It is incumbent upon psychiatrists and other mental health clinicians to
empower some of their African-American patients to advocate for themselves as
they navigate a complex maze of systems and agencies that can be
This was one of the messages delivered to those at the Solomon Carter
Fuller Award Lecture on the mental health treatment of African-American
patients and their families at the APA Institute on Psychiatric Services in
October in San Diego.
The award, which this year went to Nancy Boyd-Franklin, Ph.D., honors a
black individual whose work has significantly benefited the quality of life
for black people.
Boyd-Franklin is a professor at Rutgers University's Graduate School of
Applied and Professional Psychology and author of several books, including
Black Families in Therapy: Understanding the African American
Experience and Boys Into Men: Raising Our African American Teenage
Sons. Both books were co-authored by her husband, A.J. Franklin,
Nancy Boyd-Franklin, Ph.D., pointed out that racism continues to impact
African-American patients who receive mental health services.
During the session, Boyd-Franklin showed heart-wrenching video footage of
psychiatrist Salvador Minuchin, M.D., counseling an African-American woman
whose two children had been taken away from her.
Minuchin pioneered structural family therapy and supervised Boyd-Franklin
in her studies.
Boyd-Franklin explained that the patient's infant had cerebral palsy and
was "failing to thrive" due to the illness. A neighbor reported
the mother to child protective services, which removed the infant and an older
child from the home due to a suspicion that the mother was neglecting her
After the mother's children were removed, a psychiatrist misdiagnosed the
grieving mother as psychotic, making it extremely difficult for her to reclaim
her children in the courts. "When an African-American patient is
misdiagnosed," said Boyd-Franklin, "it can stay with them
She also called attention to "the power of these outside
agencies," such as the courts and child-protective services on African
Americans receiving mental health treatment.
Though Minuchin was able to advocate for the mother in her fight to get her
children back, it is important that clinicians help African-American patients
be able to advocate for themselves, she said.
Boyd-Franklin also spoke about some of the ways many African Americans
perceive mental health treatment. For instance, mental health clinicians of
any color working with African-American patients should be aware that their
patients may be resistant to or have a "healthy cultural
suspicion" of psychotherapy.
"In African-American communities," Boyd-Franklin said,"
therapy and psychopharmacology are often seen as the domain of sick
people, crazy people, white people, or rich people." This belief"
impacts the way black patients and their families interact with our
system," she added.
All mental health clinicians should know that "racism has absolutely
impacted our [African-American] clients and continues to affect them,
irrespective of class and education."
As a result, many African Americans have traditionally turned to family and
church, or spirituality, which serve as "buffers" against racism,
In years past, psychiatry residency programs and graduate psychology
programs either did not acknowledge these coping mechanisms, or worse,
pathologized them, she said.
While training to receive her doctoral degree in the 1970s, Boyd-Franklin
said "there was no mention of family in mental health training.. .we
were seeing clients in a very Eurocentric, individualized framework,"
"One thing they don't tell us in graduate or medical school is that
in many African-American communities, the work we do in psychiatry and
psychology is considered antispiritual," she said.
In the past, when African-American patients reported to their therapists
that in order to survive a certain ordeal they "prayed to the
Lord," Boyd-Franklin said, more often than not, clinicians were trained
to write "religiosity" in their notes on the patient.
Boyd-Franklin also encouraged attendees to respond to African-American
patients "from the gut" in the context of psychotherapy. "It
is that response that will enable you to connect and establish therapeutic
rapport with a client who is perhaps totally different from you in class and
race," she emphasized. ▪