10 The Racially Blind History of Mental Health Care

1 Introduction

From the beginning of the 20th century up until current times, societies have seen many changes and major developments related to mental health and treatment of mental illnesses. With a quick online search, one can easily find the timeline and a plethora of information concerning the evolution of mental health care, such as the history of institutionalization and deinstitutionalization, mental health movements, the discovery of psychiatric drugs, development of psychotherapy, etc. However, the most easily found and more commonly used sources on the history of mental health don’t usually give enough consideration to the racial climate – of blatant racism, racial segregation, eugenics, forced assimilation – that coincided with those events, and fail to highlight how racialized people would’ve experienced them differently from white people – who tend to be the ones writing history. Because of this, the historical experiences of racialized people with mental health care are not properly acknowledged, and we also fail to fully understand their current mental health context. The American Psychological Association (APA) has recently apologized for its role in perpetuating systemic racism, and – among many other things – acknowledged that, historically, there has been both misdiagnosis and overdiagnosis of non-white people (APA, 2021). While there is more acknowledgement of racism in mental health care now (APA, 2021), there still is a lack of culturally safe and culturally appropriate care that considers the consequences of experiencing racism. In this piece, I will be discussing how even though there have been major developments aiming for improvements in mental health care and treatment since the beginning of the 20th century, racialized people have continuously remained more vulnerable to poor mental health outcomes due to continuous experiences of racism and discrimination, and due to society’s failure to properly address those issues and their consequences over time. While mental asylums were created to treat patients with mental illnesses, and were indeed very important in the provision of care for those people, segregation and blatantly racist attitudes were extremely prevalent issues at the time, so white patients and racialized patients were bound to receive differential treatment. With the contributions of people like Dorothea Dix, who advocated for compassionate and dignified care for people with mental illnesses, mental asylums were created and allowed people in bad conditions – imprisonment, poverty, homelessness – to have proper access to care (Gollaher, 1993; Modak et al., 2016). However, throughout the 19th and 20th century, racism was very prevalent – as observed by the Jim Crow laws in the U.S.A., and the Indian Act in Canada –, and influenced attitudes of individuals and institutions towards racialized people; this, in turn, would come to influence those people’s experiences in mental asylums. Having segregation laws in place meant that black and white patients could be racially segregated, for example. Considering the outright racism and discrimination against black people at the time, it wouldn’t be too far fetched to infer that mental asylums for black people didn’t get the same investment and infrastructure as the ones for white people, and also that the quality of care provided by the staff was probably drastically different. Another matter is the historical issue of misdiagnosis and overdiagnosis of racialized people, as was recently recognized by APA (APA, 2021). Black people in the U.S.A after the Emancipation, for example, were at higher risk of misdiagnoses or overdiagnoses, which contributed to wrong treatment courses, increased stigma, and, consequently, poorer outcomes (Misra et al., 2022). So we can deduce that many black people were probably admitted to mental asylums due to wrong causes – and perhaps even admitted wrongfully –, affecting the care they were supposed to receive. With segregation laws and racial bias influencing the workings of mental asylums, racialized patients and white patients certainly had very different experiences. While also an important factor in the history of mental health care, the deinstitutionalization movement in the 20th century had the unpleasant consequence of leaving some people without proper support, and racialized patients had – and still have – a higher risk of suffering from that consequence. The deinstitutionalization movement was important because it pushed for more freedom and less stigmatization of patients with mental illness (Modak et al., 2016). But then, after the closure of wards, shortening of stays, etc., not enough resources for community support were provided in some places, and some patients lost the support they used to have (Milaney et al., 2022). It is, of course, important to also look into this situation in a way that takes race into consideration. Historically, there has always been poorer investment and lacking infrastructure in neighborhood and residential areas with larger population of racialized people – and fewer white people –, which resulted in unequal access to community care and support during the process of deinstitutionalization (Bailey et al., 2017; Misra et al., 2022). This also remains a modern issue that is a barrier to racialized people accessing quality care in general (Bailey et al., 2017). While poverty, homelessness, living in an area without good community resources, etc., are not situations that are exclusive according to race, we have to consider that, historically, racialized people have been more affected to those issues due to systemic racism, and, consequently, have had more difficulty in accessing good resources and proper care.

Another thing to consider is that some situations experienced by racialized people, that have been found to contribute to poor mental health situations and outcomes, were very prevalent in past history – and some still are to this day. Research has found that racism and poor mental health – and poor mental health outcomes, such as depression, anxiety, etc. – are strongly associated (Paradies et al., 2015). Being a target for racism or witnessing racism as a non-white person can have an impact on someone’s mental health. Situations such as going through or witnessing bad interactions with police or police violence as a Black person, for example, are associated with an increased risk of poor mental health outcomes (Misra et al., 2022), and that’s a prevalent issue even in current times. Both historically and contemporarily, there have been multiple ways in which racism can be felt in non-white people’s daily lives, such as interpersonal discrimination, lack of economic opportunities, biased treatment when accessing services, police violence, micro-aggressions, etc. (Bailey et al., 2017), and all this experiences, can contribute to poorer mental health. When we consider the history of racism – such as the mentioned segregation laws, racist policies, discrimination –, it becomes clear that issues that could contribute to make racialized people more vulnerable to mental illness have always been present, and with systemic racism enduring in societies, continue to exist to this day. Another factor to consider is the existence of transgenerational trauma stemming from the history of racism, discrimination, and bad experiences with authorities and institutions, which can add extra layers to the mental health needs of racialized people, and also make them less likely to seek help for mental health, widening the gap between white and non-white people in terms of possible positive outcomes. People who are victims of traumatic events can “pass on” their trauma onto their offspring and descendants, who may also come to suffer from effects of trauma – increasing the risk of mental illness – even though they didn’t experience the events firsthand (Isobel et al., 2021). There are many different ways in which racism can generate situations that lead to a trauma that can affect whole families and communities. As previously mentioned, bad interactions with the police force or police violence are associated with a higher risk of poor mental health outcomes (Misra et al., 2022). As targets of racial bias, black people are more likely to have bad experiences with the criminal system, and are disproportionally – and often unjustly – represented in penal systems (Misra et al., 2022), which are negative experiences that can be felt not only by the individual at the center of the situation, but also by their families, friends, and communities they are a part of, potentially creating a general distrust of authorities and feelings of distress and injustice that may affect mental health. Transgenerational trauma due to previous mistreatment can also cause people do distrust care providers (Miller & Miller, 2021). Indigenous peoples, for example, commonly report feeling unsafe when accessing mental health services due to experiences of racism, discrimination, stigmatization, and lack of cultural safety (Turpel-Lafond, 2020). This is an issue that can directly affect the probability of these people accessing the services again in the future, and the sharing of these negative experiences among family members and friends may affect others’ perceptions of practitioners and the health system too. We have to remember that people exist within the context of their families and communities, so when one person is negatively affected by an experience, its effects and consequences can sometimes be felt by others as well, including trauma and their perceptions of the figures involved in the event. Overall, while mental health care has progressively evolved since the 20th century, non-white were continuously placed in more vulnerable situations due to systemic racism, and by failing to effectively address the consequences of racism on the lives of racialized people, they remain more susceptible to poor mental health outcomes. Going forward, societies need to address issues of systemic racism and its consequences, such as inequity in access quality mental health care, racially biased service providers, and unequal life opportunities that increase stress and emotional burdens. There should be an effort to build trust between racialized people and mental health service practitioners, and an inclusion of more non-white professionals in mental health care, and more non-white perspectives on mental health research. Mental health care providers should work on providing culturally safe care, and on incorporating culturally appropriate practices according to individual needs.

2 An extensive look into the Western World’s domination and its flaws

For this section we will be focusing and discussing on western societies and its practices dominating the psychology field. It is important to criticize the flaws in the history of psychology. The psychology field is often selfish and benefits the western culture more, its racist roots are still prevalent in our present day, because these western societies are the dominant factor in the psychology field. I believe that these points highlight the inequity that that psychology has promoted and the unfair practices throughout history. To start off, one of the flaws with psychology and the ugly truth behind it is that many influential figures of psychology who contributed to this field held many racist views and ideologies. One of the most notable figures would G Stanley Hall who many consider to be a great mind. He was a very respectable psychologist of his time, and his most appraised accomplishment would be that of establishing the American Association of Psychology. The APA is proof that the western field dominates the world of psychology as for every paper we write, and every reference section, this associate will always show up and is most entrusted in the world of psychology and education. G Stanley Hall in his lifetime not only had astounding accomplishments, but he also happened to have published many articles under his name with racist and degradative views towards minority groups. Hall had articles tiled ‘The relations between higher and lower races” and “University Association undeveloped races in contact with civilization Bulletin” (D. Alards-Tomalin, personal communication)..  Both articles presented here have racist connotations as it is apparent that Hall is deeming that those not of the white race, minorities are under civilized. It is also easy to understand which group he qualified to be the higher race and which he saw as lower. Racism in the root of history is an undeniable fact as even the APA itself has apologized for their hand in promoting racist ideologies. In this apology issued in 2021 the APA expressed their sorrows and takes responsibility for the hurt they have caused towards minorities through their promotion of racist ideologies and views. One of the gaps in research we should be addressing is the actuality that we do not rely on an association that is not western. We let APA dominate the psychology field by utilizing it for our papers, citations etc. Perhaps we should be asking ourselves this reason and checking our biases, and the inclination to always rely on the western world first and foremost. Psychology has provided much for humanity over the course of times, it has offered new approaches, research, and cases. However, after taking all the points mentioned above into account, it is profoundly apparent that this field has segregated and marginalized minorities while uplifting what Hall considered and to be the higher race. The ideology of this movement was that minorities were inferior. Eugenics sought to determine human fitness and it desired to dispose of unfit individuals i.e., those that with a different coloured skin tone (Yakushko, 2019 p.2). The concept of eliminating people of colour in favour of having what is deemed as the Arian race the only group is very dehumanizing. Additionally, it is also absurd to determine who is unfit and who is not as well as there are no one correct method to do so. Others flaws in psychology happens to also be that it can be culturally insensitive as well, one example of this is the culture insensitivity in its mental research. According to an article cited by Rogler (1999), psychology has failed to acknowledge the culture behind what promotes an individual’s behaviour and preferring white middle class groups over any other group seems to be the case. There is also an unwillingness to translate original work into other languages which promotes cultural insensitivity (p.3). This ostracizes researchers, psychologists, and others from non-western world to access this work from the western psychology world and in a way leaves them outcast. A fact of the matter is that psychotherapy is practiced worldwide; Psychotherapy and psychopharmacology primary methods (Koc & Kafa 2018 ). This proves again that western psychology is the common dominator in the world of psychology. There is no inherent problem with this fact but having these two methods be the primary ostracizes eastern approaches and does not accommodate those that are in regions with different access for mental healthcare. The two methods stated although helpful and can better those struggling can be unattainable for many, one being financial and other being the economic status as previously suggested. The question we should ponder is how to accommodate those in places where these practices are not custom. Eastern psychology is not only pharmacotherapy, on top of counselling, it also focuses on practices like mindfulness, and yoga which can be advantageous to an individual (Chan,2009 pg.1). These eastern approaches could be more favorable towards the individuals that feel like these methods psychotherapy and psychopharmacology are of their reach. The so-called dark history of psychology should be discussed in a very nuance manner and criticized further in the future to educate others on the past to not repeat the same mistakes. As per next steps what I suggest is that we should focus on stopping halting racism in psychology we see today, become customed to eastern approaches as well as providing more resources to individuals, minorities as well/ those these racist views have harmed. The wrong doings of psychology cannot be mended, however taking accountability, and recognizing the flaws can prevent history from repeating itself.

3.1 Psychology’s Mental Health Roots: The Fundamental Ideologies Extending to Racialism in Modern Psychology

Psychology’s mental health roots attempted to lessen the stigma around mental illness while ensuring proper care for mental health patients. During a time of great discovery and expansion following the First and Second World Wars, institutions like psychology, specifically clinical psychology, took off. Notably, after the end of the Second World War, the need for clinical psychologists rose (Waiting on the citation, 2022). As cities in America and Canada became more densely populated, the need for clinical psychologists became clear (Waiting on the citation, 2022). Consequently, after the Second World War, American Psychological Association (APA) memberships increased significantly (Alards-Tomalin, 2022). The post-war era made the psychological distresses experienced by soldiers returning from the war observable (Alards-Tomalin, 2022). This noticeable distress piqued government interest and led to increased funding for Clinical Psychology (Waiting on Citation, 2022).

The political and societal ideologies of the time took a firm hold on the development of psychology’s mental health roots. Psychology’s mental health roots are not all they are cut out to be. Psychology’s mental health roots are founded on racist, eugenic principles and were backed by the American Psychological Association (APA) (Winston, 1998). In the past, psychology’s mental health roots were used in various dehumanizing and malicious ways, including segregation, discrimination, and profiling, notwithstanding the previous methods that social structures or institutions used against racialized minorities for political gain and social control (APA, 2022). Hence, psychology as a science has added to the exclusion, management, and discrimination of racialized minorities commonly seen today. These historical ideologies have laid the foundation for today’s exclusionary, racist, discriminatory institutions. Thus, psychology’s mental health roots were founded on racist ideologies and aided in systemic racism, causing long-lasting effects on racialized individuals.

3.2 Racist Ideologies of the time

The history of psychology is laced with racism; many of the ideas present in psychology’s early years were based on the zeitgeist of the times, which was inherently racist. To illustrate, Sir Francis Galton, during the year 1883, began expressing the belief that only the “fittest” individuals should be allowed to reproduce (Farber, 2008). Galton believed that white persons were more intellectual than other races. In 1889 Galton published a book entitled Hereditary Genius. In this book, Galton claimed that particularly Black individuals were “two grades below our own” (Galton, 1869, pp. 336-338 as cited in APA, 2022). Galton’s book became very popular in psychology and was referenced by other psychologists throughout history (APA, 2022). When the Eugenics movement in the late 19th century began to take off, many emerging and long-withstanding social structures began to accept and adopt these ideologies as well; thus, racism went from being purely biological to including dominant a social component (Omi & Winat, 1986 as cited by Thomson & Neville, 1999). The dogma of this movement consisted of breeding out “undesirable” traits from individuals to create a perfect human race. In the early stages of the development of psychology’s mental health roots, many psychologists were focusing their research on ways to prove White superiority (Thomson & Nevelle, 1999). Thus, many ideas around this time consisted of some racist tenets accepted by the American Psychological Association (APA), which in its beginnings was full of white-Eurocentric like-minded men in support of the Eugenics movement (APA, 2022). The Eugenics movement of the 19th century became the central political ideology of the time. Thomson and Nevelle (1999) emphasize that Psychology was not naïve to proving “White superiority.” In making this comment Thomson and Nevelle (1999) acknowledge that Galton was not the first to come up with the notion of superiority. For example, around 1895, psychologists of the time tried coming up with the “biologically based hierarchy” (Winston, 2020). This hierarchy paved the way for other psychologists like Stenson in 1897 to conduct studies on racialized individuals with the intent to prove that white individuals are superior (Winston, 2020).

In other words, Psychology supported ostracization, discrimination, and dehumanization of people of colour. The American Psychological Association (APA) gladly adopted this movement, taking a firm hold on psychology extending into the 1940s. This idea of “eugenics” was used by many psychologists in studies to determine “White superiority” over racialized minorities (APA, 2022). Studies like these continued long into the 1940s and 1950s, fueling the racist inclination that white individuals hold superiority. Around 1946, a year after the end of the Second World War, the segregation of races was pushed once again when Henry E. Garrett became president of the APA (APA, 2022). The end of the war marked a pivotal point in psychology’s mental health and clinical roots; it allowed for the instrumentalization of psychological tools, theories, and practices to be used for social or capital gain. That said, between 1900 and 1925, during the first World War, the Eugenics movement took an even stronger hold on psychology when many people took up the anti-immigration opinion (APA, 2022). This is important to the history of psychology’s mental health roots as it spotlights the prominence of psychology’s contribution to the eugenics movement and the hand it played in the management and control of racialized minorities in a social and political sector.

3.3 Social Control 

Psychology, historically, was more of a political agent than a helpful social structure. According to Dorthy A. Brown’s Critical Race Theory, social institutions are full of racist ideologies and racism (Brown, 2003). The essence of Brown’s argument is that many institutions consist of discriminatory or prejudiced views. Therefore, it is not surprising that the American Psychological association accepted a request from the “Committee to study and report on the Best Practical Means of Cutting off the Defective Germ-Plasm in the American Population to help determine who was mentally unfit, deeming them either a “degenerate” or “feebleminded” (APA, 2022). However, the psychologists tasked with making such determinations only targeted racialized minorities and those with disabilities (APA, 2022). Although this may seem trivial, it is, in fact, crucial in terms of the concern for discrimination, marginalization and racialization attached to psychology’s mental health roots; tools were created by psychologists to help segregate racialized minorities and those deemed mentally unfit. As a result, throughout 1914, many individuals were racialized, profiled, and sterilized because they were deemed mentally unfit by racially biased psychologists (APA, 2022). Even more, the treatment and psychological diagnoses for racialized individuals were greater and more detrimental than white individuals, furthering the segregation of racialized minorities.

During the Eugenics movement, psychologists and other social institutions also used Intelligence Testing (IQ test) as a tool for pushing the white superiority philosophy- minorities have a lower intellectual ability than white individuals. The IQ test would be used to control an individual’s education type or level, which would control the types of employment available, thus filtering into an individual’s quality of life (APA, 2022). Hence, the IQ test was specifically used by psychologists to prove white superiority. In short, psychology’s mental health roots implemented these tools and practices in racially biased ways as a means of social control. To take a case in point, things like immigration were influenced by racially prejudiced psychological diagnoses, tests and tools like the IQ test, thus dictating one’s outcome in life. This is important because it highlights how social structures or institutions are not all that meets the eye and the many interconnected and underhanded ways institutions and social structures, like psychology, can determine and control an individual based on ethnicity. Using psychological tools in a biased and unjust way to determine one’s “fitness” illuminates the bigotry embedded within psychology’s mental health roots even more.

3.4 Racism in Psychology Today

Unfortunately, the age-old adage that history repeats itself is sadly true in the case of psychology as an institution. Nevertheless, the American Psychological Association (APA), in October of 2021, issued a public apology regarding the role psychology played in supporting and advancing racial discrimination and inequality (APA, 2021). By focusing on apologizing and acknowledging past wrong-doings, the APA overlooks the transgenerational and intergenerational traumas and lack of trust resulting from the system. As a science, influences from psychology’s mental health roots have laid the foundation for discrimination and marginalization seen contemporarily (Nara, 2021). Consequently, the racial divide created by psychology’s mental health roots is vastly influential today (Nara, 2021). For instance, Bingham and colleagues (2019) compared Indigenous and non-indigenous homelessness rates highlighting significant difference between Indigenous and non-Indigenous individuals. The researchers in this study concluded that homelessness rates were higher for Indigenous peoples, but the reasons for their homelessness differed from those non-Indigenous (Bingham et al., 2019). As noted by Bingham et al. (2019), many differences stemmed from colonialism’s traumatic effects. The findings by Bingham and colleagues are interesting insomuch as they highlight one aspect typically overlooked in psychology – the cultural differences of the individual.

To put it another way, white individuals are still at more of an advantage than minorities. Even though the Diagnostic Statistical Manual in its fifth edition (DSM-5) states that culture should be acknowledged within the clinical setting, it is not (Kupfer, Kuhl & Regier, 2013 as cited by Dozois, 2015). By extension, Bingham and colleagues noted that there is a fundamental difference in homelessness between Indigenous and non-Indigenous individuals stemming from a difference in life experience (Bingham, 2019). Ultimately, the difference in individual experience is not acknowledged in the contemporary clinical setting. There is still a “one type fits all mentality” dominating mainstream psychology; thus, modern psychology treats the societal norm rather than the individual.

In addition, many individuals whom the system has discriminated against typically avoid it; many racialized minorities do not trust the system because of the experiences they or someone in their family has had. Specifically, the many Indigenous individuals were traumatized due to the Indian Act and Colonization (Bingham, 2019). However, clinicians still neglect to acknowledge the cultural differences and experiences that many racialized individuals have gone through; hence, the lack of trust in psychology as an institution. Thus, the one-type fits-all ideology is racist in that it is geared to white individuals whose daily experiences differ from those not (Nara, 2021). Not only this, but non-ethnic individuals can access and receive mental health help at more significant rates than those who are of an ethnic minority (Nara, 2021)

3.5 Conclusion

In sum, the foundation of psychology’s mental health roots is intrinsically intertwined with racialism, influencing the current racial prejudice we see in psychology today. Throughout this section the influence, that World War II had on the development of psychology’s mental health roots was discussed. Moreover, this section discussed the fundamental racist ideologies, like the Eugenics movement pushed by Sir Francis Galton and supported by the APA. This section incorporated the discussion surrounding the American Psychological Association’s biased panel of members who supported the Eugenics movement and research into white superiority. Also, this section considered how the development of psychology as an institution could take advantage of the developing times and capitalize on the tests and tools available. Finally, this section highlighted how Psychology as a science is still a discriminatory, marginalizing social construct.

The beginnings of psychology as a science were fueled by the “us versus them” perspective that spread anti-immigration and anti-diversity propaganda which has thus spilt over into today’s contemporary setting. The prejudice perspective that lay psychology’s mental health roots has consequently become interwoven with other unjust social institutions resulting in the segregation, discrimination and racialism seen braided into psychological and other contemporary social structures.

The future of psychology’s mental health care should focus more on treating to the individual. As opposed to using tools riddled with Eurocentric ideologies more attention need be paid to the reconciliatory ways in which psychology as an institution can rebuild trust within the mental health care system. For instance, one way to acknowledge cultural diversity and the prejudice experienced by racialized individuals would be to ensure more clinicians recognize the diverse experiences of their clients. It follows then, that psychology’s mental health future become more accepting and open to the varied ways marginalized individuals have been affected by psychology as a social institution.

Definitions

Eugenics: an ideology that consists of getting rid of ‘defects’ to improve humanity through selective sterilization and reproduction (APA, 2022)

Feeblemindedness: term once used to describe an individual with an intellectual disability- this  term is no longer used and is considered derogatory (APA, 2022)

Fittest: describes an individual who is most suited for reproduction (Farber, 2008)