Therapy is Political. It’s High Time Therapists Acknowledge This.

Erica Woodland didn’t intend to create a directory of queer and trans therapists of color. He was working as a therapist, supporting fellow queer and trans people of color (QTPOC), when he realized something had to change. Generational trauma, racism, incarceration, and state surveillance caused “pretty persistent mental health crisis” among the activists he worked with, said Woodland. 

Yet the people most impacted by this violence had a difficult time accessing therapy — and even when they did, inbuilt bias in the system often caused more harm than good. “Folks would tell me, ‘I’m terrified of therapists,’” Woodland said. He needed to know that the therapists he worked with would actually empathize with and be able to treat activists’ needs. “For five years, I was like ‘somebody should start a national network,’” said Woodland. “At a certain point, my ancestors and spirit were like, ‘That’s supposed to be you.’”

So Woodland founded the National Queer and Trans Therapists of Color Network (NQTTCN), a database of dozens of queer and trans mental health workers of color that spans the entire United States. 

A Shift Toward Healing Justice

Woodland’s group takes a healing justice view toward mental wellness. The framework was developed by Black feminists and other organizers of color in groups such as the Kindred Southern Healing Justice Collective. Healing justice emphasizes the historical violence — such as colonization and slavery — and contemporary oppression — such as the prison industrial complex — that shape collective well-being. 

“Our mental health is impacted by our entire ecosystem,” said Yolo Akili Robinson, Founder and Executive Director of Black Emotional and Mental Health Collective, a group of wellness workers dedicated to the healing of Black communities. “Healing justice really says in order for us to heal, we must transform the entire ecosystem.” 

Healing justice challenges everyone in the mental health field to acknowledge that wellness isn’t just individual: it is inherently political. That’s because our health is shaped by our identities and our access to resources. But that’s also because the mental health establishment itself has long been complicit in the criminalization and abuse of marginalized people in the United States, especially communities color and LGBTQ communities. 

In order to truly do no harm, therapists must acknowledge this history. They also must develop crucial skills to not just affirm marginalized clients, but to support the reality that healing goes beyond individualized treatment and encompasses the lived, political and economic conditions of our world.

Who Defines Mental Illness?

“Where I come from, social workers take the babies away,” said Woodland. Born and raised in Baltimore, Woodland went to social work school in his twenties, after encountering deep mental health needs among the justice system-involved, street economy-engaged, and HIV-positive people he was organizing with. 

Yet Woodland felt a deep tension in and with his new role. Even when he went to social work school, “Politically, I was very clear that I didn’t want to be a social worker,” Woodland said. Eventually, however, he had to come to terms with his new position, and find a way to practice social work that challenged the fraught history of the field. “I’m accountable for the harm even though I didn’t create the harm,” he said. 

Since its origins in the 1800s, social work — and the mental health field in general — has been intertwined with the systemic racism, sexism, ableism, and homo- and transphobia that have defined much of American history. Many of the so-called “diagnoses” used to classify mental illness throughout American history have been rooted in the desire of white, male landowners to control women and people of color. “Public health has historically been about public control,” said Robinson.

Racism and fictitious mental illness

Since the origination of American slavery in 1619, white enslavers invented stereotypes of Black people as “naturally” violent, restive, or unintelligent as a means of justifying their enslavement. In the 1850s, as abolition gained in popularity, supporters of slavery invented a new psychological diagnosis to justify white control of Black people: “Dysaesthesia aethiopica,” a fictitious, racist malady that they claimed struck Black people who sought freedom. 

After the Civil War, the migration of newly freed African Americans from the South to the Northeast and Midwest for work threatened white elites’ racist sense of “public order.” At the same time, an influx of immigrants from Southern and Eastern Europe, coupled with a lack of government poverty relief, led to overcrowded, deeply impoverished urban immigrant neighborhoods. The native-born upper classes labelled these communities as hotbeds of vice, and many of them founded “settlement houses,” university or charity-based organizations that championed new, scientific theories of population management and public health. 

Many of these groups provided concrete poverty relief and medical care to impoverished communities. Yet many were also sympathetic to eugenics, a racist and ableist ideology, which argues that some human beings and qualities (usually Europeans) are “naturally superior” to others. Aid workers often saw Black and Southern and Eastern European clients as “dirty” and in need of “civilizing,” and established social service systems that often controlled and punished poor clients more than they supported them.

Black resistance continued to be pathologized well into the 20th century, with some white psychologists claiming that Black Power and Civil Rights activists suffered from “protest psychosis.” This racist pathologization of Black resistance, coupled with enduring racial trauma, has led to elevated rates of mental health diagnoses in Black communities to this day. 

Gender and sexual control 

The psychological establishment has long been hostile to women and LGBTQ people, as well. Many so-called mental illnesses, like “hysteria,” were historically defined to stigmatize women who didn’t adhere to social norms. Sigmund Freud first designated homosexuality as a sign of improper development in the late 19th century, and when the American Psychiatric Association published the first Diagnostic and Statistical Manuel in 1952, it characterized homosexuality as a disorder. 

Thanks to queer activism, the diagnosis was lifted from the DSM in 1973, but harmful and pseudoscientific practices like gay conversion therapy persist to this day. Transgender identity also remains highly medicalized, which Woodland says creates unfair barriers for trans people seeking care. “Gender dysphoria is still a diagnosis that is required to receive gender affirming care,” said Woodland. “Do cis women who are getting cosmetic surgery have to see a therapist before they alter their bodies? No.”

Mental health and mass incarceration

This history has translated to the modern-day criminal justice system. From childhood, Black people are far more likely to be perceived as having behavioral difficulties than their white counterparts, part of the school-to-prison pipeline. Today, prisons are the largest mental healthcare providers in the country, and people with mental illness are sixteen times more likely to be killed by police as those without. 

“A great proportion of black and brown people’s first engagement with the mental health industrial complex is through the prison industrial complex,” said Robinson. Numerous systems, like child protective services and ICE, actually feed Black and brown people into the prison system by criminalizing poverty, rather than providing families with needed resources. 

Beyond Culturally Competent Care

“Being QTBIPOC, you have to live with a pretty high level of fear around the community, the family, the state,” said Woodland. “You can’t really be an apolitical QTBIPOC person.” 

To address the health disparities resulting from these inequalities, mental health providers use a framework of “culturally competent care.” This emphasizes understanding and respecting the cultures and values of clients. But Robinson and Woodland say that providers need to go beyond simple cultural sensitivity, and instead address the ways in which mental health is inherently about power — and thus, inherently political. 

“A lot of therapists might talk about social justice, but fundamentally in the work that’s happening, in the therapeutic relationship, we don’t get a lot of training and support around the way those institutions and legacies live in our individual bodies and in our collective bodies,” said Woodland. 

To address this, Robinson’s and Woodland’s organizations both train mental health practitioners in a healing justice framework. Rather than considering racism and sexism individual ills, says Robinson, he assumes that all mental health practitioners have internalized racist and sexist ideas from our broader society, and supports them in addressing and shedding these attitudes so they can provide better care. 

Meanwhile, Woodland’s organization, the NQTTCN, focuses on connecting queer and trans people of color with the people most likely to empathize with their experiences: queer and trans therapists of color. Even the act of therapists listing themselves in the database is political. “We tell practitioners to out themselves as part of the directory,” said Woodland. “That itself, especially in this political moment, is putting us at risk.”

Finally, healing justice groups like BEAM and NQTTCN help support forms of healing that fall outside of the conventional mental health system. “Therapy is really built on this kind of middle class model — this idea that someone can get away from their life for an hour a week and sit down with someone,” said Robinson. In contrast, communities have always had grassroots healing practices, from church to herbal remedies to rituals. “We fundamentally believe that therapy is a very important tool, but it’s only one tool for our healing,” said Woodland. “Our people have had traditions and cultural practices since the beginning of time to address violence, to address trauma, to address harm.” 

For many people of color, histories of colonization or enslavement have led to the banning or appropriation of these traditions — for example, through the criminalization of marijuana, which has sacred or healing properties in many cultures. Yet these care traditions, including food and spiritual traditions, have also sustained some of the most powerful movements for liberation.To encourage these grassroots healing practices, BEAM provides funds to Black Southern wellness workers, including doulas and community gardeners, and also hosts mental health training programs for community leaders like barbers, teachers, and activists. 

Healing for Liberation

Mental health is expansive: it is shaped by all the histories and systems that shape how we experience the world. That’s why, according to healing justice practitioners, we can only achieve well-being through systemic change. “When we see folks fighting for clean water, that is a mental health intervention,” said Robinson. “When I see Black Lives Matter shutting down streets, that’s a mental health intervention.”

Ideally, says Woodland, we would all have free, universal healthcare. But until that is a reality, he credits the daily work of community mental health practitioners with creating the kind of care communities deserve — now. From political violence to the death and economic fallout of the coronavirus pandemic, this year, more people than ever are experiencing the kind of deep harm that many people of color have endured since the United States’ founding. 

While he wishes it didn’t take so much crisis to wake people up to the need for deep change, Woodland also sees the collective response to our current moment — including the rise of social movements and mutual aid — as an example of the deep power communities have to create wellness. “We don’t have to look too far in the future to find examples that point us towards what’s possible,” said Woodland. “The reality is despite the despair of this moment, our people are the antidote.”