Were late-twentieth century British psychiatrists racist? Or psychiatry as a discipline? Or were they both products of the wider society they were situated within? For the ninth post in the RHS’s ‘Writing Race’ blog series, Jamie Banks investigates “cannabis psychosis” and its disproportionate diagnosis amongst Britain’s Afro-Caribbean communities. Studying this intersection of medicine, culture, and policing brings to light the methodological difficulties around motivation and responsibility, which racism poses for historians.
During the 1980s and early 1990s, British psychiatric journals were awash with debates about a ‘new’ condition called cannabis psychosis. Despite the prevalence of these debates, however, there was little agreement about what the condition actually was. This is to say that while many studies agreed that cannabis could precipitate its own, distinguishable form of mental illness, there was considerable variance in opinion regarding its distinctive features.
In the first instance, then, reflecting upon the case of ‘cannabis psychosis’ is important, given the continued debate about whether or not cannabis causes mental illness. The case of ‘cannabis psychosis’ is also significant, however, because of the highly disproportionate rates of ‘cannabis psychosis’ amongst young Black men, and the difficulties which historians face in trying to explain this fact.
Ambiguous definitions of ‘cannabis psychosis’
The ambiguities surrounding ‘cannabis psychosis’ were illustrated by a study published in 1988, which probed psychiatrists’ perceptions of the diagnosis. The study ultimately found that, of a possible 25 unique symptoms, only five were seen as distinctive by 50% of respondents. Of these, only one was agreed upon by more than 60%. Thus, the study suggested that the diagnosis which emerged from medical journals was not that of a clearly distinctive psychological disorder, but perhaps rather an ill-defined constellation of ideas about the psychological effects of cannabis.
The ambiguity surrounding what cannabis psychosis actually was also proved to be a source of significant criticism amongst those who questioned the validity of the diagnosis. In particular, some critics made unfavourable comparisons between ‘cannabis psychosis’ and ‘masturbatory insanity,’ suggesting that both conditions had more grounding in contemporary societal prejudices than in medical fact.
A separate, if related, strand of criticism also expressed concerns about the disproportionate diagnosis of ‘cannabis psychosis’ amongst young, Afro-Caribbean men. As indicated by one particularly notable study of psychiatric admissions to the borough of Sandwell, Birmingham, ‘cannabis psychosis’ was diagnosed 95 times more commonly in Afro-Caribbean than in white patients. This clear disparity in turn fostered suggestions that ‘cannabis psychosis’ was little more than ‘the pathologisation of drug use amongst the Afro-Caribbean community; that particular social habits were being treated as if they were a medical condition.
How do we explain the disproportionate rates of ‘cannabis psychosis’?
Why was the diagnosis of ‘cannabis psychosis’ so much higher amongst Afro-Caribbeans? In the first instance, some suggested that the disproportionate rates of diagnosis reflected the biases of individual practitioners, many of whom were white and middle class. Consequently, McGovern & Cope indicated that their findings in Sandwell drew attention to how “racial and cultural differences between psychiatrists and patients lead to a less competent diagnosis.” Others interviewed as part of Ranger’s study took a somewhat dimmer view, suggesting that the diagnosis seemed to represent a “certain laziness” in the practices of psychiatrists. As eloquently put by a community-support worker, interviewed by Ranger, it felt like “psychiatrists see ‘locks’, think ‘Rasta’, and conclude ‘abusing ganja.’”
Beyond individual practitioners, some also questioned the systems of knowledge engendered by psychiatry as a discipline. After all, psychiatry was, and still is, a medical discipline born from the mores of European colonialism, encouraging practitioners to think of their patients and their maladies in particular ways. This includes an implicit emphasis on the differences between practitioner and patient, be they in terms of gender, class, race, or state of mind. Thus, in provocatively questioning whether or not “British psychiatrists were racist,” Lewis et al suggested that the evidence of “racialised thinking” amongst British psychiatrists was also the product of prejudices shaped by professional literature and psychiatric training. In short, Lewis et al suggested that practitioners had effectively been taught to racialise the patients.
The role of prejudice in psychiatry and society
Finally, and perhaps most significantly, others questioned the extent to which broader societal prejudices influenced the ideas which underpinned ‘cannabis psychosis.’ Most notably, Littlewood’s response to Lewis et al questioned whether such racialised ideas were the result of psychiatry’s colonial origins, or if psychiatry merely helped to replicate “the social power and prejudice[s] located outside of medicine.” In short, Littlewood asked if psychiatry and psychiatrists created these prejudices, or merely served as the vector for their spread?
In the case of one particular assumption – that cannabis use, and by extension drug use, was more prevalent amongst the Afro-Caribbean community – one can definitely see a clear continuity between the views of psychiatrists and society at large. Concerning the views of psychiatrists on the matter, Littlewood’s survey of 1988 also found that 44 of his 104 respondents regarded the disproportionate rates of the diagnosis to be due to the more extensive use of cannabis amongst Afro-Caribbean patients. This was despite the fact a national survey conducted by New Society in 1986 found that cannabis consumption was proportionally higher amongst white, rather than Afro-Caribbean, teenagers.
What did the media say?
Such assumptions mirrored similarly prejudicial attitudes freely expressed in the British press. Most notably, contemporary reports on disturbances in Brixton, Toxteth, St Paul’s and Handsworth in the early to mid 1980s persistently blamed drug use and distribution amongst Afro-Caribbean communities as a key contributing factor for later events. Thus, in reportage about the disturbances in Handsworth, Birmingham, the Sunday Telegraph laid blame at the feet of a “hardcore of drug dealers,” worried about police efforts to crack down on the sale of cannabis, heroin, and cocaine. Likewise, the Times reported on the unrepentant attitude of the police in Bristol. For instance, the police denied that drug raids conducted on premises such as the Black & White café in St Paul’s, which had caused the subsequent disturbances, were “overkill.”
More strikingly, however, was the fact that such assumptions were also seemingly commonplace, part of what Paul Gilroy calls the “everyday logic of racism.” For example, a report in the Telegraph in 1986 noted the controversy which erupted in Reading, following a questionable advertisement posted in an estate agent’s window. Promoting what it called a “lovely little number,” it attempted to allay concerns that the property was in a “bit of an ethnic minority area” by remarking that this fact ensured plentiful access to “cheap grass.”
Cultural stereotypes about Afro-Caribbean communities
Broader culture stereotypes about Afro-Caribbean communities also underpinned how psychiatrists understood ‘cannabis psychosis.’ For example, there were widespread misapprehensions about Rastafari, which was becoming increasing prevalent amongst Afro-Caribbean communities from the 1970s. In psychiatric studies such as Onyango’s, the image of the Rastafarian as a “mentally ill cannabis abuser” came to serve as the archetypal ‘cannabis psychosis’ patient. Such an image was, in turn, fuelled by the representation of Rastafarians in official reports such as the Silverman inquiry, which intimated the close relationships between cannabis, the Handsworth riots, and “the dreadlocks, the people who called themselves Rasta … [but] are disapproved of by genuine Rastafarians.”
Other assumptions which fed into the diagnosis included the increasingly strong links drawn between Afro-Caribbean communities, crime, and violence. In discussions about how Afro-Caribbean patients interacted with mental health services, for example, Harrison et al noted that these patients were perceived as being significantly more violent towards themselves, a perception accompanied by considerably higher rates of reportage of “assaults or violent acts” against staff. While this contention needs more thought, it seems to stem from what Gilroy has described as the “moment that crime and legality [began] to dominate the discussion of the ‘race’ …, when ‘black youth’ became a new problem category…”.
In sum, the case of ‘cannabis psychosis’ illustrates how difficult it can be for historians to disentangle the prejudices of societies, institutions and individuals. This is because none of the above ever operate in isolation from one another, instead mutually informing and consolidating one another. This poses its own questions – what or who was to ‘blame’ for the diagnosis? Was it psychiatrists, whose racialised biases led to the misdiagnosis of patients? Was it the fault of psychiatry, the discipline in which these practitioners were trained? Or was it the stereotypes permeating British society at the time, which in turn fed into the ideas underpinning the diagnosis? The answer is – all of them, to varying degrees.
- Paul Gilroy, There Ain’t No Black in the Union Jack (London: Routledge Classics, 1987), esp. chapter 3.
- Roland Littlewood, ‘Community-Initiated Research: a study of psychiatrist’s conceptualisations of ‘cannabis psychosis,’ Psychiatric Bulletin, 12.11 (1988), pp. 486-88.
- James H. Mills, Cannabis Nation: Control and Consumption in Britain, 1928-2008 (Oxford: Oxford University Press, 2021), esp. chapter 7.
- Chris Ranger, ‘Race, culture and ‘cannabis psychosis’: The role of social factors in the construction of a disease category,’ Journal of Ethnic and Migration Studies, 15.3 (1989), pp. 357-369.
ABOUT THE AUTHOR
Dr Jamie Banks is a Wellcome Trust ISSF Postdoctoral Fellow at the University of Leicester’s department of History, Politics, and International Relations. He is a social historian of drugs in Britain and its empire, and his current research explores the intersections between cannabis, race, and mental illness amongst Afro-Caribbean communities. His first publication, on cannabis, mental illness, and indentureship, will be published as part of an edited collection on MIT Press in August 2021.
Follow @jamie_banks26 on twitter.
IMAGE HEADER: A young man smoking marijuana during the Finsbury Park Carnival, London, 1978. Photograph by “Babs” and reproduced online by Alan Denney.