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Looking Back on Race and Schizophrenia

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In his ground-breaking work on the subject, Dr. E. Fuller Torrey writes of schizophrenia: “the lives of those affected [by schizophrenia] are often chronicles of constricted experiences, muted emotions, missed opportunities, unfulfilled expectations…the fate of these patients has been worsened by our propensity to misunderstand.”

Torrey’s quote paints a rather gloomy state of affairs for those living with the illness. However, one thing is certain: there is a propensity to be misunderstood.

Schizophrenia and race have roots far beyond Jim Crow, but a few examples of racial “psychoses” stem from the period of pre-Civil War American society. “Drapetomania,” a term coined in 1851, by Dr. Samuel Adolphous Cartwright, was said to be a psychosis that explained why enslaved peoples would run away from their captors. Cartwright also brought forth the idea of “dysaesthesia aethiopica,” a psychosis he believed was triggered by the perceived laziness of enslaved peoples. The cure for which, was whipping.

One cannot understand the history of race and schizophrenia without understanding the history of whiteness, Blackness, and the mental health care system. The disease, as we know it today, was first termed “damentia praecox,” as it was thought to be an early stage of dementia. Its name was later changed to schizophrenia, referring to the splitting of the mind (and also contributing to the confusion with dissociative identity disorder). As discussed in his book “The Protest Psychosis: How Schizophrenia Became a Black Disease,” Dr. Jonathan Metzl writes that in the beginning, damentia preacox was mostly a white disease. As it fell out of fashion, the diagnosis became increasingly Black. When schizophrenia was introduced, it became a white woman’s disease, characterized by women who could no longer “keep house” or “child rear.”

So what changed? How did schizophrenia go from being a non-threatening white housewife’s disease to the stigmatized “dangerous, unpredictable” disease it is today? To put it succinctly, the answer is this: racism, and loose associations of racism.

It was somewhere around the 1960s that the coin flipped. Behavioral health facilities, especially those that were pipelines from prisons, saw a shift, or rather a cataclysmic change, in patient demographics. Suddenly, facilities were filled with mostly Black, male patients, when before, the ratio had been 1:1 or less. Much like Cartwright, their predecessor before them, psychiatrists Bromberg and Simon documented what they called “protest psychosis” in a 1968 paper. The paper characterized Black men fighting for their civil rights as having a type of psychosis. The correlation between the sociopolitical environment and the prison-to-hospital pipeline could not, in retrospect, be ignored. Black patients who committed petty crimes were being carted off to high-security mental hospitals and serving sentences far beyond their original date. They were immediately marked as aggressive and non-compliant, and some never made it out.

What are the implications today? Well, for one, social science tells us that Black men are still diagnosed with schizophrenia at a rate that is three to four times higher than white men or women, even though science tells us that schizophrenia equally affects every race. The Department of Justice tells us that our prisons house concerning numbers of those with serious mental illness, while our state hospitals hold less. We know that the roots of racism and mental health care run deep in the United States, and that we must continue to fight for equality because lives and rights and liberty depend on it.

As Metzl writes, “Thus did the men develop schizophrenia not because of symptoms, but because of civil rights.”

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Originally published: April 12, 2023
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