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.
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!
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.”  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.  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.  “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 . 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 , or in New Zealand . 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.
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.
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.
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.
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.
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.
Ritalin Advertisement, CIBA (1959)
*Some of these were found in my own independent research, but many were retrieved from The Bonker’s Institute here.
As Socrates languished in a cell on the acropolis for “corrupting the youth,” a mysterious figure in robes raved and babbled under the spell of noxious gasses on the mountain of Delphi, and she was called Oracle.
In the same century in which Justinian constructed his master work of the Eastern Orthodox faith, the Hagia Sofia, the Syrian monk Simeon was dragging hound corpses around town and throwing nuts at churchgoers, and they called him a Holy Fool and venerated him as a Saint. For the early Christians, East and West, from St Anthony to St Paul, madness or at least foolishness was respected since even Christ was called Fool.
In 1763, in the Chinese province of Fujian, a certain Lin Shiyuan tossed a roof tile upon which he attached small pieces of paper with scribbles and nonsense words. The problem was, he threw this absurdist tile in the direction of the governor of the province, Dingzhang. Governor Dingzhang sent investigators to find out why Lin had done this. His relatives claimed madness, and the investigator and the governor agreed. Lin was sentenced to decapitation for “blithely circulating devious words, writing placards and rousing and confusing people’s hearts.”
These stories illustrate a few persistent features of the history of madness: odd or even antinomian behavior is either identified as having a deeper mysterious meaning beyond the spectator, or else is immediately feared, evaded, or criminalized. In these few narratives, the general patterns are reversed: while the West certainly did have figures and positions of lauded madness, they were, and are, few and far between, while Chinese knowledge schemas from the ancient world to the early modern period generally did not categorize the same behaviors as “mad” at all, but identified them as symptoms of a general physical malaise. The immediate criminalization of “madness” here recounted was something of an anomaly in Chinese history, but was very frequent in the West, especially in the 18th century and beyond.
What these exceptions remind us is that the problem of madness and of those who were locked up, shocked, and tortured in its name is to a large extent a problem of language and discourse. Neither in China nor in Europe or the U.S. were the “mad” consistent characters of history or scientific observation, but changed according to reigning normative beliefs and needs. This begs the question: what is madness, then? Just a shifting crisis for the sane? If so, how is something so fluid so easily criminalized? And lastly, is something like madness still an actual possibility for us moderns?
a) diagnostic crises
“There is no such ‘condition’ as ‘schizophrenia,’ but the label is a social fact and the social fact a political event.” -R.D. Laing
At the Democratic primary debates in March, 2016, Bernie Sanders joked that we need “. . . to invest a lot of money into mental health . . . And when you watch these Republican debates, you know why we need to invest in that.” We’ve been hearing about a nationwide mental health crisis for years now. If Bernie Sanders, a political candidate hoping to reach millions, can so casually make a joke about mental health with no set-up, that is because he is aware of the popular conceptions and common feelings around it. He, like so many others, assumes you know the basics, and jumps right into the details.
Today, so much attention is being given to how to prevent crises, proper training for police, and possible causes for mental illness that no one is asking the most basic questions: What is mental health and what is mental illness? Liberal pundits indignantly proclaim that right-leaning politicians are comfortable attaching the label “mentally ill” on their enemies or on the enemies of society in the midst of crises. Whenever someone picks up a gun to kill random civilians, the right will be there to assure us that they had a “mental disturbance.” If they can adequately prove the shooter’s illness, public opinion quickly shifts from rage to pity. On the left, some have pondered how Americans could have elected Trump who obviously “has a mental illness” or a “learning disability.” Even radical groups on the left sometimes call capitalism or the state “insane.”
This comfort with diagnosing problems using the language of mental illness betrays a tendency to see the enemy not as a foe who should be fought, but an inferior being who should be pitied and managed. It betrays how much the average citizen has come to resemble the police. Both the right and the left, even when not motivated by threats to gun policies or the outcomes of electoral politics, assume not only the objective existence of mental illness but also how to identify it. Psychoanalysis, which has primarily been a therapeutic option available for those with means, has for years been the object of serious critical and historical research; psychiatric power, on the other hand, has been both more far-reaching and less questioned. For most, those other people who reveal themselves to be crazy are the crazy ones, and deserve for this reason to be exposed to the power that claims to exist to care for them, or to cure them.
These self-elected psychiatrists have surpassed the “real” or certified psychiatrists who are moving in the opposite direction and have long conceded that they do not agree on what mental illness is. The “Bible of psychiatric diagnosis,” the Diagnostic and Statistical Manual, or the DSM, published by the American Psychiatric Association, is consistently a cause for controversy. Psychiatrists may not be pulling out their copy every time a prospective patient enters their office, but the presence of a diagnosis in the DSM determines whether a health insurance company will pay for the patient’s treatment. The diagnoses in the DSM can also affect where the patient will live, what jobs they can hold, and how their children will be educated, as it is used by public housing authorities to decide eligibility, by employers who must comply with the Americans with Disabilities Act, and by public school systems to determine whether to provide free special services for students. It is also employed by lawyers, judges, and prison officials seeking mental health services for convicted criminals.
Yet, despite the importance of a reliable diagnosis, there is still no consensus about who is mentally ill, or what a “disease” like schizophrenia is or isn’t. Nancy Andreasen, the editor of the American Journal of Psychiatry, the official journal of the APA, confessed in 1998 that, “Someday in the twenty-first century, after the human genome and the human brain have been mapped, someone may need to organize a reverse Marshall Plan so that the Europeans can save American science by helping us figure out who really has schizophrenia or what schizophrenia is.” For every psychiatrist ready to assure the public that schizophrenia really exists and needs to be treated before behavior becomes violent, there are others who entirely reject this. Allen Frances, the editor of the DSM-IV, told writer Gary Greenberg that “There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.” Given the frequency with which one hears politicians and the disaster-profiteers in the media comment on the mental illness crisis apparently sweeping across America, it is somewhat shocking to hear the man who edited the book on how to diagnose these illnesses tell us that “These concepts are virtually impossible to define precisely with bright lines at the boundaries.” Perhaps it would shock many to learn that the “diseases” listed there are not chosen because they objectively exist and were discovered through scientific means, but because a member of the APA suggested them, they were discussed, and eventually voted on for inclusion or exclusion. Homosexuality was ousted from the DSM by a vote, not because they suddenly “realized” it wasn’t a disease.
The reason why the DSM was written in the first place was in an attempt to correct psychiatry’s total failure to produce evidence of its ability to identify the “mentally ill.” A series of embarrassing scandals in the 20th century exposed the fact that psychiatrists did not know what it was they were treating and had no reliable means to track their success in treating it, nor any idea of what “success” even looks like.
One 1970 study in El Paso, Texas found that of the 463 people interviewed, every single person experienced some thoughts and fantasies that could potentially qualify them for diagnosis of a mental illness. But the most publicized scandal was an experiment performed by Stanford’s professor of Psychology, David Rosenhan, in 1973. He and seven others went to twelve different mental hospitals complaining that they heard the word “thud,” otherwise acting “normal.” In every instance, they were admitted for schizophrenia. Once in, they acted completely normal, and did not complain again. Not only were they not discovered to be frauds, they were given more than 2000 neuroleptic pills and had trouble getting the doctors to let them out. They also ran the experiment in reverse. Rosenhan advised a mental hospital that someone would come in the next few months to try to fraud them and that they should be on the lookout. They sent no such fraud, but forty-one prospective patients were nevertheless turned away as imposters. “We know now that we cannot distinguish insanity from sanity,” Rosenhan wrote in Science magazine.
Frances talks of “diagnostic inflation” covering larger and larger portions of “normal society,” while other psychiatrists, like Jim van Os, talk about the “psychotic spectrum” that we are all on in different degrees. Either way, mental illness — or at least its diagnosis and treatment— is encompassing increasingly larger swaths of the population (about 17.9% of adults in America according to the statistics from the National Institute of Mental Health for 2015) while consensus about those same diagnoses and treatments is becoming more scattered, confused, and polarized.
The reason why the diagnosis and treatment of mental disorders continues to spread even as agreement about what it is becomes less certain is simple: psychiatry has never been about helping people who suffer. The diagnosis and treatment of the “mentally ill” are police concerns regarding the safety and health of the general population, and hence, there is no need to have an acute knowledge of mental illness. In fact, it is better to be vague. It’s easier to capture more disorders in the net.
b) the whole world is/will be/has been mad
Examining the origins of the diagnosis and treatment of the “mad,” we can see that the ancient world had no madmen per se. Madness was not a distinct category. The word, when it was used at all and not just projected from future readers, was highly divergent in its meanings. Madness for many named a spirit that passed through a person. In Greece, one could be possessed by Mania and become frenzied or violent, or by Bacchus and become intoxicated with pleasure and ecstasy. This possession certainly wasn’t a bad thing. The most common word for happiness, eudaimonia, meant to be possessed by a good spirit. Madness was an experience, and a vital one at that. Madness passed through a body as it danced, as it seethed in fury, as it performed ritual, or as it writhed and suffered. The Muses inspired new artistic works, and the War Gods gave one the strength to battle again. For Plato’s Socrates:
Madness[…] is the channel by which we receive the greatest blessings … the men of old who gave things their names saw no disgrace or reproach in madness; otherwise they would not have connected it with the name of the noblest of arts, the art of discerning the future, and called it the manic art … So, according to the evidence provided by our ancestors, madness is a nobler thing than sober sense … madness comes from God, whereas sober sense is merely human.
Socrates seems aware that some recoil and withdraw from the experience of madness when he says that the “men of old . . . saw no disgrace” in it. Nevertheless, he points to the possibility of madness as a learning experience far greater than any revelation that may come from “sober sense.” Madness is a dangerous gift.
Some historians of madness trace the phenomenon to the stories of possession in the Bible. Never named “madness” or “insanity,” these historians believe that the stories of spirit possession there have enough similarities with later stories of “mad possession” to warrant inclusion. There were horrible and punishing possessions: Saul failed to decimate the Amelekites and needed to be punished and so the Lord sent an evil spirit to posses him. It is written that he lived out his days in fear and rage. There were also holy ones: the prophets were likewise possessed, would shake, hallucinate, describe lengthy delusions. The Hebrew word “prophesize,” which meant “to act like a prophet,” also meant “to rave,” “to act beside oneself” or “to act in an uncontrollable manner.” Their delusions were the inspired ravings of messengers communicating the wisdom and providence of God to a thankful people. The problem with locating “madness” in these stories is that some historians then posit a transhistorical concept of madness that is merely being interpreted as prophesy or curse despite there being nothing more than circumstantial evidence that how these figures acted could in any way be identified with those we call mad today. With that caveat in mind, we would say that spirit possession in the Bible, like in Plato, was not positive or negative in itself, but indicated a possibility of experience or knowledge.
There was, however, a medical tradition in the ancient world, the Hippocratic tradition, that sought to locate the sufferings of the mind or the convulsions of bodies usually associated with possession in physical or environmental sources. This medical discourse is most often thought of as circulating around the works of Hippocrates (c. 460-357 BCE) and his circle of students and followers in Greece and Galen (c. 129-216 CE) in the Roman Empire, who largely modified and expanded upon the work of Hippocrates. The diseases —with their sufferings and convulsions— they described in their work were likewise not named “madness” nor always mirroring what was culturally and religiously experienced as divine possession. Hippocrates, and the tradition of medicine he inspired, sought primarily to demonstrate that the body is a system made up of essentially interrelated parts with an irreversible relation to its surroundings, and that sickness always has natural causes. In his text “On Sacred Disease,” he recalls the faith in divine possession and refutes it in the first sentence: “It is thus with regard to the disease called Sacred: it appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause from which it originates like other affections.”
He and his circle of disciples propagated the medical theory of “humors” most often associated with the Middle Ages, which speculated that every body is composed of four circulating elements: blood, phlegm, yellow bile, and black bile, each of which has properties that balance the others out. Changes in weather, in environment or surrounding, or major developmental changes can throw this balance into disarray and thus also the body, which we then call sick. This theory has lent itself to appropriation by those who wish to assert a hard biological gender differentiation, including Hippocrates, who claimed that women’s bodies are more “moist” and hence are more susceptible to alteration. The female body in shambles acquired its own name, “Hysteria,” first used by Hippocrates, but with its own long and harmful legacy. The word itself, Hysteria, despite later attempts to prove it could be multivalent, has always been intensely gendered, meaning “womb” in Greek. He, like many other Greeks, believed moreover that the woman’s womb was not stationary, but wandered around the body when irregularities were present in the woman’s lifestyle. Insufficient food was named, but the primary causes were perceived to be abstinence and irregularities of the menstrual cycle. The primary cures were then naturally sexual activity and pregnancy, providing a medical grounding for pathologizing non-normative lifestyles of women.
The Hippocratic theories of health flourished in the Arabic kingdoms during Europe’s Early Middle Ages, or so-called Dark Ages, where they became almost unknown. Europe would later rediscover these texts, as well as the vast majority of texts we now recognize as belonging to Western Antiquity that were lost following Rome’s descent, by importing them from the libraries in the Arabic kingdoms. Galen’s work was largely preferred to those of the Greek Hippocratic circle because his “emphasis on health as the product of harmony, order and equilibrium could be seen as implicitly endorsing the Muslim conception of God.” Avicenna (who wrote the largest medical compendium and synthesis known at the time) and others took from Galen a pronounced emphasis on empirical method, as well as a representation of the body as a “unity.”
Though never entirely lost, the West would not have widespread access to these texts until they were translated from the Arabic into Latin in the 11th century. With this significant break in the medical traditions from Antiquity, madness in the Middle Ages of the West was still largely considered an experience, a divine state, or a possession. Foucault locates a figure of madness in the Middle Ages in the Ship of Fools riding off into the unknown. Madness was the farthest possibility of human experience. It represented an absolute limit at the end of the world, a dark power in which one could descend to find fantastic and esoteric knowledge — “A strange passage from here to the hereafter”. Pieter Breugel the Elder’s 1562 painting “Mad Meg” (“Dulle Griet”) depicts a woman surrounded by wild and terrible scenes, armed with a sword, storming the gates of Hell. The mad woman and her cohort of pillaging women flee the horror of the world to face the unspeakable in an act of bravery and wherewithal. Is she mad because she is delusional about her circumstances or precisely because she is capable of this encounter with the unknown? By depicting her in heroic attire, we tend to believe the latter.
In sharp contradistinction with what Foucault saw as the abyss of silence between the sane and mad today, the Middle Ages had a rich and sustained conversation with and about madness. Writers, artists, playwrights, and philosophers mused about the thin line separating inspiration and madness, as well as their occasional forays into the latter. “Great wits are sure to madness near allied, And thin partitions do their bounds divide” was the accepted maxim from poet John Dryden. Melancholy or “Melancholie” was especially in vogue in the Late Middle Ages and Early Modern period between the 16th and 17th centuries. Robert Burton informed his readership that while his contemporaries may “get their knowledge by books,” he got his “by melancholizing.” Shakespeare’s plays featured characters who, through the course of their actions, come to experience some form of madness, sometimes even returning to reason from it, as King Lear does, or at least appears to. This plot, and contemporaneous ones from Shakespeare and others like Cervantes’ Don Quixote, in which the title character alternates between delusion and reason, indicate a belief in a madness that is dynamic, fleeting, and not related to the biology or anatomy of its host.
It isn’t until the “modern era” —the 17th through 19th centuries — that we find a more stable category of “insanity”. In the modern era, there was “. . . no longer a boat at all, but a hospital,” a careful circumscribing and categorization of the minutiae of the forms of madness. Despite there being no fixed category of mad people in earlier eras, but rather descriptions of experience, does not mean that the modern mad person was simply invented out of nowhere. The mad emerged as an ill-defined group representing those who had proven themselves incapable of self-governing in the era when police emerged to take over management of the public, albeit one that evolved in a different discourse. This places the emergence of the modern concept of mental illness as a concept in the history of household management, which would sometimes appear as necessary for the good of society, sometimes as a medical imperative, and sometimes as a scientific fact. A split occurred and the good mad were suddenly called genius or inspired while the bad lunatics (i.e. those acting disorderly) were placed in poorhouses and asylums. “Psychiatry” is the name this fluid and broad tool of medical police classification has taken on, though in some of its functions it has been called “Public Health” or “Public Hygiene.”
c) genesis of the psycho
“They called me mad, and I called them mad, and damn them, they outvoted me.” -Nathaniel Lee
The core of the problem of madness for the West can be found in the Great Confinement that took place in the 17th century through the 19th century. Though there is some disagreement about when this process began, it is undoubtable that in this time, vagrants, criminals, prostitutes, drunks, and the insane were locked up together in large numbers. In that process one finds, in all its nakedness and scandal, the essence of psychiatry as a tool of police. The early madhouses and poorhouses of Europe and America captured innumerable disorderly individuals from the streets and lumped them together just as early police documents mixed disorderly acts, dangerous things, and unacceptable statuses. The Hôpital Général was established in 1656 and the first German Zuchthaus, or house of confinement, was founded in Hamburg in 1620. The origins of confinement in England go back further to a 1575 act that ordered the construction of at least one “house of correction” in each county for “the punishment of vagabonds and relief of the poor.” The first place of confinement for the mad in America, the “mad wards” of the Pennsylvania Hospital, still operated as a jail for its inhabitants, despite being built after many major reforms in Europe. For Benjamin Franklin, one of the founders of the hospital, there were too many lunatics “. . . going at large who are a Terror to their neighbors, who are daily apprehensive of the Violences they may commit.” The lunatics, the vagrants, the prostitutes, the criminals, the drunks, and the dangerous were heaped together in one big mass and treated in the same way.
Those called mad or criminal had two options: forced labor or imprisonment. The origins of the treatment for the mad corresponded with the origins of police in wake of breakdowns and crises in the late Middle Ages and the inception of the public household. The task of the general hospital, according to the French Royal Proclamation of 1656, was to “. . . prevent begging and idleness, which are the source of all unrest.” Foucault insists that this confinement and forced labor had both an economic aspect (since the imprisoned can provide low-cost labor in times of need) and a moral aspect (since by absorbing the idle, mad, and unemployed, they protected civil society from those elements considered dangerous). The general hospitals arose as institutions with “. . . full powers where authority, direction, administration, commerce, policing, tribunals, correction and punishment are concerned [with] gallows, iron collars, prisons and dungeons” at their disposal. In the era of confinement, police power and psychiatric power emerged as a single undifferentiated power of producing a society out of a disparate and disorganized mass.
But who were the insane and how were they different from the criminals? All modern (post-Enlightenment) conceptions of mental illness from the 18th century onward have been based on a theory of rationality. Madness here means “loss of reason,” indicating that one must begin with what reason is. As Thomas Szasz pointedly argued in his book The Myth of Mental Illness, there are no consistent physical markers or lesions connected to a “mental disease” in the sense that one can point to the visible characteristics of a physiological disease like diabetes. One can point to symptoms, but not disease. There are brain diseases, but these are not necessarily equivalent to the diagnoses of madness. One can have a neurological disease and not be judged mad, just as one can be called mad without any recognizable biological or organic changes in their brain. Nevertheless, madness and its various forms are most often attributed to “diseases of the brain,” despite there being no consistent evidence for this. If one characterizes madness first of all as a lived experience, the experience of madness or suffering — it is important that these are not made to be equivalent — is shared by the people who live through it who can foster it or ward it off. When madness becomes identical to “disease,” an expert or doctor must be granted full control over the patient to oversee their treatment.
The real dividing line between the sane and the insane depends on the definitions of rational and normal. While normality as a basis for mental disorder may be criticized for being too subjective, rationality is considered comparatively objective. Thomas Willis’ The Practice of Physick: Two Discourses Concerning the Soul of Brutes, one of the proto-texts of psychiatry and the earliest English work on medical psychology, states the familiar maxim that reason is the one thing that defines mankind and makes civil society possible. Those who do not display this reason or prove to be dangers to civil society have revealed themselves to be animals, and, like animals, they needed to be trained to be deemed safe. This “training” includes “. . . discipline, threats, fetters, and blows […] as much as medical treatment.”
The identification of the mad with animality was a common position in early texts concerning the mad and their treatment. The English physician Richard Mead wrote in 1751 that the madman is likely to “. . . attack his fellow creatures with fury like a wild beast [thus he needed] to be tied down and even beat.” Physician Charles Bell advised artists who wanted to depict madmen “to learn the character of human countenance when devoid of expression, and reduced to the state of lower animals.” Just like Aristotle argued that a slave showed himself closer to a work horse by demonstrating his lack of rational capacities, early psychiatrists and doctors identified the mad with animals and thus demonstrated their need for management.
The taxonomy of the forms of madness and their divergence from the discourse of criminal law became possible with the Great Confinement of dangerous individuals, since their confinement introduced the possibility of observation. Benjamin Franklin’s hospital in Philadelphia, for instance, charged four pence to observe the lunatics. In 1760, they had to erect a fence “. . . to prevent the Disturbance which is given to the Lunatics confin’d in the Cells by the great Numbers of People who frequently resort and converse with them.” Doctors could also come and observe these abnormal individuals. In 1793 France, the superintendent Pinel began going to madhouses and taking note of the condition and behavior of the madmen, their treatment, and eventual outcomes. He had much to be disgusted by. Men and women chained to the walls of dungeons, some covered in feces, some screaming in the dark. There were beds made out of straw and men were dunked in water and whipped in order to scare or brutalize the madness out of them. The situation in America was much the same. One popular treatment was to bring patients to the point of drowning to shock the lunacy out of them. Pinel and other reformers eventually rallied doctors to let the mad out of their chains and cease to beat them. Their treatment improved all around.
But don’t assume that this was primarily about helping the mad. Pinel’s observations of Poussin’s reformed hospital show us the intended goal of the reform movement:
I saw a great number of maniacs assembled together, and submitted to a regular system of discipline. Their disorders presented an endless variety of character; but their discordant movements were regulated on the part of the governor by the greatest possible skill, and even extravagance and disorder were marshaled into order and harmony. I then discovered, that insanity was curable in many instances, by mildness of treatment and attention to the state of the mind exclusively, and when coercion was indispensable, that it might be very effectually applied without corporal indignity.
Here, insanity is not considered from the perspective of the patient (their health, happiness, or desires), but from the perspective of order. Hence, it is necessary to categorize their disorders and marshal them “into order and harmony.” In other words, the production of a specific psychiatric power coincides with the differentiation of police power, and directs itself toward the management of behavioral disorders. Though one risks over-simplification through such a schematic, one could say that police came to be seen as a force of social management directed towards crime, public health towards diseases or other threats to the health of the population, welfare towards surplus and unemployment, and psychiatry toward the population’s behavioral abnormalities.
Despite this differentiation, the mad never lost their structural connection with criminality, just as neither criminality nor insanity lost its connection with filth or unemployment. At times, they may appear totally separate, but the broad police power that underlies them betrays the link often enough. The Ionia State Hospital in Michigan is a clear example of their fundamental equivalence. The hospital was opened in 1883 with the name “Michigan Asylum for Insane Criminals,” which was changed a few years later to “Ionia State Hospital” to avoid too direct a connection between the mad and criminal. Despite the name change, the hospital would continue to house both the “insane” and “criminals” (primarily those acquitted of crimes on grounds of insanity) until 1972. In 1977, it was reopened as a prison.
Sometimes the identification of criminals is said to be “scientific” and sometimes the treatment of the mad is characterized as “essential for public safety.” The appearance of the discourse of security in psychiatric texts or the discourse of mental health treatment in police texts reveals that their objects may be functionally different, but their goal is the same: to maintain public order. When it is possible, psychiatry and policing appear as distinct practices with different objects — the one dealing with a myriad of “criminals,” the other with the treatment of “madmen.” When the social climate is perceived to be calm and resources are available, this will result in a minute differentiation of diagnoses and treatments. As Pinel discovered, this allows one to more closely observe and manage the particular activities of the disorderly and produce more orderly subjects. In the late 18th century into the 19th century, this manifested as the spread of “moral treatment.” Quakers were the largest provider of this kind of care. In the Quaker’s institutions, often on large open farms, the insane and disorderly were treated like friends, allowed to roam free, and given practical work tasks to do, all while receiving moral instruction from their Quaker hosts. The treatment was certainly more pleasant than being chained to a wall, but that was not really the point. What this personal and open treatment allowed for was individualized observation and correction of disorderly behavioral patterns.
The insane asylum at the Pennsylvania Hospital opened in 1841 under the direction of Thomas Kirkbride. The treatment there was typical of a “moral” establishment: patients were woken up at six am to exercise in the gym, they were given fine clothes and encouraged to dress well, they had to admit that their behavior was their fault, and they were taught to develop shame and guilt so as to better monitor their own behavior. “You must be thoroughly convinced in every point,” Kirkbride advised them, “of some regular employment, and of resisting fancies that may enter your mind.”
In the early 20th century, the reform movement was in the decline. Hospitals were overwhelmed with madmen, syphilitics, senile elderly, and alcoholics. The fluidity between the figure of the madman — most often the “schizophrenic” — and the criminal became clear again as the hospitals began admitting more generally disorderly individuals and lumping them together in their treatment. The hospital, like the jail and workhouse, was being over-exploited as a correctional center for the disorderly, and a crisis was at hand. In 1840, there were only 2,561 mentally ill patients in the United States. Fifty years later, there would be 74,000 patients in state hospitals alone. At this point, only rich families could afford to put a disobedient wife or raving son in a reform hospital, while the rest ended up in environments that resembled the poorhouses of the Confinement. With so many patients, hospital employees reached back into their old toolboxes of coercive treatments and began confining, ignoring, and even beating the patients again. An undifferentiated mass of prisoners with an undifferentiated set of coercive tools means predictably bad outcomes for the patients.
This huge influx of patients occurred parallel to the development of a neurological discourse that stated that mental illness was a “brain disease.” This new discourse (spearheaded by the neurologists who studied nervous diseases during the Civil War) caused a decisive and lasting split between psychiatric discourse and the legal police discourse we examined above. The hospitals came to be seen as ineffective. Edward Spitzka of the New York Neurological Society mocked the asylum directors, calling them “charlatans” who knew nothing about “the diagnosis, pathology and treatment of insanity.” The public was already well aware of the ineffectiveness and terrible conditions of the hospitals. From that point on, psychiatry would be a medical profession and a science that treated a wide range of “mental disorders” or “mental diseases.” It would cease to justify itself as curative to the evils of society and would begin to justify itself as curative for “mental diseases.”
Psychiatry’s origins in managing civil society would not stay hidden very long, as the first practical outcome of this medical discourse was the idea that madness could be “cured” or managed. As with any pathology, one must be able to diagnose the disease before it can be treated. The origin of psychiatric diagnosis can be traced to the work of the German psychiatrist Emil Kraepelin and the Swiss psychiatrist Eugen Bleuler. Before them, the texts that characterized madness made no distinction between public disorders, criminal behavior, odd behavior, or psychotic behavior. Medical texts contained passages on “old maid’s insanity,” “erotomania,” “pauperism insanity,” “masturbatory psychosis,” and “chronic delusional disorder.” These texts were still examples of the undifferentiated police power. Kraepelin set out to develop a new classificatory system for mental patients that would tie symptoms to predicted outcomes. He created two broad groups: patients with psychotic episodes along with emotional disturbances were manic-depressive, while patients who exhibited a lack of affect or emotion had premature dementia. He predicted that the first group had prospects of getting better, while the latter would mostly deteriorate into end-stage dementia. Later, Bleuler would rename premature dementia “schizophrenia,” which means “split mind” in Greek.
Throughout the 20th century, “. . . the referents of schizophrenia gradually changed until the diagnosis came to be applied to a population who bore only a slight, and possibly superficial, resemblance to Kraepelin’s.” By the end of the 20th century, schizophrenia was associated with hallucination, delusions, and bizarre thoughts. With such a broad diagnostic territory, schizophrenia became the tool of choice for psychiatrists diagnosing social disorders. Why is speaking to God in a cathedral considered “prayer,” while speaking to a friend who passed away a “hallucination?” Why is believing you live in the “greatest country in the world” and showing reverence to a piece of cloth considered “patriotic,” while believing you are or could be a spy “delusional?” How is believing immigrants are coming over the borders in waves a “healthy fear,” while believing the FBI is spying on you “paranoid?” Simple. One adheres to an acceptable norm and the other does not. If we were to stick to only material referents to produce meaning, then we would have to abandon language. The relations we imagine between things are imaginary and do not materially exist. Delusion and psychosis are common parts —indeed, necessary parts— of the human experience and could be shared and discussed were it not for the shame implicit in “schizophrenia” or any other psychiatric diagnosis.
One of the most dramatic examples of the diagnostic fluidity of schizophrenia happened between 1940 and 1960 and was examined by Jonathan Metzl in his book The Protest Psychosis: How Schizophrenia Became a Black Disease. In the early 20th century, schizophrenia was considered a benign disease that mostly affected white women who were not adequately performing the expectations associated with being a wife or daughter. It was largely perceived to be a disease of docility and inaction. The wife was melancholic and failing to perform her womanly chores. Jonika Upton was diagnosed as schizophrenic. Some of her “symptoms” included carrying a Proust book around and running away with a boyfriend.
This changed in the 1960s during the Black Power movement when schizophrenia suddenly became associated with the fears of white civil society about Black protest. The DSM-II added “hostility” and “aggression” as new criteria for diagnosing schizophrenia; advertisements for anti-psychotics began portraying aggressive Black men; and asylums began admitting Black men for schizophrenia about five times more often than white patients. Malcolm X and Robert F. Williams were both diagnosed as schizophrenic by the FBI.
As Maetzl makes clear, there is a long history of diagnosing Black dissent dating back to the slave plantations. The physician Samuel Cartwright recorded “drapetomania” and “dysaesthesia aethiopica” as diseases in his Diseases and Peculiarities of the Negro Race. The first is a mental illness characterized by an insatiable desire in the slave to run away from their plantation, and the second a mental illness characterized by general laziness and drowsiness. Both could be “cured” by a whipping and returning to work. In moments of dissent and civil unrest, criminal law and civic law will capture some of the disorders by criminalizing them, welfare will capture others by regulating them, and psychiatry is tasked with picking up the rest by medicalizing them. Those who talk of “mass incarceration” are telling less than half of the story. To tell the story of policing, we need to also talk about “mass regulation” and “mass medicalization.”
After Emancipation and the drafting of the 13th Amendment, the incarceration rate in the South spiked dramatically as those who were just freed were funneled into the prison system to perform free labor within the new Convict Lease program. The North, always seeking ingenious new ways to police disorders, preferred instead to medicalize free Black people. The 1840 census reports that insanity was eleven times more common for Black people in the North than in the South. That number would rise five-fold between 1860-1880. W.M. Bevis wrote in a 1911 issue of the American Journal of Psychiatry (still the official journal of the APA) that “Negroes” were more prone to psychotic diseases because they descended from “savages and cannibals” and could not handle the psychological pressures of living in “an environment of higher civilization for which the biological development of the race had not made adequate preparation,” placing him well within the confines of the “ethno-psychiatric” trend we will discuss below (see section d). Psychiatrists, always such willing apologists, have consistently used their medical expertise to mask the American police power’s connection with slavery and the subsequent disorders arising from its dissolution. Frederick Goodwin, the NIMH (National Institute of Mental Health) Scientific Director and Chief of Intramural Research from 1981 to 1988, was appointed to head the Alcohol, Drug Abuse, and Mental Health Administration in 1988. In 1992, he headed what he called the “Violence Initiative.” His concern, he said, was that “certain areas of certain cities” were like “jungles” where “monkeys” were killing and breeding at higher rates. Goodwin, though he later resigned due to controversy around such frank comments, estimated that 100,000 children as young as five years old would be identified for psychiatric interventions in the inner city. He named the Violence Initiative as the number one funding priority for the Federal Mental Health Establishment in 1994.
Most often in the 20th century, psychiatry has applied the broad tool of “schizophrenia” to manage public disorders, but this is not the only diagnosis that betrays a connection to notions of criminality, normality, and public management. The conduct disorders are the most obvious of these tools of social control, and are most often applied to children, with children of color being an even more over-represented sub-group (Black students make up about 66% of EBD cases in the St. Paul, Minnesota school system, and 80% of total students enrolled in special education services). It is with the conduct disorders that the police power of psychiatry shows its face most bluntly. Oppositional Defiant Disorder (ODD), which the present author was diagnosed with as a teenager, requires that one show at least four of the required symptoms for six months, some of which include “often angry and resentful,” “often argues with authority figures,” and “often actively defies or refuses to comply with requests from authority figures or with rules.” Under some of the causes, one can find “low socioeconomic status,” “limited employment opportunities,” and “living in high risk urban areas.”
Another common diagnosis is Emotional and Behavioral Disorders (EBD). Some of the diagnostic characteristics include
Difficulty to build or maintain satisfactory interpersonal relationships with peers and teachers […] Inappropriate types of behavior (acting out against self or others) or feelings (expresses the need to harm self or others, low self-worth, etc.) under normal circumstances […]A general pervasive mood of unhappiness or depression […] A tendency to develop physical symptoms or fears associated with personal or school problems.
This medicalization of rebellion and opposition can now be carried out at as early an age as two. Rather than being legitimate forms of rage against their political conditions, anger and defiance against authority are considered medical issues to be worked out with a therapist or medication. Between 1993 and 2012, there was a seven-fold increase in the number of children under 13 being prescribed antipsychotics. About 63% of those given antipsychotics were for “disruptive behavior disorders” like ODD. By citing low socioeconomic status as a cause for a medical diagnosis and intervention, the police (psychiatrists and school officials here) can avoid it being a cause for a political action, i.e. a riot, sabotage, or student strike. As psychiatrists continue to bicker about what the hell schizophrenia is, what “normality” is, and about how to diagnose anything at all, they are nevertheless comfortable with prescribing aggressive personal therapy for “oppositional” children and antipsychotics for pre-teens.
The most vague and broadly applicable of these diagnoses of control is ADHD. Russell Barkley, one of mainstream psychology’s leading experts on ADHD calls it a “deficit in rule-governing behavior.” This can be virtually anything from making weird noises to standing up too often to hitting others. Adults with authority in our society are unable to ask the obvious question: whether kids are bored because school is awful and boring. Instead, they weave a story about “brain chemistry” and categorize anyone who doesn’t respond well to the world they’ve reproduced as “deficient” so they can stuff them full of pills.
d) cures and treatments (for the patient’s own good)
Still, Kraepelin was interested in developing a medical science of disorders rather than a criminal science. What is special about this discourse is that, unlike police discourses that center around (false) concepts of justice and law, which are seen as products of consensus, the policing of mental illness, because is is based on what’s considered “rational” behavior, is presented as a “science” or a “form of knowledge” that is always growing and becoming more objective. The policing of mental disorders is thus capable of bypassing even the thin veneer of legal protection offered by the principles of “justice,” as the mentally ill are said to be a danger to themselves or others. “Such individuals have no rights,” wrote the American eugenicist William Robinson, “They have no right in the first instance to be born, but having been born, they have no right to propagate their kind.” Since Bleuler and Kraepelin’s diagnosis of schizophrenics hinged on the pessimistically expected outcome, the term came to be associated with those who have very few prospects and need a lot of care. This despite the fact that the diagnostic criterion shifted completely and came to cover a wide range of people with psychotic or delusional experiences. Over time, psychosis became equivalent with schizophrenia, which was associated with suffering and early death. The consequences of this were immediately clear. Both Bleuler and Kraepelin were eugenicists and argued for the sterilization of schizophrenics and those with other social abnormalities, setting a precedent for the “modern” psychiatric treatment of those identified as mad.
The first psychiatric treatment movement to emerge after the production of a “scientific” and “biological” model of diagnosis was the eugenicist project. Darwin’s cousin and eugenics pioneer (as well as the man who coined the term), Francis Galton, asked, since the farmer could ensure healthier plants and animals through careful breeding, “could not the race of men be similarly improved? Could not the undesirables be got rid of and the desirables multiplied?” The “insane” were the most common targets, but the eugenicist project was aimed at all social deviants and threats. A common theory held that Eastern European immigrants carried a “defective germ plasm” that made them more likely to rape and murder. Criminals were called “social wastage” who carried their predisposition to crime in their genes. The American Eugenics Society (which included John D. Rockefeller Jr. and George Eastman of Eastman Kodak), or the “Society for the Control of Social Cancer,” believed that the mentally ill were an “insidious disease” and that each new mentally ill child was a “new cancer in the body politic.” They went on tour with an exhibit entitled “Some People Are Born to Be a Burden on the Rest,” which featured a flashing light every 15 seconds to indicate that $100 had been spent caring for defectives. Every 30 seconds, another light would flash to indicate that another defective had been born.
The practical effects of American eugenics were widespread. Indiana was the first to pass a compulsory sterilization law in 1907. Thirty-three states would introduce similar laws and eventually sterilize (usually without consent) around 65,000 people. These sterilizations were mainly targeted at “mentally ill” and disabled people, but the nets were huge. The Iowa 1913 sterilization bill said those in need of sterilization included “criminals, rapists, idiots, feeble-minded, imbeciles, lunatics, drunkards, drug fiends, epileptics, syphilitics, moral and sexual perverts, and diseased and degenerate persons.” Black and Native women were disproportionately affected by these policies. The language of California’s sterilization laws was particularly direct. Most of the 9,782 individuals sterilized under the state’s laws were women. Many were simply classified as “bad girls,” diagnosed as “passionate,” “oversexed” or “sexually wayward.” In North Carolina, 85% of those sterilized were women, and 40% were women of color, a disproportionate amount of the whole. Jane Lawrence claims that between 25%-50% of Native women were sterilized in the 1970s.
The Minnesota Eugenics Society was founded in 1923 with the help of Charles Fremont Dight. His career in eugenics began as a legislative campaign to pass a sterilization law in 1921. In March of that year, he wrote a letter to the editor of the Minneapolis Morning Tribune with the following remarks:
This country for many years has been the dumping ground for inferior people from Europe. This accounts in part for our excess of incorrigibles. It is estimated that from 6 to 7 per cent of the immigrants who have recently been arriving are feeble-minded […] In view of the grave situation it is almost criminal to continue to absorb European undesirables. To get rid of the over-load of mentally sub-normal people which we already have is the big problem.
Dight helped pass a bill in 1924 whose goal was “to Delay Marriage Until After Eugenical Sterilization In Cases of Those Whose Offspring Would, In the Opinion of Experts, Be Feeble-Minded, Epileptic or Insane, And to Prevent Reproduction By Those Who Are Thus Afflicted.” In a letter to Hitler in 1933, Dight commended him for his efforts in trying to “stamp out mental inferiority among the German people.” He certainly wasn’t the only American scientist to support Hitler or to be in direct contact with him about his eugenicist plan.
“There is today one state,” Hitler wrote in Mein Kampf, “in which at least weak beginnings toward a better conception [of immigration] are noticeable. Of course, it is not our model German Republic, but the United States.” He learned from the best: “I have studied with great interest,” he told a fellow Nazi, “the laws of several American states concerning prevention of reproduction by people whose progeny would, in all probability, be of no value or be injurious to the racial stock.” And the connection goes beyond mere influence. The Rockefeller Foundation helped establish the German eugenics program by sending materials, booklets, and scientists overseas. It also helped by financing the German Psychiatric Institute at the Kaiser Wilhelm Institute, which was later directed by Ernst Rüdin, one of the architects of the Nazi’s euthanasia program.
Eugenics fell out of favor after the evidence of the Nazi genocide became public, but psychiatry has not ceased connecting biology to abnormality. It wasn’t until 1973 that the APA decided homosexuality wasn’t a mental disorder and ceased trying to find a biological “cause” for it to cure. And the APA is still conducting tests trying to prove a connection between brain biology and criminality and advocating for more humane eugenics through medication. In February, 2014, they published an article entitled “The Criminal Mind,” in which they argue that, “If we know that certain brain characteristics may predispose some people to violence [we can] intervene.” They write that one must “change brain to change behavior.” They don’t seem to grasp that crime is a normative concept and not a biological one. Nobel Prize winning scientist Alexis Carrel was more honest in the 1930s: “The abnormal prevent the development of the normal. This fact must be squarely faced. Why should society not dispose of the criminal and insane in a more economical manner?” There can be no biological proof of crime because there is no eternal category of crime. This is simple and obvious, but, again, psychiatry is not concerned with “truth” — it is concerned with normativity and social management, and, sometimes, planning threats out of existence seems to be the best way to deal with them.
The same pattern repeated itself in the 1970s. After decades of degrading and brutal treatments like electroshock therapy and lobotomies and the continuation of simple confinement and neglect, psychiatry seemed to have finally found a better solution to their abnormality problem: drugs. The terrain decisively shifted in 1963 when president Kennedy, backed by the Joint Commission on Mental Illness and Mental Health and an army of pharmaceutical investors, announced he would be replacing the country’s shameful state mental hospitals with a network of community clinics. This valiant effort would be made possible by the neuroleptics, which, according to Kennedy made “it possible for most of the mentally ill to be successfully and quickly treated in their own communities and returned to a useful place in society.” The Joint Commission on Mental Illness and Mental Health described the anti-psychotics as “moral treatment in pill form.” Our concern is not with the power of the pharmaceutical industry that helped lead to the over-prescription of neuroleptics nor even with the notoriously bad outcomes of the patients treated with them, but rather with how they were perceived to be necessary and how they were supposed to act on the body of the mad. When they work, they will tranquilize.
“Antipsychotic” is a misnomer. They do not directly affect psychosis or the content of a psychotic experience. They are tranquilizers. When the first one, chlorpromazine, was discovered by French naval surgeon Henri Laborit, he found it to be like “a veritable medicinal lobotomy.” The tranquilizing effects were so powerful he found he could operate without using anesthesia. In 1954, when lobotomy was still a socially acceptable form of halting the outbreaks and disturbances of those cast out as mentally ill, Philadelphia psychiatrist William Winkelman Jr. approvingly found that “The drug produced an effect similar to a frontal lobotomy.” His agitated and upset patients when treated with the drug became “immobile, wax-like, quiet, relaxed and emotionally indifferent.” As we began opening the doors of the asylum, new methods were concocted to lock the patients up in the asylum of their bodies in a perpetual slumber.
Robert Whitaker, in his book Mad in America, identifies a turning point in the perception of antipsychotics during the Cold War in 1970, when it was found out that the Soviet government had been using the same drugs as a form of torture against political dissidents. The most common torture drug was haloperidol, which is still the most commonly used neuroleptic. A samizdat manuscript entitled Punitive Medicine described the effects of the drug on the dissidents:
The symptoms of extrapyramidal derangement brought on by haloperidol include muscular rigidity, paucity and slowness of body movement, physical restlessness, and constant desire to change the body’s position. In connection with the latter, there is a song among inmates of special psychiatric hospitals which begins with the words, “You can’t sit, you can’t lie, you can’t walk…”
It wasn’t long before journalists and politicians began comparing it to Nazi wartime practices and calling it “spiritual murder.” And yet American psychiatrists were also forcibly administering the same drugs, and not only on “mental cases,” but also on the elderly, juvenile delinquents, and people with Down’s Syndrome. All the hubbub resulted in a brand change (the drug companies put out new drugs called “atypicals,” which functioned in the same way) and some ineffective legal loopholes (hospitals had to apply through the court before forcing medication on a patient). Birch Bayh, an Indiana senator in charge of investigating the use of neuroleptics in juvenile detention centers, elderly homes, and jails, called them “chemical handcuffs” which “rob you of your mind, your dignity, and maybe your life” and put you in the “solitary confinement of your mind.” But, he assured a senate hearing in 1975, “We are not concerned with those [medical] situations where those drugs are used appropriately after proper diagnosis.”
Bayh’s statement is typical. What is horrible torture for “normal” people is only necessary for the “mentally ill.” Because the crazies speak in a way we don’t understand, their unwillingness to succumb to treatment must be discounted as an aspect of their illness. What has been missing from all these accounts in the history of psychiatry is the experience of the patients themselves. This is necessarily so from the perspective of psychiatry and from the police power more generally. The experience of the patient lies sprawled out before the psychiatrist as a series of symptoms to be treated. The reality of their experience is unrelated to the life of the person in consideration. They are the manifestation of the falsity of the disease. John Modrow records in his book How to Become a Schizophrenic that, before he could take his antipsychotics, he himself had to internalize the fact that he was a “schizophrenic — a pitiful, helpless defective human being.” Experience comes to be, for the one making a diagnosis, the expression of an internal delusion. Anything the patient says about their hatred of their medication, any manifestation of anger towards the doctor, or any aggressive behavior towards their jailors is perceived to be an expression of illness, not a person.
Ebenezer Haskell finally escaped from the Pennsylvania Hospital for the Insane in 1868 using a rope drawn from his window, and promptly released memoirs of his captivity in a pamphlet along with a series of drawings to illustrate what he’d been subjected to despite his protests that he was perfectly sane. His drawings show scenes of men side to side in cages he refers to as “dungeons,” being held down while having water poured on his face, and close-ups and details of the implements of torture. Each image of the insane shows some measure of coercion, whether fetters, chains, or simply groups of men holding them down.
Judge Daniel Paul Schreber was one of the rare authors to write memoirs in the midst of their confinement not only about their experience of confinement, but also their spiritual experiences. Schreber discovered that the world was composed of nerve fibers. He was slowly being filled with “female nerve fibers” and becoming a woman. Soon after this realization, he found himself institutionalized in a long-term psychiatric hospital. When she was given medicines that were to influence her sensations of the “nerve-language” of the world, he refused them. We do not think it is so difficult to understand that Schreber acted in the way he describes in his memoirs:
Having, as I thought, definitely come to realize this abominable intention [of the medication], one may imagine how my whole sense of manliness and manly honor, my entire moral being, rose up against it […] Completely cut off from the outside world, without any contact with my family, left in the hands of rough attendants with whom, the inner voices said, it was my duty to fight now and then to prove my manly courage, I could think of nothing else but that any manner of death, however frightful, was preferable to so degrading an end. I therefore decided to end my life by starving to death and refused all food.
The attendants then began a system of force-feeding to make him live this degrading life.
80 years later, Janet Gotkin wrote about her experiences in a more modern and humane psychiatric setting, where drugs replaced aggressive coercion:
[The drugs] turned me into a fucking invalid, all in the name of mental health […] I became alienated from my self, my thoughts, my life, a stranger in the normal world, a prisoner of drugs and psychiatric mystification, unable to survive anywhere but in a psychiatric hospital […] These drugs are used, not to help or heal, but to torture and control. It is that simple.
What has remained the same is that the stigma of a diagnosis situates the experience of the person within a predefined set of symptoms, so that, when the person expresses rage or discontent, it can be interpreted as another sign that more treatment is needed. The diagnostic criteria are so wide that once one gets trapped in this self-legitimizing circle, it is extremely difficult to escape. Such a vicious circle can only be truly escaped by diving head first into the existential terror of living in a world where no single rationality has jurisdiction over the truth of the others.
In periods of relative stability and growth, police power tends to spread and diversify its range of objects. It also tends to diversify its range of available tactics. At a certain point, dumping dissolute masses of crazies or criminals into a single location ceases to make any sense. Confinement treats all disorders with the same blunt coercion. If you don’t fall in line, you will be captured and forced to comply. This is clumsy. It is more economical to devise techniques that accommodate for the wide range of possible disorders. Just as criminal police can now respond to social disorders with a broad range of devices, like civil forfeiture, fines, arrest, parole, plea bargaining, and execution, so too did psychiatric police develop their own broad range of tools, including welfare checks, doping, shocking, confining, shaming, and transporting to new institutional sites.
But today, psychiatry and criminal law are collapsing in on each other. This doesn’t mean that the range of devices of control are becoming more limited — it just means that the public perception of the forms of deviancy are losing their specificity and reverting into the basic outlaw and enemy of society. Someone suffering from a mental disturbance is perceived to have a predisposition to crime, just as the “terrorist” is said to have mental problems.
For kids, the fields of control have never been separate. The teacher appears as and acts like the police officer, the welfare officer, psychiatrist, and therapist. Horace Mann pointed out the ultimate equivalence of these roles when he said that, “Jails and state prisons are the complement of schools; so many less as you have of the latter, so many more you must have of the former.” In the adult world, where citizens have “rights,” we expect these roles to be performed by different functionaries in different settings. When they begin to collapse into one, this shows how similar they really are. The American Psychological Association recently published a study that declared “Mental Illness Not Usually Linked to Crime” where they find that, “In a study of crimes committed by people with serious mental disorders, only 7.5 percent were directly related to symptoms of mental illness.” Yet in Chicago, Mayor Rahm Emanuel plans to add 500 new police officers to the force, while schools and mental health facilities continue to close. There are estimates that about 30% of Cook County jail’s 9000 inmates would be or are diagnosed with a mental illness.
In Minnesota, the situation looks much the same, if not more drastic. Minnesota state law holds that a person diagnosed with a mental illness in the county jail system must be moved to a treatment facility within 48 hours, but, citing health and safety concerns, this law is now being widely ignored. Statewide, there are 570 beds for the mentally ill in psychiatric hospitals or treatment centers. As the diagnostic criterion expands and more disorderly are caught in its net, jails and hospitals begin to resemble psychiatric institutions while psychiatric institutions, filled to the brim and operating beyond their capacities, begin to rely on older confinement techniques, thus taking on the qualities of a prison. Beltrami County Sheriff Phil Hodapp is right when he says “We are at a crisis across the state.” On any given day, according to records reviewed by the Star Tribune, anywhere from 100 to 200 inmates have diagnoses of a mental illness.
They also reported that between 2009 and 2015, “the amount of time that so-called ‘non-delinquent’ children spent in state-licensed juvenile correctional facilities rose 28 percent.” Hundreds of kids whose parents sought state-run mental health services are languishing in juvenile detention facilities without having committed a crime. Minnesota also subsidizes some of the most sheltered workshops in the country (more than 300) where it funnels more than half of its citizens with cognitive disabilities (53%). These institutions (usually located far outside of any cities or large towns) operate like a mix of prison, factory, and care institution. Residents are bussed from their group home directly to their job site where they can hope to make $2 per hour stacking cans, packaging candy, or collecting trash. These group homes house those designated “cognitively disabled” and “mentally ill.” “This feels like a prison,” said Joshua Burt, 28, who was placed in a Rochester group home six years ago against his will. “This is not the place for me, but it feels like my life is outside of my hands.”
We ought not bemoan the fact that “people who should be in mental institutions” or “kids who should be in school” are ending up in jails or vice-versa. The fact that people can so easily be funneled into one or the other shows how both are designed to manage differences and assure civil society that its dissolution is not at hand. If the greatest threat is perceived to come from “criminality” (as in Chicago), then money will be transferred to the police, the jails, and the ever-increasing parole system of checks and surveillance. If it is decided that the real threat comes from delinquency, more money will be pushed back into schools and juvenile prisons, newly endowed with therapists, security officers, and metal detectors. If the “mad” ever become a great threat again, we will see the emergence of a new mental institution, more refined than the asylum.
e) the ethnopsychiatric scandal
We have . . . drawn the attention of both French and international psychiatrists to the difficulties that arise when seeking to ‘cure’ the native properly, that is to say, when seeking to make him thoroughly a part of the social background of the colonial type. Because it is a systemic negation of the other person and a furious determination to deny the other person all attributes of humanity, colonialism forces the people it dominates to ask themselves the question constantly: “In reality, who am I?” -Frantz Fanon
Many people know the story of Nelson Mandela and his 18 years of imprisonment on Robben Island. Fewer know that the island served as an indiscriminate zone of exclusion for lepers, the mad, and other troublesome or unwanted people in the Cape Colony of South Africa before it became a prison. The fluidity between police power and psychiatric power is perhaps nowhere more apparent than in the psychiatry and policing practiced in the colonies of the 19th and 20th centuries. The colonizers of this era had use of a psychiatry that had already come into its own and solidified as a science using Kraepelin’s diagnostic method, whose concepts, they realized, could easily be utilized to counter settlers’ growing anxieties about the inferior races —and the inferior among the settlers— in the urban core by categorizing, medicalizing, and imprisoning them. In this way, colonial psychiatry aided more in defining a stable category of “fit” and “proper” colonial citizen than it did in actually treating those suffering in extreme states.
Given that ethnopsychiatrists (as theorists of this colonial psychiatry liked to call themselves before the simple settler-colonized relationship began to fall apart) based their professional assumptions on the belief that natives of Africa and Australasia were the most primitive and deficient of minds, we will focus our attention on some of the colonies of these regions. Psychiatric institutions and practitioners came late to the colonies, and first only to the wealthy colonies with a sizable white administrative class. This is logical for the settlers, since, in the colonial situation, it is “the policeman and soldier who are the official, instituted go-betweens, the spokesmen of the settler and his rule of oppression.” Fanon makes it clear here that the settler government can only “speak the language of pure force.” Due to the lack of funds and the indifference towards the natives characteristic of the colonies, the settlers preferred cheaper and more aggressive means of control. This helps to explain the relative lack of psychiatric institutions in the African colonies for the first half of the 20th century.
The major psychiatric institutions and asylums were located in the urban cores, where the colonizer was most likely to come into intimate contact with the native African. The various mental health bills and ordinances of the colonies demonstrate clearly the purpose of these institutions: clearing the public of social refuse, particularly those who may not be immediately perceived as “criminal” and who have no committed a crime. The Lunacy Ordinance of 1908 in Southern Rhodesia allowed for the committal of “idiots” and those of “unsound mind” for the protection of the community, while Kenya operated until 1949 using the Indian Lunacy Asylums act written in 1856 allowed for the involuntary confinement of anyone walking around deemed insane.
The first asylum opened in the Gold Coast, in so-called Victoriaborg, in 1888. Like all of the early asylums in the colonies, it served as a prison for dangerous populations. For some of the asylums, this function remained fluid far into the 20th century: “As late as 1944 the annual reports on asylums for British West Africa, for example, appear as a subheading under prisons.” Small psychiatric hospitals and asylums were also established in Senegal, Algeria, Cameroon, Belgian Congo, Angola, Sudan, Ethiopia, Mozambique, and even smaller ones elsewhere. Larger asylums were opened in so-called Nyasaland of Southern Rhodesia, the Zomba Lunatic Asylum, as an annex to their central prison, as well as in Kenya and South Africa. These asylums all share the same few basic characteristics: they were small compared to their European counterparts, they functioned as prisons more than treatment centers, the majority of the patients were identified as “schizophrenics,” and they at least made attempts to keep the settler and native populations separate (although this was not always possible) in terms of living quarters but also in terms of treatment.
The line dividing the “primitive lunatic” from the “civilized” one was clear in the colony. While Africans and “Asiatics” were usually charged fees (or their families were), whites were generally supported by public expense. While Europeans were served meat and butter with their bread, Africans generally received grains and vegetables. At the Mathari Mental Hospital in Kenya, it was considered a major concern that the white patients were lacking sufficient means of entertaining themselves. To rectify this, the administrative staff introduced tennis and dominoes, while the Africans, who lived in a ward so overcrowded that the overflow was kept in the jail, were put to work in the hospital’s garden, producing the food for all the patients. Perhaps most telling of all, the stories and voices of Africans confined in these places have been lost to time. There is a history of white patients complaining about mistreatment and the public scandal that followed, while “African patients remain anonymous; there is no evidence in internal documents of complaining relatives or distressed patients protesting about the violation of their rights.” If, in the history of psychiatry, the mad have generally been likened to animals and been excluded from the project of civilization, it seems that, in the case of ethnopsychiatry, some animals are better than others.
Ethnopsychiatry has also been an essential tool in pathologizing the resistance of colonized and other subjects. The pathologization of the Māori —who, being “Australasian natives,” were also considered to be biologically closer to an animal than to the European— in the 20th century provides a clear example. The Māori have lived in Aotearoa New Zealand since sometime between 800 and 1200 CE, but their first encounters with the Europeans would not be until the 17th century, and they would not have sustained relations with Europeans until the 19th century. In 1840, a number of Māori chiefs signed the Treaty of Waitangi with the British Crown, which ostensibly kept sovereignty in the hands of the tribes, while establishing a British governor of New Zealand and making the Māori British subjects. Within 30 years, various conflicts over land and British expansionism turned into war. In 1871, a Joint Committee on Lunatic Asylums brought in psychiatric professionals from Britain, whose authority was made absolute with the Tohunga Suppression Act of 1908, which made the tohunga’s (“experts”) traditional practices of care and healing illegal. The purpose of this was made clear in the law’s text:
Whereas designing persons, commonly known as tohungas, practice in the superstition and credulity of the Māori people by pretending to possess supernatural powers in the treatment and cure of disease, the foretelling of future events, and otherwise, and thereby induce the Māoris to neglect their proper occupations and gather for meetings where their substance is consumed and their minds are unsettled, to the injury of themselves and the evil example of the Māori people generally.
Despite this attack on the self-organization of care, the Māori still were admitted into psychiatric asylums for psychosis in relatively small numbers up until the mid 20th century.
But the proportion of Māori being confined increased dramatically in the years between 1950 and 1970, far outpacing any other group, following a period of rapid urbanization for the Māori. This period of urban immigration quickly gave rise to an urban Māori protest movement, which emerged in the 1960s, demanding “the downfall of those sections of New Zealand society which oppress and exploit the Māori people.” This movement culminated in a land rights march to Wellington in 1975, and the subsequent establishment of a Waitangi Tribunal to meet with the Māori and make arrangements with Parliament for resettlement. After failure to meet demands, and further affronts on the independence of Māori land, numerous actions were undertaken in the 1970s and 1980s, including a 506-day occupation of Bastion Point, a suburb in Auckland.
The number of Māori institutionalized would only increase in the 1980s. A disproportionate number were hospitalized for “schizophrenia” (47.9%). In fact, “compared to other groups, Māori are 3.5 times more likely to be hospitalized for schizophrenia and 2.4 times more likely for bipolar disorder.” Many psychiatrists claimed and continue to claim that these are real mental illnesses that resulted from the Māoris’ inability to cope with the pressures of civilized life. This argument relies on racist and colonial imaginings of the native as simple and fragile, when the opposite could just as easily be put forth. The fact that natives have persisted through wars of extermination, suppression of their languages and practices, and loss of land shows very well that the simple, fragile native exists only in the imaginary of the settler. One could very well argue that it was the fear of the settlers that caused them to begin diagnosing more and more Māori as insane. For the settler-colonist, the idea that the deficient colonized native could actually assert themselves politically is delusional and psychotic.
Psychiatric discourse allows a group of speakers to designate any resistance to their designs as symptoms of an illness and those who carry it out as sick, pitiful, and in need of treatment. For the colonial-psychiatrist, the native who experiences persecution and violence from whites is “paranoid,” and the native who fights to bring about some form of self-organization using their own way of speaking and thinking is aggressively “schizo” and “delusional.” In one study on Māori mental illness, the authors find that “Genetically, Māori as a culture seem predisposed to mental illness” “…especially psychosis” adds a commenting psychiatrist. Through another lens, this could could also be expressed in the following way: the native thinks and lives in a fundamentally different way, and, thus, is a threat to the hegemony of the civilized.
Colonial psychiatry is colonial violence, abstracted by degrees of reference to the colonial situation but not by the quality of its effects. For Frantz Fanon, it is “a form of scientific violence” that uses medical terminology to pathologize resistance and difference. The small number of asylums and psychiatrists does not in any way mean that psychiatry did not play a role in colonizing Africa or Australasia, but rather that a psychiatric discourse, by medically designating the African or the Native as closer to an animal than human, more often played the role of legitimating violence against those seen as beyond normalization. Colonial psychiatry may have left few physical traces, but its language continues to inform paternalistic and degrading theories about the difference between the “civilized” and the “savage” or the “primitive.”
Colonial psychiatry can be seen as one of the characteristic discourses of what Achille Mbembe called the movement of national colonialism, which is primarily a nationalization of the biological. Central to this movement was the careful circumscribing of the differences between the races, with the final goal of producing a definitive hierarchization of the races. The science of racial difference and inferiority was produced by multiple hegemonic discourses, whose purposes were ultimately to justify the abject status of the inferior races. The majority of people would come across the thematic of racial hierarchy through “museums and human zoos; through advertisements, literature, art, the creation of archives, and the dissemination of fantastical stories relayed in the popular press.” Ethnology, social anthropology, geography, and psychiatry supported each other in their fundamental premise: the white race was the only one with access to the rationality that characterizes civilization. In this discourse, which is fulfilled and completed in eugenics, the inferior races are host to degeneration and prone to commit acts of violence at any moment.
Given the diversity and scope of colonial psychiatry, we could here only provide a broad overview of some paradigmatic examples, with both the intention to return to it in later texts, and in the hopes that more people will become acquainted with the field.
f) let madness speak, and speak madly!
“All right, but how do you begin? What words do you use? It makes no difference, use the words” -Sasha Sokolov
Rationality is the conversation the rational have with themselves about themselves. What they call irrational is whatever is incompatible with this conversation — whatever interrupts it. We do not mean to make irrationality prevail over rationality or vice-versa, but to expose them both as inconsistent markers in an irresolvable conflict with one another. “The philosopher-civil servant,” wrote Reiner Schürmann, “declares the law by suppressing the counter-law.” We only add that he suppresses by situating it in mental hospitals, in the home, in isolated rooms of the school. We persist in seeing in the madman the distortion of the rational, and in the “cripple” the incapacity to achieve real goals. Much like the white civic imagination must represent to itself an image of Black suffering and criminality to legitimate itself against, rationality creates images of the suffering madman tearing at his hair and rubbing shit on the walls to legitimate its own excesses and desires. David Cooper wrote that “The ‘good,’ ‘sane’ people, who define themselves as such by defining certain of their number as ‘mad’ and ‘bad’ and then extruding them from the group, maintain a safe and comfortable homeostasis by this lie about a lie.” Rationality becomes closed off and ignorant of its own irresolvability once it claims completeness and a scientific base. At that point, it must criminalize difference, identify it with suffering, and torture it to maintain its own inner stability.
In order to even begin to have a conversation about madness today, we must do three things: one, disentangle madness from suffering (i.e. treat suffering as suffering and not as equivalent to psychosis or a “brain disease”); two, dissociate madness and psychosis from falsity or delusion; three, leave behind the “status” of mad people in favor of a discourse prioritizing the experience and passages of madness. Given that the majority of psychiatrists in the world are white and come from a Western European background, one must immediately put into question any objectivity or shared common core of the concepts “delusion” and “psychosis,” since we know that all groups do not experience phenomena in the same way. If the “normal” people continue to see the mad as people with diseases who suffer greatly and are essentially deluded and who operate with different understandings, they have closed off any possibility of conversation with them and have abandoned them to the discretion of police.
If we cared about each other’s well-being, we would begin with our experience, our needs, and our desires, and not with our brain chemistry or diagnostic label. The situation becomes even more complicated as a psychiatric discourse is largely dissociating itself from the institutions with which it is associated, i.e. the asylum or the mental hospital. We hope we have demonstrated that this discourse and mode-of-perception has never resided or been confined in those places, but today it seems that psychiatric pathologization of everyday life has claimed new territories. This is expressed as 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 criterion around the world.
There is also a counter-current to this trend being expressed in the public’s perception of crime, which is tending towards medicalization and pathologization. Within minutes of a scandalous crime being committed —murder, terrorism, or assault— journalists begin to present us with an abundance of evidence indicating the criminal’s “mental instability” or “history of mental illness.” This ultimately leads to the conclusion that mental illness is a sign of potential criminality; as well as the opposite, that criminality is an indicator of potential mental illness. Such a fluid relation just means that more behaviors fall under the category of “potential threat,” that whether or not such behaviors can be clearly designated as an infraction of the law or of a dangerous psychotic breakdown is less important, and that thus those who act suspiciously open themselves up to the possibility of surveillance or confinement —or execution at the hands of fearful police officers who see all unpredictable scenarios as threats. Thus we have the paradox of an anxious public that perceives itself as a multitude of isolated depressives and paranoiacs, while extruding those who explode by amplifying their exceptional qualities to the degree that they become monstrous and inarticulable. Both trends flee from common, sharable experience.
When crises arise, we need to find ways to respond that exclude the police and police powers. An article posted on the website libcom.org in October 2016 by Soapy, called attention to our “hatred of solidarity” when we call the police to deal with crises, particularly those crises involving behavior we find incomprehensible. The author recalls the public discourse ascribing police execution to some fault of the victim. “They must have made a bad choice” is a common one. “If you don’t act violent, you won’t get shot!” goes another. Comments like these and the softer ones like “well, we need police…” and “what about the really bad guys…” reveal both a general unawareness of practices of care and a hatred of dealing with the conflicts of life. Care and conflict involve exposing oneself to risk and potential dissolution. We don’t call the police because we think they actually care about us and are the best people suited for the job, we call them because we don’t understand what’s going on in our isolation and want someone else to return things to normal for us.
But the history of psychiatry and of the control of what is called “madness” or “insanity” reveals a shameful dark side in the history of the democratic citizen himself, not just in the operations of the police officer. While officially held together by a network of experts, professionals, doctors, psychiatrists, and cops, the machine of rationalism has maintained itself by asking those who identify with it to periodically shame, spit at, and destroy those who cannot. From the “lettres de cachet” of the French Monarchy, which allowed everyday citizens to request the arbitrary imprisonment of a neighbor, to the modern day 911 call, the self-construction of citizenship and involvement in a rational whole seems to involve some form of collective, bottom-up practice of exclusion.
Asking what the person experiencing psychosis or another mental or physical crisis actually desires instead of managing it away means questioning our own perceptions and desires. For some, hearing voices can be a pleasant experience so long as the voices are not too disruptive or negative. We’re all psychotic in some way and we all suffer in some way. Let’s cease to assume their equivalence so we can figure out how to best care for each other.
Everyone experiences delirium, even those who show up to work everyday convinced that it’s the right thing to do. Most just ward it off, stifle it, or give it other names. Delirium is that unexplainable rush that carries us to new places. The passion for work is delirious, and so is the passion to smash up the workplace. Our particular delirium merely indicated above created senses when there were none to be shared in the world we shared with others, when our enforced body ceased being the right one, when our enforced life ceased being our life. In such cases, we need the potential for new bodies, for new lives, or for experimentation with the ones we have. Nothing is gained by maintaining an arbitrary line between the mad and the sane, or, as it more often happens today, between the general condition of mental instability —the depression and anxiety— present in the wider population and the “serious mental illness” of a dangerous minority. Nothing, except perhaps heavier medicalization, further abstraction from the reality of care for each other, and the auto-refusal of difference.
Efforts at embodying some form of “irrationalism” have so far been mere distortions of the rational, and, at its worst, racist portrayals of a “savage” or “pre-civilized” way of thinking as in the fantasies of the surrealists in the 20th century. Madness will continue to name the mask the democratic citizen keeps around to give a face to the emptiness that surrounds him so long as he, the rational democratic citizen, sustains his existence by naming others mad. This madness will persist until it becomes a radical multiplicity, an endless unfolding of always incomplete rationalities, so diverse and yet residing in such close quarters that they sequentially and spatially prevent one another from their wholeness. The question of madness beckons us to approach the beyond, but not the “Beyond,” but rather, all the beyonds we will never fully reach. Neither a person nor a pattern of behaviors, madness is the other side we flirt with at the edge of our own nothingness.
The question is never “is it mad, or not?” The question for us is “how will we act with this delirium pulsating through us?”
*Note: The footnotes to this piece can be found in the zine version on our PDF page.