health

‘We were made to feel like outcasts’: the psychiatrist who blew the whistle on racism in British medicine


In 1980 a man called Steven Thompson was just one week from completing a six-year prison sentence at Gartree prison in Leicestershire. Then the prison guards cut his hair off. Thompson was a Rastafarian and his dreadlocks were an important spiritual connection to his beliefs. So he resisted. It was taken as a sign of a violent psychiatric disorder – and, instead of going home, Thompson found himself committed to a secure hospital. His detention caused outrage in the Black community and, soon, Dr Aggrey Burke was asked to help getting him released.

Burke – the first Black consultant psychiatrist in the NHS – remembers travelling through the snow to Rampton Secure Hospital in Nottinghamshire. In a more than 40-year-long career he would fight tirelessly against discrimination in healthcare, sacrificing his own advancement to do so. He would take on racism in medical schools and offer psychological support to those traumatised by the infamous New Cross fire in 1981 that killed 14 young people. Yet Thompson’s case stuck in his mind as one that encapsulated many of the prejudices he had to battle. At the time, however, he just knew he would need to muster all his expertise and experience to convince the authorities Thompson was safe to release.

Burke, who turns 79 this year, still has a Jamaican accent even after decades in the UK. “Unfortunately, my colleagues in psychiatry have tended to see the Caribbean person through tinted glasses,” he tells me over Zoom. “The first thing that comes to the observer’s eye is: ‘This is a dangerous one, watch out!’”

Thompson’s detention led to “massive” protests in London, and in the House of Lords Lord Brockway asked for an inquiry into it. Burke was one of a group of independent psychiatrists who challenged Thompson’s diagnosis and negotiated with the staff. Finally, Thompson was released, to Burke’s “tremendous relief”.

Burke’s arrival in the UK was entwined with the country’s history of racial tension. His father, Edmund Burke, was a high-ranking civil servant, and was dispatched to England by the Jamaican chief minister Norman Manley to ease tensions in the aftermath of the Notting Hill race riots in 1958. The riots involved seven nights of attacks by white teddy boys on Caribbean migrants. Edmund arrived with his wife, Pansy, and three of their sons – leaving their eldest son in Jamaica like many who migrated.

Aggrey Burke
Aggrey Burke, centre, who in the early 70s documented the experiences of Jamaican psychiatric patients who had been deported from the UK. Photograph: Courtesy of Aggrey Burke/Anselm Ebulue/The Guardian

The family settled in Kew, west London, a “strange place” to Burke, then a 16-year-old from St Elizabeth, Jamaica. He was the only Black child in his class, and though there was little explicit intolerance he felt isolated and excluded. One day he visited a friend after school. “I was in my blazer, my tie, everything,” he recalls. Walking up to the house he saw his friend’s mother sitting in the front room and knocked on the window. When she looked out and saw him she panicked. “She was frightened,” he says. Burke watched, helplessly, as his friend’s mother tried “to get help for this invader”. It was the first moment he remembers feeling how he – a young, talented student and member of the Christian Union – could be in front of someone, when all they could see was a terrifying stereotype. It was a “really sad moment”, he says, embarrassing for both himself and his friend’s mother.

He enrolled in University of Birmingham medical school in 1962, one of a handful of Caribbean students. As well as studying, he volunteered with the grassroots self-help group Harambee Organisation, which organised a Black supplementary school to combat the neglect and abuse that Black children were facing in the education system. Burke says of that time: “I guess we didn’t call it racism, but whatever it was, it was pretty grim. And those early years were very, very unsettling.”

Never one to be restricted by borders, he began his psychiatric training in Trinidad and Tobago, and then went on to teach at the University of the West Indies.

In 1972 he returned to the UK and took up a research fellowship at the University of Birmingham. Then, in 1976, he was appointed the first Black forensic psychiatrist in London, working at St George’s hospital. Yet instead of retreating into privilege he focused on the issues facing Britain’s Black community.

In his early landmark work he documented the experiences of Jamaican psychiatric patients who had been “repatriated” (often a euphemism for “deported”) – supposedly for their own good.

“The idea among my colleagues was that by sending them home to liveunder the coconut tree or a banana tree’, they would get better,” says Burke. But when Burke toured Jamaica he saw the real consequences of this medical decision to return people who had come to the UK to raise money for their families home, apparently “broken”.

Far from recovering in the heart of their communities, many patients were “rejected because of the stigma attached to coming home mentally ill and penniless”. He met “so many who were living in the bush. Quite a number died by drowning themselves … Jamaica is not a welcoming environment if you’re not 100% well.” The message to people in Jamaica was clear in the refrain Burke remembers hearing as he travelled round tiny villages, often by minibus: “Going to England will mad you.”

Reflecting on lessons from this work in the wake of the Windrush scandal – where hundreds of people who had lived in the UK since they were children were threatened with deportation – Burke says it’s clear these policies, then and now, create feelings of rejection and instability. They send a message to people of colour that they do not truly belong.

“Do we have a long-term stay in Britain – and can it be altered? That’s a huge question for the youngsters to deal with. Because I don’t think there is a sense of security yet. And I don’t think it’s going to come overnight,” says Burke. “So you know, there’s going to be this question of who qualifies to be part of the British clan. And can one achieve it by protest, or by negotiation?”

Alongside his NHS work Burke was also at the forefront of helping those in one of the ugliest episodes in recent Black British history – the New Cross fire. The fire killed 13 young people at a house party in 1981, with one survivor later taking their own life, and a bungled police investigation, lack of media coverage and silence from politicians sparked anger and resistance throughout Black communities. The slogan “13 dead, nothing said” became a rallying cry for political action.

Burke helped set up a group to attend to the emotional needs of the survivors and the families. It was gruelling, emotionally and mentally. “I did two jobs every day for about 18 months. The pain was alarmingly high,” he says. With no state support, it was essential work. “We worked to boost the morale of the community and those who were injured.”

His therapeutic support for the bereaved continued during the burials, the anniversaries, and what Burke calls “the horrendous business of the inquest”. To this day he works with the Young Lewisham Project, dealing with the continuing trauma to the community. He says: “So many people suffered who weren’t in the fire.”

Burke in graduation gown
Burke graduated from the University of Birmingham in 1968, but says exposing racism and sexism in medical school selection stalled his career. Photograph: Courtesy of Aggrey Burke/Anselm Ebulue/The Guardian

With his impressive CV Burke could have been a professor by the 1970s, yet it was a position he was never offered throughout his long career. He is quite clear why: he spoke out about racism and sexism, and was punished for it. In 1986, along with his colleague Joe Collier, he published a damning paper that showed clear evidence that women and people with “foreign-sounding names” who sought admission to London’s medical schools were being discriminated against. In the paper he named his employer at the time, St George’s.

Burke says he knew the risks of publishing such criticism: “It’s always very difficult challenging a system that you’re integrally involved in.” Yet he would not let the consequences stop him. “After a little time thinking about it, we decided that it had to be exposed.” The blowback was immediate. “It is as though one had offended against the whole system; we were blamed, unfairly treated and made to feel that we were outcasts.”

Burke believes such attitudes are still too prevalent today. Black people remain more than four times as likely to be detained under the Mental Health Act, yet even this figure hides the scale of the problem, because those who identify as “Black other” are more than 11 times more likely to be sectioned. This group is likely to include a significant proportion of descendants of Caribbean migrants who no longer feel a strong bond to the region.

For Burke this is because the “baggage” from slavery is still in the “DNA of the system”. He points out: “You can’t capture a group of people, treat them worse than you treat all kinds of animals and say that they’re free.”

Aggrey Burke
Burke says that, after the civil rights protests of the 1960s, the label of psychotic became more associated with Black people. Photograph: Courtesy of Aggrey Burke/Anselm Ebulue/The Guardian

Burke notes that the assumption that Black people have “much more mental illness” remains prevalent in psychiatry but the biases in diagnosis can be seen in the way psychosis has been treated over the years. Psychosis, which Burke defines as being in a state where “delusions predominate”, is often associated with patients who are seen to be “dangerous and violent”. Before the 1960s, psychosis and conditions such as schizophrenia were seen as affecting highly intelligent, artistic white people, whose creative minds had led them to lose touch with reality. But, when the civil rights era brought Black anger and protest on the streets, psychosis became associated with violence and danger and became a label disproportionately placed on Black bodies. Some psychiatrists genuinely theorised there was a “protest psychosis” brought on by delusional dreams of racial equality. Burke believes the reason so many Black people are sectioned is because fear of the violent, disordered, rebellious Black body remains rooted in psychiatric practice.

For Burke “psychiatry labels people, and I think one of the tragedies that we’re talking about is that to be Black is to become a baddie”. In trying to understand why there has been so little improvement on the issue of race and mental health Burke sighs: “Society doesn’t actually believe that we are healable, so there is no attempt made to make things better.”

Burke continued working at St George’s until he retired, but being a pioneer came at a serious cost. “Coming to London as the first Black psychiatrist was a bit of a problem,” he says. “The first problem is you do not have a support structure in place.” Instead: “You need to have a bus-full of firsts – so when something’s wrong, we can come and support you.” Without that protection Burke felt vulnerable: “New Cross and the medical school event – they were quite close together. The system decided that I’m finished.”

Even today, however, that is far from true. His next target is education and he is currently working to raise attention to the disproportionate exclusions of Black youth in schools. “One of the tragedies that we’re talking about is that to be Black and play truant is different from white and playing truant,” he says. Once a child has been labelled “difficult” it sets them on a path to “bad outcomes”, he says, including incarceration. After almost 50 years, Burke’s work is not completed. And, he says, nothing will stop him from “continuing the work that my father was sent here to do” – to improve life for Black communities in Britain.



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