Young, Depressed, and Of Color: Why Schools and Doctors Get It Wrong

From the classroom to the clinician's office, there's a long and troubling relationship between racism and the mental health field.

By Jamilah King May 29, 2012

Editor’s note: This is the first installment of a two-part series on people of color and mental health. Read the second part: "How to Do Right By Yourself While Saving the World"

Earlier this month, news surfaced of a Louisiana school psychologist who posted racially charged messages on Twitter. Mark Traina, who later resigned, worked as a psychologist at an alternative school in Jefferson Parish Public School System, a district that’s been under intense scrutiny in recent months. According to a court complaint filed by the Southern Poverty Law Center, Jefferson County has been sending a disproportionate number of black and special education kids to "languish for months" in the district’s alternative schools.

Traina had already taken to Twitter to post his support of George Zimmerman, the former neighborhood watch captain charged with murdering Trayvon Martin. But back in January, Traina went on a rant against "young black thugs." Traina, a self-proclaimed ‘American Civil Rights Activist who unlike Jessie Jackson and Al Sharpton presents all Americas", tweeted that "Young black thugs who won’t follow the law need to be put down not incarcerated. Put down like the Dogs they are!"

While black children aren’t often ceremoniously "put down like dogs", they do face harsh school punishment at much higher rates than their white counterparts. Jefferson Parish’s problems are symptomatic of a disease that’s already been diagnosed nationally: the  tendency to dole out harsher than average treatment for people of color. From the classroom to the clinician’s office, there’s a long and troubling relationship between racism and the mental health field.

Research has also shown the black students are disciplined more severely than white students, even when they commit offenses that are less serious. The National Education Policy Center at the University of Colorado reported (PDF) that more than 30 percent of black students caught using, or in possession of, a cell phone for the first time were suspended. The rate for white students who committed the same infraction was just 17 percent. 

The disparity lead Education Secretary Arne Duncan to lament that "the everyday educational experience for too many students of color violates the principle of equity at the heart of the American promise."

Data released this year by the U.S. Department of education showed that black students are three times more likely to be suspended than their white classmates. Even though black students make up just 18 percent of students nationally, they comprise 35 percent of suspensions and 39 percent of expulsions. Additionally, as Liz Dywer points out at GOOD, 70 percent of students arrested or referred to police are black or Latino.

Yet many contend that the problem extends far beyond the classroom. When it comes to mental illness, people of color are more likely to be given more severe diagnoses than their white counterparts. In 2005, the Washington Post reported that even though schizophrenia has been shown to affect all ethnic groups at the same rate, black people in the U.S. were more than four times as likely to be diagnosed with the disorder than whites. Latinos were more than three times as likely to be diagnosed as whites.

"The way we define mental illness is slanted toward pathologizing basically angry black men," said Jonathan Metzl, a psychiatrist at Vanderbilt University and author of the book "The Protest Psychosis: How Schizophrenia Became a Black Disease."

There’s a deep mistrust between communities of color and the mental health field. The National Alliance on Mental Health notes (PDF) that African Americans are more likely to be misdiagnosed and, in turn, receive inadequate treatment often due to a "lack of cultural understanding."

In 2005, the Washington Post published a wide-ranging series on the role of culture in mental illness and told the story of a case encountered by Dr. Roberto Lewis-Fernandez. While completing his psychiatry training at a hospital in Massachusetts, Fernandez encountered a suicidal 49-year-old Puerto Rican woman who begged for help to resolve a conflict with her son. The woman also said she was hearing voices, seeing shadows, and felt invisible presences. At first, the Harvard-affiliated doctors diagnosed the woman as depressed and psychotic. She was given medication and sent home.

"I wasn’t sure if she was psychotic, but I treated her as if she was," Lewis-Fernandez told the Post.

But Lewis Fernandez, who’s also Puerto Rican, found the diagnosis unsettling and thought the hospital had misjudged the situation. He knew that at a certain level, seeing shadows and sensing presences was considered normal in some Latino communities. After another argument with her son, the woman nearly overdosed on the medication. She was taken back to the hospital where she was re-evaluated, given a less severe diagnosis, and given help to reconcile with her son.

Race and institutional definitions of insanity share a long and troubling history. Metzl outlines in his book that in the 1850’s, American psychiatrists believed that runaway slaves suffered from an acute mental illness called "drapetomania." The era was also littered with references to "dysaesthesia aethiopis", a form of madness characterized by disrespect for the slaver owners’ property and best treated with extensive whipping.

In the early twentieth century, American psychiatrists thought that schizophrenia patients were largely white, middle class and harmless to society. The disease was misunderstood as one that was deeply emotional and, in turn, associated with melancholy housewives, novelists, and poets. In 1935, Metzl notes that the New York Times speculated that many white writers demonstrated a symptom called "grandiloquence", a propensity toward flowery prose then thought to be "one of the telltale phrases of schizophrenia, the mild form of insanity known as split personality."

It wasn’t until the 1960’s that societal attitudes toward the disease dramatically shifted. Schizophrenia was no longer seen as harmless, but was instead a dangerous disease defined by rage and associated with the Civil Rights and Black Power movements. In 1968, while protest movements became more radical — particularly those in poor black neighborhoods, the field  of psychiatry introduced a radically new definition of the disease. That year, the Diagnostic and Statistical Manual (DSM) updated its definition. "The patient’s attitude is frequently hostile and aggressive and his behavior tends to be consistent with his delusions." 

Metzl makes the argument in his book that the change on societal attitudes was the unintended consequence of growing white anxiety about cultural and social change. And while obvious bias can’t be easily discounted, sometimes misdiagnoses are the unintended side effects of persistent cultural misunderstandings. Metzal argues that racial tensions are structured into clinical interactions long before doctors and patients meet in the exam room. 

In the early 1970’s a series of influential studies established the fact that people of color were often over-diagnosed with much more severe mental illnesses than their white counterparts. When psychiatrist miss the mark so consistently, one obvious side effect is that persistent — though perhaps less severe — mental illnesses often go untreated.

Metzl notes that black men are historically underdiagnosed with illnesses like depression, anxiety, and attention deficit disorder.

"There’s a mistrust of psychiatry that I think is very well-founded. In the 1960’s we see very clearly that psychiatric experts were pathologizing civil rights protests and particularly black power protests as being insane. And it’s very hard to turn around from that and say, ‘Oh no, we made a mistake, please trust us.’ If you have a history of pathologizing legitimate political protests as mental illness, you set conditions for mistrust on both sides."