Black Lives Matter Syllabus Project, Pedagogy

The Anthropoliteia #BlackLivesMatter Syllabus, Week 20: Sameena Mulla on Policing Mental Health and Metzl’s The Protest Psychosis

The editors of Anthropoliteia are happy to continue an ongoing series The Anthropoliteia #BlackLivesMatterSyllabus Project, which will mobilize anthropological work as a pedagogical exercise addressing the confluence of race, policing and justice. You can see a growing bibliography of resources via our Mendeley feed.  In this entry,  Sameena Mulla discusses the entanglements of mental health diagnostic categories, policing, and criminalization. 

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Dontre Hamilton. Alfred Olango. Lavall Hall. Laquan McDonald. We say their names and are reminded of one recurring theme in the on-going discussion about racialized police brutality: the deadly confluences between mental health crises and the lethal force that meets them in police responses. I live and teach in Milwaukee, WI, the city in which Christopher Manney killed Dontre Hamilton in Red Arrow Park on April 30, 2014. The Milwaukee District Attorney did not charge Manney, though Manney was fired from the Milwaukee Police Department and the firing was upheld even after appeal. Mr. Hamilton’s family publicly shared their family member’s struggles with mental health issues, and the police chief, Ed Flynn, issued a statement that outlined Manney’s recognition of Mr. Hamilton’s health status as the basis of Manney’s violation of MPD protocols. As Flynn laid out in his official statement,

Christopher Manney, by his own statements in his response to charges, accurately assessed Dontre Hamilton as an Emotionally Disturbed Person (EDP). He made a determination that Mr. Hamilton was dangerous based solely on observations of apparent mental illness, absent any overt actions on the part of Mr. Hamilton. Despite his accurate assessment of Mr. Hamilton as an EDP, Christopher Manney treated Mr. Hamilton as a dangerous criminal instead of following his training and treating Mr. Hamilton as an EDP. Christopher Manney’s approach, including an out-of-policy pat down, was not based on individualized reasonable suspicion but on an assumption of his mental state and housing status. This intentional action, in violation of training and policy, instigated a physical confrontation that resulted in a deadly use of force. (10/15/2014)

The statement is itself an eminently teachable (and troubling) document. For example, before the section cited above, Chief Flynn says that,

Fearing that Mr. Hamilton would seriously injure or kill him, Officer Manney transitioned to his service weapon and discharged rounds at Mr. Hamilton to stop the threat. Mr. Hamilton died of his wounds.

This sentence achieves that ubiquitous police speech devoid of police actors actively engaged in killing. One can teach an entire class on this statement alone. Readers can imagine a simpler sentence, “Officer Manney drew his gun, and shot and killed Mr. Hamilton.” This statement is correct. The syntax of these phrases arrange Officer Manney’s bodily gestures and actions such that they never intersect with Mr. Hamilton’s. The violent turn inevitably begins with the victim: Mr. Hamilton’s body activated Officer Manney’s fear. Thus, Manney then “transitioned” to his “service weapon,” from which he “discharged rounds at Mr. Hamilton” as if he is just firing in Mr. Hamilton’s general direction and the bullets just happen to hit Mr. Hamilton and harm him, or “wound him” as the statement asserts. Mr. Hamilton then “died of his wounds,” another tragic accident as some of us imagine that perhaps not every person who is shot 14 times dies from their wounds. This statement is then followed by Flynn’s discussion of how Manney’s actions violated police protocols for approaching an “EDP” or “emotionally disturbed person.”

The killing of Mr. Hamilton triggered protests, many calls for accountability and changes in local policing practices and training protocols. Some attribute Milwaukee Police Department’s adoption of police body cameras to Mr. Hamilton’s death. The mayor and police chief have made a commitment to mental health crisis intervention training for all police officers, while the city and county continue to grapple with inadequate mental health resources. These problems are not new and research has examined the additional risk mental health patients face when police respond. Body cameras and mental health crisis intervention training seem laudable, but lest we be lulled into thinking that these solutions will effect deep transformation to the institutional and historical realities that undergird racialized policing and police brutality, books like Jonathan Metzl’s The Protest Psychosis: How Schizophrenia Became a Black Disease remind us that racial justice and ethical policing practices are co-constituted in very complicated ways.

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Where to begin? It is tempting to think that better training for police will result in higher survival rates for the mental health patients they encounter. Better yet, if we sufficiently resourced the mental health support and treatment capacities of our communities and police never had to respond to mental health crises, we might imagine a more just world. While this may well be worth advocating for, Metzl’s meticulously researched story of the Ionia State Hospital for the Criminally Insane is a sobering reminder that clinical medicine, mental health regimes, criminal justice systems, and diagnostic categories are also part of racism’s deep structures in the U.S. That is to say that police departments are but one institution through which racialized policing is achieved, and we need look no further than Foucault to appreciate that disciplinary and policing functions are also embedded in institutions empowered to intervene in mental health, be they asylums or clinics.

In my Culture, Health and Illness class, I prefer to open with Metzl and bring on the  Foucault later. Students in this class are a combination of anthropology, sociology and pre-med science majors, and find Metzl’s positioning as both an M.D. and Ph.D. compelling. That annoys me. Why can’t they just take a Ph.D.’s word for it? But let me be real here. We live in a world in which medical doctors have an ungodly level of credibility and authority, and if I have to use that to teach about the deep structures of racism, I will. Metzl summarizes the key findings of his project in this 24 minute video.

If you don’t have 24 minutes to watch this video right this second, here’s a sloppy synopsis of Metzl’s book (major spoilers in the interest of pedagogy): until the civil rights era, the typical inmate with a schizophrenia diagnosis at Ionia was a white woman. She was probably married and the case notes in her file likely referenced her failure to keep up with domestic duties. After many decades of this persistent pattern, Metzl observes a shift. Schizophrenics are more likely to be black men. Metzl compellingly explains that this is not, in fact, because of higher prevalence of schizophrenia among black men, but for other reasons. The rest of the book goes into details about the other reasons, many of which are how resistance and protest become signs of mental illness, what happens to the women and men who are committed and held at Ionia, be they housewives or protestors, and how something can be all about race without ever mentioning race.

The book is blunt in its assertions. Metzl is not interested in motivations— the pattern is what the pattern is. The methodology chapter is, itself, ridiculously teachable. Anthropologists struggling to explain why field research is worth undertaking are well-served by Metzl’s description of navigating Ionia’s archives, including visual artifacts, and developing an over-arching analysis that delivers a hard and important truth. There is both breadth and depth, intimate case studies that describe the plights of many Ionia patients, interspersed with broader patterns within the patient case loads, and interviews with former Ionia staff. I am teaching the book in its entirety this semester, which will allow me to introduce the movement for black lives into our medical anthropology class in meaningful and distinct ways. Students who want to know more can read any number of book reviews, watch a panel hosted by Johns Hopkins University’s Urban Health Institute, watch a talk by Metzl hosted by the University of Washington, read about the book on the medical anthropology blog, Somatosphere, explore the racial and gendered components of pharmaceutical advertisements in this blog post from Sociological Images, and supplement their understanding with essays by Foucault on the abnormal.

Images of pharmaceutical advertisements, dating to a time when drug advertisements could not target consumers and appealed only to physicians, depict the shifting patient population, making a very compelling case for what Metzl describes at Ionia occurring on a national level. The Haldol ad at the top of this blog post is among several advertisements Metzl analysizes, describing “black men with clenched fists, under the headline ‘Assaultive and belligerent?” (p. xiv). In short, Metzl’s excellent work reminds us that mental health diagnoses are yet another way to criminalize black patients in the U.S. These mechanisms are not straightforward, and neither are the solutions to dismantling them. It is the criminalization of mental health patients that guarantees that those patients will continue to be diverted into the criminal justice system, where they are met with the violence of incarceration rather than care. Educating police officers to recognize patients and respond to them with care may be one piece of the puzzle, but it is not the social safety net that creates the conditions under which  mental health patients can be safe and/or black. What’s more, thinking about how political resistance itself comes to be characterized as mental illness is worth thinking about in these important moments where social movements are organizing against police brutality and political oppression.

Sameena Mulla is Associate Professor of Anthropology in the Department of Social and Cultural Sciences at Marquette University, and the author of The Violence of Care: Rape Victims, Forensic Nurses and Sexual Assault Intervention, which was based on research in a Baltimore, MD emergency room-based sexual assault intervention program. Everything in Baltimore was and is about race without being (explicitly) about race, too. She hopes you are having an eye-opening Black History Month. 
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