Adoption Competent Mental Health Care: Part One
Before we get started, I want to acknowledge that long blog posts don't do well. Anyone who knows me knows I am one wordy creature, a vice, and relic from my time at USC trying to fill 15-20 page papers when I could have gotten my point across in 6. I started writing on adoption-competent mental health care as one post: 31,375 characters later, I recognized this would not work. It didn't feel right to break it up into multiple posts, and I have to at this point. I have decided to present a multiple post series. Complex, historically painful issues deserve time, and blog posts are not books. Over the next several posts, I will offer a great deal of information to illustrate the ecology of systems and how they affect our society, communities, families, and personal realities. We can not separate adoption from historical and current inequality and injustice as adoption is very much part of a broader system set up to be profoundly unfair and founded in White Supremacy Culture. When I refer to White Supremacy Culture or simply White Supremacy, I am also speaking about Patriarchy and Capitalism as I do not feel there is any distinction between them.
Please Note: No real names have been used in this post.
The Very Hard Truths Working in Community Mental Health Taught Me
I used to be a proponent of the standard refrain about the broken system; therefore, social workers should fix the system. I was going to put on my cape and pull up my tights as a Bachelor's level social worker (BSW) and get to fixin' it. My superhero name would be The Fixer, or so I thought. I graduated and couldn't find a job, so I had to hang up my cape and put away my tights. I then decided to get my Master's in Social Work (MSW). I graduated with a head full of theory and got out into the workforce with just my cape this time (the tights had become too Pollyanna for me), and I became jaded faster than a speeding bullet. Do you know that cape I mentioned earlier? It is long gone as it was shredded with my hopes and dreams of fixing anything, including myself, my family, friends, husband, people, or the "Broken" system Fixing is not the work.
Dismantling, naming truth, taking accountability, holding accountable those who use power to oppress, allowing for redemption, remembering our inner strength that often is obscured by a system that seeks to make everyone feel broken, that's the work.
It took me about three agonizing months to realize that most of the people I was working alongside were in full-on survival mode, with caseloads numbering in the hundreds with little time to think about their participation or upholding of systemic oppression. They had their own stories that they were grappling with, which held heartbreak, pain, and loss. They had rent to make, families that depended on them, and the pressure of productivity within their jobs as mental health providers. I soon recognized I was participating in a community mental health system that would eat me alive and spit me out. At the same time, I tried to do my job within a structure that screamed "Trauma-informed care!" at the top of its lungs while actively retraumatizing and traumatizing all parties involved. I had caseload after caseload of first family members, adoptees, and foster alums.
Trauma-Informed Care can be a fantastically buzzy and catchy phrase that gleams with the promises of hope and help. If not implemented appropriately, it becomes a great disguise to cover issues embedded in systems that we have no choice but to engage in to meet our needs.
My Every Day Grid with Racism and Adoptee Othering in Community Mental Health
My daily grind consisted of a coworker yelling, "Whatchu talkin' 'bout Willis?" at me whenever I spoke up during team meetings. One supervisor who often presented as overworked and in constant fear of losing his job exclaimed, "Becca, I thought you would be more urban!" when he found out I enjoy playing Banjo, an instrument of African origin. Another coworker who struggled to manage her temper at work asked me to help her to "Learn how to make Black people not hate" her. I was the only person who was Black in the building except for the clients we served in most cases. I tried to point out systemic racism while recognizing my job could be stripped away if I stepped too far out of line as the only person who was Black at each of my respective positions. You see, I, too, was trapped in survival mode. In every instance, I sounded the alarms, and nothing happened. At each job I held, it was the subtle and not-so-subtle lack of understanding of what participating in systemic injustice looked like, and here comes the intersectionality of it all. I had coworkers find out I was adopted. One asked me if I was a crack baby, another asked if I was happy I found my real mom and commented about my Blackness being part of why my White Birthmother must have abandoned me. Another got deeply offended that I was not grateful for being adopted because it afforded me such a "Grand education," which had to be why I spoke so well. Ah yes, the intersectionality OF IT ALL!
So What Does Community Health Care Have to Do With Education
In each of these cases, the examples of these microaggressions were between me, an MSW, and another highly educated mental health professional. Every person who participated in the proliferation and maintenance of racist behavior was, directly or indirectly, responsible for providing services to marginalized communities with many intersecting identities. I needed to get back into my place lest I be considered "uppity." My very favorite conversation was: "We have to build trust on this team; you are not helping our team build trust." My boss's call for trust-building felt like a hot slap across my cheek because I had called attention to Chets' use of racism when he lied about not calling a client back when he said he would, by using the client's Blackness to explain why she was out to get him when she complained. Chets' second show of racist behavior in a week, the previous being his use of the common pejorative "Hillborito." to describe the majority Latino town down the road. He was shocked that I called him out for it. He was offended that told him that his behavior was not okay. He was surprised; I told our boss. He was not scared in the least with what the outcome would be for him. Nothing happened. There were many instances where racism and systemic oppression were in full view, and I became part of the problem because I stayed. Yes, I called it out, and I stayed. When we are participating in a system that runs on fear and scarcity, survival mode is a way of life. I needed the hours to get licensed, and I still do. I felt trapped in a system for which I wanted no part, and I had to take part to gain standing. I needed more social power to give back to my community, and to survive in this system meant watching and feeling the toll racialized trauma had on me and those who looked like me. The system continues to grind on, not broken in the least.
The Power to Get Our Needs Met
The broader mental health system asks people with little resources or power to seek mental health treatment from community mental health programs. Community mental health is a system tightly intertwined with White Supremacy. The community mental health system allows those in power to hold on tightly to their implicit biases and even supports this holding on. The lack of challenge to the participation in systemic oppression makes it impossible to provide individualized, culturally competent, truama informed care because the "Need is just too big to manage." or the standard "Thanks Obama." which seemed to be the mantra of everyone above me. My education prepared me to deal with my own unconscious biases. Still, I foolishly assumed collaboration with coworkers would dismantle systemic injustice as we provided mental health care. Mental health care from providers who have eye twitches from the amount of stress they are under is probably not the best mental health care possible. I often found White Supremacy Culture with its bodyguard White Guilt standing firmly and solidly in the way of progress. So yes, mental health education needs to include information on adoption to make any meaningful change. To truly understand adoption, it is imperative to understand the social issues that cause the need for adoption to exist in the first place.
Adoption runs deep with classism, sexism, heterosexism, moralism, racism, faithism, ableism, and ageism. The American Psychiatric Association is responsible for identifying normative and non-normative behavior, also known as mental wellness and pathology. The association is responsible for the Diagnostic and Statistical Manual of Mental Disorders. There is a disturbing history of the American Psychiatric Association and psychiatry in the United States being used to pathologize behaviors of people who are not white, Male, middle/upper-class, and heterosexual. An example of the foundation of White Supremacist ideals that have been part of US psychiatry from the start is the fake mental disorder known as Drapetomania, identified as a mental disorder of African peoples who ran away from enslavement. If a person who was Black and enslaved escaped and was captured, the treatment for "Drapetomania" was a whipping and the removal of the two big toes to prevent the enslaved person who suffered from the pathology of daring to want freedom from running in the future. According to the APA (2021), Drapetomania was used to support "Prevailing Black stereotypes in US psychiatry included fallacies that patients were hostile, unmotivated for treatment, had primitive character structure (i.e., not psychologically minded) and were child-like." The APA finally apologized in 2021 for its active participation in the systemic racism against Black, indigenous, and other people of color. 2021. I first read the year as 2000, which already seemed damningly late for an organization with responsibilities to "Do no harm."
Who Decides What's Normative Anyway
As it stands now, the academy is mired in socially biased information that often looks at the pathology of the "Other" it's clear that there is a lack of looking at the majority. Why is there not a classification in the DSM-5 for racism as a pathological mental process? Plausible examples might be: White Supremacist Delusion Disorder, White Guilt Syndrom, or White Saviorism Disorder; surely, there is a pathology that is taking place when someone feels that they have a right to participate in violence against another human because that person happens to have darker skin, what about the pathology that comes from using tears to stave off having to look at one's contribution to very real truama they have created for others or the belief that taking a child from a culture that is not White and participating in cultural isolationism or forcible faith assimilation is somehow purifying or saving that child in some way? According to Alvin Poussaint (2002), the APA has not identified racism as a form of mental dysfunction or pathology due to the APAs' past assertion that racism is a normative process in the US, which means that the prevalence of US citizens racist thought process and participation in racist behavior is a normative one. Therefore, violence against others that can come from extreme racism is normative. The APA defined the mental process of racism as a mere social problem and not based on a pathological mental process. This refusal of APAs to look at the historical and current violence of White Supremacist Culture shows the connection between how pathology is used to marginalize "The Other" and can be, done with all 'isms that show up in the US psyche. To name White Supremacy for what it is and add the pathology label to it is to acknowledge and identify the need to dismantle an entire society built on it.
What I learned as an MSW is labeling pathology is not helpful in many ways, primarily when used to punish and sow seeds of fear. When we categorize people's reactions, especially adaptive reactions that facilitate survival, even at the expense of others, we take away the chance to see the whole person. To use pathology as a tool against White Supremacist Culture does not work because, as Audry Lord states, "The master's tools will never dismantle the master's house."
In pathologizing every behavior that has developed out of living in a society where the commodification of basic human life is par for the course, we lose the chance to change. White Supremacy is part of every waking moment of living in the US. There becomes no pathway for accountability, redemption, forgiveness, or reconciliation within pathologizing behaviors. The only way to move forward is to dismantle this system created and founded on atrocity after atrocity. The system was never broken but instead fixed to create a sense of scarcity, fear, and the standard shame-driven thought process that echos throughout history what I term the "At least I'm not-s" - At least I'm not- insert any marginalized group here. You have at least the fundamental workings of how White Supremacy stays stable.
My "Whatchu talkin' 'bout Willis." coworker profoundly disagreed with my thoughts about systems and the ecology model being imperative to providing truama informed, culturally competent care; she eloquently stated: "Social workers don't belong in mental healthcare because understanding systems and the ecological model are useless in looking at pathology; you should just stick with taking babies away." Her assessment was historically founded in terms of how Social Work has developed (the APA is not the only profession with a history of White Supremacy Culture embedded in its foundation.) I still hold firmly to my belief that we need to understand the historical and current cultural context and the many effects systems have on how and why we behave in the ways we do. Especially when it comes to this idea of pathology and what can be deemed pathological, an example of the systems' effect on behavior; this same coworker had to work as a server at a major chain restaurant to help support her family because the pay as a Master's level mental health provider was abysmal. It was not feasible for supporting her family of four. She constantly spoke about feeling overwhelmed and angry. Systems impact our lives and make it hard to be our best selves when we have to hustle to meet our most basic of needs and the needs of those who depend on us. How easy is it to uphold the status quo as there is very much a sense of power in participating in a system that seemly hurt people who are White slightly less than their fellow humans? It's a falsehood, however, and that process of thinking there is no harm to people who are White is seductive. The reality is human beings are intensely complex, and we are all affected by the systems and social structures we engage with to survive. We are the products of our forbearers and our current environments. The US wants to detach from the evils and harms of the past, and; it can not. The evils and harms live on through our social problems and our supposed current social fixes.
In the next installment of this series, I look at the intersection of graduate mental health education, White Supremacy Culture, and adoption.
Becca Flatt, MSW, CSWA