Implicit Bias and Mental Health – Part II: The evolution of the White housewife’s disease

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The Dallas Examiner


During the Implicit Bias and Mental Health “For the Culture” presentation by Dr. Ryan Sutton, director of Heman Sweatt Center for Black Male and Professor of Education at the University of Texas at Austin, Feb. 25, he revealed the history of schizophrenia as being first known as a White woman’s disease.


“Schizophrenia in the early 1900’s really was more so a White woman housewife’s disease,” he explained. “It was a whimsical disease. It was a nonviolent disease and most of all people in inpatient hospitals were White women diagnosed with schizophrenia because their husbands didn’t like the way they cooked. Their husbands didn’t like the way they took care of the kids. Their husbands didn’t like the way they dressed. And they are getting hospitalized because of the view and standpoints of the husband. But when you fast forward into the 1960’s, these inpatient hospitals start transforming from White women to Black men. And the idea around schizophrenia is now that it’s a violent disease that was happening in the 1960’s civil rights protests, demonstrations, so in a way it becomes a way of invalidating and silencing a whole group of people.”


Sutton then showed images from a 1900’s magazine that showed ads of psychiatric medicines, such as the psychotropic Morphine. One ad showed a White woman smiling and cooking breakfast. The caption read, “Now she can cook breakfast again.”


Another schizophrenia advertisement was for Haldol, which is also a psychotropic medication. The ad had an image of a Black man with a fist as he looked assaultive and belligerent


“What are you thinking? How are you going to perceive them, what are you going to believe about them? And how are you going to engage them?” he asked. “So what you see here is from a social political context, a greater context, there are messages that are continuously passed down implicitly and explicitly that shapes the way that you perceive, how you believe, and how you engage other people.


“When we look at things like that in 1960, we start seeing the build out of cultural mistrust that is happening within our communities, within our populations and says established things of mistrust between many communities of color and the health care professions.”


A cultural of mistrust


Sutton said the mistrust could still be noticed today with the COVID-19 vaccines when it came out.


“What’s the biggest argument you see in our communities?” Sutton asked. “Do you get the vaccine or do you not? Cultural mistrust is there. But you also see the cultural mistrust because for so long our symptoms, like our emotions, our cognitions and our behaviors, have been misconceptualized. What do I mean by that? I mean that the way people see our behavior, the way people see the verbalization from our thoughts and our emotions, they get misconstrued, they get misinterpreted, they are not done justice. And what happens from them is that we are often misdiagnosed, the idea that Black people are more inclined to receive a behavioral based diagnosis than they are receiving an affective based diagnosis.


“As a Black person you are more likely to get hit with something more like schizophrenia, you are more likely to get hit with something like antisocial personality disorder, you are more likely to get hit with something like oppositional defiant disorder or conduct disorder but your less likely to get hit with something like depression, or anxiety, or even PTSD for a reason. And we know that a lot of these may come from communities that may have triggered some PTSD in us but you won’t get hit with it too often.”


Sutton said those within the Black community are often misdiagnosis, but may also suffer from missed diagnosis.


“What I mean by that is that you have a diagnosis and it is never recognized,” he said. “It is not detected because sometimes symptoms manifest culturally so they are missed by a lot of practitioners.”


Sutton then posed the question about what people think of when they hear the word depression.


“Many of you all may think of someone who is sad, someone who is crying, someone who can’t get out of bed, someone who has low energy, but many people don’t realize that oftentimes especially in the Black community, depression could manifest as anger. Depression can manifest as a little bit of more energy in agitation,” Sutton said. “And then what happens is you see somebody with more energy and agitation and you don’t picture depression. So you hit them with something else in being defiant and that brothers and sisters is oppressed. So these misdiagnosis that we carry with us also add on to the cultural mistrust.


Affects of stereotypes


Sutton talked also about the stereotype threat.


“Living in this society you might not feel comfortable opening up about your struggles because the stereotype threat says you don’t want to endorse or perpetuate negative stereotypes of your people,” he said. So if you hear something like that angry Black woman, or that angry Black man, I am going to push that down because I don’t want to perpetuate the negative stereotypes and therefore I end up suffering because I can’t speak out about it.”


At UT Austin where Sutton teaches, he said he sees this a quite a bit.


“The first day of school, up in the student services with disabilities offices, there will be a long line of White kids outside the office with all their paperwork, saying I need academic accommodations,” he said. “I need extra time. What you don’t necessarily find is a lot of Black students in that line because the idea is they already think I don’t belong here. They already think it was an affirmative action why I got in there and it is not because I am smart enough and if I go get that extra help, it is only going to confirm the stereotypes that exist about me. So I would rather struggle, I would rather struggle in my relationships, I’d rather struggle all around in order to save face and not perpetuate another stereotype that people would see about me.”


Sutton wonders how many times that this attitude affects people in their everyday lives.


“I wonder how many times we in our fields and our everyday life we may prevent speaking up, speaking out doing so because we don’t want stereotypes throughout, we don’t want to perpetuate these negative stereotypes,” he said. “Under that is there is this sense of mistrust that I don’t feel safe enough to express this because you are going to pin me with something that I am not trying to hold onto.


Sutton also said that the cultural mistrust comes up in the reduction in service utilization. He said that the majority of mental health treatment in the Black community for African American individuals happens in the emergency rooms.


“It happens in emergency situations,” he said. “Because too often we don’t get the services, things escalate, and by the time we have to get the services, it is an extreme situation. ER, cops called, it is an extreme elevated situation. Once again, it is a little bit about the stigma but it is also the insensibility of services in our communities. It is also the inaccessibility from the physical standpoint but from the monetary standpoint. Do you have insurance? Are you underemployed? Do you not have the insurance in order to get this taken care of. Just the way this is inaccessible to us, it ends up going down to emergency rooms, and emergency services being the number one places we get treated. This cultural mistrust is built on predicated history and a continuation of certain aspects of ideologies and thoughts in social political context that kind of keeps us here.”


Bias and attribution


Sutton then said that behaviors often are conceptualized based on the bodies the behaviors emanate from.


“If you have two people who enact the same behavior depending on their race, their gender, their sex, their ethnicities, you might view that same behavior differently by these two individuals even though the actual behavior was the same,” he said.


Two things that affect these thoughts according to Sutton are bias and implicit bias and also attribution.


“How do you attribute and what do you attribute someone’s behavior to?,” Sutto said. “So where do we see this happening? Here are four areas we see this happening today: the healthcare system, my system, we have research that shows recent research shows that when they state doctors’ case studies of patients with the exact same symptoms all they did was change their gender and change their race. Their diagnosis changed and their prognosis changed. The unequal treatment document from the Institute of Medicine that came out said the belief system was that Black patients were more defiant and not cooperative with treatment and that our Black patients couldn’t afford treatment. You see the implication that it has on race. Or the idea that Black people really don’t experience depression. Or the pain tolerance for Black people is a lot higher so I might not have to be cured or listen to them as well because they are tolerant in society.”


He said these beliefs are clouding the judgement.


“So you talk about bias and attribution, what are you attributing their defiant behavior to?,” Sutton said. “How are you classifying defiant behavior? And are you really bringing your own self in what you contribute to this relationship and determining what that is. It is impacting the healthcare system.”


Next week in part III, will talk about dealing with mental health issues with in the educational system.



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