Decades of research has found that racialized citizens are diagnosed with the disorder at far higher rates – and the single biggest risk factor is having darker skin than most of their neighbours
This translation has been automatically generated and has not been verified for accuracy.One of the first patients Kwame McKenzie treated as a psychiatrist in London, England, was a young Black man diagnosed with schizophrenia. Dr. McKenzie, then years away from becoming the director of health equity at Toronto’s Centre for Addiction and Mental Health , remembers the father, an African-Caribbean immigrant, trying not to cry while asking questions.
But the finding that Black citizens are being diagnosed more often with psychosis is more complex than improving access to care. It goes back more than 50 years and has been the subject of more than 100 peer-reviewed papers. In the United Kingdom and the Netherlands, extensive studies have found rates as much as five times higher in migrants from the Caribbean and Africa than the native-born white population.
What many researchers increasingly believe to be an important risk factor for schizophrenia, this most terrible of brain disorders, is racism.Myrna Lashley of McGill University and Toronto court worker Shawn Pendenque have seen how racism affects mental health from both ends. Mr. Pendenque was diagnosed with early-stage schizophrenia in jail. Dr. Lashley is part of an emerging field of research to make mental-health supports more equitable. Read more about their experiences later in this story.
Yet, even as those post-war white doctors were diagnosing Black patients with the mental illness of challenging a racist society, a talented psychiatrist in colonial Algeria was pointing the blame outward – toward society itself.Frantz Fanon proposed that racism itself caused mental illness, including psychosis. In an earlier book,, published in 1952, Dr. Fanon eloquently described his own experience with racism.
This was one of the earliest theories for why certain ethnic groups had higher rates of schizophrenia – that migrants were bringing the illness with them from their home countries. Over time, that hypothesis has been refuted by epidemiological studies, which have found no evidence of higher rates in places such as the Caribbean, Surinam and India.
Another significant risk factor for schizophrenia is living in a city. Researchers are still figuring out why, but some theorize the frenetic landscape, pollution and sense of isolation even in a crowded place could be contributors. During her clinical practice, Deidre Anglin, a psychology professor at City University of New York, says she saw examples of colleagues being too quick to diagnose schizophrenia in Black patients, especially those who came in agitated and with a police escort. She says racialized patients, because of their experience in society, including a distrust of the system, may present with a “constellation of symptoms” that aren’t fully reflected in the diagnostic manuals.
Mr. Pendenque was born in Canada, to parents who had migrated separately from Dominica and met in Toronto. As a child, he was sexually and physically abused, and by 16, he was living on the street. With the help of LOFT Community Services, a group that provides support and housing to at-risk populations, he eventually became a counsellor for youth – many of them also Black – awaiting trial or sentencing.
Aristotle Voineskos, vice-president of research at CAMH and a specialist in schizophrenia, points to evidence that chronic stress weakens the immune system, which has been linked to the development of psychosis. The “social defeat” hypothesis proposes that the long-term experience of being excluded from the majority group eventually leads to chemical changes in the brain. Dr.
Did that person cross the street to get somewhere or to avoid me? Was I seated in the back of the restaurant because I’m Black? Is that police officer just walking by or following me? Still, Dr. Voineskos cautions against over-simplifying a complex illness. The vast majority of people victimized by racism do not go on to develop psychosis, and patients diagnosed with psychosis, such as Mr. Pendenque, typically present with a unique combination of risk factors.
An older British study, co-authored by Dr. McKenzie, recruited people with no history of psychosis, recorded their experiences with discrimination and their level of perceived racism, and followed them for three years. At the end, the study found a link between the onset of delusional thinking and higher rates of discrimination, from 0.5 per cent for those reporting no discrimination to 2.7 per cent for people reporting more than one type of discrimination.
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