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

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

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

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

Go here for the free study guide.’

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

Transcript of the episode

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

I. Approaching Madness

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

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

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


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

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

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

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

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

I spit on life
I Spit on Life by William Kurelek

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

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

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

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

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

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

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

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

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

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

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

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

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

II. The Psychiatric Era

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

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

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

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

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A page from Linneas’ Classes Plantarum and Bibliotheca Botanica

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

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DSM-V page on Bipolar disorders

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

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

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

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

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

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

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

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

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Hiawatha Asylum for Insane Indians

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

1967 ad for Thorazine

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

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

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


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

III. Listening to the voices

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

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

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

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

kidnapping packard.jpg

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

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

COnvicts and lunatics suffragettes .jpg

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

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

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

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

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

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

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

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

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

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

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

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

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


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

S o n g s  u s e d:

Fizz “Submarine Intro”;

King of Hearts Sountrack “La Valse Tordue”;

2 tracks produced and mixed by Sasha Durakov;

Bud Powell “Polka Dots and Moonbeams”;

Annie Ross “Twisted”;

Luboš Fišer “Valerie a týden divů”

* Header image is The Maze by William Kurelek

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


General Introduction to the Study Guide

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

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

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

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

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

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

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

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

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

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


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

Suggested Further Reading

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

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

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

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

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

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

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

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

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


**Song featured in this episode:

Talking Heads – Psycho Killer (Instrumental)

Sonic Youth – Schizophrenia

The Kinks – Acute Paranoid Schizophrenia Blues

Betty Hutton – Bluebirds in My Belfry

Dr. Dre and Ice Cube – Natural Born Killaz

Tupac – 16 on Death Row

Vince Staples – Loco

Kendrick Lamar – The Blacker the Berry

Daniel Johnston – Like a Monkey in a Zoo

Prince Buster – Madness



Global Uncivil War

Whether or not you think of historical struggle through the lens of civil war, democratization, or revolution affects in large part the way in which you conceive of the functioning and politico-juridical foundation of international and civil institutions; it alters or problematizes political claims of legitimacy of the police and even the state itself; and, on a more local/interpersonal level, it affects our libidinal and psychical investments in the activity of politics and the subjects involved therein. What follows here are a number of thoughts, problems, concerns, and complications that we’ve seen or picked up on since we accepted these theses and tried to use civil war as a paradigm to organize our thoughts and actions.

Civil war has never been pinned down legally, despite frequent attempts by jurists, sovereign powers, and political theorists since Rome’s Republican era over 2000 years ago. These actors have primarily tried and failed at codifying the following problems seen to be internal to civil war: whether it is a problem of the city or of the home, or a mixture of the two; whether it needs to involve some amount of physical coercion or force, or if it can also occur through language or in the minds of citizens; whether it concerns two or more parties, and, related to this, whether these parties must be attempting to take over the government; whether it only concerns those contained within specific sovereign limits or the whole of “humanity;” and whether it pertains solely to those already considered citizens, or those who, through violence or other means, could become citizens, or at least political subjects. Indeed, in our view, it is precisely because the concept is a paradox and has always been one that we find it useful. The combination of historical centrality and structural lack of definability opens up the supposedly autonomous domain of law to broader problems of citizenship, domesticity, war, (and later) risk management and policing, and it does so from within the paradigmatic forms of our political history itself — the citizen, the city, the home, and even humanity itself are, through the lens of civil war, seen as structurally inconsistent and contested forms.


Given that we still stand by that thesis, what’s questionable about the term? We decided to write this addendum after a number of experiences challenged our ideas of the language of civil war, or at least the effects of the language, and the ways in which one might try to explicitly utilize it. In the Summer of 2017, we, along with the other two current members of the Belli Research Institute, were invited to speak at two events, one in Chicago and one near Seattle about the concept of civil war. We attempted to formally structure these talks, which we called “Civil War as a Political Paradigm,” to allow for as much disagreement and debate about even our most basic statements by encouraging the audience to interrupt us in various ways. We wanted the format of the talk to highlight the part of the civil war concept we found most interesting and immediately comprehensible, namely the fact that irresolvable conflicts exist in various groups, and the different ways we deal with them (ignoring, accepting, discussing, burying, denying). In this, we failed. At least part of that failure arose out of the various understandings — and, in our view, misunderstandings — of what we were trying to problematize with this word. Yet we see such misunderstandings as interesting problems in themselves.

We choose to make use the word first and foremost due to its structural connection with some of the most basic terms of the Western political imagination: civility, citizen, civilization, and civil society, as well as war. In opposition to these terms —as we indicated above and will deal with at greater length in later sections— civil war is essentially problematic, by which we mean that it has always been contested. One could certainly make the case that “citizen” or any of the others above is also a contested term (and we certainly agree with this), but “civil war” is a preferable gateway into those problems, since it is both unambiguously a problem for Western political theory, and also central to its operations. These concerns all belong to what one might call the political and juridical aspects of civil war. Going into the talks, we assumed that the audience would not be uniformly interested in questioning the legal categories of citizenship nor the history of Western political theory. Instead of offering a dry and sterile account of the evolution of the Greek stasis into bellum civile and what it means for a political paradigm, we wanted to offer as little information about what concretely we would talk about as possible, and try to guide people into experiencing some amount of discord among themselves and see how it got handled in the moment. We wrote up a corny and vague description, created a complicated handout with instructions on how to disrupt the talk (it included, among other options: playing a song over us, shouting at us, shooting at us with a slingshot), and hoped a lot of people came and acted in surprising ways.

Instead of beginning by talking about the Greeks or the legal history of “civil war,” we started with a few direct experiences we had previously had wherein one group instrumentalized the language of “democracy” and “unity” to dominate the actions of another group during an intense public event. One example was a group of protesters in St. Paul who chanted “Unity!” over the chants of a smaller faction that had broken off in a move to silence them, thereby utilizing a word implying a collective will to prevent the expression of different perspectives. We referred to these as incidents in a “civil war,” hoping that the language would be heard as dissonant and that this dissonance would provoke thought. We wanted more than anything to ground the concept by encouraging people to think of examples where this management of difference and disagreement occurred and to create a discussion around how we handle these events.

This didn’t happen in the way we intended. In Chicago, quite a few people did show up, certainly more than we expected. Perhaps due to our inexperience with and general anxiety around speaking, we had difficulty not relapsing into the examples we’d thought up previously, and were unable to achieve the results we desired. A lot of the talk ended up looking like primarily a small number of men (including the two in our group) debating the finer points of our “argument,” with two other women occasionally chiming in, and waiting for us Main Speakers to supply answers to questions. It seems to us in retrospect that there was some basic confusion around exactly what we were talking about. Some thought we were only talking about the historical concept of civil war, some thought we were talking about the way “radicals” should imagine conflict, others thought we were solely talking about interpersonal strife and how it gets resolved. This confusion is certainly a part of the concept itself, as it refers to all of these, and more, at once. So we may have had too much on our plate, since, while we did want to focus on the interpersonal or local playing out of conflict, we also didn’t want to reduce it to that, nor convince anyone that that lens is the “correct” interpretation. By the very end, a larger portion of the room had understood what we were going for and had begun to chime in with a number of interesting and ambiguous examples of conflicts and their resolutions. This earlier reticence to speak on the part of those outside the small group of men was, beyond being just the playing out of masculine overconfidence in public spaces, perhaps also a result of the arrangement of the room. We three were seated on a couch facing the rest of the room. This was a limitation of the room itself we had not foreseen, as we intended to sit in a circle to encourage participation.

Yet, at our talk in Seattle, where we were able to sit in a circle, we had similarly disappointing results. If the problem in Chicago was both a lack of participation and the presence of multiple asymmetrical registers, in Seattle, we saw the presence of a conflict so specific that it was opaque to the majority of the audience, and also the expression of a number of ideological positions, which were impossible to discuss on account of their rigidity and circularity. Many voices, no conversation. While more members of this audience seemed to grasp the idea and were ready to discuss specific events, a number of men chastised us for not towing a Marxist line of interpretation, some even charitably “translating” our language into a more palatable Marxist dialect. One man, with the tone of someone who believed they were reconciling two groups of scuffling children, spoke up and stated that it seemed like we were “really talking about the ‘state’” when we spoke about those who use the language of democracy to silence their enemies. Another man, quite irate, grumbled that it seemed like this civil war thing didn’t “have anything to do with the working class revolution.” “No, it doesn’t” we told him, provoking furrowed eyebrows on a number of 30-something-year-old very serious Marxists. Some called us “identitarians,” another said something or other about Hegel and Stalin, which we didn’t understand at all, and yet another accused us of nihilism. Besides all these, there were two in the group who right then and there had a fight about a public space in a nearby city and whether its atmosphere was welcoming or not to certain groups. It was very clear none of this could be resolved in any simple fashion, by simply making one change or another, nor by apologizing to anyone, so we used the opportunity to take a smoke and bathroom break. In an unexpected sort of way, this turn of events did demonstrate the validity of our concept, since, despite everyone being present because they are interested in “radical” ideas of some sort, the presence of hidden conflicts haunted us all, and it was revealed that we were really speaking different languages, and coming to the circle with incompatible presuppositions.

It’s amazing anyone wanted to talk to us at all after this. Needless to say, there were certainly some who really did not want to, but we welcomed the paradox nonetheless, and invited those who wanted to come to a smaller talk the next day. This talk was a pleasant break from the previous two. The smaller size meant we were able to clarify some of the misgivings and misunderstandings people had the day before. We found out that a group had come the year before to give a talk on a similar theme and were rude and aggressive. One criticism we heard was that it seemed like speaking about “civil war” left no room for talking about patriarchal and white supremacist violence, and, at its worst, could even be used to cover up these powers, performing the exact gesture of forgetting/denying we were trying to highlight in our talk. The book most people there were familiar with on the theme of civil war, Intro to Civil War by Tiqqun, is virtually silent on these topics [1]. Further, our talk was scheduled at the same time as another that focused on “care,” which, because it temporally competed with ours, created a war/care binary and made our theme appear by contrast as if it were about “violence” or “aggression,” given the presence of the word “war.” Not being aware of these previous understandings, we were quite baffled by some of the responses we received the day before. This smaller talk allowed us to clarify that it is precisely conflicts around gender, race, and concrete, lived, local issues that we wished to discuss under the umbrella of “civil war.” Some assumed because of the term, and the problems listed above, that we would be interested in discussing the tired idea of “class war,” that we would be defending an “attack by any means necessary” approach, or that we were either attempting to avoid or sacralize identity and its relation to struggle. These associations and presumptions are real, and ought to be taken seriously.

Our talks, while failures, did reveal something important to us: despite the commonalities of groups that come together to create something or talk with one another, we speak in radically different registers, and gather with radically different understandings of the world, and we can’t understate these differences. We can’t assume they are merely the inessential and sweep them aside in broad strokes. We have to face them head on, even if that entails the feeling of loss or failure.

The diagram we presented at the talk.


Some of the tendencies and problems we encountered at the talks came into focus in distilled form in David Armitage’s new book Civil Wars: A History in Ideas and Patricia Owens’ response and addition to it “Decolonizing Civil War.” Armitage’s book is the longest and most sustained attempt at a genealogy of civil war in the academic anglophone world we are aware of, and worth engaging with for its coherent narrative, to point out its shortcomings, and for its wealth of citations.

Armitage begins his book by countering and qualifying the optimism of those who pronounce that global warfare is on the decline by interjecting that, while this is true for war between states, intra-state warfare, or civil war, is on the increase. Although there are quantitatively less incidences of violence on the global scale, the increase in cases of civil war also means that we are seeing a more heart-wrenching, long-lasting, disorienting, and emotionally damaging kind of violence. In Armitage’s words, civil war represents “the most destructive” [2] form of war. To this end, he fondly quotes Civil War general William Tecumseh Sherman who famously said that “war is hell,” but adds that “surely the only thing worse is civil war.” [3]

Homer calvary.jpg
The heroic ideal of bellum civile: two sides engaged in a contest of might that ends in tragedy. The Calvary Charge by Winslow Homer.

Much of his research reaffirms the central thesis: civil war has been both extraordinarily generative for the Western political tradition, but simultaneously a source of constant problems it has never been able to work through. It functions like a cipher. It cannot consistently hold onto any political meaning, yet we require it to make sense of politics, to differentiate between other political categories. Civil war has always been in the paradoxical position of naming the war between citizens while also being the lens through which one can establish political legitimacy at all. Armitage successfully demonstrates that the problem of civil war has in no way receded from its political importance in his two last, and most profound, sections “Worlds of Civil War,” and “Civil Wars of Words.” He argues there that the concept of civil war, despite still being contested and indefinable, continues to haunt global politics in two major ways. First, it is used by states to avoid conflicts they do not want to be involved in, and also, paradoxically, to intervene in crises when they have no legitimate legal grounds to do so. Civil war in the first sense is named to exempt oneself or one’s political constituency from guilt or involvement. Inversely, civil war can be used affectively to proclaim that because such-and-such a political situation is so dire and chaotic, our state is justified in intervening. Western states continue to mobilize this discourse at strategic moments to either avoid taking or as an excuse to take a decided, public, stance (or deliver aid) in myriad conflicts in the Middle East and Africa (most recently in Syria, but also continually in Somalia, for instance), despite the long and well-documented role of Western intervention in the formation of those conflicts. “Civil war,” in these examples is a strategic cipher capable of imparting the opposite meanings: “that’s a civil war, and thus their problem,” and “we must, on humanitarian grounds, intervene because it is a civil war.”

Second, civil war is a decisive concept of international governance agencies and humanitarian organizations, because its application or non-application to a specific crisis can determine the legitimacy of an uprising and thus whether or not these international agents will get involved in aid, or allocate resources and funds. On this international level, it can — Armitage cites Libya in 2011-12 as an example — grant political status and legitimacy to forms of conflict that otherwise might be seen as a mere rebellion or insurrection, and not qualified for the international protections of combatants, and the penalties for those who violate the laws of war.

There is little to disagree with in this account of civil war’s continued importance for international relations and laws of war. It’s in how Armitage begins his book (and how this beginning affects his overall outlook) that troubles us. Armitage, after considering the differences between the Greek concept of internal war, stasis, and the Roman one, bellum civile (civil war), ultimately chooses the latter as his foundation, claiming that stasis belongs to an altogether different tradition. What he attempts by doing so is, in our view, an act of “civilizing civil war,” a process he himself ironically critiques in his chapter on the American Civil War. His stated reason for doing so is that we borrow the term directly from the Romans, along with the primary way in which we imagine the words that make it up (Civil and War). The Greek term seems too foreign, and too bound to its time and place. Stasis, in Armitage’s account, refers solely to a world in which wealthy male Greek householders would gather in a public place to do politics; stasis was what happened when that particular relation was destabilized and subjected to war or at least disruption. We, on the other hand, like the Latins, see ourselves as citizens bound to a polity, who, in civil war, take up arms against each other. Later translations of stasis into bellum civile are anachronisms, in Armitage’s account. [4]

Political theorists deal heavily in images. More exactly, they deal in images that represent or perform the very acts of politics itself. The spatial boundaries of sovereignty were seen for millennia in the paradigmatic image of Romulus erecting walls around the city of Rome; while Remus’ leap over that wall was the basic act of transgressing sovereignty. Armitage ignores a whole tradition (largely going by the name of stasis) that saw “civil war” in images of women rising up against colonial rulership, of slaves picking up stones and speaking in public, and of the moral decay of the slaveowners and their civilization that came out of these riotous events. [5] Instead, Armitage sees “civil war” in the Strong Man and Dutiful Citizen Julius Caesar crossing the Rubicon, military regalia all around, armed and ready to kill opposing armies for his claims of rightful rulership. By beginning with this closed notion of politics and citizenship, and a militaristic notion of war, Armitage prioritizes a Eurocentric formulation of politics that cannot take into account how profoundly civil war destabilizes our sense of belonging. While the Greek term effectively destabilized the relation between who qualifies as a citizen — or even a human — and who was mere property, the Latin term ideally implies that we already unproblematically can see who is a citizen and who isn’t, who belongs and who doesn’t. All conflicts that occur are thus strictly between the men.


Patricia Owens’ solution, in her friendly critique of Armitage’s book, “Decolonizing Civil War,” is only partly satisfactory. She first succinctly identifies the problem with Armitage’s “civil war:” civil war has been called the worst, most gut-wrenching, form of war because it is represented as a war between brothers. “Brothers,” for the West connotes not just that the conflict occurs in close proximity to the household, but specifically, that it occurs between people who are already considered worthy: male, and already qualified as citizens. She writes: “Class, civilizational and gendered hierarchies were foundational to the very concept. Hence to fully understand civil war’s generative powers we must account for the constitutive exclusions and inclusions of those whose struggles elite Europeans refused to recognize as co-belligerents or eligible for ‘civilian’ protection.” [6] David Armitage offers, in short, a pre-civilized version of “civil war,” one where the civilizing process is already internally complete and unrelated to this horrifying thing called “civil war,” and which says little about its supposed “outside.”

Arendt begins her book On Revolution by immediately differentiating it from civil war and stasis. On this distinction, Owens and Armitage are in agreement. But Arendt’s account goes on to discuss and center the American and French revolutions, thus silently circumscribing the bounds within which revolution can occur strictly as relations between those already qualified as citizens/civilized. Armitage was greatly indebted to Arendt for making his distinction between revolution and civil war. He claims that revolutionaries are those who merely present themselves as the founders of something new within a civil war, hence the latter term is the foundational one, and destabilizes the first.

But there were agents with little to no legitimacy fighting at the same time and for drastically different aims than the revolutionaries proper: slaves, housewives, natives. Armitage, like Arendt, doesn’t go that far, still favoring his “already-included” subjects. Owens holds both Armitage and Arendt accountable for this Eurocentric prejudice, and offers a novel solution: what if, instead of the French and American revolutions, we use the Haitian Revolution as a paradigm? She offers the new image of the slave-revolt-turned-revolution. Would this not also characterize the political capacity of the non-included (non-civilized, non-citizen, or non-human) to transform themselves? In her eyes, this “successful slave revolt would undermine Armitage’s central claim” [7] that revolution is just a repackaged civil war. She peremptorily excludes the possibility that the Haitian Revolution could be seen as a civil war appropriated and narrativized as a revolution by reminding us that “if we are to adopt Roman categories at all, then Haitian’s were engaged in a servile war,” which is qualitatively different from a civil war and presents fewer difficulties in their eyes.

While this solution satisfactorily brings to the fore the humanizing/dehumanizing or politicizing/depoliticizing relation that lies at the empty core of Western politics, it still doesn’t escape the other problem associated with the revolutionary tradition: the fact that it absorbs the asymmetrical parties — the various différends — and gradients of a conflict and represents them in a simple binary (revolutionaries vs. the old order). While we can’t speak about the intricacies of the Haitian Revolution, it seems clear to us, even on the surface, that the events were not as simple as the term “revolution” tends to imply. This is largely a problem of the function of words: it is simply too easy for us to imagine that the “revolution” represented all those whom we see now in hindsight as “revolutionaries” and, in this way, to lose sight of the asymmetries and conflicts that existed among them. In the process, we lose valuable lessons and tend to oversimplify our present circumstances, overstating the binary conflicts we can extract from situations.


Armitage’s arguments hinge on the theses that the Greek and Roman concepts are fundamentally different, and, further, that we stand firmly in the Roman tradition. He justifies his distinction in four tightly interrelated points: 1. The question of forms of belonging. Stasis represented those conflicts that occurred between those considered “Greek,” and thus concerns a hereditary or even ethnic form of conflict, whereas bellum civile concerned war between citizens in the political sense. 2. The question of the “space” of civil war. The Greeks organized politics according to a fundamental division between the household, oikos — where the house-holding men organized their property (including slaves, wives, and children) in the most economical way possible — and the city, polis — where the worthy, economical men would meet and decide on the shape and future of their union. Stasis was a “war between households” in Armitage’s eyes and thus not a political war, while the Romans imagined it as two actually political groups vying for control of the state. This also includes the problem of scale. The Greek city-states were simply too small, and their notion of citizenship too limited, to imagine the kind of macro conflicts we associate with a civil war. 3. The question of militarization. The Greek stasis represented in large part a “state-of-mind” as opposed to an actual war between armed parties. He cites Thucydides here who emphasizes the moral decay of intracity conflict over any actual fighting. Calling the Greek “stasis” a “civil war” seems misguided in this light, because it remains a question whether it was a “war” at all if it did not require that military standards be raised and arms be leveled against the enemy. 4. The question of its entrenchment in politics/history. This is the most subtle point of distinction. The Greeks imagined their forms of politics and belonging as a body, with many of the biological metaphors that come with that representation. Stasis, for them, was like a disease in the body, and one that they could structurally not do away with. The Romans, on the other hand, tended to view bellum civile as a curse haunting history.

His first point that stasis is “hereditary” while civil war is “political” is contradicted by the most historically well-known passage on stasis, and one which Armitage himself quotes from: Thucydides’ third book in The History of the Peloponnesian War. The stasis he describes there is one in which a colonized people, the people of Corcyra, exploit the chaotic circumstances of the war between the two great colonial powers Athens and Sparta. In this section, women and slaves throw stones, and the women speak for the first and only time in Thucydides’ entire history. In the West, to be capable of speech is historically the prerequisite to being a political subject. The Greek paradigm of civil war, stasis, occurs along political lines, and concerns the question “who is capable of living a political life?”

This undermines Armitage’s first two lines of distinction at once: not only does the image of the woman or slave becoming political agent through effective action not concern who is Greek and who isn’t, it also clearly demonstrates that the Greek version of civil war is not merely between householders, but complicates the distinction between who runs the house (and is thus “political”) and who gets ruled  (or is merely “domestic”). This relation is part of all the civil wars Armitage later describes as paradigmatic of his Latinized concept, but most clearly for us in the American Revolution and American Civil War, when, as Mill put it, what was at stake was millions of enslaved people who were “human beings, entitled to human rights.” [8] Armitage quoted Mill there without grasping the fact that it was within civil war that these peoples’ humanity was at stake, and that it was through the conflicts themselves (slaves joining the British or rebelling during the American Revolution; slaves fighting for their freedom or escaping during the Civil War; or native tribes using the war as an opportunity to rebel on their own terms), and not on account of a legitimate legal process, that their status as people would be decided. Instead, he sees all this as a “by-product” of the real content of civil war: civilized men fighting with weapons.

Armitage seems to think that civil war must include “real” fighting, i.e. bloodshed, death, guns, and military regalia. Appian and Lucan are his poets of choice when it comes to the images that accompany civil war. Appian, like Armitage, makes the distinction between civil disturbance and civil war, writing that a civil war took place when “Open revolts took place against the republic and large armies were led with violence against their native land. . . They attacked it as if it were an enemy city.” [9] Appian’s influence on later war theoreticians is indisputable, but, this choice similarly betrays his prejudice. Armitage only looks for his imagery in the sphere he already proclaimed to be the special terrain of civil war: bloodshed, and binary acts of violence committed by militarized bodies. He only looks for his evidence in authors who write about military conflicts.

He maintains this false distinction for the period between the Roman Republic and the late 20th century, when he suddenly admits of a “civil war of words,” wherein it could be said that the words one chooses to use to describe a conflict could be said to be part of the conflict itself (e.g. with Libya and the UN above). He even calls to mind multiple other forms of civil or internal conflict that don’t necessarily include violence, namely, in addition to stasis, the Chinese nei zhan, and the Arabic fitna, saying nothing about the former, but adding that the latter can mean discord, temptation, anarchy, civil strife, or division, before excluding any further consideration of either due to their “obscurity.” Armitage is not ignorant to the fact that war or strife need not be the internecine catastrophe marked by physical force, swords, guns, or killing. If he had chosen a broader, less militaristic notion, perhaps he would have included passages using war language in novels of the infidelity of wives (the civil war of the family and lovers), in memoirs of mental illness (the civil war of the mind set against parts of itself), in histories of religious heresies (the civil wars of Christianity, Judaism, Islam), in fearful letters written between slaveowners worried about an uprising (the civil war concerning the humanity of slaves). For Armitage, these can only be metaphors derived from Caesars heroic battles, but, if civil war originally means conflict, strife, division, or discord, then we can unproblematically proclaim that these are civil wars in the original sense, and the armies duking it out in the city are in this light an appropriation of civil war, merely one possibility among many. But the colonial, civilized mindset is lacking creativity; because the colonizer achieved his goals through spilling blood and enslaving his enemies, he cannot see that his generalized aggression and hostility towards living things represents one way of living in the world and handling conflict among others.

Otto dix war.jpg
Otto Dix. The War. 1929-32. The poverty of the colonial/civilized imagination sees all conflict as essentially reducible to murder or a metaphor for murder.

Finally, there is the question of whether civil war is a disease or a curse. Stasis was very clearly thought of as a “disease,” while bellum civile was, at least in the Roman literature, referred to as the “curse” of civilization. In fact, stasis was another word for disease, and still persists in medical terminology to this day meaning “a stoppage of circulation” in phrases like “stasis of the blood” or in classifications like “stasis ulcer.” Stasis was thought of as an internal, inherent process to politics where elements (slaves, for example) cease to operate correctly and the circulation of power is blocked. And there was no cure for this disease, only medication and management. The curse, on the other hand, can return and strike at any moment, disrupting the day-by-day routine and setting brother against brother. They likened this curse to a natural disaster as in the poems of Tacitus (“The history on which I am entering is full of disasters”) or Florus (“The rage of Caesar and Pompey, like a flood or a fire, overran the city”). This moves the event outside and represents it as a force that strikes the otherwise perfect city; it reproduces a strong City/Nature or Civilized/Non-civilized binary. This is clear in the descriptions by Horace, who bemoans the fact that “harsh Fate . . . drives the Romans, and the crime of fratricide since Remus’s blameless lifeblood poured upon the ground— a curse to generations yet unborn.” It is Fate, that cruel god, who enters from the divine Supernatural Realm to set us against our brothers.

Though it seems small, there is a world of difference between the representation of strife as an outside curse and as an internal disease. The first performs a closing off of the boundaries of civilization by announcing that the only thing that can threaten its identity comes from outside. The curse reinforces the solidity of the political union being cursed, because it assumes that the union is real, and internally peaceful, i.e. operational. The incurable disease, however, posits the imperfection of the body in question, and points to the process of its own establishing as the cause of its recurring trauma. The disease places the body in question, opens it up to the outside, and denies any possibility of total health or prevention. Normative politics, in this light, is the permanent medicalization of the diseased body. The Romans did in fact think of civil war as a curse, but Armitage is incorrect in assuming that this representation won out over the idea of the internal disease, and it suffices to point to a number of quotations he himself included to demonstrate this. In every section of his book past the beginning on the Romans, he quoted political theoreticians referring to civil war as a “disease:” in the 17th century, Whitney calls civil war an “intestine strife,” and Hobbes similarly refers to them as “Intestine Broils,” while De Mably, nearly 200 years later, assures the reader that “civil war is sometimes a great good” because it can provide the impetus to remove the diseased limbs of the body politic as a surgeon would remove the diseased limbs of the individual’s body.

A 1940 poster warning of the danger of syphilis and gonorrhea, especially from those “risky” (female) bodies of sex workers. Keeping the social body clean is directly equated with ensuring a healthy stock of soldiers to fight the country’s wars and defend from the enemy. This linkage goes both ways: we must fight (political sphere) to defend our healthy citizens; we must be healthy (medical sphere) so that we may continue fighting wars. One is not a metaphor for the other. From the U.S. National Library of Medicine/Wikimedia Commons.

Given that Armitage’s Latinized “civil war” cannot be so cleanly distinguished from the more complicated stasis, one must conclude that his preference was an attempt to “civilize” the term, to reel it in away from the dark borders of civilization and settle it as an accidental conflict between brothers. He says as much himself in the most revealing sentence of his book: “Alas, the treatment of non-European peoples became quite another matter; a toxic by-product of this effort was the opening gap between those who were to be dealt with humanely and those who were not, the latter not even considered human.” [10] What for him is merely a “toxic by-product” of the effort to “civilize” conflict is for us the whole core of the problem of “civil war.” It is precisely his militaristic, civilized, presentation that allows him to exclude the horrifying possibility that perhaps the mechanism with which Western civilization establishes its own authority and legitimacy is broken, and never actually worked; that, in fact, the West has only violence, forgetting, lies, and negativity at its disposal for convincing itself it truly is “civilized” and its outside “barbarous;” that “civilized” stands for nothing other than a deep emptiness and a hopeless struggle to climb out of it, all the while naively believing in one’s own eternal superiority.


There are and will be those who have questioned why one would spend so much time with Greek and Roman concepts to begin with, and seemingly arguing for one’s conceptual priority over the other. Why look to these slaveowners for anything at all, especially tools for understanding our world? One response would be to point out that we who borrow from the Western political lineage uncritically appropriate concepts from that tradition without paying much attention to where the concepts came from and how they’ve been used. The most common term, in our experience, is “democracy,” which has undergone many ironic twists and metamorphosed from a favorite term of slaveowners to being a core concept in the political lexicon of the marginalized. The same has happened with “humanity,” “citizenship,” “rights” and others. More importantly, “civil war” has a special status in that it has always been a problem at a much deeper level than any of the others. It’s fair to say it’s among the most contested term in our political lexicon. Possibilities lie dormant in this fact. If there is something that the West wants to avoid in the term, maybe that’s because there is something dangerous in it. We could ask activists, radicals, and dissidents at this point: why do you give such credence to those concepts the preeminent political theorists of the West have happily fostered, and dismiss those they clearly perceive as unruly and threatening?

A second response could be that paradoxical formulations are necessary for a non-totalizing politics. Because a paradoxical formulation cannot be satisfactorily completed, it can prevent its user from elevating one or another subjectivity as the paradigmatic political or revolutionary subject. It forces its user to stay firmly situated in the process of politicization and its effects. We found “civil war” to be one such formulation. However, we did not fully account for the power of psychic investment in the representations of seemingly familiar words. This is the only thing that can explain the fact that, even after giving an account of the tumultuous history of the word, and clearly indicating that it does not essentially concern physical force, one could still hold onto simple images of bloodshed, guns, and infighting. We don’t have a satisfactory answer to this problem. One could, as we tried to, intentionally apply the term to situations where it sounds dissonant and ill-fitted. In our talk in Washington, we talked primarily about small, interpersonal conflicts as a paradigm of civil war. The risk here is that this usage can be interpreted as a metaphor or allegory, as opposed to the primary concept itself, so that one hears merely “our conflict with each other is like a civil war, but without all the guns and bloodshed.” One person present at our talk later said that one of their greatest fears was the possibility of “civil war.” The danger of a militarization of the representation of struggle or an aggressive understanding of conflict —of the prioritization of physical damage over the usage of words or the construction of space— looms large here.

attica riot.jpg
“Uncivil war” describes a political nexus in which people can change from being considered voiceless, non-political, even non-human objects of management to political actors through some form of disruptive action. In the case of the Attica Prison uprising of 1971 pictured above, the prisoners went from being depoliticized micro-managed objects of the prison staff’s gaze with mostly individual relations to the outside to being self-organized political actors with strong connections to outside activist groups, media, and lawyers through non-military, but still fierce, actions.

Alternatively, one could adopt a foreign word like stasis. Very few people have the same psychic or libidinal investments in stasis, which on the surface makes this solution attractive, but, on the other hand, even if one were to explain the structural connection to words like “state” or its continued use in medical formulations like “stasis of the blood,” one would still have a hard time demonstrating the stakes involved in the concept. The solution we — at the time of this writing — propose is simply to add a prefix to the already familiar term “civil war” making it simultaneously familiar and unfamiliar: “uncivil war.” [11] Uncivil war centers the decentering mechanism of civil war, making the inessential marginalia the problematic essence of the civilizing process.

What does civil war, or uncivil war, still have to offer us? The whole purpose of the book, and of discussing shared political concepts, is to problematize the way we think with our concepts, in a passive way. One doesn’t bring up the term “democracy” every time they decide to undertake a political project with others, but it informs the way they go about acting within that project. In the back of their mind, they see and act out the classic images of democracy, whether in its direct or representative form, and measure their activities against these primordial ideas. It’s the tendency to produce collective safety nets and existential securities we intended to challenge. It seems we are incapable of eradicating these images completely, so instead we tried to construct a tripping machine. Just as the political images form and begin to run along, our machine trips them so that they land on their faces.

Uncivil war is not a thing, not resolvable, and has no existence. It is enough for us to attack ourselves at the foundation, to take our leave, and begin. But begin what?


[1] As opposed to the one we used to think about civil war, The Divided City by Nicole Loraux, which more or less centers on this gesture.

[2] Armitage, David. Civil Wars: A History in Ideas. Pg. 8.

[3] Ibid. Pg. 8

[4] Ibid. Pg. 44

[5] This is from the account of Thucydides, who recorded in a few pages the events of the riots in Corcyra in Book 3 of The History of the Peloponnesian War. 

[6] Owens, Patricia. “Decolonizing Civil War.” Pg. 3

[7] Ibid Pg. 5

[8] Armitage, David. Civil Wars. A History in Ideas. Pg. 174

[9] Ibid. Pg. 49

[10] Ibid. Pg. 171

[11] We borrow this term from St. Augustine who referred to civil war as “civil, or uncivil, war” in City of God.

Why We Need Mass Shooters to be Crazy

Saying the Unsayable Every Time

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

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

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

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

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

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

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

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

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

More Than Just Normal

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why We Love Throwing Lunatics to the Dogs

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

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

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

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

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

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

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

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

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

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



[2] Elias, Norbert. The Civilizing Process.

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

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

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

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

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

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

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

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

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

Peter Conrad in The Medicalization of Society writes:

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

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

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

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

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

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

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

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


Women, Hysteria, and Housework

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

1890 ad for an “Electropathic Belt” for Hysteria and “Weak Nerves.” “I can perform all my duties without pain” reads this “female testimony.” There’s not too much in the way of images here. A drawing of a woman stares blandly ahead towards the viewer, both wearing a belt over her dress and holding one in front of here, as if to offer it. This ad, unlike most of those to follow, actually promises a complete cure.
ritalin-1956 (2)arouse
Ritalin Advertisement, CIBA (1956). This Ritalin ad shows a disturbed woman sitting near a window with exposed skin around her legs, her side, her chest, and her arms. The text tells the viewer to “arouse the depressed psychiatric patient.” One cannot help but be struck by the word choice of “arouse” when shown a female patient with the presence of  exposed skin, often stereotyping sexual waywardness. The bottom left shows a woman, maybe the same, happily reaching upwards for her medication. Again there is a possible sexual implication given the association between the word “arouse,” the skin, and now her position as desirous of what the doctor offers.  
Dexedrine Advertisement, Smith Kline & French (1956). This pharmaceutical ad aimed at women shows the future patient in a domestic role, suggesting that her problem is her inability to perform such roles. Like other such ads, the writers seem to recognize that the position of the hosuewife is dull and negative, but concoct chemical solutions instead of practice ones.
Mornidine Advertisement, Searle and Co. (1959). “Now she can cook breakfast again… When you prescribe new Mornidrine”
1967 ad for Serax. Nothing you can do about patriarchal power, but you can stuff your wife full of drugs! This ad, by placing the woman with her domestic appliances behind a veritable prison of brooms and mops, acknowledges that the duties entrusted to the normal housewife are oppressive and extreme and akin to being locked up, but then tells us that “Serax cannot change her environment, of course,” offering instead to “strengthen her ability to cope.” In other words, it allows her to continue living in the prison.
A 1973 ad for Anquil, a neuroleptic advertised as a cure for deviant sexuality: “exhibitionism, compulsive masturbation, incest, erotomania” and “anti-social sexual behavior.” We see an oversized face imposed over the dark bodies of sexualized women who even seem to be melting into one another staring darkly at us from about where the women’s breasts would likely be. This ad is puzzling, because it both exploits and warns of over-sexualization. It wants your attention, and seeks to gain it by showing idealized shadows of sexualized feminine figures in which a grotesque floating face seems to reprimand you. Is it trying to tell us that such a gaze is “anti-social” and that we perverts are like him? Or is he the face of “society” gazing at us gazing at these shadow ladies?
Meprospan advertisement, 1967. Another example of advertising psychiatric drugs explicitly as a coping mechanism (a “tranquilizer”) for the pressures of household work. What exactly this child did to stress the mother out is unknown, but we can guess from his nudity and from her exhausted expression that something has just happened to off-set her mood/day. The drug offers “tranquility” but not salvation, once again. No solution, which could be sought in the reorganization of the family unit or of another social unit, just treatment.
These representations have remained largely the same. This is a 2002 ad for Paxil, which shows how this housewife became reintegrated into her family by taking anti-depressants. The top image shows the distant mother surrounded by her emotional and cognitive failings, while the bottom, post-paxil, image displays her smiling with her son in her arms.
And this scary one for Pristiq from 2009 seems to suggest that a woman is like a wind-up toy that, when beginning to fail, can use anti-depressants to help get through the day. This ad, by portraying the housewife as a wind-up, also seems to suggest the pessimistic idea that household duties are mechanical and wooden. It presents this first as a challenge by saying that “depression can make you feel” that way, but does nothing to alter the image, instead merely offering the anti-depressant on the bottom of the left side of the image with more information on the right. Will this drug eliminate the wind-up or merely make it run longer? By offering no counter-image, we must assume Pristiq can only offer the latter.
Effexor 2002 2.jpg
Effexor Advertisement (2002). Ad for the selective serotonin-norepinephrine reuptake inhibitor (SNRI) Effexor, which, like many ads for pharmaceuticals featuring woman portrays recovery as the reintegration into the family structure.
Effexor 1998.jpg
1998 Ad for selective serotonin-norepinephrine reuptake inhibitor (SNRI) Effexor. This one is interesting because it is one of the few with actual data on the page, although the source of that data -and any counterdata- is not present (it does indicate it came from a “study” but any information as to how to follow up on this study is not provided); next to the data is the contrasting image of the mother reunited with the child and “I got my mommy back” in children’s handwriting. Once again, the relief from depression is symbolized by the reconstitution of the patriarchal family. 


Children and their “Bad Conduct”

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


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

Psychiatry and Anti-Blackness

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

Noncompliance is a Symptom of your Illness!

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

thorazine 1956 handcuffs.jpg
Thorazine, Mental Hospitals Magazine (1956). This Thorazine ad claims to show how the drug can aid in getting the patient out of the hospital by keeping them in chemical handcuffs, preventing them from potential acts of violence. 
thorazine-1956 (5).gif
Thorazine Advertisement, Smith Kline & French (1956). Thorazine ad tells us that “disturbed wards have virtually disappeared.” Notice that all the patients in this ad are women. 
Prolixin Advertisement, Squibb (1981). 1981 ad for Proxilin informing the reader that the schizophrenic psycho may be hard to identify, and also that he may deny his own illness. But, don’t worry, because, with Proxilin, he need only be injected once a month, and hence, “will not have to be reminded every day of the illness they reject so strongly.” While it may seem, on the surface, that this ad is actually combating the stigma of a schizophrenia diagnosis and reminding the viewer that anyone may potentially be schizophrenic, this displacement from visual characteristics to visible behavioral patterns further strengthens the belief that one can identify the crazy person not based off how they look, but rather, how they are in a situation, or how they act.

black hood ad

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

black hood ad.jpg

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

Ritalin Advertisement, CIBA (1959)

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

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

Schizo-Genesis // Mad Apocalypse: The Story of the Psycho—Bellum Primer One

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.

Another womb -or something else entirely- is possible. Aloïse Corbaz was institutionalized at 32 for schizophrenia and allowed to make art. For her, creativity was the “miraculous. . . endless source of perpetual ecstasy.”

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.”

Das Narrenschiff by Sebastian Brant. Woodcut from 1494.

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.

Dulle Griet by Pieter Brueghel, 1561

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.

Anatomy of melancholy frontispiece.jpeg

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.

The asylum from the insider’s point(s) of view. “Irren-Anstalt Band-Hain” (Mental asylum Band-Hain) by Adolf Wölfi, 1910.

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.

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“Madman” by Sir Charles Bell, 1806.

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.

Ad for Haldol from 1974

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.

Advertisement for Intuniv, an ADHD treatment drug.

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.

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Some People are Born to be a Burden on the Rest. 1926.

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.

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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.

The fractious patient in spread eagle form receiving medical treatment of Douche Bath in the Penna. Hospital for the Insane, July 4th, 1868. By Ebenezer Haskell

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.

Robben Island Prison. Pictured in 2013.

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.

African Guernica.jpeg
“African Guernica” (1967) by Dumile Feni, an artist from South Africa who seems here to be portraying the awful, grotesque, and thinly scattered imaginary of a rationality that imagines some as being both closer to animals and more prone to mad breakdowns. Aimé Césaire: “the colonizer, who in order to ease his conscience gets into the habit of seeing the other man as an animal, accustoms himself to treating him like an animal, and tends objectively to transform himself into an animal.”

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.

“All Me (II)” by Winfred Rembert, a Black American artist.

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.

Page from “In the Realms of the Unreal…” by Henry Darger.

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 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.