Meta-review: Schizophrenia and racism

The publication of Jonathan Metzl's The Protest Psychosis: How Schizophrenia Became a Black Disease has generated a number of reviews. While all reviewers have plenty of praise for his project, there is a discussion about his main argument that the becoming of schizophrenia as a black disease is basically a matter of misdiagnosis because of the psychiatric professions' racism. Some of these reviews rubbed me the wrong way, and this blog post is my attempt in explicating my unease.

Tanya Luhrmann, anthropologists and author of a great ethnography of psychiatric institutions, argues that this argument missing a crucial point: the different rates of prevalence of schizophrenia in different ethnic groups.

If one has a dark skin, one's risk of schizophrenia increases as one's neighborhood whitens, a disturbing finding known as the "ethnic density" effect. The risk of developing schizophrenia among African Caribbeans who have migrated from Jamaica to the United Kingdom is as much as 15 times higher than that among the local whites; the effect holds true for black-skinned Surinamese who have immigrated to the Netherlands.

There is, therefore, a mixture between "being schizophrenic" and "being classified as schizophrenic" in action: Not only are members of racially disadvantaged groups more likely to be diagnosed (Metzl's position; misdiagnosis model); but members of racially disadvantaged groups are more likely to have schizophrenia (Luhrmann's model; racism as risk factor model).

These two explanations are not completely incompatible--Luhrmann clearly acknowledges that misclassification is indeed going on-- but they also don't go together easily. First, if persons from racially disadvantaged groups are indeed at higher risk of having schizophrenia, then one could argue that a higher rate of diagnosis for them just reflects this reality and there is no problem. In this sense, the coming into existence of schizophrenia as a black disorder that Metzl describes could actually be seen as an improvement. Obviously, this is not where Luhrmann and Neely Myers, who reviewed the book on Somatosphere, want to go, but I think this issue has to be addressed.

The underlying ontological and epistemological issue that would help sorting this out is that of the reality of mental illness. Luhrmann's position is based on a position that assumes that schizophrenia exists "out there," without explicating what that schizophrenia is. Is schizophrenia sufficiently defined by its behavioral symptoms listed in the DSM? Is is it an experiential category? Is it a specific kind of "physiology of despair and resilience and [...] individually shaped both genetically and epigenetically," as Neely Myers argues? Aside from this problem, in principle, there is nothing wrong with insisting on the reality of mental disorders, and Luhrmann points out that members of African Caribbean communities in London themselves "attribute their high rates of schizophrenia to the experience of living in poverty with a history of racism and slavery." Dismissing Metzl's misdiagnosis argument as that of a detached liberal academic that doesn't want to acknowledge the devastating effects of poverty and racism appears misguided, though.

Why, for example, do the African Caribbeans mentioned above think of their condition as resulting in schizophrenia and not in terms of a different diagnosis or in non-psychiatric terms? The creation of categories and that of identities go hand in hand, as Ian Hacking has so convincingly argued. Metzl's historical account of the classification of schizophrenia helps us to unravel the creation of an "ecological niche" (Hacking) that not only has allowed psychiatrists to label and institutionalize "angry black men" as schizophrenic, but also allowed disadvantaged communities to think of their social situation in terms of mental disease.[1]

My objections notwithstanding, I think Luhrmann and Myers have pointed out something important when it comes to the conclusions to be drawn from Metzl's analysis. Racism is not merely a matter of the psychiatric profession misdiagnosing certain groups of people. Living in a racist and economically unjust society clearly does something to those affected by it, and dealing only with psychiatry won't make that something go away. To think of the effects of racism primarily in psychiatric terms, however, is no solution either. I hope this debate will continue in a productive manner.

Notes:
[1] I wonder if those diagnosed with schizophrenia by psychiatrists and their community share the perspective of schizophrenia as a product of racism. Emily Martin's Bipolar Expeditions is very helpful in thinking about the experience of "living under the description" of a mental disorder. 

Spaces of Fear, Vol. 2

A quick update on the debate about no-go areas for people of color in Germany: the former spokesman of the red-green government, Uwe-Karsten Heye, who is now head of the anti-racist organization Gesicht zeigen! (Show our face!) has also advised caution for non-white visitors of Germany--and quickly withdrawn his remarks. In an interview with the public radio station Deutschlandradio Kultur he said:

There are small and medium-sized towns in Brandenburg, as well as elsewhere, which I would advise anyone of another skin colour to avoid going to. It is possible he wouldn't get out alive.

He was heavily criticized for these remarks and withdrew them to a certain extent, expecially making clear the he didn't want to single out Brandenburg. On the other hand, there was support for his claims, often saying that he was only stating the obvious. For an English article on the debate click here.

Spaces of Fear

In the aftermath of the racist attempted murder that now no one any longer regards as racist. the German weekly Die Zeit has published an interesting video about "Spaces of Fear: Where black people in Berlin and Brandenburg do not dare to go." In the short documentary people of colour talk about their experience of racism in the Berlin-Brandenburg area, where a significant amount of places are off-limits for them. One of the interviewees from the Africa Council Berlin also talks about plans to publish an brochure and map for visitors of African origin of the soccer world cup that gives advice on "precautionary measures" to avoid becoming victims of racist violence during their visit.

The video (partly in English) is accompanied with a (German) interview of the urban sociologist Hartmut Häußermann. He discusses the situation in Berlin and possible counter-measures to no-go areas and everyday racism from an urban planning point of view.

Denk ich an Deutschland

Denk ich an Deutschland in der Nacht,
dann bin ich um den Schlaf gebracht.
(“When I think of Germany at night, I can no longer sleep”; Heinrich Heine 1843)

Why do I always have to write about bad news here? Is it my German angst, is it only natural that I, a German student, am "usually not "begeistert"? Or is it maybe the state of the world in general and of Doitschland in particular? Judge for yourself:

On April 16, an Afro-German citizen was attacked by two men and one woman in the East-German city of Potsdam. Prior to the attack, the man tried to call his wife from his cell phone, got only her mailbox, and somehow he didn't hang up. Thus we have a recording of the racist insults (e.g. "Dirty nigger") that preceded the attack. The attack left the man severly wounded and he was put in an artificial coma, now still struggling for his life. So far, so terrible.

Immediately after the racist attempted murder became public there was a large outcry of concern and politicians from all over the spectrum condemned the attack. However, several observers suspected that some people might have been more concerned with Germany's reputation than with the racist crime itself, especially only a few weeks before the soccer world-cup will begin (slogan: "The world hosted by friends"). Attacks on foreigners (or those who are believed to be non-German) are not uncommon and this case is by no means unique.

The suspicion about the motives of politicians is furthered by the disgusting remarks of the German minister of the interior, Wolfgang Schäuble (Christian Democrats). In an interview with the public broadcaster Deutschlandradio Kultur four days after the attack he proclaimed: "We don't know about the motives, we don't know the offenders. We should be a bit careful." As if this was not enough, he then fantasized about poor Aryan victims: "Blond, blue-eyed people are also victims of violent crimes, partly even by offenders that possibly don't have the German citizenship. That is no better."

I am so sick!