Psychiatrist Brian Dixon wants the government to issue debit cards for African Americans with funds to be used solely for therapy
How do you compensate a people for a lifetime – many lifetimes, in fact – of economic harm, violence and brutality that began with slavery and the splintering of families and continued with prohibitions against the right to vote, to own a home, to pursue higher education or to work in a job of your choosing? With a history that has exacted such a devastating toll on the psyche of Black Americans, what is needed to undo this incalculable damage?
Dr. Brian Dixon, an African American psychiatrist based in Texas, has a proposal. He wants to provide reparations for the damage. But he’s not talking primarily about economic reparations. Along with several other Black therapists, Dixon is a leading advocate of therapy reparations. In his view that means providing free therapy to Black, brown and indigenous Americans to help them cope with generations of racial, psychological and economic trauma.
Dixon is focusing on Blacks and therapeutic reparations, something he hopes will pave the way for other BIPOC groups. In addition to economic reparations, he proposes that the government provide all Black people the psychotherapy they deserve by giving those who want it a prepaid debit card usable only for mental health services.
“We have to acknowledge that there was a trauma mostly caused by white people, and that you need to repair that,” says Dixon, 42, who speaks in a tenor tone with a slight Texas accent. “And how do you repair that? We need – as a country, as a culture – to recognize that every Black person should have a therapist and we should pay for every Black person to have one.”
“That is not to say that therapy is not important to white folks,” he adds. “It’s saying that therapy should be the most important thing for Black folks, and we need to prioritize it and pay for it.”
Dixon’s quest for a solution to the psychological trauma of Black Americans began in Lufkin, Texas, the small town 120 miles northeast of Houston where he grew up. He jokes in one of his blogs that he grew up in East Texas and “dreamt of a time when kids like me wouldn’t have to worry about their lights or water being turned off (you ain’t a true tested Texan until you’ve lived a Texan summer with no air conditioning, eating bologna out of coolers.)” It wasn’t until high school that he discovered an unexpected difference between him and his friends.
Raised with limited access to television, Dixon spent a lot of time outside with other neighborhood kids. Being poor taught them to be resourceful in finding ways to have fun. They’d go swimming in roadside ditches (a terrible idea, he notes in hindsight), and used old bicycle inner tubes to play a game called “Circulation.” Five to ten kids would stuff themselves in the center of an inner tube at waist height, then run and spin to try to make each other fall. The winner was the one left standing.
Dixon showed academic promise at a young age. He was bussed to a neighboring, predominantly white elementary school because his family thought it was better than in his local school and he’d receive a better education. Though he was one of only a few Black students, he enjoyed school and excelled in the classroom. Those early years gave him an academic advantage that he noticed when he returned to his neighborhood for middle school and high school. But he also encountered in middle school an emotional challenge that he never expected.
As adolescence set in, he and his teenage classmates needed to dress in front of each other for PE class. If the jokes among preteen boys about each other’s development weren’t enough, Dixon realized to his shock that he was attracted to boys. But as the son of a Black pastor in Texas in the 1990s, the thought of coming out wasn’t even an option he considered. He knew he’d be met with “the-devil-is-a-lie” lectures – a phrase used by evangelical Christians to dismiss ideas they believe are the devil’s work.
Dixon needed support, but he didn’t have anyone he could talk to about being gay. The idea of therapy “was not even in the vocabulary,” he says. “I didn’t even know that term or concept.” This wasn’t unique or about his identity, he notes; it was part of the stigma directed against mental health in the Black community at that time.
Dixon felt isolated, but he found his own sources of relief. An avid reader, his getaway was in literature, specifically comic books, which he began collecting as an early teen. His favorite was the X-Men series, because he related to their feelings of not fitting in. (The original X-men, created by Marvel comics, were teenagers born with an X-gene that gave them supernatural powers. Because they were “mutants,” they suffered fear and prejudice; many X-men stories, in fact, feature battles against bigotry and injustice.) Dixon especially loved X-man Dr. Charles Xavier, a telepath, and he’d get lost in the pages to clear his mind. One of Dr. Xavier’s lines stuck with him: “Any dream worth having is a dream worth fighting for.”
Finding a home in psychiatry
Dixon may not have known it at the time, but growing up Black in the Deep South, grappling with a divorced family, and suppressing part of his identity gave him an inside perspective on the struggles of his future clients. In later years, these experiences would help him realize the importance of making mental health resources available to Black people in America.
After finishing high school, Dixon went on to Baylor for his undergraduate work, Texas A&M for medical school, and the University of Kentucky for his residency. As a medical resident, he struggled to find his niche.
“Most surgeons are white dudes, and they are not creating environments that are healthy or accepting for people who look like me,” he recalls. “When I was doing my rotations through surgery, it was stressful. Pretty much everybody was nice, but it doesn’t fit my personality to be in that setting. As a poor Black kid whose parents were Democrats, I didn’t see myself represented anywhere throughout that experience.”
But once he did his psychiatry rotation, those feelings disappeared. “I loved it because I could sit and talk to people,” he said. “I could help the little black kids, I could help the little gay kids, I could help their parents, I could help people live their best lives. So all of these things kind of came together my third year or medical school, and that’s why I decided to do psychiatry.”
In 2014, Dixon started a psychiatry practice in his home state and he strives to serve as many people as possible, particularly people that come from backgrounds like his own. But he also realized that he couldn’t serve everyone, and he only wanted to recommend other therapists who lived up to his standards of quality. So he created an app called GIDE. It helps therapists find and refer to one another – rather than forcing clients to go with the therapists who have the best marketing and SEO strategies and dominate search-engine results.
Dixon’s years as a psychiatrist have made the inequities of the healthcare system abundantly clear – and they make it hard for him and other mental health professionals to serve people with the greatest need. Psychiatrists are one of the lowest-paid medical specialties, giving doctors who enter this field less flexibility to provide sliding-scale fees or to accept low levels of compensation from health insurance companies.
To make matters worse, when it comes to being paid for their services, psychiatrists receive lower in-network reimbursement than non-psychiatrist doctors, which may contribute to their lower participation in insurance networks. Just 56% of psychiatrists accept commercial insurance, compared to 90% of other, non-mental health physicians. As a result, people seeking mental health care are over five times more likely to seek care from an out-of-network mental health professional than for medical or surgical services.
Dixon is one such physician. He doesn’t contract with insurance companies so his clients must pay him directly. Then, if they have insurance, they can seek reimbursement from their insurer.
“I did that very purposefully,” Dixon says, “because insurance purposefully underpays any doctors or therapists that they work with.”
As a result, the clients served by Dixon and many other mental health clinicians tend to be those who can afford the out-of-pocket expense. About 30% of his clients are BIPOC and 10% are Black. He serves all age groups, with a slight skew towards children, and treats clients for all kinds of mental health needs. Before the 2016 election and then the pandemic, he saw people mostly for anxiety and depression, followed by ADHD in children. Now, however, Dixon sees patients who are shrouded by what he calls “existential dread,” a feeling he says is constantly reinforced by social media.
“A small step toward healing and atonement“
Dixon argues that more than any group in the U.S., Blacks are in need of therapy due to their history and present status. Nikki Coleman, a licensed psychologist and colleague of Dixon who specializes in racial equity, agrees.
“Black people in this country are the descendants of people who have experienced really unprecedented levels of trauma for generations,” she says. “When we were emancipated, there was never any way to deal with the grief, to be able to reconcile the violence and trauma inflicted. And so what we had to do was, in our best and most magical ways, be resilient and move forward toward surviving. But there are a lot of things that are in our community that we’ve accepted as being true that are actually remnants of our trauma survival.”
Dixon’s crusade for “therapeutic reparations” – providing all Black people the therapy they deserve – might seem to some like tilting at windmills, but the idea has started to gain more traction.
Therapist Kamilyah Jackson Cooper, LCSW, PLLC, who practices in New York State, is so supportive of the idea that she has raised money to provide free therapy for clients of color.
“As a Black female therapist living through the COVID-19 pandemic and the global racial uprising for Black people, I was feeling dejected,” she wrote on her professional website. “I felt like it was unfair to talk to Black folks about racism and oppression and require them to pay for it.”
“Talking to my friends, I got some inspiration to do something about it, so I created a fund for people to donate for therapy reparations. I have received thousands of dollars and am having free therapy sessions for my Black clients and reduced fees for my clients of color. I wanted to share this because I am amazed and thankful with the money I received.”
In an interview with Goop magazine, Cooper underscored that such reparations weren’t about guilt. “It’s not, ‘Oh, I’m going to do this because I feel sorry for you. Let me do it because I acknowledge I have privilege, and I feel bad about that.’ Not at all. We all have privileges, and the point of therapy reparations is to acknowledge the oppression that Black, brown, and indigenous folks have endured and continue to endure, and to provide one small step toward healing and atonement.”
She concludes that “therapy reparations are a great way to get people who have never been in therapy into therapy and people who can’t afford even to think about therapy into therapy. In addition, they’re also about ensuring therapists of color are fully compensated. Those two things go hand in hand.”
Reparations and mental health is also making inroads in the public discourse, along with policy ideas of how to put it in motion. Not long before the pandemic, storyteller, artist and yogi Daniele Martin gave a TED talk in Asheville, N.C., about the need to transform school systems to promote human dignity and to create government-funded and Black-run reparation health centers across the country to deal with trauma. “Reparations is not about money,” she said in the talk. “It’s about accountability. It’s about repair. It’s about responsibility. I hope we can think about reparations in a more abundant way, in a way that makes us all feel better about the country we live in.”
“Talk with somebody”
Dixon has spoken about therapy reparations at Noon Conference, Grand Rounds, and a range of diversity, equity and inclusion lecture series in medical schools. While his current focus has been on providing his patients with the best care possible, Dixon is constantly dreaming of how to scale these ideas on a macro level to have a larger impact on how his community can have equitable access to mental health services. He has also embarked on an overt rather than a covert mission to change how Black people access care.
The government, Dixon says, needs to simply write a check. Then Black people should be given debit cards that can be used exclusively for therapy.
“The pandemic proved that we have the ability as a country to give people money directly,” he says. “We can’t force folks into therapy. It only works if the person buys into it, but we must provide the opportunity and respect people’s ability to make the decision themselves.”
Dixon hopes that the option to access mental health services without financial burden will allow communities to deepen their understanding of what therapy can do in their lives.
“If you need to get your car fixed, do you fix your own car?” he asks. “You could try, but most times you are going to take it to a service station or somebody who does it all the time. [In life] there are certain things that you’re doing that you can’t see that you’re doing. Having an expert point those things out to you in a very kind and supportive way and then help you find workarounds – it can be very, very helpful.”
“Talk to somebody,” he adds.
Therapeutic reparations, he says, may be the best way to help Black Americans do just that.
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