Chicago author’s ‘(Mis)diagnosed’ makes the case that care for your mental health depends on where you live
Jonathan Foiles, inelegant as it sounds, is an activist therapist. That’s not an official title — he’s a Hyde Park psychotherapist and lecturer at University of Chicago Crown Family School of Social Work, Policy and Practice. But activist therapist works, too. For several years, across a pair of books and several articles for Slate and Psychology Today, he’s been advocating for a seemingly obvious practice — therapists need to more intimately consider a person’s neighborhood, history and the systemic forces at play before settling into a mental-health diagnosis. He’s written on health insurance, questioned links between mental illness and violence, pushed back against calls to replace police with social workers. But in his 2019 book “This City is Killing Me: Community Trauma and Toxic Stress in Urban America,” and his latest, “(Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health,” Foiles wants to rework the way psychology approaches mental health in disinvested neighborhoods. The following is an edited version of a longer conversation.
Q: Where in Chicago do you think people are more likely to be misdiagnosed?
A: Broadly, disinvested communities. If you overlap maps of where Rahm Emanuel closed community mental health centers with maps of where there is a lack of health care, maps of where there is a low vaccination rate, maps of where schools have been closed — it’s the same neighborhoods. So it can’t just be ‘You’re depressed and you live in a neighborhood with a lot of problems, here’s how to think differently, here’s a medication.’ There has to be an element of trying to make the city work better.
Q: Which, of course, is a broad point, but it comes from individual experiences?
A: Well, from clinical cases in which people were diagnosed with schizophrenia or bipolar disorder and have varying reactions to this — some find the diagnosis freeing, because something was wrong, and now they had a name of it, and some saw it as a death sentence. But also, as a student of psychology I was interested in hysteria, a big diagnosis for decades that seemed to disappear. Where did that go? I suspected it ended up under other names.
Q: Women were often diagnosed with hysteria.
A: That was the cliché — it usually meant being diagnosed with ‘wandering uterus.’ But males received it, too. At some point though, I was reading the (New York Times’) 1619 Project and there was a mention of a ‘mental illness’ that supposedly caused enslaved people to run. Which got me thinking in general about garbage diagnoses we don’t hear about anymore but still seem present now. Consider, historically, in 1968, there’s a change in the diagnostic criteria for schizophrenia and what’s deemed ‘anti-social behavior,’ and of course, ‘68 was a consequential year in the civil rights movement. So Black radicals are labeled with ‘schizophrenic tendencies.’ Even where I used to work (before going into private practice), you would see Black men often placed on the schizophrenic spectrum whereas white people (with comparable issues) got ‘major depression.’
Q: Not being a psychologist, how controversial is any of this?
A: Not very, I don’t think.
Q: So then do you think more therapists should be outwardly activist?
A: I am a social worker and it’s built into the ideal that you work for social justice. I understand I have more latitude in a university community in Hyde Park, but yes. There is a long-standing idea of Freud-like neutrality, of a therapist as a blank screen for a client, and we need neutrality. But there are times I don’t hesitate to say what I agree with. During the (Trump) administration, as a white guy at Mt. Sinai, a lot of people assumed I aligned with the president. Speaking up doesn’t mean ‘Yeah! (Expletive) Trump,’ but when an issue come up, I will say how I feel. To not do that is not moral.