All of a sudden in 1968 the second Diagnostic Manual comes out, the DSM 2, in the context of probably the most racially charged year in the history of the Civil Rights Movement—1968, where there are many riots, many protests. And also the DSM 2 importantly added language in the paranoid sub-type of schizophrenia, it added several important terms, it said the new criteria included aggression, hostility and projection. These hadn't been characteristics in DSM 1 and the manual explained, 'the patient manifests the characteristics of aggression and hostility and also attributes to others characteristics he cannot accept in himself.Even the advertisements at the time for sedative drugs used for treating patients echoed this racial paranoia:
I unearthed a series of advertisements for serious tranquilisers, Haldol, Stelazine, Thorazine that either represented African iconography, so African tribal masks, and would use incredibly charged racial language—so it would say this is the tool of primitive psychiatry and they would show these African masks—or images that quite literally showed, shockingly enough, angry black men protesting in the streets. And there's one image I reproduce in the beginning of the book, it's a Haldol advertisement that shows an angry black man in a burning urban scene who's shaking his fist. And the important point for both of these is that the iconography from these images literally appearing in the leading psychiatric journals was taking directly from the themes of the Civil Rights movement. The kind of Return to Africa Movement played out in these African scenes, and the idea of a clenched fist which was...This wasn't the first example of psychiatry being used in the service of racism in the US; in the 1850s, a surgeon named Samuel Cartwright put forward the theory that escaped slaves were suffering from illnesses he called drapetomania and dysesthesia aethiopis; his argument being that, as Negroes are psychologically unfit to cope with the pressures of freedom, escaping from one's rightful master was a sign of mental illness. This idea was, of course, very useful to those with a stake in maintaining the status quo, and flourished for some time for that reason.
Anyway, the shifting of the meaning of schizophrenia during the civil rights era was subsequently remedied partly by a deliberate programme to harmonise diagnoses with those used in Europe, though one might argue that the likelihood of the mentally ill to slip through the cracks to the prison system is part of the legacy of this phenomenon (according to Metzl, those diagnosed with schizophrenia in the US today are far more likely to end up in prison than in hospital; given that in America's neo-Calvinist penology, prisons are emphatically places of punishment first and rehabilitation a distant second, this is particularly disturbing).
Meanwhile, back in Europe, a converse relationship between mental illness and radical politics was posited from the other side; West Germany's Sozialistisches Patientenkollektiv, a radical Marxist group comprised of mental patients and the odd psychiatrist, argued that mental illness was a cultural construct, a reaction to the iniquities of capitalism.
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