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Discrimination, Ethnicity and Psychosis

Written by Steven Coles on . Posted in Clinical Psychology Bite-Size

Discrimination, Ethnicity and Psychosis

Issue 02 – May 2008

Author: Steven Coles (steven.coles@nottshc.nhs.uk)

Key points

  • Evidence points to environmental factors rather than genetic / biological factors as the reason for the increased rate of psychosis in some ethnic minority groups. Social factors in particular have been put forward as likely.
  • Encountering discrimination seems to be related to people experiencing ‘delusional ideation’ at a later time.
  • Individual discrimination can be subtle as well as blatant. Subtle forms can be as psychologically damaging as more obvious forms.
 

Implications for practice

  • Service users should be sensitively asked about their experiences of discrimination. How and when this is done should be thought about carefully.
  • In understanding and making sense of a service user’s distress, it will be important to consider their experience of different forms of discrimination and the reality of the social worlds they live in.
  • Staff should have adequate awareness and knowledge of their own stereotypes and prejudices, so to be able to work effectively with service users who experience discrimination and racism.
  Incidence rates of psychosis, ethnicity and discrimination Studies have found an increased rate of psychosis in African Caribbean people in the United Kingdom (this is not the case in the Caribbean). A review of the hypotheses1 argues that biological variables such as prenatal and perinatal factors, and cannabis misuse do not explain the increased incidence rates. Further, the review highlights that genetic factors cannot explain the increased incidence rate as the evidence strongly points to an environmental cause.   Social factors have been suggested as important in explaining the increased rate. For example, research2 found that the rate of “schizophrenia”[a] was higher for ethnic minority people in electoral wards where they made up the smallest number.  They suggested the reasons for the higher rates of psychosis as due to increased exposure to stress / life events and less protection against stressors in smaller communities. The specific factors put forward as possible causes were discrimination, racism, alienation and isolation.   Two large community studies3, 4 in England and Wales found that people reporting ethnic discrimination were more likely to have psychosis, depression and anxiety. The studies could not differentiate which came first. However, research5 looking at people who had never experienced psychosis found that encountering discrimination predicted experiencing ‘delusional ideation’ 3 years later. This study suggests that experiencing discrimination can lead people to psychotic symptoms, rather than people with psychosis being more sensitive to perceiving discrimination.

Racism and practice

Research into discrimination and racism has also highlighted that individual acts of racism can be blatant (e.g. verbal abuse) as well as subtle (e.g. body language, tone of voice etc). Subtle forms can also be outside the awareness of the person acting in a racist manner. However, subtle forms of racism that a person themselves is unaware of, does in fact effect how they interact with others, biases decision making and it is noticeable to others (see Dovidio & Gaertner, 20046 for an introduction to this research). Further, witnessing subtle, minor and day-to-day forms of discrimination can have as great a negative effect on people as more blatant and obvious forms of discrimination8.   Given all of the above, it seems important for mental health professionals to be able to discuss issues of discrimination and racism with service users. However, the fact that racism can be subtle also suggests that this needs to done sensitively, for example it has been argued that staff who lack awareness of their own prejudices are likely to continue the oppression that service users have already faced (see Patel et al. 20009 for further discussion).  Many clinical and academic writers have also strongly argued against staff seeing service users’ perception of discrimination as ‘hypersensitivity’, particularly as ‘hypervigilance’ in an hostile social environment can be seen as adaptive.  

Summary

Research concerning the higher rates of psychosis in some ethnic groups points to the importance of social factors in the causation of psychotic symptoms, including discrimination. It is also suggested that mental health professionals need to ask about service users’ experiences of discrimination and the realities of the social worlds they live in.  

REFERENCES

  1. Sharpley, M., Hutchinson, G., McKenzie, K., & Murray, R. M. (2001). Understanding the excess of psychosis among the African-Caribbean population in England: Review of current hypotheses. British Journal of Psychiatry Supplement, 40, s60-80.
  1. Boydell, J., van Os, J., McKenzie, K., Allardyce, J., Goel, R., McCreadie, R. G. & Murray, R.M. (2001). Incidence of schizophrenia in ethnic minorities in London: Ecological study into interactions with environment. BMJ, 323, 1-4.
  1. Karlsen, S. & Nazroo, J. Y. (2002). Relationship between racial discrimination, social class and health among ethnic minority groups. American Journal of Public Health, 92, 624 – 631.
  1. Karlsen, S., Nazroo, J. Y., McKenzie, K., Bhui, K. & Weich, S. (2005). Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychological Medicine, 35, 1 – 9.
  1. Janssen, I., Hanssen, M., Bak, M., Bijl, R. V., De Graad, R., Vollebergh, W., McKenzie, K. & Van Os, J. (2003). Discrimination and delusional ideation. British Journal of Psychiatry, 182, 71 -76.
  1. Dovidio, J. F. & Gaertner, S. L. (2004). Aversive racism. Advances in experimental social psychology, 35, 1 – 52. San Diego, CA: Academic Press.
  1. Bentall, R.P.(Ed.) (1990). Reconstructing schizophrenia. London: Routledge.
  1. Essed, P. (1991). Understanding everyday racism: An interdisciplinary theory. London: Sage.
  1. Patel, N., Bennett, E., Dennis, M., Dosanjh, N., Mahtani, A., Miller, A. & Nadirshaw, Z. (Eds.) (2000) Clinical psychology, ‘race’ and culture: A training manual. Leicester: BPS Books.
[a] The current author has used the terminology employed by the authors of the articles. See Bentall (1990)7 for a critical perspective on the concept of schizophrenia.  

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