Race-based misdiagnosis emerged in the context of the civil rights era of the 1960s and 1970s, when activism became equated with mental illness, says Jonathan Metzl, an associate professor of psychiatry and women's studies.
Metzl examined archives of Ionia State Hospital for the Criminally Insane and learned that black men, mainly from Detroit during the civil rights era, were taken there and often misdiagnosed with schizophrenia.
"Some patients became schizophrenic because of changes in their diagnosis rather than their clinical symptoms," said Metzl, a 2008 Guggenheim award recipient.
Events at Ionia, located in a mostly white northern Michigan community, mirrored national conversations that linked the disease with blackness, madness and civil rights, he said. Many black men came to the hospital during the Detroit riots, dramatically increasing the facility's black population.
How the psychiatric profession defined schizophrenia also changed during this period. In the 1920s-1940s, doctors considered the illness as affecting non-violent white individuals (mainly women), but later changed the language to violent, hostile, angry and aggressive as a way to label black men, he added.
"It's an easy thing to say this was racism, but it's a much more complicated story?that's still playing out in present day," said Metzl, director of U-M's Culture, Health and Medicine Program.
He noted that the criminalization of mental illness and misdiagnosis of schizophrenia meant many black men have been placed in prisons rather than psychiatric hospitals. The Ionia facility, for instance, became a prison in 1977.
Despite increased efforts for cultural competency training, over-diagnosis of schizophrenia in black men has remained.
"Multicultural training is important, but it often does little to address how assumptions about race are structurally embedded into health care delivery systems," said Metzl, whose findings appear in the new book, "The Protest Psychosis: How Schizophrenia Became a Black Disease."