Schizophrenia revisited: consensus and confusion

There is no consensus on the rates of schizophrenia among ethnic groups at home in the Caribbean and abroad. Investigations of gender and ethnic differences on the rates of first contact outpatients with schizophrenia in two geographically different areas in Trinidad are reported. In a prospective study, 134 first contact patients with a diagnosis of schizophrenia were selected from two catchment areas in east and Central Trinidad. Almost fifty seven percent (56.7%) of the tested population was of African origin, 32.1% of Indian descent. Gender differences were significant with males accounting for 66.4% 9n=89) of patients with schizophrenia (Chi-square =14.448, df = 1, p=0.0001). Further analysis by age categories revealed significant male predominance at the 20-24 (p=0.0001) and 25-29 (p=0.002 age groups. There was a predominance of young African males (15-19 years, p=0.049) in the east compared to central. The findings revealed an excess of Afro-Trinidadian men in both outpatient clinics (p<0.05).

Somatization disorders among Indians in Jamaica and Trinidad and its association with social and psychological factors

Data on presence of somatization disorder, depression, anxiety, distress, stigma associated with having somatic symptoms, having a female somatizing relative, a history of domestic violence, sexual abuse and the presence of an alcoholic spouse was collected from Indo Trinidadians and Indo Jamaicans. Within the entire sample elevated somatization was reported by 27.5% of the sample. Thirty percent (30%) had elevated scores of distress, 26% for depression, 10.5% for anxiety and 15.5% gave history of domestic violence, 7.5% reported stigma and 9% had a history of sexual abuse. Chi-square analyses revealed a significant moderate relationship exists between depression and somatization, there was a P value of .000 (Chi-square (1) = 45.580. p<0.05). There was also a significant relationship between somatization disorder and anxiety for the entire sample ( Chi-square (1) = 22.710, p<0.00). A moderate relationship existed between somatization disorder and distress (chi-square (1) = 28.691, p<0.00). A statistically significant relationship was found between persons feeling that they are weak or worth less than others if they have somatic symptoms and the presence of somatization disorder (Chi-square (1) = 8.591, p=0.03).

Forensic psychiatry in the colonial and post colonial eras

In this chapter, the concepts of common and statue laws are reviewed with respect to their application and the duties of the psychiatrist. The history, development and practice of forensic psychiatry in the colonial period in Trinidad are explored and later following independence during the establishment of a Mental Health Act and the introduction of the Sectorization Plan in 1975. Three case histories are presented: the first investigates liability in a mentally ill offender, the second is a court report intended to assess mental illness in a man charged with murder and the third examines the role of the Psychiatric Tribunal in discharge from prison following illegal detention. Defenses available for these individuals are briefly discussed. Despite a PAHO's expert finding of human abuse in the Forensic system in Trinidad, the assessment of mentally ill offenders in developing countries with different social and cultural imperatives is no easy task.

Lunacy, time of the year and absconding from a psychiatric hospital

Personal characteristics of patients and environmental factors at psychiatric hospitals have been identified as predictors of absconding. In this chapter we seek to establish a relationship between time of the year and absconding. All characteristics of absconders were taken over a two-year period from hospital records (N=104). Public holidays and lunar phases were obtained through almanacs for each year; and school vacation period was determined by reference to a school academic calender. Fridays was the most popular day of the week for absconding. Males were more likely to escape on the weekends while females tended to escape during the wet season. Christmas was the most popular holiday season for absconding. The largest percentage of absconding was at the full moon phase. It is recommended that the system of patient care should be client driven at all times and greater supervision of patients is needed on weekends, vacation periods and during the full moon phase.

The effects of multiculturalism and multi-ethnicity group dynamics in a Caribbean setting

The ethnic and racial composition of the Caribbean is a convergence of many cultures that were brought together through slavery and indentureship. The region holds similar characteristics among the islands because of similar history and subsequent settling of migrants. This heterogeneous lifestyle has produced new cultures distinct to the Caribbean which to some extent acts unifying forces among the migrant population. The reality is the social, economic and political structures are still realms which serve as opportunities for discriminating against the Indian race and Indians which the financial advantage are easy targets for criminal attack. Women of the two main races are still characterized by stereotypical characteristics of their history. African women are seen as strong black women and Indian women as passive and docile independent of circumstance. These self appraisals and natural competitiveness among individuals of a country or group highlights the negative aspect of multicultural societies. The Caribbean today remains a hot pot of multiculturalism rather than a melting pot.

Do Trinidadians have a carnival mentality?

Stereotyping characteristics of island people are well known throughout the Caribbean region. These labels often narrated in everyday humor have some hidden truths. In Jamaica, for example there is the belief that the population is homophobic. In Barbados, there is a perception that the native population is xenophobic, with a dislike for everyone not Bajan, with an exception for those with a lighter shade of black. In Trinidad, the population has been dubbed as having a carnival mentality where individuals have a very slack, laid back or don’t give a damn attitude towards work. It is thought that this non-stop party mentality is continuous throughout the year with little commitment to hard work or industry.

Dancing frotteurism or rubbing at the carnival celebrations in Trinidad

Paraphilias are sexual disorders characterized by sexual impulses, urges, fantasies or practices that are strange, deviant or bizarre. It is more common in men and attributed to fixation at one of the psychosexual phases of development, learning theory, child abuse or culture. Trinidad and Tobago has been influenced by a medley of cultures which find its greatest expression during the carnival season. During this time a local dance form of wining with suggestible sexual movements is pervasive. It is associated with distortions of normal courtship behavior with paraphilic disturbances. In a case presentation, a young male is presented showing paraphilic disturbances touching, holding, rubbing and coercive sex. This behavior of frotteurism and other parahilias are common occurrences at carnival in Trinidad and Tobago and are considered to be cultural normative practices. This case-report therefore, identifies a number of paraphilic behaviors such as toucherism, frotteurism and preferential rape during the carnival celebration and examines their relationship with the law. Professionals abroad ought to be aware of the local culture due to the recent export of carnival to metropolitan countries.

Cybersuicide and the adolescent population: challenges of the future

Cybersuicide is a term used in reference to suicide and its ideations on the internet. It is associated with web sites which lure vulnerable members of society and empower them with various methods and approaches to deliberate self-harm. Ease of accessibility to the internet and the rate at which information is dispersed; contribute to the promotion of offing one's self which is particularly appealing to adolescents. This study aims to explore this phenomenon which seems to be spreading across generations, cultures and races. Information and articles regarding internet suicide and other terminology as well as sub classifications concerning this new form of suicide were reviewed. Through search engines such as Google, Yahoo and Wikipedia differentiations between web cam suicide, net suicide packs, sites which merely offer advice on how to commit suicide and sites which are essential in providing the means of performing the act were investigated. Also, materials published in scientific journals and data published by the Public Health Services, Centers for Disease Control, and materials from private media agencies were reviewed. Resources were also sourced from The Faculty of Medical Sciences Library, UWI at Mt. Hope. Cybersuicide is a worldwide problem among adolescents and is a challenge of the future.

Forging a new dimension of black psychiatry in the Caribbean

There is a concerted effort among many black politicians, academics and writers to paint the Caribbean with a black brush, unmindful of the presence and contribution of other ethnic groups within the Caribbean region. The recent upsurge of black consciousness among Afro-Caribbean people is necessary, but not at the detriment of other ethnic groups who have also contributed to the social, economic and cultural lifestyles of the Caribbean. Attempts to foist a version of United States imported black psychiatry in Jamaica with the introduction of a curriculum in black psychology have raised some concern among Trinidadian students studying there. In this chapter, A Trinidadian Psychologist who studied in the Jamaican system discusses the concept of Black Psychiatry and its relevance to the Caribbean.

Indentureship as a contributory factor to mental and physical illnesses in the Indo-Caribbean diaspora

There is an ethnic pattern of mental and physical diseases associated with the export of Indian labor overseas between the period of 1830-1920. The establishment of Indian communities overseas emerged from the culture and civilization of the Indian sub-continent and was a direct consequence of mainly British exploitation of economic wealth overseas. This movement of Indians from their homeland with the maintenance of the practice of their religion, culture and lifestyle is referred to as the Indian diaspora. This chapter looks at the effects of the 'coolie migration' particularly to Trinidad, but with reference to other Caribbean islands and at least a dozen countries across the seas. Information is gathered from published reports but more importantly, from dozens of immigrants and hundreds of first generation Indians with whom the author has been in contact during their treatment. There appear to be a commonality of social, psychological and physical diseases in these migrant groups within the diaspora. A possible explanation is the similarity of the genetic pool and environmental influences experienced by the migrants overseas.

Dopamine, demons or divination? The dichotomy of science and religion in traditional societies

The presentation and interpretation of mental disorders [in] the Caribbean region is often considered to be the effect of divine interventions, demonical possession, drug abuse or defects in dopamine synthesis. Common occurrences are families, friends and priests advising the diseased person to seek help in one or all of these modalities. Thus, while increasing numbers of mentally ill persons seek treatment from western trained psychiatrists, they likewise cover all the other bases of traditional, folk and spiritual treatments. This results in a medley of healing processes which are in conflict with each other since empirical scientific findings are not in keeping with religious-driven values, which purports an ontological claim to human existence. The dichotomous relationship between science (authoritative facts) and religion (ethics and values) has caused an epistemological divide, with the consequences of reductionism, in both areas. Disturbed persons, their families and caregivers are engaged in a prolonged and expensive journey with traditional healers, priests and doctors who complicate the curative process. These practices undermine the principle of western scientific medicine, while at the same time attributing credence to magic and supernaturalism, thereby reinforcing the behavior of the patient adding mysticism to the folk practitioner.

Recognizing social and cultural behaviors in Trinidad and Tobago

Trinidad and Tobago, not unlike many Caribbean countries is a plural society resplendent in its cultural diversity. It prides itself with an ethno historical background of African slavery, Indian indentureship and European migration emerging into a post emancipation society of open expressions of social commentaries in song, dance and language. It remains today and easy going society with a style of picong communication which to the observer remains strange. This chapter underlines the relevance of the behaviour of migrant groups both from the sending and receiving countries since the relics of a culture persist despite cultural changes. A questionnaire survey on the culture of Trinidad and Tobago is undertaken to study the cultural behaviours existing in Trinidad and Tobago and to assess the population's awareness, perception and description of these behaviours. Respondents were presented with nine identified behaviours and perceived five of them to be part of Trinidadian culture: Liming, carnival mentality, player or playboy personality, Tabanca and obsessional lateness were identified as existent cultural behaviours.

Race, politics and behavior in Trinidad and Tobago

Racism is a loaded word with too much surplus meaning. Its contemporary common usage encompasses every aspect of human and social sciences. It is an emotive word that is often avoided since it also defines the unconscious processes of the commentators whose creations are invariably within their own experiences rather than the spoken context. Regardless of which Government is in power, the stereotypes associated with whether the party is Indo or Afro-dominated add fuel to the phenomenon of racism, with each race fighting for eventual control. Whether this is a historical or evolutional instinct, the political parties employ means to get their supporters aroused and incensed, tugging at their emotions, a psychological display to secure party votes. This phenomenon sows the seed for human destructiveness and crime that is now rampant in the twin island states. The simple solution to this complex problem is power sharing, but the sociopathic leaders obsessed with power and control will have none of it.

Anorexia nervosa and religious ambivalence in a developing country

The aim of this study is to report the first case of the primary nuclear form of anorexia nervosa in Trinidad and the West Indies in an 18 year old female Islamic student attending a Roman Catholic Convent. Ambivalent values due to her early development in a strict Muslim home with Catholic influence and contemporaneous exposure to a western society are explored. The dynamics of family interaction in a dual religious home are investigated. Similarities are noted from reports from western countries that link ritualistic fasting to the month of Ramadan. The influence of the Roman Catholic period of fast, Lent and the dynamics of family interaction are discussed. We wish to propose religious ambivalence as an etiological factor in anorexia nervosa in a developing country.

Culture and suicide

Undefined cultural factors cannot be dismissed and significantly contribute to the worldwide incidence of death by suicide. Culture is an all embracing term and defines the relationship of an individual to his environment. This chapter seeks to investigate the effect of culture on suicide both regionally and internationally. Culture-bound syndrome with suicidal behaviours specific to a particular culture or geographical region are discussed. Opinions are divided as to the status of religious martyrs. The law itself is silent on many aspects of suicidal behaviour and despite decriminalization of suicide as self murder, the latter remains on the statues of many developing countries. The Caribbean region is of concern due to its steady rise in mean suicide rate, especially in Trinidad and Tobago where socio-cultural factors are instrumental in influencing suicidal behaviour. These include transgenerational cultural conflicts, psycho-social problems, media exposure , unemployment, social distress, religion and family structure. The methods are attributed to accessibility and lethality. Ingestion of poisonous substances is most popular followed by hanging and most recently shooting. The gender differences seen with regard to suicidality can also be attributed to gender related psychopathology and psychosocial differences in help seeking behaviour. These are influenced by the cultural environment to which the individual is exposed. Culture provides coping strategies to individuals; as civilization advances many of these coping management of suicidal behavior, a system of therapeutic re-culturation is needed with an emphasis on relevant culture-based therapies.

Adolescent suicide in Trinidad and Tobago

Previous research in Trinidad and Tobago has been limited in examining suicidal behavior through psychological autopsy, secondary data and psychiatric populations. To date there has been no community survey with an emphasis on causation and prevention. A total of 1.845 respondents age 14-20 were selected in 24 schools across the country. Data were collected on socio demographic variables and suicidal behavior. Gender differences existed for both suicidal ideation and attempts (p<0.001). Respondents from reconstituted families had higher suicidal ideation compared to other family structures (p<0.001), while intact families had the lowest rate if suicide attempts (p<0.001). Attendance to religious institutions lowered only suicide ideation (p<0.05), while prayer with the family lowered both suicidal ideation (p<0.01) and suicidal attempts (p<0.001). Individual with alcohol abuse in the family had a higher suicidal ideation (p<0.001) and attempts (p<0.001). Significant social predictors of suicidal behaviour in Trinidad and Tobago are gender, attendance to religious institution, prayer with family, family structure and alcohol abuse in the family. It is essential to consider these predictors in planning public health policies.

Patterns of suicide and suicidal behaviors: context and causation

The context and causation of suicidal behavior and suicide in many developing countries may vary from most developed societies. In this chapter, four local areas of interest are highlighted with respect to common but less reported precipitating factors in suicide and suicidal behavior. These are family culpability with reference to the present trend of assisted suicide, transgenerational family conflicts resulting in family dysfunction, imitation or copy-cat suicide in a child and suicidal behavior in a psychotic patient. The manifestations of these behaviors are often interwoven into a tangled net of social, religious, cultural, traditional and superstition beliefs that prevent intervention. Even among children, excessive punishment viewed by some as abuse is acceptable. In Trinidad with a rainbow of modern and traditional influences, special training of cultural therapists are recommended for psychological and psychiatric intervention into this sensitive area.

Derma-abuse with cutting in young adolescents

Derma abuse or self-inflicted epidermal damage is introduced here for the first time to describe a number of blood-letting behaviours, it is associated with low lethality and the absence of suicidal attempts. Derma-abuse encompasses a number of behaviours replete with synonyms and acronyms. Researchers for the most part have described a medley of behaviours that have been categorized as life threatening and equated with suicidal intent. The purpose of this study is two-fold: First, to present and discuss vignettes of four young adolescents and second to study the dynamics and characteristics of six derma abusers who have attended Dual Group Therapy (DGT) concurrently with their parents for a six month period with an emphasis on the dynamics of behaviour and treatment. Our findings suggest that patients involved in derma-abuse are generally non suicidal but engage in comfort cutting for the psychological release of pain, tension reduction and anger management. There is a preponderance of females (80%) with an over representation of mixed origin and borderline cultural states. In this small group, males amounted to 20% and were more bizarre, gruesome and brutal in their self-abuse. Of the total sample 10% were of African origin, 60% were of Indian descent and 30% were of mixed ancestry. Psychodynamic factors explored in Dual Group Therapy (DGT) are the emphasis on non-suicidal intent, association with tension reduction, reclaiming power and mastery over self and others, life and death instincts, the significance of bloodletting in a socio-cultural context, trans-generational, dysfunctional family dynamics frequently with parental separation and sexual abuse and early sexual induction. A novel form of DGT is introduced for the treatment of these patients. The changing attitudes of adolescents in today's culture as they freely engage in risky behaviors present a major mental health crisis to service providers both in developing and developed countries.

Self-poisoning by pesticide and other substances in a general hospital

Self-poisoning by pesticides is a major public health problem, especially in agricultural communities. The purpose of this study is to investigate the pattern of poisoning of all patients admitted to an emergency care at a general hospital in Trinidad for the period 2003-2004. In a two-year retrospective study, data on self-poisoning from hospital archives were analyzed for demographic and other patterns. A total of 765 cases of self poisoning were identified. The most common source of poisoning was ingestion of pesticides (n=275, 35.9% of all cases). Differences in age and gender were found; patients with pesticide ingestion were younger (mean age 25.8 years) and more frequently female. The majority of patients with pesticide poisoning were admitted to wards and one death reported. Poisoning by pesticides is prevalent in South Trinidad. The high incidence indicates an urgent need for implementing public health strategies for prevention in keeping with the recommendations of the World Health Organization.

Consultation-liaison psychiatry in Trinidad and Tobago with reference to suicidal behavior

Consultation-liaison psychiatry (C-LP) has been defined as the area of clinical psychiatry that encompasses clinical, teaching and research activities of psychiatrist and allied mental health professionals in the non psychiatric divisions of a general hospital. Over the years, consultation-liaison services have expanded to provide care in health care facilities other than the general hospital, such a community health clinics, rehabilitation centers, convalescent hospitals, nursing homes and doctors' private offices. The term Consultation-Liaisons reflects two interrelated roles of the consultant. Consultation refers to the provision of expert diagnostic opinion and advice on management regarding a patient's mental state and behavior at the request of another health professional. Liaison refers to a linking up of groups for the purpose of effective collaboration. The present chapter reviews how these roles are addressed in Trinidad and Tobago.