[Tlc] C-Cambodian Americans

[justinm at ucr.edu]

Cambodian immigrants in the US, Culture gap, Life in the US,
Psychiatric help
March 24, 2008
By Patricia Wen
Boston Globe Staff (Massachusetts, USA)

LOWELL - Heap You's doctors thought she was crazy. The
Cambodian immigrant
kept saying her neck was going to explode, though an
examination showed
nothing physically wrong. One hospital put her on antipsychotic
medication.But eventually, the mother of five was referred to
Dr. Devon
Hinton, a psychiatrist with a clinic in this city's struggling
downtown.
She arrived in his office one spring day 10 years ago with her
neck
upright and rigid, even as she sobbed about her troubled
family life. She
told Hinton that she didn't want to move her neck because
excessive
"wind," bottled up in her body, might surge through her neck,
break blood
vessels, and kill her.

Hinton realized the patient was not out of her mind. The
Harvard assistant
professor, who specializes in treating Southeast Asian
patients, knew that
some Cambodians believe that the circulation of wind
throughout their
bodies maintains their health, and poor circulation from an
ill body can
cause a dangerous strokelike explosion of wind.

Hinton, speaking in You's native Khmer language, told her to
taper off her
antipsychotic medications, according to his records, and
handed her
prescriptions for two other drugs - one to help her sleep,
another to
control her anxiety attacks. He urged her to continue her
traditional
Cambodian practices to help "wind" flow.

After regular therapy sessions with Hinton, You's emotions
stabilized. And
she trusted these words from him: You're not going to die from
your neck
vessels bursting.

Hinton was one of the first foot soldiers in a national push
to offer more
culturally sensitive mental health care to immigrant groups,
often in
small clinics in urban areas. These clinicians are part cultural
anthropologists, part psychiatric professionals, part medical
detectives.
A key part of their work is properly diagnosing mental illness
that
patients often first articulate as body pain, headaches, or
stomach
ailments.

"You often see emotions expressed as a bodily symptom," said
Dr. Glenn
Saxe, a psychiatrist at Children's Hospital Boston who has
helped develop
a new mental health clinic for Somalian refugees.

Among newcomers to this nation - one in eight Americans is now
foreign-born - mental illness can be an alien, stigmatizing
term, and many
immigrants from Latin America, Africa, and Asia are far more
likely to
talk initially about physical ailments than seek psychiatric
services.

Over the past several years, top mental health specialists
have begun a
number of new initiatives to improve psychiatric care for
immigrants. The
Massachusetts Department of Mental Health, along with a team of
researchers, are educating primary care doctors around the
state about
what physical symptoms might be signs of mental disorders.

Primary care clinics in Somerville and Cambridge, run by the
Cambridge
Health Alliance, are going a step further, installing computerized
educational programs in Portuguese, Spanish, and Creole, aimed
at teaching
immigrants how fatigue, intestinal complaints, and other physical
ailments, as well as intense homesickness or loneliness, can
be signs of
depression.

Researchers say cross-cultural psychology was once relegated
to the
margins of mental health practice, viewed as a kind of exotic
sideshow to
mainstream medicine. But ever since a 1999 surgeon general's
report on
mental health found the impact of culture has been "historically
underestimated," a growing number of clinics focused on
immigrants' needs
have opened. Many have blended traditional practices from
patients'
homelands with conventional Western treatments, and have hired
translators
and staff who share the patients' immigrant roots.

Like many other clinicians, Hinton, who practices at Arbour
Counseling
Services, in Lowell, is careful not to overgeneralize about
any ethnic
group. Not every Cambodian with anxiety disorders, for
instance, will
focus on neck pain. And some neck pain is just that - and
needs an X-ray
follow-up. But after working with Southeast Asian refugees for
more than
two decades, Hinton has identified more than 400 Cambodian
patients who
complained about neck ailments while being diagnosed with
panic and
anxiety disorders. In research papers he has published, he
calls the
phenomenon "sore-neck syndrome."

Hinton said each immigrant group has a particular
"ethnophysiology," or
the way in which they perceive their body's inner workings. He
said
English and German culture often raise "heart-focused"
complaints when
conveying anxiety, while Latin American cultures refer to
attacks of
"nerves."

Hinton said many Cambodians believe in the importance of wind,
and that
this wind must exit regularly through their feet and hands.
But when their
extremities become cold, perhaps because of an involuntary
physical
response to stress, they worry that the wind is becoming
trapped in their
torso.

As a result, Hinton said, they develop culturally rooted fears
about the
trapped wind suddenly bursting through the neck. He sees it as
his job to
reverse this type of snowballing, disastrous thinking - which
can lead
some doctors, unfamiliar with Cambodian culture, to mistakenly
think the
patient is psychotic.

During Hinton's sessions with You, he asked her to rotate her neck
repeatedly while he was present, a way of convincing her that
she would
not die from such movement. He encouraged her to use native
treatments to
help alleviate her stress, such as "cupping," in which a
person places a
suction cup on the forehead for several minutes to help the
wind flow.
When the cup is removed, it leaves a red circular mark that
looks like a
raised welt, which can remain for days.

"It helps me suck my headache out," the 50-year-old You said in an
interview in her Lawrence home. Her therapy with Hinton has
convinced her
she will not die of "wind overload," she said, and she no
longer has the
overwhelming worries that she once did.

But, at home now and then, she still uses the "cupping"
technique, which
she learned from her grandparents in Cambodia, and has since
encouraged
her children to use it as well. She also continues to take
what she calls
"Dr. Hinton's medicine," including a sleep medication and an
antidepressant.

Hinton believes that his encouragement of "cupping" practice
helped build
You's trust in him, and explains in part why she continues to
confide in
him about her family and financial struggles.

Ultimately, Hinton diagnosed Heap with depression and a panic
disorder
common among Cambodian refugees, particularly those who lived
through the
brutal Khmer Rouge regime, responsible for killing more than 1
million
Cambodians in the late 1970s.

Dr. Francis Lu, a specialist in cultural diversity with the
American
Psychiatric Association, who is familiar with Hinton's work,
said the
typical American clinician may find it a daunting task to
understand the
nuances of all the culturally diverse groups in this country.

"We don't know all the intricacies of hundreds of cultures,
but that
doesn't mean we throw up our hands," Lu said. "There's a
certain body of
knowledge that we're collecting. And at least we should know
what we don't
know."

Patricia Wen can be reached at wen at globe.com.
Labels: Cambodian immigrants in the US, Culture gap, Life in
the US, Psychiatric help

posted by Socheata at 2:09 PM Permalink
 
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