A Psychiatrist’s Perspective on Racism: 2020

Racism is defined as a belief that one’s race is the primary determinant of the differences that produce an inherent superiority of one group over another. It is one of the ugliest aspects of human nature. It is still present today in all walks of life. This typical pattern of racism in America more commonly disadvantages African Americans.

The first memory I have of police brutality was at the age of eight years old in 1972. This happened to my next-door neighbor, the most prominent individual of the community, Mr William "Boy" Brown, a radio personality and cousin of singer James Brown.¹ One night he accidently bumped into and broke an officer’s flashlight. He was then slammed against the police vehicle. Instantly breaking his neck. He was arrested and dragged to jail because he was unable to walk. Was left unattended for 6 hours until finally a cellmate noticed him motionless and called for help. Only then the ambulance was called. He was now quadriplegic and suffered this way for 4 years until his untimely death. Despite the family pursuing legal recourse, the court ruled that no one was at fault. It left a deep feeling of powerlessness in the community.

Years later another seminal incident occurred close to where I grew up, in Jasper, Texas. A person named James Byrd had gone to the store. Three white men, possibly drunk, snuck up behind him, tied a rope around his neck, and drove off in a car at high speeds leaving him decapitated. This received international attention, again this created the circumstance where the entire black community felt powerless due to this racist act.

Many had hoped that progress would have occurred after events such as the burnings of Tulsa in 1921 or the brutal murder of Emmett Till in 1955. Unfortunately, this is not the case as recently witnessed by Mr Floyd’s murder. This reinforces the powerlessness mindset in African Americans.

Racism also manifests itself in more pernicious ways, such as microaggressions.² This type of racism is experienced by many African Americans, with the subsequent deleterious effects being immeasurable. I had this experience of being blamed for stealing by my pathology professor in medical school for something I did not do. I was involved with a medical student organization which was sponsoring a health fair where we displayed organ models on a Saturday. The following Monday, before I could return them, the professor walked in, without talking to me first, humiliated me for “stealing” them in front of the whole class. This was perhaps the most embarrassing incident in my life, where I perceived that I was being treated unfairly because of my race.

Regrettably, my daughter went through a similar experience in medical school. During testing, a professor, who had a track record for mistreatment of his ethnic students, asked questions that were unbefitting for a third-year medical student. As a result, he humiliated her by calling her names like “below-average” openly in front of her peers with great animosity and antipathy. Two of her Caucasian classmates documented to the dean that the professor had mistreated her. For me, as an African American father, this is particularly challenging. This is another example of how racist actions undermine the ability to feel competent in my capacity to protect my family. Another aspect of how contemporary racism is detrimental to society.

What makes an individual racist? Carl Bell, MD,³ described these individuals having a psychopathological defect/narcissistic personality disorder which allows for dehumanization of others. Other psychiatrists have opined that racism may meet the criteria for a full psychotic disorder. Alvin Poussaint, MD,⁴ explains that “extreme racism” is a type of delusional disorder. I think, racism is a multifaceted construct. In my experience as a Forensic Psychiatrist, Psychiatric disorders cause functional impairment. This is not the case in most racist individuals. I believe racism is intentional. For example, an African American athlete/celebrity is cherished, only because of their achievements. Whereas a typical person of color may not be given the same treatment. One thing we can agree on is the psychological effects racism has on its victims.

These effects are numerous and include depression, anxiety, psychological stress, and various other outcomes.⁵ Higher rates of substance abuse and affective moods disorders are also seen.⁶ Prejudice against African American populations lead to many socioeconomic factors which contribute to a negative psychological impact, such as reduced access to employment, housing, education, and health care, even psychiatric care.^7,8

Here it is most egregious. African Americans are often overdiagnosed and/or misdiagnosed due to racial bias.⁹ The clinician can have pre-formed expectations or assumptions of ethnic patients. African Americans are often diagnosed more with psychotic disorders that deem them more violent.¹⁰ Therefore, leading to more intrusive, aggressive, and severe interventions for these patients. For 30 years I have worked in prisons and state hospitals witnessing this mistreatment. Psychiatrists should be mindful of sociocultural factors that may influence behavior. Awareness may prevent this bias.

This time tangible changes must be implemented. One example is the removal of racist remnants. Things like the Confederate Flag and Monuments to Confederate Heroes. We must not embellish the deeds of white supremacy by encouraging their adverse racist principles. The Confederate Flag has always represented racism. For example, after the shooting by Dylann roof in 2015 at the AME church in South Carolina, Governor Nikki Haley removed the confederate flag immediately.

Racism is a problem of the majority; we can no longer expect just the minority to fix it. It requires an active process by White Americans to bring about change for the whole. All people need to unite because racism is an issue that affects all of us. It brings down our society. Sowing hatred and bigotry.

Dr Bailey is Assistant Dean, Clinical Education, Charles Drew University School of Medicine; Chief Medical Officer, Kedren Community Health Systems, Los Angeles, CA. He reports no conflicts of interest concerning the subject matter of this article.

References
1. Edwards F, Lee H, Esposito M. Risk of being killed by police use of force in the United States by age, race-ethnicity, and sex. PNAS. 2019;116:16793-16798.
2. Hotchkins BK. African American males navigate racial micro-aggressions. Teachers College Record. 2016;118.
3. Bell CC. Racism, narcissism, and integrity. J Natl Med Assoc. 1978;70:89-92.
4. Poussaint AF. Is extreme racism a mental illness? West J Med. 2002;176:4.
5. Sohail Z, Bailey RK, Richie WD. Misconceptions of depression in African Americans. Front Psychiatry. 2014;5:65.
6. Paradies Y, Ben J, Denson N, et al. Racism as a determinant of health: a systematic review and meta-analysis. PloS One. 2015;10:e0138511.
7. Quillian L, Page D, Hexel O, Midtböen AH. Meta-analysis of field experiments shows no change in racial discrimination in hiring over time. PNAS. September 12, 2017; Epub ahead of print.
8. Yancy CW. COVID-19 and African Americans. JAMA Network. April 15, 2020; Epub.
9. Lawson WB. Schizophrenia in African Americans. Presented at the APA 2014 Institute on Psychiatric Services. November 2014.
10. Metzl JM. The Protest Psychosis. Boston, Ma: Beacon Press; 2011.