By Prof Suman Fernando January 2010
‘It may be that AESOP (Aetiology and Ethnicity of Schizophrenia and Other Psychoses) with its poor research is being used for political purposes i.e. withdrawing funding from ethnic minority services and explaining the failure of DRE - killing two 'political' birds with one AESOP ,' consultant psychiatrist, professor Suman Fernando says.
Genetic markers for schizophrenia have never been found January 2010
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The phenomenon of high rates of ‘schizophrenia' being diagnosed among African Caribbean people has been noted in UK since the early 1980s. I recall geneticists seeing some mileage in the quest for the ‘cause' of schizophrenia (at that time assumed to be genetic) resulting from intense studies of black people. As we know genetic markers for schizophrenia were never found anyway, and the modern approach to most ‘mental illness' is that there is unlikely to be specific genetic or biological causes, although psychiatry still seems to adhere to its Krapelinian tradition.
In the late 1980s, the so-called high incidence of schizophrenia among black people was attributed to perinatal virus infection in the mothers of women who migrated from West Indies. This theory was based on a series of assumptions concerned with minor brain damage caused by virus infections. Several eminent (sic) researchers supported this hypothesis - for example Wing, Eagles, Harrison and Wessely (see page 55 of the book referred to below).
Institutionaised racism in the diagnostic models in psyciatry
From the 1990s onwards there was a great deal of debate around issues about (lack of) cultural sensitivity and institutionalised racism in the diagnostic models in psychiatry and more generally; discriminatory processes in mental health services themselves; and racism in society at large.
Much of this debate was fostered by high profile reports of serious injustices in society, including mental heath services and psychiatry.
Social scientists and mental health professionals voiced critical comments about the current system of mental health care and psychiatry in particular, and several reports highlighted the extent of racism in mental health services. (See 'Cultural Diversity, Mental Health and Psyciatry' for references)
In this context, the view gained ground that the ‘high incidence' of schizophrenia among black people in the UK was a phenomenon arising from culturally inappropriate ways of assessing people for ‘mental illness' coupled with institutional racism within mental health services (including the practice of psychiatry) and society at large. However, very little research apart from medical-type traditional diagnosis-based research was funded. Power structures in the way research money was allocated did not allow much else.
Pilot Study of Schizophrenia - (IPSS) has been largely discredited among thinking people
It is now about thirty years since the first observations were made about ‘racial inequalities' in psychiatry and mental health service provision. Over these years, narrow medical-type research (the type that was used in the International Pilot Study of Schizophrenia - IPSS) has been largely discredited among thinking people. But now medical researchers have come up with a ‘new' claim.
The AESOP studies concluded that the cause (of schizophrenia in black people) is not genetic, or indeed ‘social' in a wide sense, but lies in abnormal family patterns, especially early separation of (black) children from their parents, especially fathers. This so-called finding is an extrapolation from an association that the researchers claim to have found in their data on family history between these family patterns and schizophrenia in adults.
The approach of AESOP was flawed from the start. The researchers used a way of diagnosing schizophrenia identical to that used by IPSS in the 1970s; this approach to ‘diagnosing' was criticized at the time for being culturally insensitive mainly because it consisted of merely imposing a diagnostic system without allowing for how populations in non-western cultures viewed health and illness.
An even more serious error of the AESOP is that the researchers seem to have extrapolated from association to ‘cause' in a situation as complex as family life. Because they say they found some aspects of family life in childhood associated with adult ‘schizophrenia', they assumed that one caused the other. This is unscientific and totally unacceptable, especially when it results in highly contentious - possibly racist - ‘conclusion' being arrived at.
Mental health tzar's plans for social engineering
We can perhaps just ignore AESOP - after all it was published over five years ago and made little impact on thinking at the time. Although it was carried out several years ago, its ‘conclusions' about family ‘pathology' have apparently been taken up by the mental health tsar with a view to devising government policy.Why now?
According to an article in the Society Guardian of December 15, 2009, the mental health tsar appears to back the views of one of the authors of AESOP who talks of ‘social engineering, particularly to try to strengthen family structures in the , with a view to keeping children in stable families'.
The tsar claims that government will shortly bring out a ‘public health and prevention publication' to address the causes of mental illness in ‘ethnic minorities'. He goes on to say (perhaps letting the cat out of the bag): ‘Instead of trying to build separate services for individual groups, it is about a service that is more personal to individuals'. Is this then an excuse for withdrawing funding from services directed at needs of ethnic minorities?
Another political reason for using the spurious conclusions of AESOP may relate to the fact that the government plan called ‘Delivering Race Equality' (DRE) is just about ending with apparent complete failure to meet any of its targets in redressing racial inequality in mental health services. The mental health tsar is quoted in the Society Guardian article: ‘The causes [of schizophrenia in African Caribbeans] are social causes affecting people before they come into contact with mental health services'. Is this then being presented as the reason why DRE has failed?
It may be that AESOP with its poor research is being used for political purposes i.e. withdrawing funding from ethnic minority services and explaining the failure of DRE - killing two (political) birds with one AESOP. Presenting all this in terms of meeting an ‘epidemic of schizophrenia' brings in a racist undertone that may have a populist appeal. No wonder the Guardian article and the AESOP ‘research' has been taken up by the far right.
About the author
Suman Fernando is visiting professor in the Department of Applied Social Sciences at London Metropolitan University, UK, and Senior Lecturer at the European Centre for Migration and Social Care (MASC), University of Kent, UK. He was a consultant psychiatrist for over twenty years in the National Health Service and is involved in non-governmental organisations in the UK and abroad. He has written and lectured widely on mental health development. Fernando was an expert witness during the Bennett inquiry and was also active campaigner during the passage of the 2007 Mental Health Act. In 2007 Fernando turned down an OBE in protest of the government's flawed plans to extend compulsion of those detained under the Mental Health Act.
For more information go to Prof. Suman Fernando's website.
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