Culture

The Medicalization of Rebellion

The long, shameful history of using science to stigmatize dissent

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In 1861 Samuel A. Cartwright, an American physician, described a mental illness he called "drapetomania." As Wikipedia points out, the term derived from drapetes, Greek for "runaway [slave]," and mania for madness or frenzy.

Thus Cartwright defined drapetomania as "the disease causing negroes to run away [from captivity]."

"[I]ts diagnostic symptom, the absconding from service, is well known to our planters and overseers," Cartwright wrote in a much-distributed paper delivered before the Medical Association of Louisiana. Yet this disorder was "unknown to our medical authorities."

Cartwright thought slave owners caused the illness by making "themselves too familiar with [slaves], treating them as equals." Drapetomania could also be induced "if [the master] abuses the power which God has given him over his fellow-man, by being cruel to him, or punishing him in anger, or by neglecting to protect him from the wanton abuses of his fellow-servants and all others, or by denying him the usual comforts and necessaries of life."

He had ideas about proper prevention and treatment:

[I]f his master or overseer be kind and gracious in his hearing towards him, without condescension, and at the sane [sic] time ministers to his physical wants, and protects him from abuses, the negro is spell-bound, and cannot run away. . . .

If any one or more of them, at any time, are inclined to raise their heads to a level with their master or overseer, humanity and their own good requires that they should be punished until they fall into that submissive state which was intended for them to occupy in all after-time. . . . They have only to be kept in that state, and treated like children, with care, kindness, attention and humanity, to prevent and cure them from running away. [Emphasis added.]

Dysaethesia Too

The identification of drapetomania is not Cartwright's only achievement. He also "discovered" "dysaethesia aethiopica, or hebetude of mind and obtuse sensibility of body—a disease peculiar to negroes—called by overseers, 'rascality.'" Unlike drapetomania, dysatheisa afflicted mainly free blacks. "The disease is the natural offspring of negro liberty–the liberty to be idle, to wallow in filth, and to indulge in improper food and drinks."

Cartwright, I dare say, was a quack, ever ready to ascribe to disease behavior he found disturbing. A far more informative discussion of the conduct of slaves can be found in Thaddeus Russell's fascinating book, A Renegade History of the United States.

Have things changed much since Cartwright's day? You decide.

The current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) lists Oppositional Defiant Disorder (ODD) under "disorders usually first diagnosed infancy, childhood, or adolescence." (Hat tip: Bryan Hyde .) According to the manual,

The essential feature of Oppositional Defiant Disorder is a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persist for at least six months. It is characterized by the frequent occurrence of at least four of the following behaviors: losing temper, arguing with adults, actively defying or refusing to comply with the requests or rules of adults, deliberately doing things that will annoy other people, blaming others for his or her own mistakes or misbehavior, being touchy or easily annoyed by others, being angry and resentful, or being spiteful and vindictive.

Marked on a Curve

In diagnosing this disorder, children are marked on a curve. "To qualify for [ODD], the behaviors must occur more frequently than is typically observed in individuals of comparable age and developmental level" (emphasis added). The behaviors must also be seen to impair "social, academic, and occupational functioning."

The parallel with drapetomania is ominous. Children, after all, are in a form of captivity and as they get older may naturally resent having decisions made for them. They may especially dislike being confined most days in stifling government institutions allegedly dedicated to education ("public schools"). Some may rebel, becoming vexatious to the authorities.

Is that really a mental, or brain, disorder? PubMed Health, a website of the National Institutes of Health, discusses treatment and prevention in ways that suggest the answer is no. "The best treatment for the child is to talk with a mental health professional in individual and possibly family therapy. The parents should also learn how to manage the child's behavior" (emphasis added), it says, adding, "Medications may also be helpful."

As for prevention, it says, "Be consistent about rules and consequences at home. Don't make punishments too harsh or inconsistent. Model the right behaviors for your child. Abuse and neglect increase the chances that this condition will occur."

Strange Illness

It seems strange that an illness can be treated by talk and prevented by good parenting. And how was four arrived at as the minimum number of behaviors before diagnosis? Or six months as the minimum period? Odd, indeed.

While ODD is discussed with reference to children, one suspects it wouldn't take much to extend it to adults who "have trouble with authority." Surely one is not cured merely with the passing of adolescence. Adults are increasingly subject to oppressive government decision-making almost as much as children. Soviet psychiatry readily found this disorder in dissidents. Let's not forget that the alliance of psychiatry and state permits people innocent of any crime to be confined and/or drugged against their will.

So we must ask: Do we have a disease here or rather what Thomas Szasz, the libertarian critic of "the therapeutic state," calls "the medicalization of everyday life."  (Szasz's chief concern is commonly thought to be psychiatry, but in fact it is freedom and self-responsibility. See my "Szasz in One Lesson." )

It seems that the common denominator of what are called mental (or brain) disorders is behavior that bothers others which those others wish to control. Why assume such behavior is illness? Isn't this rather a category mistake? Why stigmatize a rebellious child with an ODD "diagnosis"? (Let's not forget what psychiatry not long ago regarded as illness  and abetted control of.)

Scientism

In our scientific age, many people find scientism, the application of the concepts and techniques of the hard sciences to persons and economic/social phenomena, comforting. In truth it is dehumanization in the name of health.

Szasz, a prolific author who celebrated his 92nd birthday earlier this week, writes,

People do not have to be told that malaria and melanoma are diseases. They know they are. But people have to be told, and are told over and over again, that alcoholism and depression are diseases. Why? Because people know that they are not diseases, that mental illnesses are not "like other illnesses," that mental hospitals are not like other hospitals, that the business of psychiatry is control and coercion, not care or cure. Accordingly, medicalizers engage in a never-ending task of "educating" people that nondiseases are diseases.

No one believes drapetomania is a disease anymore. Slaves had a good reason to run away. We all have reasons—not diseases—for "running away."

Sheldon Richman is editor of The Freeman, where this article originally appeared.