What Get Out Gets Right About Psychiatry, Psychosurgery and Social Control

As a forensic psychiatrist, I’ve interviewed people who have been accused of committing violent and deadly crimes. I’ve always felt comfortable doing this work, and have never felt afraid. I am, however, deeply fearful of horror movies. Blame Arachnophobia for permanently scarring me as a child. My intense fear of horror movies is superseded by my love for progressive, provocative works on race. For this reason, I voluntarily endured Get Out’s 104 teeth-clenching minutes.

Get Out continues to break box office records. According to Forbes it recently became “the second-biggest R-rated horror movie ever in North America”, second only to the Exorcist. Jordan Peele’s hit film is a terrifying masterpiece that has inspired multiple analyses on race. What is missing from this rich discourse however is thoughtful dialogue on another pervasive theme in Get Out: the use of psychiatric and psychosurgical theories to exert social control over black people. This is a highly disturbing concept, and one that Peele presents in an exaggerated yet impactful fashion. No, people cannot be forcibly hypnotized and there has never been a human brain transplant. What does ring eerily true about Peele’s portrayal however, is that at various points in history, members of the American medical profession have actually championed psychiatric and psychosurgical theories that have been used to advocate for social control over black people.

In 1851, physician Samuel Cartwright published a disturbing report, “Diseases and Peculiarities of the Negro Race” , in which he discussed two mental diseases he made up, Drapetomania and Dysaesthesia Aethiopica. According to Dr. Cartwright, Drapetomania was a mental disease that caused blacks to run away from their enslaved conditions. Dr. Cartwright’s recommended “cure” was for blacks to “be punished until they fall into that submissive state which it was intended for them to occupy...”.

Dr. Cartwright described Dysaesthesia Aethiopica as an illness that affected free blacks as well as enslaved blacks on “badly-governed” plantations. He suggested that it caused blacks to be violent, destructive, gluttonous and insensitive to physical pain. While he didn’t explicitly state a cure for Dysaesthesia Aethiopica, one was implied. If his proposed “cause” was freedom, then his likely “cure” would be enslavement.

Fast forward to the 1960s and 1970s when another disturbing trend emerged. There was a sudden “blackening” of the print advertisements for antipsychotic medications and a noticeable transformation in the language used to describe schizophrenia. Both changes coincided with the rise of the Black Power Movement. Psychiatrist Dr. Joseph Metzel closely examined this trend and discovered some unsettling data in his research.

In his article, “Mainstream Anxieties about Race in Antipsychotic Drug Ads”, Dr. Metzel discusses how prior to the 1960s and1970s, print advertisements for antipsychotic medications mainly featured meek white women engaged in non-threatening tasks. Around this same time, schizophrenia was described in medical journals as a predominately white disease that did not cause the affected to become violent or threatening. In the 1960s and 1970s, advertisements for antipsychotic medications suddenly began to feature images of blacks with menacing appearances and aggressive posturing. African tribal masks and relics also suddenly appeared in antipsychotic medication advertisements. Medical journals began describing schizophrenia as “a condition that also afflicted Negro men” and noted that “black forms of the illness were more hostile and aggressive than the white ones.” A 1968 article in the Archives of General Psychiatry even went so far as to introduce the concept of a “protest psychosis” into the medical literature.

These perceptions of blacks continue to influence current psychiatric practices. Studies have shown that blacks remain overrepresented in schizophrenia diagnoses, compared to whites. Even when other factors are controlled for, there are still higher rates of schizophrenia diagnoses amongst blacks when compared to whites. Studies have also shown that black patients are also more likely to be prescribed antipsychotic medications than non-blacks.

Psychosurgical theories have also been used to advocate for social control over certain black populations. After the Detroit riots of 1967, three Harvard physicians submitted a letter to the Journal of the American Medical Association citingbrain dysfunction in certain individuals as a possible factor in urban riots.” These noted doctors — two neurosurgeons and a psychiatrist — requested research be done to assess and provide medical treatment to ‘‘those people with low violence thresholds before they contribute to future tragedies.” In 1971, the Law Enforcement Assistance Administration of the Justice Department awarded them an $188,000 grant to study “the biological basis of criminal behavior.”

What does all of this mean for my profession? It means that Get Out represents an opportunity for all psychiatrists to get real about the ways in which racism has infected and continues to affect our profession. But psychiatrists must do more than just dialogue about this. We must develop and implement real solutions and identify ways to begin remedying any damage that has been done.

What does all of this mean for neurosurgery? I could argue that Get Out has similar implications for the neurosurgical profession as well, but then again, I’m no neurosurgeon. Perhaps Dr. Ben Carson can weigh in.

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