An excerpt from How I Know White People Are Crazy and Other Stories. Copyright © 2025 Dr. Jonathan Lassiter. Published by Legacy Lit, a Hachette Book Group company. Reproduced by arrangement with the publisher. All rights reserved.

According to Dr. James M. Stedman, a white male clinical psychologist from the University of Texas Health Science Center at San Antonio, there was a shortage of [doctoral] internships as early as 1976. Data from APPIC indicate that this shortage got worse from 1999 to 2013 with an 8 percent decline in matching, dropping from 84 percent to 76 percent. Some scientists have suggested that the shortage was due to several factors, ranging from internship programs not having enough funding for interns and thus reducing intern slots, to some doctoral programs accepting too many students that created higher demand for internship positions.

In 2012, 22 percent of all applicants did not match. Of the Black students who applied that year, 26 percent were not offered a doctoral internship position. The Black psychology trainees made up just 5 percent of all the psychology students who were matched to internships that year, compared to the 13 percent of Black people in the United States that year. Concretely, that means that in 2012, 124 Black psychology doctoral students were able to get the required training opportunity they needed to graduate and become a professional psychologist. One hundred and twenty-four new Black psychologists to help serve the estimated 39,696,000 Black people in the United States that year.

I was not one of those new professionals.

Unbeknownst to me, I was the victim of a problem that was present long before I applied for an internship in 2012. The whiteness mindset structured the match system according to its values. APPIC and the American Psychological Association’s (APA’s) membership and accreditation, respectively, are prioritized as the standard of quality in professional psychology education. If one does not complete an internship at a site that is an APPIC or is APA accredited, one is typically seen as less qualified for the profession. There is a lot of stigma associated with forgoing an internship unaffiliated with APPIC or the APA. Not completing an APA-accredited internship can lead to ineligibility for certain jobs, such as working as a staff psychologist at a Veterans Administration medical center or a psychology professor at some universities. This is a major problem not just for psychology doctoral students but for the wider public who may need mental health services.

By prioritizing training at an APPIC member site or APA-accredited internship and simultaneously stigmatizing training at other sites, that may be just as or more clinically rigorous and culturally appropriate, mental health standards of care are determined by organizations that often do not look like the communities most in need of care.

This means that predominantly white organizations are positioned to determine what constitutes the proper training for all mental health professionals, and thus mental health care for all people. This training and these standards of care may or may not be appropriate for the communities the mental health professionals will serve. It seems to me that due to the lack of cultural diversity in staff and culturally informed practices offered in predominantly white, cisgender, and heterosexual APA-accredited training sites, mental health professionals are often not trained to serve clients in ways that center non-white, cisgender, and heterosexual ways of being. Clients from the global majority are effectively being provided mental health services sanctioned and, largely, provided by their oppressors.

I witnessed this as a graduate student. One of my clinical placements was at a nonprofit mental health clinic that served predominantly Black and Latine children and their families. However, 99 percent of the staff was white. As one of the two Black students, I was appalled by the ways in which my clinical supervisors, who were licensed psychologists, often pathologized families due to their perceived failure for not living according to white family norms (i.e., two-parent household, middle-class). It was not uncommon to hear some of my supervisors and classmates use the term “lack of a father figure” as a possible explanation for “aggressive behavior” when discussing Black children who were referred to their services for misconduct in school.

The whiteness mindset maintains its power to determine what is normal, right, and desirable by positioning white ways of being on a pedestal, and white organizations as the arbiters of what constitutes appropriate mental health training and services. White mental health care becomes the only acceptable form. Simultaneously, the whiteness mindset perpetuates mental health disparities in marginalized communities by ensuring that the standards of training and care are culturally misaligned with marginalized communities. Instead of finding their own values and needs respected and understood, people in marginalized communities are offered treatments that do not speak to their lived experiences. These treatments and providers may be approved by whiteness but not by them.

For example, the mis- and overdiagnosing of Black children with disruptive behavior disorders rather than ADHD, a mood disorder, or no diagnosis at all may be due to cultural misalignment between mental health professionals and the communities they serve. Black children often display a preference for high levels of verve, or physical stimulation. This can look like attending to several different tasks at once, using expressive body language, and moving around a lot. Many Black children are raised in households with high energy levels, with music playing in the home, friends and family coming and going, and communal activities like dancing and storytelling, all of which have their roots in African and Black American cultural dimensions. Though not exclusive to Black families, verve is much more commonly observed in low-income Black households compared to middle-class white families.

However, whiteness centers the norms of middle-class white families. When Black students, used to busy homes and expressive ways of being, bring their norms into the classroom, teachers and therapists who have been trained in an educational system structured by the whiteness mindset are less likely to understand. Instead, they interpret their students’ actions as behavioral problems. Too often this results in the child receiving a stigmatizing mental health diagnosis, such as conduct disorder, that often leads to poor educational and disciplinary outcomes for the child.

Similar patterns of misdiagnosis are present for people who are Latine, Native Hawaiian, and Asian American/Pacific Islander. They are also more likely to receive stigmatizing diagnoses such as substance use disorder, alcohol use disorder, and schizophrenia. Relatedly, many youth from the global majority do not seek the mental health services they need. For example, Dr. Alfiee Breland-Noble’s team at the AAKOMA Project found that over half of Asian American/Pacific Islander youth did not seek mental health treatment even when they believed they needed it.

Jonathan Lassiter is a clinical psychologist and author of How I Know White People Are Crazy and Other Stories.