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Objectives. I tested the hypothesis that Black men with high levels of distrust (i.e., mild paranoia) are at greater risk of hospitalization for mental health problems than their White counterparts.
Methods. Secondary analysis was conducted of data from a subsample of 180 men in an epidemiological study. Mental health hospitalization was the outcome and ethnicity/race, mild paranoia, and their interaction were main predictors in a logistic regression analysis. The ethnicity/race by mild paranoia interaction tested the study hypothesis.
Results. The ethnicity/race by mild paranoia interaction was statistically significant. Contrary to the hypothesis, Black men with mild paranoia were less likely to be hospitalized.
Conclusions. Black men's lack of trust regarding the mental health system may cause them not to seek services. Factors critical to increasing their trust are acknowledgment of racial biases in the mental health system and sincere efforts to eliminate racial disparities in mental health treatment. (Am J Public Health. 2004;94:78-81)
Prevalence studies of inpatient samples have revealed that paranoid schizophrenia is a common diagnosis given to Blacks.1,2 Several researchers attribute these findings to biases associated with racial stereotypes, especially those about Black men. The stereotype that Black men are prone to violence contributes to the misdiagnosis of paranoid schizophrenia.3,4 Racial stereotypes of violence often operate at the unconscious level in mental health clinicians' diagnostic judgments about Black men.5 The racial stereotyping of Black men, which has been euphemistically labeled "racial profiling," has now been publicly acknowledged by criminal justice and other governmental agencies.6 These racist experiences or cultural stereotypes in American society and their consequences contribute to the development of what has been referred to in the past as "healthy cultural paranoia," or the more contemporary term of "cultural mistrust," on the part of Black men.7,8 Healthy cultural paranoia or cultural mistrust is Black Americans' distrust of White society as a defense against threats of racism and discrimination. Paranoia can therefore be viewed either as a symptom of psychopathology or as a type of cultural coping response in Black men.
Moreover, given the prominent role of paranoia in the diagnosis and treatment of severe mental illness, studies focusing on such symptoms are warranted. Mental health service providers must be able to distinguish between cultural and pathological aspects of Black men's coping...