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- [00:02]
Kal Penn
Hey everyone, it's Kel Penn. I'm inviting you to join the best sounding book club you've ever heard with my podcast, Hearsay The Audible and iHeart Audiobook Club. Every episode I nerd out with amazing guests and dive into the best new audiobooks available on Audible. It's the book club for your ears. Listen to Earsay the Audible and iHeart audiobook club on the iHeartradio app or wherever you get your podcasts.
- [00:32]
Lowe's Announcer
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- [00:59]
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- [01:31]
Martha (Kohler Cast Iron Ambassador)
When Kohler, global design leader in luxurious kitchen and bath products, asked me to be their ambassador for timeless, elegant, durable cast iron, I said, I'm in. Soon after, I was in their Kohler Wisconsin foundry watching molten iron poured, enamel applied by hand and the beautiful finished pieces ready to ship. Since 1883, Kohler cast iron has been crafted by incredible artisans and seeing it firsthand gave me a whole new appreciation for for their craftsmanship. Now I am proud to lend my stamp of approval to my favorite Kohler cast iron products for their durability, beauty and enduring style. Shop my curated picks@kohler.com as the Kohler Cast Iron Ambassador, I say long live Cast Iron.
- [02:35]
Katie Charlewood
Hello delicious friends, and welcome to who did what now the History podcast. That is not your history class with me, your host, Katie Charlewood, history harlot and reader of books. And I had a funny one this week. You know how people like to complain about my content. Well, I had someone accuse me of being nasty with my USA History Month. This month, if you're unaware, July 2026 is, is the celebration of the agreeing of the Declaration of Independence, not the gaining of independence in the US and so everyone's like, it's America's birthday. And so I was like, well, let's do American history then. Because it seemed like a very reasonable and logical option. So some people got a little bit tasty about that and I had someone accuse me of being nasty with my USA History Month because I'm talking about how the USA became the usa, which is, which is wild. Like, you think actual history is me bad mouthing a country like Sugar Lump. No, if you think this is nasty, right? And I haven't even touched on the British Empire yet. Like, I'm, I'm just getting started. But also it's not nasty or cruel or horrible to talk about the entire history of somewhere. And he's like, I'm not even doing the entire history. I've cut so much out because history is vast and large and, and I don't know if you know, this has lasted a long time. So it's one of those things, right? Because history, like, if you're only focusing on, you know, the rainbow and lollipops and you ignore everything else, then that's, that's not history, you know, that's. It's fan fiction, you know. But anyway, back to me. I do have more tour dates coming soon. Once I have them locked in, y' all will be the first to know. Well, no, the people, people who signed up like in the show, voting to know first. Well, know first and then Patreon supporters will be the first to know as. And then, and then everyone else will listen to her. But Belfast is at selling the hotcakes and Los Angeles, come on. It is a tragic day in Sunset Boulevard when you don't get your tickets. I'm not even on Sunset Boulevard, but you know, I'm chronically online and if you get it, you get it. Some people are going to be listening to this going, what Sunset Boulevard could have do with this? Like, just so you know, I'm gonna be such a broken record about this because like international tour guys. Also in today's news, because it is too funny not to share, Andrew Tate got arrested in Capris and a going out top like full mid 2000s style. Like I swear that I think my mom had a day to night outfit just like this. So for those of you who don't know, there was a big thing in fashion where people were genuinely concerned about their outfits and their makeup, being able to go from day to night so you could go from the office to the club, which is why everyone wore a blazer. But speaking of clubs, the Tate brothers like when they got arrested. So you've got Andrew Tate and he's in his little purple Elizabeth Taylor outfit. And then you've got Skabrees and his sensible lovers. And then you've got the other brother who's in a full three piece suit and fedora, like they both somehow look like Russian American nightclub owners in a direct VHS movie somewhere between 98 and 2000. And I stand by that. Absolutely. Also. Also, more news. The Gold. I was a big fan of the Gold. The Gold is making a movie which my little nerdy heart is so excited for. So there's a lot of good news going around here. But I know what you're thinking. You're thinking, katie, quit your Jabba Jabba and fact me. In fact you.
- [07:10]
Ryan Reynolds
I will.
- [07:10]
Katie Charlewood
But first we've got to get our source on
- [07:14]
Pandora Jewelry Announcer
our sources.
- [07:16]
Katie Charlewood
The Protest How Schizophrenia Became a Black Disease by Jonathan Metzl. How the Black Man Became Schizophrenic by Karen Franklin. The Effects of Race and Ethnicity on Individual and Neighbourhood Context by Augustine J. Kosa, Glenty Tsunakai and Edward W. Butler. Madness, Race and Insanity in the Jim Crow Asylum by Antonia Hilton. And of course, we have our old favourites, biography.com and history.com. are you sitting comfortably? Good. Then let's begin. There are a few things history loves more than watching powerful institutions convince themselves that they're being perfectly rational while doing something that future generations will collectively look back on and say, all right, well, that was disturbing. And so this, this story today is one of those moments like it is about psychiatry, race, politics, and what happens when medicine, like history, does not exist in a vacuum. So I'm going to talk about today, as I'm sure you know from the title of the episode, the Protest Psychosis. Now, I want to clarify, before I get into anything else, that this episode is not about whether schizophrenia is a real illness. Because it is. Because schizophrenia is a serious psychiatric disorder and it affects millions of people worldwide. And because we've researched it for decades. You know, our modern research has dramatically improved our understanding of causes, diagnoses, treatment. And nothing that we're discussing today should be interpreted as dismissing the experiences of people living with schizophrenia or suggesting that modern psychiatry views political activism as evidence of mental illness. Only idiots do that. No, this episode is about history. Specifically, it's about how psychiatric ideas changed over time, how social and political attitudes can shape medical thinking and how one diagnosis, schizophrenia, underwent a remarkable transformation during one of the most turbulent periods in American history. Because diseases don't exist in isolation. Now, the biology might stay the same, but the stories societies tell about illness, it. It doesn't like, things change. It's like, okay, sidebar. You know, when they talk about leprosy in the Bible, the disease that is leprosy, that is known as leprosy is not the same leprosy that exists today. It is a very, very different. It's a very, very different disease, which I will happily talk about one day because I really like historical diseases. But we will cover this. And that's the thing, right? So, as you guessed, I'm going to be talking about mental illness quite a bit in this week's episode. I'm going to talk about racism. I'm going to be talking about many horrible things consecutively, one after another in a row. And if you think that's something that's going to be a bit much for you to listen to, feel free to exit stage left and we will see you next time. Now, the civil rights movement in the US Won many great things for nation's minorities, right? But these victories came at a cost for the people who won them. Now, I know I joke about viva la revolution quite a bit, or not as much recently, because it's not as funny when the world is burning. But people who look like me, white women and just white people in general, a lot of the time when they talk about revolution and switching things up and fighting back and changing the system, they very conveniently forget that it's always the most vulnerable members of society who will be hurt first. Like, you can't make an omelette without breaking eggs. And I think that people need to be aware of exactly the consequences of their actions and ensure that they are comfortable with that. Of the consequences of that. Are they okay with it? Is everything happy? Are they good with that? Can they live with the consequences of their actions? Because a lot of the time they don't consider it. Like when people demand change and they. And they, you know, they forget that it's always going to be the marginalized who are in, you know, the firing line. But the civil rights movement is. And like a lot of people are aware of the civil rights movement, but they managed to ignore how black communities suffered through protests, riots, and I'm gonna call it vigorous police enforcement. Of course, discrimination from this time, which almost no one knows about, which is one that put a lot of black Men into mental hospitals, or at least tried to. So the phrase protest psychosis was not an official diagnosis that appeared in psychiatric manuals. You couldn't walk into a hospital and be formally diagnosed with protest psychosis. Instead, the term refers to a historical phenomenon in which psychiatrists, institutions, and the media increasingly associated schizophrenia with black political activism, anger and resistance during the civil rights era. In the following years, schizophrenia diagnosis in angry black men skyrocketed. This is a very specific type of schizophrenia, right. Suddenly discovered paranoid schizophrenia, sufferers of which were typified as having delusional and anti whiteness, which is frankly, laughable considering, you know, the lynching and the bombings and the segregation and the arson and all of the medical experimentation. Like, how, how is that delusional? Anti whiteness. Like pal, that is delusional for black men not to be anti white after being through that and that. I know, I know, you might be thinking, were these psychiatrists racist? Yes. Yes, they were. Right. Like, they reflected the social tensions of 1960s America. And so this influenced this, this decision. It was enhanced by their inherent biases. Like, this wasn't a cold clinical decision. The new diagnosis procedures were heavily intertwined with the cultural values of the day. Sorry, the cultural values of white doctors, leading them to create what was essentially a modern version of drapetomania, an illness that was concocted to explain and rationalize why the enslaved would so often flee their masters. So this diagnosis of schizophrenia, it's. It's a, it's a big flip at this time period because schizophrenia had previously been associated with people, you know, quiet, withdrawn, often middle class, white patients.
- [16:08]
Pandora Jewelry Announcer
Right.
- [16:09]
Katie Charlewood
This somehow becomes linked with angry black men protesting racial injustice. Now, if that sounds convenient for those already in power. Well, that's, that's one way of putting that. So there are thousands of hospital records, psychiatric journals, advertisements for antipsychotic medications. There are newspaper articles and institutional documents to trace how ideas about schizophrenia evolved alongside changing racial politics in America.
- [16:52]
Tony Ayo
So
- [16:54]
Katie Charlewood
medicine strives to be objective. Humans, not so much. Before the 1960s, schizophrenia was commonly portrayed in psychiatric literature as an illness characterized by withdrawal, emotional flatness, passivity, and retreat from reality. Images in medical textbooks often showed anxious white housewives or socially isolated white men. Now, the illness was frightening, certainly, but it wasn't generally portrayed as violent or politically threatening. Then America changed. The civil rights movement gathered momentum. You get sit ins, freedom rides, the march on Washington. You've got up and uprisings, You've got police violence broadcast on national tv. Black Americans demanding rights they'd been promised for generations, but consistently denied. And suddenly public discussions about race became saturated with fear. Right. It's also. Okay, Sidebar. Now, if you listened to my history of Coca Cola episode, like, so Coca Cola used to have cocaine in it and it used to be cheap, right? So cheap that anybody could afford it, even black people. And so there was a fear that because of the cocaine and Coca Cola, that black men were going to drink it and they were going to violently attack white women. Like this was a genuine, a genuine concern. And that is why they removed the cocaine from Coca Cola. So fear. There wasn't fear in black communities. Right. Like they, there was. I mean, they had very good reasons to fear violence from the state, but there was fear amongst white institutions that believed social order itself was under threat. Please, wouldn't somebody think of the children? So this fear spread through politics, policing, journalism and popular culture. And psychiatry changes too. And increasingly, psychiatric articles began describing schizophrenia in terms of hostility, aggression, paranoia and violence. And some researchers explicitly linked these symptoms to black men. Others suggested that the civil rights activism itself reflected paranoid thinking or pathological hostility toward authority. Delusional anti whiteness. Now, before anyone starts sharpening pitchforks, you know, this is looking at history. Looking at history, not psychiatric mental health, like as a whole. Now there were psychiatrists who disagreed with these ideas at the time and others just accepted it without questioning it. There'll always be some people who'll, you know, just take information willy nilly, like people who watch Fox News. And there are some who actually do a little bit of research and pay attention now, right. American society suddenly began imagining schizophrenia differently, right? And it had surprisingly little to do with neuroscience and quite a lot to do with the politics of race, fear and power in 20th century America. And to basically understand how schizophrenia became entangled with race and protest, we have to understand what psychiatrists thought schizophrenia actually was before the civil rights movement. And the story, it doesn't even begin in America, it starts in Europe or a really good pasta dish. So at the turn of the 20th century, German psychiatrist Emile Kraepelin discovered what he called the dementia praecox, basically meaning early dementia. He believed it was a disease that emerged in sort of, I say, youngins, youths, so adolescence or early adulthood, and it would just inevitably result in mental decline. Now, it didn't last long because in 1911, a Swiss psychiatrist, Eugene Blair, argued that Kraepelin had been too pessimistic. Right. Like patients didn't always experience this inevitable deterioration and their symptoms, like, varied massively so Bueller, he Bueller Bueller. Bueller. Blueler. Listen. Swiss. It's hard to say. It's full of holes. So he coined a new term, schizophrenia, from the Greek words, you know, schizine, meaning to split, and friend, meaning mind. Contrary to popular culture's favorite misunderstandings, he wasn't describing multiple personalities. He meant like the breaking up, the fragmentation of mental processes, thoughts, emotions and perceptions. They kind of stopped working together in a coherent way. That being said, this misconception somehow managed to survive for more than a century and at this point, deserves its own frequent flyer miles. So throughout the first half of the 20th century, psychiatrists generally characterized schizophrenia through what today we'd call negative symptoms. So like I said earlier, patients were described as emotionally withdrawn, socially isolated, passive, apathetic and detached from reality. They may speak very little, show little facial expression, appear emotionally flat, retreat from friends and family, spend long periods with their own thoughts. You know, just an introvert. Guys, leave him alone. So the dominant image, right, it wasn't one of violence or aggression. It was absence of emotion, social engagement and motivation. Sounds a wee bit like certain flavors of autism, though, doesn't it? I'm not trying to diagnose anybody, I'm just saying.
- [23:44]
HeroBread Announcer
So
- [23:46]
Katie Charlewood
if anything, schizophrenia was viewed as an illness of retreat rather than confrontation. Now this distinction will become important later. American psychiatric textbooks through the 1930s, the 40s and the 50s repeatedly emphasized these characteristics. Hallucinations and delusions. They did feature in clinical descriptions, but they weren't always considered the defining characteristics as they are today. Instead, it focused heavily on patients appearing disconnected from the world around them. And who were these patients? According to psychiatric literature and popular media, more often than not they were white. Not exclusively, of course. That would be silly, because schizophrenia has never really respected racial boundaries. People of every ethnicity and race have experienced this disorder because ethnicity and race is different. Just feel like. Like, okay, so it is okay, no, Right. Okay. Sidebar. It's interesting, right, because, like, the amount that we know about the world in general, the fact that people are still confused in ethnicity, race and nationality, like, those are different things. And also, race is a social construct designed to keep the boot on the neck of the marginalized. But representation matters. The photographs accompanying journal articles, educational materials and the pharmaceutical advertisements overwhelmingly featured white patients, usually white women. Hospital case studies disproportionately centred on white Americans, and the illness itself became culturally associated with whiteness. Even more specifically, many portrayals focused on middle class white women. So psychiatric literature of the day frequently described housewives who had become emotionally detached, withdrawn from family Life or unable to fill domestic roles society expected of them. Now let's just take a wee second, you know, to appreciate just how enthusiastically mid century America responded to women who weren't coping particularly well with the impossible expectations placed upon them. Feeling overwhelmed by being expected to be the perfect wife, the perfect mother, the perfect homemaker, impeccably dressed, permanently cheerful, and somehow fulfilled by waxing the kitchen floor. Well, have you tried sedatives?
- [26:47]
Pandora Jewelry Announcer
Right.
- [26:48]
Katie Charlewood
By the 50s and 60s, doctors were prescribing tranquilizers to women at astonishing rates. Drugs like meltdown and Valium like these immortalized in the Rolling Stone song Mother's Little Helper, right? And it was known as Mother's Little Helper, right? And this became the pharmaceutical equivalent of putting a polite smile over systemic problems. Because the message wasn't, perhaps society should reconsider these impossible expectations. It was more like, have a tablet and try not to make everyone uncomfortable. And if medication didn't seem to be helping, well, psychiatry still had other ideas. Lobotomies, particularly. Again, in the 40s and 50s of the early 50s, these were performed on tens of thousands of Americans. Although they were used for a variety of psychiatric conditions, including severe depression, anxiety disorders and schizophrenia, women were disproportionately subject to the procedure. Ice pick to the fucking brain. Sometimes it was because they were genuinely severely ill, sometimes because they were considered emotionally unstable, difficult to manage, or simply failed to conform to expectations of femininity. I don't know if you know this guys, but history does have a habit of confusing non compliance with pathology, which we will see more later. Now, schizophrenia was one of the conditions for which lobotomies were attempted. And some physicians genuinely hoped the operation might relieve otherwise an untreatable psychosis long before antipsychotic medications existed. Now, by modern standards, the procedure is devastating, often leaving patients profoundly disabled. And it has since become one of the most infamous chapters in psychiatric history. Now, the focus of this isn't that schizophrenia was treated with lobotomies or sedatives. Like we know that. It's that the image of schizophrenia like before the civil rights era, was overwhelmingly domestic. It was the anxious housewife, the withdrawn daughter, the emotionally distant woman who no longer fit neatly into society's expectations. Good thing we've done all that research on women's health now. Good thing we know all about postpartum depression and menopause and all that research we've done into endometriosis and everything that's been done. Right? Again, we're still focusing on White women like, women like poc, like they've had it much harder. Like it's just worse. An advocacy is. Listen, okay, I'm just, I'm getting angry now, so let's not effectively. The stereotype of the danger schizophrenic had yet to take center stage. And that would come later. And it wasn't an accident. See, it's not that women were actually more likely to develop schizophrenia than men because research suggests condition affects both sexes at a broadly similar rate. Those symptoms and age, they can differ. Right. Rather, it reflects who psychiatrists noticed, who sought treatment, who had access to hospitals, and whose stories medical institutions chose to document. Medicine quite like photography always depended on where the camera's pointed. And for much of early 20th century, the camera was pointed firmly at white America. I know you're shocked. Shocked. State psychiatric hospitals in the first half of the 20th century were enormous places. By the 40s and 50s, many housed thousands of patients, often in overcrowded conditions. They served as treatment centers, but they also functioned as long term custodial institutions. Like people didn't stay for weeks, they often stayed for years. And they suffered because treatments, I'm gonna say it bit barbaric, they ranged from occupational therapy and psychotherapy to insulin coma therapy and electroconvulsive therapy. And of course, lobotomies. Antipsychotic medication wouldn't become widely available until the mid-1950s. Now, World War II had a big effect on this as well. So you have this society where men of, you know, races, religions, you know, society cultural, they're all going to war, there's conscription, there's all of this. And televisions and radio communication is, is vast. And so people are learning things, more communication is shared and people are understanding that you can rise up, you can fight, you can grow and evolve and get rights. And women took a lot of jobs and helped industries survive during the Second World War and the first. But after which, you know, they're getting all these rights and they're told they can get educated and they can do A, B and C. And then they're pushed back into this, this role. And just like black America, they were expected to fight for their country, but weren't expected to have rights in that country, which is like, you can die for the country, but you're not allowed to vote. Like, what is this? So much of psychiatric care, Right. It consisted of observation, management and containment, not really recovery. And these hospitals reflected basically the broader inequalities in American society. Segregation inside psychiatric institutions. Right. It existed just as it existed outside them. Black patients were frequently treated in separate wards, admitted to underfunded hospitals, or just denied access to facilities available to white patients. Resources were unequal, conditions were unequal. Even medical records often differed in the level of detail physicians recorded. So while schizophrenia was culturally imagined as a disease of white withdrawal, black Americans with serious mental illnesses certainly existed within the psychiatric system. They just weren't on the face of the diagnosis. At least not yet. Because over the next two decades, as the civil rights movement transformed American society, psychiatry's image of schizophrenia would undergo a remarkable and troubling transformation. The biology of the illness hadn't changed. The patients hadn't suddenly become different. But the stories America told about schizophrenia were about to change dramatically.
- [34:40]
Ryan Reynolds
Hi, Ryan Reynolds here for Mint Mobile. Are you looking for a beach read this summer? May I suggest your big wireless bill? It's got suspense, mystery, a slightly flat emotional arc, and a shocking twist where you realize you've been overpaying the entire time. Fortunately, though, Mint Story is better. Every plan $15 a month. Even unlimited. That's it. Happy ending, zero tears. Give it a try@mintmobile.com Switch upfront payment
- [35:03]
HeroBread Announcer
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- [35:10]
Martha (Kohler Cast Iron Ambassador)
See terms When Kohler, the global design leader in luxurious kitchen and bath products, came to me and said, martha, we need an ambassador for our timeless, elegant, durable cast iron products. I said, I'm in now. Let me see the factory. Weeks later, I was suited up in coveralls and work boots, walking through their Kohler, Wisconsin cast iron foundry. I stood next to the molten iron furnace, the saw the hand applying enamel and touched the gorgeous finished products waiting to be sent out into the world. Since 1883, Kohler cast iron products have been forged and finished by the incredible craftspeople right in Kohler, Wisconsin. I'll tell you, I gained a newfound respect and appreciation for Kohler's cast iron craftsmanship. So now I am lending my discerning staff of approval to my most beloved Kohler cast iron products for their durability, beauty and timelessness. Shop my Kohler Cast Iron favorites curated on Kohler.com bring the warmth, character and enduring style of these timeless products into your kitchens and bathrooms. As the Kohler Cast Iron Ambassador, I say, long live cast Iron.
- [36:33]
Pandora Jewelry Announcer
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- [37:02]
Kal Penn
Hey everyone, it's Kal Penn. I'm the host of Irsay The Audible and iHeart Audiobook Club. This week on the podcast, I am sitting down with Ray Porter, the narrator of Andy Weir's audiobook project, Hail Mary Massive sci fi adventure about survival and science and what happens when you wake up alone, very far from Earth.
- [37:26]
Ray Porter
I really had to make a decision because I caught myself getting that frog in my throat and starting to get teary as I'm narrating some of these sections and it's like, okay, yo, yo, yo, is this indulgent? And I really thought about it. I was like, no. At this point it would kind of be betraying the trust the author and the listener have in telling this story if I don't go through it. But there's places in this book that that deeply, emotionally affected me. And I left it on the mic. That's great because it served the story. People will say like, oh my God, I cried at the end. It's like, yeah, dude, me too.
- [37:58]
Kal Penn
Listen to Irsay the Audible and iHeart audiobook club on the iHeartradio app or wherever you get your podcasts.
- [38:11]
Katie Charlewood
By the late 50s, America was changing. Now you know what? Changing is a bit too gentle of a word because it was being forced to confront contradictions. It had spent generations pretending either didn't exist or or weren't quite as bad as everyone was making out. It was, after all, the self proclaimed leader of the free world, the nation that had defeated fascism, the beacon of democracy, the country telling the Soviet Union about the importance of liberty. All while millions of its own citizens were legally segregated because of the color of their skin. And this contradiction was becoming more and more difficult to explain away. And right, okay, the civil rights movement. It didn't just appear overnight. Black Americans had resisted racial oppression for centuries. But during the 1950s and 1960s, that resistance became impossible for much of white America to ignore it. In 1954, the Supreme Court ruled in Brown v. Board of Education that racial segregation in public schools was unconstitutional. A year later came the Montgomery bus boycott. And this is all sparked by Rosa Parks refusal to surrender her seat. Now, sidebar the story about Rosa Parks like, oh, my feet are tired. I don't want to sit down? No. She was a political activist and she chose to do that. Right. Like she was always going to stand up now sit. Ins followed freedom rides, challenged segregated interstate travel. You had students marches, you had churches they were organizing. You had communities who were mobilized. And television cameras captured it all. And this is the thing. Perhaps for the first time, millions of white Americans watched peaceful demonstrators being attacked with police dogs, blasted with fire hoses, beaten by officers, and arrested for simply demanding rights they had supposedly possessed all along. Because the civil rights movement was not about creating injustice, it was about exposing it. In that is an important distinction. Because while many Americans watched these events with sympathy, as did the rest of the fucking world, others saw something really different. You know, they say that beauty is in the eye of beholder. Well, so is everything. Because your perception on how you see the world will reflect on how you think about it. Because some people didn't see people standing up for themselves, those with the boot upon their neck. Instead, they saw disorder, disruption, and authority being challenged. And for institutions built upon maintaining social order, that was unsettling to say the least. Now, after which came the Auburn uprisings. Because starting and around was it the mid-1960s, cities across the United States experienced outbreaks of violence following decades, and I do mean decades, of police brutality, discrimination, unemployment, poor housing, and systemic neglect. Harlem, Watts, Newark, Detroit, like more than 100 cities, experienced significant unrest during what newspapers in increasingly described as race riots. Because it wasn't a race riot. It's like we still use it today. And sometimes I'll use it to. To name something so that people know what I'm talking about and then I'll go and explain it. Because it's not a race riot. It's a rebellion. It's an urban uprising. Because these events didn't just pop out of nowhere. They weren't random explosions of chaos. They were responses to inequalities and repeated confrontation with police and local authorities. Now, that doesn't mean that every act of violence is justified. Right? We know that. Okay, don't play silly buggers with us. People died, homes and businesses were destroyed, and an entire neighborhood suffered. There's room to acknowledge both the structural injustices that fuel these uprising and the very real human they imposed. You can't make an omelette without breaking eggs. Understanding why something happened is not the same as excusing like everything. So as the decades wore on, the atmosphere became more volatile and 63. John F. Kennedy was assassinated in 65, Malcolm X was murdered in 68. Martin Luther King Jr. Was assassinated. And just two months later, Robert F. Kennedy was shot while campaigning for the presidency. Now, against this backdrop, a new generation of activists began questioning whether non violent protest alone could achieve lasting change. The Black power movement emerged as a broad political and cultural movement emphasizing self determination, economic empowerment and community control. Like people are so focused on, oh, it was a militia that they completely ignore. The Black Panther party established free breakfast programs, health clinics, educational initiatives, organizations, all while openly advocating armed self defence against police violence. Pretty sure that's in the first, Is it the second amendment? The second amendment. I'm sorry, you have a right to a well armed militia. Well, there you fucking go lads. Supporters saw dignity, empowerment and protection. And critics often saw militancy. The media, unsurprisingly, tended to find the photographs of young black men carrying rifles considerably a bit more eye catching than the pictures of children eating free breakfasts. Because conflict sells nuance always struggle to compete. But for many white Americans, these overlapping crises created an overwhelming self that the country was losing control. Oh, we want to get back to the good old days. Public opinion polls throughout the late 60s showed rising concern about crime, protest and civil disorder. Politicians increasingly campaigned with promises of restoring law and order. Newspapers filled their front pages with images of burning buildings, armed protesters, and confrontations between demonstrators and police. Fear became part of everyday political conversation. And fear has a remarkable ability to shape the way societies interpret what they see. An angry black activist demanding equal rights, a young man confronting police officers, someone expressing distrust of government institutions. Right, all, all of this, right. Today we'd ask, you know, what led them to those beliefs. But back in the very tense political climate of the 1960s, some people, including psychiatrists, began asking a very different question. What if this wasn't simply political anger? What if it was a symptom? Right. And this would profoundly reshape the, the way schizophrenia was described, diagnosed and understood in America. Not because the illness itself had changed, but because America had. Now, if the story ended with growing social anxiety, it would already be an uncomfortable chapter in American history. But it didn't end there, because those anxieties seeped into medicine. And not through one single conspiracy. Not because psychiatrists gaveled in, you know, smoke filled rooms plotting to redefine happened gradually. One journal article, one revised diagnostic description, a hospital case report, a pharmaceutical advertisement.
- [47:06]
Pandora Jewelry Announcer
Right.
- [47:07]
Katie Charlewood
One by one. And over the course of the 60s, the public image of schizophrenia had changed almost beyond recognition. Now, if the idea of protest being treated as a symptom sounds unbelievable, allow me to introduce one of medicine's all Time worst takes. In 1851, American physician Dr. Samuel A. Cartwright coined the term drapetomania, in which he claimed it was a mental illness causing enslaved people to run away from their enslavers. Yes, you heard that correctly. Instead of maybe considering that people fled slavery because it was slavery, Cartwright suggested the desire for freedom itself was pathological. Sometimes, gentle listeners, history will hand us an example of something so absurd that satire really becomes unnecessary. Now, rapedomania was never accepted as a legitimate scientific diagnosis outside a small circle of pro slavery physicians. And today it is universally acknowledged as pseudoscience rooted in racism. Racism rather than medicine, or as I like to call it, absolute bollocks. But it is an important reminder that medicine has at times been used to defend existing power structures instead of questioning them. Because when oppression is treated as normal, resistance can begin to look like illness. It's kind of like how I'm going to talk about it. You know, everyone's like, movies are so. Sidebar. Movies are so woke now. Oh, my God, I can't believe they have an Asian man in the Odyssey. And it's like the. The ancient people who were known to travel and trade, and you're surprised that one Asian person appeared in. In Greece, really? We know people traveled. Okay, we. We have. We know. And it's like, oh, yes, everyone just stuck within their own ethnically homogenous groups. Like, no one ever went anywhere before 1492. Getty Fuck, pal. Like. Like, this is such a wild thing. It's. It's like white people, because they've weaved. Been part of the narrative for so long, and white men especially have controlled the narrative that they see themselves as the default. So whenever a character is not a straight white man, it's often, like, seen as woke or odd or peculiar or just some nonsense. And anything other than straight white man is odd, unusual, different. It's not the standard, you know, and it's so wild. Like, they just see themselves as the default setting and. No, like. Okay, another sidebar. So when I was studying history and sociology, like, I studied a lot of it in the uk and in the uk, right, we were told, don't use POC People of color. You use BAME B A M E, which is black, Asian, and other minority ethnicities. Now that term is now I'm gonna say gone out of fashion. Because it's. Yeah. So the other option is the global ethnic majority. Because white people are not the global ethnic majority. Right, you're not. So the fact that white people see themselves as the default is very very funny, especially from a nation who lives on stolen land, you know. So while protest, psychosis, and drapetomania emerged in very different centuries and under very different circumstances, they share an uncomfortable family resemblance. And both asked the wrong question. Because they didn't ask, why are these people resisting? Instead, they asked, what must be wrong with them? Because to understand this shift, we need to talk about the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the dsm, which is basically psychiatry's rulebook. Which, for the record, Sidebar Stockholm Syndrome isn't in there. Stockholm Syndrome isn't real. You're confusing that with several other different things that have been shoved under the one umbrella. And instead of I'm not going to okay, no, no, listen to the Stockholm Syndrome episode if you want to hear me rant about that.
- [52:13]
Martha (Kohler Cast Iron Ambassador)
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- [54:06]
Kal Penn
Hey everyone, it's Kalpen. I'm the host of Irsay the Audible and iHeart Audiobook Club. This week on the podcast, I am sitting down with Ray Porter, the narrator of Andy Weir's audiobook project Hail Mary Massive Sci Fi adventure about survival and science and what happens when you wake up alone, very far from Earth?
- [54:29]
Ray Porter
I really had to make a decision because I caught myself getting that frog in my throat and starting to get teary as I'm narrating some of these sections. And it's like, okay, yo, yo, yo, is this indulgent? And I really thought about it. I was like, no. At this point, it would kind of be betraying the trust the author and the listener have in telling this story if I don't go through it. But there's places in this book that deeply, emotionally affected me. And I left it on the mic. That's great because it served the story. People will say like, oh my God, I cried at the end. It's like, yeah, dude, me too.
- [55:01]
Kal Penn
Listen to Irsay the Audible and iHeart audiobook club on the iHeartradio app or wherever you get your podcasts.
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Tony Ayo
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- [56:11]
Katie Charlewood
The DSM doesn't define diseases in the biological sense, right? It provides clinicians with agreed descriptions of symptoms, helping doctors diagnose patients consistently. The first edition, the DSM one, was published in 1952. Now, by modern standards, it is brief. It reflected the influence of psychoanalytic thinking, and it often described mental illnesses in broad, rather subjective language. And schizophrenia was largely characterized by disturbances in thinking, emotional withdrawal, disordered relationships with reality, and what psychiatrists called autistic thinking. A historical psychiatric Term referring to withdrawal into one's inner world, which is not autism spectrum disorder as we understand it today. Right. The emphasis remained largely on withdrawal, detachment, emotional distance and patients turning inward. But by 1968, the DSM2 arrived. The manual still wasn't a checklist in the way later editions would become, but the language surrounding schizophrenia had noticeably shift. Descriptions increasingly highlighted hostility, aggression, suspiciousness, belligerence, paranoid thinking. Patients were more frequently described as argumentative, combative and hostile towards authority figure. To be absolutely fair, many people experiencing paranoid schizophrenia can develop persecutory delusions involving governments, police, neighbours or authority figures. Modern psychiatry does recognise this as one possible manifestation of psychosis. The issue was that psychiatrists weren't describing paranoia. The issue was whose paranoia they were increasingly choosing to describe. Because by the late 60s, examples of suspiciousness toward authority were appearing in and in America, where black citizens had a very good reason to distrust authority. The FBI was monitoring civil rights organizations, police brutality was widespread and government agencies were infiltrating activist groups in reality had become rather inconvenient for simplistic psychiatric assumptions. So, like in psychiatric journals, Right. Articles published during the late 60s began presenting patients who claimed to be members of militant organizations, believed they possessed revolutionary missions or expressed intense hostility towards white authority figures. Some papers explicitly linked schizophrenia with what psychiatrists described as anti white hostility, militant political beliefs or delusional anti whiteness. Now, psychotic delusions frequently incorporate contemporary events. Right. Someone experiencing psychosis today might believe they're being monitored through social media or artificial intelligence, because those are familiar cultural reference points. A century ago, those same delusions might have involved radio waves or secret societies. So the appearance of civil rights themes in psychosis wasn't that surprising. The troubling is, is why psychiatric literature increasingly appeared to treat black political anger itself as evidence of illness, rather than distinguishing between legitimate political grievances and genuine psychotic symptoms. Those are two very different things. And medicine blurred that distinction even more than we'd like to admit. Perhaps the most visually striking evidence comes not from medical journals, but from advertising. Throughout the 1950s, advertisements for psychiatric medications generally depicted quiet patients, withdrawn women, despondent families, individuals isolated by sadness or emotional detachment. And then came the 60s. Advertisements produced by pharmaceutical companies, published and respected medical journals aimed at psychiatrists began looking dramatically different. Gone were the housewives. Instead, doctors were shown illustrations and photographs of angry black men with confrontational body language, clenched jaws and raised fists. And sometimes they explicitly connected schizophrenia with violence, riots or social unrest. Others used imagery, you know, weirdly reminiscent of the racial tensions dominating American Headlines. Several featured black men whose expressions and poses widely circulated news photographs of protests and urban uprisings. And remember, these adverts are not aimed at the public. They're aimed at the doctors. Because this is where it changes. Because schizophrenia is no longer passive. It's dangerous. And increasingly, schizophrenia looked black. Now, pharmaceutical advertisements are marketing materials, not scientific documents. They don't tell us how every psychiatrist thought, nor do they prove that every doctor accepted these stereotypes. But what they do reveal is advertising works by appealing to assumptions its audience already recognizes. Because marketers don't invent anxieties out of thin air. That's what Fox News does. Fuck, I haven't been to Fox News twice. Can I do it a third time? We'll find out. If pharmaceutical companies believed images of angry black men would resonate with psychiatrists in the late 1960s, that tells us something uncomfortable about the cultural landscape in which medicine was operating. They reflected racial stereotypes that were already circulating through American society and reinforced them. And by the end of the decade, the transformation was remarkable. A diagnosis associated with quiet withdrawal had become associated with confrontation. One represented by white middle class women was increasingly represented by black men. Biology hadn't changed. The brain hadn't changed. But America, its imagination, had. And when cultural imagination begins influencing medical judgment, consequences don't exactly remain confined to textbooks. Because these, these ideas weren't just appearing in journals and advertisements. They were shaping real diagnoses affecting real patients admitted to real psychiatric hospitals. Now, it's tempting to just file this neatly under, well, thank goodness we've moved on, because history would probably be a bit more comfortable if that was true. But history does have this annoying habit of lingering, not in obvious ways, sometimes in institutions, sometimes in statistics, sometimes in memories passed quietly from one generation to the next. And nowhere is that perhaps more evident than in the relationship between black communities and the American healthcare system. Because one of the lasting consequences of this is distrust. Now, you'll often hear people talk about distrust of medicine in black communities as though and appeared out of nowhere, as though someone woke up one morning and just decided doctors can't be trusted. Because that's not how this works. Because trust is built on experience, and mistrust is built the same way. And for many black Americans, medicine isn't just associated with healing. It's associated with segregation. The Tuskegee syphilis study for sterilization, medical experimentation without consent. And as we've explored throughout, I mean, if you go listen to the Black History month series, periods when psychiatry interpreted, you know, responses to racism through the language of pathology doesn't mean that every doctor was racist. It doesn't mean that psychiatry is like uniquely flawed. It means that institutions are shaped by the societies in which they exist. Because if a society carries prejudice, that's going to bleed into the institutions too. And the protest. Psychosis isn't just like one outdated psychiatric theory. It opened the door to decades of research examining how unconscious bias can influence diagnosis. Black patients are more likely than white patients presenting with similar symptoms to receive diagnoses of schizophrenia or other psychotic disorders, while white patients are more likely to receive diagnosis such as mood disorders, including major depression or bipolar disorder. When psychotic symptoms are present. It doesn't mean that every diagnosis is incorrect or that it's over diagnosed in every black patient. Because mental illness is complex. And it does suggest though that cultural assumptions influence this. So imagine two patients, they're basically saying the same thing. People in authority are watching me, right? And for one they might hear like the doctor may hear paranoia and for another they might hear anxiety. Right? Now you'd hope that the doctor would do, you know, ask a couple questions about previous experiences with authority like policing or discrimination before, like making conclusions. But sometimes they don't. So removing context can basically change the meaning of what someone says. So modern psychiatry, it emphasizes cultural competence, right? Because you're supposed to have culturally informed or culturally responsive care. Because basically sidebar deciding whether a belief is evidence of psychosis, doctors should ask whether that belief makes sense within the person's cultural, historical or lived experience. Because if someone comes from a community with a long history of discrimination, mistrust of institutions, right, Isn't irrational if someone has experienced racial profiling, concerns about future encounters with police, also not irrational. It's not automatically paranoia. So context is relevant. And understanding context doesn't prevent doctors from diagnosing when it's genuinely present, right? It just helps them distinguish between illness and experience. Now if you are listening during bipoc, I keep want to call it bipoc is that. I don't know if that's right or wrong. It's. It's Mental Health Awareness one month. Bipoc Mental Health Awareness Month. And so this history is really important, which is why this is a bit different to a few other things that I've, I've done. This is very, a very psychiatry laden episode. I don't talk about it a lot, but so when I was in college, but my main areas of focus are history and sociology, but I do have a supplemental background in psychology and social geography because it's all interlinked and so this is why, this is something I really, I wanted to talk about because this is the perfect time to do it. And I understand that this is, oh God, it's a very dense episode as opposed to this happened and then that happened and the other happened. But it's important and I was making this episode. So yeah. This month, BIPOC Mental Health Awareness Month was established in the US to highlight the mental health experiences of black, indigenous and other peoples of colour. It's not just about increasing access to therapy or encourage conversations about well being. It's part of it, but it's about acknowledging history because people don't seek treatment in a historical vacuum. And understanding why some communities distrust mental health institutions isn't about assigning blame to today's doctors. Most psychiatrists, psychologists and mental health professionals, like most, are committed to providing ethical, evidence based care. But they have to know that that trust has to be earned.
- [69:58]
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- [70:01]
Katie Charlewood
doctors don't stop being members of society when they put on a white coat. Scientific progress doesn't happen in isolation from politics, culture or prejudice. And researchers don't leave their assumptions at the lab door, right? And diagnostic manuals, right, they're not, they're not gifts from fucking God, right? They're not like chiseled in, you know, stone tablets provided by the heavens. They're written by people, which means they can improve, they can be corrected, and they can also be wrong. Right? Now today's psychiatry bears very little resemblance to the field that I've been describing over this episode. Diagnostic criteria has evolved, right? It's gotten better. But clinicians are also really aware of the ways bias can influence medical decision making. And I'm gonna, okay, I'm gonna throw some stats at you now because it's important. Black patients are more likely to report not being believed. And we see cases like this all the time. 22% of black adults report that a healthcare provider did not believe they were telling the truth. 19% say a provider refused a test or treatment that they believed they needed. 18% report being refused pain medication. And overall, 36% of black adults say that there was a time they believed they would have received better medical care if they were a different race. 1 in 4 black adults report race related discrimination while receiving health care. Negative health care experiences made patients delay seeking care, switch providers or avoid health care altogether. And perhaps what's probably the clearest example of what happens when patients are not listened to is maternal health care. Black women in the United States were three and a half times more likely to die from pregnancy related causes than white women. They had around five times the mortality rate from preeclampsia. They had six times the risk of dying from postpartum cardiomyopathy. This is still happening. This is still happening today. Research consistently finds that black Americans are more likely to receive a diagnosis of schizophrenia or while white patients presenting with similar affective symptoms are more likely to receive the diagnosis of the mood disorders. Now this disparity has been documented across decades of psychiatric research and continues to be an area of active investigation. Now, there's a peculiar tradition in American history where large numbers of people begin asking convenient questions. Someone eventually suggests they're not merely wrong, they're mentally ill. And so the protest psychosis. Enter drapetomania. Now, protest psychosis was never a legitimate psychiatric diagnosis. It was, however, a disturbingly influential idea that emerged in the late 20th centuries as psychiatrists, law enforcement and broader social anxieties overlapped. And during the civil rights movement, researchers proposed that black men involved in protests and activism were more likely to develop paranoid schizophrenia. Now, this logic is circular, right? It is. It is. Wow. Like if you believed the state were surveying, targeting or oppressing black Americans, perhaps you were the one suffering from delusions. History, of course, delivered one of its favourite plot twists. The FBI really was surveying civil rights leaders. Quentopro really did exist. Martin Luther King Jr. Really was wiretapped. Turns out accurately identifying institutional racism is not in fact a symptom of psychosis. How embarrassing for the diagnostic criteria. And this idea of protest psychosis reflected something far more revealing than than any patient's mental state. It shows a society uncomfortable with protest and is willing to medicalize political dissent rather than confront the injustices inspiring it. If someone is angry because they're denied equal rights, perhaps the problem isn't the anger. Perhaps, possibly it is the denial of rights. Now again, to confirm, to clarify this is not to dismiss schizophrenia and other severe mental illnesses. They are serious medical conditions affecting millions of people and they deserve evidence based treatment free from political interference and social stigma. The tragedy is that psychiatric language, which is intended to help patients, is instead weaponized to undermine activists and reinforce existing power struggles. Good thing we don't have that today. Medicine is not immune to prejudice. Psychiatry, like every scientific discipline, exists within the society that produces it. And diagnoses have historically reflected cultural assumptions as much as clinical observation. We like. Jeez. Homosexuality remained classified as a mental disorder in the dsm. That's right, the Diagnostic and Statistical Manual of mental disorders until 1973. Right. Like how easy social discomfort masquerades as medical certainty. Now, the lesson here isn't psychiatry as inherently suspect. Science works best when it questions itself as rigorously as it questions its subjects. Because, like, if a diagnostic manual starts sounding, you know, like an editorial in favour of the status quo might be time to review the methodology. That's a thing. Like, protesting injustice is not evidence of mental illness. It's not. It's making demands for equality as symptoms of disease. Like, that's. That's a pathology history has diagnosed quite harshly. And like. And when we talk about mental illness, when we talk about it properly, you know, it's still seen with disdain. There's. There's a stigma still with it. So not only within society as a whole, but especially within marginalized communities, because black communities are always treated harsher than a white community, right? It's consistent. And I'm a white person. I'm privileged, right? I might be a woman, but I'm still a male sapien, which puts me in a place of privilege. And I think people like me especially need to check our privilege at the fucking door, you know, and actually look at what's happening around us and need to learn to be uncomfortable and need to learn to do without in order to help others. And I think that's a big thing. Again, this has been a very different episode to what I normally do, but that is. That is the story of the protest psychosis. And, yeah, that's. That's that. So, whoo. Again, very, very dense episode. Very laden with. Yeah, so with that, I'm gonna bid you adieu. I'm not gonna bid you adieu, though. No, I'm not. Because it's recommendation time. Sidebar. Actually, one more sidebar. One more sidebar. So, basically, people of color have always been judged more harshly than white people. And when it comes to being respected in spaces as well, right, black people have to be more. They have had to be more serious. Like, I remember when the Chubby Bunny Challenge was like a big thing, like, just very many years ago. I'm. I'm. I think I'm going back nearly a decade for this. And it was basically, how many marshmallows can you put in your mouth and then speak? And overwhelmingly white. You know, a lot of black creators weren't doing things like the Chubby Bunny Challenge because those silly challenges would be used to discredit them, especially online educators and things like that. So, you know, you had to be very strict. Now, luckily, things are changing slightly. Like we're kind of moving in the right direction, but it means people like me, like people who have privilege, you know, to show up, to stand up and support and sometimes to shut our fcking mouths and listen to what people are saying. Um, because I, I understand the irony that is someone who talks about many things that are not my race, religion, nation, that I'm always concerned about overstepping the mark. And I do try and be respectful. But the good thing is people are not shy about telling me when I've buggled up. So that's really nice. But yes, it's, it's recommendation time. Let's, let's, let's wrap this up. So it is recommendation time. Recommendation time for reading Blanche on the Lamb by Barbara Neely. What? I like a mystery. So for watching Ride or Die, it is my new favourite thing. I love it so much. And for listening, listen to the Wine and crime podcast. Just like those are my girls. I love them so much. So with that I shall bid you adieu. Adios. Au revoir. Au vui de ze, my friends.
- [81:07]
Tony Ayo
Bye bye.
- [81:08]
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Katie Charlewood
Not a chance.
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