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This book examines the deep roots of racism in the mental health system. Suman Fernando weaves the histories of racial discourse and clinical practice into a narrative of power, knowledge, and black suffering in an ostensibly progressive and scientifically grounded system. Drawing on a lifetime of experience as a practicing psychiatrist, he examines how the system has shifted in response to new forms of racism which have emerged since the 1960s, highlighting the widespread pathologization of black people, the impact of Islamophobia on clinical practice after 9/11, and various struggles to reform. Engaging and accessible, this book makes a compelling case for the entrenchment of racism across all aspects of psychiatry and clinical psychology, and calls for a paradigm shift in both theory and practice.