Structural Violence
by Adam Gaubinger, MSW, LSW
In my clinical work as a social worker, I join many other social workers in a commitment to listen for the structural forces that co-constitute my patients’ intersubjective and intrapsychic experiences. But I also struggle with how to work with that material once it emerges in session in ways that will be curative and not harmful. In social work training, we often discuss working with structural forces and power differences by naming them and the ways in which they are showing up in the room. But how does this intervention fit within the general theory of what is curative for our clients? I believe that therapy is curative by offering a safe enough relationship and environment to bring painful conflicts (and the histories that helped to create them) into awareness to allow for healing. Within that theory, what work does naming structural forces actually do inside my office? Is it more often liberatory or violent? Is it for me or is it for my patient?
For me, these questions are informed by my position as a clinician who directly benefits from the history of American settler colonialism and chattel slavery. These histories and the advantages they give me are one part of my identification with and use of the historically sedimented force of whiteness. And many of the patients I work with have been harmed by exactly the histories that contribute to my privileges. These histories live inside of us and are acted out between us moment to moment in the clinical encounter. They are also ones in which the mental health profession, including our use of tools like the DSM, is deeply implicated. Again then, within this context, what work does naming do? In attempting to think through this dilemma, and to better work with structural forces within my office, I have recently begun to consider how the act of naming may often actually be one of disavowal that inhibits my patients’ possibilities for healing.
In Capitalist Realism, Mark Fisher (2009) builds on Slavoj Žižek's argument that ideological critique of capitalism functions to perpetuate capitalism and its violences. This is done through an overvaluation of internal beliefs as opposed to actual changes in behaviors and their attendant impacts. “So as long as we believe (in our hearts) that capitalism is bad, we are free to continue to participate in capitalist exchange” (p. 13). In my office, this disavowal functions such that I, as an aware clinical social worker, can be awake to and actively naming the harms that capitalism unleashes on my patients while still providing care that is supposed to be curative of those harms squarely within the confines of that same capitalism (i.e., private 50-minute sessions either paid for by insurance companies or on a sliding scale). I am working within the exact trap that is making my clients sicker and often in ways in which I benefit from the accumulation of capital that harms them (as, for example, someone who is paid by an insurance company that has denied them care, or has stocks in a 401k seeing patients harmed by exploitative corporate labor practices). And yet, because we share the critique of the system, I do not feel personally implicated in their sickness and can maintain my role as their healer.
There is a similar disavowal that functions around race, as well, as Sarah Ahmed argues in Declarations of Whiteness: The Non-Performativity of Anti-Racism (2004), wherein the allegedly “good practice” of white people naming whiteness and declaring one’s racism does not actually challenge racism but instead reproduces white privilege. It does so by creating a good, anti-racist us (people who are aware of the invisibility of whiteness and can name it) versus a bad, racist them (unaware white people who are unconsciously racist). In my clinical work, this looks like: If I am naming whiteness in the clinical encounter, then I am positioning myself (at least in that moment) as one of the good people who realizes and opposes racist structures, as compared to the other “racist" white people out there who do not. Therefore, naming race and whiteness alone, which is what we are basically trained to do, is not curative of the harm that whiteness unleashes on my patients. Instead, in the moment of the utterance, it disavows my role in that harm. In both cases, while naming structural oppression often feels critical to helping patients understand a certain structure of feeling, the impact can be that it enables me, as the clinician, to disavow the actual harms of the systems named by creating distance between the clinical encounter and the impact of the structures on the client’s life.
An Example
This is a small piece of process taken from a case. Because of space limitations and to protect confidentiality I will only reproduce the basic outlines of the patient. The patient is a child of parents who have both fled violence in their countries of origin and moved to the United States. He had a financially precarious childhood and is a member of a structurally disadvantaged, racialized group and religious community. This is the start of a weekly session several months into treatment:
“I had a good weekend, finally got paid. Joys of money, joys of late stage capitalism!”
“Hah, right!”
“And so I was out at the club and buying everyone drinks and it was such a good time…. but then I got pissed off at my friends. I hate how these white guys are always asking me about Islam and being brown. White people can be so f***ing unaware.”
“I’m white, too. I wonder how that feeling with your friends might show up here between us.”
“Nah! You’re not like my friends! You haven’t done anything racist.”
In this moment, in my attempt to bring my patient's experience into the room by naming myself as white and potentially racist, I close the space in the clinical encounter for my patient to discuss his experiences of race and other structurally violent forces emerging in the moment of the club and the session. Rather, it positions me as aware of my whiteness and potential racism as different from his “unaware” friends and then enlists him in confirming that false narrative. In doing so, I re-create the harm he is stating—I am also “asking him about being brown.” Putting whiteness forward in the moment is not anti-racist; in fact, it enacts white supremacy, as my whiteness is treated as the most salient force in the session. As a result, I neglect the experience of needing to be paid, the club, of competitive masculinity, of the meaning of buying drinks, and so forth. Doing so disavows our co-participation in a structural process that brings both of us together in the room. Instead of being mutually impacted and impacting across a range of structural positions (including race), I reduce the moment to myself as “good/aware white” and leave him as only “brown.”
A Shift Away From Words Alone
If my act of naming as a clinician creates a disavowal of my role in the structural oppression that harms my patient, then my patient is left sitting alone with both the harm and my role in creating that harm. This situation is antithetical to the awareness and safety necessary for healing. Thus, while I do think that naming whiteness, power differences, and structural oppression continues to be an important tool, I think we must use it judiciously, first examining closely what work the naming does in that particular moment, and what other feelings or awareness we are trying to manage. Is it in service of the patient, or is it an utterance that prevents true listening and accountability?
Instead of reflexively naming, I’d like to argue for what Ahmed calls the "much harder work” of intimately being with racism and other structural violence—both as ourselves as clinicians and as experienced/perpetuated by the patient—"as an on-going reality in the present” (p. 12). I think this commitment to being with must also be coupled with one to fight for structural change outside of the session, without communicating these commitments directly to patients. This includes the duty of clinicians with social and financial capital to use their means to support organizations and people fighting against racism and other structural violence.
If we can recognize that we are always in a process between awareness and disavowal, and work to reduce our moments of disavowal, I believe we will be more effective clinical social workers offering a more curative experience.
References
Ahmed, S. (2004). Declarations of whiteness: the non-performativity of anti-racism. borderlands, 3(2), 1-15.
Fisher, M. (2009). Capitalist realism: Is there no alternative? John Hunt Publishing.
Adam Gaubinger
Adam Gaubinger, LSW
Adam Gaubinger, MSW, LSW, is currently practicing as a therapist at Walnut Psychotherapy Center in Philadelphia, PA.