Black and Blue. John Hoberman
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Eugenic fantasies of this kind have long served as emotionally satisfying responses to defamatory claims about the biological and mental health of blacks. The imaginary racial advantage can also take the form of a presumed superior resistance to disease. In 1970, for example, Time reported that almost half of the African American population believed that “whites are more apt to catch diseases” than blacks, a folkloric belief that has always been contradicted by the public health data.42 Jet magazine reported in 1984 that having a “touch of diabetes” had helped blacks survive the ordeals of slavery, yet another variation on the eugenic interpretation of black enslavement.43 A medically disadvantageous use of black “hardiness” is what the journalist Ellis Cose has called “an ethic of toughness” that “makes it very hard to admit that you are in pain or need help either physical or psychological.” Dr. Jean Bonhomme, president of the National Black Men's Health Network, calls this trait “pathological stoicism,” and he regards it as a health threat.44
Stoicism of this kind can affect African American attitudes toward coping with depression. One study found that almost two-thirds of African Americans regard depression as a “personal weakness,” and that the same proportion “reported they believed prayer and faith alone would successfully treat depression ‘almost all of the time’ or 'some of the time.'” A quarter said they would “handle” clinical depression alone, and only a third said they would take antidepressant medication if it were prescribed by a doctor, as compared to 69 percent of the general population.45
The stoic approach to depression incorporates several mutually related themes that have shaped African American responses to disease and medical hardship. Medical stoicism on the part of blacks is in part an abstention from participating in a medical culture that whites have created and controlled. The African American cardiologist Richard Allen Williams pointed out the following thirty years ago: “A person with chest pains may be so angry at the medical system that he may refuse to go to the hospital and may die at home. If such behavior occurs on a large scale, the effect that it will have on morbidity and mortality statistics is obvious.”46 The medical and public health literatures, which seldom look at patient behavior as a product of historical experience, treat this sort of recalcitrance as a kind of passive negligence, while others will see such recalcitrance as self-assertive and even self-protective behavior.
Medical stoicism has been embraced because it expresses a toughness or “hardiness” that can serve as a source of racial pride. Such feelings, as we have seen, can inspire eugenic fantasies of black racial superiority. “The fact,” the black writer George Schuyler said in 1927, “is that in America conditions have made the average Negro more alert, more resourceful, more intelligent, and hence more interesting than the average Nordic. Certainly if the best measure of intelligence is ability to survive in a changing or hostile environment, and if one considers that the Negro is not only surviving but improving all the time in health, wealth, and culture, one must agree that he possesses a high degree of intelligence.” At a time when the ideas of Sigmund Freud were taking the eastern seaboard of the United States by storm, Schuyler ridiculed the psychiatric fashions and emotional insecurities of “sophisticated whites” by alluding to the psychological hardiness of his fellow blacks: “It is difficult to imagine,” he wrote, “a group of intelligent Negroes sprawling around a drawing-room, consuming cigarettes and synthetic gin while discussing their complexes and inhibitions.”47
The idea that black emotional hardiness makes psychiatry unnecessary for black people exemplifies the stoic attitude that prompts some African Americans to make fewer rather than more demands on the medical system. Medical stoicism, an ethos of self-reliance, self-defensive eugenic thinking, and a doctrine of black hardiness, is a belief-system that encourages African American estrangement from the medical system. “The experience of inferior racial status has not transformed the Negro into a super human being,” the black psychologist Kenneth B. Clark wrote in 1965.48 But some African Americans have believed otherwise, persuaded that the extraordinary hardships of the African American experience must have produced a race of strong and tenacious survivors. This tension between the eugenic and tragic interpretations of the African American experience has persisted into our own era.
Calling racial health disparities a civil rights issue has become one argument health care reformers use. The Reverend Al Sharpton's declaration in 1998 that the black health crisis is “the new civil rights battle of the 21st century” did not galvanize African Americans because—unlike the O. J. Simpson verdict—it cannot be reduced to a single dramatic event that symbolizes the experience of shared oppression.49 Even the Tuskegee revelations, and the sordid details they revealed, failed to produce that kind of community outrage. The preceding pages have offered an explanation of why open revolt against medical racism has not taken place. The relevant factors include the sheer magnitude of the black health crisis and the demoralization it has caused among black laypeople and physicians alike; the mind-numbing jargon that smothers human suffering in sociological abstractions in the medical and public health literatures; the racial imbalance of power that has limited the power and influence of black physicians; the enduring reputation of “the Negro patient” among physicians, not excluding some black and foreign-born physicians; the long history of estrangement of African Americans from the medical system in general; African Americans' reluctance to draw attention to health problems that have been exploited for the purpose of defaming them as a race; and the belief in black hardiness and the medical stoicism it can encourage.
HOW DO (WHITE) PHYSICIANS THINK ABOUT RACE? EVIDENCE OF MEDICAL RACISM
Over the past twenty-five years the most prestigious American medical journals have produced massive evidence confirming that racially biased diagnosis and treatments are a fact of life in American medicine.50 These analyses document racially biased behaviors and have prompted one official investigation and no disciplinary proceedings. Other professionals serving the public, such as policemen or professors, are not granted such immunity from scrutiny of their professional conduct. The racially motivated habits whose effects are presented in the medical literature as statistical data are so ingrained that some doctors do not deviate from them even when they know their interactions with black patients are being recorded for observation.51 Their personal eccentricities and the specific harms they cause to their patients remain anonymous, buried in the statistics that make it into print. Concealed behind the sterile terminology about racial “disparities” and “cultural differences” are an unknown number of biased behaviors that in other social venues might be regarded as negligence or violations of the law.
What evidence do we have that doctors employ racially motivated thinking when dealing with patients of color? The abundant data that indicate differential diagnosis and treatment for a wide range of diseases and disorders are one type of evidence. Their crucial disadvantage is that they portray collective behavior rather than the more detailed scenarios of private professional conduct that do not appear in the medical literature. The motives for some physician behaviors can be deduced on the basis of what is known about the history of racialist thinking by physicians. Deductions of this kind are indispensable to understanding racially motivated medical thinking and behavior, given the dearth of current survey data about physicians' racial thoughts and fantasies. But they are open to the objection that what we know about doctors' racial complexes from the overt medical racism of the past may not apply to modern practitioners who have supposedly absorbed socially sanctioned disapproval of racist speech and behaviors and conduct themselves accordingly. This book's methodology is based on the premise that, to the contrary, significant aspects of the medical racial folklore of the pre-civil rights period have persisted and adapted to modern circumstances to a greater extent than many have assumed possible in an age of officially mandated racial equality and racially civil public discourse.
There is, in fact, no reason to assume that medical students and doctors are less likely to absorb and act upon the racial fantasies that still suffuse modern societies. In 2001, for example, three white medical students at the University of Alabama at Birmingham were exposed by the news media after they wore blackface to a Halloween party. One was dressed as Stevie Wonder, the second as a character from the Fat Albert cartoon show, and the third as a black woman.52 The medical school