Difference and Discrimination in Psychotherapy and Counselling (The School of Psychotherapy & Counselling) (PDFDrive)

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Difference and Discrimination in

Psychotherapy and Counselling
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Other titles in the School of Psychotherapy and

Counselling (SPC) Series of Regent’s College:
The Heart of Listening

Rosalind Pearmain
Embodied Theories
Emesto Spinelli and Sue Marshall
Wise Therapy
Tim LeBon
Heidegger and the Roots of Existential Therapy

H.W. Cohn
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SPC SERIES
Difference and Discrimination in

Psychotherapy and Counselling
Sue Marshall
SAGE Publications
London • Thousand Oaks • New Delhi
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© Sue Marshall 2004
First published 2004
Apart from any fair dealing for the purposes of research or

private study, or criticism or review, as permitted under
the Copyright, Designs and Patents Act, 1988, this publication
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any means, only with the prior permission in writing of the
publishers, or in the case of reprographic reproduction, in
accordance with the terms of licences issued by the
Copyright Licensing Agency. Inquiries concerning
reproduction outside those terms should be sent to
the publishers.
SAGE Publications Ltd

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SAGE Publications Inc.

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SAGE Publications India Pvt Ltd

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British Library Cataloguing in Publication data
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from the British Library
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ISBN 1 4129 0118 9 (pbk)
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Typeset by C&M Digitals (P) Ltd., Chennai, India

Printed in India at Gopsons Papers Ltd, Noida
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to Charles
who has always believed in me
to Harry
whose enthusiasm inspires me
and to Alice
who knows what it means to be different
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Contents
General Introduction to The SPC Series ix
Acknowledgements xiii
Introduction 1
1 Discrimination, Difference and Identity 5
2 Race and Culture 21

Racism and racial discrimination –
a historical overview 25
The process of racism and racial discrimination 45
Race and culture in counselling and
psychotherapy 55
3 Gender 70
Gender relations – a historical overview 71
Gender and gender identity – some of
the theories 82
Gender in counselling and psychotherapy 90
4 Sexuality 101
Homosexuality – a historical overview 103
Sexuality and homosexuality – some
of the theories 117
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viii CONTENTS
Homosexuality in counselling
and psychotherapy 127
5 Mental Illness 137

The treatment of madness –
a historical overview 139
Theories about mental illness 153
Mental illness and counselling and
psychotherapy 164
Mental illness and other minority groups 172
6 Conclusion 184
Bibliography 191
Index 201
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General Introduction to
The SPC Series
I T I S B O T H A G R E A T H O N O U R and a pleasure
to welcome readers to The SPC Series.
The School of Psychotherapy and Counselling at
Regent’s College (SPC) is one of the largest and most
widely respected psychotherapy, counselling and coun-
selling psychology training institutes in the UK. The SPC
Series published by Sage marks a major development in the
School’s mission to initiate and develop novel perspectives
centred upon the major topics of debate within the thera-
peutic professions so that their impact and influence upon
the wider social community may be more adequately
understood and assessed.
A brief overview of SPC
Although its origins lie in an innovative study programme

developed by Antioch University, USA, in 1977, SPC has
been in existence in its current form since 1990. SPC’s MA
in Psychotherapy and Counselling Programme obtained
British validation with City University in 1991. More
recently, the MA in Existential Counselling Psychology
obtained accreditation from the British Psychological
Society. SPC was also the first UK institute to develop a
research-based MPhil/PhD Programme in Psychotherapy
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x DIFFERENCE AND DISCRIMINATION
and Counselling, and this has been validated by City

University since 1992. Largely on the impetus of its first
Dean, Emmy van Deurzen, SPC became a full training and
accrediting member of the United Kingdom Council for
Psychotherapy (UKCP) and countinues to maintain a
strong and active presence in that organization through its
Professional Members, many of whom also hold profes-
sional affiliations with the British Psychological Society
(BPS), the British Association of Counselling and Psycho-
therapy (BACP), the Society for Existential Analysis (SEA)
and the European Society for Communicative Psycho-
therapy (ESCP).
SPC’s other programmes include: a Foundation
Certificate in Psychotherapy and Counselling, Advanced
Professional Diploma Programmes in Existential Psycho-
therapy and Integrative Psychotherapy, and a series of
intensive Continuing Professional Development and
related adjunct courses such as its innovative Legal and
Family Mediation Programmes.
With the personal support of the President of Regent’s
College, Mrs Gillian Payne, SPC has recently established
the Psychotherapy and Counselling Consultation Centre
housed on the college campus which provides individual
and group therapy for both private individuals and
organizations.
As a unique centre for learning and professional training,
SPC has consistently emphasized the comparative study of
psychotherapeutic theories and techniques while paying
careful and accurate attention to the philosophical assump-
tions underlying the theories being considered and the
philosophical coherence of those theories to their practice-
based standards and professional applications within a
diversity of private and public settings. In particular, SPC
fosters the development of faculty, and graduates who
think independently are theoretically well informed and
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GENERAL INTRODUCTION TO THE SPC SERIES xi
able skilfully and ethically to apply the methods of

psychotherapy and counselling in practice, in the belief that
knowledge advances through criticism and debate, rather
than uncritical adherence to received wisdom.
The integrative attitude of SPC
The underlying ethos upon which the whole of SPC’s

educational and training programme rests is its integrative
attitude, which can be summarized as follows.
There exists a multitude of perspectives in current psy-
chotherapeutic thought and practice, each of which
expresses a patricular philosophical viewpoint on an aspect
of being human. No one single perspective or set of under-
lying values and assumptions is universally shared.
Given that a singular, or shared, view does not exist,
SPC seeks to enable a learning environment which allows
competing and diverse models to be considered both con-
ceptually and experientially so that their areas of interface
and divergence can be exposed, considered and clarified.
This aim espouses the value of holding the tension between
contrasting and often contradictory ideas, of ‘playing with’
their experiential possibilities and of allowing a paradoxical
security which can ‘live with’ and at times even thrive in the
absence of final and fixed truths.
SPC defines this aim as ‘the integrative attitude’ and has
designed all of its courses so that its presence will challenge
and stimulate all aspects of our students’ and trainees’
learning experience. SPC believes that this deliberate
engagement with difference should be reflected in the man-
ner in which the faculty relate to students, clients and col-
leagues at all levels. In such a way this attitude may be seen
as the lived expression of the foundational ethos of SPC.
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xii DIFFERENCE AND DISCRIMINATION
The SPC Series
The SPC Series seeks to provide readers with wide-ranging,

accessible and pertinent texts intended to challenge, inspire
and influence debate in a variety of issues and areas central
to therapeutic enquiry. The Series reflects SPC’s inter-
nationally acknowledged ability to address key topics from
an informed, critical and non-doctrinal perspective.
The continuing expansion of texts within the SPC Series
expresses what is hoped will be a long and fruitful relation-
ship between SPC and Sage. More than that, there exists
the hope that the series will become identified by profes-
sionals and public alike as an invaluable contribution to the
advancement of psychotherapy and counselling as vigor-
ously self-critical, socially minded and humane professions.
P ROFESSOR E RNESTO S PINELLI

Series Editor
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Acknowledgements
I F I WERE TO TRACE BACK THE thoughts,

ideas, events and conversations that have culmi-
nated in the writing of this book, I would have to credit the
original impetus of the project to the inspirational teaching
of June Roberts, whose seminar on social issues I took one
spring in the early 1990s. June died in 2000, sadly, but I
would like to think that some of her passion, energy and her
attitude of challenging orthodoxy live on in the pages that
follow.
I have gained much in my professional career from the
many students I have taught. Their input and ideas are also
represented in this book – I am grateful both to them and
for the richness of experience that teaching others always
provides.
I would like to thank the many people who have helped
me in a number of ways throughout the writing of this
book. My first acknowledgement has to go to Ernesto
Spinelli, whose encouragement and help inspired me to
think about making a beginning. Many friends and col-
leagues have provided support along the way. In particular
I would like to thank Sarah-Gay Fletcher, Marilyn Foster,
Sue Kork, Michael Montier, Kelly Noel-Smith, Boo
Orman, Beryl Semple and Frances Wilks – their friendship,
professional input and belief in me have been invaluable.
Very special thanks must go to Tato Bromley, whose tireless
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xiv DIFFERENCE AND DISCRIMINATION
work in helping with research and typing has made the

whole project possible within the deadlines set.
Finally, I would like to thank my family for their consistent
and tireless interest, support and encouragement through-
out this project.
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Introduction
I N M Y O W N E X P E R I E N C E A S A therapist,
supervisor and trainer I have frequently been struck
by the dangers of ignoring or minimizing social reality. The
majority of the trainees, students, supervisees and col-
leagues I have encountered over the years have, like myself,
come from backgrounds which would not necessarily
expose them to the kinds of attitudes, prejudices and
adverse discrimination which, unfortunately, still pervade
our society. I have come across lamentable ignorance,
which is excusable, and occasionally a blinkered unwilling-
ness to challenge this ignorance, which is not. On this
count, what I am hoping to provide in this book is some
information that will remove the blinkers and fill in some of
the gaps. The BACP Ethical Framework for Good Practice in
Counselling and Psychotherapy states that ‘the practitioner is
responsible for learning about and taking account of the
different protocols, conventions and customs that can per-
tain to different working contexts and cultures’ (BACP,
2002: 9), which is a considerable improvement on their
previous code of ethics which merely mentioned ‘sensitiv-
ity to cultural context’. We do need more than sensitivity –
we need understanding and we cannot understand without
information and learning.
As counsellors and therapists, as well as increasing our
knowledge about what goes on out there in society, we need
to understand what is going on inside ourselves – what is
2 DIFFERENCE AND DISCRIMINATION
commonly referred to in the trade as ‘self-awareness’. I

have always understood this to mean owning up to all the
nasty bits – not necessarily to anyone else, though under
the right circumstances that can be very therapeutic – but
primarily to one’s self. I believe we all hold views which
have the potential to be discriminatory, prejudiced or
exclusionary; I believe we all have difficulty, in some
degree, with people who are in some significant way differ-
ent from ourselves. On this count what I am hoping this
text might do, for readers who may not have explored fully
this part of their being, is to challenge them to do so. In the
BACP Ethical Framework we find the statement, ‘Practi-
tioners should not allow their professional relationships
with clients to be prejudiced by any personal views they
may hold about lifestyle, gender, age, disability, race, sex-
ual orientation, beliefs or culture’ (BACP, 2002: 7). The
implication of this is that practitioners may well hold views
on such matters which could prejudice their professional
relationships. What is missing (although perhaps implicit)
in this statement is the recognition of the need for practi-
tioners to be aware of what those views are. The previous
BAC Code of Ethics did not pull any punches; it stated cat-
egorically that ‘counsellors have a responsibility to consider
and address their own prejudices and stereotyping attitudes
and behaviour’ (BAC, 1998: B.2.4). This is what I think we
need more of – too many of us, therapists, counsellors, super-
visors, trainers, do not sufficiently consider and address
such attitudes and behaviour in ourselves.
In the course of my research for this book I conducted an
informal survey of counselling services and training courses
throughout the UK. It was by no means comprehensive, but
served as a useful straw poll of some of the characteristics of
those engaged in the enterprises of counselling and psycho-
therapy. In the questionnaire sent out I posed questions first
about the gender and racial or ethnic origin of counsellors,
clients, training staff and students. Most organizations who
INTRODUCTION 3
returned the questionnaire were willing to supply this

information. I also asked questions about the psychiatric
history of the same group. This yielded less information.
Part of the questionnaire was devoted to the content of
training courses and the extent to which topics such as
race, gender, sexual orientation and mental illness are
covered, if at all. The information that I gleaned from this
survey forms the basis for many of the assertions in the first
chapter, and elsewhere in the book.
The first chapter consists of an overview of some of the
themes that occur and recur in connection with all the sub-
jects examined in this text: identity, our response to differ-
ence, the nature of prejudice, and the debates around
nature and nurture as well as around sameness and equal-
ity. The chapters that follow are all devoted to a particular
topic – an element of being which has the potential to
attract adverse discrimination. Within these chapters I have
begun with a historical overview of each particular subject,
and then attempted to analyse the themes and theories that
surround it. There follows an examination and discussion
of the relationship between the topic and the psychothera-
peutic enterprise. In Chapter 5, on mental illness, there is
a further section devoted to some of the intersections
between all the subjects covered in the book. My discus-
sions centre principally on the western world – Europe, the
USA and, in particular, the UK.
The scope of this book is necessarily limited. In order to
do justice to the topics I wanted to cover, I had to restrict
the number of topics that could be included. Apart from
the four subjects I have examined – race and culture, gen-
der, sexuality and mental illness – there are many others
that are equally significant within the context of discrimi-
nation and difference. Disability, class, age and religion
spring immediately to mind, and there are many more. I
would like to emphasize that I have not excluded such top-
ics on the grounds of seeing them as less worthy of study,
but on the grounds of pragmatism and lack of space. I was

faced with some invidious and difficult choices. There is
much scope for further fruitful work in this field to examine
other elements of experience where issues of difference and
discrimination play a significant role.
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I Discrimination, Difference
and Identity
E A C H I N D I V I D U A L P E R S O N I S unique. Our
uniqueness defines us and separates us. It may
also be the source of our delight in each other and enrich
our personal relationships. Over and above our uniqueness
we also share characteristics with other people – some char-
acteristics with almost everybody else, others with only a
few. Common features, like unique qualities, can also form
the basis of connections and relationships between people
and groups. So, in varying degrees, we are like and unlike
other people we encounter. Despite the fact that most peo-
ple are able to tolerate, even celebrate and enjoy, the
unique differences of others with whom they come into
contact, in general we are most comfortable in the com-
pany of those with whom we share common features. Such
features may be social class, educational background, taste
in music, religious beliefs, professional interests and a
whole host of other possible factors. The more we have ‘in
common’ with another person, the more likely we are to
feel an affinity with them. Differences, too, may be a source
of interest, but they are potentially more challenging and
divisive. There is a level of comfort in being able to identify
with elements of another person’s being or experience.
History and observation demonstrate that our response to
differentness is not universally one of acceptance. Neither is
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it universally one of condemnation and rejection. I would

maintain, however, that it is more often a response which
veers away from inclusion and tends towards withdrawal.
Such withdrawal can take many forms – some relatively
benign, others with a greater capacity for causing offence or
damage. Prejudice and adverse discrimination exist in all
social groups. The fact that there are laws against discrimi-
nation of various kinds in every western country attests to its
existence. You do not need to outlaw something unless it
has proved to be problematic. Such laws have helped by
punishing offenders – people who have been shown to be
actively practising racism or sexism or some other form of
discrimination – and, presumably, by acting as deterrents.
The deterrent effect would be to discourage people from
engaging in overt expressions of prejudices, but would do
nothing to remove the underlying beliefs, thoughts and feel-
ings which motivate such expressions. It would be con-
venient to assume that the phenomena of prejudice and
adverse discrimination manifest themselves in a small and
reprehensible group within society and that most of us are
in the clear – unbiased and prejudice-free. I do not believe
this to be the case. Fortunately, it is only a small minority
who choose to engage in the most extreme forms of dis-
criminatory behaviour – violence or even murder on the
basis of a person’s skin colour, religion or sexual orientation.
But that does not exonerate the rest of us from harbouring
prejudices. We all have preferences and we discriminate, in
the sense of making choices based on our values and tastes,
in all areas of our lives. Many of these choices and prefer-
ences are in response to the perceived similarities and dif-
ferences of others. And it is in these responses, I believe,
that the potential for prejudice is present in all of us.
The presence of our own prejudices or biases is some-
thing we prefer not to acknowledge or examine, precisely
because it conflicts with that aspect of our chosen identity by
which we would like to see ourselves as non-judgemental,
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DISCRIMINATION, DIFFERENCE AND IDENTITY 7
fair-minded, accepting of all humankind. How, then, do we

address it? Only by scrupulously honest and searching self-
examination. This can be achieved on our own, in dialogue
with others, maybe in therapy or with close friends. But, like
all dimensions of self-discovery, it cannot be forced upon us
by others. You can take a horse to water, or a client to therapy,
but … as the saying goes. I suspect that many students of
counselling or psychotherapy sit through their mandatory
hours of therapy while in training without really looking too
closely at some of those parts of their inner life that they are
least happy about. In writing this book I am hoping, possibly
vainly, to provoke in the reader the impulse to look within
and own some of those uncomfortable, possibly deeply
hidden, prejudices and dislikes.
There are many facts and much information within these
pages. This is intentional. By remaining ignorant it is easier
to hold on to the belief that we live in a just and equitable
society. Once we have learnt that things are not quite how
we would like them to be, it becomes harder to deceive our-
selves and also, I hope, harder to maintain the pretence that
we are not part of the system. Society is made of people –
you and me and him and her. If the society we have created
is imperfect, unjust, pernicious or oppressive it is because
we have made it so, or allowed it to be so made.
In any interview process for counselling training courses,
one of the things that causes me the greatest disquiet is an
attitude of ‘them’ and ‘us’; the candidate who feels that he/
she would like to ‘help’ those poor afflicted souls who are
troubled and need some ‘direction’ in their lives. I believe
you are only of any benefit as a counsellor or therapist if
you see clients’ issues in terms of being part of the human
predicaments and problems which affect us all, yourself
included. By the same token, the person who retreats
behind the clichés of ‘Some of my best friends are black/
gay’ or ‘I don’t have a problem with the disabled/lesbians’
is taking the ‘them’ and ‘us’ stance, as well as laying claim
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to a position of total impartiality which I suspect conceals

an unwillingness to own the inner prejudices we all possess.
I am not trying to suggest that there is not a distinction
between overt racist violence and the moral position of
most members of society. It is, however, too easy to disown
our own prejudices by focusing on the more extreme mani-
festations of adverse discrimination. We are, by definition,
part of society and the inequalities within its structure and
institutions are but a reflection of the biases and values of
each individual member of which society is constituted.
One of the recurring themes in this book is identity. Our
individual identity is made up of a vast number of compo-
nents which intersect with and interact upon one another;
there is an artificiality about attempting to tease them apart,
to isolate them and analyse them separately. And yet that is
what I have attempted to do in order to examine the nature
of the responses that are evoked by individual elements of
differentness. It is important to bear in mind that each person
is many other things as well as that element of his/her iden-
tity that has the potential to provoke a response of preju-
dice or discrimination. This has been highlighted by the
lobby who urge use of the term ‘gay men’ instead of
the term ‘gays’. Using the word ‘gay’ as a noun implies the
identification of a group of people by their sexual prefer-
ence, as though that and that alone defined them as
people. Society, however, still regularly refers to ‘gays’,
‘lesbians’, ‘the disabled’, ‘the mentally ill’ – a tendency which
fosters the false assumption of homogeneity in such groups
as well as having the effect of defining people by a single
element of who they are. Both of these processes – the
assumption of homogeneity and the defining of people by
one aspect of their being – are central to the process of
adverse discrimination.
The subjects I have chosen to examine are all ones which
attract the highest levels of social interest and concern – and
of discrimination and prejudice. For those of us, like myself,
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who are in the majority group for most elements of social

identity – white, heterosexual, able-bodied, free of a
psychiatric diagnosis, middle-class, educated – it is hard to
imagine the experience of those who are not. It is all too
easy to deny the extent to which elements of being such as
skin colour or sexual orientation (among many) incite
responses from others that are experienced as alienating,
exclusionary, rejecting or demeaning. In her book Mixed
Feelings, Yasmin Alibhai-Brown writes, ‘however mixed-
race couples and mixed-race children choose to live their
lives, they cannot shake off historical baggage or isolate
themselves from the assumptions and bigotries of the out-
side world’ (Alibhai-Brown, 2001: 14). You could substi-
tute many words for the phrase ‘mixed-race couples and
mixed-race children’ in that passage: ‘gay men and lesbian
women’, ‘black and coloured people’, ‘disabled people’,
‘people with a mental illness’. Being in a non-normative
minority group means you are rarely able to forget about
that element of who you are which sets you apart from the
majority, and which has the potential to provoke responses
in others that include feelings of fear, dislike, repulsion,
prejudice or hatred.
In recent years there has been a heightened awareness of
the implications of social prejudice and discrimination.
Many minority groups have formed organizations to protest
against inequitable treatment and lobby for political and
social reform. A commonplace response to such movements
goes something like this: ‘I can’t understand why such
an issue is made of being homosexual/black [or whatever
the focus is]. I never make an issue of being heterosexual/
white – it’s just part of who I am!’ What such a viewpoint
fails to realize is that the ability to take for granted any cru-
cial element of identity is a luxury only afforded those who
belong to the dominant majority group. Outside that, the
attitude of the dominant group means that however much
you might want to take being black, or gay, or disabled for
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granted, you are not allowed to because you are constantly

reminded, on a daily basis, that most people around you
have difficulty, in some way, with that part of who you are –
and that many never see beyond it to the rest of the person.
The concept of identity raises questions such as: Who
am I? Where do I belong? How do I fit in to this or that
group of people? One of the basic human quests is that of
trying to make sense of the world around us. We are con-
stantly searching for meaning in the experiences we
encounter. We also seek to organize our world into struc-
ture and routine in order to make ourselves feel more com-
fortable. Disruption of routine or an experience which
shakes our sense of structure can induce anxiety, a sense of
being undermined, lost and alone. One of the elements
which contribute to our sense of structure and meaning is
that of identity. Much has been written on the development
of human identity: how and at what stage it develops, the
critical elements that contribute to or detract from its
secure formation, and so on. In western psychology it is
generally accepted that knowing who you are, in the sense
of where you come from and how you fit into a given social
group or family, is crucial for psychological health.
Research in the field of adoption would seem to support
this notion (Verrier, 1993). But as well as wanting to know
who you are in the sense of where you came from genealogi-
cally, the question ‘Who am I?’ seems to refer to something
internal and personal – something unique to you alone.
However, the two seem to be intimately linked.
To begin with ‘external’ identity: if you ask someone to list
the elements by which they define their identity it is likely
they will enumerate a variety of things – gender, age, marital
status, nationality, occupation, perhaps religion, sexual
orientation or social class. Many of these elements exist in
polarities – man/woman, straight/gay, black/white and so on.
They also indicate not only individual identity but member-
ship of a group. I am a woman, but my understanding of that
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concept can only make sense in the context of recognizing

that there are other beings whose characteristics (those that
indicate femaleness) I share. Furthermore, the concept of
femaleness has no meaning in isolation. It only carries
meaning in contrast with another group of beings who
share characteristics that indicate maleness. Thus a central
part of the formation of our individual identity consists of
identifying those groups to which we belong and those to
which we do not belong. In other words, we confirm who
we are by comparison with others – by differentiating
elements of sameness and elements of difference. This
appears to be a process that goes on all our lives and is a
vital part of the development of an inner sense of ourselves
as a unique and valuable individual.
The comparisons we make encompass more than exter-
nal characteristics. They extend to tastes and preferences,
aptitudes and abilities, emotional and psychological ele-
ments – the whole complex web of personality and being
that constitutes who we are. External identity, however, as
the first element by which we perceive another person, has
a particular impact. All too often we draw inferences about
a person’s internal being from our perception of their exter-
nal appearance or their way of presenting themselves. It
would seem, therefore, that we form an internal sense of
identity as a direct result of observations we make of other
people and of ourselves in relation to them. As I said at the
outset, we are all unique, but that uniqueness can only
emerge in the context of elements of sameness and differ-
ence – in relation to the world around us and our response
to it.
Differentiation and comparison of self with other are part
of human interactions from the earliest moments of life.
The early stages of infancy include the process of individual
differentiation of the baby from the mother. Response to
difference, too, is observable very early – small children are
fearful of someone unfamiliar and schoolchildren are quick
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to tease anyone who looks different: the redhead, the fat

child, the boy with glasses. There seems to be a need to feel
that we are the same as others, the need to identify with
other people in a group. Is this perhaps part of a need to
reinforce our own sense of identity? It seems as though we
need to see ourselves mirrored in another person as a way of
validating who we are – almost an affirmation of our exis-
tence. It is significant that a baby’s first interactions with
his/her mother take the form of a mirroring process – an
endless reflection back and forth of gestures, movements
and facial expressions. As teenagers most of us go through
a phase where similarity to our peer group is vitally impor-
tant. Adolescents go to extraordinary lengths to adopt the
same manner of dress, hairstyle, body shape, tastes and
vocabulary as those around them. It would seem to be an
essential part of the process of establishing our own unique
identity to begin with a sense of group identity – to first be
the same as everyone else. Most people develop beyond this
phase as part of the process of gaining maturity. They
become able to claim their own uniqueness, which allows
them to feel comfortable about being different from others
in some ways, and also to feel relatively at ease in the pres-
ence of others whom they perceive as different.
However, I believe we never completely lose that deep
need to be among those who are like us and who therefore
reinforce our security in who we are. Most people’s closest
friendships are with those who would fall into that group.
This is not to say that people do not often form deep and
lasting friendships and relationships with someone who is,
in some sense, ‘other’ – but in such situations we will, if
possible, maintain a pool of friends whose similarities to
ourselves provide that sense of validation which we seem to
need. Being with people whom we perceive to be the same
or similar has the effect of affirming our own identity – of
reinforcing our perhaps fragile sense that who and what we
are is basically acceptable. By the same token, being in the
Chap-01.qxd 2/12/04 6:01 PM Page 13
presence of those who in some significant way we perceive

to be different, can undermine that sense of basic accept-
ability. For this reason I believe we all have difficulty, to
varying degrees, in fully accepting the presence in our midst
of someone who is noticeably different in some way – their
existence has the power, fundamentally, to threaten our
own. I am not mirrored in this person, so do I exist at all?
Our discomfort with difference thus has the potential to
undermine our own sense of identity. One way of decreas-
ing the tension inherent in this situation is to make the dif-
ferent person into the ‘Other’ – to retreat psychologically
into group identity and stigmatize those outside the group.
Reinforcing our own sense of belonging in a group is
obtained by the exclusion of others. My sense of being part
of the ‘in’ group is strengthened by identifying who is in the
‘out’ group. Indeed, there is no ‘in’ group without an ‘out’
group, just as the concept of ‘woman’ makes no sense with-
out the existence of men. This process of exclusion by
comparison is one that has occurred throughout history to
all groups identified as outside the social mainstream for
whatever reason. That the establishment of group identity
is psychologically reassuring is further demonstrated by the
social movements which arose in the 1960s. Identity poli-
tics created the notion of claiming one’s identity as a mem-
ber of an oppressed or marginalized group as a political
point of departure. Such politics involve the celebration of
a group’s uniqueness as well as protest against its particu-
lar oppression. Thus the source of your exclusion from the
mainstream – your difference and ‘outcast’ status – becomes
your passport to inclusion in a new group. On a different
level the proliferation and success of self-help groups
demonstrates the same process at work.
It is no longer socially sanctioned to engage in openly
hostile or discriminatory behaviour towards people whose
appearance, life-style or beliefs are different from our own –
which is not to say that such behaviour does not occur.
Chap-01.qxd 2/12/04 6:01 PM Page 14
Most people have no difficulty with an intellectual acceptance

of someone with a different skin colour, gender, religion or
sexual preference from their own. But is there something
deeper than such an intellectual stance – some deep aver-
sion to difference within us all? In other words, is adverse
discrimination a human universal? It would certainly seem
to be the case that we all need to feel we belong, and we all
struggle with acceptance of difference in others. As we have
seen, these two are inextricably linked – our identities are
forged by the marking of difference. Identity depends on
difference, and therefore on discrimination.
The subject of differences between people immediately
raises questions about the source of such differences and
about the relative merits of the various elements of dis-
crepancy. The nature/nurture debate is another theme
which runs through all the topics examined in this book.
Are differences innate or are they the result of environ-
mental influences? This seems to be intimately connected
to another question: does equality of treatment have to rest
on notions of sameness? As we shall see, the confusion
between these two questions has led to much (unneces-
sary) debate and muddled thinking.
Historically, biological theories have been invoked to
justify the worst excesses of adverse discrimination. Black
people and Jews have been seen as biologically different,
defective and inferior; women have been viewed as by
nature less intelligent, capable and rational than men;
homosexuals have been characterized as inherently mentally
ill or suffering from warped or incomplete development.
Such justifications have led to a variety of inequitable and
inhumane forms of treatment, ranging from social exclu-
sion and oppression to eugenics. By viewing the different
‘other’ as an inferior form of human life, or even as less
than human, we can argue for the differential treatment of
groups of people based on assumed immutable differences.
We can even argue that differential treatment is for their
Chap-01.qxd 2/12/04 6:01 PM Page 15
own good. Their lack of civilization, or intelligence, or

psychological development, rooted as it is in their genes or
their biology represents an inequality which demands a dif-
ferent response. Clearly this is an argument that can have
the effect of making us more comfortable about social
inequity. In its extreme forms, biological determinism has
been used as the basis for racist and sexist ideologies which
today incite moral repugnance. As we have reacted against
such extreme forms of discriminatory behaviour, so too
have we reacted against their underlying ideologies. In
order to argue for equal treatment for different social
groups, it has seemed vital to argue for equal potential – the
concept of ‘the blank slate’ (Pinker, 2002), which asserts
that everyone starts life with the same possibilities and
there are no innate biological differences. This has led to
the doctrine of social constructionism or social determin-
ism – the view that any perceived differences between individ-
uals or groups of individuals are the product of environment,
upbringing, diet, education and so forth, and nothing to do
with biology or genetic inheritance. But this was, in effect,
throwing the baby out with the bathwater. Acknowledging
innate biological differences does not have to involve an
evaluation of their respective worth.
Difference does not have to mean better or worse, but it
is very often taken to mean so. If we assume that a judge-
ment of something as different has to involve an evaluation
of better or worse, then to achieve equality we have to
argue for sameness. When sameness is manifestly not
apparent, the differences are explained by lack of opportu-
nity, environmental factors, and so on – the social con-
structionist stance. This can be seen within the arguments
surrounding the relative positions of men and women
within our society. To say that men and women have innate
differences (apart from their obvious physical ones) sets up
echoes of centuries of arguments which claimed that the
biology of women made them intellectually, psychologically
Chap-01.qxd 2/12/04 6:01 PM Page 16
and emotionally inferior to men. Difference was used as a

synonym for inferiority. To counter that, it is necessary to
argue that women are the same as men – intellectually,
psychologically and emotionally – and therefore their
equals. Equality of biological endowment demands equal-
ity of treatment. If or when men and women demonstrate
differences in aptitude or inclination in certain areas of
activity, such differences can only be explained by indoctri-
nation or discrimination – not by any innate preferences or
predispositions. The waters are muddied by the fact that
indoctrination and discrimination still take place, but
absurd positions have been taken in the attempt to disprove
the existence of innate differences between the genders.
There is, however, an alternative, which is to say that dif-
ferent means just that – different. Equally valid, not better or
worse. This notion is now in the social and political domain
and is central to the concept of multiculturalism. The
phrases ‘valuing difference’ and ‘celebrating difference’
appear regularly in the media and in sociological literature.
But it appears to be a concept with which we have consid-
erable difficulty – perhaps for all the reasons I suggested
concerning our need for establishing and maintaining our
identity. Making comparisons between ourselves and others
seems to be part of basic human psychology, and compari-
son automatically takes us into the realm of differences and,
seemingly, comparative worth. It also takes us away from
the process of looking for areas of similarity or common
ground. As Steven Pinker argues (2002: xi), the acknowl-
edgement of human nature, of innate human characteris-
tics, has the potential to ‘expose the psychological unity of
our species beneath the superficial differences of physical
appearance and parochial culture’. Our fear of admitting
that there are innate differences between individuals or
groups of individuals stems from the historical use of bio-
logical theories to justify the worst manifestations of preju-
dice and discrimination. I believe it also stems from the fear
Chap-01.qxd 2/12/04 6:01 PM Page 17
of being fixed or determined by such innate properties.

However, even a committed Darwinian like Richard Dawkins
concedes that humans possess a quality unique in the animal
kingdom – the power to make choices that override our
genes (Dawkins, 1976: 200). I return to Steven Pinker, who
states forcibly:
The case against bigotry is not a factual claim that humans are biologically
indistinguishable. It is a moral stance that condemns judging individuals
according to the average traits of certain groups to which the individual
belongs. (Pinker, 2002: 145)
What emerges then is the vital need to see differences as

elements that should be acknowledged and taken into
account in all human relationships, without either evaluat-
ing them or allowing them to blind us to the presence of
similarities. Some differences may be innate, some may be
culturally or socially determined. Their origin may well be
of intellectual or academic interest but should not influence
our response to them. It seems clear, however, that the
response of discomfort with or fear of difference is a uni-
versal human tendency. Nevertheless we possess, as with
our genes, the power to confront and reverse that tendency.
It is that tendency, within ourselves, with which we should
be battling, not the ‘Other’ as personified by the outcast in
the form of the black or disabled person, or the gay or
lesbian men and women we encounter.
What are the implications of our understanding of the

nature of prejudice, discrimination and response to differ-
ence for the enterprises of counselling and psychotherapy?
If adverse discrimination and social prejudice lead to
psychological distress, which they clearly do, and if coun-
selling and psychotherapy are in the business of alleviating
psychological distress, which they claim to be, one would
expect to find a high concentration of psychotherapeutic
services devoted to minority groups, or at the very least a
Chap-01.qxd 2/12/04 6:01 PM Page 18
statistical representation of such groups within the clients

of counselling and psychotherapy proportional to their
presence within society at large. Sadly, neither is the case.
There are indeed services devoted to counselling with
minority cultural or racial groups, and with lesbian women
and gay men, but such facilities are few and tend to be con-
centrated geographically in large cities, in particular in
London. Within the field of counselling and psychotherapy
as a whole clients from minority groups of any kind are
significantly under-represented.
Why should this be so? I think the answer is very simple.
Given that we appear to have a natural tendency to gravitate
towards people with whom we have shared characteristics,
and a need to feel part of a group, is it not possible or even
likely that in our work as well as our social lives this should
also apply? If we work as counsellors or therapists, the
implications are that we would therefore feel more comfort-
able with, accept as clients, work more productively with,
people with whom we have a natural affinity based on such
criteria as race, social group, sexual orientation, gender,
and so forth. As the vast majority of counsellors, therapists
and trainers in this field are white, educated, heterosexual
women, this would appear to place potential clients or
trainee counsellors who fall into categories other than those
in a disadvantageous position. In an ideal world all counsel-
lors, therapists and trainers will have, in their own training,
addressed their internal prejudices in such a way that would
remove the possibility of the kind of bias I am suggesting.
But the world is far from ideal and I fear this is very often
not the case. It is no surprise, therefore, to discover that the
majority of clients (and trainee counsellors and therapists)
are also white, middle-class heterosexual women. This
would be acceptable, though regrettable, if the enterprises
of counselling and psychotherapy acknowledged that they
existed primarily to provide a service to a particular, narrow
sector of society. This, however, is not the case. These
Chap-01.qxd 2/12/04 6:01 PM Page 19
enterprises pride themselves on being non-judgemental,

non-discriminatory and inclusive. The very basis of much of
their theory rests on such notions.
Many would-be counsellors come into training with an
assumption that they must somehow demonstrate their
ability to be non-judgemental. I suspect that they therefore
seek to hide (from themselves and others) any prejudices
they may have, in the fear that disclosure of such would
disqualify them from the training they are undergoing or
hoping to undergo. The task of all counsellors and thera-
pists and all training courses has to be to challenge such
notions. We need to be able to admit to the biases and pre-
judices that are an inevitable part of our make-up in order
to have any hope of relating to our clients in a way which
allows them to face their inner prejudices, or indeed
explore with us the ways in which they are different from us
or others and the impact of being on the receiving end of
adverse discrimination. Many training courses now include
factors such as gender, sexual orientation, race and culture,
and working with difference within their curriculum. Many
still do not. All too often the focus of the teaching in these
subjects is on underlying internal psychological mechan-
isms; little attention is paid to the impact of prejudice and
social discrimination in the external world. Little attention,
too, is given to the trainees’ own prejudices. Most training
courses have the unfortunate effect of reinforcing dominant
culture stereotyping. This is precisely because the theory
and practice they teach are based on the values and norms
of the dominant group in society – white, middle-class,
educated and heterosexual.
It would appear, therefore, that the enterprises of coun-
selling and psychotherapy run a severe risk of being norma-
tive, of becoming not only channels through which
the values and life-style norms of the majority group are
reinforced but also instruments of maintaining the status quo
by helping people ‘adjust’ to the inequalities within society.
Chap-01.qxd 2/12/04 6:01 PM Page 20
Some people have even suggested a more sinister agenda in

that such an activity has the effect of defusing energy that
might otherwise be directed towards social activism. Such
an argument would depict counselling and therapy as active
agents of social control (Hillman and Ventura, 1992). I
would not go as far as that, but I think there is a worrying
tendency to skate over issues of difference and, in particu-
lar, the psychological impact of social discrimination. If
counselling and psychotherapy have any hope of being truly
inclusive then each individual practitioner has to be able to
own his or her individual prejudices. Over and above that,
in working with clients from minority groups the focus has
to be on more than intra-psychic processes. The problems
of those who are the recipients of discrimination are not best
explained or understood by mechanisms such as oedipal
complexes, denial, splitting and so forth. These problems
have to be seen in an inter-relational context (Spinelli,
2001) and a social context (Williams, 1999). The challenges
that arise in working with differences are particularly severe
because they force (or should force) therapists to own and
work through those parts of themselves which are least
socially acceptable – and indeed which run counter to many
of the underlying assumptions within counselling and ther-
apy training – their own prejudices, fears and internal
biases. My hope is that we are up to the challenge.
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2 Race and Culture
T HE SUBJECT OF RACE AND CULTURE,

and our response to it, abounds with expressions
and terms which are often confusing in their usage. Is there
such a thing as ‘race’ in the sense of a means by which to
distinguish, with any precision, between groups of people?
What is the connection between race and culture?
Sometimes the two seem to coincide quite precisely – the
culture of a particular group corresponds with their distinc-
tiveness as a race, or ethnic group. In other instances the
overlap is less exact, the boundaries are blurred; two ‘racial
groups’ appear to share a similar culture, or one ‘racial
group’ displays evidence of different cultural traditions.
The focus of this chapter is on the ways in which the
response to a person’s race or culture (or both) is one
which includes adverse discrimination – prejudice against
that person because of this element of difference and con-
sequentially differential treatment. There are many terms
which have been used to describe this response: racism,
nationalism, xenophobia, tribalism, ethnocentrism, group
prejudice, or simply a sense of family or kinship. Our use of
language can make something sound either relatively
benign or potentially evil and sinister. It is important,
therefore, to begin by attempting to define some terms.
When we talk about a person’s race we are generally
making distinctions based on appearance and physical char-
acteristics. Underlying this are beliefs (correct or otherwise)
Chap-02.qxd 2/12/04 6:01 PM Page 22
about the involuntary effects of genetic inheritance. When

we talk about culture or ethnicity we are referring to the cus-
toms, social practices (and perhaps religion) that a person
chooses to follow or engage in. Race, therefore, refers to
those characteristics over which we have no choice – they
are a given, and may or may not include elements endowed
by inheritance which are specific to a particular group. It is
this distinction that informs the definition of ‘racism’ as
used by modern historians. When differences are regarded
as innate and unchangeable and are used as a justification
for persecution or discriminatory treatment, based on dis-
tinctions of superiority and inferiority attributed to those
supposed innate differences, then we have racism. If there is
the possibility for the Other to change, for example by reli-
gious conversion or cultural assimilation, what is in opera-
tion is bigotry, prejudice or xenophobia, but not racism
(MacMaster, 2001; Fredrickson, 2002). That is not to say
that prejudice and discrimination based on religion or cul-
ture are any less painful (or dangerous) for those who are its
recipients. Indeed Fredrickson (2002: 7) concedes that ‘cul-
turalism’ can work in the same way as racism, where culture
is viewed as essentialist and unchangeable and social groups
(for example, modern immigrants to England and France)
are for that reason assumed to be unable to assimilate.
Racism, by this definition therefore, is both an ideology
and a form of behaviour. It is based on theories which posit
unbridgeable differences between ethnic groups, and then
uses those distinctions to justify social exclusion, segrega-
tion, persecution or genocide. Central to the process of
racism is the identification of differences, usually the most
visible, which then become symbolic markers for racial clas-
sification and the attribution of essential forms of moral,
mental and cultural inferiority. The predominant forms of
western racism are white supremacy and anti-Semitism.
They are also the forms that have been manifested in the
most extreme manner in recent history. The word racism
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RACE AND CULTURE 23
entered the European language in the 1930s ‘to identify the

doctrine that race determines culture, the underlying con-
cept being that of race as type’ (Banton, 1997: 40). The con-
nection between race and culture is, by this definition, seen
as central, with the suggestion that culture, too, is in some
way fixed. Banton identifies the 1960s as the time when
‘racism’ took on new meanings; it came to refer to beliefs
and attitudes used to subordinate, control or exploit groups
of people defined in racial terms, and in more general terms
to refer to almost anything connected with racial discrimina-
tion, prejudice and inequality. He makes the distinction
between the bias which causes people to interpret events,
and to judge other people, in the light of their own society’s
values – a phenomenon he calls ‘ethnocentricism’ – and
prejudice, which he defines as a ‘rigid and hostile attitude
towards members of particular groups that often has sources
in the psychology of the person in question’ (Banton, 1997: 34).
In Banton’s view ethnocentricism, unlike prejudice, is an
essentially benign phenomenon. Other writers have made
different distinctions. Fredrickson describes ethnocentri-
cism, which he calls ‘a virtually universal phenomenon in
group contacts’ as ‘the tendency to discriminate against the
stranger, the alien, the physically different’ (Fredrickson,
1988). In common language usage this latter definition is
what most people would describe as racism, in other words
the prejudice and the behaviour without the underlying ide-
ology. Indeed, an even narrower usage of the word ‘racism’
would confine it to discrimination on the grounds of physi-
cal appearance, specifically skin colour. And yet anti-
Semitism is undeniably a form of racism. It could be argued
that Jews have distinctive physical characteristics, but
probably no more than, say, Italians or Norwegians. Such
physical characteristics are by no means universal or as
immediately apparent as skin colour. The factors in anti-
Semitism relate more to culture or religion or life-style, as
presumed identifiers of a racial group.
Chap-02.qxd 2/12/04 6:01 PM Page 24
While acknowledging the pertinence of historians’

semantic distinctions, and the powerful argument that
what made historical events such as the Holocaust, black
slavery in the USA, and apartheid in South Africa distinc-
tive, was the presence of an ideology which lent particular
and pernicious weight to these events and situations, I
would argue that the word ‘racism’ has taken on a wider
meaning and is now used in a more general way to describe
any manifestation of discrimination and prejudice against
others on the grounds of race, colour, religion or culture.
Such prejudice is more commonplace and widespread than
most would like to acknowledge.
In the first section of this chapter I will be looking at the
history of racial prejudice and discrimination. Within the
nineteenth and twentieth centuries this includes manifesta-
tions of racism as defined by modern historians – praxis
grounded in racist ideology. Any historical overview is
necessarily far from comprehensive. I will be focusing on
the history of racism and racial prejudice in the western
world and the train of ideological thought that linked their
manifestations. The end of this section concentrates specifi-
cally on the current situation in the UK. The second section
is devoted to a more detailed discussion of the process of
racism and racist ideology.
The final section examines the issue of race and culture
within counselling and psychotherapy. Perhaps over-
optimistically, I would assume racism as an ideology to
be absent from these enterprises. However, the issue of
response to difference is inevitably present in any contact
between two people. Physical differences no less than cul-
tural differences play a part in the counselling and thera-
peutic relationship. Skin of a different colour may invoke
stereotypes that have been absorbed and unchallenged.
The culture of both client and therapist will influence how
they think, what they value and how they express them-
selves. Culture and religion may also play a large part in
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RACE AND CULTURE 25
familial and group relationships and in an individual’s

expectations from interpersonal relationships, including
that within the counselling or therapy. To the extent that
we are all inevitably part of a culture and possess individual
or group values, we are all capable of prejudice and adverse
discrimination against someone who seems to be Other.
Racism and racial discrimination – a historical

overview
Early history
The classical period appears to be free of racial prejudice
based on colour. Both the Greeks and the Romans had a
highly positive view of the peoples they encountered whose
physical appearance differed significantly from their own.
Classical literature contains extensive references to the social,
medical and artistic achievements of both the Egyptians and
the Ethiopians. Early references to blackness of skin carry no
element of judging this as inferior. Skin colour was observed
and recorded, but appears to have been no bar to the possi-
bility of co-operation and social acceptance. The Ethiopians
inspired respect in both Greeks and Romans; they were
viewed as a military power, with their own specific culture.
There appears to be no trace of stereotyping blacks as prim-
itive peoples deficient in civilized practices or as physically or
morally inferior. Similarly it would seem that the ancients
put no premium on racial purity and were unconcerned with
degrees of racial mixture.
Colour, therefore, was not an obstacle to integration into
society in the Greek and Roman worlds (Snowden, 1983: 63).
Both Greek and Roman civilizations, however, did practise
slavery, and both held notions viewing their own social
institutions and practices and their particular race or group
as superior to those they conquered and enslaved. They
held strong views about their own perfection, both physi-
cally and in terms of the civilizations they had created, and
Chap-02.qxd 2/12/04 6:01 PM Page 26
regarded other national groups, for example the Britons, as

barbaric, savage and crude. These judgements were based
on criteria to do with levels of social and economic devel-
opment – that is to say cultural rather than racial discrimi-
nation. In antiquity slavery as an institution was a fact of
life and as such was independent of race or class. The great
majority of the thousands of slaves were white, not black.
There was no identification of blackness with slavery as
developed in later centuries. Such prejudice as did exist in
classical times was based on cultural and social evaluations
and its impact was insignificant in comparison with the
virulent forms of racial prejudice that have emerged in
modern times.
The early histories of Judaism, Christianity and Islam are
similarly free of prejudice based on colour. Religious intol-
erance and discrimination were, however, common.
Hostility against Jews was inflamed by their refusal to con-
vert to Christianity and by the notion that they were col-
lectively responsible for the Crucifixion. Throughout the
medieval period, Jews in Europe were not only socially
ostracized but persecuted and killed. Popular mythology
associated them with witchcraft and the devil. Jews were
blamed for the Black Death in the mid-fourteenth century
and thousands were massacred. By this time Jews had
acquired pariah status throughout Europe and were iso-
lated from mainstream society – a position they were to
occupy for hundreds of years.
The northern European expansion into the African con-
tinent led to the beginnings of ideas about the importance
of preserving racial purity and the dangers of mixing black
and white populations. The first European travellers and
explorers to Africa in the fifteenth and sixteenth centuries
were the Portuguese. They were interested primarily in
trade and wealth and initially there seems to have been
assimilation of the Portuguese travellers into the local cus-
toms, frequently forming relationships with African women
Chap-02.qxd 2/12/04 6:01 PM Page 27
RACE AND CULTURE 27
and fathering children. Soon, however, this became a practice

that was viewed with disapprobation, particularly by the
Catholic Church. What soon emerged was ambivalence
between the desire to convert, which was increasingly seen
as part of the imperial project, and fear of contamination by
the inter-mingling of black and white racial groups.
The English arrived in Africa nearly a century after the
Portuguese. They too were initially interested in trade with,
rather than the conversion or the conquering of, the natives.
Unlike the Portuguese and the Spanish, the English had
hitherto had no contact with Africans or dark-skinned
peoples. The contrast between the Africans’ skin colour
and that of the English traveller had a powerful impact on
these explorers. They appear to have perceived Africans as
a group of people characterized by their difference, in every
respect, from the European. Skin colour, religion and life-
style all combined to construct a picture of the African as
essentially ‘other’ – unchristian, immodest, libidinous and
black. Medieval Christian thought linked blackness with
concepts of danger, sin and evil. For the English explorer,
therefore, the African was barely human, and clearly at risk
of eternal damnation. The assumption of racial superiority
by white explorers and settlers was present from the earli-
est contact between Europeans and Africans. Indigenous
populations were seen as inferior and expendable or, less
commonly, as projects for conversion, both to Christianity
and the ‘civilized’ social conventions of the European way
of life.
Notions of symbolism associated with blackness and
whiteness pre-date the sixteenth century. The polarity of
black versus white was linked with filth versus purity, sin
versus virginity, evil versus good, ugliness versus beauty,
baseness versus virtue. For the Elizabethans, however,
whiteness carried a special significance; it was the colour of
perfect human beauty, especially female beauty as embod-
ied in their fair Queen. As black seamen, servants and
Chap-02.qxd 2/12/04 6:01 PM Page 28
slaves began to arrive in Britain the negro became the

visual encapsulation of the antithesis of beauty, virtue and
purity. The literature of the age reflects these notions.
Othello encapsulates some of the ambiguities present at the
time. While Othello is portrayed as brave and noble, his
relationship with a white woman is seen as highly ques-
tionable and against the natural order. He is revealed as
being uncontrollably emotional, irrational and murder-
ously aggressive – still in fact a barbarian. Fears of black
pollution were growing in Britain, and in 1604 Elizabeth I
called for the deportation of blacks because their presence
in her kingdom was felt to be too great. There are chilling
echoes here of events in the mid- to late twentieth century.
Europe in the eighteenth and nineteenth centuries

Most writers on race and racism concur in the view that the
foundations for modern racism were laid in the eighteenth
century. This is not to say that elements of racist thought
and/or behaviour are not discernible earlier, but that there
emerged in the period of the Enlightenment and beyond,
theories and beliefs which formed a substantial racist ide-
ology. This provided a rationale for racism which had not
existed previously. Strains of this ideology are still evident
in society today.
George Mosse (1985) traces three strands in eighteenth-
century thought which were crucial to the development of
this racist ideology. The first was the attempt of the intel-
lectual elite to substitute an emphasis on man’s reason for
outmoded superstitious ideas. The ‘enlightened’ rejected
Christianity and turned to the classics, the ideals of the
Graeco-Roman world, for inspiration. The second strand
was Christianity itself, which continued to thrive through-
out Europe. Religious fervour and revival created an
atmosphere in which great value was given to the emotional
life of the ‘inner man’; this was viewed as indicative of the
state of his spiritual health. The third strand was the
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RACE AND CULTURE 29
growth of natural science and radical attempts to define

man’s place in nature.
These different strands of thought were intermingled
right from the start. Nature and the classics were both seen
as essential in understanding man’s place in the universe.
The new sciences which developed during the century
involved studying different groups of men and animals;
physical measurements and observations of behaviour
formed the basis of comparisons and classifications. The
value judgements which accompanied these studies were
based on aesthetic criteria derived from Ancient Greece,
which was upheld as the epitome of civilization both in its
social structures and in the proportions and elements of its
sculpture, arts and the people themselves. There was a
desire for harmony in the affairs of man; evidence of its
existence was taken in the outward form of man himself.
Thus we can see the origins of the idea that the outer physical
appearance of a human being indicates his inner nature –
and not only his personality but his position in society and
his very soul.
Throughout the eighteenth century attempts were made
to classify nature, beginning with Linnaeus in 1735. Like
his predecessors and successors, Linnaeus was influenced
by one ‘item of intellectual lumber common to educated
man’ (Curtin, 1965), namely the ancient belief in a ‘Great
Chain of Being’. This was the idea that all living things fit-
ted into a hierarchy extending from God to man to the
smallest animal on earth. Even when (for some) God was
removed from the equation, the notion of a hierarchy per-
sisted, carrying with it the assumption that the varieties of
mankind too existed in a sequence characterized by higher
and lower orders. Linnaeus’ first racial classification was
based on skin colour with four races: white, red, yellow and
black, each located on one of the four major continents. He
later modified his classification, and other biologists and
ethnologists suggested variants of his thesis. Like Linnaeus,
Chap-02.qxd 2/12/04 6:01 PM Page 30
all of the scientists engaged in this field in the eighteenth

and nineteenth centuries were European. Not surprisingly
when it came to arranging the races in a hierarchy, all of
them placed the white European at the top.
In the first half of the eighteenth century Romantic ideal-
ism and a desire to forge close links with nature as a route
to Christian purity gave rise to the notion of the ‘noble savage’.
The black man was seen as embodying a primitivism which
was unsullied by the corruption of so-called civilization. He
was viewed as innocent, charmingly naïve and in tune with
the natural elements of his environment. This view was not
to last, and as the scientific notions of the age began to
dominate popular thought, natives were seen not as uncor-
rupted by civilization but as lacking in civilization. The
image emerged of the black man as lazy, undisciplined, and
therefore in need of education and guidance.
By the end of the eighteenth century anthropologists were
unanimous in their view that the negro was the lowest link
on the great chain of being. Various theories posited that
they were closer to the animal world than to the human
world, or were halfway between the two, providing the
‘missing link’ between animals and man. Physical appear-
ance was cited as evidence for these notions along with
pseudo-scientific theories based on facial measurements
and brain weights. The ideal of classical beauty was used
as the prototype for comparison. What emerged from the
eighteenth century, therefore, was not only the basis of
views about the inherent inferiority of the black man, but
notions about the ideals to which the superior race was sup-
posed to conform. Within these ideas the connection
between outward physical appearance and inner moral and
intellectual characteristics was firmly established.
At the beginning of the nineteenth century there was still
much debate about why the peoples of the world differed
so much in their physical appearance. Michael Banton
(1997) summarizes the contemporary explanations into
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RACE AND CULTURE 31
four possible answers. The first was based on the Bible. We

are all descended from Adam and Eve and God had placed
a curse on the descendants of Ham, making them black.
Variations of this theory posited Shem and Japhet, Ham’s
brothers, as founders of other distinct racial groups. The
second answer was environmental. Living in tropical cli-
mates had the effect of turning the skin black. The third
answer was close to Darwinian theory; accidental variations
are selectively preserved because of environmental or other
factors. As this ran counter to the teachings of the Bible it
seemed at the time unlikely as well as unpopular. The
fourth answer was the one that gained ascendancy, sup-
ported as it was by the developing science of anthropology.
This was the idea that the world was divided into a series
of natural provinces. There is a finite number of permanent
human types, each with its own set of distinct characteris-
tics. The theory of ‘racial typology’ was significant because
it asserted that the different human groups were distinct
species rather than varieties of the same species.
Proponents of this theory believed that the pure human
types were permanent and unchanging and that if there was
(ill-advised) mixing between different groups, the hybrid
lines would die out.
As theories of ‘scientific racism’ developed, the belief that
whites were naturally superior to other races was reinforced
by citation of their achievements as evidence of such. It was
suggested that one of the characteristics of the white race
was that of being ideally suited to develop and colonize
other, less endowed, areas of the world. Thus the difference
between whites and blacks was not just one of different
stages of advancement, but stemmed from an innate and
permanent superiority of white over black. These views
were supported by a spate of pseudo-scientific studies meas-
uring and comparing such things as the ‘facial angle’, the
shape of the skull (phrenology) or the weight of the brain,
all of which purported to demonstrate the inferiority of the
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black and coloured races and the superiority of the whites.

As physical characteristics were indications of other aspects
of the human personality, racial type was seen as an immut-
able indicator of such things as intelligence, morality, inven-
tiveness, orderliness and so on – that is to say the values of
the white middle-class nineteenth-century European.
The most exhaustive exposition of racial typology was
provided by Arthur de Gobineau in his book Essay on the
Inequality of the Human Races (1853–4). Gobineau classi-
fied man into three races: yellow, black and white. The
black race was seen as the lowest and was assigned charac-
teristics by now traditional in racial thought: limited intel-
ligence, animality and over-developed sensual desires,
inability to distinguish between vice and virtue, horrific
impassiveness to suffering, and a crude and terrifying
energy. The yellow race, he believed, was materialistic,
pedantic, apathetic and lacking in physical strength. It was
seen as mediocre and with weak desires. The white race,
however, embodied the virtues of nobility, love of freedom,
honour, spirituality, perseverance, physical power and
superior intelligence. Gobineau believed that the mixing of
the races was sadly inevitable but that over time this would
lead to the degeneration and eventual disappearance of
racial purity. Many of Gobineau’s ideas, in particular the
notion of blood purity, were taken up and used by theorists
who followed. As Biddiss states, ‘the subsequent treatment
of Gobineau’s theory was far from what he intended, and
he became the inventor of twentieth century racism rather
by accident’ (Biddiss, 1966). Gobineau’s thesis was taken
up by German thinkers and there is a clear line of intellec-
tual thought from here to Hitler.
In a similar way the theories of Charles Darwin were
adopted by racial theoreticians. It is easy to see how con-
cepts like ‘natural selection’ and ‘survival of the fittest’
could be diverted for such use. Darwin’s ideas were com-
plex and placed emphasis on the environment as the main
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RACE AND CULTURE 33
factor in the variation of species. His followers changed this

emphasis to one of heredity, which led to a focus on the
inherent qualities of racial stock. Francis Galton, a follower
of Darwin, dominated European research into heredity,
and in his work Hereditary Genius (1869) he laid the foun-
dations of the eugenics movement. Here we find the chilling
notions that the birth rate of the unfit should be checked
and that of the fit encouraged through early marriage. It
was a short step from here to the idea that those considered
unfit (because of undesirable characteristics which were
innate in their racial type) should not only not be allowed
to reproduce, but should be exterminated, for reasons of
‘racial hygiene’.
As is so often the case, the events of a period lag
behind the developing intellectual thought. During the
latter part of the eighteenth and the beginning of the
nineteenth centuries, Europe experienced a period of
democratic revolution and liberal humanism. The
Enlightenment and the French Revolution promoted
ideas which emphasized the shared characteristics and
fundamental equality of all humankind. The position of
Jews and other oppressed minorities improved signifi-
cantly in most European countries during this time. This
movement was echoed in the New World, where slaves
were emancipated in 1863 and the Fourteenth Amendment
(1868) granted equal citizenship for all born in the USA.
The civil and political emancipation of the Jews took
place throughout Europe between 1789 and 1871. Prior
to this, Jews had been set apart from Christians in
Europe by special taxes, residential restrictions, public
stigmatization and limited civil status and autonomy.
However, their reprieve was short-lived and from the
1870s onwards there was a significant backlash against
such liberal ideas. The ideologies that had been develop-
ing since the beginning of the eighteenth century were
brought into play as scientific racism constructed absolute
Chap-02.qxd 2/12/04 6:01 PM Page 34
boundaries between the races based on notions of fixed

biological differences (MacMaster, 2001: 16).
USA and slavery

Slavery has existed in many forms throughout recorded
history – and not only of black or coloured groups of
people. It has historically been regarded as a justifiable way
of treating those you have conquered in battle. By virtue of
being defeated, the conquered race, group or nation is
demonstrably less strong; slavery is also an effective way of
subjugating any residue of resistance. Slavery was practised
in America for almost 200 years. American slaves, however,
were not the subjects of a nation defeated in battle. They
were human beings specifically captured and sold to pro-
vide lifelong, and very economical, labour in a country
short of manpower. Slaves imported from Africa were a
commodity whose transportation and sale provided a liveli-
hood for traders, as well as meeting the economic and
labour needs of the New World.
In examining the history of slavery in America there is a
circular debate among historians as to which came first,
slavery or racism. In other words, were blacks enslaved
because they were viewed as inferior, or was the theory of
their inferiority invented to justify slavery? This debate is
based on the distinction between societal racism and ideo-
logical racism. As we have seen in Europe, there is consid-
erable evidence of racism existing in the social treatment of
minority groups well before the ideology that developed in
the eighteenth and nineteenth centuries. In many ways the
history of America over the same period mirrors this pat-
tern. The theories about race that emerged during this time
were useful to many whites in America in providing a
‘scientific’ rationale for their behaviour and practices.
According to Fredrickson (1988), the English colonists
brought with them to the New World a predisposition
towards colour prejudice as a result of England’s early
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RACE AND CULTURE 35
contacts with Africa. Blackness was associated with savagery,

heathenness and a general lack of civilized behaviour. There
was also the age-old association of black with evil. The
unfavourable black stereotype already existed by the seven-
teenth century. Blacks were first introduced to Virginia as
‘servants’ between 1619 and 1640, and by the 1660s slavery
was legally sanctioned. By the early eighteenth century the
development of a slave plantation economy saw the intro-
duction of laws banning intermarriage between blacks and
whites and forbidding private manumission. Blacks were
deprived of all rights granted to whites and a rigid social
classification sanctioned the treatment of blacks in ways
which were in many instances inhumane and brutal.
A racist ideology did not fully develop in America until the
nineteenth century when we see an emergence of theoretical
concepts similar to those in Europe. The environmentalist
view of the eighteenth century, however, had significant
impact in parts of America. The idea that racial characteris-
tics were not innate but rather the result of environmental
factors, combined with the natural-rights philosophy, led to
an attack on the institution of slavery in the north during the
era of the American Revolution. This precipitated the begin-
ning of emancipation in the northern states. However, fol-
lowing the Declaration of Independence, abolitionist feeling
forced pro-slavery southerners to refine and articulate a
racist theory to defend their treatment of black slaves. The
expression of this theory in America was focused on black
groups, whereas in Europe it became the cornerstone of
anti-Semitism. In the American South both personal
wealth and the social structures in place were dependent
on the slave economy and the maintenance of the negro’s
inferior status. In the northern states, where slaves had been
emancipated after the Revolution, blacks were subjected to
segregation, discrimination and violence. Following gen-
eral emancipation anti-black racism reached horrific
heights. Blacks were frequently hanged or burnt alive by
Chap-02.qxd 2/12/04 6:01 PM Page 36
lynch mobs and the popular view was of the black man as
a vicious brutal beast who needed to be kept in his place.
Emancipation could not be carried to completion
because it was impossible for the white American, in the
North as well as the South, to think of blacks as genuine
equals. As Fredrickson (2002: 81) puts it: ‘efforts to extend
the meaning of emancipation to include black civil and
political equality awakened the demons of racism to a
greater extent than the polemical defense of slavery had
done’. Thus the Civil War resulted in the emancipation of
the negro from slavery but not from caste discrimination
and the ravages of racism. The civil rights movement in the
USA, which gained momentum after the Second World
War, succeeded in finally outlawing legalized racial segre-
gation and discrimination in the 1960s. This movement
benefited from a feeling of revulsion against the Holocaust
as the logical extreme of racism. Following the Second
World War scientific racism lost its credibility, although
societal racism and racial discrimination persisted in the
USA as in Europe.
Europe in the twentieth century

In the early years of the twentieth century there was mass
migration of non-white peoples from the third world to the
industrial societies of the first world. This led to social
unease in many places, and in Britain the right of free entry
to the country was restricted by the Aliens Acts of 1905
and 1919. Those immigrants who settled in Britain
encountered widespread prejudice which adversely affected
their opportunities in key areas such as employment and
housing. Surveys of the time portray this group as a social-
pathological minority; on the whole they remained isolated
in the worst social and economic conditions. The main-
stream of English racial prejudice centred upon the black,
because of Britain’s imperial past. On the continent, how-
ever, racial discrimination became focused on the Jews.
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RACE AND CULTURE 37
Anti-Semitic feeling had been present in Germany

before unification. The movement towards a unified
German state was based on the concept of national mem-
bership defined by ethnic origins rather than human rights.
The German philosopher Johann Gottfried von Herder
(1744–1803) had propounded the theory that each ethnic
group possesses a unique Volksgeist (folk soul) which should
be protected from contamination. Jews were seen as a
source of such contamination. However, broader libertarian
attitudes throughout Europe in the nineteenth century led
widely to the emancipation of the Jews. This allowed
German Jews to participate in their country’s prosperity in
the latter part of this century. Despite this, deep-seated
racial prejudice, combined with German nationalism and
fears of Jews over-running those of pure German descent,
led to overt expressions of anti-Semitism by the turn of the
century. It was the Nazis who combined these powerful
feelings with scientific racism to such devastating effect.
The eugenics movement, begun in the late nineteenth
century, gave rise in the early twentieth century to the doc-
trine of ‘racial and social biology’. Any racial mixing was
seen as dangerous, leading to ‘degeneracy’. The black race
was still seen as innately inferior, but by the mid-1930s the
negative characteristics which had for so long been attrib-
uted solely to the blacks were also assigned to the Jewish
race. The desire to preserve racial purity meant that eugen-
ics must be practised by the superior race to keep it from
degeneration and the threat of extinction. The ‘unfit’, that
is those belonging to a lesser race or those damaged by dis-
ease or disability, should at the very least be sterilized but
preferably eliminated. The history of Nazism and Hitler’s
implementation of anti-Semitism is well documented. But
it is vital to see the Holocaust in the context of the racial
ideology that had been developing in the preceding 150
years. The Nazis were only carrying to a logical conclusion
the racist opinions and doctrines that held sway throughout
Chap-02.qxd 2/12/04 6:01 PM Page 38
Europe and America before the Second World War. As a

result an estimated 5,933,900 Jews and other ethnic minori-
ties were killed.
In his analysis of European racism, George Mosse
stresses the continuity of thought in racial stereotypes from
the early eighteenth century to the Holocaust. The stereo-
types of beauty and ugliness remained the same, as did the
crucial notion of the outward appearance of a man mirror-
ing the workings of his inner nature.
From the eighteenth century to its use by the Nazis in the holocaust,
this stereotype never changed. The virile, Hellenistic type juxtaposed with
the dark and misshapen villain, the Aryan of Greek proportions versus
the ill-proportioned Jew, made racism a visually centred ideology. (Mosse,
1985: 233)
Racism, however, did not die out with the Holocaust.

Notions of ideological racism, racial biology and eugenics
were largely discredited in the aftermath of the Second
World War. Many, however, have re-emerged with different
labels – ‘ethnic cleansing’ being the most recent. The post-
war world was very sensitive about any expressions of anti-
Semitism, but this sensitivity did not spread to the blacks.
Countries which had fought to defeat Hitler and National
Socialism continued to accept black racial inferiority for
many years after the war, while being vociferous in their
condemnation of Nazi racism. Racist ideology was central,
for example, to the implementation of apartheid in South
Africa. Established in 1948, this regime restricted Africans,
more than 70 per cent of the total population, to approxi-
mately 13 per cent of the total land area of South Africa.
Blacks and whites were segregated in all areas of life, with
intermarriage forbidden. The aim of this regime, like others
before it, was white supremacy based on an ideology of
innate black inferiority.
When we look at the history of racial ideology, what
emerges quite clearly is that ideas of racial difference and
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RACE AND CULTURE 39
the notions of inferiority and superiority that go with them

existed long before they were underpinned by pseudo-
scientific theory. They have continued to exist long after
such theories have been discredited.
Britain after the Second World War

The history of racism and racial ideas in the period from
1945 to the present day is characterized by a move from
racial difference as the justification for overt racist behav-
iour based on assumptions about superiority and inferior-
ity, to an ideology where racial difference is ‘celebrated’ as
in notions of multiculturalism and cultural pluralism.
While there is no doubt that in general the position and
social treatment of black and coloured people has
improved immeasurably since the 1930s, it is also the case
that racism has continued to be manifested in all areas of
society. It is undeniable too that many white Britons,
because of the prevailing liberal ideas of ‘multiculturalism’
professed by the media, have an image of their country and
of themselves as being tolerant, accepting and free of preju-
dice, an image which is very far from being true.
In the period following the end of the Second World War,
most of Britain’s colonies in Africa, Asia and the Caribbean
came to experience full independence at approximately the
same time. Partly because of this there were large groups of
peoples who migrated from these areas to Britain between
the late 1940s and the 1970s. Prior to this Britain had seen
itself as a white country. But this was no longer feasible by
the 1960s when the ideology of multiculturalism began to
emerge. Up until this point the prevailing assumption had
been that any newcomers would be assimilated into the
dominant culture. This assumption was easier to maintain
when those entering the country were less visible – as with
Irish, Poles, Germans and other Europeans who moved to
Britain in the nineteenth and twentieth centuries. With the
advent of large groups of black and coloured people, the
Chap-02.qxd 2/12/04 6:01 PM Page 40
idea of assimilation became more problematic. This was

not only because there continued to be resistance to inter-
marriage between people of different colours (by both
blacks and whites) but also because the immigrants them-
selves in many instances maintained ties with their coun-
tries of origin and showed no desire to relinquish their own
customs and cultural practices. On the contrary, by the
1960s many minority racial groups were uniting in a call for
racial cohesion and pride in their own cultural heritage, as
well as demanding greater representation in all areas of
British life. It is significant that in Britain the word ‘immi-
grant’ has come to mean people who enter the country and
who are black or brown. This takes no account of the vast
numbers of arrivals who are white. Indeed in the 1980s
there were more white than black immigrants.
The political focus that began in the 1950s and contin-
ues to the present day has been on how to control or cur-
tail immigration. A series of Acts, beginning with the
Immigration Act in 1971, have attempted to limit entry by
various means. What these various pieces of legislation
demonstrate is the ever-present resistance to the entry of
black people to the UK. There is a fear, rarely articulated
but occasionally hinted at, that a relaxation of control of
immigration by blacks will lead to a situation where whites
are no longer in the majority. At the same time there has
been a political and social awareness of the need to fight
racial discrimination as evidenced by the three Race
Relations Acts (1965, 1968 and 1976). The counterpoise
between the exclusionary nationality and immigration laws
and the anti-discriminatory legislation seems to imply an
underlying principle that more immigration would be
inimical to good race relations in Britain. Significantly the
1976 Race Relations Act heralded a shift in emphasis, pro-
mulgating the notion of a multicultural society in which
there should be no attempt to achieve integration through
assimilation, but through promoting mutual tolerance
Chap-02.qxd 2/12/04 6:01 PM Page 41
RACE AND CULTURE 41
within diversity. This Act made discrimination unlawful on

grounds of race, colour, nationality and ethnic or national
origin.
Throughout the second half of the twentieth century,
and into the twenty-first century, there has been continual
racial tension in the UK, erupting periodically into riots,
mob violence and countless individual incidents of racially
motivated attacks of varying severity. Many commentators
point to the legislation on immigration as a source of exacer-
bating the existing problem by creating, or reinforcing, an
image of black and Asian immigrants as a social problem –
in other words stigmatizing and stereotyping these
groups. At various times resistance to immigration and
explicit racist thought have crystallized around specific
groups. The National Front in 1967 emphasized in their
programme the need to preserve ‘our British Native
Stock’ by ‘terminating non-white immigration’ (Holmes,
1991: 57). In 1968 Enoch Powell delivered his infamous
‘Rivers of Blood’ speech, spawning for a time the move-
ment of Powellism. In the late twentieth century the
British National Party has been increasingly active. Their
use of the Union flag as an emblem is symptomatic of
their belief in British nationalism as an exclusively white
prerogative.
The contemporary situation

The Commission for Racial Equality, set up in 1976 to
enforce the Race Relations Act, has been active in moni-
toring the situation in all areas of life throughout the UK.
Despite this, their current findings are depressing. Ethnic
minorities are three times more likely than whites to be
homeless and five times more likely to be living in poor or
overcrowded conditions (CRE, 1999a). There is still a dis-
proportionate number of ethnic minorities engaged in
unskilled and low-paid jobs, and black and Asian men are
twice as likely to be unemployed as white men – in London
Chap-02.qxd 2/12/04 6:01 PM Page 42
and some other inner-city areas this figure rises to three

times as likely (CRE, 1999b). The 1996 Ofsted report
showed that Afro-Caribbean boys are excluded from
school up to six times more frequently than their white
counterparts for similar behaviour. Since then both exclu-
sion rates and the disproportionate exclusion of children
from ethnic minorities have risen. Those young people
from ethnic minority groups who do achieve good educa-
tional qualifications (more commonly Asian than Afro-
Caribbean children) experience more difficulty than their
white counterparts in securing employment.
Efforts to become part of the political body have also been
largely unsuccessful – black and Asian groups are grossly
under-represented politically. In 1998 there were twelve
non-white MPs in the House of Commons. In order to
reflect a percentage of the population this figure should be
fifty (CRE, 1999b). A 1994 Home Office report found that
each year there are between 89,000 and 171,000 racially
motivated incidents such as assaults, threats or vandalism
directed against Asians or Afro-Caribbeans. The police and
justice systems have increasingly come under public
scrutiny, particularly since the murder of Stephen Lawrence
in 1993 and that of Damilola Taylor in 2001. The inquiry
following Stephen Lawrence’s death brought acknowledge-
ment from the British government, for the first time, that
institutional racism exists in the police force. Despite that,
an undercover operation by a journalist in October 2003
exposed racist beliefs and behaviour in members of the
Greater Manchester police force, leading to the resignation
of several police officers. The fact remains, however, that
black and brown people are far more likely to be the victims
of attacks on the streets or in their homes than are white
people. Furthermore, black men are eight times more likely
to be stopped and searched by the police than white men,
Asian men being three times more likely. So, despite
repeated legislation and high levels of social awareness,
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RACE AND CULTURE 43
black and Asian groups in the UK continue to encounter

racism and discrimination in all areas of their lives.
Meanwhile the vast majority of the white population have
succeeded in retaining an image of themselves, individually,
as non-racist. A survey conducted in 1984 revealed that 90
per cent of the survey sample believed that blacks and
Asians in Britain met with prejudice. However, 64 per cent
of the respondents placed themselves in the ‘not prejudiced
at all’ category and only 4 per cent admitted to being ‘very
prejudiced’ (Holmes, 1991: 3). An opinion poll conducted
in 1995 came up with similar results; the term ‘pluralistic
ignorance’ has been coined to describe this phenomenon.
From the late 1980s there has been a growing hostility in
Britain, as elsewhere, towards Muslims, generated by fears
of Islamic fundamentalism. Following the horrific events of
11 September 2001, there have been many violent incidents,
both in Europe and the USA, against people who are per-
ceived (correctly or incorrectly) to be Muslim. The identifi-
cation of an individual as belonging to a particular ethnic
group by their appearance (colour of skin, or their manner of
dress – in this instance wearing a turban) can lead to the
assumption that the individual shares the attitudes and views
of other members of the group who have committed acts of
violence. This process – the assumption of homogeneity in
all aspects of personality and life-style because of one shared
aspect – is common to all forms of prejudice and discrimi-
nation and is particularly pernicious for those who are its
recipients. In the current climate it is potentially dangerous
or even life-threatening for many Muslims residing in
Europe or the USA. Intense sensitivity and controversy over
immigration into the UK has been revived since 11 September;
in the media and public consciousness ‘asylum seeker’ has
become almost synonymous with ‘terrorist suspect’.
Fredrickson (2002: 145) suggests that what we are wit-
nessing is a process whereby culture and religion are being
essentialized to a point where they serve as the functional
Chap-02.qxd 2/12/04 6:01 PM Page 44
equivalent of biological racism – in other words a person’s

faith or culture is judged to be an unchangeable and poten-
tially threatening element of who they are, and has become
the grounds on which it is justifiable to discriminate against
or persecute him or her. He posits the possibility of the
colour line of the twentieth century being replaced or over-
shadowed by the faith or creed lines of the twenty-first
century (ibid.: 148). The social and political events of the
current century do nothing to refute such a view.
Meanwhile, theories which underpin a racist ideology
have never completely gone away. E.O. Wilson’s theories of
sociobiology (1975) led to a resurgence in ideas of biological
determinism, which have been used as justification by racist
movements such as the National Front. Wilson’s claims that
territoriality, tribalism and xenophobia are part of the human
genetic constitution have been taken up by such organiza-
tions in their crusade for maintaining Britain as an exclu-
sively white nation and as a justification for their attacks on
blacks and Asians residing in Britain. Carter (1995: 32) cites
a number of contemporary scholars (zoologists, social scien-
tists and anthropologists) whose theories of racial topology
and inferiority, based on skeletal morphology, hair, facial fea-
tures, head size and genetic structure are strikingly similar to
the writers of the eighteenth and nineteenth centuries. Like
their predecessors, these modern theorists are not simply
pointing out differences between racial groups, but are
implying a comparative standard of better and worse, with
whites portrayed as superior to blacks. In The Bell Curve,
published in 1994, Herrnstein and Murray claimed to show
that whites are superior in intelligence to blacks and other
people of colour. These ideas seem to resurface regularly and
are widely disseminated through media reports, provoking a
chorus of voices and research that challenges and rejects
such thinking. What we are seeing here is a manifestation of
the confusion between different and better/worse. Theories
that attempt to highlight possible differences between racial
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RACE AND CULTURE 45
groups are quickly adopted and (if necessary) distorted by

some to ‘prove’ white racial superiority. In order to ‘dis-
prove’ such assertions it is seen as imperative to insist on
total equality of biological endowment.
It would seem that despite a widespread growth in liberal
ideas since the Second World War, a general recognition of
the importance of equality and acceptance within society, and
the establishment of humanitarian movements and organiza-
tions which reject, intellectually at least, the old ideologies of
superiority/inferiority based on colour and race, prejudice and
racial discrimination have never ceased to exist. In any situa-
tion of stress – competition for jobs, housing or advantage;
incidents of violence or sexual attacks involving people of dif-
ferent racial groups or different skin colour; situations which
threaten national security – old stereotypes have surfaced
anew and the likelihood of the presence of racism is high.
Some socialist theorists believe that antipathy towards minority
groups is an inevitable consequence of capitalism (Holmes,
1991: 85). In some respects this appears to be borne out by
history – as societies have become industrialized, more com-
plex and more economically sophisticated, racial disharmony
has become an increasingly predominant feature within
them. A factor of greater significance, however, would appear
to be the movement of groups of people made possible by the
technological developments of the nineteenth and twentieth
centuries. As soon as different racial groups live side by side
within the same social structure, rather than separated by
geographical distance, hostility and prejudice inevitably sur-
face. The potential for the expression of that hostility towards
minorities appears to reside in all societies, and in all indivi-
duals within those societies.
The process of racism and racial discrimination

To what extent is adverse discrimination against another
person or group on the grounds of their race or cultural
Chap-02.qxd 2/12/04 6:01 PM Page 46
practices a phenomenon rooted in human nature, and to

what extent is it the product of particular historical or
social circumstances? As we have seen, the typologists
believed that each racial type inherited not only physical
but also psychological characteristics. Each type was also
believed to inherit innate attitudes towards members of
other races. Thus racial prejudice was believed to be an
inherited disposition. This view was challenged with the
development of psychological research and environmental
theories which claimed that racial prejudice was learned in
the course of a child’s upbringing. The kind of inherited
psychology suggested by the typologists – that the white
races are naturally superior, leaders and colonizers, and the
black races are naturally inferior and subservient, has been
widely discredited, not the least because of its obvious
racist undertones. But, as we have seen, there does seem to
be some human disposition to fear the Other, which is
aroused in a particularly virulent way by difference in skin
colour, and which can manifest itself in the form of preju-
dice and racial discrimination.
Central to the debate about the origins of racist manifesta-
tions and regimes and to discussions around the use of ter-
minology such as ‘racism’, ‘ethnocentricism’, ‘xenophobia’,
and the like, is an attempt to distinguish between that ele-
ment of a prejudiced or ‘racist’ response which stems from a
person’s individual psychology and that element which has its
origin in generally consensual group or social attitudes. At the
heart of this are questions about both individual and group or
‘generally human’ psychology, and how the two interact. In
addressing these issues, it would be useful to examine the dif-
ferent ideas, concepts and psychological mechanisms that
underlie the process whereby racism, racial discrimination
and racial prejudice are manifested. Some of these elements
can be traced back historically – they have their roots in the
history of racial thought, as already outlined. Others are spe-
cific to a particular time, place or social group.
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RACE AND CULTURE 47
Black/white symbolism
The association of white with good and black with evil, and
all the related connotations, pertains particularly to the
western tradition. It found its apotheosis in Christianity,
but there is no doubt that it existed before. White stands
for purity, joy, beauty, health, virginity, cleanliness, virtue;
black stands for negation, disorder, defilement, ugliness,
illness, corruption, filth, and so on. In literature and art the
symbolism is carried further – they are symbols of two
opposing universes and irreconcilable opposites; day and
night, renunciation and sensuality, culture and nature, life
and death, God and the devil.
In non-western cultures there does not appear, histori-
cally, to be the same black/white imagery. In Africa black
may represent something auspicious or benevolent. In clas-
sical Chinese opera, black-painted faces represent integrity,
white faces evil. However, one of the effects of the colonial
period on many parts of the world appears to have been to
import the connotations of white as superior. Following the
abolition of slavery and the end of colonial rule, the
Christian missions perpetuated the idea that blacks could
achieve an ‘inner whiteness’ by conversion to the Christian
faith. This would ‘wash away’ their sins if not their outer
blackness, and allow them to be saved from the damnation
to which the blackness of their souls otherwise condemned
them.
We still apply a more or less strict division between black
and white when talking about racial groups. This distinc-
tion applies despite the presence of mixed-race relation-
ships and the fact that people of mixed-race descent are an
increasing proportion of society. And it applies despite the
fact that differences of complexion constitute a continuous
distribution, from very dark to very light, with varying
shades of brown, yellow and pink between. In the United
States, in particular, there is a rigid white/black classifica-
tion. This is the result of what is known as the ‘one-drop
Chap-02.qxd 2/12/04 6:01 PM Page 48
rule’, which has its origins in the ideology propounded to

justify black slavery. According to the one-drop rule a
person is racially black if he or she has one black ancestor
anywhere in his or her genealogical line of descent, and
regardless of how many white, Asian or native American
ancestors are involved. By contrast a person is white only if
he or she has no non-white ancestors. The one-drop rule is
still public policy in the USA and has the effect of perpe-
trating not only the black-is-bad, white-is-good symbolism
but also the ideas of racial or ‘blood’ purity and the fears of
contamination which had such catastrophic consequences
in Europe in the 1940s. Recent results from the Human
Genome Project have found that humans are 99.9 per cent
alike, and scientists in this field have been quick to refute
the idea that race has a genetic or scientific basis. However,
genetic testing is able to identify specific ‘markers’ which
are indicative of ethnic origin, and one scientist has esti-
mated that people who are considered black in America are
on average 20 per cent Caucasian (Griffith, 2002). What is
striking is that, despite such findings, people are universally
judged on their appearance of colour, with dark skins being
less desirable than light ones.
Many commentators have drawn attention to one of
the more insidious effects of black/white symbolism and the
ideas of innate inferiority/superiority associated with it: the
adoption of these ideas by blacks themselves with the result
that they too begin to place greater value on lightness of
skin colour. Virginia Harris calls this phenomenon ‘col-
orism’; it is particularly noticeable in the Caribbean and
some parts of Latin America, where those people with
lighter skins are assigned greater status, are more sought
after as marriage partners, and those with darker skins suf-
fer greater deprivation due to discrimination. Harris
ascribes this phenomenon also to African Americans and
cites evidence of the same prejudice operating in China and
the Philippines (Harris, 1998: 67). Yasmin Alibhai-Brown
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RACE AND CULTURE 49
draws attention to the effects of this complex in Britain,

where she notes a tendency among successful black and
Asian men to choose white partners ‘almost as the finishing
touches to their impressive cvs’ (Alibhai-Brown, 2001: 13).
The implications here are clear: to be accepted by the
majority culture you need to become like them in as many
ways as possible. This may mean denying your own race
and colour. To succeed you need to assimilate, regardless
of the costs. In this way racism can become internalized
within black and coloured people as part of their inner
world as well as present in their external reality.
Stereotyping
We have seen how the strands of intellectual thought in the
eighteenth and nineteenth centuries gave birth to racial
stereotypes based on classical ideals of beauty. The black
stereotype was that of an inferior group, incapable of being
civilized, lacking in the virtues exemplified by the superior
white races. The black man was seen as a savage, first
noble, then barbaric. He was stereotyped as immoral, dis-
honest, unclean, lazy, with limited intelligence or potential
for intellectual development. The advantage of this kind of
attitude (for those in the superior group) is that it gives
everyone a designated place, and one which is immutable.
If these characteristics are not susceptible to change
(because they are inherited, or are indicative of belonging
to a particular racial ‘type’, or whatever theory holds sway
at the time) then the social order is fixed – and not by any-
thing as potentially guilt-provoking as exploitation.
A similar process has been a central part of anti-
Semitism. Jews have always been stereotyped as evil and
corrupt, unscrupulous and cunning. Like the black man in
the nineteenth century, the Jew was characterized as lack-
ing in physical beauty and grace – as the epitome of ugli-
ness. This was to lead to the fateful contrast between the
Jew and the Aryan. With both the Jew and the black, fear
Chap-02.qxd 2/12/04 6:01 PM Page 50
of contamination by intermarriage has produced the

stereotype of the sexual predator – the black or the Jew who
preys on white women and will thus violate racial bound-
aries and dilute the ‘purity’ of the white race.
The black stereotype has in particular been associated
with notions of physical power, violent tendencies, sexual
prowess and attractiveness, uncontrollable lust. Many of
these stereotypes persist today. Black and mixed-race
women are still viewed as being exotic, erotic and morally
suspect (Zack, Shrage and Sartwell, 1998: 82); Asian
women are seen as ‘submissive’ and black women as
‘whores’ (Alibhai-Brown, 2001: 10). The attack or sexual
assault of a white woman or man by blacks arouses a greater
degree of public moral outrage than that accorded to white
rapists or non-white victims. By the same token black men
are far more likely to be imprisoned for acts of assault than
white men committing a similar offence.
In writing about racism in the early twentieth century
Mosse says, ‘the mental and physical characteristics attrib-
uted to these outsiders reflected the fears of society: rest-
lessness, lust and sloth’ (Mosse, 1985: xiv). This is a
process which continues. We not only attribute to the out-
sider the fears of society as a whole, but perhaps also those
parts of ourselves which we fear to acknowledge – our
aggression and our sexual desires.
Fear
The idea that we project onto others the impulses we find
unacceptable in ourselves is of course a notion grounded in
psychoanalytic theory. Combined with ideas of white/black
imagery it constitutes a powerful argument for the expla-
nation of racial discrimination. The black becomes the
dirty, hidden, unacknowledged, repressed part of ourselves
we would prefer not to own – the shadow, the dark part of
the self. The frustrations engendered by ‘normal’ social and
personal difficulties often seek to be released by aggression.
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RACE AND CULTURE 51
Displaced aggression is easier to cope with because we are

then able to maintain our own image of ourselves as
decent, moral, clean, honest, and so on. By projecting onto
the Other our unacknowledged impulses and desires and
then attacking the Other for possessing such undesirable
elements, we are, in effect, killing two psychological birds
with one stone. If we accept this theory we have to accept
that every white person has a personal and individual
responsibility for racism.
Littlewood and Lipsedge (1989) draw attention to cer-
tain dangers inherent in the psychoanalytic approach. The
principal one is that it ignores any historical or social con-
text. Racism comes to be located solely within each indi-
vidual and is re-invented, as it were, in each person’s
lifetime. No account is given of why in a particular society
at a particular time racism exists and functions. Similarly,
no cognizance is given to the powerful and undeniable
cumulative effects of intellectual thought over a period of
time. However, it would seem that whatever the particular
historical circumstances that give rise to racism, there has to
be something within each individual which responds to the
call. Our potential to be judgemental and discriminatory,
our tendency to self-deception about unacceptable aggres-
sive or sexual impulses may, under the right conditions,
erupt in hostility towards the perceived ‘Other’. Racism is
thus a combination of external and internal factors.
There is no doubt that fear plays a part in racism. This
can take many forms: irrational fear of the unknown, the
different, the Other. Fear perhaps of part of ourselves as
represented by the Other, or projected onto that person or
group unconsciously; fear of ‘contamination’ – that our
society might be undermined by inter-racial contact, that
our dominant ‘white’ culture will be weakened or cease to
be the prevailing one; fear of being overwhelmed by the
other race. At times when such fears are activated and
appear to have the potential to be translated into reality,
Chap-02.qxd 2/12/04 6:01 PM Page 52
racism is at its most intense. The incarceration of Japanese

residents in the USA towards the end of the Second World
War is an example of this. Similarly, racial violence has
erupted in Britain at times when an influx of immigrants
has created greater competition for employment and hous-
ing. Such rational explanations do not, however, account
for the vehemence of feeling engendered in such events.
Part of the response produced by fear is the global identifi-
cation of all members of a race or group as being the cause,
or potential cause, of a particular incident or perceived
threat. This was painfully evident in the aftermath of the
events of 11 September 2001, when Muslims throughout
the western world were attacked indiscriminately.
Attribution of racial group identity

One of the most striking, and indeed inescapable, elements
of race is the visibility of racial characteristics. This is of
course particularly true of the coloured races. As we have
seen, in Britain’s history black and Asian groups who have
entered the country at various times have found integration
virtually impossible, while non-coloured immigrant groups
have met with fewer difficulties.
Accounts by black writers of their experiences in a pre-
dominantly white society focus again and again on the expe-
rience of being defined by their skin colour. As Fanon puts
it: ‘I am overdetermined from without. I am the slave, not
of the “idea” that others have of me but of my own appear-
ance’ (Fanon, 1986: 116). Many prejudgements about indi-
viduals are based on outward differences such as skin colour
or mode of dress. We are usually assigned by others to a
racial group on sight. It thus becomes an involuntary classi-
fication over which we have no control, and a process which
can exert a lot of pressure upon individuals to identify them-
selves with the group to which they have been assigned.
Identity as part of a group is an important part not only
of our individual psychology but also of our social survival.
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RACE AND CULTURE 53
We are all part of many different groups by virtue of our

gender, social class, race, educational achievement, eco-
nomic status, religious beliefs, and so on. The difficulty
arises when we are assigned to a group by others by virtue
of a characteristic we possess over which we have no con-
trol and when that characteristic becomes the main or sole
element by which we are identified. This is very often the
case with race and particularly with black or coloured racial
groups. A black person is not only never invisible in a pre-
dominantly white society, but his blackness can have the
effect of blinding others to any other part of who he is.
Group identity as part of a race also carries with it, as we
have seen, assumptions by others of collective responsibi-
lity for any act carried out by that race. In this way indivi-
dual identity is not only reduced to one element of a person’s
whole being, but that reduced identity is then subsumed
into a larger group with an assumption of homogeneity and
collective action. Common sense tells us that all members
of any racial group are not homogeneous. To assume that
they are further diminishes our understanding of each indi-
vidual within that group.
Political correctness
Social activism, which began slowly in the middle of the
twentieth century and gained momentum in the 1970s, has
led to a shift from overt expressions of racial beliefs to more
covert manifestations. Expressions of racial prejudice are
suppressed, disguised or distorted as they have become
socially unacceptable in most western countries. The
emphasis on ‘political correctness’ in our use of language in
particular is seen by many as a defensive attempt to hide,
or deny the existence of racism. It is by no means an indi-
cation that racism has ceased to exist – simply that we
should take special care not to articulate such beliefs. By
adopting a stance of ‘colour blindness’ in this way, many
people school themselves to act as if there is no such thing as
Chap-02.qxd 2/12/04 6:01 PM Page 54
race. My colour and your colour must not be mentioned,

least of all as in any way having an impact on the way the
two of us interact. This is particularly so if we happen to be
in possession of different skin colours. This stance is clearly
as nonsensical as identifying someone solely by the colour
of their skin. Denying that their race is part of their (many-
faceted and complex) identity is equally dehumanizing. As
Goulbourne points out, such a stance is the luxury of those
in the majority group:
groups and individuals placed on the deficit side of the racial or

colour-line can have little sympathy with the absurdities of the supposed
colour blindness on the part of those who, structurally if not through indi-
vidual choice, benefit from being placed on the privileged side of the colour-
line. (Goulbourne, 1998: ix)
Furthermore, political correctness can have the effect of

inhibiting discussion and debate about racial prejudice,
both internally within each of us individually and within
the wider social context.
Racial minority groups in our society continue to be dis-
advantaged, and the conclusion is inescapable that this is,
at least partly, due to racial discrimination. To pretend that
it does not exist is not only socially irresponsible, but con-
tributes to the perpetuation of the very thing we are trying
to ignore. Attempts to be ‘politically correct’, to ignore race
as a factor in interpersonal, social or political relationships
can lead to the emergence of a response which can be both
patronizing and paternalistic. It contains within it the
enduring idea of white superiority: we must not victimize
those who are less developed, less able, less intelligent. We
must help the oppressed and disadvantaged, not because
we are their oppressors but because they are in need of our
help due to their inherent deficits. This attitude too has a
long history both in the anti-slavery movement and in
social activism in the nineteenth century. It is insidious and
difficult to combat because of its seemingly benign public
Chap-02.qxd 2/12/04 6:01 PM Page 55
RACE AND CULTURE 55
face. It is encapsulated in the sentence ‘I am not racist;

some of my best friends are black.’ But at the heart of this
kind of paternalism is the normative ideology that the infe-
rior races should be kept in their place.
Race and culture in counselling and psychotherapy

The relationship between black and coloured groups and
the mental health professions in Britain has long been rec-
ognized to be problematic. In the UK there is a dispropor-
tionately high incidence of Afro-Caribbean men being
diagnosed as mentally ill and being compulsorily admitted
to an institution under the Mental Health Act. At the same
time black and ethnic minorities are significantly under-
represented as clients in the fields of counselling and psy-
chotherapy. Very few psychiatrists, psychotherapists and
counsellors come from these groups. The obvious conclu-
sion to draw is that racial discrimination is at work in this
area. It would be useful, however, to examine further the
background to this state of affairs, and to assess the differ-
ent theories offered as to why this should be so.
Psychiatry
The development of psychiatric theory in the twentieth
century was heavily influenced by the beliefs in racial infe-
riority that flourished in the nineteenth century. Biological
determinism had been a very useful doctrine to justify colo-
nialism, slavery and economic exploitation. Black slaves
were seen as psychologically adjusted if they were content
with their subservient position; to protest or rebel was
taken as a sign of mental disorder. Following emancipation,
studies of mental illness frequently focused on the differ-
ences between whites and blacks, with the assumption that
the latter had a less developed, or inherently inferior, psy-
chological and mental state, and were therefore more prone
to insanity. The early mental institutions in the USA were
Chap-02.qxd 2/12/04 6:01 PM Page 56
segregated on racial lines; the belief was that different races

had different psychologies and therefore required different
forms of treatment. By the 1950s in the USA and Europe,
changes in the social and political climate led scholars to
acknowledge the existence of racial discrimination and
social oppression. Different theories have been offered to
explain psychological disturbance in black and coloured
people.
It is disturbing to note, however, that the view that black
people are more disturbed and more prone to mental ill-
ness than white people still persists – and not only among
psychiatrists. Carter cites a study by E.E. Jones in 1982 in
which black and white therapists assessed the treatment
and outcome of black and white clients. Jones found that
white therapists tended to evaluate black clients as signifi-
cantly more psychologically disturbed than white clients.
Black therapists’ evaluations did not support this bias
(Carter, 1995: 160).
Many studies have been conducted to examine mental
illness in immigrant groups. The findings uphold the per-
ception that immigrants are more likely to be treated
for psychiatric disorders than non-immigrants. Various
hypotheses have been put forward to explain this: that vul-
nerable people are more likely to emigrate, or that the
processes of emigration, immigration and adjustment are
themselves potentially psychologically damaging and there-
fore likely to cause mental illness. The term ‘culture shock’
was coined to describe the processes experienced by people
moving to a different country and culture. This may have
gone some way to highlighting the inner experiences of
immigrant groups – psychological strain, loss, rejection,
anxiety and so forth – but it took no account of the exter-
nal reality of prejudice and racial discrimination. However,
while many of these theories hold water for first-generation
immigrants, they should not apply to subsequent genera-
tions, of which there are large numbers in both Britain and
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RACE AND CULTURE 57
the USA today. It is these people, no longer immigrants,

though frequently described inaccurately as such, who are
still disproportionately over-represented in our psychiatric
hospitals and institutions.
A powerful explanation for this phenomenon is put for-
ward by Littlewood and Lipsedge in their seminal work
Aliens and Alienists (1989). They argue that the dominant
social group actively alienates those who are perceived as
different. As the dominant group, or ‘alienists’, have no
adequate frame of reference for judging the values and
behaviours of those from different cultures, they are more
likely to describe behaviour they do not understand as
deviant or sick. Furthermore, the experience of being dis-
criminated against has the potential to exacerbate the inci-
dence of ‘strange’ or ‘different’ behaviour in the ‘alien’
group, thus increasing the likelihood of receiving a diagno-
sis of mental illness.
The suggestion that black or Asian ethnic groups may be
genetically predisposed towards certain forms of mental ill-
ness is one that has been repeatedly made but never
proved. Even within genetic science it is difficult to differ-
entiate genes associated with the cause, rather than the
symptoms, of specific diseases, and while research has
shown ‘correlations’ between race and some diseases, such
correlations may be the result of environmental factors
such as diet, living conditions or the experience of preju-
dice, rather than of genetics (Griffith, 2002). Clearly a
genetic basis for mental illness in black people would be a
convenient discovery, as the only other explanation for the
disproportionate representation of this racial group in the
psychiatric statistics would have to include factors such as
racial discrimination, social inequality, or lack of under-
standing (or worse) between (white) doctors and (black)
patients. The disturbing and problematic relationship
between race, culture and psychiatry is discussed further in
Chapter 5.
Chap-02.qxd 2/12/04 6:01 PM Page 58
Psychotherapy and counselling

Historically, psychoanalysis was unavailable to several
classes of people, such as those who were thought to be less
intelligent or insufficiently verbal or articulate. It has always
been inaccessible to those who cannot devote sufficient
time to treatment or cannot afford it. Based on those
criteria, coloured people have often been judged unsuitable
for psychoanalysis and many other psychodynamic
approaches. Littlewood (in Kareem and Littlewood, 2000: 6)
identifies the psychotherapeutic neglect of minority
groups as a particularly British phenomenon. He
describes our society as one in which access to mental
health resources is determined in part by wealth and edu-
cation and in part by racial identity. The black commu-
nity in Britain, being predominantly working class, is thus
faced with a double disadvantage in this area (as indeed
in other areas).
The emphasis in the field of counselling has always been
on the importance of the relationship between counsellor
and client, with Carl Rogers’ conditions of empathy, gen-
uineness and unconditional positive regard forming the
cornerstones of this all-important relationship. The greater
part of the counselling literature historically contains no
reference to race as an element in this relationship. The
presumption is that ‘good’ counsellors are effective with all
their clients if they are able to establish this kind of gen-
uine, empathic and non-judgemental rapport. The recog-
nition of race as an issue deserving special attention has
only begun to develop in the last decade or so. However, it
is still the case that black and coloured people have less
access to counselling and psychotherapy than whites.
Blacks and Asians are viewed by many within these profes-
sions as more ‘physical’ and less verbal, manifesting
‘somatic’ symptoms rather than genuine psychological
problems and deemed to be less capable of psychological
insight and self-awareness. For this reason they are more
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RACE AND CULTURE 59
likely to be given physical treatments – prescribed powerful

anti-depressants and anti-psychotic drugs or subjected to
electro-convulsive therapy – than to be referred for coun-
selling or psychotherapy. As d’Ardenne and Mahtani point
out, ‘the counselling needs of ethnic clients … are still a
very long way from being heard by the majority culture.
This, despite the fact that counselling is above all else
about active listening’ (d’Ardenne and Mahtani, 1989: 10).
As we have seen, racial prejudice is clearly at work in
making therapy unavailable to black and coloured people
and other ethnic minority groups, but there appears to be
something within the very enterprise of the profession itself
which works against the interests and needs of these
people. Studies have shown that black and coloured clients
are more likely to leave counselling and therapy early, and
less likely to have favourable outcomes from treatment. Why
should this be so? The most convincing explanation seems
to be that all models of counselling and psychotherapy are
rooted in white western values. The theory and practice of
psychotherapy developed in a white western middle-class
milieu, so it is hardly surprising that it should contain
within it the values and ideals of that social group. Many
writers have drawn attention to this (Katz, 1985; Littlewood
and Lipsedge, 1989; Palmer and Laungani, 1999; Fernando,
2002). In a recent paper in Counselling and Psychotherapy
Research, Sue Cornforth emphasizes what she calls ‘an
inherent tension within the activity of counselling. The
profession has a strong ethical commitment to both equity
and self-awareness. However, it works within a western,
Eurocentric individualistic and economically based para-
digm, which mitigates [sic] against both’ (Cornforth, 2001:
196). The white western bias within psychotherapy and
counselling is of course a reflection of the bias that exists
within society at large. Inherent in our institutions, the
structure of education, health care and access to housing
and employment is a socialization process whereby the
Chap-02.qxd 2/12/04 6:01 PM Page 60
values, communication patterns, life-styles and family

structures of whites, which comprise the dominant group,
are upheld as preferable and therefore normative. There is
an implicit assumption that this is the world-view to which
all people, regardless of their race, culture or ethnic origin,
should aspire. This fails to take into account the different
(and equally valid) world-views, which are held by peoples
from different cultural and racial backgrounds.
Many studies have compared the cultural values of dif-
ferent racial and ethnic groups. Attention has been drawn
to factors such as forms of self-expression, temporal focus
(past, present or future), relationships between man and
nature, social and familial relationships, systems of deci-
sion-making, aesthetic preferences, and so forth. What
emerges are marked differences between white Anglo-
American values and social systems and those of Asians,
Africans or any other ethnic group. All of these differences
will have an impact on the process of therapy and coun-
selling. It is striking, however, that some of the central
tenets of these enterprises are directly opposed to the values
held by groups other than the white western cultures. An
example of this is individualism. Central to many thera-
peutic models is an emphasis on the client’s self-fulfilment
and personal responsibility, combined with a belief that a
person can and should take control of his life, overcome his
problems, and carve out his own individual path. This
notion is central to the western idea of identity, the healthy
acquisition of which is seen as an essentially individual
process. Individualism also contains within it ideas about
personal boundaries, both physical and psychological.
Many Eastern cultures, however, are based on communal-
ism or collectivism. Problems are seen as belonging to the
group rather than the individual, and are therefore addressed
in a communal context. Groups are organized in complex
systems and within that system one’s identity is ascribed
and not achieved. Ideas of personal space (as understood in
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RACE AND CULTURE 61
the west) are lacking – instead, being a useful and integral

part of a group is given high value. Group loyalty and cohe-
sion take precedence over ideas about individual personal
development.
A similar difficulty exists in the concept of the self.
DeVos, Marsella and Hsu (1985) describe how the western
tradition focuses on the development of a solid, well-
functioning ego. The inner experience of the self should be
clearly delineated from external experiences. In Hindu
thought the aim is the opposite – to achieve union with the
immutable self, which is central to an understanding of the
harmony with the totality of the universe. Palmer and
Laungani (1999) point to further contrasts in culture in
such areas as cognitivism and emotionalism, free will and
determinism, materialism and spiritualism. All of these
notions are central to the theories underlying psychotherapy
and counselling and will have powerful influences on how a
client expresses himself, his expectations from the therapist,
his assumptions around the origins and causes of his prob-
lems, and his ideas about how those difficulties might best
be overcome. Triandis (1985) draws attention to the con-
trast between ‘tight’ highly regulated cultures and ‘loose’
heterogeneous cultures, between ‘contact’ cultures and ‘no-
contact’ cultures, and d’Ardenne and Mahtani (1989) cite
the different modes of non-verbal communication which
exist in different racial groups and which directly impact on
the process of counselling and therapy.
What is clear, therefore, is that a counselling or psycho-
therapy process which fails to take into account such cul-
tural gulfs will have little chance of success. The theories
that underpin psychotherapy and counselling are based on
the values and cultural practices of one (white western)
culture. They are often upheld, however, as a kind of uni-
versal psychological blueprint. To attempt to impose this
model on other cultural groups smacks of the arrogance
and assumed superiority which has been central to the
Chap-02.qxd 2/12/04 6:01 PM Page 62
white man’s relationship with other racial groups since time

immemorial. We should not be surprised, therefore, that
clients from ethnic minorities who do make it to the therapy
room, despite the odds, are likely to leave quickly.
Kareem (in Kareem and Littlewood, 2000: 29) cites our
understanding of the sense of loss as an example of the
difference between western and non-western cultures.
Bowlby’s theories of attachment and loss and the central
part for human development played by the bonding
between the human infant and its biological mother are
generally accepted by most psychotherapists and counsel-
lors as a kind of universal psychological truth. They are
taught in most, if not all, training programmes and form
the basis for many other theoretical formulations within the
field – much of the literature on bereavement, adoption
and fostering, for example, is based on John Bowlby’s ideas
and on the theories which have been developed from his
original formulation. Kareem, however, challenges the nor-
mative assumption contained in these theories, one of
which is that the loss of a parental figure, particularly the
mother who feeds the infant, is of paramount psychological
significance. He describes how family patterns in many
African and West Indian societies are completely different
from the western nuclear family unit. In these societies it is
the extended family group, encompassing grandparents,
uncles, aunts and cousins that is involved in childcare and
child-rearing. In this context separation from, or loss of,
the biological mother does not have the psychological sig-
nificance which it is given in western psychological theory.
As Kareem points out, white professionals frequently mis-
understand the nature of the loss felt by a client who is
separated from his whole family, and/or impute spurious
psychological damage because the client was brought up by
multiple adults rather than a single pair. What has happened
here, as in other instances, is the transformation of a western
cultural pattern into a universal human psychology.
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RACE AND CULTURE 63
The issue of misunderstanding within the therapeutic

enterprise runs deeper than differences in cultural prac-
tices. It taps into the history of racial oppression and the
racial inequality still inherent within our society. As
Littlewood puts it: ‘the provision of “white” therapies for
“black” people presenting with problems that result from
existing patterns of white–black dominance is problematic,
to say the least’ (Kareem and Littlewood, 2000: 42). The
implications of such a situation are that psychotherapy
becomes a means by which political tensions and indigna-
tion and distress resulting from social injustice are trans-
formed into the less inconvenient form of ‘individual’
pathology. This is the charge that has most frequently been
levelled at the psychoanalytic and psychodynamic varieties
of psychotherapy.
The application of psychoanalytic theory to black groups
ignores their social and economic circumstances. In these
formulations psychological and emotional difficulties are
seen as the result of poor ego functioning, uncontrollable id
impulses or maladaptive defence mechanisms, rather than
having anything to do with poverty or racial oppression.
Psychotherapists who are analytically trained learn to work
with the inner world only. Consequently there is resistance
to dealing with psychological problems that originate in the
outer world. However, most black people would admit that
the most traumatic feature in their personal lives is that of
being black in a white society. While many clinicians
acknowledge that the black client is likely to be socially dis-
advantaged, they see their therapeutic work to be about
exploring the client’s response to that, rather than encour-
aging the client to do anything about it. Thus psychoanalysis
and psychotherapy become a process of maintaining the
status quo and encouraging people to accept things as they
are, however inequitable. A more cynical reading of this
situation would be that the white therapist enjoys the fruits
of dominant group membership and so has a vested interest
Chap-02.qxd 2/12/04 6:01 PM Page 64
in the status quo – one which sees people of colour as

deprived, inferior or deviant rather than different. The ther-
apist, therefore, has no interest in creating social change –
the client’s adaptation to the circumstances would be (for
the therapist) the more desirable and comfortable outcome.
This may be a rather extreme interpretation. However,
what is certainly common is a process whereby the ‘patho-
logy’ is attributed to the client’s culture rather than to the
client’s individual psychology. In this way behaviour, ways
of communicating or values that the therapist cannot
understand, or cannot fit into the western psychological
template, are all attributed to the other’s culture which by
definition then becomes not different and equally valid, but
deviant and inferior.
In recent years there has been an increasing tendency to
recognize race as a factor in counselling and psychotherapy.
The UKCP and BACP have both set up divisions whose
aim is the implementation of good practice within the area
of intercultural and cross-cultural counselling and therapy.
Some excellent facilities have been established which are
devoted to this work, most notably the Nafsiyat intercul-
tural therapy centre, established in London in 1983. There
is also a growing body of literature on the subject. In many
ways, however, it is still considered a ‘specialist’ or mar-
ginal area of interest, outside the psychotherapeutic main-
stream. Although more training courses now include some
input on cross-cultural issues, it is usually lamentably
small, and more often than not offered as an optional extra
workshop or seminar rather than an integral part of the
course. In some respects the pendulum has swung away
from the traditional psychoanalytic stance in examining
these issues, to a point which is also fraught with potential
dangers. Theories have been put forward which draw
attention to the deprivation and social oppression of minor-
ity ethnic and racial groups; they then assume this to be the
direct cause of all psychological and emotional difficulties
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RACE AND CULTURE 65
experienced by people in these groups. In extreme examples

these theories create a picture of the black person perma-
nently psychologically damaged by the effects of racial dis-
crimination – an individual incapable of ever developing
positive self-esteem or a degree of mental health. The prob-
lems with this view are twofold. Firstly it takes no account
of the variety of individual responses to the effects of
oppression and stress and assumes that all members of
visible racial and ethnic groups are socially oppressed and
have suffered the consequence of severe psychological
damage. Secondly it attributes all the difficulties that a
black client might bring to therapy as being related to, or
directly caused by, his race.
The notion that race is an issue only for the black client
is one that is prevalent in many texts devoted to the subject
of race in counselling and therapy. Robert Carter chal-
lenges this idea and emphasizes the importance of race as
part of everyone’s identity. In an overview of the mental
health literature he concludes that race as a factor in this
field is mentioned only in the context of victims of racism.
Whites are ‘seldom explicitly included in the discussion of
racial effects on individuals and society’ (Carter, 1995: 24).
He stresses the need for us to take into account the impor-
tance of race as an element of experience for white people
as well as black and coloured people, a view reiterated by
Kareem who believes that the issue of race is rarely absent,
even when one shares a client’s ethnic and cultural identity.
He puts the notion of culture into a wider context when he
says, ‘beyond the fact of our shared humanity, individuals
are unique and distinct from each other and thus there is
always an interpersonal and “intercultural” dimension to
any encounter between two people, including that between
therapist and client’ (Kareem and Littlewood, 2000: 19).
The idea of a white racial identity is one that is rarely
explored in the psychotherapy literature. There appear to
be several reasons for this. Most white westerners associate
Chap-02.qxd 2/12/04 6:01 PM Page 66
an emphasis on white identity with racist groups such as

the Ku Klux Klan and the BNP. Socially aware or ‘politi-
cally correct’ liberal whites would automatically eschew
such an association. By distancing themselves from an
identity that is associated with racism, white people are in
the position of avoiding or not acknowledging their racial
group membership. Nevertheless the fact remains that
whites are socialized to feel superior to ‘racial/ethnic’ people
by virtue of their white skin alone. ‘This sense of white
superiority is so prevalent that it operates as a racial norm
in our society, on an individual, institutional, and cultural
level’ (Carter, 1995: 103). This leaves the white person in
an untenable position – feeling superior, but unable to
acknowledge it (to self or others) or to act on it. Avoidance
of the issue is the most common strategy. Being forced to
confront it by the presence of a black or coloured person
can induce confusion and anxiety. Such uncomfortable
feelings can be all too easily allayed by the notion that race
is the other person’s issue rather than one’s own. Certainly
race is seen as an element in experience by black people,
but not by white people. Frantz Fanon eloquently writes,
‘The white man is sealed in his whiteness. The black man
in his blackness’ (Fanon, 1986: 11). The difference is that
the black man is aware of this, the white man is not. One
of the effects of this awareness is internalized racism. Just
as white people are socialized to feel that a white skin is
superior to a black skin, so are black people. The effects of
a deeply embedded sense of inferiority, which may not even
be totally within awareness, can be deeply damaging and
long-lasting. If a therapist fails to address the issue of race
effectively, he can collude in the black/white dominance
paradigm and in effect reinforce the internalized racism
present in the client’s view of himself.
The need for therapists and counsellors to explore and
understand their own values and the influence of their own
race and culture on those values cannot be understated.
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RACE AND CULTURE 67
Empathy is not enough – that can be used as the basis of

what has been called the ‘myth of sameness’ (Smith, 1985).
If a counsellor is unaware of the assumptions and biases
inherent in her own racial and cultural group, she will be
unable to relate to a client from a different group without
those biases having a detrimental effect on the relationship.
Similarly a counsellor who claims to be non-judgemental
with all clients, regardless of colour, may well be rationaliz-
ing and avoiding difficult inner racial conflicts. Being non-
judgemental is a laudable goal, rarely an achievable state.
Racial awareness and identity are part of human devel-
opment and include the absorption of stereotypes about racial
groups at a very early age. Like gender, race-appropriate
roles and behaviour are communicated and learned
through socialization. For the contemporary white person
part of this process is the denial of white identity because
of the ensuing discomfort and ambivalence associated with
it. Carter (1995) proposes a model of racial identity aware-
ness ranging from low awareness to high awareness, which
he applies to both black and white people. In order to
understand what is happening in any counselling relation-
ship (black/white, white/black, black/black, white/white) he
suggests it is vital to assess each person’s level of racial
identity awareness.
Contemporary literature and research refutes categori-
cally the notion that black and ethnic minority groups
cannot benefit from psychotherapy and counselling
because of some inherent lack of self-awareness or psycho-
logical insight specific to their racial group (Moorhouse,
2000). Awareness is growing that failure in this field is due
to practitioners’ inadequacies, or the bias in psychological
theory, rather than some deficit in the client. Littlewood
points to the experience in the USA where family therapy
has been particularly successful with minority racial
groups, perhaps because the theory in this model eschews
individual developmental notions in favour of an approach
Chap-02.qxd 2/12/04 6:01 PM Page 68
derived from a family’s shared values understood through

systems theory (Kareem and Littlewood, 2000: 10).
When two people from different cultural or ethnic back-
grounds meet for counselling or psychotherapy they both
bring with them preconceptions about the other. These
preconceptions will be heavily informed by both the history
of their respective ethnic groups (colonialism, oppression,
slavery, and so on) and the relationship that currently exists
in our society between white and non-white groups (contin-
uing inequality and racial discrimination). It is the respon-
sibility of the therapist to address these issues in order for
there to be any chance of therapeutic effectiveness. All too
often therapists avoid such interventions because of their
own discomfort and their desire to appear ‘liberal’ and
‘colour blind’. The effect of this is to create in the therapy
room a mirror image of the situation in society at large,
where the person from the minority group feels devalued,
misunderstood, patronized or worse. Almost certainly there
would be an unwillingness to disclose feelings and details
about personal experiences involving racial identity or
racial discrimination with any hope of being truly under-
stood. Psychotherapy should be about the totality of a per-
son’s being. As Kareem remarks, ‘a psychotherapeutic
process that does not take into account the person’s whole
life experience, or that denies consideration of their race,
culture, gender or social values, can only fragment that
person’ (Kareem and Littlewood, 2000: 16).
It is clear that race and culture are central issues in all
counselling and psychotherapeutic relationships. There is a
general consciousness in the literature that where there is a
racial or cultural difference between therapist and client,
the existence of aspects of racism must be assumed. The
vast majority of counsellors and therapists in the UK are
white and part of the dominant culture. The importance of
these professionals examining their own culture and racial
issues as well as being familiar with the differences in the
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RACE AND CULTURE 69
values and practices of people from different racial and ethnic

groups is recognized as vital. And yet most training courses
barely cover such subjects, if at all. Sue, Arendondo and
McDivis (1992) suggest that inadequate training is the
major reason for therapeutic ineffectiveness in this area. As
we have seen, one of the reasons for this lies in the theory
which forms the core of counselling and psychotherapy
training programmes. Most theoretical models and orien-
tations have not considered the psychological meaning and
importance of race and culture; furthermore, many of their
central theoretical tenets are founded in normative Euro-
centric cultural values.
More disturbing is the idea that racism is embedded in
all our social institutions as well as in the socialization and
education received by all members of our society. Conse-
quently, those people who train to be counsellors and thera-
pists and those trainers who train them will also have
absorbed racist notions which will then be perpetuated in the
training and practice of counselling and psychotherapy itself.
Chap-03.qxd 2/12/04 6:02 PM Page 70
3 Gender
I T I S G E N E R A L L Y R E C O G N I Z E D that the
relations between men and women throughout
history are characterized by the domination of the latter by
the former. At the turn of the twenty-first century this state
of affairs is beginning to be challenged. Some commenta-
tors talk about ‘post-feminism’ as though the aims of the
feminist movement had been achieved, or as though ques-
tioning whether they even needed redressing. It is undeni-
able that social, political and domestic arrangements have
changed dramatically in the last fifty years, and that the
position of women has improved immeasurably in all areas
of life. One of the themes of modern social concern is the
disaffection and under-achievement of young men and
boys and their decreasing academic performance in com-
parison with young women and girls. Despite this, the
gender balance in work and opportunity in all spheres in
the western world is still weighted in favour of men.
In examining the subject of gender, therefore, I intend to
look first at the history of men and women in terms of their
relative social, political and economic positions. An intrin-
sic part of this is an examination of feminism, both as a his-
torical and political movement and as an ideology. I then
intend to examine the concept of gender, in particular in
the context of the psychological, medical and scientific theo-
ries that have been brought to bear on it. Finally I aim to
analyse the impact of gender within the field of counselling
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GENDER 71
and psychotherapy; in the training and practice of counsellors

and therapists and in their relationships with their clients.
Gender relations – a historical overview

The social and economic relationship between men and
women has varied considerably over time, and between dif-
ferent societies and cultures. The overwhelming evidence,
however, would seem to point to the fact that in most soci-
eties, in most places, women have been subordinated to
men to a greater or lesser extent.
Early history
Attempts have been made, principally by feminists, to
prove the existence of prehistoric matriarchal societies.
There appears to be some evidence of societies in which
women were held in high esteem in the Neolithic and
Bronze Ages, with suggestions of goddess worship derived
from archaeological artefacts. Theories abound about the
worship of the ‘Great Mother Goddess’ as central to pre-
historic cultures in Europe, Asia and Africa (Miles, 1993).
To view such societies as matriarchal is controversial. They
were at best egalitarian. In Gerda Lerner’s view, if we
define matriarchy as a mirror image of patriarchy, no true
matriarchal society has ever existed (Lerner, 1986: 31).
There appears, however, to be a consensus about the true
nature of hunter/gatherer societies. The stereotypical image
of man-the-hunter whose greater physical strength pro-
vided both the food and the protection for the weak and
vulnerable female has been disproved by anthropological
evidence. It is now understood that the main food supply
in such societies was provided by the women and children –
by gathering activities and small-game hunting. Big-game
hunting, done by the man, was an infrequent and auxiliary
pursuit, and by no means a reliable source of regular food.
The gender relations in these societies appear to have been
Chap-03.qxd 2/12/04 6:02 PM Page 72
essentially complementary; there was a division of labour

by gender, but such divisions carried with them no conno-
tations of superiority or inferiority.
The classical period, however, presents a picture where
male supremacy was the norm. In Greece, women were
viewed as inferior to men in all respects and had consider-
able restrictions put on their freedom of movement. Their
social role was restricted to the home: domestic manage-
ment, childbearing and child-rearing. In ancient Rome,
too, the patriarchal system held sway – the man was the
head of the family and had the power of life and death over
all members of his family. Women had no legal status or
property rights. Similarly in the western world, as societies
became organized and complex, ownership and property
evolved as predominantly male rights.
A significant factor in gender relations worldwide is the
part played by religion. Rosalind Miles (1993) draws atten-
tion to the fact that all the world’s major religions are
monotheistic, centred round a male god and with beliefs
which condemn women to the status of second-class citizens.
She sees the emergence of the world’s major religions as the
foundation of patriarchy; monotheism being built on the idea
of men and women as complementary opposites, with men
arrogating to themselves all the strengths and virtues, thus
relegating women by definition to inferior status. Certainly
within Christianity many biblical texts can be cited to support
this idea. The story of Adam and Eve gives us woman as cre-
ated second, from man, to be his companion; on top of this
Eve is also the temptress, the one responsible for man’s fall
from grace. As such there is every justification for her punish-
ment and oppression. In the third century AD St Ambrose is
reputed to have said, ‘Adam was led to sin by Eve and not
Eve by Adam. It is just and right that women accept as lord
and master him whom she led to sin’ (Ussher, 1991: 44).
In the early years of the medieval period the part that
women played, in society and in organized religion, was
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GENDER 73
more significant than in the latter years of this period.

Pastoral and agricultural communities tended to be more
egalitarian than the more sophisticated and organized
urban societies which had emerged by the 1500s. However,
women were consistently restricted from land and property
ownership as these were dependent on the provision of
military service. Within the developing institutions of society –
the church, law and administration – women were either
totally excluded or held subordinate positions. As societies
evolved, the view that women were intellectually inferior
meant that the majority of women had no access to educa-
tion. The growth of urban communities initially gave some
women a degree of freedom, as many women ran their own
businesses in early medieval times. However, as trade and
commerce became increasingly capitalized in the seventeenth
century and beyond, women were excluded from owner-
ship and control in this sphere too. Throughout Europe in
the pre-industrial period, society consisted of a system of
rigid stratification based on birth and wealth. Women took
their social status first from their fathers and then from
their husbands. In the aristocracy in particular women led
very restricted lives, confined mostly to the domestic
sphere. For such women the only alternative to marriage
which offered a degree of independence and education was
enrolment into a religious order. However, the dissolution
of the nunneries in the mid-sixteenth century removed that
option too. At around the same time there was an increase
in literacy and the growth of universities and grammar
schools – both of which were exclusively male preserves.
With the Reformation education became marginally
more available to women, but at the same time the impor-
tance of the institution of marriage came to be firmly estab-
lished as the basis of social and gender organization. Wives
were legally subordinate to their husbands as well as finan-
cially dependent on them. Except in some of the lower
social classes, inheritance of property and money was
Chap-03.qxd 2/12/04 6:02 PM Page 74
strictly through the male line. Women who did have assets
were not free to dispose of them, and on marriage such
assets became the property of the husband. Divorce was
very rare, as it was only available by Act of Parliament, so
marriage was for life. Further illustration of the double
standards in operation is the fact that in 1650 the death
penalty was instituted for female adultery. Men who com-
mitted the same act were only guilty of fornication, which
carried a lesser penalty. This discrepancy is a stark reflec-
tion of the view of women’s sexuality as only acceptable in
terms of procreation and the maternal instinct. Men’s
sexuality, however, was seen as an irresistible natural force.
Such notions have persisted until recent times.
Europe in the eighteenth and nineteenth centuries

Until the Industrial Revolution in the latter part of the
eighteenth century work was organized within the home or
within small communities, with men and women often
working together for their common good. With the shift to
an industrial economy women lost the flexibility they had
previously possessed when work had been home-based.
They were paid less in the factories than their male counter-
parts, as well as retaining the responsibility for running the
home. The machine age split society into the public and
private spheres: the worlds of office and factory versus that
of the home. In this new order women were ‘granted the
privilege of low-grade, exploited occupations, the double
burden of waged and domestic labour, and the sole respon-
sibility for child care that has weighed them down ever
since’ (Miles, 1993: 187). In the higher social classes work
was seen solely as the prerogative of men; women were rel-
egated to an exclusively domestic and maternal role.
The nineteenth century was probably the period where
patriarchy and the stereotypes associated with it reached
their zenith. Men began to define themselves increasingly
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GENDER 75
by their work as their involvement with child-rearing and

domestic production declined. Women were viewed as des-
tined by their biological functions to be wives and mothers.
The medical model at the time held that the body had a
finite supply of energy. Female bodily functions – menstru-
ation, pregnancy, childbirth – were deemed to consume an
inordinate amount of this energy, thus rendering women
unfit for any mental or intellectual activity. Men were
strong; women were delicate and potentially unstable. This
was viewed as the natural order. The development of
science led to a plethora of theories proposed to support
this view: women’s brains were smaller than men’s, or less
evolved; women were more prone to a variety of illnesses
which threatened their health and sanity and made them
ill-suited to make rational or moral decisions. Such theories
were a justification for depriving them of civil and legal
rights. The masculine stereotype was seen as the physical
and psychological norm; women were an inferior version of
this norm.
Many writers have documented the physical and mental
indignities to which women have been subjected over the
ages. The list is endless: chastity belts in the Middle Ages,
menstrual taboos, enforced marriage, female infanticide,
suttee in India, footbinding in China, female circumcision
and genital mutilation, rape, sexual violence and sexual
objectification through pornography. Many if not all of
these practices focus on women’s sexuality and its control
by men. This element of the relationship between men and
women has always been a source of tension and a point
at which the nature of that relationship – mutuality or
domination/submission – is thrown into sharp relief. It is
intimately connected with views about the nature of sexu-
ality per se, the biological function of reproduction, and the
social role and rights of women. In the western world in the
latter part of the twentieth century sexual freedom became
Chap-03.qxd 2/12/04 6:02 PM Page 76
a central part of women’s demands for equality. In the

nineteenth century sex was still taboo as a subject for open
debate. Initially, therefore, women’s struggles for greater
freedom focused exclusively on political and civil rights.
The beginnings of emancipation

The women’s rights movement began to develop in the mid-
nineteenth century in the USA with the Seneca Falls
Convention of 1848 and the resulting Declaration of
Sentiments in which women claimed the liberty and equality
expounded in the American Declaration of Independence.
This led to the founding of women’s suffrage movements in
both the USA and Britain. There had been demands before
this time by women for an amelioration in their position,
both in France following the French Revolution, where the
newly-won rights were restricted to men, and in England
with the publication in 1792 of A Vindication of the Rights of
Women by Mary Wollstonecraft. However, it was not until
the late nineteenth and early twentieth centuries that the
demand for equal rights for women really took hold and
gained sufficient momentum to produce results. The suf-
frage movement in the UK united women from all social
classes, with energies focused initially on the issue of politi-
cal representation. With the granting of the vote (for women
over thirty in 1918 and those under thirty in 1928) there fol-
lowed swiftly a number of changes in the law which consid-
erably improved women’s social and legal positions – for
example allowing women access to public office, granting
them greater property rights and parity with men in such
issues as divorce, and a decrease in the gender differential in
pay. The social changes brought about by two world wars led
to a considerable shift in the relative positions of men and
women. The issue of equal rights for women became a mat-
ter for public debate, and has remained so ever since.
The suffrage movement is often described as the ‘first
wave’ of feminism, the ‘second wave’ occurring in the 1960s
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GENDER 77
and 1970s. But feminist thought and action continued

throughout the twentieth century. Sheila Rowbotham
(1999) identifies the 1950s as a time which was particularly
problematic in women’s demands for greater social equal-
ity. The post-war period saw many women, who had done
responsible and fulfilling jobs during the war, revert to the
role of housewife as men were demobilized and returned to
the workforce. But the war experience left many women
ultimately dissatisfied with the roles they had filled before.
The demand for social change was gaining momentum.
Further difficulties, however, were created by the post-war
emphasis on the family as the building block of a stable
society. Within the stereotypical family the man went out to
work and the woman stayed at home. Such a stereotype
was reinforced by the psychological thought at the time
which placed great emphasis on the centrality of the
mother–child relationship. The theories of D.W. Winnicott
and John Bowlby roused fears that maternal deprivation
was psychologically damaging for babies and young children.
This had the effect of undermining women’s demands for
nurseries and after-school care. The centrality of the family,
and the traditional female role within it, still made it diffi-
cult for women to gain equal access to education and
employment. Many would claim that this continues to be
the case in the present day.
The 1960s saw the beginning of another period of social
ferment and upheaval. Opportunities for women were back
on the political agenda. Abortion was legalized and, with
the advent of the contraceptive pill, birth control became
widely available. Further reforms to matrimonial and
divorce laws gave women greater financial independence.
The Women’s Liberation Movement in the 1970s focused
on women’s rights in the areas of family, sexuality and
work. In this decade the Sex Discrimination Act and the
Equal Pay Act came into force, and the Equal Opportu-
nities Commission was set up. The social changes in the
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latter part of the twentieth century were extensive. Sexual

freedom and permissiveness led to the social acceptance of
divorce, single mothers, and couples living together and
having children without getting married. Nearly all areas of
work have now been opened to women. Women have
achieved positions as business leaders, cabinet ministers,
high court judges, consultant surgeons and even (in 1994)
Church of England priests. But, despite this, their repre-
sentation in such positions of power is still lamentably
small, and top women are still paid less than top men.
The feminist debate

Central to the feminist ideology that emerged in the 1960s
and 1970s is the equality–difference debate – one that still
rages, as its significance has implications for women and
men today no less than it did fifty years ago. Put starkly, the
debate is over whether women should struggle to be equal
to men, or whether they should demand reforms based on
their differences from men. Since feminist thought and
action have always attacked the male assumption of super-
iority, they led many into the position of challenging the
assumption of natural differences per se. This was an under-
standable position given that historically women have
always been accorded inferior status precisely because of
assumed natural sex differences. Any admission that there
were such differences appeared to be supporting the ideo-
logy that underpinned patriarchal exclusion. Extreme femi-
nists have seen all men as oppressors and heterosexuality
as an instrument of male oppression. Thus lesbianism
becomes a political choice and the only way to achieve true
female liberation.
Other feminists have argued for an acceptance of the dif-
ferences between men and women together with a recogni-
tion that these differences carry with them no connotations
of superiority or inferiority. ‘Female’ qualities should be
seen as equally important and valuable as ‘male’ ones, or
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GENDER 79
maybe even more so. The problem inherent in this argument

is that it seems impossible to argue for difference without
creating some kind of hierarchy. As with so many of the
debates around discrimination where, historically, oppres-
sion has been justified by biological differences, there is a
difficulty in suggesting the recognition of such differences
as part of the fight against discriminatory treatment. Such
a suggestion can revive the spectre of sexist domination of
women by men. Controversy is also generated by the ques-
tion of what kinds of differences are to be recognized – bio-
logical? psychological? physical? How and by whom are
these differences to be defined?
This debate dovetails with the other central theme of
feminist ideology and women’s struggles for improvements
in their social position – the insoluble dilemma of the
demands of motherhood and work. Some would argue that
reproduction is a burden, and a cause of women’s oppres-
sion. Others see motherhood as one of the great pleasures
of being a woman, but feel that the biology of reproduction
should not disadvantage women who also want a career.
The availability of reliable contraception has given women
greater choice over when, or whether, to have children.
There have, however, been few social advances to help
those women who choose to have both career and family,
and the experience of most in this position is that even
short career breaks for pregnancy and childbirth have
detrimental effects on a woman’s career path.
Furthermore, in a family where both partners work, the
burden of domestic and childcare arrangements still falls
principally on the woman.
Contemporary gender relations in the UK

The current state of legislation in Britain should theoreti-
cally grant equality of opportunity to men and women in all
spheres of work and public life. The picture portrayed by
actual achievement is rather different. Twenty years ago,
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for the first time, girls gained parity with boys in terms of
success at school examinations. By 2001 girls were achiev-
ing significantly better results both at school and at the
level of higher education. This reversal of past trends has
not yet been carried through to the workplace. Sixty-seven
per cent of managers and administrators are still men,
while 71 per cent of clerical and secretarial staff are women.
The earnings of female employees working full time are on
average 82 per cent those of male full-time employees, with
women being highly represented in the part-time workforce
which is, almost by definition, less well paid. Only 18 per
cent of Members of Parliament and 8 per cent of High
Court judges are women (EOC, 2001). Even allowing for
the time it takes for trends to adjust to the entry of quali-
fied women to the workforce, fewer women occupy high-
status positions than would be expected from their
numbers in the workforce as a whole. This is the case even
in occupations where women are in a numerical majority,
for example counselling, of which more later. Even when
women do make it to the top, their financial rewards are
significantly less than men. A survey in the Independent in
1999 revealed that male academics in almost every univer-
sity and college in the UK were being paid more than
women – in some instances the average salary differential
was as much as £20,000 per year (Clare, 2000: 94).
It is generally accepted (and deplored by some) that
gender stereotyping plays a large part in the kind of work
chosen by, or made available to, men and women. There is
‘men’s work’ and ‘women’s work’. Such ideas can have a
big impact both on levels of aspiration and educational and
professional opportunities. Although gender stereotypes
tend to reflect traditional ideas about what men and
women are good at, studies have shown that what has a
bigger impact is the fact that work carried out by men,
whatever it is, has a higher status. Thus jobs that shift from
being predominantly performed by men to becoming
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GENDER 81
women’s occupations lose social status (Archer and Lloyd,

1985: 239) – an indication of the extent to which the differ-
ential in gender status is embedded in our social attitudes.
Whereas the world of employment presents a picture
where women still receive a raw deal, the social picture is
rather different. The decline of the traditional family unit
and the increase in the number of households headed by
single females is depriving men of involvement in family life
and parenting to an extent which is causing considerable
concern. The male role in the nineteenth century and the
beginning of the twentieth century was characterized as
that of the breadwinner. As women’s earning power rises,
and, more significantly, women embrace a willingness to
live lives independent of men, the position of man is
severely weakened. He becomes, at best, the provider of
sperm, after which he serves no useful purpose. The
development of reproductive technology such as AID
carries this to its logical conclusion, dispensing with the
need for men as an actual presence in the lives of women
and their children. As Anthony Clare puts it, ‘artificial
insemination by anonymous donor strikes directly at mas-
culinity and fatherhood’ (Clare, 2001: 107). Clare’s analy-
sis in On Men – Masculinity in Crisis is that men have only
themselves to blame for their precarious position. Their
social estrangement is caused by their own unwillingness
to relinquish the outmoded stereotype of masculinity – the
stereotype in which maleness resides in such values as
‘control, indifference to feelings and a ruthless pursuit of
power’ which produce what he calls ‘a psychopathic mas-
culinity’ (ibid.: 217).
The tension between men and women has always existed
and continues to do so. The debate still rages around their
respective roles, rights and positions in society. Such a
debate encompasses ideas about the differences and simi-
larities between the genders – their characteristics, attrib-
utes and how these can best be utilized for both individual
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satisfaction and social harmony. It is to these ideas that I

shall now turn.
Gender and gender identity – some of the theories

Biology versus environment
The use of the words ‘sex’, ‘gender’, ‘sexual identity’ and
‘gender identity’ can be confusing. To some extent the con-
fusion over the meanings of these words and terms reflects
the unresolved issues surrounding this whole topic. My
understanding and my use of these terms are as follows.
‘Sex’ refers to a biological (usually anatomical and/or
genetic) classification as belonging to either the group of
males or the group of females. ‘Gender’ refers to an indi-
vidual’s own felt sense of identity as belonging to either the
group of males or the group of females. ‘Sexual identity’
refers to an individual’s felt sense of belonging to a group
of people whose sexual practices are characterized as
heterosexual, homosexual, bisexual, and so on. This is dis-
cussed fully in the next chapter. The debate central to the
issue of gender and gender identity is the origin of the
observed differences in behaviour between men and
women, boys and girls. Do these differences stem from
innate biological distinctions, or are they socially learned,
the result of environmental influences? Some would say
that our identity as belonging to a particular gender is
entirely socially constructed. Others would claim that
gender differences are deeply rooted in biology. It’s the old
nature/nurture argument writ large!
Observation, and statistics, tell us that there are differ-
ences between male and female behaviour that are signifi-
cant enough to be categorized in generalizations such as the
following: men appear to be more aggressive, competitive,
physical, mathematically gifted than women. Women
appear to be more emotional, nurturing, verbally adept
than men. But why should this be so? Clearly if these
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GENDER 83
differences are biologically determined there is little that

can be done to change things, should we wish to do so,
short of tinkering with our hormones or our genes – options
which of course are becoming more viable with current
scientific advances. If, however, these differences are the
product of social conditioning, we have the power to reorga-
nize things differently.
It is no accident that the history of the theories that have
gained ascendance in this field mirrors the history of the
social relations between men and women. Until second-
wave feminism, the view that women were ‘naturally’ inferior
to men was largely unchallenged. This hierarchy was seen
for a long time as ordained by God, or by some grand
cosmological order. The advances in science and anatomy
in the eighteenth century led to greater understanding of
the physical differences between men and women and
the workings of the reproductive organs. This was the
beginning of biological determinism – male/female physical
differences being seen as the cause of the male/female dis-
tinction itself (Nicholson, 1998: 195). In the 1960s, origi-
nating with Robert Stoller’s work Sex and Gender (1968),
the theory of gender as socially constructed began to gain
credence. It was immensely popular with feminist activists
as it focused on social processes and structures – the very
things they wanted to change. According to the condition-
ing view, gender differences in temperament and ability are
to be understood not in terms of female inadequacy and
weakness; rather, they are the result of societal (male)
pressures that have resulted in female subservience and
under-achievement.
The response to this notion has been a resurgence in the
view that male/female differences are biological – not only
that, but that they are rooted in their evolutionary origins.
The 1980s and 1990s saw a renewed interest in social
Darwinism with E.O. Wilson’s sociobiology and Stevens
and Price’s evolutionary psychiatry. These theorists claim
Chap-03.qxd 2/12/04 6:02 PM Page 84
that behaviours such as aggression and maternalism are

encoded in the genes. If we believe that the roles of men
and women reflect their evolutionary origins, the natural
place for women is in the home, looking after children. It
follows that drastic social changes would be both undesir-
able and doomed to failure. It would seem no accident that
these theories have emerged – or reappeared – at the very
time when the traditional position of men within the social
structure is under threat.
The biological determinists assert that there are innate
physical and psychological differences between men and
women and that these differences centre on the division of
labour whereby women take responsibility for child-rearing
and men take responsibility for hunting and warfare. This
division is seen as biologically rather than socially deter-
mined (Stevens and Price, 1996: 163), although the impli-
cations seem to be that the reason for the evolution of these
differences lay originally in the demands of the environ-
ment and the needs involved in species survival. This theory
is based on a conceptualization of the hunter/gatherer
societies which we now know to be fallacious, and also
takes no account of the effects of evolution since that time.
We are no longer living in caves, fighting off predators. If,
as the theory of evolutionary adaptation implies, we change
according to the different circumstances in which we find
ourselves, then the adaptations appropriate to the Stone
Age would have been overtaken by now.
Another biological theory holds that our gender identity
is determined by our hormones. The critical factor here is
the extent to which the brain of a foetus is exposed to male
hormones prior to birth. Given that all human foetuses
start as biologically female, there is a point in development
when the Y chromosome in the genetically male foetus
stimulates the production of male hormones that cause the
sexual differentiation of the brain. In their convincingly
argued book, Brain Sex (1989), Moir and Jessel make out
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GENDER 85
the case for this being the basis for all the observed differences
in behaviour, attitudes and feelings between men and
women. For other writers in the field these theories are
held to be too simplistic. Arguments have been put forward
suggesting that the differences discovered in the brains of
men and women are the result of the social environment of
an individual during development rather than genetic or
hormonal influences (Rose, Lewontin and Kamin, 1984:
142). The argument that the existence of a physical differ-
ence in a physical organ is automatically proof of a physical
cause has been seriously questioned. Our understanding of
the relationship between mind and body now recognizes
the complexity of this relationship and the multiplicity
of potential influences. Traumatic events, emotional
responses and physical and psychological environmental
factors all have an impact on the brain’s development and
functioning, as well as any biological or genetic distinctions
present at birth.
The theories of the biological determinists are seen by
many as dangerous because they appear to recommend a
continuation of the status quo, and take no account of the
social pressures and expectations which stem from gender
stereotypes. That such stereotypes persist is undeniable.
Despite the social changes that have taken place since the
middle of the twentieth century, there is still an expectation
for boys to be more aggressive, physical, mechanically
minded and so on, and for girls to be nurturing, emotional
and dependent. Over and above this, the qualities that we
categorize as being typically ‘masculine’ carry more posi-
tive connotations than the qualities we categorize as being
typically ‘feminine’ (Archer and Lloyd, 1985: 40). ‘Male’
attributes include qualities such as courage, confidence,
ambition, stability; females are associated with characteris-
tics such as dependence, passivity, frivolity, weakness and
sentimentality. It has been observed that parents respond
differently to their baby boys than to their baby girls
Chap-03.qxd 2/12/04 6:02 PM Page 86
(Rose et al., 1984: 142), interacting in a more robust manner

with boys and in a more caring and gentle way with girls.
This would seem to confirm social conditioning theory.
And yet it could also be argued that it is something in the
baby, himself or herself, that stimulates such different
parental responses.
There are many characteristics and attributes cited as
differentiating men from women. Studies purport to show
that, among other things, men are better at mathematics,
activities involving ‘spatial ability’, have better hand–eye
coordination than women, and that women are more fluent
at languages, have greater sensitivity to sound, smell and
pain and have better memories than men (Moir and Jessel,
1989; Stevens and Price, 1996). Some writers have
attempted to either disprove or minimize the significance of
such studies, claiming that the tests were unscientific,
unsound or that the differences that result are so minimal
as to be negligible (Rose et al., 1984; Archer and Lloyd,
1985; Clare, 2001). There is, however, one feature associ-
ated with each gender that is overwhelmingly supported by
both observation and statistics: male aggression and female
depression. The populations of our prisons and our mental
hospitals seem to show that in extremis men commit violent
crimes and women succumb to depression and mental ill-
ness. Depending on which camp you belong to, this can be
explained either by biology (men are naturally aggressive,
women are naturally more emotional and inward-looking)
or by conditioning (men and women both respond to social
expectations which demand certain behaviours of them
and inhibit others). Feminists would go further in respect
of female depression and explain it as the inevitable conse-
quence of male oppression. Clare makes out a convincing
case for the effects of cultural and societal pressures on the
incidence of male violence citing, among other arguments,
the significantly higher rates of male violence in countries
where the masculine code of ‘machismo’ is strongest. In his
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GENDER 87
view, ‘maleness and aggression do not have to go together’

(Clare, 2000: 59); one of the reasons why they have come
to be so closely associated is the fact that in our modern
capitalist society men are defined by actions and what they
do rather than by who they are – their ‘being’.
It would seem nonsensical, therefore, to deny that there
are real and distinct differences between men and women.
The difficulty arises when those differences are evaluated.
The traditional outcome of such an evaluation is to view the
differences as necessarily involving female deficiencies. It is
this view which sparked the feminist movement and has
fuelled much of the writing attempting to prove that
all gender differences are environmentally caused. Steven
Pinker (2002) cogently argues the case that gender differ-
ences are indeed rooted in biology, but that those differ-
ences do not have to imply either inferiority or superiority.
We seem now to have arrived at a point where we need to
accept and value both those qualities that we associate with
men and those qualities that we associate with women. At
the same time we need to be aware of the dangers inherent
in the stereotypical male and female qualities. As Gerda
Lerner puts it:
Regardless of whether such qualities as aggressiveness or nurturance
are genetically or culturally transmitted it should be obvious that the
aggressiveness of males, which may have been highly functional in the Stone
Age, is threatening human survival in the nuclear age. At a time when over-
population and exhaustion of natural resources represent a real danger for
human survival, to curb women’s procreative capacities may be more ‘adap-
tive’ than to foster them. (Lerner, 1986: 20)
Psychological theories
Classical psychoanalytic theory has played a large part in
the development of theories surrounding gender and gen-
der identity. Freud believed that both maleness and female-
ness are present in all human beings and that this innate
bisexuality has consequences for both normal and abnormal
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development (Freud, 1905). However, he also believed

that maleness and masculinity are the primary and more
natural states and that both men and women consider
femaleness and femininity less valuable (Freud, 1933).
Freud’s theory of psychosexual development centres
around the male child whose chances of successfully nego-
tiating the various stages of the oedipal complex are con-
siderably greater than the female child. The main reason
for this is the anatomical fact of the male penis. Resolution
of the oedipal conflict rests on observation (in both sexes)
of the female deficiency in this department. For the boy,
the resulting castration anxiety leads to his renouncing his
oedipal desires for his mother and completes this phase of
his development. For the girl, there is a less clear-cut impe-
tus for oedipal resolution as she is already castrated, so to
speak. This, for Freud, signified a seriously compromised
super-ego. As a result, women, he believed, have less
judgement and sense of justice than men, and are more
prone to jealousy and narcissism – these being the by-products
of penis envy.
The phallocentric nature of Freud’s theory, based as it was
on an assumption of the natural superiority of the male gen-
ital organs, has aroused criticism from its inception to the
present day. Karen Horney (1924) was one of the first to
challenge Freud’s notion of penis envy, suggesting that issues
of power and control and the influence of the male position
in society played a part in the formulations put forward by
Freud and other male psychoanalysts. More recently
Anthony Clare’s analysis of Freud’s concept of penis envy
concludes that it is a classic example of projection – the
projection of male anxiety about the actual basis of phallic
superiority and male potency onto women in the form of
spurious female desire for a penis (Clare, 2000: 196).
Not surprisingly, psychoanalytic theory about female
psychology has proved to be fiercely controversial among
feminists from the 1920s to the present. Early psychoanalytic
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GENDER 89
theory stressed the primacy of the father in human

development as well as centring psychosexual issues on the
male child and the male appendage. By the 1970s psycho-
analysis had gained a reputation as an ideology which
encouraged women to adapt to the situations which cre-
ated not only their unhappiness, but also their depression
and psychological problems. However, many post-
Freudians had emphasized the importance of the maternal
role (for example, Winnicott and Bowlby) and with second-
wave feminism came a reassessment of the value of psycho-
analytic thought to an understanding of female psychology.
Orbach and Eichenbaum (1984; 1985) stressed the impor-
tance of the mother/daughter relationship and in so doing
reassessed the nature of men’s and women’s dependency.
They suggest that women are brought up to meet men’s
dependency needs, not their own. Consequently women
have difficulty achieving autonomy and independence as
they have permanently unsatisfied dependency needs
which hold them back. Men, meanwhile, are well catered
for by their mothers and wives and are therefore in a better
position to separate and individuate. Moreover, in order for
a man to provide nurture to a woman he has to draw on his
own ‘femininity’ – that aspect of himself which he feels he
has to repress in order to be a man. To provide what a
woman needs, therefore, a man is involved in a process that
directly threatens his concept of his self.
This conflict is seen by many theorists as the central ele-
ment of male psychology – the need to separate from
women, combined with the fear of loss of identity and
‘maleness’ when intimacy with a woman is achieved
(Lemma-Wright, 1995: 47). This is the explanation given
for men’s difficulty in sustaining intimacy and for a pur-
ported male fear of women and female sexuality. The
history of women’s oppression can be told in terms of male
attempts to cover, hide, control and contain women’s bodies
and physicality. Parallel to this, women have throughout
Chap-03.qxd 2/12/04 6:02 PM Page 90
history been seen as of use only for their bodies – for the
pleasure of man and to give birth to his children. This is
seen as a classic conflict between desire and fear – which
results in portraying women as sinister, destructive and
insatiable. They are witches, whores and madonnas all at
the same time. A woman can arouse a man’s desires, and
in so doing she triggers his fear of losing his male identity,
a fear of being engulfed and no longer separate, and for
that reason she is an object to be feared and if possible kept
under control.
Gender in counselling and psychotherapy

Of all the issues under consideration in this book, that of
women as the oppressed ‘minority’ has a particular feature
in that within the field of psychotherapy and counselling
women are in the majority, both as practitioners and
clients. Numerically, the majority of counsellors and thera-
pists embody the characteristics of the dominant or ‘nor-
mative’ group in respect of the colour of their skin (white),
their sexual orientation (heterosexual), and in their physi-
cal and mental health (able-bodied, and not suffering from
a diagnosed mental illness). However, the majority of
counsellors, therapists and clients come from what is tradi-
tionally perceived to be the oppressed group when it comes
to gender – most of them are women (Coldridge and
Mickelborough, 2003). Feminists would argue that, as far
as female clients are concerned, this is precisely because
they have been oppressed and therefore deserve special
attention within the field of psychological thought. As we
have seen, traditional psychoanalytic theory – and indeed
the theory within all schools of psychotherapy – has been
formulated predominantly by men. The earliest theories of
human development focused specifically on the develop-
ment of the male infant and, feminists would argue, perpe-
trated the notion of male superiority and importance. This
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GENDER 91
has been very largely redressed by later theorists and in

particular by the feminist movement of the 1970s and
beyond. Indeed there exists an impressive body of literature
devoted to the subject of feminine psychology and feminist
counselling and psychotherapy.
The fact remains, however, that men are in the minority
in the field of counselling and psychotherapy, both as
trainees, practitioners and clients. Why should this be so?
And given that it is the case, what are the implications for
the experiences of men who come to this field, either as
would-be practitioners, practitioners or clients?
Why more female clients?

Gender stereotypes contain the idea that women are more
comfortable with their feelings than men. This would
clearly make them both more drawn to the ‘talking thera-
pies’ and more suitable, and even successful, as clients of
such. My own belief is that there is no innate gender dif-
ference between the capacity of men and women to iden-
tify, talk about and make sense of their own emotions, or
those of others, but that cultural and environmental influ-
ences play a big part in encouraging some men (and boys)
not to develop this capacity. There is instead heavy empha-
sis on the need for men to channel their energies into
action, achievement and goal-oriented activities. Men are
encouraged to adopt the attitude that they should be strong
and sort out their own problems. Seeking help is seen as an
indication that alone you are unable to do this. This is
viewed as a weakness – and an admission of failure to meet
the ‘male’ standard of behaviour. Women, on the other
hand, are more likely to accept that vulnerability is part of
being human (or female?) and that both asking for help and
talking about their problems is an acceptable way of deal-
ing with the inevitable difficulties of life.
A more radical explanation for the preponderance of
female clients is that the oppression they experience at the
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hands of men makes them ill, renders them susceptible to

depression, or even sends them mad. It has been suggested
that women’s lack of status in society is experienced as a
loss which generates frustration and anger. These emotions
can find no expression precisely because of women’s power-
less social position – they therefore turn inward, which may
result in depression (Chesler, 1972). Gender-role socializa-
tion has been compared to the psychological condition of
‘learned helplessness’ which characterizes depression in
terms of passivity, lack of observable aggression and
reduced effectiveness in solving problems (Litman, 1978).
At its most extreme this line of reasoning would claim that
women’s distress is the result of institutional and individual
oppression, not individual pathology. Misogyny either
causes female madness or labels women as mad in order to
silence them (Ussher, 1991). The general tenet of this
school of thought is that sexism has adverse effects on
women’s emotional and psychological health – this is why
they present for psychological help in greater numbers than
men. This view forms the basis for much of the literature
on feminist counselling and psychotherapy, which seeks to
redress this situation by encouraging women to develop
greater self-confidence and autonomy; to challenge patri-
archy and thus free themselves from the psychological ill-
health that it creates.
Attention is beginning to be drawn to the gender imbal-
ance in clients of counselling and psychotherapy (Garde,
2003; Wheeler, 2003). Despite the fact that men, generally
speaking, are less healthy than women, and are more likely
to commit suicide than women, they are less likely to seek
psychological help than women at a ratio of about 2:1
(Millar, 2003). What appears to underlie this are deep-
seated cultural stereotypes about what constitutes mas-
culinity which inhibit men from utilizing resources such as
counselling or therapy.
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GENDER 93
Why more female counsellors and therapists?

The same arguments about gender stereotyping would
apply here. Given that women are, generally speaking,
more comfortable expressing their feelings and talking
about their problems than men, it follows that they are
going to be better at facilitating others to do the same.
There is also a high incidence of people drawn to train as
counsellors and therapists by having been through personal
difficulties of their own, and having been helped by thera-
peutic experiences. The over-representation of women as
clients of therapy would therefore carry through to their
preponderance as practitioners. Similarly, all training pro-
grammes require of their participants an extensive period
of personal therapy, usually concurrent with the training
itself. As a factor within the training for the profession this
is more likely to appeal to prospective female applicants
than to their male counterparts.
The ethos, modes of communication and forms of
expression which pertain in counselling and psychotherapy
training courses are all those which are likely to be more
congenial and familiar to women than to men. There is a
culture of personal disclosure, empathic expression and
sharing of emotions and experiences which many men
experience as both unfamiliar and excluding (Gillon,
2002). The qualities and skills that trainee counsellors are
required to demonstrate are undeniably those that are tra-
ditionally viewed as being ‘female’ attributes: empathy,
understanding, self-awareness, intuition and sensitivity.
A more practical reason for women being attracted to
work as counsellors and therapists is the potential flexibility
that such work offers. There is considerable scope for
organizing working hours round such commitments as
childcare and domestic management. Many female coun-
sellors work part-time for this reason, their earnings being
‘supplementary’ to the household income. By the same
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token it is relatively hard to make a full-time or financially

viable career out of working as a counsellor or psychothera-
pist. There are very few full-time psychotherapy posts
within the National Health Service and competition within
the private sector is fierce. It is not surprising, therefore,
that in a profession populated predominantly by women,
men are heavily over-represented in the full-time posts, in
the management of training facilities and counselling cen-
tres and in the top academic posts in universities.
Men as counsellors and clients

The experience of many men who undertake training to
be counsellors and psychotherapists is that they are dis-
counted, victimized or at the very least overlooked as
trainees. In any training I have been a part of, either as par-
ticipant or trainer, men have been both a significant minor-
ity and more likely to fail to complete the course than their
female colleagues. I have observed that, as clients, men
attract more hostility and criticism in (all-female) super-
vision groups than female clients. In psychoanalytic terms
this could be explained as the individual male client,
trainee or therapist being the recipient of the projections of
their female colleagues and therapists – becoming the focus
of the repressed aggression resulting from years of oppres-
sion by a male-dominated society. It could also be under-
stood in terms of role reversal. In society at large women
are the disadvantaged ‘minority’ group, fighting to achieve
equal standing with men. Finding themselves in an envir-
onment where they are, for once, in the majority, their
behaviour towards the hapless men who happen to stray
into that world has the potential to contain within it elements
of revenge.
Another significant factor which militates against men in
the field of counselling and therapy, either as practitioners
or clients, is the growing public perception of all men as
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GENDER 95
potential abusers (Clare, 2000: 185). The high incidence of

male violence generally, combined with an increasing
awareness of the problems of child abuse and domestic vio-
lence, has had the effect of painting a picture of men as
beings who can barely contain their impulses to rape and
assault women and children at every available opportunity.
Cases of assault (sexual or otherwise) on female clients by
their male therapists receive much publicity and add fuel to
this concern. Similarly, the furore created by the False
Memory/Repressed Memory Syndrome debate has further
blackened the case for men. When Bass and Davis pub-
lished their book The Courage to Heal in 1988, there was a
sudden and huge increase in young women accusing their
fathers of incest when they were children, both in the US
and in Britain. Dealing with this trauma is not appropriate
work for male therapists who by virtue of their gender alone
are highly suspect. Many male counsellors and therapists in
private practice feel the need to instigate elaborate meas-
ures in order to convey to their female clients the absence
of their desire to abuse or exploit them.
Gender in the therapeutic relationship

It is surprising to discover that in all the literature about the
counselling and psychotherapeutic relationship, there is
almost nothing on the subject of the impact of gender.
Given the history of the social relationship between men
and women and the existing tensions within their respec-
tive current positions, it would seem inevitable that in any
therapeutic dyad the gender of client and therapist would
play a part in their relationship.
There is, as mentioned, a huge body of literature on the
subject of feminist counselling. The philosophy underlying
most of this is that women’s psychology and experiences
are specific and different from men’s – at least partly due to
the effects of patriarchy and the historical oppression of
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women. The conclusion that is drawn is that women need

a particular type of counselling to help them escape from
their stereotypical roles and overcome their socialized
passivity and depression. This involves developing
women’s self-esteem and self-confidence and facilitating
them in greater assertiveness (Chaplin, 1988; McLeod,
1994; Lawrence and Maguire, 1997). It is axiomatic that
feminist therapy is carried out by women, for women.
In her chapter entitled ‘Counselling and Gender’ in the
Handbook of Counselling in Britain (1989), Jocelyn Chaplin
provides a brief but succinct outline of the way the power
relationships in counselling can be affected by the respec-
tive genders of client and counsellor. She draws attention
to the ‘social stereotype of the strong male doctor curing
the weak female patient’ (ibid.: 227) which can have an
impact on the female client/male counsellor dyad, where
the female client may be tempted to play a passive depen-
dent role and the male counsellor a dominant, or protective,
role. Where the client is male and the counsellor female,
the power struggle can be felt quite strongly as the male
client may feel a need to assert control of the situation aris-
ing from a dislike of being in the ‘supplicant’ role. When
both parties are male, Chaplin says, there is potential for
the stereotypical male competition for supremacy, and
when both are female, there is the risk of the relationship
sliding into something more cosy and intimate than formal
counselling would sanction.
Over and above this I believe there are particular dangers
for female counsellors and therapists precisely because
of the history of gender relations, the preponderance of
women in this field, and the very nature of the activities of
counselling and therapy. The history of discrimination
against women and their continuing fight for equality may
lead a female counsellor or therapist to encourage (or sug-
gest) a course of action for her female client primarily
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GENDER 97
because it is in line with the wider ideals of the women’s

movement. In other words, a female counsellor who has a
female client may be tempted, particularly when examining
issues concerning relationships with men, to proselytize
and lose sight of the client’s unique circumstances. By the
same token female counsellors may find themselves fiercely
confronting what they perceive to be male clients’ stereo-
typical attitudes concerning gender relations. The counsellor/
client dyad can thus become a battleground for gender
relations rather than a therapeutic space for the client’s
self-exploration. The psychological theories which under-
pin the enterprises of counselling and psychotherapy lay
considerable emphasis on the desirability of attributes such
as autonomy, independence, individuation and such like.
These notions dovetail nicely with the aspirations of fem-
inism and can lead to the dangerous assumption that any
woman who is in a relationship where there is not total
equality must automatically be frustrated and oppressed,
and any man in a similar relationship is by definition auto-
cratic and sexist. It is a short step from here to believing
that your duty as a counsellor is to set things straight. As
with anything else, counsellors and therapists need to work
out their own values and establish what their gender means
for them and their relationships. It is inappropriate and
unethical to impose these values on clients.
Practitioners do, of course, need to be aware of the effect
that the gender stereotyping inherent in our culture has had
on their own perceptions, both of themselves and others.
This awareness should play a conscious part in therapists’
consideration of the response their clients invoke in them,
and the response they, in turn, evoke in their clients.
Similarly, therapists need to be aware of the impact of gen-
der stereotyping on the client’s world-view and his/her ability
to connect with, express and examine their feelings, thoughts
and emotions.
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Counsellors and psychotherapists have a responsibility to

gain a deep level of self-understanding. Part of this must be
an awareness, for each person, of what it means to him or
her to be a man or a woman in modern society. As part of
any thorough training to become a counsellor or therapist,
trainees should be invited to question their own assump-
tions about gender and the respective roles of men and
women both towards each other and within society as a
whole. There is a variety of assumptions which are preva-
lent and rarely challenged that can be detrimental to ther-
apeutic work if the practitioner is lacking in self-awareness.
Some of these assumptions are: women should be more
giving and conciliatory than men; all people are psychologi-
cally better off if they are married, or at least in an intimate
(heterosexual) relationship; women are only truly fulfilled
if they have children; men are only truly fulfilled if they
have a successful career. Of course, some of these assump-
tions may be true for some people, but the role of counsel-
lor or therapist requires an openness to the different value
systems with which people operate as well as a deep under-
standing of one’s own.
Because of the preponderance of women in the field of
counselling and therapy, and because of the ‘feminine’
nature of the attributes encouraged by counselling and
psychotherapy training, there is a risk that ‘masculine’ attrib-
utes and qualities come to be denigrated, discounted and
undervalued. In order for men to succeed within this field,
as practitioners or clients, they have to demonstrate their
ability to think and feel in ways that may be quite different
from what has previously been expected of them. This is all
very well, as long as it is not at the expense of ‘male’ qual-
ities. Counselling and therapy are areas where ‘female’ lan-
guage, values and styles of relating dominate. Those within
the profession are generally enthusiastic about the idea of
encouraging more men to train as counsellors and therapists,
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GENDER 99
but, as Chris Rose points out, ‘the condition sometimes

seems to be that they are required not to behave as men’
(Rose, 2002: 9). The challenge to counselling, she believes,
is to recognize and redress this denigration of the male gen-
der and its associated qualities. In this context it is men
who are the marginalized group.
The need for an integration of masculine and feminine
values and ways of thinking is held up as the way forward
in this field (Chaplin, 1988; Lemma-Wright, 1995; Clare,
2000). What this comes down to is a celebration of differ-
ence and diversity (both within us and among us) rather
than judging differences as either superior or inferior.
Theorists as far back as Freud have pointed out the exis-
tence within all of us of both ‘male’ and ‘female’ attributes.
It was Jung, however, who saw the recognition of the femi-
nine and masculine aspects of the psyche, and the desir-
ability of their integration, as the most important and
challenging part of human development. Chaplin draws a
parallel between the hierarchies within society and the hier-
archical splits or tensions that operate within each one of
us. Polarities exist between the desire for intimacy and the
fear of rejection; between control and chaos; dependence
and independence; power and powerlessness; perfection
and uselessness (Chaplin, 1988: 50). We need to reconcile
the opposites by realizing that they do not cancel each
other out – we can have both. This, I believe, is what she
means when she writes, ‘Counselling needs to help people
become more psychologically androgynous’ (Chaplin,
1989: 236).
It is not necessarily androgyny which is the aim, rather a
recognition of the individual needs, characteristics and
attributes of both men and women. In order to achieve that
we need to be able to acknowledge and embrace all aspects
of our own psyches, in particular those parts which are
stereotypically associated with the opposite gender from
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our own. Denigration of ‘masculine’ attributes if you are

female, or ‘feminine’ attributes if you are male, is ulti-
mately a denial of part of yourself. Self-knowledge, and the
ability to facilitate others in their quest for greater self-
understanding, is not achieved by denial but by the inte-
gration of the different components of our individual
personalities.
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4 Sexuality
T H E C O N C E P T O F ‘ S E X U A L I T Y ’ as part of
human experience and behaviour as distinct
from other areas of our experience is relatively modern.
With this concept there comes the division of sexual behav-
iour into different types of activity: with partners of the
same gender or the opposite gender; on one’s own, with
one partner, or more than one partner; activities involving
different sexual positions and different parts of the
anatomy. This in turn has generated numerous attempts to
classify activities (either socially or legally) as acceptable or
unacceptable, natural or unnatural, normal or abnormal.
The regulation of sexuality, by legislation, social opinion
or both, led to the idea of people being identified, indivi-
dually and in groups, by their sexual practices. The notion
of possessing a heterosexual, homosexual or lesbian ‘iden-
tity’ is problematic for a number of reasons. It presupposes
that each of us belongs exclusively to one group or the
other. Furthermore, there is the assumption that by belong-
ing to that group we automatically possess a number of
characteristics common to all members of the group, other
than our sexual preferences. Throughout history the west-
ern world has predominantly taken the view that sexual
activity with a member of the opposite gender is ‘normal’
and ‘natural’ and that anything else is ‘abnormal’ and
‘unnatural’. The proscriptions within this formulation have
varied over time and place: whether or not such activity is
Chap-04.qxd 2/12/04 6:02 PM Page 102
sanctioned only within marriage or a stable relationship,

what types of activity are acceptable, the expectations and
assumptions around the relative roles (active or passive) of
men and women, and so forth. At one time women of good
social class were not expected to experience sexual pleas-
ure, and any activity other than genital heterosexual inter-
course was highly suspect. By the late twentieth century
there was a widespread assumption that everyone, men and
women, could or even should engage in a wide variety of
sexual practices, provided these remained within the con-
fines of legality. Not to do so, or not to experience regular
orgasm, has come to be viewed by many as undesirable,
unhealthy, or even psychologically damaging.
Despite this, there remains widespread discomfort with
both male and female homosexuality. The sexual liberation
of the 1960s and 1970s was decidedly heterosexual – it did
little to change public opinion about same-sex relation-
ships. It is disquieting to observe that among schoolchildren
and adolescents the epithet ‘gay’ is a widely used term of
abuse. In adult life people who identify themselves, or are
identified by others, as homosexual or lesbian, are still
widely stigmatized and discriminated against. The fact that
a person’s sexuality needs to be commented on – which is
only the case if it is not heterosexual – is indicative of the
prejudice around this area which is still endemic in our
society. While I am aware that there are many other kinds
of sexual behaviour for which people are stigmatized
(transvestism, bisexuality, etc.), I will be focusing primarily
on homosexuality and lesbianism which for too many
people are still seen as representative of a sexuality which is
in some way abnormal, alien or even sinful.
As with previous chapters, this chapter will begin with a
historical overview of how differing sexual practices have
been regarded and treated in different societies and at dif-
ferent times in history. This is followed by an examination
of the theories that have arisen around attempts to explain
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SEXUALITY 103
homosexuality and lesbianism. The last section focuses on

the problematic relationship between homosexuality and
the enterprises of counselling and psychotherapy.
Homosexuality – a historical overview

The term ‘homosexuality’ was first used in 1868 in corre-
spondence between a German-Hungarian journalist, Karl
Maria Kertbeny, and the sexologist Karl Heinrich Ulrichs.
It was adopted the following year by the medical sexual
theorist, Dr Karl Westphals, and was being widely used in
medical and psychiatric circles by the end of the nineteenth
century. The term ‘lesbian’ was also first used, with its spe-
cific meaning of same-sex female sexuality, in a medical
context, by Richard von Krafft-Ebing in his text
Psychopathia Sexualis published in 1886. For some time
after that lesbianism was commonly subsumed in the liter-
ature into the term ‘homosexuality’ which was taken to
indicate male and female same-sex sexuality. ‘Lesbian’ did
not enter widespread social use until the 1950s with the
advent of the feminist movement. The term ‘homosexual-
ity’ came into popular social use in the 1920s, preceding
the invention of the term ‘heterosexuality’ in the 1930s.
Since then the terms ‘homosexuality’ and ‘heterosexuality’
have become fixed in public opinion and medical terminol-
ogy as identifying two separate and definitively different
kinds of sexuality, practised by two separate and defini-
tively different groups of people. Most pre-modern and
non-western cultures did not differentiate human beings in
this way; that is to say at the level of sexual preference. A
person’s sexual tastes were not ascribed to some positive,
structural or definitive feature of his or her personality.
However, the behaviour described by the term homosexu-
ality has always been part of human sexual activity. The
visual arts, literary, medical and religious texts of all histor-
ical periods abundantly demonstrate that human beings
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have desired, loved and had sex with members of their own
gender throughout history.
Early history
There is a widely held belief that the society of Ancient
Greece was an ideal world in which homosexual love and
sexual activity was as acceptable as heterosexual relation-
ships. There is some truth in this, but it is important to
understand the social conventions that governed the sexual
practices at that time. The distinction prevalent in Ancient
Greece, and also in the Roman world, was between the
‘active’ and the ‘passive’ person in any sexual act, rather
than the gender of the two persons. This distinction was
viewed as vital as an indicator of superior or inferior social
status. The convention for an adult male was to be the
dominant partner in all sexual acts. What was not accept-
able was to engage in anything that suggested effeminacy –
in other words to be the submissive sexual partner. Sex was
viewed as an activity characterized by domination rather
than by mutuality. Adult male citizens in Athens and
Rome, therefore, could have legitimate sexual relations
with those of inferior social status – women, boys and
slaves – but not with those of the same social status – other
adult male citizens. In Greece the relationship between
an adult male and his boy lover carried with it elements
of mentoring; it was viewed as a recognizable stage of
social development for a boy on his road to maturity. In
both Athens and Rome the emphasis in sexuality was on
social status as evidenced by being a freeborn citizen and
demonstrated by taking a dominant sexual role. Both soci-
eties were male-dominated and in them, for sexual pur-
poses, women and boys were seen as almost functionally
interchangeable.
In later antiquity and, significantly, with the advent of
Christianity, this view began to change dramatically. The
idea emerged that only love between a man and a woman
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SEXUALITY 105
was natural and socially acceptable. The concept that men

who love men and men who love women are separate and
different begins to appear. Tolerance for homosexuality
began to decrease in the first centuries of our era.
Procreation came to be seen as the principal reason for
sexual activity; consequently marriage became the funda-
mental social institution, the template for acceptable human
and sexual relations. Early Christianity rejected homosexual-
ity as unnatural, sinful and inimical to marriage. In God’s
‘natural order’ there was no place for same-sex relation-
ships – indeed they were seen as a violation of that order
and automatically excluded the sinner from God’s king-
dom. By the fourth century AD homosexuality had become
a moral crime as well as a sin, punishable by a variety of
means including exile, castration, head-shaving, whipping
and burning at the stake (Fone, 2000: 120).
Throughout the medieval period in the Christian world
social opinion, endorsed by theological writings, viewed
same-sex relationships as aberrant, shameful, sinful and
unlawful. Few references are made in the literature of this
time to lesbianism, though it was assumed to be included
in the many laws proscribing homosexuality. In the numer-
ous legal cases where homosexuality was brought to trial,
only a handful involved a lesbian relationship. From the
thirteenth century in Europe the death penalty was fre-
quently invoked for acts of sodomy, which at various times
was seen as infectious, politically suspect and indicative of
heretical beliefs or treason. For a brief period during the
Renaissance the glorification of classical writings produced
a celebration, in literature at least, of male homosexuality
or ‘Greek love’. Despite this, the legal position remained
unchanged, as did the view of the church. Between 1450
and 1650 ‘some of the most ferocious laws against sodomy
were promulgated and more sodomites were executed than
at any previous period of European history’ (Fone, 2000:
214). In England the Ecclesiastical Courts held the power
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to punish those who transgressed the strict moral laws laid

down by the church. Such transgressions included acts of
‘sodomy’ or ‘buggery’. With the Reformation this situation
changed – regulation of aberrant sexual practices was taken
over by the state. In 1533 a law was passed which crimi-
nalized ‘buggery’. It became a vice rather than (or as well
as) a sin, and a crime carrying the death penalty. This
situation persisted for the next 300 years.
Europe – the seventeenth to nineteenth centuries

The dominant view in Europe throughout the seventeenth
and eighteenth centuries was that sex should be a means to
an end. Procreation as its aim was seen as paramount. The
family unit was the basis of society, and the man was the
head of that unit. To be manly was to experience sexual
desire only for women. While prostitution flourished and
there was, in most countries, a tolerance of men who had
sex outside marriage (though not an equal tolerance of the
women with whom they had this illicit sex), the social atti-
tude towards same-sex relationships remained hostile and
condemnatory. Nevertheless there is ample evidence that
such relationships took place. The emergence of a homo-
sexual subculture is identified at about 1700 in many of the
major European cities (Haussen, 1991; Trumbach, 1991;
Weeks, 1991). By this time homosexual activity was viewed
as forbidden and shameful behaviour of a deviant, effemi-
nate minority of adult males; therefore the social control of
this behaviour was seen as the task of the state. With the
Enlightenment in the eighteenth century, however, there
was a gradual decriminalization of sodomy in most parts of
mainland Europe, bringing with it a removal of the death
penalty. In England, by contrast, the pace of persecution and
executions dramatically increased. England did not aban-
don the death penalty for sodomy until 1861 and homo-
sexual acts remained criminal until well into the twentieth
century. It is important to recognize that decriminalization,
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SEXUALITY 107
whenever it took place, did not mean social tolerance.

Sodomy was still viewed, variously, as a disease, a vice, a
deviation, a mortal sin and, above all, a bestial and unnat-
ural act.
Nineteenth-century thought was characterized by a pre-
occupation with social and public order. Men and women
were seen to have ‘natural’ characteristics and attributes
that fitted them for particular tasks and for particular roles –
social, economic and sexual. Nature was seen as the
supreme example of the genuine and the immutable. It was
believed that nature knew no vice and man should strive to
get close to what was natural. The (erroneous) view that
homosexuality did not exist in nature reinforced the belief
that such behaviour was ‘unnatural’ and abnormal.
Furthermore, homosexuality was seen as a threat to manli-
ness and to the ‘natural order’ of things, and therefore to
the whole social fabric. From early in the nineteenth cen-
tury a link was made between immorality, sexual behaviour
and disease. This appeared in the medical discourse of the
time and was reinforced by the Christian ethic. Medical
theory held (among other things) that masturbation led to
homosexuality, which led to insanity, disease and death. It
was widely believed that homosexuals could contaminate
and ‘infect’ so-called ‘normal’ men. Victorian morality
maintained that for men sexual desire was normal and nat-
ural, as long as its focus was women. For women the norm
was seen as absence of sexual desire. As female hetero-
sexual desire was denied, so female same-sex desire was
unthinkable. Lesbianism, therefore, was socially invisible.
But even for men the control of sexual passions was advo-
cated as a safeguard against ill-health. These views reached
their zenith towards the end of the century in the Purity
movement, which was heavily informed by Christian ideals
of moderation and prayer, and in a paternalistic middle-
class evangelism towards the dissipated, animalistic and
intellectually inferior lower classes.
Chap-04.qxd 2/12/04 6:02 PM Page 108
Sexology and the medical model

In 1885 the first comprehensive law relating to male
homosexuality was passed in England. The Criminal Law
Amendment Act used the dangerously vague term ‘gross
indecency’ and in effect made all homosexual acts illegal.
By this time the term ‘homosexuality’ had come into use,
originating as we have seen in a medical context. This was
the period when scientific determinism was at its height,
characterized by the desire to classify, categorize and find a
place for everything and everyone in what was perceived to
be a conflicting and changing world. Darwinian theory dis-
tinguished between sexual selection and natural selection;
that survival depended on sexual selection leant weight to
the burgeoning scientific and medical interest in the nature
and causes of different sexual behaviours. The new disci-
pline of sexology led to the invention of the terms ‘invert’
and ‘pervert’ and, more significantly, to the notion of sex-
uality as a means of defining an individual. Richard von
Krafft-Ebing’s work Psychopathia Sexualis, published in
1886, was an attempt to categorize people by their sexual
practices. He listed a huge array of sexual perversions and
abnormalities. The fundamental premiss to his work and
that of other sexologists was that heterosexual object choice
was the natural and normal state. Anything else fell into the
category of perversity. Krafft-Ebing defined homosexuality
as an absence of ‘normal sexual feeling’ and saw its cause
as mental ‘degeneration’ (Fone, 2000: 275).
This was the beginning of the debate about innate and
acquired sexual characteristics and preferences which con-
tinues to this day. The focus in much of the sexological
writings is on male homosexuality, with the search for
explanations or causes centred on biology. There was,
however, a recognition of the existence of lesbianism,
which was, like male homosexuality, viewed as degenerate
and deviant. However, the existence of same-sex female
desire and sexuality was a particular challenge to paternalistic
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SEXUALITY 109
Victorian morality and the social role assigned to women.

How could a woman find satisfaction, either sexual or emo-
tional, with anyone other than a man? Attempts to explain
lesbianism, therefore, focused more on social than sexual
behaviour, linking lesbianism with a misguided rejection of
the conventional female role, or seeing it as a result of the
lamentable increase in female education and political
involvement. However, the legal situation created by the
1885 Act did not apply to women. An attempt to extend
the provisions of this Act to women was made in 1921. This
failed, partly at least on the grounds that publicity about
lesbianism would only serve to make more women aware of
its existence. Invisibility and denial have always been a
central part of the social response to lesbianism.
The medicalization of homosexuality brought about by
the scientific determinism and sexological theories of the
late nineteenth century added pathology to the list of defi-
nitions of same-sex sexual desire. Viewed historically as a
sin, a crime, a vice and a disease, it now became a patho-
logical biological condition by which a person could be
defined as separate and different from the norm. In his
book Coming Out: Homosexual Politics in Britain from the
Nineteenth Century to the Present (1977), Jeffrey Weeks
reflects on the fact that homosexuality has existed through-
out history, but that what has varied has been the ways in
which it has been regarded and defined by different soci-
eties. He distinguishes between homosexual behaviour
which is ‘universal’ and homosexual identity which he calls
‘historically specific’ (Weeks, 1977: 3). The late nineteenth
and early twentieth centuries saw the invention of the
notion of sexual identity, with homosexuality seen as an
aberration, and the term ‘heterosexuality’ coined to define
what was viewed as the natural and normal state. Thus the
sexual practices a person engaged in became the means
whereby they were identified as individuals. Psychoanalysis
served only to reinforce this trend. Freud’s theories on
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sexuality in general, and homosexuality in particular, will

be discussed in the next section. Suffice to say here that
broadly speaking he was singing the same tune as the sexo-
logists. Whereas Freud’s theories indubitably present at
times a more open and controversial picture of the nature
of human sexuality, his successors adopted an orthodox
stance in which anything other than heterosexuality was
viewed as indicative of incomplete or distorted psychologi-
cal development and consequently as perverse.
The twentieth century

At the beginning of the twentieth century there was little
organized resistance to the prevailing homophobic social
attitude. However, networks of subcultures of gay men and
lesbian women were growing in both Europe and the USA.
For many the notion of sexual identity became a means of
self-definition – this was what eventually blossomed into
the individual and collective resistance of the Gay
Liberation Movement. Two world wars had the effect of
expanding the sense of homosexual unity on both sides of
the Atlantic. Old social structures and values were chal-
lenged or changed and men and women were either mobil-
ized or involved in war work which took them outside their
local communities. At the same time, in the nations on
both sides of the global conflict, war produced a xenopho-
bic strain of homophobia as sexual difference was conflated
with betrayal of a nation’s values. In Germany the Nazi
regime targeted homosexuals, along with other minority
groups, viewing such aberrant behaviour as contaminating
and corrupting the Aryan race and, like the Jews, endan-
gering its survival. Mosse reports that between 10,000 and
20,000 homosexuals died in the concentration camps
(Mosse, 1985: xx).
By the end of the Second World War homosexuality had
become an issue exposed to social, medical and scientific
discussion. As a group, homosexuals were becoming more
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SEXUALITY 111
visible – and as such widely exposed to social ostracism.

The Kinsey report, published in the USA in 1948, was an
attempt to cast some light on the nature of sexuality in
men. Kinsey claimed that 37 per cent of the male popula-
tion of the United States had some homosexual experience
between adolescence and old age and that between 4 per cent
and 10 per cent of American men were exclusively homo-
sexual. The implications of Kinsey’s work were that
homosexuality was widespread and, more controversially,
that it was a normal and healthy form of sexual expression.
This attempt to foster a more liberal view had the unfortu-
nate effect of provoking enormous public moral outrage. In
England there was a heavy social and police crackdown on
homosexuality around this time. Prosecutions and convic-
tions frequently led to enforced psychiatric treatment in an
attempt to ‘cure’ what was seen as a dangerous perversion.
Treatment included aversion therapy, lobotomy, electric
shock treatment, castration and hormone and drug therapy
( Jeffery-Poulter, 1991: 14, 51). In the USA the homosexual
witch-hunt acquired political overtones. McCarthy’s
investigation of suspected communists in government
linked the politically suspect with the sexually suspect and
the notion of the homosexual as a political menace was
added to the stereotype. A similar phenomenon took place
in the UK with the defection of Guy Burgess and Donald
Maclean to the Soviet Union, an event which fuelled para-
noia about homosexuality, associating it with disloyalty,
treachery and treason.
Many commentators see the persecution of homosexuals
in the 1950s as the spur to the creation of the modern
homosexual rights movement ( Weeks, 1985; D’Emilio,
1991; Jeffery-Poulter, 1991; Fone, 2000). For the first time
it was argued that homosexuals should be seen as a minor-
ity group and therefore viewed within the discourse of civil
liberties and human rights rather than within the confines
of social morality or medical diagnosis. Prejudice against
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homosexuality, however, was and still is deeply rooted.

From the mid-1950s to the mid-1970s there were radical
changes in attitudes to sex and sexual behaviour in the
western world. Despite that, traditional attitudes have been
persistent including the continued discrimination of sexual
‘deviants’. The so-called ‘sexual revolution’ was predomi-
nantly sexist and heterosexist. But homosexuality had
found a voice and changes began, albeit slowly. The
Stonewall Rebellion in New York in 1969, following a
police raid on a gay bar, led to the birth of Gay Activism in
the USA which soon spread to England and mainland
Europe. In England in 1967 homosexual acts in private
between consenting males over the age of twenty-one were
decriminalized. Scotland and Northern Ireland followed
suit in 1980. In 1973 the American Psychiatric Association
removed homosexuality from their list of sexual disorders,
primarily as a result of social pressure rather than scientific
reassessment. It took a long time for similar changes in the
UK to be effected, homosexuality remaining in the ICD
classification of mental disorders until 1992. To this day
both countries continue to have diagnoses such as ‘gender
identity disorder’ within their classification systems – an
indication that the medicalization of homosexuality and
lesbianism has never fully disappeared.
Since the 1980s there have been huge changes in social
attitudes to homosexuality. The terms ‘gay’ and ‘lesbian’
have widely come into use, ‘homosexual’ being largely
rejected by those to whom it is applied due to its medical
and diagnostic origins. The numbers of pubs and clubs
which accept gay men and lesbian women have increased
from the late 1970s and many people in public and politi-
cal office have become able to acknowledge their homo-
sexuality openly without losing their jobs. The development
of the feminist and gay liberation movements empowered
lesbian women and gay men to speak out and ‘come out’.
But despite a growing climate of toleration, many saw these
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SEXUALITY 113
trends as threats to old values and the traditional family

unit. ‘Family values’ as expounded by the politics and
social policies of Reagan and Thatcher continued to be
vaunted as the epitome of social and moral purity. Such
values were, by definition, heterosexual and patriarchal and
anything outside that was by implication denigrated and
devalued.
The advent of AIDS in the mid-1980s accentuated these
deeply ingrained prejudices. AIDS happened at a time
when the revolution in the gay world was incomplete.
Jeffrey Weeks makes the distinction between the homosexual
who at this time was ‘partially accepted’ and homosexual-
ity which was still eschewed (Weeks, 1985: 45). AIDS
acquired a particular moral stigma because it was associ-
ated with a group of people who were already marginalized
and disapproved of. It provoked widespread moral panic
and was seen by many as retribution for unhealthy,
immoral or perverted sexual practices. Jeffery-Poulter
(1991) details the social and political reaction to AIDS in
the UK, highlighting the fact that there was little public
concern until heterosexuals became infected. While large
sums of public money were given for haemophiliac AIDS
sufferers, pitifully small amounts were given for gay men
who had the disease. The gay community was scapegoated;
while they themselves ‘deserved’ illness, they were pilloried
for putting other ‘innocent’ victims at risk. AIDS had the
effect of reviving lingering beliefs in homosexuality as a
disease and, moreover, one which was infectious.
Homophobia increased dramatically with calls for the re-
criminalization and imprisonment of homosexuals.
Homosexuals were seen as carriers of disease, potential
corrupters of the nation’s youth and as child molesters.
Within this climate the infamous Section 28 of the Local
Government Act was passed in 1988, prohibiting the pro-
motion of homosexuality in schools. This reflected public
anxiety about the stability of the family and the need to
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protect society against the moral decay that, for many,

homosexuality had come to represent. Section 28 had the
effect of producing an unprecedented display of gay and
lesbian solidarity and provoked the establishment of orga-
nizations by the gay community to lobby the media and the
legal and parliamentary systems.
Prior to this there had been a lack of unity between les-
bian women and gay men as their aims and aspirations had
diverged throughout the twentieth century. In the early
part of this period female sexuality was seen primarily in
the context of the heterosexual family and male domi-
nance. Lesbianism was largely invisible in the public con-
sciousness and in the legal sense. This was in effect a denial
of female sexuality as much as of lesbianism. With the
advent of the women’s movement this situation was
changed dramatically. For many women within this move-
ment lesbianism was seen as the ultimate expression of
female solidarity and the rejection of male oppression.
Lesbianism thus acquired a political as well as a sexual
dimension. Many lesbians left the male-dominated Gay
Liberation Front in the 1970s to join the women’s move-
ment and adopted a separatist stance. Like gay men, les-
bians gained little from the sexual revolution of the 1960s
and 1970s, but, unlike gays, they were little affected by
AIDS. However, they were, by implication, included in the
public condemnation of non-heterosexual sexual relations
following the outbreak of AIDS and were united with the
male gay community in their outrage at the implications of
Section 28.

The last decade of the twentieth century saw a significant
rise in violence against homosexuals. As the gay commu-
nity has become more visible and more vocal, the result has
been a homophobic backlash rather than greater tolerance.
Homosexuality has continued to be seen as both a sin and
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SEXUALITY 115
a disease, homosexuals as both ill and immoral – a logical

impossibility. Thus homosexuality is something you can be
born with, seduced into, or catch from someone else. As
Halperin points out, in these terms heterosexuality
becomes by definition, at the same time a natural condi-
tion, a highly laudable accomplishment and a precarious
state that can be overthrown by contact with an unscrupu-
lous homosexual seducer (Halperin, 1998: 263). Public
perception of homosexuality has become illogical and con-
fused, conflating paedophilia, homosexuality and mental
illness. Incidents of sexual abuse of children and the expo-
sure of paedophile rings, which have received wide media
coverage, have only served to add to this confusion.
Homosexual men are widely believed to be dangerously
predatory, putting at risk all boys or young men with whom
they come into contact. The confusion between homo-
sexuality and paedophilia creates public suspicion of any
gay man whose job involves working with young children.
And yet the vast majority of cases of child sex abuse are
perpetrated not by homosexuals but by heterosexuals.
In Europe and the USA homosexuality is no longer
either illegal or classified as a mental illness. However,
there remain many areas of law which are discriminatory of
same-sex relationships. In the UK in particular changes in
the law have been slow; declassification as a psychiatric dis-
order only coming in 1992, and the ban on homosexuality
within the armed forces finally being lifted in 1999. The
age of consent for homosexuals in England was reduced
from twenty-one to eighteen in 1994, whereas for heterosex-
uals it is sixteen. England, unlike many other European
countries and some states in the USA and Canada, does not
yet recognize same-sex partnerships in law. This has impli-
cations for a number of areas where gays and lesbians are
disadvantaged: pensions, fringe benefits, inheritance, tax,
and transfer of property. They are not recognized as next of
kin which can cause complications in matters such as illness
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and death – only next of kin are consulted by hospitals and

health professionals and only they have the right to make
funeral arrangements. In many of these legal matters same-
sex couples are in the same position as unmarried hetero-
sexual couples, the difference being that the latter can
choose to marry whereas the former cannot. The situation
is changing. Some companies do now offer fringe benefits
and pension rights to same-sex partners, and in 2001
changes were made to the Criminal Injuries Scheme which
extended eligibility for fatal awards in the same way. In
November 2002 a gay man won the right to take over a
dead partner’s tenancy, setting an important precedent in
this area. At the same time gay (and unmarried) couples
won the right to adopt, a decision that was greeted by wide-
spread public concern.
Within the gay community the philosophy that is increas-
ingly being adopted by gay men and lesbian women is that
of gay rights as human and civil rights. In the USA this has
already proved problematic; in many states the courts have
ruled that homosexuals possess no rights as a minority
group because homosexuality (unlike race or gender) is
not an ‘immutable characteristic’ (Halperin, 1998: 255).
Although the post-AIDS backlash is subsiding, and toler-
ance is once more on the increase, it is an uneasy tolerance,
tinged with the ‘political correctness’ of the late twentieth
century, and a far cry from true and universal acceptance.
At the beginning of the twenty-first century many openly
gay men and lesbian women are pursuing successful
careers in various spheres of public and political life, but
there are still large areas of the establishment where the
merest hint of homosexuality leads to disgrace and dis-
missal. The most recent area which has been widely
exposed to scrutiny in this regard is the Church. In 2003
the issue of openly gay clergymen being appointed to high
office has created worldwide schisms within the Anglican
community. In the UK Canon Jeffrey John, an openly gay
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SEXUALITY 117
priest, declined the offer of the Bishopric of Reading,

following weeks of bitter argument over his sexuality within
the Anglican Church. In the US, however, Gene Robinson
was successfully appointed as Bishop of New Hampshire.
His appointment provoked an emergency summit of all the
primates of the Anglican Church to discuss the issue of
homosexuality and the Church’s attitude towards it.
In the twenty-first century a significant number of gay
men and lesbian women have ‘come out’ publicly but they
are still in the minority – many more lead lives where an
important part of who they are and what they experience is
kept hidden. Lesbians and gay men are still consistently
victimized in schools, colleges and universities, and dis-
criminated against in the workplace. They frequently lack
the support of their families and are at higher risk of stress-
related illnesses, depression and suicide. All too often they
remain trapped in secret double lives because of the all-
pervading nature of the homophobia endemic in our society.
Sexuality and homosexuality – some of the theories

An individual’s sexual preference, unlike their gender, skin
colour or race, is not visible at birth. It is, by contrast,
something that manifests itself over time, usually becoming
apparent as the person reaches, or approaches, adolescence
and sexual maturity. As many studies have shown, begin-
ning with Alfred Kinsey’s texts in 1948 and 1953 (Kinsey,
Pomeroy and Martin, 1948; 1953), to engage in same-sex
sexual activity is common among people who also engage
in opposite-sex sexual activity, many of whom will then
develop a pattern of exclusively opposite-sex sexual activ-
ity. This calls into question the validity of identifying a
group of people by a type of behaviour which is by no
means exclusive to that particular group. As Foucault (1976)
pointed out, the use of language to create sexual categories –
homosexual, heterosexual, transvestite, and so on – by which
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we then regulate and categorize sexuality, is an imposition

of a structure upon human experience which may not exist
within the experience itself. In other words, by inventing
terms like heterosexual and homosexual we are making
divisions between groups of people and the activities they
engage in which are intrinsically artificial.
Nevertheless, the history of sexuality, homosexuality and
lesbianism reveals that the advent of scientific and medical
research provoked a desire to find the cause or reason for
what was perceived to be a significant difference in an area
of human behaviour from the assumed norm. It may be
that the question ‘what causes homosexuality?’ is spurious.
However, it was a question that was asked, and continues
to be asked. A variety of answers has been posited, and
along the way many have challenged the validity of both the
question and the various answers. An essential part of this
debate is played by those to whom the various theories have
been applied; how they perceive themselves in relation to
their sexuality and sexual practices, and in relation to the
theories about their sexuality and the response this incites
in society at large.
Essentialism versus constructivism

As with so many debates about the nature of human char-
acteristics one of the central questions focuses on whether
homosexuality is an innate characteristic, present at birth
but not yet apparent, or whether it is in some way learned,
acquired or chosen – the product of environmental or
social influences.
The sexologists were in the forefront of this debate.
Their aim was to discover and analyse what they saw as ‘the
laws of nature’. Krafft-Ebing defined the ‘natural instinct’
as male sexuality whose natural object was the opposite sex
(Weeks, 1985: 69). Heterosexuality was a priori taken as the
biological norm and all other sexual practices were defined
as abnormal or perverse. For the sexologists sex is seen as
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SEXUALITY 119
an essentially biological force, a natural process and therefore

innate in the individual man or woman. The definitions put
forward in their works are fundamentally medical, with
considerable emphasis on the physical and behavioural
manifestations of the various categories of behaviour. Some
made distinctions between innate and acquired homosexual-
ity; the term ‘invert’ was used to define those believed to be
genetically different, the term ‘pervert’ reserved for those
whose moral weakness led them to indulge in homosexual
behaviour. ‘Inversion’, a congenital state, was largely
viewed as a defect, the result of genetic abnormality or
physical trauma, resulting in a condition comparable with
mental illness or insanity. The early sexologists’ attempt to
explain sexuality in terms of the ‘sexual instinct’ raised the
question of the focus of that instinct. Bound as they were
to ideas of nature, they saw the only proper aim as reproduc-
tion. Women’s sexuality, if acknowledged at all, could then be
respectably explained as a product of the ‘maternal instinct’.
Sexual variations, therefore, become failures of heterosexual-
ity. It has been pointed out, however, that such a theory does
not explain the greater part of heterosexual sexual activity,
only a small proportion of which is activated by the desire to
reproduce or parent (Weeks, 1985; Spinelli, 2001).
The sexologists’ mission to find the truth about sex and
sexual differences in biology, nature and the instincts has
continued to the present day. With the further develop-
ment of scientific research in the twentieth century, sexual
essentialism has focused more on chromosomes and
hormones, DNA and genetics. Sociobiology, founded by
E.O. Wilson, proposed a synthesis between sociology and
genetics. It attempts to do this by finding a genetic basis for
all human behaviour, on the premise that all characteristics
that survive are adaptive and therefore serve a function.
Genetic determinism is thus seen as the explanation for all
human characteristics and social behaviour; within this
framework sexual practices are seen as ‘bonding devices’ as
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well as a means of procreation, and homosexuality is

explained in terms of aiding the evolutionary process by
providing ‘helpers’ within the social group (Wilson, 1975:
555). This is an interesting hypothesis in the light of the
social ostracism to which homosexuals have widely been
subjected in western societies. In the late twentieth century
the focus has been on the science of genetics rather than its
sociological implications, with attempts to isolate differ-
ences in the X chromosome as the ‘cause’ of homosexuality
(Hamer, 1994). While many (Rose et al., 1984; Satinover,
1998) refute the logic of a genetic cause for homosexuality,
research into the genome, and its accompanying attempt to
isolate specific human characteristics within particular
genes, has gained a momentum which is unlikely to be easily
stopped. The history of scientific and medical research
would suggest that even if/when no biological or genetic
link is found, theorists committed to the existence of such
would remain undaunted. Philosophically it is impossible
to prove that something does not exist.
A challenge to essentialism comes in the form of a refu-
tation of the reductionism that it represents. It is argued
that the view of sexuality offered by the sexologists and
biologists is too narrow, too rigid and in many ways misses
the point entirely. Foucault, for example, sees sexuality as
a ‘historical construct’ which is far wider and more com-
plex than notions of instincts or procreative aims. An alter-
native to the biological view suggests that sexual definitions
such as homosexuality are socially constructed, a way of
categorizing people, the need for which arises from the
impulse for social organization and the establishment of
norms and stereotypes. As Jeffrey Weeks puts it, ‘there
exists a plurality of sexual desires, of potential ways of life,
and of relationships’ (Weeks, 1985: 10). These are not
given credence in the essentialist view, except in terms of
definition and regulation. Many modern commentators
tend towards the view of homosexuality as a choice. It is
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SEXUALITY 121
important to distinguish here between homosexual activity

and homosexual identity. To identify oneself as homosex-
ual or lesbian is indeed a personal choice, one motivated
by, among other things, political or social factors. The fact
that many people who identify themselves as heterosexual
do at some time in their lives engage in homosexual behav-
iour is put forward as an argument for seeing homosexual-
ity not as an irreversible, exclusive condition, but as a
choice which, some would argue, is an unhealthy and inju-
rious one (Satinover, 1998), and can be changed. This is
countered by the view that homosexuality should be seen
as an expression, like other expressions, of human sexual-
ity, which can manifest itself in a rich variety of ways, no
one way being necessarily better or worse than any other.
The view that sexuality should be understood as a con-
tinuum or spectrum directly challenges the bipolarity
inherent in the heterosexual/homosexual dichotomy. It also
calls into question the notion of a fixed sexual orientation –
a challenge which is supported by experience and observa-
tion. Single-sex institutions – prisons, boarding schools,
religious orders, the armed forces – have long been recog-
nized as places where a high level of homosexual activity
takes place without any or all of the participants necessar-
ily continuing with an exclusively homosexual life-style once
outside the institution. Davies and Neal (1996) point out
that many people who define themselves as heterosexual
have sex with their own gender and that many more have
dreams or fantasies about doing so. Similarly, many les-
bians and gay men have sex with the opposite gender and
yet continue to define themselves as lesbian or gay. Weeks
defines the ‘homosexual component’ as ‘an aspect of the
body’s sexual possibilities’ and continues that the ‘possibil-
ities of homosexuality and heterosexuality are socially
structured limitations in the flux of potentialities developed
in the process of emotional socialization’ (Weeks, 1991: 44).
The nature of sexual identity is central to the discussion of
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what those limitations are and how they affect an individual’s

own understanding of his or her sexuality. But before pro-
ceeding with that, it is important to examine the contribu-
tion of psychoanalysis to the debate.
Freud and the post-Freudians

Freud was writing at the time when sexology and the study
of sexual ‘perversions’ were at their height. His theories
about sexuality are fundamentally rooted in biology and
tend towards the determinist end of the spectrum.
However, there is in Freud’s theories a rather more liberal
and tolerant attitude towards aberration than is often
recognized – a tolerance that disappeared in the formulations
of his successors. There are also, as with so many of
Freud’s ideas, ambiguities in his view on homosexuality.
For Freud the starting point is polymorphous perversity.
The human infant begins life as innately bisexual – perver-
sity is thus seen as something which is present in all people,
from which there is a circuitous path to reach the point of
adult heterosexual desire. In Freud’s view, ‘the disposition
to perversions is itself of no great rarity but must form part
of what passes as normal constitution’ (Freud, 1905: 86).
He deliberately severs the connection between the sexual
instinct and heterosexual genitality, seeing the latter as
something which is achieved through a complex process of
development, rather than something which is pre-given.
Thus so-called normal sexuality is not an a priori aspect of
human nature – ‘the exclusive sexual interest felt by men
for women is also a problem that needs elucidating and is
not a self-evident fact’ (ibid.: 57, n. 1). Within this formu-
lation, homosexuality becomes a variant of sexual life.
Indeed Freud wrote that everyone has the capacity for
homosexual object choice: ‘in addition to their manifest
heterosexuality, a very considerable measure of latent or
unconscious homosexuality can be detected in all normal
people’ (Freud, 1920: 399).
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SEXUALITY 123
Despite all this, Freud does have a normative view of

psychosexual development. He saw homosexuality as the
consequence of an ‘arrest’ in normal sexual development.
The implication from this is that full maturity has not been
achieved in that the (for Freud) essential stages of the oedi-
pus complex have not been passed through. So, although
Freud saw all sexuality as a restriction in object choice, and
condemned the view of homosexuality as a vice or a crime,
he clearly viewed heterosexuality as the normal or desirable
outcome of psychosexual development. It was this aspect of
his theory that passed into psychoanalytic orthodoxy. Later
psychoanalytic theorists stress the ‘natural’ course of hetero-
sexuality, seeing homosexuality as a perversion and a devia-
tion from the norm (Chodorow, 1994). This became so
much a dominant view that by 1962 an eminent psycho-
analyst was able to say, ‘all psychoanalytic theories assume
that adult homosexuality is psychopathologic’ (Izzard,
2000). The more tolerant view of homosexuality present in
Freud’s early writings had by then largely disappeared.
Whether homosexuality is seen as an essential part of a
person’s being, or as a characteristic that is acquired,
learned or chosen, has a significant impact on the view that
society has of those identified as homosexual. Adopting an
essentialist view leads in two directions. If homosexuality is
biological – genetic, hormonal or in some other way physi-
cal – then that opens the way to abusive forms of psycho-
surgery, drug therapy, genetic modification or even
eugenics. On the other hand, an inborn trait absolves the
individual from responsibility – one cannot be blamed or
punished for a characteristic comparable with the colour of
your eyes or an aptitude for sport. Seeing sexual orientation
as fixed and immutable puts minority sexual groups on the
same footing as other minority groups in regard to
demanding equal civil and human rights.
A constructionist view, meanwhile, offers a different pic-
ture. If homosexuality is seen as a choice, then clearly the
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individual is personally responsible for making that choice.

This also takes us in two, conflicting directions. It raises the
issue of human freedom in the context of the right to make
individual choices and adopt individual life-styles, even if
they are different from the perceived norm. It also causes
moral panic at the prospect of other people, especially the
young, being indoctrinated into a way of life that many per-
ceive as unnatural and unhealthy. If, however, homosexua-
lity is viewed as the result of a complex combination of
psychological and environmental influences, it becomes
something for which the individual cannot really be blamed,
but which could be amenable to change. This brings us
back to various forms of psychological treatment, aversion
therapy, drug therapy, and the like.
It is these considerations which, among other things,
have had an impact on the concept of sexuality as an iden-
tity, and the positions adopted by gay and lesbian activists
in their struggle against discrimination.
Sexual identity
The idea of sexual identity began with the sexologists in the
late nineteenth and early twentieth centuries. The notion
that what you did, in terms of your sexual activity and pref-
erences, determined what sort of person you were, divided
people into separate categories by which they were defined.
This is seen by many as a spurious or even deliberately
manipulative concept, with no basis in the reality of human
experience, or, as Weeks puts it, ‘a crude tactic of power
designed to obscure a real sexual diversity with the myth of
sexual destiny’ (Weeks, 1991: 74). However, homosexuals
have themselves accepted this identity as a way of self-
definition and a means of individual and collective resistance.
It has provided a sense of social location, which has been
both liberating and validating to people who have been
consistently stigmatized and persecuted by society. The
attacks on sexual deviants in the 1950s and 1960s had the
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SEXUALITY 125
effect of consolidating this sense of identity, and it became

an essential part of the gay movement in the late 1960s. In
order to campaign for civil rights it is imperative for a group
to ‘present’ as unified round a common factor. Homo-
sexuality as an identity provided that unifying rallying-point.
The difficulty that then arises is that it becomes problem-
atic to challenge the notion of a fixed sexual orientation
without undermining the achievements and forward
momentum of the movement for equality and recognition.
This is the tension that exists within the gay and lesbian
community to this day. Many within that community reject
the connotations of sexual identity that suggest something
static and unchangeable; they also reject the associated
assumption that they are a homogeneous group who share
other characteristics apart from their sexual preferences.
Moreover, not all people who are inclined towards
homosexual behaviour wish to embrace a homosexual iden-
tity. The latter has become as much a statement of life-style
and of a political commitment as of sexual preference. The
term ‘gay’ is used by many to indicate this separation. It is
an attempt to depart from the medical underpinnings of
the designation ‘homosexual’ and indicate choice in all
areas of human existence. Modern gay identity is as much
a political as a personal or social identity, with no necessary
relationship between sexual practice and sexual identity.
The reaction against being defined solely or primarily on
the basis of one’s sexuality is becoming increasingly appar-
ent in the contemporary gay community. The politically
correct collective term has become ‘lesbian, gay, bisexual,
transgendered and friends’, and the suggestion has been
made that, having broadened it thus far, we might as well
adopt the term ‘sexual beings’ and forget the distinctions
altogether (Queen and Schimel, 1997). Sexuality, be it
homosexual, heterosexual or any-other-sexual is seen as
being about diversity, change and choice, and the concept
of sexual identity negates that choice by trying to proscribe
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and fix people within a limited range of behaviour and

experience.
The tension between sexual identity and sexual practice
has been an intrinsic part of lesbianism throughout the
twentieth century. With the advent of the feminist move-
ment lesbianism became for many women a political state-
ment. The point of protest – that heterosexual sex for
women is viewed as male domination – does not exist for
gay men. But feminism and lesbianism are not cotermin-
ous. There is a separation between on the one hand those
who identify themselves as lesbians, but who see them-
selves as politically feminist and would understand their
lesbianism to be an expression of that political commit-
ment, and on the other hand those who identify as lesbians
but whose political expression is not feminism – for them
lesbianism is about sex. The difficulty with lesbian identity
as a political statement is that it quickly moves away from
anything even vaguely sexual towards ideas of female soli-
darity, independence and sisterhood. The danger here is
the denial of female sexuality altogether, which undermines
the notion of sexual lesbianism, a notion that for many is a
vital part of both their experience and how they view them-
selves within the context of their sexuality.
Debate about the nature of homosexuality continues
within scientific, medical and political spheres and within
the gay community itself. As with many other minority
groups, the emphasis from those within the group is on
demands for acceptance of who they are in all aspects of
their lives and beings. While solidarity is achieved by unit-
ing under a common banner, individual lesbian women
and gay men are increasingly challenging the assumptions
of homogeneity that homosexual and lesbian ‘identity’ car-
ries with it. For many heterosexuals, however, it is more
comfortable to keep homosexuality as the characteristic of
a distinct ‘other’ group, and to theorize about it as a sepa-
rate and different condition. Such theories serve to maintain
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SEXUALITY 127
the ‘norm’ of heterosexuality and to retain the illusion of a

divide between the two groups. This divide perpetuates the
notion that same-sex sexual relations are only practised by
the ‘other’ group – gay men and lesbian women. To chal-
lenge this idea would be profoundly uncomfortable and
disturbing for many people who identify themselves as
heterosexual.
Homosexuality in counselling and psychotherapy

Within the enterprises of counselling and psychotherapy
there has always been a specific difficulty in relationship to
sexuality in that, as we have seen, the classical theory
underlying much therapeutic and counselling practice
divides sexuality into specific orientations and regards any-
thing other than exclusive heterosexuality as a perversion
or as in some way an aberration of the norm. This has led
in the past to difficulties for gay men and lesbian women
who wish to undergo psychotherapy or counselling train-
ing, as well as to practices within the profession where
clients who present with sexual orientations other than het-
erosexual are subjected to attempts to ‘cure’ them of their
sexual leanings. Such practices are, thankfully, rare today,
but there remains a legacy of viewing homosexuality as in
some way pathological, in particular within psychodynamic
and psychoanalytic models. Even where such a view is
absent, the ‘otherness’ of gay or lesbian sexuality is experi-
enced by many counsellors and therapists as faintly alarm-
ing, disturbing or distasteful. Such responses, acknowledged
or denied, can clearly have a significant impact on
both the therapeutic relationship and the outcome of the
work.
The experience of being homosexual

In order for a therapist to be able to empathize with his or
her client there needs to be some understanding of what it
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is like to inhabit that client’s world. With a gay or lesbian

client it is vital to have some understanding of the various
components and manifestations of homophobia.
Discrimination and persecution of sexual minorities is
inextricably linked with the gender stereotypes that are
central to our culture, these stereotypes being founded in
heterosexism – the assumption that heterosexuality is the
only acceptable and viable life option. Such an arrangement
reinforces the idea of the ‘manly’ man – dominant, assertive,
in command, and so forth – and the ‘feminine’ woman –
passive, dependent and in need of protection. Because gay
men and lesbian women breach these stereotypes they are
seen as a threat to the established order – and in particular
to the patriarchy in which men and ‘masculine’ values are
dominant. It is for this reason, as history reveals, that the
social and legal focus has been more on male homosexuals
than on lesbians. Even in Ancient Greece the emphasis was
on the dominant (that is, masculine) nature of a sexual act,
and in modern times the focus of police surveillance and
arrests has been male homosexual activity almost exclusively.
The emphasis on gender conformity begins very early in
life, with girls and boys expected to behave in ways appro-
priate to their gender. It is striking, however, that gender
non-conformity in boys attracts significantly more negative
attention than in girls. Little girls are permitted, generally
speaking, to play rough games, wear trousers and behave
like ‘tomboys’. Boys, on the other hand, who act in any way
that is perceived to be ‘girlish’ or ‘effeminate’ are corrected
very quickly. As we have seen, however, the counterpart of
this for girls and women is the ‘invisibility’ of lesbianism,
which is part of the general repression and denial of
women’s sexuality. In her analysis of homophobia, Karen
Franklin puts forward the notion that ‘homosexuals are
viewed as culturally threatening more because they are per-
ceived as violating essential gender norms than because
they violate sexual taboos’ (Franklin, 1998: 11).
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SEXUALITY 129
Another central element of homophobia which is

frequently cited is that of repressed homosexuality. If we
view sexuality, in all its manifestations, as a continuum of
different expressions and behaviours of which we are all
potentially capable, then the imposition of strict sexual
identities and categories poses a problem for all of us. What
do we do with those elements of our sexuality which do not
fit our personal identification? The argument goes that we
repress any socially deviant tendencies which then lend
extra weight to the condemnation and persecution of those
who openly identify themselves as deviant – in this case,
homosexual. An extreme form of this view would see the
so-called normal person as the one who is sick and dis-
turbed because he or she represses all but their hetero-
sexual desire, a process which produces an anxiety and
paranoia which is then projected onto others (Archer and
Lloyd, 1985). This would seem to be borne out by evi-
dence that negative attitudes towards gay men and lesbian
women are associated with people who tend to hold rigid,
traditional and conservative views in other spheres, includ-
ing non-permissive attitudes towards sex and traditional or
oppressive views regarding the roles of women (Simon,
1998). Such people are the least likely to have identified or
accepted those components of their own sexuality which
fall outside the heterosexual norm.
Homophobia manifests itself further in the stereotypes
that are culturally prevalent about homosexuals them-
selves. They are seen as promiscuous, dishonest, predatory,
incapable of committed or sustained relationships, cor-
rupters of children and unsuitable as parents. Same-sex
relationships, being non-procreative, are viewed as primar-
ily sexual in nature, a characteristic not commonly attrib-
uted to heterosexual relationships. The more lesbian
women and gay men present as ‘stereotypical’, that is, as
butch or effeminate, the more negative attention they
attract. The current social situation seems to be one where
Chap-04.qxd 2/12/04 6:02 PM Page 130
gays and lesbians are tolerated by society as long as they

remain relatively invisible. This presents a personal
dilemma for each lesbian and gay person. By remaining
‘closeted’ there is less likelihood of encountering direct dis-
crimination. But long-term concealment of an aspect of
who you are is itself very stressful. Many lesbian and gay
people feel they need to ‘pass’ as heterosexual at least some
of the time in order to keep their jobs or maintain a particu-
lar social position. Consequently they inhabit two different
worlds, living in constant fear of being exposed and
rejected.
For the gay or lesbian person one of the effects of being
brought up in a world dominated by heterosexist attitudes
is the creation of an internal negative self-image. From
early childhood we are exposed to anti-homosexual biases
that are sanctioned by western culture. The realization that
they are different from the social norms and are negatively
regarded by society can cause lesbian women and gay men
to incorporate these negative feelings into their self-image,
resulting in internalized homophobia. This can range from
self-doubt to overt self-hatred and is implicated in the high
incidence of depression and suicide among young homo-
sexuals (DiPlacido, 1998). An alternative response is one
of denial – the construction of a self-image which excludes
the label ‘lesbian’ or ‘gay’, regardless of one’s sexual prac-
tices. This psychological ‘split’ is a type of self-deception
and can lead to heightened distress when faced with nega-
tive social responses. Such a stance is not conducive to self-
acceptance and is stressful to maintain on a long-term
basis.
The process of ‘coming out’ is widely regarded as pivotal
to psychological health and well-being, though it must be
remembered that this is an individual choice, and a path
eschewed by many. Central to this process is the response,
or imagined response, of the individual’s family.
Unequivocal delight is unlikely to be the response. Even
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SEXUALITY 131
where there is acceptance and support there is usually an

element of ambivalence, and for many the major or sole
source of support is the lesbian and gay community rather
than family members. Similarly the response of friends,
colleagues and employers can have a big impact on the
individual who may have to re-evaluate dramatically many
social and professional relationships.
Gay men and lesbian women are constantly and contin-
uously confronted by homophobia. Anti-homosexual atti-
tudes manifest as rejection by friends, colleagues or family,
in violent assaults and in discrimination in housing, employ-
ment, entitlements and basic civil rights. Lesbians and gays
must constantly monitor their surroundings and the safety
or otherwise of any situation they are in. They are very
careful about displaying affection to same-sex lovers in
public. A heterosexual relationship is celebrated and
acknowledged by family and friends; it is socially accept-
able for the couple to acknowledge openly their love for
each other. A lesbian or gay couple, however, are expected
to keep their affections and affairs out of the public eye.
Social tolerance is very thin – the underlying condemnation
and fear of difference is never very far away.
Counselling and therapy with gay

and lesbian clients
Although most current models of psychotherapy and coun-
selling do not teach students that homosexuality is an ill-
ness or a perversion, there is nevertheless a strongly
heterosexist bias in the developmental models that are
included in training. Freud’s psychosexual stages of devel-
opment and Eriksson’s eight-stage model frequently form
the backbone of counselling training programmes. Both of
these take heterosexual development as the norm; thus
individual human development, sex, gender, couples, family
and relationship issues are all explored and discussed solely
within a heterosexual context. Most British counselling and
Chap-04.qxd 2/12/04 6:02 PM Page 132
psychotherapy training programmes do not include specific

input on working with gay or lesbian clients as part of their
core curriculum. At most it is offered as an optional sem-
inar or an additional workshop.
Until recently psychoanalytic training institutes refused
to accept lesbian women or gay men for training – classical
Freudian orthodoxy viewed their sexuality as a manifesta-
tion of ‘unresolved and unanalysable neuroses’. It is still
more difficult to gain a place on a psychotherapy training
course if you are openly not heterosexual (Davies and Neal,
1996; 2000a) and those who are accepted frequently report
a discomfort throughout the training, as much from the
attitudes of their trainers and fellow trainees as from the
heterosexist bias in the material being taught. Davies and
Neal (1996) contend that there is institutionalized preju-
dice of a global nature operating in most British counsellor
training programmes. Courses fail to attract students from
all minorities and consequently fail to address the needs of
clients from these groups. Course staff are often exclusively
white, able-bodied heterosexuals; the course content and
the majority of the students reflect the same bias.
What is significantly missing from training courses is
both education about the experience of being homosexual
and of living in a homophobic and heterosexist society, and
any attempt to confront trainees with their own, inevitable
prejudices and anti-homosexual attitudes. Without such
input, our trained counsellors and therapists emerge with
little self-awareness in this area and an inadequate ability to
understand the specific needs and experiences of any gay or
lesbian clients they may subsequently encounter. Further-
more, they will be largely unaware of their deficiency. As
David Mair puts it: ‘recognizing and owning homophobia
and ignorance can be a threatening and painful process,
and it appears that it is one which may often be side-
stepped by both gay men and heterosexuals, clients and
counsellors’ (Mair, 2003: 33).
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SEXUALITY 133
The seminal work for counselling and psychotherapy

with gay and lesbian clients is widely recognised to be Pink
Therapy, published by Davies and Neal in 1996; they fol-
lowed this with Therapeutic Perspectives on Working with
Lesbian, Gay and Bisexual Clients and Issues in Therapy with
Lesbian, Gay, Bisexual and Transgendered Clients in 2000.
Davies and Neal offer a model of ‘gay affirmative therapy’
whose emphasis is, as the name implies, affirmation of les-
bian and gay identity as a positive human experience and
expression equal to that of heterosexual identity. They
emphasize that, because we have all been exposed to soci-
ety’s negative messages about homosexuality, therapeutic
neutrality is impossible. Therapists, therefore, have a duty
to explore their own values for attitudes that may cause
them difficulty. An essential part of this is an understand-
ing and acceptance, by therapists, of their own homosexual
feelings as well as an awareness of the extent to which they
have internalized society’s homophobic attitudes. An
understanding by the therapist of the kinds of experiences
the gay or lesbian client will have encountered is an impor-
tant part of helping the client confront any shame, guilt and
internalized homophobia. There is a high probability of
such clients feeling devalued and worthless internally, how-
ever successful they may appear outwardly, as a result of
cultural discrimination against sexual difference.
The second volume of Davies and Neal’s trilogy consists
of a collection of contributions examining gay and lesbian
therapy from a variety of different theoretical perspectives.
The consensus that emerges from this, as from their other
works, is that the therapist needs to have examined his or
her own prejudices and sexuality deeply and thoroughly
before embarking on this work. Furthermore, practitioners
need considerable information and understanding about
homophobia, homosexual experiences, and gay and lesbian
life-styles. Some but not all contributors would argue that
in this context the therapist should be willing to provide
Chap-04.qxd 2/12/04 6:02 PM Page 134
information and act as an educator, for example about the

stages of coming out, the local lesbian and gay community,
and HIV awareness.
Davies and Neal do not hold the view that it is essential
for the sexual orientation of the therapist to be the same as
the client. A heterosexual therapist can provide a positive
experience by gaining the client’s respect and thus helping
to heal the wounds of heterosexism. If, however, the thera-
pist is homosexual, he or she can act as a positive role
model for the client. An alternative view is put by Young
(1995) who believes that significant differences between
client and therapist, be they of gender, sexual orientation,
race or class, automatically cause problems in the relation-
ship which will render the therapy ineffective. Young’s view
of effective therapy for lesbian clients tends towards a more
radical position. She takes the stance that lesbians are
rarely fully understood by therapists. This, she believes, is
because lesbians, having intimate and painful experience of
being a persecuted minority, have developed considerably
more self-awareness, understanding and insight than most
therapists, who are predominantly white, middle-class and
heterosexual and who are consequently hampered in their
ability to fully empathize with the issues and experiences
being brought by their lesbian clients.
The issue of the need for a therapist to share, on a per-
sonal level, elements of a client’s lived experience, is one
which has been extensively debated in relation to sexuality,
gender, race and many other factors. While it is clearly
impossible to ‘match’ client and therapist in every element
of personality and experience, the question remains as to
whether it is desirable in specific instances where the dis-
parity may be so great as to be obstructive for the client. In
my view the element that is most likely to impede the
psychotherapeutic relationship is a normative stance on the
part of the therapist. Such a blinkered position is the result
both of ignorance about other people’s experiences and
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SEXUALITY 135
world-views and a denial, by the practitioner, of his or her

own internal biases. In regard to sexuality I see no reason
why a therapist should not be able to work with a client
whose sexual practices are different from his/her own, pro-
vided the therapist is aware of the issues of heterosexism
and homophobia and has, as far as it is possible, thoroughly
and honestly examined his/her own sexuality and preju-
dices. Theoretically, the client of course is always free to
choose a counsellor or therapist whose sexuality is close to
their own. There are increasing numbers of therapists and
counsellors of all sexual orientations, despite the difficulties
they are likely to encounter in achieving professional status.
Their numbers, however, are still small, and they are by no
means widespread throughout the country.
There are the beginnings, within the counselling and
psychotherapeutic world, of a recognition that the life-
styles painfully constructed by gay men and lesbian
women, and without social validation, may contain much
from which heterosexuals could fruitfully learn. Traditional
social models of family relationships are being challenged
in many western societies. As Sketchley puts it: ‘homo-
sexual people have much to teach their heterosexual coun-
terparts about personal commitment, rather than external
pressures or sexual activity, serving as the basis for com-
mitted relationships’ (Sketchley, 1989: 250). In many insti-
tutes and counselling centres gay men and lesbian women
are now able to train and practise as counsellors and ther-
apists, and to participate in the training of others. But the
beginnings are small, and the process much too slow.
Although there is no longer any direct bar to gay and les-
bian people training as counsellors or psychotherapists, the
legacy of the past may well deter many from even applying.
The homophobic attitudes, which have pervaded our soci-
ety for so long, are still very evident within the enterprises
of counselling and psychotherapy. Davies and Neal (1996)
catalogue the ways these can be seen in the counselling and
Chap-04.qxd 2/12/04 6:02 PM Page 136
therapy community – in training, supervision or general

debate: joking about homosexuality, uneasiness, hostility or
stereotyping, denial, exaggerating the significance of a
client’s sexual orientation, pity, and taking the view that
sexual orientation makes no difference, thus ignoring the
impact of anti-homosexual attitudes. In my own experience
all of these responses are, sadly, familiar – I have encoun-
tered them among colleagues and students whom, in other
respects, I would regard as people with integrity and insight.
As we have seen, the current counselling and psychother-
apy trainings include scanty input regarding homosexuality,
or even sexuality, and the prevailing ethos in the bulk of the
material taught has a predominantly heterosexist bias.
Counsellors and therapists emerge, however, with the belief
that the skills and knowledge they have acquired will equip
them to deal with any problems that their clients might bring.
This is doomed to create a situation where clients who are not
heterosexual feel marginalized, misunderstood or, worse,
patronized. Small wonder that many feel the only therapeutic
help that can really be effective for them is with therapists
who share their experience of being part of a sexual minority.
Of all the issues covered in this book this is the one
where I feel there is the greatest risk of practitioners not
being aware of their own hidden prejudices, precisely
because the element which is the focus of that prejudice is,
to some extent, present in all of us. Sexuality is complex
and diverse; its potentialities of expression transcend the
socially imposed divisions and categories that were
invented by the sexologists and, in large part, have survived
to this day. The implicit social sanctions against challeng-
ing the boundaries of these divisions are strong and deeply
embedded in our culture and its institutions. The homo-
sexual or lesbian client embodies an element of our being
which we have been socialized into disowning; for many
practitioners, encountering this element in another is both
disturbing and problematic.
Chap-05.qxd 2/13/04 10:06 AM Page 137
5 Mental Illness
T HE TITLE OF THIS CHAPTER IS, in itself,

controversial enough to have been the subject of
academic discussions that have filled whole books. What is
mental illness (or ‘mental illness’)? Does it really exist? Are
we referring to something that is of the mind, of the brain,
or of the whole person? Is it an illness? (What is an illness
anyway?) Or is it a cluster of random symptoms and behav-
iours? Or one point on a wide continuum of possible
human experiences? It is outside the scope of this book to
discuss in depth the attempts that have been made to
answer these and other related questions, though I will be
touching on many of the relevant theories and hope that
the bibliography will point the interested reader in the right
direction for further study.
Numerous terms have been used to describe what is uni-
versally recognized to be a painful and profoundly disturb-
ing experience: lunacy, madness, insanity, mental illness,
psychological disturbance – with a plethora of sub-
categories such as ‘catatonia’, ‘hysteria’, ‘paranoia’, ‘neurosis’,
‘psychosis’, ‘schizophrenia’, ‘manic-depression’, ‘melan-
cholia’, ‘mania’, and many more. The terminology that
currently holds sway in the literature and in the forum of
public discourse is the term ‘mental disorder’, or, where
possible, the neutral ‘mental health’. This is the legacy of
political correctness – we can no longer say someone has
‘gone mad’, but must describe him or her as having ‘mental
Chap-05.qxd 2/13/04 10:06 AM Page 138
health issues’. Such linguistic circumlocutions, however,

do nothing to reduce the stigmatization and discrimination
which have always been society’s response to the mad.
The observation of strange symptoms or types of behav-
iour appears to generate the need to categorize or give this
behaviour/condition a name, or diagnosis. It also leads to
attempts to find both the cause of the condition and the
solution, or best treatment. But diagnostic categories for
mental disorders are notoriously arbitrary, shifting and
changing over time. The two major current diagnostic clas-
sification systems, the DSM (Diagnostic and Statistical
Manual of Mental Disorders, produced by the American
Psychiatric Association) and the ICD (International
Classification of Diseases, produced by the World Health
Organization), have both undergone numerous changes
and revisions, and do not even now agree in their descrip-
tions of symptoms for many of the mental illnesses. A diag-
nosis very often carries with it implications concerning
cause and treatment. It would be comforting to assume
that the theory (or preferably knowledge) about the cause
of a problem informs the diagnosis and treatment. Such an
assumption cannot always be made. In looking at the sta-
tus of those deemed mad, both now and historically, it
would appear that in many instances the theory as to cause
provides a post hoc justification of the treatment, without
such theories necessarily having been proved to be correct.
Furthermore, our knowledge in this area is far from com-
plete. Innumerable hypotheses have been advanced con-
cerning the aetiology, course and outcome of mental
disorders, and innumerable methods of treatment have
been implemented. Research and clinical practice have
both failed to come up with any definitive answers. History
appears to show that the explanation of mental disorders
has always been controversial, with numerous ideas in cir-
culation at any one time. This is a situation that continues
today.
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MENTAL ILLNESS 139
While it is clearly difficult to tease apart the different

strands of aetiological theory, diagnosis and treatment, I
will attempt to do so to some degree in this chapter by
looking first at the history of madness, focusing mainly on
the treatment that it has attracted – social, medical and
otherwise. There follows a summary of the principal theo-
ries regarding the nature and cause of mental disturbances.
The third section deals with the relationship between
mental illness/health and psychotherapy and counselling. As
the topic of mental illness appears to be a place where the
other subjects of this book intersect, the final section of this
chapter examines the complex and disturbing relationship
between mental illness and the experience of being in
another minority group. For being a lunatic, a madman or
madwoman, a mental patient, or a person with a psychi-
atric diagnosis has the effect of rendering a person outside
the norm, and as such the recipient of discriminatory atti-
tudes and prejudice. In 1972 Manfred Bleuler urged us to
see the mental patient as a ‘fellow sufferer and comrade in
arms’ rather than someone whom ‘a pathological heritage
or a degenerate brain has rendered inaccessible, inhuman,
different or strange’ (Bleuler, 1972). It would appear his
appeal has not yet been answered.
The treatment of madness – a historical overview

Madness has existed in all societies, past and present. The
ways in which it has been interpreted and responded to
have differed widely over time and place, treatment ranging
from the benign to the abusive and cruel.
Early history
Archaeological evidence reveals the practice of trepanning –
boring a hole in the skull, presumably to allow the release
of devils – as early as 5000 BC (Porter, 2002). Beliefs about
supernatural possession were common in the classical
Chap-05.qxd 2/13/04 10:06 AM Page 140
world, as evidenced by the wealth of literature from that

period: the treatment for such conditions was prayers,
incantations and sacrifices. From the fourth century BC the
writings of Hippocrates (c. 460–377 BC) cast a different
light on the concepts of health and sickness. He dismissed
the idea of a diabolical cause for madness, or any other
aspect of human behaviour, seeing all emotional experi-
ences, including anxiety, delirium and madness as emanat-
ing from the brain. Hippocratic medicine explained all
illness, mental and physical, in terms of the ‘humours’ –
vital bodily fluids which, by their relative balance, deter-
mined the physiology, temperament and health of an
individual. The four humours, blood, choler, phlegm and
bile, were seen as being related to the four elements of the
universe – air, fire, water and earth respectively. This sys-
tem was holistic, viewing mental and physical conditions as
extensions of each other. Treatment for madness was var-
ied, the most common being blood-letting. Diet and exer-
cise were also recommended, as was talking to the
deranged person. Others advocated shock treatment and
isolation in total darkness. Both Greek and Roman law
attempted to regulate the insane, holding their families
responsible for their containment. Even after humoral
theories had gained ascendance, public belief in diabolical
possession continued in the classical world and the
deranged were generally feared and shunned. The medical
tradition begun by Hippocrates, based on the humoral
approach, continued through the medieval period and into
the Renaissance.
The advent of Christianity saw a return to the idea of
madness as caused by the devil, who was seen as locked in
battle with God for possession of individual human souls.
Insanity was deeply shameful and in early Christian Europe
families frequently kept deranged individuals locked up. In
the Islamic empire a similar approach led to the establish-
ment of mental hospitals called moristans as early as the
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MENTAL ILLNESS 141
thirteenth century (Fernando, 2002: 72). By the end of the

Middle Ages in Europe there was the beginning of a more
formal segregation of the insane, religious institutions pro-
viding for their custody or care. St Mary’s of Bethlehem, a
religious house in London, was founded in 1247. It was
catering for lunatics by the end of the fourteenth century
and was later known as ‘Bedlam’. Similar asylums were
established throughout Europe by the fifteenth century,
largely under religious jurisdiction. Treatment in these
institutions included perforating the skull (for ‘mania’),
‘plaguing with squealing pigs’, rest and quiet, punching
and thrashing, binding with ropes, and exorcism (Howells,
1991: 34). In St Mary’s of Bethlehem patients were kept
chained to the wall or on long leashes, in cramped and
unsanitary conditions. They were also exposed to public
exhibition as freaks of nature. As early as 1324 in England,
‘lunatics’ lost their civil rights and their property was taken
over by the crown (ibid.: 42).
In the late fifteenth century religious fervour caused
unprecedented levels of persecution in the witch craze
which spread across Europe. Symptoms of madness were
attributed to satanic maleficium (malice) caused by witches
who had compacted with the devil. Over 200,000 people,
mostly women, were executed during this period. Religious
doctrine justified this with a self-serving circular argument
by which ‘the mad were judged to be possessed, and reli-
gious adversaries were deemed out of their mind’ (Porter,
2002: 21). In his seminal work The Myth of Mental Illness
(1962), Thomas Szasz draws a parallel between the fate of
witches in the Middle Ages and that of mental patients in
the late twentieth century, seeing both as scapegoats for the
society of their time. Others (for example, Sedgwick, 1982)
are critical of Szasz’s analogy, pointing out that the men-
tally ill were seen as evidence of witchcraft, rather than
themselves being accused of it. Be that as it may, this
lamentable episode in history is a chilling example of the
Chap-05.qxd 2/13/04 10:06 AM Page 142
treatment meted out to those seen as odd or different – the

vulnerable, the deranged, those on the margins of society.
Philosophical developments in the seventeenth century
had profound implications for the treatment of those
deemed insane. Descartes’ distinction between mind and
matter (including the body) led to a conceptualization
which conflated the mind with the soul, encompassing con-
sciousness, moral responsibility, immortality and rational-
ity. Treatment had to be aimed at the body, for to implicate
the mind (or soul) in insanity would be to call into question
the soul’s immortality and hence the very foundations of
Christianity. Thinking in this period held reason and
rationality to be the one capacity that distinguished man
from animals. Insanity was characterized as loss of reason,
or as delusional thinking or faulty cognition. (The parallels
with the theories underlying twentieth-century cognitive
therapy are striking.) There was a belief then (as now) that
the mentally disturbed could be re-trained to think cor-
rectly. However, the favoured method in the seventeenth
century was the use of fear to restore reason. This gave a
mandate for a variety of abusive physical treatments, justi-
fied on the basis that the insane were no longer human
because they were without reason – so could be treated like
animals (Scull, 1981; Seligman and Rosenhan, 1998).
Institutionalization – the eighteenth and

nineteenth centuries
As societies became more organized it seemed to become
more imperative to exclude the socially deviant from the
social mainstream. The eighteenth century saw a steady
rise in the number of institutions dedicated to the custody
of the insane. Many of these were private institutions, the
‘pauper lunatic’ usually being assigned to the miseries of
the workhouse. There was no regulation of such institu-
tions until towards the end of the century, and no laws gov-
erning the criteria to justify incarceration in a ‘madhouse’.
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MENTAL ILLNESS 143
Foucault describes this Europe-wide institutionalization as

the ‘great confinement’ of the mad and the poor, a move-
ment of ‘blind repression’ (Foucault, 1965). Thus people
were shut away not as a therapeutic measure but as a
custodial act of state. Porter (2002) criticizes Foucault’s
interpretation as simplistic and over-generalized. The
involvement of the state in the incarceration of the mad in
the eighteenth and nineteenth centuries did indeed vary
from country to country, as did the nature of the regimes
within these institutions. Some were clearly worse than
others, but all inmates were locked away, for indefinite
periods of time, with no means of securing their own
release. What emerges clearly, however, is that the medi-
calization of insanity came after the great era of asylum
building. The original impetus for their construction came
from religious organizations; the involvement of the state
and the medical profession became apparent in the late
eighteenth century, gaining ascendancy in most countries
by the mid-nineteenth century. In England, Acts were
passed in 1842 and 1845 which made the erection of
county and borough asylums mandatory. By this time a
medical presence in the asylums was also required.
The medical model and the rise of psychiatry

Medical theories about madness began to proliferate;
insanity was characterized as a mental disorder, a pathol-
ogy, and medical treatment within the asylums was
vaunted as the means to restore the insane to health. The
optimism of this era, which viewed lunacy as curable, gen-
erated for a brief period a humanitarian approach to the
treatment of the insane – namely, ‘moral therapy’, which
was a reaction against the chains, whippings, dungeons and
other physical treatments to which asylum inmates had
hitherto been subjected. Many hospitals began to remove
restraints and unlock their wards. The Retreat in York,
established in 1796, is often cited as the supreme example
Chap-05.qxd 2/13/04 10:06 AM Page 144
of this new approach. The emphasis here was on community

living, with kindness, consideration and dignity the values
propounded as essential for the care of patients. Other
relatively benign treatments practised in the eighteenth and
nineteenth centuries included mesmerism and hypnotism,
the latter pioneered by Jean Martin Charcot at La Salpêtrière
in Paris. Charcot’s methods were ultimately discredited but
hypnotism continued to be practised widely in Europe and
America well into the twentieth century. It has returned
more recently in the form of hypnotherapy.
The era of moral therapy, however, was short-lived, and
by the late nineteenth century most asylums had reverted
to being closed, overcrowded institutions with rigid, harsh
regimes and little chance of release for those committed to
them. The explanations for this are legion. One argument
is that the optimism about the curability of insanity proved
to be unfounded, and that consequently numbers in the
asylums rose and any attempt at benevolence became
impractical as well as discredited as a form of treatment
(Barham, 1992). Other commentators point to the rise in
psychiatry as a medical speciality, and to the need for psy-
chiatrists to justify their existence and their hold over the
mad as their special area of concern, by establishing a physi-
cal basis for insanity. Moral therapy threatened this, so it
had to go (Scull, 1981). An alternative explanation is that
asylums became a form of social regulation – the place for
those who were unwanted by society by dint of being odd,
or mad, or poor, or socially deviant (Sedgwick, 1982).
Whatever the reason, the effect on those classified as mad
was one of punitive segregation and social ostracism. By
the end of the nineteenth century the incurability of insan-
ity was taken for granted, and the fast-growing asylum sys-
tem had accentuated society’s fears of the insane. Locking
people up is an excellent way of conveying the message that
those under lock and key are dangerous and unfit to be
included in ‘normal’ society. It is no coincidence that the
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MENTAL ILLNESS 145
Victorian madhouse keeper, or psychiatrist, was called an

‘alienist’, whose job was to identify and control those
‘alienated’ from society by virtue of their lack of sanity or
rationality. As Roy Porter puts it, this was, in effect, a
process of sanctioning ‘the stigmatization and exclusion of
“outsiders” and “aliens” … The walled and locked asylum …
backed by the medical specialty of institutional psychiatry …
underscored the differentness, the uniqueness, of those
thus “alienated” or “excluded” ’ (Porter, 1987: 25).
The rise of psychiatry was based on the assumption that
insanity had an organic aetiology. Research began into the
pathology of the brain which was assumed by many to be
the root of ‘mental disease’. The concept of insanity as ill-
ness was given considerable credibility by the discovery in
1897 of the link between syphilis and paresis (insanity
resulting, sometimes many years later, from syphilitic infec-
tion). This led to research into the biological foundations
of all other mental disorders – research which continues to
the present day. Some other conditions have been found to
have a physical basis, but no such neat biological link has
been found for the major ‘mental illnesses’ such as schizo-
phrenia, manic depression or paranoia. Other theories
which gained ground at the turn of the twentieth century
concerned the possibility of inherited psychopathic tenden-
cies. This so-called ‘degenerationist’ model suggested that
such tendencies accumulated and worsened over genera-
tions – thinking which was given scientific support by the
evolutionary ideas of the time. Degenerate traits were
posited to be present in non-European races, in sexual
‘inverts’ (that is homosexuals) and in women. Degenera-
tionist ideas were the ‘scientific’ foundations of eugenics.
In America by 1900 there were calls for compulsory con-
finement and sterilization for those judged to be insane, or
degenerate in other ways, as well as for the use of psychia-
try in immigration control (Porter, 2002: 152). Psychiatric
sterilization was widely practised in America and other
Chap-05.qxd 2/13/04 10:06 AM Page 146
European countries well before the rise of Nazism in

Germany. Degenerationism and eugenics reached their
zenith in the killing of a quarter of a million mental
patients by the Nazis between 1940 and 1942 – an act
justified by the concept of ‘life unworthy of life’ (Barham,
1992: 79).
Twentieth-century approaches
The beginning of the twentieth century saw a significant
split in the treatment of the mentally disturbed which per-
sists to the present day. In simple terms the split is between
somatic and psychological approaches. Freud’s theories
lent considerable weight to the psychological camp but it is
significant that Freud, and many of his colleagues, worked
mainly with the less seriously disturbed. Freudian thought
created a division between the ‘neurotic’ and the ‘psy-
chotic’, with the belief that paranoid and psychotic patients
were unable to form a transference and were therefore
unamenable to psychoanalysis. Some post-Freudians, and
many psychotherapists from other schools, have used psy-
choanalysis and psychotherapy to treat schizophrenia,
manic-depression and other mental illnesses, but the over-
arching distinction persists: therapy and counselling are for
the ‘worried well’; the insane remain the domain of the psy-
chiatrists. As such they have been subjected to a wide vari-
ety of physical treatments. Shock treatments of various
kinds have been used, at first with insulin therapy and then,
by the 1940s, with ECT (electro-convulsive therapy).
Prolonged-sleep therapy, induced by barbiturates, was
practised for a time in the 1920s, and psychosurgery has
been widely used since the 1930s. Many of these interven-
tions had the effect of rendering patients placid and sub-
missive. There is inevitably much controversy over the
desirability of such an outcome. These treatments were
invasive, unpleasant and very often carried out without the
patient’s consent. Many had permanent, and not necessarily
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MENTAL ILLNESS 147
beneficial, effects. Psychiatry, meanwhile, was gaining in

credibility as a medical speciality. These developments can
either be seen as the desperate attempts of well-meaning
doctors to help the afflicted, or as the abuse of powerless
patients used as guinea pigs by arrogant and power-hungry
psychiatrists. The truth surely lies somewhere between
these two extremes.
The 1950s saw the beginning of the drug revolution.
Anti-depressant and anti-psychotic drugs came into use and
rapidly became the favoured treatment for all kinds of men-
tal disturbances. Extravagant claims have been made for the
effectiveness of these drugs. At best they appear to reduce,
or mask, symptoms such as anxiety, depression, hallucina-
tions, paranoia, etc. Many people with debilitating condi-
tions such as severe depression, mania and schizophrenia
are able to manage their symptoms with medication in such
a way as to lead relatively normal and fulfilling lives. How-
ever, they offer no cure and are only effective as long as they
are being taken, their effectiveness often reducing over time.
Most worryingly, the side-effects of these drugs are little
publicized. In 1990 Pilgrim estimated that around half of
the world’s 150 million users of major tranquillizers suffered
from tardive dyskinesia (Pilgrim, 1990: 228), a condition
resulting from permanent damage to the central nervous
system which causes involuntary and uncontrollable move-
ments of the face, body and limbs. Peter Breggin identifies
not only tardive dyskinesia but also tardive dementia, which
he describes as ‘a global deterioration of the mind and
mental faculties caused by the [neuroleptic] drugs’ (Breggin,
1993: 86). His investigation of clinical studies in the USA
on tardive dyskinesia revealed that many and sometimes all
patients in these studies were also suffering from serious
mental dysfunction, including dementia, as a direct result of
long-term use of psychotropic medication.
Many consider that the main purpose the psychotropic
drugs serve is to render patients calm and manageable
Chap-05.qxd 2/13/04 10:06 AM Page 148
(Sedgwick, 1982; Newnes, 1999). In the crowded mental

institutions of the first half of the twentieth century this had
obvious benefits. The stated purpose of such drugs is to
relieve disturbing psychological and behavioural symptoms –
symptoms which the biological theories claim are caused
by biochemical imbalances in the brain or nervous system.
However, there are some who maintain that the drugs pre-
date the theories, which they say are a post hoc justification for
drugging mental patients into submission (Newnes, 1999).
While it is difficult to disentangle the exact sequence of
events, it is indisputable that the biological theories clearly
gave massive credibility to the use of these drugs.
Scepticism is further fuelled by the fact that the drug com-
panies themselves are the major source of funds for research
in this field. Furthermore, research findings are compro-
mised by the fact that patients studied in the attempt to
demonstrate brain biochemical abnormality in those with a
diagnosis such as manic-depression or schizophrenia will
have already been treated with the neuroleptic drugs, sub-
stances known to cause brain damage. The therapeutic
effectiveness of the anti-psychotic drugs has been seriously
questioned by a number of studies. In a survey of such
studies Scull (1984: 87) concludes that large doses func-
tion as a ‘chemical straitjacket’ and lower doses have little
or no effect in comparison with a placebo.
The advent of drug therapy is often offered as the expla-
nation for the de-institutionalization of mental patients
which took place throughout Europe and in the USA
around the middle of the last century. In fact this had
already begun in most places before such drugs were widely
available. In the UK the decline in the numbers of mental
patients in hospital began in the early 1950s and continued
steadily throughout the rest of the century. By the 1980s
many mental hospitals had closed down. The pattern was
similar in other European countries and was the result of
specific governmental policy. A benevolent reading of such
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MENTAL ILLNESS 149
policy would place at its centre a desire to reform the

outdated and repressive regimes of these Victorian institu-
tions and replace them with a more humanitarian approach
to mental disorder. An indisputable outcome, intended or
not, was a massive cost saving. The facilities intended to
replace the care and treatment provided by the mental
hospitals were either slow in arriving or never appeared at
all. Many people who had been in hospital for extended
periods were ill-equipped to adjust to life outside an institu-
tion, and one of the direct results of de-institutionalization
has been an increase in the number and proportion of peo-
ple with mental health problems among the homeless and in
prisons. Over the past thirty-five years in the UK, 100,000
long-stay patients have been discharged from psychiatric
hospitals but fewer than 4,000 places have been provided in
local authority hostels (Barham, 1992: 17). There is also a
growing number of so-called ‘revolving-door’ patients –
short-stay patients with frequent admissions.

The policy of ‘Care in the Community’ is generally recog-
nized to be far from successful, partly due to a woeful lack
of resources, partly due, it seems, to a lack of political will,
and partly because, as a policy, it is inherently flawed. It is
based on an assumption that the community will want to
care for its less fortunate individuals – those deemed men-
tally ill. Sadly, this is far from being the case. Mental health
patients experience many practical problems to do with the
management of their daily lives, but on top of that they are
subjected to social isolation and exclusion as well as to a
dearth of services. As Richard Warner puts it: ‘much of
what today is called community treatment, is, in fact, the
antithesis of treatment: people suffering from psychosis are
consigned to a sordid, impoverished existence in which even
basic needs, such as food and shelter, are not met’ (Warner,
1994: x). There is a huge gulf between the aspirations of
Chap-05.qxd 2/13/04 10:06 AM Page 150
social policy-makers who talk about maintaining vulnerable

patients ‘in an appropriate setting in their community, free
to come and go and to participate in an urban environ-
ment’ (Bennett and Morris, 1983) and the reality for most
people with severe mental disorders. Such people are aware
that disclosure of a psychiatric diagnosis will make it more
or less impossible for them to obtain a job or decent hous-
ing. It will also work against them in any efforts at social
integration. Their access to medical services is restricted to,
at best, a monitoring of their medication, or, more usually,
repetition of prescriptions without even a consultation with
a doctor. Should they make the choice to discontinue
taking their prescribed drugs, they are at risk of being com-
pulsorily committed.
The process of involuntary admission to a psychiatric
hospital is based on specific criteria, all of which are the
result of subjective judgement, such judgement being deliv-
ered by a psychiatrist. The criteria are: the presence of a
mental disorder, the judgement that absence of treatment
would lead to deterioration in the person’s mental state,
and the belief that the person represents a serious danger to
themselves or another person. These criteria are contained
in the 1983 Mental Health Act which also gives profes-
sionals legal powers to override an individual’s right to
decline treatment on the basis that they, the professionals,
know best. Patients committed involuntarily thus have few
civil rights and their stay in hospital can be indefinitely
extended on the recommendation of the psychiatrist.
Under the current law, people can only be given treatment
against their will if they are detained in hospital, although
the 1996 Mental Health (Patients in the Community) Act
provides for the compulsory supervision of patients in the
community, and alongside that gives professionals the
power to remove a patient to hospital (where they can be
treated involuntarily) if the patient does not adhere to an
agreed treatment plan. However, the proposed Mental
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MENTAL ILLNESS 151
Health Act reforms contained in a draft bill published by

the Department of Health in June 2002 includes the pro-
posal to extend compulsory treatment to those outside hos-
pital. This has caused grave concern in many quarters. A
Mind Policy Briefing points out that Community
Treatment Orders ‘would either make users too frightened
of the consequences to contact services or discourage them
from seeking help. This cuts people off from the very ser-
vices which should provide help and support, thus making
a deterioration of their condition more likely’ (Mind Policy
Briefing, 2002a: 2). The situation is made worse by the fact
that the structure of funding for resources in the UK is
such that very often money granted for mental health care
is used for areas where results are more easily seen, and the
‘hopeless’ cases – the long-term mentally ill – are frequently
overlooked.
It is clear that the insane, the mad, the mentally ill, have
been universally stigmatized throughout history. They
arouse in others feelings of anxiety and fear. Bowers (1998:
128) suggests that this response is caused by several factors.
Their perceived unpredictability makes us fearful for our
own safety and the inexplicability of mental illness threatens
our need for logic and reason. Furthermore, it reminds us of
our own potential for madness, something we would prefer
not to think of. Mental illness lessens the humanity of the
sufferer and generates in others feelings of revulsion and a
fear of contamination. This is essentially a process of de-
humanization which sheds light on much of the inhumane
treatment the mad have been subjected to over time. The
stereotype of the unpredictable, potentially violent maniac is
one which is particularly prevalent today. The current, and
proposed, mental health laws are heavily skewed towards
measures to protect the public from these lunatics, rather
than measures to enable the latter to recover their sanity.
Mind’s Policy Briefing (2002a) quotes an article in the
British Journal of Psychiatry which showed that between 1957
Chap-05.qxd 2/13/04 10:06 AM Page 152
and 1995 in the UK there was overall a fivefold increase in

homicide, but in the same period a 3 per cent decline per
annum in the contribution to these figures by people with
mental illnesses. Despite this, ‘two-thirds of media reports
misleadingly portray people with mental health problems as
violent’ (Mind Policy Briefing, 2002b: 1).
The split between psychological and physical treatments
still prevails. On the whole, the worse your condition is
judged to be, the more likely you are to be given a physical
treatment – usually drug therapy. A growing sense of unease
about the efficacy of such treatments, combined with a
resistance to the infringement of civil liberties implicated in
many psychiatric interventions, has given rise to the service
user/survivor movement. Begun in the 1980s, this move-
ment is at heart a reaction by its members to being seen in
terms of a diagnosis, and a challenge to the discrimination
and marginalization that they experience as a result of the
perceived status of the diagnosed mentally ill in society.
There is a powerful argument that much of the prejudice
against the mentally ill is created by the disease model, with
its battery of psychiatric diagnoses and labels. I will be
examining the concept of the disease model in the next sec-
tion. It is disquieting to note, however, that the concept of
mental disturbance as an illness, with its assumption of a
physical cause and concomitant physical treatment, appears
to be getting ever wider and all-encompassing.
All kinds of human behaviour have now been given a
psychiatric diagnostic label which, by definition, carries
with it implications that this should/could be treated. Some
of the more recent ‘discoveries’ have been ‘attention
deficit hyperactivity disorder’ (ADHD), ‘pre-menstrual
dysphoric disorder’, ‘gender identity disorder’ and the
worryingly catch-all ‘personality disorder’. The diagnosis of
‘personality disorder’ has the effect of drastically reducing
the services on offer to those to whom it is applied. As it is
considered to be unamenable to treatment, appointments
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MENTAL ILLNESS 153
with a CPN or even a psychiatrist are withdrawn. The

individual with a ‘personality disorder’ is left on a prescribed
drug regime infrequently monitored by his/her GP. The
idea of a physical cause for all illnesses, including those
considered mental, has been further fuelled by the Genome
Project. Many assume that before too long the genes for all
illnesses and disorders will be identified and we will then be
in a position to ‘engineer’ them out of existence. This
prospect raises a number of ethical questions, not the least
of which centres on the definition of what exactly is a men-
tal illness, which is where we came in!
Theories about mental illness

As we have seen in the previous section, by the end of the
nineteenth century there was general acceptance that cer-
tain behavioural patterns and mental states were the result
of illness, rather than the consequence of possession by
demons or a state of sin. This brought madness out of the
jurisdiction of religion into that of medical science. Parallel
with this development was the growing acceptance that the
mind is the function of brain. This belief gave rise to
somatic psychiatry. In the early part of the twentieth cen-
tury the development of psychology and, at that time more
specifically psychoanalysis, led to a break between physical
and psychological modes of treatment. The central issues
in these developments – the status of mental illness and the
relationship of mental functioning to brain anatomy and
physiology – remain with us, and are still unresolved. Much
of the literature on this subject takes the form of impas-
sioned attacks on the discipline of psychiatry, which, by
definition, embraces the medical model.
The medical model

This is the model of madness which has general public
acceptance. Any newspaper account, or radio or TV item
Chap-05.qxd 2/13/04 10:06 AM Page 154
on the subject is based on the premise that madness in any

of its manifestations has a physical basis and consequently
should receive medical attention. This is doubtless partly
due to our cultural faith in science and our belief that we
should, by right, be in full possession of physical and men-
tal health at all times. Should this not be the case, we
believe or hope that a pill will put it right. Since the dis-
covery of the link between paresis and syphilis in 1897, and
the invention of penicillin and antibiotics, people have been
searching for a similar biological basis for all other mental
disorders. Other conditions have indeed been established
as having a physical origin: Alzheimer’s, Wernicke’s
encephalopathy, Korsakoff psychosis, alcohol-induced psy-
chosis, and the like.
The focus on an organic basis for mental disorder has
gained further credibility with research in the neural sci-
ences, which appears to provide evidence for measurable
physical disturbances and differences in people with spe-
cific disorders. An example of this is the predominant
biochemical theory of schizophrenia – the dopamine
hypothesis – which suggests that the underlying abnormal-
ity may be a relative overactivity of tracts of neurons in
which dopamine is the chemical mediator (Warner, 1994:
18). Other research has identified degenerative changes in
the limbic system area of the brain in schizophrenic
patients. This is not present in all schizophrenics, but it is
important to note that it has been found not only in those
patients who have been treated with neuroleptic drugs but
also in those who have not (ibid.). The degree of influence
of genetic characteristics on the emergence and pattern of
mental disorders is highly debated. Much research in this
area appears to point to a genetic predisposition in dis-
orders such as manic-depression and schizophrenia, rather
than genetic factors being the total cause. Work by epi-
demiologist Irving Gottesman, drawing data from over
forty European studies conducted between 1920 and 1987,
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MENTAL ILLNESS 155
reveals that the closer the relationship a person has to

someone diagnosed with schizophrenia, the greater is the
risk that that person may also develop the disorder. Thus,
the identical twin of a schizophrenic, who has precisely the
same genetic constitution, has a 50-per-cent risk, the rate
in the general population being 1 per cent (Gottesman,
1991). Other studies focusing on twins who have been
adopted or reared separately have produced concordance
rates as high as 80 per cent in monozygotic (identical)
twins for the manic-depressive disorders (Prior, 1999: 66).
However, it is clear that genetics cannot be the whole story,
as in all of these studies a significant proportion of the
monozygotic twins did not develop the disorders.
Moreover, nearly two-thirds of schizophrenic people have
no relative at all with the illness (Warner, 1994: 21).
Research into the biology of depression has identified
several physiological changes which are absent in the brains
of people who are not depressed, for example platelet and
lymphocyte 5HT binding site density, cation transport and
cortisol secretion (Cowen and Wood, 1991). In all this
research, however, there is an inherent danger of reduc-
tionism, and of reverting to a Cartesian split between mind
and body. We know that the social, the psychological and
the physiological intricately interact with each other.
Stressful, and joyful, events have an impact on our physiol-
ogy, just as physical illness affects our psychological state.
It is a circular, chicken-and-egg process rather than a linear
one of A causes B. A further cautionary note is struck by
Len Bowers who points out that, for mental states, nor-
mality is not determined by structure or process in the
brain, but by function, ‘and with the brain, function will
always have entirely social and psychological criteria’. He
goes on:
It is the symptoms that are the criteria for deciding normality/health,

and these are always psychosocial with mental illness. Otherwise I
Chap-05.qxd 2/13/04 10:06 AM Page 156
could say that having less than average intelligence was abnormal and an
illness and perhaps be able to point to a discernible difference in brain func-
tion. Difference or variation in brain activity does not by itself equal
malfunction. (Bowers, 1998: 175)
To date it would appear that physiological accounts of

cause in mental illness are always partial, though this does
not rule out the possibility that future research will discover
something new in this area. The relationship between phys-
iology and psychology is more complex than many of the
theories within the medical model, together with the treat-
ments that such theories legitimize, take into account.
Socio-cultural models
In the 1960s and 1970s a variety of theories emerged, all
having as their base starting-point a rejection of the exclu-
sively biological, physiological and genetic theories and an
opposition to the traditional psychiatric theory and practice
embodied in the medical model. The most vehement rejec-
tion of the medical model is manifested in a movement
which has become known as anti-psychiatry. Its main pro-
ponents are generally accepted to be Thomas Szasz in the
United States and R.D. Laing in the UK, although Szasz,
in his book Schizophrenia: The Sacred Symbol of Psychiatry
(1976), dissociated himself from the anti-psychiatry move-
ment, claiming it to be as demeaning to the ‘patient’ as tra-
ditional psychiatry. Szasz’s earlier book The Myth of Mental
Illness (1962) dismisses the notion that mental disturbance
of any kind is an ‘illness’ or a ‘disease’. He views it rather
as one way of surviving in a particular social situation. His
perspective is broadly socio-political, seeing the mental
patient as a scapegoat for society, made necessary by the
discrepancy between prescribed rules of conduct and
actual social behaviour. Consequently the more we insist
on the axiom of psychological health and a balanced men-
tal state, ignoring any other aspects of our personality, the
greater our need to victimize those exhibiting psychological
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MENTAL ILLNESS 157
disturbance. People so doing become ‘sacrifices as a means

of maintaining the social myth that man lives according to
his officially declared ethical beliefs’ (Szasz, 1962: 193).
The notion of ‘mental illness’ is thus a rationalization for
forms of social control dressed up in the guise of medical
treatment, and the mental patient is the latest representa-
tion of ‘the perennial scapegoat principle’, replacing the
witch, the Jew and the black slave in a long line of perse-
cution and subjugation of non-conformity (Szasz, 1970;
2002).
R.D. Laing’s work aims to demonstrate the meaningful-
ness and intelligibility of behaviour which has been labelled
mad (usually schizophrenic). He progresses from seeing
schizophrenia as a social and family creation, to a celebra-
tion of madness as one stage in a natural psychic healing
process. In this light psychosis is viewed as a mystical expe-
rience, a journey towards primeval one-ness, a higher form
of sanity (Laing, 1967). He eschewed drug therapy and
established therapeutic communities for those diagnosed as
mad.
The notion of social control is extended in the labelling
theory of deviant behaviour. By diagnosing (or ‘labelling’)
people as schizophrenic, manic-depressive, paranoid, and
so forth, psychiatry is viewed as an instrument by which the
status quo is maintained and deviants are marginalized – it
becomes ‘modern capitalism’s ultimate weapon of social
control against dissidence’ (Sedgwick, 1982: 5). Labelling
theory was first expounded by Howard Becker who pro-
posed that ‘social groups create deviance by making the
rules whose infraction constitute deviance, and by applying
those rules to particular people and labelling them as out-
siders’ (Becker, 1963: 9). Thus deviance ‘is not a quality of
the act’ (ibid.) but a consequence of the labelling by some-
one observing and judging the act. The observation of
behaviour, and categorization of that behaviour as deviant,
produces a crucial change in self-identity within the person
Chap-05.qxd 2/13/04 10:06 AM Page 158
being labelled. From this the theory claims that ‘labelling is

the single most important cause of chronic mental illness’
(Cochrane, 1983: 151).
Several studies have shown that the manifestation of
behaviour which is taken as indicative of mental illness
leads to social rejection, the likelihood of rejection being
greater the more severe the disturbance adduced. Similarly,
the experience of many who have acquired a psychiatric
diagnosis is that disclosure of that diagnosis is likely to pro-
voke similar levels of social rejection, even if their behav-
iour is manifestly symptom-free. Moreover, the theory
suggests that the label itself, together with the attitudes and
reactions of those who apply it, will produce such symptoms
in the person being labelled. It is primarily in the mental
hospitals that the identity transformation posited by this
theory takes place, as so graphically described by Goffman
in his book Asylums (1961), in which he suggests that the
mental hospital is not a place of refuge and recovery, but an
institutionalized form of repression and social conformity.
Whereas the mental hospitals of the 1960s no longer exist,
psychiatric labelling is alive and well, and inventing new
diagnoses by the day. The stigmatization that it creates is
very real, and a psychiatric diagnosis, unlike a bout of ’flu or
a broken leg, does not fade with time.
Broader sociological approaches take the view that the
factors most implicated in the incidence of psychological
illness are nothing to do with biological or physiological
abnormality and everything to do with such things as low
social status, limited economic opportunity, unemploy-
ment, lack of social support and stressful life events.
Furthermore, studies have shown a higher incidence of
mental disorders of all kinds among women, the lower
social classes and certain ethnic groups. Many of the argu-
ments here fall again into the circular category. Studies
have shown that lower social status is associated with a
higher risk of psychological problems. The suggestion is,
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MENTAL ILLNESS 159
therefore, that these mental disorders are ‘caused’ by poor

environment, lower educational value, excess of stress, and
so on. However, an alternative explanation is the ‘social
drift’ hypothesis which posits that those suffering from
mental disorders will be less likely to maintain their educa-
tional status, job or profession, and will sink to the lowest
socio-economic condition. A similar difficulty exists with
an established correlation between depression and stressful
life events. Do the stressful events cause the depression, or
is it that people with ‘disturbed personalities’ are more
likely to create disruptive life events? Cochrane (1983) pro-
vides a detailed review of this approach, and, while con-
ceding that with many social factors no direct causal
relationship with mental disorders can be definitively estab-
lished, concludes that a combination of negative factors,
such as poverty, lack of social support, membership of a
social or racial minority group, and stressful life events can
produce ‘long-term and unrelieved mental arousal [which]
may lead to psychological problems like neurotic anxiety,
alcoholism, depression and possibly psychoses’ (Cochrane,
1983: 113).
The argument for the social creation of mental disorders
is taken further by others (for example, Warner, 1994;
Barham, 1997). Warner argues that the attitudes of mental
health professionals towards the mental patient are even
more rejecting and dehumanizing than those of the general
public. He cites an article by G. Serban published in 1979
in the American Journal of Psychiatry in which it was
demonstrated that people with schizophrenia are capable of
experiencing human emotions such as depression. The
authors conclude that ‘chronic schizophrenics do become
depressed when they are aware of their marginal lifestyle in
the community’. Warner asks, ‘how could the editors of the
Journal possibly imagine that such findings were worth
publishing? Only by assuming that a number of their read-
ers would have doubts about the human qualities of their
Chap-05.qxd 2/13/04 10:06 AM Page 160
schizophrenic patients’ (Warner, 1994: 181). Warner then

goes on to argue that the symptoms which are taken by psy-
chiatrists as evidence of the illness (in this case schizophre-
nia) – depression, apathy, irritability, negativity, emotional
over-dependence, social withdrawal, isolation and loneliness,
loss of self-respect and a sense of time – are in fact socially
induced and ‘may be attributed to the purposeless lifestyle
and second-class citizenship of the schizophrenic’ (ibid.). It
should be noted here that Warner fails to include the more
florid symptoms associated with schizophrenia in his list.
Nevertheless, his findings would appear to demonstrate that
recovery from schizophrenia is most common in those who
reject the ‘mentally ill’ identity and all the negative symptoms
that mental professionals associate with it. This is made
extremely difficult by a view (in western cultures) of schizo-
phrenia and other ‘mental illnesses’ as chronic biological dis-
orders from which a patient is never cured – in such a
formulation a person who appears well is ‘in remission’ and
thus is expected to become ‘ill’ again at any time.
In all these theories mental illness is seen as intricately
related to the social environment of the individual. Some
assert a social aetiology for mental disorders, some a high
degree of influence by social forces and others that mental
illness is thoroughly and completely socially constructed.
The latter is demonstrated dramatically by the political
abuses of psychiatry in the Soviet Union, where political
dissidents were labelled insane and incarcerated in mental
institutions or worse. It can also be seen in the ever-
fluctuating diagnostic categories of the ICD and DSM, the
most controversial of which was the decision by the American
Psychiatric Association in 1973 to declassify homosexuality
as an ‘illness’.
Psychosocial and psychological models

Psychological theories for mental disturbance have existed
throughout time. In the second century AD Galen posited
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MENTAL ILLNESS 161
that hysteria had a sexual basis; although he linked it to a

physical malfunction of the uterus (hystera), he emphasized
the psychological component of the disturbance. It was, of
course, Freud, with his systematic formulations concerning
the psychological nature of human distress, who had the
biggest impact in this sphere. The concepts of the uncon-
scious, repression and the potentially traumatic effects of
early childhood experiences on later life have had a lasting
influence on western psychological thought.
The psychoanalytic movement in its development not
only as a therapy but also as a universal psychology tended
to look at the less serious ‘neurotic’ disorders. However,
there have always been exceptions to this. In 1911 Eugen
Bleuler invented the term ‘schizophrenia’ and deployed
psychoanalytic theory in his description of this condition.
He saw it as a global splitting of mental functions, charac-
terized by delusions, hallucinations, disordered thought
and inappropriate affect. He felt that people with this con-
dition were ‘incapable of empathy, sinister and frightening’
(Porter, 2002: 185); their outcome was poor and psycho-
analysis ineffective. Jung also worked with the severely
disturbed and reported some psychotherapeutic success
( Jung, 1939), but the medical opinion at that time was that
if a ‘schizophrenic’ patient recovered with therapy or analy-
sis, then he/she was not suffering from schizophrenia.
Within psychoanalytic thought, the theories of the inter-
personal school focus most on the more severely disturbed –
the psychotic. A variety of formulations is offered. Psychosis
is seen by several theorists as provoked by a defence against
homosexual impulses, creating a regression to a primitive
stage of narcissism; by others as a disturbance in the
relationship between the ego and the outer world; and by
yet others as a diminished ability to neutralize aggression.
A defective super-ego is suggested, a fixation at the
oral-sadistic stage of psychosexual development, or a
rupture of the ego boundary leading to the creation of a
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false reality (Stone, 1991). Harry Stack Sullivan was most

influential in working with psychotic patients. He saw
schizophrenia as ‘a disorder which is determined by the
previous experience of the individual’ (Sullivan, 1924: 12).
The interpersonal relations to which the individual is
exposed produce a defence reaction – an irrational ‘uncon-
scious’ protection of the self. The defence may be against
either external or internal stimuli, and leads the individual
to psychotic excitements, substitutive rituals, transference
of guilt to others, or total incapacitation. Sullivan writes:
‘the mental structure is disassociated in such a fashion that
the disintegrated portions regress in function to earlier lev-
els of mental ontology, without parallelism in individual
depth of regression’ (ibid.: 13). There is then an eruption
of primitive functions and a profound alteration of the ego-
istic structures.
A wider focus is offered by the family theorists, who
attempt to explain the eruption of psychosis by examining
the interpersonal relationships within an individual’s
immediate family context. Bateson et al.’s seminal paper
‘Toward a Theory of Schizophrenia’ (1956) proposed the
mechanism of the ‘double-bind’ as being instrumental in
the development of schizophrenic symptoms. In this mech-
anism one individual (the child) receives two conflicting
messages from another (the parent, usually the mother)
together with an injunction against commenting on the
conflict or leaving the field. The child is thus in a ‘no-win’
situation where whatever he or she does will be construed
as wrong, and therefore punishable. Bateson et al. stress
that the pathogenic element arises from the constant and
repetitive nature of the double bind, producing a person
who is unskilled on all levels of expressing and receiving
communication. Other authors have suggested similar
pathogenic interactional patterns within the family. Haley
(1967) described the ‘perverse triangle’ in which two indi-
viduals within a family form a covert coalition against a
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MENTAL ILLNESS 163
third person. As with the double bind the coalition is denied

at a metacommunicative level. With these and other pro-
posed mechanisms – fragmentation, mystification, transac-
tional disqualification – the family is seen as a complex
system of idiosyncratic rules, norms and modes of behaviour,
where communication becomes fraught with conflict and
double meaning. The more ‘disturbed’ the family, the more
highly organized and restrictive the rules and patterns. In this
context the ‘psychotic’ individual’s behaviour is adaptive –
symptomatic not of an individual ‘sickness’ but of the dys-
functional nature of his or her interpersonal environment.
Psychological theories for severe mental disturbance
have had limited impact on the medical model. Their use
within traditional psychiatry is negligible, despite the fact
that many attempts have been made to offer psychoanaly-
sis and psychotherapy to those judged insane, as we shall
see in the next section.
In evaluating the plethora of theories regarding mental ill-

ness, disturbance, disorder, insanity, madness, or whatever
it is called, what emerges is the subjective nature of the dis-
tinction between normality and abnormality, sanity and
insanity. Such judgements have always been not only sub-
jective but also dependent on a variety of socio-politico-
economic variables which fluctuate over time and from
place to place.
If ‘society’ is making these judgements, the whole deci-
sion-making process around who is sane and who is insane
becomes a socio-political one. To be considered sane
means to be viewed as conforming to the expectations and
regulations of society and its norms. This fails to address
the question of whether the expectations and values of a
particular society are indeed right, just or humane. The dis-
tinction between social maladjustment or deviant behav-
iour and fully functioning mental and psychological
capacity then becomes blurred. Being diagnosed insane
Chap-05.qxd 2/13/04 10:06 AM Page 164
may be an indication of deviance rather than of psychological

or mental ill health. In this context psychiatry, psychother-
apy and counselling all become potential instruments of
social control – persuading, cajoling or forcing people back
into compliance with a particular social role or position.
The danger is that if we travel too far down this line of
thought we can lose sight of the reality of the suffering that
goes with madness. The view of the mentally ill as mis-
judged visionaries with a better understanding of reality
than us blinkered drones can also be misleading. To be
with a person who is experiencing deep depression, or
manic hyperactivity, or madness in any of its manifesta-
tions, is to witness someone in the grip of terrifying pain,
distress and confusion. It is not a state that the individual
welcomes, or would choose to perpetuate.
Mental illness and counselling and psychotherapy

As we have seen, psychological theory from Freud onwards
has proposed a neat division of mental states into the neu-
rotic and the psychotic – with the nebulous ‘borderline dis-
orders’ hovering somewhere between the two. The barrier
between neurosis and psychosis (or ‘normal anxiety’ and
‘madness’) is shored up by the way we view the two states,
and the kinds of treatment they receive. This serves to rein-
force the deception we perpetrate upon ourselves of believ-
ing that we are ‘normal’ (or perhaps at times a touch
neurotic) and, as such, safe from lapsing into psychosis.
The division between neurosis and psychosis is under-
pinned by, and in its turn feeds into, our own fear of men-
tal illness. It is a way of consigning those whose behaviour
may remind us of our own (if unacknowledged) potential
for madness to the category of ‘other’ – that is to say ‘not
us’. So, on the whole, the neurotic receive counselling and
psychotherapy and the psychotic get drug treatment, ECT,
hospitalization, and the like. Psychotherapy and counselling
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MENTAL ILLNESS 165
require an intimate personal encounter between two people

over a period of time, sometimes prolonged. The adminis-
tration of drugs and other physical treatments does not
involve a close relationship between the person receiving
the treatment and the person meting it out. Perhaps this is
because such a relationship would be too frightening, too
threatening for the professional, rather than because it
would be of no benefit for the individual in distress.
If, on the other hand, we view mental health as a contin-
uum which includes all forms of disturbance, from the mild
to the most severe, then the possibility of having a creative
interpersonal therapeutic relationship with someone who is
severely disturbed becomes a possibility. By empathizing
with and attempting to understand the nature of the expe-
rience of madness, we perforce touch on the ways in which
such an experience is familiar to us, and the extent to which
the ‘other’ (mad person) is similar to ourselves. This view
has been expounded by Bertram Karon, who points out
that despite the fact that psychological treatments have
been demonstrated to be effective with schizophrenics, they
are still largely avoided. He maintains that this is due to the
fact that psychotherapy involves understanding the patient,
and ‘understanding schizophrenic persons means facing
facts about ourselves, our families and our society that we
do not want to know’ (Karon, 1992: 192). The fear of psy-
chosis is certainly endemic within the professions of psy-
chotherapy and counselling just as much as in the wider
social sphere. In my own experience of teaching and super-
vising counsellors, the suggestion of working with a client
who may be mentally ill, or even one who has a history of
mental illness, engenders almost universal panic and fear –
a reaction which cannot be wholly explained by the coun-
sellor’s self-perceived lack of knowledge and experience.
There is an assumption that this kind of work would be
qualitatively different – based on the neurotic/psychotic
split that all counsellors are familiar with. But there is also,
Chap-05.qxd 2/13/04 10:06 AM Page 166
I believe, a fear of the insane which we all share. It is an

almost visceral response which can arouse feelings of revul-
sion and an instinct to withdraw. As the accepting non-
judgemental professionals we believe ourselves to be, we
may have difficulty in acknowledging such responses.
There is no doubt that we can be reminded of the fragile
nature of our own sanity by an encounter with another’s
madness. Most people would prefer to avoid such re-
minders – the dread of disintegrating into insanity is many
people’s worst nightmare.
Psychotherapy with mental illness

Psychoanalysts who have advocated applying psycho-
analytic and psychotherapeutic techniques to the severe men-
tal disorders range from Harry Stack Sullivan and Frieda
Fromm-Reichmann in the earlier part of the last century
through to Bertram Karon and Gary VandenBos and many
other contemporary practitioners. Freud commented in the
Introductory Lectures on Psychoanalysis (1916–17) to the
effect that psychotics cannot form transference relation-
ships, hence psychoanalysis with them was of little use.
Whereas some would argue that Freud’s statements should
be understood in the context in which they were made, and
that privately he felt much progress could be achieved with
psychotics, there is no doubt that his views, stated publicly,
have acted as a deterrent to many generations of psycho-
analysts and psychotherapists of all persuasions. Fromm-
Reichmann specifically rejected this notion and, like
Sullivan, worked extensively with schizophrenics and other
psychotic patients. She explicitly eschewed the fundamen-
tal components of classical psychoanalytic procedure in
working with psychotic patients: the couch, free associa-
tion, interpretation, the detached impersonal attitude of
the analyst, the assumption that all repressed content is of
a sexual or hostile nature, the prohibition of ‘acting out’,
the pretence that the analyst’s values do not influence the
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MENTAL ILLNESS 167
therapy. What she advocated in place of all this was

alertness and spontaneity, attention to the patient’s own
interpretations and meanings, awareness by the analyst of
his own values, and the ability to convey convincingly his
interest in the patient’s growth (Fromm-Reichmann,
1943). The latter description will no doubt sound familiar
to the modern student or practitioner of counselling or
psychotherapy.
The concept of providing space for psychosis to be
expressed and explored was put into practice most fully by
R.D. Laing, David Cooper, Joseph Berke and their col-
leagues in the 1960s and 1970s. Laing’s first therapeutic
community, Kingsley Hall, was set up in 1965 by the
Philadelphia Association, which by 1974 had established
seven similar communities in London. In these residential
centres individuals were allowed to give psychosis free rein,
to explore and re-evaluate the meaning of their experi-
ences, and were given no treatment they did not want.
Laing described the process that people went through in
his households as ‘a natural sequence of experiences’
(Laing, 1967: 102), likening it to death and rebirth, from
which people emerge reintegrated at a higher level of func-
tioning than before. He saw psychotic ‘symptoms’ not as
indicative of illness or disintegration but as the beginning
of the process of becoming well. It was crucial, therefore,
that people be allowed to express and experience those
‘symptoms’ rather than have them ‘treated’ by drug ther-
apy. Laing’s methods met with fierce opposition from tra-
ditional psychiatry at the time, and have continued to be
viewed as controversial by many.
Many other attempts have been made to treat psychotic
disorders with psychotherapy. In the USA the Agnews
Project in the 1970s demonstrated the non-therapeutic
effects of medication on hospitalized schizophrenic
patients, and was followed up by the founding of Diabasis,
a residential centre for the treatment of psychosis with
Chap-05.qxd 2/13/04 10:06 AM Page 168
psychotherapy and without medication. Although short-

lived, this project reported an 85 per cent success rate
(Perry, 1972). It should be noted, however, that this result
seems to focus on early improvement, no mention being
made of long-term follow-up. Another experiment was
conducted by Mosher and Menn – the Soteria House pro-
gramme, set up in the 1970s. Also drug-free, this facility
was largely informed by Laing’s work and aimed at creat-
ing a cohesive group setting where regression was accept-
able and possible. Comparisons were made at various
stages with the progress of schizophrenic patients receiving
traditional psychiatric treatment – neuroleptic drugs. The
outcome for the drug-free patients compared very
favourably with those who had received anti-psychotic
medication, the former in some cases doing significantly
better. Mosher and Menn conclude: ‘our data indicate that
antipsychotic drugs need not be used routinely with newly
admitted schizophrenics if a nurturant, supportive psy-
chosocial environment can be supplied in their stead’
(Mosher and Menn, 1978).
Meanwhile Theodore Lidz, working and writing in the
1970s, was advocating the family therapy approach to schiz-
ophrenia in particular. Building on the work of Bateson and
others, described earlier, he maintained that psychotherapy
was entirely possible with schizophrenics and that it was
unnecessary to look for biological or genetic causes; this dis-
order was totally comprehensible in terms of personality
development, family interactions and the environment in
which the individuals grew up (Lidz, 1975).
Karon and VandenBos (1981) provide a review and cri-
tique of the major studies which have attempted to assess the
effectiveness of psychotherapy with schizophrenic patients.
What emerges from this is that where the findings appeared
to demonstrate that psychotherapy was ineffective, the
therapists employed were either inexperienced overall, or
inexperienced in working with psychotic individuals.
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MENTAL ILLNESS 169
Furthermore, the belief of these therapists in the possibility

of the efficacy of psychotherapy was, in many cases, ques-
tionable. The Michigan State Project (1966) attempted to
overcome these difficulties by utilizing therapists experi-
enced in dealing with severe psychological disturbance, with
appropriate supervision. The results of the project demon-
strated that ‘psychotherapy produces significantly greater
patient change than medication’, that ‘in the long run, psy-
chotherapy costs less than treatment by medication’, and
that ‘it is a good thing for the therapist to be experienced
and to believe in the treatment he or she practises’ (Karon
and VandenBos, 1981: 453). Over and over again in the litera-
ture on this subject emphasis is laid on the importance of the
relationship between the therapist and the client, Fromm-
Reichmann going as far as to say that if a workable doctor–
patient relationship seems impossible with a psychotic
individual, ‘it is due to the doctor’s personality-difficulties,
not to the patient’s psychopathology’ (Fromm-Reichmann,
1952: 91). These experienced practitioners tell us that it is
possible to do psychotherapy with those who have a diagno-
sis of ‘mental illness’ – that there is meaning in the behaviour
and symptomatology of such clients – and that with skilled
therapeutic help these people can make sense of their world.
The current status of therapy and counselling

for the mentally ill
Despite the evidence that treatments other than orthodox
psychiatry can be very effective in working with severe men-
tal disturbances, attempts to offer anything that departs
from the interventions dictated by the prevailing ideologies
of the time – the straitjacket, the asylum, electro-convulsive
therapy or neuroleptic drugs – are like oases in a vast desert.
They have had little impact on medical orthodoxy.
Through the medicalization of mental disorders, and, as
we have seen, through the split in psychological theory
between neurosis and psychosis, a division has been created
Chap-05.qxd 2/13/04 10:07 AM Page 170
between those disorders which are considered amenable to

counselling and psychotherapy, and those which are not.
There is an almost universal assumption that the more
severe disturbances are outside the remit of the ‘talking
therapies’ and come under the jurisdiction of the medical
profession. The treatment of choice is usually drug therapy.
This has had the effect of accentuating the undesirability of
falling within the category of the ‘mentally ill’. In some
countries (the USA in particular) it is considered almost
fashionable to be ‘in therapy’. This is viewed by many as
indicative of psychological health and a high degree of self-
awareness. In the UK, being a recipient of counselling or
therapy is still seen by some as somewhat suspect, though
this is slowly changing. In all western cultures, however, the
response to those who are diagnosed with a severe mental
disturbance or mental illness or who are undergoing psy-
chiatric treatment is one of suspicion, fear, incomprehen-
sion and ‘otherness’. This has a profound impact not only
on the social response such people receive, but on their
prospects of establishing themselves in society in terms of
appropriate education, employment, housing or social
integration.
Within the state-run facilities in the UK, the provisions
for the severely disturbed are significantly under-funded at
all levels. Clinical psychologists have taken little interest in
the mad, compared with less disturbed clinical popula-
tions. As Pilgrim puts it, they ‘have sought to make a bid
for legitimacy to manage the “neurotic” population, leav-
ing madness to the medical profession’ (Pilgrim, 1990:
223). Research into madness and its treatment has always
had a biological slant, with psychotherapeutic approaches
being largely neglected. This is hardly surprising, since
most of the research money has been either supplied by
drug companies or, when research is state-funded, regu-
lated by committees dominated by psychiatrists. Both of
these groups have a vested interest in further legitimizing
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MENTAL ILLNESS 171
traditional concepts as to the possible causes and treatment

of the mental illnesses.
Many psychiatrists are fearful of working with drug-free
patients. Having drugged them, however, the treatment
that is offered usually consists of little more than a short
consultation on a sporadic basis, the main purpose of
which is to monitor the progress of the medication.
Paradoxically, and ironically, many counsellors and psycho-
therapists are disinclined to see clients who are on medica-
tion. This in effect places the severely disturbed in a position
where the only treatment open to them is drugs. Even if
they are strong-minded and well-informed enough to
refuse medication and attempt to access a counselling or
psychotherapy service, the likelihood is that they will be
turned away if they reveal ‘psychotic’ symptoms such as
hallucinations, hearing voices or paranoid thought pro-
cesses. The counselling and psychotherapy that is available
in this country through the National Health Service or
Social Service Departments can only be accessed through
GPs and psychiatrists. It is limited and will almost certainly
involve some degree of drug therapy. The many excellent
counselling services operating throughout the country per-
petuate the distinction between the ‘worried well’ and the
‘mad’. Very few of them will accept clients with severe dis-
turbances or a mental health history. Private psychothera-
pists and counsellors, while more often catering for such
clients, are by definition only available to those who can
pay for such treatment. As many studies have shown, one
of the more immediate effects of experiencing severe men-
tal disturbance is to reduce the individual to the lowest
socio-economic status.
It is hardly surprising, therefore, that the ‘mentally ill’
avoid, if at all possible, admitting to a mental health prob-
lem. Diagnostic labelling will stigmatize them permanently,
reducing their chances of social rehabilitation; psychiatric
treatment is seen as unhelpful and potentially damaging;
Chap-05.qxd 2/13/04 10:07 AM Page 172
and psychotherapy and counselling are by and large

unavailable to them.
Mental illness and other minority groups

Social inequality can be seen in terms of dimensions of
being, like gender, race, class, age and sexuality, which are
‘hierarchies of domination that limit and restrict some
people while privileging others’ (Williams, 1999: 29). These
hierarchies are centred on power relationships which bene-
fit one group at the expense of another. Thus the differ-
ences between social groups are not simply about differences
in life-style or cultural beliefs, but about fundamental
inequalities based on the exercise of power. Psychiatry has
been accused of abusing its power by removing or alienat-
ing social undesirables from the mainstream by virtue of
diagnosing them as mentally ill. Whereas there are un-
doubtedly historical instances when this has been a con-
scious process, it is by no means the stated or implicit aim
of modern psychiatry. Despite this, many would claim that
the outcome, intended or not, of psychiatric treatment is
often exactly that – the ostracism and social alienation of
those diagnosed with a mental illness.
There are, however, other ways in which the relationship
between mental illness and socially marginalized groups is
problematic. The theories that underpin the most widely
accepted forms of treatment for mental illness pay little
attention to the existence of structural inequalities in our
society. Attempts to explain the relationship between gen-
der, race, sexuality or social class and mental health/illness
very often focus on the individual’s pathology rather than
the experience of being part of a persecuted or repressed
minority. And yet studies have shown that mental illness is
more common in the socially disadvantaged groups
(Cochrane, 1983). What emerges, therefore, is a situation
where those people who are already a minority group and
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MENTAL ILLNESS 173
subject to discrimination and disadvantage, are more

susceptible to succumbing to forms of mental or psycho-
logical distress which will place them at further risk of
stigmatization and alienation – and this by virtue of their
original ‘out’ status. As Williams states unequivocally, there
is ‘little doubt that social inequalities – including those
based on gender, race and class – are a root cause of the
despair, distress and confusion that is named “mental ill-
ness”’ (Williams, 1999: 29). Discrimination is thus seen as
a direct cause of mental illness. Another dimension to this
process is that the very experience of being discriminated
against can make someone behave in ways that are per-
ceived by others (the dominant group) as strange, different,
or even ‘mentally ill’ (Littlewood and Lipsedge, 1989). In
other words, the responses that people may have to oppres-
sion are interpreted incorrectly as signs of mental dis-
turbance. Diagnosis and ‘treatment’ are then a way of
diverting attention from the inequalities and the oppression
and thus maintaining the status quo.
We have seen how those disorders judged to be the most
severe are those which are most likely to be treated with
physical interventions rather than with therapy or coun-
selling. There appear to be further distinctions made by
virtue of a person’s class, race, gender, sexual orientation
and other characteristics which might mark an individual
as outside the majority group. People from oppressed
groups are more likely to receive forcible treatment, and
more likely to receive treatment with drugs and ECT. This
includes women, people from black and minority ethnic
groups, lesbian women and gay men, and older people.
Service user groups have found that the majority of mental
health service users would prefer to have access to the ‘talk-
ing treatments’ – counselling and psychotherapy. Access to
such services is significantly affected by race, ethnicity and
social class. Those least likely to be referred for counselling
or therapy are older people, ethnic minorities, people with
Chap-05.qxd 2/13/04 10:07 AM Page 174
learning disabilities and those with serious mental health

problems. The outlook is bleak for those who fall into more
than one of these categories.
Gender
Women are more likely than men to be labelled mad. The
mass of empirical data reveals women’s dominance in the
psychiatric statistics. There are variations within this; for
example, women are far more likely to be diagnosed with
depression or affective psychosis, whereas for schizophrenia
the gender split is more or less equal (Cochrane, 1983;
Ussher, 1991). Men are more likely to be compulsorily
admitted for psychiatric treatment but women use psychi-
atric services more often and are prescribed twice as many
psychotropic drugs as men (Prior, 1999). Women are also
subjected to ECT treatment more often than men and, his-
torically, were more likely to receive psychosurgery such as
lobotomies (Ussher, 1991).
However, Prior draws attention to a changing trend; in
1991 men outnumbered women in psychiatric beds in
Britain for the first time this century, the result of a process
that began in the 1950s. As overall psychiatric bed num-
bers have decreased, the fall in the number of female
patients has been more rapid than that in males. Prior
explains this by a change in the conceptualization of men-
tal disorder which gives more prominence to an individ-
ual’s potential for dangerous behaviour – the perceived risk
to the public. As men are more likely to be diagnosed with
disorders which are associated with violent or disruptive
behaviour – personality disorders, alcohol or drug-related
disorders – they are more likely to be hospitalized (Prior,
1999). It could be, of course, that the stereotype of men as
aggressive informs the perception of the nature of the dis-
orders to which they seem to be more susceptible, rather
than the other way round. The fact that involuntary psy-
chiatric admissions are most likely to be young, black males
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MENTAL ILLNESS 175
would seem to support this notion. The association of

aggression with the stereotype of blackness as well as male-
ness has a long history. The picture that emerges is one
where legal powers are being used not just to ensure that
people receive treatment, but rather to protect the public
from a perceived risk – a perception, moreover, which is ill-
founded. The stereotypes which still prevail are that
women are mad, and men are mad, bad and dangerous.
Thus women receive psychotropic medication and men are
locked up, as evidenced by the fact that the psychiatric sec-
tions of the British prison system are occupied predomi-
nantly by men.
The fact remains, however, that when considering the
overall use of psychiatric services, women heavily outnum-
ber men. Feminist explanations for this fall into two cate-
gories: social causation and social construction. Social
causation theories argue that the very nature of the tradi-
tional female role sends women mad. Gender inequality is
endemic within society and within family life. Like other
social institutions the family persists in forms that serve the
interests of men, and often at women’s expense; marriage
is comparatively more beneficial to the psychological well-
being of men than women (Cochrane, 1983; Williams,
1999). The traditional gender role definitions of male domi-
nance and female submissiveness create a female suscepti-
bility to psychological problems. Women’s experience is
thus of a lack of control over their own lives, which is a
recognized factor in depression and other psychological
disturbances.
The social construction view of women and mental
health holds that psychiatric diagnoses are constructed by
men on women. A patriarchal society is unable to tolerate
female behaviour which challenges the norms of gender-
defined roles; such behaviour, therefore, is labelled mad.
This has the effect of locating the problem within the indi-
vidual, and distracts attention from the social reality of that
Chap-05.qxd 2/13/04 10:07 AM Page 176
person’s life. Arguments for social constructionism are

supported by evidence that the stereotype of mental illness
is analogous with the stereotype of femaleness, concepts
related to maleness being closer to those associated with
the general norm of psychological health (Cochrane, 1983:
49). Despite Freud’s ideas about the constitutionally bisex-
ual nature of human beings, with the construction of both
masculinity and femininity being seen as precarious, post-
Freudian theorizing has identified mental health with gen-
der orthodoxy, especially conventional heterosexuality and
marriage. Such formulations feed into the bias which
defines femininity itself as pathological. Jane Ussher cites a
study which demonstrated that, paradoxically, ‘women
who conform to the female role model, as well as those who
reject it, are likely to be labelled psychiatrically ill’ (Ussher,
1991: 168). In this study the stereotype of masculinity was
seen as the epitome of mental health – but only for men.
Women who are competitive, ambitious, independent, or
who reject the role of wife and mother, may be at risk of
being diagnosed as mentally ill. An example of how gender
stereotyping affects social and clinical assessments of
behaviour is in the expression of anger. Where anger might
be seen as an appropriate and normal aspect of behaviour
for a man, for women it can be seen as pathological.
Consequently, if a man expresses anger inappropriately, for
example through physical violence, he would be punished
by the legal system. A woman doing the same thing is more
likely to be sectioned.
Theories of social construction and causation are based
on a view of the respective positions of men and women
which are undoubtedly changing – there are social develop-
ments since the period of second-wave feminism which have
improved the position of many women in the western
world. But this is not true for all – social class plays a big
factor in this respect, the ameliorations in opportunity, edu-
cation and status being most felt by the wealthier sectors of
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MENTAL ILLNESS 177
society. Paradoxically there is now a growing group of such

women who appear to be experiencing greater stress as a
result of attempting to fulfil the roles of mother and home-
maker as well as that of career woman. There are also many
women who have not escaped from the ‘traditional’ female
role – or who, indeed, choose to embrace that role. Given
that gender inequality continues to exist throughout society,
and that psychiatric diagnosis has an inherent gender bias,
the feminist arguments continue to have validity today.
The implications of gender stereotyping can also have an
impact on men’s mental health. The stereotype of the
strong bread-winning male is still very evident in western
cultures. Being part of the dominant group (white, male,
heterosexual, etc.) makes it hard to challenge the values
and expectations of that group – you are unlikely to receive
support from other members of the in-group by doing so.
As Williams writes, ‘even if men think that masculinity and
the social and economic dominance of men might be a
problem, they receive very little encouragement from each
other to explore the implications’ (Williams, 1999: 37).
The male role is associated with success, strength, and the
ability to support both themselves and a family; status and
self-esteem are intimately connected with employment and
achievement. Failure to meet those expectations can have
severe consequences. Men who are unemployed, or retired,
are at far greater risk of depression and other psychological
problems than are women in the same situation. Men are
also less likely to seek help – another consequence of the
gender stereotype that men are strong and should be able
to cope on their own.
There is much debate about the diagnosis of ‘antisocial
personality disorder’, a label which men are far more likely
to acquire than women. This is defined as ‘the violation of
the rights of others and a general lack of conformity to
social norms’ (Robins and Regier, 1991). Many mental
health professionals regard this ‘condition’ as untreatable
Chap-05.qxd 2/13/04 10:07 AM Page 178
and it is often omitted from mental health statistics. Treating

such behaviour as ‘badness’ leads to judicial enforcement
and imprisonment; such a response is a symptom of a
patriarchal society’s intolerance of both male weakness and
social deviance. Treating such behaviour as ‘madness’,
however, is an inappropriate medicalization of something
which has more to do with the wider social context than an
individual’s pathology. Both responses fail to take into
account the implications of social deprivation and the
impact of gender stereotyping.
Race and culture

The presence of racism in western cultures clearly has an
effect on the mental health of the individuals within ethnic
minorities (see Chapter 2). Being part of a socially margin-
alized group and being subject to prejudice and discrimi-
nation impacts on the psychological welfare of such people
as well as on their opportunities for education, housing,
employment and justice. All these factors lead to poor self-
esteem, little social and political power, and low socio-
economic status. Internalized racism adds another element
to the process of dehumanization.
Western psychiatry and psychotherapy are products of
western culture. The history of psychological thought and
theory includes notions such as the innate inferiority of
black people, the benefits of slavery to the maintenance of
the mental health of black Americans, and suchlike. While
these ideas are patently discounted today, racism continues
to permeate current psychiatric thought and practice. In
both the US and Britain black people receive dispropor-
tionately high rates of diagnosis for the more severe mental
disorders, in particular schizophrenia. Furthermore, blacks
are over-represented among those patients who are com-
pulsorily detained and are more likely to be given physical
treatments rather than referred for psychotherapy
(Fernando, 2002: 121). Mental health studies conducted in
Chap-05.qxd 2/13/04 10:07 AM Page 179
MENTAL ILLNESS 179
the general population on both sides of the Atlantic have

found a lower prevalence of mental health disorders in black
groups than in other ethnic groups, and yet the statistics on
psychiatric diagnosis and admissions show completely the
opposite picture (Prior, 1999: 38). The implication is
inescapable that this has something to do with the relation-
ship between the predominantly white medical profession
and their black patients. As with the male stereotype, black
people (particularly black men) are seen as violent. Black
men are also viewed as unpredictable, lacking in insight and
difficult to relate to – all good reasons for compulsory deten-
tion and psychotropic medication, and counter-indications
for engaging with such a person in therapy or counselling.
A further element in the relationship between race, cul-
ture and mental disorders is the different ways in which
people both express distress and interpret distress in others.
The dominant western culture has specific notions about
how we manifest psychological and physical pain; the
application of these notions to those whose values and
ideas are culturally different can lead to gross misunder-
standings. Where the relationship between doctor and
patient is informed by racist ideology and stereotypical
notions engendering fear, the likelihood of a diagnosis of
mental illness is increased. Similarly, culturally specific
explanations and formulations of mental disorders can
have an impact on both treatment and outcome. In coun-
tries where schizophrenia is viewed as a disorder which,
after treatment, is cured, the outcome is far better than in
those countries, like Britain, where the diagnosis of schizo-
phrenia implies a lifelong disability with periods of remis-
sion (Cochrane, 1983; Warner, 1994). Although there are
difficulties in standardizing the interpretation of symptoms
and diagnosis in cross-cultural studies of schizophrenia, it
appears to be the case that the outlook for people diag-
nosed with this condition in the third world is considerably
better than for those in western cultures. Where the
Chap-05.qxd 2/13/04 10:07 AM Page 180
prevailing cultural belief is that people do recover from

schizophrenia then that tends to happen, but where the
prevailing belief is that it is an incurable disease then peo-
ple tend to enter into a long-term career of illness. The fact
that those so diagnosed in the west who reject the chron-
icity of their condition and their ‘mental patient’ status have
a better prognosis would provide further evidence for this.
In many African countries symptoms typically associated
with schizophrenia are seen as temporary afflictions caused
by external forces (supernatural or unknown). The indivi-
dual is not an outcast, does not deserve blame or punish-
ment and needs to be maintained in the community until
the symptoms pass. In western societies we are both less
optimistic regarding outcome and less tolerant of psychotic
symptoms. Despite the benevolent-sounding policy of
‘Care in the Community’, this is precisely what we do not
offer. Current or former psychiatric patients are isolated
and excluded by western cultures. And because of the
effects of racism and our unwillingness to attempt to
understand the different ways in which ethnic groups other
than our own may express and conceptualize psychological
and mental distress, such groups are heavily over-
represented in the population of psychiatric patients.
The process of ‘culturizing racism’ within psychiatry is
described by Fernando as a trap that many fall into because
of our reluctance to face up to our own racism. This is a
process whereby injustices and disadvantages suffered by
black and ethnic minorities are attributed to their own cul-
ture which causes them to behave in ways that are per-
ceived as unhelpful or self-defeating. Examples of this
would be by distorting patterns of illness (somatizing psy-
chological symptoms), being too ‘demanding’ or too ‘pas-
sive’ (exaggerating symptoms or not expressing them), or
not benefiting from treatment (communicating in ways
that psychiatry sees as ‘primitive’). In this way, Fernando
tells us, ‘the power of white over black is maintained because
Chap-05.qxd 2/13/04 10:07 AM Page 181
MENTAL ILLNESS 181
the explanations for “ethnic problems” are looked for in the

“alien cultures” and the blame for the problems is attached
to them – the “cultural aliens”’ (Fernando, 2002: 123).
Sexuality
As I discussed in Chapter 4, notions about the ‘pathology’
or ‘abnormality’ of homosexuality and lesbianism go back
a long way but received specific impetus with the growth of
psychological theory at the beginning of the twentieth cen-
tury. Modern society continues to find same-sex relation-
ships problematic, and despite the declassification of
homosexuality as a psychiatric disorder in 1973, the expe-
riences of many gay men and lesbian women is that the
medical profession, like the wider society, is unaccepting of
life-styles that are outside stereotypical notions of ‘normal’
male and female behaviour.
Although homosexuality per se was declassified, it was
replaced in the psychiatric classification systems first by
‘sexual orientation disturbance’ then by ‘egodystonic
homosexuality’ and most recently by ‘gender identity dis-
order’. Historically, homosexuals have been subjected to a
plethora of treatments in misguided attempts to change
their sexual orientation: ECT, brain surgery, castration and
hormone injections. The current situation is that any
attempt to change a person’s sexual orientation is deemed
unethical in the USA and highly questionable in Europe.
Theoretically, therefore, only if a person has problems with
his or her sexual orientation or identity should it come to
psychiatric attention. The problem remains, however, in
the assumption that any such difficulties are due to indi-
vidual pathology rather than social intolerance. If ‘gender
identity disorder’ is an official mental illness, then, in psy-
chiatric terms, it is seen as residing within that individual’s
mind, brain, genes or biochemistry.
Like other minority groups, gay men and lesbian women
are exposed to the stresses associated with social ostracism
Chap-05.qxd 2/13/04 10:07 AM Page 182
and prejudice. Being brought up in a society which has a

predominantly negative view of sexual orientations other
than heterosexuality can lead to internalized homophobia
and a negative self-image. Unlike the factor of race, a per-
son’s sexual orientation is not immediately visible and
apparent to others. The process of ‘coming out’ is in itself
potentially stressful and requires a major shift in personal
identity. Many gay men and lesbian women choose to
‘pass’ as straight in certain situations to avoid discrimina-
tion, particularly in the workplace, which creates a confus-
ing and difficult double life. Whereas gay men and lesbian
women do not wish to have their sexual orientation med-
icalized, there is a growing demand for their difficulties to
be acknowledged. There are significantly higher rates of
depression, substance abuse and attempted suicide among
lesbians and gay men than among heterosexuals in both the
USA and the UK (Davies and Neal, 1996; Herek, 1998).
If we discount the possibility of inherent psychopathology
within the homosexual population, then this is likely to be
due to the heterosexism and homophobia in society at
large, and the effects it has on those outside the heterosexual
norm.
As sociological and socio-cultural theories about mental

illness demonstrate, the incidence of psychological distress
is closely associated with such factors as low socio-
economic status, poverty, lack of support, poor educational
and occupational opportunities or absence of material and
financial independence. All research shows a consistent
inverse relationship between wealth and mental disorders.
The experience of being in a minority group, whatever that
may be, is likely to increase the probability of an individ-
ual’s being exposed to any or all of these sociological fac-
tors. Should they then become in any way mentally
disturbed and, in addition, receive a psychiatric diagnosis,
they will have achieved the dubious honour of having
acquired double minority status.
Chap-05.qxd 2/13/04 10:07 AM Page 183
MENTAL ILLNESS 183
What appears to be lacking in mainstream mental health

services is a recognition of the significance of wider social
factors on the mental health problems of those they treat.
As with the lunacy policies of the nineteenth century, the
mental health policies of the twentieth and twenty-first
centuries have consistently reinforced the hierarchical divi-
sions between rich and poor, men and women, hetero-
sexuals and homosexuals and between majority and
minority racial groups.
Chap-06.qxd 2/12/04 6:03 PM Page 184
6 Conclusion
I T I S I R R E F U T A B L E T H A T T H E situation for
all minority groups, socially, politically and eco-
nomically, has improved significantly over the last fifty
years. All too often, however, such improvements are seen
as obviating the necessity for further social action. Relative
progress is mistaken for an indication that inequalities and
injustices in the form of discriminatory attitudes and prac-
tices no longer exist or need to be addressed. Despite the
manifest amelioration in the situation of people for whom
an element of their being or experience puts them outside
the social mainstream, there is still an unacceptable level of
prejudice and discrimination meted out to such people in
all areas of their lived experience. To ignore that, or to pre-
tend that it does not exist, simply adds to the injustice.
One of the things that emerges from my examination of
various aspects of an individual’s identity which have the
potential to attract prejudice and adverse discrimination is
the problematic way in which we use language within this
context. Despite the fact that in many instances there is
considerable doubt about the validity or relevance of strict
distinctions between groups that are perceived as different
in some respects, the language we use to describe such dif-
ferences has the effect of fostering the impression of huge
unbridgeable gulfs between the people in whom they are
located. Thus we talk about ‘black’ and ‘white’ people
when we know that many, if not all, of us are of mixed
Chap-06.qxd 2/12/04 6:03 PM Page 185
CONCLUSION 185
descent, our ancestors possibly originating in many different

cultural and racial traditions. Similarly, we use the terms
‘heterosexual’ and ‘homosexual’ as though they indicated
two definitively separate groups. In fact people’s sexual
experiences, inclinations, practices and fantasies span a far
wider spectrum than these terms alone imply. ‘Sanity’ and
‘insanity’ too are set up as dichotomous states, with little
cognizance given to the vast area between them, a place
which many of us inhabit much of the time. Likewise
gender is perceived as a polarity, with considerably more
emphasis being laid on the differences and distinctions
between men and women than on their similarities, or on
the fact that we are all a blend of the stereotypical ‘male’
qualities and attributes and the stereotypical ‘female’ ones,
regardless of our actual gender.
My belief is that we use language in this way precisely
because of the need to categorize, fix, encapsulate those
elements of being which we find disturbing or threatening.
By creating firm divisions between groups in this way there
is the implication that the boundaries are impermeable and
the ‘otherness’ is ‘out there’. Identity is fundamentally rela-
tional – at base it boils down to ‘me’ and ‘not me’. If I am
white, then I cannot be black. If I am sane, I cannot be
insane. If I am heterosexual, I cannot be homosexual. If
I am female, I cannot be male. In this way we attempt to fix
and affirm our sense of identity and blind ourselves to the
complexities of being of which we are all composed. Being
confronted with another person who embodies ‘otherness’
is therefore alarming and has the potential to undermine
our shaky sense of confidence in who we think we are.
One response to this discomfort with difference is the
attempt to make the ‘other’ more like us. This can be seen
in calls for immigrants to ‘assimilate’ and ‘integrate’ – to
give up their cultural practices and religious beliefs and
adopt the customs and life-style of the majority group. It is
also evidenced in the view that sees homosexuality as an
Chap-06.qxd 2/12/04 6:03 PM Page 186
aberration, something to be overcome or ‘cured’, thus

returning the individual to the ‘normal’ state of hetero-
sexuality. Interestingly, it is also evident in certain elements
of feminist doctrine, where emphasis is laid on succeeding
in a man’s world by being as much like men as possible,
and denying or denigrating ‘feminine’ attributes.
Another, more covert, response is to adopt an attitude
whereby we deliberately, or unconsciously, ignore differ-
ences. In an interpersonal encounter we may choose not to
register another person’s skin colour, or to disregard their
homosexuality. On one level this can be seen as laudable –
we are acknowledging our shared humanity rather than
focusing on those elements which could be perceived as
marking us out as different from one another. However,
this response also has the effect of ignoring or denying an
important part of the other person’s identity. This is a
response which I suspect occurs frequently within therapy
and is often clothed in respectability by calling it ‘being non-
judgemental’ – a stance which most therapeutic models
would hold up as a goal for the practitioner to strive for, but
which can be misunderstood as meaning ignoring those
elements of another person’s being which provoke judge-
ment. I suspect that what underlies this type of response is
the desire to relate exclusively with those aspects of the
other with which we can resonate or identify – partly
because that has the effect of reinforcing our own identity,
and partly because those elements we are ignoring are the
ones that have the potential to make us feel uncomfortable,
anxious or threatened. In effect, this response is the direct
opposite of that which sees a person as characterized only
by their element of difference – their race, or gender, or
sexual orientation – and takes that to be the sum total of
their identity. Either extreme fails to take account of the
person in their totality, and as such diminishes them and
restricts the possibility of our relating with them on all
levels of their being.
Chap-06.qxd 2/12/04 6:03 PM Page 187
CONCLUSION 187
When any of these responses take place in a social

encounter they can be experienced as exclusionary, patroniz-
ing or downright discriminatory, depending on the extent
to which they are conveyed or perceived. When they take
place within counselling or psychotherapy the implications
are, in my view, far worse. At the very least they would seri-
ously undermine the potential for any effective therapy to
occur. At worst they could be experienced as demeaning or
abusive.
The language we use, therefore, has the effect of categor-
izing and pigeon-holing people into groups. Groups are
assigned worth and importance to varying degrees depend-
ing on a variety of factors, not the least of which is the
judgement of what is ‘normal’, ‘acceptable’ or ‘natural’.
Such words appear, at first glance, to convey some objec-
tive standard. In fact what they usually mean is the behav-
iour, beliefs, attitudes and values of the majority group.
Within all societies there exist established social categories,
the maintenance of which is in the interests of the largest
group of people. For this reason society is always preju-
diced towards the protection of established categories and
resistant to their being threatened. That such an arrange-
ment is to the detriment of any minority group is self-
evident – in a sense social inequalities structure society, and
are also deeply embedded in our personal identities.
The need to be aware of these issues is particularly
pertinent for anyone within the field of counselling and
psychotherapy precisely because these are enterprises which
lay claim to providing a service which enables people to
address the full scope of their personal issues and examine
all aspects of their being; they also purport to do so within
the context of an objective, accepting and non-judgemental
professional relationship. If, as I have suggested, these
activities are themselves blinkered by unacknowledged
prejudices and limitations, and are informed by theories
and attitudes which are in fact reflective of only one sector
Chap-06.qxd 2/12/04 6:03 PM Page 188
of society, that is to say the majority or mainstream, then

those of us involved in these professions have a duty, at the
very least, to acknowledge these limitations, or, preferably,
to attempt to address them.
One of the things that emerges clearly from my research
into the treatment of difference within counselling and
psychotherapy is the extent to which the theories on which
these activities are founded are themselves infused with
concepts which perpetuate the normative values of the
majority social group – that is to say white, western,
middle-class and heterosexual. Although many of the early
theories also carry a sexist (that is, male-oriented) bias, within
contemporary practice the emphasis is decidedly in favour
of ‘female’ qualities and modes of expression, to the detri-
ment or even denigration of ‘male’ attributes. The danger
lies in the fact that not only are these biases largely unrec-
ognized, but the theories and practices enshrined within
psychotherapy and counselling, and passed on within their
training courses, are presented as a kind of universal psycho-
logical template or blueprint, applicable to all people regard-
less of their individual circumstances in terms of social
position, race, culture or life-style choices. The fact that
psychotherapy and counselling training courses fail to
attract (or fail to accept?) students from all minority groups
(and in this context I would define men as a minority
group), and that such groups are also significantly under-
represented as clients of counselling and psychotherapy
would seem to confirm that such biases are indeed in oper-
ation and that there is a lamentable failure on the part of
psychotherapy and counselling to meet the needs of the
individuals in these groups.
As I discussed in the first chapter, the process of dis-
criminating, making comparisons and choices and distin-
guishing our preferences is something we all engage in all
the time. It involves an awareness of similarities and differ-
ences; it also involves judgements based on these distinctions
Chap-06.qxd 2/12/04 6:03 PM Page 189
CONCLUSION 189
as well as on our individual tastes, views and moral values.

The vital factor is to be aware of the judgements and
choices we are making and also to be aware of the criteria
on which those judgements are based.
As counsellors and psychotherapists it is essential to be
aware in several distinct and interlocking areas. Firstly, we
need to be aware of the social influences that have inevitably
impacted upon us. By virtue of growing up in a society
which is infused with notions which are prejudiced against
certain groups perceived as different, our environmental
heritage inevitably contains elements of sexism, hetero-
sexism and homophobia, racism and other discriminatory
attitudes towards minority groups. We need to be aware of
our own internal prejudices and accept that, like many
aspects of who we are, it may not be possible to completely
eradicate them. However, being aware of the capacity they
have to affect our responses to others allows us to make
choices which override them.
Secondly, we need to inform ourselves of the experiences
of those people who are outside the social mainstream. We
need to find out about their life-styles, and the difficulties
they encounter by virtue of being in some way different
from the majority – difficulties which, if we are part of that
majority ourselves, we have never personally encountered.
Thirdly, we need to be aware of the limitations endemic
within the theories and practice of psychotherapy and
counselling. Only if we are aware of the normative bias
within the tenets of many psychotherapeutic models will
we be able to challenge and transcend such a bias.
Fourthly, we need to be aware of the various dimensions of
difference that can exist between practitioner and client:
gender, race, culture, class, age, sexual orientation, mental
and physical capacity. We need to be sensitive to how such
differences impact on the therapeutic relationship and be
willing to address these issues with our clients appropri-
ately, owning the elements we ourselves bring to the
Chap-06.qxd 2/12/04 6:03 PM Page 190
encounter and in full cognizance of the attitude of society

at large.
Finally, I would urge all practitioners of psychotherapy
and counselling and all students training to become practi-
tioners to adopt a questioning and critical stance to the
theories and ethos of their training and the institutions and
facilities in which they work. Individually we need to con-
front and challenge the normative and prejudiced influ-
ences to which we are subjected in order to ensure that we
do not bring those either to our work or to our social
encounters. The goal has to be that of recognizing the value
of difference, eschewing the assumption that different means
worse, or less than, or incomplete or abnormal. On the
contrary, we need to acknowledge that differences add
richness, complexity and variety and as such should be
embraced.
Bibliography.qxd 2/12/04 6:01 PM Page 191
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Index.qxd 2/12/04 6:03 PM Page 201
Index
abortion, 77 biological determinism, 15, 44,

Adam and Eve, 72 55, 82–5
age of consent, 115 Black Death, 26
Agnews Project, 167 blackness, 27–8, 35, 47, 175
AIDS, 113–14 Bleuler, Eugen, 161
Alibhai-Brown, Yasmin, 9, 48–9 Bleuler, Manfred, 139
alienation, 57, 145, 172–3 Bowers, Len, 155–6
Ambrose, St, 72 Bowlby, John, 62, 77
American Journal of Psychiatry, 159 Breggin, Peter, 147
American Psychiatric Association, Britain
112, 138, 160 facilities for the mentally ill, 170
anger, 176 gender relations, 79–82
Anglican Church, 116–17 racism, 27, 39–44, 52
anthropology, 31, 71 British Association for Counselling
anti-psychiatry, 156 and Psychotherapy (BACP), 64
anti-Semitism, 22–3, 26, Code of Ethics (1998), 1–2
35–8, 49–50 Ethical Framework for Good Practice
apartheid, 38 in Counselling and Psychotherapy
Arendondo, P., 69 (2002), 1–2
artificial insemination by donor British Journal of Psychiatry, 151–2
(AID), 81 British National Party (BNP), 41, 66
assimilation, 39–40, 49, 185 buggery 106
asylum seekers, 43 Burgess, Guy, 111
asylums for the mentally ill,
141–5, 158 capitalism, 45, 157
attachment theories, 62 Care in the Community, 149, 180
Carter, Robert, 44, 56, 65–7
Banton, Michael, 23, 30–1 Catholic Church, 27
Bass, E., 95 Chaplin, Jocelyn, 96, 99
Bateson, G., 162, 168 Christianity, 26–7, 47, 72,
Becker, Howard, 157 104–7, 140, 142
Bedlam, 141 chronic conditions, 180
Bennett, D., 150 civil rights movement, 36
Berke, Joseph, 167 Clare, Anthony, 81, 86–8
Biddiss, M., 32 Cochrane, R., 158–9
‘colorism’, 48 ‘double-bind’ mechanism, 162

‘colour blindness’, 53–4, 68 drug treatments, 147–9, 168, 174
‘coming out’, 117, 130, 134, 182
Commission for Racial Equality, 41 ego concept, 61, 161
communalism, 60 Eichenbaum, L., 89
community treatment orders, 151 electro-convulsive therapy (ECT),
contraception, 77, 79 146, 181
Cooper, David, 167 Elizabeth I, 27–8
Cornforth, Sue, 59 Enlightenment philosophy, 28,
criminal injuries compensation, 116 33, 106
cultural beliefs, 179–80 Equal Opportunities
cultural values, 60 Commission, 77
culture shock, 56 ethical issues, 1–2, 153
Curtin, P., 29 ethnic cleansing, 38
ethnocentrism, 23
d’Ardenne, P., 59, 61 eugenics, 33, 37–8, 123, 145–6
Darwin, Charles, 32–3 evolutionary psychiatry, 83–4
Darwinian theory, 108; see also
social Darwinism family relationships, 62, 67–8,
Davies, D., 121, 132–5 77, 106, 130–1, 135,
Davis, L., 95 162–3, 175
Dawkins, Richard, 17 family therapy, 168
degenerationism, 145–6 ‘family values’, 113
dementia, 147 Fanon, Frantz, 52, 66
depression, 92, 130, 147, 155, fear
159–60, 164, 174–7, 182; see also of difference, 131, 151, 164–6
manic-depression and racism 51–2
Descartes, René, 142 feminism, 70, 76–9, 83, 86–91,
determinism 95, 97, 112, 126, 175,
biological, 15, 44, 55, 82–5 177, 186
scientific, 108–9 Fernando, S., 180–1
social, 15 Foucault, Michel, 117–18,
deviance, 157, 163–4, 178 120, 143
DeVos, G., 61 Franklin, Karen, 128
Diabasis project, 167–8 Frederickson, G., 22–3, 34, 36, 43
Diagnostic and Statistical Manual of French Revolution, 33, 76
Mental Disorders (DSM), Freud, Sigmund, 87–8, 99, 109–10,
138, 160 122–3, 131–2, 146, 161, 164,
discrimination, 6–9, 13–20, 184 166, 176
as a cause of mental illness, 173 Fromm-Reichmann, Frieda,
on grounds of sexuality, 79, 166–7, 169
112, 115, 128
racial, 21–5, 40–1, 50, 56, Galen, 160–1
68, 178 Galton, Francis, 33
religious, 26 gay affirmative therapy, 133
dissidents, political, 160 gay identity, 125
divorce, 74–8 passim gay liberation movement,
dopamine, 154 110–16, 124
INDEX 203
gender, meaning of, 82 humours, 140

gender identity, 82, 84; see also hypnotism and hypnotherapy, 144
sexual identity
gender identity disorder, 181 identity
gender relations concept of, 8–11
in contemporary Britain, 79–82 personal sense of, 12–14, 82, 185–6
in counselling and psychotherapy, western idea of, 60; see also western
90–100 culture and western values
history of, 71–9 see also gender identity; group
and mental illness, 174–8 identity; racial identity; sexual
theories of, 82–90 identity
genetics, 48, 57, 83, 119–20, 155 immigrants, 36, 39–41, 52, 56,
Germany, 37, 110 145, 185
Gobineau, Arthur de, 32 individualism, 60
Goffman, E., 158 International Classification of Diseases
Gottesman, Irving, 154–5 (ICD), 138, 160
Goulbourne, H., 54 ‘inversion’, 119
Great Chain of Being, 29
Greater Manchester Police, 42 Jeffery-Poulter, S., 113
Greek civilization, 25, 28–9, 72, Jessel, D., 84–5
104, 128, 140 John, Jeffrey, 116–17
group identity, 12–13, 53 Jones, E.E., 56
Judaism, 26
Haley, J., 162 Jung, Carl Gustav, 99, 161
Halperin, D., 115
Harris, Virginia, 48 Kareem, J., 62, 65, 68
Herder, Gottfried von, 37 Karon, Bertram, 165–9 passim
heredity, 33 Kertbeny, Maria, 103
Herrnstein, R.J., 44 Kingsley Hall, 167
Hinduism, 61 Kinsey Report (1948), 111, 117
Hippocrates, 140 Krafft-Ebing, Richard von, 103, 108, 118
Hitler, Adolf, 32, 37
Holmes, C., 43 labelling, 157–8, 171
Holocaust, the, 36–8 Laing, R.D., 156–7, 167–8
homophobia, 110–17 passim, Laungani, P., 61
128–35 passim Lawrence, Stephen, 42
in counsellors and learned helplessness, 92
psychotherapists, 135–6 Lerner, Gerda, 71, 87
internalized, 130, 133, 182 lesbianism, 78, 101–17 passim,
homosexuality, 102–3, 185–6 121–36 passim, 181–2
explanations of, 119–20 as a political statement, 126
history of, 103–14 Lidz, Theodore, 168
as an identity, 125 Linnaeus, Carolus, 29
in relation to counselling and Lipsedge, M., 51, 57
psychotherapy, 127–36 Littlewood, R., 51, 57–8, 63, 65–7
Horney, Karen, 88
Hsu, F.L.K., 61 McCarthy, Joseph, 111
Human Genome Project, 48, 153 McDivis, R.J., 69
Maclean, Donald, 111 multiculturalism, 16, 39–40

Mahtani, A., 59, 61 Murray, C., 44
Mair, David, 132 Muslim communities, 43, 52
manic-depression, 146, 148,
154–5, 157 Nafsiyat intercultural therapy
marriage, 73–4, 105, 175–6 centre, 64
Marsella, A.J., 61 National Front, 41, 44
masturbation, 107 National Health Service, 94, 171
matching of therapists to nature/nurture debate, 14, 82
clients, 134–5 Nazism, 37–8, 110, 146
matriarchal societies, 71 Neal, C., 121, 133–5
Members of Parliament, 42, 80 neuroleptic drugs, 147–8, 168
Menn, A.Z., 168 neurosis, 155, 157, 169
mental illness, 55–8, 65, 86, ‘noble savage’ concept, 30, 49
92, 137–83
contemporary treatment of, 149–53 oedipus complex, 123
current status of therapy and ‘one-drop rule’, 47–8
counselling for, 169–72 Orbach, S., 89
degenerationist model of, 145–6 Othello, 28
and discrimination, 173 otherness, 13, 46, 51, 126–7,
and gender relations, 174–8 164, 185
history of treatment of, 139–49
institutionalization of, 142–3 paedophilia, 115
legislation on, 150–1 Palmer, S., 61
medical model of, 143, 152–6, 163 paresis, 145, 154
and other minority groups, 172–82 paternalism, 54–5, 107–9
psychological theories of, 160–4 patriarchy, 72, 74, 95, 113, 128,
in relation to counselling and 175, 178
psychotherapy, 164–72 penis envy, 88
socio-cultural models, of 156–60 personality disorders, 152–3,
statistics of, 177–8 174, 177–8
theories of, 153–64 ‘perverse triangle’, 162–3
mesmerism, 144 phallocentrism, 88
Michigan State Project, 169 Philadelphia Association, 167
Miles, Rosalind, 72, 74 Pilgrim, D., 147, 170
Mind, 151–2 Pink Therapy, 133
minority groups, 9, 17, 36, 40, Pinker, Steven, 16–17, 87
54, 181–2, 184, 187 policing, 42, 128
counselling and psychotherapy political correctness, 53–5, 66,
for, 58–62, 67–8 116, 125–6, 137–8
sexual, 111, 116, 126 Porter, Roy, 143, 145
misogyny, 92 Powell, Enoch, 41
Moir, A., 84–5 power relationships, 172
‘moral therapy’, 143–4 prejudice, 9, 17, 184
moral values, 188–9 against the mentally ill, 152
Morris, I., 150 in counselling and psychotherapy,
Mosher, L.R., 168 6–8, 19–20, 132–6, 187, 189
Mosse, George, 28, 38, 50, 110 racial, 21–5, 43, 46, 53–4, 59, 178
INDEX 205
prejudice, cont. same-sex couples, 115–16, 129, 181

sexual, 102, 111–12, 181–2 sanity and insanity, concepts of,
in society, 187–9 163–6, 185
Price, J., 83 scapegoating, 156–7
Prior, P.M., 174 schizophrenia, 146–8, 154–68
prison system, 175 passim, 174, 178–80
prolonged-sleep therapy, 146 scientific determinism, 108–9
psychiatric hospitals, 148–50, 174 Scull, A., 148
psychiatry, 55, 144–7, 153, 157, Section 28 (of Local Government
172, 178 Act 1988), 113–14
psychoanalysis, 50–1, 58, 63, Sedgwick, P., 141, 157
87–90, 94, 109, 122–3, 127, self, concept of, 61
132, 146, 153, 161, 163, 166 self-awareness, 58, 67, 170
psychodynamic theory, 127 of counsellors and psychotherapists
psychosexual development, 88–9, 1–2, 98, 132–3, 167
123, 131, 161 self-identity, 157–8
psychosis, 157, 161–9, 180 self-image, 130, 182
psychosurgery, 146, 174 Seneca Falls Convention, 76
psychotropic drugs, 147–8, 174, 179 September 11th 2001, events of,
purity movement, 107 43, 52
Serban, G., 159
race, meaning of, 21–2 Sex Discrimination Act, 77
Race Relations Acts, 40–1 sexism, 188
racial identity, 65–8 sexology, 108–10, 118–22, 136
racism, 36, 38, 50–2, 178–80 sexual identity, 82, 101, 109–10,
in Britain, 27, 39–44, 52 121–9, 182; see also gender identity
in counselling and sexuality, 74–7, 101–36, 181–2
psychotherapy, 69 concept of, 101, 108, 124
history of, 25–41 essentialism with regard to,
ideology of, 28, 34–9, 44 119–20, 123
institutional, 42 in relation to counselling and
internalized, 66, 78 psychotherapy, 127
‘scientific’, 31–7 passim theories of, 109–10, 117–27
societal, 34, 36 see also psychosexual development
Reagan, Ronald, 113 shock treatments, 146
Regier, D., 177 Sketchley, J., 135
religion, 26, 72–3; see also slavery, 25–6, 33–6, 55, 178
Christianity; Hinduism; social activism, 53–4
Judaism social conditioning, 83, 86
The Retreat, York, 143–4 social constructionism, 15, 120,
Robins, L., 177 160, 175–6
Robinson, Gene, 117 social control, 20, 106, 157, 164
Rogers, Carl, 58 social Darwinism, 83
role models, 134 ‘social drift’ hypothesis, 159
Roman civilization, 25, 28, 72, social inequality, 172–3
103, 140 social reality, 1, 175–6
Rose, Chris, 99 social regulation, 144
Rowbotham, Sheila, 77 Social Service Departments, 171
socialization, 59–60, 66–9, 92, 83–4 tranquillizers, 147

sociobiology, 44, 119 transference relationships, 166
sodomy, 105–6 trepanning, 139
somatic psychiatry, 153 Triandis, H., 61
Soteria House programme, 168 twins, mental disorders in, 155
South Africa, 38
Soviet Union, 160 Ulrichs, Karl Heinrich, 103
stereotyping, 19, 35, 38, 45, 49–50, 67 United Kingdom see Britain
on the basis of gender, 77, 80–1, United States, 34–6
85, 91–3, 96, 111, 128–9, Usher, Jane, 176
176–8, 185
of mental conditions, 151, 176 VandenBos, Gary, 166, 168–9
racial, 175, 179
sterilization, 145–6 Warner, Richard, 149, 159–60
Stevens, A., 83 Weeks, Jeffrey, 109, 113, 120, 124
stigmatization, 158, 173 western culture and western values,
Stoller, Robert, 83 59–61, 64, 69, 179–80
Stonewall Rebellion (1969), 112 Westphals, Karl, 103
stress, 158–9 whiteness, 27–8, 47
Sue, D.W., 69 Williams, J., 172–3, 177
suicide, 130, 182 Wilson, E.O., 44, 83, 119
Sullivan, Harry Stack, 162, 166 Winnicott, D.W., 77
syphilis, 145, 154 witchcraft, 141, 157
Szasz, Thomas, 141, 156–7 Wollstonecraft, Mary, 76
women
talking therapies, 170, 173 as counsellors and
tardive dementia and tardive psychotherapists, 93–7
dyskinesia, 147 differences from men, 86–7
Taylor, Damilola, 42 and mental illness, 174–5
Thatcher, Margaret, 113 status of, 15–16, 70–81, 92
therapeutic relationship, 134, women’s movement, 76–7, 114
165, 189 World Health Organization, 138
gender in, 95–100 world-views, 60, 97, 134–5
training of counsellors and
psychotherapists, 69, 93–4, Young, V., 134
131–2, 135–6, 188, 190

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What is the book about?

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3146-Prelims.

qxd 2/12/04 6:00 PM Page i

Difference and Discrimination in

Other titles in the School of Psychotherapy and

The Heart of Listening

Heidegger and the Roots of Existential Therapy

Difference and Discrimination in

© Sue Marshall 2004

First published 2004

Apart from any fair dealing for the purposes of research or

SAGE Publications Ltd

SAGE Publications Inc.

SAGE Publications India Pvt Ltd

British Library Cataloguing in Publication data

A catalogue record for this book is available

ISBN 1 4129 0117 0

Library of Congress Control Number: 2003115331

Typeset by C&M Digitals (P) Ltd., Chennai, India

General Introduction to The SPC Series ix

1 Discrimination, Difference and Identity 5

2 Race and Culture 21

5 Mental Illness 137

A brief overview of SPC

Although its origins lie in an innovative study programme

x DIFFERENCE AND DISCRIMINATION

and Counselling, and this has been validated by City

GENERAL INTRODUCTION TO THE SPC SERIES xi

able skilfully and ethically to apply the methods of

The integrative attitude of SPC

The underlying ethos upon which the whole of SPC’s

xii DIFFERENCE AND DISCRIMINATION

The SPC Series

The SPC Series seeks to provide readers with wide-ranging,

P ROFESSOR E RNESTO S PINELLI

I F I WERE TO TRACE BACK THE thoughts,

xiv DIFFERENCE AND DISCRIMINATION

work in helping with research and typing has made the

2 DIFFERENCE AND DISCRIMINATION

commonly referred to in the trade as ‘self-awareness’. I

returned the questionnaire were willing to supply this

4 DIFFERENCE AND DISCRIMINATION

but on the grounds of pragmatism and lack of space. I was

6 DIFFERENCE AND DISCRIMINATION

it universally one of condemnation and rejection. I would

DISCRIMINATION, DIFFERENCE AND IDENTITY 7

fair-minded, accepting of all humankind. How, then, do we

8 DIFFERENCE AND DISCRIMINATION

to a position of total impartiality which I suspect conceals

DISCRIMINATION, DIFFERENCE AND IDENTITY 9

who are in the majority group for most elements of social

10 DIFFERENCE AND DISCRIMINATION

granted, you are not allowed to because you are constantly

DISCRIMINATION, DIFFERENCE AND IDENTITY 11

concept can only make sense in the context of recognizing

12 DIFFERENCE AND DISCRIMINATION