Burnout and Moral Injury Among Black Psychiatrists and Other Black Mental Health Professionals

As psychiatrists, we have worked for decades as leaders in academia, professional associations, for-profit and nonprofit organizations, corporate environments, and clinical practice. And as Black women, our experiences have been marked by challenges associated with our perceived differential treatment based on race and gender. We have grappled with blocked opportunities in which our achievements have been devalued, sometimes leading to preference being given to underqualified White colleagues. In addition to our personal experiences with this phenomenon, we are aware of numerous colleagues, both Black men and Black women, who have endured similar incidents.

We have accepted many invitations to speak at professional events or to serve on committees because of historical experiences of blocked opportunities for Black mental health professionals. We have done so not to augment our resumes but because we have felt a responsibility to be present in order to center the mental health needs of Black and other marginalized communities of color in decision making and to challenge the resistance of some White professionals to the merits of more equitable representation.

At times, we have been the sole Black psychiatrist in certain professional settings. This situation is an example of tokenism, in which the illusion of full inclusion and participation is presented to outsiders, when, in reality, it is a perfunctory act. In these environments, we were often invisible and discounted; still, we remained aware of the dynamics of our presence. One dilemma related to this circumstance is our moral responsibility to voice perspectives that are in line with our personal experiences related to racial identity and that challenge the cultural mainstream. This taking of responsibility can be an isolating experience, especially when our contributions are devalued and dismissed as not being germane to the discussion.

The expectation to be involved in every initiative focused on diversity in an institution is an aspect of the “minority tax.” This experience is especially taxing when Black mental health professionals do not have the sphere of influence or authority to implement change. Although these professionals are aware of the need to incorporate diversity into programs, they understand that such initiatives often lack sufficient financial and human resources to be successful. The additional responsibilities associated with the minority tax may interfere with meeting other personal and professional obligations and ultimately become burdensome and detrimental to career advancement.

Even with widespread knowledge about the importance of addressing racial disparities in health care, Black mental health professionals who speak up about inequities face significant risk for increased adversity. For example, after we reported on racial treatment inequities in mental health settings, we have been criticized, and our credibility was questioned. We were sometimes regarded as disruptive forces or threats to team cohesion. When one of us proposed a solution to address these disparities, the offer was met with skepticism, and eventually, the workplace became toxic and untenable. Colleagues withdrew their support, which caused further marginalization and isolation. This perceived mistreatment appeared to be racially motivated; however, it is exceedingly difficult to substantiate perceptions about colleagues’ motivations.

We have had numerous encounters in which White colleagues mistook us for other women who were Black or from other non-White racial backgrounds. In one instance, a White male colleague insisted that one of us was late in providing him with a deliverable. However, this was a case of mistaken identity. The colleague did not recognize that he had originally requested the deliverable from another woman who was not a psychiatrist and who had no physical resemblance to the coauthor of this column other than being Black. This example illustrates how a microaggression can obscure personhood and render someone invisible. In another interaction with a White colleague, one of us was asked, “Why are you dressed up all the time?” The author responded that dressing professionally minimizes the chance of being misidentified as a housekeeper. Because of these racial biases, we were raised to always maintain appropriate dress. However, professional attire does not always prevent the assumption, based on powerful racial stereotypes, that Black people occupy service roles. In another example, one of us, on arriving at an exclusive professional meeting, was questioned about her presence, despite being invited by the president of the organization. In each of the preceding scenarios, we first questioned ourselves about whether we were at fault for our colleagues’ false assumptions (7). These episodes were emotionally draining, engendering a multitude of feelings, ranging from embarrassment to anger.

The layering of stressful work situations in professional environments over time contributes to racial battle fatigue (9). This theoretical concept refers to psychosocial, psychological, physical, and behavioral responses triggered by “the oppressive systemic conditions of racism” (9). Racial battle fatigue may lead to significant health consequences, such as hypertension, anxiety, depression, and other symptoms associated with burnout. We are aware of several prominent Black psychiatrists who have resigned their memberships in national psychiatric organizations because of the accumulation of blocked opportunities, racial insults, and disrespectful treatment (4). Black mental health professionals who work in toxic settings in which harmful racial practices are pervasive may choose to leave their workplaces to seek respite, greater fulfillment in their careers, and improved work-life balance. Remaining in these environments places Black mental health professionals at risk for adverse health consequences.