Els van der Ven Els van der Ven

Ethnic outsiders at risk of psychosis

In Mind
Written by  Hans van Vinkeveen Wednesday, 20 April 2016 08:36

Remarkable: the risk of psychosis among young Dutch-Moroccan men is five times higher than that of Dutch-Moroccan women. Psychologist Els van der Ven looked to behaviour and the social environment to find an explanation, and she found that the cause is social exclusion. Her recommendations: more validating interventions to prevent people from becoming lonely. “Key figures within the community need to learn to recognise feelings of failure and alienation.”


A psychosis is not a scary or mysterious brain disorder; it’s a lot more common than we assume. According to psychologist Els van der Ven, it starts with very recognisable experiences. Feelings of suspicion. Seeing things that are not actually there. Illusions of having a special power. It only becomes pathological where these experiences start disrupting your life. The same applies to migrants. “The only difference is that a psychotic disorder can be coloured by a person’s cultural background. The Moroccan culture, for example, has what are called djinns, a type of spirit creature that can influence people and make them think their thoughts are not their own.”

Increasingly suspicious
In her dissertation, Ethnic minority position as risk indicator for autism-spectrum and psychotic disorders, Van der Ven presents some fairly sensational and alarming research results. Belonging to a minority group doubles a person’s risk of a psychosis. This increased risk also persists in second generation migrants. Young Dutch-Moroccan men were found to have five times the risk of psychosis as women with a similar background. She is quite certain about the cause: social exclusion. “A chronic feeling of being an outsider can have a pathological effect in the long term. You also see that in children who are bullied. They retreat into themselves because the world is not a safe place. They become lonely and increasingly suspicious. That is the most likely mechanism.”

High expectations
This means that the more a person is pushed into a minority position, the greater their risk of developing a psychosis. This is not only unpleasant and sad for the people themselves, says Van der Ven, but it is also a major social problem. Naturally this comes with an expensive price tag. “In addition, a lot of potential and talent is lost. Psychoses develop in the stages of adolescence and early adulthood. That is precisely when people start a degree or their career. That puts a lot of pressure on society.”

Why are young Dutch-Moroccan men such an especially vulnerable group? Van der Ven has no definitive explanation. She suspects it is related to their high social status at home and in their own community. “While the girls seize the opportunities they would not otherwise have had, the boys struggle with too high expectations. Their lack of success can cause them to feel excluded. This is reinforced by a lack of parental control and discrimination, which leads them to not feel at home in either their present country or their own community.”

The final risk is especially interesting. Van der Ven: “Young men in the study told me that in Morocco they are seen as wealthy Europeans. But when they come back to the Netherlands, they are Moroccans. They feel displaced, and no longer trust their social surroundings, which makes them psychologically vulnerable.” Such an observation is all the more reason not to stir up conflict, she says. “This can lead to an increase in new cases of psychosis.”

On the other hand, more support should come from the community. We know that strong group cohesion has a protective effect against psychoses. Van der Ven sees a role for key figures such as imams and football trainers. “They must learn to recognise feelings of failure and alienation and make validating comments along the lines of: You can be valuable as you are. You matter and are good just the way you are.”

Environmental factors
It is striking that she looks to behaviour and the social environment to find the causes of psychoses. Van der Ven criticizes biological psychiatry, which is quite popular at the moment: “It is a form of blindly fixating on looking to the brain and genes for the cause of psychoses. But there is increasing evidence that certain social experiences can lead to changes in the brain.” This relies on the 'social defeat' hypothesis: the feeling of being a loser is the common denominator in five risk factors for psychosis: growing up in a city, low IQ, traumatic experiences, drug use and a history of migration. “By not reducing psychosis to a brain disorder, you have more influence as a practitioner and have more intervention options.”

Refugee crisis
In the future, Van der Ven would like to focus more on the refugee crisis in the European Union. “You are now seeing that people are very focused on the short term. I think it would be useful to make recommendations based on scientific findings from migrant research. Using the right resources can help us prevent new migrants from developing mental health issues.”


Els van der Ven (1983) will be defending her dissertation “Ethnic minority position as risk indicator for autism-spectrum and psychotic disorders” at Maastricht University. She studied psychology at Utrecht University and earned her master's degree in Neuropsychology there in 2007. From 2008 to 2010, she worked with young patients suffering psychosis at the Douglas Mental Health University Institute in Montreal, Canada. Since 2011 she has been working at the School for Mental Health and Neuroscience at Maastricht University.

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