SPECIAL SECTION Introduction Black Children and Child Psychiatry JAMES P. COMER, M.D., M.P.H.
A growing body of literature indicates that children who grow up in stressful environments are at greater . risk for social, emotional, cognitive, and psychological problems and illness as children and adults than children who grow up in the average expected environment (Garmezy and Streitman, 1974). Low family income and prejudice against racial minorities are two major sources of socioenvironmental stress (Brenner, 1979; Willie et aI., 1973). It is to be expected, then, that black children are overrepresented among groups of children who are underdeveloped or in distress in the social, emotional, cognitive, and psychological areas; and that these and other black children will be overrepresented in social problem and mental illness areas as adults. On the other hand, it has long been noted-and pointed out again in this special section by Bowmanthat most black children and families make healthy social and psychological adjustments in spite of poverty and racial prejudice against blacks. (Billingsley, 1968). Unfortunately, the social and behavioral science literature has given much more attention to problems among black children and families than to the mechanisms for successful adjustment. Yet, it is a better understanding of the latter that is needed to address child and family developmental and mental health problems in the black community. Indeed, effective psychotherapeutic treatment of black children and families requires the same understanding. There is little focus on successful adjustment mechanisms by child psychiatrists and other social and behavioral scientists for several reasons. First, the one-to-one clinical or medical model remains a prominent approach to understanding and addressing problem behavior. In the last 30 years the experimental research or investigation design, most appropriate in the biological and physical science areas, has gained Dr. Comer is Maurice Falk Professor of Child Psychiatry at the Yale Child Study Center and Associate Dean of the Yale University Medical School. Reprint requests to 333 Cedar St., P.O. Box 3333, New Haven, CT 06510. 0002-7138/85/2402-0129 $02.00/0 © 1985 by the American Academy of Child Psychiatry. 129
great prestige in the social and behavioral science areas. Neither the clinical nor the experimental research approach is capable of adequately accounting for the effects of powerful and changing socioenvironmental variables such as economic conditions, social attitudes about class, race, sex, adaptive responses of disadvantaged groups, and others. The more useful social ecological or interactive model of analysis is less favored. This approach is particularly useful in the study of black children and families in that it permits an assessment of the effects of individual-group-institutional interaction over time. Mechanisms of and obstacles to adjustment of the individual, group, and larger society are equally important. There are other major reasons why the study of black children and families has not had a major focus on successful adjustment mechanisms and why problem analysis has been severely flawed. The black experience in America, while improved, is still, in many areas and ways, contrary to our most cherished Judeo-Christian, democratic principles. This has led to critical omissions, distortions, and negative stereotyping of the experience in basic history and social science texts, literature, the arts, and in mass communication of all kinds. Education and training programs of social and behavioral scientists often contain the same omissions, perhaps with fewer distortions and stereotypes. Indeed, many behavioral science training programs provide very little to no opportunity for students to understand the impact of structural or social conditions on children and families of any group. The papers in this section by Lewis and by Spurlock strongly suggest the the diagnosis and treatment of black patients and social problems among blacks are hampered by lack of knowledge and confusion about adjustment mechanisms; by transference and sometimes attitude problems among white therapists and other support service providers. Hill and Comer suggest that social policy and/or factors beyond the individual patient interfere with family adjustment and, in turn, with black child development. Lyles and Pow-
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ell show that social problems adversely affect the confidence, identification, and self-concept of black and mixed racial children. Powell's paper is particularly challenging in that it might appear to suggest that racial integration in schools-a major policy emphasis in America for the last three decades-is harmful to black children. That is not the point she is making. Her paper-along with the papers of Bowman and Comer-suggest very strongly that a cohesive Afro-American community, in which black families and children are enmeshed, can have a decidedly positive effect on the confidence, identification and/or self-concept, and school achievement of black children. Satisfactory school achievement has become very important in this postindustrial period or since the early 1970s. In fact, early school success appears to be correlated with successful sociopsychological adjustment in school and in later life. Understanding this correlation, and a number of other findings presented in the papers in this section, requires an ecological and/or interactive perspective; an individual-groupinstitutional interaction over time (historical) analysis rather than the traditional clinical or experimental investigation approaches. This is particularly the case for blacks where the "common knowledge" often utilized by therapists and social policy advisors is generally limited, inaccurate, or stereotypic. For this reason, I will briefly review the aspects of the majority American experience which have had the greatest social and psychological impact on families and children today and contrast it with the black American family and child experience. In all societies the functioning of families and the development and performance of children is greatly influenced by culture (attitudes, values, ways), family and economic conditions. In this country-and others in which economic mobility is possible-economic conditions often outweigh and even greatly determine cultural patterns. Economic and cultural conditions for black and white Americans have been decidedly different. Thus, a discussion of black families and children requires an analysis of the effects of contrasting economic and cultural conditions.
The Economy, Families, and Children Until the beginning of the 20th century, the American economy was largely based on agriculture, changing dramatically to an industrial base in the 1940s. The country moved rapidly through and beyond three stages of industrial development-early, 1850-1900; middle, 1900-1940; and late, 1940-1970-to the postindustrial period of today. Each period presented different demands on and opportunities for families and permitted and promoted different cultural conditions.
But under all conditions, heads of households were and are expected to earn a living for themselves and their families. Being able to do so is an important source of an individual's and family's sense of adequacy, belonging, power and well-being. It permits identification with the leadership and institutional power structure of the larger society. These conditions are a large part of the motivation to rear children in accordance with cultural expectations and to contribute constructively to the larger society (Lidz, 1963). Earning a living in a low technology agricultural economy was often difficult but required little education, technical, interactional and/or social skills. The same was true of the early industrial period. A moderate level of education, technical, social and interactional skills were required for the job market of the middle industrial period; and finally, a high level of education and skill were and are required for the best opportunities in the late industrial and postindustrial periods. Those families able to earn a living wage, or to provide for themselves and their families, were and are in the best position to transmit attitudes, values, and ways which will enable their children to function well in the next generation. Every group of newcomers to America was blocked in their effort to meet group and family needs to some extent. In response to this, and for other reasons, a pattern of homogeneous ethnic and racial enclaves developed across the country. And while the trauma of dislocation from cultural roots and rejection from the social mainstream often led to a disproportionate amount of troublesome behavior among newcomers in such enclaves, such communities also provided a reasonable degree of cultural continuity-religion, language, attitudes, values, and ways-and resultant cohesion (Handlin, 1959). Cohesion, coupled with reasonable access to the political institutions, and other institutions of power, led to significant economic opportunities for newcomers within a generation (Abbott, 1969). Also, massive immigration was precipitated by and paralleled industrial development. Thus, many families from new groups were able to undergo three generations of development-low to no, moderate, high levels of education and skills-in step with the demands of early, middle, and late industrial development. They experienced the social and psychological benefits associated with being able to do so. Also, America became an affluent nation after the 1860s and many familieseven without adequate functioning-rode to economic success in the rising tide of economic opportunity. These conditions enabled the new groups to reduce the levels of troublesome behavior among their members and to reduce societal obstacles to them usually within one generation.
BLACK CHILDREN AND CHILD PSYCHIATRY
The Black Experience Consideration of four periods of the Afro-American experience will be helpful here-preslavery, slavery, postslavery, and after the 1940s or modern times. Most black Americans are descendants of the sub Saharan, middle West African coast. Relationships in this area were determined by tribal-nation kinship arrangements. Political-economic-judicial and social operations were kinship based. Life was communal and land was often held, worked, and production shared in common. Child to parent, and the reverse, expectations were clear but child-rearing was also, in effect, communal. And persons born within a certain time frame often formed a social support group and participated in birth, marriage, death, and other key life event ceremonies together (Gibbs, 1965). I am not suggesting that life in West Africa was utopian. The point of significance here is that the preslavery social organization of Afro-Americans fostered extremely tight- knit relationships. The sense of belonging, identification, power, and well-being can be- and it is reasonable to speculate, was-very great with such social arrangements. (This can be the case even under adverse economic conditions.) Disruption of this culture and subjugation in a culture fostering individuality, independence, and competition was probably more traumatic than it might have been for persons from a similar culture. Also, the transition to America was forced and violent with a sudden and extreme disruption of culture (Drachler, 1969). Slavery in America was a system of forced dependency. Cultural continuity was possible only in areas that did not threaten the slave system-verbal and physical style expression and some aspects of communalism. But all of the communication, executive, and instrumental functions-political, economic, judicial, social institution management-were denied to the slaves and in the hands of the slave master. Even the institution of family was controlled by the master. Food, clothing, shelter, and even sexual arrangements could be determined by the master. Again, control of these functions, either directly or through identification with the society leadership group, is the source of a family's sense of adequacy, belonging, power, and well-being. The small size of slave holdings, minority status, and identifiability of blacks in the country increased the control of the master, opposite to conditions of slavery in South America and the Carribbean (Mintz, 1974). With this extreme degree of control, the slave's identity was tied to that of the master to a very great extent. Because of the nature of the religious origins ofthe country and the democratic ferment at the time, slavery had to be strongly rationalized (Jordon, 1968). Thus, slaves were described as less adequate human
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beings than the master or other whites. This promoted troublesome slavery and postslavery attitudes and treatment of blacks. American slavery persisted for about 250 years. Thus, the culture of slavery (attitudes, values, ways), among the slaves and whites alike, was transmitted from generation to generation. Fortunately, several factors prevented even more severe psychological and social consequences and sequelae. First, there was always an antislavery sentiment in America which rejected the rationalized attitudes toward blacks and positively affected the thinking of some blacks and whites (Thomas, 1965). Second, slave conditions ranged from humane treatment to treating them as lower animals. While the attitude and behavior of all slaves was adversely affected, those who lived under more humane conditions were less adversely affected. And most important, most slaves developed adaptive mechanisms, institutional and personal. The most important institutional mechanisms were religion and family (when family living was permitted). The slaves fused aesthetic remnants of the African culture-song, verbal expression, etc.-with Christian Protestant concepts to create a protective and adaptive mechanism or "the black church" (Frazier, 1962). The key significance of the black church was that the slave's sense of adequacy, belonging, power, and well-being came from being a child of an accepting, caring, equal opportunity God in Heaven rather than a rejecting, denying, often abusive master on earth. And the attitudes, values, and ways required to enter "The Kingdom of Heaven" were the same as those required to be responsible family members, workers capable of achieving long range goals, and contributing citizens. Free blacks, far fewer in number than slaves, lived under harrassment and other conditions only slightly better than that of slaves (Bennett, 1982). After slavery, reasonable opportunity in the political, economic, and social institutions of the larger society could have sharply decreased the ill effects of the slavery experience. But this was not the case. Legal and illegal means-including violence and terror-were used to close black access to the institutions needed to provide members of the group with a sense of adequacy, belonging, power, and well-being. Racial antagonism, political and economic powerlessness forced most black heads of households to eke out a subsistence existence as agricultural laborers and domestics (Spero and Harris, 1968). But despite their marginal economic status, mf.ny of these families were able to use the black ch1.1rch as a "substitute society" and as an anchor am} support for adequate functioning. Many practiced and developed planning, organizational, problem-solving leadership skills within the
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context of the church world and the black community which grew out of it. Black family life, enmeshed in the church culture, provided the same nurturant and protective functions family life provides among all groups. But the function was particularly important and special for many blacks. Black families had to heal the hurt of a higher than ordinary level of rejection within the larger society. They had to provide human support services unavailable to blacks in the larger society. They had to give instructions to children which would enable them to survive and thrive in a continuously hostile society. All of these things had to be done in a way that promoted and maintained individual and racial dignity. Many families were able to achieve these ends. But given the magnitude and complexity of the task, many were not able to do so. In the latter situation, low self and group esteem, hopelessness and despair led to troublesome family functioning, child-rearing, and performance. Successful black families promoted performance which prepared a nucleus of people for achievement in the major institutions of the larger society. Completely denied political and economic power (Franklin, 1961), successful black families moved toward educational opportunities in large numbers. But until the 1940s, 4-8 times as much money was spent on the primary and secondary education of white children as on that of blacks. In areas in which blacks existed in disproportionate numbers, the differential was as much as 25 times or more (Blose and Caliber, 1936). The endowment of colleges and universities is a reflection of the society's value of, and intent to utilize, the students prepared by them. As late as the mid-1960s the combined endowment of two prestigious white women's colleges or 50% of one prestigious white men's college was more than that of the more than 100 black colleges combined. 1 Similar inequities existed in segregated land grant or state colleges where most blacks were educated prior to the 1950s (Comer, 1972). And once educated, most blacks were denied employment opportunities except in racially segregated settings that were socially and psychologically excluded from the political, economic, and social mainstream of the society. During and after the 1940s, the modern period, a number of forces-demands of the economy, technology, social pressure, etc.-coalesced to weaken the racial caste system in America. Migration from south to north weakened the culture of segregation and made better paying, though still low level, industrial labor jobs available to blacks in large numbers for the first 1 1964-1965 Voluntary Support of Alt1erica's Colleges and Universities (1967), New York: Council for Financial Aid to Education, Inc. pp. 3, 21-59.
time. But by the time this occurred at a significant level in the 1950s, industrial development was already in its last phase. A high level of education and training-even when not truly needed for a job-was a part of the entry requirement. And blacks, closed out of educational opportunities made available to other groups over the previous three generations, were more often excluded by these requirements. Also, overt racial antagonism closed blacks out of better job opportunities and the networks which made them available. These conditions continued to block opportunity. Thus, three generations after slavery-unlike the one generation adjustment of most groups-the black community was still effectively denied, rejected, and abused. Denial, rejection, and abuse over time begins to weaken the motivation for achievement, decrease the models of success, and increase the number of social and psychological problems. In the 1960s the most successful segment of the black community, supported by many whites and changed industrial and social conditions, eliminated remaining laws and the more overt practices excluding blacks from participation in the political, economic, social, and education mainstreams. But by this time the pressures of urban and metropolitan, high mobility, high level of information (often conflicting and confusing) living had already put stress on all families and their social networks. The least well-situated families-economically, educationally, and socially-were most vulnerable. Blacks were overrepresented among this group. Combined with the dislocation effects from massive south to north migration of many blacks, a number of once adequately functioning families begin to function less well. In addition, the more secular style of the period weakened the influence of religion and the church. The black church-still needed as a transmitter of a supportive culture-had less impact after the 1950s than previously. Individuals who are repeatedly blocked in their efforts to seek opportunity still attempt to develop adaptive and defensive behavior. But, over time it becomes less healthy and effective. Avoidance, denial, dependency, sexual and social acting out, and a number of other patterns of behavior develop in all but those psychologically prepared to sustain long-term obstruction and abuse. Also, where economic independence is a reality, heads of households delay childbirth and reduce the number of children to increase their chances for successful functioning as a family. Past and present conditions make economic independence less of a possibility for a disproportionate number of blacks compared to groups with a less traumatic experience. It is against this historical backdrop of interacting economic, political, social, educational, and psycholog-
BLACK CHILDREN AND CHILD PSYCHIATRY
ical variables that the behavior of black families and children can best be understood and that the findings in the papers in this section can best be considered. The source and consequences of inadequate social power and the nature of the adaptive responses by the black community helps to explain the different selfconcept findings among black children discussed in Powell's paper. The historical black experience helps to explain the special importance and the protective role of the black family-and the negative consequences when it is not present as shown in the papers by Lyles and Bowman. Obstacles to the most efficient and effective approaches to social problems, such as delinquency, and individual psychological problems, as discussed by Lewis and Spurlock, are best understood from a historical interactive perspective. Likewise, the rationale for a school-based, shared power management team, discussed by Comer, is patently obvious in light of the history of black powerlessness, exclusion, and abuse. And finally, the social policy errors and possibilities outlined by Hill and Comer are based on the premise that the different black family and child experience over time compared with that of the majority, requires social policy and individual treatment approaches which are sensitive and responsive to the difference. References ABBOTI, E. (1969), Historical Aspects of the Immigration Problem. New York: Arno Press.
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BENNE'IT, L. (1982) Before the Mayflower. A History of Block America, Ed. 5. Chicago: Johnson Publishing. BILLINGSLEY, A. (1968), Black Families in White America. Englewood Cliffs, N.J.: Prentice Hall. BLOSE, D. & CALIBER, A. (1936), Statistics of the education of Negroes, 1929-30; 1931-32. Washington, D.C.: U.S. Department of the Interior, Office of Education, Bull. 133, p. 16. BRENNER, M. H. (1979), Influence of the social environment on psychopathology: the historical perspective. In: Stress and Mental Disorder, ed. J. E. Barrett. New York: Raven Press. CARPENTER, N. (1969), Immigrants and Their Children. New York: Arno Press. COMER, J. P. (1972), Beyond Block and White. New York: Quadrangle Books, Chap. 3. DRACHLER, J. (ed.) (1969), African Heritage: An Anthology of Block African Personality and Culture. New York: Macmillan. FRANKLIN, J. H. (1961), Reconstruction After the Civil War. Chi· cago: University of Chicago Press, p. 108. FRAZIER, E. F. (1962), The Negro Church in America. New York: Schocken Books. GARMEZY, N. & STREITMAN, S. (1974), Children at risk: the search for the antecedents of schizophrenia: 1. Conceptual models and research methods. Schizo. Bull., 8:14-90. GIBBS, J. L., JR. (ed.) (1965), Peoples of Africa. New York: Holt, Reinhart & Winston. HANDLIN, O. (ed.) (1959), Immigration as a Factor in American History. Englewood Cliffs, N.J.: Prentice Hall. JORDON, W. D. (1968), White Over Block: American Attitudes Towards the Negro, 1550-1812. Chapel Hill, N.C.: University of North Carolina Press. LIDZ, T. (1963), The Family and Human Adaptation. New York: International Universities Press. MINTZ, S. W. (1974), Caribbean Transformations. Chicago: Aldine. SPERO, S. D. & HARRIS, A. L. (1968), The Block Worker. New York: Atheneum. THOMAS, J. L. (ed.) (1965), Slavery Attacked: The Abolitionist Crusade. Englewood Cliffs, N.J.: Prentice Hall. WILLIE, C. V., KRAMER, B. M. & BROWN, B. S. (ed.) (1973), Racism and Mental Health. Pittsburgh: University of Pittsburgh Press.