February is Black History month. As we often hear, if we don’t learn from history, we are prone to repeat it. The history of American psychiatry and Black Americans should give us renewed inspiration to reduce disparities in behavioral healthcare.
Diagnostically, there are historical lessons for us. Leading up to the Civil War, for example, there was a diagnosis termed “Drapetomania”1 that was discussed in an article published in 1851 in the Southern states. It was defined as flight-from-home madness. In other words, slaves who ran away were psychotic rather than courageous. In the Northern states at the time, the theory was widely mocked.
It’s impossible to imagine such a theory as anything but horrendous.
In modern times, studies indicate that we have diagnostic disparities to address in the Black community. For instance, studies indicate that paranoid schizophrenia is overdiagnosed in Black men particularly, and bipolar disorder and PTSD are underdiagnosed.2,3 Of course, this has treatment implications, as different medications are used for each and the prognosis is viewed as poorer for schizophrenia.
Though these problems have lessened some with an emphasis on cultural competence, we must recognize and dedicate even more resources to addressing such health disparities. Optimal care is paramount for all patient populations.
Keep in mind that Black Americans are also underrepresented in mental healthcare professions, especially psychiatry and administration. In May, the American Psychiatric Association will welcome Altha Stewart, MD, as its president. I know her well. Her current role is associate professor of psychiatry and director of the Center for Health in Justice Involved Youth at the University of Tennessee Health Science Center in Memphis.
We can look forward to Stewart effecting positive change and fostering more dialogue around new solutions for care improvements.References: 1 Cartwright S: Report on the Diseases and Physical Peculiarities of the Negro race. New Orleans Medical and Surgical Journal, 1851. 2 Bell CC, Jackson WM, Bell BH: Misdiagnosis of African-Americans with Psychiatric Issues - Part I. J Natl Med Assoc. 107(3): 25-34, 2015. 3 Bell CC, Jackson WM, Bell BH: Misdiagnosis of African-Americans with Psychiatric Issues - Part II. J Natl Med Assoc. 107(3): 35-41, 2015.