January 18, 2021

Historical Addendum to APA's Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psychiatry

In this document, the APA hopes to elaborate on some past events that have contributed to structural racism's pervading presence today.

When Eastern State Hospital (ESH), the first psychiatric care facility, was founded in 1773, it was not segregated. Seventy years later, however, when the 13 founders of what is now the APA met to discuss improvements in mental health care delivery, the treatment system they created and the organization they founded aligned with that era's racist social/political policies. In this system, Black patients received psychiatric care separately from white patients. A former ESH superintendent also implicated that payment for psychiatric care was accepted in the form of enslaved people at least during the facility's founding.1 Additionally, prevailing Black stereotypes in psychiatry included fallacies that patients were hostile, unmotivated for treatment, had primitive character structure (i.e. not psychologically minded), and were child-like.2 These misconceptions were perpetuated by a now-debunked diagnosis, Drapetomania, centered around the idea that Black Americans who did not want to be slaves were mentally ill.3 During that time, the APA chose to remain silent on these issues.

At critical points in the United States' sociopolitical evolution throughout the 19th and 20th centuries, the APA failed to act in Black Americans' best interest. This inactivity was notably evident while white supremacists lynched Black people during the Reconstruction Era as well as when Jim Crow segregation was in effect which led to "Separate but Equal" standards of care starting in 1896.4 Later, our APA failed to declare support for Brown v. Board of Education of Topeka in 1954,5 along with further major civil rights legislation designed to improve social/psychological conditions for Black people. In 1969, Black APA members demanded that the organization address inequities and their resultant negative impact on minority mental health. In response, the APA created the Solomon Carter Fuller Award, named for the first recognized Black psychiatrist in America, and added a non-voting seat for a Black psychiatrist to the BOT. Unfortunately, these 1969 actions served more as a conciliation rather than a commitment to meaningful structural change by the APA.

Psychiatric misdiagnosis among Black, Indigenous and People of Color (BIPOC) populations throughout the decades that followed was also common. For example, late 20th century psychiatrists commonly attributed their minority patients' frustrations to schizophrenia, while categorizing similar behaviors as "neuroticism" in white patients.6 One study found that a sample of largely APA members diagnosed more Black than white patients with schizophrenia, even when both had otherwise identical vignette-style clinical presentations.7 This reveals the basis for embedded discrimination within psychiatry that has contributed to reduced quality of care for BIPOC populations and perpetuation of dangerous stereotypes. The everyday use of microaggressions, which are subtle, verbal and non-verbal "put- downs" directed toward BIPOC, further maintains structural racism today.8

The APA sincerely apologizes and strives to make psychiatry's future more equitable for all.

References

  1. Jones, Granville L. "A History of the Founding of the Eastern State Hospital of Virginia", American Journal of Psychiatry, Vol. 110, No.9, March, 1954.
  2. Sabshin M, Diesenhaus H, Wilkerson R. Dimensions of Institutional Racism in Psychiatry. American Journal of Psychiatry, Vol. 127, No.6, December 1970.
  3. Medlock, M., Weissman, A., Wong, S. S., & Carlo, A. D. (2016). Addressing the Legacy of Racism in Psychiatric Training. American Journal of Psychiatry Residents' Journal, 11(2), 13-13. doi:10.1176/appi.ajp-rj.2016.110206
  4. Supreme Court Of The United States. (1895) U.S. Reports: Plessy v. Ferguson, 163 U.S. 537. [Periodical] Retrieved from the Library of Congress, https://www.loc.gov/item/usrep163537/.
  5. Warren, E. & Supreme Court Of The United States. (1953) U.S. Reports: Brown v. Board of Education, 347 U.S. 483. [Periodical] Retrieved from the Library of Congress, https://www.loc.gov/item/usrep347483/.
  6. Moore, L. J. (2000). Psychiatric Contributions to Understanding Racism. Transcultural Psychiatry, 37(2), 147-183. doi:10.1177/136346150003700201
  7. Loring, M., & Powell, B. (1988). Gender, race, and DSM-III: a study of the objectivity of psychiatric diagnostic behavior. Journal of health and social behavior, 29(1), 1–22.
  8. Pierce, C. M., Carew, J. V., Pierce-Gonzalez, D., & Wills, D. (1977). An Experiment in Racism. Education and Urban Society, 10(1), 61-87. doi:10.1177/001312457701000105