A leading psychiatrist and scholar exposes the racialization of a biologically based disease-starting with the civil rights era and continuing today
Revolution was in the air in the 1960s. Civil rights protests demanded attention on the airwaves and in the streets. Anger gave way to revolt, and revolt provided the elusive promise of actual change. But a very different civil rights history evolved at the Ionia State Hospital for the Criminally Insane in Ionia, Michigan. Here, far from the national glare of sit-ins, boycotts, or riots, African American men suddenly appeared in the asylum’s previously white, locked wards. Some of these men came to the attention of the state after participating in civil rights demonstrations, while others were sent by the military, the penal system, or the police. Though many of the men hailed from Detroit, ambulances and paddy wagons brought men from other urban centers as well. Once at Ionia, psychiatrists classified these men under a single diagnosis: schizophrenia.
In The Protest Psychosis, psychiatrist and cultural critic Jonathan Metzl tells the shocking story of how schizophrenia became the diagnostic term overwhelmingly applied to African American men at the Ionia State Hospital, and how events at Ionia mirrored national conversations that increasingly linked blackness, madness, and civil rights. Expertly sifting through a vast array of cultural documents from scientific literature, to music lyrics, to riveting, tragic hospital charts Metzl shows how associations between schizophrenia and blackness emerged during the 1960s and 1970s in ways that directly reflected national political events. As he demonstrates, far from resulting from the racist intentions of individual doctors or the symptoms of specific patients, racialized schizophrenia grew from a much wider set of cultural shifts that defined the thoughts, actions, and even the politics of black men as being inherently insane.
Ultimately, The Protest Psychosis provides a cautionary tale of how anxieties about race continue to impact doctor-patient interactions, even during our current, seemingly post-race era of genetics, pharmacokinetics, and brain scans.
“The Protest Psychosis is insightful, challenging, and singularly compelling, presenting intimate narratives of individuals; tracing the organizational history of an institution; and reading these stories through the lens of America’s shifting and troubled racial politics. Metzl forces readers to reexamine our deeply held beliefs about the nature of disease, the process of medical diagnosis, and the influence of the political world on our racial ideas. An exceptional book.” —Melissa Harris-Lacewell, author of Barbershops, Bibles, and BET: Everyday Talk and Black Political Thought
“Rarely can a book be described as both powerful and measured, but The Protest Psychosis is that book. Jonathan Metzl is a psychiatrist with a respect for schizophrenia as a real and serious illness, but in this brilliant page-turner he also breathes life into the social history of schizophrenia and amasses compelling evidence of how it became a catchall diagnosis fed by racial bias and actively engineered by an ugly social agenda. And Metzl’s sensitive analysis of this tragedy supplies much more than damning evidence: he also offers positive solutions that can contribute to a future devoid of the racial skewering that blights the lives of misdiagnosed black Americans.” —Harriet A. Washington, author of Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present
“A stunning and disturbing book. Jonathan Metzl shows how white fears of black militancy, radical shifts in diagnoses, the pharmaceutical industry’s promotion of new antipsychotic drugs, and the rise of a carceral state converged to invent the schizophrenic Negro. The Protest Psychosis is a compelling cultural history that exposes postwar psychiatry’s racist character and its enduring legacy.” —Robin D. G. Kelley, author Thelonious Monk: The Life and Times of an American Original
“In this riveting book, Jonathan Metzl anatomizes the ways in which social forces, cultural anxieties, and political protests shaped schizophrenia as a black disease. The story that emerges is fascinating and heartbreaking from the first word to the last.” —Emily Martin, author of Bipolar Expeditions: Mania and Depression in American Culture
“Jonathan Metzl offers a richly textured story of the confluence of race, psychiatric diagnoses, and social upheaval. The result is an absorbing account of how schizophrenia became a highly racialized label.” —Earl Lewis, author of Love on Trial and To Make Our World Anew and provost, Emory University
“The Protest Psychosis offers a compelling and expertly crafted study of the ways in which racial tensions are structured into medical interactions and shape its disease categories. This innovative historical portrait of the interaction of race and medicine should provoke deep reflection on how racial meanings become attached to docility, rage, and aggression, and become reified in psychiatric nomenclature and practice.” —Keith Wailoo, author of Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health
“In this remarkable book, Jonathan Metzl brilliantly traces the racialized process whereby the prison ultimately replaced the mental hospital. Digging through the rich and fascinating archives of the Ionia State Hospital in Michigan, Metzl excavates, in the tradition of our best archeologists and sleuths, how it is exactly that schizophrenia was transformed from an illness of docile white women to a disorder of black male belligerence. This book is a must-read for everyone interested in contemporary society.” —Bernard E. Harcourt, author of Against Prediction: Profiling, Policing, and Punishing in an Actuarial Age
“The Protest Psychosis is the most important book on schizophrenia in years. Jonathan Metzl shows how schizophrenia was transformed from a largely white, middle-class, nonmenacing disorder to one that is widely perceived as dangerous and threatening, precisely at the time of the U.S. civil rights movement. Metzl demonstrates convincingly that fears associated with urban violence and the rise of black power in the 1960s became an essential part of the very definition of schizophrenia.” —Byron Good, author of Medicine, Rationality, and Experience, and professor of medical anthropology, Harvard Medical School
“The Protest Psychosis is an incisive and unexpectedly riveting book, equal parts medical history, social criticism, and investigative journalism. A very impressive work of scholarship.” —Carl Elliott, author of Better than Well: American Medicine Meets the American Dream
Reviews
Review: Journal of the American Medical Association - May 19, 2010
“. . . a fascinating, penetrating book by one of medicine's most exceptional young scholars. . . . Folding together equal measures of historical analysis, psychiatry,social criticism, and impeccable research, The Protest Psychosis offers not only psychiatrists but anyone involved in health care new insight into the nature of disease, the ongoing flux of medical knowledge, the influence of culture and politics on medicine and science, and the "unequal treatment" still at play regarding race in the United States.”
Review: Booklist - January 1, 2010
"An enlightening look at how those in power define aberrant behavior and evade self-analysis."
Chapter 1: Homicidal
Cecil Peterson had no history with the police. Even on the day the white stranger insulted his mother, Peterson simply wanted to eat lunch. He sat in his usual seat at the counter of the diner on Woodward Street and ordered his usual BLT and coffee. Somehow he caught the stranger’s eye in the squinted way that begets immediate conflict between men. The stranger glared. Peterson was not one to walk away from confrontation, but he knew the implications of glaring back. One should not glare back at a white man. So he looked down. But the two men crossed paths again after Peterson paid his tab and walked outside. And then came the remark. And then came the fight.
Two white Detroit police officers happened to be passing by the diner that September day in 1966. They ran to the altercation and tried to separate the combatants. At that point, according to their formal report, Peterson turned on the officers and struck them “without provocation.” According to the report, Peterson knocked one officer down and “kicked him in the side.” A second police team arrived and assisted in apprehending the “agitated” Mr. Peterson. Medics took the first officers on the scene to the Wayne County Hospital emergency room. The ER physician’s report noted that both officers had “bruises,” though neither required treatment. The white stranger was not charged.
Peterson was twenty-nine, African American, and an unmarried father of four who worked the line at Cadillac Motor Company. He had not previously come to the attention of the state. He had not been diagnosed or treated for any physical or mental illness. Nor had he been held for crimes or misdemeanors. He had limited interactions with white people and preferred to stay close to home. But on that September day in 1966 his life changed along with his identity. He became a prisoner. And then he became a patient.
The Wayne County court convicted Mr. Peterson of two counts of “assault on a police officer causing injury requiring medical attention” and sent him to the Wayne County jail on a two- to ten-year sentence. After several weeks of incarceration, prison notes described Mr. Peterson as “extremely paranoid and potentially explosive,” screaming that “the white stranger” had “insulted my mother” and that his “civil rights” were being violated. The prison psychiatrist provided a diagnosis of “sociopathic personality disturbance with antisocial reaction,” and recommended seclusion, restraint, and continuous doses of Thorazine at 200 milligrams. Within six months, Mr. Peterson’s unprovoked outbursts became so severe that he earned the distinction of being a “problem inmate” who was “dangerous on the basis of his presenting a threat to the guards.” Soon thereafter, he began to ramble incoherently. One guard’s note explained that Mr. Peterson “occasionally grimaces, remains silent for long minutes, then looks up toward the ceiling with his eyes rolling in all directions.” A year into his incarceration, Mr. Peterson loudly accused the prison staff of “depriving him of women.” They observed him to be “hostile, suspicious, and increasingly annoyed” without any apparent provocation. He soon escalated, and the prison psychiatrist was called again. This time the psychiatrist recommended transferring Mr. Peterson to the notorious Ionia State Hospital for the Criminally Insane. The transfer sheet described Mr. Peterson as “HOMICIDAL.”
The drive to Ionia took four hours, much of which Mr. Peterson slept off in the back of the police car. But he stiffened when the vehicle pulled into the winding drive that led up to Ionia Hospital; and his attention reached the level of panic when the car doors opened onto the expansive, forty-onebuilding campus of bricks and chimneys and yards and fences and crazy people as far as the eye could see.
Dragged inside one of the largest of these buildings, Mr. Peterson shouted and struggled to get away. He said he was an “African warrior” and spoke gibberish, which he claimed to be his native African language. Then, in English, he loudly accused the guards of detaining him against his will. He claimed to be under attack by all white men.
Sylvan Cabrioto was not fazed. He had been the on-call physician at the Ionia receiving hospital since 1958, fully ten years before Cecil Peterson appeared in his examination room. A first-generation psychiatrist and secondgeneration American, Cabrioto was an authoritative, robust man of fifty-three who had a different bow tie for each day of the week. Treating the steady flow of burglars, peeping toms, pedophiles, and murderers who came through the Ionia doors gave Cabrioto a detached air of competence that undoubtedly resulted from having seen it all before. So he was not intimidated, at least not overtly, when Peterson appeared in the receiving hospital, or when the two prison guards drove off, or even when, after his handcuffs were taken off, Mr. Peterson “doubled up his fists” and gestured in a manner that was “irritable, disturbed, and sarcastic.”
It was, after all, a stance Cabrioto had seen in nearly every one of the growing number of “Negro” patients brought to the Ionia State Hospital for the Criminally Insane in the 1960s. One man heard the voice of Jesus telling him to come home. Another was certain that loved ones were trying to poison him. Another performed “mystic voodoo movements” while claiming an “eternal struggle against the white man.”
Like Peterson, most of the men came from “deteriorated neighborhoods” of Detroit. Most nonetheless held gainful employment. Like Peterson, each was convicted of a crime against person or property, ranging from larceny to murder to various forms of civil unrest. Few of the men had seen psychiatrists prior to their convictions, though this was not surprising since few psychiatrists resided in the urban sections of Detroit in the 1960s and 1970s. The men passed through various courts, prisons, and other state institutions. By the time they arrived at Ionia, they were nothing if not psychotic. Like Peterson, they hallucinated and ideated, or acted withdrawn, suspicious, paranoid, or combative. They argued, and fought, and resisted, and projected. And, according to Cabrioto and his colleagues, these actions were easily explained with a single diagnosis.
Preface The Protest Psychosis
Part I Ionia
1 Homicidal
2 Ionia
Part II Alice Wilson
3 She Tells Very Little about Her Behavior Yet Shows a Lot
4 Loosening Associations
5 Like a Family
Part III Octavius Greene
6 The Other Direction
7 Categories
8 Octavius Greene Had No Exit Interview
9 The Persistence of Memory
Part IV Caeser Williams
10 Too Close for Comfort
11 His Actions Are Determined Largely by His Emotions
12 Revisionist Mystery
13 A Racialized Disease
14 A Metaphor for Race
Part V Rasheed Karim
15 Turned Loose
16 Deinstitutionalization
17 Raised in a Slum Ghetto
18 Power, Knowledge, and Diagnostic Revision
19 Return of the Repressed
20 Rashomon
21 Something Else Instead
Part VI Remnants
22 Locked Away
23 Diversity
24 Inside
25 Remnants
26 Controlliní the Planet
27 Conclusion
Acknowledgments
Notes
Index
- Click here to read an interview with Jonathan Metzl in New Books in Sociology
- Click here to read Lisa Wade's review of Metzl's work in Sociological Images
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Click here to see Metzl as a guest on MSNBC'sMelissa Harris-Perry discussing the Trayovn Martin case.
- Click here to see Metzl as a guest on MSNBC'sMelissa Harris-Perry segment entitled "The Science behind Political Thinking".
- Click here to see Metzl as a guest on MSNBC'sMelissa Harris-Perry segment entitled "Who Said It: Newt Gingrich or Kanye West?".