The mental health stigma: In Somali community, culture can be a barrier to treatment
By Selam Berhea
WAALI. WAALAN. MAJNOON.
These three words may look different, but they are commonly used in the Somali community to describe one thing: crazy.
“I first heard it when I was young, like 4, and I started understanding it when I was 7,” said Sumaya Warsame, a senior at Blaine High School. “It is used to describe a crazy person usually. When I say something weird, my mom might say, ‘waa waalantahay.’” (Translation: “You are crazy.”)
But the stigma surrounding these words can be so strong that some Somalis in the U.S. are less likely to seek help for mental illness, local experts say.
“Nobody wants to talk about depression or mental illness because back home someone goes crazy and they are just institutionalized, so there are no good pictures of someone who becomes broken down mentally,” said Fartun Weli, the executive director of Isuroon, a Minneapolis nonprofit that promotes the well-being and empowerment of Somali women.
UNDERSTANDING THE STIGMA
To understand the stigma, it’s necessary to understand the view of mental health in Somali culture.
Sometimes mental illness is seen as brought on by God or by an evil spirit (djinn or jinn). And because it is seen as a trial from God, this results in quicker acceptance.
“The acceptance is part of the religion,” Weli said. “You are going through hardship, but also functioning while you’re depressed. It becomes the norm but back home ... you’re either normal or you are crazy.”
Minnesota is home to the largest Somali population in North America, experts say, and the vast majority live in the Twin Cities.
Major depression and Post-Traumatic Stress Disorder are the most common mental illnesses seen among refugees, according to the Centers for Disease Control and Prevention. These are also the most common mental illnesses seen in the Somali community.
PTSD is prevalent — especially among older Somali refugees — usually due to trauma from the civil war. According to a multi-year study of Somali refugees at a Minneapolis clinic, published in 2010, 64 percent of Somali refugees over the age of 30 suffer from PTSD combined with depression.
The civil war in Somalia occurred in the early 1990s and has left the area destabilized. During the war, some witnessed murder, torture or rape of loved ones. The loss of family members also was coupled with the loss of homeland, as stated in a 2008 study by David Schuchman of Macalester College.
Depression in the Somali community has several underlying factors, including social isolation due to immigration, poverty, change in role in society and change in family dynamics, experts say.
In coming to the U.S., some Somalis find themselves switching from communal life with large families to single-family homes. A man who was once a doctor in Somalia might find that his degree doesn’t transfer and ends up working as a cab driver. Parents find themselves relying heavily on their children due to lack of English skills.
Fartun Well, the executive director of Isuroon, a Minneapolis nonprofit that promotes the well-being and empowerment of Somali women. (Photo submitted)
UNDERSTANDING THE CONTEXT
The first thing practitioners need to look at when dealing with mental health issues in the Somali community, Weli said, is the context in which their patients are living.
“Mental health is a global issue,” she said. “To the Somali community, or African community, or immigrant community, there are other issues that perpetuate it: the refugee camps, social issues — having a community connection and suddenly they are alone by themselves; the female household that doesn’t have a lot of community support because the community is busy here; the poverty of it; the lack of preventative culturally specific services.
“I mean, I can go on and on and on, but it’s taboo.”
Untreated mental illness can have dramatic negative effects on a person’s quality of life and their overall health, experts say.
“If people hide and suffer alone, quite often they don’t learn English, they’re not able to retain a job and might have multiple chronic pain and physical issues and other illnesses that result from other unaddressed mental health distress,” said Patricia Shannon, an associate professor at the University of Minnesota School of Social Work.
TREATING MENTAL ILLNESS
Prior to working at the University of Minnesota, Shannon was a research associate at the Center for Victims of Torture in St. Paul. She is credited with developing a new mental health screening tool for new immigrants, which involves one-on-one interviews using questions that work well for diverse refugee populations. These questions worked to identify people with mental illness.
Although there are internationally recognized symptoms of some mental illnesses, the way these illnesses are described varies. Understanding how a culture talks about mental illness is a great first step toward appropriately treating the patient, experts say.
“A Somali person might talk about having a fuzzy brain ... whereas a Bhutanese person might talk about their heart in terms of emotional effect,” Shannon said.
When asked about what mental health centers and practitioners can do, Weli lists a few things: Have a workforce that reflects the demographic changes of the state. Build relationships with the patients. Provide treatments that can be adapted to the culture.
“For example, most of the moms we serve, they don’t want to take antidepressant meds, they want to do massages, they want to do acupuncture, they want to deal with the other issues they have,” Weli said.
But mental health issues are treatable, Shannon said.
“And so it’s important to say that these are normal reactions,” she said, “and not only are they normal, (but) you don’t have to suffer with it for decades.”