Examining Race and Prejudice in Mental Health

By Jocelyn Gardner '17
Mental Health Columnist & Webmaster

There is no way to crop one’s experience to reflect only one aspect of identity. However, people often do try to reduce certain aspects of identity (such as mental illness or race) as contingent upon, or subordinate to, other factors that play roles in shaping a person’s mind.

While we cannot determine the cause of mental “illness,” (I use the term in quotes because I dislike seeing mental illness described as pathological-- “illness”-related words are used for lack of more accurate terms) we do know that-- like everything else in the human body-- genes are a map of possibilities; experience and stimuli help determine the expression, or the path our development takes throughout life. Race might not necessarily be the one and only determining factor leading up to some kind of negatively perceived mental condition, but it certainly cannot be discounted.

The articles I found discussing the intersections of race and mental health drastically oversimplified both factors of identity, both as their own stand-alone topics, and in conjunction with one another. I was extremely disappointed to find that “race” is often equated to being “African-American” as opposed to “White;” news flash: there are other races. All races drastically influence how we perceive ourselves; it is not so clear-cut as these articles suggest, and such a fabricated dichotomy often used in discussing race is reductive, ineffective and problematic. Additionally, issues of race can affect a mind in various harmful ways-- from warping one’s self-view all the way to the more overt, negative effects caused by prejudice and racism. Issues of race are also relevant in shaping the way that people view help-seeking and their own mental health. Cultural context is very significant and cannot be taken out of the equation. In this respect, we can go deeper than race, as differences in individual families and circumstances (think economic inequality) have a staggering psychological impact. (We come again to a point I repeatedly make about how you can't quite apply broad generalizations to the intricacies of a single, human psyche.)

On a (rare) personal note, I'm especially bothered by this because I've felt weirdly out of place in most racial discussions-- I'm biracial, and in my experience, this is treated as a very bizarre phenomenon. I can attest to the way this part of my identity shapes or affects the way others view me and how I feel about myself. My argument is that similar situations affect others in this way as well. Race can encompass so much more than effects of“racism” on “minority groups.” What about the sense of displacement felt by some who feel tied to more than one contradicting identity (for instance, feeling that you belong to both and neither race, culture, country, etc. of which your identity is composed)? Other groups also deal with problems differently, and don't want to change this. Some people would rather turn to religion, family or substances instead of mental health professionals. Unfortunately, psychology as a whole is seen as very “white,” and this makes it less comfortable and accessible to other groups. In a practice where comfort is a necessity rather than a luxury-- for it’s nearly impossible to share deep-seated personal details with someone, in this case a mental health professional, you don’t trust-- psychology’s being seen as very “white” has a monumental effect. While the mindset shouldn't be infected with the social disease of racism, race in all its relevant connotations mustn't be swept under the rug or reduced to a small, inaccurate shell of an idea.

In the general mindset reflected in the aforementioned articles,  mental “illness” is also drastically and harmfully oversimplified. I won't get into this here in order to spare you from a novel-length rant, but it does exist in a very real way, even in “trustworthy” writing and in the words of “experts.” I should also mention that it is accepted that race alone doesn't affect rates of mental “illness” the way it can affect some more physical phenomena such as heart disease. There aren't really significant differences in occurrences of mental health issues among races, according to research. Yet chronic stress attributed to racism shouldn't be ignored, so it is interesting that the rates of mental “illness” are roughly the same, right? Actually, it isn't interesting, because our perception of mental “illness” numbers are completely based on numbers of diagnoses, and, for the reasons outlined above, people of color are less likely to be correctly diagnosed if they seek help (and, as we’ve seen, they are less likely to seek help than their white counterparts). Note: you cannot equate diagnoses to the actual numbers.

Even if a person of color does seek help and is correctly diagnosed, certain barriers may restrict this person’s access to treatment. As anyone who has taken Core I and been subjected to Foucault will recognize, there is institutionalized, systematic racism at work in our society. Some of the more negative outcomes we've found in the healthcare system involve the way diagnostics, insurance and the nature of professional development works. One outcome of our national education system is that we end up with a vast majority of our mental health professionals coming from similar backgrounds. This poses a difficulty, as it makes it hard for them to understand other backgrounds, and, as a result, people from these unfamiliar backgrounds are less likely to trust these healthcare professionals. Cultural competency is not taught, though it needs to be. Additionally, the diagnostic and other criteria that make up the “normal” we compare people against are also based on research with samples not representative of the population. Thus, the misdiagnosis problem grows. The misunderstanding of cultural backgrounds also causes differences in diagnosis. (It can also come from racism, but for the sake of not perpetually bashing everyone, I'm going to mix things up and give them the benefit of the doubt.) Going back to institutional violence, research has shown that race alone led to a difference in diagnoses. For example, a June 28, 2005 article from Washington Post entitled “Racial Disparities Found in Pinpointing Mental Illness” explained how African-Americans receive diagnoses of serious mental health problems more often, citing the discrepancy in rates of schizophrenia diagnoses.

An issue that has been hotly debated over the past few decades is the idea that extreme bias, including racism, should be classified as a mental “illness.” The main few reasons that it is not recognized by the DSM-V as such are that basically all people are a little biased or have a preference for those more like themselves (these biases are involuntary and happen even if someone fights against conscious racism. Scientists think that this is possibly due to evolutionary adaptation-- you want your kin, those like you, to survive over the strangers) so you can't call something that 100% of the population has a “disorder,” as that implies abnormality. Also, people think that classifying racism as an “illness” might give free excuses to those who are racist, letting criminal offenders off the hook. It is also believed that this will take the need to address racism and its causes out of society.

Some people would rather draw a distinction and say that “symbolic” racism, the kind we would define as microaggressions, is the mark of normalcy in society (the Dec. 10, 2005 article entitled “Psychiatry Ponders Whether Extreme Bias Can Be an Illness” implied here that “society” can refer to humanity on a larger level), and that “direct” racism, exemplified in overt prejudice and hate crimes, shows a disregard of social norms and indicates mental “illness.”

I found the counterarguments to the claim that racism should not be considered a mental “illness” quite interesting as well. Some psychologists say that social norms are instrumental in defining all mental “illness,” so the argument that the population at large is inherently racist is weak in application to racism as a disorder. One psychologist, Dr. Edward Dundas, is cited in the “Psychiatry Ponders…” article referenced above as noting that pedophilia is considered a mental disorder, yet pedophiles are still prosecuted, indicating that racism's classification as a disorder wouldn't leave justice out of the equation. He also said that bias is “no less scientific” than depression. He uses depression to explain his point further, comparing the difference between “sadness” and clinical depression to the difference between ordinary prejudice and pathological bias.

It is quite possible to harbor disabling levels of prejudice. “When I see someone who won't see a physician because they're Jewish, or who can't sit in a restaurant because there are Asians, or feels threatened by homosexuals in the workplace, the party line in mental health says, 'This is not our problem,'" said Psychologist Dr. Edward Dundas. "If it's not our problem, whose problem is it?" Further support is seen in the fact that antipsychotic medication helps treat extreme prejudice, which presents like delusions and/or paranoia.

The oppression we find at the intersection of marginalized groups and identities is quite dangerous. Consider the little-mentioned fact that some assessment of “danger,” which may be based on superficial, biased or false observations of mental health professionals and administrators, can lead to the complete obliteration of a person's rights, as with involuntary institutionalization and medication, which can also lead to injury and even death. Having seen a glimpse of this, I can tell you it is a serious problem with the mental healthcare system. This in itself is a huge topic for another article, as it explosively projects violence, stigma and dangerous misconceptions.

Identity is multifaceted, and is often harmed by reductionistic tendencies rampant in our society, even among mental health professionals. It is important to identify these tendencies and to recognize them in our own behavior, as the social justice issue of mental health is truly everyone’s responsibility. Our awareness can help us reshape the way we interact with others, and, in time, a new, collective awareness may bring about the end of stigma and racism, particularly in regard to mental “illness.”