The Protest Psychosis is a passionate condemnation of the relationship between psychiatric diagnosis and race. It is deliberately provocative—"the book explores the processes through which American society equates race with insanity"—with the aim, it seems, of shocking readers into recognizing their own underlying racism. The tale it tells is grim. In the early 20th century, "schizophrenia" was a problem of white middle-class women. They needed help, but above all they needed kindness, and the institutions built to house them existed not to protect others from them but to restore them to themselves. Most psychiatrists are aware that DSM-III narrowed the category of schizophrenia. Patients left within it after 1980 were sicker, crazier, and more violent than those who fit within its earlier capacious boundaries. Many may not realize that before the category was narrowed, back in the days when psychoanalysis still dominated psychiatry, African American men came to represent the problem of schizophrenia in popular culture and, arguably, in psychiatry. Advertisements for antipsychotic medications in the psychiatric journals showed angry black men or even just African tribal symbols. Metzl attributes this association to civil rights-era anxieties about racial protest, and he insists that with this history, the category of schizophrenia itself is racist: "Diagnosis is an inherently political interaction because diagnostic terminology is inherently politicizedâ¦even a correct diagnosis is always already a misdiagnosis." In electronic searches of articles in the New York Times, the Chicago Tribune, and the Los Angeles Times from the late 1950s on, "schizophrenic" and "schizophrenia" repeatedly draw associations with "Negro" and "black."