A Historic Election

Source: Altha Stewart, used with permission

Recently, the American Psychiatric Association membership chose Altha Stewart, M.D., as its next president-elect. This election is historic because the American Psychiatric Association, the oldest medical association in the United States founded in 1844, has never had an African American president.

Dr. Stewart is an African American woman noted for her advocacy for minority youth as the Director of the Center for Health in Justice Involved Youth at the University of Tennessee Health Science Center in Memphis, and as a leader and administrator in numerous public sector jobs over the past three decades.

It, therefore, is also historic given the role of psychiatry in addressing racial issues in the past. During pre-civil war days, diagnoses were often consistent with such institutions as slavery. Physicians such as Samuel Cartwright promoted the diagnoses of mental disorders peculiar to slaves such as drapetomia, which was the tendency to run away from service. He also reported another disorder equally peculiar to slaves called dysaethesia aethiopica, a disease that the overseers referred to as rascality.

Benjamin Rush, the father of American psychiatry and a signatory of the Declaration of Independence, was an abolitionist considered ahead of his time. Nevertheless, he believed African Americans suffered from an affliction called negritude, which was thought to be a mild form of leprosy that caused dark skin. He felt that treating this condition would make African Americans indistinguishable from Caucasians. The American Psychiatric Association often had members that tolerated disparities in care for people of color and promoted racial integration as mentally destructive to Black people.

Finally, in 1969, African Americans psychiatrists led a protest to change the direction of the APA and that led to an increased recognition of the need to address the unique circumstances of African American patients, the attitudes of their members, and institutional racism of the organization.

In recent years, the APA has publicly and strongly opposed all forms of racism and racial discrimination. Moreover, the APA stated that it has long recognized that racism and racial discrimination adversely affect mental health and lead to disparities in mental health care. Nevertheless, despite various updates to the DSM, the diagnostic manual, still allows African Americans to be overdiagnosed with schizophrenia and underdiagnosed with affective disorders.

A report by the surgeon general and other studies continue to show substantial disparities in the care that African Americans with mental or substance abuse disorders receive. It will be interesting to see whether this election is reflecting a change in how American psychiatry regards race.