Month: January 2020

The pathologisation of activism

Activism and struggle-activism

This article is concerned with social change and particularly with change agents. So I started this piece by looking at basic definitions of activism. They naturally abound, here are three. Activism according to the Cambridge dictionary is ‘the process of campaigning in public or working for an organization in order to bring about political or social change’. The Collins dictionary proposes that ‘an activist is a person who works to bring about political or social changes by campaigning in public or working for an organization’. Finally Oxford dictionary suggests that ‘activism is the activity of working to achieve political or social change, especially as a member of an organization with particular aim’.

I am not sure about these definitions. I am not sure that activism necessarily entails organising, organised action or even taking a public stance. When I wrote the skeleton thread which inspired this piece, I used activism to encapsulate all actions aimed at effecting structural and social change, although I accept doing so is not without problems either. In truth a concern for and involvement in the struggle for social justice and liberation is more what I have in mind. Thus, I would call this kind of activism, struggle-activism. Struggle-activism I would say is much more transparently rooted in one’s active and on-going struggle. Activism as an integral part of the struggle for survival. As a necessary tool to resist injustice, inequality and oppression.

Struggle-activism carries higher levels of risks because it always involves activism in the mist of some harm or wrong personally experienced and often on-going. It is rawer because the trauma of injustice has to be negotiated live, as it occurs, as we refuse to be bystanders in our own structural experiences. But as we take a stand however, our action transcend our own experience, our system focused change directed action, effects change beyond ourselves. Students organising to hold professors who have sexually harassed them within their institution, is an example of struggle-activism.

Drapetomonia and Rascality

Within the mental health system, various mechanisms have been employed to suppress and punish dissent, resistance and quash or pathologise struggle-activism or concern for social justice. Potent examples of such practices are illustrated by the diagnoses of Drapetomania and Rascality. Drapetomania was believed to be an inheritable but preventable ‘mental illness’ that caused enslaved Africans to run away and flee captivity, often repeatedly and always against their best interests. Their best interests of course being dutifully serving their white master. The short paragraph below describes the causes and serious risks of the illness which of course included getting into contact with dangerous abolitionists and presumably, being enlisted to fight against the institution of slavery and/or being emboldened in one’s freedom aspirations.

‘The cause in the most of cases, that induces the negro to run away from service, is as much a disease of the mind as any other species of mental alienation, and much more curable, as a general rule. With the advantages of proper medical advice, strictly followed, this troublesome practice that many negroes have of running away, can be almost entirely prevented, although the slaves be located on the borders of a free state, within a stone’s throw of the abolitionists’

Rascality scientifically known as Dysaesthesia Aethiopica on the other hand, was a disease of the mind characterised by laziness, defiance, lack of work ethics and mischievous behaviour. This mischief was clear. It was always related to indifference and disregard or to the sabotaging of the interests or property of the master. Contrary to drapetomania, Rascality could helpfully be recognised by clear physical symptoms which were visible e.g. marks and lesions on the back of the sufferers evidencing not only their insensitive skin but also their diseased mind. Rascality was such a serious and communicable disease it led to countless rebellions, the liberation of Haiti and thus, instilled fear in the hearts of white slave holders the world over.

‘From the careless movements of the individuals affected with the complaint, they are apt to do much mischief, which appears as if intentional, but is mostly owning to the stupidness of mind and insensibility of the nerves induced by the disease. Thus, they break, waste and destroy everything they handle, -abuse horses and cattle, – tear or burn or rend their own clothing, and, paying no attention to the rights of property, steal others, to replace what they have destroyed. […] They slight their work, -cut up corn, cane, cotton or tobacco when hoeing it, as if for pure mischief’

Black dissent and resistance as illness 

It was Louisiana based physician Samuel Cartwright who discovered drapetomania and Rascality (Dysaesthesia Aethiopica) and reported them to the New Orleans Medical and Surgical Journal on diseases prevalent among the black populations of the South of the States. The diagnoses took off as slave owners and overseers readily recognised them. All of this is of course unscientific and utter nonsense (arguably like most diagnoses of ‘mental illnesses’ today, but that’s not what we’re discussing here). All the same, these diagnoses were attempts at ensuring that Negroes remain ‘the submissive knee-bender’ they were intended to be, by nature. And, that god’s plan, beautifully aligned with white men’s capitalist plans. God works in mysterious ways, they say.

The management of drapetomania included cutting off big toes, foots, lashes deep in the flesh and when the case was too severe or advanced, death. In the case of rascality, the first steps it was recommended to cure it, were to attend to the wounds and lesions on the back of the slave (in case this was not clear, injuries inflicted while disciplining the sufferer) if this failed, beating them with a leather strap (thus creating more lesions) then, attempting again to make the slave work. In either case, treatment for these ‘mental illnesses’ were about returning the slave to their original position. A position of unopposed, compliant and productive servitude.

A century or so later, racism could still be evidenced in diagnostic practices which have arguably remained tools to maintain the racialised social order thus white economic interests. The diagnosis of schizophrenia for example, had until the 1970’s in the States been used to diagnose largely non-violent white petty criminals became racialised and disproportionately applied to African American men from urban areas who were concerned with civil rights and thus again…freedom. And so conveniently, the second edition of Diagnostic Statistical Manual DSM-II added ‘hostility’ and ‘aggression’ as signs of ‘schizophrenia’ to capture this new development in the manifestation of the ‘illness’, racial belligerence and protest in the mist of the civil right struggle; ‘protest psychosis’ (Metzi, 2009) became recognisable manifestations of schizophrenia, evidencing once more, the undeniable relationship between mental health practices, and the pathologisation of dissent.

Being stuck on racism

This historical context also reminds us that mental health disciplines, psychiatry and medicine have long histories of racism. But more than that, it tells us something of critical significance about the role the ‘sciences of the mind’ have played in the production and reproduction of the dominant values of society and how deeply invested in the status-quo thus, in the maintenance of the racialised social order, they have been. We can also see that the practice of silencing black people, their social realities however violent, however unjust, however torturous, however traumatic, has been normative and that those seeking to challenge or change unequal structures have always been at risk of pathologisation and violence within health systems.

My first exposure to this pathologisation was early in my psychology journey. Maybe about 12-15 years ago. This was in London. A psychologist, a woman of colour complained to me about black patients she was allocated to work with, within a culturally specific service working exclusively with black people. She bemoaned, ‘it’s impossible to work with these patients, they’re stuck on racism’, then casually walked away, angry. It took me several years to even come close to grasping the racism contained within this simple statement and the history it laid bare. It is only recently that I got in touch with the anger revising this experience now triggers in me. Perhaps partly because it speaks to me personally.

By way of background, the group admonished for being ‘stuck on racism’ was a group of service users/patients who have received some of the most adverse mental health ‘care’ imaginable. Some had spoken about police officers sitting on their back during arrests or mental health staff restraining them to the point of broken bones. All had been deprived of their liberties. Then experienced racial harassment or stereotyping within mental health systems. The context is a context where black people remain more likely to be diagnosed with ‘schizophrenia’, more likely to be detained against their will, more likely to be over-medicated and more likely to die within systems meant to care for them, than any other group on this land. Inequality well documented.

Analytic thinking and the social order

The context is therefore one of institutional racism amidst interpersonal experiences of racism. Despite this, that these vulnerable patients, clearly harmed and traumatised by racism would use their space to try to give their experience a voice, created irritation and disparagement. There are various ways in which experiences of everyday racism, concerns for social justice or activism can be pathologised or dismissed. All amount to racism. Thus, being stuck on racism has echo of ‘lacking psychological mindednesses’ a notion which has been used for centuries to support the psychological thus alleged intellectual inferiority of black people. A limitation in their ability to psychologise their experience. Evidence of a limited capacity to reflect and be introspective in relation to the same rather than evidence of them speaking to it in a way that simply does not fit neatly into white individualistic apolitical therapy frameworks.

All schools of therapy have the potential to do this and indeed do this to various degrees, although here I mainly focus on analytic practice where those who seek to change systems and activists have tended to be looked upon with contempt and/or considered immature psychically, defended or resistant to true insight. A deficit based assessment of their psychological functioning which is reliant on various interpretations all based on the decontexualisation of injustice, inequality and trauma and on the tacit premises that the world as is, sits outside of the realm of our operation or psychological functioning and relational configurations and, that non-engagement in its politics and structures, is desirable and healthy.

Following on from this logic, concern for social justice or racism are often interpreted as an act of displacement. Displacement is a defence mechanism that occurs when negative feelings related to an object/person are transferred to another usually less threatening object/person. In shifting targets, the mind finds a safe outlet for the expression of emotions, impulses or wishes which would be too overwhelming or anxiety provoking to express towards the actual source of the conflict. Therefore, activist efforts may be seen as a manifestation of some latent conflict rooted elsewhere, usually in our initial object of attachment or primary group, i.e. our family.

With displacement, the failure or deficit thus lies in not understanding that this concern with social justice is evidence of a disturbance located elsewhere. It is not ‘really’ about the socio-political or about the violence we experience in the material world, but about our internal worlds and its configurations. Therefore activism has a long history of being interpreted as displaced anger toward an authority figure from our past usually a parental figure, often the father. An alternative or concurrent interpretation would be that one is defending against anger towards the analyst.

Now it can get a lot more harmful. Where oppression related violence or any retaliation you may experience for your change focused action may be interpreted as unconsciously wished, an enactment of sado-masochist impulses, for example. This is how we can in the analytic literature, find views of colonialism being the unconscious wish of the colonised or the consequence of some inherent pathological predisposition in them. Another way of saying that really deep down they wanted it or, they needed it and, thus invited it. Unconsciously. Equally disturbing, the same logic is often applied to all sorts of violence, including sexual abuse.

Working and thinking at multiple levels of functioning offers us the richest formulations and understanding of the world. Thus, I would not as a matter of course, reject analytic interpretations however far-fetched or convoluted they may appear. They offer a symbolism that can be helpful and, of course can help us make sense of more unconscious dynamics and motivations. The issue thus is not that those interpretations exist as units of meaning. Meaning making that does not resonate and is problematic can be discarded. The problem is that they become the only lens, unreflectively employed if not imposed, to formulate activism, resistance and dissent and, that opposing them can often lead to even further pathologisation. Human beings are complex. One behaviour can serve multiple functions and be attributed to multiple units of meanings, both conscious and unconscious, both social and psychological. Sometimes they may be contradictory but often they can co-exist. Still, the exclusion of socio-political analyses of activism, the refusal to engage with the structurally located lived experience of people of colour has significant implications, not least the protection of the status-quo. It consequently amounts to complicity and collusion.

Concluding thoughts 

Activism can be a defence. Not all defences are problematic or ‘immature’ (e.g. sublimation). There are plenty of reasons those seeking to change systems and struggle-activists may be vulnerable, not least, the violent responses they trigger precisely because they resist and, because of their history of having been harmed by the systems they seek to change. And again, there may well be unresolved conflicts (whatever this means) in our history. There are, for most people. All the same, the pathologisation of the impulse, wish or engagement in social change continues to be a way for the mental health professionals to uphold the status quo thus, white supremacy. The defensive functions of these analytic or diagnostic devices also need attention. Indeed, we can see them as defences on the part of the therapist/analyst. Acts of denial and repression. The refusal to engage with the reality of racism and oppression or injustice more broadly. Similarly here, these defences may serve multiple functions. Psychologically or psychically: the avoidance of guilt, shame, helplessness, or the contemplation of complicity; socially: the upholding of white supremacy, the invisibilisation of whiteness and, relationally: the enactment of discursive or epistemic power and the reproduction of historical relational configurations.

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