Slavery and Its Afterlives in US Psychiatry.

Antecedents of racist treatments of Black patients by the psychiatric profession in the United States affect the way they view treatment today. Specifically, in this essay, we explore the enduring consequences of racial science on various treatment practices. We examined a range of primary sources on the history of racial theories about the mind, medical and psychiatric publications, and hospitals. We contextualize this analysis by examining the secondary literature in the history and sociology of psychiatry. Through analyzing racial thinking from the antebellum through the Jim Crow periods, we show how US medicine and psychiatry have roots in antebellum racial science and how carceral logics underpinned the past and present politics of Black mental health. Changing this trajectory requires practitioners to interrogate the historical foundations of racist psychiatric concepts. This essay urges them to reject biological racial realism, which bears reminiscences to 19th-century racial science, and embrace the variable of race as a social construct to study social inequalities in health as a first step toward moving away from the legacies of past injustices in medicine. (Am J Public Health. 2024;114(S3):S250-S257. https://doi.org/10.2105/AJPH.2023.307554).

Science and the 'emancipation of the mind': dreams, the mind, and slavery.

Dreams were a subject of interest to philosophers thinking about the connection between the mind and the body in the nineteenth century. Many scholars have pointed out that the mind and the body were intimately linked and affected each other. Although science was on its way to becoming more technical and numbers focused in its investigatory practices, medical students and other physician-philosophers investigated the nature of sleep and dreams. Medical students and advanced researchers speculated on the nature of consciousness and mused on where the mind travels to during the sleep processes. Other romantic figures like Dr Polydori speculated on the nature of sleep walking in their medical dissertations. Dreams also had a powerful moral and motivational component, as dreams and activities in dreams, drove people like Benjamin Rush to embrace abolition. Other promoters of abolition used the nature of dreams to discusses the dreadfulness and suffering of slavery.

Spatiotemporal Changes in the Slavery-Inequality Relationship: The Diffusion of the Legacy of Slavery.

Despite the persistence of relationships between historical racist violence and contemporary Black-White inequality, research indicates, in broad strokes, that the slavery-inequality relationship in the United States has changed over time. Identifying the timing of such change across states can offer insights into the underlying processes that generate Black-White inequality. In this study, we use integrated nested Laplace approximation models to simultaneously account for spatial and temporal features of panel data for Southern counties during the period spanning 1900 to 2018, in combination with data on the concentration of enslaved people from the 1860 census. Results provide the first evidence on the timing of changes in the slavery-economic inequality relationship and how changes differ across states. We find a region-wide decline in the magnitude of the slavery-inequality relationship by 1930, with declines traversing the South in a northeasterly-to-southwesterly pattern over the study period. Different paces in declines in the relationship across states suggest the expansion of institutionalized racism first in places with the longest-standing overt systems of slavery. Results provide guidance for further identifying intervening mechanisms-most centrally, the maturity of racial hierarchies and the associated diffusion of racial oppression across institutions, and how they affect the legacy of slavery in the United States.

Ecological variation and institutionalized inequality in hunter-gatherer societies.

Research examining institutionalized hierarchy tends to focus on chiefdoms and states, while its emergence among small-scale societies remains poorly understood. Here, we test multiple hypotheses for institutionalized hierarchy, using environmental and social data on 89 hunter-gatherer societies along the Pacific coast of North America. We utilize statistical models capable of identifying the main correlates of sustained political and economic inequality, while controlling for historical and spatial dependence. Our results indicate that the most important predictors relate to spatiotemporal distribution of resources. Specifically, higher reliance on and ownership of clumped aquatic (primarily salmon) versus wild plant resources is associated with greater political-economic inequality, measuring the latter as a composite of internal social ranking, unequal access to food resources, and presence of slavery. Variables indexing population pressure, scalar stress, and intergroup conflict exhibit little or no correlation with variation in inequality. These results are consistent with models positing that hierarchy will emerge when individuals or coalitions (e.g., kin groups) control access to economically defensible, highly clumped resource patches, and use this control to extract benefits from subordinates, such as productive labor and political allegiance in a patron-client system. This evolutionary ecological explanation might illuminate how and why institutionalized hierarchy emerges among many small-scale societies.

A public health approach to modern slavery in the United Kingdom: a codeveloped framework.

OBJECTIVES: Modern slavery is a public health challenge. The objective of this research was to build and refine a public health approach to addressing it. STUDY DESIGN: This was a participatory qualitative study with a proof-of-concept exercise. METHODS: Nine deliberative workshops with 65 people working across the antislavery sector. Thematic analysis of qualitative data. Of the nine workshops, two were proof of concept. These explored and tested the public health framework devised. RESULTS: Participants contributed to the development of a public health framework to modern slavery that included multiple elements across national, local, and service levels. There were six 'C's to national components: policy that was coherent, co-ordinated, consistent, comprehensive, co-operative and compliant with international law. Local components centred on effective local multiagency partnerships and service design and delivery focussed on trauma-informed, flexible, person-centred care. CONCLUSIONS: A public health approach to modern slavery is a promising development in the antislavery field in the United Kingdom and globally. It was well supported by workshop participants and appeared to be operable. Barriers to its implementation exist, however, including the challenge of intersectoral working and an incongruent policy environment.

Modern slavery in the United Kingdom: The illegal migration act risks undermining efforts to combat exploitation.

The Illegal Migration Act, which recently passed through the United Kingdom (UK) parliament, poses a serious threat to the well-being of victims of modern slavery and efforts to combat exploitation. The Act gives the UK Government greater powers to deny support and allow the detention and deportation of potential victims and has been widely criticised, including by medical associations and charities. Measures included in the Act risk perpetuating the deprivation of safety, dignity, and medical care experienced by victims, instead of providing the protections to which they should be entitled.

Anthropological genetics perspectives on the transatlantic slave trade.

During the Trans-Atlantic Slave Trade (TAST), around twelve million Africans were enslaved and forcibly moved from Africa to the Americas and Europe, durably influencing the genetic and cultural landscape of a large part of humanity since the 15th century. Following historians, archaeologists, and anthropologists, population geneticists have, since the 1950's mainly, extensively investigated the genetic diversity of populations on both sides of the Atlantic. These studies shed new lights into the largely unknown genetic origins of numerous enslaved-African descendant communities in the Americas, by inferring their genetic relationships with extant African, European, and Native American populations. Furthermore, exploring genome-wide data with novel statistical and bioinformatics methods, population geneticists have been increasingly able to infer the last 500 years of admixture histories of these populations. These inferences have highlighted the diversity of histories experienced by enslaved-African descendants, and the complex influences of socioeconomic, political, and historical contexts on human genetic diversity patterns during and after the slave trade. Finally, the recent advances of paleogenomics unveiled crucial aspects of the life and health of the first generation of enslaved-Africans in the Americas. Altogether, human population genetics approaches in the genomic and paleogenomic era need to be coupled with history, archaeology, anthropology, and demography in interdisciplinary research, to reconstruct the multifaceted and largely unknown history of the TAST and its influence on human biological and cultural diversities today. Here, we review anthropological genomics studies published over the past 15 years and focusing on the history of enslaved-African descendant populations in the Americas.

Surgeon Burnout and Usage of Personal Communication Devices: Examining the Technology "Empowerment/Enslavement Paradox".

INTRODUCTION: Access to patients' electronic medical records (EMRs) on personal communication devices (PCDs) is beneficial but can negatively impact surgeons. In a recent op-ed, Cohen et al. explored this technology "empowerment/enslavement paradox" and its potential effect on surgeon burnout. We examined if there is a relationship between accessing EMRs on PCDs and surgeon burnout. METHODS: This was a cohort study with retrospective and prospective arms. Trainees and attendings with a background in general surgery completed the Maslach Burnout Index for Medical Personnel, a validated survey scored on three areas of burnout (emotional exhaustion, depersonalization, and low personal accomplishment). Data on login frequency to EMRs on PCDs over the previous 6 mo were obtained. Pearson correlation coefficients were calculated to determine if burnout and login frequency were associated. RESULTS: There were 52 participants included. Residents were 61.5% (n = 32) of participants. The mean login frequency over 6 mo was 431.0 ± 323.9. The mean scores (out of 6) for emotional exhaustion, depersonalization, and personal accomplishment were 2.3 ± 1.1, 1.9 ± 1.2, and 4.9 ± 0.8, respectively. There was no correlation between burnout and logins. Residents had higher median depersonalization scores (2.3 versus 1.2, P = 0.03) and total logins (417.5 versus 210.0, P < 0.001) than attendings. Participants who overestimated logins had higher median emotional exhaustion and depersonalization scores than those who underestimated (2.6 versus 1.4, P = 0.03, and 2.4 versus 0.8, P = 0.003, respectively). CONCLUSIONS: Using EMRs on PCDs is common, but frequency of logins did not correlate with burnout scores in this study. However, perception of increased workload may contribute to experiencing burnout.

A Legacy of Scientific Racism: William Osler's "An Alabama Student".

William Osler's essay "An Alabama Student" made John Young Bassett (1804-1851) a widely admired avatar of idealism in medicine. However, Bassett fiercely attacked the idea that all humans are members of the same species (known as monogenesis) and asserted that Black inferiority was a justification for slavery. Antebellum physician-anthropologists bequeathed a legacy of scientific racism that in subtler forms still runs deep in American society, including in the field of medicine.

Acute safeguarding essentials in modern-day paediatrics: neglect, unsupervised minors and modern slavery.

As part of a case-series exploring acute safeguarding essentials in modern day paediatrics, this article focusses on themes of neglect, unsupervised minors and modern slavery. Considerations around initial management, relevant legislation and useful resources, and available to all professionals involved in safeguarding children.

Autonomy, the moral circle, and the limits of ownership.

Why can't we own people? Boyer proposes that the key consideration concerns inclusion in the moral circle. I propose an alternative, which is that specific mental capacities, especially the capacity for autonomy, play a key role in determining judgments about human and animal ownership. Autonomous beings are viewed as owning themselves, which precludes them from being owned by others.

Historical roots of implicit bias in slavery.

Implicit racial bias remains widespread, even among individuals who explicitly reject prejudice. One reason for the persistence of implicit bias may be that it is maintained through structural and historical inequalities that change slowly. We investigated the historical persistence of implicit bias by comparing modern implicit bias with the proportion of the population enslaved in those counties in 1860. Counties and states more dependent on slavery before the Civil War displayed higher levels of pro-White implicit bias today among White residents and less pro-White bias among Black residents. These associations remained significant after controlling for explicit bias. The association between slave populations and implicit bias was partially explained by measures of structural inequalities. Our results support an interpretation of implicit bias as the cognitive residue of past and present structural inequalities.

Anarcha Lets Blood September 4, 1836.

There are at least two Anarchas that appear in J. Marion Sims's autobiography. One, is the famed Anarcha from the Wescott Plantation who endured numerous experiments at Sims's hands, but there is also the Anarcha that appears earlier in Sims's self-story described here. She was described as a mulatta who assisted in a bloodletting of Sims himself. These two Anarchas appear to Sims as turning points in his own thinking, experience, and practice of and with medicine. I imagine this Anarcha speaking here, toward his description of her and the practice of bloodletting in the larger scope of Sims's infamous medical practices. To view the original version of this poem, see the supplemental material section of this article online.

Slavery, Health, and Healing Now: The State of the Field.

The scholarship on slavery, health, and healing has dramatically transformed over the past two decades. This essay synthesizes several themes within the thriving subfield, highlighting its relevance to historians of medicine and science working in adjacent fields, and suggesting new directions forward. The recent scholarship builds on research begun in the 1970s, but where earlier scholarship relied on quantitative methods and retrospective diagnoses, the new scholarship takes a social constructivist approach. Scholars today are exploring how slavery shaped the natural and built environment to create new disease environments in the New World; how Black healing knowledge was either circulated or suppressed by White physicians; and how gender and race intersected in slave societies to influence diagnoses and the categorization of specific diseases. Most importantly, the new scholarship suggests that medical knowledge produced in slave societies was not marginal-but central-to the rise of early modern medicine. The lack of any synthesis of the recent literature, combined with the recent public attention given to racial health disparities, make this literature vitally important to all historians of medicine and allied sciences. It can provide useful insights for scholars working in other areas, and it can diversify and complicate the stories we tell about the origins of modern medicine.

Ship fever, confinement, and the racialization of disease.

This paper presents the case of ship fever as a disease whose colonial origins and description by English-speaking physicians contributed to the racialization of European and African bodies in the second half of the eighteenth century. Historicizing ship fever as a disease associated with the health of sympathetic White soldiers and sailors, and notions that enslaved Africans were less vulnerable to a disease caused by confinement, contributes to ongoing analyses of the intersection of medicine, race, and slavery in the British Atlantic world after the Seven Years' War.

Origins, Admixture Dynamics, and Homogenization of the African Gene Pool in the Americas.

The Transatlantic Slave Trade transported more than 9 million Africans to the Americas between the early 16th and the mid-19th centuries. We performed a genome-wide analysis using 6,267 individuals from 25 populations to infer how different African groups contributed to North-, South-American, and Caribbean populations, in the context of geographic and geopolitical factors, and compared genetic data with demographic history records of the Transatlantic Slave Trade. We observed that West-Central Africa and Western Africa-associated ancestry clusters are more prevalent in northern latitudes of the Americas, whereas the South/East Africa-associated ancestry cluster is more prevalent in southern latitudes of the Americas. This pattern results from geographic and geopolitical factors leading to population differentiation. However, there is a substantial decrease in the between-population differentiation of the African gene pool within the Americas, when compared with the regions of origin from Africa, underscoring the importance of historical factors favoring admixture between individuals with different African origins in the New World. This between-population homogenization in the Americas is consistent with the excess of West-Central Africa ancestry (the most prevalent in the Americas) in the United States and Southeast-Brazil, with respect to historical-demography expectations. We also inferred that in most of the Americas, intercontinental admixture intensification occurred between 1750 and 1850, which correlates strongly with the peak of arrivals from Africa. This study contributes with a population genetics perspective to the ongoing social, cultural, and political debate regarding ancestry, admixture, and the mestizaje process in the Americas.

Skin color and race.

Skin color is the primary physical criterion by which people have been classified into groups in the Western scientific tradition. From the earliest classifications of Linnaeus, skin color labels were not neutral descriptors, but connoted meanings that influenced the perceptions of described groups. In this article, the history of the use of skin color is reviewed to show how the imprint of history in connection with a single trait influenced subsequent thinking about human diversity. Skin color was the keystone trait to which other physical, behavioral, and culture characteristics were linked. To most naturalists and philosophers of the European Enlightenment, skin color was influenced by the external environment and expressed an inner state of being. It was both the effect and the cause. Early investigations of skin color and human diversity focused on understanding the central polarity between "white" Europeans and nonwhite others, with most attention devoted to explaining the origin and meaning of the blackness of Africans. Consistently negative associations with black and darkness influenced philosophers David Hume and Immanuel Kant to consider Africans as less than fully human and lacking in personal agency. Hume and Kant's views on skin color, the integrity of separate races, and the lower status of Africans provided support to diverse political, economic, and religious constituencies in Europe and the Americas interested in maintaining the transatlantic slave trade and upholding chattel slavery. The mental constructs and stereotypes of color-based races remained, more strongly in some places than others, after the abolition of the slave trade and of slavery. The concept of color-based hierarchies of people arranged from the superior light-colored people to inferior dark-colored ones hardened during the late seventeenth century and have been reinforced by diverse forces ever since. These ideas manifest themselves as racism, colorism, and in the development of implicit bias. Current knowledge of the evolution of skin color and of the historical development of color-based race concepts should inform all levels of formal and informal education. Awareness of the influence of color memes and race ideation in general on human behavior and the conduct of science is important.

Ancestry, health, and lived experiences of enslaved Africans in 18th century Charleston: An osteobiographical analysis.

OBJECTIVES: In 2013, the burials of 36 individuals of putative African ancestry were discovered during renovation of the Gaillard Center in downtown Charleston, South Carolina. The Charleston community facilitated a bioarchaeological and mitogenomic study to gain insights into the lives of these unknown persons, referred to as the Anson Street Ancestors, including their ancestry, health, and lived experiences in the 18th century. METHODS: Metric and morphological assessments of skeletal and dental characteristics were recorded, and enamel and cortical bone strontium stable isotope values generated. Whole mitochondrial genomes were sequenced and analyzed. RESULTS: Osteological analysis identified adults, both females and males, and subadults at the site, and estimated African ancestry for most individuals. Skeletal trauma and pathology were infrequent, but many individuals exhibited dental decay and abscesses. Strontium isotope data suggested these individuals mostly originated in Charleston or sub-Saharan Africa, with many being long-term residents of Charleston. Nearly all had mitochondrial lineages belonging to African haplogroups (L0-L3, H1cb1a), with two individuals sharing the same L3e2a haplotype, while one had a Native American A2 mtDNA. DISCUSSION: This study generated detailed osteobiographies of the Anson Street Ancestors, who were likely of enslaved status. Our results indicate that the Ancestors have diverse maternal African ancestries and are largely unrelated, with most being born locally. These details reveal the demographic impact of the trans-Atlantic slave trade. Our analysis further illuminates the lived experiences of individuals buried at Anson Street, and expands our understanding of 18th century African history in Charleston.

Historical overview, current research, and emerging bioethical guidelines in researching the New York African burial ground.

OBJECTIVES: The issues addressed in this article are those related to the bioethical actions and decisions surrounding the excavation of the New York African Burial Ground (NYABG) in the 1990s, the significance of conducting research on historical African/African American remains, and the eminence of protecting newly discovered African American burial sites in the future for research purposes. MATERIALS AND METHODS: Skeletal (n = 419, at the time of excavation) and soil (n = 92) remains of the 17th and 18th century New York African Burial Ground were used to discuss the necessity of research on historical African/African American remains. DISCUSSION: Studying the remains of enslaved Africans is critical to understanding the biological processes and existence of all people. Researching the NYABG site, the oldest and largest burial site of free and enslaved Africans, illuminates the necessity and significance of scientific research on other historical African/African American cemeteries throughout the nation. The results of future research will provide a more profound sense of identity for a group of people who were forcefully severed from their genetic and cultural origins. This research will increase the representation of African descended people in genomic, anthropological, and cultural research, and ultimately help researchers to learn more about the origins of all humans.