Pathologizing Oppression
Pathologizing refers to the process of viewing or treating natural behaviors, emotions, or responses as abnormal, unhealthy, or indicative of a medical or psychological disorder. It involves assigning a pathological label to phenomena that may be understandable reactions to specific circumstances, cultural norms, or environmental factors.
For example, pathologizing might occur when:
A person's sadness due to grief is misinterpreted as clinical depression.
Behaviors shaped by cultural or societal factors are labeled as deviant or disordered.
Natural responses to systemic oppression, such as anger, hypervigilance, or withdrawal, are mistaken for psychological abnormalities.
Pathologizing Natural Reactions to Racism and Oppression
The practice of pathologizing natural responses to oppression stems from a history of psychological frameworks and diagnostic systems that have failed to take into account the unique experiences of marginalized groups. As Dana (2005) notes, psychological tests and diagnostic systems have been constructed primarily based on the experiences, norms, and standards of middle-class, White, Euro-American populations. These systems have consistently excluded or under-represented people of color, leading to significant misdiagnosis and misinterpretation of their mental health.
The Diagnostic and Statistical Manual of Mental Disorders, the primary tool used to diagnose mental health conditions in the United States, has long been critiqued for its Eurocentric framework. The DSM and its previous editions often fail to consider cultural differences and use diagnostic criteria that may not align with the realities of individuals from different racial and cultural backgrounds. This lack of cultural sensitivity results in diagnoses that lack accuracy and fail to capture the full complexity of mental health experiences in marginalized communities (Dana, 2005).
Racism-Related Behaviors: Logical Responses, Not Mental Illness
According to research (Utsey et al., 2001), several racism-related behaviors and reactions are often wrongly diagnosed as mental health disorders by mental health professionals. These behaviors and reactions are understandable and logical responses to the daily stresses and traumas caused by living in a racially discriminatory society. For example:
Racism-Related Trauma: People of color who have been exposed to racism or discriminatory practices might experience trauma symptoms similar to those of post-traumatic stress disorder (PTSD), such as intrusive thoughts, nightmares, anxiety, depression, anger, and hypervigilance. However, these responses are not pathological in nature—they are a normal reaction to trauma caused by systemic racism and oppression.
Racism-Related Fatigue: The constant exposure to racism and oppression can lead to a form of psychological and physical exhaustion. This fatigue is not merely tiredness; it is a result of the ongoing mental and emotional labor that people of color must expend to navigate a society that marginalizes them. Over time, this fatigue can significantly impact an individual’s overall well-being.
Anticipatory-Racism Reaction: Many people of color develop a heightened sense of vigilance and fear due to past experiences with racial discrimination and hostility. This anticipatory reaction can manifest as hypervigilance, paranoia, distrust, and anxiety, often as a means of protecting oneself from further harm. It should be acknowledged for what it is-a defense mechanism-not a mental illness.
Racism-Related Stress/Distress: Chronic exposure to racial discrimination can result in significant stress and physical symptoms such as chronic muscle tension, headaches, and difficulty concentrating. Over time, this stress can weaken the immune system and make individuals more susceptible to both mental and physical health problems.
Racism-Related Confusion: People of color living in a society that constantly devalues their identity may experience confusion and identity crises. This confusion often manifests as low self-esteem, depression, self-doubt, and a tendency to sabotage one's own success. This is not a mental illness—it is a reaction to the societal forces that undermine one's sense of worth and identity.
The Need for Cultural Competency in Mental Health Diagnosis
To address the issue of pathologizing oppression, it is essential to promote cultural competency and humility within the mental health field. Clinicians must recognize psychological reactions of people of color to racism and oppression are not indicative of mental illness, but rather natural responses to living in a society that marginalizes them.
Cultural competency in mental health care also involves using diagnostic tools and frameworks that account for the unique experiences of marginalized communities, and integrating decolonized and trauma-informed practices into therapeutic approaches.
Conclusion: Moving Beyond Pathology
Pathologizing the natural responses of marginalized individuals to oppression not only misrepresents their experiences but also perpetuates the cycle of marginalization and injustice. By recognizing that behaviors such as trauma, stress, and anticipatory reactions are adaptive responses to the ongoing trauma of racism and discrimination, we can move toward more accurate and compassionate understandings of mental health.
To truly support the mental well-being of people of color, it is crucial to shift away from Eurocentric diagnostic frameworks and embrace a more inclusive, culturally competent approach to mental health. By doing so, we can provide individuals with the care and support they need without pathologizing their very real and understandable reactions to a society that continues to oppress them.
References:
Dana, R. H. (2005). Cultural considerations in the diagnosis of mental health disorders in the African-American community. In Handbook of Cross-Cultural and Multicultural Personality Assessment (pp. 121-140).
De Arth, R. D. (2012). Psychological assessment and cultural considerations: Moving beyond Eurocentric norms. Journal of Cross-Cultural Psychology, 43(6), 923-937.
Utsey, S. O., Bolden, M. A., & Brown, S. E. (2001). Racism-related stress, ethnic identity, and mental health among African Americans. Journal of Counseling Psychology, 48(4), 333-344.
Suzuki, L. A., Prendes-Lintel, M., Wertlieb, D., & Stallings, D. (1999). Cultural factors in the diagnosis and treatment of mental health disorders among minorities. Clinical Psychology Review, 19(2), 189-206.
