Jack Dawkins, 2024
(CW: Altered states/psychosis/reality shifting. The discussion is academic and contains minimal details of our or anyone else’s psychotic episodes, but I know the topics can be triggering nonetheless. Also, brief mentions of abuse.)
It is bad enough when one’s self-knowledge is wobbly, thanks to the relentless exposure to people and situations that degrade one’s ability to recognise oneself as a valid knower. Racism and sexism (which includes misogyny, homophobia, and transphobia) are the commonest of these self-knowledge-destroyers; ableism, xenophobia, and classism play a similar role. This is what we’ve experienced as a Black, transmasculine, disabled plural system. Everywhere we look, we marginalised people are told that our self-knowledge is invalid, that it is impossible for a marginalised person to step outside their experience and analyse a situation objectively and logically. It is, in short, the presumption that to be marginalised is to be less intelligent or rational. This hostility toward one’s capacity to know oneself and understand one’s experiences logically is called “epistemic injustice,” an idea introduced by the philosopher Miranda Fricker in 2007, in a book by the same name.
Abuse, too, destabilises one’s self-knowledge. When we are told, either in word or in deed, that we are unworthy of existence and respect, it stands to reason that we will reflexively challenge the validity of our thoughts and perceptions. After all, if we have been groomed to see an abuser as an authority, we will grant them the power to define our reality for us. Once you try to extricate yourself from the relationship, the abuser will try to cast your dissatisfaction as counterfactual nonsense. They will cite the rankest bullshit like “false-memory syndrome” to invalidate the real suffering we have experienced at their hands.
It is possible that this already-shaky epistemic state may lead to mental states that degrade one’s knowledge further. When people enter psychosis, the entire foundation of their knowledge and sense of the world is disrupted, distorted, disjointed. Jepsson (2022) describes this as “radical psychotic doubt” in a jargon-laden article.
After marginalised people have been incessantly accused of being out of touch with reality, this may turn into a self-fulfilling prophecy with the onset of psychotic symptoms, either in permanent conditions like schizophrenia, episodic ones like the manic and depressive states of bipolar disorder, or conditions in between, like schizoaffective disorder. The emergence of psychosis is not independent of cultural factors, including the influence of systemic discrimination. It cannot be interpreted in a strictly clinical sense, deracinated from all context that may explain why someone may lose touch with reality.
Scholarly literature suggests that there may be a connection between marginalisation and psychosis. According to this article by Lazariou et al. (2023; open access), Black and African Caribbean migrants in Germany were more likely to develop psychosis, and the authors posit that racism may be a contributing factor. Another study by Mirza & Birtel (2019; paywalled) on the cultural dimensions of psychosis in the UK cited findings that indicated that Black and South Asian British people were more likely to experience psychosis than their white counterparts.
So where do we, Plures House, come in? We experience layers upon layers of marginalisation in a country that is partly built on the subjugation of our ancestors. We are survivors of childhood sexual and emotional abuse, with some physical abuse as well. And we exist in a society that routinely devalues the lives of disabled people, especially people with conditions that are typically called developmental disabilities. (Although we’re autistic, it feels a bit disingenuous to say we have a developmental disability, but the fact remains that autism is categorised thus.) We have been subjected to economic privation: homelessness, scanty access to food, limited healthcare coverage. This interplay of cultural, socioeconomic, and interpersonal factors is a perfect storm for a veritable panoply of mental maladies, including ours: PTSD, OCD, generalised anxiety disorder, and, most notably, bipolar disorder. We have had two episodes of mania with psychotic features. In both cases, precipitating stressors—racism, domestic violence, and religious abuse in particular—played a pivotal role in the delusions and hallucinations we developed. Racists have shaped our reality to devalue our Black experience, and our abusers have shaped our reality to dismiss our suffering as survivors. And as former evangelicals, we were propagandised ad nauseam with fire-and-brimstone sermons about the horrors of Hell and the primacy of a Muscular Christianity who defied weak-willed feminists and liberals in favour of a tough-guy Jesus who would redeem America—and the world. Racism, domestic abuse, and religious fundamentalism—all these have produced a fertile environment to disrupt our epistemic foundations. And they have produced a kind of “radical psychotic doubt” in us, in which we do not, cannot, face the world with the same certainty that our “sane” counterparts do.
The ability for psychosis to accompany and make use of preexisting stressors is almost as frightening as the actual delusions and hallucinations themselves. It creates a new avenue through which racists can declare that the complaints of “people of colour” (an expression I dislike, but I’ll use it for convenience’s sake, unlike Vova, who refuses to use it at all) are the mere mumblings of madmen, or abusers can vindicate themselves by saying their victims were too crazy and irrational to make valid complaints. Of course, this is a load of rubbish: even those who have been in altered states can identify correctly oppression and abuse. But the destabilising effect of psychosis gets in the way of this.
How, then, should we proceed? I’m no neuroscientist or research psychologist, unfortunately; I’m merely a member of a plural system with “lived experience” (an irksomely redundant expression). Sometimes I fancy myself a philosopher, but I fear I haven’t read enough of the classics and lack the academic credentials to back that up. But I think research ought to focus more on the systemic contributors to psychosis, rather than merely the biochemical or neurological basis for people’s flight from consensus reality. If the research bears this out, then so should practice. It does no one any good to treat psychosis as an atomised phenomenon that is separable from the context that surrounds it.