Why Is Black History Month Important to Psychiatry?

BLACK HISTORY MONTH

Black History Month is important so that as Americans, we never fail to remember the democide to African Americans in this country. In addition, we should acknowledge, admire, and celebrate Black heroes for their respective contributions. Moreover, for me, it is important to respect overall humanity and improve the quality of life for all Americans. Black history is American history.

Racism is pervasive. Its negative impact exists in many forms. The field of psychiatry has not been exempt from this unfortunate truth, past or present. Such truth is of great concern as psychiatry represents a group of professionals whose primary purpose is to assess, diagnose, and treat serious persistent mental illness. Furthermore, as trained professionals in this medical discipline, society depends on us to set definitions, criteria, and standards to treat psychiatric illnesses. Therefore, it is imperative that as leaders we understand our past, in order to move forward toward eliminating structural forms of racism within our profession.

The early treatment of psychiatric disorders in this country was a forewarning of where we are today. There was a dark period in the beginning of psychiatry in America which predates the formation of the American Psychiatric Association (APA) in 1844. At that time, the perception of African Americans was inhumane. American psychiatry was started by 13 white men who were superintendents of asylums at the time.¹ Early on in their organizational meetings, they decided to segregate facilities for African Americans—that is, if they were to receive treatment at all. Whether you lived in the free north or the enslaved south determined the care (or lack thereof) a Black patient would receive.

Diagnoses such as drapetomania were assigned to individuals who were considered mentally ill because they wanted to run away from their slave owners. Another diagnosis, dysaesthesia aethiopica (rascality), was considered an illness that compelled slaves to commit offenses. An early founder and leader of American psychiatry, Benjamin Rush, promoted the theory that the “color” and “figure” of Blacks were derived from a form of leprosy.² In order for our society to evolve and move forward from structural racism we must cease glorifying legacies of individuals that promoted it originally. These misconceptions were promulgated by psychiatrists for a century.

In more recent history the vestiges of racism still exist. In 1910, the Abraham Flexner report led to Black medical schools being shut down except for Meharry Medical College and Howard University.³ This meant less training of Black doctors and therefore less quality health care for African Americans overall. Prior to the inclusion of Title VI into Medicare, hospitals were segregated. Black hospitals were significantly underfunded compared with white hospitals. Black physicians were not given the opportunity to work at white hospitals, and Black patients were denied health care. After the enactment of Title VI of the Civil Rights Act of 1964, 1000 White hospitals joined the program in a mere 4 months. Then and only then were African American doctors allowed to work and African American patients treated in those hospitals. This is an indisputable example of racial discrimination, only a half century ago.⁴

In 2015, I was invited to a research meeting being presented by a lead cancer research scientist at a medical school where I was previously employed. Local African American community doctors were invited to discuss proposals for cancer research, hopeful that several would agree to refer African American patients to our clinical site. It was eye opening the degree of distrust, feelings of betrayal, and resentment that existed within many of those senior doctors who had experienced the ongoing racism in that setting. In fact, more than one commented on having never been invited to the university site, for any activity.

This reality is particularly important because it sets a framework for the ongoing process of mistrust that many in African American communities feel toward research—and their government. This mistrust leads to fewer African Americans participating in clinical research, therefore compromising the validity of the results. Often, studies do not accurately represent the African American population. Hence, this leads to a lack of scientific progress and advancement for African American health indices.

In terms of education, I believe every child in America should receive equal educational opportunities. Particularly, such should include comparable funding. Our current system is fundamentally flawed, as it bases resources on the variable of location. Children have no influence on factors such as where they live or which zone has the highest property taxes. Thus, this strategy of funding public education is discriminatory to African Americans and/or ethnic minority children, many of whom reside in communities with fewer financial resources. Such a system of funding and governance has evolved into a cycle of less overall educational support. This current system must change.

Reparations have been discussed to address the historical governmental mistreatment of African Americans. This topic has been particularly polarizing here in America. Since this country’s inception, the principles of equality, opportunity, and freedom have been declared and promulgated with eloquence. However, the reality of life for African Americans as citizens has been markedly different compared to Whites. Our collective history has recorded over 4 centuries of slavery, oppression, and mistreatment of African American communities.⁵

In many statistical categories which measure health, success, and prosperity in American life, there is a wide divide between white Americans and African Americans.^6,7 Some dissenters who criticize the concept of reparations use the counterargument of highlighting extraordinarily successful African Americans (eg, Carl Lewis in track and field). Unfortunately, that analogy overlooks the fact that such does not represent the majority of people. This issue must be addressed if we are to truly exemplify the ideals of this country.

Furthermore, reparations do not solely need to be in the form of monetary compensation (see Table). A powerful beginning can be made by addressing the 2 key initial pillars that would level the playing field for ethnic minorities in this country: health care and education.⁸ Reparations are not a handout. The idea represents the core construct of recalibrating life in American society, changing its structure and placing our country on the correct path to fundamental fairness.

Dr Bailey serves as Assistant Dean of Clinical Education at Charles R. Drew University and Chief Medical Officer of Kedren Health Systems Inc. He served as president of the National Medical Association and chair of the American Medical Association’s Commission to End Health Disparities. He currently is a member of the American Psychiatric Association Board of Trustees. Throughout his career, Dr Bailey has worked with underserved and minority populations and has authored numerous papers on the topic. Dr Grover is a research associate with Charles R. Drew University and Kedren Health Systems Inc.

References

1. Curwen J. The Original Thirteen Members of the Association of Medical Superintendents of American Institutions for the Insane. E. Cowan; 1855.

2. Omi M, Winant H. Racial Formation in the United States: from the 1960s to the 1980s. New York; London: Routledge & Kegan Paul; 1986.

3. Flexner A. Medical education in the United States and Canada. From the Carnegie Foundation for the Advancement of Teaching, Bulletin Number Four, 1910. Bull World Health Organ. 2002;80(7):594-602.

4. Smith DB. Eliminating Disparities in Treatment and the Struggle to End Segregation. Commonwealth Fund. August 2005. Accessed February 16, 2021. https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2005_aug_eliminating_disparities_in_treatment_and_the_struggle_to_end_segregation_775_smith_ending_disparities_in_treatment_pdf.pdf

5. Miles LA. A Systematic Review on the Impact of Slavery: 400 Years of Trauma. Doctoral dissertation, California Southern University. 2020.

6. Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666-668.

7. Herring C, Henderson L. Wealth inequality in black and white: Cultural and structural sources of the racial wealth gap. Race Soc Probl. 2016;8(1), 4-17.

8. Office of the Legislative Counsel. May 1, 2010. Compilation of Patient Protection and Affordable Care Act. Accessed February 16, 2021. http://housedocs.house.gov/energycommerce/ppacacon.pdf