An ethnography of the 'epidemic' of schizophrenia among individuals of African-Caribbean heritage in England

This dissertation examines how social inequalities, in combination with identified social risk factors, contribute to disparities in the incidence of schizophrenia among individuals of African-Caribbean descent in England. It addresses the psychiatric epidemiological puzzle that indicates African-Caribbbeans in England have significantly greater rates of schizophrenia than the general British population. Based on two years of ethnographic fieldwork with patients diagnosed with schizophrenia, their relatives, and community members in North London, the researcher argued that specific social changes and historical forces interlink to create a toxic environment characterized by negative expressed emotions and social defeat to affect African-Caribbeans' mental health.;The dissertation is organized into five chapters that examine specific sociocultural risk factors. These include social inequalities, social fragmentation, rapid social changes, isolation, and community expressed emotions. The first chapter argues that notwithstanding the conceptual and diagnostic limitations of schizophrenia, epidemiological studies provide compelling evidence for the elevated rates of the illness in this group. Chapter two sets out a sociohistorical framework for understanding the relationship between social inequalities, disparities, and schizophrenia. The third chapter examines the role of community fragmentation in psychosis; it explores the community's anxieties about the perceived loss of their Caribbean culture and identity, their level of social capital, and their integration into British society. Chapter four focuses on the emotional worlds of African-Caribbeans and offers a concept of Community Expressed Emotions (CEE) to explore their experiences of specific negative emotions such as experiences of hostility and isolation, and their interface with risks of schizophrenia. The fifth chapter analyzes the community's collective response to the mental health crisis and examines the ways racial identity and slave history are mobilized in African-Caribbeans' explanatory models for schizophrenia. The conclusion explains how these various risk factors interact to create a toxic social environment that induces risks of schizophrenia. The analysis builds on psychological and anthropological theories of the self to link individual vulnerabilities to schizophrenia to larger social processes.