From Drapetomania to Disparities: Freedom as a Diagnosis

They called it a disease.

The yearning for freedom, the aching swell in the chest of the enslaved, the quiet plotting under moonlight, the running feet slicing through thickets at dawn, the desperate leaps into rivers, and the stolen whispers of liberation: All of it was pathologized.

In 1851, Samuel Cartwright, a white Southern physician, stood before his peers and declared that enslaved Africans who fled captivity suffered from a mental illness he named drapetomania. He defined it as a condition that caused Black people to irrationally flee the plantations. His proposed cure was chilling: more surveillance, physical punishment, and forced submission. In his view, enslaved people were not resisting inhumanity. They were simply unwell.

This was not science. It was control disguised as care. It was medicine turned into a weapon, used to criminalize the most basic and sacred human instinct: the desire to be free.

The word drapetomania has long been discarded from medical texts, but its logic continues to shape the way Black people are treated in mental health systems today. It continues to haunt how clinicians assess, diagnose, and respond to Black distress, Black rage, and Black autonomy.

The Plantation as Psychological Warfare

The plantation was not only a site of labor; it was a site of psychological terror. Black bodies were stripped, branded, raped, and bred. The violence was systemic and unspeakable, but it was also deeply psychological. Every expression of selfhood was punished. Every attempt at autonomy, punished. To love freely, to cry, to question, to run, all of it was seen as disobedience and, eventually, disease.

Drapetomania taught white society that Black resistance was a symptom, not a truth. That the longing for liberation was irrational. That survival instincts were symptoms of dysfunction. It was a cultural lie turned clinical.

This narrative has not disappeared. It has simply adapted, weaving itself into the fabric of mental health care, criminal justice, and public policy.

The Modern Faces of Drapetomania

The logics of drapetomania are alive today. In the 1960s and '70s, schizophrenia diagnoses among Black men increased sharply. As political resistance grew, psychiatry rebranded activism and anger as symptoms of mental illness. Jonathan Metzl’s work shows how diagnostic manuals were revised in ways that made it easier to conflate hostility with psychosis, allowing clinicians to use psychiatric labels as tools of social control.

Today, Black Americans are more likely to be diagnosed with schizophrenia and conduct disorders, while depression and anxiety often go undiagnosed or misdiagnosed. Our sorrow is misread as aggression. Our trauma is ignored. Our silence is interpreted as compliance, and our refusal is seen as defiance.

This is not accidental. It is the continuation of a worldview that cannot hold space for Black emotional complexity, that still fears Black power, and that often reads Black wellness as a threat rather than a goal.

Afrofuturism as Reclamation

Afrofuturism allows us to imagine a future where Black mental health is not shaped by white fear but by Black freedom. It invites us to envision wellness not as assimilation, but as sovereignty. In an Afrofuturist frame, healing is cosmic, communal, and rooted in ancestral wisdom. Mental health becomes more than symptom reduction. It becomes liberation.

What if therapy for Black clients included music, movement, ritual, and storytelling? What if rest was considered clinical intervention? What if crying out was sacred, and silence was safety? Afrofuturism tells us we can build that world, not in the distant future, but now.

Where Drapetomania Shows Up Today

In clinical practice:

• Black children are more likely to be suspended or expelled for behaviors deemed normal among white peers.
• Black men in emotional distress are more frequently diagnosed with psychotic disorders instead of mood disorders like depression or posttraumatic stress disorder (PTSD).
• Black women’s expressions of pain or assertiveness are labeled as aggressive, noncompliant, or treatment-resistant.
• Black parents are more frequently flagged by child protective services when advocating for their children's needs.
• Black patients report higher rates of therapeutic rupture and dissatisfaction due to feeling judged or misunderstood.

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In community life:

• Mental health services are underutilized in Black communities due to generations of justified mistrust and current harms.
• Police are often the first responders to mental health crises in Black neighborhoods, increasing the risk of violence or incarceration.
• Cultural messages around strength and survival stigmatize vulnerability and discourage help-seeking.
• Generational trauma is often unspoken, passed down through silence rather than story or healing.

What We Can Do as Scholars, Clinicians, and Healers

As clinicians:

• Practice cultural humility and interrogate how racism has shaped the field of psychology.
• Reassess diagnostic frameworks to avoid mislabeling Black clients' emotional expressions.
• Use healing-centered engagement practices rooted in community, culture, and consent.
• Create space for grief, anger, joy, and rest as valid parts of the therapeutic process.

As researchers:

• Design studies that include community voices as experts, not just subjects.
• Frame Black mental health within sociopolitical, historical, and structural contexts.
• Challenge deficit-based models and elevate narratives of resistance and resilience.
• Advocate for publication standards that value culturally grounded interventions.

As policy advocates and leaders:

• Promote crisis response models that center care, not policing.
• Push for funding and legislation that support Black-led mental health initiatives.
• Invest in prevention, education, and access within Black communities.
• Train providers in anti-racist, trauma-informed, and culturally responsive care.

Conclusion: We Were Never Broken for Wanting to Be Whole

Drapetomania was never about our minds. It was about their fear. Our ancestors were not sick for running away. They were sane. They were sacred. They were trying to survive.

To reclaim Black mental health is to break from the lie that wanting more is pathological. It is to rewrite the story. It is to say with full voice and certainty that the desire to be free is not a symptom. It is the cure.

Let our work as clinicians, scholars, and community members honor that truth. Let us be bold enough to imagine healing that is expansive, not constrictive. Let us be brave enough to name the past, and visionary enough to rewrite the future.