Author: Kelsey Brown, Medical Student at The Warren Alpert Medical School of Brown University
This post is one of a series of mental health pieces from the AMSA WSL Committee
Black people in America are experiencing trauma: physical, mental, emotional and vicarious trauma. The trauma stems from the rampant racial discrimination that Black people face in America. Black people report experiencing discrimination at a significantly higher rate than any other major ethnic minority.
Black medical students are not immune to or protected from these kinds of trauma. Some symptoms of experiencing past or current trauma can include, but are not limited to, difficulty in beginning new tasks, blame, guilt, concerns for safety, depression, inability to trust (especially those in power), fear of risk taking, disturbed sleep, eroded self-esteem/confidence, inability to concentrate, and panic attacks.
To say that a lot is asked of the present-day medical student is an understatement. To ask that Black medical students meet the demands of medical school under the stress of ongoing racial trauma, without additional structural supports, is unreasonable.
Beyond the sweeping statements emphasizing commitment to diversity and the utilization of diversity training, medical schools need to do more to support the mental health and wellbeing of their Black students. Although many physicians work diligently to provide trauma-informed care to patients, medical schools have struggled to create trauma-informed learning environments for black students.
In her 2000 article, “A Multidimensional Conceptualization of Racism-Related Stress: Implications for the Well-Being of People of Color”, Dr. Shelley Harrell details the effects of race-related stress on the well-being of Black people and suggests various interventions.
Dr. Harrell explains that there are a variety of ways to facilitate well-being. She writes, “Within a stress framework, well-being is generally facilitated by eliminating the stressor, changing its nature or one’s perception of it, or strengthening the internal or external resources needed to deal with it effectively.”
“Eliminating the Stressor.”
Systemic racism in America has been oppressing and brutalizing of Black bodies for the last 400 years. It is unlikely that medical schools can single-handedly and immediately eliminate the stressor of racial injustice. However, administrators should reflect on how they perpetuate these systems, personally and institutionally. That being said, reflection alone is not going to get the job done. Change takes action.
“Changing its Nature or One’s Perception of It”
Perception of racial injustice is so intrinsically tied to individuals and their life experiences. As such, medical schools, as larger institutions, may encourage individual changes but may not be able to intervene on racial injustice in this way.
“Strengthening the Internal or External Resources Needed to Deal with it Effectively”
Here are some suggestions to create institutional infrastructures and practices to better support Black students. This list is not exhaustive, but it is a start.
Dr. Harrell explains that “collective coping efforts” such as “participation in social change activities directed toward eliminating or altering the nature of the stressor should be considered”. She later cites that these sorts of activities can be psychologically empowering.
We need medical institutions to get involved in anti-racist work. Time-intensive, fiscally-supported anti-racist work. What does that mean? That means spending the money and the time to ensure that all levels of faculty and staff are educated about systems of oppression within medicine and within medical education. It means spending the time and money to get rid of racist curriculum. Student leaders at Brown University put together a call to action for our administration on how they can further engage in anti-racist work. If you don’t know where your institution could start, the 10 calls to action from my peers would be a good place.
We also need medical administrators and educators to get involved in anti-racist work on a personal level. That means checking in with their personal racial biases, educating themselves on medicine’s racist history and showing up to protests and actions that align with their personal values.
While access to intra- and intergroup peer support depends on the student body’s racial makeup, social awareness and individual comfort level, administrative bodies can help ensure access to community and institutional social support.
One way to build community support would be for administrators to support safe and protected spaces for students to process the many forms of racial trauma. Student Health Council at Brown University is sponsored by and collaborates with the school administration to create spaces that facilitate student processing. We have two main examples/models for these spaces. The first would be Real Talk, which is a student-only (no administrators or faculty) session that aims to create a safe and open space for students to discuss the challenges of navigating mental health conditions in the midst of medical school. The second would be SPACE, which stands for Students Promoting Awareness, Compassion, and Empathy. These sessions are designed to give each medical school class a place to have conversations that might not otherwise happen in the midst of the chaotic times that come with being in medical school. We are looking forward to organizing a new space called For Us which would be a space for black students to process ongoing racial trauma both within the medical community and the community at large.
Another mechanism of providing institutional support would be to employ a team of readily available, socially aware and diverse mental health professionals who are specifically trained in mental health care of medical students. By providing free access to counselling with diverse and socially aware mental health professionals, students are able to access necessary mental support throughout their years as trainees.
Unfortunately, there are a million reasons why black medical students find it difficult to trust various academic administrative bodies and the medical system as a whole. From the use of enslaved women as experimental subjects to further the field of gynecology, to the horrors of the Tuskegee Syphilis study, and to the increased incidence of black maternal mortality, racial trauma is embedded in how we have practiced medicine. Medical school administrators have the unique opportunity to earn the trust of their Black students and potentially the larger Black communities they serve by validating our struggles.
When racially violent events occur, it is important that you show your support of black students by being timely in your responses, clear about your plans to support students moving forward, and transparent about your institution’s shortcomings.
Author Bio: Kelsey Brown is a third year medical student at Brown University. She is the third year chair of the Student Health Council, which supports medical student mental health through peer-counseling, debriefing sessions and many other wellness programs.