Schizophrenia is a mental health condition that may cause someone to act and perceive things differently. Symptoms include experiencing hallucinations (seeing, hearing and sensing things that are not there), having disruptive fixed beliefs, muddled thoughts (which compromises their functionality) and exhibiting “strange” behaviours because of these things (e.g. responding to voices). Due to the sometimes eccentric presentation of the condition, it is heavily misunderstood, stigmatised and therefore people living with schizophrenia are often discriminated against, abandoned and thus, their recovery is delayed.
The way that schizophrenia presents in a person can be influenced by one’s culture and environment, so someone from Britain may have delusions of the FBI spying on them due to watching shows about such in the past – even though the FBI does not operate in the UK. Some people may interact with their delusions/hallucinations in loud and flamboyant ways; this can cause fear to rise amongst family members, loved ones and members of the public; so on top of dealing with an illness that causes distress, people living with schizophrenia face stigma and social exclusion.
Working with people that live with schizophrenia and other psychotic disorders (in hospital wards and in the community), I noticed the overrepresentation of black people, particularly black men, using the services – this also reflects in national statistics. The locations that I have worked in have not had particularly high numbers of black people for such a reflection in the mental health services. So why do African and Caribbean men make up a high percentage of service users?
After some research of my immediate community and literature on this topic, I realised that we heavily stigmatise this illness and so many people tend to keep symptoms to themselves. For lack of a better comparison, hiding schizophrenia is like hiding a pregnancy, avoidance of the topic only causes it to grow and become more noticeable. Black people, especially men are less likely to recognise a mental illness in themselves, due to pride, lack of information, denial and/or cultural disapproval of mental health problems etc. Black men are also more likely to be in high risk groups that are more prone to mental health problems e.g. exclusion from schools, social deprivation, crime and drug cultures and racial victimisation.
Combined with the general fear and stigma associated with schizophrenia, black people living with the condition are also subject to racist perceptions of aggression, rebellion and criminality, this is heightened when exhibiting “odd” behaviours and as a result, a lot of health care staff are unsure about how to approach the matter. Because of this, black mental health service users are more likely to receive heavier dosages of medication, more restraint, be placed on community treatment orders (obligatory medication orders to take at home), be offered medication as a primary form of treatment as opposed to talking therapies, and experience social discrimination by staff.
The distrust for mental health services amongst black men and the negative perceptions of black men by wider society (including in mental health services) reinforce each other as self-fulfilling prophesies: black men seek help later than others (and more often through the criminal justice system than others) which means that they are more symptomatic when they finally arrive at services, staff approach them in a more hostile manner due to negative prejudices, as a result of this, black men with schizophrenia may become more distressed which can lead to more restraint and harsh treatment by staff, this affirms negative stereotypes and causes the on-going mistrust of the services by black men and the negative perceptions of black men in the mental health services.
Masculinity also plays a role in this. Men in general feel more shame when seeking help. They are pushed more to appear as self-sufficient so are more likely to seek help later than women.
We also have a lot of spiritual beliefs which align with symptoms of schizophrenia, so instead of seeking medical advice, a lot of people rely on spiritual interventions. While religion and spirituality have aspects that are beneficial to one’s mental health, using it a as a substitute to medical treatment can be counterproductive, medical and more holistic approaches to one’s health can compliment each other, it does not have to be a competition and one does not negate the other.
A lot of common misconceptions about people living with schizophrenia and psychotic disorders include:
They are dangerous so you should stay away from them! – This is false. People living with schizophrenia are more likely to harm themselves or be harmed by others than they are to cause harm onto others. The condition makes them vulnerable, not harmful.
They have split personalities – this is not a symptom of schizophrenia.
Don’t bother talking to them, they only talk to their hallucinations – while experiencing hallucinations is a symptom of schizophrenia, it is rarely a 24 hour occurrence for those living with the condition and not everyone with schizophrenia experiences this. Likewise, not everyone that experiences hallucinations has schizophrenia or a psychotic disorder.
If you have schizophrenia, you’ll be locked up – mental health services aim to promote independence and individuality, detaining someone under the mental health act/ "sectioning" (keeping someone in hospital by law) is done as a last resort when someone is believed to be harm to themselves or others. People with other mental illnesses can be sectioned too; this includes complex depression and personality disorders.
If you are experiencing any symptoms of schizophrenia and/or another type of psychotic disorder, you can go to your GP to be referred to the appropriate services that can offer help.