Electronic Letters to:
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eLetters: Electronic letters published:
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Perceived disadvantage is subjective
- Dr Arun Viswanath (9 April 2008)
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Perception of Disadvantage: A Third World View
- Hari D. Maharajh (11 June 2008)
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Dr Arun Viswanath, Speciality Registrar
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arun.viswanath{at}sct.nhs.uk Dr Arun Viswanath
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The case control study by Claudia et al. (1) was very fascinating. Though it is very hard to define what exactly a ‘perceived disadvantage’ is as it is very variable and subjective. Given that the sample was from tightly defined catchment area like Nottingham and South East London where people may be living in disadvantageous condition, it may not be surprising to perceive the same. There is possibility that the people may perceive disadvantage or racism because of their premorbid personality. The author should have commented if the perceptions were before the illness or part of the illness or related to personality. Also, the case and the control group were significantly different in terms of numbers and the assessor was not blinded. There are also chances that the disadvantage experienced may be because of their nature of their illness like for example being less communicative, not socialising etc.Their understanding of English and cognitive abilities are also not explained in detail. Mental health research in areas like this may run the risk of medicalising social struggle and distress (2). Though the outcome is not very conclusive it is a good effort in raising a clearly significant issue which may lead to further research. Most of the research on social perceived disadvantages like racism for example is cross sectional .There is need for more longitudinal studies to establish causality. Competing interests: None declared References: 1. Perceptions of disadvantage, ethnicity and psychosis The British Journal of Psychiatry (2008) 192: 185-190. doi: 10.1192/bjp.bp.107.042291 2. Does racial discrimination cause mental illness? APU CHAKRABORTY, MRCPsych ,St Ann's Hospital, London KWAME McKENZIE, MRCPsych .The British Journal of Psychiatry (2002) 180: 475-477 |
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Hari D. Maharajh, Senior Lecturer
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drharim{at}carib-link.net Hari D. Maharajh
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PERCEPTION OF DISADVANTAGE: A THIRD WORLD VIEW. The AESOP study of Cooper et al BJPsych (2008) stated that people from Black ethnic groups were more prone to develop psychosis in Western countries. This excess might be explained by perception of disadvantage. Also, people with psychosis would report more disadvantage than controls. The authors underline two theoretical issues on causation- the effects of the social context on the genesis of psychosis and secondly, that perceived disadvantage will cause paranoid thoughts resulting in persecutory delusions. This is a very difficult study with qualitative analyses done on a number of confounding variables, albeit, utilizing small numbers. A notable observation is the pointed questionnaire administered to psychotic patients and the validity of their responses- “Do you believe that you experience any disadvantage when compared with other individuals in British society?’ On a Likert scale, they were then asked to rate given causation of skin colour, culture and cultural beliefs, religion, social class and other. Is this not too leading? In mixed communities like Trinidad and Guyana, some studies have reported higher rates of psychosis among Afro-Caribbeans (Lewis 1973, Maharajh et al 2006). This has also been consistently reported in Britain (Gordon 1967, Harrison et al 1988). In Trinidad, the hypothesis of perception of disadvantage is difficult to accept. There is less psychosis among the disadvantaged Indo- Trinidadian group when compared to the advantaged Afro-Trinidadian group. The second hypothesis is also unlikely - that perceived disadvantage will lead to paranoid thoughts. Afro-Caribbeans at home are seen as being more paranoid. This is associated with drug use, an important variable not controlled in this study. A possible explanation is that the Indo- Trinidadian group has developed protective mechanisms in order to neutralize disadvantages such as economic investment, family life and education. According to the authors, among Africans, a paranoid view of the world may increase the perception of experiences as disadvantageous, seems more plausible. Experiences at home suggest that the African population in a mixed community show total loyalty and allegiance to that which they perceive belonging to them without the purposeful need to be introspective, to scrutinize or to challenge their beliefs. They do not fare well in mixed communities. This study is difficult to accept due to sampling size, methodology and hypotheses. The question must also be asked, do Psychiatrists engage in research with a perception of advantage or disadvantage to a given hypothesis? Aesop’s Fable or Grimm Fairy Tale? Lewis, LFE (1976) Schizophrenia in Female Inpatients at St Anns Hospital, Archives, St Anns Hospital, Port of Spain, Trinidad. Maharajh, H.D, Konings, M, Baboolal, N.S (2006) Gender and Ethnic differences in Urban and Rural First Contact Schizophrenia Outpatients in Trinidad. Reviews on Environmental Health, Vol 21, No 1 p 69-79. Hari D Maharajh FRCPsych Senior Lecturer, Psychiatry Department of Clinical Medicine University of the West Indies Champ Fleurs Trinidad, WI. |
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