Cultural Psychiatry in Nebraska

Written by Mariam Garuba

The concept of cultural psychiatry is not and should not be new to our state of Nebraska; in fact, with contemplation, one will realize that cultural psychiatry is the most ancient form of the field worldwide. In this day and age, the state of Nebraska has become home to an influx of immigrants, many of whom bring with them experiences that have unduly impacted their mental health.

What is cultural psychiatry? Simply, it is the application of psychiatry in its full but appropriate form to persons of any culture. Why does cultural psychiatry matter? As the surgeon general eloquently stated: “because values differ across cultures as well as among some groups (and indeed individuals) within a culture, the ideal of the uniformly acceptable definition of mental health is illusory.”

In the 1980s Lincoln had become the 5th in refugee resettlement per capita in the United States. As of 2004, Lincoln/ Lancaster County had resettled over 5500 refugees. These refugees come from Afghanistan, Vietnam, Bosnia, Mexico, Russia, Ukraine, Kurds, Sudan, and China. Many of the immigrants came and come today as refugees from war torn areas. Omaha, Nebraska has also become home to refugees, many of whom are Sudanese, which has been home itself to refugees from war torn areas as well. Compounding the horrors they faced in their native countries, many immigrants now suffer from post traumatic stress disorder (PTSD) and depression. They also face the challenges of acclimating to a foreign land.

Typically, in the first three years of immigration, most immigrants face the greatest psychological stress. In studies of Southeast Asian refugees, in the first year they initially experience euphoria. This is followed by a strong disenchantment and demoralization in the second year. In the third year they return gradually to a sense of well being and satisfaction. Addressing the needs of a population such as this, for example, in the first year could reduce the incidence of mental illness or the potential for mental illness.

With the introduction of new cultures to a foreign land, inevitably the culture of the receiving land will change. According to the DHHS, Nebraska’s foreign born population is growing at an exponential rate, where now there are 76 languages spoken in the state of Nebraska. As the original Native Americans, African Americans, Alaskan natives and Asians, some of the newer immigrants face disparities in income, education, and because of language and other barriers, are at risk of remaining at a lower socioeconomic stratosphere.

There are several agencies devoted to assisting refugees/immigrants. The agencies include the Department of Health and Human Services, Lutheran Family Services, and the Southern Sudan Community Association, to name a few. These agencies help tremendously in providing services and assisting immigrants in adjusting to their new residence.

Mental health services are available for this population. However, it is difficult to state how many refugees have sought help for mental illness or required mental health services in the state of Nebraska. It is difficult for different reasons, including cultural beliefs, perceptions/ignorance of mental health care, and the pressures of a new culture. There may also be limited resources to do this. Even though studies have shown that treatment of most mental illness should be equivocal with medications and therapy (save subtle differences), it is evident that how people present with mental illness and treat mental illnesses in their culture can affect how they respond to treatment. Each ethnic population has unique needs and beliefs that affect their reception of mental health treatment.

The mental health community has a wonderful opportunity before them. The most important thing to do at this time is to make refugees and native minorities aware of the services available to them. We also have to learn about different cultures and how best to make our services available to them. It is a challenge, but if mental health providers can collaborate, implement cultural sensitivity and responsiveness, provide availability of services, and adopt openness to learning, a positive change is something we will all be looking forward to.

*Mariam Garuba, M.D. is a fourth year resident in her psychiatry residency at Creighton/University of Nebraska residency training program.

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