no
WWTINC,
of his long Tired and bewildered, an old man sits among his luggage waiting to start the final stage of Photo: Syndication international journey to a new life which will be fraught with misunderstandings.
In
a
strange land
traditions of immigrants leads to misin mental illness among people whose new home seems intimidating as Dr. Farrukh Hashmi, a psychiatrist and a member of the Midlands Race Relations Board, explains.
Ignorance of the culture and understanding and is a factor
an immigrant was taken to a
mental hospital be-
was said to have been
had
thought
this country. Similarly,
in
has
a
name
ending
every
Sikh
in Kaur. One Indian
he aggressive, been shouting at his family, and he had threatened to kill his son. The police were called by the neighbours. When he reached hospital, the doctor found the man had simply made the threat in a fit of temper in order to discipline his teenage son.
nervous breakdown when two 'babl mixed up in a maternity hospital it Singhs' this country. After breast-feeding the wrong bab1 for a short time, she refused to accept her red baby when the mix-up was discovered.
The name Singh applies to all Indian men of Sikh religion and is not a surname, as it is often
A girl in her 'twenties, with English education, was upset at
cause
woman woman
had
a
were
a
good, advanc family's angt1
her
when she refused to marry a chosen husband, a labourer from a primitive village. She was found praying in a street and was admitted to a mental hospital. It took considerable effort to make her parents understand and accept her problem and the reason for her unhappiness. One Pakistani, who spoke hardly any English, was admitted to a psychiatric hospital, suffering from a delusion that he had 'won the Pools' and that he was a rich man. After admission it was discovered that he had 24 points on his coupon. Unfortunately the dividend was only worth a few Pounds that week. He was sent home. Most cultures, even very primitive ones, recognise mental illness. But their understanding of it, and their reaction to it, varies widely. A mentally ill person may be left alone and tolerated or be
confined, depending on the meaning his symptoms have for the community as a whole. The measures a community takes to deal with its mentally ill, reflect its social attitudes and its acceptance of what constitutes aggression or anti-social behaviour by an individual in that culture.
Therefore,
it is necessary that those of us worklng in social psychiatry and mental health should set ourselves an initial goal of completely understanding the environment in which we are worklQg?both the cultural patterns and the background of the community concerned. If we accept that cultural factors are relevant to the understanding of mental illness among our immigrants, and Jf We are willing to put in a little effort towards this Understanding, we will be amply rewarded by the Warm relationship and the deep sense of gratitude that immigrants express towards those who are sympathetic and can gain their confidence.
Social factors play just as important a role in the causation of mental illness as physical and psychological factors. The modern concept of psychiatric treatment is a three-dimensional approach deal with each aspect of the illness. It is essentjal when working with immigrants to understand the cultural and displacement factors. The form mental illness tends to have the same range Whatever the culture. It could be organic or functlonal, i.e. psychotic, neurotic or a personality dis0rder. The content of mental illness, however, spends on environmental factors and on social and religious upbringing. To ignore this would ^ake it almost impossible to understand the Psycho-pathology of the suffering involved. It has been suggested that behaviour disorders are related to technological development and the rate of social change as well as other factors, such as how freely people mix in a particular society, the type and frustration of their basic tendencies,
and on the characteristics of early mother-child relationships. Conversion hysteria, for instance, a phenomena frequently noted in the past, is nowadays seen more often in the under-developed countries and among the economically weaker classes. In the realm of mental illness, some questions
are very difficult to answer. Is a nervous breakdown in an immigrant due to uprooting, to having to live in slum areas, having difficulties with lan-
guage, job-hunting and exposure to prejudice, mental isolation and loneliness? Or is it mainly the unbalanced person who leaves home to come here? We might ask if the incidence of breakdown is higher amongst the immigrants in the slumarea?and if so, is it due to the conditions or was their drift into the slums due to mental instability
or
inadequacy?
When one gets depressed one is likely to lose confidence in oneself and the order of priority is that one loses confidence first in the things of which one is most proud. In the patriarchal Pakistani society, the father is the head of family and there is a great deal of mystique attached to ideas about potency and sex. When a Pakistani starts
becoming mentally ill, it would appear that he first goes to the doctor complaining of nocturnal emissions, the power being sapped out of his body, sexual weakness, etc. A West Indian is more concerned with his physical strength and perhaps that might explain why, when they get depressed, many West Indians go to a psychiatrist complaining of aches and pains
in the body, burning in the eyes, low back pain, feelings of strange sensations going up into the head and an inability to go to work. The reason for these people presenting their problem in the way they do probably lies in their cultural background and a greater understanding of their traditions and way of life is required before the symptoms can be evaluated correctly. Immigrants also have financial strain, unemployment, language barriers?some of them have to use sign language?and, most of all, the social stress of colour prejudice with which to cope. One can understand the difficulties of anyone leaving home to go to another country?the diffi-
culty
of
finding
a
job, feeling lonely,
not
having
suitable accommodation; the sort of problems which many Eastern Europeans faced with the disruptions of the second world war. Colour prejudice might add to the stress of other difficulties. Because of enormous
guilt feelings surrounding
the subject, attitudes towards and Pakistanis
sex
affect Indians
than they do the West Indians. There are difficulties of colder climate, and of changes in habits and of food. Many Indians are vegetarians and most would not eat beef, because the cow is held sacred in the Hindu religion. Pakismore
tanis and Muslims do not eat pig products because of the Old Testament teaching that the pig is unclean. Many of them in early stages prefer to go hungry, rather than eat food that their custom will not allow. Conservative Muslims would only eat meat from animals killed by the Jewish method.
Some problems
are peculiar to immigrants. dealing with the law of this country, criminal responsibility and the concept of what is right and wrong in the eyes of the migrant may not be the same as for the host society. The concept of 'Mens Rea' implies that a person cannot be convicted of a criminal offence, unless he is guilty of the inten-
When
tion to commit it at the time. He may therefore find himself in difficulty with the law of this country in spite of his innocent intentions, in the context of his own culture. The language difficulty and the necessity to use interpreters puts the immigrant in a position of unfair disadvantage when he is dealing with the complicated process of form filling or officialdom. The difficulty of conveying the exact implications of a word or a sentence in a different language should not be underestimated. Students are a separate group who have their peculiar problems. Their stay is limited, they are usually from good, middle-class homes and most of them can speak English when they arrive. But the incidence of mental illness among them does not appear to be lower than the other immigrants. Perhaps leaving home for the first time, having to live on one's own in unfamiliar conditions, unsympathetic landladies and the absence of family
members to fuss over, make the overseas student, and particularly the Asian students, more prone to emotional stress than their British counterparts. Added to that are the problems of cooking, food, climate, shortage of money and delays in foreign exchange remittances from home. The exams are difficult and people often underestimate and misjudge the higher standards of education required in Britain. The family have great expectations and high hopes of their child's success and he has to live up to their ambitions and dreams. Last, but not least, is the stress of a new kind of adaptation, learning the English ways, making new friends and, learning to live in a
society where girlfriends are an accepted norm. Problems of sexual adjustment can become insurmountable from
woman
for a
a
young,
immature
man
or
strict, religious-minded and old-
fashioned family upbringing. Immigration, leaving a homeland and relations to better oneself, causes a great deal of strain? both physical and mental. The stress is carried over to the second generation, where efforts to be accepted by the host country are even more important. This, alone with the difficulties of loneliness, job-hunting, climate and colour-prejudice, can all combine to make life a struggle against fairly heavy odds. In every struggle, there are bound to be casualties. Those of us working in medicine,
and social and mental health, may often find ourselves picking up the pieces of a migrant's romantic dream which has turned into a psychiatric
nightmare.
A West Indian woman strides down a deserted street in Smethwick.
Photo:
International Syndication Internationa'
WWTINC,
of his long Tired and bewildered, an old man sits among his luggage waiting to start the final stage of Photo: Syndication international journey to a new life which will be fraught with misunderstandings.
In
a
strange land
traditions of immigrants leads to misin mental illness among people whose new home seems intimidating as Dr. Farrukh Hashmi, a psychiatrist and a member of the Midlands Race Relations Board, explains.
Ignorance of the culture and understanding and is a factor
an immigrant was taken to a
mental hospital be-
was said to have been
had
thought
this country. Similarly,
in
has
a
name
ending
every
Sikh
in Kaur. One Indian
he aggressive, been shouting at his family, and he had threatened to kill his son. The police were called by the neighbours. When he reached hospital, the doctor found the man had simply made the threat in a fit of temper in order to discipline his teenage son.
nervous breakdown when two 'babl mixed up in a maternity hospital it Singhs' this country. After breast-feeding the wrong bab1 for a short time, she refused to accept her red baby when the mix-up was discovered.
The name Singh applies to all Indian men of Sikh religion and is not a surname, as it is often
A girl in her 'twenties, with English education, was upset at
cause
woman woman
had
a
were
a
good, advanc family's angt1
her
when she refused to marry a chosen husband, a labourer from a primitive village. She was found praying in a street and was admitted to a mental hospital. It took considerable effort to make her parents understand and accept her problem and the reason for her unhappiness. One Pakistani, who spoke hardly any English, was admitted to a psychiatric hospital, suffering from a delusion that he had 'won the Pools' and that he was a rich man. After admission it was discovered that he had 24 points on his coupon. Unfortunately the dividend was only worth a few Pounds that week. He was sent home. Most cultures, even very primitive ones, recognise mental illness. But their understanding of it, and their reaction to it, varies widely. A mentally ill person may be left alone and tolerated or be
confined, depending on the meaning his symptoms have for the community as a whole. The measures a community takes to deal with its mentally ill, reflect its social attitudes and its acceptance of what constitutes aggression or anti-social behaviour by an individual in that culture.
Therefore,
it is necessary that those of us worklng in social psychiatry and mental health should set ourselves an initial goal of completely understanding the environment in which we are worklQg?both the cultural patterns and the background of the community concerned. If we accept that cultural factors are relevant to the understanding of mental illness among our immigrants, and Jf We are willing to put in a little effort towards this Understanding, we will be amply rewarded by the Warm relationship and the deep sense of gratitude that immigrants express towards those who are sympathetic and can gain their confidence.
Social factors play just as important a role in the causation of mental illness as physical and psychological factors. The modern concept of psychiatric treatment is a three-dimensional approach deal with each aspect of the illness. It is essentjal when working with immigrants to understand the cultural and displacement factors. The form mental illness tends to have the same range Whatever the culture. It could be organic or functlonal, i.e. psychotic, neurotic or a personality dis0rder. The content of mental illness, however, spends on environmental factors and on social and religious upbringing. To ignore this would ^ake it almost impossible to understand the Psycho-pathology of the suffering involved. It has been suggested that behaviour disorders are related to technological development and the rate of social change as well as other factors, such as how freely people mix in a particular society, the type and frustration of their basic tendencies,
and on the characteristics of early mother-child relationships. Conversion hysteria, for instance, a phenomena frequently noted in the past, is nowadays seen more often in the under-developed countries and among the economically weaker classes. In the realm of mental illness, some questions
are very difficult to answer. Is a nervous breakdown in an immigrant due to uprooting, to having to live in slum areas, having difficulties with lan-
guage, job-hunting and exposure to prejudice, mental isolation and loneliness? Or is it mainly the unbalanced person who leaves home to come here? We might ask if the incidence of breakdown is higher amongst the immigrants in the slumarea?and if so, is it due to the conditions or was their drift into the slums due to mental instability
or
inadequacy?
When one gets depressed one is likely to lose confidence in oneself and the order of priority is that one loses confidence first in the things of which one is most proud. In the patriarchal Pakistani society, the father is the head of family and there is a great deal of mystique attached to ideas about potency and sex. When a Pakistani starts
becoming mentally ill, it would appear that he first goes to the doctor complaining of nocturnal emissions, the power being sapped out of his body, sexual weakness, etc. A West Indian is more concerned with his physical strength and perhaps that might explain why, when they get depressed, many West Indians go to a psychiatrist complaining of aches and pains
in the body, burning in the eyes, low back pain, feelings of strange sensations going up into the head and an inability to go to work. The reason for these people presenting their problem in the way they do probably lies in their cultural background and a greater understanding of their traditions and way of life is required before the symptoms can be evaluated correctly. Immigrants also have financial strain, unemployment, language barriers?some of them have to use sign language?and, most of all, the social stress of colour prejudice with which to cope. One can understand the difficulties of anyone leaving home to go to another country?the diffi-
culty
of
finding
a
job, feeling lonely,
not
having
suitable accommodation; the sort of problems which many Eastern Europeans faced with the disruptions of the second world war. Colour prejudice might add to the stress of other difficulties. Because of enormous
guilt feelings surrounding
the subject, attitudes towards and Pakistanis
sex
affect Indians
than they do the West Indians. There are difficulties of colder climate, and of changes in habits and of food. Many Indians are vegetarians and most would not eat beef, because the cow is held sacred in the Hindu religion. Pakismore
tanis and Muslims do not eat pig products because of the Old Testament teaching that the pig is unclean. Many of them in early stages prefer to go hungry, rather than eat food that their custom will not allow. Conservative Muslims would only eat meat from animals killed by the Jewish method.
Some problems
are peculiar to immigrants. dealing with the law of this country, criminal responsibility and the concept of what is right and wrong in the eyes of the migrant may not be the same as for the host society. The concept of 'Mens Rea' implies that a person cannot be convicted of a criminal offence, unless he is guilty of the inten-
When
tion to commit it at the time. He may therefore find himself in difficulty with the law of this country in spite of his innocent intentions, in the context of his own culture. The language difficulty and the necessity to use interpreters puts the immigrant in a position of unfair disadvantage when he is dealing with the complicated process of form filling or officialdom. The difficulty of conveying the exact implications of a word or a sentence in a different language should not be underestimated. Students are a separate group who have their peculiar problems. Their stay is limited, they are usually from good, middle-class homes and most of them can speak English when they arrive. But the incidence of mental illness among them does not appear to be lower than the other immigrants. Perhaps leaving home for the first time, having to live on one's own in unfamiliar conditions, unsympathetic landladies and the absence of family
members to fuss over, make the overseas student, and particularly the Asian students, more prone to emotional stress than their British counterparts. Added to that are the problems of cooking, food, climate, shortage of money and delays in foreign exchange remittances from home. The exams are difficult and people often underestimate and misjudge the higher standards of education required in Britain. The family have great expectations and high hopes of their child's success and he has to live up to their ambitions and dreams. Last, but not least, is the stress of a new kind of adaptation, learning the English ways, making new friends and, learning to live in a
society where girlfriends are an accepted norm. Problems of sexual adjustment can become insurmountable from
woman
for a
a
young,
immature
man
or
strict, religious-minded and old-
fashioned family upbringing. Immigration, leaving a homeland and relations to better oneself, causes a great deal of strain? both physical and mental. The stress is carried over to the second generation, where efforts to be accepted by the host country are even more important. This, alone with the difficulties of loneliness, job-hunting, climate and colour-prejudice, can all combine to make life a struggle against fairly heavy odds. In every struggle, there are bound to be casualties. Those of us working in medicine,
and social and mental health, may often find ourselves picking up the pieces of a migrant's romantic dream which has turned into a psychiatric
nightmare.
A West Indian woman strides down a deserted street in Smethwick.
Photo:
International Syndication Internationa'
