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Schizophrenia began to be over-diagnosed in the Black community in the mid-twentieth century.

Mischaracterization of Black mental health clients as aggressive or dangerous complicates pathways to care.

Psychologists can self-reflect to help reduce racial bias in diagnosis and care.

By Danielle Curiin, PhD, on behalf of Atlanta Behavioral Health Advocates

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. What do we know about the impact of these biases, and what can we do to address them?

How Diagnostic Bias Took Hold—and Still Lingers

The overdiagnosis of schizophrenia and other forms of psychosis in Black individuals was not limited to the civil rights movement. Perceptions of Black individuals as “mad” rather than “sad” or “paranoid” rather than “afraid” may stem from civil rights era shifts towards viewing psychosis as a Black disease, but they continue even now to contribute to the racial gap seen in the rate of diagnosed psychosis (Faber et al.,........

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