Forty Years of Wrestling With Racism

October 12, 2020

A psychiatrist considers the role of race in American culture, psychiatry, and his own life.

I once heard Tom Hanks being interviewed about his acting on a TV interview. Something he said stuck with me. “We only have 3 days: yesterday, today, and tomorrow.” That insight seems to fit my own personal story about racism, from what some might say is a “white” experience and others might see as a Jewish experience.

Yesterday

I think my entree into racism and psychiatry started with my exposure to jazz as an adolescent. It was musical love at first hearing. Until the second year of medical school at Yale, I even reviewed jazz records for a publication under the name Dr Jazz.

I found out that jazz was developed by Black Americans and was among the first social situations in the United States where integration took place. I felt the cognitive dissonance keenly: how could a people create such an original and magnificent musical form (beloved around the world), yet be so discriminated against otherwise? When I later looked at the musical industry beyond the music, I saw that it was controlled by white executives and clearly had some racist policies, including reimbursement of the artists. One intermittent response to the lack of financial control was was for Black jazz musicians to set up their own recording companies, as I wrote about many years ago in an article for The Black Collegian titled: "Toward Self Determination: The Black Jazz Recording Companies."1

When I decided upon my early focus in psychiatry, my love of jazz, combined with my Jewish value of Tikkun Olam (healing the world), naturally led me to want to serve the underserved, with Black Americans being over-represented among the underserved.

Early in my academic career in community psychiatry, I was asked to set up a cultural education series at Baylor College of Medicine for the psychiatric residents. Thankfully, my knowledge base was enhanced by the psychiatric faculty anthropologist, Charles Cheney, PhD, and faculty sociologist, Howard Kaplan, PhD. Along with a Black male psychiatry resident who was also interested in the project, we came up with a series that became the first national model.2,3 Moreover, in my clinical and administrative work, I benefitted greatly from co-leadership with a Black female social worker in a large community mental health clinic.

In the 1980s more Black Americans and other minorities entered the psychiatric residency at Baylor and some other medical schools. Soon, it didn’t seem that my leadership in addressing racism in psychiatry was needed, as minority psychiatrists began to make major contributions to the field. At times it felt like I was not even wanted anymore, as organizations of Black physicians developed in psychiatry and the rest of medicine.

I did, however, continue to focus on other disparities in psychiatry. I had other cultural psychiatry teachers and role models: psychiatrist Francis Lu, MD, on Asian Americans and cultural competence, Tony Arce, MD, on Hispanics and Carl Hammerschlag, MD, on Native Americans. After obtaining state and federal grants when I joined the Medical College of Wisconsin in 1989, I developed systems of care for various refugee groups, especially the Hmong and Black Somalis. When I saw many patients from the former Yugoslavia, I was shocked at the degree of trauma and cruelty they encountered, which at times seemed to rival that of Holocaust survivors.

In the 1990s, I also benefitted from writing a monthly Ethics Column for Clinical Psychiatry News with the help of a Black female editor. Improving the care of minority patients is certainly an ethical priority.

Not too many years ago, I had some ambivalent reactions about the Black Lives Matter movement, not because of the basic necessity for such a movement, but because the left political fringe seemed devoted to the BDS (Boycott, Divest, Sanction) movement against Israel, due to the plight of the Palestinians. For me, Israel’s existence seemed too crucial to endanger it in any way.

Today

During the past year, examples of police brutality against minorities have been clearly caught on camera. How well psychiatry was addressing racism became a question. When I was asked to help assemble a feature article on racism and psychiatry, I thought that I could not possibly–or appropriately-do it myself. I would need help and a collaboration for at least 2 reasons.

One reason is that I had unfortunately drifted away from the ongoing need—despite advances—for psychiatry to address the harm of racism internally in our organizations, and in patient care. Actually, most white psychiatrists had drifted away from racial issues, as far as I knew, perhaps other than Jonathan Metzl, MD. He has continued to do innovative activities regarding racism while teaching undergraduates at his home base at Vanderbilt University. He wrote a book on the misdiagnosis of schizophrenia in black males.4,5

A second reason was the question of who would be an appropriate spokesperson(s) for the issue. Young Black psychiatrists were coming up with new ideas and perhaps some of the ideas of older white psychiatrists were outdated. When I brought up the possibility of reverse racism in an online discussion, I was told that was an erroneous concept, although I am still not sure how that can be the case if a minority is in a power and uses it against white individuals. But maybe that is just a different expression of racism.

As a sort of compromise, I ended up thinking that the best model would be a multi-cultural authorship. Given that white psychiatrists seemed to have reduced concern for racism in society and psychiatry yet still had power, multi-cultural authorship seemed like a necessity. Fortunately, I found such a coalition in SPAR, Seven Psychiatrists Against Racism.6 Although I was the senior author of the article, our youngest Black female psychiatrist moderated the follow-up webinar.

Tomorrow

Now, I am more prepared to step aside. There seem to be more than enough qualified and concerned Black psychiatrists. New models of analysis have emerged and are helpful to find hidden societal and institutional racism that can go along with whatever personal psychological racism may be present. The key this time around, in society and psychiatry, is to maintain our focus on racism after this crisis period is over. I will contribute what I can, when I can, since I have concluded that a sustainable multicultural approach is a necessity.

Psychiatric Times® has begun publishing stories about the role racism has played in psychiatrists’ lives. We welcome more from those of any cultural background.

Dr Moffic 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 Psychiatric Times®.

References

1. Moffic HS, Gani H. Toward self determination: the black jazz recording companies. The Black Collegian. 1974;4(5), 46 & 54.

2. Moffic HS, Kendrick EA, Lomax JW, Reid K. Education in Cultural Psychiatry in the United States. Transcultural Psychiatric Research Review. 1987;24(3):167-187

3. Moffic HS, Kendrick EA, Reid K, Lomax JW. Cultural education during psychiatric residency. Acad Psychiatry. 1988;12 90-101.

4. Metzl J. The Protest Psychosis: How Schizophrenia Became a Black Disease. Beacon Press, Illustrated Edition, 2011.

5. Metzl J. Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland. Basic Books, Illustrated Edition, 2020.

6. Moffic HS: Dismantle racism in psychiatry and society. Psychiatric Times. August 10, 2020. Accessed 9/18/2020. https://www.psychiatrictimes.com/view/dismantle-racism-in-psychiatry-society