July is Minority Mental Health Awareness Month . According to the website for the National Network to Eliminate Disparities in Behavioral Health, Minority Mental Health Awareness Month was started in 2008 by the US government in an effort to improve access to mental health treatments and services through public awareness. In an effort to raise awareness about BME (Black and Minority Ethnic) individuals and psychosis specifically, I wanted to blog a few facts and resources I recently learned about:
- Black people seeking mental health services are three to four times more likely than their white counterparts to be diagnosed with a psychotic disorder (Schwartz & Blankenship, 2014).
- Black patients are prescribed higher doses of antipsychotic medication than white patients (Arnold et al., 2004).
- Black patients are are more subject to polypharm prescribing practices than white patients (Chaudhry, Neelam, Duddu, & Husain, 2008).
- The pattern for over-diagnosing black people with schizophrenia been long-standing throughout the history of the United States, with the association between schizophrenia and blackness developing as a direct reaction to black protestors during the Civil Rights era (Metzl, 2010).
- Although comparative studies have not been done in the United States, the over diagnosis of schizophrenia in Afro-Caribbeans in the UK (including non-immigrants) has been the subject of marked controversy (Ayonrinde, 1996; Pinto, Ashworth, & Jones, 2008).
- Public health researchers have explored the reasons behind this over-diagnosis from a variety of angles including, cultural bias among clinicians, acculturative stress, genetic predisposition, greater cannabis-use, and other social factors, including racism and poverty (Pinto et al., 2008). It is important to note that psychosis does not occur more frequently in Afro-Caribbeans living in the Caribbean, indicating migration/immigration and sequelae as highly important (Pinto et al., 2008).
- In Haitian populations specifically, paranoia and suspiciousness have been found to be common symptoms of depression. Bibb and Casimir (1996) state that the common presence of symptoms such as persecutory delusions, suspiciousness, and paranoid ideation in depressed Haitians is a leading factor in the misdiagnosis of schizophrenia in this population.
- Irrespective of depression or other mental health issues, Bibb and Casimir (1996) state that paranoid discourse is common in Haitian clients, and has “historical, political, and religious underpinnings” (p.107). Specifically, mass intergenerational traumas of the Haitian people, including colonialism, torture by dictatorial regimes, oppression, and slavery have all led to the development of a “socio-cultural paranoia” that is not necessarily “pathological” in nature.
- Racism is a risk factor for psychosis.
- Mental Health Foundation & SurvivorResearch created a highly informative document called “Recovery & Resilience: Lessons in Healing From Black Women’s Stories” – a must read!
- Icarus Project offers a free guide called Madness & Oppression that can help inform personal wellness as well as illuminate important connections between oppression and mental health
- My Damn Mind is a harrowing interview with Alan Pean, a young black man shot by police while attempting to seek treatment for psychosis.
This year, ISPS-US’s national conference is focusing on the issue of psychosis and intersectionality. Here’s a description:
Extreme mental states and psychotic experiences occur within a context that includes a person’s unique family story, ethnicity, religion, race, socioeconomic status, gender and sexual identity, trauma experiences, and more. The attempt to isolate these states and experiences from the soil in which they grow often results in diagnosing people instead of understanding them. Yet individuals’ reactions and adaptation to the nexus of social constructs, cultural beliefs, and personal and collective histories that form the backdrops of their lives are sources of their strengths and their suffering alike. How can those who are struggling come more fully to appreciate the complexities of who they are, why they hurt, and what the possibilities might be for transformation? And how can helpers better understand the intersection of these layers of relevant factors so that assistance can be provided that truly fits the person?
ISPS has focused on psychological and social approaches to psychosis, madness, and extreme states of mind for over 50 years. The ISPS-US 16th Annual Meeting will feature a diversity of perspectives on psychotherapies, research on recovery, and theoretical developments. The points of view of experts by experience and family members will be highlighted. A main focus will be intersectionality or the interconnected nature of social identities as they relate to systems of discrimination and oppression.
Come join us in Portland November 17-19th as we discuss these complex questions.
Arnold, L. M., Strakowski, S. M., Schwiers, M. L., Amicone, J., Fleck, D. E., Corey, K. B., & Farrow, J. E. (2004). Sex, ethnicity, and antipsychotic medication use in patients with psychosis. Schizophrenia Research, 66(2-3), 169-175. doi:10.1016/S0920-9964(03)00102-6
Ayonrinde, O. A. (1996). Schizophrenia in Afro-Caribbean immigrants. Journal of the Royal Society of Medicine, 89(8), 480.
Bibb, A. & Casmir, G.J. (1996). Haitian families. In M. McGoldrick, J. Giordano, & J.K. Pearce (Eds.), Ethnicity & family therapy, 2nd edition, (pp. 97-111). New York: The Guildford Press.
Chaudhry, I., Neelam, K., Duddu, V., & Husain, N. (2008). Ethnicity and psychopharmacology. Joural of Psychopharmacology, 22(6), 673-680. doi:10.1177/0269881107082105
Metzl, J.(2011) The protest psychosis: How schizophrenia became a black disease. Beacon Press.
Pinto, R., Ashworth, M., & Jones, R. (2008). Schizophrenia in black Caribbeans living in the UK: an exploration of underlying causes of the high incidence rate. British Journal of General Practice, 58(551), 429-434. doi:10.3399/bjgp08X299254
Schwartz, R. C., & Blankenship, D. M. (2014). Racial disparities in psychotic disorder diagnosis: A review of empirical literature. World Journal of Psychiatry, 4(4), 133-140. doi:10.5498/wjp.v4.i4.133