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.

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8 Responses

  1. I am shocked, shocked I tell you, that a shrink’s own white, middle-class biases could get in the way of an accurate diagnosis. Say it ain’t so.

    No, folks. You should be a flamboyant, insouciant gay man, who couldn’t give a rat’s rear end about the shrink’s opinions or the heteronormative social mores and see where that gets you diagnosis wise.

    • Very good point indeed, BetaSheep. I can only say that LGBTQ is well represented among service users, ex-patients and survivors. Much better represented percentile-wise than among the general population. When you’ve got a profession designed to persecute people who deviate from a norm, this shouldn’t come as too much of a surprise.

      The funny thing is I’ve never seen any research conducted on the subject the way research is conducted on racial bias. Instead you get this concern about gay people being more at risk for “mental health issues” than other groups. Maybe more research should be conducted into the biases of psychiatrists and mental health workers.

      It’s also a well known fact that there are more women in the mental health system, and on psychiatric drugs, than men. Research might be conducted on sexual bias in psychiatry as well.

  2. The shrinks might partially agree with what you are suggesting. But they will then say that mental illness is more prevalent than even they had up till recently suspected.

    They will say that it might appear to the ignorant that they are maliciously and falsely diagnosing minority and marginal individuals. But they can say that is just easier to diagnose people who are under understandable stresses but stresses that make it difficult to mask the symptoms of their congenital mental illness.

    They can then say that with more power and more funding that they would be able to diagnose mental illness at the same frequency amongst hitherto supposedly normal white middle class people.

    • They can say whatever they like. I think if they are shown to be biased, pressure can be applied towards alleviating that bias. A great deal of progress has been made in race and gay/straight relations over the years, and psychiatrists are not immune to this march of progress. A few decades ago homonsexuality was removed as a “disorder” from the DSM, for instance, and this removal would not have taken place if pressure hadn’t been applied upon psychiatrists to do so.

      A petition critical of the current DSM revision process was drawn up not that long ago by a section of the American Psychological Association. I believe this petition in part represents a split in perspective between mostly psychologists on the one hand, and mostly psychiatrists on the other. I think psychologists, sociologists, and some members of other related professions, would be the parties more interested in this matter of bias in psychiatry, and they would be the disciplines to conduct any research into the subject. Psychiatrists themselves, not so much.

  3. They intend to correct the bias by increasing the rate of diagnoses amongst whites by a factor of 2 1/2 or 3. They’ll get rid of the few remaining sensible nurses, psychologists and social workers.

  4. As an African American man currently undergoing cognitive behavioral therapy, I particularly appreciate this article. But with that being said, are there advocacy groups that have taken up the cause of equal diagnosis and non-biased evaluations? What can we do, and how would we even know if we were victims of misdiagnosis, when a doctors opinion is assumed trustworthy?

    • A quick search of the internet didn’t lead anywhere when it came to advocacy groups on this issue. If you wanted form such a group, the field seems open.

      I wouldn’t take diagnosis too seriously as doing so becomes a way of making any diagnosis more serious than it needs to be. Doctors need a disease to charge the insurance company for, and thus you’re going to have a lot of misdiagnosis. People can and do recover from their mental health issues regardless of bias over skin color.

      Doctors are fallible, and doctors of psychiatry are more fallible than doctors in other branches of the medical profession. I’d keep that in mind when visiting a psychiatrist. As psychiatrists make mistakes, a little vacation from the mental health treatment world can help a person clear his or her mind sometimes. Sometimes such a vacation can lead to a more permanent forsaking of the patient role.

  5. […] source Share this:FacebookTwitterDruckenGefällt mir:Gefällt mirSei der Erste, dem dieser post gefällt. Veröffentlicht: Februar 25, 2012 Filed Under: Psychiatrie, Rassismus Tags: Psychiatrie : Rassismus […]

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