Ethics, Social Justice
& Advocacy
in Multicultural Counselling
A critical examination of how psychiatry and psychology have been entangled with power, oppression, and social control — and what ethical, justice-oriented practice demands of us today.
When Medicine Became a Tool of Control
These cases are not merely historical curiosities. They reveal how entire systems — slavery, colonialism, institutional confinement, unregulated research — have recruited medicine and mental health in projects of control and profit, disproportionately targeting those who are poor, racialized, disabled, or caste-marginalized.
Drapetomania & the Psychiatry of Slavery
Dr. Samuel Cartwright “diagnosed” enslaved Black men who fled captivity with Drapetomania — a fictitious mental disorder. Prescribed treatment: whipping and forced submission. Resistance to oppression was pathologized as illness.
The Tuskegee Syphilis Study
Hundreds of poor Black men were enrolled under the promise of “free treatment.” They were never told they had syphilis. Even after penicillin became available, doctors withheld treatment and observed disease progression — including preventable deaths and transmission to families.
Willowbrook State School
Children with intellectual disabilities were deliberately infected with hepatitis to study disease progression. Researchers justified this by claiming the children “would get it anyway” in the overcrowded institution. The study used institutional power to make informed consent impossible.
Colonial Asylums & Erwadi Tragedy
The Indian Lunatic Asylums Act (1858) empowered magistrates to confine “lunatics” indefinitely. In August 2001, a fire at a faith-based home in Erwadi, Tamil Nadu, killed 28 residents who were found still chained to their beds — illustrating the fatal consequences of confinement, poverty, and inaccessible services.
The Churu Drug Trials
Dalit and OBC labourers were lured to Jaipur with promises of hospital jobs. Instead, they were enrolled — without consent — in a Phase 2 clinical trial for an osteoarthritis drug (GRC 27864). Within hours, many lost consciousness. The trial violated age criteria, consent procedures, and ethics committee oversight.
Rohith Vemula & Institutional Casteism
A Dalit PhD scholar at the University of Hyderabad died by suicide after experiencing sustained institutional exclusion, suspension, and dehumanization. His final letter described feeling reduced to “a vote, a number, a thing.” His death brought caste discrimination’s mental health consequences into national consciousness.
“These are not just stories of bad people doing bad things. They are illustrations of how entire systems can enlist medicine and mental health in projects of control and profit.”
Core Thesis — Ethics in Multicultural CounsellingThe Diagnostic Gaze: When Labels Harm
Diagnosis is not a neutral technical act. It is a social process embedded in cultural assumptions, institutional power, and implicit bias. When clinicians carry unexamined prejudices about race, caste, gender, or sexuality, diagnostic tools become instruments of harm.
Schizophrenia Over-Diagnosis in Black Clients
Research (Rutgers University) shows that African Americans are significantly more likely to be diagnosed with schizophrenia than white patients with identical presentations, as clinicians over-emphasize psychotic features and under-recognize depressive symptoms. The result: overuse of antipsychotics, under-treatment of mood disorders.
The Rosenhan Experiment (1970s)
Pseudopatients presented with one complaint — hearing a voice say “thud” — and were quickly admitted and labelled with schizophrenia. Once the label was applied, all everyday behaviour was read as pathological, and discharge became extremely difficult. Add race, caste, or gender — and the stakes multiply.
Homosexuality Removed from the DSM
Homosexuality was classified as a mental disorder until 1973 — not removed by neutral science, but through sustained LGBTQ+ activism, disruptions of APA conferences, and internal advocacy. A residual category, “Sexual Orientation Disturbance,” persisted until 1987. De-pathologization is always a political and social achievement.
Universal (Etic) Codes Assume:
- Individual autonomy
- Privacy as a core right
- Informed consent as personal
- Family as secondary to individual
- Diagnosis as culture-neutral
- Western DSM categories as universal
Collectivist (Emic) Contexts Involve:
- Family elders as health decision-makers
- Caste panchayats mediating disclosure
- Confidentiality tied to honour and shame
- Religious authorities in healing
- Indigenous idioms of distress
- Community, not individual, as unit of care
A young woman discloses suicidal ideation but pleads not to involve her family — disclosure, she says, “will destroy the family’s honour.” You stand at the intersection of duty to protect life and the cultural violence of coerced disclosure. There is no clean algorithm. There is only cultural humility, collaborative safety planning, and creative use of culturally trusted mediators.
Clinical Ethical Dilemma — Multicultural Counselling PracticeThe Long Road from Diagnosis to Rights
The removal of homosexuality from the DSM, and the decriminalization of same-sex relations in India, remind us that ethical evolution in mental health is inseparable from social movements, legal reform, and community resistance. Ethics is not just internal virtue — it is social practice.
DSM Timeline · USA
PRE-1973 · PATHOLOGIZED
Homosexuality listed as a diagnosable mental disorder in the DSM. Clinical practice included conversion attempts and institutional confinement.
1973 · APA BOARD VOTE
Following sustained LGBTQ+ activism and disruptions of APA conferences, the board voted to remove homosexuality as a diagnosis. A 1974 referendum upheld the decision.
1974–1987 · RESIDUAL CATEGORY
“Sexual Orientation Disturbance” — a compromise category — persisted in the DSM until 1987, continuing partial pathologization under a softer label.
TODAY · AFFIRMATIVE ETHICS
Ethical codes now prohibit conversion therapy and mandate affirmative practice. The ACA Code, NAADAC, and MSJCC actively require examination of heteronormative assumptions.
Legal Journey · India
Section 377 · Colonial Criminalization
Under British colonial law, consensual same-sex relations were criminalized — a law that persisted decades into Independence, enabling psychiatric and legal persecution of LGBTQ+ persons.
2009 · Naz Foundation Judgment
Delhi High Court read down Section 377, briefly decriminalizing same-sex relations between consenting adults on grounds of dignity and equality — later reversed by the Supreme Court in 2013.
2018 · Navtej Singh Johar
The Supreme Court of India unanimously struck down Section 377, affirming constitutional rights to dignity, privacy, and equality. Consensual same-sex relations decriminalized.
IPS Position Statement
The Indian Psychiatric Society formally declared homosexuality is not a psychiatric disorder and explicitly opposed attempts to “cure” sexual orientation — ethics as social movement, not just internal virtue.
Ethical Codes: Necessary but Never Sufficient
Contemporary ethical codes are deliberate responses to the historical misuse of psychology in projects of social control and cultural dominance. They encode hard-won lessons — yet they are themselves cultural documents, written at particular historical moments by particular people, and must be applied with critical reflexivity.
- Actively understand diverse cultural backgrounds of clients
- Recognize how counsellor’s own cultural identity shapes practice
- Explain confidentiality in a culturally competent manner
- Respect cultural meanings of privacy and disclosure
- Prohibit discrimination on grounds of race, caste, gender, religion, sexual orientation
- Mandate cultural sensitivity in assessment and diagnosis
- Examine personal, professional, and cultural values
- Seek supervision when personal values conflict with client worldviews
- Recognize substance use through culturally specific lenses
- Challenge pathologizing of culturally normative coping
- Extends classic triad: Attitudes, Knowledge, Skills — adds Action
- Counsellors must be prepared to challenge harmful policies and structures
- Cultural competence is not just self-awareness — it requires social action
- Intersectionality of client and counsellor identities is central
- Challenging oppressive systems is an ethical responsibility
- Not an optional specialisation — a core professional duty
- Training must prepare future counsellors for social justice practice
- Advocacy Competencies span individual, community, and public arena
When a counsellor says “You’re not sick, but your lifestyle is against my values,” they are replaying — on a micro scale — the macro history in which entire identities were once classified as medical problems. Affirmative practice demands active interrogation of how theological, caste, class, or heteronormative assumptions seep into case formulations.
Imposed Values & Professional EthicsSocial Justice Counselling: The MSJCC Architecture
Manivong Ratts and the MSJCC remind us that multicultural counselling and social justice counselling are inseparable. A culturally competent counsellor is not just self-aware and informed — they are prepared to act.
Micro — Individual
- Question a schizophrenia diagnosis in a Black client whose narrative suggests severe depression
- Challenge punitive attendance policies applied to a student from a rural, caste-marginalized background
- Support Dalit labourers from Churu in understanding their rights and filing complaints after illegal drug trials
- Co-create safety plans that maximize informal supports and minimize coercive systems for trans clients
Meso — Community
- Collaborate with LGBTQ+ collectives after hate-crime incidents to design accessible, trauma-informed mental health workshops
- Partner with families in communities like Erwadi to develop alternatives to chaining and confinement, grounded in both faith and rights
- Develop caste-affirmative group interventions in institutional settings
- Build practitioner networks to share the burden of advocacy and prevent burnout
Macro — Systemic
- Support the Mental Healthcare Act, 2017, which guarantees non-discriminatory access, community living, and protection from cruel treatment
- Advocate for tighter regulation of clinical trials to prevent exploitation of poor and illiterate citizens
- Push for caste, queer-affirmative, and disability justice integration into counselling curricula — substantively, not as token single lectures
- Challenge institutional policies that disproportionately harm marginalized clients
A Scenario Without a Clean Answer
Ethical codes provide principles, not algorithms. The following scenario — drawn from the kinds of cases counsellors actually encounter — illustrates why practice requires ethical imagination, not just rule-following.
The Case of the Trans Client from a Caste-Marginalized Background
A young trans client has been repeatedly misgendered, mocked, and over-pathologized in previous services. They ask you not to involve their family, and not to alert authorities about episodes of self-harm. Their reason: the last time they were reported, they were restrained, sedated, and threatened with being “locked away.” You are acutely aware of Erwadi’s chains, Rohith Vemula’s despair, the DSM’s history of pathologizing queerness, and the colonial asylum’s use of confinement against the “unruly.” You also carry your legal and ethical duties of care. No code gives you a clean answer.
“That uneasiness is not a sign that you are failing as a counsellor. It is evidence that you are awake to the ethical complexity of multicultural practice.”
Core Pedagogical PrincipleWhen there is no ethically clean option —
what kind of counsellor do you want to be?
The histories of Drapetomania, Tuskegee, Willowbrook, colonial asylums, Erwadi, Rohith Vemula, the Churu drug trials, and the DSM’s pathologization of queerness all testify to what happens when our profession forgets its entanglement with power. Our aim is not a tidy checklist of do’s and don’ts, but an ethical imagination capable of holding multiple truths at once.