Studies suggesting a link between minority or outsider status and psychosis run back about a century. A 1932 study looked at hospital admissions for psychosis in Minnesota. It found that Norwegian immigrants were admitted at twice the rate of native Minnesotans or Norwegians in their home country. By the 1970s, researchers were turning specifically to racial divides in psychiatric disorders, and by the 2000s, the relationship between race and psychosis (which appears to outstrip any correlation between race and more common conditions like depression) was becoming well studied in both the United States and Europe. Yet despite the mounting data, in the United States, until recently, the issue was relegated to the edges of mainstream psychiatry — or perhaps beyond the edges.
“A voice in the wilderness,” Roberto Lewis-Fernández, a professor of clinical psychiatry at Columbia University, says, describing the feeling that work on the issue was long marginalized. He and Deidre Anglin, a leading U.S. researcher into the relationship between psychosis and race, both point to the keen cultural focus on pervasive racism after George Floyd’s murder as one reason for what Anglin calls an “exponential increase in attention” to the striking racial patterns in psychosis.
Though psychiatric disorders have mostly eluded precise scientific explanations, proving too complex for brain imaging and other technology to illuminate, it’s clear that some combination of genetic and circumstantial factors contributes to psychosis. The genetic creates a predisposition. But predisposition is not disease; it is susceptibility, a shifting of the odds that is, researchers assume, equally distributed across races. Triggers are needed to profoundly alter the mind. Current explanations for the racial gaps in psychosis tend to zero in on the catalysts of discrimination, denigration and the insidious sense of helplessness — or “social defeat,” as psychiatry terms it — that racism can impose. The data is strongly suggestive, if short of proving causation. Intuitively, the link is hard to ignore. Experiences of racism seem to stir and amplify the deafening voices of self-condemnation and fears of terrible danger that can be part of the alternate realities of psychosis.
For Miller, the damning, lacerating voice started when he was around 13, on his first psych ward, where he wound up after physical abuse by his mother, a failed placement with a foster family and a spiral into suicidal thinking. On the ward, he remembers, his anger led to being locked into an isolation room and bound in restraints. He was given Thorazine, an antipsychotic that can also act as a drubbing sedative. In his childhood eyes, and in his adult analysis, his race was a big reason for such treatment. “They couldn’t see me as a kid,” he said. “I saw white kids throw furniture at the staff, do all these things that were always de-escalated, because the staff knew they would have to call the parents who would say how are you doing this to my child, whereas it seemed like me and every other Black and brown kid in that space was a foster kid, and there was no one to hold them accountable.”
It didn’t help that “the people making the decisions” — about treatment plans, privileges, discharge dates — “were all white.” Or that “the kids who were there for a long time all looked like me.” A hallucinatory voice screamed at him that staff were poisoning his water, his food. “You’re going to die. Look what you did. Nobody wants you. Get out! Get out! Get out!”