Race And Mental Illness: Do African Americans Suffer More Schizophrenia Or Is It Bias?
By Melissa Healy, Los Angeles Times February 7, 2012
Black Americans are far more likely than their white countrymen to be labeled schizophrenic, one of psychiatry‘s most serious and intractable diagnoses. But a new study suggests that psychiatric bias, compounded by the squishiness of diagnostic standards in psychiatry, may account for some of that difference.
When a patient arrives in a clinic speaking incoherently, beset by delusions or hallucinations, and either severely withdrawn or manic, schizophrenia is a distinct possibility. But sometimes those same symptoms point to extreme cases of depression or bipolar disorder. Before assigning a diagnosis of schizophrenia, a physician is expected to rule out these more treatable conditions.
The new study found that in a group of 610 patients seeking treatment at six regional psychiatric clinics scattered across the nation, African American patients were diagnosed with schizophrenia more than two and a half times as often as were white patients. That was the case even when the diagnosing psychiatrists based their conclusions entirely on reports of a subject’s symptoms and his or her responses to a structured interview, with any hints of the subject’s race stripped away.
Even when African American patients showed significant signs of a mood disorder such as depression or bipolar disorder, it was the severity of their psychotic symptoms that jumped off the page to the color-blinded psychiatrists. For white patients, even psychiatrists blinded to race were more likely to balance signs of psychosis with signs of a mood disorder.
The article appeared Monday online in the Archives of General Psychiatry. The study also looked at Latinos with psychiatric symptoms, but found that they were assessed no differently than whites.
“In African American subjects, psychotic symptoms may be overvalued by clinicians, skewing diagnoses toward schizophrenia-spectrum conditions,” the authors of the new study write. They suggest that “previous discriminatory experiences, and reactions to them, i.e. healthy paranoia,” may lead some African Americans to express their fears and anxieties in ways that are interpreted as more extremely psychotic, or that delays in seeking treatment may make their psychotic symptoms more prominent than evidence of their mood instability.
The results also challenge mental health practitioners “to consistently challenge their own diagnostic assessments” when treating individuals from racial groups other than their own.
Commentary: An Explanation for Increased Black Schizophrenia
It’s African-American Mental Health Awareness Week and a new study says Black schizophrenia is overhyped.
By Cord Jefferson BET February 14, 2012
Though you may not have heard of it, African-American Mental Health Awareness Week begins this week at California’s UC Riverside. A convening of mental health professionals from around the United States, AAMHAW says its goal can be summed up in one sentence: “Replace misinformation about mental health and erase prejudice, fear, and blame, thereby reducing stigma and disparities to the African-American community.” As it stands, the taboos about mental health woes in the Black community are many, and they’re only augmented by the fact that just 2 percent of psychiatrists and 2 percent of psychologists are African-American. AAMHAW hopes to help change that, and it turns out the week may be arriving just in time.
The Los Angeles Times recently reported something very frightening: A new study shows that African-Americans, who are diagnosed as schizophrenic at disproportionate rates, might not be suffering from increased instances of schizophrenia at all. Rather, they may be suffering from incorrect diagnoses brought on by biased mental-health practitioners.
“The new study found that in a group of 610 patients seeking treatment at six regional psychiatric clinics scattered across the nation, African-American patients were diagnosed with schizophrenia more than two and a half times as often as were white patients,” writes the Times. “That was the case even when the diagnosing psychiatrists based their conclusions entirely on reports of a subject’s symptoms and his or her responses to a structured interview, with any hints of the subject’s race stripped away.”
That doctors were diagnosing Blacks as schizophrenic more often even when blind to race suggested that it wasn’t just doctor bias that was resulting in incorrect diagnoses. The behavior of Black patients mattered, too. The authors theorize that “previous discriminatory experiences, and reactions to them, i.e. healthy paranoia,” might result in Blacks explaining their anxieties in a way that sounds more psychotic, even when it’s not.
The study, published in the Archives of General Psychiatry, ultimately recommends that doctors treating patients of a different race should “consistently challenge their own diagnostic assessments.” In other words, don’t jump to conclusions and, perhaps, try putting yourself in their shoes. Sometimes, the simplest lessons are the ones easiest to forget.