Psychiatry & Psychotherapy Podcast - Racism & Trauma: Discussion with Danielle Hairston M.D.

Episode Date: June 6, 2020

Join Dr. Danielle Hairston and Dr. Puder on a discussion of recent events. Dr. Hairston has served as the Black Psychiatrists of America Scientific Program Chair since 2016. She is also the American Psychiatric Association Black Caucus' Early Career Representative.  She is the residency director at Howard University.  She has a Consultation-Liaison Psychiatry Fellowship. Dr. Hairston has also had the opportunity to speak nationally and internationally about the impact of racial trauma and culture on mental health. She is a contributing author to the recently published book, Racism and Psychiatry: Contemporary Issues and Interventions. Her interests include consultation-liaison psychiatry, resident education, minority mental health, cultural psychiatry, and collaborative care.  By listening to this episode, you can earn 0.5 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Okay, today on this podcast, I am joined with Danielle Hirsten. She is a psychiatrist, physician, program director, and a CNL fellowship trained psychiatrist at Howard University. She's one of the youngest program directors. She's African American, black American, and she is an advocate. She's also a part of the APA, the head of the Black Caucus. And I'm really excited to have you on and just create a conversation around some of the recent events that have been going on. I wanted to create a dialogue and kind of see from your perspective and from a psychiatrist's perspective and from, you know, someone in leadership as well in psychiatry, how you're hit by the recent events. And I've read a couple of the things that you've been quoted in the news saying.

So, yeah, tell me, tell me a little. a little bit about how you feel as a black American going through this as a psychiatrist with the death of George Floyd and this just really unique time that we're in? So it's twofold, I guess, because as a psychiatrist, you know, we go into training. We want to help people cope with trauma, depression, anxiety, things like that, you know, deal with post-traumatic stress disorder, PTSD, but at the same time, aside from me being a psychiatrist and a program director, I'm a black person. So my identity is a black person first, a black person in the United States of America who is witnessing this trauma, who's witnessing vicariously

the killing of people who look like me and people who look like my family members. And that's, Well, it's a lot. It's a lot to process. I think that what I'm noticing is in medicine, as a leader, as an expert in trauma and mental health and anxiety, depression, whatever you want to call it, I think that people reach out to you. A lot of non-black people reach out and say, oh, I just don't know what I could do to help. And I think that they don't even process that we as black psychiatrist as myself as a black psychiatrist is really trying to process my own thing, you know, deal as a person, as a black person in the United States. So, or in the world, in the universe, who's watching this trauma, who's watching the repeated killing and violence towards people who look like me, who has to worry about weaponized privilege, who has to worry about if I'm just going outside living my life, or my boyfriend is outside living his life, or my godson that someone will call the police on you for just being a person jogging who's sleeping, who's eating.

Yeah. Yeah. And I almost, I know that it can be a lot to have to talk about it, have people ask you all these questions, and then through your own sort of experiential life, have to as well sort of see these images, see these pictures. I mean, like when I saw the image of George Floyd, like that was, that was like a, a painful thing for me to see. And I can only imagine for you to see that and for you to, it's not like this is the first time you've seen it. It's like a repeating of prior things

that you've seen, of prior things that you've experienced. Right. So let's be clear that being black people as victims of crime, as race-based, of race-based hate, of race-based killings, of lynchings, that's not new. So that's not new for Black Americans. That's not new for anyone who's black in this world. It goes back to, you know, Emmett Till, going back to having images of lynchings throughout the South and even some places in the North, things like that. So it's not new, but it's just that it keeps happening.

And it's just traumatizing to keep seeing this over and over and over. And I think it's traumatizing as a human. So for me to hear you say, like, it's traumatizing for you. I think it should be traumatizing for us all in this country. But then when you can visualize yourself going through this or someone that you love and care about, or just as a human, as a black person who feels for the black community knowing that this is what we're going through, you know, it's distressing. And it's not something that you want to see.

And I can say that outside of movies and TV, like television shows, I've never seen a white person be killed. a white person jogging down the street and be murdered like I just saw for Amma Arbery. I think that one is the one that really just was so hard to just digest and just process because he was literally just running down the street and then you just see him on TV, no warning, no this might be, or on social media, no warning, this might be distressing to your viewers or you know, whatever it is, the warning it is, but I just see him as someone who could be myself

or someone who could be my brother and be shot and killed. And that's a lot. Yeah, and I think you're entitled to the full range of emotions in that, you know. And I know it's a lot probably even coming on and talking about this, but I think it's an important conversation to have with the psychiatry community, with the psychotherapists that listen to this? I agree, and I appreciate that you took the initiative. Like, this is what I like to see and I like to hear, like actually saying this is something

that needs to be talked about. We need to have this discussion. So it is difficult, but I appreciate the opportunity, and I really appreciate that you're doing this so that others in the psych, whether it's psychiatry or psychology, community can really be aware that this is something that is affecting their patients, their colleagues in the communities that they do. treat. Yeah, one of the black residents that we had, you know, we kind of checked in before a psychotherapy clinic this week. It's a clinic that I lead. And she said, you know, guys,

I'm very aware that I'm the only black resident here. You guys may not be aware that I'm the only black resident, but I'm aware that I'm the only black resident. And I'm also aware that right now, you guys are talking about this and I'm glad you're talking about this and I'm glad you guys are paying attention but I just want you guys to know that a couple weeks from now when this is all died down I'm still living in this life and and it really hit me and it was really kind of like okay I know we're having this conversation right now but I really want to dig into some books in the coming months and maybe have you come back on in another time when this has died down to continue the conversation to continue to put it out in front of people's minds.

That's great. I have many books and ideas. Even if we want to talk about a couple of them today as some homework to get prepared for the future, that's fine. Yeah, yeah, that would be good. That would be really good. Maybe towards the end I'll write down a couple of them and then anyone who listens to this can write them down as well and be reading them. and then we'll have a second conversation about that. I think that would be really meaningful. Okay. So I think one of the questions I have is if you were talking to someone who's not black and you were giving them input on how to help them understand black racial trauma

or help someone who's black with their mental health issues, I'm curious about how you would coach them, what you would say. Well, just like you talk about other traumas, and it's difficult, like it's difficult to talk about abuse, right? It's difficult for people to talk about, sometimes even substance use, but you really just have to do it. You have to ask your patience, is this something that's affecting you? Is this something that you're worried about? Is this something you're experiencing? Or what are you experiencing?

Or if they say, you know, what's going on is really disturbing to me, I'm not able to take this, don't say, okay, check and go to the next box and ask them about any side effects of their medications or how their sleep is, because they're trying to tell you how their sleep is. They're trying to tell you about their symptoms, and you as a psychiatrist or psychotherapist need to explore that further. You have to be comfortable with getting uncomfortable. You have to just make it happen. You have to ask. You have to be deliberate, even if it's hard for you, even if it's uncomfortable for you. Because you want to help the patient, it's correct.

So you have to do the work. Do you think this is the uncomfortability? Do you think it's part of, there's this statistic that I was looking at recently that black people get half as much psychiatric care as people of other races, white people? I don't know if you have something more accurate than that. Half as much. I've heard I've read one third as much.

Okay. Hey, hey, correct me. I'm looking at some data. You probably, you know the data much better than I do. So one third is much. One and three. Black people get the same mental health access or care as non-black people or as white people. So yeah, that that has to do with the level of discomfort. I think that we, have to really acknowledge the historical context that we are not without history. This country doesn't have a perfect history or a nice, pleasant history when we think about race relations. So we have to consider that one of my colleagues said, like, oh, this has been going on for what, like 100 years or 200 years or like 400 years of black people being enslaved in

this country. So you have to think about that for generations, generational trauma that people have experienced. So when you're talking to a patient who is what in their 50s or 60s, they or 70s, Dave, they could have experienced rioting and uprising in the civil rights movement. And they could have been had hoses sprayed on them or dogs attacking them when they were just trying to express their feelings about their rights to just live their lives. There are people whose family members, some who are still alive, were involved in the Tuskegee experiment. So things like that are not foreign. Like it's not, oh, that's so far away. Like we now live in an environment that's free of racism. So I think that it's important to understand the

historical context and understand that this is generations in the making. So it's not that, oh, I'm just talking to you here. I think maybe the psychodynamic people can really discuss and understand, like, this is not just what's happening here and now between me and you in this therapeutic, what we hope to be an alliance. But this goes back further. So there's that lack of, you know, there's just a cultural mistrust.

There's also a lack of diversity in psychiatry. There are not, in psychiatry and medicine, period, There are not many black psychiatrists. There are not many black psychologists. There are not many black physicians, period. Yeah, do you, okay, so I want to, I want to backtrack on what I said because I, in no way do I think that the discomfort is the reason why there's one third of people getting care. I think that it's, I think that there is lots of levels of bias and, and things. And so I want to ask you, like, what do you think are some of those reasons for that one-third number?

You know, like, what is keeping, is it the doctors choosing? Is it the insurance? Is it? There's a myriad of reasons why there's a limited access. Many reasons that go from economic reasons, housing, residential. potential reasons just based on access to care, like where you live and how close you are to a therapist or a psychiatrist or a hospital. So if I have a patient who lives in one ward of DC, they have to take two buses in a train to get to see me. However, if they're late or they can't make, you know, I have to reschedule them.

Yeah. Or they can't be seen because, and then they'll have to decide should they use their money to pay for the bus fare or for their co-pay for their medications or to have a meal for their family next week. So there's that, the access to care. There's also, like as I was saying, there's a lack of diversity and there's a lack of diversity. a cultural mistrust. There's a cultural mistrust of psychiatrists, but there's a cultural mistrust for physicians, period, because we are not without history. And when you've seen for generations, your people being treated a different way, or even if you haven't, some people experience racial profiling or weaponization of privilege. And they've never seen that before. They've grown up in a completely, you know, higher socioeconomic status neighborhood. And

And they never expected that they would get pulled over for being a black male adult driving through their neighborhood. But that's where we are. Yeah, I saw a clip of a very tall black male who was kind of pulled over by these two policemen in this sort of situation that we're in right now. And he pulled out his FBI badge. And the policemen were like, oh, it's a very surprised. Right. Right. Now he, what if he didn't have his badge or what if he wasn't an FBI?

It's like your freedom passed. So I could pull out what my hospital badge, right, and say, hello guys, I'm a doctor or a student might be able to pull out their badge and say, oh, I'm a, you know, I'm a student at Harvard. I'm a student at Yale. Don't call the police on me for sleeping here in the lobby of the dorm. I actually go here. But they didn't know that they would experience that. But we have those quote unquote freedom cards.

like I as a physician or a student or as you just brought up the example of an FBI officer. However, what if you're, what if you don't have your ID? What if you can't prove that, oh, I pay my rent. Oh, I, I have a job or I'm employed. Like, why do I have to prove that I'm a human and deserve to not be profiled? Okay. Yeah, I, it's, it's horrible. That's horrible.

There are things that we can do to attack, to treat, and combat this. Yeah. So what are some of those things that you feel like for the APA, like what are some of the things that you were pushing for within psychiatry? Or what are some of the things that you get excited about? Like, okay, these are the places of progress that I would like to see happen. I like when people make statements of solidarity. like we are here together,

but I only like those statements if they come with actions behind them. So if you say that you are supporting black people and that you care about black people and this is terrible, okay, let me see some programming about this. I want to see something about the APA presents, which they already are going to, by the way.

Oh, yeah. Racism and psychiatry and really talks about how racism is a public. health issue, how racism is traumatic to people. Like, I want to see that. I want to see that you are telling your members that this is something that your patients and your colleagues are going through. So I want to see action like that. I also want to see some diversity in these committees, in your executive boards, in your recruitment committees. Like, show me. Don't just say we stand here,

but be deliberate. Promote people to these positions. Sponsor people in these positions. Fund these things. Put your money, your funds, and your efforts behind diversity initiatives. You want to talk about them? You want to write about them. Do them.

Yeah, 100%. Totally makes sense. And I'm glad to give you this platform to say those things or say the things that you're excited about. And yeah, I'm curious, like, what do you think we can do to get more medical students going into psychiatry? Or what can we black medical students or get more black medical students? You know, what are some things there that you feel like we could do? As far as medical students, I think that, so I'm in a unique place, you know, Howard being at HBCU, one of the oldest with the medical school.

its own medical school and we are deliberate in our searching and our recruiting of medical students. Like we are looking for medical students who say that they are here to serve the underserved patient population and that they want to promote diversity and come back and serve these communities when they're finished their training. And I think that that's not something that should be unique to Howard. That's something that all programs, if you generally care about this, all medical schools should say that, like should take initiative to include diversity and equity in their recruitment and in their education. And as far as getting medical students to go towards choose psychiatry of a specialty, there is a stigma, of course, about psychiatry and

medicine that we are all aware of, no matter what color we are. You know, we have attendings who tell my residents when they're rotating on internal medicine. Like, you need to switch. You're too good for psychiatry or you're too smart for psychiatry. So there's that stigma that we have to fight. And then there's, you know, a mistrust about psychiatry in the black community, about whether or not you should talk about your problems, whether or not you should take medication, things like that. So I think that we really have to work on reaching out, making out, making it. Pipeline programs, reaching out to undergrad, do things. Make yourself visible. Do programs with them. The APA does that. The APA has a pipeline with undergrad programs and

to help them. It's to get into medical school period, but we hope that they might be aligned with psychiatry, things like that. But that shouldn't just be the APA. That should be any university. That should be any hospital. Yeah, that's good. So if you're listening to this and you're, You are undergraduate black student who wants to get into medical school. Send me an email. And I'll make you a co-author of our next articles or next episodes that we do together. Okay.

And we'll put you first author, get you, get you something for your CV. Yes, that's what I'm talking about. From membership. Yeah. Because I really, I really think like a lot of it's just access to mentors, maybe. You know, when you only have 3%, is it 3% of psychiatrists or black? Is that the correct number? That's what your friend told me.

You put us in contact. Sometimes for a percent, I see like 2.7 percent consistently. So I go 3 percent. That's fine. Yeah. Okay. So which books should I be reading or which books would you recommend for a therapist or a psychiatrist to read? And we'll make a little, we'll make a list of like the top maybe three.

Let's go with three. Okay, go for it. You just tell me, tell me which ones. Okay, I think that period for a psychiatrist or a psychologist, a book called Why Are All the Black Kids Sitting Together in the Cafeteria and other conversations about race by Beverly Daniel Tatum is a good book. Also, racism and psychiatry, that's actually a book that I had the opportunity to work on with, Morgan Medlock, and it really goes through many different levels of how you can address racism, how you can help in therapy, how you can help with treatment, how you can help with assessment, and really discusses everything from food insecurity to lack of housing.

So that's a good one. Also, another one that's a little bit older, but one that I liked from residency is called Black Pain. We just look like we're not hurting, and that's by Terry Williams, and I think that's a really good example of a black woman who describes her experience in going through depression, anxiety, insomnia, and the difficulties with seeking help just on many levels. So I think that's a good one. And the last one is not necessarily for black people, but the last one is one called the Body Keeps the Score.

I can't remember the author right now. That one? I have that. I have that one. by Bessel van der Kalk. Besser Vandig? Yeah, he's fantastic. Well, I feel like there's so much more for us to get to,

and we'll have you back on. Maybe I'll get through one book. Little of known fact, I'm not very fast reader. Maybe we'll do one book at a time. Out of all these books, which one would you say is like the first one to read? It's a tie. I got to say it's a tie.

It's a tie with medlock and the wire all the black kids sitting together in the cafeteria. Between those two. Okay. Perfect. I also use audible because I'm very slow reading as well. Yeah, I can do audible a lot faster because. Well, I'm walking. Yep.

Yep. Well, hey, thank you so much for coming on. Thank you so much for giving up a little bit of your time this Friday afternoon. And great, went well, in my opinion. Yeah. And we will be excited to have you back on and continue this conversation. Much needed conversation. Okay. I was ready with their questions about why do fewer Black Americans get SSRIs? Oh, man. Do you want to give that one real quick? probably because is depression, does depression show up differently or do the symptoms that they present with? Is it sometimes symptoms present differently in African American, not just African American, but Latin X, also Asian, Asian populations with a lot more somatic symptoms and not so much outright saying, you know, I am depressed, my mood is low. And if people really aren't able to really finesse and pick through and understand those symptoms, then depression and mood symptoms are constantly missed in the black patient population.

And they're often overly diagnosed or misdiagnosed with primary psychotic disorders like schizophrenia when they are missing completely mood and trauma. So there's that. They have not offered the same new antidepressants or not offered or not referred to therapy. We see the same thing with substance use and the use of buprenorphine and Suboxone. J.M. I had an article about that last year about how they are not referred to these programs and medication. So it's a combination of the access and also just implicit and sometimes explicit bias. Yeah, I've seen a couple black Americans that come in with what looks very much like trauma to me and they've been put on like antipsychotics.

And not given the correct referrals to therapy. So I think that's a really good thing to point out. Well, we will have a lot to discuss in the future. Jod anything down that you would like to say in the future and we'll include it. And thanks for coming on today. Thank you.