24 September 2013

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.


  1. One of the many problems with Oppositional Defiant Disorder and that whole diagnostic path is how major problems are framed as "noncompliance" or similar terms and concepts rather than what they actually are. If you're 15 years old and stealing from your parents and beating up your siblings, the problem isn't that you're "oppositional/defiant," the problem is that you're a jerk and/or you have a lot of seriously bad things going on in your life. In this or similar contexts, a diagnosis of ODD would be, if anything, minimizing and distracting from the things that actually need addressing.

  2. i agree with you that we must make an ongoing effort in correcting our language, if we want to be credible advocates for whatever cause and especially in the disability sector, this calls for attention to, learning about and understanding the impact of the use of certain words, terms and medical descriptives, especially in the case of 'events', crimes committed etc.
    but from a personal perspective, the very fact that psychopathy is not an official diagnosis makes me associate it with those who - while a certain mental illness and social conditions may have had an influence on their general feelings and behaviour - have actively decided to NOT do anything about it but rather indulge in their behaviours, ie being abusive towards others in a conscious kind of way. i am thinking of domestic violence btw. I see the reasoning of your article, and i have yet to think about the social meaning of how these diagnosis contribute to further marginalisation (my son has ASD and got a mention of 'elements of ODD' for good measure from the doc who confirmed the diagnosis. i completely contest this, he is not defiant at all) but it's true that now I wonder what one can call those who do make this step towards, violence and even murder, although they have been conscious about being at risk of doing so, have done it before etc. just abusers or criminals seems not strong enough.

  3. In the 19th c. criminality was considered to be genetic by phrenologists and eugenicists. Does "sociopath" have a specific psychological meaning? The DSM 5 is really messed up, I hope there will be some renegade mental health professionals who break away from it (and then they'll be said to be non-compliant) The real reason for these so-called disorders is that they are a way for institutions (esp schools) basically to separate out difficult students so the "mainstream" teachers don't have to deal with them. In some cases behaviors are result of other disabilities, lack of sleep, nutrition, abuse, stress- and/or bad parenting. The reason white & middle class kids don't get these labels as much (though they do plenty of misbehaving) is that their parents have the agency to fight it, they are more likely to get help they need, and if they are not involved in social services or the criminal "justice" system they are not scrutinized as much.

    I admit I am guilty of using metaphors like "so and so is blind to problem X" or "outsourcing has crippled the economy" just as I've weeded "retarded" out of my vocabulary I need to transition out of using those as well.


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