The City as Patient
Matthew Dumont was another NIMH administrator who offered the commission his advice in the form of a report on the positive, community-building roles of ghetto gangs, and he suggested
that policy-makers would be wise to consider their potential to act as counterrioting forces. His semioptimistic interpretation of civil disturbance was similar to Liebow's: "One may have to conclude that the rioter is a more mentally healthy person than the non-rioter. He is a person who still believes that action means something, that things can improve." Dumont, however, did not make his special concern with black men, or masculinity, explicit. He did not really have to. Rioters, or most of them anyway, were male; therefore, his subjects were male. That rioting was a gender-specific behavior was an assumption made by most, if not all, of the Kerner Commission experts. Rarely was it considered necessary in reports or recommendations to point out that rioters were male. In this sense, Dumont was not at all exceptional.
As an advocate of community psychiatry, Dumont represented one of the most innovative and significant developments in the postwar clinical professions (see chapter 9). By the late 1960s, popular perception no longer tied clinicians to their historic charges: the institutionalized insane. Perfectly normal (if painfully maladjusted) individuals had become appropriate participants in clinical exchanges, and healing complex social environments had been gathered under the mantle of clinicians' ever-expanding list of therapeutic chores. Even the names of their respective movements made it evident that psychiatrists and psychologists were prepared and eager to bring diagnosis and treatment to communities at large. The working definition of community psychiatry typically covered all aspects of life, supplementing the profession's conventional commitment to clinical work with hefty chunks of research, education, urban planning, government administration, community organization, and political activism. Community psychiatry and psychology implied sweeping social interventions in the name of mental health because "everything a patient does and says, including what he does and says as a participant in a social system, falls within the therapists' purview."
In the case of rioting, Dumont thought it sensible to consider violence a symptom in need of immediate treatment. He was not alone. To consider "the city as patient" was to acknowledge a truly remarkable expansion in the subject of psychological authority, founded on the World War II preoccupation with "prevention," expressed through massive campaigns to instill mental health in the U.S. public during the period after 1945, and finally enacted on the level of state policy through federal legislation. In 1963 the Mental Retardation and Community Mental Health Centers Construction Act institutionalized
psychology's progress in the form of an ambitious federal program: two thousand community centers would be built to replace the outmoded system of segregated asylums. They would be accessible to all U.S. citizens on the assumption that combating the scourge of mental disease in the community would prevent most, if not all, of the negative social consequences associated with severe psychological illness.
By the time the Kerner Commission was established, their community focus made the purposes of psychiatry and psychology virtually indistinguishable at times from those of the welfare state, and advocates were quick to notice similarities between their goals and assumptions and those of the Great Society; both envisioned community participation and the enfranchisement of the poor and oppressed through deliberate improvement of damaging environments. The mission of community psychology, Robert Reiff announced in September 1967, was to "place the psychologist in the position of social interventionist, whose primary. task was to intervene at the social system level to modify human behavior."
Matthew Dumont stated the alliance between psychology and liberal politics even more simply: "Mental health is freedom." He showed how useful a justification mental health had become for social welfare programs and how intertwined it was with language of 1960s activist politics. And he brought this perspective to the attention of the Kerner Commission, some of whose members embraced this advantageous, new way of expressing policy concerns. Like Kenneth Clark's testimony, Dumont's rhetoric relied on extensive disease metaphors and called for the prompt diagnosis and treatment of social disorder. He referred frequently to "urban organisms," "painful tissue destruction," and the "sensory deprivation psychosis" experienced by ghettos. The spread of rioting convinced him that entire communities, not just individuals, were suffering the pain of poor self-esteem. "This, then, is the diagnosis. A riot is a symptomatic expression of deficits of stimulation, self esteem, a sense of community, and environmental mastery. The treatment of the condition is no secret and in inadequate dosages it has already been administered."
While the parallels between socially sensitive mental health approaches and an expanded welfare state seemed obvious to Dumont, Clark, and many others by the late 1960s, some dissenting voices persisted, reminders that the application of psychological expertise to urban rioting (and social problems in general) need not result in liberal public policies. A widely discussed letter to the Journal of the American
Medical Association in September 1967 suggested that "brain disease" was being overlooked in the rush to stem the tide of urban violence with better jobs, housing, and education. According to two of the authors, Vernon Mark and Frank Ervin, who later expanded their controversial thesis in Violence and the Brain (1970), "The real lesson of the urban rioting is that, besides the need to study the social fabric that creates the riot atmosphere, we need intensive research and clinical studies of the individuals committing the violence. The goal of such studies would be to pinpoint, diagnose, and treat those people with low violence thresholds before they contribute to further tragedies."
Complaints about the workability of expanded social programs were not limited to experts determined to unlock the biological mysteries of assaultive behavior, however. The June 1968 issue of Psychiatric Opinion featured a series of short pieces by psychiatrists involved in riot studies, including John Spiegel and Elliot Luby, whose work was duly considered by the Kerner Commission. All of the contributors shared a fundamental commitment to exporting psychiatric insights to the policy-making process, but Robert McMurry forcefully disagreed that extending social welfare programs was either a necessary outcome of this process or a viable solution to the ills of the city. In his view, greater permissiveness in society at large was to blame for lessening the burden of guilt for antisocial activities. This development deeply affected "riot-prone" individuals who had "no internal policing agencies in their egos."
The crucial point is that many of these participants in riots are people who have little or no control over their aggressions, are largely or wholly lacking in conventional moral standards, and many are to some degree out of touch with reality. In consequence, almost none are reasonable people. Logic, kindness and a regard for consequences have little or no influence on their behavior. They are chronically and, in many instances, irredeemably incorrigible. They are not only misfits in society; they are threats to its integrity. . . . Like a forest fire, once ignited, this mass madness is not only contagious but is very difficult to extinguish and can lead to astronomical costs in human life, injuries and property losses.
Equally determined to see urban violence addressed in a psychological fashion, McMurry nevertheless believed that aggressive surveillance, probation, and protective custody—and not employment opportunities or decent housing—would help to eliminate the problem. His argument should serve as a reminder of the political flexibility of the psychological worldview. For Dumont, the philosophy of community psychia-
try implied freedom from material and spiritual impoverishment. Yet for McMurry, psychiatry held a different lesson: "Just as the criminal and the insane must be denied their freedom, so must the sociopaths, psychopathic personalities, and the emotionally immature delinquents be subjected to control. The alternative is a form of anarchy, the letting loose upon the population of a pack of potential mad dogs . . . with the capability of limitless harm."