Refusing Neutrality

Context, care, and the cost to the body

Photo by Aimee Giles on Unsplash

I have spent decades sitting with people whose pain was never just intrapsychic. In doing psychodynamic therapy, we often explore the psyche.

Their suffering did not arise in isolation. At times, this suffering presented as stress, anxiety and depression. It was shaped by racism, terror, exclusion, poverty, and the slow violence of being unseen. Long before a symptom appeared, there was a context. Long before I could even make a consideration of a diagnosis, I realized that there was a system doing harm. And yet, in counseling/clinical spaces, we are often taught to treat that suffering as though it can be separated from the world that produced it.

When therapists claim neutrality in those moments, what often goes unnamed is how that stance protects dominant norms rather than the person sitting in front of us. Neutrality is not absence. It is alignment. Too often, it asks people to metabolize structural harm as personal pathology. It turns survival into a diagnosis.

For me, ethical practice has always meant telling the truth about context. Helping people locate their distress not only within themselves, but within the systems that constrain them. I share my view about how intersecting identities, for example, Black, LGBTQIA, Invisible disabilities are often connected with interlocking systems of oppression. Here I am Naming power. Naming harm. Naming what has happened without asking the client to carry that burden alone.

That is not politics intruding on therapy. That is therapy refusing to collude with erasure.

I’ve been thinking a lot about clinicians, particularly those who are Black, Gay, Queer, or Trans, who are quietly holding tensions they may have never been trained to name. The pressure to remain “neutral,” to stay silent about power, or to translate structural harm into individual pathology takes a real toll. And it often lands hardest on those of us whose identities make neutrality impossible to perform.

I’ve worked across hospitals, universities, community mental health settings, and research focused on racialized trauma and health disparities. I’ve held leadership roles in mental health organizations. And I’ve navigated all of it as a Black, gay man shaped by the very systems we’re often asked not to name.

There is a particular exhaustion that comes from being expected to practice ethically while erasing parts of yourself to fit professional norms that were never built with you/us in mind. Many clinicians try managing this tension quietly. Others burn. Some leave the field altogether. Few are given language for what they are experiencing, much less space to think honestly about it.

At this stage of my career, mentorship feels like an ethical responsibility. Not supervision. Not therapy. But reflective, grounded mentorship for clinicians who want to practice with integrity and clarity without disappearing themselves in the process. If this resonates, I want to say this plainly: you are not imagining it. The strain is real. And you do not have to navigate it alone.

These questions of neutrality and power do not live only in therapy rooms. They live in the body.

Many of us have recently seen or heard about circulated racist imagery. It was disgusting, angering, and inhumane. I don’t want to debate the harm, that part is obvious. What I want to name is what happens after exposure.

Racism is not abstract. It is a weaponized stressor. It lands directly in the nervous system. And the body does not parse intention.

When we view, repost, or repeatedly circulate racist imagery, even to condemn it, the nervous system reads threat. Cortisol rises. Heart rate increases. Blood pressure shifts. Blood sugar changes. The body responds as though it is under attack, because in many ways, it is.

Over time, repeated activation is linked to anxiety, hypertension, diabetes, and cardiovascular disease, conditions our communities already carry at disproportionate rates. Outrage is understandable. But sustained physiological arousal is costly. Every replay, every forced re-witnessing is another hit to systems already carrying too much.

We do not owe anyone our cortisol. Refusing neutrality does not require living in constant activation. It requires telling the truth while tending to the body and to one another with intention.

That, too, is part of the work.

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A gentle invitation

If this piece resonated and you are a clinician or scholar navigating questions of power, ethics, burnout, or identity in your work, I occasionally offer reflective mentorship spaces; grounded, honest, and outside the constraints of supervision or therapy. You’re also welcome to explore my writing here, my scholarly work, or simply stay and read quietly. Presence counts.

— Brian