“Of all the forms on inequality, injustice in health is the most shocking and the most inhuman.” – Dr. Martin Luther King, Jr. -- March 25, 1966
This quote by Dr. King boldly denounced healthcare racism as an egregious offense to Black lives, more than 50 years before the COVID-19 pandemic devastated our communities due to structural inequality.
Dr. King’s use of the word “inhuman” to describe systemic racism’s deprivation of health is profound. Merriam Webster defines the word “inhuman” as, “lacking pity, kindness, or mercy; not worthy of or conforming to the needs of human beings.” Thus, white supremacy denies the humanity of Black Americans by intentionally creating and sustaining inequitable health resources, including safe housing, adequate nutrition, and formal access to medical care.
His words also reveal that it is actually those who uphold these injustices who lack humanity – not we the people enduring that mistreatment. Therefore, one of the most powerful tools to defy health injustice is reconnecting with our humanity despite white supremacy’s best crafted ploys to continually break our hope.
As a Black psychiatrist and physician educator specializing in antiracism, I am personally and professionally aware of the psychological devastation that racism – ranging from police brutality to mass incarceration to employment and education discrimination and now COVID-19 – can take on the mental health wellbeing and resiliency of Black Americans, myself included.
Centuries of systemic racism have blocked Black communities from accumulating intergenerational wealth and instead disproportionately concentrate us amongst the impoverished who must rely upon government insurance and resources. The clinic where I elect to work only serves those with Medicaid, Medicare, or no insurance at all, meaning that I have the fortune of serving many clients who are Black.
Having access to formal mental health treatment at my clinic is certainly a key component of advancing health equity, yet many clients struggle to live on a fixed monthly income that is less than what many clinic staff pay in property taxes each month. Indeed, poverty and systemic racism burdens the minds of Black communities in ways that my prescriptions could never fix.
In addition to hearing daily narratives of how racism is harming our patients’ lives, Black physicians are frequently gaslit as we advocate for equality. Many people are constantly trying to convince us that the wrongdoings we see against Black patients are somehow not wrong – that we are wrong, not the discriminatory actions of healthcare we know we just witnessed.
How, then, can mental healthcare providers reconnect with the humanity of Black patients even as white supremacy tries to erase it?
During one virtual patient visit last year, I noticed that my patient seemed more closed off and irritable than I had ever known her to be. Finally, I paused the appointment. “What’s wrong?” I asked, “You don’t seem yourself today.” She huffed a disbelieving laugh before answering. “Dr. Black, I haven’t eaten in three days. This always happens at the end of the month. And what? What are you going to do about it now that you know? Just give me the Prozac and leave me alone.”
The painful truth of her words struck me: How inhuman would it be for me to keep casually asking about her psychiatric symptoms – her mood, her sleep, her appetite… after just learning that she’s starving?
“You’re right,” I replied. “Let me find some resources for you.” This earned me another sarcastic laugh. Years of being invisible to physicians gave her reason to doubt that I would do any more than the countless before me who did nothing.
My clinic maintains supplies of $25 food cards to help our clients, many of whom are poor. I campaigned to get a card for my client, but she had no bus pass to come pick it up. I campaigned to get a bus pass too. A state vehicle was even parked in the parking lot ready to be driven, but no support staffers were available to drive the car to deliver those resources.
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My patient kept calling to check in throughout the rest of the day, daring me to disappoint her. Thoroughly frustrated, I finally did something as a physician that medical school never taught me to do: I went to deliver the food card and bus pass myself. As I drove up to my patient’s house, I watched as her skepticism transformed into a mixture of tears and the brightest smile I’d ever seen. “Dr. Black, no doctor has EVER cared this much. NEVER! They’re always talking about how much they care while I’m still sitting here hungry. I felt invisible. Unimportant.”
I reclaimed precious pieces of my client’s humanity, mental resilience, and hope from white supremacy that day, more than Prozac could have ever accomplished in that moment. Yet, it never feels like enough.
Instead of food cards and bus passes, I wish to end the structural racism keeping our communities in poverty in the first place. Nevertheless, in the spirit of the life and legacy of Dr. Martin Luther King Jr, from healthcare professionals to next door neighbors, let us continue to defy the injustice to our mental wellbeing as we cope with racism through small acts of kindness, as one human being to another.
Dr. Carmen Black, MD is an Assistant Professor in the Yale Department of Psychiatry at Yale School of Medicine and a Public Voices Fellow in the Op-Ed Project.