Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
An important determinant of one's stereotypes is one's race.......
- Kallur Suresh (21 October 2001)
-
Re: An important determinant of one's stereotypes is one's race.......
- Helen Minnis (22 October 2001)
-
'Stereotypes' are useful in clinical medicine
- Ted Willis (27 October 2001)
-
Psychiatrists' Perspective Insufficient to Root Out Racism
- Apu Chakraborty, Kwame McKenzie (30 October 2001)
-
Re: An important determinant of one's stereotypes is one's race.......
- Shubulade Smith (3 November 2001)
-
Re: 'Stereotypes' are useful in clinical medicine
- Shubulade Smith (9 November 2001)
|
|
|||
|
Kallur Suresh, Specialist Registrar Royal London Hospital (Mile End) London E1 4DG
Send response to journal:
|
I read with interest the article by Minnis et al. which provides evidence for how psychiatrists still maintain racial stereotypes with regard to their patients.
The authors have not given any data about the ethnicity of respondents. A significant proportion of British psychiatrists comprises doctors from ethnic minorities. It is possible that the number of such paychiatrists has increased considerably over the last ten years. I feel one of the important determinants of racial stereotypes is one's race itself. The respondent's ethnic background may have influenced their own racial stereotypes. It is heartening to note that psychiatrists are not as 'racist' as ten years ago. This will go some way towards reducing the stigma attached to race and mental illness, but highlights how slow the process of attitude change is. Regards Kallur Suresh |
|||
|
|
|||
|
Helen Minnis, Specialist Registrar Yorkhill NHS Trust
Send response to journal:
|
Thanks for your comments about our paper. We fully agree with your point that the ethnicity of respondent is likely to influence responses to a survey such as ours. Unfortunately, the Royal College of Psychiatrists declined to give us ethnicity data on members, even anonymised, due to concerns about sensitivity under the Data Protection Act. We considered including a question about respondent's ethnicity in our survey, but thought this might make respondents more likely to guess the hypothesis. Yours sincerely, Dr. Helen Minnis |
|||
|
|
|||
|
Ted Willis, gp principal brigg n lincs
Send response to journal:
|
It is very odd that psychiatrists profess not to make any connection between race and likelihood of violent behaviour. Behaviour patterns including violent behaviour are strongly influenced by culture and hence ethnic origin, just as alchohol and drug abuse are, which are both strongly related to violent behaviour. Of course we all use stereotypes in our daily work. For instance i tend not to think of lung cancer in patients who dont smoke, even though i am aware that it occurs. Stereotypes are useful, as long as one is aware of their limitations. I have worked in Accident departments in which patients with stab wounds in the chest have been almost exclusively black. If i had a job as a security guard and was particularly careful to check young black males for knives would that be in any way unfair? Perhaps the security guards at Boston airport thought it would be 'racial stereotyping' to pay particular attention to passengers who appeared to come from the middle east! Frankly i am amazed that so many psychiatrists spent their time answering the survey. No wonder waiting lists are so long. As for the BMJ publishing it, i suppose it is useful for other doctors to see what passes for medical research. I hope dalrymple ( the medical columnist) spots the article and i look forward to his demolition job. |
|||
|
|
|||
|
Apu Chakraborty, Specialist Registrar, Psychiatry; Senior Lecturer, Transcultural Psychiatry St Ann's Hospital; Royal Free & University College Medical School, Dept of Psychiatry, London, Kwame McKenzie
Send response to journal:
|
PSYCHIATRISTS' PERSPECTIVE INSUFFICIENT TO ROOT OUT RACISM EDITOR - Minnis et al's vignette-based report claims that racial stereotyping which occurs at the first psychiatric interview is insufficient to account for the inequalities in diagnosis of schizophrenia between black and white men in the UK.1 Their findings are not surprising. What people say and what they do are often two quite separate things. Respondents may have consciously or sub-consciously over-compensated for their prejudices in the current climate of sensitivity to racial issues and because previous studies in psychiatry have used similar investigative formats.2 The clinical evaluation that a psychiatrist performs is not simply a list of objective facts. It is a subjective account of an interaction between two people. This interaction is fashioned by the perceptions of the evaluator and the importance (s)he chooses to give to certain information. The relative importance of different parts of the history depends on the culture of the speciality of psychiatry and the individual psychiatrist's beliefs, understanding, value judgements and prejudices. This reliance on pre-conceived beliefs is likely to be especially significant on the first meeting with a patient. It is difficult for the assessor to acknowledge these beliefs let alone for them to be elicited in a vignette study. Studies have demonstrated that although initial pathways to psychiatric care are similar for different, UK, ethnic minority groups,3 the subsequent care given to patients of African and Caribbean origin is more coercive and their service-related outcome is poorer.4 There is something about the interaction of these groups of patients with psychiatric services that leads to their detriment. Patients of African and African-Caribbean origin in the UK often have a negative experience of psychiatry. Unpublished work in our department has shown that this is more likely to be attributed by the individual to racism. A way forward may be to assess the service-users' perceptions of discrimination and use these to improve services. Attention to this may improve the therapeutic alliance and outcome. However, racism is a complex, multifaceted process and likely to affect the outcome of therapeutic interactions at the inter-personal, institutional and community level.5 Minnis et al’s study is a welcome start but racism needs to be examined on a number of different levels and from a number of different perspectives if we are to produce a truly equitable service. 385 words Apu Chakraborty* Kwame McKenzie *: corresponding author. 1 Minnis H, McMillan A, Gillies M, Smith S. Racial stereo-typing: survey of psychiatrists in the United Kingdom. British Medical Journal 2001; 323:905-6. 2 Lewis G, Croft-Jeffreys C, David A. Are British psychiatrists racist? British Journal of Psychiatry 1990; 157:410-5. 3 King M, Coker, E, Leavey, G, Hoare A, Johnson-Sabine E. British Medical Journal 1994; 309, 1115-9. 4 Bhugra D, Cochrane R. Mental illness and ethnic minority groups. In Psychiatry in Multicultural Britain (eds D. Bhugra & R. Cochrane). London: Gaskell. 5 Sashidharan, S. Institutional racism in British psychiatry. Psychiatric Bulletin 2001; 25(7):244-7. |
|||
|
|
|||
|
Shubulade Smith, Consultant Psychiatrist Maudsley Hospital
Send response to journal:
|
We welcome the comments made by Chakraborty and McKenzie and are in full agreement with most of their points. However, it is important to note that over the past 11 years there has been a change in the way that psychiatrists perceive black patients. This increased consciousness of racial issues may represent an improvement in the racist attitudes that exist within the psychiatric system. We are aware that this is a very complex area which requires further in- depth research, but feel that our finding is a positive one on which the psychiatric community can build. |
|||
|
|
|||
|
Shubulade Smith, Consultant Psychiatrist Maudsley Hospital
Send response to journal:
|
We were concerned to read Willis' comments regarding the use of stereotypes in clinical medicine. A stereotype is defined as "an unduly fixed mental impression" (1). Stereotypes are often based on subjective feelings and not objective evidence. In medicine we now espouse an evidence-based approach, this best serves both patient and clinician (2). When stereotypes are subjected to scientific testing they are frequently dispelled. This was the case with our survey. 1. Concise Oxford Dictionary of current English. 6th Ed. Oxford University Press. 2. National Service Framework for Mental Health - Modern Standards and Service Models. Sept 99. |
|||