Changing psychiatric perception of African Americans with psychosis

In the years before the American Civil War, medical observers deemed psychosis to be rare in slaves, but common in free blacks of the North. After 1865, the prevailing psychiatric perception of African Americans was that psychosis was increasing at an alarming rate. Reasons for the increasing rates were initially ascribed to the effects of emancipation, but as researchers reported rates of psychosis to be on the rise through the first half of the 20th century, the stress of internal migration and social adversity were increasingly invoked as explanatory factors. After 1970, however, attitudes influencing the psychiatric assessment of African Americans changed profoundly. Psychiatrists no longer reported differential rates of psychosis by ethno-racial category. Observed racial differences were attributed, instead, to misdiagnosis with clinician bias emerging as the principal cause. Hence, in the new way of thinking, African Americans were over-diagnosed with psychosis, thereby creating a false impression of high rates. These changes in attitude and perception have taken place in the context of historical trends that have increasingly viewed African Americans as equal to rather than inferior to whites. Links from past to present will uncover racial stereotypes that continue to influence the psychiatric diagnosis and treatment of African Americans today. In the United Kingdom over the last forty years, high rates of psychosis were reported in Caribbean and African migrants compared to the white population (Fearon et al. 2006). Psychosis carried with it significant social stigma (Rao et al. 2007), socioeconomic decline (Silverton and Mednick 1984), increased risk of involuntary hospitalization (Morgan et al. 2004), and potentially serious treatment side effects (McCue et al. 2006); being labelled with psychosis was not something to be taken lightly. Despite the serious consequences, reasons for the high rates of psychosis in black Britons eluded discovery. To further confuse the issue, no comparable increase in rates of psychosis was reported in the large African American populations of the United States (Hutchinson and Haasen 2004). This article set out to discover why the American literature was silent on this important issue. To the author’s surprise, answers were difficult to find. Discussion of rates of psychosis in African Americans disappeared from the American psychiatric literature almost forty years ago (Jarvis, 2007). Gradually it