Editor’s Note: This is a transcript of Will’s talk from the INTAR 2016 conference panel “Mental Health, Community Development, and Human Liberation” with Gayathri Ramprasad, Jayasree Kalathil, and Dominic Makuvachuma-Walker.
Mental Health, Community Development, and Human Liberation
I want to thank the INTAR India group and especially Bhargavi for all their work bringing me here, it is really an honor to be invited. Throughout my life I have, like many of us, felt deeply enriched by the cultural and religious traditions of India and originating in India, and so it was with enormous gratitude that I heard I was invited to come here to join you in this gathering. I feel that above all I am a learner in your country, a student of the knowledge arising from India and its traditions. I am just at the beginning of this learning and I very much appreciate the opportunity to be with you here, it is of huge significance and personal meaning to me.
India, like all things in this life, appears to us in its dual aspects; both a rich source from within its own indigenous history and also a result of the imposition of forces from without. Both within India and from outside there is a learning for us around mental health, both as an ancient country at the source of so much human civilization, and also as a modern country only relatively recently colonized by empire and shaped from the imposition of an external cultural and political frame. Like all of us and all things it emerges from this encounter between the inner and outer, for India the inner nature of a country and the outer history and present of political colonialism.
When we speak of mental health, and specifically mental health crisis, we also cannot avoid this dual aspect. We have a human experience: hearing voices, falling into withdrawn states of pain and isolation, seeing inspiring messianic visions, torn by urges to end our own lives, mapping signs and symbols of vast menacing coordinations around us, or whatever strange mysteries we might call madness or have labeled as psychosis. And then from these inner experiences we encounter an external relationship, we respond with a label for understanding, we are motivated to speak or to withhold our speech, we pray or we pick up a pen to write a poem, we seize up and become like stone or we collapse and weep like a river, we shut out or we burst forth, we explore and talk back or we turn away in fear.
In mental health, in the human psyche, nothing reaches us as a thing in itself. There is no depression, there is no sadness, there is no mania, there are no voices, there is no suicidality. There is only something created by the relationship with these, relationships both within us, between us and others, between the inside of us and the cultural milieu outside in which we find ourselves. There is sadness and our relationship to it, which makes sadness something not just what it is without that relationship. There is depression and our relationship to it, which makes depression something not just what is without that relationship. And so with voices and visions and the rest of what we see as madness.
In mental health, like all human experience, we do not stand before glass and look at an object in the field of view before us. In mental health, like all human experience, we find ourselves already in a relationship, already in a dance and a current, an encounter between dual forces that propel and shape and above all move, impact and interact, engage and disengage. Our relationship to the thing creates the thing that we then relate to and create anew. It is relationship, not a thing, we see outside, and because we are in relationship we always see a reflection of ourselves.
In the 1980s homosexuality was removed from the Diagnostic and Statistic Manual of the American Psychiatric Association. Psychiatrists at the time were convinced that to experience sexual and romantic attachment to another of the same gender was a mental illness. In examining the “thing” of homosexuality, it was clear: homosexuality was distress, homosexuality was anxiety, depression, addiction, depression, suicidality, fear, and conflict. That homosexuality was a disease, it appeared, was beyond a doubt, because the thing of homosexuality that was observed carried with it so much of these mental health problems. It was verifiable statistically, clinically, and phenomenologically: to be homosexual was to suffer and to be maladapted. And so it was considered only obvious that homosexuality was abnormal and a mental disease.
But in the diagnosis from behind the glass, in looking at the object of homosexuality in the field of view, the dual aspect of the thing observed was ignored. The reflection of the doctors was there in what they saw, but they didn’t look within when they looked without. Like all human experience and like all of what is called mental health, there was a relationship and there was an engagement. A flow and a dance, not an object.
And so by observing that homosexuality was a thing of suffering associated with mental distress, it was not seen that homosexuality was and is also a relationship, and that only relationship reveals human experience. It was not seen that loving someone of the same gender was met with a relationship to the homophobia and violent repression of an oppressive society. The relationship between the inner experience of homosexuality and the outer relationship to homophobia — both in society and within individuals internalizing society as a relation to themselves inside themselves — was what created the human experience of loving someone of the same gender. And it was this relationship, shaped so centrally by homophobia, that was responsible for the higher rates of anxiety, depression, suicide, addiction, and all the mental distress observable associated with it.
It was the relationship to homophobia, not homosexuality in itself, that was the problem. The relationship, not just an object. What doctors saw in the thing was the society’s relation of homophobia, and a reflection of their own homophobia and their own fear. And this was not seen.
Then, of course, the relationships changed. The glass was broken. Police raided the Stonewall Bar in Greenwich Village New York like they had done so many times before, attacking and arresting and harassing, but this time the drag queens and trans people and gay men and lesbians threw rocks and set fire to police cars. They plunged the night into a protest we now remember as the Stonewall Rebellion. That rebellion ignited the modern gay rights movement, as hundreds of gay liberation groups were formed across the US and the world and took to the streets in organizing in the wake of that uprising in New York.
It was after Stonewall, not after Kinsey or psychological or sociological research, that the American Psychiatric Association was forced to change its relationship and no longer view homosexuality outside of the context of homophobia. Being gay was taken out of the DSM, allowing in some ways for the real work to begin of helping people survive in a homophobic world as someone who is different. Different human experience — minority experience to be sure but different, not illness or a disease — could become more recognized as a normal expression of human variation and diversity.
It is not an exaggeration to trace the Stonewall Rebellion to the anti-colonial movement in India. Human challenges to institutional power move across time and space. India produced Gandhi; Gandhi deeply inspired Dr. King, Dr. King inspired the civil rights movement that in turn nourished the anti-war, Black Power, disability, and women’s movements. Those movements were on the minds and in the hearts of the angry queers who rose up that night at the Stonewall Bar. And those movements inspired and nourished the patients rights and critical psychiatry initiatives across time and space that have brought us here to INTAR in India today.
With the change in relationships the thing being observed changed. We have a new understanding and conversation today around what it means to have sexual and romantic attachment to people of the same gender. Crucially, the scientific and medical discourses surrounding that experience have changed their relationship and so it is now different to be gay — the inner experience encounters an outer relationship that has shifted, reflecting new power relationships redefined by the Stonewall Rebellion and the liberation movement it helped usher in. Change continues and fear remains, but there is something new in the relationship now. The thing is not the same.
And so now we are struggling for a new relationship with other criteria held in the American Psychiatric Association’s compendium of scorn. Our critical stance today can trace its roots to the patient’s movement in the 1970s and 1980s, back through the consciousness raising groups of the women’s movement, to the Black Pride that came from the civil rights movement, back to nonviolence and anti colonial struggles. What we are addressing, and what we are here today to consider and to challenge, is the domination relationships of colonial power that take place not just between empire and nation but between black and white, men and women, gay and straight, able bodied and disabled, and normal and labeled as mentally ill. We are here to challenge how this thing called madness and mental health is in fact a reflection and a relationship, to redefine how society responds, and to insist that in the definition of madness we also see a reflection of the society looking at it.
I was a patient at Langley Porter Psychiatric Institute of the University of California at San Francisco Medical Center. Incidentally the same psychiatric hospital where Gregory Bateson did his pioneering work on the relationships of context and communication surrounding people diagnosed with schizophrenia. The violence done to me at Langley Porter took the form of restraints, being locked in a solitary confinement cell, threatened with being strip searched, having risky and toxic drugs administered to me without informed consent, and a constant environment of paternalism at best and degrading dehumanization at worst from which I could not escape.
I was given a diagnosis of schizophrenia, alongside a list of all the things observed about me that met that clinical criteria in the Diagnostic and Statistical Manual. I spent days and weeks almost immobile, speaking very few words and moving as slow as if I wore clothing weighted with lead. I heard voices echoing again and again my own voice and the voice of the person asking me, clouding my thinking and disorienting my responses. I believed I was poisoned, I believed my body was rotting, I believed I had committed some terrible act that deserved a punishment of death, I spoke in elliptical roundabout twists and turns that left others puzzled, thoughts intruded from others and there were screaming voices. I wanted to die.
What I was not given was the honest consideration of my experience within the dual aspect of the thing and the relationship to it. When my diagnosis was ceremonially pronounced, what was not understood was that these inner experiences were my own, that they arose from my life and I lived with them as part of my life as a meaning-making conscious being. That I and those around me would have relationships to these experiences was not considered or addressed in any way. My illness symptoms were attributes revealed, not relationships engaged. I was a thing to be defined. There was no recognition of the experiences I was undergoing as arising through my relationship to them, through the relationship of my life to them, or from the relationship of the people around me — including those with the clinical gaze — to what they were observing. Instead these observers presumed to be behind a glass in their field of view, not in an engaged relationship of becoming, dance, and movement and duality at the very ontological essence of what it was they claimed to see.
Every clinical symptom called psychosis can be induced in any human being in a laboratory context by controlling the person’s environment. Any human being. The presence of these stressors accounts for the psychosis, as a response to a relationship — without any disease process whatsoever within the individual or anywhere. By establishing certain kinds of stimuli — sleep deprivation for example, sensory deprivation or overload, neglect or isolation, confounding moral dilemmas or double binding communication contexts — all of the criteria for psychosis can be induced in any person who undergoes the stimulus. With enough of the right kind of stress, for long enough time, anyone, any human being, will become psychotic.
This clinical and readily observable laboratory fact leaves us with several undeniable conclusions, conclusions that would be readily admitted scientifically if they were not denied politically. First of all, we see that the experiences of psychosis are, like homosexuality, just expressions of human variation and diversity. Psychosis is no more disease than homosexuality is. Psychosis is and always has been a human capacity shared as a species — psychosis is something that we do under the right circumstances and that some of us seem to always do. That we cannot define precisely in a natural context what those circumstances are, that we cannot predict those circumstances, doesn’t take away from the fact that it is circumstances, it is relationships, that account for psychosis. In all instances. This is derived from the immediately observable fact that all forms of psychosis can be induced in any person in an experimental context by controlling stress circumstances they are subjected to.
Secondly, we see that since psychosis is a human variation and capacity, we can more readily understand why psychosis and schizophrenia appear to be found trans-culturally and trans-historically. All society and culture express experiences that would meet contemporary criteria for psychosis. Because all human societies are by definition human, we would therefore only expect a human trait of diversity psychosis to be found in all human societies, just as we do homosexuality. And we do.
We can also assume, and this is crucial, that the capacity for psychosis must confer some evolutionary advantage and fitness for the species as a whole. Without this advantage and fitness it would defy what we know about the nature and meaning of all aspects of humans as a species in the context of evolutionary biology. It simply does not add up to what we know about evolution to simply consider psychosis as a failure, limit, obstacle, or breakdown of the organism. If it were, it would have disappeared from the evolution of the human mind as a species, rather than what we see — that psychosis consistently appears as a feature of human capacity in all cultures at all times.
Third, we then have to ask what it is that denies the proper understanding of psychosis as a trait of human diversity, and the suffering associated with it a relationship to context and engagement with inner and outer forces? And this is the question all liberation movements confront. It is not enough to ask what political and financial interests are served, though it is clear that plunder drives empire, slavery drives racism, and unpaid work and servile status drive sexism. There are also colonialisms that stretch inside us, there are also oppressions that arise from our fears of the Other in society and the fears of traces of the Other within ourselves.
The Gay liberation movement pushed aside psychiatry’s questions of why are gay people sick and raised the question: “Why are we afraid of homosexuality?” The survivor and critical psychology currents are now pushing aside the question how do we treat the diseased brains of mad people and instead raise the question: “Why are we afraid of human difference?” These movements stretch our politics both to the outer world of social domination and inequality and to the inner worlds of fearing the Other in ourselves and between us. To grasp our misunderstanding of the human diversity of psychosis we have to understand the full range of colonialism as both economics and as psychology.
My own liberation has not been a recovery of normalcy. I still hear voices, I still fall mute, I still become frozen, I still see signs and symbols and vast coordinated intelligences, I still meet demons and I still wrestle with the urge to die. I have found my way, however, to a new relationship, a relationship you might call a post-colonial relation to my surround and to what is inside me. Instead of dependency on a master story about who I am, I have a counter story created by a survivor movement. I have an intimate social grouping of close and like-minded, similarly post-colonial friends and no-longer-labeled friends. I have a new language of spirit, nature, and ancestors. I live within a field of meaning and synchronicity, not a mechanistic collision or cause and effect. I discovered that relationships of isolation and powerless were what I needed to change — not any symptoms of what got labeled as psychosis itself.
Change within me came when change came to the communities I live in. From first exploring myself as a trauma survivor against the psychiatric discourse, today I see myself as in a cultural conflict, with my indigenous ancestry nurtured by counterculture and informing a clash with assumptions and preconceptions derived culturally, not objectively, from the scientific and technological society that labeled me as disordered. My reality, different and minority perhaps, is no longer under colonial rule, but the legacy of colonialism remains, both within me and without.
Humans are always found in communities, and it is to communities that this conference is dedicated and to which we turn our focus. Mental health, as my friends and colleagues here will be exploring these several days, is about the relationship of how we view what is called madness. Do we treat diseases and disorders in individual brains and psyches? Or do we locate those who suffer and those who we don’t understand, and locate ourselves, within communities? Psychiatry has offered treatments. We promote community development. We ask new questions that bring a new relationship to the fore. We break the glass that separated the observer from the thing of madness and we look instead to engage, relate, and connect. We step outside the colonial frame and look to traditional and indigenous wisdom that has already answered so many questions of how to best respond to madness.
We build up the communities that already exist, the resources and capacities to respond already happening, rather than impose more colonial mechanisms of consumerism and expertise. We look without and also within ourselves, to the forces of Othering and fear within us, to understand how to strengthen and nourish the communities in which we live. We do this without denying physical problems or illness, which can so often mimic mental illness, and we do this without romanticism or denying suffering. We are carried forward by the work of the liberation movements that come before us, that stretch from the Gay rights movement to the women’s movement and the Black Power and Civil Rights movements, and then back again to the anti-colonial movement of Gandhi and India.
It is my great honor to be here as part of these questions and initiatives and discussions. I am enormously grateful to have the opportunity to learn with you, and I thank the movements and the colleagues that carry me with them. I am inspired to be here with you, as we explore what it means to be human, inside ourselves and in our relationships with each other and the world, and as we all seek to find a way to liberation, together.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.