Drs Chakraborty and McKenzie (Reference Chakraborty and McKenzie2002) seek to answer the question, ‘Does racial discrimination cause mental illness?’, but in doing so they raise further concerns. They refer to high community prevalence rates of depression in the UK, compared with the countries of origin of minority groups, but very high rates have been reported in indigenous populations from Uganda, the Himalayas and the Indian subcontinent. Further reliable studies would be desirable, but this is not a fashionable field for research. In Manchester, Shaw et al (Reference Shaw, Creed and Tomenson1999) found no difference in rates of common mental disorders between the White and African—Caribbean populations.

When the authors suggest that social and service-related risk factors ‘may be better studied using qualitative’ rather than ‘quantitative epidemiological approaches’, this should provoke serious disquiet. If attempts at scientific measurement are to be discarded, what will be put in their place? The accusation that, for example, ‘this work is racist’ is qualitative enough, but how can its truth be demonstrated or compared with others?

The statement that racism is ‘wide-spread in the UK’ is not helpful in itself. Is it worse than in Rwanda or Sri Lanka? And does ‘phenotypic difference’ refer only to skin colour? The all-White Jewish population of Europe in the 1940s was not notably exempt from racism — a fact rarely mentioned in this literature. If ‘some believe’ that minor hostile incidents have a greater impact on health than racist attacks, they have not demonstrated this to be so. Similarly, ‘paranoia’ cannot, by definition, represent a healthy coping strategy, since it is separated from reality.

It is argued that ‘racism produces and perpetuates socio-economic difference’. This may be true to some extent, but most socio-economic difference is unrelated to race. Pre-World War 2, Britain contained only minuscule numbers of non-Whites, yet was rigidly affected by social difference and advantage. Race merely adds an additional factor.

When the question is examined in terms of ‘stress’, it is usually assumed that this only applies to the host society. Yet the reason people migrate is primarily to escape the stress of their original home. This may take such forms as desperate poverty, corrupt government, climatic disasters, civil strife, absence of essential services, etc. Is it more stressful to live in a ‘racist’ welfare state or to die in the street of a monoracial African or Asian country?

Two authors are quoted who reported that African and Caribbean patients with psychosis in Britain were more likely to attribute their problems to racism, but in the absence of any comment, it is not clear what we are to make of this.

The relationship between the proportion of ethnic minorities in a local population and their prevalence of mental disorder is said to reflect ‘complex interactions between exposure to discrimination, social support, socio-economic factors and social capital’. In other words, just about everything except the kitchen sink. How can any meaningful relationship between factors possibly be extracted from this mélange?

A relationship is then suggested between community-level racist attitudes and mental illness in American minority groups, but the only evidence cited is for all-cause mortality, which is totally different and largely unrelated.

Fernando (Reference Fernando1991) is quoted as arguing that the European emphasis on an individualised pathology renders psychiatry a racist institution. But in fact, the opposite is more likely to be true. Considering each patient more as an individual respects his/her unique situation, whereas emphasis on ‘race and culture’ tends to reduce the individual merely to membership of a category — which I would regard as ‘racism’.

It is then claimed that ‘a public health approach’ to discrimination is likely to be more effective in decreasing rates of mental illness than intervention at a health service level. But of what would such an approach consist, and how long would it be before its effects could be seen in a reduced prevalence of disorder? Regrettably, the causes of most mental disorders remain unknown and although large resources have been spent throughout the world on ‘primary prevention’, any positive results have been modest in the extreme.

If, as Sashidharan (Reference Sashidharan1993) has argued, research should focus on ‘power disparities in a predominantly racist society’, it would be very likely to show that the majority of such differences have nothing to do with racism, as Chakraborty and McKenzie partly admit. Yet, if representatives of the majority were to propose that the emphasis should be moved away from the White—non-White difference, this would be used to prove how ‘racist’ they really were. It is a double-blind situation.

The authors call for acknowledgement of institutional racism in psychiatry, but the work they have quoted in support of this view consists only of allegations and not of evidence. Unfortunately, in the current climate of political correctness, there is a lack of serious scientific debate on the subject. Their call for longitudinal research into a possible link between racial discrimination and mental illness should certainly be supported.