Historical Scientific Racism and Psychiatric Publications: A Necessary International Anti-racist Code of Ethics

Ethical aspects of publishing in scientific journals are an important issue addressed since the late 1970s by the International Committee of Medical Journal Editors (1978). Today, medical journals also benefit from other international organizations’ recommendations such as the Committee on Publication Ethics, World Association of Medical Editors, and World Health Organization (WHO). These international best practices guidelines cover various ethical issues related to integrity in research, authorship, conflicts of interest, and so on.

However, ethical principles of publishing in psychiatry have received little attention in the literature, ¹ and more specifically, to date, there are no international anti-racist policies to guide the management of historical psychiatric publications with pseudoscientific and racist content. The World Medical Association (WMA) defines the term pseudoscience as “a set of statements, assumptions, methods, beliefs and practices which, without having been tested by a valid and recognized scientific method, are falsely presented as scientific.” ² Embedded in intersectional dimensions, racism is more complex to define. However, despite different formulations in the literature, there is a consensus that racism manifests through discriminatory actions or inactions towards a group belonging to a different race, culture, or ethnicity based on the belief that there is a hierarchy among human groups, or on unconscious prejudices, in the absence of any underlying racist ideology. Although race also has different definitions, its major social repercussions make it a social concept. ³

Publications with racist content written during historical and political contexts of colonialism, slavery, or Nazism currently remain available, sometimes in prestigious psychiatric journals. This racist literature raises an important contemporary ethical issue as to whether their access should continue without prior disclosure or warning to the reader about the presence of racist and pseudoscientific content.

It is important to be cognizant of how widespread this literature is. Globalization and online access to several scientific journals make it easy today to access these publications all around the world. In addition, it suggests the risk for tragic and not yet analyzed effects of these publications on scholars and clinicians who “learned” about themselves, their brain, and their abilities from these books and publications such as The African Mind, by John C. Dixon Carothers, first published by WHO in 1953, and again until the seventies, “training” many African psychiatrists about their presumed inferiority as Africans.

While it is important to be able to access scientific archives as historical documents, the absence of disclaimers about racist content highlights the urgent need to develop an international code of ethics providing a framework for historical scientific racism to guide editors and scientific journals. This manuscript addresses from an ethical, psychological, and social perspective (1) the relevance of an international anti-racist scientific policy framing historical publications with discriminatory content, whether it is racist, anti-Semitic, Islamophobic, homophobic, casteist, sexist, and so on and (2) proposes a possible solution.

Intersections of Historical Colonialism, Scientific Racism, and Political Abuse of Psychiatry

Political abuse of psychiatry is the misuse of psychiatry to violate the fundamental human rights of some groups and individuals in a society. ⁴ It has been historically used by colonial regimes and several totalitarian regimes around the world. Instances of political abuse in the history of psychiatry involved psychiatrists who sometimes had great prestige within the psychiatric community and in their countries of origin. For example, the American psychiatrist Donald Ewen Cameron (1901 to 1967), who became an honorary member of the Canadian Psychiatric Association in 1965,( ¹ ) was complicit with the tragic experiences of the “Duplessis Orphans,” several thousand orphaned children who were falsely certified as mentally ill by the government of Quebec during the 1950s. Austrian psychiatrist Hans Asperger (1906 to 1980), who gave his name to the famous autistic syndrome, was complicit with the Nazi ideology of “racial purification.” ⁵ The German psychiatrist Emil Kraepelin (1856 to 1926), after conducting a comparative psychiatry research in Java, proposed a racial developmental hierarchy to explain the observed clinical differences while ignoring the social context. ⁶ The Italian physician and anthropologist Cesare Lombroso (1835 to 1909), considered as the leader of the scientific school of criminology, developed a theory of “innate criminality,” stating that criminality is recognizable by craniological and physical characteristics. In his book The Criminal Man (1867), Lombroso writes⁽²⁾

( … ) Criminals resemble savages and the colored races. These three groups have many characteristics in common, including thinness of body hair, low degrees of strength and below-average weight, small cranial capacities, sloping foreheads, and swollen sinuses ( …. ), upwardly arching temporal bones, sutural simplicity, thick skulls, overdeveloped jaws and cheekbones, oblique eyes, dark skin, thick and curly hair, and jug ears.

Scientific racism that marked the history of medicine and psychiatry during the 19th and 20th centuries was at the origin of several publications in scientific journals in the United States and Europe despite their pseudoscientific or racist content. The American psychiatrist George Alder Blumer published in 1899 an editorial correspondence in the American Journal of Psychiatry ^{( 3)} in which he describes patients during a trip in the Antilles. Blumer writes (p. 716)

(…) many of the patients—the majority impress one as degenerates, are not much higher in the scale of existence than the anthropoid ape. (…). Nowhere did I see patients working, as we understand the word work. The native negro is naturally an indolent fellow, and the very liberal poor laws of Barbados are calculated to enervate him.

Racist assertions of Black people’s inferiority in brain size, intelligence, and morality have persisted in psychological literature over the last 100 years despite repeated critiques. ⁷ The Canadian psychologist John Philippe Rushtel was still claiming an intellectual inferiority of Blacks in a text published in 2012 in the prestigious journal American Psychologist( ⁴ ). In 1908, the French psychiatric journal Annales Médico-psychologiques published a text written by Boigey describing what he considers “the psychological profile of the Muslim”( ⁵ ). Boigey writes, for example (p. 8, translation):

The manifestations of this state are the following: 1—The existence in the intellectual territory of any Muslim, of real “dead spots” where certain impressions are never registered ( … ) 2—The obsession or, if we prefer, the madness of words. These words are: Allah, Illah! and others contained in prayers and invocations to the Godhead. You must have seen the Muslims in the mosque say like hallucinators, for hours and a hundred times a minute, these two words Allah, Illah! swinging their heads like floating buoys undulating on an invisible sea, to get an idea of this kind of madness. After an hour of this exercise, the wisest became ecstatic delirious.

According to Berthelier ⁸ (p. 131–132), this was the first psychiatric publication “properly and entirely racist” of a rare violence.

The Annales Médico-Psychologiques published other racist papers written by the French psychiatrist Antoine Porot in his “Notes de psychiatrie musulmane” in 1918( ⁶ ) and “L’impulsivité criminelle chez l’indigène algérien” with his student Arrii in 1932( ⁷ ). Author of theories of primitivism and “criminal impulsiveness” among North Africans, Antoine Porot describes them by stating

The true indigenous mass, a shapeless block of profoundly ignorant and credulous primitives, far removed from our mentality and our reactions. (Notes de psychiatrie musulmane, p. 377, translated)

The native, a large mental deficiency, whose higher and cortical activities are little evolved, is above all a primitive being whose life, essentially vegetative and instinctive, is mainly regulated by his diencephalon.( ⁸ )

The history of psychiatry is marked by several other pseudoscientific publications conveying hateful theories. ⁹ Renneville ¹⁰ underlines that a false or erroneous theory can still have a wide following: “Whatever status one grants to these discourses, ‘false science’, ‘error’, ‘ideology’, we would probably have a lot to lose by underestimating their effects in our societies” (p. 1723–1724, translated). Although racism in psychiatric literature is reported by several authors in North America and Europe, ^11,12 the effects of pseudoscientific racist texts remain little recognized by the international psychiatric and scientific community. The American Psychiatric Association’s recent apology ¹³ was an important step in recognizing that past inaction has contributed to perpetuating structural racism. Decolonization of psychiatry, initially embodied by Frantz Fanon’s anti-racist psychiatry during the French colonial period, has become a postcolonial contemporary issue ^14,15 that could take different forms involving both the fields of psychiatry and ethics.

Scholarly Publishing and Anti-racist Policies: Ethics’ Role in Dismantling Structural Racism

Despite the efforts to dismantle scientific racism since the end of World War II, it is not yet completely eradicated. ¹⁶ According to Potter ¹⁷ and Ibrahim and Morrow, ¹⁸ intersections of scientific racism, colonialism, and political abuse of psychiatry are historical roots of current persisting systemic oppression in psychiatry and structural racism in our societies. As highlighted by Memmi, ¹⁹ historical relations between colonizers and colonized inevitably influence contemporary social relations between ex-colonizers and ex-colonized.

According to Johnstone and Kanitsaki, ²⁰ racism has been neglected as an ethical issue, and, if this problem remains unaddressed in the field of scientific and scholarly publications, the potential harmful consequences will remain difficult to prevent and manage. Racism is a social determinant of health that has an impact on the health status of children, adolescents, adults, and their families. ²¹ Experiences of racism, discrimination, and micro-aggressions are documented to be associated with race-based stress, physical and mental health impacts, and potential racial trauma. ²² The concept of historical trauma refers to trauma symptoms related to a collective trauma with generational implications such as colonialism, genocides, and slavery. While a diagnostic category of post-traumatic stress disorder can validate the traumatic event, it could simultaneously cover the political, racial, and historical roots of suffering. ²³ Thus, historical trauma requires complex analysis to avoid simplistic interpretations.

Bioethics could play an increasingly important role in the development of institutional policies to address racism and social injustice. ²⁴ According to Mayes, ²⁵ bioethics has not been able to respond to institutional racism as it is itself shaped to favour majority groups over minority groups. Mayes emphasizes that institutional racism in health care is compounded by the fact that both medicine and ethics are implicated. Fernando ¹² highlights that one of the reasons institutional racism persists is the collective denial and the failure of our societies to face the horrors of racism in the past with a full appreciation of their consequences. Ben-Cheikh ²⁶ proposes psychoeducation to help dismantle structural and institutional racism, including education on explicit contextualization of racist historical publications. Knowledge of the historical and political context of the past does not change the racist character of a text today. An implicit contextualization is thus insufficient and should not justify the absence of an explicit disclosure about a racist content.

In Europe and in North America, sensitive contents in media (e.g., violence, profanity, obscenities) are routinely preceded by disclaimers. The aim of these warning signs or messages is not to censure but rather to allow the reader to have a critical thinking, to know what to expect, and to make a clear choice whether or not to view the content. While it is important to keep historical documents of scientific publications, we suggest an anti-racist strategy implicating an international publishing code of ethics that should define how editors present pseudoscientific and racist articles to the readership. Science and bioethics should no longer collude with the invisible violence purported by historical racist publications. Only when our professions, in partnership with publishers, recognize and correct the “epistemological ignorance” generated by what Charles Mills defined as a “racial contract,” we will be actively countering an ignorance that continues to invisibly permeate our knowledge: “a cognitive and moral economy psychically required for conquest, colonization, and enslavement” ²⁷ (p. 19).

Conclusion and Recommendation

The American and Canadian psychiatric associations have recently recognized the existence of structural racism in psychiatry and are committed to developing anti-racist policies that promote equity in mental health for all. ^13,28 Several editorials around the world have also called for action against racism and social injustice. ^26,28,29,30 Historical psychiatric publications with racist content should not be forgotten or ignored. The role of colonial pseudoscience in the roots of contemporary structural racism should be recognized and analyzed. Today, it is a matter of scientific, social, and editorial responsibility to develop an international anti-racist code of ethics that fights scientific racism and provides a framework for historical publications.

Editors have the challenge and responsibility to both preserve access to historical archives and treat the entire readership with respect and dignity, regardless of their ethnicity, colour of skin, religion, gender, and Otherness. We recommend that all scientific journals identify any historical publications that have a racist content and add at the beginning of these publications a disclosure statement such as The reader is warned about racist content in this paper, written at a time of political oppression against groups of human beings based on their racial, ethnic or religious identity. While this potential solution is simple, it represents nonetheless an unprecedented action in terms of anti-racist policies in the scientific publishing field. Furthermore, the process to achieve such a change is complex. While some racist content would be obvious to all readers, others may be subject to interpretation and debate. To achieve an effective sorting of historical publications, especially for more subtle or ambiguous cases, we suggest that editors get the support of relevant national and international professional organizations such as the Society for the Study of Psychiatry and Culture in North America and the Centre Ressource Européen en clinique transculturelle (Centre Babel) in Europe and that a competent and diverse committee of experts gets implicated. Finally, as historical racist publications concern many disciplines in medicine and in psychology, an international anti-racist publishing code of ethics should target scientific publications broadly and would need the support of important organizations like the World Psychiatric Association and the WMA.

Psychiatry has been used politically and socially, in a malicious way, at different periods of history. As scientists, physicians, ethicists, psychiatrists, psychologists, we should take a critical look at this past, which is not gone as much as we would like, to both recognize the embedded impact of our history on our contemporary societies and embrace our collective responsibilities in the face of these drifts.