Benjamin Rush - Myths Turned Into Propaganda

  

If you are a casual reader of this blog, you may not have noticed a large post in the past that was dedicated to countering common antipsychiatry propaganda that involved Benjamin Rush (1746-1863).  Rush was a physician who was a participant in the Continental Congress and a signer of the Declaration of Independence. He is considered both a Founding Father and the Father of American psychiatry.  In the latter case, I have expressed the opinion that he was not really a psychiatrist and that his methods as a physician were somewhat primitive – particularly the propensity for bloodletting that he encouraged his own physician to use. Of course, writing this in 2023 and calling his 18^th century methods primitive is an easy task and I am sure that if civilization lasts – 24^th century physicians may say the same thing about the current practice of medicine.  The reason why Rush’s connection to psychiatry has persisted is that he was an important historical figure and prolific writer, he made useful observations about alcoholism and the care of patients with mental illnesses in his time and provided asylum care.  He was considered one of the most prominent physicians of his time.  There is also overlap between Rush’s lifetime and the American Journal of Insanity (1844-1943) – the precursor to the American Journal of Psychiatry. 

His historical prominence  was probably the reason the American Psychiatric Association (APA) incorporated Rush and his image into various seals, certificates, and awards.  As an example, I have two medals and two certificates that contained his embossed image and name from the APA.  These same considerations are probably why the detractors of psychiatry have either made up stories about him or interpreted his work in the most negative possible light. Much of that rhetoric has been so successful that it now exists in the psychiatric literature.  In a 2015 rebranding the APA dropped Rush's image from its logo - but retained the image for ceremonial purposes. 

Rush has been a target of antipsychiatry criticism and rhetoric since the 1970s. Some of the most enduring but inaccurate tropes have been about him – most notably involving the invention of the condition negritude and being affiliated with Samuel Cartwright – a southern proslavery physician who promoted the concept of drapetomania or a disease that caused slaves to want to run away and the need to treat that condition with physical coercion.  Szasz successfully developed both conditions into antipsychiatry tropes in a 1971 paper.  Both are still actively used today as antipsychiatry critics seek to tie modern day psychiatrists with racism and social injustice as well as early physicians who were not really psychiatrists.  By my estimate the discipline has existed in the US for about 100 years.  These tropes have been so successful that they have found their way into professional literature including the flagship journal of the American Psychiatric Association – The American Journal of Psychiatry.

Here are a few examples of the inaccuracies:

“Of particular interest was Benjamin Rush (considered the father of American psychiatry), who believed that Black skin was a mild form of leprosy that he called “negritude,” which could be cured only by becoming White. An apprentice of his, Samuel Cartwright, coined the diagnosis “drapetomania,” a mental illness that caused Black slaves to flee captivity. After the Civil War, the frequency that severe mental illness was found in the diagnoses of patients admitted in the country’s first psychiatric hospital for Blacks patients—Central Lunatic Asylum in Petersburg, Va.—raises an important question about whether Black patients were overdiagnosed with severe mental illness, as they have been in modern times. In addition, numerous references can be found to the hypothesis that mental illness in the Black population increased substantially with the end of slavery.” (1)

“In 1851, Samuel Cartwright, a prominent Louisiana physician who had studied under Benjamin Rush but was not a psychiatrist, identified two mental disorders peculiar to slaves: Drapetomania, or the disease causing blacks to run away, and Dysaethesia Aethiopica, or the condition that accounted for laziness among slaves. Such diagnoses, of course, were racist pathologizing of reasonable behavior.” (2)

“Cartwright’s theories were embraced in the slave states and mocked in the free states, including in medical journals,” Geller said. “APA was silent, and that is our shame. They were silent then, and we have been silent for 176 years.”

In fact, Cartwright’s theory was not embraced in either group of states, it was not a diagnosis that was used.  The APA and psychiatry did not exist. (3)

“Over 60 years after the ratification of the U.S. Constitution, physician Samuel Cartwright played a prominent role in the rise of racism in the field of psychiatry. His descriptions and characterizations of mental health conditions in enslaved Africans, particularly drapetomania, which he described as the illness of enslaved people wanting to run away and escape captivity, and dysaesthesia aethiopica, a disease of “rascality” or laziness in enslaved Africans, were the beginning justifications of pathologizing normal behavioral responses to trauma and oppression. These “diseases” paved the way for long-standing rationalization of harsh, inhumane treatment of mental illnesses in communities of color; Cartwright’s prescribed treatment for both conditions was whipping (22). The historical origins of racism in psychiatry set the stage for instances of structural racism that impact the diagnosis, management, and treatment of mental illnesses and substance use disorders to this day.”

If you consider Cartwright to set the “historical origins of racism in psychiatry” then there is no structural racism in psychiatry. (4)

“In 1792 Benjamin Rush, considered the father of American psychiatry and the best known physician throughout America in his era, proclaimed that Black skin was actually a disease. Rush was a remarkable mix of contradictions. He was an ardent abolitionist who owned a slave. He spoke out on the position that Blacks were of equal intelligence and morality as whites. Nonetheless, he created a disease called negritude, a disease whose cure was turning a Black person white.” (5)

“I consider Cartwright's "Report," and especially the two diseases afflicting the Negro that he discovered, of special interest and importance to us today for the following reasons: first, because Cartwright invoked the authority and vocabulary of medical science to dehumanize the Negro and justify his enslavement by the white man; second, because the language and reasoning he used to justify the coercive control of the Negro are identical to those used today by mental health propagandists to justify the coercive control of the madman (that is, the so-called "psychotic," "addict," "sexual psychopath," and so forth); and third, because Cartwright's "Report" is the sort of medical document that has, for obvious reasons, been systematically ignored or suppressed in standard texts on medical and psychiatric history

One such omission, discussed in detail in The Manufacture of Madness, is Benjamin Rush's theory of Negritude, according to which the black skin and other physical "peculiarities" of the Negro are due to his suffering from congenital leprosy (1, pp. 153-159).”

Any serious historical look at the diagnosis of drapetomania would show that it was ignored – even by southern physicians interested in racial medicine.  Szasz's analogy of slavery and mental illness is purely rhetorical. (6)

The tropes about Rush and his relationship to Samuel Cartwright and racial medicine seem entrenched at all levels of discussion of psychiatry including writing by psychiatrists. From a rhetorical standpoint they are used to legitimize an argument that the profession is either racist, built on a racist foundation, or did not actively counter racism when the opportunity presented itself. They are also used to suggest that psychiatric diagnoses are invalid - even though these pseudo-diagnoses by a non-psychiatrist were never used by any physicians.  Those specific narratives are false at best and fabricated at the worst.  This historical record is now clearly available and should be consulted in the future when writing on this topic at the University of Pennsylvania Benjamin Rush Portal.  If you read all the segments what I have written in this post covers only a portion of the myths.  You will also note that some of the myths are described as villainizing Rush.  I think the same characterization could apply to Szaszian rhetoric that has been applied to the entire profession of psychiatry in modern times on a repetitive basis.

While it may be unrealistic to think that historically accuracy will have much of an impact in this era of for-fame-and-profit-misinformation, I am suggesting a higher standard.  That standard is that members of the psychiatric profession and the editors of that literature should be aware of it and make the necessary changes.  I am fully aware of the current concerns about structural racism and building diversity. That cannot be based on a false narrative.  In fairness to Rush, I think it is necessary to set the historical record straight as his biographer Stephen Fried has done. Like most of the historical figures I write about on this blog – I see him just as that - with no relevance to modern day psychiatry.  Anyone reading Fried’s detailed biography of Rush will see him as a progressive thinker that would probably easily maintain that description even in today’s polarized political climate.

    

George Dawson, MD, DFAPA

 

 

References:

1:  Dike CC.  Misuse of Psychiatry.  Psychiatric News. Published Online:23 Apr 2022 https://doi.org/10.1176/appi.pn.2022.05.5.30

2:  Jeffrey Geller, MD, MPH. The Rise and Demise of America’s Psychiatric Hospitals: a Tale of Dollars Trumping Decency.  Published Online:26 Feb 2019 https://doi.org/10.1176/appi.pn.2019.3a36

3:  D’Arrigo T. Black Psychiatrists Call on White Colleagues To Dismantle Racism in Profession, APA.  Psychiatric News Published Online:23 Jun 2020 https://doi.org/10.1176/appi.pn.2020.7a34

4:  Shim RS. Dismantling Structural Racism in Psychiatry: A Path to Mental Health Equity. Am J Psychiatry. 2021 Jul;178(7):592-598. https://doi: 10.1176/appi.ajp.2021.21060558

5:  Geller J.  Structural Racism in American Psychiatry and APA: Part 1.  Psychiatric News.  Published Online:23 Jun 2020 https://doi.org/10.1176/appi.pn.2020.7a18

6:  Szasz TS. The sane slave: An historical note on the use of medical diagnosis as justificatory rhetoric. American Journal of Psychotherapy. 1971 Apr;25(2):228-39.

 

 

Supplementary:

I decided to include a section on Rush’s theory of black skin color to avoid the typical gotcha arguments from antipsychiatrists.  These arguments are contained in the reference below and I have supplied a link where you can download the entire paper. Context is always important when considering the medical, social, or political opinions from over 200 years ago.  The important contexts would include prevalent racial bias that obviously persists today, and the lack of important medical advances including germ theory, general pathophysiology, and medical genetics. 

He opens by referencing An Essay On the Causes Of The Variety Of Complexion and Figure In The Human Species by Rev. Samuel Stanhope Smith, DD – a professor of moral philosophy.  The essay is a book the content of which was based on a previous lecture given on February 28, 1787.  Rush touches on the four main causes listed in this text – climate, state of society, diet, and diseases.  Citing a moral philosopher and clergyman is not an ideal start to an opinion piece on pathology or pathophysiology, but it forms the main outline of his essay.

He suggests that the color and figure “of that part of our fellow creatures who are known by the epithet of negroes, are derived from a modification of that disease, which is known by the name of Leprosy.”  He says the leprosy outbreaks in Europe in the 13^th and 14^th centuries were caused by “unwholesome diets.”  He observes that “in some instances” leprosy causes a black color of the skin and that some Africans have other symptoms. He notes Biblical and real world observations describing inconsistencies in skin color. He suggests that “insensibility” as a feature of leprosy (meaning sensory neuropathy) may explain why people with African origins have a lower pain sensitivity.  He also connects leprosy with “strong venereal desires” and suggests this is also true in people of African origin.  He comments that leprosy can produce characteristic skin changes in whites as well and notes that matted hair in people of Polish descent is a sign.  He notes the longevity of the illness and that it took 3 to 4 generations to clear in Iceland.  He gives other examples of physical signs that are locally transmitted among ethnic groups.

He anticipates the objection that leprosy is an infectious disorder but that does not appear to be the case in Africans by saying that it has “ceased to be infectious” but also that there are exceptions in the case of mixed-race couples where white women acquired the features and skin color of their black husbands. Since he expects that leprosy does not significantly affect longevity he expects these traits to continue.  The causative bacterium for leprosy (Mycobacterium leprae) was eventually discovered in 1873 by Hansen.  The genetics of skin coloration was not discovered until the 21st century.

These are clearly very weak and biased observations.  Rush’s conclusions based on these observations are interesting.  First, claims of superiority of whites based on skin color are “founded in ignorance and inhumanity.” He suggests that if a disease is causing this difference “it should entitle them to a double portion of our humanity, for disease all over the world has always been the signal for immediate and universal compassion”.  Second, the facts outlined should teach white people to not keep intergenerational prejudices. Third, science and humanity should unite to find a cure for the disease, but the science at the time was non-existent. He goes on to list several anecdotal approaches.

Rush ends his paper speculating about how curing this disease of leprosy producing blackness would add greatly to the happiness in the world and that of people with African ancestry.  He qualifies that by noting that black people seem to prefer their skin color to white. He wraps it up in a Biblical myth at the end to say:

“We shall render the belief of the whole human race being descended from one pair, easy, and universal, and thereby not only add weight to the Christian revelation, but remove a material obstacle to the exercise of that universal benevolence which is inculcated by it.”     

This was 60 years before Darwin's Origin of the Species. It is doubtful than anyone at the time had a theory of how isolated groups of humans might evolve with different characteristics.

Although Rush did not technically invent a disease or word called negritude or suggest that it was responsible for skin color in African Americans – he certainly proposed what I would characterize as an off-the-wall theory.  His writing further suggests that a solution of universal white skin would allow for a more harmonious existence – with less discrimination and that would be a solution to the problem of racism. It is an overly simplified and biased solution by today’s standards.  Since Rush was obviously not racist the logical explanation for this opinion is a significant knowledge deficit and speculating outside of his lane.     

 

Rush B: Observations intended to favour a supposition that the black color (as it is called) of the Negroes is derived from the leprosy. American Philosophical Society Transactions 4 (old series): 289-297, 1799.  Link directly loads PDF:  https://canvas.emory.edu/courses/86982/files/5134312/download?download_frd=1