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A Black and White History of Psychiatry in the United States

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Abstract

Histories of psychiatry in the United States can shed light on current areas of need in mental health research and treatment. Often, however, these histories fail to represent accurately the distinct trajectories of psychiatric care among black and white populations, not only homogenizing the historical narrative but failing to account for current disparities in mental health care among these populations. The current paper explores two parallel histories of psychiatry in the United States and the way that these have come to influence current mental health practices. Juxtaposing the development of psychiatric care and understanding as it was provided for, and applied to, black and white populations, a picture of the theoretic foundations of mental health emerges, revealing the separate history that led to the current uneven state of psychiatric care.

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Endnotes

1 In this paper, I use “psychiatry” as shorthand for the mental health profession more broadly, including psychologists, social workers, and mental health researchers.2 A quote by Francis Fauquier, Governor of Virginia, highlights this fact very clearly “…a poor unhappy set of People who are deprived of their Senses and wander about the Country, terrifying the Rest of their Fellow Creatures. A legal Confinement and proper Provision, ought to be appointed for these miserable Objects, who cannot help themselves. Every civilized Country has an Hospital for these People, where they are confined, maintained and attended by able Physicians, to endeavor to restore to them their lost Reason” (Kennedy 1906, 12).3 This overconfidence is exemplified in Horace Mann’s statement on the effectiveness of the new treatments available in psychiatric hospitals: “Until the period comparatively recent, insanity has been deemed as an incurable disease […] It is now most abundantly demonstrated, that with appropriate medical and moral treatment, insanity yields with more readiness than ordinary diseases” (Massachusetts Commissioners Appointed to Superintend the Erection of a Lunatic Hospital at Worcester; Mann, Horace,1796-1859; Taft, Bezaleel,1780-1846; Calhoun, William B.(William Barron),1795-1865; Massachusetts General Court 1832, 19-20).4 The State Lunatic Asylum in Utica, New York, for example, had over six hundred patients in 1884, 2 % of which slept on the floor due a lack of beds (Grob 1983).5 It should be noted that the records between 1801-1821 are incomplete, and do not report on any white admissions to the asylum, though two free black men are listed (Savitt 2002, 259).6 Even when they were admitted, it appears that they were not truly given equal access. Between 1846 and 1861, only fifty-five slaves and seventy-six free black people were admitted to the Eastern Lunatic Asylum, whereas eight hundred thirteen white people were admitted in the same period (Savitt 2002, 259).7 Cartwright explained his position thus: “If the white man attempts to oppose the Deity's will, by trying to make the negro anything else than "the submissive knee-bender" (which the Almighty declared he should be), by trying to raise him to a level with himself, or by putting himself on an equality with the negro; or if he abuses the power which God has given him over his fellow-man, by being cruel to him, or punishing him in anger, or by neglecting to protect him from the wanton abuses of his fellow-servants and all others, or by denying him the usual comforts and necessaries of life, the negro will run away; but if he keeps him in the position that we learn from the Scriptures he was intended to occupy, that is, the position of submission; and if his master or overseer be kind and gracious in his hearing towards him, without condescension, and at the same time ministers to his physical wants, and protects him from abuses, the negro is spell-bound, and cannot run away” (Cartwright 1851).8 Skinner versus Oklahoma (1942).9 Virginia, for example, had sterilization laws until 1973 (Fischer 2012, 1099), and social workers in North Carolina were found to be advocating sterilization as late as 1977 (Conrad 2018).10 While Freud’s work does not make claims to racial distinctions in his analysis of psychopathology, many of his followers in the United States did (Thomas and Sillen 1974). A number of articles in early volumes of Psychoanalytic Review, for example, paid particular attention to the mental lives and presumed psychopathology of black people. See Evarts (1914); Lind (1914b, 1916); Prudhomme (1938); as well as White (U.S. House of Representatives 1907).11 Less than a decade later, Bevis (1921) would claim that “It is the conscious or unconscious wish of every negro to be white. This is brought out in his dreams, in the hope of being white in the eternal life and in his delusions” (412).12 See, for example: Popenoe, P & Johnson, R.H., 1918. Applied Eugenics. New York: The Macmillan Company.; Grant, M. 1916. The Passing of the Great Race or The Racial Basis of European History. Abergele: Wermod & Wermod (it may be noted in passing that Adolph Hitler wrote a letter to Grant wherein he referred to this book as his “bible” [Ummel 2016, 392-393]); Stoddard, L. 1920. The Rising Tide of Color Against White World-Supremacy. New York: Charles Scribner’s Sons.13 Stoddard’s preface makes this concern explicit in catastrophized terms: “The subjugation of white lands by colored armies may, of course, occur, especially if the white world continues to rend itself with internecine wars. However, such colored triumphs of arms are less to be dreaded than more enduring conquests like migrations which would swamp whole populations and turn countries now white into colored man’s land irretrievably lost to the white world” (1920, vi).14 See: Lake versus Cameron (1966), which established that patients be treated in the “least restrictive setting”; Wyatt versus Stickney (1971), which asserted the constitutional right of all psychiatric patients to “(1) a humane psychological and physical environment, (2) qualified staff in numbers sufficient to administer adequate treatment and (3) individualized treatment plans” (Wyatt versus Stickney, 334 F. Supp 1341, 1343 (M.D. Ala. 1971)); O’Connor versus Donaldson (1975), which ruled that an individual must present an immediate danger to him/herself or to others; Olmstead versus L.C. (1999), which declared that those with mental illness were protected by the Americans with Disabilities Act (1990).15 In joint report the Treatment Advocacy Center and the National Sheriff’s Association (2014) revealed that about 356, 268 people with severe mental illnesses were incarcerated in the United States in 2012 compared to only 35,000 in psychiatric facilities.

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Conrad, J.A. A Black and White History of Psychiatry in the United States. J Med Humanit 43, 247–266 (2022). https://doi.org/10.1007/s10912-020-09650-6

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