Faber Sonya C, Khanna Roy Anjalika, Michaels Timothy I, Williams Monnica T
Department of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, ON, Canada.
Front Psychiatry. 2023 Feb 9;14:1098292. doi: 10.3389/fpsyt.2023.1098292. eCollection 2023.
There is a notable disparity between the observed prevalence of schizophrenia-spectrum disorders in racialized persons in the United States and Canada and White individuals in these same countries, with Black people being diagnosed at higher rates than other groups. The consequences thereof bring a progression of lifelong punitive societal implications, including reduced opportunities, substandard care, increased contact with the legal system, and criminalization. Other psychological conditions do not show such a wide racial gap as a schizophrenia-spectrum disorder diagnosis. New data show that the differences are not likely to be genetic, but rather societal in origin. Using real-life examples, we discuss how overdiagnoses are largely rooted in the racial biases of clinicians and compounded by higher rates of traumatizing stressors among Black people due to racism. The forgotten history of psychosis in psychology is highlighted to help explain disparities in light of the relevant historical context. We demonstrate how misunderstanding race confounds attempts to diagnose and treat schizophrenia-spectrum disorders in Black individuals. A lack of culturally informed clinicians exacerbates problems, and implicit biases prevent Black patients from receiving proper treatment from mainly White mental healthcare professionals, which can be observed as a lack of empathy. Finally, we consider the role of law enforcement as stereotypes combined with psychotic symptoms may put these patients in danger of police violence and premature mortality. Improving treatment outcomes requires an understanding of the role of psychology in perpetuating racism in healthcare and pathological stereotypes. Increased awareness and training can improve the plight of Black people with severe mental health disorders. Essential steps necessary at multiple levels to address these issues are discussed.
在美国和加拿大,种族化人群与白人相比,精神分裂症谱系障碍的观察患病率存在显著差异,其中黑人的诊断率高于其他群体。由此产生的后果带来了一系列终身的惩罚性社会影响,包括机会减少、护理质量低下、与法律系统的接触增加以及被定罪。其他心理状况并未表现出像精神分裂症谱系障碍诊断那样大的种族差距。新数据表明,这些差异不太可能源于基因,而更有可能源于社会因素。通过实际例子,我们讨论了过度诊断在很大程度上是如何植根于临床医生的种族偏见,并因种族主义导致黑人中创伤性应激源发生率较高而加剧的。文中强调了心理学中被遗忘的精神病历史,以帮助从相关历史背景的角度解释差异。我们展示了对种族的误解如何混淆了对黑人精神分裂症谱系障碍的诊断和治疗尝试。缺乏具有文化意识的临床医生使问题更加严重,内隐偏见使黑人患者无法从主要为白人的精神卫生保健专业人员那里获得适当治疗,这表现为缺乏同理心。最后,我们考虑了执法部门的作用,因为刻板印象与精神病症状相结合可能会使这些患者面临警察暴力和过早死亡的危险。改善治疗结果需要理解心理学在医疗保健中延续种族主义和病理刻板印象方面所起的作用。提高意识和进行培训可以改善患有严重精神健康障碍的黑人的困境。文中讨论了在多个层面解决这些问题所需的必要关键步骤。