3

“Between the Sewer and the Church”

The Emergence of the Lafargue Mental Hygiene Clinic

Living in the rectory of the St. Philip’s Episcopal Church during the Great Depression, Elizabeth Bishop could occasionally hear her father, Rev. Shelton Hale Bishop, the church’s pastor, as he counseled his parishioners in a nearby room. While he primarily offered advice for newly married couples or those facing domestic difficulties, Elizabeth saw that he sometimes left his office knowing his pastoral counseling was insufficient. Reverend Bishop told his family that some of those whom he counseled were in real need of professional psychiatric care. He was often exasperated that there was no suitable place to refer black New Yorkers for psychotherapy. One of the oldest black congregations in New York, at West 134th Street and Seventh Avenue, St. Philip’s sat at the intersection of Upper Manhattan that the U.S. Census defined as the Central Harlem district. Harlem Hospital, just a few blocks away, would have no outpatient psychiatric clinic until 1947 and no department of psychiatry until 1962. When Bishop suggested going to Harlem Hospital for emergency treatment, his parishioners usually rejected the idea: “I’m not going there; they’ll strap me down on a gurney and have the police take me to Bellevue. And if I go there, they’ll send me along to Manhattan State Hospital, where I’ll never be heard from again.”1 When in the winter of 1946 a young Ralph Ellison asked Bishop if he would be interested in meeting with a group of men and women who wanted to open a walk-in mental health clinic for the people of Harlem, Bishop immediately embraced the idea.

Bishop had been trying for years to persuade the New York Department of Hospitals to establish a mental health center for the black community of Harlem. Appointed pastor of St. Philip’s in 1933, he quickly became one of the black community’s most vocal advocates for civil rights and economic opportunity. He was active in Progressive politics and social movements in the 1920s and ’30s, including working with the Socialist Party on the presidential campaigns of Norman Thomas, and he participated in founding the Fellowship of Reconciliation, an ecumenical precursor to the Congress of Racial Equality. In the late 1920s, Bishop established a department of social welfare within St. Philip’s, which became increasingly vital during the Great Depression, supplementing any relief benefits African Americans in Harlem may have received from the City of New York. Under his leadership, St. Philip’s membership had grown, attracting not only the traditional upper crust of black Harlem’s Episcopalian elite, but many of the West Indian and southern-born migrants who streamed into Harlem through the 1940s.

Saint Philip’s was Bishop’s base of activism.2 From St. Philip’s, he looked outward to the whole of the Harlem community and was keenly aware of the difficulties finding adequate housing and employment, especially for new migrants. But he also had a larger vision of the health of black Harlem, its emotional and psychological well-being. When Bishop once requested that the city establish a fully staffed, fully funded mental hygiene clinic, officials in the Department of Hospitals pointed to Bellevue or claimed that black people only needed life’s basics; “Negroes don’t need psychiatry; they simply need bread.”3

One evening in March 1946, Reverend Bishop led a group of visitors down to the basement of the St. Philip’s parish house. Richard Wright, Fredric Wertham, and Dr. Hilde L. Mosse, Wertham’s Queens General Hospital colleague, followed Bishop through a maze of hallways, down a flight of stairs, and into a dirty two-room basement furnished with nothing but a wobbly red table and several unvarnished benches. There sat a young black woman, who had heard a rumor that a free psychiatric clinic was opening in the basement of St. Philip’s. “How much money are you going to take from me,” she asked. None, they told her. Dr. Mosse sat down with her, and over the course of several minutes discovered that in the past few months she had spent all her savings on shock treatment for anxiety, depression, and suicidal thoughts. This woman was the Lafargue Clinic’s first patient.4

Figure 5. Fredric Wertham and Rev. Shelton Hale Bishop in front of St. Philip’s Episcopal Church, February 1948. Photo by Lisa Larsen. Courtesy of the Library of Congress.

A remarkable convergence of both history and autobiography brought Wright, Wertham, and Bishop together in 1946 to establish the Lafargue Clinic. Three distinct traditions—black intellectual radicalism, Jewish émigré scientific radicalism, and the Progressive black church—met together in the basement of a church in Harlem to address an urgent community need. Beyond the immediacy of providing inexpensive and accessible mental health care within the Harlem community, the founders of the clinic confronted one of the central problems of postwar American society: the psychic fallout of black Americans’ struggles to live a human life in an antiblack social world. This world required blacks to accommodate the ideology of white supremacy, while systematically subjugating them as a source of readily exploitable labor.5 And so Wright’s writings and activism joined with Wertham’s politicized medical science and Bishop’s Christian social justice traditions to set in motion the creation of a new type of institution on the American scene, the Lafargue Mental Hygiene Clinic.

“Harlem: Dark Weather-Vane”

Harlem in the 1940s differed considerably from the celebrated days of the New Negro Renaissance years of the mid-1920s. In the midst of the First World War, tens of thousands of blacks from the South and from the West Indies had descended upon that six-square-mile section of Upper Manhattan, and by the start of the Great Depression the black population of Harlem had increased from nearly thirty thousand to over two hundred thousand.6 Most of those who moved to Harlem were the second and third generation of black people born outside slavery, and many envisioned themselves as “New Negroes,” casting off offending minstrel images of docile and “happy-go-lucky darkies.” In Harlem, a critical mass of New Negroes worked self-consciously to forge a new assertive identity for black Americans. The resulting community of black people established Harlem as the Mecca of “Negro culture and society.”7

But the Great Depression hit Harlem hard, harder even than it had hit Richard Wright’s Chicago. The boom years of the 1920s, when black men and women could find work in the light industries within and around New York City, turned into the depressed 1930s. Black people bore the brunt of economic catastrophe. Not only were blacks in Harlem less likely to be employed than their white fellow New Yorkers; they often had difficulty gaining access to welfare relief and the social agencies that administered New Deal programs and services. A major riot in March 1935, sparked by rumors of a department store clerk killing a young black boy, led to days of violent unrest. It also produced a good deal of liberal hand-wringing about the conditions of life for New York’s black minority, segregated into a small section of the city and discriminated against in all facets of the institutional life of New York. A comprehensive report on the Harlem “disturbance,” written in large part by the Chicago School–trained black sociologist E. Franklin Frazier, detailed the conditions in Harlem that led to the outbreak of mass violence and offered specific recommendations for remedy. Wary, however, of the broader New York public’s response, Mayor Fiorello La Guardia shelved the report, demanding that its findings not be released to the public (though the New York Amsterdam News printed it serially in the following year).8

In the wake of the 1935 outburst, Harlem became to some observers the measure of black America’s collective health and well-being. In his essay “Harlem: Dark Weather-Vane,” Alain Locke, doyen of the Harlem Renaissance, contrasted the hopeful moment of the Renaissance ten years prior with the reality of Harlem’s becoming an “over-expensive, disease- and crime-ridden slum.” “What we face in Harlem today,” wrote Locke, “is the first scene of the next act—the prosy ordeal of the reformation with its stubborn tasks of economic reconstruction and social and civic reform.” No matter how one characterized the events of March 1935, the riot served a diagnostic purpose, according to Locke, making plain the significance of the Negro’s oppressed condition. “As the man farthest down,” wrote Locke, “[the Negro] tests the pressure and explores the depths of the social and economic problem. In that sense he is not merely the man who shouldn’t be forgotten; he is the man who cannot safely be ignored.” Yet Locke, like many other black and white intellectuals and civic leaders, remained hopeful that Negroes and whites might work together to confront the social and economic ills of Harlem, particularly in areas of housing and health. Harlem, once a sign of the Negro’s cultural advancement, a self-conscious, representative community of strivers, was now the symbol of the struggle against the dire conditions of the urban ghetto.9

Harlem’s paradoxical status as both Mecca and ghetto intensified with the onset of World War II. Negro migration to New York and other northern cities shot up rapidly, as industries needing labor opened their doors to black workers.10 As migrants streamed into New York, they encountered an entrenched, systematic residential segregation. Those who came to Harlem were squeezed into already overcrowded tenements at a higher rate than the notoriously densely packed Lower East Side of turn-of-the-century Manhattan.11 In his famous autobiography, Manchild in the Promised Land, Claude Brown lamented the plight of these migrants: “It seems that Cousin Willie, in his lying haste, had neglected to tell folks down home about one of the most important aspects of the promised land: it was a slum ghetto. There was a tremendous difference in the way life was lived up North. There were too many people full of hate and bitterness crowded into a dirty, stinky, uncared-for closet-size section of a great city.”12

Yet even in this ghetto, a new black militancy emerged, born of a mixture of participation in and exclusion from the nation’s wartime mobilization. The war forced black Americans into a peculiar position, as it asked them to participate in the defense of the nation, but on Jim Crow terms, with no changes in blacks’ second-class status. Most whites must never have expected that the war would provoke a widespread assertive mood among black Americans. Harlem was ground zero for black American democratic aspirations, and the tone of these hopes was militancy.13

The Harlem community reflected its new militancy in both its institutions and in a general mood. Many believed that the city, and the country, for that matter, was on the precipice of catastrophic change.14 Writer James Baldwin, a Harlem resident through the Depression and war, recalled that “all of Harlem, indeed, seemed to be infected by waiting. I had never known it to be so violently still. Racial tensions throughout this country were exacerbated during the early years of the war, partly because the labor market brought together hundreds of thousands of ill-prepared people and partly because Negro soldiers, regardless of where they were born, received their military training in the South.”15

In response, a coalition of black and white liberal leaders organized around combating antiblack discrimination in New York City. The City-Wide Citizens’ Committee on Harlem was formed in 1941 to address the same oppressive conditions that led to the paroxysm of mass violence in Harlem in 1935. Members explicitly linked its program to the broader national issue of fighting Jim Crow, while fighting the war abroad. Their work was part of the wider, national campaign, Double V, victory against fascism at home and abroad, promoted by the black press and the rest of black civil society. The Citizens’ Committee, while initially dedicated to the problems that stimulated chronic juvenile delinquency among black youth, expanded its purview to address the several areas of city life that were primary sources of grievance among Harlem’s residents: housing, health and hospitals, education and recreation, employment, and crime and delinquency. Hoping to stem the rising tide of hostility, yet well attuned to the militant mood of the people, the committee called for both immediate remedies—especially an end to employment discrimination and to racist policing of Harlem—and “long-range social reconstruction” of New York City in relation to its black citizens.16

But the Citizens’ Committee’s reform work was no match for what Baldwin termed Harlem’s “need to smash something.” As he explained, “To smash something is the ghetto’s chronic need. Most of the time it is the members of the ghetto who smash each other, and themselves. But as long as the ghetto walls are standing there will always come a moment when these outlets do not work.” On August 1, 1943, Harlem erupted for one night of mayhem, sparked by rumors that a police officer had murdered a black soldier who was still in uniform. After recent mass violence between whites and blacks, and whites against Latinos, most notably in Detroit and Los Angeles, there was a simmering sense that the whole of America could erupt in race war.17

Many contemporary observers took pains to explain that “the Harlem disturbance” was not a race riot. Unlike Detroit and other conflagrations, the violence on the streets of Harlem did not involve members of different races attacking one another. Rather, as Richard Wright told one reporter the day after the outburst, the riot seemed to be a response to the wartime “economic pinch,” with the rioters turning their ire against property rather than persons. Black people had expressed a general grievance about the way they had been cooped up in Harlem and exploited by shopkeepers and excluded from the general prosperity they witnessed all about them in the United States. While the origins of the Harlem riot seemed to lie in the economic order of things, the outburst was for many a harbinger of more chaos, perhaps a race war to come.18

Fredric Wertham predicted that unless something was done to address the hostile atmosphere created by Jim Crow in the North, New York City might see an unprecedented explosion of violence in the streets. He argued that northern racism, “half-concealed and generally insidious,” produced psychological conflicts distinct from those engendered by stark southern white supremacy.19 He explained that African Americans uprooted from the South and encountering northern society inevitably experienced various forms of alienation. Many black patients he encountered were what he called “mental DP’s (Displaced Persons).”20 Wertham used the language in the air during the World War II years likening black migrants to the war’s roaming refugees in Europe—DPs.21 Blacks too were experiencing the traumatic effects of loss, dispossession, and instability.

Wertham was not the only person who adopted the term DP in reference to southern-born black migrants in New York City. In his essay “Harlem Is Nowhere,” Ralph Ellison referred to blacks in early post–World War II America as “displaced persons of American democracy.” Ellison’s and Wertham’s appropriation of the term represented a call to Americans to consider migrating black Americans as part of a global phenomenon unleashed by the Second World War. The notion of displaced persons resonated with many Americans aware of the predicament of refugees with no home country in which to settle. Wertham and Ellison thus made black Americans’ recent experience migrating from the South to the urban northern ghetto conceptually legible, as part of the upheavals shaping the postwar world.22

Migration and the associated changes in work, family, and recreation produced a destabilizing effect on the psyches of some African Americans who settled in Harlem. In a 1936 study, renowned epidemiologist Benjamin Malzberg found that during June 1928 to June 1931, out of a total of 1,403 of “U.S. born Negroes admitted to all institutions for mental disease in New York State, only 130, or 9.3 per cent, were born in New York State.” The other 90.7 percent, the 1,273 admitted to mental hospitals, were migrants. Malzberg argued that “it seems a justifiable conclusion, therefore, that migration is in itself and through its attendant circumstances an important contributory factor in the causation of mental disease.”23 The loss of home and place was a profoundly important variable in the psychological well-being of the black migrant. The rankest white brutality may have been absent in the North, and formal equality recognized in law, but racial discrimination confronted black northerners at every turn. Such contradictions, Ellison argued, left “even the most balanced Negro open to anxiety.”24

Segregation and Mental Health Care in New York City

Fredric Wertham often regaled Wright with stories of the terrible treatment of the mentally ill in New York City. According to Wright, Wertham had “a dark story to tell of how hospitals are run,” especially the treatment of black New Yorkers at Bellevue and other hospitals, as well as blacks’ exclusion from services at centers such as the New York Psychiatric Institute attached to Columbia University. As a psychiatrist in the New York City Department of Hospitals system, Wertham came into contact with the black men, women, and children hospitalized for various mental disorders, which he identified as having their etiology in the oppressive social order of Depression- and war-era United States. He described his failure in the 1930s to get the La Guardia administration to establish an outpatient psychiatric clinic in Harlem, a time when even Harlem Hospital, the only city hospital in the area, offered no psychiatric services.25

The burgeoning black population of New York City faced outright exclusion from mental health care. From the late 1930s through the 1940s, residential segregation and official health care policies denied African Americans access to the increasing number of psychiatric facilities within New York City. Between 1940 and 1950, the official number of black people in New York City grew from 458,444 to 749,080. While this population increasingly settled north and east of Harlem, about 70 percent of black New Yorkers were concentrated in Harlem. Black sociologist E. Franklin Frazier noted that “although as a result of a Supreme Court decision racial restrictive covenants are no longer enforceable, residential segregation and slums remain the Negro’s most important problems” in large cities of the North such as New York.26

Sections of the city were divided into Health Areas for census purposes, making where one resided the basis for access to hospitals and psychiatric facilities located in other districts.27 One 1942 report on the availability of psychiatric services for black children explained that for black New Yorkers, districting was used against them when applying for help because, with characteristic circular logic, “they are out of district,” making the psychiatric services offered in various Manhattan hospitals nearest to Harlem largely irrelevant. Further, this report found that two of the most prominent “in-service” psychiatric research and treatment centers, the Psychiatric Institute at the Columbia Medical Center and the Cornell Medical Center, were “essentially closed to Negroes.” Thus while hospitals in different districts were establishing or expanding both inpatient and outpatient psychiatric services, black New Yorkers were both restricted from admission to facilities outside their communities, owing to residential segregation, and denied access within their own districts to adequate care and treatment, as a result of unequal provision of health care facilities and programs within sites such as Harlem Hospital.28

In 1942, the Sub-Committee on Health and Hospitals of the City-Wide Citizens’ Committee on Harlem recommended the establishment of a mental hygiene clinic in Harlem. The committee proposed a clinic designed “to combat frustrations, behavior and personality problems, and crime incidence in the community, and a psychiatric ward in Harlem Hospital for observation and diagnostic purposes.” The problem of black New Yorkers’ lack of access to facilities for psychiatric treatment within their own communities was now publicly placed before city officials and private agencies and institutions whose mission was purportedly the provision of various forms of health care and welfare services to those in need.29 However, it wasn’t until the Lafargue Clinic had been up and running for several months, proving itself a vital service to the Harlem community, that city hospital officials were persuaded to establish a mental hygiene clinic within Harlem Hospital. Even then, the clinic had only one full-time psychiatrist and a total staff of six nurses and assistants.30

For Wertham the nature of the psychiatric treatment blacks received was just as significant as the question of access. He feared that even if African Americans did gain access to psychiatric facilities, they would be receiving forms of treatment founded on a misguided approach, an approach that failed to understand mental disorders whose etiology was to be found in the social order of an oppressive society rather than the pathology of an individual psyche. Blacks constituted a reported “50% of the [annual] intake” at the Bellevue psychiatric ward, according to one early 1940s report, which of course means that they had access to a form of psychiatric care.31 Even so, there is no indication that blacks in New York considered Bellevue a place where they would be both respected as human beings or receive the type of care and treatment that acknowledged the socio-psychological stress of living in oppressive conditions. By most accounts, blacks at Bellevue were treated according to the reigning stereotypes of black inferiority and puerility.32

Philanthropy and Failure

In the spring of 1945, Wertham phoned Wright with the idea of establishing a clinic in Harlem that would provide psychotherapy at the cost of a quarter per visit. Wertham envisioned an inexpensive outpatient psychiatric clinic in Harlem, open several evenings per week, and staffed by volunteer psychiatrists, psychologists, social workers, and nurses. Wright said he would see what he could do to help him with the plan, immediately suggesting that they approach the Field Foundation to secure funding. Wright had recently attended a luncheon at Marshall Field’s Manhattan home to discuss a new race relations commission. Wright generally disdained the “folklore of race relations,” but he understood the practical value of proximity to men such as Marshall Field III and Edwin Embree, director of the Julius Rosenwald Fund, the philanthropic agency of the Sears, Roebuck fortune. At the Field luncheon he happened to sit next to Louis Weiss, Field’s lawyer, who had made overtures of friendship. Engaging in a “long and amazing talk” about race, economics, and psychology, they agreed that “making what Negroes experience known to the American people was one of the most powerful things that could be done to help solve the race problem.” Weiss was keen to support any work being done in that direction, so Wright naturally thought of him when Wertham proposed the Harlem clinic.

A mental hygiene clinic in Harlem would not only serve its patients, thought Wright; it would make public the psychological and emotional effects of antiblack discrimination and segregation.33 In June 1945, Wright arranged a dinner at Weiss’s home, where Wertham would be able to pre-sent the clinic plan in full detail. Wright and Wertham assumed that they, along with their wives, would be the sole guests of Mr. Weiss. They were surprised then when two other people joined the dinner party. Sitting with Mr. Weiss were two “consultants,” one a prominent juvenile court judge and the other a psychoanalyst, both known “for their high-toned public utterances about social and philanthropic matters.”34

What occurred was a fiasco. Immediately following Wertham’s presentation of his plan and request for funding, the two consultants dismissed the plan as unrealistic. They offered several objections: black Harlemites would never come to a clinic run by a white psychiatrist; the clinic would simply be reproducing the same structure of white doctors’ control that existed in psychiatric institutions throughout the city. They advised Weiss that the Field Foundation should have nothing to do with Wertham’s envisaged clinic. Weiss agreed.

Decades later, Wertham would recall this meeting as one more indication of the failure of liberal philanthropy, of the inability of powerful liberals to imagine new methods of providing care and treatment for the poor and excluded.35 “I really got a great feeling of let-down after the dinner at Mr. Weiss,’” Wertham wrote to Wright a short time after the failed meeting. “You see, I think I know even a little more about what happens to children in Harlem than you do, how they are really crushed so that they can possibly never come back again.”36 Wertham may have been exasperated by the Field Foundation’s rejection of his proposal, but he remained determined to establish a clinic in Harlem that would use psychotherapy in the broader cause of helping black New Yorkers to “survive in a hostile society.”

The Struggle for Mental Hygiene for Black Americans

Prior to Wertham’s and Wright’s efforts in the mid-1940s, professional and lay concern for the provision of mental health care to black Americans had coalesced around the founding of the Committee for Mental Hygiene for Negroes (CMHN), a short-lived project that did not last through the war. Founded in December 1939 at St. Augustine’s College in Raleigh, North Carolina, the committee grew out of the experiences and advocacy of one lone African American woman named Rosa Kittrell. Kittrell had herself been hospitalized for mental illness, first in North Carolina and later in New York. As a patient she discussed with her psychiatrists “her resolve to work for better psychiatric care for her people.” When she returned to her home in White Plains, New York, she organized the White Plains Mental Hygiene Group, collaborating with her psychiatrist to convene a group of mental health professionals and representatives of historically black colleges and universities, including Howard University, the Tuskegee Institute, and Meharry Medical College in Nashville, Tennessee.

The committee launched a campaign to create psychiatric hospitals at Howard and Meharry, modeled on Boston Psychopathic Hospital and the Phipps Clinic of Johns Hopkins Hospital. It also called for the development of regional mental hygiene groups to promote awareness of the psychiatric needs of Negroes, as well as the establishment of preventive public mental health clinics in Negro communities. Some on the committee were worried that the proposed hospitals would simply be another accommodation to Jim Crow segregation, arguing that efforts should be directed toward combating discrimination in already existing state and private hospitals. Others suggested it was not necessary to choose between challenging discrimination and establishing facilities for Negro patients. Given the reality of segregation, efforts on both fronts were essential.37

The United States’ entry into World War II interrupted the work of the committee, as many of its officers and members were called upon to serve in the war effort. The primary question posed by committee chairman Dr. T. P. Brennan was, “What justification does this program have in our War?” For Brennan, the issue of addressing the mental health needs of Negroes, as the signal minority people in American society, was part of the larger politics of minority-majority relations in a democracy: “This is a subject that has a legitimate psychiatric and mental hygiene component. In it, exquisitely potent human and social processes are at work. They are processes that do things to individuals—to individuals on both sides of the relationship.” Arguing that psychiatry constituted a valid tool for both the exploration and solution to the individuated effects of race relations, Brennan maintained that the work of the CMHN was vital and must continue in the midst of the war.38

Unfortunately, no record exists of the committee being a persistent and effective advocate for the provision of mental care for black Americans during or after the war. In the wake of an initial mobilization in the early 1940s, there is no indication that the work of the committee gained much traction within the broader campaigns to promote the expansion of mental hygiene services and facilities in the postwar era. Various members of the advisory council, including Harlem’s Rev. Adam Clayton Powell Jr., seemed relatively well positioned to influence policy changes and the redirection of material resources toward Negro mental health needs. It appears that the committee simply faded away. We are left to wonder where went the concerted energy and interest of members of this organization.

Northside Center for Child Development

While efforts to organize a comprehensive system of mental health care for black Americans may have faltered as a result of wartime mobilization, concern over the emotional and mental health of black children led to the birth of a new institution that paralleled the establishment of the Lafargue Clinic. The Northside Center for Child Development opened in Harlem the very same month as Lafargue, March 1946. Northside differed, however, from Lafargue in that its founders, Drs. Kenneth and Mamie Clark, were psychologists, rather than psychiatrists. The Clarks envisioned a place for troubled children of all races to receive psychological testing and counseling, as well as remedial education. The Clarks approached children’s mental health issues with a blend of Progressive-era child guidance interventions aimed toward children’s basic social adjustment and novel socio-environmental behavioral sciences that used testing and therapy to diagnose and rehabilitate troubled children. In practice this approach directly confronted the Negro child’s social and cultural experience of antiblack racism and the effects of societal marginalization.

In the early 1940s, the problems of black children had become a focal point for mental health professionals, juvenile court jurists, and liberal philanthropists determined to improve public and private child guidance services designed to combat juvenile delinquency and education-related maladjustment. A number of men and women who sat on various subcommittees of the City-Wide Citizens’ Committee on Harlem soon became integral participants in the founding, operation, and financing of the Northside Center.

While Northside and Lafargue shared a similar orientation to addressing the psychological effects of racism, the Clarks succeeded in gaining philanthropic support where Wertham could not. The same philanthropists who rejected Wertham’s plan became the primary underwriters of the Northside Center. The two Field Foundation “consultants” who counseled Louis Weiss to reject Wertham’s plan appear to have been Children’s Court judge Justine Wise Polier and Dr. Viola W. Bernard, a prominent New York psychoanalytic psychiatrist. These two women served on the board of directors of Northside, and it was Dr. Bernard who ultimately convinced Marion Ascoli to be chief sponsor of the Clarks’ new institution. Ascoli was one of Julius Rosenwald’s daughters, and thus an heir to the Sears, Roebuck fortune. In their study of the Northside Center, historians Gerald Markowitz and Mark Rosner show how the Clarks were able to attract the interest and largesse of a small group of mostly Jewish philanthropists and psychiatrists by effectively framing the need for a type of clearinghouse for the most vulnerable of New York’s children. Ultimately the Clarks had to struggle against various forms of cultural and professional paternalism in their relations with their board of directors. Even so, the Northside Center was able to operate as a full-time, comprehensive facility in a way that the Lafargue Clinic was never allowed the opportunity to develop.39 Perhaps the problems of black children were easier for some clinicians, reformers, and philanthropists to face than those of adults suffering from society-induced mental disorders. Perhaps the fact that the Clarks were African American made Northside more legitimate in the eyes of some of its supporters. For some, including Dr. Bernard, the Field Foundation consultant, and even Dr. Brennan of the CMHN, it was of prime importance that black psychiatrists be the advance guard in treating black patients. As there were only a handful of board-certified black psychiatrists in the United States, options for a comprehensive clinic or hospital department of psychiatry headed by blacks were very limited. The fact that Wertham was white remained a problem for some figures and institutions with the power to allocate resources. (Kenneth Clark himself confirmed this point while on a February 1951 conference panel alongside Wertham: “They wouldn’t tell us that a Mental Hygiene Clinic in Harlem was not needed—they’d tell Dr. Wertham because he is white.”) For Bernard and for Brennan, with this opinion went the feeling that white psychiatrists such as themselves were not ideal candidates for directing a mental hygiene clinic within a black community, let alone Harlem, the capital of black America. While a principled and understandable sentiment, it made no room for exceptional figures like Wertham.40

The Birth of the Lafargue Clinic

The years of 1945 and 1946 were pivotal to Wertham’s frank recognition of who he was and where he stood in relation to the American psychiatric profession. As an outsider, a marginal person—someone who, at his core, identified with the oppressed—Wertham created a space for himself apart from the mainstream of psychiatry, as well as the institutional confines of liberal social reform agencies. Replying to a letter from his erstwhile mentor Dr. Adolf Meyer, shortly after the founding of the Lafargue Clinic, Wertham explained,

The time for waiting on the powers that be to endorse Wertham’s vision of democratizing psychotherapy was over. In March 1946, without philanthropic or public funding, but with the support and assistance of his friends, colleagues, and students, Wertham found in Harlem a welcoming figure in Rev. Shelton Hale Bishop and a small space to engage in a modestly radical experiment in providing “expert psychotherapy for those who need it and cannot get it.”42 It was simply stated as such in the Lafargue Clinic’s brochure—but in back of this plan was a social philosophy and scientific orientation that read black psychological suffering as linked to an oppressive social and economic order and saw therapy as transformative rather than palliative.

In the winter of 1946, Bishop offered Wertham, who continued to serve as director of the Queens General Hospital Mental Hygiene Clinic, the use of two rooms in the basement of the St. Philip’s parish house. The Lafargue Mental Hygiene Clinic opened its doors on March 8, 1946, and operated every Tuesday and Friday evening until November 1958. That the Lafargue Clinic was housed in a prominent African American church signaled to Harlem residents that they would be offered legitimate care and treatment with a truly human touch. The Harlem community regarded the church as a safe space where black people would not be toyed with or treated as objects of scientific experiments, to be poked and prodded.43 Bishop viewed the establishment of the Lafargue Clinic as a Christian service and proclaimed it “the greatest thing to happen to Harlem in many years.” In the St. Philip’s Church newsletter, published one week after the first night of the clinic’s opening, Bishop declared

It must have been a remarkable experience for residents of Harlem to enter those basement rooms of the parish house. A contemporary report described the scene:

The Will to Survive in a Hostile World

A single page in the collected papers of Fredric Wertham titled “Objectives of Lafargue Clinic” succinctly captured the fundamentally radical, antiracist orientation of the institution:

Practicality governed the clinic’s method. Each therapy session was only thirty minutes, an hour in special cases. Given the brief amount of time for each patient, the clinic staff had to offer targeted, creative therapy. Thus each member of the staff had to be relatively versatile as counselors and therapists. A September 1952 memo on the clinic’s organization read: “The Clinic is entirely oriented to psychotherapy, to all the different forms of psychotherapy. Every staff member with the exception of clerical workers should get instruction in psychotherapy on all levels.”47

Wertham directed the clinic staff to pay close attention to the broader context of the patient’s experiences as sources of discontent, anxiety, delusions, and other mental distress. Upon entering the Lafargue Clinic a patient would answer a series of questions designed to enable an initial impression of a diagnosis, or at least an identifiable category of disorder that was causing a problem for the patient. Each staff member the patient encountered was trained to engender trust and to alleviate the patient’s doubts, suspicion, or anxiety about seeking help. Getting patients to feel at ease in telling their story was essential. And the clinic viewed the patient’s presentation of his own case history as beginning the therapy process. Dr. Luise Zucker, a psychologist at the clinic, offered these suggestions for first examinations: “Establish a good working relationship with [patient]. This can be achieved by showing him both your sympathy and your respect for him as a human being. Listen carefully to what he says and how he says it. Take notes while [patient] is talking, not in retrospect. His own formulations rather than yours can be very enlightening.” Zucker further emphasized a focus on the patient’s personal information as it related to her attitude to her job and her interactions with friends and other social bonds. Moreover, Zucker warned fellow staff members not to “delude yourself into thinking that you will ‘psychoanalyze’ your [patient] in seeing him once a week or less often. You may do a good job by using a modified therapeutic approach, based on psychoanalytic principles. Both methods can be helpful, but don’t get them mixed up.” At the end of each night, Dr. Wertham and Dr. Hilde L. Mosse, the physician-in-charge, would assemble the staff to discuss each case seen that evening, to review the diagnoses, and plan future treatment.48

Despite Zucker’s admonition, psychoanalysis remained an essential frame and method for the clinic’s psychotherapeutic orientation—and Wertham and his staff exceeded the strictures of orthodoxy through a pragmatic polyglot embrace of a variety of methods of treating its patients.49 Wertham referred to his psychoanalytically based method as analytic psychotherapy and emphasized the necessity of getting to the heart of a patient’s story, their life history and current experiences affecting their mental well-being. The clinic’s physician-in-charge and Wertham’s Queens General Hospital colleague Dr. Mosse explained that “the psychiatrist’s skill has to be such as to make the patient feel that the doctor is on his side and that he respects the patient as a human being.” Together, patient and doctor must become allies in achieving insight into what is ailing the patient, how it occurs, and why. In this therapeutic encounter, Wertham and Mosse emphasized the necessity of offering initial simple reassurance to the patient, as well as giving basic advice guided by a thorough grasp of who the patient actually was—hence the importance of the patient’s historicizing and ongoing self-narration and self-presentation. “Our analytic insight into the dynamics of the patient,” explained Mosse, “makes it possible for us to help him work through his past experiences. It also enables him in the planning of the future.”50

For the Lafargue Clinic, two psychoanalytic concepts were of great significance to diagnosing and treating its patients. For an oppressed clientele, gratification and sublimation took on a different cast than they would for the usual white, bourgeois subject of long-term psychoanalysis. Mosse explained that “it is here that Freudian understanding of psychological mechanisms meets the impact of social and economic forces. We have to find a way for the patient to gratify his drives and to sublimate them. To find the right kind of work for the patient, to find a place for him to live, is psychotherapy just as important as the uncovering of the patient’s unconscious.”51

The obstacles to achieving gratification of human drives for sex, for interpersonal and social recognition on one’s own terms for a black person in 1940s New York City, were legion. Tools, rituals, practices, and institutions structured to assist the individual’s sublimating of his or her drives, of distilling them into a productive and rewarding form, tended either to be denied, or required extraordinary effort to access for African Americans. When confronted with the forms of racial and class subjugation foisted upon African Americans, the Lafargue Clinic was forced to acknowledge the wide impossibility of obtaining “adequate ways of gratification and sublimation for our patient.” Taking this as a frank reality of the social world in which its patients lived, the clinic then worked as a group—psychiatrists in collaboration with social workers in collaboration with psychologists and with Reverend Bishop—to “strengthen the patient to such a degree, that he is able to see and face the actual social situation, and to instill in him the will to survive in a hostile world.”52

A clear example of the clinic’s approach to its patients can be seen in the case of a twenty-three-year-old woman who came to the clinic in early 1947 with the chief complaint of “nervousness” and repeatedly waking with a severe pain in her breasts after a night full of sexual dreams. She met with a Dr. Husserl (a relative of the founder of phenomenology Edmund Husserl), who soon diagnosed her with mild hysteria, psychoneurosis with conversion. This meant that she was converting her nervousness into physical symptoms. This young black woman was a domestic worker, who lived on her own in Harlem. Both her parents had died when she was four years old. Her grandmother raised her until she was eleven, at which point she was sent to a boarding school. She returned to New York and lived briefly with her grandmother. The patient expressed the feeling of being unwanted both as a child and later as an adult. She stated that from a young age she had been made to feel ugly, which in turn made her feel as though the whole world was hostile to her. She felt this even in romantic relationships with men. On her second visit, Dr. Husserl noted that this young woman’s physical symptoms were spreading to headaches and to arm and back pain. The sexual dreams persisted, almost every night. The doctor reported “encouraging” her that she was not unattractive and urging her to “integrate her life [with] a social group.” A week later this patient returned for another visit, after having a full physical with X-rays as well. There were no apparent organic causes for her pains, and the patient reported that all her symptoms, except for pains in her breasts, had disappeared. She then said that the intense sexual dreams had disappeared as well. The patient also reported feeling better because she was pursuing other work, beginning with taking a “vocational aptitude test.” The doctor’s diagnosis was kept as mild hysteria, but he noted a significant improvement. Based upon what was in the report, Dr. Mosse noted in a 1949 review: “Neurosis Recovered.”

This patient’s case is rather unremarkable, to be sure. But it demonstrates the straightforward, practical work done by the clinic. She had, in psychiatric terms, a “complaint” and told the doctor what she thought of the reasons for it; Dr. Husserl countered her negative feelings about herself by persuading her to see the reality that she was not ugly. She had obviously held on to negative feelings about herself from childhood, and Husserl knew that she needed to make the adult decision to place herself in a fruitful social situation where she would be involved in productive activities with other adults.53

Culture and Society in Postwar Psychiatry

By the time the Lafargue Clinic had opened in the late winter of 1946, a number of schools of “environmental,” “interpersonal,” and “cultural” psychiatric thought had come to fruition. One important group coalesced around the work of the psychiatrist Harry Stack Sullivan, cultural anthropologist Louis Sapir, and Harold Lasswell at the William Alanson White Foundation.54 Another was the “culture and personality” group whose primary home was Yale University and was best represented in the work of Dr. Karen Horney and the group of psychoanalysts who came to be known as “neo-Freudians” or “post-Freudians.”55 Throughout the life of the Lafargue Clinic, though, Wertham remained critical of the major trends in psychoanalytic psychiatry that explicitly incorporated what he termed “supra-personal” factors into the total picture of human personality and mental health. He resisted the two predominating paradigms that contributed most to the environmental turn in psychiatry, namely “culture and personality” and (ironically) “social psychiatry.”56

It would appear that Horney’s brand of psychoanalytic environmentalism would have considerable insight to offer Wertham in his work. Horney and the so-called neo-Freudians challenged the biologism of both traditional somatic psychiatry and the orthodox Freudians insistent on the primacy of the sex and death drives in man’s personality. And more fundamentally, Horney challenged scientists and the public to confront the cultural forces that make people think and act the way they do, apart from their supposed instinctual drives fixed in their bodies and minds. But Wertham argued that the neo-Freudians did not offer a substantive advance in psychotherapy, because they still failed “to take into full account the dynamic interaction between personal and impersonal [social] factors.” In Wertham’s view it was not good science to equate cultural factors with social factors, namely because the former remained in the arena of the subjective. This meant that psychiatry, cultural or otherwise, would still treat the individual in terms of how he negotiated psychologically the culture of which he was a member. Wertham argued that a focus on culture elided the relationship of individuals and classes of people to the means of production and their place in the larger social structure, particularly how race and class intersect to structure individual and group experience.

Other contemporary scientists and doctors were using the term social psychiatry, as well, to describe a desired rapprochement between psychodynamic psychiatry and the social sciences of psychology, anthropology, and most especially sociology. Historian Gerald Grob situates social psychiatry in the larger trend of post–World War II psychiatry’s deinstitutionalization.57 After the war a new generation of psychiatrists made the whole of American society the home of psychodynamic research, treatment, and prevention. The psychodynamic paradigm of psychiatry had its roots in psychoanalysis and the mental hygiene movement but was very much the child of World War II. Many psychiatrists took notice not only of the individual patient’s relationship to his or her mother and father but began focusing on the place of that individual in the social order and how the sociocultural environment might play a role in the development of a mental disorder. One prominent exponent of social psychiatry expressed the main thrust of the new framework, “If psychiatry is truly to move into a vigorous period of real preventive work, it must begin to look beyond the individual to the forces within the social environment which contribute to the personal dilemma.” The psychodynamic framework’s focus on a variety of causes—somatic, constitutional, and environmental—of personality problems and mental disorders and its use of psychoanalytic clinical methods provided the theoretical and methodological compass directing the development of social psychiatry in the early postwar era.58

By the mid-1950s an interdisciplinary consortium of psychiatrists and sociologists in the United States and Britain were making a coherent attempt to define the meaning of social psychiatry.59 In the wake of the war, the concern over mental illness had grown, and the experience of some psychiatrists working in the military and then in outpatient clinics had bolstered their confidence in preventive measures. Moreover, these doctors and scientists wanted to make it possible for all psychiatrists and affiliated professionals to develop and apply new scientific knowledge about the sources and nature of mental illnesses in individuals and in particular communities. In the editorial of the first issue of the International Journal of Social Psychiatry, Dr. Joshua Bierer of London explained: “The causes of most mental and social illnesses and maladjustments have not yet been fully explored. If we are to find these causes, we must change our attitude and our approach. Our attitude so far has been either particularistic—concentrating on one part of the body or of the mind, or total—concentrating on the person as a whole, or on the ‘total personality.’ Our future attitude should be a ‘universal’ one; we must concentrate on the ‘whole situation’—i.e. the total personality plus environment and relationships.”60 But what would this concentration on the “whole situation” mean in terms of a new discipline or specialty within psychiatry? And how might broadening the purview of psychiatry through the sociological study of mental illness affect actual psychiatrists and social workers who cared for and treated the mentally ill (or those simply suffering from everyday mental stresses)?

Some historians have argued that social psychiatry was never a coherent field or specialty with which psychiatrists could apply specific clinical methods to real mental illnesses. Social psychiatry, some argued, could indeed be viewed as part of a larger revolution in understanding personality and behavior taking place since the early 1940s, a paradigm shift stressing the interrelatedness of physical, biological, cultural, social, and psychological factors in human behavior. But social psychiatry supposedly had little to offer in the way of specific tools or methods for actual practice. One team of authors wrote in 1966 that

Writing a generation later, historian Gerald Grob concluded that “at best social psychiatry was a label for cross-disciplinary research training and research procedure; it lacked many of the attributes of clinical practice.”61

None of these historical accounts of social psychiatry mention the ideas or work of Fredric Wertham. None of the surveys of the field written during the years of the Lafargue Clinic’s operation mention him or consider the clinic’s efforts to implement the social psychiatric paradigm.62 Perhaps this was because Wertham was not a part of the Group for the Advancement of Psychiatry (GAP), a psychodynamic-oriented association within the American Psychiatric Association (APA) committed both to environmental explanations of etiology and to social activism informed by psychiatry. Its most prominent members were Karl and William Menninger, Thomas Rennie, Robert Felix, Daniel Blain, and Marion Kenworthy.63 None of Wertham’s articles, clinical or otherwise, appeared in the American Journal of Psychiatry (AJP) during the 1940s or 1950s.64 He chose instead to submit his scientific studies to the American Journal of Psychotherapy, published by the Association for the Advancement of Psychotherapy, of which he was president for the years 1943 to 1948. We can only wonder whether initial retrospective assessments of the “coherence” of social psychiatry might look different had they considered the work of Wertham and his colleagues at the Lafargue Clinic.

Wertham’s brand of social psychiatry gave answers to the basic question of the origins and manifestations of mental disorders that addressed the concrete, reality-based nature of human personality and psychological problems people confronted. In order to treat anxieties, for example, a doctor had to grasp the origin and character of those anxieties. In New York City both before and after World War II he saw racial discrimination and class exploitation and made the step that his putative colleagues had not, could not, or would not: he opened a clinic “in and for” the community of Harlem for the practical treatment of socially induced anxieties and mental maladies. Wertham’s problem with the putative social psychiatrists the culture and personality psychoanalysts was, therefore, never theoretical or methodological alone. His main criticism was quite basic. All the progressive theories and treatments in the world would mean little if the majority of people never had access to psychotherapy.

Wertham’s contempt for various brands of psychiatry and some of the leading figures in the field may have blinded him, though, to the changes going on within the American Psychiatric Association. By the late 1940s more and more members of the Group for the Advancement of Psychiatry assumed positions of leadership and implemented psychodynamic approaches within the association, within the pages of the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I), and at medical schools. Wertham may have simply chosen to be marginal, to be an antagonist, where he could remain a critic and not a more conventional participant in the changes taking place within psychiatry at mid-century. Or maybe Wertham just thought he was right and that others, even putative allies in social psychiatry, were wrong both conceptually and clinically—that they were blind to the social in social psychiatry. Nevertheless, Wertham, despite his pedigree, his scholarship, and the positions he held, was not a member of the circle of social scientists and psychiatrists most prominent in defining and implementing a form of social psychiatry held in common and based upon the work of men like William Menninger and Thomas Rennie, professor of psychiatry at Cornell University. Wertham’s problem with his colleagues in the social and mental sciences led him to be marginal to the very field in which he sought to make his greatest contribution. And his marginality led to a great silence on Wertham and the Lafargue Clinic in the relevant scientific literature of the day.65

Diagnosis and Treatment at Lafargue

The establishment and operation of the Lafargue Clinic also coincided with the years in which the first Diagnostic and Statistical Manual of Mental Disorders was drafted and ratified by the American Psychiatric Association. Commonly known as DSM-I, this manual appeared in 1952 and presented board-certified psychiatrists with a systematized definition and classification of mental disorders and identified which symptoms of speech and behavior when taken together composed a diagnosable syndrome or “reaction-type,” in language still beholden to Wertham’s erstwhile Phipps Clinic mentor, Dr. Adolf Meyer. Psychiatrist and historian Jonathan Metzl explains that though the DSM-I “retained a good amount of diagnostic language from earlier classification systems,” it also reflected the psychodynamic turn in psychiatry in the wake of World War II—so that “the [psycho-]analytic presence helped shape the first postwar classification of psychopathology” and had the result of codifying “the belief that mental disease resulted, not only from biological lesions, but from early life conflicts.”66

While an advance from the exclusive somatic paradigm as the basis for diagnosing mental disorders, the DSM-I failed, in Wertham’s eyes, to account for the social context and basis for the emergence of mental disorders among the American populace, especially among the oppressed. There was at this time in postwar America, according to Wertham, “a great contradiction between the tendency to apply psychiatric and psychoanalytic ideas to the social sciences and the failure of psychiatry so far to study adequately even those social problems which are most closely related to the care and treatment of mental patients.”67 Wertham’s fundamental critique of psychiatry and psychoanalysis was that its practitioners focused too much on either the individual or the biological aspects of human thought and behavior to the exclusion of their social basis. He wanted his fellow psychiatrists to understand that a patient must be understood first and foremost as belonging to a class, each patient positioned with a distinct social relation to the means of production, with specific concerns and problems based on this relation. The psychiatrist must be concerned with whether one was a boss, worker, or part of that group of have-nots that some have called the underclass, which Marx called the Lumpenproletariat. By paying close, clinical attention to the social basis of mental life, psychiatry would advance itself as a science. Wertham argued that “there is no contradiction between scientific and social psychiatry. Psychiatry cannot be social if it is not truly scientific, and it is certainly not scientific if it is not social. The road to progress is the integration of Kraepelin, Freud, and Marx—which means to do justice to the dynamic dialectic interaction of conscious, unconscious, and social factors.”68

While this Kraepelinian-Freudian-Marxian integration served as the framing point-of-view for encountering the patients who came to Lafargue, Wertham repeatedly stressed to his staff the importance of proper individualized diagnosis of discrete mental disorders: “Diagnosis is the cornerstone on which all scientific medical therapy and psychotherapy rests. Diagnosis should not consist of a single label but be a formulation of the structure of the interplay of personality, illness and situation.”69 The clinic encountered among its patients the full gamut of mental disorders extant in American society in the early postwar era. Exactly ten years after the clinic first opened its doors, three staff members drafted a statistical report on the clinic’s patients. It is the only comprehensive report in the clinic’s archival records. From a total of 1,489 files, the report’s authors examined and categorized 250 patient charts. There is no explanation in the report of how the authors chose this sample of 250 charts; 185 were adults (69.4% of patients), 65 children under the age of sixteen (30.6%). The report also included 31 court cases (12.3%), of which 16 were adults, 15 children. The clinic diagnosed 113 adults (62.5%) and 8 children (14%) with neurosis; 38 adults (21%) and 1 child (1.8%) with psychosis; 2 adults (1.1%) and 4 children (7%) with organic conditions; 6 adults (3.3%) and 2 children (3.5%) with physical problems; 22 adults (12.1%) with “social and family problems”; and 42 children (73.7%) with “behaviour problems.” The results of treatment were then divided as follows: 34 adults (25%) and 6 children (14.3%) unimproved; 64 adults (47.1%) and 17 children (40.5%) improved; 22 adults (16.2%) and 16 children (38.1%) recovered; and 16 adults (11.7%) and 3 children (7.1%) hospitalized.70

The Lafargue Clinic often questioned and challenged the diagnoses and treatment plans of other agencies in New York. In a 1956 statistical report on the clinic’s diagnoses over the years, there was a note reading: “Re: Psychoses: When we diagnose psychosis we mean it. We do not mean what all the other clinics and papers talk about, namely what they call ‘latent’ schizophrenia. We diagnose unquestionable psychoses…usually not recognized before they came to the Lafargue Clinic…. It is still amazing how many patients with major mental diseases are undiagnosed and untreated in spite of the increase in mental hygiene facilities in the past 10 years.”71

There were a number of cases in which other New York public and private agencies had diagnosed both children and adults as being a “problem personality” or as being a “malingerer.” In one notable case, a twenty-six-year-old man, originally from Norfolk, Virginia, came to the Lafargue Clinic in January 1951 with a pain in his head and hips. He also complained of nervousness and “bad thoughts, [wishing] I was dead, thinking about killing myself.” This man told a staff doctor that he had been referred to Lafargue from a fellow patient at the Bellevue Hospital Psychiatric Division, where the twenty-six-year-old had been hospitalized during March and April 1949. He stated that his current symptoms had been present for at least three years. He had previously sought help at Bellevue Mental Hygiene Clinic, Montefiore Hospital, and Metropolitan Out-Patient Department (better known as Welfare Island). The diagnoses of each agency were, respectively: schizophrenia, neurosis, and “too lazy to work.” The report from Welfare Island declared “this is a 26 year old man who does not like to work; there is nothing in the history or findings to justify his visits here; Discharge: Rx heavy work”!72

Wertham discussed this case at one of the staff meetings held at the end of each evening’s work. Based upon the evidence of neurological, psychological, and clinical examinations, Wertham concluded that this young man’s problems were most likely the result of an organic disorder, although schizophrenia could not be ruled out. The clinic gave a provisional diagnosis of Picks Disease, a form of premature dementia caused by atrophy of the frontal and temporal lobes of the brain, which resembles the organic aspects of Alzheimer’s disease, and the symptoms of some forms of schizophrenia.

In another case, a young woman came to the clinic first in 1952 and was seen a number of times over the next two years. She discussed her anxiety over what the staff termed “problems of everyday living.” She hated her job as a domestic and was having difficulty as a single mother with three young boys. The clinic staff never diagnosed her as neurotic or having any other type of mental disorder; nevertheless, she continued to come to the clinic because the staff was helping her in ways that other social service agencies had failed to do. This young, single mother was behind three months’ rent on her Harlem tenement apartment. So one of the clinic’s social workers helped her apply for public housing and other aid. Her son was diagnosed by the clinic staff as having a severe behavior disorder, so the staff worked to place the boy in Rockland State Hospital, just north of New York City, where he could receive intensive treatment.

The outcome of this woman’s case is not in the Lafargue Clinic records, nor is that of her son. But we can see that the clinic addressed this woman’s anxiety in practical terms by assisting her in attaining her basic needs. And by intervening to help place her son in a hospital, the clinic enabled this young woman to attend to the needs of her two other, younger sons, who according to one staff member were being neglected as a result of the mother having to deal with the elder son’s behavior problems. We may wonder exactly how this family’s experience of the clinic compared to its encounters with the other institutions in New York City designed to aid those in similar circumstances. It is clear though that the variegated service that the clinic provided is evident in this case, as is its comprehensive aim of taking social circumstances seriously in treating each patient.73

In November 1950, Wertham referred a young black boy to the Lafargue Clinic. Wertham had seen the six-year-old at the Queens General Hospital Outpatient Clinic because the boy was acting out at school and resisting his mother and father at home. He had been aggressive several times with his baby sister as well. A year prior, the family had moved from Harlem to Jamaica, Queens, into a predominantly white neighborhood. In September of that year (1949), the boy began attending public school in the new area, and soon after had an acute asthma attack. He had never had asthma before, but soon had daily minor attacks. The clinic staff spoke at length with the boy’s mother and soon recommended putting the boy in playgroups, as a form of examination and therapy. The child’s mother told the staff that her son had shown an early preference for light skin and having white playmates. The mother suggested that part of the reason for the child’s resistance to her and her husband was that the boy resented their dark color, and possibly even his own. Dr. Florence Brand-Grossman, one of the clinic’s psychologists, wrote that on one occasion the boy remarked to his mother “that some of his white playmates expressed a fear that if they touched him they would turn colored. [Patient] very much disturbed by this.” Dr. Mosse, the physician-in-charge, noted in the child’s file that the asthma likely had a psychological basis, and she prescribed attending the clinic’s child playgroup.

Over the next five months, the young boy attended the playgroup once a week. By January 1951, the child’s mother told Dr. Grossman that the boy was doing much better since coming to the playgroup, that he no longer sucked his thumb, and that he hadn’t had any asthma attacks since the fall. The sociogenic nature of this boy’s problems is clear from the reports in his patient file. The hostile social world in which the boy was thrust engendered “pathological” physical and emotional responses. This child lived the paradox of attraction to and repulsion from whiteness. The clinic’s playgroup offered this boy a space and a form of interaction with an interracial group of children that countered the experience of displacement and alienation in his new whiter environment. The clinic did not adjust the child to antiblack racism. Rather the clinic presented another mode of play and interaction for the boy, one that countered the hostility of his school and neighborhood environments.74

“Freud Turned Upside Down”

Contemporary newspaper and magazine articles about the Lafargue Clinic focused on its novelty and hardscrabble operating conditions. Journalists portrayed the work of the clinic in terms that would appeal to a broad American audience in the early postwar years. One report exemplifies this approach:

Such articles offered narratives of redemption aimed at making their audience sympathetic both to the travails of individuals and families struggling with mental disorders and to the work of the clinic. Reporters often referenced the conditions of discrimination against Negroes that precipitated its founding. But they avoided discussion of the clinic’s radical orientation linking racism and class subjugation to the increased anxiety and full-blown mental disorders among black New Yorkers.76

Richard Wright, however, presented the Lafargue Clinic as an underground anomaly, radically subverting the foundations of psychiatry. In his essay “Psychiatry Comes to Harlem,” published in 1946, Wright used various literary tropes alongside “the underground” to describe the La-fargue Clinic. He explained that “though the Lafargue Clinic does exist, there is a widely prevalent feeling among many of the people that it does not exist.” Wright and Ralph Ellison both would use the trope of absence or nonexistence in their essays on Lafargue and its place in the world of 1940s Harlem. As a form of framing the reality of the clinic’s existence, both “absence” and “the underground” could easily be counterpoised to the truth of the historical presence of the Negro in American society and the need for psychiatrists and the rest of white America to recognize the reality of black Americans’ need for mental health services. In his essay, Wright likened the establishment of Lafargue to the appearance of that which has been psychologically repressed in the individual. “Social needs,” he wrote, “go underground when they have been emotionally or morally rejected, only to reappear later in strange channels.” Like individually repressed needs, socially repressed needs such as basic medical care—in this case psychiatry—are realized often through methods that subvert the sanctioned order of things. People form institutions that begin on an underground level when they do not have their basic needs met in those institutions already established within society. It is the underground, the absent from daylight, that is the subsoil for radical social upsurges.

In his essay on Lafargue and the Harlem community, Ralph Ellison noted that when asked how they are doing, many Harlemites very often replied, “Oh, man, I’m nowhere.” Ellison argued that this phrase expressed “the feeling borne in upon many black people that they have no stable, recognized place in society. One’s identity drifts in a capricious reality in which even the most commonly held assumptions are questionable. One ‘is’ literally, but one is nowhere; one wanders dazed in a ghetto maze, a ‘displaced person’ of American democracy.”

Figure 6. Lafargue Clinic patient waiting for treatment; caption written by Ralph Ellison. Photo by Gordon Parks, 1948. Courtesy of the Gordon Parks Foundation.

Ellison and Wright devoted themselves to exploring the black American experience of migration, urbanization, and, ultimately, modernization. They joined many other fiction writers and social scientists at midcentury in their concern over the effects of modernity on the personality of African Americans.77 Ellison was concerned that in leaving behind the folklife of the rural South, African Americans had jettisoned modes of being and thinking that equipped them for keeping their personality intact in a hostile world. Ellison expressed in “Harlem Is Nowhere” a profound worry that in surrendering those cultural practices and institutions that gave them meaning and sustenance, black people were left untethered and unmoored from their roots and simultaneously segregated from the institutional life of the rest of society. Ellison explained that “they lose one of the bulwarks which men place between themselves and the constant threat of chaos. For whatever the assigned function of social institutions, their psychological function is to protect the citizen against the irrational, incalculable forces that hover about the edges of human life like cosmic destruction lurking within an atomic stockpile. And it is precisely the denial of this support through segregation and discrimination that leaves the most balanced Negro open to anxiety.”78

Fredric Wertham’s efforts at addressing how black Americans at midcentury reacted to the degradations of antiblack racism derived both from his conversations with Wright and Ellison as well as a combination of life experience and social psychiatric theorizing. Wertham’s entry point into the conversation had been through his work as a clinical psychiatrist in Baltimore, where blacks and whites were legally segregated, and in New York City with its peculiar type of de facto Jim Crow. Public spaces and facilities were not legally segregated in New York, but through code and custom, whites made it quite clear to blacks where they were allowed to live, work, shop, and seek services, including medical care.79

Wertham’s clinical experience treating black people was only part of a broad-ranging process of gauging the social problem of “race relations” and class exploitation. He encountered black patients in prominent mental hygiene institutions, and this firsthand knowledge of the manifestations of mental disorder among African Americans coalesced with his habits of mind oriented toward comprehending and challenging both oppressive and repressive forces in modern society.

At the very moment the Lafargue Clinic hit its stride, Richard Wright chose exile in France. In a letter to Gertrude Stein just after the war ended, he informed her that he would like to see France and maybe stay for a good while. With his wife Ellen and daughter Julia, Wright visited Paris from May through December 1946 as a guest of the French government. As the clinic gained notoriety and prominence through the publicity of several articles, including his own, Wright was not only in the process of reconsidering his relationship with his native land; he was beginning to think of himself less and less an American, more and more a citizen of the world. He had seen in the clinic an opportunity to address in practical terms the psychological impact of being black in a hostile society. With Wertham he had created a new type of institution in the most prominent black community in America, but he was exhausted by the daily trials of trying to live an ordinary life without the basic freedoms taken for granted by his fellow white citizens, not to mention his fellow men of letters.

When Wright returned from Paris at the end of 1946, he gave no indication that he considered moving permanently to France. One reporter asked why he had even come back to the United States, given his newfound love for Paris. “I live here,” he replied. “My work is here.” But in New York, he soon encountered one racist humiliation after another: salt placed in his coffee at a New York diner, a sign to all Negroes letting them know they were not welcome; menacing looks and threatening words from his Italian neighbors in Greenwich Village; a thwarted attempt to purchase a summer home in rural Connecticut, a house he afterward saw advertised for sale in a New York newspaper. These reminders of American racism hurt him personally and deeply. But the defining issue for Wright revolved around his imagination of what racism would do to his five-year-old daughter, Julia.

In the end he could not stomach the idea of Julia developing the same circuit of fear and hatred Wright knew in his core was endemic to black children in racist America. So on July 30, 1947, Richard, Ellen, and Julia Wright boarded the aptly named SS America; they brought along the necessary items they knew would be difficult to acquire in a France rebuilding itself after the war, and they brought their cat Knobby. The Wrights had quit America. Wertham’s wife, Hesketh, wrote later to the Wrights, apologizing for her husband and herself for not being able to see them off. In her long letter she asked Wright if he would seek out Dr. Edgar Longuet, the nephew of the clinic’s namesake Paul Lafargue, to get some of his uncle’s writings not available in the United States. Wright wrote back, agreeing to do so. Soon after arriving in Paris, the Wrights received a follow-up telegram from the Werthams: “many thanks wonderful cable lafargue clinic flourishing.”80

Figures 7 and 8. Lafargue Mental Hygiene Clinic brochure. Courtesy of Dr. Elizabeth Bishop Davis Trussell.