In 2021, the American Psychiatric Association (APA), the guild of U.S. psychiatrists, acknowledged its history of racism. However, it is difficult to imagine how psychiatry will ever acknowledge that its entire edifice is built on a fundamental bigotry.
Bigotry is defined by Merriam-Webster as: “obstinate or intolerant devotion to one’s own opinions and prejudices.” Racism is one type of bigotry, but not the only type. The fuel of all bigots is the same: the belief that their discomfort over others different from themselves justifies declarations of defectiveness in others.
While discomfort over racial differences fuels racial bigotry, the discomfort over other human differences fuels psychiatry’s opinions and prejudices with respect to all its diagnostic declarations as to which behaviors evidence “mental illness” and which are “normal.” All bigots reduce their discomfort by declaring others different from themselves as defective in some manner.
The APA’s Political Apology for Structural Racism
Just as it has been long known to Black Americans that being Black makes them more vulnerable to police violence, being Black also makes one more vulnerable to psychiatric violence.
Why, in 2021, did the APA finally issue the APA’s Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psychiatry (followed by its Historical Addendum to APA’s Apology to Black, Indigenous and People of Color for Its Support of Structural Racism in Psychiatry)? The APA makes clear what precipitated their apology: “Events in 2020 have clearly highlighted the need for action by the APA to reverse the persistent tone of privilege built upon the inhumanity of past events.”
While the APA has a long history of ignoring science and perpetuating social injustices, it has just as long a history of attempting to be politically in step with mainstream U.S. society. Following the 2020 murder of George Floyd by police, the APA recognized that the U.S. political climate had dramatically changed. In this new climate, not only would there be no political cost for the APA to acknowledge psychiatry’s racism, the APA recognized that it may well be a political win for them to proclaim their historical racism as loudly as possible. The APA recognized that in this new climate, to acknowledge racism is evidence of “virtue,” so virtue signaling the APA did. The politically astute APA knows that in today’s political climate, institutions will not lose status for acknowledging their historical racism because the mainstream consensus now acknowledges that most U.S. institutions have been historically racist. A loss of status will only result from not acknowledging racism, and the APA has always been extremely concerned about their status.
The political strategy of acknowledging one type of wrongdoing to evidence an institution’s capacity for “self-correction” without acknowledging its essential moral criminality is a long-time institutional strategy to maintain status. For much of U.S. history, massacres by the U.S. government of Native Americans, such as at Wounded Knee, were simply buried; and when these massacres were finally acknowledged, the U.S. government ignored the fact that such massacres were only one component of a policy of genocide of Native Americans (which included destroying their food supply, forced sterilization, and other components that meet the United Nations definition of genocide). Similarly, during the Vietnam War, owing to investigative journalism, the U.S. government was forced to acknowledge the My Lai massacre of Vietnamese women, children, and the elderly; but the U.S. government has never acknowledged that the Vietnam War was based on politically motivated lies—and that those U.S. leaders who orchestrated it are war criminals.
The APA begins its 2021 apology for racism with a self-congratulation: “Today, the American Psychiatric Association (APA) . . . is taking an important step in addressing racism in psychiatry.” The APA then apologizes first to its own members—then to patients, their families, and the public: “The APA Board of Trustees (BOT) apologizes to its members, patients, their families, and the public for enabling discriminatory and prejudicial actions within the APA and racist practices in psychiatric treatment for Black, Indigenous and People of Color (BIPOC).” The APA acknowledged that their racism is not simply historical but exists presently, giving the example of “variations in schizophrenia diagnosis between white and BIPOC patients.”
The APA apology also includes the following: “Since the APA’s inception, practitioners have at times subjected persons of African descent and Indigenous people who suffered from mental illness to abusive treatment, experimentation, victimization in the name of ‘scientific evidence’. . .” Note that this is an apology for the APA’s cruelty to individuals who suffered from mental illness—not an apology for labeling people as mentally ill.
Psychiatry’s Essential Bigotry
Understanding psychiatry’s essential bigotry means examining psychiatry’s criteria for “mental illness.” The key question is: What is the actual criteria that psychiatry uses to decide whether we are “mentally ill” or “normal”?
Psychiatry’s “mental illnesses” and their “symptoms” are voted in by the APA and listed in their diagnostic manual, the DSM, which the APA regularly revises. On rare occasions, when there have been dramatic socio-cultural changes—such as those with respect to homosexuality—a “mental illness” has been voted out of existence. More often, socio-cultural changes have resulted in “mental illness” additions.
Homosexuality as a mental illness was abolished by an APA vote in 1973, and it was no longer catalogued as a mental illness in the APA’s 1980 DSM-III. However, in that same DSM-III, we see the addition of so-called “child disruptive behavioral disorders” of attention deficit disorder (later renamed attention deficit hyperactivity disorder or ADHD) and oppositional disorder (later renamed as oppositional defiant disorder or ODD). “Symptoms” of ODD include: often argues with authority figures, actively defies or refuses to comply with their requests or with rules, loses temper, and easily annoyed and angry. Eventually, these young “disruptors” would be heavily drugged, including with antipsychotic drugs; as the Archives of General Psychiatry reported in 2012, “From 2005 to 2009, disruptive behavior disorders were the most common diagnoses in child and adolescent antipsychotic visits.”
Psychiatry’s illness abolitions and additions are a window to psychiatry’s actual criteria for its “mental illness” declarations—the criteria being those behaviors that the APA believes create discomfort, tension, and inconvenience in society.
By the 1980s, U.S. society was growing more tolerant of homosexuality, which was creating less discomfort. However, U.S. society had grown increasingly intolerant of young people who weren’t cognitively and behaviorally complying with academic demands and adult authorities, and the APA believed that these young people were creating increasing discomfort, tension, and inconvenience in U.S. society.
By the 1980s, academic success was increasingly seen as so vital in U.S. society that psychiatry was able to exploit the parental fear that children who did not cognitively and behaviorally comply with school demands and go on to college would be financial failures. With such fear, there was little thought as to whether illness diagnoses and drug treatments would in fact help these noncompliant children in the long run. There was even less thought as to whether or not it is desirable to have a society in which those children who don’t comply with standard schooling should be considered mentally ill. In contrast to the 1960s and 70s, an era in which authoritarianism was routinely challenged, there has been decreasing efforts to provide truly diverse education for the large group of children who are not, by their nature, compliant and conforming.
Once U.S. society took ADHD and ODD seriously, and once drugging of school-aged disruptive children was deemed “appropriate,” it was a simple matter to move on to pathologizing preschoolers and drugging them. In recent years, socio-economic variables have resulted in parents becoming increasingly stressed by the demands of survival, with decreasing time and community support to help them be patient and loving in the face of normal frustrating behaviors by their children. Financial survival for parents demands pre-school daycare, and parents are anxious about the prospect of their disruptive child not being able to cut it there. Enter preschool ADHD and pediatric bipolar disorder.
What are some of the “symptoms” of preschool ADHD and pediatric bipolar disorder that can result in a three-year old being heavily drugged? “Symptoms” for preschool ADHD include: talks a lot and makes more noise than peers, doesn’t pay close attention to details, fails to follow instructions, unable to wait their turn, and interrupts others often. The “symptoms” of pediatric bipolar disorder include: acting hyper, exuberantly happy or incredibly silly behavior, talking quickly or switching topics mid-sentence, and erupting in extreme upset when obstacles arise or they are told “no.”
In 2007, even the mainstream media was appalled by one tragedy ensuing from these preschool ADHD and pediatric bipolar diagnoses. The 2006 death of four-year-old Rebecca Riley was reported on 60 Minutes by Katie Couric in her September 30, 2007 story: “What Killed Rebecca Riley?” When Rebecca was twenty-eight months old, following complaints by her mother that she had difficulty sleeping, seemed hyperactive, and was “constantly getting into things, running around, not being able to settle down,” psychiatrist Kayoko Kifuji, at the Tufts-New England Medical Center, diagnosed Rebecca with ADHD; and Kifuji prescribed clonidine, a hypertensive medication with significant sedating properties. When Rebecca was three years old, Kifuji added the diagnosis of pediatric bipolar disorder and prescribed two additional drugs, the antipsychotic Seroquel and the anticonvulsant Depakote. At age four, primarily due to clonidine intoxication, Rebecca died. Rebecca’s parents were convicted of murder (viewed as sedating her to make her easier to manage, and attaining a psychiatric diagnosis to garner disability payments); however, a juror, who voted for the second-degree murder conviction of Rebecca’s mother, spoke for her fellow jurors: “Every one of us was very angry. Dr. Kifuji should be sitting in the defendant’s chair, too.” However, Kifuji’s treatments were defended by Tufts-New England Medical Center, whose spokesperson told 60 Minutes the following: “The care we provided was appropriate and within responsible professional standards.”
Mental Health Professionals and Bigotry
The essential fuel of psychiatry’s bigotry is the arrogant belief by psychiatrists that their discomfort over humans different from themselves justifies declarations as to which human behaviors are deemed “mental illnesses.”
Bigots don’t routinely believe that they are bigoted, and this is certainly the case for psychiatrists and other mental health professionals. Bigots tend to view their own personal traits as either “normal” or “superior,” and they see their discomfort over others different from them as justification for their declarations of the defectiveness of others.
What are the characteristics of the majority of mental health professionals? The process of gaining acceptance into medical school or graduate school and becoming a psychiatrist or psychologist requires a great deal of cognitive and behavioral compliance. Both the selection and socialization process results in obedience to demands of authorities—an obedience that many professionals label positively as “adjustment.” Thus, for many of these professionals, noncompliance appears to be “maladjustment” and evidence of “mental illness.”
My experience is that most mental health professionals are unaware of how this selection and socialization process results in extraordinary compliance, and so few of them rebel against the arrogant assumption that noncompliant individuals are “mentally ill.”
If, in an imagined society, the noncompliant and disobedient were in charge of deciding who are “mentally ill” and who are “normal,” they could make the case that submissive compliance by one parent can enable emotional and physical child abuse by the other parent; and they could make the case that ass-kissing by subordinates can enable disastrous societal policies.
In contrast to this imagined society of authorities having respect and affection for the noncompliant, existing U.S. society has had mostly very different authorities—from psychiatrists to presidents. Former president Lyndon Johnson, who deceived the American public about the Gulf of Tonkin incident that set in motion the Vietnam War tragedy, discussing a prospective assistant, stated: “I don’t want loyalty. I want loyalty. I want him to kiss my ass in Macy’s window at high noon and tell me it smells like roses. I want his pecker in my pocket.”
In the world we live in, submissive compliance and ass kissing not only don’t create discomfort for most authorities but are pleasurable for them—including for psychiatrist authorities. No wonder then that there are no mental illnesses called “submissive-compliant disorder” and “ass-kissing disorder.”