The Schizophrenic Sixties

PETER ONUF: It’s often argued that a diagnosis can be limited by language. That the very words used to describe an illness can determine who is seen to have that illness. And this can have very real implications for those people diagnosed.

BRIAN BALOGH: In his book, The Protest Psychosis, Psychiatrist and Sociologist Jonathan Metzl looked at the new definition for schizophrenia that emerged in the 1968 version of the DSM. He discovered that it led to one particular demographic been disproportionately associated with the disease. Mental Story begins with a man that he calls Caesar Williams, committed to Michigan’s Ionia State Hospital for the Criminally Insane, in the 1950s.

JONATHAN METZL: He would have a pretty stable life, and then all of a sudden out of the blue would be involved in kind of travelling somewhere spontaneously, spending a lot of money, money that he didn’t have, and getting into particular fights.

And one day, lo and behold, at a time of great stress in his life– his wife was about to give birth to their child– he ended up traveling to Michigan and getting somehow involved in a card game that turned kind of violent, probably because he didn’t have the money, and ended up being arrested.

And when he was arrested, was saying that he was royalty, and the king, and other types of things. And so he was sent first to jail, and after a prolonged period of solitary confinement, where he was, I think, probably physically abused, was sent into a psychiatric hospital.

BRIAN BALOGH: And what was his diagnosis?

JONATHAN METZL: He was given a diagnosis, in the late 1950s, of what was called the psychopathic personality with psychosis. And what I found is that a lot of men like Mr. Williams, who were admitted in the 1950s and diagnosed with psychopathic personality disorder, or antisocial personality disorder, found that there are diagnosis changed while they were in the hospital. And particularly when the DSM II came out in 1968.

New terminology, particularly the terms were projection, projected anger, anger and hostility, these terms became part of the diagnosis of schizophrenia in 1968. And what we see is that the charts of people like Mr. Williams change, in which the doctors literally go through and change the diagnosis from a personality disorder to schizophrenia.

BRIAN BALOGH: Now as I recall, Mr. Williams was African American?

JONATHAN METZL: That’s right. That’s a very large factor in the way that his diagnosis played out. There’s particular language, language that’s actually coming from black power protests, that makes its way into psychiatric definitions of schizophrenia, in particular.

And so there are a bunch of articles that I look at that are from leading psychiatric journals, that talk about the argument– and this was not in any way made in secret, it was right there in the leading psychiatric journals of the time– that black men who participated in Civil Rights protests were at risk of developing schizophrenia, because protesting was driving them crazy.

And in fact, they coined a new term in a journal called the “Archives of General Psychiatry,” one of the leading psychiatric journals in the country, they coined this term called the protest psychosis, to talk about black men who were protesting against the government, or in Black Power protests, who are developing schizophrenia as a result of trying to assert their civil rights.

BRIAN BALOGH: Was there any discussion of paranoia? Because, as we know in retrospect, some civil rights activists had good reason to be, quote, “paranoid.” Their phones were being tapped.

JONATHAN METZL: It’s funny, because one of the cases that I look at is the case of Malcolm X. And Malcolm X had, at least according to the CIA file, it’s kind of contested, a family history of mental illness, they argued. And Malcolm X as much as anybody had reason to suspect that the government was about to get him, because he was being profiled, his phones were being tapped. And I’ve got the FBI profile, and they diagnosed Malcolm X with having schizophrenia, particularly because he was paranoid against the government.

And even though it’s incredibly tragic to read this file, you can’t but think like, of course he was paranoid against the government, because the government was profiling him and tapping his phone. So a lot of leaders at the time had psychological profiles that we’re done by the government. And they had good reason to be looking over their shoulder.

BRIAN BALOGH: So to return to the psychiatric implications of all of this, how does that influence Mr. Williams’ life?

JONATHAN METZL: At the time, there were tremendous diagnostics shifts that were happening, but also governments were deciding– because a lot of these asylums were federal funded– what types of diagnoses warranted long-term stay in psychiatric hospitals.

And certainly schizophrenia was identified as being a diagnosis that warranted more intense treatment and longer stays in an asylum. So by diagnosing a lot of these African American men, like Mr. Williams, with schizophrenia, they really did increase, not only the amount of time that these men were kept in asylums, but also limited their ability to contest their incarceration, or being kept there.

So I’ve got long letters and correspondences, for example, between family members and the doctors at Ionia where they were saying, he’s fine. Let him go. We’ll take care of him. And the response was, our job is to restore him to sanity. And because he had this schizophrenia diagnosis that implied that he was insane, it meant that he stayed in the asylum for quite a bit longer than they would have otherwise.

BRIAN BALOGH: What do you do, as a Professor of Psychiatry, to ensure that the social context that you live in does not to taint your treatment of patients?

JONATHAN METZL: That’s a wonderful question. I’ve actually had instances in my professional career where patients have come in to the clinics or emergency rooms where I’m working, and they voice exactly the themes that I write about in my book.

So when I was in Michigan, I was working in the ER one night, and there was an angry African American man who was brought in by the police with clearly having mental symptoms, delusions or hallucinations. And at that moment I’m not going to say, oh, we’re suffering from a socially constructed condition here that we need to look at culture.

I think that’s an answer that would be malpractice. But I will say that we have to remember the lessons of history, which is that our diagnoses, for better or worse, are shaped by social, and political, and environmental factors. And probably psychiatry more than other specialties.

And so the patient that I’m talking about was brought in, and even though he was clearly in distress, he was also talking about threats made against him by the police, an uncertainty. And I think that in a way, for me at least, knowing the particular context of the history, I would hope changed the kinds of questions that I asked of this patient.

I think all doctors, their main goal is to alleviate suffering. But I don’t think that we need to automatically discount the content of symptoms. And so in this case, I probably spent more time asking this person about his sense of safety and what the threat was.

BRIAN BALOGH: Jonathan Metzl is the Director at the Center for Medicine, Health, and Society at Vanderbilt University. It’s time for a short break. When we get back, a woman sleepwalks her way into fame, and a room at the brand new asylum.

PETER ONUF: You’re listening to Back Story. We’ll be back in a minute.