Racial differences or unfair differences within the mental health system are well documented. Studies show that compared to people who are white, black, indigenous and colored (BIPOC):
Less likely to access psychiatric services
Less likely to seek services
Less likely to get the necessary care
The quality of care is more likely to be poor
Services are more likely to stop early
With regard to racial differences in misdiagnosis, schizophrenia, for example, is overdiagnosed in black men (four times more often than in white men), while underdiagnosis is present in post-traumatic stress disorders and mood disorders. In addition, concerns are compounded by the fact that BIPOC often provides psychiatric care in prisons, which raises a variety of problems.
BIPOC are overrepresented in the criminal justice system because the system overlays race with crime. Statistics show that over 50% of the detainees have mental health problems. This suggests that BIPOC is not receiving treatment for mental illness, but is being detained because of its symptoms. In prisons and prisons, the standard of psychiatric treatment is generally low, and prison practices themselves are often traumatic.
The vast majority of psychosocial care providers in the United States are white. For example, approximately 86% of psychologists are white and less than 2% of the American Psychological Association members are African-American. Some research has shown that provider bias and stereotyping are relevant factors in health differences. For almost four decades, mental health has been called upon to focus on improving cultural skills training, focusing on examining providers' attitudes / beliefs and increasing cultural awareness, knowledge and skills.
Despite these efforts, there are still racial differences after checking factors such as income, insurance status, age and symptom presentation. Established obstacles to BIPOC are:
Different cultural perceptions about mental illness, behavior seeking help and well-being
Racism and discrimination
Greater vulnerability to non-insurance, access barriers, and communication barriers
Fear and distrust of the treatment
In addition to emphasizing culturally competent services, other recommendations for bridging the gaps and removing obstacles largely focused on diversifying the workforce and reducing the stigma of mental illness in color communities.
One area that is not often mentioned is the historical (and traumatic) context of systemic racism within the mental health institution, although it is known that race and madness have a long and troubled past. This focus could begin to explain how racial differences affect or lack of treatment encounters, even if barriers are controlled and the explicit races of the provider and the customer are not in question.
Historical context
Scientific racism has been used in the United States to justify slavery and to soothe moral opposition to the Atlantic slave trade. Black men have been described as "primitive psychologically organized," which makes them "uniquely suited to bondage."
Benjamin Rush, often referred to as the "father of American psychiatry" and the signer of the Declaration of Independence, described "Negroes as suffering from a disease called Negritude". This "disorder" was thought to be a mild form of leprosy where the only cure was to go white. Ironically, Rush was a leading mental health reformer and co-founder of the first anti-slavery society in America. However, Rush noted that "in some cases, we are told that Africans go crazy shortly after they encountered the strains of eternal slavery in the West Indies."
In 1851, the well-known American doctor Samuel Cartwright defined “drapeomania” as a treatable mental illness that led to black slaves escaping captivity. He explained that the disruption was a result of slave masters "making themselves too familiar with the slaves and treating them as equals". Cartwright used the Bible to support his position, explaining that slaves should be kept in a submissive state and treated like children to prevent and heal them from running away. As a preventive measure, the treatment included "whipping the devil out of them" if the warning signal "grumpy and dissatisfied for no reason" was present. Remedy was to remove large toes to make walking physically impossible.
Cartwright also described "Dysaethesia aethiopica", an alleged mental illness that was the proposed cause of laziness, "villainy" and "disregard for master's property" among slaves. Cartwright claimed that the disorder was characterized by symptoms of lesions or skin insensitivity and "such a large amount of intellectual skills [mental dullness or lethargy] that it is like a person who is half asleep". Whipping was undoubtedly prescribed as treatment. In addition, according to Cartwright, Dysaethesia aethiopica was more common among "free Negroes".
The claim that those who were free were more likely to suffer from mental illness than those who were enslaved was not unique to Cartwright. The U.S. census made the same claim, and it was used as a political weapon against abolitionists, although it was found that the claim was based on incorrect statistics.
As early as the turn of the 20th century, leading academic psychiatrists claimed that "negroes" were "psychologically unsuitable" for freedom. And still in 1914, drapeomania was listed in the Practical Medical Dictionary.
After the abolition of slavery, the southern states adopted the criminal justice system as a means of racial control. "Black Codes" led to the incarceration of an unprecedented number of black men, women and children, who were brought back into slavery-like conditions through forced labor and leasing of convicts, which lasted well into the 20th century.
Scientific racism indicates early on control and containment motives for profitability. Leading health professionals propagated the idea that blacks were “smaller than” to justify exploitation and experimentation. The misnomer of behavior such as fleeing slavery as a by-product of a mental illness did not stop here. There were also significant changes in the definition of mental illness during the time of civil rights, suggesting that institutional racism is growing stronger in the context of heightened racist tensions in the collective social consciousness.
Before the civil rights movement, schizophrenia was described as largely white, docile and generally harmless. Mainstream magazines from the 1920s to the 1950s linked schizophrenia to neurosis and therefore linked the term to middle-class housewives.
The assumptions about race, gender and temperament of schizophrenia changed from the 1960s. The American public and the scientific community began to increasingly describe schizophrenia as a violent social illness, even as psychiatry took its first steps to define schizophrenia as a disorder of biological brain function. More and more research articles have claimed that the disorder manifests itself in anger, volatility and aggression and is a condition that affects "Negro men". The cause of urban violence was now "brain dysfunction" and the use of psychosurgery to prevent outbreaks of violence was recommended by leading neuroscientists.
Researchers have further linked the symptoms of black people to the perceived schizophrenia of civil rights protests. A 1968 article in the prestigious General Psychiatric Archives described schizophrenia as a "protest psychosis" in which black men developed "hostile and aggressive feelings" and "delusional anti-whites" after listening to or joining activist groups like Black had power, the Black Panthers or the nation of Islam. The authors wrote that psychiatric treatment was necessary because symptoms threaten black men 's own health and the social order of white America.
Advertisements for new pharmacological treatments for schizophrenia in the 1960s and 1970s reflected similar topics. An advertisement for the antipsychotic Haldol showed angry black men with clenched fists in urban scenes with the heading: "Attack and war?". At the same time, white mainstream media described schizophrenia as a state of angry black masculinity or as a warning of crazy black schizophrenic killers at large. A category of paranoid schizophrenia for black men was created, while women, neurotics and other non-threatening people were divided into other expanded categories of mood disorders.
The black psyche was increasingly portrayed as uncomfortable, immoral and inherently criminal. This helped justify the need for police brutality in the civil rights movement, Jim Crow laws, and mass incarceration in prisons and psychiatric hospitals, which was sometimes a very thin line. In general, attempts at rehabilitation took a back seat to structural control attempts. Some government hospitals, chaired by white male superintendents, employed unlicensed doctors to administer massive amounts of electroshock and chemical "therapies" and to bring patients to the fields. Unfortunate conditions remained unchallenged in some states until 1969.
De-institutionalization, a government policy to close state psychiatric hospitals and fund municipal psychiatric centers, began in 1955. Over the next four decades, most state hospitals were closed to discharge mentally ill people and permanently reduce the availability of long-term hospitals. Term inpatient care facilities. Currently, more than three times as many people with severe mental illness live in prisons and prisons as in hospitals. The shifts in the definition of mental health reflect the reality that the definition is shaped by chemical, biological and social, political and ultimately institutional factors.
Conclusion
A look at the historical and systemic context of the mental health system can shed light on why racial differences persist and why these differences were resistant to interventions such as cultural skills training and standardized diagnostic tools. An approach that disregards the system itself, the functions of diagnosis, and its structurally developed connections to protest, resistance, racism, and other associations that work against the system focuses primarily on the race of the provider and the customer therapeutic Connection.
Racial concerns, sometimes overt racism, have been written into the mental health system in a way that is now invisible to us. Understanding the past opens up new ways to address current implications and identify obstacles, including how schizophrenia became a “black disease”, why prisons were created where hospitals used to be, and how racial differences in the mental health system still exist today.
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Additional resources
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Tahmi Perzichilli is a licensed professional clinical advisor and licensed alcohol and drug advisor who works as a psychotherapist in a private practice in Minneapolis. Contact them through their website at www.tahmiperzichilli.com.
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