How did mental health professionals respond to the social and political upheavals of 1960s America? Lucas Richert explores the emergence of Radical Psychiatry in 1969, and how some clinicians challenged their own profession to become a force for change rather than pacification.
Many mental health professionals rebelled against the use of psychological adjustment or weaponization of psychiatry in any form during the 1960s. Yet, pushback in the psy-sciences was not always about explicit brainwashing and reprogramming. Just as often, criticisms of mental health centred on the softer side, on the less invasive, more mundane side of mental health treatment in the U.S.. This, it was argued, could still be a form of social or political pacification. Radicals in psychiatry helped illuminate this in 1969.
Pacify: “Quell the anger, agitation, or excitement of…” [i]
In early May 1969, the American Psychiatric Association, the U.S.A.’s most powerful mental health group and the umbrella organization for the profession, held its annual meeting at the grand Americana Hotel in Miami, Florida. As participants registered on Sunday and early Monday, the temperature hovered benignly around 25 degrees Celsius (77 Fahrenheit), but there was some tension in the air. A few lone protestors walked along Miami Beach and relaxed outside the hotel, while long-haired, and more militant members of the APA were preparing to make some waves during the conference.
After the previous APA conference in 1968, the organization’s liberal caucus had decided to rebrand itself a “Radical Caucus.” It adopted a bolder, fist-pounding style that targeted some of psychiatry’s long-standing paradigms. The radicals aimed their critiques squarely at such American institutions as police and government, the medical profession and military, and argued in favor of closer engagement with prevailing issues of the day. It was time to get angry, they shouted, and time to take action. The newly christened Radical Caucus cautioned psychiatrists and others in the mental health field against hiding “behind the couch” and demanded “bold new leadership.”[ii] In particular, they warned that psychiatry pacified the American people.
Pacify: “Bring peace to (a country or warring factions), especially by the use or threat of military force….”
The collection of radical psychiatrists at the APA meeting in 1969 exemplified tensions within the mental health field. Antipsychiatry, alternative therapies, and biopsychiatry were on the rise. While these fought the system and the “Establishment,” the radicals also fought with each other. They argued that psychiatry, and other mental health fields, needed to modify their training methodology and service delivery models. Psychiatry needed to engage more closely with civil rights groups, the women’s movement, and anti-Vietnam movements. Detached, arms-length neutrality ought to be discarded in favour of a full-on embrace of individual and collective sickness, which many radicals contended were natural byproducts of militarism, alienation, and endemic racism.[iii] More importantly, they suggested psychiatrists needed to recognize their role in mollifying – if not brainwashing – Americans.
To an extent, radicals in psychiatry and other psy-sciences were responding to socio-political developments that closely linked militarism and madness. By 1969, the Nixon administration had complicated the conflict in Southeast Asia and was employing a so-called “madman theory” to frighten the enemy.[iv] “I want the North Vietnamese to believe I’ve reached the point where I might do anything to stop the war,” Nixon suggested.[v] He wanted his enemies to believe that he was no longer a rational political actor, to use the language of geopolitics. He concluded that mad threats, especially when uttered by a leader perceived as unstable and unpredictable, might coerce the North Vietnamese to settle the war on U.S. terms.
Nixon carefully cultivated an image of a maniacal bomber. According to one account, the policy was not a stretch, considering Nixon displayed features that were “paranoid, antisocial, narcissistic, and passive aggressive.”[vi] He shifted from stages of depression and mania, to fits of apoplexy and then paralyzing uncertainty. Seemingly addicted to the 1970 Oscar-winning film Patton, a biography of the eponymous WW2 general, watching it, rewinding, and watching it again, Nixon exhibited signs of strain and defiance in equal measure.[vii] By November 1971, as Elton’s John’s Madman Across the Water hit record stores, negotiations between the U.S., China, as well as North and South Vietnam, reached a deadlock, which set the stage for operation Linebacker, a colossal bombing campaign.
Radicals in the APA felt that the profession of psychiatry buttressed hostilities in Vietnam, and that they backed U.S. military machine by desensitizing the public and deluding soldiers. The Vietnam War was, according to radical pamphlets at the time, one of the major points of pacification for psychiatry. The caucus denounced the war in Vietnam and demanded the end to the draft. The caucus publicly demanded that the APA end all complicity with the military as long as the war in Vietnam continued. It called for all psychiatrists engaged in military training or war research to face expulsion.
One military psychiatrist, Michael S. Perlman, challenged his colleagues to recognize acute combat reactions in Vietnam veterans. As a psychiatrist in the United States Naval Disciplinary Command, a maximum-security prison in Portsmouth, New Hampshire, Perlman was exposed to the manifestation of “psychiatric symptoms as a result of traumatic situations peculiar to the Vietnam War.”[viii]
According to Perlman, the psychiatrist’s proper role was to “recognize and communicate hard reality, however painful that truth” happened to be. Yet, this basic premise was placed in danger when a given psychiatrist allied his or herself with an institution, whether it was an outpatient psychiatric clinic, a private office, or the military. While Perlman rejected the idea of any conscious pressure in the Navy to subvert psychiatry, he nevertheless concluded that the “pressures to compromise professional integrity” were more “subtle, unconscious and related to a naturally adopted character styles and defenses…” The outcome was that hard reality was often obscured, which was harmful to the “patient, the psychiatrist, the military establishment, and to society itself.”[ix] In chronicling his experiences in Portsmouth, New Hampshire, he unwittingly echoed the radical psychiatrist critique, but, more productively, Perlman also offered a tangible first-person account of the behavior of military psychiatrists.
Community Mental Health Clinics: From Foreign to Domestic Pacification
Pacification also took place in relation to domestic socio-political strife. In 1963, the Community Mental Health Act of 1963 (CMHA) was passed, which signalled a fresh era in Federal provision for mental health services in the United States. The National Institute for Mental Health (NIMH) assumed responsibility for watching the country’s community mental health centers (CMHC) programs. Thereafter, the newly created NIMH launched a comprehensive assault – a war, perhaps? – on special mental health problems. This was before the War on Poverty, and before the War on Drugs.
The Community Mental Health Act was “a personal and organizational triumph” for leaders like Robert Felix at the NIMH, even though the law was relatively “vague.”[x] In 1966, the first center opened. By 1967, 53 more had opened. Thirteen years later, a total of 789 would be funded across the country, amounting to roughly $2.7 billion dollars in outlays.[xi] The officials in charge of NIMH, which had seen its rule-making authorities enhanced by the new legislation, signaled that a bold new era of mental health was ahead. Were they considered radical? For many, the answer was affirmative. And mental health leaders made clear that the profession of psychiatry would adopt a more activist role in society, intensifying its participation in such social practices as parenthood, early childhood education, poverty, and the wider economy.[xii]
In May 1969, however, the Radical Caucus in the American Psychiatric Association addressed community-based mental health. They presented the possibility that the urban mental health center movement – the collection of clinics across the US – was merely an effort to mollify the ghettos, that the centers were mechanisms to “cool out” protests. Such ideas were also presented in “radical” journals. Radical Therapist articles, including “Radical overview of community psychiatry” and “Community mental health as a pacification program,” argued that the average community mental health center was a weapon of the establishment; it acted, in short, as a means to pacify angry communities and promote harmony rather than working toward social change.[xiii]
Undoubtedly a hot-button topic, just a month earlier, in April, the Lincoln Community Mental Health Clinic in the South Bronx, NYC, which had been the recipient of an APA award in 1968, and whose directors were strongly committed to improving the lives of the “disadvantaged urban community,” was taken over. It was occupied and re-staffed by the community itself. The physicians were deemed square, outmoded, agents not of reform but of oppression. The takeover effort lasted three weeks and was chronicled by the New York Times; it grew increasingly contentious as the center’s award-winning psychiatrists (Drs. Harris Peck, Seymour Kaplan, and Melvin Roman) were replaced by non-professionals, including Black Panthers and Students for a Democratic Society, among others. After the New York City police were sent into the center and arrested 23 individuals, the CMHC idea faced, much like American psychiatry at the time, a crisis of legitimacy. “To be locked out of your own office by your own employees was humiliating enough, but to be hoisted on the petard of your own rhetoric and ridiculed” by the papers “went beyond the pale.”[xiv]
Community consultation and community clinics, which sounded innocuous enough, garnered considerable attention and grew as a point of contestation among radicals. On the one hand, some authors suggested totally abandoning community mental health center consultation altogether (since it served institutions, including prisons, the police, corporations, schools, and universities) and focusing exclusively on social activism instead. On the other hand, some Radical Therapist writers proposed working within the system to achieve their ends. The libertarian psychiatrist Thomas Szasz, called for a full-scale halt to “government-psychiatry mind control operations.”[xv] The takeover of the Lincoln CMHC embodied the diverse approaches to community clinics that were high-minded and publicly funded; the Black Panthers that displaced the well-meaning and award-winning therapists certainly had different views to the psychiatrists.
The radicals’ belief about the CMHCs testified to their outsider views. Indeed, radical psychiatrists – whether they were self-professed anti-psychiatrists or not – often identified themselves as being on the fringe of their field and very alienated themselves. At the same time, such individuals posited that alienation was the crux of all psychiatric conditions. Informed by Marxist thought, as well Erving Goffman’s books, among many others, alienation epitomized the philosophy and activities of many mental health radicals. These thinkers valued alienation because, however painful, it was seen as part of a dialectical, dynamic process towards revolution, whereas ‘pacification’ stifled the awareness of oppression.
“Therapy means political change,” the radical psychiatrists averred at the end of the 1960s, which meant that mental health was tied to transformation in society.[xvi] Therapy, in other words, required social, political, and personal change. Achieving mental health was a struggle and was “bullshit unless it involves changing this society which turns us into machines, alienates us from one another and our work, and binds us into racist, sexist, and imperialist practices.” The self-proclaimed radicals and the term ‘pacification’ are important for a number of reasons. They asked tough questions of their colleagues and of the psy-sciences. What was the role of psychiatry and psychology in treating individuals and the collective? Were they agents of social control? Debating these ideas, moreover, typified how mental health professionals have struggled with ideas and practice, pulled from pole to pole, tugged back and forth, and driven in various directions by socio-political changes and the demands of national interest.
In 1969, certain psychiatrists felt they were agents of social control. They were critical of militarism, external social and political forces that traumatized people, and, above all, oppression, elitism, and alienation. War in Vietnam brought them together, as did the problem of economic and social inequality. Some protestors were fixated on promoting social progress and human rights in American mental health services as well as beyond the shores of the U.S.; others were focused on advancing single issues, including homosexuality, feminism, and civil rights.
With all of these questing energies concentrating on powerlessness, rights, and discrimination, the pressure for change at the APA conference in 1969 was enormous. The radical psychiatrists were asking questions of the organization, and of society more generally. They sought to redress mental illness at the individual and collective levels, and they wanted more refined practices to do so.[xvii] Products of the counterculture themselves, they were testing the very limits of civil society, psychiatry, and the field of mental health.
Lucas Richert lectures at the University of Strathclyde. He writes on the social and political history of mental illness, intoxicants and pharmaceutical regulation in the 19th and 20th centuries. He is the author of Conservatism, Consumer Choice and the Food and Drug Administration during the Reagan Era: A Prescription for Scandal (Lexington Books, 2014), and the recently submitted Strange Medicines: Drugs, Science and Big Pharma in Culture (McGill-Queen’s University Press, 2018). He is currently researching the history of radical psychiatry and the countercultural mind in North America.
[ii] Robert Coles, “Young Psychiatrist Looks at His Profession,” Atlantic Monthly, July 1961: 108-111.
[iii]Lucas Richert, ‘“Therapy Means Change, Not Peanut Butter”: Radical Psychiatry in the United States, 1967-1975,’ in Social History of Medicine (2014) 27 (1): 104-121.
[iv] See William Chafe, The Unfinished Journey: America Since WWII (New York: Oxford University Press, 2003) 38.
[vi] Jeffrey Kimball, Nixon’s Vietnam War (Lawrence, KS: University of Kansas Press, 1998), 12.
[vii] Ibid, 204-205.
[viii] Michael S. Perlman, “Basic Problems of Military Psychiatry: Delayed Reactions in Vietnam Veterans,” International Journal of Offender Therapy and Comparative Criminology 19 (1975): 129-138. 135
[xi] E. Fuller Torrey’s American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System (New York: Oxford University Press, 2013), 62-63.
[xii] Gerald Caplan, Principles of Preventive Psychiatry (New York: Basic Books, 1964); John A. Talbott, “Fifty Years of Psychiatric Services: Changes in Treatments of Chronically Ill Patients,” Review of Psychiatry Volume 13, edited by John M. Oldham and Michelle B. Riba (Washington, D.C.: American Psychiatric Press, 1994), 93-121.; Matthew Smith, Hyperactive: The Controversial History of ADHD (London: Reaktion Books, 2012), 89-91; Sandra Bloom, Creating Sanctuary, 111-117.
[xiii] Carl I. Cohen, et al., ‘The Future of Community Psychiatry’, Community Mental Health Journal 2003, 39, 460-462. See Morton O. Wagenfeld and Stanley S. Robin, ‘Social Activism and Psychiatrists in Community Health Centers’, American Journal of Community Psychology, 1978, 6, 254 and Doyle, ‘Deinstitutionalization’, 38.
[xiv] E. Fuller Torrey’s American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System (New York: Oxford University Press, 2013), 70.
[xvi] Jerome Agel, ed., The Radical Therapist: The Radical Therapist Collective (New York: Ballantine Books, 1971), viii-xi.
[xvii] Walter E. Barton, The History and Influence of the American Psychiatric Association (Washington, D.C.: American Psychiatric Press, 1987) 297-299.