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The Crime and Illness of Being Black: Past and Present

The George Floyd killing and the perception of systemic racism.

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According to a June 11 ABC News analysis, Black people are arrested at a rate five times higher than white people. These findings were used in the analysis as evidence that American policing of Black people is different than it is for white people. These findings could have been used in the analysis as evidence that Black people were simply more likely to engage in arrestable behaviors than white people. But, arguably, a consequence of seeing the blatant killing of George Floyd sparked an enlightened shift in the way criminal occurrence, responsibility, and policing data in America are seen and interpreted.

The ABC analysis reminded me of several published articles reporting that Black people are diagnosed with schizophrenia at rates nearly five times higher than white people [1,2]. I question if this is evidence that American psychiatric diagnosing of Black people is different than it is for white people. I question whether the killing of George Floyd will result in an enlightened shift in the way psychiatric and psychological diagnosticians and analysts see and interpret findings and data about schizophrenia diagnoses in America.

More specifically, I hope they more carefully question if the elevated rates of schizophrenia diagnoses for Black people could be attributed to diagnosticians (rather than the Black person at the center of concern) and the psychiatric diagnostic system [3,4]. This is a personally difficult area of wondering and questioning because a significant part of what I do for a living is complete psychiatric diagnostic evaluations. And because I am a Black man and many of the persons for whom I’ve completed schizophrenia diagnoses are Black men too.

Much like the American policing system, the American psychiatric diagnostic system has roots in anti-Black racism. Two hundred years ago, when there was no organized policing or psychiatric diagnostic systems in this country, the beginning forms of policing and psychiatric diagnosing were being developed to address a major societal problem: Black people attempting to escape from slavery. Slave patrols, primarily made up of white men, were designated to police Black individuals who were angry with and attempting to escape slavery and recapture those who had escaped. This is because it was against the law to be angry with or escape slavery.

The slave patrol model of criminalizing certain behaviors prevalent among enslaved Black people, and chasing down, catching, arresting and physically punishing and killing lawbreakers turned out to be a foundational base for the subsequently developed armed police system that continues today, especially in dealing with Black people [5]. The pervasive racially targeted criminalization associated with the War on Drugs (the “New Jim Crow”) is a more recent example of such targeting [6]. The criminalization associated with the War on Drugs resulted in Black people being jailed, imprisoned, and killed by the criminal justice system at much higher rates than white people [7].

In 1792, Benjamin Rush, who has been called the father of American psychiatry (his sketched image is on the back cover of every Diagnostic and Statistical Manual to this day) espoused negritude, a form of leprosy, as a diagnosis based on pigmentation; recovery involved becoming white. In 1851 Samuel Cartwright coined the diagnosis of “drapetomania”—“an irrestrainable propensity to run away”—as the rampant mental illness that caused enslaved Blacks to flee captivity; the “treatment” included making running a physical impossibility by the removal of both big toes and preventing the urge to run away by “whipping the devil out of them.”

The racial profiling model of diagnosing the angry, protesting and “dangerous” behaviors of oppressed and deprived Black people as mental illness, and providing poor management interventions that frequently involved the criminal justice system, foreshadowed more contemporary discriminatory diagnosis [8]. The racial targeting associated with the DSM-II change of criteria for schizophrenia from a passive, mild condition to an aggressive, serious condition during the period of racial protests and riots 52 years ago is a more recent example of such targeting. The diagnostic criteria change resulted in Black people being diagnosed with severe and dangerous psychiatric disorders and involuntarily hospitalized, overly sedated with major tranquilizing agents, institutionalized and inadequately treated or not treated at much higher rates than white people.

I am appreciating how much the current response to the George Floyd incident is a call to open the shut-eye to systemic racism, especially against Black people. I am appreciating the current emphasis on seeing and interacting and dealing with others, especially Black people, as fully equal humans — not animals, not criminals, not illnesses, not a long list of systemic derogatory labels and terms. Further, I am appreciating the current call to identify and rectify recognized and possibly unrecognized (especially those prior to the current perception-shift) individual and systemic racist behaviors, attitudes, practices, symbols, language, and relationships. This is the time to actively divest from America’s historical enslavement of Black people, especially in our policing and psychiatric diagnosing practices. It is time to replace embellished symbols of flagrant racism and race-based criminalization and psychiatric illness diagnostic practices with humanistic approaches guaranteeing “liberty and justice for all.”

By Keith Wood, Ph.D., ABPP on behalf of the Atlanta Behavioral Health Advocates


1. Schwartz RC, Blankenship DM. Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World Journal of Psychiatry. 2014, 4: 133-140.

2. Gordon-Achebe K, Hairston DR, Miller S, et al. Origins of Racism in American Medicine and Psychiatry. In Racism and Psychiatry: Contemporary Issues and Interventions, Medlock MM, Shtasel D, Trinh NT, Williams DR (Eds.), Springer Nature Switzerland AG, 2019.

3. Citizens Commission on Human Rights. The History of ‘Scientific Racism’ in Creating Racism, Psychiatry’s Betrayal. The Citizens Commission on Human Rights, 2004.

4. Medlock M, Weissman A, Wong SS, et al. Addressing the Legacy of Racism in Psychiatric Training. American Journal of Psychiatry Residents’ Journal, 9 May 2017.

5. Turner KB, Giacopassi D, & Vandiver M. Ignoring the Past: Coverage of Slavery and Slave Patrols in Criminal Justice Texts. Journal of Criminal Justice Education, 2006, 17 (1): 181–195.

6. Alexander M. The New Jim Crow: Mass Incarceration in the Age of Colorblindness, The New Press, 2012.

7. Beckman D, Myrick KJ, Shtasel D. Mental Illness, Addiction and Incarceration: Breaking the Cycle. In Racism and Psychiatry: Contemporary Issues and Interventions, Medlock MM, Shtasel D, Trinh NT, Williams DR (Eds.), Springer Nature Switzerland AG, 2019.

8. Metzl J. The Protest Psychosis: How Schizophrenia Became a Black Disease, Beacon Press, 2010.

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