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Thank you Kae, Lori, Michelle Ray, and many others for tuning into my live video with Damon Tweedy!
Damon Tweedy Bio:
Dr. Damon Tweedy, is a psychiatrist, author, and leading voice on race, medicine, and mental health. He’s a professor of psychiatry at Duke University School of Medicine and a staff psychiatrist with the Durham Veterans Affairs Health System, where he co-leads an integrated primary care mental health team. A graduate of Duke School of Medicine, he also earned a law degree from Yale Law School, focusing on health policy and medical ethics before returning to Duke to complete his psychiatric training. Dr. Tweedy is the bestselling author of Black Man in a White Coat, which takes a hard look at racism and American medicine. The book was a New York Times bestseller and was named a top nonfiction book of the year by Time Magazine. His latest book, Facing the Unseen, explores the struggle to center mental health within medicine and was recognized by Nature as one of the best science books of 2024.
The full transcript is available below.
Transcript:
Joshua Dolezal:
Welcome back to The Things Not Named. I’m Joshua Dolezal, and my series this year is based on one of Willa Cather’s famous passages. She said that it’s the presence of the thing not named that gives high quality to fiction, drama, and poetry. And so for my series this year on the medical humanities, I’m applying that principle to how we might all be more attentive to what goes unsaid in the clinic, in popular culture, and in the experience of illness from the patient’s side.
My guest today is Dr. Damon Tweedy, psychiatrist, author, and leading voice on race, medicine, and mental health. He’s a professor of psychiatry at Duke University School of Medicine and a staff psychiatrist with the Durham Veterans Affairs Health System, where he co-leads an integrated primary care mental health team. A graduate of Duke School of Medicine, he also earned a law degree from Yale Law School, focusing on health policy and medical ethics before returning to Duke to complete his psychiatric training. Dr. Tweedy is the bestselling author of Black Man in a White Coat, which takes a hard look at racism and American medicine. The book was a New York Times bestseller and was named a top nonfiction book of the year by Time Magazine. His latest book, Facing the Unseen, explores the struggle to center mental health within medicine and was recognized by Nature as one of the best science books of 2024.
So thanks for joining me, Dr. Tweedy.
Damon Tweedy:
Yeah, it’s a pleasure.
Joshua Dolezal:
So Damon, maybe we can start with your family origins. If I’m not mistaken, you and I are both first-gen college students. So it was kind of a long road that you took from where you were born and raised to Duke and then also to Yale.
Damon Tweedy:
Yeah, so, you know, growing up, it didn’t feel that way. But now, looking back — I’m 51, almost 52 — it does feel like, yeah, you know, it was quite a journey. So I grew up in a two-parent home, mom and dad, both of whom traced their families back to America’s origins, right? Back through segregation, even back to slavery — because I have an 1860 census my dad showed me of some of his relatives. And so they grew up from Southern Virginia, grew up during the time of segregation. My parents are still living, they’re elderly now, and literally, you know, the things that we read about in textbooks were their lived experience. The Civil Rights Movement came to them when they were in their early 20s. So their whole first 20 years were in that space. And so that undoubtedly impacted how they experienced the world, see the world.
And so for me, I grew up — so my dad worked in a grocery store, a food store. Mom worked in a sort of government, kind of administrative secretarial type work. And I had an older brother and we were in a community that was all Black, literally 100% Black, a very working-class sort of Black community outside of Washington, D.C.
Back in those days, busing was still around. And so we were bused to a neighboring district that was all white. And so those are probably my first earliest kind of signs of, okay, you’re different. And what do people make of you by being different?
And so for me, that difference was that, you know, I was kind of really into math and numbers — I was sort of an odd kid in that way, really into that. So I excelled in math, but I was also one of the Black kids bused to a school that was all white. And there were a lot of perceptions among teachers there about the Black students not being capable or being somehow, you know, a problem — things that we sort of all hear about. And so for me, I was finding myself in a space where, at the same time, I was a top student. And so people didn’t know what to make of me — the teachers and sometimes my classmates — because there were all these perceptions about what it meant to be a Black person, you know, largely negative, right? And so I experienced that sort of duality at a very early age.
When I got to high school, my middle school was a local Black neighborhood school, but then I tested into a magnet program in high school. Little did I know at the time how powerful a school it was in terms of some of the people who went there and what they achieved. But it was a magnet school that was pretty much all white and Asian within a school that was otherwise Black. And so I was in these magnet classes with white and Asian students, but the rest of the school was mostly Black. And there was always this sort of tension between — where do I fit in in these two worlds?
And so that was sort of a common theme, and it played out in a lot of really kind of crazy ways. One story I can tell real quick that will encapsulate this. In high school, in 10th grade, I was in a chemistry class — literally the only Black student in a class of 30 students. And one day, our school was a school of excellence, and so they brought in several leading politicians to sort of talk about our tech program and how great it was. And so at that time — given my age — this was Governor Bill Clinton before he was president, and several people across both parties. And they sort of took them around our school to the tech programs. So here I am, the only Black student in that class. And before they get to our particular classroom, there’s suddenly four or five other Black kids in the class who are just sort of there, positioned. And then you see where I’m going with this? And then suddenly, as soon as these political people leave, those kids are just kind of told to leave. And so I’m back here as the only Black student in the class. And I’m looking around like, what the hell just happened? And no one had any reaction. It was like no one else seemed to get what had just taken place.
And that sort of in some ways encapsulated my perspective of being different, you know, and having to navigate two worlds. So my first book sort of starts with me being a medical student, but that’s sort of the backdrop to that. And so when you get to medical school at a place like Duke, that’s just accentuated — that whole idea of two worlds. The world of the doctors, you know, mostly white and Asian. Then there’s the world of patients and the community that you’re around, which is largely Black. And how do you navigate those two worlds? And so that was sort of the tension that I experienced at a young age, but it just really was accelerated in a medical setting.
Because for me, you know, part of what attracted me to medicine was the idea that it was objective, that it was concrete. It was data-driven. You know, it doesn’t matter what you look like on the outside. A bone is a bone. A blood vessel is a blood vessel. And so that’s part of what appealed to me. It’s like I could contribute to society, but in a very concrete way. And so it was really kind of a shock to the system to get into medicine and realize that it was sort of in some ways the same old thing in terms of those problems that I’d experienced as a young person.
Joshua Dolezal:
Yeah. One of the philosophers that I used in my dissertation was Helen Longino, whose iconic book is called Science as Social Knowledge, kind of questioning this idea that science is just objective because it always takes place in a context that is social, and that certain questions get privileged and certain research gets funded and all of that.
We’re the same age. So I remember Clinton when I was in high school and all of that.
Two questions came up as you were telling a little bit of that story. One — you said that you tested into this program. I know that recently there’s been some debate about whether standardized tests are actually exclusionary, whether they set arbitrary barriers for diversity in college. And I know during COVID, a lot of those standards were just taken away. And yet I’ve heard other writers talk about this — Thomas Chatterton Williams is another one who felt like standardized testing was the only way that he got noticed at all, that he would have been lost in the cracks if it hadn’t been for some kind of merit-based way of breaking through. So I’m curious what your thoughts are on that, whether standardized testing is actually a way of bringing more diverse voices into medicine or whether it’s been kind of exclusionary.
Damon Tweedy:
I think it’s a mixed picture. I think it depends on how you use it. I think that if it’s used — like, a number in and of itself — it has to be — it’s going to sound crazy to some people, but a number has to almost be contextualized. Like, if you take, let’s say, an SAT score — let’s just say 1,200, right? Now, 1,200, depending on what your background is leading up to that place, that could be a not-so-good score, that could be an exceptional score, depending on what your background is and what you sort of had to overcome and deal with.
So you think about my situation. First, you know, parents did not go to college. Despite my mom’s best efforts, I was sort of like anti — you couldn’t get me to read a book. I was kind of anti-intellectual, because that was sort of what was cool, and that was sort of the internalized message as a Black person — that these books you’re learning about in school, about 18th century England, that’s not for you, so why even bother? And so in some ways you’re kind of — it’s easy to sort of go down that path. And so you think about me getting a score like that. You know, given my background, that score may show a lot of potential. But if you compare it to someone who has had all the tutoring and — I was even told when I was in middle school and early high school that you couldn’t even study for the SAT. Like, I was like, really? I mean, looking back now, I think, really? People told me that? But that’s what I was actually told. Obviously there’s a whole testing industry that would prove otherwise.
And so if you compare people — again, the score in isolation — if you’re comparing someone like me with that score to someone who has had a much more privileged background, and putting us on the same footing, then I would say no, that’s not great. But if you sort of contextualize that person — what is that person’s distance traveled to get to this place? Then I think the scores could be potentially very useful. So again, it’s all about how you choose to use it. But if you just use it as a blanket number and say this is your value, then no, I think it could be more harmful than good.
Joshua Dolezal:
I heard Scott Galloway talking about that — you know, that it used to be that you could be kind of average and then get into an environment where you could become exceptional over time. But a lot of elite universities now seem to screen for these superhumans that are already superhuman at age 17. And yeah, it’s a problem.
The second question from your background — you’d mentioned feeling kind of caught between two worlds. You didn’t know quite where you fit. And there’s a saying about comedians, right? That they’re all damaged people. And I think there’s a similar saying about memoirists, which is that we felt dislocated or marginalized somehow, and that we try to write our way back into normalcy. I don’t know if that is true for you — that the impetus to write your first book came from that sense of wanting to bridge the two worlds. Is that accurate?
Damon Tweedy:
I never heard that exact saying. I heard about comedians, but not about memoirs. But I will say, it was an effort to make sense of what I’d experienced. Like, I would have an experience — it all started — writing not even with the intent that I would one day be writing a book for a public audience. It was more about writing for my own sense of like, how do I make sense of this experience internally. You know, I spent eight weeks in a hospital setting — again, patients often all Black, staff the opposite. I’m the only Black person in it. I would always find myself caught in these two different kinds of spaces and not having — as I put in the book — one foot in both worlds but not two feet in either. A sort of dislocation. And so it was kind of just a way to make sense of what I was experiencing initially. That’s how it all kind of really got started.
And then as I began to write a little bit more, I began to realize that there were aspects of what I was writing about that other people could connect with. And then it just sort of built upon — often Black people, but even beyond that, because in so many ways, as you learn, there are so many ways in which someone can be othered, right? And I was able to feel like I could connect with people in other ways as well. So that’s sort of how it kind of all sort of evolved. But it started as something to make sense for myself.
Joshua Dolezal:
I had the pleasure of teaching Black Man in a White Coat. I used to be an English professor in Iowa before I pivoted to independent writing and podcasting, but I loved teaching it, and students resonated with a lot of your stories and learned a lot. They appreciated the research that you brought to it and the historical perspective. What really struck a lot of them was the opening, so I wanted to talk about that first scene that really hooks the premise. And I’d like to also maybe get into some of your influences — people that shaped you as you were writing this or models that you had for the book — because the book doesn’t come out of nowhere. You join a conversation about what it’s like to be a doctor and there’s a great body of literature on that already.
Damon Tweedy:
Yeah, so, you know, just to quickly start that last point. As I got into medical school and once I was there, I started getting interested in stories. Like, it was fascinating to me that, you know, in some ways a story — like a doctor could write a 750-word essay about an experience in a clinic with a patient, and you could learn so much from that. And it was a sort of way you could connect to that. And I found it ultimately became more interesting in some ways than, say, the latest New England Journal study comparing this drug to this placebo. And it was like, wow, these stories are fascinating.
But what I noticed — and there were many books, many writers who were really successful, and I drew on many of them, I have a whole library of books over here that’s nothing but medical memoirs in one row — what I thought I brought to the table, looking back, is that those stories were set in big cities often, but there wasn’t that dynamic of what is it like to be a Black person, given our country’s history, to be in these same rooms? And what were the tensions between patient and doctor that maybe someone who is not Black and didn’t have my experience growing up could sort of understand? So that’s sort of how the book situates within that literature of medical memoirs.
But as for that opening story — so I’ve already kind of laid out for you some of the dislocation I felt and how medical school would start to be this space in which I could kind of escape that. I initially started medical school thinking I’d become a cardiologist or an orthopedic surgeon — very, from my mind, very concrete, objective enterprises, you know, a blood vessel is a blood vessel, a bone is a bone, right? And that was sort of how I was thinking about medical school when I started.
So in the background, of course, in the mid-90s, Affirmative Action was — there was an earlier attack. There’s always been attacks on it, right? There’s always, you know, history repeats itself. So there was always a sense of, you know, you’re in this place like Duke — man, do I really belong here? You know, my parents didn’t go to college. I’m a Black guy here. This guy next to me, his dad’s the dean of this law school. This guy’s mom owns a company. They’re driving Mercedes to school and like, man, you know, I don’t belong here. Right? And they’ve all gone to Ivy League schools, Princeton and whatnot. And so what am I doing here? So there was always that there.
And then there was this early day, first few weeks of med school, where basically I leave the classroom for a break, come back between lectures, and the professor confronts me in the room and says, “Sir, are you here to fix the lights in the room?” And I’m looking around like, who’s he looking at? He’s looking at me. And I’m like, well, no. And he’s like, “Yeah, but I mean, I called about this last week. Why haven’t you done it?” He sort of got irritable about it. And he really kind of doubled down. I’m like, whoa, what’s happening here? Why is it me? And I’m not someone who wants to just jump to the idea that race is always the reason why someone treats you a certain way. But I couldn’t come to anything else. It’s like, wait, why else — I’m dressed the same, everything’s the same as everyone else except the obvious, right? And so I was like, man. It always comes back to this.
And so how do you deal with that? I’m a really big, tall guy. Am I going to come back with anger? Is that going to — how is it going to be received? Am I going to be some, you know, angry Black guy who’s looking to make everything a problem? And this guy was small — so I could visualize how that could have gone south so quickly. And so what do you do? I mean, just based on life experience, that could have gone south really quickly. And so you kind of retreat and you’re like, man, this guy thinks I don’t belong here, right? So I had to — it was like a test for me. Do I belong here? And so I really kind of internally just — maybe he’s right. Maybe all these things are true. And so I just really kind of tapped into something I didn’t know I necessarily had at that point in my life, where I doubled down and I studied like hours around the clock, basically, almost literally. Ended up at the very end getting one of the highest grades in the class.
And the way it worked back then is that you would meet with the professor at the end of the course. And then it was a weird thing because, you know, I knew that at this point I’d done well. But then the professor — when he saw my score and he saw me — he did this double take and started getting nervous and stumbling. And it was weird because it was like in some ways I vindicated myself. I’d shown him — I stuck it to him, if you will. But at the same time, it was like, you know, I’m different, right? And people are going to see me differently. And no matter how much I just want to be like everyone else, I just want to be a medical student — I have to navigate this reality that people will see me differently. And I have to figure out how to make that work. And so that was sort of the opening salvo to that journey.
Joshua Dolezal:
And he, as I recall from the book, offered you a chance to join his research team, and he wanted to be part of that.
Damon Tweedy:
It was like a patronizing kind of thing, right? Because I think he remembered the first encounter in retrospect, and I think it was just so awkward. And it was like, no, we just need to move forward.
Joshua Dolezal:
What you’re describing — being seen a certain way by professors — it didn’t stop once you started practicing. And one thing I love about memoir writing and your book in particular is that our lives happen to us in chronological order, but we don’t have to tell everything that way in a memoir. We can choose how we’re going to order things. And so sometimes the way you place two stories side by side is enlightening. And in this case, you had a self-admitted white supremacist named Chester, and then in the same chapter you had a Black man named Robert. And neither one of them wanted you as their doctor. That was a really interesting contrast — for both of them, coming from very different backgrounds, to draw the same conclusion. So why did you juxtapose them like that in the same chapter? And what did you learn from that?
Damon Tweedy:
At that point in the book, I’m an intern, a medical intern, which is the — people have probably seen TV shows — busiest year in a doctor’s life, you know, all those stories about interns. And so, yeah, you just want to be dealing with all these other challenges: the 3 a.m. call, you know, the heart attack in the room, whatever. And so you’re dealing with — can you cut it, right? And so that’s the context of every intern. And so in some ways, it’s extremely stressful. And you want to feel like you’re just like every other doctor, but then these things happen and you’re reminded you’re different.
