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“Iris,” a 37-year old Black woman and full-time parent, was hospitalized for an acute manic episode after sheltering in place with her family. Until the COVID-19 pandemic, she had been psychiatrically stable, having regained custody of her children after their removal from her home following her last acute mania. Preoccupied with coronavirus on this admission, she talked rapidly about Donald Trump’s pandemic-related announcements and excitedly commanded everyone who walked into the unit to wash their hands and stay six feet apart. She described to me her efforts to protect her family from the pandemic, including extensive home-cleaning and anxiety about keeping visitors away from her children. I am a woman psychiatrist of Chinese descent.
By her second evening in the hospital, Iris’ anxiety escalated to the point of physically unsafe agitation, and she was placed in seclusion. When my on-call colleague—also a woman psychiatrist of Chinese descent—spoke with her through the seclusion room door, Iris spat at the window between them, called my colleague an “Asian bitch,” and accused her of carrying the coronavirus. When I saw Iris in the morning, she was calmer, and told me that all the nighttime staff were “demons.”
Amidst all of the interpersonal, bureaucratic, racial, and COVID-related dynamics present, I wondered why Iris only lashed out at one of us. I cannot and should not speak for Iris’ experience as a Black woman or patient, and can only draw some hypotheses based on my own experience. I came to feel that I was being seen as an authority figure from the mental health or child welfare system, one who could be protective and/or destructive. I met Iris during a pandemic wherein keeping her children safe had become even more difficult, and after she had been involuntarily hospitalized and separated from them once before. I was now the authority who could pass judgment on when she could return home, and influence whether she could keep her children. This object repre