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From the Editor

A Turbulent World

OLDHAM, JOHN M. MD

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Journal of Psychiatric Practice: July 2020 - Volume 26 - Issue 4 - p 261-262
doi: 10.1097/PRA.0000000000000484
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July, 2020. As I write these words, in early June, 2020, the streets of most of the major cities in our country are jammed with angry crowds, protesting the death, at the hands of the police, of George Floyd, an African American citizen of Minneapolis. Graphically recorded on video, this brutal murder by police is horrifying to see, and the national outcry is no surprise. It’s not, of course, the first time such dangerous brutality perpetrated against African Americans has occurred in our country, far from it, and a tsunami of anger and resentment was ready to boil over at any moment, such as the moment the Floyd tragedy hit the headlines.

But these are not random times; they’re COVID-19 times, when tragedy is hitting citizens from underrepresented groups, particularly African Americans, disproportionately hard. An April 22 report from the US Centers for Disease Control (CDC) stated that “current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups.” The report also noted that “Among COVID-19 deaths for which race and ethnicity data were available, New York City identified death rates among Black/African American persons (92.3 deaths per 100,000 population) and Hispanic/Latino persons (74.3) that were substantially higher than that of white (45.2) or Asian (34.5) persons.”1 The CDC presents a synopsis of presumed contributing factors to these disparities, involving living conditions, work circumstances, underlying health conditions, and lower access to care. So on top of the preexisting and ongoing forces of racial bias, it doesn’t take much imagination to consider, for those who survive paycheck to paycheck, the stress-to-the-breaking-point of unemployment, a bleak and uncertain future, and fears of eviction and homelessness. As Michelle Goldberg put it in an op-ed piece in the NY Times on May 30, “America is a Tinderbox.”2 Referring to the widespread protest demonstrations throughout the country, Goldberg emphasized that they “were sparked by specific instances of police violence, but they also take place in a context of widespread health and economic devastation that’s been disproportionately borne by people of color, especially those who are poor.”

I hope that by the time the July issue of the Journal is published, the fever pitch of the demonstrations has subsided, but more importantly that constructive new bipartisan strategies are being developed to work on these thorny and persistent problems of disparity, and that the pandemic has begun to ebb. On the good news side, however, I would like to congratulate the winners of our annual resident paper competition, Dr Tina Thomas, along with her co-authors Drs Scott Lane, Rania Elkhatib, Jane Hamilton, and Teresa Pigott. Ironically, given my comments above, the title of this winning paper is “Race, History of Abuse, and Homelessness Are Associated With Forced Medication Administration During Psychiatric Inpatient Care,” so the focus of this study could not be more relevant. And the focus is on the use of force—in this case in the context of providing compassionate care—and whether or not this intervention is also used disproportionately in people of color. The authors found that forced medication was “more likely to be instituted in psychiatric inpatients who are of a minority race (African Americans), are in a homeless living situation, and/or have a history of abuse.” The authors provide a thoughtful discussion of these concerning issues and emphasize the “importance of culturally competent and trauma-focused care.”

Also in this issue of the Journal, in our Law and Psychiatry Column, Wortzel and colleagues discuss “Therapeutic Risk Management for Violence: Clinical Risk Assessment,” which is the first of a series of columns on this topic—one that is always of critical importance, but never so much as in these turbulent times.

Special Note: It is my pleasure to welcome to the Journal our new Clinical Case Discussant, Dr. Amir Garakani. Dr. Garakani serves as Director of Education at Silver Hill Hospital in New Canaan, Connecticut and is Assistant Professor in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai in New York. In addition, he is an Adjunct Assistant Professor in the Department of Psychiatry at Yale School of Medicine in New Haven. Dr. Garakani has served as a research fellow in mood and anxiety disorders and as a fellow in forensic psychiatry. He has a part-time private practice and has had broad clinical experience in addiction medicine, emergency psychiatry, inpatient psychiatry, and consultation liaison psychiatry. He brings enthusiasm, intellectual curiosity, and clinical wisdom to his new role. Glad to have you on board, Amir!

REFERENCES

1. US Centers for Disease Control and Prevention (CDC). COVID-19 in racial and ethnic minority groups. Atlanta, GA: CDC; April 22, 2020. Available at: www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html. Accessed June 1, 2020.
2. Goldberg M. America is a tinderbox: scenes from a country in free fall. New York, NY: New York Times; May 29, 2020. Available at: https://www.nytimes.com/2020/05/29/opinion/george-floyd-protests-minneapolis.html. Accessed June 1, 2020.
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