Impacts of Racism in the Mental Health Field on Black Americans

Introduction

In 1851, American psychiatrist and physician Samuel A. Cartwright revealed to his colleagues that he had created a groundbreaking mental disorder that only Black people could experience (Smith, 2020). He called it drapetomania and it was defined as a mental disorder that compelled enslaved peoples to run away from slave owners. The cure? Torture in the form of whippings and, sometimes, mutilation (Dimuro, 2018). Cartwright’s discovery of this illness was widely accepted by fellow Southern psychiatrists, affecting how Black people were treated in the mental health field for decades after (Smith, 2020). While it was not the first instance of racism in the history of the psychiatric field, Cartwright’s creation of this pseudoscientific illness is an important example of events that have led to Black Americans’ distrust of the mental health field. Unfortunately, it was not the last. Though the mental health field has changed a lot throughout the years, the impacts of racism in the field's history are still present today in Black Americans’ minds. In order to discover how far-reaching these effects have been, it is necessary to ask: How has the racist history of the mental health field and ongoing lack of race-conscious therapists affected Black Americans’ beliefs about the field of mental health and seeking treatment for mental health issues?

History of Racism in Mental Health Field

One of the best ways to learn about how history has shaped Black Americans’ views about mental health related topics is by conducting personal interviews. Black Public Media is a YouTube channel dedicated to showcasing the unique experiences of Black people. In one video, the creators of the YouTube channel asked people in the community to name some things that Black people don’t do, to which a Black woman responded, with disappointment, “go to therapy” (Black Public Media, 2011, 1:05). The video was filmed in 2011, but the statement is true even today over a decade later. According to Terlizzi and Zablotsky (2020), in 2019, only about 13% of African American adults sought mental health treatment. This is a surprisingly low number considering African Americans are “more likely than white adults to report persistent symptoms of emotional distress” (National Alliance on Mental Illness [NAMI], n.d., p.1). When asked about what she thought causes Black people to avoid therapy, the woman pointed out among other things, Black people’s general mistrust in doctors (Black Public Media, 2011, 2:42). This statement is supported by psychotherapist, Dr. Jameca W. Cooper, who, in a separate YouTube video, spoke about people of color having a stigma around receiving treatment due to “the history and practices” mental health professionals have participated in (MedCircle, 2020, 9:41).

As mentioned above, Cartwright's sick and twisted views about Black people were not the last to poison the mental health field. The truth is that, historically, mental health professionals have misused their power to reinforce anti-Black beliefs and inflict horrific treatment on Black patients. Dr. Theophilus O. Powell's beliefs are a great example of this. In 1895, he blamed the rise of mental illness among Black people on the abolition of slavery (Umeh, 2019). He claimed that Black people needed the structure that slavery provided in order to function normally, effectively blaming the abolition of slavery for their madness. As absurd as that sounds today, it made perfect sense to many psychiatrists in the past. Seeing as Powell is known as “one of the fathers of mental health reform,” there is no doubt that his beliefs both encouraged and reaffirmed the abuse of Black patients (Davis, 2015, p. 1). Almost seventy years after Powell broadcasted his racist beliefs to the public, the Civil Rights Act of 1964 banned segregation, including in medical settings. However, racist psychiatrists attempted to argue that it was “medically necessary to segregate patients along racial lines” (Smith, 2020, p. 2). Evidently, utilizing pseudoscientific reasoning to defend the mistreatment of Black patients was a trend that continued to go on long after Cartwright's death. 

Mental health professionals’ attempts to enforce the inferiority status of Black people led to more inhumane treatment of mentally ill Black patients in mental hospitals. Black patients were forced to perform exhausting tasks as part of their treatment while white patients were thought to be too unwell to do any work, even though both groups suffered from the same illnesses (Smith, 2020). The treatment Black patients received was often harsh and unhelpful. According to Smith (2020), an inspector from the Department of Health, Education, and Welfare stated that one of the asylums even “seemed to be running a southern plantation” due to the amount of work Black patients were forced to do (p. 2). With so many examples of racist treatment within the field, it is not surprising that many Black Americans are distrustful of mental health providers today.  

While mistreatment of Black patients is not as blatant as it was in Cartwright’s time, mental health providers still cause harm to them today. One way in which racism against Black Americans presents itself in the mental health field today is misdiagnosis. In America, Black people are diagnosed with more “extreme” mental disorders at higher rates than white people. For example, according to Mental Health America (n.d.), Black Americans “are more often diagnosed with schizophrenia and less often diagnosed with mood disorders” even when displaying the same symptoms as white Americans (p. 5). While misdiagnosis may seem completely accidental, Smith (2020) suspects that it may be deeper than that. In psychology, word choice is very important, especially in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which health providers use as a guide to diagnose patients. In her article, Smith mentioned that the misdiagnosis of schizophrenia may be a result of a change in definition of the illness in the DSM, specifically the addition of the word “aggressive”—a term that has historically been applied to Black Americans to characterize them as unstable (p. 2). This is a problem because aggression being associated with Black Americans means that psychiatrists may interpret their Black patients’ symptoms as more extreme than they actually are. This may result in a misdiagnosis of schizophrenia. In most cases, a misdiagnosis means psychiatrists prescribe ineffective drugs to mentally ill patients that negatively affect their quality of life. In nursing homes across America, a schizophrenia diagnosis is required to prescribe antipsychotics to patients. Many theorize that the rise of schizophrenia diagnoses that has occurred in nursing homes are not a true reflection of patients’ health, but are a result of health professionals finding a loophole so that they can prescribe antipsychotics to patients with dementia in order to sedate them (Gebeloff, 2021). Studies show that in nursing homes across the country, Black patients with dementia are more likely to be diagnosed with schizophrenia than white patients with dementia (Gebeloff,  2021). Considering that many of these diagnoses may be inaccurate, this is incredibly worrying. While health providers may think that they are doing things correctly by following the direction of the DSM, they may be causing harm to Black patients by misdiagnosing them. 

Misdiagnosis may also occur as a result of mental health professionals’ personal perceptions of people. While potentially accidental, this cause has more to do with the providers’ personal bias than the DSM bias. The main difference between the two is that mental health professionals’ bias can be conscious or unconscious. In a YouTube video, a Black man named Chris shared that a “huge problem” about biased therapists is that Black people are being measured through what non-Black people consider “normal” which is at odds with what Black people consider to be normal within their communities (Her Expressive Mind, 2020, 7:00). This is a problem because it means that white therapists that are not aware of what is considered normal in Black communities may misinterpret Black patients behavior and misdiagnose them at higher rates. Supporting this is a study which noted that mental health providers were capable of having “negative perceptions,” especially towards Black men, which could “affect their diagnostic assessment” (Hankerson et al., 2015, p. 24), meaning therapists can misdiagnose Black people due to their own beliefs about them, which tend to be rooted in racism. This causes great harm to Black people and creates mistrust in the mental health field. While everyone has biases, not attempting to identify and work against them may cause unintentional harm to Black patients. In the mental health field, it is important for a patient to trust their provider. Therefore, it is crucial for providers to be anti-racist and race-conscious in order to earn the trust of their Black patients.

Solution: Race-Conscious Providers

As mentioned before, access to race-conscious providers can have a significant impact on Black Americans views on the mental health field by increasing their trust in therapists. To be race-conscious is a foreign idea to most because it is the direct opposite of the color-blind approach that most Americans were taught when it comes to thinking about race. In order to move on from a racist past and unify the country, many believed that ignoring a person's race would help push the country towards equality. However, color blindness has only caused more damage to the mental health field since it does not factor in personal biases. Dr. Jameca noted that “90 to 95%” of mental health providers in America “are not people of color” (Black Public Media, 2011, 3:37). This means that people of color who seek treatment for mental health issues will most likely have to be treated by white psychologists which creates a big issue in the Black community, since many do not trust white providers to take their issues seriously. Rashawnda James (2017), a licensed therapist, argued that Black people avoid seeking mental health treatment because “most don't trust white people to understand who they are” (3:15). James went on to explain that Black people fear that “they might have to change how they speak or how they dress” for therapists to understand them, which is the opposite of how a good provider–patient relationship should work (3:18). In order for therapy to be most effective, the patient must feel safe and comfortable with being their authentic self in front of the therapist. However, in an attempt to prove to color-blind therapists that their problems are valid, Black patients may feel pressure to alter or filter their personality and appearance.  

To provide the right treatment for a client, therapists must understand or empathize with the client's problems. Since the “Black and African American experience” has been “characterized by trauma and violence,” it is important that therapists are aware of racial issues and acknowledge the effects they may have on their Black clients (Mental Health America, n.d., p. 2). However, according to Cénat (2020), there is a “lack of training of mental health professionals on racial issues and disparities,” meaning that most mental health professionals are not truly equipped to treat Black patients, and it is up to the individual to educate themselves on racial issues (p. 929). Garretson (1993) found that mental health providers who are not educated on the oppression Black Americans face “tend to pathologize or overpathologize Black patients” (p. 121). This may explain why Mental Health America (n.d.) reported that Black mental health professionals are more likely to give “more appropriate and effective care” to Black people—since they face the same oppression and are, therefore, able to empathize with Black clients (p. 3). Since white providers make up the majority of psychologists in America, it is up to them to educate themselves on racial issues in order to empathize with Black clients on issues that they might not initially perceive as serious. 

So, how can psychologists become race-conscious? One way, according to Smith (2020), is to educate them on the racist history of the mental health field, that way they develop a better understanding of “what factors have shaped the way people approach mental health” (p. 2). This could make them more aware of the factors that might make Black Americans hesitant to seek treatment which would help them in creating a more inviting environment for Black clients that would ease some of their concerns. Cénat (2020) listed many guidelines for providers striving to be anti-racist, one of which is “be aware of and know the impacts of discrimination, microaggressions, racial profiling, and racism on physical and mental health” (p. 930). This guideline highlights that racism appears in many forms, and no matter how big or small they may seem to a non-Black person, they all affect the mental health of Black Americans and should be addressed in a serious manner. The guideline requires providers to do some inner work of their own—requesting that they reflect on their own bias and the effect it has on their work. Though it may take a lot of work, the effort providers put in to become race-conscious and anti-racist will be worth it if it means that Black Americans will become more willing to seek mental health treatment.

Conclusion

In order to understand why Black Americans are hesitant to receive mental health treatment despite facing racial violence and trauma, it is necessary to examine the effects of the racist history of the mental health field and the lack of race-conscious providers in the present. Addressing both of these issues is essential for understanding Black American's views on mental health treatment which then aid mental health providers in figuring out how to make Black Americans more comfortable with receiving treatment. By doing so, the mental health field can continue to grow into a more equitable and inclusive field that no longer carries on the ideology of racist psychiatrists like Samuel A. Cartwright and Theophilus O. Powell. Most importantly, race-conscious mental health providers could potentially increase the possibility of Black Americans seeking treatment, thus improving the well-being of many in the community. 

References

Black Public Media. (2011, August 22). Black People Don't: Go to Therapy [Episode Two]  [Video]. YouTube. https://www.youtube.com/watch?v=dVPl0SQXan8&t=67s

Cénat, J. M. (2020). How to provide anti-racist mental health care. The Lancet Psychiatry, 7(11), 929-931. https://doi.org/10.1016/S2215-0366(20)30309-6

Davis, C. (2015, November 2). Inside Central State Hospital history. USA Today.  https://www.usatoday.com/story/news/local/2015/11/02/inside-central-state-hospital- history/75070462/

Dimuro, G. (2018, April 4). Southerners Actually Thought Slaves Escaping Was A Sign Of  Mental Illness. All That's Interesting. https://allthatsinteresting.com/drapetomania

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Gebeloff, Robert. (2021, October 15). A Racial Disparity in Schizophrenia Diagnoses in Nursing Homes. The New York Times. https://www.nytimes.com/2021/10/15/upshot/schizophrenia-nursing-homes-race.html

Hankerson, S. H., Suite, D., & Bailey, R. K. (2015). Treatment disparities among African American men with depression: implications for clinical practice. Journal of health care  for the poor and underserved, 26(1), 21–34. https://doi.org/10.1353/hpu.2015.0012

Her Expressive Mind. (2020, February 28). How Scientific Racism Causes Misdiagnosis of  Schizophrenia [Video]. YouTube. https://youtu.be/X4uMjeW2Mdk

MedCircle. (2020, July 2). What Is an Anti Racist Therapist? [The Surprising Mental Health  Benefits][Video]. YouTube. https://youtu.be/OesP1XaNogA

Mental Health America. (n.d.). Black And African American Communities And Mental Health.  https://www.mhanational.org/issues/black-and-african-american-communities-and- mental-health

National Alliance on Mental Illness. (n.d.). Black/African American.  https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Black-African- American

Rashawnda James. (2017, July 21). Black People and Mental Health | Why Black People Avoid  Therapy [Video]. YouTube. https://youtu.be/zWrdSistEos

Smith, K. M. (2020, July 6). Discrimination and Racism in the History of Mental Health Care.  National Alliance on Mental Illness. https://www.nami.org/Blogs/NAMI-Blog/July-2020/Discrimination-and-Racism-in-the- History-of-Mental-Health-Care

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Umeh, U. (2019, March 11). Mental Illness In Black Community, 1700-2019: A Short History.  Black Past. https://www.blackpast.org/african-american-history/mental-illness-in-black-community- 1700-2019-a-short-history/