Shimon Cohen:

Welcome to Doin' The Work: Frontline Stories of Social Change, where we bring you stories of real people working to address real issues. I am your host, Shimon Cohen.

In this episode, I talk with Dr. Jessica Isom, a board-certified community psychiatrist, who practices clinically in the federally qualified health center Codman Square Health Center in Dorchester, Massachusetts. She is also involved in graduate medical education and health care workforce development in her role as a clinical instructor in the Yale University Department of Psychiatry, which has inspired many invited talks and workshops around social justice and health equity. Additionally, Dr. Isom is a physician-entrepreneur who owns the consulting business Vision for Equity LLC that focuses on Diversity, Equity, and Inclusion (DEI), antiracism, and racial equity. We talk about how in medicine and mental health, race, specifically being Black-identified, is typically discussed as a risk-factor for ill health when racism is the root and primary risk factor. Dr. Isom explains that this approach pathologizes Blackness, as it’s intended to, and directs interventions and treatment in ways that do harm and perpetuate racism by incorrectly explaining health disparities as individual and biological rather than rooted in the systemic racism that creates inequity, stress, barriers to access, poor treatment, and that intersects with many other social determinants of health. She further details how this approach of pathologizing Blackness is deficit focused and promotes a deficit-based ideology and approach to addressing health disparities and the overall well-being of Black people. We talk about how whiteness and Western/Eurocentricity shows up in mental health, including the DSM, and Dr. Isom shares how she navigates this in her clinical work. She also shares her thoughts on Black healing and joy. I hope this conversation inspires you to action.

Hey, Dr. Isom, thanks so much for coming on the podcast. You and I have been trying to get this scheduled for a while now, so I'm just so excited to have you on here and get to share your expertise with folks who follow the podcast.

Dr. Jessica Isom:

Yeah. I'm excited to be here, and I'm glad that we could figure it out eventually.

Shimon Cohen:

Yeah. Before we get into it, I just want to say, you have some of the best, most epic Twitter threads ever, just phenomenal use of graphics and pictures and memes you've got going on.

Dr. Jessica Isom:

Yeah, thank you. It's actually pretty fun creating those. Even though the topic itself could be heavy at times, it's fun searching through and trying to make it as engaging as possible to kind of lighten it a bit. So thank you.

Shimon Cohen:

So I think one of the ways you and I really connected, and I don't remember if it was a year ago or more because ever since 2020, everything's a bit of a time warp, but I know we were engaging around how, in mental health and in medicine and really in so many things, race gets talked about as a risk factor when it's discussed, when education's done around it. Right? So future doctors, future mental health providers, are learning this, that race is this risk factor. And we were talking about how racism is the risk factor. So I wanted to just go for it right away around that and get your thoughts on that.

Dr. Jessica Isom:

Yeah. Every time this comes up, I have flashbacks to my medical education experience, which is pretty stereotypical. However, I was a completely different Jessica back then, that was before I'd had my public health exposures. So I was coming out of undergraduate, and really, really green, and I was sitting in my medical school first and second year courses. And there's these presentations, these recordings that you watch, and repeatedly, in every one, they talk about risk factors and they would put Black on those slides. And I would always wonder, "When did I become a risk factor just by being alive? This is strange." And there was never really a clear articulation of that in those first two years besides a really brief four-hour health disparities half day. So when I got to my school of public health here and took a health equity class, that's where my brain kind of exploded like, "Wow, this is that context that explains the spidey senses that were activated in these different settings where Blackness became a risk factor without any really further interrogation." So that was pretty amazing.

Shimon Cohen:

And so what does it mean for people? Because we're talking about physicians, mental health providers, patients, clients, people, participants, what does it mean for people when race is considered a risk factor? Because we're going to get right into these specific around anti-Black racism here.

Dr. Jessica Isom:

Mm-hmm. I mean, it serves multiple functions. So one, to say that within a thing, and here we're talking about Blackness embodied by Black-identified people, to say that's the source of a pathology, specifically for us as health professionals, it functions to shape how we might intervene on the way that pathology "reveals itself." So we're having a conversation about racial or ethnic disparities. We can explain away a lot of the root causes as something within the individual that's inherent, that's biological. And then that really narrows down what we could do to help those people. So that's one function, kind of allows us to morally disengage from our own complicity in contributing to the real risk factor, which is racism.

Dr. Jessica Isom:

Two, I think it functions in a very sinister way to invade Black people specifically the way that they think about themselves in their own community, in a really deficit-focused way where we're born naturally with this assumed pathology that makes us more sick, more ill, more disordered than other groups. And that affects how we engage throughout our life course as well. That's probably the most difficult part to contend with because I'll see in even public conversations about race and racism that that is a very popularized understanding even within my own community. So there has to be intervention on everybody's misunderstanding, not just that of White people in positions of power and privilege.

Shimon Cohen:

Yeah, absolutely. So what happens when we flip it and we are clear that racism is really the risk factor, or even really beyond a risk factor? Racism creates multiple risk factors that affect people. What does that do when we frame it that way?

Dr. Jessica Isom:

Well, the first thing it does is it forces us to have a conversation about what racism is, which often can be a hot mess because people are socialized into so many different understandings of what racism is. For people who have lived experience of racism, it's very clear what it is to a certain extent. However, even those with lived experience can often narrow down the definition to just interpersonal prejudice and discrimination, and convince themselves that other manifestations are not there such as institutional manifestations of racism or systemic manifestations of it. So when that conversation happens in whatever context, it's great that it's happening, but it's often not very productive because there's a real resistance to talking about racism in a multi-level way.

Dr. Jessica Isom:

But at the same time, there is interpersonal racism. It does happen. It is the way that institutions are allowed to perpetrate race-based treatment of people. It's through people enacting policies and practices and adopting a culture where that's normative and okay. So it's not not helpful to have a focus on that conversation, but it can't be the only focus at the interpersonal level because it obscures all of the other ways that racism is kind of baked into how we are accessing lots of things, from banking institutions to educational institutions, to going to get some food at Starbucks. So there's a lot of layers there that get missed because of that narrow focus on the interpersonal level.

Shimon Cohen:

Yeah. When we talk about racism and we get into the systemic aspects of it and we look at mental health, what are some ways that racism affects mental health and the way we address mental health as well?

Dr. Jessica Isom:

Yeah. I mean, there's a lot of ways to answer that question. It's interesting because I am a psychiatrist trained in a traditional psychiatry residency on top of traditional medical training as a physician. And all of that is a very Western European focused way of understanding what goes well inside the human body and brain and what does not go quite so well. And specifically with mental health because we do imagine, to a certain extent, what is this demarcation between what's normal and what's not, what's normal versus pathological, or what's normal versus disordered.

Dr. Jessica Isom:

When there's a dominant orientation or a dominant narrative or dominant way of understanding human behavior, that infiltrates the entire field that's not really representative of the global majority. It becomes a bit tricky to know what to do with this training that I invested so much time and finances in. So here we are with the current conflict of, well, what do you do with this? And how do you negotiate that tension of, this is a piece of understanding that it's considered to be superior, but it's not necessarily superior at all? I mean, there wasn't a real competition to determine who's understanding of the human mind, and human behavior should be supreme. So it's complicated as I'm sure you know.

Shimon Cohen:

Yeah. As you're talking about that, I think of whiteness and how it sets itself up as the standard. Right?

Dr. Jessica Isom:

Mm-hmm.

Shimon Cohen:

And then for someone to even get treatment, if they're going to have insurance, insurance is only going to cover certain types of treatment, which then again have to be whatever was deemed acceptable, evidence-based by whiteness once again so it just keeps reinforcing itself.

Dr. Jessica Isom:

Mm-hmm. Yeah. I was just doing a talk with a friend, Frederick Shegog, who talks about his lived experience of having a substance use disorder and experiencing lots of different, very vulnerable positions throughout his life, including lacking stable housing. And he talks about these expectations in that particular space that everybody will do the same cookie-cutter approach to their substance use disorder, which often includes things like AA, a peer support intervention, when AA is quite clearly created by White men specifically and has a very specific orientation around spirituality. And often, many other context that doesn't really allow for conversations about lived experiences that include racism, or really a lot of other social positions and their consequences in our society.

Dr. Jessica Isom:

So to say, for example, for Freddy, that he's in a program and there's an expectation that he will do AA and that that represents for him as a client or patient being truly engaged in his recovery, for that to be the expectation, that's a manifestation of an interrogated whiteness shaping, like what's supposed to be normative. When in reality, AA may not be for Freddy. It may or may not be, right? Different people will make use of different resources. But there are lots of other ways, other paths to recovery from a substance use disorder that might be more culturally sensitive and culturally responsive, but those are not a part of the mainstream so they may not be respected or valued as much. For example, if Freddy were pursuing those and he gets a couple notches taken off of his recovery reputation, that's problematic, and applies to a number of other areas beyond substance use disorders as well.

Shimon Cohen:

Yeah, if people are given a specific treatment, medic- whatever it is, and then for whatever reason they have an issue, so let's say someone gets prescribed medication, but they can't afford the medication so they're not taking the medication, or your friend Freddy, what was told for him to do doesn't work for him, then they get labeled as non-compliant or non-adherent. Right? So it was like, I remember at one point in my training, I think instead of saying non-compliant, we were supposed to say non-adherent as if that was less stigmatizing or something.

Dr. Jessica Isom:

Yeah. I say, non-adherent now, I did make the shift. But the question is, is adherent to what? And then the other question is, is adherent to what, and why? Why is this the thing to be adhered to? And then who decides what makes it adherable or adherent worthy?

Shimon Cohen:

Totally.

Dr. Jessica Isom:

But we never get there. We don't really get there often.

Shimon Cohen:

So as you're talking about Eurocentric view with medicine and mental health, let's talk a little bit about the DSM. And for folks who are listening, who don't know about the DSM, it's the Diagnostic and Statistical Manual, which has the various mental health diagnoses, and people have to meet certain symptoms, and if you meet these symptoms and duration and different things like that, when it began, then you could be diagnosed with that disorder or whatever it might be called. So I guess before I get into some more specific questions, what are some of your initial thoughts about the DSM and some of the challenges you have with the DSM?

Dr. Jessica Isom:

Yeah. One of the exercises we did during residency was around the DSM during our intern year, which is our first year. And it was to help us process our conflicted feelings about, what's considered to be, "the bible of psychiatry" and really so many other mental health professions as well. I appreciated that exercise, and yet it still didn't necessarily dive deep into who created it, what gets filtered through, and what gets left out, and all of those multiple layers. So one of the reasons why we had to interrogate it is because we have to use it and our patients have to use it as well because that's our gateway to getting compensated treatment. It's our gateway to being able to bill for a service, which helps us function in our role, and it's their gateway to accessing our time and referrals and all sorts of things. So we're tied to it.

Dr. Jessica Isom:

It does have a complicated history. It has helped the mental health professions be more similar to other disciplines. So being able to hand a diagnostic label to a patient parallels how the rest of medicine functions. You present with signs and symptoms, they meet criteria for this particular diagnostic label, you get that diagnostic label applied, and then there's the treatment that comes after. So it makes sense in that way, but it's a bit more messier than that. So I do have conflicted feelings about it. And some of that has been processed just by the very nature of being in the profession that I'm in.

Dr. Jessica Isom:

But often, there's not a lot of conversation around who's been invited to the table. Even in that context, who's invited to the table to have a conversation about what exactly are we doing here? What are we describing? For whom are we describing this? What's centered versus on the periphery, in the back of the DSM, all the way in the back, like those culture bound syndromes, for example? We don't often talk about that very much. So that's the messy part alongside the rest of the mess that I haven't even gone through yet.

Shimon Cohen:

Yeah, I mean, I think it's always important with a discussion of the DSM and mental health to point out that in 1851, Samuel Cartwright came up with a diagnosis called drapetomania, which was "a disease causing slaves to run away."

Dr. Jessica Isom:

Mm-hmm.

Shimon Cohen:

And that was considered a legitimate, well, again, by whom, diagnosis because slavery was supposed to be considered so great that it would be crazy for Black people to escape, right?

Dr. Jessica Isom:

Mm-hmm.

Shimon Cohen:

That's the history we're dealing with with mental health.

Dr. Jessica Isom:

And I would say all of medicine too. I mean, if people were really thorough in exploring the origins of their profession, they would understand that all of them have a developmental history that coincides with colonialism, race-based slavery, just lots of icky things from our history. And they weren't just these silo things developing alongside each other; they reinforced each other in lots of ways. So there is just very, what we would consider to be, ridiculous ways of associating racial groups with diagnostic labels, with cultural characteristics and behaviors and all those sorts of things that we don't necessarily verbalize explicitly, necessarily as explicitly, not that we don't, some of us still do, anymore, but it still reveals itself in the way that we think about the patients that we're working with.

Dr. Jessica Isom:

So it might come out in a comment about how someone's presenting and what it means, even if it doesn't explicitly say, "Well, I believe that all Black women, for example, are highly promiscuous." It might reveal itself in "Here we go, another person coming in for SDI testing. They can't keep their legs closed. Hahaha." You know? So if people were really thorough in their exploration of those roots, they would see a lot of the explicit language that describes how we still think today, but it just comes out in more socially acceptable ways, which often just means it's more subtle, and or it's said behind closed doors or only in specific groups.

Dr. Jessica Isom:

We were talking about this book the other day that has a lot of primary quotes in it from different specialties within medicine, including psychiatry and also neurology, which would be relevant to mental health professionals, that talk about Black brains and Black nerves and Black eyes and Black hearts and Black kidneys and Black emotions, Black feelings in a really biologically race-based way that was infused with this racial inferiority and superiority belief of Blackness being at the bottom and Whiteness being superior. Again, we can't disavow that and pretend that didn't make its way into the DSM from its origins, all the way to the DSM-5-TR that just launched from the APA. Again, a conversation that's subjugated in favor of this, pretending that we are past those historical origins. When in reality, we haven't really metabolized them. They're just there.

Shimon Cohen:

Yeah. And I think one of the challenges, and you spoke to it, is this is something we have to use if we're going to get paid and if people are going to have their insurance cover, these services. And so that always feels like this tension that's incredibly frustrating because it's like, "Okay, we have to use this, but it's so problematic, but we have to use it." How does that then affect practitioners also by just continuing to accept in a way, even though that we might be critical of it? I think it's doing something over time because it's like, there's a potentially numbing that can happen to the practitioner utilizing it as well. I don't know if that makes sense.

Dr. Jessica Isom:

I mean, I think it does because for example, what I'll say is, I know a lot of clinicians who will make use of the diagnosis: adjustment disorder. It could be adjustment disorder with mixed anxiety and depression symptoms. But really, to me, adjustment disorder is what these people specifically use to describe normal reactions to experiences of life, inclusive of oppression. So your job, your boss is racist and sexist, just misogynoir everywhere. You come to my office, you're describing me symptoms: adjustment disorder. Or you just lost access to stable housing: adjustment disorder. I've seen that as one way of combating this pressure to apply something by making use of some of those diagnostic labels that give you some flexibility.

Dr. Jessica Isom:

And then I've also seen people, not as many, make use of Z codes. I am still not making use of these on a consistent basis. And recently got a list from one of my colleagues, Dr. Francis Lu, who spent time going through the entire DSM, pulling out Z codes that are relevant to cultural or social issues. And that has been one way, for example, of naming lack of stable housing or naming racism or some form of discrimination (it's not racism), but some form of discrimination in the chart, which can feel like you're honoring more the patient's experience and your own. So those are two things that can be helpful.

Dr. Jessica Isom:

And at the same time, we are forced to, to certain extent, come to some conclusion about what's going on to make a case for this patient or client being appropriate for accessing us, so that there's such a transactional nature to the application of diagnostic label that we and the patient/client have to be complicit in to maintain our relationship through an insure-based system. Cash pay, obviously, you can kind of do whatever you would like to do there, I'm assuming. I don't do cash pay, but a lot of people do, and it's probably a bit less constrained in that particular treatment model.

Shimon Cohen:

Yeah. And then it can be an access issue for people, right?

Dr. Jessica Isom:

Mm-hmm.

Shimon Cohen:

Yeah. I think something that it just always comes down to is, this approach puts the problem inside the person. You know?

Dr. Jessica Isom:

Mm-hmm. Yeah. I know I've read a lot of things from people, not people, individuals and groups who are critical of psychiatry specifically and the mental health professions broadly, and I don't recall if someone specifically made use of the language gaslighting. However, as I've become more familiar with that language relevant to my own professions, developmental journey, training, where there's lots of gaslighting in there, I think it's applicable to how we interact with patients in the mental health profession, because it is. I mean, it's not genuine to say this is your... And for some people, it truly is MDD. You have major depressive disorder, you meet criteria, you have debilitating periods lasting a week or more where these are things that you experience and you cannot function or it's very difficult for you to do so.

Dr. Jessica Isom:

And at the same time, it can get a little bit murky where we're not also acknowledging that what's producing maybe a depressive episode or producing something that looks like MDD might very well be what you're exposed to in the environment around you, completely outside of your control. That's often not the conversation that we're having, which is why we often recommend individual-based things, like medication. You should exercise more, eat more healthy, find some friends, go get some sunlight, which doesn't really acknowledge the structural vulnerabilities that put them in a position to have that depressive episode in the first place potentially for that individual where it's a bit more complicated than just being vulnerable to depressive episodes.

Shimon Cohen:

Addressing the structures that are affecting- the oppressive structures is a huge challenge, right?

Dr. Jessica Isom:

Mm-hmm.

Shimon Cohen:

There's some interesting stuff around the clinician activist and kind of doing empowerment advocacy process with clients that I think is pretty interesting. And I've done some of that with youth I've worked with in the past. But it's always a challenge because if those systems were easy to change, they wouldn't still be there, affecting all of us. Right?

Dr. Jessica Isom:

Mm-hmm. Right, right. I think that the clinician activist role, I mean there could be a partnership in doing that and helping, supporting advocacy by leveraging credentials, which happens for me a lot. So for example, there's some slum landlord or a really slow to respond system or institution, and throwing around the credentials can help a response happen more quickly or more thoughtfully. Another activist orientation might be someone's presenting with workplace stress, and just naming that this is your environment, it's not you. And yes, you do have to cope, and at the same time, this is a hostile workplace and there are some rules and regulations that you're supposed to be able to make use of to protect you from that treatment. Or, someone's having a struggle with anxiety or ADHD and it's letting them know that, "Hey, there's this thing called the ADA and you can get access to accommodations in your workplace."

Dr. Jessica Isom:

Those sorts of things feel like they're more of that clinician activist intervention. And at the same time with very limited time and with the insurer's eyes on your chart, there's the expectation that you're going to go through and do a symptom assessment in a number of domains that may or may not be directly relevant to what's most distressing to that patient or client in the moment. So there's always this negotiation between, how am I going to use this 15 or 25 minutes or 60 minutes that I have to accomplish the goals that the insurer wants me to accomplish, but also accomplish something that's more meaningful to both me and the patient or client that I'm working with?

Shimon Cohen:

It's a lot to juggle.

Dr. Jessica Isom:

Yeah. It can be fun though, sticking it to the man. I'm like, "We're going to get them today. They're going to respond to this email, or they're going to see this letter and they're going to transfer you out of this housing that has rats and bed bugs." Those are the wins that feel good. And at the same time, those wins don't necessarily outnumber the not wins, the losses. So it is tough.

Shimon Cohen:

Yeah. I meant that juggling with the insurance part, the chart part.

Dr. Jessica Isom:

Oh, yeah.

Shimon Cohen:

But do you just say to the patient like, "Hey, this is the situation in terms of, we kind of have to cover what the insurance is looking at. But also, this is what I see is going on for you and you're telling me is going on for you. Let's figure out a way to make this all work"? Do you have that conversation with patients?

Dr. Jessica Isom:

Well, I might say things like, "These are the questions I have to ask. Just bear with me." Or depending on the level of acuity for the visit, I'll start off in a more conversational way, and then I'll reserve time towards the end or maybe towards the middle to dive into those questions that are sometimes more relevant to the insurer than they are to how the patient's doing in the moment. So it's kind of creating space for all those things at the same time and letting them know upfront, especially if they're like, "Whoa, where's this coming from?"

Dr. Jessica Isom:

"Look, I have to ask these questions. This is just how it is, so just bear with me and we'll get through these." But sometimes those questions are directly relevant to what they're presenting with, so it's just not that big of a deal. So it kind of varies. But I do think, I mean at least for me in the way that I practice, I want it to be more of a conversation than an interrogation. And I fortunately don't have to do 15-minute med checks, so I have more time for my follow-up visit. So there's that flexibility to do more of the check-in in addition to the check list that's required for documentation and billing purposes. So I feel lucky in that way.

Shimon Cohen:

Yeah. That sounds a great way to do it, the way you're describing there. So I wanted to talk about something that you wrote about recently where you left the American Psychiatric Association due to its unwillingness to address racism beyond statements. At least that's part of what I got from what you wrote in your position on that. I was just wondering if you wanted to talk a little bit about that.

Dr. Jessica Isom:

Yeah. It's interesting because I think a lot of people, well, not a lot of people, some people have dived into this, the water of naming institutional dynamics and trying to figure out a way to address them, more recently. And then there are people who've been doing it for a very long time, pre George Floyd. I think that's important to acknowledge, and I'm one of those people who's been doing it for a very long time, by choice and force based on how I'm positioned. So as a Black college student, as a Black medical student, as a Black resident, and now as a Black psychiatrist, there's this responsibility, and this is from the ancestors, but also from the institution, that you'll not only do your job but you'll also work to improve things currently for people like you and also those who come after you. So that arc is important to understand.

Dr. Jessica Isom:

So entering into the APA, it's like, "Okay, I've been doing this for how long. Okay. And now we're here, I've arrived and grown. I want to contribute to how the organization functions, its outputs, and how that can directly benefit people, even my own family who access psychiatry, and psychiatry's been a large part of keeping them functional." So it's also very personal too. I'm very optimistic. I always have been. I can be very enthusiastic and hopeful, and I brought that energy to the APA and got a lot out of it, especially early on, as far as networking and meeting people and getting a better understanding of the larger scope of the field. But as I got more into what some people have called, which I agree with, the pet-to-threat transition, things got a bit shakier. So it was less fun and engaging and a sort of enjoyable challenge and more of a tax in trying to work within the APA assembly, which is the governing body of the organization. And it wasn't fun anymore. It felt like taking hits.

Dr. Jessica Isom:

Although people would express, what I would say, a spectrum of authentic empathy and moral engagement with the issues I was talking about all the way to more performative empathy and performative moral engagement, after a while it was sort of like, "Well, either you walk the walk, or talk the talk." And there was a lot more talking than walking. Time is very limited. And as I've grown into being a mom, having that responsibility and also just doing other things outside of being in that one organization, I realize that we have to ration our time and be in places where our full value is appreciated and things of that nature. So if I notice at this point, and it's been this way for some time, if I notice that I'm not able to grow and expand, then I don't want to be there. So I was being more constrained than anything else.

Dr. Jessica Isom:

For me, looking back, I contributed a lot and I'm grateful for having had moments to contribute in spaces, to kind of insert my ideology in places that will live on forever, like modules and presentations and articles and things that. But at the same time, life is short. So if I'm going to intervene and make psychiatry something more useful to Black people, I have to be in places in spaces where that's more possible. So I wrote the piece to catalog that journey and that evolution and to offer some last suggestions, at least for now, about what things would need to change, but to just really be honest and authentic.

Dr. Jessica Isom:

So if I have a conversation with my daughter, 15 years from now, she can say, "Okay, you were true to yourself and you made a decision that was authentic to you and how you want to show up in the world." So that's kind of the arc of that particular story, which is not unique in any way, shape or form. And I got that feedback after I released it, that it spoke to and validated a lot of people's experiences in a number of different spaces.

Shimon Cohen:

For sure. DEI committees and things like that, so many spaces.

Dr. Jessica Isom:

Yeah. I mean, the thing that's fascinating about whiteness is that, if people only knew, and they do know, and that's why it's threatening, if they could fully appreciate the level of excellence required to exist in the same spaces as people who've been granted access to positions of power and privilege through some merits and a whole lot of whiteness, I think we would have different experiences.

Dr. Jessica Isom:

But in a very psychodynamic way, you can't be too good as a Black person, it's just not, it's not possible. It's just not. And you can't be too good and also be countercultural at the same time. You have to be non-threatening, which means not that good. And also, you have to be interested in kind of going with the flow of the dominant culture. So any person I know, and I talk to lots of people across the country, who are really good at what they do, they're excellent and are counter-cultural, they run into lots of trouble. And DEI spaces or DEIA spaces are one of those ways that it reveals itself. But even separate from that space, just being a good psychiatrist, who's a medical director, for example, and does no DEIA, you might run into some of the same difficulties because Black excellence is just not supposed to exist.

Shimon Cohen:

I'm just pausing because that is a powerful statement and a horrific reality.

Dr. Jessica Isom:

Yeah. And irrational, right? You, in a rational sense, want the best people for the job or want all hands on deck where people can contribute equally what they have to offer, but what racism distorts is a rational way of existing in relationship with other human beings. It does not make any sense. And I've come to accept that it does not make sense. I was just telling some residents today, it's not supposed to make sense. It's irrational. It absolutely makes no sense. And starting from that point helps, but it doesn't take away the real human reaction to having to exist with people who are being entirely irrational in their decision making and in their beliefs. But that's sanctioned by dominant culture. So yeah, a very young realization, an early career realization for me, which I appreciate because it will help me as I continue to grow in my career for future decades.

Shimon Cohen:

Yeah. One of the things that Eduardo Bonilla-Silva writes about is how racism and whiteness and that ideology is not rational and it will change to fit whatever white supremacy needs it to fit. And so it's always a challenge to expose it, to critique it and everything because it can just change and it's not a rational argument. Like you're saying, it can't be rational. And then the sick irony with what we're talking about is, you've got then irrational people who are running medicine, and then you talk about mental health and it's like, "So who's got the issue? Who's got the issue?"

Dr. Jessica Isom:

Right, right. And I have issues because I'm a human being, I've been through things, things have happened to me. I can appreciate the issues I possess in working through, and at the same time, society does not permit my issues to take over how I operate. I can't do that. I don't have the wiggle room to do that. I have to have my stuff over there, and I have to show up in the ways that I have to show up for the roles and responsibilities that I have. A lot of White people, specifically in positions of power, they have not had to do that. They can bring all of their issues into committees, work groups, meetings, and it's just all on the table and expect it to be processed as if it's a therapy moment, or even ignored as if it's not present. And that's very bizarre.

Dr. Jessica Isom:

Those kinds of things, again, those are happening in the APA as well. It gets really difficult for me personally to keep swallowing things that don't make sense because I am such a sense-making, sense-seeking person. I really struggle with things that just don't make sense. So I did write about some of that in the Medium piece, like for example, not being allowed to participate in spaces where I had demonstrated expertise. That doesn't make any sense, especially when it's alongside a expressed commitment to the very topic of DEI. And I think that just again represents the true ambivalence that most people in these organizations are walking around with.

Dr. Jessica Isom:

There's an external pressure to be empathetic towards and engaged with morally the issue, but there's not a real authentic engagement with it. There's not real empathy there. And that ambivalent shows up in this just really silly decision making around how to solve this identified problem of lacking diversity, not being inclusive, not being equitable. And that's why people just appear to be disturbed. If you just sit and watch as if it was a show on TV, people appear to be disturbed. They don't appear to be congruent in what they express and what they're actually doing. And I feel bad or I feel sympathy for that position, maybe a little bit of empathy, a little bit. For the most part, I feel much more empathy for the people who have to suffer the consequences.

Shimon Cohen:

A hundred percent. And when you were talking about that, about White people come in whatever spaces, bring in this issue, racism and all the multiple ways that manifest in various forms of oppression as well. But then if you say anything about it, it's like, "Come on now. We have to act civil. Come on now. Keep it professional." It's like, "You weren't civil and you weren't professional from the jump, but because it's normalized..." You know?

Dr. Jessica Isom:

Mm-hmm.

Shimon Cohen:

You say anything, you're the one with the problem. It's like, you're the one with the problem.

Dr. Jessica Isom:

Right. Right. I was talking about this recently with someone about what society could learn specifically from Black people and really any person and or group that exists on the margins, because being on the margins or being pushed to the margins requires you to tolerate a lot of things that those in the center don't have to. And by tolerate, I mean, restrain yourself and constrain yourself from your natural reactions to, for example, mistreatment. So if someone's disrespectful towards you or treats you with less dignity than you deserve, your natural human reaction would be to be corrective of that insult. It's just very interesting in professionalism conversations that it's actually split where we have to be the people on the margins. We have to be educated on professionalism. We have to be held accountable to professionalism. And if those people who believe themselves to be the utmost professionals, specifically White, often men, often cisgender, often the whole list, are often ones who get the most permission to be unprofessional.

Shimon Cohen:

Mm-hmm.

Dr. Jessica Isom:

And should we make a mistake ever in showing anything suggestive of our human response to disrespect or indignities, we'll be burned at the stake. So it's just so interesting how that racist perception of racialized minority groups distorts even the reality that we are forced to be the utmost professional because of our very existence on the margins. And there's a lot others could learn about that. Specifically, we were talking about earlier what people bring into meetings and committees and work groups, we don't- well, that's not true -we manage ourselves because there's a higher expectation that we will, and others have a capacity for managing themselves as well. But there's a disproportionate burden on some in that space versus others. So that's where things like fragility are a part of the discussion where a high level of emotional reactivity can be permitted in ways that just would never be allowed for other people.

Dr. Jessica Isom:

One specific example of this was, when I was in a meeting within the APA where I was talking under a high level of racial stress, I mean sweating, heart racing, brain going a hundred miles per hour, trying to articulate a point in a space where people were not really understanding the point, and someone comes off of their mic in this virtual space just to offer an annoyed sigh of frustration in the middle of a business meeting. I was like, I had to restrain Jessica from Fayetteville in that moment because I didn't have a choice, because should I break for my commitment to professionalism that would be a ding against my advocacy moment?

Dr. Jessica Isom:

Whereas this person was permitted to let out their full emotional experience in that moment of frustration with me and what I was advocating for, which was addressing cultural racism in the organization. So there's so many of those micro moments, micro meaning at the level of interpersonal moments that happen. And that's not often talked about in conversations where they're trying to teach often us how to be more professional. It's like, "No, we should teach you because we're really good at this, because we have to be."

Shimon Cohen:

Yeah, back to the racial gaslighting, right?

Dr. Jessica Isom:

Yeah. I was like, let me find out who sighed. I'm going to send you a stern email. Or we need to have a conversation about this offline because I want to sigh all the time, and I do but I turn my camera off and I keep myself muted and I just send an exasperated text because that's the professional thing to do, not to disrupt a meeting with my feelings, especially when they're misplaced.

Shimon Cohen:

Yeah, that is ridiculous, but that kind of stuff happens all the time.

Dr. Jessica Isom:

It does.

Shimon Cohen:

Like you said, all the time.

Dr. Jessica Isom:

Yeah.

Shimon Cohen:

As we're kind of getting towards wrapping up, I want to talk about healing and get your thoughts on healing, mental health, medicine and healing, and Black healing and Black joy and kind of how all that ties together for you.

Dr. Jessica Isom:

Yeah. I mean, there might be some elder person with lots of wisdom who would answer that question in a really beautiful way that suggests that they've gone through a journey of figuring out an answer and answer, maybe not the perfect answer. And I would say, for me, right now, like for most people, it's trying to figure out how to reconcile my desire for healing with the realities of my daily experience, which really doesn't create space for healing. I think there are ways of accessing it that are accessible such as meditative practices and things like that.

Dr. Jessica Isom:

I remember one meditation that's helped me in particular after a really, really high stress moment, especially racial trauma moments. It has been this meditation from a Black psychologist, is the Black Lives Matter meditation. It's 17 minutes, and I have cried every single time and that feels my healing. And all that she is saying in this meditation is that you're important, that you deserve to be loved, that you're intelligent. Just really countering what white supremacy rhetoric would convince you otherwise about your Blackness. Those things are really beautiful as representation of healing. And then mostly, as far as joy, it's just existing and commiserating and laughing at, finding some humor in our condition.

Dr. Jessica Isom:

So I was just doing that yesterday in Seattle with a group of four Black women, two neurologists, me the psychiatrist, and a medical student. We were talking about all kinds of stuff, and it was talking about authentically and openly and helping support each other in those moments. Just really not having to worry about the White gaze, specifically for me, can be very healing. And also, there's a lot of joy in that, and it just feels really good. So with the pandemic, not disappearing, but lessening. I'm personally looking forward to having more of those moments in real time, in real life with people, because those have been sustaining for me, and I need a lot more of those to survive 2022.

Dr. Jessica Isom:

But as a collective, I do think the organizing around addressing the larger system issues, the larger institutional issues is also a part of healing as well. Because we're not just intervening on individuals now, but we are creating something for our children, for our offspring. And I do find that to be really rewarding too. And there's literature based that supports that advocacy, like we talked about earlier, can be a helpful part of addressing living this life.

Shimon Cohen:

Yeah, like resistance as healing.

Dr. Jessica Isom:

Yeah. Yeah. What else is... Well, I will say, I will back up and say, if there was a hundred percent pie, how much of that pie should be devoted to resistance is also something I'm interrogating. I've heard really beautiful articulations of this from a really young Black woman. I think she's 19. And she was basically saying, maybe we don't need to resist 24/7. Maybe we just need to go eat a piece of pie, or watch a show on TV, or go out and look at the sky and not give a damn about anything for however long we want to. So I am also personally negotiating how much of my time I spend devoted to resistance versus existing. And I think that I'll have a more developed proportion as I continue on my own personal journey.

Shimon Cohen:

I so much appreciate you sharing your personal journey along with this professional journey and the work you do. And coming on here to talk with me and get your message out there to Doin' The Work listeners. And also, just to thank you for doing the work. The work you do is so critical.

Dr. Jessica Isom:

Yeah. Yeah. I mean, what else is there to do? Yes, eat pie.

Shimon Cohen:

I was going to say, eat pie, right?

Dr. Jessica Isom:

Yes. When you're given power and privilege, I'll say, when you earn access to power and privilege, what else is there to do with it besides contribute in some way? So yeah.

Shimon Cohen:

Thank you so much.

Dr. Jessica Isom:

You're welcome.

Shimon Cohen:

Thank you for listening to Doin' The Work: Frontline Stories of Social Change. I hope you enjoyed the podcast. Please follow on Twitter and leave positive reviews on iTunes. If you're interested in being a guest or know someone who's doing great work, please get in touch. Thank you for doing real work to make this world a better place.