On Race and Schizophrenia

A new book released by a researcher at the University of Michigan has concluded that black men are five times more likely to be diagnosed with schizophrenia than white patients and that the trend dates back to the 1960s.  In his book, titled The Protest Psychosis: How Schizophrenia Became a Black Disease, Dr. Jonathan Metzl, an associate professor of Psychiatry and Women's Studies  and director of the University of Michigan's Program in Culture, Health and Medicine, provides an overview of his archival research examining decades of psychiatric admissions to the Ionia State Hospital  in Michigan's Ionia County.  Before its closure in 1972, the hospital (one known as the Michigan Asylum for the Criminally Insane) often housed the most severely disturbed psychiatric patients in the state, including offenders who had been found not guilty for reasons of insanity.

In presenting his conclusions , Dr. Metzl noted a dramatic shift over time in how schizophrenia was viewed by treating psychiatrists.  When the schizophrenia diagnosis was first introduced at the dawn of the20th century, psychiatrists often viewed schizophrenics as being primarily docile.  Until the 1940s, diagnosed schizophrenics were often white, middle-class females whose behaviour was deemed inappropriate by civil authorities or their own families.  During the 1960s , with the advent of the the civil rights era in the U.S., a redefinition of schizophrenia occurred leading to an increasing tendency to diagnose violent black men as suffering from the disease. The former perception of schizophrenics as being non-violent changed and schizophrenics were more likely to be seen by psychiatrists and the general population as being violent, unpredictable, and in need of psychotropic medication to control theirbehaviour .  This shift was reflected in the popular media with "mad slasher" films and newspaper accounts of violent psychosis becoming more prevalent.

Metzl also discussed psychiatric literature from 1968 relating to "protest psychosis": a supposed condition in which black men developed "hostility, aggression, and delusional anti-whiteness after listening to Malcolm X, joining the black Muslims, or engaging in Civil Rights protests".  Not surprising, the schizophrenia diagnosis became a handy way of dealing with black activists who were often sent to psychiatric hospitals and subjected to involuntary psychiatric treatment. According to Metzl's statistics, 88 percent of Ionia's post-1960 "US Negro" admissions- 9 6 percent of whom were male-were diagnosed with schizophrenia.  By comparison, only 44.6 percent of "U.S. White" admissions received the schizophrenia diagnosis.  Black schizophrenics were also more likely to be regarded as violent.  The book provides specific case histories which highlight the changes thatMetzl noted.

In his book, Metzl concluded that  "the transition of schizophrenia from a disease of white, feminine docility to one of black, male hostility resulted from a confluence of social and medical forces."  Whatever their actual mental status on admission to psychiatric hospitals, forced psychiatric treatment almost certainly led to their mental deterioration over the course of their hospitalization and after their release.

Whether or not you agree with Jonathan Metzl's conclusions (and I'm not entirely sure that I do), his provocative arguments concerning the role of cultural and political factors in psychiatric diagnosis and treatment are sure to trigger debate. We are still dealing with the consequences of this radical shift in psychiatric admissions even in the era ofdeinstitutionalization , both in terms of homeless mentally ill and treating diagnosed schizophrenics in the prison system.  Perhaps most of all, we are dealing with this legacy of the 1960s in terms of the persistent stigma thatstill surrounds mental illness and how people with psychiatric problems are treated.

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Comments

[DJ]

There is extensive evidence that one cause of sz could be a viral infection in utero at 3rd trimester. It is therefore possible that exposure to increased exposure to viruses (which is often associated with economics) could explain supposed increased incidence in African Americans

[Enisa]

fabulous book. I've been wondering why schizophrenia has such high noncompliance rates (medication nonadherence rates). Medicaid pays for 70 % of antipsychotics prescriptions. schizophrenia is a harmless disease. As blacks who are most likely to be (mis)diagnosed as schizophrenic have low suicide rates. And schizophrenics rarely commit murder.