All Doctors Should Be Activists. Sincerely, a Psychiatry Intern
“...if we call ourselves doctors, if we call ourselves leaders and protectors, then we should call ourselves activists.”
— Dr. Amanda J. Calhoun, excerpted from article published in Academic Psychiatry on May 18, 2020.
“I don’t want to know more.”
“I want my attendings to quiz me on the pathophysiology of a genetic disease seen in less than 1% of the population. I also want them to teach me about racism in the medical system which affects more than 30% of the population.” — Dr. Amanda J. Calhoun, PawPrints, A Yale Pediatrics Blog.
The Face of Medicine Is Not My Face… But, It Should Be.
It all begins with an idea.
“The American eugenics movement, and medical atrocities in general, would be substantially more difficult to replicate today if the stakeholders at the table represented the many demographics most subjected to societal abuse…
The “face of medicine” does not traditionally look like the faces of those suppressed by historical and ongoing white supremacy. The “face of medicine” is not my face, but it should be.”
— excerpt from Calhoun, A., Parker, C.B. The Face of Medicine Is Not My Face…But, It Should Be. J. Racial and Ethnic Health Disparities (2020). https://doi.org/10.1007/s40615-020-00834-3
You want to talk about trauma? Let’s talk about racism
It all begins with an idea.
“Taking the trauma of racism into account is crucial to understanding and implementing trauma-informed care. If you want to talk about trauma, you should talk about racism.” — Dr. Amanda J. Calhoun, The Council on School Health Newsletter, American Academy of Pediatrics.
Full article originally published in the Summer 2019 edition of the COSH newsletter. The text of the article is below:
You Want to Talk About Trauma? Let’s Talk About Racism
Amanda Calhoun, MD, MPH Psychiatry Resident, PGY-1, Yale School of Medicine, Albert J. Solnit Adult/Child integrated residency track
“I wish I was white and had straight hair. Then, I would be smarter and prettier.” My heart broke when these words were spoken by my friend’s 5-year old daughter after her first week of school. Her mother and I had been waiting for that moment and we’d known it would come. Those same words had been uttered by so many other African-American girls we knew--us included. We knew that the trauma of racism would catch up to her, but it was always sad to see it catch up so soon.
If a pediatrician, teacher, or any other individual desires to truly give trauma-informed care to children, whether in schools or in clinics, it is imperative that they themselves become informed and educated about the impacts of racism. The American Academy of Pediatrics’ recent policy statement discusses racism as an important social determinant of health and a chronic stressor to minority communities.1 Although the word “racism” is sometimes used interchangeably with prejudice, the definition of racism referred to in this case is the systematic structuring of opportunities and assigned value based on the social interpretation of one’s skin color. As early as preschool, racial differences in treatment are evident. Studies have shown that black preschoolers are disproportionately targeted for suspension, and another study suggests that whites begin to perceive black boys as dangerous as early as 5 years of age.2 A report released by Georgetown University surveyed 325 adults. Compared to white girls of identical age, black girls were perceived to be more “adult” and sexually mature, and require less support, protection, and nurturing as young as five years old.3 Children who are exposed to racism are linked to higher rates of obesity, greater susceptibility to illness, worsened sleep, and lower self-esteem.4 Racism is an unpredictable, chronic stressor that many children of color are forced to endure in the United States. Racism is trauma. One cannot hope to fully connect with children, especially minority children, without addressing it.
How can non-minorities, who have never experienced racism (not prejudice, but racism) help children recover from the trauma of it? First, encourage the recruitment of minorities when choosing a team to deliver trauma-informed care. Second, acknowledge that it exists and introduce it into conversation. Just as a teacher might check in to ask how a child is adjusting to school, they can also ask that child about their experiences with racism and how they are coping with its effects. Third, it is imperative that adults giving trauma-informed care learn the levels of racism, namely: institutional, interpersonal, and internalized. Understanding how to help students navigate their growth and progression through childhood and adolescence and helping to minimize trauma must include helping them to navigate the experience of being a minority in the United States. Fourth, teachers and other adults should work to ensure that they are not contributing to racism with their own biases. Many children will experience racist interactions in school, either from teachers or from peers. The relationship between students and teachers influences their comfort in school, test scores, and even grade point averages.5-7 Studies have shown that African-American children are more likely to receive worse behavioral reports when they have a white teacher, compared to an African-American teacher.8 Data has also shown teachers to underestimate the performance abilities of Latino and African-American students, which has actually been shown to lead to lower grades and school enrollment.9 These racist biases result in internalized racism and are harmful to students of color. Multiple studies looking at the impact of these stereotypes and racist mindsets found that African-American students performed worse on tests when they had to begin by identifying their race versus when they did not, while white and Asian students performed better when asked to identify their race.10 Taking the trauma of racism into account is crucial to understanding and implementing trauma-informed care. If you want to talk about trauma, you should talk about racism.
References for this piece can be found in the References Supplemental File.
The Great Magnifier
It all begins with an idea.
“...Schools should refrain from conceptualizing COVID-19 as the ‘great equalizer’ and start thinking of it as the ‘great magnifier’ of structural racism.”
— Dr. Amanda J. Calhoun, “Resident Perspective,” COSH Newsletter, American Academy of Pediatrics (AAP) Council on School Health (COSH), Summer 2020.
Layers
It all begins with an idea.
“As a Black woman, I can never appear too passionate or too unhappy, because this quickly can and has been misconstrued as me being an ‘angry Black woman.’ As a minority and as a woman, we must always be aware of our stereotypes.”
— Dr. Amanda J. Calhoun, “Resident Column: Layers,” which originally appeared in Connecticut Psychiatrist, a publication of the Connecticut Psychiatric Society, Vol. 57, No. 2, Spring 2020. The full text is below.
I am a psychiatrist in training. I am also an activist in training. I will never have the luxury of “just focusing on the medicine.” If I did, it would be like looking the other way, ignoring a crucial layer of my life.
I grew up watching my parents advocate for my brother, who has severe autism, all the time. Mom and Dad, an inpatient clinical pharmacist and child/adolescent psychiatrist, were fortunate to even have the language to discuss the complexities of my brother’s medications. They provided pushback against psychiatrists who slumped be- hind their computers at my brother’s appointments, diving immediately into discussions about dosage increases, without look- ing up from their screens once. Mom placed calls of concern to the staff at his residential home, who failed to notice that my brother was dressed in old, ratty clothing, despite having newly bought apparel.
But on top of that layer, on top of the constant battle that only those with disabled family members can truly understand, there was another layer.
I remember a White couple, who lived down the street from my brother’s residential home, threatening to press legal charges against him. A group of boys were tampering with streetlights. The couple asserted that they “saw one who looked like my brother,” which is code for: one of the boys looked Black. I remember my mother, very calmly and shrewdly, saying “My son is extremely autistic. He doesn’t have any friends. I wish that was him whom you saw.” The couple was quiet after that. Now, as a psychiatry trainee, I am doing my best to model my parent’s poised, yet vigilant, activism, but some- times, I have trouble.
One day, I was interviewing one of my patients. He was a complex kid, in all realms of the biopsychosocial model. Extremely intelligent and self-motivated, but badly in need of an advocate. He was a ward of the state with a DCF worker who seemed overworked and exhausted. But, there was another layer.
“Another patient called me a nigger today. He kept chanting it,” he said softly, hanging his head in embarrassment. The pieces fell into place. I learned that staff were present, but watched the scenario happen with no intervention. No one said anything to the patient tormenting mine. No one came to my patient to ask if he was okay after being repeatedly called such a historically loaded, traumatizing word. My blood began to boil. “So basically, no one did ANYTHING?!” I questioned thunderously. I quickly lowered my voice and glanced at my attending. Another layer. As a Black woman, I can never appear too passionate or too unhappy, because this quickly can and has been misconstrued as me being an “angry Black woman.” As a minority and as a woman, we must always be aware of our stereotypes. “It’s okay,” insisted my patient, attempting to comfort me. “People chant nigger at my school too,” he whispered.
I felt powerless, just like my patient. My idea to hold a staff meeting was politely declined. I told my colleague, who had just arrived for their night shift, what happened. We went together to check in with my patient and to apologize for what he endured. I wrote some emails to leadership, hoping to change how racism is responded to in the future. But, it makes me wonder, what if I hadn’t been there? What if I hadn’t had the energy to advocate for him, as my parents have for my brother? And even more importantly, what is happening to Black boys out there and why aren’t we doing a better job of protecting them?
“I Feel Like I Know Them”: the Positive Effect of Celebrity Self-disclosure of Mental Illness
“Currently, the general public is getting the bulk of their mental health education from movies, television, and entertainment news. As such, representation of mental illness matters. Yet, mental illness is often left out of storytelling.”
Calhoun, A.J., Gold, J.A. “I Feel Like I Know Them”: the Positive Effect of Celebrity Self-disclosure of Mental Illness. Acad Psychiatry 44, 237–241 (2020). https://doi.org/10.1007/s40596-020-01200-5
Letter to the editor: Commentary
“It is essential, when discussing reasons why disparities exist among faculty, to discuss the effects of racism targeted specifically towards African Americans.”
Calhoun, A., Parker, C.B. Comment on “US Psychiatry Faculty: Academic Rank, Gender and Racial Profile”. Acad Psychiatry (2020). https://doi.org/10.1007/s40596-020-01253-6
I’ll Wait With You
Poem by Dr. Amanda J. Calhoun
(Originally published in PawPrints, A Yale Pediatric Blog.)
At times my thoughts are just as loud
As the beep of the machine
At times my thoughts are just as loud
As the code being screamed
I shush them as I jog, then sprint, into the patient’s room
I shush them as I do compressions, fight impending doom
I refuse to let my thoughts venture to that awful place
Years ago, at my school, where I paced
Waiting to hear news I knew would come
Hoping what was done would come undone
My principal found me. “I’ll wait with you,” she said.
“Ok.” I looked out of the window at the roses, focusing on the red.
My parents arrived, my heartbeat began to quicken
My stomach began to hurt, then sicken
Mom’s voice shook as she whispered what I knew
I rushed into her arms, hot tears flew
“What happened…?” said my principal
“I’m so sorry…” I spaced out and there was a lull
I tell myself my tragedy
Will help me to relate
But all I can feel is fury, sorrow
All I can do is recreate
That moment long ago
When I realized children die
When I realized he would never come home
I never got to say goodbye
Death is not always calm, like never waking from a dream
Sometimes it comes suddenly, an extinguishing light with a scream
And all we can do is hug each other tight
The doctor can’t cure them
We lost the fight
But that is not the time for doctors to go away
In that moment, just stay
Comfort them, tell them you did all that you could
Even if it you don’t think it will help, or that it should
Even though they are overcome with grief
Even though you feel you can bring no relief
I promise that they will never forget that day
They will, undoubtedly, remember all you do and say