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The Diagnosis of Oppression

How mental illness became a weapon

The New Physician March 2010

The Protest Psychosis: How Schizophrenia Became a Black DiseaseDuring the civil rights era, the diagnosis of schizophrenia was used to silence the political protests of black men, and an illness once perceived to predominately affect white middle-class women became one used to institutionalize and imprison black men.

The Protest Psychosis: How Schizophrenia Became a Black Disease (Beacon Press, $24.95), by Dr. Jonathan Metzl, shows how the diagnosis was used against black men and examines the differences in medi-cal treatment due to class, gender, race and the inherently politicized nature of diagnostic terminology.

The author compares medical charts from before the 1960s through the 1970s to demonstrate the sudden demographic shift in those diagnosed with the illness.

Metzl, an associate professor of psychiatry and women’s studies at the University of Michigan Medical School, meticulously uses statistical analyses to illustrate medicine’s lack of objectivity and tendency to mirror mainstream attitudes—the effects of which include how contemporary mental institutions and prisons were created and how those incarcerated were overwhelmingly black.

Taking us back in time, Metzl systematically describes the effect that culture, social beliefs, newspapers, magazines and pharmaceu-tical advertisements had on the perception of schizophrenia in the medical com-munity in the 1940s as an illness that afflicted docile white women.

Throughout the next five parts of the book, the author distinguishes the devastating experiences of four black psychiatric patients in the 1960s.

During this period of black protest and social revolution, the media stigmatized this disease as the “protest psychosis.” When leaders in the psychiatric field published an update to the Diagnostic and Statistical Manual of Mental Disorders, history repeated itself as white mainstream beliefs affected the definition of numerous conditions.

Metzl compares pre- and post-civil rights era medical charts from the notorious Ionia State Hospital for the Criminally Insane in Michigan to contrast the definitions of schizophrenia. The results demonstrate the vast shift in the disease’s demographics.

To further his argument of the impact of society on schizophrenia, Metzl explains the ideals of 1960s and 1970s black philosophy during the period of unrest. He illustrates different social perspectives in the black community from that of Martin Luther King Jr. to the Black Panthers and delves into the causes of the dispro-portionate diagnosis of the illness among blacks.

The concluding chapters intricately depict the role of deinstitutionalization in American mental hospitals and prisons, and how this affected the high proportion of blacks at each.

The author shows how the families of these men suffered with the effects of the diagnosis. In letters written in 1972, one man stated that he would not be released from the hospital since he was not able to “function in the community.”

Metzl uses a vast number of references and primary sources to prove the book’s merit. However, as in all statistical analyses, the larger the research group, the more accurate the study. Perhaps a follow-up book or study will rely on data from other institutions to further prove the book’s thesis. An analysis of the past decade would be a highly interesting read on modern medicine and its improvements and deficiencies.

In the end, The Protest Psychosis convincingly portrays how mainstream values affected psychiatry and “racialized” various mental disorders. In the process, Metzl presents the compelling historical, political and phi-losophical ideas that affected the very foundation of medicine in the 20th century.

Manfred Tejerina is a second-year at Phila-delphia College of Osteopathic Medicine.

Understanding Terror Through the Patient’s Eyes

by Anjani Tilak

Medicine in Translation: Journeys with My PatientsWhen you start reading Medicine in Translation: Journeys with My Patients (Beacon Press, $24.95), you will need to hold back your initial “Oh my god” reaction to the tale of Samuel Nwanko, a Nigerian college student who was viciously at-tacked in his apartment and left disfigured.

Such stories will unsettle you thoroughly. However, if you do make it past the first chapter, you will be granted the opportunity to learn how to become comfortable with the uncomfortable.

While the book chronicles the dark side of man and human suffering, it also gives examples of kindness and of those who manage to rise above overwhelming adversity.

Author Dr. Danielle Ofri offers nearly two dozen vignettes of her immigrant patients at Bellevue Hospital in New York City, a hub for a diverse patient population. Many of her patients were survivors of torture. In caring for them, she faces daunting challenges.

She works to keep up with a patient’s “Mach 3 velocity” Spanish; she tries to explain cancer to a Haitian patient whose culture doesn’t understand illnesses that have no visible signs; she humbly describes patients brutalized for religious or political reasons in their native countries.

Ofri, whose previous books Incidental Findings and Singular Intimacies also chronicled her life at Bellevue, offers in her latest book her patients’ life stories as the ultimate teaching tool. The episodes are presented from a physician’s point of view, and she uses her own lack of cultural sophistication as examples of what other doctors might go through. Ofri finds herself gaining maturity from these insightful experiences through personal reflection.
After 15 years of working at the hospital, Ofri manages to navigate her own emotions and opinions as her immigrant patients run the gamut of what medical or psychological help they require. Some, as in the case of her Nigerian patient, erase all of her previous assumptions.

Another patient, an elderly Puerto Rican man named Juan Moreno, appoints Ofri as the sole decision-maker when his cardiologists recommend a prophylactic AICD, a procedure that has its share of complications. Ofri hesitates to make the decision without first completely understanding his personal, cultural and spiritual philosophies. She is surprised by the complete authority entrusted to her because, in contrast, her American patients “almost reflexively offer their opinions—positive or negative—on any medical recommendation.”
Ofri admits that her afternoons with the torture patients are sometimes the most daunting because her clin-ical repertoire can fall short of meeting their needs.

In trying to understand man’s inhumanity to man, Ofri writes, “Nobody did diabetes to anyone—the disease just occurred,” acknowledging the tremendous fact that violent acts have a human face.

“To live in this world, to accept that such cruelty was a reality, I had to know that beauty was an equal reali-ty,” she writes. “Even if some humans seemed to exist solely to offer pain and destruction, there were others who existed only to create beauty.”

This book is a powerful piece that is multifaceted in its appeal. It will touch, teach and sensitize those in the medical profession to consider the spectrum of experiences that their immigrant patients may have had. This may spur doctors to customize their treatment for foreign patients, making the care more comprehensive and in the process spark some soul-searching for the doctor as well.

Anjani Tilak is a second-year at the University at Buffalo, State University of New York, School of Medicine.