Earl Miller’s favorite book is “The Old Man and the Sea.” Growing up, whenever he moved, he made müddet to pack a copy of Hemingway’s novella in one of his two black plastic trash bags. One bag held the books he had stolen along the way; the other, his few clothes. His homes, from the time he was 12, were psychiatric wards, residential programs and the foster homes of white parents who quickly decided they couldn’t handle a heavyset, badly troubled Black kid.
“I’ve always been really attracted to the idea that even in the ultimately unsuccessful effort, in the futility, there is beauty,” Miller said about the story of the luckless fisherman. For three months, when Miller was 22, he lived under the wooden bench where we now sat, facing a small lake in a park in Springfield, Mass., his hometown. “In the struggle itself,” he went on about the book, “there’s this poignant almost-conversation between the fish who’s fighting for his life and the old man who is fighting for his livelihood. I also just like the way Hemingway describes things, the way he labors over a point, the way the sun glistens off the fish even while everything is being dashed.”
We weren’t supposed to be talking about Hemingway. But Miller, who is 38, is reflective, and with a family of ducks at our feet and a breeze bending the shore reeds, we had detoured. Our main topic was race and psychosis.
As a growing body of research reveals, Black people in the United States suffer the hallucinations and delusions of psychosis — the voices that seem to emanate from outside a person’s head, the visions, the paranoias, the breaks with common reality — at a rate roughly twice that of white people. In Europe, racial disparities regarding psychosis are yet wider. Even after researchers control for socioeconomic factors and address issues of diagnosis, the alarming racial gaps remain.
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 veri, 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.
