The professional and personal journey of a Senior Psychiatrist of colour in an unnamed mental health trust is the focus of a new four-part blog series: 'Surviving at the Frontline'. Written during the pandemic, she shares her challenges around race, privilege, gender bias, structural and interpersonal racism, as well as her own mental health journey as a clinician of colour. She says: “It isn’t the volume of work that burns one out. It is the moral injury of being a part of decisions, conversations and a culture that is completely misaligned with one’s core values.”

Synergi Collaborative Centre Stroke

The cost and the reward of resisting

I have often grieved the loss of valuable time at medical school where learning about some biochemical cycle was prioritised over the socio-political landscape that our health service sits within.

Now, I wonder, if indeed this was by design, in the name of tradition. To overwhelm our young sponge-like minds with so much irrelevant information that we didn’t have the capacity to emerge and learn about the things that mattered.

For example, we would find our ‘machine-like’ selves certifying death or taking a history from someone with terminal cancer while not quite knowing what to do with the feelings this all evoked.

During it all I struggled with depression, which I struggle with now. The same ‘machine-like’ behaviour was expected, rewarded and valued back then as it is now. The only difference is that I am no longer 18 years old.

We have learned from life and, over the past year, from death. We are repeatedly told that no one was prepared for a pandemic such as Covid-19, yet we are actively steered away from the ‘pandemic of inequalities’ that has existed for over 500 years.

As is the way in Western medicine, we jumped to address comorbidity among ‘BAME’ populations and came up with simple biological explanations such as diabetes, cardiovascular disease and vitamin D deficiency.

I suppose to our ‘medic machine minds’, this felt comfortable. After all, we felt omnipotent again. We could solve the problems by a) pointing a finger at ‘BAME’ genes or lifestyle and b) offer medications so we could bask in the smugness of ‘helping’. This tactic works well for most of us.

But what if we have experienced injustice-related trauma in our own lives? Such as racism, patriarchy, stigma related to mental illness and immigration. What happens to us when we see our parents being mocked and jeered at for their accents? We either ensure that this never happens to us or we choose to challenge the assumption that there is only one way of speaking English.

The former would be the path of least resistance for many. But this is not where it stops. For many of us, we internalise this ‘racism’ and next time we are part of the group that mocks other ‘accents’ because we wish to avoid being mocked.

It’s too painful to see our parents in ourselves and, ironically, our parents expect us to do “better” because of their sacrifices. They want us to be the ‘insiders’, the Consultants and Professors, not the rebellious fool biting the hands of whiteness that feed us. They accept that they were ‘fresh off the boat’. They didn’t know any better, so what’s our excuse? They didn’t realise that our dreams may differ and that we don’t have to make excuses for having them.

If the above example feels miniscule in the larger scheme of things, then imagine what unjust treatment around bigger issues look like? A bit like the inequalities laid bare by Covid-19, possibly?

So, what does this have to do with mental health? Everything. We are more likely to fight for justice if we have experienced injustice, because we identify with what this feels like. We are primed to react in the evolutionary fight/flight/freeze response.

For each of these responses, calling it out or keeping it silent has a cost. In a world that is based upon the survival of the fittest, trauma is the tool used to elicit a response that eventually affects the mind, body and agency of individuals in a detrimental way.

It would not be too much of a leap to say that trauma is a political strategy to strip people of their sense of autonomy and agency. It is an oppressive tool and therefore not something that wellbeing sessions on good sleep, exercise and mindfulness can satisfactorily address.

When referring patients to have psychological therapy for trauma, we are always asked if the trauma is persisting in the form of a court case, etc. The rationale being that no therapy will alleviate trauma that is ongoing.

Sitting in my clinic room, I consider how similar this is for trauma experienced via racism, sexism, ableism, transphobia, classism and all other forms of discrimination that accumulate and multiply. How does one seek healing in a society where intersectional trauma persists? How much of this is to do with one’s own personal wounds and those inflicted by the system?

I remember a day in June 2020 when I wanted to destroy my life. When Meghan Markle talked of her suicidality to Oprah Winfrey recently, I heard her so clearly. Within my institution, there was initial support in the spirit of tokenism. However, while challenging deeper processes and policies around Covid-19 deployment, PPE and ‘BAME’ risk assessments, I experienced intimidation, exclusion and finally threats of a disciplinary.

I was also asked to channel my concerns via the ‘official’ processes. This reminded me of Audre Lorde’s famous quote: “For the master’s tools will never dismantle the master’s house.”

What hurt me more was the aggression I experienced from my colleagues of colour. The silence was deafening. I was offered explanations such as: “We can’t make any changes without our white, male allies in powerful positions.” “We cannot stand by you in calling people out because that is your personal battle.” Critiques like those levelled against Megan for airing her experiences publicly.

And there’s more. “We don’t believe in divisive identity politics as there’s only one race – the human race.” These colleagues continue to ascend the career ladder, one promotion and Queen’s honour after another. I do wonder what their ‘successes has cost them? I also wonder if I envy their sense of belonging to a whiteness which makes their ‘voices’ heard leaving me overwhelmed with the rage of betrayal.

I think about the diagnoses I have been given this summer: severe depressive disorder; burnout; work-related stress – the list goes on. I consider the unsaid diagnoses: racial trauma, gaslighting, scapegoating, exclusion, intimidation. This makes me highly cognitively dissonant about my own use of mental health diagnoses as a Psychiatrist. Disproportionate diagnosis of personality disorders in women and the detention of black men under the Mental Health Act are at top of my mind.

If as a Senior Psychiatrist I shudder at the thought of seeking solace in a psychiatric ward, what am I doing within this institution? If being subject to multiple intersectional oppression leads to trauma, and I am rendered ‘mentally ill’ while my lived experiences of trauma is dismissed and denied, how do I envisage formulating such lived experiences for my patients?

As I have phased myself back into work, I have had severe doubts about how to ‘be’. But I know that my passion for good mental health for myself and the community that I serve is crystal clear.

I found myself comparing my situation to an Olympic sprinter who finds themselves with a broken leg, in my case, a psychiatrist losing her mind. But as I let go of the need for certainty and build depth in my own purpose for my life, I realise that to my institution I may have lost my mind but to me, I am reclaiming it bit by crucial bit.

Even if the trauma has set me back on the career, finance and status ladder, it has opened my eyes to who I am and what I want. I want to practise psychiatry in the most socio-politically just way that I can. The tools for this will not come to me in one go (like my medical school’s lectures and exams) but they will and have started to emerge.

I have discovered the voices of many others like me. I have heard the anger and passion of women of colour and they have heard mine without calling me disruptive, divisive and unproductive. It is a freeing feeling.