The weaponization of medicine: Early psychosis in the Black community and the need for racially informed mental healthcare

Abstract

There is a notable disparity between the observed prevalence of schizophrenia-spectrum disorders in racialized persons in the United States and Canada and White individuals in these same countries, with Black people being diagnosed at higher rates than other groups. The consequences thereof bring a progression of lifelong punitive societal implications, including reduced opportunities, substandard care, increased contact with the legal system, and criminalization. Other psychological conditions do not show such a wide racial gap as a schizophrenia-spectrum disorder diagnosis. New data show that the differences are not likely to be genetic, but rather societal in origin. Using real-life examples, we discuss how overdiagnoses are largely rooted in the racial biases of clinicians and compounded by higher rates of traumatizing stressors among Black people due to racism. The forgotten history of psychosis in psychology is highlighted to help explain disparities in light of the relevant historical context. We demonstrate how misunderstanding race confounds attempts to diagnose and treat schizophrenia-spectrum disorders in Black individuals. A lack of culturally informed clinicians exacerbates problems, and implicit biases prevent Black patients from receiving proper treatment from mainly White mental healthcare professionals, which can be observed as a lack of empathy. Finally, we consider the role of law enforcement as stereotypes combined with psychotic symptoms may put these patients in danger of police violence and premature mortality. Improving treatment outcomes requires an understanding of the role of psychology in perpetuating racism in healthcare and pathological stereotypes. Increased awareness and training can improve the plight of Black people with severe mental health disorders. Essential steps necessary at multiple levels to address these issues are discussed.

The Burden of Psychosis in Black Communities in Canada: More than a Feeling, a Black Family Experience

“…Second, there is a concern that Black individuals have been misdiagnosed (e.g., those with affective symptoms-mainly bipolar-who are diagnosed with schizophrenia; exaggeration of psychotic symptoms in poverty context; misinterpretation of cultural mistrust and racial discrimination experiences as paranoia symptoms) and medicated excessively (dosage and frequency) in cases of schizophrenia. 3,8 This echoes American studies that have shown that Black individuals were misdiagnosed and given more antipsychotic medication than people from other groups. Third, families consider court-ordered coercive measures for Black individuals diagnosed with psychosis to be generally abusive.…”

“…This perception worries Black communities and fuels stigma among Black individuals regarding mental illnesses in general and psychosis in particular. 3 Over the past three decades in Canada significant disparities linked to psychosis within Black communities were observed. [4][5][6] Black individuals are at a higher prevalence of psychosis, experiencing involuntary admissions and treatments, having their first contact with healthcare institutions through emergency services in crisis situations, and are more likely to receive poor-quality care and demonstrate less adherence to medical treatments.…”

Disentangling the Consequences of Systemic Racism and Clinical Paranoia to Promote Effectiveness of a Cognitive-Behavioral Intervention for Persecutory Delusions in Minoritized Individuals: A Case-Example

“…Worry (rather than problem solving) may result in greater acute danger or unproductive outcomes (e.g., in the case of James, staring at the woman who crossed the street and making her more uncomfortable, perhaps prompting a confrontation or call to police). Unfortunately, the involvement of law enforcement rather than understanding or pathways to healthcare for Black Americans is staggering and results in more harm to the individual (Faber et al, 2023). The clinician employing a strategy based on an accurate conceptualization reduces the factor (worry) that puts the patient at increased risk by shifting engagement to productive behaviors (e.g., problem-solving, refocused activity).…”

“…Accordingly, anxiety and mood disorders which have similarly implicated stress systems are also elevated in Black Americans (Berger & Sarnyai, 2015) and exhibit within-group increases as a function of higher race-based stress (Hudson et al, 2016). Black individuals experience higher rates of trauma and often meet criteria for PTSD at higher rates than White individuals, a well-established risk factor of psychosis (Faber et al, 2023). Elevations in stress hormones also result in changes to bodily functions, including hypertension, compromised immunity, etc.…”

The Restorative Integral Support (RIS) Model: Community-Based Integration of Trauma-Informed Approaches to Advance Equity and Resilience for Boys and Men of Color

“…Cusack and colleagues [ 33 ] and, more recently, DeAngelis [ 34 ] have suggested that boys and men of color receive less comprehensive care, have less access to experienced providers, and are faced with fewer resources, while at the same time their mental health is challenged by racism. There continues to be a notable disparity between the prevalence of schizophrenia in people of color in the United States and Canada and their white counterparts in these same countries, with people of color receiving a higher diagnosis rate [ 35 ]. The overdiagnosis of Black and brown people is deeply rooted in the racial bias of practitioners and further illustrates the argument that service providers have not been trained to acknowledge or treat the trauma present within this group.…”