The notion of human dignity remains a relatively complex concept that has roots in classical Greek and Roman antiquity and links to religious teachings and Kantian philosophical notions. From the Latin dignitas, human dignity means worth and implies excellence and distinction. Human dignity, also found in 20th century constitutions and international declarations, has been considered in bioethics, general medicine, and psychiatry. The application of dignity to forensic psychiatry practice has received less attention. Through a review of texts in medicine and related fields, such as philosophy and anthropology, we aim to clarify the concept of human dignity and its application in forensic psychiatry practice. We first outline the historical origins of the term. We then consider several varieties of human dignity applied in medical ethics and psychiatry. We review individuals' lived experiences of indignity and dignity's place in forensic practice in different loci. We present recent scholarship related to human dignity and highlight the importance of dignity in forensic practice. Focusing on dignity in evaluator-evaluee and doctor -patient relationships should improve forensic work. Training in dignity -imbued forensic practice should remind us of the human dimensions of those we serve in the forensic arena.

Back to table of contents Previous article Next article On Mental Health, People, and PlacesFull AccessReflecting on ForgivenessEzra E.H. Griffith, M.D.Ezra E.H. Griffith, M.D.Published Online:25 Mar 2024https://doi.org/10.1176/appi.pn.2024.04.4.25I have been participating recently in a weekly group discussion with psychoanalysts. The talk generally focuses on scholarly writings of analysts, and sometimes others, who have been reflecting on race and its place in analytic discourse. I am indebted to this group's interest in and disciplined exploration of this intriguing arena of scholarship and clinical practice. In my case, it has meant expanding my intellectual horizons and engaging with a literature that, without explicit encouragement, I would probably have left untouched.Not long ago, the assigned reading was Chapter 12 ("After the Offense: Thoughts on Forgiveness") from Donald Moss's 2017 text At War With the Obvious: Disruptive Thinking in Psychoanalysis (Routledge). Moss is a well-known public intellectual who enjoys linking psychoanalysis to contemporary social and political problems. Our group selected this chapter for exploration because it focused on forgiveness, a theme we have encountered repeatedly in texts framing discrimination, caste, and privilege.In the chapter's introduction, Moss asserts that in the relation between any two people, "along with questions of retaliation, revenge, and punishment, the question of forgiveness emerges." He suggests that our ignorance of the term "forgiveness" stems from its lack of structured meaning, as well as from a plethora of interpretations that we attribute to it. Moss uses the film "Facing Fear" to help explain his frustration with our tendency to use terms, inexact as they are, to communicate the fundamental principles by which many of us live. The film's narrative portrays a young gay man's urban encounter with a group of skinheads. They get into a fight with the youth and mercilessly beat him almost to death while taunting him.Twenty years later, one of the skinheads and the victim of the attack realize that they are both working in the same museum. They eventually get past the chasm that separates them and start "working together, giving presentations on forgiveness." Moss comments that the short film "celebrates forgiveness without going into its workings … ." The film leans on and confirms the idea that this sort of forgiveness is "best treated at its face value of self-evident good." Our psychoanalyst-author is not pleased with this reflexive conventional outcome. He wants contemplation of a more balanced story that includes consideration of the gay man eschewing forgiveness and even planning some form of revenge. Moss proposes that the victim should be no more "obligated to forgive than he is to seek vengeance." He dismisses, somewhat casually, the notion that forgiveness should be seen as the film's hero, while revenge is sort of banished offscreen. He is similarly not pleased with the easy slide from forgiveness into strategic reconciliation, while vengeance is relegated ignominiously. Moss states that impulsive forgiveness or vengeance, while promising relief, is not the way of psychoanalysis. After the offense, there must be a pause that heralds the transformation of impulsive thinking, which is, I believe, his gift to us.Not surprisingly at all, Donald Moss employs case vignettes to be more persuasive. In doing so, he lapses into a specialized style of narrative that requires of us a disciplined familiarity with clinical praxis. However, at the end of his reflections, he concludes that the important goal for clinician and patient is "construction of a zone safe enough to promote separateness and thought." He underlines it. The essential task is for the patient "to find an exit from the … zone of pure reflex." Then will come nonreflexive possibilities for forgiveness and revenge.It seems to me an overly intellectualized demand. I thought psychoanalysis, with its renewed emphasis on the needs of the community, would engage a broader swath of citizenry with simpler tools. We want a reduction in vengeance, not a therapeutic interlude that exalts the analyst.Moss is persistent. He establishes a link to Fyodor Dostoevsky's famous The Brothers Karamazov and its account of Christ's encounter with the Grand Inquisitor. That interaction partially mimics the biblical description of the temptations of Jesus Christ found in the Gospels of Matthew, Mark, and Luke. Moss conjures up the turning of stone into bread, the question of Christ's protection by angels as he hurls himself from a height, and the offer of wealth in exchange for devil worship. After a long night of unsuccessful importuning by the Inquisitor, Jesus simply stands up, kisses the Inquisitor, and walks off. Moss asks us: "What do we do about this kiss?" He agrees we could interpret it as a kind of forgiveness, a convenient package all neatly tied up by Christianity. If we know that the "kiss means forgiveness, we will also know what forgiveness means."Moss is toying with us. He points out that there is nothing certain about the kiss. After all, there is no commentary and no hints about its qualities or the intentions of the kisser. Nevertheless, in a strange twist, he notes that Christ strikes a posture of love and offers the possibility of a new beginning, one that sets us on the task of forgiving. Yes, Jesus appears to take a long time to reflect before walking away. However, I think the more important point is that the posture of love precedes everything. It vitiates the theatricality of the pause and asks us to think more about the possibility of reflexive and impulsive charity, which mobilizes forgiveness. ■Ezra E.H. Griffith, M.D., is professor emeritus of psychiatry and African American Studies at Yale University. ISSUES NewArchived

In recent decades, there has been an evolution in forensic psychiatry and psychology toward closer examination of the professionals' attitudes and intentions in their practice. We theorize that the progressive change reflects increased attention to the experiences of evaluators and evaluees in their social worlds. This cultural focus complements the traditional emphasis on biomedical elements, such as neuropsychiatric disorders. We suggest that sociocultural factors (such as poverty, trauma, and sexual orientation) and ethnocultural factors (such as those related to ethnic status, discrimination, and racialized application of risk assessment) have contributed substantially to these developments in forensic practice. We utilize past and current literature to illustrate the change and to frame it as a way of improving practice. This is a call for forensic practitioners to enhance their awareness of the impact of social and ethnocultural factors. We recommend further examination of these ideas by training programs and broader scholarly discussion in educational forums.

Back to table of contents Previous article Next article On Mental Health, People, and PlacesFull AccessSeeing the World Through Writers’ EyesEzra E. H. Griffith, M.D.Ezra E. H. GriffithSearch for more papers by this author, M.D.Published Online:27 Oct 2022https://doi.org/10.1176/appi.pn.2022.11.11.24Almost two years ago, I wrote a column on psychiatric rehabilitation and creative writing (Creative Writing and Psychiatric Rehabilitation). It highlighted a program run by Fellowship Place, a health care agency serving adults and located in the Greater New Haven area of Connecticut. Their mission, as I said then, was wellness, independence, and meaningful living. Among their programs were those that promoted creative expression through painting, writing, and music. I was attracted once again to Fellowship’s literary journal, The Beacon, as I eyed the summer 2022 edition, wondering what the program’s writers were doing presently.The new issue reaffirms, in an invitation printed on the last page, that Fellowship’s Writers Group “is a safe space for writers from all genres and levels of experience to come together and share their work.” The reaffirmation was so simply stated and meaningful! I wondered whether it would garner more attention placed on the front page. In nine pages of text, 15 individuals produced a variety of writing forms: poetry, essays, and journalistic reports. One identifiable theme of this edition was summertime. Tim S. wrote of events from his youth: the visit of an ice cream truck to his neighborhood and a trip with his parents to see the Yankees play baseball in New York City. Schnaider T., describing a perfect summer day, could “hear the birds chirping and singing all types of melodies,” while the squirrels ran after each other and jumped in the air. Julie N. talked of creating a new holiday for her part of the country. Celebrants of the event would wear some sort of Mardi Gras costume. On rethinking, she allowed people to show up dressed as a teardrop, a wallflower, a unicorn, or anything else. There were perceptible elements of grace, freedom, and movement in these writers’ visions.I enjoy an author’s invitation to view an imaginary landscape while framing the story. On page 5 of this issue, Nicole K. and Desiree B. penned vignettes on the subject of “My Spirit Animal.” Nicole imagined being a lioness: eating a lot, hunting for food, swimming, fighting with siblings, exploring the environment. Desiree admired the beauty, grace, and delicacy of a monarch butterfly, sitting on flower petals and smelling their sweet fragrance. Connections between us and the fauna we encounter domestically and through films and our imagination continue to amaze me. We invest them with our hopes, love, dreams, and sometimes our deepest fears.The painting above is titled “Three Children With Fruit” by Jacques Richard Chéry. He is a 20th-century Haitian artist who is known for his humorous scenes of life and use of bright colors.Photo by Brigitte GriffithThere was also playfulness in the writing. On page 7, Nichole D. described the world waking up to the color yellow as the Beatles sang “Here Comes the Sun” and people recognized there was no ongoing war. Yolanda W. conceptualized a world seen in different shades of red. Attracted by its power, she framed the trees, grass, and flowers in dark red, fitted against a sky bathed in pink and purple, and a ground painted violet. I could not decide what my favorite color is, and I did not dare to imagine a uni-shaded universe. I have seen vast impressive fields of yellow sunflowers on trips to Europe and also been spellbound by the variegated canvases of southern European and Caribbean artists. The painting by Jacques Richard Chéry, a 20th-century Haitian artist, illustrates this combination of humor intermingled with bright colors. The result is a landscape of optimism and joy amid mundane country life.Lynda S. composed a short autobiographical essay on her proudest moment, “the design and creation of 12 stained glass windows for a Jewish temple.” She said proudly, “I designed the themed window from the Rabbi’s desires for his temple.” And the pride encompassed her family. “My family came down … for one installation and dedication ceremony. I’ll never forget the words my dad said to me … That had been the first time he ever said that he was proud of me.” I have recently been reading about the differences between intrinsic and extrinsic or attributed dignity. Many of us hear repeatedly about our inherent, inviolable dignity. We still long for social dignity, the dignity attributed by groups and people who are important to us. Parents play an important role in this ritual of attribution.I could not contain my curiosity about these writers and their personal worlds. Disentangling their writing processes from the themes they elaborated and the memories they evoked was complex and delicate. I liked their plainly spoken observations and the humanizing of traits found in life around them. Rereading their writing made me think of Anton Hart’s notions of radical openness and curiosity. The more genuinely curious I became, the more my connection to these writers grew. ■Ezra E. H. Griffith, M.D., is professor emeritus of psychiatry and African American Studies at Yale University. ISSUES NewArchived

Back to table of contents Previous article Next article On Mental Health, People, and PlacesFull AccessCreative Writing and Psychiatric RehabilitationEzra E. H. Griffith, M.D.Ezra E. H. GriffithSearch for more papers by this author, M.D.Published Online:1 Apr 2021https://doi.org/10.1176/appi.pn.2021.4.23These days it feels like a blessing to receive some positive news in my email inbox. This time it arrived in a message from Fellowship Place, a health care agency created well over 50 years ago. It has been serving adults living with mental illness in the Greater New Haven area of Connecticut. Fellowship, as many in the mental health community call it affectionately, is widely known for offering rehabilitation services that include supportive housing, vocational training, and homeless engagement. The objective is wellness, independence, and meaningful living. There are also programs that promote creative expression through painting, writing, and music. The email message contained the winter 2021 issue of The Beacon, Fellowship’s literary journal.Perusing the 10 pages of text brought back the pleasure I took in writing “Visibility in a Psychiatric Hospital’s Museum” (Psychiatric News). That column was an account of my visit to a painting exposition at Paris’s Sainte-Anne Psychiatric Hospital. The creative work had been done by individuals receiving care at the hospital. I remember thinking about the role of the visual arts in our treatment plans and the cost in human and financial resources, institutional commitment, building space, and the technical expertise of teachers.The Beacon is a wonderful example of what the engagement in writing can produce. About 14 individuals took part in this edition of the journal, which encompassed both poetry and short essays. Both forms of writing recounted personal experiences of times gone by and recollections of encounters with places and people. One prose piece talked of breeding a new, enormous vegetable from the cabbage family. Another author contemplated outer space as the last genealogical frontier. On the very first page of the journal, there was a note mentioning that some of the contributions were written while members of the group were confined during the COVID-19 pandemic. One writer mused about lessons learned from 2020, such as the acquisition of inner peace. Notice was taken of some similarity between the confinement and the movie story of Anne Frank. Someone regretted that COVID-19 had caused suspension of a theater group’s meetings, which resulted in a feeling of disrupted friendship. The loss was partly diminished by a cat’s companionship.I wondered whether one of the writing group’s exercises may have focused on personal identity, as several poets addressed the subject.Who do I want to be?I want to be a high school graduate.I want to be a Christian author.I want to be a loving wife, mother and friend.One writer was more contemplative:Sometimes I am confused.Sometimes I am confident.Most of the time, I am love.This is me too.Another invoked a sense of freedom:Who do I want to be?I want to be free.I want to be at peace.I want to be awake.This is who I am.This is who I want to be.This poet seemed focused on the goings-on within the environment:I enjoyed reading the writing quietly. Then I recited the language out loud and found myself transported by my soliloquy. The words took on life, and I could feel the writers’ reflection and imagination at work. In my reading, I grasped why experts like Deborah Philips, Liz Linington, and Debra Penman (Writing Well: Creative Writing and Mental Health, Jessica Kingsley, Philadelphia, 1999) recommend creative writing’s place in mental health therapeutics and rehabilitation. It facilitates the expression and management of memories, while also promoting trust and community. There is a positive effect on concentration and orientation. People who write note their enhanced sensitivity to others and awareness of their surroundings. This comes through practiced observation and imagination, as expressed in The Beacon.While basking in the warmth of a drowsy, blazing, hot sun,Friendly, furry, brown squirrels play, jump and run,Mating, multiplying, take a husband or wife,Eating acorns, and nuts,Surviving,Grasping hold of life,Swiftly climbing green leafy oak trees,Inhaling fresh air from a summer breeze,As colorful rainbows light up the sky with their smile,In their own language, squirrels sing the love song of the wild. ■Ezra E. H. Griffith, M.D., is professor emeritus of psychiatry and African American Studies at Yale University. ISSUES NewArchived

In the last year, medical organizations of all types have been declaring their opposition to structural racism.[1][1],[2][2] This has been catalyzed by the national conversation about race and the devastating deaths in police custody that reinvigorated it. Besides the general affirmations, medical

A major part of forensic psychiatry’s work is focused on framing stories about individuals who find their lives, for one reason or another, suddenly linked to the legal system. How did the story’s subject come to terms with the choice offered by the poet Robert Frost in his early 20th-century poem, “The Road Not Taken”? Contemplating the choice of diverging pathways, how did the evaluee choose one direction over another? Telling stories about these choices is an intriguing task. As the years have passed, I find there is also something to be said about reflecting on the lives of psychiatrists who have decided to practice their discipline at its intersection with the law. I believe time will make plain the literary, historical, and cultural significance of this type of narrativity in our work. In this essay, I write about Donna Marie Norris, an African-American forensic child psychiatrist. The current agitation in the United States attached to the unavoidable interaction of race, health matters, and injustice make her a natural subject for biographical inquiry. She is a highly visible psychiatrist, partly through her political activities in the American Psychiatric Association (APA). She has spent decades in that and other organizations influencing policy regarding the public’s mental health. Remarkably, too, the frankly political dimension of her career has not obliterated her activities in forensic psychiatry. I cannot help but think of Dr. Norris in the light of Senator Kamala Harris. They are black women whose achievements stand out against the harsh forces that have opposed forward and upward movement of black women for a long time in this country. After graduating from the Ohio State University School of Medicine in 1969, Donna Norris completed a one-year rotating internship in 1970. She recalled the medical school experience of caring for a depressed patient following the patient’s suicide Donna M. Norris, MD

Back to table of contents Previous article Next article On Mental Health, People, and PlacesFull AccessAncestral Dignity in Public MonumentsEzra E. H. Griffith, M.D.Ezra E. H. GriffithSearch for more papers by this author, M.D.Published Online:28 Mar 2023https://doi.org/10.1176/appi.pn.2023.04.4.26AbstractSome months ago, I wrote an article for this column about the removal of Lord Horatio Nelson’s (1758-1805) statue from a public square in Barbados. The political decision to uproot artistic evidence of the country’s long history of being colonized had generated much commentary throughout the island about dignity and identity. I ended the column with a reference to the Caribbean Nobel winner Derek Walcott, who had chastised Caribbean peoples for their envy of European statues and had urged them to contemplate the beauty of the Caribbean and other matters more relevant to their modern lives.The monument pictured above honors Clement Payne (1904-1941), a trade unionist who was named a National Hero of Barbados.Brigitte GriffithIn my most recent trip to Barbados, just about everybody urged me to visit the Golden Square Freedom Park. It was obvious that the creation of the park was an event that had galvanized a return to families and friends interrogating themselves about their roots, the meaning of their country’s independence from colonial masters, and who and what should be celebrated. Nelson was not even an afterthought in any of these discussions. I learned that in 1999, the Ministry of Education and Culture commissioned a group to develop a project that would celebrate individuals who had contributed to the island’s overall development. From my discussions, I understood this to include “unsung heroes” like the Amerindians who had inhabited the island before the arrival of the first British settlers, the indentured servants who were members of the island’s labor force, and the African enslaved persons and their descendants who had made contributions to the island’s progress.The two-acre park rests a stone’s throw away from the site previously occupied by the Nelson statue in Bridgetown, the capital city. The park’s inauguration occurred on November 29, 2021, a day before the island’s transformation into a parliamentary republic. We should remember that Barbados became independent from Great Britain on November 30, 1966. It is with these dates in mind that I reflected on friends’ urging me to visit the new space. Many of them were enthusiastic about describing their impressions and providing background information. Construction of the Freedom Park required demolition of several buildings that previously occupied the site. Not everybody was pleased with the decision.The Freedom Park was established in a working-class area of Bridgetown, where Clement Payne used to conduct mass meetings in the 1930s urging Black Barbadians to resist the White planter class. Clement Osbourne Payne was born in Trinidad to Barbadian parents in 1904. His parents apparently returned to Barbados with their young son around 1908. He progressively earned a reputation in Barbados as a trade unionist and advocate of social justice, especially after spending more time in late-1920s Trinidad sharpening his militancy. He was opposed by the White landowners and ultimately deported from Barbados on July 26, 1937, following the riots provoked by his political agitating. The statue of Clement Payne, shown in the photo, is an important symbol in Freedom Park and is accompanied by another monument nearby. The two make a collective memorial to the individuals who lost their lives or suffered in the struggle for freedom in the 1937 revolt.The “Builders of Barbados Wall” honors unsung heroes who contributed to the country’s development.Brigitte GriffithThe conceptual idea of unsung heroes mentioned earlier was concretized by the creation of the “Builders of Barbados Wall.” It is constructed from bricks on which are inscribed Barbadian surnames. The wall, shown in the photo, celebrates thousands of ordinary people who, although lacking fame or prominence, contributed to the development of Barbados over the past 600 years. Commentators have noted that the monument symbolizes an appreciation of ancestral dignity and illustrates a sense of belonging that everyone hopes can be cultivated in the island’s youth. It is considered an interactive method of bringing history to life.I did visit this new Golden Square Freedom Park. I stood and looked, walked around, and approached strangers to talk about this new development. Only one man, sitting on a bench absorbed in his private business, gave me a withering look. I left him alone. I watched small groups searching for their names, obviously absorbed in the task of self-recognition with satisfaction on their faces once the discovery was made. I heard regrets and concerns expressed about the park’s proximity to neighborhoods that needed refurbishing. This suggested to observers that the surrounding blight might engulf the park unless maintenance remained a central feature. There was clear understanding of what some have called a gospel of self-respect, enunciated by Clement Payne. There was talk, too, of the new theme of ancestral dignity evident as families searched for their names on the monument’s bricks. Like everybody else, I scrutinized bricks and felt satisfied when I discovered my name in its three Welsh versions: Griffith, Griffiths, and Griffin. It made me think about what my father and grandfather had contributed to the nation building. In any case, they had done more for Barbados than Lord Nelson. ■Ezra E. H. Griffith, M.D., is professor emeritus of psychiatry and African American Studies at Yale University. ISSUES NewArchived

A few years ago, I was invited to give a lecture at the Yale Law School on the performative dimensions of the forensic psychiatry report. Before I could even settle down to my task, a member of the law faculty approached me. She asked whether I knew Richard Dudley and placed a copy in my hands of

We analyze and comment on a legal case (Edward Gatherer v. Drexel Gomez, 1989) from Barbados. We theorize that in this kind of case a forensic psychiatrist consultant could helpfully advise the principals regarding pitfalls to avoid in resolving their conflict. Use of the consultant has certain advantages over taking such disputes to courts of law. In this case the rector of an Anglican Church in Barbados sued the bishop of his diocese. At question was whether the mandatory retirement age of 65 years applied to the rector. The case was eventually appealed to the United Kingdom's Judicial Committee of the Privy Council, and their decision was rendered in June 1992 in favor of the plaintiff. We describe a reference framework of techniques and methods that we think would be useful in this hypothetical forensic consultation. One important aspect of the analysis and case commentary is that going to court circumvents the obligation of those having disputes in this unique space to safeguard each other's dignity. The court system ignores reconciliation of the disputants to each other and to the Church body. We explore the complexity that attaches to transcultural forensic consultation.

Back to table of contents Previous article Next article On Mental Health, People, and PlacesFull AccessThe Steel Pan and Decolonizing Mental HealthEzra E. H. Griffith, M.D.Ezra E. H. GriffithSearch for more papers by this author, M.D.Published Online:24 Sep 2020https://doi.org/10.1176/appi.pn.2020.10a27AbstractIn an earlier column, I noted that the COVID-19 pandemic has stimulated my reflecting on articles published some time ago. Here I discuss a piece sent by a friend who has a deep interest in solving problems evoked by oppression and discrimination. The article, “Surviving Hating and Being Hated: Some Personal Thoughts About Racism From a Psychoanalytic Perspective,” was written by the psychoanalyst Kathleen Pogue White and published in Contemporary Psychoanalysis.Dr. White invites the reader to ponder “racial hatred.” She does not define it crisply. However, the clinical vignettes she provides evoke intense animosity or hostility. She calls hatred a common human experience, one that we fear and forces us into a collusion of silence. It is understood that, while her focus is on the racial context, people experience hatred and hating on other bases like gender, religion, language, and disability. She exhorts us to tear the veil off this taboo, get it out in the open. Let fresh air into the space. Our clinical work might improve. I suggest that so may our social interactions and political discourse.She sees three ways of thinking about racial hatred: being hated, hating the self, and hating the other. She emphasizes that her model derives from her experiences. For the first concept, she tells us about her kindergarten interaction with a nun. The nun asked whether anyone could read. Young Kathleen put her hand up to announce her achievement in reading. The nun replied that her pupil was not telling the truth. Dr. White goes through some psychoanalytic commentary before concluding that the nun had “spewed venom on a little person. …” The hatred continued as the teacher persisted in calling her “a rotten apple” throughout grade school. The analyst-author explains that there is a strategy for surviving this hatred: recognizing the projection from the nun, getting angry, and turning it back. So much for the problem of being hated.White employs similar brief stories in talking about hating the self, which she defines as the internalization of “pernicious, destructive attributions and projections.” Her explication of these processes is important. She wants to assure us that the psychoanalytic method may offer a pathway to healing. I reminded myself that there must be a role for positive experiences coming from others around us: at home, work, and leisure, for example.Steel pans stand ready for a concert at St. James Parish Church in Barbados.R.C. Grantham ArchitectWhite’s third way of thinking about hatred has to do with hating the other: “re-externalizing malignant projections and regarding the projective source with extreme hostility.” This response is variable, as we all know. It may take the form of a quiet rebuke, a serene sit-in, a rambunctious march, or a frightening manifestation of plundering and violence. She calmly wonders what internal pressures on whites colonizing America may have caused them to hate Blacks and other groups, with resulting revulsion and outright murder. She suggests the mayhem of those early colonizing years may have been produced by the toxicity involved in the colonizers’ expulsion from their original countries. She invites white people to mull this problem over, as she lays bare her own pronounced hatred toward whites.Kathleen White leaves the meaty challenges for last. She notes, “For blacks to come out of collusive racial self-hatred, we have to take back the good projections (white is good) and tolerate the experience of our own self-hatred (black is bad). For whites to break the collusion of racial hating, they have to take back the bad projections (black is bad) and tolerate the experience of whatever self-hatred they experience as a result.” These recommendations are complicated by our traditions and habits, White points out. We are accustomed to reflecting on what it means to be Black. Now, how about considering the experience of being white?Other scholars have been recognizing this new turn in our field, leading to a renewed exploration of “white privilege.” My late colleague Professor Frederick Hickling had for some years been using the term “European-American psychosis.” He raised questions about the birth of this delusional idea that whites are inherently superior to everybody else. In her Fanon-esque psychoanalytic model, White points out that both the oppressor and oppressed are caught up in a collusion related to racial hatred. Unraveling it requires a joint agreement to self-examine. It is a tough assignment, as we are inclined to attack the blameworthy other. White wants more than that, although she concedes she may not see it in her lifetime. She urges us to end the bilateral self-hating legacy of racism. The crucial first step is for us to talk about it. ■“Surviving Hating and Being Hated: Some Personal Thoughts About Racism From a Psychoanalytic Perspective” is posted here.Ezra E. H. Griffith, M.D., is professor emeritus of psychiatry and African American Studies at Yale University. ISSUES NewArchived

Back to table of contents Previous article Next article On Mental Health, People, and PlacesFull AccessCelebrating Psychiatric Health and PlaceEzra E. H. Griffith, M.D.Ezra E. H. GriffithSearch for more papers by this author, M.D.Published Online:15 Jul 2019https://doi.org/10.1176/appi.pn.2019.7b11AbstractI welcome you to this new column in Psychiatric News. I hope you will find my periodic excursions enjoyable and instructive. I will focus on exploring the connections of mental health, people, and places.The interconnectedness of these elements is constantly on show in current multidisciplinary discourse. For example, the Nobel Laureate Derek Walcott described his search for home, with tropical St. Lucia as his reference point. There, sunlight and sea transformed his body and made it sing and hum. Mindy Fullilove, M.D., a professor of urban policy and health at the New School for Public Engagement, described how the bulldozing of a city’s neighborhoods can produce stress reactions in people who had lost their homes in such brutalizing urban renewal. Michael Rowe, Ph.D., a Yale professor and mental health theorist, has explored what factors enhance or impede the successful reintegration of severely mentally ill patients into their home communities after an acute phase of illness. Some of those factors are intra-psychic and others environmental. All are related to the patients’ regaining the skills to return to the rights and privileges of community citizenship.These examples demonstrate that “geography” has become increasingly connected to both general and psychiatric health. “Geography” represents the construct of place, space, landscape, or terrain. In recent years, medical anthropology and medical geography have taken the lead in the relevant scholarship that clarifies the interaction of place and both general medical and psychiatric health. It is accepted that the idea of a healing environment encompasses the physical dimensions of the space as well as the enactments and rituals related to biomedicine that take place within the space. That is why home-space becomes a healing environment when family members participate meaningfully in their caregiving roles. Currently, many religious groups are expanding their remit and redefining their commitment to becoming healing communities.The Danielle-Mitterand garden in Rue de Bièvre, Paris.R. C. Grantham ArchitectI visited a recent exhibition titled “Personal Geographies” at the Yale Center for British Art. The focus was the English painter Eileen Hogan (born 1946), whose work combines attention to portraits and landscapes. Her visual presentations captured individuals interacting with their unique spaces. It was left to the viewer to divine the quality of the interaction between these two fundamental elements. For example, one portrait revealed Britain’s Prince of Wales, without necktie, sitting at his desk in a naturalistic, informal home setting, attending to correspondence. Conveying measured relaxation and a modicum of task-oriented activity, it illustrated the therapeutic aspects of limited work or active leisure.Hogan also spent time painting unique dimensions of public parks in Britain. In commentary on the exhibition, she explained that she had sought opinions from the public of their preferred park areas. So, for example, she painted an intimate and personal pathway surrounded by lush greenery; on another canvas, she highlighted the simple gushing of silvery water from a three-foot-high sprinkler. Both scenes evoked images of nature catalyzing reverie and healing calm. Art critic Kathy Czepiel in The Daily Nutmeg New Haven (June 14, 2019) explained that “Hogan’s ability helps us see places and people both as they are and in a new light.”These thoughts reminded me of my attraction to the Danielle-Mitterand garden in Rue de Bièvre, a narrow street located in Paris’s 5th arrondissement. This tiny park, named after the wife of a French president, offers a tranquil space away from mundane pressure to rest, recuperate, and think about those one loves. I don’t wield a paintbrush of any sort. But there, I have been urged to wonder at the magical effect of the architect’s and urban planner’s work on my mood. At those times, I inevitably return to the work of Chester Pierce, M.D., the Harvard public health intellectual. He advanced the notion of extreme environments like prisons and submarines, comparing them, not surprisingly, to America’s urban ghettos and their detrimental psychological effects. Environments can affect psychological healing processes. ■Ezra E. H. Griffith, M.D., is professor emeritus of psychiatry and African American Studies at Yale University. ISSUES NewArchived

Back to table of contents Previous article Next article On Mental Health, People, and PlacesFull AccessThe Silence of the DeafEzra E. H. Griffith, M.D.Ezra E. H. GriffithSearch for more papers by this author, M.D.Published Online:10 Oct 2019https://doi.org/10.1176/appi.pn.2019.10a8Several decades have gone by since that morning when I passed him the ball. He ran into a forward position from the left wing, but diagonally, and stretched out his left arm at a slight upward slant so I could see it. Neither of us wanted to attract attention from the opposing team. He couldn’t verbally ask for the ball anyway, as he couldn’t speak. I didn’t say anything because he couldn’t hear. As he turned to straighten his position toward the goal, I kicked the ball to his right with what soccer aficionados call a perfectly weighted pass. The ball passed him with the initial speed. As he moved more quickly, and the ball slowed down, he was on track to connect with it in about 10 yards. He reached it and shot it into the net in a one-touch move. What a beauty! After the game, he came toward me. Five yards away, he stopped, clasping both hands at chest level with palms touching each other. He bowed with a grin that said thanks, and I returned the gesture. For a single special moment, I had entered the silent world of the deaf.That distant memory came back to me as I entered the Pantheon in Paris this summer to visit the exposition “L’Histoire Silencieuse des Sourds” (“The Silent History of the Deaf”). The displays recounted a brief history of the deaf in France with occasional allusions to what had taken place in the United States. At first, I found “silent” in the title puzzling. However, as I proceeded with the visit, things got clearer. In some cases, a child’s deafness is picked up very late by the family, and the youngster never develops speech and other communication skills. Thus, the child remains isolated in a uniquely silent community. I’ve also noticed how some older folk, losing their capacity to hear, avoid seeking medical help to adapt to the incipient disability. The result is progressive isolation in an environment of decreasing social interaction and increasing silence. The exposition’s title also invites reflection on the world of silence inhabited by many of those suffering from severe mental and other chronic illnesses and those in extreme environments such as the segregated units of prisons. At first, the retreat may be comforting. But soon, the deterioration of important social and cognitive skills becomes a problem.The exposition shone a light on my ignorance. I was not fluent in the theoretical connections between the sign language used by the deaf and mechanisms developed by monks of the Middle Ages who lived in silence. I was embarrassed that as a forensic psychiatrist I had never heard of the late-18th century French case of Madeleine Le Mansois (1750-1826). At the time, she appealed to the highest court in the land to overturn a lower court ruling that had stopped her from marrying the man of her choice because of her disability. She won the case, aiding in the development of the concept of “free consent” with regard to matrimony, so long as a woman could make her preference clear. At least I had heard of the advocacy movement that the exposition had termed “deaf militancy.” The movement focused on a language for the deaf that would help them acquire skills for social, intellectual, and cultural situations.I have spent a substantial part of my professional life fighting on behalf of disadvantaged groups. But, partly because of their small numbers in the system, a fraction of that time has involved representation of those who cannot hear. I recalled how difficult it had been for me to obtain optimal psychiatric care for several hospitalized patients with severe hearing impairment. I had to represent their needs formally to the administration and insist that outside experts be hired to carry out specialized assessments and provide care. In my experience, many caregivers lack the requisite training. Few of my colleagues have mastered the art of signing and immersed themselves in the culture of the deaf.I shall remember the scene at the Pantheon’s exposition. Individuals with hearing impairments were well represented, visible by their vigorous signing to each other, obviously discussing the salient points of each presentation. Their relaxed appearance said they felt they belonged there—and indeed they did. They were signifying and celebrating, proud that curators wanted to feature historic contributions to the culture of the deaf. ■Ezra E. H. Griffith, M.D., is professor emeritus of psychiatry and African-American Studies at Yale University. ISSUES NewArchived