\u201cLawlessness.\u201d \u201cViolence.\u201d \u201cInsurrection.\u201d <\/p>\n
In the wake of mass protests against federal immigration raids, politicians and pundits are using these kinds of words<\/a> to discredit public dissent. In this view, protesters are framed not as engaged citizens exercising their rights but as threats to public safety and social order.<\/p>\n Terms like \u201cTrump Derangement Syndrome\u201d<\/a> go even further by pathologizing dissent itself. Framing resistance as mental instability makes it easier to dismiss, delegitimize, and punish, rather than confront the real harms that sparked it.<\/p>\n But this impulse isn\u2019t new. The reflex to recast resistance as disorder has long been embedded in medicine. Psychiatry, in particular, has a long and troubling history of treating dissent not as a demand for justice, but as a symptom of illness. <\/p>\n As a psychiatrist who has worked across emergency rooms, inpatient units, and community clinics, I\u2019ve seen how our systems can punish people for suffering\u2014especially when anger or resistance stems from trauma<\/a>, racism<\/a>, or state violence.<\/p>\n A Legacy of Pathologizing Protest<\/p>\n In the mid-19th century, Southern physician Samuel Cartwright coined the term drapetomania <\/a>to describe what he saw as a mental illness afflicting enslaved people who tried to flee captivity. Rather than recognizing an attempted escape as a fight for freedom, psychiatry labeled it pathological. The proposed treatment? Whipping.<\/p>\n A century later, in the heat of the Civil Rights Movement, Black men protesting racial injustice were labeled as schizophrenic under the so-called diagnosis of protest psychosis<\/a>. Once viewed as a docile disorder of white middle-class women\u2014one primarily characterized by withdrawal, confusion, and guilt<\/a>\u2014schizophrenia was redefined, its symptoms rewritten to reflect aggression<\/a>, hostility, and paranoia<\/a>. What changed wasn\u2019t the science but the patient; the shift from white women to Black men transformed the condition into something dangerous.<\/p>\n Just as disturbing as what psychiatry diagnosed is what it ignored. “Drapetomania” pathologized the enslaved, but not the enslavers who tore families apart and sanctioned physical and sexual violence<\/a>. “Protest psychosis<\/a>” pathologized civil rights activists, but had nothing to say about the mobs who tormented Black children at Little Rock Central High School<\/a>, or the state brutality used to enforce segregation.<\/p>\n These weren\u2019t fringe ideas. They were published in respected psychiatric<\/a> journals, taught in medical schools, and used to justify the control, punishment<\/a>, and institutionalization<\/a> of people whose only \u201ccrime<\/a>\u201d was the desire to be free.<\/p>\n Modern Echoes: Diagnosing Defiance in Youth<\/p>\n One of the clearest modern descendants of this legacy may be oppositional defiant disorder (ODD), a diagnosis defined by symptoms like irritability, defiance, argumentativeness, and vindictiveness, especially toward authority figures. On paper, it seems like a neutral clinical category. In practice, it often functions as a tool for criminalizing resistance, particularly in Black, Hispanic, and Indigenous youth.<\/p>\n A child who talks back, refuses to comply, or expresses justified anger after experiencing racism or neglect is rarely seen as resilient<\/a> or perceptive. Instead, they are more likely to be labeled “disordered.” Research confirms that ODD is overdiagnosed<\/a> in racially minoritized children\u2014particularly in group homes, foster care<\/a>, and juvenile detention, where the label can be used to justify restraint, exclusion, and criminalization. A recent study found that ODD diagnoses are 35 percent more prevalent<\/a> in Black people than in white people. Prevalence reaches half in juvenile detention<\/a> and foster care<\/a>. <\/p>\n I\u2019ve seen this happen firsthand. A 16-year-old Black nonbinary<\/a> teen<\/a> who was a ward of the state arrived at the emergency room in full restraints. The group home had called 911, reporting \u201caggression,\u201d \u201cdefiance,\u201d and \u201cdanger to others.\u201d But the child wasn\u2019t violent\u2014they were terrified. Their chart showed a history of being forcefully restrained, injected with sedatives, and discharged. \u201cPlease don\u2019t give me a shot,\u201d they begged me, clearly traumatized by their care. <\/p>\n Nowhere did the chart mention the trauma of being separated from their family, systemic neglect, or exclusionary disciplinary practices at school. No one had asked what they were surviving \u2014only what they were resisting. <\/p>\n This is the legacy of pathologizing protest. Survival strategies become symptoms. Resistance against racism and other forms of oppression becomes proof of dysfunction. And it ensures that psychiatry, rather than addressing injustice, becomes an agent of control.<\/p>\n Psychiatry Essential Reads<\/p>\n Psychiatry and the Carceral State<\/p>\n Psychiatric emergencies\u2014especially when framed as danger to self or others\u2014are often met with a familiar set of instructions: call 911, dial 988, or go to the nearest emergency room<\/a>. What patients and families aren\u2019t always told is that these responses can trigger law enforcement involvement, surveillance, and the use of force. <\/p>\n In 2024, Yong Yang, a Korean American man experiencing a mental health crisis, was killed after his parents called a mobile crisis team. Minutes later, the team called the police, who shot Yang in front of his family. His story reflects a pattern where psychiatry defers to policing, sometimes with fatal consequences.<\/p>\n Mental health standards of care do not require disclosing these risks. Families are not routinely warned that calling 988 may result in armed officers arriving at their door, particularly when operators determine someone is an \u201cimminent risk.” Because 988 crisis centers follow a disjointed set of regional policies, police involvement varies significantly by location\u2014up to 17 percent according to independent data, though the 988 organization claims less than 2 percent. There is no transparent data from 988 regarding which crisis centers are more likely to involve the police. Furthermore, there\u2019s no formal obligation to warn patients about the disproportionate use of restraint,<\/a> seclusion, or involuntary hospitalization<\/a> on racially minoritized people.<\/p>\n Reckoning and Reimagining Psychiatric Care<\/p>\n During the country\u2019s 2020 racial reckoning, mental health organizations\u2014including the American Psychiatric Association<\/a>\u2014 issued public apologies for their roles in perpetuating racism. But apologies are only the beginning. A true reckoning demands structural change\u2014starting with how we train, diagnose, document, and respond to people in distress.<\/p>\n Right now, psychiatry has no formal obligation to disclose the risks of police involvement in mental health crises, no protections against the weaponization of diagnoses like ODD, no expectation to account for racism, poverty, or state violence when interpreting behavior\u2014and no accountability when coercive interventions inflict trauma.<\/p>\n