Race, Health Care and the Law 
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An Early History - African American Mental Health

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Vernellia R. Randall
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Vanessa Jackson.

excerpted from: Vanessa Jackson, "In Our Own Voices: African American Stories of Oppression, Survival and Recovery in the Mental Health System", pp 1-36, p. 4-8 http://www.mindfreedom.org/mindfreedom/jackson.shtm l(Last visited: March 20, 2002)(citations omitted)

A review of the history of mental health includes few references to the African-American experience. Robert Meinsma's Brief History of Mental Therapy offers a review of philosophical and medical views on mental illness dating back to 600 BC that includes nearly a thousand entries. However, this very comprehensive document boasts fewer than five entries pertaining to the experiences of people of African descent. A similar criticism can be offered of the timeline compiled by the American Psychological Association. African-Americans have presence in America dating back to at least1619 when the first African indentured servants arrived in America. This chapter attempts to supplement the official records by offering a few accounts of African-American psychiatric survivors' experiences, and the philosophy and policies that guided the treatment of our ancestors and which still influence our treatment today.

A review of the history of African-American psychiatric survivors would quickly disabuse a reader of the notion that the process of recording history is apolitical. One of the earliest records dealing with the issue of insanity among African-Americans was in1745 when the South Carolina Colonial assembly took up the case of Kate, a slave woman, who had been accused of killing a child. After being placed in the local jail, it was determined that Kate was "out of her Senses" and she was not brought to trail. However, the problem of how to care for Kate was an issue since her owner was too poor to pay for her confinement and South Carolina had made no provision for the public maintenance of slaves. Ultimately, the colonial assembly passed an act that made each parish in the colony responsible for the public maintenance of lunatic slaves whose owners were unable to care for. Not surprisingly, there is no further record of what happened to Kate or what circumstances led to the murder of the child.

Scientific Racism

Benjamin Rush, MD (17461813), signer of the Declaration of Independence, Dean of the Medical School at the University of Pennsylvania and the "Father of American Psychiatry, "described Negroes as suffering from an affliction called Negritude, which was thought to be a mild form of leprosy. The only cure for the disorder was to become white. It is unclear as to how many cases of Negritude were successfully treated. The irony of Dr. Rush's medical observations was that he was a leading mental health reformer and co-founder of the first anti-slavery society in America. Dr. Rush's portrait still adorns the official seal of the American Psychiatric Association. However, Dr Rush's observation-"The Africans become insane, we are told, in some instances, soon after they enter upon the toils of perpetual slavery in the West Indies"-is not often cited in discussions of mental illness and African-Americans, how-ever valuable it might be in understanding the traumatic impact of enslavement and oppression on Africans and their descendants.

In1851, Dr. Samuel Cartwright, a prominent Louisiana physician and one of the leading authorities in his time on the medical care of Negroes, identified two mental disorders peculiar to slaves. Drapetomia, or the disease causing Negroes to run away, was noted as a condition, "unknown to our medical authorities, although its diagnostic symptom, the absconding from service, is well known to our planters and overseers. " Dr. Cartwright observed, "The cause in most cases, that induces the Negro to run 4 away from service, is such a disease of the mind as in any other species of alienation, and much more curable, as a general rule. " Cartwright was so helpful as to identify preventive measures for dealing with potential cases of drapetomania. Slaves showing incipient drapetomania, reflected in sulky and dissatisfied behavior should be whipped-strictly as a therapeutic early intervention. Planter and overseers were encouraged to utilize whipping as the primary intervention once the disease had progressed to the stage of actually running away. Overall, Cartwright suggested that Negroes should be kept in a submissive state and treated like children, with "care, kindness, attention and humanity, to prevent and cure them from running away. "

Dr. Cartwright also diagnosed Dysaethesia Aethiopica, or "hebetude of the mind and obtuse sensibility of the body-a disease peculiar to Negroes called by overseers-Rascality. " Dysethesia Aethiopica differed from other species of mental disease since physical signs and lesions accompanied it. The ever-resourceful Dr. Cartwright determined that whipping could also cure this disorder. Of course, one wonders if the whipping were not the cause of the "lesions" that confirmed the diagnosis. Not surprisingly, Dr. Cartwright was a leading thinker in the pro-slavery movement. Dr. Cartwright, in his article "Diseases and Peculiarities of the Negro Race, " chided his anti-slavery colleagues by noting "The northern physicians and people have noticed the symptoms, but not the disease from which they spring. They ignorantly attribute the symptoms to the debasing influence of slavery on the mind without considering that those who have never been in slavery, or their fathers before them, are the most afflicted, and the latest from the slave-holding south the least. The disease is the natural offspring of Negro liberty-the liberty to be idle, to wallow in filth, and to indulge in improper food and drinks. "

Drapetomania and Dysethesia Aethiopica could be relegated to obscurity along with the spinning chair and other ridiculous assumptions about mental illness and its treatment if African-Americans were not constantly assaulted by updated efforts to put social and economic issues into a medical framework that emphasizes our " pathology. " In the late1960s, Vernon Mark, William Sweet and Frank Ervin suggested that urban violence, which most African-Americans perceived as a reaction to oppression, poverty and state-sponsored economic and physical violence against us, was actually due to "brain dysfunction, " and recommended the use of psychosurgery to prevent outbreaks of violence. Clearly, the spirit of Dr. Cartwright was alive, well and receiving federal research grants. Drs. Alvin Poussaint and Peter Breggin were two outspoken opponents of the updated "Drapetomania" theory, along with hundreds of psychiatric survivors who took to the streets to protest psychosurgery abuses. The issue of brain dysfunction as a cause of poor social conditions in African-American and Latino communities continues to crop up in the federally funded Violence Initiatives of the1990s and current calls for psychiatric screening for all children entering juvenile justice facilities. Exposing scientific racism is essential to protecting us from further psychiatric abuses and facilitating resolution of social, political and economic problems without blaming the victims of oppression.

In1895, Dr. T. O. Powell, Superintendent of the Georgia Lunatic Asylum, reported an alarming increase in insanity and consumption among Negroes in Georgia. Dr. Powell noted that these conditions were virtually unheard of among Negroes up to1860. A comparison of census records between1860 and1890 showed that insanity among Negroes had increased from one in10, 584 to one in 943. Dr. Powell believed that the hygienic and structured lives led by slaves served as protective factors against consumption and insanity. According to Dr. Powell, "Freedom, however, removed all hygienic restraints, and they were no longer obedient to the inexorable laws of health, plunging into all sort of excesses and vices, leading irregular lives, and having apparently little or no control over their appetites and passions. "To sum it up, freedom made us nuts. Apparently, Powell failed to factor abject poverty, further disruption of family and kinship ties, racism, and terrorism into the high rates of insanity.

The1840 census revealed dramatically increased rates of insanity among free blacks. African-American physician James McCune Smith challenged the findings of 1840 census, which was frequently used by pro-slavery writers to confirm that enslavement was beneficial to slaves. Dr. Smith wrote, "Freedom has not made us `mad. ' It has strengthened our minds by throwing us upon our own resources. "

What role did the need for cheap labor to staff psychiatric hospitals play in the incarceration of former slaves? The Georgia Lunatic Asylum, which would come to be known as the largest lunatic asylum in the word, was operated exclusively by slave labor from18411847, when the first white attendants were hired. The slave attendants and help-patients were a critical adjunct to hospital staff. Other factors that may have influenced the rates of insanity following the Civil War were starvation and poor nutrition, which led to pellagra, a niacin deficiency with symptoms of loss of appetite, irritability and mental confusion. This disease disproportionately affected poor and displaced former slaves.

The Colored Hospital

African-Americans were frequently housed in public (as opposed to private) facilities such as the poorhouse, jail or the insane asylum. These facilities almost always had substandard conditions. If conditions in the facility were poor for white patients, conditions were completely inhumane for African-American patients. For instance, one of the first patients admitted to the South Carolina Lunatic Asylum in1829 was a fourteen-year-old slave named Jefferson. Jefferson's name was not recorded in the admission book and he was reportedly housed in the yard. The young slave was admitted as a favor to his owner since the facility did not officially receive blacks.

The issue of housing Black and white mental patients in the same facility was a struggle in both Northern and Southern States since many leading mental health experts felt that it undermined the mental health of white patients to be housed with African-Americans. The distress of having Blacks and white patients in close proximity to one another was balanced by the unwillingness to fund segregated facilities for black patients.

In March1875, the North Carolina General Assembly appropriated $10, 000 to build a colored insane asylum. The Eastern Asylum for the Colored Insane was opened in1880 with accommodations for four hundred and twenty patients. The facility at Goldsboro underwent several name changes throughout its history and remains in operation as a psychiatric facility. In1925, Junius Wilson, a seventeen-year-old, deaf and mute black man was accused of rape, castrated and remanded for incarceration at Goldsboro by a" lunacy jury. "The rape charges were eventually dropped in the1970s and at some point authorities realized that Mr. Wilson was neither mentally ill nor retarded-simply hearing impaired. In1994, at the age of 86, Mr. Wilson was moved to a cottage on the grounds of the facility (now known as the Cherry Hospital). The move to the cottage was the state's effort to make up for Mr. Wilson's 72-year incarceration. He died there in March of 2001.

Virginia established an asylum for the "colored insane" in Petersburg that received its first patients in April 1885. At that time there were approximately four hundred "insane Negroes" in the state, all of whom were cared for in the Petersburg facility. Apparently little concern was given to the ability of family and friends throughout the state to visit their loved ones at the facility that was so far from home for so many.

The Alabama Insane Hospital was not for the exclusive use of African-Americans, but to accommodate the increasing number of African-American patients, separate facilities were created on the grounds. In1897, Dr. T. O. Powell reported that the Alabama facility had about three hundred and fifty African-American patients. The facility maintained a "colony" of one hundred African-American men about two miles from the main facility. Dr. Powell noted, "They are contented, are the healthiest class of patients under this management and by their farm labor contribute to the support of the institution. " It is interesting to note that the positive presentation of the "colony farm" obscures the reality that the primary "treatment" provided to these African-American male patients was hard physical labor. It seems odd that individuals who had been incarcerated in an asylum due to their insanity were able perform tasks that must have required some degree of skill and focus.

Dr. James Lawrence Thompson, in his memoir of life at the South Carolina State Hospital, noted "It was customary to employ as many of the patients as possible-those who were in condition to work-both male and female, white and colored. The white females would make beds, sweep the floors, sew, work in the kitchen and even sweep the yards. The colored females would work on the wards in various ways and in the laundry. The colored males did most of the rough work, such as working on the farm, cutting wood and the like. The white males were somewhat handicapped in their work as it was not customary to have the white and colored males working together and we did not have land enough to have the white males work on the farm, hence they were confined to work mostly in cleaning up the yards and moving trash from about the building. " Perhaps patients, both African-American and white, could have benefited more from the restorative power of gainful employment provided in their own communities and with adequate financial compensation.

The state of Maryland opened its hospital for the colored insane in1911near Crownsville, MD. The first patients were composed of12 patients from the Spring Grove facility and112 inmates from jails or other asylums. The inmates, who lived in a temporary camp while they began to clear the land and operate the farm, built the facility. It was noted that Dr. Robert Winterode decided to "entrust" the patients with axes and tools to complete the construction. Prior to the opening of the Crownsville facility, African-American patients were housed in segregated facilities on other facilities and in local jails. At the turn of the century, African-American males at Maryland's Spring Grove facility often spent up to eight months living in tents, made with patient labor, on the grounds. A cottage for African-American females was completed at SpringGrove in1906.

In1919, Rusk State Penitentiary in Texas was turned into a hospital for the "Negro insane. "The facility achieved notoriety when, on April16, 1955, a group of African-American prisoners in the maximum-security unit rebelled and took over the hospital for five hours. The rebellion was led by nineteen-year-old Ben Riley, who articulated inmate demands for better counseling, organized exercise periods, an end to prisoner beatings, and that all inmates have the same rights enjoyed by the white inmates regarding meals, bathing and freedom of movement. The article in the Austin Statesman reflects the power of having control of the media: it stated that the prisoners had "no specific complaints, " and described Ben Riley as the "leader of the gang of criminally insane Negroes" and as someone who "likes to exhibit his muscles. " Readers get the sense that the reporter was barely restraining himself from calling the young leader a "big Black buck. "The Austin Statesman's article is accompanied by a photo of a shirtless Riley with a caption that notes that the man was pointing to scars on another inmate that were reportedly caused by a beating. Is it possible that Riley was not just taking the opportunity to "exhibit his body" but was showing his own scars?

During the siege, the inmates reportedly hooked the hospital superintendent up to the electroshock machine and attempted to deliver maximum voltage to him. The superintendent escaped injury when the inmates pushed the right button but failed to set the spring correctly. In her well researched book on the Texas State Lunatic Asylum, it is notable that author Sarah Sitton fails to note that Rusk State Hospital was established to serve African-American patients. Sitton is very sympathetic to the plight of attendants dealing with threats of violence from African-American prisoners but shows little concern for the violence perpetrated against African-American inmates.

This section is not intended to imply that the only place where African-Americans experienced the psychiatric system was within facilities. The history of institutional-based treatment is simply better documented than other interventions provided to-or abuses perpetrated against- African-American psychiatric survivors. There is a rich history regarding natural healing and spirituality that needs further exploration to fully understand the efforts used in the community to honor and heal mental illness and trauma reactions.

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Professor Vernellia R. Randall
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