Common Terms And Phrases
Learn More About Racial Disparities In Schizophrenia
Top researchers and experts shed light on the reasons for higher rates of diagnosis in the Black community and offer solutions.
Simon Desjardins, MD, MBA, founder of Boston-based Forsythia Behavior Health Services says the term schizophrenia has nothing to do with the actual disease. Its not a split mind disease at all and, in fact, psychosis for which it is known isnt even the most prominent part of the disease its the negative symptoms, specifically, the cognitive problems that are so devastating, Dr. Desjardins explains.
To put it plainly, schizophrenia is a severe chronic mental illness and brain disorder that interferes with the ability to think clearly, relate to others, and manage emotions effectively. Experts say one of the hallmarks of schizophrenia is psychosis or a psychotic episode. Some refer to this as a psychotic break, but that suggests that symptoms come on suddenly, when they often arise gradually.
In men, psychotic symptoms often begin in the teens or 20s. In women, psychotic symptoms often begin in the 20s and 30s. A person is not considered to have schizophrenia unless symptoms last for at least six months. The National Alliance of Mental Health reports that its not common for schizophrenia to be diagnosed in a person younger than 12 or older than 40. It should be noted that psychotic events can be reduced and controlled with antipsychotic medication.
In The Late 1960s Schizophrenia’s Profile As A Disease Changed Dramatically
First, some preliminaries about your fascinating book, The Protest Psychosis: How Schizophrenia Became a Black Disease . How did you come to unearth such a trove of important documents at Ionia State Hospital in northeastern Michigan?
Ionia State Hospital for the Criminally Insane was, for much of the 20th century, one of the nation’s more notorious mental asylums, occupying an incredible 529 acres, and its annual census hovered above 2,000 patients. But, like many American asylums, Ionia suffered a rapid fall from grace in the late 1960s and early 70s, during the so-called era of deinstitutionalization. By 1974, the census was a paltry 300, and in 1975 the facility closed, then quickly reopenedas a prison.
That rapid transformation fascinated me. What had happened to the patients? What had changed? Why did the hospital become a prison? I spent a long time searching for the records, and ultimately discovered that much of the hospital’s institutional memorynearly a century of patient charts, reports, photographs, ledgers, and other artifactshad been placed randomly in storage in the State Archive of Michigan, in Lansing. I spent another year gaining clearance from various review boards since of course the archive contains highly personal and confidential information, then spent the next four years reviewing the charts of over 800 patients.
When did you first suspect that diagnostic patterns with schizophrenia had become heavily racialized?
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Syllabus: A History Of Anti
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The ongoing Coronavirus pandemic is revealing longstanding American health and healthcare disparities yet to be addressed. While some have described COVID as a great equalizer, policing, public health, medical care, and public funds are revealing otherwise. COVID-19s impact on Black people in general and poor and working-class Black people in particular, has elucidated this countrys long disparate treatment of Black people and centuries-long neglect of Black health concerns. We hope this syllabus offers insight into those historical legacies, while simultaneously paving way for equitable health for all underrepresented populations.
Although the focus of this syllabus is the history of anti-Blackness in American medicine, we are aware that many of the texts are not from historians of medicine. Those scholars insights, however, are invaluable to our dissertation research and theoretical approaches. The selection of texts here also reveals the gaps that remain between the histories of medicine and science and Black studies. Though this syllabus is certainly not exhaustive, it lays important groundwork for bridging this gap and illustrating that questions of race and racism should be central to studying the histories of medicine and science. We hope that this syllabus serves not as an endpointbut as a beginning.
Week 1. Medical and Scientific Theories of Racial Difference
Early Life And Education
Metzl was born and raised in , to a Jewish family. His father was a pediatrician and his mother was a psychoanalyst. He has three brothers, two of whom are doctors. He received two , one in and one in , from the , where he went on to earn his . He then completed his residency in at , where he also earned a in . In 2001, while working as a psychiatrist, he earned a in from the .
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Renaming Schizophrenia: A Possible Solution
To remedy societys understanding of schizophrenia and eliminate some of the stigma surrounding it, theres a movement underway to have the disorder renamed. Many researchers and advocates believe the word is a misnomer that misrepresents the condition. On top of that, some say the negative connotation interferes with the ability of people diagnosed with the condition to assimilate and be accepted in society.
Some countries have already dropped the word.
In Japan, a name change was approved in 2002 from a term meaning mind-split disease to one that means integration disorder. In 2012, the Korea Psychiatric Association followed suit and began using a term meaning attunement disorder. Taiwan then renamed the disorder dysfunction of thought and perception. In other countries, including the United States, a name change is still under debate.
But whats in a name?
The language of psychiatry not only helps mental health professionals and patients communicate between and among themselves, it helps shape the attitude of society toward those with mental health conditions. As research delves deeper and provides a greater understanding of schizophrenia, commonly used and accepted terminology can become outdated.
The Protest Psychosis: How Schizophrenia Became A Black Disease
The Protest Psychosis: How Schizophrenia Became a Black Disease is 2010 book written by psychiatrist Jonathan Metzl , and published by Beacon Press, covering the history of the 1960s Ionia State Hospitallocated in Ionia, Michigan and now converted to a prison. The facility is claimed to have been one of America’s largest and most notorious state psychiatric hospitals in the era before deinstitutionalization. The book focuses on exposing the trend of this hospital to diagnose African Americans with schizophrenia because of their civil rights ideas. The book suggests that in part the sudden influx of such diagnoses could be traced to a change in wording in the DSM-II, which compared to the previous edition added “hostility” and “aggression” as signs of the disorder. Metzl writes that this change resulted in structural racism.
The book was well reviewed in JAMA, where it was described as “a fascinating, penetrating book by one of medicine’s most exceptional young scholars.” The book was also reviewed in the American Journal of Psychiatry, and in the journals Social History of Medicine and Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine.
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Psychiatry In Troublecan It Be Fixed
In the worst cases, psychiatric authors conflated the schizophrenic symptoms of African American patients with the perceived schizophrenia of civil rights protests, particularly those organized by Black Power, the Black Panthers, the Nation of Islam, or other activist groups. Ultimately, new psychiatric definitions of schizophrenic illness in the 60s impacted persons of many different racial and ethnic backgrounds. Some patients became schizophrenic because of changes in diagnostic criteria rather than in their clinical symptoms. Others saw their diagnoses changed to depression, anxiety, or other conditions because they did not manifest hostility or aggression.
How did the psychiatric profession characterize schizophrenia before the first and second editions of the DSM?
Insanity has a long and fascinating history. Before the advent of what we call “modern psychiatry,” conventional wisdom had it that specific actions and life events caused specific types of insanity. Paupers Lunacy was thought to result from habitual intemperance, poverty, and destitution, treated by a diet of wholesome digestible bread and milk porridge, along with occasional topical bleedings. Masturbatory Insanity came from onanistic self-corruption and led to a form of idiocy manifest by sallow skin, lusterless eyes, flabby muscles, loose stools, and, of course, cold and clammy hands. And Old Maid’s Insanity was, as the name implied, the insanity of old maids.
What People Are Saying
In The Protest Psychosis: How Schizophrenia Became A Black Disease, Jonathan M. Metzl writes, Psychiatric definitions of insanity continue to police racial hierarchies, tensions, and unspoken codes …Read full review
interesting, rather than a must have, heard reviewed on an ABC health showRead full review
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The Politicising Of Schizophrenia To Become A Black Mans Disease
Before the 1960s most doctors in America viewed schizophrenia as an illness that affected nonviolent, white, petty criminals, including women. During the 60s this view changed radically to become one that affected hostile, aggressive and mostly black men.
The book The Protest Psychosis: How Schizophrenia Became a Black Disease, by Jonathan M. Metzl explains how this happened.
Metzl Jm The Protest Psychosis: How Schizophrenia Became A Black Disease Boston Ma: Beacon Press Reviewed By Nadia Monique Richardson The University Of Alabama
At the peak of the civil rights movement, notable activists such as Stokely Carmichael, Malcolm X, and Martin Luther King, Jr. garnered national and international attention as they vehemently opposed segregation and protested for the equal rights of Black Americans. The nation was on fire, literally and figuratively, as resistance turned into riots and impatience with the progress of racial equality gave way to a by any means necessary mantra. According to professor, psychiatrist, and cultural commentator, Jonathan M. Metzl, it was also during this time that medical psychiatry came to view schizophrenia as a disease rampant amongst Black men.
The Protest Psychosis skillfully crafts a clear connection between the discriminatory perceptions of schizophrenia as a disease prone to Black men and the continued pathologization of Black men and women within a healthcare system that relies on language that has been shown to oppress. In the midst of the social angst of the civil rights movement, the second edition of the Diagnostic and Statistical Manual was released. Metzl asserts that the language of the DSM-II, released in 1968, was not racist but operated as such because it unintentionally reflected the social tensions of the 1960s and equated protest with mental illness .
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The Case Against A Name Change
Still, some experts say that schizophrenia by any other name is still schizophrenia. They feel that renaming the illness is simply a matter of semantics, and nothing more than a distraction from other changes that are needed when it comes to diagnosing and treating the disorder.
Its a big, expensive, and time-consuming job to make changes to the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders , a guide used by medical professionals to recognize and diagnose mental illnesses to provide appropriate treatment. Years of evidence-based study debate among researchers, advocates, consumer groups, and others who voice the pros and cons of change and economic considerations go into updating the manual and related literature. In fact, the most recent edition of the DSM, cost about $25 million to produce. Some believe the time, money, and effort spent on renaming schizophrenia would be better spent on improving diagnoses, treatment plans, and support services.
While there are some clear benefits to a name change, the effectiveness of such a change must also be proven. The results of studies designed to determine the effects of name changes for schizophrenia in countries where it has already occurred have mostly been inconclusive.
Language is incredibly important, Dr. Desjardins believes. And the term schizophrenia carries with it a lot of unnecessary negativity and baggage.
The Past And Racial Disparities In Mental Health
According to the American Psychiatric Association, differences in rates of diagnosis can be explained by a confluence of factors in the Black community including lack of access to high-quality mental health care services, cultural stigma surrounding mental health care, discrimination, and an overall lack of awareness about mental health.5Mental Health America, a national non-profit organization dedicated to mental health, says these factors translate into Black and African American people being more likely to experience chronic and persistent , rather than episodic , mental health conditions.
Of course, disparities exist across an eagles wingspan of mental illness. But the relationship between schizophrenia and Black Americans has a particularly nefarious past.
In The Protest Psychosis: How Schizophrenia Became A Black Disease, psychiatrist Jonathan Metzl wrote of the unseemly link between the mental condition and racism. Schizophrenia, he claims, was once seen as a rather benign mental disorder impacting middle-class White women. Much later, in the 1960s and 1970s, schizophrenia developed a reputation as a violent disease, falsely linked with male Black activists during the Civil Rights movement. In 1968, the Diagnostic and Statistical Manual of Mental Disorders listed dangerousness as a symptom of schizophrenia perhaps a way to justify the psychiatric treatment of Black people protesting again injustice.6,7
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What We Get Wrong About Schizophrenia
Technically, the word schizophrenia translates into split mind. First coined in 1911 by Swiss psychiatrist Eugen Bleuler, schizophrenia was used to describe a disorder of thought and feeling, a split in the mental process between the intellect and the external realityemotion and cognition.8
The result of this split, he thought, was a fragmented mental process that led to symptoms first described as social withdrawal, apathy, an inability to carry out the activities of daily living, and psychotic events such as hallucinations. Despite Bleulers observations though, schizophrenia was believed to be a psychotic reaction to neglectful parenting, especially from cold, uncaring, perfectionist, and domineering mothers, rather than a disease rooted in brain pathology.
Reflecting The Disorder As A Spectrum
Mental health professionals agree that there is no one set of absolute symptoms that show up in an individual with schizophrenia. Rather, the condition is a syndrome, a collection of symptoms that surface in different combinations in different patients for a variety of reasons. And there can be just as many different outcomes and responses to treatment among those with schizophrenia as there are different combinations of symptoms.
The use of one defining termschizophreniadoes not reflect the spectrum of varying types and degrees of symptoms. Thats why some believe that the word spectrum or syndrome should be included in a new name, such as Psychosis Susceptibility Syndrome or Psychosis Spectrum Disorder.
Coming up with a name that more aptly describes the pathology of this illness is a great idea, Dr. Desjardins says. Many people who work in the field dont really understand it, let alone the public, so any changes that can shed light on what this collection of symptoms really is and how it affects people would be worthwhile.
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