The Intersection Between “Race” and “Mental Illness”

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

7 COMMENTS

  1. Very nicely written, Faith, and agree with you wholeheartedly! Another industry that comes to mind is the Traumatic Brain Injury Industry and oppression by the “powers that be” (the so called experts) that prescribe the same psychiatric drugs! And fortunately many TBI survivors are waking up to the fact that the drugs do not work and actually hinder the healing process. I find it so unbelieveable that medical would prescribe brain damaging drugs to the already brain injured, and thereby reducing their life span 15-20 years. The abuse and neglect in TBI facilities is enormous and this is now coming out in press and being exposed and hopefully addressed. Definitely a Human Rights issue!

    Thank you for your paper!

  2. My toddler used to attend a Montessori school where he was cornered and i was pressured to get him intervention. The teachers and the management’s assessment was that he was not normal kid. They listed a lot of behavioral issues that i had never seen in him before. I did not grow up in this country and i have been second guessing the way i have been raising my child. I was almost convinced that he needed help but it was something from within that did not agree. I changed his school to make sure i get a second opinion. He was moved to a more play based school and did not receive any complaints. He has since moved to higher grades and years have passed and he has not shown any signs that require intervention.

  3. Good for you, aps.0721 and for your son! It is nice to see one child saved from the “experts”!

    Faith, yes, I have joined many advocacy groups in the TBI Industry and they are now speaking out, actually forming their own “entity” of family members and survivors, exploring alternatives that work (as it has proven that drugs do not), and reaching out and supporting each other for better lives.

    The survivors in institutions are the last, though, to be helped as they are at the mercy of the people who care for them and medical, which is a very sad state of affairs, currently (and can be compared to the horrors of psychiatric hospitals). There are some good places, but far and few between!

    From what I am ‘seeing’ right now, people and advocacy groups (such as Psych Rights, MindFreedom,TBI Survivor Network, AbleChild, etc.) have truly brought to “light” the states of our society in order for all of us to move into one that works.

    Amazing how we are witnessing “our evolution” as we speak and write, and looks to be speeding up!

    Yes, we appear to not have come very far (with all that you have mentioned) and yet, we have and will continue in this shift of consciousness. And all of our efforts will not be in vain! We have much to celebrate!

    As they say, we are the ones we have been waiting for and our time has arrived to push the old systems out with a new system for the greatest good of all!

  4. A very thoughtful piece! It reminds me of some of Michel Foucault’s insights about objectifying discourses. From Foucault’s perspective, authoritative fields (and bodies) label people and these labels become objectified. Regarding mental illness, people become their diagnoses and are divided from the well. The penal system divides the “criminal” from those who are law-abiding. The racial/ethnic minority is labeled “other” to those in the mainstream. One could go on. Knowledge and power are merged. But I do ask, is all biomedical psychiatry oppressive? Is there any practical use for it? In some cases it seems that people cannot function without psychotropic medications. If one finds such drugs helpful, how is that oppressive?

  5. The book “The Protest Psychosis: How Schizophrenia Became a Black Disease” (Metzl, 2011) details how demanding your rights can wind up bringing down another wave of oppression on an entire class of people. Kind of like Oppositional Defiant Disorder now with kids. People who can’t get what they need and are oppressed as an entire labeled group of people – well, they get mad, don’t they? Seems an entirely natural phenomenon to me. And the institutional response, entirely predictable.