Jonathan Metzl. The Protest Psychosis: How Schizophrenia Became a Black Disease. Boston: Beacon Press, 2009. xxi + 246 pp. $24.95 (cloth), ISBN 978-0-8070-8592-9.

Reviewed by Yasushi Miyazaki (Syracuse University School of Education)
Published on H-Disability (March, 2011)
Commissioned by Iain C. Hutchison (University of Glasgow)

Journey of Matching Pieces from Desperate Historical Figures on Racism and Psychiatry

Jonathan Metzl is both a psychiatrist and a professor in women’s studies, disciplines that he combines in The Protest Psychosis in order to investigate “how race gets written into the definition of mental illness” (p. ix). In his quest, Metzl uses a vast amount of archival information, interview data, and quantitative analysis of the adjectives used in psychiatric journal articles. Focusing on Ionia State Hospital for the Criminally Insane in Ionia, Michigan, the book unravels a complex history to suggest that mental illness is a combination of its societal perception and its medical analysis.

Metzl’s book discusses the process of the transformation of schizophrenia as a disease of Caucasian (white) men and women to that of African American (black) men and women. The initial chapters review cases of Caucasian women in Ionia State Hospital for the Criminally Insane in the small town of Ionia. Statistics in the hospital’s annual reports, written by its superintendent, Perry C. Robertson, indicate that the majority of schizophrenic patients were traditionally Caucasian. Metzl analyzes the reasons why schizophrenia became a condition identified primarily in African American men by the 1960s. Although psychiatrists tried to exclude bias from their diagnostic criteria, embedded meanings in texts on this criteria may have supported bias directed at African Americans, especially as mental hospitals admitted more African American men in that era. In short, focus on schizophrenia was greater during this later period than in former times when fewer African American men were admitted and when there were also more Caucasian women patients.

How the American system engages with ethnic minorities remains relevant today, as highlighted by the massacre of thirty-two people by Seung-Hui Cho at Virginia Tech in 2007. In the aftermath of the massacre, focus was on gun laws and the background checking system, psychiatric assessments and support procedures, and privacy rights. People in the Republic of Korea experienced feelings of guilt and shame even although Cho was American-born (but of Korean descent). Incidents such as this give rise to stereotyping of ethnic minorities and different cultures. Metzl traces how ethnic minorities have been treated within the psychiatric system through the nineteenth and twentieth centuries, and how mental illness has been treated in different cultures. Metzl’s study also bears comparison with other ways in which American psychiatry has been used to pursue secondary agendas as demonstrated by Ethan Watters in Crazy Like Us: The Globalization of the American Psyche (2010). Watters’s work has a cross-cultural dimension in its examination of the American pharmaceutical industry’s vested interest in exporting American approaches to mental illnesses into other cultures.

I followed the journey woven by Metzl, with its variety of data used to create a historical perspective, as a Japanese former graduate student who studied in the United States. Metzl uses case records to depict histories of patients at Ionia, comparing Caucasian identity and American African identity. His way of sampling strengthens the cohesion of racism and psychiatric diagnosis, including research on psychiatric journal articles regarding patients with schizophrenia, and descriptive variation between Caucasian identity and American African identity. One remarkable analysis of his article research is the comparison of the number of adjectives appearing in random articles where race is unspecified or assumed “white,” and articles in specifically psychiatric journals in which race is identified as “Negro” or “black.” This analysis demonstrates that stronger words, such as “aggressive” and “violent,” are mostly exclusively used for African Americans. Yet Metzl’s findings are not based on statistical analysis. Rather, Metzl explains how social understanding of African Americans’ experience has resulted in schizophrenia patients being depicted differently because of race, noting 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).

This book strongly suggests that both racism and gender affected text and usage of diagnosis in mental illness. Furthermore, Metzl shows the importance of the historical context; this shift evolved in the midst of the civil rights movement. This is an interdisciplinary book in which historians will be deeply interested. In particular, Metzl’s disciplines of psychiatry and women’s studies are crucial tools in his painstaking review of the transformation of psychiatric diagnosis using cases in this work. Metzl urges historians and other scholars who are interested in mental illness to learn the foundations (e.g., principles and history) of psychiatry. This book focuses on schizophrenia, but scholars researching any form of mental illness can learn both from Metzl’s methodology and the consciousness that he exhibits in his book.

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Citation: Yasushi Miyazaki. Review of Metzl, Jonathan, The Protest Psychosis: How Schizophrenia Became a Black Disease. H-Disability, H-Net Reviews. March, 2011.
URL: http://www.h-net.org/reviews/showrev.php?id=29837

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