Internalised racism: the racism that dare not speak its name

 

The most potent weapon in the hands of the oppressor is the mind of the oppressed

Steve Biko

Following the recent vote by The Royal College of Psychiatrists, the result of which was denying affiliates (notably SAS doctors) from having voting rights in the College, I had a discussion with a BME colleague. They expressed the view that SAS doctors (66% of whom are BME versus 44% of all doctors being BME) are less capable even when they are more experienced.  Racism comes in many flavours. There’s the interpersonal (e.g. name-calling, security officers selectively checking a Black person); there’s the institutional (discriminatory policies that privilege certain racial groups); but a form that is relatively less discussed is the racism that operates at the internalised level.

The term internalised racism (IR) originates from WEB Du Bois in 1903 describing the ‘double consciousness’ of being both Black and American. Since America was founded on an ideology that diminished Black people, to be Black and American was incompatible without internalising negative beliefs about oneself. More recent thinking has evolved IR in two ways: firstly, the generalisation of IR from the individual to the whole group – projecting negative beliefs on all minoritised people. And secondly, from internalising just negative belief about self to the internalisation of beliefs of white superiority. Thus, IR is especially harmful because it perpetuates the internalisation of beliefs or behaviours that perpetuate racial inequality.

Underpinning any form of racism is the theme of oppression; and there is a paradox in IR that it implies internalising oppression, which feels so obviously harmful as to be counter-evolutionary. At root, oppression centres on the idea that there is unequal power between groups, with the dominant group using their power to exploit or sideline the minoritized group. In other words, oppression reflects a state of inequity which results in a process of inequity. Oppression implies inequalities of power (access to resource) and privilege (unearned advantage) between groups. The dynamic of oppression means that while ethnic minority people may internalise beliefs about racial inferiority, dominant group individuals may internalise beliefs about racial superiority, which perpetuate racist hierarchies. This internalised dominance is the mechanism for maintaining privilege. Internalisation of negative beliefs has an intersectional element: when studying ethnic minority LGBTQ+ people, internalised heterosexism was a more contributory component to mental health than internalized racism.

So, how does IR arise? Black psychiatrist Frantz Fanon theorised that the repeated experience of discrimination leads to self-doubt and feelings of inferiority. The classic doll studies of Clark and Clark demonstrated that the internalizing of these feelings begins in infancy and extends the alleged inferiority to the whole of one’s racial group. This internalised inferiority can lead to individuals avoiding their ethnic group and aspiring to the majority culture which may be viewed as superior. This concept has been expanded on and studied from a colonial lens: among Filipinos in the USA there was a cohort whose desire for assimilation drove their interpreting colonialism as advantageous to the Filipinos. What this weight of evidence points to is that the mechanism of IR has both unconscious and intentional elements.

Does recognising IR matter? Well, it is a contributor to inter-racial (i.e. anti-Black) racism as previously written about in this blog. Additionally, IR has been shown to be associated with psychological and physical harms to ethnic minority people as per the report of the surgeon general, being associated with a range of conditions including hypertension and depression. There is a positive correlation between Black Americans who are exposed to frequent anti-Black racism subsequently developing IR and adverse responses to external stressors. Internalised negative feelings are associated with lower self-esteem and greater body mass index among Hispanic people in the USA.

Another key reason to acknowledge IR is that in order to be truly anti-racist, one has to understand all forms of racism, including an understanding how oppression is internalized and reproduced. The Black consciousness movement of Steve Biko was the epitome of how to forge effective methods of resistance through self-awareness.

A further benefit of recognising IR in healthcare is that it should define how services are provided, incorporating a framework to understand how racial oppression can contribute to a patient’s presentation and ability to recover. Embedding such a social justice approach helps break the self-propagating cycle of patients tolerating discrimination, with beneficial effects on both patient outcomes and on service delivery. As healthcare professionals it is important to recognise how internalised cognitions have an effect on our patients’ and our own behaviours, and thus recognise our roles in addressing these for better outcomes.