Suzanne Smith was an elderly white woman who experienced a violent assault some odd years ago. Since then, she’d never been quite the same. Plagued by fears and sleepless nights, the concepts of medicine and psychotherapy were alien to her, and from my understanding in speaking to her children prior to her coming in, she wasn’t keen on speaking to medical professionals. The sole catalyst of her winding up in my office: the passing of her husband. With her life partner departed and no other avenues to turn to, her children pushed her to meet with a psychiatrist. She did so, as reluctantly as one could, I imagine.
When she walked into my office, she looked fragile. A delicate pace underscored her hesitation with it all. She slowly found her seat, looking at me with eyes that exuded fear. I had of course seen patients like her before. It’s hard to disentangle the empathy and emotion you feel looking into someone’s eyes, especially when you need to be an objective and analytic clinician. But I try to do so as much as humanly possible. A shrink shouldn’t have their judgment clouded by emotion, despite immersing themselves in it day in and day out.
I introduced myself. She introduced herself. A few moments of silence passed as she looked at me and the decor in my office and fiddled with her purse before resting her gaze back on me. I didn’t want to push. I’d let her start the conversation and tell me her story. I’d gone into psychiatry for moments like these. Moments of unimaginable tension where I could make a difference. I could help her, maybe. I didn’t want to botch things and fail her.
As her eyes eased and she began to breathe comfortably, she said, “I…I’m glad you’re not one of them….” It was said with an air of suspicion and paranoia. I didn’t understand. Did I read the wrong chart?
“One of who?” I asked.
“The immigrants. Like the other doctors that work here.”
She was referring to my colleagues. ”Why is that?”
“They scare me, and I can’t understand them. And they’re Islamic or Arab, or Lord knows what. I don’t know what’s going through their heads. I’m sure they’re smart, but I don’t want to deal with them. No.”
It took me a moment to digest what she’d said. In truth, I momentarily thought she was talking about me. Because the irony here was that my colleagues were neither Arabs nor Muslims, but I was both.
While I’ve certainly had to experience racism throughout my career, it had never taken me off guard in such a peculiar way. And never from someone I’ve had such a power differential with. For a moment, I didn’t know what to do. Do I just treat her? Do I defend my coworkers—or my ethno-religious background? That would destroy any chance of rapport I had with her. And aren’t I here, sitting in my seat, ready to listen and take action, for her? And what if she finds out that I’m an Arab? My last name is ambiguous enough, but I don’t know that Ibrahim is. Would she even know what an Ibrahim is?
“I gotcha. Let’s talk about why you’re here….” and with that, the conversation moved on. We never went back to it. I treated her and prescribed medications. She ultimately trusted me, took her medications and began improving. She also saw the white therapist that I very cognizantly referred her to. She slept better and, in her old age, reclaimed a portion of her life that she’d lost. But the encounter stayed with me longer than I expected it to.
What exactly was my role here? I certainly have an obligation to rebuke xenophobia, but is it my obligation to my patients’ suffering that I should put first? In that instance, I thought so. But what exactly am I supposed to treat as a psychiatrist?
I still think back to that interaction from time to time, knowing that I hadn’t failed my patient (at least on a superficial level), but wondering if I had failed myself.