A Turbulent World.
A Turbulent World.
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动荡的世界。
DOI：
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发表时间：
2020
影响因子：
1.9
通讯作者：
J. Oldham
中科院分区：
文献类型：
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作者：
J. Oldham
2020年7月当我写这些话的时候，在2020年6月初，我国大部分主要城市的街道上挤满了愤怒的人群，抗议明尼阿波利斯的非裔美国公民乔治弗洛伊德死于警察之手。从录像中可以看到，警察的这起残忍谋杀令人毛骨悚然，全国的强烈抗议也不足为奇。当然，这不是我们国家第一次发生这种针对非裔美国人的危险暴行，远非如此，愤怒和怨恨的海啸随时都会爆发，比如弗洛伊德悲剧登上头条的那一刻。但这些不是随机的时间;他们是COVID-19时代，当悲剧打击来自代表性不足的群体的公民，特别是非洲裔美国人，不成比例地严重。美国疾病控制中心（CDC）4月22日的一份报告指出，“目前的数据表明，种族和少数民族群体的疾病和死亡负担不成比例。”报告还指出，“在有种族和族裔数据的COVID-19死亡人数中，纽约市确定的黑人/非裔美国人（每10万人口中有92.3人死亡）和西班牙裔/拉丁裔人（74.3人死亡）的死亡率大大高于白色人（45.2人）或亚洲人（34.5人）。”[1] CDC概述了造成这些差异的假定因素，包括生活条件、工作环境、基本健康状况和获得医疗服务的机会较低。因此，在种族偏见的预先存在和持续的力量之上，对于那些靠薪水生存的人来说，不需要太多的想象力就可以考虑失业的压力，黯淡和不确定的未来，以及对驱逐和无家可归的恐惧。正如米歇尔·戈德堡在5月30日《纽约时报》的一篇专栏文章中所说，“美国是一个火药盒。”2提到全国各地广泛的抗议示威，戈德堡强调，他们“是由警察暴力的具体事件引发的，但他们也发生在广泛的健康和经济破坏的背景下，有色人种，特别是那些穷人，承受了不成比例的压力。我希望，到《华尔街日报》7月号出版时，示威活动的热度已经消退，但更重要的是，正在制定建设性的新两党战略，以解决这些棘手和持续存在的不平等问题，而且这一流行病已经开始消退。然而，在好消息方面，我要祝贺我们年度住院医师论文竞赛的获奖者蒂娜·托马斯博士，以及她的合著者斯科特·莱恩博士、拉尼亚·埃尔哈提布博士、简·汉密尔顿博士和特蕾莎·皮戈特博士。沿着。具有讽刺意味的是，鉴于我上面的评论，这篇获奖论文的标题是“种族，虐待史和无家可归与精神病住院治疗期间的强制药物管理有关”，所以这项研究的重点不能更相关。重点是使用武力-在这种情况下，在提供同情心护理的背景下-以及这种干预是否也不成比例地用于有色人种。作者发现，强迫用药“更有可能在少数民族（非洲裔美国人）、无家可归和/或有虐待史的精神病住院患者中实施。”作者对这些相关问题进行了深思熟虑的讨论，并强调了“文化能力和创伤护理的重要性”。同样在本期杂志中，在我们的法律和精神病学专栏中，Wortzel和他的同事讨论了“暴力的治疗风险管理：临床风险评估”，这是关于这个主题的一系列专栏中的第一个，这总是至关重要的，但从来没有像在这些动荡的时代那样多。
July, 2020. As I write these words, in early June, 2020, the streets of most of the major cities in our country are jammed with angry crowds, protesting the death, at the hands of the police, of George Floyd, an African American citizen of Minneapolis. Graphically recorded on video, this brutal murder by police is horrifying to see, and the national outcry is no surprise. It’s not, of course, the first time such dangerous brutality perpetrated against African Americans has occurred in our country, far from it, and a tsunami of anger and resentment was ready to boil over at any moment, such as the moment the Floyd tragedy hit the headlines. But these are not random times; they’re COVID-19 times, when tragedy is hitting citizens from underrepresented groups, particularly African Americans, disproportionately hard. An April 22 report from the US Centers for Disease Control (CDC) stated that “current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups.” The report also noted that “Among COVID-19 deaths for which race and ethnicity data were available, New York City identified death rates among Black/African American persons (92.3 deaths per 100,000 population) and Hispanic/Latino persons (74.3) that were substantially higher than that of white (45.2) or Asian (34.5) persons.”1 The CDC presents a synopsis of presumed contributing factors to these disparities, involving living conditions, work circumstances, underlying health conditions, and lower access to care. So on top of the preexisting and ongoing forces of racial bias, it doesn’t take much imagination to consider, for those who survive paycheck to paycheck, the stress-to-the-breaking-point of unemployment, a bleak and uncertain future, and fears of eviction and homelessness. As Michelle Goldberg put it in an op-ed piece in the NY Times on May 30, “America is a Tinderbox.”2 Referring to the widespread protest demonstrations throughout the country, Goldberg emphasized that they “were sparked by specific instances of police violence, but they also take place in a context of widespread health and economic devastation that’s been disproportionately borne by people of color, especially those who are poor.” I hope that by the time the July issue of the Journal is published, the fever pitch of the demonstrations has subsided, but more importantly that constructive new bipartisan strategies are being developed to work on these thorny and persistent problems of disparity, and that the pandemic has begun to ebb. On the good news side, however, I would like to congratulate the winners of our annual resident paper competition, Dr Tina Thomas, along with her co-authors Drs Scott Lane, Rania Elkhatib, Jane Hamilton, and Teresa Pigott. Ironically, given my comments above, the title of this winning paper is “Race, History of Abuse, and Homelessness Are Associated With Forced Medication Administration During Psychiatric Inpatient Care,” so the focus of this study could not be more relevant. And the focus is on the use of force—in this case in the context of providing compassionate care—and whether or not this intervention is also used disproportionately in people of color. The authors found that forced medication was “more likely to be instituted in psychiatric inpatients who are of a minority race (African Americans), are in a homeless living situation, and/or have a history of abuse.” The authors provide a thoughtful discussion of these concerning issues and emphasize the “importance of culturally competent and trauma-focused care.” Also in this issue of the Journal, in our Law and Psychiatry Column, Wortzel and colleagues discuss “Therapeutic Risk Management for Violence: Clinical Risk Assessment,” which is the first of a series of columns on this topic—one that is always of critical importance, but never so much as in these turbulent times.