Chapter Seven

Third World Students in the Gauntlet

The Etiology and Symtomatology of Emotional Problems in Black Medical Students

Allyce Gullattee, M.D.

Transcription of Recording of Speech Delivered
10th SNMA Conference/Convention

I don't think whites appreciate how trying and difficult it is to spend 24 hours around them.

Therapeutic Reflection - when I want to get away from a situation that will not support my particular image of myself I use this to reflect upon my self. [This being recording of blues songs] Wherever there are those of you living in an environment which does not have a critical mass of Black students to have just such a reflective tool to reflect upon yourself.

A tool for therapeutic reflection becomes important because it is important for Black students to find a therapeutic environment in white schools.

Our students have been trapped in an environment where they have undergone constant cultural shock.

Critical Mass of Black - the number of Black students necessary in order to support the presence of other Blacks so that at least in number there is some feeling of unity. When there is not a critical

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mass of Blacks the student tends to feel somewhat alienated. Where there are few in number or few in terms of sexual groups you may find yourself put in a very precarious position. Where there are only a few Black women in an environment where there are a gross number of white men, there is obviously going to be a deal of social pressure on the person which have to do with problems of identity which have to do with negative image of self which have to do with the entire environmental syndrome which I call subrosa vaginlis - the pink pussy syndrome.

White men who date Black women are dating the negative image of their fathers so the girls are actual embodiments of male images and the relationship becomes a homosexual incestuous one... likewise where the white woman is involved with the Black man the Black man is not a male in the masculine sense but the negative image of her mother, and therefore that relationship is not between man and woman but between negative white woman embodied in Black man with white daughter so that relationship too becomes an incestuous homosexual one. Now when there are not a critical mass of Blacks in terms of social needs that can create a problem especially if you have periodically the need of being reinforced in terms of your own self-image or your sense of personal worth.

On The 1st Year Students

1. Reciprocal inhibition - sibling rivalry.

In a situation where there is a small number of Blacks relative to a large number of whites, the Blacks tend to form social groups analogous to a nuclear family - Blacks tend to operate in families of kinship systems - thus, the Blacks compete among themselves instead of with the massive numbers of
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whites. The white school tends to reinforce this behavior by limiting the number of Black students and praising the competition as long as it remains within the Black subculture. Negative labeling and stigma. Appointment to the assistant flunky committee as an advisor.

2. Agitated Depression - feelings of hopelessness (as contrasted with helplessness), low self-esteem, and irrational protestations of guilt.

Demonstrated by:

a) non-nutritional orality - cigarette smoking, pill taking, herb smoking, alcoholism.

b) hording - notes, exams, little tidbits of private information, knowledge of social events where being social is not the point but where knowledge is disseminated on how to succeed.

c) Evolution of depressive equivalents - somatization

3 Cultural shock

a) Black-oriented Black students vs. White- oriented Black students.

b) Adequacy of prepartation pre-medically is not enough to get you over in medical school.

c) Euphoria - epecially in White-oriented Blacks (large amount of Manic-Depressive Overtones) Euphoria (especially 1st grading period). Students have delusions of grandeur that they are part of an elite special group,

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and the mere fact of their existence as medical students is sufficient demonstration of their ability to make it through successfully. After the 1st exam, there is cultural shock, profound depression, apathy.

4. Identification with the Aggressor

a) Students become masochhistic (sadistic) upon their fellow Black students.

1) White-oriented Black condescend Black-oriented Black black students as being inadequately prepared.

2) The excacerbation of attitudes Blacks tend to hold about themselves.

1st Year Spouses

1) Exploration of the competitive love object - the
medical institution.

2) Ruminations of unfaithfulness;

a) Must know who are classmates, lab partners, etc.

b) Are you really studying that late, away from
home, all the time?

c) Problems of situational adjustment.

2nd Year Spouses

1) Vocalization of chronic themes.

2) Conflict over priority establishment.

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a) They finally realize that 1st is med school; 2nd is them.

b) Med student begins to wonder if they should be married.

c) Exacerbation and increased frequency of depressive equivalent behavior.

d) Sexual identity crisis.

2nd Year Students

1) Identity crisis - displacement behavior

2) Increased frequency of depressive equivalent behavior.

3) Incestuous sexual involvement - medical students become involved with each other; it's incest because everyon'e common objective is to become a doctor so it's like sisters and brothers being involved with each other - a method of acting out of frustration.

4) Mini-affairs

a) sexual identity crisis

3rd Year Students

1) Role responsibility identity crisis

a) Panic -anxiety reaction

2) Identification with client (Counter Transference)

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4) Oedipal - Electra behavior - rap to the faculty

5) Resentment of their own children especially those 2-4 years of age because the child is actively in competition with them for mother's attention.

3rd Year Spouses:

1) Breakdown of communication
a) An increasing inability to discuss the routine stresses and occurrences on the ward with the medical students.

2) Extra marital affairs

a) Often times the medical students classmates - cross familial involvement.

4th Year Students

1) Pathological Paranoid Behavior - suspicion that every and everything will not let you graduate.

a) may or may not have realistic reinforcement.

2) Concomitant Identity Crisis

a) Non-nutritional orality - obesity.

3)Success Neurosis - Anxiety Neurosis

a) Guilt

b) Seeking professional therapy counseling


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c) Denial, embarrassment and guilt, concerning parental background - the end of the euphoric lie at graduation.

4) Separation Anxiety

a) Role competency anxiety - Role identity conflict

b) Desire to cling to the mother ( medical institution)
c) Desire to assert independence from mother - push for graduation.

5) Displacement behavior

a) Marital conflict

1) Bitchy wives

2) Fisticuffs - Sadism

3) Divorce ruminations

a) Economic barrier to divorce is chief obstacle.

There is seldom true psychosis exhibited by Black students under stress, and the suicide rate for Black medical students is lower than for white medical students. White medical students at predominantly Black medical schools do become psychotic if they enter the Black school with a preexisting neurosis because his coping and defense mechanisms are not as developed as those of Black students whose whole life has been directed to adaptation for survival within the white culture.


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The white medical student in increasing numbers when faced with the stress of cultural shock within the Black medical school reverts to homosexuality.

When there is not a critical mass at the school, the school makes the females academic whores and the males intellectual drag queens.

Academic whores - the administration uses the small numbers of females in the all white environment to in some way educate them about Black people and so they gain from you in terms of information so you turn an intellectual trick for them and they bring you in with that in mind.

Intellectual drag queen - the administration put you in an environment where they are always going to hold up top you as the standard bearer the white male and they're going to have available for you the white female so that they're going to make you turn tricks with the white female, when all she's doing is having a relationship with the negative image of e mother - that makes the male a drag queen - a homosexual in the instance.

Emotional problems in white schools should not be handled by seeing white psychologists and psychiatrists because it has been the nationwide experience, that Black patients send the white psychiatrist back into psychoanalysis. The results of negative counter transference by the white psychiatrists have in many instances led to tragic results. If the Black student feels he needs, or the school strongly suggests that the student needs psychiatric help, the school should either send the student to a Black psychiatrist or import some, as did the University of Michigan.

If faced with instances where there is not a

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critical mass and there exists Black-Hating negroes, then the technique should be withdrawal into therapeutic reflection and evacuation to a better environment at the first opportunity. For example preceptorships or clerkships at other institutions.