Giving consideration to the unique skills and training of psychiatrists and most human behavioral scientists, I am chagrined that we have abdicated our responsibilities as private citizens and professionals to help create a more emotionally healthy and secure America. Is it asking too much of mental health professionals to contribute their knowledge of normal and pathological behavior to discussions of social issues that negatively impact society?
What became of the research generated by the Task Force on Racism of the American Orthopsychiatric Association a few years ago? The Group for the Advancement of Psychiatry, Psychiatrists for a Better Psychiatry and the American Society of Social Psychiatry have knowledgeable members with research experience in the area of race relations. Ostensibly, President Clinton's Commission on Race is without input from these organizations and individuals.
The American Medical Association, undoubtedly following the lead of the American Psychiatric Association, has extended to African American physicians full membership with all rights and privileges, and in 1996 appointed its first African American president, Lonnie R. Bristow, M.D.
In point of fact, the AMA has been vocal and proactive with an initiative to strengthen affirmative action by establishing the Consortium on Minority Affairs (Larson, 1997), which replaces the former Advisory Committee on Minority Physicians. The group's goals are to achieve greater medical school population diversity and to increase the number of minority students and physicians participating in the AMA.
Recognizing that the country's political winds are shifting away from affirmative action, AMA's trustee, Regina M. Benjamin, M.D., has become publicly outspoken in reaffirming that the association supports a diverse physician workforce, a position that has been overshadowed in psychiatry by an obsession with managed care.
The most convincing evidence in favor of affirmative action in medicine has come from AMA statistics. African American and Hispanic doctors report that approximately 40% and 37%, respectively, of their patients are poor-compared with 29% of white physicians' patients. About half of the patients of African American and Hispanic physicians are members of minority groups compared with about a quarter among white physicians' patients. Young African American and Hispanic women physicians provide the most care for poor patients. Physicians whose parents were of low income and had less than a high school education saw more patients in underserved groups than did other physicians, but race and ethnicity were more highly associated with services to those patients than economic background. The explanation of these findings is that even with affirmative action at work for more than 30 years, racism has prevailed (Mitka, 1996).Commitment to Full Equality
There was a point in time when the APA appeared to be deeply committed to full equality for all people and engaged in the struggle to do something about it. For example, the American Journal of Psychiatry devoted a special section on racism in its December 1970 edition (Vol. 127, No. 6). Written by a group of young and sincere white American psychiatrists (Melvin Sabshin, M.D.-who later became the medical director of the APA-Herman Diesenhaus, M.D., and Raymond Wilkerson, M.D.), it became their treatise on the "Dimensions of Institutional Racism in Psychiatry."
These authors had concluded that "Our heretofore essentially quite controlled professional organizations, as well as federal and state agencies, should take the lead in exposing and significantly diminishing institutional racism...One way to begin to focus attention on the institutional white racism of psychiatry is to devote a special section of the American Journal of Psychiatry to racism's origins, history, and current status in psychiatry and in our nation as a whole, as well as to present strategies for change [italics added]."
Suffice it to say, these recommendations were never acted on, and instead there has been a paucity of psychiatric writing to help our understanding of America's racial dilemma.
Psychiatry must hold a steady course, constantly speaking out against racial injustices, and seek to include racial minorities in all functions of professional organizations. We must be eager to share our expertise with our nation's president, Congress, and others in decision-making capacities, just as aggressively as we seek parity for the treatment of our patients. Without a doubt, there will be colleagues who will question the possibility of reclaiming the idealism of the 1960s.
Our rationalization that racism, like other euphemisms such as communism, is based more on attitudinal factors than on a defined medical or psychological condition does little to help our nation and the world grasp the value of respect and diversity.