“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?”

“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)

“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)

“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).

“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)

 “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)

“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)

“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).

“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).

“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).

“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)

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)

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)

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]

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).