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The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.

The COVID-19 pandemic and murder of Mr George Floyd served as catalysts for examining antiracism efforts in psychiatry training programs and health care systems. Our recruitment and retention of Black, Indigenous, and other racial/ethnic minority psychiatry trainees has not met the demand for care and does not represent the communities served. Training directors at a critical juncture in creating systemic changes to recruitment, retention, policies, and curricular competencies to address ongoing inequities and disparities in health care. We describe several strategies and considerations for training directors in supporting a diverse psychiatric workforce.

Dr. A, a Black woman researcher and clinician-educator in the Department of Psychiatry at a prestigious academic institution, was appointed chair of the Diversity, Equity, and Inclusion (DEI) committee in 2017, in the context of public complaints and media coverage concerning sexism and racism. Following recent high-profile murders of Black people by police, Dr. A is called upon by the department chair to develop "antiracist programming." As a first step, Dr. A drafts a strong message against racismandexcessive police force.Despite the statement being vetted by all senior leadership, the department chair insists thatDr.Aplace only her name on it, in case it is not "well received." Dr. A receives negative e-mails in response to the statement, with minimal support from the department. Not to be dismayed, Dr. A assembles a DEI committee to plan an "antiracist" strategy for the entire department, without financial support, protected time, or additional resources. The DEI committee progress is slowed by the lack of institutional and departmental commitment. Additionally, several well-meaning non- Black colleagues in the department organize responses to the murders-including protests, town hall events, and public statements-without concerted coordination with the DEI committee, implying that "nothing was being done." In parallel, Dr. A is tasked with organizing and dispatching the limited number of Black psychiatrists, psychologists, and social workers in the department to deliver care to the entire Black community at her institution. Feeling overwhelmed by the number of tasks she has been asked to initiate-while navigating a tense climate, with minimal financial or administrative departmental support-Dr. A requests a meeting with the department chair and executive committee. At the meeting, Dr. A, a tenured faculty memberfor the past 10 years, is addressed by another colleague's name-the only other Black professor in the department. When Dr. A points out this microaggression, a senior colleague tells her she is being "too sensitive," and is "overreacting." Despite this interaction, Dr. A highlights multiple institutional barriers, including the structural racism that minimizes the work of DEI initiatives in the department. She presents her proposal for protected time and resources to successfully execute robust antiracist programming but is toldmoneyis tight and to "scale back" and "do the best you can.".

The Mohists may have been the first consequentialists on earth. Their most important principles are that right action is what benefits the world and that the underlying outlook for benefiting the world is inclusive care, whereby each person receives equal consideration. The early Mohists are clearly objective-list consequentialists, whereby benefiting the world amounts to promoting the most basic goods. Stephens argues that the later Mohists shift to a preference-satisfaction consequentialism whereby benefiting the world amounts to promoting what happens to please individual people. Stephens argues that while the direct texts are ambiguous between an objective-list interpretation and a preference-satisfaction interpretation, the latter better explains later Mohist engagement with opponents. I argue that the direct texts actually preclude Stephens' preference-satisfaction interpretation, which moreover has the later Mohists concede an implausible amount to their opponents. [ABSTRACT FROM AUTHOR]

For many, striving to attain first place in an athletic competition is explicable. Less explicable is striving to attain first place in a virtue (aretē) competition. Yet this latter dynamic appears in Aristotle's Nicomachean Ethics. There is 4.3's magnanimity, the crown of the virtues, which seemingly manifests itself in outdoing one's peers in virtue. Such one-upmanship also seems operant with 9.8's praiseworthy self-lover, who seeks to get as much of the fine (to kalon) as possible for herself. Contrary to many interpreters, this paper argues that praiseworthy self-love and magnanimity involve one-upmanship. The relevant exemplars are not simply striving to be the best that they can be in respect to virtue (in virtuous activity), but to be better than others. The paper argues that Aristotle's axiology, which sets activity (energeia) above state (hexis) and potentiality (dunamis), engenders one-upmanship. For only the level of activity substantially differentiates individuals, settling for inferiority is obviously objectionable, and equal achievement for Aristotle is not static but involves matching and surpassing the achievements of others. The paper concludes that modern discomfort with these dynamics is due to an axiology Nietzsche attributes to Christianity, one that bases human value fundamentally on non-differentiating potentiality. [ABSTRACT FROM AUTHOR]

In the Nicomachean Ethics, Aristotle claims that friendship and justice are the same, apparently flouting the not uncommon contrast between friendship and justice. I start by assessing Aristotle's principle of equality: friends of equal standing engage in exact reciprocity in goods and friends of unequal standing engage in proportional reciprocity. In a number of ways that have gone unnoticed, the equalization principle is a requirement for understanding the sameness of friendship and justice. Just relations and friendship share the same domain, that is, the same relationship of a corresponding community. Moreover, asking how to be just to someone is the same as asking how to be a friend to that person, indicating that the virtue of justice and the virtue of friendship are also the same. [ABSTRACT FROM AUTHOR]

Aim: Cannabis use is common among individuals with first episode psychosis (FEP) and persistent use is associated with worse outcomes. The purpose of this qualitative study is to identify factors pertaining to onset of cannabis use and persistent use among young adults with early psychosis receiving coordinated specialty care (CSC) in the United States and begin to develop a theoretical framework to drive further study and hypothesis testing and inform the approach to treatment of cannabis use disorder in this setting. Methods: Participants were ages 16–30 years with early psychosis attending a CSC program in New York State. Interviews were conducted in December 2018. Coding and analysis was conducted in Atlas.ti and themes were identified via a thematic analysis approach. Results: Thirteen individuals completed the interview. The mean age in years was 20.7 and the majority were male (n = 10). Almost half (46%) were Black, non‐Hispanic and 39% were Hispanic. Seven participants indicated they were currently using cannabis and six participants indicated they had stopped for at least 6 months at the time of the interview. Several themes emerged including the influence of family and social norms, motivating factors for persistent use and for reduced use or abstinence, and ambivalence regarding the impact of cannabis use on mental health. Conclusion: A theoretical framework emerged which may help identify future research in this area and inform the approach to treatment of cannabis use disorder in this setting. [ABSTRACT FROM AUTHOR]