Thursday, 01 February 2018 23:15

Being Brown and Depressed

By: Aparna Sanyal in Montreal, QC

We have yet to understand the impact of covert racism and misogyny on the mental health of Canadian citizens, particularly “ethnic” women. However eager they are to contribute to society, however skilled they may be, they face a unique combination of social isolation and career limitations that can trigger illness.

My personal story perhaps speaks to many women from ethnic backgrounds in Ontario and all over Canada. After all, mental illness accounts for about 10 per cent of the burden of disease in Ontario, yet receives just seven per cent of healthcare dollars. Relative to this burden, estimates show that it is underfunded by about $1.5 billion.

My journey to the depths of despair began somewhere around 2014, when after several years of untreated, chronic depression, I developed psychosis. I remember it as the “terror.” I lived alone, had no family in Canada (although I was born in Sherbrooke, Quebec) and had a precarious job as a freelance writer-editor. Somewhere along the way, I thought moving to Toronto might help, but that turned out to be a disaster as well.

The terror began when my editor at a national publication was promoted, and I could no longer expect regular work. The $250 dollars I received from them every month was significant. I made $500-600 a month in total, if I was lucky; I had looked for over a year for more secure and lucrative employment, to no avail.

But the terror I felt was, I realize, largely social. I feared marginalization more than I feared hunger.  My former editor had been an encouraging man, one who made me feel valued as a writer. When I no longer had that monthly job, it was as though my only railing on a cliff fell away. I had already questioned my worth to myself, and the answer was now confirmed by the outside world. What value was there to me now? It was as though I had seized to exist.

[quote align="center" color="#999999"]39% of Ontario workers indicate that they would not tell their managers if they were experiencing a mental health problem.-Centre for Mental Health and Addiction[/quote]

After this, the terror came upon me, sudden and all-encompassing. Public Health Ontario estimates the disease burden of mental health at 1.5 times greater than that of all cancers put together and I was feeling every bit.

Finding a safe place

I lived in a sort of dormitory house near the University of Toronto, on Madison, a Victorian “bay-and-gable” mansion that had been cut into rickety, rented rooms. We did not have a personal letter box. Our letters were placed on a table near the entrance. I noticed my bank had not sent me the last monthly statement. I became certain my next-door neighbour, a young red-headed man who seemed to be in his room all the time, had stolen it. My problems began to proliferate. I could not find a toenail-clipper, and this only confirmed my suspicions about my neighbour; then I discovered I could not find an old sweater and a journal, and became convinced he had taken these too.

Around that time, I began to smell a strange odour. I thought it might be a noxious drug seeping from his room, but I could not identify it. At night I huddled under my comforter, hoping to protect my lungs from the fumes. As I heard my neighbour moving about restlessly at night, I imagined he was only waiting to do me harm. I also began to think I was being followed, by my neighbours or perhaps by the then-conservative government, whom I thought might have started tracking my strong political beliefs. I began to fret about being anywhere alone, especially in my room. I walked around the city and spent as much time in cafés and parks, as the homeless do. I was unable to sleep at night.

One night, convinced I was under imminent threat — for my neighbour seemed to have banged against my door— I fled the house and called the police. Little need be said about the fiasco that followed, except that one short, tired, blond sergeant shouted at me, and suggested to her two constables, one of Asian origin and one South Asian, that I might be drunk. (I did not drink.)

They had come up to the room with me, and had tried to stir up my neighbour, but he did not answer. At first, they listened to my story. After I told them about the possibility of my neighbour having made a wax key to break into my room, they lost patience. The sergeant threatened to have me charged. I still remember that she kept telling her colleagues, “After all, it’s not as though she works in an office!” My desk, laptop, books, and papers, which were before her, had no significance. I was illegitimate in her eyes because I did not work in an “office.”

The next morning I promptly moved into the Holiday Inn nearby. I called several women’s shelters around town. The sympathetic co-ordinators pointed out that their beds were full. The only one available was too far away, in another borough.

There was no one in the country of my birth for me to turn to. I had, over the previous years, alienated many people from my life. I had lost faith in the Montreal arts community I had worked in for eight years. I had developed an aversion to what I saw as its insular, largely white milieu, and sensed it could only abuse me. This sense, extreme as it was, was rooted in reality.

Overworked and under-paid

My depression had started a couple of years back, after I had left a debilitating job as an Editor and Executive Director of a well-known Montreal publication. The job, I think in retrospect, had been one often taken by women and minorities. It had been given an inflated title, but left one overworked and under-paid. The board of the organization that ran it was composed of local publishers, mainly old, male and white, who had created it as a para-governmental agency. With federal and provincial grants, they had created jobs that the government deemed necessary but refused to do itself or pay for adequately. I had made $18 an hour, a third of what I had made when working for the government a few years before. I had been paid for 30 hours a week, but worked 60.

For almost two years I had worked around the clock. My health had rapidly deteriorated. My employers had been unhelpful and unfriendly. They had rarely responded to my emails when I required information or a signature, and I often had to travel the city to find them. In spite of my difficulties, I had increased the budget and improved the magazine of the organization. Yet I had been invariably criticized by the board. I had begun to cry every night, and occasionally dreamt of suicide. My social skills had become jagged, unreliable. I had snapped at colleagues and clients. I had met a therapist, a European woman, to whom I did not mention my thoughts of suicide. She had suggested I quit my job. I had eventually fought with my board and resigned in a fit of anger, without first securing another job.

After this, I felt hopeless. Each time my mind turned to the people who shared my environment, my heart grew heavy. I could not help brooding on the daily racial slights I endured within an overwhelmingly white community: one well known director, introduced to me, turned away without speaking to me and asked the person introducing me whether I was her “bookkeeper”; that person was someone with whom I shared a large space, and who suggested to me, since I disliked using the air-conditioner in the summer, that my ethnicity made it easier for me to bear the heat. These “micro-aggressions” were little in themselves, but together, happening regularly, as I grew more depressed, they further intensified my sense of alienation.

I had enough money to isolate myself and devote myself to my own reading and writing. When the money began to run out, I made the huge leap to Toronto, where I could start afresh. It was a disastrous decision.

After two days in the Holiday Inn near the Madison house, feeling unsafe, I relocated to an International hostel in Kensington. My terror was so great now that I prepared to fly to Kolkata, India, where I had inherited a house, and would be surrounded by people familiar to me, of my own origin. One day, I spotted a red-headed panhandler near the hostel who looked eerily like my former next-door neighbour; seeing him triggered both my sense of alienation and intense fear of poverty. Inevitably, I felt the need to leave the hostel.

Identifying the Problem

I stayed, during these three weeks of terror, in five hotels. They cost me roughly $10,000 and I received no security from them; each successive place of sanctuary turned into a house of horror. I must have contacted the police five times, expressing my fears. I tried to tell many people about the “drugs” I could smell in my rooms — from policemen to maids to night-managers. But they smelt nothing and were puzzled that I could not specify what I smelt. Only one person told me I should see a doctor. A young, Asian constable in a police station I had run to one night, he said, “All I’m saying is that you should see your family doctor. Because if you are mentally ill, you will be the last person to know.”

I went to a hospital eventually, because I was so anxious I felt I could hardly breathe. The nurse suspected my illness, and asked if I saw things that others didn't see; I said no, for I smelt things others didn’t smell. The medics performed a brain CT on me. It was normal, and I was sent back to my hotel.

I was bitter. I felt I was being forced to flee the country of my birth, and somewhere in my pent-up mind I thought this was because I was a social threat. This happened to be somewhat true, but not in the way my sickness told me it was. Simply put, as a brown, thinking, writing woman, I was negligible in the society I had been born in. Its various attacks on my mind, from micro-aggression to economic hardship to isolation, caused my mental illness and my ejection from that society.

(*For those living in Ontario, the Mental Health Helpline is a free, confidential live service that is available 24/7 to provide callers with information about mental health services in this Province.)

Aparna Sanyal is a writer and journalist who has worked with the Globe and Mail, the Gazette, the Montreal Review of Books, and Rover. She has been an advocate of mental health awareness and is presently pursuing a Master’s degree in English at McGill University. This piece is part of the "Ethnic Women as Active Participants in Ontario" series.

Published in Health

by Beatrice Paez in Toronto

As a child, it wasn’t unusual for Ann Y.K. Choi to be at work behind the counter of her family’s convenience store in Toronto. She and her two brothers were expected to help their parents when they finished school.

Choi’s teenage daughter, a third-generation Korean-Canadian, isn’t familiar with the ins-and-outs of running a variety store – no more stocking shelves with instant noodles, no more keeping a wary eye out for shoplifters.

But Choi says the children of immigrants shouldn’t be spared from learning about the sacrifices their parents made to ensure their children would not undergo the same hardships they endured.

It’s one of the reasons she wrote Kay’s Lucky Coin Variety, a fictional, yet deeply personal, account of life in a downtown Toronto convenience store. Mary, the novel’s headstrong, yet conflicted, protagonist, is a composite of Choi and other young Korean women she knew whose stories had yet to be told to a wider audience.

Preserving Canadian history

Choi says she wasn’t ready to pen a memoir for her debut as a writer, but wanted her daughter and other young Canadians to be aware of the Korean-Canadian experience.

“Nobody has gone on to inherit the store, and if I [didn’t] write this story, this whole history would be lost,” says Choi. “This is a part of Canadian history.”

The Choi family moved to Toronto from South Korea in 1975. Choi’s parents worked miscellaneous jobs before saving enough money to buy a variety store on Queen Street West.

What distinguishes the immigrant experience of Koreans, says Choi, is that they had to bounce from neighbourhood to neighbourhood to compete in the convenience store market. Owning a mom-and-pop shop was unlike having a restaurant, which could exist alongside others on the same block.

“We were scattered all over Toronto. We got to experience and live in every pocket,” says Choi. “It gave us insight into Toronto on a bigger level . . . And in some ways, it helped us integrate.”

They led a somewhat “nomadic” life. Moving was dictated by the rising and falling fortunes of the family business.

[quote align="center" color="#999999"]“It gave us insight into Toronto on a bigger level . . . And in some ways, it helped us integrate.”[/quote]

Mixing family and business

The store demanded so much of the family that Choi says it was like their “baby.”

Looking after the store barely gave them time to unwind together. There were no family dinners and no socializing until after the convenience store closed at midnight.

“We were all very aware that we needed the baby to thrive because our success depended on it,” she says.

It was only when she became a mother herself that Choi says she fully appreciated the courage and nerve it took her mother to run a store that was always at risk of being robbed.

“It’s hard not to be resentful [growing up], but looking back, I realize she must have been so afraid, but she didn’t show it,” says Choi.

[quote align="center" color="#999999"]The store demanded so much of the family that Choi says it was like their “baby.”[/quote]

Taking on taboo topics

At a Toronto Public Library event organized as part of its eh List Author series, Choi recalls how she came to write the book, which explores the relationship between mother and daughter.

It took a little nudging from a former student back in 2007, says Choi, who works as a high-school guidance counsellor. She explains how he flipped the question about his ambitions back at her and persuaded her to fulfill her dreams.

“I told him I wanted to write a book, and he challenged me to do that,” she says.

For five years, she would write after her family went to bed at night. “It seemed safer to delve into the Korean psyche when it was quiet,” she says.

[quote align="center" color="#999999"]“We’re very guarded about sharing pain.”[/quote]

She took several writing courses, eventually graduating from the University of Toronto’s creative writing program in 2012. Her final project, Kay’s Lucky Coin Variety, was presented before a literary panel and earned the attention of renowned editor Phyllis Bruce, who acquired the novel for Simon & Schuster.

What struck her editor, Choi explains, was that the book tackled themes of depression and anxiety from the perspective of a Korean-Canadian.

As universal as people’s struggles with mental health issues are, for Choi and other Korean women she interviewed, such anxieties were rooted in a deep resentment toward their mothers. They were seen as an “obstacle” to their desire to be Canadian.

Although aspects of Korean culture have become mainstream, literature still lags behind K-Pop and kimchi in popularity.

This is what partly led Wai, a Chinese-Canadian immigrant, to Choi’s library reading.

“I’m interested in literary diversity,” she says. “I’d like to hear about the Korean experience. Most of it is a universal theme, but it would be nice to hear different perspectives.”

Choi hopes her book will open up the space for other Korean writers who are reluctant to share their experiences.

“There’s a little bit of fear,” she says, adding there are things that Korean Canadians as a cultural group do not discuss.

“We’re very guarded about sharing pain. It’s one thing to share music, food, but stories are so intensely personal.”

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Published in Books
Friday, 29 January 2016 23:03

Yes, Let’s ALL Talk About Mental Health

Commentary by Rosanna Haroutounian in Quebec City

“I guess you have to be white to have a mental illness,” my mom said. 

I looked up from my laptop to see a promo on CTV News Channel for Bell’s Let’s Talk day on January 27. 

Indeed, there were no visible minorities in the newsreel – a representation that is far from the reality of Canada’s diversity, and the reality of mental illness. 

The Centre for Addiction and Mental Health (CAMH) defines mental illness as “a wide range of disorders that affect mood, thinking and behaviour.” Depression, eating disorders, anxiety disorders, schizophrenia and addictions are all examples of mental illnesses. 

According to the Canadian Mental Health Association (CMHA), 20 per cent of Canadians will have a mental illness at some point in their lives. Mental illness affects all Canadians indirectly through family, friends or colleagues. 

[quote align="center" color="#999999"]Some languages do not even have words for the types of mental illnesses that are commonly diagnosed in the West.[/quote]

Genetic, biological, personality and environmental factors can interact to cause mental illnesses, meaning they can affect Canadians of all ages, backgrounds, and education and income levels. Like other health problems, early and effective diagnosis of mental illness is key to its treatment. 

That’s why talking about mental health in a way that is open and accepting is so important – and why immigrants can be at higher risk of not being treated. 

More education, accessible services are imperative

A study published in the Canadian Medical Association Journal (CMAJ) in 2011 found that while rates of depression and other disorders were lower for new immigrants than the general population, they rose over time.

Language and cultural differences can create barriers to seeking help. Some immigrants distrust mental health services because they have never had experience with them in their country of origin and are not accustomed to speaking openly about mental health issues. Some languages do not even have words for the types of mental illnesses that are commonly diagnosed in the West.

[quote align="center" color="#999999"]“Immigrants are less than half as likely to get professional help for depression compared to self-identified Canadians.”[/quote]

A study by University of Toronto researcher Tahany Gadalla found “immigrants are less than half as likely to get professional help for depression compared to self-identified Canadians.” Gadalla said there are not enough programs geared towards educating people from different cultures about mental health issues.

Migration and resettlement can also create environmental stressors that contribute to mental health problems. Social and economic strain, social alienation, and discrimination are a few examples of these stressors. Refugees are at higher risk than the general population of developing specific psychiatric disorders as a result of exposure to war, violence, torture and forced migration. 

Many of the Syrian refugees who are now arriving in Canada have experienced these types of traumas. 

The CMAJ study states “immigrants and refugees are less likely than their Canadian-born counterparts to seek out or be referred to mental health services, even when they experience comparable levels of distress.” 

This makes it imperative for Canada to prepare accessible services to support refugees as well as educate them about the importance of seeking help.

All Canadians must be a part of the conversation 

CAMH provides resources in languages other than English, and put together a video for Let’s Talk Day that features a truer representation of the Canadians affected by mental illness than the Bell Let’s Talk promo I saw. 

Across Boundaries is one of several mental health organizations that support people from ethno-racial communities in Toronto. It shows that there are discussions taking place within newcomer communities, but for some reason these aren’t portrayed in the broader national conversation. 

[quote align="center" color="#999999"]For a large portion of Canadians, star power and re-tweets will not change their perception that mental illness is a problem they cannot experience, talk about or seek help to treat.[/quote]

I noticed that the Let’s Talk website features the profile of Rwanda native Michel Mpambara, though he appears more prominently in the French-language campaign, presumably because he is a resident of Quebec. 

Each January since 2010, on Let’s Talk Day, five cents for every call and text message sent on Bell's network, as well as every Facebook share promoting the campaign, and every tweet using the hashtag #BellLetsTalk, is pledged towards mental health initiatives in Canada.

This year’s campaign raised over $6 million, which will be donated to research programs and organizations through Bell’s Community Fund. 

Despite being accused of glossing over the real obstacles to mental health strategies and failing to support its own employees’ mental health, Bell’s campaign gains popularity each year. 

Everyone from Prime Minister Justin Trudeau to American talk show host Ellen Degeneres took part in Bell Let’s Talk this year. 

People in the CAMH video acknowledge that simply seeing the words “let’s talk” sends a powerful message about starting a discussion on mental illness. 

Let’s Talk has the backing of six-time Olympic medalist Clara Hughes, who acts as the campaign’s spokesperson, as well as comedian Mary Walsh, TV personality Howie Mandel, and singer Serena Ryder. As a social media campaign, it is especially relevant among youth, 10 to 20 per cent of whom are affected by mental illness. 

But for a large portion of Canadians, star power and re-tweets will not change their perception that mental illness is a problem they cannot experience, talk about or seek help to treat. 

We all need to take responsibility for our mental health – families, schools, employers, governments and media. Television, radio, newspapers, and now the Internet have the power to shape our perceptions of what is normal. A news agency has the added duty to represent the truth. 

As one of Canada’s largest telecommunication companies, taking on the responsibility of leading a discussion about mental illness requires Bell to speak to all Canadians in order to make the most impact. 

Rosanna Haroutounian is a freelance writer and the assignment editor at New Canadian Media. She studied journalism and political science at Carleton University and now splits her time between Quebec City and Peterborough, ON. 

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Published in Commentary

by Belen Febres in Vancouver 

Immigrating to a new country can put a strain on a person’s mental health and well-being. Art therapy, one of the disciplines being recognized in November as part of arts and health month, can have positive benefits for newcomers’ mental health. 

“Moving to another country can be an exciting experience, but it can also be nerve-racking or sad,” explains art therapist Debbie Anderson. “Art making can help people find the inner peace that they may have lost in the migration process.” 

According to Arts Health Network Canada (AHNC), arts and health is an interdisciplinary field that embraces different forms of art to promote health, prevent diseases and enhance health service delivery. There are multiple arts and health initiatives available across Canada. 

AHNC’s communications coordinator, Zara Contractor, mentions that the World Health Organization (WHO) defines health as an individual's complete physical, mental, social, emotional and spiritual well-being, and not only as the absence of disease. 

“The arts can positively impact all these dimensions in different ways,” Contractor says. 

[youtube height="315" width="560"][/youtube]

Art as therapy 

Contractor highlights the importance of making a distinction between expressive or creative arts therapies from other arts and health practices within the field.  

Expressive art therapy focuses on art making as a therapeutic process, while other arts and health practices focus on engaging people in the arts for reasons such as enjoyment, education, distraction from illness, social connection and self-exploration.

Different materials and techniques, such as colouring, painting, collage, clay and weaving are used in expressive art therapy.

[quote align="center" color="#999999"]“People may think that they are not artists, but everybody can use art as a means of expression.”[/quote]

Moreover, expressive art therapies are regulated by professional associations and require a postgraduate or master’s degree.

Mehdi Naimi, president of the Canadian Art Therapy Association (CATA), explains that only qualified art therapists graduated from programs regulated by specific standards can practise this profession in Canada.

Tzafi Weinberg, CATA’s advocacy chair, explains that emphasis is placed on safety, confidentiality and unconditional acceptance in a non-judgemental atmosphere throughout the whole therapeutic process.

She adds that the focus of the therapy is not the final product, but the creation process instead. For this reason, no previous experience in art is required.

“People may think that they are not artists, but everybody can use art as a means of expression,” says Jannika Nyberg, co-founder of ArtQuake, a grassroots organization that connects young people through the arts in Vancouver.

For this reason, Nyberg encourages everyone to try different artistic forms. “In this way, you may realize that you enjoy these activities and that they can be a positive outlet to deal with your emotions.”

Benefits for newcomers

The sessions in art therapy can be individual or in a group. While some people can feel more comfortable in individual sessions, group sessions can contribute to creating a sense of community and allowing interaction with people from different backgrounds.

“They also offer a space to find collective support, input and understanding,” explains Tanissa Martindale, a recent art therapy graduate and the registrar and practicum coordinator of the Winnipeg Holistic Expressive Arts Therapy Institute (WHEAT).

[quote align="center" color="#999999"]“Art has allowed me to express my longing for my family and my country, and to explore my journey and my identity.”[/quote]

According to Anderson, group sessions can be particularly beneficial for newcomers because by sharing their stories, people discover that they have similar experiences as others, and share attributes of resilience and strength.

Newcomers can bring their own culture into the session through the use of symbols, materials, and images that are familiar to them.

Therapists do not interpret the artwork in this process. Instead, they guide the individuals to find its meaning.

“People are their own experts, they know what they need and all the answers are within them,” says Weinberg.  

Hana Pinthus Rotchild, a registered social worker and art therapist working with different populations including immigrants and refugees, explains that this approach allows people to recreate the reality they left behind and process any grief or anxiety they may be experiencing.

Through different art projects, she has reflected on her own migration process from Israel to Canada in 2003.

“Art has allowed me to express my longing for my family and my country, and to explore my journey and my identity,” she shares. “It has also been an avenue to cope with my losses, separations, and transitions, while helping me to stay connected with my roots.”

Non-verbal methods of expression

People of all ages suffering from different conditions like depression, grief, anxiety, trauma and eating disorders can benefit from art therapy.

Anderson explains that this is possible because non-verbal methods can be effective in helping people express themselves.

By encouraging individuals to make art instead of talk about their own emotions and ideas, art therapy can provide gentle, healthy and positive communication outlets and coping mechanisms.

[quote align="center" color="#999999"]“In art therapy, people can express through their own visual voice without the need of words.”[/quote]

This can also break the language barrier that newcomers may face.

“In art therapy, people can express through their own visual voice without the need of words,” says Pinthus Rotchild.  

Naimi explains that once people express what cannot be said through other mediums, they find relief, process their experiences, improve their self-esteem and envision the future they want for themselves.

“In this way, art therapy encourages therapeutic healing and creative problem solving,” he adds.

For Nyberg, art has also been a means for personal transformation.

“Art is the one place where I can get out of my mind and into my body to express and process my emotions,” she says. “If I didn’t have that outlet, I don’t know where all those emotions would have gone.”

Video By: Samantha Lui for New Canadian Media

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Published in Health
Tuesday, 15 September 2015 13:47

Addressing Mental Health of Resettled Refugees

by Leah Bjornson in Vancouver

Canadian party leaders have all pledged to resettle thousands (if not tens of thousands) of Syrian refugees over the next few years, but little has been said to address the fact that for many, the crisis doesn’t necessarily end upon reaching Canadian shores.

A new report commissioned by the UN Refugee Agency (UNHCR) explains that even after refugees have escaped a crisis zone, they must deal with the damaging repercussions of having experienced war-related violence. 

If they are able to find safety abroad, refugees still must confront the daily stressors of displacement, which include poverty, a lack of basic needs and services, ongoing risks of violence and exploitation, isolation and discrimination, loss of family and uncertainty about the future.

[quote align="center" color="#999999"][T]he UNHCR’s report’s aim is to make mental health and psychosocial support (MHPSS) staff aware of the cultural issues they might encounter when working with refugees.[/quote]

According to the World Health Organization (WHO), Syria in particular is suffering from a mental health crisis, with two million or more citizens experiencing mild to moderate mental health illnesses.

Titled “Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians,” the UNHCR’s report’s aim is to make mental health and psychosocial support (MHPSS) staff aware of the cultural issues they might encounter when working with refugees so that they can better address this group’s specific and acute mental health needs.

The report

“The idea really is to help practitioners equip them[selves] with the knowledge, but also the attitude that they need to have with a Syrian refugee,” explains Ghayda Hassan, one of the organizers of the report and an associate professor in the Department of Psychology at Université du Québec à Montréal (UQAM).

Hassan began working on this report two years ago when the UNHCR and the WHO were investigating how to better support mental health and psychosocial services practitioners following a crisis.

The organizations decided to commission professionals in the field to design a primer for MHPSS staff that would guide them through interventions while educating them of the present cultural context and any cultural issues they might face working with Syrian refugees.

[quote align="center" color="#999999"]Exposure to such devastating events has the potential to create extreme psychological and social distress among refugees.[/quote]

The report begins by describing how the current conflict in Syria has caused “the largest refugee displacement crisis of our time.” Since March 2011, nearly half of the country’s population has been displaced and over 200,000 people have been killed.

Those who have survived have been witness to massacres, murder, execution without due process, torture, hostage-taking, enforced disappearance, rape and sexual violence, as well as the use children in hostile situations.

Exposure to such devastating events has the potential to create extreme psychological and social distress among refugees.

Many are able to establish healthy coping mechanisms such as talking to friends and family, praying or remembering good times.

However, others might have had their social support systems destabilized during conflict, forcing them to develop less effective or negative coping strategies such as smoking, obsessively watching the news, worrying about others back in Syria or ‘doing nothing’, says the report.

When this lack of support is compounded with the trauma they’ve experienced in crisis zones, these individuals are especially at-risk of developing mental health issues or mental disorders.

Idioms of distress

The report intends to tackle this problem by helping “MHPSS professionals and humanitarian professionals become more sensitive – not to stereotype the Syrians, [but] to make them aware,” Hassan says.

One of the most important ways in which mental health practitioners can support refugees is by understanding and using cultural ‘idioms of distress’, which according to the report, “refer to common modes of expressing distress within a culture or community that may be used for a wide variety of problems, conditions or concerns.”

In order to help mental health practitioners communicate their diagnoses in ways refugees can understand, the report provides specific ways to express common expressions used in Western medical traditions. It also outlines common expressions used by Syrians.

[quote align="center" color="#999999"]“Even when we talk about anxiety and depression, anxiety and depression and other disorders are not experienced in the same way [in different cultures].”[/quote]

For example, the phrase in Arabic that translates to “I feel my soul is going out” should be understood as an expression of worry, inability to cope, and a warning sign of a dysphoric mood.

A similar statement, which translates to “It is humiliating to complain to someone other than God” is a reference to shame in asking for help as well as a statement of despair and surrender.

By understanding the true intent behind these expressions, doctors can better understand exactly what a patient is experiencing.

Nevertheless, this issues go beyond simple vocabulary.

“Even when we talk about anxiety and depression, anxiety and depression and other disorders are not experienced in the same way [in different cultures],” Hassan explains. “So we kind of described for instance not only what words a depressed Syrian refugee patient may [use], but also what exactly depression means and how is it existentially experienced.”

Hassan says addressing these issues as complex cultural and emotional experiences rather than solely as diagnoses “really provides the ability for practitioners to be more aware and understand better the emotional and psychological experience of their patients.”

Intervention beyond Syria

While this report is specifically focused on a Syrian context, Hassan explains it has the potential to help mental health practitioners beyond the current refugee crisis.

“The advantage I think to this review is that we have included some advice or information on how to design a contextually appropriate service in terms of mental health and psychosocial support,” she says. “It can be used by any mental health psychosocial service in Canada who is hoping to improve the services that they provide to their population.”

Hassan says this could be especially important for Canada given its multiethnic population.

She ultimately hopes that this report is widely distributed so that both professionals and the public become more aware of the long-term health consequences of refugee situations and how they can get involved.

“Canada has to play [a role] in assisting refugees. And not only waiting here to assist them.”

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Published in Health
Wednesday, 25 March 2015 17:21

Recovering from Mood Disorders

Mood disorders are common psychiatric diagnoses which affect a sizable chunk of the population. They exact an exorbitant cost at both the personal and societal level.

The terms depression and

Published in Health

by Aparna Sanyal

Imagine that you are an Afghan refugee. You are a single mother of two children who has fled an abusive marriage, and survived two rapes, including one in a refugee detention centre that resulted in pregnancy. You have endured separation from your supportive parents, who die in Afghanistan while you are still awaiting asylum. While attempting to cope with all this, together with unemployment, isolation and ostracism from your ethnic community, you hear that your refugee claim has been denied. In despair, you threaten to kill yourself and your children.

The immediate response of mental health care professionals? A stark recommendation that your children be placed in protective custody.

The preceding scenario is unfortunately all too real, and representative of an ominous deficit in Canadian mental health care: a lack of training in treating immigrants and refugees. The case is one of many staggering examples cited in the work of Dr. Jaswant Guzder, head of child psychiatry at Montreal’s Jewish General Hospital, and co-founder of Canada’s first cultural consultation service. She notes, in a 2011 paper titled “Second Skins: Family Therapy Agendas of Migration, Identity and Cultural Change,” that many mental health issues dealt with by immigrants and refugees “are not necessarily intra-psychic but rather related to social suffering, institutional or host society issues.”

The urgent need for cultural mental health care training is underscored by a fact reported in a February 2014 Globe and Mail column by Margaret Wente: four-fifths of students in Toronto public schools now have at least one parent who was born outside the country.  

In a recent interview via email, Dr. Guzder answered questions about her groundbreaking work as a cultural consultant:

AS: In your published work you repeatedly describe suicidal ideation among South Asian female immigrants. Are certain mental health problems more common among immigrants, and among certain communities? 

JG: We have studies in Canada that confirm that immigrant women are at higher risk for post-partum depression and psychosis, a factor that puts infants and mothers at high risk and has long-term consequences. In addition, many of these mothers refuse treatment of their depression. We have good documentation that migration increases risk for psychosis and affective disorders, especially where racism is an issue in the host society. Black populations in Europe have well documented escalations of psychosis on migration versus a comparable population that did not migrate. South Asian women that I see who have serious depression risk are often those who have survived political conflicts such as the Sri Lankan war, have a domestic abuse history, suffer social isolation, or do not have the support of their family of origin to negotiate better options for conflict resolution or for divorce when the marriage breaks down.

The mythology is: South Asians, Chinese, Blacks and other minorities underutilize mental health services, so that means they don’t have significant mental health risk or mental health problems. It would seem from our community research that the situation is more complex than that. It involves stigma, accessibility of health care, support of family, language access, etc.  Our study of high-risk parents suggests that general practitioners under-refer minority families. We are not sure whether cultural stereotyping, that these minorities are not ‘psychologically minded,’ is a factor, or whether the patient minimizes any mental health needs -- it is not clear. There is good evidence that minorities benefit from psychotherapy as well as the host culture clients.

AS: In case studies you've noted that clinicians in a host culture can mistakenly think that condemning a taboo in an immigrant’s culture as "primitive" is a form of help. Please explain.  

JG: The host culture often misinterprets ethnic minorities through a lens of stereotyping, or does not gain access to a full account of mental health or systemic issues due to language barriers or lack of culture brokers [professionals who bridge, link, or mediate between cultural groups]. The projections onto Others who are not part of Euro-North American groups are often complex to uncover or deconstruct, as we are now living in an increasingly globalized and technologically adept world of cultural identities that are hybridized or creolized. Assessing the mental health needs of immigrants includes openness to exploring cultural formulations to elicit the meaning of symptoms, and an understanding of such factors as family silencing, rituals, gendered hierarchies or post-colonial issues. A presenting complaint has to be explored to understand the suffering behind the symptom; many cultures do not, for example, have a framework for depression or have very strong taboos on reporting domestic abuse. We must be sensitive to the systemic and family settings where people construct their distress or try to gain support from others. Our voice and agency are generally constructed within a cultural matrix. Often women have greater options in Canada if they shift from patriarchies to egalitarian values, while men find that these values diminish their power and agency within families.

AS: What are some of the ways a cultural consultant can navigate barriers to treatment such as social stigma?

JG: The cultural consultation is always done with an interpreter and, if needed, a culture broker. Our primary aim is to establish cultural safety, and explore all aspects of the presenting complaint.

Sometimes the clinician has a stereotyped approach, has not had interpreters available, or is unaware of crucial cultural factors. For example, there was a case where a Tamil Sri Lankan woman was told by her family doctor that it was best she return home as she might be homesick. But she had been a war victim: the therapist had little information on the Sri Lankan civil war and did not know that she had no home or family to return to. Her symptoms were related to a strain with a psychotic mother-in-law and a triangulation with her husband. After multiple suicide attempts and no response to medication trials the clinic had sent her for a [cultural] consult. The clinic did not realize that the patient was enmeshed with [emotionally dependent on] her interpreter as she was socially isolated, and the interpreter was advising her to convert from her religion to Christianity to save herself from depression. The patient had also never taken the antidepressants consistently or understood the prescribing instructions. All this was evident in the consult, but the clinic had not fully explored these issues nor the familial background, and projected blame onto the husband as a stereotype of a patriarchal abuser -- while in fact, as a son, he was also caught in a difficult familial situation. 

AS: You've mentioned that the lack of translation services in mental health care is a major problem.

JG: Lack of translation services impacts all of our minority patients, as it impedes us in doing an assessment and offering therapy. The government has been slow to acknowledge that interpreters are vital to quality of mental health care delivery.

AS:  What is the potential long-term impact of cultural training among Canadian mental health care providers?  

JG: We are working towards a wider acknowledgement that training in cultural competency should be part of the curriculum for all mental health professionals, including teachers, nurses and medical students. The potential gains are: the reduction of stigma; the reduction of institutional racism (difficulties reflected in attitudes towards minorities); wider access (currently our studies have shown that many communities associate mental illness only with psychosis and need to feel safer, with options of care modified for their cultural group); and encouragement of collaborations with cultural communities to address modifications in approach (e.g. work has been done to modify mental health care approaches for First Nations, Black, Chinese communities, etc.) Trauma and wellness have to be framed within the cultural norms of the communities:  their ways of presenting distress or modifying protective factors that help them become functional and more resilient.

(This interview has been condensed and edited for clarity.)

Aparna Sanyal is the former editor of the Montreal Review of Books. You can find more about culturally safe and competent mental health care for Canada's diverse population at

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