What is an Afro-Caribbean? Implications for psychiatric research

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What is an Afro-Caribbean? Implications for psychiatric research

G. Hutchinson and K. McKenzie
The term Afro-Caribbean is used to describe black people of Caribbean origin in Britain. Migrants from the Caribbean, their children and their children's children are all covered by this term. The group as a whole is reported to have a higher incidence rate of schizophrenia than white groups, (King et al, 1994), and British-bom children of Caribbean parents have an even higher rate (Harrison et al 1988). These reports have led to the hypothesis that Afro-Caribbeans may have a special vul nerability to schizophrenia. While limitations to these studies have been identified, (Wessly et al, 1991) none has sought to question the use of the term Afro-Caribbean as a valid and reliable ethnic grouping. If we are to be able to produce good hypotheses for the aetiology of the reported increases in incidence, or to produce research which is useful to Black and ethnic minority groups, we need a clear understanding of the people under study.
There have been many criticisms of the way researchers employ ethnicity as a variable. They rarely report how their groups are defined or exacuy how people were placed in them. The logic behind their dÃ©finitionsis rarely stated, (Sheldon & Parker, 1992;McKenzie & Crowcroft, 1994;Senior & Bhopal, 1994). Bhopal et oÃ-(1991), have objected to the way the term Asian is used to describe a diverse group of peoples and cultures from Japan to Sri Lanka. Because of this they argue that research on 'Asians' defined as such is of little use in producing hypotheses to explain differences in the rates of illness, mortality or morbidity. The term Afro-Caribbean is similar in this respect. Using the term tends to diminish understanding of the immense cul tural diversity of the Caribbean peoples and, in this country, ignores the differences between different generations resident here. It is clear, however, that such an understanding is vital if sensible hypotheses are to be generated to explain reported research funding or if we are to produce ethnically sensitive services.
The term Afro-Caribbean is made up of two parts Afro-and Caribbean-both of which need to be examined if we are to understand what it means.
Afro-. The prefix Afro-conveys very little. There are considerable social and cultural differences between and within nations which make up the African continent as exemplified by comparing Algerians to Zambians or com paring the diverse colours, cultures and re ligions encountered travelling from the north to the south of Morocco. The term African or of African origin does not convey sufficient in formation to use as a homogenous ethnic grouping in a scientific context. The use of the prefix Afro-in Afro-Caribbean conveys even less information. It has little to do with cultural identity or origin but seems more related to colour of skin. Few would have categorised the light-skinned Michael Manley, the ex Prime Minister of Jamaica, as Afro-Caribbean although he is partly of African origin. This represents a good example of the ethnic mixtures in the West Indies and as such the difficulty in describing ethnicity in this population.
Caribbean. The Caribbean is a geographical area rather than a cultural entity. It is difficult to describe a Caribbean identity or culture in a meaningful way. The region represents a large archipelago of islands divided by water and the legacy of the European countries which colonised them. Puerto Rico on the North American mainland, Belize in central America and Guyana in South America are all part of the Caribbean. There are English, French, Spanish and Dutch-speaking Islands with cultural influences to match them. The indi genous inhabitants of the region were Carib and Arawak Indians who populated the is lands from the South American mainland. Most died during the early colonial years. The current inhabitants are mainly descended from a variety of migrant groups including slaves from Africa, indentured labourers from India, European Colonials and people from the Far and Middle East. There has been much miscegenation.
The islands exist as distinct cultural and national entities with their own laws and passports and are more like a pre EC Europe than a USA.
The English-speaking Caribbean is also known as the West Indies. These islands are as geographically and culturally diverse as the rest of the Caribbean (Beaubrun, 1992). This diversity exists because of the mixtures of language, ethnicities, religion and colonial influences. They are also compounded by the long distances between the islands and the fact that there are major differences in the propor tion of people of different origins in each island. For instance in Trinidad there are roughly equal numbers of people of African and Indian descent, whereas in Barbados and Jamaica over 90% of the population is of African descent.
Afro-Caribbean as an epidemiological vari able. It is questionable whether a term such as Afro-Caribbean which describes such a diverse group of individuals and cultures could be useful as a scientific variable. But apart from the heterogeneity of the group there are three other problems. First, genetic research using polymorphic probes has shown that there are greater differences within groups such as people of Caribbean origin or white English, than between such groups (Jones, 1981). Different groups merge into each other geneti cally and there is no typical member of a group (Sheldon & Parker 1992). Second, there is little evidence of significant biological differences between people of Caribbean origin and other groups in the UK which might be of relevance in psychiatric research and third, research which compares different ethnic groups in the UK is substantially confounded by social class, ma terial deprivation and experience of adversity (Sheldon & Parker 1992;McKenzie & Crowcroft, 1994).
One of the few logical reasons for demarcat ing groups using colour as a basis is to investigate the impact of discrimination and racism and to investigate equity in access to health care. This is because one would want to mimic racist thinking in society to produce at risk groups. We would argue that the choice of research into differences between people of Caribbean origin and whites in psychiatric research is, at least in part, an example of racialised thinking: there has been no attempt to accrue evidence of significant cultural or biological differences and the research has arisen from clinical impressions of differences between groups demarcated by colour. Be cause the choice of groups is not hypothesis led it is difficult to make sense of the findings of research. Further research built on these foundations would be similarly flawed. For more thorough scientific biological or cultural research, racialised thinking is clearly not an adequate basis.
Without hard evidence of cultural or biologi cal differences from other groups, with the wide diversity that is present within the group and with the term confounded by socio-economic variables it seems that there is little justification for the continued use of the term Afro-Carib bean except when racism or discrimination are possible factors.
Psychiatrists, like the rest of society, live in continual interaction with and are products of the society to which they belong. Evidence has been found for racial stereotyping by British psychiatrists (Lewis et al 1990) and by using the term Afro-Caribbean we are in danger of perpetuating and reinforcing stereotypes and ignorance. Adopting basic scientific principles, selecting groups led by hypotheses and de marcating them with firm evidence would, to some extent, protect us against social preju dices.
Black populations in the UK see psychiatric services as racist and not catering for their needs (Francis et al 1989). Research appears to relegate them to statistics and stereotypes without attempting to understand them or their problems. An appreciation of the needs of our patients can only come from an under standing of the historical and socio-cultural context from which they come and in which they live. We would argue that research which does not understand or acknowledge the diversity of Caribbean cultures will always be viewed with suspicion. Moreover, because it is scientifically flawed, it is likely to yield mis leading results.