“There is a schizophrenia, as the psychologists or the psychiatrists would call it, going on within all of us. And there are times that all of us know somehow that there is a Mr. Hyde and a Dr. Jekyll in us….There’s a tension at the heart of human nature. And whenever we set out to dream our dreams and to build our temples, we must be honest enough to recognize it….”
—Dr. Martin Luther King Jr.
African-American men are diagnosed with schizophrenia at rates four to five time more than other groups. Schizophrenia is a biologically based disease, with no genetic links to ethnicity or gender. Are black men inherently crazy?
From the 1920s to the 1950s, schizophrenia was considered a fairly harmless disease that primarily affected whites. The illness was associated with “emotional disharmony” and the suggested treatment for those affected was that they be nurtured, not feared.
But in the 1960s and 1970s, advertisements for new schizophrenia drugs appeared featuring scary-looking black men under the tagline, “Assaultive and belligerent?” Apparently, “cooperation” could be achieved with doses of an antipsychotic drug, Haldol.
Schizophrenia became a black disease. And black men, labeled paranoid, hostile and violent, literally became the poster children.
Jonathan M. Metzl, an associate professor of psychiatry at the University of Michigan, decided to trace the troubled history of schizophrenia. By gaining access to archives of Ionia State Hospital for the Criminally Insane, a mental asylum located in Michigan that was open between 1885 and 1975, Metzl began unraveling the tangled roots of schizophrenia and race. He compiled findings in the new book The Protest Psychosis (Beacon Press, 2009). Part reportage, part analysis, part theory, Metzl challenges readers to peel back the layered complexities of race and medicine.
Metzl talked with The Root about hostile black men, the FBI, psychiatry and structural racism.
The Root: How did this study of race and schizophrenia come about?
Jonathan M. Metzl: The main interest for me in this project was the fact that there’s this long, unknown history of schizophrenia being associated with different races and classes. More broadly, there’s a troubled history between race and sanity. With schizophrenia, the definition of this particular illness has changed radically, and I wanted to track the disease over time to see how it changed.
TR: Most of the book is centered on research that you did in the archives of Ionia State Hospital. How did you choose this facility?
JM: The archives from Ionia turned out to be the perfect because of how close the hospital was to Detroit and what was happening politically in the 1960s.
The second explanation is that there were bigger cultural associations happening in the ‘60s—such as the anxiety about civil rights—that got mapped to schizophrenia.
TR: One of the manifestations of that anxiety was “protest psychosis.” Can you talk about how this term came about and how it plays a role in the conversation that we’re having now about schizophrenia and black men?
JM: What I argue in the book is that the assumption about race and schizophrenia are remnants of history so they don’t make sense to us without looking through the lens of history. Attitudes about this disease were shaped in the ‘60s.
Protest psychosis is a term used in psychiatric literature in the 1960s by white doctors in New York. It basically categorized black men who were participating in civil rights as insane. It was a way to pathologize the civil rights protest.
There was a flip side of this. The black press and black leaders like Malcolm X were saying that it wasn’t the fight for civil rights that drove people crazy; it was racism, and therefore white mainstream society had to change. It became a debate about what was causing who to go crazy and why. To me, that’s the central debate of what was happening.
TR: How did leaders like Martin Luther King Jr. and Malcolm X use psychological language to advance their agendas and ultimately transform the protest psychosis to a protest identity?
JM: Schizophrenia literally means a split mind. Martin Luther King Jr. used the metaphor of schizophrenia as a divide between good and evil, love and hate, and violence and nonviolence to promote nonviolent resistance. On another hand, others like Robert Williams and Malcolm X used schizophrenia as a potent metaphor to justify exactly the opposite. They were saying ‘Yeah, we’re being driven crazy, and we need to fight back. If there’s violence, it’s justifiable.’ So there was also this debate between black political and philosophical thought at the time. While psychiatry was assuming that there was an illness in the black mind, in this discourse, it was assumed that the illness was in white society and/or was the cause of racism.
TR: Speaking of which, the FBI had diagnosed Malcolm X with “pre-psychotic paranoid schizophrenia.”
JM: There was a history of the FBI diagnosing political heroes like Malcolm X and Robert Williams with schizophrenia. A number of people were diagnosed this way. It was a way of engendering anxiety about them.
TR: Beyond the disproportionate amount of black men that are diagnosed with schizophrenia today, what are some of the other lingering effects of schizophrenia’s troubled past?
JM: There are several key areas. One is that the narrative of schizophrenia tells the story of the increasing belief that people with schizophrenia are violent. In the ‘30s and ‘40s, doctors looked at people with schizophrenia as unruly children. They were taken care of and given arts and crafts to keep them busy. Then in the ‘60s, schizophrenia became a violent disease. The racial demographic of Ionia State Hospital changed as well. More barbed wire was built around the facility. Then in 1977, the hospital literally became a prison. It wouldn’t make sense to put people with schizophrenia in prison unless it was seen as a violent disorder.
Another effect is that popular opinions about schizophrenia have changed. Even as other disorders like depression and OCD are destigmatized, there seems to be an increased stigma attached to people with schizophrenia. They’re seen as hostile and violent. This doesn’t exclusively have to do with race, but if you look at the ‘60s, it had a lot to do with race, to the point that there was a diagnosis for “Negro schizophrenia.” We often talk about stigma against mental illness, but if you look at stigma historically, there’s a close connection between stigmatization of mental illness and stigmatization of race. If you’re taking history into account, and you’re trying to correct stigma against mental illness, then you have to consider racial history as well.
TR: What about black women? There was a very low admittance of them to Ionia. Where are they in this history?
JM: It’s understandable that black women aren’t prominent in this because Ionia became much more male. It started out with 30 percent women in its population and became an all-male hospital. But why is it that women disappear in these sources? Hopefully, that will be my next project. But the assumption was if you were angry and protesting in the streets, you were male. Black men were the primary source of anxiety.
TR: What are your recommendations going forward regarding how schizophrenia is viewed and diagnosed?
JM: There needs to be a better conversation about race and medicine. We’ve had certain interventions like cultural competency that’s used in medical education to urge doctors and patients to be more culturally aware in order to better understand one another. But part of my book argues that it’s great if both parties are more culturally aware, but a lot of what affects where race and medicine intersect—such as race-based misdiagnosis—are happening because of much bigger structural issues. So I argue for structural competency where we teach doctors about the bigger picture.
With schizophrenia, there are things—like why schizophrenia has been left behind in this evolution of destigmatizing certain mental illnesses—that don’t make sense in the present day, but history helps us understand why.
is a writer, speaker, author of books for adults and youth, and the book columnist for The Root. Her most recent book is \"The Message: 100 Life Lessons from Hip-Hop’s Greatest Songs.\" Visit her at feliciapride.com.