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Origins of Racism in American Medicine and Psychiatry

  • Kimberly Gordon-Achebe
  • Danielle R. Hairston
  • Shadé Miller
  • Rupinder Legha
  • Steven Starks
Chapter
Part of the Current Clinical Psychiatry book series (CCPSY)

Abstract

Like most structures, American medicine has been susceptible to the effects of racism. In matters of racial oppression, the field of psychiatry has been both slowly responsive and complicit in its reaction to the cultural challenge of racism; all too often it avoids matters of social justice. Unwittingly, it contributes to the perpetuation of health disparities. This chapter reviews the history of racial oppression in medical education and organized medicine by examining its origins in American colonization and slavery, which have engendered mental health disparities for black Americans. It also explores racial stereotypes in psychological theory, clinical practice, and health policies that adversely affect blacks in America, and it highlights the medical community’s role in creating historical trauma in the black community. Psychiatrists play a crucial role in the development of interventions that will help shape healthy racial identities for blacks, and they can also foster psychological well-being for all Americans by recognizing racism as a mental health disorder. Girded with an understanding of the historical context of how blacks view medicine and psychiatry, health care systems, policy makers, and providers can undo racism and racial mental health disparities by engaging in antiracism work and advocating for this work to be implemented and embedded in all aspects of organized psychiatry and medical education.

Keywords

Racism Mental health disparities Eugenics Medical experimentation Racial identity Organized medicine Medical education Racial health equity and policy 

References

  1. 1.
    Franklin JH, Higginbotham EB. From slavery to freedom. New York: Knopf; 1956.Google Scholar
  2. 2.
    Joseph PE. Waiting ’til the midnight hour: a narrative history of black power in America. London: Macmillan; 2007.Google Scholar
  3. 3.
    Gates HL. Life upon these shores: looking at African American history, 1513–2008. New York: Knopf; 2011.Google Scholar
  4. 4.
    Alexander M. The new Jim Crow: mass incarceration in the age of colorblindness. New York: The New Press; 2012.Google Scholar
  5. 5.
    Baptist EE. The half has never been told: slavery and the making of American capitalism. New York: Hachette; 2016.Google Scholar
  6. 6.
    Coates TN. The case for reparations. The Atlantic. 2014.Google Scholar
  7. 7.
    Olshansky SJ, Antonucci T, Berkman L, Binstock RH, Boersch-Supan A, Cacioppo JT, Carnes BA, Carstensen LL, Fried LP, Goldman DP, Jackson J. Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Aff. 2012;31(8):1803–13.CrossRefGoogle Scholar
  8. 8.
    Rothstein R. The color of law: a forgotten history of how our government segregated America. New York: Liveright Publishing; 2017.Google Scholar
  9. 9.
    Guinier L. From racial liberalism to racial literacy: Brown v. Board of Education and the interest-divergence dilemma. J Am Hist. 2004;91(1):92–118.CrossRefGoogle Scholar
  10. 10.
    Gamble VN. A legacy of distrust: African Americans and medical research. Am J Prev Med. 1993;9(6 Suppl):35–8.CrossRefGoogle Scholar
  11. 11.
    Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997;87(11):1773–8.CrossRefGoogle Scholar
  12. 12.
    Fernando S. Cultural diversity, mental health and psychiatry: the struggle against racism. London: Routledge; 2004.Google Scholar
  13. 13.
    Grier WH, Cobbs PM. Black rage. Eugene: Wipf and Stock Publishers; 2000.Google Scholar
  14. 14.
    Brown TN. Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification. J Health Soc Behav. 2003;44(3):292–301.CrossRefGoogle Scholar
  15. 15.
    Jackson V. In our own voice: African-American stories of oppression, survival and recovery in mental health systems. Int J Narrat Ther Community Work. 2002;2002(2):11.Google Scholar
  16. 16.
    Rush B. Medical inquiries and observations. Philadelphia: J. Conrad & Co.; 1805.Google Scholar
  17. 17.
    D’elia DJ. Dr. Benjamin Rush and the Negro. J Hist Ideas. 1969;30(3):413–22.CrossRefGoogle Scholar
  18. 18.
    Suite DH, La Bril R, Primm A, Harrison-Ross P. Beyond misdiagnosis, misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color. J Natl Med Assoc. 2007;99(8):879.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Gamwell L, Tomes N. Madness in America: cultural and medical perspectives of mental illness before 1914. New York: Cornell University Press; 1995.Google Scholar
  20. 20.
    Cartwright S. Diseases and peculiarities of the Negro race: Africans in America. 1851.Google Scholar
  21. 21.
    Kendi IX. Stamped from the beginning: the definitive history of racist ideas in America. New York: Hachette; 2016.Google Scholar
  22. 22.
    Babcock JW. The colored insane. Alienist Neurol. 1895;16:423–47.Google Scholar
  23. 23.
    Galt JM. Asylums for colored persons. Am Psychol J. 1844;1:78–88.CrossRefGoogle Scholar
  24. 24.
    Powell TO. The increase of insanity and tuberculosis in the southern Negro since 1860, and its alliance, and some of the supposed causes. J Am Med Assoc. 1896;27(23):1185–8.CrossRefGoogle Scholar
  25. 25.
    Lombroso C. Crime, its causes and remedies. Boston: Little, Brown; 1911.Google Scholar
  26. 26.
    Meehan MC. Racism and psychiatry. JAMA. 1972;220(4):593.CrossRefGoogle Scholar
  27. 27.
    Grob GN. Mental illness and American society, 1875–1940. Princeton: Princeton University Press; 1987.Google Scholar
  28. 28.
    Breggin PR. Psychiatry’s role in the Holocaust. Int J Risk Saf Med. 1993;4(2):133–48.PubMedGoogle Scholar
  29. 29.
    Breggin PR, Breggin GR. The war against children of color: psychiatry targets inner-city youth. Monroe: Common Courage Press; 1998.Google Scholar
  30. 30.
    Dowbiggin I. “An exodus of enthusiasm”: G. Alder Blumer, eugenics, and US psychiatry, 1890–1920. Med Hist. 1992;36(4):379.CrossRefGoogle Scholar
  31. 31.
    Dowbiggin IR. Keeping America sane: psychiatry and eugenics in the United States and Canada, 1880–1940. Ithaca: Cornell University Press; 1997.Google Scholar
  32. 32.
    Lombardo PA. Three generations, no imbeciles: eugenics, the supreme court, and Buck v. Bell. N Y Univ Law Rev. 1985;60(1):30–62.PubMedGoogle Scholar
  33. 33.
    Allen GE. Eugenics and modern biology: critiques of eugenics, 1910–1945. Ann Hum Genet. 2011;75(3):314–25.CrossRefGoogle Scholar
  34. 34.
    Norrgard K. Human testing, the eugenics movement, and IRBs. Nat Educ. 2008;1(1):170.Google Scholar
  35. 35.
    Black E. The horrifying American roots of Nazi eugenics. 2003. Retrieved 10 Feb 2007.Google Scholar
  36. 36.
    Trent J. Inventing the feeble mind: a history of intellectual disability in the United States. New York: Oxford; 2017.CrossRefGoogle Scholar
  37. 37.
    Braslow J. Mental ills and bodily cures: psychiatric treatment in the first half of the twentieth century. Berkeley: Universe of California Press; 1997.Google Scholar
  38. 38.
    Starks SL, Braslow JT. The making of contemporary American psychiatry, part 1: patients, treatments, and therapeutic rationales before and after World War II. Hist Psychol. 2005;8(2):176.CrossRefGoogle Scholar
  39. 39.
    Armstrong TD, Crum LD, Rieger RH, Bennett TA, Edwards LJ. Attitudes of African Americans toward participation in medical research. J Appl Soc Psychol. 1999;29(3):552–74.CrossRefGoogle Scholar
  40. 40.
    Axelsen DE. Women as victims of medical experimentation: J. Marion Sims’ surgery on slave women, 1845–1850. Sage. 1985;2(2):10.PubMedGoogle Scholar
  41. 41.
    Brandt AM. Racism and research: the case of the Tuskegee syphilis study. Hastings Cent Rep. 1978;8(6):21–9.CrossRefGoogle Scholar
  42. 42.
    Carmack HJ, Bates BR, Harter LM. Narrative constructions of health care issues and policies: the case of President Clinton’s apology-by-proxy for the Tuskegee syphilis experiment. J Med Humanit. 2008;29:89–109.CrossRefGoogle Scholar
  43. 43.
    Brandon DT, Isaac LA, LaVeist TA. The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care? J Natl Med Assoc. 2005;97(7):951.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Thomas SB, Quinn SC, Butler J, Fryer CS, Garza MA. Toward a fourth generation of disparities research to achieve health equity. Annu Rev Public Health. 2011;32:399–416.CrossRefGoogle Scholar
  45. 45.
    Baker RB, Washington HA, Olakanmi O, Savitt TL, Jacobs EA, Hoover E, Wynia MK. African American physicians and organized medicine, 1846–1968: origins of a racial divide. JAMA. 2008;300(3):306–13.CrossRefGoogle Scholar
  46. 46.
    Baker RB, Washington HA, Olakanmi O, Savitt TL, Jacobs EA, Hoover E, Wynia MK. Creating a segregated medical profession: African American physicians and organized medicine, 1846–1910. J Natl Med Assoc. 2009;101(6):501–12.CrossRefGoogle Scholar
  47. 47.
    Baker RB. The American Medical Association and race. Virtual Mentor. 2014;16(6):479.CrossRefGoogle Scholar
  48. 48.
    Duffy TP. The Flexner report―100 years later. Yale J Biol Med. 2011;84(3):269.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Harley EH. The forgotten history of defunct black medical schools in the 19th and 20th centuries and the impact of the Flexner report. J Natl Med Assoc. 2006;98(9):1425.PubMedPubMedCentralGoogle Scholar
  50. 50.
    American Psychiatric Association, editor. One hundred years of American psychiatry. New York: Columbia University Press; 1944.Google Scholar
  51. 51.
    Barton WE. The history and influence of the American Psychiatric Association. Washington, DC: American Psychiatric Pub; 1987.Google Scholar
  52. 52.
    Spurlock J, editor. Black psychiatrists and American psychiatry. Washington, DC: American Psychiatric Press; 1999.Google Scholar
  53. 53.
    Brown BS, Okura KP. In: Willie CV, Reiker PP, Kramer BM, et al., editors. A brief history of the Center for Minority Group Mental Health Programs at the National Institute of Mental Health. Mental health, racism, and sexism. Pittsburgh: University of Pittsburgh Press; 1995. p. 397–426.Google Scholar
  54. 54.
    Franklin AJ, Boyd-Franklin N. Invisibility syndrome: a clinical model of the effects of racism on African-American males. Am J Orthopsychiatry. 2000;70(1):33.CrossRefGoogle Scholar
  55. 55.
    King M Jr. King’s challenge to the nation’s social scientists. Washington, DC: American Psychological Association; 1967.Google Scholar
  56. 56.
    Baratz JC, Baratz SS. The social pathology model: historical bases for psychology’s denial of the existence of Negro culture. Washington, DC: American Psychological Association; 1969.Google Scholar
  57. 57.
    Fernando S. New racisms appear in the 1960s. Institutional racism in psychiatry and clinical psychology. Cham: Palgrave Macmillan; 2017. p. 59–90.Google Scholar
  58. 58.
    Delphin-Rittmon ME, Flanagan EH, Andres-Hyman R, Ortiz J, Amer MM, Davidson L. Racial–ethnic differences in access, diagnosis, and outcomes in public-sector inpatient mental health treatment. Psychol Serv. 2015;12(2):158.CrossRefGoogle Scholar
  59. 59.
    Franklin AJ, Boyd-Franklin N, Kelly S. Racism and invisibility: race-related stress, emotional abuse and psychological trauma for people of color. J Emot Abus. 2006;6(2–3):9–30.CrossRefGoogle Scholar
  60. 60.
    Fullilove MT. Comment: abandoning “race” as a variable in public health research—an idea whose time has come. Am J Public Health. 1998;88(9):1297–8.CrossRefGoogle Scholar
  61. 61.
    Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212.CrossRefGoogle Scholar
  62. 62.
    Jones CP. Invited commentary: “race,” racism, and the practice of epidemiology. Am J Epidemiol. 2001;154(4):299–304.CrossRefGoogle Scholar
  63. 63.
    Ford CL, Airhihenbuwa CO. The public health critical race methodology: praxis for antiracism research. Soc Sci Med. 2010;71(8):1390–8.CrossRefGoogle Scholar
  64. 64.
    Corneau S, Stergiopoulos V. More than being against it: anti-racism and anti-oppression in mental health services. Transcult Psychiatry. 2012;49(2):261–82.CrossRefGoogle Scholar
  65. 65.
    Poussaint AF. Is extreme racism a mental illness? West J Med. 2002;176(1):4.CrossRefGoogle Scholar
  66. 66.
    Lindsey KP, Paul GL. Involuntary commitments to public mental institutions: issues involving the overrepresentation of blacks and assessment of relevant functioning. Psychol Bull. 1989;106(2):171.CrossRefGoogle Scholar
  67. 67.
    Hatcher SS, King DM, Barnett TM, Burley JT. Mental health for youth: applying an African-centered approach. J Hum Behav Soc Environ. 2017;27(1–2):61–72.CrossRefGoogle Scholar
  68. 68.
    Wang MC, Joel Wong Y, Tran KK, Nyutu PN, Spears A. Reasons for living, social support, and Afrocentric worldview: assessing buffering factors related to black Americans’ suicidal behavior. Arch Suicide Res. 2013;17(2):136–47.CrossRefGoogle Scholar
  69. 69.
    Davis K. Slaves don’t get stress: the evolution of mental health policies and services for African Americans: implications for current and future public policy. Rockville: Center for Mental Health Services; 1998.Google Scholar
  70. 70.
    Munson C, Bent-Goodley T. African-American social workers and social policy. New York: Routledge; 2014.CrossRefGoogle Scholar
  71. 71.
    Acosta D, Ackerman-Barger K. Breaking the silence: time to talk about race and racism. Acad Med. 2017;92(3):285–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Kimberly Gordon-Achebe
    • 1
    • 2
  • Danielle R. Hairston
    • 3
  • Shadé Miller
    • 4
  • Rupinder Legha
    • 5
  • Steven Starks
    • 6
  1. 1.Department of Psychiatry and Behavioral SciencesTulane UniversityNew OrleansUSA
  2. 2.Hope Health Systems, Inc.BaltimoreUSA
  3. 3.Division of Consultation—Liaison PsychiatryUniversity of Maryland Medical CenterBaltimoreUSA
  4. 4.Queen’s UniversityKingstonCanada
  5. 5.Department of PsychiatryUCLA Semel Institute for Neuroscience and Human BehaviorLos AngelesUSA
  6. 6.Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonUSA

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