Imagine Harlem in the borough of Manhattan, New York City in the early to mid-20th century, a throbbing and heaving ecosystem with polyphonic and diverse cultural groups permeating the social fabric. Visualise the increasingly ambitious and imposing horizon of giant skyscrapers leaving their shadows on the poverty, cacophony and hustle of the streets down below.
It is against this backdrop that this historiography of psychiatry and psychiatric services in New York has been written; a detailed narrative of African-American health needs amid social deprivation and marginalisation. 1940s Harlem, a high-density Black neighbourhood, was devoid of in-patient psychiatric resources. In the absence of local facilities, the predominantly African-American mentally ill from uptown Manhattan were treated in out-of-neighbourhood state hospitals – an alien world.
In 1935, higher New York mental hospital admission rates (ratio 2.3 to 1) of Black than White patients reinforced racial determinism theories of a susceptibility to psychosis. However, in 1936 it was observed that the majority of these hospitalised ‘negroes’ were from desegregated Southern states and the discrepancy more likely an economic and migration effect than racial. The immigrant search for opportunity and freedom produced a continuous demographic shift among Harlemites. Interestingly, ethnicity, migration and mental health debates still endure in contemporary psychiatric literature.
This book takes the reader on a journey through service disparity, coercive psychiatric care pathways and strained community relationships. Historical perceptions of a ‘Black psyche’ in a heterogeneous world of immigrants, unskilled labour, music and faith draw interesting comparisons with modern times. Vivid descriptions of over 90% Black Harlem neighbourhoods transport the reader into an ecological pocket of New York defined by marginalisation, poor schools, and inadequate healthcare with higher mortality rates. An environment in which mental illness and juvenile delinquency led to correctional care in one of the only hospitals in New York to offer psychiatric care to African-Americans: Bellevue Psychopathic Hospital. Only few walked in: voluntary hospitalisation, often out of helpless desperation, occurred only if an individual was too disturbed to be contained at home.
In the 1950s and early 1960s, the Civil Rights Movement of Martin Luther King and others was visible in American consciousness; nevertheless, this political movement did not unilaterally narrow the health gap for those in the dark shadows of Harlem. The emergent racial liberalism was, however, transformational on racial assumptions across the social sciences, psychology and medicine. This book recognises previously unsung heroes of the era who drew attention to health disparities, nudging health and social care policy across popular media, schools, courts, housing and hospitals. Through the convergence of these efforts, support of Columbia University's Psychiatry and Public Health programmes, a sympathetic New York Mayor and a dynamic Hospitals Commissioner; psychiatry finally arrived in Harlem Hospital (Ward 9-K) in 1962.
This anthropological historiography challenges concepts of colour-blindness, equality and equity in healthcare. A compelling read for the mental health professional, historian, anthropologist, or scholar of mental health and policy.
Medical practice reflects knowledge and values in time and place. Ultimately, as the pages turn, one is left reflecting on how history may appraise our contribution.
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