Forbidden madness: challenging clinician identities

Forbidden madness: challenging clinician identities

Clinician identity and the expulsion of madness

It is a well-known fact in our profession that subjectivities and identities are formed according to the relationships and the context individuals need to navigate. As clinicians, and regardless of our motivations to enter the mental health professions, we have undertaken difficult training courses that can feel like unending emotional and intellectual work. It is during this process and later, during the course of our careers that our identities as clinicians are built and evolve with time. In turn, our sense of self as well as external perceptions of us also change. This process often touches on our inner processes linked to deep-seated needs, the relationship with ourselves and the reasons why we chose this profession.

In relational work, we are often taught to consider what we might be bringing into the therapeutic relationship and the impact we can have on the transference. I believe our sense of self in relation to our profession is often overlooked in this work. However, the processes we undergo to build and maintain a professional identity are part of the baggage we bring to the relationships we built with people. It has to do with how we relate to ourselves; our profession and its current frameworks can have a profound impact on our capacity to relate to the people we support. In this chapter I offer introductory considerations on the impact of clinician identity formation. In the hopes this will offer avenues for deeper reflections on the need to challenge our participation in systems that repeatedly harm and disempower people who are in need of support.

Subjectivity and Identity Formation

Theories of subjectivity and self formation abound in philosophy and psychoanalysis. One such theory is Lacan's views on infant entering language and the mirror stage. I will use the word identity for simplicity with the knowledge that these theories talk about subjectivity and ontology, not exactly the same.

Fanon builds on Lacan's mirror stage to understand how the black man is the Other of the white man. White identity constructed as opposed to the black man. Blackness becomes the repository of "all that we are not," the unidentifiable and unassimilable: in simple psychoanalytical terms, what whiteness splits off because it can't accept in itself, and projects onto the Other.

Khanna quote:

"But for Fanon, it is the white man who makes the black, and vice versa, just as Sartre's anti-Semite makes the Jew, and as de Beauvoir's woman is made the Other of man."

Our identities are thus constructed within these hierarchical social systems and according to them.

What happens when we undergo training and step into the language of psychiatrisation ourselves? How does our subjectivity and self evolve and transform into our new professional selves?

We could argue Fanon is specifically talking about race and the colonial context, to which I would respond that current conceptions of madness and mental "ill health" were also born within the same context. Colonialism, race and identity formation are directly linked to questions of mental health and views on madness. Example of human classification, drapetomania, and Fernando's work on the pathologisation of people of colour. Madness, mental deficiency and disability were historically linked to race and used as both a tool to control and degrade the racial Other. The white man possesses rationality and health, which allows him to decide on how to treat the Other who is seen to be causing problems, disrupting the order of things. The Other, whether it's the black person or the white woman, is seen as a repository of what the dominant group is not: insane.

I'm not particularly attached to psychoanalytical interpretations of social realities. However, the way Fanon's theories mirror social realities show us in this case that the construction of difference and social hierarchies run much deeper than what concepts like unconscious bias or ignorance might describe. They are also much more interlinked with the very formation of our identities and sense of selves than we would like to imagine. Which, in my opinion, is why challenging these structures of power becomes so difficult. Challenges are often met with defensiveness and strong barriers to change to the point that transformation sometimes feels like an impossibility. We have to look inwards at the same time as outwards, and we will find the ways.