Abstract
Background
In 1983, responding to an increasingly multi-racial and multi-cultural matrix in Britain which highlighted inadequate psychodynamic psychotherapeutic provisions for minority groups, Nafsiyat was set up by Jaffar Kareem. The three-syllable name ‘Nafsiyat’, Kareem explained, is made up of three ancient languages that ‘stand for MIND, BODY and SOUL’ (1992: 14). In 1992, Kareem co-edited Intercultural Therapy: Themes, Interpretations and Practice (2019), as a way of exemplifying a culturally sensitive, anti-racist, anti-colonial and holistic approach that paid attention to the personal histories of minority ethnics, including ancestral inheritances of traditions and traumas. It also challenged the assumption of distress always being located in the individual alone.
Introduction
This follow-up publication, Intercultural Therapy: Challenges, Insights and Developments was published in 2019 and could not have anticipated the explosion of outrage, accelerated change and reforms resulting from the death of George Floyd and the rise of the Black Lives Matter movement. Like me, one might approach the book with a weary conviction that this now well-ploughed ground has nothing new to offer. This, however, would be a mistake.
There is much densely packed into this deceptively compact book which weaves theory, historicization and vignettes to emblematize the complex, intricate and dynamic maze of intersectionality across cultures, grappled with by clinicians and patients alike. Topics include racism, sexism, gender, neoliberalism, capitalism, colonialism, oppression, religion, poverty, cultural values, splitting, intergenerational trauma and the return of the repressed. There is also an interesting argument against the prevalence of a dyadic model of infant development (Chapter 13) and a rare exposition of unconscious dynamics in interracial dyads, explored through transference dreams (Chapter 10). The Contributors’ biographies (p.x-xiii) are worth cross-referencing, providing illuminating insights into how formations of subjectivity, including cultural values and beliefs, are revealed and concealed in particular contexts.
As an evaluation of intercultural therapy, the book is primarily for clinicians, supervisees and trainees. However, taking the notion that the group or organization represents a microcosm of the wider world (Foulkes and Anthony, 1957), its themes and insights make it suitable for anyone interested in issues of power and privilege.
Neoliberalism and socio-political strife
Chapter 1 opens with Inga-Britt Krause highlighting the invidious and enduring problem of neoliberal authoritarianism in public and clinical settings. She identifies a contradiction between, on the one hand, the acknowledgment of racism as a social rather than individual problem and on the other, the criminal justice system’s classification of racial attacks as ‘hate crimes’ (p.11). The author argues that this displacement of racism has resulted in a ‘racialisation of politics’ and a ‘personification of racism’ (Giroux: 2004: 57, p.11), characterizing a neoliberal agenda which absolves the state of responsibility and produces ever fragmented and commodified individuals. This timely observation is borne out by a creeping and sustained trend in society in which central governments and corporations—under the guise of empowering people—are imposing many problem-solving tasks and responsibilities back on to increasingly isolated and overwhelmed individuals. We are all our own bank managers, IT specialists, physicians and psychologists now.
Mapping the neoliberal terrain and its impact on mental health is revisited in ‘Who’s Being Assessed?’ (Chapter 2), which succinctly lists a range of psychological and behavioural obstacles to social justice that, taken together, illustrate how multiple systems conspire in creating ‘oppression trauma’, a ‘social trauma that deeply impacts on the psyche of the individuals and affects the wellbeing of whole communities’ (p.29). The author’s attention to the relationship between external and internalized forms of oppression exposes some of the hidden ways in which cultural hegemony is maintained (p.27). Agoro’s contextualization of problems of oppression in the current system of pathological capitalism where poverty is singled out as the ‘world’s most ruthless killer’ (p.26) feels especially poignant. Winnicott once remarked, ‘to one whose subject keeps him all the time in touch with the unconscious, economics has often seemed like a science of Greed in which all mention of Greed is banned’ (1986: 170). Positing a Marxist intervention for addressing socio-economic problems, Agoro offers us some sobering statistics: The wealthiest 85 people in the world have more money than the poorest 3.5 billion people, with the poorest half of the earth’s population owning 1 percent of the earth’s wealth, and the richest 1 percent of the earth’s population owning 45 percent of the earth’s wealth. (p.26)
Agoro’s alignment of psychological suffering with material poverty may remind us not only that the ‘personal is political’, but the ‘psychic is also social’ (Levin, 2105: 204). In Chapter 9, Sigalas unearths the process of ‘Inferiorisation’, described as the imposition of a ‘grandiose delusion of superiority over another’ (p.113) which he associates with a ‘punitive super-ego/ideal’ (p.112). The author looks at how ‘inferiorisation’ is inculcated into refugees, asylum seekers and economic migrants as they undergo a process of adaptation to a new culture espousing different values from their own. The chapter concludes with a cogent observation from Slavoj Zizek: actual universality is not the sharing of basic values, but the sharing of the struggle to overcome ‘the inadequacy within’ each culture, as reflected in experiences such as repression, exploitation and suffering that can be very familiar and common to us all. (p.117)
Suitcases of trauma are evoked by Eugene Ellis (Chapter 5) who draws on ‘recognition’ (p.74) as a catalyst to attending to ‘ancestral baggage’ (p.75—see also McKenzie-Mavinga’s Chapter 14). Unpacking these cases, the author invokes a Kleinian approach that ‘sits well with the healing process of racism’ (p.75) along with emphasizing the importance of facilitating the emergence and processing of destructive and often legitimate forces (Fanon, 2001). He writes, ‘There is something about rage being witnessed and hurt being acknowledged and validated on both sides of the racial divide that make it a very important part of the healing process’ (p.80). The importance of processing ‘generationally transmitted trauma’ is elaborated on in Chapter 12, where the late Lennox Thomas reflects on ‘post-traumatic slavery trauma’ (p.141). He traces ‘broken attachments and emotional distance’ back 300 years to the time when mothers knew ‘their children would be taken away and sold’ (p.142). In this way we are reminded of the foundations of trauma, the robust register of the unconscious and its indestructible (timeless) nature.
Ababio’s moving title ‘Not yet at home’ (Chapter 3), is a fascinating and illuminating account of internalized shame and/or guilt (‘passing’) and ‘its activity within and between some sections of the black community in Britain’ (p.56). Here, the author unpacks traumas of ‘flight and arrival’ (p.41) and the resultant ‘psychological drama’ of aural and verbal ‘passing’ as it plays out in a ‘theatre and arena’ of displacement dressed up as belonging (p.57). The author traces the history of African migrants in Britain back to sub-Saharan Africa. He makes a distinction between those who were enslaved—severed from their homeland and transported to plantations in the Caribbean or the Americas—and those who remained. Britain becomes a point of intersection between these two histories along with the transgenerational traumas and tensions between them. Some of these traumas, Ababio posits, can also be found in works of art and passed down in oral tradition. References to ‘The African individual who endeavours to pass as Black British’ or ‘Jewish people resorting to pass as Gentile’ (p.55), are linked to ‘internalized colonial objects’ operating ‘within overarching oppressive white western frameworks’ (p.57).
Something particularly striking for me in this chapter was a fleeting but powerful reference to ‘Arab imperialism’ and ‘slave trading on the African continent’ (p.52). The history of Arabs as slave owners is rarely spoken about. Why is this? Their own continued struggles against forms of western imperialism (among other forms of oppression), may partially account for this undiscussed area, but I suspect it is not the only reason. From the perspective of my intersectional identity also being Arab-Muslim, reading this felt piercing, guilt-inducing but important; another complex area to revisit.
‘Embodied Intercultural Ground’ (Chapter 11) explores the mind-body ‘interplay’ through the ‘dignity-ignominy polarity’ experienced by ethnic minorities (p.128). In discussing how to transform intersectional resonances of oppression and stuckness to ‘intercultural possibilities’ (p.130), Carmen Joanne Ablack offers a vignette to guide us through working with the ‘essences and energies of shame and humiliation’ that constitute an ‘overarching presence in processes of identity’ (p.130). Reading this as a sensory-specific invocation of embodiment’s potentiality, I wondered whether placing it at the start of the book would have activated deeper levels of engagement with such rich and stirring material.
Cultural differences or human rights?
One concern I have with the book, although it is actively exploring complex intersectional terrain, is the way some chapters engaged or rather, did not engage, with the treatment of women in some traditionally Islamic cultures, leaving me speculating upon what was not being confronted. In Chapter 1, I read with unease about the case of 11-year-old Khadija, a traumatically withdrawn girl whose mother had fled from the household two years earlier (for reasons we are not told), leaving her and her brother in the precarious and at times disturbing care of their father, Mr Islam.
The author painstakingly details her entanglement with a constellation of ‘cross-cultural tensions and difficulties’ (p.12), between the institution and Mr Islam, between her own values and his and perhaps between her professional identity as a social anthropologist and that of a psychotherapist. While I sympathized with her desire to make the best out of a seemingly impossible situation, I also found myself wondering about psychological disturbance and abuses, along with complicitous taboos against uncovering them. One such example is Mr Islam’s practices and beliefs around the role of women and associated far-reaching notions of ‘purity and pollution’ (p.18). Critical of the profession’s attitude towards making his problems psychological rather than cultural, Krause resolves to support Mr Islam in bringing a new wife from Bangladesh as a way of relieving pressures upon Khadija. This I found difficult to digest; the cycle of objectification and dysfunction seemingly (re-)displaced on to another woman, but certainly not broken.
Perhaps I am overreading this. But it remains an appalling fact that to this day, in large swathes of the Islamic world, a pernicious mix of patriarchy, misogyny, and religious-dogma leads to sex-shaming, body-shaming and the brutalization of women. Open and questioning conversations about the way that repression and its intersection with aggressive impulses culminates in horrendous forms of violence—including sexual violence—against women and girls continue to be supressed. While there may be an inevitability in the observation that ‘the complexity of intersectionality and interlocking oppressions appears to become diluted in practice’ (Hulko, 2009: 45), the combination of a white western therapist who fears accusations of racism, cultural insensitivity and/or Islamophobia and a client from a strict repressive and repressed culture in which harmful practices are legitimized under the rubric of Islam, raises broader difficult questions, but ones we must nevertheless ask.
Are cultural differences conveniently invoked as a way of avoiding deep-rooted psychological problems? Is there not the danger that in acknowledging someone’s culture we are obliterating their or another person’s human rights? In this case, I wondered about an earlier reference Krause makes to a ‘whip’ rather than ‘carrot’ (p.11) approach to effecting change, and how this resonated with the ‘cancel-culture’ we are living in today. Are we, in these polarized and confusing times which on the one hand promise inclusion and on the other perpetuate a punitive climate of intolerance to non-politically correct differences, disavowing indispensable therapeutic concepts pertaining to the unconscious, repression and denial? I also wondered about the author’s choice of pseudonyms. The name Khadija is inspired by the prophet Mohammed’s first wife, an older, more educated, successful merchant and financially independent woman for whom he worked and on whom he came to rely for emotional and material support—was this how she saw her 11-year-old patient? I support the idea that working towards decolonization necessitates careful revisiting and reflection rather than rushing to evaluate individuals against established Eurocentric theories. At the same time, our work and indeed the work of Nafsiyat is underpinned by a therapeutic model which situates the unconscious as the ultimate engine of growth. In the intersections of race, gender, misogyny, Islamophobia in the context of cultural values and beliefs (whose culture and whose values), were some issues simply too complex or unbearable to stay with? As Cockersell points out (Chapter 7), it is easier to work with a Muslim who shares similar western values (p.101).
The question of disentangling cultural rights from human rights surreptitiously resurfaces in a different context in Chapter 8. ‘Postcolonialism and Countertransference in Two Cases of the Sexual Abuse of Women by Doctors’, can be taken as an example of the return of the repressed. Originally written in 2006, it refers to a case that occurred 20 years earlier. Here, it is re-edited with only select words and phrases being changed. The chapter opens with a quotation that seems both pointed and ambiguous: ‘I myself should have everything to fear if the spirit of tyranny and the spirit of culture ever went hand-in-hand’ (p.104). The author goes on to describe being overtaken by a ‘horrid fascination’ (p.108) with the case of two doctors, one Arab and the other Indian, whose sexual exploitation of their female patients spiralled into unspeakably horrendous compulsions of chronic abuse.
From the outset, the author’s sense of inner conflict is conveyed through sentences punctuated with hesitation and contradiction. In the 2006 version the subjects are referred to as ‘doctors’, but here acknowledged as ‘patients’. In both versions he writes cryptically about patients who were not really patients, claiming ‘they came to me by chance, as it were’ (p.105) and that neither of them came for ‘formal psychotherapy’ (p.109). He expresses disgust and contempt towards his patients/doctors who ‘initially idealized’ him and yet ‘rather mysteriously’ (p.109) stopped attending their sessions. Elsewhere, his assertion that neither patient showed any remorse for his behaviour seems at odds with other signs of guilt and self-sabotage enacted by the failure of one to claim his inheritance and the other’s repeated failure of his medical exams. Towards the end of the chapter Littlewood finally asks, ‘What fantasies of black immorality and subversion of medical ethics might I impose on my two clients?’ (p.109) ‘Where culture, where horror? From whence my fascination? An identification with their apparently limitless sexual power’ (p.109). This is a paper that feels equally revealing in its efforts to obscure; like a confession that, as the Introduction suggests, has ‘come out’ (p.5) but not yet come clean. It is also deeply thought-provoking, human and honest. And yet, apart from what felt like a token Oedipal analysis, the writing seemed to evade deeper levels of engagement, always staying just beneath the surface of self-accountability. No wonder the introduction describes this chapter as ‘too interesting’ (p.5). Chapter 6, Deri Hughes’ Racism in the Room, touches on similar themes of countertransference and projective identification, but in a very different context. In projecting their own unconscious fantasies on to their patients/clients what do western therapists in particular, enact and turn a blind eye to?
A glimmer of hope
Violence against women is encountered against a backdrop of tragedy and hope in Gongor’s ‘Group Psychotherapy with Turkish-speaking Women’. The author begins by dedicating the Chapter (4) to the memory of a client who, though not forming part of the group she presents, was murdered by her husband. She is referred to as ‘Mrs AX’. In the pages that follow, the fate that befell ‘Mrs AX’ is implicitly juxtaposed with the stories of survivors who shared a forced internalization of ‘second-class gender identity’ (p.64) and whose control was ‘socially recognized and legitimized’ (p.64). What unfolds is a deeply moving, lucid and humane account of the wisdom and profound reach of simplicity in group analytic work. The potential creativity of drawing on one’s own intuition and not relying solely on rigid theoretical formulations is illustrated. In one example, the author describes stepping outside the frame to advocate for her clients by writing letters to the Home Office. In another, she encourages a mother to bring her newly born baby girl into the group to be celebrated by the women, a reparative experience to counter the usual socially induced shaming response to the birth of a daughter. In another instance, she shows how a conversation on envy was facilitated through wearing a traditional symbolic blue amulet, which caught the attention of the group. She also describes how a group member celebrates her ability for the first time to say, ‘I am’ not ‘we are’ (p.63) a statement that underscores the importance of context in thinking about the individual and social paradox. Here, we see how the collective and social nature of humanity which is currently so popular in the West is reframed in the context of a people who have been suffocated by collective cultural tyranny: ‘the extreme of identification with society with total loss of sense of self and self-importance is not normal at all’ (Winnicott, 1986: 27).
Curiously, Gongor tells us that in the transference she is the ‘wise, educated sister’ (p.62) reflecting the ever-increasing importance of being ‘alongside’ people who are oppressed. This affirms a slightly modified way of working in cultures with a strict authoritarian vertical paradigm, moving to a more horizontal one which reduces fear and cultivates a greater egalitarian environment which is central to reflection, breaking taboos and self-expression. Perhaps a further consideration of the horizontal motif is its capacity to put one in touch with loss of the parental dyad, whether literal or psychic. This in turn can create a space for mourning, grief and grieving being such key themes of these women’s experiences and needs. What I found especially appealing about this chapter is its plain writing, lack of jargon and complexity, which seemed to allow for an effortless flow and unfolding of narratives. Written in a style that conveys creative theoretical wisdom, I found myself transported into the room and having a visceral sense of the warmth and healing potential contained within it.
Clinical supervision is vital to learning and development; located between theory and practice, therapist and patient, personal and professional, the individual and culture, it is a fertile and abundantly creative triadic bridge. Mckenzie-Mavinga’s chapter (14), the concluding chapter of the book, situates supervision as a safe place to identify and acknowledge possible racist biases and the dangers of lapsing into ‘postracism’ as a ‘defensive discourse’ (p.167). Invoking Jung, she invites us to stay alert to ‘the trickster shadow’ and its ‘harmful negative perceptions of the self and other’ (p.174). She concludes her chapter by offering 16 useful ‘pointers’ (p.176) to help address the challenge of racism within and beyond the supervisory space.
Conclusion
This is a modest volume, dense and rich with experience and ideas. Chapters can be read individually although its most effective and affective impact is achieved through reading it as a whole. An indispensable aid to learning and reflection, some intersectional and/or politically hot topics are noticeably avoided. On face value, it might seem that there is a lot of repetition of previously covered ground. However, remembering that repetition is intrinsic to the process of working through, this book succeeds in putting us in touch with our own cultural biases, projections, and internalized oppressions, reminding us that in revisiting these themes, the same story is never told twice and the learning is always new.