The Haunting and Mourning of Subaltern Voices in Psychiatry

Sarah Kamens invites readers to consider ways that psychiatry is colonizing, drawing on the concepts of ghostwriting and voice-hearing as mirrored points of haunting in medical regimes. Her article is provocative and engaging, and she is spot on about some of the more concerning aspects of psychiatry. I suggest some ways that Kamens can expand on this work, but my emphasis is on ghostly and emergent voices of service users.

Post-Colonialism

I find myself wishing that Kamens would dig deeper into some of the core concepts she employs. Take post-colonialism. Setting aside the fanciful thinking signified by use of the suffix “post”—a term that is used to indicate that we have moved past the practice itself, as in “post-racial society” or “postfeminism”—I wonder how Kamens means us to understand the term “colonizing.” In common understandings of the concept, colonizers are those who steal land and property, including people/bodies/minds, and install their own language, laws, moral codes, social norms, religious practices, epistemology and formation of identity. It also involves sorting people into classes or groups and, as Lugones writes, “the process of active reduction of people, the dehumanization that fits them for the classification, the attempt to turn the colonized into less than human beings” (Lugones, 2012, as quoted in Potter, 2015; see also Lugones, 2007).

As Kamens indicates, an apt deployment of a discourse on “colonizing” is found in the authorizing of experts to enforce norms of behavior and experience by granting psychiatrists the right, responsibility, and power to interpret and medicate certain behaviors and experiences as signifiers of mental disorders. Kamens argues, with some strained argumentative moves regarding their parallels, that hearing voices and ghostwriting “demonstrate the existence of hierarchical, universalist, and indeed hegemonic and discursively colonizing practices in psychiatry that subjugate the interpretation of content (messages) to the media (or mediums) through which they arrive” (Kamens, p. 259). She has in mind the ways a service user/survivor’s voice, knowledge and experience most often are interpreted through the lens of the expert/authorizing diagnostician and the psychiatric institution, and the person herself, being already positioned as ill, cannot (or, cannot easily) refuse that positioning. We might call this the colonization of a person’s body and mind.

Yet, in a brilliant and challenging article, Tuck and Yang (2012) argue against framing colonization and decolonization metaphorically, or too broadly.

Equivocation is the vague equating of colonialisms that erases the sweeping scope of land as the basis of wealth, power, law in settler nation states. Vocalizing a “muliticultural” approach to oppressions, or remaining silent on settler colonialism while talking about colonialisms, or tacking on a gesture towards Indigenous people without addressing Indigenous sovereignty or rights, or forwarding a thesis on decolonization without regard to unsettling/deoccupying land, are equivocations. That is, they ambiguously avoid engaging with settler colonialism; they are ambivalent about minority/people of color/colonized Others as settlers; they are cryptic about Indigenous land rights in spaces inhabited by people of color.

(Tuck & Yang, 2012, p. 19)

We need to be cautious in applying the term to psychiatry, then, especially when it allows us to gloss over settler colonizing and to whom it is done—and to ignore the erasures that it enacts. It is disappointing that Kamens’s article stays at an abstract and generalizing level that seems to homogenize service users. For example, numerous studies have found that African Americans are more often misdiagnosed with schizophrenia than non-Hispanic Whites, and one reason this occurs is clinicians’ bias when making diagnoses (Gara, Minsky, Silverstein, Miskimen, & Strakowski, 2019; see also Kalathil, 2011; Metzl, 2010). If Tuck and Yang are right—and their argument is compelling—it becomes difficult (or ill-advised) to see psychiatry as colonizing. Yet it is appealing to describe what happens to service users of mental health as a form of oppression and/or colonization. It puts a name to many people’s experiences.

The Subaltern

One way to understand the problem of oppression in psychiatric practices is in terms of voices and...