Structural Racism in American Psychiatry and APA: Part 9
Abstract
This is the final article in Dr. Geller’s series on the history of racism within APA and psychiatry.
In my preceding presidential columns on structural racism in American psychiatry and APA, I have tried to trace how unquestioned assumptions of white supremacy (supported by or masquerading in the guise of pseudo-scientific notions of Black inferiority) have permeated our history from its beginning. Recall that Benjamin Rush, long revered as the father of American psychiatry, owned a slave (despite being an abolitionist) and proposed a disease called “Negritude”—fundamentally declaring Black skin a disease. Moreover, segregation of Blacks in psychiatric hospitals—and later hospitals built exclusively for Blacks—was a long-standing policy in this country. This history of systemic racism has affected all aspects of psychiatry—research, treatment, and advocacy and the staffing and leadership structure of our Association.
In a previous column, I highlighted APA’s own history with a description of the dramatic encounter at the Board of Trustees in 1969 when a group of Black psychiatrists led by Chester Pierce, M.D., delivered nine demands aimed at eradicating racism within the organization and American psychiatry (including academic institutions that recruit and train psychiatrists and agencies that fund research such as the National Institute of Mental Health). None of the demands they made were “radical” by any definition; it is a sobering confirmation of the reality of structural racism in American society that such elemental demands needed to be made 125 years after the founding of the APA.
Fast forward to May 25, 2020, and the killing of George Floyd at the hands of Minneapolis police. In the midst of a global pandemic, virtually every agency and institution in America began a reckoning with the persistence of racism. So too did APA, and we asked ourselves: How much has changed since those eminently reasonable demands were presented in 1969?
Surely, it would be unfair to say that nothing has changed. Our organization—leadership and membership—is markedly more diverse than it was 50 years ago. But the representation of Blacks in American medicine, including psychiatry, is still not anywhere near where it should be, and health disparities remain rooted in inequities—in housing, health care, employment, and education—that go back generations.
In June I created the Presidential Task Force to Address Structural Racism Throughout Psychiatry, chaired by Board member Cheryl Wills, M.D., and comprising a diverse array of thought leaders and Board and Assembly members. The processes of the task force are intended to be collaborative, inclusive, and member informed. Task force members are ambassadors for the project and are expected to interface with members, share information, accept suggestions and other forms of feedback, and share their experiences with other task force members. While presidential task forces usually end with the end of a president’s term, the plan is to transform the task force into a committee with an expectation its work will continue for many years.
Brief surveys have been conducted regarding structural racism in organized psychiatry and patient care. A survey on the impact of racism on psychiatric practice was conducted last month.
The task force has met with all of the APA councils and is meeting with APA committees and APA Areas and district branches. Two of five town halls have been held: the first dealt with the impact of structural racism on Blacks in health care and the legal system and the challenge of building healthy communities as a way to diminish health disparities; the second town hall dealt with the history of structural racism in medicine and psychiatry and its effects on children, their families, and LGBTQ communities.
The other town halls will address transgenerational trauma and mental health (November 16), growing a diverse and inclusive mental health workforce (February 8, 2021), and lessons learned from the first year of the task force’s work. The latter will take place during the APA Annual Meeting in May 2021.
The task force has several work groups that are looking critically at structural racism within APA itself, gathering and analyzing data on the diversity of members within the governance structure—Board, Assembly, councils, committees, and fellowship and research programs. Work groups are charged with identifying actionable items to address any disproportionate representation that can be submitted to the Board of Trustees for approval. The first set of action items was presented to the Board of Trustees at its October meeting (see story).
At the administration and staff level, the task force has recommended that each APA division chief include a section on diversity and inclusion in its reports to the Board. Additional work groups will be appointed to address structural racism in workforce development and psychiatric practice, including patient care.
APA Assembly Area 1 Council Recommended Changes at Council Meetings to Address Racism
If Area 1 Council is part of the world we live and work in, why not make its culture and processes more to our liking and reflective of our values? We have added several steps to our meetings to address the ongoing problem of structural racism and its effects on health.
Before our meeting begins, we will make the following Native American territorial acknowledgement. The tribal nations we mention will rotate among those from the different states represented in Area 1:
We would like to acknowledge that we are on the traditional territory of the Missisquoi tribal band of the Abenaki Nation. This tribe’s ancestors are honored today as we acknowledge that they have been the keepers of their tribal histories, as well as the shared history of this country and the state of Vermont. These ancestors can inspire us as well in the present day, and we recognize that they have endured loss of land, culture, and language and undergone oppression since the time of European contact.
After the meeting continues and the Area Council members have been introduced, we will further state the following:
We would also like to call out the history of Black enslavement and legally sanctioned second-class citizenship. We acknowledge the Black, Indigenous, and people of color (BIPOC) who have been marginalized and discriminated against historically and in the present day, and we commit to being part of a comprehensive solution to this severe intergenerational trauma for members of this group. We include in this commitment efforts to address all ongoing structural oppression, including oppression based on race, ethnicity, gender, immigration status, gender identity and expression, sexual orientation, disability, religious beliefs, language spoken, or other aspects of human diversity.
Furthermore, we would like to define the working environment we wish to create:
We wish this meeting to be a liberated space that is inclusive and does not discriminate against any group, requires a respectful attitude toward one another, and allows us to process mistakes or hurtful incidents in a constructive way. This liberated and inclusive space also allows for the sharing of information and real-time learning. We, as members of Area 1, realize that we are all very much “works in progress” in our level of enlightenment in matters of bias and discrimination.
As an Area Council, we will begin to take a live account of the potential impact of our recommendations on marginalized groups before we pass an action paper or position statement by asking the following questions:
What are the equity impacts of this decision?
Will any of these decisions put at risk the respectful treatment of all minority and underrepresented groups?
Will this decision reduce or increase mental health disparities and challenges for these groups?
Who might either benefit from or be harmed by this particular decision?
We suggest that we conduct this review in real time by delegating two willing individuals from the group for each meeting (on an Area-wide rotation) whose task will be to help us monitor our progress on these questions during the meeting and will offer feedback about how we have done at the end of each discussion or decision.
We also recommend that as individuals, APA members self-reflect and educate ourselves about racism and that, as a group, we openly declare our own intentions and mission to help dismantle the racism that undergirds every aspect of our society. If we hope to be clear and present allies for members of the Black community, we must learn how to avoid our own problematic behaviors and statements about race. To that end, below is a link to an excellent and enlightening scaffolded reference sheet on anti-racist resources, created by members of the Black community. As Assembly representatives, we can also work with our own district branches and Area Councils to encourage them to provide resources on these topics.
Perhaps the most important goal of the task force is to encourage APA internal and affiliated groups to initiate their own projects on structural racism, so that this will be a “living” process that will be ongoing. There are promising developments already: Several Areas and district branches have initiated educational programs on structural racism, diversity, and inclusion. For example, the Ohio district branch plans to have a remote residency recruitment event to attract minority and underrepresented medical students to psychiatry residencies in the state. Area 1 developed a protocol it will follow at all its meetings to ensure racism is considered throughout all its actions. Other Areas are considering adopting this protocol for their meetings (see box).
So .... we have made a start on a process of self-examination that is bound to be a long-term project—and one that is not going to be painless or comfortable. Our Black colleagues have told us that an authentic reckoning with racism and the way white supremacy is built into our institutional structure will be difficult; indeed, we should probably acknowledge that if it isn’t difficult, it isn’t authentic. “Not everything that is faced can be changed,” said James Baldwin, “but nothing can be changed until it is faced.”
Personally, I am hopeful. I am convinced that together we can face our own history, own it, and build a future in which diversity throughout APA and psychiatry occurs organically and ceases to be an issue demanding solutions. We should have set that goal for ourselves 50 years ago. The process we have begun of looking critically at ourselves will benefit all of us, confirming (albeit redundantly) the truth of that old truism—which psychiatrists know better than most—that there is no way out but through. ■
