of them. So, that's what implicit bias means, right? And we didn't come up with that idea, or at least the researchers who wrote the 1st study on what that was. It wasn't until 1998, I think, or 95, where they wrote about what is implicit bias. The idea that you can consciously think you're good and egalitarian, but unconsciously have negative fantasies about race. And those are all in a negative way, and the culture needed that. If you go back and read the historical record of slavery, Lonegay wrote a book called The Pleasures of Owning Persons. He showed that the forefathers actually were painstaking when they wrote slavery into the historical record. They knew. That it was horrible, yet they substantiated for economic reasons. So, it is a conflict within the culture, and it's a conflict that we all internalize, and it's a conflict with that we're still trying to figure out. How do we help people talk about it? That foundational guilt that came through in the study, we can shift to talking about the results, was those were the issues that made it really difficult. One, for people to talk about these issues. We don't really train clinicians. How do you think about race as part of a treatment? How do you think about race in psychotherapy? How do you think about your own attitudes and how that influences diagnosis?
JAMA ADAMS: I point out to my white liberal friends that never have they ever made a white referral to me. It's always black folks. I refer all kinds of folks to them all the time. Part of it is, I think, racism, and part of it is also economics, because as I said, if that person's got good insurance, it could come from the Sahara and desert, they're going to keep that person.
KELLIE NEWSOME: See Jama Adams, PhD, from Black Psychoanalysts Speak.
BEVERLY STOUTE: There's copious data on the differential aspect of our healthcare system, both in terms of diagnosis, care that gets recommended, how that care is administered, and what the response rates are. And so this, I think, gets at. How do we look at that in a helpful way? And how do we help clinicians change it?
CHRIS AIKEN: Let’s pause for a preview of the CME quiz for this episode – earn your CME through the link in the show notes.
What is the mental state where we can consciously endorse egalitarian ideas about race while unconsciously harboring negative stereotypes about other races?
A. Projection
B. Racial enactment
C. Structural racism
D. Implicit bias
Beverly Stoute is a Supervising Analyst and adjunct professor of the Emory University School of Medicine and Child Supervising Analyst at the New York Psychoanalytic Institute. She is the co-editor with Michael Slevin of the 2023 book, The Trauma of Racism: Lessons from the Therapeutic Encounter. She co-chaired the Holmes Commission on Racial Equality and American Psychoanalysis along with Drs. Dorothy Holmes, the eponymous chair, and co chairs Anton Hart and Dionne Powell.
The Carlat CME Institute is accredited by the ACCME to provide continuing medical education for physicians. Carlat CME Institute maintains responsibility for this program and its content. Carlat CME Institute designates this enduring material educational activity for a maximum of one quarter (.25) AMA PRA Category 1 CreditsTM. Physicians or psychologists should claim credit commensurate only with the extent of their participation in the activity.
