Racial bias is real, and it has measurable effects on health care outcomes.

Today, we talk with Beverly Stout about how unconscious racial biases play out in the therapy room.

Welcome to the Carlyte Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief of the Carlatte Psychiatry Report.

And I'm Kelly Newsom, a psychiatric MP, and a dedicated reader of every issue.

Psychoanalysis was built on the things we can't talk about.

The stuff that gets suppressed, repressed, or otherwise goes

unconscious. In Freud's time, that was sex and aggression. But what ideas do we shy away from

in the U.S. today? Religion, politics, money, privilege, power, and race.

The issue of race so prompts excessive anxiety that it blocks off our capacity to think.

Patients can come and talk about murderous, rageful feelings toward family members.

But then if you ask them about a negative racial thought, they'll close up on you.

In America, we don't talk about that.

That was Kirkland Vaughns from the documentary Black Psychoanalyst Speak.

The idea is that you can't keep the unconscious lockdown forever.

Sooner or later, it leaks out.

And today, we're going to speak with psychiatrist and psychoanalyst Beverly Stout about racial enactments in psychotherapy.

But first, some terminology.

An enactment is when two people, hear the therapist and the patient, play out their unconscious biases or motivations without being aware of what they are doing.

For example, suppose you're treating a patient with chronic depression who has an unconscious desire to be rescued.

Meanwhile, you have an unconscious desire yourself, to be a hero, a bit of a

savior complex, perhaps that you've never fully grasped, but that is part of the reason that

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