The words “race” and “mental illness” appear in quotations here because I consider these words to be formalized ideas that have been used to impose particular value on various physical and behavioral attributes of a diverse species. These ideas, “race” and “mental illness,” have led to the abuse and exploitation of some populations for the economic and cultural benefit of others.
The history of psychiatry and the history of racism are closely intertwined. In fact, one could say that the practice of biomedical psychiatry and racism rely on the same very basic phenomenon of oppression, which occurs when a formal institution assumes the right to externally impose definitions of value to another human being’s personhood and potential.
No cultural construct exists in isolation from other ideas and there is evidence that “mental illness” applies to some groups differently than it applies to others. For example, there is a statistical suggestion of connection between being African American and rates of schizophrenia. Does this mean that being black may make a person more likely to be “mentally ill?” No. This means that one’s race affects the likelihood that a diagnosis of schizophrenia will be made. In fact, African Americans are two to four times more likely to be diagnosed with schizophrenia than white people in an inpatient setting.
The reasons for this disparity in diagnostic rates are rooted in the complex dynamics of institutional racism and systemic cultural incompetency. Not only is diagnosis affected by race bias, a person’s experience in having a “mental illness” is affected by race, as well. As early as the mid-1990s, it was observed that African Americans are less likely to receive voluntary outpatient services and that African Americans who carry a mental health diagnosis are more likely to be incarcerated.
Many people are familiar with the tragic phenomenon of racial profiling, in which people are seen as inherently criminal (or conversely, inherently innocent) due to their perceived racial attributes. The content of one’s character is assumed on the basis of race. A similar process of external assumption occurs in psychiatric profiling, in which a person is seen (due to communication, appearance, or previous diagnosis) as having a “mental illness” and, from that assumption, is then viewed in ways that are not representative of the person’s actual state of being and which put them at risk for involuntary psychiatric intervention.
In both racism and mental health based stigma and mistreatment, the externally imposed perspective is held as having higher validity than self-definition and the prescribed treatment takes precedence over an individual’s self-determination. As in racism, if the person who is being psychiatrically discriminated against questions, resists, or challenges discrimination and mistreatment, they are likely to be further discriminated against or punished for their lack of compliance.
Many of the expanded outpatient commitment laws that are currently being considered and implemented are designed to allow formal systems to force treatment in ways that strip individuals of their right to refuse treatment. Force and coercion in psychiatry and mental health systems are used to enforce external definitions and relegate one to a diminished human capacity in much the same way that constructs of race were (and are) used to broad-handedly deny people their human rights.
While race-based discrimination differs from psychiatric discrimination in the unique ways that it affects people’s lives and identities, there is a universal element in all experiences of oppression. This element exists at the core of humanity’s conflict between who we are and who we are told that we are, who we are made to be. Systems of exploitation have the capacity to oppress us all in their creation of a world that reduces humanity to the value placed on perceived attributes and which constructs mental health as one’s ability to comply with normative expectations of experience, expression, interest and behavior.
It is vital that we consider how, in the context of our individual and community lives, we are collectively affected by systemic injustice and the ways that awareness of overlapping oppression might inspire us to realize that we are all, in one way or another, being abused by systems of profit and power that have taken our right to define our own best possible meaning and outcomes.
You are invited to share links and insights on the intersection between “race” and “mental illness” in the comments section below. There are many conscientious groups and individuals working to defend the human rights of individuals affected by systemic bias and oppression. Please share your awareness!
Barnes, Arnold. (2004). Race, Schizophrenia, and Admission to State Psychiatric Hospitals. Administration and Policy in Mental Health and Mental Health Services Research. 31:3, pp 241-252. http://link.springer.com/article/10.1023/B%3AAPIH.0000018832.73673.54
Jefferson, Cord. Commentary: An Explanation for Increased Black Schizophrenia: It’s African-American Mental Health Awareness Week and a new study says Black schizophrenia is overhyped. BET, Health. 02/14/2012. http://www.bet.com/news/health/2012/02/14/commentary-an-explanation-for-increased-black-schizophrenia.html
Lane, Christopher. 05/ 05/2010. How Schizophrenia Became a Black Disease: An Interview with Jonathan Metzl. Psychology Today: Side Effects. http://www.psychologytoday.com/blog/side-effects/201005/how-schizophrenia-became-black-disease-interview-jonathan-metzl
Grekin, P., Jemelka, R. & Trupin, E. (1994) Racial Differences in the Criminalization of the Mentally Ill. Bulletin of the American Academy of Psychiatry and the Law. 22:3. http://www.jaapl.org/content/22/3/411.full.pdf
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.