Just as the stories told in Lost in the City are grounded in community (as well as place), so too is the history of mental health in the African American community. This article begins with condensed history of mental health before and after the Civil War for African Americans before addressing contemporary issues, such as overdiagnosis and the enduring trauma of slavery. I then cover the complexities of the Black church and community with regards to mental health, drawing on the story “A Dark Night” to highlight my analysis. Finally, I will cite ways in which African Americans have pioneered within or protested the field of psychiatry.
Early mental health treatment of African Americans begins in slavery, with the diagnosing and pathologizing of reactions to being enslaved. For example, early psychiatric pioneers diagnosed African American slaves with “Negritude,” which was believed to be a form of leprosy that also caused madness (Jackson 14). In 1851 one physician, Dr. Samuel Cartwright, devised two of his own diagnoses: Drapetomia, which was thought to be a disease driving slaves to run away, and Dysaethesia Aethiopica, “hebetude of the mind and body,” whose diagnosis included not only mental characteristics, but also “physical signs and lesions” (Jackson 14). Both of these diseases were believed to be treatable with beatings (Jackson 14). It goes without saying that both of these “diagnoses” were results of the trauma of enslavement and are not considered mental illnesses by today’s standards. But the pathologization of African Americans did not end after emancipation. After the Civil War, there was an observable increase in the amount of “colored insane-asylums” and African American patients at these institutions. Such “hospitals’ patients would often labor for no pay in the hospital farms or by making beds” (Jackson 16). Subsequently, African Americans have been subject to increases in institutionalization in mental hospitals as well as prisons (Jackson 15).
African Americans seeking mental health treatment today face many obstacles, including (but definitely not limited to) misdiagnosis, racism in treatment, and stigma in the African American community. A 2014 literature review of psychiatric studies found that African Americans are three to four times more likely to be diagnosed with a psychotic disorder than white Americans (Blankenship et al.). Two likely explanations are medical professionals’ lack of cultural literacy, such as failures to understand some African Americans’ spiritual connections to their ancestors, as well as racism against African Americans in clinicians, such as microaggressions or denial of racism in other aspects of patients’ lives (Blankenship et al.). Additionally, stigma against mental illness is an issue within the Black community, causing many to not seek treatment or to find support in other forms (Clifton).
An American Psychiatric Association study found that approximately 85 percent of African Americans describe themselves as religious and that the most common way of coping with stress for such individuals was prayer (Clifton). This is a complex issue, as church is by no means a replacement for mental health treatment, but the African American church has played a vital role in the Civil Rights Movement and in community support for many neighborhoods.
Edward P. Jones dramatizes this role of the church in “A Dark Night” from Lost in the City. In that story, Carmena Boone and several other women sit in an economy apartment, waiting for their pastor to arrive for a prayer meeting. Suddenly, an uninvited guest, Mrs. Garrett, arrives knocks on the door and invites herself in (Jones 217). While still waiting for the pastor, Mrs. Garrett tells a story from her childhood of her uncle’s family being killed by a lightning strike. It is clear while she tells the story a lot; the women are annoyed both by the telling, and they later dismiss and ignore her attempts to tell another story (221-225). None of this action highlights a community of support, until Mrs. Garrett knocks on Carmena’s door at four in the morning. At this point, there is a large thunderstorm going on outside, and while Carmena does not regard the two as friends, she nonetheless lets Mrs. Garrett in. The two women sit in the bathroom with the door closed and a towel placed in front of it to block out the light. They pray together and sit together while the storm drags on (227-228). This act of kindness highlights a deep understanding about the need of Mrs. Garrett in this vulnerable state. In no way am I trying to diagnose Mrs. Garrett as a character with a mental illness, but there is an obvious aspect of Beatrice supporting her during the remembrance of a traumatic event. In this way, Jones highlights the supportive and compassionate role of the community centered in the Black church.
Jones’s writing registers the consequences of social injustices such as slavery, segregation, and mass incarceration. It also registers responses to those injustices, some of which exemplify institutional failures to help the community heal and some of which dramatize the its collective strength and resilience. That resilience includes people who have worked in medicine historically as well as today. Lost in the City illustrates the continuing importance of such action.
Works Cited
Blankenship, David M. and Robert C. Schwarz. “Racial Disparities in Psychotic Disorder Diagnosis: A Review of Empirical Literature.” World Journal of Psychiatry, Baishideng Publishing Group Inc, 22 Dec. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4274585/.
Clifton, Derrick. “6 Important Facts Reveal Why Mental Health Is a Serious Issue for Black People.” Mic, Mic Network Inc., 25 Oct. 2015, mic.com/articles/113030/6-actual-facts-show-why-mental-health-is-an-issue-in-the-black-community#.739FdFgzB.
Jackson, Vanessa. “In Our Own Voice: African-American Stories of Oppression, Survival and Recovery.” Off Our Backs, vol. 33, no. 7/8, 2003, pp. 19–21. JSTOR, JSTOR, www.jstor.org/stable/20837870.
