An ‘aetiology’ is an attempt to explain the origin of something. Most Caribbean societies accept that there is an unquestionably a link between features of their cultures and slavery. But can this be demonstrated scientifically?
Movement for Justice and Reconciliation
Attitudes of Caribbean people are highly conflicted over their past history of slavery. They either want it fully acknowledged (the ‘injustice gap’), or to ‘move on’ (and forget it, because denial makes coping with the shame easier).
These objectives appear to be incompatible.
Most are profoundly aware of the resultant family dysfunctions (in a way that western liberals are not, and indeed want to have a ‘silent space’ over, so that it cannot be discussed, again a form of denial, of not facing the shame).
Caribbean people want related issues of mental health and crime addressed. They want self-esteem and justice.
But how can justice be achieved if the past history is not acknowledged or addressed, in depth?
I believe that people must acknowledge this past, if they are to find healing, both personal and social. According to Professor Everett Worthington, an open discussion (with appropriate rules of engagement) is essential if true empathy is to be developed between victims and perpetrators.
In a very interesting paper on forgiveness and coping strategies, Kenneth Pargament and Mark Rye make the points that the key factors lie in whether or not a situation is felt to be controllable or non-controllable.
If it is felt to be controllable, then ‘action’ strategies are best (changing the local administration of justice, health and education); if non-controllable, ‘emotion-based’ strategies work best (beliefs regarding self and the social and spiritual universe).
Forgiveness makes for personal peace, but may not make for justice. Pargament and Rye conclude with the remark that ‘we cannot dismiss this troubling scenario: a forgiveness that facilitates the well-being of the forgiver, but at the same time supports the perpetrator’s misbehaviour’.
Ideally, therefore, for society to work, and both personal healing and social healing to be realised, both of these apparently conflicting objectives must be implemented.
Both the emotional (personal forgiveness) and the demands of justice, are compatible, and can be pursued at the same time. What is not needed is personal vengeance, but restoration of both offender and offended into wholeness and healing.
‘Action’ strategies and ‘belief’ strategies can be pursued in parallel, and can be compatible: much depends on the trajectory of both, whether leasing to increased healing, or increased pathology.
Schizophrenia and bipolar disorder
Another key factor in the escalation of mental illness, especially for African-Caribbean people, appears to be a perceived sense of alienation and social isolation.
Ann Olson believes that there is a ‘causal circle’ of alienation and schizophrenia. She writes that the ‘action’ and ‘emotion’ strategies are related to personality, with extraverts using an action strategy, and introverts an emotion-based approach. This would not be surprising, and further research would be helpful. Therapeutically both approaches should be married together for greatest healing personally and socially.
Olson also remarks that there is a synergy of the three main features of schizophrenia: divergent thinking, alienation, and introversion, leading to ever-increasing social dysfunctionality. This dysfunctionality impairs a person’s mature ability to make fine social distinctions, causing problems in social relationships.
This, in turn, leads to failure to negotiate life in the real world. Given that these patterns are likely to be related to poor childhood and early adult social relationships, past family and social history are certainly implicated. That there is a ‘downstream effect’ from slavery seems all but certain.
That there is a need to examine family support structures is made clear by research that shows that there are clear differences between ethnic groups.
Asians show an important lower risk of schizophrenia than African-Caribbean people, even if they are similar in other significant ways, such as their experience of racial discrimination, social disadvantage, and the same time in which they came to the UK as immigrants.
The raised rates for African-Caribbean people and, to a lesser extent, for Africans, does not apply to their countries of origin. Similar studies of immigrants from Surinam into the Netherlands support these findings.
Causal factors therefore lie in the country to which the immigrants seek to make a new life, not in the countries of origin. However unsatisfactory, dysfunctional and perhaps predisposing towards mental illness the Caribbean family may be, it appears that increased loss of social support following emigration is the key variable.
Kwame McKenzie et al have published a helpful paper in which they summarise the well-tried explanations, such as misdiagnosis, (traditional) genetic predisposition, selection factors in migration, birth complications, childhood risk factors, cannabis use, the effects of urban living, social disadvantage, family dynamics and attitudes, racism, psychological factors that shape attitudes, such as education, and self-esteem.
All of these are likely to be important. McKenzie and his colleagues conclude by saying that African-Caribbean people in the UK are at higher risk of meeting ‘operational criteria for schizophrenia’ than either people in their countries of origin, or UK white people. Such people also show a higher affective (mood component, e.g., sadness) than white people; related to this is an increased rate of mania (bi-polar disorder).
It seems clear from previous research that environmental factors are acting on second generation patients with schizophrenia who are in vulnerable families.
Social factors therefore seem to be disproportionately implicated, and that ‘operational definitions’ are not working well cross-culturally, i.e., some things, such as religious manifestations, are being misinterpreted as mental illness. Indeed, one piece of research even showed that white people were 50% more likely to have a biological reason for their schizophrenia, than black people. Put in another way, this means that black people’s causal mechanisms are likely to be cultural. (Next week: Part 2)