Young, Depressed, And Of Color: Why Schools and Doctors Get It Wrong

By Guest Contributor Jamilah King, cross-posted from Colorlines

Courtesy: istockphoto

Editor’s note: This is the first installment of a two-part series on people of color and mental health. Read the second part: “How to Do Right By Yourself While Saving the World”

Earlier this month, news surfaced of a Louisiana school psychologist who posted racially charged messages on Twitter. Mark Traina, who later resigned, worked as a psychologist at an alternative school in Jefferson Parish Public School System, a district that’s been under intense scrutiny in recent months. According to a court complaint filed by the Southern Poverty Law Center, Jefferson County has been sending a disproportionate number of black and special-education kids to “languish for months” in the district’s alternative schools.

Traina had already taken to Twitter to post his support of George Zimmerman, the former neighborhood watch captain charged with murdering Trayvon Martin. But back in January, Traina went on a rant against “young black thugs.” Traina, a self-proclaimed “American Civil Rights Activist who unlike Jessie (sic) Jackson and Al Sharpton presents all Americas,” tweeted that “Young black thugs who won’t follow the law need to be put down not incarcerated. Put down like the Dogs they are!”

While black children aren’t often ceremoniously “put down like dogs”, they do face harsh school punishment at much higher rates than their white counterparts. Jefferson Parish’s problems are symptomatic of a disease that’s already been diagnosed nationally: the  tendency to dole out harsher than average treatment for people of color. From the classroom to the clinician’s office, there’s a long and troubling relationship between racism and the mental health field.

Research has also shown the black students are disciplined more severely than white students, even when they commit offenses that are less serious. The National Education Policy Center at the University of Colorado reported (PDF) that more than 30 percent of black students caught using, or in possession of, a cell phone for the first time were suspended. The rate for white students who committed the same infraction was just 17 percent.

The disparity led Education Secretary Arne Duncan to lament that “the everyday educational experience for too many students of color violates the principle of equity at the heart of the American promise.”

Data released this year by the U.S. Department of Education showed that black students are three times more likely to be suspended than their white classmates. Even though black students make up just 18 percent of students nationally, they comprise 35 percent of suspensions and 39 percent of expulsions. Additionally, as Liz Dywer points out at GOOD, 70 percent of students arrested or referred to police are black or Latino.

Yet, many contend that the problem extends far beyond the classroom. When it comes to mental illness, people of color are more likely to be given more severe diagnoses than their white counterparts. In 2005, the Washington Post reported that even though schizophrenia has been shown to affect all ethnic groups at the same rate, black people in the U.S. were more than four times as likely to be diagnosed with the disorder than whites. Latinos were more than three times as likely to be diagnosed as whites.

“The way we define mental illness is slanted toward pathologizing basically angry black men,” said Jonathan Metzl, a psychiatrist at Vanderbilt University and author of the book “The Protest Psychosis: How Schizophrenia Became a Black Disease.”

There’s a deep mistrust between communities of color and the mental health field. The National Alliance on Mental Health notes (PDF) that African Americans are more likely to be misdiagnosed and, in turn, receive inadequate treatment often due to a “lack of cultural understanding.”

In 2005, the Washington Post published a wide-ranging series on the role of culture in mental illness and told the story of a case encountered by Dr. Roberto Lewis-Fernandez. While completing his psychiatry training at a hospital in Massachusetts, Fernandez encountered a suicidal 49-year-old Puerto Rican woman who begged for help to resolve a conflict with her son. The woman also said she was hearing voices, seeing shadows, and felt invisible presences. At first, the Harvard-affiliated doctors diagnosed the woman as depressed and psychotic. She was given medication and sent home.

“I wasn’t sure if she was psychotic, but I treated her as if she was,” Lewis-Fernandez told the Post.

But Lewis Fernandez, who’s also Puerto Rican, found the diagnosis unsettling and thought the hospital had misjudged the situation. He knew that, at a certain level, seeing shadows and sensing presences was considered normal in some Latino communities. After another argument with her son, the woman nearly overdosed on the medication. She was taken back to the hospital where she was re-evaluated, given a less severe diagnosis, and given help to reconcile with her son.

Race and institutional definitions of insanity share a long and troubling history. Metzl outlines in his book that in the 1850’s, American psychiatrists believed that runaway slaves suffered from an acute mental illness called “drapetomania.” The era was also littered with references to “dysaesthesia aethiopis”, a form of madness characterized by disrespect for the slaver owners’ property and best treated with extensive whipping.

In the early twentieth century, American psychiatrists thought that schizophrenia patients were largely white, middle class, and harmless to society. The disease was misunderstood as one that was deeply emotional and, in turn, associated with melancholy housewives, novelists, and poets. In 1935, Metzl notes that the New York Times speculated that many white writers demonstrated a symptom called “grandiloquence”, a propensity toward flowery prose then thought to be “one of the telltale phrases of schizophrenia, the mild form of insanity known as split personality.”

It wasn’t until the 1960’s that societal attitudes toward the disease dramatically shifted. Schizophrenia was no longer seen as harmless, but was instead a dangerous disease defined by rage and associated with the Civil Rights and Black Power movements. In 1968, while protest movements became more radical–particularly those in poor black neighborhoods–the field  of psychiatry introduced a radically new definition of the disease. That year, the Diagnostic and Statistical Manual (DSM) updated its definition. “The patient’s attitude is frequently hostile and aggressive and his behavior tends to be consistent with his delusions.”

Metzl makes the argument in his book that the change on societal attitudes was the unintended consequence of growing white anxiety about cultural and social change. And while obvious bias can’t be easily discounted, sometimes misdiagnoses are the unintended side effects of persistent cultural misunderstandings. Metzal argues that racial tensions are structured into clinical interactions long before doctors and patients meet in the exam room.

In the early 1970’s a series of influential studies established the fact that people of color were often overdiagnosed with much more severe mental illnesses than their white counterparts. When psychiatrist miss the mark so consistently, one obvious side effect is that persistent–though perhaps less severe–mental illnesses often go untreated.

Metzl notes that black men are historically underdiagnosed with illnesses like depression, anxiety, and attention deficit disorder.

“There’s a mistrust of psychiatry that I think is very well-founded. In the 1960’s we see very clearly that psychiatric experts were pathologizing Civil Rights protests, and particularly black power protests, as being insane. And it’s very hard to turn around from that and say, ‘Oh no, we made a mistake, please trust us.’ If you have a history of pathologizing legitimate political protests as mental illness, you set conditions for mistrust on both sides.”

 

  • Anonymous

    Hey, I’m Bi-Polar II as well! You don’t see as much of it, I think, as the other one.
    Um…nothing else to say, I just got excited there for a minute.

  • Japples24

    I am a person of color who is in a training program to become a school psychologist. I attend a large public university in Georgia. Based on the people in my program (and related programs) and the professors who train me, I am not surprised by what came out of the Louisiana school psychologist’s mouth. Never before in my life had I met so many seemingly well intentioned people who engage in the most racist, sexist, etc. actions. I have experienced and seen subtle racism and its after effects. Unfortunately, that kind of racism is very hard to document, and the source of much of the racism stems from what Mildred Lewis pointed out (white americans often misjudge/misread POC…and then project negative intention on the part of the POC while the white students who do the same thing get the benefit of the doubt). 
    Even more unfortunate, is the additional burden of having to defend oneself or remain silent because of the politics and power differentials (between the student and the professors/institution) or fear of retaliation (school psychology can be viewed as a niche field where everybody knows everybody else and our names truly travel with out work when we write eligibility for special education placement reports…so finding a job and keeping a job is very important and gossip or a less then favorable recommendation can weigh heavily). The counseling professors have been the worst. 

    Although there can be many benefits to special education, please be a well informed, savvy, and responsible parent when it comes to intelligence testing, counseling, and consultation with anyone involved with the education system. Ask what are the educational outcomes for the special education students that have the categorization/label (e.g., ADHD, emotionally behaviorally disturbed (EBD), learning disability, etc.) that educators/psychologists/doctors try to place on the child/student? Chances are, the person(s) you’re asking won’t know the outcomes or will not share the data with you. 

    Also ask how the child’s special education will actually happen. One reason it may not work is that a student may not get enough of the special education intervention for it to actually work (they get picked up for their special math class and by the time they sit down and receive instruction for 10 minutes, it’s time to line up and go back to their regular class). Also do some research on whether or not the intervention has been proven to work with students similar to your student (was the intervention successful on black males ages 10-15 in an urban school setting working on decoding words and reading comprehension). Check out research journals through a search engine like google and make sure the intervention is implemented correctly. Also ask what type of diploma your student may get because he/she is in a special education program…can the student use it to get into college, the military, etc.? If your student will benefit from special education, how long will he/she stay in the program? What’s your exit strategy?

    And please remember that just because someone has an advanced degree(s) that does not mean they are smart or intelligent. Please do not be intimidated by the degrees or the psychology jargon if you find yourself in an eligibility meeting. If you’re not agreeing on the educational category/classification, DO NOT SIGN ANYTHING until you ask the principal for a second opinion (the school district is legally required to pay for an independent evaluation if you disagree with the initial results so you can get an evaluation from a school psychologist/psychologist/doctor not affiliated with your school district) and you’ve given yourself time to reflect on your decision because anyone can collect data and get very different INTERPRETATIONS of it based on their training, agenda(s), etc. Link this with what Mildred Lewis said about what is basically a subconscious agenda. 

    Inform yourself, watch where you get your information from (who wrote it? how was the data collected? what are other people’s motives, how old is the information?), think for yourself, trust your gut, watch out for BS and incompetence, protect yourself and your families, and make your own choices. 

    One last thing, The National Association of School Psychologists (NASP) and the North American Education System has data that shows suspensions do not result in better behavior or school performance and holding/keeping students back a grade (“retaining a student”) does not result in academic gains/better school performance (likely due to the student receiving the same instruction that did not work for him/her the first time). 

  • http://twitter.com/TheMil10 Mildred Lewis

    This seems symptomatic of a much larger problem that I think may go beyond the intellectual.  White Americans often misidentify people of color in photographs, misjudge the ages of POC, and misread cultural cues — seeing black women with neutral expressions as hostile or Asian men as obsequious.  Some recent research like Harvard’s Implicit Association test (https://implicit.harvard.edu/implicit/demo/) suggests that this kind of differential treatment is not based solely on conscious choice. That’s going to make bias much harder to untangle than we’d hoped. A luta continua turns out to refer to the long haul.

    • Anonymous

      In our supposedly “post-racist,” “post-feminist” society (remember when we solved those problems so they went away completely?  There’s a black president!  Women make way more money than they used to!  Way to go, white men, for fixing all the problems.), these things aren’t talked about anymore.  Because we (middle-class white people) don’t talk about it, we end up ignorant and unaware of our own biases.  The hardest problem to fight is one you don’t know exists.  You’re right, it’s a tangled mess.