Structural Racism in American Psychiatry and APA: Part 3

In the first decade of the 20th century, as reported in the American Journal of Insanity (which became the American Journal of Psychiatry in 1921), the accepted belief by educated white people was that there were almost no Black people in the United States. Rather, there were “colored” people who were the product of generations of the offspring of white men and Black women. The offspring of white women and Black men were thought to be so small in number as to fail to contribute to the size of the overall U.S. population. (Frederick Hoffman, considered an expert in race at the time, said in what was more hubris than science, “No considerable crossing of the negroes with the white females has ever taken place.”)

In 1914 Dr. Mary O’Malley, a psychiatrist at St Elizabeths Hospital in Washington, D.C., wrote in the journal that the so-called “mulatto more nearly approached the white in the contour and shape of the cranium; that the facial angle in the mulatto is larger than in the negro; that the cranial capacity has been increased, but that there has been no increase in the vital force; that the race may have gained in an intellectual way but not in a moral.” The reason is that while the “mulatto” learned more easily, the Black person worked harder at it and excelled above people of a mixed race.

O’Malley also pointed out that the colored race (“colored” is her term) was awash in self-deception so the histories they provided about themselves are contaminated with inaccuracies. They also lacked the ability to use the experiences of their own lives to influence their present behaviors: “They dwell in the present, and neither the past nor the future is taken into account.” This, she indicated, explained why colored people were so superstitious. Moreover, she continued, the ignorance of colored people led them to pay no attention to hygienic practices, to eat and drink to excess, and to engage in promiscuous relations.

As I indicated in my previous column, in 1910 these behaviors were believed to have been occurring for the last 50 years because “colored” people were no longer under the “rigorous supervision of the master.” With this perspective, O’Malley conducted a study comparing mental illness in white (n=455) and “colored” (n=345) women who had been patients at St. Elizabeths Hospital.

O’Malley found that the increase in mental disorders in Black people was “obvious” since they had attained their freedom; the symptoms of psychosis and prevalence of dementia praecox (schizophrenia) were not different from whites’; bipolar disorder was uncommon and hysteria rare in Black people; Black people were immune to the effects of alcohol; and involutional melancholia and depression were rare. That depressive syndromes were rare in Black people was because “these individuals do not react to the graver emotions—grief, remorse, etc.—owing to the fact that they have no strict moral standards and no scrupulosity as to social convention and the absence of self-depreciatory ideas of sin.”

Racist Assumptions Won Out Over Facts

When O’Malley began her study, why did she think she would find a difference in mental illness between whites and Blacks? The answer does not lie in social determinants of health; racial differences in access to health care; or different diets, educational opportunities, or parenting styles. The answer is embedded in the concept of the “colored” or “negro” brain as it was referred to then. When one did find Black people in hard-life conditions, these were not contributors to mental illness, but the results of a brain exposed to more than it could handle. Dr. Charles Edward Woodruff, in a 71-page article in the journal in 1901, went so far as to say degeneration and disease had progressed so far in Blacks that he thought they were headed to “inevitable extinction.”

Long before O’Malley was conducting her research, there had been pushback against the commonly held belief that Black people were inferior because their brains were smaller and structurally different from whites. Fredrich Tiedemann, a German expert in brain anatomy and a “Foreign Fellow” of the Royal Society of London, gave a talk to that group in 1837. He emphatically stated his studies had led him to conclude that the size of brains in white people and in Black people did not differ, that there was no difference in the internal structure of the brain between the two races, and that the Black brain bore no more resemblance to the brain of an orangutan than did a white brain. Tiedemann went on to say that “the apparent inferiority of the Negro is altogether the result of the demoralizing influence of slavery and the long-continued oppression and cruelty which have been exercised towards this unhappy portion of mankind. …” History tells us his work neither persuaded the professional community nor the general population.

In the November 1894 issue of Sewanee Review, America’s oldest continuously published literary quarterly, the author of “The Material Advancement of the Negro” stated with absolute certitude, “The physiologist sees in the negro the lowest physical and mental order of the human being. The structure of the native African is so unanalogous to that of the Caucasian, that even so eminent a scientist as Mr. Darwin hesitated to designate him as higher than a sub-species of mankind.”

An article in the American Anthropologist in 1896 described the Black man as “an example of arrested or retarded development.” The brain of the Black person was described in the same period in the journal Alienist and Neurologist as “sluggish and uncultivated brains for vigorous and effective action.” In that decade, it was thought that recent work was confirming that of earlier “cranologists”: They believed that there was a material difference in the shape and dimension of the heads of white people and Black people. (This ignores Tiedmann’s work.) But no one had yet done a systematic study.

‘Scientific’ Debate Continues

This was to be rectified by Robert Bennett Bean, an anatomist and self-appointed world expert in the comparison between the white and the Black brain. In 1904 he reported to the Association of American Anatomists the results of his analysis of 37 brains from Black people and 17 from white people. Further study brought that number to 103 brains of Black people and 49 of white people. His article in the American Journal of Anatomy has more charts, tables, and figures than an entire issue of the American Journal of Psychiatry does today. After making his measurements, examining the brain from different angles, looking into sulci, weighing brains, and looking at gender effects, Bean concluded the following:

• Black brains are smaller than white brains, especially in the frontal lobes.

• The less white blood that has mixed in with Black blood, the more accurate can one be in distinguishing between white and Black brains.

• The anterior half of the corpus callosum is smaller in Black brains than white brains.

• From these structural differences, he deduced the following:

  • Black people are more objective; white people more subjective.

  • Black people have lower mental faculties well developed (for example, smell, sight, handcraftsmanship, body-sense, and melody).

  • White people have higher mental facilities well developed (for example, self-control, willpower, ethical and aesthetic senses, and reason).

Bean had largely succeeded in his intent to show there were differences between the brains of the two races. He had a problem, however. He did not find a difference in the weight of Blacks’ and whites’ brains. According to Bean’s preconceived notions, the brains of Black people should have weighed less. In an ingenious display of pseudoscientific hocus-pocus, Bean said that the reason there was no weight difference was because he was comparing the brains of a disproportionate number of high-class Blacks and low-class whites. He presented five reasons that it turned out this way, each more racist than the next and all focused in one way or another on his belief that Blacks have “less respect for the dead.” One example: “It is generally known that the lowest class of whites is unclaimed, especially among women, who are apt to be prostitutes, or depraved, or the like, while among Negroes it is known that even the better class neglect their dead unless provision has been made for their care after death.” Bean agreed with a predecessor that the white brain was a “greyhound” while the Black brain was a “bulldog.”

Bean’s mentor, Franklin P. Mall, displeased and distrusting of Bean’s results, conducted his own study in 1909, even using some of the same brains as had Bean. Mall’s results did not support Bean’s measurements. Mall challenged each man of medicine who had posited racial differences between the brains of the two races, dissecting their methods and outcomes with the precision of a pathologist with his dissecting tools. Mall concluded that all earlier work on the brains needed to be dismissed, and new data, scientifically studied, were needed.

Bean was not about to be deprived of his racist views on brain differences. In 1914 he published another article, carrying on as though Mall had never studied anything. He found the temporal lobe was smaller in Blacks’ brains. But of course he did!

Once the white-Black brain differences were “proven,” it became a “fact,” written as if in indelible ink. In a 1934 article in Science from the Johns Hopkins School of Hygiene and Public Health, the authors reminded the reader, “It is an accepted view that the skull capacity and the brain weight of the Negro, whether pure or mixed with white races, tends on the average to be smaller than the same dimensions in whites.” They then wrote, “The amount of precise data upon which this opinion rests is, however, meager.” This is a racist introduction to the authors’ review and amounted to quack science. As men of science, they could have instead written, “There are meager data in support of the belief that the Black brain is smaller than the white brain.”

In 1957, when reliable measurements were possible, a comparison of white and Black brains using an electroencephalogram showed no significant differences. Nonetheless, the question of the white-Black brain comparisons didn’t disappear. In 1969 a South African in the Department of Medicine at the University of Cape Town proclaimed that all the so-called evidence that had gone before—about 150 years’ worth—was based on insubstantial evidence. In 2010 an article on variability in frontotemporal brain structure began, “The question about potential differences in brain anatomy across populations of differing race and ethnicity remains a controversial issue.” These researchers found that the only difference between white and Black brains was that the left orbitofrontal cortex was larger in Blacks. And in 2020, an unreplicated brain study showed that Black people experience more pain than white people to the same stimuli in a lab.

In the 21st century we have fine-tuned our understanding of brain development. Brain development is sensitive to many factors including socioeconomic factors. If there are reliable and valid differences between white and Black brain structure and size, what we are observing may well be the differential effects of white and Black socioeconomic environments and not a difference due to skin color. We should stop looking at whose brain is bigger and start looking at how we can get everyone’s brain directing us to work together. Maybe then “We shall overcome.” ■