Race Impacts Prognosis, Not Prevalence

Racialized diagnostic patterns impact the efficacy of treatment for people of color

By Lauren O'Shaughnessy

Noteworthy

  • Minority groups are less likely to use mental health services and receive poorer quality care, despite having similar community rates of mental health problems.
  • Communities of color experience traumatic conditions like racism, poverty, and incarceration at far higher rates than white communities — all of which are detrimental to mental health.
  • Psychotherapists are more likely to offer appointments to middle-class white people than to middle class African Americans or working class people of any race.

Racial profiling — the use of ethnicity as a measure of one’s criminal history or likelihood of criminality — is a familiar concept. Turn on your TV or scroll through your phone, and you’ll find stories of racial profiling by law enforcement, employers and regular people (think BBQ Becky and Permit Patty). Psychiatric profiling, however, is a newer concept.

For decades, people of color have weathered false assumptions about their mental health on both systemic and individual levels. Cultural myths have lead people to believe that minorities are more likely to experience mental conditions, while bias amongst clinicians has allowed these misconceptions to seep into the healthcare system.

All races and ethnicities are affected by similar rates of mental conditions. Being white doesn’t make you more prone to a chronic anxiety disorder, the same way being black doesn’t make you more prone to schizophrenia.

Providers of mental health services… often know little about the cultural values and backgrounds of the patients they are treating, or about the traditions of healing and the meaning of illness within their cultures,” said the Surgeon Generals report.

What does impact our experiences and diagnoses, are cultural norms, rates of disclosure, access to care, community trauma and psychiatric profiling. In others words, our mental health is greatly affected by our personal experiences, with socioeconomic status and racial identity being key components of who we are. To some, this has been construed as a difference between ethnicities, when in reality, it is a sign of a healthcare system lacking in cultural competence.

Arguably the best example of psychiatric profiling, is the reported correlation between African Americans and schizophrenia. A 2004 study found that African Americans are four times more likely to receive a schizophrenia diagnosis than white Americans. But this wasn’t always the case.

From 1970 to 1986, the percentage of African Americans hospitalized with schizophrenia jumped from 33% to 50%. Psychiatrist, Jonathan Metzl, set out to understand this shift, and uncovered racialized diagnostic patterns that started in the 1960s during the American civil rights movement, and on the tail end of deinstitutionalization — the breakdown of the US asylum system. Metzl states that prior to the 1960s, schizophrenia was considered a largely non-violent, female, white condition. But as the civil rights movement gained traction, more and more black men were hospitalized with schizophrenia diagnoses, in part, because of their participation in protests.

Soon thereafter, the DSM officially recharacterized schizophrenia as a disorder of “masculinized belligerence” that caused hostile and aggressive behavior. Throughout the 70s, 80s and 90s, rates of schizophrenia skyrocketed amidst black populations, with African American men being 5 to 7 times more likely to receive a diagnosis than white men. Thus, the stereotype ingrained itself in the minds of everyday people and professionals alike, while simultaneously supporting other harmful beliefs, such as the correlation between black communities and violence.

Racialized diagnostic patterns aren’t the only way ethnicity impacts mental health. Minorities also face massive disparities in treatment.

The 2001 report Mental Health: Culture, Race, and Ethnicity commissioned by the Surgeon General, states that “Most minority groups are less likely than whites to use services, and they receive poorer quality mental health care, despite having similar community rates of mental disorders.”

Even when treatment options are available, misdiagnosis rates remain high due to practitioner bias. Clinicians aren’t well versed in the norms of outside cultures, causing them to overlook symptoms or misunderstand disclosed experiences. “Providers of mental health services… often know little about the cultural values and backgrounds of the patients they are treating, or about the traditions of healing and the meaning of illness within their cultures,” the report says. In turn, rates of misdiagnosis and mistrust remain high amongst communities that are in dire need of support.

Our mental health is greatly affected by our personal experiences, with socioeconomic status and racial identity being key components of who we are. To some, this has been construed as a difference between ethnicities, when in reality, it is a sign of a healthcare system lacking in cultural competence.

While ethnicity can’t cause a mental condition, minority communities do experience traumatic conditions at far higher rates than white communities — racism, poverty, incarceration — all of which are detrimental to mental health.

Studies have shown that the lifelong effects of poverty are real and wide ranging, including higher rates of depressive disorders, anxiety disorders, psychological distress and suicide. Racism has been proven to cause psychological and physiological problems, including stress, depression and hypertension. And incarceration is deeply linked with mental conditions, with individuals experiencing a mental crisis more likely to encounter law enforcement than a medical professional. In fact, in the US, more severely mentally ill individuals sit in prisons than in hospitals.

As with all intersecting cultural constructs, the relationship between ethnicity and mental health is a complicated one. What’s clear, is that our current healthcare system is not meeting the needs of at risk populations, and that institutionalized racism has forced years of hardship on already marginalized communities. Moving forward, we need services tailored to the experiences of minorities, better training for counselors and clinicians, and increased representation amongst professionals. A mental health movement that solely services the needs of privileged populations is one that will ultimately fail.

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