Lecture Three: The Medical Racial Script

Starting in the colonial period and crystalizing during the Republican Period, American doctors differentiated themselves from their European colleagues and from non-traditional healers by instituting a medical-racial script.  We'll discuss what the script is, how it helped American healthcare and its white male doctors to establish legitimacy, and the toll it took on the African American community.  The script will be woven throughout this course.  Nothing more united white male doctors, helped grow the American medical infrastructure and academic foundation, and imprinted on American medicine its enduring stamp than the script.  As we study the nidus of the AMA in the mid 1800's, the Progressive rise of orthodox medicine in the early 20th century, and the consolidation of modern orthodoxy, the script emerges as an often covert but powerful catalyst to the health care system we know today.

Transcript

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So today we're going to talk a little about the medical racial script. And by the way, this is a concept I kind of invented, not to take full credit, but it was the basis of my thesis for my master's degree, is the idea that this script was somewhat subconsciously created, as we talked about in the colonial period, but really hit its stride during the Republican period, which we'll discuss in the next lecture, when America had to find its own way apart from Europe. Important to know that when it had its revolution, basically it severed itself from Britain, and that's where most Americans had gotten their medical education. So all of a sudden now they were on their own. And the medical racial script gave them an identity. What is a medical racial script? The historian Natalie Molina, who wrote excellent books about public health and how the public health system, especially in the late 1800s and early 1900s, was used to satisfy the goals of racial separation, especially with African Americans, Chinese, and other Asians, Jews, etc., define the racial script as something that is normalized in America. That there was a script that essentially said that races other than white were somehow non-human or subhuman, and that treating them like whites was not necessary and in fact could be dangerous. She writes, racial scripts work in part because they are not wholly new. Their familiarity itself generates credibility. Making ideas about race that might otherwise be considered outrageous or flagrantly racist seem normal. Racial scripts make it possible and permissible to consider racist ideas as simply common sense, i.e., um, black people uh are able to work in warmer climates because they're biologically different, hence using slaves in those climates makes medical sense. Uh and and when we add the medical racial script to this, now we look at that same concept through a medical lens. So we're looking at black bodies as somehow being different. And the difference itself is crucial to this. You know, what is the difference? So let's talk a little background stuff about um what what this means. Uh because the idea of alterity is a crucial word that I kind of learned recently, but essentially is a word that means separation. Using someone, some other group's differences to somehow create cohesion through the dominant group, i.e. the white group. Isabel Historian, who's written wonderful books about the African-American migration after uh World War I to the North, also her recent book, CASET, 2024, says that racism in this country comprised not a series of acts or statements, but an entire fabric of myths. The key is myths, that these myths became legitimated essentially through a medical scientific lens. So what could be considered a myth now was validated by early American doctors into scientific reality. Um, historian uh Yuvil Noah Harari, who is well known for his book Sapiens, and if you haven't read it, I strongly recommend it, uh, wrote um more recent books. Uh, one of them is called Nexus, which was actually published in 2024 also, talking about communication. But he talks about how, and I quote, racism pretended to be an exact science. It claimed to differentiate between people on the basis of objective biologic facts. But the cloud of numbering categories was just a smokescream for absurd intersubjective myths. What does that mean? Intersubjective myths are myths that have no basis in reality, but have been stated over and over again to become norms. And Foucault, and you can't have a cleanse without talking about Foucault, and we'll talk about them more. Foucault talks about how liberal society essentially was built on the idea of creating myths to unite the white population and make them compliant to a single idea. And we'll talk about that more later, but it's really crucial when we see the development of the AMA and the formation of a cohesive orthodox medical establishment in America. Racial capitalism also plays in. Other writers such as Cedric Robinson and, of course, W. B. Du Bois, talk about how through Americans, America's evolving capitalist system, it was essential to create white unity by creating an intersubjective myth that posed African Americans with, infused them with alterity, differentness, in a way to pull white people together. As Du Bois says, white people gained access to what he says, quote, a sort of public and psychological wage, earning titles of courtesy and power simply by being white. Well, see, in the medical world, this translates to the fact that white doctors, in a sense, elevated themselves by differentiating themselves from black healers. It gave them credence, it gave them power by creating this oppositional binary. Their medicine, their very bodies, were different than those of black people, hence superior and believable. Historian Susan Craddock states, and I quote, used in his accuracy toward the already deviant, disease intensifies the rhetoric of hatred, fear, and blame utilized against undesirable populations. It shifts the quality of this rhetoric from the socially constructed to the medical, medically legitimated, from a vaguely, if forcefully defined rationale of difference to a rational basis for surveillance, control, and exclusion. In other words, by medicalizing blackness, and that's a word that Rona Hogworth in her book, Medicalizing Blackness, really relies on, that black becomes a disease. A disease not only that legitimates the exclusion of African Americans from the entire healthcare system, but also a disease that can be studied and explored for several reasons. One, for the basis of scientific research, two, to protect the white population, i.e., these diseases can be spread. So if we understand them, we can actually prevent their spread to the whites. It was all about helping whites, right? And that's a message that sold well in colonial and early Republican period. Hence, doctors used it. We are going to protect you from these diseased people who we brought over to toil the soil for us. They are, by the way, the only people who could toil the soil because we have scientific proof that they could survive when white people can't in certain environments. But we have to keep them contained. We have to understand their biology, much like we would with other animals. And that's kind of how they talked about it. Looking at the discussion, the the debate between Thomas Jefferson and his good friend Benjamin Rush is kind of illustrative of this. Um, if you don't know about Jefferson, you can read some stuff from uh his notes on Virginia, which I think are in the suggested readings. Um what he says might be shocking uh to people who read them, given that this guy has a has has a monument in DC. But I mean he believed that black people had more in common with orangutans than white people, that they preferred to have sexual encounters with orangutans rather than white people. Um, that that's how they should be viewed. He believed that um that blackness was inherent uh to um uh the body, that it could not be removed, that it was that it was deep in the body and hence um unremovable. So Jefferson wrote um in this uh that quote the blacks, whether originally a distinct race or made distinct by time and circumstance, are inferior to the whites in the endowment both of body and mind. He was actually a what we call a polytheist. He believed in two separate creations, black and white, were created on different times. And again, believed they were animals, and he experimented on them. He even separated uh children from parents and believed that the parents would not be upset. Much like an animal, they'd grieve for a couple days and then be okay. That was Jefferson. Rush, who was his good friend, Rush was an abolitionist. Rush was one of the founders of the University of Pennsylvania, one of the first schools in America, um, truly a pioneer, um, and was a friend to the black community in Philadelphia. But he did not believe in inherent racial differences deep down. He believed they were skin deep. In fact, he considered blackness a form of leprosy. He and others experimented on black people to try to remove or to somehow bleach their skin with the hope that they would become whiter. Um, and he um also believed that they were immune to certain diseases. In fact, in a tragic episode, he sent um a bunch of black people into Philadelphia uh during um an outbreak uh of disease, believing they were immune, and uh they ended up all dying, which he didn't attribute to um anything more than just circumstance. He's he held to his beliefs uh of difference. So difference was inscribed in the medical liturgy from the beginning. Whether the difference was skin deep or whether it was um deep down became the debate, not whether it existed. And and by the way, Jefferson's view won in the medical world uh ultimately. Um liberalism that developed in America and and across the world was somewhat dependent on this delineation of difference. Um again, Foucault talks about how homogenization of a certain population to try to get the white people into a single unit that was compliant with the nation. Remember, we had a nation that was now a democracy and we needed compliance, and it was done through this form of liberalism that that it was somewhat dependent on marginalizing other groups. Um what he says, the Enlightenment, which discovered the liberties, also invented the disciplines. In other words, to have the liberty, we have to discipline. And other people go further than that. Um Lisa Lowe, for instance, uh wrote that um that inequity, inequities among populations occur, quote, from processes through which the human is freed by liberal forms, while other subjects, practices, and geographies are placed at a distance from the human. As modern liberalism defined the human and universalized its attributes to European man, it simultaneously differentiated populations as less than human. And that became kind of the the very nidus of the racial script. The script we talked about in the last talk that emerged during the colonial times was that blackness was a disease, um, that black people were a threat to white people, uh, that we need to study them. Experimentation was crucial, uh, and that black healers um uh as an inferior group of people who are dangerous should not be allowed in the medical profession or not be allowed to practice medicine at all, including on plantations. That's a two-pronged nature of the script: racial difference and demonization of African-American providers. Remember those two because they they come up and up again. Um it's illustrative that Benjamin Rush, again, who was prominent in the University of Pennsylvania, never even considered admitting an African-American to that school, which didn't occur for a hundred years, um, well past his death, even though he was an abolitionist. A lot of people have talked about this racial script being a means of um perpetuating slavery, and certainly there was something to be said for that. But the fact is that it was in the North and the South, even shared by abolitionists like Rush. It was universalized by the entire medical system. Difference became scientifically validated. Um, and this again, we have to always, when we talk about medical science, realize that it is completely subjective. That people create medical science, and this is true even today, as we'll get to, they create it to satisfy an agenda. And in many ways, the medical science that developed in America satisfied the agenda of racial difference, which was crucial to uh legitimate the different populations, white and black, needed to be separated, whether in the north or south. Again, even in the north, separation was the norm. The emergence of respected medical thinkers and researchers in this country was completely dependent on the science of medical racial difference. And that helped create an academic medical world in this country. Understand that the medical schools that were created also depended on black bodies for both live and dead, again for experimentation and also for dissection, um, and spread a corpus of ideas of racial difference. Um, you look at the Southern Medical Journal in 1836, half the articles were based on experiments done on black bodies. The father of American gynecology, who is also the head of the New York Medical Society, president of the American Medical Association, his statue still stands in Central Park across from the uh New York Medical Academy. His name was Marion Jane Sims, and um he gained all his expertise, his development of gynecologic techniques by experimenting on slaves without anesthesia and in a cruel way that caused massive harm to them. He didn't believe black women felt pain, something that has also found its way through the medical liturgy. It's interesting, his biographer, Deirdre Cooper Owens, um, says even today, as a woman of color, doctors feel that she is more insensitive to pain than white people. Um, but she she writes something very interesting in her book that is cited uh in the readings, a fascinating book, um, uh, and it's called Medical Bondage, basically about Sims. She writes, quote, gynecologic surgeons during the early and mid-19th century were neither exceptionally cruel nor statistic physicians who enjoyed butchering black women's bodies, as some scholars have argued. They were elite white men who lived in an era when scientific racism flourished. And that scientific racism was the medical um dogma that there were differences. That again, that was the racial script that was in there. And we see in the early 1800s several prominent American researchers who gained prominence not only in this country but uh but abroad, who completely did their work on proving racial difference. And we'll see this again in the Civil War. Same thing happened. Abolitionists fighting for the Northern cause were experimenting on black bodies even then. Um, again, not a north-south thing necessarily. Uh Lewis Agus Agas's, um was a um Harvard professor uh and did all his work on uh differentiating white and black physiology. Samuel George Morton, um, a prominent physician uh in Philadelphia who worked with the University of Pennsylvania and also um with many Europeans, used the idea of craniology using skulls to prove racial difference. Henry Ramsay um uh did all his research uh on uh black bodies and became prominent in Europe. Samuel Cartwright also invented diseases. One disease he invented was called drapatomenia, which he continued caused slaves to run away. He felt like when slaves um and African Americans in general exhibited behaviors that were either opposed to their subjugation or that made them resist toiling, that these were diseases that were unique to black people and he was going to show them. Um, I have in the reading uh uh something by Christopher uh Willoughby and his book, Masters of Health, is truly one of the most eye-opening books you'll ever read. Um, but he he looked at medical curriculum, medical theses during the 1800s um and found that north and south medical difference between black and white was enshrined. It became uh the norm. There was no debate about it. The the Rush Jefferson debate, again, was a superficial one. So is it the skin or is it the body? And it evolved to become the Jefferson, it is the body. You cannot change black bodies. They are diseased people who will spread disease and all the research and a lot of what happened in medical school was predicated on that difference. He writes that um racial difference, quote, instead of a niche field, was a foundational part of the fabric of U.S. medical training, a part that was spread through the mundane operations of institutional medical education, and that once medical students graduated, they acted as foot soldiers for racial science and medicine, and they were part of an emergent managerial class in American life. They actually went through um American life uh by spreading the idea of racial difference, legitimating, scientifically legitimating this, saying there's no question. So when people were bigoted, hey, doctors are saying this is normal. You're supposed to be. Again, this is the racial script of differentiating it uh black and white, it allowed these people to find jobs, it allowed their profession to grow, it allowed them to experiment, it allowed American medical schools to be created. It was crucial to the development of uh of the American medicine's growth. Um they they also flowed into society. Example is the 1840 census, which was largely legitimated by the doctors at the time, and um it derided African Americans as dangerous, sick, and likely to become extinct. Uh, something that uh Calhoun used to prove that scientifically slavery was necessary. Because this census actually came up with the idea that enslaved blacks were much healthier and psychologically better off than blacks who were freed. Um again, that be that that flowed from this medical-racial script. It was nothing that um that that became that was that was done outside of a scientific framework. Calhoun, in fact, called the abolitionist um misinformers. We've heard that word before, during COVID, especially, but misinformers anti-science, uh, and that he was speaking from a scientific platform, which in fact he was. So, I mean, this medical racial script is crucial to understand because it wasn't peripheral to the healthcare system in America. It was foundational. It was one of the keys to the development of academic medicine, to the development of medical schools, development of medical practices. Um, it legitimated the doctors who were poorly trained and had terrible outcomes uh as necessary to make to constrain and contain the threat, the biologic threat from black bodies. And so it helped really not only grow the medical profession, but also to unite it. And it's important to know that not everyone thought the same way medically. Orthodox medicine was evolving at this time, as we'll see. But the medical script, medical racial script, was a uniting factor. This is something to which everyone agreed. It was taught in the medical schools, it was normalized, it was legitimated. And when we see the AMA. And how it dealt with race, we have to understand that this was the primary way. So we'll get into now the origins of the American healthcare system after the revolution, what we call Republican medicine, and how that flowed into the founding of the AMA, American Medical Association, and what the AMA meant and signified. Looking forward, the AMA became the uh the architect of our medical system today. And the racial script became a large part of that. In fact, enshrined in the AMA's primary document of establishing our medical system, the Flexner Report, the racial script has a prominent role. So we'll get to uh this beginning of American medicine, and we'll talk more about this.