Black Psychiatrists Link History of Structural Racism to Current Outcomes

Just a few days before the 57th anniversary of the civil rights March on Washington, where the Rev. Martin Luther King Jr. gave his “I Have a Dream Speech,” APA hosted the second in a series of town hall meetings to address structural racism in psychiatry. A distinguished panel of two Black psychiatrists and a physician spoke to approximately 425 people about how the Black Lives Matter movement is an outgrowth of the civil rights initiatives of the 1960s, the effects of racist policies on Black people and their families, and the impact of racial injustices within the organization and the profession.

APA President Jeffrey Geller, M.D., M.P.H., who hosted the town hall, described how the actions and ideals put forth in the March on Washington are not only relevant, but necessary today.

“The tradition of advocacy and organizing continues because racial injustices are very much alive in the United States,” Geller said. “Beyond the appalling scenes of police brutality and the deaths of innocent Black people, the systemic impact of racism hits home in the house of medicine and psychiatry as health inequities and racism impact Black people, Latinos, indigenous people, Asian Americans, and others.”

Geller called upon the APA Board of Trustees to address racism within APA and psychiatry. He noted that Board members are predominantly white and that they must take the initiative and be proactive in confronting and dismantling structural racism.

“We cannot turn to the Black members of the Board to guide us. That would take them out of the role of being Board members with us,” Geller said. “It would signify our lack of understanding that racism is about us [whites].”

Aletha Maybank, M.D., M.P.H., the AMA’s chief health equity officer and group vice president, discussed how the harmful legacy of segregation is evident today in the housing, health, and economic status of many Black individuals. She described how the COVID-19 pandemic has illuminated the disparity in life expectancy between Blacks and whites. “Communities that had higher COVID rates also had higher poverty rates, higher household crowding, higher percentages of people of color, and higher racialized segregation,” Maybank explained. “Why did they have higher poverty? Why were they more likely to die not just of conditions related to disease, but conditions related to the health care system [in their area]?”

Maybank attributed these phenomena to redlining, the discriminatory practice of denying financial and other services to residents of certain areas based on their race or ethnicity.

“The reality is that policy has dictated where people can live, especially as it relates to race and ethnicity over time,” she explained. “It determines where people live, what kinds of investments are made in their neighborhoods [such as health care], and what people have access to in terms of jobs, transportation, and food.”

Maybank also spoke of the importance of providing space in which young people can use their voices to propel societal change.

“I really don’t feel we would be here today if it weren’t for the young people of the Black Lives Matter movement,” Maybank said. “The young people who speak … continue with the tradition of the civil rights movement, but in their own way because they’re young [and] it’s a new time. I feel they are leading with great power, great purpose, and great authenticity and truth. … We, as we get older, need to step aside and allow them to have that place of leadership.”

Kevin M. Simon, M.D., the 2020-2021 Recognizing and Eliminating disparities in Addiction through Culturally informed Healthcare (REACH) scholar, described anti-racism as supporting anti-racist policy through action or the expression of anti-racist ideas.

“It has to be something that becomes part of your daily routine,” said Simon, who is completing a fellowship training in child and adolescent psychiatry and addiction medicine at the Boston Children’s Hospital/Harvard Medical School. “Much like we ask patients to practice behavioral techniques, we have to practice being anti-racist.” Simon discussed the importance of changing racist policies and explained the impact that some of those policies have had on Black children and families, building upon Maybank’s discussion of redlining.

“There are places where if you are Black, regardless of how much money you have to put down for a home, there are realtors who will say, ‘Well, I don’t think you’re putting down enough,’ ” he said. “Then when you see that the home is sold two weeks later for a lower price, [it is clear] there must be a policy that still exists, even though there [are laws] to say it is illegal to not sell a home to someone who is Black.”

Black families are therefore more likely to rent, rather than own, a home. This then filters down into disparities in access to green spaces, because rents tend to be much higher where there are parks, which then affects Black children and their families, Simon said.

“There is evidence to show that green spaces improve mental health,” he explained. “So we went from a policy regarding redlining to housing to green spaces to mental health. That is just one stream of connection [that shows] how policies impact individuals.”

Former APA President Altha Stewart, M.D., discussed critical junctures in history when psychiatrists, as represented by APA and its precursor, the Association of Medical Superintendents of American Institutions for the Insane, failed to address racism. These touchpoints in history include the years before, during, and after the Civil War, the years of the “separate but equal” doctrine, and the Jim Crow era.

“[Now] we have this very important moment in time where what we do will be looked back upon by generations in the future,” said Stewart, who is senior associate dean for community health engagement at the University of Tennessee Health Science Center. “When they ask what did we do to move the needle, what did we do to improve the psychological well-being of [Black people] in this country, I’d like to say that we took the bull by the horns, addressed these issues head on, and did the hard work … that is emotional, that makes you vulnerable, that can be challenging, but that is not too difficult for psychiatrists.”

She added that psychiatrists are primed for doing the work of dismantling racism both in the profession and in society at large.

“Our wheelhouse is in the difficult place. We are the people that people bring their most private, chaotic thoughts, and we help sort that out,” she said. “We have to be on the front lines of doing that for psychiatry, for America, and for the American Psychiatric Association.” ■