Racism: Psychiatry's Unsolved Dilemma

Across America, mean-spirited television and radio talk show hosts, skinheads and select politicians demonize multiculturalism. Academicians such as Abigail and Stephen Thernstrom, authors of the new book America in Black and White: One Nation, Indivisible, openly attack affirmative action as thinly disguised racial preference.

Voters in Houston recently rebuffed an initiative to eliminate affirmative action, believing that such programs applied primarily to higher education, specifically medical and law school admissions, California voters, however, approved legislation that seeks to eliminate all state-sponsored affirmative action. The fact that affirmative action has placed countless white women in jobs previously denied them is seldom acknowledged. Moreover, the scarcity of racial minorities receiving major federal and state contracts for building projects and entrance into other industrial businesses is often overlooked when affirmative action is debated.

Charles Murray and Richard Herrnstein's 1994 book, The Bell Curve: Intelligence and Class Structure in American Life, became a manifesto on abolishing all laws against racial discrimination. Murray recommended that the nation leave justice and fair treatment to the virtuous forces of a self-regulating market, despite the recent nationally reported discrimination complaints lodged against Texaco, Dunn, Fleet Financial, Shell Oil, Nations Bank and National Car Rental, to mention a few (The Journal of Blacks in Higher Education, Autumn 1997). Murray contends that because racial minorities, primarily African Americans, are genetically intellectually inferior, the country is wasting its money on educational and social programs designed to improve the education and social functioning of minorities. Seemingly, Charles Murray's opinion has had a profound influence on Congress, as it has drastically changed our nation's welfare laws, including Medicare.

What has happened to our nation since the 1960s and 1970s? The quest for racial equality appears to be rapidly dissipating. Blatant pre-civil rights racism has been replaced by a more virulent, yet camouflaged, form of racial bigotry. At times it seems that the most grotesque forms of racism are rationalized, as demonstrated by television commentator Pat Buchanan during his last bid to "reclaim America."

To wit: USA Today (Feb. 26, 1996) reported that Buchanan made a public presidential campaign appearance in Phoenix, where vendors sold hats emblazoned with swastikas and copies of the Anarchist Cookbook, which contains recipes for homemade bombs. In that same article, Mr. Buchanan unashamedly commented that "Illegal immigrants come here to get on welfare...or come to rob, beat and assault American citizens." Similarly, racism is never far from our national consciousness as we struggle to explain the burning of African American churches throughout the South.

Abdicating Responsibilities

Giving consideration to the unique skills and training of psychiatrists and most human behavioral scientists, I am chagrined that we have abdicated our responsibilities as private citizens and professionals to help create a more emotionally healthy and secure America. Is it asking too much of mental health professionals to contribute their knowledge of normal and pathological behavior to discussions of social issues that negatively impact society?

What became of the research generated by the Task Force on Racism of the American Orthopsychiatric Association a few years ago? The Group for the Advancement of Psychiatry, Psychiatrists for a Better Psychiatry and the American Society of Social Psychiatry have knowledgeable members with research experience in the area of race relations. Ostensibly, President Clinton's Commission on Race is without input from these organizations and individuals.

The American Medical Association, undoubtedly following the lead of the American Psychiatric Association, has extended to African American physicians full membership with all rights and privileges, and in 1996 appointed its first African American president, Lonnie R. Bristow, M.D.

In point of fact, the AMA has been vocal and proactive with an initiative to strengthen affirmative action by establishing the Consortium on Minority Affairs (Larson, 1997), which replaces the former Advisory Committee on Minority Physicians. The group's goals are to achieve greater medical school population diversity and to increase the number of minority students and physicians participating in the AMA.

Recognizing that the country's political winds are shifting away from affirmative action, AMA's trustee, Regina M. Benjamin, M.D., has become publicly outspoken in reaffirming that the association supports a diverse physician workforce, a position that has been overshadowed in psychiatry by an obsession with managed care.

The most convincing evidence in favor of affirmative action in medicine has come from AMA statistics. African American and Hispanic doctors report that approximately 40% and 37%, respectively, of their patients are poor-compared with 29% of white physicians' patients. About half of the patients of African American and Hispanic physicians are members of minority groups compared with about a quarter among white physicians' patients. Young African American and Hispanic women physicians provide the most care for poor patients. Physicians whose parents were of low income and had less than a high school education saw more patients in underserved groups than did other physicians, but race and ethnicity were more highly associated with services to those patients than economic background. The explanation of these findings is that even with affirmative action at work for more than 30 years, racism has prevailed (Mitka, 1996).

Commitment to Full Equality

There was a point in time when the APA appeared to be deeply committed to full equality for all people and engaged in the struggle to do something about it. For example, the American Journal of Psychiatry devoted a special section on racism in its December 1970 edition (Vol. 127, No. 6). Written by a group of young and sincere white American psychiatrists (Melvin Sabshin, M.D.-who later became the medical director of the APA-Herman Diesenhaus, M.D., and Raymond Wilkerson, M.D.), it became their treatise on the "Dimensions of Institutional Racism in Psychiatry."

These authors had concluded that "Our heretofore essentially quite controlled professional organizations, as well as federal and state agencies, should take the lead in exposing and significantly diminishing institutional racism...One way to begin to focus attention on the institutional white racism of psychiatry is to devote a special section of the American Journal of Psychiatry to racism's origins, history, and current status in psychiatry and in our nation as a whole, as well as to present strategies for change [italics added]."

Suffice it to say, these recommendations were never acted on, and instead there has been a paucity of psychiatric writing to help our understanding of America's racial dilemma.

Psychiatry must hold a steady course, constantly speaking out against racial injustices, and seek to include racial minorities in all functions of professional organizations. We must be eager to share our expertise with our nation's president, Congress, and others in decision-making capacities, just as aggressively as we seek parity for the treatment of our patients. Without a doubt, there will be colleagues who will question the possibility of reclaiming the idealism of the 1960s.

Our rationalization that racism, like other euphemisms such as communism, is based more on attitudinal factors than on a defined medical or psychological condition does little to help our nation and the world grasp the value of respect and diversity.

References:

References

1.

Larson, P (1997), Am Medical News Vol. 40, No. 45, p. 4.

2.

Mitka, M (1996), Am Medical News Vol. 39, No. 32, pp. 1, 23.