A case vignette I wrote back in the spring, “A Racial Enactment Amid COVID-Focused Anxiety and Mania,” was published this month in Psychoanalytic Dialogues. The vignette focused on some racially charged interactions and I and a colleague (who is also of Chinese descent) had with a Black patient, “Iris,” in the inpatient setting. The full vignette is behind the journal paywall, but below is the closing paragraph:
Also present was another internal object that is both insidious and impossible to ignore: the reality that we psychiatrists, no matter our own ethnicities, are part of a mental health system with a long history of pathologizing and criminalizing Black anger as a symptom of mental illness (rather than a reaction to centuries of oppression and intergenerational trauma), supporting the shattering of Black families, and over-diagnosing Black individuals with learning disabilities or schizophrenia while underdiagnosing them with depression. This institutional racism continues to haunt our present systems of care, and has understandably wrought mistrust of psychiatry. I may be a well-meaning and even idealistic resident psychiatrist who sought to connect with and understand Iris. However, within the setting of involuntary hospitalization, I represent an institution of racial and social power, eliciting caution, deference, and fear. I am discomfited by two coexisting truths: I am a physician of color whose own ethnicity, especially during the present pandemic, leaves me vulnerable to racial enactments; and at the same time, I occupy a position of privilege and power within a system that can retraumatize patients, even as I seek to treat their illnesses.
One of the [long-overdue] changes I’ve made in my practice over the past few months is that I’m trying to be intentional about naming and validating structural racism (particularly structural anti-Black racism) as a factor in my patients’ experiences, whether longitudinally in their lives, during the past few months in context of national events, or as it affects their relationship with the mental health system. Some of my patients have brought up race and racism of their own accord, which has led to some unexpected conversations and interactions that were deeply meaningful for me. Sometimes, I have tried to name race and structural racism as being present in the room with me and my patient, and to openly acknowledge my own role within the power structure of the mental health system.
These interactions haven’t always been graceful or effective. The stumbles are real. But, stumbles and all, it feels necessary to continue learning from my patients’ perspectives, and for me to be able to broach the topics of race and the pain of racism as determinants of health. The work continues.
A Contemplative Couch 