Mental health: ethnic minority experiences
Views about causes of mental health problems: social & environmental factors
Research suggests that various factors may interact and cause or contribute to the development of mental health problems, including physical, social, environmental and psychological factors. Here, people talk about what they believe caused their mental health problems. This summary focuses on social and environmental factors; individual factors are discussed elsewhere (see 'Views about causes of mental health problems: individual factors).
Many people we talked to believed that various social and environmental factors led to the development of their mental health problems. Some people identified a range of factors building up over time rather than any one single cause, whereas others pinpointed one specific factor or incident. People also said that there was a difference between 'triggers' and 'causes', an underlying predisposition to mental health problems that can be set in motion by any one of a number of factors (see Edward's story).
Work, finances and housing
Some thought that they developed mental health problems because of work or business problems and the associated stress. For a few people, being unemployed or unable to work was a factor. One woman believed that wealth and inequalities in society contributed to ill-health and thought that her degree level education and attempts to escape poverty were unnatural and caused her nervous breakdown.
Raj was unable to work following a heart attack and says this made him depressed. (Audio in Punjabi, text in English).
Raj was unable to work following a heart attack and says this made him depressed. (Audio in Punjabi, text in English).
When I was discharged from [general hospital], the psychiatrist told me to visit the doctor and he would give you medication, so I made an appointment and I told him that I been told to get medication from you but he said, “Sorry, my budget doesn't allow it, it's too expensive per month, all I can do is give vitamin tablets,” what he has asking to give me on the… I have red vitamin capsules but it doesn't matter if I have them or not.
How did it feel when you were told no to the medication?
It hurt a lot, that gave me depression. If a person can go to work then he should be supported by the medication then at least he is able to work. At least he will do something for the county, employment, if we are British we do something for the country, then if we work then we will earn. Now taxi work is not great but I still tried, rather than sitting around. If a government man is saying that he can't give medication and to sit at home it's all right then it's not my fault. But since I heard this I got depressed, no-one has an idea.
So this is a cause of your depression?
Yes.
Were you forced to say that you shouldn't do this as I need it?
No, I wasn't forced, since I been to this doctor, this surgery. This doctor has treated us better than the other doctors. What he told us about the budget I tried to understand it, as they treat us well, give us good medication, when we need a test then straight away they say it, 15, 16 years they haven't messed about. We were happy that we even recommended other patients to them and when we call them they have our details on their computers. Like now I have a cold and told them I have a cold and I want to see the doctor and they checked the computer and said come tomorrow. When someone looks after you well, you don't want to say anything wrong about them or even have argument, everything is taken for granted.
Do you know the name of the medication?
The medicine was written directly to him and told us go and visit your doctor after 10 days, then when we went he said that he can't afford it, but I can't remember the name of the medication. [Interruption] But the doctor looks after you so well, he saved my life, you don't want to go and argue with him. No.
Did you talk with the psychiatrist, to say that the doctor will not give medication?
The psychiatrist is retired and is not there. I saw the doctor in town and thanked him that he looked after me and he said that he's retired now. He isn't there.
Do you feel if you had this medication you could have gone back to work?
Yes I did have hope, but look since 1994 up until now, much damage has been done now and muscle have set and I don't think the medication will work now. He then said that it's new, the artery will be opened he said the soft tissues and soft muscles, when they get damaged they are not repairable. It's now long term damage and I don't think the medication will work. The reassurance that I could go to work and got the letter, it's all down in the dumps.
You don't think you can manage it?
No not now, and the medication they give me now when I see how I manage day to day, it's not possible to work now. The reassurance has gone not my health and then if I go to work then I worry about my wife, the matter will get worse not better. T
Others mentioned money problems - although one man said he didn't think poverty was a factor in his case - and either losing their home or living in poor quality housing. Although some thought migration “or the hardship adapting to British society” might have contributed to their mental health problems, others emphasised that they didn't think this was a factor for them.
Hanif doesn't think migration contributed to his mental health problems.
Hanif doesn't think migration contributed to his mental health problems.
Migration often is a, is kind of mentioned as a factor' I'm not convinced that my migration was a factor on its own. It could be another, could be a contributory factor but on its own, I don't think so' You know, certainly, you know, lots of, some studies have shown that, you know, that migration does affect individuals or societies or, you know, groups of people. But yeah it's a, it's out to jury really. So, I mean, you know, either that was a, could be a contributing factor, yeah.
Relationships & upbringing
Many people thought that their family and social relationships had affected their mental health. Some mentioned having bad relationships, marital problems or splitting up from partners. [See Jay below] They also believed that not having a partner or friends, being lonely and feeling unsupported or unloved contributed to their mental health problems (see Devon's story). A few people thought not having anyone close enough to talk to about their problems played a part: “I could not express my sorrows and that's why it was not going away from my mind”.
Lots of people we interviewed felt that their upbringing and relationship with their parents was an important factor. They described being subjected to strict rules and being under pressure to do specific things, for example doing well academically or losing weight. A few people described their mothers treating them particularly harshly, including forcing them to eat or diet, accusing them of having inappropriate sexual relations and punishing them physically. One woman described being rejected by her father because he didn't believe she was his biological daughter.
Other people had been separated from their parents or surrogate parents as children and felt their mental health problems stemmed from this (also see 'Onset of mental health problems').
Marlene was separated from her parents and brought up in Pakistan by her grandmother and thinks...
Marlene was separated from her parents and brought up in Pakistan by her grandmother and thinks...
And with my parents, I didn't have any love from my parents. And I think that has more affected what I've been through. Since I, still nobody understands me. Only my husband, my kids. Me and my mum, I love my mum but we never, we didn't get touched like should daughters and mums been. And my dad the same thing. And now it's, we've a family problem. I lost my grandma and my uncle because with family's problem. They brought me up and everything. And when, every time I think that, I think every time I love somebody, I have to lose that person. And then I've got fear that I might lose my husband. I might change for my husband and I think about bad stuff. And the thoughts come in my mind'
But when I came back, my, backwards, like I didn't have any love from my mum and my dad. It could be that. And it's the worse thing to not know your mum and your dad. You know them, but you, you don't have that love. And you don't want to share that love to your mum and your dad, because you don't know them. They're saying different things, I'm saying different things. And they don't understand me and I don't understand them. And it's very difficult for me. And I, I, sometimes I start getting anxiety. And now, it's, it's not anxiety, it's feel like I'm tired. I've got, like when I eat I feel full. I can't eat, digesting my food. And then I start thinking bad stuff.
Some people experienced confusion about their identity, especially where their upbringing was at odds with their ethnic and cultural background, sometimes following migration (theirs or their parents). People talked about the difficulties of growing up amongst the White majority and not being able to identify with the culture of their background; sometimes this was because of their parents' choice to adopt a 'White, western culture' - as one woman said, “my mother was very adamant that we should live an English existence and we should eat sausages and mash rather than yam and plantain”. Being of mixed heritage created problems for the identity of some people. For others, confusion about their identity arose as a result of being in local authority care.
David says various factors contributed to his mental health problems, including an unstable...
David says various factors contributed to his mental health problems, including an unstable...
An unstable family, I think. I think it was a number a factors. My mother not being a very motherly type of character, being basically a kid who had a kid, at seventeen years old. I think that's way too young to be having children. My father not being there. My grandfather, my grandfather being in denial about me, I, I mean if I get called Black this and so and so, he, he'd just say, you're white all the time and he'd keep on saying that. And after awhile I believed, I started believing that. I actually, I almost came to the point where my vision changed.
And, and emotionally and culturally I still feel that I'm a white person but I know that I'm not. So in a way I'm caught in a limbo between these two worlds because I can't speak Arabic and I don't live in an Arabic country. But I don't look like an English person. So like most people of mixed race I think this is a separate ethnic group all in its, all in its own right. Like most people of mixed race I'm trapped in limbo. And for questions of identity which are very important for people, you just, you just feel trapped and you feel lost. And that's, that's not a very nice place to be at, at anytime in your life.
So is there I mean you, you don't have a, a feeling that you identify more with the, your father's side or with now?
I don't feel I have any identification or indeed any ability to relate to anybody at all in significant way.
Another woman felt that being labelled as “abnormal and in need of psychiatric treatment” became a self-fulfilling prophecy which meant that she saw herself as different from other people. She also felt that the pressures on women in society may have contributed to her having an eating disorder.
One woman reported many traumatic experiences that together led to her schizoaffective disorder, including witnessing her parents' arguments and having her own baby before she felt ready to become a mother. Other people described how conflicts, tensions and lack of contact with members of their immediate and extended family, including in-laws, contributed to their mental health problems. One man said that the difficulties he experienced after arranging two marriages (one for his brother and one for his son) caused him so much worry that he became depressed.
Spirituality
People also had other beliefs about what may have caused their mental health problems. Some felt that God was trying to “torture” them or had put a curse on them. One woman felt that she had been rejected by God and this had triggered her depression (see 'The role of faith, religion & spirituality for people with mental health problems'). Others thought that hearing the voice of God might trigger psychosis, or that reading religious texts could add to feelings of depression.
Ali sometimes wonders whether God is out to get him. (Played by an actor).
Ali sometimes wonders whether God is out to get him. (Played by an actor).
Yeah, this is actually my belief that if God goes after someone then he just completely annihilates their life. It's like, you're born poor, and without legs, and you'll have all sorts of tragedies going on in your life. It's like, I don't know, you'll be born in a famine-ridden country and this and that. It's just absurd. It's, I don't know if God does that or, but, it's, I can't explain it. You'll probably have to improvise on my relationship with God, but it's sometimes, I don't know, I believe he doesn't exist. I want to believe that he doesn't exist, but I can't believe that he doesn't exist. I think that's, that's probably the correct statement.
Traumatic events
Many people felt that traumatic events in their life had triggered their mental health problems: “my brain, it was just in overload”. They mentioned being subjected to bullying and violence, being violent towards others and witnessing violence and murder. A few women had experienced domestic violence, which one woman described as “like a stain spreading through my life”.
David says he experienced a lot of trauma while he was growing-up that made his personality ...
David says he experienced a lot of trauma while he was growing-up that made his personality ...
Hmm. And that, the guilt and the shame that you refer to what, what was that in relation to?
I feel quite guilty that, you know, that I was born in a way because, you know, if I hadn't been born I keep thinking my mother would've had a different life. Although I've come to realise that's not quite true. All that happened was that she passed the responsibility on to my grandparents. I never saw her for a lot of the time when I was younger. She spent most of her time going to parties, going up to London coming back with a new boyfriend. It was quite horrendous really. And, well the shame, is, you know, back at that time if you're father wasn't around you, you get called a lot of very unpleasant names. And people say like, you know, you're father doesn't give a damn about you etcetera, etcetera. Now that sort of stuff doesn't really bother me at all. But then it was just another really blow at someone who's trying to grow to up.
Lots of people mentioned bereavement, including one woman who experienced 6 miscarriages and a few who had relations who'd been murdered. As one man said, bereavement “just gets hold of you, you can't shove it off”.
Many people we talked to felt that their mental health problems were connected to experiences of being sexually and physically abused in childhood at the hands of their family or whilst in the care of the local authority.
Others mentioned experiences of racism in the form of bullying, physical and verbal assaults and other kinds of attacks. One woman said that the BME hostel where she stayed 'diagnosed' racism as a cause of her mental health problems. One man however, who also experienced racism, did not feel that this played a part in his mental health problems.
Niabingi realised that racism had played a part in her developing schizophrenia when she stayed...
Niabingi realised that racism had played a part in her developing schizophrenia when she stayed...
Well for me that was, that was a positive experience because I hadn't, because I think they thought, one of the diagnosis apart from anything else that had happened you know, in my life and my background they said a lot, that some, some, that my, so you know, what contributed significantly to my mental ill health, and I will use ill health rather than, or mental distress because that would be very good in this case, was, was racism. And you know, you know, you know, you know, that I, looking back I things I think that that was quite an accurate diagnosis'
Well in, in, the name calling, it was just the name calling that was just, I mean you grow up with that sort of thing you know, this, at school and all that kind of thing like coon and all that kind of thing, you know, the N word. and then there was you know, then there was you know, sort of attitudes at, well at school a lot of my friends and myself were told we were only good enough for factory jobs, oh yeah we were only good enough for factory jobs, do you know what I mean you know, things like that. I know of a lot of , males in my generation where we grew up that weren't allowed, you know, just a little bit older than me, about four or five years older than me who were told they weren't allowed to take O levels because you know, they weren't, you know, they weren't intelligent enough. And they've gone on later in life to get degrees so you know, there was that. Then you know, there was, then there was going for a job when you did leave school there was going for a job you know, you know, just never getting the job, just never getting a job you know, like a shop assistant or something where you're going to be seen in public. If you were in the back stuck in, you know, stuck in the stockroom that would be alright but not on the shop floor. sort of you know, the, and just generally knowing you know, growing up you know, you know, being told, 'Oh.' You know. I mean where I, I grew up there was only two black people on our road and that was, yeah and the other black person was the only house I went into, you know, the neighbours didn't really talk to me, they didn't invite me in, they didn't let their children play. Well sometimes some of the children played with us but in general it wasn't you know, an easy, you know, you hear about all this thing on EastEnders oh you're in everybody's else's house and everybody's else's business you know, it just wasn't like that, it wasn't like that growing up, it wasn't like that, not for me anyway.
And you know, so you know, and then you know, obviously you've got, you know, your parents sort of telling you about their experience and you grow up thinking that and you live according to that, you know, you don't overstep the mark, do you know what I mean, you live within your boundaries so you know, so you don't get attacked or something. I remember, I remember sort of like you know, sort of growing up and seeing you know, in those days, I mean now it's the BNP but in those days it was the National Front you know, having you know, and you know, growing up thinking oh don't go down there because that's an area where lots of them live or you know, or you or you know, so, you know, or you know, or you know, or they'll be around tonight be careful and all that kind of thing you know, living in fear. You know, that's just, you know, and you're a little child growing up, you've got, you know, you can't explore your world. One thing about, you know, children they need to explore their world and identify with it, you know, and, you know, and you're cut off from half of it, you're told, you know, this is n
Shaukat says racism did not contribute to his anxiety, although he was attacked.
Shaukat says racism did not contribute to his anxiety, although he was attacked.
And the other thing was that I wasn't always picked on as well, in, in my class. Apart from those times or some, you know, verbal abuse or whatever about, you know, being Asians or whatever, there was always something else that, you know, these people could pick on. So I wasn't always the one that was getting picked on, so it wasn't, that wasn't a major thing. I was more anxious about not having any friends than being picked on. Because when I did that, I just sort of used to ignore it anyway. Well, you know, I'd get angry, but mainly at myself for not, you know, saying anything back. But then I knew that I hadn't got any friends so, you know, if I do get into a fight or something then, you know, I'd get jumped on by a few people. So, you know, I was scared of that So, yeah, it was, it was a, you know, the idea of like being anxious or being, you know, not having friends that was always, you know, more stronger than sort of the, the thing about getting abused.
Last reviewed September 2018.
Last updated February 2013.
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