Medical Racism and the Ignoring of Black Pain

Education is often considered the cure for racism; a way to erase bigoted, erroneous and myth-based beliefs with colorblind facts. But biases are stubborn, deeply held things, more impervious to truth than we might like to consider. Researchers from the University of Virginia discovered this when they queried a group of 222 white medical students and residents and found that half believed in phony biological differences between black and white people, including “that blacks age more slowly than whites; their nerve endings are less sensitive than whites’; their blood coagulates more quickly than whites’; [and] their skin is thicker than whites.”

Among those who cosigned at least one of those madeup racial differences, false beliefs correlated directly with the potential to screw up medical treatments. Future doctors who demonstrated racially biased thinking were also more likely to underrate the pain levels of hypothetical black patients. The end result was that those med school students were “less accurate” — a nice way of saying “more wrong” — than their less biased peers in recommendations for mitigating pain experienced by African American versus white patients.

These findings may be troubling, but they’re not particularly surprising. Prior studies have not only shown the existence of racism in medicine — as in every American institution — but proved it to be a malignant condition with potentially life-threatening consequences for African Americans. In 2012, researchers at Johns Hopkins University School of Medicine found doctors with “unconscious racial biases tend to dominate conversations with African-American patients,” ignoring patient needs and engendering mistrust, discomfort and a decreased likelihood to return for necessary followups. Black children suffering from stomach pain are less likely than white children to be given pain medication by emergency room personnel, and Hispanic and African-American kids experience longer ER waits than their white cohorts.

Daily Beast contributor Keith Wailoo cites two 1990s studies finding “white patients… treated for long bone fractures were dosed [with pain meds] more liberally than Latino patients in Los Angeles, and more liberally than black ones in Atlanta.” The Institute of Medicine noted in 2002 that “racial and ethnic minorities receive lower quality health care than whites, even when they are insured to the same degree and when other healthcare access-related factors, such as the ability to pay for care, are the same.” Like the UVA study, numerous others have found white doctors, as well as white laypeople and even white children think black people can endure more pain than whites.

This idea of black immunity to pain is purely magical thinking, rooted in longstanding, widely circulated and scientifically baseless beliefs that essentially cast black people as something other than human. (Researchers behind one 2001 study concluded that “white Americans superhumanize black people relative to white people.”) Racist misconceptions about black people’s extraordinary tolerance for pain and suffering — what I would label a sort of “animalizing othering” — has helped rationalize centuries of cruelty and brutality against African Americans, assuaging white consciences around harsh mistreatment and reifying the fable of white humanity’s superiority. Keith Wailoo notes that backward ideas about “blood differences were once used [as the reasoning for] segregating the blood supply and to argue against racial integration.” Kelly Hoffman, the UVA psychology Ph.D. candidate who led the survey of medical students says, “These beliefs have been around for a long time in our history. They were once used to justify slavery and the inhumane treatment of black people in medicine.”

Thoroughly modern systemic racism continues to be fueled by this sort of misinformation about African-American subhumanity, detrimentally affecting black life, and in plenty of cases, leading to black death. In addition to fallacious ideas about African Americans and pain, unfounded racial stereotypes about black and Hispanic tendencies toward drug addiction also make doctors less likely to prescribe needed pain medications to people of color. The University of Dayton Law School’s Race, Racism and the Law site notes that fears based in racial stereotypes are related to pharmacies in minority communities understocking opiate medications, with concerns varying from not wanting to “attract opioid-using clients” to “fear of drug theft from the pharmacy.” A population seen as unable to experience pain encounters resistance to treating that pain on nearly every front.

If AfricanAmericans are innately more resistant to pain than other groups — and by that same supposition, more dangerous, threatening, beastial and just plain old scary — negative reactions ranging from medical neglect to police violence can be regarded as warranted. Fantastical ideas about inhuman black strength bolster shoot-to-kill policies and one-directional justification of stand-your-ground laws, while also negating anti-chokehold and other excessive force prohibitions. Under this skewed logic, unarmed black teenagers murdered by armed assailants who physically outweigh and pursued them are somehow transformed into aggressors who merited precisely what they got. African-American girls are seen as deserving physical assault and vicious manhandling by male officers. African Americans suffering from illnesses such as renal failure, cardiac disease and cancer are, studies show, less likely to be recommend curative care by their physicians than whites, even when insurance coverage is the same.

These outcomes reflect the way medical racism devastates black lives, but what’s often left out of the conversation is the unintended consequences for other communities. The simultaneous overprescribing of pain drugs to white patients has heavily contributed to the current opiate epidemic, which has primarily affected white rural and suburban communities. Over the last 10 years, almost all new users of heroin — an astounding 90 percent — have been white. Three quarters of those users originally developed opiate addictions through habitual use of prescription painkillers. As Wailoo writes at the Daily Beast about the UVA survey:

The study highlights how a confluence of mistaken attitudes — about race, about biology, and about pain — can flourish in one of the worst possible places: medical schools where the future gatekeepers of relief are trained. And it illuminates what I’ve called the divided state of analgesia in America: overtreatment of millions of people that feeds painkiller abuse at the same time that, with far less public attention, millions of others are systematically undertreated. Think of it as a pain gap between the haves and the have-nots, along lines of class and race.

What is particularly interesting about these findings is not just the implications they hold for the widespread medical undertreatment of African Americans, or the way those attitudes affect everything from policing to violence against African-American women, though those issues are of massive importance. It also seems worthwhile to consider how these ideas about pain — who is and isn’t capable of feeling it, and whose pain does and doesn’t deserve recognition — go beyond the physical. The insidious idea that black Americans are less susceptible to the pain that afflicts white Americans extends beyond the body, reaching into other areas where black suffering is also perceived not to go.

Certainly, mental health issues are often undiagnosed and undertreated in every segment of the American populace. The inaccessibility of mental health services for many Americans is a source of national shame. But while there have been strides made, depression, mental anguish and sadness are presumed to be more profoundly, and legitimately felt by white Americans, so much so that they’re often considered the reason for negative resulting behaviors. This plays out time and again when, for example, white perpetrators carry out mass shootings, and their feelings — their hurt, their isolation, their mental anguish — become a central theme of the ensuing media coverage.

The New York Times reflected on the “dark thoughts and…paranoid delusions of major depression” that may have plagued James Eagan Holmes in the weeks before he went on a shooting spree in a packed Aurora, Colorado movie theater, killing 12 and injuring 70. An op-ed from Fox News headlined “Why didn’t anyone help Dylann Roof?” — the man who killed nine African-American parishioners in a South Carolina church — acknowledged that while the shooter “expressed hateful white supremacist” views, he may also have suffered from the kind of depression that can cause “bizarre beliefs that sometimes lead to the destruction of others.” (The article goes on to suggest that “those beliefs can look just like intense hatred of a particular person or a whole race of people,” as if being a hardcore racist should be reclassified as a mental condition.)

In the wake of the Sandy Hook shootings, an investigation by the Connecticut Office of the Child Advocate resulted in a lengthy report detailing the “predisposing factors and compounding stresses” that contributed to Adam Lanza’s “commission of mass murder”:

Authors conclude that there was not one thing that was necessarily the tipping point driving AL to commit the Sandy Hook shooting. Rather there was a cascade of events, many self-imposed, that included: loss of school; absence of work; disruption of the relationship with his one friend; virtually no personal contact with family; virtually total and increasing isolation; fear of losing his home and of a change in his relationship with Mrs. Lanza, his only caretaker and connection; worsening OCD; depression and anxiety; profound and possibly worsening anorexia; and an increasing obsession with mass murder occurring in the total absence of any engagement with the outside world. AL increasingly lived in an alternate universe in which ruminations about mass shootings were his central preoccupation.

Though researchers are careful to point out that the report is not meant to serve as a statement of exoneration (“[He, and he alone, bears responsibility for this monstrous act,” they write), it suggests that Lanza’s pain, due to his parents divorce, his feelings of alienation and loneliness, played a role in his anger in isolation, and was among the motivating factors in his crime. In whole or in part, we are meant to understand that Lanza’s depression, anxiety and sadness played a role in his murderous acting out. Researchers write that numerous “interventions and services…could have and should have been delivered over the course of his life.” Compassionate statements like these, as well as the undertaking of the report, indicate a willingness to separate Adam Lanza from his crime, to see him as fully human, to investigate the underlying pain he endured that might make a person behave so abominably.

This kind of empathy is never extended to African-American victims, much less those accused of horrific crimes. Compare the Lanza report with The New York Times description of Michael Brown, the unarmed 18-year-old killed by Ferguson police officer Darren Wilson. As cultural critic LaSha notes at Salon, the Times implicates Brown as “no angel,” notes that he “dabbled in drugs and alcohol,” wrote raps that “were by turns contemplative and vulgar” and would sometimes “talk back” to his mother. The article even digs into Brown’s infancy, dubbing him “a handful” presumably because “when his parents put up a security gate, he would try to climb it” (as if this is a rarity among toddlers). The author mentions that Brown “lived in a community that had rough patches,” but declines to suggest this may have been a source of pain and site of struggle. In fact, there has been no serious investigation of Brown’s mental state, of the anguish and inner turmoil he may have experienced or coped with through self-medication.

African-American writer Trina Young perfectly sums up the frustration of witnessing this empathy gulf, and wonders about the dehumanizing effect of ignoring black pain. “Why shouldn’t we get this privilege that whites do?” Young writes in a Blavity post. “Why can they shoot up schools and the media highlights their mental health struggles, saying they were ‘just in pain’ and ‘no one saw it until it was too late?’ Instead of going along with the stigma of mental illness, we should be saying, ‘Hey, we go through this too. We are humans just like everyone else.'”

The idea of black people’s extraordinary strength is likely rooted in the fact that suffering has been central to black American experience and overcoming that suffering is in many ways a source of black communal pride. But African-Americans’ internalized notions about black super-strength have also bred resistance to psychiatric interventions and other therapeutic responses to trauma and pain. Multiple studies find that African Americans are “significantly more likely to report major depression” than other groups, with one group of researchers concluding that black Americans are “20 percent more likely to report having serious psychological distress than” whites. In addition to the everyday difficulties that impact white lives, blacks must deal with “race-based trauma,” the result of both personal confrontations with racism and secondhand experiences, such as those that arise from viewing repeated coverage of racist violence, which has been linked with post-traumatic stress disorder. The trauma incurred from issues that disproportionately affect African Americans, from poverty to unemployment, can also take a deadly toll. A 2015 study found that over the last two decades, the suicide rate for black boys aged 5 to 11 nearly doubled even as it declined among white children of the same age.

Despite all this, a 2011 CDC study found less than 8 percent of African Americans engaged with mental health services that year. Black notions of resilience contribute to these figures, as do the myriad other factors that make mental health care so difficult to access, such as expense. But Janet Taylor, a New York City psychiatrist, notes practitioner biases can also have a detrimental impact. “There are some health care providers who assume that…strife in black people or having a difficult time are what’s to be expected,” Taylor said in an interview with Ebony magazine. “In some cases they may normalize what may be a traumatic reaction.”

There are groups working to address issues around medical racism. White Coats for Black Lives, primarily comprised of medical students, has staged die-ins to protest issues from police brutality to racism in medicine. Last year, David A. Ansell, and Edwin K. McDonald wrote a widely circulated New England Journal of Medicine article imploring practitioners, “for the sake of not only black lives but all lives…to examine the implicit biases in our academic medical centers.” There are increasingly studies dedicated to examining the unmet needs of African Americans, in terms of pain interventions across the board. But change is slow, as the UVA study indicates.

The need to constantly reiterate black humanity — because that’s what this comes down to — is both fatiguing, and frankly, infuriating. Pain is universal and no community is uniquely immune. Ignoring black pain begets more pain, and as long as white America refuses to see it, willingly engages in its perpetuation.