Amanda Calhoun, MD, MPH

You know, I am not typically attracted to Black men, but…” said my non-Black attending as we walked down the hallway to our next patient. I did not listen to the rest. Fortunately, she was not looking at me as she spoke. If she had been, my facial expression would have clearly communicated my disdain. Listening to this attending sexualize Black men, which is a longstanding racist behavior,

 was not something I ever wanted to do—let alone as I was being supervised during a clinical rotation in my first year of residency. Racist statements are cognitively disarming when I am trying to learn how to be a psychiatrist. But, as a Black resident, I have learned to deal with them—I have to.

I thought back to medical school when I was summoned by a senior attending to discuss a psychiatric patient. I ruffled through my notes, reviewing my patient formulation and speculating about the questions he might ask me. I took a deep breath and pushed open the door, making a mental note of my proposed medication management. “Ah, Amanda,” said the senior attending, looking up from his desk. “I wanted to ask you. This patient wants to apply to college, but she doesn’t think she can get a scholarship. I was wondering if you had some tips. I mean, she’s Black, she’s female, and she has a mental illness. Isn’t that the perfect trifecta for easily getting a scholarship to college?”

I frowned. “I don’t think there is anything easy about being Black, female, and having a mental illness,” I said. “Unfortunately, I can’t give tips about scholarships because I didn’t have one as a college student at Yale.” His jaw dropped.

Conversations like these are some of the least troublesome I have encountered. In fact, I have come to expect them, and, since I grew up in predominantly white spaces, I found insensitive statements with racist assumptions that I am somehow less-than to be commonplace.

 As a child, they upset me, but I had coaching from brilliant parents who are professionals at navigating racism.

Some interactions with supervisors are more troubling. Attendings have deleted my notes documenting racist events in the hospital, stated somewhat ominously that my activism can “hurt or help me” in my written evaluations, or told me that I am overly confident when I state that the impact of racism cannot be minimized. I find that some supervisors simply do not want to discuss racism at all, maybe because they do not believe it is a factor or because their knowledge about racism is lacking.

There is a hierarchy in medicine. I am not just a resident learning psychiatry—I am also an activist and a scholar in anti-Black racism pursuing a PhD on the impact of racism on Black youth. I relentlessly study the work of Black scholars in conceptualizing racism and its impacts. Although I do not consider myself an expert yet, others do, and that can make some supervisors, who expect to know more than me, feel uncomfortable. Navigating the supervisor-supervisee relationship as a Black female resident, activist, and scholar in anti-Black racism can be challenging, but I have refined my process of interaction along the way, largely by trial and error.

I always do a supervisor “temperature check.” A supervisor’s response to my vague and palatable statement about racism often gives me more than enough information about safety. The temperature is just that: a range of safe to unsafe, with many nuances along the spectrum. For instance, a supervisor may be safe to discuss racism with abstractly, but not in real-time clinical circumstances.

In such an example, the supervisor may feel that racism plays a role in the medical system at large, but if I point out that a white staff member in their unit seems to be treating patients differentially based on race, the supervisor becomes angry or defensive, rather than investigative and concerned. Sometimes the supervisor sets the temperature before I test it. If they make an offensive statement like, “You know where the most child abuse happens? In Native American reservations…” then I know that the supervisor is unsafe. On the contrary, if they make a statement acknowledging the impact of racism, stating the actual word 

, then they are on the safer end of the spectrum.

Actions are important, too. Once, a supervisor and I were listening to a white patient discuss his experience. Quite randomly, he stated, “Yeah, and then the visiting nurse came in…and you know, she was Black…” My ears perked up immediately. The supervisor let the patient finish and then replied, “I noticed you mentioned the race of the visiting nurse. Why? Did you have an issue with the fact that she was Black? Was racism at play there?” The actions of that supervisor spoke volumes for me.

My perceived safety level of a supervisor determines whether and how often I discuss racism. I may leave out any mention of racism during supervision with unsafe supervisors, even though helping the patient to navigate racism was a crucial part of their treatment. On the contrary, I discuss racism much more openly with safe supervisors. We may engage in in-depth discussions about how to shape the patient’s treatment in the context of the racism they experience. The safest attendings are the ones who not only discuss racism in an abstract and intellectual way, but who respond to racism in real time.

I won’t consult with an unsafe supervisor if I witness or experience racism while working with them. My next step is deciding whether to report the racist event, which is a complex decision. It requires that I attend a series of meetings with leadership, not to mention that there are inherent risks of retaliation. Usually, I will reach out to a trusted supervisor to seek advice—a “supervisor for my supervisor.”

Racist events that clearly impact patient care only touch the surface of the many types of racism that are problematic in the medical system, like everyday racism. Everyday racism or microaggressions refers to the common cuts and slights I experience: the lack of eye contact and eye-rolling by white staff (behavior that they do not exhibit toward white colleagues), the questioning of my orders, the ignoring of my questions—the list goes on. Everyday racism may be subtle, and even undetectable to those who are not targeted by it, so voicing a complaint when it happens, even though its effects are profound,

 requires that I have the utmost trust in my supervisor. The usual end result? I never mention the everyday racism I experience, even if I am quite upset by it. And frankly, I will not report it, either. It is too difficult to “prove,” and sadly, there are few structures in place in the medical system to adequately capture and effectively respond to everyday racism that Black and other minority physicians and staff experience.

To be sure, there are many positive aspects of the supervisor-supervisee relationship. As a resident, supervision is crucial to my learning and development as a psychiatrist. The invaluable opportunity to present and discuss patients with a senior attending is a central part of psychiatric training.

It is uncomfortably common to have unsafe supervisors, so additional planning as a minority supervisee is required, which often results in missed opportunities for important conversations about racism to occur. However, encountering truly safe supervisors is invigorating, because so few spaces are safe to discuss racism. In fact, I firmly believe that safe supervisors are the best supervisors. They feel that supervisees, like me, have knowledge to contribute through our lived experiences and our scholarship. They listen to us in addition to teaching us, and, in situations where racism plays out in real time, they help us.

 is an adult/child psychiatry resident at Yale Child Study Center/Yale School of Medicine. She is also a Public Voices Fellow of the OpEd Project at Yale University.

Fetishization of Black men is a form of prejudice

 November 7, 2020. Accessed October 19, 2021.

3. Overland MK, Zumsteg JM, Lindo EG, Sholas MG. 

Microaggressions in clinical training and practice

Articles

How I navigate the supervisor-supervisee relationship as a Black female resident, activist, and scholar in anti-Black racism—and how a "temperature check" can help.

Temperature Check

“You know, I am not typically attracted to Black men, but…” said my non-Black attending as we walked down the hallway to our next patient. I did not listen to the rest. Fortunately, she was not looking at me as she spoke. If she had been, my facial expression would have clearly communicated my disdain. Listening to this attending sexualize Black men, which is a longstanding racist behavior,

 was not something I ever wanted to do—let alone as I was being supervised during a clinical rotation in my first year of 

. Racist statements are cognitively disarming when I am at work trying to learn how to be a psychiatrist. But, as a Black resident, I have learned to deal with them—I have to.

I thought back to medical school when I was summoned by a senior attending to discuss a psychiatric patient. I ruffled through my notes as I walked towards his office, reviewing my patient formulation and speculating about the questions he might ask me. I took a deep breath and pushed open the door, making a mental note of my proposed medication management for the patient. “Ah, Amanda,” said the senior attending, looking up from his desk. “I wanted to ask you. This patient wants to apply to college, but she does not think she can get a scholarship. I was wondering if you had some tips. I mean, she’s Black, she’s female, and she has a mental illness. Isn’t that the perfect trifecta for easily getting a scholarship to college?”

I frowned. “I don’t think there is anything easy about being 

Black, female, and having a mental illness

. Unfortunately, I cannot give tips about scholarships because I did not have one as a college student at Yale.” His jaw dropped.

Conversations like these are some of the least troublesome I have encountered during supervision. In fact, I have come to expect them, and growing up in predominantly white spaces, insensitive statements with racist assumptions that I am somehow less-than are commonplace.

 As a child, they upset me, but I had coaching from brilliant parents who are professionals at navigating racism.

Some interactions with supervisors are more troubling. Attendings have deleted my notes documenting racist events in the hospital, stated that my activism can “hurt or help me” in my written evaluations, or told me that I am overly confident when I state that the impact of racism cannot be minimized. I find that some supervisors simply do not want to discuss racism at all, maybe because they do not believe it is a factor or maybe because their knowledge is lacking in the area.

There is a hierarchy in medicine, and psychiatry is no exception. I am not just a resident learning psychiatry—I am also an activist and a scholar in 

. In addition to my lived experience, I am pursuing a PhD focusing on the impact of racism on Black youth, and I relentlessly study the work of Black scholars before me in conceptualizing racism and its impacts. While I do not consider myself an expert yet, many others do, and that can make some supervisors, who expect to know more than me about everything, feel uncomfortable. Navigating the supervisor-supervisee relationship as a Black female resident, activist, and scholar in anti-Black racism can be challenging, but I have refined my process of interaction along the way, largely by trial and error.

I always do a supervisor “temperature check.” A supervisor’s response to my vague and palatable statement about racism often gives me more than enough information about safety. The temperature is just that: a range of safe to unsafe, with many nuances along the spectrum. A supervisor may be safe to discuss racism with abstractly, but not in real-time clinical circumstances.

For example, the supervisor may feel that racism plays a role in the medical system at large, but if I point out that a white staff member in their unit seems to be treating patients differentially based on race, the supervisor becomes angry or defensive, rather than investigative and concerned. Of course, sometimes the supervisor sets the temperature before I test it. If they make an offensive statement like, “you know where the most child abuse happens? In Native American reservations…,” then I know that the supervisor is unsafe. On the contrary, if they make a statement acknowledging the

Actions are important, too—maybe more so than words. 

Actions are important, too—maybe more so than words. Once, a supervisor and I were listening to a white psychiatric patient discuss his experience. During the story, and quite randomly, he stated, “Yeah and then the visiting nurse came in…and you know, she was Black…” My ears perked up immediately. The supervisor let the patient finish and then replied, “I noticed you mentioned the race of the visiting nurse. Why? Did you have an issue with the fact that she was Black? Was racism at play there?” The actions of that supervisor spoke volumes for me.

My perceived safety level of a supervisor determines whether and how often I discuss racism. I may leave out any mention of racism during supervision with unsafe supervisors, even though helping the patient to navigate racism was a crucial part of their treatment. On the contrary, I discuss racism much more openly with safe supervisors. We may engage in in-depth discussions about how to shape the patient’s treatment in the context of the racism they experience. The safest attendings are the ones who not only discuss racism in an abstract and intellectual way, but who respond to racism in real-time, in hospital settings, and in their own departments.

If I witness or experience racism while working with an unsafe supervisor, I will not consult them about it. My next step is deciding whether to report the 

, which is a complex decision. Reporting racism requires that I attend a series of meetings with leadership, which is taxing in and of itself. Not to mention, there are inherent risks of retaliation when one reports. Usually, I will reach out to a trusted supervisor to seek advice about next steps—a “supervisor for my supervisor.”

Racist events that clearly impact patient care only touch the surface of the many types of racism that are problematic in the medical system, like everyday racism. Everyday racism (also known as 

) refers to the common cuts and slights I experience—the lack of eye contact and eye rolling by certain white staff (behavior that they do not exhibit towards my white colleagues), the constant questioning of my orders, the ignoring of my questions—the list goes on. Everyday racism may be subtle to those who are not targeted by it, so voicing when it happens, even though its effects are profound,

 requires that I have the utmost trust in my supervisor. The usual end result? I never mention the 

 I experience to most supervisors, even if I am quite upset by it. And frankly, I will not report it either. It is too difficult to “prove,” and sadly, there are few structures in place in the medical system to adequately capture and effectively respond to everyday racism that Black and other minoritized physicians and staff experience.

To be sure, there are many positive aspects to the supervisor-supervisee relationship. As a resident, supervision is crucial to my learning and development as a psychiatrist. The invaluable opportunity to present and discuss patients with a senior attending is a central part of psychiatric training. Nevertheless, navigating the supervisor-supervisee relationship as a Black woman and an anti-Black racism scholar can be tricky. 

It is uncomfortably common to have unsafe supervisors, so navigating supervision requires additional planning as a minoritized supervisee, which often results in missed opportunities for important conversations about racism to occur in supervision. But, encountering truly safe supervisors is invigorating for me, because many spaces are not safe to discuss racism. In fact, I firmly believe that safe supervisors are the best supervisors. They feel that supervisees, like me, have knowledge to contribute through our lived experiences and our scholarship. They listen to us in addition to teaching us, and, in situations where racism plays out in real time—they help us.

 is an Adult/Child Psychiatry Resident at Yale Child Study Center/Yale School of Medicine. She is also a Public Voices Fellow of the OpEd Project at Yale University.

1. Smith D. Fetishization of Black men is a form of prejudice. 

. November 7, 2020. Accessed October 19, 2021. 

https://www.ntdaily.com/fetishization-of-black-men-is-a-form-of-prejudice/

3. Overland MK, Zumsteg JM, Lindo EG, Sholas MG. 

Microaggressions in clinical training and practice.

Navigating the supervisor-supervisee relationship is difficult when supervisors are dismissive of racism, especially when the impact of racism cannot be minimized. 

Some Attendings Are Safer Than Others: Navigating Supervision as a Black Psychiatry Resident

 plays a role in all of this?” I asked my Black female adolescent patient in her hospital room. She had been avoiding eye contact with me, but when I asked that question, she looked at me suddenly, her carob-brown eyes widening in surprise. She nodded slowly, then more quickly, and began to speak more openly. She was admitted for attempting suicide and had been dropping hints since she began describing her depression to me. She felt isolated, did not blend in, and was punished more than her peers at her preparatory school.

When you talk to enough patients about racism, you recognize when you are being tested. She was testing me to see if it was safe to discuss an experience that has been minimized by those who are not targeted, and sometimes by those who are. The taboo experience in our conversation that day was not, in fact, her suicide attempt—it was racism.

I presented my assessment to the attending, citing racism as a central component of my patient’s major depressive disorder and suicide attempt. The attending interrupted me. “Nope. Racism isn’t the issue here.” I wondered if the attending was aware of the damaging impact that predominantly white spaces can have on Black individuals, a concept referred to as the 

 I wondered if the attending was aware that Black girls are more likely to be criminalized in schools for the same behaviors as their white counterparts.

 Most importantly, I wondered how many other Black patients whose main drivers of attempted suicide—the isolation and poor treatment they experienced due to racism—had been dismissed and silenced by that attending. As for me, I stopped discussing the racism that future patients relayed to me with that attending, even though racism was a crucial component of my patient formulation and treatment. I stopped talking to that attending about racism because, as my patient had done with me, I had tested her, and she was not safe.

Medical education teaches us that suicide is less of an issue in Black youth, yet the 

suicide rate in Black youth is increasing

 than in any other racial/ethnic identity.

 A recent study, released just last month, documented this significant increase in Black youth suicide, especially among Black youth aged 15 to 17 years, and in Black girls.

 Yet, select suicide risk assessments continue to include 

 as a risk factor for suicide, an additional point in the algorithm that can shape care. Experiences of racism are absent from this risk assessment, yet race-related stress impacts the development of Black youth.

 It is no surprise that suicide predictor models, which are accurate for white populations, have been found to have poor sensitivity for Black populations.

 A mounting number of studies document the deleterious impact of racism on the mental health of Black youth, including depression, yet it is largely left out of the narrative when discussing Black youth suicide. It should not be. Racism is the missing piece to the puzzle of Black youth suicide.

Black girls specifically, like my patient, experience unique challenges contributing to their depressive symptoms. The racism that Black girls experience is known as 

, anti-Black racist misogyny that is distinct from the racism that Black boys experience, and from the sexism that non-Black women experience.

 Black girls are more likely to be viewed as older, more sexually mature, and less in need of comforting compared to white girls, a racist phenomenon known as adultification.

 The societal expectation that Black girls must be strong, also known as the 

 archetype, is damaging to mental health and wellbeing of Black girls who may be struggling emotionally.

Although racism affects the physical and mental health of Black youth and is a driver of health inequities,

 psychiatrists are not routinely trained to identify and mitigate racism. Experiences of racism can have a dose-dependent relationship with depressive symptoms. Black adolescents can experience racism multiple times within a single day, with a greater number of racist experiences correlating to greater depressive symptoms.

 Yet, there is a dearth of research targeting the mental health of Black youth specifically. In fact, race is rarely mentioned in psychological research, and when it is, the research is authored and edited by mostly white scholars.

If psychiatrists want to elucidate the cause of the increase in Black youth suicide, they must conduct more studies that target Black youth and their experiences of racism. Clinically, psychiatrists must stop treating racism as an unacknowledged elephant in the room and start helping Black adolescents handle or confront it. Their lives may depend on it.

Black youth are less likely than white youth

 to access and remain engaged in the mental health system.

 And to be sure, socioeconomic status plays a role in this, although one cannot fully examine the socioeconomics of Black youth without first examining white supremacy and the intentional economic oppression of Black Americans. Yet lack of access to care due to economic resources is not the whole story. Socioeconomics may be the non-taboo reason, a reason that can be attributed to patient factors, not psychiatrist factors.

Perhaps Black children do not access mental health because psychiatrists, largely non-Black, fail to establish a therapeutic alliance with them. Perhaps studies cannot understand why Black youth suicide is rising is because research is not targeting Black youth and their experiences of anti-Black racism specifically. And perhaps the psychiatrists who Black children are encountering, like my former attending, are minimizing and silencing their experiences of racism, which is further traumatizing. As one of my Black patients once told me, when I asked why she stopped attending therapy, “I’m never going back to therapy. I don’t want to spill my guts to another stone-faced, condescending therapist who looks like Judge Judy.”

 is an Adult/Child Psychiatry Resident at Yale Child Study Center/Yale School of Medicine. She is also a Public Voices Fellow of the OpEd Project at Yale University.

The white space. Sociology of Race and Ethnicity

Pushout: The Criminalization of Black Girls in Schools

3. Coleman BW. Ring the alarm: the crisis of black youth suicide in America. Emergency Taskforce on Black Youth Suicide and Mental Health: A Report to Congress From the Congressional Black Caucus. 2021. Accessed October 6, 2021. 

https://watsoncoleman.house.gov/uploadedfiles/full_taskforce_report.pdf

4. Sheftall AH, Vakil F, Ruch DA, et al. 

Black youth suicide: investigation of current trends and precipitating circumstances. 

5. Jones SCT, Anderson RE, Gaskin-Wasson AL, et al. 

From "crib to coffin": navigating coping from racism-related stress throughout the lifespan of Black Americans

6. Coley RY, Johnson E, Simon GE, et al. 

Racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visits

On misogynoir: citation, erasure, and plagiarism

8. Epstein R, Blake JJ, González T. Research confirms that Black girls feel the sting of adultification bias identified in earlier Georgetown Law study. Georgetown Law: Center on Poverty and Inequality. May 15, 2019. Accessed October 6, 2021. 

https://www.law.georgetown.edu/news/research-confirms-that-black-girls-feel-the-sting-of-adultification-bias-identified-in-earlier-georgetown-law-study/

9. Geyton T, Johnson N, Ross K. “I’m good”: examining the internalization of the strong Black woman archetype. 

Journal of Human Behavior in the Social Environment

10. Trent M, Dooley DG, Dougé J; Council on Community Pediatrics; Committee on Adolescence. 

The impact of racism on child and adolescent health.

11. English D, Lambert SF, Tynes BM, et al. 

Daily multidimensional racial discrimination among Black U.S. American adolescents

12. Roberts SO, Bareket-Shavit C, Dollins FA, et al. 

Racial inequality in psychological research: trends of the past and recommendations for the future

Racial and ethnic disparities in pediatric mental health

How does the experience of racism contribute to suicidal ideation and attempts?

The Missing Piece to the Puzzle of Black Youth Suicide

 death of 54-year-old actor, Michael K. Williams, confirmed to be due to an overdose of heroin, cocaine, and fentanyl,

 was a sobering reminder that the opioid crisis is far from a problem limited to white Americans, although it has 

 about his own struggles with substance abuse, and celebrities disclosing mental illness can be a powerful method to increase help-seeking behaviors, especially for minoritized communities.

 In addition, he was quite invested in community work for children, founding 

, a charitable organization that creates community centers to provide children with safe places to play and to learn. Williams himself experienced significant childhood trauma and admitted that he began to use substances as an adolescent to 

 In fact, studies have shown that most adults who struggle with substance use disorders (SUDs) begin using substances 

 If psychiatrists want to combat the opioid epidemic, they must appreciate the needs of often-overlooked communities and start early—in childhood and adolescence.

I recently attended a lecture about the effects of maternal opioid use on newborns. The presenter showed slides depicting mothers with opioid use disorders (OUDs) through a humanizing, rather than criminalizing, lens. All these mothers happened to be white. This was a particularly troubling coincidence, given the racialization of drug use and the racist pattern in the media—the favorable portrayal of rural and suburban white opioid users versus the unfavorable portrayal of black opioid users living in urban communities.

 Black Americans with OUDs are too often represented as poor, urban, criminals injecting opioids. This is a racially inaccurate depiction in and of itself, given that Black individuals with OUDs also live in the suburbs and in rural areas.

In 2017, the US Department of Health and Human Services declared the opioid epidemic a 

 after witnessing the monumental number of deaths due to opioid overdose.

 Since then and through 2019, although white deaths have been on the decline, opioid overdose deaths in Black Americans, and in particular in Black men, have been 

 Synthetic opioids have hit Black communities disproportionately hard. From 2011 to 2016, Black Americans had the greatest increase in opioid-related death rates due to synthetic opioids, such as 

 and from 2016 to 2017, Black Americans experienced a 61% increase in synthetic opioid fatal overdoses, compared to a 

The current interventions used for OUDs, and arguably SUDs overall, are not working optimally for everyone. To be sure, white individuals have been harmed by the opioid crisis, and before the onset of fentanyl they had the highest rates and numbers of deaths due to opioid overdose.

 However, the opioid crisis is not only harming white people, and Black people are often left out when it comes to OUD interventions.

OUD treatment interventions should not be the same for all populations, because all populations are not treated equally when it comes to OUDs. The racist war on drugs, which disproportionately targeted 

 is only one example. Black individuals are disproportionately criminalized for SUDs, making it more difficult for them to trust and therefore access substance use treatment. Even though white individuals are more likely to sell drugs than Black individuals, Black individuals are 

 Black Americans are also more likely to be arrested for drug possession, even though white and Black individuals use substances at similar rates.

Racial disparities exist even in the distribution of psychopharmacological treatment for OUDs.

 There is differential access to buprenorphine and methadone, with the former less likely to be available in Black communities versus the latter. Methadone requires daily appointments, while buprenorphine is a take-home-pill. In essence, the more convenient treatment is less accessible for Black people. OUD interventions must do more to target Black communities specifically, and advertisements and slides for OUD interventions that feature white-only families misrepresent the true demographics of the epidemic. Black patients must be reassured that their SUDs will be humanized and treated as psychiatric disorders, not as punishable crimes.

During the opioid crisis, there has been less attention on the impact of OUD on children and adolescents. Although a myriad of research studies exist on OUDs’ impact on newborns, children 1 year or older get less attention when it comes to OUD research, with only 2% of federal funding for addiction research focusing on children or families.

 Beyond research, there is a need for clinical training on navigating OUDs in children and adolescents—and additionally, helping to prevent them. Children and adolescents of parents with OUDs should receive anticipatory guidance about opioid use, including support in understanding why they may be at greater risk for developing an OUD.

To be sure, child and adolescent psychiatrists have these sorts of conversations with their patients individually all the time, but having these conversations (or not) is often left up to the psychiatrist’s discretion, rather than having it be a standard of care. As an adult/child psychiatry resident, I have received the bulk of my training in SUDs from my time with adults, rather than with children.

While we are certainly trained to ask about SUDs in children and to monitor and treat them once they occur, what about preventing them? Perhaps newborns who suffer from neonatal abstinence syndrome should be flagged to receive preventative SUD care when they reach a certain age, although the long-term psychiatric outcomes of newborns exposed to opioids in utero is still a subject very much debated.

 Perhaps children who are exposed to trauma should be counseled about the risk of engaging in substance use, among risky behaviors, in an attempt to cope, especially if these children are already being seen by a child and adolescent psychiatrist for other reasons. One thing is for sure, the opioid crisis is far from a white people problem or an adult problem, for that matter. And, sadly, it is far from over.

1. Gold M, Bromwich JE. Michael K. Williams died of a drug overdose, authorities say. 

. September 27, 2021. Accessed September 26, 2021. 

2. Shihipar A. The opioid crisis isn’t white. 

. February 26, 2019. Accessed September 26, 2021. 

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

4. Murray E. Michael K. Williams never hid his addiction struggles. Addiction Center. September 9, 2021. Accessed September 30, 2021. 

5. Jackson D. Everything Michael K. Williams has said about addiction and his mental health struggles. 

. September 24, 2021. Accessed September 26, 2021. 

6. National Institute on Drug Abuse. Principles of adolescent substance use disorder treatment: a research-based guide. Revised January 2014. Accessed September 30, 2021.

7. Netherland J, Hansen HB. The war on drugs that wasn’t: wasted whiteness, “dirty doctors,” and race in media coverage of prescription opioid misuse. 

8. US Department of Health and Human Services. HHS acting secretary declares public health emergency to address national opioid crisis. October 26, 2017. Accessed September 26, 2021. 

9. White C. Progress against the opioid epidemic is not reaching Black Americans. 

. February 8, 2021. Accessed September 26, 2021. 

10. Agency for Healthcare Research and Quality. Blacks experiencing fast-rising rates of overdose deaths involving synthetic opioids other than methadone. February 2020. Accessed September 26, 2021.

11. Goodnough A. In cities where it once reigned, heroin is disappearing. 

. May 18, 2019. Accessed September 26, 2021. 

12. United States Sentencing Commission. 2015 report to the Congress: impact of the fair sentencing act of 2010. 2015. Accessed September 26, 2021.

13. Ingraham C. White people are more likely to deal drugs, but black people are more likely to get arrested for it. 

. September 30, 2014. Accessed September 30, 2021. 

14. Winstanley EL, Stover AN. The impact of the opioid epidemic on children and adolescents. 

15. Larson JJ, Graham DL, Singer LT, et al. Cognitive and behavioral impact on children exposed to opioids during pregnancy. 

How can psychiatrists improve substance use treatment for Black and pediatric patients?

The Opioid Crisis Is Neither a White Nor an Adult Problem

In a chilling scene of the television series, 

 set in rural North Carolina, an unnamed elderly white woman tauntingly sings these lyrics with a wide grin as she trespasses on the Black female protagonist Lucky’s property. This serenade foreshadows the racist violence that ensues after. This song, “Old Black Joe,” written by the “Father of American music,” 

 Foster also wrote many minstrel songs, a form of entertainment for white audiences in which white performers donned 

, a facial costume in which white individuals smeared their faces with burnt cork and drew on larger, red lips, with the intent of looking like Black/African-American individuals.

“Old Black Joe” represents an entire culture of songs, written by white composers, that were dehumanizing to Black individuals. These cringeworthy songs were enmeshed in American society to the detriment of the psychological wellbeing of Black individuals, and their songwriters are still memorialized even to this day. A statue of the renowned Stephen Foster, with an African slave sitting at his feet strumming a banjo, was only recently removed.

 is a horror/thriller series recently released on Amazon Prime. The series joins a growing collection of movies and television shows, like 

 that graphically illustrate 1 key point: the violence of white individuals towards Black individuals, simply due to the color of their skin, is scarier than any horror movie monster.

 expertly combines elements of reality and the supernatural to illustrate the horrors of racism and white supremacy to its audience. The series centers on a Black family who moves from the south to California in the 1950s, during a time in history known as the 

, in which Black families moved north to flee the racial violence of the South.

In fact, my mother’s family was one of them, having left the brutal environment of Mississippi for Ohio, hoping for a better life. I have cousins who were murdered by white individuals for attempting to register Black voters. My father’s family, from Macon, Georgia, remained in the South. My uncle, alive and well today, remembers seeing a Black man who had been lynched, swinging from a tree. He was just a child. His father, my grandfather, took pictures of the lynching and published it in a Black-owned Macon newspaper he led. White individuals in the area were furious—not because a Black man had been murdered, but because it had been publicized in the newspaper.

Black children have never had the luxury of being shielded from racism, and 

 highlights this. Ruby, the adolescent protagonist, is sent to the principal’s office for disrupting her class (the disruption being when she raises her hand to answer a question, her white classmates begin making sounds like a monkey). Gracie, the youngest in the family, is forced to see a myriad of Black dolls hanging from ropes in front of her house as she leaves for school. The dolls were placed there by her white neighbors to intimidate Gracie’s family into leaving the neighborhood.

 does not just give the audience a window into the lives of Black Americans, but it also gives a powerful account of the silenced truths of American history, the facts that are largely erased from history books in favor of a narrative that places white Americans in a more positive, nonviolent, light. The series illustrates the harassment and violence that Black Americans endured across the United States upon moving into predominantly white neighborhoods.

White families did not want to live next to Black families due to a host of fears, such as Black men raping white women, a common racist idea that was used to support the 

 This becomes especially ironic, given that rape of Black women by white men was a widely used 

 The series follows a group of housewives in the area who will stop at nothing to remove the Black family from their neighborhood. The series also delves deeper to show how realtors denied home loans or intentionally offered predatory loans to Black families with the goal of disadvantaging them. Viewers get the opportunity to watch how the color grading system, known as 

, developed by the Home Owners’ Loan Corporation to place value on property values in a given area, plays out in the lives of 

 The series follows a female realtor who participates in this heinous system, and partners with a policeman, who only protects Black families from being murdered by white neighbors in return for a profit gained from the predatory home loan given to the Black family.

Although redlining is no longer technically legal today, homeowner racism is still very real, with Black homeowners still given 

 for the same property as their white peers.

, while no longer legal, is also still very much in effect.

Psychiatrists Need to Learn About White Supremacy

When some hear the words “white supremacy,” they think of extremist groups on the fringe of society. Indeed, this terminology was used to describe such groups in the past. But today, white supremacy is often used to describe a political and socioeconomic system in which those racialized as “white” enjoy structural advantages and rights that other racial groups do not. In this way, white supremacy is woven throughout American society. Psychiatrists must learn about the effects of white supremacy on Black Americans if they are to even begin to understand the plight of Black Americans and help them navigate it. Although a horror/thriller show with its share of supernatural monsters, 

 highlights the very real thoughts and behaviors of white Americans in a white supremacist system, many of which persist today. 

Racism and white supremacy incorporate many behaviors that one might deem antisocial, being executed seemingly without compassion or empathy for the lives of Black Americans. 

 shows us how white Americans murdered Black Americans with smiles on their faces, and as one character reports, “lynch Black people just for shade.” Thousands of Black Americans were 

, but these widespread, racially terrorizing behaviors of white Americans are largely left out of history accounts.

 Yet, one can easily turn to the internet to read about the 

 of white Americans having picnics with their families while they watched Black Americans be lynched.

 The ease with which white Americans justified their hateful behaviors towards Black individuals is upsetting, and disturbing to say the least.

Although Black Americans are no longer (openly) hung from trees (although, activists in the Black community still continue to be mysteriously lynched, 

), the continued murder of unarmed Black men by the police and the mass incarceration of a 

 for nonviolent crimes is but a manifestation of the same story.

 The murder of George Floyd has come to be known by many as a modernized lynching, and he the modern 

 Those who engage in racist acts are often everyday citizens rather than extremists, and this series shows this with gut-wrenching clarity.

Psychiatrists need to understand how damaging racism and white supremacy have been, and continue to be, for Black Americans. How can psychiatrists help Black Americans heal from the generational trauma of racism if they themselves do not even know what that trauma entailed? How can psychiatrists help Black Americans to navigate the white supremacy of today if they themselves have not learned about it?

Movies and television can be a powerful, visual way of learning about the plight of Black Americans. The media can be a gateway for psychiatrists to do further research, leading them to the mounting empirical evidence documenting the 

 of racism on the mental and physical health of Black Americans today.

 It is imperative that psychiatrists learn about white supremacy and racism if they are to rectify its traumatic and violent effects on Black Americans. Start by watching 

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. Friedman M. Can’t escape Stephen Foster. 

Psychiatrists who want to understand white supremacy should watch this series… 