Today we relaunch the IMH Blog, and are thrilled to do so with a fantastic piece from Rupal Patel, a PhD student in the School of Sociology and Social Policy at the University of Nottingham. Rupal’s doctoral research has explored the reasons behind low rates of mental illness within the Gujarati community in Britain, and below she discusses the central findings of that research.
As a PhD student, I have become so familiar with the question ‘what is your PhD all about? Many of you may agree, the dreaded question is almost impossible to say in one sentence. After all it would do our years of work and findings injustice. However, after 2 and a half years of being asked the question on a monthly basis, I am more than closer to passing the back of the envelope test. My PhD explores the reasons behind low rates of mental illness prevalence amongst the Gujarati Community by addressing how they come to understand and conceptualise mental health and social and cultural barriers to help –seeking. Here I seek to provide a brief overview of my PhD study and some of the findings that have been emerging.
Diagnosing mental illnesses aids measuring mental illness prevalence. In the UK we can only measure rates of mental illness on a statistical measure of people using official health services. But, there are problems with measuring mental illness in this way.
Published information on prevalence tends to focus on admission to psychiatric hospitals. How do we know that everyone who has a mental health problem is approaching available western services? Secondly, prevalence rates and epidemiological studies use the category ‘South Asians’ which, according to Nazroo et al (2002), is too wide and misleading to be useful in health research. It isn’t correct to homogenise such a diverse population because it increases the risk of making cultural stereotypes. Therefore, previous studies that have focused on south Asian communities face problems of ecological fallacy that is an “error of assuming that inferences about individuals can be made from findings relating to aggregate data” (Bryman 2004:212). These studies are also rooted in western psychiatric practice and do not account for cultural differences in experience and somatic expression of mental illnesses (Kleinman 1986). For example, prevalence rates could simply present differences in pathways to treatment rather than differences in rates of illnesses.
To avoid the extent of these criticisms, I used a qualitative approach which could capture these cultural and social experiences and opinions that perhaps other domains would lack. I will now begin to look at empirical data gathered from semi structured interviews with the Gujarati community in Leicester to demonstrate how culture shapes illness both as an experience and the way we understand mental health. I will focus on two broad areas: language and Religion and spirituality.
Interviews that were conducted in Gujarati more commonly always said ‘depression’ in English when asked what mental illness meant to them. When probed, the participants could not explain what was meant by depression but vaguely thought it was to do with loneliness and exclusion. Interview data has suggested that language surrounding mental illness is not common in everyday language in Gujarati and thus they know more about depression post migration.
Additionally, it poses two problems; firstly my participants demonstrate that they are unclear on what is meant by depression and may use the word incorrectly as they are aware of it post-migration, and secondly are unable to express their emotional wellbeing clearly in Gujarati and this could be a reason why the community commonly express symptoms somatically (Kleinman 1986).
Additionally, the community relates to depression as a mental health issue; for example Pratik, a 49 year old male, who works as a full-time production engineer and moved to Leicester in 2005 with his family, for work opportunities stated:
“If you ask me, one is worry if somebody is in a worried state I’m not calling that as bad mental health it’s just temporary kind of things then the other level is stress levels. That’s the second level in our kind of thing. Stress level is again 50/50 you can say its bad mental health but at the same time you can say it is a short term kind of thing and the third level is depression. And I always say that if you are in depression then it’s a bad mental health”.
This is interesting because, as Pratik suggests, emotions that come prior to depression may not be considered as a mental health problem but rather a way of life. Kleinman and Good (1985) argue fundamental emotions such as anger and sadness cannot be assumed to be the same things in different cultures. There are two key things that need to be understood here. Firstly language can be limiting for the community to express mental health and thus can be difficult to understand, express and diagnose. Secondly, understanding and opinions can be mistranslated from Gujarati to English; meaning different things and thus making it difficult to understand the true nature of mental health with the community.
Religion & Spirituality
The majority of Gujarati residents in Leicester are historically twice migrants, moving from India to East Africa and then to Britain. Despite this, Guajarati’s have remained conservative and religious (Bachu 1985). Bachu (1985) puts forward that a reason for maintaining conservative is migrating with family networks which also catalysed their settlement in the UK.
Exploring religion has revealed two key threads: helping people live a way of life which reduces mental health problems and religion playing an influencing role in help-seeking behaviour. For example, Manish put forward:
“If someone asked me personally because I am very much involved in this kind of things by God’s grace I studied so many things I am always trying to co-relate the faith the religion along with the human things how our dharma how our religion can be used in order to cultivate positive things in human beings. So if somebody asked me then you know I can try to help them psychologically and spiritually”.
This suggests that religion is viewed as an aid that helps people to think positively and thus promotes good mental health supported by Geertz’s (1975) argument of religious beliefs offering meaning to existence and a positive guide for living. If religion is such an integral part of people’s lives it could be argued that it has an impact on help-seeking and when things do go wrong religion could provide meaning or help. Similarly, Manish explores how religion helps him and people to increase spirituality which can be positive for your psychological level as well as your physical health. However, in terms of help-seeking there has been mixed opinions but there is consensus that the thought God had destined people to go through certain struggles, pain and worries is old fashioned.
My empirical data from my interviews has begun to demonstrate that attitudes towards mental health are not as simple as being educated about it but rooted deeply in cultural practices, beliefs and traditions. Rightly so as Dogra et al (2005) argues conceptualisation and expression of mental health can vary across cultures and thus these need to be considered when looking at ethnic groups. I agree with Shaw and Middleton (2000) and argue that once this is established, social support and treatment can then be effectively provided, be it a medical approach of drug treatment or other therapies. However, this will need to be negotiated with the community; if alternative routes such as Ayurveda are working successfully amongst the community then perhaps a medical approach and other professions can learn from this.
Bachu, P. (1985) Twice Migrants East African Sikh Settlers in Britain, London, Tavistock publications
Bryman, A. (2004) Social Research Methods, New York: Oxford University Press
Dogra, N. Vostanis, P. Abuateya, H. and Jewson, N. (2005) ‘Understanding of mental health and mental illness by Gujarati young people and their parents’, Diversity in Health and Social Care, vol.2, pp 91- 97
Geertz, C. (1975) The Interpretation of Cultures, New York: Basic Books.
Kleinman, A. & Good, B. (1985) Culture and Depression. Los Angeles: University of California Press.
Kleinman, A (1986) ‘Somatization. The interconnections among culture, depressive experiences and the meaning of pain’ in A Klenman, B Goods (eds), Culture and Depression, Berkeley CA: University of California Press
Middleton, H. & Shaw, I. (2000) “Distinguishing mental illness in primary care”, British medical Journal, pp 1420-1421
Nazroo, J. Fenton, S. Karlsen, S. and O’Connor, W. (2002) ‘Context, Cause and Meaning Qaulitative Insights’, in Sproston, K. and Nazroo, J. Ethnic Minority Psychiatric Illness Rates in the Community EMPIRIC, UK: Her Majesty’s Stationery Office, pp 137- 155.