Schizophrenia: Maintaining hegemonic ideologies by silencing Black bodies

Schizophrenia has been reconstructed throughout history to be used as a form of control over individuals, to maintain social control and the status quo. The targets of schizophrenia diagnoses have changed over time to address the largest threats faced by hegemonic institutions (Metzl, 2009). In recent decades schizophrenia was reconstructed to become a violent, Black disease that is used to create the perception that Black individuals are a threat to society. Hegemonic institutions and the medical model have constructed diagnoses based on racist assumptions and have pathologized Black individuals’ adaptive reactions to discrimination (Metzl, 2009). Diagnoses have been used throughout history to frame Black bodies and their responses to discrimination as deviant (Cohen, 2016). Black individuals are more at risk of being considered deviant by resisting this discrimination and as a result are more likely to be labeled as Mad (Nagendra et al., 2023). Today, this socially constructed diagnosis leads to numerous inequalities that perpetuate the discrimination, stigmatization, and oppression experienced by Black individuals. These inequalities include barriers to education, income, housing, and social support. The labelling of Black individuals as violent threats to society puts Black bodies at a higher risk of experiencing violence and even death (Nagendra et al., 2023), which was sadly the case for Abdirahman Abdi, Pierre Coriolan and Andrew Loku (Cole, 2020). I will argue that hegemonic institutions have socially constructed schizophrenia as a violent, Black disease by pathologizing adaptive behaviors in order to use the diagnosis as a weapon for control, oppression, and discrimination, leading to unjustified violence against Mad, Black individuals who are deemed a threat to society.

Hegemonic institutions have been using the idea of mental illness and disability as a form of control for a very long time (Hon-Sing Wong & Vega, 2020, p.181; Meerai et al., 2016). Sanism is an example of this as it normalizes discrimination and violence against minority groups. Sanism operates through hegemonic and psychiatric institutions targeting minority groups whose presence threatens the dominant groups of society (Meerai et al., 2016, p. 21). A particular form of sanism is anti-Black sanism, which occurs when racism intersects with sanism to target Black people who threaten the power of white society. This construct allows hegemonic institutions to violate Black lives and justify such acts by socially constructing psychiatric diagnoses and ‘treatments’ to control them (Meerai et al., 2016, p.21). These diagnoses are a form of social control because they allow the hegemonic, psychiatric institutions to discriminate, oppress, and ultimately silence Black individuals to maintain white supremacy. This is not a new phenomenon. In 1851 the mental illness called drapetomania was created to regain control over Black slaves that tried to escape. Slaves were diagnosed with this ‘illness’ to justify using physical violence as ‘treatment’ to return slaves to their ‘normal’ state of obedience and acceptance (Hon-Sing Wong & Vega, 2020, p.188). In more recent decades schizophrenia has been used to pathologize and control Black individuals who resist the dominant ideologies of white society (Metzl, 2009). Diagnoses are not necessarily a reflection of symptoms experienced but rather a form of colonial violence used to marginalize and stigmatize those who deviate from the social norms that benefit hegemony (Hon-Sing Wong & Vega, 2020, p.199). Anti-Black sanism explains how diagnoses such as drapetomania and schizophrenia are constructed and changed over time to control Black bodies that are deemed a threat to society.

Perception of and criteria for diagnosing schizophrenia has changed over time to target those who are a threat to power and the dominant ideologies that keep certain individuals in power (Metzl, 2009). During the 1920s, schizophrenia was portrayed as a relatively harmless illness that generally affected one’s ability to think and feel (Metzl, 2009, p. xii). The primary demographics diagnosed at this time were white middle-class housewives and intellects. These groups were likely deemed a threat to the patriarchy and as a result this diagnosis was used to silence and oppress them to maintain hegemonic power (Metzl, 2009, p. xiii). However, in the 1960s during the civil rights movement there was a shift in the primary demographic diagnosed with schizophrenia and how the illness was portrayed to the public (Metzl, 2009, p. xiii). During this period, the threat to power shifted and schizophrenia was reconstructed to target and ultimately silence Black individuals. Schizophrenia was no longer a harmless illness that affected thoughts and feelings. It became a disease that was said to be expressed through rage (Metzl, 2009, p. xiii). The term ‘protest psychosis’ was used to describe how Black men would develop hostility and aggression towards white individuals after listening to civil rights leaders such as the Black Panthers or Malcolm X (Metzl, 2009, p. xiv). This is an example of how anti-Black sanism was used to diagnose Black bodies. Psychiatric institutions pathologized this behaviour not because Black individuals were a threat to themselves but because their resistance was a threat to white society (Meerai et al., 2016, p.19). During this time, the DSM-2 was released with amendments to the diagnostic criteria for schizophrenia that conveniently targeted Black individuals. The DSM did not claim that only Black individuals would be diagnosed with schizophrenia, but it did frame the disease as more violent and threatening when diagnosed in Black individuals compared to when the person was White (Metzl, 2009, p. xv). The paranoid subtype of schizophrenia was reconstructed as a disorder of hostility and aggression where behaviour was deemed to be consistent with delusions (Metzl, 2009, p. xv). This reconstruction of schizophrenia was created to disproportionately diagnose Black individuals as a way to silence their resistance and perpetuate discrimination and oppression.

Black individuals are disproportionately diagnosed with schizophrenia despite the illness being described as the most biological of all mental illnesses (Metzl, 2009, p. x). If the illness is biological, race should be irrelevant in diagnoses and schizophrenia should affect all ethnic groups equally. In reality Black individuals are diagnosed four times more than white people. During the 1980s and 1990s the paranoid subtype of schizophrenia was diagnosed five to seventimes more frequently in Black individuals than any other race (Metzl, 2009, p. xi). Racism is built into the diagnostic criteria for schizophrenia (Nagendra et al., 2023 p. 2). The diagnostic measures and assessment tools are developed by white people and in favor of white people. Various behaviours that are adaptive for Black individuals are pathologized to justify a diagnosis of schizophrenia (Neighbours et al., 2003, p. 249). Black individuals experience discrimination through overt racism such as being wrongfully terminated, and more covert everyday experiences such as being followed around a store. Experiences such as these lead Black individuals to develop adaptive behaviours (Nagendra et al., 2023, p. 2). Vague speech, blunted affect, and suspiciousness are adaptive behaviours that Black individuals use to protect themselves. However, these behaviours are pathologized and are often seen as a form of deviance resulting from paranoid schizophrenia rather than reactions to generations of oppression, violence, and discrimination (Nagendra et al., 2023, p. 2; Neighbours et al., 2003, p. 249). The medical field and psychiatric institutions cannot eliminate these racist tendencies until they consider the characteristics that are unique to specific races as adaptive and normal rather than deviant behaviours that are symptoms of an illness (Metzl, 2009, p. xi; Neighbours et al., 2003, p. 249).

Psychiatric institutions link deviance with madness and Blackness by creating definitions and diagnoses that maintain oppression and racist ideologies. Sanity and normative behaviour are aligned with the socially constructed racial status quo. Deviation is considered a threat to hegemonic ideologies and institutions. One solution to this is to label those who threaten the status quo as deviant or Mad (Metzl, 2009, p. ix). The increased rates of Black individuals being labelled as Mad is an unavoidable consequence to resisting the racial hierarchy that benefits white hegemonic ideals (Cohen, 2016, p. 175). The seriousness of an individual’s illness is not based on the impact on their own life. Rather the seriousness is based on how far their behaviour deviates from social norms and threatens hegemonic institutions (Dohrenwend & Chin-Shong, 1967, p. 427). Deviant behaviour in minority groups typically concerns aggressive and anti-social behaviour that is considered a threat to others. This leads to harsher solutions such as police brutality, stigma, oppression, and institutionalization (Dohrenwend & Chin-Shong, 1967,p. 432). Hegemonic institutions such as psychiatry label social deviants from minority groups as inherently abnormal or mentally ill. The medical model labels, incarcerates, and ‘treats’ groups who are considered deviant because they are trying to oppress their threat to power (Cohen, 2016). This was done to slaves by diagnosing individuals with drapetomania, and it is done today by disproportionately diagnosing Black individuals with schizophrenia (Metzl, 2009, p. ix). The medical model has reframed legitimate protest as deviant behaviour that is a symptom of mental illness (Hon-Sing Wong & Vega, 2020, p.189). White deviance is seen as an individual anomaly or mental illness whereas black deviance is synonymous with being a threat to society and criminality (Heitzeg, 2015, p. 202-204). Unfortunately, this idea that Mad, Black people are deviant threats to society leads to increased violations and violence against Black bodies.

Labelling Black individuals as threats to society and as mentally ill violates and harms Black bodies. This harm against Black bodies is not always physical. There are a number of risk factors associated with a diagnosis of schizophrenia including lower rates of employment, education, income, and social support (Nagendra et al., 2023, pp. 1-2). Pathologizing Black experiences and disproportionately diagnosing Black individuals with schizophrenia has been an effective way for hegemonic institutions to limit their mobility in society and perpetuate the oppression against Black bodies (Nagendra et al., 2023, pp. 1-2). Unfortunately, the social construction of schizophrenia as a Black disease leads to increased violence against Black individuals. Too frequently this violence comes from the hands of those served with protecting citizens. A disturbing statistic shows that 70% of people who were killed by police were diagnosed with a mental illness (Cole, 2020, p. 56). When mental health intersects with race then mad, Black bodies are more likely to experience police brutality (Cole, 2020, p. 56). This is a fact that is shown to be true over and over as more Mad, Black individuals are killed at the hands of police. Abdirahman Abdi, Pierre Coriolan, and Andrew Loku are men who experienced this because their Blackness, madness, and behaviour that deviated from the norm labelled them as threats, which apparently justifies such horrific violence. All these men were experiencing what witnesses considered to be mental health crises and when police arrived at the scene each of these men ended up murdered (Cole, 2020).

Abdirahman Abdi was a 32-year-old, Somali Canadian. Police were called following a disturbance and within minutes the officer had begun to beat Abdi (Cole, 2020, pp. 42-46). As Abdi tried to run to his nearby home a second officer arrived. The officers beat Abdi in the legs, chest, face, and neck until he was no longer moving. Despite being trained in life-saving strategies, the officers left Abdi unattended as he laid still in his own blood until the paramedics arrived ten minutes later. Abdi was pronounced dead the following day (Cole, 2020, pp. 42-46).

Pierre Coriolan was a 58-year-old Haitian man. Police were called to attend to a man having a mental health crisis alone in his own apartment (Cole, 2020, 54-55). An officer who was there that day says that when the police entered his apartment to find him alone on his couch, they should not have opened fire of any kind and rather should have had a single officer communicate with him (MacLellan, 2022). Instead, the multiple officers who arrived at the scene shot Coriolan with rubber bullets and a stun gun until two officers shot and killed him with live ammunition (Cole, 2020, pp. 55-56).

Andrew Loku was a 45-year-old Sudanese man and a father of five. Police were called to assist with an argument. When police arrived, Loku was in the hallway of his apartment with a neighbour. The police immediately intervened, acted violently, and murdered another Black man (Cole, 2020, p. 79).

In the cases of Abdirahman Abdi and Andrew Loku, there were neighbours engaging with the men, trying to listen and de-escalate the situation (Cole, 2020). Violence was not the immediate reaction for untrained civilians, so why should it be for those who have received training in de-escalation tactics? Desmond Cole (2020, p. 15) believes that a key part of policing is disciplining Black individuals on behalf of those in power. Unfortunately, those in power regularly justify violence against Mad, Black individuals by saying that it is the only option (Cole, 2020, p. 56). The notion that Black individuals are disproportionately Mad and therefore a threat to society leads to unnecessary violence and loss of life.

Hegemonic institutions socially constructed schizophrenia as a violent, Black disease by pathologizing adaptive behaviors in order to use the diagnosis as a weapon for control, oppression, and discrimination, leading to unjustified violence against Mad, Black individuals who are deemed a threat to society. Schizophrenia is considered by psychiatric institutions to be the most biological mental illness, and should therefore affect all races equally (Metzl, 2009, p. x). Anti-Black sanism helps explain how the increased rate of schizophrenia diagnoses within Black communities is not due to race, rather it is a result of racism built into the diagnostic processes (Meerai et al., 2016, p. 21; Metzl, 2009, p. x; Nagendra et al., 2023, pp. 1-2). This is done by creating diagnoses that specifically target Black bodies, by pathologizing behaviors that are adaptive reactions to years of discrimination and oppression (Nagendra et al., 2023, p. 2; Neighbours et al., 2003, p. 249). This reconstruction of schizophrenia as a violent Black disease has been an effective way to limit the mobility of Black individuals within society, silence their voices, and control their ability to resist hegemonic, racist, ideologies (Metzl, 2009). Unfortunately, there are numerous consequences to this racist reconstruction of schizophrenia including barriers to education, housing, income, and social support (Nagendra et al., 2023, pp.1-2). Sadly, the harm does not stop there. The socially constructed idea that Black individuals are disproportionately Mad and therefore a violent threat to society leads to unjustified violence and even the unnecessary death of Black bodies (Cole, 2020) as we have seen in the cases of Abdirahman Abdi, Pierre Coriolan, and Andrew Loku.

References

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Cole, D. (2020). The skin we're in: A year of Black resistance and power. Doubleday Canada.

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Hon-Sing Wong, E., & Vega, T. (2020). “Is that man going to be of use to Canada?" Disability as social control in immigration. In M. Daschuk, C. Brooks, & J. Popham (Eds.), Critical perspectives on social control and social regulation in Canada (pp.180-212). Fernwood Publishing.

MacLellan, A. (2022, February 16). Death of Pierre Coriolan shows police lack training, Quebec coroner finds. Canadian Broadcasting Channel. https://www.cbc.ca/news/canada/montreal/pierre-coriolan-report-1.6353562

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