Diagnosing the Black body: Race, culture and power in schizophrenia diagnosis

Candice Valenzuela, MA, MFTI, YT-200

California Institute of Integral Studies

Introduction

A man who has a language consequently possesses the world expressed and implied by that language. What we are getting at becomes plain: Mastery of language affords remarkable power. Paul Valery knew this, for he called language “the god gone astray in the flesh.” (Black Skin White Masks, p.9)

These words by liberation psychiatrist Frantz Fanon (1952) speak to the godlike power of language to create, determine and influence one’s reality. Therapists hold particularly powerful access to language through the tool of diagnosis. A diagnosis can open a door to relief, resources and treatment; it can also set the stage for continued stigmatization, neglect and/or disenfranchisement. For marginalized communities, the latter is often true. African Americans are diagnosed with schizophrenia at a rate four times that of white Americans. (Canyon, 2013, p. 5) And this diagnosis makes them more likely to be incarcerated when interacting with police. (Canyon, 2013, p. 130) According to the Treatment Advocacy Center (2018), people with untreated mental illness are 16 times more likely to be killed by law enforcement. So not only are African Americans diagnosed with schizophrenia more frequently than other groups, but a schizophrenia diagnosis also increases their risk of institutional harm and even death.

It is urgent that mental health providers examine forces inside and outside of the treatment room that impact the efficacy of the overall mental health delivery system. This paper interrogates the historical, societal, and cultural contexts for schizophrenia overdiagnosis in people of African descent, and explores interdisciplinary possibilities for ethical, effective, and culturally respectful psychiatric treatment.

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Anthropologist T.M. Luhrman (2016) begins his study of schizophrenia across cultures with this statement, “Schizophrenia is and is not a thing in the world. To borrow from Steve Shapin, there is no such thing as schizophrenia…