Interview: Mical Raz on poverty, mental health, and U.S. social policy

In the following interview, Mical Raz, author of What’s Wrong with the Poor?: Psychiatry, Race, and the War on Poverty discusses how the understanding of poverty and mental health has affected social policy in the United States.

Mical Raz, photo by Daniel Mazza Levin

Mical Raz (photo by Daniel Mazza Levin)

Q: You are a physician and a historian of medicine. How did you become interested in American psychiatry and social policy and how has your interdisciplinary training uniquely prepared you to write this book?

A: As a physician, I am interested in questions of disparities in medical care and in providing quality medical care to disadvantaged populations. While volunteering at an open clinic in Israel, serving undocumented workers and asylum seekers, I became more aware of how political conditions shaped individuals’ access and experience of health care. This interest intersected with my training in the history of psychiatry as I embarked on this study of poverty and mental health in the 1960s.

As a historian of medicine, my analysis reconstructs what understandings of mental health were reflected in policy makers’ decisions and interventions, bringing an uncommon view to social policy analysis. As a practicing physician, I think I can better comprehend and even identify with the predicament of clinicians in the 1960s, who often pathologized poor, black men and women in order to be able to offer medical solutions to social problems which had no ready resolution.

Q: Your book centers around cultural deprivation theory and its impact on both policy and practice. Could you briefly explain this theory?

A: Theories of cultural deprivation focus on what low income children lack in their disadvantaged homes. It refers to a wide range of experiences experts believed these children were lacking; this image was deeply stereotyped. Parents were seen to be non-verbal, mothers did not adequately stimulate their children, homes were bleak and drab, and there were no books or educational toys for the children to play with. Accordingly, these children lacked what was seen as necessary stimuli for mental and psychological development, leading to scholastic disadvantage reflected in subsequent attempts to join the work force.

Q: How did the theories of cultural deprivation and the cycle of poverty come to permeate left-leaning research and policymaking in the 1960s, only to be later disavowed and attributed to conservatives?

A: I believe these were seen to be non-racialist explanations for why communities of color were lagging in traditional measures of success (income, education, employment). Rather than blaming an innate racial inferiority, left-leaning researchers and policy makers sought to locate the defect in the home lives of disadvantaged communities. This was a palatable explanation for perceived African American underachievement that rejected racially based explanations, but also did not threaten the hegemonic structure of American society.

Q: How has American society explained poverty and how has that history contributed to the narrative of deprivation you explore in this book?

A: Poverty is often seen as a personal failure, whereas success is a mark of hard work; thus economic status serves a surrogate for individual self-worth, and not an indicator of society’s structure and its limitations. Poor men and women are still often portrayed in stereotypical terms as being lazy and unmotivated. Cultural deprivation is an intra-psychic explanation for the cause of poverty, focusing on the myriad of deficits in an individual’s life that leads to economic disadvantage—maternal failure, lack of stimulation, lack of appropriate role models. While it does not blame individual girls and boys for their scholastic disadvantage, which further perpetuates the “cycle of poverty,” it does blame their parents and their home environment. Thus deprivation theory is an example of “blaming the victim” in the discussion of poverty and its causes.

What's Wrong with the Poor?: Psychiatry, Race, and the War on Poverty, by Mical RazQ: Among the concerns your book raises is that the proponents of cultural deprivation relied on little if any empirical evidence, yet articles advancing or assuming the theory continued to be published in academic journals, presented at conferences, and relied on by researchers, practitioners, and policymakers? What allowed the tenants of this framework to go unquestioned?

A: A combination of factors came into play. The theory was intellectually appealing and politically palatable, and it relied on data from fields that were well-established—sensory, nutritional and maternal deprivation. Experiments from these fields were uncritically incorporated into discussions of cultural deprivation, lending it scientific legitimation far beyond what it warranted.

Q: Explain how the growth of “Mild Mental Retardation” diagnoses in the 1950s and 60s was based on assumptions of deprivation in the African American home and arguably even constituted a form of re-segregation.

A: In my book, I argue that using cultural deprivation as an acceptable explanation and even a synonym for “mild mental retardation” enabled the overdiagnosis of black boys and girls as intellectually disabled. It was a simple equation–black children were seen as culturally deprived, cultural deprivation was taken to be a cause of “mild mental retardation,” and as a result, black children were diagnosed as disabled, leading to their placement in distinct tracks or classes. As desegregation brought children from diverse educational, cultural, and racial backgrounds to the same classroom, teachers struggled to find ways to teach effectively in heterogeneous classrooms, and placing black children in “special ed” or in slow tracks offered a solution. I don’t think that teachers were motivated by racism, but rather that this new diagnosis provided a convenient solution to the many challenges of desegregation.

Q: The cover of What’s Wrong with the Poor? features Lady Bird Johnson, who was honorary chair of Project Head Start. She claimed in announcing the project that the children served “don’t even know a hundred words, because they have not heard a hundred words”; “they had never seen a book or held a flower; some of them did not know their names, which their parents had failed to teach them.” Are these statements representative of popular opinion at the time? Are they still pervasive beliefs today?

A: I believe that these statements were representative of popular opinion at the time. As the lay public became increasingly concerned over America’s poor boys and girls, as a result of media attention to growing national poverty rates, they readily accepted these extreme stereotypes of poor children. Focusing on what poor children lacked helped motivate the public to accept change and take action to assist poor children, but also had the unfortunate effect of perpetuating stereotypes of their home lives and abilities.

Q: The field of social service is dominated by clinicians and direct-service providers who focus on psychotherapy and, to a much lesser extent, case management. Are psychiatry and psychology helpful lenses to understand and combat poverty?

A: This is a really difficult question to answer. I think in broad strokes, I would argue that poverty is a result of social policy and structural inequalities, and that would be the most appropriate lens to use when attempting to understand and combat poverty. However, there are numerous correlations between poverty and mental illness, as some forms of mental illness are overrepresented in poor populations, while poverty is a significant barrier for mentally ill people to attain appropriate care, and poverty in itself is a stressor that can cause symptoms of mental illness. There are certainly nuanced ways to use the mental health disciplines in combating poverty and its wide-ranging detrimental effects, but it is important to avoid a pathologization of poor men and women, or to interpret poverty as a sign of psychological inadequacy.

Q: There’s been a lot of debate recently over the efficacy of Head Start programs and other early interventions aimed at low-income families. Since you argue that these programs are based on cultural deprivation theory, do you believe they are valuable?

A: Yes! I think they are fantastic programs that provide valuable educational opportunities for children. While they may have been flawed in their views of poor children’s backgrounds and perceived deficits, the remedy they offered—quality care by professional educators with an enriched environment offering intellectual stimulation—is certainly beneficial. I believe that high-quality educational programs for young children should be made available to each and every child in the country, and not only to the very poor, who qualify for federally subsidized programs, and the very rich, who can afford private educational programs.

Mical Raz, M.D., Ph.D., is a physician and historian of medicine. What’s Wrong with the Poor?: Psychiatry, Race, and the War on Poverty is now available. Raz is also author of The Lobotomy Letters: The Making of American Psychosurgery.