A half century ago a “radical caucus” formed in the American Psychiatric Association. The group believed that mental medicine needed to change. The caucus also felt this way about the United States more generally. Racism. Sexism. Poverty. Dislocation. Militarism. Political divides. Corruption. Sound familiar?
Black Lives Matter. When we think critically about the needless death of George Floyd and other people of color, the removal of confederate statues and symbols, and massive protests across the country, it’s worth highlighting that racial justice was an important element of radical mental medicine over fifty years ago. Reflecting on discussions and debates a half century ago also enables one to think through the struggles related to white allyship and activism in 2020 and beyond.
In 1968, the radicals first coalesced as a group at the APA’s annual meeting in Boston under the rubric “Psychiatrists for Action on Racism and the Urban Crisis.” During the May meeting, concern “about the grave social conditions in the nation,” the “danger of riots,” and “the effects of racism and poverty on the social and emotional well-being of the entire country” resonated.
The Radical Caucus, mostly white in composition, fully supported the APA’s Black Caucus, which had existed since 1965. The Black Caucus members held up racism as a crucial mental health problem in the United States and stated that black psychiatrists were systematically barred from positions of influence and authority.
Problematically, this area of psychiatric history is extremely underdeveloped. At present, there are far more questions than available answers. And more research should be done in the APA archives and through interviews. What I can say is that members demanded more participation in the management of the APA, total desegregation of mental health facilities, and more training for black psychiatrists; the Black Caucus, rooted in a larger socio-political environment of civil rights activism, was a powerful faction advocating for change.
In 1968 and then afterward, the Radical Caucus took cues from the Black Caucus and also widened the discussion. The group circulated pamphlets indicting APA members for persecution of “black and Puerto Rican mental health workers” and “complicity with the military,” tying in the Vietnam War.
Radical Caucus members keyed in on four topics during the conference. One was how to work with grassroots groups; the second had to with the provision of emergency care during violent outbreaks. A third topic dealt with how to tackle racism. And fourth: how could radicals in mental health provide education and career ladders?
Answers were not always clear. But records of the meeting show that its aim was to create awareness of, as well as share experiences about, the practicalities involved in working with social movements.
For instance, in California, some psychiatrists and doctors had developed a working relationship with the Black Panther movement. It had, for its part, began to push for health rights. This took the form of political support for Black Panther candidates running for office. It also took the form of medical and psychological support during demonstrations. The practical lesson to be drawn was that mental health providers should “make [themselves] available and open up contacts with these local groups.”
The radical psychiatrists at the APA meeting also argued that they had opportunities to strengthen race relations in Boston and elsewhere. This would be a difficult task, since racism took “different forms and guises” and did not lend itself to a “specific activity [intervention] with a short range goal.” It was agreed that various strategies targeting institutions and individuals had borne fruit. One such strategy was to recruit medical students from the “negro ghetto,” thereby boosting the numbers of “racial and ethnic minorities” in hospitals and medical schools. Another strategy was to organize “programs to increase constructive contact between the races” through small “tea parties” or “more prolonged intensive mixed T-group” gatherings.
According to the former head of the APA, Dr. John Talbott, the radicals were actually a “disparate amalgam of people.” They were “everything from Marxist-Leninists to anarchists to people like me who were antiwar and were very upset about Kent State.” (In May, 1970, Ohio National Guards opened fire on student protesters at Kent State.)
Talbott added: many of them—radicals, that is—believed that the mental health establishment had to throw off neutrality and embrace individual and collective trauma which, they contended, were natural by-products of militarism, alienation, and endemic racism. The idea was that psychiatrists in general needed to be more aware of the wider socio-political environment and less focused (purely) on the individual. Talbott agreed in parts.
Other white male psychiatrists who agreed in principle occupied the Radical Caucus. Dr. Paul Lowinger was one. As early as 1964, he sought to locate his profession’s practices within larger societal changes, intellectual transitions, and notions of changing American exceptionalism. Lowinger participated in numerous marches for social justice during the early and mid-1960s and witnessed firsthand the violence and racism that were leveled against African Americans. He treated cuts and bruises, broken bones, and the emotionally traumatized.
White allyship then, as now, proved complicated. In targeting issues like pollution, overpopulation, racism, and nuclear war, mental health providers moved beyond the health of the individual and reconceptualized mental health as a national and global concern. As the Radical Caucus expanded its range of issues during the early and mid-1970s, as members moved into publishing and working with psychiatric survivors, some of the focus on civil rights struggles was lost.
The pages of the Radical Therapist also identified the wide-ranging etiological factors that contributed to mental distress in modern America. The list included not just sexism, racism, militarism, and the consumer economy but also the American educational system, environmental degradation, bureaucracy, and technological growth. For many radicals in mental medicine, society itself was sick. And it’s debatable whether it grew healthier.
Power and the medical model, mental health services delivery, the psychiatric oppression of minority groups, and psychiatry and the individual patient were all addressed. Without deviation, authors framed the goal of traditional psychiatry as “the maintenance of personal and professional power and prestige, economic well-being, and control over others.”
As was the case with other American conflicts and crises in the 20th century, the fallout from the Vietnam War and civil rights era helped redefine the role of psychiatry and society’s perception of mental health. I’ve written elsewhere that it was an era of transition, and even fear, with American society fractured by protests, a rights revolution on the home front, and hostilities abroad. A half century later, it’s worth asking, amidst our own crisis, what lessons can we draw from the late 1960s and 1970s?
One is that current protests and the Black Lives Movement, along with #MeToo and environmental activism, have the potential to be subsumed in the absence of political leadership. Champions, black and white alike, must continue to press forward for meaningful change. APA members still have the opportunity to join Minority and Underrepresented (M/UR) Caucuses—and should. Two, anxieties and precautions about COVID-19 and economic issues might also stymie civil rights momentum without planning. The Radical Caucus exists still and it can.
In recent weeks, the American Psychiatric Association has held town halls (for members only) to address structural racism in the United States. The American Psychological Association President, meanwhile, has suggested that “we are living in a racism pandemic.” Racial justice remains a part of mental medicine and health providers have a significant role to play in the current milieu, just as they did over fifty years ago.
Yet, prominent Black psychiatrists are leaving the APA, accusing the organization of systemic racism. According to Ruth S. Shim in STAT, “In our mental health system, people of color are overrepresented, misdiagnosed, and mistreated, and organized psychiatry has no plan to guide the correction of these well-studied and long-standing inequities.”
If the APA and the radicals are intending on paying more than lip service to the current crises, demonstrable action might take several forms. Besides focusing on individualized treatments and placing too much stock in new drug therapies such as psychedelics, mental medicine should fully recognize racism’s impact on mental health as it did for the first time in 1969. Psychiatrists and others might embrace social psychiatry, which was a major movement in mental medicine after WWII and showed how poverty, inequality and social isolation impaired mental health. Policymakers might think about legislation (including Universal Basic Income) that specifically addresses the gap between the rich and poor, and especially in light of COVID-19’s blowback, which will disproportionately impact people of color.
Lucas Richert’s new book, Break on Through: Radical Psychiatry and the American Counterculture, describes the influence of radical approaches to the mental health system in the 1970s.