Black Hang-Ups

Do blacks have special emotional problems? Medical science has no division known as black psychiatry; the psyche cannot be segregated. The best psychiatric opinion holds that the same kinds of emotional problems are found among virtually all the world's peoples though with varying frequency. For the American Negro the problems of being black are often merely the problems of being a minority and being poor. Says Harvard Sociologist Lee Rainwater, author of a book on the black ghetto to be published this fall: "The most central generalization is that when the total situation of being lower-class is the same, then the behavior is the same." The incidence of mental illness seems to vary by class, not by color. The middle class--black and white--tends to get neurotic, whereas the lower class--black and white--is more likely to get psychotic (perhaps because treatment is unavailable).

Still, color can magnify the problem. "Blacks do not have obsessive-compulsive neuroses, which is more of a puritanical thing," says Black Psychiatrist Alvin Poussaint. "But they have more anxiety. I have a theory that blacks feel more depleted or worn out psychically than whites, but I don't know how to measure that. They are always dealing with a lot of problems about race that must use up a lot of their energy. Even when you just walk into a room, race is always there, taking its toll." At the same time, says Poussaint, "black people always seem a bit ambivalent, the approach-avoidance, love-hate type of feelings." They are particularly ambivalent toward the dominant white society; they may be attracted by some of it and yet also despise much of what it stands for.

Many Channels. Black Psychiatrist Orlando Lightfoot, now studying at the Harvard Medical School's Laboratory for Community Psychiatry, cites what he calls the "success neurosis." "In essence, this says that no matter how well a person is.prepared, he is unable to grasp the opportunity, when it's presented to him, to take the major role," says Lightfoot. "When white society has told you, and reinforced it in many ways, that you are no good, many patients cannot differentiate race from their real ability." Lightfoot points out that blacks have no monopoly on this symptom: it can also be found among whites, although not for the same reasons.

The same is true of the anger against what the black regards as the white oppressor. Self-hatred is one channel that the black uses to reduce his anger. There are other ways, and the black has tried them all: compliance (love the enemy, or pretend to), denial of rage (the happy-go-lucky black), sublimation (diverting the repressed energy of aggression into such outlets as sports, music and the dance). Oppression's victim can also take refuge in apathy, alcoholism and drugs. All three are routes that some American blacks--as well as American Indians, Mexican, Americans and some other ethnic minorities--have systematically taken in an effort to survive.

Different Approaches. Treating a black patient and treating a white patient can call for differences in approach, and some black psychiatrists subtly accommodate them. Where traditional therapy encourages the patient to adjust to the world as it is, black therapy extends a more activist invitation. "How can you tell a black patient to adjust to this society?" asks Black Psychiatrist Price M. Cobbs. "We don't. For the black patient to become healthy, he must engage himself in changing a society that needs changing." This is not to say, of course, that all black emotional problems can be traced to the superordinate white society and should be treated as byproducts to that relation.

As necessary, the black therapist also redefines mental illness. "There are some behavior patterns that one could call pathological," says Charles Wilkinson, a black psychiatrist and executive director of the Kansas City Mental Health Foundation. "But it's a question whether they are really pathological or simply adaptive. If judged by the majority of the prevailing culture, they could be called pathological. But from the black person's standpoint, they have been patterns he has had to use to make it." It is scarcely paranoid, for instance, for the black to distrust and fear the white society. Says Dr. William Malamud Jr., a white psychiatrist in Boston: "What's labeled as pathology is very often psychic health in blacks. You can say: 'How else would you expect them to act?' "

Many psychiatrists are less impressed by the incidence of emotional disorder in blacks than by their ability to find positive and useful ways of living with the severe stresses imposed by their environment. "I don't know why they aren't crazier than they are," says Dr. Hugh F. Butts, a black psychiatrist from Manhattan. Dr. Robert Sharpley of Boston, a black therapist whose practice includes a number of black students from Harvard, feels that the black capacity to survive against huge odds deserves more attention than it has received. He speculates that the kind of solidarity so often found in oppressed minorities may "give the blacks a feeling of protection and support."

Small Fraction. Black psychotherapists are acutely aware of their own problems. Says Charles Pinderhughes, a black psychiatrist and assistant dean of Tufts Medical School in Boston: "The delusion of white superiority and black inferiority has been so supported by contrived and forcible alterations in relationships, in psychology, and social, economic, political and other cultural institutions, that most white Americans and many black ones, do not perceive their beliefs as delusion." Black therapists, he adds, have developed a consciousness of racism's presence at the therapeutic session. But he believes that white psychiatrists have a long way to go to exorcise the unconscious racism that can pervade the white doctor-black patient relation. Sometimes the black patient, says Alvin Poussaint, "can feel that because you're black, you're not as powerful or important." His attitude can be: "I don't have to listen to you!" Nevertheless, black psychiatrists are sometimes better able to treat black patients than are white doctors because they speak the same language and have shared many of their patients' experiences.

Black psychiatrists--like white psychiatrists--can treat only a tiny fraction of those who need therapy. The high cost of private therapy substantially limits it to the middle and upper classes. All black therapists see both white and black patients partly because there are simply not enough blacks with the money and the will to enter private therapy.

Sick Society. Black therapists agree that the fundamental problem is one that lies beyond their reach or, for that matter, beyond psychiatry itself. "We're not going to solve all our problems with psychiatry," says Price Cobbs. "We're going to have about as much impact on the ghetto as heart surgery. But we will have a few more healthy people." Individual treatment, in short, can only palliate a condition that is society-wide: the infection of racism, conscious or unconscious. As Manhattan's Dr. Kenneth B. Clark, a leading black educator, has argued, the ghetto's pathology is a social illness and can only be treated as such. It is the institutionalization of racism, says Clark, that largely accounts for the malaise of American society--both white and black.

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