12.1.3 Migrants, refugees and stress: Mental health outcomes.

We live in the times of globalization and people are moving legally and illegally in large numbers to new cultural societies. The adaptation to a new culture is stressful and creates mental health problems for many immigrants as they seek to adapt to new languages and cultural ways different from their former communities (Sam, 2000). The effect of migration on mental health is complex as some immigrant groups rate better in overall mental health than even the host population whereas members of other groups fare poorly by comparison (Berry, Phinney, Sam, & Vedder, 2006). It is thought that migrants with better mental health probably had stronger support from local ethnic communities and family structures. Further, to have the personal courage to immigrate to a foreign land takes to start with a robust personality and healthy ego. A critical factor in mental health is how well the immigrant adapts to the host culture. Immigrants who find it difficult to accept new ways are more likely to report mental disorder, than individuals who adapt well (Eschbach, Ostir, Patel, Markides, & Goodwin, 2004). Another factor is the disparity between the original culture and the new host society. The more divergent the two cultures the greater the challenge for adaptation and the greater the stress experienced by the migrant.

Because we live during times of bitter conflict there are also many refugees from violence seeking new homes abroad. Many of these refuges have experienced very traumatic conditions linked to their flights from the homeland that predisposes them to a variety of enduring mental disorders (Bhui, Craig, & Muhamud, 2006; Marshall, Schell, Elliott, Berthold, & Chun, 2005). Of great importance to well-being is the network of support in the new host society. Refugees are faced with significant stress in starting life over, for example by the need to build a home and otherwise live a meaningful life. Many refugees had standing and status in the old society, but arrive without a meaningful social role in the land of refuge. Problems of adaptation produce additional stress reactions that compound the original trauma and contribute to psychological disorders. However, when the refugees have the support of their ethnic group these symptoms are ameliorated and a better outcome can be expected.

12.2 The role of culture.

Culture plays a major role in mental health in how behavioral symptoms are manifested, in the way mental disorders are communicated, and even whether patients will seek assistance (Eshun & Gurung, 2009). Ethnic groups experience varying stress living in a multicultural world and that in turn affects the rate of mental illness. Culture is often mediated through integrated ideologies including religion and beliefs in the supernatural world. A balanced perspective about mental illness supports the role of culture in having a moderate effect on mental health and outcomes (Draguns, 1997). In the therapeutic relationship culture plays a role in both directions as cultural values affects judgments of both patient and therapist. In fact mental health differs across cultural groups for a variety of reasons that include varying stress and cultural values. In addition diagnostic differences are created by unique cultural understandings that affect the rates of reported illness across cultures (Gurung, 2010).

Culture determines how symptoms develop and the level of psychological support for the patient faced with the challenges of mental illness. Patients carry cultural interpretations of the nature of illness and how, when and by whom treatment should be sought. The cultural understanding that mental illness is the just punishment of god may delay treatment and produce a self-fulfilling prophecy of chronic ill mental health. Culture may impact not only the conceptualization of the illness but whether treatment will be sought from scientific or superstitious sources. Mental illness that reflects broader social obsessions can also be promoted by culture. For example eating disorders are primarily found in wealthy Western countries obsessed with thinness, whereas in food poor countries people are just happy to fill their stomachs. With globalization these obsessions may be increasing in the developing world.

Culture is a factor in the administration and providing of medical services. The Western scientific medical approach while complex is well understood. It is a model based on collection of evidence and medical experts provide treatment according to what is known about the illness. Progress for a variety of serious illnesses can be reported as with treatment based on the scientific model and the use of technology experts understand more about causes and efficacious treatments. Although many illnesses are still not understood researchers have made remarkable progress in some medical fields. However, poverty condemns entire generations when diseases like river blindness or malaria in Africa could be eliminated with preventive efforts.

Modern Western style health care is often supplemented by religion and superstition in the developing countries. These superstitious practices have no medical benefit other than that produced by placebo effects (Prasadaro, 2009). However, healing approaches like traditional Chinese medicine continue to have followers although based on ideas that are unverifiable like the presence of the bodily forces of the yin and yang. Practitioners of Chinese medicine argue that these opposing body forces must be in balance to create optimal health, and that this goal can be accomplished through diet and various plant and animal parts used in medicine. The importance of understanding culturally based health approaches is emphasized by the number of people who believe in their usefulness. Millions of Indians still believe in Ayurveda, a holistic form of medicine in which the use of herbs and plants play a major role. Some of these plants may in fact have an actual medical benefit probably found as a result of trial an error over centuries (Ding & Staudinger, 2005).

Superstitious beliefs continue to influence health decisions among many cultures including among the Native Americans who seek health care through purification rites in sweat lodges, the utilization of voodoo religion among the Caribbean people, and in health practices among Mexican-Americans and Latin people. Some superstitious belief-based treatments go beyond strictly medical issues and try to also deal with psychological and social issues that contribute the health or illness (Trotter & Chavira 1997). These folk remedies became popular over centuries as part an attempt to control health outcomes in the vast sea of what was unknown about disease. That some approaches might by trial and error produce useful medicine is not surprising, although the superstitions beliefs associated with these practices may also delay appropriate scientific medical treatment (Gurung, 2010).