Abolition Must Include Psychiatry
Abolition Must Include Psychiatry
By Stella Akua Mensah
Edited by Stefanie Lyn Kaufman-Mthimkhulu
Content notes: sanism, racism, violence, state violence, incarceration, institutionalization, forced ‘treatment’, torture, medical coercion, restraint, seclusion, abuse, sexual violence, settler colonialism
There is a dangerous tale in the United States, one based on a myth of the deinstitutionalization of psychiatric asylums¹. Through this story, we are told that the asylum died and is a thing of the past. We are told that, now, “patients” have rights, are treated with human dignity, and are not criminalized for their neurodivergence. We’re told that restraints and forcible medication only happen in “extreme” cases. We’re told that the mental health care system is here to help us, support us, and “treat” us. And now, when abolition has entered mainstream discourse, we’re told that this very system should be considered an alternative to incarceration in jails and prisons. But those of us who have survived psychiatric incarceration know that not only did the asylum never die — it is, and always was, another prison. Knowing the truth of these myths, we work towards writing a new story.
As Hussein Abdilahi Bulhan states in his work Frantz Fanon: The Revolutionary Psychiatrist, “psychiatry like any therapy should be the meeting of two ‘free’ people.” In our current society, this could not be further from the truth. Every state (and Washington DC) allows for a person to be involuntarily held for “treatment, observation, or stabilization.” Though specifications vary by state, the three main forms of commitment are: emergency hospitalization for evaluation, involuntary inpatient commitment, and “assisted” outpatient treatment. This means that other people may decide (without your consent) that you present a risk to yourself or others, and need to be removed from or surveilled within your community for “treatment.” Though Disabled people have fought tirelessly for our right to live in the community, as we approach ADA 30, we must acknowledge the many existing loopholes that make our involuntary confinement in congregate settings a reality.
As we talk about prison Abolition, discourse that was largely founded and remains spearheaded by revolutionary Black Women, we must reckon with the history of psychiatry, and better understand how the mental health system perpetuates processes of criminalization, policing, and surveillance. When we look deeper, we can see striking similarities between prisons and psychiatric institutions. As Leah Ida Harris described, both prisons and psychiatric institutions: have an overrepresentation of BIPOC (Black, Indigenous, and people of color), disregard the rights and safety of TGNC (trans and gender non-conforming) folks, use law enforcement transport/response, use solitary confinement and seclusion in cells/“rooms”, forcibly medicate folks (also known as chemical restraints), use physical restraints, offer extremely limited access to sunlight, fresh air, cell phones, news/media, and the outside world. In addition, sexual violence is routine, there is limited power to appeal legal/medical decisions, and the overwhelming majority of inmates are survivors of previous traumatic experiences. This year, the UN Special Rapporteur on Torture presented a report asserting that involuntary psychiatric interventions “may well amount to torture.”
Prison culture is not solvable by ‘funding the mental health system’ more robustly. The mental ‘health’ system is fundamentally carceral, meaning that it is one of the many kindred systems that function to contain and surveil people, take away their locus of control, isolate them from their communities, and limit their freedom. As it functions in America and in all places touched by colonialism, psychiatry is rooted in torture, white supremacy, and a culture of shame and punishment. Yes, the asylum lives on — and the police love the asylum.
Abolition means that all the cages come down, including those that function under the guise of psychiatric ‘care.’
The abolition of psychiatry does not mean that no one is allowed to identify with psychiatric diagnoses that they feel serve them, or that no one is allowed to continue taking psychiatric medications they find effective². It does mean, however, that the notion of ‘mental illness’ was invented to pathologize logical responses to the stress and trauma that are omnipresent in a world brutalized by colonialism and capitalism. Psychiatry has been described as a “medicalized colonizing of lands, peoples, bodies, and minds.” A notable example of psychiatry’s colonial intentions was the diagnosis of ‘drapetomania’: the mental ‘disease’ that explained why enslaved Black people in the Antebellum south ran away from their death camps (the ‘treatment’ for which was to treat them more ‘like children’). As China Mills states in Globalizing Mental Health, “distress caused by socio-economic conditions (and often neoliberal economic reforms) comes to be rearticulated as ‘mental illness’, treatable using techniques that draw upon similar rationales to those that led to distress initially.”
Psych abolition means that the intended and realized outcome of the advent of ‘mental illness’ as a signifier is to make folks feel like they will never get better and that their distress is inherent to their brain chemistry rather than a reaction to external stimuli. This logic is essentially victim-blaming and shifts responsibility away from cycles of violence that create the conditions for psychological suffering — not to mention that the “chemical imbalance” theory has been numerously debunked. It means, too, that psychiatry was built with a core desire to dehumanize, drug, and discard those whose behavior and ways of being diverged from the status quo. This status quo was and is white, patriarchal, and absolutely enamored with respectability and compliance with the state’s self-serving notions of “normalcy.”
Many Psychiatric Survivors have made incredible strides in pursuit of justice, reform, and sometimes abolition. But the current nature of psych wards, which, for the most part, have remained violent, degrading prisons at which a majority of ex-inmates assert that they were not helped and were further traumatized, arguably indicates that the asylum never died. Why? Because it was never supposed to. Psychiatry IS the ethic of the asylum, and it will not fall until Psychiatry falls.
***
Our discussions of psychiatric abolition are deepened when we look to the history of prison culture in its many forms — policing, the death penalty, disposal of the divergent, and underneath it all, an allegiance to the binary notion that there are good people, and there are bad people. The punishment and disposal of the “bad” and divergent is not just an American problem, but its manifestations in this country are unique and inextricably rooted in the enslavement and genocide of Black and Indigenous folks. In Amerikkka, those who are ‘good’ adhere to (or fit naturally into) the state’s status quo, and are useful cogs in the twin machines of white supremacy and capitalism. Within the state’s ‘bad’ category are those whose utility to the state is questionable, which disproportionately includes BIPOC, TGNC folks, LGBTQIA2S+ folks, Disabled and Neurodivergent folks, poor folks, and those who attempt to hold the state accountable for its violence.
It’s important, too, that we talk about harm. When many of us think of institutions, we think of keeping society safe from the most harmful among us. The truth is that we will all cause harm in our lives, and owning this rather than projecting it onto certain individuals is so important to abolition so that we can practice the antidote to punishment: accountability. Prison culture has put us in denial of our shared capacity for the full spectrum of harm, while prioritizing “crime” and defining it largely in terms of how we disrupt “order” rather than how we harm each other. The truth is that the structures to which we are supposed to adhere to be deemed “good” are at the very root of the cycles of violence that create our capacities for harm. Not only that, but our reasonable reactions to state-sanctioned violence are deemed “harmful,” putting the blame on the victims. Yes, there is much harm in the world, but if we try to imagine a world in which colonial structures no longer abuse our communities while happily sponsoring cycles of violence within them, it is possible to see us healing interpersonally and communally in a way that has the potential to transform us beyond prison culture.
It’s worthwhile to point out that prison culture has existed in our world for at least 4,000 years, with some anthropologists dating capital punishment back tens and even hundreds of thousands of years. All this to say: prison and punishment culture are fairly fundamental to humanity. Naming captivity for what it is — ancient — helps us face the colossal task of healing towards abolition. At the same time, there have been — and still are — societies and communities that resist harmful hierarchies and punishment. Indigenous peoples used talking circles for thousands of years, “which embodied hozjooji naat’aanii, a Navajo phrase meaning “something more like ‘people talking together to re-form relationships with each other and the universe.” We look to these Restorative Justice (RJ) practices as revered guides in our pursuit of abolition. Transformative Justice (TJ) is an evolution out of RJ that recognizes our need to also heal the systems of oppression that are causing us to harm our relationships in the first place.
Our world’s widespread prison culture is largely the result of a hierarchy of human value that has long served to simplify our understandings of each other. If we actually share a capacity for harm, then we are all worthy of getting in touch with our shared capacities for transformation. If we share, too, a capacity for diverse manifestations of distress and neurology, we must do away with the “sane”/“insane” binary and give each other permission to be free and find healing. Grounded in the teachings of Restorative, Transformative, and Disability Justice, we firmly believe a post-institution world is both possible and happening.
There is no way for us all to be free without dismantling the reductive systems of control that enforce state-serving notions of normalcy and rightness, the consequences of which are fatal for so many of us. Spiritually, they may be fatal for us all.
Disability Justice and Restorative and Transformative Justice ask us to imagine the world we want to live in, collectively, and practice those ideas and values each day. These frameworks give us the tools needed to shape a society that supports our healing. When we think of a post-psychiatric and post-prison world, we see peers walking with each other through suffering and developing empathic skills that foster mutuality. We see TJ processes helping us resist shame and punishment, embrace accountability, and dismantle internalized tendencies towards harm and abuse. We see us knowing that our distress is an understandable response to cycles of harm and suffering³. We see us spending restful and formative time with loving people in loving spaces when we are in crisis. We see us healing our trauma at our own paces and in our own ways. We see us no longer pathologizing and vilifying beautiful and harmless manifestations of neurodiversity. We see us never, under any circumstances, putting psychiatric drugs into each other’s bodies without (read: non-coerced) consent. And, perhaps most fundamentally, we see us taking actual care of each other, not paternalizing and imprisoning each other while referring to this violence as “care.”4
Non-carceral, loving forms of community care and crisis response are already evolving around us, to help us write this post-prison story. Project LETS does this work every day, through our Peer Mental Health Advocate (PMHA) models that exist outside of the carceral-industrial complex. Other wonderful examples include: The Hearing Voices Network, Mad in America, Sins Invalid, Health Justice Commons, Western Mass Recovery Learning Community, HEARD, and many more. The foundation has been laid, but together, we must do the work of building, imagining, and creating the new worlds we want to live in. As Frantz Fanon brilliantly stated, “if it is society that is ‘sick’, then it is ‘society that needs to be replaced.”
Notes
1 We refer to deinstitutionalization as a myth because it was never fully realized. Though populations inside of institutions were reduced, many of our community members are still incarcerated in psychiatric institutions, prisons, nursing homes, residential homes, and other congregate settings used to disappear people. For further context, we recommend: Decarcerating Disability by Liat Ben-Moshe.
2 Though psychiatry is a fundamentally violent system, there are some psychiatric drugs that are effective for some folks (though the structural, cultural trauma creating distressed manifestations of neurodivergence needs to be prioritized). We are not anti-medication, and do not advocate people stop taking medications that are useful to them. We believe, however, that the creation and evolution of psych medications could feasibly be taken over by post-psychiatric entities that recognize/build upon the small wisdom that has incidentally come out of this violent structure.
3 Some manifestations of neurodivergence do not feel like responses to interpersonal trauma or stress. Sometimes this is because they are responses to systemic trauma and stress that are so ubiquitous, we don’t realize their impact on our bodyminds. Sometimes, this is because the trauma and stress are inherited in the body from our parents and/or ancestors. Sometimes we don’t know where our distressing neurodivergence came from, and therein lies the value of identifying with a ‘mental illness.’ Sometimes our neurodivergence is not distressing in any way, and therefore needs no explanation. You get to choose the language for your own experience. Our hope is that you’ll allow yourself the exploration of how psychiatric diagnoses and mechanisms may be taking away your knowing of yourself, making choices for you, and categorizing your experiences in solely medical terms.
4 We would also like to validate that some folks have had good experiences in psych institutions. From an abolitionist lens, we believe that the good parts of those experiences could be replicated and improved upon within respite centers and other innovations in non-carceral healing spaces. Also, saying you had a good experience on a psych ward and therefore psychiatry shouldn’t be abolished is like saying the police have helped you and therefore shouldn’t be abolished—the point being that you are in the minority, and the wisdom of those who have suffered at the hands of these institutionally-backed harm-doers needs to be centered.
ABOUT
Stella Akua Mensah is a Black, Neurodivergent Peer Support Specialist, Psych Survivor, writer, Transformative Justice advocate, and artist from Chicago. She studied Literary Arts at Brown University, writing magical realism centering on themes of inherited trauma, Madwomanness, and Black Diasporic approaches to healing. Stella now serves as a Peer Support Housing Navigator for Homeless Women in Boston. Her ongoing passions center on transformative, decarceral, and communal care.
Twitter: @stellakuamensah
Stefanie Lyn Kaufman-Mthimkhulu (they/she) is a white, Latinx, and Jewish organizer and Director of Project LETS; a national grassroots organization led by and for folks with lived experience of mental illness, Disability, trauma, and neurodivergence. Their work specializes in building peer support collectives and community mental health care structures outside of state-sanctioned systems of “care” — grounded in principles of anti-racism and Disability/Transformative/and Healing Justice. Stefanie has extensive experience as a facilitator, curriculum developer, and consultant for mental health policies, program development, and accessibility. As a person with lived experience of madness, Disability, neurodivergence, and a survivor of psychiatric incarceration, they are invested in disrupting multiple carceral systems which disproportionately harm and kill our community members worldwide. They are also a graduate of Brown University’s Medical Anthropology and Contemplative Studies program.
Twitter: @stefkaufman
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