The professional and personal journey of a Senior Psychiatrist of colour in an unnamed mental health trust is the focus of a new four-part blog series: 'Surviving at the Frontline'. Written during the pandemic, she shares her challenges around race, privilege, gender bias, structural and interpersonal racism, as well as her own mental health journey as a clinician of colour. She says: “It isn’t the volume of work that burns one out. It is the moral injury of being a part of decisions, conversations and a culture that is completely misaligned with one’s core values.”

Synergi Collaborative Centre Stroke

The power of privilege

I am months into my sick leave from my role as a Senior Psychiatrist. My inner chatter is on a loop of ‘no quality without equality’. I try to silence it and remind myself of the cost it carried. For a short while, I return to some peace of mind but I’m left with the questions: How do I return to work? How do I trust again?

To help, I have chosen to give voice to these feelings, to the details of my lived experiences, to my wounds and healing, to my annihilation – and survival. It’s my belief that these internal ‘scripts’ are shared by many others, but which are often denied when brought to light. Shame flourishes in darkness. Having the courage to shine a light on shame makes it die an exposed death. If the oppressors are not ashamed of their actions, why should the oppressed be ashamed of their feelings?

The other reason for writing is to translate the theory, definitions, and rhetoric of oppression into the movie of my daily life. The place where one lives these scripts. Feelings speak louder than intellect and even when (especially when) we don’t have the words to describe them, they can exert a profound impact upon our psyches and the quality of our daily lives. I want to show, not only tell.

In March this year, the pandemic of inequalities took the name of Covid-19. It is true that when a crisis hits, we tend to buckle down on the people and systems that we have a delusion of control over. Hierarchy solidifies into the very grooves that we have managed to loosen by a millimetre.

My mind flashes back to that ‘Bronze strategic command meeting’, a structure to manage crisis that is borrowed from the army, I am informed. Plans are set in motion to send us to battle as canon fodder, risking our lives while being hailed as heroes. Is this what we signed up for? We sit in the meeting quietly as white managers (there are very few black managers in these positions in the NHS) demand: “How many are you giving to the Covid ward? Gold command wants a minimum of five per team by the end of the day.”

I try to raise the ethics of “giving” staff to Covid wards, but I am silenced because these decisions are operational, not clinical. This is not the first time I have felt put in my place. It was also the case when I asked questions about the gender pay gap report, the WRES standards, the allocation of clinical excellence awards, the poor treatment of agency staff.

In fact, this feeling has become a litmus test for speaking truth to power. If I was being intimidated by seniority, I was rocking the boat right. The goal was that I titrated the rocking of the boat proportionately to the injustice. Some say this is stupidity and isn’t protecting oneself. Instead, it is setting oneself alight to keep others warm. But what if one sees the opposite in action every day and everywhere? A situation where one is ‘setting the underprivileged alight to keep oneself warm?’

The next morning, in the team meeting, only a handful of people appear. Five black agency nurses had resigned after being told that “they were not getting paid for sitting on their computers at home”. Two health care workers were deployed to Covid wards, despite strong protest. “Feeling anxious is no reason to not be deployed” was the view.

I was witnessing the terrifying impact of ‘operational’ decisions trickling down the privilege hierarchy to people who had little of it. Intersectional marginalisation, after all, was not a new pandemic. Although working with half the staff numbers was unsafe, it felt comforting to know that those colleagues who had left, had chosen their health, maybe even their lives. They were right to trust their gut feeling of endangerment, but they were also afraid of suffering poverty. The latter was one reason that many didn’t feel they had the option to protect their own lives.

The politics seeped into my personal life, more quickly than at other times. My partner felt dutybound to take up extra work as the Covid hot hub health professional. Men (and society) tend to place their value on duty at work. I keenly felt the unequal burden of care.

The spare room was my clinic, leaving little boundary between work and home. My tele-clinic started with talking on the phone to a young lady who felt hopeless. She struggled to utilise our support and interventions in the best of times. Not seeing anyone for days on end was intolerable. Still, we talked about some basic living strategies like eating and sleeping, all the while oblivious to the similar conversation others would be having with me. The artificial boundaries of doctor-patient vulnerability had never felt more apparent.

When I heard clapping outside my front door for NHS heroes for the first time, I was inside apologising to a male patient for pouring myself a glass of water while on the call “Why don’t you call me after you have done your washing up doctor?” My son asked what was for tea and why he was the only one clapping at our doorstep while I spoke to the pharmacist on the phone. There was a shortage of various medications without which many of my patients and I would struggle to maintain our mental health.

Over time, small injustices accumulate in one’s heart and mind which makes treating the hearts and minds of others an impossible task. One patient, from central Africa was detained to hospital for treatment after a severe relapse. We had to request a police warrant to forcibly enter his house. Upon admission to hospital, his recovery was slow and minimal. A scarcity of hospital beds often puts pressure on staff to discharge patients.

My social work colleagues worked hard to get all his benefits in order, only to realise that he didn’t have legal residency. This had prevented him from engaging with us for years and his illness became severe and enduring. He was terrified of getting deported which, in his mind, was undoubtedly worse than living with a mental illness.

It isn’t the volume of work that burns one out. It is the moral injury of being a part of decisions, conversations and a culture that is completely misaligned with one’s core values. It’s not that these issues didn’t exist before. It’s just that there is now no hiding from them anymore as the cost of such misalignments could be life itself.

I come from a family of NHS doctors. I have seen the shifting positions through the generations from ‘grateful recipients’ to ‘critical negotiators’. I find myself in the space in-between. I wonder if this transitional, almost in limbo, space is made by design – for people who look like me? I wonder if, like my patient, we are always on the verge of deportation from a decision, a position, or an embodied physical space to exist as equals?

Privilege is relative, and I accept mine, but the problems arise when I try to use it by challenging the status quo. One of the most hurtful aspects of ‘whiteness’ is that privileged colleagues of colour benefitting from the system can shut down those that challenge it. This, then, makes it more about power than the colour of one’s skin. One doesn’t have to be white to benefit from “whiteness,” but it certainly helps.

It is hard to stand up to coercive leaders, including leadership that seems uninterested in integrity, but we must find the courage to do so. Not least as one can be faced with a disciplinary process, or considered unprofessional when speaking up for the truth

Within a system so delicately balanced on hierarchies of privilege, where does one begin their work of anti-oppression? After contemplating this deeply – and at length – I believe that it must start from within.