The Underbelli Podcast #4 – Approaching New Pathways in Mental Health

Episode 4 of the Underbelli: Beyond Psychiatry and Self-Care – Approaching New Pathways in Mental Health

This episode is comprised of a reading Sasha Durakov did first in Minneapolis in July and then in Chicago in August, with some minor changes to account for the switch to an audio format. The description read:

‘Many of us are familiar with some ideas, images, or theories of madness, “mental illness”, and perhaps also psychiatry, but feel a lingering skepticism and doubt about what they mean. In this episode, we will attempt to challenge common beliefs about mental health; present the problem of madness in an open, nuanced way informed by the voices and stories of people with lived experience; and to introduce the audience to alternative ways of responding to and approaching madness and to provide the materials and direction to help foster new discussions and practices in mental health (and hopefully some reading groups!).

Go here for the free study guide.’

What follows is a transcript of the episode, with some minor changes made during the editing process. Check the study guide for the sources used for the creation of this reading. Also included are some images I used during the events. Listen to the episode wherever you get your podcasts, or go to this link:

Transcript of the episode

Welcome to the Underbelli. My name is Sasha Durakov. What follows is reading from a text I wrote for and read at an event in Minneapolis in July, and Chicago in August called “Beyond Psychiatry and Self-Care: Approaching New Pathways in Mental Health”. The text is partly a culmination and summary of my last few years of research and reading, but more so a reckoning with events and understandings of the past and present. I also presented an annotated bibliography, which I’ll properly introduce you to at the end, so stick around. This reading is in three parts. Each of the readers for this episode has had experience in the psychiatric system, two as patients, one as a service provider.

I. Approaching Madness

In which I’ll argue that the way we approach mental illness is dominated by a number of cultural and scientific presuppositions, which need to be challenged before we can even begin to talk of “alternatives”. 

Have you ever asked yourself how many angels can dance on the head of a pin? While it’s debatable that any of the theologians of the Middle Ages ever actually asked this question, it’s become a sarcastic allusion to the reality that the learned doctors and men of science in Europe asked many such questions for hundreds of years, filled books with them, and became the most respected scholars for generations.

More recently, just 150 years ago, the Hygienists reigned supreme in Europe and were considered the most trusted and necessary of health professionals. These Hygienists made it their mission to bravely venture out into the decrepit hovels of the ragpickers and the infested brothels of sex workers to find out why tuberculosis, venereal disease, and leprosy made its eternal home with the poor, as if the shadow of the working classes formed the gaseous outline of the four horsemen of the apocalypse on the horizon.


These men of science made two empirical observations: one, that lepers, poor people, and sex workers smell rotten; and two, that those who stink are carrying a disease. This observation turned into science when they discovered that they could classify such smells into a detailed diagnostic system: if you smelled like semen and musk, you are a homosexual and carrier of venereal disease; if you smell rotten, you are a ragpicker and likely a victim of tuberculosis. The smell was not an effect of the disease, but its cause.

That we now laugh at these geniuses of the past and consider their practical conclusions absurd is irrelevant. What is revealed by these two examples is that neither the accumulation of detail and fact, nor the trust we place in experts, nor empirical correlation are the foundation of certain truth. Science at all times claims to be a steady island at the center of a tempestuous ocean; a valueless place of pure, positive discovery and neutrality. In this image, scientists spend their days peering behind bushes in an empty field called knowledge, discovering to everyone’s benefit that a disease lives there for anyone to see.

Keep that in mind as we consider a number of facts about mental health. The number of people who are diagnosed with a mental disorder is steadily growing every year, especially when looked at globally. According to the World Health Organization (WHO), over 450 million adults have a diagnosable mental disorder worldwide. They also report that the number of suicides increased by 60% over the last 45 years. So, what are the possible conclusions from this? Something must be done, right? We need “more mental health services”, as many activists and others are apt to say. But what does that actually entail? Access to medication? Yoga classes? More hospital beds? Free or affordable therapy? Special psychiatric security officials? The return of the asylum?

Calling for “more mental health services” starts to look somewhat questionable when one looks at a number of other facts. In the 1970s, WHO conducted a global five-year study in which they found that those diagnosed with schizophrenia —usually considered the most debilitating of all mental disorders— fared better in developing countries than in the U.S. In three of the developing countries in the study —India, Colombia, and Nigeria— only 16% were on antipsychotics, the first line of treatment for schizophrenia cases in the US and Europe. In a repeat of this study, they found the same results, and concluded that living in a developed country was a “strong predictor” that a person would never fully recover. A number of follow-up studies found that patients who had weaned themselves off the antipsychotics, which were said to “fix their brains by correcting an imbalance” had actually fared better than those who continued to take them. When faced with this second set of facts, the idea of mental health treatments being a human rights issue starts to break down.

How do we examine or compare such facts? Do we examine them in relation to all the studies that have been done on psychotropic medication, on hospitalization, and on therapy and simply choose to fund the means with the highest number of “recovered patients” at the end? A number of questions get lost in such an analysis, questions beyond the scope of these studies, questions which perhaps trouble the foundation and presuppositions of the studies themselves. For example: how does one get diagnosed as schizophrenic or bipolar? This isn’t a question about symptoms, but about power. Who does the diagnosing? With what tools? How are these tools legitimated? Against what standard is mental or emotional pathology measured? How did the person getting diagnosed end up in their position? What does it mean to recover from such conditions? And, most importantly in my eyes, what is the concrete experience of the mad person in these relationships?

I spit on life
I Spit on Life by William Kurelek

In Sylvia Plath’s book “The Bell Jar”, the narrator, Esther —a stand-in for Plath— often considers suicide when she is forced to move back and live with her mother again. She tries hanging, drowning, pills, but nothing seems to work. At the peak of her desperation, she finds herself socially coerced into spending time with peers who have no idea what she’s experiencing. One of these peers talks incessantly about a play. Plath writes

The only reason I remembered this play was because it had a mad person in it, and everything I had ever read about mad people stuck in my mind, while everything else flew out…

Plath or Esther wants merely to reflect on her madness, on her morbidity and longing for death. She wants to know others who have experienced such states of mind and find out what happened to them. It’s one small glimmer of the fire for living otherwise extinguished at this point in her life. She doesn’t find such people, and she can find no such stories. What she does find is a textbook on abnormal psychology, and at her absolute lowest point, she explains her desperation in the following way

my case was incurable. I had bought a few paperbacks on abnormal psychology at the drugstore and compared my symptoms with the symptoms in the books, and sure enough, my symptoms tallied with the most hopeless cases.

If Plath had been alive today, she may have found one of many patient-centered groups, and groups of those who identify with unusual experiences typically seen as “crazy” (hearing voices, extreme mood shifts and expressions, seeing things, having “strange beliefs”) who are organizing themselves in social groups, study groups, support networks, and activist groups. The mere existence of such groups already wears upon the more extreme claims made by psychiatry that, for instance, unmedicated “psychotic” patients will flounder in their undertakings and live solitary lives trapped in a world of fantasy. If such people were able to form international social, support, activist and political groups, something is amiss about those claims.

But before we get to stories and theories of madness, of psychiatry, or of “mental illness”, we have to address something more fundamental: people feel very strongly about “mental health”, even (or maybe especially) when they do not have a definition for it. Worse still is that the noble language of “abolishing stigma” has by and large been appropriated by the proponents of the medical model, creating a situation in which all mental health activism is assumed to be part of a movement to make psychiatric diagnoses and treatments more acceptable, which is patently not the case. The opposite of stigma is not the act of admitting to illness.

The confusion around mental health revolves around the fact that, despite what nearly everyone is saying, the problem is not that people don’t know enough or don’t have enough information or awareness about it. The world feels over-saturated with ideas, facts, and awareness weeks about mental health. This “ever more facts” model serves above all to bury the essential problems related to madness under a mountain of details. The problem then is that people feel like they know enough to make definite claims or actions about mental health. That confidence in the ability to identify mental illness, and use words like “depressed,” “psychotic,” or “anxious” to describe others or ourselves; the self-deputization to diagnose friends, family, or someone on the street; the comfort with calling the police or a psychiatric crisis team when faced with something unexpected or extreme are indications that we actually have profound confidence in one particular understanding of what “mental illness” and “madness” can be. When the public space for dialogue is so crowded with contradictory scientific theories, with rhetoric of terror around violence and mental illness, and with pharmaceutical solutions, it leaves no space for new approaches, let alone the space for the mad to tell their own stories in the depth and complexity they require. When someone becomes so certain that they know enough about mental health, when they’ve reduced the range of possible experiences of madness to a set of diagnoses in a book, they cease to be receptive to different ways of experiencing and organizing the reality around them. If you are so invested in researching whether or not the angels dancing on the tip of a needle must wear shoes, or classifying which mental disorders your favorite cartoon characters likely have, you are surely missing the important questions like “is this actually important or helpful?” and “do I even believe in the angels or the diagnoses at all?” We need concepts that help us cut through the fog as a lighthouse does over the shore, so that we may find our way in this infinite sea, at least at moments.

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The Death of Pentheus, red figure kylix from Athens, c. 480 BCE; terracotta; painting attributed to Douris

So let us discuss madness. Experiences, ideas and concepts of madness predate psychiatry by hundreds, if not thousands, of years. People throughout history have talked about, theorized about, respected, feared, and treated madness. The history of madness up to the birth of psychiatry is truly an impossible history, for there is no consistent subject nor object to trace. It is not a linear history beginning from some primitive understanding of madness, slowly evolving into modern day psychiatry. Without retroactively applying contemporary psychiatric diagnoses, like depression or schizophrenia, on people in the past, all we have available to us is who was called mad, by whom, and why. Madness, if we want to talk about it as something that extends centuries, cannot be represented by a class of people, nor by sets of symptoms, since these have shifted so often and so dramatically. Instead, looked at historically, madness has represented at almost all times both a relationship of power and a possibility of experience. Historically speaking, madness exists between people, not within them. This complex interplay between the experimental forms of communication and thought called madness on the one hand, and the acts of authority and diagnosis implicated in seeing the Other as mad are what make madness impossible to pin down definitively.

In Ancient Greece, the prophets who convulsed and told of wars and famines to come were called mad, as were the artists and philosophers who envisioned new ways of thinking about or representing the world. Socrates called madness the greatest gift. This is madness as the possibility of having novel experiences closed off to reason and normality. Now consider a play like “The Bacchae” by Euripides, also from this era. The Bacchae were the female followers of the god Dionysus, the god of wine, theater, illusion, and madness. The play features a male character named Pentheus who refuses to honor Dionysus, believing solely in the power of reason, who is punished by being torn to shreds by the bare hands of the Bacchae. This play would have been a scandal at that time, as the men thought of themselves as the only ones untainted by irrationality, and thus the only ones reasonable enough to govern. According to them, women, slaves, and foreigners operated more so on base instinct, emotion, and impulse. The men, as they have at nearly all times, defined themselves by their ability to reason in distinction to the mad, irrational subjects. Thus, this play marks one of the first cultural documents in the West to make the connection between the mad, and everyone else excluded from patriarchal civilization. Women and slaves were akin to mad people in that all of them were considered to be incapable of correctly reasoning as the “civilized” do. For any civilization whose members define themselves by their ability to use reason, madness becomes a symbol of exclusion. The mad are those who cannot reason, and only the reasonable can be included.

These two trends evolved and branched out over the years. Sometimes, they coalesce into a single, dramatic event as when the English poet Nathanial Lee began to write increasingly extravagant plays critical of the king until they eventually sent the authorities to have him dragged off to infamous Bedlam Asylum in 1684. He is quoted as having said “they called me mad, I called them mad, and damn them, they outvoted me.” In the Middle Ages, there was a profound ambiguity between who was “mad” and who was a divine prophet. Further, many Christians considered the ravings and frenetic behavior of vagabonds and the insane as a religious trial, who were thus respected for being in the middle of a spiritual journey. Somewhere around the 16th century, a new police force arose which was allowed to arrest without distinction the mad, the poor, the decrepit, the unknown, and the unwanted and put them to work in poorhouses, or place them in hospitals, which gradually morphed and reformed into the asylums of the 20th century. Many of the classic images of the mad come from the early period of incarceration when lunatics were put on display like circus animals in Germany, England, and later in the US for people to gawk and throw stones at. At the dawn of the modern era, in the 17th century, when melancholy was fashionable among the literary class in Europe who believed it gave them access to special insights, the French doctor De Laurens, and the English doctors Thomas Willis and Richard Mead made concrete the connection between colonized and foreign subjects with the mad when they theorized that both share a mental constitution more so resembling an animals than a humans. Willis wrote this about melancholy for instance in “Two Discourses concerning the Soul of Brutes”

as Melancholick people talk idly, it proceeds from the vice or fault of the Brain, and the inordination of the Animal Spirits dwelling in it.

Madness is best described historically as a term of relation that can describe either novel, unusual or extreme experiences of those who are called or call themselves mad or within the operations of a class with power who names another class delusional and mad. It hasn’t so much evolved as broken apart and leapt around. What is special about that last quote, and what makes it a text of proto-psychiatry, is that it collapses all the different former possibilities of madness and crystallizes them into a single biological, and invisible process in the individual. With this new language, it claims to explain every former instance of madness in a dramatic bid to, in effect, erase the history of madness, so as to inaugurate the history of mental illness.

II. The Psychiatric Era

In which I will question the psychiatric hegemony over the idea of madness, and the way it has reduced its possibilities to mean only mental illness.

Sometime after the French Revolution, around 200 years ago, there came into being a group of doctors (iatros) who began to exclusively study and treat the mind (psyche). Psyche-iatros, psychiatry. We can conclude from our brief historical survey that madness and psychiatry as we know it are not essentially related to one another; the latter represents one possible response to what is called “madness,” yet one that is becoming globally dominant as a language of explanation and as the first line of treatment as it continues to export its diagnostic labels and psychotropic medication into the global south. One of the central powers of psychiatry, and the activity that separates it from previous explanatory regimes, is the ability to define what madness is, concretely and physically, or, in contemporary language, what a “mental illness” is, and also to classify —and thus simplify— their manifestations into a classificatory system (a “nosology”). Psychiatry, then, reduces the possibilities of madness to just one: mental illness.

Psychiatry claims, like any branch of medicine, to have discovered positive and real diseases, which it purports to treat. But psychiatry is not like other branches of medicine for a number of simple reasons: First, its categories are based on notions of normality, and thus are contingent culturally and historically, which we’ve briefly touched on. We’ll come back to this. Second, it now claims to study “brain diseases”. This can’t be said to be literally true. When neurologists discover the biological roots of a disease in the brain, it largely ceases to be considered a psychiatric disorder and becomes a neurological problem. This has happened with epilepsy, the various forms of dementia, Down’s Syndrome (which used to be called feeble-mindedness) and is now happening with autism spectrum (Here, I am not implying that autism nor Down’s Syndrome are “disorders” but merely remarking on where they land in scientific literature). Far from bolstering or combining with psychiatric knowledge, as many hoped, the growth of neurology has pushed psychiatry into the defensive. Third, and connected with the second point, psychiatry is the only medical branch I can think of that has its fundamental concepts and diagnoses consistently put into question, and not just by its detractors, but by its proponents as well. I can’t think of any respected doctor alive today who would deny the very existence of cancer, or diabetes, yet there are respected psychiatrists working within the hospital system like Jim van Os who publicly deny the existence of schizophrenia, bipolar, and others. Nor can I think of any anti-cardiologist or anti-rheumatologist activist groups, and yet we have a global and historical anti-psychiatry movement. Why?

The clearest way to approach this problem is through the tool psychiatrists and some clinical psychologists use to make a diagnosis. Diagnosis is arguably the most contentious power in the toolbox of psychiatry, and also its source of authority. If the physician could not make authoritative claims as to who is mentally ill or not, then they would have no power to treat. In America, this tool is called the DSM, or the diagnostic and statistical manual, now in its fifth edition. The DSM is an extremely important document, which has changed millions of peoples lives. It’s important for legal reasons, as many may not receive any services unless they meet the criteria for a diagnosis, and because it can affect your status in a trial; it’s important for insurance and billing purposes, as many mental health professionals need to dole out a diagnosis if they want to be legitimate in the eyes of the state; it’s also important for subjective purposes, as many in a state of crisis or confusion seek out authoritative explanations that help them make sense of their lives.

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A page from Linneas’ Classes Plantarum and Bibliotheca Botanica

It is based off of the German psychiatrist Emil Kraepelin’s 1883 textbook “Compendium of Psychiatry: For the Use of Students and Physicians”. There, he treated the psychiatric understanding of mental illness as being like botany (and his brother Karl was a famous botanist): the goal was to classify all the different types into their correct generic orders and species. No psychiatrists before him attempted such a systematic approach. He established many trends in his book, which would come to dominate psychiatry up to today: the major distinction between affective and psychotic disorders comprising the major “types” of madness; the emphasis placed on psychosis as a measure for the severity of the illness; and the strange mixture of confidence that a biological explanation is soon to come coupled with the admission that they do not yet have one.

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DSM-V page on Bipolar disorders

Ask yourself whether you think the following diagnoses have appeared in either an edition of the DSM or in another official clinical manual of psychiatry. We’ll start with the easy ones: Schizophrenia? Major Depression? Bipolar disorder? How about Inadequate Personality Disorder? Oppositional Defiant Disorder? Masturbatory Psychosis? Gender Identity Disorder? Caffeine Withdrawal? Old Maid’s Disease? Hysteria? Homosexuality? Perhaps you will find it surprising that all of these have appeared at one time or another. I would hope every person listening to this would derisively view Hysteria and Homosexuality as nothing more than medical codifications of the male doctors internalized homophobia and misogyny. But, according to psychiatric dogma, the diagnoses in their manuals are real diseases they have discovered. Does it not seem odd then that the American Psychiatric Association votes on which diagnoses to include in their new additions? This is ultimately how homosexuality was eventually ousted in the wake of a number of protests by gay rights activist groups. “Homosexuals gain instant cure!” read a a humorous headline in 1973. Do you imagine that the editors of medical textbooks on cancer voted as to whether to include ovarian cancer in their newest edition? The situation is made worse by the fact that the leaders of the last two task forces of the DSM, essentially the editors of the most authoritative diagnostic book in global psychiatry, Allen Frances and David Kupfer have made public statements declaring the continued lack of biological evidence for the diagnoses. Kupfer, the head of the task force for DSM-5 has said in a statement in 2013

The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide precise diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.

One need not have professional knowledge to know that psychiatry is indeed like no other profession if Thomas Insel, the director of the National Institute of Mental Health, can announce, as he did in April, 2013 that he believes DSM categories lack any scientific validity or objective measure.

Many people likewise assume that psychiatry and psychology are basically on the same page, in the way that a cardiologist and a nutritionist might be in basic agreement about your state of health but merely offering to explain different aspects of it. This is quite far from true. This is clear from the petition leveled against the DSM 5 by the American Psychological Association and from the statement and table put out by the British Psychological Society, an organization of around 50,000 psychologists in the UK, following the publication of DSM-5 in which they wrote

The putative diagnoses presented in DSM-V are clearly based largely on social norms, with ‘symptoms’ that all rely on subjective judgements, with little confirmatory physical ‘signs’ or evidence of biological causation. The criteria are not value-free, but rather reflect current normative social expectations.

Diagnostic systems such as these therefore fall short of the criteria for legitimate medical diagnoses. They certainly identify troubling or troubled people, but do not meet the criteria for categorization demanded for a field of science or medicine.

The question we all must confront in ourselves at this point is: why do I feel so confident using psychiatric vocabulary and feel the need to do so when even professionals in psychiatry and psychology (not to mention the many others in sociology and anthropology) can’t seem to agree on what mental disorders are, or at least have expressed serious doubts as to their ability to identify them? What exactly does diagnosing allow you to do? Without referencing anyone in particular, I think it must be squarely faced that many average citizens feel a sense of relief in being able to say “there are just crazy people out there.” This imaginary citizen does not have to confront whether he has done something to frighten, traumatize, or provoke the mad person; he need not worry that he has not yet confronted the horrors of slavery and violence in his country’s history and the way they live on today; he need not concern himself with the idea that perhaps there are other ways of thinking about the world that do not align with his own. Calling someone on the street acting bizarre or the mass shooter in the news mad serves the function of easing the contemporary citizen’s anxiety about the uncertainty of the world. “There are just crazy people out there, it’s something in their brain” he repeats to himself like a mantra, and his world-view remains in this way untainted and unthreatened by anything outside of it. In order to even begin to have a conversation about madness or mental illness, we need to see that we feel that we know more than we actually can know about madness, confront why we desire to wield the coercive power of diagnosing, and begin from that careful skepticism and admission of impossibility.

The question of why mental health professionals use categories of mental illness so often put into question is much simpler to answer. The most obvious reason is that mental illness, as opposed to madness, is marketable. One can sell pills to manage the former, but there is nothing to sell someone suffering from the effects of capitalism. The second is that their categories are predicated on a conflation between normality, health, and morality. The poet and madman Antonin Artaud explained the underlying magnetic drive towards normality in psychiatry in his own furious and frenetic way, clearly influenced by the imprisonments and insulin shock treatments he had been forced to withstand. He said: “Medicine is born of evil, if it is not born of disease, and it has even, on the contrary, provoked sickness out of whole cloth in order to give itself a reason for being; but psychiatry is born of the vulgar soiled earth of people who have wished to maintain the evil at the source of illness.” Artaud is not implying that medicine and psychiatry are themselves evil, but that they come into existence when professionals feel they have discovered some evil which needs to be rectified.” In mental health, this becomes more complicated, since the “evil” in question is not the destruction of the body by a discrete disease or plague, but of behavior, emotional expression, and thinking. A cartoon drawn by Emil Kraepelin in the 1850s shows Kraepelin himself clad in the armor of an arch-angel, wings spread out behind him declaring “Psychiatrists of Europe! Defend your sacred diagnoses!”

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Hiawatha Asylum for Insane Indians

Psychosis is defined by the presence of supposedly unreal phenomena like hearing voices, or seeing visions, and the belief in unreal truths. This definition ought to make anyone familiar with American history feel uneasy. Was not slavery considered completely normal in this country, along with the idea that black people and natives were closer to animals and only partly human? So too was expropriation, genocide, and cultural theft and destruction of the Native perfectly aligned with the program of a nation whose aim was to “kill the Indian” and “save the man”. In such a case, how, for instance, is a white psychiatrist supposed to diagnose a Native Dakota Indian without speaking her language, understanding his customs, ways of acting or speaking? How could a physician diagnose a mental illness when another people’s entire way of being in the world is a problem in their eyes? Pemina Yellow Bird writes in “Wild Indians: Native Perspectives on the Hiawatha Asylum for Insane Indians” that ‘Native peoples generally do not have a notion of “insane” or “mentally ill.” I have been unable to locate a Native Nation whose indigenous language has a word for that condition. The closest I can come is a word more closely aligned with “crazy,” which means someone is either very funny, or too angry to think straight.’ And yet they did, and do, at extraordinarily high rates beginning with the Hiawatha Asylum for Insane Indians in the late 19th century when hundreds of Native peoples were sent from hundreds of miles away, incarcerated and punished for practicing their religion, performing dances, or speaking their native languages and forced to speak English. Most patients, or prisoners, went undiagnosed, and were just called “insane” or “defective”, after which they were sterilized and kept until the end of their lives. Nine out of ten discharges were due to death. Today, American Indians have the highest rate of serious and minor mental illness besides multiracial individuals, according to the National Institute of Mental Health. In our second episode “The Madwives’ Blues”, we discussed the schizophrenic women of the 1950. At that time, schizophrenia, the disease most characterized by psychosis, was a disease mostly attached to the disorderly wives of white men who were then placed in asylums and given shock treatments. The schizophrenic woman was the wife or single woman whose delusions were were characterized by their doctors fantasies about sleeping with the neighbor, or running away from home. One advertisement for the antipsychotic Zyprexa portrays a woman with a puzzle piece shaped hole where her mouth should be. The text reads “You’re trying to piece her life together, but she won’t swallow it”. Similar stories can be told about homosexuality, the history of the treatment of transgender people, women through the diagnosis of hysteria and personality disorders, with the rebellion of children through oppositional defiant disorder and emotional behavioral disorder, and colonialism through psychotic disorders.

1967 ad for Thorazine

Psychiatry also provided, along with the burgeoning field of genetics, the intellectual and clinical backbone of the eugenics movement in the United States, and later in Nazi Germany. The father of psychiatry, Kraepelin himself, was a eugenicist who believed genetic cleansing would finally restore the great german people tarnished by the insane and disabled. Mothers with deficient heredity were sterilized well into the 20th century, people with disabilities and those acting mad were incarcerated, subjected to experimental treatments against their will, and, in the case of Germany, murdered en masse. Individuals labeled schizophrenic were the first to be gassed in Germany, having been deemed the most expendable and least likely to be missed in the gene pool. Eugenics is the logical and final outcome of the total overlap between medical science and the moral drive for normalization, and one which we are never entirely safe from. Much of the language we use to talk about our minds and emotions comes from this era. The term “mental health” itself arose from the American eugenics and mental hygiene movement.

What we must take away from these examples is not that past displays of rebellion and radicalism were being misunderstood or misconstrued as psychosis, but rather that they were indeed psychotic in the terms defined by psychiatry. A world unaffected by white supremacy, by patriarchal violence, by the legacy of colonialism or capitalism is unreal, and to imagine it is dangerous, aggressive, and delusional to those who decide what’s medically reasonable. Normality is whatever is made normal, through language and culture, yes, but also through political maneuvering, armies and economic structuring; psychiatry allows those who see themselves as normal to recast the abnormal as not just different, but “sick” and “delusional”, unworthy to even listen to. In fact, a symptom of many mental illnesses today is “anasognosia” or “lack of insight into condition”. If you visit an asylum’s graveyard in New York, California, Illinois, or any other state in this country, you will likely find gravestones marked with number, not a name, because those buried there were not considered individual human beings at all. This was the case in Minnesota as well until the disability group Advocating Change Together did the research in the 2010s to find 7,000 of the near 15,000 anonymous buried on Minnesota’s asylum properties.

This is why mental illness is not “like any other illness” or “breaking a leg.” If I break my leg, my words and actions, or even my human status will not be put into question, I will not be carried away by the police, drugged or held against my will, nor will I have to bear the stigma and erasure imposed by a psychiatric label. Anosognosia implies that those labelled as mad are the last people we ought to seek guidance from and that there is nothing to learn from the content of their speech. Truly listening to those called mad and those we think of as mad is thus from the outset a political stance, in that you are demonstrating by doing so that you hear in their language more than word salad and the expression of abnormal brain chemistry.


To close part two, I’d like to say that self-care strategies are necessity for mitigating the effects of our distress, and for staying healthy in this toxic world, but if your self-care paradigm is based off the idea that the problem with the medical model is that schizophrenics ought to be substituting Haldol for St. John’s Worth, then the broader paradigm of care remains unchallenged. I acknowledge also that some people have had good experiences with a medication or a psychiatric treatment. In my experience, many of those people sought out their diagnoses and treatments voluntarily. I would only say that this does not warrant making these individual experiences grounds for a social program, in the same way that someone meeting a nice police officer cannot serve as a counter-argument to critiques of policing or the police. This comparison is particularly useful since, in the absence of clear or consistent scientific legitimacy or validation, psychiatry appears historically to more closely resemble a police force than a medical science.

III. Listening to the voices

In which I will show that it is from the mad themselves where we could learn true mental health alternatives, if only we were able to hear them.

At long last, it’s time to celebrate the works of the mad, the lunatics, and the crazies. I will briefly and quickly show the various movements and trends in the mad movement around the world with the hope that you will follow up on whatever resonates with you.

But who are the mad we ought to listen to? Without implying that they are in any way separate from one another, the literary, social, and political expressions of the mad have generally followed the two pathways we indicated earlier: the work either appears as a novel form of expression outside of the norms of an era; or it situates itself as a response to the real repression of what is called madness through incarceration, forced diagnosis and medication, stigma, and mistreatment. Within these two possibilities, we’ve already seen even in my brief exposition myriad ways in which madness can appear: madness as deviance, madness as extreme suffering or elation, madness as scapegoat, as disease, as difference, as spiritual emergence and connectedness, and madness as inspiration or genius. These are nearly always implicated in one another, twisting and winding about in each others soil like so many ecstatic fungi.

The mad people who have been locked up, medicated, or “treated” without their consent or under premises they later saw as false have created a global “psychiatric survivor” movement that spans over a hundred years. An early organization for psychiatric survivors came to be right here in the Midwest, when Elizabeth Packard was diagnosed as mad and put into the Illinois State Hospital for the Insane when she disagreed with her husband’s Calvinist religious doctrines. Some of the signs of her insanity included not wanting to shake his hand, and preferring Methodist Christianity. Once her son was able to get her out, she wrote multiple books on the incident and started one of the earliest psychiatric survivor groups: the “Anti Insane Asylum Society”. The 1970s saw a resurgence of patient-led groups undoubtedly inspired by the Black Power, feminist, queer liberation, and especially disability movements of the era. One of the major figures was Judi Chamberlin, who, following her involuntary hospitalization in 1966 for schizophrenia following a crisis after a miscarriage, helped form the Mental Patients Liberation Front. She wrote that “Only when a group begins to emerge from subjugation can it begin to reclaim its own history…The movement of people who call themselves variously, ex patients, psychiatric inmates, and psychiatric survivors is an attempt to give voice to individuals who have been assumed to be irrational – to be out of their minds.”

kidnapping packard.jpg

David Oaks, also a member, went on to form MindFreedom International, a large coalition against forced treatment with chapters in the UK, Africa, and elsewhere who focus on documenting psychiatric abuse. There’s the World Network of Users and Survivors of Psychiatry, a more institutional reform group with similar goals. There’s also the National Empowerment Center, cofounded by Chamberlin, with its emphasis on the recovery and peer-support model. Some of those in this movement call for more attention to trauma-centered care; some desire the abolition of certain psychiatric labels (like the “Campaign for the Abolition of Schizophrenia Label”); some call for a model of care not reliant on the DSM or medical professionals at all; some offer alternatives outside of psychiatric institutions (like crisis houses, or peer respite); while others propose to include newer diagnoses formed in collaboration with those with lived experience as a kind of harm-reduction. All are united, despite some major differences, under the same banner as the disability movement with which the mad movement shares so much: “nothing about us without us.” Listening to mad survivors of psychiatry or trauma teaches us to always be alert to the intricate maneuvers of power in our language and behavior. When the mad say “respect us”, what do you hear? A howl from deep within a noxious imbalance of chemicals being badly managed, or the cry from a potential friend who has suffered greatly to be treated with dignity and grace?

The mad share a natural solidarity with all those who have at one time or another been excluded from the process of civilization, rendered speechless and placed into the position of an animal. We can be more emphatic here: a disproportionate amount of those called and labeled mad have been black, indigenous, women, queer, or Othered in some manner. The mad at times have served as a convenient scapegoat for those desiring more political representation, a way to say “we are reasonable, we are not like those mad savages” as in a 19th century British propaganda poster for the suffragettes which shows a prisoner and a “defective” in a cage with a woman with the text “Convicts and lunatics have no vote for parliament, should women be classed with these?” When we respect madness and refuse to minimize or exclude it out of fear, we can better see how these exclusions support and necessitate one another. We can learn how the games of power compel us to destroy one another.

COnvicts and lunatics suffragettes .jpg

Our questioning of psychiatry should not lead anyone to believe that we intend to efface the experiences of extreme suffering sometimes called “madness”, or deny these possibilities to anyone. To the contrary, only by truly listening to the stories of the mad can we become more sensitive to such sufferings, experts of suffering, psychonauts more capable of sailing into the darkest corners of the human experience and come back stronger for it. For me, pushing back against psychiatry gives us more space to be sensitive to eccentricity of expression and a wider variety of emotional or mental reactions to life’s difficulties. Anyone could learn from the coping strategies of the mad. We are experts of the extreme.

Psychiatric discourse is full of convenient circles: because you are suicidal, you are mentally ill; because you are mentally ill, you are suicidal. Or: because you are psychotic, you are unintelligible; you are unintelligible because you are psychotic. Within the circle, there is no possibility of escape for those caught within, and no possibility of nuanced understanding, or careful practice for those lucky enough to evade its ever-growing span. The mad, and I speak with them, need to be able to speak about the voices we hear and the visions we see that others don’t without them reacting with fear and repulsion, without the banal refrain “have you seen a doctor about this?” being the only possible response, which is both an act of erasure and a threat (“if you don’t contact a doctor perhaps I will, or the cops”, etc). Listening to the mad means practicing a new radical form of listening: one in which we must come with curiosity and patience to the other, despite how far away they may seem, rather than dragging them to us in their moment of crisis. This may take hours, days, or months. We need patience because many of us are reacting to past violence, abuse, and trauma in our lives. These scars can be deeply buried, and confusedly expressed in moments of difficulty, sometimes woven into intricate and detailed symbolic systems opaque to the uninitiated. Self-care strategies that emphasize returning to a balanced homeostasis miss the fact that sometimes we need space to be mad, we need to go through crises or ecstatic reveries in a safe environment to process trauma or to reach a different stage of our development. We need elastic patterns of response to replace the rigid ones now in place. Psychiatric and trauma survivors say, as Jacqui Dillon does, that the question is not “what’s wrong with you?” as the doctors ask, but “what has happened to you?”

Agnes Richter Jacket
The jacket of Agnes Richter, a German psychiatric patient

Not everyone who has been labelled “mad” (or who sees themselves as such) has or wants a relationship, positive or negative, to a medical model at all, but see madness as a spiritual process, a muse, the call of the ancestor, see themselves as host to nerve fibers or waves of radiation or perhaps even the mysticism of cats to which no one else is sensitive. What could madness mean distinct from psychiatry? How do we mad people find each other outside of its networks? What do we share in common besides shared trauma or suffering? What do we have to offer each other beyond mutual support? One approach has been to take something which is thought of as a “symptom” and make it into the grounds for social and political organization.

The International Hearing Voices Network is one such group. The network began in the 1980s when, in the Netherlands, Patsy Hage, a distressed voice hearer, began to talk more and more about her suicidal thoughts with her psychiatrist Marrius Romme. She wanted to talk about the voices and what they were saying, but Romme had been taught that their words are meaningless. She noticed a cross on the wall. “Why shouldn’t you believe in the voices I really hear” she asked Romme, when “you believe in a God we never see or hear?”

Calling oneself a “voice hearer” has a very different ring than “schizophrenic” or “bipolar with psychotic episodes”, and is productive of an entirely different conception of the self and that selfs place in history. Shamans, religious or spiritual mystics and prophets including the Jewish mystic Isaac Luria, the Christian mystics William Blake, Joan of Arc, and Margery Kempe, the slave who fomented an insurrection Nat Turner, and the prophet Mohammad all reported hearing voices and seeing visions, as did writers Virginia Woolf, Bessie Head, Charles Dickens, Philip K. Dick; so too do many children report hearing the voices of imaginary friends; and adults the voice of a recently deceased loved one. Talking about “voice hearers” creates a broad continuum of experience rather than a category of pathological individuals. Mad Pride groups and The Icarus Project also take the time to explore creative ways to think about experiences typically seen as symptoms of madness, but with different emphases.

There are in-between spaces and groups with practical aspirations like the crisis houses and peer respite centers of the past and present like Kingsley Hall in England, Afiya in Massachusetts, and the Run Away House in Germany where patients make the important decisions, and live without fear of punishment or diagnostic stigma. Would thousands of people still be funneled in and out of hospitals during crises in the Twin Cities if we had more such spaces where former patients, mad people, and their friends were free to pass through their extreme distress or creative reveries in a supportive environment? What sort of space facilitates learning and growth through crisis rather than feelings of desperation and illness? Let us create spaces from which we will emerge from our crises and say the words Gerard de Nerval, the famous lobster-walking mad man of Paris, did following his crisis

The way I had been cared for brought me back to the affections of family and friends and I was able to judge with greater sanity the world of illusion I had lived in for a while. All the same, I feel happy over those convictions I have acquired and I compare this series of trials I went through to that ordeal which, for the ancients, represented the idea of a descent into hell.

We must listen to the voices of the mad for, while there may be some usefulness in looking at statistics, we often place too much emphasis on their importance. While it’s true that statistics may tell us of the effectiveness of a certain treatment, or of negative side-effects of a drug over time, they cannot tell us what these interventions mean to a person with a past, a present, and a future, friends, family, loves, fears, hopes, desires; they cannot tell us anything about what madness means to those experiencing it; they cannot tell us why people believe they have the experiences that they have. Listening to people tell their own stories in their own ways gives us access to information that can never be obtained within the limits set by scientific research. Even if the research were all correct and supported by evidence, understanding the science behind madness does not mean that you understand madness, just as understanding how the brain processes and synthesizes the scenes of a film does not grant one access into the meaning of that film.

The radical diversity of madness narratives speaks to the need for the fostering of what Martin Luther King Jr. called spaces for “creative maladjustment”. The experiences of those called mad and their explanations for it do not form a cohesive system. To approach this, we need elastic, adaptable frameworks. The mad already have these, by and large, because we have to bend and twist our speech and thinking so far to make the public comfortable, to not show our scars, our grand ambitions, our connections to things unseen, lest we be locked up in hospital again. The problem with both the psychiatric model and the individual self-help model is that they tend to impose a set of universal beliefs on the one in need of help. If I were to say “I hear voices, sometimes wonderful, other times horrific, because I have a connection with spirits of the past”, this imposes nothing on the other, but yet is still something sharable. I can share their words, their wisdom, their pain. Setting aside whether it is true or false, to tell me in this case “this is the effect of a failure of your dopamine inhibitors” is to collapse all meaning and reduce it to the interplay between some chemicals in a body. It implies all those who adopt different frameworks for themselves are essentially deluded. Despite good intentions, this explanation is imperial, and, when expressed, excludes all other possibilities under the warlike banner of “chemical imbalance”.

The problem is not that some people find meaning in a diagnostic label, but that such self-identification is presented as the only possibility for those among us who regularly undergo crises or unusual experiences. Ask yourself: what means do we have today or what means do I myself offer my friends for legitimating suffering, extreme states, ecstasy or voice hearing without passing through a medical model, without saying “his art is beautiful, it’s amazing what bipolar people can do” or “She’s such a great person, it’s so sad what people with schizophrenia have to suffer through.” How many people choose to identify as “depressives” or “schizophrenics” not because it is the best possible option for them, but because it is the only one they are aware of, and the only one which anyone else will take seriously? How can we say “I believe you” without also implying “I also believe you are ill”? Listening to the mad and respecting the frameworks in which the mad think does not entail a rejection of responsibility and closure away from others into the world of fantasy, but the opposite. Nothing for me is more closed-off to sharing than the abstractions of brain chemistry, no choice or responsibility is granted me when my choices are merely effects of my brain malfunctioning.

To finish, I’d like to read a poem by Emily Dickinson:
Much Madness is divinest Sense-
To a discerning Eye-
Much Sense-the starkest Madness-
‘Tis the Majority
In this, as All, prevail-
Assent- and you are sane-
Demur- you’re straightway dangerous-
And handled with a Chain-

Revelation, beauty, suffering, energy, silence, violence, abuse, politics, fear: such is the company the mad find themselves with when they board the ship of fools we call madness. When you spot it coming on the horizon, full of dancing, drinking, screaming, tattered and broken souls, will you let it dock, and rest, perhaps even board it for a while as we travel down the river, or will you hide beneath the covers, turn off the lights and hope we don’t notice you as we pass?


Sasha again. I want to take just a second to tell you about a bibliography and study guide I put together around the materials introduced in this talk. It’s separated into 10 units on mental health, madness, and psychiatry, and designed for you, the reader, to add, subtract, mix and match, take or leave anything included. There’s readings, podcast episodes, artworks, movies, websites, and resources listed, along with summaries of each text, and questions for you or a reading group to consider. Every unit includes at least one text written by someone who has been identified as or personally identifies as “mad”. The study guide is free, as are all the texts included. Find it on the front page of our website

S o n g s  u s e d:

Fizz “Submarine Intro”;

King of Hearts Sountrack “La Valse Tordue”;

2 tracks produced and mixed by Sasha Durakov;

Bud Powell “Polka Dots and Moonbeams”;

Annie Ross “Twisted”;

Luboš Fišer “Valerie a týden divů”

* Header image is The Maze by William Kurelek

Mental Health, Madness, and Psychiatry: a study guide and annotated bibliography


General Introduction to the Study Guide

This reader is a study guide and a work book for those who are familiar with some ideas, images, or theories of madness or “mental illness” (and perhaps also psychiatry), but feel a lingering skepticism and doubt about what they mean. What are the first images that come to your mind when you think of the word “madness?” If it’s more familiar, go ahead and substitute the word “insanity” or “craziness” for “madness”. What about “mental health,” “mental disorders”, “chemical imbalances”, and “delusions”? Can you think of any other words that seem related to these, but are missing?

It is more important than ever that we all talk about what “mental health” is and how we relate to it. Let’s look at some basic facts. The number of people who are diagnosed with a mental disorder is steadily growing every year, especially when looked at globally. According to the World Health Organization (WHO), over 450 million adults have a diagnosable mental disorder worldwide. They also report that the number of suicides increased by 60% over the last 45 years. Mental disorders apparently account for “8.8% and 16.6% of the total burden of disease due to health conditions in low- and middle-income countries“. So, something must be done, right? We need “more mental health services”, as many activists and others are apt to say. But what does that mean? Medication? Yoga classes? More hospital beds? Free or affordable therapy?

Calling for “more mental health services” starts to look somewhat questionable when one looks at a number of other facts. In the 1970s, WHO found that those diagnosed with schizophrenia —often called the most debilitating of all mental disorders— fared better in developing countries than in the U.S. In a repeat of this study, they found the same results. A number of follow-up studies found that patients who had weaned themselves off the antipsychotics, which were supposed to “fix their brains” had fared much better than those who continued to take them. When faced with these facts, simply calling for “more mental health” starts to look unsatisfactory.

We also live in a time when patient-centered groups, and groups of those who identify with unusual experiences typically seen as “crazy” (hearing voices, extreme mood expressions, seeing things, having “strange beliefs”) organize themselves in social groups, study groups, support networks, and antipsychiatry activist groups. The mere existence of such groups already wears upon the more extreme claims made by psychiatry that, for instance, “psychotic” patients will flounder in their undertakings and live solitary lives trapped in a world of fantasy. This uneasy feeling deepens when we see that some such groups have publicly accused psychiatric treatment to be unhelpful, unnecessary, and, in some cases, torturous. Others have argued that psychiatry is operating as nothing more than a police force, incarcerating the unwanted or unsightly from the streets to sedate them or simply hold them in hospitals or asylums out of sight, and, for their less unsightly patients, providing simple drug fixes to the complex problems wrought by political and economic systems.

This is a very personal document for me. I have heard talk about this thing “madness” for as long as I can remember. Multiple members of my family have undergone interventions for their “madness.” Sometimes that meant taking pills; sometimes it meant getting taken away to a hospital or treatment center against their will; other times it meant going to those places willingly; but it always meant that the person diagnosed and the people closest to them had to rethink their life, their personality, and relationships. I too have undergone psychiatric intervention in my life, unwillingly and willingly. The effect these treatments have had on my life is immense. I have also had a number of bizarre or extreme experiences, which, up until recently, I had always been afraid or felt unqualified to talk about, in large part due to my feeling threatened and delegitimized in my experiences with psychiatry and clinical psychology.

This study guide is for those who feel similarly doubtful, uncertain, or uneasy about the way we talk about “madness” or “mental disorders.” It’s for those who have been diagnosed, hospitalized, and drugged and feel like their psychiatrist doesn’t know best, but they aren’t sure how to express that; it’s for those who have seen a family member or friend “treated” for mental illness and were confused or dissatisfied by the process; it’s for those who have never had interface with psychiatry, but feel like madness or mental illness has touched them, and they don’t know what to make of that feeling; it’s also for those who feel like they know enough about mental health, and what to do about it. They won’t find any easy answers here. This guide is not structured so that the reader will walk away with a cohesive ideology or belief; it was made to initiate and facilitate a process of questioning and doubt, and hopefully of discovery.

My hope is that people use this guide either for self study or for aiding in the formation of critical mental health reading groups or film groups. The reader is organized into 10 units. One could either decide to study a little bit from each unit, focus entirely on a unit of particular importance to you or your group, or do the entire thing. At the beginning of each unit, you will find a summary of the themes and questions explored, and, at the end, a couple questions you are invited to use as a note-taking device. Most will have a primary text to introduce the themes and ideas in a general way. This will be followed by a few optional texts, podcast episodes, films, or other media that go deeper into the themes. There will be hyperlinks for all the texts, podcasts, and more on the pdf (with the exception of the films, which you will have to find on your own). As a rule, the main text and materials will be shorter and more like a survey of the problem/question of that unit. The optional texts will either be primary documents or somewhat denser secondary texts illuminating one or two aspect of the general theme. In many cases, the primary texts are interviews or surveys of a theme.

The units and the optional texts within them are merely suggestions, and, if excluding something, mixing-and-matching, skipping units, or changing the order would help facilitate your understanding, please do it. The LISTEN, SEE and WATCH sections offer podcast, song, art, and film recommendations for opportunities for learners of different types to use what they feel most comfortable with to approach the questions at hand. A general warning for what is to come: we have not excluded texts which discuss many unpleasant and challenging topics including child abuse, suicide, self-harming, and rape. Please use your own discretion as you continue.

Every section will feature at least one text or work by a person who feels they have passed through/live with “madness” or has had a psychiatric label forced upon them. This is necessarily a difficult category to pin down, as you shall see. I let the writers themselves define what it means to them to be mad, and did not use any diagnostic system or nosological schema (classification system for defining and organizing diseases) to decide who warranted inclusion or not. I see such people as primary authors and thinkers on the pathway to understanding and not as case studies for one to examine at a distance (as if there are the works by the “normal” authors about madness and then ones by crazy people for one to check their ideas against).

I’ve designed the guide in three parts with a particular narrative structure in mind, even though the parts as I’ve conceived them will blur into one-another. The first part is largely negative, in that it is meant to challenge dominant beliefs about mental health. Sometimes this is done through critique, other times it is done through illuminating alternatives to the normal, accepted ideas. The world seems over-saturated with ideas and facts about mental health. This “ever more facts” model serves above all to bury the essential problems related to madness under a mountain of detail. So first, this guide will challenge beliefs already held by most people in American society, and since most of these beliefs come from psychiatry (directly or indirectly), the first half will largely be about psychiatry and the process of labeling and treating someone as “mad” (roughly units 1-5); the second cluster of units (units 6-7) will then offer up unique perspectives on “madness,” will outline some reform and harm reduction efforts of the past and present within psychiatry, and potential alternatives to our practices of “mental health;” the last part (units 8-10), will focus on the experiences of those who have experienced something they’ve called madness, and will look outwards, to try to draw connections and remove the question of madness from its imposed isolation in medicine and draw new lessons from it. The entire guide is permeated through and through with the voices and experiences of the “mad”. Through their voices, I hope that readers will experience a guided, soft, break down, because it is only by breaking down that we can open up space to hear those voices that are desperately calling out for us to listen.


Below, I will include books and texts that were either too long, or cost money so that they didn’t make it into the final copy of the bibliography. I will continue to add to this list. The “units” correspond to those in the bibliography, to make it easier for anyone who wanted to follow up on a particular idea or interest.

Suggested Further Reading

Unit 1
  1. Escher, Sandra; Hage, Patsy; and Romme, Marius, “VOICE HEARING: A QUESTIONNAIRE”,
  2. Leudar, Ivan and Thomas, Phillip, Voices of Reason, Voices of Insanity: Studies of Verbal Hallucinations, London, Routledge, June 22, 2000.
  3. Luhrmann, T. M.; Padmavati, R.; H. Tharoor and A. Osei “Differences in voice-hearing experiences of people with psychosis in the USA, India and Ghana: interview-based study”,, April 3 2014,
  4. Morin, Roc. “Learning to Live With the Voices in Your Head”, The Atlantic, Nov 5, 2014,
  5. Scull, Andrew. Madness in Civilization: a Cultural History of Insanity, from the Bible to Freud, from the Madhouse to Modern Medicine. Princeton University Press, 2015.
  6. Thiher, Allen. Revels in Madness: Insanity in Medicine and Literature. University of Michigan Press, 1999.
Unit 2
  1. Conrad, Peter. Medicalization of Society: On the Transformation of Human Conditions Into Treatable Disorders. Johns Hopkins University Press, 2007.
  2. Greenberg, Gary. The Book of Woe: the DSM and the Unmaking of Psychiatry. Plume, 2014.

Unit 3
  1. Littlewood, Roland, and Maurice Lipsedge. Aliens and Alienists: Ethnic Minorities and Psychiatry. Routledge, 2014.
  2. Metzl, Jonathan. The Protest Psychosis: How Schizophrenia Became a Black Disease. Beacon, 2011.
  3. Warren, Carol A. B. Madwives: Schizophrenic Women in the 1950s. Rutgers University Press, 1991.
Unit 4
  1. Biehl João. Vita: Life in a Zone of Social Abandonment. Univ. of California Press, 2008.
  2. Foucault, Michel. History of Madness. Edited by Jean Khalfa. Translated by Jonathan Paul Murphy, Routledge, 2009.
  3. Foucault, Michel, Psychiatric Power: Lectures at the Collège de France, 1973–1974, Picador; June 24, 2008. Retrieved from:
  4. Whitaker, Robert. Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Basic Books, 2010.
Unit 5
  1. Gilman, Sander L. Disease and Representation: Images of Illness from Madness to AIDS. Cornell University Press, 1994.
  2. Mills, China. Decolonizing Global Mental Health: the Psychiatrization of the Majority World. Routledge, 2014.
  3. Mirowsky, John, “Subjective Boundaries and Combinations in Psychiatric Diagnoses”, The Journal of Mind and Behavior, Summer and Autumn 1990, Volume 11, Numbers 3 and 4,
Unit 6
  1. Cooper, David. Psychiatry and Anti-Psychiatry. Routledge, 2013.

  2. Hornstein, Gail. To Redeem One Person Is to Redeem the World: the Life of Frieda Fromm-Reichmann. Other Press, 2005.
  3. Laing, R. D. The Divided Self: an Existential Study in Sanity and Madness. Penguin Books, 1969.

Unit 7
  1. Romme, Marrius A. J., et al., editors. Living with Voices: 50 Stories of Recovery. PCCS Books in Association with Birmingham City University, 2013.
Unit 8
  1. Cvetkovich, Ann. Depression: a Public Feeling. Duke University Press, 2012.
  2. Frame, Janet. Faces in the Water. Women’s Press, 2000.
  3. Gotkin, Janet, and Paul Gotkin. Too Much Anger, Too Many Tears: a Personal Triumph over Psychiatry. HarperPerennial, 1992.
Unit 9
  1. Burstow, Bonnie, et al., editors. Psychiatry Disrupted. Theorizing Resistance and Crafting the (r)Evolution. McGill-Queen’s University Press, 2014.
  2. Hall, Will. Outside Mental Health: Voices and Visions of Madness. Madness Radio, 2016.
  3. LeFrançois, Brenda, et al., editors. Mad Matters: A Critical Reader in Canadian Mad Studies. Brown Bear Press, 2013.
  4. Shimrat, Irit. Call Me Crazy: Stories from the Mad Movement. Press Gang Publishers, 1997.

Unit 10
  1. Deleuze, Gilles, and Félix Guattari. Anti-Oedipus: Capitalism and Schizophrenia. University of Minnesota Press, 2008.
  2. Sass, Louis. Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought. Harvard University Press, 1994.

*Image is of Agnes Richter’s jacket in the Hans Prinzhorn Collection in Heidelberg of art works created by past and present psychiatric patients.

The Underbelli Podcast #1 – The Monsters You Make of Us: On Sex Work and Stigma

Welcome Episode 1 of The Underbelli! In this episode Erma VIP pulls listeners through a web of texts pertaining to how sex work is stigmatized and policed in the present moment. Their spinnerets take us from personal meditations on doing sex work to the rescue industry of the Twin Cities to strippers organizing in New Orleans and to worker struggles nationwide against the dangerous effects of FOSTA/SESTA.

Please do get in touch with any recommendations or feedback of any kind! Special thanks to our friends who mix spit with us on the microphone and who inspire us. You can also now subscribe to The Underbelli on all the major podcast things.


Texts read in this episode:

Against Stigma, Not Sex Work by Erma VIP

The Fragrance of Citizenship//The Acridity of Others: Towards Health Skepticism by Sasha Durakov (excerpt)

5 findings from Super Bowl Minneapolis on anti-trafficking operations by BRI (excerpt)

Leave us Alone, No Pigs in Our Clubs by Anonymous Strippers of New Orleans

City Pages is Cancelled by Erma VIP

Also check out the Belli reader The Myths of Sex Trafficking for more critiques of the language of sex trafficking

Featured music:

Original theme by Fizz

“Normal” by The Petticoats

Audio clips from the film Klute (1971)


The Underbelli Audiozine #1 – Schizo-Genesis // Mad Apocalypse

We are very pleased to say we finished recording our first audio zine! This is us and some of our friends reading from Sasha Durakov’s “Schizo-Genesis // Mad Apocalypse—The Story of the Psycho,” which you can read here. Schizo-Genesis is a text in which Sasha Durakov attempts to situate psychiatry within the history of policing, trace its relation to various ideas of “normality,” and question its premises and assumptions. He ultimately argues that we should not fear madness, but recognize its elasticity and consider it from new, and often contradictory, angles. It’s in two parts, so make sure you listen to them in order.

Our first few podcast episodes will likely be similar to this: readings of our texts with audio enhancements. But there’s a reason we aren’t calling it an audio book project. In the near future, we will branch out and do oral histories and narratives of under-discussed topics of concern for us around mental health, sex work, policing, and surveillance. We are so excited to share this with the world! Please contact us if you have recommendations or feedback of any kind!


**Song featured in this episode:

Talking Heads – Psycho Killer (Instrumental)

Sonic Youth – Schizophrenia

The Kinks – Acute Paranoid Schizophrenia Blues

Betty Hutton – Bluebirds in My Belfry

Dr. Dre and Ice Cube – Natural Born Killaz

Tupac – 16 on Death Row

Vince Staples – Loco

Kendrick Lamar – The Blacker the Berry

Daniel Johnston – Like a Monkey in a Zoo

Prince Buster – Madness



The Fragrance of Citizenship // The Acridity of Others: Towards Health Skepticism—Bellum Primer Two

Take a journey with us to the upscale night-life district in Uptown, Minneapolis. Look at the glittering golden tinsel above the vulgar racist depictions of Chinese-Mexican men on Chino-Latino; see the stupidly bright light-up guitar above the mall announcing the existence of a now-closed “Famous Dave’s BBQ;” sit on a bench on Hennepin Avenue and ask yourself what the appeal of a dance night in a renovated civic building called “The Mansion” that would host the hateful cowboy cop David Clarke could possibly be to your demographic.

Go down just a few blocks to Lyndale Avenue and enter the Uptown VFW post 246, once the nightly home of a scene familiar to many white Midwesterners: older veterans getting trashed and singing shit songs from the 60s and a mixed younger crowd appreciative of the ironic lifestyle and cheap beer getting trashed singing awful 90s songs.

The first thing you see is some 20-something laughing uncontrollably, when, after one powerful inhale, he sneezes half onto his hand, half onto the glasses on the table. His friend, taken entirely by surprise, knocks his table’s half pitcher of Bud Light Lime all over the floor and table. The bartender takes a break from squeezing old lemon slices with her unwashed hands and comes over now, noticeably peeved, takes the rag, which she’s folded in half so nobody can see that she used it earlier to wipe up a small nosebleed, and begins furiously wiping one part of the table, leaving some sections totally soaked. The most adventurous —no worries, still heterosexual!— and drunkest couple in the group emerge from the bathroom after having just fucked, and, wiping the little bit of cum and excess fluid from their hands onto the inside part of their shirts, see the mess their comrades have created and rush with all haste to buy more alcoholic fluid for the group to guzzle in solidarity. An older man stops scratching his staph infection under his leather jacket and saunters by with a crooked smile, patting all the funny kids on the back, telling them he used to be just as clumsy as they were. They all laugh and grab a handful of nuts along with the small flecks of feces on top of them, which, microbially speaking, comes out to about 40 E. coli per gram, 11,500 enterobacteria, and 30,000 coliforms, giving the whole raucous crew a raucous case of diarrhea the next morning.

“But wait!” You think, “Surely our health administration is aware of these probable crimes and is sending out some grumpy nerd with a clipboard to investigate these potential atrocities!” But then the thought comes to you: “No! It is in fact you, the sinister authors, who are spinning tales and riling me up against this fine establishment to extract exactly this reaction! Why do you hate bartenders and veterans?” True, the story is fictional, but it could happen, anywhere, at any time, given the right people (or perhaps the wrong ones) and enough whisky shots.

And yet, the health department does not conduct regular investigations to check for E. coli infested bar nuts, nor for chlamydia trachomatis bacteria in semen wiped on the fabric of booths, nor for staphylococcus bacteria on the tops of tables. The City of Minneapolis did however commission an unannounced investigation on 17 “adult entertainment clubs” in Minneapolis called the “Environmental Health Assessment in City-licensed Adult Entertainment Establishments Testing for sources of contagion” following “Complaints from public and concern from City inspectors.” In addition to strip clubs, three well-known gay bars and clubs were investigated as well. This was quickly followed up by a second “worker-centered” report by the University of Minnesota’s Urban Research and Outreach-Engagement Center, commissioned and funded by the Health Department, which involved interviewing twenty-four workers on conditions and practices within the clubs. As a result of the first report, the city will soon be passing more strict regulations on the clubs and workers.

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Figure 1: Screenshot of a slide from the city’s PowerPoint on the raids. Look, a stain with an envelope next to it! This Sherlock doesn’t mess around!

The narrative produced by the Health Department is fragile, and, examined even superficially, appears as a humorous exercise in hyperbole and panic. Three consecutive panels on a PowerPoint produced by the city of Minneapolis are obviously leading for any reader paying attention. The first panel, called “Epidemiological Risk,” defines “OPIM”s or “Other Potentially Infectious Material” as “fluids [including] semen and vaginal secretions […] in which disease could be present and Come into contact with an entry point (hangnail, broken skin, eyes, lips, mucous membranes, etc.);” the second panel, “Disease Concerns,” simply lists unrelated infectious diseases like Zika, Ebola, and HIV; and the third, “Testing for semen: field sampling procedures” informs the reader that investigators used black lights and blue lights with orange goggles to search for semen in the adult establishments.

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Figure 2: A black light, a glove, a bottle, another envelope. Watch out! There’s some very serious science stuff going on here!

Not once do they say that they have ever found HIV infected semen in any of the strip clubs, not to mention Zika or Ebola, but they let the reader draw the conclusion that it could be there. Take a moment to consider all the hypotheticals the Health Department required to retroactively convince the public that these raids and investigations were necessary: semen potentially could be infectious; such potentially infectious fluid could contain HIV, Zika, or (gasp!) Ebola; strip clubs could have infectious semen and be a source of contagion. We can play this game, too: blood is a OPIM and could be infectious; infectious blood could contain HIV or Ebola; members of the Health Department could have nosebleeds or small cuts on their fingers and could be a source of HIV or Ebola throughout the city. Therefore, a raid is necessary.

As entertaining as that would be, we are in no way advocating for more raids or investigations, but rather in order to question why we do it in the first place when no credible risk exists. But we can’t stop there. We need to ask: what do we even mean by “credible risk” when it comes to health and sanitation? And to go further: what is “hygiene?” or “sanitation?” or “health” for that matter? It should be unsettling that we tacitly accept the authority of institutional powers (the Health Department, the CDC, local health commissions, public health administrations, or the police acting for them) to conduct operations in their names without being able to define them. That will be our task here: to try to figure out what it is we are talking about when we use these hygiene-related terms and how they function in the world.

We do not intend to offer here a history of the Health Department, the CDC in the United States, nor of global health or epidemiological governing agencies. What we can do, however, is offer tools for understanding the ways in which various governing agents (like the Health Department, but also the police, or even civilians) make use of the concepts of “hygiene” and “health.” In doing so, we can begin to parse out not what they mean abstractly —as if there could be a universal standard for “clean”— but functionally.

a) Making the other visible: an outline of hygienic technologies of power

It is in protecting extreme indigence from the necessities to which it would otherwise be compelled to submit, and in enforcing police regulations – important alike to the health, the manners, and the morals of the lower orders – that the power of government is most beneficially exerted. Like the laws of quarantine or of public cleanliness, such regulations are necessary to enforce those salutary rules, which…indigence [is] too often unwilling to obey.

—Dr L. C. A. Motard, Essay on General Hygiene

If we were able to go back in time in our supposedly advanced Western Civilization and observe people eating at the dinner table in, say, medieval Europe or colonial America, we would likely find much to be disgusted by. The peasants and poor people especially would likely strike most of us as filthy. Depending on the time and place, former citizens of the empires, kingdoms, and colonies could be seen blowing their noses into their tablecloths, killing animals in the dining room, eating with their unwashed hands, or farting and pissing quite openly. Some of you readers would perhaps not be offended by one or all of these scenarios, but many of you probably would by at least one.

Does that mean that blowing your nose into a handkerchief, killing animals in a factory, eating with a fork, and excusing yourself to fart and pee are necessarily more hygienic and clean? There are too many other factors to consider for us to make blanket statements, but what we will say is that the older, more “filthy,” habits can be done in such a way that they are not the direct cause of illness or the spread of contagion (if that is our basis for something being “unclean”); and also that one can eat with a fork covered in infectious material, or get sick from eating bad meat killed in a clean location, or get ill from holding gas in for too long. The latter set of practices are not, abstractly considered, objectively more “sanitary” or “healthy” than the former.

The main difference between these sets of practices is perceptual: when we say that eating with your hands is “filthy,” it is more so because we believe that by not eating with our hands, we have advanced into a cleaner, and more civilized, position (this is a selective logic: we eat sandwiches and cookies with our hands). In a general sense, when someone uses the word “hygienic” or “clean,” they are implicitly or explicitly establishing a binary: hygienic vs unhygienic, clean vs dirty. One is supposed to feel shame if they fart in front of others, and thus most do not do so in public. Some may even call it “dirty” or “unhygienic,” but what do these words mean when farting does not put one at risk of contracting or spreading an illness? At the same time, one is not ashamed to put their fingers in an uncleaned bowling ball and then eat chicken wings when those same fingers are potentially covered with infectious bacteria. Some may call this practice “unhygienic,” but many would do it without thinking twice. Farting is an especially interesting example, as it went from being seen —in France and Germany, at least— as unhygienic not to fart, because doing so could upset one’s stomach, to eventually being seen as “dirty.” In everyday usage, “sanitary,” “hygienic,” “clean,” and “healthy” have a moral meaning, and are not necessarily correlated to objective factors like the quantity of infectious bacteria, since “[m]otivation for social consideration exists long before motivation from scientific insight.” Those who use these terms in this moral way do so in order to distinguish themselves from those below them who do not act as they do.

Figure 3: A 19th century ad for Pear’s Soap depicting a dark-skinned native discovering civilization in the form of soap.

This operation is what Norbert Elias referred to as “the civilizing process.” According to Elias, the higher classes within civilization need to socially and aesthetically distinguish themselves from the lower classes, or from other, outmoded social classes, as when the bourgeoisie distinguished themselves from the withering aristocracy. The term “civilize” —along with “cultivate,” “police,” and “culture”— was a part of a lexicon of technical terms used to govern and regulate the appropriate behavior of the citizens of states. As Mark Neocleous notes in his Fabrication of Social Order, “proper” behavior is etymologically derived from the same root as both “propriety” and “property.” These then form a constellation of symbols in which what one must morally or legally do is intimately connected with what is seen as the cleanest, most hygienic thing to do, which is connected to what one has: “[t]hat property is intimately connected to cleanliness is illustrated by the converse assumption that poverty is intimately connected to dirt and disease.” In Elias’ account, once the higher class has adopted a new practice to distinguish itself from the peasants, the practice slowly drifts downward until it becomes standard morality. Over time, these practices become so essential to the fabric of social life that adults adopt a variety of “naturalist” explanations:

Much of what we call ‘morality’ or ‘moral’ reasons has the same function as ‘hygiene’ or ‘hygienic’ reasons: to condition children to a certain social standard. Molding by such means aims at making socially desirable behavior become automatic, a matter of self-control, causing it to appear in the consciousness of the individual as a result of his own free will, and in the interests of his own health or human dignity.

One task, then, is to find out when agents are using the neutral “hygienic” and “healthy” to make moral or social claims about the world.

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Figure 4: A 2011 ad for Nivea with highly racialized overtones depicting a black man “re-civilizing” himself through the use of cosmetic products.

Yet, even when there are supposedly objective factors like a quantity of harmful bacteria or the presence of a virus, these social forms of affect control can be very difficult to isolate and consider alone. Due to their complexity, these “unhygienic” practices become coded in a variety of ways: Elias writes of how the desire to sniff something stinky can be coded as a “remnant of childhood;” certain behaviors can be coded in national discourses, like eating with different utensils (e.g. chopsticks in Japan, fork in the U.S.) versus eating with your hands (as in Ethiopia); others can be coded in religious, political, or racial vernaculars. The most drastic shift of the civilizing process described by Elias occurs during the colonial period. At this point, a fold was introduced into the concept of “civilized,” and, with it, “hygienic” and “healthy:” affluent Europeans needed to make sure that the distinction between the civilized people and savages was clear, while also distinguishing themselves from the less civilized among them. The practices we talked about above (like using a fork) become a kind of “social technology” for denying humanity to those who are denied access to them or who live differently, both outside and inside the imagined limits of civilization.

One of the principal forms of ordering the regimentation between different groups takes place in the field of representations of health and cleanliness. It consists in being able to say: “you are dirty” or “you are (potentially) contagious.” Such images are not hard to call to mind: sex workers contagious with STIs; madmen smearing shit across walls; the poor living in rat-infested, wet hovels; the savage impotently performing magic to stop the spread of disease; or, if you remember back just a few decades, gay men with AIDS acting recklessly. There may, in fact, in individual cases, exist a disease or a practice that facilitates the spread of illness, but that is not what is at stake. What matters here is that bacterial or viral cleanliness is thoroughly mixed up with social cleanliness, an ideal that cannot be made equivalent to a particular state of health or sickness, but is nevertheless bound up tightly with it. Mark Neocleous argues that physiological and social health coalesce into the symbol of dirt:

As matter out of place, dirt is essentially disorder[…] Indeed, dirt is an offense against order, evidence of imperfection and a constant reminder of change and decay. Eliminating it is thus an attempt to organize and stabilize the environment. As crime came to be one of the strongest reminders of disorder, so it came to be thought of in terms of dirt and garbage.

There is environmental dirt, which must be cleared, but also human dirt, which must likewise be cleaned up. This connection is illuminated in the term “mental hygiene,” popular in the 20th century among social hygienists. There is no possible way for one to literally have a “dirty” or “unhygienic” mental state or brain, if by that we mean that it is a source of contagion (or stench for the proponents of the miasmatic theory), which indicates that the word “hygiene” has the capacity to mean only “correct” and “right,” distinct from any association with infectious material. This does not mean that hygiene is just being used as a metaphor in this case. Hygiene cannot be considered separately from the ways in which we represent otherness, nor from the practices we participate in to separate the morally good from the corrupt.

This relation was perhaps most clear in the early to late 19th century, before the spread of Pasteur’s theories and the subsequent rise of bacteriology, when the hygienist movement was at its peak in Europe and the UK. The hygienists were holistic health reformers with an orientation towards the whole environment, and the lifestyles of the individuals who lived in them. They believed in the “miasmatic” theory of disease, which presupposed that disease was spread in a gaseous form, and was thus identifiable by its smell. That fetid odor in the nostrils is the disease entering to infect you. In The Foul and the Fragrant: Odor and the French Imagination, Alain Corbin tells us that, in this stench-based model, “[i]nvasion by disease could be diagnosed both by the loss of a healthy odor or by the appearance of a morbid one.” The various figures of the lower classes became so deeply associated with dangerous smells that, in French, the vulgar word for “prostitute” is “putain,” which derives from the word for “stinky.” One’s particular smell, in this paradigm, was a result of environment, food, and the air they breathed. With this circular logic, the hygienists could bolster the public’s beliefs about the lifestyles of the homosexual, distributing literature that he smells of cum and musk, because of the secret, filthy private life he led; that the ragpicker smelled rotten because of their proximity to trash; and that the African smells “differently […] because he is fond of putrid foods.” These theories both bolstered the common citizen and administrators’ beliefs that they could recognize these outsiders via olfactory sense alone, and also instilled a deep terror, since breathing these airs could infect or even kill you.

The hygienists, though only briefly given the kind of power they sought, nevertheless contributed widely to social perceptions of otherness by granting scientific legitimacy to the “civilized” prejudices about the poor, sex workers, the insane, homosexuals, or the colonized. They also, in various contexts, gained access to administrative authority over towns and cities where they were able to enact their reforms. These reforms were geared toward eradicating, or at least controlling, the “contagion environment.” The hospital, the prison, and the ship became the laboratories of hygienic reform and sanitary regulations due to their semi-enclosed nature and their reputation for being spaces of contagion. The problem was that, in the towns and cities, this threat could arise from anywhere at all. Overcoming that transition was no easy matter. First, a successful sanitary system requires near constant vigilance and surveillance to make sure there are no deviants contributing to the spread of disease or filth. In the 19th century, this usually took the form of an administrative agent or welfare agent visiting spaces and noting the conditions on a regular basis. This was much easier in the hospital, for example, where authorities would constantly be present. Besides educating the public, the terrifying information that was spread about the disease or potential disease in question and its supposed proximity to “problem people” probably served the additional functions of encouraging citizens to perform additional surveillance on their neighbors, to report prostitutes, to exclude mad family members, and to fear outsiders.

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Figure 5: “‘The kind of ‘assisted emigrant’ we can not afford to admit.’ So reads the caption to this 1883 Puck drawing, which shows members of the New York Board of Health wielding a bottle of carbolic acid, a disinfectant, in their attempts to keep cholera at bay.” Image and text found at:

The aspirations of the hygienists lay mainly in city planning. The threats from contagion could come from anywhere, so the hygienists wanted control over as much infrastructure as possible in order to prove that, under their watchful eyes, illness could be slowed or halted, and disorders decreased. They wanted to prevent overcrowding by constructing open and clear passageways, they wanted to drain bogs and swamps to clear the air of the putrid stenches, they wanted vents in every building and drains on every street. Their plan was to deodorize the world, and rid it of disease, but also of sloth and laziness, of which stench and dirt were signs, and so, on the whole, to incrementally increase the orderliness of the cities. Only some were granted the power to design infrastructure and reform public health policy in domestic cities, including perhaps most influentially Edwin Chadwick in London, but their recommendations and ideas played a role in the further development of public health policy and of infrastructure and architecture, particularly of factories and other workplaces.

White Man Burden is to teach cleanliness described in a Pears Soap advertisement 1890s
Figure 6: “The White Man’s Burden” ad from Pear’s Soap promises again to bring civilization to the uncivilized through soap and cleaning.

We haven’t yet mentioned the colonies, that other ground for experimentation in medical policing. The colonies of Europe and America, populated as they were by people thought of as subhuman, were ripe territories for testing out new practices and theories in the administration of hygiene and health on large groups of people. The colonists were able to take risks they couldn’t take on full citizens of their national states. Further, because the very bodies of the colonized were considered unruly, disorderly, and unhygienic, hygienic administration in the colonies was not an accidental or extra feature of colonial rule, but a primary form of governing. It is in the colonies, when the civilizing process is conceived as internally complete and externally expanding, where the boundaries of citizenship are decided through “national borders, immigration restriction lines, quarantine lines, racial cordons sanitaires and the segregative ambitions of a grafted eugenics and public health.” In other words, lines dividing the “unhygienic” from the “hygienic” were the very same borders dividing the citizen from the savage:

public health and hygiene offered not just metaphors and rhetoric (or the ‘pretexts’ as Proctor writes of the Nazi enclosures of Jews in Warsaw) for cleansing and purifying, but were the actual modes and tools of management for colonialism, nationalism, and in the interwar period, racial hygiene and eugenics: these were all part of the project and the imperative of public health.

It is in the colony also that the deep connection between hygienic and racial discourses is most clearly illuminated. As Alison Bashford writes, practices of segregation are “both hygienic – that is, […] part of public health – and racial – […] part of the systems and cultures of race management, including[…] the management of whiteness.”

It would be easy to say that once Pasteur “discovered” the microbe, science and hygiene corrected itself from the hygienist diversion, but that is simply not the case. The Pasteurians emerged out from the very same social milieu, participated in projects with the hygienists, and saw themselves as carrying their legacy forward. More importantly, the reorientation towards the microbe did not eradicate social, racial, sexual, or other preconceptions from science, nor did it put it on a path progressing away from them toward “pure science.” The same figures who formally were feared for their “miasmic threat” (the sex worker, the poor, the homosexual, or the African, among others) were now feared because of their “potential bacterial threat.”

Figure 7: How much has changed? This 2017 Dove ad for shampoo shows a black woman taking off a brown shirt and revealing white skin and a white shirt.

The mechanism of social differentiation via hygienic practice described above as the “civilizing process” could be seen as a form of segregationist stigma designed to separate the “potentially contagious” from the “healthy.” The target of this operation is the dangerous individual or group, e.g. the prostitutes, the mad, or the homosexuals. In Pasteur’s bacterial paradigm, the stigma does not disappear. Instead, it is situated in the discourse in such a way that it appears as accidental. No longer is the individual the target, now it is the disease entity, or the bacteria itself, in question. It is not a group that acts and makes others sick, but a bacterial agent. Individuals are only to be considered as members of a population, which, depending on a number of factors at times including location, status, ethnicity, familial status, gender, and medical history, are at variable levels of contagion risk. The individual is still visible as a subject, but only as a peripheral figure mediating the isolated visibility of the microorganism. If we think about the way AIDS was tracked by medical authorities along with the way it affected queer life in the US, it’s clear that these two forms of hygiene/public health policing operate in tandem, and that there was no moment in which one replaced the other. AIDS was certainly tracked as a disease agent, with consideration given to its prevalence in various locations, how it spread, and its rate of contagion, but individuals marked as AIDS carriers were simultaneously subjected to exclusions and social stigma. The public health authorities, in this case operating publicly under the data-driven model, were able to claim that any stigma experienced by the individual is merely accidental to their practice. This logic is hard to accept when one considers that AIDS was originally called “GRID,” or “Gay Related Immune Deficiency.”

This shift of focus away from the diseased and onto the disease resembles what Didier Fassin sees as the shifts in perception between the clinical model of health and the public health model. In his “Public Health as Culture,” he defines public health as “the cultural activity through which a biological fact […] is constructed as a social fact, an infantile epidemic with its figures and images, its economic and ethnic characteristics, its etiological models and its practical answers.” There, he describes a situation in which cases of lead poisoning in 1980s France were transferred as an issue affecting individuals and their bodies to being an epidemiological, public health issue affecting populations. It was “now an issue of population, risk, thresholds, collective measures instead of individuals, symptoms, biology and medicines.” With this new object in mind, those claiming ownership over the illness no longer apply the tools of the doctor for examining the body, like the x-ray, but the tools of the public health expert for screening populations and measuring risks, like surveys on buildings, calculations of poisoning rates, and comparative studies.

This data collection is part of a process in which the public health expert naturalizes the disease by inscribing the epidemic as a part of a natural course of things. This power over the perceptual limits of the disease gives them enormous power over how it will be understood and reacted to. In the case of lead poisoning in the text, the threshold of a “dangerous” amount of lead in the body was continually lowered from its original quantity until the amount of people with the new, lower amount was considered an “epidemic.” Without ascribing pessimistic or conspiratorial intentions to public health authorities, it’s clear that there are material benefits for their practice when a disease becomes an epidemic: funding will likely increase and they will be given more discretionary powers over how the crisis will be averted. In addition, because a lower threshold means more minor cases of poisoning, the rates of recovery will likewise be higher than if they only included the most serious cases. Their position also gives public health authorities the ability to make claims about the origin and cause of the disease. The majority of those with lead poisoning in the case study were of African origin. Instead of looking at the amount of lead in the cheap, overcrowded housing buildings, these investigators made claims that immigrants of West African origin were tolerant of “geophagy,” or eating dirt and mineral substances. This assumption, based off preconceived anthropological theories of the ethnic group in question, displaces the question of appropriate housing, and implicitly places the blame on a shared ethnic habit.

Figure 8: This 2014 cover for Newsweek magazine similarly evokes racist stereotypes (connecting Africa and a chimp) and supposed ethnic habits (eating and smuggling bushmeat) to the spread of a disease. That such habits were later proven to have been overstated and unrelated to the spread of Ebola is unimportant, rather they served the function of more deeply connecting the “African” with the dreaded disease. Read this great article for more analysis specific to Ebola:

We’re getting ahead of ourselves. One might say at this point that public health administration today is not related to the other practices from the past. This will be our next task in this piece: to take the line we’ve briefly drawn from the hygienists through the Pasteurians, and extend it to the social purity and social hygiene movements, and into modern-day public health administration. The lines are in many cases already drawn for us. Many of the same individuals participated in multiple groups at the same time, as when the hygienists worked with the Pasteurians, and in the case of the merger between members of the “Purity Crusaders” and the “Sanitarians” in the “American Social Hygiene Association” (ASHA) in the Progressive Era (~1890-1920). Further, the former social hygiene organizations didn’t just disappear: they were either absorbed into one or another governmental or philanthropic organization, or merely changed names, as was the case for the American Social Hygiene Association, which is now called “the American Sexual Health Association.” Using the critical health models we’ve combined in this section, we will, in the next three sections, examine specific cases in which hygiene or health was the driving operator or ordering principle of government. For the sake of consistency and detail, we will look at public health discourse that centers in on the intersection between sex and disease: in section b, we will further examine health administration in the 19th century, looking at the implementation of the Contagious Disease Acts; in section c, we’ll come back to the US, and how the social hygiene reform organizations handled the control of venereal disease and prostitution during and after WWI; finally, in section d, we will arrive in the present usage of hygiene and sanitary laws and ordinances to regulate spaces and actors associated with sex and the potential for disease in the US. In all of these cases, public health is the name for a practice that defines the limits of the status or the appropriate activity of citizenship through representations of cleanliness and dirtiness, personified most often in the figure of the “prostitute,” and the diseases she is supposed to carry. We hope that our observations can be exported and applied to hygienic language that makes no reference to sex, and that our criticism of policing done in the name of “sanitation” can instill a skepticism in the reader and become a tool to make further use of.

“Well,” you may be thinking, “it’s simple! If these bastards say that the poor, the sex workers, and the insane live in garbage huts and ruins, then so be it! I welcome this filthy garbage life!” We see the attraction of such a position, and, before we continue, we feel it necessary to make it clear that to conclude that the solution to the “health problem” is to denounce bourgeois morality, and cast ourselves into unhygienic, unhealthy authenticity is not so simple. This was arguably the conclusion of an older article from the anarchist collective Crimethinc called “Washing … And Brainwashing. ‘Cleanliness is Next to Godliness’” from their book Days of War, Nights of Love. They begin well enough by correctly making the connection between the idea of cleanliness and social differentiation: “we can see that cleanliness has been used as a standard of worth by those with power to ascribe social status.” But soon after arguing that we have all foolishly bought into the idea that “being ‘clean’ according to social norms is desirable in itself,” they begin making the argument that not being clean is therefore laudable. They walk on this fence for the rest of the essay, unsure of whether “cleanliness” is a wholly abstract and meaningless social norm of power, or if there really is something to it, and that, by opposing it and the sanitation products sold to us to attain it, we can embody an authentic working class position by embracing sweat and stink.

The authors of that essay had other polemical intentions in mind, but we feel that the piece demonstrates a tendency of critiques of sanitation and health to imagine that “anti-sanitary” or “anti-health” positions are possible, or desirable. We will not follow this line of thinking. Nor, following Foucault in The History of Sexuality, will we affirm, in our analysis of the regulations aimed at “prostitutes,” the existence of a “liberated sexuality.” Sexuality was invented as a site of the regulation of practices and knowledge. We’ll have more to say of this in the conclusion, but it’s important that we not allow ourselves to stray into the seductions of the negative pole in a binary territory. We will try to stay focussed on how agents use sanitation and health to govern, so as not to reproduce (even negatively) another abstraction of “true hygiene” or “true health.”

  b) Case I: The Contagious Disease Acts (1860s) and regulation

Although the regulation of diseases and the health of populations extends far back into the reaches of the Middle Ages, a recognizable combination of public health operations with their requisite medical and moral explanations took shape in the mid to late 19th century in the British Empire. The Contagious Disease Acts were passed by Parliament in 1864 following a commission into the treatment of venereal diseases in the British Armed Forces, and were amended twice in the course of the decade before being repealed in 1886 after a lengthy campaign against them by middle class feminist reformers and local acts of resistance. The stated goal was to reduce the spread of venereal diseases in spaces where they could most easily be spread. The main target of the Acts were “prostitutes” in port and army towns, and the women of the colonies. The Acts granted the power to police officers to arrest suspected prostitutes, confine them in lock hospitals “until better,” issue penalties to them, and subject them to obligatory venereal disease tests. Who exactly these “prostitutes” were depended on the discretionary gaze of these same police officers, who were authorized to subject any suspected women in public space to their regulatory measures. The women in figure 9 do not have the make-up nor clothing of the stereotypical image of the Victorian prostitute, but the title “The Great Social Evil” and the text clearly identifies them as such (“gay” here refers to their status as prostitutes and not homosexuality). In this way, the moral and sexual identity of women was determined on a case-by-case basis by the police in the name of disease control for the nation.

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Figure 9: “The Great Social Evil.”

The Contagious Disease Acts represent a pivotal moment in a broader movement for public regulation of health. Other systems, strongly resembling the Acts, already existed for decades or even centuries in the colonies and on university campuses in the British Empire. The Acts can be seen as the climax of the 19th century “regulationist” policy movement. This movement aimed at the control of the spread of disease, but it also made broader moral and social claims as the limitations and effects of such control. The regulationists believed, reflecting widely shared truisms, that men were endowed with uncontrollable sexual urges, while women mostly passively engaged in sexual activity out of domestic obligation, with the possible exception of the “disorderly prostitutes.” Prostitutes, in this view, were a necessary evil, who existed to satisfy the insatiable urges of men, protecting the purity and sanctity of unmarried women, who, in contrast to men, deserve to be severely punished for promiscuity. The implementation of the Contagious Disease Acts was situated in these broader presuppositions. The purpose was not to repress or put an end to prostitution, but to control its practice and concentrate it into easily monitored “vice zones” or private brothels. Public space was the target of this control, and private spaces of prostitution, unless they were especially disruptive to the public, were not subject to the same level of regulation that the so-called “streetwalkers” were.

Figure 10: “Running the Gauntlet”

The sexual double standard is made apparent in figure 10, an image called “Running the gauntlet–A scene in front of a popular hotel in New York City at five o’clock P.M.,” by John N. Hyde published in Frank Leslie’s Illustrated Newspaper on May 16, 1874. The men stare and ogle the woman, raising their eyebrows in interest as they puff their pipes, with indifferent, but confident surveilling eyes. The woman, following the highest standards of etiquette of the day, strides forwards without looking, maintaining her disinterestedness in the opposite sex, and a tacit acceptance of the gaze of unknown men.

Not only did the Acts codify the sexual double standard that only constructed female extra-marital sexuality as illicit, but, because any woman who appeared sufficiently dangerous or sexualized could be registered as a prostitute once suspected, they also served to codify social and domestic norms ordering the lives of women in general by policing their appearance, their behavior around men, and their ability to inhabit public space at different times. According to Philip Howell, the majority of women confined and registered were “apprehended for casual assignations or even more or less innocent flirtations.” One can also deduce this fact from the protests against the practice of registering and arresting suspected prostitutes at the end of the century. One author wrote in The Telegraph about the proctors at Cambridge:

Cambridge is . . . no fit place for a decent and respectable woman to live in. […] Young girls, of stainless character and modest manners, have been seized in the streets, their garments half torn off by their brutal assailants, scoffed at as prostitutes, subjected to humiliating examinations by medical men and foully insulted by the cross-questioning of their secret judge, and, after suffering this most abominable and lawless treatment, have been released, with or without punishment, utterly unable to vindicate themselves.

On the other side, social purity advocates, including the largely middle-class feminist alliance credited for the repeal of the ordinances, were disgusted that such regulations served the purpose of providing “clean women” for young men to satisfy their urges with. These protests from both sides —those who viewed such laws as protecting vice by not repressing prostitution and those who saw them as affronts on the liberty of young women— strengthen the general picture of a broad system of regulation targeting all women in public to varying degrees of severity.

This is not to say that the problem with such laws was that they accidentally targeted “normal girls.” In the end, it’s impossible to say how many “real prostitutes” were locked up or affected in comparison with “normal girls,” precisely because the idea of the prostitute was a plastic and imprecise term symbolizing potential disease and disorder. The prostitute —equivalent to the “streetwalker”— was more than just an occupation, she was a symbol for all the potential disorders of society and of the body. Because she blurred “the boundaries between public and private worlds, between the commercial and the conjugal,” she symbolized the subversion of the norms that determined female sexual behavior and lifestyles: she stayed out late on the streets searching for sexual partners, and, mirroring her status as disruptive agent of the social body, was a carrier of diseases that ruined the biological one. The Contagious Disease Acts appear in this light not so much as a regulator of venereal disease as the expression of a balance between the representation of prostitution as a social evil and a faith in their utility as the outlet for young men’s desire. It’s a balance mirrored in today’s average citizen’s pity of the presupposed “plight” of the common prostitute’s life circumstances combined with his disgust with the fantasized conditions of her occupation. The concern and discourse around venereal disease and the nationalistic fear of it spreading throughout the Empire’s forces codified the intersection of sexual and domestic norms and needs, granting them a scientific and medical legitimacy that magnified and glorified the defense of the family by positioning it as the protection of the nation.

The ordinances and the discourse surrounding them served manifestly different ends in the colonies. There the Acts legitimized “negative perceptions about the sexuality of non-white and working-class, recently emancipated women.” The Venereal Disease and Contagious Disease Ordinances were passed in the 1850s in colonial Hong Kong with nearly identical language and purpose to the first Contagious Disease Act: to register prostitutes and inspect or confine women believed to be carriers of contagious diseases. One difference is that these ordinances reached further than the domestic ones by licensing brothels in addition to individual prostitutes. More importantly, however, was the introduction of a new racial fold. The ordinances were targeted specifically at women who catered to Europeans, and took measures to separate brothels which served Chinese and non-Chinese clients, thus confirming “the central importance of race in the attempt to promote or impose sexual discipline.” The brothels and their regulation, according to Phillip Howell, could be seen as inscribed within a commercial and military economy: Hong Kong was a rapidly growing colonial economy and migration hub for cheap Chinese laborers, and the license given to the brothels was an incentive in a new sexual economy saturated with these young, single men, mainly from the Chinese mainland. Soon, however, the “threat of venereal disease posed serious challenges to the security and efficiency of the colonial state, particularly where the military and naval forces was considered.”

But, Howell suggests, there’s more to this biopolitical logic than a simple balance of economic growth and the defense of the state’s security forces. Central to the implementation of hygienic regulations in the colonies was the clear distinction between the Western subject and the racialized Other, whether Chinese, Indian, African, or Caribbean. The commissioners of the Hong Kong Contagious Diseases Ordinances subscribed to a culturally relative theory of the “regulationism” described above. Their report in 1877 stated that “prostitution, brothels and the system of licensing brothels with a view to raise a revenue […] were indigenous institutions in China centuries before the present nations of Europe emerged from barbarism” and further referred to the “national Chinese system of prostitution” as being due to causes natural to China. Such views are based on and inevitably bolster conceptions of the racialized Other as essentially different, more sexual, more ignorant, more base and “natural.” This makes the Chinese, in this case, a “natural” danger to the more sanitary European, hence the necessity of spatial differentiation. Such divisions could not have had any major effect on the spread of venereal disease. Rather, they naturalized the perceived behaviors of the Other and masqueraded the pathologization of the colonized as medical and scientific fact.

For another example of the racial inscription in the language of “hygiene” and “disease,” we can turn to Denise Challenger’s analysis of the Contagious Disease Hospital in Barbados. The Bridgetown Contagious Diseases Hospital was built in 1869 in accordance with the Contagious Diseases Act of 1868, after Jamaica in 1867 and before Trinidad in 1869. It was designed to detain “women that medical authorities and police officers believed were most dangerous to the men of the British Army and Navy.” As was the case in Hong Kong with Chinese laborers, the medical authorities naturalized a conception of black civilians as “licentious” and “promiscuous” and therefore at a greater risk of contracting venereal disease then their former slave owners. The colonized Chinese subjects were said to be at particular risk because of a historical and cultural lineage of prostitution, which in turn were the result of “natural conditions.” In the Caribbean, the discourse fixates on the idea that there were “links between the high rates of VD and the way in which black civilians acted as free people” following the end of the slave system. In both cases, the ordinances codified racial and gendered differences: while the supervising officers were white men, Afro-Barbadian men were often the street patrollers of black women under suspicion of engaging in prostitution. This hierarchical system of surveillance contributed to a shift in the perception of Afro-Barbadian women as the dangerous agents of an infection that harmed both white and black men. All women were potentially suspect, and were expected to police their behavior in accordance with that fact, but this system of surveillance of discipline was most visible in the Hospital itself where women could get sent to prison for infractions like “bad conduct,” “fighting,” “indecent language,” “making noise,” “theft,” or “attempting to contact persons outside the hospital.”

The Contagious Disease Acts were repealed as early as 1886 (later in the colonies) amidst campaigns by social purity reformers, who saw the ordinances as permissive of the “social evil” of prostitution; by feminist “anti-trafficking” campaigners, who held that they facilitated trafficking; and by the Ladies National Association for the Repeal of the Contagious Diseases Acts who opposed the representation of sex workers as criminals by urging parliament to see them as victims of circumstance. Among other things, the anti-trafficking reformists fought against the sexual double standard taken for granted at the time, holding that it was the men who should be criticized or punished, because they were the ones creating the demand. In this rhetorical structure, the difference between the binary genders is still taken for granted, only the moral denunciation is reversed: the women are not immoral perverts, it’s the men whose sex drives are causing all the problems.

Let’s take a moment to acknowledge the fact that these policy reformers were not the only ones fighting the ordinances. Beneath the public reform movements, there were the women who resisted these measures everyday by running away, causing a scene, or fighting when being detained, most of whose actions have gone unrecorded. Denise Challenger begins her essay on the Contagious Diseases Hospital in Barbados with a story of women who chose prison over continued medical surveillance in the hospital through rioting. Judith Walkowitz highlights these everyday resistors and posits a simple truth that the social purists and middle-class feminists didn’t understand, namely that prostitutes “were not rootless social outcasts but poor workingwomen trying to survive in towns that offered them few employment opportunities and that were hostile to young women living alone.” Put another way, sex work was just work, and was not “dangerous.” Its practitioners were neither helpless victims nor libertines.

c) Case II: WWI and the social hygiene alliance in the US

The First World War prompted a new wave of fear around the widespread infection rates of venereal disease among soldiers, giving rise to a sanitary paradigm that looks at the outset similar to the case we just summarized in Britain: an alliance between different groups formed in 1913 in New York under the name ASHA (American Social Hygiene Association) with the goal of ending prostitution and, in this way, end the spread of venereal diseases. The major difference between the social hygienists in the United States and the British parliament at the time of the Contagious Disease Acts is that the former ultimately aimed to end prostitution, while the latter only wanted to regulate it. ASHA, while not comprising the entire social hygiene movement, was the most influential, and represented in its structure the most popular trends in the movement. It was formed in 1913 by an unlikely alliance of mostly male sanitarians on one side, who, like the hygienists discussed in section a, wanted to use science to influence policy and infrastructure to make a cleaner, better society; and “purity crusaders” on the other, who, being mostly women, were largely excluded from the political processes and means to bring about their desired “single standard” of sexual behavior, which underwent some transformations in this era.

The sexual double standard was upheld by at least some in the social hygiene movement, especially by the male medical experts. One poster, designed by the American Social Hygiene Association with the U.S. Public Health Service and the YMCA, read “Men who fail to develop self-control sometimes yield to sex temptation to indulge in sexual intercourse with immoral girls and become infected with a venereal (sex) disease. The chief venereal diseases are syphilis (pox) and gonorrhea (clap).” In this construction of gender, men are those who have powerful urges they must control, while women who partake in extra-marital sexual affairs are “immoral girls” carrying disease. Another poster in the same series informs boys that their “sex instinct” is an internal power, which if “controlled and directed […] gives ENERGY, ENDURANCE, FITNESS.” This view was not shared by all, especially the purity crusaders including one founding member of ASHA, Anna Garlin Spencer, who called for the “single sex standard” so that both agents involved in the sex act would be held mutually responsible. At the same time, Spencer also held that, because men had formerly been given a free pass on the moral consideration of their sexual practices, they were the ones who needed to level themselves to their moral standard set by chaste domestic women. The binary model of the sexes and their morals is still upheld, but it is considered a “cultural” problem rather than a “biological” one. The Women’s Christian Temperance Union —a precursor to the purity crusaders— collected pledges from men that they would stay true to the “single standard.” Figure 11 is a simple example of this new configuration, in which the woman dressed in her white wedding gown is an icon of purity and the family, moral standards which the man is expected to live up to.

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Figure 11: “Have you a right to go to the marriage altar demanding honor and purity in the girl you marry, unless you are willing to offer her a clean life?” from the YMCA collection

Despite their differences, the two groups joined with the shared goal of eliminating venereal disease and prostitution under the name “social hygiene.” The physicians and sanitarians agreed that male chastity was at least a good preventative strategy —even if they did not philosophically agree with its underpinnings— especially as treatment for VD was painful and not always effective. To achieve those ends, the strategy turned toward ending irregular sexual relations (pre/extra marital sex), which in turn would mean the reduction/elimination of prostitution. This would result in a lower rate of infection for venereal diseases, and the end of “sex slavery.” Practically, this meant introducing a new expanded definition of “prostitution,” renamed “sex crime,” which was defined as “giving or receiving the body, for hire, or the giving and receiving of the body for indiscriminate sexual intercourse without hire,” as well as new prohibitions on keeping “place, structure or conveyance” for prostitutes or “lewdness” or taking someone to place of prostitution or transporting prostitutes. Kristin Luker goes on to tell us that by 1920,

ten states had passed laws that enacted these provisions in their entirety, (including the expanded definition of prostitution) and thirty-two states had laws that enacted at least some of these provisions. This new statute definition of prostitution was simultaneously reinforced with other innovative legal strategies championed by the social hygiene movement, namely measures such as the “red light abatement acts” and the “tin plate ordinances.” “Red light abatement acts” (passed by thirty-nine states and two territories) permitted ordinary citizens to close places suspected of harboring prostitutes by injunction, and “tin plate ordinances” (passed by 18 states by 1915) made public the legal ownership of a building (on tin plates attached to the building) where prostitutes were thought to gather.

The use of “licensing” ordinances and these laws brought saloons, taxis, dance halls, and road houses under regulatory control by threatening their property, status, livelihoods, or licenses. By 1918, 32 states had laws permitting health departments to quarantine those suspected of venereal disease, and since social hygienists believed that 90% of all prostitutes were infected, and the definition of prostitution had increased, such laws could be used to detain massive groups of women (~30,000 during WWI). This required the construction of an expanded set of carceral institutions and the increase in the number of prisons, especially women prisons. New courts created by reformers dedicated to prostitution employed fingerprinting and examined women for venereal diseases, and sorted women into the workhouse, prison, public health hospital or “feeble minded” population. This combination of moral zeal and (male) medico-technical expertise and jargon allowed the social hygienists to “call upon seemingly-neutral ‘scientific’ and medical information in one era of public concern about a dreaded disease (a concern they themselves had helped kindle) to argue for a new moral, social, and sexual order.” The women’s groups were eventually abandoned, and their “single standard” was replaced by the military standard of “fit to fight,” exemplified in the 1940 war-time propaganda poster in figure 12. This further demonstrates that the standards being touted as scientific or objectively sanitary/hygienic are in reality only opportunistic.

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Figure 12: “HEALTH is a patriotic duty. KEEP FIT.” From ASHA

It’s at this point that we can bring our discussion into the present and see how the lineage of something like prostitution regulation affects modern-day public health policy. What we tried to highlight in these last two sections was that the discourse centered around notions of “sanitation” and “hygiene,” even when related to or centered on the objective existence of venereal disease, for instance, is in no way a neutral object of desire. First of all, notions of “cleanliness” are always bound to beliefs of cultural or natural superiority. This makes “hygiene” an advantageous gateway for proponents of racist or gendered configurations who desire a “scientific” or “objective” standard for their theories. We don’t mean to say that the eugenists and chauvinists of the world knowingly take and apply notions of hygiene, but rather that notions of hygiene already carry with them the idea that there exists “clean” things and people and “unclean” ones. This becomes more complicated when the “unclean” becomes associated with a figure like the “prostitute” who is herself a complex assemblage of racialized, gendered, and classed fantasies and attitudes. Second, and this is closely related to the first, hygiene cannot be wholly distinguished from moral systems and logics. One’s notion of what is “clean” speaks to the values of those who say it. Hygiene and sanitation are inherently normative and value laden, but what those values are depends on the user and their purposes. The purity reformers, for example, were able to combine their moral outrage at the double standard of the sexes with a pseudo-scientific logic identifying it as the cause of venereal disease. Lastly, the idea of “hygiene” mobilizes those who hear it into action. When one speaks of sanitation, it calls to mind with it the actions that one considers clean, as well as those one considers unclean.

It’s important to recognize here that administration through hygiene is much more diffuse today than it was in 19th century Britain. The American picture sketched above demonstrates that the policing of health or hygiene can be codified in policy, law, city codes, or ordinance; it can be carried out by police officers, licensing agencies, judges, and even everyday citizens (through complaints); and it can be positioned as if it were targeting a group (e.g. prostitutes), a disease, or a “contagious environment.” Public Health, as we’ve outlined it, is a mobile and elastic power that weaves in and out of different vernaculars and institutions, capable of reshaping or reinforcing existing racial, sexual, domestic, and moral paradigms. We must keep all these facts in mind as we return to the present day.

d) Case III: public health and spatial reconfiguration

In mid to late 2017, a debate started in Minneapolis around meeting spaces where upwards of 300 people would meet, party, hang out, or have sex, which most people locally didn’t even know existed. The conversation began to get picked up by the local paper City Pages and a few others after a raid on an underground, unlicensed gay bathhouse in January 2017 in North Minneapolis. The police, acting on behalf of the housing and fire department, rushed in one night, flashing their flashlights on the patrons, and ordered everyone out. That space, the Warehouse, was the last of the banned sex clubs. These raids make an instructive case study for how the intersection between hygiene discourse, the fear of disease, and city ordinances operate in tandem to regulate people and spaces deemed risky today.

The city codes used to boot this sex club and the others that came before it, along with the fear of disease that accompanies them, date back to the late 1980s, when HIV was still a terrifying, unstoppable disease thought to be emerging from the gay underground. To find these codes, one needs to open the Minneapolis city ordinances to Title 11 – Health and Sanitation, Chapter 219 – Contagious Diseases, Article V – High Risk Sexual Conduct. This is the code that bans such “high risk sexual conduct” in buildings constructed for that purpose across the city. The part of the ordinance that concerns us reads:

The sexually transmittable disease of acquired immune deficiency syndrome, currently found to be irreversible and uniformly fatal, is found to be of particular danger to persons in this community. The incidence of this disease is found to occur in discernible population groups. The risk factors for obtaining or spreading the disease are associated with high-risk sexual conduct. The commercial premises, buildings and structures where persons are placed at risk of infection from this disease or other communicable disease facilitated by their design or use for high-risk sexual conduct are in need of regulation, and of establishment of minimal standards for the prevention of the spread of this disease and other communicable diseases for the protection of the public health, safety and welfare of the community. [My emphasis]

It defines such “high risk” behavior as either “(a) Fellatio; (b) Anal intercourse; (c) Vaginal intercourse with persons who engage in sexual acts in exchange for money.” When the city ascertains that a space is a site of this activity, the health commissioner has the ability to “issue warning,” close the space after calling it a “hazardous site,” and “may secure a court order for the closure of the premises.” Notice it does not allow the Health Department or the health commissioner to order an immediate shut down of the space.

In practice, health code ordinances are rarely used alone. More often, as was the case here, they are used to conduct an initial investigation or raid so that the police or the commissioner can find another, simpler violation to make use of. For the gay bathhouse, there was no license. In the city’s own report on the raids on the “adult establishments” we wrote about in the first section, they note in the section “Current Regulatory Tools” that Article V is “Outdated,” has “Incorrect scientific information,” and “Lacks effective enforcement.” But these are small hurdles. They recommend that one could also make use of a Minnesota statute 145.A, Public Health Nuisance, which allows county boards to “adopt ordinances to define public health nuisances and to provide for their prevention or abatement.” When public health actors have the ability to both define what the problem is and make arrangements to solve the problem, the only thing that matters as far as the public is concerned is a convincingly scary disease or hygiene narrative to stop them from prying any further.

This method offers the city an easy way to get into spaces they might otherwise have legal difficulties getting into, and provides a simple retroactive explanation after they’ve already raided or investigated a space. It was due to sanitary violations that the FBI were able to raid and eventually shut down the Black Panther’s Chicago health clinics. In April 1970, Bobby Seale issued a directive to the Black Panthers that all chapters should open a health clinic as soon as possible. While the rollout was unequal across different cities in terms of capacity and expertise, most clinics offered basic care, check ups and referrals at no cost, while some offered ambulatory and dental services, with a broad focus on preventative care. Some clinics offered an advocacy service, so that a Panther with more experience could accompany patients to the doctor and make sure they were getting the best care, and they also held teach-ins to inform people about sickle-cell and other ailments that could potentially affect them. When the FBI felt unable to just bust in and shut the Chicago clinic down, they relied on housing and health authorities to make the move for them. First, the city of Chicago issued a directive that the clinic would have to get a license through the health board and allow unannounced inspections. The Panthers refused and the city did a “sanitation” check and was able to shut them down on health code violations.

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Figure 13: Screenshot of an article from connecting the double entendre “human waste” to “petty crime.”

More recently, the Occupy Wall Street encampment in Zuccotti Park was raided and shut down in November 2011 due to concerns around sanitation and hygiene. An article by the New York Times called “A Petri Dish of Activism, and Germs” was published just a few days before the raid on the 15th of November. The structure with which the author builds his case for the unsanitary conditions is reminiscent of the articles on strippers as it’s just as contingent and fragile. He starts by mentioning that someone coughed, and then someone wheezed, then just a few paragraphs down quotes “the director of clinical microbiology and immunology at NYU Langone Medical Center,” who said that

the conditions could leave park-dwellers susceptible to respiratory viruses; norovirus, the so-called winter vomiting virus, which can lead to vomiting and diarrhea and which could quickly overwhelm the limited bathroom facilities in the area; and tuberculosis, which is more common in indigent populations and can be spread by coughing.

Just as was the case with the strip clubs, there are no mentions of these diseases actually existing, only the potential that they could exist. They go on to trade in the clichés and prejudices of all those who try to use notions of health to delegitimize their enemies. He mentions at one point that, although “licensed doctors and nurses often take volunteer shifts in the [medical] tent,” one could also see “shamans walking the premises,” at which point the audience is supposed to laugh at these fools who would employ primitive means to fight (potential, not-yet-existent) diseases. He ends the piece with the ultimate gesture of fear-mongering by noting that these protestors aren’t just putting their own idiotic lives at risk, but also those of good, normal people: “Of course, contagions may not be confined to the park population,” he says, before quoting a demonstrator as saying “We’re the biggest tourist attraction in New York, [a]nd we shake everyone’s hands.”

There’s more to that piece than providing a rationale for evicting the park. The derisory descriptions of the sanitary conditions and sarcastic allusions to the means available for correcting them are written so that the reader walks away with an understanding that those people are not only at risk of spreading disease, they are themselves a kind of disease. They are surrounded by filth and garbage, and are collectively the filth and garbage of the human race. The title of the article in figure 13 makes this equivalence directly when they refer to “human waste.” Human waste firstly as shit, but also human waste as in humans who are waste and shit. This was also the case with the Standing Rock “trash scandal.” After the camps were raided, and the remaining occupiers either fled or were arrested, there were piles of trash left behind. It was below zero degrees for months and much of the collected trash was frozen into the ground; the raid caused a panic and, amidst fire and riot police, trash collection was not a top priority; and many of the roads were blocked, creating massive difficulties for regular trash disposal. In the end, it doesn’t matter what the reasons were. What matters in this case is that those who would like to regard the entire affair as not only pointless, but idiotic and regressive latched onto this story about trash piles hearkening back to the age-old Western performance of superiority. We are noble, clean, and pure, and our enemies commune with garbage.

An early Bismarck article published in February 2017 called “Sanitation crews work to remove massive amounts of garbage from DAPL protest camp before spring thaw” seems to be the story that provided the fodder and the tone for the more sensational and morality-laden publications that followed. The author, Sara Belinger, informs the reader that 250 trucks worth of trash would need to be removed, and that the amount of trash was equal to six months worth of garbage “from a community the size of Wahpeton or Valley City.” No mention is made to the size of the encampment, nor to what this “garbage” consisted of, nor to the trash disposal methods already in practice at the camp, nor to how long the camp was there. These facts don’t matter, because these “objective descriptions” are anything but that. They are codes that signal to the reader that the NoDAPL encampment was the opposite of what it said it was. Belanger follows up her list of isolated sanitary violations with a statement from Morton County Sheriff’s Office Captain, saying “As bad as it sounds, we’re looking for people that may have died and could be wrapped up in a canvas or a tarp or tent.” The demonstrators were claiming to protect the environment, but, in reality, they were infecting it with their filth. Not only were they potentially guilty of killing the environment they were there to protect, they may have also killed people in the process. Hygiene is the vector through which presupposed political and historical values —the Western superiority over the imagined primitive— become inscribed in scientific and pseudo-scientific fact. It’s the symbolic vector through which piles of garbage viewed completely abstracted from all circumstance can become tentative proof that the protesting native is a danger to the world and even a potential murderer.

Returning back to our local example, it is interesting to note that the two articles on the gay bathhouses for City Pages were both written by Susan Du, the author of a mean, but supposedly sympathetic, piece on strippers following the “semen investigation” in which she referred to them as “flesh merchants.” She began the piece called “Behind the fantasy at Minneapolis strip clubs” by listing bodily fluids, calling strip clubs “filthy,” and then listing diseases some of the dancers had. Her tone in the two articles on the gay bathhouses is much more understanding. She doesn’t list the bodily fluids she can find or that she heard were there, she doesn’t examine the couches and call them filthy, she doesn’t interview the patrons and ask them what diseases they have. “How shameless, how normal” she writes, not like those nasty flesh merchants who trade in immorality and disease. She’s ostensibly sympathetic to both the underground gay sex scene and the strippers working in bad conditions, but her unfortunate, sensationalist descriptions allow the reader to come to the conclusion that strippers themselves are disgusting people. Whatever her reasoning or lack thereof, we reject any gesture that defends the honor and status of one stigmatized group by deriding and degrading another. Another article by Daniel Villarreal on the website Hornet titled “There’s a Battle Brewing That Would Bring Gay Bathhouses Back to Minneapolis” also attempts to uphold the hygiene of these bathhouse spaces at the expense of strip clubs by referring to the aforementioned semen investigations.

The sex worker once again serves as the virtual object onto which anyone can project their own fears of disease, sickness, and moral calamity; the spaces she inhabits are fluid-soaked dens of iniquity and disaster, ruining everyone who steps into them. In this case, this fantasized image works to protect other marginalized subjects and spaces. She ought to at least get paid double for this abstract labor, don’t you think?

e) So what do we do with our bodies?

Social reality is as real as biological reality. One could even say that the former is a weapon that can be used to act upon the latter. We simply need to be aware of that if we are to be adequately prepared for battle.

                                                                                      —Didier Fassin, “Public Health as Culture”

The question facing us now is “what to do with our bodies?” What do we mean by that? No matter how abstract and distant their usages have come to seem —no matter how convoluted their political meanings have become— we nevertheless acknowledge that the words health, sanitation, and hygiene speak directly to us, and to the way we imagine our bodies.

It should be clear by now that an unqualified “pro-health” or “pro-hygiene” position is dangerous. The public function of the word “sanitary” or “hygienic” today has very little to do with disease and their modes of infection, nor with the well-being of a person and their body. More often, such words indicate that a group is a potential danger (as with Occupy and the strippers), they provide a legal means to perform otherwise inhibited police operations (as with the gay bathhouses as well as the “adult establishments,” and Black Panther clinics a few decades ago), a means of defaming and ascribing moral failure to a group by associating them with garbage (as with Standing Rock, and all the other examples to some degree), and, associated with this last method, a way to highlight the values and morals of one group by taking jabs at the sanitation of another (as when writers demonstrate the cleanliness of the gay bathhouses by comparing them to the “dirtier” strip clubs).

When we say “words,” we also include the images and icons of a visual language. Above, we included some images produced by public health organizations. Today, it is clear that such posters no longer have the same relevance. Can you name a single poster released by the CDC or the Department of Health in the last ten years? We don’t mean to say that public health has lost its visual language. To the contrary, the language of hygienic segregation is so diffuse that its visual vocabulary has been widely disseminated via pop cultural products, social media “meme warfare,” and journalistic productions. During the presidential campaign for Hilary Clinton, far-right groups posted memes that showed images of trash piles and dilapidated houses in Haiti, making connections between the unsanitary conditions portrayed in the pictures and both decolonization (the incapacity of “savages” to take care of themselves) and supposed corruption in the Clinton Foundation’s activities in Haiti. When a reporter wants to discredit someone or a group without saying so, it’s usually simplest to show photos of blighted housing or unsanitary conditions, as we’ll see later in this section. The visual language of hygienic superiority is no dead language, it’s common slang.

An “anti-hygiene” position looks just as untenable as a pro-health one, and downright silly if applied too generally. Don’t get us wrong. It can be a valuable way in certain scenarios to reclaim an activity deemed filthy and immoral. There have been some wonderful gestures from this position, with the most extravagant examples coming from acts of queer resistance. In John Water’s Pink Flamingos, a group of reporters begin an interview by asking Divine whether she’s a lesbian, and go on to ask about her political beliefs to which she responds “Kill everyone now! Condone first degree murder! Advocate cannibalism! Eat shit! Filth are my politics! Filth is my life!” Antonin Artaud wrote love letters to syphilis and glorified the lowest trash above the police and psychiatrists who wanted to control him: “shit, fart of my prick/(this fart let go in the grand imprecatory style, while belching under the boots of police)” or, at another time “my existence is beautiful but hideous. And it isn’t beautiful only because it is hideous./Hideous, dreadful, constructed of hideousness./Curing a sickness is a crime.” Artaud learned to love sickness and filth. Not in themselves, but insofar as they were the exact opposite of what the doctors and psychiatrists (who arrested him, shocked his brain, and forced medication on him) wanted for him. Around the time Pink Flamingos aired, Front homosexuel d’action révolutionnaire in France made banners that read “Proletarians of all countries, caress each other!” Or: “Sodom and Gomorrah, the struggle goes on!” And finally: “Ah, it’s nice to be buggered!” The contemporary, but now defunct, network Bash Back brought this attitude into the present with slogans on their banners and proclamations of their pride in being dirty. To proudly proclaim your filth and radical distance from the safe, conservative world picture of Western hygiene is not the antithesis to the abstraction of “health,” but speaks to a different standard and conception of what it means, and the necessity of declaring one’s distance from the norm. Rarely does it mean for those who say it that one ought to embrace death and self-destruction, but more often that the moral cleanliness accepted as an objective norm is undesirable and even damaging.

Figure 14: Divine on her political views. From Pink Flamingos.

A number of concepts have emerged in popular parlance in the course of the last decade to try to account for this gap between the necessity of adapting to the hazards of living in this world and the baggage that accompanies every way we know how to talk about remedying that toxicity. Calling for improvements to health or more healthcare without explaining what that means just wont do. After the events of Charlottesville, the American College of Physicians declared racism a “public health issue,” as have some psychiatrists. Racism as a public health issue means displacing racism as a politico-historical issue into the domain of the biologico-medical. Certainly, the effects of white supremacy on the psyches and bodies of black and brown people are traumatizing and even deadly, but that does not make them primarily an issue of “health policy.” That would be to discount the very material politico-historical processes of slavery and institutional white supremacy that got us to where we are. On the day I wrote this paragraph, February 9th, 2018, the New York Times published an opinion piece called “Is Loneliness a Health Epidemic?” in which they questioned the recent decision by British Prime Minister Theresa May to appoint a “minister of loneliness” and subsequence announcements that loneliness has become a “health epidemic.” Naturally, a neoliberal administration would not want to call attention to the tendency within neoliberal programs to create pockets of isolated and precarious workers. Whether or not that idea sticks, “loneliness” has apparently become the next buzzword of the global health administration’s progressive medicalization of all political and economic problems. If we remain unaware of these appropriations while continuing to demand more healthcare, we are creating a foundation for the medical colonization of political problems.

Figure 15: “Racism makes me sick,” an Australian public health advertisement. It’s true that racism has bad effects on bodies, but calling it a “public health issue” can obfuscate the political history behind the racism.

Every place that Western nations have come to lay claim to, they have also brought their “health” with them. The settler-colonists cannot use the word “health” unless they first eradicate everything that resembles it. When the Western powers talk of health, one can be sure that people will be slain, practices banned, holy sites demolished, and herbs destroyed. The cultivation of civilization in the Middle Ages meant banning the use of traditional remedies and medicines, particularly those used by women, who were burned as “witches”; expanding American civilization and health meant the banning of American Indian religion and medicinal practices from the 1870s until native activists incrementally regained through struggle the ability the use peyote, perform Ghost Dances, and took back some of their ancestral lands, protection for grave sites, and the right to practice religion in the 20th century; spreading British civilization meant banning “witches” in South Africa under the Witchcraft Suppression Act of 1895 and then again in 1957, which bans “supernatural” remedies for distress; bringing civilization to New Zealand meant banning the Tohungas, the traditional healers, in the Tohunga Suppression Act of 1907. Such examples demonstrate that “health” does not exist as a single thing, and that the controversies of health are just as much controversies of politics and ways of living, not merely the absence of disease. When one points out that the Europeans sought to eradicate diseases in the colonies, they fail to mention that they did so solely to pave the way to slavery, resource extraction, and colonization.

Figure 16: Hexenbrennung (Burning of Witches) from the “Bilder Cautio,” 1632.

Nobody should take unqualified injunctions to “improve health” seriously anymore. Calls for “self-care,” or even “radical self-care,” have been heard in its wake. What exactly this means is difficult to glean from scanning the range of its usage on social media feeds and longreads from the website Medium about topics as wide-ranging as food choices, meditation, and “letting yourself relax.” For the most part, such “self-care” offers strategies to regather one’s strength to continue working. The neoliberal subject is expected to take care to ensure their body and mind are ready for another long day of work. Some of the most cynical iterations of this concept encourage the reader to immerse themselves in an array of consumer products like soaps, chocolates, or movie streaming services. The notion of “radical self-care” seems to have been developed explicitly to combat this market driven rejuvenation of the body, at times also offering a means of incorporating an understanding of race, gender, disability, and difference into the notion of “care.” It remains to be seen whether this “radical self-care” will truly distinguish itself from the “traditional value systems of worthiness and productivity” and be able to resist “the culture that tries to marginalize, define, and shame us” rather than, say, offer practices of the body that preserve it in activist roles as long as possible. In that case, the logic would remain the same (preserve your body and extract as much value out of it as possible via such-and-such simple tips), but the realm of activity would be different (one extracts value for a job, the other for activism). Still others use the term “radical self care” to mean only “moving self-care high up on your priority list,” which makes it basically indistinguishable from simple “self-care.”

Others, often of a more radical bent, speak of “health autonomy.” We profess that we don’t always understand exactly what is meant by this concept.  What exactly is meant by “autonomous” in this context? Some highlight the need to de-professionalize health and spread knowledge of practices one can do on their own or with others to prevent illness. Some take this approach a step further and provide workshops to teach skills one would otherwise require a doctor for. Frank Coughlin, in an interview published in Mask Magazine from April 2017, talks about his disillusionment with medical institutions and doctors following his realizations about structural violence and power. “I realized the institution itself is the problem,” he says. His concept of the “radical doctor” resonates with many other ideas of what it means to practice “radical health:” one, that we recognize that all disease is social, and two, that we ought to be de-professionalizing health and decreasing our reliance on health institutions by increasing the capacity of “community organizations.” To summarize, the “autonomy” in “health autonomy” refers to a spectrum ranging from de-professionalizing skills and knowledge to the intentional construction of accessible spaces to learn these skills and provide treatment.

The polyvalency of “health,” on the other hand, remains attached to its “autonomous” iteration. If we do not immediately make clear what this “health” is we are making autonomous, we open the door to grave dangers. The de-institutionalization of the mental health system in the 1960s is an instructive case in this regard, and one which we’ve covered in more detail elsewhere. If the process of “de-institutionalization”/”de-professionalization” occurs, as it did with rise of the community mental health treatment centers and the diffusion of the diagnostic and police authority of psychiatrists, then the fundamental assumptions surrounding so-called “mental health” remain, with all their baggage. Coughlin, for example, makes it clear that “if someone is having an acute psychotic break, we may not be able to treat them. Sometimes there is a role for medication, but those are the last resort versus our first resort,” and later remarking that “People are anxious, depressed, manic, and suicidal.” We don’t quote him here in an attempt to pigeon-hole his perspective as “uncritical,” but rather to point to the danger of calling for “mental health” without fundamentally questioning the diagnostic labels and conceptual tools handed down to us from institutional psychiatry. The same could be said about “health.” The assumption of the materiality of these health/mental health concepts is widely accepted among proponents of “autonomous health.” We don’t want the “health” of this civilization, nor its mental health, which is why we ought not mistake its concepts developed in many cases for social control, scientific-racial paradigms, and/or eugenicist taxonomies as “real” in and of themselves.

In the wake of these alternative health perspectives, we propose only a healthy dose of health skepticism combined with an orientation towards health as a collective strategy, and not an individual goal. The Black Panthers offer a particularly instructive example of the possibilities of the skeptical health position. Alondra Nelson, in her preface to Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination writes “Health is politics by other means,” and should be treated as such. The Panthers surely treated health with the gravity and nuance it deserved. They paid attention to the ways in which ideals of health are held up as reflecting conceptions of the “good society;” they saw how health marked the boundaries of citizenship for black Americans, declaring they lived in a state of “Medical apartheid;” and how health and politics are intertwined “vectors of power,” and thus the site of uneven encounters between racialized subjects of biomedicine and the agents of public health. They created their clinics, as we’ve already discussed, but they also popularized alternate theories for the origin and spread of disease, as well as practices of prevention users could practice on their own.

They did their best to shut down attempts to medicalize the effects of white supremacy as when they opposed the creation of the “Violence Center” in California that would have looked into the biological connections between violence and race. The skeptical health disposition questions any statement about health and hygiene that does not take the historical and the political into account. When the Panthers shut down the Violence Center, we imagine they asked “whom does this serve? What ends does this serve?” The answer could only be the institution of white supremacy that protected the position of the doctors propagating the “racial theory of violence.” The skeptical health disposition means adopting this attitude and desire to learn in context without becoming self-destructive. One can be critical of health without desiring to be ill. The gay bathhouses offered a space for people to openly engage in sex acts once considered extremely dangerous and still widely thought of as “unsanitary,” offering condoms and informational pamphlets about HIV and the availability of PrEP.

Figure 17: The May 21, 1971, issue of the Black Panther newspaper.

The Summer 1971 of the Black Panther newspaper published an article called “America’s Racist Negligence in Sickle Cell Research Exposed by its Victims,” in which two women were interviewed on their experience with the disease. The illness narrative is one of the primary tools available for the skeptical health disposition, and the Black Panthers were especially capable of integrating a personal narrative into bigger picture. If we want to disrupt the hegemony of public health explanations for what ails us, we need more such narratives from those who carry the diseases and illnesses we’re being told to fear so much. We need to illuminate the broader circumstances that contribute to our ill-feeling, as a total picture, entwined and mutually implicated in the lives of others, without reducing these to individual issues.

How we talk about our health will continue to be a problem. Care was appealing at first because it implied an action, “to care,” rather than an abstract state, “health.” At the same time, it bears a troubling relation with traditions of sovereignty, as when the king declares his intention to “care for the people.” Care, in the vocabulary of welfare bureaucracies and empires alike, is a biopolitical regulatory principle; in our neoliberal present, where we are all asked to make our bodies and our lives as profitable as possible, care and “self-care” are just synonyms for investment. So how do we talk about our bodies and the problems we face, if not through the words and concepts we know and have available? How do we care for one another without relying on abstractions that perpetuate the bloody amnesia of colonization?

So it is that I consider
That it’s up to the everlastingly sick me
To cure all doctors
—born doctors by lack of sickness—
and not up to doctors ignorant of my dreadful
states of sickness
to impose their insulintherapy on me
their health for a worn-out world.

-Antonin Artaud, “Doctors and Patients”

Scientific objectivity was barred for me, for the alienated, the neurotic, was my brother, my sister, my father.

-Frantz Fanon, Black Skin, White Masks

*Note: The footnotes to this piece can be found in the zine version on our PDF page.


The Myths of Sex Trafficking

This is the introduction to The Myths of Sex Trafficking: A Reader on Law Enforcement and Carceral Feminism.** Download the reader here and find the full length articles here.

This reader was put together in the shadow of the 2018 Minneapolis Superbowl. With a major sporting event like this there is—among other things—an intensified deployment of law enforcement, a rapid push to “clean up” neighborhoods, and a purported increase in sex trafficking, used in part to rationalize the increased policing.

For two centuries moral panic and reformist policies around sex trafficking have been used to abuse, imprison and control sex workers, women of color, immigrants and so-called deviant women. The term “traffic in women” emerged in the U.S. as a replacement for “white slavery”, a racist myth proliferated by white politicians who were panicking about the abolition of slavery and “racial impurity”.

In the 20th century, social-purity reformers (or moral hygenicists) used anti-trafficking campaigns for their eugenicist projects to “clean up” American cities of criminals and the unruly and to lock women into reformatories and prisons—of course categories like “criminal” have always been racialized and therefore have always most affected women of color.

Anti-trafficking campaigns have consistently conflated prostitution with trafficking, which has furthered the criminalization and stigmatization of sex work. Today, actual victims of trafficking are often most harmed by the work of anti-traffickers who rely on police and state intervention. Even when portrayed as a victim (such as Cyntoia Brown) those who are trafficked are treated as prisoners and their stories largely go untold. They are pushed through victimization to criminalization to institutionalization.

What if the humanitarian words we are so used to hearing don’t mean what they claim? What if those being rescued don’t need rescuing? What if the options of rescue are doing more harm than good? What does it mean to align oneself with the white supremacist legacy of anti-trafficking?

What follows are three articles tracing the history of anti-trafficking through social-purity reformers to the cooperation of evangelical Christians and liberal (white) feminists to moral panics around major sporting events. These texts are intended to demystify the vast misunderstandings and misconceptions that exist around the beliefs of sex trafficking. In an attempt to make the articles somewhat more digestible, they have been slightly abridged (indicated by […] where content has been removed). The citations and footnotes have also been removed as these seem like academic conventions that most readers probably don’t care about. It should also be noted that the term “women” is used throughout as the subject/object of inquiry, in which we would unquestionably include transwomen—with race further structuring levels of harm. Moreover, all sex workers, no matter their gender identity, are targeted in some regard by anti-trafficking campaigns.

“Surveillance and the Work of Antitrafficking” follows the early history of anti-trafficking, specifically in the context of colonialism and “social hygiene” movements. The article examines the shift away from the term “white slave traffic”, replaced by the more “universal” and “neutral” term “traffic in women”, and the explicit and implicit white supremacy of this mythology. The article looks at the international body the League of Nations and their various reports related to their efforts to surveil and control the bodies and movement of women.

“Militarized Humanitarianism Meets Carceral Feminism” looks at anti-trafficking movements in a contemporary setting and ways in which evangelical Christian groups and liberal feminist organizations have merged since the 1990s. The author shows how evangelicals have swung to the left to take up the cause of anti-trafficking while liberal feminists have at the same time swung to the right and how both have committed to state and carceral solutions. The connections between anti-trafficking campaigns and criminalization are shown as well as the negative effects on sex workers and people of color.

“Evangelical Ecstasy Meets Feminist Fury” provides specific examples of anti-trafficking campaigns around large scale sporting events. The article shows how from World Cup to Superbowl to Olympics, sex trafficking is touted as a central problem but time after time the outcomes are the same: little to no evidence of trafficking, increased complaints of police brutality and arrest of sex workers, and moral panic based on a racist legacy of unsubstantiated claims. The article also emphasizes the important rhetorical move in anti-trafficking ideology conflating trafficking with prostitution.


** 3/3/18 The title of the reader was updated to make it clear that this is relevant to contexts beyond just sporting events. We are baffled how people continue to uncritically accept the discourse around trafficking and prostitution.

Why We Need Mass Shooters to be Crazy

Saying the Unsayable Every Time

When the unspeakable occurs, where do we turn for answers?

Whenever a politician or pundit — the two rusty gears of the great national blah-blah-chatter-machine — informs us that a shooting is an inarticulable tragedy — an unspeakable event — one can be sure this statement will be followed by excessive explanation.

In the wake of yet another mass shooting event in the US, journalists struggle to find answers as to how or why these keep occurring. Perhaps too many people have guns, or America is too violent, or maybe we’ve just lost our faith in God.

Through all this chatter, one answer is consistently appealing to all sides: the killers are crazy, psychos, lunatics, deranged, deluded, psychotic, mentally ill, Mad. Trump only said what everyone was thinking: Devin Patrick Kelley is another symbol of a national mental health crisis.

CNN reporters Emanuella Grinberg and Eliott C. McLaughlin believe that “the warning signs were there.” [1] Which warning signs? “Domestic violence. Sexual assault accusations. Animal cruelty. Escape from a mental health facility. Threatening text messages. An obsession with guns and mass shootings” they tell us.

This continued obsession in the biographical, the subjective, or the personal, means that the systemic and the historical will once again be swept aside. Hegemonic normative systems can only reproduce themselves if they can prove that the incident of extremity and ultra-violence are explainable solely by reference to the particular and not an expression of the system itself, even if it is an extreme one.

With this in mind, there is something profoundly disturbing about that list from CNN above. Each characteristic is listed as if we the readers ought to register them as Other, as abnormal and incorrect.

Their statement contains two dangerous errors in this regard: 1. none of these forms of ultra-aggression and terror are “outside” to Western values, rather, they are integral to them; and 2. escaping from a mental hospital does not belong on a list of assaults. Wrong first because they fail to see how these forms of aggression and hostility towards perceived weakness grew out of his experience as a normal, white, straight male, and not as some bizarre abnormality. Wrong also because they lump these forms of aggression in with the drive to escape from the controlling environment of the mental hospital.

The smooth integration of this supposed proof of mental instability and abnormality in  their list is a sly trick and one which serves a specific purpose: if they can point a finger at the psychos, they can continue to ignore the violence we all let fester within and around us.

More Than Just Normal

We find ourselves incapable of reading Devin Patrick Kelley’s “warning signs” as exactly that, as warning signs. Rather, they seem like the normal objects of our collective psychic environment. We see it like this: the nice, pleasant, normal, environs we live in, and the nice, pleasant, normal young men who most confidently move around in them were produced through acts of terror and aggression; they maintain themselves through these, and the act of locating the source of these hostile tendencies in the “mad” is a part of this structure.

White identity was/is produced through both legal and discursive acts of separation on the one hand and acts of performative domination and actual terror and destruction on the other. It was constructed in the Plantation era to separate the low, the nonhuman or partly human, from the high, the Whites. When whiteness came under threat — whether from slave insurrections, mixed race revolts in the pre-revolutionary era, or black organizing in the 60s — it was reconstituted with acts of extreme violence: mass executions, bombings in the South, re-enslavement and public torture. These events clearly had a performative and demonstrative element: they demonstrated that whiteness was untouchable and perceived encroachments would not be tolerated.

Silvia Federici, in Caliban and the Witch, wrote extensively on the physical and psychical violence committed against women in the construction of what might be called the “modern” form of Western Patriarchy. [4] Patriarchy for her isn’t some wisp or spook, nor a spectral abstraction used only for pointing out the meanness of men. Federici shows that it’s a real material process of degradation and terror leveled against the autonomy and abnormal behavior of women. This process didn’t occur merely through forms of discourse, but also through the physical destruction of medicines, degrading representations of women, the burning of “witches.” In other words, through systemic  terror and aggression.

Terror — the severing of limbs, the wanton violation and destruction of bodies, the performance of absolute domination and control — is more than just a normal part of our normal value systems (what many call White Supremacy and Patriarchy), it is the ritual element required for their continued existence. It may be extreme to hurt animals, to beat your wife, or to obsess about tools of murder, but it isn’t abnormal, not here, not in the West.

The designation of a class of “mentally ill” is part of this structure itself. As Erma VIP did in her critique of Susan Du’s City Pages article on strippers, we must ask ourselves who benefits from the further stigmatization of the mad? Who will suffer on account of Kelley’s portrayal as “mentally ill?” Probably not us (Sasha), at least not directly. Because we look the way we do (i.e. white and male), our abnormalities are not often read in public (although not never) as “dangerous schizoid behavior” but more often as drunkenness, or just weird. Certainly, we could suffer on account of this perception. It all depends on how we are seen in the moment, and Kelley’s portrayal as “crazy” won’t help.

Of course, that doesn’t yet take into account how these public accusations fit into a psychic economy. The self-representation of our differences as illness and the self-doubt around our own “threat potential” are not nothing. Concern over our “condition” (at this point of cognition, the condition is already separate and no longer simply a part of who we are) and whether or not we are perhaps actually a danger, or will be perceived as one, means that we, and others in our position, will be less likely to want to reach out and either share experience or seek care when needed. As some begin to publicly argue that increasing the rate of forced commitment is necessary to solve the “mental health crisis,” suicide suddenly becomes, in the moment of distress, a more tenable and attractive option.

But “madness” and “mental illness” themselves are constructed and traversed by contradictory lines of race and gender. The further stigmatization of the umbrella group  “the mentally ill” will only foster the mentality of fear, which makes a life-or-death situation out of the encounter with a “schizo” or “psycho.”

Whiteness, in the context of the insecurities it itself has reproduced through its exclusions, lives in perpetual fear of retribution for its history. The darker the skin, the more likely the White Man will feel himself existentially threatened, and the more likely he is to call the police, who, as protectors of white society and its values, themselves perceive danger at every turn.

Even though Kelley himself was white, the “mentally ill” appellation cascades hierarchically downward, increasing the chance for others — those who are already primarily under threat — of being even more heavily policed or murdered.

Calling someone “mentally ill” is also a favorite weapon of misogynists, who see difference or vulnerability in expression as further proof of feminine weakness. Men like Devin Patrick Kelley think difference is a sign of inferiority and justify their own acts of terror with this fact.

Unfortunately, it isn’t as easy as saying “we all must love each other” or “why can’t we just accept everyone for how they are?” We can’t take refuge in beloved universals. “Civilized” is a word-weapon we Westerners have used to elevate ourselves above and separate us out from those we see as beneath us: the savages, the primitive, the diseased and pathological. [2] “Humanity,” as Achille Mbembe has shown in his Critique of Black Reason, despite its seeming universality and biological foundation, was historically never supposed to represent all living things who talked and lived in communities. “Modern ideas of liberty, equality, and democracy are . . . historically inseparable from the reality of slavery” he writes [3]. This has been true since the Ancient Greeks established the form of government we still claim to practice today. Democracy for all! Except, of course, for women, slaves, children, the insane, foreigners.

The understandable anger of those who ask why white men are never labelled terrorist quickly turns into a demand that they be seen as such. In this way, they perform the same universalizing gesture but in reverse: we are united in seeing his behavior as so abhorrent and inexplicable that we cast him out from humanity. But in the West, terror is all too human, and the more we search for “terrorists,” the less we search around and within for the foundational source of that terror.

The radical acceptance of difference means being capable of being silent, of listening, of not over-hastily subsuming the other in your ideas about them. It means valuing receptivity above performance and communicability. Those excluded from the beloved universals have been forced to learn this skill. The so-called crazy people must do it, lest they get locked up again.

It’s time the ones doing the excluding do so as well.

Why We Love Throwing Lunatics to the Dogs

Sometimes a “progressive” journalist will meekly question the dominant belief that the schizo will kill you, flay you, eat your face off, or whatever. He or she will surely cite statistical reports from the Annals of Epidemiology or the US Department of Health and Human Services that show that only a tiny percentage of violent crime is attributable to those with a mental illness diagnosis.

We refuse to play this game. The mad, the “mentally ill,” as we are now called, do not exist as a permanent, stable group.

The mad have been women who wanted to escape what had become a boring, domestic hell. Maybe they wanted to sleep with other women. Maybe they didn’t want kids. Maybe they hated their husbands. Maybe they altered or even refused the gender assigned to them at birth.

The mad have been children who found it impossible to sit still in school. Maybe their teacher was unbearable. Maybe she found his lessons degrading, insensitive, and pointless. Maybe he didn’t want to hear about the accomplishments of Europe any longer.

The mad have been black and native men and women who decided to resist unlivable or unacceptable conditions whether in 1960s urban centers in America [2], or in New Zealand [3]. This is a global phenomenon. Maybe they were too loud, too black, too scary, or too strange to be understood by the white doctors who ultimately decided who was mad and who wasn’t.

The mad have been those experiencing extreme mental or physical distress who require care. Not the expert care that originates in the minds of those who pathologize them, but situated care, deeply aligned with their world and their desired place in that world. The exact same kind of care we all need.

Yes, we need to talk about specific intersections of mental health and care, but not uncritically. By automatically assuming the existence of “the mentally ill,” the criteria for identifying them, and the need for “treatment,” and by not asking any questions about who gets to decide who is mad, about the effects of stigma, about the various labels’ historical functions, about the power relations within which they exist, about the structure and formation of the medical knowledge that make up their foundations, or about the diverse experiences of those who receive these labels, even the most progressive calls for “care” can unthinkingly reproduce power relations of domination, scientific racism, gender policing, and the isolation of the suffering.

The crisis is not insanity, nor mental illness. The crisis is our normal way of thinking and acting itself; its hegemony and our inability to admit the legitimacy of another way of thinking and living. The mad have been those who think differently, who have organized their thoughts in their own way. This act of insolence must be punished in the eyes of the normal, hence they are a natural scapegoat for society’s most extreme perversions.

The mad, whether as insolent housewife, as rebellious subject, as “bad kid”, as sufferer, or as abnormal freak are not essentially the unreasonable, the nonspeaking, the abnormal. We represent another kind of reason, another way of speaking, a different norm, and for that reason we must be represented as the truly Outside, as unpredictable violent brutes capable of random violence.

We are a threat, true, but not because of a heightened physical capacity for murder or violation of consent — that belongs more so to Jeff and John down the street — but because we live according to other standards, whatever they may be.



[2] Elias, Norbert. The Civilizing Process.

[3] Mbembe, Achille. Critique of Black Reason.

[4] Federici, Silvia. Caliban and the Witch.

[5] Metzl, Jonathan. The Protest Psychosis: How Schizophrenia Became a Black Disease.

[6] Cohen, Bruce. “Passive-Aggressive: Māori Resistance and the Continuance of Colonial Psychiatry in Aotearoa New Zealand.”

“You can’t set her free”: A Visual Essay on Pharmaceutical Advertisements and the Always Shifting Perceptions of Madness

Looking at the ways in which the psychiatric profession advertised for its drugs and treatments can tell us a lot about shifting perceptions of mental health. We’ll keep the explanations short here, but if you want a more thorough critique of psychiatry, read our article Schizo-Genesis // Mad Apocalypse: the Story of the Psycho here.

[Update 12/7/17] We came across some more advertisements recently that we really wanted to include, and so we decided that this post could be regularly updated to become a concentrated database of tropes and paradigms for pharmaceutical ads. The plan is to include the visuals that communicate something either essential or at least typical. If it gets too big, we’ll make separate pages for different sections.

We indicated at the end of Shizo-Genesis that pharmaceutical companies are big players in shaping the way previously non-medical problems are represented and branded as treatable diseases. [See this essay by Ethan Waters for a good summary of this line of critique] We argued that there is a

drive towards the hyper-individuation of “mental problems,” which apparently are unrelated to political events, but are merely subjective psychological, or even biological, defects in a person. This hyper-individualization of psychological speculation is driven or at least structurally supported by an immensely powerful pharmaceutical industry, which, as it attempts to capitalize on the untapped markets in the global south, is now the main exporter of Western notions of “mental illness” and its diagnostic criteria around the world.

Peter Conrad in The Medicalization of Society writes:

pharmaceutical companies are now marketing diseases, not just drugs. This change is in part a result of the 1997 changes in FDA regulations that allowed for “educational” broadcast advertising that focuses on the disease or disorder, rather than on a specific drug, and in part as a result of the pharmaceutical industry’s attempt to develop markets for its products […] While physicians are still significant […] we will see that physicians’ role in medicalization is decreasing as that of the pharmaceutical promoters is increasing.

Given that these perceptions continue to shift depending on the changes in the market, it makes sense to have an ongoing, updated database of images with some commentary to keep up. This is based in part off of efforts by the Bonkers Institute, which you can see here, but with the intent to provide ongoing commentary (as far as we can tell, they do not update anymore, nor include commentary). Some of the ads posted here were also found there, and they have a number of humorous articles on the pharmaceutical industry (here’s one making fun of the medicalization of addiction). We’ve also decided to include visuals from other sources that either are directly involved with selling or distributing pharmaceuticals, like guides for consumers and website visuals, so this post could potentially be said to be about “pharmaceutical visual culture” rather than strictly advertisements.

It should be said that none of this is intended to shame consumers of drugs, or question their life choices. It is, however, indisputable that the pharmaceutical industry has a heavy hand in shaping our perceptions of mental illness, and that their role in this process is influenced by the market for their drugs.

Lastly, if you have any suggestions or see an ad that you think should be here, email us at belliresearchinstitute [at] riseup [dot] net or sashavs [at] riseup [dot] net. Going forward, we will continue to add some vintage advertisements if they express something important or continuous with today’s representations, but will focus on more recent

Depression, Anxiety, and the Pathologization of “Personal Problems”

At the forefront of the medicalization of previously normal problems are the labels “depression” and “anxiety.” Unlike bipolar and schizophrenia, which remain forms of so-called “extreme mental illness,” these two diagnoses have become so widespread and normal that often one’s reaction to simple sadness or withdrawal is to ask whether or not the person is “depressed.” What is the difference between sadness or fear and depression or anxiety? Well, one difference is that the latter set are medical diagnoses that can be treated with drugs, or otherwise monetized by medical professionals. Another would be that the first set presents the possibility of seeing your ailment as an element of the environment you are living in, your material circumstances, your marginalization, or mistreatment at the hands of others (something is saddening/scaring me), while the latter two are largely presented as “chemical imbalances” (my body/brain is causing my depression/anxiety because I am imbalanced).

A satirical article from the Bonker’s Institute excitedly informs the audience about “asymptomatic depression” and the “huge untapped market” that lies within. They present a laundry list of totally everyday circumstantial problems like “having too much or not enough of something,” and “marriage to the wrong person,” and also serious geopolitical problems like “global economic collapse, thermonuclear war, mass starvation, genocide, etc.” as causes. For “symptoms,” they list again some very everyday activities and behaviors: “slumped shoulders; downcast eyes; inability to concentrate” as well as again political ones “tendency to worry about nuclear proliferation, vanishing coral reefs, mounting budget deficits and the legacy we’re leaving our children” This differs very little from the actual criteria for Major Depressive Disorder. In the DSM-V, the first qualifying symptom for the criteria of Major Depressive Disorder is having a “depressed mood most of the day as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).” How exactly is a “subjective report” or “observation” an element of a supposedly objective medical diagnosis? This isn’t the place for an in-depth critique of the language around depression or anxiety, but to examine some of the visual language used by pharmaceutical companies to sell us on it.

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Ad for Prozac showing what looks kind of like a child’s drawing of a rain cloud on one side with the words “depression hurts” and a sun on the other with the words “Prozac can help.” This ad is not exactly subtle, and the language is almost humorously insistent. The first two sentences of the text read “Depression isn’t just feeling down. It’s a real illness” as if they expect the reader to doubt them right away. The sincerity of this statement truly ought to be questioned when it’s qualified immediately by the presence of a medication claiming to treat it.
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Ad for Zoloft. Ads for Social Anxiety and for Major Depressive tend to be very simple in nature. One possible reason is because, if they were too specific, then the viewer would not recognize their problems as a disease. This one shows an unremarkable woman, lighted from below, with her head down and her face partially covered by a hat. The light and the curvature of her nose give the impression that she may be sneering. Her dark lips and frown further indicate that this is a “dark” or “brooding” person. The words “is she just shy” are extremely vague for what is supposed to be a “disorder” or at least an “imbalance.”
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Ad for the antipsychotic Abilify. All we see is a soft portrait of a woman with a feint smile drinking coffee or tea, perhaps talking to her doctor. Its primary use as an antipsychotic is not mentioned, nor is its link to a potential increase in suicidal ideation and action warned about on their own website (<a href=”; rel=”noreferrer nofollow”></a>) on the top of the page.


Women, Hysteria, and Housework

This first group of ads shows the progression of certain “women’s issues,” which range from the classic “hysteria” to anxiety and depression disorders, to psychotic disorders. These disorders and illnesses tend to be portrayed as the causes of the woman’s failure to perform their household duties with a good attitude or else when they show “devious” sexual proclivities. A study by Donna Stewart, M.D., chair of women’s health at University Health Network and the University of Toronto in Canada called “Who Is Portrayed in Psychotropic Drug Advertisements?”  found that, in ads from three different psychiatric magazines in the years 1981, 1991, and 2001, women were portrayed in family roles 90% of the time, and in sleeping, leisure or passive roles 77% of the time.

1890 ad for an “Electropathic Belt” for Hysteria and “Weak Nerves.” “I can perform all my duties without pain” reads this “female testimony.” There’s not too much in the way of images here. A drawing of a woman stares blandly ahead towards the viewer, both wearing a belt over her dress and holding one in front of here, as if to offer it. This ad, unlike most of those to follow, actually promises a complete cure.
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Ritalin Advertisement, CIBA (1956). This Ritalin ad shows a disturbed woman sitting near a window with exposed skin around her legs, her side, her chest, and her arms. The text tells the viewer to “arouse the depressed psychiatric patient.” One cannot help but be struck by the word choice of “arouse” when shown a female patient with the presence of  exposed skin, often stereotyping sexual waywardness. The bottom left shows a woman, maybe the same, happily reaching upwards for her medication. Again there is a possible sexual implication given the association between the word “arouse,” the skin, and now her position as desirous of what the doctor offers.  
Dexedrine Advertisement, Smith Kline & French (1956). This pharmaceutical ad aimed at women shows the future patient in a domestic role, suggesting that her problem is her inability to perform such roles. Like other such ads, the writers seem to recognize that the position of the hosuewife is dull and negative, but concoct chemical solutions instead of practice ones.
Mornidine Advertisement, Searle and Co. (1959). “Now she can cook breakfast again… When you prescribe new Mornidrine”
1967 ad for Serax. Nothing you can do about patriarchal power, but you can stuff your wife full of drugs! This ad, by placing the woman with her domestic appliances behind a veritable prison of brooms and mops, acknowledges that the duties entrusted to the normal housewife are oppressive and extreme and akin to being locked up, but then tells us that “Serax cannot change her environment, of course,” offering instead to “strengthen her ability to cope.” In other words, it allows her to continue living in the prison.
A 1973 ad for Anquil, a neuroleptic advertised as a cure for deviant sexuality: “exhibitionism, compulsive masturbation, incest, erotomania” and “anti-social sexual behavior.” We see an oversized face imposed over the dark bodies of sexualized women who even seem to be melting into one another staring darkly at us from about where the women’s breasts would likely be. This ad is puzzling, because it both exploits and warns of over-sexualization. It wants your attention, and seeks to gain it by showing idealized shadows of sexualized feminine figures in which a grotesque floating face seems to reprimand you. Is it trying to tell us that such a gaze is “anti-social” and that we perverts are like him? Or is he the face of “society” gazing at us gazing at these shadow ladies?
Meprospan advertisement, 1967. Another example of advertising psychiatric drugs explicitly as a coping mechanism (a “tranquilizer”) for the pressures of household work. What exactly this child did to stress the mother out is unknown, but we can guess from his nudity and from her exhausted expression that something has just happened to off-set her mood/day. The drug offers “tranquility” but not salvation, once again. No solution, which could be sought in the reorganization of the family unit or of another social unit, just treatment.
These representations have remained largely the same. This is a 2002 ad for Paxil, which shows how this housewife became reintegrated into her family by taking anti-depressants. The top image shows the distant mother surrounded by her emotional and cognitive failings, while the bottom, post-paxil, image displays her smiling with her son in her arms.
And this scary one for Pristiq from 2009 seems to suggest that a woman is like a wind-up toy that, when beginning to fail, can use anti-depressants to help get through the day. This ad, by portraying the housewife as a wind-up, also seems to suggest the pessimistic idea that household duties are mechanical and wooden. It presents this first as a challenge by saying that “depression can make you feel” that way, but does nothing to alter the image, instead merely offering the anti-depressant on the bottom of the left side of the image with more information on the right. Will this drug eliminate the wind-up or merely make it run longer? By offering no counter-image, we must assume Pristiq can only offer the latter.
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Effexor Advertisement (2002). Ad for the selective serotonin-norepinephrine reuptake inhibitor (SNRI) Effexor, which, like many ads for pharmaceuticals featuring woman portrays recovery as the reintegration into the family structure.
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1998 Ad for selective serotonin-norepinephrine reuptake inhibitor (SNRI) Effexor. This one is interesting because it is one of the few with actual data on the page, although the source of that data -and any counterdata- is not present (it does indicate it came from a “study” but any information as to how to follow up on this study is not provided); next to the data is the contrasting image of the mother reunited with the child and “I got my mommy back” in children’s handwriting. Once again, the relief from depression is symbolized by the reconstitution of the patriarchal family. 


Children and their “Bad Conduct”

The second group shows some ads directed at parents of unruly children, or even just “weird” children. These problems were in the past generally viewed as anxiety related or else as “mental defections” while today they tend to be seen as “conduct disorders” like ADHD and Oppositional Defiant Disorders, which are much more commonly diagnosed than any previous disorders in children. Provisionally, it looks like such conduct disorders are the avant-garde of the social control mechanism of psychiatry, in so far as they both mix social/political factors with biogenetic assumptions and remain broad enough to be widely diagnosed. The diagnostic criteria for ADHD, for example, includes multiple references to difficulty with school work, or the school setting. This may seem obvious, but “school” is neither a biological fact nor a constant feature of human societies, yet it is mentioned here as if one’s behavior in it could be a symptom of a biological pathology. Psychiatrists often complain that their “science” is the only one with an “anti” wing. Not that the other sciences don’t merit criticism, but psychiatry is special in so far as it indiscriminately mixes the rhetoric of social deviance with the rhetoric of the genetic and biological.
Adolescent/child psychiatry is the new frontier. Prescriptions of antipsychotics are on a drastic rise. The Scientific American reports that
Between 2002 and 2009 pediatric prescriptions for atypical antipsychotics increased by 65 percent, from 2.9 million to about 4.8 million. A staggering 90 percent of those prescriptions are off-label, according to a 2012 study published in JAMA Psychiatry, with ADHD and disruptive behavior disorders accounting for about 38 percent of all antipsychotic use in children and teens.
In 1997, the FDA (in the Food and Drug Administration Modernization Act) loosened restriction on the information that pharmaceutical companies can distribute and allowed for “educational broadcast” advertising that advertises or educates about a disease or condition, rather than a specific drug, facilitating the widespread prescription of drugs for “off-label” use. This facilitates a mutual process of expansion whereby the availability of new drugs requires new markets, and new broad diagnostic tools allow for the pathologization of what was previously considered deviant behavior.
Ad for Compazine (unknown year) an antipsychotic and anti-emetic, which promises “Prompt improvement in ward and cottage behavior, table training and toilet training”


Sparine Advertisement, Wyeth (1959). Ad for Sparine highlights both how quickly it works to sedate the patient, but also how much more compliant he is, and how much more convenient that is for the doctor and psychotherapist. 
different child
1959 ad for Equanil, a discontinued anti-anxiety drug, “for the child who is different.” This is a case of surprisingly direct marketing for managing difference with medication, so that the child may “enjoy a normal life.” The child is shown partially submerged in shadow, creeping around a corner alone with a dark passageway behind him. The descriptions provided for his “different” behavior, like the visuals presented here, are extraordinarily vague, and hinge, in the end, on the perception of the adults he spends time with. Who gets to decide whether nervousness is “undue?” Who can tell whether a tantrum is “exaggerated?” These aren’t quantitative terms, but discretionary ones. This highlights that pediatric psychiatry is the avant-guard of the policing mechanisms inherent to psychiatry. The police, in this case, are deputized adult-psychiatrists. This drug, like antipsychotics today, began as an adult-only drug and moved downwards through marketing for its off-label pediatric usage.
2007 pamphlet explaining ADHD medication Atomoxetine in over-simplistic and sugary language to kids, normalizing the medication of children. “It works in the brain to help you concentrate and listen better” does not actually tell you how the medication works or what it does chemically. While it does mention short-term effects, it does not mention either alternatives nor long-term effects.
Ad for Intuniv, an ADHD drug. This one is pretty straight forward: badness is illness, which is combined in the figure of the “monster,” and our drug can “treat” it, revealing the smiling, white child (the Western ideal of innocence) underneath. The crossed eyes are also the prevalent representation of learning disorders and cognitive disabilities. As such, this ad is either implying that their is a co-morbidity with ADHD and these disorders, or that ADHD, the monster, “causes” similar disabilities, which can be treated with the drug. They probably intended this to be just another “monstrous” trait, the implications of which are no less problematic.

Psychiatry and Anti-Blackness

This group shows the anti-blackness (and anti-indigeneity) inherent in the psychiatric profession, which makes illegitimate any alternative methods of care or diagnosis and presents any form of resistance to white supremacy as pathological. In the early 20th century, mostly white women who failed to perform their household duties were diagnosed with schizophrenia and other psychotic disorders, but, in the wake of the Black Power movement in the 1960s and 70s, the second edition DSM highlighted the “aggression” of the illness in its new description of symptoms. Jonathan Metzl: “In the 60s, National Institute of Mental Health studies found that ‘blacks have a 65% higher rate of schizophrenia than whites.'” As we wrote about in Schizo-Genesis, psychiatry was also a foundational discourse for colonial scientific racism, and the hierarchization of the races. Both trends are apparent in these ads: the degradation of the idea of the native, and the pathologization of resistance to colonial or white supremacist rule.
A 1974 ad for Haldol, an anti-psychotic advertised here as a curative for “aggressive and belligerent” behavior with an image of a black man shaking his fist. This image appeared in 1974, after a decade of the civil rights movement and a series of destructive race riots. Jonathan Metzl, in whose book we found this image, argues that these images proliferated explicitly to pathologize the rebellious behavior of black people and to ensure that more of them get locked up and/or seen as essentially sick. These images suggest that, instead of having legitimate concerns and arguments, the “angry black male” is simply a sick individual with a “brain disease” or a “chemical disorder.”
Antipsychotic Thorazine presented as “modern” tool opposed to “primitive” African tools (represented by a Ekpo mask from Nigeria and a “konde” from Zaire) while also highlighting its special use in controlling “psychotic agitation.” This anti-blackness and attack on traditional medicine is essential and not accidental to the project of psychiatry, which must discount and ridicule both other ways of seeing illness and methods of dealing with them to deepen its own hegemony and establish white doctors as the ultimate experts on health and illness. The “compare and contrast” visual language attempts to display a progression, as if one method belongs to the primitive past, and the drugs belong to the present. The advertisers of course do not mention the “effectiveness” of either, nor explain the practical uses and combinations of the former. This is unnecessary in their eyes. They do not want the viewer to actually consider them as tools, but to immediately recognize them as “primitive” and foolish. This both bolsters their authority by encouraging an “automatic” recognition of their abilities and knowledge while also denigrates the contemporary methods of those who oppose them or provide alternatives.
list the mask
A 1977 ad for Stelazine. “Remove the mask of schizophrenic withdrawal,” which is presented as an Tlingit Shaman’s tribal mask. This suggests not just an ineffective method of controlling or “treating” schizophrenia or any other psychotic condition, but goes further and implies that “primitive” culture is itself psychotic and equivalent to the “pathological” conditions. This is a double attack: the psychotics are like savages, while the savages are like psychotics. This means that the psychiatrists ought to have more power in treating the psychos, while the civilized ought to be able to “treat” the savages, who are also deluded.

Noncompliance is a Symptom of your Illness!

The last group shows the way in which the psychiatric profession trains the public to recognize the ill with representations of delusional psychos who would go to any length to convince others they were normal and resist treatment. The final conclusion of this is that 1. psychiatrists can identify when abnormal behavior is a symptom of pathology and not a legitimate form of protest or resistance to life circumstances, and 2. they know how to treat it.

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Thorazine, Mental Hospitals Magazine (1956). This Thorazine ad claims to show how the drug can aid in getting the patient out of the hospital by keeping them in chemical handcuffs, preventing them from potential acts of violence. 
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Thorazine Advertisement, Smith Kline & French (1956). Thorazine ad tells us that “disturbed wards have virtually disappeared.” Notice that all the patients in this ad are women. 
Prolixin Advertisement, Squibb (1981). 1981 ad for Proxilin informing the reader that the schizophrenic psycho may be hard to identify, and also that he may deny his own illness. But, don’t worry, because, with Proxilin, he need only be injected once a month, and hence, “will not have to be reminded every day of the illness they reject so strongly.” While it may seem, on the surface, that this ad is actually combating the stigma of a schizophrenia diagnosis and reminding the viewer that anyone may potentially be schizophrenic, this displacement from visual characteristics to visible behavioral patterns further strengthens the belief that one can identify the crazy person not based off how they look, but rather, how they are in a situation, or how they act.

black hood ad

Ad for Stelazine that recommends disguising medication to trick patients into taking medication they perceive as poison. Not for a moment do these ads entertain the idea that there may be elements of their medication that could rightly be considered poisonous (their effects on the long-term physiological health of the patient including extrapyramidal symptoms and rapid weight gain well recorded), nor is there any curiosity as to why the patient may perceive them as such. Instead, it is simply assumed to be a symptom of the central “disease” of schizophrenia. This again highlights the special character of psychiatry. It is the only medical profession where the resistance to it can be pathologized as a “symptom” of the illness they are treating. This is why we refer to it as a police science and not primarily a medical profession.

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This ad for Haldol does much the same, noting that it is “tasteless” and difficult to detect. These ads visually construct the “patient” as an aggressor and enemy who needs to be controlled. By portraying this man in a state of aggressive non-compliance and confusion, this ad communicates to the viewer that the schizophrenic is a danger to himself and those around him. Rather than questioning the basis of that “danger” or its environment and representation, the ad suggests that Haldol can “treat” this danger.

Ritalin Advertisement, CIBA (1959)

Ritalin Advertisement, CIBA (1959). This ad for Ritalin offers to help the doctor to “break down” the resistance of the patient, to get them to submit to a therapeutic plan they’ve expressly denied wanting. Such ads are dangerous not just because of the potentially coercive use of the drugs but also in how it reinforces the idea in the mind of the doctor that the patient is not someone who should be accompanied in their journey towards health, but distrusted and coerced when necessary. 
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Stelazine Advertisement, Smith Kline & French (Date unknown, 1960s?). This ad for the antipsychotic Stelazine shows us some scary, but absurd, black-hooded figures (one cant help but note their similarity to the white hoods of the KKK), and the text from the patient “they come around three or four times a day and try to poison me…” The text then goes on to warn about the schizophrenic and his likely aversion to medication. By connecting this aversion to a patently absurd image, the viewer ought to come to the conclusion that other schizophrenics who fear their medication are likewise deluded and merely expressing a similar bizarre delusional belief rather than, say, a legitimate aversion for the medication.
This 1982 ad for Proxilin promises to help “break the web of noncompliance” with an injection of the drug. What all these ads assume is that the oftentimes awful and painful side effects are preferable to the symptoms associated with schizophrenia and other psychotic disorders. They make this choice for the patient, who actively rejects this treatment and seeks to avoid it. It is a reality that some who have extreme or hallucinatory experiences prefer to take dangerous drugs over continuing to have such experiences, but there are others whose assertion of the ability to make that decision is interpreted as symptomatic. The visual of a “web” representing “non-compliance” is odd. Are they suggesting the patient is trapped in this web, or did they make the web themselves? Who is the spider and who is trapped? The web that reaches over the psychotic woman’s face suggests that she, the patient, is the one trapped in the web of non-compliance, and that the drugs placed over the whole ensemble represent perhaps a way out, but the visual metaphor here is not so clear and the possibility or a second reading is possible. The drugs themselves trap one in the “web of non-compliance” (being an asymmetrical power relation with the psychiatrist or prescriber) and it is only by lying and sneaking behind them both that one can escape.
Lithium Advertisement, CIBA. Date unknown. Ad for Lithium for treatment of manic-depression (or bipolar). “Control the fire in the mind” reads the text, above an image of a Greek-statue-like figure with flames bursting from his head. The image of fire highlights that the main issue at hand is “lack of control”, further demonstrated by the word “control” above and that the ad claims it can “aid compliance”.  
A 2006 ad informing the reader of the hidden danger of “partial compliance” including the “delusional belief” that “medication is poison.” What about when it is poison, or experienced as such? The image of the iceberg is also ambiguous. They are certainly suggesting that the exposed tip of the iceberg is the compliant, good, aspect of the patient, while the majority, bad, part remains beneath the water submerged in psychotic delusions. This still suggests a continuity between the upper and lower part, and an assertion that they do, in fact, represent the same whole human being. The image of the iceberg contains an image of power, since the submerged part is really where the base and strength of the iceberg lies. This second reading suggests that the whole patient is primarily hidden from the world, and that it is this hidden part where their true strength and power lies. That last word is no accident, for, when combined with the first reading of this ad, it is clear that the patient must lie about this hidden part if they want to keep it at all.
Ad for Zyprexa, an antipsychotic. This ad contains has a number of disturbing visuals and text. Beginning with the top, it starts with “You’re trying to piece her life together” and follows this up with “She won’t swallow it.” This creates an “Us vs Them” framing that seems at odds with how medical treatment ought to be pursued. In the center, we see a woman pictured with a puzzle-piece hole where her mouth should be. The message is: the last thing missing to fulfilling her care is getting her to swallow Zyprexa. The word “Removing the obstacles to care” reinforces the message at the center of this whole arrangement: in order to help this woman, you must force her to swallow that which she will not. This is an extremely disturbing message in a patriarchal society, and is part of a visual culture utilizing and normalizing the imagery of forced acts perpetrated against women.
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Ad for Haldol. The picture is pretty standard fare. We see a women colored with “trippy” or “weird” colors, next to what looks like it could be a smiling Satyr mask. One thing it would be interesting to examine more extensively would be the reliance on pharmaceutical ads and other visual representations of psychosis on images from the Western artistic canon. We often see satyr masks, images from Renaissance painters, or Surrealist paintings. The words “Consider the advantages of starting her on Haldol” again produces a “you” acting on “her” like the image above.
calling mom
This ad for Seroquel implies the impossible correlation between the level of the dosing and how often they call their mother, i.e. “come out of their illness.”

*Some of these were found in my own independent research, but many were retrieved from The Bonker’s Institute here.