UK Black-Carribeans Have A Nine Times Increased Likelihood Of Developing Schizophrenia

“To some extent, people who are insane are nonconformists, and society and their family wish they would live what appear to be useful lives.” – Nobel Prize Winner John Nash Who Suffered From Schizophrenia
The median global prevelance of schizophrenia has been estimated at 4.6 per 1000 of the general population. In the UK, a GP with an average list size of just under 2000 patients can expect to care for about eight patients with Schizophrenia, and possibly 12 if their practice is in an urban area. But the incidence rates of Schizophrenia in UK-resident Black-Carribeans have been consistently reported to be a great deal higher. When these findings were first reported many assumed it to be a first generation migrant effect or merely the result of methodological artefacts associated with inconsistencies in the diagnosis of schizophrenia in black carribeans. More recently however it has become clear that incidence rates of schizophrenia is even higher in second generationUK Black-Carribeans.
There was an enormous study conducted by the UK based Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP). It looked to examine the ethnic variations in schizophrenia incidence in the UK. In 2006, it was reported that there is a ninefold increase in the risk of developing schizophrenia in the UK Black-Carribeans when compared to the white British population. To put it into perspective Black Africans had a 5.8 increased likelihood and South Asians had a 1.4 increase. These findings are a big concern to Black-Carribean communities in Britain, to their GPs and to health service management responsible for their wellbeing. So why is Schizophrenia more prevalent in UK based Black Carribean communities?
GENETICS
Genetics seems to be quite a powerful risk factor in the development of schizophrenia.
The lifetime risk increases with genetic relatedness: 2% in third-degree relatives (first cousins); (uncle/aunt) to 6% (half-siblings) in second degree relatives; and 6% (parents) to 9% (siblings) in first degree relatives of suffering individuals. For twins, the risk is highr still: 17% for dizygotic twins and 48% for monozygotic twins.
Since studies have demonstrated a genetic contribution, it would then be that schizophrenia among Black-Carribeans are a feature of the emigrated rather than the native community. And indeed studies have found pretty similar levels of Schizophrenia in both populations. But there is still a huge argument stating that UK-based clinicians can do more to better protect the UK-resident Afro-Carribean community.
CLINICIAN BIAS
Alot of the time with psychiatric diagnoses, the process has a slightly subjective element. This may mean that clinicians may diagnose incorrectly at times. Clinicians are like average people, and can sometime carry limited biases that may impact the diagnosis of schizophrenia in UK based Black-Carribeans. To quantify the possibility of clinical bias, British and Jamaican psychiatrists were compared. The british psychiatrists classified 62% of Afro-Carribean patients as having schizophrenia where as the Jamaican psychiatrists recorded this diagnosis for 55% of these patients. ‘Race thinking’ (resorting to cultural stereotypes), and examples of institutional racism within the mental health service (discriminatory within an organisation) may also result in a degree of clinican bias in everyday practice. Cultural differences may also contribute to diagnostic error. At one extreme, Fernando has argued that existing cross-cultural incidence studies are flawed by the ‘category fallacy’ whereby western definitions of mental illness are applied to non-western cultures. Differences between cultures in the way hallucinations and religious experiences are regarded may have contributed to excess diagnoses in ethnic minority groups, as many non-western cultural beliefs could be considered to overlap with features of schizophrenia. The role that clinician bias plays in diagnoses of Schizophrenia in UK Black-Carribeans is often overlooked, but it is an incredibly important discussion to be had.
TREATMENT AND PATHWAYS TO CARE
Another issue that has to be mentioned is the marked differences between African-Carribean and white British patients with psychosis in terms of their pathways to care. Black Carribeans typically follow adverse pathways during their first and subsequent episodes of psychosis they are more likely to experience compulsory admission, more likely to be referred to psychiatric services through the criminal justice system, less likely to be referred by a GP, and have more protracted untreated symptoms during their first episode of psychosis. This difference in treatment between the two ethnic minority groups is slightly alarming to say the least. Are UK Black-Carribeans receiving the same care that White British people are when their psychotic epsiodes begin?
SOCIAL ISSUES
The association of schizophrenia with unemployment, poverty, and lower social class is well known. Urbanicity itself is associated with the incidence of schizophrenia, even allowing for confounding by known socioeconomic indicators, with growing up in an urban environment increasing the risk of developing schizophrenia later on in life by a factor of around 1.7. Since most Black-Carribeans in the UK live in inner city areas, and growing up in an urban area contributes to the risk of developing schizophrenia, it can be argued that undertermined factors operating in an urban environemnt may account for some of the ethnic variations in incidence. Levels of social and family support may also play a role in the excess incidence of schizophrenia in UK Black-Carribeans. Parental separation and loss before the age of 16 years were found to be strongly associated with the onset of psychosis. UK resident Black-Carribeans living in predominantly white neighbourhoods have been found to have a higher incidence of schizophrenia. This has been termed, the ‘ethnic density effect’, and may be another expression of social isolation. Individuals living in areas where their own ethnicity constitutes a smaller proportion of the local population have been reported to feel excluded from local social networks. It seems that many Schizophrenic episodes may be triggered by feeling of social isolation. Being Black-Carribean in a largely white society with limited community support may be a reason behind the increased incidence of Schizophrenia in these communities.
PSYCHOLOGICAL FACTORS
Psychological factors appear to play a large role in the development of Schizophrenia, adversity in many forms appears to contribute to higher rates of Schizophrenia, but attitudes to adversity are also likely to play a role. Studies show that migrants whose skin colour is substantially darker than that of the native population are most vulnerable to schizophrenia. Racism based on the darkness of skin colour rather than merely on ethnic grouping may account for such findings, and perception of racism have been found to increase according to skin darkness. Larger visible differences between an ethnic group and the host population may enhance an outside status. Again it seems that the darker you are in a predominantly white society means the greater amount of racism you may receive.
The higher level schizophrenia in Black-Carribeans living in the UK probably reflects the interaction of multiples risk factors, many of which cluster in the Black-Carribean community in the UK. Particularly significant factors appear to be the combination of isolation and exclusion, both within society (living in areas of low ethnic density and reduced participation in society) and within the family (family break-up and paternal separation). These factors seem to be more powerful than socioeconomic disadvantage, which is more likely to be a consequence than causal. Racism itself may contribute to social exclusion, further increasing the vulnerability to schizophrenia.
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Leaders Are Made Not Born

Confident, charismatic and tough are some traits that you would expect to find in a successful leader. That is why it is widely believed that all leaders have similar personality types, meaning there is an archetypal personality for leaders. A good leader is thought of as someone who has such a strong personality that people just follow them because of their forceful ideologies and values. Those who have sufficient character are likely to triumph over whatever reality they confront.

A new picture of leadership has emerged however, which focuses on how a persons ability to lead is largely dependent on their understanding of their followers, not by how charismatic they can be. It explains that leadership is the ability to shape what followers want to do instead of enforcing compliance; leadership is dependent on constituent co-operation and support rather than punishment and fear. To gain any form of credibility amongst followers, leaders must try to position themselves among the group and never above it.

Recent literature identifies that a good leader does not have any fixed set of personality traits. Instead a leader is often a choice by the group being led, in fact leaders can even select the traits they want to project to followers to increase their standing amongst the group. A leader shares in the same identity as their followers, they are a representation of their group. The most influential presidents, captains and chief executives adopt the values and identity of the group then try to shape that identity for their own ends.

No accident that George. W. Bush, has often presented himself to Americans as a regular guy rather than the next in line from an elite East Coast Yale University dynasty!

From Charisma to Consensus

100 years ago, the dominant theory of leadership was that all leaders have the ideal personality. There was a romanticised view of leaders, with many people seeing them as heroes and saviours. However, post WW2, and following the rise of fascism and Nazism many turned against the notion that character alone determined the effectiveness of leaders. To believe that entire nations could be lead by one charismatic person into carrying out some of the Nazi atrocities was hard to stomach, so psychologists began to look for other explanations of leadership.

Scholars began to favour ‘contingency models’ which focus on the context which leaders operate, as opposed to the leader alone. Influential social psychologist Fred Fiedler suggested that the secret to good leadership lies in finding and settling in the ‘perfect match’. By this Fiedler meant that there is an ideal leader for every group, basically, every would be leader has an ideal leadership context. Strong leadership comes out of a symbiotic relationship between leaders and followers within a social group, it requires an intimate understanding of group psychology.

The study of how groups can restructure individual psychology provides the first clues into the secrets of effective leadership. Henri Tajfel and John. C. Turner’s research into social identity in the 1970s may provide some answers. Social identity refers to the part of a person’s self that is defined by a group. Turner pointed out, social identity allows people to identify and act together as group members. Social identities thus make group behaviour possible; enabling us to reach a consensus on what matters to us to co-ordinate our actions with others and to strive for shared goals.

This viewpoint does not appeal to leadership directly, but clarifies why leadership requires a common ‘us’ to represent a group. Leaders are at their most effective when they can induce followers to see themselves as a group member and to see the group’s interest as their own interest. An example of this comes from Bernard Bass from the American Binghamton University when he showed that leaders are best when they ensure that followers see the group’s identity as their personal identity, and therefore they can lead them to do certain things because it is in the best interest of everyone.

A prime of example of how it is integral for a leader to share similar identities as followers comes from the European monarchs. Before national identities emerged, many monarchs ruled by force, using power rather than understanding. Once people identified with nations, effective monarchs needed to rule as patriots who were able to lead the people because of a shared national identity. Monarchs such as Louis XVI of France misunderstood or ignored this transition and litterally lost their heads.

One of the Gang

When shared social identity exists, leaders can best represent the identity that will have the most influence over the group members. The best leaders are usually prototypical of the group that they are leading. George. W. Bush is a prime example in the way he connected with Middle America – intentionally or otherwise – when he littered his speeches with verbal gaffes, something that columnist Kevin Drum suggested in the Washington monthly worked in Bush’s favour during the 2004 election. Indeed, those who scoffed at Bush’s awkward utterances suffered, because their criticisms cast them as the alien elite, out of touch with most ordinary Americans.

Even the way Bush dressed helped him to appear as representative of the group’s he was leading. His leather jackets and cowboy clothes create an image of him as a regular guy. In the same vein the late Palestinian leader Yasser Arafat adopted the headscarf of the peasantry to identify with his people. Such examples counter the idea that leadership requires a particular set of personality traits, the only desired traits and actions necessary have to fit in with the culture of the group being led.

This may explain why young people have become so disinterested in politics in recent years. They may not relate to the politicians today, and therefore feel indifferent about voting any one group in.

If fitting in is important for gaining influence and control, then anything that sets leaders apart from the group can compromise their effectiveness. Acting superior or failing to treat followers respectfully or listen to them will undermine a leaders credibility. That is why paying CEOs disproportionately large wages often results in unrest within a company, because those who are being led find it hard to relate to those who are leading, because of the differences in salary.

Wielding words – The Skill of lincoln
“Four scores and seven years ago our fathers brought forth upon this continent a new nation, conceived in Liberty, and dedicated to the proposition that all men are created equal”
– Abraham Lincoln
Leadership is not just conforming to group norms! The best leaders define their groups social identity to fit with policies they plan to promote, enabling them to position those policies as expressions of what their constituents already believe. In Lincoln’s Gettysburg address, Abaraham Lincoln strongly emphasised the principle of equality to rally people around his key policy objectives: unification of the states and emancipation of the slaves
Lincoln elevated equality to a position of supreme importance and made it the touchstone of American identity. After Lincoln’s address, Americans interpreted the constitution in a new way. This reshaping of American identity as centred on equality allowed Lincoln to unite and mobilise Americans around freeing slaves.


No matter how skilled a person may be a leader’s effectiveness is highly dependent on two things: Do followers see their leaders as one of them? Do followers find their leader’s vision of identity compelling? Psychological analysis tells us that for leadership to function well, leaders and followers must be bound by a shared identity and by the quest to use that identity as a blueprint for action. The division of responsibility in leadership can vary. In more authoritarian cases, leaders can claim sole jurisdiction over identity and punish anyone who dissents. In more democratic cases leaders can engage the population in a dialogue over their shared identity and goals. Either way, the development of a shared social identity is the basis of influential and creative leadership. If you can control the definition of identity, you can change the world.

Musa Clarke