‘‘RACE’ AND CULTURE ISSUES IN MENTAL HEALTHRACE’ AND CULTURE ISSUES IN MENTAL HEALTH&&

THOUGHTS ON IDENTITYTHOUGHTS ON IDENTITY

Suman Fernandowww.sumanfernando.com

European Centre for Migration & Social Care (MASC), University of KentDepartment of Applied Social Studies London Metropolitan University

ETHNIC ISSUES IN UKETHNIC ISSUES IN UK

Black / Ethnic Minorities more often:

Diagnosed as schizophrenic

Compulsorily detained under M.H.Act

Admitted as ‘Offender Patients’

Held by police under S. 136 of M.H.Act

Transferred to locked wards

Not referred for ‘talking therapies’

Given high doses of medication

Sent to psychiatrists by courts

Ref: Fernando, S. (2009) ‘Inequalities and the politics of race in mental health’, in S. Fernando and F.

Keating , Mental Health in a Multi-ethnic Society second edition, Routledge, London and New York

‘‘CIRCLES OF FEAR’ REPORTCIRCLES OF FEAR’ REPORT20032003

SERVICES Too coercive, lack respect, and not integrated with community

PATHWAYSDo not involve primary care and community based facilities

DISCOURSEModels of ‘mental illness’ do not acknowledge cultural diversity

SERVICE USER AND CARER INVOLVMENTPoor or non-existent

BLACK-LED INITIATIVESNot valued or supported properly

Ref. Keating et al., (2003) Breaking the Circles of Fear. A Review of the relationship between mental health services and African and Caribbean communities. (London: Sainsbury Centre for Mental Health).

‘EASTERN’

HARMONY WITH OTHER PEOPLE‘OTHER-ESTEEM’ VALUED

RELATIONSHIPS

BALANCE (‘ecological’)

KEEP OUTER WORLD CONSTANTCONFORMITY WITH SOCIETY

FREEDOM OF INNER EXPERIENCEVARIETY OF INNER EXPERIENCE

‘WESTERN’

INDIVIDUAL (SELF) SUFFICIENCY‘SELF-ESTEEM’ VALUED

PERSONAL AUTONOMY

EFFICIENCY (‘machine-like’)

KEEP INNER WORLD CONSTANTCONTROL ALTERED STATES OF C-NESS

FREEDOM OF EXPRESSION VARIETY IN BEHAVIOUR

IDEALS OF MENTAL HEALTHIDEALS OF MENTAL HEALTHDIMENSIONS OF CULTURAL DIFFERENCE

RACIST DISCOURSE IN 19RACIST DISCOURSE IN 19thth C CDo black people have higher rates of ‘insanity’ (when compared to white

people)?

------

1. (White) civilisation causes insanity

• So ‘noble savage’ is free of insanity

Supported by Tuke, 1858; Maudsley, 1867; Esquirol (Jarvis, 1852)

2. ‘Savages’ are mentally degenerate anyway (quoted by AubreyLewis, 1965)

3. Insanity levels (in US) among Blacks:

• Low when in slavery; High when set free (Anon, 1851)

Models of psychiatric pathology19th Century influences

‘Degeneration’ (Morel, 1852)

‘Born criminal’ (Lombroso, 1871)

Dementia praecox (schizophrenia)

(Kraepelin, 1896; Bleuler, 1911)[‘Depression’ as melancholia goes back to Hippocrates]

ReferencesKraepelin, E. (1896) Psychiatrie, 5th Edition. (Leipzig: Barth) Bleuler, E. (1911) Dementia Praecox or the Group of Schizophrenias. Trans. J. Zitkin (New York: International Universities

Press; repr. 1950)Morel, B. A. (1852) Traites des Mentales (Paris: Masson)Pick, D. (1989) Faces of Degeneration.: a European Disorder c. 1848-c.1918. (Cambridge: Cambridge University Press)Fernando, S., Ndegwa, D. & Wilson, M. (1998) Forensic Psychiatry, Race and Culture. (London; Routledge)Fernando, S. (2003) Cultural Diversity, Mental Health and Psychiatry. The struggle against racism. (Hove and New York:

Brunner-Routledge)Lombroso, C. (1871) White man and the coloured man; Observations on the origin and variety of the human race, PaduaLombroso, C. (1911) Crime its causes and remedies, trans. H. P. Horton, London: Hennemann.

RACIST THEORIES IN RACIST THEORIES IN PSYCHIATRY & PSYCHIATRY & PSYCHOLOGY

‘Idiots and ‘imbeciles’ suffer from ‘racial throwback’ (degeneration) to Ethiopian, Malay, American and Mongolian racial types

(John Langdon Down, 1866)

Indians, Africans and North American Aborigines are ‘adolescent races’ equivalent to children of white races (Stanley Hall, 1904)

Javanese do not get depressed or suffer from guilt – ‘psychically under-developed’ (Kraepelin, 1921)

Psyche of (white) Americans liable to be pulled down by racial infection’ of living too close to primitive black people (Jung, 1930)

RACIST DISCOURSE IN MODERN RACIST DISCOURSE IN MODERN TIMES (examples)TIMES (examples)

Africans did not get depressed because they lacked ‘sense of responsibility’ and their thinking resembled that of ‘leucotomised Europeans’ (Carothers, 1951)

Asians, Africans and African-Americans show less developed ‘emotional differentiation’ (Leff, 1973, 1977)

Racist IQ movement (Jensen, 1969) supported by Eysenck (1971,1973)

Repeated by Herrnstein & Murray (1994) and Rushton (1997)

Also noteDepression became commoner in Africans after Ghana became

independent (Prince, 1968) ‘Schizophrenics’ have better outcome in under-developed

countries (WHO, 1979)High rates of schizophrenia diagnosis among Blacks in US, UK,

Netherlands (see Fernando, 2003), ?Canada

ETHNIC ISSUES IN UKETHNIC ISSUES IN UK

Black / Ethnic Minorities more often:

Diagnosed as schizophrenic

Compulsorily detained under M.H.Act

Admitted as ‘Offender Patients’

Held by police under S. 136 of M.H.Act

Transferred to locked wards

Not referred for ‘talking therapies’

Given high doses of medication

Sent to psychiatrists by courts

Ref: Fernando, S. (2009) ‘Inequalities and the politics of race in mental health’, in S. Fernando and F.

Keating , Mental Health in a Multi-ethnic Society second edition, Routledge, London and New York

PSYCHIATRIC DIAGNOSESPSYCHIATRIC DIAGNOSES

Not objective facts but hypotheses that may or may not be useful

Distinction between ‘mental’ and most physical illnesses

Usefulness rather than validity is what matters in mental health matters

Refs:Kendell, R. E. (2001) ‘The distinction between mental and physical illness.’ British Journal

of Psychiatry, 178, 490-493. [http://bjp.rcpsych.org/vol178/issue6]

Kendell, R. & Jablensky, A. (2003) ‘Distinguishing between the validity and utility of psychiatric diagnoses.’ American Journal of Psychiatry, 160, 4-12 [abstract http://ajp.psychiatryonline.org/cgi/content/abstract/160/1/4]

SOCIAL FORCES UNDERPINNING ETHNIC STATISTICS

Conflation of medical and social control agendas in

‘psychiatry’

Medicalization of what is perceived as deviance and

difference

Political pressures to put away people considered

‘dangerous’

Social pressures & disadvantage apply differentially on

people seen as ‘the other’ racially and / or politically

Sense of alienation of ‘the other’ seen as their problem

DIAGNOSTIC MIS-PERCEPTIONSDIAGNOSTIC MIS-PERCEPTIONSinvolving ‘race’ and ‘culture’involving ‘race’ and ‘culture’

Because of

Cultural dissonance (‘culture-clash’) between psychiatry / western psychology and background of clients

Assumption of ‘objectivity’ of diagnosis / psychological assessments and certainty of western cultural thinking

Adherence to traditional ethnocentric practice with its racist history

Clinical judgements by psychologists and psychiatrists that disregard cultural difference

Disregard of service-user perceptions of ‘problems’ and diversity in expression of distress and anger

Influence of stereotypes in clinical judgement

Racist perceptions of ‘psychosis’, ‘schizophrenia’, and dangerousness

INSTITUTIONAL RACISMINSTITUTIONAL RACISM

‘The collective failure of an organisation to

provide an appropriate and professional service

to people because of their colour, culture or

ethnic origin. It can be seen or detected in

processes, attitudes and behaviour which

amount to discrimination through unwitting

prejudice, ignorance, thoughtlessness and

racist stereotyping which disadvantages

minority ethnic people’.

The Stephen Lawrence Inquiry by Sir William Macpherson (Home Department, 1999: 28)

PERSONAL IDENTITYPERSONAL IDENTITYSELF / EGOSELF / EGO

• EMPHASIS IN ‘WESTERN’ THINKING

• SEPARATE• AUTONOMOUS• IMPORTANT

• REFLECTED IN PSYCHOLOGY AS:

• SELF ESTEEM• INTEGRITY• EGO-BOUNDARIES

• REFLECTED IN PSYCHIATRY AS:

• SELF-DEPRECIATION• PASSIVITY FEELINGS• DEPENDENCY• ENMESHED

• Ref: Fernando, S. (2003) Cultural Diversity, Mental Health & Psychiatry. Brunner-Routledge, Hove & New York.

PERSONAL IDENTITYPERSONAL IDENTITYCOMMUNITY (AND FAMILY) -BASED

RELATIONSHIPS (REAL / IMAGINED)

PARENTAL (‘NOMINAL’) RELIGION

‘RACIAL’ BACKGROUND OR APPEARANCE

HISTORICAL BACKGROUND

PROFESSIONAL (OR OTHER ) ALLEGIANCE

INDIVIDUAL-BASED (PERSONAL CHOICE)OWN (CHOSEN) RELIGION / BELIEFS

LOYALTIES

VALUES

SENSE OF BELONGING (REAL / IMAGINED)

CONTEXTUALLY DETERMINED

FORCES IN SOCIETY AT LARGE (E.G. RACISM)

CATEGORISATION BY AUTHORITIES

PROFESSIONAL OR OTHER ALLEGIANCE

Refs.Sen, Amartya (2006) Identity and Violence. The illusion of destiny. London: Allen LaneAnderson, B. (1991) Imagined Communities, Reflections on the Origin and Spread of Nationalism . London and New

York: Verso.Fernando, Suman (2010) Mental Health, Race and Culture, third edition Basingstoke: Palgrave Macmillan.

Ethnic identity in a Ethnic identity in a multicultural contextmulticultural context

Flexible identity is a buffer against depression in a context of ethnic tolerance

Single strong ethnic identity protects

from depression in a context of racism

ReferencesFernando, S. (1986) ‘Depression in ethnic minorities’, in J. L. Cox (ed.)

Transcultural Psychiatry. London: Croom Helm pp. 107-138. Linville, P. (1987) ‘Self-Complexity as a Cognitive Buffer Against Stress-Related

Illness and Depression’, Journal of Personality and Social Psychology, 52(4): 663-676.

WEBSITES

•www.sumanfernando.com

• www.bmementalhealth.org.uk• http://www.criticalpsychiatry.net• www.aen.org.nz• www.spn.org.uk

Anon (1851) 'Startling facts from the census', American Journal of Insanity, 8(2): 153-5

Bleuler, E. (1911) Dementia Præcox or the Group of Schizophrenias (trans. J. Zitkin). New York: International Universities Press, reprinted 1950

Carothers, J. C. (1951) ‘Frontal Lobe Function and the African’, Journal of Mental Science, 97: 12–48.

Down, J. L. M. (1866) ‘Observations on an ethnic classification of Idiots’, Lectures and Reports from the London Hospital for 1866, reprinted in C. Thompson (ed.), The Origins of Modern Psychiatry, Chichester, England: Wiley, 1987, pp. 15-18

Eysenck, H. J. (1971) Race, intelligence and education, Temple Smith, London

Eysenck, H. J. (1973) The inequality of man, Maurice Temple Smith, London

Fernando, S., Ndegwa, D. and Wilson, M. (1998) Forensic Psychiatry, Race and Culture. Routledge, London

Fernando, S. (1986) ‘Depression in ethnic minorities’, in J. L. Cox (ed.) Transcultural Psychiatry. London: Croom Helm pp. 107-138.

Fernando, S. (2003) Cultural Diversity, Mental Health and Psychiatry. The Struggle against Racism. Brunner-Routledge, Hove, East Sussex and New York.

Gottesman, I. I. (1991) Schizophrenia Genesis: the Origins of Madness, New York: Freeman.

Herrnstain, R. and Murray, C. (1994) The Bell Curve: Intelligence and class Structure in American Life. Free Press, New York

Jarvis, E. (1852) 'On the supposed increase of insanity', American Journal of Insanity, 8: 333-64.

References

Jensen A. R. (1984) 'Obstacles, problems and pitfalls in differential psychology.' In S. Scarr (ed.), Race, social class and individual differences in I. Q., Part 5.2, Lawrence Erlbaum Associates, Hillside, New Jersey, pp. 483-514.

Jung, C. G. (1930) ‘Your Negroid and Indian Behaviour’, Forum, 83(4): 193–9.

Kraepelin, E. (1896) Psychiatrie 5th edn. Leipzig: Barth.

Kraepelin, E. (1921) Manic Depressive Insanity and Paranoia (trans. R. M. Barclay) in G. M. Robertson (ed.) Textbook of Psychiatry 8th edn. Edinburgh: Livingstone.

Kraepelin, E. (1921) Manic-depressive Insanity and Paranoia, trans. and edited R. M. Barclay and G. M. Robertson. Edinburgh: Livingstone.

Leff, J. (1973) ‘Culture and the Differentiation of Emotional States’, British Journal of Psychiatry, 123: 299–306.

Lewis, A. (1965) 'Chairman's opening remarks.' In A. V. S. De Rueck and R. Porter (eds), Transcultural psychiatry. A Ciba Foundation symposium. London: Churchill pp. 1-3.

Linville, P. (1987) ‘Self-Complexity as a Cognitive Buffer Against Stress-Related Illness and Depression’, Journal of Personality and Social Psychology, 52(4): 663-676.

Lombroso C. (1871) L’uomo bianco e l’uomo di colore: Letture sull’origine e varietá delle razze umane (White Man and the Coloured Man: Observations on the Origin and Variety of the Human Race), Padua

Lombroso, C. (1911) Crime: Its Causes and Remedies (trans. H. P. Horton). London: Heinemann.

Maudsley, H. (1867) The physiology and pathology of mind, New York: Appleton.

Morel, B. A. (1852) Traité des Mentales (Paris: Masson) cited by Gottesman (1991).

Pick, D. (1989) Faces of Degeneration. A European Disorder c. 1848-c. 1918. Cambridge: Cambridge University Press.

Prince, R. (1968) ‘The Changing Picture of Depressive Syndromes in Africa’, Canadian Journal of African Studies, 1: 177–92.

Rushton, J. P. (1990) Race differences, r/K theory, and a reply to Flynn. The Psychologist: Bulletin of the British Psychological Society, 5, 195-8

Tuke, D. H. 1858) 'Does civilization favour the generation of mental disease?' Journal of Mental Science, 4: 94-110.

WHO (World Health Organisation) (1979) Schizophrenia: An International Follow-up Study Chichester, New York, Brisbane& Toronto: John Wiley.