HISTORY
Editor: David S. Jones, MD, PhD
The Deprivation Riots: Psychiatry as Politics in the 1960s Mical Raz, MD, PhD
T
he 1967 Detroit riot was the most destructive and violent race riot of the 1960s.1–3 As the state police and National Guard failed to regain control of the city, President Lyndon Johnson sent in thousands of paratroopers. Leaving 43 dead (of whom 33 were African American), 2000 injured, and 7000 arrested, the riot left an indelible imprint on Detroit race relations.4,5 Erupting at a time when support for the Johnson administration was faltering, the Detroit riot forced the president to take immediate action. Within five days, he appointed the National Advisory Commission on Civil Disorders, headed by Illinois Governor Otto Kerner—a commission charged with investigating the outbreak of the riots and, in particular, how others could be prevented.6–8 A bipartisan commission, it consisted of 11 members, all moderate in their views, 2 of whom were black: Massachusetts Senator Edward Brooke and National Association for the Advancement of Colored People Director Roy Wilkins. As historian Ellen Herman has argued, the commission, in its effort to understand the cause of the urban riots, relied on theories of individual psychology and was further informed by the testimony of mental health experts.7(p224) This column argues that such psychological interpretations drew heavily on concepts of deprivation, enormously popular in the mental health discourse of that time. Deprivationbased interpretation of the riots framed the different interventions recommended by the experts testifying for the commission, and influenced the commission’s final report.9
DEPRIVATION THEORY Deprivation theory developed in the mid-1950s, and by the early 1960s it had gained a privileged status in American mental health discourse. Deprivation was a multifaceted theory, relying on differing perceptions of the crucial social From the Department of Medicine and Section of the History of Medicine, Yale School of Medicine; Van Leer Jerusalem Institute, Jerusalem. Correspondence: Mical Raz, MD, PhD, Section of the History of Medicine, Yale School of Medicine, P.O. Box 208015, New Haven, CT 06520–8015. Email: [email protected] © 2013 President and Fellows of Harvard College DOI: 10.1097/HRP.0000000000000011
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or psychological components that certain populations might lack. Relying on the work of British psychoanalyst John Bowlby, who had coined the term maternal deprivation in 1951, American mental health professionals were concerned over the detrimental effects of inadequate maternal care early in life.10,11 During this same period, experiments carried out by psychologist Donald Hebb and his colleagues at McGill University highlighted the psychological damage that could be caused by even a brief period of sensory deprivation. As these experiments were reproduced across North America, garnering growing attention, mental health experts began to reinterpret well-known phenomena through the framework of deprivation. Were religious revelations in the desert actually a form of hallucinations caused by prolonged sensory deprivation? Deprivation theory—an approach highlighting the role of certain deficits—soon came to be invoked as an explanation for a wide range of phenomena, from hallucinations following ophthalmologic surgery to the effectiveness of the psychoanalyst’s couch.12–14 By the early 1960s, this emphasis on deprivation begat a new term—cultural deprivation—used to describe the perceived deficits and disadvantages afflicting low-income individuals, mainly referring to children of color. Mental health experts focused on what was it that low-income and minority children lacked for healthy psychological and intellectual development. In designing interventions to alleviate these deprivations, mental health experts joined forces with educators to provide children with what was seen as compensation, from colorful and stimulating toys, through nutritious meals, to a caring mother-substitute. The well-known early-intervention program, Project Head Start, was conceptualized in 1965 as an intervention to alleviate cultural deprivation. Furthermore, the early 1960s saw a surge of interest in the perceived dangers on “matrifocal” families. This research culminated in the well-known report by Assistant Secretary of Labor Daniel Patrick Moynihan, The Negro Family: A Case for National Action.15 Often referred to simply as the Moynihan Report, this document aroused much controversy and debate, as it viewed the African American family structure to be pathological, serving to perpetuate the cycle of poverty. Historically headed by women, men did not assume central and traditionally masculine positions in their families. Although the black www.harvardreviewofpsychiatry.org
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mother was accorded a central role in Moynihan’s presumed family structure, the children in these families were seen to be maternally deprived, as mothers were unable to pay adequate attention to their children and provide them with guidance and support in domestic and scholastic matters. This unique form of maternal deprivation, caused by the present yet overly dominant mother, was used to explain numerous perceived ills in urban black communities.16 Theories of deprivation—maternal, cultural, and sensory— provided the basis for the Kerner Commission’s understanding of the race riots and guided its recommendations. The use of these theories was highly political. Recent scholars who have examined the use of mental health disciplines in explaining the outbreak of urban violence in the 1960s have focused on how this professional discourse effectively medicalized and depoliticized the riots.17–19 This trend to medicalize was certainly evident at the time: an egregious example is an infamous 1967 letter to the editor of the Journal of the American Medical Association. Written by a psychiatrist and two neurosurgeons, and titled “Role of Brain Disease in Riots and Urban Violence,” the letter suggested that a preoccupation with social causes of urban violence distracted attention from the role of “focal brain lesions.”20 This extreme, biologically based response was not representative, of course, of the mental health profession’s responses to the urban race riots. Nonetheless, mental health professionals did invoke their expert knowledge of theories of deprivation to advance highly political, yet still medicalized, interpretations of the cause of the riots and the potential remedies. Similarly, politicians relied on those theories to give scientific legitimacy to their social interventions, which were designed to address long-standing social inequalities.
THE KERNER COMMISSION AND THEORIES OF MENTAL HEALTH The Kerner Commission conducted hearings behind closed doors, solicited expert testimony, and commissioned research groups to examine data on the riots and their participants. National Institute of Mental Health (NIMH) social psychologist Robert Shellow was appointed as research director and set up a task force of six social scientists who would serve as the in-house research team for the commission.7,21,22 Large-scale research projects were supported by the commission or other federal agencies. For instance, the NIMH funded nearly 50 different research projects on the cause of mass violence, and the briefs and reports from these projects figured in some of the debates and publications stemming from the commission’s deliberations.7(p218),23,24 In a brief, confidential report prepared by NIMH staff for the Kerner Commission, extensive reference was made to structural deprivation, a unique form of deprivation that had not figured in previous publications on race and poverty. The cause of urban race riots, the report argued, was “the intense, complex and inclusive system of deprivation 346
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to which Negro- Americans living in our urban ghettos have been subjected.”25 The term structural deprivation called attention to the manner in which social structure relied on de facto discrimination as a tool to exclude African Americans. Structural deprivation “put the Negro in the position of being ‘invited’ to participate equally in the opportunities of American life but simultaneously blocks his entry by making him unprepared and unfit to do so.” This dynamic resulted from the “the series of deprivations in education, employment, medical care, housing, sources of satisfaction and self-respect, etc., which are reflected pervasively through everyday social, legal, and economic practices.” Significantly, economic and psychological deprivations were seen to be equally important in understanding the cause of the riots. By depicting deprivations in education, health care, and housing opportunities to be as psychologically damaging as the deprivation of selfrespect, the NIMH report relied on psychological factors to strengthen its argument for the need to address racial discrimination.
PARENTAL DEPRIVATION The Kerner Commission and its expert consultants saw parental deprivation as a salient field by which to understand the cause of the riots. Reflective of the ongoing debate over the controversial Moynihan Report, members of the Kerner Commission were interested in the prevalence of matriarchal African American families and the lack of masculine role models that they believed contributed to the outbreak of urban violence.7,26 As both the rioters and the experts who studied them were predominately male, images of normative masculinity played a significant role in debates over the psychological characteristics of participants in the riots. For instance, commission member and New York Mayor John Lindsay wanted to know whether rioters had been raised in homes of one or two parents—viewing this factor as relevant to understanding the rioters’ background.22(pp137–40),23 The commission’s interest in family structure and parental deprivation was perhaps epitomized in a November 1967 hearing, as three sociologists and anthropologists provided their opinions of the causes of urban violence. Hyman Rodman of the Merrill Palmer Institute, Detroit, and NIMH researcher Elliot Liebow, a salaried Kerner Commission consultant, were promising junior scholars, and John Mogey was chair of the sociology department at Boston University. The three examined the “structure of the family in the ghetto and its relationship to civil disorders.” Economic circumstances and particularly unemployment, they argued, led to the marginal position of the male in the family and, in turn, to familial instability, to female-headed families, and ultimately to the conditions that result in riots. When asked to address the relations between fatherlessness and rioting, the three experts agreed that these Volume 21 • Number 6 • November/December 2013
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relations were complex but that there were nevertheless clear connections. Mogey argued that the presence of a father helped preserve a “kin network” that strengthened agencies of “social control,” including schools, churches, and law enforcement. Fatherlessness led to a “breakdown of internal personal control,” particularly among adolescents.27(pp3719,3750) Fatherless youth suffered from a loss of respect for religion, social welfare, education, police, and the courts—factors that reflected then-current views as to the importance of individuals’ loci of control and the need to aid disempowered individuals in strengthening their internal control.28 In this context Mogey suggested that the commission support the marital unit in its own right as a couple rather than viewing the two only as parents.27(p3775) The experts also discussed ongoing debates over proposed welfare reforms programs that would have required young mothers to work in order to be eligible for government assistance. Addressing these suggestions, which ultimately remained unimplemented, Rodman expressed an uncommon view. Whereas discussion participants largely focused on the potential ill effects of separating mothers from their young children, Rodman cited possible positive aspects of such a separation: early-intervention programs, including early child care and compensatory education, could be useful tools for addressing deprivation in the homes of the “Negro poor,” whether the mothers were working or not.27(p3757) And it was, indeed, deprivation at home and the necessity of early compensatory education that the Kerner Commission determined to be of primary importance in understanding how to prevent urban riots.
SENSORY DEPRIVATION Matthew Dumont, a psychiatrist and NIMH consultant, reflected on the role of the community psychiatrist in his Absurd Healer (1968).29 Making extensive reference to the urban riots, Dumont appended a report that he had prepared for the Kerner Commission examining the role of youth groups in African American communities. In the chapter “The City as Patient,” Dumont depicted the city as an organism that suffered from basic deficits in four essential fields: stimulation, self-esteem, sense of community, and sense of environmental mastery. All these deficits led to the “symptomalogy” of urban violence; the riots were a symptom of a “sick” city. In addressing the perceived deficit of stimulation, Dumont first summarized current knowledge of sensory deprivation phenomena, describing both laboratory experiments and the “clinical situations that mirror” these experiments, such as psychosis following ophthalmological surgery. Summarizing, he argued that humans had a “biopsychological hunger for stimulation” as basic as the need for food or water. “And what of the ghetto?” Dumont then asked rhetorically. Although it might seem to be stimulating, he argued, the ghetto was actually monotonous and unchanging. While some viewers might erroneously believe that the Harvard Review of Psychiatry
ghettos had an atmosphere of “intense vitality and violent passion,” this impression could be attributed to outsiders’ “anxiety and hysteria.” Ghetto residents suffered from a “stimulus deprivation,” which Dumont saw as caused by the “lack of expectation of change.” In light of this monotonous environment, he speculated, riots infused desperately needed stimulation into a sensorily deprived environment.29(pp954–55) The race riots were depicted as a direct result of the “sensory deprivation psychosis” caused by the urban ghetto. Yet Dumont’s usage of sensory deprivation was not designed to depoliticize the urban riots or to depict them as a physiological outburst inevitably resulting from the lack of certain environmental input. His analysis was highly political. “Mental health is freedom,” he argued; for the mentally ill, freedom was curtailed by their own “internal constraints.” For the “slum dweller,” freedom was limited by poverty, unemployment, and segregation. Like mental illness, poverty and discrimination led to the “restriction of opportunity and a narrowness of choice.” Calling for social solidarity, Dumont argued that the “communality” of the human experience led victims to “share the common burden of guilt with the criminal.”29(pp50–51) A shared aspiration for social freedom, Dumont summarized, was an aspiration for mental health. Dumont’s writing was rife with medical metaphors. The riots were an “iatrogenic disease”; in inner cities it was necessary to “drain an abscess” in order to resolve urban violence. Yet the solutions that Dumont suggested were clearly political.29(pp75–77) Treating “this ailing organism,” he argued, required a “redistribution of the wealth and resources of this country on a scale that has never been imagined.”29(p80) His use of medical terminology and sensory deprivation theory thus lent scientific validity to a radical social proposal and was not designed to medicalize social issues. Dedicated to working with underserved population, Dumont went on to direct a mental health clinic in Chelsea, Massachusetts, and later published a memoir of his work with impoverished populations.30
MARTIN LUTHER KING JR. The framework of deprivation and compensation reverberated in the testimonies of speakers from diverse backgrounds. Martin Luther King Jr., in his testimony before the Kerner Commission, warned of the “syndrome of deprivation” rampant among the African American community.31(p963) He suggested a compensation program, modeled after the GI Bill, to rectify this inequality. “Special measures for the deprived have always been accepted in principle by the United States,” he argued, citing child labor laws, Social Security, unemployment benefits, and benefits for war veterans. Such a “Bill of Rights for the disadvantaged,” he argued, would have a profound effect on the “basic psychological and motivational transformation of the Negro.”31(p958) For King, www.harvardreviewofpsychiatry.org
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rectifying economic deprivation could correct psychological deprivation, as he viewed the two as interrelated. King had made nearly identical statements over the course of the decade, including in his third book, Why We Can’t Wait,32(p152) based on his 1963 letter from the Birmingham jail.31(p961) While emphasizing the perils of economic deprivation, King also referred specifically to psychological aspects of deprivation. Poverty created “emotional disturbances,” which led to “antisocial acts.” Children were the most “tragic victims”; their “impoverished parents, frantically struggling day by day for food and a place to live,” were unable “ to create the stable home necessary for the wholesome growth of young minds.”32(p153) King lamented the “separate culture of poverty in which the half-educated Negro lives”—a culture that had been further compounded by technological developments that had led to the loss of unskilled and semiskilled jobs.32(p141) King thus utilized the different meanings of deprivation, referring to a spectrum of deficits that were economic, familial, and psychological. Steeped in the rich oral tradition of black folk preachers, King borrowed ideas and even exact phrases from a wide range of influences, creating a unique synthesis that often bordered on, and sometimes even amounted to, plagiarism.33,34 This borrowing is evident in his sermons and publications, where he often relied on terms, metaphors, and ideas appropriated from health discourse. In 1961, he famously urged his followers to be psychologically “maladjusted”—to embrace nonviolent protest against injustice. Later, he used schizophrenia as a metaphor for the experience of the basic African American experience, torn between anger and the desire to make the right, nonviolent choice.19(pp120–21) King’s use of deprivation terminology before the Kerner Commission to argue for a large-scale compensatory program demonstrates how well accepted deprivation theory had become. Deprivation was the scientific basis on which King could propose a radical restructuring of American society.
THE FINAL REPORT The Kerner Commission’s final report was published in 1968. The paperback copy, designed for the general public, featured white lettering on a black cover, outlined by an orange-red frame, warning readers of the perilous state of American race relations.9 Deprivation theory served as the rationale for many of the interventions the commission suggested, providing coherence in a report that was riddled with inconsistencies. The introduction, a powerful indictment of white racism, famously argued that the nation was “moving toward two societies, one black, one white— separate and unequal.”9(p2) Yet in contrast to the tone set in the introduction, other chapters made scarce reference to white racism and readily adopted the discourse of cultural deprivation and its emphasis on the pathology of the black family. 348
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Deprivation theory was invoked in numerous different contexts. The African American community had suffered long-standing economic deprivation, and the commission supported “enrichment” programs targeting low-income neighborhoods as a means of avoiding further rioting. Other forms of deprivation implicated the structure of African American society and family life, rather than the structure of a racist American society. In the chapter “Unemployment, Family Structure and Social Disorganization,” the commission reiterated the standard themes of the destructive psychological effects of unemployment and underemployment on black men who could not fulfill their roles as family providers, along with the detrimental effects of large-scale female employment. The ill effects of fatherlessness were further exacerbated when women were forced to work outside of the home, leaving the children to roam the streets.9(p262) This description, echoing the Moynihan Report, highlighted the “handicap” of “poverty and deprivation” that led to a “culture of poverty.” Economic, parental, and cultural deprivation all played an important role in creating the conditions leading to urban riots. In its educational recommendations, the commission relied on the prevailing educational discourse promoting compensatory education to combat cultural deprivation. Emphasizing the “debilitating effect” of a “disadvantaged environment” on learning ability, the commission recommended expanding Head Start and additional popular preschool programs to reach more children, and starting at a younger age. Additional enrichment programs were proposed to target older children and teens.9(pp9446–49) Sensory deprivation was seen to be part and parcel of poverty; interventions were specifically designed to provide the environmental stimulation seen to be lacking in homes of lowincome families.
EPILOGUE: THE KERNER REPORT AND ITS LEGACY While the Kerner Commission’s final report itself was widely read and cited, and had a significant impact on public opinion, the Johnson administration effectively buried its recommendations. Released at a time when public support for the president was at an all-time low, and when the War on Poverty was widely criticized, the recommendations for overreaching changes at an estimated cost of up to $5 billion dollars were silently ignored. The report was too radical for the conservatives and too conservative for those who wished to see a radical restructuring of American race relations and an emphasis on the detrimental effects of racism and structural inequalities. The overall result was that many were left unhappy with the commission’s conclusions and recommendations.7(pp243–46),35 As an indication of his displeasure with the commission’s report, President Johnson himself famously refused to send thank-you notes to commission members. While the report reaffirmed the Johnson administration’s social policy, the extent of funding Volume 21 • Number 6 • November/December 2013
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that the Commission recommended to address the problems of poverty, racism, and urban neglect provoked the president’s wrath.7(p211),22(pp147–90) By the late 1960s, the alleviation of perceived deprivation among low-income minority children through programs such as Head Start had garnered bipartisan support. Addressing the long-standing social and economic deprivation of African American adults, however, was seen as politically radical and fiscally impossible, and entailed profound structural changes that American politicians were unwilling and unable to make. The framework of deprivation and compensation, while allowing politicians to rely on theories of mental health as they argued for otherwise controversial funding priorities, proved insufficient to ensure public acceptance. At some point the content of the recommendations, which included extensive social reform and ultimately a redistribution of wealth through tax-funded interventions, became more salient than their structure, despite its reliance on the palatable framework of compensating for deprivations. Nevertheless, the Kerner Commission’s deliberations and findings are a powerful example of how mental health theory can be used to call attention to pressing political problems, rather than solely as a tool for medicalization and depoliticization. By calling attention to what was portrayed as a devastating psychological syndrome that had long-term detrimental effects on individuals and their ability to participate in mainstream society, the Kerner Commission was able to initiate a discussion of the structural causes of urban violence. In early 2013, as this article was being written, a renewed debate on firearms has been rekindled in the United States—the aftermath of the horrific shooting at an elementary school in Sandy Hook, Connecticut. This debate is far from settled, of course, since the regulation of firearms is a deeply contentious topic in American society. Even so, bipartisan support seems to have emerged in the debate over mental health and violence, resulting in proposals to increase access to mental health services. In many ways, the debate over mental health and violence is a distraction that circumvents the still much-needed discussion regarding the omnipresence of firearms in American society. Current data indicate that only 3% to 5% of all shootings involve perpetrators diagnosed as mentally ill.36,37 Yet this focus on mental health, again, has facilitated a debate on a pressing political problem—even as it demonstrates how American society has repeatedly projected its fears onto a marginalized group, the mentally ill, in order to contain volatile political problems and address them on a small scale.
REFERENCES
Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.
* The references to the “KC Records” are taken from the microform collection Civil Rights During the Johnson Administration. 1963–1969, Part V: Records of the National Advisory Commission on Civil Disorders (Kerner Commission), published by University Publications of America, Frederick, MD.
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1. Boskin J. The revolt of the urban ghettos, 1964–1967. Ann Am Acad Polit Soc Sci 1969;382:1–14. 2. Lieberson S, Silverman AR. The precipitants and underlying conditions of race riots. Am Sociol Rev 1965;30:887–98. 3. Rucker W, Upton J, eds. Encyclopedia of American race riots. Westport, CT: Greenwood, 2007. 4. Sugrue T. The origins of the urban crisis: race and inequality in postwar Detroit. Princeton, NJ: Princeton University Press, 1996. 5. Kenyon AM. Dreaming suburbia: Detroit and the production of postwar space and culture. Detroit, MI: Wayne State University Press, 2004. 6. Remarks of the president upon issuing an executive order establishing a National Advisory Commission on Civil Disorders. 29 July 1967. In: Report of the National Advisory Commission on Civil Disorders. New York: Bantam, 1968. 7. Herman E. The romance of American psychology: political culture in the age of experts. Berkeley: University of California Press, 1995. 8. Lipsky M, Olson DJ. Commission politics: the processing of racial crisis in America. New Brunswick, NJ: Transaction, 1977. 9. Report of the National Advisory Commission on Civil Disorders. New York: Bantam, 1968. 10. Bowlby J. Maternal care and mental health: a report prepared on behalf of the World Health Organization as a contribution to the United Nations programme for the welfare of homeless children. Geneva: World Health Organization, 1951. 11. Vicedo M. The social nature of the mother’s tie to her child: John Bowlby’s theory of attachment in post-war America. Br J Hist Sci 2011;44:401–26. 12. Ziskind E, Jones H, Filante W, Goldberg J. Observations on mental symptoms in eye patched patients: hypnagogic symptoms in sensory deprivation. Am J Psychiatry 1960; 116:893–900. 13. Menninger K. Theory of psychoanalytic technique. New York: Basic, 1958. 14. Rapaport D. The theory of ego autonomy: a generalization. Bull Menninger Clin 1958;22:13–35. 15. Moynihan DP. The Negro family: a case for national action. Washington, DC: U.S. Department of Labor, Office of Policy Planning and Research, 1965. 16. Raz M. What’s wrong with the poor? Race, psychiatry and the war on poverty. Chapel Hill: University of North Carolina Press, 2013 (forthcoming). 17. Nelson A. Body and soul: the Black Panther party and the fight against medical discrimination. Minneapolis: University of Minnesota Press, 2011. 18. Staub M. Madness is civilization: when the diagnosis was social, 1948–1980. Chicago: University of Chicago Press, 2011. 19. Metzl J. The protest psychosis: how schizophrenia became a black disease. Boston, MA: Beacon, 2010. 20. Mark V, Sweet W, Ervin F. Role of brain disease in riots and urban violence. JAMA 1967;201:895. 21. Shellow R. Social scientists and social action from within the establishment. J Soc Issues 1970;26:207–20. 22. Lupos L. Flak-catchers: one hundred years of riot commission politics in America. Lanham, MD: Lexington, 2011. 23. Gardner J. Statement to the Kerner Commission. KC Records, Reel 1.*
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24. Masotti LH. Preface. Am Behav Scientist 1968;2:1–4. 25. National Institute of Mental Health. Toward an understanding of mass violence: contributions from the behavioral sciences [Confidential report]. Aug 1967. KC Records, Reel 15:372. 26. Mumford K. Untangling pathology: the Moynihan report and homosexual damage, 1965–1975. J Policy Hist 2012;24:53–73. 27. Commission meeting transcripts. 9 Nov 1967. KC Records, Reel 5. 28. Baistow K. Problems of powerlessness: psychological explanations of social inequality and civil unrest in post-war America. Hist Hum Sci 2000;13:95–116. 29. Dumont M. The absurd healer: perspectives of a community psychiatrist. New York: Science House, 1968. 30. Dumont M. Treating the poor: a personal sojourn through the rise and fall of community mental health. Belmont, MA: Dymphna, 1992.
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31. King ML Jr. Statement before Kerner Commission. 23 Oct 1967. KC Records, Reel 4. 32. King ML Jr. Why we can’t wait. New York: Harper & Row, 1964. 33. Thelen D. Becoming Martin Luther King, Jr.: an introduction. J Am Hist 1991;78:11–22. 34. Miller KD. Voice of deliverance: the language of Martin Luther King, Jr. and its sources. New York: Free, 1992. 35. Kim CJ. Clinton’s race initiative: recasting the American dilemma. Polity 2000;33:175–97. 36. Metzl JM. Why are the mentally ill still bearing arms? Lancet 2011;377:2172–3. 37. Metzl JM, MacLeish K. Triggering the debate: faulty associations between violence and mental illness underlie U.S. gun debate. [2013]. http://www.lse.ac.uk/researchAndExpertise/ units/CARR/publications/LSE-CARR-Triggeringthedebate.pdf
Volume 21 • Number 6 • November/December 2013
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Editor: David S. Jones, MD, PhD
The Deprivation Riots: Psychiatry as Politics in the 1960s Mical Raz, MD, PhD
T
he 1967 Detroit riot was the most destructive and violent race riot of the 1960s.1–3 As the state police and National Guard failed to regain control of the city, President Lyndon Johnson sent in thousands of paratroopers. Leaving 43 dead (of whom 33 were African American), 2000 injured, and 7000 arrested, the riot left an indelible imprint on Detroit race relations.4,5 Erupting at a time when support for the Johnson administration was faltering, the Detroit riot forced the president to take immediate action. Within five days, he appointed the National Advisory Commission on Civil Disorders, headed by Illinois Governor Otto Kerner—a commission charged with investigating the outbreak of the riots and, in particular, how others could be prevented.6–8 A bipartisan commission, it consisted of 11 members, all moderate in their views, 2 of whom were black: Massachusetts Senator Edward Brooke and National Association for the Advancement of Colored People Director Roy Wilkins. As historian Ellen Herman has argued, the commission, in its effort to understand the cause of the urban riots, relied on theories of individual psychology and was further informed by the testimony of mental health experts.7(p224) This column argues that such psychological interpretations drew heavily on concepts of deprivation, enormously popular in the mental health discourse of that time. Deprivationbased interpretation of the riots framed the different interventions recommended by the experts testifying for the commission, and influenced the commission’s final report.9
DEPRIVATION THEORY Deprivation theory developed in the mid-1950s, and by the early 1960s it had gained a privileged status in American mental health discourse. Deprivation was a multifaceted theory, relying on differing perceptions of the crucial social From the Department of Medicine and Section of the History of Medicine, Yale School of Medicine; Van Leer Jerusalem Institute, Jerusalem. Correspondence: Mical Raz, MD, PhD, Section of the History of Medicine, Yale School of Medicine, P.O. Box 208015, New Haven, CT 06520–8015. Email: [email protected] © 2013 President and Fellows of Harvard College DOI: 10.1097/HRP.0000000000000011
Harvard Review of Psychiatry
or psychological components that certain populations might lack. Relying on the work of British psychoanalyst John Bowlby, who had coined the term maternal deprivation in 1951, American mental health professionals were concerned over the detrimental effects of inadequate maternal care early in life.10,11 During this same period, experiments carried out by psychologist Donald Hebb and his colleagues at McGill University highlighted the psychological damage that could be caused by even a brief period of sensory deprivation. As these experiments were reproduced across North America, garnering growing attention, mental health experts began to reinterpret well-known phenomena through the framework of deprivation. Were religious revelations in the desert actually a form of hallucinations caused by prolonged sensory deprivation? Deprivation theory—an approach highlighting the role of certain deficits—soon came to be invoked as an explanation for a wide range of phenomena, from hallucinations following ophthalmologic surgery to the effectiveness of the psychoanalyst’s couch.12–14 By the early 1960s, this emphasis on deprivation begat a new term—cultural deprivation—used to describe the perceived deficits and disadvantages afflicting low-income individuals, mainly referring to children of color. Mental health experts focused on what was it that low-income and minority children lacked for healthy psychological and intellectual development. In designing interventions to alleviate these deprivations, mental health experts joined forces with educators to provide children with what was seen as compensation, from colorful and stimulating toys, through nutritious meals, to a caring mother-substitute. The well-known early-intervention program, Project Head Start, was conceptualized in 1965 as an intervention to alleviate cultural deprivation. Furthermore, the early 1960s saw a surge of interest in the perceived dangers on “matrifocal” families. This research culminated in the well-known report by Assistant Secretary of Labor Daniel Patrick Moynihan, The Negro Family: A Case for National Action.15 Often referred to simply as the Moynihan Report, this document aroused much controversy and debate, as it viewed the African American family structure to be pathological, serving to perpetuate the cycle of poverty. Historically headed by women, men did not assume central and traditionally masculine positions in their families. Although the black www.harvardreviewofpsychiatry.org
Copyright @ 2013 President and Fellows of Harvard College. Unauthorized reproduction of this article is prohibited.
345
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mother was accorded a central role in Moynihan’s presumed family structure, the children in these families were seen to be maternally deprived, as mothers were unable to pay adequate attention to their children and provide them with guidance and support in domestic and scholastic matters. This unique form of maternal deprivation, caused by the present yet overly dominant mother, was used to explain numerous perceived ills in urban black communities.16 Theories of deprivation—maternal, cultural, and sensory— provided the basis for the Kerner Commission’s understanding of the race riots and guided its recommendations. The use of these theories was highly political. Recent scholars who have examined the use of mental health disciplines in explaining the outbreak of urban violence in the 1960s have focused on how this professional discourse effectively medicalized and depoliticized the riots.17–19 This trend to medicalize was certainly evident at the time: an egregious example is an infamous 1967 letter to the editor of the Journal of the American Medical Association. Written by a psychiatrist and two neurosurgeons, and titled “Role of Brain Disease in Riots and Urban Violence,” the letter suggested that a preoccupation with social causes of urban violence distracted attention from the role of “focal brain lesions.”20 This extreme, biologically based response was not representative, of course, of the mental health profession’s responses to the urban race riots. Nonetheless, mental health professionals did invoke their expert knowledge of theories of deprivation to advance highly political, yet still medicalized, interpretations of the cause of the riots and the potential remedies. Similarly, politicians relied on those theories to give scientific legitimacy to their social interventions, which were designed to address long-standing social inequalities.
THE KERNER COMMISSION AND THEORIES OF MENTAL HEALTH The Kerner Commission conducted hearings behind closed doors, solicited expert testimony, and commissioned research groups to examine data on the riots and their participants. National Institute of Mental Health (NIMH) social psychologist Robert Shellow was appointed as research director and set up a task force of six social scientists who would serve as the in-house research team for the commission.7,21,22 Large-scale research projects were supported by the commission or other federal agencies. For instance, the NIMH funded nearly 50 different research projects on the cause of mass violence, and the briefs and reports from these projects figured in some of the debates and publications stemming from the commission’s deliberations.7(p218),23,24 In a brief, confidential report prepared by NIMH staff for the Kerner Commission, extensive reference was made to structural deprivation, a unique form of deprivation that had not figured in previous publications on race and poverty. The cause of urban race riots, the report argued, was “the intense, complex and inclusive system of deprivation 346
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to which Negro- Americans living in our urban ghettos have been subjected.”25 The term structural deprivation called attention to the manner in which social structure relied on de facto discrimination as a tool to exclude African Americans. Structural deprivation “put the Negro in the position of being ‘invited’ to participate equally in the opportunities of American life but simultaneously blocks his entry by making him unprepared and unfit to do so.” This dynamic resulted from the “the series of deprivations in education, employment, medical care, housing, sources of satisfaction and self-respect, etc., which are reflected pervasively through everyday social, legal, and economic practices.” Significantly, economic and psychological deprivations were seen to be equally important in understanding the cause of the riots. By depicting deprivations in education, health care, and housing opportunities to be as psychologically damaging as the deprivation of selfrespect, the NIMH report relied on psychological factors to strengthen its argument for the need to address racial discrimination.
PARENTAL DEPRIVATION The Kerner Commission and its expert consultants saw parental deprivation as a salient field by which to understand the cause of the riots. Reflective of the ongoing debate over the controversial Moynihan Report, members of the Kerner Commission were interested in the prevalence of matriarchal African American families and the lack of masculine role models that they believed contributed to the outbreak of urban violence.7,26 As both the rioters and the experts who studied them were predominately male, images of normative masculinity played a significant role in debates over the psychological characteristics of participants in the riots. For instance, commission member and New York Mayor John Lindsay wanted to know whether rioters had been raised in homes of one or two parents—viewing this factor as relevant to understanding the rioters’ background.22(pp137–40),23 The commission’s interest in family structure and parental deprivation was perhaps epitomized in a November 1967 hearing, as three sociologists and anthropologists provided their opinions of the causes of urban violence. Hyman Rodman of the Merrill Palmer Institute, Detroit, and NIMH researcher Elliot Liebow, a salaried Kerner Commission consultant, were promising junior scholars, and John Mogey was chair of the sociology department at Boston University. The three examined the “structure of the family in the ghetto and its relationship to civil disorders.” Economic circumstances and particularly unemployment, they argued, led to the marginal position of the male in the family and, in turn, to familial instability, to female-headed families, and ultimately to the conditions that result in riots. When asked to address the relations between fatherlessness and rioting, the three experts agreed that these Volume 21 • Number 6 • November/December 2013
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relations were complex but that there were nevertheless clear connections. Mogey argued that the presence of a father helped preserve a “kin network” that strengthened agencies of “social control,” including schools, churches, and law enforcement. Fatherlessness led to a “breakdown of internal personal control,” particularly among adolescents.27(pp3719,3750) Fatherless youth suffered from a loss of respect for religion, social welfare, education, police, and the courts—factors that reflected then-current views as to the importance of individuals’ loci of control and the need to aid disempowered individuals in strengthening their internal control.28 In this context Mogey suggested that the commission support the marital unit in its own right as a couple rather than viewing the two only as parents.27(p3775) The experts also discussed ongoing debates over proposed welfare reforms programs that would have required young mothers to work in order to be eligible for government assistance. Addressing these suggestions, which ultimately remained unimplemented, Rodman expressed an uncommon view. Whereas discussion participants largely focused on the potential ill effects of separating mothers from their young children, Rodman cited possible positive aspects of such a separation: early-intervention programs, including early child care and compensatory education, could be useful tools for addressing deprivation in the homes of the “Negro poor,” whether the mothers were working or not.27(p3757) And it was, indeed, deprivation at home and the necessity of early compensatory education that the Kerner Commission determined to be of primary importance in understanding how to prevent urban riots.
SENSORY DEPRIVATION Matthew Dumont, a psychiatrist and NIMH consultant, reflected on the role of the community psychiatrist in his Absurd Healer (1968).29 Making extensive reference to the urban riots, Dumont appended a report that he had prepared for the Kerner Commission examining the role of youth groups in African American communities. In the chapter “The City as Patient,” Dumont depicted the city as an organism that suffered from basic deficits in four essential fields: stimulation, self-esteem, sense of community, and sense of environmental mastery. All these deficits led to the “symptomalogy” of urban violence; the riots were a symptom of a “sick” city. In addressing the perceived deficit of stimulation, Dumont first summarized current knowledge of sensory deprivation phenomena, describing both laboratory experiments and the “clinical situations that mirror” these experiments, such as psychosis following ophthalmological surgery. Summarizing, he argued that humans had a “biopsychological hunger for stimulation” as basic as the need for food or water. “And what of the ghetto?” Dumont then asked rhetorically. Although it might seem to be stimulating, he argued, the ghetto was actually monotonous and unchanging. While some viewers might erroneously believe that the Harvard Review of Psychiatry
ghettos had an atmosphere of “intense vitality and violent passion,” this impression could be attributed to outsiders’ “anxiety and hysteria.” Ghetto residents suffered from a “stimulus deprivation,” which Dumont saw as caused by the “lack of expectation of change.” In light of this monotonous environment, he speculated, riots infused desperately needed stimulation into a sensorily deprived environment.29(pp954–55) The race riots were depicted as a direct result of the “sensory deprivation psychosis” caused by the urban ghetto. Yet Dumont’s usage of sensory deprivation was not designed to depoliticize the urban riots or to depict them as a physiological outburst inevitably resulting from the lack of certain environmental input. His analysis was highly political. “Mental health is freedom,” he argued; for the mentally ill, freedom was curtailed by their own “internal constraints.” For the “slum dweller,” freedom was limited by poverty, unemployment, and segregation. Like mental illness, poverty and discrimination led to the “restriction of opportunity and a narrowness of choice.” Calling for social solidarity, Dumont argued that the “communality” of the human experience led victims to “share the common burden of guilt with the criminal.”29(pp50–51) A shared aspiration for social freedom, Dumont summarized, was an aspiration for mental health. Dumont’s writing was rife with medical metaphors. The riots were an “iatrogenic disease”; in inner cities it was necessary to “drain an abscess” in order to resolve urban violence. Yet the solutions that Dumont suggested were clearly political.29(pp75–77) Treating “this ailing organism,” he argued, required a “redistribution of the wealth and resources of this country on a scale that has never been imagined.”29(p80) His use of medical terminology and sensory deprivation theory thus lent scientific validity to a radical social proposal and was not designed to medicalize social issues. Dedicated to working with underserved population, Dumont went on to direct a mental health clinic in Chelsea, Massachusetts, and later published a memoir of his work with impoverished populations.30
MARTIN LUTHER KING JR. The framework of deprivation and compensation reverberated in the testimonies of speakers from diverse backgrounds. Martin Luther King Jr., in his testimony before the Kerner Commission, warned of the “syndrome of deprivation” rampant among the African American community.31(p963) He suggested a compensation program, modeled after the GI Bill, to rectify this inequality. “Special measures for the deprived have always been accepted in principle by the United States,” he argued, citing child labor laws, Social Security, unemployment benefits, and benefits for war veterans. Such a “Bill of Rights for the disadvantaged,” he argued, would have a profound effect on the “basic psychological and motivational transformation of the Negro.”31(p958) For King, www.harvardreviewofpsychiatry.org
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rectifying economic deprivation could correct psychological deprivation, as he viewed the two as interrelated. King had made nearly identical statements over the course of the decade, including in his third book, Why We Can’t Wait,32(p152) based on his 1963 letter from the Birmingham jail.31(p961) While emphasizing the perils of economic deprivation, King also referred specifically to psychological aspects of deprivation. Poverty created “emotional disturbances,” which led to “antisocial acts.” Children were the most “tragic victims”; their “impoverished parents, frantically struggling day by day for food and a place to live,” were unable “ to create the stable home necessary for the wholesome growth of young minds.”32(p153) King lamented the “separate culture of poverty in which the half-educated Negro lives”—a culture that had been further compounded by technological developments that had led to the loss of unskilled and semiskilled jobs.32(p141) King thus utilized the different meanings of deprivation, referring to a spectrum of deficits that were economic, familial, and psychological. Steeped in the rich oral tradition of black folk preachers, King borrowed ideas and even exact phrases from a wide range of influences, creating a unique synthesis that often bordered on, and sometimes even amounted to, plagiarism.33,34 This borrowing is evident in his sermons and publications, where he often relied on terms, metaphors, and ideas appropriated from health discourse. In 1961, he famously urged his followers to be psychologically “maladjusted”—to embrace nonviolent protest against injustice. Later, he used schizophrenia as a metaphor for the experience of the basic African American experience, torn between anger and the desire to make the right, nonviolent choice.19(pp120–21) King’s use of deprivation terminology before the Kerner Commission to argue for a large-scale compensatory program demonstrates how well accepted deprivation theory had become. Deprivation was the scientific basis on which King could propose a radical restructuring of American society.
THE FINAL REPORT The Kerner Commission’s final report was published in 1968. The paperback copy, designed for the general public, featured white lettering on a black cover, outlined by an orange-red frame, warning readers of the perilous state of American race relations.9 Deprivation theory served as the rationale for many of the interventions the commission suggested, providing coherence in a report that was riddled with inconsistencies. The introduction, a powerful indictment of white racism, famously argued that the nation was “moving toward two societies, one black, one white— separate and unequal.”9(p2) Yet in contrast to the tone set in the introduction, other chapters made scarce reference to white racism and readily adopted the discourse of cultural deprivation and its emphasis on the pathology of the black family. 348
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Deprivation theory was invoked in numerous different contexts. The African American community had suffered long-standing economic deprivation, and the commission supported “enrichment” programs targeting low-income neighborhoods as a means of avoiding further rioting. Other forms of deprivation implicated the structure of African American society and family life, rather than the structure of a racist American society. In the chapter “Unemployment, Family Structure and Social Disorganization,” the commission reiterated the standard themes of the destructive psychological effects of unemployment and underemployment on black men who could not fulfill their roles as family providers, along with the detrimental effects of large-scale female employment. The ill effects of fatherlessness were further exacerbated when women were forced to work outside of the home, leaving the children to roam the streets.9(p262) This description, echoing the Moynihan Report, highlighted the “handicap” of “poverty and deprivation” that led to a “culture of poverty.” Economic, parental, and cultural deprivation all played an important role in creating the conditions leading to urban riots. In its educational recommendations, the commission relied on the prevailing educational discourse promoting compensatory education to combat cultural deprivation. Emphasizing the “debilitating effect” of a “disadvantaged environment” on learning ability, the commission recommended expanding Head Start and additional popular preschool programs to reach more children, and starting at a younger age. Additional enrichment programs were proposed to target older children and teens.9(pp9446–49) Sensory deprivation was seen to be part and parcel of poverty; interventions were specifically designed to provide the environmental stimulation seen to be lacking in homes of lowincome families.
EPILOGUE: THE KERNER REPORT AND ITS LEGACY While the Kerner Commission’s final report itself was widely read and cited, and had a significant impact on public opinion, the Johnson administration effectively buried its recommendations. Released at a time when public support for the president was at an all-time low, and when the War on Poverty was widely criticized, the recommendations for overreaching changes at an estimated cost of up to $5 billion dollars were silently ignored. The report was too radical for the conservatives and too conservative for those who wished to see a radical restructuring of American race relations and an emphasis on the detrimental effects of racism and structural inequalities. The overall result was that many were left unhappy with the commission’s conclusions and recommendations.7(pp243–46),35 As an indication of his displeasure with the commission’s report, President Johnson himself famously refused to send thank-you notes to commission members. While the report reaffirmed the Johnson administration’s social policy, the extent of funding Volume 21 • Number 6 • November/December 2013
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that the Commission recommended to address the problems of poverty, racism, and urban neglect provoked the president’s wrath.7(p211),22(pp147–90) By the late 1960s, the alleviation of perceived deprivation among low-income minority children through programs such as Head Start had garnered bipartisan support. Addressing the long-standing social and economic deprivation of African American adults, however, was seen as politically radical and fiscally impossible, and entailed profound structural changes that American politicians were unwilling and unable to make. The framework of deprivation and compensation, while allowing politicians to rely on theories of mental health as they argued for otherwise controversial funding priorities, proved insufficient to ensure public acceptance. At some point the content of the recommendations, which included extensive social reform and ultimately a redistribution of wealth through tax-funded interventions, became more salient than their structure, despite its reliance on the palatable framework of compensating for deprivations. Nevertheless, the Kerner Commission’s deliberations and findings are a powerful example of how mental health theory can be used to call attention to pressing political problems, rather than solely as a tool for medicalization and depoliticization. By calling attention to what was portrayed as a devastating psychological syndrome that had long-term detrimental effects on individuals and their ability to participate in mainstream society, the Kerner Commission was able to initiate a discussion of the structural causes of urban violence. In early 2013, as this article was being written, a renewed debate on firearms has been rekindled in the United States—the aftermath of the horrific shooting at an elementary school in Sandy Hook, Connecticut. This debate is far from settled, of course, since the regulation of firearms is a deeply contentious topic in American society. Even so, bipartisan support seems to have emerged in the debate over mental health and violence, resulting in proposals to increase access to mental health services. In many ways, the debate over mental health and violence is a distraction that circumvents the still much-needed discussion regarding the omnipresence of firearms in American society. Current data indicate that only 3% to 5% of all shootings involve perpetrators diagnosed as mentally ill.36,37 Yet this focus on mental health, again, has facilitated a debate on a pressing political problem—even as it demonstrates how American society has repeatedly projected its fears onto a marginalized group, the mentally ill, in order to contain volatile political problems and address them on a small scale.
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Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the article.
* The references to the “KC Records” are taken from the microform collection Civil Rights During the Johnson Administration. 1963–1969, Part V: Records of the National Advisory Commission on Civil Disorders (Kerner Commission), published by University Publications of America, Frederick, MD.
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24. Masotti LH. Preface. Am Behav Scientist 1968;2:1–4. 25. National Institute of Mental Health. Toward an understanding of mass violence: contributions from the behavioral sciences [Confidential report]. Aug 1967. KC Records, Reel 15:372. 26. Mumford K. Untangling pathology: the Moynihan report and homosexual damage, 1965–1975. J Policy Hist 2012;24:53–73. 27. Commission meeting transcripts. 9 Nov 1967. KC Records, Reel 5. 28. Baistow K. Problems of powerlessness: psychological explanations of social inequality and civil unrest in post-war America. Hist Hum Sci 2000;13:95–116. 29. Dumont M. The absurd healer: perspectives of a community psychiatrist. New York: Science House, 1968. 30. Dumont M. Treating the poor: a personal sojourn through the rise and fall of community mental health. Belmont, MA: Dymphna, 1992.
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31. King ML Jr. Statement before Kerner Commission. 23 Oct 1967. KC Records, Reel 4. 32. King ML Jr. Why we can’t wait. New York: Harper & Row, 1964. 33. Thelen D. Becoming Martin Luther King, Jr.: an introduction. J Am Hist 1991;78:11–22. 34. Miller KD. Voice of deliverance: the language of Martin Luther King, Jr. and its sources. New York: Free, 1992. 35. Kim CJ. Clinton’s race initiative: recasting the American dilemma. Polity 2000;33:175–97. 36. Metzl JM. Why are the mentally ill still bearing arms? Lancet 2011;377:2172–3. 37. Metzl JM, MacLeish K. Triggering the debate: faulty associations between violence and mental illness underlie U.S. gun debate. [2013]. http://www.lse.ac.uk/researchAndExpertise/ units/CARR/publications/LSE-CARR-Triggeringthedebate.pdf
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