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(Mis)Diagnosed: How Bias Distorts Our Perception of Mental Health
Jonathan Foiles, author of the acclaimed This City Is Killing Me, argues that class, race, and gender bias still influence mental health diagnoses.
Why are women more likely to be labeled borderline personalities? Is transphobia being treated as was homosexuality in the past? Has “protest psychosis,” a term used to diagnose Black men during the civil rights era, simply been renamed schizoaffective disorder? How different is our current label of “intellectual disability” from the history of eugenics? What, in other words, does it mean to be diagnosed with a “mental illness”?
In his clear, empathetic style, Jonathan Foiles, author of the critically acclaimed This City Is Killing Me, walks us through these and other troubling examples of bias in mental health, placing them in context of past blunders in the history of psychiatry and the DSM. Diagnoses are helpful but not necessary, he argues, and here he offers a pragmatic and sympathetic guide to how we might craft a better and more just therapeutic future.
Why are women more likely to be labeled borderline personalities? Is transphobia being treated as was homosexuality in the past? Has “protest psychosis,” a term used to diagnose Black men during the civil rights era, simply been renamed schizoaffective disorder? How different is our current label of “intellectual disability” from the history of eugenics? What, in other words, does it mean to be diagnosed with a “mental illness”?
In his clear, empathetic style, Jonathan Foiles, author of the critically acclaimed This City Is Killing Me, walks us through these and other troubling examples of bias in mental health, placing them in context of past blunders in the history of psychiatry and the DSM. Diagnoses are helpful but not necessary, he argues, and here he offers a pragmatic and sympathetic guide to how we might craft a better and more just therapeutic future.
176 pages, Paperback
First published January 1, 2021
11 people are currently reading
574 people want to read
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Displaying 1 - 29 of 29 reviews
October 15, 2021
This is a very easy to read and recommend book that explores the faults within our cultural understanding of mental illness. And while I think this could’ve gone more in depth in basically every way, this books is a brilliant as a way to start a conversation and I really hope this author does some form of follow up to the ideas explored in this book.
Will absolutely being buying his other work.
Will absolutely being buying his other work.
February 14, 2022
An insightful look into mental health as we see it today as opposed to ancient beliefs, labels and stigma.
“…we have seen how notions of class, race and gender have shaped psychiatric discourse from the beginning.” (Pg.73)
Subjects discussed are bipolar / homosexuality / PTSD to name a few.
Some very interesting discussions based on the author’s own experiences as a psychotherapist and University lecturer.
“…we have seen how notions of class, race and gender have shaped psychiatric discourse from the beginning.” (Pg.73)
Subjects discussed are bipolar / homosexuality / PTSD to name a few.
Some very interesting discussions based on the author’s own experiences as a psychotherapist and University lecturer.
October 3, 2021
A decent reiteration of the fact that the field of psychology and the DSM is a tremendously flawed method of organization for the wide variety of personal experiences and mental disorders. This book convincingly talks about how the field is oriented in such a way as to disproportionately negatively affect people of minority and disadvantaged backgrounds.
And I’d agree with just about everything said within. Diagnoses are transient. Circumstances dictate your state and equanimity much more than we would ever like to admit.
This is half a book, maybe a great talk at a conference. But as a book it lacked impact. Psychology is a concept. A swirling ocean of information that changes and updates over time. Thank god we don’t still do things how Freud imagined them a century ago. The things described in this book are systematic issues with the implementation of psychological principles. But the book reads like an ad hominem attack on the field itself. And while I agree with the attack, it’s lacking as a compelling book.
And I’d agree with just about everything said within. Diagnoses are transient. Circumstances dictate your state and equanimity much more than we would ever like to admit.
This is half a book, maybe a great talk at a conference. But as a book it lacked impact. Psychology is a concept. A swirling ocean of information that changes and updates over time. Thank god we don’t still do things how Freud imagined them a century ago. The things described in this book are systematic issues with the implementation of psychological principles. But the book reads like an ad hominem attack on the field itself. And while I agree with the attack, it’s lacking as a compelling book.
February 24, 2024
A decent short and sweet pop psych book that balances the reality of mental health and illness existing with the very real problems regarding it's weaponization, mishandling, misdiagnosis, stigma, systemic inequalities, etc in regards to oppressed peoples. Wish it was longer in my case. I knew a lot of stuff that was in here, but found it refreshing the way this author juggled so many things. This is definitely a book I'd hand to someone who might be newer to these topics. So many others either practically go full 'psychiatry is god' or 'mental illness doesn't exist.'
February 2, 2022
This was a very interesting, and quick, read. It is arguing that there is still a very strong bias in the mental health fields in the areas of class, gender, and race. Very compelling, and well researched. I am a patient with a lot of experience in this area, not a trained professional. With that said, I found this to be a great read, and would like to find more books in the future to expand on this topic. Definitely recommend this book.
September 3, 2024
4.5 stars
December 4, 2024
5/5
12/4/2024
Phenomenal. We need more people like Jonathan Foiles in the mental health field. Empathetic and caring with an emphasis on equity and an understanding that the DSM-V is far from perfect and largely based on research involving mostly White people and that diagnoses are helpful but should not be used to put people in strict boxes. His review of the literature and explanations of the inequities that exist in mental health care for racial, ethnic, sexual, gender, and socioeconomic minorities were outstanding, and the thought that went into when and how to insert his own opinions were noticed as he remained humble, yet confident and persuasive, throughout. As someone who works in the mental health research field, I think Foiles highlighted some of the most relevant disparities that exist and navigated intertwining example cases from his therapeutic work with recent and novel academic literature incredibly well. I will be keeping this book as a resource as I progress in my career and eventually enter the world of clinical mental health work to remind myself of the biases that exist, including within myself.
12/4/2024
Phenomenal. We need more people like Jonathan Foiles in the mental health field. Empathetic and caring with an emphasis on equity and an understanding that the DSM-V is far from perfect and largely based on research involving mostly White people and that diagnoses are helpful but should not be used to put people in strict boxes. His review of the literature and explanations of the inequities that exist in mental health care for racial, ethnic, sexual, gender, and socioeconomic minorities were outstanding, and the thought that went into when and how to insert his own opinions were noticed as he remained humble, yet confident and persuasive, throughout. As someone who works in the mental health research field, I think Foiles highlighted some of the most relevant disparities that exist and navigated intertwining example cases from his therapeutic work with recent and novel academic literature incredibly well. I will be keeping this book as a resource as I progress in my career and eventually enter the world of clinical mental health work to remind myself of the biases that exist, including within myself.
September 16, 2023
4.5 stars rounded up. A great easy reader exploring different aspects of clinical psychology and mental health and it’s relationship to social, intellectual, gender, sexuality, and racial biases. I appreciated how every chapter gave a clear and concise overview of the subject. If your deep into mental health work/reading this book might be a little surface for you- but for me, someone who typically doesn’t explore this field in my readings I enjoyed it.
Read
October 11, 2021A concise guide, beneficial to a layperson, to the cultural biases in mental health sciences.
December 13, 2023
I am once again wishful that I could own physical copies of all these cool nonfiction books I find because I would like to reference them again.
Short but insightful. As a stats girlie, I would not have minded a few more empirical data beyond the author's anecdotal experiences in the field. I can appreciate its small page count and accessible writing (having just finished Black on Both Sides: A Racial History of Trans Identity, this was a breath of fresh air) but I think there was so much more I wanted from this, and needed from this.
My starting point
Misdiagnosing is a topic I've encountered more often as I've ventured more into online mental health/disability spheres but something I am often uncomfortable discussing. I want to trust in medical professionals and listen to their opinions, however, it's silly to think they are incapable of making mistakes, being misinformed or have wrong intentions. Especially in terms of dismissing symtoms and underplaying effects when it comes to marginalized patients is a well-documented issues, so I think its important that people inside those institutions hold up a mirror to old and current practices and examine them and themselves.
Who's the author?
Jonathan Foiles is a licensed clinical social worker in private practice, a Lecturer at the University of Chicago Crown Family School of Social Work, Policy, and Practice, and Clinical Associate Faculty at the Chicago Center for Psychoanalysis. He has written for Slate and Psychology Today and this is his second published work.
What did I learn?
The basis on which most current psychology practices are based on are, at best, misguided, at worst, malicious. Yet these structures are now in place and progress is slowgoing from both a textual standpoint (e.g. updating the DSM) and from an educational standpoint (e.g. the older generations not being up-to-date when teaching the new ones).
I appreciated his inclusion of factors beyond the individual person's health (sex, race, living situation, economical status) to inform his practice and acknowledge the overemphasis of medical remedies when treating any mental illness.
His examples ranged from ADHD over Bipolar and Schizoaffective disorder to cPTSD.
This affirmed many of my beliefs on these necessary but flawed institutions.
He makes a lot of statements that I've heard to be true several times before but doesn't offer any sources. I am unsure if this is simply what is "common" knowledge in his field or if he refrained from it to appeal to a wider audience.
Additional Notes
I know need to look into the current state of multitasking because whoo, boy, I think I had a lightbulb moment.
(I should also fact-check a few of his claims just to see what I find, maybe another time?)
I truly wonder how many incorrect or flawed assumptions the average person has about any given mental illness and therapy in general. There are so many common concepts that exist in the zeitgeist that we cannot seem to shake despite having them disproven several times (e.g. Stockholm Syndrome) yet pop up again and again. How many of those do I have and how many of them come from the media?
Short but insightful. As a stats girlie, I would not have minded a few more empirical data beyond the author's anecdotal experiences in the field. I can appreciate its small page count and accessible writing (having just finished Black on Both Sides: A Racial History of Trans Identity, this was a breath of fresh air) but I think there was so much more I wanted from this, and needed from this.
My starting point
Misdiagnosing is a topic I've encountered more often as I've ventured more into online mental health/disability spheres but something I am often uncomfortable discussing. I want to trust in medical professionals and listen to their opinions, however, it's silly to think they are incapable of making mistakes, being misinformed or have wrong intentions. Especially in terms of dismissing symtoms and underplaying effects when it comes to marginalized patients is a well-documented issues, so I think its important that people inside those institutions hold up a mirror to old and current practices and examine them and themselves.
Who's the author?
Jonathan Foiles is a licensed clinical social worker in private practice, a Lecturer at the University of Chicago Crown Family School of Social Work, Policy, and Practice, and Clinical Associate Faculty at the Chicago Center for Psychoanalysis. He has written for Slate and Psychology Today and this is his second published work.
What did I learn?
The basis on which most current psychology practices are based on are, at best, misguided, at worst, malicious. Yet these structures are now in place and progress is slowgoing from both a textual standpoint (e.g. updating the DSM) and from an educational standpoint (e.g. the older generations not being up-to-date when teaching the new ones).
I appreciated his inclusion of factors beyond the individual person's health (sex, race, living situation, economical status) to inform his practice and acknowledge the overemphasis of medical remedies when treating any mental illness.
His examples ranged from ADHD over Bipolar and Schizoaffective disorder to cPTSD.
This affirmed many of my beliefs on these necessary but flawed institutions.
He makes a lot of statements that I've heard to be true several times before but doesn't offer any sources. I am unsure if this is simply what is "common" knowledge in his field or if he refrained from it to appeal to a wider audience.
Additional Notes
I know need to look into the current state of multitasking because whoo, boy, I think I had a lightbulb moment.
(I should also fact-check a few of his claims just to see what I find, maybe another time?)
I truly wonder how many incorrect or flawed assumptions the average person has about any given mental illness and therapy in general. There are so many common concepts that exist in the zeitgeist that we cannot seem to shake despite having them disproven several times (e.g. Stockholm Syndrome) yet pop up again and again. How many of those do I have and how many of them come from the media?
July 9, 2021
I’m fascinated by the challenges of mental health diagnostics. From the Rosenhan experiments (mentally well researchers checked into psychiatric hospitals) to the perpetual disappointment with new editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM,) a lot has been written about the difficulties of diagnosing disorders that largely express themselves through subjective experiences. Foiles’ book looks at how this challenge (combined race, gender, and gender identity biases) leads to differential diagnoses between various demographic groups.
The book serves as a call to action to be more aware of biases, and how they play into diagnoses. Though, in some cases it does a better job of that than in others. The six chapters present six faces of the problem: race and psychosis, race and ADHD [Attention Deficit Hyperactivity Disorder,] sex and Borderline Personality Disorder, and changing (though skewed) views of gender dysphoria, trauma, and intelligence.
Overall, I felt I learned something from the book, but sometimes it wasn’t as strong in supporting assertions and objectively presenting evidence as other times. For example, Chapter three examines how borderline personality disorder was (at least until recently) overwhelming seen as a female disorder. It went on to say that now it’s believed to have the same incidence in males, but that men present with different symptoms. To a neophyte, this sounds a lot like: “The Smiths eat meatloaf 50% of the time for dinner on Wednesday. Until recently, it was thought that the Joneses only ate meatloaf 10% of Wednesdays, but then it was discovered they also had meatloaf 50% of the time – but the Joneses meatloaf was made of ingredients such that it usually looked like chicken pot pie.] What?
For the most part, I found this book intriguing and informative, and would recommend it for those interested in the issue.
The book serves as a call to action to be more aware of biases, and how they play into diagnoses. Though, in some cases it does a better job of that than in others. The six chapters present six faces of the problem: race and psychosis, race and ADHD [Attention Deficit Hyperactivity Disorder,] sex and Borderline Personality Disorder, and changing (though skewed) views of gender dysphoria, trauma, and intelligence.
Overall, I felt I learned something from the book, but sometimes it wasn’t as strong in supporting assertions and objectively presenting evidence as other times. For example, Chapter three examines how borderline personality disorder was (at least until recently) overwhelming seen as a female disorder. It went on to say that now it’s believed to have the same incidence in males, but that men present with different symptoms. To a neophyte, this sounds a lot like: “The Smiths eat meatloaf 50% of the time for dinner on Wednesday. Until recently, it was thought that the Joneses only ate meatloaf 10% of Wednesdays, but then it was discovered they also had meatloaf 50% of the time – but the Joneses meatloaf was made of ingredients such that it usually looked like chicken pot pie.] What?
For the most part, I found this book intriguing and informative, and would recommend it for those interested in the issue.
April 22, 2024
Could have been a bit more… ‘something’ felt lacking here. A few times I was left in the middle of some sections feeling like the author was almost implying that some neurotypes or Mental Disorders did not really exist. A soft implication hung overhead that left the subtle feeling that all perceived “disorders” are more a social/cultural construct; this is somewhat of an interesting idea, but the book doesn’t actually explore this, only implies some historical context of how prejudice has often greatly impacted certain marginalized people for their differences, and upheld discrimination by means of “insanity” during times of socio-demographic transition. I found the account informative and intriguing, but still wished there was more of a point/greater goal of the thought process. This felt like a psychologist just putting some ideas out on paper, and the greater analysis is still to come.
July 3, 2022
A very insightful and compelling assessment of the social influences on mental health, both from the perspective of the causes and the misdiagnoses made by health care practitioners. However, at times it veers a bit into rhetoric against the biologic basis of mental health conditions, and doesn't seem to recognize that our lack of knowledge of the brain's biology doesn't translate into biology being excluded as a cause of the disorders. At other times, the author acknowledges his bias and is able to address it. Overall, this is certainly worth reading if you have an interest in mental health, and especially the biopsychosocial model of disease.
December 12, 2022
Extremely well done.
Foiles lays it out well-- mental health diagnoses are fundamentally different from other medical diagnoses, are subjective and descriptive, are a short hand for symptoms rather than a diagnosis of some specific, actual thing-in-itself. That is not a bad thing, and diagnoses aren't just a bunch of BS, but the subjective nature of mental health diagnoses makes them susceptible to abuse and to unconscious bias. Foiles details many of these abuses and urges us to understand the concerns he presents without simply throwing away all the good that goes on in the field.
Picked this up more or less at random, very glad I did.
Foiles lays it out well-- mental health diagnoses are fundamentally different from other medical diagnoses, are subjective and descriptive, are a short hand for symptoms rather than a diagnosis of some specific, actual thing-in-itself. That is not a bad thing, and diagnoses aren't just a bunch of BS, but the subjective nature of mental health diagnoses makes them susceptible to abuse and to unconscious bias. Foiles details many of these abuses and urges us to understand the concerns he presents without simply throwing away all the good that goes on in the field.
Picked this up more or less at random, very glad I did.
December 31, 2022
i think this book could include a lot more things that would make it feel more like it had A Thing To Say, but it's a good introduction to how systems of oppression intertwine with psychology/psychiatry. i'm not sure i agree with all the premises or conclusions, i think it does end up at a conclusion that is more pro-psychology than the rest of the book supports. at the start, psychiatric abolition is already dismissed, and i would have liked to see reasons other than "well it's just common sense, it goes too far" for it. refreshing change from my psychology degree though
October 10, 2021
This is a fairly quick, thought provoking discussion of how an understanding of mental health that focuses on identifying and naming certain disorders can invite systemic bias in terms of what behavior we pathologize and what behavior we do not. Instead the author says psychiatrists should focus just on the patient and what their needs are. The information can be a little dense at times, but I did really find myself learning a lot and thinking about things in a new way.
November 17, 2021
This is surprisingly radical, for professor of psychiatry. I really liked it, and I like his many personal examples of patients he had experiences with to support the more abstract points he was making. Time and perspective and presumptions change how we look at people, and of course, their brains - which seems like common sense, but it's great to see the phenomenon explained and challened in detail.
June 12, 2023
It's ironic that a book about biases is itself utterly biased. While the book has a considerable amount of worthwhile content, it seems to drink the cool-aid of contemporary culture, making it the ultimate arbiter of what is normative. A short field trip through history reveals that those are very shaky foundations on which to establish "truth."
December 31, 2023
A really good reminder of how flawed the DSM can be and how problematic the mental health system is. A reminder for those of us working in mental health that we can't just look at the diagnosis and it is impossible to expect positive change when people are not supported by their communities or have support networks or even have access to resources.
July 13, 2021
Great and accessible overview of history of bias in psychology. Its briefly review all the way from pre civil war to borderline that more frequently is attributed to women behaviors. Would highly recommend it looking for some reference material about CRT for other areas of focus.
January 13, 2024
Insightful, thought provoking, easy read. I found the authors views to be relatable and a lot made sense. Some concepts seemed to be a stretch to me, but it’s a good reminder about focusing less on the label and more on the person.
February 5, 2024
3.5/5 - Bom mas muito expositivo. Apresenta o problema (o quanto a psicologia é injusta e vulnerável a preconceito dos próprios profissionais e da sociedade que eles estão inseridos) mas nao se aprofunda em alternativas para esse sistema vigente
June 9, 2022
Excellent: concise, yet evidenced and thoughtful, this book explores how the dark shadows in the DSM's history have current strongholds. A compelling and necessary book.
December 28, 2025
Great insight into the current issues with mental health classification and the history of oppressive measures that have led us here.
March 14, 2024
“I used to picture placing all of the accused information I had received regarding a client on the little shelf behind my head while I was in session. It was there if I needed it, but it didn’t and couldn’t get in the way of listening to them.”
I think this author does a great job of listing the ways that bias can impact clinical practice. He provides specific examples of how bias can interfere with client-centered perspective. I really appreciate the ways that he explores the history of where those biases came from, and particularly notes the voices of other professionals at the same time period who simply were not recognized, often due to other, separate biases. I absolutely love both of Foiles’ books, although I would argue that this is definitely more of a clinical-oriented book than This City Is Killing Me.
I think this author does a great job of listing the ways that bias can impact clinical practice. He provides specific examples of how bias can interfere with client-centered perspective. I really appreciate the ways that he explores the history of where those biases came from, and particularly notes the voices of other professionals at the same time period who simply were not recognized, often due to other, separate biases. I absolutely love both of Foiles’ books, although I would argue that this is definitely more of a clinical-oriented book than This City Is Killing Me.
January 2, 2025
There’s a lot more to say about this topic, yet Foiles elegantly covers a surprising amount of ground in this short yet insightful read. An absolutely worthwhile read for anyone who has ever worked in/received support from the fields of psychology, social work, and human services.
November 19, 2024
This was excellent!
Displaying 1 - 29 of 29 reviews