RACE, CULTURE & PSYCHOTHERAPY
M Fakhry Davids
Conference on
Race, Culture and Psychotherapy
Psychiatry Section
Royal Society of Medicine
London, 20 June 2008.
CONTEXT
Our world today has become increasingly multi-cultural and multi-ethnic,
creating a global village in which we are very likely to encounter others from
racial or cultural backgrounds different to our own. Greater diversity makes for
a richer, more varied and interesting world, but it also draws attention to what is
unknown and unfamiliar. The unknown and unfamiliar may turn out to alien
and hostile, a delicate issue to which there is near-universal sensitivity. In the
children's film “Toy Story”, for example, the toy who is to become the child’s
new best friend introduces himself to the other toys as “I'm Buzz Lightyear. I
come in peace” when, in fact, his very arrival on the scene shatters the preexisting harmony.
By heightening awareness of the unknown, the arrival of the newcomer brings to
life different sets of emotional forces. On the one hand, there is interest and
curiosity: will something new come out of the encounter that might take us
beyond the comfort zone of the familiar and enrich us all? On the other, it
deprives us of the security, however illusory that may be, of living in a world
that is familiar, known and predictable. At the material level, there is a further
dimension in that the other is also likely to be a rival in the struggle for
resources that are finite, and it is no accident that racism often comes into play
in this situation. Farhad Dalal (2002) argues that the dividing lines deployed in
racism create an arbitrary distinction between us, the must-haves, and them, the
must-not-haves, in order to justify the exclusion of the demonised other from
power and privilege.
A heterogeneous and diverse world is thus a complex one in which we are
confronted by the fact that our knowledge base is limited. This should be
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welcome to the psychoanalyst: Freud, for example, saw analysis not primarily
as a psychological treatment but as an instrument of research into how an
individual’s mind functions. The greater the unknown, therefore, the greater
should be the challenge that stimulates the analyst’s curiosity. However, when it
comes to analysing patients across the boundaries of race and culture serious
difficulties arise.
The difficulties for the minority patient begin at the assessment stage. Based on
his clinical experience in the UK, Acharyya (1992) argues that when faced with
culturally-alien ways of showing distress western practitioners adopt a heavy
handed approach, unwittingly playing “a colonialist game” whereby the
unfamiliar is seen as inferior, a judgment that lies concealed beneath diagnoses
that sound neutral and objective. The minority group patient is thus more likely
to be diagnosed as suffering from severe pathology than a comparable patient
from a mainstream background. It lies behind oft-cited statistics that show
psychological distress is more likely to go undetected in the minority group
patient – “… GPs have an uncanny tendency to underdiagnose psychological
problems when confronted with West Indian patients…” (Burke 1983, cited by
Fletchman Smith, 1994, p. 53). Subsequent treatment is generally more punitive
(e.g. heavy medication, detention orders etc), and these patients are therefore
less likely to be referred for psychotherapy (e.g. Bhugra & Bhui, 1998).
Minority patients who do proceed to analysis/therapy are likely to encounter a
further problem, that of feeling seriously misunderstood by the mainstream
clinician, reporting that issues important to them are not properly explored and
understood whilst issues seemingly irrelevant to them are prioritised.
WHAT GOES WRONG?
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At a conference in London in 1988 Jafar Kareem, founder of the Intercultural
Therapy Centre in North London, gave an example of how profoundly
disturbing an experience the cross-cultural encounter between a patient from a
Third World background and a native European clinician can be. Kareem, a
young UK-based clinical psychologist of Indian descent, had recently arrived in
Vienna – the birthplace of psychoanalysis – to work with refugees. He became
depressed and sought psychotherapy, a process that took time since he needed
an English-speaker. In the first interview he is patronised by the therapist, who
explicitly calls into question his awareness that psychotherapy is costly, his
capacity to manage the “sophistication” of the therapeutic process, together with
his intelligence and his “familiarity” with the complex ideas of psychoanalysis.
To crown it all, the therapist checks whether he knows how to use a telephone
(in case he should need to ring) since “the telephone is a western thing”.
Notwithstanding these racist slurs Kareem decides to give it a go.
In the fifth session he brings a short dream: It is during the uprising against the
British in India. He is on a march with his fellow students when they are
confronted by a mass of policemen with red turbans. Suddenly, shots erupt and
the friend next to him is shot and lies bleeding on the ground. Meanwhile, the
police drag Kareem away to a waiting black van. He associates the red turbans
with the therapist's red scarf.
After first reprimanding him for going on a march (“Didn’t your parents tell you
not to take part in such things?”) the therapist eventually interprets his rebellion
against authority as directed against the father he had lost within a month of his
birth. Kareem doubts this – he had no memory of his father and a number of
uncles seemed to have been good surrogate fathers to him – and insists,
tentatively, on a transference link: in the dream the therapist was “behind the
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police” in a vague sort of way. She interprets that he holds all Europeans
responsible for his oppression (“Maybe you think we all shot your friend”) in a
way that underlines the irrationality of such a view, and suggests that he wishes
to take revenge on her (Kareem, 1988, pp. 58-62). Following that session
Kareem terminates the treatment, and thankfully finds his way to a second
therapist who is able to speak about Kareem’s hatred of European oppressors in
the dream as something that must have a meaning as yet unknown, adding that
he is now in Austria, where there is a history of collaboration with the Nazis.
Implicit in this is the idea that in Europe, too, a regime was in place built on the
idea of the superiority of the putatively native Europeans, the Aryans, which
murderously targeted Jews whose oriental origin was seen as polluting the
landscape. Whose side was the therapist on? He openly acknowledges that a
great deal is as yet unknown about these matters, both between them and in the
patient’s mind, and raises the possibility of them working together to explore
this. This strikes a completely different note to the first therapist and
unsurprisingly Kareem pursues the therapy to a satisfactory outcome. Same
formulation
What went wrong with the first therapist? It is tempting to think that it lies in
an openly racist attitude on the part of the therapist as revealed in the first
interview – the account is written with hindsight after the treatment broke down,
and she must have done enough right in that interview to convince him to try
notwithstanding the patronisingly racist strands. It lies rather in her failure to
strike a chord with him in interpreting the dream. The dynamic hypothesis
underpinning her interpretations had two elements: first, that he is on a protest
march against an authority felt to be not only unjust but also tyrannical and
murderous in stifling protest; and second, the protest concerns parental failure –
identified as the absence of a proper father – stirred up by the failure of the
therapist as a transference figure. This formulation is plausible, but the way in
which she translates it into interventions is not only clumsy and ham-fisted, it
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completely lacks the creativity and nimbleness of mind that we all strive for as
clinicians. It is as if something quite concrete has been enacted in the session –
the therapist appears not to want to accept that she is the transference object.
Even when her attention is explicitly drawn to this (he insists her red scarf is
behind the red turbans in some sort of way) she is unable to accept the
accusation against her, and hence to investigate it more deeply, and instead turns
it around so that the accusation is directed elsewhere else – against him for his
rebelliousness, and for irrationally holding all of Europe responsible for his
oppression etc, and against his absent father. By contrast, the second therapist
puts into words the silent accusation against him – is he a Nazi collaborator? –
which allows things to move on.
It is tempting to think that a misunderstanding such as this can be attributed to
the therapist’s ignorance of the patient’s cultural background. If only she knew
more about Indian culture – e.g. the prevalence of the extended family in which
parenting functions may be shared among uncles and aunts living under the
same roof, and what this implies as regards normality and psychopathology. Or,
if she were familiar with the experience of political oppression, and how Indians
from all walks of life were inevitably caught up in it and thus in the anti-colonial
struggle for freedom from the yoke of British imperialism. Whilst it is usually
helpful to know more about such aspects the patient’s cultural background,
whether that would be sufficient to avoid this breakdown in communication is
questionable. I think the inappropriate use of cultural referents here results from
a failure in symbolic functioning, leaving concreteness to prevail in the crucial
therapeutic interchanges. Notice, for example, the way in which the dream is
treated as real – Kareem is reprimanded for going on a march when he is, in fact,
dreaming of doing so. This is symptomatic of the breakdown of ordinary ego
functioning in the cross-race or cross-cultural encounter, a breakdown that
characteristically results in a highly charged atmosphere in which cultural or
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racial matters become over-determined. Sometimes, as in this case, it leads to
racial insensitivity uncharacteristic of the person concerned, as if everything
connected with the difference between them has become racialised; at other
times the opposite response, that of political correctness that stifles all creativity
and spontaneity, is observed. In either case, one’s ordinary capacity to think
creatively in a way that addresses reality is compromised. This paralysis of
one’s ordinary functioning is not confined to the clinical setting, and can be
observed elsewhere.
PARALYSIS
Let me give you an example from a non-clinical setting, namely the scene of the
racist murder of the black teenager, Stephen Lawrence. I quote from a report in
The Guardian on 16th May 1998:
The inquiry [into the case]… heard that, on the night of the attack in April 1993, Mr
[Duwayne] Brooks and [his best friend] Stephen had been searching for a bus in Eltham,
south-east London, when six white youths had approached. The ringleader had called out,
“What, what, nigger”, and then pulled from his jacket a weapon of steel or wood, the size
of a rounders bat.
“I saw [him] raise his right arm in the air . . . I saw him strike a blow towards Stephen. I
heard Stephen scream as if in pain [and] fall,” Mr Brooks said.
They began running, but Mr Brooks heard Stephen call out, “Duwayne. Look at me. Tell
me what's wrong”. “I looked back and saw blood on his jacket. I said, ‘Just keep
running’, and he said, ‘I can't. I can't’.”
When Stephen slumped to the ground, Mr Brooks rushed to telephone for an ambulance,
and tried to flag down cars. He said: “I was pacing up and down. I was crying. I was
desperate for the ambulance. It was taking too long. I was frightened by the amount of
blood Steve was losing. I saw his life fading away.”
I have read you this account verbatim because I wanted you to know the facts
since, when we look at them away from the heat of the moment, the priorities
that flow from them seem obvious. First to try to get help to the wounded boy,
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and then to pursue any lead that might allow his assailants to be apprehended.
Now, let us look at what actually happened:
He [Brooks] said that the police arrived but seemed to be “repulsed” by the blood, and
they refused to drive Stephen to a hospital two minutes away. When he pointed out the
road where the attackers had run, PC Linda Bethel “did nothing”.
The inquiry was told that the WPC involved was an ordinary, conscientious
police officer who was not a racist. We have no reason to doubt this as her
character was subjected to critical scrutiny during the inquiry. If so, then
something happened at scene to seriously interfere with her capacity to function
in her usually conscientious way, so that she “did nothing”. She was probably
unaware that something out of the ordinary was happening inside her but, on the
receiving end of it, Duwayne Brooks was in no doubt:
“It was like she didn't believe me . . . she was treating me as if she was suspicious of me,
not like she wanted to help,” he said… “I am sad and confused about this system where
racists attack and go free, but innocent victims like Steve and I are treated like criminals.”
[italics added]
He felt the police officer see him through a racist lens, so that the victim of a
horrific crime became, in her eyes, a violent black youth who had killed his
friend and was trying to pin the blame on a fictitious white gang. If we accept
that she is not a racist, we can nonetheless hypothesise that internal racist
mechanisms were mobilised unconsciously – and perceived accurately by the
object (as clinicians might feel things in the countertransference) – resulting in
her momentary loss of perspective. Had these mechanisms not been mobilised
she would have functioned in her usual way and got her priorities right.
At the scene of the crime anxiety is at its most intense and it is therefore likely,
as I have said, that she was completely unaware that she was in the grip of these
defences. The following morning, however, she had recovered a little, and now
felt burdened by guilt. She visited the hospital where Stephen was taken to find
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out whether she “could have done more” (Norton-Taylor, 1999 p.30). This is
guilt associated with racist projection which involved pushing the stereotype of
a violent black youth into Brooks. At that point the situation might have been
rescued: although Stephen could not be brought back to life, everything might
yet have been thrown into bringing his killers to book, an act of reparation that
might have mitigated guilt. Instead, the possibility that something racist
happened at the murder scene could not be faced – the hospital's reassurance did
not reassure – and the subsequent investigation was fatally undermined by
further, quite extraordinary, police failures in which crucial evidence was lost or
never gathered. Psychoanalytically, this suggests that the guilt was unbearable,
and dealt with through re-enactment of the original failure. It is as if everyone,
not just the police officer herself, felt unconsciously accused of racism and
determined to protect themselves by closing ranks. This cover-up stretched to
the highest levels, and it was to take a change of government in 1997 to finally
respond to the widespread clamour, including the voice of Nelson Mandela, for
an independent inquiry. In the end, the inquiry held institutional racism in the
Metropolitan Police responsible for the failure to successfully prosecute killers
whose identity is, in fact, known.
INTERNAL RACISM
The understanding of internal racism that is possible today draws on
developments in psychoanalysis that are relatively recent. The first is our move
away from Freud’s emphasis on drives to one that prioritises object relationships
in the mind, which are now seen organised in an inner world of phantasy that
mediates our relationship with the outside world. The beauty of the concept of
the inner world is that it is infinitely variable and is populated, therefore, by
objects that are meaningful to that individual. Although each person’s inner
world is unique, some objects are to be found in every internal world and can
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thus be thought of as part of the structure of the mind. Self, mother, father and
superego fall into this category, and it is to this list that I think the “racial other”
belongs. This is an observation – that it is impossible to find an internal world
in which the racial other does not exist – although the need for such an object
can also be accounted for in theory. It results from the need to find a lasting
solution to the problem of primitive, psychotic anxiety (which is ubiquitous) that
involves splitting the source of that anxiety and projecting it into an object, thus
creating a dangerous and feared object of which one is phobic. The earliest
instance of this is the infant’s projection of primitive hostility into the father,
turning him into a bad object. In time, actual good experience with the father
causes the infant’s benign circle to expand to include him, and at around 8
months the stranger takes on that role. Soon, however, the infant learns that the
stranger, too, is “one of us” who cannot be demonised without cost and the
benign circle expands yet further. Finally, when the child learns to use the
socially-stereotyped bad object, saturating it with a personal individual
projection, a final resting place for this solution becomes possible, creating what
I am calling, for want of a better term, the racial other.
In overtly racist or prejudiced individuals the racial other is easily identifiable;
in more liberal individuals it is likely to live inside another object, making it
difficult to distinguish the subject’s projected racism from the racism that
belongs to the object.
What is the nature of the relationship between self and racial other?
Psychoanalysts have known for a very long time that it involves projection from
self into object, and as we have come to understand projective processes more
fully it has become apparent that the projections involved in racism are violent
and forceful, akin to those used in psychotic states (i.e. projective identification).
However, it is the understanding of pathological organisations put forward by
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John Steiner (1987) that has allowed a real leap forward. Steiner showed that in
certain disturbed patients (e.g. borderline patients) an organised network of
phantasy relationships in the mind defend against the most feared aspects of
contact with reality. This phantasy system constitutes an alternative reality in
which the patient lives psychically, but unlike the frankly psychotic patient, a
relationship with the outside world is permitted as long as it can be seen to
conform to the parameters of the defensive organisation. This external
involvement, in turn, keeps both the existence of the phantasy world and the
patient’s allegiance to it hidden. Once relationships are organised in
accordance with the phantasy system, the initial projections are hidden, and all
that is left is the demand that everyone follow rules – one must do what is
expected of one. (Lawrence example – drive one to violence, paradoxically
fulfil the role). This reveals the fact that a projection has taken place, for one
must not be an ordinary individual, which reveals the extent to which the racial
other has been projected into. Everyone has to keep to their proper place. I am
suggesting that the inner relation Following rules is related to the concreteness
of thinking that is mobilised in the cross-race, cross-cultural encounter.
Resistant to change, capable of permutations in which matters of detail are
sacrificed in order to keep the structure in place.
ENGAGING THE DYNAMICS OF RACISM
M grew up in a former British colony and hated the liberalism of the ex-pats. It
concealed an attitude that took privilege and power as theirs by right, and it was
from such a haughty position that they spoke to you, in a way that he felt was
patronising. Their professed belief in equality was therefore hypocritical. He
himself was from a close-knit, working class community where money was
always tight. Tantalisingly, they lived just close enough to the ex-pat world to
get a glimpse into their world of privilege. As a child, this was encapsulated in
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one pre-occupation: in their local general dealer’s store there were matchbox
cars – utterly realistic miniatures – that were the young boy’s ultimate object of
desire. Yet only the ex-pats could afford them, and they remained out of reach.
For years he dreamed, with a cousin, of shoplifting one but they could not work
out how to explain to their respective parents how they had acquired such
expensive toys.
Many years later, M described this situation to his analyst, who had an excellent
reputation and with whom he was well satisfied, together with the way in which
it was finally resolved. Their parents had fallen out and when, after some
months it became clear that the rift would not heal in a hurry, he and his cousin
saw their chance: each could claim that the other’s parents had generously
given them the car as a present, certain that the bad blood between them meant
that their alibis would not be checked. This was indeed so, and they became
proud owners of two cars, meticulously “made in England”.
M’s analyst spoke powerful longings and desire in him that were, perhaps,
irresistible. Could she understand the intensity of such wanting, in the context
of his privation, or did her more privileged background prevent her from being
able to empathise with it?
The interpretation made sense, but it enraged M. In the session he controlled
this response, taking issue with her for a white liberal attitude that sympathised
with criminality on the part of blacks, on the grounds that colonial inequality
was to blame for it. Why condone theft? Frantz Fanon’s words accusing the
white, by this attitude, of sealing “the native in his inferiority” sprang to mind,
which he spat at her sarcastically. In the course of the session she pointed out
that if she focused on the criminality, the nature and intensity of the need that
drove it slipped out of focus, and if she focused on the need, criminality slipped
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out of focus. He had no sooner agreed with this observation when he found
himself furious with her again, this time because her problem as an analyst was
being prioritised over the problem he, as a patient, had brought. Why should he
care about putting her in an impossible position? What about what he was
trying to raise? If he proceeded along her path he would be being “reasonable”
– he’d become a thinking white liberal out of touch with his own experience on
the streets. Fuck her, he wouldn’t. He was going to stay true to himself.
By the time M spoke to me (on the telephone that evening) he had decided to
stay away from his session the following day – that was the only way to convey
the gravity of the problem that had arisen1. As he saw it, the problem was that
he felt patronised by her – she spoke to him as a white liberal and he would not
stand for it. It was as if she was driving through their streets back home, in one
of those posh cars, looking out at him shoplifting. From this vantage point she
felt sorry for those poor “blacks” driven to crime by the system. Empathy – that
sense that an analyst could, somehow, experience something of what was alive
in the patient – was utterly missing. Her interpretation had been glib, making
him feel that she could not be bothered to get out from the comfort of her car to
feel what life on the streets was like, before opening her mouth. Instead, the
black person was to live life in the ghetto whilst she would comment on it from
above. She was not going to get her hands dirty. This, he thought, lacked
analytic legitimacy, and enraged him absolutely. It was a white liberal attitude
to analytic involvement. How could she treat him in such a racist way? Fucking
white bitch!
His own racist abuse of his analyst shocked him, yet it was what he really felt
and would have to be reported. He anticipated that she would reduce it to
something familiar, such as an infant/child’s fury at a mother felt to be incapable
1
He had not previously intentionally missed a session.
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of empathy, which would compound the problem, changing the subject once
more (to a familiar/comfortable theme). He would be invited into her
comfortable car, from where the two of them would view the problem on the
streets. Given that the “problem on the streets” was his, this was a recipe for
alienation from his experience, and he would not have it.
I hope I have said enough to show that a racial internal object relationship had
come alive in M’s analysis in a way that brings out the stubbornness with which
M clung to his way of seeing things. His demand was simple – she should treat
him with respect and not patronise him. What could be more reasonable? And
everything she said (on this issue) was viewed through a single lens: what
position she was speaking from? Was she in the car or outside? Inevitably she
was inside – how could she not be? – and they would be back in the vicious
cycle. Work on other matters slowly got under way but for months, whenever
they strayed onto this sensitive area, the fault line opened up again as he
inevitable felt patronised and his own racialised hatred towards her was
reignited, together with his guilt for being so racist, for which he hated her more.
How could she drive him to this?
This stubborn-ness and inability to change perspective is characteristic of racist
organisation functioning concealed the internal racism hard-wired into the
system. For the sake of brevity I shall outline this schematically: M’s racial
other was located in the mind of white liberal, in line with colonial social
stereotyping. , who, when those dynamics came alive in the transference, was
literally believed to have a disdain for the person on the street. It was racialised
as it used the existing distinction between black native and white settler
dominant in the colonies. Schematically, we could say that M hated his state of
constant need blackness – the poverty, lack of resources privilege and power etc
- , That projection was concrete, and hatred of this and he was reacting to the
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fact that a racist object relationship existed between them (and in his mind)
when he had believed himself to be free of it. And he insisted that she should
solve his projected racism by not speaking to him “as a liberal”. It
institutionalised for him
….but more important is the way of working M missed his next session, and .
He found a way of telling his analyst about the racist abuse in his mind without
going into gratuitous detail that might have detracted from its seriousness2, and
hence the need to resolve things properly. She seemed to understand that she
had touched an exceptionally raw nerve in him, and seemed genuinely
concerned to get to the bottom of what was going on.
In the weeks that followed, however, the stalemate continued. As before, her
interpretations made sense (as the original one had), yet he found himself
scrutinising these offerings from one vantage point only: was she speaking from
the comfort of her white car, or was she trying to walk the streets beside him?
Invariably, his guts told him that she was speaking from a familiar comfort zone
inside the car. To go along with her would, then, be to allow a change of subject
to a more familiar, or comfortable, psychoanalytic theme, and this would ignite
his hatred and fury afresh. He just could not do it, since it had the symbolic
meaning of selling out to “white” authority. He had an inalienable right, he felt,
to be understood as himself; he should not have to “become white” to achieve
this. Since he himself was already doing all he could, it was up to her to try
harder.
She did try harder, clarifying precisely the nature of the dilemma he was in, and
beginning to recognise when a comment from her was experienced as emanating
from the white car. With the passage of time the intensity of his rage and hatred
2
By relieving pressure, thereby diminishing the tension and unease that drives one to work on the issues.
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lessened, probably as a result of her recognising, and putting into words, this
reaction to a particular interpretation of hers perceived as emanating from within
her perspective. Increasingly, other issues unrelated to this came to the fore in
the analysis, and they seemed able to work together on these as before. When a
better atmosphere prevailed as a result, it was often his analyst who drew
attention to the unresolved matter between them, seeming to want to try again to
address it. The intensity of his feelings ignited as a result usually surprised him,
as if the negativity contained there was quite isolated from any good feeling
associated with work on other spheres.
In time he It always surprised him have anoand the intensity of his feelings
sometimes took him by surprise. For her part, his analyst seemed as determined
as he not to sweep this problem between them under the carpet. For example,
when something else had been actively worked on for a period, it was she who
sometimes reminded him that the source of that ill-feeling between them was yet
unresolved. In this respect, she continued to offer interpretations even though
they risked evoking his perception of them as racist seduction that, in turn,
elicited his racist attack on her.
Despite the fact that none of the heat went out of this situation it gradually
became possible, according to C, to put it to one side. After the first few
sessions he felt that the seriousness of the patronising violence that her
interpretation had visited on him, together with his racist reaction to it, had been
fully discussed and properly acknowledged. His overt rage subsided though his
feelings were no less heartfelt and passionate. A more sober way awareness of
the problem between them was now present. Meanwhile, other day to day
issues increasingly came up and were worked on as before, C once more
appreciating the sensitivity, helpfulness and general goodness of his analyst.
But when either of them raised the race issue it was plain that it remained as
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inflamed as ever, and the sequence of events described earlier would repeat
itself. She would offer an interpretation which he, inevitably, The answer
would invariably be, from inside the car looking out, provoking the same hatred
and fury in him. In time he would simply leave things in silence and she might
comment on the intensity of hatred he felt towards her, articulating terms of
racist abuse he had hinted at, and sometimes she commented on his pain at not
getting the response he sought from her, which he felt she was not trying hard
enough to find. All of these interchanges helped to soften the blow of what he
suffered at her hands but did not, of course, address the underlying issue.
After our initial conversation I heard very little more of this, other than the
occasional update that confirmed the issues were unresolved and ongoing. We
had said all that could usefully be said and it seemed clear that it would have to
be resolved in C’s analysis. Several months after these conversations C told me
how the matter had been resolved. continuing in the same vein. ten in the
earlier man(probably because he felt his analyst took the point of how serious it
all was after he missed the session) They came to see that . if she interpreted
that she could not get it right I accused her of expecting me to feel sorry for her
when it was I the patient who was not properly understood. He was
hypersensitive to answers that seemed pat, accusing her of not wanting to do the
emotional work involved in really trying to develop an understanding based on
proper empathy, of getting her hands dirty. When she did try to describe –
merely repeating understand him. Is she asked what he didn’t know – only that
they had not found it. to
CLINICAL EXAMPLE
REFERENCES
Acharyya, S. (1992). The doctor's dilemma: the practice of cultural psychiatry in
multicultural Britain. In J. Kareem & R. Littlewood (Eds.), Intercultural
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Therapy: Themes, Interpretations and Practice. Oxford Blackwell Scientific
Publications.
Bhugra, D., & Bhui, K. (1998). Psychotherapy for ethnic minorities: Issues,
context and practice. British Journal of Psychotherapy, 14(3), 310-326.
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