Before the civil rights movement, schizophrenia was mostly diagnosed in non-violent, white women. However in 1960-1970, psychiatrists began to misdiagnose black men with a history of activism as schizophrenic. Essentially, social activism was translated into a form of mental illness.
Jonathan Metzl, associate professor of psychiatry and women’s studies at the University of Michigan- Ann Arbor, examines this phenomenon in his book, “The Protest Psychosis: How Schizophrenia Became a Black Disease,” released at the beginning of this month. In it, he broaches the controversial relationship between psychiatric diagnosis and racial bias. He focuses primarily on the correlation between black civil rights activists and the diagnosis of schizophrenia in the 1960s. Based on research collected from the archives of the Ionia State Hospital for the Criminally Insane, he details how society’s perception of schizophrenia changed as it was more frequently associated with black men.
Schizophrenia was no longer perceived as a relatively innocuous mental illness. Doctors redefined schizophrenia as a violent, hostile, and aggressive disease. Metzl notes that this was probably a way to label the black population, and an obvious act of racism. Especially in Ionia, a predominantly white town where the majority of perceived schizophrenics were black males, the term “schizophrenia” was no longer a disease but a racialized label.
Over time, the possession of a mental illness became a criminal offense. This may have arisen as a result of the high number of black men who had been diagnosed with a mental disease but there is no concrete evident. As a result of this new development, the majority of the people being moved from psychiatric hospitals to prisons were black males because so many of them had been misdiagnosed with schizophrenia. The Ionia facility, in fact, was converted to a prison in 1977 presumably to make sure that all of those who “deserved” to be incarcerated could be imprisoned as soon as they were diagnosed.
Although the time has long past since mental illness has warranted a prison sentence, Metzl has found that the rate of over-diagnosis of schizophrenia in black males has remained alarmingly high. Because racism has been a factor is diagnosis for so long, it has been difficult to eradicate racial assumptions from healthcare delivery systems despite rigorous cultural competency training.
Metzl’s findings illuminate not only the racial undertones in psychiatric diagnoses, but also the way in which cultural anxieties and social forces defined and continue to define a seemingly impartial industry like medicine.