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When the pandemic hit in 2020, individuals disappeared into isolation. And so did I.

I got through by returning to my childhood of 60 years ago. Someone once told me that what makes us happy as adults is what made us happy at age 7. At that age, I loved my Lionel train, movies, making up stories, and plays.

I grew up in the North Carolina mountains. My father was a high school principal, World War II medic, basketball star, and a summer outdoor theater manager. When I was 9 years old, he dragged me to

, a play that dramatized the settlement of High County. He thought it would teach me business principles. During breaks from business lectures, I sneaked into summer stock theatre rehearsals. I was stunned by the truths declaimed in Tennessee Williams and Eugene O’Neill plays. Certainly not the truths I heard and saw at our family’s dinner table. Tennessee? Eugene? You guys hooked me.

One day I announced to my father, “I want to audition for a role in 

” Dad wanted to shield me, concerned I would be devastated if I lost competing against New York actors. After weeks of the air being sucked from me, Dad gave in. I landed a role. When I jogged to him and announced out of breath that I was cast, he said he looked at my face and knew I was lost to the business world forever.

Outdoor drama led to summer stock theater. Before long, I organized neighborhood children and my cousins to perform in plays that I wrote. My parents’ garage was our theatre and the garage door our curtain.

At age 9, I learned I was legally blind and required glasses. No wonder I could not catch Dad’s pitches. I could not even see the ball. Blindness was a good reason to spend afternoons in my grandfather’s movie theater, sitting in the front row. I could see people’s gigantic faces and expressions. Childhood blindness was a gift that led me to music, theater, writing, and eventually medicine.

Mom and Dad were not parents who read to their children. My teachers and librarians did. After I got home from school, I read to my little brother. Dad said I used to grab napkins, paper bags, anything I could write on, and sit at the end of the hall and write. He liked showing his basketball friends that if I was writing he could not distract me. Writing was necessary to me, like breathing.

All the while, I loved my chemistry set, math, and physics. (To this day I still read 

 cover to cover.) In fifth grade, I learned to play the clarinet and joined the marching and symphonic bands.

At the University of North Carolina at Chapel Hill, although I majored in chemistry and played in the symphony, I took theatre courses, acting and directing. I also took electives in creative writing, novel writing, short story writing, feature story writing, and playwriting. What skills the university could not fit into my schedule, I studied in art schools, from ballet, stage dance, choreography, stage and television light design, and editing to screenplay writing.

In medical school, I composed music and gathered classmates who also adored writing. We put on a full-blown musical: an allegory of Merlin the Magician apprenticing to become a Medicine Man in days of old. Students in our class joined in acting, singing, dancing, playing instruments in the pit orchestra, building sets, making costumes, running sound and lights. It was a smash hit.

During psychiatry residency, professors asked if I could combine show business with teaching. What a terrible idea, I thought. They dragged me into it. Using drama to teach landed me on the UNC-Chapel Hill psychiatry faculty. Following passions opens unexpected doors.

And so, in Chapel Hill; Morgantown, West Virginia; Australia; and New Zealand, I spent over 30 years teaching psychiatry while a half day a week I taught theatre. I recruited drama students to play patients for my medical student classes. One hundred-ten medical students gathered, eager to raise hands and each pose a single question to the patient—they often forgot “the patient” was an actor.

If medical students messed up, they got to do something they could not do on the wards: have second and third chances to rephrase questions. And those classes were favorite activities for my West Virginia University theatre students.

, friends, and theatre students portraying patients and used those videos to teach. That led to cofounding a company in San Diego where we produced over 400 videos of simulated patients using New York and Los Angeles actors. Those videos teach in classrooms across the country. Meanwhile, I continued writing plays for local community theatres, occasionally acting and directing.

Then in the blink of an eye, I got old. Amazing how fast that happens when you are having fun. I decided to narrow my focus. No more doctoring. No more acting or directing. No more producing plays or videos. Just write. Just breathe. Get better at it. Eight hours, 9 hours a day. Expose myself to others’ works. Learn.

 hours to become an expert. Working 8 hours a day, except for an annual 2-week vacation, means 3 and a half to 4 years to become an expert. I think—no, I know—it takes longer for writers.

Every day I improve. And thank gosh for collaborations. My multitalented friends and colleagues at the 

 are producing a video series on the history of psychiatry. During the pandemic, by using 

, we were able to continue producing videos.

During a decade of so-called retirement, I have had plays performed nationwide in universities, community theatres, and professional theatres. 

is the story of a young United States soldier with Afghanistan nightmares being treated by a military psychiatrist still suffering from traumas in Vietnam. Tons of conflicts in that therapy.

 garnered the Cleveland Critics Circle Theatre Award and moved onto Chicago and New York. It was made into a video by a theatre company in Carlisle, Pennsylvania. It was the first serious drama to be performed in an Alaskan indigenous village where during a performance, children crawled onto the set to examine props. At least they were well behaved.

Far more important than awards, audiences cry. Audience members hug and thank the cast. They say they feel understood. Talk about their own heartbreaks. Or their sons and daughters’ heartbreaks. Or fathers and mothers’ tribulations.

I write more—lots more. I breathe. My mind aches to fill blank pages. My characters act up while I am still lying in bed. They scream at me to vault out of bed, to scribble and then type. They surprise me. They enchant me. They teach me truths I do not even know I know.

Maybe they spring to life because I am old, old enough to have lived adventures with individuals from varied cultures. Australian Outback tribes, Persian Gulf mountain Bedouins, Kodiak Alutiiqs, New Zealand Maori, Appalachian rural folks—and of course: the college students, adolescents, adults, and elderly blessing my psychiatry office. Truth poured out from those people. I was a collection vessel. I tap into that fullness, shape bits of lives into plays, novels, stories, into daydreaming.

And what about memories of life journeys with family and friends? They are the glue that holds my center together.

Time flies. And what about this pandemic? It is becoming more fodder in my rearview mirror.

was an endowed chair of education psychiatry at West Virginia University. He is also a decorated playwright and founder and senior clinical consultant at Symptom Media.

Do you have a passion you would like to share with your colleagues? Please contact us at 

The pandemic has driven a psychiatrist into isolation, but his long history in the arts helps him reconnect. 

Calling on the Arts to Thrive During a Pandemic

C. Addressing social problems like homelessness or incarceration

What is the most important contribution by peer support staff in mental health care? Take the quiz and learn more.

Mini Quiz: Peer Support and Mental Illness

, I would like to thank each and every one of our contributors for making the Black History Month series impactful, current, and relevant to advancing the conversation about equality in psychiatry and the world. 

Special thanks to Frank Clark, MD, Diversity & Inclusion section editor, for marshalling the project. Please enjoy each of this month’s pieces.

Mentorship: Salute to a Windy City Educator

Balkozar Adam, MD, Rameshwari V. Tumuluru, MD, and Sarah H. Arshad, MD

Why Psychiatry Training Must Include Discussions on Structural Racism

Black Americans’ Distrust of the COVID-19 Vaccine

Why Is Black History Month Important to Psychiatry?

Race and Opioids: Lessons From the Civil War-Era Opioid Addiction Crisis

H. Steven Moffic, MD, and Rahn Bailey, MD: 

If I Had a Hammer: Advancing the Conversation in Psychiatry and Racism

Purcell Pearson: A Young Black Man Who Dreamt of Becoming a Psychiatrist

7 Black Physicians That Made History in the Mental Health Field

, History of Psychiatry section editor for 

 is medical director, Brain Health, Exeter, NH; editor in chief,

; staff psychiatrist, Seacoast Mental Health Center, Exeter, NH; consulting psychiatrist, Exeter Hospital, Exeter, NH; consulting psychiatrist, Insight Meditation Society, Barre, MA.

As February comes to a close, we reflect on this month's contributions.

A Tribute to Black History Month

Opioid addiction has deep, troubling roots in American history. Not merely a plague of recent decades, the phenomenon of widespread opioid addiction dates back to the 19th century, when the Civil War sparked the United States’ first opiate addiction epidemic among ailing veterans. Nineteenth-century opiate addiction cases usually originated in doctors’ prescriptions, a disturbing parallel with today’s ongoing 

, which has roots in opioid overprescribing during the 1990s. The alarming parallels between the 19th- and 21st-century opioid crises in the United States are not limited to iatrogenesis, however. 

Both crises exhibit a history of troubling racial inequalities in access to opioids as well. Addiction was far more common among white Civil War veterans than Black veterans, who lacked equitable access to opiates, a pattern that presaged the opioid underprescribing experienced by Black Americans in recent decades.1 Thus, the history of the Civil War-era opiate addiction epidemic not only reveals the deep historical origins of iatrogenic opioid addiction in the United States, but also underscores how Black Americans have experienced longstanding racial inequalities in access to opioid medicines.

Historical Opioid Use Patterns in the Civil War Era

During the antebellum decades, addiction to rudimentary opiates such as laudanum and opium in gum, pill, and powdered forms was common among white Americans. Discussion of opiate addiction, often dubbed the “opium habit” or “slavery” to opiates, frequently appeared in medical journals, monographs, textbooks, and even newspapers beginning in the 1830s. Psychiatrists, physicians, and other Americans widely attributed opiate addiction to the sufferers’ mental illness, constitutional weakness, or moral failings. Consequently, Americans afflicted by the so-called opium habit were frequently victim-blamed, stigmatized, and even institutionalized.

In reality, Americans addicted to opiates could usually trace their troubles to medical care. Most opiate addiction in the 19th-century was iatrogenic, 

 from physicians’ prescriptions or medical advice.

 Opiates were standard remedies for hundreds of ailments, including dysentery, cholera, malaria, pneumonia, menstrual pain, painful injuries and wounds, and more. Surveying 30 antebellum American medical textbooks, 

commentaries and formularies, medical handbooks, medical dictionaries, and home health guides published between 1813 and 1858, I identified approximately 150 distinct ailments for which opiates were indicated. The figure fluctuates slightly depending on how one classifies certain illnesses, as many nineteenth-century medical diagnoses do not map precisely on to modern diagnoses.

 indicate that opiates were among the most commonly prescribed medicines of the 19th century. In a pre-germ theory era when typical medical interventions failed to effectively address the microorganisms at the root of many sicknesses, doctors and patients prized opiates as utilitarian remedies that effectively mitigated a legion of symptoms, regardless of cause. Indeed, as one enthusiastic medical student at the University of South Carolina 

, opium was “the ‘Magnum Dei Donum’”—or, the great gift of God—“of the 

In the aftermath of the Civil War (1861-1865), the phenomenon of opiate addiction reached epidemic levels for the first time in American history, developing into a major public health crisis with alarming social implications. This epidemic, the earliest opioid crisis in U.S. history, was driven initially by sick and injured Civil War veterans, who became the first distinct cohort in the nation to be widely associated with opiate addiction. The Civil War presented the greatest health disaster of the 19th century, prompting surgeons to rely more heavily than ever on opiates, including newly available hypodermic morphine injections.

 summed up the medical consensus of the day when it described opium as the most “indispensable drug on the battlefield—important to the surgeon, as gunpowder to the ordinance.”

Accordingly, military surgeons North and South prescribed opium pills and morphine injections liberally to ease pain stemming from gunshot wounds, amputations, and traumatic nerve injuries. Surgeons also doled out opium and laudanum to treat dysentery and diarrheal sicknesses, the most common health complaints of the war. Many soldiers, taking their cue from army surgeons, continued purchasing and consuming opiates after leaving the military, there being few legal restrictions on narcotics until the early 20th century. The Civil War thus sparked an unprecedented surge in iatrogenic opiate addiction, resulting in tens of thousands of cases of chronic addiction among veterans. Predictably, overdose deaths were frequent among veterans, and the medical literature of the period is 

 with cases of men whose lives were upended by addiction.

Black Civil War Soldiers and Opiate Addiction

Racial disparities were evident among Civil War veterans addicted to opiates, the majority of whom were disproportionately white. Although Black soldiers comprised approximately 10% of the U.S. army during the Civil War, they were not equally represented among the cohort of veterans who were addicted. In a sample of approximately 150 Civil War veterans who experienced opiate addiction in their postwar lives—the largest sample of any study to date, compiled from spotty, extant Civil War-era medical records—I could identify only 1 Black Civil War veteran who suffered from an opium habit.

Contemporary physicians and psychiatrists likewise noted a distinct racial gap in opiate addiction. In 1885, a physician reported that the Eastern North Carolina Insane Asylum had admitted an exceedingly rare case of “colored insane man” of whom “it was alleged that his insanity was caused from the opium habit.” The man’s case was worthy of note because “this was the only case of opium habit he [the doctor] had ever seen in the negro.”9 The next year, a white Alabama physician also 

 that “the opium habit is rare” among the Black population after the Civil War.10This racial gap persisted for decades.

Surveying the records of morphine maintenance clinics that dotted the United States from 1910s to 1920, historian David Courtwright 

 that while the southern white population experienced the highest rate of opiate addiction in the nation, few Black southerners appeared in the clinics’ records, although the facilities were ostensibly open to Black patients.

 This enduring racial gap in the opiate addiction rate stemmed largely from racist 19th-century medical beliefs about Black bodies, coupled with substandard medical care provided to Black Civil War troops. Nineteenth-century psychiatry posited that, among other causes, opiate addiction stemmed from mental overstimulation, which led to insanity and substance abuse. Such overstimulation could only occur among intelligent, sensitive white Americans, according to Civil War-era psychiatrists. In contrast, white medical authorities 

 that Black Americans were too “simple-minded” to experience mental overstimulation, precluding them from insanity and opiate addiction.

According to J.D. Roberts, a North Carolina doctor, Black bodies lacked “the same delicate nervous organization” as whites, and thus “d[id] not demand the form of stimulant conveyed in opium” as did whites. Black people, Roberts claimed, also had a “general ignorance” of medical care, an assertion implying that Black Americans lacked the knowledge to care for their health needs by self-medicating with opiates, as whites often did.9 This constellation of racist beliefs was developed by antebellum white southerners to justify keeping Black people enslaved and to ward off abolitionist critiques.12 After the Civil War, apologists of Jim Crow fine-tuned these beliefs and used them to explain why white Civil War veterans had opiate addiction more often than Black veterans.

In reality, the relative infrequency of opiate addiction among Black Civil War veterans and other African Americans during the late 19th century stemmed from structural racism in medicine and health care. Undertreatment for pain and subpar medical care in the military left Black veterans far less likely to become addicted to opiates than their white counterparts. Just as white doctors believed that Black Americans were less liable to mental overstimulation than whites, so too did these physicians believe that Black bodies were less sensitive to pain.

 Consequently, Black Americans were much less likely to be prescribed opiate painkillers during the Civil War.

Prescription records from the war are exceptionally rare, and none are extant for Black regiments. But anecdotal evidence suggests that army surgeons, who were overwhelmingly white, often refrained from prescribing opiates to wounded Black soldiers because they believed that Black men were not troubled by pain. One white surgeon assigned to a Black regiment refused to give painkillers to a soldier whose foot was partly severed by shrapnel. Under such circumstances the standard of care for white soldiers was morphine, given early and often. But when confronted, the surgeon claimed that the wounded man in question “was not suffering much pain,” despite the gruesome nature of the wound.

 The surgeon in this episode—and likely countless similar, unrecorded incidents—seems to have been motivated by the mainstream contemporary medical belief that Black men were impervious to painful injuries that would have debilitated white soldiers and warranted opiates.

Doctors also seem to have avoided giving opiates to Black soldiers debilitated by diarrhea, although surgeons usually administered opiates to white soldiers afflicted by the same illnesses. Surgeons knew that well-timed, liberal administration of opiates could, and often did, stave off soldiers’ deaths by dehydration, the risk of poisoning or addiction notwithstanding. Consequently, the mortality rate for diarrheal sicknesses among white troops—for whom surgeons prescribed opiates liberally—was a relatively low 17.3%. In contrast, the mortality among Black troops was 33.9%, nearly double that of white soldiers.

 This excessive mortality suggests that Black soldiers did not have access to prescription opiates, the standard of care for diarrheal ailments.

Black soldiers’ lack of access to opiate analgesics and antidiarrheals was typical, not exceptional, when considered within the broader scheme of Civil War medicine. Indeed, scholars have documented pervasive racism in Civil War military and humanitarian medicine, which diminished the quality of medical care accessible by Black Americans and resulted in thousands of avoidable Black deaths during the Civil War and its aftermath.

Persistent Racial Inequalities in the Opioid Crisis, Past and Present

A troubling undercurrent of racial inequality runs through the United States’ historical and ongoing opioid crises. Racial disparities in access to essential opioid medicines has been a persistent feature in American health care, both during the Civil War era and in recent decades. Amidst the ongoing opioid crisis, multiple studies have found that Black Americans are less likely to suffer from prescription opioid addiction than white Americans. This trend is because, like Black Civil War veterans in the late 19th century, African Americans today have less access to prescription opioid painkillers than white Americans. Persistent 

 in opioid prescribing rates have been so extreme that, until recently, white Americans were about 

 to die from prescription opioid overdose as African Americans.

The relative infrequency of opiate addiction among Black Americans when compared with white Americans has been touted as a “protection” shielding African Americans from the 

 of the opioid crisis.20 But considered in historical context, such rhetoric misses the mark. While it is true that during the Civil War-era opioid crisis and that of today, iatrogenic opioid addiction has been less prevalent among Black Americans than whites, this racial disparity should not be celebrated as a metaphorical silver lining. Instead, the relative infrequency of prescription opioid addiction among African Americans in the last century and a half merely reveals the longstanding, destructive influence of structural racism in American health care that has been, and continues to be, manifested in Black Americans’ unequal access to essential opioid medicines.

Special thanks to Greg Eghigian, PhD, History of Psychiatry Editor for 

is Postdoctoral Scholar, George and Ann Richards Civil War Era Center, Pennsylvania State University, State College, PA. His website is 

1. Jones JS. Opium Slavery: Veterans and Addiction in the American Civil War Era. PhD Dissertation, Binghamton University, 2020.

Preventing and Treating Narcotic Addiction—A Century of Federal Drug Control

The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885.

 Cambridge, MA: Harvard University Press; 1986.

Nineteenth century drug therapy: computer analysis of the 1854 prescription file of a Burlington pharmacy

5. Wilson TD. On the effects of opium upon the system. 1857, Waring Historical Library Inaugural Theses Collection, Waring Historical Library, Medical University of South Carolina, Charleston, South Carolina, 2. Accessed February 23, 2021. 

http://digital.library.musc.edu/cdm/compoundobject/collection/wit/id/2776/rec/10

Marrow of Tragedy: The Health Crisis of the American Civil War

. Baltimore, Maryland; Johns Hopkins University Press: 2013.

A Manual of Military Surgery. Prepared for the Use of the Confederate States Army.

 Richmond, Virginia: Ayres & Wade; 1863. Accessed February 23, 2021. 

https://collections.nlm.nih.gov/bookviewer?PID=nlm:nlmuid-0257706-bk#page/4/mode/2up

Opium Slavery: Civil War Veterans and Opiate Addiction

9. Roberts JD. Opium Habit in the Negro. 

10. Tipton F. The Negro Problem from a Medical Standpoint. 

 1886:569-570. Accessed February 23, 2021. 

https://archive.org/details/101710951.nlm.nih.gov/page/n1/mode/2up

The Hidden Epidemic: Opiate Addiction and Cocaine Use in the South, 1860-1920

Aberration of Mind: Suicide and Suffering in the Civil War-Era South,

 Chapel Hill: University of North Carolina; 2018: 85-88.

Medical Bondage: Race, Gender, and the Origins of American Gynecology.

 Athens: The University of Georgia Press; 2017.

Washington, Eagles on Their Buttons: A Black Infantry Regiment in the Civil War.

 Columbia: University of Missouri Press; 1999:22-23.

Intensely Human: The Health of the Black Soldier in the American Civil War.

 Baltimore, Maryland: Johns Hopkins University Press; 2008:11.

 Sick from Freedom: African-American Illness and Suffering During the Civil War and Reconstruction.

 New York: Oxford University Press, 2012.

Trends in Black and White Opioid Mortality in the United States, 1979–2015

Racial/Ethnic Differences in Prevalence Trends for Heroin use and Non-Medical use of Prescription Opioids Among Entrants to Opioid Treatment Programs, 2005-2016

 Baltimore, Maryland: Johns Hopkins University Press, 2014:194-195.

A ‘Rare Case Where Racial Biases’ Protected African-Americans

Black soldiers’ lack of access to opiate analgesics and antidiarrheals was typical, not exceptional, when considered within the broader scheme of Civil War medicine.




2020 has been a year of hardship for all Americans. The COVID-19 pandemic struck our country in a way that we have never seen in living memory. It has infiltrated all corners of the country and killed more Americans than 

. The virus has caused a cascade effect of disruption that not only challenged the physical and mental health of Americans, but also overran our health care system and the economy, causing widespread economic shutdowns and leaving millions without jobs.

Aside from its medical effects, the virus has exposed many of our society’s vulnerabilities, including the darker underbelly of our social fabric: the longstanding, deeply-rooted racism towards Black Americans. 2020 put a magnifying glass on racial disparities in this country, forcing us to confront realities affecting Black Americans that have always been there: economic disparities, health disparities, and police violence to name a few. The virus highlighted health disparities affecting Black Americans, who were 

 from COVID-19, compared to their white counterparts, and twice as likely to die from the virus. Black Americans disproportionately lost their jobs due to pandemic-related economic losses. The virus also reminded us that Black Americans are more likely to be uninsured and less likely to have access to and utilize health care services.

2020 appeared to end with an encouraging turn. Two COVID-19 vaccines were found to be over 90% effective in preventing illness from the virus, and they were approved emergently for use (and now a third vaccine is currently seeking emergency use authorization). This could be the turning point for our country and offer hope for all Americans, right? If only it were that simple.

 found that in December of 2020, 35% of Black Americans stated they definitely or probably would not get the vaccine. This was a significantly higher percentage of reluctance compared to all other ethnic counterparts surveyed. The revelation of this study, in a similar vein to the rest of 2020, reflects a much deeper problem within our society. Many Black Americans distrust the American medical system.

This is understandable. Our country’s medical establishment has a longstanding history of abusing Black Americans. One of the most heinous generational traumas was the 

, in which a massive cohort of Black participants were recruited with the incentive of free medical care. In truth, they were diagnosed with syphilis without being informed or offered treatment, but instead deceitfully monitored to study the progression of the disease.

When doctors and research scientists today pursue basic research training, all must review the tenants of the Nuremberg Code, a globalized set of research principles drafted in 1947 that emphasize the ethics of patient consent for research participation. The 

 was established after the 1941 Nuremberg trials, which sought justice for the heinous experiments by Nazi doctors involving torture, poisoning, and mass murder of Jewish individuals in concentration camps during World War II. What we as modern doctors and researchers tend to overlook is that the Tuskegee experiments here in the United States, that involved no informed participant consent, no knowledge of their infection with a deadly disease, and withholding of proper treatment for their illness, ran from 1932 all the way up until 1972.

It is no wonder, then, that when the COVID-19 vaccine trials began, social media posts among Black Americans erupted with references to Tuskegee. Even though the trials ended in 1972, the trauma remains etched in the Black community’s historical memory.

As psychiatrists, most of us were trained with a clinical framework that considers a patient’s feelings towards the doctor. But with our focus on mental health, we are prone to view other domains of our patients’ physical health and wellbeing as beyond our purview. Consequently, many of us are reluctant to confront the topic of 

 with our patients; however, it is important for us to do so in order to establish trust with our patients. The reluctance of Black Americans to get the COVID-19 vaccine reflects a deeper distrust of the medical system as a whole, that not only failed them, but also took advantage of them and deliberately hurt them. So how can we as psychiatrists overlook such a critical underpinning of our Black patients’ transference towards us as their medical doctors?

I, like many others, only just began in 2020 to take a hard look in the mirror and confront my own implicit biases towards my Black counterparts and patients. I recently began to talk with my Black patients about their racial experience, and I have been astonished and humbled by the revelations of everyday racism that my patients would share with me. Explorative conversations about race have proven to be invaluable, and have brought me closer with my patients and helped me grow as an individual and a doctor. As we see these discrepancies in trust over the 

vaccine (one of our only hopes to resume social normalcy), I think we must take the conversation further.

We as psychiatrists can and should start talking with our patients about the COVID-19 vaccine. COVID-19 does not only affect our patient’s physical health, but also has devastating mental and emotional consequences. We need to engage in conversations with our patients about their mistrust of the health care system, as we are part of it. Educating our patients about the seriousness of the illness and the benefits of the vaccine can go a long way. Providing them with reliable resources, especially if it comes from trusted agencies, organizations, faith leaders, professionals, or a nationally-recognized African American figure, may make a difference.

Advocating for our patients’ wellbeing is a basic responsibility of being their psychiatrists. With our additional support, we can continue our efforts to help our patients live healthier and happier lives—and rebuild broken trust.

is a clinical instructor of Child and Adolescent Psychiatry, and of Psychiatry at New York University’s Grossman School of Medicine. 

is Clinical Professor of Psychiatry, University of Missouri- Columbia, Columbia, MO.

1. Hamel L, Kirzinger A, Munana C, Brodie M. KFF COVID-19 Vaccine Monitor: December 2020. 

Kaiser Family Foundation: Health Policy Analysis, Polling and Journalism

. December 15, 2020. Accessed February 19, 2021. 

https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/

A case for why psychiatrists should discuss the COVID vaccines with their patients.

Virtually all of the eulogies that we have published over the years have been about psychiatrists. The only exception I recall has been the neurologist Oliver Sacks, MD. We now add another, a 22-year-old black male who was planning to be a psychiatrist. Purcell Pearson was shot and killed in broad daylight on Saturday February 6th, in Milwaukee.

Milwaukee is where I have lived for over 30 years now. When I first came to town, I was asked by the media if there was rampant psychosis in the black community. I answered that it was more likely posttraumatic stress disorders (PTSD) from all the trauma encountered by those living in our very segregated inner city. That was verified 20 years later when I worked part-time in our medium security prison, where young black males were overrepresented and were almost inevitably diagnosed with sociopathy, whereas my reassessment often came up with PTSD.

Over those 30 years, the number of black psychiatrists was minuscule. Research continues to indicate that black psychiatrists are significantly underrepresented among psychiatrists nationally, yet black patients trust them more and tend to have better outcomes, all other variables being more or less equal. In 2020, the overt resurgence of racism, which seems to me to be a psychosocial pathology, calls for more black psychiatrists.

We had Mr Pearson in that pipeline in Milwaukee. A 

 reported that he wanted to be a psychiatrist to help people of color and to address the stereotypes that negatively influence how black males view themselves.

 posted by his college, the University of Wisconsin-Whitewater, Pearson is quoted as saying:

“If you start to break down some of the stereotypes and break down some of the challenges and barriers to African-American males being successful in society, you might start to create different outcomes for these males.”

A psychology department chair and mentor also noted Pearson’s interest in how buildings influenced people psychologically. Also stressed was his curiosity about individuals and the world.

Of course, we have black male psychiatrists who are doing just what Mr Pearson called for, including the editor of this series, Frank Clark, MD, and my coauthor, Rahn Bailey, MD, among so many others. But what a tragedy that we will not have another in Purcell Pearson, who already showed signs of being a charismatic leader. We can honor his legacy and life by continuing to address racism, not only with an increase in black psychiatrists, but by reducing gun violence, among other antiracist actions.

is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of being a Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He has recently been leading Tikkun Olam advocacy movements on climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of 

1. Shastri D. ‘He held us all together’: UW-Whitewater grad and young entrepreneur Purcell Pearson remembered as a leader. 

https://www.jsonline.com/story/news/obituaries/2021/02/11/purcell-pearson-uw-whitewater-grad-killed-milwaukee-leader/4440656001/

2. Pohorski J. Warhawk Purcell Pearson wins 2020 WiSys Quick Pitch state final. 

https://www.uww.edu/news/archive/2020-06-purcell-pearson

A potential young psychiatrist lost too soon. 

h is important so that as Americans, we never fail to remember the democide to African Americans in this country. In addition, we should acknowledge, admire, and celebrate Black heroes for their respective contributions. Moreover, for me, it is important to respect overall humanity and improve the quality of life for all Americans. Black history is American history.

Racism is pervasive. Its negative impact exists in many forms. The field of psychiatry has not been exempt from this 

, past or present. Such truth is of great concern as psychiatry represents a group of professionals whose primary purpose is to assess, diagnose, and treat serious persistent mental illness. Furthermore, as trained professionals in this medical discipline, society depends on us to set definitions, criteria, and standards to treat psychiatric illnesses. Therefore, it is imperative that as leaders we understand our past, in order to move forward toward eliminating structural forms of racism within our profession.

The early treatment of psychiatric disorders in this country was a forewarning of where we are today. There was a dark period in the beginning of psychiatry in America which predates the formation of the 

 (APA) in 1844. At that time, the perception of African Americans was inhumane. American psychiatry was started by 13 white men who were superintendents of asylums at the time.

 Early on in their organizational meetings, they decided to segregate facilities for African Americans—that is, if they were to receive treatment at all. Whether you lived in the free north or the enslaved south determined the care (or lack thereof) a Black patient would receive.

Diagnoses such as drapetomania were assigned to individuals who were considered mentally ill because they wanted to run away from their slave owners. Another diagnosis, dysaesthesia aethiopica (rascality), was considered an illness that compelled slaves to commit offenses. An early founder and leader of American psychiatry, Benjamin Rush, promoted the theory that the “color” and “figure” of Blacks were derived from a form of leprosy.

 In order for our society to evolve and move forward from structural racism we must cease glorifying legacies of individuals that promoted it originally. These misconceptions were promulgated by psychiatrists for a century.

In more recent history the vestiges of racism still exist. In 1910, the 

 except for Meharry Medical College and Howard University.

 This meant less training of Black doctors and therefore less quality health care for African Americans overall. Prior to the inclusion of Title VI into Medicare, hospitals were segregated. Black hospitals were significantly underfunded compared with white hospitals. Black physicians were not given the opportunity to work at white hospitals, and Black patients were denied health care. After the enactment of Title VI of the 

, 1000 White hospitals joined the program in a mere 4 months. Then and only then were African American doctors allowed to work and African American patients treated in those hospitals. This is an indisputable example of racial discrimination, only a half century ago.

In 2015, I was invited to a research meeting being presented by a lead cancer research scientist at a medical school where I was previously employed. Local African American community doctors were invited to discuss proposals for cancer research, hopeful that several would agree to refer African American patients to our clinical site. It was eye opening the degree of distrust, feelings of betrayal, and resentment that existed within many of those senior doctors who had experienced the 

 in that setting. In fact, more than one commented on having never been invited to the university site, for any activity.

This reality is particularly important because it sets a framework for the ongoing process of mistrust that many in African American communities feel toward research—and their government. This mistrust leads to 

 participating in clinical research, therefore compromising the validity of the results. Often, studies do not accurately represent the African American population. Hence, this leads to a lack of scientific progress and advancement for African American health indices.

In terms of education, I believe every child in America should receive equal educational opportunities. Particularly, such should include comparable funding. Our current system is fundamentally flawed, as it bases resources on the variable of location. Children have no influence on factors such as where they live or which zone has the highest property taxes. Thus, this strategy of funding public education is discriminatory to African Americans and/or ethnic minority children, many of whom reside in communities with fewer financial resources. Such a system of funding and governance has evolved into a cycle of less overall educational support. This current system must change.

Reparations have been discussed to address the historical governmental mistreatment of African Americans. This topic has been particularly polarizing here in America. Since this country’s inception, the principles of equality, opportunity, and freedom have been declared and promulgated with eloquence. However, the reality of life for African Americans as citizens has been markedly different compared to Whites. Our collective history has recorded over 4 centuries of slavery, oppression, and mistreatment of African American communities.

In many statistical categories which measure health, success, and prosperity in American life, there is a 

 between white Americans and African Americans.

 Some dissenters who criticize the concept of reparations use the counterargument of highlighting extraordinarily successful African Americans (eg, Carl Lewis in track and field). Unfortunately, that analogy overlooks the fact that such does not represent the majority of people. This issue must be addressed if we are to truly exemplify the ideals of this country.

Furthermore, reparations do not solely need to be in the form of monetary compensation (see 

). A powerful beginning can be made by addressing the 2 key initial pillars that would level the playing field for ethnic minorities in this country: health care and education.

 Reparations are not a handout. The idea represents the core construct of recalibrating life in American society, changing its structure and placing our country on the correct path to fundamental fairness.

 serves as Assistant Dean of Clinical Education at Charles R. Drew University and Chief Medical Officer of Kedren Health Systems Inc. He served as president of the National Medical Association and chair of the American Medical Association’s Commission to End Health Disparities. He currently is a member of the American Psychiatric Association Board of Trustees. Throughout his career, Dr Bailey has worked with underserved and minority populations and has authored numerous papers on the topic. 

 is a research associate with Charles R. Drew University and Kedren Health Systems Inc.

The Original Thirteen Members of the Association of Medical Superintendents of American Institutions for the Insane

Racial Formation in the United States: from the 1960s to the 1980s

. New York; London: Routledge & Kegan Paul; 1986.

Medical education in the United States and Canada. From the Carnegie Foundation for the Advancement of Teaching, Bulletin Number Four, 1910

Cultural Psychiatry