During the 2012 Republican presidential primaries, former Speaker of the House Newt Gingrich argued that children from low-income families lacked role models to teach them the importance of a good work ethic; they thus failed to understand the concept of “showing up on Monday and staying all day.” They should be employed, he suggested, in jobs such as “assistant janitor” at their schools to help them learn the value of work as well as earn wages.1 With this controversial statement, Gingrich illustrated the extent to which images of deprivation in the home lives of low-income children remain a part of current political debates. By championing middle-class and wealthy mothers who choose to stay home to raise their children while simultaneously calling for eligibility criteria that require low-income mothers of young toddlers to work to receive public assistance, conservative politicians reveal deeply ingrained views of maternal deprivation and normative mothering. Time and again, politicians have enlisted a variety of images, words, and metaphors to argue that the poor have less. The interventions developed to provide the poor with what they are assumed to lack, however, do not provide them with the material goods they so desperately need: income, affordable housing, or access to health care, much less such basic amenities as food and clothing. Rather, many of these interventions attempt to remedy perceived psychological or experiential gaps. Even Gingrich’s proposal to employ poor children to clean school bathrooms was framed as a way of providing them with the experiences they sorely needed, helping them to develop a work ethic that more advantaged children would have derived from role models in their own communities.
While the poor undeniably have less of certain resources, the interventions examined in this volume rarely targeted these material aspects of poverty. From encouraging mothers to “take interest” in their children to slowly familiarizing children with different shapes and sizes, many of the 1960s War on Poverty interventions were designed to provide the poor with things they in fact did not lack or did not need. Liberal-minded experts and politicians expressed confidence that they could effectively identify and provide what the poor needed. These perceived missing components often reflected a moralizing psychological interpretation of the personal failings believed to be common among low-income and particularly minority groups. Children were unloved or unstimulated; mothers were deficient both in their homemaking abilities and in their capacity to understand and care for their children; fathers lacked self-esteem and positive masculine role models. Many of the programs examined in What’s Wrong with the Poor? certainly had profound positive impacts on the lives of low-income families and their community, providing much-needed educational and health services. At the same time, the delivery of these services reflected deeply rooted stereotypes of what was “wrong” with society’s marginalized groups.
Writing this history of the intersection of psychiatry, civil rights, and public policy in the 1960s places me in the uncomfortable position of criticizing programs I support and even admire, among them Project Head Start and the ill-fated radical community action program Mobilization for Youth. While their negative views of low-income persons of color seem abrasive to the modern reader, these experts were not racial conservatives or bigots. Their liberal politics and idealistic goal of attaining social equality through early intervention reflected the giddy optimism of the era. From Carl Bereiter, who compared African American children to deaf children who “have no language,” through Bettye Caldwell, who lamented the lack of a “literacy test” for parenthood, to Susan Gray, who worried about how frying pans in disarray would interfere with children’s intellectual development, the child development experts who sought to prevent and treat deprivation were deeply committed to the children they hoped to help. Rejecting hereditarian explanations for the achievement gap, these experts firmly believed that compensatory education was the key to racial equality. Similarly, members of the Kerner Commission genuinely wanted to understand the causes of civil unrest; their recommendations would have radically transformed the structure of American society. Although much of their analysis was based on deprivation theory, their attempt to make sense of urban violence was ultimately far more sympathetic to the plight of low-income inner-city African Americans than any previous interpretation.
Examining how key political moments in the 1960s embodied racially and socioeconomically biased interpretations of deprivation theory runs the risk of being read as a personal indictment of the main actors involved. That is certainly not my intention. Rather than examining how well-intentioned mental health experts could unwittingly embrace approaches that pathologized African American home life and devalued minority culture, this analysis studies the interchange between psychiatry and politics. It considers how theories of mental health were based on a collection of inherently racist and classist presuppositions. Experts privileged the white middle-class home as the normal or healthy environment; deviations from this monolithic standard were labeled pathological.
Having volunteered as a physician at the Israeli Physicians for Human Rights clinic in Jaffa, which provides health care for asylum seekers, undocumented immigrants, and Palestinians who are not Israeli citizens, I can certainly identify with experts’ attempts to help the less fortunate. Dispensing advice, prescribing medication, and trying to create a safe space for these marginalized individuals, I have inevitably provided the poor with things they did not need and have been unable to offer a structural solution for the greater challenges they faced. From renewing psychiatrists’ prescriptions for Ritalin while wondering whether this was the best possible response to refugee children’s difficulties, to sending patients for tests to diagnose illnesses that they could not afford to treat, I have agonized over the inadequacy of our medical response in light of the structural obstacles these men and women face. While sympathetic to the attempts of the liberal-minded mental health experts, I believe that important lessons can be learned by examining their errors alongside the structural variables that predestined their interventions to remain at best problematic and at worst counterproductive.
So what went wrong with well-intentioned child development and mental health experts’ valiant efforts to help the poor? Politicians proved eager to capitalize on current trends in child development, hastily assembling Project Head Start as a large-scale summer intervention despite inadequate data and planning.2 Child development experts, aware that these programs were woefully underfunded and underresearched, cooperated in spite of their reservations, recognizing the importance of early childhood education. Academic prestige was also at stake. Apart from experts’ desire to make a difference for the disadvantaged, cooperating with federal agencies had professional advantages. The significance of academic research was gauged by its ability to inform public policy. Thus, psychologist and sensory deprivation pioneer Donald Hebb was awarded the 1979 Distinguished Scientific Contributions to Child Development Award by the Society for Research in Child Development. Hebb received the award alongside Julius Richmond and Harry Harlow, known for his studies on monkeys raised without their mothers.3 Neither Hebb nor Harlow had worked with children; Richmond had directed Project Head Start.
Politicians also influenced researchers’ career trajectories through their direct engagement with discussions of deprivation among the poor. From President John F. Kennedy’s endorsement of the theory that a lack of stimulation caused intellectual disability through Lady Bird Johnson’s tour of Martin Deutsch’s IDS to the Kerner Commission’s depiction of inner-city homes as deadening and impoverished, these public figures played a powerful role in facilitating the acceptance of theories and interventions that were aligned with their political goals.
The ease with which researchers from loosely related fields borrowed concepts in deprivation research proved to be an additional weakness of these interventions. Policymakers and educators regarded animal studies as directly and unproblematically applicable to humans, appropriating a vocabulary with little critical reflection. The science of toy arrangement was derived directly from sensory deprivation experiments in a controlled laboratory setting, and maternal, nutritional, and cultural deprivation were often used interchangeably. To use literary theorist Mieke Bal’s term, deprivation served as a traveling concept that bounced among different disciplines, acquiring new meanings and spheres of influence along the way.4 The concept’s subtlety, specificity, and variety of meanings were often lost in policy recommendations. Policymakers eager to advance their agendas paid little heed to the lack of data on how cultural deprivation could be targeted effectively, much less on its actual existence. Until the late 1960s, few researchers adequately addressed the differences or even the similarities among sensory, maternal, and cultural deprivation.
Nevertheless, this casual conflation of concepts would likely have been less significant had it not been complicated by the association of deprivation with poverty and race. Deprivation was not originally associated with low-income urban blacks. Yet by the early 1960s, it had begun to provide a language and a framework for white experts to describe a variety of traits attributed to poor blacks. In the era of civil rights and racial liberalism, experts saw African Americans as having less rather than being less. Deprivation thus became an ostensibly color-blind means of transforming racial inferiority into racial disadvantage. Today, “low-income” and “inner-city” have supplanted the no-longer-fashionable “culturally deprived”; “single-parent” families have replaced the matriarchal families of the 1960s. All too often, these terms serve as fillers for race. Not talking about race enables us to ignore the ways in which these theories of mental health are deeply embedded in racialized presuppositions. Articulating the overlap among “cultural deprivation,” “mild mental retardation,” and race might have enabled well-intentioned mental health professionals to recognize their overdiagnosis of African American children as mildly intellectually disabled. It remains impossible to know whether recognizing the homogenous racial makeup of the children the Institute for Developmental Studies (IDS) served would have altered their curricular recommendations. Still, the liberal activists in the racially conscious Mississippi Head Start programs printed books that featured the lively stories of black children in their own words, explicitly celebrating the children’s cultural heritage. The members of the IDS staff, in contrast, were discouraged from employing highly imaginative stories that might overwhelm their sensorily deprived charges.5 Ignoring race thus enabled experts to discount their racial assumptions and to disregard the structural biases of the system within which they worked.
Deprivation theory allowed experts to ignore the racial overtones of their perceptions of normative behavior, maintaining a seemingly coherent theory despite obvious contradictions. Black single mothers could simultaneously be regarded as so involved in their children’s lives that they were termed “matriarchs” yet at the same time be seen as causing maternal deprivation; the spoken language of African American children was compared to that of deaf children. Revealing what today seem to be unquestionably racist views, experts repeatedly argued that in many low-income African American homes, communication was “nonverbal,” devoid of meaning, and often discouraged. Discounting the actual experiences of African American families, experts advanced a limited view of a healthy home environment, designing interventions to provide low-income African American children with an experience as similar as possible to that of an idealized middle-class white upbringing.
The attempts by child development experts to solve America’s problems through enrichment programs for toddlers reflects what historian of education David Labaree has criticized as the trend toward “educationalizing” social problems. Using minimally effective pedagogical tools to address such pressing social problems such as racial and social inequality, Labaree argues, is a political strategy that allows those in power to avoid structural reform. Educationalizing social problems serves as a proxy for the changes American society is unwilling to make; educational opportunity becomes a poor substitute for authentic social opportunity. By projecting liberal democratic goals onto the educational system, politicians can rest assured that these goals will be implemented only within a limited scope and will not threaten the integrity of the existing social structure.6
Mental health and child development experts’ views on early childhood intervention also reflect what has been termed the “medicalization” of education. Historians have documented the extent to which the cultivation of a healthy personality became the focus of Progressive Era education.7 These studies have shown how the classroom came to lie within the purview of mental hygienists and later child development experts. In the process, educators embraced psychotherapeutic values and oversaw the administration of health interventions such as vaccinations and medical screening tests. What’s Wrong with the Poor? points to a different form of medicalization: Educational programs came to represent a form of medical therapy in and of themselves. Educational enrichment programs, later subsumed under the umbrella of Project Head Start, were seen by mental health experts, politicians, and the American public as both a public health measure and a solution to America’s pressing problems of racial and social inequality. Designed to overcome “environmental deficiencies,” early intervention was conceptualized in medical terms that dictated day-to-day activities from playing in a sandbox to the color of each toy. Similarly, the diagnosis of poor African American children as intellectually disabled entailed placing them in “special education” classes as well as the therapeutic provision of stimulation seen to be lacking in their homes. Using this ostensibly color-blind medicalized diagnosis as a form of educational intervention enabled experts and politicians to turn educational opportunities into a sadly ineffective proxy for racial justice.
How can mental health professionals help the poor without pathologizing them? Doing so has an inherent risk of “poverty knowledge,” which, as Alice O’Connor has shown, shifted the focus from economic and structural causes of poverty to the individual qualities of poor men, women, and children.8 Social intervention, from early education to the very structure of the welfare system, has been conceptualized as a form of medical intervention, designed to fix what is wrong with low-income Americans. Since the 1960s, welfare discourse has conceptualized poverty as an illness, medicalizing social barriers to achieving ideals of individual responsibility and diligence.9 Rather than treating the social causes of poverty and injustice, the emphasis too easily shifts to the identification and treatment of psychiatric disorders seen to afflict the poor. Present-day concerns over an apparent epidemic of depression among America’s poor raises similar concerns; an approach that emphasizes individual shortcomings and their medical treatment has the potential to forestall discussions of fundamental economic change. Recommendations for social action are often couched in medical terms and presented as public health interventions.10 Mental health experts are not trained to engage in a discussion of wider social ills; their goals should necessarily be the benefit of their individual patients. Still, they should avoid labels that medicalize poverty or locate its cause in individual defects. I do not advocate withholding treatment from low-income individuals who suffer from depression. Nevertheless, conceptualizing depression and its attendant symptoms of apathy and lack of motivation as the cause of poverty is simply a continuation of the deprivation discourse by other means. Mental health interventions serving low-income and minority populations would be well advised to focus on empowering rather than fixing individuals, drawing on their strengths, abilities, and coping mechanisms rather than correcting their deficiencies.
Clearly, this process is easier said than done, and this book is a historical analysis rather than a blueprint for change. Nevertheless, examining how mental health professionals unwittingly developed racially and socioeconomically stratified interpretations of deprivation presents a cautionary tale about the risks of using seemingly neutral theories of child development and mental health in attempts to address social problems. This approach reveals some of the hazards involved in uncritical exchanges between psychiatry and public policy. As mental health research informed public policy and public policy in turn dictated federal funding to support similar research, researchers and politicians colluded to perpetuate a certain kind of research that provided the scientific scaffolding for their policymaking. Government funding for research on “cultural deprivation” and “mild mental retardation,” concepts whose utility withered within a decade and a half, could perhaps have been put to a different use.
Thus, while the poor clearly do have less, this book is a study of how mental health experts and politicians developed and propounded a theory of what they believed the poor lacked and how these deficiencies could be rectified. Only by recognizing the structural ways in which mental health discourse perpetuates and reifies negative images of low-income and minority Americans will mental health professionals be able to join forces with policymakers to make sure that the poor get what they need, not just what others think they should have.