Systemic Violence and the Mental Health Industrial Complex

Dr. Eric Greene’s new paper uses three cases to illustrate the systemic violence perpetuated by a mental health clinic in the US.

Zenobia Morrill
26
2009

A recent paper, by Dr. Eric Greene, builds upon critiques of the biomedical model and illustrates how the mental health industrial complex overmedicates, stigmatizes, and creates long-lasting iatrogenic effects for those most marginalized in society.

By positioning mental health problems as purely individual issues, the mental health industrial complex depoliticizes distress, effectively conditioning people to overlook structural issues, such as racism and classism. He argues that the mental health field in the United States perpetuates systemic violence, suggests that being human is reducible to our brain chemistry, and ignores context and culture.

“This specific ontology of subjectivity, which defines the entire human experience as a result of brain chemistry, is a singular, restrictive and reductive understanding of all the ways in which humans and their subjectivity can be understood,” Greene writes. “And, this reduction serves a specific political function. That is, it keeps those who are oppressed inward looking and forecloses knowledge of the dominant class as they exert enough force to contribute to extensive suffering and mental illness in the oppressed.”

Photo Credit: BLM

Greene goes on to explain that endorsing this biomedical philosophy of life, which obscures structural violence, props up the mental health industrial complex as a business, built upon a model in which suffering is exploited, and billions of dollars of revenue are brought in. Greene writes:

“This specific kind of colonization of consciousness (i.e., ideology or false consciousness), by the mental health industrial complex contributes to what the professor of humanities, Dr. Robert Zaslavsky, has coined as the current ‘culture of incapacity’ and elicits mantras of self-blame while exploiting humans as patients for the bottom-line dollar. In short, the definition and diagnosing of mental illness is political.”

At the same time, the inner workings of the mental health industrial complex and the state are overtly evidenced by the extensive coordination of services between mental health facilitates and police, prison systems, and education systems.

In this paper, Dr. Greene shares his first-hand experiences of the mental health industrial complex as a therapist working with disenfranchised individuals in the Northeastern United States. To describe the complex dynamics, he analyzes three case studies of black male patients.

Greene suggests that the patient population he works with represents individuals who have been placed within “zones of social abandonment.” Drawing from the work of Biehl, he summarizes this abandonment process as one in which “persons are marginalized to the fringe of society wherein they are further exploited, oppressed or abandoned with little to no recourse.”

He connects this to his work at the mental health clinic, writing that it represents one of these zones of abandonment. He goes on to describe overt abuses of power by the clinic staff that he felt paralleled the damaging sociopolitical dynamics taking place within the wider community setting.

For example, he attempted to confront a staff member who regularly slept with their patients. The staff member was indifferent to this confrontation, inviting him to report him because he “had no proof.” Indeed, when Greene made the report, he was informed that if he did not personally see or witness anything, the authorities could not act.

Greene recounts a disturbing, overtly racist comment made by a senior psychiatrist:

“On one unforgettable day, a senior psychiatrist said, in reference to poor black patients, ‘We should just drop a bomb on this whole community and end their suffering. They are evil and broken. They can’t help themselves. All they do is act like wild animals, and there is no way to help them.’ I was so stunned by the comment. The only phrase I could utter was ‘How can you say something like that?’ To which, he replied, ‘Because it’s true. They can’t be helped.’”

The clinic functions on a model of providing quick fixes, he writes. Medication is administered liberally. Greene recalls how patients would often forego therapy sessions, yet lines would build in the medication refill room.

The fleeting nature of the psychotherapy relationship is enforced by a system designed to “get as many patients out and in as possible,” according to the clinic director. As a result, patients who would most likely benefit from long term, supportive relationship are more likely to re-experience abandonment in therapy.

Clinical conceptualizations of client distress were not only saturated by biomedical understandings of individuals as chemically disordered but were influenced by racially biased misperceptions. For example, young black boys were criminalized, perceived as older, and described as aggressive.

Greene provides specific details of the entrenched racist and classist functioning of the clinic and its employees when outlining the three cases. In one of the cases, he discusses and analyzes the clinic’s response to an 8-year-old black boy referred to in the paper by the name of John.

John was given diagnoses of ADHD and Oppositional Defiant Disorder (ODD). He had missed a lot of school in the last year and had been expelled from a previous school. The psychiatrist described John’s case as hopeless, with the possible exception that the “miracle of medicine could cure him.” Therefore, they prescribed John aripiprazole, an antipsychotic associated with adverse effects such as headaches, weight gain, insomnia, and anxiety. John developed all of these side effects. He developed a more subdued, quiet disposition. Although his grades appeared unchanged, he was able to attend school and “sit still.” He was prescribed trazodone in response to his drug-induced sleep difficulties.

Dr. Greene describes how his conceptualization of John differed from that of the clinic’s formulation. As he learned about how John’s father was incarcerated, he understood John as demonstrating the effects of trauma rather than ADHD or ODD. Greene calls attention to his hesitance to develop close relationships, despite his pain and desire for care, as a valid presentation, given his experienced relational inconsistency. John’s mother opened up to Greene about her suffering, hopelessness, and short temper. She was a single mother, working multiple jobs. She expressed guilt and shared that this manifested in physical abuse of John, sharing one instance in which she hung him in the closet by his hands, beat him with a belt, and called him racial slurs. Greene recognized this as a manifestation of intergenerational trauma and the hopelessness generated by slavery, historically, as well as the modern-day systems that sustain racism and classism.

Greene writes that his attempts to contest the clinic’s mode of operations were not effective. He writes that “the psychiatrist dismissed the family situation as ‘normal’ for ‘black people.’ On multiple occasions, he told me that ‘they have no sense of family integrity.’ This type of racist statement completely disregarded the greater political dynamic by which black people have been dominated for centuries, and from which currently black people continue to suffer, thus making the cohesion of a family structure problematic and difficult.”

He goes on:

“Within our case consultations, protesting such racist statements was not effective. On several occasions, I attempted to discuss alternative dimensions to the patient’s suffering including economic hardship and historical context.”

Ultimately, such protests were dismissed, and the psychiatrist’s scientifically objective stance was reinstalled as a defense to considering alternatives.

“These concerns were met with a nodding agreement and then a change of subject, or, the phrase uttered in response was, ‘yeah, but there’s nothing we can do about that’, or stated disagreement. On one occasion, I approached a psychiatrist privately to ask if he thought his opinion was obscured by racial and class bias, and he scoffed in reply, stating that his ‘objectivity’ was ‘intact’ and that (i.e., race and class) ‘did not matter’”

As Greene goes on to depict his experiences across the additional two cases, he notes how the clinic’s myopic focus on personal shortcomings that relies upon racist and classist ideologies perpetuates systemic violence. This myopic focus on the individual’s deficits simultaneously renders the complex nature of their suffering invisible. He writes:

“It appeared that both racism and classism were entrenched in the functioning of the clinic and in the minds of its employees. These ideas and attitudes were not susceptible to critique. Accordingly, this structural violence perpetrated on the poor and the marginalized clients had less to do with inner-personal problems — which were also present — and much more to do with a system that seemed to have both given up on them and related to them by means of an antagonistic dynamic. This subaltern population had no voice and was, therefore, invisible.”

Greene writes that although these experiences were unsettling, they are perhaps not surprising. Very little training is afforded to examining the insidious impact of racism and classism in our society, much less its foundational role in structuring mainstream mental health services.

Greene supplements his writing consistently with statistics that document an ongoing trend of the pathologization and psychologization “ (i.e., converting socio-political problems into problems of personal failure)” of poverty and other forms of marginalization. He ends discussing the deep-seated realities of how structural violence has permeated within and perpetuated by the mental health industrial complex:

“The clinic and the therapies provided therein act as a tool of systemic oppression. Unless clinicians actively work against dominant racial inequalities and institutional forms of oppression, our tools work to perpetuate and exacerbate them.”

“Focusing on multiculturalism, empathy, understanding the ‘other’, identifying everyday violence and microaggressions, and recognizing the potential for empowerment are all helpful to create greater awareness and consciousness of the problems one faces, but institutional changes which impact the psychology of disenfranchised persons are more likely to happen by means of a radical confrontation with a racist and classist system. The social world needs to be changed, too.”

 

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Greene, E. M., (2019). The Mental Health Industrial Complex: A Study in Three Cases. Journal of Humanistic Psychology, 0022167819830516. (Link)

26 COMMENTS

  1. “They exert enough force to contribute to extensive suffering and mental illness in the oppressed”
    Lets talk about “Big” psychiatry. Keeping the psychosis in mind. If you have psychosis without a reason, then you have been sick since childhood. If psychosis has a cause, then you are not sick. Everything is simple.
    Those who are confused and do not understand what psychosis is will never know it, because it is a big secret.
    This quote is valid for fictional diagnoses such as depression. Assuming that a person can get seriously mentally ill, as a result of dominant class activity is a singular, restrictive and reductive understanding of all the ways in which humans can experience psychosis and get a lifelong misdiagnosis.

  2. BLACK MISDIAGNOSIS + CHEMICAL DEATH

    It’s dreadful that in the UK a 2nd Generation Caribbean man is 10 times more likely to be diagnosed as “Schizophrenic” (than a White UK man) – because we all KNOW that this CANNOT be TRUE.

    BUT, the Fact that 9 out of 10 Diagnosed UK Black Men DO NOT Recover demonstrates (In my opinion) that the Psychiatric Drug Treatments CAUSE the LONGTERM Psychiatric Illnesses.

    The Psychiatric Drugs also eventually KILL the Patient.

    • A social worker recently admitted to me that she’d been meaning to go back to her alma mater to discuss the societal problem that “there are entire black neighborhoods that are being psychiatrically drugged” in a city near me. I encouraged her to do that, since I work with underprivileged children, many of whom are black, and I hate to see them drugged.

      But the reality is that the “mental health” industry is a “racist and classist system.” It is also an iatrogenic illness creating system, since “the Psychiatric Drug Treatments” do, indeed, “CAUSE the LONGTERM Psychiatric Illnesses.”

      The ADHD drugs and antidepressants can create the “bipolar” symptoms, as Robert Whitaker pointed out in “Anatomy of an Epidemic.” And was pointed out in every DSM, except the newest, the DSM5, where this disclaimer was taken out of the DSM5.

      “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

      Plus, the antidepressants and antipsychotics can create the positive symptoms of “schizophrenia,” via anticholinergic toxidrome.

      https://en.wikipedia.org/wiki/Toxidrome

      And the antipsychotics/neuroleptics can also create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.

      https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome

      But the “mental health” workers deny this, because neither of those medically known, psychiatric drug induced syndrome/toxidrome are listed as billable disorders in their “invalid” and “unreliable” DSM billing code “bible.”

      https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

      Perhaps, if the psychiatrists garnered insight into the adverse effects of their “wonder drugs,” then the psychiatrists might be able to garner insight into the reality that they are doing harm to the black people, by psychiatrically drugging them.

      Black people can be helped, I know because I’ve seen amazing growth in the black children with whom I work. But black people will not be helped with the psychiatric drugs, which are the only tools of the psychiatrists. And the same goes for people of all colors. The psychiatric drugs are neurotoxins.

  3. Having worked in a community mental health clinic as a therapist for 22 years, ALL OF THIS sounds painfully very familiar.

    The Psychiatric/Pharmaceutical/Industrial/Complex is so deeply and firmly entrenched in modern capitalist society, that NOTHING short of a Revolution can dislodge this form of systemic oppression.

    Attempting to focus on reforming this System is an illusion. Fighting for “reforms” should ONLY be viewed as an important means to prepare minds and organize forces to get rid of this System once and for all.

    The profit system ultimately corrupts everything it touches, and it stands as THE major obstacle to the overall progress of human society on a worldwide basis.

    Richard

  4. Systemic violence, systemic state sanctioned violence, I’m glad to see the issue brought into the light of day. Racist and classist the system is, but it is cloaked in the language of biology, a language that becomes racist and classist when applied to certain socio-economic groupings of human beings. Obviously, in some situations, your “helpers” are not actually being so “helpful” at all, or, rather, they are, like buzzards, “helping” themselves instead.

  5. Fiachra,
    You write about the UK and I have witnessed white stupid nurses aggravate the heck out of black men and then call 4 400 lb white male security guards to tie them down while the idiot nurse injects them. This only happened to me once on my last capture in a “hospital/torture” center in Albany NY. But I witnessed a black male be tortured 3 to 5 times a day. When I got out I filed a complaint and of course was told other pts “care” is not my business. When I told the head nurse who called me after persistent complaint, I told her there was no food available at night and the man was tied down and injected 3 x a day after the nurses aggravated him. This man was so kind when I spoke to him and told him there was no food available, he went in his room and brought me packets of graham crackers. The nurses response was she ordered 4 sandwiches. If I was told that story, I would be more concerned about the man than the sandwiches. I knew this was getting no where so I did not waste my time talking w her. She also, a head RN, asked me how a human being should be treated. I am not kidding. I said with love care and kindness to start.

    I am sort of rambling here but I just found out the truth about psychiatry and I question… Is there a better place on the planet than the USA? Here our health care system is not about care, our justice system is not about justice and parents can harm their children and there is something wrong with the child??? Is this the world?? I have never been out of the USA. This country brags about all our money, but at what expense.

    • I, too, witnessed “mental health” workers harass a very large, but extremely nice, black man in a hospital. His name was John. They harassed him, then force injected him, despite the fact he did nothing wrong. I think they did it to terrorize the rest of us, really. And John was such a nice guy, if the “mental health” workers had harassed anyone else, he probably would have tried to help any other patient.

      • The racism in Upstate NY is sickening. I am still trying to do a few things to have this stopped at the two local hospitals/torture centers. One is literally called a teaching hospital. That is exactly what is taught in Upstate NY. As each year passes and I get no where with these horrible people I wonder if I am wasting my time. I do not know what else to do about this horrific “medical practice”. I see people have been working on this for decades.

  6. “By positioning mental health problems as purely individual issues…”

    This is still acting like ~mental health problems~ are somehow real. Hence this opens the door to the further legitimation of survivors via psychotherapy, recovery, and salvation programs.

  7. The blatantly racist quote cited by the author of the paper is very disturbing. It is from a senior psychiatrist and is grounds for dismissal or disciplinary action. This is a violent blatantly racist statement; it is documented from a credible source. I’m sure the author would have no reason to slander someone or use hyperbole to make a point. Therefore, wouldn’t the senior psychiatrist who is quoted as saying a ‘bomb’ should be dropped on an entire community of people of color be subject to some disciplinary action or licensing review for unprofessional conduct at the very least? I know a civil rights attorney who may have some suggestions for actions if someone could verify the facts in this paper? Logically, even without the advice of an attorney, it seems like if this psychiatrist is working for a hospital that is accredited by Medicare, then this would violate some basic civil rights standards and a grievance or human rights complaint should be lodged against this facility that could employ such a monster. I’m assuming the comments were made ‘on the clock’ and surely there are standards of professional conduct that a licensing board that this person could hold its members to.

    • wouldn’t the senior psychiatrist who is quoted as saying a ‘bomb’ should be dropped on an entire community of people of color be subject to some disciplinary action or licensing review for unprofessional conduct at the very least?

      The Philadelphia police dropped a bomb on an entire community of color in 1985, destroying two blocks and killing 11 men, women and children, and not one cop or city official was prosecuted or disciplined. So my guess would be no, as psychiatry is basically a police force itself.

    • What wasn’t made clear in this article but is stated in the original paper, is that the clinic the author worked at was in fact located in West Philadelphia, very near to where the MOVE bombing actually occurred. This doctor isn’t just suggesting something random and racist, he suggested bombing the very same community which was once already bombed. And not only was no one ever held accountable, the explosives were procured from the FBI and the bombing was approved at the very highest levels of the federal government.

      We have a cultural narrative that suggests the south is racist and the north isn’t. The difference is that in the south, individual racist people make trouble for Black folk, while in the north, the state and federal governments are happy to take on the role of terrorizing Black communities.

      As Oldhead mentioned, psychiatry is but another tool of the police state and the psychiatric industrial complex is in fact the prison/psychiatric/policing/military industrial complex. Divide and conquer tactics work because if we’re fighting each other, we’re not fighting Them. And by Them, I mean specifically the law enforcement/social control mentality that promotes the notion that we’re safer with policing – policing our schools, communities, workplaces, the world.

      This same policing concept is why the US military has nearly 1000 bases in over 100 foreign nations and why many foreigners accuse the US of policing the world. Social control is part and parcel of the imperialist and colonialist, white male dominant paradigm we live in. Once you realize the purpose that policing/prison/psychiatry/military industrial complex(es) serves, it’s hard to not become an abolitionist. How the heck can we call ourselves free?

      It is not surprising in the least that those in power are fighting so hard to remain in power and that those in power cannot relate to the marginalized. This goes far beyond race relations, and into interrelated and overlapping *systems* of oppression that keep most marginalized folks from fighting back effectively.

  8. Speaking of racism — “mental health industrial complex” is an unacceptable appropriation of the term “prison industrial complex.” If the anti-psychiatry movement purports to be in solidarity with the larger struggle of political prisoners we would limit our references to such as the “prison/psychiatric industrial complex” (or simply educate people about psychiatry being part of the prison industrial complex.

  9. The system itself is organized along racist/classist/sexist lines, and unless the field suddenly and miraculously divorces itself from the DSM and all the attendant “diagnoses” and similar medicalized language toward people in distress, it will continue to function as an agent of oppression, despite the scattered patches of sanity that one finds here and there fighting for their own survival. The fact that the psychiatrist could make that incredibly racist statement without an outcry from the entire staff shows how completely accepted it is that psychiatrists get to do whatever they want and the rest of the staff either go along with the bully or get bullied themselves. How anyone could get “saner” in such an environment is a miracle that occurs in spite of rather than because of the system itself.

    • Yes, there are very few women and People of Color on the DSM committees that pull strange and ludicrous “diagnoses” from out of their lily White hats. But of course the DSM is oh so scientific, especially when new “diagnoses are proposed by White men as they’re washing their hands in the men’s bathroom, and as they vote on these ridiculous things by a show of hands. So scientific. It’s disgusting.

    • Indeed, how anyone gets “saner” being traumatized by the forced treatment is beyond me. I had a doctor screaming at me, “Are you paranoid and do you have weapons?”-treatment as usual. I have noticed that most community mental health psychiatrists in my area are 1) from India, and 2) cold, brash, elitists. I hate to sound xenophobic but why are they importing so many psychiatrists (I know this is anecdotal evidence). I digress. In general, they are just bullies with high paying jobs. I dont even think they believe their BS but, hell, it pays for the new Porsche. Lets be honest its mostly about money and prestige. There world is divided between the mentally ill and them the sane doctors. They get to walk with an air of superiority while having the do-gooder mentality. Its fascinating, how few people even question the shaky ground of diagnosis? That goes for progressive types to boot. In fact, the amount of celebrities advocating for mental health awareness, which is always medication is depressing in itself. But it really is an industry full of fads and cons. Just read the research and notice hardly ever a mention of a subjective viewpoint from a client. The patient has disappeared under the microscope. How convenient for them-not having to deal with pesky things like racism, oppression, or lack of love.

    • Don’t forget promotion of ignorance among the characteristics of psychiatry/psychiatrists. Mental health is one of those career areas where you can be demoted/discharged for successfully treating patients by unapproved and/or irregular means, no matter how complete your patient’s recovery is.