Decolonising Psychiatry : The Danger of a Single Story

Decolonising Psychiatry : The Danger of a Single Story

While employed as a psychiatric social worker at an inpatient facility in Florida, I witnessed the intersection of racism and psychiatric practice. I observed the danger of a single story which is the hegemonic biological explanation for mental disorders. In a compelling TED Global Talk Nigerian novelist Adichie expounded upon what she termed “the danger of a single story”. Drawing from her experiences as a growing child in Nigeria, she explored the subtle ways power structures tend to make a single perspective the most definitive way of understanding a concept—thus marginalising other perspectives and knowledge frameworks. 

Reflecting on my time as a psychiatric social worker, I recall a patient named Jamal, an African-American man in his late sixties. Jamal arrived at the hospital in an orange jumpsuit because he got diverted from the prison system. Jamal had a long history of smoking crack. In a treatment meeting, the psychiatrist spoke to Jamal in a paternalistic tone and said, ” You have schizophrenia, and you need to take your medication.” Jamal replied back, “I ain’t got no damn schizophrenia that shit is racist!” Jamal was very hostile and angry toward the psychiatrist. Jamal went from a polite, courteous older gentleman to a Dave Chapelle caricature of a “crackhead” in a matter of seconds. The treating psychiatrist was viewing Jamal’s behaviour from the medical gaze of psychiatry. The doctor framed Jamal’s behaviour as arising from his inner world rather than being motivated by the features of the situation (Smith, 1978). Observing the situation, it was apparent that his emotional state was driven by feeling subjugated by the psychiatrist.

Jamal exhibited symptoms of psychosis and paranoia which are often attributed to the “disease of schizophrenia”. Jamal would spend most of his days pacing the walls of the psychiatric ward and talking to himself.

However, an alternative explanation is that his symptoms could be attributed to witnessing violent events on a regular basis and his paranoia could represent a fear of being harassed by law enforcement which is a legitimate fear ling in his neighbourhood. Jamal was from Overtown, a historically black section of Miami which has a long-standing history of violence and drug trafficking. When I spoke to Jamal like a regular person, he was very polite and courteous. An alternate explanation for his presenting symptoms is that they could have been caused by smoking crack for many years. Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations (Roncero et al., 2011), If crack had caused his symptoms of psychosis by altering the structure of his neurons, the logic is shaky as why he would be administered Haldol, an antipsychotic that has been proven to promote the death of neurons. The traditional argument is that Jamal needs to take his medication because he represents a danger to society when his “illness” is “untreated”. However, an alternative explanation to that is that psychiatry’s role in society is that of social control: Jamal is misbehaving, and the role of medication is to control his deviant behaviour.

The psychiatrist explained Jamal’s defiance as a feature of his disease and that he just needs to accept his diagnosis and take his medication. The prevailing narrative around the hospital is the essential variable in whether a patient would be stable in the community was whether they were compliant with their “medication”. It is commonly stated that patients refuse their medication because they lack insight into their illness rather than then finding the medication unhelpful with may unpleasant side effects. Like the prison systems, African-Americans are overly represented in inpatient psychiatric facilities. African-Americans continue to be over-represented in emergency and in inpatient services, and this has been affirmed by the data (Snowden et al., 2009).

Psychiatric facilities are extremely oppressive institutions. A person can be involuntarily committed based on an interview from a mental health professional. In practice, an individual can have their freedom taken away without ever committing a crime; they just have to be determined as a danger to self or other. Currently, in the US, we are coming to an agreement that it is not helpful to incarcerate non-violent offenders. We have also identified that the majority of people that fill the prisons are persons of colour. What I fear is by reducing the use of our prisons, we are going to increase the use of forced psychiatric care. It is especially ironic that the mental health system is being asked to solve the problems of the prison system, given that the primary — if not the only treatment offered, or forced against a person’s will — consists of psychotropic drugs many of which are sold on the street (Whitaker, 2010). Modern-day psychiatry has not left behind its legacy of racism. The public mental health system in the US functions as a regime of control and repression just like the prison system targeting African-Americans and other people of colour disproportionately for coercive and intrusive interventions such as: electroshock treatment, medication with high doses of brain-damaging drugs, commitment to institutions, and the use of restraints and solitary confinement (Whitaker, 2010). These are complex issues which require creative solutions. There are no easy answers to these problems. My intention writing this is to spread awareness regarding the intersection between racism within the prison system and inpatient psychiatric care and prompt dialogue about these salient issues. 


Jeff Friedman is a Licensed Clinical Social Worker. He is passionate is about spreading awareness how trauma is at the root of most mental health and substance abuse problems. He advocates for sensible drug policy and harm reduction approaches to addiction.  He is the host of a Podcast called The Trauma Informed Podcast on Soundcloud. You can follow him on Twitter @jmfriedman

 


 

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  1. Our mental health system lacks solutions or paths to recovery, and frequently traps people with an invalid paradigm. We need to explore how hate, greed and ignorance contribute to the problems not just in the mental health system, but throughout our society. How we deal with anger is also a problem.

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  2. The current paradigm of mental health care is oppressive and disempowering. It is inherently corrupt and it makes people into infants, dependent and ill. My daughter is an example of the lack of justice and empowerment in the mental health system. After six years of forced drugging and institutionalisation, she is much much worse. After more than a million dollars of taxpayers money was lavished on her psychiatric incarceration and “treatment” she is worse than when she entered the system six years ago. It has become nearly impossible to distinguish between the severe side effects of her “treatment” and her original trauma that led her to the system in the first place. For a fraction of the cost, had our family received group counselling, had she been provided with nutritional support, mindfulness training, bio feedback, hypnosis, shamanistic services, yoga, dance, vocational rehab, housing, support to attend college, etc. her outcome would have been much better.

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  3. It is rare that a writer from the Whitaker side of “the great divide” gets my attention and respect as you have. I follow the commentary on Mad in America, so I have a good amount of experience to say that.

    I wish that divide were not there. I wish the some 4% who had enough/sufficient genetic predisposition to the Serious mental Disorders were seen as a special case, and that the rest taking medications designed fr that extreme population were not lumped in. I do not consider the drugs the fault, but the prescribers and the lack of a complete Differential Diagnosis. I am sad that some, too many have taken the point of refusal for drugs and insisted that no one ever should be drugged, especially against their will. The main founder of NAMI (her birthday was last week)and I thought we were on different sides there until we talked face to face and realized it was not so.

    Face to face means a lot to me, and “off the clock” while we are venting on how therapy should be done. I walked before I was fully in the system of caring. So my question is this: those who go along with the tragedy, with the malpractice etc…are they truly clueless, are they hardhearted. are they burned out and fearful to loose job? I looked into online of a facility last night where a friends family member is not being helped. Staffing chaos, overworked, no communication and several comments about getting dressed down for trying to do it right. Please tell me the biggest problems are front line burnout. Why do you think it plods on as it does getting less that no results for so many?

    Advocate by the Salish Sea

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