Answers to Your Questions on Dismantling Racism

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SPAR’s cover story for the August 2020 issue of Psychiatric Times was “Dismantle Racism in Psychiatry & Society.” Following its publication, the authors conducted a webinar on the subject on August 20, 2020. The audience, around 300 participants, participated with gusto, and we were left with about 50 unanswered questions. We are now embarking on answering some of them, and this column will be the first. In part, we picked this one first because of the serendipitous timing of the New York Times article on the same day of the webinar. Gradually answering the questions will also help keep the focus on racism.

Question: What organization recently issued an apology through the New York Times?

Answer: The American Academy of Pediatrics

Discussion

What is so important about answering the simple question of an apology? We could have just answered with: The American Academy of Pediatrics. However, that would beg such related questions:

Why did the organization apologize?

Why hasn’t organized psychiatry apologized?

What is the psychology of apology?

How does apologizing apply to other societal institutions?

What is an appropriate apology anyway?

The apology of medical organizations

The American Academy of Pediatrics formally apologized for its history of internal racism in the September issue of their journal, Pediatrics. In addition, it went beyond an apology by acting to change its bylaws to prohibit discrimination based on various social and cultural identifications.

Let’s take a look at history. Roland B. Scott, MD, a nationally renowned pediatrician for his research in sickle cell disease, applied for membership numerous times beginning in 1939. The minutes from the organization’s 1944 executive committee meeting are chilling, and include:

“If they became members, they would want to come and eat with you at the table. You cannot hold them down.”

If you were not a member of a local or state medical society, you could not join the American Medical Association (AMA). For many Black physicians, exclusion from the AMA and other specialties meant the loss of career opportunities and specialty certification. The AMA also played a role in closing some of the Black medical schools, which were important since many Black applicants had trouble getting acceptance into medical schools just because they were Black.

The AMA issued an apology in 2008.

The current president of the American Psychiatric Association, Jeffrey Geller, MD, has been writing a regular column for our organization’s newsletter, Psychiatric News, detailing the APA’s extensive history of internal racism. He has also formed a Task Force to investigate the problem over the year of his presidency.

However, the APA has not yet issued a formal apology.

The importance of apology

This column is being written as the Jewish Day of Atonement, Yom Kippur, arrives. It is the time of year when Jews are supposed to ask for forgiveness for their wrongs, committed consciously or unconsciously, from God and other people.

In that spirit, let us apologize to any reader who we have wronged in the past year.

The Jewish tradition stresses real teshuvah, literally meaning “return,” from what we did wrong. That process involves 5 parts: recognizing wrongdoing, feeling remorse, not repeating the wrongdoing, providing restitution when possible, and confession. Actually, it seems like most every religion has some version of this apology process, suggesting that it is an essential process for humans, perhaps because it can restore people’s trust in the community.

The psychology of apology

The psychiatrist Aaron Lazare, MD, examined apology in depth, culminating in his classic text, On Apology (Oxford University Press; 2005). He concluded that apologies, once the typical initial reluctance to do so is overcome, have the power to heal humiliation, reduce undue guilt, eliminate vengeance, and restore broken relationships.

Apologies are healing.

However, there are apologies that do not work or can make things even worse. Here are some of those ways:

1. Saying “Sorry if… ”

Instead, say you were sorry that you were hurtful without any shadow of doubt.

2. No excuses, as in “Sorry but…”

If you did something wrong, do not sugarcoat it with excuses.

3. Avoid a “poisoned apology.”

This is an apology when you blame the other for triggering your bad behavior.

4. “I was just being funny” when it was not funny.

In other words, you are telling the other party that they are being oversensitive.

5. “Let’s move forward” takes time.

Forgiveness should not require forgetting. That can take more time, if ever.

Organizations need to apologize

If the concept of structural and institutional racism is valid, it would be no surprise that racism has become embedded, covertly or overly, in all medical specialty organizations. Therefore, it seems inevitable that apologies would be needed from all.

It is unclear why the APA has not yet apologized for its internal racism, racism which has been documented over many years, as well as extensively and conclusively by Dr Geller recently. Of all specialties, we should know how psychologically harmful racism has become. Specialty organizations in psychiatry, although formed at a later date, would probably have also developed embedded internal racism and likely need to apologize. Moreover, state branches of the APA might have the right to do so even if the APA does not. Given that societal racism by definition involves most any psychiatric organization to some degree, thereby including clinical systems ranging from solo practices to hospitals, apologies might be a needed step in reducing racism clinically.

Indeed, the same antiracism principle may apply to any institution in society. Slogans, pledges, and tokenism do not suffice, but accountability, change, and outcomes will. Psychiatry, by its very expertise in the psychological aspects of racism can-and perhaps should-should lead the way. The only exceptions might be Black organizations.

Here is a timely societal example that also involves a physician. On the day before Yom Kippur, the Los Angeles Timespublished their plans for “An examination of the Times’ failures on race, our apology and a path forward.” The owner of the Times, Dr Patrick Soon-Shiong, is a surgeon and medication innovator. His father fled China during World War II, and, after arriving in South Africa, became subjected to the discrimination of apartheid. Dr Soon-Shiong fled that discrimination to come to the United States in 1980. He advocates for the kind of truth and reconciliation that was used in South Africa to peacefully transition out of apartheid.

We call on the APA and other psychiatrist organizations to apologize by their next annual meetings, and then continue on a documented antiracism journey. Saying you are sorry, and meaning it, is a start, but not the required ending.

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®.

Dr Bailey is Assistant Dean, Clinical Education, Charles Drew University School of Medicine; Chief Medical Officer, Kedren Community Health Systems, Los Angeles.

Both doctors are Members of SPAR (Seven Psychiatrists Against Racism).