Why is it that so many people seem to think it’s a good idea to replace certain functions of police with mental health workers?
It is likely that deep down, people know that the mental health system, particularly psychiatric hospitals, serve much the same function as the police and jails: social control.
As stated by Stefanie Lyn Kaufman-Mthimkhulu, in her recent article We don’t need cops to become social workers: We need peer support + community response networks,
“Psychiatric institutions are, in fact, part of the carceral state. This means that they are part of the many systems that function to: contain people, take away their locus of control, offer surveillance, isolate them from their communities, and limit their freedom.”
To be clear, replacing police presence with mental health interventions will look nothing like a cozy visit to one’s beloved therapist in a private practice office, sipping oolong tea and smelling lavender oils.
There may be times when a caring social worker listens, de-escalates the situation, mediates conflict, and directs the person and/or family toward resources without violence and without force. This stuff works and I’m certainly here for it.
More often, however, mental health workers responding to emergency calls and crises results in coercion, labelling and othering, paternalism, force, and, yes, even violence, all under the guise of “for your own good.” The penal system and that of mental health are both spokes of the same wheel: built on patriarchy, oppression, isolation, silencing, and control.
And, before the refrain of “not all professionals” or “not me” or “not anyone I’ve ever known” starts to reverberate, know that these words are always the words of an oppressor. So, please, just stop. This is about systems, not individuals, even if individuals within such systems inevitably become part of the problem.
The Mental Health System is Built on Racism and Bias
It is nothing new to point out that the mental health professions have been designed to act in the role of regulating the marginalized and reinforcing White male control.
Since its beginnings, psychiatry has used its medicalized language and pseudoscience to deny experiences of abuse, tyranny, and assault as delusional or, worse, the uneducated perceptions of lesser stock that cannot appreciate help when they see it. Drapetomania, a purported “peculiar” mental illness that made slaves run away, is certainly a prime example.
Mental health professionals played a central part in the development and legitimization of the Eugenics movement. Psychological tests were designed based on White, American norms to determine intelligence and mental fortitude. Those who did not do so well were thought to be genetically inferior and in need of either help from the superior genetic class and/or sterilization or, worse, extermination as in the Nazi camps.
Though it may be believed that much has changed, only just this last month did universities in California decide to stop using the SAT due to its inherent racial and socioeconomic prejudices. This test was designed in a not dissimilar manner to those of a century ago. And it’s 2020.
Aside from such egregious arrogance, the current bio-medical paradigm is also fundamentally racist (and sexist, and heteronormative, etc., etc., etc.) at its core. Diagnostic categories exist based on whatever deviates from the social norm, which, of course, is that of the upper-class White Western man.
Think that’s an unfair overstatement? First, diagnoses are based on committees that consist of almost entirely White men. Second, these categories are nothing more than descriptions of behaviors, not a disease that one can locate and define. Lastly, in an effort to legitimize these made-up categories by looking at the brain, fMRIs have been used to suggest that these diseases can be found in the brain. How do they know? By comparing “ill” patients to “controls.” Who are the controls? White middle-upper class college kids in America. For added fun, these brain scans aren’t even that useful in telling scientists anything about any individual’s brain anyway.
But, there’s more.
Rates of admission into psychiatric facilities, even without bringing more mental health professionals into Black communities, are three or more times higher among various Black groups. These admissions are also more likely to be by force. In other words, Black individuals are being forcefully locked up far more than White people—Does this sound familiar?
And, as soon as a person becomes diagnosed as mentally ill, the contextual and societal factors (racism, poverty, lack of education, chronic stress, oppression, abuse, neglect, violence, etc.) that underly the emotional distress in the first place immediately become secondary or forgotten altogether.
Giving greater power to mental health professionals to diagnose and institutionalize is directly antithetical to finally giving weight to these social traumas and putting them front and center.
People Do Die as a Result of Mental Health Care
Granted, when a mental health professional shows up to an emergency call, it’s much less likely that someone will be murdered. That’s a good thing. But, this doesn’t absolve the mental health professions.
This article in the Huffington Post begins with the very confident statement: “So far there have been zero deaths at the hands of social workers.”
Confident absolutes do not equal truth.
While it is true that social workers do not show up to a person’s home, pull out a gun, and cold-heartedly kill them, insinuating that no one ever dies due to psychiatric interventions is inaccurate, at best.
Early death, by up to 25 years, is frequently found to be associated with long-term use of neuroleptics/tranquilizers (euphemistically called “anti-psychotics). And guess who’s most likely to be forced to take these dangerous drugs? Black people.
While some may suggest that the odds would be worse without the drugs, anyone reading Mad in America should be familiar with Robert Whitaker’s work in this area, showing this suggestion to be complicated and largely false. The socially accepted, but scientifically invalid, idea is that these drugs are insulin for schizophrenia. They are not.
Oh, and guess who’s most likely to be diagnosed with schizophrenia? Black people.
In fact, as outlined by Jonathan Metzl in his book The Protest Psychosis, schizophrenia has essentially become a Black disease. Its very definitions and clinical portrayals are designed to epitomize the stereotype of the angry Black man. This was purposefully done in reaction to the Civil Rights Movement of the ’60s, with ads at the time almost exclusively depicting a caricature of a rabid Black man.
The relationship between early deaths associated with cardiovascular disease, actual diabetes, hypertension, and suicide among those with severe mental illness diagnoses is complicated, but there is no doubt that the effects of the drugs play a large role in much of this. So, too, do the larger traumatizing interventions.
Suicide, in fact, is directly associated with mental health care. Acknowledging mental illness early on after a diagnosis of schizophrenia is directly associated with depression and suicide attempts. Simply being given a diagnosis of schizophrenia is enough to make a person take his or her own life.
Completed suicide is also consistently shown to increase in tandem with increased involvement in mental health services, especially when such interventions are forced or coerced—which would be the case in almost every instance of replacing police with doctors.
Oppression is oppression whether the uniform is a badge and gun or a white lab coat and prescription pad. Many who have experienced both prison and psychiatric hospitalizations prefer the police. Psychiatric survivors have described their forced hospitalizations as torture. Many would rather be beaten with a baton than to be forcefully injected with mind altering substances that invade one’s core internal being, a process that has been described as akin to rape. As documented by Mindfreedom, Michael Heston, who committed suicide as a result of his psychiatric “care,” wrote:
“I’m sure you’ve heard it all before, but I am being tortured. Force injected in solitary. Medicine makes my spirit sick and torments the very soul within me. As well my legs shake and my feet are all antsy. This bodily torture is intolerable. The rape, and not having determination about what goes into my very blood is having extreme psychological effect of me. The forced Risperdal injections are causing my body to deteriorate and I am in mental agony nearly all the time.”
Secondary to all of this is the fact that people with a psychiatric diagnosis receive a lower quality of care for their actual physical health, which also increases the rates of mortality.
Even when people don’t die, there is plenty of violence involved with involuntary commitments. Restraints, take-downs, seclusion, and, of course, forced injections of mind-altering drugs, are commonplace in most psychiatric facilities throughout the country.
Beatings Hurt, But Psychological Abuse Sometimes Hurts More
Being beaten, bullied, abused, and/or assaulted can scar a person for life. But, doing these same things emotionally, and telling the person that they should appreciate it is devastating beyond belief. This is emotional and psychological abuse. Period.
In fact, studies have shown that psychological abuse has effects that are at least as dangerous, if not more so, than physical abuse. Emotional pain and assault are real, and sometimes worse than physical pain.
One of the worst ways that emotional manipulation, oppression, abuse, paternalism—call it what you will—deeply harms is by fundamentally changing one’s sense of self and agency. If you’ve spent a lifetime experiencing microaggressions, lack of opportunities, surveillance, poverty, and/or overt racism and then meet a doctor who tells you that the emotional distress and fear you experience as a result are, in fact, symptoms of a brain/genetic illness in need of drugs (of course, their drugs, not yours!!!), your sense of defectiveness and helplessness risks becoming solidified at the very core.
Replacing the taser guns and brute force of militarized police with needles and the psychological manipulation and gaslighting from medicalized authoritarian do-gooders is flipping the same coin on its head. It’s like entering the Upside Down in Stranger Things.
I mean come on! Is this the best answer we, as a society, can come up with when calling for dismantling systems of oppression and racism?
Black Voices Matter
More than anything, being labeled as mentally ill and given mind-altering, numbing, and tranquilizing drugs serves first and foremost to silence and to tame the voices of the suffering. Trauma and oppression give way to chemical imbalances and brain diseases, despite no physical or scientific evidence to justify this.
People are not ill for being angry, crazed, overwhelmed, fearful, suspicious, hurt, sad, and/or unable to express it in ways others find tolerable. And, they sure as heck are not sick because they’re poor, despite the apparent fact that poverty has, quite literally, been medicalized and pathologized as “mental illness.”
The voices of the traumatized, the tortured, the oppressed, the abused, and the hurting deserve to be heard. Psychiatry will ensure that that only happens if it is done in a docile, pleasant, and non-discomforting, straightforward, logical manner. Even then, you’ll still be gaslighted into thinking you’re crazy or be told you’re just paranoid.
As stated in this recent article in The Atlantic: “The country needs to shift financing away from surveillance and punishment, and toward fostering equitable, healthy, and safe communities.”
Who can argue with that? If funding were directed toward programs and initiatives that provide basic needs, hope, and empowerment; if oppressive patriarchal systems were dismantled and rebuilt on a diverse platform of equality; if humanity and relationship were valued above money, retribution, and preparing for war, then we all might find the peace in our communities that we are hoping for. If we had universal healthcare, universal childcare, caring and empathic doctors of all kinds who were trained to listen instead of know everything, and interventions based on safety, validation, and empowerment, then maybe people might actually start to heal.
Sadly, however, the movement towards progress appears to be suggesting taking a parallel road that leads to reliance upon yet another racist system based on oppressive patriarchal ideals. While it might sound caring and kind to turn towards the mental health system to respond to community distress, it must be recognized that this is an intertwined system with that of the (in)justice system and is one equally built on institutional racism, surveillance, punishment, and abuse.
Having social workers, peer workers, and other advocates respond to emergency calls by providing de-escalation of crises through listening and facilitating problem-solving, and by offering home visits (particularly to the elderly and disabled) along with housing connections, food, supplies, family interventions, supportive relationships, and assessment of abuse is a promising initiative that should most certainly be funded to a greater extent than it is currently. More efforts toward inclusion of peers and community members versus healthcare workers is an even more promising step.
At the same time, having social workers, medicalized peer workers, psychologists, and psychiatrists respond to distress calls or community violence through the lens of getting them mental health treatment is simply replacing one racist, oppressive regime with another. They may not come in guns a-blazing or physically beating up innocent bystanders, but, as a system, they are granted the authority to psychologically manipulate your reality, beat you down with words and restraints, and drug you into submission—and insist you thank them for it afterward.
What is needed is anti-violence, preventative, humane, community-based initiatives, not another racist, White-centered, patriarchal, oppressive, violent, forceful system that is dictated by powerful White men and demands a submissive and complacent sort of happy silence.
People need to be brought together with compassion and harmony, not split apart and isolated through diagnosing their pain as existing in the brain, drugging them, and locking them away in a veiled jail cell.
Please, if change is gonna come, can we at least try to do better than this?
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.