4/ Editorial introductions

Chapter 11 - Asserting Difference: psychiatric care in black and white by Karla Boyce

As argued in the previous chapters, the negotiation of personal reality is a vital part of the therapeutic process, if not the therapeutic process itself. Our culture and our race are critical components of the 'reality' we experience. The positive acceptance and exploration of difference in race and culture between clinician and client are thus vital. Equally, attention to these issues in other areas of their experience is crucial. Clearly, any sense that particular cultures are 'alien' thus has enormous implications for the clinical work. Similarly, the sense that all cultures are the same will adversely affect the work. In chapter eleven Karla Boyce reflects on her experience as a black student nurse and as a newly qualified black clinician in London. She describes the alienating effect of a system that expects assimilation without acknowledging difference. Developing a case study in which she was involved with the restraint and seclusion of a black woman, Karla explores the implications of this experience of alienation both for clients and clinicians. She discloses her own response to working in such an environment. Karla describes her attempt to change things locally, including involvement with a black women's staff group, challenge to the procedures in the institution where she worked and the introduction of a course she devised on race, ethnicity and mental health.

When BD trained with Karla as a mental health nurse they shared a trip to Friern Barnet hospital in North London, where the process of deinstitutionalisation was progressing apace. Nearly all of the patients, many of whom were lifelong residents of the institution, had been decanted into the community. Two striking pieces of history emerged from the visit. One was that the hospital boasted the longest corridor in Europe (substantially more than a mile in length), to which all the wards were connected. The experience of walking down that echoing, ghost-ridden tunnel from nowhere to nowhere else is unforgettable, and must be an endlessly recurring image in the mind of any former patient. But also of note was the institution's history, particularly to BD as the grandson of East European Jewish immigrants who had come to England in fear of their lives around the turn of the century, escaping from pogroms in Russia (now Lithuania) and Poland. It appeared that the vast majority of the madfolk catered for by the institution in its early decades were Jewish ‚migr‚s, diagnosed mad but presumably responding to the impact of their oppression, dispossession, cultural and geographical disclocation and an experience of savage anti-semitism in their new 'home' country. Presumably their presence was the reason the asylum had been located in this area.

In the following pages the experience of racial discrimination and the impact of stereotyping on mental health and mental health care is discussed only in relation to black people. It may be objected (the editors are inclined to object likewise) that this is an ommission, as the experience of racial and cultural prejudice, discrimination and disadvantage is far more universal. Which is true; of course the issues addressed apply to other groups, and are of universal importance. But the point which this chapter emphasises is how we may, individually or in groups, try to remain true to our experience and work with it to make a difference. Karla speaks from experience and if her experience conveys something of a practitioner at the start of a career, taking the greatest interest in issues that affect her personally, so be it. What it is hoped the chapter may also display is the possibility that one may use one's experience to make a positive difference, by asserting that this is the reality one is experiencing, in black and white terms or otherwise.