In the Somali language, there are words for “crazy” and “sane,” but there are few if any distinctions in between, said David Schuchman, the director of Immigrant and Refugee Behavioral Health for Volunteers of America (VOA). In contrast, U.S. doctors have the huge DSM-IV manual listing several hundred mental disorders — schizophrenia, bipolar disorder, delirium, depression, attention deficit disorder, dissociative disorders, eating disorders and more.
There are many ways communication breaks down between cultures as new immigrants struggle to fit into a new home. Mental health is only one of a long list of cultural disconnects, but it’s a particularly thorny one to talk about.
As big as the mental health stigma is in American culture, the stigma is even worse in immigrant cultures, said Schuchman, who offices at the VOA Alternative School at 924 19th Ave. S. — a school that focuses on the Somali community.
Back in Somalia, people would go to a doctor or healer and expect to get something that would help them, Schuchman said. Maybe it was just a vitamin shot, but they wanted something tangible. That contrasts with the psychotherapy model where people come into the office, sit down and talk about things.
“The idea of paying a stranger to talk about your problems is really foreign to most people around the world,” he said.
In an effort to break the stigma in the Somali community, several community organizations got together last fall to produce a video called Egal Shidad (in Somali with English subtitles). The video uses storytelling, accounts of traditional ceremonies, guidance from an Imam, and insights from mental health professionals to discuss the issue. Schuchman is one of those interviewed.
According to the project’s website, Egal Shidad is a humorous Somali folktale character. “We have borrowed him for this project not only to serve as an ‘ice breaker’ for such a stigmatized issue, but also to demonstrate how a family can confront mental illness and begin working together,” states the website.
Part of the video was shot at the Brian Coyle Center in Cedar-Riverside, the headquarters for the Confederation of Somali Communities, one of the Egal Shidad partners.
Sara Rohde, project coordinator for Egal Shidad, said she has sent out 710 DVDs to people in 22 states and 11 countries. Someone in Finland wants to duplicate the effort. “The creative work being done in our backyard is having an impact on Somali mental health far and wide,” she said.
Trauma: part of the community
Many Somali immigrants lived through the civil war, Schuchman said. Older adults have been beaten, tortured, raped or shot. Others witnessed family or neighbors experience those things. “If they were lucky to not have that happen, they have close family members that have been affected,” he said. “Trauma is part of the Somali community.”
Ahmed Yusuf is a case manager at the Community-University Health Care Center at 2001 Bloomington Ave. S. He works with Somali and East African patients. His caseload of 30–40 people includes cases of psychosis, bipolar disorder, schizophrenia, depression and post-traumatic stress disorder.
Yusuf said that, back in Somalia, religious leaders and cultural healers would play a role in addressing mental illness. The family would do its best to accommodate you. If people went to a total stranger, they were beyond help.
He recalled very few people with acute mental illness in his Somali hometown. They were on society’s fringe, some “just walking like a cow or camel or a sheep in the middle of the street, that no one bothers,” he said. “They were very rare.”
In his current job, it can be a struggle to explain to Somali family members that mental illness is a chemical imbalance in the brain.
He recalled a recent emergency room visit with a man apparently suffering from psychosis. His mother was there, too — a bright, articulate woman. Yusuf said the mother was convinced the problem had resulted from a recent time when her son had a sinus infection and a tooth extraction at the same time.
It is not uncommon for Somalis to connect the mental illness to some recent event that happened when the individual was still well, Yusuf said. To the mother, the tooth-and-sinus combination caused the mental illness. “Why wouldn’t there be a pill for that?”
Signs of progress
Yusuf said he has been working at his job for 11 years and he sees signs of progress — the Egal Shidad video among them.
“We know that it is not simply, ‘you are crazy or you are not,;’” he said. “We have progressed to a point where people know that if someone is afflicted by this illness, that there is a place to go.”
He also wonders how mental illness contributes to misunderstandings. What if a longtime Minnesotan saw a Somali misbehaving but did not understand his language?
“Will you attribute that to his culture, or will you attribute that to his mental illness?” he asked.
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