Commentary

The Perils of Reductionism

  • By Howard Fenn, MD and Kurt Miceli, MD
  • November 12, 2025

In their article, “Neighborhood Social Vulnerability and Racial Disparities in Schizophrenia Spectrum Disorder Prevalence,” Deidre Anglin and colleagues posit that disparities in schizophrenia spectrum disorders (SSDs) between the black population and non-Hispanic whites are explained by structural racism.[1] The claim is made with generalities, broadly referencing “racially inequitable policies” related to housing, education, and economic structures. Doing so unfortunately fulfills an ideologically one-sided narrative that diverts attention from medically actionable practices such as prenatal care during pregnancy and psychiatric treatment for substance use disorders. 

More specifically, in outlining “racially inequitable policies,” Anglin and colleagues reference unsubstantiated claims like “police victimization,” including two footnotes which provide no evidence linking such to the development of SSDs. They also offer a series of risk factors, including “childhood trauma, prenatal and perinatal complications induced by stress in mothers, and chronic environmental stress.” While we take no issue with exploring these variables, the connection to “structural racism” itself is not established. 

Despite this lack of clarity, the authors are quick to collect any contributor to population differences within the construct of “structural racism.” This preoccupation with a singular, overarching explanation for disease also adds a political valence to the discussion. In doing so, the authors overlook additional researchable risk factors, some of which are modifiable, including: parental age, low birth weight, obstetric complications, maternal malnutrition, maternal infections, brain structural abnormalities, and cannabis use – all of which have been related to SSDs.[2]

This study feeds a divisive narrative that neither encourages individual agency nor examines critical non-racial factors that contribute to the formation of SSDs. Its  conclusions misguide public health efforts and limit the development of targeted interventions that could address the complex interplay of genetic, behavioral, and environmental influences on mental health. Should we follow this reductionist presumption for the etiology of SSDs, we will be limiting rational and scientifically sound medical care for many individuals.

References

[1] Anglin D, et al. Neighborhood Social Vulnerability and Racial Disparities in Schizophrenia Spectrum Disorder Prevalence. Am J Psychiatry. 2025 Sep;182(9):850-860. doi: 10.1176/appi.ajp.20240906.

[2] Schmitt A, Falkai P, Papiol S. Neurodevelopmental disturbances in schizophrenia: evidence from genetic and environmental factors. J Neural Transm (Vienna). 2023 Mar;130(3):195-205. doi: 10.1007/s00702-022-02567-5. Epub 2022 Nov 12. PMID: 36370183; PMCID: PMC9660136.