The Protest Psychosis: How Schizophrenia Became a Black Disease by Jonathan M. Metzl
My rating: 4 of 5 stars

The schizophrenia rate for African Americans is still 3 times that of Caucasians. If schizophrenia is as heritable of a disease as it has been presented, this statistic should not happen. The author did a great job of showing the importance of structural prejudice in understanding mental illness. He argues that it was not and is not the racist intentions of individual psychiatrists but rather the much larger cultural structural situation that the psychiatrists cannot see outside of.

In my work I am part of a team that is constantly diagnosing schizophrenia and it is very easy to see it as a heritable disease that culture has no say in. But it is also obvious to see that the young schizophrenics are much more likely to be Hispanic than White. And yet I cannot think of a single case where a Hispanic was diagnosed schizophrenic and shouldn't have been. It is only when I take a step back that I can see my racial/cultural bias.

Where the author is weak is his explanation of schizophrenia and symptoms. The people he used as case studies would not be diagnosed schizophrenic unless they were showing signs of psychosis, I.E. talking to themselves or other signs of responding to internal stimuli. He makes it sound like African Americans were being detained because they were angry. While I am sure that happened at times, I imagine most of that population was hidden in jails and not institutions.

Another part of this equation that I don't think got enough attention was the role of illicit substances. Anyone who has worked with the severely mentally ill knows the co-morbidity issue and how it clouds all diagnosis. There are times it is very hard to tell if the psychosis is caused by the drugs, or if the patient is attempting to mask the psychosis with drugs. The issue of chemical dependency treatment and diagnosis with African Americans is a much larger topic again, and it goes perfectly with the author's assertion of the racial/structural blinders that continue to bias decision making in mental health.

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