But there is a lot to apologize for — from Reconstruction to today.
By Judith Warner
April 30, 2021
Dr. Danielle Hairston, president of the American Psychiatric Association’s Black caucus. “They’re taking these tiny, superficial, palatable steps,” she said, “but as far as real work, the A.P.A. has a long way to go.”Credit…Cheriss May for The New York Times
Dr. Benjamin Rush, the 18th-century doctor who is often called the “father” of American psychiatry, held the racist belief that Black skin was the result of a mild form of leprosy. He called the condition “negritude.”
His onetime apprentice, Dr. Samuel Cartwright, spread the falsehood throughout the antebellum South that enslaved people who experienced an unyielding desire to be free were in the grip of a mental illness he called “drapetomania,” or “the disease causing Negroes to run away.”
In the late 20th century, psychiatry’s rank and file became a receptive audience for drug makers who were willing to tap into racist fears about urban crime and social unrest. (“Assaultive and belligerent?” read an ad that featured a Black man with a raised fist that appeared in the “Archives of General Psychiatry” in 1974. “Cooperation often begins with Haldol.”)
Now the American Psychiatric Association, which featured Rush’s image on its logo until 2015, is confronting that painful history and trying to make amends.
In January, the 176-year-old group issued its first-ever apology for its racist past. Acknowledging “appalling past actions” on the part of the profession, its governing board committed the association to “identifying, understanding, and rectifying our past injustices,” and pledged to institute “anti-racist practices” aimed at ending the inequities of the past in care, research, education and leadership.
This weekend, the A.P.A. is devoting its annual meeting to the theme of equity. Over the course of the three-day virtual gathering of as many as 10,000 participants, the group will present the results of its yearlong effort to educate its 37,000 mostly white members about the psychologically toxic effects of racism, both in their profession and in the lives of their patients.
Dr. Jeffrey Geller, the A.P.A.’s outgoing president, made that effort the signature project of his one-year term of office.
“This is really historic,” he said in a recent interview. “We’ve laid a foundation for what should be long-term efforts and long-term change.”
Dr. Cheryl Wills, a psychiatrist who chaired a task force exploring structural racism in psychiatry, said the group’s work could prove life-changing for a new generation of Black psychiatrists who will enter the profession with a much greater chance of knowing that they are valued and seen. She recalled the isolation she experienced in her own early years in medicine, and the difficulty she has had in finding other Black psychiatrists to whom she can refer patients.
“It’s an opportunity of a lifetime,” she said. “In psychiatry, just like any other profession, it needs to start at the top,” she said of her hope for change. “Looking at our own backyard before we can look elsewhere.”
Dr. Cheryl Wills chaired a yearlong task force exploring structural racism in psychiatry. “In psychiatry, just like any other profession, it needs to start at the top,” she said.Credit…Amber Ford for The New York Times
For critics, however, the A.P.A.’s apology and task force amount to a long-overdue, but still insufficient, attempt at playing catch-up. They point out that the American Medical Association issued an apology in 2008 for its more than 100-year history of having “actively reinforced or passively accepted racial inequalities and the exclusion of African-American physicians.”
“They’re taking these tiny, superficial, palatable steps,” said Dr. Danielle Hairston, a task force member who is also president of the A.P.A.’s Black caucus and the psychiatry residency training director at Howard University College of Medicine.
“People will be OK with saying that we need more mentors; people will be OK with saying that we’re going to do these town halls,” she continued. “That’s an initial step, but as far as real work, the A.P.A. has a long way to go.”
The question for the organization — with its layers of bureaucracy, widely varied constituencies and heavy institutional tradition — is how to get there.
Critics operating both inside and outside the A.P.A. say that it still must overcome high hurdles to truly address its issues around racial equity — including its diagnostic biases, the enduring lack of Black psychiatrists and a payment structure that tends to exclude people who can’t afford to pay out of pocket for services.
“All these procedural structures that are in place are helping to perpetuate the system and keep the system functioning the way it was designed to function,” said Dr. Ruth Shim, the director of cultural psychiatry and professor of clinical psychiatry at the University of California, Davis, who left the A.P.A. in frustration last summer.
They all add up, she said, to “an existential crisis in psychiatry.”
A racist history
White psychiatrists have pathologized Black behavior for hundreds of years, wrapping up racist beliefs in the mantle of scientific certainty and even big data. The A.P.A. was first called the Association of Medical Superintendents of American Institutions for the Insane, according to Dr. Geller, who last summer published an account of psychiatry’s history of structural racism. The group came into being in the wake of the 1840 federal census, which included a new demographic category, “insane and idiotic.”
The results were interpreted by pro-slavery politicians and sympathetic social scientists to find a considerably higher rate of mental illness among Black people in the Northern states than among those in the South.
In the decades following Reconstruction, prominent psychiatrists used words like “primitive” and “savage” to make the cruelly racist claim that Black Americans were unfit for the challenges of life as independent, fully enfranchised citizens.
T.O. Powell, superintendent of the infamous State Lunatic Asylum in Milledgeville, Ga., and president of the American Medico-Psychological Association (the precursor to the A.P.A.), went so far as to outrageously state in 1897 that before the Civil War, “there were comparatively speaking, few Negro lunatics. Following their sudden emancipation their number of insane began to multiply.”
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