Amanda Calhoun, MD, MPH

This time last year, families cruised through grocery store aisles, scouting for snacks. Back then, difficult decisions were simpler: chips and dip or chicken wings? Should I go to my friend’s party or that coworker’s party? Individuals of all sorts, from dedicated to fair-weather fans, gathered around their television screens to share in an American tradition: the Super Bowl. Everyone would be abuzz later, not just about game time plays, but also with commentary about the halftime show or that hilarious commercial.

More than 400,000 people are dead in the United States, many of us forced to remotely stream funerals of our loved ones. Parties are discouraged, with physical distancing in place. Many of us are exhausted—from debates about schools opening, from the stress of a new coronavirus 2019 (COVID-19) breakout on the inpatient psychiatric unit, from waiting for this pandemic to pass. And many of us are sad—that our uncle’s favorite armchair will forever be empty and that it has been weeks since we have seen a stranger’s face in public. 

But still, many of us will watch the Super Bowl anyway.

It may be just our own household or may be over Zoom with friends, but regardless, many will conjure up creative ways to enjoy this American tradition together. We will drag ourselves out of our exhaustion and find the energy to laugh and shake our fists at the television, all the while knowing that the pandemic roars on. That is what traditions do.

Traditions give us some semblance of normalcy in a time when almost nothing seems normal. The Super Bowl is not only our entertainment, but it is also our refuge. An excuse to slow down just for a moment and indulge in our favorite snacks while lying on the couch, because everyone knows that Super Bowl calories don’t count. Traditions bring family and friends together who might normally not have schedules in sync, and they bind us together in inspiring ways. Traditions are always important, making their content all the more impactful. But some traditions should not continue.

This year, the Kansas City Chiefs will play the Tampa Bay Buccaneers in Tampa. In the 1990s, the Kansas City Chiefs adopted a racist, derogatory chant commonly known as the “Tomahawk chop” or “Arrowhead chop.” This chant, complete with a song that sounds as if it came out of an old western, involves fans imitating a Native American chant and making a tomahawk-like hand motion. Native Americans have spoken out against this cheer, and the Florida Indigenous Rights and Environmental Equality organization, located in St. Petersburg, Florida, has plans to protest the Super Bowl this weekend. The Native American group has shined a light on the team’s name and chant, citing that it is cultural appropriation, not to mention an offensive caricature of their culture. Although the National Football League has, since last year, banned fans from wearing ceremonial headdresses and face paint, this is too little too late. The Tomahawk chop is currently “under review,” yet cheerleaders are allowed to continue the chop with a closed rather an open fist, and the team name remains. To be sure, some have defended these racist chants and mascots, saying that they are a tribute to Native Americans, but the National Congress of American Indians maintains that the behaviors are disrespectful to Native American culture and further damaging stereotypes.

The Kansas City Chiefs are not alone in their racist chants. These are white-centered traditions that were not made with the respect of Native Americans in mind. Black and Indigenous populations have a history of being exploited and caricatured by white American society in racist imagery. Aunt Jemima syrup and Uncle Ben rice are 2 such examples, which have recently undergone pressure to undergo name changes, and there are many, many more. It is time to upend these racist traditions and instead replace them with actions that do not serve to “other” minoritized populations. Everyone deserves the chance to be able to enjoy American traditions without being offended. Words matter. Symbols matter. Actions matter. Let us continue our traditions, but not the disrespectful ones.

The pandemic has shined a light on racial inequities that existed long before COVID-19 became a mainstay in our conversations and thoughts. Racism is embedded in American structures and systems, from our health care to our chants at sport’s games.

Let us use this pandemic as a lesson learned about valuing each other. Let us use this pandemic to push back against the racism deeply baked into this country. At the very least, when you are watching the Super Bowl game this weekend, while eating your favorite chips and dip, please aim to be respectful of all Americans.

is a second year psychiatry resident at Yale School of Medicine/Yale Child Study Center in the Adult/Child Albert J. Solnit integrated program. Dr Calhoun’s research centers on the improvement of mental and physical health outcomes in Black Americans by targeting the trauma of racism. Dr Calhoun calls herself an “activist trainee” and through public speaking and writing, exposes current and historical racism in the medical system. She firmly believes that all doctors should be activists and promotes the integration of social justice teaching with medical education.

Articles

Which traditions will keep us afloat during the pandemic, and which ones need to go? 

The Super Bowl and the Importance of Tradition (Or Not)

“I’m strong and I don’t need your help. I just want to go home. I’m fine…” I sat next to my new patient, who had just been admitted to the hospital after a suicide attempt. His dark brown eyes avoided my concerned gaze as he quickly rolled down his sleeves, hiding fresh bloody streaks across his wrists. He was far from fine. 

“I have no doubt you are strong,” I said. 

As a psychiatry resident, I spend just as much time—maybe more—convincing people that mental health treatment does not equate to weakness or some societal flaw, as I do in the actual psychiatric treatment. Stigma around psychiatric illnesses runs deep and is ingrained in our society, from horrific tales of shrinks passed down in communities to negative and inaccurate portrayals of mental illness in the media. In fact, TV characters living with mental illness are significantly underrepresented, with a recent study showing that less than 2% of film characters and less than 10% of TV characters have psychiatric illnesses.1 The characters with mental illness are often portrayed in stigmatizing and inaccurate ways, associated with words such as “crazy” or freak.”

 As such, I have my work cut out for me when I explain to patients that psychiatric treatment should be viewed the same way as any other medical treatment. According to the media, and even amongst healthcare providers and students

For this reason, I was disappointed, but not surprised, to read Skip Bayless’ statement towards Dak Prescott, the quarterback of the Dallas Cowboys. Dak bravely revealed his struggle with anxiety and depression during the pandemic and after the suicide of his brother and football inspiration, Jace Prescott. On FOX Sports’ “Undisputed,” Bayless questioned Prescott’s ability to be a leader after his self-disclosure of mental illness. Not only was this comment insensitive, it is inaccurate. In fact, Prescott’s decision to discuss his own mental illness struggles likely resulted in others seeking care. More than 7% of Americans have suffered a major depressive episode, and more than one-third did not receive treatment.

 Self-disclosure of mental illness is a powerful form of storytelling and has been shown to reduce stigma and increase normalization of mental illness, increase education and awareness, inspire others to seek care, and encourage advocacy.

, we argue that psychiatrists should work with the media to promote positive portrayals of mental illnesses.

Bayless’ comment further illustrates this widespread notion that being a masculine leader of football does not allow for mental illness, which I believe is far from the truth. A meta-analysis showed that individuals who upheld masculine societal norms were less likely to pursue mental health treatment

, and this needs to change. Prescott explained beautifully that not being truthful about one’s struggles is being a “fake leader,” and his strong statement will join those of Dwayne Johnson, The Rock, Kevin Love, and Michael Phelps in encouraging men to seek mental health treatment. 

Additionally, as a Black and Mexican-American man, Prescott represents 2 different underrepresented groups and serves as a powerful voice for those populations. The Black American and Latinx/Hispanic populations are known to struggle with seeking mental healthcare.

 For Latinx/Hispanic individuals, language barriers as well as legal status play a role in their comfort in seeking mental health care.

 Black and Latinx/Hispanic TV or film characters with psychiatric disorders are vastly underrepresented in the media compared to their white counterparts.

 Fortunately, celebrities such as Ariana Grande, Taraji Henson, and Jada Pinkett are among some of the Black and Latinx celebrities that have led the charge in normalizing mental illness in Black and Latinx communities. 

For Black Americans, there is even more to the story. In addition to stigma, even when Black Americans do seek care, they may not continue to engage with the mental health system. This is due to a myriad of issues, including the fact that Black patients are less likely to receive the same quality of care as white patients, racial discrimination by largely nondiverse mental healthcare providers, and a justified mistrust of the medical system.

 Psychiatry itself has a history of using mental illness as a way to dehumanize Black Americans. African slaves fleeing their slaveowners were said to be suffering from a mental illness known as drapetomania.

 Benjamin Rush, MD, known as the ‘father of psychiatry,’ believed that being Black was a disorder that he called “negritude.”

 During the Civil Rights movement, haloperidol was marketed as a medication for “protest psychosis,” with an advertisement of a cartoonish, angry Black male, as a means of quelling Black protests for basic human rights.

 Today, disparities in psychiatric treatment continue to exist due to racism. Black patients are more likely to be diagnosed with psychotic disorders, like schizophrenia, compared to their white counterparts with comparable presentations

, and Black children are thought to be over-diagnosed as having oppositional defiant disorder.

 Given that Black children as young as 5 years old are more likely to be seen as aggressive compared to their white peers, this finding is not surprising.

All of these factors work against individuals seeking care for their mental illnesses and against the normalization of mental illness. It is crucial that we continue to amplify the powerful voices of leaders like Dak Prescott. His voice could very well make the difference between someone seeking care or not. His voice could save a life.

is a second year Psychiatry resident at Yale School of Medicine/Yale Child Study Center in the Adult/Child Albert J. Solnit integrated program. Dr Calhoun’s research centers on the improvement of mental and physical health outcomes in Black Americans by targeting the trauma of racism. Dr Calhoun calls herself an ‘activist trainee’ and through public speaking and writing, exposes current and historical racism in the medical system. She firmly believes that all doctors should be activists and promotes the integration of social justice teaching with medical education.

1. Smith SL, Choueiti M, Choi A, et al. Mental health conditions in film & TV: portrayals that dehumanize and trivialize characters. USC Annenberg Inclusion Initiative, American Foundation for Suicide Prevention, and the David and Lura Lovell Foundation. 2019. Accessed September 20, 2020. 

http://assets.uscannenberg.org/docs/aii-study-mental-health-media_052019.pdf

2. Martin A, Chilton J, Gothelf D, et al. Physician self-disclosure of lived experience improves mental health attitudes among medical students: a randomized study. 

3. Mehta SS, Edwards ML. Suffering in silence: mental health stigma and physicians’ licensing fears. 

4. Martin A, Krause R, Chilton J, et al. Attitudes to psychiatry and to mental illness among nursing students: adaptation and use of two validated instruments in preclinical education. 

5. National Institute of Mental Health. Major depression. Accessed September 20, 2020. 

https://www.nimh.nih.gov/health/statistics/major-depression.shtml

6. Gray JB. The power of storytelling: using the narrative in the healthcare context. 

7. Beck CS, Aubuchon SM, McKenna TP, et al. Blurring personal health and public priorities: an analysis of celebrity health narratives in the public sphere. 

8. Wong NCH, Lookadoo KL, Nisbett GS. “I’m Demi and I have bipolar disorder”: effect of parasocial contact on reducing stigma toward people with bipolar disorder. 

9. Calhoun AJ, Gold JA. “I feel like I know them”: the positive effect of celebrity self-disclosure of mental illness. 

10. Wong YJ, Ho MR, Wang SY, et al. Meta-analyses of the relationship between conformity to masculine norms and mental health-related outcomes. 

11. National Alliance on Mental Illness. Latinx/Hispanic. 2019. Accessed September 20, 2020. 

https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Latinx-Hispanic

12. National Alliance on Mental Illness. African American Mental Health. 2019. Accessed on September 20, 2020. 

https://www.nami.org/find-support/diverse-communities/african-americans

13. American Psychiatric Association. Mental health disparities: African Americans. 2017. Accessed May 1, 2019. 

https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts

14. McGuire T and Miranda J. Racial and ethnic disparities in mental health care: evidence and policy implications. 

16. Jackson, Vanessa. In Our Own Voices: African American Stories of Oppression, Survival and Recovery in the Mental Health System. 

. Posted online April 28, 2015. Accessed October 1, 2020. 

http://academic.udayton.edu/health/01status/mental01.htm

17. Metzl J. The protest psychosis: how schizophrenia became a black disease. Beacon Press; 2011.

18. Schwartz RC, Blankenship DM. Racial disparities in psychotic disorder diagnosis: a review of empirical literature. 

19. Ballentine KL. Understanding racial differences in diagnosing ODD versus ADHD using critical race theory. 

20. Todd AR, Thiem KC, Neel R. Does seeing faces of young Black boys facilitate the identification of threatening stimuli? 2016;27(3):384-393.

Dak Prescott of the Dallas Cowboys spoke up about his mental illness and was questioned. Dr Calhoun argues his bravery should be commended, not criticized.  

Amanda Calhoun, MD, MPH

Articles

The Super Bowl and the Importance of Tradition (Or Not)

Seeking Help Is Not Weak