As we all know, it is a great sadness in our profession that people with mental illness have been discriminated against and therapy has been seen as taboo. For African Americans and other People of Color, this has been especially true. The reasons for this may or may not be obvious, but the colonization of the mental health field by white people is one of the primary obstacles facing Black, Indigenous and other People of Color when they seek psychotherapy. Another reason is that the field of psychiatry and subsequently, the field of mental health in general, has a long history of pathologizing African Americans in order to retain white supremacy culture in this country through systemic oppression.
Prior to the Civil Rights Act in 1964, hospitals and other agencies providing mental health services were segregated. Although Title VI made it illegal for facilities receiving federal funds to discriminate based on race, some states fought the federal government in court, claiming states’ rights and asserting that segregation was medically necessary. However, dating back to the early 1800’s psychiatrists and physicians claimed that Africans were incapable of taking care of themselves and therefore benefitted from slavery. “Scientific racism” was used to rationalize slavery and assuage the moral dilemma of it. Samuel Cartwright published a report in 1851 in which he created two diagnoses for African slaves: “draeptomania,”(drapetomania) the psychiatric diagnosis given to slaves when they tried to run away, and “dysaethesia aethiopica,”(dystheesia Ethiopica) the diagnosis given to slaves who did not embrace the hard labor of slavery. Cartwright pathologized Africans, who had been enslaved and therefore were without the means or education to advance themselves, by saying they were not capable of psychological complexity or emotional maturity. Cartwright’s assertions led to segregated care in hospitals, where Black people received substandard care and were put to work in kitchens and laundry, instead of receiving adequate psychiatric services. These practices remained in place until the 1960’s. Still, the desegregation of services did not mean equality.
At the time of the Civil Rights movement, schizophrenia began to be described as a “violent social disease.” This description was accepted by the medical community, and in 1968, an article published in the Archives of General Psychiatry, described schizophrenia as a “protest psychosis,” (modern day draeptomania?) in which Black men developed “hostile and aggressive feelings and delusional anti-whiteness” due to the influences of activist organizations such as the Black Panthers, Black Power and the Nation of Islam. Today, we are hearing similar refrains about the Black Lives Matter movement, which has been referred to as the Antifa, or a violent terrorist movement. In the 1970’s, psychiatrists changed the diagnosis of schizophrenia to include the word aggressive, and used Black patients who were deemed out of control to market new anti-psychotic medications such as Haldol. The advertisements featured an image of a Black man who appeared menacing, and the headline read, “Assaultive and Belligerent?” The media helped promote the image of angry Black men as deranged and psychotic killers in the streets. Paranoid Schizophrenia became a diagnosis in reaction to these images. In the 1970s, Black people were more likely to be hospitalized for longer periods and in poor conditions. In the 1980’s when federally funded psychiatric hospitals were closed, prisons took their place.
The problems with the mental health care system can still be seen today, with far more African American men than white men being diagnosed with schizophrenia – 4 times more likely – without scientific justification. Additionally, African American men and women with mental illness are far more likely to be incarcerated rather than treated medically than their white peers. African Americans are less likely to be diagnosed with PTSD and mood disorders.
African Americans are far less likely to seek mental health care, for reasons cited so far, but also because of the racial disparities in care providers: 86% of psychologists are white and less than 2% of APA members are African American. These statistics bear out in our training graduate schools, training opportunities and in our clinical organizations.
“Black Analysts Speak,” and the article, “Whiteness Matters, are two resources that illustrate the effects of systemic racism in the field of mental health today. I hope you have a chance to watch and read, because you will see how far behind as a field we are in addressing the effects of racism on our patients as well as in our academic and training institutes. The time for reckoning and reconciliation is upon us, and our question today is, what are we going to do about it?
Sources:
https://academic.udayton.edu/health/01status/mental01.htm
https://ct.counseling.org/2020/05/the-historical-roots-of-racial-disparities-in-the-mental-health-system/
https://www.mhanational.org/issues/black-and-african-american-communities-and-mental-health
https://socialwork.simmons.edu/racial-disparities-in-mental-health-treatment/
https://www.washingtonpost.com/outlook/2019/07/29/how-bigotry-created-black-mental-health-crisis/
Book:
Overcoming Unintentional Racism in Counseling and Therapy by Charles Ridley 2nd edition
As we all know, it is a great sadness in our profession that people with mental illness have been discriminated against and therapy has been seen as taboo. For African Americans and other People of Color, this has been especially true. The reasons for this may or may not be obvious, but the colonization of the mental health field by white people is one of the primary obstacles facing Black, Indigenous and other People of Color when they seek psychotherapy. Another reason is that the field of psychiatry and subsequently, the field of mental health in general, has a long history of pathologizing African Americans in order to retain white supremacy culture in this country through systemic oppression.
Prior to the Civil Rights Act in 1964, hospitals and other agencies providing mental health services were segregated. Although Title VI made it illegal for facilities receiving federal funds to discriminate based on race, some states fought the federal government in court, claiming states’ rights and asserting that segregation was medically necessary. However, dating back to the early 1800’s psychiatrists and physicians claimed that Africans were incapable of taking care of themselves and therefore benefitted from slavery. “Scientific racism” was used to rationalize slavery and assuage the moral dilemma of it. Samuel Cartwright published a report in 1851 in which he created two diagnoses for African slaves: “draeptomania,”(drapetomania) the psychiatric diagnosis given to slaves when they tried to run away, and “dysaethesia aethiopica,”(dystheesia Ethiopica) the diagnosis given to slaves who did not embrace the hard labor of slavery. Cartwright pathologized Africans, who had been enslaved and therefore were without the means or education to advance themselves, by saying they were not capable of psychological complexity or emotional maturity. Cartwright’s assertions led to segregated care in hospitals, where Black people received substandard care and were put to work in kitchens and laundry, instead of receiving adequate psychiatric services. These practices remained in place until the 1960’s. Still, the desegregation of services did not mean equality.
At the time of the Civil Rights movement, schizophrenia began to be described as a “violent social disease.” This description was accepted by the medical community, and in 1968, an article published in the Archives of General Psychiatry, described schizophrenia as a “protest psychosis,” (modern day draeptomania?) in which Black men developed “hostile and aggressive feelings and delusional anti-whiteness” due to the influences of activist organizations such as the Black Panthers, Black Power and the Nation of Islam. Today, we are hearing similar refrains about the Black Lives Matter movement, which has been referred to as the Antifa, or a violent terrorist movement. In the 1970’s, psychiatrists changed the diagnosis of schizophrenia to include the word aggressive, and used Black patients who were deemed out of control to market new anti-psychotic medications such as Haldol. The advertisements featured an image of a Black man who appeared menacing, and the headline read, “Assaultive and Belligerent?” The media helped promote the image of angry Black men as deranged and psychotic killers in the streets. Paranoid Schizophrenia became a diagnosis in reaction to these images. In the 1970s, Black people were more likely to be hospitalized for longer periods and in poor conditions. In the 1980’s when federally funded psychiatric hospitals were closed, prisons took their place.
The problems with the mental health care system can still be seen today, with far more African American men than white men being diagnosed with schizophrenia – 4 times more likely – without scientific justification. Additionally, African American men and women with mental illness are far more likely to be incarcerated rather than treated medically than their white peers. African Americans are less likely to be diagnosed with PTSD and mood disorders.
African Americans are far less likely to seek mental health care, for reasons cited so far, but also because of the racial disparities in care providers: 86% of psychologists are white and less than 2% of APA members are African American. These statistics bear out in our training graduate schools, training opportunities and in our clinical organizations.
“Black Analysts Speak,” and the article, “Whiteness Matters, are two resources that illustrate the effects of systemic racism in the field of mental health today. I hope you have a chance to watch and read, because you will see how far behind as a field we are in addressing the effects of racism on our patients as well as in our academic and training institutes. The time for reckoning and reconciliation is upon us, and our question today is, what are we going to do about it?
Sources:
https://academic.udayton.edu/health/01status/mental01.htm
https://ct.counseling.org/2020/05/the-historical-roots-of-racial-disparities-in-the-mental-health-system/
https://www.mhanational.org/issues/black-and-african-american-communities-and-mental-health
https://socialwork.simmons.edu/racial-disparities-in-mental-health-treatment/
https://www.washingtonpost.com/outlook/2019/07/29/how-bigotry-created-black-mental-health-crisis/
Book:
Overcoming Unintentional Racism in Counseling and Therapy by Charles Ridley 2nd edition
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