When the term white supremacy culture is used, people get uncomfortable — they picture the skinhead as the prototypical racist. And while those people are dangerous, whether by their openly racist views being broadcast or in other subtle ways, they are largely recognizable.
White supremacy culture is inescapable in the United States. We have been saturated in it. Our country was founded on its tenants. The far more dangerous racist is the person who refuses to acknowledge and examine their bias. These unexamined biases allow the continuation of structural, systemic, and personal racism in this nation. It allows terribly unjust verdicts to continue to happen in this nation over and over and year after year. We can no longer stand by and shudder at the terms that correctly describe the milieu in which we live.
We in medicine are far from immune. The practice of medicine continues to fail Black mothers and babies, Black patients in pain, and continues the inequitable care of breast cancer and countless other diseases. We continue to use lab standards that were developed with the false idea that Black bodies are different, i.e., GFRs and PFTs. We continue to largely leave out anti-racism curriculum in the teaching of our students and residents. We continue to fail in promoting diversity as well as having people of color in the boardrooms and in the upper echelons of academia and hospitals.
In psychiatry, we learn early in training that bias exists in the diagnosis of psychiatric illnesses — namely schizophrenia which is overdiagnosed in Black individuals, especially men.
It is difficult to accept that many things we are taught in medical school are based on racist ideas. We trust our training, and now in a time when our society is rife with misinformation and mistruth often aimed at our profession, it can feel even more threatening to examine our training and acknowledge errors.
But we know science changes, and our profession is particularly adept at examining the data and making corrections. We are a group of resilient and adaptable individuals, and it is time to tackle inequality. We cannot ask nor expect our Black and other BIPOC to lead the charge to change these things. We have to embrace being uncomfortable and risk offending people and work toward making medicine better.
Courtney Markham-Abedi is a psychiatrist in Lexington, Kentucky. She has written widely about physician suicide and other psychiatric topics for online publications and has appeared on several podcasts, work that led feedspot.com to name her one of the 1,000 best health care journalists and editors.
Her peer-reviewed work centers on the metabolic and neurologic effects of antipsychotic medications, including case reports on a probable association between ziprasidone and worsening hypertension, ziprasidone-induced catatonic symptoms, and hypertriglyceridemia tied to the direct effects of olanzapine rather than to weight gain.
She has also written a novel, Unlocking Lakin, set in a psychiatric hospital in her hometown. The manuscript won first place for full-length prose from West Virginia Writers, and she is currently seeking an agent to represent it.
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