Social Adversity Precedes Psychosis Onset…

Morgan, C., & Hutchinson, G. (2009). The social determinants of psychosis in migrant and ethnic minority populations: a public health tragedy Psychological Medicine, 40 (05) DOI: 10.1017/S0033291709005546

I recall attending a lecture at the University of Melbourne sometime in the late 1990s, where now Australian of the Year, Pr Patrick McGorry, argued that we need not discuss the aetiology of schizophrenia any more, since that debate had been settled long ago. It has not. Bio-psychiatry, big pharma, and other vested interests would have us believe that faulty genes or organic illness cause mental disorder, without providing a shard of objective evidence to back up their grandiose claims. Theirs is the promise of seemingly unrealisable future tense discoveries that will retrospectively prove to be ‘correct’. Understandably, perhaps, those who adhere to this ‘duck that will one day become a swan’ paradigm are mightily hostile to anyone who dares to question their legitimacy.

I question their legitimacy. Like Morgan and Hutchinson (2009, p.706), I accept the fact that the evidence is both compelling and irrefutable that maddening environments can cause people to become mad. Laing (1971), Cooper (1970), and Esterson (1970), knew that 40 years ago, when they respectively discussed how oppressive families could create mentally disordered children (Kanter, 1974). Here, Morgan and Hutchinson (2009, p.706) show that social adversity leads to increased rates of mental disorder amongst the UK Black Caribbean and Black African populations. They contend that these increased rates can be explained by social but not by biological causative factors (Morgan and Hutchinson, 2009, pp.706-707). In short, the mental health of these particular populations suffers because of entrenched disadvantage and discrimination…

‘It is well established that early disadvantage sets a developmental trajectory characterized by increased likelihood of exposure to subsequent adversities, each of which is likely to have a compounding effect (Engle et al. 2007). To paraphrase Jones et al. (1994), early disadvantage sets in train a cascade of problematic social development, one consequence of which might be an increased risk of psychosis. Addressing the high rates, therefore, has to be part of a wider social strategy. If institutional racism is relevant, it is that which affects every institution in society, structuring access to decent housing and heating, to an adequate education, to employment and effective social services. The problem is not ‘in’ migrant populations, it is not ‘in’ psychiatry. The problem is ‘in’ society’ (Morgan and Hutchinson, 2009, p.707).

The rate of schizophrenia and other psychotic disorders amongst the UK Black Caribbean and Black African populations, when compared to the UK White population, is an astonishing 500 per cent higher (Morgan and Hutchinson, 2009, p.707)! We can divert ourselves into circular conversations about how we might better detect ‘at risk’ (of mental disorder) individuals within these particular populations. However, I would consider that a wasted effort. It is far preferable, as Morgan and Hutchinson (2009, p.707) suggest, to prevent the development of mental disorder through whole-of-life and targeted public health strategies. Combating racism, for example, would doubtless yield considerable mental health gains for those citizens who are routinely subjected to that evil practice…

A postscript…

There are, as you would expect, invaluable lessons for other historically disadvantaged groups in recognising the inviolable links between oppression and madness. For example, I’ve said it before, and I’ll keep shouting it from the rooftops, how completely reckless it is for gay rights groups in Australia to tag along with Team Bio’s wish to declare us to be, super, super mad! By agreeing to pathologise gay men, those gay rights groups have reinforced the odious concept that homosexuality is a disease, and us fags are essentially fucked in the head…