Read aloud or translate

The protest psychosis: how schizophrenia became a Black disease

Helen Delmar, Speak Out Facilitator and Advocate 22 November 2023

This Safeguarding Adults Week, Helen Delmar discusses how many African Americans were diagnosed with schizophrenia because of their civil rights ideas.

Have you ever heard of a condition called Drapetomania’? I should think not. But in 1851, it was rampant amongst people of colour. It was a condition assigned to anyone absconding from slavery. 

The hypothesis centred around the belief that slavery was such an improvement in the lives of slaves that only those suffering from some form of mental illness would wish to escape it. Of course, now, to you and me, it would seem totally reasonable for a person to resist and evade becoming owned and sold into slavery.

Time and time again, history has proven to us that the medical profession misappropriates diagnoses in a way that undermines people’s reactions to their lived conditions. Thanks to Jonathan Metzl’s research, we better grasp the ways in which this can occur.

The term schizophrenia’ was brought over in the 1920s, originally a European concept that predominantly impacted White housewives. However, during the 1960s, African Americans became at least 4 times more likely than White people to receive a diagnosis of schizophrenia. 

This was due to a new form of schizophrenia being written into all diagnostic manuals. It detailed that anyone presenting feelings and actions that could be construed as inspired by the civil rights and black power movement must be understood as mere symptoms of a psychotic illness. 

This diagnosis could be said to have resulted in damaging and oppressive attitudes that have affected society’s approach to people of colour. Institutions, that could have been addressing very real systemic problems, chose to dismiss people as mentally unwell and demonise them, as well as imprison them (quite literally, as Ionia hospitals later became prisons).

Through Jonathan’s 12 years of research, we see examples of structural racism where police were more likely to use violent means of handling people of colour when they made arrests due to the diagnosis of schizophrenia’. Jonathan Metzl also explains that when looking through police reports he found, despite the popular opinion that schizophrenic people were violent and dangerous, it was those with schizophrenia who were the victims of violence rather than the perpetrators.

From the outset, the intention of the DSM (Diagnostic and Statistical Manual of Mental Disorders) was to create a diagnostic assessment system that attempted to be neutral with respect to the causes of mental disorders.”

In 2019, though reviews were held in the US to identify out-of-date material by addressing any racism and discrimination, it was only the non-stigmatizing language” that was altered and did not include conceptual changes to the criteria set”. With this awareness, we have to ask ourselves, as advocates and anti-racists, has enough been done to explore whether or not the mental disorders outlined within the DMS-5 are truly as neutral” as they claim to be?

Why does this have any bearing on us here in the UK?

Consider that all professionals working within the NHS refer to the ICD (International Classification of Diseases), which is heavily influenced by the DSM-5 criteria.

In the UK, Black people are almost 5 times as likely as White people to be detained under the Mental Health Act – 342 detentions for every 100,000 people, compared with 72 for every 100,000 people.

The rate of people from Black backgrounds being restrained in mental healthcare has now more than doubled, widening the gap with other racial groups, according to NHS data.

Critiques have suggested that the book written by Jonathan Metzl is a warning to people not to assume that the diagnostic system is wholly scientific’ and objective’. This suggests that it should be adapted at the grassroots level, using culturally appropriate (indigenous) ways of understanding the human condition, consistent with the social, cultural, and political contexts in different regions, populations and countries.

When committing to becoming anti-racist, we not only need to change our words but also our analysis of situations which impact our actions. Let us make sure we are applying the social model, where we see the barriers society may be placing on people, rather than using the medical model, which seeks to disable people for their differences. 

Ask yourself: are you too concluding that when someone is being angry’ that it is part of their mental health’ condition? Or are you using your non-judgmental approach and professional curiosity to empathise with them?

It’s vital to understand that people may have felt unsafe in spaces where others are not ready to change their attitudes — and make real, genuine efforts to address the systemic problems which go on to impact their health on a daily basis.