Although I think we’ve moved pretty far away from that perspective in mainstream, especially US, society today, that sense of vulnerability at the heart of psychiatric expertise is still with us, along with the perpetual quest for the magic bullet right around the next corner.
Amanda Anderson: Well, to continue this really interesting question of the relationship between psychiatric care and let’s just say larger society, Jenny, let me turn and ask you about the French West Indian psychiatrist and political philosopher Frantz Fanon, who is a hugely important figure within the history of psychiatry, given his focus on colonialism and the more general treatment of the political and the psychological across his work. How does he fit into the history that you are alluding to? What was interesting about Fanon, both theoretically and practically, in terms of the concrete work he did in changing the institutions that housed mental patients?
Jennifer Lambe: Yeah. As much as Leon and I were eager to get away from gurus, I have to say we left a little bit of room for one, a standalone week for Fanon. In part, I think that is a result of the fact that historically he has not been at the center of many discussions of psychiatry and anti-psychiatry, even though I think, in our perspective, he perhaps better anticipates many of the questions we are having about psychiatry today, namely its cultural specificity and even the role that it can play in shoring up racial, social, class, ethnic hierarchies.
Of course, Fanon, like many of the others we’ve discussed, is someone who was trained as a psychiatrist, who practiced as a psychiatrist, and he was profoundly interested in reforming psychiatric practice. At the same time of course that he pursued a broader critique, for which he has become most famous, of the ways in which psychiatry and psychoanalysis in particular, or a particular strand of colonial psychiatry, served to naturalize and shore up white supremacy in the colonial project; moreover, that the Western subject, as conceived at the moment, was to some degree a construction of psychiatry; and that therefore one had to inhabit and deconstruct that psychoanalytic language in order to in turn dismantle white supremacy.
I think Fanon, like many of the figures we’ve discussed, also begs the question of where action should lie, if it should be targeted at the individual or the society. I think at many points he answers “both,” even though over the course of his career, of course, he shifts towards a more radical, revolutionary politics and away from institutional solutions that he had sought early on.
But I have to just say, on a personal note, Fanon holds interest for me, as a scholar of Cuba, because whenever anyone learns that I work on Cuba or the history of psychiatry in Cuba, they in fact assume that Fanon is an important touchstone for Cuban psychiatrists. I always have to explain that, in fact, he was not, that he was very rarely referenced, but that does not mean that the project that he was pursuing was unfamiliar to Cuban psychiatrists. In fact, from my vantage point, the corner of the world that I study and approach in my research, this question about the cultural specificity of psychiatry is the question of the 1960s, ’70s, ’80s, ’90s, the aughts, and today.
In other words, many of the themes that we associate with anti-psychiatry in the global North, in fact as experienced and registered in the global South, look quite different, and in fact are targeted to critiquing imperialism, colonialism, as themselves being upheld by psychiatry to some degree and insisting on a need for a psychiatry or mental health practice, mental healing practice, that is attuned to the cultural specificities of places outside the global North.
Amanda Anderson: One thing that’s interesting is that Fanon’s work within institutions, and then of course the larger trajectory of his thinking, raises the larger question of the tension between institutional reform and anti-institutional impulses in the history of psychiatric activism, as you pointed out. Leon, can you talk a little bit about that issue, since I know it was central to discussions in the seminar?
Leon Hilton: Yes. One of the things that was really fascinating about where we read Fanon in the course of the syllabus is that it actually allowed us to trace a parallel between histories of anti-colonialism, anti-imperialism, and histories of what gets called deinstitutionalization. Deinstitutionalization is a complex concept. It’s much disputed now. But basically it’s thinking about the history of attempts to basically shut down large state-run asylums and hospitals that had developed over the course of the late 19th and first part of the 20th century.
There’s a question about what to replace them with, but if you look at the rapid decline in the number of, for example, psychiatric hospital beds in just the United States from around the 1960s through the present, it’s really, really striking how there is this massive movement of people from institutions out into other settings. Really, the question of the institution and its social role, its role as a social space, became really crucial for us. Fanon was somebody who is not necessarily read often in that context, but provided insight into the other critiques of institutions that we were reading from around the same time. It was a really interesting reframing of some of the ways in which these ideas are understood in relationship to each other.
Amanda Anderson: One aspect of the history that you trace is the powerful effect that social movements of the ’60s and ’70s had on therapeutic practices and cultures. For example, feminism and feminist therapy really challenged any normalization of women’s roles or any approach that advocated individual adjustment to conventional roles or dynamics. The gay rights movement had a profound effect on the way the field approached homosexuality, which had been pathologized. How do you see the current therapeutic field? Are there forces at present that are playing a role similar to the role that certain radical movements played in the ’60s and ’70s, or are we looking at a different landscape altogether? Jenny, perhaps we can start with you.
Jennifer Lambe: Yeah, I encountered this question a lot in the course of not only teaching this class with Leon, but teaching undergraduates about the history of psychiatry. In part what I have discovered very quickly, and in an evolving way, is that this history associated with the ’60s and ’70s in some ways is endemic to the way that we understand psychiatry now, but also that we’ve moved quite far away from it.
Part of this is a function of some of the perpetual questions that I mentioned regarding psychiatry, I think the most important one being “Has psychiatry found a way to, as philosophers of science call it, carve nature at its joints? Are the categories that we use to describe the ways our minds experience reality intrinsic to nature or are they categories that we’ve imposed on nature, this idea of mental illness as itself a myth?”
What I think is often striking for students in encountering the ’60s and ’70s and the multiple fronts of contestation that psychiatry was confronting at that moment, from gender to sexuality — we’ve talked about race and culture as well; we could name others — is that the 1980 DSM-III so shifts the terms of the conversation that, in fact, that history can seem almost unthinkable from the perspective of 2022.
What I mean by that is that DSM-III represents this revisionist attempt, and also ends up being, I would say, a revolutionary attempt, to recenter diagnosis in the practice of US psychiatry, to actually put diagnosis at the heart of what psychiatrists do, and to do so in a way premised on clear, discreet diagnostic criteria presumed to respond to the reality out there in nature.
Now, almost every person who has spearheaded a process of DSM reform in the post-DSM-III era has come to repudiate the document that they or others have created as not matching reality closely enough. Yet, what’s so interesting, I think, and striking about our moment in particular, is how naturalized these DSM categories have become, how many of us in the United States and beyond — of course the DSM is the document in the United States; the ICD [International Classification of Diseases] prevails on the international level — become linked not only to psycho-pharmaceutical treatments, of course, beginning in the 1990s, but also to ways of understanding self, that we have come to bear these diagnostic categories that many of us understand, and certainly the psychiatrists who wield them understand, to be necessary fictions or complicated nonfictions or lying somewhere in between as a way to mark and understand our place in the world and the way in which we experience the world.