The Radicalization of a White Psychiatrist

On June 3, 2020, I attended an emergency town hall meeting on structural racism, held by the American Association of Community Psychiatrists. The Zoom event consisted of a panel discussion arranged after an African American psychiatrist sent an e-mail to our Listserv with the subject line “Crickets,” referencing the fact that nobody had initiated any discussion about racism in response to recent incidents of police brutality in the United States.

Dr. Ruth Shim, a woman of color who has recently published a book on social justice issues in psychiatry, started her talk by acknowledging the white fragility elephant in the room with a quote from James Baldwin: “Guilt is a luxury that we can no longer afford. I know you didn’t do it, and I didn’t do it either, but I am responsible for it because I am a man and a citizen of this country and you are responsible for it, for the very same reason.” She spoke about the long history of racism in our profession, at one point showing a pharmaceutical advertisement from a medical journal from the early 1990s. There is a drawing of a furious-appearing Black man lunging forward with a clenched fist, the caption reading: “Assaultive and belligerent? Cooperation often begins with Haldol.” That ad solved the mystery of why I have inherited so many patients of color who were on massive doses of Haldol, often despite marked tardive dyskinesia, a sometimes permanent adverse effect. But the ad was most jarring not because it was peddling a toxic drug, but because it explicitly appealed to psychiatrists to control the behavior of angry Black men by means of chemical restraint.

Encouraged by my colleagues of color to engage in some uncomfortable self-reflection, I realized that the trajectory of my career was directly influenced by my racial biases. To back up for a moment, I was born and raised in a town in Michigan’s Thumb called Bad Axe. Its population is about 3,000, about 2,996 of whom are white. It is mostly made up of farmers and working-class folks, although I lacked any real sense of class consciousness until I got to college in Ann Arbor; compared with my friends, many of whom had come from private schools in wealthy suburbs, I felt like a mixture of Rose Nylund and Tonya Harding and was fairly convinced I would fail out. But I compensated for my sometimes crippling sense of inadequacy with massive degrees of hustle, which, along with my whiteness and penchant for rote memorization, was a formula for academic success.

After medical school, I moved to New York City to complete my residency at Columbia University. However, after 4 years, I was done with New York, mostly because I do not speak Spanish, and the communication barrier was the bane of my existence as a resident working in the largely Dominican neighborhood where Columbia Presbyterian Hospital is located. My mother of course enthusiastically championed the idea of my moving back to Michigan. By this time, I had married a native New Yorker who identified only two cities in the Mitten State he was willing to relocate to: Detroit or Ann Arbor. I chose Ann Arbor, and I will now summon the courage to admit that one of the reasons I did so was because I was afraid of Black men.

James Baldwin told me that guilt is a luxury, so I will spare you the commentary about how difficult it was for me to write that, and we will move along.

The panel discussion triggered a memory from my first year of psychiatric residency. It was just my second month as a doctor, and I was working in the psychiatric emergency room (ER) at Columbia Presbyterian. The hospital was right across the street from one of the city’s largest homeless shelters. Many of the patients who ended up in the psychiatric ER were folks who had been kicked out of or denied entry into the shelter (usually because they were intoxicated), so they would just wander across the street. Psychiatric patients were triaged to an area officially called “Area D” but colloquially referred to as “the pen”—not as in penitentiary, but as in a coop where animals are squished up against each other. On Friday or Saturday nights, 20 to 30 men in various states of consciousness were crammed into a small area in the back of the ER. They were not allowed to leave until they had been assessed by a psychiatrist and discharged; the residents worked solo on midnight shifts, which led to long wait times (and stressed-out residents). The hospital’s security team was highly effective at using aggressive takedowns to quash any uprisings or attempted elopements. A few officers patrolled the area at all times, so it was not a matter of “calling security,” which would have given clinicians some discretion as to when to involve them. These men were getting paid to guard the pen.

One day, I was interviewing an African American patient in Area D when my attending physician appeared behind me and gently pulled me back. “We’ll be back a little later,” she said to the patient and led me back to our workstation. I had no idea why she had stopped my interview, but she explained to me that she had noticed cues that the patient was “escalating.” He was subjected to more than one takedown for medication over objection (Haldol, of course) while he was waiting in the pen to sober up or get transferred to an inpatient psychiatric ward somewhere in the city, whichever came first. “Sooner or later you will develop a gut instinct about these things,” my attending told me.

When I was a third-year resident at Columbia Presbyterian, one of my psychopharmacology supervisors was an older man by the name of Dr. M. We had been working together for a few months before a hugely improbable coincidence came to light: we both had been born and raised in Bad Axe, Michigan. One day, Dr. M brought me a printout of an article he hoped we could discuss, because he thought the study was so elegantly designed. I do not remember who wrote the paper or much of its content, probably because I stopped reading immediately after I realized that it claimed that people of African descent have lower IQ scores because of various genetic factors. I told my assistant residency training director about this incident, and together we speculated that perhaps Dr. M was in the early stages of a frontotemporal dementia that was causing disinhibition. Looking back, I wonder why we did not just call it what it was: blatant racism intended to influence a trainee’s perspective. I was set up with a new psychopharmacology supervisor, and Dr. M was not asked to supervise any residents the following year. I remember feeling guilty that I may have cost him his faculty appointment—he had no affiliation with Columbia outside volunteer supervision of residents. Now, if I allowed myself the luxury of guilt, I would be more focused on how I did not denounce his behavior strongly enough, instead offering a simple biological explanation for it (much like racists might offer to explain things like IQ). Regardless, 4 years of living in New York City could not free me from the influence of the racist backwoods of Bad Axe, Michigan. And when it came time to choose Ann Arbor or Detroit, I chose Ann Arbor.

I worked at the Ann Arbor Veterans Affairs Hospital for 6 years before leaving to take a job as an assertive community treatment psychiatrist at Livingston County Mental Health in Howell, Michigan. As it turns out, this small town housed the headquarters of the Michigan chapter of the Ku Klux Klan. I started the job just after Donald Trump had been elected President in 2016. After I made a (semidecent) anti-Trump joke that inexplicably got zero laughs at a team meeting, I realized with some horror that most of my coworkers were pleased with the election outcome. One of the program directors had in his office a huge portrait of Ronald Reagan, whose policies and “war on drugs” led to the capture of millions of Black men in cages. And pens.

As I settled into my work environment, I was less and less able and willing to disguise my contempt whenever one of my Make-America-Great-Again teammates would make a political comment in team meetings. Although I worked in Howell, I was commuting from the liberal bubble of Ann Arbor where I continued to live, and over the course of the previous year I had been politically radicalized. This came about through my involvement with a prison abolition committee within my religious community, the Ann Arbor Friends Meeting (also known as the Quakers). I Googled Murray Bookchin (readers should too), and I now identify as a social anarchist. In short, through both intellectual and spiritual lenses, I finally caught sight of the brutality of state violence and how it disproportionately affects people of color. And once I did, I could not look away. I have forced myself to watch videos of state-sanctioned murders of people of color, most recently George Floyd’s casually gruesome execution. I have chanted some of their names on marches, but there are too many to count. Rest in power, all of you.

In early 2019, I left my job in Howell to work at a Federally Qualified Health Center in Detroit, where my patients were almost exclusively people of color. In an extremely busy and chaotic clinic, my job was largely to hold space as I listened to their stories of how they have been traumatized by the criminal justice system. One of my first patients was a young man who, while driving downriver (through the largely white working-class suburbs south of Detroit), was pulled over by police for having an air freshener hanging from his rearview mirror. The cops beat him so badly that he suffered a traumatic brain injury and then refused to take him to the hospital. This was the second violent police encounter he had suffered in just 2 years. My job was to treat his anxiety about leaving the house. (“Undo centuries of racism and call me in the morning,” I wanted to tell him.)

I had read a vague description of the episodes of police brutality in the patient’s chart before I met him. Initially, he was very reserved, offering mostly nonelaborative answers to my questions. When I took a sip from my insulated coffee mug, he noticed a sticker on it that read “Everybody hates cops now,” which was my intentionally light-hearted way to signal to my patients that it is safe to talk to me about incidents of racial violence. He chuckled at the sticker, and within a few minutes, he told me the whole story.

It did not occur to me until I had been working in Detroit for several months that my patients might think I would be offended if they talked about experiences of racism or discrimination. The day it finally dawned on me was when a patient told me that his grandmother “doesn’t believe in mental health” and was criticizing him for coming to the clinic for help. I asked him to tell me more about what she had said, and he got quiet and seemed embarrassed. “She’s really racist,” he said sheepishly. “She said, ‘Oh, you’re just gonna go listen to what all those white people tell you to do, when you can just come to me with your problems.’” I sat with the heaviness of the embarrassment he felt in telling me that, and my own embarrassment that he used the word “racist” to describe his grandmother’s completely legitimate mistrust of white people. (I was very glad that his therapist is a woman of color.)

After COVID-19 hit and our agency scrambled to get telehealth up and running, I did a telephone evaluation with a patient I had never met in person. Although we did not meet face to face, he must have known by my voice that I am white. He was homeless, scared, and desperate, speaking a mile a minute. “Ma’am, I’m not a criminal, I’ve never broken the law. I don’t do drugs. I don’t have eight kids runnin’ around by different women.” I realized with intense shame that he was trying to convince me that he was worthy of my help by setting himself apart from racist stereotypes about Black men. I am sure my voice failed to reassure him that he did not have to audition, and I was left with the shame of how I may have contributed to his feeling this way. Had I had access to it the way I do now, after a more thorough and honest reflection of my (un)conscious biases, I would have told him: “These were words I needed to hear 10 years ago when I was asked to choose between Ann Arbor and Detroit. If you can forgive me for the path that brought me here, I will make sure you know I see you. I see you now.”

My partner and I live in Detroit now. We can sometimes hear the nightly chants of protestors taking to the streets with Detroit Will Breathe, an activist group working to stop police brutality. We love our neighborhood, but it is not uncommon to hear helicopters flying over our house at night as some police officer tries to track down some Black man for doing something desperate. It’s unsettling. But it’s home.

I remember years ago, my then-husband, who was charmed by my country-bumpkin Midwestern accent when we first met but was sometimes caught off guard by my ignorance, calmly explaining to me all the confounding variables around why so many Black men are in prison and that their incarceration rates have nothing to do with how dangerous they are. A simple “correlation does not confirm causality” discussion reframes the problem from “Black men end up in prison because they are dangerous” to “a dangerously oppressive system puts Black men in cages.” Yes, I needed someone to explain that to me at one point in my life, and yes, I am embarrassed about that now. But I am grateful that someone did explain it and even more grateful that I listened.

Writing this account has been part of my journey of understanding, and I hope that it might help my colleagues reflect on their own as well. I hope I will continue to be brave enough to keep learning. I hope that my children will grow up to be brave people in a brave country.

Most of all, I hope cops stop murdering Black people.