Role of Social Context in Medical Diagnosis


Metzl (2010) makes a worrisome case that psychiatry and society distorted the meaning of the schizophrenic diagnosis to unfairly characterize African American civil rights activists as suffering from psychopathology. The author examines the past relationship between racism and psychosis in the United States. The belief and emotion that inspired the term ‘Black Power’ were seen as symptoms of psychosis, much as escaping slavery was perceived as an indication of mental illness. Despite the book’s heavy focus on the past, Metzl’s (2010) findings about what might be done to reduce institutional racism in healthcare settings and psychiatric practice are insightful. An argument that the ‘cultural competency’ strategy is flawed because its ‘emphasis on the person obscures the influence of the structural’ is provided. Practicality educates clinicians to stay blind to situations in which the diagnosis and treatment fundamentally transmit racial and cultural connotations. Psychiatrists should become structurally competent and experts in system dynamics and the role of social context in medical diagnosis.

Examples of Thought-Provoking Points

The conversion of the former Ionia State Hospital for the Criminally Insane into a correctional facility is intriguing. The prison and former hospital continue to share many characteristics. Readers may attribute the abuse of Black male patients at Ionia State Hospital to the racist behavior of the psychiatrists. Metzl (2010) urges people to delve profoundly into the systemic controls that drove the behaviors of individual doctors. Racial preconceptions, tensions, and biases, according to Metzl (2010), are “structured into clinical interactions before doctors or patients enter examinations rooms (p. xi),” and they stay “embedded into the very DNA of healthcare delivery systems” (p. 202).

Schizophrenia’s false reputation has been explained in The Protest Psychosis as a black disease. An intriguing look at how the analysis, perception, and treatment of schizophrenia in the United States shifted when racial and emotional health intersected in the social climate of the late 1960s and early 1970s. Throughout the American civil rights movement, schizophrenia went from being seen as a benign disease affecting mainly White middle-class women to being linked to the dangerous behaviors of Black men. The Black community’s collective perspective on mental illness remains shaped by this association. Racial stereotypes about schizophrenia patients stem from an incomplete understanding of the African American experience. Metzl (2010) notes that “the numbers quantify how emerging anxiety about social change is embedded into emerging diagnostic language embedded into science, law, policy, and common sense” (p. 159).

The Protest Psychosis deftly links the pathologization of Black people in the healthcare system and the racist stereotype that schizophrenia is more common among African American men. This procedure depended on rhetoric that has been proven to oppress in the context of widespread skepticism about the progress toward social equality. Metzl (2010) claims that “the language of DSM delivered in 1968, was not only a bigot but instead worked as such because it unexpectedly mirrored the social pressure of the 1960s and likened fight with dysfunctional behavior” (p. 98).


The book makes a significant scholarly contribution to understanding racial issues’ impact on psychotherapy in the United States. However, its implications are far-reaching as its message, particularly regarding the mental health system’s approach to assigning diagnoses, is profound and demanding for all those involved in the field of psychiatry. It is a call to action for communities and government agencies to tailor their services and develop them from the bottom up, following local knowledge of the human condition and specific historical, cultural, and political circumstances.


Metzl, J. M. (2010). The protest psychosis: How schizophrenia became a black disease. Beacon Press.

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