PHYCHIATRY COMES TO HARLEM

by RICHARD WRIGHT We hear much of "minorities" "minority rights." And we think of the Italian minority in Yugoslavia, or the Muslim minority in India. But we need not go so far afield. Here is a case study of merely one of the problems of one of the minorities in our own democracy, in our own New York City.

T would be far easier to confiscate private in guises as fantastic as the images of a nightproperty than to violate, under however mare. This mechanism, of course, is an old story. laudable a pretext, the contemporary metaphysical canons of organized medicine in Amer- We are familiar with the technique by which ica. Even if the pretext be that of chronic our Constitution becomes more sacredly idealhuman need, glaring and scandalous, the ized in direct ratio to the means adopted to cirsteady, unblinking eyes of American medicine cumvent its essential spirit and meaning. Indeed, one could state without a tinge of would look past that need and say in a toneless, neutral voice (as one doctor actually said cynicism, that the more idealistic the haze surto me): "We must wait. These things must rounding a public question, the more likely be done in a slow, sound, traditional manner." one is to find at its core corruption, ignorance, And the need would remain, fester, spread, moral timidity, profit-seeking, and even just while the canons of organized medicine would plain stealing. continue to loom pure and unadulterated. Thurman Arnold, in his Folklore of Capitalism, says in effect that the more idealistic O N E of the least thought of and most obvious men wax in defending an institution, the more examples of "idealism protecting corruption" one should suspect that that institution has is that of the total lackuntil very recentlyof become separated from the needs of reality any real, sustained psychiatric aid for the 400,and is serving narrow, anti-social ends; and 000 hapless black men, women, and children the more our institutions are divorced from the who inhabit a ghetto popularly known as needs of reality, the more urgently will men, Harlem. For more than 10 years a demanding responding to the desire to meet the needs of yell has gone up from social reformers, doctors, reality, devise sub rasa, almost lawless or crim- and the clergy that a mental hygiene clinic was inal methods to service the community, to heal needed to serve the artificially-made psychologthe sick, to aid sufferers, to defend the victims ical problems of Harlem; that Harlem's 400,000 black people produced 53% of all the juvenile of injustice. deliquents of Manhattan, which has a white population of 1,600,000; that, while in theory PSYCHOLOGICALLY, repressed need goes Negroes have access to psychiatric aid (just as underground, gropes for an unguarded outlet the Negroes of Mississippi, in theory, have in the dark and, once finding it, sneaks out, access to the vote!), such aid really does not experimentally tasting the new freedom, then exist owing to the subtle but effective racial at last gushing forth in a wild torrent, frantic discrimination that obtains against Negroes in lest a new taboo deprive it of the right to exist. almost all New York City hospitals and clinics; As with the human personality, so with human that it is all but impossilale for Negro internes institutions which seek to administer to human to gain admission to hospitals to receive their needs. Social needs, too, go underground when psychiatric training; and that the powerful they have been emotionally or morally rejected, personality conflicts engendered in Negroes by only to reappear later in strange channels and the consistent sabotage of their democratic

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1946

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aspirations in housing, jobs, education, and social mobility creates an environment of anxiety and tension which easily tips the normal emotional scales toward neurosis. H OW did this situation come about? What excuses are offered to keep it in being? How does organized medicine explain it? The following summarized list of medical objections to establishing a mental hygiene clinic in Harlem might well seem sadistic, but it should be remembered that these objections are uttered not only with straight medical faces, but, indeed, with moral solemnity. First, it is argued that the establishment of a mental hygiene clinic in Harlem must wait upon the training of Negro psychiatrists to man such a clinic. Yet it is doubtful if there are eight practicing Negro psychiatrists in the entire nation; race hate and the quota system of our medical schools have made it well-nigh impossible for a Negro to receive such training. Second, despite the endless flow of black mental patients to our state and city hospitals, doubt is expressed that need for a clinic in Harlem is acute, for it is traditionally assumed that Negroes would naturally account for a large proportion of the mentally ill. After all, aren't Negroes "pleasure-loving," "lazy," "shiftless," naturally inclined toward crime, slow of comprehension, and irresponsible? (I take these adjectives from official psychiatric court reports.) Third, it is ironically charged that the establishment of a mental hygiene clinic in Harlem would be tantamount to extending the already well-set pattern of racial segregation, and aren't we all today opposed to segregation? (It is neatly overlooked that Harlem itself is an artificially made community!) Fourth, it is contended that the nowexisting institutions serving the mentally ill must be made to give up their racial prejudices against Negroes. This contention is not only blatantly ironic, but playfully sadistic, for no lawand there are anti-discriminatory laws prohibiting such practicescan possibly cope with the manifold dodges used by institutions to deprive Negroes of treatment. It is a matter of record that many institutions have dosed down deliberately rather than extend equal treatment to Negroes.*
* Dorothy Norman, N. Y. Post columnist, writing in the June 26, 1944 issue, cited the following: " I n October, 1942, a Race Discrimination Amendment went into effect, denying city funds to private child-care agencies which refused to take Negro children on the same basis as others. Seven private agencies have refused to accept city funds rather than obey this law."

Fifth, many psychiatrists become dangerously defensive when pressed about their racial prejudices in relation to Harlem. They assert that the psychiatric needs of Harlem, despite figures to the contrary, are not more acute than those of any other section, and that anyone who says the opposite is merely trying to single Harlem out for special aid, which indicates, they claim, over-sensitivity. Sixth, it is stated that there are many private white psychiatrists available to serve the people of Harlem, and if the fees charged by these psychiatrists are rather high for poverty-stricken Negroes, then it should be remembered that payment of psychiatric fees is considered an indispensable ' part of the psychotherapeutic process. And on and on . . . WE know now some of the "ideals" that are being protected, but what kind of corruption is bred when "idealism" blocks the extension of services to a needy area? With the city of New York walled racially against them, Harlem's emotionally disturbed must turn blindly to what is nearest at hand for help; to the hordes of petty politicians and racketeers; to fantastic forms of violent self-help (crime); to the embracing of ever wilder outlets of racial emotionalism which drives the bewildered men and women to demagogues; to the creation of juvenile gangs which are schools of crime; to trivial bribery; to the "pay-ofE" system; to thievery; to "log-rolling"; to cynicism; to the formation of ever more infantile brands of religion (Father Divine) and politics (varieties of nationalism); and, in the end (as can be seen in the volatile conduct of Harlem during the war), to racial outbursts which can be described as brutal instances of spontaneous social therapeutics. This paradox of "idealism protecting corruption" held fast for Harlem until there occurred to the one psychiatrist who is striving to build a "social psychiatry," a bold, sub rosa idea as to how to break the deadlock and subvert the defensive "idealism" of psychiatry in New York City. Dr. Frederic Wertham, one of the nation's leading psychiatrists, devised a stratagem that was extraordinary in its directness, simplicity, honesty, and passion to serve. Wertham's attitude is that psychiatry is for everybody or none at all. He came to the conclusion that "reform is possible only if one keeps away from the reformers." After 10 years of futile pleading for the extension of psychiatry to Harlem, Wertham asked himself and a dozen or more of his friends and aides. FREE W O R L D

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"if money is really necessary to start a mental hygiene clinic?" He suggested, "Why not begin without money? Let those of us who feel the need contribute our services and see if psychiatry cannot be given to the poor. Let us see if we cannot shorten the long, drawn-out methods of psychotherapeutics. There must be some way to bring psychiatry to the penniless urban masses . . ." When one recalls that modern psychiatry got on its feet through the lush fees demanded of rich patients who sought its aid, Wertham's idea is indeed radical and the reactions to his daring proposal range all the way from a denunciation of it as impossible to a branding of it as romantic. Wertham organized a staff, white and Negro, that would serve free, a staff composed of the best technical talent in the city, medical people and social workers of so high a standing in their respective fields that no one would dare question their qualifications. The next step was the securing of space in an areaHarlemwhere space is truly at a premium; at one time it seemed that the project would fail for lack of space. At last one of Harlem's prominent Negro clergymen. Father Shelton Hale, Bishop of St. Philip's Episcopal Church, made available two rooms in the basement of his Parish House for the Clinic. These rooms were considered adequate for a beginning, and the Lafargue Clinic quietly opened its doors on March 8, 1946, and is at present operating two full evenings a week. And before any publicity had been sent out, news of the existence of the Clinic had spread by word of mouth in Harlem and patients began to flow through its rooms. Within a month, appointments had piled up weeks in advance. JL HE sub rosa. methods of establishing the Lafargue Clinic amount in the main to a complete reversal of all current rules holding in authoritative psychiatric circles. No referrals are needed to gain admission to the Clinic; anyone may literally walk in off the streets and tell his troubles. A fee of 25 cents per visit is charged, and 50 cents is charged for a court appearance; but if a patient lacks this, it is waived. Though the Lafargue Clinic does exist, there is a widely prevalent feeling among many people that it does not exist; it is apparently almost psychologically impossible for many literate people to believe that a clinic could be SEPTEMBER, 1946

built without being backed by renowned committees and financed by well-known millionaires. This does not mean that the Lafargue Clinic does not need money; but it does mean that money oftimes monopolizes the attention of those who seek to build institutions to the extent of paralyzing their minds. T o date, most of the cases handled by the Clinic have been those of Negroes temporarily swamped by the Jim Crow conditions of Harlem, who would no doubt have been committed for indefinite periods of state institutions had not the Lafargue Clinic intervened. One month's intensive operation has proved that Harlem's high rates of deliquency and nervous break-down stem not from biological predilections toward crime existing in Negroes, but from an almost total lack of community services to cope with the problems of Harlem's individuals. This extension of psychiatry to Harlem must not be confused with philanthropy, charity, or missionary work; it is the extension of the very concept of psychiatry into a new realm, the application of psychiatry to the masses, the turning of Freud upside down. The Clinic has found that the most consistent therapeutic aid that it can render Harlem's mentally ill is instilling in them what Wertham calls "the will to survive in a hostile world"; that the many Negroes sink under their loads because of hopelessness, social fear, worry, frustration, and just plain hunger. Organized medicine has not yet publicly acknowledged the existence of the Lafargue Clinic, but the ofiiciai attitude can be discerned by the refusal of New York City's Department of Welfare, so far, to act upon the Clinic's application for a license. The Welfare officials were so astounded when they learned of the Clinic's operation that they have not yet issued a license on the grounds tlrat they are not satisfied with the "financial background" of the new institution. The Clinic continues, however, for its doctors are all duly licensed to practice medicine, and they are practicing it in their new and unheard-of way, donating their services freely. Maybe one day somebody with millions of dollars, prompted by a benign vanity which the Lafargue Clinic would surely diagnose as utterly normal, will come forward and financially underwrite this new idea, thereby helping to expand this social experiment in psychiatry and tear "idealism" away from corruption and weld it to human need, which is the way of passion even in science. 51

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DIVIDE and CONQUER

GERMAN STYLE
b y WILLIAM HARLAN HALE

H A T is defeated Germany worth? Judging from his recent denunciation of the French plan for separating the Ruhr, Foreiign Minister Molotov thinks that Germany is worth more than France. Secretary of State Byrnes, meanwhile, is bidding for only half of Germany; he regards the merging of the economies of the American and British zones as so important as to be worth the risk of endangering any ultimate settlement with the Soviet Union on Germany's over-all economic future. Any way you look at it, the bidding is pretty steep. There is this difference between the contestants, though: while Molotov's bidding may be done in the name of expansion, Byrnes' is being done in the name of economy. What worries the Americans in Germany is the prospect of having to manage, police and feed 15,000,000 Germans indefinitelya job which seems not only unrewarding but is actually costly to the American taxpayer. These Germans are not turning out anything like enough industrial goods to pay even for their own upkeep, let alone the costs of occupation. The Russians obviously want to attract the Germans. The Americans act as if they simply want the Germans to pay their own way. While the Russians have decided to overlook the dissatisfaction of the French Communiststheir most powerful single following abroadin exchange for the support of the German population nearer home, the Americans appear to think of the balance of power in terms of balancing the budget. So the conflict is not only between wills but between values. It is quite clear whose values are on the defensive. The Russians, placing a high bid each time, have made off with these psychological prizes: 52

First, by appearing as the champions of German territorial integrity (after having lopped off their own share) they step forth as the friends and protectors of western Germany, right under the noses of the western allies; Second, by calling for a strongly-knit, national German government, they top the western allies' bid for a loose-knit, federal administration, and set themselves up as champions of unification. Meanwhile, in fact, they have been blocking all moves in the direction of unification; Third, by boldly walking out on the allied policy of industrial removals and declaring they will now take a large portion of their reparations out of current German production, they emerge as the champions of the survival of German industryand make the undecided western powers look like vengeful Morgenthau men by comparison. In making these high bids, the Soviets know, exactly what they are after: the allegiance of the German masses. The dilemma of the western occupying powers arises from the fact that their stakes are lower and that each power has its own special stake which sets it apart from the rest. The four contenders seem to tally up like this: SOVIET UNION. Aim: T o transform all Germany into an ally by means of a national administration dominated by a Communist-led united front (the Socialist Unity Party), and controlled from Berlin. Appeal: Directed not only to left-wingers, but to all national-miijded Germans, irrespective of class. Method: Expropriation of landed and business property and its redistribution to peasants, small businessmen, etc., thus forming new property-holding classes that owe their fortune to the Soviets. Special appeals to bureaucrats and former army FREE WORLD

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