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An Exploration of Implicit Racial Bias as a Source of Diagnostic Error

Abstract

Recent events led this author to realize that an error made during the Vietnam War by him and others had been due to focusing too narrowly on predisposing factors for PTSD while failing to consciously acknowledge acute systemic stressors. In not accepting that along with the stress of combat, Black troops daily experienced acute pervasive systemic racism, he failed to understand correctly their disproportionately higher levels of PTSD when compared to white troops. Motivating factors to examine this error included a recent movie by Spike Lee. Oral histories of Black veterans were then used to research the experience of Blacks in the military in two world wars and the Vietnam War. Little change in the treatment of Black service members was evident across the time frame which included WWI, WWII and the Vietnam War. An understanding of Shay’s concept of moral injury was found very valuable in understanding the consequences of PTSD.

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Correspondence to Edmund C. Levin.

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Edmund C. Levin, M.D., was an active staff member at the Alta Bates Medical Center from 1976 to 2001 and an affiliate staff member, since 2001. He is Chair of the ABMC Psychiatric Grand Rounds Committee, Department of Psychiatry.

Address correspondence to: Edmund C. Levin, M.D., 38 Seagull Drive, Richmond, CA 94804, USA. E-mail: eclevin@earthlink.net.

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Levin, E.C. An Exploration of Implicit Racial Bias as a Source of Diagnostic Error. Am J Psychoanal 81, 496–510 (2021). https://doi.org/10.1057/s11231-021-09327-6

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  • DOI: https://doi.org/10.1057/s11231-021-09327-6

Keywords

  • Vietnam
  • military
  • PTSD
  • moral injury
  • systemic racism
  • Black Lives Matter
  • pseudospeciation vs. cultural differences