“Afro-Caribbeans” could have been of Chinese, Indian, European, or African extractionBMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7039.1157b (Published 04 May 1996) Cite this as: BMJ 1996;312:1157
EDITOR,—I wish to point out serious flaws in Kwame McKenzie and colleagues' study of the prognosis of psychosis in Afro-Caribbean people.1 It is courageous of the authors to tackle this comparative study, but their failure to clarify their sampling leaves their work with glaring methodological flaws.
Two groups of people were compared. The first group, the “white” group, was selected by skin colour, place of birth (United Kingdom), and place of parents' birth (United Kingdom). The second group, the “Afro-Caribbean” group, was selected simply on the basis of the place of parents' birth (the Caribbean islands): there is no reference to skin colour or to the patients' place of birth. Besides, McKenzie and colleagues assert that white skinned people born in the United Kingdom of parents also born in the United Kingdom form a “culturally homogeneous” group. This is misinformed: it takes a brave person to say that people such as the white Irish, Scottish, Welsh, and English are of the same culture. What is more, being white skinned is a property of both the Caucasoid and the Mongoloid divisions of humankind.
The Caribbean islands are home to people of all the main races except Australian Aborigines. So what is the “Afro-” in the authors' Afro-Caribbean group? The Afro-Caribbean group could have been made up of people of Chinese, Indian, European, or African extraction. And if the subjects were born in the Caribbean but now live in the United Kingdom then environmental factors that acted on them in infancy or childhood could account for the difference in the outcome of their illness compared with that of people born in the United Kingdom. This is either poor science or poor reporting of research.
It is interesting to note that, in the November issue of the Psychiatric Bulletin, McKenzie and an associate argued that the term “Afro-Caribbean” should no longer be used to describe any group of people as it was too imprecise2—yet here we find McKenzie and other associates applying in the BMJ the very term he repudiates elsewhere. This is the reason why the study reported in the BMJ is so unsatisfactory: McKenzie is struggling, like all of us, with the elusive concepts of race, culture, and ethnicity and how these relate to the origins and outcome of human disease.
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