Anti-Racism Can’t Succeed Without Advocacy

Two years ago, as a 63-year-old former corporate lawyer and current practicing psychiatrist who had focused my medical career on clinical, educational, and administrative work in an academic setting, I did not believe I had much more to learn about psychiatry, other than perhaps the latest important findings in our field. I perceived one of my biggest strengths as being “fair,” and I would have proudly claimed that I was “colorblind.” I now realize how wrong I was. My ignorance was rooted in, though not excused by, privilege, and it very much discounted the experiences of people of color.

The last two years have taught me that I still have much to learn about the impact that structural racism has had and continues to have on Black and Brown people in our country, including on our patients and colleagues. For a White person to understand the insidious effects of racism, they need to be open to the possibility of having been uninformed at least partially due to privilege and to put in time and effort to grow, as opposed to undertaking performative gestures. While this growth is very personal, it is also critical to our professional roles as psychiatrists, including as members of the APA, particularly given the organization’s history.

Like many White Americans, the ceaseless police killings of unarmed and innocent Black individuals covered in the news led me to learn and introspect about racism. While self-reflection about racism is necessary, it isn’t enough. We must understand the history, the power structures, the court systems, and the laws that underlie and support racism in the United States. What they reveal is that racism and white supremacy are fully alive in psychiatry in its preference for private insurance and private pay, its frequent treatment of Black people as hostile and dangerous, and its minimization of racism itself as a cause of psychic suffering. Moreover, psychiatry can reinforce the criminal legal system and the carceral state and their disproportionately negative impact on minority communities. I began to see the power I wield in all kinds of ways that I hadn’t thought about.

Here’s why I am pushing myself to be more knowledgeable: because I am the one in the Emergency Department who watches security forcibly restrain those who have come to the hospital seeking help, who are, by far, most often Black. I am the one who suspends people’s civil liberties in the name of providing treatment. I am the one who works in an outpatient clinic with exclusionary policies that disproportionately impact minority individuals. Myriad factors at many levels are at play in each scenario—individual; interpersonal; health care system; and community, state, and federal governments—that impact how I wield my power. Whether I think about these forces or not, they are central to my work as a psychiatrist. If I do nothing, I continue perpetuating racism. If I can learn, appreciate, and understand, I may be able to wield my power differently.

As a leading voice in the behavioral health care field, APA has a responsibility as an organization, along with its members at the district branch level or through individual efforts, to advocate for anti-racist policies and positions across the multiple levels of care in which underserved populations, particularly communities of color, are negatively and disproportionately impacted. This means being able to identify a relevant issue that results in the disparate treatment of psychiatric conditions (not necessarily confined to health care policy given the social determinants of health); identify anti-racist policies to address that issue; and, most importantly, advocate for anti-racist practice and/or policy changes that will promote solutions to that issue.

Not surprisingly, given the complexity of our health care system and the bidirectional impact between other major social systems that structurally undermine communities of color (for example, criminal justice system, educational and housing opportunities, and income inequalities), this advocacy work needs to be done at multiple levels—from the level of the patient and physician, to the level of a specific health care system or community, to all levels of government. While we see a specific advocacy role for APA’s Council on Advocacy and Government Relations as well as the staff of APA’s Department of Government Relations, the eradication of health inequities requires all psychiatrists to advocate for the dismantling of existing racist policies and practices that underlie mental health disparities. We believe this is an ethical imperative; without our advocacy, there will likely be little to no real change. ■