Far More Than Diversity: What the Field of Medicine Needs

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SPECIAL REPORT: DIVERSITY

When Psychiatric Times invited me to chair its Diversity Special Report, I was pleased. But I was also at a loss for words. I called my dad, also a child psychiatrist: “What do you think I should say, Dad?”

“Diversity? Are they still talking about that? People were talking about that 200 years ago, when I was in medical school,” my dad said, chuckling.

His words encapsulated what I was feeling, and why, when I put my pen to paper, the words I kept writing felt empty. It was because it felt futile.

During my third year of residency, I did an OpEd Project fellowship. “Raise your hand if you think you are working on a forever problem,” the facilitator asked, straightening his glasses. “You know, a problem that will not be solved in our lifetimes.” I raised my hand.

The importance of diversity in psychiatry, and in medicine in general, cannot be overstated. But the percentage of Black physicians has barely budged—only by 4%—in the past 120 years. And of these current Black physicians, it is unknown how many of these are Black American Descendants of the Enslaved, like me and my dad. Who knows? Those numbers may have decreased. And that matters. Most demographic spreadsheets and checklists put all individuals racialized as Black in a box, regardless of whether they are immigrants who are unfamiliar with the unique impact of anti-Black racism on health, or whether they are Foundational Black Americans who have been in this country for generations and live that impact every day.

Like my dad said, we as a field are still talking about increasing diversity when we need far more than diversity, far more than mere representation. Black children are more likely to be physically restrained than white patients and more likely to be diagnosed with disruptive mood disorders than white children, which trickles down to poor diagnoses and inadequate medication regimens. The stress of everyday racism in Black individuals leads to a splintering effect of depressive and anxiety symptoms, even those akin to posttraumatic stress disorder. It leads to telomere shortening and diminished lifespans. Racism is killing Black people and wearing down on our mental health, so we need far more than diversity.

We need research funding that does not just highlight another devastating white-Black disparity but funds the implementation of antiracist initiatives that lead to better health outcomes in Black individuals and other marginalized groups. We need more funding for programs that will increase the pipeline of Black physicians, by funding their medical school and undergrad programs. We need hospital and academic institutions to listen to us when we talk about the impact of racism on our Black patients, instead of silencing us. We need media platforms to listen and amplify our voices.

This Special Report is just that, and I am thankful to Psychiatric Times for walking the walk, not just talking the talk, and for supporting my voice, as well as the voices of the authors included in this report.

Dr Calhoun is an adult/child psychiatry resident at the Yale Child Study Center at the Yale School of Medicine. She is an expert on the harms of medical racism and the mental health effects of anti-Black racism in children.