Patel Nimisha (2003) Clinical Psychology - Reinforcing Inequalities or Facilitating Empowerment

This article was downloaded by: [Florida State University]
On: 29 December 2014, At: 23:18

Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
The International Journal of Human

Rights
Publication details, including instructions for authors and subscription
information:
http://www.tandfonline.com/loi/fjhr20
Clinical Psychology: Reinforcing

Inequalities or Facilitating
Empowerment?
Nimisha Patel
Published online: 08 Sep 2010.
To cite this article: Nimisha Patel (2003) Clinical Psychology: Reinforcing Inequalities or Facilitating
Empowerment?, The International Journal of Human Rights, 7:1, 16-39, DOI: 10.1080/714003792
To link to this article: http://dx.doi.org/10.1080/714003792
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis, our
agents, and our licensors make no representations or warranties whatsoever as to the
accuracy, completeness, or suitability for any purpose of the Content. Any opinions and
views expressed in this publication are the opinions and views of the authors, and are not
the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be
relied upon and should be independently verified with primary sources of information. Taylor
and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs,
expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or
indirectly in connection with, in relation to or arising out of the use of the Content.
This article may be used for research, teaching, and private study purposes. Any substantial
or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply,
or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access
and use can be found at http://www.tandfonline.com/page/terms-and-conditions
71hr04.qxd 06/03/03 11:30 Page 16
Clinical Psychology:
Reinforcing Inequalities or
Facilitating Empowerment?
N I M I S H A PAT E L
Downloaded by [Florida State University] at 23:18 29 December 2014
To what extent do psychologists continue to reinforce inequalities by

unquestioningly reaffirming existing oppressive theorising and practices, thereby
maintaining the status quo and endorsing human rights violations? Or, to what
extent do they attempt to facilitate empowerment by those who have suffered
human rights violations, and do they challenge the social and political order by
offering theoretical and practical alternatives towards a more just psychology? It
is argued that for any psychologist committed to the humanitarian values
embedded within psychology, the challenge is, first, to engage in critical
reflection of their own professional and personal biases, which serve the social
order and which contribute to the perpetration of abuses of power and the
maintenance of social inequalities; and, second, to seek more just alternatives.
Unfortunately, a case can be made that by virtue of its constricted

focus and failure to see its derivation from and relationship to the
social order, psychology has adversely affected the lives of many
people.1
In their efforts to address the psychological impact of injustices against
humanity clinical psychologists, often with the best intentions, have
applied psychology in a way that has continued to ignore the relationship
between the individual and the historical, social and political contents
which have shaped their lives and given rise to their distress. The advent
of the Human Rights Act 1998 in Britain has enabled this issue to be
brought into focus by integrating the European Convention for the
Protection of Human Rights and Fundamental Freedoms 1951 into the
legal system. The right to freedom from torture and other cruel,
inhuman or degrading treatment or punishment, also voiced in the
European Convention and in the Universal Declaration of Human
Rights, constitutes Article 3 within the Human Rights Act. It is this
Article which has increasingly become the focus for psychologists
The International Journal of Human Rights, Vol.7, No.1 (Spring 2003) pp.1639
PU B L I S H E D BY F RA N K C A S S , LO N D O N
71hr04.qxd 06/03/03 11:30 Page 17
C L I N I C A L P S YC H O LO G Y A N D I N E Q UA L I T I E S 17
working with asylum seekers, particularly because many asylum seekers
are seeking protection from torture or inhuman treatment, and
deportation may lead to a violation of this Article. Ironically, in working
with asylum seekers and refugee people, psychologists and other mental
health practitioners seem rarely to spare more than a cursory glance at
the historical, social and political factors, and the vital ingredients of
social inequalities, marginalisation, discrimination and conflict, which
give rise to the very human rights violations leading to the rise of asylum
seekers world-wide.
In this article three main issues are addressed: first, the range of
human rights violations and the process of exile experienced by many
asylum seekers and refugee people; second, the way in which psychology
has addressed these experiences in its theorising, research and clinical
practice; and third, the limitations in psychologys response to such
human rights violations. The article ends with some examples of how
psychologists may attempt to work in a way that does not
unquestioningly and unwittingly serve the social order and reinforce
inequalities but seeks to facilitate empowerment.
HUMAN RIGHTS VIOLATIONS AND EXPERIENCE OF EXILE

Human rights violations in recent history and currently include atrocities
committed in conflicts, genocide, ethnic cleansing, arbitrary detentions
and torture. All such violations require the foundations of social and
structural inequalities, marginalisation, exploitation and the abuse of
power. State terrorism, harassment, intimidation, persecution, organised
violence and torture become the vehicles of oppression, power in action.
As an example, in recent history and currently torture has been used
for such purposes as to extract information, to disable political and social
activists, to assist ethnic cleansing, to obtain confessions, to force
collaboration, cooperation or a change of beliefs, to punish and
discipline individuals and to terrorise whole communities.2 Notably,
those perpetrating such human rights violations have included health
professionals, most commonly physicians and psychiatrists.3 And as a
response to such practices the United Nations adopted the Principles of
Medical Ethics:
It is a gross contravention of medical ethics, as well as an offence
under applicable international instruments, for health personnel,
particularly physicians, to engage, actively or passively, in acts
which constitute participation in, complicity in, incitement to or
attempts to commit torture or other cruel, inhuman or degrading
treatment or punishment (Principle 2).
71hr04.qxd 06/03/03 11:30 Page 18
18 T H E I N T E R N AT I O N A L J O U R N A L O F H U M A N R I G H T S
The reference to health personnel could be interpreted as including

all those involved in conceptualising, developing and delivering health
care, that is including clinical psychologists and other psychological and
mental health practitioners. It is argued here that the active or passive,
intentional or unintentional engagement in the commission of acts which
support abuses of power in the form of say subjugation, persecution and
violence are equally important as the commission of acts which might
redress such abuses. As such, psychologists have an ethical duty to
critically examine their own role in sustaining the very inequalities and
abuses of power which lead to human rights violations, whether it is in
their knowledge base, research, clinical or service-development
activities. Thus, focussing on acts of torture alone in terms of their

psychological impact is considered inadequate.
The experience of exile is another important aspect of the way in
which asylum seekers and refugee people fleeing torture, organised
violence and persecution are subjected to further human rights violations
and indignities. Difficulties often experienced by refugees can be
described in terms of four phases of refugee experience, including the
pre-flight phase, flight phase, temporary settlement or asylum-seeking
phase, and the resettlement or repatriation phase.4 Loss and separation
are recurrent themes for those forced into exile as a result of human
rights violations: the loss of home, of homeland; the loss of health, of
role, language and culture; the loss of and separation from family,
friends, compatriots; the loss of identity, dignity, purpose and
opportunity in life. The loss of hope is a predominant theme: the hope
of justice, the hope of recognition, the hope of safety and protection, and
the hope of a life without fear. In exile, the experiences of multiple and
profound losses are compounded by the experiences of further
inequalities and subjugation for example, being subjected to hostility
and suspicion from the authorities, experiencing racism both at an
individual level and at institutional levels, and being conveniently placed
to be exploited and manipulated by the media, all of which amount to
different levels and degrees of intimidation and persecution. In relation
to health services, asylum seekers and refugee people may face enormous
difficulties in accessing statutory services to which they are entitled, in
being able to make use of health services due to the unavailability or
withholding of professional interpreting services, and in being able to
collaborate in choosing health care options. They are not uncommonly
denied particular services on the grounds that they do not speak English,
or they are not informed of the range of available options, or they are
given a limited service and excluded from accessing other services within
the National Health Service (NHS) on the grounds that they do not have
71hr04.qxd 06/03/03 11:30 Page 19
a permanent address, or that certain services are costly (in time and
financial terms).
Not surprisingly, experiences in exile are often subjectively described
by asylum seekers or refugee people as worse than the torture I suffered
before, but just in a different form, or as emotional torture.
WAR, RIGHTS ABUSES AND PSYCHOLOGICAL CONSTRUCTIONS

The psychological health field owes much to the tragedies of war, human
rights abuses and its products. Indeed, psychology as a discipline has
emerged, advanced and expanded at historically significant points,
namely following the two World Wars. In its early development, British
psychology was dominated by positivism and empiricism and focussed
on the study of individual differences. In applied form this involved
serving the social policy function of classifying and regulating certain
parts of the population, for example, children, people with mental
health problems and criminals.5 War also served to stimulate the
development of other branches of psychology, such as organisational or
industrial psychology, by focussing on the relationship between
productivity and stress; or such as clinical psychology, with a central aim
of providing free psychological healthcare to all in post-war
reconstruction. The specific political and social contexts following major
wars were highly influential precipitants for the development of an
increasingly individualised psychology. The focus was firmly on health
and on the psychological impact of war and human rights abuses.
The discourse on war has been invariably dominated by the construct
of life enhancement, that is, wars where Western states have been
involved (for example, both World Wars, the former Yugoslavia, Somalia,
the Gulf, the Falklands and more recently, Afghanistan) have been
portrayed as a struggle for freedom, democracy and in defence of human
rights.6 As Mary Boyle points out, it is not simply that our gaze is
persistently turned away from the deliberate slaughter of war. It is that
war itself is transformed at least in the official version into something
so different from large-scale killing that the enterprise becomes scarcely
recognisable as involving it.7
Psychological contributions to understanding the nature, causes or
function of war and human rights abuses, and therefore to developing
options for preventative measures, have been stunted by psychologys
sole pre-occupation with the individual suffering of war veterans or of
victims of atrocities and human rights abuses committed outside Britain.
While the cost to individuals, whether war veterans or survivors of
torture and other human rights abuses, is an extremely important area
71hr04.qxd 06/03/03 11:30 Page 20
where psychology can contribute, the parallel neglect of wider socio-

political and historical factors and the economic, social and
psychological consequences for whole communities puts into question
the ethics of the continued symbiotic relationship between psychology
and the social order. Considerable literature exists on combat
experience.8 and on the psychological sequelae and therapeutic
interventions with war veterans.9 Disturbingly, there is a dearth of
Western psychological literature addressing the cost of conflict and
human rights violations to people where Western countries themselves
have been the perpetrators, either in conflict (for example, in the Gulf,
Falklands, or more recently, in the war against terror in Afghanistan) or
in other human rights violations.

Similarly, there is a paucity of literature illustrating and critiquing the
relationship between structural inequalities, abuses of power and their
consequences on both individuals and on whole communities and
nations. Little exists on the role of psychology in either challenging such
practices and in providing healthcare in a way which does not neglect the
political and social contexts of conflicts and human rights abuses and
which does not reinforce these very inequalities.
Not surprisingly the psychological literature on the psychological
problems experienced by war veterans is characterised by a discourse
centred on moral conscience, the clear challenge being war costs us and
we have a moral duty to take care of our war veterans. The reasons for
war, the human rights abuses inflicted in the name of war, and the costs
to civilian victims of war remain startlingly invisible on the whole,
particularly where Western states have been engaged in conflicts.
The psychological health fields interest in victims of conflict and
human rights abuses and their distress does however, date back to the
1950s in Britain. Before exploring the constructions of those fleeing
human rights violations and conflicts that is, refugee people within
the psychological and mental health field, however, it is useful to
examine some of the discourses relating to the history of immigration to
Britain in order to provide a backdrop to understanding current
psychological discourses and their potential functions.
IMMIGRATION AND REFUGEE PEOPLE AS OUTSIDERS

In Britain, the slave trade was not the only human rights abuse nor the
first instance of populations moving into the island, but it was arguably
the beginning of population movements to Britain under involuntary
conditions. Slavery was therefore not forced exile, but rather forced
immigration for the economic benefit of the traders and of the country.
71hr04.qxd 06/03/03 11:30 Page 21
As early as the sixteenth century and well into the nineteenth century
slavery was practised by Britain, despite the Abolishment of Slavery Act in
1806. The slaves were widely construed and portrayed as savages,
cannibals and inhuman.10 Among the first people to come to Britain as
forced exiles were the Irish following the potato famine in the 1840s.
Between 1880 and 1914 Jewish refugees also arrived in Britain, fleeing
persecution in Eastern and Central Europe. Brotherhood as the prevailing
discourse necessitated a humanitarian response to the Irish and the Jewish
refugee people. Culture, religion or colour did not seem to be organising
factors, and the discourse of displaced persons or refugees as being
different and unwanted seemed to be in tense relationship with the
discourse of providing humanitarian aid to brothers.

Since the Second World War the number of displaced persons in
Britain had increased. Two reasons for Britains acceptance of them
included first, that there was a moral obligation to offer asylum to the
Polish people who had fought alongside the British in the Middle East,
Italy and Holland,11 the implication being that humanitarianism, fraternity
and gratitude were possible motives. Second, in respect of the DPs
(displaced persons) pity was mingled with self-interest, for their
recruitment under various schemes had from the very beginning been part
of a plan for alleviating the economic crisis, i.e. the acute labour
shortage.12 The term DP was replaced by EVW, denoting European
Voluntary Worker. Already a distinction had been made in the relative
contributions the refugee people had made or were expected to make to
British society. For the EVWs brotherhood and fraternity were clearly not
the chief motivating factors in granting them asylum. Britains task was
post-war reconstruction, and EVWs were a ready supply of cheap labour.
In the same vein, in 1946 and 1947 Britain had actively selected Baltic
women without dependants from the refugee camps in Germany and
Austria to come to work in Britain as domestics, nursing auxiliaries and
textile workers. In the 1950s an increasing demand for labour in post-war
reconstruction prompted the British government to invite people from its
former colonies to seek employment in Britains developing industries.
However, the subsequent downturn of the economy in the late 1960s saw
the introduction of stricter entry requirements, and racism was destined
to flourish, fuelled by political speeches warning the nation that Britain
would be swamped by black people.
Ian Spencer provides a cogent account of how the experience of
racism by black and minority ethnic settlers was used in debates around
tightening immigration laws.13 It was those populations construed as
being most different and foreign from the majority British population
which were targeted in immigration policy. Cultural difference, not
71hr04.qxd 06/03/03 11:30 Page 22
colour, was the explanatory framework utilised in immigration policy

and dispersal policies which aimed to enforce cultural assimilation.
Immigration policy and legislation were progressively tightened,
disguised in cultural terms. In 1978 Margaret Thatcher, Prime Minister
at the time, had declared a war on numbers in a notorious speech,
suggesting that:
People are really rather afraid that this country might be rather
swamped by people with a different culture the British character
has done so much for democracy, for law, and done so much
throughout the world, that if there is any fear that it might be
swamped, people are going to react and be rather hostile to those
coming in. So if you want good race relations youve really got to
allay peoples fear on numbers.
In the 1970s, refugee people fleeing persecution continued to seek asylum
in Britain, arriving from Uganda, Cyprus, Chile, Vietnam and Argentina.
Immigration policies continued to be tightened and in 1993 the
amalgamation of Britains immigration and asylum laws indicated a clear
conceptual shift, the implication being that the influx of foreigners
needed greater control, regardless of the differing and often complex
reasons for migration. The discourse of refugee people as being the same
as all immigrants and as being different and unwanted and as an
economic burden, continues to prevail. The discourse and constructions
of refugee people as seeking a humanitarian response and protection from
human rights violations has become increasingly obscured and, not
surprisingly, refugee people remain vulnerable to stereotyping, exclusion
and to further human rights abuses both within the receiving country and
in the countries to which they are later deported.
PSYCHOLOGYS MAKING OF REFUGEE PEOPLE

Refugee people, and not the circumstances or experiences which led
them to seek safety in another country, have been the subject of
considerable research and theorising in the psychological health field. In
its traditional preoccupation with establishing difference, psychological
research has been dominated by questions which centre around the
differential ways in which refugee people express their distress in
comparison to indigenous populations, and the possible reasons for these
differences. Eurocentric notions of health, characterised by Cartesian
dualism, have resulted in a clear division of physical and psychological
health research. In terms of psychological health, research has largely
focussed on questions such as: Are refugee people more likely to suffer
71hr04.qxd 06/03/03 11:30 Page 23
from psychological problems than the receiving, majority, indigenous
population? What are the most prevalent psychological disorders within
refugee populations? What are the psychological sequelae of exile and
torture?
Many studies have focussed on establishing a difference in rates of
mental illness among refugee and the indigenous population.14 The focus
on difference has been operationalised in the employment of research
methods designed to compare refugee groups with non-refugee groups,
in search of a statistically significant difference. While being a potentially
useful starting point for psychological research, such traditional research
has served the discourse of refugee people as being a distinct group,
homogenous and different from the majority population in the receiving

country. The within-group differences, the heterogeneity of refugee
people and their differing historical, social, economic and political
contexts are neglected. An opportunity to closely examine the
relationship between different human rights violations, forced exile and
the psychological, social and economic needs of refugee people is missed.
The regulatory and control functions of human rights violations and
psychologys role in sustaining such processes is unacknowledged in
psychological research.
Earlier writers and researchers have focussed on the migration
process itself, not necessarily distinguishing between voluntary migrants
and refugee people forced into exile. Some have suggested that it was the
migration process itself which led to psychological vulnerability and
psychological disturbance in migrants.15 The concept of psychological
vulnerability within migrants has been a persistent theme in
psychological theorising and research, the theoretical assumption being
that it is the constitutional vulnerability of migrants that accounts for
psychological and mental health problems experienced by them. In such
paradigms, the migration itself is understood as a precipitant. Some have
blamed the apparent phenomenon of mental health problems among
immigrants on the fact that migration supposedly attracts mainly the
destitute and the incompetent.16
Thus, the psychological constitution of the migrants was in question
and migration stresses were seen to have either accelerated or triggered
existing psychological weaknesses. In describing what he referred to as
refugee psychoses in post-war Britain, Kino suggests that in the great
majority of these instances the external conditions represent only an
additional, precipitating, etiologic factor which is operating as a trigger
mechanism to a mental derangement of non-specific character already
present in a latent state.17 Studies in the 1960s and 1970s continued to
focus on narrow questions such as why migrants have supposedly higher
71hr04.qxd 06/03/03 11:30 Page 24
rates of mental disorders, under which conditions they develop these

disorders and the prevalence rates of mental illness in their country of
origin.18 The explanatory discourses utilised were still those relating to
inherent constitutional weaknesses within refugee people and those
relating to the stresses of migration and adjustment to the receiving
community. The refugee person was the location of the problem itself,
and while external conditions were acknowledged in essence, they were
incidental to the real vulnerability or disorder assumed to already be
there. This trend in psychological literature was not confined only to
refugee people, but in its continued popularity it holds particular
significance for those who were in the making both politically and
psychologically: refugee people who are fleeing persecution and

violence.
Psychological research in the last decade has continued to report
increased rates of serious psychopathology among refugee people.19
Many studies report on the prevalence of post-traumatic stress disorder
in refugee people.20 A relationship is suggested between the disorder and
precipitating stressors, including migratory stressors and those stressors
related to persecution and war, such as torture, violence and the loss of
loved ones. The psychological discourses of refugee people as being
different and as constitutionally weak or vulnerable appears to have been
increasingly superseded by the discourse of trauma.
Since its inclusion in the Diagnostic and Statistical Manual of the
American Psychological Association in 1980, the construct post-
traumatic stress disorder began a revolution in the psychological health
field and in other fields. Trauma has become the dominant construct and
experiences of conflict, atrocities, organised violence, torture and exile
are accounted for by theorising about the traumatised victim, not the
foreigner, the gastarbeiter or economic worker. In so doing, the
psychological discourse of trauma has skilfully averted the professional
gaze from the causes that is social inequalities, injustices and human
rights violations to the individual. The discourse of refugee people as
different has by no means disappeared as evidence in the media and
political rhetoric, but in psychology it has become encapsulated within
the discourse of trauma and in so doing, has neutralised challenges to the
discriminatory functions of such discourses. Within psychology the
discourse of refugee people as different could have developed to
encompass positive constructions of difference and diversity in
experiences, cultural and political backgrounds, belief systems and
methods of survival of the human spirit in extreme circumstances. The
advances which could be gained in understanding the nature of the
inextricable links between people and their social and political contexts,
71hr04.qxd 06/03/03 11:30 Page 25
and in developing a just psychology aimed at the prevention of human
rights violations and at developing conditions for psychological, social
and political health, have been severely hampered if not stunted by the
domination of the discourse of trauma.
Inevitable consequences of the dominant trauma discourse have
included the theoretical and service developments within psychology and
psychiatry, giving such professions questionable, unrivalled credibility in
explaining and addressing the problems related to social injustice and
human rights abuses. Post-traumatic stress clinics are developed and
resourced within statutory health services to address the needs of refugee
people, and research activities secure funding to identify psychological
need and the prevalence of psychological disorders. A disturbing question

to ask is: would psychologists remain so naively earnest and resistant to
reflexivity if there were similar suggestions to develop, say, depression
clinics for the unemployed or the homeless? The trauma discourse has
also been utilised to develop many psychosocial programmes in conflict
zones, designed to offer a rapid home delivery of Western psychological
technology to people whose primary concerns may not be their
constitutional weaknesses, or their traumatised psyches, but perhaps a
combination of personal and collective distress, a lack of basic resources,
and the devastation of their infrastructure and their social world. Alastair
Ager argues that in the last 60 years responses to the psychosocial needs
of refugee people has developed to consider both individual needs and
broader social needs, resulting in an increasing number of programmes
developing population-level interventions, for example by strengthening
community structures and activities, as well as offering or enabling access
to individual interventions.21 Significantly, the individual-based
interventions continue to rely invariably on Western psychological
psychiatric theories, methodologies and practices, heavily reliant on and
integral to the trauma discourse. In a powerful critique of psychological
trauma programmes in war-affected areas, Derek Summerfield analyses
key underlying assumptions, arguing that such assumptions have
promoted the idea of war as a mental health emergency and that
psychosocial programmes have reflected the medicalisation of distress
and the reframing of the suffering of war as a technical psychological
problem to which short-term technical solutions such as counselling are
applied.22
In the next section some of the functions of prevailing psychological
discourses and practices in relation to survivors of human rights abuses
are explored, and the limitations of traditional psychological approaches
in relation to the field are highlighted.
71hr04.qxd 06/03/03 11:30 Page 26
DOES CLINICAL PSYCHOLOGY REINFORCE INEQUALITIES?

The popularity of psychology and related advances in the field have led
to descriptions of the twentieth century as the psychological century.23
Given that psychological discourses and practice have gained
tremendous ground and status in the West, it is only logical that
psychologists should be prepared to, first, unveil their own professional
values and ideologies and, second, to explore the possible ideological
functions of this privilege that psychology currently enjoys.
In examining psychological contributions to the field of human rights
abuses four main themes and limitations become more transparent:
Eurocentricity in Psychology
Mainstream psychology is inherently Eurocentric in that the constructs,
theories, research and clinical practice methods have all been developed
within a Western context; assessment tools, often utilised as research
tools too, are standardised on norms established with white European
and American populations. Health is constructed within dualist
philosophical traditions, that is, it is understood in terms of physical and
psychological health alone. The body and mind constitute the self.
Psychology, as theorised and practised in the West, is therefore
unquestionably culture-bound. Yet it is centred on the assumption of
universality: that ultimately, all human beings are configured in the same
way, their biologies and psychologies are designed and function in the
same manner and therefore, individual differences acknowledged, all
psychological theories and practices are equally valid and applicable to
all. For example, the assumption of universality in psychological
responses to extreme events leads to discourses and practices which hold
that constructs such as trauma, post-traumatic stress disorder or clinical
depression exist everywhere24 and have the same meaning in whichever
culture. Patrick Bracken et al.25 argue that this amounts to what Arthur
Kleinman calls a category fallacy: the verification of a nosological
category developed for a particular cultural group that is then applied to
members of another culture for whom it lacks coherence and its validity
has not yet been established.26
Of course, the development and the use of diagnostic categories even
within the confines of the West is not without problems, and diagnoses
continue to be severely criticised for their ideological derivations, social
control functions and spurious validity.27 But in the context of human
rights violations and working with refugee people little attention has
been paid to the ideological functions of psychological theorising and
practice.
71hr04.qxd 06/03/03 11:30 Page 27
Isaac Prilleltensky has eloquently justified the relevance of an
ideological analysis of psychology,28 particularly given that Western
society holds psychology in such high regard and that psychology
unquestionably plays an important role in the cultural and political
mechanisms which support and perpetrate the position of the ruling
majority. The Eurocentricity of psychology inevitably serves those whose
norms and values are represented within psychology. Inevitably, the
discipline of psychology and the profession of clinical psychology is
dominated by white, middle-class people. The domination of patriarchal
and Eurocentric values and assumptions in theory-production research
activities, therapeutic endeavours and health services development is a
given. The elitist activity of doing therapy, the psychological technology

of current times, is reserved for largely white, Western professionals.
Psychologists from minority ethnic backgrounds, including refugee
backgrounds, are in the minority or absent. Academics and health
professional experts who contribute to conferences, international
agencies, academia and service delivery are rarely refugee people who
have experience of human rights violations. It is the already empowered
who are licensed to speak on behalf of the disempowered. In
perpetuating existing power relations psychologists have thus continued
to serve the social order. However, as Prilleltersky points out, this is not
a result of a conscious effort to serve themselves, by deceiving the
population as to the nature of power relations; rather it derives mainly
from an efficient socialisation which has taught psychologists not to
question or challenge the existing social system.29
Unfortunately, psychologists and other psychological or psychiatric
health practitioners, in their genuine efforts to address the difficulties
faced by refugee people, may inadvertently compound the oppression
already experienced by refugee people by the unquestioning use of
Eurocentric theories and practices. Elsewhere, this has been described as
paradoxical oppression,30 that is, the phenomenon where practitioners
intended meanings of psychological language and constructs and their
practices contradict their implicit oppressive meanings and functions and
the psychological discourses from which they are drawn. Using
Eurocentric theories and practices in a constructive way simply serves
the function of alternative discourses and practices which could be more
empowering to survivors of human rights abuses.
Individualistic Nature of Psychology

Western psychology in its ethnocentricity has naturally privileged the
Western notion of self as an individual, separate, autonomous and
independent being. The privileging of such constructions of self within
71hr04.qxd 06/03/03 11:30 Page 28
psychological theories, research and practice has ensured that the

significance of context is marginalised or completely ignored. The
context-specificity of the development of Western philosophies and their
products, Western psychologies, this remains largely unquestioned at
worst and at best merely acknowledged. The political, economic,
historical, social and cultural contexts within which psychology has
flourished are central to understanding the limitations of psychology
when applied to those from differing contexts.
Despite critical advances in this direction in psychology, particularly
in countries where there are significant numbers of minority ethnic
people, including refugees, such as the United States and Britain, the vast
majority of psychological theorising and practice in relation to refugee

people has remained oblivious or unsophisticated in addressing issues of
power and of cultural, social and political contexts. Cultural contexts
vary tremendously from one community to another, ranging from
differences in philosophies, religious beliefs, language, rituals, traditions,
child-rearing, mourning practices, constructions of self, emotions and
healing. For example, the Western ideals of psychological individuation,
separation and independence, markers of healthy adulthood, are
perceived in other cultural contexts as primitive modes of relating and as
requiring efforts to transcend such narcissistic tendencies.31
Constructions of emotion are equally culturally-specific and subject to
cultural influences in the development of theoretical, political, religious
or explanatory frameworks and methods which are designed to address
those emotions. The emphasis on the individual in Western
psychological approaches to emotional distress thereby neglects the way
in which each persons cultural context has shaped their sense of self,
their understanding of distress, their expression of distress (emotional,
spiritual, physical) and the relationship between their distress and the
distress in their family or community. Methods of dealing with distress
within Western psychology most commonly entail individual therapy,
with the exception of systemic therapies, group therapies and
community psychology, although the latter are equally culturally-bound
and Eurocentric in their origins and often in their application. At the
heart of almost all these therapeutic approaches is the assumption that
talking is healing:
the use of talk therapy aimed at altering individual behaviour
through the individuals insight into his or her own personality is
firmly rooted in a conception of the person as a distinct and
independent individual, capable of self-transformation in relative
isolation from particular social contexts.32
71hr04.qxd 06/03/03 11:30 Page 29
In many cultures talking may be considered a useful healing method
in the context of group or social gatherings, while for others, talking,
particularly to an individual stranger, is tantamount to a loss of dignity
and humility and can be seen as not only self-indulgent but as bringing
shame onto the family or community. Culture in this sense can also
extend to political culture for example, a Kurdish political activist once
remarked in therapy, Talking makes things worse; talking costs lives and
while I am here talking my comrades are being slaughtered by the
dragon. How can talking help them? For the client talking was equated
to inaction, self-indulgent and as a betrayal to his colleagues and his
people. Equally significant was his privileging of his political identity and
sense of duty in relation to his comrades and the values in his political
culture of stoicism, secrecy and solidarity, values which stand starkly in
contrast with the values and aims embedded in psychological theorising
and practice.
In focussing on the individual as the location of the problem or
distress, and therefore as the target of change using psychological
therapy, psychologists have also conveniently neglected the wider social
context. Individuals do not exist in isolation, in a vacuum. As social
beings people are inevitably and inextricably connected to each other in
complex ways. In the context of war, Summerfield33 stresses that war is
a collective experience, and perhaps its primary impact on victims
Western and non-Western is through their witnessing the destruction of
a social world embodying their history, identity and living values, and
roles. This is not a private injury, being carried by a private individual.
The impact of conflict and atrocities reverberates beyond the individual,
affecting whole communities and societies,34 and often violence is an
ongoing and pervasive reality with devastation extending beyond the
individual to peoples homes, schools, hospitals, work in short, to their
social world. In exile, experiences of hostility, verbal harassment,
aggression, racist violence, enforced dispersal, separation from loved
ones and comrades, social isolation, no or inadequate housing, poverty
and prohibitions to employment, all constitute the impoverished and
harsh social context within which the seeds of distress are sown.
The individualisation of distress, a hallmark of traditional
psychological approaches, thus seems to extricate the cultural, social,
political and historical contexts from personal and collective distress.
Inevitably, and conveniently, the psychologists gaze is averted from
social injustices and human rights violations which continue to be
perpetrated both in Britain and elsewhere in the world. Furthermore,
such approaches provide an ideological benefit: solutions are to be found
exclusively within the self, leaving the social order conveniently
71hr04.qxd 06/03/03 11:30 Page 30
unaffected. Furthermore, technological solutions are deemed to be with

35
professionals psychological health experts, not those who have

endured and survived human rights violations and a privileged status
and technologies are secured.
Pathologising in Psychological Approaches

In examining the discourses within psychology, particularly with
reference to refugee people, it becomes apparent that the language most
widely used is heavily reliant on constructs of pathology and illness, a
malaise itself within psychology. Distress is skilfully explained in
medicalised and psychologised ways using constructs of pathology,
deficiency, deviancy from the assumed norm and dysfunctionality.

Already vulnerable in emotional, social, material and political terms,
refugee people become prime repositories for psychologists own
professional frustrations and sense of helplessness in accounting for and
addressing the social injustices and abuses of their time. In their efforts
to ease the suffering experienced by individuals they unfortunately make
liberal use of psychological, apparently expert, language and theories to
offer meaning and palliatives to essentially social and political problems.
For example, terms such as traumatisation, psychological damage and
psychic injury with the labels of psychiatric diagnostic categories are all
used to point to individual suffering, which in itself is not problematic
for there is unquestionably a link between personal and collective
suffering and wider social inequalities and abuses of power. What is
under contention here is, first, the utility of weak, unsophisticated
psychological explanations for complex political realities and, second,
the ideological functions of discourses furnished in the language of
pathology.
Most notably, discourses of pathology legitimate the expertise and the
role of psychology and psychiatry in addressing human rights abuses. The
psychologists privilege is a stronger standing in the human rights arena,
a more powerful voice in the field and a greater access to limited financial
resources to conduct more psychological research in the same vein, to
disseminate their ideas to a wider audience via international conferences
and publications, and to develop more psychological or psychological
services both locally and abroad. The voices of refugee people who have
experienced human rights abuses remain marginal or silent. Discourses of
resiliency, strength and the struggle and survival of the human spirit
remain subjugated on the whole. The political and social efforts of whole
communities to manage their suffering, continue their struggles against
oppression and injustice and to rebuild their lives in exile are rarely
acknowledged, let alone privileged, in psychological discourses.
71hr04.qxd 06/03/03 11:30 Page 31
Of course inevitable social actions result from discourses.
Psychological therapies are apparently logical solutions to psychological
explanations, and as such options for alternative methodologies or
ideologies are blocked or become invisible. The position of psychological
experts is reinforced, protected and elevated with a parallel subjugation
of the already disempowered. The silenced are further silenced, their
voices heard mostly when they are perceived as seeking help. In this
enforced silence previous experiences of oppression and persecution can
be re-experienced and their relative helplessness and dependence on the
receiving countrys government and experts is compounded. Global
inequalities and power relations are maintained, and in exile the refugee
person is positioned not only as in need of professional, economic,

political and psychological help, but as someone who is licensed only to
show gratitude to those who grant them the opportunity to live a healthy
life free of social injustice.
De-politicising Human Distress and the Stance of Neutrality

By locating the causes and experiences of distress at the level of the
individual psyche, psychological approaches have a tendency to actively
de-politicise distress. Psychologists continue to focus on effects, not the
root causes of distress. Political violence, human rights abuses, poverty,
racism, environmental degradation, conflicts and so on are only of
interest in the products that they give rise to: the destruction of human
lives and the assault to peoples physical and emotional integrity. The
relationship between systems of structural inequality and oppression and
the accumulation of wealth, power and privilege remain marginal, if not
totally absent, in psychological theorising and methods to alleviate
suffering. The role of human rights abuses in sustaining inequalities is
not explored. The relationship between those inequalities and peoples
emotional, social and political well-being is not the focus of
psychological investigation and solutions.
However, that is not to say that psychology is apolitical or politically
neutral. On the contrary, the history of psychology is replete with
examples of how psychologists have served political motives, most
notably in its contributions to the area of race and IQ, which held that
black people are innately intellectually limited and that this justifies
differential treatment towards them in education and immigration.36
Similarly, the political position held by psychologists and psychiatrists
in the development of the diagnostic category of post-traumatic stress
disorder after the Vietnam War provides another example of the deeply
embedded political values within psychology and psychiatry. As
Summerfield37 points out, PTSD was as much a socio-political as a
71hr04.qxd 06/03/03 11:30 Page 32
medical response to the problems of Vietnam War veterans, and its

inclusion as a disease category in 1980 directly related to Vietnam War
veterans and participants of the antiwar movement in USA, who argued
that war veterans seen as having committed atrocities were also victims
and traumatised by their roles, and as such they deserved specialised
psychiatric care. Allan Youngs38 extensive analysis of the development
and use of the construct post-traumatic stress disorder provides a clear
illustration of the lack of political neutrality in psychology and
psychiatry:
The psychological pathology of the individual, the microcosms, has
a mirror image in the moral pathology of the collectivity, the social
macrocosms. The collective secret is a wilful ignorance of traumatic

acts and a denial of post-traumatic suffering. Patients are victims
twice over: victims of the original perpetrators and victims of an
indifferent society. The therapeutic act of bringing the secret into
full awareness is now inextricably linked to a political act. Vietnam
war veterans are the first traumatic victims to demand collective
recognition.39
But the most serious deception lies in the strategy within psychology
and psychiatry to obscure the personal and professional political values
and motives by claiming impartiality, scientific objectivity and neutrality.
Clinical practice portrays professionals as neutral actors in establishing
psychological needs and the solutions to alleviating distress. The stance
of neutrality also lends itself to various ideological uses. As Prilleltensky40
points out, by portraying itself as a strictly objective endeavour, many
of psychologys prescriptive biases are erroneously interpreted as merely
descriptive assertions about human behaviour but their prescriptions or
solutions often conform with dominant ideologies. However
unintentional, this ideological position of apparent neutrality also allows
psychologists to ignore the significance of their own values and privileges
and to avoid questioning their own part in perpetrating oppressive
practices in the guise of professional help. The cloak of professional
neutrality ultimately functions to defend and legitimate human rights
abuses and contradicts the humanitarian values of psychological
investigation and interventions with those who have suffered human
rights violations.
DOES CLINICAL PSYCHOLOGY FACILITE EMPOWERMENT?

It could be argued that psychological approaches, by enhancing self-
awareness, by developing individuals capacities to make choices and by
71hr04.qxd 06/03/03 11:30 Page 33
emotionally processing the impact of extreme human rights violations,
provide a route towards personal rights and freedom in a democracy.
However noble in their intentions and in making such assertions,
psychologists adopting such views could be challenged on the grounds of
political naivety and for perpetuating the belief that the responsibility for
change lies with the individual, and that inequalities, injustices and
powerlessness can be effectively addressed only from within the
individual. The main thrust of the argument here is that the route to
emotional, social and political well-being is through equality, justice and
human rights and that psychological interventions aimed solely at the
individual cannot in themselves effect any meaningful and lasting change
towards a more just society. Empowerment thus interpreted represents

not simply the process by which psychologists facilitate personal power
and the capacity of individuals to make their voices heard and to effect
change in their personal lives, but also represents political power, that is,
the creation of opportunities for people to challenge and change the
social and political realities which impact on their lives and their health.
The questions psychologists might ask themselves are: Is there a role
for clinical psychology in the field of human rights abuses and social
inequalities? If so, what is that role and how can psychologists contribute
constructively to upholding basic human rights in a way that does not
unwittingly serve the social order? Is empowerment possible in
psychological practice and what might it entail?
The position taken here is that if there is a role for clinical psychology
then it has to be to:
Acknowledge, account for and address both the individual and the
social cost of human rights abuses, conflict and organised violence.
Use psychological research methodologies, theorising, clinical practice
and strategies for service development both in a way that makes
explicit and critiques those approaches from the point of view of the
ideological functions and social consequences, and in a way that
actively addresses the causes of distress, not just the effects.
Use psychological approaches both to make explicit the relationship
between social injustices, structural inequalities, oppression and health
and to suggest ways in which the health costs to individuals,
communities and whole societies can be prevented.
In such an approach empowerment comes to mean grappling not

only with personal helplessness, powerlessness and distress through
therapies aimed at the transformation of the individual, but actively
challenging the very inequalities and acts of oppression experienced by
71hr04.qxd 06/03/03 11:30 Page 34
survivors of human rights violations in everyday life. Empowerment can

be facilitated to some extent in therapeutic endeavours, and in the
Foucauldian sense of power, sites and acts of resistance can be nurtured
in the privileging of subjugated voices and narratives. But empowerment
beyond the use of language and alternative discourses can only be
achieved by addressing the material realities of structural inequalities.
Talking is not enough and social action has to become part of the
repertoire of skills of clinical psychologists and other psychological
health practitioners.
There are a plethora of ways in which psychologists can engage in
social action in the field of human rights and refugees, and only some
examples are given here, as a fuller illustration and discussion of each

strategy or approach is beyond the scope of this article.
Social action can be operationalised in the research process which
psychologists engage in. For example, ethical research should be
empowering research, whereby the development of research questions
lies with the very people to whom the research pertains. More often than
not, it is psychologists who construct research questions to pursue areas
of research in which they have a vested interest, regardless of whether
those research questions are of any real interest, relevance or utility to
the researched. The research process needs to entail an active
involvement of refugee people, survivors of human rights abuses, both
from the early stages including formulating research questions,
conducting the research, analysing results, interpreting and discussing
analyses, and also in the subsequent acts of producing verbal or written
reports of the research and in deciding which audiences the research
findings should be disseminated to, in what form and to what end. For
research is a political act, and the use of psychological and research
technologies to publicise the effects and processes of injustices, human
rights violations and oppression, as well as to demand change in
particular practices and oppressive structures is in itself an act of
resistance. In this regard, psychologists can be more honest and more
accountable for their role in serving or in challenging the social order but
they can only do this by making explicit their own political values and
motives at every stage of the research process. Psychological research
skills can be offered to and used by survivors of human rights abuses to
effect change in the form of justice and reparation.
Social action can also operate at the level of developing health
services. Discriminatory practices and policies (informal or formal)
within health services which have an obligation to serve refugee people
can be exposed and actively challenged by psychologists, for example
where clients are denied access to a psychological service on the grounds
71hr04.qxd 06/03/03 11:30 Page 35
that they do not speak English, or that their emotional social and asylum
needs are too complex, time-consuming or costly. All psychologists have
an ethical and professional duty to challenge the assumptions, inherent
biases and the very policies and practices which not only reinforce
inequalities but actively abuse peoples basic human rights to access
equitable and quality health services. Social action can involve writing
letters, demanding explanations and change, providing active support,
consultation and guidance to enable health services to better address the
needs of survivors of human rights abuses in empowering ways.
Initiatives within health services designed to address refugee peoples
emotional and social needs can be developed in genuine partnership with
refugee community organisations services conceived of and developed

in response to what refugee people themselves prioritise as their needs,
which of course may not match professional constructions of need or
professional expectations of what constitutes healthcare. Social action
thus means privileging the constructions and desired outcomes of the
very people whom psychologists profess to serve by making available
themselves, their skills and their access to resources in away that
empowers them, that enables them to demand and realise change in their
social context, however local.
The role of psychologists in openly contributing to social policy and
government practices is often hugely underrated and neglected. Social
action can begin with the acknowledgement that psychologists have
played powerful roles historically in adversely influencing and shaping
social policies, for example in education and health services and even in
sustaining apartheid. Thus, psychologists do have a role in influencing
social policy but with an obligation to ensure that their roles and
contributions are ethical and ultimately prioritise and protect the welfare
of clients, such as refugee people. The range of ways in which
government policy and practices can be influenced includes using
psychological research as previously suggested, providing consultation to
and engaging in active dialogue with policy makers about the deleterious
impact of government policies and practices on the emotional, social and
political health of refugee people, and providing training to civil servants
on, for example, their interviewing styles and methods with asylum
seekers, or dealing with an asylum seekers memory difficulties,
emotional traumas and the effects of torture.
Social action can of course be operationalised within the process of
theory-production in psychology. Psychologists can contribute to the
developments of theories which attempt to account for the uses and
abuses of power, the role of social inequalities in health outcomes and
the abuses inherent in psychological practices themselves. Theory-
71hr04.qxd 06/03/03 11:30 Page 36
production can actively involve and be accountable to those whom

psychologists may be theorising about, that is, developing theories based
on the subjectivity and narratives of refugee people who have
experienced human rights abuses. But as no theory is ideologically
denuded and politically neutral, any psychological theorising which
attempts to account for distress, its origins and processes, must also make
explicit its own inherent biases and values in the solutions to which it
points or implies. As such, psychological theory-production is inherently
and inevitably context-specific, and the potential for its uses and abuses
need to be acknowledged, highlighted and challenged, particularly
where its effects may be harmful or reinforce inequalities already
experienced in other ways by refugee people.

Finally, there are many ways in which social action can be integral to
clinical therapeutic approaches to working with refugee people who
have experienced human rights violations. One example is the
development and application of Hollands social action psychotherapy
model41 to working with survivors of torture.42 In this approach, only
highlighted here, a key aim in any therapeutic endeavour is to address a
persons own sense of powerlessness and distress as it relates to the
social, political and material contexts from which it arises, but in a way
that enables the person to actively challenge and perhaps change those
inequalities wherever possible. Clients can thus be facilitated to move
from various stages, for example, from symptom acknowledgement and
management to meaning-making and to the stage of articulation of the
social self, and towards the stage of using the collective voice to demand
and effect structural changes not only in their own environments and
lives, but also more widely in the social and political contexts where
human rights abuses continue to be perpetrated.
CONCLUSIONS
This article has discussed the ethical responsibilities of clinical
psychologists in addressing the experiences of human rights violations
and exile in their psychological theorising and practice. The main issues
explored were, first, to what extent psychologists continue to reinforce
inequalities by unquestioningly reaffirming existing oppressive
theorising and practices and thereby maintaining the status quo and
endorsing human rights violations and second, to what extent could they
attempt to facilitate empowerment of those who have suffered human
rights violations and by challenging the social and political order by
offering theoretical and practical alternatives towards a more just
psychology. For any psychologist committed to the humanitarian values
71hr04.qxd 06/03/03 11:30 Page 37
embedded within psychology, the challenge is to engage in critical
reflection of their own professional and personal biases which serve the
social order and which contribute to the perpetration of abuses of power
and the maintenance of social inequalities. If they are to confront human
rights violations and to contribute to social change the question to which
psychologists should all direct their personal, professional and material
resources and privileges as psychologists is: what constitutes a just
psychology?
NOTES
1. S.B. Sarason, Psychology Misdirected (New York: Free Press 1981) Preface, p.x.
2 J. Welsh, The Problem of Torture, in M. Peel and V. Iacopino (eds.), The Medical
Documentation of Torture (London: GMM), p.4.
3. Ibid., p.6.
4. A. Ager, Responding to the Psychosocial Needs of Refugees, in M. Loughry and A.
Ager (eds.), The Refugee Experience, Psychosocial Training Module, revised edn.
(Oxford: University of Oxford: Refugee Studies Centre, 2001), pp.1617.
5. D. Pilgrim and A. Treacher, Clinical Psychology Observed (London: Routledge 1992),
pp.24.
6. M.E. Boyle, Re-thinking Abortion: Psychology, Gender, Power and the Law. (London:
Routledge 1997), pp.54.
7. Ibid., p.54.
8. For example, see R. Yehuda, S.M. Southwick and E.L. Giller, Exposure to Atrocities
and Severity of Chronic Post traumatic Stress Disorder in Vietnam Combat Veterans,
American Journal of Psychiatry, Vol.149 (1992), pp.3336.
9. For example, see T.M. Keane, J.A. Fairbank, J.M. Cadell and R.T. Zimmering,
Implosive (Flooding) Therapy Reduces Symptoms of Post-traumatic Stress Disorder in
Vietnam Veterans, Behaviour Therapy, Vol.16 (1989), pp.912. Also, see L.S. OBrien
and S.J. Hughes, Symptoms of Post-traumatic Stress Disorder in Falklands Veterans
Five Years after the Conflict, British Journal of Psychiatry, Vol.159 (1991) pp.13541.
And in relation to the long-term psychological effects of war in veterans of the Second
World War see N. Hunt, Trauma of War, The Psychologist, Vol.10 (1997), pp.357.
10. P. Fryer, Staying Power: The History of Black People in Britain (London: Pluto 1984),
pp.1367.
11. M. Bulbring and E.Nagy, The Receiving Community in Great Britain, in H.B.M.
Murphy (ed.), Flight and Resettlement, 2nd edn. (Montreal: GIRAME 1955), p.113.
12 Ibid.
13. See I.R.G. Spencer, British Immigration Policy since 1939:The Making of Multi-racial
Britain (London: Routledge 1997).
14. For example, see P.J. Hitch and P. Rack, Mental Illness among Polish and Russian
Refugees in Bradford, British Journal of Psychiatry, Vol.137 (1980), pp.20611; J.
Krupinski, Sociological Aspects of Mental Ill-health in Migrants, Social Science and
Medicine, Vol.1 (1967), pp.26781.
15. For examples, see O. Odegaard, Immigrants and Insanity: A Study of Mental Disease
among the Norwegian-Born Population in Minnesota, Acta Pschiatrica et Neurologica
Scandanavia, supplement 4 (1932); J. Krupinski, F. Schaechter and J.F. Cade, Factors
Influencing the Incidence of Mental Disease among Immigrants, Medical Journal of
Australia, Vol.2 (1965), pp.26981; J. Krupinski, A. Stoller and L. Wallace, Psychiatric
Disorders in Eastern European Refugees Now in Australia, Social Science and
Medicine, Vol.7 (1973), 316; V.D. Sanua, Immigration, Migration and Mental Illness:
A Review of the Literature with Special Emphasis on Schizophrenia in E.B. Brody (ed.)
71hr04.qxd 06/03/03 11:30 Page 38
Behaviour in New Environments (Beverly Hills: Sage, 1969).

16. G. Grob, The State and the Mentally Ill (Chapel Hill: University of North Carolina
1965).
17. F. Kino, Refugee Psychoses in Great Britain: Aliens Paranoid Reaction, in H.B.M.
Murphy (ed.), Flight and Resettlement, 2nd edn. (Montreal: GIRAME 1955), p.195.
18. See H. Murphy, Migration, Culture and Mental Health, Psychological Medicine, Vol.7
(1977), pp.67784; B. Malzberg, Are Immigrants Psychologically Disturbed? in S.C.
Plog and R.E. Edgerton (eds.), Changing Perspectives in Mental Illness, (New York:
Holt, Reinhart and Winston 1969).
19. For example, D. Kinzie, Post-traumatic Effects and Their Treatment among Southeast
Asian Refugees, in J. Wilson and B. Raphael (eds.), International Handbook of
Traumatic Stress Syndromes (New York: Plenum 1993), pp.31119.
20. For example, R. Mollica, G. Wyshak and J. Lavelle, The Psychosocial Impact of War
Trauma and Torture on Southeast Asian Refugees, American Journal of Psychiatry,
Vol.144 (1987), pp.156772; D. Kinzie, R. Frederickson, R. Ben, J. Fleck and W.
Karls, Post-traumatic Stress Disorder among Survivors of Cambodian Concentration

Camps, American Journal of Psychiatry, Vol.141 (1984), pp.64550; J. Kroll, M.
Habenicht and T. MacKenzie, Depression and Post-traumatic Stress Disorders in
Southeast Asians, American Journal of Psychiatry, Vol.146 (1989), pp.15927.
21. Ager (note 4), pp.1327.
22. D. Summerfield, A Critique of Seven Assumptions behind Psychosocial Trauma
Programmes in War-affected Areas, Social Science and Medicine, Vol.48 (1999),
pp.144962.
23. S. Koch and D. Leary (eds.) A Century of Psychology as Science (New York: Mcgraw-
Hill 1985), p.33.
24. P.J. Bracken, J.E. Giller and D. Summerfield, Psychological Responses to War and
Atrocity: The Limitations of Current Concepts, Social Science and Medicine, Vol.40
(1995), pp.107382.
25. Ibid., p.1074.
26. A. Kleinman, Anthropology and Psychiatry: The Role of Culture in Cross-cultural
Research on Illness, British Journal of psychiatry, Vol.151 (1987), p.447.
27. See M.E. Boyle, Schizophrenia: A Scientific Delusion?, 2nd edn. (London: Routledge
2002).
28. I. Prilleltensky, Psychology and the Status Quo, American Psychologist, Vol.44 (1989),
pp.795802.
29. Ibid., p.796.
30. See N. Patel, Assessments with Refugee People: An Exploratory Study, unpublished
manuscript by University of Hull, 1998.
31. K.N.C. Dwivedi, Social Structures that Support or Undermine Families from Ethnic
Minority Groups: Eastern Value Systems, Context, Vol.20 (1994), pp.1112.
32. G.M. White and A.J. Marsella (eds.), Cultural Conceptions of Mental Health and
Therapy, (Dordrecht: D. Reidal 1982), p.28.
33. Summerfield (note 22), p.1455.
34. I. Martin-Baro, War and the Psychosocial Trauma of Salvodorian Children, Posthumous
presentation to the Annual meeting of the American Psychological Association, Boston,
MA, 1990.
35. For a discussion of ideology and psychology, see G.W. Albee, Politics, Power,
Prevention and Social Change, in J.M. Joffe and G.W. Albee (eds.), Prevention through
Political Action and Social Change (Hanover, NH: University Press of New England
1981) pp.324. Also, see D.R. Fox, Psychology, Ideology, Utopia and the Commons
American Psychologist, Vol.40 (1985) pp.4858.
36. For more details see K. Henwood and A. Phoenix, Race in Psychology: Teaching the
Subject, in M. Bulmer and J. Solomos (eds.), Ethnic and Racial Studies Today
(London: Routledge 1999), pp.99114.
37. Summerfield (note 22), p.1450.
71hr04.qxd 06/03/03 11:30 Page 39
38. A. Young, The Harmony of Illusions (Princetown, NJ: Princetown University Press
1995).
39. Ibid., p.142.
40. Prilletensky (note 28), p.797.
41. S. Holland, Psychotherapy, Oppression and Social Action: Gender, Race and Class in
Black Womens Depression, in R.J. Perelberg and A.C. Miller (eds.), Gender and Power
in Families (London: Routledge 1990), pp.25669.
42. N. Patel, Human Rights and Clinical Psychology, Presentation to the Community
Psychology and the Race, Culture and Clinical Psychology SIGs Conference of the
British Psychological Society (1516 June 2000), Sheffield University, UK.

Patel Nimisha (2003) Clinical Psychology - Reinforcing Inequalities or Facilitating Empowerment

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Patel Nimisha (2003) Clinical Psychology - Reinforcing Inequalities or Facilitating Empowerment

Uploaded by

Copyright:

Available Formats

This article was downloaded by: [Florida State University]

On: 29 December 2014, At: 23:18

The International Journal of Human

Clinical Psychology: Reinforcing

To link to this article: http://dx.doi.org/10.1080/714003792

PLEASE SCROLL DOWN FOR ARTICLE

To what extent do psychologists continue to reinforce inequalities by

Unfortunately, a case can be made that by virtue of its constricted

HUMAN RIGHTS VIOLATIONS AND EXPERIENCE OF EXILE

The reference to health personnel could be interpreted as including

activities. Thus, focussing on acts of torture alone in terms of their

WAR, RIGHTS ABUSES AND PSYCHOLOGICAL CONSTRUCTIONS

where psychology can contribute, the parallel neglect of wider socio-

in other human rights violations.

IMMIGRATION AND REFUGEE PEOPLE AS OUTSIDERS

discourse of providing humanitarian aid to brothers.

colour, was the explanatory framework utilised in immigration policy

PSYCHOLOGYS MAKING OF REFUGEE PEOPLE

homogenous and different from the majority population in the receiving

rates of mental disorders, under which conditions they develop these

psychologically: refugee people who are fleeing persecution and

need and the prevalence of psychological disorders. A disturbing question

DOES CLINICAL PSYCHOLOGY REINFORCE INEQUALITIES?

given. The elitist activity of doing therapy, the psychological technology

Individualistic Nature of Psychology

psychological theories, research and practice has ensured that the

majority of psychological theorising and practice in relation to refugee

unaffected. Furthermore, technological solutions are deemed to be with

professionals  psychological health experts, not those who have

Pathologising in Psychological Approaches

deficiency, deviancy from the assumed norm and dysfunctionality.

person is positioned not only as in need of professional, economic,

De-politicising Human Distress and the Stance of Neutrality

medical response to the problems of Vietnam War veterans, and its

macrocosms. The collective secret is a wilful ignorance of traumatic

DOES CLINICAL PSYCHOLOGY FACILITE EMPOWERMENT?

towards a more just society. Empowerment thus interpreted represents

In such an approach empowerment comes to mean grappling not

survivors of human rights violations in everyday life. Empowerment can

examples are given here, as a fuller illustration and discussion of each

refugee community organisations  services conceived of and developed

production can actively involve and be accountable to those whom

experienced in other ways by refugee people.

Behaviour in New Environments (Beverly Hills: Sage, 1969).

Karls, Post-traumatic Stress Disorder among Survivors of Cambodian Concentration

You might also like

discourse of providing humanitarian aid to brothers.

PSYCHOLOGYS MAKING OF REFUGEE PEOPLE

given. The elitist activity of doing therapy, the psychological technology

professionals psychological health experts, not those who have

refugee community organisations services conceived of and developed

Karls, Post-traumatic Stress Disorder among Survivors of Cambodian Concentration