As a Black girl with lengthy, poofy hair, I used to be delighted to see Oregon be part of California and 11 other states which have handed legal guidelines in opposition to hair discrimination. In these states, workplaces and academic establishments can not legally discriminate in opposition to Black individuals for his or her hairstyles and hair texture.
Somewhat-discussed facet of hair discrimination is the way it can have an effect on medical care, one thing I started to significantly ponder in the course of the first 12 months of my psychiatry residency.
A part of the coaching for psych residents is to watch electroconvulsive therapy, or ECT. This medical process, carried out below normal anesthesia, delivers small electrical currents via the mind. It’s used to deal with a number of extreme psychiatric problems, together with extreme main despair that has not responded nicely to different remedies.
Though protected, ECT doesn’t come with out danger, and may trigger cognitive side effects, like reminiscence or speech issues that may generally final for months.
To carry out ECT, two electrodes are positioned on a affected person’s scalp in one of four arrangements: proper unilateral, bifrontal, bitemporal, or left anterior proper temporal placement (though this manner is used much less usually). The proper unilateral placement has fewer side effects, though it could be much less efficient. It is not uncommon to start out with the suitable unilateral placement, resulting from its decrease cognitive danger and, if it isn’t efficient, progress to one of many different approaches. Except, that’s, the affected person has voluminous, coiled hair, braids, or locs, like many Black individuals.
That’s as a result of the suitable unilateral method is the one one of many 4 that requires putting an electrode immediately on the scalp, which requires some hair manipulation.
As I watched a white nurse swiftly transfer apart a white affected person’s skinny, wispy hair to reveal the scalp with out the usage of a comb or detangling cream, I knew instantly that this methodology would by no means work on Afro-textured hair, the varied thick, coiled hair textures of many populations in Africa and throughout the African diaspora.
“How do sufferers get unilateral ECT if they’ve thick, curly hair or if their hair is braided or in locs?” I requested. The psychiatrist performing the process shrugged. “I don’t know. They don’t use that type, I assume. Or they’ve to alter their hair.”
I had many different questions however didn’t ask them as a result of I knew the reply: the employees was not routinely educated in put together Black hair for proper unilateral ECT.
I checked out an ECT electrode, which measures about 5 centimeters in diameter, in regards to the width of a enterprise card. It might not slot in between most braided hair types as a result of braids are sometimes shut collectively, so the electrode can be sitting on high of the braids as a substitute of on the scalp, which might be much less efficient. Even for individuals with unbraided Afro-textured hair, it might be troublesome to reveal sufficient of the scalp with out additional coaching or private expertise: First, as a result of Afro-textured hair is commonly thick and densely coiled, it can’t be moved apart to reveal the scalp with out the usage of hair merchandise and a comb. Second, the 5-centimeter electrode usually partially sits on high of the hair in addition to the scalp. With skinny hair that lies flat throughout the scalp, this gained’t considerably disrupt the sign. However with Afro-textured hair, which generally appears to defy gravity and prolong outward from the scalp, the sign will emerge additional away from the scalp and be much less efficient, or not efficient in any respect.
That’s why individuals with Afro-textured hair can be inspired to, because the psychiatrist I used to be observing mentioned, both change their hair or be disqualified from utilizing the unilateral type of ECT with fewer unwanted effects. That raised the query for me: Why ought to Black individuals should adapt to medical expertise that was not designed for them?
ECT expertise was clearly not made with Black hair in thoughts. However it isn’t alone. Different medical applied sciences, just like the electroencephalogram (EEG) to file mind exercise, have additionally not been designed with Black hair varieties in thoughts.
Black sufferers have been made to straighten their hair, which exposes it to warmth harm, and even to shave it, to be able to adapt to Eurocentric medical expertise. Others should prematurely take down their costly, braided hairstyles or their locs, which may end up in hair loss, to obtain unilateral ECT. Or employees members could also be unable to accurately half their hair, inflicting the electrode to be farther from the scalp, making the therapy much less efficient.
This perpetuates racism and white supremacy with devastating medical penalties for Black sufferers needing this last-chance remedy.
It would take some effort to rectify this.
It ought to begin with coaching people performing ECT to arrange Afro-textured hair for the process. Members of ECT staffs needs to be required to apply putting electrodes on completely different textures of hair, and ECT expertise firms ought to present this coaching when advertising and marketing their merchandise. When sufferers are referred for ECT, it needs to be commonplace protocol to advocate upfront that they put on sure braided hairstyles like widely-spaced cornrows that naturally expose enough scalp for electrode placement.
And if sufferers are unable to braid their hair into cornrows themselves, ECT employees needs to be educated to take action, simply as they’re educated to shave a affected person’s hair earlier than neurosurgery.
One other important repair is reformatting ECT electrodes, as has been done with different medical expertise, to raised accommodate thick, Afro-textured hair. Arnelle Etienne, a pupil at Carnegie Mellon College, noticed that the electrodes utilized in electroencephalogram expertise had been troublesome to put immediately on the scalp of people with Afro-textured hair, and developed electrode clips that would match between cornrows.
Psychiatry has an extended history of racism, from diagnosis to restraint use. Neuropsychiatric expertise needs to be added to the checklist. Denying Black sufferers entry to a safer type of therapy is unacceptable and unjust. It’s time to increase the imaginative and prescient of how Black hair racism shapes not solely the lives of individuals with hair like mine, however their medical care, too.
Amanda Pleasure Calhoun is an grownup/baby psychiatry resident on the Yale Baby Research Heart and Yale College of Drugs. She can be a Public Voices Fellow of the OpEd Mission at Yale College.