Judith Warner, New York Times, April 30, 2021
Dr. Benjamin Rush, the 18th-century doctor who is often called the “father” of American psychiatry, held the racist belief that Black skin was the result of a mild form of leprosy. He called the condition “negritude.”
His onetime apprentice, Dr. Samuel Cartwright, spread the falsehood throughout the antebellum South that enslaved people who experienced an unyielding desire to be free were in the grip of a mental illness he called “drapetomania,” or “the disease causing Negroes to run away.”
In the late 20th century, psychiatry’s rank and file became a receptive audience for drug makers who were willing to tap into racist fears about urban crime and social unrest. (“Assaultive and belligerent?” read an ad that featured a Black man with a raised fist that appeared in the “Archives of General Psychiatry” in 1974. “Cooperation often begins with Haldol.”)
Now the American Psychiatric Association, which featured Rush’s image on its logo until 2015, is confronting that painful history and trying to make amends.
In January, the 176-year-old group issued its first-ever apology for its racist past. Acknowledging “appalling past actions” on the part of the profession, its governing board committed the association to “identifying, understanding, and rectifying our past injustices,” and pledged to institute “anti-racist practices” aimed at ending the inequities of the past in care, research, education and leadership.
This weekend, the A.P.A. is devoting its annual meeting to the theme of equity. Over the course of the three-day virtual gathering of as many as 10,000 participants, the group will present the results of its yearlong effort to educate its 37,000 mostly white members about the psychologically toxic effects of racism, both in their profession and in the lives of their patients.
For critics, however, the A.P.A.’s apology and task force amount to a long-overdue, but still insufficient, attempt at playing catch-up. They point out that the American Medical Association issued an apology in 2008 for its more than 100-year history of having “actively reinforced or passively accepted racial inequalities and the exclusion of African-American physicians.”
“They’re taking these tiny, superficial, palatable steps,” said Dr. Danielle Hairston, a task force member who is also president of the A.P.A.’s Black caucus and the psychiatry residency training director at Howard University College of Medicine.
White psychiatrists have pathologized Black behavior for hundreds of years, wrapping up racist beliefs in the mantle of scientific certainty and even big data. The A.P.A. was first called the Association of Medical Superintendents of American Institutions for the Insane, according to Dr. Geller, who last summer published an account of psychiatry’s history of structural racism. The group came into being in the wake of the 1840 federal census, which included a new demographic category, “insane and idiotic.”
The results were interpreted by pro-slavery politicians and sympathetic social scientists to find a considerably higher rate of mental illness among Black people in the Northern states than among those in the South.
In the decades following Reconstruction, prominent psychiatrists used words like “primitive” and “savage” to make the cruelly racist claim that Black Americans were unfit for the challenges of life as independent, fully enfranchised citizens.
T.O. Powell, superintendent of the infamous State Lunatic Asylum in Milledgeville, Ga., and president of the American Medico-Psychological Association (the precursor to the A.P.A.), went so far as to outrageously state in 1897 that before the Civil War, “there were comparatively speaking, few Negro lunatics. Following their sudden emancipation their number of insane began to multiply.”
Psychiatry continued to pathologize — and sometimes demonize — African-Americans, with the result that, by the 1970s, the diagnosis of psychosis was handed out so often that the profession was essentially “turning schizophrenia into a Black man’s disorder of aggression and agitation,” said Dr. Hairston, a contributor to the 2019 book, “Racism and Psychiatry.”
Since then, numerous studies have shown that an almost all-white profession’s lack of attunement to Black expressions of emotion — and its frequent conflation of distress with anger — has led to an under-diagnosis of major depression, particularly in Black men, and an overreliance upon the use of antipsychotic medications. Black patients are less likely than white patients to receive appropriate medication for their depression, according to a 2008 report published in “Psychiatric Services.”
Psychiatry today remains a strikingly white field where only 10.4 percent of practitioners come from historically underrepresented minority groups, who now make up nearly 33 percent of the U.S. population, according to a 2020 study published in “Academic Psychiatry.” That study found that in 2013, Black Americans were only 4.4 percent of practicing psychiatrists.
The discipline’s history of pathologizing Black people — to “regard Black communities as seething cauldrons of psychopathology,” as three reform-minded authors put it in 1970 in the American Journal of Psychiatry — has deterred some Black medical students from entering the profession.
The difficulty in finding a Black psychiatrist can put a damper on the willingness of Black patients to seek treatment. And psychiatric help is also strikingly inaccessible for patients without money.