Irvo Otieno’s needless death exemplifies the criminalization of Black mental illness

Irvo Otieno departed this life on March 6, sprawled on the floor of Central State Hospital, his hands and feet shackled. 

Otieno died from asphyxiation after Henrico sheriff’s deputies and Central State Hospital employees took turns kneeling on him for almost 11 minutes. Earlier this week, a Dinwiddie County grand jury indicted seven deputies and three hospital staff on second-degree murder charges in relation to the incident.

Somehow, the presence of the hospital workers and the fact that the tragedy took place in a mental health facility didn’t prevent Otieno from being treated like a violent criminal instead of who he was: a sick person who needed help. In a way, that isn’t surprising. Otieno’s death represents Virginia’s historic legacy of mistreating and criminalizing Black people with mental illness.

Central State Hospital was first known as Howard’s Grove Hospital, a former Confederate facility that was designated for “colored” patients in 1869. In 1870, the hospital transformed into the segregated Central Lunatic Asylum for the Colored Insane, making it the nation’s first mental hospital for Black people. 

During and after the Civil War, a leading discourse among medical professionals held that Black people freed from slavery were bound to become “insane” if they were no longer engaged in forced manual labor. These founding fathers of American medicine ascribed an enslaved person’s natural, human desire to be free to an unsound mind.

Antebellum southern physician and open racist Dr. Samuel Cartwright famously concocted the term drapetomania, a fictitious mental disorder he claimed caused enslaved people to run away. Cartwright said in an 1851 report that drapetomania and dysaesthesia ethiopica – another nonsense condition he said made Black skin less sensitive to pain –  “is the natural offspring of negro liberty – the liberty to be idle, to wallow in filth, and to indulge in improper food and drinks.” He recommended hard work and institutionalization as the remedy. 

Horrifyingly, Cartwright’s sensibilities formed the basis of his time’s accepted medical ideology and practice. Sadly, those views still persist in some forms today. 

In 2020, a University of Virginia study found that medical students and residents “who endorsed biological differences between Black and white people also believed that [a] fictional Black patient felt less pain.” A 2016 National Library of Medicine report included evidence that “false beliefs about biological differences between blacks and whites continue to shape the way we perceive and treat black people — they are associated with racial disparities in pain assessment and treatment recommendations.” The U.S. Health and Human Services Office of Minority Health has found Black adults are more likely than white adults to report persistent symptoms of emotional distress like feeling sadness, hopelessness and worthlessness, but have less access to mental health care and medications. 

The roots of this medical racism and bias stem from Cartwright’s era, but bear fruit as modern tragedies like Otieno’s senseless death. The 28-year-old Black man, an aspiring rap artist and Henrico resident, was in mental distress when he was taken into police custody March 3, according to his mother. Initially, he had been taken to a hospital, but instead of staying there, where presumably he’d have been able to get the medical help he needed, he was thrown in jail and subsequently bum-rushed by officers, apparently beaten and carried limp to a transport van.

Why was Otieno treated more like a criminal than an ill person who needed aid? The past provides a clue.

“From the beginning, insanity – a medical condition – has been criminalized in Black people,” said Dr. Shawn Utsey, a clinical psychologist and Virginia Commonwealth University professor whose 2022 film “The Central Lunatic Asylum for the Colored Insane” uncovers the harsh reality of life for Black patients at the facility that’s now Central State Hospital. “It wasn’t seen as a health condition, it was seen as a criminal disposition of Black people. So that’s where it starts.”

Although Utsey’s research and interviews for the film revealed accounts of patient abuse and neglect by hospital workers, Utsey doesn’t wholly fault the staffers, who, like those at many mental institutions nationwide, were doing what they could with limited personnel and resources in an atmosphere tainted by pervasive racism.

“I don’t blame the workers for a culture that prescribes that Black people are basically criminals, and insanity is basically a symptom of criminality, not mental illness,” he said. “‘Mental illness in Black folks is a reflection of their criminality,’ that was the thought process.”

March 6 video shows deputies pinning Otieno to the floor of Central State’s admission area for 11 minutes as hospital staffers watched. What’s so striking and so damning from that footage is how Otieno was criminalized. He couldn’t even get help in a facility designed to treat people like him – a son, a brother, a person living with mental illness. 

Our system failed Irvo Otieno because it is built on a legacy of bias. Until we root out that root cause, it will most certainly fail many others.