Lived Experience

Dr. Laura Roberts (00:28):

Hi, I'm Dr. Laura Roberts, editor-in-chief for the Books Portfolio of the American Psychiatric Association, and welcome to the APA Books Podcast.

Dr. Laura Roberts  (00:48):

Ezra Griffith is Professor Emeritus of Psychiatry and African-American Studies at Yale University. He also received an honorary degree, the Doctor of Science, from Morehouse School of Medicine. He published a book called Belonging, Therapeutic Landscapes, and Networks in 2018. From 1989 to 1996, he was the director of the Connecticut Mental Health Center at Yale, was the deputy chairman of Yale's Department of Psychiatry for many years, 1996 to 2016. He's the editor emeritus of the Journal of the American Academy of Psychiatry and the Law, and did a beautiful book with Altha Stewart and Billy Jones for us, entitled Black Mental Health. His service to the APA is tremendous, distinguished life fellow of the American Psychiatric Association, served in the APA Assembly, the APA Council on Psychiatry and the Law, the APA Ethics Committee, I think that might be where you and I first met, APA Committee on Judicial Action. And now, retired APA committee on Misuse and Abuse of Psychiatry. Ezra has been a columnist for Psychiatric News and serves on the Editorial Advisory Board for Psychiatric News. And congratulations, Ezra is going to be receiving the Chester Pierce Award.

Dr. Laura Roberts (02:01):

So Ezra, I'm so happy to talk with you today and thank you so much for joining us. Ezra, I have to ask you, and maybe I asked you this before, there are so many ways one can use one's life, right? And you've chosen to become a physician, a psychiatrist, an administrative leader, a leader in so many ways and for so many communities, a scholar. Identify what set you on this path and how you now reflect on these choices in the kinds of roles and expertise that you've developed?

Ezra Griffith (02:38):

And you want this in what, in five minutes?

Dr. Laura Roberts (02:43):

Well, let's just get started.

Ezra Griffith (02:48):

First of all, I was reading some of Edmund Pellegrino's ethics stuff recently.

Dr. Laura Roberts (02:54):

Nice.

Ezra Griffith (02:54):

And he insists that a lot of the ethics stuff, there's a theoretical basis and then there's what he likes to call, the lived experience of a specific thing he's talking about. So there's a theoretical piece to my life, which is structured, thoughtful, influenced by discussions with wise people, old people, so on and so forth. But then there's this lived experience thing, a lot of it which Chester Pierce has talked a lot about and that is the haphazardness of life and the way experiences come along. And he always would put this in mathematical terms, you think you can control it the way that things happen. And so my thoughts about it have become deeper and more tentative I think with the passage of time.

Ezra Griffith (04:06):

So let me just summarize it quickly. All right, so I'm living in Barbados, which climatically is as a warm country. It's a tropical country. My father decides we would do better if we migrate because whenever things economically get stringent in developing countries was another issue I've learned. I'm not an economist, but I tell you I have learned this the hard way. One important experience then is access to migration because especially on an island, everything is limited on the island. I don't care what you talk about, it's limited on the island. And then migration becomes an important outlet. So I arrived in Brooklyn and was welcomed because we had relatives there, which is always something that influences lots of things that go on in this experience. I registered in school. And I was lucky, I did well. I did well because my study habits were... And I don't think they had anything to do with intellectual brilliance. It had to do with really sound and excellent study habits compared to the context of which I was living.

Ezra Griffith (05:31):

I left school. I met a couple other West Indians and we'd just go off into a library and sit quietly. We'd talk. You couldn't talk too loud, we'd talk and then we'd do the homework. And it turned out that doing homework was an important thing for success in school. And that's accidental. But for the American kid who was doing... He was active at this to do, and that to do, and so on, homework became a serious hurdle for a lot of them. I mean, that wiped out a certain percentage of the class immediately in terms of competitiveness. But I just shot to the top of the class because I never thought I could go to school without having done my homework. And that became very, very important for me.

Ezra Griffith (06:24):

All right, it's a very interesting thing because the Black stuff began to emerge in my thinking, but we didn't think about it much in Barbados in the same way. I mean, it was there because the leaders of almost everything in Barbados would've been whites, either whites on the island or descendants of whites from Britain. And a lot of people were British, a lot of the whites were British. So that's in employment, teachers at school, the bishop of the church, and so on and so forth. And I think my hypersensitivity increased then as I got to college. It was an interesting time because the class at Harvard, it was about 1,200 people in the freshman class and I think there were 20 Blacks in my class. And in fact, there were 20 Blacks and our class was the first class that Harvard had made an effort to get Blacks into. Can you imagine that? So that means before they had made an effort, I don't know, one class might have had six, another class might have had two. I have no idea. The figures I do know, there were not 20. And of course, the 20 is now insignificant compared to the 200, for example, the 250 or whatever it is that they have now.

Ezra Griffith (07:51):

So I became interested in this whole notion because it was going on and unfairness and injustice, I think, appeared increasingly. And I began to be sensitive to it. I can't say that I had people mistreating me and I never had a policeman threaten me, but I had that hypersensitivity because there are certain things, for example, yes, yes, I was Black and at Harvard, but there was clearly no expectation that I could be a member of the private clubs where the membership was... Well, obviously, predominantly white because there were only 20 of us to go around.

Ezra Griffith (08:41):

So anyhow you did it, even if you split them up and every club took one, there wouldn't be more than one or two in any club. And that, I only knew of one Black guy, one buddy of mine who was accepted into a club, which is interesting because the club that he got into, I saw a note recently because he died and Rockefeller's so was in the club at the same time. So it was pretty funny that Sir Rockefeller now in this year was just sending a note to a Black guy to show you how life had changed

Ezra Griffith (09:26):

My interest then in the Black question really I think began to come to the fore as I went into psychiatry and tried to think of what I was going to do. In a sense, I can tell you that I was just totally blessed because I don't know why a bird spoke into my ear and told me that I was going to be an academic and I loved the whole business of writing. I knew I was going to write. I think I felt published... Not, I think. I published my first paper in residency. I think I published two papers in residency.

Ezra Griffith (10:21):

So I remember in my interview at Yale... I think I had four interviews. And one guy looked at me and said, "How could you have published two papers already?" And I just burst out laughing, because he thought it was unusual. He was a clinician type person. And I just laughed because I tried to explain to him, he probably thought I was on marijuana or something, but I just knew that I was going to publish. It wasn't a burden to me. And the two papers I published were areas that just naturally appealed to me. I think both of them were on the Puerto Rican espiritismo, espiritismo stuff of Puerto Ricans in New York City. And that's what I chose to do it on.

Ezra Griffith (11:23):

And then from then on, I think I moved more, and more, and more and more readily into thinking about, again, injustice and so on. The content of the prayers in that Wednesday night service I was studying because I was parsing the things that people were talking about and those Black women to get into the spirit and so on in the Wednesday night service, and they'll tell you what the Lord was doing for them. And everything was race-based, and everything was an injustice, and the Lord was creating solutions for them. And so I just continued on along that pathway and just thought about it more and more. And this is the issue of chance, because it's only in the last five to 10 years that I actually put together the incredible experiences that I had living in a colonized country because the colonized country really, I was too young to appreciate the injustices of how colonization worked. And I didn't have the background and hadn't read in it, because I didn't read history the way I read history now, obviously.

Ezra Griffith (13:04):

And so then it flourished and I began to read more, and more, and more, and more and began to think about things in this particular arena. And I was talking to my wife the other night, because the king is coming up for renewal this weekend, and I was wondering whether I should write something about it. But a lot of people are warning me not to write anything, because it's not going to come out the way white people want to see me write.

Ezra Griffith (13:45):

So what I'm saying is that I've gone all around the world and to come back to realizing that there's a lot to be done. And when I hear how some people are still enamored of this notion that the king is superior to everybody else, and I mean inherently superior. I don't mean... inherently superior. And this superiority has been blessed by God and so on. It's a thinking that now, of course, Chester Pierce is not sleeping. Chester Pierce is still alive in me. And this thing just simply doesn't make any sense. And of course, it's tied together then with all the work I'm doing, how I'm thinking, I'm carrying on about dignity, that if you want to argue that attributive dignity serves a certain purpose in this society, I'm happy to agree with that. You need leaders. Everybody on the political scene can't be the same, and so on and so forth. I don't have any difficulty with that.

Ezra Griffith (14:59):

But to come back at me and argue that inherent dignity is distributed differently to the people lower down on the totem pole and people high up on the totem pole is a theorem that I simply cannot accept.I find that absolutely preposterous. And I say it publicly and bluntly, I think the present king at least understands that better than my dear friend Elizabeth did. Elizabeth seemed to argue that God had blessed her with special attributes and so she had an inherent dignity that she was responsible then for protecting and taking advantage of and so on, and protecting it for future generations. And I think that's really very, very sad. But I noticed the king is being more sensitive about that. He's arguing more broadly, I think, that he is the leader of the church, meaning a lower level [inaudible 00:16:17] as opposed to this person who's been blessed-

Dr. Laura Roberts (14:59):

Anointed.

Ezra Griffith (16:22):

Anointed, exactly, to be head of the Anglican church, which is just... I understand the history of it, but for any modern person to push that forward as a serious idea, it's got to be ridiculous. Anyhow.

Dr. Laura Roberts (16:39):

But wait, I have to say, I hope you're right about it. It's okay. It's important, in fact. So anyhow-

Ezra Griffith (16:48):

Well-

Dr. Laura Roberts (16:49):

... you'll have your own journey with that, but it's okay. I mean, it's okay to write uncomfortable things. Here we are, we need to be uncomfortable.

Ezra Griffith (16:59):

Well, there are a lot of people in Barbados... And again, this is generational, but there are a lot of people in Barbados, especially the older folk, who think it's outrageous that I would attack the monarchy.

Dr. Laura Roberts (17:14):

I see. I see.

Dr. Laura Roberts (17:18):

I want to mention to our listeners that you've put together such beautiful books. You wrote a book on Race and Excellence: My Dialogue with Chester Pierce. You did a beautiful book, Belonging, Therapeutic Landscapes, and Networks, which APA Publishing did not publish, but I still would recommend it.

Dr. Laura Roberts (17:40):

To you, Ezra, I'd like to tell you about a book. Maybe you've seen it. We did a beautiful book with Dave Kinzie and George Keepers on refugee mental health. And that came out, I don't know, a year or two ago. And I just did an interview, a podcast interview, with Dave Kinzie where we were all moved to tears around certain stories that he told about some of the patients he'd cared for and also bringing patients in to be the staff of his refugee clinic and all that. But I think dignity was implicit powerful message throughout that. But anyway, so we really have been trying to embrace different topics maybe then APA Publishing has in the past. And if I could, I did ask you about becoming a psychiatrist and about your participation in administration and organizational psychiatry. I'd love for you to maybe comment a little bit more on that.

Ezra Griffith (18:41):

Becoming a psychiatrist, I'm not sure how to tell the story, to talk about it in a way that makes sense for the average person. I had trained in France and an internship year is required. I did my internship year in obstetrics and gynecology and came out of that dissatisfied only because of the strange hours, and so on. I came here to... And of course, you have to redo all your training. So I came here in the US and I redid a straight internship in medicine. And seemed clear to me... I would talk with the chief of medicine. We'd have lunch from time to time. I mean, I don't know, I was just passionate in talking about broad cultural things. He and I would talk about the Harlem Dance Company, for example, in New York City. And we talk about the fact that I didn't like Porgy and Bess because it didn't sound authentic to me.

Ezra Griffith (20:07):

We got into strange discussions of this sort and that had to do with my thinking then of how I was going to live my life and the things that I wanted to talk about, and straight medicine didn't do that. Can you imagine, in the cafeteria at lunch, I'd be sitting talking with the chief of medicine, and I think he was a white male and he enjoyed having these conversations with me because I remember we got into discussion about dance. I love dance. This is totally aside, I love dance.

Ezra Griffith (20:53):

And I will mention that I was an Afro-Cuban drummer in high school, and college, and in medical school. I did a lot of Latin band dancing and... Not dancing. I drummed for dancers. So we would talk about who decides on how European ballet was top of, and the reference point, of perfect dancing. And we were both physicians, so I would come at it from all kinds of sides and I'd say, "But this can't make any sense. The female body, for dance, cannot have been prescriptive and made up, and then you just decide that somebody, who had a corpulent behind, couldn't do the dance that you wanted just in terms of aesthetic appearances. I mean, that's just crazy. Tell me that it has a right to occupy this space in a dance space because people like it and there's a tradition to it, and so on. But you cannot convince me that it has to be the best kind of dance."

Ezra Griffith (22:17):

So it was clear to me that the life I wanted to lead and the things I want to talk about, straight medicine didn't do it. And of course, definitely not surgery. And OBGYN was proximate to surgery, so I didn't like that, and the time it occupied. And I thought there was the greatest freedom then came from something like community psychiatry. And Einstein had a program at Lincoln, and so I decided to apply for that. And that's how I got into psychiatry. Now, the struggle wasn't over. The struggle wasn't over because I realized that people around me, even in the South Bronx weren't particularly... Not all of them, I shouldn't say, and I don't want to generalize too much because that's not fair, because there were some supervisors who were fabulous and they were very interested in the cultural context in which we were treating patients, and so on.

Ezra Griffith (23:31):

But then I really got excited, because I had made contacts and had relationships among the caregivers. For example, I found myself doing an observation. That's the first observation I did of this healing experience that the people in South Bronx were using with the espiritismo. And it dovetailed also with my fascination with dance, music. Dovetailed also with the fact that I was a conga drummer. So just this all came together and it really carried away by it. And my position got secured by the exposure to that business. So I did an observation there, then decided to say, "Well, why am I doing it here?" So I went to Jamaica and observed a clinic over there for several weeks, or months, and did several papers on that clinic. Interesting clinic, because it was a clinic that was set up... It was a tripartite clinic set up in a Baptist church in Kingston, Jamaica. 

Ezra Griffith (24:56)

And part of the clinic, in this church, you could get pharmaceutical services, you could get prayer. People would pray for you and then you could get psychiatric care. And so I described that clinic and it's sort of cemented, I mean, as a beginner, because that paper was an interesting paper. I had that published in the American Journal. And at the time, the editor decided he was going to experiment with me, I guess. And I published that paper in the American Journal of Psychiatry. 

Ezra Griffith (25:37):

And from then on, once I finished the stuff in Jamaica, then I switched to Barbados and did a continuous study of a church, a religious group in Barbados, which really capped everything I was interested in doing. I published, I don't know, probably 10 or 11 articles on that church, and then published a book. So I published a book that was put out by the University of West Indies Press biographically on the Archbishop who founded it. That was a part of the book. And the other part of the book was a description of all the rituals with our photographs, and if you remember our conversation about photographs and publishing. So that really had me very excited. 

Ezra Griffith (26:32):

And that sums up how I got into psychiatry. I think, by chance, got into this aspect of community psychiatry. And I was one of the few Blacks then doing international stuff with a area... In fact, everybody wanted to go to Africa. And I said, "No, that doesn't help me at all", because I wanted to bring to the fore something about the Caribbean culture, especially English-speaking Caribbean culture, that most people in the US had not studied at all. It turns out that that Spiritual Baptist group in Barbados was the first book published on the Spiritual Baptist group in Barbados, but there had been several there... I don't know, somewhere about 10 books published on Spiritual Baptist in Trinidad. 

Dr. Laura Roberts (27:23):

Interesting. Yes.

Ezra Griffith (27:26):

So I felt really good contributing to the psychiatric literature concerning Barbados. So that put me there. Now, the administrative piece is something that always continued because my first job at Yale was in the inpatient service and I was the associate director and then went to be the director of that. And then after that, I became head of a division administratively. And I was clearly interested in going that way. I mean, one of the things about the advantages of building a career like that, that was thoughtful and purposeful, I went that way because I wanted to have a certain percentage of my time on hard money, which US chair understand. I did not want to do grants and I suffered because of it in some things, but in other areas it really was a good advantage for me because it allowed me to have a certain percentage of my time paid for and I didn't have to worry about it. And because people always wanted experienced supervisors and administrators at every level. 

Ezra Griffith (28:52):

Interesting, and incidentally, the administrative part of psychiatry was very, very strong when I was coming up. And then, for some reason, got diluted. So I noticed a lot of important administrative positions in departments of psychiatry, those who were filled by biologists who had absolutely no administrative experience. But in my time, I was talking to people who were into administration and who were thinking in administration terms. So I learned a lot of language there about groups, but also particularly about the fiscal stuff. And then I ran the Kinetic Mental Health Center for 10 years, and it turned out to be one of the few people in the country working in a university-run community mental health center that was substantially funded by the state. I suppose the structure is similar to PI at Columbia. I don't know what goes on at Stanford. But it turns out then that I was in a generation where there were a bit like people like John Talbott, people who were clearly publishing a lot, but were also very much into the area of administrative psychiatry. 

Ezra Griffith (30:41):

So I've been pleased by that. I don't know if I'd recommend it as an easy pathway for anyone, particularly the issue of funding for your scholarship. I was lucky because I was doing a kind of qualitative observational work, which, by clever maneuvering, I could do on the cheap. Obviously, I had to stay away from certain studies that required lots of money and I certainly could not do quantitative studies that required working with big populations and having a team of six and seven researchers and so on, because somebody's got to think about pays for that. So my pathway was a very different pathway. 

Dr. Laura Roberts (31:46):

And then-

Ezra Griffith (31:46):

So that's how I got into that stuff. 

Dr. Laura Roberts (31:48):

Yeah. Well, and you mentioned in the prior podcast about how you met Chester Pierce when he came and gave grand rounds or came as a visiting professor to your residency program, but then you met up with him at national meetings. And I think the importance of connecting within the profession beyond your local environment is something I value very much, and I've seen many people in academic medicine value very much. But I would love to see more people in practice participate in large organized psychiatry and organized medicine, and it's really because of the relationships. It's the relationships, the connections that you can create. And influence, you can influence from the basis of your own experience and expertise, influence policies and approaches in these organizations.

Ezra Griffith (32:46):

Absolutely. No, I was lucky there, because one fellowship that I got, and I think I must have been a second year resident, was a... I forgot the name of it. It was a Solomon Carter Fuller Traveling Fellowship, and that was important in my experience because I went around to different places and met people. So I met people at Harlem Hospital, I met people at Columbia, met people that I'm pretty sure we went through Stanford. We spent several days at Stanford. And then that was supplemented by a [inaudible 00:33:38] fellowship at the APA. And so that [inaudible 00:33:42] fellowship introduced me to people like Charles Pinderhughes in Boston, and so on. That was tremendously, tremendously important because I got exposed to people, both Black and white, and certain committees that I got onto began to know people... I mean, first of all, it opens up your possibilities if you're interested in getting jobs. So several people offered me jobs across the country because I was meeting chairs, and senior faculty, and so on.

Ezra Griffith (34:24):

Then my work got me introduced into the American College, and so my contacts expanded. And there, I met people who were Columbians, so I got an appointment on the Committee of Psychiatric Services, met John Talbott and a host of other people. So the American College also was very important because I was on a committee doing cultural psychiatry. So I met a group of people who were into cultural psychiatry and people like Pedro Ruiz, and so on. I think I met Maria also, our previous president at the APA. She was on that committee. So I began to have contacts and be communicated in terms of work.

Ezra Griffith (35:33):

So it's true, you have to have a connection to these individuals and these structured functions, these structured activities, because those activities, when you think back, are obviously paid for by funds, by institutional funds. And all the institutional funds might be grants from federal government, or state governments, or whatever, but they come to places like the APA, and you are not going to get them anywhere else unless you have contacts, again, instructed... Because it's public money that you're making use of. But you're right, the traveling around that I did and so on, paid for by the public funds is something that I would recommend not to any young person trying to make it, especially in the academy, because now that's another interesting development that the requirements for promotion in many of these organizations now have been broadened and include contributions in the public sphere and in the community and so on. So you get credit for those things in addition to the standard publications.

Dr. Laura Roberts (36:57):

Ezra, I could talk with you all day, I've told you this before, about our love of libraries... I didn't know we had that in common... about sacred and important places, extreme environments, experiences, everything. Administration. I love administration leadership roles as you know, and I could talk with you all day about that. But I think we'll bring this to a close with my gratitude for being who you are and for your leadership for many, many years in our field, for these beautiful books that you've done for us and for others, and just for the conversations that you have, conversation with Chester Pierce, the conversations that I hear about. I hear about conversations that you have with people who I know and care about and the difference you make, and then the scholarship that you brought forward. So I want to thank you for all of that.

Ezra Griffith (37:57):

You are most welcome. You are most welcome. I hope our connection will continue.

Dr. Laura Roberts (38:04):

Thank you.

Producer (38:27):

Psychiatry Unbound is hosted by Dr. Laura Roberts and produced by Iain Martin. Our original music is by Willow Roberts, and our executive producer is Tim Marney. This podcast is made possible by the generous support of Stanford University. We are a production of American Psychiatric Association Publishing. Be sure to visit psychiatryonline.org/podcast to join the conversation, access show notes and the transcript, and discover new content. Or, subscribe to us on your favorite podcast platform. Thank you for listening.

Producer (38:56):

The views and opinions expressed in this podcast are those of the individual speakers only, and do not necessarily represent the views of the American Psychiatric Association. The content of this podcast is provided for general informational purposes only and does not offer medical or any other type of professional advice. If you are having a medical emergency, please contact your local emergency response number.

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