Psychiatric dysaethesia

We recently rented the video C.S.A., a mockumentary about the semi-fictional history of when the Confederate States of America won Civil War/ Northern War of Aggression. It’s a profoundly (and appropriately) disturbing film on a number of levels. This isn’t a film review, so you can look up more details about it on Amazon, the IMDB, or the official film Web site. It’s a hell of a good video, in the literal sense.

What makes good satire and mockumentary is the admixture of fiction and reality. Fiction (especially science fiction) provides the distance of unreality for us to be able to think about and discuss things that are often too difficult to deal with in full-blown reality. Reality-Lite, as it were. Not that there is anything “Lite” about slavery and the numbers of other issues woven into the story line.

But on blog-related matters, this flick gave me yoin, which is a Japanese word referring to the ongoing internal reverberation you get from something, even after the moment has passed. They made mention of Drapetomania, and apparently this was one of the reality-nuggets. There it is on Wikipedia:

“Drapetomania” was a psychiatric diagnosis proposed in 1851 by Louisiana physician Samuel A. Cartwright to explain the tendency of black slaves to flee captivity. As some slave owners felt they were improving the lives of their slaves, they could not understand the slaves’ desire to escape.

There’s not a great deal of discussion of this; the entry also explains,

The diagnosis appeared in a paper published in the New Orleans Medical and Surgical Journal, where Dr. Cartwright argued that the tendency of slaves to run away from their captors was in fact a treatable medical disorder. His feeling was that with “proper medical advice, strictly followed, this troublesome practice that many Negroes have of running away can be almost entirely prevented.” Cartwright proposed whipping as the most effective treatment of this disorder. Amputation of the toes was also prescribed.

Cartwright also described another disorder, Dysaethesia Aethiopica, to explain the apparent lack of motivation exhibited by many slaves, which he also claimed could be cured by whipping.

Wow. So here we have this doctor ascribing a natural human reaction to having a psychiatric condition, and also prescribing the “appropriate” treatment for such. We can easily imagine some alternative history where drapetomania is a regular entry in the DSM. After all, homosexuality used to be included in the real DSM.

Not every reaction or experience in the human condition is a psychiatric problem, syndrome or disorder. The DSM is useful as dictionary — it’s difficult to discuss things when people aren’t even talking about the same things, so some kind of mutual definition is necessary for a start. We also have entries that go from descriptions of the problems people have in life into the realm of Named Conditions.

Take ODD: Oppositional Defiant Disorder. Yes, there are people who are short-tempered, argumentative, annoying, refuse to follow rules, blames others for their problems, are tetchy and so on. This is a definite set of bad behaviours, and there are some people who seem to be entrenched in acting these ways to the point that it seems to be a regular part of their personalities. Do real people act like this? You bet; some of my students act like this. But is it an actual disorder? Some kind of neurophysiological problem?

That I’m not so sure about. There may well be some kind of, or several kinds of actual conditions that can result in a person acting like this, but that’s not the same thing. ODD is a good description of someone who is handling themselves badly (for any number of very real reasons), but I wouldn’t classify it as an actual “thing”, a neurophysiological problem. (Then again, we may find some kind of weird dysfunction in the brain caused by genetics or some yet-nameless virus or prion. Life has a way of throwing us curve-balls on a regular basis.)

Is every reaction to problematic aspects of life worthy of being identified as a morbidity of some sort, and assigned a billing code for the benefit of insurance companies?

The other disturbing part about “drapetomania” is the telling politics of power. You see, only Negroes were afflicted with drapetomania. Only gays and lesbians were afflicted with homosexuality. Once homosexuality is removed from the DSM as a disorder, then we suddenly have millions fewer patients with “mental illness”. No one was “cured” — they just weren’t considered ill any more.

When we find that we can’t understand why someone does what they do, does it really mean that they gone ’round the twist in some way? Or are are they just reacting to what might be an intolerable condition that we’re not properly recognising?