番茄社区

In the wake of Derek Chauvin's conviction for the murder of George Floyd, clinicians and mental health professionals are calling for the recognition of ethno-racial trauma (ERT) and the implementation of cultural humility into all clinical practices to improve care for Black patients.

ERT has been by researchers as "individual and/or collective psychological distress and fear of danger that results from experiencing or witnessing discrimination, threats of harm, violence, and intimidation directed at ethno-racial minority groups." While the term is not listed in the DSM-5, studies have established the mental health repercussions of this type of trauma.

Previous research has shown that police killings and brutality against Black Americans -- and the widespread circulation of these events on social media platforms, a phenomenon some have called "viral black death" -- has had adverse effects on the mental health of Black individuals in the U.S., a group that is already to report mental health issues than the general population. Over the past year, these psychological stressors have been compounded with the .

In a viewpoint published this week in , Gowri Aragam, MD, co-founder of the Stanford Lab for Mental Health Innovation at Stanford School of Medicine in California, and colleagues examined the importance of cultural humility as a way forward for healthcare professionals to assist in the healing of ERT.

The team came together in a moment that brought with it a sense of powerlessness and overwhelming frustration, Aragam told 番茄社区. Cultural humility, the authors wrote, is "an active, lifelong process and approach to communication that focuses on optimizing interactions between patients and clinicians with different values, backgrounds, and experiences."

For Aragam, her own experiences working in emergency medicine at a county hospital in San Francisco's East Bay crystallized the power that cultural humility could have in everyday clinical settings to treat patients.

"Oftentimes when you're in an emergency setting, you're getting a provider's impulse behaviors, or a whole system's impulse reaction to a person coming through the door, who was oftentimes disproportionately Black and disproportionately homeless," Aragam recalled.

As a psychiatrist, she said, it wasn't unusual for her to be called in to see a patient who was described as "agitated." Many times, however, she found that when she actually talked to these patients, they were expressing justifiable feelings of anger, while sometimes showing possible symptoms of psychosis or mania.

In one such instance, "I made sure to intentionally check myself before heading into the situation and was very open with myself about the fact that I was probably going to have an immediate reaction to the person I was about to see," she said. "But take a moment and actually listen to what they're saying and use your training to get a sense of if this is truly a threat or if there's a way to just ask, open-endedly, 'What's going on?'"

In a heated moment like this one, the impulse of a healthcare team might be to restrain or seclude the patient, thereby escalating an already tense situation, Aragam explained. When she spoke with the patient -- who was also showing signs of intoxication or psychosis -- she realized they just wanted a toothbrush.

"It can sometimes feel like magic to people watching, which it's obviously not, but you're expecting something to escalate and suddenly the person sits back down or goes to sleep," she said.

During this patient interaction, Aragam said, the emergency room television was showing coverage of George Floyd's murder and the protests that followed. The coinciding events made the moment -- and the choice to not jump to conclusions about this patient -- all the more striking.

Psychologist Isha Metzger, PhD, has studied the impacts of ERT in both her clinical practice and academic research. After the mass murder of nine Black attendees at the Emanuel African Methodist Church in Charleston, South Carolina, Metzger was one of the responders that worked closely with victims' families. She started to see that, beyond the trauma of violently losing a family member, they were also dealing with a myriad of racial stressors, including their mistrust of the police and the understanding that the perpetrator had an explicitly racist, anti-Black agenda. Her other clients of color, outside of the circle of the victims' families, had also started to bring up these stressors in reaction to the shooting.

Metzger, who also works as a consultant training other mental health professionals in culturally sensitive treatment, realized that many of her colleagues were not engaging in the same conversations with their clients.

"I found that it was a matter of efficacy," Metzger told 番茄社区, explaining that many clinicians felt they couldn't even broach these topics in session, nor had the training to deal with the issue of racial trauma.

"We started exploring how to systematically integrate these topics of race and systemic injustices and our reactions to them, and really normalizing and validating clients' experiences," said Metzger. "Through research, I was able to see that, not only are [clients] more engaged in treatment, they're also more likely to complete treatment."

Metzger noted that people often understand cultural humility in this context as a way for white clinicians to properly acknowledge their whiteness and the biases that come along with that privilege. But, as a Black female psychologist, Metzger herself finds cultural humility to be a crucial part of her practice.

"I'm not the expert in anyone's personal experience," she said. "So being humble in that regard and saying, 'I'm entering this space as a novice in your experience, how can you let me understand what you're experiencing?'"

Metzger recalled an experience she had in which a white colleague was working with a Black teenager who wanted to go to a protest following an act of community violence, often making visits to the teen's home and having conversations with family members. At one point, the family had referred to this clinician as their "white mama"; Metzger said her colleague was offended by this statement, arguing that she didn't want to be seen as just a white person.

"I had to tell this clinician, 'No, no, no, you've made it. They have now brought you into their family,'" Metzger remembered. In encouraging her colleague to reframe the comment, she was able to forge a deeper connection with the client and family.

Metzger believes that Black patients should be able to see a Black therapist if they want to in order to receive the care that they need; still, she sees cultural humility as a tool for therapists to engage with their clients on topics they may have otherwise deemed too uncomfortable to address.

"It's opening the conversation and letting down those pretenses that say, 'I'm the expert and have achieved this ultimate knowledge,'" she said. "Being humble about our preconceptions and even our implicit biases allows us to really engage with our clients."

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