Psychiatry, Social Unrest and Misdiagnosis

Black men have long been overdiagnosed with schizophrenia, according to a new book by University of Michigan psychiatry and women's studies professor Jonathan Metzl.  The Protest Psychosis: How Schizophrenia Became a Black Disease suggests that black men are diagnosed with schizophrenia at a rate at least five times higher than any other group, a practice that likely began when "experts" made a connection between blackness, civil rights activism, and mental illness.  Metzl's finding is consistent with earlier findings of psychiatric overdiagnoses of people of color and women.

Melissa Harris-Lacewell summarizes the book's claims:

The text's central argument is that mental illness is not solely (or even primarily) a biological or medical reality; it is largely a social construct. Madness is often diagnosed in those who do not conform to social norms, especially norms governed by identities like race, gender, and class. Illustrating this point, Metzl reminds readers that in the 1850s, American psychiatrists believed enslaved blacks who ran away from white enslavers were suffering from a mental illness called drapetomania. This illness, psychiatrists maintained, could be cured by excessive whipping.

Metzl's book examines the shift in the description of schizophrenia as a nonviolent disease afflicting socially unconventional middle-class white women to, in Harris-Lacewell's words, "a disease marked by violence, hostility, aggression, and requiring powerful psychotropic medication."  The shift in the definition of schizophrenia was accompanied by a change in who was diagnosed with the illness, with African American men's behavior and thought increasingly diagnosed as pathological.

Psychiatry as a field clearly has suffered by some practitioners' lack of awareness of practices in cultures other than their own.  A 2005 article in The Washington Post offers but one example of how a common experience in one culture can be pathologized:

Tina Tong Yee, a psychologist in charge of ensuring San Francisco's mental health services are culturally competent, said Western medicine's secular notions of normality are sometimes an uneasy fit in a deeply religious and increasingly diverse America.

"Seeing ghosts in my family was part of growing up," she said. "If I brought it up in therapy, you don't want someone to make that delusional."

Some researchers suggest that it's not just people of color being overdiagnosed with mental illness.  Robert Whitaker, author of Mad in America, shares these startling statistics:

Now, by 1903, we see that roughly 1 out of every 500 people in the United States is hospitalized for mental illness. By 1955, at the start of the modern era of psychiatric drugs, roughly one out of every 300 people was disabled by mental illness. Now, let's go to 1987, the end of the first generation of antipsychotic drugs; and from 1987 forward we get the modern psychiatric drugs. From 1955 to 1987, during this first era of psychiatric drugs -- the antipsychotic drugs Thorazine and Haldol and the tricyclic antidepressants (such as Elavil and Anafranil) -- we saw the number of disabled mentally ill increase four-fold, to the point where roughly one out of every 75 persons are deemed disabled mentally ill.

Now, there was a shift in how we cared for the disabled mentally ill between 1955 and 1987. In 1955, we were hospitalizing them. Then, by 1987, we had gone through social change, and we were now placing people in shelters, nursing homes, and some sort of community care, and gave them either SSI or SSDI payments for mental disability. In 1987, we started getting these supposedly better, second-generation psychiatric drugs like Prozac and the other selective serotonin re-uptake inhibitor (SSRI) antidepressants. Shortly after that, we get the new, atypical antipsychotic drugs like Zyprexa (olanzapine), Clozaril and Risperdal.

What's happened since 1987? Well, the disability rate has continued to increase until it's now one in every 50 Americans. Think about that: One in every 50 Americans disabled by mental illness today.

I myself have benefited from antidepressants and psychotherapy—as have countless of my fellow academics—but I've often wondered how much of the collective depression in the academy and beyond is chemical imbalance (are those of us with low serotonin levels drawn to the ivory tower?) and how much of it is environmental.  I'm far from the first to suggest that as a society we're drugging ourselves into acceptance of social ills as a way to avoid addressing them, and that it's become all too common to medicate instead of agitate.  Metzl's research highlights moments at the intersection of psychiatry and social unrest that should inspire us to reconsider our current dependence on prescription medication.

Further reading:

If you're interested in the intersection of psychology with cultural beliefs about race and gender, you'll want to check out KellyBelle's blog Ephphatha, which aims to "raise awareness about the importance of good mental health in the African American community."

For an interesting article about about some disturbing patterns in how psychotropic drugs are prescribed in the U.S.—including to young people—see nutritional biochemist Genita Petralli's piece "Green Mental Health Care—Reclaiming Lives from Psychiatric Drugs."  See also Pamela Appea's article on "Black Boys and Ritalin."

If you're interested in cases in which African Americans may actually be underdiagnosed, see the Bipolar Disorder and African Americans factsheet and this article covering a talk by Thomas Kirk, Commissioner of the Connecticut Department of Mental Health and Addiction Services, at the University of Connecticut.

What are your thoughts?

Leslie Madsen-Brooks develops learning experiences for K-12, university, and museum clients. She blogs at The Clutter Museum, Museum Blogging, and The Multicultural Toybox and is the founder of Eager Mondays, a consultancy providing unconventional professional development.

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