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?

5 Comments

  1. 1 June 2007 at 23:05

    […] look at how the assumptions we make determine how we define groups of people, from the way that we create diagnostic labels, to the sometimes-absurdities of “person-first language”, and concepts of […]

  2. Random Reader #25386 or somesuch said,

    13 November 2006 at 9:37

    I may offend you by saying this, but I hope not.

    I think there’s a lot of cases where kids are diagnosed with ADD or ADHD or whatever the proper term is, when they actually can pay attention, but just don’t want to. (To be sure, there’s also a lot of cases when kids should be diagnosed but aren’t, but that’s another story and one I bet you could tell better than I can, heh.) Their parents don’t properly discipline them, or give them super-dumbed-down kids’ books and TV shows there’s no possible benefit in bothering to pay attention to, and so suddenly they have a disease. Yes they have a disease, it’s called Lack Of Being Properly Raised And Thus Being An Annoying Brat. And so they go through the school system and life in general not really giving a crap about anything, because they never got taught that it’s good to give a crap about things. And so they give the kids who DO actually need help a bad name and make it even harder for us to understand their problems.

  3. Phil Schwarz said,

    13 November 2006 at 7:07

    The only possible sense in which I could conceivably consider ODD to be a legitimate disorder rather than a junk diagnosis, is the case of someone who gets a tremendous rush and high from defying power — so much so that they engage in such defiance in self-destructive ways that they would not touch, were there not such a craving for the rush and high it generates.
    But I don’t think that situation applies to the majority of kids labeled ODD, does it?

  4. Sharon said,

    22 October 2006 at 5:28

    Very interesting post Andrea. It is startling to imagine how aspects of human behaviour are considered illnesses in certain times and places, but seen as normal at other times.
    I’ve heard the term ODD often in the past year on parent’s lists. I dare say I could get that diagnosis for my boy if I wanted. But I think when he acts in a ‘defiant’ manner, it just indicates some problems that we need to sort out.

  5. David N. Andrews MEd (graduating Dec2006) said,

    21 October 2006 at 23:41

    Andrea,

    Much of psychiatry is about power. Psychiatrists cannot talk about autism without raising the issue of medicines to ‘control behaviour’… and medicalisation of everything that is psychological (in a Lewinian sense) is the key to this: psychiatry evolved out of the profession of medical attendants at the old lunatic asylums, and this was a place worse than working as a doctor on ‘poor law’ hospitals; so this required a shift in status.

    We can read about some of the completely ridiculous ‘experiments’ conducted – without informed consent – on the inmates of asylums in any introductory text on general, abnormal or clinical psychology: they range from the patently silly to the stupendously torture-esque. People died (very unwillingly) to give psychiatry its status.

    Psychiatry is not the bastard child of medicine, though.

    It has practically sod all to do with medicine.


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