American Psychiatric Association makes public apology for history of supporting structural racism

[beginner2011]

I came across this the other day and thought you all may be interested:

APA's Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psych

Today, the American Psychiatric Association (APA), the oldest national physician association in the country, is taking an important step in addressing racism in psychiatry. The APA is beginning the process of making amends for both the direct and indirect acts of racism in psychiatry.

www.psychiatry.org

January 18, 2021

APA's Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psychiatry​

Today, the American Psychiatric Association (APA), the oldest national physician association in the country, is taking an important step in addressing racism in psychiatry. The APA is beginning the process of making amends for both the direct and indirect acts of racism in psychiatry. The APA Board of Trustees (BOT) apologizes to its members, patients, their families, and the public for enabling discriminatory and prejudicial actions within the APA and racist practices in psychiatric treatment for Black, Indigenous and People of Color (BIPOC). The APA is committed to identifying, understanding, and rectifying our past injustices, as well as developing anti-racist policies that promote equity in mental health for all.

Early psychiatric practices laid the groundwork for the inequities in clinical treatment that have historically limited quality access to psychiatric care for BIPOC. These actions sadly connect with larger social issues, such as race-based discrimination and racial injustice, that have furthered poverty along with other adverse outcomes. Since the APA's inception, practitioners have at times subjected persons of African descent and Indigenous people who suffered from mental illness to abusive treatment, experimentation, victimization in the name of "scientific evidence," along with racialized theories that attempted to confirm their deficit status. Similar race-based discrepancies in care also exist in medical practice today as evidenced by the variations in schizophrenia diagnosis between white and BIPOC patients, for instance. These appalling past actions, as well as their harmful effects, are ingrained in the structure of psychiatric practice and continue to harm BIPOC psychological well-being even today. Unfortunately, the APA has historically remained silent on these issues. As the leading American organization in psychiatric care, the APA recognizes that this inaction has contributed to perpetuation of structural racism that has adversely impacted not just its own BIPOC members, but also psychiatric patients across America.

Events in 2020 have clearly highlighted the need for action by the APA to reverse the persistent tone of privilege built upon the inhumanity of past events. Inequities in access to quality psychiatric care, research opportunities, education/training, and representation in leadership can no longer be tolerated. The APA apologizes for our contributions to the structural racism in our nation and pledges to enact corresponding anti-racist practices. We commit to working together with members and patients in order to achieve the social equality, health equity, and fairness that all human beings deserve. We hope this apology will be a turning point as we strive to make the future of psychiatry more equitable for all.

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[dcpsychdoc]

I came across this the other day and thought you all may be interested:

APA's Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psych

Today, the American Psychiatric Association (APA), the oldest national physician association in the country, is taking an important step in addressing racism in psychiatry. The APA is beginning the process of making amends for both the direct and indirect acts of racism in psychiatry.

www.psychiatry.org

January 18, 2021

APA's Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psychiatry​

Today, the American Psychiatric Association (APA), the oldest national physician association in the country, is taking an important step in addressing racism in psychiatry. The APA is beginning the process of making amends for both the direct and indirect acts of racism in psychiatry. The APA Board of Trustees (BOT) apologizes to its members, patients, their families, and the public for enabling discriminatory and prejudicial actions within the APA and racist practices in psychiatric treatment for Black, Indigenous and People of Color (BIPOC). The APA is committed to identifying, understanding, and rectifying our past injustices, as well as developing anti-racist policies that promote equity in mental health for all.

Early psychiatric practices laid the groundwork for the inequities in clinical treatment that have historically limited quality access to psychiatric care for BIPOC. These actions sadly connect with larger social issues, such as race-based discrimination and racial injustice, that have furthered poverty along with other adverse outcomes. Since the APA's inception, practitioners have at times subjected persons of African descent and Indigenous people who suffered from mental illness to abusive treatment, experimentation, victimization in the name of "scientific evidence," along with racialized theories that attempted to confirm their deficit status. Similar race-based discrepancies in care also exist in medical practice today as evidenced by the variations in schizophrenia diagnosis between white and BIPOC patients, for instance. These appalling past actions, as well as their harmful effects, are ingrained in the structure of psychiatric practice and continue to harm BIPOC psychological well-being even today. Unfortunately, the APA has historically remained silent on these issues. As the leading American organization in psychiatric care, the APA recognizes that this inaction has contributed to perpetuation of structural racism that has adversely impacted not just its own BIPOC members, but also psychiatric patients across America.

Events in 2020 have clearly highlighted the need for action by the APA to reverse the persistent tone of privilege built upon the inhumanity of past events. Inequities in access to quality psychiatric care, research opportunities, education/training, and representation in leadership can no longer be tolerated. The APA apologizes for our contributions to the structural racism in our nation and pledges to enact corresponding anti-racist practices. We commit to working together with members and patients in order to achieve the social equality, health equity, and fairness that all human beings deserve. We hope this apology will be a turning point as we strive to make the future of psychiatry more equitable for all.

I saw this too! I think it is a start! We have so much to apologize for and so much work to do to address the harms done in the past as well as those that persist today. Thank you for posting this.

 

[AcceptingUncertainty]

I need to see a list of deliverables, and accountability in completing them.

 

[Spydra]

Isn't psychiatry also lacking in diversity which is also a part of structural racism? Is this supposed to be a blanket apology that includes that or will there be a separate statement discussing how more needs to be done to create diversity within the field of psychiatry? Or are they ignoring that entirely and just apologizing for those on the receiving end of poor care?

 

[dcpsychdoc]

Isn't psychiatry also lacking in diversity which is also a part of structural racism? Is this supposed to be a blanket apology that includes that or will there be a separate statement discussing how more needs to be done to create diversity within the field of psychiatry? Or are they ignoring that entirely and just apologizing for those on the receiving end of poor care?

Excellent points! I think this is just a start. I think both psychiatry and psychology have much work to do in dismantling the structural racist beliefs, policies and practices that have harmed so many. I also think it makes a lot of sense to ask if this is just an apology for sake of an apology, without true intention to make change.

 

[Spydra]

Excellent points! I think this is just a start. I think both psychiatry and psychology have much work to do in dismantling the structural racist beliefs, policies and practices that have harmed so many. I also think it makes a lot of sense to ask if this is just an apology for sake of an apology, without true intention to make change.

Yes there is a lot to do, but speaking only from my experiences in psychology so far I have zero expectation of actual change and the statements being made so far large and smaller scales just sound like lip service with no action behind them. I don't know enough about the behind the scenes of psychiatry to expect equally little of them, but it certainly is possible. I have often wondered if both fields (at least in terms of care provided) would be stronger if they worked more closely together and starting much earlier, but maybe that would also be helpful regarding these larger issues.

 

[dcpsychdoc]

Yes there is a lot to do, but speaking only from my experiences in psychology so far I have zero expectation of actual change and the statements being made so far large and smaller scales just sound like lip service with no action behind them. I don't know enough about the behind the scenes of psychiatry to expect equally little of them, but it certainly is possible. I have often wondered if both fields (at least in terms of care provided) would be stronger if they worked more closely together and starting much earlier, but maybe that would also be helpful regarding these larger issues.

I completely understand the expectation of little action.

 

[WisNeuro]

For everyone that wants to see action, get involved in state and national governance. I see so many people who call out for action, identify what they see as a problem, and then expect someone else to fix it. If you want something to change, do something. Even at the "leaset you could do" level, at some states and national levels, we can keep track of how many psychologists actually do things like contact their legislators about important legislation. We're lucky if we reach double digit percentages of our members doing so. If you're dissatisfied with your leaders, get into leadership yourself. In many cases, it's as simple as a self-nomination. At the state level, most filled governance positions are unopposed candidates.

 

[deleted106747]

For everyone that wants to see action, get involved in state and national governance. I see so many people who call out for action, identify what they see as a problem, and then expect someone else to fix it. If you want something to change, do something. Even at the "leaset you could do" level, at some states and national levels, we can keep track of how many psychologists actually do things like contact their legislators about important legislation. We're lucky if we reach double digit percentages of our members doing so. If you're dissatisfied with your leaders, get into leadership yourself. In many cases, it's as simple as a self-nomination. At the state level, most filled governance positions are unopposed candidates.

Strongly agree with this. I've been in so many meetings with psychologists who have great ideas, but then it's suggested to them that they carry them out, and ... crickets. Ideas are cheap. Action is what's needed. The whole if not me, then who? thing.

 

[borne_before]

I bet psychiatry is one of the most diverse specialties. Most I work with are not from the USA or white.

 

[DynamicDidactic]

We have so much to apologize for

For specificity, who are the “we” that need to apologize in this case?

 

[dcpsychdoc]

For specificity, who are the “we” that need to apologize in this case?

Hi. The field of psychology in general has much work to do to address the way in which we assess and treat people from minority, underrepresented and oppressed groups.

 

[WisNeuro]

Hi. The field of psychology in general has much work to do to address the way in which we assess and treat people from minority, underrepresented and oppressed groups.

As much as I agree with the notion that medicine and healthcare has an abysmal record with minority and underserved populations in the past, I tend to disagree with some of the messaging. Telling someone who is new to the field that "they" owe someone an apology is not seen well by some people who may feel that they had nothing to do with past injustices. It's simply a bad messaging tactic that will turn people off. Not saying it's right, just the way it is. We'd be better served focusing on how we can change things going forward to not repeat the mistakes of the past and how to build a better path in our field for those groups, so that we as a practice can better serve those populations.

 

[DynamicDidactic]

Hi. The field of psychology in general has much work to do to address the way in which we assess and treat people from minority, underrepresented and oppressed groups.

Agreed. The apology portion was the only aspect that I have difficulty with. First, this was the American Psychiatric Association's statement but I understand this is relevant for psychology as well. I am also not against apologizing but I don't know if every person should be doing the apologizing. The catchall phrase we makes it seem that way. And, as stated above, telling people they must apologizing is bound to lead to problems.

Of course, these are major topics being discussed across fields.

 

[Sanman]

Agreed. The apology portion was the only aspect that I have difficulty with. First, this was the American Psychiatric Association's statement but I understand this is relevant for psychology as well. I am also not against apologizing but I don't know if every person should be doing the apologizing. The catchall phrase we makes it seem that way. And, as stated above, telling people they must apologizing is bound to lead to problems.

Of course, these are major topics being discussed across fields.

Well, it is very much in vogue right now to apologize for everything if you have any sort of position of power. This just seems like a pre-emptive, please no one attack us, apology rather than an acknowledgment of actual issues. Rather pointless other than to be able to point to it if anything negative come out. Because people must always accept an apology and forgive.

 

[dcpsychdoc]

I very much appreciate all of these perspectives. I do come from the perspective of being a person in a position of power and wide-ranging unearned privileges. I personally believe that apology and acknowledgement of past and ongoing problems is needed in order to actually work on changing oppressive and racist systems. AND, I very much appreciate the perspective that my message could be taken as people who are members of oppressed groups needing to apologize. I need to do better about being clear about that.

 

[Sanman]

I very much appreciate all of these perspectives. I do come from the perspective of being a person in a position of power and wide-ranging unearned privileges. I personally believe that apology and acknowledgement of past and ongoing problems is needed in order to actually work on changing oppressive and racist systems. AND, I very much appreciate the perspective that my message could be taken as people who are members of oppressed groups needing to apologize. I need to do better about being clear about that.

Just a personal opinion here, but I don't think that an apology is owed unless someone does something wrong. Acknowledgement is useful, especially when adopted widely as it can lead to change. There are those with more or less privilege in this world and there is no reason not to walk through a door that is open to you. On an individual basis, that it what we are all supposed to do. Acknowledging that others may not have the same chances in life is important, but should we all apologize for any privilege we have? Where does that stop (as there will always be those with an advantage)? I say this as a minority and the child of immigrants who was afforded all the advantages that a middle class kid born in the U.S. generally has. I won't apologize for that, but I will be grateful and acknowledge many others never had what I did.

 

[beginner2011]

Just a personal opinion here, but I don't think that an apology is owed unless someone does something wrong. Acknowledgement is useful, especially when adopted widely as it can lead to change. There are those with more or less privilege in this world and there is no reason not to walk through a door that is open to you. On an individual basis, that it what we are all supposed to do. Acknowledging that others may not have the same chances in life is important, but should we all apologize for any privilege we have? Where does that stop (as there will always be those with an advantage)? I say this as a minority and the child of immigrants who was afforded all the advantages that a middle class kid born in the U.S. generally has. I won't apologize for that, but I will be grateful and acknowledge many others never had what I did.

Appreciate the perspective. I think using a slippery slope argument ("where does that stop?") isn't particularly compelling.

I'd say that there are instances where an apology from individuals who currently wield the power of institutions that have done some harm historically can alter the dialogue and narrative of individuals and communities in a beneficial way. For example, the Australian government's apology to indigenous people:

Apology to Australia's Indigenous peoples - Wikipedia

en.wikipedia.org

 

[borne_before]

This stuff reeks of original sin.

 

[Sanman]

Appreciate the perspective. I think using a slippery slope argument ("where does that stop?") isn't particularly compelling.

I'd say that there are instances where an apology from individuals who currently wield the power of institutions that have done some harm historically can alter the dialogue and narrative of individuals and communities in a beneficial way. For example, the Australian government's apology to indigenous people:

Apology to Australia's Indigenous peoples - Wikipedia

en.wikipedia.org

Governments are very different from groups of private citizens (or individual private citizens) with no ostensible wrongdoing other than being favored in society. If the American Psychiatric Association specifically wants to apologize specifically for issues in their past, as they have for classifying homosexuality as a mental disorder great. If the U.S. government wants to apologize for its treatment of indigenous people and slaves, wonderful. Blanket apologies for nothing specific is just disingenuous, imo.

 

[Ollie123]

I think the only reason these statements have become such a big deal is because of the history of denialism, whitewashing and complacency by so many people and organizations. Now we get apologies that (in my view) come across as grandstanding/virtue signaling moreso than genuine apologies. This statement is better than some. It is at least (somewhat) specific about past actions.

Seriously. Just say you did some ****ty things in the past. If you yourself didn't but represent an organization that did, apologize on their behalf. I really fail to see how this is always so controversial. I have some extended family members who are pretty ****ty human beings. If I ever meet victims of their ****tiness, best believe I would apologize for what my family did to them even though I have <literally> not even seen said individuals since I was a toddler and don't even know the laundry list of godawful things they have done. I get controversy around tangible things. Affirmative action. Reparations. Etc. I mean, I think there is room for reasonable disagreement over what and how past wrongs should be corrected. Apologizing? I think that is just the essence of being a decent, respectable human being and/or human being who is the face of an organization. I just absolutely fail to understand how there is so much political pushback on these issues (and to be clear, I'm not talking about anyone here...moreso the broader national discourse on this).

Valuable lessons to be learned from Germany. Asked a close German friend in grad school how WW2 was discussed there. Knowing how these sorts of things are in the US, I assumed it was a super-sensitive topic. I asked the question very quietly, awkwardly and in private since I was curious but genuinely didn't know how it would go. Her very nonchalant response (perhaps not directly quoted as my memory has faded, but close enough) "What? We were the bad guys. We did some of the most horrific things in history. Now we all have responsibility to make sure that we do better. This is literally what we're told from the time we're like 5 years old. What else would they tell us? Why are you being weird about this?"

Oh. Well that seems a remarkably sane attitude and approach that could probably solve a lot of problems if we would adopt here.

 

[DynamicDidactic]

Valuable lessons to be learned from Germany. Asked a close German friend in grad school how WW2 was discussed there. Knowing how these sorts of things are in the US, I assumed it was a super-sensitive topic. I asked the question very quietly, awkwardly and in private since I was curious but genuinely didn't know how it would go. Her very nonchalant response (perhaps not directly quoted as my memory has faded, but close enough) "What? We were the bad guys. We did some of the most horrific things in history. Now we all have responsibility to make sure that we do better. This is literally what we're told from the time we're like 5 years old. What else would they tell us? Why are you being weird about this?"

Oh. Well that seems a remarkably sane attitude and approach that could probably solve a lot of problems if we would adopt here.

I am not sure if that friend is representative. Is that friend from a large city school? There are inconsistencies, not denials, in teachings (I can locate an academic article if needed) and Germany still has lots of problems with far right movements and antisemitism (what else is new?).

But, I get the point. As said before, I think the statements from organizations are important. Efforts to change things are even more important. However, none of it is easy.

 

[Ollie123]

Oh certainly. And yes, she was from a large city and I'm guessing had a better education then average just by virtue of being a very successful international graduate student who has gone on to a professorship in Germany.

My point was not that adopting this attitude would magically eliminate racism. Moreso that an apology is such an incredibly small and obvious thing to do, I'm confused why there is pushback.

 

[AcceptingUncertainty]

Ayyy, how many people of color are there actually on this thread...? 🙄 Yep, I hear you.

 

[DynamicDidactic]

Ayyy, how many people of color are there actually on this thread...? 🙄 Yep, I hear you.

I would love to hear more opinions/views from people of color, particularly my question about apologizes from individuals (rather than organizations).

 

[WisNeuro]

Oh certainly. And yes, she was from a large city and I'm guessing had a better education then average just by virtue of being a very successful international graduate student who has gone on to a professorship in Germany.

My point was not that adopting this attitude would magically eliminate racism. Moreso that an apology is such an incredibly small and obvious thing to do, I'm confused why there is pushback.

I guess it's more personal than institutional for me. I just don't agree with apologizing unless you are actually sorry for something you have actually done. As an anecdotal example I've lost many close family members over the years, and people apologizing for their deaths always struck me as odd. I understand that it's a weird more, but it's still weird to me. I'm fine with acknowledging and confronting past transgressions of society and efforts to repair that damage, I'm just not going to personally apologize.

 

[beginner2011]

I guess it's more personal than institutional for me. I just don't agree with apologizing unless you are actually sorry for something you have actually done. As an anecdotal example I've lost many close family members over the years, and people apologizing for their deaths always struck me as odd. I understand that it's a weird more, but it's still weird to me. I'm fine with acknowledging and confronting past transgressions of society and efforts to repair that damage, I'm just not going to personally apologize.

When you say people apologizing for deaths, do you mean when people say "I'm sorry for your loss"? Or are you referring to something else?

To me that's different. If I tell someone "I'm sorry for your loss" I don't intend it to be an apology but more an expression of my own sorrow/compassion/empathy. Something like, "I feel sorrow that you have lost one that you cared for" without sounding like a robot from the 1700s. Maybe I'm misunderstanding you, though.

 

[WisNeuro]

When you say people apologizing for deaths, do you mean when people say "I'm sorry for your loss"? Or are you referring to something else?

To me that's different. If I tell someone "I'm sorry for your loss" I don't intend it to be an apology but more an expression of my own sorrow/compassion/empathy. Something like, "I feel sorrow that you have lost one that you cared for" without sounding like a robot from the 1700s. Maybe I'm misunderstanding you, though.

Yes, the sorry for your loss comments. I'm well aware of what the intent is, it just comes off as disingenuous in most circumstances. IMO it's more empathic to say something like "I can't imagine what you are going through" and possibly let someone that you're there if you need them, etc. Even outside of this context, I'm still not a fan of apologizing for general things of which you had no part.

 

[PikminOC]

Ayyy, how many people of color are there actually on this thread...? 🙄 Yep, I hear you.

I am.

 

[Ollie123]

Yes, the sorry for your loss comments. I'm well aware of what the intent is, it just comes off as disingenuous in most circumstances. IMO it's more empathic to say something like "I can't imagine what you are going through" and possibly let someone that you're there if you need them, etc. Even outside of this context, I'm still not a fan of apologizing for general things of which you had no part.

I mean, fair enough. Can't say I know you well, but based on all our interactions, I'm pretty darn confident if you were suddenly placed in charge of organization X that had previously done bad thing Y, you would have little hesitation saying "Hey, this organization has a history of doing some pretty terrible things. We need to right our wrongs and make sure nothing like that ever happens again" and taking action accordingly. That's more my point than the specific phrasing.

Really my post is just a long-winded way of saying I think it is a very sad that a large contingency of people would somehow find the above controversial, that "the past is the past" and be upset someone spoke of it. I mean...who raised them? We're not even talking about DOING something at this point, how is just SAYING something in any remote possible way a bad thing? Maybe awkward. Helluva lot less awkward than just pretending the bad thing never happened and we should all forget about it, in my opinion.

Never mind. I know the answer to my question. At least in this case.

 

[Sanman]

I mean, fair enough. Can't say I know you well, but based on all our interactions, I'm pretty darn confident if you were suddenly placed in charge of organization X that had previously done bad thing Y, you would have little hesitation saying "Hey, this organization has a history of doing some pretty terrible things. We need to right our wrongs and make sure nothing like that ever happens again" and taking action accordingly. That's more my point than the specific phrasing.

Really my post is just a long-winded way of saying I think it is a very sad that a large contingency of people would somehow find the above controversial, that "the past is the past" and be upset someone spoke of it. I mean...who raised them? We're not even talking about DOING something at this point, how is just SAYING something in any remote possible way a thing that shouldn't be done?

Never mind. I know the answer.

I think it can be a matter of timing of an apology as well as your attitude toward the past. I think one can acknowledge past wrongdoing without apologizing and I think apologizing long after an event is over (think decades) can feel disingenuous. Apologizing for more recent wrongdoing is more appropriate. If you are going to apologize, I also want to know how you plan to rectify the situation because an apology statement long after the events are over feels like letting people off easy. It is kind of like teaching someone it is okay to punch someone in the face as long as you apologize afterward.

 

[WisNeuro]

I mean, fair enough. Can't say I know you well, but based on all our interactions, I'm pretty darn confident if you were suddenly placed in charge of organization X that had previously done bad thing Y, you would have little hesitation saying "Hey, this organization has a history of doing some pretty terrible things. We need to right our wrongs and make sure nothing like that ever happens again" and taking action accordingly. That's more my point than the specific phrasing.

Really my post is just a long-winded way of saying I think it is a very sad that a large contingency of people would somehow find the above controversial, that "the past is the past" and be upset someone spoke of it. I mean...who raised them? We're not even talking about DOING something at this point, how is just SAYING something in any remote possible way a bad thing? Maybe awkward. Helluva lot less awkward than just pretending the bad thing never happened and we should all forget about it, in my opinion.

Never mind. I know the answer to my question. At least in this case.

You are correct in the case of the organization. In that case, there actually is a party at fault, the organization, and I would be speaking to it. SO yes, I can agree with that angle. My argument was a little convoluted as I was discussing personal responsibility vs institutional responsibility.

 

[Spydra]

I am a person of color and a graduate student, but I am here too. I have had many reactions to the apologies that have come from individuals and organizations. In both cases that apology had better backed up with action or change I can observe all by myself (not person/entity going out of their way going look what I/we did) otherwise I am unlikely to have any respect for said apology.

The first few individual apologies I heard I did what scholars are trained to do, asked more questions so I'd have more data to analyze. What I learned is that most of them were filled with shame and guilt over their own naivety or ignorance of what life is like for other people and yes this was a lot to process and I tapped my support system hard. These are people I am seeing change, not just saying they hope things get better, and it is amazing. Others were jumping on what they view as a trend and my hope is that they soon find themselves outdated. So while I am not seeking individual apologies, I have reached a healthy place of understanding regarding them.

Although it has never been my goal in life to get involved in an issue of this magnitude, I have raised a lot of questions to the power players of organizations (large and small) in our field in response to these apology statements because I have been on the receiving end of too much of the crap that is being apologized for and watched too many others crack under it. I am disgusted with the responses of 'we're talking about it,' 'we'll look into that,' and 'we can't.' Those of us at the bottom know exactly what that means, its the same damn lip service that is always offered in response to a problem and is meant to be dismissive. I am frequently that person with lots of ideas that are feasible and reasonable who says something and you know what happens? More lip service. I wish I could say I was surprised, but I am not. I just get more irritated seeing no action or change which results in my spending less time bothering, which is the aim of the lip service in the first place and the circle is dizzying. And I swear if one more person says 'change takes time' !!!!!! How much more time is needed? Will another 10 years do? Another 50 years? Maybe 100 years? Unacceptable.