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From the Editor

Guest Editorial: Going Back to My Country


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Journal of Psychiatric Practice: September 2021 - Volume 27 - Issue 5 - p 343-345
doi: 10.1097/PRA.0000000000000571
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Editor’s Note:In this issue of the Journal, I am pleased to invite our Clinical Case Editor, Amir Garakani MD, to share, as a Guest Editorial, the wonderful piece below entitled “Going Back to My Country.” In these times of heightened attention to the ever-present problems of individual, systemic, and structural racism, Dr Garakani provides a very personal window into his own experience as a medical student and, subsequently, as a physician—and as a man whose parents immigrated from another country. We can all learn from his wise words.

Also in this issue of the Journal, Smith and Boyd1present an insightful review of a timely book edited by Ruth Shim and Sarah Vinson entitled Social (In)Justice and Mental Health.2Smith and Boyd argue that “[p]sychiatry’s reckoning with its own racist past is overdue ….” They add that “Shim and Vinson thoughtfully and comprehensively investigate the systemic inequities and racist structures that permeate mental health care in the United States …” and their concluding advice is that “you need to read this book.”

I not only agree with this advice, I call your attention to an article by Ruth Shim in the July, 2021 issue of the American Journal of Psychiatry, entitled “Dismantling Structural Racism in Psychiatry: A Path to Mental Health Equity,”3in which she provides a wealth of important information as well as a roadmap to help us all participate in this essential dismantling process.



In October 2001, during my fourth year of medical school, I attended a psychiatry residency interview in New York City. I was excited because the training program director had trained with my father in the early 1970s. He spent a large part of the interview regaling me with mostly nonembarrassing stories about my dad. What did surprise me, however, was when he told me my father struggled with being a foreign-born doctor in an American hospital and how he was treated less fairly as a result. After the interview, when I spoke with my dad, he downplayed the hardships he faced. When I was growing up, he never spoke with me about discrimination that he endured at the hands of patients, peers, or superiors, or missing opportunities because of his background. He always told us we are Americans. That was it. My parents pushed assimilation so much that they did not speak Farsi in front of me and I never learned the language. I have never set foot in Iran. I am an American. I listed myself as “white” on my college and medical school applications. Years later, on online dating profiles (yes, I partook), I called myself white instead of Middle Eastern.

About a month later, in November 2001, while on a surgical rotation, I arrived early to assist in a case and found an empty operating suite. A few minutes later, an attending surgeon entered. He stared at me with suspicion. I quickly introduced myself as Amir, the medical student. He looked me over and said, “Okay. Where are you from?”

“New York City,” I responded.

He curtly said, “No, I mean where are you REALLY from? Originally?”

Taken aback, I did not respond quickly so he interjected, “Are you from one of THOSE countries? Were you born in the United States?”

I stammered, “Yes, I was born here in the US.”

Sensing my trepidation, he began laughing, and said, “Don’t worry. It’s fine. It’s just that you can’t be too sure these days, you know?”

Twenty-five years living in the United States were distilled down to that moment. There had been comments before. As they say, you never forget your first time. It is not hard to recall bigoted remarks from classmates or kids in the neighborhood. For some reason, though, the halls of the medical school, hospital, and operating rooms felt sacred. It went to my naivete as I quickly began to remember seemingly offhand comments, and the more overt racism my African-American classmates endured on a regular basis. It is that I did not want to accept that I was also different, and in many ways, an “other.”

I asked the advice of a faculty adviser, and she recommended that I report that surgeon after I graduated in May 2002. One of my Lebanese-American attending supervisors asked me to promise that I would report him. I did not, at least not then.

In October 2002, during my internal medicine rotation in my first year of residency, the attending, after rounds, joked about a disgruntled Arab-American patient, stating that we should call security to escort him off hospital grounds in case he tried to “blow up the whole hospital.” One of the witnesses to this “joke” was an Arab-American medical student. The pain in his eyes looked familiar. He confided in me that he was angry and wanted my advice. I told him to wait until after graduation to report the attending. I am certain he never did. I never did report the incident either.

In the intervening years, there were more intermittent incidents, almost always involving patients in the emergency room or on a psychiatric inpatient unit. The threat of one patient to carve up my “pretty little face” seemed strangely kind. Colleagues and friends say that these things are “part of the job,” and these days some may criticize doctors for having “thin skin” or being “snowflakes.” They tell the recipients of these taunts and jokes to not show fear and to stay strong, as if being passive to abuse is a sign of strength.

After years of festering frustration, I allowed myself catharsis, during a medical school alumni event, in the spring of 2016, when I told the president of the school what happened in 2001 with that senior surgeon. She showed visible shock and disgust. She assured me it would be addressed, and to her credit, did the best she could, given how much time had passed. A few weeks later, she said that the offending surgeon had no recollection of the incident and he wanted to apologize for what happened. I wondered why he would want to apologize if he did not even remember what he had done or said.

In late 2008, I took a job in New Canaan and decided to move to Connecticut, causing a warm yet fragile sense of security to come over me. I cannot say I felt particularly threatened or faced much racial abuse in my bubble in Fairfield County. There were some blatant utterances that crossed lines. One time, a social worker asked me to translate for a patient’s parents who were East Indian, and when I explained that I did not speak their language, and how there any many languages and dialects spoken in India, she laughed and remarked all of “you people look and sound the same.” While such comments were rare, there was no shortage of subtle discrimination at play. One of my African-American classmates from medical school called his exclusion from after-hours networking opportunities, like invitations to dinner or golf with his attendings, a form of “sneaky racism.” It reminded me of the slights and overt acts I saw him endure during our clinical rotations in medical school, and what must have been many more I never witnessed. For me, it felt better to pretend that the problem existed but would not affect me personally, which is textbook privilege. I still got dates on dating profiles. I still had mostly positive interactions with patients and to that point had only 2 incidents of being called racial slurs by patients. Not bad, right? My life evolved past that day 2 months after September 11, 2001, when my citizenship was questioned and all the uncertainty of whether I really belonged here came crashing down on me. It really did not affect me, I swear.

In August 2020, as I enjoyed a week off work with my toddler son, with his curly blondish hair and green eyes, a voicemail arrived on my office phone at the hospital, and the voice, which I did not recognize, told me that I should go back to the slums of the country I came from (the wrong country, I might add), followed by a veiled threat of harm. The police said there was little that could be done. The hospital administration showed sincere concern and offered support, but they too had few options to offer. One of my colleagues reminded me of what I already knew—it was pointless to pursue the identity of this person, likely a former patient, or to investigate the matter further, and that it was likely a “one-time occurrence.” It was, in the estimation of people around me, an empty threat of little consequence. Besides, going back to my own country? What country would that be? New York City? No thank you. Connecticut suits me fine.

We as doctors need not have our racial or ethnic identities mocked or have our gender, sexual orientation, or any part of us become weapons in attacks from patients. Sadly, for many of us, such attacks from patients become part of the job and the question of how to manage such abuses is complex given privacy concerns and our duties to treat whoever presents to us. That said, what happens when attacks are from our colleagues and supervisors, those whom we entrust to be our teachers, supports, and guardrails?

The only reasonable line of defense is for all of us to stand up against this kind of corrosive “humor” and to stop taking a laissez-faire attitude to bigotry within our own profession. Every day, we take for granted how much we help each other on the front lines of the most physically and emotionally exhausting work imaginable and yet too often we fail this common test: standing up for one another in the face of bad actions and bad actors among us. I failed to advocate for that medical student in 2002 facing a racist joke from an attending and gave the same sort of advice that I had been given a year earlier: make an empty promise to yourself and others. I was really saying to him, and myself, to pretend it never happened and move on with your life. The truth is that, if we do not speak up in the moment for ourselves, and for others, especially those who can face retribution and thus cannot protect themselves, it is very likely no one will. Here and now, I promise myself that I will speak up and speak out the next time I am confronted with such a situation. Next time. If only there could be no next time.

Department of Psychiatry and Behavioral Health, Greenwich Hospital, Greenwich, CT, and Department of Psychiatry, Yale School of Medicine, New Haven, CT


1. Smith C, Boyd JW. Book review: Social (In)Justice and Mental Health. J Psychiatr Pract. 2021;27:406–408.
2. Shim RS, Vinson SY, editors. Social (In)Justice and Mental Health. Washington, DC: American Psychiatric Association Publishing; 2021.
3. Shim RS. Dismantling structural racism in psychiatry: a path to mental health equity. Am J Psychiatry. 2021;178:592–598.
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