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201. The Protest Psychosis · Who Did What Now With Katie Charlwood

0:13
Speaker 1: Un Little Delicious friends, and welcome to Who Did What Now?
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Speaker 1: The history podcast that is not your history class with
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Speaker 1: me your host Katie Charlwood, History Harlott and reader of books.
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Speaker 1: And I had a funny one this week. You know
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Speaker 1: how people like to complain about my content, Well, I
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Speaker 1: had someone accuse me of being nasty with my USA
0:34
Speaker 1: History Month. This month, if you're unaware, July twenty twenty
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Speaker 1: six is the celebration of the agreeing of the Declaration
0:46
Speaker 1: of Independence, not the gaining of independence in the US,
0:50
Speaker 1: and so everyone's like, it's America's birthday, and so I
0:54
Speaker 1: was like, well, let's do American history then causes seemed
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Speaker 1: like a very reasonable and large option. So some people
1:03
Speaker 1: got a little bit testy about that, and someone accused
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Speaker 1: me of being nasty with my USA History Month because
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Speaker 1: I'm talking about how the USA became the USA, which
1:15
Speaker 1: is which is wild, Like you think actual history is
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Speaker 1: made bad mouth in a country like sugar lump. No
1:24
Speaker 1: if you think this is nasty, right, And I haven't
1:27
Speaker 1: even touched on the British Empire yet, like I'm I'm
1:34
Speaker 1: just getting started. But also it's not nasty or cruel
1:40
Speaker 1: or horrible to talk about the entire history of somewhere
1:45
Speaker 1: Here's like, I'm not even doing the entire history. I've
1:47
Speaker 1: got so much out because history is vast and large,
1:51
Speaker 1: and I don't know, if you know, this has lasted
1:54
Speaker 1: a long time. So it's one of those things, right
1:57
Speaker 1: because history, like if you're only focusing on you know,
2:05
Speaker 1: the rainbow lollipops and you ignore everything else than that,
2:11
Speaker 1: that's not history, you know, that's it's fan fiction. Yeah,
2:18
Speaker 1: but anyway back to me, I do have more tu
2:21
Speaker 1: dates coming soon. Once I have them locked in, you
2:25
Speaker 1: will be the first to know. Well, no, the people
2:27
Speaker 1: people who signed up like in the show, voting to
2:30
Speaker 1: know first will know first, and then Patreon supporters will
2:33
Speaker 1: be in the first to know as well, and then
2:35
Speaker 1: and then everyone else who listens here but Belfast is
2:40
Speaker 1: it's selling the cockcakes and Los Angeles, come on. It
2:46
Speaker 1: is a tragic day in Sunset Boulevard when you don't
2:48
Speaker 1: get your tickets. I'm not even on Sunset Boulevard, but
2:52
Speaker 1: you know, I'm chronically online, and if you get it,
2:55
Speaker 1: you get it. Some people are going to be listening
2:57
Speaker 1: to this going what Sunset Belove got to do with this?
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Speaker 1: Like just so you know, I'm going to be such
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Speaker 1: a broken record about this because like international tour guys.
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Speaker 1: Also in today's news, because it is too funny not
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Speaker 1: to share, Andrew Tate got arrested in capris and are
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Speaker 1: going out top like full mid two thousand style, Like
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Speaker 1: I swear that I think my mum had a day
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Speaker 1: to night outfit just like this. So for those of
3:35
Speaker 1: you who don't know, there was a big thing in
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Speaker 1: fashion where people were genuinely concerned about their outfits and
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Speaker 1: their makeup being able to go from day to night
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Speaker 1: so you could go from the office to the club,
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Speaker 1: which is why everyone wore a blazer. But speaking of clubs,
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Speaker 1: the Tate brothers, like when they got arrested, So you've
4:00
Speaker 1: got Andrew Dayton, he's in his little purple Elizabeth Taylor outfit,
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Speaker 1: and then you've caught Scapri's and sensible lovers, and then
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Speaker 1: you've got the other brother who's in a full three
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Speaker 1: piece suit and fedora like they both somehow look like
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Speaker 1: Russian American nightclub owners in a direct to VHS movie
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Speaker 1: somewhere between ninety eight and two thousand and I stand
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Speaker 1: by that absolutely. Also, oh so more news, the Guild.
4:33
Speaker 1: I was a big fan of the Guild. The Guild
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Speaker 1: is making a movie which my little nerdy heart is
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Speaker 1: so excited for. So there's a lot of good news
4:41
Speaker 1: going around here. But I know what you're thinking. You're thinking,
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Speaker 1: Katie quite Yo, Jeba Daba, in fact me, in fact you,
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Speaker 1: I will. But first we've got to get our source on.
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Speaker 1: Our sources are the Protest Psychosis House, Schizophrenia Became a
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Speaker 1: Black Disease by Jonathan Metzel, How the Black Man Became
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Speaker 1: Schizophrenic by Karen Franklin, The Effects of race and Ethnicity
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Speaker 1: on schizophrenia, Individual and neighborhood contexts by Augustine Jake, Pausa, Glente,
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Speaker 1: Sonacai and Edward W. Butler. Madness, Race and Insanity in
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Speaker 1: The Jim Crow Asylum by Antonia Hilton. And of course
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Speaker 1: we have our old favorites biography dot com and History
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Speaker 1: dot Com. I also didnk comfortably good. Then let's begin.
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Speaker 1: There are a few things history loves more than watching
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Speaker 1: powerful instigusians convince themselves that they're being perfectly rational while
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Speaker 1: doing something that future generations will collectively look back on
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Speaker 1: and say, all right, well, that was the stubborn and
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Speaker 1: so this this story today is one of those moments
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Speaker 1: like it is about psychiatry, race, politics, and what happens
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Speaker 1: when medicine, like history, does not exist in a vacuum.
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Speaker 1: So I'm going to talk about today, as I'm sure
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Speaker 1: you know from the title of the episode, the protest psychosis. Now,
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Speaker 1: I want to clarify before I get into anything else,
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Speaker 1: that this episode is not about whether schizophrenia is a
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Speaker 1: real illness, because it is, because schizophrenia is a serious
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Speaker 1: psychiatric disorder, and it affects millions of people worldwide, and
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Speaker 1: because we've researched it for decades. You know, our modern
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Speaker 1: research has dramatically improved our understanding of causes, diagnoses, treatment,
7:04
Speaker 1: and nothing that we're discussing today should be interpreted as
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Speaker 1: dismissing the experiences of people living with schizophrenia or suggesting
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Speaker 1: that modern psychiatry view is political activism as evidence of
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Speaker 1: mental illness. Only ideas do that. Now, this episode is
7:23
Speaker 1: about history, specifically, It's about how psychiatric idea has changed
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Speaker 1: over time, how social and political attitudes can shape medical thinking,
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Speaker 1: and how one diagnosis, schizophrenia underwent a remarkable transformation during
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Speaker 1: one of the most turbulent periods in American history because
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Speaker 1: diseases don't exist in isolation. Now, the biology might stay
7:52
Speaker 1: the same, but the story societies tell about illness it
7:58
Speaker 1: doesn't like things. It's like, okay, sidebar. You know, when
8:03
Speaker 1: they talk about leprosy in the Bible, the disease that
8:07
Speaker 1: is leprosy, that is known as leprosy is not the
8:10
Speaker 1: same leprosy that exists today. It is a very very
8:15
Speaker 1: different It's a very very different disease, which I will
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Speaker 1: happily talk about one day because I really like historical diseases.
8:23
Speaker 1: But we will cover this. And that's the thing. Right, So,
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Speaker 1: as you guessed, I'm going to be talking about mental
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Speaker 1: illness quite a bit in this week's episode, I'm going
8:36
Speaker 1: to talk about racism. I'm going to be talking about
8:39
Speaker 1: many horrible things consecutively, one after another in a row.
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Speaker 1: And if you think that's something that's going to be
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Speaker 1: a bit much for you to listen to, feel free
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Speaker 1: to exit stage left and we will see you next time. Now,
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Speaker 1: the civil rights movement in the US one many great
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Speaker 1: things for a nation's minorities, right, but these victories came
9:05
Speaker 1: at a cost for the people who won them. Now,
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Speaker 1: I know a joke about vivl or revolution quite a bit,
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Speaker 1: or not as much recently because it's not as funny
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Speaker 1: when the world is burning. But people who look like me,
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Speaker 1: whied women, and just white people in general, a lot
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Speaker 1: of the time when they talk about revolution and switching
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Speaker 1: things up and fighting back and changing the system, they
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Speaker 1: very conveniently forget that it's always the most vulnerable members
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Speaker 1: of society who will be hurt first. Like you can't
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Speaker 1: make a normlet without breaking eggs. And I think that
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Speaker 1: people need to be aware of the exactly the consequences
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Speaker 1: of their actions and ensure that they are comfortable with
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Speaker 1: that of the consequences of that. Are they okay with it?
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Speaker 1: Is everything happy? Are they good with that? Can they
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Speaker 1: live with the consequences of their actions? So a lot
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Speaker 1: of the time they don't consider it, Like when people
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Speaker 1: demand change and they and they you know, they forget
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Speaker 1: that it's always going to be the marginalized who are
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Speaker 1: in you know, the firing line. But the civil rights
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Speaker 1: movement is and like a lot of people are aware
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Speaker 1: of the civil rights movement, but they manage to ignore
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Speaker 1: how black communities suffered through protests, riots, And I'm going
10:46
Speaker 1: to call it vigorous police enforcement. Of course, discrimination from
10:53
Speaker 1: this time, which almost no one knows about, which is
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Speaker 1: one that put a lot of black men into mental hospitals,
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Speaker 1: or at least tried to. So. The phrase protest psychosis
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Speaker 1: was not an official diagnosis that appeared in psychiatric manuals.
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Speaker 1: You couldn't walk into a hospital and be formally diagnosed
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Speaker 1: with protest psychosis. Instead, the term refers to a historical
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Speaker 1: phenomenon in which psychiatrists, institutions, and the media increasingly associated
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Speaker 1: schizophrenia with black political activism, anger, and resistance during the
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Speaker 1: Civil Rights era. In the following years, schizophrenia diagnosis in
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Speaker 1: angry black men skyrocketed. This is a very specific type
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Speaker 1: of schizophrenia. Right suddenly discovered paranoid schizophrenia, sufferers of which
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Speaker 1: were typified as having delusional anti whiteness, which is, frankly, considering,
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Speaker 1: you know, the lynching and the bombings and the segregation
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Speaker 1: and the arson and all of the medical experimentation, like,
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Speaker 1: how is that delusional anti whiteness? That is delusional for
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Speaker 1: black men not to be anti white after being through that,
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Speaker 1: and I know you might be thinking, were these psychiatrists racist? Yes, yes,
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Speaker 1: they were right, Like they reflected the social tensions of
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Speaker 1: nineteen sixties America, and so this influenced this, this decision,
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Speaker 1: It was enhanced by their inherent biases, Like this wasn't
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Speaker 1: a cold clinical decision. The new diagnosis procedures were heavily
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Speaker 1: intertwined with the cultural values of the day, sorry, the
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Speaker 1: cultural values of white doctors, leading them to create what
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Speaker 1: was essentially a modern version of drape domania, an illness
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Speaker 1: that was concocted to explain and rationalize why the enslaved
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Speaker 1: would so often flee their masters. So this diagnosis of schizophrenia,
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Speaker 1: it's it's a it's a big flip at this time period,
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Speaker 1: because schizophrenia had previously been associated with people, you know,
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Speaker 1: quiet withdrawn, often middle class white patients. Right, this somehow
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Speaker 1: becomes linked with angry black men protesting racial injustice. Now
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Speaker 1: it sounds convenient for those already empowered. Well, that's that's
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Speaker 1: one way of putting that. So there are thousands of
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Speaker 1: hospital records, psychiatric journals, advertisements for anti psychotic medications. There
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Speaker 1: were newspaper articles and institutional documents to trace how ideas
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Speaker 1: about schizophrenia evolved alongside changing racial politics in America, So
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Speaker 1: medicine strives to be objective humans not so much. Before
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Speaker 1: the nineteen sixties, schizophrenia was commonly portrayed in psychiatric literature
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Speaker 1: as an illness characterized by withdrawal, emotional flatness, passivity, and
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Speaker 1: retreat for reality. Images in medical textbooks often showed anxious
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Speaker 1: white housewives or socially isolated white men. Now, the illness
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Speaker 1: was frightening, certainly, but it wasn't generally portrayed as violent
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Speaker 1: or politically threatening. Then America changed. The civil rights movement
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Speaker 1: gathered momentum. You get sit ins, freedom rights, the March
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Speaker 1: on Washington, You've got up and uprisings, you've got police
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Speaker 1: violence broadcast on national TV, Black Americans demanding rights they'd
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Speaker 1: been promise for generations but consistently denied. And suddenly public
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Speaker 1: discussions about race became saturated with fear. Right, it's also okay, sidebar. Now,
15:44
Speaker 1: if you listened to my history of Coca Cola episode, like, so,
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Speaker 1: coca cola used to have cocaine in it, and it
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Speaker 1: used to be cheap, right, so cheap that anybody could
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Speaker 1: afford it, even black people. And so there was a
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Speaker 1: fear that because of the cocaine in coca cola. The
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Speaker 1: black men were going to drink it and they were
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Speaker 1: going to violently attack white women. Like this was a genuine,
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Speaker 1: a genuine concern, and that is why they removed the
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Speaker 1: cocaine from Coca Cola. So fear there wasn't fear in
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Speaker 1: black communities right like they other was. I mean, they
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Speaker 1: had very good reasons to fear violence from the state.
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Speaker 1: But there was fear amongst white institutions that believed social
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Speaker 1: order itself was under threat. Place would somebody think of
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Speaker 1: the children? So this fear spread to politics, policing, journalism,
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Speaker 1: and popular culture and psychiatry changes to and increasingly psychiatric
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Speaker 1: articles began describing schizophrenia in terms of hostility, aggression, paranoia,
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Speaker 1: and violence, and some research chers explicitly linked these symptoms
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Speaker 1: to black men. Others suggested that the civil rights activism
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Speaker 1: itself reflected paranoid thinking or pathological hostility toward authority, delusional
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Speaker 1: anti whiteness. Now, before anyone starts shopping in pitchforks, you
17:34
Speaker 1: know this is looking at history, looking at history, not
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Speaker 1: psychiatric mental health like as a whole. Now, there were
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Speaker 1: psychiatrists who disagreed with these ideas. At the time, and
17:51
Speaker 1: others just accepting it without questioning it. There'll always be
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Speaker 1: some people who, you know, just take information willy nilly,
18:02
Speaker 1: like people who watch Fox News, and there are some
18:04
Speaker 1: who actually do a loveber research and pay attention. Now, right,
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Speaker 1: American society suddenly began imagining schizophrenia differently, right, and it
18:18
Speaker 1: had surprisingly a little to do with neuroscience and quite
18:22
Speaker 1: a lot to do with the politics of race, fea
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Speaker 1: and pillar in twentieth century America. And to basically understand
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Speaker 1: how schizophrenia became entangled with the race and protest, we
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Speaker 1: have to understand what psychiatrists thought schizophrenia actually was before
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Speaker 1: the Civil rights movement. And the story it doesn't even
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Speaker 1: begin in America. It starts in Europe or a really
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Speaker 1: good past a dish. So at the time of the
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Speaker 1: twentieth century, German psychiatrist Emil Krepelen discovered what you called
19:00
Speaker 1: the dementia precox basically meaning early dementia. He believed it
19:04
Speaker 1: was a disease that emerged in sort of I say,
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Speaker 1: youngin's youths, so adolescents or early adulthood, and it would
19:15
Speaker 1: just inevitably result in mental decline. And it didn't last
19:20
Speaker 1: little because in nineteen eleven, a Swiss psychiatrist, Eugene Brunell
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Speaker 1: argued that Creaplin had been too pessimistic, right, Like, patients
19:31
Speaker 1: didn't always experience this inevitable deterioration, and their symptoms like
19:36
Speaker 1: varied massively. So buler he bueler, bueler, bueler, bluler, listen Swiss,
19:44
Speaker 1: it's hard to say it's full of holes. So he
19:46
Speaker 1: coined a new term, schizophrenia from the Greek words you know,
19:51
Speaker 1: skidzign meaning to split, and friend meaning mind. Contrary to
19:57
Speaker 1: popular culture's favorite misunderstanding, he wasn't describing multiple personalities. He
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Speaker 1: meant like the breaking up, the fragmentation of mental processes, thoughts, emotions,
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Speaker 1: and perceptions. They kind of stopped working together in a
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Speaker 1: coherent way. That being said, this misconception somehow managed to
20:21
Speaker 1: survive for more than a century, and at this point
20:24
Speaker 1: deserves its own frequent fly on miles. So, throughout the
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Speaker 1: first half of the twentieth century, psychiatists genuinely characterized schizophrenia
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Speaker 1: through what today we'd call negative symptoms. So, like I
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Speaker 1: said earlier, patients were described as emotionally withdrawn, socially isolated, passive, apathetic,
20:45
Speaker 1: and detached from reality. They might speak very little, show
20:50
Speaker 1: little fashion expression, appear emotionally flat, retreat from friends and family,
20:55
Speaker 1: spend long periods with their own thoughts. You know, just
21:00
Speaker 1: an introvert caxt least alone. So the dominant image, right,
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Speaker 1: it wasn't one of violence or aggression. It was absence
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Speaker 1: of emotions, social engagement and motivation. Sounds a wee bit
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Speaker 1: like certain flavors of autism, doesn't it. I'm not trying
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Speaker 1: to diagnose anybody. I'm just saying so, if anything, schizophrenia
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Speaker 1: was viewed as an illness of retreat, raveling confrontation. Now
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Speaker 1: this distinction will become important later. American psychiatric textbooks through
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Speaker 1: the nineteen thirties, the forties, and the fifties repeatedly emphasized
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Speaker 1: these characteristics hallucinations and delusions. They did feature in clinical descriptions,
21:50
Speaker 1: but they weren't always considered the defining characteristics as they
21:53
Speaker 1: are today. Instead, it focused heavily on patience, appearing discan
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Speaker 1: from the world around them, and who were these patients?
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Speaker 1: According to psychiatric literature and popular media. More often than not,
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Speaker 1: they were white, not exclusively of gouse. That basically because
22:16
Speaker 1: schizophrenia has never really respected racial boundaries. People of every
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Speaker 1: ethnicity and race have experienced this disorder because ethnicity and
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Speaker 1: race is different. Just feel like like okay, so it
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Speaker 1: is okay, no right, okay, sidebar. It's interesting, right because
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Speaker 1: like the amount that we know about the world in general,
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Speaker 1: the fact that people are still confusing ethnicity, race and
22:45
Speaker 1: nationality like those are different things. And also race is
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Speaker 1: a social construct designed to keep the boot on the
22:55
Speaker 1: neck of the marginalized, but representation metters. The photographs accompanying
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Speaker 1: journal articles, educational materials, and the pharmaceutical advertisements overwhelmingly featured
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Speaker 1: white patients, usually white women. Hospital case studies disproportionately centered
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Speaker 1: on white Americans, and the illness itself became culturally associated
23:27
Speaker 1: with whiteness. Even more specifically, many portrayals focused on middle
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Speaker 1: class white women, so psychiatrical lecture of the day frequently
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Speaker 1: described housewives who had become emotionally detached, withdrawn from family life,
23:47
Speaker 1: or unable to fill domestic roles society expected of them.
23:52
Speaker 1: In the words, just take away seconds, you know, to
23:56
Speaker 1: appreciate just how enthusiastically mid century America responded to women
24:01
Speaker 1: who weren't coping particularly well with the impossible expectations placed
24:05
Speaker 1: upon them, feeling overwhelmed by being expected to be the
24:10
Speaker 1: perfect wife, the perfect mother, the perfect homemaker, impeccably dressed, permanently, cheerful,
24:16
Speaker 1: and somehow fulfilled by waxing the kitchen floor. Well, have
24:22
Speaker 1: you dried sedatives? Right? By the fifties and sixties, doctors
24:28
Speaker 1: were prescribing tranquilizers to women at astonishing rates, drugs like
24:33
Speaker 1: Milltown and Valium. Like these immortalized in the Rolling Stone
24:40
Speaker 1: song Mother's that will helper right and like it was
24:44
Speaker 1: known as Mother's little helper right, and this became the
24:47
Speaker 1: pharmaceutical equivalent of putting a polite smile over systemic problems.
24:54
Speaker 1: Because the message wasn't perhaps society she'd reconsider these impossible expectations.
25:00
Speaker 1: It was more like, have a tablet and try not
25:02
Speaker 1: to make everyone uncomfortable. And if medication didn't seem to
25:07
Speaker 1: be helping well, psychiatrist still had other ideas, lobotomies, particularly
25:14
Speaker 1: again in the forties and fifties. Of the early fifties,
25:18
Speaker 1: these were performed on tens of thousands of Americans. Although
25:22
Speaker 1: they were used for a variety of psychiatric conditions, including
25:26
Speaker 1: civil depression, anxiety disorders, and schizophrenia. Women were disproportionately subjected
25:32
Speaker 1: to the procedure I speak to the fucking brain. Sometimes
25:38
Speaker 1: it was because they were genuinely severely ill, Sometimes because
25:42
Speaker 1: they were considered emotionally unstable, difficult to manage, or simply
25:46
Speaker 1: failed to conform to expectations of femininity. I don't know
25:51
Speaker 1: if you know this, guys, but history does have a
25:56
Speaker 1: habit of confusing noncomplain alliance with pathology, which we will
26:02
Speaker 1: say more later. Now, schizophrenia was one of the conditions
26:08
Speaker 1: for which lobotomies were attempted in some physicians genuinely hoped
26:14
Speaker 1: the operation might relieve otherwise an untreatable psychosis, long before
26:20
Speaker 1: antipsychotic medications existed. Now, by modern standards, the procedure is devastating,
26:26
Speaker 1: often leaving patients profoundly disabled, and it has since become
26:31
Speaker 1: one of the most infamous chapters in psychiatric history. Now,
26:37
Speaker 1: the focus of this isn't that schizophrenia was treating with
26:40
Speaker 1: lobotomies or sedatives like we know that. It's that the
26:44
Speaker 1: image of schizophrenia, like before the Civil rights era, was
26:49
Speaker 1: overwhelmingly domestic. It was the anxious housewife, the withdrawn daughter,
26:55
Speaker 1: the emotionally distant women who no longer fit neatly into
26:58
Speaker 1: society's expectations. Good thing we've done all that research on
27:03
Speaker 1: women's health now, Good thing we know all about postpartum
27:07
Speaker 1: depression and menopause and all that research we've done and
27:11
Speaker 1: to endometriosis and everything that's been done. Right again, we're
27:16
Speaker 1: still focusing on white women women like POC, like they've
27:23
Speaker 1: had it much harder, Like it's just worse. An advocacy
27:27
Speaker 1: is listen, okay, I'm just I'm getting angry now, So
27:31
Speaker 1: let's not effectively the stereotype of the dangerous schizophrenic had
27:35
Speaker 1: yet to take central stage, and that would come later.
27:38
Speaker 1: And it wasn't an accident. See it's not that women
27:45
Speaker 1: were actually more likely to develop schizophrenia than men, because
27:49
Speaker 1: research suggests condition affects both sexes a broadly similar rate.
27:54
Speaker 1: Those symptoms and age of they can differ, right. Rather,
28:01
Speaker 1: it reflects who psychiatrists noticed, who sought treatment, who had
28:07
Speaker 1: access to hospitals, and whose stories medical institutions chose to document. Medicine.
28:15
Speaker 1: Quite like photography always depended on where the cameras pointed,
28:20
Speaker 1: and for much of early twentieth century, the camera was
28:23
Speaker 1: pointed firmly ad White America. I know you're shocked. Shocked.
28:30
Speaker 1: State Psychiatric hospitals in the first half of the twentieth
28:33
Speaker 1: century where enormous places. By the forties and fifties, many
28:40
Speaker 1: housed thousands of patients, often in overcrounded conditions. They served
28:45
Speaker 1: as treatment centers, but they also functioned as long term
28:50
Speaker 1: custodial institutions. Like people didn't stay for weeks, they often
28:55
Speaker 1: stayed for years, and they suffered because treatments I'm gonna
29:03
Speaker 1: say a bit barbaric. They ranged from occupational therapy and
29:08
Speaker 1: psychotherapy to insulin comma therapy, electro convulsive therapy, and of
29:14
Speaker 1: course lobotomys. Antipsychotic medication wouldn't become widely available until the
29:20
Speaker 1: mid nineteen fifties. Now, World War Two had a big
29:23
Speaker 1: effect on this as well. So you have this society
29:29
Speaker 1: where men of you know, races, religions, you know, society, cultural,
29:37
Speaker 1: they're all going to war. There's conscription, there's all of this,
29:42
Speaker 1: and televisions and radio communication is is vast, and so
29:48
Speaker 1: people are learning things. More communication is shared and people
29:52
Speaker 1: are understanding that you can rise up, you can fight,
29:56
Speaker 1: you can grow and evolve and get rights, and and
30:01
Speaker 1: women took a lot of jobs and helped industry survive
30:04
Speaker 1: during the Second World War and the first. But after
30:09
Speaker 1: which you know, they're getting all these rights, and they're
30:11
Speaker 1: told they can get educated and they can do A,
30:13
Speaker 1: B and C, and then they're pushed back into this role.
30:18
Speaker 1: And just like Black America, they were expected to fight
30:23
Speaker 1: for their country, but weren't expected to have rights in
30:27
Speaker 1: that country, which is like you can die for the country,
30:33
Speaker 1: or you're not allowed to vote, Like what fucking bullshit
30:37
Speaker 1: is this? So much of psychiatric care, right it consisted
30:48
Speaker 1: of observation, management, and containment, not really recovery. And these
30:53
Speaker 1: hospitals reflected basically the broader inequalities in American society. Segregation
30:59
Speaker 1: and side psychiatric institutions, it existed just as it existed
31:06
Speaker 1: outside them. Black patients were frequently treated in separate wards,
31:11
Speaker 1: admitted to underfunded hospitals, or just denied access to facilities
31:15
Speaker 1: available to white patients. Resources were unequal, conditions were unequal.
31:22
Speaker 1: Even medical records often differed in the level of detail
31:26
Speaker 1: physicians recorded. So while schizophrenia was culturally imagined as a
31:32
Speaker 1: disease of white withdrawal. Black Americans with serious mental illnesses
31:37
Speaker 1: certainly existed within the psychiatric system, they just went on
31:41
Speaker 1: the face of the diagnosis, at least not yet, because
31:47
Speaker 1: over the next two decades, as the Civil rights movement
31:50
Speaker 1: transformed American society, psychiatry's image of schizophrenia would undergo a
31:56
Speaker 1: remarkable and troubling transformation. The biology of the illness hadn't changed,
32:02
Speaker 1: the patients hadn't suddenly become different, but the stories America
32:09
Speaker 1: told about schizophrenia were about to change dramatically. By the
32:23
Speaker 1: late fifties, America was changing. Now you know what, changing
32:27
Speaker 1: is a bit too gentle of a word, because it
32:30
Speaker 1: was being forced to confront contradictions and had spent generations
32:34
Speaker 1: pretending either doesn't exist or weren't quite as bad as
32:37
Speaker 1: everyone was making out. It was, after all, the self
32:40
Speaker 1: proclaimed leader of the free world, the nation that had
32:44
Speaker 1: defeated fascism, the beacon of democracy, the country telling the
32:50
Speaker 1: Soviet Union about the importance of liberty, all while millions
32:54
Speaker 1: of its own citizens were legally segregated because of the
32:58
Speaker 1: color of the skin, and this contradiction was becoming more
33:05
Speaker 1: and more difficult to explain away. And like Okay, the
33:10
Speaker 1: civil rights movement. It didn't just appear overnight. Black Americans
33:15
Speaker 1: had resisted racial oppression for centuries, but during the nineteen
33:21
Speaker 1: fifties and nineteen sixties that resistance became impossible for much
33:27
Speaker 1: of white America to ignore it. In nineteen fifty four,
33:31
Speaker 1: the Supreme Court ruled in Brownbee Board of Education that
33:34
Speaker 1: racial segregation in public schools was unconstitutional. A year later
33:40
Speaker 1: came the Montgomery bus boycott. And this is all sparked
33:44
Speaker 1: by Rosa Park's refusal to suppender her seat. Now, side bark,
33:49
Speaker 1: the story about Rosa Parks are like, oh, if you're retired,
33:52
Speaker 1: I don't want to sit down. No, she was a
33:53
Speaker 1: political activist and she chose to do that, right, she
34:00
Speaker 1: was always going to stand up. Now, sit ins followed,
34:05
Speaker 1: freedom rides, challenged, segregated into state travel. You had students marches,
34:11
Speaker 1: you had churches they were organizing, You had communities that
34:14
Speaker 1: were mobilized. And television cameras captured it all. And this
34:21
Speaker 1: is the thing. Perhaps for the first time, millions of
34:25
Speaker 1: white Americans watched peaceful demonstrators being attacked with police docs,
34:31
Speaker 1: blasted with fire hoses, beaten by officers, and arrested for
34:36
Speaker 1: simply demanding rights they had supposedly possessed all along. Because
34:41
Speaker 1: the civil rights movement was not about creating ajustice, it
34:45
Speaker 1: was about exposing it. And that is an important distinction,
34:50
Speaker 1: because while many Americans watched these events with sympathy, as
34:53
Speaker 1: did the rest of the fucking world, others saw something
34:58
Speaker 1: really different. You know, they say that beauty is in
35:02
Speaker 1: the eye of beholder. Also is everything, because your perception
35:06
Speaker 1: on how you see the world will reflect on how
35:10
Speaker 1: you think about it. Because some people didn't see people
35:16
Speaker 1: standing up for themselves, those with the boot upon their neck. Instead,
35:23
Speaker 1: they saw disorder, disruption, and authority being challenged and for
35:28
Speaker 1: institutions built upon maintaining social order. That was unsettling, to
35:35
Speaker 1: say the least. Now, after which came the urban uprisings.
35:41
Speaker 1: Because starting and around was at the mid nineteen sixties,
35:44
Speaker 1: cities across the United States experienced outbreaks of violence following
35:51
Speaker 1: decades and I do mean decades of police brutality, discrimination, unemployment,
35:57
Speaker 1: per housing, and systemic neglect. Harlem, What's Newark, Detroit like.
36:04
Speaker 1: More than one hundred cities experienced significant unrest during what
36:09
Speaker 1: newspapers increasingly described as race riots because it wasn't a
36:17
Speaker 1: race riot. It's like we still use it today, and
36:20
Speaker 1: sometimes I'll use it to name something so that people
36:23
Speaker 1: know what I'm talking about, and then I'll go and
36:25
Speaker 1: explain it because it's not a race riot. It's a rebellion.
36:29
Speaker 1: It's an urban uprising. Because these events didn't just pop
36:34
Speaker 1: it in a well. There weren't random explosions of chaos.
36:38
Speaker 1: There were responses to inequalities and repeated confrontation with polace
36:44
Speaker 1: and local authorities. Now that doesn't mean that every act
36:47
Speaker 1: of violence is justified, right, we know that, Okay, don't
36:52
Speaker 1: place hilly buggers with us. People died, homes and businesses
36:57
Speaker 1: were destroyed, in an entire neighborhood suffered. There was room
37:03
Speaker 1: to acknowledge both the structural injustices that fueled these uprising
37:06
Speaker 1: and the very real human they imposed. You can't make
37:11
Speaker 1: an omelet without breaking X. Understanding why something happened is
37:17
Speaker 1: not the same as excusing like everything. So as the
37:21
Speaker 1: decades were on, the atmosphere became more volatile. In sixty three,
37:28
Speaker 1: John F. Kennedy was assassinated. In sixty five, Malcolm X
37:33
Speaker 1: was murdered. In sixty eight, Martin Luther King Junior was
37:39
Speaker 1: assassinated in Just two months later, Robert F. Kennedy was
37:45
Speaker 1: shot while campaigning for the presidency. Now against this backdrop,
37:51
Speaker 1: a new generation of activists began questioning whether nonviolent protest
37:55
Speaker 1: alone could achieve lasting change. The Black movement emerged as
38:01
Speaker 1: a broad political and cultural movement, emphasizing self determination, economic empowerment,
38:07
Speaker 1: and community control. Like people are so focused on, oh,
38:14
Speaker 1: it was a militia that they completely ignore. The Black
38:20
Speaker 1: Panther Party established free breakfast programs, health clinics, educational initiatives,
38:25
Speaker 1: ah while openly advocating armed self defense against police violence.
38:31
Speaker 1: Pretty sure that's in the first is at the second Amendment?
38:34
Speaker 1: The second Amendment, I'm sorry, you have a right to
38:38
Speaker 1: a will armed militia. Well, there you fucking go, lads.
38:43
Speaker 1: Supporters saw dignity, empowerment, and protection, and critics often saw militancy.
38:51
Speaker 1: The media, unsurprisingly tended to find the photographs of young
38:55
Speaker 1: black men carrying rifles considerably a bit more eye catching
38:59
Speaker 1: than the pictures of children eating free breakfasts. Because conflict sells,
39:06
Speaker 1: new ones always struggle to compete. But for many white Americans,
39:10
Speaker 1: these overlapping crises created an overwhelming self that the country
39:15
Speaker 1: was losing control. Oh, we want to get back to
39:17
Speaker 1: the good old days. Public opinion poems throughout the late
39:22
Speaker 1: sixties showed rising concern about crime, protest, and civil disorder.
39:28
Speaker 1: Politicians increasingly campaigned with the promises of restoring law and order.
39:33
Speaker 1: Newspapers filled their front pages with images of burning buildings,
39:36
Speaker 1: armed protesters, and confrontations between demonstrators and police. Fear became
39:42
Speaker 1: part of everyday political conversation, and fear has a remarkable
39:49
Speaker 1: ability to shape the way societies interpret what they see.
39:55
Speaker 1: An angry black activist demanding equal rights, a young man
39:59
Speaker 1: con fronting police officers, someone expressing distrust of government institutions.
40:07
Speaker 1: Right all, Oh this right today, we'd ask you know
40:13
Speaker 1: what led them to those beliefs. But back in the
40:17
Speaker 1: very tense political climate of the nineteen sixties, some people,
40:21
Speaker 1: including psychiatrists, began asking a very different question. What if
40:27
Speaker 1: this wasn't simply political anger? What if it was a symptom? Right?
40:32
Speaker 1: And this would profoundly reshape the way schizophrenia was described, diagnosed,
40:38
Speaker 1: and understood in America, not because the illness itself had changed,
40:41
Speaker 1: but because America had now If the story ended with
40:46
Speaker 1: growing social anxiety. It would already be an uncomfortable chapter
40:50
Speaker 1: in American history. But it didn't end there because those
40:54
Speaker 1: anxieties seeped into medicine, and not through one single conspiracy,
41:00
Speaker 1: not because psychiatrists gabled and you know, smoke filled Room's
41:05
Speaker 1: plot and to redefine it. It happened gradually, one journal article,
41:12
Speaker 1: one revised diagnostic description, a hospital case, report of pharmaceutical advertisements,
41:18
Speaker 1: right one by one, and over the course of the sixties,
41:26
Speaker 1: the public image of schizophrenia had changed almost beyond recognition. Now,
41:33
Speaker 1: if the idea of protest being treated as a symptom
41:36
Speaker 1: sounds unbelievable, allow me to introduce one of medicine's all
41:41
Speaker 1: time worst takes. In eighteen fifty one, American physician doctor
41:47
Speaker 1: Samuel A. Cartwright coined the term drape to mania, in
41:52
Speaker 1: which he claimed it was a mental illness causing enslaved
41:57
Speaker 1: people to run away from their enslavers. Yes, you had
42:02
Speaker 1: that correctly. Instead of maybe considering that people fled slavery
42:09
Speaker 1: because it was slavery, Cortwright suggested the desire for freedom
42:14
Speaker 1: itself was pathological. Sometimes gentle listeners history well hand as
42:25
Speaker 1: an example of something so absurd that satire really becomes unnecessary. Now,
42:34
Speaker 1: uptomania was never accepted as a legitimate scientific diagnosis outside
42:39
Speaker 1: of a outside a small circle of pro slavery physicians,
42:44
Speaker 1: and today it is universally acknowledged as pseudoscience rated in
42:47
Speaker 1: racism rather than medicine, or as I like to call it,
42:51
Speaker 1: absolute bollocks. But it is an important reminder that medicine
42:56
Speaker 1: has at times been used to defend existing power structures
42:59
Speaker 1: and instead of questioning them. Because when oppression is treated
43:05
Speaker 1: as normal, resistance can begin to look like illness. It's
43:12
Speaker 1: kind of like, how I'm going to talk about it?
43:14
Speaker 1: You Now, Everyone's like, movies are so sidebar, movies are
43:17
Speaker 1: so woke. Now, oh my god, I can't believe they
43:20
Speaker 1: have an Asian man in the Odyssey. And it's like
43:24
Speaker 1: that the ancient people who were known to travel and trade,
43:30
Speaker 1: and you're surprised that one Asian person appeared in Greece. Really,
43:40
Speaker 1: we know people traveled, okay, we know. It's like, oh, yes,
43:47
Speaker 1: everyone just stuck within their own ethnically homogeneous groups, like
43:52
Speaker 1: no one ever went anywhere before fourteen ninety two. Get
43:56
Speaker 1: ta fuck pow, Like like this is such a wild thing.
44:02
Speaker 1: It's it's like white people because they've we've been part
44:09
Speaker 1: of the narrative for so long, and white men especially
44:12
Speaker 1: have controlled the narrative that they see themselves as the default.
44:16
Speaker 1: So whenever our character was not a straight white man,
44:19
Speaker 1: it's often like seen as woke or odd or peculiar
44:24
Speaker 1: or just some nonsense. And anything other than straight white
44:28
Speaker 1: man is odd, unusual, different, it's not the standard, you know,
44:34
Speaker 1: and it's so wild, like they just see themselves as
44:38
Speaker 1: the default setting and not like okay, another sidebar. So
44:47
Speaker 1: when I was studying history and so sociology, like I
44:50
Speaker 1: studied a lot of it in the UK, and in
44:53
Speaker 1: the UK right, we were told don't use POC people
44:56
Speaker 1: of color, you use bab b ame, which is Black,
45:00
Speaker 1: Asian and other minority ethnicities. Now that term is now
45:05
Speaker 1: I'm gonna say, gone out of fashion because it's yeah.
45:10
Speaker 1: So the other option is the global ethnic majority, because
45:16
Speaker 1: white people are not the global ethnic majority, You're not.
45:22
Speaker 1: So the fact that white people see themselves as the
45:25
Speaker 1: default is very very funny, especially from a nation who
45:32
Speaker 1: lives on stolen land, you know. So while protest psychosis
45:37
Speaker 1: and dreup to mania emerged in very different centuries and
45:40
Speaker 1: not of very different circumstances. They share an uncomfortable family resemblance,
45:46
Speaker 1: and both asked the wrong question because they didn't ask
45:49
Speaker 1: why are these people resisting? Instead they asked what must
45:54
Speaker 1: be wrong with them? Because to understand their shift, we
45:58
Speaker 1: need to talk about the Dieg Gnostic and Statistical Manual
46:01
Speaker 1: of Mental Disorders otherwise known as the DSM just basically
46:05
Speaker 1: psychiatry's real book, which, for the record, thid bar Stockholm
46:11
Speaker 1: syndrome isn't in their Stockholm syndrome isn't real. You're confusing
46:15
Speaker 1: that with several other different things that have been shoved
46:18
Speaker 1: under the one umbrella instead of I'm not gonna say okay,
46:21
Speaker 1: no no. Listen to the Stockholm syndrome episode if you
46:24
Speaker 1: want to hear me rant about that. But the DSM
46:29
Speaker 1: doesn't define diseases in the biological sense, right. It provides
46:33
Speaker 1: clinicians with agreed descriptions of symptoms, helping doctors diagnose patients consistently.
46:40
Speaker 1: The first edition the DSM one was published in nineteen
46:42
Speaker 1: fifty two, and now by modern standards it is brief.
46:48
Speaker 1: It reflected the influence of psychoanalytic thinking, and it's often
46:51
Speaker 1: described mental illnesses and broad rather subjective language, and schizophrenia
46:57
Speaker 1: was largely characterized by disturbances and things thinking, emotional withdrawal,
47:01
Speaker 1: disordered relationships with reality, and what psychiatrists called autistic thinking,
47:08
Speaker 1: a historical psychiatric term referring to withdrawal into one's inner world,
47:13
Speaker 1: which is not autism spectrum disorder as we understand it today.
47:18
Speaker 1: The emphasis remained largely on withdrawal, detachment, emotional distance, and
47:22
Speaker 1: patients turning inward, But by nineteen sixty eight the DSM
47:27
Speaker 1: two arrived. The manual still wasn't a checklist in the
47:31
Speaker 1: way later editions would become, but the language surrounding schizophrenia
47:36
Speaker 1: had noticeably shift. Descriptions increasingly highlighted hostility, aggression, suspiciousness, belligerence,
47:44
Speaker 1: paranoid thinking. Patients were more frequently described as argumentative, combative,
47:49
Speaker 1: and hostile towards authority figure. Now to be absolutely fair,
47:56
Speaker 1: many people experiencing paranoid schizophrenia can develop persecutory delusions involving governments,
48:03
Speaker 1: police neighbors, or authority figures. Modern psychiatry does recognize this
48:09
Speaker 1: as one possible manifestation of psychosis. The issue was that
48:16
Speaker 1: psychiatrists won't describing paranoia, The issue was whose paranoia they
48:24
Speaker 1: were increasingly choosing to describe, because by the late sixties,
48:30
Speaker 1: examples of suspiciousness toward authority were appearing in and in America,
48:36
Speaker 1: where black citizens had a very good reason to distrust authority.
48:42
Speaker 1: The FBI was monitoring civil rights organizations, police brutality was widespread,
48:49
Speaker 1: and government agencies were infiltrating activist groups. In reality had
48:56
Speaker 1: become rather inconvenient for symplastic psychiatric assumptions. So like in
49:03
Speaker 1: psychiatric journals, right articles published during the late sixties began
49:08
Speaker 1: presenting patients who claimed to be members of militant organizations,
49:12
Speaker 1: believed they possessed revolutionary missions, or expressed intense hostility towards
49:17
Speaker 1: white authority figures. Some papers explicitly linked schizophrenia with what
49:23
Speaker 1: psychiatrists described as anti white hostility, militant political beliefs, or
49:30
Speaker 1: delusional anti whiteness. Now, psychotic delusions frequently incorporate contemporary events. Right,
49:39
Speaker 1: someone experienced psychosis today might believe they are being monitored
49:42
Speaker 1: through social media or artificial intelligence because those are familiar
49:47
Speaker 1: cultural reference points. A century ago, those same delusions might
49:53
Speaker 1: have involved radio waves or secret societies, So the appearance
49:57
Speaker 1: of civil rights themes in psycho wasn't that surprising. The
50:03
Speaker 1: troubling is is why psychiatric literature increasingly appeared to treat
50:08
Speaker 1: black political anger itself as evidence of illness, rather than
50:13
Speaker 1: distinguishing between legitimate political grievances and genuine psychotic symptoms. Those
50:18
Speaker 1: are two very different things, and medicine blurred that distinction
50:23
Speaker 1: even more than we'd like to admit. Perhaps the most
50:28
Speaker 1: visually striking evidence comes not from medical journals, but from advertising.
50:34
Speaker 1: Throughout the nineteen fifties, advertisements for psychiatric medications generally depicted
50:38
Speaker 1: quiet patient withdrawn women, despondent families, individuals isolated by sadness
50:45
Speaker 1: or emotional detachment. And then came this sixties. Advertisements produced
50:51
Speaker 1: by pharmaceutical companies published in respected medical journals aimed at
50:58
Speaker 1: psychiatrists looking dramatically different. Gone all the housewives instead, Doctors
51:08
Speaker 1: were shown illustrations and photographs of angry black men with
51:12
Speaker 1: confrontational body language, clenched jaws and raised fitss, and sometimes
51:18
Speaker 1: they explicitly connected schizophrenia with violence, riots, or social unrest.
51:25
Speaker 1: Others used imagery, you know, weirdly reminiscent of the racial tensions,
51:32
Speaker 1: dominating American headlines. Several featured black men whose expressions and
51:38
Speaker 1: poses widely circulated news photographs of protests and urban uprisings.
51:44
Speaker 1: And remember these adverts, they're not aimed at the public,
51:47
Speaker 1: but aimed at the doctors. Because this is where it changes,
51:52
Speaker 1: because schizophrenia is no longer passive, it's dangerous, and increasingly
51:59
Speaker 1: schizophrenia looked black now. Pharmaceutical advertisements are marketing materials, not
52:07
Speaker 1: scientific documents. They don't tell us how every psychiatrist thought.
52:12
Speaker 1: Not do they prove that every doctor accepted these stereotypes.
52:15
Speaker 1: But what they do reveal is advertising works by appealing
52:19
Speaker 1: to assumptions its audience already recognizes because marketers don't invent
52:25
Speaker 1: anxieties at ethanel, that's what Fox News does. Fuck, I
52:29
Speaker 1: don't mean to Fox News twice. Can't do it a
52:32
Speaker 1: third time. We'll find out if pharmaceutical companies believed images
52:37
Speaker 1: of angry black men would resonate with psychiatrists in the
52:39
Speaker 1: late nineteen sixties. That tells us something uncomfortable about the
52:43
Speaker 1: cultural landscape in which medicine was operating. They reflected racial
52:48
Speaker 1: stereotypes that were already circulating through American society and reinforce them,
52:54
Speaker 1: and by the end of the decade, the transformation was remarkable.
53:00
Speaker 1: Diagnosis associated with quiet withdrawal had become associated with confrontation,
53:08
Speaker 1: one represented by white, middle class women, was increasingly represented
53:13
Speaker 1: by black men. Biology hadn't changed, the brain hadn't changed,
53:18
Speaker 1: but America m its imagination had. And when cultural imagination
53:25
Speaker 1: begins influencing medical judgment, consequences don't exactly remain confined textbooks,
53:34
Speaker 1: because these ideas weren't just appearing in journals and advertisements.
53:38
Speaker 1: They were shaping real diagnoses affecting real patients admitted to
53:43
Speaker 1: real psychiatric hospitals. Now it's tempting to just file this
53:50
Speaker 1: neatly under wit. Thank goodness, we've moved up, because history
53:55
Speaker 1: was probably a bit more comfortable if that was true.
53:57
Speaker 1: But history does have that annoying habit of lingering, not
54:04
Speaker 1: in obvious ways, sometimes in institutions, sometimes in statistics, sometimes
54:12
Speaker 1: in memories passed quietly from one generation to the next.
54:16
Speaker 1: And nowhere is that perhaps more evident than in the
54:20
Speaker 1: relationship between black communities and the American healthcare system, because
54:25
Speaker 1: one of the last in consequences of this is distrust.
54:29
Speaker 1: Now you often hear people talk about distrust of medicine
54:32
Speaker 1: and Black communities as though it appealed it in no well,
54:35
Speaker 1: as though someone woke up one morning and just decided
54:39
Speaker 1: doc just can't be trusted, because that's not how this works,
54:43
Speaker 1: because trust is built on experience and mistrust is built
54:49
Speaker 1: the same way. And for many Black Americans, medicine isn't
54:53
Speaker 1: just associated with healing, it's associated with segregation. The Tuskegees
55:00
Speaker 1: the study for sterilization, medical experimentation without consent, And as
55:06
Speaker 1: we've explored throughout, I mean, if you go listen to
55:11
Speaker 1: the Black History Month series, periods when psychiatry interpreted, you know,
55:16
Speaker 1: responses to racism through the language of pathology doesn't mean
55:22
Speaker 1: that every doctor was racist. It doesn't mean that psychiatry
55:26
Speaker 1: is like uniquely flawed. It means that institutions are shaped
55:30
Speaker 1: by the societies in which they exist, because if a
55:33
Speaker 1: society carries prejudice, that's going to bleed into the institutions too.
55:39
Speaker 1: And the protest psychosis isn't just like one outdated psychiatric theory.
55:45
Speaker 1: It opened the door to decades of research examining how
55:48
Speaker 1: unconscious bias can influence diagnoses. Black patients are more likely
55:54
Speaker 1: than white patients presenting with similar symptoms to receive diagnoses
55:58
Speaker 1: of schizophrenia or psychotic disorders, while white patients are more
56:02
Speaker 1: likely to receive diagnoses such as mood disorders, including major
56:08
Speaker 1: depression or bipolar disorder when psychotic symptoms are present. Doesn't
56:13
Speaker 1: mean that every diagnosis incorrect or that you know it's
56:17
Speaker 1: over diagnosed in every black patient, because mental illness is complex,
56:24
Speaker 1: and it does suggest, though, that cultural assumptions influence this.
56:34
Speaker 1: So imagine two patients. They're basically saying the same thing.
56:38
Speaker 1: People in authority are watching me, right, and for one
56:43
Speaker 1: they might hear like the doctor might hear paranoia, and
56:46
Speaker 1: for another they might hear anxiety. Right now, you'd hope
56:51
Speaker 1: that the doctor would do, you know, ask a couple
56:55
Speaker 1: questions about previous experiences with authority, like placing your discrimination
56:59
Speaker 1: before or like making conclusions, But sometimes they don't. So
57:06
Speaker 1: removing contexts can basically change the meaning of what someone says.
57:13
Speaker 1: So modern psychiatry it emphasizes cultural competence. Right, you're supposed
57:20
Speaker 1: to have culturally informed or culture responsive care because basically
57:26
Speaker 1: sidebar deciding whether a belief is evidence of psychosis, doctors
57:31
Speaker 1: should ask whether that belief makes sense within the person's cultural, historical,
57:36
Speaker 1: or lived experience, because if someone comes from a community
57:39
Speaker 1: with a long history of discrimination, mistrust of institutions, right,
57:44
Speaker 1: isn't irrational. If someone has experienced racial profiling, concerns about
57:50
Speaker 1: future encounters with police also not irrational. It's not automatically paranoia.
57:58
Speaker 1: So context is is relevant and understanding context doesn't prevent
58:04
Speaker 1: doctors from diagnosing when it's genuinely present, right, It just
58:08
Speaker 1: helps them distinguish between illness and experience. Now, if you
58:16
Speaker 1: are listening during b IPOC, I can't want to call
58:19
Speaker 1: it bipop is that I don't know if that's right, wrong,
58:21
Speaker 1: It's it's a mental health awareness one month, BIPOC mentally
58:26
Speaker 1: health awareness a month. And so this history is really important,
58:29
Speaker 1: which is why this is a bit different to a
58:32
Speaker 1: few other things that I've done. This is very a
58:36
Speaker 1: very psychiatry leaden episode. I don't talk about it a lot,
58:41
Speaker 1: but so when I was in college. But my main
58:45
Speaker 1: areas of focus are history and sociology. But I do
58:48
Speaker 1: have a supplemental background in psychology and social geography because
58:53
Speaker 1: it's all interlinked. And so this is why this is
58:59
Speaker 1: some thing I really I wanted to talk about because
59:02
Speaker 1: this is the perfect time to do it. And I
59:05
Speaker 1: understand that this is Oh god, it's a very dense
59:11
Speaker 1: episode as opposed to this happened and then that happened,
59:15
Speaker 1: and then the other happened. But it's important and I
59:18
Speaker 1: was making this episode, so yeah. This month, BIPOC Mental
59:26
Speaker 1: Health Awareness Month was established in the US to highlight
59:30
Speaker 1: the mental health experiences of Black, Indigenous, and other peoples
59:34
Speaker 1: of color. It's not just about increasing access to therapy
59:39
Speaker 1: or encourage conversations about well being. It's part of it,
59:42
Speaker 1: but it's about acknowledging history because people don't seek treatment
59:47
Speaker 1: in a historical vacuum, and understanding why some communities distrust
59:52
Speaker 1: mental health institutions. Isn't about assigning blame to today's doctors,
59:58
Speaker 1: most psychiatrists, psychology some mental health professionals like most are
1:00:03
Speaker 1: committed to providing ethical, evidence based care, but they have
1:00:08
Speaker 1: to know that that trust has to be earned. Now.
1:00:17
Speaker 1: Doctors don't stop being members of society when they put
1:00:20
Speaker 1: on a white coat. Scientific progress doesn't happen in isolation
1:00:25
Speaker 1: from politics, culture, or prejudice, and researchers don't lay the
1:00:30
Speaker 1: assumptions at the lab door right, and diagnostic manuals right,
1:00:37
Speaker 1: they're not. They're not gifts from fucking God. Right. They're
1:00:40
Speaker 1: not like chiseled in stone tablets provided by the heavens.
1:00:47
Speaker 1: They're written by people, which means they can improve, they
1:00:50
Speaker 1: can be corrected, and they can also be wrong. Right now,
1:00:58
Speaker 1: today's psychiatry very little resemblance to the field that I've
1:01:03
Speaker 1: been describing of this episode. Diagnostic criteria has evolved, right,
1:01:09
Speaker 1: it's gotten better, But clinicians are also really aware of
1:01:17
Speaker 1: the ways bias can influence medical decision making. And I'm gonna, Okay,
1:01:23
Speaker 1: I'm gonna throw some stats at you now because it's important.
1:01:28
Speaker 1: Black patients are more likely to report not being believed,
1:01:32
Speaker 1: and we see cases like this all the time. Twenty
1:01:36
Speaker 1: two percent of black adults report that a healthcare provider
1:01:38
Speaker 1: did not believe they were telling the truth. Nineteen percent
1:01:41
Speaker 1: say provider refused to test or treatment that they believe
1:01:45
Speaker 1: they needed, eighteen percent report being refused pain medication, and overall,
1:01:52
Speaker 1: thirty six percent of black adults say that there was
1:01:54
Speaker 1: a time they believed they would have received better medical
1:01:57
Speaker 1: care if they were a different race. One in four
1:02:02
Speaker 1: black adults report race related discrimination while receiving health care.
1:02:08
Speaker 1: Negative health care experiences made patients delay seeking care, switch providers,
1:02:14
Speaker 1: or avoid healthcare altogether. And perhaps what was probably the
1:02:20
Speaker 1: clearest example of what happens when patients are not listened
1:02:23
Speaker 1: to is maternal health care. Black women in the United
1:02:27
Speaker 1: States were three and a half times more likely to
1:02:29
Speaker 1: die from pregnancy related causes than white women. They had
1:02:34
Speaker 1: around five times the mortality rate from preeclamsia. They had
1:02:39
Speaker 1: six times the risk of dying from postpartum cardiomyopathy. This
1:02:44
Speaker 1: is still happening. This is still happening today. Research consistently
1:02:51
Speaker 1: finds that Black Americans are more likely to receive a
1:02:54
Speaker 1: diagnosis of schizophrenia, while white patients presenting with similar effective
1:02:58
Speaker 1: symptoms are more likely to receive the diagnosis of the
1:03:02
Speaker 1: mood disorders. Now, this disparity has been documented across decades
1:03:08
Speaker 1: of psychiatric research and continues to be an area of
1:03:12
Speaker 1: active investigation. Now, that's a peculiar tradition in American history.
1:03:18
Speaker 1: Where large numbers of people begin asking convenient questions, someone
1:03:23
Speaker 1: eventually suggests they're not merely wrong, but mentally ill, and
1:03:29
Speaker 1: so the protest psychosis enter droup dumania. Now Protest psychosis
1:03:38
Speaker 1: was never a legitimate psychiatric diagnosis. It was, however, a
1:03:43
Speaker 1: disturbingly influential idea that emerged in the late twentieth centuries. Psychiatrists,
1:03:49
Speaker 1: law enforcement, and broader social anxieties overlapped, and during the
1:03:57
Speaker 1: Civil Rights movement, research has proposed that black men involved
1:04:00
Speaker 1: in protests and activism were more likely to develop paranoid schizophrenia.
1:04:07
Speaker 1: Now this logic is circular, right, It is wow, Like,
1:04:17
Speaker 1: if you believed the state were surveying, targeting, or oppressing
1:04:22
Speaker 1: Black Americans, perhaps you were the one suffering from delusions. History,
1:04:29
Speaker 1: of course, delivered one of its favorites plot twists. The
1:04:36
Speaker 1: FBI really was surveying civil rights leaders. Quental pro really
1:04:43
Speaker 1: did exist, Martin Luther King Junior really was? Why are tapped?
1:04:49
Speaker 1: Turns out, accurately identifying institutional racism is not, in fact
1:04:54
Speaker 1: a symptom of psychosis. How embarrassing for the diagnostic and
1:05:02
Speaker 1: this idea of protest psychosis reflected something far more revealing
1:05:07
Speaker 1: than any patient's mental state. It shows a society uncomfortable
1:05:12
Speaker 1: with protests and is willing to medicalize political dissent rather
1:05:17
Speaker 1: than confront the injustice is inspiring. It if someone is
1:05:21
Speaker 1: angry because they're denied equal rights, perhaps the problem isn't
1:05:25
Speaker 1: the anger. Perhaps possibly it is the denial of rights.
1:05:33
Speaker 1: Now again to confirm, to clarify, this is not to
1:05:36
Speaker 1: dismiss schizophrenia and other severe mental illnesses. They are serious
1:05:41
Speaker 1: medical conditions affecting millions of people, and they deserve evidence
1:05:46
Speaker 1: based treatment, free from political interference in social stigma. The
1:05:52
Speaker 1: tragedy is that psychiatric language, which is intended to help patients,
1:05:56
Speaker 1: is instead weaponized to undermine activists and re force existing
1:06:01
Speaker 1: power struggles. Good thing they don't have that today. Medicine
1:06:07
Speaker 1: is not immune to prejudice. Psychiatry, like every scientific discipline,
1:06:12
Speaker 1: exists within society that produces it, and diagnoses have historically
1:06:18
Speaker 1: reflected cultural assumptions, is much as clinical observation. We like, jeez,
1:06:27
Speaker 1: homosexuality remained classified as a mental disorder in the DSM.
1:06:34
Speaker 1: That's right, the Diagnostic and Statistical Manual of Mental Disorders
1:06:38
Speaker 1: until nineteen seventy three. Right, Like how easy social discomfort
1:06:47
Speaker 1: masquerades as medical certainty. Now, the lesson here isn't psychiatry
1:06:54
Speaker 1: is inherently suspect. Science works best when it questions it
1:07:00
Speaker 1: self as rigorously as it questions its subjects, because like
1:07:05
Speaker 1: if a diagnostic manual start sounding, you know, like an
1:07:07
Speaker 1: editorial in favor of the status quo, might be time
1:07:11
Speaker 1: to review the methodology. That's a thing like protesting injustice
1:07:19
Speaker 1: is not evidence of mental illness, it's not. It's making
1:07:26
Speaker 1: demands for equality as symptoms of disease. Like that's that's
1:07:30
Speaker 1: a pathology history has diagnosed quite harshly, and like and
1:07:37
Speaker 1: when we talk about mental illness, when we talk about
1:07:42
Speaker 1: it properly, you know, it's still seen with disdain. There's
1:07:51
Speaker 1: there's a stigma still with it, so not only within
1:07:54
Speaker 1: society as a whole, but especially within marginalized communities, because
1:08:01
Speaker 1: black communities are always treated harsher than a white community. Right,
1:08:06
Speaker 1: it's consistent. And I'm a white person, I'm privileged. Right,
1:08:12
Speaker 1: i might be a woman, but I'm still a Mao sapien,
1:08:16
Speaker 1: which puts me in a praise of privilege. And I
1:08:17
Speaker 1: think people like me especially need to check our privilege
1:08:21
Speaker 1: at the fucking door, you know, and actually look at
1:08:25
Speaker 1: what's happening around us and need to learn to be uncomfortable.
1:08:30
Speaker 1: I need to learn to do without in order to
1:08:32
Speaker 1: help others and I think that's a big thing. Again,
1:08:36
Speaker 1: this has been a very different episode to what I
1:08:39
Speaker 1: normally do. But that is that is a story of
1:08:45
Speaker 1: the protest psychosis and yeah, that's that's that. So who again,
1:08:54
Speaker 1: very very dense episode, very laden with yeah. So with that,
1:08:59
Speaker 1: I'm gonna be adi. I'm not gonna buy you ad
1:09:02
Speaker 1: you though, I'm not because it's a recommendation time cyber.
1:09:05
Speaker 1: Actually one more sidebar, one more sidebar. So basically, people
1:09:08
Speaker 1: of color have always been judged more harshly than white
1:09:12
Speaker 1: people and when it comes to being respected in spaces
1:09:17
Speaker 1: as well, right, black people have to be more they
1:09:22
Speaker 1: have had to be more serious. Like I remember when
1:09:29
Speaker 1: the Chubby Bunny challenge was like a big thing like
1:09:32
Speaker 1: this very many years ago. I'm I think I'm going
1:09:35
Speaker 1: back nearly a decade for this, and it was basically
1:09:38
Speaker 1: how many marshmallows can you put in your mouth and
1:09:41
Speaker 1: then speak? And overwhelmingly white. You know, a lot of
1:09:47
Speaker 1: black creaders weren't doing things like the Chubby Bunny challenge
1:09:50
Speaker 1: because those silly challenges would be used to discredit them,
1:09:57
Speaker 1: especially online educators and things like that. So you know,
1:10:00
Speaker 1: you had to be very strict now, luckily things are
1:10:03
Speaker 1: changing slightly, like we're kind of moving in the right direction.
1:10:07
Speaker 1: But it means people like me, like people who have privilege,
1:10:13
Speaker 1: you know, to show up, to stand up and support
1:10:15
Speaker 1: and sometimes to shut our fucking mouths and listen to
1:10:19
Speaker 1: what people are saying, because I understand the irony that
1:10:24
Speaker 1: it's someone who talks about many things that are not
1:10:28
Speaker 1: my race, religion, nation, that I'm always concerned about overstepping
1:10:36
Speaker 1: the mark, and I do try and be respectful. But
1:10:40
Speaker 1: the good thing is people are not shy about telling
1:10:42
Speaker 1: me when I've buggled up, so that's really nice. But yes,
1:10:47
Speaker 1: it's it's recommendation time. Let's let's wrap this up. So
1:10:51
Speaker 1: it is recommendation time. Recommendation time for reading Blanche on
1:10:55
Speaker 1: the Lamb by Barbara Neele what I like him Astray,
1:11:01
Speaker 1: so for watching Write or Die It is my new
1:11:04
Speaker 1: favorite thing. I love it so much. And for listening
1:11:09
Speaker 1: listen to the Wine and Crime podcast. Just like those
1:11:13
Speaker 1: are my girls. I love them so much. So with
1:11:18
Speaker 1: that I shall bid you adieu adios au revoir if
1:11:22
Speaker 1: we as them my friends. Bye bye,