Audrey Farley on K. A. Johnson

In a 2018 Vogue magazine cover story, tennis star Serena Williams shared her harrowing experiences in the hospital following the birth of her daughter. She developed a life-threatening complication that health care providers neglected to notice. Williams, who has a history of pulmonary embolism, recalls feeling short of breath the day after delivery. She alerted a nurse that she might have developed a blood clot, but the nurse told her that her pain medication was making her confused. Williams insisted that she needed a CT scan with contrast and a blood thinner. Instead of providing this, a doctor took her for an ultrasound of her legs, which revealed nothing. Williams reiterated the need for a CT scan and was finally sent for one. The test revealed several clots in her lungs. The athlete quipped that staff ought to have “listen[ed] to Dr. Williams.”

The story went viral, with many individuals using Williams’ experiences to comment on the systemic racism black women are subject to within medical settings. Black women are three or four times more likely than their white peers to die from pregnancy-related complications, and those complications often result from poor maternal care or disregard for patients’ concerns. Many critics attribute providers’ blithe attitudes regarding black patients’ discomfort to a myth that has long pervaded the medical profession: “black hardiness.”

According to this myth, black people better tolerate pain and even many illnesses. The southern physician Samuel Cartwright promoted this myth in the nineteenth century, theorizing that black people were more durable because they had evolved physiologically under the conditions of slavery. To this day, many health care professionals continue to believe that pain perception differs between white and black patients, and this belief in “black durability” informs their diagnoses and treatment decisions. Black patients are far less likely than white ones to receive pain medication under the same conditions. This is an example of race-based medicine, a reality that comedians Wanda Sykes and Larry David recently highlighted in a skit for John Oliver’s Last Week Tonight. (Sykes told black and women audience members that, if they wanted to be taken seriously by providers, they should reference pre-recorded video clips of David reporting similar symptoms.) Like Shakespeare’s fools, these comedians draw our attention to truths we do not wish to hear.

Despite lacking scientific basis, race-based medicine is gaining currency and even expanding to the pharmaceutical industry. K. A. Johnson’s Medical Stigmata: Race, Medicine, and the Pursuit of Theological Liberation chronicles race-based medicine’s development from the eugenics era to the present day, where it is often applied for commercial purposes (for instance, to expedite drug approval and secure patents). Johnson argues that this form of medicine might seem to benefit minority communities by promising greater precision, but it actually does the opposite. It exploits and intensifies the falsehood of genetic difference, distracting from the social determinants of health and worsening outcomes for communities that are already disadvantaged.

The reality that race-based thinking draws upon religious beliefs, as well as a scientific ones, makes a book like Johnson’s important. Like Terence Keel’s Divine Variations: How Christian Thought Became Racial Science (2018), Medical Stigmata shows how nineteenth- and twentieth-century eugenicists drew upon the progressive Christian intellectual history that those theorists claimed to be superseding. In doing so, the book exposes the fallacy that science transcends religion, while also pursuing racial justice in a resourceful way: by undermining subliminal appeals to theology to defend oppression. Given how thoroughly entwined eugenic and progressive liberal Christian teachings became a century ago, this kind of activism couldn’t be more needed today.

Focusing on racism in medicine, Johnson proposes two measures to combat prejudice and improve the care that minorities receive: cultural competency training for providers and Black Liberation Theology. The latter constitutes the book’s meaningful contribution to scholarship. By demonstrating how the theology of Civil Rights leaders like James Cone can empower patients in medical settings, Johnson offers a spiritual solution to what is largely regarded as a social or scientific problem. But Medical Stigmata implicitly does even more: it suggests how Black Liberation Theology might reclaim Christian theology from eugenics.

Medical Stigmata begins by describing how early-century eugenicists labored to scientifically verify perceived racial difference in order to implement discriminatory social programs. For instance, Johnson explains how health authorities associated Tay-Sachs and Sickle Cell disease with the Jewish and black races, respectively, in order to justify immigration restrictions, anti-miscegenation laws, involuntary sterilization, and other selective breeding practices. (By restricting the reproduction of Jewish and black communities, eugenicists claimed to be protecting against the “pollution” of the white race.) These authorities succeeded in portraying Jewish and black people as spiraling towards death by virtue of their race, utterly ignoring actual disease factors, such as ancestry and geography. Many medical authorities do the same today, Johnson writes. They use race as a proxy for biological unknowns (namely, ancestry) and divert attention from factors such as food deserts, environmental toxins, limited access to healthcare, and the stress of racial discrimination.

The development of the cardiovascular drug BiDil offers a case in point. BiDil gained FDA approval in 2005 on the basis of a bogus claim: that it could benefit African Americans, said to be genetically predisposed to heart disease and stroke. As Johnson explains, FDA officials accepted race (a social construction) as a clinically significant disease category despite scientific evidence that cardiovascular risk is only determined by ancestry, geography, and socio-environmental factors. The FDA’s error allowed the drugmaker NitroMed to obtain a race-specific patent, which extended the manufacturer’s market monopoly protection by thirteen years. Once NitroMed had the corner on BiDil, the company marketed the drug off-label to white patients and raised the price out of many black patients’ reach.

BiDil offers a vivid example of how the pharmaceutical industry, abetted by government regulators, leverages racist science for monetary gain. BiDil advanced fatalist narratives about African Americans by associating skin color with deadly disease, much the same way eugenicists did decades ago. This fatalist logic is easily perpetuated in the consulting room, Johnson explains. Thanks to the FDA’s misframing of the disease, some doctors presume certain patients are inclined toward cardiovascular problems and, therefore do not meaningfully intervene to change outcomes.

Black Liberation Theology provides an antidote. From the author’s perspective, this form of theology equips patients of color to counter the harmful stereotypes that obstruct their path to quality care. It does so by empowering them to recognize their dignity as children of God. The central tenet of black theology, articulated by Cone and others, is simple: “It does not matter what skin color one possesses, for we are all human beings and come from the same God. Therefore, it is African Americans’ human right to be treated with dignity and respect by virtue of their creation.”

Following the lead of other black theologians, Johnson highlights scripture verses that uplift dark-skinned people, including those that have historically been weaponized against black people to justify slavery, marriage restrictions, and selective breeding. For instance, he notes the high status of Moses’ Ethiopian or Cushite wife; the good-heartedness of Ebedmelech, a Cushite who rescued the prophet Jeremiah; and the sacrifice of Simon of Cyrene, who helped to carry Jesus’ cross in the Gospel of Mark. These and other dark-skinned biblical characters demonstrate the multiplicity of black experience, challenging medicine’s reductive gaze.

Johnson further discusses the Bible’s emphasis on personal choice, rather than heredity, as a determinant of fate. Beginning with Adam and Eve’s disobedience in the Garden, scripture repeatedly narrates stories of individuals who reject God’s laws only to suffer consequences. There also abound stories of low-class persons who obey God and receive many blessings. Free will, described in these parables, simply does not comport with the logic of racism, Johnson suggests.

The author also re-visits Cain’s killing of Abel, which some Christian denominations have cited as evidence of the association between blackness and sin. Envious that his brother gains the Lord’s favor with his sacrifices of sheep (Cain only offers the fruit of the soil), Cain slays Abel with a stone. For this, God “marks” him. According to Johnson, this Genesis scene does not reinforce racial difference; it warns against the kind of xenophobic thinking that underwrites racism. Johnson explains that Cain kills his brother and creates division (where before they drank from the same mother’s breast) simply because he resents and fears him.

Medical Stigmata encourages readers to apply similar hermeneutics to clinical contexts, using scripture to challenge the determinist narratives that pervade medicine and its adjacent industries. In reclaiming biblical narratives for the pursuit of justice, Johnson’s book simultaneously suggests how readers might destabilize the theological foundations of eugenics.

It may be easy to conceive of eugenics as fundamentally opposed to all Christian denominational beliefs. After all, eugenicists are those who want to “play God,” forsaking divine wisdom and authority. Eugenicists posit that God’s creation can be quantified; in fact, God’s work is infinite and incomprehensible. But history shows that the logic of eugenics and Christianity can be co-constitutive, signaling the need for theological responses to racism, in addition to political, scientific, and even moral ones.

Eugenics not only began as a religious doctrine, as Edwin Black explains in War Against the Weak: Eugenics and America’s Campaign To Create a Master Race, it leveraged religious concepts. Sir Francis Galton, the nineteenth-century English intellectual who first promoted eugenic principles, imagined that eugenics would be taken like a religious creed: on faith and without proof. How else could a scientifically baseless movement be taken? Galton often compared eugenical marriage (the marriage of two high-born individuals) to other religious duties and cited instances of selective breeding in Jewish and Christian texts. The hair stood on his arms just to imagine what a dogma like his could achieve. “It is easy to let the imagination run wild on the supposition of a whole-hearted acceptance of eugenics as a national religion,” Galton wrote in 1905. His followers agreed that eugenics could only thrive as a religion—and that “nothing but a eugenic religion [could] save our civilization,” in the words of playwright George Bernard Shaw.

It was no accident that eugenicists in the United States used scripture to promote their social program, drawing upon verses such as the following from the Gospel of Matthew: “A good tree cannot bear bad fruit, and a bad tree cannot bear good fruit. Every tree that does not bear good fruit is cut down and thrown into the fire” (7:18). By misinterpreting scripture out of the parable’s context for the promotion of racial integrity, eugenicists like Charles Davenport convinced many Methodist, Presbyterian, and Episcopal leaders that eugenic practices were biblical, as well as sensible. These progressive church leaders began to preach selective breeding principles to their congregations, participate in sermon contests hosted by the American Eugenics Society, and contribute to popular publications like Eugenics magazine. As Adam Cohen explains in Imbeciles: The Supreme Court, American Eugenics, and the Sterilization of Carrie Buck, many liberal religious leaders believed Christians and eugenicists were fighting a common battle; “both were concerned with the ‘challenge of removing the causes that produce the weak.’” The sooner the causes of weakness were removed, the sooner weakness would be removed; and the sooner weakness was removed, the closer to the Lord’s kingdom human civilization would be. An Episcopal reverend in Minnesota expressed this very idea when he told parishioners, invoking the Sermon on the Mount, “Until the impurities of dross and alloy are purified out of our silver it cannot be taken into the hands of the craftsman for whom the refining is done…Grapes cannot be gathered from thorns nor figs from thistles.”

While present day liberal mainline denominations position themselves as socially progressive, it was Catholics and conservative Christians who historically denounced eugenics. The Catholic Church was especially vocal in its opposition to involuntary sterilization. After the Supreme Court upheld the state of Virginia’s decision to forcibly operate upon a woman deemed “feebleminded,” Pope Pius XI issued an encyclical condemning eugenics, and Catholic publications like America printed long editorials affirming that “every man, even a lunatic, is an image of God, not a mere animal.” For the editors of this Jesuit magazine, “to care for [human beings] with a surgeon’s knife and nothing else and then to stamp this method as ‘enlightened’ shows how far we have wandered from the concepts of humanity and Christian civilization.” Many people of Catholic and conservative Protestant faiths agreed.

The United Methodist Church eventually apologized for its role in the eugenics movement, but not before knotting eugenic and theological imperatives in literature and sermons over the course of several decades. This troubling history raises questions about the spiritual impetuses for racism, which are distinct from the commercial ones that Johnson describes in the case of BiDil. It is conceivable that some health care providers may, on some level, believe they are acting morally when they allow fatalist narratives to shape their practice. (They are, of course, perverting theology for the reasons that Johnson enumerates.) After all, those in the medical profession (whether or not they identify with any particular religion) often take for granted that their role is to improve human society through biomedical interventions. And they, like other members of society, are prone to think certain lives less worthy than others. There may be something zealous about doctors’ race-based practice, just as there is something zealous about the nativism of political leaders like Representative Steve King of Iowa, who recently declared, in the context of immigration, “We can’t restore our civilization with somebody else’s babies.”

As Johnson’s book demonstrates, black theology is well poised to counter such xenophobia. Black theology does not merely remind believers of Christian teachings (i.e. “Christ showed compassion for outsiders and those who were oppressed”); it disentangles Christian teachings from the concept of biological determinism. Its emphases on free will and human diversity provide theological counterpoints to fatalism and racial integrity. In the process of undoing the historically progressive Christian underpinnings of eugenics, Johnson undoes the myth that science supplants religious thinking. Early evolutionary thinkers boasted that their study of race “cut loose the natural history of mankind from the Bible . . . where it [could] remain without collision or molestation,” in the words of anthropologist Josiah Nott. Medical Stigmata suggests that, far from breaking with Christianity, scientists claiming to have objective evidence of human difference are simply misappropriating the grammar of religion. This makes for bad science, bad theology, and bad medicine. Given the resurgence of nationalist thinking in our current social and political life, the lessons of Medical Stigmata could not be more timely.

Audrey Farley is a literary scholar and historian with a PhD in English from University of Maryland, College Park. She recently completed a manuscript on the life of heiress Ann Cooper Hewitt, whose sterilization in 1934 transfigured the eugenics movement. Her literary criticism has appeared in various peer-reviewed journals; and her public writing has appeared in The Atlantic, The Washington Post, The New Republic, Narratively, Longreads, Lady Science, Public Books, and ASAP/J. Tweets @AudreyCFarley.