Over the past few years, there have been a multitude of calls for better access to mental health care. While these services are valuable, how often do we consider all that operates under this service? Western therapeutic and psychiatric services descend from an extensive lineage of racism, colonialism, classism, heterosexism, cisgenderism, and ableism. These -isms shape what passes for “care” in our culture.
Queer, trans, BIPOC, and disabled communities particularly feel these inequities in the current state of care, despite the best intentions of mental health service providers. For some within these communities, “madness” has been reclaimed through critiques by various theorists like Therí Alyce Pickens who offer a different take on “madness.” These criticisms trouble common understandings of what wellness and care should look like. In the process, they also reveal how systems of care within the medical-industrial-complex can perpetuate harm and further marginalize communities. Thus, it’s helpful to consider the many alternatives offered by madness and its relation to wellness.
“Within the long history of Black literature, madness surfaces not solely as pathology or as part of a holy fool tradition, but also as a viable alternative to engagements with white racism even if it does not result in increased agency. Madness becomes the place to engage because racism adheres to a peculiar kind of rationality, predicated on the long history of the Enlightenment and its material effects” (Pickens 2019, 14).
“…even if it does not result in increased agency.”
These words haunt me, evoking the ghost of ominous ellipses: Even if it does not result in increased agency… Pickens encompasses “(in)sanity, cognitive disability, anger, and … excess” within the term mad (2019, 4). Pickens actually builds upon Menzies, LeFrançois, and Reaume’s argument that madness can “represent a critical alternative to ‘mental illness’ or ‘disorder’ as a way of naming and responding to emotional, spiritual, and neuro-diversity” (2013, 10).
Historically, madness has been entangled with race and used to condemn anyone outside the normative white mindbody. This is evidenced by American psychiatrists of the 19th century pathologizing enslaved Black folks with diagnoses like drapetomania (leading them to run away from the white enslavers) and dysaesthesia aethiopis (causing “disrespect for the master’s property”) and civil rights era diagnoses like protest psychosis (the development of “hostile and aggressive feelings” and “delusional anti-whiteness” in Black men) (Metzl 2010, ix, xiv). Importantly, these diagnoses were conditions psychiatry sought to treat.
Pickens theorizes that these psychiatric expressions of Blackness and madness create spaces outside of a “rationality” that reifies whiteness, allowing madness to be a viable alternative. In fact, Toni Morrison proclaimed Black women in the antebellum American South would strategically go “mad” in an effort “to clutch hold of one’s mind when Reason would steal or smash it” (Bruce 2017, 305). With the day-to-day abuses of white, cis-hetero-patriarchical dominion, La Marr Jurelle Bruce espouses Black women’s madness as “fugitivity” (2017, 305). Pickens and Bruce reveal a pathway for how disabled, mad, queer, and trans folks also experience marginalization by not achieving the model of health and normativity that whiteness puts forth.
French social theorist Michel Foucault literally wrote the book on (white) madness in Western civilization. As a young adult, Foucault dealt with self-harm, suicidal ideation and attempts, and other behaviors of distress, which informed his take on white madness. His psychiatrist blamed Foucault’s psychological distress on his queerness and non-cisheteronormative sexual activity.
Ironically, this remains a common trope facing the LGBTQ+ community—it is not atypical for a person’s queer sexuality and/or gender to be blamed for their mental illness/distress (Pilling 2022). Based on the experiences of 2SLGBTQ+ psychiatric patients/survivors, Merrick D. Pilling documents the many traumas frequently perpetuated in psychiatric settings: deadnaming, using incorrect pronouns, invasive (and irrelevant) questioning of sexual experiences, overdiagnosis. Despite being over 60 years ago, Foucault’s experience mirrors current circumstances. In many ways, his subsequent critique that social forces shape madness proved quite valuable for the anti-psychiatry activism of the ‘60s and ‘70s.
In 1974, Madness Network News candidly asserted, “Mental illness is not a medical issue. It’s a social issue” (Seagull 1974, 1). These ideas complicated gay and lesbian rights-based activism, which was trying to remove homosexuality as a diagnosis for psychiatric illness. Notably, they did not challenge the problematic assumption allowing prejudice to be pathologized as mental illness; they merely challenged that “homosexuality” was not a pathology. These activists maintained that if people no longer saw homosexuality as a “sickness,” they would recognize (white, middle-class, able-mindbodied) gay men and lesbians as normal people, just with different sexual desires.
Conversely, radical queer movements throughout the late 20th century embraced social critiques that produced an anti-psychiatry discourse. These radical queer activists accepted the label by psychiatry and the broader culture that queerness was irrational and psychotic. As Abram J. Lewis records, “Rather than working to disaggregate homosexuality from associations with mental illness, these activists emphasized homosexuality’s continuities with madness, positing both as politically productive models of fractured existence” (2016, 101, emphasis mine). In effect, these radical queer activists rejected their ‘claim’ to rationality. They were also more diverse and intersectional, invested in antiracist, anti-capitalist, and feminist politics. As a result, their efforts were spent forging viable alternatives to the racist, cis-heteronormative, patriarchal, nationalist systems that sought to define them.
Simultaneously, mental health services began to commodify the mental and emotional distress of marginalized groups—creating therapies tailored to their experiences of marginalization. Not only were queer folks villainized, criminalized, and pathologized, but these life experiences could be commercialized through treating the resultant mental and emotional difficulties. Addressing this concern at the 1976 antipsychiatry conference, activist Tanya Temkin proclaimed, “The presence of ‘feminist’ therapists (and their expanding, newly created clientele), does not really confront the issues of the day-to-day abuses of women confined in mental hospitals” (Lewis 2016, 105).
The Radicalesbians collective of this period used anger, madness, and rage, declaring, “A lesbian is the rage of all women condensed to the point of explosion” (Lewis 2016, 107). Madness was a “sane reaction to insane social conditions” (Staub 2011, 2). Exploding against a system of oppression is about confronting day-to-day abuses, not seeking treatment to better cope with these abuses and ongoing oppressions. We see echoed here Pickens’ provocation that madness is an alternative engagement even without increased agency.
Demonstration, with Gay Liberation Front Banner, c1972
Image from LSE Library
In our current cultural moment, queer folks generally have a greater likelihood of experiencing suicidality: up to 45% of LGBTQ+ youth seriously consider suicide and over 50% and almost 75% of LGBTQ+ youth experience depression or anxiety respectively (The Trevor Project 2022, 5, 8). Transgender youth have a starkly higher rate of experiencing depression, anxiety, and suicidality than their cisgender counterparts (Reisner, Vetters, and Leclerc, 2015; Toomey, Syvertsen, and Shramko, 2018). This is not due to some innate vulnerability of LGBTQ+ folks for mental and emotional issues but is part of social and political determinants of health. Consider the fact that approximately 30% of LGBTQ+ youth experience food insecurity and 29% experience housing instability, which significantly increases the likelihood of attempting suicide (The Trevor Project 2020).
Meanwhile, trans-affirming parenting is inaccurately conflated with child abuse, and by May of 2023, there were a landmark 520 anti-LGBTQ+ bills brought forth in the U.S. with the most extreme being anti-trans bills (Peele 2023). These data do not even capture the banal anti-queer and -trans behaviors many experience in their everyday lives. While mental health treatments can be life-saving and provide important support in people’s lives, there are profoundly distressing social and political conditions at play that reflect and require a different consideration of “madness.”
Mental illness can be used as a scapegoat, disappearing marginalized folks within institutions to avoid needed social changes. It is worth recognizing that our current neoliberal system of care, with all its hazards and exorbitant expenses, is a Band-Aid. Typically it remains people’s only option, and it is a bad option for too many facing stronger social forces. Thus, while mental health services can be helpful to people, just as it previously helped me, our mad kin (past and present) show us that simply expanding these services uncritically is not the answer.
Our “madness” can be an alternative to the oppressive logics defining our lives. But if it does not result in increased agency, what can madness’ alternatives offer? Assigning rationale to madness is antithetical to madness. Embracing madness does not cure psychological distress. Yet we see generations of examples where these alternatives manifest as searing critique, an explosion of rage, and a protest insanity that contest the physical, mental, emotional, and spiritual day-to-day abuses. Thus, I want to embrace madness and learn from our mad kin, not merely out of my queerness and experiences of distress, but to explore viable alternatives for a different path to wellness.
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Clayton Jarrard is a Research Project Coordinator at the University of Kansas Center for Public Partnerships and Research, contributing to initiatives at the nexus of research, policy implementation, and community efforts. His scholarly engagement spans the subject areas of Cultural Anthropology, Queer Studies, Disability Studies, Mad Studies, and Religious Studies. Clayton is also a co-host for the Un/Livable Cultures podcast.