Ethnopsychology—The cultural framing of the self, emotions, and suffering.
In an earlier post I discussed methodology which can elicit local idioms of distress in regard to psychological issues. In this post I will examine how treatment models can also be created which are culturally specific. One such example comes from the work done by Kohrt et al. 2012 with Bhutanese refugees. These researchers state that there is an extremely high rate of suicide among Nepali Bhutanese in the United States and that a culturally specific treatment modality is necessary to alleviate the psychological distress among this population. They propose a framework designed to increase awareness among mental health professionals about Nepali Bhutanese experiences and interpretations of psychological distress; therefore reducing suicide risk.
The Nepali Bhutanese conceive of the self differently than the Cartesian mind-body split common in Western culture. The self is organized as the physical body (Nepali: jiu or saarir), the heart–mind (man), the brain–mind (dimaag), the spirit (saato), the soul (atma), and one’s social status (ijjat). Other aspects of the self are the family (pariwaar), which includes the extended family, and the spiritual world, especially relationships with ancestral deities (kul devta). The authors suggest that for mental health treatment, the heart–mind and brain–mind divisions are key. They suggest that the heart–mind aspect is the locus of memory and emotions. In contrast, the brain–mind is the organ of cognition, attention, and social regulation. Where heart–mind problems are considered commonplace, brain–mind problems carry more social stigma. A person with a prolonged heart–mind problem may eventually develop a brain–mind problem. In Nepal there is a traditional healing practice conducted by shamans (dhamijhankri) in which the heart–mind is “ritualistically bound (man baadne) to calm its desires and intense emotions, ranging from jealousy to sadness to love, so that the brain–mind is not overpowered and socially acceptable behavior can be maintained” (2012:94).
Shamans play an important role as treatment options for Nepali Bhutanese. As is common among populations in Latin America and elsewhere, a person’s spirit may be lost (saato jaane, spirit goes) when they become frightened or possibly cursed. Also, as is the case in other populations who recognize soul loss, healing by shamans is used in these instances to call the saato back to the body in order to restore health and vitality. “The physical body (jiu, saarir) is the site of physical suffering and pain. For physical problems, individuals may seek home remedies, the care of a dhami-jhankri shaman, or go to a health clinic” (2012:95). Health care professionals should recognize the important role shamans play in the treatment of these issues and include them in the treatment plan.
The authors also discuss how they adapted two therapy modalities to work specifically with Nepali Bhutanese. The first was Cognitive Behavioral Therapy (CBT), which is commonly used in Western psychiatric medicine to treat depression and other forms of psychological distress. In their specific case the treatment goal was framed as minimizing worries in the heart–mind by changing thoughts and behaviors related to the individual’s perceived powerlessness, which then reduced brain–mind distress. Their second treatment modality was Interpersonal Therapy (IPT). The authors suggest that the syndrome that was being treated by IPT can best be described as manosamajik samasya or a “heart-mind—society problem.” Their culturally specific treatment plan highlights goals for modifying the individual’s social relations and suggests changes in the person’s emotional appraisal of those relations.
It is my opinion that not only is it important to extract local conceptualizations of psychological distress, but it is even more important to create treatment modalities and ways of managing psychological distress which are culturally and context specific. Thinking back to the group of people I worked with who were diagnosed with bipolar disorder, it became clear that they had their own model for what they could do to manage their psychological distress. I thought it was unfortunate that this model was not shared by their doctors and other health practitioners. This illustrates the importance of the work of psychological anthropologists which can inform the dominant health care system in which most people seek treatment.
Kohrt, Brandon A., Sujen M. Maharjan, Damber Timsina, and James L. Griffith
2012 Applying Nepali Ethnopsychology to Psychotherapy for the Treatment of Mental Illness and Prevention of Suicide among Bhutanese Refugees. Annals of Anthropological Practice 36(1):88.