I recently spent some time in London, where one evening a colleague invited me to dinner at his private club. The building, an ornate nineteenth-century stone structure with an unmarked entrance, was in an area of the city known for its classic style and multi-generational wealth. The club was impressive—just like its members, I presumed. In the entry sat an elderly man who served as both concierge and bouncer, politely directing me downstairs to the room marked “Ladies' Cloakroom” after verifying that I was an invited guest. I stored my coat and returned upstairs to the club's salon, a massive wood-paneled state room decorated in claret and adorned with portraits of the club's prominent members. I could not help but notice that the portraits exclusively featured old, white men, as is typically the case in such historical spaces. I glanced around the room at the club's patrons that evening, also seeing mostly old, white men. All of this was a familiar scene. I am, after all, an Ivy League academic.
I pushed these thoughts aside and greeted my colleague, who graciously offered a tour of the club. With wine glasses in hand, we strolled around the palatial building, wandering through multiple elegant libraries and dining rooms on our way to a small “writing room.” There I sat at a small desk, upon which lay relics from a bygone era: several sheets of the club's stationery, a dip pen, a bottle of ink, and a blotting pad. At my colleague's playful urging, I began to write a letter. In that moment, there was only one person with whom I wanted to communicate:
Dearest Ezra,
I wish you were here to appreciate this place with me, to marvel and laugh together. You would admire its elegance and tradition, particularly the fine furnishings and selection of periodicals from around the world. But you would also understand the queasiness I feel about being here, where people like me—dark-skinned, female, and of modest means—were historically so unwelcome. We would talk about this. Perhaps you would remind me how far the world has come in a generation, allowing greater access to these private spaces after centuries of exclusion. Or perhaps you would be outraged that these clubs still exist, constantly reminding us of past oppression. Or perhaps you would tell me just to enjoy the wine. Honestly, I'm really not sure what you would say. But I do know that you would always be willing to talk, to grapple with these issues, to acknowledge their importance by creating a space for their consideration. For that I will always be grateful.
Reena
I blotted the wet ink on the pad, folded the letter, and put it away in my purse. As the evening progressed, I forgot about that moment in the writing room, as I was thoroughly absorbed in the elegant meal and delightful conversation with colleagues. It was only a few days later that I found the letter and reread my words. I quickly realized that the letter was more of a journal entry than a communication with another; it served merely as a reminder of my conflicted emotions on that evening in London. The letter remained tucked away, and Ezra never saw it.
In the months that have passed, I've sometimes wondered why it was Ezra to whom I had such an urge to write that evening. Why wouldn't I write to my family, or to any of the other wonderful people who have mentored me in my career? I concluded that Ezra served a unique role in my professional development, heightening my consciousness about race and class struggles more than any other colleague or supervisor. When confronted with places like that club, where the history of white privilege was undeniably on display, I could not help but hold the memory of his mentorship close.
To some, the idea that I would perceive Ezra as an ally in racial and socioeconomic struggles might seem strange, as he certainly never appears outwardly conflicted about privilege and luxury. In fact, among the Yale forensic faculty members, Ezra has a reputation for being the most interested in fancy things—foreign cars, fine dining, custom suits. He has wonderful taste in art, with a beautifully decorated corner office that displayed his Caribbean painting collection prior to his retirement. In our conversations, he often refers to Yale as “the Academy,” a term I find to be equal parts antiquated and elitist. Ezra pays no attention to this complaint; it is clear that he has achieved a certain status in life and appreciates its material rewards.
What makes Ezra unique is that, despite being secure in his elite role, he has always been willing to have difficult conversations about that role and the power structure surrounding it. In fact, he never seems more at home than when enthusiastically dissecting notions of power and privilege over a well-prepared French meal. My memories of our early conversations have faded with time, but I recall him being surprisingly frank about his status as the only black professor in the Yale psychiatry department.
“What do you mean, the only one?” I asked. “You mean, like, the only one right now?”
He replied that he was the only black professor in the history of the department, and then he sat back with an expression of amusement as I registered this information.
“Seriously? But how can that be?” I asked. From there, our years-long dialogue about race and culture in America began.
This dialogue on race was particularly important because of our chosen profession and its frequent interaction with the criminal justice system. As a new forensic psychiatry fellow, I came to Ezra for supervision after my first-ever trip to a correctional facility, noting that the prison hallways were a sea of black and brown bodies. Of course, I had read about racial disparities in the legal system before, but seeing the evidence with my own eyes made the issue much more real. I began asking Ezra what accounted for the overrepresentation of minorities in prison, questioning how exactly people of color are treated differently in the criminal justice system.
“Do the police arrest more people of color?” I asked. “Do they patrol differently in ethnic neighborhoods? Are criminal sentences different based on race?”
“Well, now you're getting it,” he replied. “You're asking the right questions.” He told me to read more—an instruction he repeated nearly every time we talked.
Ezra could have directed me to his own writings on race and forensic psychiatry, but that is not his style. Instead we continued to talk about these questions in supervision, and eventually I came upon one of his seminal articles, “Ethics in Forensic Psychiatry: A Cultural Response to Stone and Appelbaum.”1 The article, published in 1998 at the height of the debate over forensic psychiatry ethics, was revolutionary. Even now, two decades later, it remains one of JAAPL's most cited articles.2 Its basic premise is that ethics considerations are different for forensic psychiatrists who are part of society's nondominant group (i.e., black people) than for those who belong to the dominant group (i.e., white people). By telling two stories of psychiatrists providing court testimony, Ezra articulated the tensions that black psychiatrists feel when participating in a criminal justice system that many believe is corrupted by racism. He concluded that these tensions cannot be alleviated by withdrawing from the courtroom, nor can they be ignored. They can be managed somewhat through the use of cultural formulation in forensic practice, taking utmost care to respect the dignity and unique narrative of people of color involved with the criminal justice system.
As a young forensic psychiatrist reading the article, I was heartened—relieved, even—to learn that someone else acknowledged racial identity as a relevant issue in our work. Up until that time, the subject had not arisen naturally, nor did it feel safe to discuss in the conservative culture of forensic psychiatry. It wasn't that race was a taboo subject; rather it seemed irrelevant to many in our profession. Ezra changed this landscape, making race a topic worthy of serious consideration for forensic psychiatrists.
Not only did Ezra legitimize the subject of race by encouraging its discussion in academic forums, he also provided an important model for how a person of color can approach the complex intersection of personal and professional identity. In the Cultural Response, Ezra discussed his blackness bluntly, writing, “I am not a forensic psychiatrist who happens to be black,” and then asserting that a theory of forensic psychiatry ethics must be helpful to the black professional to be complete (Ref. 1, p 172). He did not shy away from his racial identity when discussing an academic matter. Instead, he integrated his identity into his theory of ethics, drawing upon both personal narrative and the scholarship of black thinkers like Henry Louis Gates and Sara Lawrence-Lightfoot. This example was highly instructive, demonstrating how one could raise controversial topics like race with a diverse audience without sacrificing professionalism.
Although his views on race were certainly influential in my early career, perhaps Ezra's greatest contribution to my professional development came simply from his existence as a senior faculty member at Yale. Had he not become a full professor, I may not have believed that it was possible, for I had never met a psychiatrist of color who had risen to the rank of professor in all my years of education at distinguished institutions. Without Ezra, I would have believed in professorship for non-white people in the same way that I believe in winning the lottery: It's theoretically possible but also highly improbable, so a wise person would best make other plans. Because of Ezra, the theoretical became tangible. As I considered my early career choices, I could see that rising through the academic ranks would be difficult, but also that the goal of professorship was achievable regardless of skin color.
Ten years have passed since Ezra supervised me, and I now look back on my early questions about race and the criminal justice system as almost impossibly naïve. My understanding of these issues has deepened over time, and additional important questions have arisen in my professional life, particularly about gender. The poor representation of women in forensic psychiatry has become more obvious as my career has advanced, especially at the level of leadership in national professional organizations. I have participated in many meetings filled predominantly with men, enjoying the rich intellectual discussions but also occasionally wondering, “Where did all the women go?” Although Ezra and I have rarely discussed gender, our early conversations about race have given me a framework and vocabulary with which to describe the distinctive experience of women in forensic practice. In all likelihood, I would have tackled this subject even if I had not met Ezra, but I am undoubtedly better equipped to do so because of his insights.
Finally, Ezra's mentorship and scholarly work make it clear that people of color have a special responsibility in forensic psychiatry. He mandates that we own our place in the world, both as psychiatrists and as nondominant cultural group members, giving voice to our authentic narratives in the professional sphere. His example also serves as a reminder that status and privilege are not achievements in themselves; they are tools to be used in service of higher ideals—chief among them justice, compassion, and respect for vulnerable groups. Ezra understands that these ideals must be pursued, not only in the ivory tower, but also in the real, messy world where people of color are often marginalized and dismissed. I am lucky to have witnessed his pursuit of justice at such an early stage in my career. I can only hope to carry forward his mission, teaching future generations of forensic psychiatrists to value their esteemed role as physicians and to work tirelessly on behalf of those less fortunate.
I still have the letter that I wrote in London, and someday I may give it to Ezra so that he can appreciate the fine paper and calligraphic ink used in its creation. I think he would enjoy that. I also imagine that he would be amused by the image of me in that posh club, so distracted by the whiteness of my surroundings that I was compelled to reach out to my former supervisor. Of course, I don't need to imagine any of this; I could simply tell Ezra the story and watch his reaction. However, creating a fantasy of what he would say is just as satisfying as the real thing, at least for now. I picture Ezra smirking and asking incredulously, “Ten years in Ivy League academia and that portrait stuff still shocks you?” We would laugh, and he would walk away, hopefully with an appreciation for the profound impact he has had on at least one young professional.
- © 2018 American Academy of Psychiatry and the Law
