My first psychiatrist was a white-haired white man with blue flecks in his eyes that dared to stare mine down as he told me my life was over at 20. I was a chemical engineering junior at a major state university who had completed two internships and had mapped out my future for 20 years.
He said, “You will never finish college, and you will never work.” I went back to school anyway.
The year was 1982 when he diagnosed me with schizophrenia.
Of course, there is significantly more to the story than that, but just sit with 20-year-old me and that flippant prognosis just a sec as my world dissolves.
There is reason to believe that diagnoses are given just as flippantly and immovably as this doctor’s prognosis was delivered. For African Americans, the diagnosis and subsequent overuse of antipsychotics is a longstanding inequity. According to Dr. Carmen Black in “Psychotic Misdiagnosis of Racially Minoritized Patients: A Case-Based Ethics, Equity, and Educational Exploration,” citing literature from the 1980s to the 2010s, a diagnosis of schizophrenia and/or schizoaffective disorder is rendered up to four times more for African American patients as compared to more privileged white Americans.
Thankfully, some medical schools are already surveying the problem via social justice and health equity programs in their first-year med school programs. Some of these programs touch on racial bias and trauma. This is a start and should be required, especially for psychiatry, as a person can lose track of their whole life with a wrong diagnosis and drugs that are not meant for them to take. It takes a lot of inner strength, perseverance and family support to climb and claw your way out of a hell like that.
Dr. Black, former director of Social Justice and Health Equity curriculum for Yale Department of Psychiatry and presently Vice Chair of Education, Institute of Living at Hartford Hospital and Associate Professor of Psychiatry at the University of Connecticut speculates that there’s something missing from health equity though, and it’s the statistics getting better. She says we lecture and talk about statistics, but the misdiagnoses haven’t stopped.
“We don’t have that yet,” Dr. Black says. “I want to see the outcomes change.”
In addition, she uses a cancer metaphor to drive home the need for accurate psychosis diagnoses.
“I encourage folks to think of it like cancer. Chemotherapy is rough. So, you really want to make sure that cancer is cancer before you subject someone to that. You’re biopsying, you’re going through scans, [and] you’re doing all the things we know how to do. And by the time you’re given chemotherapy and subjecting someone to the side effects, we hope you’re certain you need it. We’re not doing that for psychosis,” she says.
“[We’re] selectively doing it less for people who are racially minoritized,” she adds.
A diagnosis tends to follow a person, as well. Mine followed me for a little more than four decades while antipsychotics and mood stabilizers were placed and replaced and I vacillated to the lows of suicidal ideation because I believed what I was told, that I have a “chemical imbalance.” Since there had been no “overt” trauma in my past, I believed this until the pandemic’s quiet roused a still, small voice insistent on finding what was under all those prescription psychotropics.
Dr. Black says medical education doesn’t help physicians recognize their own mistakes, nor do they help them critically reevaluate others.
She says that physicians are taught to believe what someone else said and that medicine is fact, science, and not wrong.
“But medicine is a social science, so it’s influenced by social forces. So, we’re taking a science that can be influenced and approaching it as fact,” Dr. Black asserts.
“What that means is that once a patient of whatever identity is labelled as psychotic, healthcare providers are inclined to trust that diagnosis versus question that diagnosis,” she says.
In April 2023, with a mental health team that was amenable to detoxing Psych meds, we started finding out what was under “there” now.
No one should be saddled with a long-term diagnosis with treatment that will endanger their psychological and intellectual well-being.
Considering the centuries of angst and inhumane treatment African Americans have had to endure on these shores, it is my belief that the following points must be stressed:
- Providers must remember that history has served us the first trauma. The trauma you are set to diagnose is not the only trauma we have.
- Some amount of emotion-based response can be expected since it is carried through centuries in DNA in mothers’ wombs from the first trauma. This is scientific fact.
- Physicians need to avoid looking at any patient through the lens of the dominant culture which has set its thought processes up as reality, but especially not for Black Americans. In my opinion, dominant cultural thinking has set the need for what W.E.B. Dubois introduced long ago as “double consciousness,” which has evolved to assimilation or “playing the game” for one’s financial and social benefit. When mixed with a traumatic event, the façade would fracture like a mirror damaged by a projectile and resemble what “they” call psychosis. The drugs administered would exacerbate the problem.
- It is my belief that an African American patient should be given special consideration regarding whom they consult, based upon their temperament and cultural outlook. This attention should last through the entire process of assessing the “problem” before any diagnosis or medication. These considerations should already be in place.
- If you think these considerations are too much, then let me tell you a little story about a 20-year-old who lost more than four decades of her life, only to regain her “consciousness” after detoxing from meds.
To be sure, I do not know whether my diagnosis was mischaracterized. I do know that I was identified as “treatment resistant.” In four decades, I never got full relief. I took the on-again-off-again life of angst and suicidal ideation as normal. Detoxing didn’t bring about “better” overnight. But two years later, I’m not suicidal, paranoid or depressed every day. That’s a blessing.
It’s been 43 years since that prognosis confrontation. I “never” completed my chemical engineering degree, but I did earn a journalism degree. I worked full-time a portion of my adult life, and I have always worked in some capacity. And I like to think I ‘ve contributed to society in some form or another. I’ve authored three books and a host of work published with other entities. I am a poet/writer/speaker/mental wellness workshop creator and facilitator. I’ve worked my share of fast-food places and retail establishments.
But if there’s anything I want to stress, it’s this: Never let anyone take your humanity. Not even if they come for it with what they call an “informed diagnosis and prognosis.”
You may have to recover your humanity in stages, starting with the narrative they sold you, but recover it you must.
This MFP Voices opinion essay reflects the personal opinion of its author(s). The column does not necessarily represent the views of the Mississippi Free Press, its staff or board members. To submit an opinion for the MFP Voices section, send up to 1,200 words and sources fact-checking the included information to voices@mississippifreepress.org. We welcome a wide variety of viewpoints.