Aggrey W. Burke

Racism and psychological disturbance among West Indians in Britain.

It gives me great pleasure to address you on the topic of racism and its relationship to mental illness. This is a difficult issue. Before arriving here for these proceedings many of you had already established your own position in this debate but a minority may have been poorly informed and still open to persuasion. For some time now it has been clear to me that from the psychological point of view racism is the singular most important issue of our time. It surpasses poverty simply because it causes that poverty. Indeed, in the last two centuries this racism had grown to become an integral part of European culture to lead to the devastation of many and to become an inevitable bugbear of populations which now bear the scars of this evil force. In the present lecture it is my intention to concentrate on black-white issues without delving into the Jew-Gentile, Latin-nonLatin or refugee-native dilemmas.

Is Racism a Causatory Factor in Mental Illness

Psychological aspects of racism have not been sufficiently studied despite the widespread nature of this phenomenon in the context of Jew-Gentile relations in Europe and of Black-White relations in many parts of the world. Racism is related to issues of power by political domination. Therefore the psychological manifestations must be considered from the points of view of dominant intimidating and subjected intimidated racial groups. The primary condition of racism refers to the psychological mechanisms and psychiatric problems which arise from this issue of power and will be found in the dominant group. Such mechanisms and problems may be subjected to close scrutiny in small multi-racial group settings. As a result of racism it will be found that there will be parallel psychological mechanisms and psychiatric problems in the subjected group. In this instance the condition is of a secondary kind and the appropriate terminology is racism-related disorders). In the present volume the material is largely related to these racism-related disorders. The text includes papers that were delivered at the conference on racism and mental illness and papers that were submitted to the editor.

Suicide in Jamaica

ABSTRACT The study describes the distribution of suicide in Jamaica in 1975 and 1976. Over 28,000 death certificates were scrutinized and field survey methods used to identify cases likely to have resulted in suicide among them. A total of 58 suicides were found. Correct identification with a suicide verdict had taken place in 16 cases. In Jamaica a low rate of suicide is related to the African background and low migration from the predominantly agricultural activity of the population.

Determinants of Delinquency in Female West Indian Migrants

A sample of young West Indian females were interviewed whilst being on remand for petty offences. Most were suffering from adjustment reactions of adolescence, a half had previously been convicted and a third gave a history of parasuicide. On investigation, it was found that there had been a characteristic pattern of multiple separation experiences, which had been closely related to the onset of early symptoms of maladjustment, with subsequent delinquency. As this pattern of separation experiences is not found among delinquents in the West Indies, this should indicate that such pathogenic experiences may be related to residence in the new environment in Britain. Early pregnancy may constitute a further separation experience, which may also be stressful in vulnerable individuals.

The Multi-Racial Small Group On Race: Theoretical Issues and Practical Considerations

There is now an extensive body of material on the dynamics of the small group in general (Anthony, 1967; Durkin, 1981; Foulkes and Anthony, 1973). However little is known on the dynamics which occur when small groups have the specific aim of making its members aware of their own fears, preoccupations and inclinations which related to race. With regard to this significant gap in psychotherapeutic knowledge the organisers of the conference on racism as a causatory factor in mental illness decided to make an experiment in this area. To achieve this aim several of the members of one clinical team of the University psychiatric department at Atkinson Morley’s Hospital in Wimbledon agred to become part of this small group. In the first part in this series, Hari Maharajh who was one of the members of the team, and of this group, gave the background material which contributed

Social Attempted Suicide: Young Women in Two Contrasting Areas

The study compares attempted suicide data among young women of two ethnic groups resident in native West Indian and immigrant Birmingham environments. Although African rates were higher than East Indian ones, the three-fold increase in the immigrant population was unrelated to ethnic origin. This was also true regarding clinical data, patients using psychotropic tablets and giving similar reasons for attempting suicide. Formal psychiatric diagnoses were, however, less frequently made in Birmingham where patients preferred analgesic tablets to the domestic agents used instead by the West Indian population. The aetiological significant of sociocultural factors is discussed.

Trends in Social Psychiatry in the Caribbean

IN the Caribbean despite efforts to replace traditional therapeutic approaches with modern ones it is a significant fact and therefore noteworthy that ’Native Healers’ retain a more prominent role than Western ones, not only because of their numerical power and their greater understanding of the social factors which precipitate affective and psychosomatic phenomena,l but also as a result of the persisting belief in them; a subject commented on in Jamaica and Guyana.15 The significance of this traditional aspect of West Indian psychiatry has been previously noted by the present author9 but omitted in the recent historical account from the area,5 in part

Outcome of Mental Illness Following Repatriation: a Predictive Study

A study is made of indices which predict the outcome of psychotic mental illness among migrant patients who had become ill in England and who were repatriated home to Jamaica. The findings of a field survey among 55 cases showed that a poor outcome had taken place in 32. This may have been predicted by indices of chronicity and the resulting poor employment history in England. Prediction in Jamaica is associated with socio-economic hardship and psychological attitudes of relatives who had agreed to accommodate patients. Diagnosis of illness and a history of this in the family are not associated with outcome. It is of interest that evidence of adequate intelligence predicts a poor outcome. These findings are discussed. The purpose of the present paper is to make an investigation of those factors which may be of significance in predicting the outcome of psychosis among patients who had been repatriated to Jamaica from England. It is widely believed that in countries like Jamaica the socio-cultural environment of the predominantly rural areas allows higher rates of recovery from psychosis than will be found in industrial cities in the western world (Barahona Fernandes et al., 1967; Murphy and Raman, 1972). These findings would indicate that when patients become ill in these developed countries their repatriation may be in their medical interest. None the less, in an early study of this problem Frey (1961) concluded that returning home had not altered the course of illness among Algerian mine-workers who had become acutely psychotic in France. Asuni (1968) traced 70 per cent of a group of Nigerian students who had become psychotic in London and who were repatriated home because of the unlikelihood that they would have been able to complete their courses of study. He concluded that repatriation had been of therapeutic benefit in the majority of these students. The most recent study of this problem was carried out in Jamaica by the present author. The findings indicated that a poor outcome had occurred among three-fifths of a consecutive series of patients (Burke, 1982). If these findings are found to be associated with diagnosis then particular groups of patients would be considered to be eligible for repatriation.

Attempted suicide among Commonwealth immigrants in Birmingham

The distribution of attempted suicide among Commonwealth immigrants has been investigated in Birmingham. Four-year data concerning 119 (43 male, 76 female) admissions to hospitals there have been used. The crude rate of attempted suicide (94 per 100,000 per annum) is lower than that for the native population. All the patients were younger than 44, and repeated suicide attempts were rarely seen and drug or alcohol abuse were found to be less prevalent than among admissions of British origin. The data indicate that attempted suicide among immigrants in Birmingham is benign in comparison with that among the natives there.

Epidemiological Aspects of the Repatriate Syndrome

A careful analysis of the mental hospital case notes of 55 Jamaicans who had become ill in Britain and were successfully traced in Jamaica show that most had suffered from recurrent episodes of schizophrenia but that few were predisposed develop this illness. After an average period of 42 months follow-up it was found that there had been an excessive mortality and that others were living in the Bush. The most important finding of the study is that the chronic symptoms of illness which have been previously described as characteristic of the repatriate syndrome, had taken place in a half of the sample. Nevertheless there was evidence of a good outcome in a third of those who were living and interviewed during the field survey. These findings have been discussed. It has been concluded that repatriation may be of therapeutic benefit but only following more careful selection of cases.