Mental(izing Health)

Newsletter #9

This image is from the Lafargue clinic.

There are multiple ways to confront the culture of white supremacy.[i]  The way that has garnered lots of attention, especially in the media, is the tearing down of statues and renaming of buildings.  I understand this: if I drove by a statue of some lousy racist every day, I would experience fresh and fulsome anger. The often-used phrase of dismantling white supremacy has a literal aspect: we ought to be free to reevaluate our “heroes”, and refuse to assent to admiring them, if they held demonstrably noxious views.  There are legitimate concerns about how to reconcile current beliefs with what was widely (if problematically) held to be true in the past and to hesitate about retroactively judging others.  Indeed, let’s keep in mind this humbling thought experiment: many of our current, widely held beliefs might well seem outlandish, and embarrassing to people 50 or 100 years into the future.  Still: it seems salutary to welcome the ongoing process of rethinking our relation to the past, weighing if we are living up to the values that we purport to believe, and refusing to obscure hypocrisy where it exists.

To sound like a philosopher for a second, we might say that tearing down statues or renaming buildings is a necessary but insufficient way to reject white supremacy.  In this newsletter, I would like to dwell upon another approach to confront white supremacy: excavating people, events, and narratives from the past that have either been forgotten, partly recognized or never recognized.  The stimulus for this effort comes from an array of sources.  One source is the powerful example of the 1619 project in the New York Times, which convincingly demonstrates that slavery has a longer history and is an intrinsic part of the birth of the country than the history books suggest (regardless that details of its account have been questioned). Another source from the New York Times, with which readers probably are familiar is the special section of obituaries of people were overlooked at the time of the person’s death, since 1851.  There have been some extraordinary examples.  I shall briefly mention two, although it is tempting to do a whole newsletter on honoring these lives.[ii]  The first is Charlotta Bass, an African American journalist and publisher, who was a vice presidential candidate in 1952, almost 70 years before Kamala Harris. (https://www.nytimes.com/2020/09/04/obituaries/charlotta-bass-vice-president-overlooked.html).  The second is Jimmie McDaniel, an African American who was denied the opportunity to have a career in tennis but played a highly publicized match that took place in Harlem against Don Budge (McDaniel lost, but Budge was gracious in acknowledging his potential for success).  This was years before Althea Gibson and Jackie Robinson integrated their respective sports.  McDaniel worked as a janitor and then line supervisor, but he paved the way for black athletes to participate in professional sports (https://www.nytimes.com/2021/02/11/obituaries/jimmie-mcdaniel-overlooked.html).

Other challenging stimuli come from the art world.  Kara Walker’s silhouettes that depict everyday life in the old South, which on closer examination turn out to reveal disturbing sexual scenes of—why distort it—rape and sexual abuse, often between white owners and black slaves (https://walkerart.org/collections/artworks/the-means-to-an-end-dot-dot-dot-a-shadow-drama-in-five-acts).  The delicate and sentimental design style exists uncomfortably with the brutal, racist content.  Walker’s art performs a demonstration: that white people fail to see what is front of them because the truth would force them to reevaluate how they think of themselves.  The death of slavery has been greatly exaggerated. 

An even more recent source is Garret Bradley’s solo exhibition at MOMA, America, a multichannel video installation, that intersperses fragments from old images along with her own fantasized versions of films that have become lost to history.  The work is a stunning and profound way of un-forgetting African Americans as part of American history (https://www.moma.org/calendar/exhibitions/5221).  America documents what has been lost, retrieves it to some extent, but also accentuates an emotionality that allows the past and present to intersect and co-exist.  We encounter black people in a way that is not defined by white people, and there emerges a zeal and playfulness that runs counter to well-worn images.  Bradley depicts the lives of black people as resilient, as having a life-affirming spirit, freed from the constraints of predictable stereotypes.

Inspired to turn to pursue the project of reclaiming the past, I would like to begin by emphasizing that I am not embracing the notion of valorizing the positive over the negative— uplifting forgotten tales over toppled marble.  It’s not a choice; they are effective, living in dialectic tension.  In addition, I do not see myself as indulging in a fishing expedition on a fine, early spring morning: encountering the displaced past means facing the consequences that remain with us.  Perhaps, my purpose will become clearer as I explore an example that is closer to home for mental health professionals.

The example I have in mind is the Lafargue clinic, the first mental health clinic devoted to serving African Americans, that existed from 1946-1958 in Harlem.[iii]  The clinic was headed by Frederic Wertham (born Friedrich Ignatz Wertheimer), a German-Jewish emigre psychiatrist with a checkered past, who sought out and consulted with Richard Wright (and also Ralph Ellison).[iv]  Yes, you read that correctly: these famous novelists helped to create a psychoanalytically oriented clinic that aimed to serve the local Harlem community with low-cost psychotherapy.  At the time the clinic was created, psychotherapy was a relatively new term that the founders readily embraced.  When hopes for funding for the clinic failed to materialize, they plunged ahead anyway, charging patients fees of 25 cents, and free for children.     

Wright, in particular, was a strong advocate for better mental health care for African Americans; at one point, he was also interested in creating a journal that would psychoanalyze the white reading public, a focus on whiteness that was way ahead of its time (Mendes, p. 39).  Insight into Wright’s thinking at the time is revealed in an extraordinary diary entry from 1945: “I’m convinced that the next great area of discovery in the Negro will be the dark landscape of his own mind, what living in white America has done to him. Boy what that search will reveal! There’s enough there to find to use in transforming the basis of human life on earth” (Mendes, p. 22). Wright’s Cassandra-like understanding of racism sealed his fate in the US, and he departed for France in 1946, emigrating the following year (but remaining interested in the LaFargue clinic).

It is important to realize how transformational it was to open a mental health clinic in Harlem.  At that time, the New York State Psychiatric Institute and other psychiatric institutions around the city excluded black patients.  Harlem hospital did not have a psychiatry department until the early 60s.  Bellevue was the main option for treatment, which was far away, and not held in high regard by African Americans.  The Lafargue clinic was able to open, when space was provided in the St. Philip’s Episcopal church, located at 134th St., by Reverend Sheldon Hope Bishop, who was sympathetic to the creation of a mental health clinic in Harlem. 

The Lafargue clinic provided psychotherapy for children as well as adults.  Outside referrals were made for medical problems.  Wertham’s approach to diagnosis in interesting, as he was trained and believed in psychiatry as a science (working under Emil Kraeplin himself in Germany before emigrating); however, he also believed that race and class were factors that needed to be taken into account in understanding mental disorders and personality problems.  Hilde Mosse, a psychiatrist at the clinic, was vociferous in criticizing the overdiagnosis of African American children as schizophrenic.  Wertham defended what he termed “social psychiatry,” which would aim to be anti-racist and anti-elitism.  As he argued: “Psychotherapy should not be limited to the wealthy alone.  Discrimination and poverty can cause as much mental confusion and neurosis as rhe bewilderment of possessing several million dollars” (quoted in Doyle, pp. 182-183).[v]   Wertham introduced the phrase “positive mental health” to describe his work.  What he meant by this was the aspiration not to understand patients in terms of what was wrong with them.   On the contrary, as he put it, the clinic would seek to produce “fighters against the debilitating ghetto.”

The clinic came into being through the confluence of different, not obviously consistent parts: scientific psychiatry, revolutionary politics, and socially minded religion.  It is not hard to imagine how difficult it must have been to hold onto the tensions of such an unwieldy, but forward-looking project.  Moreover, I do not want to obscure some of the philosophy that we might want to question, like the assumption of race-blind universalism, which Wertham espoused, emphasizing the similarity of all humans underlying the heavy weight of oppression.  Doyle also reports on clinical material from the clinic that is dismaying, where it seems that a therapist was persistent in pushing a lesbian patient to become heterosexual.[vi]

A final point about questionable aspects of the Lafargue clinic is its association with Wertham’s infamous condemnation of comic books.  His vehemence was as tone-deaf as Adorno’s attacks against jazz.  However, Wertham was not completely mistaken in detecting instances of vicious racism in popular culture.  It would take us too far afield to explore Werthan’s complicated personality.  He was a person capable of profound psychological insight, for example, in articulated the phenomenon of a “catathymic crisis,” where someone feels the compulsion to commit a violent act as the only way to find relief.  Just think of the multiple, mass shooting in which this seems to capture the motivation accurately.  Wertham also had notable flaws, running into personality conflicts wherever he worked, and no doubt, too full of chutzpah to be culturally humble.

How can we assess the legacy of the Lafarge clinic?  One clear, moving positive contribution occurred with Wertham’s experiment and testimony, comparing black and white children, that contributed to the Delaware segregation cases that preceded the Brown vs. Board of Education decision in Topeka.  According to Mendes, Wertham’s testimony proved critical to the judge, and was, in fact, cited by Chief Justice Earl Warren subsequently in Brown vs. the Board of Education, when the Supreme court ruled against segregation.  Wertham made the argument that black children experienced segregation as punishment, but he also claimed that segregation was unhealthy for white children, leading them either to be guilt-ridden or dismissive toward black people.  Ultimately, Wertham’s contribution came to be overshadowed by the Clark’s groundbreaking research, but Mendes stresses that it was pivotal and is deserving of recognition (p. 126).  After his testimony in Delaware, Thurgood Marshall wrote a letter to Wertham to thank him, and Jack Greenberg, the attorney aiding in representing these cases, made a point of correcting Wertham’s obituary, by noting his contribution to the battle to end segregation. 

I am not a historian and would be curious to learn more about the differences between the Clarks and Wertham, and their respective clinics, which began at the same time.[vii]  The Clarks’ clinic, Northside, saw only children, whereas Lafargue saw adults and children; they also differed in Northside being a more fully developed clinic, the beneficiary of greater funding, whereas Lafargue operated only two evenings per week (though saw over 2000 patients in the 12 years of its operation).[viii]  Although the Clarks used projective tests in their research, they saw themselves as committed social scientists and were less invested in maintaining a psychoanalytic identity.  Although Wertham’s psychoanalysis was hardly conventional, he was devoted to tuning into the subjective experience of patients in a way that was profoundly psychoanalytic.[ix]

The story of the Lafargue clinic continues to fascinate anyone who hears about it.  It was an audacious venture, bound to slam hard against the white supremacy of the time, but managing to leave its mark.  The respect for the emotional and psychological health of people, regardless of their economic circumstances, echoes down to the present.  African Americans’ access to decent healthcare, especially mental healthcare remains deeply problematic.  Wertham intuitively understood that while racism fostered material deprivation, it is sustained by denying the subjectivity of others.[x]  The saga of the Lafargue clinic has special meaning to me, as the doctoral program in clinical psychology at the City College of New York (CUNY), where I was a student, served as the Director, and continue to teach, in many ways has extended their work.  The clinic continuously run by the doctoral program in clinical psychology since its inception in the mid-60s, originally was located at 135th St. and Broadway, just a few blocks away from the Lafargue clinic (it is now located in the North Academic Center, between 135-138th St. and Amsterdam Avenue, on the campus of CCNY).  Patients pay minimal fees and are treated with an approach that has always tried to preserve and work within the tensions between twin commitments to psychoanalysis and social justice.  At the Psychological Center, we value diagnosis in the way we understand patients, but we believe that we can best help people by paying close attention to contextual factors in their lives and to aspire to treat the whole person.   There is no direct influence that can be established between the Lafarge clinic and the Psychological Center.   However, in bringing renewed attention to the Lafarge clinic, I recognize that it belongs to an era that has past but am left with an awareness of the power of emotional and psychological health as intrinsic to a thriving democracy.  We lack resources as much as the Lafargue clinic did, but we retain the same faith that our job is to help patients find their voices and become self-aware, informed advocates for their communities.

[i] Focusing on the culture of white supremacy is not meant to suggest that I fail to see merit in contesting it economically, that is, making the case for reparations.   

[ii] I confess to a certain obsession with obituaries, which I do not experience as morbid.  It is helpful to see the expanse of a human life in order to assess its value.  Aristotle mentions the wisdom of Solon “to wait to the end,” that is, until after someone dies in order to assess whether he/she/they were happy.  Aristotle worries that Solon’s point leads to the paradoxical conclusion that it is impossible to be happy when one is alive.  Fair enough, but it remains the case that having the complete arc of a life is illuminating.  

[iii] My account will rely on G. Mendes’ (2015) detailed history, Under the Strain of Color: Harlem’s Lafargue Clinic and the Promise of an Anti-Racist Psychiatry.(Ithaca, NY: Cornell).  Also see the New York Public Library: http://archives.nypl.org/scm/20726.  Naming the clinic after the Cuban born socialist, Paul Lafargue, was intended to highlight the social and political views of the founders.  It is strange, though, for a mental health clinic to be named for someone who jointly committed suicide with his wife (who happened to be Karl Marx’s daughter).  

[iv] Wertham and Wright were introduced by Ella Winter, a relative of Wertham, who was a radical journalist, married to Lincoln Steffens.  

[v] D. Doyle (2009). “A Fine New Child”: The Lafargue Mental Health Clinic and Harlem ‘s African-American Communities (1946-1958) J Hist Med Allied Sci, 64(2):173-212 (doi: 10.1093/jhmas/jrn064), and D. Doyle’s (2009). "Where the Need is Greatest": Social Psychiatry and Race-Blind Universalism in Harlem's Lafargue Clinic, 1946-1958.Bull Hist Med. 83(4):746-74. (doi: 10.1353/bhm.0.0276).  

[vi] Not all the cases are cringeworthy, and Doyle acknowledges that he was selective in his review of the cases.  One interesting case is with an African American therapist who chooses to introduce the issue of race while working with a white patient.  I am guessing that white therapists at the Lafargue clinic would have been reluctant to introduce race as relevant part of the transference-countertransference matrix.  

[vii] For an excellent history of the Northside clinic, see G. Markowitz and D. Rosner’s Children, Race and Power: Kenneth and Mamie Clark’s Northside Clinic. (New York: Routledge, 2000).  

[viii] One interesting overlap is that the Reverend Sheldon Hope Bishop’s daughter, Elizabeth Bishop Davis, was a psychiatrist and psychoanalyst who worked at Northside, and later became the head of the newly created department of psychiatry at Harlem hospital.  See more details at: http://www.columbiamedicinemagazine.org/features/spring-2016/women%E2%80%94long-denied-role-ps%E2%80%94helped-shape-medicine-20th-century.  

[ix] Wertham’s relation to psychoanalysis is complicated and has not been explored in depth, as far as I am aware.  He had what he referred to as “analytic inspection” (whatever that means!), but never actually underwent psychoanalysis as a patient.  He remained skeptical of psychoanalysis for minimizing the social in its overemphasis on individual differences, on the one hand, and biology, on the other hand.  

[x] As Wertham noted: “Negroes are not allowed the luxury of neuroses…the official history is that they are just unhappy, or that they need housing, or they feel downtrodden” (quoted in Mendes, p. 13).