Current debates on the nation’s health care system have been focused on the future. But for one University researcher, it is the examination of the past that is key to finding solutions.

Jonathan Metzl, director of the University’s Program in Culture, Health, and Medicine, recently wrote a book using historical context to provide reasons for the over-diagnosis of schizophrenia in black men — a problem that he says persists to this day.

According to Metzl the trend of over-diagnosis began during the 1960s and 1970s as a way to quell civil rights era protest activity.

Metzl, an associate professor of Psychiatry and Women’s Studies, said the idea behind his book, “The Protests Psychosis: How Schizophrenia Became a Black Disease,” arose as he examined historical records from the Ionia State Hospital for the Criminally Insane. He said these records show that black men were increasingly over-diagnosed with schizophrenia during the 1960s and 1970s.

Metzl said he took this information and examined how “the diagnosis itself in this hospital and in certain aspects of society became racialized.”

“I found that there was a pretty dramatic transformation in the demographics in not only who was sent to that hospital but who got diagnosed with schizophrenia,” he said.

According to Metzl, the majority of black men diagnosed with schizophrenia were forced to move away from the Detroit area — where many of them were involved in civil rights protests and rioting — to the mainly white rural community of Ionia, Mich.

During this time period the definition of schizophrenia was also changing, he said. The demographic that had been most frequently diagnosed with schizophrenia was white women, but during the civil rights movement, black men who were considered to be “violent” were increasingly diagnosed with the disease.

Metzl said misdiagnosis wasn’t only a problem in the Detroit area.

“American society came to see schizophrenia as an illness that was linked to bigger stories of anxieties about the Civil Rights Movement,” he said.

This historical development laid the foundation for the over-diagnosis of schizophrenia of black men today, which Metzl said is still a problem.

“Minority populations, and particularly African-American men, continue to be over-diagnosed with schizophrenia and under-diagnosed with illnesses like depression,” he said.

The era also brought forth the idea of the “criminalization of mental illness” and created a “stigma against schizophrenia,” which are still implicit in modern society, according to Metzl.

“All of these are directly related not just to attitudes about mental illness but also about race,” he said.

By examining history, Metzl said he is also able to better understand how these historically racial stereotypes play a role in the discussions on health care today.

“Categories of health and illness are incredibly political at different points in time, so we can’t just assume that they’re just totally neutral categories,” he said.

With the current health care debate at the forefront of the nation’s political conversation, Metzl said the public must be open to different definitions of health and illness and not just assume that all “health is good” and all “illness is bad.”

“I think we need to pay attention to the different meanings of health or illness in different populations and really interrogate what that means,” he said. “We shouldn’t just assume we know what it means.”

Metzl said being open to different interpretations of what it means to be well or ill might help address minority populations’ “mistrust of psychiatry.”

Though health care providers have begun to implement some “cultural competency” training, Metzl said they have “just scratched the surface” and could benefit from a deeper understanding of the problems of the past.

“I feel like history provides us with a really important lesson about what happens when you’re not paying attention to the ways in which culture is reflected in psychiatric diagnosis,” he said.

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