Psychiatric Annals

Editorial Free

A Difficult Conversation About Race, Racism, and Anti-Racism

Andrew A. Nierenberg, MD

After the tragedy of the murder of George Floyd, it has become a time of reckoning and conversation about race, racism, and anti-racism in the United States. It is essential as we have this conversation to acknowledge that race is a social construct, not a biologically determined taxonomy of human beings.

As I have learned from the scholarly works of Ibram X. Kendi,1,2 Ta-Nehisi Coates,3,4 Richard Rothstein,5 and Isabel Wilkerson,6 racist policies arose from economic circumstances and allowed one group of humans (who took skin color as an indicator of superiority) to treat another group of humans as inferior, as subhuman, and as property. When the legal practice of physically abducting people from Africa and transporting those people to the Americas to sell them into slavery was banned in the early 19th century, White people began to systemically force the reproduction (ie, breeding) of Black people to generate more people to keep slavery going.7 This system of forced free labor and chattel slavery over the course of more than 245 years enabled the US to establish itself as a big-business industry.8 Both the South and the North benefited from the institution of slavery in the US. These practices and policies would lead to a caste system in which Black people were exploited and did not own their bodies.

After the Civil War, which was fought primarily because of the conflicts between the northern and southern states over the institution of slavery, the Reconstruction era briefly attempted to address some of the social, political, and racial inequalities, but was quickly reversed and this reversal continues to reverberate today.9

If Black people violated the caste system, they were lynched. If they tried to vote, they were repressed (and this continues today). If they tried to get educated, they were denied. If they succeeded in building their own communities including thriving businesses, as in Tulsa, OK, White people destroyed it through violence.10 If they fought in World War I, White people attacked them when they returned. If they fought in World War II, they were banned from housing, and developers were not allowed to get federal insurance if they allowed Black people to live in their housing. This racist policy led to segregation in every city (including most suburbs)11 and allowed White people to develop wealth through equity and home ownership and prevented Black people from doing the same. Then the “War on Drugs” disproportionally jailed Black people and then disenfranchised them from voting (as in Florida today).12 Now one's zip code in a predominately Black neighborhood is more of a predictor of premature mortality than the genetic code.13

Racism is complicated and structural. The path to correct racism is with anti-racist policies. It is incumbent upon White people who have spheres of influence and privilege to correct those racist policies. We must pursue justice, including in psychiatry, if we are to ever finally realize that no group of human beings is superior to any other group. Read the essential books and articles listed in the references and then figure out what you can do to make the world more equitable.


  1. Kendi IX. Stamped From the Beginning: The Definitive History of Racist Ideas in America. Random House; 2017.
  2. Kendi IX. How To Be An Antiracist. One World; 2019.
  3. Coates T-N.Between the World and Me. Spiegel & Grau; 2015.
  4. Coates T-N.We Were Eight Years in Power: An American Tragedy. One World/Ballantine; 2018.
  5. Rothstein R. The Color of Law: A Forgotten History of How Our Government segregated America. Liveright Publishing; 2017.
  6. Wilkerson I. Caste: The Origins of Our Discontents. Random House; 2020.
  7. Spivey W. The truth about American slave breeding farms. Accessed October 6, 2020.
  8. Lockhart PR. How slavery became America's first big business. Accessed October 6, 2020.
  9. Gates HL Jr., How reconstruction still shapes American racism. Accessed October 6, 2020.
  10. Vineyard J. The Tulsa race massacre happened 99 years ago. Here's what to read about it. Accessed October 6, 2020.
  11. Brandt L. How redlining kept Black Americans from home ownership decades ago — and is still contributing to the racial wealth gap today. Accessed October 6, 2020.
  12. Elfrink T. The long, racist history of Florida's now-repealed ban on felons voting. Accessed October 6, 2020.
  13. Puckrein GA, Egan BM, Howard G. Social and medical determinants of cardiometabolic health: the big picture. Ethn Dis. 2015;25(4):521–524. doi:10.18865/ed.25.4.521 [CrossRef] PMID:26673674

Andrew A. Nierenberg, MD

Andrew A. Nierenberg, MD, is the Thomas P. Hackett, MD, Endowed Chair in Psychiatry, the Director, Bipolar Clinic and Research Program, and the Director, Training and Education, MGH Research Institute, Massachusetts General Hospital; and a Professor of Psychiatry, Harvard Medical School.

Address correspondence to Andrew A. Nierenberg, MD, via email:


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