Diagnosing Depression: Race, Medicine, and Melancholia in the Atlantic Slave Trade

December 14, 2022

Information

YCSC Grand Rounds/Viola Bernard Lecture December 14, 2022

Carolyn Roberts, PhD
Assistant Professor, Yale University
Department of History/History of Science and Medicine
Department of African American Studies
Yale School of Medicine, Program in the History of Medicine

ID9283

To CiteDCA Citation Guide

00:00Well, good afternoon, everyone.
00:02To those of you here in the
00:05Cohen and those on Zoom, thank you
00:06so much for being with us today.
00:08I do before we get started, just want
00:11to announce that the next,
00:12this is our last grand rounds for
00:14the year and we will pick up again on
00:17January 10th and I believe Linda will
00:20be addressing our community again.
00:22So we'll meet then and for today,
00:25I'm just so thrilled that we're
00:28able to have Doctor Carolyn.
00:31Roberts back with us today for our
00:33long-awaited part two of our 2022 Viola
00:37Bernard like Bernard Lecture series.
00:39And so before I pass things
00:41on to Doctor Carolyn Roberts,
00:43I just wanted to take a moment to
00:44share some information about Doctor
00:46Viola Bernard and her life's work
00:48and her generosity to our center.
00:53If my notes
00:54will cooperate, so.
00:58Let's see here. So Viola Bernard
01:02was a prominent New York psychiatrist,
01:04psychoanalyst, child welfare advocate,
01:06and political activist.
01:08Dr Bernard was a founder of the field
01:10of community psychology, which sought
01:12to use psychiatric insights to
01:14address larger social purposes.
01:15And she was an influential force in
01:17numerous child welfare
01:18organizations in New York
01:19City, was active in many
01:22professional organizations,
01:22and had particular expertise in the
01:25psychological issues surrounding
01:26adoption and infertility.
01:28Her work helped to expand
01:30adoptions to include children who
01:31had been systemically marginalized.
01:34Bernard helped found the Columbia
01:36University Center for Psychoanalytic
01:38Training and Research and was director
01:39of the university's division of
01:41Community and Social Psychiatry,
01:43a joint program of the Department
01:45of Psychiatry and Columbia
01:46School of Public Health.
01:47And she served as medical director of
01:49the Family Development Research Unit,
01:51which is a long term study of the
01:53psychodynamics of family formation.
01:56Her dedication to social justice
01:57and HealthEquity and innovation and the
02:00generosity of the Viola Bernard Foundation
02:02is part of what brings us together today.
02:04The Viola Bernard Foundation has a long
02:06history of supporting the Child Study Center,
02:08especially in the early 2000s. Doctor
02:11Bernard had little patience for
02:13Band-Aid solutions and sought
02:14instead to take a multidisciplinary,
02:16multifaceted approach to complex
02:18problems with the goal of producing
02:20sustainable and replicable solutions.
02:24It is this spirit and dedication of
02:26Viola Bernard and the child study
02:27centers approach of discussion of
02:29discovery inspiring care that led to the
02:32establishment of the Viola W Bernard Fund.
02:34With their support, we founded the Viola
02:37Bernard Prize for Social Innovation
02:39in mental healthcare delivery,
02:41in which we asked our community to innovate
02:43while incorporating the principles of
02:45design justice which seeks to center
02:47the voices of those who are served.
02:50We awarded the first prize
02:52this year to Carla.
02:53Karen and a smaller prize to
02:55Dakota Becker for their portion
02:57for the portion of her design.
02:59Excuse me,
03:00her project that supports design justice.
03:02We're grateful to the Viola Bernard
03:04fund for their generous support,
03:06which enhances our focus on
03:08HealthEquity and social justice.
03:09So that's a little bit about
03:11Viola Bernard and now I get to
03:12gush a little bit about
03:13Doctor Carolyn Roberts. So
03:15she's back with us today. Her
03:17last talk was very thought provoking
03:19and illuminating. And for those who
03:20are new to our center,
03:22she is an historian of medicine and science,
03:24holds a joint appointment in
03:26the Department of History and
03:28History of Science and Medicine
03:29and African American Studies.
03:31She also holds a secondary appointment
03:33at the Yale School of Medicine in
03:35the program of History of Medicine.
03:37Her research interests concerned
03:38the history of race science.
03:40Medicine in the context of slavery
03:42in the Atlantic slave trade.
03:44This includes attention to the
03:46critical role played by African and
03:47African descended medical and health
03:50knowledge in the Atlantic world.
03:52Doctor Roberts is currently
03:53working on several manuscripts
03:56on those topics, including to
03:57heal and to harm medicine,
03:59knowledge and power in
04:00the British slaves trade,
04:01which is under contract with
04:02Harvard University Press and is
04:04part of what informs today's lecture.
04:07The manuscript traces the troubling
04:08relationship between the British slave
04:10trade and the development of modern medicine.
04:12Doctor Robertson covers the stories of.
04:14Doctors, patients,
04:15apothecaries and early pharmaceutical
04:17companies involved in the brutal form
04:19of human commerce. The book vividly
04:21demonstrates how the seeds of Big Pharma,
04:24new power dynamics in the
04:25doctor patient relationship,
04:26and racial bias in medical care
04:28have roots in the slave trade.
04:30Since her last visit,
04:31she spent time visiting Ghana
04:33to study some medicinal plants
04:34to add to her manuscript,
04:36so she's an award-winning educator.
04:39She's the 2021 recipient of Yelles,
04:41prestigious Sydney Miskimmin Klaus.
04:44Prize for teaching excellence in the
04:46Humanities and her teaching Glenn's
04:48history with medical sociology and
04:50public health to explore present
04:51day crises related to race,
04:53racism and health,
04:54which I imagine would have sparked
04:56a fast and deep partnership
04:58with Doctor Bernard.
04:59Her award-winning lecture
05:01style seeks to tell the truth much in
05:04the way other atrocities such as the
05:06Holocaust and genocide are spoken of,
05:08while this can be triggering for some.
05:11Especially to people whose descendants
05:13are represented in her work.
05:14It is in service to knowing
05:16true and accurate history
05:17from which to learn from.
05:19In her talk today,
05:21we'll learn about accurate historical
05:22events that have not been altered.
05:24It is the raw truth in honor of
05:26those who have suffered and in
05:28service to building a future which
05:30those who have been marginalized and
05:32oppressed can rewrite the narrative.
05:34So without further ado, I'd love to
05:37welcome Doctor Carolyn Roberts to join us.
05:42Thank you.
05:46And so I was taught what to do
05:49with the computer at this point.
05:592.
06:05All right, technology works.
06:09So today's talk I'm going to begin with.
06:14Oh, it's so wonderful to be here in person.
06:18It's really wonderful.
06:22Yes. It's so nice.
06:25Oh, the microphone, thank you. It is.
06:28It's so nice to be here and to see all of
06:30you and feel all of you here in this space.
06:33It's very special.
06:34We still don't have as many in
06:37person events as as we might do.
06:39And so thank you all for gathering.
06:43I am going to begin.
06:49With this slide.
06:56Telling me that I'm obsessed with talking
06:59about racism in America is like telling me
07:02I'm obsessed with swimming when I'm drowning.
07:05So one of the things I really appreciate
07:09about this statement is how it gestures
07:12to very different experiences we have
07:15concerning race in the United States.
07:17So one person reading this statement
07:20might be filled with gratitude,
07:22saying thank you for naming
07:25the urgency of this topic.
07:28Yes, we are drowning in various
07:30ways in this society.
07:32But others might say, well, you are obsessed.
07:36I'm sick of hearing about racism.
07:38Give it a rest.
07:41So we have very different experiences
07:43of race and racism in this country.
07:46And I wanted to share an anecdote
07:49of something that happened.
07:51To me, just a month ago,
07:53so a month ago,
07:54I was in a small New Haven restaurant
07:56and it was the evening and I was
07:59waiting for one of my graduate students
08:02to arrive for a mentoring dinner.
08:04And as I was sitting and
08:07waiting for her to arrive,
08:08a white woman walked in and greeted
08:11her friend, who was also at a
08:14neighboring table right beside mine.
08:16And she said that she had
08:18just seen a black patient.
08:21She said.
08:22Wow.
08:23I'm sorry I'm late.
08:24I had this black patient,
08:26you know she hates white people,
08:28but not as much as some of the others.
08:31And then the two of them laughed and laughed.
08:34And what I learned,
08:36as I was still listening and waiting
08:39for my graduate student to arrive,
08:42was that this woman was a psychiatrist.
08:48I've thought about that episode
08:50quite a lot over the past month.
08:53The casual kind of racism that
08:57mocks the suffering of black people.
09:00Writing things off as just hating
09:03white people rather than listening
09:05to a vulnerable patient who's trying
09:08to articulate in a supposedly
09:11safe space the vulnerability.
09:13And trauma distress experienced.
09:17So what we believe about one another
09:20and our experiences of the world.
09:22They shape clinical diagnosis
09:24and treatment in mental health
09:27and in medicine more broadly.
09:29There is a chasm of experience in terms of
09:33how we relate to ideas of race and racism.
09:42Just last year, Doctor Amanda Calhoun,
09:44who many of you know wrote an essay
09:47in the psychiatric times about how
09:50her attending refused to acknowledge
09:53that a patient's experiences of racism
09:56contributed to a suicidal event.
09:59The traits and stereotypes that
10:01we ascribe to one another and our
10:05own experiences of the world shape
10:08clinical diagnosis and treatment,
10:10and both are filtered through the
10:13structures, institutions,
10:14values and norms of our society.
10:18Whose voices are heard and whose aren't?
10:22Who is legible and who isn't?
10:25What experiences are
10:27valuable and which are not?
10:29What clinical behaviors are acceptable?
10:33What is OK to laugh about or
10:36ignore or diminish or minimize?
10:39So the answers to all of these
10:41questions have deep historical roots.
10:43Deep historical roots.
10:44Histories that are much older
10:47and bigger than any one of us.
10:49These histories, in fact,
10:50predate the United States
10:52as an independent Republic.
10:53This is part of our medical
10:57and scientific inheritance.
10:58These are like legacies that we
11:01must reckon with deeply in order
11:03to understand how we got into the
11:07mess that we're in. Right now.
11:11So I won't be discussing
11:13this broader history today.
11:15Instead, this talk approaches these
11:17questions from a narrower perspective,
11:20looking at the intersection between
11:22race and mental health in the
11:25context of the transatlantic slave
11:28trade and its legacies today.
11:30So this is our outline.
11:33We're going to begin with an
11:34overview of the medical world
11:36of the British slave trade.
11:37For some of you who heard my previous talk,
11:40this might be a little bit familiar,
11:41but we're just going to revisit
11:43it so that we're all dealing with
11:46the same historical context.
11:47The British slave trade is also
11:50important for us today because
11:51the majority of black people that
11:53came to the United States came
11:55on board British slave ships.
11:57We're then going to look at
11:59debates over depression,
12:00and what I mean by that is the debate
12:04whether enslaved people were actually
12:07capable of suffering from depression.
12:10And lastly,
12:11we'll turn to race and mental
12:13health legacies today.
12:15And as Tara mentioned,
12:16I also want to give a word of gentle
12:20care and concern for all of us that are
12:23gathered here today in the room and on zoom.
12:29We're going to be discussing
12:31a crime against humanity.
12:33It was based in violence,
12:35dehumanization, rape,
12:38brutality.
12:39The worst of who we are as human beings.
12:47It will not be easy to listen to.
12:51For many of us, or for most of us?
12:54But I hope it will help you
12:57grasp the stakes of this history.
13:00How it influences us today
13:02and the reparative work.
13:04That we must do to heal the past.
13:28So the transatlantic slave
13:30trade was a watershed event in
13:33our collective human story.
13:35It began in 1441 with the Portuguese.
13:38It ended in 1867. It was a 426
13:43year human trafficking operation.
13:46It was the largest forced oceanic
13:50migration in human history.
13:52This was a global trade.
13:54Most of Western Europe was involved.
13:56Switzerland, Sweden, Norway,
13:58Denmark, Britain, France,
13:59the Netherlands, Germany,
14:01Denmark, Spain all were involved.
14:03This global trade and human beings
14:06provided livelihoods for many,
14:08it provided sustenance to the working poor.
14:12It helped the wealthy amass greater political
14:15and social capital that still endures today.
14:18So think of small town cod fishermen.
14:21Think about poor rural weavers in Wales.
14:25Think about copper miners
14:27in present day Slovakia,
14:29from Massachusetts to Brazil,
14:30from the Netherlands to Angola,
14:32from Gujarat and India to the small town.
14:35Of Ultimo in the Maldives island,
14:37the entire world,
14:39much of the world was swept up in
14:42this global trade in human beings.
14:44So one of the doctors that
14:46I study in the slave trade,
14:47doctor James Houston, he says this,
14:51that the slave trade is the hinge,
14:54the hinge on which all the
14:56trade of the globe moves on.
14:58Put a stop to the slave
15:00trade and all others cease,
15:02of course.
15:08So this video. Allows us to see a
15:12segment of those who were trafficked.
15:16Each dot represents one ship.
15:19Each ship represents hundreds of lives.
17:00Over 12 million African children,
17:02women and men. Were captured,
17:05chained and put on board slave ships.
17:09Where they were beaten,
17:11raped and medically abused.
17:13They were treated like human commodities.
17:16Doctors were the ones responsible
17:18for keeping them alive.
17:21They had to compel life
17:23by any means necessary.
17:25Doctor James Arnold explained that the
17:28medical world of the British slave trade
17:31is conducted on the principle of force.
17:34So on board thousands of slave ships,
17:36doctors whipped enslaved
17:38Africans who refused to eat,
17:40lacerating their flesh in order
17:42to preserve them for sale.
17:44They had the speculum oris,
17:46which you see in this image here.
17:48They had thumb screws, they bolus knives.
17:51They were used to force feed the enslaved,
17:53which broke off their teeth in the process.
17:56Doctors had a pharmaceutical arsenal.
17:58They drove medicine down the
18:00throats of enslaved Africans.
18:01They drained their blood.
18:03They plunged metal pipes into their
18:06rectums to administer enemas.
18:09Mariners pinned them down with whips
18:12and pistols nearby to force compliance.
18:16During the course of an illness,
18:17some medical providers whipped, punched,
18:20kicked and cursed the enslaved when
18:22they were on the brink of death,
18:24mourning the loss of their prophets.
18:27Thomas Aubrey,
18:28in his slave trade manual,
18:30recounted that six slaves were kicked,
18:33punched and beaten so much during
18:36their illnesses.
18:37That some of them.
18:39He says quote would creep under
18:42one of the platforms.
18:44And hide themselves and die there.
18:49With some quiet,
18:50with some peace.
18:55Thomas Clarkson, who was pictured here,
18:58was an abolitionist who gathered
19:00evidence all across the British
19:02Isles to help end the slave trade.
19:04And one Carpenter told him
19:06anonymously for fear of reprisal.
19:08A lot of these testimonies were
19:10anonymous because it was dangerous
19:13to testify against this traffic.
19:15The slaves and the sick birth are
19:18suffered to die in their own filth and
19:21are then thrown overboard like dogs.
19:23If they refuse the medicines
19:25that are offered them,
19:26they're beaten with a cat,
19:27the cat and nine tails.
19:28Their jaws forced open,
19:30the medicines poured forcibly
19:32down their throats.
19:37Many in the African diaspora have
19:41adopted a Kiswahili word mafia.
19:43To describe this 400 year long devastation.
19:48Muffa is the great disaster.
19:51The great suffering,
19:53the great catastrophe.
19:55And so this image of.
19:58People of color dressed in white,
20:00standing at the beach at the waterside.
20:03With candles and hands to remember
20:06and honor this living history.
20:08The ocean is a witness,
20:11a crime scene, a graveyard.
20:13Holding the remains of the
20:16millions who were tossed overboard.
20:18Or those who leapt into the cold,
20:20rushing waters of the Atlantic
20:22Ocean to escape the living
20:25death of human *******.
20:36There is an important aspect of this history.
20:39That we're going to be thinking about today.
20:41Which hasn't been studied.
20:44With any real depth.
20:46And that has to do with mental health.
20:53How did the slave trade and the doctors
20:56who participated in the slave trade?
20:58Produce harmful ideas about
21:00black people's mental health.
21:02How did those remain with us today?
21:06But this story is not only a story of harm,
21:09although it is a story of grave harm.
21:12It is also a story of hope.
21:15Because we have some doctors.
21:19Very few but a few doctors who spoke out
21:22vigorously against the racialization
21:24of mental health that was beginning to
21:27happen in this particular moment and so.
21:30As a kind of side note.
21:33I want to point out something that
21:36I think always needs to be said
21:38when we think about history and
21:40the historical wrongs of the past.
21:43And that is.
21:44For many of us, we like to take comfort.
21:49In the idea that the people in the
21:51past that have done past wrongs that
21:53they simply didn't know any better.
21:58We take comfort in imagining ignorance.
22:03But I can tell you as a historian,
22:06based on the archival evidence,
22:07the documentary evidence that exists
22:09at every single point in all of
22:12these histories, there have always
22:14been people who said this is wrong.
22:19This is wrong. This is wrong.
22:25And so some of these doctors are among them.
22:29We have to hold the past accountable.
22:34Even though at the same time,
22:36we know that the way we think about
22:39the world is different. Right.
22:41We encounter things in a different way today,
22:44but that doesn't mean that people
22:46in the past were not aware.
22:48And fought that.
22:50Rounding up millions of people,
22:53treating them like animals.
22:55Abusing them in these ways.
22:59That that wasn't wrong. Right.
23:03We live in societies today that we're.
23:07There's a lot that is wrong, right?
23:11There's a lot that's wrong.
23:16But we can't expect people in the
23:19future to look back at us and say,
23:21oh, they just didn't know because
23:23we know we see it, right? We see it.
23:25It's our relationship to what it
23:27is that we see that either makes it
23:30into the historical record or not.
23:46Beginning in the 1780s.
23:48The British Parliament began
23:51investigating the slave trade.
23:53They held hearings,
23:54they questioned witnesses and
23:56they gathered intelligence.
23:58One of the individuals who
24:00testified was Doctor Isaac Wilson.
24:02He was a 25 year old Doctor Who
24:05had recently served as master
24:06surgeon on the slave ship Elizabeth.
24:09He was trained in medicine
24:10at Trinity College, Dublin,
24:12at Edinburgh and at Glasgow.
24:14When Isaac Wilson testified
24:16before the Select Committee,
24:18he described the plight of enslaved Africans.
24:22There were 602 children,
24:25women and men on board the Elizabeth.
24:30He immediately noticed that the
24:32majority showed signs of melancholia.
24:34Which presented as depressed
24:37spirits and despondency.
24:39Wilson determined that Melancholia
24:41was due quote to their taking
24:44their situation so much to heart.
24:48Taking their situation so much to heart.
24:53Wilson determined that.
24:56The evidence was incontrovertible.
24:59The enslaved attempted a revolt
25:01while the ship lay in the bite of
25:04Biafra in present day Nigeria.
25:06During the transatlantic passage,
25:085 suicides occurred.
25:092 women hung themselves in the night.
25:12One man jumped overboard.
25:15And he exalted,
25:17Wilson says as he drowned.
25:19One man starved himself to death.
25:22Another man jumped overboard,
25:23was picked up in the water while
25:25he was still alive,
25:26and then died soon after.
25:30149 additional enslaved children,
25:32women and men died on the Elizabeth
25:36and Wilson said they died from
25:39a melancholia induced dysentery.
25:45So, Doctor Isaac Wilson.
25:49When he was in Parliament.
25:52He was asked what was the general
25:55appearance of the slaves when
25:56brought on board the vessel,
25:58and he said a gloomy pensiveness
26:01seemed to overcast their countenance.
26:04He was asked by another Member of Parliament,
26:06did this appearance of melancholy continue?
26:09And he answers yes, in a great many.
26:14Of the 155 who died on board your ship.
26:20Was there, in your opinion,
26:22a considerable proportion,
26:23the primary cause of whose disorders
26:26and death might be reasonably
26:28deemed to be this melancholy?
26:30And he answers, yes, I am in the opinion.
26:33In the proportion of two to one.
26:38Then he's asked,
26:39did you hear the slaves say anything which
26:41confirmed the opinion of their melancholy?
26:44And Wilson responds,
26:45I heard them say in their
26:48language that they wished to die.
26:50I heard them say in their
26:52language they wished to die.
26:59But it didn't end there.
27:01Members of Parliament pressed Wilson
27:04further to explain his diagnosis.
27:06And so there is another question.
27:09Do you as a professional man conceive that
27:11the grief or melancholy which you have
27:14described to have existed among the enslaved
27:16in the ship you were you were surgeon of,
27:19was the cause of the fatal dysentery
27:21which carried off so many of them?
27:23So you can hear there repeating
27:25their questions over and over again.
27:27And Wilson answers, I believe,
27:29that the melancholy and pensiveness of the
27:32enslaved were reasons why they would not eat.
27:35They became weak and debilitated
27:37and incapable of digesting
27:39the food allotted for them.
27:41The consequences were bellyache
27:44and dysentery generally ensued.
27:46And so this was Wilson's opinion as a doctor.
27:51And the medical theories of the
27:54time supported this diagnosis.
27:56The idea that emotions could destroy
27:59one's health was widely believed.
28:01And a good example is William Buchan.
28:03And pictured here is the cover
28:06of domestic medicine,
28:07which wasn't one of the most widely published
28:11medical texts in the 18th and 19th centuries.
28:15And, Buchanan writes, grief is the
28:17most destructive of all the passions.
28:20It's effects are permanent,
28:22and when it sinks deep into the
28:24mind it generally proves fatal.
28:26Anger and fear,
28:27being of a more violent nature,
28:30seldom lasts long.
28:31But grief often changes into a fixed
28:35melancholy which preys upon the
28:38spirits and waste the Constitution.
28:41So this was the general understanding
28:44of the time,
28:45the powerful intersection between the body
28:47and the mind in terms of causing disease.
28:51And it wasn't just text like this
28:53which were meant for lay audiences
28:55and lay medical texts were very
28:57popular during this period of time,
28:59but it also appeared in.
29:02Published medical text for
29:05doctors like Wilson.
29:06So this is James Gregory who was a famous
29:11Scottish Scottish medical practitioner,
29:13came from a very famous medical
29:17dynasty of the Gregory's.
29:19He was a professor at the
29:21University of Edinburgh.
29:22And he published his lectures
29:24in this particular document.
29:26Isaac Wilson would have studied
29:28with Gregory at Edinburgh.
29:32And Gregory wrote at length about grief
29:36and fear, that it depresses the spirits,
29:38debilitates the whole person,
29:40disqualifies them for all the vital natural
29:44or animal functions whence proceed lingering
29:47illness and often incurable diseases.
29:50So this powerful relationship,
29:52these doctors, these medical students,
29:54are learning about how important it
29:57is to understand the mental state
30:00of a person in terms of disease.
30:03But unfortunately,
30:04Wilson back in the committee room
30:06in front of the British Parliament.
30:09Unfortunately, he was not believed.
30:13Despite all of this,
30:14despite all of this,
30:15he wasn't believed.
30:16He was met with hostile resistance
30:18at one point.
30:19He leaves the room outraged because
30:22they keep probing at him and forcing
30:25him to speak more about Melancholia.
30:28Prove to us that it's melancholia.
30:31The parliamentary committee
30:33actually pushed Wilson to consider
30:36his diagnosis of melancholia as
30:39being a mistake for seasickness.
30:41So this is how the discussion
30:43went in the committee room.
30:45So, Wilson was asked,
30:47did not the seasickness have
30:49an apparent effect on them?
30:51Wilson answered.
30:52Not particularly so while I was in
30:55the harbor that I could perceive.
30:58So, he was then asked,
30:59are some of the symptoms which
31:01you have alluded to,
31:02such as refusing their food,
31:04not in a great measure owing
31:07to the sea sickness?
31:08And Wilson responded.
31:09For the first three or
31:11four days we were at sea,
31:13we expected that the sickness
31:15might prevent them from eating,
31:17but that could not be generally
31:19said to be of a long duration.
31:21He was asked again,
31:23were those symptoms in
31:25consequence of the sea sickness?
31:27Wilson responds.
31:28Again, I've already answered that
31:30question in my former answer.
31:32Again,
31:33he is asked,
31:34did not those symptoms which you
31:37have mentioned go off in proportion
31:40as the sea sickness went off?
31:43Wilson replied.
31:44I cannot think they did,
31:46many still continuing ill,
31:48whose primary cause of illness
31:50I conceive was not seasickness.
31:53So what's going on in this moment?
31:57Seasickness. For those Members in
32:00the committee room believe is a more
32:04legible explanation of what was
32:06going on for the enslaved people.
32:11So what's at issue here?
32:14Are Africans physiologically capable of
32:17suffering and dying from depression?
32:22At issue in this debate
32:24was the nervous system.
32:26The nervous system was becoming racialized.
32:29Knowledge of anatomy began to
32:31change during this period.
32:33So prior to all of the developments
32:36and neuroanatomy and neurophysiology
32:37that began during the 18th century,
32:40people's understanding of the
32:42body was largely cardio centric,
32:44and it was because of William Harvey's
32:46discovery of the circulation of
32:47the blood and of pulmonary transit.
32:50All of a sudden we begin to
32:54think about neurology.
32:55We begin to think about neuroanatomy,
32:58neurophysiology.
32:59The body becomes an
33:02encephalocele centric entity.
33:04We begin to think in this period
33:06of time about how feelings exist,
33:09not only through brains and and nerves.
33:13But also how those feelings
33:16transmit into the larger society.
33:19People begin to think that there must
33:21be innate differences in what they
33:24called sensibility or in the capacity
33:26for feeling among different people
33:28and among whites and blacks in particular.
33:32So ideas about black inferiority are
33:36now penetrating beneath skin color
33:38and hair texture into the brains and nerves.
33:44And so we had many prominent thinkers at
33:46the time who contributed to these ideas.
33:48You can see the first quote is by Adam Smith,
33:50the very well known economist
33:53and moral philosopher,
33:54saying that hardiness is the character
33:57most suitable to the circumstances
33:59of a savage sensibility to those who
34:01live in a very civilized society.
34:04We have Benjamin Rush,
34:05who's of course a May very important
34:08individual in the United States,
34:10is the most famous doctor in the
34:12early American, early American.
34:14Edison.
34:14He wrote the first psychiatric
34:16textbook in the United States.
34:19He was the first chemistry
34:20professor in the United States.
34:22He was also a very important abolitionist.
34:26Who believed African insensibility
34:28to the ties of nature,
34:31friendship, and gratitude.
34:32And, of course,
34:33we have Thomas Jefferson's famous notes
34:36on the state of Virginia in 1785.
34:39Their griefs are transient.
34:42Their griefs are transient.
34:46In the parliamentary inquiry
34:48into the slave trade,
34:50the British Parliament.
34:52Sought evidence about the feeling
34:55capacities of African people.
34:58The House of Commons was preoccupied with
35:01this particular question for over 20 years,
35:04and they began to gather evidence.
35:07So these were the kinds of questions
35:09that were asked to witnesses.
35:11Are the natural and social
35:13affections as strong as in the
35:15inhabitants of other countries?
35:17Are they meaning Africans,
35:18more or less attached to their wives,
35:20families and relations
35:22than the Europeans are?
35:24Do you think their affection for their
35:26families is as strong as it is in Europeans?
35:30All of these questions were asked and
35:32when you read the parliamentary evidence,
35:34almost every witness is asked
35:36to comment on this.
35:37So there is a lot of documentation
35:41on these answers,
35:42some of them a slave ship captain
35:46saying here paternal affection
35:48and filial love scarcely exists.
35:51A former governor of Cape Coast
35:54Castle in present day Ghana.
35:56I do not believe affection is very
35:59predominant in the breast of Africans,
36:01a commander in the East India
36:03Company who testified about
36:04African people.
36:05The affection of those persons,
36:07from my own observations,
36:09are by no means so strong,
36:11one slave trader said.
36:13By no means I do not apprehend.
36:17They have any such fine feelings.
36:21And even doctors weighed in and
36:23testified to this captain John Knox.
36:26Was a slave ship captain who previously
36:30served as a doctor on in the slave
36:33trade and he was part of this exchange.
36:36He was asked by a Member of Parliament,
36:38did the slaves taken by you express
36:40an anxiety to be taken away?
36:43Did they express an anxiety to be taken away?
36:47He responds.
36:48Apparently they were very
36:50indifferent as to their fate.
36:52He's asked,
36:53have you understood that the complaints of
36:55the enslaved whom you have attended when ill,
36:58have arisen from bodily disorders
37:01or uneasiness of mind?
37:04Bodily disorders or uneasiness of mind?
37:06Right.
37:07See snakes, seasickness, melancholia.
37:10He answers by every symptom
37:12which they discovered.
37:13I've always understood their
37:15complaints proceeded from the body.
37:18So according to Knox,
37:20who trafficked thousands
37:21of enslaved Africans.
37:23They were indifferent to being
37:25captured and trafficked.
37:26Grief and anxiety,
37:27he claims, are not present.
37:29The diseases which they're suffering from
37:32are not ideologically connected with sadness,
37:35grief,
37:36despair or loss.
37:38So the majority of slave trade defenders
37:42described African people as cheerful.
37:45As lacking any longing for home.
37:48Arguing that they are perfectly
37:51satisfied in their condition,
37:53witness after witness
37:54testified before the British
37:55parliament on this very point.
38:01John Newton, who some of you may have
38:04heard of who was a slave trader,
38:06famous slave trader turned abolitionist,
38:08and he's credited with
38:10writing the him Amazing Grace.
38:12So John Newton was even asked
38:16whether African women suffered.
38:18When they were raped on board ship.
38:27His response was.
38:32They did suffer.
38:34When sexually assaulted. If.
38:39We allow the enslaved women.
38:42To have any degree of sentiment. If.
38:48If we acknowledge their feelings,
38:51if we grant them the capacity to suffer.
38:55To feel grief.
38:57To feel lost and love.
39:00If we grant them humanity,
39:03if we allow them to exist not
39:05only as human in outward form.
39:10But inwardly. Through their
39:13feelings and sensations if. If.
39:17If it was an open question.
39:23There weren't many doctors like Isaac Wilson.
39:27Who tried to do this arguing?
39:30In fact, only four doctors
39:32testified on behalf of abolition.
39:36Despite the thousands.
39:38Available who could have many
39:40doctors and Thomas Trotter who
39:42are going to hear from next.
39:43Many doctors, including Thomas Trotter,
39:45said that a lot of the doctors
39:50believed in the slave trade.
39:52They supported the slave trade. Umm.
39:58So Thomas Trotter.
40:02He did make an argument that
40:04Africans could feel deeply.
40:06And that they were physiologically
40:08capable of suffering from depression.
40:11And as proof, Trotter describes
40:13a collective dream that the
40:15enslaved had on board his vessel.
40:19So he talks about how. Umm. At night.
40:26At one point during the night.
40:29Every night. All of a sudden.
40:33He hears the enslaved screaming.
40:36And yelling.
40:38So there's an interpreter on board.
40:42And he asked the interpreter to find out.
40:45Can you find out anything about what's
40:47going on at this particular moment?
40:49And what the interpreter comes
40:52back to him and says is that.
40:55They go to sleep.
40:56And they have a collective dream.
41:00That they're back home in Africa.
41:04And one by one, they all wake up.
41:07Realizing that they are on a slave ship.
41:13Now for Trotter.
41:17He believes that this proves.
41:20The perfection.
41:22Of their feelings and sensations.
41:26It proves they can feel.
41:30Right, so an experience
41:32of horror unimaginable.
41:34Unimaginable horror, is the proof.
41:40Is the proof that they feel.
41:46Think about that.
41:50That we need to prove.
41:54Feelings. And it's only through.
41:58Acts of incredible cruelty and violence.
42:03That one person that a few doctors
42:05are able to say? Oh yes. They do feel.
42:11So is the slave trade and dividing
42:14families more like dividing a
42:16litter for sale or you dividing
42:18people who love one another?
42:22When the people are taken
42:25from from the African coast.
42:28Do we imagine that families are left behind,
42:30that hundreds and hundreds and
42:32thousands of families are left behind,
42:34mourning and in loss over their loved ones?
42:40Isaac Wilson.
42:41In another part of his testimony,
42:43in order to also prove this point,
42:45he says that there was
42:47a brother and a sister.
42:50On the slave ship.
42:52And when they realized they
42:53were both on the slave ship,
42:55because these ships are very big,
42:56you heard there's over
42:57600 people on this ship.
42:58When they realized that they were to,
43:00that they were on the same same slave ship,
43:02they ran into each other and he talks
43:04about how they embraced one another.
43:07And then he talks about how the
43:09brother died from melancholy.
43:11He died from depression.
43:13And he tells the parliamentary committee
43:15every day the sister went to the brother.
43:18And try to care for him and try to help him.
43:21But he still died.
43:25And so this idea of proof this idea
43:28of proof, and I know that we are.
43:31Um, coming up on time and I only
43:35want to spend another few minutes.
43:38Speaking so that we can
43:40have time for questions.
43:48So we're going to move on to Part 3.
44:00In some ways this image sort of.
44:03Expresses how I feel.
44:09And I still haven't really decided
44:11how I wanted to end this talk.
44:16We could talk about statistics of the under
44:19diagnosis of depression in black people.
44:23We could talk about how mental healthcare
44:25continued to be racialized from when we
44:28get to the period of American slavery.
44:33Think about a doctor like Doctor
44:35Samuel Cartwright, who was an
44:37apprentice to Benjamin Rush.
44:41Doctor Cartwright, who believed that
44:43black people were naturally slaves.
44:45He believed their knees were more pliable.
44:48And so if they ran away,
44:49it would be considered a mental illness.
44:51So he concocted a mental
44:53illness called Drapetomania,
44:54which is called the running away disease.
44:56This lasted in psychiatric
44:58textbooks into the 20th century.
45:02We could talk about the 1840 census
45:05that was taken in the United
45:07States before the Civil War,
45:09which claimed that black
45:10people in the northern states,
45:12where there was gradual emancipation,
45:14were all insane.
45:17Using new statistical data,
45:19which black scientists at
45:21the time disputed and said,
45:24you're saying they're more inclined,
45:25insane people in Maine,
45:26which is more than the
45:28entire population of Maine.
45:29I mean, this was fudging
45:32numbers in a huge way.
45:34Right.
45:34We can talk about the racialization
45:37of a disease like schizophrenia
45:39that happens during the 1960s,
45:42changing from a disease of of of white
45:46people to a disease of aggressive
45:49black men because of the social
45:52protest movements and the desire
45:54to pathologize those behaviors.
45:57We can talk still about, you know,
46:00that that example that Doctor
46:02Calhoun mentioned in her article.
46:05A black patient,
46:06a young black girl who commit,
46:08tries to commit suicide.
46:11Because of racism.
46:15There's so many different places we can go.
46:18With this history.
46:22But the place that I feel I most want
46:26to go with this history. Has to do with.
46:31How we relate to one another?
46:37In our suffering.
46:41In our distress.
46:45Here. You are all in
46:49various ways involved in.
46:51With people who are going to
46:54be suffering, who come to you
46:56because they are suffering.
47:03And yet, what is the kind of disjunction?
47:08That we often feel. That sense of
47:11distance, the lack of legibility.
47:18You know when. One of the things that
47:21always that always gets me when there is
47:24a police violence against black people.
47:29When I see the news reports and you see
47:33the suffering of the family and you see.
47:38The dead individual.
47:42The thing that always gets me.
47:47Is why? When we see that suffering,
47:52we see that mother crying.
47:54We see those family members and
47:56those sisters and brothers and aunts
47:58and uncles and community members.
48:00Why isn't our heart just breaking?
48:06But we have this kind of
48:09distance to the suffering,
48:11to the suffering of others in various ways.
48:14I remember hearing years ago about.
48:18If Arab women only loved their
48:21children as much as white people.
48:24They wouldn't let their
48:26children be suicide bombers.
48:27We judge the feeling capacities
48:30of other people so much more
48:33than I think we realize.
48:39When I meet people who are doing
48:42residencies in OB GYN and they talk about
48:46racism against black pregnant women,
48:50thinking, Oh well, this child,
48:52I don't even know why she's
48:53bothering to have this child.
48:54It's just going to end up in jail or dead.
49:01The feeling capacities of
49:03black people. And our societies
49:06relationship to what those are.
49:15A black scholar called Monica
49:17Coleman wrote the following.
49:21When I was growing up,
49:23no one in my family used the word depression.
49:27No one used the term mental illness.
49:29They called it grief.
49:31They called it grief when melancholy took
49:34up residence in my grandmother's face.
49:37They called it grief when my great
49:40grandfather asked his children to help him
49:42hang the noose that would end his life.
49:45They called it grief when my grandmother
49:47smoked and drank to ease the pain
49:50of losing his friends and battle.
49:52My family knew mental illness.
49:55But they treated it like it
49:57was a normal part of life.
49:59Because it was.
50:02If you survive slavery like the old preacher
50:04who raised my grandmother and her siblings,
50:07is emotional balance of possibility.
50:10When your fingers are bleeding from
50:13picking cotton and cutting tobacco.
50:15Do you think you should stop and take a deep
50:18breath before moving on to the next task?
50:21If you manage to get out of the Jim Crow S.
50:25To find the newer,
50:26subtler forms of racism in the north.
50:30Do you think about preserving your sanity?
50:34End Quote.
50:38Some of us live with the
50:40structures of racism, colonialism,
50:41slavery and slave trading as part
50:45of our family histories and as
50:48part of our lived experience.
50:51We walk about in the world marked.
50:55Our identities are frequently
50:57seen as a problem or a question,
51:00or an accusation or suspicion.
51:04We live with different expectations
51:06thrust upon us in the workplace.
51:08We have to prove our humanity, our equality,
51:12our goodness, our deservedness.
51:15With regularity.
51:18Although we are at the bottom of
51:20America's racial caste hierarchy,
51:22no matter how far we advance.
51:25We can be called the N word on a dime.
51:28We are more likely to be
51:30misdiagnosed by our doctors.
51:31We're more likely to suffer the
51:34chronic stress of racism as
51:36our bodies wither and weather.
51:38Yet despite it all.
51:41Despite it all.
51:44We seek to endure.
51:48Thank you all so much for
51:51spending this time with me.
52:07Thank you, Carolyn.
52:09Always need a minute after
52:12they're all of what you share.
52:15I don't know. Let's take a moment.
52:18Anybody has questions now we
52:20are Doctor Robertson staying
52:21with us for a little longer,
52:23so we'll also leave the zoom on in case
52:26people have other questions to ask.
52:28But I wondered if anybody had
52:29anything they were curious about.
52:36I know I have a question.
52:38So in your research you, you know,
52:41you've looked through this exchange through
52:44Parliament and could kind of trace what
52:47the impact has been throughout time.
52:49What do you hypothesize could have happened,
52:52could have been different if they
52:56listened to his diagnosis of melancholia?
53:00That's such a very good. Question.
53:03And one of the things I love about this
53:06question is because it allows us to
53:09think about the larger structures that
53:11are in place for needing the delay,
53:14the diagnosis of seasickness.
53:16So what would have happened if all of
53:20a sudden we believed that black people
53:23were suffering from this treatment?
53:26What are the ramifications of that?
53:30You would have had to. Get rid of slavery.
53:35You would have had to end the illegal
53:38part of the transatlantic slave trade.
53:41You wouldn't have had Jim Crow. Right.
53:44All of these structures which are meant
53:48to repress and harm and dehumanize.
53:50Would have been able to be
53:54understood in different ways.
53:57You know, David Blight,
53:58who's a historian here at Yale and he
54:01works on the period of 19th century,
54:05so antebellum S slavery in antebellum South.
54:08And he explains how lucrative slavery
54:11was for the South that enslaved people
54:16at the time of the Civil war were were
54:19the equivalent of over 80 billion
54:22with a B dollars they were worth.
54:26More than all of the other industries,
54:29railroads and everything else combined.
54:33Right. And so.
54:36What is it about needing?
54:40These particular kinds of diagnosis,
54:42which are much more than diagnosis,
54:43is sort of mentioned.
54:45We think about something like
54:47schizophrenia and it's racialization.
54:48We think about drapetomania,
54:50the running away disease.
54:51In a time when people are thinking about
54:54abolishing slavery in the United States.
54:56Diagnosis are never just diagnosis.
54:58In a lot of ways,
54:59they have these broader social,
55:01political,
55:02economic and cultural implications.
55:07Sure, yeah. Yes.
55:25So lots of comments and thank yous and.
55:30Acknowledgement that
55:31it's challenging to hear,
55:34but also incredibly important.
55:37You know these comments questions.
55:41So from Doctor Emmett.
55:44Doctor Emmons.
55:46Are there sensibility or
55:48attitude scales that conditions can complete?
55:55In in terms of could you,
55:58could you say the first part of
55:59that question again the question is
56:01are there sensibility or attitude
56:02scales that clinicians can complete.
56:06So I imagine maybe we're,
56:08are we talking about like the implicit,
56:11the implicit bias test or are we
56:14talking about something else,
56:16it sounds more explicit,
56:18more explicit explicit attitudes.
56:21Ohh, this is a good question.
56:26Yeah, I I mean,
56:28I'm most familiar with the implicit,
56:31the implicit bias test, the IAT,
56:34which now has, you know,
56:36not only things about race,
56:38but things about body size and gender
56:41identity and and a lot of a lot of
56:45different metrics that it looks at.
56:47But in terms of explicit,
56:49Umm, I'm not familiar with,
56:53you know,
56:54I what I've read in some of the literature.
56:57More specific tasks given for specific
56:59studies that are being conducted,
57:02but I don't know how widespread
57:04some of those are.
57:11Amanda Calhoun has a question.
57:15Amazing, amazing talk as always.
57:20I feel all the feels always by
57:22listening to what you're what
57:24you're saying and I'm just very,
57:26very grateful for your presence
57:28here and just in our university.
57:35I'm getting emotional, but I feel like,
57:38you know, so much of what you're saying is
57:41happening today, and I think
57:43it's important, you know,
57:44especially what you said about people.
57:48You know, always sort of leaning
57:50to the comfort of that people are
57:52ignorant or they don't know any better.
57:54And I still hear this talk today.
57:58You know, I have spoken out many
58:01times about racist treatment that
58:03I've witnessed towards black children,
58:05and that's often the response that I get.
58:09You know, they don't know any better.
58:12They didn't mean it that way.
58:14Meanwhile, black children
58:16continue to be harmed.
58:17Brown children continue to be harmed
58:20and I think it's really important for
58:23people to understand exactly what you
58:25said is that there are always people
58:27around who are saying this is wrong.
58:29We need to look at this closer.
58:32There are better ways to manage this.
58:34We need to start auditing people.
58:36We need to start looking at language
58:38used towards black and brown children.
58:40And I think.
58:42Speaking as a person who's always focal.
58:45There needs to be a lot more
58:47accountability taken because right now
58:49I very much feel that racist people
58:53are protected in the medical system.
58:56It's thought, oh,
58:57you went into the medical system,
58:58you care about everyone, but.
59:00If you're listening to what
59:02you're telling us,
59:03there have always been people in the
59:05medical system and outside of it who
59:07do not care about everyone equally.
59:09So I think it's so important to
59:11think about and we've talked about
59:13this and I guess my question
59:14for you would be how do we
59:18mobilize this, you know,
59:19how do we take this and actually
59:21put it into action to hold people
59:24accountable today, you know, the, the,
59:27the, you know the thing that I talked
59:29about where the attending, right?
59:31You're at Yale, completely dismissed
59:33me and the patient when I said
59:35I think this black girl.
59:37In fact, I don't think I know
59:39because she told me. That
59:41she attempted suicide because of
59:43the racism she's experiencing.
59:44We need to talk about
59:45that. And the attending looked at me
59:47and said no, racism isn't a factor here.
59:53And not attending had no there was
59:56no accountability for that you know
59:59and and I was just
01:00:01a trainee. I still am you know and
01:00:03I didn't feel like I could speak out
01:00:05against that attending not specifically
01:00:07which is why I wrote about it you know.
01:00:09So I guess my question is how
01:00:11do we hold people accountable
01:00:13and when I say people I mean
01:00:16all of us how do we hold, how do
01:00:18we make it so that we're not continuing
01:00:20this system where anti blackness.
01:00:23Is baked into the very treatment of patients.
01:00:28Yeah, it's such, it is what,
01:00:30like the billion dollar question,
01:00:33you know, I work, we think about this.
01:00:36I think about this question a lot
01:00:38with the undergraduates that I teach,
01:00:40with the medical school
01:00:41students I teach and others.
01:00:45You know, holding people accountable.
01:00:48In some ways has to have an an
01:00:54institutional and a structural form to it.
01:00:58I did hear and you know the School
01:01:02of Medicine, you know they're,
01:01:04they're like a lot of silos
01:01:05in in the School of Medicine.
01:01:07I know that from one doctor,
01:01:10one clinician that I spoke to recently
01:01:13said that for example the experience that
01:01:16that you Amanda had with that attending.
01:01:20In some departments now there is a place
01:01:24that you can go to report them and a similar.
01:01:29This doctor was telling me a similar
01:01:32thing happened, it was reported and.
01:01:35This person got censored in a very.
01:01:40Embarrassing and difficult way
01:01:42from a professional standpoint,
01:01:44they weren't sort of like outed,
01:01:46but there was, there were letters,
01:01:48there were conversations.
01:01:49There's now something in the
01:01:51file permanently in the,
01:01:53in the work file permanently
01:01:56against this particular doctor.
01:01:58And so you know,
01:01:59so hearing about things like
01:02:01that that that they're you know,
01:02:03sort of like a punitive kind of aspect of it,
01:02:05you know is is interesting to
01:02:08think about how in the moment.
01:02:10You,
01:02:11as as a resident,
01:02:13wouldn't feel like you're just sort of
01:02:17at the whim of some of this behavior.
01:02:21Other other ideas and examples and things
01:02:24that I've been talking about with other
01:02:27people have to do with continuing education.
01:02:30That actually is that is actual education
01:02:33and that there is a way of sort of an
01:02:38implementation process like a kind of
01:02:41hands-on aspect to the implementation.
01:02:44And so when we're talking about
01:02:46when we're talking about a patient
01:02:49and practitioner encounter.
01:02:51What are the sticky places
01:02:53that are happening?
01:02:54Where is the distrust coming from?
01:02:56How is that individual actually talking
01:02:59to and embracing this individual?
01:03:02There's some really basic things that
01:03:04we are still needing to work on.
01:03:06Even eye contact, even eye contact is huge.
01:03:11And you know,
01:03:12one of the things that my partner who,
01:03:15who is African American and his
01:03:19father and grandfather were doctors.
01:03:21He grew up in hospitals and
01:03:23this was during the time when,
01:03:25you know, there was,
01:03:26it was still like basically segregated
01:03:29and he'd be going into these spaces
01:03:31and his father would get permission
01:03:33to be in that space because he
01:03:35was bringing a black patient.
01:03:37So the white doctor that comes in and
01:03:40my partner has all of these memories of
01:03:44the encounter being like this is the doctor,
01:03:48these are the patients,
01:03:49these might be the family
01:03:50members and this is.
01:03:51Where the white doctor is looking.
01:03:55And just think, you know,
01:03:57there's so there's some really basic things
01:04:00about how we interact with one another.
01:04:04That can be professionalized.
01:04:07No, I also tell this story
01:04:10about my dad's cardiologist.
01:04:14This individual, and I think this could
01:04:16be taught because he must have learned
01:04:19something so wonderful surgeon, not a person.
01:04:22Like not an interpersonal person, right?
01:04:25He's someone who you can tell he does not
01:04:27want to be having conversations with people.
01:04:29He's much more comfortable like
01:04:31going in and being a surgeon.
01:04:33But he had learned this kind of
01:04:37behavior where he comes into the room,
01:04:40he extends his hand to every single
01:04:42person that's there in the family.
01:04:44Looks every person in the eye
01:04:46refer to my dad as Doctor Roberts.
01:04:49Everything was very, you know,
01:04:51listening called me the second
01:04:53my dad was out of surgery.
01:04:56And this individual who is not someone
01:04:59who you know wants to sort of,
01:05:01he's a, you know,
01:05:02this was a shy person and someone
01:05:04who had to learn this behavior.
01:05:06So it did feel a force.
01:05:08Like it looked force, it felt force but.
01:05:11It also it made me so happy.
01:05:14I like,
01:05:15I think about this doctor a lot
01:05:17when I'm in these talks because.
01:05:19Even if it looks a little bit
01:05:21awkward and a little bit forced,
01:05:23it still engendered trust.
01:05:24So how can we figure out what is
01:05:28about training on a very human
01:05:31to human behavioral level and
01:05:33then knowledge based level,
01:05:36getting rid of the clinical
01:05:37algorithms that are race based,
01:05:39that are harming patients,
01:05:40all of these kinds of things.
01:05:42So there's multiple levels of education
01:05:45that need to happen and you know.
01:05:50Doctor Calhoun, one of the ways as well is,
01:05:55is teaching the undergraduates
01:05:57and the medical school students,
01:05:59right?
01:06:00So as I told Tara,
01:06:03we have over 500 students enrolled
01:06:05in a class that's called sickness and
01:06:08health in African American history.
01:06:10These students are going to
01:06:11be going into medicine,
01:06:12they're going into STEM fields.
01:06:13They're, they're,
01:06:14they're going to be joining the ranks.
01:06:16And so that's another way
01:06:18for us to make this change.
01:06:20Because the students at this
01:06:22point know a lot more about race,
01:06:25racism and different kinds of
01:06:28social structural forms of harm
01:06:30then the a lot of the professors.
01:06:33And so that's another another place for it.
01:06:38Thank you. And I I agree with what you're
01:06:41talking about in terms of training, right?
01:06:43And so it it's really. This is part
01:06:46of why we would like you to be here.
01:06:48And this is part of why we're so grateful
01:06:50that you're here teaching at the university.
01:06:52And then there's, there's the undergrads,
01:06:54but then there's also bringing along
01:06:56some of the folks who continue to
01:06:59practice who were trained long before.
01:07:01Yes. So. And the very fact that,
01:07:03you know, a warning or a an awareness
01:07:08about this is challenging.
01:07:10It makes me believe that many
01:07:12people avoid having this history
01:07:14taught in medical schools.
01:07:17And in clinical settings because
01:07:19of how uncomfortable it is.
01:07:21Yet it is.
01:07:25Imperative. Like there's no way around it.
01:07:27So we do have a couple of other questions.
01:07:31There's a question, so there's a,
01:07:33I think, expression of gratitude.
01:07:34Thank you so much.
01:07:35Where can we find more of the
01:07:37parliamentary conversations?
01:07:38Yes, the so if you have a login through Yale.
01:07:45You can go to the House of
01:07:48Commons parliamentary papers,
01:07:50there's it's an online database.
01:07:53When you go to the House of
01:07:55Commons parliamentary papers, HCP,
01:07:57the House of Commons parliamentary papers,
01:08:01it's all words searchable,
01:08:02which is wonderful.
01:08:04I mean, there are thousands and
01:08:06thousands of pages of these testimonies.
01:08:08There's a lot of material there.
01:08:11And you notice in one of the slides
01:08:13that is written in the the sort
01:08:15of the strange sort of script,
01:08:17but because it's word searchable,
01:08:19you can look for words like surgeon,
01:08:21you can look for doctor,
01:08:22you can look for health,
01:08:23you can look for melancholia.
01:08:25Or melancholy.
01:08:25You can look for different things
01:08:28that might direct you to exactly
01:08:30where to look in those papers,
01:08:31because there are thousands of pages.
01:08:36Couple.
01:08:42I I just want to thank you for
01:08:44this very important talk and
01:08:46this time of reflection. Umm.
01:08:48So one thing that came to mind to me is.
01:08:53I'm still trying to formulate my question,
01:08:54but even the word stigma and
01:08:57thinking of minoritized people
01:08:58and their view of mental health
01:09:01and the stigma associated with it,
01:09:04and with your talk,
01:09:05we've learned that there's
01:09:07good reason to be afraid of
01:09:09mental health professionals.
01:09:10So I'm wondering.
01:09:14How is there a different language
01:09:16that we can use or what is your
01:09:18view of stigma in the context of
01:09:21the history of mental health and
01:09:23how can we look at patients who?
01:09:26Might have stigma whether they look like us,
01:09:29don't look like us.
01:09:31How do we view stigma now that
01:09:33we understand the history and can
01:09:35understand our patients better
01:09:37and meet them where they're at?
01:09:39So I'm. I would love to hear you.
01:09:44Sort of just clarify one thing for me.
01:09:46And that has to do with.
01:09:48Are we talking about like the stigma of of?
01:09:53Having a mental illness or,
01:09:57yeah, having a mental illness.
01:10:00Going for mental health care.
01:10:02I say this as a Nigerian American.
01:10:04My family emigrated here from Nigeria.
01:10:08It's really hard to get them to understand,
01:10:10for instance,
01:10:11mental health and mental health care.
01:10:13And so this is something that's
01:10:15very passionate.
01:10:15Like I'm very passionate about.
01:10:18Improving access to mental health
01:10:20care and educating communities
01:10:23about mental health care.
01:10:25And so I have to understand the
01:10:27community that I'm trying to educate
01:10:29and the the word that we often use
01:10:31is stigma against mental healthcare.
01:10:34But I'm just wondering if there's
01:10:35another way that we can think about
01:10:37it so that we can better understand
01:10:38the people that we serve. Yeah, yeah.
01:10:40I think that's such a great question.
01:10:42It's so important.
01:10:44You know language.
01:10:46I like that you're mentioning this
01:10:48because language is so important.
01:10:50I think stigma.
01:10:54Is not a helpful word for us to have.
01:11:00The idea that some of us.
01:11:03Are going to have a certain
01:11:06amount of discomfort. And fear.
01:11:09Around what might happen to
01:11:11us in those spaces is real.
01:11:15The idea that we could encourage people.
01:11:19Who need a conversation? Right.
01:11:22They need a conversation.
01:11:25And that that conversation,
01:11:27maybe that is our version of how we're
01:11:30giving language around mental health.
01:11:33But he could help to take out that.
01:11:40This the way that there is a kind
01:11:43of there's a bigness around like
01:11:45I've got to go to therapy or have to
01:11:47find a therapist or I have to find a
01:11:50psychiatrist or I I need this help.
01:11:51It's a it's because it's part of our
01:11:54healthcare system and there's so many
01:11:56different levels and layers involved,
01:11:58even in terms of getting even in terms
01:12:02of getting your primary care doctor to
01:12:05suggest or send you to getting care.
01:12:08And I think that's one of the,
01:12:10that's one of the sticking places
01:12:12that we have with people because it
01:12:16becomes an institutionalized event.
01:12:20When it's deeply personal,
01:12:23intimate and scary.
01:12:26And So what I I guess what I would
01:12:30hope is that there would be multiple
01:12:33places around in that process
01:12:36from I feel like I need help,
01:12:39I need that conversation,
01:12:40to getting the conversation that
01:12:42all the people in between from the
01:12:45primary care Doctor Who might be
01:12:47responsible for doing a referral to
01:12:49the place where you go and walk in
01:12:52and the people who are going to be
01:12:55greeting you and again making you.
01:12:57Now, possibly feeling even worse and
01:12:59uncomfortable all along the way,
01:13:01they're all of these points where
01:13:03there are these micro moments of harm.
01:13:06They could send that person right
01:13:08back out the door.
01:13:10You know,
01:13:10and we don't often think about it in
01:13:13that sort of at that granular level,
01:13:16but I know that from myself.
01:13:18You know,
01:13:19how is that person who I'm walking into like,
01:13:23tell them I'm here for an appointment.
01:13:25How that person behaves and treats
01:13:26me is going to have a huge impact on
01:13:29my feeling of being in that space.
01:13:31And so, you know, the problem of I,
01:13:34I feel like the problem of stigma
01:13:37in some ways is built.
01:13:40Into the way our healthcare
01:13:43system works right now,
01:13:45and the only way for us to really
01:13:49think differently about it and
01:13:51make any kind of interventions
01:13:53is if we fortify that person.
01:13:56Who's going to be in those spaces?
01:13:59Fortify,
01:14:00by which I mean how can this
01:14:03person protect themself and their
01:14:05like fragile sense of Wellness?
01:14:08When they go into these spaces
01:14:10which are going to be scary
01:14:12and and potentially triggering.
01:14:14How can we do that, you know,
01:14:16and is, are there ways for us to
01:14:18help help individuals and say, OK,
01:14:20you're going to go to this place,
01:14:23you're going to like, sign in on this form?
01:14:26It might not be night.
01:14:27Night might not be comfortable.
01:14:30But all you have to do is focus on that
01:14:33form and sign your name and take a breath.
01:14:37And walk and sit down.
01:14:38What are the ways that we can help people?
01:14:42So that they're not so vulnerable
01:14:44all the time in these spaces,
01:14:47yes.
01:14:47Thank you so much for this.
01:14:51Thank you so much for your presentation.
01:14:54This has been absolutely incredible and.
01:14:58I can't thank you enough for for
01:15:01everything that you've presented here.
01:15:03I I love the questions that you showed,
01:15:07the British parliamentary questions
01:15:08and I think that showing a correlation
01:15:11between those questions and the questions
01:15:13that the things that that like that
01:15:16they're calling just spoke about how
01:15:18they're really about the same thing.
01:15:20It is very, very, very important to
01:15:22show that we're still having this same
01:15:24discussion that we've been having,
01:15:26you know. Since forever ago.
01:15:31But one thing you just hit on is
01:15:34how doctors can communicate with
01:15:36community, right?
01:15:37It's not just about being able to go in and,
01:15:41you know, take that breath and
01:15:42put your name on the paper.
01:15:44It's like, what?
01:15:46We can teach people what they can expect,
01:15:48what they should demand, right.
01:15:50The kind of respect, how they should feel
01:15:53when they go into a physicians office.
01:15:57That's really really important.
01:15:58I know as a as a child growing up,
01:16:01I I like, I'm like what what?
01:16:03What should I know?
01:16:04What should what should I expect from
01:16:07a doctor, what maybe I should walk out
01:16:10if I'm not treated in a certain way.
01:16:13That's that's education that.
01:16:16That.
01:16:17But I think that we all have a
01:16:20responsibility when talking to our families,
01:16:22our members of our Community,
01:16:24and especially physicians and whatever
01:16:26networks or whatever they're writing is like,
01:16:29you deserve to be treated a certain way.
01:16:32If you're not treated a certain way,
01:16:34then you need to go someplace else.
01:16:36And this is all part of of your your healing,
01:16:39which you can get in many different places.
01:16:41There's not only one place
01:16:42you can get that healing.
01:16:44Right,
01:16:46because even if the the the pain is here,
01:16:49you know the pain might also
01:16:51be here and they are connected.
01:16:53You don't have to take,
01:16:55you don't have to be treated in a negative
01:16:57way to to make that journey to well-being.
01:17:04Beautifully,
01:17:05beautifully put.
01:17:07Yes, yes.
01:17:08Yes.
01:17:10Yeah.
01:17:11Were there any other questions?
01:17:15Well, for those on zoom,
01:17:18we're thank you for for
01:17:19lingering and staying with us.
01:17:20We're still going to be here,
01:17:22so we'll leave it on for
01:17:22whoever would like to linger. Maybe
01:17:24has another question.
01:17:24For those in the room,
01:17:26thank you for your time.
01:17:27We also have some food.
01:17:29Feel free to linger and
01:17:30be with us here as well.
01:17:35It looks like there's another question, Jose.
01:17:39Thank you so much Doctor
01:17:41Roberts for a wonderful talk.
01:17:44I think just, I'm kind of, I guess,
01:17:45piggyback of what Doctor Calhoun said.
01:17:49Um, and also what other people
01:17:52have said. But my question
01:17:54is more along.
01:17:55You mentioned preparing
01:17:58and kind of like readying the
01:18:01troops for battle when they go
01:18:02into these places. Umm, you know,
01:18:05I think my my question is what you know?
01:18:08My, I have doubts, you know, on
01:18:10the medium, how do we
01:18:11do that? How early do we do that?
01:18:14Um, who does it, you know, where does
01:18:16it happen or is it in schools,
01:18:18you know and and I think or or is it,
01:18:19you know, on the hospital,
01:18:21you know, at home and how do we.
01:18:24Teach the right language,
01:18:28specifically to kids.
01:18:31On how to make sure
01:18:34that they are. I think you used the wonderful
01:18:37word in your in your talk which is humanized.
01:18:39And I tend to get
01:18:41emotional when I talk about this. But
01:18:42how do we make sure that you're using
01:18:45the right words so they're not,
01:18:47you know, so they're humanized and
01:18:49and they get the right treatment.
01:18:53Or care. Sorry. Yeah, no.
01:18:57I mean for those of you who
01:18:59are dealing with, you know,
01:19:01dealing with the most vulnerable,
01:19:04the children are the most vulnerable.
01:19:10You know.
01:19:11One of the things about childhood is.
01:19:15Being vulnerable to everything
01:19:17that's around you all the time,
01:19:20you're at the mercy of of everyone.
01:19:23And you know if. Like our job as
01:19:26adults in certain circumstances,
01:19:29as clinicians, as practitioners,
01:19:31is to sort of like set the table,
01:19:35set the table for so they can
01:19:38sit down and feel welcomed.
01:19:40And feel cared for.
01:19:44How do we teach?
01:19:46How do we teach love?
01:19:49How do we teach humility?
01:19:52In the clinical setting?
01:19:55How do we make ourselves smaller?
01:19:59So that that little person can be bigger.
01:20:02Have that bigger voice
01:20:04that they need to have.
01:20:07Without us having the kind of judgmental or,
01:20:11you know, reaction to things to listen.
01:20:15A lot of the things that we've,
01:20:17we've been talking about.
01:20:19In some ways,
01:20:20like your question,
01:20:23Jose is so important and impossible.
01:20:27Because one of the things
01:20:29that we're talking about.
01:20:30Is being human.
01:20:34In a particular way.
01:20:39To have empathy. To know and see
01:20:43that every person who you meet has
01:20:46a story that will stop your heart.
01:20:50And that we need to create a space that
01:20:53we can hear that story. And make it OK.
01:20:59Who should be talking to these young ones
01:21:03about what to expect in these spaces?
01:21:06You know, in some ways the these kinds of
01:21:09things are very individualized depending
01:21:11on the support structures that are
01:21:14around that child and that young person.
01:21:16And so I think that we do have to
01:21:19have an individualized approach
01:21:20to thinking about these things.
01:21:23Patient advocacy.
01:21:24How we advocate for ourselves in.
01:21:28Clinical settings is a huge issue.
01:21:32Whether we leave right when we're
01:21:35we're treated poorly.
01:21:37How do we advise people?
01:21:39There's a public health as a public
01:21:42health sort of program that I
01:21:44started at the Wilson Public Library,
01:21:47and it's with individuals in the
01:21:49community and we have these listening
01:21:52sessions and conversations on health
01:21:54questions that they're interested in.
01:21:56And one of the most frequent things that
01:21:59they ask about is like what how do,
01:22:01how should I be in the doctor's office
01:22:03so that I'm. Actually listen to.
01:22:04And they want to know this.
01:22:07And I have a clinician who partners
01:22:08with me and helps give advice,
01:22:10but still time and again,
01:22:12it's just not quite enough because
01:22:15you don't know who's going to be
01:22:17on the other side of that strategy
01:22:19that you put in place.
01:22:21You know so like one of my,
01:22:23one of my colleagues who says,
01:22:25you know,
01:22:25who's a professor who says like the
01:22:29doctor just doubled the medication
01:22:31on from my elderly mother.
01:22:34And when I went to the doctor to ask
01:22:36her why she had doubled the medication,
01:22:38refused to tell him, refused to tell him.
01:22:41And so it's.
01:22:43We've got.
01:22:45We've got a system that is fundamentally
01:22:48and profoundly broken.
01:22:50And although this doesn't
01:22:51quite answer your question,
01:22:53I want to just give you this one piece of.
01:22:57Or it sort of orienting.
01:23:00Black people were kept out
01:23:03of American healthcare.
01:23:05Until a little more than 50 years ago.
01:23:09So we're actually at the beginning
01:23:13of this experiment.
01:23:15Of having black people in these spaces.
01:23:19This is a new experiment
01:23:21in American medicine.
01:23:23And so as we think about all of
01:23:26these things which are so structural
01:23:28and personal and community based,
01:23:30all of these things we need to understand,
01:23:33I think,
01:23:35the scope of the problem,
01:23:37but also where we're at in solving it.
01:23:41We are barely at the beginning of solving it.
01:23:45For all of us who are over the age of 50.
01:23:48Think about all of the people who
01:23:51were the ones keeping the black
01:23:54people out who are still around.
01:23:57For people who only experienced
01:24:00Healthcare at Home.
01:24:01Because they couldn't get to a doctor
01:24:04or hospital that would treat them.
01:24:08Think of all the people who are
01:24:10used to only being in white medical
01:24:13spaces primarily as patients, right?
01:24:15This is all very new.
01:24:17And so I think that you know a kind of
01:24:21multi modality approach to to beginning
01:24:25to make little inroads planting seeds.
01:24:29That's where we're really at in this,
01:24:32in this scenario, I think. Yeah.
01:24:36Well, thank you Doctor Roberts, and it's.
01:24:39It, it is very much a both and right.
01:24:41There's the need to build understanding
01:24:45and empathy and care as well.
01:24:48It's kind of like here at the
01:24:50CHILD Study Center we're working
01:24:51to do some of that right.
01:24:53We're working to try to help people
01:24:55think of each other and care and and
01:24:58ask the right questions and and pause
01:25:00and not assume you know the answer
01:25:02right because I think that happens in a
01:25:04lot of places and we are doing that in
01:25:07part because it's those some of those.
01:25:09People are the ones making decisions,
01:25:11right,
01:25:11and that are in enforcing the structures.
01:25:13And so it's we have some people who like
01:25:16we just have to change the structures.
01:25:17Why are we doing this on an individual level?
01:25:19It's like we actually need both
01:25:21because we need to be able to make
01:25:23those changes and shift hearts because
01:25:25those are the folks who are helping
01:25:27to enforce some of the decisions.
01:25:29And so I invite all in our community to
01:25:32join us in the different opportunities
01:25:34that we have for learning to also
01:25:37share the different opportunities for
01:25:38learning that you would like to have.
01:25:40As well.
01:25:42And know that these are this is certainly
01:25:44not the last of this type of conversation.
01:25:47I don't know. Are there other
01:25:48questions in the room?
01:25:51So I am again so grateful to have
01:25:54you with us and and thank you for
01:25:56sharing this extra time with us and
01:25:58we hope you'll eat some food and
01:25:59linger with us a little bit in here.
01:26:01And thank you all for making
01:26:02the time and those on zoom.
01:26:04Thank you for your questions and your
01:26:06contributions to our center and everything.
01:26:08And and to everyone please enjoy
01:26:10your holiday break and know that
01:26:13there are ongoing opportunities
01:26:14here as well for you to continue
01:26:16to learn and develop in that care,
01:26:20empathy and change so.
01:26:23Thank you.