Content note: This article discusses topics such as slavery, racism, unethical science, and the COVID-19 pandemic. The author wishes to acknowledge he is not an expert on these topics nor has he personally experienced the hardships discussed below.
The Black community has experienced severe historical trauma and has a complex relationship with the field of medicine and psychiatry.
Ms. Udodiri Okwandu, a third year PhD candidate at Harvard University’s Department of History of Science, spoke to me broadly about this history and helped connect it to the struggles of the Black community today during the COVID-19 pandemic. Her research focuses on the intersection of race, medicine, science, and questions of power.
Slavery
“Mistrust in the context of psychiatry has a very long history”, Ms. Okwandu begins. “I think if we think back to the start of slavery, this is a period which, in order to reinforce the racist capitalistic system. Individuals had to create a moral and social distance between themselves and the people they were holding captive, in this case it was African individuals”. One example of this distance that originated in the field of psychiatry was created by Dr. Samuel Cartwright.
He supported two mental disorders, Drapetomania and Dysaethesia Aethiopica, which only enslaved Africans were diagnosed with. According to him, Drapetomania caused Black folks to run away from captivity and Dysaethesia Aethiopica caused them to lack a work ethic, made them lazy, and brought about disobedience. Unsurprisingly, the treatment for these conditions was more hard labor which often led to violent punishment.
“He said that rather than people having an inherent will to be free, have autonomy, and not be violently subjected by this institution, they were running away because they had a mental illness. This assumption is absolutely absurd in any rational, normal thought process. The things that they [doctors like Samuel Cartwright] are pathologizing are behaviors and actions that anyone would exhibit if they didn’t want to be in an inferior subjugated state.”
Sadly, this view of psychiatry in relation to Black individuals only evolved as time progressed.
Post Emancipation
During the post-emancipation period in the United States, freedom was thought to drive Black people insane, thus reinforcing the idea that slavery was a necessary institution to keep order in society.
“So we are seeing how medical ideas and medical knowledge were not objective and neutral, but were subjective and perverted by larger socio-political and cultural concerns”, Ms. Okwandu explains. Evidently, the relationship between Blackness, insanity, and mental illness was a way to reinforce white superiority. However, mental illness was not purely reserved for Black individuals. Mental disorders such as neurasthenia and hysteria were conceptualized as upper-middle class disorders that were a byproduct of being ‘civilized’ and of a ‘superior’ group.
Civil Rights Movement
Continuing the trend of using psychiatry as a way to maintain a racially defined social order, schizophrenia became associated with Black folks who called for racial equality during the 1960s and 70s.
“What we start seeing with the Civil Rights Movement, is that in order to undermine people’s call for equality and the end of racial subjugation… we saw an increased amount of Black people institutionalized for having schizophrenia, and a lot of these people were civil rights activists”, Ms. Okwandu explains.
In many ways, the disruption of social order produced by the Civil Rights Movement led psychiatrists to look for the ‘biological roots’ of violence and settle on the idea that riots and protests by the Black community were the result of a neurological disorder.
Mental illness, which was taken more seriously and treated professionally the closer you were to whiteness and wealth, was viewed as pathological and simply suppressed in the Black community. As in the case of Drapetomania and schizophrenia, treatment was not designed to improve any mental conditions but only to maintain the status quo. As a result of this historical trend, members of the Black community have commonly been conceptualized as not able to feel any psychological or physical pain. Ms Okwandu shares from her own experience that this has negatively affected the way Black folks discuss mental illness within the community and this discourse has only recently begun to change.
“I am seeing more of the Black community being comfortable talking about mental health and seeking therapy and trying to heal from trauma…”. There is also a “...desire to recognize and honour that we are allowed to engage in mental suffering and to seek and access treatment… we have not been able to occupy the space of ‘I am an individual that has emotional pain that deserves to be recognized and deserves to be treated’”.
The COVID-19 Pandemic
Connecting this long and violent medical history to today is not difficult. As we all know, the COVID-19 pandemic has changed the way we live our lives. However, for the Black community, elements of the response to this medical crisis have been too familiar. For example, Ms. Okwandu remembers reading articles early on in the pandemic that suggested Black folks might be immune to the virus.
“...People were questioning why isn’t Africa being devastated by this pandemic, you know, why isn’t there very high death rates in the Black community, and then we saw that that quickly shifted… we were so quick to run to these notions of biologically different racial bodies which just has no biological truth to it”.
Mayo Clinic reports that while there are no biological or genetic reasons that explain why minorities are disproportionately affected by the pandemic, factors such as underlying health risks, living in crowded cities and multigenerational homes, working in the service/essential business industry, and racism all contribute to infection disparity.
Ms. Okwandu goes on to make a very important link between the history of mistrust towards medicine from the Black community and the new virus vaccine. She points out that the government’s response to the virus has been to emphasize the wait for a vaccine. While a vaccine will certainly reduce the pandemic’s impact, in waiting for this treatment, the government has failed to support and bolster trust within Black community. The APM Research Lab reported that from April 2020 to January 5th 2021, “Pacific Islanders, Latino, Black and Indigenous Americans all have a COVID-19 death rate of double or more that of White and Asian Americans, who experience the lowest age-adjusted rates”. As a result of this disparity and the historical failures of the past, Ms. Okwandu admits that some members of the Black community will be skeptical of the vaccine.
Furthermore, all of these stressful events and worrying realities are compounded by the fact that Black individuals face barriers to mental healthcare access.
One of those barriers is the lack of health insurance or jobs that pay for time spent off while seeking care. The CDC reported in 2017 that 10% of non-hispanic Black people were uninsured in the US. Another barrier is the lack of representation in the psychiatry and psychology fields. The American Psychological Association reported in 2015 that only 4 percent of psychologists in the US were Black/African-American. As Ms. Okwandu explains, “...we know so much of mental suffering is often related to one’s identity and if we don’t have culturally competent providers that can also produce an additional barrier to access”.
Moving Forward
When asked how we might proceed into the future given this history of mistrust, Ms. Okwandu said, “I think a lot about how, if we become more aware of these larger historical issues and also the trajectory it is taking, how it can impact individuals’ day-to-day decision making.”
“Education divorced from action means nothing. It is not only being aware of these histories but also thinking about ways that we can proactively not repeat the same mistakes of the past. I think that once you are no longer ignorant to these larger issues, and also have a commitment to try to improve things, I think that we are more likely to engage in better practices”.
We must all inspect our internalized biases, be willing to be wrong, and engage in a practice of unlearning. We must “...listen to those who are being oppressed and what they need rather than try to impose something onto them top down”, Ms. Okwandu explains.
What can you do?
A great way to start doing this is by reading, listening, and following on social media, the work of those who are most impacted. An even more proactive approach would be to donate to grassroot organizations, mutual aid funds, or mental health groups that support the Black community and activists. You can even start by researching efforts that are happening within your own community or area and learn more about how you can contribute to them. Organizations such as Big Brothers Big Sisters Montreal and the Black Community Resource Center (BCRC) are great resources to find out about volunteer opportunities if you are located in the Montreal area.
Below is a list of books that Ms. Okwandu curated for us to share with you. These books can provide a better understanding of the history of race and medicine as well as race, racism, and anti-racism in the United States.
APM Research Lab Staff (2021, February). The Color of Coronavirus:
COVID-19 Deaths by Race and Ethnicity in the U.S.. APM Research Lab. https://www.apmresearchlab.org/covid/deaths-by-race
Lin, L., Stamm, K. Christidis, P. (2018, February) How diverse is the psychology workforce?. American Psychological Association. https://www.apa.org/monitor/2018/02/datapoint
Marshall, W. F. (2020, August). Coronavirus infection by race: What’s behind the health disparities?. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-infection-by-race/faq-20488802