APA Apologizes for Past Support of Racism in Psychiatry

Megan Brooks

January 19, 2021

UPDATED with comments January 26, 2021 // The American Psychiatric Association (APA) has issued a formal apology for its past support of structural racism in psychiatry.

The apology, issued January 18, coincided with the federal holiday honoring the life and work of civil rights activist Dr Martin Luther King Jr.

"We apologize for our role in perpetrating structural racism in this country, and we hope to begin to make amends for APA's and psychiatry's history of actions, intentional and not, that hurt Black, Indigenous, and People of Color," APA President Jeffrey Geller, MD, MPH, said in a statement.

The apology was written and issued by the APA Board of Trustees. It acknowledges practices and events in psychiatry that contributed to racial inequality, and expresses the organization's commitment to developing anti-racist policies that promote equity in mental health for all.

"This apology is one important step we needed to take to move forward to a more equitable future. The Board is issuing this document on Martin Luther King Jr Day, because we hope that it honors his life's work of reconciliation and equality. We do not take that legacy or his call to action lightly and will continue our important work," said Geller.

The apology is posted on the APA website along with a related document highlighting some historical instances of racism in organized psychiatry.

One of these instances involved the Eastern State Hospital in Williamsburg, Virginia, the nation's first psychiatric care facility founded in 1773.

Eastern State, which for a time in the 1800s was called the Eastern Lunatic Asylum, was not segregated when founded. However, 70 years later, when the 13 founders of what is now the APA met to discuss improvements in mental health care delivery, the treatment system they created and the organization they founded aligned with that era's racist social and political policies. In this system, Black patients received psychiatric care separately from White patients, the APA says.

The APA also acknowledges failing to act in Black Americans' best interest at critical points in the United States' sociopolitical evolution throughout the 19th and 20th centuries.

"This inactivity was notably evident while white supremacists lynched Black people during the Reconstruction Era as well as when Jim Crow segregation was in effect, which led to 'Separate but Equal' standards of care starting in 1896," the APA says.

Later, the APA failed to declare support for Brown v. Board of Education of Topeka in 1954, along with further major civil rights legislation designed to improve social and psychological conditions for Black people, the organization admits.

Throughout the decades that followed, psychiatric misdiagnosis among Black, indigenous and people of color populations were also common, the APA acknowledges.

For example, late 20th century psychiatrists commonly attributed their minority patients' frustrations to schizophrenia, while categorizing similar behaviors as "neuroticism" in White patients.

The APA points to one study that found that APA members diagnosed more Black than White patients with schizophrenia, even when both had otherwise identical clinical presentations.

"This reveals the basis for embedded discrimination within psychiatry that has contributed to reduced quality of care" for Black, indigenous, and people of color, and "perpetuation of dangerous stereotypes," the APA says.

Saul Levin, MD, the APA's medical director and CEO, said the Board of Trustees has taken "an important step in issuing this apology. The APA administration is committed to working toward inclusion, health equity, and fairness that everyone deserves," he added.

The APA Board of Trustees began drafting the apology late last year after it concluded that events and persistent inequities in healthcare and psychiatry had highlighted an organizational need for action.

The APA's Presidential Task Force on Structural Racism is continuing with efforts to educate and engage members on the issue and implement changes within the organization.

"A Good First Step"

Commenting for Medscape Medical News, Benjamin Roy, MD, general psychiatrist in Columbus, Georgia, and current president of the Black Psychiatrists of America, Inc, called the APA's apology a good "first step."

"There have been abuses throughout [the years], but we can't really do anything to rewrite history. Looking into the future, we'll look at what the follow-up is going to be. Organizations are good for making promises...and often nothing comes of it. But it seems as though a lot of people put a lot of work into negotiating and bringing this apology forward, and we want to give them the support and credit for that," Roy said.

"At the same time, we'll watch to see not only what happens but to be ready to help support the development of things that actually live up to the apology and promises made," he added.

Roy noted that the apology along with the creation last year of the APA's Presidential Task Force on Structural Racism shows that the organization is "certainly making efforts to adjust how things are structured, but there are many other things involved, like philosophies of mental health diagnoses."

"We've had some sad losses over the years, and an increasing number of minority psychiatrists who are leaving academia have become disillusioned with their experiences," he said.

In addition, he noted that there are several "shortcomings" of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM).

"The DSM has worked for the benefit of the patient, but it can also work against them; and it's been used by some psychiatrists to contribute to mass incarceration with diagnoses that portray someone to be a criminal when they may not be," Roy said.

"There's a lot to overcome from the past few decades. We've been through the ringer and kind of know what to expect from some corners of psychiatry. But there are some corners that are very supportive and not like that at all. Like President Biden, we're prepared to 'work across the aisles,' so to speak. The whole thing is to improve psychiatry overall," he said.

"We hold out hope, but at the same time there is a certain amount of wariness. We'll be watching to see but also putting our shoulder to the wheel to help."

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