Black and Blue: The Origins and Consequences of Medical Racism

305 Pages·2012·1.262 MB·English

by  John Hoberman

Black and Blue
The Origins and Consequences of Medical Racism
john hoberman
University of California Press
berkeley los angeles london
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Black and Blue
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Black and Blue
The Origins and Consequences of Medical Racism
john hoberman
University of California Press
berkeley los angeles london
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University of California Press, one of the most distinguished university
presses in the United States, enriches lives around the world by
advancing scholarship in the humanities, social sciences, and natural
sciences. Its activities are supported by the UC Press Foundation and by
philanthropic contributions from individuals and institutions. For more
information, visit www.ucpress.edu.
University of California Press
Berkeley and Los Angeles, California
University of California Press, Ltd.
London, England
© 2012 by The Regents of the University of California
Library of Congress Cataloging-in-Publication Data
Hoberman, John M. (John Milton), 1944-
Black and blue : the origins and consequences of medical racism /
John Hoberman.
p. cm.
Includes bibliographical references and index.
isbn 978-0-520-24890-8 (hardback)
isbn 978-0-520-27401-3 (pbk)
1. Discrimination in medical care—United States. 2. Minorities—
Medical care—United States. 3. African Americans—Medical care—
United States. 4. Health services accessibility—United States. I. Title.
ra563.m56h63 2012
362.1089'96073—dc23
2011045598
Manufactured in the United States of America
21 20 19 18 17 16 15 14 13 12
10 9 8 7 6 5 4 3 2 1
In keeping with a commitment to support environmentally responsible
and sustainable printing practices, UC Press has printed this book on
Rolland Enviro100, a 100% post-consumer fiber paper that is FSC
certified, deinked, processed chlorine-free, and manufactured with
renewable biogas energy. It is acid-free and EcoLogo certified.
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This book is dedicated to the African American doctors of
the past century who, despite the cruelties and indignities
of racist exclusion from American medicine, have persisted
in their humanitarian mission to serve patients of all races.
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Contents
Acknowledgments ix
1. the nature of medical racism: the origins and
consequences of medical racism 1
Introduction 1
“Avoidance and Evasion” 3
Judging How Physicians Behave 7
Judging Physician Conduct: Privacy and the “Halo Effect” 8
The Oral Tradition 11
Physicians Share the Racial Attitudes of Their Fellow Citizens 12
The Medical Liberals 14
2. black patients and white doctors 18
The African American Health Calamity: The Silence 18
Medical Vulnerability and Racial Defamation 24
How Do (White) Physicians Think about Race?
Evidence of Medical Racism 32
Resistance to the Critique of Racial Bias in Medicine 37
Medical Liberalism and the Medical Literature 41
The Physician’s Private Sphere 52
Playing Anthropologist 55
From Racial Folklore to Racial Medicine 66
3. medical consequences of racializing
the human organism 71
Racial Interpretations of Human Types and Traits 71
Introduction 71
Racial Interpretations of Black Infants and Children 71
Racial Interpretations of the Black Elderly 81
Racial Interpretations of the Black Athlete 83
Racial Interpretations of Black Musical Aptitude 85
Racial Interpretations of Losing Consciousness 87
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viii / Contents
Racial Interpretations of the Nervous System 92
Racial Interpretations of Pain Sensitivity 97
Racial Interpretations of Heart Disease 98
Racial Interpretations of Human Organs and Disorders 106
Racial Interpretations of the Eyes 107
Racial Interpretations of Black Skin 109
Racial Interpretations of Human Teeth 110
Racial Interpretations of “White” and “Black” Disorders 112
Black “Hardiness” 120
Physical Hardiness 121
Emotional Hardiness 125
Conclusion: How Human Organ Systems Acquire Racial Identities 130
Racial Folklore in Medical Specialties 130
A Century of Racial Pharmacology: From Racial Folklore
to Racial Genetics 130
The Role of Racial Folklore in Obstetrics and Gynecology
during the Twentieth Century 139
4. medical apartheid, internal colonialism,
and the task of american psychiatry 146
Introduction 146
“Africanizing” the Black Image 154
American Psychiatry as Racial Medicine 158
The Racial Primitive in American Psychiatry 160
The Task of Black Psychiatry 176
Colonial Medical Status 193
5. a medical school syllabus on race 198
Introduction 198
The Doctor-Patient Relationship 200
The Problem Patient 202
Medical Authors’ Aversion to Race 204
Race and Medical Education: The Search for “Cultural Competence” 207
Two Official Versions of “Cultural Competence” 212
Physicians’ Beliefs about Racial Differences: A (Belated) Study 216
A Medical Curriculum on Race 217
Practical Advice for Physicians 221
Social Class, Misdiagnoses, and Therapeutic Fatalism 222
“Cultural Competence” as Knowledge of Stereotype Systems 224
Raceless Humanism: “Medical Humanities” and the
Evasion of Difference 226
Medical Curriculum Change Is Possible: The Case
of Abortion Training 229
Notes 235
Index 279
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Acknowledgments
Like any work of research produced over a long period of time, this book has
been made possible by the efforts of many people and institutions. Much
of the research was done at the Francis A. Countway Library of Medicine
at Harvard Medical School, the John Crerar Library at the University of
Chicago, and the Life Sciences Library at the University of Texas at Austin.
I am grateful to those who have built and maintained these wonderful
collections. This work has benefited greatly from years of classroom dis-
cussions with the University of Texas students who have taken “Race and
Medicine in African-American Life” since 2001; some of their stories are
in the book. Many colleagues, friends, and correspondents have generously
contributed to this project by providing information, ideas, i nvitations,
introductions, good conversation, and comments about the manuscript.
I would like to offer my special thanks to Rachel Brown Ater, MSW, Carl C.
Bell, MD, Deborah Bolnick, PhD, Khiara Bridges, PhD, David Broad, PhD,
Robert Eisenberg, MD, Adriane Fugh-Berman, MD, John H artigan, PhD,
Edward Havranek, MD, Crystal Hlaing, MD, David Hoberman, PhD, Eric P.
Hoffman, PhD, Michelle Holmes, MD, Joel Howell, MD, PhD, Sherman A.
James, PhD, Shannon Jones, III, MPA, Jay Kaufman, PhD, David J.
M alebranche, MD, Jonathan Marks, PhD, David Morris, PhD, Thomas
Murray, PhD, Robert S. Schell, MD, and John Valentine, PhD.
This book was made possible by Stan Holwitz, former Associate Direc-
tor of the University of California Press. Stan’s belief in the importance
of investigating race relations in American medicine never wavered, and
I will be forever grateful for his loyalty and support. Following Stan’s re-
tirement, Naomi Schneider, Executive Editor for the Social Sciences at UC
Press, took on the project and saw it through to completion. I am very
grateful for her commitment and tenacity. Thanks also to Stacy Eisenstark,
ix
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