Lafargue Clinic

Lafargue Mental Health Clinic
Geography
Location St. Philip's Episcopal Church
215 W 133rd St, New York City
Organisation
Care system Mental health
History
Founded March 8, 1946
Closed November 1, 1958

The Lafargue Mental Health Clinic, more commonly known as the Lafargue Clinic, was a mental health clinic that operated in Harlem, New York, from 1946 until 1958. Named for French Marxist physician Paul Lafargue and conceived by German-American psychiatrist Fredric Wertham, who recognized the dire state of mental health services for blacks in New York, as well as black intellectuals Richard Wright and Ralph Ellison, the clinic operated out of the parish house basement of St. Philip's Episcopal Church and was among the first to provide low-cost psychiatric health services to the poor, especially for poor blacks who either could not afford treatment at New York hospitals or were victimized by racism from doctors and other hospital staff.[1] The staff consisted entirely of volunteers, and Wertham and Hilde Mosse were the clinic's lead doctors.

Though the clinic only operated for 12 years, Wertham and Mosse's published research from this time relating to the negative mental effect of school segregation was cited in a court decision to integrate schools in Wilmington, Delaware, and later in Brown v. Board of Education, and Wertham would use case studies from his time at the clinic to support his later arguments that comic books caused juvenile delinquency, as evidenced in his 1954 work Seduction of the Innocent.[2]

One must descend to the basement and move along a confusing mazelike hall to reach it. Twice the passage seems to lead against a blank wall; then at last one enters the brightly lighted auditorium. And here, finally, are the social workers at the reception desks; and there, waiting upon the benches rowed beneath the pipes carrying warmth and water to the floors above, are the patients. One sees white-jacketed psychiatrists carrying charts appear and vanish behind screens that form the improvised interviewing cubicles. All is an atmosphere of hurried efficiency; and the concerned faces of the patients are brightened by the friendly smiles and low-pitched voices of the expert workers. One has entered the Lafargue Psychiatric Clinic.

Ralph Ellison, Harlem Is Nowhere

Background

Fredric Wertham at his New York office, 1954. Photograph by Gordon Parks.

Plans for the Lafargue Clinic began when Fredric Wertham agreed to see author Ralph Ellison, who "refused to serve in a Jim Crow army," for a psychiatric visit intended to find grounds to void Ellison's draft notice.[1] The meeting between the two men was set up by Richard Wright, then an established Harlem intellectual. In September 1946, after the establishment of the clinic, Wright penned an article in Free World titled Psychiatry Comes to Harlem, where he described the destitute state of mental health services for blacks in New York: "[T]hat Harlem's 400,000 black people produced 53% of all the juvenile delinquents of Manhattan, which has a white population of 1,600,000; that, while in theory Negroes have access to psychiatric aid (just as the Negroes of Mississippi, in theory, have access to the vote!), such aid really does not exist[,] owing to the subtle but effective racial discrimination that obtains against Negroes in almost all New York City hospitals and clinics; that it is all but impossible for Negro interns to gain admission to hospitals to receive their psychiatric training."[3] Wright noted that Wertham long recognized the subpar state of black psychiatric services, and that "Wertham's attitude is that psychiatry is for everybody or none at all."[4] Wertham, who at that time was chief psychiatrist at Queens General Hospital, had also unsuccessfully petitioned mayor Fiorello H. La Guardia to create preventative psychiatry facilities in Harlem for at least ten years, adding to his frustration with the city's treatment of black mental patients.[5]

Discrimination in New York hospitals

In a 2009 article for the Bulletin of the History of Medicine, medical historian Dennis Doyle noted multiple ways in which antiblack discrimination manifested itself in the New York medical system. Caregivers "excluded Harlem's emotionally troubled black children", and refused to see black patients even if they could afford treatment.[6] Even state institutions, such as the New York State Psychiatric Institute, refused to admit black patients. Since Harlem Hospital (and other uptown Manhattan hospitals) had no psychiatric facilities, Bellevue Hospital was their only option, with its "overcrowded, understaffed" psychiatric wards, and some "racialist clinicians who still believed that African-Americans possessed a racially unique and inferior psyche".[6]

Founding

Ellison brought the idea of the clinic to Sheldon Hale Bishop, the reverend at St. Philip's Episcopal Church, who agreed to house the clinic in two rooms of the parish house basement.[7] The clinic, which the men named after French Marxist physician Paul Lafargue, opened on March 8, 1946, and served patients from 6 to 8 o'clock on Tuesdays and Thursdays. According to Doyle, demand was so great for services that "the waiting list was still full in the clinic's final years".[8] The clinic was staffed "by an interracial cadre of volunteers, most of them professionally accredited".[9] The 47 volunteers included "three accredited psychiatrists, two psychiatric nurses, and three psychiatric social workers, as well as a team of psychologists, general social workers, psychology students, lay case workers, and educators".[9] The clinic saw around 70% adults and 30% children (other progressive psychiatrists opened a facility called the Northside Center, which primarily served children), and operated under what Doyle referred to as a combination of "race-blind universalism" (which meant that doctors did not, as was common at the time, make adjustments in their diagnoses for biological conceptions of race) and social psychiatry, at that time a new clinical approach.[10] Said Wertham, "[W]e're not here to make a study of the Negro. . .We're simply here to treat them like other human beings".[11]

Operation

The Freudians talk about the Id

And bury it below.

But Richard Wright took off the lid

And let us see the woe.

Fredric Wertham, 1942, "Underground"

Though the clinic was only psychotherapeutic, meaning that it could not treat psychoses or other brain diseases (the clinic did diagnose 21% of its patients with psychosis), it frequently referred its patients to other inpatient facilities, with mixed results. Nearly 12% of Lafargue patients received inpatient care elsewhere in the city.[12] In some cases, patients who received referrals would follow through with treatment, but others did not. A woman known only as Rachel, listed in records as being the clinic's first referral, was referred by head physician Hilde Mosse to a respected gynecology clinic outside of Harlem for menorrhagia (excessive vaginal bleeding). She had the exam performed and came back to tell Mosse about the visit.[12] A teenage boy named Chris, the son of Southern migrants, was treated for "bad blood", a Southern euphemism for syphilis, and was referred to a local medical clinic for a spinal tap; however, the boy and his mother skipped the appointment and ended their sessions at Lafargue due to the pain of the procedure.[13]

In addition, the clinic served as a de facto social welfare office, providing connections to public housing and welfare offices, and hosting a desegregated chapter of Alcoholics Anonymous.[14] Indeed, Wertham and Mosse reasoned that improvements in the social conditions of Harlem would "relieve the main source of anxiety for an estimated third of their patients".[15]

Decline and closure

In 1954, New York State passed the Community Mental Health Services Act, establishing mental health boards in cities with more than 50,000 residents.[16] The purpose of the boards was to dispense state funds to licensed providers of mental healthcare. While the Northside Center, which worked with black children, received $72,000 in funding, the Lafargue Clinic was rejected for funds by both the city and state.[16] According to Gabriel Mendes, author of Under The Strain of Color: Harlem's Lafargue Clinic and the Promise of an Antiracist Psychiatry, "Lafargue fit the model perfectly of locally based outpatient mental health services imagined under the 1954 act. But clearly the die had been cast long before the new legislation, no amount of persuasion or pleading could undo the calumny Wertham had directed against the psychiatric establishment or his reputation as a self-important nuisance."[16]

In addition, Rev. Bishop, who had initially granted the clinic its space and was one of its strongest supporters, retired from the ministry in 1957. His replacement, a Columbia University graduate named M. Moran Weston, turned the parish house into a center for community services and health programs headed by members of the St. Philip's congregation. Said Mendes, "Weston's health inititiave was not a slight directed at Wertham and the Lafargue Clinic. Rather it reflected a changing of the guard and perhaps the desire to place the health needs of the central Harlem community in the hands of black professionals."[17]

Due to the change in leadership at St. Philip's and the deaths and illnesses of several clinic staffers, the clinic held its last session on November 1, 1958.[17]

Legacy

Wertham and comic books

Though Wertham was instrumental in the advocacy, foundation, and operation of the Lafargue Clinic, he remains known for his alarmist condemnations of comic books. Best typified by his 1954 book Seduction of the Innocent, which claimed that comics were pathological and negative influences on children, many of Wertham's case studies and anecdotal references came from his time at Lafargue and at Queens General Hospital. "In the hands of children and adolescents at Lafargue, Wertham discovered a recurring source of antiblack images and messages: crime comic books. Images of black men being bound and whipped, of white men and women 'taming' African 'natives', and of black children being ridiculed and abused pervaded the little magazines that circulated so widely among the youth Wertham and his colleagues saw at the clinic. He wondered not only how these comic books were affecting the black children of Harlem, but also how they shaped white children’s perceptions of the legitimate treatment of the black people in their midst".[18]

Wertham and several children in a playroom therapy session

In the "Children and the Violence of Racism" chapter of Under The Strain of Color, Mendes relayed a conversation that Wertham had with a black 12-year-old girl, who criticized the way comics depicted blacks: "'I don’t like the jungle', she informed him. 'I don't think they make the colored people right [in those comics]. The way they make them I never seen before—their hair and nose and the English they use. They never have an English like we have. They put them so dark—for real I have never seen anybody before like that. White kids would think all colored people look like that, and really they aren't".[19]

Dismantling school segregation

In the early 1950s, the NAACP Legal Defense and Educational Fund (LDEF) began to seek more authoritative scientific evidence that Jim Crow schools were detrimental to black children. Columbia Law graduate Jack Greenberg, who joined the LDEF in 1949, "had convinced several of his fellow lawyers at the LDEF, most importantly its director Thurgood Marshall, that testimony from social scientists. . .might play a pivotal role in a set of cases challenging segregated schools".[20] The LDEF successfully challenged segregation in higher education in Sweatt v. Painter and McLaurin v. Oklahoma State Regents, but now looked towards overturning the doctrine of separate but equal, which was still in effect from Plessy v. Ferguson. The case that the LDEF sought help from Lafargue staff on was Belton v. Gebhart, which along with its consolidated case Bulah v. Gebhart became one of the five cases combined into the review of Brown v. Board of Education.

Worried that conservative courts would reject the doll tests of black psychologists Kenneth and Mamie Clark, Greenberg sought more definitive proof of the debilitating effect Jim Crow segregation had on black children, so he wrote Wertham: "We would like you to testify for us both on the basis of your broad general experience, and on the basis of investigation of the particular plaintiffs, some of whom we will make available to you".[21] In a later book, Greenberg credited Wertham's testimony for Belton v. Gebhart as "[making] segregation a public health issue".[22] After examining a cadre of Delaware children, both black and white, Wertham testified, "Segregation in schools legally decreed by statute, as in the State of Delaware, interferes with the healthy development of children. It doesn't necessarily cause an emotional disorder in every child. I compare that with the disease of tuberculosis. In New York thousands of people have the tubercle bacilli in their lungs—hundreds of thousands—and they don't get tuberculosis. But they do have the germ of illness in them at one time or another, and the fact that hundreds of them don't develop tuberculosis doesn't make me say, 'never mind the tubercle bacillus; it doesn't harm people, so let it go'".[23] Judge Collins J. Seitz was deeply moved by Wertham's testimony, and though he did not rule segregation unconstitutional, he effectively struck down Delaware's segregation laws and ordered the integration of the state's schools.[24]

After the conclusion of Brown v. Board, Thurgood Marshall wrote to Wertham to thank him for his testimony in the Delaware cases: "...for the important assistance which you gave us in the school segregation cases which were recently decided by the Supreme Court of the United States. It is unfortunate that the opinion of the Supreme Court of the United States could not, in so many words, give recognition to all of those who were of assistance to us. However, I hope that you and the members of your clinic will have satisfaction in knowing that your great efforts contributed significantly to the end result. Not only was your testimony in the Delaware case before the Court in the printed record of testimony, but the Chancellor in Delaware came to his conclusions concerning the effects of segregation largely upon the basis of your testimony and the work done in your clinic".[25]

Over time, Wertham grew jaded with how the nation recalled the testimony that led to the dissolution of Jim Crow, feeling that too much attention was paid to the Clark doll tests, rather than the Lafargue Clinic's clinical studies. "[The Brown v. Board decision] was not based on primitive insignificant dolls play, but on careful lifelike clinical studies by the Lafargue Clinic's group of black and white psychiatrists, psychologists, teachers and social workers".[26]

Response from historians

Medical historian Dennis Doyle wrote that the clinic was "the product of a complex interaction among psychiatrists, patients, families, outside agencies, and Harlem's local leaders and young radicals. Underlying this interaction was an abiding faith in universalism, social justice, and Wertham 's brand of social psychiatry. Integrating all these forces together in practice was not easy. Both staff members and patients experienced difficulty in determining how much of a patient's problem was a matter of either psychosexual conflicts or a more complex emotional battle with external forces such as racial discrimination. The clinic's strict psychoanalytic response to homosexuality illustrates how universalism could potentially blind a clinician to the patient's own perceptions and social context. Nevertheless, universalism generally existed in balance with social psychiatry and the social justice commitments of the Lafargue staff, founders, and church community. In balance, the Lafargue Clinic was a special social institution, one that prided itself on its ability to bear witness to the social needs of patients from some of postwar Harlem's most difficult neighborhoods".[5]

Gabriel Mendes, author of the most comprehensive book-length treatment of the clinic, noted that "Fredric Wertham and his colleagues at Lafargue not only fashioned a conceptual framework for addressing the social basis of mental illness among an oppressed people, but also institutionalized that framework and applied this social psychiatry therapeutically in a way that touched the lives of thousands of everyday people. This book has shown how this intervention distinguished the Lafargue Clinic in the history of American psychiatry. Lafargue's emergence was of course the product of a widespread American concern with the mental health of its citizens, but it went further than any other therapeutic institution by linking race and class oppression as a source of mental disorder and personality problems. Moreover, the clinic's founders and supporters argued that mental health care for African Americans was an extension of democracy into the fundamental institutional life of the nation. The Lafargue Clinic became a key site in the battle for the desegregation of American society".[27]

References

  1. 1 2 Reibman, James E. (2001). "Ralph Ellison, Fredric Wertham, M.D., and the Lafargue Clinic: Civil Rights and Psychiatric Services in Harlem". Oklahoma City University Law Review. 26: 1041–1055 – via HeinOnline.
  2. ↑ "archives.nypl.org – Lafargue Clinic records". archives.nypl.org. Retrieved 9 August 2018.
  3. ↑ Wright, Richard. "Psychiatry Comes to Harlem," Free World, September 1946, 49–50.
  4. ↑ Wright, "Psychiatry Comes...", 50.
  5. 1 2 Doyle, Dennis (2009). "'Where the Need Is Greatest': Social Psychiatry and Race-Blind Universalism in Harlem's Lafargue Clinic, 1946–1958". Bulletin of the History of Medicine. 83 (4): 746–774. doi:10.1353/bhm.0.0276. PMID 20061672.
  6. 1 2 Doyle, "Where the Need Is Greatest," 751
  7. ↑ Reibman, 1044.
  8. ↑ Doyle, "Where the Need Is Greatest" 752.
  9. 1 2 Doyle, Dennis (2009). "'A Fine New Child': The Lafargue Mental Hygiene Clinic and Harlem's African American Communities, 1946–1958". Journal of the History of Medicine. 64 (2): 173–212. doi:10.1093/jhmas/jrn064. PMID 18996946.
  10. ↑ Doyle, "Where the Need Is Greatest" 754–755.
  11. ↑ Martin, Ralph G. (June 3, 1946). "Doctor's Dream Comes to Harlem". The New Republic.
  12. 1 2 Doyle, "Where the Need Is Greatest" 757.
  13. ↑ Doyle, "Where the Need Is Greatest" 758.
  14. ↑ Doyle, "Where the Need Is Greatest" 760.
  15. ↑ Doyle, "Where the Need Is Greatest" 759.
  16. 1 2 3 Mendes, Gabriel N. (2015). Under The Strain of Color: Harlem's Lafargue Clinic and the Promise of an Antiracist Psychiatry. Ithaca: Cornell University Press. p. 160. ISBN 9780801453502.
  17. 1 2 Mendes, 161.
  18. ↑ Mendes, 122.
  19. ↑ Mendes, Strain of Color, 124–125.
  20. ↑ Mendes, Strain of Color, 130.
  21. ↑ Mendes, Strain of Color, 134–135.
  22. ↑ Reibman, "Civil Rights and Psychiatric Services in Harlem", 1047.
  23. ↑ Greenberg, Jack (1994). Crusaders in the Courts: How A Dedicated Band of Lawyers Fought for the Civil Rights Revolution. , cited in Reibman, "Civil Rights and Psychiatric Services in Harlem", 1047.
  24. ↑ Reibman, "Civil Rights and Psychiatric Services in Harlem", 1048.
  25. ↑ Reibman, "Civil Rights and Psychiatric Services in Harlem", 1049.
  26. ↑ Reibman, "Civil Rights and Psychiatric Services in Harlem", 1050.
  27. ↑ Mendes, Under The Strain of Color, 154–155.

Coordinates: 40°48′53″N 73°56′43″W / 40.81472°N 73.94528°W / 40.81472; -73.94528

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