One of the recurrent themes in the examination of ethnic groups is that of immigration. The most visible ethnic group is frequently the last to arrive. In his seminal volume, Emigration and Insanity, Odegaard (1932) describes the history of concerns with regard to mental health and immigration. From the earliest days of the American colonies, concern was expressed to keep out persons who were infirm and thus could become a public burden. In the late 1800s it was documented that along with criminals and paupers, the insane were being sent from various European and non-European countries. In 1882, the first federal immigration act banned entry to lunatics and idiots, with extensions in 1907 and 1917 adding more disorders and requiring an examination determining the mental condition of all arriving immigrants. Yet it was concluded that the screening was not particularly effective based on the small numbers excluded and that indeed there were persons with mental disorder arriving in the United States with disorders or acquiring disorders over their subsequent lifetimes.

Concerns about immigrant mental health were reflected in state hospital statistics of the time, which showed higher proportions of immigrants in hospitals than were represented in the population. Some of this effect was explained as a result of statistics that did not adjust for the younger age of the immigrant population, their concentration in the northeastern United States, where more hospital beds were available, nor their poverty, which led to public and state hospitals rather than private ones. Nonetheless, the statistics of the time raised concern, which fed and was reinforced by the then thriving eugenics movement.

Interestingly, Odegaard's primary concern was about the mental health of Norwegians and particularly the deleterious effects on them of emigration from Norway to the United States. His careful analysis of rates of disorder among those emigrating to the United States and even some returning home led him to conclude that rates of mental disorder were higher for Norwegians moving to the United States than for either those staying in Norway or those born in the United States. Furthermore, for Norwegians and many of the groups reviewed, the highest rates of disorder were for those present in the United States for a number of years and not those newly arrived. Thus elements in the experiences of immigrants to the United States seemed to tend more to disorder than the experiences of those born here, even those of immigrant parentage. It was observed that often the persons having disorder had been in the United States for 5 or more years before onset of disorder, and in many cases the higher rates of disorder showed up in the elderly.

Odegaard's focus was on Norwegians, and the literature reviewed focused mostly on Europeans. It is ironic that most of the groups of concern then are now routinely lumped into a general classification of "white," "white-non-Hispanic," and sometimes "Anglo." This discussion leads to two principles that should always be taken into account, but often are not. The first is that one cannot assume homogeneity for a racial or ethnic group just because it has a label. The usual categories such as African American, Asian American, Native American, and Hispanic are exceedingly broad even if they are used in official designations. We cannot assume a common history or common culture or even a common genetic heritage. Yet most studies are forced to deal with the broad designations because of limitations of sample size and the unavailability of adequate background information for those being studied.

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