How Black hair racism affects mental health care – Boston, Massachusetts


Boston, Massachusetts 2022-01-26 04:40:59 –

ABlack woman with long and fluffy hair, I was happy to see Oregon Join California and 11 other states Passed a law against hair discrimination. In these states, workplaces and educational institutions are no longer able to legally discriminate against blacks by hairstyle or texture.

A slightly discussed aspect of hair discrimination is how it affects medical care. This is what I started thinking seriously in the first year of psychiatric training.

Part of the training for psychiatrists is to observe Electroconvulsive therapy, Or ECT. This medical procedure, performed under general anesthesia, carries a small electric current through the brain. It is used to treat multiple severe mental disorders, including severe major depression that has failed to respond well to other treatments.


Although safe, ECT cannot be achieved without risk and can be a cause Cognitive side effectsSometimes, like memory and speech problems, it can last for months.

To perform ECT, place two electrodes on the patient’s scalp. One of four arrangements: Right unilateral, binaural, binaural, or left anterior-right side arrangement (although this format is rarely used).For correct one-sided placement Less side effects, Although the effect may be low. Due to the low cognitive risk, it is common to start with the correct one-sided placement, and if that is not effective, proceed to one of the other approaches. That is, unless the patient has voluminous coiled hair, braids, or places, like many blacks.


This is because the correct one-sided approach is one of four that requires the electrodes to be placed directly on the scalp and requires hair manipulation.

Watching a Caucasian nurse quickly set aside the thin, supple hair of a Caucasian patient to expose the scalp without the use of combs or untangling cream, this method is a variety of thick and coiled. I quickly learned that afro-textured hair had no effect. Hair texture of many populations throughout Africa and the African diaspora.

“If the patient has thick, curly hair, or if the hair is braided or in place, how does the patient receive unilateral ECT?” I asked. The psychiatrist performing the procedure shrugged. “I don’t know. I don’t think they use that shape, or they have to change their hair.”

I asked many other questions, but I didn’t because I knew the answer. The staff was not regularly trained on how to prepare black hair for the right one-sided ECT.

I saw an ECT electrode about 5 cm in diameter and about the width of a business card. Because the braids are often close to each other, they don’t fit between most braid hairstyles, so the electrodes are placed on the braids rather than the scalp, reducing their effectiveness. Even for people with unbraided Afro textured hair, it is difficult to fully expose the scalp without additional training or personal experience. First, Afro-textured hair is often thick and tightly wrapped, so it cannot be moved aside to expose the scalp. Without the use of hair care products or combs. Second, 5 cm electrodes are often partially placed on the hair as well as on the scalp. With fine hair lying flat across the scalp, this does not significantly confuse the signal. However, for afro-textured hair that appears to extend outward from the scalp against gravity, the signal appears further away from the scalp, reducing or having no effect.

Therefore, as the psychiatrist I was observing said, people with afro-textured hair are advised to change their hair or disqualify the use of one-sided ECT with less side effects. It questioned me: why do blacks have to adapt to medical technologies that are not designed for them?

Clearly, ECT technology was not created with black hair in mind. But that’s not all. Other medical technologies, such as EEG, which records brain activity, have not been designed with black hair types in mind.

Black patients Straightened Their hair is exposed to heat damage and even shaved to adapt to European-centric medical technology. Others need to prematurely remove expensive braided hairstyles or areas that can cause hair loss in order to receive one-sided ECT. Alternatively, the staff may not be able to separate the hair properly and the electrodes may move away from the scalp, reducing the effectiveness of the treatment.

This perpetuates racism and white supremacism and has devastating medical consequences for black patients in need of this last chance therapy.

It takes some effort to fix this.

It should start by training the individual performing the ECT to prepare the afro textured hair for the procedure. Members of the ECT staff need to practice placing electrodes on various hairs. ECT technology companies need to provide this training when selling their products. When a patient is referred to ECT, it should be a standard protocol to recommend in advance to naturally wear certain braided hairstyles such as wide-spaced cornrows. Exposing enough scalp to place electrodes..

Also, if the patient is unable to braid himself into cornrows, ECT staff should be trained to do so, just as they are trained to shave the patient before neurosurgery. ..

Another important fix is ​​the reform of the ECT electrode. Is done Uses other medical techniques to handle thick afro textured hair well. Arnelle Etienne, a student at Carnegie Mellon University, has observed that it is difficult to place the electrodes used in EEG technology directly on the scalp of a person with afro-textured hair. Developed electrode clip It can fit between cornrows.

Long in psychiatry History of racism, from diagnose To Restraint use.. Neuropsychiatric techniques need to be added to the list. It is unacceptable and unjustified to refuse to make safer treatments available to black patients. It’s time to expand the vision of how black-haired racism will shape not only the lives of people with hair like me, but their medical care.

Amanda Joycal Horn is an adult / child psychiatrist resident at the Yale Children’s Research Center and Yale School of Medicine. She is also a Public Voice Fellow for the OpEd project at Yale University.

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