Racialized Disorders

How psychiatry excuses oppression via unequal diagnosis (a book report on The Protest Psychosis).

In the 1850’s, as enslaved people escaped their oppressors in the search of a better life, American surgeon Samuel Cartwright theorized in a medical journal that the slaves had mental disorders—either drapetomania, a belief that they were mentally equal to white people, or dysaesthesia aethiopis, a “rascality” that caused slaves to “disrespect” their master’s property. 

Though a particularly extreme example, the existence of these disorders in American medicine points to an under-discussed aspect of psychiatry and psychology—the ways in which the disciplines are used as tools to excuse oppression, lessen dissent and frame anyone who does not want to accept current power structures as mentally ill and in need of care or control. 

Jonathan Metzl’s The Protest Psychosis: How Schizophrenia Became a Black Disease is a comprehensive look at the ways in which psychological tools have been used unequally in American history. Though the book focuses on schizophrenia, its lessons are far-reaching and call into question whether any disorder or diagnosis can be separated from its racial, gendered, and political contexts. 

This isn't just a problem of old, racist psychiatrists—the disparities exist today too. An analysis of 134,523 psychiatric case files in 2005 found that African American patients were diagnosed with schizophrenia at four times the rate of white patients. This disparity has existed for decades, but it has actually grown in recent years. And it means that Black patients are often not treated for other things—depression, anxiety, bipolar disorder.