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The shocking link between racism and schizophrenia

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Research suggests that both first and second-generation migrants are up to five times more likely to be diagnosed with schizophrenia in the UK than white British people. On World Mental Health Day, Nick Harvey argues there is increasing evidence that racial discrimination within society is to blame.

Photo by Sultan al-marzoqi under a CC Licence.
Photo by Sultan al-marzoqi under a CC Licence.

Jean fled to the UK from Rwanda in 2001. Most of his family had been massacred in the 1994 genocide. The UK was to be a fresh start for him and his wife and children. He expected people to be welcoming. What he found was something different.

‘People would call us niggers, pakis and names like this. Lads would pelt our house with stones and the police would do nothing,’ he says. ‘We were continually harassed by the locals. If my children wanted to go to the park, the other children would turn them away and say no, go back to where you come from.’

While it is easy to see how this sort of abuse would cause someone to become angry, anxious or depressed, there is increasing evidence that discrimination is a trigger for much more serious mental health problems among migrants.

‘If people feel racially discriminated against, even in a small amount, chronic stress can occur which can then lead to full-blown psychosis in some cases,’ says Susham Gupta, consultant psychiatrist, and co-editor of Migration and Mental Health (2011).

Each year, one in eight people from an ethnic minority are the victims of racial harassment in the UK, with many more reporting what is known as ‘everyday discrimination’.

And with research also suggesting that, depending on the circumstances, a migrant is up to five times more likely to be diagnosed with schizophrenia than a white British person, many are beginning to link the two.

Dubious theories

Rather dubious theories have been put forward by psychiatrists in the past regarding the high levels of schizophrenia among migrants. These included there being higher rates of mental illness in the countries migrants had left, that some races are genetically predisposed to problems, or even that drug use among migrants acts as a trigger. All of these have been found to be baseless upon further interrogation.

'The risk of schizophrenia actually goes up for second-generation migrants and this kind of rules out that it has something to do with the shock of migration'

There has been some focus on migrants’ difficulties in adjusting to a new culture as the possible cause – such as language problems, homesickness and lack of support networks – but in fact rates of mental illness, particularly schizophrenia, are even higher in second-generation migrants who are born in the UK.

‘We see a pattern in many studies from all over the world where the risk of schizophrenia actually goes up for second-generation migrants and this kind of rules out that it has something to do with the shock of migration or that they were having problems before they came,’ says Elizabeth Cantor-Graae, associate professor at Lund University in Sweden and author of several ground-breaking studies in mental health and migration.

The reason some mental health problems are even higher in second-generation migrants, she says, could be that the rejection comes from a society they were born in, that is all they’ve ever known.

‘It is very important in human development that not only can you recognize your place in the social context but that you are accepted within it and that’s why this experience of being rejected by the group can be so distressing,’ says Cantor-Graae. ‘And this is particularly true for second-generation immigrants who really feel it is their country, they are going to the same schools, applying for the same jobs and one day, as young adults, they realize that they’re not getting the same job interview opportunities as their housemates who don’t have foreign-sounding names.’

'The stress of not being included in society can have an adverse effect on the brain itself if it takes place over a long period of time'

It has also been suggested that the higher rates of mental illness could be due to a racist or culturally biased medical system. Yet while the misdiagnosis of migrants could indeed inflate the figures, studies which have used mental health professionals from the same ethnic background as the patients seem to suggest that this is not the root cause.

But schizophrenia is a serious condition that involves major structural changes to the brain and, once you have it, you have it for life. So what is it about being discriminated against that could lead to the onset of such a massively debilitating illness? This is where many psychiatrists come unstuck.

Social defeat

One explanation that has been put forward is the ‘social defeat hypothesis’, which argues that the distress a migrant feels on being rejected by the people in the country they move to − whether social, educational and vocational − can actually cause changes in the brain that can then develop into full psychosis.

‘If migrants are exposed to what we call social defeat, and it’s not just any kind of stress, it’s a very specific stress of not being included in society, then this could indeed have a very adverse effect on the brain itself if it were to take place over a long period of time,’ says Cantor-Graae.

Refugees and asylum seekers are particularly vulnerable to a wide range of mental health problems as they not only face discrimination but the arduous asylum procedures they must go through on arrival can exacerbate any traumas they may have suffered in the past.

With deep cuts being made to services for refugees, including a 62-per-cent reduction in the budget of the Refugee Council, many fear that the stresses this group experience will only become worse.

‘The organizations that help ease our situation and set up activities and get-togethers for us are closing down. Even legal aid for refugees may be stopping, which is having a massive impact on refugees and their mental health,’ says Jean. ‘I don’t know how I would have survived without some of these organizations for guidance and help. I might have gone over the edge without them.’

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  1. #1 Andrew Finegan 10 Oct 11

    All the politicians in Australia should read this.

  2. #2 Tom Ash 10 Oct 11

    There is a theory that schizophrenia is linked to Vitamin D deficiency, which is naturally higher among immigrants coming from, say, Eritrea, to say, England. Some findings suggest that the link is stronger when pregnant mothers are Vitamin D deficient, which might explain the higher rates of schizophrenia among second-generation migrants that you mention.

    IANAS (I am not a scientist), so my sources for this are second hand. However there is an article titled 'Hypothesis: is low prenatal vitamin D a risk-modifying factor for schizophrenia?' by J McGrath (Schizophr Res, 40, 173-7).

  3. #3 serendipity 10 Oct 11

    Outstanding article covering a vital issue.

  4. #4 Nick Harvey 10 Oct 11

    Hi Tom, although I can see how it is tempting to neatly associate migration-related schizophrenia with vitamin D deficiency, the theory has a lot of gaps.
    Off the top of my head I can think of quite a few studies where migrants from different sunny countries travel to northern Europe but face different amounts of discrimination and have different rates of schizophrenia, for example Veling (2006) who looked at Moroccan, Turkish and Surinamese migrants moving to The Netherlands.
    There's also studies where migrants move from a hot country to another hot country or a cold country to another cold country but still have raised rates of schizophrenia, for example Cantor-Graae (2003), who found high levels of the illness among people from Greenland who migrated to Denmark (people from Greenland look different from Danes and are often discriminated against there).

  5. #5 Tom Ash 11 Oct 11

    Thanks Nick, that's interesting. Of course, causation is rarely all or nothing, and Vitamin D deficiency might explain some of the prevalence of schizophrenia but not all. However, my impression is that it's not a very strongly confirmed theory. I can give you some more citations if you want (my girlfriend wrote a dissertation for work on Vitamin D), though it's probably not really your field!

  6. #6 Saleh 11 Oct 11

    A sound article!

  7. #7 onedaywonder 12 Oct 11

    Thank you for this article which explains a lot. I would suggest that this link extends to all people suffering chronic stress as a result of social exclusion whether they are of migrant origin or not. I have personal experience of a friend who just could not cope with the hardening of social attitudes towards people who receive benefits and who withdrew into his own world to the extent that he developed psychosis and grew suicidal. It is heartbreaking to see how careless tough talk can damage vulnerable people.

  8. #8 Nick Harvey 12 Oct 11

    Hi Onedaywonder, I think you have a very good point there.
    As Cantor-Graae says in the piece: 'it is not just any kind of stress, it's a very specific stress of not being included in society' and that can indeed be extended to many other groups.
    Psychiatrists I've spoken to argue that poverty and low status put people at the biggest disadvantage in terms of mental health irrespective of whether they are migrants or not. It's just that with some migrant groups the rates seem particularly inflated, especially for schizophrenia.

  9. #9 G 12 Oct 11

    Great piece, and an important subject.

    This ’social defeat’ that you mention is spot-on. And discrimination, as someone else has pointed out, does not necessarily have to do with race or ethnicity or sexuality or gender or any of the other ’usual suspects’, if I may use this cliche - it can be as simple as being constantly rejected (even if not overtly) because of one's ’otherness’, which can be anything. A foreign accent is enough. One can try to ’fit in’ as much as they wish, but if the host population does not consider those who were born elsewhere as equally worthy, then the situation will only get worse.

    And if possible, could you please elaborate on those changes in the brain you mention? This is very serious..

  10. #10 Nick Harvey 12 Oct 11

    Thanks G, nice round-up. In terms of the actual biological changes in the brain, I have to repeat Tom earlier and say ’IANAS’ (I am not a scientist).
    If you click on the hyperlink in the article for 'social defeat hypothesis' you can access the study which says that an increased risk of schizophrenia, '..may result from sensitisation of the mesolimbic dopamine system and/or increased baseline activity of this system.'
    If that means anything to you! From what I can gather, this is just a theory at the moment which is difficult to prove as much of the actual brain research has only been done on animals.
    Scientists still do not know for sure what causes schizophrenia. But what they do know is that schizophrenia involves major changes to the brain and that rates of schizophrenia are much higher in some migrant groups, so scientists are really hoping that studies into migration-related schizophrenia will give them some insight into the causes of schizophrenia itself.

  11. #11 Kulang 14 Oct 11

    Must be true. I live in Canada. My whole family has had issues with mental health. I have three brothers and some cousins who grew up with us, within the past 10 years two have been diagnosed with schizophrenia and one cousin has committed suicide.
    My other brother has been struggling with addiction to alcohol and probably has mental health issues also.
    I also have some less serious mental health issues as the only second generation ’immigrant’ of my family.
    This article I believe it's completely true. It's not easy at all to be African in western society.

  12. #12 caroline holt 17 Oct 11

    Interesting article,but very short.Please note the diagnosis ’schizophrenia’ is an umbrella term used to describe clusters of symptoms of which there are many variations and therefore many types of experience for the person who receives the diagnosis I appreciate that this article was specific regarding the effects of trauma and then secondary trauma and stress caused by social rejection and isolation.
    It is of note though that studies indicate that people from less industrialized countries who receive this diagnosis are after some recovery more likely to return to their previous place in society and lives than those in Western or more developed countries where sadly a diagnosis of schizophrenia is often the begining of a psychiatric career, complete with alot of medication based treatments but not much else.

  13. #13 Ramon Rovira 18 Oct 11

    As I know from personal experience (mi wife) neither esquizofrenia nor depression are ’emotionally based’ deseases, they both are caused by brain biochemical malfunctioning. This means that no racial discrimination will ever be the ’last cause’ for these deseases, although certainly enough stress may trigger the appearance, not the existance, of the desease, that has always been there.
    No one discusses the today's superior and genetically based ability of coloured people when playing basketball, running or jumping. The parade of olympic medsls confirms it beyond any doubt. Why should we consider impossible that some less positive traits could also be present in their DNA? Antiracist whites are doing no good when dealing with coloured people as if they were children that need parental protection for life. One, cloured people too, must live with the whole package he has been given y nature, including the less than positive aspects of it.

  14. #14 Nick Harvey 18 Oct 11

    Hi Ramon,
    I wonder if you've considered how racist your argument comes across? I'm sure many will find your reasoning, as well as the term ’coloured people’, offensive and anachronistic.
    As I mentioned in the main piece, the idea that some races are genetically predisposed to schizophrenia has been found to be baseless. To the contrary, from the information scientists have available they've found that incidence rates for schizophrenia are uniformly distributed across the world- they are the same for each country. The problems only occur when people move countries (and face discrimination).
    There are countless examples of studies I could quote here to support this, but look into it and you'll see almost all the evidence suggests that it's not a race issue in terms of genetic predisposition.
    But if you're really hung up on the race/skin colour thing you may want to consider that the very first studies into schizophrenia and migration were conducted in 1932 by Odegaard who looked at white Norwegians moving to America. He found that the schizophrenia rate for these Norwegians was double that of the local population. People can indeed be the victims of Xenophobia and discrimination regardless of their race or skin colour.

  15. #15 lizzie 28 Oct 11

    The many hidden dangers of racism are deep and far-reaching indeed.

  16. #16 Tony Skins 02 Nov 11

    It seems that the measure of the degree of hostilerty of the dominaring group is the only socitorial problem that the phyciatrists seem not to have focust upon due to his own inhonestry of racial perceptions, due to a selfrightous lack of respect for other forms of man in his same society.

    Because it seems strange that in other parts of the world other than Europe, the order of racial perception by the dominant groups acts in reverse concept, which means mathematically that unfriendly societies label other peoples as mentally ill, weather they are mental or not. The minority groups as a result may result to doing more & more rash actions just to get around the hostillerties they face everyday.

    It is desire, jealousy & hatred that defines the socitrorial problems, the mental problems are entirly a manufacture of European man and in his close associates. Native America did not kill itself, neither Australia, Nor Southern Africa and the slaves of Caribbean & Americas did not enslave themselves.

    So if they all feel persecuted then may be they are!

  17. #17 jack 07 Apr 12

    they would be worse off if they migrated to a muslim country, not that muslim countries would allow them in, anyway.

  18. #18 Michaelmarch 28 Jul 16

    What if some degree of social rejection often precedes the disorder...its not just migrants who get rejected by their culture and its not just migrants who get the disorder...maybe this is a common precursor to developing schools zophrenia in general.

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