Black and Blue. John Hoberman
its segregated medical system was yet to come.
Open resentment of pessimistic and unflattering descriptions of black health problems emerged along with other expressions of black self-assertion during the 1960s. On occasion these reactions reversed white claims about black infirmity and exhibited a rhetorical inflation that distorted reality. On March 24, 1961, for example, Malcolm X, invoking the spectacle of biblical wrath, told a white audience at Harvard Law School the following: “Your people are being afflicted with increasing epidemics of illness, disease, and plagues, with which God is striking you because of your criminal acts against the twenty million ex-slaves.”30 The same need for compensatory illusion appeared a year later when a black doctor told the annual meeting of the National Medical Association that slavery had been “the greatest biological experiment of all times” and a eugenic boon to black Americans.31 In a different vein, the Reverend Martin Luther King, Jr accused the American Medical Association in 1966 of promulgating a racist “conspiracy of inaction” against black people. Amidst all of the apolitical and now routine celebrations of Dr. King, this prescient analysis and protest against institutional medical racism has been forgot-ten.32 By 1968 Paul Cornely had taken note of the radical moment and warned that racial health disparities were adding “fuel to the smoldering Negro revolution which explodes intermittently.”33 During the 1966 riots in Chicago, blacks had burned down a health clinic on the city's West Side. In 1969 Newsweek informed its readers that “slum dwellers themselves wryly refer to municipal hospital clinics as 'the butchershop' or 'the plantation.'”34 It is no accident that these gritty details appeared, not in a medical journal, but in a newsmagazine that was uncensored by the editorial policies of medical editors.
The point here is not that the highly credentialed Paul Cornely had become a radical. On the contrary, his conduct as a black physician and public health official remained self-disciplined and professional throughout this period of growing black dissatisfaction with the medical care white authorities chose to make available to Negro patients. What matters here is Cornely's professional deportment, his adherence to the standards of what I wish to call “the black physician as gentleman,” the black medical man of this era who constantly had to control his anger as he devoted himself to caring for black patients in circumstances that racist practices made difficult or impossible. This self-control included not alienating the white medical establishment on which black doctors were deeply dependent. While some of these men must have imagined a social protest movement that would relieve the medical misery of the black masses, the public expression of such anger and demands for relief do not begin to appear until the militant rhetoric of the 1960s offered political cover to black doctors who were moved to protest.
Black physicians have been a beleaguered and often disdained minority within the medical profession, and this marginal status has limited their ability to challenge the white medical establishment. During the early decades of the twentieth century, blacks and whites alike questioned both their competence and their motives. Black doctors were also blamed for the state of black health: “The Federal Government inadvertently contributed to the embarrassment of the Negro physician when it perennially issued statistics that showed the Negro death rate to be from 5 to 7 times higher than that of the general population. These figures could be interpreted in one of two ways. First, that the Negro was biologically different or inferior, a conclusion reached by Dr. Stoddard of Harvard and later by Dr. Putnam of Princeton. Second, that the treatment the Negro received was pathetically inadequate. The latter conclusion would reflect on the competence of Negro physicians who took care of these people….”35
Even in their own medical schools, the black historian and journalist Carter G. Woodson wrote in 1933, black medical students were made to feel inferior “in being reminded of their role as germ carriers.” Nor could black doctors be effective if their own people did not believe they were competent, since they “had difficulty in making their own people believe that they could cure a complaint, fill a tooth, or compound a prescription.”36
The self-assertive attitude among blacks that advanced during the civil rights decade also changed attitudes toward black physicians. In 1970 Time reported that African Americans were feeling an “increasing sense of security visiting a black rather than a white doctor. This is a complete reversal of the older pattern: blacks used to take their minor ills to a black doctor, but seek a supposedly superior white practitioner for major medical matters because there were few black specialists.”37 This attraction of black middle-class patients to the “great white father image” was still being discussed in the African American medical press in 1985.38 The black population was still emerging from a period that included the marginalizing and humiliation of its medical personnel, who still lacked the prestige to mount an effective campaign against the consequences of medical racism. In fact, the professional status of the black physician can still be called into question. As one of my African American students wrote in 2001: “Patients discriminate against physicians. Blacks prefer a white doctor on the white or so-called ‘good’ side of town.”
The ability of African Americans to campaign against the causes of their medical misfortunes has also been limited by the sheer volume of disease and disability, along with the accompanying demoralization, with which they and their doctors have had to contend up to the present day. Listening to physicians who care for the black poor at Meharry Medical College, it is easy to conclude that impoverished African Americans in particular have come to accept impairment by severe medical problems as a way of life. Under the doctors' attitude of realism one senses an undercurrent of resignation. “I think we are losing the war in terms of prevention,” says one doctor. “It's a socioeconomic thing. Most poor people don't have adequate access. They don't have good insurance, good education. They don't come unless it impairs their ability to work. By that time the damage has already been done.” A second black doctor addresses the issue of group demoralization head on: “The biggest issue,” he says, “is self-esteem. I don't think our hopes go as far as white people's. Our teachers don't expect us to do more. We have a tendency to let things get worse. We get caught up in crime, drugs, prison.”39 Given the emotional burden of group suffering on this scale, any sense of collective grievance that might be mobilized in the form of public protest becomes overwhelmed by doctors' and patients' immediate needs to cope and survive, whether physically or emotionally. This emotional burden is compounded by the shortage of black medical personnel in many parts of the country. “We have one black surgeon in Savannah, no black nephrologists, one black gastroenterologist, two black pediatricians, both women, no black dermatologists,” a black physician commented in 1999.40 A young black professional once told me how difficult it was for him and his wife to find a black pediatrician in as large a metropolitan area as Austin, Texas. The stresses and discomfiting situations black clients seeking black physicians experience are seldom noted in the accounts of black health issues produced by public health officials. Here, too, African Americans are expected to adapt to circumstances and endure a variety of difficult situations that are otherwise reserved for poor whites and other people who exist on the margins of society.
Contemplating this long history of medical ordeals suggests that some African Americans have, to one degree or another, become resigned to medical infirmity, because the fatal combination of poverty and institutional medical racism has made medical hardship a fact of life. Today, the memory of these hardships persists in the form of an estrangement from the medical profession that will be described throughout much of this book. But it is also important to recognize the value to black people of an adaptive response to medical hardship that amounts to more than a habituation to silent suffering. Medical hardship has played a significant role in the creation of an African American doctrine of survival—a cultural ideology that portrays black people as resilient and dignified survivors rather than as downtrodden victims.
Self-assertive expressions about black resilience can also cross the line into a kind of compensatory make-believe. In his remarkable anthology of African American testimonies Drylongso (1980), the black cultural anthropologist John Langston Gwaltney records the following declaration from a poor African American woman who had survived many hardships: “Most black people think that they are mentally and physically better than white people, and I think that they are physically superior to white people. I think it goes back to slavery-time. I think that