race – A Contemplative Couch

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.

My story “The Masked Asian Psychiatrist” was published in Pulse last week! I started writing it several months ago when I was on my inpatient psychiatry rotation in the last third of my PGY-1/intern year. By the end of the spring, much had already been written about the pandemic’s effect on mental health, and there were some incisive pieces reflecting on the pandemic’s effect on Asian healthcare workers (see this piece by Dr. Sojung Yi). I hadn’t seen much written, if anything, about the particular experience of Asian mental health workers, and that motivated me to write my story. The process of doing so and then editing it with input from friends and colleagues, and then with Pulse’s editor, was both therapeutic and stimulating for me. Seeing the story out in the world, and subsequently with an intriguing and ultimately heartening series of reader comments (on the story page), has been a thrill.

I highly encourage anyone interested in narrative medicine and perspectives from healthcare providers and participants, both poetry and prose, to subscribe to Pulse (both free and donation-based subscriptions are available) and help them continue editing and publishing.

For me, a large part of becoming an antiracist physician and an ally means reading and learning from the lived experiences and wisdom of BIPOC colleagues, friends, writers, and more. It also means learning to talk about how my own cultural identity—Chinese-American, immigrant, Northern California college town-raised, upper middle-class-raised, non-white, and non-Black, as well as cisgender, heterosexual, and able-bodied—and the privileges and complexities therein, have shaped my life and affect my work with patients. This Pulse story was the first time in my professional/adult life that I’ve “spoken” publicly about this. There is so much more that I wasn’t able to cover this time, but am still unpacking and writing about, and there is much more reflection and self-critique ahead.

I am grateful to all who have encouraged and supported me in venturing into this new space.

Tag: race

Anti-racism check-in

The Masked Asian Psychiatrist