Image – www.driverlayer.com

One might be forgiven for expecting white men to stop causing disease in black men, today. But instead of an era of atonement and correction, we pass from misdemeanour to misdemeanour. But plus ca change, plus c’est la meme chose. The history of the transfer of disease from the Old World to the Antipodes has often been repeated. At the very least, First Fleeters brought dipsomania, pestilence, and a culture of materialism and supreme self-centredness.  White men are still bringing their diseases. Some, like the metabolic syndrome, come in through the front door. Others, like severe mental illness, come in through the back. First metabolic syndrome.

Article by Paul Brown, The Pierre Janet Centre, Melbourne.

This is an evolutionary medical condition, primarily of feeding, and secondarily of stress. It consists of the tetrad of insulin resistant diabetes, hyperlipidaemia, hypertension and heart disease. Clinically it presents most obviously with increased girth. Paleopathology suggest that metabolic syndrome was unknown in prehistoric, hunter gatherer populations. See food and eat it, meant see the prey, chase it, kill it and then eat it. Gathering was just as arduous. It too required days of search for suitable tucker. Over many, many millennia, hunter-gatherers evolved sedentary modes of living, first rural, centring on pastoralism and agriculturalism, and then urban. Men got fatter, and began to die from high blood pressure, heart disease and diabetes. Today there is an epidemic in the developed world. That epidemic has spread from Second Australians to first. And, there are novel, iatrogenic forms of the metabolic syndrome.

It is unlikely that metabolic syndrome existed in First Australians, prior to First Contact.  Aborigines were lean, and their diets were non-diabetogenic. At first, cardiovascular and cardiac disease penetrated the Indigenous community. Smoking was one of the key factors. Then, with modernisation and urbanisation following Labour Liberalisation in the 1970s, Aborigines increasingly succumbed to stress, and to the dietary component of metabolic syndrome, namely hyperlipidaemia and diabetes. Hazardous use of alcohol remains a pathogenic factor. Those rural and outback communities that live closer to the store are more affected by metabolic syndrome; those that live more remotely, less so. Metabolic disease greatly shortens the life expectancy of sufferers. Treatment is a combination of dietary restriction and symptomatic medications.

Metabolic syndrome can also be iatrogenic. For six decades, following the introduction of the drug chlorpromazine into psychiatry for the treatment of psychosis, drug companies have been introducing novel anti-psychotic preparations. These all act via a dopamine receptor in the brain called the D2 receptor. Not a single new anti-psychotic drug with a more specific pattern of action has been introduced. These medications have certainly relieved a portion of the burden of severe mental illness. But, their complications have included new diseases. Metabolic syndrome is one. That is not entirely true, because it was early recognised that psychosis can be complicated in this way, without medication. Thus, in The Pathology of Mind (1897) the doyenne of English nineteenth century psychiatrists,   Sir Henry Maudsley (1835 –1918) wrote, “Diabetes often shows itself in families in which insanity prevails.” But diabetes was never a prominent problem. It only became so when anti-psychotic drugs with diabetogenic potential were widely introduced in the second half of the twentieth century. Aboriginal populations proved just as prone as the whites, if not more so. This is because poverty was rife, and the combination of stress, smoking, alcohol, poor diet and diabetogenic medication had a multiplying devastating effect.

Metabolic syndrome is not the only way in which white man’s psychiatry has impacted detrimentally on black man’s health. First Australians have a unique profile of illness sensitivities and associated illness prevalences. Respiratory illness stands at the head. Any medical procedure which can interfere with respiratory functioning must be used with special caution in Indigenous populations. Intubation is one of these. This procedure is essential to surgery, and it can be life-saving whenever the airway is blocked. Today it is constitutive to a novel means of air-transportation of seriously mentally patients from the outback to the urban treatment centres. Raving and raging patients are quietened by anaesthesia with a drug called Ketamine.  Not all patients require intubation. Those that do suffered risk of damage to the respiratory tract. The commonest subsequent medical consequence is some form of pneumonitis. Such cases have already begun to be recorded. They can be life-threatening, and hence fatal. Evacuation under Ketamine anaesthesia is billed as a safe procedure. But Ketamine is a controversial drug preparation, whose mode of action is unknown, and whose side effects include psychosis!  It is only a matter of time before casualties hit the newspaper headlines. The acutely mentally ill certainly require quietening. But, chemical restraint is dangerous. If not the lungs, the heart, circulatory system ~ and even the mind ~ can give way.

It goes without saying that the majority of those so transferred from the outback are Aboriginal, so this is another case of disease induced by white man in black. What can we do to halt and prevent these harms? Indigenous psychiatry is not white psychiatry. It is partly true that white men who man rural and outback psychiatric facilities tend to have a special interest in, and proclivity for treatment of First Australians. But, many go bush for less idealistic reasons, namely money and the great outdoors. The solution is for idealist Aboriginal professionals to gradually replace the white doctor and the white nurse, the white social worker and the white psychologist.