What Am I To Do With This Patient? Breathlessness, Everyday Life, and the Ordinary

 

by Pyar Seth

When I turned thirteen, I started walking to school. Not far. Certainly less than a mile. I liked it, especially on a nice, warm morning or afternoon. Music playing. I had a nice routine. As I prepared to walk home after basketball practice one afternoon, I saw my mother outside the gym.  By that time, I had been walking to and from school for well over a year. I was confused. She was scared. Trayvon. Police. Black. Breathless. She said it would bring her some peace of mind if she could start picking me up after practice. 

As I recalled the moment when my mother was parked outside of the gym, I reflected on my current research on race, health, and wellness, namely how stress can emerge through physiological processes commonly referred to as an “allostatic load” — the gradual wear and tear of stress on the body. I checked in with a friend of mine, a trained Black psychologist, and I asked him to reflect on his graduate training. “How would a psychologist respond to my mother, that is, a Black parent that could not find peace of mind or sleep at night because she worried that her son could have his life snatched by the state? What training did you receive on the depth of Black stress?” He laughed. “None.” 

What am I to do with this patient? 

This is a question posed by Franz Fanon (1964) in his essay “The North African Syndrome,” where he criticized how the French practiced medicine and psychology. He noticed that any complaint of illness or pain made by African people was often dismissed as whining or laziness. Most of the western world concluded that African people were destined to be less intelligent, less emotionally stable, and did not possess the rational capacities to effectively understand their bodies. On the contrary, Fanon recognized how racist thought undermined medical practice and worked toward a solution. Although his writing on social therapy came back inconclusive, he did not see his studies as worthless. He interwove psychological analyses with sociopolitical analyses, calling for the medical arena to develop a wellness intervention plan that could mediate Black pain, trauma, and suffering. Unfortunately, after Fanon passed at the young age of 36, few carried on his intellectual legacy and commitment to transdisciplinary research. 

Though my mother maintained a healthy lifestyle, she stressed. Constantly. “Each day you leave the house, I hold my breath a little bit. You are my heart that can walk and talk. I hurt knowing that I cannot protect you from everything this world has to offer.” To some, my mother is simply overprotective. Her breathlessness is not dramatic enough to compel attention; it does not reflect or constitute any rupture from the ordinary. Simultaneously, we know that stress has reached an epidemic level and that unidentified sequela of physiological and psychological stress can result in anxiety, depression, heart disease, cancer, and death. Most treatment of stress is pharmacologic and cannot be self-initiated. To create a low-cost, non-pharmacologic, self-administered intervention that can mitigate Black physiological and psychological stress, we would likely need to have some answer to the question that was earlier posed by Fanon. What am I to do with this patient? 

Amid a global pandemic that is ravaging through Black and Brown communities, my mother is doing well. When we speak on the phone, we laugh. We talk about school, family, to name a few. She is vaccinated. She is safe. She is proud of her son. As we conclude our check-in, I usually know what is next to come. “You are my heart that can walk and talk.” I wonder. What am I to do with this patient?