Racial Bias In Psychiatry

A report in the Booster Shots blog for The LA Times deals with the subject of racial bias in psychiatric diagnosis. This story bears the heading, Race and mental illness: Do African Americans suffer more schizophrenia or is it bias?

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.

If it’s not bias, then it would have to be heredity, but if it were heredity then you wouldn’t expect the rates for Black Americans to differ any more than those for Americans of other races. There is, as studies have shown, more human genetic diversity in Africa than on any other continent.

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.

So if you’re black, and you’re seeking mental health treatment in the USA, you’re 2 and ½ times as likely to receive a schizophrenia diagnosis as whitey, according to this study. This can’t be encouraging news for black people who are thinking about consulting a mental health professional.

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.

On the lack of charisma and recoverability scale schizophrenia is usually stationed at the bottom of the “mental disorder” heap. This sort of study, for this very reason, calls into question the validity of many “bipolar disorder” diagnoses as well. If, as some have speculated, schizophrenia is a label often reserved for the family scapegoat, one can see how the implications of a study along these lines may extend well beyond the relatively facile matter of skin color.