schizophrenia and immigration

something else from The Diversity Illusion:

“Diversity can make people unhappy; it may even drive them mad. In London studies have shown higher incidence of schizophrenia, suicide and self-harm among ethnic minorities living in neighbourhoods with fewer people of the same group, than in areas where they are dominant, even when they are more affluent.83 Under the Marxist consensus this was always explained as a product of discrimination and prejudice, which could be solved through anti-racism measures. The mental health profession is even accused of racism because it disproportionately sections members of some groups. When in 2007 psychologist Swaran Singh co-published a systematic review pooling data from all British studies of detention of ethnic minorities under the Mental Health Act, and found no evidence that higher rates of detention were due to racism, he was denounced in public. And yet, he wrote, ‘careful studies in different countries have shown that rates of serious mental illnesses are high in all migrant ethnic minorities, indicating that this is a function of migration rather than ethnicity. Researchers have used culturally neutral assessment scales devised by the WHO, rated the assessments blind to ethnic origin of the patients, and even had psychiatrists from the Caribbean recheck the diagnoses. The findings stand’.84

“Mental illness is a part of the immigrant’s experience, a process that can be sad, stressful and isolating, sometimes even more so for the second generation. In 1932 Ornulf Odegaard, a Norwegian psychiatrist, reported high rates of schizophrenia among his countrymen in Minnesota, and it seems unlikely that this can be explained by the racism of American natives towards blue-eyed Nordic immigrants. And higher rates of psychosis in migrants have since been reported in several countries. A 2011 University of California report found that levels of mental illness were far higher among Mexicans in the US than Mexicans back home. As Dr Singh said: ‘Childhood exposure to economic adversity, family breakdown, social exclusion and living in areas with poor social cohesion all increase the risk. Ethnic minorities have higher rates of psychosis as they are much more likely to suffer these adversities….’

“High mental illness rates are caused by the shock of dislocation and diversity, a shock that can be sustained with community support. As Dr Singh explained, in minority groups ‘values and beliefs, family structure and community norms…can bolster resilience and reduce the impact of adversity’.” [kindle locations 1809-1834]

i’ve read about this before. what i’d like to do, though, is flip the premise on its head, jayman-style:

what if it’s not migration — and winding up in a diverse setting — that results in schizophrenia (and other mental illnesses?), but rather what if schizophrenic people — or individuals predisposed to getting schizophrenia — are more likely to emigrate?

assistant village idiot?

previously: “the diversity illusion”

(note: comments do not require an email. albatross!)

Advertisements

21 Comments

  1. Reporting for duty: Schizophrenia is something of a trigger phenomenon. You can have miserably bad things happen to you and not become psychotic, because you don’t carry that particular vulnerability. You become depressed, or alcoholic, or phobic, or have nightmares instead.

    Speaking (mostly) not from the research, but from what sits across the table from me, I will tell you the following:
    Drug abuse, particularly among the hallucinogen class, is a clear trigger. That LSD, psilocibin, mushrooms, or ecstasy (MDMA) have long been recognised as triggers. The newer fashionable drugs, such as spice, K2, bath salts, or the synthetic marijuana products have us very, very worried. There is a hockey-stick graph on use of those. Marijuana has a documented huge increase in schizophrenia diagnoses (even accounting for cart/horse phenomena), but it is from a low (1%) level to start with, so I don’t tend to be anti-marijuana, unless you have schizophrenia anywhere in your bloodline. If you do, stick with moderate alcohol and nothing else.

    Physical and sexual trauma when young – not so much teenaged – is also a big trigger, likely due to cortisol levels. Chaos and neglect may be bigger problems than abuse, actually. Speculation abounds as to why that may be, and I don’t think my opinion is better than anyone else’s there. Infection, prenatal stress, and ongoing, rather than acute trauma, show up with uncomfortable frequency in psychosocial histories.

    And then there are those who seem to emerge with schizophrenia from no trigger at all – Ivy-league daughters of professionals, with no trauma, no drug abuse, no family history. [Anecdotal tangent: If you are looking to strain for some weird association from that description, I have known six (if you include Seven Sisters with Ivy League). They majored in German literature, French literature (2), Russian Literature, philosophy, and Medieval Literature. Go figure.]

    Immigrants tend to have high rates of isolation and substance abuse. Maybe that’s it. I am leaning toward the prenatal stress on the impoverished (or war-exposed) moms, however.

    Reply

  2. Or what if there exists in the environment that is new to the immigrant, a biological trigger that was missing in their native land, making them symptomatic? Some pathogen or strain of a pathogen that they’d not encountered in their native land, exposure to sun or lack of exposure to sun–environmental triggers like these, even food changes as triggers.

    Reply

  3. Key quote “Mental illness is a part of the immigrant’s experience, a process that can be sad, stressful and isolating, sometimes even more so for the second generation”

    Key phrase “Second Generation”

    I recall Steven Pinker quoting a study that found Schizophrenia to be ~90% heritable as opposed to other environmental/Freudian causes such as the parents toilet training too harshly in early life.

    I think the HBD chick asks the right questions!

    Reply

  4. Has there ever been a study of the rates of mental illness among a native white population that gets turned into a minority through immigration? I doubt it but from experience i think you’ll find elevated levels of all kinds of substance abuse and mental illness in those populations as well.

    Most groups aren’t adapted to living in a diverse environment. They’re only adapted to living among a homogenous group. It’s why immigrant groups all tend to self-segregate in their own areas where they can be mono-racial and mono-cultural because that’s the kind of environment that makes most people feel secure.

    Reply

  5. Or maybe different ethnics have different rates of schizophrenia and immigrants come from ethnics that have a higher rate than the natives.

    Reply

  6. schizophrenia is pretty darn genetic – any trigger is merely speeding up the process of the first psychotic break – in fact the triggers are merely assumed ex post facto – & are not necessary to the equation – they just help the process to bloom sooner.

    Reply

  7. http://www.ncbi.nlm.nih.gov/pubmed/23177929

    Non-random mating, parent-of-origin, and maternal-fetal incompatibility effects in schizophrenia.

    Kim Y, Ripke S, Kirov G, Sklar P, Purcell SM, Owen MJ, O’Donovan MC, Sullivan PF.

    Source
    Department of Genetics, University of North Carolina at Chapel Hill, NC, USA.

    Abstract

    Although the association of common genetic variation in the extended MHC region with schizophrenia is the most significant yet discovered, the MHC region is one of the more complex regions of the human genome, with unusually high gene density and long-range linkage disequilibrium. The statistical test on which the MHC association is based is a relatively simple, additive model which uses logistic regression of SNP genotypes to predict case-control status. However, it is plausible that more complex models underlie this association. Using a well-characterized sample of trios, we evaluated more complex models by looking for evidence for: (a) non-random mating for HLA alleles, schizophrenia risk profiles, and ancestry; (b) parent-of-origin effects for HLA alleles; and (c) maternal-fetal genotype incompatibility in the HLA. We found no evidence for non-random mating in the parents of individuals with schizophrenia in terms of MHC genotypes or schizophrenia risk profile scores. However, there was evidence of non-random mating that appeared mostly to be driven by ancestry. We did not detect over-transmission of HLA alleles to affected offspring via the general TDT test (without regard to parent of origin) or preferential transmission via paternal or maternal inheritance. We evaluated the hypothesis that maternal-fetal HLA incompatibility may increase risk for schizophrenia using eight classical HLA loci. The most significant alleles were in HLA-B, HLA-C, HLA-DQB1, and HLA-DRB1 but none was significant after accounting for multiple comparisons. We did not find evidence to support more complex models of gene action, but statistical power may have been limiting.
    Copyright © 2012 Elsevier B.V. All rights reserved.
    PMID: 23177929 [PubMed – in process]

    Reply

  8. Maybe some of both: you’ve got to be a pretty desperate to leave the land of your birth, and the strange society you land in has got to be more than a little disorienting. Stress all around. And stress is a factor, is it not, Mr. assistant village idiot?

    Reply

  9. Yes, but “stress” is an elastic concept. Erica’s suggestion is fascinating. Panjoomby’s is likely true but not as well-established as he presented here. Chris davies’ link is new to me. I would have guessed that the third factor was stronger, and that seems to be, but I’m not sold on it yet, not aby a long shot. Because schizophrenia tends not to show until the third decade (and paranoid schizophrenia, or one version of it, not until the fourth decade), there are just an insane number of variables in retrospect. And the nature of my business is to see things in retrospect rather than the good longitudinal studies, I don’t have a good nose for the research in some ways.

    Reply

  10. A lot of ideas, but the simplest explanation is as HBD Chick notes (as I would indeed note):

    “what if it’s not migration — and winding up in a diverse setting — that results in schizophrenia (and other mental illnesses?), but rather what if schizophrenic people — or individuals predisposed to getting schizophrenia — are more likely to emigrate?”

    The people likely to leave their homelands are going to be malcontents in one form or another, so…

    Of course, there is the IQ thing. There is the (tentative) connection between IQ and mental illness…

    Reply

  11. @avi – “The newer fashionable drugs, such as spice, K2, bath salts, or the synthetic marijuana products have us very, very worried.”

    oh, bath salts sound REALLY scary! totally nightmarish. at least the stories that make it into the press. =/

    @avi – “Physical and sexual trauma when young – not so much teenaged – is also a big trigger, likely due to cortisol levels.”

    interesting. they’re not short of that in places like somalia. =/ (being in a war zone i was thinking.)

    Reply

  12. @avi – “Anecdotal tangent: If you are looking to strain for some weird association from that description, I have known six (if you include Seven Sisters with Ivy League). They majored in German literature, French literature (2), Russian Literature, philosophy, and Medieval Literature. Go figure.”

    well, that actually fits with what i’ve heard about before re. schizophrenia: a connection between schizophrenia and creativity (note that i haven’t read much about this — never read any books about it).

    that’s what i had in mind when i wondered if people predisposed to getting schizophrenia might be the ones to more frequently leave home. i’m thinking schizophrenia, creativity, an interest in new ideas/new places? dunno. just a thought.

    Reply

  13. @erica – “Or what if there exists in the environment that is new to the immigrant, a biological trigger that was missing in their native land, making them symptomatic? Some pathogen or strain of a pathogen that they’d not encountered in their native land….”

    ah ha! yes, a schizo germ! interesting thought. (^_^)

    Reply

  14. @g.w. – “Has there ever been a study of the rates of mental illness among a native white population that gets turned into a minority through immigration?”

    ooo, that would be interesting to see. =/

    Reply

  15. “ooo, that would be interesting to see”

    There’s higher levels of all sorts of dysfunction in diverse areas partly because they’re disproportionately poorer because most immigrants are low-skilled.

    .
    “A lot of ideas, but the simplest explanation”

    Immigrants congregate in certain areas therefore any comparison of immigrant mental health rates with the native rates needs to be with the natives in the *same* areas not nationally. If mental health has a diversity premium then if you compare like with like there may not be a higher rate of schizophrenia to explain.

    An even if not there’s also the different age/sex distribution and the above-mentioned different social class distribution as well.

    Basically are the studies on higher rates of schizophrenia among immigrant populations comparing like with like?

    Reply

  16. When comparing the schizophrenia rate of, say, Somalians in America with Somalians still in Somalia, might there not be a problem regarding diagnosis in a place like Somalia? In many third world places there might be few professionals to make the diagnosis and there might be huge social pressures against talking about mental illness, or admitting to it.

    I would think that even in places such as China or South Korea the way schizophrenia is diagnosed is probably very different than in the west. So if you wanted, say, to compare the rate of schizophrenia among recent Chinese immigrants to Canada with the rate in China, there wouldn’t be anything reliable to compare the Canadian figures to.

    I remember reading that Somalis in Minnesota had an unusually high rate of autism. Unusual compared to what? (Furthermore, I have also read that people on welfare get more benefits if they have a child with autism, and the Somalis were scamming the system by somehow going out of their way to have their kids diagnosed so get the extra benefits.)

    Reply

    1. @melkin:

      “When comparing the schizophrenia rate of, say, Somalians in America with Somalians still in Somalia, might there not be a problem regarding diagnosis in a place like Somalia? In many third world places there might be few professionals to make the diagnosis and there might be huge social pressures against talking about mental illness, or admitting to it.”

      Indeed. I am highly suspect of these findings for that and other reasons…

      Reply

  17. I read somewhere (forgot where) that the lower estimates for schizophrenia are due to not measuring it dimensionally but in distinct categories. Then you have discordant twins because one is having a good day. If it is some 80-90 percent heritable then that leaves little room for the environment and more likely to be an influx of people vulnerable to this condition.

    Although if they move from a small village to a large city when immigrating (as most do) that could perhaps lead to sensory overload and in that way be an environmental factor, although probably not a very large one.

    Reply

Leave a Reply to Anonymous Cancel reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s