Aliens and Alienists

Ethnic Minorities and Psychiatry

Maurice Lipsedge, Roland Littlewood

• Publisher: Routledge
• Year: 2005
• eBook ISBN: 9781134728879
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In this classic text the authors examine the links between racism, psychological ill health and inadequate treatment of ethnic minorities. Through a series of case studies they discuss: * the psychological legacy of colonialism and slavery * the racist bias in psychiatric and psychological theory * diagnostic bias * the role of religion in mental health or illness * the value of anthropological and pschoanalytic insights. The concluding chapter in this edition reviews the development of 'transcultural psychiatry' and summarises changes in administration of the Mental Health Act.

CHAPTER ONE
ETHNIC MINORITIES AND THE PSYCHIATRIST

MEDEA: Come, I’ll ask your advice as if you were a friend,
Not that I hope for any help from you; but still,
I’ll ask you, and expose your infamy. Where now
Can I turn? Back to my country and my father’s house,
Which I betrayed to come with you?
Euripides, Medea
(trs. Philip Vellacott, Penguín Books, 1963, page 32)

CALVIN JOHNSON

Calvin Johnson left Jamaica and came to live in London twenty years ago. His father, a mason, died soon after Calvin left, but his mother still lives in the family home in Spanish Town, near the capital Kingston, with his sisters. Family life was harmonious, but as a boy Calvin was always getting into trouble at school. Although intelligent he never seemed to concentrate on anything for very long. He was teased by teachers and pupils for being tall and thin, which made him look older than he was; he always seemed to stand out. Calvin responded by getting into fights at the slightest provocation and was eventually expelled when he was twelve.

He then left home for some time and went to stay in Kingston with one of his mother’s brothers. He discovered the local library and read voraciously, achieving a broad but rather idiosyncratic general knowledge. Eventually, at his uncle’s insistence, he became apprenticed to a carpenter. To everyone’s surprise he immediately took to his work and soon gained a reputation as a friendly and skilled craftsman. Carpenters were plentiful in Kingston however, and, with a slump in building, Calvin was often out of a job. He decided to emigrate, and with the support of his family started to save. The year before he left, he married Alice. She is the opposite of Calvin, dull where he is bright, prosaic where he is imaginative, careful where he is sometimes over-hasty. But both are ambitious: indeed she seems to have seen in Calvin a chance to leave Jamaica and settle in Britain.

Things went badly from the beginning. Calvin had not arranged a job before leaving and had to work as a cleaner in a factory. As a skilled worker he became rather depressed about this. Alice, to her annoyance, was forced to work as well. They nagged each other. Calvin felt she was ‘acting superior’ with no reason. Alice was exasperated by what she saw as his indolence. Three children were born and married life continued in a setting of muted hostility.

The Johnsons live in the two ground-floor rooms of a Victorian terraced house in South London. They share a kitchen on the stairway and the outdoor lavatory with four other families. Fellow Jamaicans live in most of the other houses along the road; in each there are three or four households and the neighbourhood has a rather run-down air. Gates and fences are missing, pavements are broken and the gardens are usually just flattened earth with piles of rubbish and disintegrating cars. Focal points for the street are the local market a quarter of a mile away, the Pentecostal chapel round the corner and an illegal drinking club in a basement. Although structurally unsound, the houses are carefully decorated inside. Each household is clearly separated into living and ‘reception’ rooms. The casual visitor is struck by the constant activity: neighbours are visiting each other, children play on the pavement, women are singing in the yards, men are mending cars in the road and a group of teenagers sit on the walls discussing, as elsewhere, music, money, sex and the future.

Three years ago Calvin had saved enough to be able to go on his first visit back to Jamaica. While he was there he had a strange experience: he heard a voice from God which told him to read certain verses in the Bible. With divine inspiration he was able with some difficulty to interpret their meaning. Having learnt that meat was sacred food reserved only for the saints, he became a vegetarian. At the same time he became a Rastafarian. On returning to London he began to have doubts about the whole business, but he now thinks these doubts were prompted by the Devil.

Later in the same year he went to his local post office with his daughter Victoria to cash a postal order—advance payment for a job he was to start later that week, replacing some floor boards in a near-by house. Disturbed by Victoria’s latest school report and an argument he had had with her teacher, Calvin was feeling rather irritable and tense: after some weeks without work the offer of a job was particularly important. He signed the form, but after examining it the cashier told him to wait and went behind a partition. A quarter of an hour later he re-appeared with three policemen who rather abruptly asked him how he got the postal order. Humiliated and angry, Calvin tried to walk out of the post office with his daughter, but was pulled back. Completely losing his temper, he lashed out, hitting a policeman more by chance than intention, and was promptly arrested. Victoria, the cashier and a small group of bystanders watched silently. While struggling, Calvin took out of his pocket and waved a 1966 coin which he always carried with him: ‘The sun was shining on it as if the lion would step out. I began to sing “The Lord is My Shepherd”. The police said “You black bastard—you believe in God?” They took me to a mad-house—Oh God, since when are we religious mad?’

After some weeks in a psychiatric hospital the charge was withdrawn and Calvin went home; the postal order had been cleared but the job was now lost. In the course of the next year his relationship with the local police was tense. He was arrested for assaulting his two cousins while he himself pursued an unsuccessful case against the police for assault with the help of a community legal aid centre. Calvin became well known at the local magistrates’ court and his quarrels with the police became a vendetta.

While remanded on the assault charge he was seen by the prison psychiatrist: ‘This man belongs to Rastafarian (sic)—a mystical Jamaican cult, the members of which think they are God-like. This man has ringlet hair, a goatee straggly beard and a type of turban. He appears eccentric in his appearance and very vague in answering questions. He is an irritable character and he has got arrogant behaviour. His religious ideas are cultural. He denied any hallucinations. He is therefore not schizophrenic at the moment. He came to England in 1961 but he has obviously been unable to adjust to the culture of this society. He tells me that he would like to be repatriated to his homeland and I am of the opinion that this certainly would be a most desirable outcome because if he continues to live in the United Kingdom there is no doubt that he will be a constant burden to society.’

We first met Calvin after he came to the hospital where we worked, admitted under Section 136 of the Mental Health Act. Using this provision, the police can take anyone they feel to be in need of psychiatric attention from a public area ‘to a place of safety’, which usually means a psychiatric hospital. This time the trouble had started after Calvin had been smoking cannabis and arguing with Alice. Normally it had little effect on him apart from inducing a mild euphoria, but ‘This time round I let it all out. I told my probation officer I would do something. I knew what I was doing but I couldn’t stop. I wasn’t mad.’ The police were called by neighbours after he had thrown the family pans and an oil stove out of his window. Seven policemen eventually got him to the local hospital, where the Indian doctor on duty noted: ‘He was lying in the lift with two policemen on top of him. The patient was unkempt with long matted hair, talking in broken English and was difficult to follow. He frequently mentioned Christ and lions. There were ragged lacerations on his hands where he had been handcuffed. Probably a relapsed schizophrenic. Observe carefully.’

A West Indian nurse had visited his wife earlier that week after Alice Johnson had become concerned about her husband’s increasingly aggressive behaviour. Alice said that she had escaped being knocked about only because he was still on probation. The nurse also saw Calvin: ‘Overactive but did not feel ill. He felt God had been using him to try and put the world right. I would say he is very mad and I think a lot of this is due to smoking marihuana.’

His wife told us that she thought he had been well until the first episode with the police. Since then he had become increasingly irritable and had even hit her twice. Unlike Calvin, she dated his religious interest to the post office incident. He insisted on reading the Bible to the family, particularly the Book of Revelation, with his own interpretations and talked continuously of the importance of the date of ‘the beating’—7 July. Alice did not feel he was mentally ill and was anxious for him to leave hospital ‘after his aggression was cured’.

When we talked with him the morning after he was admitted, Mr Johnson was obviously humiliated by the events of the preceding day, but attempted to conceal this behind an infectious humour. He said the police had probably beaten him up only because he struggled; although they were racially prejudiced against black people in general, he did not think they had picked on him personally. He explained to us how God talked through him. Perhaps he really did have some special mission, but he was not quite sure. After the usual blood tests and X-rays and further discussion between his wife, the doctors and the probation officer, Calvin went home with an offer of another talk the following week.

He did not take up that appointment—or others—and we next met a year later in almost identical circumstances. This time the admitting psychiatrist felt the diagnosis was ‘mania or marihuana psychosis’. The police had been called by a traffic warden who complained that Calvin was now claiming to be Jesus: ‘The police are still beating me, they have given me a terrible beating. I keep running from them. I am very much afraid of the police. My father told me to stay away from the police when I was young because they are not nice. They are going to put me into prison. No trouble till they beat me up. I think the whole world has come to an end— the prophecy has been fulfilled. A man is a weakness against his whole self—I see the testing in my heart. He loves us all—a man can break the Devil—we are all Jesus if we live the life. If you know God you feel things inside you: I hear voices and I get visions every night. When I close my eyes I see a light.’

We did not feel that he needed to be in a hospital and he returned home to his family.

ETHNIC MINORITIES IN ENGLAND

Before trying to understand what has been going on between Calvin Johnson and the medical profession, we must take a brief look at the background of the two groups involved—the ethnic minorities and the psychiatrists. Is this sort of situation a common experience for members of ethnic minorities?

Most members of minority ethnic groups¹ are recent immigrants to Britain together with their descendants. In this book we are principally concerned with immigrants from Europe and the Third World rather than with immigrants of white British origin such as Australians or New Zealanders. The minorities comprise a wide variety of quite different groups. There is certainly no single ‘immigrant culture’, although they do face similar problems of cultural adaptation and economic insecurity. Some, such as the half a million Polish-born, have been settled here for many years.

Table 1 Immigrants in England and Wales (% of total population)

Those from Asia and the Caribbean are more recent immigrants. Since the 1960s the migration of people from the New Commonwealth has dropped and has been almost exclusively of the spouses and children of immigrants already settled here [229]. The number of other (‘foreign’) immigrants has, however, continued to rise [192]. The total number of people entering the country each year is usually substantially less than the number leaving [305]: immigration from the Commonwealth has only twice in fifteen years been greater than the emigration to the Commonwealth. Table 1 shows what percentage of the total population migrants form.

Although ‘immigrants’ are generally conceived of as non-white, we can see that a significant proportion of them come from Europe and North America. There are nearly as many immigrants from Italy and Poland together as from the Caribbean. ‘New Commonwealth immigrants’—those from Commonwealth countries attaining independence since the war—are usually ‘nonwhite’: the expression is an official euphemism for immigrants popularly perceived as ‘black’ or ‘brown’.

The table does not show the numbers of the descendants of immigrants who have been born in Britain. There are for instance half a million British Jews, many of whose parents and grandparents came here earlier in the century. By 1985 there were 2.2 million people including immigrants whose ethnic origins were in the New Commonwealth or Pakistan. 48 per cent of them were born here [304].

Seventy per cent of British Jews live in London, as do over a third of the Irish and more than half of New Commonwealth migrants [304]. Only half of the total population live in large towns, compared with 90 per cent of West Indians and 80 per cent of Asians [315]. Local sex ratios vary—a higher proportion of West Indians in London than elsewhere are women because of the type of work which is available.

The different migrant groups have brought with them a diversity of cultures. Some of these persist; others are discarded. Previous knowledge of British society varies from Caribbean countries familiar with English names, places and history, to Asian communities with quite different patterns of social structure and language. While the East Europeans were drawn from communities with virtually total literacy, two thirds of Indian villagers cannot read or write [226]. In the Caribbean, where 70 per cent of the population are not born to formally married couples, the typical family unit has been described as the mother and child with the father rather loosely attached to them [394]. Indian immigrants have usually brought with them a tight knit family kinship system based on jatis or sub-castes, in which a dominant male member heads each family.

While some immigrants to Britain, such as the East Europeans, originally lived in towns, New Commonwealth immigrants usually come from villages, often in particular areas (such as the Punjab and Gujarat) which have a tradition of migration to Britain. Some immigrant groups were already minorities before they came to Britain—East African Asians, European Jews and the ethnic Chinese of Vietnam.

The major reason given for migration from the Caribbean has usually been economic instability and unemployment because of reliance on a single industry, sugar, followed by the passing of the McCarran Act in 1952 which reduced West Indian migration to the United States. Up to a third of the citizens of some small islands now live in Britain [420]. In India, pressure on the land, population growth and unemployment also resulted in immigration as an urgent necessity. Political and racial persecution are now seldom the reason for migration; since the Polish, Jewish and Ukrainian migrations of two generations ago, the only large groups of exiles have been the East African Asians, Vietnamese and Latin Americans. Apart from the Jews there has been little immigration solely for religious reasons since the Huguenots. Other big groups include students, especially from West Africa, who have settled here, and soldiers and prisoners who remained after the Second World War, in particular Poles and Italians.

The reasons for inviting immigrants to Britain in the 1950s and 1960s were economic. Many groups were selected for specific jobs: a large proportion of the Filipinos in London were recruited by one agency as domestic servants and nursing aides. London Transport conducted recruiting trips in the Caribbean. The textile and transport industries throughout Western Europe required labour on a large scale; the size of the industrial labour force had decreased relative to the total population and upward social...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• PREFACE TO THE THIRD EDITION
• ACKNOWLEDGEMENTS
• CHAPTER ONE: ETHNIC MINORITIES AND THE PSYCHIATRIST
• CHAPTER TWO: MEDICINE AND RACISM
• CHAPTER THREE: THE QUESTION OF BLACK DEPRESSION
• CHAPTER FOUR: MENTAL ILLNESS AMONG IMMIGRANTS TO BRITAIN
• CHAPTER FIVE: A DIGRESSION ON DIAGNOSIS
• CHAPTER SIX: THE PRICE OF ADAPTATION
• CHAPTER SEVEN: SICK SOCIETIES
• CHAPTER EIGHT: A PRELUDE TO INSANITY?
• CHAPTER NINE: NORMAL AND ABNORMAL
• CHAPTER TEN: THE ILLNESS AS A COMMUNICATION
• CHAPTER ELEVEN: SOME CONCLUSIONS
• CHAPTER TWELVE: THE DEVELOPMENT OF TRANSCULTURAL PSYCHIATRY’ IN BRITAIN 1982–96
• REFERENCES