Amid talks about how African Americans are disproportionately affected by the COVID-19 pandemic and speculation about their reluctance to get vaccinated, the Tuskegee experiment has been used several times as some sort of seminal explanation for why African Americans hesitate to be treated. The Tuskegee experiment recruited African American men for what they thought was medical treatment, but in reality it was a study of untreated syphilis that continued long after penicillin was an accepted intervention for the disease. In fact, the men were never treated, and many infected their partners as well. As unethical as this research may be today, the reluctance of African Americans to trust the systems and seek treatment is actually rooted in the long history of mental health abuse and failed mental health interventions among African Americans.
Today, African Americans face numerous challenges that affect their mental health, including high unemployment, poverty and incarceration; health differences and disability; the emotional and psychological impact of the pandemic; and the steady increase in police shootings in the African American community. All of these challenges are complicated by the intergenerational trauma of slavery, the mere mention of which, even 150 years after its end, often evokes an almost visceral response. In fact, Africans have been brought into this country as slave labor and laws have been passed along the way to ensure that they and their descendants remain enslaved forever. Over time, her skin color has been equated with bondage and privation in a way that has lasted for over 400 years. Slavery is our shared history, and if it's a shame, it's our shared shame.
Now there are new mental health challenges in the emerging myths that ignore the history of African American people and slavery. The first myth is that slavery is a hoax, which means that blacks have never been enslaved in this country. The second myth is that blacks were enslaved, but slavery really wasn't that bad. In the first myth, the devaluation of history is insidious. It's supposed to be confusing and confusing in the same kind of gaslighting that the main character experiences in the movie of the same name (Gaslight). In this case, the myth is supposed to raise doubts about perception and historical memory so that blacks are told, "You think you went through hell but it didn't happen." In an era of tumultuous racial tension, the second myth of slavery as a harmless social good conveys a rethinking tone of slavery for African Americans, and recent electoral restriction laws help shape the second boogeyman as a political reality. This historical revisionism retraumatizes, annoys, and reactivates centuries-old cross-generational fight-or-flight strategies for coping, including confrontation (rallies and marches) and retreat.
According to the Centers for Disease Control and Prevention (2017), non-Hispanic blacks are more likely than non-Hispanic whites to report feelings of "sadness, hopelessness, worthlessness, or that everything is an effort – all or most" of the time. "The US Department of Health's Office of Minority Health (HHS) reported that suicide was the second leading cause of death in 2019 among African Americans ages 15 to 24, and the death rate from suicide among African American men was four times that of African American women one of the highest poverty rates in the United States, and according to the HHS Office of Minority Health, African Americans are twice as likely as other people to report mental distress. In 2019, the Department of Substance Abuse and Mental Health reported Health that in adults who have passed n years of mental health problems, non-Hispanic blacks were significantly less likely to receive mental health treatment than non-Hispanic whites (8.7% versus 18.6%). ).
Despite the obvious need for psychosocial counseling, many African American people are reluctant to seek treatment. Part of this reluctance may be due to the reality that African Americans' mental health has been abused in the past and their mental treatment has been carried out with a generous dose of discrimination and bias. Initially, it was believed that African Americans couldn't be mentally ill. The general idea was that in order to become mentally ill, a person had to own property and be actively involved in business and civil affairs, and because African American slaves had "nothing and nothing to worry about," they could not be mentally ill. When both the 1840 and 1850 US censuses found such low rates of mental illness in slaves, it was concluded that slavery actually protected slaves from the diagnoses known at the time.
Science hastened to support the views of slavery. Doctors and scientists promoted the idea that slavery was such a good thing that a slave would have to be mentally ill to want to leave it. This is how drapetomania emerged as the first race-based diagnosis. Doctor Samuel Cartwright coined the term in 1851 to describe a "disease" that caused slaves to develop an irrational urge to flee slavery. He also identified a second physical and mental anomaly, Dysaethesia aethiopica, which is believed to attack blacks who had too much freedom. This condition is supposed to lead them to sabotage their work, to destroy things and to come into confrontation with others.
While early attempts to label Afro-American behavior seem antiquated and almost ridiculous today, they had a profound influence on the regulation of black behavior and the transmission of intergenerational prejudices. Over time, resistance to oppression and free labor has stereotyped African Americans as "lazy" people unwilling to work, and they have often been labeled "disturbed" for their loudest opposition to slavery. In this way, race and control were merged in the lives of blacks with mental illness, and that was just the beginning. Slavery in the United States ended in the mid-1860s, and with it the usefulness of blacks for free labor and the reproduction of more slaves ended. Slavery left many broken families who could never reunite. There was almost no employment, and the Jim Crow Laws codified new submissive behaviors for blacks who had to go to the back door for duty and leave the sidewalk to let whites pass. From 1882-1968, according to the Tuskegee Institute, 3,446 blacks were lynched in a terror campaign.
Also at the end of the 19th century, Francis Galton coined the term “eugenics”, the idea that only certain people should be able to reproduce. Herbert Spencer supported this idea with his now famous "Survival of the Fittest" theory or social Darwinism. Eventually, the concept of eugenics was adopted and applied for various purposes: the genocide of the Jews by Adolf Hitler, in immigration policy, and finally in the forced sterilization of people who are considered to be mentally handicapped, including people with disabilities. According to the Equal Justice Initiative (2013), alongside people with disabilities and prisoners, "thousands of poor southern black women were sterilized without their knowledge or consent".
The ideas of Galton and Spencer have further fueled the views on racial or biological mix and the legal prohibitions on mixed marriages. The assumption was that by banning multiracial unions, the white race would remain the strong, pure race, while multiracial individuals called "mulattos" would merge with the black race. It worked. By definition, mulattos disappeared nearly a century ago after the US census dropped that category and mixed race were forced to identify themselves as blacks and marry blacks. The prohibition of mixed marriage was legally in effect until the Supreme Court of 1967 in the Loving v. Virginia picked up. But in the prevailing discourse it took much longer.
Well into the 20th century, the realities of black mental health were minimized in the service of age-old beliefs about the dangers of too much freedom for black people – namely, that it would lead them to ruin and madness. Mental health care and facilities were in their infancy and limited imagination for everyone at the time, but institutionalization was grim for blacks. Because of the segregation, mentally ill blacks were accommodated separately from whites, up to and including accommodation on the premises or in overcrowded rooms, forced to work in the facilities and often rented out to support the institutions.
In some cases people were placed in homes because of other disorders, other disabilities were confused with mental illness, and people were confined to the word of an employer. Despite the enactment of the 1964 Civil Rights Act, some states continued to offer discriminatory mental health services in which African Americans were more likely to be aggressive, less likely to participate in counseling therapy, more likely to be segregated from pharmaceutical interventions, and more likely to be labeled schizophrenic and reticent in African American men.
As a result, many African Americans remain skeptical that psychologists are here to help and they are often right. According to a 2017 data sheet from the American Psychiatric Association, African Americans are less likely to receive “guideline-consistent” care, are more likely to use the emergency room or a GP for interventions, and are less likely to be involved in research. A 2013 study by Earlise Ward, Jacqueline Wiltshire, Michelle Detry, and Roger Brown found that African Americans were generally reluctant to consider mental health issues, were concerned about the stigma associated with mental illness, and about mental health services Were “a little open”, although they preferred “religious coping”. A 2015 study by Janeé Avent, Craig Cashwell, and Shelly Brown-Jeffy found that in southern black churches, the leader or "preacher" is often a frontline source of support for church members suffering from mental health problems.
In order to attract black people to counseling, we have to address old prejudices about the flawed construct of race, persistent prejudice in the treatment of mental illnesses and the lack of access to mental health services for people living in poverty. We could recruit more counselor students from marginalized groups, and we could address the shortage of African American counselor teachers. According to the 2017 CACREP Vital Statistics Report, African Americans make up only 14.52% of counselor trainers, and of that 4.11% are African American men. We might wonder why the counselor training textbooks say nothing about what happened to African Americans in the treatment of mental illness]
We could have an integrated discussion of the separate history of psychiatric treatment in this country. We could stop saying that blacks “drop out” of treatment and start a conversation about why African Americans are skeptical of our labels and our ideas and potions when referring to the historical regulation of black behavior. After all, it is late – but not too late – to conduct due diligence in the clinical evaluation of people who have bought and sold people and, in many cases, committed horrific acts of violence. The victims who resisted oppression have been labeled "insane," but we have yet to identify the perpetrators of these atrocities.
For these reasons, the myths that deny the injustices of slavery or that slavery even existed are not benign. African Americans have lived in some kind of psychological fun house for more than 400 years, with mirrors reflecting everything in exaggerated forms. The message: "Your life experience does not matter."
Ultimately, the justification for the Tuskegee experiment was to view enslaved people as less than human, to label them ruthlessly, and then willfully disregard the mental health of African Americans for two centuries. So if African Americans are reluctant to seek treatment, it has less to do with race and more to do with trust. This is what reluctance is about. Fortunately, it is also about advice.
Pixelheadphoto digitalskillet / Shutterstock.com
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Patricia Bethea Whitfield holds a PhD in Education and is Associate Professor and Coordinator of the CACREP-Accredited Clinical Program of Psychological Counseling in the Department of Counseling at North Carolina A&T State University, where she teaches “Counseling for Poor and Ethnically Diverse Families”. She is a member of the Executive Council of the North Carolina Counseling Association, president of the North Carolina Association for Specialists in Group Work, and past president of the North Carolina Association of Marriage and Family Counselors.
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