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The intersection of race and neurodiversity: One psychiatrist’s story

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Dr. Loucresie Rupert is a child, adolescent, and adult psychiatrist with ADHD. She wasn’t diagnosed with ADHD until she was a medical intern. Now, being open with her patients about her own neurodivergence allows her to connect with them — and be the best doctor she can be.

Loucresie didn’t have an easy time getting her diagnosis as a Black woman. When she first sought an evaluation, she was labeled as narcissistic and told she wasn’t smart enough to be in medical school, even though she was already attending one. After failing a two-day licensing test she had trouble focusing on, she knew it was time to get a second opinion. Now, she’s a co-founder of the organization Physician Women SOAR (Support, Organize, Advocate, Reclaim).

Tune in to this week’s episode of How’d You Get THAT Job?! to hear more about the intersectionality of being a Black woman with ADHD, racism in the medical community, and Loucresie’s upcoming podcast.

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Episode transcript

Loucresie: You take your third general license test in your intern year, and I flunked it. I have never flunked anything in my life. It's over two days — I think it was like eight hours one day, five hours the next day. And I was just like, no way for me to focus for that amount of time. That's when I was like, yeah, we got to do this again, because I can't be unmedicated and take like a what is that 12-, 13-hour test?

Eleni: From the Understood Podcast Network, this is "How'd You Get THAT Job?!," a podcast that explores the unique and often unexpected career paths of people with learning and thinking differences. My name is Eleni Matheou, and I'm a user researcher here at Understood. That means I spend a lot of time thinking about how we find jobs we love that reflect how we learn and who we are. I'll be your host.

Dr. Loucresie Rupert is a child, adolescent, and adult psychiatrist with ADHD. She co-founded the organization Physician Women SOAR (Support, Organize, Advocate, Reclaim). And she participates in Black Leaders Acquiring Knowledge, also known as B.L.A.C.K. She's a Black neurodiverse LGBTQ woman, and she discusses how these intersectional identities have played a role in her diagnosis, her career, and her life. Her neurodiversity allows her to connect with patients who learn and think differently, and it's what makes her a great physician. Welcome to the show, Loucresie.

Loucresie: Thank you for inviting me.

Eleni: So, you are our very first doctor on the show. I thought a good place to start would be just telling us about what you do.

Loucresie: So, I'm a child, adolescent, and adult psychiatrist. In my practice, I see children with any and every diagnosis. And then I also see vulnerable adults with developmental disabilities. So, adults that are in group homes. Or even if they're at home, just the more vulnerable adults with developmental disabilities. So, that's what I do day to day.

Eleni: What is something that you think would surprise people about your day-to-day as a psychiatrist?

Loucresie: Well, I think that one is that I'm really open with my families about my own struggles. You know, kind of in psychiatry, especially in the past, you know, psychiatrists were supposed to be, quote-unquote, this blank slate of perfection. And our patients were not supposed to know anything about us because they were coming to ask for help. So, you know, we couldn't, quote-unquote, need help.

But my kids — and I call my patients my kids — my kids very much enjoy the fact that sometimes I don't know what I'm doing either, as all kids do. But I have kids that have special needs in addition to I'm neurodiverse myself, my kids are neurodiverse, most of my patients are neurodiverse — not all of them.

So, and I also live in a smaller community, so my patients might actually have some of the same resources and supports as my actual children. I think that surprises people is that I don't mind telling them that I know what they're going through. And I didn't like this condescending way that sometimes people do like, "Oh, I'm going through that too. You can handle it." But truly, we're all trying to figure things out and do the best we can with what we have. So, I think that's one thing that's surprising for people that don't know me.

Eleni: I'm sure that really helps you connect with your patients and also makes it feel less scary for them that they can see you as a role model who has been through this before and is doing really well.

Loucresie: Right. Right. I am neurodiverse. I'm still a psychiatrist. I still made it through medical school and in fact, I made it through medical school undiagnosed, which I do not recommend at all, to be undiagnosed and untreated.

Eleni: Can you talk a little bit about your diagnosis journey?

Loucresie: So, I was in medical school when I realized I was ADHD. I mean, there's kind of a joke in medical school that you think you have everything you learn about. So, I kind of did the whole like, "Do I really have ADHD? Or I’m I just doing the medical student thing?" I was pretty sure that I did have ADHD.

But I did go see a psychologist in medical school to try to get diagnosed, and he told me I did not have ADHD but did not really share anything else. So, I asked for my medical records, and looking through my medical records, he basically put that I was not smart enough to be in medical school, and that's why I was struggling and that I was narcissistic because I thought that I could do great things. And the example he put of the great things that I could do was like be in medical school, which I was literally in medical school at the time.

So, after that experience, I didn't go back until actually as an intern. So, you take your third general license test in your intern year, and I flunked it. I have never flunked anything in my life. It's over two days — I think it was like eight hours one day, and five hours the next day. And it was just like, no way for me to focus for that amount of time. I flunked the test. And that's when I was like, yeah, we got to do this again, because I can't be unmedicated and take like a what is that 12-, 13- hour test? "

So, I actually then went through the process again of getting diagnosed. I had my residency director fill out some of the questions. I was appropriately diagnosed, sent for treatment, and passed my boards the second time with no problems when I took it again. So, it definitely was just a focus and concentration thing.

Eleni: Well, I'm sorry you had to go through that experience at that initial doctor. That sounds super invalidating and really angering.

Loucresie: I mean, you guys can't see me, but I'm Black. So, I definitely think that was a racist experience, because why would you say somebody who has made it into medical school can't be in medical school? Like, I was already there. So, it's definitely something that women of any ethnicity and then people of color really go through, and it makes it hard to kind of reach out for help. And especially if you reach out for help and get that experience, to then reach out again. So, it definitely can be invalidating. But if that does happen, I just want to say try again with someone that is a little bit more culturally competent. And don't let that deter you from getting the help you need.

Eleni: We talk a lot on the show about intersectionality and like, thank you for being vulnerable in sharing a racist experience. I did see on the internet that you co-founded an organization that works on a number of intersectional causes, called Physician Women SOAR, so Support, Organize, Advocate, Reclaim. Can you talk a little bit more about what intersectionality means to you and a little bit about that organization and what you do there?

Loucresie: So, it started off as a Facebook group, and it is mainly a Facebook group, of physician women of all intersections. So, disability, ethnicity, race, religious, areligious, all of those things, where we come together, and we can learn from each other. And the rule of SOAR is whatever topic we're discussing, we center the least heard voice or the voice that we're talking about. So, if we're discussing Black issues, then Black voices are centered. If we're discussing Jewish issues, Jewish voices are centered, trans, you know, on and on.

We do do some education, like with physicians. So, we've done book clubs, reading a book called "Medical Apartheid," which talks about the history of racism in medicine, which every single medical student should have to read but does not have to read. And then we raise money for organizations that we find important.

My kind of rule of life and what I tell people all the time is really listen. So, even as a psychiatrist, and I think especially for physicians of any kind, that we are experts —and we are experts — but we are still generally not the people going through whatever we are treating. And so, it's still important to listen to lived experiences.

Eleni: Such important work. Yeah, I love that idea of learning through listening. I can, I really resonate with that a lot given what I do. So, I know there was a recent study that revealed that Asian, Black, and Hispanic children are significantly less likely to be diagnosed with ADHD compared with white children. And white children are also more likely to receive treatment for ADHD. It's pretty clear that there's more work that needs to be done within intersectionalities and medicine and learning and thinking differences.

Loucresie: The reasons for that is twofold. Both reasons actually relate back to racism. But racism in the medical community itself, so, when you see an Asian kid, for example, that is maybe making A's or B's because they study 24/7, but they're really struggling to keep those grades up, or not making good grades at all. So, the stereotype is that Asian people are going to be smart, especially in math and sciences, right? So, you're not going to look for additional reasons. You just would be like, oh, they're doing what they're supposed to do, even though they're saying that it's taking them twice as long or they're making tiny mistakes or whatever the case is, you expect them to do well and you just kind of don't look for reasons.

Or say you have a Black or a Hispanic kid that are stereotypically not expected to be smart. Although I want to be clear that the bell curve is the same in all races and ethnicities. But if you have, say, a Hispanic or a Black kid that's not paying attention, not doing well, maybe speaking out of turn or whatever, then you kind of jump to, oh, they're probably at a single-parent home and they probably just don't know better. They're not being taught better. Versus looking for neurodiversity or reasons that that might be going on.

So, the second thing is, is parents, is the community. Rightly so, Asian, Black, and Latino communities are suspicious of medicine. Especially Latino, indigenous, and Black communities have had a horrible history of been used and abused by the medical community in multiple horrendous ways. And so, there's a valid mistrust of the medical community.

When I was growing up, so, when I was a child, if your kid was a quote-unquote special education kid, they were kind of just put in a room, got a certificate for a graduation instead of a real diploma, not really taught anything. Now, my generation, our parents, our grandparents that are older than us are the ones raising kids. And so, when you kind of hear from a teacher or a physician, "Hey, I think your kid needs to be evaluated for a learning disability," and you're in my job so "You're not going to just put my kid in a room and not educate them," you know. Rightly so, because that's what used to happen. And sometimes, honestly, it can still happen if you're not on top of it.

That's an appropriate response that takes education with the families and also takes them being able to trust their clinician. So, having those conversations about racism and the history of medicine and not pretending that you're the expert, you come into the room, "Hey, you do what I say," and leaving out the fact that there is — generations of trauma here that comes into the room with these patients.

Eleni: Yeah, definitely. And inform people that that's the context that people are coming from. You know, you mentioned some of the challenges that you had in med school. What advice do you have for anyone who's entering med school with ADHD and wants to succeed in this field?

Loucresie: ADHD is one of the two diagnoses in psychiatry where the overwhelming evidence is that medications just really are helpful for ADHD. But please go through that process, because there's lots of things you could do for ADHD. One of my kind of takes on it is if you're able to get done what you need to get done, and your self-esteem is still intact, and your relationships are still intact, and you don't need medication for that to happen, cool.

But for me, my self-esteem dropped tremendously in medical school to the point that I kind of was like, hey, did I trick these people to get into medical school? Like to think I'm smart enough to get into some medical school? Like, maybe I actually don't deserve to be here because I was just struggling so bad. So, I would recommend that for medical school, college, high school, especially with people that are able to kind of pull it together? And in lower grades, sometimes that ability to overcompensate for — or to compensate for ADHD — falls apart at higher levels. So, when you get into high school and you have like more independent studies.

Sometimes it doesn't happen till college, sometimes it doesn't happen till people that are parents and have to take care of themselves and others. Or until you're a boss at work and have multiple people. But if you get to that point where you're starting to fall apart, like please consider medications in addition to the many other things you can do. But don't shy away from medications just because they are medications.

Eleni: Yeah, it's all about figuring out what works for you, and it's definitely not the same for everyone.

Loucresie: Right. Right.

Eleni: What tools did you use in med school to help you get by?

Loucresie: My tool that I used before med school was flashcards, so that's pretty much how I survived my grade school education and college education, I was using flashcards for everything. Because flashcards like for me, helped me focus because there's a question on the front and then the answer on the back, and I'm not just reading a page, getting down a page of reading, and realize I don't even remember what I read.

So, once I got to medical school, our lectures were recorded. So, listening to the recording while going through the written transcripts and kind of highlighted things — that helped. I had study group.

Study groups have always, always, always been my thing, and I didn't realize that that's a very good tool for ADHD people in general until actually a couple of years ago. Like as an adult, I realized I had trouble getting things accomplished without one. And so, I started just having friends that I would like jump on Zoom with. And we would, you know, do our own task, where it's called body doubling, and it is pretty common for people with ADHD.

The other thing that I will say, I did go to the campus psychologist to help with test anxiety. At that time — again, I did not know I had ADHD. But if you are struggling, campus is a resource. So, there are psychologists who may be able to provide testing, not all of them. But even if they can't, they can help with like helping you figure out how to study. So, remembering that there's resources on campus too, it's helpful.

Eleni: On my God, you covered, so many great, useful things. Yeah, body doubling is something that we talk about a lot here at Understood — having like an accountability buddy. So, I hear that you're working on a podcast. Can you tell us about it?

Loucresie: Yeah, so I have a podcast named "Friday Night Sound Bytes." And it's named that initially just because I was doing Twitter live on Friday nights. It's basically a podcast that talks about anything that's intersectional related. So, it's very ADHD-friendly because the topics are all over the place. But they have to relate back to either being an ethnic minority, disabled, LGBTQ, adoption.

So, we've done things that definitely we've talked about ADHD, we've talked about being LGBTQ and Christian, and we've talked about trauma in indigenous and Black communities. We've talked about how to navigate disability, like if you're going through the disability process, like trying to get disability, how to navigate that. So, again, the topics are really pretty vast. So, you can follow my website to follow when it will be released, and we'll have an episode on Friday nights.

Eleni: Perfect. So, thank you so much for taking the time to be on the show. This is a really fun conversation. Really insightful. Appreciate you being here.

Loucresie: Thank you guys for having me. I really enjoyed the podcast. I love the work you guys do at Understood, so hopefully we can keep in touch.

Eleni: You've been listening to "How'd You Get THAT Job?!" from the Understood Podcast Network. This show is for you. So we want to make sure you're getting what you need. Email us thatjob@understood.org with your thoughts about the show. Or maybe you'd like to tell us how you got THAT job. We'd love to hear from you.

If you want to learn more about the topics we covered today, check out the show notes for this episode. We include more resources as well as links to anything we mentioned in the episode. Also, one of our goals at Understood is to help change the workplace so everyone can thrive. Check out what we're up to at u.org/workplace. That's the letter U dot org slash workplace.

Understood.org is a resource dedicated to help people who learn and think differently discover their potential and thrive. Learn more at Understood.org/mission.

"How'd You Get THAT Job?!" is produced by Margie DeSantis and edited by Mary Mathis. Briana Berry is our production director. Our theme music was written by Justin D. Wright, who also mixes the show. For the Understood Podcast Network, Laura Key is our editorial director, Scott Cocchiere is our creative director, and Seth Melnick is our executive producer. And I'm your host, Eleni Matheou. Thank you for listening.

Host

  • Eleni Matheou

    leads user research for Understood. She helps Understood to center its work on the lived experiences and voices of people who learn and think differently.

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