Like the rest of American culture, psychiatry is
at a crossroads with respect to race and racism and
its treatment of black, indigenous, and people of
color (BIPOC). The American Psychiatric Association (APA) recently apologized for psychiatry's role
in historical direct and indirect acts of racism. In
its apology, the APA wrote that "early psychiatric
practices laid the groundwork for the inequities in
clinical treatment that have historically limited
quality access to psychiatric care for BIPOC The
APA apologizes for our contributions to the structural racism in our nation and pledges to enact
corresponding anti-racist practices."1
Psychiatry's reckoning with its own racist past is
overdue, but what exactly should the path forward
look like? After all, it is easy to decry some of the
overtly racist theories of someone like Benjamin Rush
(whose image graced the APA's logo until 2015), but it
is quite another to systematically explore and expose
the myriad less visible and less overt ways that racism is infused throughout mental health care.
Enter the new volume edited by Drs Ruth Shim
and Sarah Vinson entitled Social (In)Justice and
Mental Health, a book whose timing could not be
more perfect. In this multiauthored volume Shim and
Vinson thoughtfully and comprehensively investigate
the systemic inequities and racist structures that
permeate mental health care in the United States and
that cause-and exacerbate--health disparities and
generally worse outcomes for BIPOC.
Social (In)Justice and Mental Health looks
beneath the surface of mental health care and
offers the most extensive excavation and critique of
the pervasive racism throughout mental health
that we have read. Shim and Vinson describe the
myriad ways in which the mental health field has
not only failed to see racism in its various forms
but has also actually contributed to racial
disparities. These authors tell their readers that
they want "to make the invisible visible" and,
indeed, they do just that.
From its outset, this volume puts standard mental health practice on notice. Shim and Vinson, who
authored or co-authored a majority of the chapters
in this multiauthored book, state that they hold the
mental health field in high esteem and "it is for this
reason that [they] insist on viewing the field with an
unflinchingly critical eye." No matter their personal
feelings about issues of social justice and race, the
authors note that the book is "informed by data
rather than by sentiment."
The authors address the question of whether or
not mental health care workers ought to care about
social injustice. After all, the argument goes,
shouldn't mental health providers confine their
view toward conditions like major depression or
posttraumatic stress disorder or anxiety and not
delve into larger societal questions? Why should
clinicians look at social conditions and determinants of health when those factors were not the
focus of our training?
Shim and Vinson are unequivocal in their answer
to this question. Their position--as is ours--is that
health is more than medicine, and clinical care is
ultimately one small aspect of what factors into
one's health. One's social environment, political
context, and socioeconomic status all play significant roles as well. And racism, as a system that
distributes unequal access to resources, power, and privilege based on a social construct called race, is a
major social determinant of mental health. As the
authors write, "As health care workers, it's impossible for us to divorce our work from the relentless
societal challenges our patients face. We have to
expand our field of intervention beyond the consultation room." Moreover, they add, "The failur