02 - Diagnosing the myth of black violence - Lottie Hayton
The events of this year have in some ways expediated and improved the movement for social equality. The BLM protests, as well as perhaps the extra time people have had in lockdown has meant more varied thinking on the experience of minorities, especially Black people.
The higher rates of mortality among BAME individuals from Coronavirus (around 10-50% higher when compared to White ethnic groups, according to Public Health England), has triggered discussions about the influence of racism on medical treatment, as well as calls for more varied medical education.
The focus in this discussion to date, however, has been largely on physical treatment. This has missed larger systemic issues at play, which are reflected in the way mental health diagnoses in the UK and US differ based on race.
Synergi, a five year UK national initiative designed to rethink and transform ethnic inequalities in mental illness, has highlighted the disparities in the diagnosis of psychoses among Black people. Black African people are 5.84 times more likely to receive a diagnosis of schizophrenia than the White reference population, and 5.41 times more likely in ‘Other Black’ identifying individuals. Diagnosis of a mood disorder is 3.15 times more likely and 3.67 times more likely consecutively in these same groups.
People have previously supposed this points to a higher occurrence of schizophrenia, bipolar, other mood disorders, and their associated psychoses in Black people. Some blame for this has been attributed to greater cultural stigma among minority ethnic groups, leading people to seek treatment too late.
More recent thinking, however, has pointed to the characterisation, even demonisation of Black people, in a way which impacts their diagnoses.
There is, for example, a prevalent view which implies Black patients are more violent, and prone to cause harm than white patients. This has no basis in evidence.
Violence is also associated with mood disorders. For example, Bipolar disorder, characterised by swings in mood from mania (elevated mood, the most extreme end of which can trigger psychosis), or hypomania (a less severe form of mania), to depression is often supposed to cause violent behaviour. It has now been shown that this is more likely to do with connected substance abuse, than with the disorder itself. Nevertheless, the association remains.
There is, then, a concurrent and false association of violence with both Black people, and mood disorders and psychoses (as opposed to other mental illnesses where this link is perhaps less emphasised, although not altogether ignored). This would explain the apparent prevalence of these mood disorders amongst Black patients and might suggest that conditions are being diagnosed too quickly as a result of bias. If this is the case, it can only be contributing to a false narrative of violence.
Similarly concerning is the fact that detention under the Criminal justice system is 3.41 times more likely for Black people broadly defined in the UK; and under Sections 2 and 3 of the Mental Health Act is 3.96 times. Both types of detention imply that the response to Black behaviour is a punitive one, which can only serve to reinforce detrimental stereotypes and characterisations of Black people. In turn, this consistent reaffirmation of the message that society negatively values and characterises Black people, could further detriment their mental health.
The representation of Black males globally in the media outlines the systemic challenges we face in remedying these issues. In a small sample of local Chicago TV news from 1993-4, stories about Black people were four times more likely to include mug shots than stories about White people accused of crimes. Although a dated example, this consistent visual reinforcement of an association between Black people, violence, and crime continues today. In the games industry, for example, characters of colour are often not active or playable.
There have also been instances where sports magazines when talking about a Black or mixed race players have featured a picture of the wrong person, as in June when an article on Ellis Genge, Leicester prop featured his England teammate Lewis Ludlam, showing little regard for the individual. Similarly, in June, the BBC used an image of the wrong George Floyd (New York Jets American footballer) to illustrate the coverage of the funeral of the George Floyd from Minneapolis whose death ignited the BLM protests.
In film too, there are many examples of Black characters who are presented as macho, involved in violent activity or crime, without other dimensions to their character. The ‘Black men die first’ trope, for example Dick Hallorann in The Shining, illustrates the sidelining of characters of colour. Jada Pinkett Smith and Omar Epps in Scream 2 are killed off even before the opening credits, illustrating the extent to which Black people’s deaths are often considered insignificant, in turn implying an inferiority.
Black women and gender non-binary people face other issues around the way racist thought characterises them. These are equally pernicious, and I will do a disservice here if I try to cover them too briefly.
My focus on the Black experience was not intended to sideline the disparity in mental health diagnoses bias experienced by other racial groups. However, the way in which the demonisation of Black people contributes to misdiagnosis, mistreatment, and in turn a cycle of negative Black experience, suggests efforts to remedy the situation should be focused with most urgency here.
There have been some initiatives in medical institutions triggered by the review of the Mental Health Act in 2018. ‘Cultural competency’ training, teaching medical professionals about different cultural experiences, is one such instance. While a good place to start, this fails to take into account the need for a holistic approach to dismantling bias and damaging perceptions in society as a whole.
The social construction of a detrimental and overgeneralised view of the personalities and characters of people who belong to minority ethnic groups is something which needs to be urgently and rigorously addressed, both by individuals and institutions across all industries.
For any interested:
- resources from Synergi are good on the UK Mental Health system inequalities;
- the book ‘Black Demons: Media's Depiction of the African American Male Criminal Stereotype’ is interesting place to start on the topic of media portrayal
- Candice Brathwaite, both on Instagram, and in her book ‘I am not your Baby Mother: What It’s Like to be a Black British Mother’
- Lottie’s blog can be found here: https://medium.com/@lottie.hayton