A paradoxical view of Black people emerged as a defense for the killing of George Floyd

In the trial of former Minneapolis Police Officer Derek Chauvin, the defense mounted a perplexing account. Mr. Floyd, we were told, had an enlarged heart and inelastic lungs. Mr. Floyd was so weak that his death was all but inevitable. Had Mr. Floyd been healthier, he might have survived the relentless pressure of a knee upon his neck. But, then, the defense's narrative seemed to change: Derek Chauvin's use of lethal force was, in fact, necessitated by Mr. Floyd's purported superhuman strength.

Was Mr. Floyd so physically weak he succumbed to an innocuous use of force? Or was he so strong that restraining him required extraordinary force? One defense witness offered a unifying explanation: perhaps Mr. Floyd's terrifying strength was caused by heart disease itself. Or, perhaps, a tumor triggered a fight-or-flight response that elevated his blood pressure. In this narrative, Mr. Floyd died because his underlying fragility triggered superhuman strength which, in turn, triggered fatal weakness.

It may be tempting to attribute this illogical argument to desperation on the part of the defense. This would be a mistake. Chauvin's defense was sadly rational. The prejudice it sought to exploit is pervasive and longstanding. In American society, Black people are viewed as both preternaturally strong as well as uniquely weak.

White people must fear Black people and use extraordinary measures to protect themselves. Except, of course, when white violence or negligence triggers Black illness or death. Then, it is the fragility that precipitates the demise of Black bodies. Either way, one thing is clear: In American consciousness, Black people can rarely be victims. This notion—that Black people are at once too strong and too weak—has deep roots in American history, beginning in slavery and continuing in modern medical racism.

During slavery, doctors postulated that Black people were especially susceptible to Tuberculosis and malaria. That this susceptibility was produced by the conditions of slavery was not seriously considered. Rather, vulnerability to disease was identified as a feature of Blackness. Enslaved Black people were also, according to doctors, uniquely resistant to pain, even as they suffered disproportionately of all manner of disease. Doctors used these false premises—inherent medical fragility paired with pain resistance—as justifications for the use of Black bodies in horrific medical experiments, ranging from intentional infection to gynecological mutilation to the boiling of flesh. The purported frailty and strength of Black bodies made Black human beings, in the eyes of many doctors, a perfect specimen for scientific exploration.

Even today, health outcomes for Black Americans, by virtually every measure, and at every stage of life, are comparatively poor. Some of this disparity can be explained by socioeconomic and environmental factors. Black people are disproportionately struck by poverty. They are more likely to live in segregated neighborhoods afflicted by pollution and nutritional deprivation. They suffer from inadequate access to healthcare. These factors matter. But they do not tell the whole story. Disparities persist even when socioeconomic or environmental differences are controlled for.

Indeed, researchers are finding that racism itself is an environmental variable that crosses socioeconomic barriers and induces life-long health complications. From diabetes to reproductive care, the evidence is converging. The chronic stress of anti-Black racism, independent of other variables, ravages Black American bodies. Little is spared. From brains to kidneys to bones, Black American bodies endure trauma, misdiagnosis and neglect. These patterns begin at birth and persist until death.

For example, Black babies are less likely than white babies to have early hearing loss identified and treated. Black children are less likely to receive tubes to treat otitis media, a crucial intervention that correlates with language development. In school, Black children are under-diagnosed with ADHD and over-diagnosed with conduct disorder, compared to their white peers, even when their symptomology is similar.

As Black Americans enter adulthood, health disparities become even more stark. Black men, for instance, are more likely to be diagnosed with schizophrenia and less likely to be diagnosed with depression than their white male peers. Diagnoses of dementia—critical for early intervention—are also chronically delayed for Black Americans.

Racial disparities are especially stark in reproductive outcomes. Black women are more likely to experience miscarriages, preterm birth and stillbirth when compared to white women of the same socioeconomic status. Black women are less likely to get breast cancer, but they are 43percent more likely to die after diagnosis. Black women are also more likely to undergo hysterectomy. In cases of heart disease, Black people are less likely to receive diagnostic angiography and preventative catheterization.1

Black people are also often blamed for health outcomes, in both subtle and overt ways. The most obvious examples are in the right-wing media, as well as in specific cases such as the criminal defense of Derek Chauvin. However, we can also see examples throughout even ostensibly unbiased sources, such as the medical literature.

Type II diabetes has long been blamed on the "African American Diet." Differential success of diabetes treatment has been attributed to poor "medical literacy." Poor medical literacy is cited as a factor in the delayed diagnosis of Black infants' hearing impairment. Note the explanatory variable of "medical literacy" places responsibility on Black patients, not their doctors. This is in spite of research indicating that racial disparities in doctor-patient communication results from doctors' behavior, such as reduced listening, personal interaction and devotion of time to outpatient care.

The blaming of Black people has, in some cases, extended beyond "poor medical literacy" or "bad diets" to the nature of Black bodies themselves. One literature review went so far as to state "variation in obesity and body-fat distribution" may be a primary factor in the late diagnosis and poor prognosis of breast cancer in Black women. Similarly, doctors have explained that the systematic late diagnosis of Lyme disease in Black people is attributable to early signs of disease being difficult to detect on dark skin, to which one Black doctor responded: Is it actually that hard to identify on Black skin, or have doctors just been exclusively trained to treat white people?

And then, finally, we must address Black pain. Multiple studies have shown that Black patients are under-diagnosed and under-treated for pain. Black patients are less likely to receive pain treatment for almost any diagnosis, even in the case of visible physical harm, such as a broken bone. Even Black children with appendicitis are less likely to be given pain treatment than white peers are. Research has shown white medical workers endorse racist stereotypes related to pain. One study demonstrated that an astonishing number of white medical workers endorsed a variety of racist myths, such that they believed Black patients' skin is thicker and their blood coagulates more quickly. These judgments most certainly correlate with treatment decisions.

The clearest example of racial disparities in medicine is in kidney disease. Here, we can see a trajectory beginning with negligence and ending with tragedy. We all learn that Black people suffer from disproportionate rates of kidney disease. We are told this is the fault of Black Americans. But we do not learn that Black people are:

• 23 percent less likely to be assessed for transplantation, even when all other variables are controlled (e.g. socioeconomic status; disease stage).
• 18 percent less likely to be placed on a transplantation list.
• 53 percent less likely to receive a life-saving organ once on the list.
• And we certainly do not learn that, all other variables being equal, Black Americans are more likely to receive a limb amputation than white Americans.

Let that sink in: This country does not only deny life-saving organs to Black Americans, but we also lop off their toes, feet and legs at disproportionate rates.

The treatment of Black bodies and minds in medicine reflects broader societal biases about Black pain. Physiological research indicates that white people exhibit decreased physiological responses to the emotional and physical pain of Black people. To put this plainly: if a white person witnesses a Black person experiencing pain, their neuronal responses remain close to baselines. They sweat less. Heart rates barely budge. And, although diminished responses to Black people in pain do correlate with overt racism, they also persist in white people who score very low on cognitive measures of racism.

This history—the rejection of Black pain and dehumanization of Black bodies—was the clear pretext for the criminal defense of Derek Chauvin. Mr. Floyd was to blame for his own death, because he was weak. However, his body could also be abused, because he was so strong. Chauvin's defense team was not unreasonable to attempt this, because they must have known, intuitively, as we all know, that a Black man's body is not viewed as the same as a white man's body. That a Black man's pleas for his mother or even oxygen will never be as worthy as a white man's same suffering.

These societal biases—and the cruelty they facilitate—were clear in our country's response to COVID-19. As the pandemic struck, it became apparent that Black people would be hit especially hard. And thus the frame shifted to a constant repetition of "Well, the only people who suffer will be those with pre-existing conditions."

The more we heard a right-wing refrain about diabetes, obesity, asthma and other ailments, the clearer it was: if you're Black and you die from COVID, it is your fault. We need not take extraordinary measures to protect you. The Trump administration itself admitted it was not compelled to relieve those who were not "[their] people."

Here, as in the murder of George Floyd, Black bodies were on trial. Black people were, again, to blame for their own suffering. In law enforcement, Black bodies induce white violence. In medicine, Black bodies deserve nothing more than white negligence.

In the case of Derek Chauvin, the defense placed George Floyd's body on trial. The jury rejected this argument in a verdict we should celebrate. But the problem is much bigger than this single case. Black bodies and minds are abused from birth until death. Before we can adopt policies that might fix the problem, we need to appreciate its scope and history. We must recognize our society characterizes Black people as too strong as well as too weak. Above all, we need to recognize our society's systematic abuse of Black bodies, and our almost pathological denial of Black victimization.