RACE AND RACISM

In the biomedical sciences of the United States and in their wider cultural context, ideas about race and gender play a prominent but unacknowledged role. Despite their appar ent universality, these concepts vary over time and place. Different beliefs about them and their social consequences are found across cultures past and present. Both are, in fact, cultural constructions, one or another culture's folk theories of human biological variation. The great variability found in racial and gender notions is indicative of their local cultural construction.

Biological and behavioral assertions concerning race are without empirical validity. After decades of research, largely in anthropology, the social and cultural bases of racial conceptions have become clear (American Anthropological Association; American Association of Physical Anthropolo gists). Race is a folk-culture concept. While many, perhaps most, cultures of the world do not hold racial theories, such theories are important to consider in discussions of biomedi cine and biomedical ethics, especially in the United States. Here, we find that admittedly folk ideas of race and ethnicity serve as the formal basis for government practice, policy and research (Office of Management and Budget). Given the demonstrable negative social, psychological, and health re sults of the perpetuation of the invidious distinctions repre sented by racial (and gender) conceptions, and the antipathy generated by their stereotypes, the continued use of such identities in biomedical work can be said to represent serious ethical, as well as biomedical research, problems.

Historical Constructions of Race

Race is one of a number of popular cultural conceptions about human variability. The Western concept was developed in its present scientific and related lay versions largely in the nineteenth century (Barkan; Gossett; Naroll and Naroll; Stocking). At its most abstract level, race is an explanation for observed human variation; people differ in appearance because they belong to different races. Behavior is also implicated; people behave differently because they belong to different races. Racism is a set of negative beliefs held by individuals or groups with respect to a population thought to be biologically distinct. Such beliefs about fundamental biological differences came late to the Western world, but not as a result of scientific progress.

The ancients—whether the civilizations of Nubia and Egypt or the later Minoan, Mesopotamian, Greek, and Roman civilizations—held no beliefs about essential human biological or racial differences. There was recognition that people differed in appearance, language, custom, and even ethics (MacIntyre), but such differences were not considered reflections of immutable, biological differences among humans. Nor could there have existed assertions that biology determined behavior, for most of these civilizations were composed of a variety of physical and cultural types in various stages of assimilation to a titular ethnic identity (e.g., Sherwin-White). Were this not the case, the ancient empires could not have expanded their numbers through the recruitment of physically and culturally different peoples, for they would have thought them fundamentally different and nonassimilable.

An important step in the development of the notion of race is to be found in the work of the Swedish botanist and taxonomist Carolus Linnaeus (1707–1778). Linnaeus built upon earlier notions of species, distinct groups of living things that cannot interbreed. Linnaeus proposed a classification comprising six human groups; he did not use the term race. These human groups were understood as neither pure nor (biologically) stable; they were not represented as distinct species. Such an assertion would have been contradicted at the time by considerable evidence of interbreeding of Europeans and other groups. Such empirical evidence was later ignored in the West.

The French naturalist and founder of invertebrate paleontology George Louis Buffon (1707–1788) introduced the term race into the biological literature in 1749. The term then did not refer to distinct human groups with separate origins or biologies (Montagu). Buffon's and Linnaeus's early reflections on human difference regarded such differences, correctly, as representing variations of a single species.

In the eighteenth and nineteenth centuries, English and German philosophy and science began the construction of ideas of fundamental, incommensurate biological differences dividing human groups (Barkan; Boas; Gould). While evolutionist views of monogenesis (a theory of a single origin of all humans) replaced polygenesis (a theory of multiple, separate origins) and creationist views (those based on religious beliefs and not on investigations of the natural world) in Europe, nineteenth-century theories were largely alike in expressing racist sentiments, though the sentiments were not recognized as such. Triumphant nineteenth-century evolutionism fitted well in racist science.

Monogenecists assigned to non-Europeans fates of early separation from a "main" line of Europeans. JeanBaptiste Lamarck (1744–1829) suggested that differences among human groups around the world were to be attributed to the inheritance of acquired characteristics. He implicated the role of the environment in evolutionary change, although he misconstrued the mechanism of biological change.

Non-Europeans, and many eastern and southern Europeans, were believed to have a common origin by many western European scholars, but were seen as less evolved. Some were said to be little different than nonhuman primates (Barkan; Stocking). And some ethnic groups of western Europe created racial alliances. English historians of the nineteenth century repeatedly referred to the "rational and freedom-loving" character of the English as racial traits of the Anglo-Saxon, believed to be a branch of the "German race" (Gossett). As with the Nazi race science of the next century, the notion of the German race excluded most people commonly regarded in the United States as belonging to a "white race" (e.g., the French and other circum-Mediterranean people, Celtic ethnics, the Slavic people) as well as people from what are commonly regarded as other "races" in U.S. ideology—Asians, Africans, and Native Americans.

In England, Sir Francis Galton (1822–1911), the father of statistical manipulation, lent both ideas and methods to racial theories. He coined the term eugenics, and conceived of this new "science" as a program of "racial" improvement. The idea of group biological improvement was carried to horrendous extremes by Nazi "hygienists." Galton's work on head size and intelligence lent credence to later racist work in the United States as well, such as that of physician Robert Bean of Virginia. His work, in 1906, purportedly showed that parts of the brain were of different sizes in "Whites and Negroes" (in Gould). He also claimed to have found measurable differences in males and females and between higher and lower classes. His interpretations and biased readings, soon disproved (Gould), showed the affinity of the ideas of racism, sexism, and elitism in the United States that are also apparent in English science.

Sir Cyril Burt, dean of twentieth-century educational psychology in England, studied twins during the first half of the twentieth century. He purported to show that twins raised apart had the same IQ. It appears he sought scientific proof for the English folk notion that nature determined human abilities such as intelligence. As a consequence, his views were widely received for decades and influenced the establishment of national examinations. The examinations were used to limit the educational opportunities of millions of young people in Britain. In the 1970s, it was discovered that the late scientist had, in fact, fabricated most of his data. He had also fabricated his long-time research assistants, who supposedly collected most of the data, as well as his coauthors (Gould). The advocates of nature over nurture suffered a heavy blow when this key body of literature was discredited.

In the United States, a multicultural society usually referred to as multiracial, Burt's elitist arguments were converted to racist (and sexist) theories by his students, psychologists such as Hans Jurgen Eysenck and Jensen (Gould), as well as others (Fausto-Sterling). Research aimed at showing that African-Americans and other "minorities" were intrinsically less intelligent than the generic "White race." Within each group, moreover, women were said to be less capable than men. Many flaws appear in this sort of research. One of the major problems is the fact that social labels, such as White and Black, were used to make genetic arguments; the arguments were flimsy because they regularly excluded from consideration profound differences in the social and educational experience of the members of the various social categories. This was done in order to arrive at (prejudged) conclusions of inborn racial differences.

A similar idea concerning mental illness was developed in German psychiatry in the mid-1800s. The leader of nineteenth-century German psychiatry, Wilhelm Griesinger, adopted a biological definition of mental disorders. His dictum was that "mind diseases are brain diseases" (Gilman). The idea that mental illness was based in biology and not social environment was actually borrowed from German philosophy, which in turn had taken the idea from popular German culture. Griesinger passed on this popular prejudice in his psychiatric science to a follower, Emile Kraepelin. Kraepelin became the twentieth century's father of biological psychiatry and the creator of a racially based "comparative psychiatry" (Gaines, 1992a; Gilman). This influential figure made the case for the biological basis of major mental diseases such as schizophrenia. His ideas were greatly influential on Nazi and contemporary U.S. biological psychiatry (Barkan; Gaines, 1992c; Gilman).

The Nazi "race science" of the 1930s reverted to nineteenth-century polygenesis to explain differences among racial groups and to assert its group's alleged superiority (Montagu). Some Germans were likewise seen as unfit; they were the disabled, the mentally ill, and the homosexual. In contemporary German society, popular and medical beliefs still express the model of mental illness that considers the mentally ill to be biologically different from "normal" people (Townsend).

As is evident, both English and German cultures exhibit biological theories of human difference. A brief historical look suggests that the ideas of these two cultures are related. In both systems, differences are held to be intrinsic and groups are hierarchically ranked, allegedly in terms of abilities. In the relatively isolated society of England, the Germanic notion of inherent differences and similarities based upon shared "blood" was doubtless introduced by invading Germanic tribes in the fifth century. The idea remained but was applied to internal social differences within England. This focus transformed the theory of difference based upon blood into the English notion of "breeding" that was and is applied to members of the British (which includes the Celtic peoples) social system. It produced Britain's rigid class systems wherein abilities are said to be differentially inherited by those differing in breeding. This conception of inborn qualities then serves to justify the respective social positions of society's members.

The Critique of Scientific Racism

Evolutionists explained the increasing knowledge of human diversity in biological terms (Barkan; Gossett). The allegedly different developmental levels of various societies were said to indicate inferior inborn abilities in the societies' people compared with the usual apex of evolution found in (western) Europe. Eastern Europe, not a direct heir to the Renaissance, has been considered marginal in much of western European thought and totally alien and inferior in Germanic thought. History tells us, however, that Europe was the last of the world's areas to develop the hallmarks of civilization, hallmarks largely borrowed from others who were later alleged to be less evolved than (western) Europeans.

ANTHROPOLOGICAL ARGUMENTS. Racist evolutionist ideas, and many not evolutionist, permeated much of medicine, psychology, biology, and other sciences in Europe and the United States at the beginning of the twentieth century. Among the first to lead a concentrated and protracted attack on scientific racism was Franz Boas (1858–1942). A German immigrant, Boas was the foremost anthropologist of his time and the founder of U.S. anthropology. Among many other things, Boas's research demonstrated the plasticity of the human form and the overlap in measurements (anthropometry) of anatomical features previously asserted to be unique to specific racial groups. These findings flatly contradicted the conceptions of races as stable, unchanging, and distinct physical types. Time has continued to enhance our understanding of the enormous plasticity of human biology, a biology so changeable that it has produced all the variations in the human form found in the world in less than 180,000 years.

Boas himself demonstrated how rapidly biology can change, as well as the nonempirical basis of racial differences, by showing that very different anthropometric readings could be obtained from the children of immigrants to the United States when compared with their parents. The cause was the change in environmental factors, especially nutrition. These measurements indicated, according to the current, specific racial measurement norms, that people in the same family appeared to belong to completely different racial groups (Boas).

Boas also advanced fatal arguments against notions of the relatedness of race to behavior. He showed that so-called races did not exhibit distinct religious, linguistic, or general cultural patterns. People of a variety of races spoke the same language and practiced the same religion. And members of the same race spoke different languages, held different religious beliefs, and otherwise exhibited distinct cultures. Race could not be shown to determine even major forms of human behavior (Boas; Stocking). Many of the positions advanced by Boas remain the most powerful antiracist arguments. It is remarkable that he began his assault on scientific racism before 1910, a time when blatantly racist statements were common in science and in the White House (see Brandt, 1985).

Evolutionary schemes were soon generally recognized as based on biased conjecture. There were no empirical bases for the evolutionary stages of Karl Marx, Herbert Spencer, Edward Tylor, or any of the other evolutionary theorists. Boas replaced evolutionist theorizing with the study of the historical diffusion of cultural traits. Historical diffusionism based its arguments on empirical evidence from all the branches of anthropology, physical anthropology, linguistics, archaeology, and sociocultural anthropology as well as from history. Such evidence was used to demonstrate that the current cultural (or physical) features or organization of any group were a result of contact and borrowing from other groups it had encountered. Of less influence in cultural change were innovation and creativity. Cultural arrangements, then, had more to do with a particular history of contact than with innate abilities related to alleged evolutionary stages. This understanding replaced a notion of the evolution of a single human general culture with an understanding of particular cultures' histories.

Evolutionists rank people and cultures from low to high, worst to best. Implicit in evolutionist thinking is the idea of progress, the idea that things are changing for the better. Evolution and progress are unrelated in fact and must be kept separate. Evolutionary change is simply descent with modification; there is no implication of improvement or superiority of later social or biological forms over earlier ones.

But evolutionists depicted some groups, such as Africans, as being near the apes because the groups were perceived as different. They were said to resemble nonhuman primates, such as chimpanzees and apes, who were described as having thick lips, curly hair, and dark skin. This representation has persisted despite the fact that nonhuman primates actually have straight hair covering their rather white skin and are totally lacking lips. That is, nonhuman primates exhibit precisely the characteristics claimed by Europeans as indicative of their own racial superiority.

While racism is still common, though less so than earlier in the twentieth century in the United States, evolutionist notions containing the idea of progress persist. A counter to these ideas is one of Boas's most enduring contributions: his articulation of the notion of cultural relativism, which is not a theory but a descriptive reaction to wide experience with other cultures. While evolutionists ranked people and cultures, anthropologists after Boas came to see them in relative terms; cultures were not better or worse than one another, they were simply different. One could not judge a culture using values from another; cultures must be evaluated using internal, not external, criteria. Relativism has become a central tenet of anthropology, the science of culture.

Biomedical sciences often evidence not the relativism of Boas but the hierarchical evaluative thinking indicative of evolutionism. An implicit ranking system appeared in medicine and persists in notions of defects afflicting groups of people. Historians of medicine show that this idea was disseminated by medicine's association of specific illness states with specific ethnic groups (called races) and/or genders (Chesler; Gilman; Pernick). This was but one of many techniques for the pathologization of often fictitious differences.

Difference from an implicit standard, that is, Anglo, male, adult (Gaines, 1992a; Gilman), in medical and psychiatric thought has been represented as problematic, dangerous, exceptional, pathological, defective, weak, vulnerable, and/or requiring "special" treatment (Gaines, 1992a; Osborne and Feit). Ultimately, the idea communicated is that culturally defined "others"—in the United States, non-European ethnics, women, and children—are simply, and inherently, "not normal" (Ehrenreich and English; Gilman).

One significant problem with the theories about natural racial groups is the fact that the precise number of them has never been agreed upon. Throughout the last century and a half, enumerations of groups said to constitute races fluctuated from author to author. Indeed, the number of racial groups is still changing. A recent example is the creation, starting in the early 1980s, of a Hispanic race.

The dynamics of the numbers of races should not be surprising given that the boundaries created to distinguish among the various groups have no empirical bases. Such discriminations are everywhere the arbitrary choice of an author (Gould; UNESCO; Stocking). The lack of fixed criteria for differentiation is reflected in the changes over time in racial labels of individuals in modern health statistical records (Hahn), in local and personal history (Domínguez), and in the ever-changing number of races, a number that varies somewhere between one race and three hundred. The correct number is one.

THE HETEROGENEITY OF RACE. Analyses of biogenetic differences of human groups lead to the recognition of a great variety of characteristics, most of which are shared in various proportions. Local configurations of traits (height, color, etc.) produce a huge number of distinguishable groups. On the African continent, there are about one thousand biologically distinguishable groups, as opposed to races (Hiernaux). Human groups are not divisible into groups that exhibit unique, nonoverlapping physiological characteristics. Differences in biology are always local differences that are characteristic of a local inbreeding population. What is seen as normal human biology also changes from culture to culture (see Kuriyama, in Leslie and Young). Just as the cultural elements exhibited by individuals of ethnic groups vary, so does the biology of members of so-called races.

The central problem for racial classifications is that there exist no intrinsically significant human features. Cultures have selected specific features as worthy of concern and hence as criteria of inclusion or exclusion. The selection of any one trait—such as skin, hair, or eye color, body hair, height, weight, religion, or place of birth—as a criterion of group exclusion or inclusion is, by definition, arbitrary. The selected characteristics represent historical attributions of meaning in local cultural contexts, not the expression of universal human nature or physical characteristics.

Racial Theories in the United States

Most observers in the United States, whether lay or scientific, believe that observation of racial differences and racial antipathy has existed since time immemorial, being an understandable outcome of the encounter of dissimilar social groups. However, this is understandable only in a specific cultural context and is not an accurate rendering of the history of cultural contact.

The deleterious effect of racism on perception and cognition is obvious if the ancestry of U.S. racial groups is examined. Misrepresentations appear in scientific research as well as the popular media. The two—research and media—engage in a kind of cultural conversation that confirms the reality of race. An objective look at the ancestry of members of the major groups in the United States reveals race as a fatal conceptual problem in public health and medical research.

In the United States, most people labeled by self and others as Native Americans are biologically part European; in many cases, they are largely so. Many such individuals also have West African ancestry. Virtually all American "blacks," or African-Americans, are biologically part European. In many if not most cases, more of their ancestors came from Europe than from West Africa. Quite commonly, African-Americans also have Native American ancestry (Blu; Domínguez; Gaines, "Medical/Psychiatric Knowledge," in Gaines, 1992a; Hallowell; Naroll and Naroll; Watts).

All classificatory whites claiming multigenerational descent in the South can be shown to have West African ancestry and, very likely, Native American ancestry (Domínguez; Hallowell; Naroll and Naroll). This is not surprising since most of the colonists who settled in the U.S. South were single males. The relatively few unmarried females were generally of lower status and in long-term bond service. Without Native American and African women, European males in the South could not have had offspring. In the move westward into what was northern Mexico, where the Spanish had settled with Native Americans a century before the English came to the East Coast, one finds again that those "Americans" who went were primarily males from the South and the East. For this reason, the descendants of these early settlers in the West (settlers who were themselves illegal immigrants because this was northern Mexico) are today of mixed ancestry, although this is not publicly known.

Another distortion relates directly to Latinos, Mexicans, and other groups of "Hispanics." Latinos are descendants of western European, Native American, and West African peoples. This mixture is what the term la raza means: a "race" born of a mixture of elements. Because many Mexicans are actually Indians or partly so, the difference between Native Americans (many of whom are Spanish-speaking) and Hispanics is often only nationality, a matter of sociolegal definition and not biology. In other instances, Hispanics have no Native American ancestry but do have West African along with their western European ancestry. In many Latino groups (such as those of Venezuela and Puerto Rico), West African ancestry is virtually universal.

Despite the very definition of Latino as people of mixed cultural and biological ancestry, this language group has been homogenized in the scientific literature and, in the 1980s, became a discrete biological group, a "race" (Gaines, "Medical/Psychiatric Knowledge," in Gaines, 1992a; Hahn). In reality, the groups seen as discrete in the United States—white, African-American, Native American, and Latino—are not at all biologically distinct. Indeed, individuals in any of the categories may embody the same mixture of ancestors as do individuals in the others. The difference in the group to which one is assigned depends not on biology but on local context and social history. These groups represent social categories that are unstable and without common biogenetic content.

VARIABLE RACIAL CRITERIA. In considering the referents of the term race, no fixed criterion exists even within the United States. Many nonbiological criteria are used to identify races. The term is applied, for example, to people from a region or geographical direction, one usually designated from the perspective of Europe (e.g., Asians/Orientals). Another referent of this cultural term race is a specific continental location (e.g., African, [Native] American). A new basis for a racial group has also emerged quite recently—language. Hispanic, a new racial identity in the United States, may be attributed on the basis only of a surname; here language is biologized.

Putative skin color is commonly used as a marker of race, for example, white, red, black, brown, yellow. This use of color-as-race continues despite the fact that Asians run the gamut in complexion from white to black, as in southern India. The same range of skin color is found among people labeled black or white in the United States. The lack of real color "lines" produces cases of people who are black but look white or the reverse, as well as many other oddities. In such instances, it is social history (i.e., knowledge of ancestry) that produces assignment to an allegedly biological category.

A final criterion of race in the United States is religion. Judaism is employed to demarcate an allegedly biologically distinct group. But it is clear that Jews conform to the local physiological characteristics of the communities in which they reside (e.g., Germany, Poland, Russia, England, Scandinavia, Spain, France). The Jews in the United States represent a (fictional) biological group created by religious intolerance.

If a cultural approach has some predictive value, one can anticipate that the antipathy of U.S. people toward Arabs in the 1980s and 1990s will likely result in the social construction of yet another historically unknown race—Muslims. (The British have used the term Wogs.) Some indication of this process may be seen in the descriptions of the 1990s conflict in the former Yugoslavia. The U.S. media described the conflict as between "Muslims, Serbs, and Croats," although the Muslims were themselves either Serbs or Croats whose ancestors converted to Islam.

Because racism clearly influences cognition, perception, and affect (emotion), it could well appear in psychiatric classifications as a specific disorder. Rather than a condition of professional psychiatric concern, racism and its twin, sexism, instead appear as significant implicit elements in psychiatric (mis)diagnosis and (mis)treatment (Adebimpe; Chesler; Good).

The erroneous views of race found in the United States encode several distinct ideas: (1) a fixed number of distinct biological populations, or races, exist in nature; (2) races have distinctive physical, mental, and/or behavioral characteristics; (3) racial characteristics (physical and behavioral) are naturally reproduced over time; and (4) specific group characteristics—physical, mental, and often moral—are hierarchically ranked, that is, some groups are superior to others (Boas; Gould; Stocking; Montagu). These assumptions, however, are not the only extant racial views of human difference.

Cultural Systems of Racial Classification Beyond the United States

Some writers have argued that capitalism, with a need for cheap labor and for justifying expropriation of land and resources, provided the political context and motivation that drove science to create a defensible basis in biology for immoral acts such as slavery and genocide (Rex and Mason). Certainly, Europeans' encounters with Native Americans and imported West Africans affected their constructions of human difference (Gossett). However, it appears more likely that racial views are a form of ethnobiology, a cultural classificatory theory about the nature of human variability (Gaines, 1992a), because some racial ideologies predate capitalism. As well, various capitalist countries exhibit distinctive notions of race. Their differing views have resulted in very different treatment of those designated as belonging to different races.

RACE IN EUROPE. Both English and German science and society produced biological constructions of affinity and difference (Gaines, 1992a). Those who are alike share a common "blood" in Germany and "breeding" in England. Those of the same blood constitute a "race." This German belief is a kind of biological essentialism. It is a much more exclusive notion of race than that found in the United States. It is in reality a kind of ancient kinship theory, a theory of a coherent, related descent group (Gaines, 1992a) that later merged with evolutionist ideas. As such, it is much narrower than U.S. notions. In contemporary Germany, the cultural system of group membership based upon descent from a common ancestor continues. It determines social identity as well as citizenship and suitability to hold political office, for non-Germans cannot hold office or become citizens.

The same system of social classification is found in Alsace, the culturally Germanic northeastern province of France. The biological German system exists alongside a very different, French cultural system that determines ethnic identity by other means. It accords in-group identity to those sharing French civilization and culture. Membership is primarily based on language, not appearance or place of birth (Gaines, 1992a). The term race in France thus refers to people who share a particular language and civilization. Both can be acquired, but the latter only by means of the former. Anyone can become French; being French is a linguistic existential state, not a biological one as in the case of the German system.

The so-called racist groups of France may be seen as culturalists; their targets are not races but culturally distinct groups, such as unassimilated Muslims. French-speaking sub-Saharan Africans are not targets of the French racism. North Africans have been historically white even though their complexions run the gamut from black to pale. The conflicts in France thus cannot be based upon race, though they are reported as such in the U.S. media where cultural differences are always interpreted as "racial differences."

RACE IN JAPAN AND SOUTH AFRICA. In Japan, a modern, industrial, and scientific society, a conception of human races exists that differs from that of the United States. Japanese sciences hold, and offer evidence to support, that the Japanese are a race distinct from Koreans, Chinese, the indigenous Ainu people, and the outcast Eta group (DeVos and Wagatsuma). In contrast, U.S. science and society hold that all these people from the East constitute a single biological race, along with South Asians, Indonesians, Filipinos, and others. These people do not evidence a common language, culture, or physical appearance, so the U.S. cultural system converts a geographical designation of people, borrowed from Europe, into an "Asian race."

In South Africa, there exists yet another system that classifies "racial groups." There, before the official collapse of apartheid, a sociolegal system was in place that distinguished four groups: Black, White, Asian, and Coloured. All people with ancestry in more than one of the first three groups were categorized as Coloured. Chinese were Asian, but Japanese were White. Each group historically has had different rights and privileges (see Schwartz, in Gaines, 1992a). All have equal status, at least legally, in the new South Africa.

In the United States, unlike South Africa, science and society ignore mixed ancestry and label individuals as wholly belonging to the least prestigious group of his or her parents, that is, to one exclusive category or another. In medical research, epidemiological studies, and clinical practice, people of mixed ancestry—that is, most Americans—are treated as if they had no ancestry except (West) African, Native American, Asian, or European. Designations are assumed to refer to homogeneous, distinct biological groups. If "admixture" is noted, researchers tend to ignore European ancestry and focus on genetic "vulnerabilities" deriving only from the subject's putative "minority" ancestry (Duster; Gaines, 1985; Wailoo).

In the United States, virtually all people called black or African-American, a term coined by anthropologist Melville Herskovits, would be classified in South Africa as Coloured because of their mixed ancestry (West African, western European, Native American). Indeed, all U.S. residents who claim long lines of U.S. antecedents would be likewise classified because they too have mixed ancestry. The same would hold true for most Native Americans and Latinos. Ironically then, the major U.S. racial groups, those with major antipathies and conflicts enduring over centuries based on their racial differences, all would be classified in South Africa as belonging to the same racial group—Coloured.

Race as a Key Variable in Biomedical Research and Practice

The ideas of race enumerated above underlie almost all medical and psychiatric research in the United States that pertains to group differences other than age or sex (Gaines, 1992a; Hahn; Robbins and Regier; Osborne and Feit). Remarkably, these beliefs concerning the existence or homogeneity of human populations called "races" have not the slightest scientific (or logical) basis; no empirical evidence has ever existed for the differentiation of humanity into broad racial groups (Gould; Montagu; UNESCO, 1969). In reality, thousands of biologically distinct human groups exist (Hiernaux, 1970; Montagu; Naroll and Naroll; Watts).

Assertions of the biological bases of differences among races are used to justify caste systems; that is, the results of oppression, discrimination, and poverty are commonly used to justify further discrimination and prejudice (Boas; DeVos and Wagatsuma; Naroll and Naroll; Thomas and Sillen). As is shown below, medical research, theory, and practice often play this same role in U.S. society and thereby serve as "scientific" justification for the persistence of popular conceptions of racial difference and of racism (Brandt, 1985; Gilman; Duster).

Racial groups are mental constructs. As mental constructs they cannot evidence medical conditions. Yet "one of the most common methodological blunders in scientific studies of the significance of racial differences in the United States is the tacit acceptance of this phantasmic notion of race as the basis for establishing research samples" (Harris, 1968, p. 264). Given this, it can be noted that a folk medicine, or ethnomedicine, is largely a creation of cultural beliefs. Its practices serve to reinforce and even justify those beliefs. Such is precisely the nature of medical research on group differences in the United States. This supportive role may be seen in research on afflictions said to appear only in certain populations.

THE MYTH OF RACE-SPECIFIC DISEASES. In biology or psychology, research science is used to reach conclusions that are in fact a priori assumptions; "prejudice not … documentation dictates conclusions" (Gould, p. 80). In today's medical and scientific community, expressed ideas concerning ethnic and gender inferiority are largely implicit. They are replaced in the medical literature by vague assertions such as vulnerability, susceptibility, tendency, increased risk, and difference. One aspect of this discourse that constructs and maintains racial difference concerns "racespecific diseases." Since it is believed that races are distinct groups with their own biologies, it stands to reason that they would exhibit particular diseases. Sickle-cell anemia is a case in point.

At the beginning of the twentieth century, sickle-cell anemia was found originally through laboratory analysis of the blood of five patients—two European-Americans, two mulattos (in the parlance of the time, persons of mixed European and West African ancestry, but very largely the former), and one Negro (who doubtless was also part European). The findings were reported in the medical literature, however, as a condition found only in Negroes (Wailoo). In fact, this condition has existed in most world populations including the Mediterranean, Middle Eastern, Indian, Filipino, and South American. Instructively, the condition is not found among people in eastern, southern, or central Africa. Rather, it is found largely in West Africa, the ancestral area of most people in the Americas with African ancestry. Clearly, the condition is not a "racial disease" but rather a characteristic of some local populations.

Tay-Sachs disease is said to be a Jewish disease. In fact, it is a disorder found in a specific local population of the eastern Mediterranean from which some Jews, as well as Arabs, came. Jews not from this area, and not descended from people who were, have no risk of developing the disorder. The same is true of the so-called Portuguese disease, a degenerative, fatal neurological disease said to afflict Portuguese people. The afflicted are in reality descended from a single person (one Joseph) who carried the gene causing the disease. It is purely by chance that the antecedent person was Portuguese. Unrelated Portuguese are not at risk for developing the disease. In Tay-Sachs and the Portuguese diseases, specific sites of affliction are generalized to all in the racial category of the afflicted. "Local biologies" (Gaines, 1992a) are ignored in favor of "racial" ones.

The medical assertion that certain diseases are peculiar to specific races is without merit. The fiction is maintained through a number of techniques. Findings in a single person of a racial group are regularly generalized to all members of that putative group (Brandt, 1978; Wailoo); a part is made to stand for a whole. For example, a clinical finding that Indians in Britain required lower therapeutic levels of certain psychotropic medications became the basis for research comparing "Asians" and "Caucasians" (Lin et al., 1990; Lin et al., 1986; Mendoza et al.).

Tendencies discerned in research are commonly rein-terpreted to suggest significant differences in research on hypertensive medications; "diuretics are best for 'blacks' and beta-blockers for 'whites.'" Since members in neither group have common ancestry in the United States, such stereo-types can limit diagnosis of problems to groups "known" to be afflicted; others are then overlooked, misdiagnosed, or considered to be exceptions. As such, they do not challenge the stereotype, though logically such exceptions should call into question the very notion of racial distinctiveness.

Despite the absence of any scientific basis, the idea of race represents the basic population variable, aside from age and sex, on which inquiries focus and in terms of which results are interpreted and recommendations made. The huge body of literature on race-specific problems and racial comparisons are actually of unknown scientific value, though they represent a rich corpus for cultural study.

As long as medical science continues in its archaic racial folk beliefs, its claims to objective, acultural, and disinterested status in the health field are seriously compromised. Because these and gender beliefs are purely popular, modern medical sciences appear as cultural medicines, ethnomedicines, albeit professional ones (Gaines, 1992c; Hahn and Gaines). The validity of racial conceptions has been challenged and its use compromised. The continued use of racial conceptions in biomedical research and practice looms as a central conceptual and methodological problem in the biomedical sciences.

CONSEQUENCES OF RACIAL BELIEFS. Common to intentional and unintentional discriminatory motivations is the unstated theory that ancestry in nonwhite groups "taints" the individual, not only determining identity but also causing disease. This is the implicit pathologization of perceived "difference" typical in research on high blood pressure and diabetes as well as a variety of other conditions (Cowie et al.; Harris, 1991; Jones and Rice). Affliction is attributed to the fact that the individuals are "minority," by which is meant biologically different and therefore "defective."

Considering the study of diabetes in African-Americans more closely, it is found that while no risk factors and very few cases of diabetes exist in West Africa, individuals classified as African-Americans are still commonly said to be at "high risk" for developing the disease because of their "racial or ethnic ancestry." The presence of diabetes in these populations has other probable causes that are normally overlooked in research. They are (1) the European genetic background of the African-Americans; (2) poverty and related poor nutrition caused by discrimination; and (3) the high animal-fat content of the dominant northern European diet.

Racial thinking leads researchers to ignore oppression, racism, and discrimination—all of which can implicate the researchers themselves—as well as other cultural and biological factors. Research is confined to allegedly biological problems existing as defects within the afflicted. The real biogenetic makeup of individuals goes unanalyzed while their social identity is blamed for their illness.

Research on the treatments of choice and treatment recommendations in U.S. biomedicine demonstrates that medical and psychiatric diagnoses and therapeutic choices are often made on the basis of patients' social identity, be it race, class, or gender rather than objective need (Brandt, 1985; Ehrenreich and English; Gilman; Good; Lindenbaum and Lock; Osborne and Feit). Historically, this includes the differential use of anesthesia; the poor didn't need it but the wealthy did, as they were more delicate! (Pernick).

The form of intervention in psychiatry, pharmacotherapy, and psychotherapy is today heavily dependent on racial and/or sexual stereotypes rather than on empirical psychiatric signs or symptoms (Katz; Gaines, 1982, 1992a, 1992c; Littlewood). Blacks and Hispanics are often seen as belonging to that group of patients termed psychologically unsophisticated or not psychologically minded (e.g., Leff; MacKinnon and Michels; Sudack). Psychopharmacotherapy is seen as more "appropriate" for such patients than forms of "talk" therapy.

It should be recalled that U.S. psychiatry in the nineteenth century "found" that psychiatric disorders afflicted black slaves who otherwise "unaccountably" ran away from their masters. This is a historical version of a biological psychiatry and posits that all conditions are biological and will ultimately yield to somatic interventions. Environment, in this view, can be discounted or its consideration delayed until suspected "biological components" can be studied.

In medical research, behavior is also related to race. Medical researchers often choose research topics that implicate behaviors judged as immoral or incautious when dealing with minority populations, for example, number of sex partners, unwed mothers, and drug addiction (Gaines, 1985; Osborne and Feit). In this way, medical research also becomes moral research and supports blame-the-victim thinking.

In the psychiatric literature, neo-evolutionist racial theories lurk behind some assertions. Certain groups, such as the English, are said to be more evolved and psychologically normal (see Leff). In this view, somatization is allegedly less evolved and is characteristic of less developed "traditional" or "primitive" societies. The position inserts a cultural view of emotion and thought into a not-too-implicit neoevolutionist scheme.

In the West, emotions are believed to be natural, universal, and distinct from cognition. But anthropological research has shown that specific emotions are not universal nor are they naturally distinct from cognitive or bodily states and functions (see Good et al., Lutz, Obeyesekere, Schieffelin, in Kleinman and Good). While highly valued in a very few cultures, psychologization of distress is not "natural," but rather a learned, shared, and transmitted cultural approach (Kleinman). Psychologization is not found in many areas of Europe itself, for example, the Mediterranean and eastern Europe (Gaines, 1992c; Gaines and Farmer; see Good et al. in Kleinman and Good), or in China, Japan, or India (Kleinman and Good; Leslie and Young).

Research on racial differences provides the scientific bases for the maintenance of popular and scientific racial ideology in the United States. This ideology clearly leads to differential evaluation of social actors in medical and nonmedical contexts. As such, biomedical practices can be said to contribute to the social problems caused by racism. These problems include unequal access and poor medical outcomes (Good). The use of racial categories in biomedical research and practice, then, may be seen to breach the medical profession's own primary ethical injunction "to do no harm."

GENES, RACE, AND VIOLENCE. Biomedicine conceives of its domain as the discovery and manipulation of nature (see Gordon, in Lock and Gordon). Its wider culture perceives nature as something to be dominated and controlled (Pike). Ideas of nature, as well as those of difference and inferiority that are encoded in racial and gender identities, greatly affect practice and research in U.S. biomedical sciences. Classes of people believed to be closer to nature are seen as requiring control and guidance, even domination. Such people—among them women, children, non-Anglo or non-Germanic European ethnics (e.g., French, Italian, Spanish, Celtic, and Slavic people), Africans and their descendants, Native Americans, Hispanics, Pacific Islanders—are, in the United States, rather widely believed to be emotional, and therefore dangerous, unpredictable, and wild. Comments about "natural abilities" (intuitive, musical, irrational, fierce, shrewd) or characteristics of particular groups indicate their closeness to nature; they, like animals, are thought to be dominated by instinct and irrationality, not by "reason," a European cultural and masculine virtue (Chesler; Fausto-Sterling; Kleinman and Good; Pike).

The imputation of wildness, impulsiveness, and irrationality is doubtless a culturally constituted defensive projection of aggression that actually exists in the dominant group (Gilman; Pike). It is used to justify control, domination, and even extermination, as with Africans and Native Americans in the United States and non-German ethnics and the disabled in World War II Germany.

A similar logic appears in contemporary U.S. society. Urban violence, born of repression, discrimination, violence, and poverty, is recast as "genetic predispositions to violence or criminality" in individuals and the groups to which they are ascribed, especially after periods of civil unrest. However, rather obvious examples of genetic predispositions toward criminality and violence in the dominant group are regularly ignored as are centuries of clear provocations of African-Americans.

If researchers were indeed interested in a dispassionate evaluation of genetic components of violence and criminality, it would be appropriate to study people descended from generations of individuals all of whom have committed crimes of a serious nature. In the United States, such a population would be the many immigrants from Russia or Germany, as well as their offspring. Another group of subjects would be the descendants of slave traders and owners. Mass murderers and serial killers in the United States and Europe are virtually always white; their relatives would be suitable subjects of biological research on white criminality. These data might suggest some genetic basis for the inheritance of violent tendencies, if one were to think in racial terms. But researchers on violence and its causes regularly ignore such evidence. It appears that violence and criminality are possible genetic predispositions only when they appear in individuals belonging to specific low-status racial groups.

RACE AND CLINICAL STUDIES. That racial groups are considered unequally in U.S. biomedical science and society is clearly demonstrated by the infamous and tragic Tuskegee syphilis study. In 1932, the U.S. Public Health Service (PHS) began a prospective study of syphilis infection among four hundred rural Alabamans who were black male share-croppers. The researchers asserted that the study could be a "natural experiment" because it was assumed (for racist reasons) that "such people" were all infected and would not seek treatment for their condition (Brandt, 1978). For these reasons, the PHS argued that it could observe the natural history of syphilis infection in these black men. As it happened, the subjects, who had been unknowingly selected, began to seek treatment almost immediately.

Rather than provide healthcare, the PHS initiated a vast conspiracy to prevent the subjects from receiving care from any source. It conspired with local and state health officials, clinics and hospitals, and the U.S. Army, in which some of the men had enlisted, to prevent disclosure to the subjects of their diagnosis and to prevent treatment of their affliction.

Despite the fact that the natural experimental premise was invalidated in short order, this horrendous project continued over four decades until 1972, when public outcries finally stopped it. Until that time, however, the study was often reported in the medical literature without raising ethical concerns about informed consent, the sometimes fatal use of these human subjects, or the conspiracy to prevent them from receiving efficacious treatments (Brandt, 1978, 1985).

Aside from specific research projects that indicate differential concern for specific groups in the United States, "minorities" in day-to-day medical settings are often underdiagnosed for problems that could be treated (e.g., heart disease) and overdiagnosed for others. For example, blacks are regularly misdiagnosed with schizophrenia. These misdiagnoses lead to confinement and inappropriate pharmacological regimens. Loss of freedom and improper use of powerful psychotropic medications may themselves lead to chronicity in the illnesses that are left untreated, illnesses that led the patient to the attention of health professionals in the first place (see Adebimpe; Mukherjee et al.; Bell and Mehta; Good). This is one means by which medicine creates chronicity of particular disorders as well as increases in the reported incidence of these disorders in a specific population. The circular logic is completed by the subsequent tendency to diagnose in an individual a disorder that is reported as "common" in members of his or her racial or ethnic group.

It is important for a full understanding of the role of racial classifications in the biomedical field to see it as part of a cultural system. This allows for the recognition of both the clearly concerned altruistic practitioners and researchers and the profoundly troubling aspects of racial thought in biomedical practices. In this view, the problems of racial thinking may be seen to arise frequently from the use of popular racial notions by force of tradition—tradition in the Weberian sense, wherein it is one source of authority for human action (Weber). The use of racial categories is thus not necessarily racist.

Conclusions

The U.S. version of human biology is a folk biology that assumes that social categories—"races"—are reflections of nature rather than culture. As a result, biomedical work, as well as public healthcare, is conducted and interpreted in these terms. In clinical practice in U.S. medicine, every patient record begins with three basic bits of information thought to be of critical importance: age, race, and gender(e.g., "A thirty-seven-year-old black female presented with …"). This is a significant part of the discourse of medicine that reconfirms the cultural conceptions that race, age, and sex are natural and empirical realities that make a difference.

Specific forms of communalism, such as racism and sexism, are intrinsic to U.S. society. As a result, they are fundamentally part of its medical institutions, because U.S. medicine is a reflection of the culture that created it. Culturally specific prejudice makes U.S. biomedicine an expression of a particular culture and its history. That culture has held and still expresses empirically problematic and ultimately unethical conceptualizations of human variation. However, neither contemporary medicine nor society remains monocultural; different ethnic and gender voices are being heard advocating what may be seen as more cultural and therefore humane and equal medical-research concerns and treatment. In many scientific fields, the lessons learned from the Nazi atrocities—as well as the inclusion of Jews, African-Americans, and women into collegial relations—has helped to reduce scientific racism and sexism since the 1950s (Barkan). Trends of pluralism begun then continue and expand.

Modern biomedical thought in the United States appears to lag in its understanding of the bases of human differences. The basis is culture, not biology. Even though racial terms are now often exchanged for ethnic ones, the problems persist in biomedicine and related sciences. Ethnicity has a cultural referent, and race has a putatively biological one. The two terms are incommensurate and cannot be used interchangeably.

Intentionally or unintentionally, biomedicine conserves, employs, and disseminates racial and gender-biased conceptions in its theory and practice. Such actions may be seen to derive both from habit and from nefarious intent. Comparisons are at the heart of science. U.S. science, along with U.S. popular society, has always thought that comparisons of black versus white or other races are the more or less "natural" ones to make in a "multiracial" society. Some others yet seek to show one group's superiority over others.

Biomedical enterprises will surely be subject to increasing ethical and practical criticism in the future "both from without and within its cultural tradition by those it fails to serve and those it serves to fail" (Gaines, 1992c). The growing understanding of the cultural biases of the professional medicines (and sciences) of the world suggests that medicines, like their particular medical ethics, reflect local cultural realities. A pluralistic medicine is needed in a multicultural country such as the United States. In such a country, a single medical voice may easily lead to, if not generate, bioethical conflicts. A medicine without cultural understandings, unreflective of its own cultural foundations, is inadequate, and an inadequate medicine cannot be of great help in a multicultural society.

atwood d. gaines (1995)

bibliography revised

SEE ALSO: Bioethics, African-American Perspectives; Biology, Philosophy of; Eugenics; Feminism; Genetic Discrimination; Genetics and Racial Minorities; Genetics and Human Self-Understanding; Holocaust; Human Dignity; Human Nature; Mental Illness: Conceptions of Mental Illness; Minorities as Research Subjects; Psychiatry, Abuses of; Sexism; Women, Historical and Cross-Cultural Perspectives

BIBLIOGRAPHY

Adebimpe, Victor R. 1981. "Overview: White Norms and Psychiatric Diagnosis of Black Patients." American Journal of Psychiatry 138(3): 279–285.

American Association of Physical Anthropologist (AAPA). 1996. "AAPA Statement on Biological Aspects of Race." American Journal of Physcial Anthropology 101: 569–570.

Asma, Stephen T. 1995. "Metaphors of Race: Theoretical Presuppositions Behind Racism." American Philosophical Quarterly 32(1): 13–29.

Babbit, Susan E., and Campbell, Sue, eds. 1999. Racism and Philosophy. Ithaca, NY: Cornell University Press.

Barkan, Elazar. 1992. The Retreat of Scientific Racism: Changing Concepts of Race in Britain and the United States Between the World Wars. Cambridge, Eng.: Cambridge University Press.

Bell, Carl C., and Mehta, Harshad. 1980. "The Misdiagnosis of Black Patients with Manic Depressive Illness." Journal of the National Medical Association 72(2): 141–145.

Bernasconi, Robert, and Lott, Tommy Lee, eds. 2000. The Idea of Race. Indianapolis, IN: Hackett Publishing Co.

Blu, Karen I. 1980. The Lumbee Problem: The Making of an American Indian People. Cambridge, Eng.: Cambridge University Press.

Boas, Franz. 1940. Race, Language and Culture. New York: Free Press.

Brandt, Allan M. 1978. "Racism and Research: The Case of the Tuskegee Syphilis Study." Hastings Center Report 8(6): 21–29.

Brandt, Allan M. 1985. No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880. Oxford: Oxford University Press.

Boxill, Bernard, ed. 2001. Race and Racism. New York: Oxford University Press.

Chesler, Phyllis. 1972. Women and Madness. San Diego: Harcourt Brace Jovanovich.

Cowie, Catherine C.; Port, Friedrich K.; Wolfe, Robert A.; Savage, Peter J.; Moll, Patricia P.; and Hawthorne, Victor M.1989. "Disparities in Incidence of Diabetic End Stage Renal Disease According to Race and Type of Diabetes." New England Journal of Medicine 321(16): 1074–1079.

DeVos, George A., and Wagatsuma, Hiroshi. 1966. Japan's Invisible Race: Caste in Culture and Personality. Berkeley: University of California Press.

Domínguez, Virginia R. 1986. White by Definition: Social Classification in Creole Louisiana. New Brunswick, NJ: Rutgers University Press.

Duster, Troy. 1990. Backdoor to Eugenics. New York: Routledge.

Eckersley, Robyn. 1998. "Beyond Human Racism." Environmental Values 7(2): 165–182.

Ehrenreich, Barbara, and English, Deirdre. 1973. Complaints and Disorders: The Sexual Politics of Sickness. Old Westbury, NY: Feminist Press.

Fausto-Sterling, Anne. 1992. Myths of Gender: Biological Theories About Women and Men, 2nd edition. New York: Basic Books.

Gaines, Atwood D. 1985. "Alcohol: Cultural Conceptions and Social Behavior Among Urban 'Blacks.'" In The American Experience with Alcohol: Contrasting Cultural Perspectives, pp. 171–197, ed. Linda A. Bennett and Genevieve M. Ames. New York: Plenum.

Gaines, Atwood D. 1992a. "From DSM-I to III-R: Voices of Self, Mastery and the Other: A Cultural Constructivist Reading of U.S. Psychiatric Classification." Social Science and Medicine 35(1): 3–24.

Gaines, Atwood D. 1992b. "Medical/Psychiatric Knowledge in France and the United States: Culture and Sickness in History and Biology." In Ethnopsychiatry: The Cultural Construction of Professional and Folk Psychiatries, pp. 171–201, ed. Atwood D. Gaines. Albany: State University of New York Press.

Gaines, Atwood D., and Farmer, Paul. 1986. "Visible Saints." Culture, Medicine and Psychiatry 10(3): 295–330.

Gaines, Atwood D., ed. 1992c. Ethnopsychiatry: The Cultural Construction of Professional and Folk Psychiatries. Albany: State University of New York Press.

Garcia, J. L. 1999. "A Philosophical Analysis and the Moral Concept of Racism." Philosophy and Social Criticism 25(5): 1–32.

Gilman, Sander L. 1985. "Difference and Pathology: Stereotypes of Sexuality, Race, and Madness." Ithaca, NY: Cornell University Press.

Good, Byron J. 1993. "Culture, Diagnosis and Comorbidity." Culture, Medicine and Psychiatry 16(4): 427–446.

Gossett, Thomas F. 1965. Race: The History of an Idea in America. New York: Schocken.

Gould, Stephen Jay. 1981. The Mismeasure of Man. New York: W. W. Norton.

Hahn, Robert A. 1992. "The State of Federal Health Statistics on Racial and Ethnic Groups." Journal of the American Medical Association 267(2): 268–273.

Hahn, Robert A., and Gaines, Atwood D., eds. 1985. Physicians of Western Medicine: Anthropological Approaches to Theory and Practice. Dordrecht, Netherlands: D. Reidel.

Hallowell, A. Irving. 1976. "American Indians, White and Black: The Phenomenon of Transculturalization." In Contributions to Anthropology: Selected Papers of A. Irving Hallowell, pp. 498–529. Chicago: University of Chicago Press.

Harris, Marvin. 1968. "Race." In International Encyclopedia of the Social Sciences, vol. 9, pp. 263–269, ed. David L. Sills. New York: Macmillan.

Harris, Marvin. 1991. "Epidemiological Correlates of NIDDM in Hispanics, Whites, and Blacks in the U.S. Population." Diabetes Care 14(7): 639–648.

Hiernaux, Jean. 1970. "The Concept of Race and the Taxonomy of Mankind." In The Concept of Race, pp. 29–44, ed. Ashley Montagu. New York: Free Press.

Holloway, Karla F. C. 1996. Codes of Conduct: Race, Ethics and the Color of Our Character. Piscataway, NJ: Rutgers University Press.

Jones, Woodrow, and Rice, Mitchell R., eds. 1987. Health Care Issues in Black America: Policies, Problems, and Prospects. New York: Greenwood.

Kleinman, Arthur. 1988. Rethinking Psychiatry: From Cultural Category to Personal Experience. New York: Free Press.

Kleinman, Arthur, and Good, Byron, J., eds. 1985. Culture and Depression: Studies in the Anthropology and Cross-Cultural Psychiatry of Affect and Disorder. Berkeley: University of California Press.

Lang, Berel. 2000. Race and Racism in Theory and Practice. Totowa, NJ: Rowman and Littlefield.

Leff, Julian P. 1981. Psychiatry Around the Globe: A Transcultural View. New York: Marcel Dekker.

Leslie, Charles M., and Young, Allan, eds. 1993. Paths to Asian Medical Knowledge. Berkeley: University of California Press.

Lin, Keh-Ming; Poland, Russell E.; and Chen, C. 1990. "Ethnicity and Psychopharmacology: Recent Findings and Future Research Directions." In Family, Culture and Psychobiology, ed. Eliot Sorel. New York: Legas.

Lin, Keh-Ming; Poland, Russell E.; and Lesser, Ira M. 1986. "Ethnicity and Psychopharmacology." Culture, Medicine and Psychiatry 10(2): 151–165.

Lindenbaum, Shirley, and Lock, Margaret M., eds. 1993. Knowledge, Power and Practice: The Anthropology of Medicine and Everyday Life. Berkeley: University of California Press.

Littlewood, Roland. 1982. Aliens and Alienists: Ethnic Minorities and Psychiatry. Harmondsworth, Eng.: Penguin.

Lock, Margaret M., and Gordon, Deborah R., eds. 1988. Biomedicine Examined. Dordrecht, Netherlands: Kluwer.

MacIntyre, Alasdair C. 1966. A Short History of Ethics. New York: Macmillan.

MacKinnon, Roger A., and Michels, Robert. 1971. The Psychiatric Interview in Clinical Practice. Philadelphia: W. B. Saunders.

Mendoza, Ricardo; Smith, Michael W.; Poland, Russell E.; Lin, Keh-Ming; and Strickland, Tony L. 1992. "Ethnic Psycho-pharmacology: The Hispanic and Native American Perspective." Psychopharmacology Bulletin 27(4): 449–461.

Montagu, Ashley. 1964. Man's Most Dangerous Myth: The Fallacy of Race, 4th edition, rev. Cleveland: World.

Mukherjee, Sukdeb; Shukla, Sashi; Woodle, Joanne; Rosen, Arnold M.; and Olarte, Silvia. 1983. "The Misdiagnosis of Schizophrenia in Bipolar Patients: A Multiethnic Comparison." American Journal of Psychiatry 140(12): 1571–1574.

Naroll, Raoul, and Naroll, Frada, eds. 1973. Main Currents in Cultural Anthropology. New York: Appleton-Century-Crofts.

Office of Management and Budget (US) (OMB). 1997. Race and Ethnic Standards for Federal Statistics and Administrative Reporting. Washington, D.C.: U.S. Government Printing Office.

Osborne, Newton G., and Feit, Marvin D. 1992. "The Use of Race in Medical Research." Journal of the American Medical Association 267(2): 275–279.

Pernick, Martin S. 1985. A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteenth-Century America. New York: Columbia University Press.

Pike, Fredrick B. 1992. The United States and Latin America: Myths and Stereotypes of Civilization and Nature. Austin: University of Texas Press.

Rex, John, and Mason, David J., eds. 1988. Theories of Race and Ethnic Relations. Cambridge, Eng.: Cambridge University Press.

Robins, Lee N., and Regier, Darrel A., eds. 1991. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press.

Schmid, W. Thomas. 1996. "The Definition of Racism." Journal of Applied Philosophy 13(1): 31–40.

Sherwin-White, Adrian Nicholas. 1967. Racial Prejudice in Imperial Rome. Cambridge, Eng.: Cambridge University Press.

Stocking, George W. 1968. Race, Culture and Evolution: Essays in the History of Anthropology. New York: Free Press.

Sudak, Howard S., ed. 1985. Clinical Psychiatry. St. Louis, MO: W. H. Green.

Thomas, Alexander, and Sillen, Samuel. 1972. Racism and Psychiatry: A Comparison of Germany and America. Secaucus, NJ: Citadel.

Townsend, John Marshall. 1978. Cultural Conceptions and Mental Illness. Chicago: University of Chicago Press.

UNESCO. 1969. Race and Science.L New York: Columbia University Press.

Wailoo, Keith. 1991. "'A Disease sui generis': The Origins of Sickle-Cell Anemia and the Emergence of Modern Clinical Research, 1904–1924." Bulletin of the History of Medicine 65(2): 185–208.

Ward, Julie K. and Lott, Tommy Lee, eds. 2002. Philosophers on Race: Critical Essays. Williston, VT: Blackwell Publishers.

Watts, Elizabeth S. 1981. "The Biological Race Concept and Diseases of Modern Man." In Biocultural Aspects of Disease, pp. 3–23, ed. Henry Rothschild and Charles F. Chapman. New York: Academic Press.

Weber, Max. 1978. Economy and Society, vol. 1, ed. Guenther Roth and Claus Wittich. Berkeley: University of California Press.

INTERNET RESOURCE

American Anthropological Association. 1998. American Anthropological Association Statement on "Race." Available from <www.aaanet.org/stmts/racepp.htm>.