Mental health outreach needs cultural context

October 21st, 2005 by admin

Source: Georgie Straight Newspaper
Web Link: http://www.straight.com/content.cfm?id=13548

Article By: Gail Johnson 

Publish Date: 20-Oct-2005

When English is your first language and you’re depressed, you might say you’re feeling “blue” or “down in the dumps”. Those phrases wouldn’t mean much to folks who speak Cantonese, say, or Farsi. The language barrier is just one factor that makes treating mental illness complex in a city like Vancouver.

Mental Health Sikhs BC Sikhism
 Mark ‘Atomos’ Pilon illustration

Local psychiatrist Hiram Mok says the need for ethnically sensitive care is vital, since so many British Columbians speak a language other than English at home. “We don’t have the language or words to refer to different psychological states,” he says in a phone interview. Take Punjabi, which is linguistically rich but has no single term to define depression. “The language of distress is different in certain ethnocultural groups. In the Chinese community, they express emotional problems via physical symptoms: aches and pains, problems with the bowel, persistent headaches, chest pain,” adds Mok, who practises privately and also works at UBC’s Mood Disorders Centre and in the Vancouver Hospital and Health Sciences Centre’s cross-cultural psychiatry program, a division of UBC’s psychiatry department. The latter offers services in Cantonese, Hindi, Farsi, Punjabi, French, Japanese, Spanish, and Vietnamese.

Straightforward translation, however, is just the first step, says Sarah Hamid-Balma, communications director for the Canadian Mental Health Association’s B.C. branch. “You can’t just look at language,” she says on the line from her office. “There’s also the cultural translation.”

Social phobia is one example. In the western world, it usually involves the anxiety a person experiences due to potential criticism by others. According to a winter 2000 issue of Visions: B.C.’s Mental Health Journal, which is published by the CMHA, a similar fear of people in social situations exists in Japan. But there, a condition called taijin kyofusho tends to arise because of the embarrassment an individual might inflict on someone else.

Besides language difficulties, other elements of the immigrant experience can trigger conditions like depression: culture shock, racism, unemployment, isolation, and loss of professional status.

Kala Singh, a multicultural mental-health liaison worker for the South Asian community with Vancouver Coastal Health, says many in Sikh, Hindu, Chinese, Vietnamese, and other groups aren’t aware that help is available or worry that caregivers won’t understand their background.

“A lot of people believe that mental illness is not a doctor’s problem but a supernatural problem,” Singh explains in a telephone interview. “They’ll worry about the ‘evil eye’ and might go to a priest for help.” (The evil eye is a metaphor in some cultures for disease or misfortune.)

Then there are more insidious barriers to treatment.

“Stigma is a huge issue, especially in the Asian community,” Mok says. “It [mental illness] brings shame to the family.”

According to Visions, stigma plays out in different ways. For the Vietnamese, having a mental illness brings humiliation to the family, and recovery is perceived as being nearly impossible, the journal states. Some people in the South Asian community see sickness as possession by evil spirits or a form of punishment by God. Others attribute disordered thinking to ghosts or superstitions. Still others conclude that their parenting skills are to blame for their kids’ mental-health problems.

What’s considered the best course of treatment for mood problems differs from group to group as well.

“Asians believe in stoicism: You can get out of depression on your own,” Mok says. “You need to pull up your socks; there’s no time to feel sad. You need to be strong and not be seen as weak.” He adds that it’s crucial for families of those who are suffering to understand mental illness as well.

Sharing information is the aim of the 2005 Immigrant & Refugee Mental Health Symposium—presented by the Vancouver Hospital and Health Sciences Centre’s cross-cultural psychiatry program, Vancouver Community Mental Health Services, Vancouver Coastal Health, and the Immigrant Services Society of British Columbia—taking place next Thursday and Friday (October 27 and 28) at SFU at Harbour Centre (515 West Hastings Street). Singh will be one of the speakers addressing mental-health professionals and the public alike about cultural interpretations of mood disorders.

For example, Sikh religion and spirituality play a role in treatment, Singh explains. “Transcendental meditation helps a lot,” he says. “Doing this regularly reduces stress hormones. Spiritual meditation brings you closer to the God, makes you one with the God, and means the God is helping you. It calms you, it makes you stress-free, and by helping yourself you are helping the community around you.”

It’s this kind of mind-body connection that many Sikhs find either leads to a cure or prevents mental illness in the first place. That’s not to say that a pharmaceutical approach doesn’t play a role. “The Sikh religion doesn’t say you can’t take medication,” Singh says. But there are other components to health.

“The cause of most mental-health problems, like depression and anxiety, is due to stress, due to politics like war and terrorism, and due to our own problems,” Singh claims. “How can this be prevented? By talking about our problems. By being a good citizen, a good person….This isn’t for Sikhs only. This benefits your family, your coworkers, your friends.”

Tai chi, yoga, and Ayurvedic breathing are among many other cultural activities that some practitioners say can positively affect the mind.

Mok urges people needing help to talk to their family doctor or call the South Asian crisis line (in Cantonese, Hindi, Korean, Mandarin, Punjabi, Spanish, Urdu, and Vietnamese, at 604-596-4357) or the multilingual help line (in Chinese, Spanish, Korean, and Vietnamese, at 604-572-4060). The CMHA offers information on topics like schizophrenia, depression, stress, and eating disorders in several languages, including Punjabi, Chinese, Spanish, and Cantonese. (See www.cmha-bc.org/.)

Singh and Mok both say that things are getting better, particularly with younger generations being receptive to psychiatric care. And they emphasize that barriers to treatment can be overcome, no matter what one’s mother tongue.

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