Having worked as a psychoanalytic therapist for over 50 years, and still mystified by the term ‘mental health’, I am floored by the news about mandated, involuntary psychiatric treatment in New York City and Yale University. In November, New York City Mayor Eric Adams directed police and emergency medical workers to hospitalize people deemed to be too mentally ill to care for themselves, even if they posed no threat to others. The plan was billed as a “compassionate new vision” to address mental illness, invoking a “moral mandate” to “deliver for our most vulnerable.” In California, Gov. Gavin Newsom recently signed a law that could force some homeless people with disorders like schizophrenia into treatment. Many states have laws that allow for involuntary outpatient treatment, and Washington State allows people to be committed to hospitals if a judge finds that they pose a threat to themselves or others.
Democracy Now (also) interviewed Yale University students painfully impacted by forced expulsion due to signs of mental illness. Interviewed students spoke of being forced to leave Yale, given two hours to pack up, and losing medical coverage, accommodations, housing, forfeiting part of their tuition, and barred from stepping foot on campus at a time when they most needed help. At other universities, criteria for expulsion include “so-called community disruption, including help-seeking behaviors.” “If a student with suicidal thoughts tells their friends, and that can be upsetting to roommates and friends, that can be construed as community disruption and can have a leave of absence imposed on them…. If a parent, for example, requests that the campus security do a wellness check to make sure that their child in the dorm is okay, that has been construed as community disruption.”
In a recent article, I quoted Nigerian writer Wole Soyinka on “a world gone haywire”, about the world completely transformed in the way people are understood and treated. Fortunately, many people have not gone haywire, but explaining people by behavior traits leaves out the individual psychology of personal memories, feelings, needs, values and is a far cry from the psychologies of Freud, Shakespeare, Tolstoy. Seeing people as ‘products’ is concerning: quantifying people and life, people as products of conditioning or the system, of neural networks and DNA and biochemistry, of mathematically-determined game constructs, of manufactured consent. And at the opposite pole: people as inexplicably subjective and unknowable. Generalizations about human nature are belied by the range and complexity of what individual people say in their own words as reported in a wealth of good research.Hannah Arendt listened very carefully to Adolf Eichmann and had many helpful insights about him, but then she generalized his psychology to all perpetrators of these crimes. [1]
Having come of age in 1960s Los Angeles, as described in Mike Davis’ Light the Night on Fire, I’ve seen profound societal shifts. The 1960s saw the anti-war and civil rights movements. Education aimed at broad knowledge of science, social science, the humanities, and much new critical research exposed ubiquitous US apartheid practices in housing, healthcare, police brutality, food distribution, American dirty wars, the dysfunctional set-up of the UN, and more. By the end of the 60’s, John F. Kennedy and Martin Luther King were assassinated, protesting students at Kent State were killed, Judge Julius Hoffman bound and gagged Bobby Seale in court, COINTELPRO assassinated leaders of color. In the 70s, Bob Dylan turned to religion, Buffy Ste Marie was taken off the air, leftist academics did not get tenure, many young people became a-political flower children, radical San Francisco-Berkeley celebrated Renaissance Fairs in ceremonies of innocence, many rejected books altogether and claimed that the printed word was not real, Israel’s 1967 Six Day War excited pride in militaristic phallicism and left-leaning magazines turned neo-liberal and Zionist. Professional schools and the sciences came to dominate academia, and the ‘managerial mentality’ described by C. Wright Mills materialized in Schools of Management, psychological treatments about managing behavior, and education methodology focusing on learning skills and not meaning. The practice of law considerably narrowed, and lawfare and casuistry replaced the pursuit of justice.
In the 1960s I worked in a therapeutic nursery school with highly disturbed children where we saw very directly and clearly the severe, often subtle impacts of extremely troubled parenting. Soon after, bio-chemical, neurological, genetic determinants became the exclusive focus of diagnosing and treating children. Many were labelled as autistic with minimal assessment, with no attention to family background or interest in understanding the meaning of a child’s behavior. At UCLA Ol Lovaas experimented with electric shocks to eliminate autistic symptoms in young children. I saw a 3-year old child diagnosed as autistic after ½ hour observation through a one-way screen, whose mother was instructed how to hold him down to administer medication. At the Yale Child Study Center, Donald Cohen used painful spinal taps on children diagnosed with Tourettes to find a biological cause. Behavioral approaches to diagnosed ‘mental illness’ discarded inquiries about a person’s history and the meaning and function of identified symptoms. Working at an outpatient psychiatric clinic, I saw the rapid adoption of new diagnostic categories. Women, especially, were casually, derisively diagnosed as borderline. In the U.S. there was an epidemic of ADHD, and presently some perceived “oddness” puts a person “on the spectrum”(autism). Gone is confidentiality.
And Yale? There had previously been collaboration between Yale Law professor Joseph Goldstein with two child psychoanalysts on protecting children from unwarranted state removal of children from their families, purportedly for neglect, while the state did not intervene when there were clear indications of threats to life. Law and psychoanalysis were also integrated in the work of law school professor Jay Katz in formulating the standard of informed consent in response to revelations about the Tuskegee syphilis research on Black men who were uninformed about the experiment in which at least 100 men died.[2] Yale is now a heartless environment for students.
Psychologically, people react differently to stress and anxiety, but the belief that people inherently cannot deal with difficult information, cannot bear stress, rationalizes and feeds into silence about actual frightening conditions and shuts out what some people actually do and how people cooperate and organize in crises. It’s not a Hobbesian world crying out for military securitization and cutting-edge technologies. Technology can pinpoint incoming meteors and missiles but evidently people in positions of responsibility haven’t cared enough to locate the families of children in ICE. In past psychology, there was an immense amount known about children and their need for parents at different phases of childhood, about the devastating effects of not having a good parent. Paul Robeson sang “sometimes I feel like a motherless child.” The loss of children is most certainly community disruption but the perpetrators are not diagnosed with mental illness and involuntarily expelled from office.
The Diagnostic and Statistical Model (DSM) classification of psychopathology has social and political consequences. A number of clinician/researchers including Bruce Levine have written for the public about the highly flawed premises and data of the DSM. [2]. Child psychoanalyst Dr. Robert Furman has written about ADHD, first diagnosed as Minimal Brain Dysfunction (MBD), then Hyperactivity Disorder, then Attention Deficit Disorder (ADD), finally Attention Deficit Hyperactivity Disorder. MBD was at best “an uncertain hypothesis” and at worst a diagnosis that “created a neuromythology.” The use of psychostimulants was described as a medication in search of a diagnosis. Psychostimulants suppress active behavior of normal prepubertal boys, so its effectiveness is not an indication of a diagnosis. Ritalin is classified as a Schedule II Substance along with opium, morphine, amphetamines; it is a controlled substance with a high abuse potential and psychic or physical dependence liability. “Almost always missing from any reports about the drugs are children’s responses to them, often very poignant ones, complaining of insomnia, loss of appetite, feeling estranged from themselves, feeling stigmatized with no one to turn to, as it seems as if parents, teachers and doctors all want them on drugs….Mention does have to be made of the abdication of responsibility possible with the diagnosis of an ‘illness in the child,’ presumably caused by some chemical deficiency in the brain. Parents are spared responsibility for their child’s behavior, the child is spared a type of responsibility for his own behavior, teachers are spared responsibility for managing their classrooms, society is spared responsibility for the inadequate funding of schools that creates such large classroom sizes a teacher has problems coping with active children.” (p 159).” The criteria for diagnosis are now increasingly broad, requiring a certain number of attention symptoms and hyperactivity symptoms, until the latest iteration does not include any symptoms as the diagnosis can be made when the diagnostic criteria are not met. Furman quotes Steven Rose, co-author of Genes, Cells and Brains, on neurogenetic determinism: “In a social and political environment which has largely despaired of finding social solutions to social problems, neurogenetic determinism that argues for a directly causal relationship between genes and behavior has found great favor.” [3]
Accounting for individual psychology is not a libertarian erasure of social conditions and social institutions. Omitted from current usages of ‘human nature’ are Freudian observations of the multiple interacting forces in a person’s psychology, the capacity to reality test and to objectively understand people, the capacity to bear difficult feelings, to mature beyond early childhood and dream logic to have a realistic sense of time and of cause-and-effect relationships, to differentiate human from non-human and animate from inanimate, to give up beliefs in omniscience and omnipotence. “At present, in its starkest form, the struggle is between a vulgar biological determinism, typified by sociobiology, and an extreme subjectivity.” [4]
NOTES
[1] Examples of listening to people as complex, thoughtful, individuals: see Joel Alden Schlosser’s Herodotus in the Anthropocence, Chicago U Press 2020; Barbara Ehrenreich’s books, Arlie Hochschild’s The Managed Heart: the commercialization of human feeling, U of Calif. 2012; Jana Mohr Lone, Seen and Not Heard: why children’s voices matter 2021 Rowman and Littlefield, 2021; Timothy Williams, The Complexity of Evil: Perpetration and Genocide, Rutgers 2020; Democracy Now interviews.
[2] Joseph Goldstein, Anna Freud, Albert Solnit , 3 volume work on the best interests of the child first published in 1973 by The Free Press, New York. On the Tuskegee syphilis experiments, see Harriet Washington, Medical Apartheid: the dark history of medical experimentation on Black Americans from colonial times to the present. Penguin Random House, 2008.
[3] Robert A. Furman. “Methylphenidate and ‘ADHD’ in Europe and the U.S.A. Child Analysis 7, 1996, p 132-145. Robert A. Furman, “On Symptom Diagnosis”, Child Analysis 9, 1998, p. 170-194. Robert A. Furman, “Correspondence”, Journal of Child Psychotherapy Vol.22 No.1, 1996. P. 157-60.
[4] p. 35 “The biological and social” in Richard Lewontin and Richard Levins Biology Under the Influence, Monthly Review Press, New York 2007. See Freud’s opposition to the medicalization of psychoanalytic training and practice: “The question of lay analysis”, Standard Edition XX, 1926, p. 179-258.