In a 1983 interview, Elizabeth Davis recalled a public forum held at 135th Street's Countee Cullen Library in the late 1960s. At the event, citizens reacted to a controversial new Harlem Hospital program. The psychiatric department had been prescribing elective tubal ligation as a treatment for poor mothers diagnosed with postpartum psychosis. Some locals strongly opposed this therapy. Black Power advocates—whom Davis remembered as “no-doubt sincere community leaders”—called sterilization a genocidal white plot. These “leaders” did not trust the hospital authorities. Instead, they regarded them as conspirators. One man, directing his venom at Davis, accused this Harlem-raised African American of being a Jewish outsider preying on the black community.

What had happened? The opening of Harlem Hospital's psychiatric department in 1962 seemed to have been a success story. Nevertheless, the vignette indicates that it would be misleading to end this book on a note of uncomplicated triumphalism. Certainly racial liberals expected that racial inequality would decline as African Americans received greater access to public resources. Historical outcomes often defy expectations, however. Ward 9-K and its race-neutral standard of care had not eliminated the mental health disparities facing the black community. In some ways, color-blind psychiatrists even exacerbated those inequalities.

This chapter examines Dr. Davis's first five years of community psychiatry in Harlem, taking stock of its successes and its failures. First, it will investigate how universalism became widely accepted among antiracist psychiatrists even as they became divided over the best way to implement it. Second, it will explore the consequences of color-blind psychiatry's own built-in contradictions. The drive to understand a black patient's social circumstances without reference to race actually blinded Davis and her associates to racism. In place of race, community psychiatrists at Columbia, Wiltwyck, and Harlem Hospital framed their patients’ problems as a class issue. These clinicians were drawn to the ostensibly raceneutral “culture of poverty” and “cultural deprivation” theories, both of which blamed Harlem's ills on the behavior of its poorest families.

Third, this chapter examines the relationship between Harlem Hospital and the community it served. Throughout the 1960s, central Harlem had become more racially segregated, economically disinvested, and radicalized.