Is Racism a Disease?
In the wake of the killings of George Floyd, Breonna Taylor, and Ahmaud Arbery, the American Psychological Association President, Dr. Sandra Shullman released a public statement marking a public health crisis.1 We are now in the midst of a “racism pandemic.”2 Comparing racism to a virus could appear as mere rhetorical flourish if it were not so widespread a response to recent events by scientific associations.3 In any case, the linguistic impulse is revealing. Proposals to consider racism an illness are not new; this understanding fits within the postwar trend of viewing racism as a pathological disorder residing within individuals.
Since its inception, proponents of the disease framework have contested the contours of the illness. The host of the disease—perpetrators of racist acts, their victims, or society at large—and its signs and symptoms have always been in continual flux. Whether racism differs from other forms of prejudice has also been considered. Some have argued that racism does not carve nature at its joints; rather, it has been viewed as a manifestation of more fundamental psychic instincts, including but not limited to in-group bias, authoritarianism, or powerlessness and dependency that accompany the culture of poverty. To add to the confusion, the universality and normalization of racism have been used to argue both for and against the disease model. Could racism be like other preventable maladies such as cardiovascular disease and hypertension—relatively common pathologies symptomatic of poor social conditions? Further still, as the racial disparities literature suggests, could preventable diseases be the physical instantiations of pervasive racism themselves? Or must racism, like other mental disorders, be abnormal to be determined a disease?
Arguments for each of these positions were staked out by different political groups and scientists beginning in the mid-century. Each conceptualization of racism was used to serve a particular political project, with appeals to scientific authority to support their positions. This scientific research was often financially supported by institutional and business interests who sought to rationalize their political aims. Though these projects varied in validity, scope, and purpose, the invocation of racism as a disease had the effect of transmogrifying it into a transhistorical biomedical phenomenon.
The following outlines several ways in which racism was invoked as a psychopathological phenomenon starting in the interwar period and culminating in the American Psychiatric Association’s (APA) 1969 annual meeting, when the inclusion of “extreme bigotry” in the Diagnostic and Statistical Manual of Mental Disorders (DSM) was finally considered. Immediately after World War I, scientists and policymakers began to frame racial inferiority as the consequence of social conditions—conditions that had biological and psychic correlates. This short-lived moment was characterized by competing understandings of what mid-century academics have termed the “race problem,” with many social scientists rooting their analysis in social structures. Despite more careful efforts by some scholars and activists to see the psychology and behavior of blacks and whites as inextricably intertwined with political economy (or, at the very least, social systems), the discourse on black pathology increasingly took an individual turn and moved away from structural explanations.4 Due to institutional incentives and broader political-economic shifts, post-World War II scholarship and popular writings shifted away from structural understandings of race and racism and rejected class as an analytic.
This period witnessed an influx of social psychological research that posited transhistorical and transcontinental understandings of racism, which rooted damage in individuals. Psychologizing racial prejudice had the effect of emphasizing conflict between racial groups and minimizing conflict between workers and bosses. With the civil rights movement as backdrop, black mental health professionals offered moral heft to the carving away of public mental health institutions that were already under attack. This nascent black elite argued for community control on the basis that community mental health would address the health inequities and psychopathologies uniquely plaguing blacks. These ideological turns came to a head with the rise of the Black Power-inspired group “The Black Psychiatrists of America,” who organized around several demands at the APA 1969 annual meeting. Though the motion to include bigotry in the psychiatric taxonomic system failed, pathologizing racism prevailed through the material gains secured by the Black Psychiatrists, including the establishment of the Minority Mental Health Research Program within the National Institute of Mental Health (NIMH). The institutionalization of a racial disparities research program ensured the legacy of the Black Psychiatrists. Pathologizing racism through the lens of racial disparities persists in the present. The biomedicalization of a social problem, and its pitfalls, are enumerated in what follows.
Between Two Wars: Conflicting Views on Racial Prejudice
The nature of racial prejudice was at the heart of scholarly debates over what mid-century scholars have termed the “race problem,” understood tautologically as “the racial situation resulting from the presence of twelve million Negroes in a population preponderantly and increasingly white…commonly accepted as America’s greatest social problem.”5 Not all scholars accepted this transparently racist framing; nevertheless, the interwar period generated an immense amount of sociological and anthropological research that sought to explain the differential conditions of blacks and whites in the U.S. and how racism factored into this account. In the interwar period, racism was not yet fully embraced by scholars as a disease, though incipient psychological understandings of racial prejudice as the cause of psychic damage gained currency during this period. The precise nature of racial prejudice generated significant debate within the social sciences, and the question of whether racial prejudice constituted an innate and transhistorical feature of all societies or whether it was a historically specific phenomenon was contested.
There were multiple and, in practice, overlapping, sides of the debate. Social anthropologists and sociologists, many of whom trained at the renowned University of Chicago school of “social ecology,” began to understand race as culture—they viewed out-group prejudice as a natural and primordial feature of organized social life and saw differences between races as the product of in-group norms.6 At the time many researchers rejected this ahistorical understanding of racial prejudice and instead suggested that the state-sanctioned denial of black Americans’ basic rights was by no means natural. Other more radical thinkers went further to critique prevailing sociological notions of “race relations,” grounding the conditions of black Americans in political economy. These scholars resisted the neat separation between racial antagonism and class forces. Though sociological explanations, however different in outlook, dominated and competed with one another during the interwar period, psychological explanations of racism also began to surface. These psychological theories emphasized the psychic damage of racism, which would become the prevailing framework during and after World War II.
Renowned sociologist from the University of Chicago, Robert E. Park, played an outsized role in the interwar discourse on race within academia. During his time at Chicago, Park continued his study on “race relations,” which he began at the Tuskegee Institute where he was Booker T. Washington’s close colleague and ghost writer.7 As Kenneth Warren and Michael Rudolph West document, Washington’s concept of race relations, which would shape the debates on race after World War II, was often promoted by black elites who saw their fortunes tied up with those of white elites, not those of black laborers.8 Washington’s innovation, which Park carried forward in his work, emphasized conflict between races in order to downplay conflict between workers and industrialists. Indeed, Park’s research sometimes explicitly naturalized race —early on in his career, Park believed in innate psychological and temperamental differences between racial groups9 —and crafted ecologically deterministic schemas about how races would first culturally conflict and invariably assimilate one another, largely ignoring the differential power relations both within and between groups.10
Park’s students would go on to reject his psychologizing of race and racial oppression—Charles S. Johnson wrote analyses of violence against blacks in the North and E. Franklin Frazier conducted research on institutionalized discrimination in employment and public services.11 Though both scholars acknowledged the psychic effects of black subordination, they rooted it in political oppression and economic exploitation. Among other political interventions, they, along with other sociological scholars writing for The Journal of Negro Education, saw an interracial labor movement as a crucial component of racial emancipation.12 Oliver Cromwell Cox, also one of Park’s trainees, would become his most vocal critic, accusing Park’s theories of a primordial and transhistorical conception of racial prejudice.
Cox, who centered racism and race in an understanding of capitalist dynamics, was also critical of social anthropological work that compared racial hierarchy in the U.S. to a caste system.13 The “caste school” of social anthropology separated race from class and suggested that white supremacy was a system designed to maintain racial subordination. Research from this period, including John Dollard’s Caste and Class in a Southern Town, Allison Davis, Burleigh B. Gardner, and Mary B. Gardner’s Deep South: An Anthropological Study of Caste and Class, and Hortense Powdermaker’s After Freedom: A Cultural Study in the Deep South, offered theoretical and empirical support for the caste school’s claims. According to its proponents, America’s caste system’s aim was to create a rigid racial hierarchy, supported by “interlocking mechanisms of economic, political, and legal control” as well as “rigid and absolute taboos that had become ingrained in black as well as in white culture and personality.”14 The caste school, in Cox’s view, conceived an idealized and rigid understanding of racial stratification since America’s founding and “treated racial hierarchy as if it were a timeless, natural form of social organization.”15 Cox vehemently opposed the separation of race and class, which he saw as constitutive of one another. He argued against locating racial prejudice or out-group bias as central causes of racism in the U.S., suggesting “If beliefs per se could subjugate a people, the beliefs which Negroes hold about whites should be as effective as those which whites hold about Negroes.”16 On the side of Cox, many social scientists during the 1920s and 1930s did not afford prejudice a primary causal role in the understanding of racism in the U.S., but located the “race problem” in institutions.
Several prominent academics during this period leveraged their stature to voice support for the position that the conditions of blacks were fundamentally intertwined with political economy. These scholars were reacting to ideologies that still captivated the general public outside of the academy—with scientific racism and its subtler varieties still circulating in mainstream discourse. For context, by the end of the 1930s, a survey of Americans found that 71% of whites still believed in innate racial differences in intelligence and the majority of public school and college textbooks still taught the doctrine of scientific racism.17 Among liberals, scientific racism took the form of pathologizing blacks not for their genetic deficiencies, but for pathologies they developed as a result of prejudice.18
In his 1931 Science paper “Race and Progress,” anthropologist Franz Boas, vocal opponent of scientific racism, dispelled notions of inborn or cultural differences among races and pointed to the economic crisis as source of psychopathology: “The economic depression of our days shows clearly how easily perfectly competent individuals may be brought into conditions of abject poverty and under stresses that only the most vigorous minds can withstand successfully.”19 Renowned physicist Albert Einstein’s 1932 contribution to the National Association for the Advancement of Colored People (NAACP) magazine The Crisis at the request of W.E.B. Du Bois described both the economic conditions of black Americans and the damaging psychic effects of social exclusion, which resulted in the internalization of inferiority.20 Einstein’s piece earned him the New York Times headline: “Einstein Hails Negro Race; Decries Tendency of Minorities to Accept Inferiority Prejudice.”21 The newspaper’s perversion of Einstein’s sentiment, which reads more like an accusation, was emblematic of the liberal position in this period.
Though a political-economic understanding of racism did not enjoy majority consensus, it was also not entirely marginalized in the political sphere. Outside of the university, the notion that racism was a social and political problem, not a transhistorical dimension of group life or the cause of psychic damage, found sympathy in a left-wing opposition. This “Depression era ‘interracial left,’ which included coalitions of civil rights workers, communists, socialists, laborites, religious advocates of social welfare, and New Dealers, joined forces with the ‘African American popular front’ to root the race issue in political economy.”22 In the 1920s and 1930s, left political activity and social scientific studies were sometimes explicitly intertwined. E. Franklin Frazier undertook research as part of a commission by New York City’s mayor, Fiorello LaGuardia, after the Harlem Riot of 1935. In coalition with labor leader A. Philip Randolph and NAACP board member and civil rights lawyer Hubert Thomas Delany, among others, Frazier issued a report that outlined how precarious economic conditions such as insufficient housing, grim employment prospects and discrimination, and unequal access to healthcare explained why blacks took to “public disorder” in 1935. Dispelling rumors that the Communists were responsible for the race riot, the report instead suggested that the Communists deserved “more credit than any other element in Harlem for preventing a physical conflict between whites and blacks.”23
An American Dilemma: Squaring “The Vicious Circle” of Racial Prejudice
As the Second World War approached and unfolded, however, political economic understandings of racism were shelved as burgeoning research psychologized racism and underemphasized social relations. Scholars have characterized this historical shift in sociological and psychological research as the rise of “racial individualism.”24 Corporate philanthropies and well-funded advocacy organizations, such as the Rockefeller Foundation, the Russell Sage Foundation, and the Carnegie Corporation, began to fund studies that embraced a conception of racism that resided within individuals. In addition to attributing blacks’ place in society to their unique afflictions, this research also began to pathologize whites (often poor and uneducated) for the intense feelings of hatred they harbored. These scientific investigations marked a significant turn away from class as an analytic and, if not explicitly, implicitly rejected Marxism.
The most famous case from this period is the Carnegie Corporation-funded study of race relations, commissioned in 1937. Carnegie tasked the foreign-born Gunnar Myrdal (a Swedish economist who later won the Nobel Memorial Prize in Economic Sciences with Friedrich Hayek) to conduct “a comprehensive study of the Negro in the United States, to be undertaken in a wholly objective and dispassionate way as a social phenomenon.”25 And by social phenomena, the multivolume work meant “personal relations, particularly those of an intimate sort.”26 In this seminal text, Myrdal and colleagues described Southern whites’ propensity to lynch black Americans as psychopathological. For Myrdal, the pathologies plaguing whites and blacks derived from broader political and economic conditions (for whites, economic anxiety and low educational attainment, for blacks, the myriad forms of social exclusion and immiseration). Nevertheless, these pathologies were viewed as independent causes, which reinforced one another and created what Myrdal described as a “vicious circle.”27 The psychopathologies and afflicted social structures of black families were granted a life of their own. Though An American Dilemma was attentive to the political and economic at times, it explicitly rejected Marxist theory. The Carnegie-funded writer dismissed the fanciful notion that white and black proletariats could unite in the class struggle, and instead favored the caste school theory of race relations. Further still, Myrdal suggested that the “Negro’s friend” is not the white working class but the “upper class of white people.”28
To support his arguments, Myrdal copiously citied the work of E. Franklin Frazier, who in his 1927 article “The Pathology of Race Prejudice” described Southern whites as driven insane by a “Negro-complex.”29 Myrdal also cited Frazier’s work on black adolescent development in the United States, describing black youth as suffering from a “social pathology”: “Since the Negro is not required to compete in the larger world and to assume its responsibilities and suffer its penalties, he does not have an opportunity to mature.”30 It is worth noting, however, that, as previously discussed, Frazier was more tempered in his writing about the importance of psychological factors—he saw the plight of black American as multiply determined. Two decades after he published “The Pathology of Race Prejudice,” he reflected that future sociological work should “discard all the rationalizations of race prejudice and provide orientation for the study of the constantly changing patterns of race relations in American life.”31 Indeed, many scholars have observed the curious assemblage of Myrdal’s report and the latitude he granted himself in theoretically synthesizing the studies he aggregated. At the time of writing, Ralph Bunche, serving as Myrdal’s main researcher, provided Myrdal with three-thousand pages of research. Bunche was an adherent of Marxist understandings of race and was critical of the assumption that all problems plaguing blacks were racial in nature, opposing the sharp division between race and political economy. Drawing from his extensive research studies on black life, Bunche wrote about how the conditions of black workers were identical to the conditions of white workers and that emancipation for blacks would not occur until the masses of the dominant group had better living conditions. In the manuscript he submitted to Myrdal, he suggested that blacks would need to form coalitions with the white working class and represented racial prejudice not as America’s moral failing, but as a rationalization of social conditions.32 Notably, Myrdal used his editorial discretion to contest Bunche’s formulations. The historian Walter Jackson recounts that, though An American Dilemma’s main thesis hinges on the centrality of individual attitudes and dispositions, Myrdal never commissioned a psychological study on prejudice to support his claims. Thus, despite drawing upon sociological research that attended to political economy, Myrdal’s thesis rested on psychological motivations, rendering his argument largely unsubstantiated. Despite this, Mrydal’s An American Dilemma achieved immense popularity upon its release in 1944, selling over 100,000 copies; it was eventually cited in the 1954 Brown v Board of Education decision as evidence of the deleterious psychological effects of racial segregation on children.33
Among the citations of the now-famous eleventh footnote of the Supreme Court decision was the work of psychologists Kenneth and Mamie Phipps Clark, whose coloring test and doll studies beginning in the 1930s provided scientific evidence of the psychological effects of racism. Building on the work of Ruth Horowitz, who studied the racial identification of nursery school children34 —which, one can’t help but note, were Works Progress Administration nurseries—the Clarks conducted studies demonstrating the harmful effects of segregation on child development. Many of these studies were also funded by the Carnegie Corporation (as well as the Office of War Information and several Jewish advocacy organizations). The Clarks posited that segregation stymied black children’s ability to develop a “consciousness of self.”35 They concluded that young children were aware of their societally sanctioned inferior status and that this feeling of inadequacy was “integrated into the very structure of the personality as it is developing.”36 Reflecting on this research agenda after the Brown decision, Kenneth Clark provided a program for action in his 1955 Prejudice and Your Child.37 This program emphasized the work that parents, schools, social agencies, and churches could do to inculcate a sense of self and to foster democratic attitudes in children. Aside from Clark’s call to continue the legal battle against discrimination, these proposed interventions focused on the behavior of individuals so that one day “children will be free to develop genuine health, strength, and stability of personality.”38
The New Type of Human Being
In the ensuing years, a flurry of mutually reinforcing psychological studies on racial prejudice and antisemitism were ideologically reinforced by the war against the Nazis. As Sander Gilman and James Thomas have extensively documented in their book Are Racists Crazy?, World War II and the years following marked a prolific research program between European-born (largely German) social scientists studying antisemitism and American psychologists studying anti-black racism.39 This work accelerated the tendency to psychologize prejudice and to underemphasize its political-economic dimensions. This turn was symptomatic of larger ideological shifts in the academy, purged of many left-leaning scholars, and constitutive of the postwar racial liberal order.
Just one example of the work on antisemitic attitudes that influenced research on racial prejudice were the well-known Studies in Prejudice. In 1944, the American Jewish Committee (which also funded the Clarks’ research) commissioned a series of studies to investigate the psychological causes of racial and religious prejudice. The Studies in Prejudice were initiated and directed by Max Horkheimer, former director of the Frankfurt Institute of Social Research (now known as the Frankfurt School) and then director of the Scientific Division of the American Jewish Committee. The first volume of this series was its most famous—The Authoritarian Personality, authored by Theodor Adorno and several colleagues at the University of California Berkeley.
In his introductory reflections to the volume and in his later writings, Adorno cautioned against purely psychological explanations for social phenomena.40 Yet, the study’s empirical work belies a more subjectivist account of racial prejudice. One central hypothesis of The Authoritarian Personality was that “an individual’s susceptibility to this [anti-Semitic] ideology depends primarily upon his psychological needs.”41 The volume’s authors rejected what they considered to be “economic determinism,” or any deep economic analysis at all, undermining Adorno’s early and later warnings. Indeed, the proposed intervention by Horkheimer in his foreword to the Studies in Prejudice is revealing—he suggested that eradicating prejudice involved not transformations of the political terrain, but “reeducation.” As many have observed, the Frankfurt School’s influential studies on antisemitism, which extended beyond The Authoritarian Personality, were ultimately a retreat from a Marxist class analysis and a turn toward a subjectivity divorced from materiality.42
Adorno’s studies also influenced the research of Gordon Allport. The eminent American social psychologist’s seminal work The Nature of Prejudice was informed by his studies of World War II refugees. In his influential book, Allport took an ecumenical approach to prejudice and suggested that it is multiply determined. However, Allport emphasized that prejudice was an idea in an individual’s head, not a social condition that could theoretically operate behind our backs. He defined prejudice as “thinking ill of others without sufficient warrant.”43 Like the Frankfurt School, he critiqued a straw man of economic determinism: “We conclude, therefore, that the Marxist theory of prejudice is far too simple, even though it points a sure finger at one of the factors involved in prejudice, viz., rationalized self-interest of the upper classes.”44 Though Allport was critical of understanding prejudice solely through the lens of personality traits and was critical of The Authoritarian Personality’s methodology, he applauded Adorno and colleagues for their significant contribution to the understanding of prejudice. The Nature of Prejudice went on to become one of the most influential scientific works of its time and continues to inform the study of race as “intergroup relations” and “intergroup conflict” in social psychology today.45
Understanding racism as a function of personality factors and “intergroup conflict” had the effect of sharpening racial divides and locating the source of racial prejudice in the white worker. Alfred Marrow—student of renowned psychologist Kurt Lewin, an early colleague of Adorno—served as chair of New York’s Commission of Intergroup Relations. Marrow was interested in understanding how to combat the disease of racism through intergroup interventions, interventions that largely targeted white workers.46 Trained as an industrial psychologist, Marrow wrote about the ways in which scientific management could be leveraged to combat prejudice. Invoking psychotherapeutic concepts, Marrow exhorted industry leaders to diversify their workforce even if they met resistance from their white employees:
When a psychotherapist is attempting to alter the behavior of a patient, he expects resistance from him. The therapist takes the position that the pattern of behavior used by the patient (which makes him a “sick” person) is a means to some satisfaction he craves even though it may also make him ineffective or unhappy. The case is the same when an administrator initiates a change in the on-going relationship toward minority members.47
In Marrow’s view, what was good for business was good for the black worker. Marrow reinforced the notion that white workers—not bosses—were the obstacle to reducing workplace prejudice. Thus, conflictual “intergroup relations” could be resolved by paternalistic, quasi-therapeutic, and, invariably, profitable transformations in the workplace.
The scientific research that emerged in the immediate postwar period about the psychological dimensions of prejudice flattened the historically specific experiences of European Jews and American blacks. By positing transhistorical and transcontinental psychic motivations that tightly linked Jewish genocide with American segregation, this research naturalized prejudice, etching it into human nature. In so doing, it was explicitly antagonistic to understanding racism through a political-economic perspective, which resulted in understanding conflict along purely racial lines. By ignoring the political-economic foundations of racial hierarchy, this work scapegoated white workers and proposed highly individual interventions that targeted the most exploited whites as the solution to the problems of authoritarianism and oppression.
Community Mental Health: Professionalization & Deinstitutionalization
In the following decades, increasingly psychological conceptions of racism merged with transformations within the field of psychiatry to support the carving away of public mental health institutions. Popular exposés of underfunded state mental health institutions and the attendant horrifying conditions of asylum patients reached a national audience as reformers within psychiatry promoted changes to the provision of mental healthcare as a racial justice issue.48 Writing for The New York Times Magazine shortly after the war, eminent psychoanalyst William Menninger—one of the leading reformers within the APA and the scientific association’s president in 1948—suggested that “mental health hygiene” could “mobilize the citizenry to an intelligent understanding of the psychological factors in other social ills: of unemployment, prejudices and discrimination, racial tensions, housing problems.”49
As with many significant cuts to public goods, the actors involved in the deinstitutionalization of long-term mental healthcare were multiple and often opposing on their own grounds—these actors ranged from civil rights leaders to anti-psychiatrists to anticommunists.50 Nevertheless, the postwar transformation in mental healthcare benefited from narratives that suggested the disease of racism could be cured not in public mental health institutions, but in the community. Community control, or self-determination, aligned genuine grievance with corporate interest, and became an exercise in decentralization and the hollowing-out of public mental healthcare. Just as the Ford Foundation would go on to support the community control movement in New York public schools, racial liberalism coalesced with the profit-motive in the realm of mental healthcare. In the years following World War II, reform efforts within psychiatry, supported by large sums of foundation money, served to professionalize mental health and initiated a rapid process of deinstitutionalization.
Menninger and other reformers, along with several lobbying groups, advocated for the formation of the NIMH (which was established by the 1946 National Mental Health Act). The establishment of a formal professional and congressional lobby through the Act’s passage led to the establishment of the Joint Commission on Mental Illness and Mental Health in 1955, which published an influential report in 1961 to tackle the significant challenges of mental healthcare. Though deinstitutionalization was never mentioned in the commission’s report, accelerating the push toward community care that was already underway was seen as the solution to the issues outlined by the Joint Commission.
The bad press garnered by public mental institutions, the zeal of activists for community control, the potential for cost-saving by reducing the state hospital census, and the advent of psychotropic medications and novel psychotherapeutic techniques all coalesced in the push for deinstitutionalization in the 1950s. The culmination of these efforts resulted in the passage of the 1963 Community Mental Health Act, which established federal funding for community mental health centers. Of course, the “community” was rarely consulted in the establishment of these centers; instead, as psychiatrists Donald Scherl and Lee Macht described, the rapid deinstitutionalization that ensued in these years “dumped” thousands of formerly housed patients into inadequate settings including single-occupancy hotel rooms, nursing homes, and boarding houses.51
Revisionist historical accounts of the community mental health “movement” posited that its central aim was to eradicate mental health problems in blacks. Mildred Cannon and Ben Locke, mental health researchers for the Public Health Service, introduced their piece “Being Black is Detrimental to One’s Mental Health: Myth or Reality?” by writing, “The community mental health movement came about largely as a result of the realization that enormous disparities existed between psychiatric treatment provided to white Americans and that provided to the poor, the deprived, and the black.”52 The piece evaluated whether community mental health programs were able to accomplish the post hoc aim of narrowing the disparities in mental health problems between blacks and whites. They did not, but the authors concluded that the movement’s failure could be remedied, in part, by hiring black mental health professionals who could “raise their own questions, and develop their own priorities” (428).
Notably, many community health programs made a significant effort to infuse their programming with the “lifestyle, language, culture, and labor of black people”53 to ameliorate the mental health problems they perceived to uniquely plague blacks. Psychiatrist June Jackson Christmas who directed and designed the Harlem Rehabilitation Center in 1964 and who later served as Commissioner of the New York City Department of Mental Health, Mental Retardation, and Alcoholism Services, recalled that before austerity in the 1970s, the community center’s advantage was that, “In the spirit of the Civil Rights movement we tapped the strength of struggle and survival, the beauty of soul, and the essence of the black experience in the rehabilitative process.”54 In addition to implementing several innovations, such as practice-based research supported by the then-adolescent NIMH, the center also trained paraprofessionals from largely working-class backgrounds. One central content area in the training program was to teach employees about “The Black Family: Social Forces, Special Issues and the Human Condition.”55
The “Tangled Pathology” of the Black Family
The trope of the pathological black family, already present in Myrdal’s The American Dilemma, took on new life in the 1950s and ’60s. The pathologies of blacks were described as emerging from “disorganized” family structures rather than their broader social conditions. Work that emerged during this period explicitly rejected materialist explanations, and even when attentive to political-economic factors tended to disproportionately give weight to the psychological and cultural correlates of these conditions. Though certain researchers emphasized that the psychic damage of black family life was an effect of their conditions, many researchers and popular writers soon saw these pathologies as independent causes. The psychological was granted a life of its own.
Social scientific, psychiatric, and popular writing on the damaged personalities of black people proliferated during this period. In 1950, E. Franklin Frazier suggested that black children raised by working single mothers and without male role models failed to receive adequate love, which explained their propensity to commit crimes.56 Well-known psychoanalysts Abram Kardiner and Lionel Ovesey cited Myrdal and the class and caste school to affirm Frazier’s thesis that women-led households produced significant pathologies that were challenging to overcome: “The chief of these vicious circles that plague the lower-class Negro are the broken home and the disturbed relation between the sexes.”57 In their widely read work, The Mark of Oppression: Explorations in the Personality of the American Negro, Kardiner and Ovesey posited that the caste-like status of black families led black men to experience frustration and rage, which caused them to both internalize submission and commit rageful acts of violence. Frazier’s thesis that black working poor families failed to provide adequate conditions for normal child development and socialization “resurrected the late-nineteenth-century image of blacks as savages.”58 In his 1961 speech to the Group for the Advancement of Psychiatry (the reform organization founded and led by William Menninger) Frazier used Freudian theory to explain that black families were damaged because they lacked culture and civilization.59
Black savagery and Freudian theory were also invoked in the historian Stanley Elkins’s 1959 Slavery: A Problem in American Institutional and Intellectual Life. Drawing from psychoanalytic research by Bruno Bettelheim on the psychic effects of World War II concentration camps, Elkins psychologized the experience of American plantation slavery. In so doing, Elkins went further than mid-century psychologists who connected the Jewish experience in Eastern Europe with the black American experience of segregation by establishing not only the universality, but also the timelessness, of racialized experiences. Elkins advanced the hypothesis that planation slavery, like the Nazi prisons, caused significant regression: “The [concentration camp] experience was analogous to that of slavery and was one in which wide-scale instances of infantilization were observed.”60 American slavery formed blacks into “Sambos”—docile and dependent personality types who fawned over, rather than resisted, their oppressors. Citing novelist Richard Wright’s memoir Black Boy as just one example, Elkins suggested that traces of the psychic effects of slavery persisted in black culture.
In this era, it was common to understand black people as sharing a damaged culture that maintained their immiserated conditions. In 1959, Oscar Lewis first propounded his culture of poverty of thesis.61 According to Lewis, poverty generated its own culture of powerlessness and deficiency, which only reinforced and trapped people in their social conditions. Contra Elkins, Lewis argued that the culture of poverty was to blame for blacks’ pathological family structure, not American slavery: “A high incidence of commonlaw marriage and of households headed by women has been…attributed to the Negro’s historical experience of slavery…such households express essential traits of the culture of poverty.”62 In the late 1950s and early 1960s, renowned psychologist Walter Mischel began to conduct cross-cultural studies that relied on these tropes to study the personality effects of poverty and black family life.63 Mischel investigated whether children with absent fathers were less able to delay gratification, and found that “The presence or absence of the father may be significant not as, or just as, a causal factor in itself in relation to preference for delayed versus immediate reinforcement, but as an index of the extent to which parents of the family participated in a delayed reward culture.”64 Other psychologists, such as Gordon Allport’s student Thomas Pettigrew, published works that claimed to be the definitive source on black personality. The Profile of the Negro American, published in 1964, suggested that blacks’ sense of inferiority determined “all aspects of daily living,” and that the “resulting confusion of self-identity and lowering self-esteem are two of the most serious ‘marks of oppression’ upon Negro American personality.”65
Citing the influence of Pettigrew and borrowing European metaphors, Kenneth Clark published his Dark Ghetto: Dilemmas of Social Power in 1964. Comparing himself to “involved observers” of the Holocaust, Bruno Bettleheim and Victor Frankl, Clark integrated his personal experience growing up in Harlem to develop his thesis on the corroded and damaged black family. Though Harlem was not walled like the Jewish ghettos of Eastern Europe, Clark made use of the metaphor to describe the ills of segregation. Guided by Gunnar Myrdal’s foreword, Clark’s book outlined his observations of what he perceived to be an American caste system that led its victims to accommodate and even desire their victimized status.66 Conjuring well-trodden tropes, Clark’s visions of black life were marred by the presence of “broken” matriarchical families. In the rare instances Clark mentioned labor, he vacillated between victim-blaming and suggesting that unions (but especially white workers) were racist. The pathologies of the black ghetto and blacks’ lack of self-worth accounted for their disinterest in rising the ranks in their jobs. Alluding to Lewis and Mischel’s arguments on the pathological culture of poor black families that stymied forward thinking, Clark suggested that black people were unable to hold out in their search for decent jobs:
The alienation of the Negro poor is such that the “hustler” or “bop” or unwed ADC [Aid to Dependent Children] mother, the members of the “deviant subculture” often respond with an attitude of “include me out,” which reflects the cynical desire to “cash in” on a less demanding mode of adjustment. In the ghetto to “cash in” means to earn a livelihood for imaginary services, or for an outright disservice, and it means that one must establish a mutually exploitative relation with others—one must have a “hustle.” “Cashing in” and the “hustle” reflect the belief that one cannot make a living through socially acceptable vocations in a complex and rejecting racist society.67
Clark cast sexually promiscuous welfare-dependent black mothers and white workers as the cynical actors in his tale. Though Dark Ghetto acknowledged the few employment opportunities available to all workers in New York, Clark ultimately blamed black mothers for their willingness to accept welfare dependency and white workers for their grasping onto “white status” in lieu of partnering with the black proletariat.
Daniel Patrick Moynihan cashed in on Clark’s images of black life in his 1965 The Negro Family: The Case for National Action. The assistant secretary of labor under President Johnson, he wrote in what is better known as the Moynihan Report that black families were plagued by a “tangled pathology” of “immature, criminal, and neurotic behavior.”68 Citing Frazier, Moynihan concluded that though many of the pathologies of black families stemmed from discrimination and historic injustices, these factors were not the most proximal or important determinant of blacks’ conditions in the 1960s. Instead, he leveraged research from Mischel and Pettigrew on “illegitimate births” and “woman-led households” to claim, “At the heart of the deterioration of the fabric of Negro society is the deterioration of the Negro family” (5). The culture of poverty was ultimately responsible for blacks’ problems, not poverty itself.
The Moynihan report caused considerable controversy upon release and a significant amount of scholarship has indicted the report for its, albeit mediated, victim blaming. Moynihan’s report marked a significant point in the discourse pathologizing racism. Emphasizing black personality damage helped distract from the root causes of black poverty, ideologically buttressed a series of often punitive policy measures, and crowded out a more robust social democratic approach to solving inequality.69 In lieu of a Freedom Budget,70 which proposed universal healthcare, full employment, living wages, and other public goods to tackle poverty, the Moynihan Report dovetailed nicely with the War on Poverty, which developed a patchwork of means-tested reforms that were insufficient to tackle the structural causes of inequality. During the 1950s and 1960s, black personality damage as well as underclass ideologies, such as the culture of poverty, were weaponized to significantly cut state funding for public mental health institutions and ideologically undermined struggles for universal public goods.71
Battles Within Psychiatry
During the 1950s and 1960s, as social problems were increasingly framed in psychological terms and as public mental health institutions crumbled, battles within the mental health profession raged on. Political turmoil outside of psychiatry, the importation of psychological constructs in social scientific research, and professionals’ experiences working in community mental health led many within the field to see the study of social issues as part of their professional role. Other psychiatrists, some conservative, were critical of the discipline’s overreach and believed that social activism marked a “retreat from patients.”72 Several incidents within the APA served as cautionary tales against wading into politics, including the famed Goldwater controversy of 1964.73 These public controversies delegitimized the specialty and stoked right-wing groups’ accusations that psychiatry was an atheist and communist cabal.74 Despite the APA’s increased institutional caution, the maturing civil rights movement and the rise of black physicians invariably influenced the character of psychiatry and medicine more broadly.
In 1964, the same year of the Goldwater controversy, upon the request of the Student Nonviolent Coordinating Committee (SNCC), hundreds of medical professionals including several prominent psychiatrists joined the Medical Committee for Human Rights (MCHR) to provide medical care for activists volunteering in the Mississippi Summer Project (better known as the Freedom Summer). The MCHR was a group of largely white medical professionals who were opposed to the conservative American Medical Association’s (AMA) practice of devolving decisions to local chapters about medical facility integration and inclusion of black physician members.75 When the MCHR was formed, many local chapters of the AMA still barred black physicians and were resistant to desegregation efforts. Moreover, the AMA was also opposed to Medicare and Medicaid, which they derided as “socialized medicine.”76 In coordination with SNCC and other civil rights groups, reformers within medicine and psychiatry volunteered to stay in Mississippi to address the dramatic health inequities they observed due to medical facility segregation.77
Stationed in Jackson, Mississippi, the psychiatrist Alvin Poussaint served as the Southern director for the Medical Committee for Human Rights for two years. During this period, Poussaint penned several articles for scientific journals as well as popular outlets on the pathologies of whites—the “White African Queen Complex” for women and the “Tarzan Complex” for men.78 It is worth noting that these comments often alienated him from many of the white medical professionals he worked with, many of whom helped build the MCHR’s Southern office, including nurses Phyllis Cunningham and Josephine Disparti.79 Though Poussaint also suggested that blacks suffered from their own pathologies—“Uncle Tomism”—he ultimately located the disease within whites: “No one denies that many Negroes have feelings of self-hatred. But the limitations of the thesis become apparent when one realizes that a Negro with all the self-love and self-confidence in the world could not express it in a system that is so brutally and unstintingly suppressive of self-assertion.”80 Poussaint attributed whites’ pathological hatred of blacks to the rise of the Black Power movement, which he saw as a movement for blacks to sublimate their anger and self-hatred.81
The Black Psychiatrists
Toward the end of the 1960s, the emergence of new social movements splintered the already tenuous civil rights coalition. The MCHR went on to become a single-payer healthcare advocacy organization; SNCC dissolved; and the Black Power movement emerged. With the advent of Black Power, “black rage” became a salient concept and yet another way of pathologizing racism—both racists and blacks—for their aggression. Following Martin Luther King Jr’s assassination in 1968 and the Washington D.C. riots that ensued, two prominent black psychiatrists released a popular book that gripped the public imagination and entrenched the notion that racism was a psychological disorder. Black Rage, released in 1969, was written by psychiatrists William H. Grier and Price M. Cobbs, who ran a community mental health clinic in San Francisco and were inspired by Black Power. Echoing The Mark of Oppression, Grier and Cobbs suggested that black people were angry and that “Aggression leaps from wounds inflicted and ambitions spiked. It grows out of oppression and capricious cruelty.”82 By drawing an uninterrupted through-line from slavery to 1968, with King’s assassination as validation of this thesis of unchanging oppression—“black men face the same danger now as then”83 —Grier and Cobbs turned to psychoanalytic-inflected theory for solutions. Grier (who had trained in the psychoanalytic Menninger Clinic that William Menninger cofounded) and his coauthor wrote that white people had driven black people mad. They posited that the “amount of rage the oppressed turns on his tormentor is a direct function of the depth of his grief, and consider the intensity of black men’s grief.”84 Black Rage explicitly put forward transhistorical notions of blackness and cast economic questions to the side by focusing on the monolithic black psyche. The book achieved immense popularity upon release and a television special devoted to the book called “To Be Black” was aired on ABC.85
Within psychiatry, the contest over whether blacks or whites were the targets of the disease of racism coalesced around a concrete set of demands to the APA. In 1969, several psychiatrists, including Alvin Poussaint, formed the Black Psychiatrists of America, a caucus within the APA that also acted as a pressure group within the NIMH. The group was successful in creating the NIMH Minority Mental Health Research Program, which would create a funding mechanism for the study of racial disparities. Within the APA, the group’s success was mixed. At the 1969 APA annual meeting in Miami, the group interrupted the APA trustees’ breakfast and presented them with a list of ten demands. The Black Psychiatrists were able to secure a task force to increase the presence of black psychiatrists within the field and secured grants and positions of responsibility within the APA as well as an office for a Black Psychiatrist at APA headquarters. The APA did not meet the Black Psychiatrists’ demands to take a position on desegregating medical facilities or opposing the Vietnam War to avoid embroiling itself in activity that was perceived to be overtly political. The APA also did not accept the demand to bar members who discriminated against blacks in their practice.86
The question of whether racism would be considered a mental disorder was also considered at the 1969 APA conference. Poussaint, who led the charge, was unsuccessful at petitioning the APA to add “extreme bigotry” to the Diagnostic and Statistical Manual of Mental Disorders. The APA’s response to the 1969 petition observed that considering white racism a disease would pathologize normalized behavior.87 According to the APA, such a view would categorize large swaths of an otherwise healthy population (past, present, future) mentally ill. It is worth noting that the Black Psychiatrists of America did not formally adopt the demand and significant heterogeneity existed within the group about whether racism was a disorder and, if so, who was afflicted by it. Charles Prudhomme, a black psychiatrist and psychoanalyst elected vice president of the APA the following year (with the endorsement of the Black Psychiatrists) penned an editorial in The American Journal of Psychiatry in which he dismissed according special significance to racism as a pathology: “Racism is today’s fashionable label for an old symptom-complex cluster—a euphemism of man’s basic insecurity related to impermanence. The essential ingredient is rooted in each of us.”88 Despite losing his battle within the APA, Poussaint and the Black Psychiatrists secured a more significant victory. The establishment of a racial disparities research program ensured the Black Psychiatrists professional advancement, guaranteed funding mechanisms to support their research, and institutional prestige.
The Legacy of 1969: The Establishment of a Racial Disparities Research Arm
Although, as recently as 2002, Poussaint has written several scientific perspectives and popular editorials (citing Allport’s work) charging the APA to include “extreme racism” as a subtype of delusional disorders in their classification system, there has not been an organized coalition to push for a new taxonomy since the 1969 APA Conference.89 Poussaint’s petitions have been met with similar responses by APA leaders, who remarked that there was little scientific basis to include racism in the psychiatric taxonomic system and that racism did not deviate from normal behavior. Robert Spitzer, the renowned psychiatrist and leading architect of the DSM responded to one of Poussaint’s editorials by suggesting that mental disorders are and should be definitionally abnormal: “For many good reasons, psychiatry has always defined a delusion as an irrational idea that is not one ordinarily accepted by other members of the patient’s culture or subculture.”90 Though some scientists have sporadically advocated for designating racism as a mental disorder since the 1969 conference, these calls never gained significant traction.91 The classification debate consistently failed to generate agreement among psychologists and psychiatrists, largely because the criteria under the current diagnostic system suggest that mental disorders should fall on the extreme end of the Gaussian curve.
Even if racism were deemed a mental disorder, disagreements about the nature of the illness would have to be resolved. The question of who the disease targets—the perpetrators of racism or its victims—was never decided. The identity of the diseased would elucidate its cardinal symptoms—rage and submissiveness or fear and authoritarianism? Scientists would have to empirically motivate whether racial prejudice is distinct from other mental disorders already catalogued in the 1,000-page manual of psychiatric diseases or whether it is better considered as a subtype of already existing taxonomies. However, as in 1969, it is unclear whose interests pathologizing racism as a clinical disorder would serve, especially when the work of divorcing race from materiality is already complete. Though pop psychology books such as sociologist-cum-corporate consultant Robin DiAngelo’s White Fragility attract a large middle-class readership, scientific debate on this issue has stalled.
Though Poussaint and his allies did not win a new psychological category, the Black Psychiatrists secured the establishment of the NIMH Minority Mental Health Research Program. This victory ensured that research on mental health disparities would have an institutional home and a guaranteed funding mechanism. Since 1969, several Institutes within the National Institutes of Health have established their own minority research programs, culminating in the establishment of an additional institute, the National Institute on Minority Health and Health Disparities (NIMHD) in 2000, signed into law by President Clinton. In addition to funding allocated to the several minority programs housed under other associations, the NIMHD’s budget is $335.8 million and is devoted to studying minority health and minority health disparities.
In other words, while Poussaint may have lost the battle, the Black Psychiatrists won the war. Due to the large financial investments in this research, the racial health disparities framework now serves as the new way to understand racism as a disease. Under this logic, black people are damaged not for their unique psychological ailments; rather, they suffer disproportionately from diseases to which all individuals are theoretically susceptible. The new understanding rejects the position that racism is simply a pathological form of prejudice that leads to oppression or exploitation; it also rejects the idea that racism is merely the psychic manifestation of impoverished cultural and economic conditions. In only this way is it an advance, for it replaces simplistic explanations for dangerous ideas.92
Instead, the disparities logic reinforces idealistic notions of race where material realities need not be considered. Starting from effects not causes, racial disparities carve out a heterogenous demographic in the population—black Americans—finds higher rates of a variety of illnesses and suggests that a unitary cause—racism—must be the explanatory factor that ties the race together. Under this framework, racism is rarely operationalized and is viewed as so embedded in the “system,” that it is used as a proxy for everything and anything—even conditions that are not unique to poor and working-class black people such as toxic environmental exposure, inadequate healthcare, and chronic stress. Not only does this conceptualization ignore other segments of the population who are similarly vulnerable to preventable diseases due to shared social conditions, it also inadvertently reifies the category of race as a natural kind. Recent calls to consider race a biological reality should reveal the way health disparities discourse entrenches rather than combats racial ideologies.93
The disparities framework tends to emphasize the racialized character of disease burden, rather than identify and understand underlying causes of illness that cut across groups. By emphasizing race, not political economy, the focus on racial disparities serves elite interests by eliding the class character of racial categories.94 Racial disparities research has enabled professionals to serve as race experts, eliding class differences within races while furthering elites’ material interests. The disparities framework does not threaten the class interests of white elites, in part because the research program’s goal is not to investigate the root causes of health disparities (the dynamics of American capitalism) but instead to document correlations that are at best descriptive and at worst obfuscating. It is therefore not surprising that, among the limited victories gained by the Black Psychiatrists, they were granted a program to proliferate such research.
Racism has increasingly been understood as a disease in public and scientific discourse. Where the disease resides—the minds or bodies of blacks, whites, or all people—has been considered and debated over the past century. Between World War I and World War II, competing understandings of racial prejudice vied for dominance. Over this period and beyond, as political-economic transformations both within the U.S. and abroad shaped knowledge production, the thesis that blacks were psychologically damaged gained currency. In the postwar years, the disease framework reached new heights with research projects enjoying the financial backing of corporations, advocacy organizations, and philanthropies. Not coincidentally, political-economic explanations of racial conditions were cast aside and critiques of American capitalism were shelved in favor of idealistic conceptions of race divorced from materiality. Psychopathological conceptions of racism provided ideological fodder for the carving away of the welfare state, the weakening of universal public goods, and the sharpening of divisions between black workers and white workers. Racial divisions were accentuated over class divisions—by the 1950s, bosses recognized that it was in their favor to emphasize discord between employees through proto-human-resources management.
Though petitions to include racism as a psychiatric disorder failed in 1969, as they did decades later, the Black-Power inspired group that led the charge, the Black Psychiatrists, helped usher in the contemporary understanding of racism as a disease—racial disparities. The Black Psychiatrists’ victory in establishing institutional pathways to fund racial disparities research has left an indelible mark on scientific and popular understandings of racism. The new model of racism-as-disease, like all theories that attempt to separate racism from political economy, relocates the pathologies at the heart of American capitalism in the hearts and minds of individuals. By emphasizing the racialized character of disease burden, this discourse mystifies and distracts from the ways the present political and economic system truly does damage to its subjects. It isn’t any wonder that elites (both black and white) who benefit from the status quo have proactively propagated the disease model of racism.
What, then, are the implications of understanding racism as a disease and not a social problem today? The pathological perspective ignores the historical character of racism and race and fixes individuals (perpetrator and victim) in place and, notably, outside of time. In lieu of understanding the conditions that shape the vast inequities that exist within society, explanations that naturalize racism lead us to believe that it is a universal and unchanging force. This way of seeing reinforces and perpetuates the notion that racism is a problem lodged permanently in people’s heads and bodies, not a problem of public policy. Yet, discriminatory attitudes and social inequalities are not permanent—they are the product of political-economic forces and historical contingency. The rise of unprecedented levels of inequality offers us an opportunity to comprehend the ways capitalism harms the vast majority of its subjects. We can choose to unite in the struggle against the damage present social relations inflict on all human life, or we can proliferate more categories that pathologize and divide us.
Bio: Briana S. Last is a doctoral student in the clinical psychology program at The University of Pennsylvania. She studies the social determinants of mental health and the provision of public mental health services, with a particular interest in the effect of resource scarcity on clinical decision-making.