'We need a transformation in how we regard difference, diversity and inclusivity in psychology’

Ian Florance meets Zenobia Nadirshaw.

Zenobia Nadirshaw received an MBE in the 2019 New Year Honours List for services to people with learning disabilities and to mental health treatment. But that’s just one of many experiences and achievements. These include her 44 years of work for the NHS and Social Services; a Professorship at the University of West London; being made a Freeman (or more accurately Free Sister) of the City of London; the inclusion of her portrait in the National Portrait Gallery in 2007 as a Woman of Inspiration; three honorary degrees; and involvement in both the Board of World Zoroastrian Organisation UK and the Young Chef Olympiad, where young chefs from 51 countries compete with each other.

Zenobia Nadirshaw has led a fascinating, packed life. Doing it justice in one interview may be beyond my skills, so we’ll look mostly at her work on what she describes as, ‘the clash between Western thinking and the clients’ different ethnic and class backgrounds and cultures’.

Zenobia’s early life and path to psychology plainly influenced her views. ‘I grew up in Mumbai, not far from the international cricket stadium. My family was an upper middle-class Parsee family.’ Parsees are a community who came to India from what was Persia in the 7th century. They are Zoroastrians, a religion whose most famous recent son was Freddy Mercury, though he tended to disown that identity since he felt it might affect his role in rock music. ‘The Parsees community were appreciated by British administrators. We had a fairly Westernised background with a strong cultural and religious identity. We tended to be taught that we were “a cut above the rest” – something I really regret now.’

Zenobia studied her first and master’s degrees at a college and university in Bombay. How did she get interested in psychology? ‘My twin sister was very quiet and tended to get bullied a lot. She’d run to me for advice and safety, and then I found more and more girls coming to see me with issues and problems. It started from there. In fact I and my twin both studied psychology and used to study together. She’d got married by the time I did my master’s but I’ll always be grateful that she came to help me every time I needed help and guidance.’

Originally Zenobia wanted to go to California after her master’s, ‘but my parents wanted me to live in the UK for a while to acclimatise myself to the West. I ended up staying here and getting married. Initially I was interviewed for a job in intellectual disability services in Hertfordshire… I was going to get the job, but it was felt the Bombay University qualification wasn’t enough. So I spent three years working as an assistant psychologist while studying and training. Working at Harperbury Hospital, moving people out of the hospital into community care in the London Boroughs of Barnet, Kensington and Chelsea, and Haringey and Westminster, was when I really began to understand the impact of cultural clashes and misunderstandings between services and the individual client from black and minority ethnic backgrounds.’

Training is the solution
Zenobia has a wealth of stories to illustrate these cultural clashes. ‘A physical therapist recommended that a young girl should go to a swimming pool every day and should wear a Western swimming costume. The Mum said, “Over my dead body”. In fact she wasn’t against swimming as such but insisted that she shouldn’t wear Western clothes and should only swim at all-girl sessions. It seemed an easy issue to solve but it wasn’t. In the end I had to go right up to the Director of Social Services to get it sorted out because of specific attitudes and policies of senior management and their power base.’

Another time, Zenobia was called in to speak to a client in East London. ‘He was refusing medication, attacking female nurses, swearing, shouting and was placed in an isolation room as a consequence. He was a Bangladeshi and I didn’t speak his language but my immediate thought was “is there an imam here?”. When one was found I asked him whether there was anything in the Koran that covers this. Sure enough, the imam was able to read a relevant passage from the Koran and the man calmed down. The imam then gave him his pills which he took and within one week he was out into the general ward, with no signs of disturbed, aggressive behaviour towards female staff.’

Zenobia emphasises that the evidence of culture clash doesn’t just consist of these sorts of stories. ‘Statistics paint a picture too. 18- to 24-year-old black men in forensic, in-patient wards are given 3.5 times more ECT than a white equivalent as well as three times more psychotropic medication. In certain cultures, talking to your forefathers is an important part of life and family continuity: it’s often diagnosed as schizophrenia in the West. BAME clients are often vulnerable, partly because they often don’t know their rights. There’s a mismatch between the sorts of people becoming clinical psychologists and the sorts of people they’re dealing with. This is partly because of the cost and time taken to become a clinical psychologist. We need to get more BAME psychologists into the profession.’

What is the solution? ‘Training. In particular training people not to rely on macro theories, useful as those are, but to help them use the information the person gives them to inform their problem and treatment; not to jump to conclusions because the information they’re receiving seems strange or difficult to understand. The issue of communalism vs individualism is a key one. Western psychology, on the whole, has tended to concentrate on the individual; psychology from non-Western countries and traditions will tend to stress the social, familial and community solutions.’

Zenobia recalls a social worker telling her, ‘I can’t get through to this Guajarati family because the Grandmother tells me to leave after 20 minutes’. ‘The client was a 17-year-old girl with Down's Syndrome’, she says. ‘I went to a meeting with the social worker and, as usual, the whole extended family was there. The social worker had been taught to stress the positives and talked about how pretty and attractive the girl was and how she would thrive if she was allowed to live independently. The grandmother got more and more uncomfortable and said, “throw her out”. I’d noticed the black velvet bracelet round the girl’s wrist and, whilst talking to the grandmother, two things became clear to me. One was to know that the band was there to ward off evil spirits. Second, the social worker’s talk was attracting, in their culture, the “evil eye”. The grandmother also argued: “These are our manners. We (the family) take individual responsibility for our people’s care. We cannot accept institutional care.”’

‘Personal relationships are critical’
Zenobia has published widely in the areas of double discrimination, mental health, intellectual disabilities and clinical psychology services. She co-edited Clinical Psychology, ‘Race’ and Culture: A Training Manual: A Resource Pack for Trainers which was published by BPS Books in 1991 and which won the first prize in the mental health series from the British Medical Association. When I was interviewing her, she showed another chapter on The Different Aspects of Equality in the Leadership Agenda of the BPS in the just-published Routledge book Leadership and Diversity in Psychology: Moving Beyond the Limits. With other psychologists, she was instrumental in setting up a ‘Race’ and Culture Special Interest Group under the Society’s Division of Clinical Psychology in the early 1980s. She sits on several BPS committees and chairs two of them.

Zenobia stresses that influencing policy and practice is not just about publishing widely and giving formal talks. ‘Personal relationships are critical in all these initiatives.’ Zenobia’s Zoroastrian background influences her approach to these areas. ‘I’m not “religious” but I practice what my religion teaches: Good Thought; Good Words; Good Deeds. This means that I’m very involved with a number of not for profit, charitable initiatives, for instance Ki which provides seed funding for people with disabilities to set up their own businesses.’

Putting diversity in a positive light
In concentrating on one theme I’ve left out large areas of Zenobia’s life. She was involved in delivering services and management in the NHS for 44 years. To some extent, her emphasis on training, originates in her experience at Harperbury Hospital. ‘I got a fair idea of nurses’ often negative attitudes towards people with learning disabilities at that time. I trained nurses on the ward. As Head of the Psychological Services in Learning Disability in Hammersmith and Fulham and in Kensington and Chelsea I got involved in five reorganisations so I have experience of organisational change and development. In fact I enjoyed leadership in the NHS, and indeed in any work that had a positive outcome for our clients and their carers. I disliked the old style psychological intellectual tests which simply involved administering huge assessment batteries. I also had a problem working with malingerers who would do anything to get a disability allowance. Now I’m retired from the NHS, but my life is very varied: writing, teaching, supervising, lecturing and acting as an external examiner, and as a National Assessor for NHS consultants.’

Zenobia is still ‘very committed to BAME issues, diversity and inclusivity in psychology. We have to put diversity and difference in a positive light. Culture has been politicised and we need to move away from the “all needs are the same /colour blind” approach. Work in the area is challenging but, as I’ve said, BAME people are vulnerable and we need to offer them better services by achieving a positive transformation in how we regard difference, diversity and inclusivity in the psychology profession.’

I walked back to the tube station with a bag of edible goodies, partly exhausted by the thought of Zenobia’s energy, partly wishing we could have covered a wider range of activities. Perhaps that would take an autobiography. I’d certainly read that!

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