The racial foundations of American psychiatry

In 2005, the Washington Post has published an investigation by researchers showing that schizophrenia indifferently affects all of the ethnic groups in the United States. However, psychiatrists from the 1980s and 1990s overdowed this pathology among African-Americans: there are five times more schizophrenics than in other ethnic groups. For American psychiatrists, the racial factor always seems to take precedence over the social and individual factor in the genesis of this disorder. Jonathan Metzl reconstructs through this book the history of this racial construction of mental illness in XX^e century.

From the previous century, American alienists formed the concept of “ drapetomania To denounce the behavior of black slaves deemed unfit for any form of freedom. The European conception of “ early dementia “, Disposed in the United States around the First World War, strengthened the systematic association between crime, immigration and psychiatric incurability. It was then a question of preventively detecting the schizophrenic adolescents in order to neutralize the action of these “ criminals ». At that time, however, began to emerge a new vision of mental illness. The psychoanalytic interpretation of Bleuler forge in the 1910s the image of a more positive schizophrenia, artists’ disease, personality disease and especially white disease. As she changes her name – “ early dementia “In” schizophrenia -, this mental disease is the subject of a cultural and social displacement. Of imported and threatening disorder, schizophrenia becomes in an intermediary a disorder of indifference, symptomatic of the evolution of Western civilization. The commonly accepted opinion, including by doctors, is that schizophrenia is a white (or rather white) disease. Anatole Litvak’s film, The Snake Pit (1946), illustrates this classic pathology of women in the middle classes. The salvation of these failed women is expected in fashionable psychoanalysis or in the consumption of revolutionary neuroleptics. In the institution of the Ionia State Hospital for Criminally Insane (Michigan), whose files form most of the sources used by Metzl (with the professional press), this disease was considered, before the 1950s, as typical of rural women.

In this reference institution, the number of women diagnosed as schizophrenics declines in the following decade. In the first half of the 1950s, Ionia hospital received dozens of new patients from Michigan prisons who were the scene of violent mutinies. These mutineers, reclassified in case of psychiatric, upset the demography of the hospital institution: African-Americans, who represented around 15% of patients, count for 40% in 1955. Medical examinations are certainly contradictory, but they all conclude by The same verdict: “ paranoid schizophrenia ». In the space of twenty years, schizophrenia has migrated to American culture. It is no longer the indifference and passivity that characterize the disease, but rebellion and violence. It is no longer white women who are affected, but black men. They are no longer rural people who are the subject of this classification, but individuals from degraded districts close to Detroit. At the end of the 1960s, 60% of Ionia’s admissions were pronounced for African-American men from the region.

This protest psychosis was theorized, in the years 1960-1970, by American psychiatrists who rediscovered the racial paradigm in their work. Research carried out on the subject from comparisons of groups of black and white patients may have been a side effect of the struggles for civil rights. The fact remains that this American psychiatry racializes its in connection with, on the one hand, with the creation in 1968 of the Dsm II (Diagnosis and Statistical Manualinstrument called to become a global reference in psychiatry) which identifies the paranoid subtype of schizophrenia by associating it with bellicose male behavior and, on the other hand, with the rise of the activity of activists of activists civil rights. The Princeps article by Bromberg and Simon, entitled “ The Protest Psychosis », Clearly makes the link between the movement of civil rights, violence and a form of illusory madness which leads to a negation of Western civilization. The development, by these sick subjects, of a racial antagonism founding of American society is considered by these authors as a paranoid projection. It is also an aggressiveness influenced by the speeches of Malcom X and Black Muslims which is identified by professional journals, in particular by pharmaceutical advertisements. The film Shock Corridor by Samuel Fuller (1963) clearly evokes the psychiatric internment of these civil rights activists. As the concept of schizophrenia becomes popular, it is therefore invariably associated with the civic cause of African-Americans and the threat of national dissolution.

The most surprising, in this story, perhaps lies in the way Martin Luther King was able to take up the term schizophrenia in some of his most famous speeches, and also in the way in which black rappers regularly evoke this pathology in their Texts. In addition to this integration of the racialization of language, the saddest is that at the time of the deinstitutionalization of American psychiatry, which began in the 1960s, patients who remain locked up are most often these African-Americans considered as schizophrenic. Some of them are also found in prison with the closure of the Ionia Institute in 1977. It is a quality of this book to provide a historical perspective of the imprisonment of madmen at the end of XX^e century, from the requalification of schizophrenia as an incurable violent illness.

The choice of a source located in a region of great migration, strong racial tensions (Michigan) and characterized by the internment of “ criminals Essentially male could put the author’s conclusions into perspective. It is to forget that the National Institute of American Mental Health said, in the 1960s, that African-Americans had a remarkable proportion of schizophrenic disorders, much higher than that of the white population. It would certainly have been interesting to say how schizophrenia was instrumentalized worldwide for political purposes in the years 1960-1970. We must remember here that at that time, in USSRthe use of the diagnosis of “ Torpid schizophrenia Was used to silence opponents of the diet. The fact remains that this book, at the crossroads of concepts of race and gender, contributes in a remarkable way to renew the history of psychiatry. It shows, without denying the existence of pathologies, the way in which these respond to a form of social and cultural construction evolving according to political events and social developments. The book is also a salutary invitation to denounce the reductive interpretations of mental illnesses and to take into account the clinic and culture as much as the biological and mechanical explanations, so well represented in the new American psychiatry.