Month: September 2014

Sociology journal Transition has a fascinating article giving a history of the surprisingly frequent appearance of schizophrenia in rap music.

In psychiatric circles, schizophrenia is considered a serious mental illness that causes delusions, hallucinations, and social withdrawal. But in rap, schizophrenia means something else: a mode of defiance, a boast, or a threat. The term appears frequently when describing competition between rappers. In “Speak Ya Clout,” the duo Gang Starr rhymes that they are “schizophrenic with rhyme plus we’re well organized” as a way of warning that they are “stepping rugged and tough.”

Schizophrenia also enhances claims of competitive violence—in “16 on Death Row,” 2Pac famously warned that, “I’m kind of schizophrenic, I’m in this shit to win it.” Schizophrenia also helps rappers describe collective responses to racism or injustice. In the multi-artist hit “Everything,” Busta Rhymes calls for action by rapping, “Panic and schizophrenic, sylvy-Atlantic / Wrap up your face in ceramic, goddamit we controllin the planet.”…

Yet something much larger than mere sampling is at play in rap’s use of the terms schizophrenia and schizophrenic. Rap lyrics are the latest installments in a political debate that has evolved over the past century (at least) regarding the contested relationships between race, madness, violence, and civil rights… At stake is a series of existential and material questions about the causes, actions, and implications of sanity itself.

The article is locked but a pdf has made its way online.

It’s a fantastic piece that traces how schizophrenia and psychosis have become deeply politicised, racially charged concepts.

They were used to pathologise black civil rights protesters, whose demand for equal rights were considered part of a ‘protest psychosis’, and have been used in civil rights discourse to symbolise the effects of a racist society.

And this is how it seems to have ended up as a borrowed badge of pride for generations of MCs.

The piece is by psychiatrist Jonathan Metzl who also wrote the definitive history of the so-called ‘protest psychosis’ and it serves as a great introduction to an important chapter in the bitter history of race, psychiatry and psychosis.
 

Link to locked Transition article in JSTOR.
pdf of full-text.

Journalism site The Toast has what I believe is the only first-person account of Cotard’s delusion – the belief that you’re dead – which can occur in psychosis.

The article is by writer Esmé Weijun Wang who describes her own episode of psychosis and how she came to believe, and later unbelieve, that she was dead.

It’s an incredibly evocative piece and historically, worth remembering.

Somatic details figure heavily in these recollections: what I wore, what I looked like. I told myself, through mirrors and dressing-up and Polaroids and weighing myself, You have a body. The body is alive.

But the more that I tried to remind myself of the various ways in which I did, in fact, seem to have a body that was moving, with a heart that pumped blood, the more agitated I became. Being dead butted up against the so-called evidence of being alive, and so I grew to avoid that evidence because proof was not a comfort; instead, it pointed to my insanity.

Link to ‘Perdition Days: On Experiencing Psychosis’

If you work in mental health, you could do much worse than reading the editorial in today’s Lancet Psychiatry about unpleasant debates and how to avoid them.

Unfortunately, debates in mental health tend to get nasty quite quickly – but I’ve seen no part of the debate spectrum which has a monopoly on bigotry or a blessed surplus of consideration.

But instead of throwing up their hands in despair, the editorial team wrote some sensible guidance on bringing some respect to moving mental health forward.

The first is to assume the best of one’s opponent: that their argument proceeds not from self-interest, financial interest, or wilful ignorance, but from genuine curiosity and a desire to improve the lives of people with mental health problems. There is a view that so-called punching up to perceived figures of authority is justifiable and necessary, but punching up is still punching someone. There is always potential in the discussion of mental health issues to trigger distress, as everyone, patient or professional, has an unseen personal history and sensitivity.

Second, it is worth questioning whether one line of investigation or treatment necessarily diminishes the other. Although a holistic medical perspective on mental distress is useful, alternative types of assistance might also be of value. Such services need to be taken seriously, evaluated thoroughly, and, when appropriate, considered for public funding. Perhaps some arguments about which model of research or practice should be prioritised would be better resolved by a united campaign for better funding across the board.

Third, as Sun Tzu advised, know your enemy. Do not dismiss biological data as an irrelevant folly, nor philosophical and sociological analysis as a form of obscurantism. Take some time to consider your opponent’s intellectual discipline, and how his or her work might be criticized on its own terms. This might be a long, difficult, and tedious process, but it is what patients, and the public, deserve.

The final point is to ensure that those whose voices are not listened to enough are given the space and opportunity to be heard. Their numbers include individuals such as mental health nurses and social workers, who provide a large amount of care but who are given little time compared with psychologists and psychiatrists. Most important, the voices of patients must be “airtime” respected in all their diversity. If a new form of mental health care is to be built, all involved would do well to remember the three principles of James Madison, President of the USA and father of its constitution: compromise, compromise, compromise.

A tip of the hat to you.
 

Link to Lancet Editorial ‘Duel diagnosis’ (via @PsychiatrySHO)