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“It’s ironic that a political leader who made such sweeping decisions affecting Americans with mental health issues ultimately came face-to-face with the dangers of untreated mental illness. In 1981, President Reagan was shot by John Hinckley Jr., a man suffering from several different types of personality disorders.” —from “Did Reagan’s Crazy Mental Health Policies Cause Today’s Homelessness?” an Oct 14, 2013 article by Joel John Roberts, March 30 1981.

After delivering a speech to the American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) at the Washington Hilton in Washington, D.C., a gunman opens fire on Ronald Reagan, the 40th President of the United States, as he walks to his limousine. The assailant empties his cheap 22. caliber revolver, as all six shots miss their target. The last round however, hits the armored limousine’s right rear quarter panel, and then ricochets into the chief executive’s left side, nicking a rib before lodging into his left lung. Reagan survived the attack to live out his two terms in office and setoff fiscal policies that stimulated economic growth, cut inflation, and pulled America out of a recession.

His attacker, John W. Hinckley, was diagnosed as suffering from borderline, narcissistic, schizoid, and schizotypal personalities (principal diagnosis), as well as erotomania (having delusions that he and actress Jodie Foster were embroiled in a torrid love affair) and major depression, for which he was variously prescribed such psychotropic drugs as Resperdal, Surmontil, Tofanil, Valium and Zoloft.In short order, Reagan would set about dismantling his predecessor’s Mental Health Systems Act (MHSA) of 1980, a move that unleashed scores of patients out into the streets. This in turn led many to claim it initiated the explosion of homelessness that crippled the nation at the end of the 20th century and beyond (and possibly resulting in an increase in street crimes-particularly mass shootings). This shift likely contributed to the escalation of the prison population as well.

Funding ups and downs

“By vilifying the mentally ill and proposing to cut and restructure Medicaid and Medicare, the Administration has made it even harder for people in poverty to access mental health services.” —March 8, 2018 by Isha Weerasinghe, senior policy analyst on mental health at The Center for Law and Social Policy.

Lack of funding is the primary hurdle in providing mental health for people of color, says psychotherapist Sandra Cox. As head of South Los Angeles’ Coalition of Mental Health Professionals (CMHP), she has toiled in the psychiatric field for decades, and is aware of the ebb and flow of funding and shifts in public opinion per political whim. Impoverished areas have always played second fiddle to the needs of the more affluent westside. In recent years as funding dried up, facilities towards the ocean have hunkered down and opened satellite services in poorer neighborhoods to widen the net for public funding. Even then, available financing is slow and intermittent.

Democratic regimes as a rule are more generous, but she notes that former Gov. Arnold Schwarzenegger made a special effort to streamline the bureaucratic process and ensure economic support reached CMHP in a timely manner. Presently, the ethnic make up of those coming in to partake of her services are perhaps 65-70 percent Hispanic, which includes immigrants from Central America. Of these, many are asylum seekers from the chronic civil unrest, organized crime, and street violence endemic to that part of the world. They suffer from emotional development issues, family pathologies, and narcotic abuse, and Post-traumatic stress disorders (PTSD), exacerbated exposure to poverty traumatic events. However, Cox’ Black clientele remains the most emotionally damaged of those seeking help.

Lekeisha A. Sumner, a clinical psychologist in the Psychiatry Department at UCLA agrees. Her clientele is likely more diverse then one found in South Los Angeles, but comes to the same conclusions: “Many clients of color are grappling with issues and stressors associated with “shifting” as it relates to assimilation, acculturation, navigating complex work and relational dynamics along with family and partner demands.” She notes, reinforcing the observation that “fitting in” to a racially inhospitable environment is in itself a considerable challenge. Within the CMHP staff no psychiatrists (who are medical doctors) are available to write prescriptions, but 25 percent reportedly utilize psychotropic medication to address their issues. This doesn’t include those who “self-medicate,” using street intoxicants to address their psychological issues and get through their day.

A cookie cutter approach

Pathology – The study of the nature and origin of disease. —Defined as “that branch of medicine which treats of the essential nature of disease.” —From the Greek words “pathos” meaning “disease” and “logos”meaning “a treatise” = a treatise of disease.

Coincidentally, the day before my interview Dr. Cox had a session with a man who related his past history within the psychiatric/penal system. During his stay in an unnamed facility he described as among “the most restricted” in the system, the professionals assessing him deemed him as having “the mind of a 5-year-old.” The fact that this man, a poly substance abuser from the Deep South with a primary school education, could articulately recount this episode with such clarity has Dr. Cox convinced he is one of the countless unfortunates rubber stamped through the system and “over-pathologized.” She, along with scores of minority health professionals working in psychology are adamant that well-meaning clinicians are hamstrung by the tendency to assess their clientele through the prism of westernized notions of normalcy.

Her colleague over at UCLA, psychologist Sumner, concurs. “Too often in the research literature, ethnic communities are grouped together using White Americans as a benchmark,” she notes. “This is a grave mistake as all groups—including Whites—exhibit variations within the group, especially as it relates to socioeconomic status and gender.”

This rampant bias means that patients are evaluated (or judged) by standards inherently different from their culture, experiences, and society they are accustomed to. Disregarding the nuances of cultural differences is an impediment to effective therapy.

Cultural insensitivity

“Bias is inherent in models of diagnosis that were founded on European ways of being, believing and doing—Not every problem is rooted in culture, but culture provides context about how people see and experience the world and how they perceive wellness and illness.” —Ruth C. White

Moving west to USC, Ruth White, an associate clinical professor, is in agreement with Cox, citing a lack of “cultural competence,” as a barrier for some therapists to fully relate to their patients. “Some mental health professionals can view some ethnic communities through a lens of pathology,” she believes, “instead of through a lens of resilience, if they are not trained to take culture into account.” She takes pains to stress this may not be the fault of individual clinical staff.

“Most models of diagnosis and intervention were not modeled on ethnic communities, so they are not necessarily culturally relevant. ‘Different’ isn’t always ‘wrong’ and so mental health professionals need to put behaviors and beliefs in context, and to also be open to ethnically specific healing practices.” All of this begs the question: does the treatment of an ethnic minority mean an entirely different approach then would be applied to a patient from West L.A. or the San Fernando Valley?

“The methodology wouldn’t necessarily be different just because of race and class,” says White.” “It really depends on the individual context. However, the questions asked may be different and the response to answers may differ,” she continues. She finishes this thought by suggesting “…the intervention will be unique to the client, their problem and their resources.” Cox believes that respect is essential to a successful therapeutic treatment plan, regardless of the race or ethnicity of the client base. Any assessment or intervention must be built on an understanding of their past history (as with refugees from war-torn areas).

As for American-born Blacks, the specter of abuse extending back through segregation to slavery is an unavoidable obstacle. “They (the psychiatric hierarchy) don’t have an appreciation for who we are, nor do they respect our culture.” Building on the writings of Michelle Alexander, she declares that mass incarceration contributes to the destruction of the Black family, citing scores of educated Black women in affluent areas like the Silicon Valley with a dearth of suitable marriage partners.