Ionia State Hospital for the Criminally Insane was, for much of the twentieth century, one of the nation's more notorious mental asylums, occupying an incredible 529 acres, and its annual census hovered above 2,000 patients. But, like many American asylums, Ionia suffered a rapid fall from grace in the late 1960s and early 70s, during the so-called era of deinstitutionalization. By 1974, the census was a paltry 300, and in 1975 the facility closed, then quickly reopened—as a prison.
That rapid transformation fascinated me. What had happened to the patients? What had changed? Why did the hospital become a prison? I spent a long time searching for the records, and ultimately discovered that much of the hospital's institutional memory—nearly a century of patient charts, reports, photographs, ledgers, and other artifacts—had been placed randomly in storage in the State Archive of Michigan, in Lansing. I spent another year gaining clearance from various review boards since of course the archive contains highly personal and confidential information, then spent the next four years reviewing the charts of over 800 patients.
What I found troubled me greatly. As I write in the book, "the charts documented in minute detail the tragedy of what it meant to be warehoused in a state asylum at mid-century—and, in particular, in an asylum where short court sentences devolved into lifelong incarceration. A number of charts contained yearly notes from patients to their doctors voicing such sentiments as Doc, I really think I am cured or Dear Doctor, I believe I am ready to go home, or, You have no right to keep me here. These letters stacked thirty-deep in some charts, signifying years of pleading and longing and anger, together with thirty years of responses from clinicians urging, You are almost there, or: Perhaps next year. Invariably, the last note in each stack was a death certificate from the Ionia coroner."
When did you first suspect that diagnostic patterns with schizophrenia had become heavily racialized?
I found dramatic racial and gender shifts in persons diagnosed with schizophrenia at Ionia during the 1960s—so much so that schizophrenia's racial and gendered transformation became the central narrative of my book. This shift became apparent very early in my research. Before the 60s, Ionia doctors viewed schizophrenia as an illness that afflicted nonviolent, white, petty criminals, including the hospital's considerable population of women from rural Michigan. Charts emphasized the negative impact of "schizophrenogenic styles" on these women's abilities to perform their duties as mothers and wives.
To say the least, these patients were not seen as threatening. This patient wasn't able to take care of her family as she should, read one chart; another, This patient is not well adjusted and can't do her housework; and another, She got confused and talked too loudly and embarrassed her husband.
By the mid- to late-1960s, however, schizophrenia was a diagnosis disproportionately applied to the hospital's growing population of African American men from urban Detroit. Perhaps the most shocking evidence I uncovered was that hospital charts "diagnosed" these men in part because of their symptoms, but also because of their connections to the civil rights movement. Many of the men were sent to Ionia after convictions for crimes that ranged from armed robbery to participation in civil-rights protests, to property destruction during periods of civil unrest, such as the Detroit riots of 1968.
Charts stressed how hallucinations and delusions rendered these men as threats not only to other patients, but also to clinicians, ward attendants, and to society itself. You'd see comments like Paranoid against his doctors and the police. Or, Would be a danger to society were he not in an institution.
Did the second edition of the DSM, released in 1968, have a significant influence on that shift in emphasis?
One of the key pieces of evidence I use to help explain the shifts seen at Ionia is through an extensive analysis of the changing language associated with the official psychiatric definition of schizophrenia. Before the 60s, psychiatry often posited that schizophrenia was a psychological "reaction" to a splitting of the basic functions of personality. Official descriptors emphasized the generally calm nature of such persons, in ways that encouraged associations with middle-class housewives.
But the frame changed in the 60s. In 1968, in the midst of a political climate marked by profound protest and social unrest, psychiatry published the second edition of the Diagnostic and Statistical Manual. That text recast the paranoid subtype of schizophrenia as a disorder of masculinized belligerence. "The patient's attitude is frequently hostile and aggressive," DSM-II claimed, "and his behavior tends to be consistent with his delusions." I have a lot of data in my book that shows how this language—particularly terms such as "hostility" and "aggression"—was used to justify schizophrenia diagnoses in black men at Ionia in the 1960s and 1970s.
How would you explain that shift, and would you view American psychiatry in those years as exhibiting either manifest or unconscious racism? Was it just coincidence that the DSM-II language enabled the diagnosis of schizophrenia among increasing numbers of African Americans?
That's a very important question. I argue extensively in my book that the purpose of my analysis is not to lay blame for individual racism, because I feel that such blame-games oversimplify what was going on. Many of the doctors at Ionia genuinely wanted to help their patients. I also talk to psychiatrists who worked on the DSM-II who told me that they were trying to do the best they could to produce scientific, objective diagnostic criteria.
At the same time, my evidence shows how even the most scientific diagnostic criteria can reflect the social environments in which they are produced, a process I discuss through the language of structural or institutional violence.
This was certainly the case for the DSM-II. As I show, the manual's emphasis on hostility and aggression reflected a much-wider set of national conversations and anxieties about civil rights. The shifting frame surrounding schizophrenia had dire consequences for African American men held at the Ionia State Hospital during the civil-rights era. More broadly, my evidence also shows that growing numbers of research articles in professional journals used this language to cast schizophrenia as a disorder of racialized aggression.
In the worst cases, psychiatric authors conflated the schizophrenic symptoms of African American patients with the perceived schizophrenia of civil rights protests, particularly those organized by Black Power, the Black Panthers, the Nation of Islam, or other activist groups. Ultimately, new psychiatric definitions of schizophrenic illness in the 60s impacted persons of many different racial and ethnic backgrounds. Some patients became schizophrenic because of changes in diagnostic criteria rather than in their clinical symptoms. Others saw their diagnoses changed to depression, anxiety, or other conditions because they did not manifest hostility or aggression.
How did the psychiatric profession characterize schizophrenia before the first and second editions of the DSM?
Insanity has a long and fascinating history. Before the advent of what we call "modern psychiatry," conventional wisdom had it that specific actions and life events caused specific types of insanity. Paupers Lunacy was thought to result from habitual intemperance, poverty, and destitution, treated by a diet of wholesome digestible bread and milk porridge, along with occasional topical bleedings. Masturbatory Insanity came from onanistic self-corruption and led to a form of idiocy manifest by sallow skin, lusterless eyes, flabby muscles, loose stools, and, of course, cold and clammy hands. And Old Maid's Insanity was, as the name implied, the insanity of old maids.
When did you first suspect that diagnostic patterns with schizophrenia had become heavily racialized?
I found dramatic racial and gender shifts in persons diagnosed with schizophrenia at Ionia during the 1960s—so much so that schizophrenia's racial and gendered transformation became the central narrative of my book. This shift became apparent very early in my research. Before the 60s, Ionia doctors viewed schizophrenia as an illness that afflicted nonviolent, white, petty criminals, including the hospital's considerable population of women from rural Michigan. Charts emphasized the negative impact of "schizophrenogenic styles" on these women's abilities to perform their duties as mothers and wives.
To say the least, these patients were not seen as threatening. This patient wasn't able to take care of her family as she should, read one chart; another, This patient is not well adjusted and can't do her housework; and another, She got confused and talked too loudly and embarrassed her husband.
By the mid- to late-1960s, however, schizophrenia was a diagnosis disproportionately applied to the hospital's growing population of African American men from urban Detroit. Perhaps the most shocking evidence I uncovered was that hospital charts "diagnosed" these men in part because of their symptoms, but also because of their connections to the civil rights movement. Many of the men were sent to Ionia after convictions for crimes that ranged from armed robbery to participation in civil-rights protests, to property destruction during periods of civil unrest, such as the Detroit riots of 1968.
Charts stressed how hallucinations and delusions rendered these men as threats not only to other patients, but also to clinicians, ward attendants, and to society itself. You'd see comments like Paranoid against his doctors and the police. Or, Would be a danger to society were he not in an institution.
Did the second edition of the DSM, released in 1968, have a significant influence on that shift in emphasis?
One of the key pieces of evidence I use to help explain the shifts seen at Ionia is through an extensive analysis of the changing language associated with the official psychiatric definition of schizophrenia. Before the 60s, psychiatry often posited that schizophrenia was a psychological "reaction" to a splitting of the basic functions of personality. Official descriptors emphasized the generally calm nature of such persons, in ways that encouraged associations with middle-class housewives.
But the frame changed in the 60s. In 1968, in the midst of a political climate marked by profound protest and social unrest, psychiatry published the second edition of the Diagnostic and Statistical Manual. That text recast the paranoid subtype of schizophrenia as a disorder of masculinized belligerence. "The patient's attitude is frequently hostile and aggressive," DSM-II claimed, "and his behavior tends to be consistent with his delusions." I have a lot of data in my book that shows how this language—particularly terms such as "hostility" and "aggression"—was used to justify schizophrenia diagnoses in black men at Ionia in the 1960s and 1970s.
How would you explain that shift, and would you view American psychiatry in those years as exhibiting either manifest or unconscious racism? Was it just coincidence that the DSM-II language enabled the diagnosis of schizophrenia among increasing numbers of African Americans?
That's a very important question. I argue extensively in my book that the purpose of my analysis is not to lay blame for individual racism, because I feel that such blame-games oversimplify what was going on. Many of the doctors at Ionia genuinely wanted to help their patients. I also talk to psychiatrists who worked on the DSM-II who told me that they were trying to do the best they could to produce scientific, objective diagnostic criteria.
At the same time, my evidence shows how even the most scientific diagnostic criteria can reflect the social environments in which they are produced, a process I discuss through the language of structural or institutional violence.
This was certainly the case for the DSM-II. As I show, the manual's emphasis on hostility and aggression reflected a much-wider set of national conversations and anxieties about civil rights. The shifting frame surrounding schizophrenia had dire consequences for African American men held at the Ionia State Hospital during the civil-rights era. More broadly, my evidence also shows that growing numbers of research articles in professional journals used this language to cast schizophrenia as a disorder of racialized aggression.
In the worst cases, psychiatric authors conflated the schizophrenic symptoms of African American patients with the perceived schizophrenia of civil rights protests, particularly those organized by Black Power, the Black Panthers, the Nation of Islam, or other activist groups. Ultimately, new psychiatric definitions of schizophrenic illness in the 60s impacted persons of many different racial and ethnic backgrounds. Some patients became schizophrenic because of changes in diagnostic criteria rather than in their clinical symptoms. Others saw their diagnoses changed to depression, anxiety, or other conditions because they did not manifest hostility or aggression.
How did the psychiatric profession characterize schizophrenia before the first and second editions of the DSM?
Insanity has a long and fascinating history. Before the advent of what we call "modern psychiatry," conventional wisdom had it that specific actions and life events caused specific types of insanity. Paupers Lunacy was thought to result from habitual intemperance, poverty, and destitution, treated by a diet of wholesome digestible bread and milk porridge, along with occasional topical bleedings. Masturbatory Insanity came from onanistic self-corruption and led to a form of idiocy manifest by sallow skin, lusterless eyes, flabby muscles, loose stools, and, of course, cold and clammy hands. And Old Maid's Insanity was, as the name implied, the insanity of old maids.
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