Dr. Jonathan Metzl and The Structural Competency Conference

Last week, I had the pleasure of attending a lecture by Dr. Jonathan Metzl, a psychiatrist from the University of Vanderbilt, whose research focuses on the intersection of race, gender, and mental illness. As portrayed in his fascinating book, The Protest Psychosis, Dr. Metzl argues that historical and structural forces transformed schizophrenia from a disease that was diagnosed among white, docile females in the 1940s and 1950s, to a disease that was diagnosed among angry African American men participating in the Black Power Movement and other associated groups in the 1960s and 1970s. While the lecture was not filmed at UCLA, a similar video can be found HERE.

At the end of his lecture, Dr. Metzl described one of his new initiatives, which focuses on why teaching cultural competency to mental health professionals and psychiatrists is insufficient. Rather than focus only on sociocultural factors of patients and doctors, structural competency aims to recognize the invisible structural inequalities that shape the definition of a diagnosis.  In other words, Dr. Metzl stated it's not enough to acknowledge the race and gender of the patient and the doctor, but the racial factors of the diagnosis have to be accounted for as well.

For those interested in learning more about structural competency, Dr. Metzl is hosting a FREE day-long conference in New York City on March 23, 2012. All the details can be found here.

Changing the Definition of Mental Illness

For better or for worse, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is used as a core learning tool in social work programs across the country. Currently, I am taking a psychopathology class at UCLA where students are taught the basic criteria for differentiating groupings of mental disorders (i.e. thought vs. mood disorders), and how social workers might begin to formulate diagnoses for patients/clients in various practice settings.

In order to keep readers informed about the revisions to the DSM, I wanted to mention two of the more prominent changes expected to appear in the fifth version of the DSM, which is due out in 2013. Last November, the DSM task-force announced that 5 personality disorders will be removed. Ironically, narcissistic personality disorder will be among the personality disorders axed from the manual. More recently, psychiatrists have debated the inclusion of hypersexual disorder and compulsive gambling as official diagnoses.

As a social worker, I am disappointed in what little discussion there is regarding the role of culture in conceptualizing mental disorders in the DSM. Currently, cultural considerations are a mere afterthought in the manual, and any considerations to this issue are thrown in the appendix of the DSM. A mere 7 pages are devoted to the topic in the 943-page manual!

Because there is such a dire need to contextualize mental disorders with cultural considerations, I wanted to applaud Jonathan Metzl, a psychiatrist at The University of Michigan, who just released a new book called The Protest Psychosis: How Schizophrenia Became a Black Disease. Metzl evaluated hundreds of patient records, studies, and pharmaceutical advertisements to uncover how and why schizophrenia is over-diagnosed in African American men. I believe this is a must read for every mental health professional, and a great way to start the discussion on how and why we need to expand cultural considerations in the DSM. In the following video, Metzl explains the root cause of how Schizophrenia came to be over-diagnosed in African Americans:

How Schizophrenia Became a "Black Disease"

Capturing Mental Illness with Art

“This benefit of seeing... can come only if you pause a while, extricate yourself from the maddening mob of quick impressions ceaselessly battering our lives, and look thoughtfully at a quiet image... the viewer must be willing to pause, to look again, to meditate.” - Dorothea Lange

In order to expand my knowledge and understanding of mental illness, I am always on the lookout for powerful images that capture the internal experiences of my patients. I find the most compelling pictures to generate a deeper understanding of my patients' pain and suffering, and in turn, help deepen my empathy and respect for them.

As the above quote states, we often carelessly glance at images in our daily lives, and never take the time to ponder or contemplate their meaning or connection to the present moment. On the days where I feel calloused from the maddening nature of the inpatient unit, I find it helpful to direct my attention to a portrait or photograph to remind me of what my patients are going through.

The following is a collection of pieces from a few artists who did a wonderful job depicting symptoms and related emotions of individuals suffering from psychiatric disorders.

Jason Bard Yarmosky

"Cheerleader"

"Tight End"

Brian Lewis Saunders

"Cocaine"

"Hydrocodone, Oxycodone, and Xanax"

"Morphine"














Andres Guzman

Marion Bolognesi