“Get out of my face you Paki bastard or I’ll bang you out!”
I can smell the stale alcohol on his breath. Wiping the spit from my face, I carefully comply with his demand to back away.
I’m a consultant psychiatrist and I’m in in a police cell assessing one of my patients who has been picked up after threatening passers-by in Leeds city centre. He is suffering a relapse of his bipolar illness and my recommendation will be that he needs admission to hospital for treatment.
Whilst my priority is his mental health, somewhere deep down, the racist abuse does register. It always does. I grew up in Huddersfield in an era when the National Front marched the streets. One of my earliest memories is of a youth sporting a badly-shaved head and a colourful Union Jack T-shirt issuing a Nazi salute before spitting with disgust on my mum’s car. I was confused as to why he called us Pakis. Aged just six or seven, I didn’t know that “Paki” was an insult - it made no sense to me, my parents hailed from Sri Lanka not Pakistan!
The prevailing culture of my schooldays was shaped by alleged comedy gold like “Mind Your Language” and “Love Thy Neighbour”. The former peddled degrading racial stereotypes and the latter poked fun at the most xenophobic of the already xenophobic Brits. Bernard Manning was literally a comedy giant, Black football players and the race riots of the day provided him with staple material. And those warped views subtly permeated society. In childhood I heard them from figures of authority including my teachers and the police and I knew no better.
As a medical student, discrimination came in many guises, some of them surprising. Of course the P-word made a regular appearance but I do remember one cantankerous old chap on a chest ward who would only allow me to take his blood. The reason was that his dementia transported him back to his days in India and my white coat identified me as his favourite tea boy.
The issue of racism creates conflict for me. My oath as a psychiatrist is to provide the best care for patients under my care. I see people with psychosis who other services have failed to engage. Sometimes the racist vitriol bubbles to the surface only during breakdowns but it is always a quandary as to how much it reflects the individual’s underlying attitudes.
My faith helps me to reflect on all of this constructively. As a Buddhist I see another’s aversion towards my skin colour as stemming from a fear and ignorance of something alien to them and I have compassion for this. And as a psychiatrist I am curious to understand it better.
This can be uncomfortable but I have never refused to see a patient because of their racist views and I have never acceded to their requests to refer them to a white doctor. Somehow I have always managed to navigate my way through to the person beneath these hateful beliefs; ironically most patients don’t want to be discharged from my care when the time comes. Indeed some have become very interested in my culture particularly my religion.
That is not to say that I am an apologist for racism from those with mental illness. I do not shy away from challenging them and at times I have had to approach the police. Sadly their response to these hate crimes has usually left a lot to be desired; a mixture of minimisation, misconceptions about mental illness and a reluctance to pursue anything unlikely to lead to successful prosecution.
Let’s not kid ourselves that racism is yesterday’s news. Compared to other social attitudes, racism hasn’t changed much over the last thirty years. I have huge respect for the author Reni Eddo-Lodge but unlike her I won’t give up on talking to white people about race, because my experience has been that when I do, and when that connection is made, even the most shackled mind has the potential to be freed.