After Charlottesville: What are physicians responsible for?

White nationalists and neo-Nazis marched through Charlottesville, President Trump addressed the nation in what should have been a straightforward call for unity against racism and bigotry. Instead, he left us perplexed, wondering if he had just insinuated anti-racist counter-demonstrators were to blame for the violence that ensued. Trump then made explicit his intentions by attempting to spin an argument of moral equivalence between white supremacists and racial justice advocates. He stated that he saw “fine people” in the images of angry, torch-wielding, White men storming a Southern college campus bearing the banners of slavery and genocide. He did not mention by-name Heather Heyer, the 32-year-old woman murdered by a white nationalist as he drove his car into a crowd of counter-demonstrators.

Reaction from members of Congress and the media was swift. However, one constituency has remained largely silent: America’s medical doctors. For psychiatrists like myself, we see patients every day who are struggling to cope with the sequelae of social injustice, from racism to homophobia to misogyny. This hate often manifests in words but sometimes breaks-through into violence. Mr. Trump clearly does not recognize the power of words to incite violence and inflict harm on marginalized and historically disenfranchised communities.

One reason many psychiatrists remain silent is their misinterpretation of the Goldwater Rule, an ethical principle whereby psychiatrists are forbidden from commenting on the mental health of individuals whom they have not personally examined. The Goldwater Rule is a sensible professional standard.

However, racism is not a mental illness; and it requires neither a medical degree nor psychiatric training to recognize Trump’s actions and words as racist. Physicians, especially white physicians, have a moral obligation to lend our voices and our stature to the chorus currently castigating Trump for his rhetorical allegiance with the most repugnant elements of our society. Remaining silent communicates a lack of compassion, ambivalence toward human suffering, and indifference to the everyday lived experiences of racism endured by both our colleagues and patients of color. The American Medical Association and the American Psychiatric Association have taken clear stances against racial bias. Now is the time for individual physicians to deploy these policies so they may work on behalf of our patients. Physicians must speak truth to power at the highest levels and call Trump to task for his racist and xenophobic remarks.

Recently in the New England Journal of Medicine, Dr. Rachel Hardeman and colleagues explicated how structural racism impacts the health and well-being of communities of color. Delineating concrete steps that health professionals can take to combat structural racism, Dr. Hardeman writes, “To pursue these efforts, we will have to recognize racism, not just race.” It is not enough for us to embrace racial diversity. We must also recognize and name racism when we see it. White nationalists and neo-Nazis waged a racist war on a small Southern city; and President Donald Trump defended them in an unequivocal and racist manner. Like most anxiety-provoking tasks, appropriately labeling racist words and deeds as such becomes less intimidating with exposure. Unfortunately, given our history as a nation and with President Trump in the White House, physicians will likely have more opportunities to practice.

Jeremy D. Kidd is an addiction psychiatry fellow.

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