Reflections on the explanations of higher psychosis rates among migrant and ethnic minority populations: A critical discourse analysis

Abstract

A growing number of studies suggest that migrant and ethnic minority populations are at higher risk for being diagnosed with psychosis. However, the reasons why have been disputed. This study aims to explore different interpretations of the observed higher rates of psychosis diagnosis among immigrants and ethnic minorities in some parts of the world. We sought to examine these interpretations through a critical lens, acknowledging the social underpinnings of discourses and their power to shape real-world practices. Peer-reviewed editorials, commentaries and letters regarding the topics of interest were retrieved from database searches and subjected to a pattern-based critical discourse analysis. Across a 30-year span of literature, conceptualizations and explanations of higher psychosis rates amongst migrant and minoritized populations evolved in relation to the larger social context, at times opposing one another. Three discursive themes were identified, reflecting intersecting explanations: institutional racism in psychiatry; psychiatry as a scientific discipline that sees and treats all patients equally; and the social locus of high rates. Tensions surrounding psychiatry as a field, including issues of evidence, biological reductionism, and the conceptualization of psychiatric nosological categories have played out within the evolution of this discourse. Exploring how discursive constructions in relation to psychosis and minoritization have been shaped by historical and social factors, we consider the role of local and global dynamics of social power in favouring one explanatory model over another and how these may have affected efforts to prevent and better treat psychosis amongst immigrant and minoritized groups.

Keywords: critical discourse analysis; ethnic minorities; explanatory models; migrants; psychosis; race.

Figure 1.

Discursive constructions on explanations for the high rates of psychosis among migrant and ethnic minority populations. The depicted themes and sub-themes represent explanations of the epidemiological findings of higher rates of psychosis in minoritized populations. The themes emerged from a critical discourse analysis of academic papers across a 30-year span. The first two themes were contemporary and evolved in opposition to each other; the third theme represents a more recent focus on the social determinants of (mental) health.