When Psychiatric Diagnosis and Culture Clash

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Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More

Two recent articles refocus attention on the serious issue of mis diagnosis in psychiatry. It is known that this can happen under any number of circumstances and for a variety of reasons. However, it is particularly disturbing when it happens as a result of cultural misunderstanding.

I. The first study was done by Jonathan Metzl, an associate professor of psychiatry and women’s studies at the University of Michigan.


Metzl examined archives of Ionia State Hospital for the Criminally Insane, located in Michigan, and learned that black men, mainly from Detroit during the civil rights era, were taken there and often mis diagnosed with schizophrenia. During the civil rights era of the 1960s and 1970s there were riots in Detroit. Many of those arrested were brought to Ionia and diagnosed with Schizophrenia.

Metzl is careful to point out that mis diagnosis of black men was not a result of racism but of a total lack of familiarity with African American Culture. In addition, the psychiatrists came from white, middle class backgrounds while the black patients were from poverty stricken areas.

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In a significant turn of events, this particular psychiatric hospital, Ionia, was converted into a prison.

Metzl points out that, today, schizophrenic patients often end up in prison, especially if they are black men. He asserts the reason for this is the continuing problem of mistaking the anger and violence of these black men as symptomatic of serious mental illness.

II. The second is an article in the Sunday New York Times Magazine section of January 10, 2010. The title is “The Americanization of Mental Illness.” The writer, Ethan Watters, states that American and Western psychiatric views are based on physiology. As a result, we rely a lot on medications as well as the notion that the problem of mental illness lies in the malfunctioning of the brain.

He states that it was hoped that this view would end the stigmatization of mental illness. Instead, it seems to have worsened that stigmatization.

From his studies, the impact of the spread of western ideas of psychiatry, not all bad or negative, has had an adverse effect. For example, people with schizophrenia who may have been assigned a particular role in the local social setting, are now becoming isolated and rejected, much like happens in Europe and the United States.

As with the first article, how we view those with mental illnesses depends a lot on our cultural understandings and biases. Here, in the west, there is a strong tendency to view the mentally ill as potentially violent and out of control. They are feared, shunned and rejected out of our fear of the unknown.

It is interesting to note that Watters cites a longitudinal study done by the World Health Organization on mental illness around the world. The findings, dating back many decades, finds that the relapse rate for schizophrenia is much less in the non western world than in the west.


There is no question that we need to change our attitudes towards mental illness, who becomes mentally ill and to cultural diversity so that we become more educated and accepting of differences.

Your comments and questions are welcome.

Allan N. Schwartz, PhD

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