«Separate and Unequal: The Legacy of Racially Segregated Psychiatric Hospitals A Cultural Competence Training Tool Vanessa Jackson, LCSW For ...»
Separate and Unequal: The Legacy of Racially Segregated Psychiatric Hospitals
A Cultural Competence Training Tool
Vanessa Jackson, LCSW
For permission to use or duplicate this manuscript,
Please contact Vanessa Jackson
P.O. Box 10796, Atlanta, Georgia 30310
The content of this does not necessarily reflect the views and policies of the Center for
Mental Health Services (CMHS), Substance Abuse Mental Health Services
Administration (SAMHSA), or the Department of Health and Human Services (HHS) In Celebration of Jennie Fulgham for her passion for mental health And her willingness to tell a brutal truth when necessary In Memory of Quincy Boykin, Pearl Johnson and Cookie Gant, fierce and loving advocates for African American consumers/survivors/ex-patients I. Introduction In the preface to the Mental Health: Culture Race and Ethnicity (2001), a supplement to the landmark Mental Health: A Report of the Surgeon General (1999), Surgeon General
David Satcher states:
“This Supplement documents that the science base on racial and ethnic minority mental health is inadequate; the best research, however, indicates that these groups have less access to and availability of care, and tend to receive poorer quality mental health services. These disparities leave minority communities with a greater disability burden from unmet mental health needs.
A hallmark of this Supplement is its emphasis on the role that cultural factors play on mental health. The cultures from which people hail affects all aspects of mental health and illness, including the types of stressors they confront, whether they seek help, what types of help they seek, what symptoms and concerns they bring to clinical attention, and what types of coping styles and social supports they possess. Likewise, the cultures of clinicians and service systems influence the nature of mental health services.” The Supplemental report was a long-overdue effort to focus attention on the unique needs and experiences of persons of color within mental health systems. It documents the reality that, 225 years after Charity, a free Black woman in Virginia, was admitted to the first public psychiatric facility in America (Zwelling, 1985), African Americans continue to be disadvantaged in mental health systems. Unfortunately, Dr. Satcher’s assertion that “the culture of clinicians and service systems influence the nature of mental health service” is frequently minimized in the development of culturally appropriate services for African American communities. It is critical to understand the cultural values and beliefs that affect how African Americans access mental health services. However, it is equally, if not more, important to explore how mental systems interface with African American communities relative to funding allocations, comprehensiveness of services, availability of African American providers and access to services. These are system-controlled factors and require that the leadership of mental health systems shift their gaze to acknowledge and rectify these impediments to care. Disparities in funding and access to treatment are long-standing challenges for African American communities and it would be beneficial to explore the development of mental health services for African Americans to understand some of the modern day barriers to recovery. This monograph will explore the development of freestanding public psychiatric facilities for African Americans through a review of primary source documents, secondary sources and oral history interviews with former patients, staff and family members at the facilities. The monograph will conclude with recommendations related to legacy of these institutions on current mental health policies and practices. This monograph seeks to highlight the importance of the historical underpinnings of mental health care on the development of truly culturally competent services for African Americans.
It is essential that the evolution of mental health care for African Americans be examined within the context political, social and economic factors that have shaped the lives of African Americans since their forced arrival in Jamestown in 1619. White supremacy or institutional racism is both a historical and current set of attitudes and behaviors that privileges the experiences of European-Americans and negatively impacts opportunities for non –European Americans. Anti–racism activist and author, Paul Kivel (2002) describes the institutionalization of racism as “ the uneven and unfair distribution of power, privilege, land and material goods favoring white people.” It is beyond the scope of this monograph to provide a detailed overview of the history of Africans in America, and the on-going impact of institutional racism on African American communities.
Readers are encouraged to review the resource materials listed in Chapter Four to ensure that they have an adequate historical and political foundation upon which to develop culturally competent mental health services.
II. Institutional Racism and Mental Health Systems
Godfrey Goffney is listed as the thirteenth patient on the 1870 admissions register for Central State Hospital in Petersburg, Virginia, the first hospital created for the care of “insane Negroes.” Mr. Goffney was committed to the facility with a diagnosis of “homicidal mania” and the supposed cause of his lunacy was freedom. A more detailed note related to his condition indicated that he “attempts to kill every white man” (Report of Board of Directors of the Central Lunatic Asylum, 1870, appendix). When Mr.
Goffney entered Virginia’s psychiatric system on December 5, 1868, he was pushed up against a wall of racially biased care that was nearly one hundred years in the making.
Under these conditions, it is not surprising that Mr. Goffney would remain in the facility under state control for eighteen years before being released as “restored.” This monograph begins with the story of Mr. Goffney because his life and confinement highlights the complexity of mental illness and race in America. There is little written about the mental health needs of African Americans prior to emancipation and much of what was published focused on positive influence of enslavement on the mental health of African Americans (Cartwright, 1851;Golleher, 1995; Powell, 1895). Several of the 18th century leaders of the mental health movement, which focused primarily on the development of asylums, also worked to bolster the institution of slavery through their pronouncements regarding the underdeveloped natures of African Americans; thereby linking white supremacist values with mental health care for African Americans. In 1847,
Dorthea Dix, who led international efforts for lunacy reform, wrote (Dix, 1847):
Ms. Dix describes the temperament of “Negroes” but seems to pay little attention to the contexts in which they lived that deprived them of opportunities to have their “nervous energies roused and nourished.” Ms. Dix was well aware of the conditions in which enslaved Africans were maintained when on an1831 trip to St. Croix, she had an opportunity to witness slavery up close. In Voice for the Mad: The Life of Dorthea Dix, biographer David Gollaher reports, ”In short, Dorthea largely ignored the cruelty, inhumanity and repression of the human spirit essential to any slave system (p.74).” Dorthea Dix’s capacity for selective recognition of neglect and brutality was a political asset as she began her lunacy reform activities in the South beginning in 1848.
Thomas Story Kirkbride served as Superintendent of the Pennsylvania Hospital for the insane and was the leading expert on asylum construction. He was a founding member of the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), the forerunner of the American Psychiatric Association established in 1844.
In 1855 Dr. Kirkbride wrote in the American Journal of Insanity, “The idea of mixing up all colors and classes as seen in one or two institutions in the United States is not what is wanting in our hospitals for the insane” (Vol.12 p. 43). Dr. Francis T. Stribling, Superintendent of the Western Lunatic Asylum in Virginia and another AMSAII founder, was credited with originating the movement for the establishment of separate facilities for Negroes (AJI, Vol.1, 1845-6, p.157). At the inagural meeting of AMSAII, Dr. Stribling was appointed to a committee on asylums for colored persons. Dr. Stribling had successfully repelled all attempts to admit African Americans to his facility, leaving Eastern State Hospital in Williamsburg headed by Dr. John Galt, as the state repository for such patients. Gamewell and Tomes (1995, p.59) indicate that Dr. Galt integrated some of the wards during his tenure (1841-1862) at the facility and was penalized for his commitment to the care of Negro patients by consistently being appropriated less financial support than Dr. Stribling’s facility. However, another source indicates that Dr.
Galt’s interest in racial mixing was limited to training African American patients to care for white patients (AJI, Vol. XXX, 1873-4, p.179).
Gamewell and Tomes (p.56) described the status of institutional care for African
Americans in the mid-1800’s as follows:
“Because the number of free Blacks in the North was relatively small, northern asylums had few African American applicants. Some private asylums, including the Friends Asylum [in Philadelphia], simply did not admit Blacks. While other, like the Pennsylvania Hospital for the Insane, discreetly kept quiet about its admissions. State mental hospitals accepted African Americans more openly but placed them in segregated wards or separate buildings where they had fewer amenities than white patients.
Most commonly, public officials assumed that the expense of hospital treatment was wasted on Blacks, who were confined instead in jails and almshouses, where they received decidedly inferior care.
Working Cures: Healing Health and Power on Southern Slave Plantations, provides extensive documentation of the “harrowing history of medical abuse and neglect of African Americans” from enslavement to the present” (Fett, 2002,introduction p.1).
Fett (introduction p.2) notes:
“White physicians and medical students subjected enslaved men and women to experimentation and humiliating displays as medical specimens.
By the late nineteenth century, white pundits and scientist alike employed evolutionary theory and population statistics to project the extinction of the ‘Negro race.’ Twentieth century eugenics, forced sterilization of poor women, nonconsensual experimentation and massive discrimination complete a history of medical abuse built on the legacy of slavery and racism. It is a historical accounting that clearly renders African American distrust of white medical institutions, to borrow sociologist Kirk Johnson’s phrase, ‘a sensible act.’ In 1851, Dr. Samuel Cartwright, a physician and defender of slavery, described two
forms of mental illness that was unique to African Americans (Cartwright, 1851):
Dysaethesia Aethiopica, or hebetude of the mind and obtuse sensibility of body- a disease peculiar to Negro-called by overseers, ‘Rascality.’ Dysaethesia Aethiopica is a disease peculiar to negroes, affecting both mind and body in a manner as well expressed by Dysaethesia, the name I have given it, as could be by a single term. There is both mind and
Dr. Cartwright attempts to pathologize a human instinct for freedom and dignity to support the pro-slavery argument that America’s “peculiar institution” was beneficial to the mental and physical well being of African Americans. Dr. Cartwright’s medical assessment of the disabling impact of freedom on African Americans came a decade after the 1840 census which fueled concerns regarding the increase in insanity among African Americans, specifically those afflicted with freedom. The clearly fraudulent data included Northern counties in which all Negro residents were listed as insane, was challenged by African American and White physicians and politicians. A congressional investigation was demanded but was effectively undermined by the appointment of John Calhoun, an ardent defender of slavery, to lead the investigation. As the Secretary of State, Mr. Calhoun had overseen the original census survey. Not surprisingly, the 1840 census data was upheld and remained as the official record (Gamwell and Tome p.