Psychopathy: Racism and Ableism from the Medical-Industrial Complex

Trigger warning/Content: Disability-related slurs and other ableist language, mention of rape, racism, and ableism.

Edit: In the original post, I neglected to ntion the connections between Antisocial Prsonality Disorder and Cnduct Disorder and Oppositional Defiant Dsorder, nd structural racism, sxism, and ableism. typos b/c eited from pphone.

Psychopathy: Racism and Ableism from the Medical-Industrial Complex

When we commit to examining our language and our ideas and deconstructing the ableism we find in them, we must make a full commitment, no partial or half-hearted commitments allowed. When we stop using "autistic" and "retarded" as insults, when we realize the urgent need to stop scapegoating mass murder and rape on "mental illness" and "emotional instability," when we learn to stop referring to our political opponents as "blind," "deaf," or "crippled" in their ideologies, we must also critically re-examine our use of the psychopathy label.

This constructed term of art does not in fact refer to an accepted diagnostic label in psychiatry or psychology. In the recently-replaced DSM-IV (the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders), the closest label was "Antisocial Personality Disorder," a diagnosis that still exists in the current DSM-5. The DSM-5 also contains the newly created diagnosis of Conduct Disorder. The diagnostic criteria for Antisocial Personality Disorder and Conduct Disorder come perhaps the closest to the lay definition for psychopathy that is usually intended when the term is invoked.

The lay definition for psychopathy typically goes like this:
Someone who has little or no empathy for other people and no real control over their behavior.

Psychopathy is usually invoked when referring to either

1. violent people, such as murderers, serial killers, school shooters, terrorists, or rapists, either by the mass media or by legal professionals, including prosecuting and defense attorneys, judges, sentencing advocates, probation and parole officers, and corrections officers and prison guards
2. other disabled people, such as autistics, people with mental health or psychiatric disabilities, or learning disabilities (though usually when a person in this group has been accused of or formally charged with a crime)
3. members of oppressive classes, such as wealthy people, cisgender men, or abled people, and especially when the member of the oppressive class is in a position of political power in addition to apolitical structural power

Yet, as noted before, psychopathy is not even a medical or psychiatric diagnosis. It doesn't exist in the DSM-IV nor does it exist in the DSM-5, and as much as I hate lending any further credence to the medical-industrial complex's state-sanctioned and socially-approved authority, this is important to recognize. Even the medical-industrial complex does not officially recognize psychopathy as a diagnosis. 

On the other hand, Antisocial Personality Disorder is recognized as a psychiatric diagnosis by the medical establishment. And who are the people typically diagnosed with Antisocial Personality Disorder? They are overwhelmingly poor students of color who frequently have other disabilities. Antisocial Personality Disorder, the diagnostic category that comes closest to approximating the lay definition of "psychopathy," is a tool for criminalizing poverty, blackness and brownness, and disability. It is the diagnostic label to legitimize non-compliance as a mental health problem.

Refusal to take psychiatric medications? Non-compliant. Doing poorly in math class? Non-compliant. Stimming in public? Non-compliant.

If you are non-compliant, you are anti-social. You are mentally ill. You have Antisocial Personality Disorder. You are a psychopath.

The language of pathology, of mental illness, of disease, of disability, has long been used to reinforce existing structural oppressions like racism, classism, sexism, heterosexism, binarism, cissexism, and ableism. I spoke at UC Berkeley this past Friday on the need to recognize and move beyond ableist metaphor. Ableist metaphor is all-pervasive in public discourse, in academia, in grassroots organizing, in progressive and radical movements as well as in conservative, neoliberal, and nationalist movements. Ableist metaphor draws on the language of disability to characterize, to denigrate, to attack, to rhetoricize, to politicize -- and it does so based on the presumption that deviation from typical thought, movement, emotional processing, communication, bodily/mental functioning, learning, remembering, sensing is evidence of defect, deficiency, disorder, and ultimately, moral failure. And if this is so, then it is certainly justifiable to refer to one's political opponents as blind or deaf to progressive ideas, or to refer to structures like capitalism or anarchy as social diseases, or to refer to violence visited either by individuals or oppressive systems as evidence of psychopathy.

To use psychopathy as the lens through which one views systemic or individual violence -- the violence of capitalism or patriarchy, for example, or the violence of a single serial killer or rapist -- is to reinforce the structural power of the medical-industrial complex, and to do so at the expense of disabled people, poor people, and people of color who have been victimized by the labels of non-compliant, anti-social, and psychopathic.

To defend the use of this term as medically accurate is to imply that you have knowledge that an individual has been medically assessed as and diagnosed with Antisocial Personality Disorder or Conduct Disorder, which in itself, cedes control and power to the psychiatric establishment and the medical-industrial complex. It presumes personal medical knowledge, it reinforces the creative fictions of these diagnostic labels, and it enables the systems of violence that use the language of disability to pathologize and ultimately, to dehumanize.

Be precise in your language, and say that oppressive structures are violent and manipulative. Say that those who abuse their structural positions of power act with reckless disregard for other human beings. Say that they are callous and unabashedly wielding the power that comes with their privilege.

But don't call them psychopaths.

I've experienced enough ableism in my life to last me several lifetimes. I don't need fellow radicals feeding into ableism.

Fighting ableism with ableism doesn't work

Fighting ableism with ableism doesn't work. In fact, it's just bad policy. Yet that's precisely the tactic that Disability Scoop, "the premier source for developmental disability news," decided to use in its criticism of the latest episode of Glee, in which the character with Down syndrome brought a gun to school. Here's the relevant part of the Disability Scoop article:

“Acting like every other teenager in doing things like sports and going to college, those are things great to portray for Becky,” said Julie Cevallos, vice president of marketing for the organization [National Down Syndrome Society]. “Taking a gun to school is something very serious and would likely come with a mental health condition. That’s not appropriate for someone with Down syndrome and not a stigma they need.”

Meanwhile, comments from viewers on Twitter criticized the characterization for being “disgraceful” and “seriously lame.”

The first bit of this is simpler to process and explain. It's in the second paragraph quoted, where one of the quotes from a Twitter used reads "seriously lame." Lame means someone who can't walk, whether because of amputation or paralysis, quadriplegia or paraplegia, or certain types of cerebral palsy. Using this word as as an insult or a criticism already denotes that "lame" is understood as a negative attribute or characteristic. This wouldn't be the case if being "lame" were not also implicitly understood to be a negative state of being. Lame can only be an insult so long as being lame is a bad thing, just as using "gay" as an insult only works with the understanding that being gay is a bad thing.

Given that the criticism in question is directed toward the (potentially?) ableist representation of a disabled character, this is particularly ironic and biting.

(I say potentially because I've never seen Glee and didn't see the episode receiving the criticism across the netscape, and so feel unqualified on that basis alone to make much commentary on the actual TV episode in question. I'll agree, though, that based only on what I've read, it was probably an incredibly poor choice at best, given the dangerous and inaccurate stereotype of disabled people, particularly the developmentally disabled after the recent media hullabaloo after Newtown, as [more] [more likely to be] violent.)

The second bit of ableism, encapsulated in the first paragraph of the quote above, is quite a bit more serious, where Julie Cevallos from the National Down Syndrome Society says, "Taking a gun to school is something very serious and would likely come with a mental health condition. That’s not appropriate for someone with Down syndrome." Unpacking this is going to take quite a bit longer to do.

Ms. Cevallos is actively contributing to the oppression of people with psychiatric disabilities. Read that first sentence again -- "Taking a gun to school is something very serious and would likely come with a mental health condition." This statement implies a) that people with psychiatric disabilities are more likely to bring a gun to school, b) that they are more likely to do this with violent intentions, c) that they are more likely to commit a school shooting or other act of violence, and that d) it would be more accurate to portray someone bringing a gun to school as "mentally ill."

These are untrue for a variety of reasons. In certain parts of the country where hunting continues to be a major part of the culture, students with and without disabilities might "bring guns to school" in the sense that they're in their cars or trucks for hunting or sport shooting after school. Further, there is no evidence to suggest that murderers are more likely to have psychiatric disabilities than not. Here's an excerpt from a recent New York Times article (and yes, the sources are linked in the original article -- if you want more, see my earlier post with links to full texts of several peer-reviewed articles on the topic):

Only about 4 percent of violence in the United States can be attributed to people with mental illness. This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence. One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.

Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts.

[...]

But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness.

Ms. Cevallos is wrongfully suggesting that while it would be "inappropriate" to portray someone with Down syndrome bringing a gun to school, it would be perfectly "appropriate" to portray someone with a psychiatric disability -- say schizophrenia, bipolar, post-traumatic stress disorder, reactive attachment disorder, or dissociative identity disorder -- doing the same thing. If we did not live in such an ableist culture where stereotypes about disability and violence didn't exist, I would have no problems with portraying someone with any type of disability bringing a gun to school. Unfortunately, because of the cultural context in which I am writing this piece, I must urge against such portrayals of disabled people because they further affirm and reinforce existing negative and inaccurate stereotypes of all types of disabled people.

I'm a writer (of fiction, I mean -- I'm working on my seventh novel right now). Don't get me wrong; I'm all for creativity and freedom of expression. I see nothing inherently wrong with portraying someone disabled bringing a gun to school; however, the extremely heightened potential for such a portrayal to ignore current cultural realities, as well as the certainty of such a portrayal further contributing to dangerous and harmful stereotypes about disabled people, mean that I cannot condone such representations of disability.

Granted, the offending remarks are contained within quotations of things other people said or wrote, but the author and editors at Disability Scoop would have been perfectly capable of selecting quotations expressing criticism of the episode that didn't also espouse ableism. In fact, I believe that they had a responsibility to either use different quotes (especially in the Twitter case) or to distance themselves from their problematic content (more relevant to Ms. Cevallos's remarks, had they chosen to keep the quote) and make it clear why the distancing would be necessary.

In any case, it's readily apparent to me that criticizing ableism using, well, more of the same, simply isn't the right thing to do. It's not merely hypocritical; it's actually completely counterproductive. It significantly diminishes the strength and force of your arguments, and it does absolutely nothing to actually benefit any disabled people. When some of us fall, all of us fall. As Dr. Martin Luther King, Jr. wrote from the Birmingham City Jail, "Moreover, I am cognizant of the interrelatedness of all communities and states. I cannot sit idly by in Atlanta and not be concerned about what happens in Birmingham. Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly."

Halloween's Ableism Problem: The Commercialization of Disability Oppression and Mental Health Stigma

Trigger Warning: Direct quotes of ableist hate speech.
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Halloween's Ableism Problem

The Commercialization of Disability Oppression and Mental Health Stigma

A few weeks ago, I was asked to speak for Professor Sylvia Wing Önder's medical anthropology class on disability, neurodiversity, and stigma. During my presentation, I asked the students in the class to raise their hands if they had ever watched a crime drama or police serial on TV that portrayed a character explicitly identified as having a mental health or psychiatric disability, such as bipolar disorder or schizophrenia, in a negative light. Nearly all of the students (if not all of them) raised their hands. When I reversed the question and asked if anyone could think of a neutral or positive TV or film portrayal of a character explicitly known to have a mental health or psychiatric disability, one student tentatively raised her hand.

I asked the students to raise their hands if they had read news coverage of a shooting incident, mass murder, or other violent crime during which a reputable journalistic publication used language like "psychopathic," "insane," "mentally ill," or other derogatory descriptions referring to mental health and psychiatric disabilities as a way of discussing the perpetrator's known or suspected neurology. Most, if not all, hands shot into the air.

The common practice of conflating violence--or indeed, any other ill in society or personal flaw of an individual--with mental health and psychiatric disabilities occurs not only in the popular and news media but in everyday conversations. This myth is perpetuated by TV shows that depict rapists, murderers, and terrorists as "mentally ill," and by supposedly objective and unbiased news reports that use the same dehumanizing language to construct horrifying and appalling visions of what mental health and psychiatric disabilities look like. The rhetorical and discursive constructions of mental health would leave the average individual convinced that anyone with a mental health or psychiatric disability is a raging monster incapable of normal emotions or empathizing with others, ready at any trigger to spring vicious, murderous violence upon anyone unfortunate enough to be in their way or say the wrong thing at the wrong time. These people, we are told, are menaces to society and ought to be locked away in secure facilities for their own good and for the good of everyone else.

And always, they are others. The process of othering is not new to disability, whether in general or around mental health and psychiatric disabilities in particular. Given that the ability to empathize with other human beings--the ability to understand another's emotions not only intellectually but emotionally--is frequently upheld as an innate characteristic of humanity that separates us from less sapient creatures, the message that certain groups of disabled people inherently lack empathy underscores the deeply troubling trend of dehumanizing those people. Whether it's the Autistic like me or those with mental health and psychiatric disabilities, the stigma we face is staggering. Unlike those believed to be non-disabled, we are forced to prove our humanity, to prove our worthiness to be included as having equal value and worth as everyone else. Because we are other, it is possible for the mainstay of society to make light of our marginalization. And, as you may well know or have suspected yourself, the commercial exploitation of disability enfreakment is a lucrative business.

Fright at the Museum: Dead Men Walking is this year's haunted house experience at the Museum of Crime and Punishment here in Washington, DC. I heard about the haunted house experience when reading a list of Halloween-themed activities in the District. The language used on the brief advertisement described the haunted house as "featuring the criminally insane." Appalled at the blatant ableism, I searched for the attraction on the internet and found this language on the official website--"This Halloween the Crime Museum will transform into a hunting ground for the criminally insane." Yet despite my horror and disappointment, I was not surprised.

Every year at Halloween, haunted house attractions pop up across the United States, in people's basements, in stores, in hotels, in museums, in frat houses, in amusement parks, and just about anywhere else one can imagine decorating with skeletons and spiderwebs and coffins and fake corpses with fake blood and weapons nearby. I don't have a problem with that. What I do have a problem with is the commonplace use of "the insane" or "the criminally insane" as features in these attractions. Firstly, it's dehumanizing of actual people with mental health and psychiatric disabilities. Secondly, it's usually grossly inaccurate. Thirdly, it contributes to the already massive stigma against people with mental health and psychiatric disabilities in potentially extremely dangerous and harmful ways.

The attitude that leads otherwise decent people to believe that there is nothing wrong or problematic with featuring "the criminally insane" in a haunted house attraction is one deeply rooted in and perpetuated by an ableism so pervasive in society that it even taints disability rights movements. Ableism against those with mental health and psychiatric disabilities is not only widespread in society writ large, but it is a particularly vile  and virile thorn embedded deeply into the disability community in general, including the autism and Autistic communities. This ableism gives rise to the attitude that sees those with mental health and psychiatric disabilities as legitimate material for twisted humor, freak exhibits, and fright experiences. (After all, if it is legitimate to fear an entire group of people based on dangerously misconceived prejudices against them, then it makes sense that that group of people would be used in a fright experience like a haunted house.)

Let's deconstruct this. To use actors or exhibits portraying people belonging to a marginalized group--in this case, people with mental health and psychiatric disabilities--as a form of entertainment is not only belittling, but dehumanizing. Why? Because it says that they are fodder for entertainment. This process of enfreakment has a long history that includes the freak show sideshows accompanying circuses that put people with visible disabilities and deformities on display for public amusement and pity. When it comes to these types of portrayals, it contributes to the message that says that these are not people worthy of respect or dignity for no reason other than their disabilities.

The suggestion that all or many people with mental health or psychiatric disabilities are now or will in the future become violent murderers or rapists is not only ableist and stigmatizing, but grossly inaccurate. Not only are those with mental health and psychiatric disabilities not any more likely to commit violent crime than the general population, they are at significantly higher likelihood of being targeted as victims of both nonviolent and violent crime. The ableism that perpetuates this harmful myth does a disservice to people with mental health and psychiatric disabilities twice over. It wrongfully insinuates that they are more likely to commit violent crimes--thereby allowing for the disturbing proposition of pre-emptive confinement and containment of these people that sounds suspiciously like Minority Report--and it allows society to ignore their needs when they are victimized by crime.

This is not merely Halloween's ableism problem, but the consequence of ableist attitudes embedded across all levels of society. The commercialization of disability oppression poses a unique problem in that it is doubly exploitative. It harms the disabled and it allows the rest of society to become complicit in its perpetuation. It is morally abhorrent, but rarely questioned. Those in positions of power and privilege can remain unchallenged because they have the social capital and financial resources to maintain their power and privilege. It is no object to oppress people who are already marginalized in society.

In order to combat the frequency of these appallingly ableist depictions of disabled people, we must begin by combating the attitudes that justify and excuse them as harmless and valid. That begins with changing the portrayals we see on TV and in film, in literature, and in the news media. It begins with changing the way we talk about mental health and people with mental health and psychiatric disabilities, whether that be in public speeches or debates, university classrooms or compulsory education, or everyday conversations. It begins with challenging enfreakment as the norm. In the absence of widespread public outcry, both individually and at the organizational level, President Obama will be able to continue to pontificate about keeping guns away from "the mentally ill," reputable newspapers will be able to continue to speculate about how "insane" suspected perpetrators of mass killings must be, and professors will continue to be able to make tasteless, ableist jokes about involuntary restraint and seclusion. The understanding that these rhetorical constructions and public enfreaking depictions of disability contribute to a society in which those with mental health and psychiatric disabilities are unwelcome, unaccommodated, and in perpetual danger of victimization of hate speech and hate crimes is necessary in order to deconstruct them and work toward ending them.






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Note: The idea that mental health and psychiatric disabilities, among other temporary or permanent conditions, can render one legally "insane," for purposes of the popularly-called "insanity defense" (in legal terms, "not guilty by reason of mental disease or defect"), deserves another critique in its own essay.

Addendum: The language used in the DC Museum of Crime and Punishment advertisement--"hunting ground for the criminally insane"--actually has two possible interpretations. I intended to include a bit about this in the original essay, but it seems to have slipped my mind. This phrase might be interpreted as furthering the dangerous misconception that people with mental health and psychiatric disabilities are murderers waiting to happen, and that the "hunting ground" is those people hunting down the "normal" people. Its other interpretation, however, is far more sinister and haunting. The second possible interpretation is that the event planners are implicitly condoning the "hunting" of people with mental health and psychiatric disabilities--i.e. that the "hunting ground" is a place for the "normal" people to hunt and kill the "criminally insane." This carries many problematic consequences, not the least of which is the direct condoning of violence against those with mental health and psychiatric disabilities as acceptable.