mental illness, racism, rehabilitation

Mental Illness, Medication, and Race

I’ve been reading Jonathan Metzl’s book The Protest Psychosis (Beacon, 2011). Metzl writes that both black and white psychiatrists in the U. S. diagnose schizophrenia in African-American men at rates four to five times more than other groups.

Metzl noticed a shift in the public image of gender and race in the 1950s and 1960s. While in the 1930s and 1940s schizophrenia was often associated with white, middle class housewives “whose schizophrenic mood swings resulted from domestic strife or emotional isolation,” in the 1950s and 1960s ads for the antipsychotic drug Haldol showed “angry black men with clenched, Black Power fists in urban scenes whose symptoms of social belligerence required chemical treatment.”

Metzl’s book shows how drug companies, researchers, individual doctors and the DSM-II from 1968 perpetuated common stereotypes involving gender and race.

“Researchers used DSM-II criteria to uncover hostile aspects of black schizophrenia with civil rights demonstrations. Meanwhile, studies conflated black schizophrenia with Black Power in order to illustrate evolving understandings of the illness as hostile or violent, or used long-standing stereotypes about manic, crazy black men to demonstrate ‘new’ forms of schizophrenic illness.”

“Yet the DSM-II functioned as an implicitly racist text because it mirrored the social context of its origins in ways that enabled users to knowingly or unknowingly pathologize mental illness. This was because the 1960s was an era when the notion that large groups of people acted in hostile ways while rationalizing their aggression as a justifiable response to the attitude of others was a tremendously powerful social message. But that group was not schizophrenia; it was people who were black.”

According to Metzl, in medical charts from 1960 to 1975 black schizophrenic patients were consistently labeled as “hostile,” “aggressive,” threatening,” “dangerous,” “suspicious,” and “belligerent” and were said to have “issues with police [and] authority figures.” (White patients, on the other hand, were more likely to be described as “cooperative,” suicidal,” “depressed” and “withdrawn.”)

This made me wonder about—and hopefully pay more attention to—the ways in which contemporary drug companies, psychological studies and individuals conflate and abuse issues like race and gender when illustrating and analyzing mental illness.

Here some illustrations from The Protest Psychosis: