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‘ RACE’ AND CULTURE ISSUES IN MENTAL HEALTH & THOUGHTS ON IDENTITY

‘ RACE’ AND CULTURE ISSUES IN MENTAL HEALTH & THOUGHTS ON IDENTITY. Suman Fernando www.sumanfernando.com European Centre for Migration & Social Care (MASC), University of Kent Department of Applied Social Studies London Metropolitan University. ETHNIC ISSUES IN UK.

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‘ RACE’ AND CULTURE ISSUES IN MENTAL HEALTH & THOUGHTS ON IDENTITY

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  1. ‘RACE’ AND CULTURE ISSUES IN MENTAL HEALTH&THOUGHTS ON IDENTITY Suman Fernando www.sumanfernando.com European Centre for Migration & Social Care (MASC), University of Kent Department of Applied Social Studies London Metropolitan University

  2. ETHNIC 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

  3. ‘CIRCLES OF FEAR’ REPORT2003 SERVICES Too coercive, lack respect, and not integrated with community PATHWAYS Do not involve primary care and community based facilities DISCOURSE Models of ‘mental illness’ do not acknowledge cultural diversity SERVICE USER AND CARER INVOLVMENT Poor or non-existent BLACK-LED INITIATIVES Not 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).

  4. ‘EASTERN’ HARMONY WITH OTHER PEOPLE ‘OTHER-ESTEEM’ VALUED RELATIONSHIPS BALANCE (‘ecological’) KEEP OUTER WORLD CONSTANT CONFORMITY WITH SOCIETY FREEDOM OF INNER EXPERIENCE VARIETY OF INNER EXPERIENCE ‘WESTERN’ INDIVIDUAL (SELF) SUFFICIENCY ‘SELF-ESTEEM’ VALUED PERSONAL AUTONOMY EFFICIENCY (‘machine-like’) KEEP INNER WORLD CONSTANT CONTROL ALTERED STATES OF C-NESS FREEDOM OF EXPRESSION VARIETY IN BEHAVIOUR IDEALS OF MENTAL HEALTHDIMENSIONS OF CULTURAL DIFFERENCE

  5. RACIST DISCOURSE IN 19th C Do 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)

  6. 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] References Kraepelin, 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, Padua Lombroso, C. (1911) Crime its causes and remedies, trans. H. P. Horton, London: Hennemann.

  7. RACIST THEORIES IN 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)

  8. RACIST DISCOURSE IN MODERN 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 note Depression 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

  9. ETHNIC 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

  10. PSYCHIATRIC 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]

  11. 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

  12. DIAGNOSTIC MIS-PERCEPTIONSinvolving ‘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

  13. INSTITUTIONAL 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)

  14. PERSONAL IDENTITYSELF / 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.

  15. PERSONAL IDENTITY COMMUNITY (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 Lane Anderson, 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.

  16. Ethnic identity in a multicultural 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 References Fernando, 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.

  17. WEBSITES www.sumanfernando.com www.bmementalhealth.org.uk http://www.criticalpsychiatry.net www.aen.org.nz www.spn.org.uk

  18. References 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.

  19. 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.

  20. 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.

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