APA Board Issues Apology for History of Racism
Abstract
The apology and historical addendum acknowledge that early psychiatric practices laid the groundwork for the inequities in clinical treatment that have historically limited access to quality psychiatric care for Blacks and other people of color.
Above are iron markers displaced in the 1960s from the graves of psychiatric patients at Milledgeville State Hospital in Georgia, now Central State Hospital. The markers are part of a memorial to the patients. The hospital started admitting Black patients in 1867 under a segregation policy with far different standards of care for patients based on race. For example, White patients were given light work and luxury goods, while Black patients endured discrimination and neglect, leading to poor health and death.
The APA Board of Trustees issued an apology last month for a history of racism in APA and psychiatry and for “enabling discriminatory and prejudicial actions within APA and racist practices in psychiatric treatment of Black, Indigenous, and People of Color (BIPOC).”
The statement of apology—issued on Martin Luther King Jr. Day and addressed to members, patients, their families, and the public—was accompanied by a document outlining specific practices and policies (including failures to speak out and protest racist practices) that have damaged Black and indigenous people and their families dating back to APA’s founding.
“The Board is issuing this document on Martin Luther King Jr. Day because we hope that it honors his life’s work of reconciliation and equality,” said APA President Jeffrey Geller, M.D., M.P.H., in a statement released that day. “We do not take that legacy or his call to action lightly.”
He added, “Many will argue this apology should have come sooner. That said, the events of 2020—the killings of Black people by police, the health inequities laid bare by the pandemic—were an eye-opener for many among our membership and a clarion call that it was past time to take action.
“We have made an investment this year in several ongoing strategies to ensure the APA moves toward greater accountability on race,” Geller said. “Ultimately it will fall to the leadership and member leaders to hold us accountable, but this year has changed everyone.”
In the statement, APA’s trustees acknowledged that early psychiatric practices laid the groundwork for the inequities in clinical treatment that have historically limited access to quality psychiatric care for Blacks and other people of color.
“The events of 2020 were an eye-opener for many among our membership and a clarion call that it was past time to take action.” —Jeffrey Geller, M.D., M.P.H
“These actions sadly connect with larger social issues, such as race-based discrimination and racial injustice, that have furthered poverty along with other adverse outcomes,” according to the statement. “Since APA’s inception, practitioners have at times subjected persons of African descent and Indigenous people who suffered from mental illness to abusive treatment, experimentation, victimization in the name of ‘scientific evidence,’ along with racialized theories that attempted to confirm their deficit status. Similar race-based discrepancies in care also exist in medical practice today as evidenced by the variations in schizophrenia diagnoses between white and BIPOC patients, for instance.”
The statement continues, “Unfortunately, APA has historically remained silent on these issues. As the leading American organization in psychiatric care, APA recognizes that this inaction has contributed to perpetuation of structural racism that has adversely impacted not just its own BIPOC members, but also psychiatric patients across America. … We hope this apology will be a turning point as we strive to make the future of psychiatry more equitable for all.”
APA Past President Altha Stewart, M.D., a member of the Board and the first Black psychiatrist to be president of the Association, said the apology is a first step, but an important one. “The pandemic and the economic downturn have really highlighted disparities affecting people of color and indigenous people, and it is time for an acknowledgement of the role APA has played in building and sustaining structural racism that has created those disparities,” Stewart said.
“From the beginning of our country with its uniquely violent form of chattel slavery, the founders of APA began segregating treatment of mental illness according to race,” she said. “Mental health is critical to everything people strive to do—holding a job, building a career, raising a family and children, contributing to the community—and from the start of this nation, psychiatry has had a role in limiting the ability of people of color to achieve those things. In some cases, there is documented evidence of APA and psychiatry positively working against those goals.
“More often, APA has not spoken out and seized on the opportunity to raise its voice when a different policy choice could have been made that would have benefited Black people,” Stewart said. “The apology is a way to begin repairing that longstanding national wound.”
The apology is part of an initiative begun by Geller soon after he became president last April to address structural racism in psychiatry and eradicate it. Leading this effort is the 11-member APA Presidential Task Force to Address Structural Racism Throughout Psychiatry, chaired by Area 4 Trustee Cheryl Wills, M.D.
The task force has been charged with providing education and resources on the historical roots of structural racism within APA and the profession of psychiatry and how that history continues to affect patients and their families and contribute to inequities in mental health care for Black people and people of color generally. The task force was further charged with developing achievable recommendations for change to eliminate structural racism in APA and psychiatry and to provide reports with specific recommendations to the APA Board of Trustees at each of its meetings through May. This work will continue beyond Geller’s one-year presidency.
“This is an important milestone in APA’s progression toward fulfilling its strategic initiative of diversity and inclusion,” Wills told Psychiatric News. “Now that APA has formally acknowledged its history, there is more work to be done, and the task force, in collaboration with the Board, will continue to take an objective look at how race impacts psychiatric care and will make recommendations when they are deemed necessary.”
A fourth town hall led by the task force was held Monday, February 8, titled “Structural Racism and Psychiatric Residency Training: Recruitment, Retention, and Development.” A report on the town hall will appear in the next issue of Psychiatric News.
Wills urges members with questions or concerns to communicate with the task force by writing to [email protected] or visiting the task force microsite on the APA website.
The annotated document that accompanied the public apology is a more detailed description of events in APA’s history that have contributed to pervasive structural racism today.
“[W]hen the 13 founders of what is now APA met to discuss improvements in mental health care delivery, the treatment system they created and the organization they founded aligned with that era’s racist social/political policies,” the document states. “In this system, Black patients received psychiatric care separately from white patients. ... Additionally, prevailing Black stereotypes in psychiatry included fallacies that patients were hostile, unmotivated for treatment, had primitive character structure (i.e., not psychologically minded), and were child-like. These misconceptions were perpetuated by a now-debunked diagnosis, Drapetomania, centered around the idea that Black Americans who did not want to be slaves were mentally ill. During that time, APA chose to remain silent on these issues.”
APA CEO and Medical Director Saul Levin, M.D., M.P.A., said the APA apology and accompanying historical context document were developed after lengthy discussion and deliberation. “The Board of Trustees of APA has taken an important first step in acknowledging the impact of structural racism on mental health inequities,” he said. “The APA administration is committed to working with our members to increase diversity and inclusion and being anti-racist in our approach to advance quality mental health care for all.” ■
