_________________________________________________________________ VOLUME 6, ISSUE 1 PSYCHNEWS INTERNATIONAL May 2001 _________________________________________________________________ SECTION F: ARTICLE WHY DO AMERICAN MINORITIES -- ESPECIALLY BLACKS -- DISTRUST AMERICAN PSYCHIATRISTS? (1,2) Maxie C. Maultsby, Jr., M. D. One reason American minorities distrust psychiatry is the same reason that most Americans distrust psychiatry: To varying degrees, most Americans still believe in pre-World War II ideas about sane or normal people versus insane or crazy people. At that time, the average American believed there were only two groups of people: There were sane or normal people and there were insane or crazy people. The sane or normal people were the ones like you and me, seen walking around in everyday life. The insane or crazy people were the ones psychiatrists locked up in stone fortresses, usually located in the country and commonly referred to as "nut houses", the "crazy houses" or the state hospitals. Prior to World War II, the concepts of community mental health, community mental health clinics, and outpatient psychiatry were largely unknown in America. Understandably, most Americans then also believed that normal people were supposed to solve their own emotional problems by themselves. If they could not, or did not, they went crazy and a psychiatrist would lock them up in the "nut house". Here's another reason why most Americans distrust psychiatrists: To some degree, most Americans believe that psychiatrists can and do read people's minds. In addition, most people, at one time or another, have unusual, if not weird ideas they are ashamed to let others know about. Understandably, most people feel nervous when they think about talking to a psychiatrist. They are afraid the psychiatrist will read their minds, discover their weird ideas, decide they are crazy, and that they need to be locked up in the "nut house". Despite those similarities, American minorities still distrust psychiatry much more than non-minority Americans distrust psychiatry. That distrust has produced, in my opinion, two undesirable psychiatric situations: (a) American minorities in general (and Black people in particular) are less likely than non-minorities to accept psychiatric treatment, even when psychiatric treatment is prepaid and readily available; and (b) American minorities in general (and Black people in particular) are less likely to comply with their prescribed psychiatric treatments. They are more likely to stop their treatments before completing them. Therefore, even with the same treatment for the same psychiatric disorders, American minorities usually benefit less than non-minorities benefit. Those facts lead concerned psychiatrists to wonder: Why is it that minorities have such a self-defeating distrust for American Psychiatry? Here are what I consider two main reasons most psychiatrists know, but consistently ignore. First, when American minorities seek psychiatric help, they are much more likely than non-minorities to be incorrectly diagnosed, as having a more serious psychiatric disorder than they really have. Second, American minorities are much more likely than non-minorities to be hospitalized and or treated with potentially dangerous, mind-altering drugs. Patients' rights to the least restrictive and least invasive psychiatric treatments make it important for psychiatrists to answer this question: Why do American minorities receive such undesirable psychiatric care? Probably the main reason is ignorance on the part of most American psychiatrists. Usually, American psychiatrists have not been trained to recognize the unique, culturally-conditioned, normal behaviors of various minority groups, behaviors which lead uninformed psychiatrists to misdiagnose them as more psychiatrically disturbed than they really are. Fortunately, though, most psychiatric training programs now include seminars on cross-cultural psychiatry. The new emphasis on cultural correlates of behavior, plus more complete assimilation of the well known, basic assumptions of American Psychiatry about mental health, should help to solve the problems related to distrust of American Psychiatry for all minorities, except American Black people. The origin of the distrust that American Black people have for American Psychiatry is different from, and is more ominously momentous than, the case for other minorities. Consequently, the solution to the problem of distrust of American Psychiatry that Black people have is more complex than is the case for other American minorities. For example, the worst thing Black people could do to themselves is to more completely assimilate the well-known basic assumptions that have historically directed American Psychiatry's approach to the mental health of Black people. That first assumption was and still is that Black people are inferior to White people. The second assumption is that psychopathologic behavior for Black people is often the opposite of psychopathologic behavior for White people. Most modern American mental health professionals don't know that fact. In addition, that idea is anathema to modern, scientifically-minded American mental health professionals; therefore, they initially resist believing it. In a moment, therefore, I shall describe the historical facts which show that those two basic assumptions are the "guiding lights" for American Psychiatry's approach to Black people. These historical facts will also show why American Psychiatrists made those odious assumptions in the first place. However, first I will point out four important facts about American Psychiatry that most people, including psychiatrists, either don't know or simply want to ignore. First, the relationship that American Psychiatry has with American society is different from the relationship that the other medical specialties have with society. Physicians in other medical specialties discover and describe the facts about health and illness, then they teach those facts to society. In addition, those physicians teach society which beliefs and laws are most appropriate for protecting and enhancing the health of both sick people and society as a whole. In American Psychiatry, however, that historical relationship between physicians (that is, psychiatrists) and American society has always been somewhat reversed. The most obvious example of this fact is the diagnosis of insanity. The recognition and treatment of this condition is the backbone of psychiatry. Yet, psychiatrists have never been allowed to make that diagnosis. Instead, insanity has always been a legal declaration by a judge, whose knowledge of psychiatric illness is almost never any greater than that of the person being declared insane. Second, harmless human behaviors are sometimes legally labeled as "psychiatric diseases" solely because those behaviors conflict with laws passed by ignorant legislators, rather than because those behaviors conflict with Mother Nature's laws of human health. Numerous examples of that fact now exist as a result of the prohibitive laws relating to harmless sexual behaviors between sane, consenting adults in the privacy of their homes. This brings me to the third, usually ignored, but important fact about American Psychiatry. Unlike the other medical specialties, until the 1950s American Psychiatry had always been at least as much of a subjective social philosophy as it was a medical science. Consequently, American Psychiatry has not officially disavowed the plethora of 19th and 20th Century racist propaganda about American Blacks that remains today in the American, psychiatric, peer-review literature. The two most pernicious of those American myths were the two basic assumptions in American Psychiatry about Black people just mentioned above, neither of which American Psychiatry has officially disavowed. Predictably, therefore, American psychiatric research and treatment practices have always reflected America's current legally-supported, (and often medically-repudiated), wide-spread social prejudices and racial bigotries. Now let's consider the fourth and most important, but usually unknown or ignored fact about American Psychiatry. Until the civil rights era of the 1950's, there had been a de facto, anti-Black mental health conspiracy between the American medical (and therefore the American psychiatric) profession and the American government. That conspiracy tried to prove scientifically that Black people were inferior to White people; and in addition, when compared to White people, the personality structure of Black people was said to be irrevocably and pathologically flawed. At first, the reality of that conspiracy may be hard for you to believe. If so, your disbelief could prevent you from fully understanding the solutions to the self-defeating distrust Black people have for American Psychiatry. To avoid that fate, pay particular attention to the definition of de facto conspiracy that I am using in this paper. Second, without excuse or explanation, let the facts of Black American history speak for themselves. A de facto conspiracy has these two unique features: First, there are two or more subgroups sharing the same negative beliefs and behavioral tendencies toward another group, called the victim group. Second, without any formal cooperative agreement, the independent actions of the former two or more groups consistently reinforce, excuse, and otherwise rationalize their shared, but objectively-incorrect negative beliefs and therefore, inappropriate, unconstitutional behaviors toward the victim group. In this article, the victim group is the American Black people. The conspiring groups are the American medical (and therefore psychiatric) professions and the American government. A BRIEF LOOK AT AMERICAN BLACK HISTORY American Black people never wanted to come to America in the first place. To prove that fact they frequently committed suicide and infanticide, both on the slave ships and as soon as possible after arriving in America. To justify enslaving such unwilling victims, the "Christian" slave owners first had to convince themselves that Black slaves were an inferior race of people, descendants of Ham, and cursed to forever be the servants of servants, which, when translated into early American English, meant to forever be American slaves. To ensure that the clause "All men are created equal" would not apply to Black Americans, the writers of the American Constitution estimated the humanity of a slave to be only three-fifths that of a White person. With that respected governmental sanction, it was easy for slave owners to believe that owning Black slaves was their Christian duty to help those mere three-fifths human beings qualify for "Divine Salvation" after having been worked to death as slaves. Accordingly, many of the American colonies passed laws that permitted only slaves who had been converted to Christianity to be brought into the colony. The industrial revolution in the northern American states quickly began to make slavery unprofitable there. That fact freed northern Christian ministers to rethink and question the popular belief that American slavery was really what God had in mind for Ham's descendants. As a result, the abolitionist movement became progressively stronger. To protect and justify their investment in slavery with a clear "Christian" conscience, the slave owners switched from their then, unreliable, doubting ministers for support of slavery to physicians. Now let's consider how that switch to physicians seemed to slave owners to be a smart move. As is the case now, physicians in America were better and more widely accepted as experts on human nature than were ministers. Also, physicians were believed to have had a more scientific basis for their claims about Black people than ministers had. Yet, like ministers, physicians have always been and still are among the strongest believers in and supporters of the current social and racial prejudices and bigotries of their societies. In addition, psychological research clearly shows that higher education and training as health professionals does not free those professionals of their life-long, culturally-conditioned racial and other prejudices. Predictably, therefore, long before slave owners turned to American physicians for scientific support for their justification for slavery, nationally-respected White American physicians were already publishing in the American medical journals pseudoscientific reports that seemed to prove the biological inferiority of Black people. One such early-American medical science fiction writer was Dr. Samuel Morton, Professor of Anatomy, at the nationally-prestigious Pennsylvania Medical College. In the 1840's, Morton published that "the brains of people become progressively smaller as one descends from the Caucasian to the Ethiopian". Morton based his false claim on his own, highly-variable method of measuring the volumes of human skulls using buckshot. He wrote that "as one descends from the Caucasian to the Ethiopian". That clause reveals that Morton believed in the then popular myth of racial Darwinism. That myth claimed that within the human race the same evolutionary process had occurred that seemed to have occurred throughout the animal kingdom. A mythical racial evolution was supposed to have resulted in Caucasians achieving the highest level of human development. The other races were supposed to have reached their highest level of evolutionary progress at lower levels on the human evolutionary ladder. Black people and Native American Indians were supposed to have stopped developing at the very bottom of the human evolutionary ladder. That pseudoscientific belief was published in peer-reviewed, American medical journals. It was, therefore, accepted by the most influential members of the American medical community. Unfortunately, as is still the case, even pseudoscientific myths that get published in peer-reviewed medical journals immediately acquire the same authoritative influence on the minds of naive, unsuspecting scientists that objective facts should have. Those pseudoscientific myths can pollute the minds of unsuspecting scientists for decades. Next, I present three examples of that fact in American, peer-reviewed, health literature. Over fifty years later, Dr. G. Stanley Hall, the first president of the American Psychological Association and founder of the prestigious American Journal of Psychology, published in that peer-reviewed journal this pseudoscientific myth: He claimed to have objective data indicating that Black people and Indians are members of adolescent races and in a permanent state of arrested human development. Samuel Morton's pseudoscientific reports about the size of human brains and its implications were still polluting the minds of unsuspecting anatomists more than 50 years later. For example, in 1906, Dr. R. Bean, Professor of Anatomy at the prestigious Johns Hopkins University, wrote these pseudoscientific claims in the peer-reviewed, American Journal of Anatomy: "The Negro's brain is smaller than and has fewer nerve cells and fibers than the brains of White people. Therefore," Bean concluded, "Negroes lack judgment and are incapable of devising hypotheses. So, it is useless to try to elevate the Negro by education". Unfortunately, Bean was not alone in believing such racist nonsense. To the contrary, in the first half of the twentieth century pseudoscientific reports about Black people were common in peer-reviewed American medical literature. Those false reports remain in prestigious American medical journals to confuse and mislead unsuspecting future American and foreign human behavioral scientists. Fortunately, anatomy is such an objective medical science it cannot be used for long to support racial myths. For example, in the same Journal of Anatomy, Bean's own chairman of his anatomy department refuted Bean's pseudoscientific claims. But, as is usually the case, it took three years for that refutation to get published. Scientific refutations can never prevent all of the future harm that the original, peer-reviewed, pseudoscientific nonsense causes. Also, in America, a sensational, negative, but scientifically worthless report gets much more widely published in both the professional and lay news media than its later refutation does. More important, the refutation does not remove the false report from among the earlier, equally-trusted scientific literature. Depending on which issue of the same journal scientists read, they can be grossly misled by original, false, and later refuted reports that have both been published in the same peer review journal. This is the important fact I want to emphasize here: Rather than accept objective evidence against the myth of Black inferiority, and give up that absurd idea, what did the American medical professions do? They recommitted themselves to finding genuine scientific support for that myth. How? By simply switching from physicians who were anatomists to physicians who were and are psychiatrists. To see how that was a brilliant move, remember this fact: As it largely still is, until the 1950s, American Psychiatry had always been more of a subjective social philosophy than an objective natural science. Consequently, as is still the case, it accepted, as objective facts, the popular myths that American society held about Black people. For example, in the mid-nineteenth century, Dr. Sam Cartwright, a widely acclaimed White Louisiana psychiatrist, wrote in American medical journals the following diagnostic information about the mental health of Black people. According to Cartwright, there were three groups of Black people. The first group, a majority, was theoretically composed of psychiatrically-healthy slaves. Their three main distinguishing characteristics were: (a) They were faithful to their masters; (b) they were hardworking; and (c) they were happy-go-lucky. Second, there was the smaller group of psychiatrically-ill Black slaves who allegedly had Dysesthesia Aethiopica. In Cartwright's words, this unique slave insanity was "a hebetude of the mind and insensibility of the nerves, which caused Black slaves to try to avoid work, to try to maim and kill their master's work animals, to destroy their master's plows and other valuable property and just generally be irritants for their overseers and owners". The third group, a small group, was allegedly composed of psychiatrically-ill slaves who allegedly had Drapetomania, or flight-from-home madness. The sole diagnostic feature of this unique, Black psychiatric illness was trying to or actually succeeding in running away from slavery. To my knowledge, those three groups of diagnostic criteria are the only ones ever published in the American medical literature that dealt specifically with the mental health of Black people. However, the most important fact to remember about those criteria for diagnosing psychopathology in Black people is this: Those criteria are the opposite of diagnostic criteria for diagnosing psychopathology in White people. Can you imagine White people being diagnosed as psychiatrically ill merely because they ran away from slavery, or because they resisted being slaves? Of course not! To my knowledge, there has never been another race of people that physicians have been willing to label psychiatrically ill solely because they ran away from or otherwise resisted being slaves. That incredible historical fact of American Psychiatry makes perfect sense, in light of the de facto conspiracy I mentioned earlier and restate here to refresh your memory. Starting with the American Constitution, a de facto conspiracy began between the American government and American physicians to make American Black people appear both biologically inferior and psychologically defective when compared to White people. Probably the single most obvious example of that conspiracy in action was the 1840 U.S. Federal Census. The U.S. Census of 1840 was the first one in which insane and mentally defective people were counted. To get the full significance of that event, keep in mind that official government statistics normally have the same authoritative influence that scientific facts have on the minds of both scientists and lay people. Also, remember that in 1840 the U.S. Census program was administered by the Office of the Secretary of State. The Secretary of State in 1840 was the slave-owning, former South Carolina Senator, John C. Calhoun. In the common political practice of that time, many if not most of the census takers were temporary, southern White political appointees. Even so, hardly anyone was prepared for the next shocking surprise. The 1840 Census reported that the combined insanity and idiocy rates for free Black Americans in the northern free states was 10 times higher than that of slaves in the southern states. The precisely stated ratio for the free Blacks was one out of every 162.4 free Blacks in northern free states was either an idiot or insane. However, out of every 1,558 Southern Black slaves only one was either an idiot or insane. Maine, then the most racially liberal of the Northern States, seemed to be particularly hazardous for the mental health of Black people. Census takers reported that one in every 14 free Black people in Maine was either an idiot or a lunatic. However, the census takers found only one idiot or lunatic in every 4,310 Louisiana Black slaves. There was only one problem with those sensational 1840 US Census data: Almost all of the data related to Black people was false. The census takers often obtained their data by arbitrarily changing the racial designation of White insane and mentally defective people to Black. That fact is usually as hard for today's well-trained American health professionals to believe as it first was for Dr. Edward Jarvis to believe. However, his disbelief quickly disappeared when he read the Census report that 133 Black patients were in the then all-White, Worcester, Massachusetts Insane Asylum. Jarvis was a White Massachusetts physician and statistician. He knew that all of the patients in the Worcester, Massachusetts Insane Asylum were White people. He also knew that Black people were not generally admitted to American hospitals at that time. Yet the 1840 census reported only Black patients in that all-White insane asylum. The 133 White patients seemed to have just disappeared, or never to have existed. With a quick personal trip to the Worcester Insane Asylum, Jarvis reconfirmed the obvious: The census figures were false. He personally checked the reported Black idiocy, insanity and mentally defective census data for the states of Maine and New Hampshire. There he found more instances where insane, blind, deaf and dumb, and idiotic Black people were reported in towns that did not have a single Black resident. The facts indicated that in many instances the census takers fabricated their Black census data. Much more commonly, the census takers arbitrarily changed the racial labels of White insane, blind, deaf and dumb and idiotic people to Black. Later, Dr. Jarvis made a systematic study of the insanity figures in the other northern states. He found that changing the racial designation of White insane or mentally defective people to Black was a common practice in the 1840 Census program. In an 1844 issue of the American Journal of Medical Science, Jarvis published a detailed account of the 1840 U.S. Census fraud. Jarvis was not the only physician to discover the 1840 census fraud. Among the many others was Dr. James McCure Smithe, the first American Black physician. Smithe even described his proof of the 1840 Census fraud in his famous Memorial of 1844 to the United States Senate. By 1844, the nationally-embarrassing evidence of the 1840 U.S. Census fraud was so obvious that John Quincy Adams, the former President of the Unites States and then U. S. Representative from Massachusetts, chaired a congressional investigation of the 1840 Census. During those congressional hearings, Secretary of State John C. Calhoun, admitted there were errors in the 1840 Census. However, Secretary Calhoun explained, the errors were so numerous that they balanced themselves out. Therefore, Calhoun maintained, the reported rates of mental defectiveness and insanity of free Black people in northern states would have been the same, even if no errors had been made. Ultimately, Secretary of State Calhoun gave in to congressional pressure and appointed William A. Weaver to investigate the claim of 1840 Census fraud. Except for one small detail, that appointment might have solved the problem. That small detail was that Weaver had been the personal supervisor of the whole 1840 Census program. So, in effect, Weaver had been asked to investigate himself. I don't have to tell you how unlikely it was for that investigation to reveal any fraud, and it didn't. After Mr. Weaver's careful investigation, he reported that no errors at all had been made in the 1840 Census. So, despite much widely-published objective proof of obvious census fraud, the fraudulent figures remained as the official 1840 U. S. Census. Now let's see how those false, but official governmental data polluted the minds of unsuspecting future scientists. Here is a direct quote from an article that appeared in the American Journal of Insanity, 11 years after the fraudulent 1840 census data were published. "Who would believe it without the facts in black and white before him, that every fourteenth colored person in the state of Maine is either an idiot, or a lunatic?" You are probably as aware as I am of the old joke that says government statistics are either lies or damn lies. As I shall now show you, once those damn lies are officially declared to be facts, they are no longer jokes: They are automatically reacted to as if they were objective facts. For example, Mr. Calhoun used those fraudulent 1840 census figures when he tried and failed to persuade the British to return escaped American slaves to what Mr. Calhoun claimed had been proven to be the more emotionally-healthy climate of slavery. Mr. Calhoun was able to stop "the westward spread of Black insanity" by successfully using the fraudulent 1840 census figures to help justify admitting Texas into the Union as a slave territory and later as a slave state. If you recall the de facto conspiracy between the American government and American Psychiatry, you will understand this current academic deception: When you look under Negro or Black in the index of almost any psycho-social textbook, it almost always gives you these directions: "See AIDS, see alcoholism, see street crimes, see gang wars, see Black on Black murders, see drugs, see juvenile delinquency, see teenage pregnancy, see sexually-transmitted diseases, see illegitimacy, see welfare, see probation and parole, see prisons, see rape, see female single-parent families, see unwed mothers, see suicide" and on and on. You will almost never see anything that gives you even a hint that such a thing as a mentally healthy, successful Black person exists in America. In fact, even today, some of the most influential American psychiatrists loudly proclaim that emotionally-healthy and successful Black people either don't exist, or, they are so rare that it's a waste of time to try to find and study them. Two such psychiatrists are Drs. Abram Kardiner and Lionel Ovesey. In the training programs for American mental health professionals throughout the USA, their book, entitled "The Mark of Oppression", even today is often standard and required reading about the mental health of Black people. However, the many scientific-minded, American psychiatrists I have interviewed about that book say that it is probably the most pernicious example of widely-believed pseudoscientific trash about Black people since the nonsense that Dr. Samuel Cartwright published in the mid-nineteenth century. In their book, Drs. Kardiner and Ovesey state that the personalities of Black people are caricatures of the personalities of White people, that Black people have every reason to hate themselves and that they have no basis for healthy self-esteem. These psychiatrists admitted that they could not tell from their studies what comprises the psycho-social adaptation of the successful Negro. That's because, they stated, a composite picture of successful, psycho-social Negro adaptation is unimportant because psycho-socially healthy Negroes are exceptions and not the rule. As a well-trained American psychiatrist, I can confidently predict this factual future for American Psychiatry. As long as academic American psychiatrists, almost all of whom are White, maintain their historical mindset about Black people, they will continue to train unsuspecting, White and Black psychiatrists to incorrectly diagnose Black people as more psychiatrically disturbed than they really are. Therefore, Black patients will continue to be treated much more than similar White patients with incarceration on psychiatric wards. Black patients will also continue to be unnecessarily treated with more potentially dangerous mind-altering drugs. Because peer-review articles and books the like of "The Mark of Oppression" are both intellectually and medically dangerous, I shall now describe four universally-accepted, scientific reasons why Drs. Kardiner's and Ovesey's book would never have been published if it had been written about any other group of people than American Black people. The first reason is insufficient sample size of the group studied. Remember, this book is heralded as a valuable scientific, comparative study of the personality structure of American Black people, compared to the personality structure of middle-class White people. That means the statements these doctors made about Black people are supposed to have applied to almost all of the more than 20 million of us who were living in 1951. In addition, this book's status as a standard reference on Black people's mental health implies that that pseudoscientific nonsense is accepted today by most mental health training programs as an accurate picture of American Black mental health. Let's begin by looking at the group of Black people Drs. Kardiner and Ovesey believed they needed to study. Of the more than 20 million Black people living in 1951, how many thousands, or even hundreds of Black Americans did those self-styled human behavioral scientists study as the basis for making their claims about the then more than 20 million Black Americans? Also, from how many different states of the United States do you think these psychiatrists obtained their Black subjects? Would you believe these doctors only interviewed 25 Black people? Can you stretch the limits of your intelligence to believe, or even imagine, that all of those 25 Black people lived in Harlem, New York? That's right, Harlem, New York, a place where over 75% of Black Americans most probably had never even visited, much less had the miserable disadvantage of living there. However, 25 Black Americans were those psychiatrists' sample Black population. What does that fact loudly and clearly say to sane, intelligent, American Black high school graduates, as well as to drop outs from the generally, legally-imposed, White-dominated educational systems with its de facto conspiracy between White administrators and their White and "Oreo" teachers? Does this give Black American students as inferior an education as possible, despite legal and only pseudo-classroom integrated teaching? It tells Black students that White psychiatrists, who are legally and medically expected to know better, believe the following old, and still nationally popular, idiotic idea about Black people: "If you have talked to one or two, who are on welfare, you know all there is to know about those primitive-minded, ignorant people and why it's foolish to expect them to achieve a White person's standard of living regardless of legally-enforced attempts to educate them in White/Black, integrated schools". Having been raised by one of the millions of successful, educated, American Black families Drs. Kardiner and Ovesey ignorantly believed were too rare to include in their study, the following was easy for me to understand: Those White psychiatrists received the usual unchallenged, lifelong White American family and secondary group cultural conditioning to make Black racism as natural as expecting Christmas presents under their Christmas trees. With that pre-adult firm grounding in Black racism, plus their college and professional training in America's finest racist teaching universities, I would not have believed it. So, my only surprise about Drs. Kardiner and Ovesey's sample size was that they bothered to study as many as 25 poor, ignorant American Blacks. My explanation about that is this: Their scientific naivete (plus that of their peer reviewers) and their pernicious ignorance of American Black people was great. They sincerely believed that studying only 25 of 20 plus million Black American people reveals all that is worth knowing about all of them. Now, I ask you to honestly consider the following scenario. With the exception of a sick book of Black racist jokes, can you imagine a reputable American White publisher, assumed to be non-racist, (such as the original New York, W. W. Norton publisher claims to be) would publish and distribute such a book as this one? I can't. No reputable publisher that wants to protect itself from being legitimately classified as doing the infamous American-type publishing done in the 1880s called "Yellow Dog Publishing" would have published Drs. Kardiner and Ovesey's book, "The Mark Of Oppression, A psychosocial study of the American Negro." Early in their book, Drs. Kardiner and Ovesey asked themselves this question: "How do we know that our sample of 25 Black people is a correct and good representation of American Blacks?" Then they honestly admitted that they didn't know whether their small sample was a correct and good representation of Black people. However, they defended their sample size with the following logic: They said, "Our control is the American White man. Both White and Black people live under similar cultural conditions, with the exception of a few easily identifiable variables, which exist only for Black people. It was logical therefore, to expect to find in Black people a White middle class, White people's type of American personality". Now let's look objectively at what that expectation says and at what it does not say: It does NOT say that White people who are not members of the White middle class have something wrong with their personality. That expectation does say that if Black people fail to qualify for membership in the White American middle class, that proves something is innately wrong with them that cannot yet be corrected. Most Black high school science students, even with their often inferior, integrated education, can see the absurdity of such reasoning. Such pseudo-logic alone should have disqualified this book for publication and could easily be added to the second reason, described above, or to the third reason, that now follows below. That third reason is this: To have a valid comparative study of two subgroups of the same group of people, you must specify exactly all the known relevant factors that are objectively the same for the two subgroups that make it logical to study the two groups. To accurately study different groups of people or any non-human things, you must specify some characteristics that are known to be present in both groups. As most junior high school students know, you cannot logically equate oranges with watermelons just because they grow on the same farm. In my opinion, the following facts made it less logical for Drs. Kardiner and Ovesey to have tried to compare their 25 Black subjects to the typical, successful White middle class family, just because they live in the same American country. I assume that you have a valid mental picture of the typical successful White middle class family. So, as you read on, I ask you to honestly ask yourself if their Black sample was a valid basis for seriously making "The psychosocial study of the American Negro" that the cover of "The Mark of Oppression" proclaims it to be. DRS. KARDINER AND OVESEY'S STUDY SAMPLE These psychiatrists interviewed 25 Black people. In their words they were "of different, sex, age, and status, sufficiently varied to cover as many aspects of Negro adaptation as possible. All subjects were seen once, twice or three times a week for a minimum of twenty to a maximum of more than a hundred visits. The average subject was observed during a period of four to six months, except for one who was seen only ten times in six seeks. Fourteen (56% of the subjects) were unpaid, but were psychiatric patients of Dr. Ovesey's throughout the study. Eleven subjects were paid $1.50 per interview immediately at the end of the interview and each received a $20.00 bonus at the end of the twentieth session. There were 10 male adults, ages 26 -35 and two 15-year-old males. There were 2 female teenagers, 16 and 18-years-old, and 12 adult females, ages 21 to 35-years-old. There were four college graduates, two teachers and two un-described government clerks. The remaining adults were either domestic servants, unskilled laborers or unemployed, living either in the streets or with relatives, receiving public assistance, if eligible". Now let's look at how these doctors justified comparing 56% of known neurotically-ill Black patients in a sample of 25 American Blacks and (a) claiming that they are a typical cross section of the other twenty-plus millions American Blacks; and (b) then comparing those 25 Blacks to the typical, ideally-healthy, middle-class White person and his or her personality structure. In my opinion the logic and knowledge of basic human nature that produced that research design is a joke at best and at worse, an obscene insult to the intelligence of genuine human behavioral scientists. Drs. Kardiner's and Ovesey's mindset below was so childish that if I was not quoting them, I would not have the courage to put it in print. They said: "For the purposes of this study, neurotics are people. Except for localized disorders like anxiety and impotence, the personality of neurotics functions normally. But," they emphasized, "since that is not true of insane people, we did not include any psychotic people in our study". The failure to compare psychotic Blacks to normal middle-class White people is about as surprising as refusing to include women in any comparative study of men. So don't let that mealy-mouthed disclosure distract you from this fact: Those White psychiatrists were trying to get their readers to believe this blatant bit of pseudo-scientific nonsense, namely, that whether or not Black people are neurotic, if they are not psychotic, it's logical to expect them to be, and if they do not measure up to Drs. Kardiner and Ovesey's ideas of the then healthy White, middle-class American, then those Black people, and all American Black people, have pathologically-flawed personality structures. Here's the fourth reason. The Mark of Oppression should never have been published: These psychiatrists said that their standard social unit of comparison for their Black subjects was the intact, stable, monogamous White family, with the father as the titular head and income producer. Yet, these doctors did not describe any personal efforts to interview comparable Black families or any intact Black families at all. Nor did they describe any contacts with any Black churches or Black schools or Black social organizations. Understandably, therefore, only half of their Black subjects were living in intact families. None of those subjects even came close to measuring up, financially or otherwise, to the authors' ideal White middle-class family. As Drs. Kardiner and Ovesey presented their findings, they can and often do easily lead unsuspecting readers, especially unsuspecting White readers, to conclude that there are no Black families who measure up to the White American standards for healthy stable families. Yet, genuinely scientific studies of Black families done during that same era, revealed this objective fact: According to White American standards, over 75% of Black families qualified as being both healthy and stable. In addition, if only Black families with incomes above the poverty line were considered, the percentage of healthy, stable Black families jumped to 98%. Thus, both useful and scientifically-sound research by American Black human behavioral scientists is only rarely available in the libraries of America's White institutions of higher learning and it rarely becomes required reading. For reporting a purported scientific study, not mentioning even one of those studies is unthinkable for genuine human behavioral scientists. However, it is not surprising that the equally racist peer reviewers of this book did not insist that at least one of those contrary studies be a cited reference in that book. For the following reason, that omission is all the greater intellectual shortcoming, assuming that such a thoroughly academic worthless book with great potential for intellectually harming unsuspecting graduate health students can have a legitimate shortcoming: In the short 11 years after the original publication of The Mark of Oppression, the second edition of it was reprinted as one of the prestigious Meridian Books by the World Publishing Company. That fact guarantees that this intellectually obscene book is now a permanent fixture on the encouraged, if not required reading list of most major White institutions of higher psychosocial learning. In my opinion, worst of all is this fact: In the preface of that second edition, Drs. Kardiner and Ovesey proudly wrote: "Nothing has been changed in the text except the subtitle.", i.e., "A psychosocial study of the American Negro". I think the fact that such an obvious falsehood is printed in the preface of such a prestigious but objectively worthless academic book can only be objectively understood based on this fact: There has always been and now still is a powerful American, de facto, anti-Black mental health conspiracy in the psychiatric sciences and many of the other psychosocial sciences. In addition, as long as it consciously or purposely persists, American Blacks shall continue to have an excellent mental and emotional self-defense reason to distrust American Psychiatry. THE CURRENT AMERICAN PSYCHIATRIC SCENE Too many improvements to count in American Psychiatry today have occurred to the great benefit of all psychiatric patients. However, that fact does not begin to excuse or make up for the following unchanged conditions that need quick, permanent change. Though American Psychiatry no longer relies much on religious leaders and anatomists as a source of expert knowledge about American Black patients and people in general, almost exclusively, psychiatry now relies on its own profession for that knowledge. But, unfortunately, the basic psychiatric goal with reference to American Black patients and people in general still remains basically its historical self, namely, to find a scientific biological basis for clinging to probably the strongest White American myth about Black people-That they are by nature, nurture, or both, hopelessly inferior to White people. AMERICAN BLACKS AND AMERICAN PSYCHIATRY? The facts presented in this talk seem to support the following three conclusions: First, even the most educated Black Americans distrust American Psychiatry much more than White Americans do. Second, Black distrust of psychiatry is mainly justified, a healthy self-defense of their sanity, which White psychiatrists teach to their unquestioning, racially-naive White and Oreo, Black psychiatric residents. Blacks are still compromised with the excessive use of potentially dangerous neuro-psychotropic drugs and inappropriate incarceration in prison-like psychiatric institutions. Before the era of the tranquilization of America, American Blacks had to avoid, as best they could, the frank physical abuse that was rationalized as being psychiatric treatment. Third, in light of that history, to protect their sanity as best they could, American Black people, along with most poor people, were forced to develop their current, strong, culturally-conditioned preference for solving their own mental problems, for themselves, by themselves. Since that is the case, you may wonder, why not solve the problems of Black distrust of psychiatry by just letting Black people solve their own emotional problems? Unfortunately, as a group, Black people don't have any more basic knowledge about scientifically valid concepts and techniques of safe, therapeutic emotional self-help than White people have. However, that situation is not hopeless. Here are three practical, as well as readily available research-supported solutions: First, American Psychiatry needs to give up its historical preoccupation with trying to prove that Black people are inferior to White people. There is no credible evidence to support that idea. Second, American Psychiatry needs to commit its research on Black people to finding objectively healthy ways to help Black people safely help themselves, psycho-emotionally, socially, and economically. That focus would lead directly to the third practical solution to the distrust Black people have for American Psychiatry. That solution is to require that training in cognitive-behavior therapy and counseling be included in the training programs for psychiatrists and for all other mental health professionals. Why? Because methods and techniques of cognitive-behavioral psychotherapy and counseling teach patients medically-reliable yet practical concepts and techniques of emotional and general behavioral self-help. In addition, these methods and techniques are largely culture-free. Therefore, therapists and patients of different races and ethnic groups who have that training are most likely to automatically leave at the consultation room door, unsuspected, but anti-therapeutic "baggage" related to those differences. Then they are ideally suited for efficient and effective work with all patients, regardless of differences in demography. The technique of cognitive-behavior therapy that I have personally researched throughout my professional career and which I teach and strongly recommend is the one that I formulated. It is called Rational Behavior Therapy, or RBT for short. In addition to being culture-free, it is a comprehensive approach to short-term psychotherapy and counseling that produces long-term results. That's because adequately treated patients also learn skills in using the therapeutic, self-help method called, Rational Self-Counseling, which is based on the therapeutic concepts and maneuvers in professionally-delivered Rational Behavior Therapy. As an additional therapeutic plus, adequately treated patients leave RBT treatment better able to cope with their past and future life problems than ever before. That's what makes RBT short-term psychotherapy that produces long-term therapeutic results. NOTES 1. This paper was presented as the keynote speech of the Minority Issues Conference, "Unfinished Business: The Challenge of Meeting the Needs of Seriously Mentally Ill Minorities in the 90's," National Institute of Mental Health, Tuskegee University, Tuskegee, Alabama, August 15-17, 1990. This article was largely based on a chapter, titled "Why American Blacks Distrust Psychiatrists," published in 1982 in Behavior Modification in Black Populations: Empirical findings and Psychological Issues, Turner, S.M. and Jones, R.T. eds, New York, Plenum Press. I mention this because many of the facts presented here are at first hard for even a few naive American Blacks and most naive White readers to believe. However, in my chapter in the book Behavior Modification in Black Populations, you will find a plethora of scientific reference for the sometimes hard to believe facts present in this lecture. Both the Black and White peer reviewers of submitted, possible publications by Black authors insist on such verification and scientific support. 2. Copyright, Maxie C. Maultsby, Jr., M.D., 1990, reprinted in Psychnews International by permission of the author. SELECTED REFERENCES Bean, R.B. (1906). Some racial peculiarities of the Negro brain. American Journal of Anatomy, 5, 353-415. Bevis, W.M. (1921). Psychological traits of the southern Negro with observations as to some of his psychoses. American Journal of Psychiatry, 1, 59-78. Boyd, N. (1979). Black families in therapy. Psychiatric Spectator, (by Sandoz), 11, 212-215. Dorfman, D.T. (1978). The Cyril Burt question: New finds. Science, 201, #4562, 1177-1186. Fanon, F.B. (1967). Black sin white mask. New York: Grove Press. Hall, G.S. (1904). Adolescence. New York: Appleton, Vol. 2. Hollinghead, A.B. and Redlich, F.C. (1958). Social class and mental illness. New York: Wiley. Jarvis, E. (1844). Insanity among the coloured population of the free states. American Journal of Medical Sciences, 8, 71-83. Jones, F. (1972). The black psychologist as consultant and therapist. In Black Psychology. Reginald L. Jones (Ed.). New York: Harper and Row. Kardiner, A. and Ovesey, L. (1962). The mark of oppression. New York The World Publishing Company. Katz, J.H. (1978). White awareness. Norman: University of Oklahoma Press. Mall, F.P. (1909). On several anatomical characters of the human brain, said to vary according to race and sex. American Journal of Anatomy, 9, 1-32. Maultsby, M.C. (1984). Rational behavior therapy. Englewood Cliffs, New Jersey: Prentice-Hall Publishing Co. (To obtain a copy send a check (only) for $22.95 USD, payable to "Training Center," and addressed to RBT, P.O. Box 9610, Alexandria, Virginia, 22304, USA). Maultsby, M.C. (1979). Rational Behavior Therapy in behavior modification. In Black populations: Psychosocial issues and empirical findings. S.M. Turner and R.T. Jones (Eds.). New York: Plenum. Morais, H.M. (1967). The history of the Negro in medicine. New York: Publishers Company, Inc. O'Malley, M. (1914). Psychosis in the colored race. Journal of Insanity, 71, 309-336. Prudhomme, C. and Musto, D.F. (1973). Historical perspectives on mental health and racism in the United States. In Racism and mental health. Willie, C.V. et al. (Ed.), Pittsburgh: University of Pittsburgh Press, pp. 25-57. Stanton, W. (1960). The leopard's spots: Scientific attitudes toward race in America, 1815-1859. Chicago: University of Chicago Press. Thomas, A. and Sillen, S. (1972). Racism and psychiatry. New York: Brunner/Mazel. Turner, S.M. and Jones, R.T. (Eds.) (1979). Behavior modification in black populations: Psychosocial issues and empirical findings. New York: Plenum Press. Weatherby, D.G. (1910). Race and marriage. American Journal of Sociology, 15, 433-454. White, W.A. (1903). Geographic distribution of insanity. Journal of Nervous and Mental Disease, 30, 258-279. Willie, C.V., Kramer, M.B. and Brown, B.S. (1973). Racism and mental health. Pittsburgh: University of Pittsburgh Press. - - - Maxie C. Maultsby, Jr., M.D., former Chairman of the Department of Psychiatry at Howard University Medical School, is Professor of Psychiatry at Howard University Medical School in Washington, DC., and the author of many books and articles on Rational Behavior Therapy. His e-mail address is: maxiejr@maultsby.net