Oppositional Defiant Disorder is the 21st Century Version of Drapetomania: Diagnostic Condemnation in Child Mental Health

Oppositional Defiant Disorder (ODD) is a common behavioral diagnosis used to label defiance, anger, and resistance, traits disproportionately ascribed to Black, Hispanic, and Indigenous children. This paper argues that the overdiagnosis of ODD in racially minoritized children functions as a modern version of drapetomania, the 19th-century pseudoillness invented to pathologize enslaved Black people fleeing captivity. Both diagnoses criminalize survival responses to racial violence while obscuring the systems that produce harm. Drawing on historical analysis, current data, and clinical insight, I show how psychiatry has long pathologized resistance to white supremacy—from drapetomania to “protest psychosis” to ODD—shaping clinical care, legal outcomes, and educational trajectories. In schools, foster care, and juvenile detention, ODD is frequently deployed to explain behaviors without acknowledging context, detaching children’s anger and defiance from poverty, trauma, and grief. I name this pattern diagnostic condemnation: the use of psychiatric labels to punish those harmed by structural oppression. Diagnostic condemnation reinforces racial hierarchies, legitimizes carceral responses, and silences clinicians who are rarely trained to recognize racism as pathology. This paper calls for a reparative approach to child mental health that moves beyond behavior management and compliance, and toward structural care rooted in historical accountability. It urges providers to ask not “how do we fix this child?” but “what are they resisting—and why?” Unless psychiatry confronts its role in racial control and reimagines its diagnostic frameworks, it will continue to serve systems of punishment rather than care, pathologizing the very children it claims to help.