Radical Psychology
Volume Seven, 2008


Psychiatric Slave No More:

Parallels to a Black Liberation Psychology

Lauren J. Tenney [*]


Preface


This work was inspired by a participatory action research project with emancipatory underpinnings about The Opal (1851-1860). It is an historical and theoretical exploration of the liberation process of people involved with modern-day psychiatric systems. It is important to understand that the original boundaries of this work had nothing to do with Race and everything to do with Liberation from Oppression. Relying on Nigrescence Theory, I draw parallels of the experiences people breaking free from the shackles of psychiatry have had and those breaking free from racist reality in a time post-segregation. I deepened my investigation because one person saw this as a “banal parallel” because it belittled the long-term negative ramifications of slavery, the failures of Reconstruction, and segregation. Here I present what I have learned about the appalling racialized aspect of the Asylum and Psychiatric Systems, dating back to the 19th century with the historical drama of the Sixth Census. Of concern to this paper are the deeply rooted problems of how data and values have and continue to oppress people. It is with some hesitation that I present an analysis of troubling trends in public data published by the New York State Office of Mental Health and American Community Survey and I ask you to read it understanding the limitations of the data and join with me in requesting the government service delivery systems become more transparent. I question if it is individual and/or institutionalized racism of today that is at the root of the problem that is causing gross over-representation of people who are Black, and in some cases, people who are Latina/o, in court-ordered involuntary treatment. I then move into a discussion concerning racism in modern day systems of social, behavior, and thought control. It is at this point that I feel I have given enough information to discuss the parallels of the liberation processes. Lastly, I offer insight into future work. I want to assert that I do not use these words lightly at all and understand the deep implications that they hold. I believe the situation warrants these words’ strength. Psychiatric Slavery is alive and well on Planet Earth and for centuries it has been the mission of many who have been subjected to the practices, regardless of their names, to abolish them. I ask you to join us in our Movement for Human Rights.

Introduction

The discovery of The Opal (1851-1860), a ten volume, monthly journal containing more than 3,000 pages of essays, poems, politics of the day, questioning of lunacy and insanity theories, and hints of a lunatics liberation movement spurred this work. The Opal was written, edited, and printed by the inmates of the Utica State Lunatic Asylum, at the Asylums’ “Utica Print Shop,” which still operates today. It is interesting to note that The Opal was printed on the same press as the American Journal of Insanity, which is now called the American Journal of Psychiatry, published by the American Psychiatric Association. Further, there is not even acknowledgement by some academics of the sordid history of the Journal. For example, in a very concise way, Cooper (2007) explores Jarvis’ work, which I explore in detail below. Her brevity leaves large gaping holes of the culture and beliefs of the time. For example, she writes that she uses “articles published in the American Journal of Psychiatry between 1844 and 1962,” even though in her references she properly identifies the Journal of Insanity as the source of the materials. Creating historical research involves presenting the life and times of a people. The obfuscation or omission of details such as this, I believe is core to the problem of the modern-day system, where we routinely deny our past and re-write it in ways which make us comfortable. I discuss this in detail to offer a contextualized history.

Cooper (2007) describes the goal of emancipatory research is to ensure that “good values” are embedded into research design and theory, revealing the murkiness of whose truth do you use, which she determines to be a fundamental problem of the framework. She offers as an example of this the debate among gay activists concerning the genetic base of homosexuality pointing to the fact that differing opinions about the same situation that can be found in activists involved in the same cause. Emancipatory research is research that is conducted by the group that is affected by the problem that is trying to be understood and out rooted. This is because it comes closest to the truth about a situation and she points out that this type of research is “epistemically superior”.

However, Cooper questions whether or not this idea of the “mentally ill” taking over the research process has ever even happened, but assumes at some point it will. Thousands of calls to society to understand the atrocities that those in asylums or psychiatric institutions face are made by those who escaped or were freed. Thousands of papers may yet to be found. Hundreds of theories and critiques of the asylum and psychiatric systems have routinely been published by those who are deemed mad (Hornstein, 2005; The Opal Project [1], 2007). The research and theory of people [2] who have experienced oppressive conditions in the name of “insanity” and “mental illness” and have broken free from them long break Cooper’s claim that those with psychiatric histories are not doing research.

Further breaking Cooper’s claim, this paper [i] is written as a companion to “Who fancies to have a Revolution here? The Opal Revisited (1851-1860)” (Tenney, 2006) which was written in response to a call for “Psychiatric Survivor Material” made by the Journal of Radical Psychology (2006), that reports the results of “Can You Dig It?” a participatory action research project with emancipatory underpinnings (Cresswell, 2003). I asked advocates and activists with psychiatric histories to read through random sections of The Opal and asked:

 “What, if anything do you think ought to be done with The Opal and how, if at all, does The Opal relate to any of your current work as an advocate and/or activist?”

Participant’s suggestions inspired The Opal Project [3], which is the outcome of “Can You Dig It?

One of the The Opal Projects’ focuses is a historical research project to find out about the Asylum System and to learn if there were other inmate publications in the 19th Century. To this end, Gail Hornstein’s (2005) bibliography of First Person Narratives of Madness Third Edition -- with hundreds of entries  --  dates back to the 17th Century has been phenomenally helpful in creating a time chart [4]. This historical work and courses at the Graduate Center with Doctor William Cross (1971; 1991, 2008), who introduced me to a theoretical approach to liberation, led me to a greater understanding of theories that I now work within.

It is essential to understand that the original boundaries of this work had absolutely nothing to do with Race. The original focus of this work was liberation from psychiatric oppression.

In light of the Liberation Theology debate that has consumed large amounts of time and space in the coverage of the 2008 Primaries for the Presidential Campaign in the media, this paper is topical. There were many authors that Reverend Wright referred to in his storm of speeches at the height of the controversy. Among the thinkers he cited is Woodson’s (1990/1933) “Mis-education of the Negro.”

Nearly a century ago, Woodson made a statement that testifies to a long-standing White skin privilege:

“The parts inhabited by the Caucasian were treated in detail. Less attention was given to the yellow people, still less to the red, very little to the brown, and practically none to the black race. Those people who are far removed from the physical characteristics of the Caucasians or who do not materially assist them in the domination or exploitation of others were not mentioned except to be belittled or decried” (1990/1933 p. 18)

Background

What I have suggested through many versions of this paper is that there are parallels between the processes of liberation from oppression that African Americans have been subjected to in the United States and the processes of liberation from oppression people in the psychiatric system, particularly when their involvement is on an involuntary status face. Perhaps it was that I have had a unique experience in life that got me (a White Woman) to the point of being able to immediately relate to the Liberation process that Cross lays out in the “Negro to Black Conversion: Toward a Black Liberation Psychology” (1971) and Shades of Black (1991) which I detail below. So, I shared versions of my work, which was a visceral response to the theory, with my peers  --  people who have psychiatric histories  --  to see if I was reaching. The overall consensus of these discussions was that I was not reaching, but others expressed a shared experience with the processes that Cross describes, as well. Many of my peers who reviewed this work felt excited by adopting this notion of a five-stage process of liberation in explaining how people break free from the shackles of the psychiatric system and believed it to be valid.

In fact, part of the title of this article, “Psychiatric Slave No More” came from discussions the working drafts spurred with my peers. The fact that I drew lines in this way was thought to be offensive, by one person, so I imagine others might share this view. It is certainly not my intention to in any way minimize any one’s lived experience or the horrendous and shameful way the United States operates. The criticism was that my “banal parallel” belittled the long-term negative ramifications of slavery, the failures of Reconstruction, and segregation.

Using historical evidence and the most recent New York State Office of Mental Health’s raw data and statistics, I argue that very often it may be the legacy of slavery, the failure of Reconstruction, and segregation that is causing these disparities in over-representation of involuntary commitments and highly controlled programs in the African American population but question if it is individual and institutionalized racism that exists today that is creating this phenomenon. There are troubling trends the data exhibits, that puts most people who receive the highest levels of involuntary psychiatric treatment  --  with gross over-representation of African Americans -- in the position of a professional patient or psychiatric slave.

In this paper I define a psychiatric slave as a professional patient -- someone who spends all of her or his time within psychiatric programming under court order ultimately creating a job for a psychiatric service provider. The notion of a psychiatric slave was first received as too radical to promote by some within Government Systems Advocacy circles. However, Psychiatric Slavery is not a new idea. Elizabeth Parsons Ware Packard of the 19th century draws distinctions between Slave owner and the asylum system:
  

“The insane are permitted to be treated and regarded as having no rights that any one is bound to respect  --  not even so much as the slaves are, for they have the rights of their master’s selfish interests to shield their own rights. But the rights of the insane are not even shielded by the principle of selfishness. What does the keeper of this class care for the rights of the menials beneath him? Nothing. His salary is secured by law whether there be few or many under the roof which shelters him. Unlike the slaveholder, he can torment and abuse unto death, and his interests are not impaired by this wreck of human faculties.” (p. 62)

In fact, in Women of the Asylum (Geller  Harris, 1994) several authors note comparisons to slavery. Davis (1855) writes, “Such patients were used as servants in the bad halls . . . the patients do all that part of labor which the attendants feel above doing” (p. 54). Elizabeth Stone writes, the asylum is “a system of slavery, and any crime can be done there and covered up under the garb of derangement and no one interferes” (p. 39). Phylis Chesler [5], in the forward to this compilation, described how she called for Reparations of one million dollars at the American Psychological Association’s annual conference in 1970 on behalf of the Association for Women in Psychology, citing abuses women have been subjected to at the hands of the system and their use as “slave labor in state mental asylums” and was not only unsupported but deemed “crazy” suffering from “penis envy” (p. xvi).

Thomas Szasz, MD, a Father of the anti-psychiatry movement, has written two books on the subject of Psychiatric Slavery (1977/1998; 2002). Szasz (2002) compares the psychiatric system, particularly court-ordered, coerced, and involuntary treatment practices with Chattel Slavery. He illustrates professional rules of conduct found in both involuntary outpatient commitment and institutionalization that create the experiences people subjected to psychiatry have had which created for them a need to break free from various psychiatric systems (pp. 13-17).

The liberation of oppressed groups apparently makes people very concerned and militancy appears to concern some. This is often because of the violent over-throw of the oppressor sentiment some of the models of militancy espouse. I was reminded by one of my peer reviewers about a Psychiatric Survivor Movement button that she has worn over the years which reads, ‘Is there a polite way to do a Revolution?’. Of course, acts of Civil Disobedience are part of this and another button which I have worn reads ‘Civil Disobedience is Self Defense’ and there have been occasions where activists have been arrested for seemingly uncontroversial acts such as handing out information about the side effects of Electroconvulsive Treatment (ECT).

While many activists are militant in their desire to abolish forced psychiatric procedures and confinement and others are committed to an abolishment of the entire psychiatric system, these actions are consistently taken within our rights as American Citizens to peaceably assemble and protest for our Human Rights and the end of our torture and oppression at the hands of the psychiatric system. Importantly, Cross (1971) acknowledges that Fanon’s model is not practical in changing society. Confirming this perception, David Oaks, the director of MindFreedom International, a human rights organization of people involved with psychiatric systems, continues to make calls for a Non-Violent Revolution in Mental Health.[6]

It is such a shame that the stigma that those with psychiatric histories experience exists, but it is commonly held and portrayed in the media and the popular press that people with psychiatric histories are violent. It is important for the general population, researchers, practitioners, policy makers, and those affected by psychiatric systems to know that recent research (Brekke, 2001) shows that people with psychiatric histories are actually fourteen times more likely to be a victim of a violent crime than a perpetrator. The myth of the violent mental patient must be ended with apologies to those who have been so misconstrued. For the record, I echo Oaks’ call and specify that this particular Revolution toward the liberation of those involved with psychiatric systems be grounded in Non-Violent techniques.

Early Traces of Institutionalized Racism

In this section I explore racial disparities in the Asylum System of the mid-19th Century. While this work was spurred by a visceral response I had to Cross’ Liberation Theory (1971) it begs the question, is oppression I was experiencing as a White Woman intensified for people who are African Americans and involved with the psychiatric system? I do not think I would have been able to understand the relevance of much of this work without Cross’ Shades of Black (1991) which so straightforwardly explains much of the history on Black Identity research and Nigrescence Theory development focusing on personal identity and reference group orientation.

Through two courses I took with Doctor Cross, Black Achievement Motivation and Black Identity, my understanding of the worldviews, history, and deeply rooted culture of African Americans was enhanced. Webber’s (1978) Deep Like the Rivers: Education in the Slave Quarter Community, 1831-1865 holds an analysis of more than 6,000 first-hand accounts in the forms of autobiographies and interviews he found of people who were stolen from their land, held captive and forced into labor in the reality of abject poverty, at the threat of violence and death for non-compliance. However, within the Slave Quarters Webber finds a rich culture that included music, dance, art, religion, and education. I ask you to keep strong within you the deeply rooted and rich culture of African Americans as we enter this discussion that includes the underside of some of the most shameful times in American History.

While the original boundaries of this work had little to do with race and everything to do with the experience of becoming liberated from oppression, what I have found about the racialized aspect of psychiatric treatment is appalling. Comeau and Allahar (2001), liken psychiatry to eugenics and “sanitary science” (p. 143) in work discussing what they term Canada’s ethnoracial identity and psychiatry’s role in immigration practices. This is not a stretch and many point to Hitler’s Aktion (Action) T4 program that killed an estimated 200,000 people with disabilities during the Third Reich (Heberer, 2002. pp. 49-72). I was horrified to learn that there was an argument using the data from the Sixth Census of the United States (1840) that slavery kept Africans well (Anonymous, Journal of Insanity, 1851-1852, pp. 153-156) and there is a wealth of research that has been conducted to learn more about how this could have happened (Jarvis, 1852; Litwack, 1958; Reagan, 1973; Grob, 1978; Vander Stoep and Link, 1998).

The Historical Drama of the Sixth Census of the United States of America (1840)

The American Journal of Insanity (1851-1852) was the authority on insanity and lunacy in the 19th Century. It evolved into the staunch authority of the American Journal of Psychiatry currently published by the American Psychiatric Association. Volume VIII includes articles ranging from the famous Kirkbride Model of guidelines for the construction of hospitals for the insane (p. 74) to the first legislation for a friend to start commitment proceedings (p. 150). Discussions of mania (p. 88), melancholia (p. 186), and hints to medical witnesses (p. 50) fill the pages. There are two articles that need attention, the first concerns data from the Sixth Census of the United States (1840) and arguments made about race and involvement in the Asylum system (p. 153) and the latter to “disabuse our reader’s mind” (p. 278) of the materials set forth in the former.

The first of these two articles entitled, “Startling Facts from the Census” (pp. 153-155) was reprinted from the New York Observer without an author. Concerning the “Free colored population” the unmentioned author argues, “there is something in their social condition that is entirely inimical to their physical prosperity” (p. 153). There was a denial of the other possibility offered in the text, that these people, freed from the bonds of slavery, were “voluntarily emigrating at a rate beyond what is generally supposed” (p. 153). The article offers a statistical table based off of the United States Census of 1840. To the author, this work:
  

“Exhibits, in a most striking light, the amazing prevalence of insanity and idiocy among our free colored population ever the whites and the slaves” (p. 153).

 

The author notes problems in the data concerning the fact that the Census “groups both of these classes of unfortunates together [lunatics and idiots], as if they were involved in one and the same calamity” (p. 154) and expresses wishes for the Census takers to discern between Freedmen and Slaves. The author notes that an attempt to contact the Commissioner of the 1850 survey went without notice.

This unnamed author notes, “it is evident that the free States are the principal abodes of idiocy and lunacy among the colored race” (p. 154). The chart supplied listed the thirteen original states and Ohio and Kentucky as a means of comparison, “to show the same contrast between the old free and slave states exists in the new” (p. 155), with Kentucky having just one person who is an idiot or lunatic and Ohio having ten people with these labels. The author’s grand finale argument is made with Louisiana, a state where he reports only one person being listed as an idiot or insane, concluding the argument:
  

“In fact, the want of sense or reason appears to be a rare visitation upon those who are held in slavery. This is an ample theme for the speculations of the physiologist and moralist.” (p. 155)

In October 1851, a decade before slavery would be abolished in the United States, there were some who argued that slavery kept African’s ‘well’ and the American Journal of Insanity, without any indication of its disagreement, published it. To contextualize the relevance of this, the American Journal of Insanity is now the American Journal of Psychiatry and if one goes to their website, one can see the article for oneself. The publisher, the American Psychiatric Association has not, to my knowledge, released a retraction of the report. In other words, there is still no disclaimer for the senseless, stigmatizing material that was published and corrected by Jarvis in later articles in the Journal of Insanity (1852a; 1852b).

If Edward Jarvis, M.D., (1852a) had not taken the time to realize the grave mistakes of the Sixth Census of the United States, which became the basis of a pro-slavery propaganda campaign; and if Jarvis had not wrote a response article with such clarity of the problem, which in fairness to the Journal of Insanity, was published in the same volume in the January, 1852 edition of the Journal, which I will discuss in a moment; then, there may have never been a second look at the census data, which was unconditionally and conclusively wrong. Please understand that had Jarvis not pointed out the flaws in the data set of the Sixth Census of the United States, the prevailing view of alienists, physicians, and moralists, may have been maintained with the idea that slavery had a “wonderful influence” on Africans who were Slaves because there were more incidences of idiocy and lunacy in the North than the South. (Litwack, 1958; Regan, 1973). What a thing for doctors and moralists to support!

But, not all doctors did support it once it was realized the data was incorrect. Jarvis (1852a) delineates that a handful of communications had actually occurred concerning the census data. One such communication remains a valued part of the history of the American Statistical Association  --  an 1845 memorial to Congress from the organization in its founding years pointing out the flaws of the Census data. For the benefit of removing any further questions about the erroneous data, Jarvis (1852a) explains that the Census data first appeared in 1841, and that the writer of these ‘startling facts’ was not giving any new information as the data “published in The Observer were published in several journals, newspapers, and in some of the lunatic hospital reports” (p. 269). Jarvis explains how the data was so contrary to what was known that some people made a deeper investigation into the situation, literally tracking back to the original Census data that had been acquired from families across the Northern states.

At the time, according to Regan (1973) the family was still the level of how data was enumerated by Census takers. It was not until the Seventh Census that data was collected at the level of the individual. Jarvis is reported to be a significant player in the redesign of what would be known as the modern Census in 1850, 1860, and 1870 by the American Statistical Association and others (Litwack, 1985; Tenzer, 2000). Speaking on the Seventh Census, Jarvis writes:

 “But it is now hoped that the seventh census, that of 1850, will not fail as did its predecessor . . . such as the government can honestly offer to the people, and such as we shall not be ashamed to present to foreign nations.” (p. 282)

Jarvis is known as the father of psychiatric epidemiology (Vander Stoep and Link, 1998; Grob, 1978). Vander Stoep and Link, however point out flaws Jarvis made in his analysis of Irish immigrants to Massachusetts, even after Jarvis uncovered one of the gravest mistakes of the use of Census data (1852a). According to Litwack (1958), in 1845, Jarvis reports that the American Statistical Association, just six years old, prepared a Memorial to Congress outlining the flaws of the Sixth Census of the United States, asking to “disavow the whole, and cause another and correct one to be prepared and published” (p. 269). What Jarvis did not report, in my reading of his work of 1852, “Insanity and the Colored Race”, (1852a) was that he was on the committee that wrote the memorial. Litwack reports that Jarvis’ repeated attempts to have the data dismissed fell on deaf ears. This is important because pro-slavery propaganda and policy was argued and created based on what Tenzer (2000) termed “fraudulent statistics on ‘Free Colored’ insanity sanctioned by the federal government [7]” and points to the long history of institutionalized racism.

An example of this cited by Litwack (1958); Regan (1973); and Tenzer (2000) is John Calhoun’s, Secretary of State’s letter to the British government offering the 1840 Census as proof of the benefits of slavery and rejection of the federal government outlawing slavery in the newly acquired Texas, ultimately leaving it to a ‘local issue’. Litwack quotes Calhoun’s letter stating:
 

“The condition of the [free] African, instead of becoming improved has become worse. They have been invariably sunk into vice and pauperism, accompanied by the mental inflictions incident thereto - deafness, blindness, insanity, and idiocy  --  to a degree without example.” (p. 265)

This was popular thought at the time and the American Statistical Association (ASA) felt a base responsibility to make sure the statistics were accurate, and let it be known that they were not. According to the ASA website, Jarvis served as President of the American Statistical Association for the thirty years beginning 1852, the year his article, “Insanity of the Colored Race” was published in the Journal of Insanity.

Opal Regan (1978) points out that Jarvis had actually first written of the census data in 1842 stating that slavery had a “wonderful influence” on slaves. I have been unsuccessful, thus far, in finding this article, entitled, “Statistics of Insanity in the United States” printed in the Boston Medical and Surgical Journal XXVII, in 1842, but discovered another article that also focused on that quote, but expanded it. Litwack writes that Jarvis actually wrote that slavery had a “wonderful influence upon the development of moral faculties and the intellectual powers” (pp. 265-266). Upon realizing the deficits of the data, his focus changes from the power of slavery having a “wonderful influence” on Africans to a deep examination of the flaws in the Sixth Census. Both Regan and Litwack explore the blatant errors of the Census, citing Jarvis’ later work. They both expand the discussion and offer how damaging the mistakes in the Census were to the Abolitionist movement, as those who were pro-slavery were now using the Census data as propaganda for their cause.

Steckel (1991) literally runs through this period of time in his discussion of the efficacy of census data in historical inquiry. His point clearly has nothing to do with insanity or racism, but the quality of Census data and that serious problems occurred in early attempts at enumerating the population. I find some discrepancy between his descriptions of the population schedules, which he lists as being on two ages with 80 columns (Steckel, p. 583) and Jarvis, who reported the schedule being 74 columns wide, explaining, “It required much discipline, therefore, to follow with the eye, any column from its title, at its head, to its place of entry below” (Jarvis, 1852a, p. 271). An example of such an error is in one family, it was listed that there were “one hundred and thirty-three colored lunatics,” but it is also stated that in that particular family, “there were no colored persons at all” (p. 272). This scenario was repeated so many times that it added to the movement of rejecting the findings of the Sixth Census in full. Human error is one of the simplest and most benign reasons the data was so wrong. Case in point, Steckel is quoting information from another author, (Cohen, 1978, p. 193) and this might explain some of the discrepancies.

Nevertheless, Steckel’s point concerning the under-or over-enumeration of people remained a problem throughout the 1850, 1860, and 1870 census periods and I would argue, remains an issue today. Regan (1973) outlines, as does the American Statistical Association’s website [8], that the years Jarvis served as the ASA’s president he is also credited for contributing to the development of the decennial Census. Steckel’s overall opinion of the Census as a means of extracting data is not very high, but he cannot argue that the data is not widely used. He offers statistical strategies for internal and external checks and balances including concrete suggestions for the use of technology to re-enumerate the population from the 19th century. What Steckel urges the historian who uses Census data to do is “not view them beyond reproach” (p. 593).

The case of the 1840 Census speaks exactly to this mess and that is why the 1850 Census, or the Seventh Census is known as the Modern Census because information collection moved from the level of the family to the level of the individual. Steckel also warns of implications of research at the individual level  --  and that it is different than research at the National level. I think he and Bronfenbrenner (1979) would have gotten along nicely, concerning Systems Theory, understanding that at the micro level  --  or the system of the individual is much different than the systems that surround her in ecological concentric circles.

Steckel urges that for accuracy, the use of technology to re-enumerate the Census data from earlier centuries is essential. It is also imperative to pay particular attention to the fact that people whom were poor, uneducated, living in urban environments, or immigrants might find it particularly hard to even be counted. Even in our 21st Century attempts at enumerating the population, these factors remain. For this work, it is important to note that in the 2000 Census people in institutions were not counted.

Cooper’s (2007) draft chapter, which she disclaims may differ from its final form, is about how values influence psychiatric research which she determines is different than psychiatric practice but specifies that those judgments are not “at hand” implying that judgments made by psychiatrists in session are acceptable  --  an issue I strongly disagree with. In her current work she focuses on gender and race as examples of how disenfranchised groups have suffered for poor psychiatric theory. She offers methods one can use to present historical data, and I appreciate the option of simple raw data. She makes very valuable points concerning the use of historical theory, data, and practice  --  and that is not just one paper that ought to be examined, but the body of work from the historical period that ought to be examined. Even though I find this as the research for this paper comes to an end, I have worked hard to use this technique in the current work and traversing centuries is no easy task.

Historical Roots of Racism in Systems of Social, Behavior, and Thought Control

The Quakers, or the “Friends” have long been associated with the liberation and education of oppressed groups. Woodson (2007/1919) explains in The Education of the Negro Prior to 1861 that it was the Quakers who filed the “first protest against slavery in Protestant America” in 1688 (p. 27). He illustrates how the Quakers were involved in developing the first educational systems for Slaves. Of course, Woodson, like Foucault, indicates that the goal of this education was to create ministries for the religion  --  and Woodson cites Locke’s Anti-Slavery (p. 30) stating that by 1713 there was a, “definite scheme for freeing and returning them to Africa after having been educated and trained to serve as missionaries on that continent” (p. 28) created. Woodson reports that the Quakers had succeeded in their mission to educate Slaves and were operating schools for the Slaves in North Carolina by 1731  --  which allowed for “household servants” to be given the rudiments of an English Education (p. 29). This of course caused much controversy over the years, and in other work, I further explore this and the larger implications of Reconstruction and educational systems.

Unlike the 18th century education of the Slave, in the 19th centuries, the Quakers, particularly through Tuke, developed a “Moral Treatment” in where work  --  not education  --  would be the salvation of the mad. outlines the deep history of power in these systems, describing a phenomenon of how the policy of reformers reverted to unspeakable conditions that we see in the American System in The Great Confinement (pp. 38-64). Speaking of the European system, he writes “In a hundred and fifty years, confinement has become the abusive amalgam of heterogeneous elements” (p. 74). Foucault (1965) rails against this idea that physicians and constructors of madness were liberators and saw Pinel and Tuke as doing little more than peddling morality (p. 197) and “philanthropy” (p. 243) even though they came from entirely different frameworks of religion and medicine, their ultimate goal was to restore society. Barchilon, in the Introduction to Foucault’s work suggests that Pinel went further and saw something extraordinary about the physical bodies of the mad  --  as they were routinely able to withstand being naked, chained, and cold with no ill effect and suggests that Pinel questioned “Didn’t they have too much animal spirit in them? (p. viii).

Despite the struggle faced by the current psychiatric liberation and even consumer and peer movements to gain access to those inside the walls of institutions, patients and ex-patients working inside of Asylum Systems is nothing new. Jean-Baptiste Pussin, who was superintendent of the Bicetere Asylum, in France in the 18th Century implemented a no-restraint policy. He had been successfully treated there earlier and was then hired to run the place. Phillipe Pinel was in charge of Sapaleteire Hospital, after visiting the Bicetere and seeing that there were alternative ways of creating the environments of the Asylum, he hired Pussin to change the culture of his institution to meet the requirements of a no-restraint environment. Though Pinel is credited for establishing Restraint-Free Asylums in the 18th century, he acknowledges it was Pussin who had the idea and implemented it first (The Opal, 1852; Weiner, 1979). What Pinel truly invented was the waistcoat  --  or the straightjacket. Despite their knowledge of this, the Opalians celebrated Pinel’s birthday  --  as a great liberator -- the Doctor who a century before freed the inmates from chains -- and they wrote pages about his and Pussin’s work in The Opal.

Foucault highlights the dangers of using legendary historical figures to determine present and future practices. He ascribed to Pinel and Tuke a “mythical value which nineteenth-century psychiatry would accept as obvious in nature” (p. 243). However, he sees the approaches of the Quaker’s Moral Treatment, Pinel’s medicine, and the creation of madness as simply other types of oppression. Foucault rejected the idea that liberation was the goal of the asylum and writes that “Tuke created an asylum where he substituted for the free terror of madness the stifling anguish of responsibility; fear no longer reigned on the other side of the prison gates, it now raged under the seals of experience” (p. 247).

Szasz (2002) echoes this railing, though he does not discuss Foucault’s work and it creates a sad illustration of how the Opalians could be viewed as having been liberated by oppression. Although some Opalians, like the Editor of 1852 called for “revolution” (The Opal, p. 28) there was an acceptance of assigned diagnosis that is found in the mentality of consumerism in modern times. Both Foucault and Szasz (2002) illustrates how moralists, alienists, and psychiatrists have segregated this community of people from the rest of society as “sick”  --  to be cured with religion, work, or medical treatment  --  from a “disease” that has never been proven to exist (p. 14). Frame this within the work of Rush (1799) and Cartwright (1851) and we get a further idea of just how depraved what would become modern-day psychiatry, was.

Part Three of Vanessa Jackson’s Monograph Series (2001), “African American Stories of Oppression, Survival, and Recovery in Mental Health Systems” details many of the atrocities this population has had to overcome as a people. Doctor Benjamin Rush, one of the signers of the Declaration of Independence, was also an inventor. For example, he invented the Tranquilizer Chair - which was quite different than the Rotary Machine Foucault discusses that spun the inmate around so “melancholic rigidity gave way to manic agitation” which he reports was used more as a punishment and threat than treatment (Foucault, 1965, p. 177).

The Tranquilizer Chair as described by Whitaker (2002) was a restraining device that had a sliding back that could be adjusted to the inmates’ height. Once seated in the chair, the back was positioned so that a wood padded box would go over the inmates’ head, preventing movement. There was a door at the front of the box that would allow medical staff to see the inmates’ face. There were two leather belts that went around the stomach and chest. The arms and legs were strapped down to the chair, rendering the inmate immobile. Finally, a hole was cut at the bottom of the chair, with a bucket attached to it, to allow inmates to empty their bladders or defecate without having to be removed from the chair. Inmates were left in the Tranquilizer chair for extreme periods of time as a form of treatment, to teach ‘excitable’ inmates how to control themselves and reduce the level of stimuli they were exposed to (pp. 14-16).

Two diseases Cartwright details are particularly troubling: Drapetomania and Dysaesthesia Aethiopica. Drapetomania was a disease of the mind that caused slaves to run away. Symptoms of Drapetomania included a “sulky disposition and dissatisfying behavior” (Jackson, 2001, pp. 4-5). Cartwright (1851, pp. 707-709) outlines this disease of wanting to be free (remember, Rush, 1799 warned of this) and actually states that "they are easily governed" when well cared for and that they must always be oppressed, subservient, treated like children, and "punished until they fall into that submissive state which it was intended for them to occupy" (p. 709). All of this, says Cartwright is to "prevent and cure them [Slaves] from running away" (p. 709).

Ferns and Cochrane (2004) write, “The diagnosable signs included disobedience, answering disrespectfully, refusing to work, and deliberate damage toequipment and tools. The "cure" was putting the person to some kind of hard labor which apparently sent "vitalized blood to the brain to give liberty to the mind" (p. 9). The cure for this rascality was hard labor and whippings. In light of this idea of physicians liberating the mind, we see how important Jarvis’ work to debunk the Census of 1840 was. Foucault and Szasz are not exaggerating how some doctors’ view their work. In fact, as recently as 2007, Link and Castilles, in an oral presentation to the World Psychiatric Association, thematic conference on Coercive Treatment in Psychiatry in Dresden, Germany, report a unique study on the perspectives of enrollees in the Assisted Outpatient Treatment program, otherwise known as Involuntary Outpatient Commitment. They find the “case manager assists the recipient in gaining more control over his life and may facilitate an improved quality of life.” (Link and Castilles, 2007, p. p. S85). This gives evidence to the “liberation by oppression” mentality that Szasz (2002) and Foucault (1965) explore.

In a presentation of her work at the Library of Science and Technology, with the backdrop of Penney and Stastny’s Suitcase Exhibit in New York City in November, 2007, Jackson asks -- “What do these diagnoses remind you of?” Her answer, “Oppositional Defiance Disorder” a diagnosis whose DSM IV-TR symptoms fits practically part and parcel with the 1850s version of Rascality. Diagnostic code, 313.81 Oppositional Defiance Disorder is often attached to any young person who challenges the status quo -- especially if they run away from a treatment facility. Other thinkers throughout time have explored this sentiment that Jackson was shedding light on: psychiatry is a system of oppression.

In Liberation by Oppression, psychiatrist and social commentator, Thomas Szasz (2002), further calls out the complicated relationships between Chattel Slavery and psychiatric slavery not only for Black people in the 19th century, but for White people who were abolitionists, as well. Szasz outlines how famed abolitionist, John Brown was offered an insanity defense when he faced the gallows. Brown, who he describes as “incensed at the idea”, lost his trial and was eulogized by Frederick Douglas in this way: “Mine was as the taper light; his was as the burning sun. I could live for the slave; John Brown could die for him” (p. 53). For Szasz there is little distinction between Chattel Slavery and Psychiatric Slavery and he asserts that until the stereotype of the dangerous mental patient is removed from society’s mind, psychiatric slavery will not cease. He argues that psychiatric reforms are simply activities in “prettifying plantations” and asserts that “Slavery cannot be reformed - it can only be abolished” (p. 5).

Troubling Trends in Current OMH Public Data

Below I discuss what I have found out about the racialized aspect of involuntary psychiatric treatment and this new knowledge I have acquired is appalling. However, one has to ask, how much about this situation is stemmed from racial disparities and cultural incompetence and how much about this situation is about economics, lack of social capital and education (Saegert, et al, 2001)? In general, I have had little success answering these questions because while the Office of Mental Health publishes some characteristics of the people it serves, such as socio-demographic data of age, race, gender, and geographic location, it does not publish data about economics, education status, or general health. This leaves some arguing institutionalized racism is an intellectual fallacy. In light of what I have learned from this review, I see this argument as little more than a deep denial of racial disparities in American culture.

As a person aware of her societally-assigned White Skin Privilege to escape the gaze of hate (Fanon, 1967, p. 110) and the blunting effects of racial discrimination (Cross, 1991), I am interested to know if racism -- either individual or institutional -- intensifies the possibility of forced or involuntary psychiatric experiences for individuals who already fight to overcome racial discrimination. There is a long history of institutionalized racism and psychiatric treatments and programs and while it is not as pronounced as it was in the decades prior to the Civil War (Cartwright, 1851; Jarvis, 1852a; Jarvis, 1852b; Rush, 1799) cultural (in)competence and racial disparities are commonly encountered within psychiatric systems. It is important to view this current work within the context of the New York State Office of Mental Health’s “D” of the “ABCD’s of Mental Health Care” and the inclusion of “D” in goals of their strategic plans for adults and children’s (draft) plans:

“Disparities Elimination and Cultural Competence, whereby all service components are held accountable to address disparities in access to and participation in services, differences are managed skillfully, cultural knowledge is absorbed organizationally, language assistance services are provided routinely, and service modifications are made to take into account the diversity of individuals, families and communities.” (New York State Office of Mental Health, Comprehensive Statewide Plan for Mental Health Services, 2007).

 

As illustrated by the need for the addition of these “Disparities Elimination and Cultural Competence” goals into OMH’s overall goals, it is widely accepted that access to services is a tremendous barrier that people face in getting services in the psychiatric system for people who are economically disadvantaged, many who are people of color, (Geronimous and Thompson, 2004; Sabshin, et al, 1970). Not as accepted is the idea that institutionalized racism is engaging more people of color in the highest levels of court-ordered and involuntary services. Wilkinson (1970) warns, “Well intended plans to eradicate these disparities may prove to be destructive instead” (p. 1087). An example of this can be found in the OMH’s Patient Characteristic Surveys (PCS, 1999; 2001; 2003; 2005; 2007 [9]) which illustrate some disturbing trends in who gets what types of services.

Issues of using Census data, which I discussed above, complicate the problem of making any statements about the data that OMH produces. One of the biggest obstacles of using Census data, removing the general problems of whom Census Takers reach, is that the Census does not enumerate people in institutions  --  many of the people we discuss below. Finally, this data in no way allows for people who are receiving psychiatric services (such as pharmacology) through their private physicians or all of the untold “private” or “cash-only” services of people who want no record of receiving psychiatric services. Further complicating the issue, since this paper was originally submitted, OMH has changed the way it presents its public data. For example, racial demographics of AOT “recipients” are now presented as “Race/Ethnicity Distribution of AOT recipients since November, 1999" [10] as opposed to quarterly statistics.

Vander Stoep and Link (1998) published an article reviewing other wrong conclusions Jarvis had made concerning Irish immigrants being diagnosed at a greater rate with Insanity than in the General population of Massachusetts. So, I ask you to read the data below with a skeptical eye and question, as I do, what these trends are about.

The Assisted Outpatient Treatment (AOT) initiative - otherwise known as Involuntary Outpatient Commitment - is a program carried out by OMH to meet the requirements of Kendra’s Law which requires people to comply with pharmacological management while in the community at the threat of institutionalization for non-compliance. In a 2005 report from The New York Lawyers for the Public Interest. entitled, “Implementation of ‘Kendra’s Law’ is Severely Biased” racial discrimination in the psychiatric system is addressed, noting that Blacks made up 16% of the general population, but 24% of those with a label of “Serious and Persistently Mentally Ill”.   Even taking into account the hurdles of number crunching [ii], there is the appearance of gross racial disparities in psychiatric services in New York State. According to the now-unavailable OMH published report on characteristics of enrollees of Assisted Outpatient Treatment (AOT) [11], people who are Black -- and in some boroughs people who are Hispanic (read: Latina/o) -- in New York City are consistently over-represented within involuntary psychiatric treatment through this infantilizing and coercive measure for treatment compliance  --  to be a professional patient  --  a psychiatric slave. These reports have been replaced by “distribution rates since 1999”, according to this data currently available through OMH [12], the distribution of race/ethnicity of people subjected to AOT in New York City Region since 1999 also show clear disparities when compared to demographics in the 2006 American Community Survey [13].

Table 1.

Percent comparison of racial demographics of New York City as compared to Racial Characteristics of those enrolled in Involuntary Outpatient Commitment (AOT) since 1999.
Race               NYC†            AOT††            Difference
------------------------------------------------------------------------------------------------------------
White            43.9%            23%            +20.9
Black            25.1%            40%            -14.9
Hispanic        27.6%            34%            -  6.4
Asian            11.7%            3%            + 8.7

† Source: U.S. Census Bureau, 2005 American Community Survey, using table that asked both race and whether Hispanic, this is similar to how OMH now asks its respondents their race & ethnicity
†† Retrieved July 31, 2008 from http://bi.omh.state.ny.us/aot/characteristics.


As is evident in Table 2, the relative number of Black people required to comply with AOT are much higher than the relative number of Black people in the general population; the percent of Black people in AOT can reach over three times the percent of Black people within the general population. This gross disparity is less pronounced among Hispanic people. Note that the percent of White and Asian people in involuntary treatment is always lower than the percent of Whites and Asian people in the general population.

table 2

While these trends are intriguing, it is clear there are efforts by the New York State Office of Mental Health to complicate analysis of data it publishes by continually changing the way it presents data and taking down data that it once made available, as illustrated by Table 2. In light of the incorrect statistics of the Sixth Census and their subsequent horrific uses, what we really need is more complete data that better describes the human condition and the economic realities of this Brave New World we are living in. With gasoline prices nearly five (5) dollars a gallon in New York State, it is as essential to understand the difference between economic hardship and what is perceived as psychiatric disorder as well as the difference between different cultural values and psychiatric disorder. We must guard against racist practices in any type of government services, but especially those that are compelled, coerced, or court-ordered. Please, join with me in calls to psychiatric systems around the world to improve data collection methods and fidelity to them in practice  --  and release it - as Jarvis outlined hopes for in the 19th century (1852a, pp. 331-361).

Racism in Modern Day Systems of Social, Behavior, and Thought Control

Pinderhughes (1969) explores how language not involving race associates “black” as symbolizing those things negative (i.e “evil”) and “white” as those things positive (i.e. “good”) has created a societal paranoia that extends to race. Exploring the Black Power movement, he suggests that it is a necessary “sociotherapy” (p. 1555) movement to change the image of Blacks, by Blacks and for Blacks, stating, “What most Whites perceive as an orderly American social system, most Blacks experience as an unresponsive, unremitting, dehumanized, well-rationalized, quiet courteous, institutionalized violence not unlike colonialism” (p. 1555). Just two years later, Cross’ (1971) liberation psychology, which became known as the Psychology of Nigrescence (1978; 1991), is published in Black World. It outlines a five-stage process in which people go through to overcome oppression, with the conversion being from “Negro” to “Black”. One of the quotes of a participant in the development of his theory showed how the movement evolved, “Black power must be more than group therapy. To be effective it must be programmed” (p. 14). Ultimately, it is accepted that for the way people viewed themselves to change, the world had to change  --  and language had a lot to do with it. According to Cross, Nigrescence is simply, “the process of becoming black” (1991, p. 157). Cross distinguishes his model from Fanon’s in that Fanon’s model of militancy required war with the enemy to acquire “total freedom”  --  something we have yet to achieve  --  and he asks the readers to “note the emphasis” on this is a model of “psychological liberation under conditions of oppression” (1971, p. 14).

Ahluwlia (2003) discussion of hegemony of the “White nation” included a scene from Fanon’s (1967, p. 110) Black Skins, White Masks, where he describes Fanon’s encounter with the White child. Ahluwlia breaks the encounter itself into three stages. In the first stage of the encounter, he cites Fanon, “I made up my mind to laugh myself to tears, but laughter has become impossible (p. 344). To me this is a clear example of buffering, one of the enactments outlined by Strauss and Cross, (2005). Buffering is an act of protecting oneself from “the full brunt of a hostile, aggressive, threatening, racist person or situation” (p. 70). Ahluwalia argues that the second stage of the encounter is facing the truth of the racist experience. Fanon is reduced to a nauseated state, “It is this nausea which forces him to conclude that he has indeed interpreted the gaze for what it represents  --  ‘hate’” (p. 344). The third stage of the encounter is where I see Ahluwalia describing Fanon moving from the pre-encounter stage to the encounter stage outlined by Cross: 

“It is in the third stage of the encounter that the mood changes from being disempowered by nausea to the recognition of being trapped, injured, and most importantly of the possibility to break out of that condition, to be a ‘man among other men’” (p. 1971; 1991).

Perhaps this is why there is such fluidity in Cross’ Black Liberation model. He explains, “Blackness is a state of mind” and that it is dynamic not static (p. 14). If it is true that each of these stages could have stages of their own, a linear progression is impossible. This idea of a variation of stages also was addressed by Parham (1989) with his ideas of cycling through different phases of Nigrescence at different points of life, dependent on life circumstance, the environment, and larger socio-political climate one finds oneself in three stages of life, young adulthood, adulthood, and senior years.

Questions I still have include: Can one do anything other than buffer at a pre-encounter stage? At what rate do people at pre-encounter stage buffer as opposed to carry out other enactments described by Strauss and Cross (2005) and bond, bridge, code-switch or even act as an individual? I guess people must have to go beyond this one dimension; otherwise, the implications would be so bleak  --  that without that awareness, precious exchanges between individuals would not be able to occur at all. However, if I believe I am “mentally ill”  --  a ticking time bomb, waiting to go off (to borrow a phrase of the news); that it is best that I have minimal socialization and that my socialization ought to be confined to others who also are diagnosed with this calamity, and that I ought to even contemplate sterilization, what are my odds of really developing a relationship with another in any way other than buffering? I realize that the need to buffer ordinarily has little to do with the person, as it is in response to a racist or discriminatory situation due to the environment or interactions one has. So, while it might be less likely that someone at a post-encounter stage might not need to buffer as often as those in a pre-encounter stage, they are not exempt from the need to protect themselves from incidences of racism and discrimination, which we see, are still pervasive throughout societies.

Keeping in mind that the Patient Characteristic Survey encompasses both the public and private psychiatric systems, my questions in addition to the ones asked above include: why are there such marked racial disparities concerning who receives which kinds of treatments? To me, these statistics indicate individual, institutional or cultural racism outlined by Jones et al. (1997) and discussed by Utsey and his colleagues (2000). Geronimous and Thompson (2004) explain how cultural oppression has created the structuring forces of health as an economic issue. They warn of the “economic assumption” stating it “is problematic when considering racial disparities in health, not only because it promotes ‘victim blaming’ or ‘ameliorative’ interventions, but also because at best, it ignores the culturally mediated, psychosocial aspects of health” (p. 254). Racial inequalities and economic disparities are evident. Geronimus and Thompson call for a restructuring of society stating, “Those hoping to eliminate racial health inequality must be responsive to the evidence that African Americans of all social classes pay a disproportionately high price in stress-related disease for their membership in American society” (p. 257). This is probably most evident in how few African American people over 75 years of age there are, barely one-third (539), compared to White people (3,092), who are present in the Patient Characteristic Survey of 2005 (OMH, 2007). It is important to note that people who are Latina and Latino are even less represented over 75 years old (499).

Empowerment is another issue that Geronimus and Thompson (2004) deal with in several ways. The seven examples offered as risks that “exacerbate weathering and increase allostatic load” include “feelings of stigma and frustration or anger at racial injustice” (p. 258). This is key to understanding why programming that privileges empowerment, like self help, mutual assistance, and advocacy, are so essential and why it is such a travesty that it is not routinely and genuinely available to people. The weathering model offers an alterative perspective to why the structures of the social system have to change. It
  

“suggests that behaviors such as smoking, poor diets and sedentary lifestyle may be secondary to the constraints or stresses of everyday life, or may interact with allostatic load to produce adverse health outcomes”(p. 258).

In an era that is post the National Association of State Mental Health Program Directors study on the Morbidity/Mortality rate of people with a psychiatric diagnosis (2006) this alternative framework of the weathering model becomes even more important. Right now cigarettes, caffeine, and sugar, are being outlawed in psychiatric facilities because the report shows an average of 25 years of loss of life for people with psychiatric diagnoses. The Federal, State, and Local Government Units are rolling out neoliberal health plans such as the New York State Office of Mental Health’s Life SPAN (Stop Smoking; Practice Prevention; Increase Activity; and Improve Nutrition) putting the weight of responsibility for early death on those labeled with a psychiatric disorder while ignoring large segments of the report that point to the deleterious side effects of medications, including Tardive Dyskinesia, Neuroleptic Malignant Syndrome, Liver and Kidney failure, Diabetes, Brain Damage, and Suicide, to name a few. Racial disparities need to be and in some states, like New York, are being addressed (OMH Comprehensive Plan, 2007).

Harrell (2000) clearly outlines the detrimental effects of racism-related stress for people of color. She points out that “mental health practitioners have had little systematic guidance in exploring the ways that racism may influence their clients’ well-being” (p. 42). Her review of definitions of racism begins to bring into focus the enormity of the issue and its pervasive nature, happening with or without intention, in a multitude of contexts and relates these experiences to the level of exposure a person has to racist or racialized situations. Race-related stress that a person experiences in their transactions with the environment has deep implications for the health and mental well being at both the micro- and macro- levels of society across the five domains of human experience that she outlines as “physical, psychological, social, functional, and spiritual” (p. 47). She addresses the misguided attitudes of those who place responsibility on the individual and urges the conversation be re-directed to creative ways of combating the resulting problems of racism, as a way of beginning to eradicate it.

Secker and Harding (2002) report on users’ perceptions of an African and Caribbean mental health resource centre in Kensington and Chelsea, England that Harrell would probably support. The British seem to be more comfortable citing evidence of racism in their psychiatric system, the authors citing other works that indicate a higher rate of a diagnosis of schizophrenia for Black people; that Black people are more likely to be referred to services by the police; and Black people are more likely to be subjected to compulsory treatment in institutions (p. 270). This particular resource center is offered as a model. Its goal is to help people deal with the problems associated with racism and users have a high regard for the program. They offer an innovative approach to addressing the effects of racism that would otherwise be reduced to a “biological mental illness” or “brain disease”.
 
Hall and Cheston (2002) argue that the effects of a psychiatric label are particularly deleterious. They suggest, “negative stereotyping and exclusion from valued social roles have serious implications for the social identity of people who are regarded as having a mental illness” (p. 30). This is another paper that has come out of the United Kingdom. By and far, when it comes to psychiatry and race, some researchers in England seem to be quite progressive in their thinking. They urge, “issues of identity and self-concept must be included in any evaluation of services, or the psychological needs of individuals” (p. 40).

Cross and Cross (2008) discuss that Group Identity is born of Personal Identity and that the construal of the personal identity is deeply intertwined with the idea of security that comes from a loving, nurturing bond between baby and mother. In the typical trajectory, once personal identity is formed, one has developed a type of personal capital. This leads them to search for their reference groups, or group identity. Personal and Group identities must effect one’s social capital (Saegert, Thompson and Warren, 2001).

If trauma or abuse occurs prior to the development of personal and group identity, the normal trajectory is halted and the experiences forever changes the course of development. If a psychiatric label is attached to abuse or trauma, this enhances the break of normal development. Further, the construal of personal and group identity now are not consecutive developmental tasks. A dynamic relationship between the trauma, abuse and psychiatric label forms between personal and group identity, as if the person is a pinball stuck between two dividers, consistently bouncing back and forth, attempting to get out.

This inability to construe the personal and group identity, particularly due to the psychiatric label, which offers a new “identity”, creates a situation where a person is oppressed. Only if a person can find, or is introduced to the concepts of liberation from a psychiatric label, will they be able to overcome the oppression. I use Cross’ (1971) five stages of liberation to illustrate the process. Depending where one is in the liberation process will determine their social and personal capital.

Littlewood (1998) suggests that even though some version of what we call schizophrenia exists all over the globe, different parts of the world address the problems of psychiatric diagnosis differently. For example, he cites a World Health Organization study on schizophrenia that suggests, “fewer poor outcomes for people [patients] were found in developing countries” (p. 1056). His conclusion is that Western individualism makes for a poor prognosis, as the responsibility for the ‘illness’ is put squarely on the shoulders of the individual as opposed to society. What groups, and indeed, realms of society, people are accepted into and put out of, often determine their identity  --  or at least the social processes of labeling are involved with how we create our identities. He acknowledges that the outcome of psychiatric disorder is largely dependent on how the society views the disorder and that those who are in charge of the system and its treatments largely determine which psychological theory it to be utilized, which guides, and is guided by public opinion and confirms Foucault’s (1965) warning discussed earlier about glorifying mythtical historical figures and their practices (p. 243). An important point that Littlewood makes is that there are limitations to cross-cultural study because of all of the various meanings attributed to the similar experiences; “Terms have to be considered in actual use: in one situation analogues of insane or mad may refer to subjective experience; in another to observed behavior” (p. 1057).

This relates to the argument that Ertugrul and Ulug (2004) concerning the perceptions people who have been diagnosed with schizophrenia have about stigma. It is interesting, or sad, to see the difference between the ways stigma is handled in England as opposed to Turkey, where this article originated. It is somewhat horrifying and at points, it seems that eve though they write about the effects of stigma, they miss the point and do not understand it. Despite this, they do offer a valuable model that can be employed in a daily diary study. Based on a study concerning the stigma of epilepsy, they rely on Scambler and Hopkins (1986; 1990) “hidden stress model” to explain enacted and felt stigma (p. 74). Enacted Stigma can be defined as actual discrimination experienced due to ‘illness’. Felt Stigma, on the other hand, is the self-imposed discrimination that one experiences from oneself, such as negative talk concerning their mental status. For example, “If I wasn’t so crazy then this would not be happening.” This model looks at the difference between felt and enacted stigma and Etugrul and Ulug (2004) “concluded that felt stigma, and particularly the fear of enacted stigma, has a more disruptive effect on people’s biographies than enacted stigma” (p. 74) suggesting the deep impact felt stigma has on the psyche. This confirms the idea that moves many of the restraint elimination efforts in facilities that are attempting to be progressive: witnessing violence is more damaging than experiencing it, because of the fear-factor it creates  --  that this could happen to you  --  coercive at its core.   How people organize their identity, particularly concerning schizophrenia, is the subject of Finlay, Dinos and Lyons (2001) work. They begin their argument by stating that many researchers have tried to make a connection between a “chronic threat to self-esteem” and a psychiatric label. However, they do not see this as a valuable research strategy and suggest that research:
  

“Looking downward, upward, and lateral comparisons in a sample of people with schizophrenia may demonstrate the variety of ways in which the social context can be categorized as well as the ranges of identity dimensions that are presented as salient among stigmatized individuals.” (p. 580)

  This reverberates Cross’ earlier work and Cross and Cross’ (2008) construal of the self and begins to expand notions of the dimensionalized personality. Further, Finlay and colleagues stress that even though a bulk of the literature on identity of those with psychiatric disorders concerns self-esteem, like with African Americans, self-esteem is not a predictor of anything, least of which personal identity or group identity, again, reflecting Cross and Cross’ work. Finlay, Dinos and Lyons (2001) suggest taking the approach of a “reciprocal relationship between social categorization and social comparisons” (p. 581). They emphasize that what researchers see as categories may not match the reality of those they wish to understand. There is a warning to researchers not to make something a negative unless it comes from the population that it is negative. Simply because the researcher, in the presumed majority, does not understand the experience does not mean it is negative.

From the perspective of environmental psychology, particularly concerning research, Finlay, et al address concerns about moving research out of the laboratory into the natural setting. Lewin’s field and action research with minority groups (1946, 1951) set forth many of these issues. Finlay, Dinos and Lyons (2001) offer, “research on social comparisons in stigmatized groups illustrates that people still have ethnic, religious, familial, professional, and political identities” (p. 581). This is the epitome of group identity  --  or reference group orientation  --  which I have learned may change and is not dependent on personal identity. Personal Identity and Group Identity can be, as illustrated by Cross and Cross (2008), arranged in matracies, literally giving dimension to the human experience. This is so much more valuable that simplistic models of research concerning only depression or self esteem outcomes could yield.

As Cross and Cross point out, it is the self-concept, or one’s meaning making system that is under attack when research takes this singular, simplistic approach toward personality. The self-concept ought to be looked at from at least two perspectives, first an individual’s personal identity, second, his or her group identity. These can be organized in the form of a matrix, which literally dimensionalizes the personality, allowing the researcher to see psychodynamic relationships between different personality traits and reference groups. It is Doctor William Cross’ legacy of work that has helped me unpack this complicated process. In the next section, I look to Cross' earlier work on developing a Black Liberation Psychology.

Psychiatric Slave No More: Parallels to a Black Liberation Psychology

 

The Negro to Black Conversion, William Cross (1971), published seven years after the Civil Rights Act of 1964 in Black World, outlines a five-stage liberation process that African Americans go through to achieve Liberation  --  if they get to the second stage  --  which is an encounter that changes their lives. While there is something very real about this theory of liberation, the reality is frightening. This theory, to a large degree, relies on a chance encounter of such magnitude that it will inspire someone to overcome oppression. This alone, in a civil society that prides itself on liberty, might be enough evidence for situations and environments in which oppressed people exist to begin to magnify opportunities for liberation and denounce oppression. Of course, I have been asked, “Who among us is really liberated?” and to this I respond, “This too, must change. Do you fancy to have a Revolution here?”

The first stage Cross outlines is the “pre-encounter” (p. 16). This is a time where people have low or no self-image, where “the other,” in this case, the White World, is deified, and the result is an active attempt at putting down one’s ‘Blackness.’ In this stage, the focus is on the self  --  and in many ways self-preservation (Hobbes, 1651). Though a person might be aware of a group, the groups’ survival or success is not at hand (Cross, 1971, p. 16). The overwhelming attitude or atmosphere of the pre-encounter stage has a tension at its root, a rejection of one’s nature. Cross illustrates the impact of the socio-cultural environments on “pre-encounter Negroes” stating that they have an “extreme dependency on White leadership” and a “distrust of Black-controlled businesses or organizations” even preferring other labels to “Black” (p. 16).

When you think of the active psychiatric slave, a psychiatric professional patient, survival, not progress is what is at hand. Under Cross’ theory, pre-encounter psychiatric slaves are those people who are still in search of being fixed, or targeted as those who accept a poor prognosis and idly sit by and ascribe to a medical model, which emphasizes their powerlessness and passivity. Bombarded by societal messages of the stereotypical mental patient, they succumb to the belief that they cannot finish school, obtain and retain employment, housing, families, and love. Broken by a system that requires compliance with its prescribed regimen the institution denies personal experience including trauma and creates professional patients (Auslander, 1998; Bassman, 2000; Clay, 1994; Tenney, 2000) -- or what I now refer to as psychiatric slaves.   In the Introduction to Madness and Civilization, Barchilon writes, “As the madman replaced the leper, the mentally ill person was now a subhuman and beastly scapegoat; hence the need to protect others (p. vii). Foucault writes this passage that deserves attention about how skewed the idea of liberation is:

 

The obscure guilt that once linked transgression and unreason is thus shifted; that madman, as a human being originally endowed with reason, is no longer guilty of being mad; but the madman, as a madman, and in the interior of that disease of which he is no longer guilty, must feel morally responsible for everything within him that may disturb morality and society, and must hold no one but himself responsible for the punishment he receives.” (p.246)

Pre-encounter psychiatric slaves are confined by a system that requires their sickness to survive as they blindly Thorazine-Shuffle through their days. At this remark, one participant suggested that there is a wealth of information that the Federal Drug Administration has put out in the last several years concerning the newer pharmaceuticals  --  a tremendous issue in psychiatric systems.

The second stage of the conversion process is the “Encounter”  --  that thing that jostles a person to awareness of their Blackness. Cross (1971) suggests that it was an experience that brings about the encounter that causes the self to reassess (or assess) its situation in relation to others who are similar (p.17). Cross notes the encounter is not about an intellectual exchange, but a feeling that motivates people  --  something that touches them at the core of who they are  --  and gives them an idea of who they can be. He argues that for many people of color, the witnessing of Reverend Martin Luther King Jr.’s assassination was the encounter that got them thinking about the Black Power Movement. He also offers “a friend or loved one who is further advanced in the Black Power Movement could ‘turn a person on’ to his own Blackness” (p. 17).

Whereas in the first stage the self is incredibly affected by society’s views, by the encounter stage, the self is not held powerless by her/his surroundings, even if horrified by them. In fact, Cross explains that this phase has two steps: first, the experience of the encounter itself and second, a reinterpretation of the world because of the encounter. Again, as a comparison, the psychiatric slave who is currently held involuntarily in a psychiatric facility has the ability to meet a peer advocate. “Recluse,” an “insider” from the liberation movement, warns that the term peer advocate embodies multiple meanings. In this sense we are referring to a person who is liberated from a life-long diagnosis of serious and persistent mental illness with a poor prognosis, due to the leverage of the ideas of “recovery,” or as suggested by George Ebert, an adviser to this project,  --  “Mad Pride". [14] Ebert found a document the very morning of our conversation concerning this paragraph that addressed this very issue -- from the Mental Patients Liberation Project, Syracuse (Colletti,1972):

We are saying the people must no longer suffer denigration in the name of diagnosis and persecution in the name of prognosis; we are saying no more shall we pretend that the jailers of the people are the healers of the people. (p. 2)


Te pre-encounter self, having met such a person on the front line as a “peer”, who shared a label s/he has been subjugated to, now in a position of power inside of the institution who has given him/her a new piece of information about this thing called recovery, or Mad Pride  -- or advocacy  --  has had the possibility of the encounter. Though possibly distrustful of such a notion at first, s/he will question why s/he couldn’t be liberated - a survivor, just like the peer advocate. Another “insider” involved with the Movement, with no name, urged me to clarify, that I am in no way referring to the peer-operated industry but a true experience shared by two people; one who acts at the others wishes, despite any potential personal repercussions. I found this passage from Phebe Davis (1855) expose of her stay the Utica Lunatic Asylum, where the The Opal (1851-1860) was published, to be an excellent illustration:


There she was, and no one to speak for her; but at length another patient who was more capable saw the daughter alone for a moment, to who she whispered and told her to take her mother home with her with which request she complied. It is dangerous even for one patient to interest herself in the welfare of another patient unless it is a benefit to the house. (p. 78)

 

The same as the person who will challenge him/herself and begin to explore and learn about the Black Power Movement, and its history, the psychiatric slave begins to ask him/herself challenging questions. “Do I really need this medication?” Or “Can I survive in society?” What if “Can I survive in society with supports of my choosing and reasonable accommodations?” and “Why am I here, anyway”? Cross offers that in this stage the person can only compare to what they knew before, that is their pre-encounter selves and often guilt, internalized and externalized anger as it is realized that he or she has been ‘programmed or brainwashed’ are often responses. The person emerging from the encounter stage is filled with Black rage and guilt, and compelled to find him/herself. Cross states, “A ‘Negro’ is dying and a ‘Black American’ is being resurrected” (p. 18). The mental patient too puts all faults with the system, creates a backlash against psychiatry, and searches herself for who she is, not as a patient  --  a psychiatric slave -- but as a survivor.

 

Cross’ (1971) interpretation of stage three is brilliant. He suggests it be called “Immersion-Emersion” (p. 18). In this one stage the person, the self, is completely engaged, swallowed even, by their rage and movement toward liberation, however, the survivor must come out of that deep-seated intensity, if s/he is to move on. In this third stage, it’s almost as if the person builds a quasi-environment around themselves; “the experience is an immersion into Blackness and a liberation from Whiteness” (p. 18). The immersion is powerful with the person being “energized by Black rage, guilt and a third new fuel, a developing sense of pride” (p. 18). In the immersion phase the white world and people are vilified  --  dehumanized and the “Black person and Black world are deified” (p. 18). The self undergoes a transformation in how she reacts to herself; ‘Black is Beautiful’ and what once was hidden or an embarrassment is now amplified.

 

This process has been seen in the psychiatric slave who is in the immersion into personhood as well. Doctors become “shrinks,” medication becomes “poison,” grandiosity become dreams and goals (Knight), and those who were annoying other patients before the encounter, now are peers  --  “brother and sister lunatics” as written by the Editor of The Opal in the 1850s. Cross keys that it is in the immersion phase that the language begins to change also, “The word ‘Negro’ is dropped and the person becomes an Afro-American, Black, Black-American, or even African” (p. 18). Concurrent with the psychiatric slave undergoing change, they become a recipient, consumer, survivor, ex-patient, peer, or even a person  --  a human being. It is in this phase, and maybe what moves one from immersion to emersion that, according to Cross, people become creative, using the arts as way of expressing their newfound selves. There are too many creative works of art, literature, music, and performance to list done by this community of people and it deserves attention (Bluebird, G. & Schell, B.J.).

 

It is also in this stage, the immersion-emersion stage when activists come to be as a “need to confront the ‘man’” becomes important. Cross states, “When this impulse is coupled with a revolutionary rhetoric and program, a Black Panther is born” (p. 19). The violent overthrow of the oppressor, as Fanon had suggested is explored, according to Cross, in a daydream-like manner, “Kill Whitey fantasies appear to be experienced by Black people regardless of age, sex, or class background” (p. 19). Referring to the doctors, Davis (1855) writes,

 

“Are the only ones that ever I felt as though I could see executed. But I do feel it would relieve any feelings of a great burden to see them swinging off, and I was not alone in feeling so while in the institution.” (p. 46)

 

However, Cross (1971) reports that people rarely act on these fantasies and that Black para-military groups “never devote themselves to the Fanon model suggests that paradigm may not be adequate (practical) for inclusion in strategizing for Afro-American liberation” (p. 19). Oaks (2005) call for a “non-violent revolution in mental health” might also answer some of these concerns about appearing militant or in any way mixing an already stigmatized people with potential acts of violence. Certainly, this way of thinking falls into Alinsky’s (1971) model of pragmatic radicalism.

 

At this third stage also, a “Blacker than thou mindset” (Cross, 1971, p. 20) can grow and everyone is neatly pigeonholed into different groups. Cross states, “Labeling others helps the person clarify his own identity” (p. 20). However, this labeling is stereotyping people and racist. What the person is trying to do is ensure that they are the best Black person they can be  --  that their “Blackness is pure and acceptable” (p. 20). Certainly in this Movement of Many Names (Tenney, 2006) labeling each other and ourselves occasionally takes a good deal of time. Some argue it is important to have the groups clearly defined; consumers often want better or more services while those who are survivors of treatment often want to see the system dismantled. Getting over this and coming together to work on shared interest, like eliminating the use of restraints, seclusion, and forced psychiatric drugs and electroconvulsive treatment is a challenge that, in many ways, we see New Yorkers in the Movement meet. What is happening, according to Cross (1971) is the person “shifts preference from individualism to mutualism or collectivism” (p. 20). The self moves from concern for herself to concern for her people. This Cross says is the zenith of the third stage where the person moves from total immersion to emersion.

 

This is the brilliance in Cross’ outline of the liberation process. Cross acknowledges that the immersion stage is intense: the self becomes overwhelmed by a prolific sense of right  --  led by rage and guilt. If the self can fill itself, creatively work out the angst and pain caused by the situation it has been in, separate itself from others, and from itself and maintain an interest in the collective of which it is, but one, the self emerges “from the dead-end, either/or racist, oversimplified aspects of the immersion experience” that Cross describes (p. 20). The self begins to level-off. This process of complete emersion from the immersion is tumultuous  --  it’s emotionally draining, though often exhilarating.

 

Leaders of movements can guide others to experience the larger environments, which begin to come into view. Certainly, the larger systems in which the self operates are now the target for change. “Black rage with reason” (p. 20) leads the person through the examination of the worlds in which s/he is discovering s/he exists. This is analogous to the psychiatric slave emerging from his/her process of immersion into survivor-hood, or even into consumer mentality, as a peer. Suddenly, there is awareness that the “hospital” has rules that it must follow that are created by people who work for the local, state and federal governments with no training in “mental health,” yet operate, regulate, and evaluate the “mental health system” which is jargon for the psychiatric system (Declaration of Principles, 1982).

 

This rising person develops awareness that there are some medications that are given because pharmaceutical companies give incentives to institutions for using their drugs. . . Awareness that all pharmaceuticals are labeled with warnings that people are not being given. . . Awareness that it is not just the nurse that called the “Code” to begin a restraint take down that is the problem, but that there is a whole entire system devoted to maintaining the status quo. This person comes together with other like-minded people who have had a shared experience to affect policy and hope to prevent others from experiencing it in the future. Cross states (1971), “When control, awareness and incorporation predominate, the person is progressing into the fourth stage” (p. 21).

 

For Cross, the fourth stage, internalization is the most difficult for the self to achieve. He also says it is the most difficult to explain, “because the events that occur in the immersion-emersion stage may frustrate or inspire an individual” (p 21). The self may never come out of the third stage, because of disappointment, rejection, or a fixation of what happened to them  --  what type of access a person has financially, emotionally, socially, etc., affects the outcome. For many this move into the fourth stage of Liberation is like Kierkegaard’s leap of faith and where one lands effects the outcome. Let’s not fool ourselves for one second, money, power, role, position, class, gender, religion, age, sexual identity, and race  --  all of these factors effect how the person survives outside the walls.

 

The reason for failure at this stage is that “‘Black is beautiful’ becomes an end in itself rather than the source of motivation for improving one’s skills or for a deeper understanding of the Black condition” (p. 22). Combating this becomes crucial if the self is to come through this fourth stage of internalization, if the self is to become active in the movement, lead others to learning how to redefine themselves, the self must change the way it views itself, in its internal environment. “In fact,” Cross writes, “Black revolutionary changes may only be possible after Black people have been exposed to a more positive perception of themselves” (p. 22).

 

This poem, written by one Opalian urges fellow inmates to follow the lead of trying to get out and exhibits signs of the fourth stage, internalization:

 

Do As Well As You Can.

Do as well as you can,

            And hope for the best,

Leave fate then to plan,

            And divine for the rest;

Do as well as you can,

            Nor venture without;

All your life ever scan,

            Thus to grapple with doubt.

 

Do as well as you can,

            And you’ll do well enough;

Unless you do so,

            Life will all be to rough:

Do as well as you can,

            And banish all fear;

Do as well as you can,

            And dry every tear.

 

27 Oct., 1851  A.W.L.S. (The Opal, 1851, p. 88)

 

Just because the self has a new sense  --  awareness  --  does not mean s/he will immediately possess a political sense  --  though there may now be an interest whereas before there was none. Cross urges Black planners and leaders to take this into account, so too have those working for the liberation of those involved with psychiatry realize that even though people can be led to liberation, Mad Pride or even “recovery,” does not mean that they will want to experience it, or put in the work required to achieve it. In review of this, one participant, who also chose to go unnamed, acknowledged the problems of consumerism, but defended people who are consumers saying,

 

“It is very difficult to survive in this society  --  and there are certain things I cannot do -- it took me a long time to find a job that would allow me both my expertise and eccentricities --  as a consumer, a lot of those fears are calmed by the impoverished life the title “mental patient” affords you. (Anonymous Participant, Can You Dig It, 2005)

 

The leaders of liberation movements must appreciate the anxiety and outright fear that comes along with change. Surely, James (1890) noted what the process of taking in new view entailed - a slow assimilation of information, until it becomes accepted as new knowledge. Alinsky (1971) wrote that people “need a bridge to cross from their own experience to a new way” (p. xxi). Cross does not limit liberation to obtaining new knowledge. Rather, liberation creates new identities. He termed some of the anxiety that comes when a person begins to “change his identity” Weusi Anxiety, meaning anxiety over Blackness. For if the self has only known one existence, changing into a radically different identity can halt the process or shift into a multi-dimensional reality where the self exists in all of the realms in the environment: social, economic, political, spiritual, physical, sexual, educational, etc. Cross explains how one moves in this fourth stage from “rage toward White people to controlled, felt and conscious anger toward oppressive and racist institutions” (p. 22). The focus goes postmodern, from the individual to the society, looking at the larger imprints of the macrosystem on the microsystem and everything in between (Bronfenbrenner, 1979) and this is largely the focus of the fifth and final stage, internalization-commitment.

 

Cross’ fifth stage is characterized by the idea that “He is going beyond rhetoric and into action and defines change in terms of the masses of Black people rather than the advancement of the few” (p. 23) and emphasizes the importance of looking beyond Western thought. This is most interesting, and it seems to be a theme among liberation movements, that the final stage begins with the person becoming a scholar. Yet, Cross rails against academia for not allowing the Black voice and states, “In essence, the Negro Western scholar seeks continued sophistication of intellect as he prays for emotional impotence” (p. 23).

 

The self goes from pre-encounter to encounter, passes into the immersion-emersion stage, and according to Cross, if the self can make it through the most difficult stage, internalization, the self will have experienced a new environment as he or she fulfills the internalization-commitment stage. In this fifth stage, Cross discussed the challenges “Black Researchers” faced in academia.

 

For months, I had been asking for an explanation of why I cannot draw upon my personal history as a tool when others discuss factors of their lives without question. Finally I was given a pragmatic answer and told, “Because it makes people uncomfortable.” I never understood that before. It was so clear, and like many things of a pragmatic nature, upsetting. It was probably the most useful piece of information I have gathered to make sense of my academic environment. I did not take it personally, but for a second, my reaction was, I am sorry my “psychiatric history” makes others uncomfortable. If I were blind, or physically (dis)abled, perhaps, I would not have to clarify it; it would be out in the open and accepted (yet perhaps an uncomfortable reality). However, this “psychiatric label”, this is my “private (dis)ability” and the message I receive from my collective environments is it should remain that way. Like people of color, and women, gay, lesbian, bisexual and transgender people, and other groups who are or have been oppressed, I have trouble accepting that. I am not alone.

 

How the self is perceived is highly influenced by society’s view of the group in which one exists. The way Black people were viewed, influenced how it is Black people viewed themselves. Changing the way Black people viewed themselves, in part, required society to change. I think as Cross has significantly laid out the battle for the liberation of a people, it is easily, eerily, followed by other oppressed groups.

 

Future Work

 

My future work is carved out by utilizing Audrey Cohen’s (1978) theory of a dimensionalized, interdisciplinary approach to solving problems, which is accomplished by a person taking a Constructive Action. Once a goal, objectives, and strategies have been established for a Constructive Action, one must view the problem through the dimensions of the self and others; values; systems; and skills and re-create the Constructive Action based on these findings. The Self and Others dimension is concerned with a reflexive process, where the person examines the human relationships he or she is encountering, paying specific attention to different cultures and creating a true competence for interacting in a multicultural world. The Values dimension asks the person to consider values on an individual and systemic level that may be consciously or unconsciously fostering prejudices or moving projects in a way that is trapped within outdated mores. The Systems dimension requires the person to examine systems involved with the problem, taking an ecological approach toward how the source and point of the problem interact with systems of education, government, religion, sexuality, politics,  etc. Finally, the Skills dimension focuses on what types of skills a person needs to develop and cultivate to meet the requirements of successfully carrying out the Constructive Action.

 

 

Concerning Self  Others: I have not explicitly discussed the other side of stigma in this paper and intend to do so in future work. The other side of stigma includes the idea of the immersion-emersion stage (Cross, 1971; 1991) as a point where a “Black Panther” or member of the Psychiatric Survivors Liberation Movement can be born. I also have not discussed any of the resiliency literature  --  the idea that people are like rubber bands and can snap back to their original elasticity despite the horrendous stressors they are under. This moves us into a discussion of evidence of the positive influence of stigma for some as a motivating factor (Goffman, 1963; Herman and Miall, 1990) and the concept of “Mad Pride” as discussed by George Ebert of the Mental Patients Liberation Alliance and David Oaks, of MindFreedom International.

 

Concerning Systems: This future work expands the focus of future research by addressing economics (Sen, 1970; Hopper and Bergstresser, 2007) through capabilities theory. It also moves from the neoliberal attitude that places the fault of the problem within the individual on the micro-system to finding solutions and fixing problems at the meso-, exo- and macro- systems in which a person exists, using the idea of Bronfenbrenner’s, (1979) Transforming Experiment  --  where we -- those effected by the problems created by psychiatric systems, are in fact, the designers, researchers, and analyzers of issues that affect us. Issues of social capital and the level of impact that support networks and restorative environments have on an individual will also be explored (Saegert, Thompson,  Warren, 2001; Wandersman and Nation, 1998) Paying attention to the larger systems with which we are all involved will be key. As future research concerning potential racial disparities in involuntary psychiatric treatment, identity, and liberation evolves I will continue to utilize participatory action research with emancipatory underpinnings.

 

Concerning Values: Cooper (2007) writes, “It is true that these groups are and have been oppressed” but argues that the oppression is not linked to our capitalist society saying,

 

“I conclude that full-bloodied Marxist of feminist versions of standpoint epistemology cannot be straightforwardly extended to the case of disabled people/Deaf people/Mental Health Users." [15]

This sentiment is at the core of my future work concerning the psychiatric industry and pharmaceutical companies and I respectfully but emphatically disagree. “Can You Dig It?” the research that spurred this review of the literature and paper, was “participatory action research with emancipatory underpinnings” and feminist in nature (Tenney, 2006). I am a psychiatric survivor. Cooper’s statement illustrates a deep stigma that must be erased because discrimination ensues creating parlous conditions.

Also of concern to values are some of the responses I have gotten from people when discussing this paper. More often than I care to report, this work has spurred people to suggest that I am racist against white people and created racist responses toward African Americans. As much as I have been appalled to learn the racialized aspect of psychiatry, I am even more appalled by the level of racism in individuals I have encountered. I am concerned that the responses to this work are so close to the responses of the Sixth Census where the data was used as a pro-slavery propaganda. I understand there is little that can be done to control the way people use information and in conversations with many multicultural experts, they have urged me to put forth this work. In future work, I intend on exploring this further.

Concerning Skills: In one of my peers readings of this work it was also suggested to continue exploring the deep history of failure that as a society we had, in the period of time after Slavery’s abolishment. Certainly, the failures of Reconstruction can be found in the works of many (Butchart, 1980).  My archival work is turning to this period and continues to find and explore parallel paths taken in the abolishment of Slavery and establishment of Reconstruction and the abolishment of the Asylum System and the creation of State Hospital System, which was eventually overturned for the modern day Psychiatric System. Gerald Grob’s historical body of work on Edward Jarvis’ legacy, epidemiology, and public policy work demands my further exploration as do the inquiries Link has made into psychiatric epidemiology, social economic impact, coercive psychiatric treatment, and stigma. Further exploring the bodies of work of Gerald Grob, Bruce Link, Rachel Cooper, and Michel Foucault will be key to this undertaking.

Concerning the Constructive Action: The denial and cover-up of the impact of psychiatry as a social structure that works to keep a class of people under control must be further investigated, and if I ever get IRB approval [16], I will do so.

Conclusion

This review process demonstrates that the experience of being bombarded by years of oppression  --  like a constant blunting of the lived experience  --  has an effect on the one’s outlook of their lived experience. Researchers attempt to simplify the human experience through the use of labels, which at best, further trivializes, or at worst, totally misrepresents an individual’s meaning making system as disordered, often citing an unfounded brain disease. All of this research suggests that when members of a stigmatized population encounter daily discrimination, stress is increased, despite anecdotal evidence of individuals who have made their life rich despite being under oppressive conditions. For people who are members of several stigmatized groups, it is even more important to look at their personal identity and group identity to gain a full understanding of the way they operate in the world and what they think ought to be done to change the conditions to which they are subjected.

It is readily apparent that there are clear-cut disparities when it comes to race, class, gender and age. While government entities and researchers have discussed that these disparities include lack of access to needed medical services, I argue that these disparities also include higher rates of compulsory psychiatric treatment in highly manipulated and surveilled environments. These disparities include actual treatment(s) and the role one has within the ancient asylum or modern day psychiatric systems. Whether it is the Commission on Lunacy or the Office of Mental Health if the names change and the practices do not, the results will not change.

As we are, in fact, having a Revolution here, we will make deeper connections, find more ironies, and learn more of how as a people those who have been psychiatrically labeled not only survive but also flourish after the shackles of psychiatry have been broken. For now, what has been presented is a good starting point for parallels of a professional patient, or psychiatric slave, breaking free from oppression of a psychiatric system and Nigrescence Theory. I want to re-assert that I do not use these words lightly at all and understand the deep implications that they hold. I believe the situation warrants these words’ strength. Psychiatric Slavery is alive and well on Planet Earth and for centuries it has been the mission of many who have been subjected to the practices, regardless of their names, to abolish them.

I conclude with Phebe Davis' words and echo her call, which illustrate that we have come some way in this movement for our human rights. However, we still have so long a way to go. In her expose of her two year three month stay at the Utica State Lunatic Asylum Davis wrote hopefully:
  

And the time is not far distant when we shall all cut loose from crazy houses, and straps, and belts, and waists, and muffs, and mitts, and cribs, and bedstraps and twisting of arms, and smothering huts, and drownings” (1855, p. 80).



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Notes


[1] http://www.theopalproject.org/ourstory.html

[2] There are too many of these people to list. An in-progress time line of these materials is over 90 pages long and can be found at http://www.theopalproject.org/ourstory.html.

[3] http://www.theopalproject.org

[4] http://www.theopalproject.org/ourstory.html
[5] Author of Women and Madness (1972).
[6] http://www.mindfreedom.org
[7] http://multiracial.com/site/content/view/458/27
[8] http://www.amstat.org/about/index.cfm?fuseaction=history

[9] Retrieved July 31, 2008 from http://www.omh.state.ny.us/omhweb/pcs/previous_years.htm

[10] Retrieved July 31, 2008 from http://bi.omh.state.ny.us/aot/characteristics?p=demographics-race

[11] Retrieved April 3, 2008 from http://bi.omh.state.ny.us/aot/characteristics.

[12] Retrieved July 31, 2008 from http://bi.omh.state.ny.us/aot/characteristics?p=demographics-race

[13] Retrieved July 31, 2008 from http://factfinder.census.gov

[14] MindFreedom International (www.mindfreedom.org) has spurred a worldwide Mad Pride Movement that recently won attention on the front cover of the the New York Times Fashoin  Style Section (May 11, 2008).

[15] http://eprints.lancs.ac.uk/624/1/values.htm

[16] Despite the fact that I abhor Cooper’s (2007) statement about people with psychiatric histories not doing research, but eventually attempting to do so, I can say with certainty that on some level, researchers who are “out” abut their psychiatric histories will cause IRBs pause. After a lengthy IRB review of a follow-up study to replicate “Can You Dig It” with people who are policy makers and psychiatric service providers, my application was rejected. I am in the process of re-submitting my research design.



[i] This work is feminist in that the personal is political, educational, and researchable. My life experiences deeply affect my work and I am brutally honest about my motivations. Through advocacy and activism I have been involved in since 1992, my personal experiences have to some degree been shaping New York State Regulation and Policy through the New York State Office of Mental Health (OMH) and to a lesser degree, the Vocational and Educational Services for Individuals with Disabilities (VESID) of the New York State Education Department. Campbell, Ruth,  Glover (1993) discuss the “lab rat to researcher” phenomenon and it inspired me to get an education. I am not a researcher who has a psychiatric history, but a person who has a psychiatric history that is trying to figure out what researchers are talking about. The opportunity to reach an audience of psychologists and those who are interested in radical psychology, who question practices, has been exciting. I am grateful for the opportunity to further define my position in this forum.

[ii] William Samuels, PhD and Joseph Glick, PhD who are aiding me with understanding statistics were incredibly patient and thoughtful while me represent my findings and I am indebted to them for the knowledge and the skills they have helped me acquire.

 

Acknowledgements

I would like to thank Dr. William E. Cross, Jr. for his many reviews of this work and guidance during its preparation.  I would also like to thank Deborah Baker, Celia Brown, David Chapin, Architect, Amy Colesante, Eva Dech, George Ebert, Michael Fields, Joseph Glick, PhD, Daniel Hazen, Vanessa Jackson, LCSW,  d.a. Johnson, Sabrina Johnson, David Oaks, Stephanie Orlando, Susan Saegert, Ph.D, William Samuels, PhD, Dally Sanchez, and  Carlton Whitmore, for their guidance concerning the presentation of these materials. Heartfelt thanks to Martin Downing for assisting with his editorial eye. Finally, I would like to thank the Journal of Radical Psychology for looking beyond my writing (which I continue to strive to improve) to the ideas which I am attempting to present. 



Biographical Note:

Lauren Tenney, a psychiatric survivor, holds a master's degree in public administration and is currently a provost's fellow in the doctoral program in Environmental Psychology at the Graduate School and University Center, City University of New York where she is conducting partcipatory action research on The Opal. She is an active member of the Mental Patients Liberation Alliance and MindFreedom International.

Contact: Lauren J. Tenney, MA, MPA, Psychiatric Survivor. www.theopalproject.org lauren@theopalproject.org



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