Customer Reviews

The Protest Psychosis: How Schizophrenia Became a Black Disease

5 star:		(1)
4 star:		(1)
3 star:		(0)
2 star:		(0)
1 star:		(0)

 

 

As you probably know, African American men are disproportionately diagnosed with schizophrenia. But what you may not know is when this pattern emerged, or why. The Protest Psychosis tells that story.

Up until the 1950s, the overwhelming majority of those diagnosed with schizophrenia were white. They were the delicate or eccentric -- poets, academics, middle-class women like Alice Wilson in The Protest Psychosis, "driven to insanity by the dual pressures of housework and motherhood."

Then, in the mid-1960s, the Long Hot Summers hit urban America. Smoldering anger over racism and poverty erupted into rioting, fires, and harsh repression. In Detroit, a police raid on a party triggered an uprising that left 43 dead, 1,189 injured, and more than 7,000 arrested. Convinced that they would never win civil rights through sit-down strikes, a nascent Black Power movement became increasingly militant.

Coincidentally, just as this urban unrest was reaching its zenith, the American Psychiatric Association was busy revising its Diagnostic and Statistical Manual of Mental Disorders (DSM). Published in 1968, the DSM-II was touted as a more objective and scientific document than its 1952 predecessor.

"However, the DSM-II was far from the objective, universal text that its authors envisioned," writes Metzl. "In unintentional and unexpected ways, the manual's diagnostic criteria -- and the criteria for schizophrenia most centrally -- reflected the social tensions of 1960s America. A diagnostic text meant to shift focus away from the specifics of culture instead became inexorably intertwined with the cultural politics, and above all the race politics, of a particular nation and a particular moment in time."

The psychoanalytically imbued "schizophrenic reaction" of the DSM-I was an illness meriting pity and compassion rather than fear. In contrast, the DSM-II's more biologically oriented schizophrenia was menacing and required containment. In particular, the language that described the paranoid subtype foregrounded "masculinized hostility, violence, and aggression," implicitly pathologizing protest as mental illness.

Almost overnight, the previous class of schizophrenics at Ionia State Hospital was relabeled with depressive disorders. As the formerly schizophrenic exited the hospital en masse in the wake of the Community Mental Health Centers Act of 1963, their places were taken by a new class of schizophrenics - volatile young Black men from inner-city Detroit.

A mountain of archived charts from the defunct asylum at Ionia provided the raw material for The Protest Psychosis. In his four years of sifting through the treasure trove of data, Metzl found clear evidence of shifting racial and gender patterns in diagnosis. Because the DSM-II was published in the days before computers, clerk typists simply used hatch marks (/) to mark out the old diagnoses, leaving them clearly legible alongside the new.

Randomly selecting a subset of charts of white women patients, Metzl found schizophrenic diagnoses crossed out, and replaced with labels such as Depressive Neurosis or Involitional Melancholia.

In contrast, the charts of African American men saw Psychopathic Personality crossed out to make way for the DSM-II's schizophrenia, paranoid type.

Neither set of patients had undergone a sudden metamorphosis. Their observable symptoms and behaviors, as documented by their chart notes, remained the same. The only thing that changed was the diagnostic manual.

Occasionally, a deep thinker like Metzl comes along to dig through historical records and shine a spotlight on historical biases. Metzl's message is especially relevant today. As Ethan Watters explores in Crazy Like Us: The Globalization of the American Psyche, American psychiatry is sweeping the globe like a virus, importing PTSD to Sri Lanka and Western-style depression to Japan. As Christopher Lane describes in Shyness: How Normal Behavior Became a Sickness, diagnostic expansion is especially easy with psychiatric illnesses, because of their nebulous nature and subjective boundaries. Metzl, in a clear and lyrical style, proves once again that supposedly objective science is never truly pure.

A lengthier, illustrated version of this review is available at the url 3.ly/Protest, my Psychology Today site, Witness.

I tend to think of people freaking out as a cultural response to the lack of wealth and status that will become more common as Americans run out of money and lose their homes. The Ionia State Hospital for the Criminally Insane is not likely to solve our problems after it has closed and the files were studied for how particular cases were treated during the twentieth century. I lived in Grand Rapids, Michigan, when I was in high school, and had greetings from the draft board in Michigan a few years later, but I have been avoiding the people who exhibit the kind of social activities I consider pathological as much as possible. Trying to say anything about the profound imposters who have set up tremendous repudiations that make a significant number of Americans seek treatment for mental illness is becoming as tricky as the condemnation of witchcraft was for a jurist who studied enough about wichcraft to practice it himself and turned himself in as a witch. American society is not particularly nice. Some fights become official matters which create hostile attitudes that makes any form of authority suspect. Then when DSM-II 295.3 Schizophrenia, Paranoid Type says, "Excessive religiosity is sometimes seen" (p. 96), it might be because so many religions get used to being persecuted. David Koresh was worried that April 19, 1993, was in the cards according to the book of seven seals in Revelation, but he did not want to be evaluated by anyone who was checking how rational he was.

America is Alcohol, Tobacco, and Firearms. I was even in Vietnam when my commanding officer asked, "Why didn't you shoot him?" That attitude was part of the training.