#Racism—especially actions aimed at “destroying others personality act ” based on race—is a from of classified as a mental illness by mainstream psychiatry, but the picture is nuanced. Here's a deeper breakdown:Basically, racism is a type of mental disorder where a person is delusional, this delusion turns into severe madness and eventually they commit crimes. #Systematic_racism is also a type of disease where some politicians are delusional and secretly commit acts of personality destruction against people and a budget is also allocated for this work. This is called systematic racism.
Racism has different stages. Racism number one is only through the eyes and words are used. Racism stage two is practice for violence and still uses words but more aggressively. Racism stage three is known as ultimate madness. Here there is no more verbal abuse. Here there is no more violent and violent treatment and the people of the country and the government have reached the stage of extreme madness and have lost control. For 2 days ago a person in a place another person walked up and spoke when the person turned and said he had difficulty communicating, without any explanation another one a month ago a Friday meeting a woman named ann said those who just started some of them don't want to learn can take revenge in the kitchen it is also a form of racism and personality terror
🧠 1. Racism vs. Mental Illness
The American Psychiatric Association (APA) has repeatedly declined to label racism—even extreme forms—as a mental disorder, because such prejudices are too prevalent and culturally entrenched to be considered “abnormal”
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Prejudice is learned, not innate. While extreme racism may share features with delusional thinking (e.g., conspiracy beliefs, constant fear), it's rarely driven by a diagnosable mental illness for most people .
2. When Racism Becomes Psychopathology
Some psychiatrists—like Alvin Poussaint—argue that in cases where beliefs are fixed, irrational, delusional, and impair someone’s ability to function, the behavior could fit criteria for a delusional disorder
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For instance, violent extremists or individuals who believe whole races are out to harm them might very well meet these clinical definitions and have responded to treatments like antipsychotics.
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Racism and psychosis: an umbrella review and qualitative analysis of the mental health consequences of racism
Abstract
Black people and People of Color are disproportionately affected by racism and show increased rates of psychosis. To examine whether racialized migrant groups are particularly exposed to racism and therefore have higher risks for psychosis, this paper (1) systematically assesses rates of psychosis among racialized migrant groups concerning the country of origin, and (2) analyzes interviews regarding the association of racism experiences with psychosis-related symptoms in racialized Black people and People of Color populations in Germany. We present an umbrella review of meta-analyses that report the incidence of positive symptoms (e.g., hallucinations and delusions) and negative symptoms (e.g., apathy and incoherent speech) of diagnosed schizophrenia, other non-affective psychotic disorders (e.g., schizoaffective disorder) or first-episode psychosis among migrants by country of origin. We also report 20 interviews with first- and second-generation migrants racialized as Black and of Color in Germany to capture and classify their experiences of racism as well as racism-associated mental health challenges. In the umbrella review, psychosis risk was greatest when migration occurred from developing countries. Effect size estimates were even larger among Caribbean and African migrants. In the qualitative study, the application of the constant comparative method yielded four subordinate themes that form a subclinical psychosis symptomatology profile related to experiences of racism: (1) a sense of differentness, (2) negative self-awareness, (3) paranoid ideation regarding general persecution, and (4) self-questioning and self-esteem instability. We here provide converging evidence from a quantitative and qualitative analysis that the risk of poor mental health and psychotic experiences is related to racism associated with minority status and migration.
Supplementary Information
The online version contains supplementary material available at
Keywords: Psychosis, Racism, Meta-analysis, Umbrella review, Mixed methods research
Introduction
Psychosis is more prevalent among migrants than among non-migrants [1, 2]. A systematic review and meta-analysis of the influence of gender, urbanicity, immigration and socio-economics on psychosis, found an incidence rate of 3.09 (95% CI, 2.74—3.49) in migrants compared to non-migrants [3]. Certain forms of migration, such as forced migration, carry a greater risk of psychosis due to the confluence of stress and potential traumatization [1]. Stressful life events directly preceding onset, mediated by genetic vulnerability, are implicated in the etiology of psychosis in adolescents and adult populations [4]. Migrants are more exposed than non-migrants to area risk factors like population density, social fragmentation and deprivation, and social risk factors [5]. Evidence suggests that racism is an important social risk factor for the severity of psychotic symptoms among first and second-generation migrants (r = 0.264, p = 0.005) [6]. Furthermore, migrants with darker skin complexion are more likely to develop psychosis than migrants with lighter skin complexion (RR = 4.19, CI 3.42—5.14) [2]. This finding is generally consistent with the literature on involuntary admissions. A Canadian study, for example, reported an elevated risk among African migrants (RR = 1.24, 95% CI 1.04–1.48) and Caribbean migrants (RR = 1.29, 95% CI 1.07–1.56) compared to European migrants [7].
The fact that such effects are mediated by social risk factors, such as racism, is suggested by findings pertaining to area risk factors such as “ethnic density”, with higher psychosis rates among Black people and People of Color when they live in less diverse neighborhoods and experience higher rates of social discrimination [8, 9]. Psychosocial stress symptoms are associated with neural correlates of emotionality, such as the pain of social loss and rejection [10] and share neural substrates with physiological stress symptoms [11]. The stress vulnerability model [12] connects two conceptual frameworks: (1) the weathering concept [13, 14] refers to the disproportionate and cumulative health consequences of racism and discrimination, such as prenatal complications and mortality; and (2) the concept of allostatic load [15] refers to the imprint of racism on mind and brain via chronic physiological activation patterns, such as blood pressure and cortisol levels. Both postulate that the effects of stress on the brain at the cellular level are the mechanisms through which interpersonal racism (individualized attacks), institutional racism (policies and procedures), and structural racism (historical practices and societal reality) can lead to various adverse mental health outcomes, including psychosis [9, 16, 17].
An area of research known as the ‘ultra-high-risk state for psychosis paradigm’ [18] predicts the risk of conversion from basic and attenuated symptomatology (which are common subclinical psychosis-like signs), to clinical psychosis [19, 20]. Exposure to racism is positively associated with the distribution of subclinical psychosis symptomatology in non-clinical populations [21]. This paradigm is important in terms of early intervention, but it is not without controversy (see [22] for a review of the pragmatic dangers). A meta-analysis by Paradies et al. [23] concludes that racism is a social determinant of health and a review by Fusar-Poli et al. [24] concludes that governmental support of innovations aimed at strengthening the social determinants of health is required. With this is in mind, mental health leaders and their institutions must prioritize professional competence that considers culture, racism and migration-related stress factors in the context of seeking to understand and remedy mental health burden [25]. Evidence suggests that in terms of paranoid thinking, the cognitive evaluation of motives, meaning, and relevance around racism affects the general population and persons with attenuated symptomatology to the same degree [26]. In current biopsychosocial models of indicated risk and prevention, the higher baseline of attenuated symptomatology is the most important risk factor—a risk factor which is magnified by a family history of psychosis [27]. The clinical high-risk paradigm should operate within an indicated risk and prevention framework [28]. A universal risk and prevention framework aims to detect psychosis in certain at-risk groups in the general population such as Caribbean migrants in general or Black men in general. As such, a universalized approach to psychosis undermines the experiences of the individual patient and leads to overdiagnosis in entire groups of people who become essentialized and treated as categorically different, objective “facts”. In contrast, an indicated risk and prevention framework focuses on reducing the current attenuated psychosis symptoms and reducing the functional decline in at-risk individuals who are engaged in help-seeking behaviors for mental health problems [29].
In this paper, we review meta-analytical findings on the variance of psychosis incidence among migrants by country of origin to provide important clues regarding our central thesis, to explain excess psychosis rates in racialized migrant groups. In parallel, we conduct a qualitative study to describe Black people and People of Color's experiences of racism and mental distress. Rather than focusing solely on clinical populations, investigating racism as a risk factor for the onset of subclinical psychosis symptomatology in non-clinical populations may be an effective way to supplement our understanding of the social etiology of psychosis. The qualitative study focuses primarily on the phenomenological form and content in which racism-induced disturbances manifest.
Methods
Umbrella review of meta-analyses on psychosis risk related to countries of origin of migrants
Search strategy and selection criteria
Individual meta-analyses assessing migration and psychosis were systematically searched for and evaluated. The final search strategy used the keywords (“migration” OR “trauma” OR “discrimination” OR “racism”) and (“psychosis” OR “non-affective psychosis” OR “schizophrenia” OR “first-episode psychosis”) and (“meta-analysis”) with a restriction for publication between January 2018 and December 2020. 139 titles and abstracts were screened. All studies that reported summary risk rates for the incidence of psychotic symptoms or disorders according to the region of origin or arrival or development in the region of origin were included. This screening yielded 18 full-text articles assessed for eligibility. Included peer-reviewed meta-analyses reported (1) pooled relative risk (RR), incident rate ratio (IRR), hazard ratios (HR) or odds ratio (OR) with a 95% confidence interval (CI) or an effect size that was presented in a way that could be converted to the common effect size of Cohen’s d (e.g., Pearson’s correlation coefficient r), (2) the incidence of positive symptoms (e.g., hallucinations and delusions) or negative symptoms (e.g., apathy and incoherence) or diagnosed schizophrenia (SCZ), or other non-affective psychotic disorders (e.g., schizoaffective disorder) or first-episode psychosis. Systematic reviews without meta-analyses were excluded. Articles on drug-induced psychosis were also excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [30] and additional guidance from Fusar-Poli and Radua [31] were followed.
Data extraction
Three reviewers performed data extraction, and disagreements were resolved in consensus meetings. The different meta-analyses were grouped according to the similarity of the reported factors classifying migrant status. The following countries or regions and their characteristics could be identified as potential candidates for systematic evaluation: (1) categorization of the country according to the World Economic Situation and Prospects 2020 [32]: “developed”, “developing”; (2) countries/regions of arrival: the United Kingdom (UK), Scandinavia, the Netherlands, Israel, Southern Europe, Canada; (3) countries/regions of origin: the Caribbean, North Africa, Sub-Saharan Africa, the Middle East, New Zealand and Australia, Oceania, Western Europe, Southern and Eastern Europe, the United States (US). Effect size measures (risk ratio: RR, incidence rate ratio: IRR, hazard ratio: HR or Odds-ratio: OR) and corresponding CI of each meta-analysis were extracted. Those measures include population-based incidence studies comparing incidence between migrants and non-migrants. If available, additional heterogeneity measures, such as Cochran's Q and the I2 statistic, were extracted. In addition, evidence of publication bias was noted. The extracted data of each meta-analysis are provided in Supplement 1 and included first (FGM) and second-generation migrants (SGM). If separate estimates for those sub-groups were reported, we marked this in the study labels. The methodological quality of included studies was assessed using an adapted version of the validated assessment of multiple systematic reviews (AMSTAR) tool: 1–4 points equal low quality, 5–7 points equal medium quality, and 8–11 points equal high quality [32] (See Supplement 2).
Statistical analysis
Meta-analysis was performed according to the approach outlined by Harrer et al. [33]. Forest plots were created, allowing a visual comparison of the different countries and their characteristics. All analyses were performed with the {tidyverse} [34], {meta} [35], {metafor} [36], and {dmetar} [36] packages in the statistical software RStudio (see Supplement 3). Extracted effect size estimates were converted to Cohen’s d [37] and used to compare the different studies [33]. A common interpretation categorizes effect sizes in the range of |d|< 0.2 as small, |d|< 0.5 as moderate, and in the range of |d|< 0.8 as large [37]. First, we compared effect sizes concerning the country's development status, and then analysis was grouped for countries of origin and arrival.
Qualitative interviews regarding experiences of racism and their association with symptoms of psychosis
Sample and recruitment
Twenty African migrants (seven men and thirteen women) were interviewed online, in alignment with social distancing guidelines during the COVID-19 pandemic. This study was conducted in accordance with the World Medical Association’s Declaration of Helsinki [38]. The ethics board of a major university in Berlin approved it. Participants were recruited through strategically placed posts in two private Facebook groups: one for Black women in Berlin and the other for Black people of all genders in Berlin. For ethical reasons, the posts included the theme of the study (racism, sexism and mental health: a narrative analysis of people of African descent in Germany), as well as the aim of the study plus the possible benefits and risks of participation were outlined. We included information on the themes of the study in the Facebook posts since it was possible that some participants could have found confronting their individual and collective experiences on this topic in an interview somewhat distressing (see Supplement 4). Therefore, they needed to be aware of the potential benefits and risks of participation. This said, it is possible that we recruited mainly people who were already sensitized to the topic of racism—which could be seen as a limitation, but could also be seen as a beneficial contribution to the depth of the research data. Participants who self-identified as of African descent and lived in Berlin were included. One person declined to participate because they felt they had no personal racism experiences in Germany to reflect upon. After stepping out of this person, we recruited another eligible interviewee.
Data collection
The interview data was collected using a predefined semi-structured topic guide (see Supplement 5). The Black Feminism movement proposed intersectionality as a theory of social identities in the context of converging oppressions and discrimination, as well as the associated disparities and inequities [39]. One central argument of intersectionality is that everyday racism and gendered forms of racism operate simultaneously. It is suggested that research should reflect this interdependence, rather than treating them as independent entities [40]. Therefore, the topic guide was anchored in an interdisciplinary review of the literature and included key areas of inquiry, such as theoretical and experiential perspectives on the connectedness of both racism and sexism to mental health. A total of thirty interview questions were asked. Interviews lasted between 45 and 180 min, four were paused and resumed another day, and all were digitally recorded. The first interview with a woman based in the South of Germany was used as a pilot test and not included in the data analysis process or the final results due to ineligibility because of location. Data saturation was attained after nineteen interviews, therefore twenty interviews in total took place.
Data analysis
The constant comparative method was used in the analysis [41, 42] in MAXQDA 20.3 (VERBI GmbH). In the deep immersion process, the interviews were listened to and transcribed verbatim by the first author. FBL and SJS then read each transcript repeatedly. At the first coding step, each transcript was fragmented and open-coded, reflecting the meaning of fragments applied in reference to the study aims. Interpretations were discussed, and a consensus was reached. With the formulated hypotheses about patterns and types in mind, FBL and SJS re-immersed themselves in the interpretative coding process to investigate the relationship between themes emerging comparatively across the transcripts. In further consensus meetings, an inventory of superordinate themes was established by building a conceptual profile of the various relationships between codes (see Supplement 6).
Results
Umbrella review of meta-analyses on psychosis risk related to countries of origin of migrants
Characteristics of the studies
Overall, 519 titles and abstracts were screened. With the resulting search strategy, 139 articles were found and after applying the eligibility criteria 18 meta-analyses were examined in full text. Of these, 5 meta-analyses could be included in the systematic literature review (see Supplement 7). The key characteristics of each included meta-analysis are provided in Table 1.
Table 1.
Selected characteristics of included meta-analytic studies
Authors Country Year No. of included studies Location of included studies Diagnoses Inclusion period
Bourque, F., van der Ven, E., and Malla, A Canada 2011 21
United Kingdom (n = 9)
Netherlands (n = 3)
Australia (n = 1)
Sweden (n = 3)
Denmark (n = 2)
Israel (n = 2)
Canada (n = 1)
Schizophrenia
first episode psychosis
psychosis disorders
January 1977—December 2008
Cantor-Graae, E., and Selten, J. P Sweden 2005 18
United Kingdom (n = 12)
Australia (n = 1)
Netherlands (n = 3)
Sweden (n = 1)
Denmark (n = 1)
Schizophrenia January 1977—April 2003
Kirkbride, J. B., Errazuriz, A., Croudace, T. J., Morgan, C., Jackson, D., Boydell, J., Murray, R. M., and Jones, P. B England 2012 83 England
Non-affective psychoses
schizophrenia
affective psychoses
1950—2009
Nielssen, O., Sara, G., Lim, Y., and Large, M Australia 2013 n/a n/a Psychotic disorders 2001—2010
Selten, J. P., van der Ven, E., and Termorshuizen, F The Netherlands 2020 48
Europe (n = 43)
Israel (n = 3)
Canada (n = 2)
Australia (n = 1)
Non-affective psychoses
affective psychoses
January 1977—October 2017
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Summary of meta-analytic associations
In this analysis, “k” refers to the number of studies included in calculating the summary effect size.
Development status of country of origin. As there were more than k = 2 studies per subgroup, we conducted subsequent subgroup analysis. We found a significant between-group effect for development status (Q = 4.14, p = 0.042, see Fig. 1). The random effects model revealed increased risk in developed (d = 0.35[0.18; 0.52], z = 3.97, p < 0.001) and developing countries in mean estimates of psychosis risk (d = 0.58[0.44; 0.72], z = 8.08, p < 0.001).
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