Jonathan Metzl

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Schizophrenia is a real, frightening, debilitating disease. But what are we to make of the fact that several studies show that African Americans are two to three times more likely than white Americans to be diagnosed with this malady, and that black immigrants from Africa and the Caribbean are six to nine times more likely to be judged schizophrenic than other residents of the United States.  Is there a racist–or, at the very least, racialized–element in diagnoses of schizophrenia? According to psychiatrist and cultural critic Jonathan Metzl, the answer is “yes.”

In The Protest Psychosis: How Schizophrenia became a Black Disease (Beacon Press, 2010), Metzl argues that psychiatrists at the height of the Civil Rights movement used the example of supposedly ‘volatile,’ ‘belligerent’ and ‘unstable’ African American men to define schizophrenia. Drawing on a variety of sources—patient records, psychiatric studies, racialized drug advertisements, and metaphors for schizophrenia—Metzl shows how schizophrenia and blackness evolved in ways that directly reflected the white status quo’s anxiety and uneasiness with growing racial tensions and upheaval.  Schizophrenia, Metzl explains, went from being a mostly white, middle-class mental illness in the 1950s to one identified with blackness, madness, and civil strife in the decades that followed.

Jonathan Metzl is a contributor to Public Books.

As you listen to the interview take a look at some the pharmaceutical advertisements that Metzl cites in his research, and how schizophrenia went from being code for white and docile, to later black and threatening…

 

{ 4 comments… read them below or add one }

David May 21, 2011 at 3:03 pm

This was a fascinating book. However, while Metzl sheds light on some of the ways that racial stereotypes and fears may have become embedded in psychiatric diagnoses, institutions, and interactions, it seems this focus closes the door on certain other questions . Specifically, I don’t think he addresses the possibility that a greater percentage of black Americans actually may have begun experiencing psychotic symptoms around the time of the civil rights movement. This idea is counter-intuitive if one accepts the prevailing view that the essential causes of schizophrenia are biological. But as Metzl notes in the opening of the book, after all of the research and advances in neuroscience, there is still no test that can be used to identify schizophrenia in the brain, and despite the often repeated claim that “as a biological disorder, schizophrenia is an illness that should occur in 1 percent of any given population,” Metzl writes that “in the real world, 1 percent is a delusion.”

Sociologist Liah Greenfeld has hypothesized that debilitating mental illnesses which are often diagnosed as schizophrenia, bipolar, and major depression, are actually not as old as humanity, (as is often supposed), but modern phenomena, caused by anomic cultural conditions which make the process of identity formation problematic. (Without getting into the details of her historical research and her theory of culture and the mind here), I only want to note that for black Americans in the 1960’s, the dissonance between legislation moving the nation closer to its professed ideals and the still persisting discrimination, the often contradictory solutions offered by black leaders ranging from MLK to Malcolm X, as well as the varying media and institutional responses from those who were not black, must have made it an incredibly difficult time to try to determine one’s place in the world. Understandably, Metzl takes issue with the racist advertising and articles that appeared in psychiatric journals in the 60’s and 70’s, but in dismissing hypotheses which saw a relationship between black protests and psychosis as merely racist, I think he may be throwing the baby out with the bathwater. I’m not suggesting that protests themselves might have been an immediate cause of psychosis, or that black men must have been insane to participate in these protests to begin with, or that the perception that American society was oppressive and dominated by whites was evidence of delusional thinking. But the possibility that changing cultural conditions could have played a causal role in an increase in actual psychotic symptoms among black people deserves to be taken seriously. I was particularly struck by the fact that some black leaders found the psychiatric language useful for describing the difficulties they faced. While the schizophrenia they talked about was metaphorical, the conditions they were pointing to were quite real, and perhaps capable of producing literal schizophrenia.

We know from many individual cases that political and religious elements often figure prominently in delusions. When mental illness is viewed from the biological position, the details of one’s delusions might be seen as unimportant; more or less random outputs. But if culture is considered as a potential causal force, the language and thought processes of the sufferer take on real significance. It would almost be strange if there weren’t references to racially charged political events mixed into the delusions of some of those black men who were in fact suffering from psychotic symptoms at this time. In keeping with Metzl’s analysis, it is then very possible that the appearance (and possible increase) of genuine cases of psychosis among men involved in black political movements may have aided in the racist, paranoid reframing of the diagnosis that Metzl identifies. In other words, the response of the psychiatric establishment may not have been proportional to the facts, but that doesn’t mean there wasn’t some reality to the claims, distorted as they may have been. The point for me is to recognize the multiple directions in which the cultural conditions of the day may have been working – both as a cause of actual illness and as a rationale for a change in diagnosis – reinforcing one another in a kind of confounding loop.
Metzl might feel that because of the racist institutional and diagnostic framework, data which might otherwise be relevant in determining any causal role that culture may have played in genuine cases of schizophrenia is hopelessly obscured. Perhaps this is so for the charts and documents from Ionia, but hopefully we can start thinking more about this question today.

Maya May 11, 2011 at 11:05 am

The interview was fascinating and extremely well done. The book sounds like a great read. I just wish the audio quality was a little better.

Arturo May 10, 2011 at 12:02 pm

CM
I think you’re right that there’s definitely a class story underpinning much of what Metzl describes. Both the issues of stress, but more substantively access to appropriate treatment are moderated by one’s class standing, which in turn likely explains some of the disproportionality in symptom severity we see across groups. I know that some epidemiological studies have recently found that SES does explains at least half of the racial disparities with schizophrenia (if you can really unpack race and class so easily), but even controlling for both SES and severity of symptoms some researchers claim there are still a noticeable race effects in the odds of being diagnosed schizophrenic. I think there’s something symbolic to the condition, both as cause and effect, that Metzl gets at his book. It’s more complicated than an explicit racism, but I think his book convinced me that even for organic conditions race can play an implicit role in the “social-ness” of how individuals come to see themselves as having a split mind, and how practitioners react to them.

CM May 10, 2011 at 11:06 am

The book sounds intriguing. A couple of thoughts popped into my head in reading the abstract.
1) The lower social classes have always had an excessive loading of extreme diagnoses. This is because they do not get the best clinical evaluations from experienced psychiatrists and clinical psychologists, but often from residents in psychiatry or grad. students in clinics.

2) I think you would need to take the lower social classes from diverse ethnic backgrounds and compare them.

My guess would be that the social class would be the determining factor rather than race per se, but I stand ready to go by whatever empirical studies come up with

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