Hunting the Real: Psychosis and Race in the American Hospital

Abstract

It has been consistently observed that black Americans receive psychotic disorder diagnoses at higher rates than white Americans. While this finding has proven robust across time and setting, with other demographic variables accounted for, reasons for the disparity remain obscure. This paper aims to provide a psychoanalytic and historical framework for thinking about this correlation. Rather than categorizing black liberation as insane (a well-worn trend within American psychiatry) or dismissing the elevated rates of insanity as mere racist fabrication, here, I propose to listen to what speaks through insanity for what it may reveal about the historical and present realities of being black in America. To do so, I will first outline Francoise Davoine and Jean-Max Gaudilliere’s framework for thinking about psychosis alongside historical trauma and then turn to clinical experiences at a city hospital in the Bronx.

Keywords:

• race
• psychosis
• psychoanalysis
• racism
• trauma

This article responds to:

Discussion of “Hunting the Real”

Discussion of “Hunting the Real”

Notes

¹ As I am interested in the impact of the historical and social position of those defined as “black” in America (which cuts across ethnic origin), I will refer primarily to “black Americans”. Some of the research has focused exclusively on African Americans, so I will use this term when appropriate.

² While this research has been important in refuting an essentialist reading of the relation between black race and psychosis, it is important to note that it ends up relying on an essentialist conception of blackness, where people across different societies and geographies are assumed to be part of an overarching category of “black” people, as if the term referred to an ontological reality and not a context-specific social construction.

³ It is worth noting that psychoanalysis in America was historically thought to be inappropriate for the treatment of psychosis as well as of those with significant socio-economic stressors. To the contrary, I argue that working psychoanalytically can reveal links to historical trauma, often especially relevant to those cast out of the social order.

⁴ Institute for Policy Studies, “Dreams Deferred: How Enriching the 1% Widens the Racial Wealth Divide.” January 2019: https://ips-dc.org/racial-wealth-divide-2019.

⁵ (April, 2018). Why Build a Memorial to Victims of Racial Terror? Retrieved from: https://museumandmemorial.eji.org/memorial.

Additional information

Notes on contributors

Hannah Wallerstein

Hannah Wallerstein, PhD, is a clinical psychologist in private practice. She recently completed a postdoctoral fellowship. She has published on gender identity and transgender phenomena, psychosis and historical trauma, and the concept of truth in Studies in Gender and Sexuality, Transgender Quarterly and The Psychoanalytic Study of the Child. Her article “Real Gender: Identity, Loss and the Capacity to Feel Real” won the 2016 Symonds Prize.