Racism and African American Mental Health

I have written a few posts about the effects of prior, earlier American racism on African American psychology and how that interacts currently with White preconceptions resulting in a “game without end,” so that common ground is difficult to establish. I’ve been quite clear in saying that despite much progress, there is still a fair amount of both implicit and explicit racism in society, especially in the criminal justice system. 

The usual criticism I get when I write about racism from certain people is that as a white person I have no business opining about such things because I haven’t had the personal experiences that Black people have. (In some circles people also say all whites are responsible for systemic racism, as if tribalism isn’t a major influence all over the world on everyone, but that’s another story).

Well, while it’s true I haven’t experienced certain things personally, such experiences as personal observations, reading different black writers, seeing black patients in psychotherapy, and gaining knowledge of common psychological processes such as the intergenerational transfer of trauma do not count for nothing. If that were true, therapists would never be able to help anyone who was not a personal clone who had never left their sides and were treated the same way by everyone they came in contact with.

Janee M. Steele, Ph.D a black author, wrote a book called Racism and African American Mental Health: Using Cognitive Behavior Therapy to Empower Healing. She was interviewed by Judith Beck, daughter of CBT founder Aaron Beck, and she said a few things that are highly consistent with my viewpoint.

Steele is s a cognitive behavioral therapist, so I would assume she doesn’t do genograms on her patients to uncover the history of a patient's family's past family trauma. Therefore, she may not know all of the implications of her ideas.

She describes a Black woman patient of hers who had significant performance anxiety at work, especially while being observed by her bosses and fellow (white) workers. She told the author she was concerned about being falsely labeled with racist stereotypes. Ms. Steele picked up on the fact that at least some of her anxiety was that these concerns were being attributed to stereotype threat rather than personal deficits.

Although Ms. Steele didn’t say this specifically, it sounded as if the patient had, as of yet, no actual experience with racist attitudes at the job. Furthermore, she was a good employee. While I agree with Ms. Steele that she should be cognizant of stereotype threats at work, and that a sense of powerlessness and internalized anti-Black attitudes may be a factor, I’m not certain the author knows some important ideas about how that may play out.

I have two questions. Why would her patient  ever consider any racist comments to be a valid description of her abilities? She knows very well what she can do. Second, if she were to have such an experience, why couldn’t she  just say in her mind to the offender (or even out loud if there would probably be no other consequences), “f*** off, you ignorant a-hole,” and then go about her business.

These issues are relatively common in minority communities, but are particularly prevalent among African Americans. It makes sense, however, that being overly anxious about doing this may have come about because of fears of her family for several generations of being “uppity,” which in the not-too-distant past could literally get you killed. Even though lynching is not a big issue any more, children can be confused about how much of their intrinsic abilities it would be wise to exhibit even now. Furthermore, these feeling engender a sense of mistrust of other people that may adversely affect their relationships.

The author goes into detail about internalized racism and resultant self-hatred and the devaluation of other Black people. These “core beliefs” result in feelings of inadequacy, powerlessness, and self-blaming. With the above client, she asks about her opinions about racial stereotypes. How did she learn them? Where did they come from? She blamed them on her treatment during her elementary school experiences and the portrayal of Black people on TV. But why should she start to seem to believe some of the stereotypes when they were not true.

To further add to my point, she apparently never mentioned what she learned about racism from her parents and other family members, and their childhood experiences and feeling ashamed of themselves. (They were often ashamed of their being powerless, not of their inherent capabilities). The CBT approach to her was to change the patient’s opinions about black people without invalidating her experiences. A worthy goal indeed.

In the interview, Steele talks about problems experienced by white therapists working with black people. There can be discomfort due to the white folk’s apathy, guilt, and vulnerability. But couldn’t plain old ignorance also be an issue? The author does mention a fear of inadvertently saying something rude or potentially offensive. And there is no mention of therapists who may have a relative lack of understanding of race issues facing a patient who doesn’t trust them to begin with – leading to the game without end mentioned in a previous post.

The author then goes on to talk about the underutilization of mental health services by Black people. She mentions something one of my own black patients told me: people in that patient’s church discouraging use of therapists and saying these folks just need to pray harder.

As the author correctly points out, there may very well be denial of racism by white people who are covertly promoting anti-Black attitudes and discrimination. But it can also be due to inexperience dealing with a variety of other cultures including Blacks with no ulterior motives at all. Just ignorance. Certain sectors in American society seemingly deny that there has been any racial progress at all, even during and after the civil rights movement.

A patient should try to keep an open mind about a therapist until they actually do or say something overtly racist.

 

 

Racism in Medicine

Opening of anatomical theater at medical faculty at Bogomolets National Medical University circa 1853

                                               Unknown author.  Creative Commons Attribution-Share Alike 4.0

 

When I read the program for any medical meeting, such as the annual American Psychiatric Convention, there has for years been a plethora of talks and  forums about racism in medicine, equity and diversity, and the like. Perhaps medical offices really are rife with bigotry and a lack of concern for minorities – particularly black people.

Now don’t get me wrong. I’m sure there is still some racism in medical practice perpetrated by today’s doctors, just as in the rest of society. But people seem to lose sight of the fact that there has been tremendous progress in decreasing it in most of U.S. society. As author Steven Pinker writes in his book Enlightenment Now: "But it's in the nature of progress that it erases its tracks, and its champions fixate on the remaining injustices and forget how far we have come." (p. 215).

I once got into an argument with a young African American woman about this. She said there hadn’t been any progress here, even after the civil rights movement!  The odd thing was that at the time we were enjoying a meal at a restaurant here in Memphis. I reminded her that when I was a kid, we wouldn’t have been allowed to eat together like that. In fact, she probably would not have been allowed in the restaurant at all. Her answer? Something to the effect of “Well, they still don’t like us here. It was probably better when it was out in the open.”  Really? 

The problem with poor outcomes in medical treatment for Black patients has several different causes besides racism, such as poverty, the crazy medical insurance situation in the U.S., and what I'm about to talk about. To hasten further progress, ALL of the various causes should be addressed. And before accusing me of "blaming the victim" in what I'm about to discuss, please keep two things in mind. 1. Just because behavior can be easily understood and justified does not automatically mean that it can't also be counterproductive. 2. When it comes to the results of repetitive human interactions in current U.S. society, "It's all my fault" and "I had nothing to do with it" are almost always false positions to take.

I’ve written before about the “game without end” aspect of relationships between Blacks and Whites (7/23/13, 1/17/13, 4/3/12). The basic point is that a lot of difficulties in the current relationships between Blacks and Whites stems from past racism, not current racism.

In a study presented at the 2023 American Association for the Advancement of Science annual meeting, Somnath Saha reported that he had came across a cluster of studies showing that black people with cardiovascular disease were treated less aggressively compared to White people. This professor of medicine at Johns Hopkins University began poring through medical records. He found that doctors are more likely to use negative language when describing a Black patient than they are with a White patient. He found them described as “really difficult,” “non-compliant,” and “uninterested in their health.”  He attributed this to implicit bias by physicians— unconscious judgments that can affect behavior.

Now, again, implicit bias is a real thing. We ALL profile other people, because we can't read minds. But is that the whole picture? Two studies bring up an important point. In an article talking about Saha’s study, Antoinette M. Schoenthaler (a professor of population health and medicine at New York University's Grossman School of Medicine), said that disparities in pain management are pervasive and widespread across the medical profession. But she also mentions a reason for it that is seldom brought up: "Patients of color go into an appointment with feelings of heightened anxiety because they're expecting mistreatment.;  we've seen minoritized patients have higher blood pressure in the context of a clinical visit because of these expectations of anxiety and fear, and disappointment."

Medical mistrust leads to greater health disparities in minority communities, according to a poster presentation at DNPs of Color annual meeting held in Washington, DC, October, 2023. It is not a phenomenon but a “true medical issue,” said Clydie Coward-Murrell, MSN-Ed, BSN, RN, an African-American. “This clinical issue is not as prevalent in other minority communities simply because of the atrocities in health care that African Americans had to suffer for hundreds of years.

Can anyone blame black patients for being suspicious of white doctors? They seem to all know about the Tuskeegee syphillus experiment in which severe damage was done to black patients. They may even know that black surgery patients were in the past given less anesthesia than whites because doctors thought they had a higher pain tolerance – a myth left over from slavery times invented by slaveowners so they would not feel so bad about whipping them. They'd literally have to be crazy to completely trust doctors.

So maybe that’s part of why they seem to be angry and non-compliant with medical treatments? And if that’s true, then couldn’t that be a significant factor in explaining why other studies show that black patients seem to have worse outcomes than white patients with similar conditions? Because they don’t follow doctors’ orders as blindly? In that vein, let me tell you what one of my black psychotherapy patients told me: She had to hide the fact that she was seeing a therapist because her fellow church members would give her an extremely nasty round of criticism if they knew. Accusing her of just not praying hard enough.

In my own experience as a medical student, resident, and psychiatrist, I have not personally witnessed a whole lot of obvious racism in my instructors and colleagues. Of course I am not black so I might not have seen racism that was present since it would not be directed at me. But I was a residency training director at a Southern medical school for 16 years. I had a lot of black psychiatry residents, and none of them complained about this. 

We were told by the dean in charge of residency programs that, although our school did not have affirmative action, if there was a black applicant and a white one of roughly equal qualifications, to take the black one.

The only time I ever personally witnessed really nasty racism (and simultaneous sexism) among doctors was way back in the early 70’s when I was a medical student in San Francisco. Clearly, my school was ahead of its time so I had a biased sample – my class was 20% female at a time when there were a lot fewer elsewhere (there are now more female medical students than male ones). A Black female classmate wanted to become an orthopedic surgeon. Surgeons were by far the biggest Neanderthals for these issues back then. Boy, did they ever give her a raft you know what when she applied.

So all this talk among doctors about how racist they all are is not something that only they hear. Black people hear it too. So what they are hearing is that they are right to be suspicious of white doctors. While racism in medicine must still be addressed, talking about it way too much has the potential to backfire and make the problem worse rather than better.

Guest Post: My Experiences with Family Dysfunction and Therapists - Anonymous

Editor’s note: This guest post came in response to my request for stories from those on my Facebook  fan page who had a bad experience with therapists who seemed to think that all of their problems were in their heads (for example, poor distress tolerance, irrational thoughts, or anger issues) and had little to do with other people who were stressing them out or pissing them off.

When I was 6 or 7, a neighbor (age 17 or 18), took me into his house "to play a game." He blindfolded me, made me kneel, and took his penis out for me to suck. The blindfold wasn't properly attached so I was able to figure out what he was doing. Afterwards - and after the mandatory "don't tell anyone" - I told my grandma, who then informed my parents.

Now, my mom certainly has her own issues. She hates being touched, always tends to think only about herself, is obsessed with TV shows, tends to be depressed and spends most of her free time in her room, and has a very high fear of going to the doctor - even though she is one! My Dad was certainly narcissistic (as you'll see it in a minute), so they both decided it was best to sweep it under the rug.

Years later, when I was 12, I had my dad's brother pull me close while dancing in order to rub his large stomach against my budding breasts.  Thinking back, I later realized that my Dad never ever let me stay with my cousins. My mom then confirmed that his brother is a pedophile. His poor, poor stepdaughter from my aunt's previous relationship! My dad must've known this, yet when I was raped, his answer was...to become my rapist's godfather!!!

My dad - and mom - made me go to my rapist's Confirmation (a Catholic ritual for teens) a year after my rape. We remained neighbors, and my Dad had weekly breakfasts with that family. No, I am not kidding. When I was 8 or 9, my mom bought a house two doors down from my grandparents...but only she and my dad moved out. I was told to stay with my grandparents "because I would be more comfortable there, and we need money to build a second floor." They never did.

My Dad was never steadily employed. I caught him kissing the maid when I was almost 13. So my mom, who at that time was working in a different region, came back home and told him to get out. He then blamed me for the "breakup of our family." I was also sexually harassed several times as a teen, but I never told my mom or grandma because my grandma told me I was "dirty" because I was still talking and playing with that neighbor. Why would I stop? NO ONE bothered to explain that what had happened to me was sexual abuse.

My uncle on my mom’s side slapped me when I was 13 for defending his teen housekeeper, and my aunt and mom (after I had come back home) wept but said nothing. Again, no one talked to me about what had happened. My dad got cancer when I was 17 and I asked him to come home. His siblings were robbing him and not taking care of him. He initially rejected our offer. Only when he knew for certain that his siblings were taking important property deeds (he owned a house in the mountains. I am Peruvian), did he finally agreed to come back to be looked after by us. He was bitter and scared, but was still a bad parent. I had barely seen him during the 5 years that he was not living with me - his choice, of course. I again saw him flirting with the maid during his remission. He died when I was 22.

Although I've barely ever been beaten, and no one in the family did drugs or alcohol, I nonetheless had a highly traumatic childhood. I'm a Psychology student. I am a 4-time college dropout from 3 universities. I am married now and living in Europe. I have been subjected to verbal abuse at home, but he's getting treatment. I’ve been diagnosed with ADHD, but I’m wondering if it's the right diagnosis. I do acknowledge that a trial of Concerta did show me I can do more, although I stopped after 14 days because the side effects on my mood were too much for me.

With all of this, I have also been subjected to racism and homophobia in society. I'm not a lesbian, but I "look like one,” apparently because of my very short hair and baggy pants. Once,  when I had messy hair and not-fancy clothes, I had to leave a store because of a screaming security guard who was asking me what the hell was I doing at that store (I lived in a "well-to-do" neighborhood). Where I am, racism is expressed with frowning faces and rude attitudes from clerks. But when they see me with my White husband, I am "graciously welcomed" anywhere. I guess those two (racism and sexism) can never be escaped, but I am DAMNED sure happy I am far away from my family's dysfunction now.

At 22 I started psychoanalysis, and my therapist wanted me to focus on forgiving my parents.

Later, I did CBT, and that psychologist wanted me to focus on my goals, when all I could think of was how damaging the sexual abuse had been, and how troubled I felt about being neighbors with the rapist.

I don't know what kind of treatment I received from a third therapist I took on, but he said I should focus on why I went into the neighbor's house in the first place. That was said to mean that I was starving for male attention, and I was told I should work on that.

There was that psychiatrist too, when I was 26, who I told about my anxiety and possible ADHD, He said I should just take it easy, that no one is supposed to demand too much of themselves and that is okay not to accomplish everything I want. He added that it's all about "finding contentment." I felt that that one was sexist AND racist.

My parents and I went to ONE session of family therapy when I was 16, but as soon as the therapist pointed out to my parents their troublesome, inattentive behavior towards me, we stopped going.

So from my experience, what I learned is that even people with the best intentions (or at least who are supposed to have them) will try to redirect you to what they think it's best for you, instead of actually listening to you. Validate your own feelings, and after that, inform yourself  both about what psychology says about your own experiences AND about how to pick a good therapist. Work from there. Too many uninformed people will spout their opinions, whether they are family or professionals.

Book Review: "High Price" by Dr. Carl Hart: A Life and the Lies in Drug Abuse Research

For a long time I have been critical about conclusions drawn from animal experiments which purported to be models for addictive behavior with drugs in humans. In particular, I got annoyed hearing over and over about how rats and rhesus monkeys would press levers to get cocaine, heroin, or methamphetamine compulsively, even until they died, choosing drugs over even food and water. These experiments were touted  incessantly by so-called experts. As I mentioned in a previous post, the head of the National Institute for Drug Abuse, Dr. Nora Volkov, even had the nerve to say that rats and humans could have the same phenotype!

My usual response to this was that rats and monkeys do not know about the damage the drugs might do to them, but that humans do, and that makes the comparison ridiculous if not completely preposterous. Furthermore, if a monkey experienced the “crash” that followed stopping cocaine or meth, it would not know that the crash was due to the drug, only that the drug stopped the crash.  And scientists even STILL have had no luck in finding rats who hide bottles of alcohol.

As it turns out, these points, while probably valid, are only minor considerations in determining the lessons to be learned from these animal studies. A far bigger issue was that the experiments were not even accurately or honestly described by those touting them. In an outstanding new book called High Price by African-American neurospsychologist Carl Hart, a faculty member at Columbia University, the author points out that descriptions of the environments in which the animals were kept were completely missing from the descripions, but that environmental factors were key in determining animal drug use behavior.

Dr. Carl Hart

The animals in these experiments were essentially kept in solitary confinement, as they had throughout most of their lives, and had nothing else to do but push the lever!  If they were instead placed in an enriched environment with alternatie activities available and other animals with which to socialize, their “drug-seeking” behavior changed drastically.

A series of experiments that the drug warriors don't want you to know about were conducted in the 1970s, and known as Rat Park. Researchers allowed two groups of rats to self-administer morphine. They housed the first group in stark cages, one rat to a cage. They placed the second group in an “enriched environment,” which offered opportunities to burrow, play, and copulate. The isolated rats drank 20 times more morphine-laced sugar water than those enjoying the Rat Park. These results have been reproduced using both cocaine and amphetamine.

Dr. Hart points out that if you were held in solitary confinement with just one movie to watch, you might watch it over and over. That would not prove that the movie itself was addictive!  In people, when they have appealing alternatives, they often do not choose to take drugs in a self-destructive manner.

Add to the mix of misinformation about drug abuse is the unheralded but monumental effect of racism on both drug use and the prevailing ideas about it.  Legal bans on certain drugs (and not others) were legislated after widespread reporting of highly exaggerated horror stories about drug use by a despised minority:  crack cocaine by Blacks, marijuana by Blacks and Mexicans, methamphetamines by toothless "poor white trash" in Appalachia, and opium by Chinese railway workers. No one was immune from these cultural influences and myths, including the minorities themselves. The Black Caucus in the United States Congress was, originally, solidly behind the huge and unfair differences in the length of jail sentences for people convicted of using crack vs. powdered cocaine, the effects of which drugs are physiologically identical.

Some facts:  The problems in the black urban community attributed to crack were already prevalent well before crack was even introduced. The vast majority of illegal drug users do not become addicted or even psychologically dependent on the drug. Among addicts, half are employed full time. Violent convicts in jails are less likely to abuse drugs than other prisoners. The vast majority of homicides do not involved drug use, and alcohol is probably the worst offender among those that do. Dealing crack is only about as profitable as working at McDonalds for low level dealers. Few people who abuse drugs take only one drug, yet there are very few studies of the effects of combinations of drugs. Self reports from addicts who are asked about their cravings for the drugs do not predict whether or not an addict in recovery will relapse.

Adderall and Methamphetamine are nearly identical molecules with identical effects, yet drug manufacturers go out of their way to say that those children treated with stimulants for “ADHD” are no more likely to go on to abuse drugs than anyone else.  Of course, since their drugs are already being legally provided to them by physicians, they have no need to obtain them from illegal sources, which is one of the measures the experts use to measure drug abuse!

This kind of circular reasoning in the literature abounds. In a series of experiments with rhesus monkeys, Dr. Hart reports, “…researchers found that the animals’ choice to use cocaine is reduced to the size of the food reward they are offered as an alternative.” People are now using this data to claim that junk food is as addictive as cocaine, when initially cocaine was claimed to be “…especially addictive because animals preferred  it to food when hungry.” (p.93).

The book by Dr. Hart is especially eye opening because it combines discussions of this sort of pseudoscience with the author’s explorations about his own personal story. As an African-American having grown up in an inner city in which many of his friends and relatives did poorly and got into drugs and crime, he asks himself why he not only escaped this but became an Ivy League professor and an expert. The experiences of this black man in America shines a bright light on the real causes of self destructive behavior. It is not drugs.

The following graphic is not discussed in the book, but, with what we know about the havoc that a felony conviction and hanging out with convicts for months or years can create in the lives of young men, it is clear that far more harm is inflicted on drug users by the laws against drug use than by the drugs themselves.

By the way, do you know how to abuse drugs? You hold them in your hand and scream at them, “You worthless pile of sh*t!  You call that a buzz?? You suck!” You then throw them to the ground and stomp on them. 

Yeah, it’s the self that’s being abused by addicts, not the drugs. 

You owe it yourself to read this highly engrossing and informative book.

Medical Racism in America: a Giant Mind-Boggling Game Without End

An explosive book that came out last year, Black and Blue:  the Origins and Consequences of Medical Racism, should have reverberated throughout the medical community and caused we physicians to closely examine our own prejudices and how they have affected the behavior of, and our relationships with, our black patients. 

So of course there has hardly been a whimper in the medical community. I did see a rather bland, "balanced" (almost namby-pamby) review by two African-American psychiatrists in the American Journal of Psychiatry, the official journal of the American Psychiatric Association. I don’t think much will come of it.

The author of the book, University of Texas professor John Hoberman, explains many of the reasons why the medical profession does not look at itself much in this regard, most of which I will not discuss in detail here. One of the biggest reasons can be summed up in one phrase: the mutual estrangement of puzzled Whites and resentful Blacks.

John Hoberman

Just to be extremely clear, there is no doubt that the problem of racist beliefs in medicine started with white racists and not their black victims. Many of the ideas about physical and mental differences between Blacks and Whites came from the colonialist opinions of Europians that Africans were more primitive than white people – less further along than Whites on the evolutionarily scale and therefore sub-human. Thus, their bodies and minds were supposedly simpler and therefore less or more prone to certain diseases. 

As seen originally by colonialists,  the black body, being more simple, was hardier than the white one. Black skin, for example, was thought to be tougher. This conveniently provided slaveholders a justification for working their slaves in the cotton fields for long hours in the hot sun. At the same  time, being supposedly simpler mentally, slaves could be thought of as less likely to get depressed, so the myth was born of the happy black slave, grinning from ear to ear with his strong white teeth while eating watermelon, content being taken care of by his benign white masters.

While physicians in general no longer express these ideas, derivatives of them became part of medical folklore and were passed down as an oral tradition from medical student to medical student. For example, observations by white doctors of what a non-naïve individual would see as the understandable reluctance of Blacks to be put under anesthesia (and therefore under the complete control of a potentially racist doctor), was instead put together with the notion of black hardiness, and voila!  Black patients are far less likely even today of being given adequate anesthesia during surgery.

Hoberman describes in detail how racist ideas from the past have morphed into medical folklore about Blacks concerning the treatment of diseases of nearly every organ system.

Disparities in the health care of white and black patients such as the one just mentioned have been endlessly documented, so their existence should not be in the least controversial. White doctors unfamiliar with the racist history of American medicine, however, are likely to misinterpret the mistrust of their black patients as an innate tendency to be non compliant - or just plain lazy - which in turn makes the white doctor reluctant to put a whole lot of energy into convincing black patients to follow their advice.

Black patients have good reasons for their mistrust of the medical profession, including of psychiatrists.  White physicians tend to think that 1962 was a long time ago.  That was the year the American Medical Association stopped deferring to Southern state medical associations (doctors have to join the state and national associations at the same time), and allowed all African American physicians to become members.

Then again, I guess 1972, while more recent, seems like the distant past to such physicians.  That was when the Tuskeegee Syphilis Experiment came to public light -  a clinical study conducted between 1932 and 1972 by the U.S. Public Health Service to study the natural progression of the untreated disease in rural African American men who thought they were receiving free health care from the U.S. government. The men were never told they had syphilis, nor were they ever treated for it.

When I moved to Memphis, I was impressed that seemingly every African American I spoke with was aware of this history – even those who were not particularly educated.  For white doctors, not so much. Unfortunately, human beings have very long memories. The Serbs and Albanians, for example, still have strong feelings about a battle that was fought in the year 1389! 

It doesn’t help when white doctors like conservative commentator Sally Satel blame treatment disparities entirely on the resistant attitudes of black people without any reference to this history.  She also writes that racial profiling is important in medicine and justifies this idea (http://www.nytimes.com/2002/05/05/magazine/i-am-a-racially-profiling-doctor.html?pagewanted=all&src=pm) with the example of the implications for choosing medications based on the real difference in the racial distribution of different versions of enzymes that metabolize certain drugs (different alleles on the genes responsible for producing the metabolizing enzymes). 

In picking on one of the extremely few areas where there actually are racial differences, she ignores the far greater quantity of ideas within medical folklore purporting differences that do not in fact exist.  Like the supposed proneness of the black brain to produce hallucinations in psychiatric disorders, for example (originally attributed by doctors to its “primitive” state).

The mistrust of racism in medicine has unfortunately led a significant proportion of Blacks to believe in some seemingly far-fetched conspiracy theories. Many Blacks believe HIV and birth control programs were invented and designed by the white establishment in order to commit genocide against minority groups. 

These conspiracy theories even reached all the way to Africa, leading to the disasterous AIDS policies of South African president Thabo Mbeki. To most Whites, these theories sound completely irrational and paranoid. Of course, historically, Planned Parenthood was indeed founded by an Anglo-American eugenicist, one of whose goals was to limit the number of children of east European immigrants to the United States, whom she considered genetically inferior beings.

There is also a rather crazymaking problem for Whites who attempt to take an interest in the whole problem of the consequences of racism on black folks. This problem was exemplified by the vicious attacks on Senator Patrick Moynihan for his 1965 report, “The Negro Family: The Case for National Action.” The report discussed the “pathology” that racism had created for many Blacks and their families.

According to the Hoberman’s book, the black intelligentsia protested the report with sentiments something akin to, “How dare some white social scientists tell black people who and what they are?”  They thought that the report pathologized and stigmatized black urban culture, and that it seemed to be an oblique endorsement of old racist biology that regarded black people as inherently diseased and beyond salvation.

This has led to a situation where even today it is considered a breach of academic etiquette for any white social scientist to theorize about Black culture. I personally was crazy enough to do some of that in my first book, since a problem seen frequently in the Black urban poor community provided the clearest example of a point about the development of family system dynamics I was trying to make. Fortunately - I guess - that section of my book was completely ignored by reviewers. Whew!

So one of the reasons that white doctors are reluctant to look at their own attitudes and the history and consequences of medical racism is a fear of open discussions about that very subject. They do not want to be considered racists. So what are they supposed to say?  That racism did not create a host of problems for African Americans, so they do not seem to pathologize them and over-generalize about them? If it did not, then what is the big deal? If they ignore the problems, they could then be accused of covertly wanting racist practices to continue. Damned if you do, damned if you don’t.

Maybe if we just do not bring up the subject, no one will notice. Except maybe for that troublemaker Hoberman.

So here we have the explanation  for the “mutual estrangement of puzzled Whites and resentful Blacks” phenomenon. To oversimplify a bit, Blacks will not tell doctors that they are mistrustful of white doctors (and of Black doctors as well, for reasons discussed in the Hoberman’s book) for fear of being labeled as paranoid, and white doctors are afraid of getting labeled as racist no matter how they discuss the problem!

This is a perfect example of the family system game without end on a larger, societal scale, which makes solving this problem so devilishly difficult. No one trusts anyone else who claims they want things to be different, so anything anyone does or says can be - and invariably is - reframed as just the same old thing – just another manifestation of the Black belief in the incorrigible racism of all Whites, or of the White belief in the presence of innate Black pathology and inferiority. No wonder we get stuck!

This game without end can lead to paradoxical and at times bizarre situations. Hoberman bemoans the fact that black kids are much less likely to get stimulants for “ADHD” than white kids, which he attributes partially to white doctors’ subconscious belief in the stereotype of the “happy Negro” described above. Black mothers, on the other hand, do not want their kids to take these drugs because they believe that the drugs would be used to pacify young black males and rob them of their spontaneity, thereby making social control of Black people easier.

I doubt that the motives of most White doctors are that pernicious, but the mothers are actually right about the effects of the drugs. In this case, the idea that stimulants are being used to control behavior is correct, and the black kids are better off not getting the drugs. The problem is not, as Hoberman implies, that black children are not getting a needed medication, but that too many white kids are getting medication they do not need instead of getting family therapy! Of course, black families are not getting as much of that as white families either.

The author’s solution to the problem of medical racism, although he probably does not know about the concept of the game without end nor necessarily totally appreciate the intricacies of interpersonal miscommunication, is for medical schools to teach the history of medical racism and about the presence of incorrect folkloric beliefs that many physicians still hold. This way, the doctors would hopefully not misinterpret the lack of cooperation they receive from their black patients, and take time to explain more about what they are recommending, and reassure the patients that they understand any reluctance the patient may have to follow their doctorly advice. 

Hoberman admits, however, that there are not very many people available who are qualified to even begin to teach such a course.

As to his book itself, it is sometimes annoyingly repetitive, and at time a little confusing. When he discusses discrepancies in the care of black and white patients, it is sometimes unclear if his examples are due in his opinion to medical mythology, a misunderstanding of actual differences, black mistrust of white doctors, or all of the above. Nonetheless, since there aren’t many books that take this whole subject on, I recommend it.

The History of Racism in America: The Curious Case of Al Campanis

Alexander Sebastian Campanis (1916 –1998) was an American executive in Major League Baseball. He had a brief Major League career, playing for both the Brooklyn Dodgers and the Montreal Royals, the Dodgers' minor-league team. Campanis is most famous for his position as general manager of the Los Angeles Dodgers from 1968 to 1987, from which he was fired on April 6, 1987 as a result of controversial remarks regarding Blacks in baseball during an interview on Nightline.

The odd thing about Al Campanis, a white man of Greek descent, was that nobody who knew him ever thought he had a racist bone in his body.  In fact, when Jackie Robinson famously broke the modern major league color barrier in 1947, Campanis, then a Brooklyn Dodger infielder, offered – repeatedly - to room with him. 

Jackie Robinson

Campanis taught Robinson how to turn a double play to avoid spiking by the charging, Robinson-hating base runners. Throw the ball at the base runner's forehead, Campanis advised. Do that a couple times, he said, and goodbye, human javelins.

Being the first Black player in major league baseball, Robinson faced a daunting challenge. He was subjected to  a horrible barrage of the most vitriolic, vile, and vicious racist bile imaginable from fans and other players alike, but had to keep his cool so he would not get his whole race labeled as incapable of playing in the big leagues. 

According to Robert Kuwada, a sportwriter for the Orange County Register in Southern California, while in the minor leagues, “Campanis once threw down his glove during a game and challenged an opponent who was bullying Robinson. He was also known to invite Robinson to eat with him while many other whites chose to keep their distance."

As a player development executive with the Dodgers, Campanis signed, among others, African-American stars Roberto Clemente, Willie Davis and Tommy Davis.

On the fortieth anniversary of Jackie Robinson’s Major League Baseball debut, Campanis was invited by the ABC TV newsmagazine show Nightline to comment, and began making what sounded like the most racist comments imaginable, basically seeming to say that he did not think Blacks had the mental capacity or administrative skills necessary to serve in baseball as managers or general managers. He compared this to Blacks not being good swimmers because they “don’t have the buoyancy.”

Ted Koppel, the interviewer, could not believe what he was hearing. He kept giving Campanis the chance to clarify what he was saying, but Campanis seemed to keep digging himself into a deeper and deeper hole.

Here’s most of the interview (watch it at http://www.youtube.com/watch?v=O4XUbENGaiY).

KOPPEL: Mr. Campanis, it's a legitimate question. You're an old friend of Jackie Robinson's, but it's a tough question for you. You're still in baseball. Why is it that there are no black managers, no black general managers, no black owners?

CAMPANIS: Well, Mr. Koppel, there have been some black managers, but I really can't answer that question directly. The only thing I can say is that you have to pay your dues when you become a manager. Generally, you have to go to minor leagues. There's not very much pay involved, and some of the better known black players have been able to get into other fields and make a pretty good living in that way.

KOPPEL: Yeah, but you know in your heart of hearts -- and we're going to take a break for a commercial -- you know that that's a lot of baloney. I mean, there are a lot of black players, there are a lot of great black baseball men who would dearly love to be in managerial positions, and I guess what I'm really asking you is to, you know, peel it away a little bit. Just tell me, why you think it is. Is there still that much prejudice in baseball today?

CAMPANIS: No, I don't believe it's prejudice. I truly believe that they may not have some of the necessities to be, let's say, a field manager, or perhaps a general manager.

KOPPEL: Do you really believe that?

CAMPANIS: Well, I don't say that all of them, but they certainly are short. How many quarterbacks do you have? How many pitchers do you have that are black?

KOPPEL: Yeah, but I mean, I gotta tell you, that sounds like the same kind of garbage we were hearing 40 years ago about players, when they were saying, ''Aah, not really -- not really cut out --" Remember the days, you know, hit a black football player in the knees, and you know, no --" That really sounds like garbage, if -- if you'll forgive me for saying so."

CAMPANIS: No, it's not -- it's not garbage, Mr. Koppel, because I played on a college team, and the center fielder was black, and the backfield at NYU, with a fullback who was black, never knew the difference, whether he was black or white, we were teammates. So, it just might just be -- why are black men, or black people, not good swimmers? Because they don't have the buoyancy.

KOPPEL: Oh, I don't -- I don't -- it may just be that they don't have access to all the country clubs and the pools. But I'll tell you what, let's take a break, and we'll continue our discussion in a moment.

Later:

CAMPANIS: Well, I don't have the crystal ball, Mr. Koppel, but I can only tell you that I think we're progressing very well in the game of baseball. We have not stopped the black man from becoming an executive. They also have to have the desire, just as Jackie Robinson had the desire to become an outstanding ballplayer.

Still later

KOPPEL: Just as a matter of curiosity, Mr. Campanis, what is the percentage now of black ballplayers, for example, in your franchise?

CAMPANIS: I would say, I think Roger mentioned the fact that about a third of the players are black. That might be a pretty good number, and deservedly so, because they are outstanding athletes. They are gifted with great musculature and various other things, they're fleet of foot, and this is why there are a lot of black major league ballplayers. Now, as far as having the background to become club presidents, or presidents of a bank, I don't know. But I do know when I look at a black ballplayer, I am looking at him physically and whether he has the mental approach to play in the big leagues.

Wow. Naturally a national uproar ensued, and Campanis was of course fired from his job almost immediately after the interview. Everyone was talking about how horrible a racist the man was.  Except for everyone who knew him. They just could not believe the man could have possibly meant was he was saying. It seemed so totally out of character.

So what happened here? I surely could not blame anyone, Black folks especially, for assuming the worst about Mr. Campanis. I certainly did at the time of the interview. That is, until I read a somewhat cryptic interview on the subject by one of the few African-Americans in baseball who actually was a manager – Frank (not Jackie, no relation) Robinson.

Frank Robinson (no relation)

Here is the interview with Frank Robinson, from the April 27, 1987 issue  of People Magazine:

 

Q: Why haven't blacks been able to break the management color barrier?

A: Because we haven't been in the position either to do the hiring or to say, "Hire me or else." Blacks haven't put pressure on baseball. So baseball says, "If we don't have to give you a job, we won't." Part of this is our fault. You talk to some black players and they say, "I'm a happy man. I'm making a good living. Why should I stick my neck out?" You talk to people outside the game, and they say, "I don't want to be bothered."

Q: Why don't more black players speak out?

A: Speaking up could be damaging. Someone will get buried. The ownership might think, "He's mouthing off. Who needs him?" I won't say that today they could blackball a great player. But they could make it tough for him. At the end of his career, he might not get to play those extra years if they feel he's a troublemaker.

While Robinson did not exactly defend Campanis, he did not exactly attack him either. But what was that bit about Blacks not “sticking our necks out?” What does that mean exactly, and what does it have to do with Campanis? Well of course I can only speculate, but what I hear in the interview is an implication that African Americans may not have demonstrated to White baseball people the ambition, aptitude or inclination to be higher-ups in the organization.

Why? Because just a couple of decades earlier, Black Americans who “stuck their necks out” by showing intelligence, ambition, or even moxie were labeled as “Uppity N….’s” and were in serious danger of they or their families being attacked or even lynched. If you had these qualities, it was very wise to hide them from any Whites in the area. You just could not trust them, even if they seemed to be your friends.

This certainly is not an excuse for his being so tone deaf, but at least it makes his behavior understandable.

So call me naïve if you will, or hate me if you think I am someone who appears to defend a racist, but maybe, just maybe: Campanis did not think Blacks had the capacities he spoke of because he never saw any black players demonstrate them, just as Frank Robinson was alluding to. Therefore, he had nothing with which to compare the stereotypes about Blacks to which he had undoubtedly been exposed his whole life.

Maybe , just maybe, Campanis appeared to be more of a racist than he was because he was stuck in a game without end with his Black friends.