Cultural perceptions of mental health affect treatment

When Bilal’s Somali relatives came to his home last year, they brought Kamal, his 7-year-old cousin with them for the first time.

Kamal didn’t return the family’s welcoming smiles, nor did he respond to the questions of curious relatives who wanted to get to know him. While the other children in the family were playing together, he was focused intently on organizing the forks on the dining table into a straight line.

That day, Bilal, CC ’10, who asked that his name be changed in order to protect his family’s privacy, found out that his relatives had kept it a secret from the rest of his family that their child was autistic. In the Somali community, he explained, mental illnesses were “frowned upon,” and exposing Kamal’s condition was especially difficult for the family because of the negative stigma and superstitious beliefs attached to mental illnesses.

Kamal’s case is not isolated. The Minnesota Department of Health reported that children of Somali immigrants in Minneapolis are two to seven times more likely than other children to be placed in special classes for autistic kids. The reason for this disparity remains unclear.

While many New Yorkers would not think twice before making an appointment with a therapist to cope with problems ranging from a bad breakup to suicidal thoughts, in many minority communities, perceptions of mental health are varied and access to care can be limited.

Bilal said that in Somali culture, it is not common to seek professional help for mental illnesses, since there is a general “apprehension of medicine and doctors,” as well as the problem of language. Instead, the issue is either ignored completely or dealt with using more traditional methods, such as consulting religious texts.

“I wanted to tell him [Kamal’s father] to learn about autism and realize there is nothing stigmatic about it,” Bilal said. “Not doing anything only aggravates the situation.”

In other communities outside the United States, mental health awareness isn’t stressed nearly as much by the media. Brittany Pavon Suriel, BC ’09, who was born in the Dominican Republic and raised in the U.S., said that in her family’s culture it would be considered “unnecessary” and even “ridiculous” to spend money on a shrink. “People have other things to worry about, like putting food on the table every day,” she said. “They can’t afford to see someone every time they’re stressed or sad.” According to the U.S. Department of Health and Human Services, 37 percent of Hispanics are uninsured, compared to 16 percent of all Americans.

Accessing mental health services can be difficult for African-Americans as well. In fact, the percentage of blacks receiving care is about half that of whites. One black student, CC ’09, who wished to remain anonymous when revealing such personal stories, said that her sister works a full-time job that barely pays enough to support her two children. “When you don’t have the time or money to take care of yourself, it’s harder to deal with it,” she said, referring to anxiety problems that run in her family and have affected her sister as well. Her sister ended up going to therapy, which she said was not helpful. “Some of the stress issues are objectively there,” the student said. “There are some things she just can’t change because she doesn’t have the resources.”

While financial concerns are part of the reason why many minorities may not access mental health professionals, the cultural importance placed on family can also play a role. Pavon Suriel recalled that when she was going through a difficult time in high school, she suggested to her mother that seeing a therapist could help. Her mother offered a different remedy—spending more time with family. “No matter what’s going on in your life,” Pavon Suriel said, “you always come back home to your family to deal with it.”
For some students, religion can serve as a source of comfort and mental well-being. Karen Winkler, BC ’11, said that many of her Jewish friends went to their rabbis when struggling with personal issues, including marital problems. “Sometimes you just need a little spiritual guidance,” she said, adding that if the situation was serious, the rabbi would often refer them to a professional therapist.

One Korean-American student, CC ’12, who wished to remain anonymous to avoid negative reactions from her community, was struggling with depression and found solace in Christianity. Attending a predominantly white high school, she said she felt alienated because her classmates didn’t understand the academic pressures placed on her by her family. She said that she considered mental illness to be a weakness, one that could be overcome by personal improvement, rather than therapy. By becoming more involved at her church, she connected with other Koreans who “understood my parent’s expectations of me and my own expectations of myself.”

Some can be reluctant to seek treatment because they have trouble finding a counselor who will be able to relate to their particular experiences which are shaped by specific cultural nuances. By offering a diverse panel of providers, Columbia’s Counseling and Psychological Services tries to reach out to these minority groups. “Having counselors from a lot of different backgrounds ... helps people feel more comfortable coming in,” said Calvin Chin, CPS assistant director of outreach and community clinical services.

CPS also organizes groups geared toward specific communities—religious students, women of color, international students, or queer graduate students, for example—that may benefit from different resources.

“Culture affects a lot in terms of what feels okay, and I think that’s where we all really try to work flexibly and respectfully,” Chin said. “If someone really wants a therapy that has a Christian orientation, we can find that,” Chin said. “If someone is more interested in more naturalistic approaches and integrative medicine, we can find that.”

Although some minority students may benefit from this type of group therapy, others like Melanie, CC ’09, who asked that her name be changed to protect her privacy, said it was the diversity within her own group of friends that helped her deal with her eating disorder. Despite studies that have found that black women are generally more content with their bodies than white women, Melanie, who is black, developed a highly negative body image which led to a compulsive eating habit.

Pointing to the different body aesthetics of black and white women, she said she felt frustrated throughout her adolescence when she was surrounded by mostly white friends who complained about their shape and weight, even though they were “much smaller” than her. At Columbia, where her group of friends includes white, black, Latina, and South Asian women, she said she found it “much easier to appreciate different body types,” including her own.
According to Daniel Peyser, a student in the School of Social Work studying advanced clinical practice, a patient’s race, religion, and economic status are important for the clinician in matching the patient with the most effective treatment. “If I had a depressed patient who was a Southern Black Baptist, for example, I would try to look for studies in treating depression in people with a similar background.” Most traditional treatments, however, have been developed based on studies using middle-class white men as subjects and may not show the same results in individuals with different ethnicities and backgrounds.

The current Diagnostic and Statistical Manual of Mental Disorders, which provides the diagnostic criteria for mental disorders, does not recognize many culturally specific conditions. One example is ataques de nervios, a disorder that affects mostly people of Dominican and Puerto Rican origin and closely resembles panic attacks, with some distinctive features. Since the disorder is not included in the current DSM, incorrect diagnoses are common and effective treatment methods for patients suffering from ataques have been lacking. Whether the new edition of the manual, DSM-V, which will come out in 2012, is going to be more inclusive of culture-bound syndromes is being debated.

But currently, Derald Wing Sue, a Teachers College professor of counseling and clinical psychology who is also co-founder and the first president of the Asian American Psychological Association, has worked on one facet of the issue. Sue is known best for his work on racial micro-aggressions—unintended slights or social cues by members of a dominant group that make members of minority groups uncomfortable.

“Our psychological studies indicate that it is racial micro-aggressions that have the most devastating impact on people of color, even more terrible than overt acts of conscious racism or hate crimes,” Sue said. “Their life is most affected by ordinary, well-intentioned decent individuals who are unaware that they are giving micro-aggressions.”

news@columbiaspectator.com

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