Racial Bias in the Diagnosis and Treatment of Psychosis

"In 2009, Dr. Jonathan Metzl, an American psychiatrist, published a powerful deep dive into psychosis in the United States in the mid-twentieth century. This book, titled The Protest Psychosis: How Schizophrenia Became a Black Disease, revealed uncomfortable truths about how the civil rights movement and other social changes in the United States resulted in schizophrenia shifting from a diagnosis given to white women with "neurosis" to a disease characterizing "dangerous" and "violent" Black men protesting the mistreatment of minorities."

"He focused his account on the evolution of diagnostics in a particular hospital in Michigan, but the themes he presented applied far and wide in not only the healthcare system, but also the media and public eye. Since the publication of this book, research has continued to bolster evidence of historical and present-day bias for overdiagnosis of psychosis in Black individuals, societal and internalized stigma regarding psychosis, and significant differences in access to and use of mental health treatment."

Schizophrenia and other psychoses became overdiagnosed in Black communities beginning in the mid-twentieth century, shifting diagnostic labels toward Black men and away from white women. Racialized portrayals framed Black people as "dangerous" or "mad," fostering stigma and misinterpretation of symptoms as aggression rather than fear or sadness. Research has continued to document both historical and current diagnostic bias, internalized and societal stigma, and unequal access to mental health treatment. Mischaracterization of Black clients as aggressive complicates care pathways. Psychologists can engage in self-reflection and bias reduction to improve diagnostic accuracy and equity in care.

Read at Psychology Today