Ass 8

1. 1. How can cultural values influence the likelihood of seeking

professional help in crisis situations and receptivity to that help? Be
specific.

2. 2. Explain culture shock and its possible manifestations in a

client.

3. 3. Ask 3 people from three different sub-cultures what kinds of

crisis they experience, and what a counsellor could do to best help
them deal with it. (The aim is to understand their experience and
expectations, not to evaluate them).

4. 4. Compare your societys typical responses to the responses

described by people from different cultures, noting both similarities
and differences.

1. 1. How can cultural values influence the likelihood of seeking

professional help in crisis situations and receptivity to that help? Be
specific.

I shall start my analysis on this question taking the risk of stating a truism
by arguing that almost of all us, as human beings, are experiencing during
our lives or, at least, witnessing, directly or indirectly, crisis situations. We

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react differently and the impact on us, in the medium or long run, is
different. Some of us may experience directly natural disasters, wars,
immigration, divorces, rape, assault, burglary, domestic violence, poverty,
abuse, sexual violence, homelessness, school violence, sudden loss of
cherished people, violence within the family, accident, fire, separation,
others only indirectly, on TV, news etc or others, the most lucky ones, to
keep themselves so far away from all these events whose existence may
be absolutely ignored.

Crisis may be individual or collective, may be a once in a life-time or

happening on a more regular basis. It may leave us very traumatised or
by having experienced it or witnessed it so many times to react in a more
defending way.

Crisis encompasses many definitions depending on the type of crisis,

individual, collective, economic, social, psychological, political etc.

A crisis can be defined as a moment, a period of breakdown, a turning

point, a time of economic crisis (Kopaliski, 2000: 282). It is associated
with an enduring disruption of the regular and goal-oriented activities,
upsetting the functional balance, and even with a threat to ones
existence. The basic characteristics of a crisis include the surprise factor,
time pressure,
late response, a loss of control, a danger to important functions, an
increase in tension, and information deficit (Gobiowski, 2003: 10).

Caplan (1961) states that people are in crisis when they face an obstacle
that is, for a time, insurmountable by the use of customary methods of
problem solving.

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Brammer (1985) considers crisis to be a state of disorganisation in which
people face frustration of important life goals or profound disruption of
their life cycles and methods of coping with stressors.

Coping with the effects of a crisis is an individual or/and a collective

matter.
In order to answer the question How can cultural values influence
the likelihood of seeking professional help in crisis situations and
receptivity to that help we need to define the terms and
examine the links between culture crisis- asking help
accepting the help received.
And we need to contextualise more if the crisis is lived at
personal level or is related to community level.
I will try to discuss both of them, giving some specific examples
throughout the presentation.

We can start from the assumption that most people do not see themselves
as needing mental health services following a disaster and will not seek
out such services, regardless of culture. Mental services request may be
assumed as a low priority for most of people having faced the harmful
consequences of a crisis situation. Depending on the nature of the crisis,
most of the time basic needs have to be covered, physiological and of
subsistence. The personal losses, the personal suffering are usually
experienced privately and especially after a crisis situation with victims on
collective level, seeking help for the personal trauma may seem
inappropriate.

We can start also the analysis from the assumption that people respond
and recover from disaster within the context of their culture. For example,
some culture may be more emotional in displaying their distress, in
helping themselves without any restrictions, in collectively engaging in
the reconstruction project. Other cultures may be more self-centred and
consider shameful to accept charity, help or to be seen in the posture of

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weak victims and reluctant to ask or accept help from outside. There may
be cultures that mistrust outside help on basis of their previous historical
or personal experiences or prejudices like the occidental imperialism or
similar reasons.

As a result of past or present experiences with racism and discrimination,

racial and ethnic minority groups may distrust offers of outside assistance,
even following a disaster. They may also be unfamiliar with the social and
cultural mechanism of receiving assistance and remain outside the
network of aid. Lack of familiarity with sources of community support and
lack of transportation are common barriers for many immigrants and
unwillingness to disclose their immigration status is a major barrier.

Depending on the gravity of the crisis, of the damages behind, people

affected may be willing to accept help, especially of the approach is not
perceived as intrusive or offensive. Even in distress people keep their
pride and it is important to know how to offer support. As a general rule,
when in big distress any kind of help is usually welcome, if not perceived
inappropriate or culturally insensitive.
In regards to what a culturally appropriate behaviour means there are
many aspects one should take into consideration.

One first aspect may be the perception some cultural groups have about
the threat, about what kind of thereat may be traumatic, their interpretation
of the threat's meaning, the nature of the expression of symptoms in response to such threats,
the cultural context of the responses of traumatized people, as well as the cultural responses
by others to those who have been traumatized, and the culturally prescribed paths to recovery
from experiencing life-threatening events.

For example, one case that was widely discussed in the media especially
in regards to the response of one entire community to an outrageous
event concerns the shooting in the Amish community. It happened on
October 2, 2006 in a school where a man took hostages and shot eight out

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of ten girls (aged 613), killing five, before committing suicide in the
schoolhouse. The reaction of the community to this crisis situation
surprised and Amish community emphasised on forgiveness and
reconciliation. Famous for their peaceful attitude towards the world, their
response was centred on forgiveness; revenge, is not a value in their
culture and they hated only the sin not the sinner. In such culture, the
likelihood to seek professional help in extremely low as the community
support and solidarity is well rooted in their philosophy of life.

We may assume that countries or cultural groups exposed more frequently to crisis situations
may be more prone to seek professional help as, chances are, special services or organisms
have already been installed to provide help.
Traumas are overwhelming and disruptive experiences and family and/ or its individual
members experienced them differently.
Medical and mental health professionals find themselves with an increasingly diverse patient
pool that may include recent refugees, asylum applicants, and immigrants from regions of the
world that have experienced profound disruption, most often in the form of a war or a natural
disaster. The vast majority of the treatment methods and models for traumatic stress have
been derived from studies of samples from industrialized countries and yet they are
increasingly applied to diverse cultural populations. The validity of this conceptualization and
even validity of the diagnosis is still in debate as applied to industrialized cultural populations

Differences in the nature of traumatic stress symptoms have been linked to individualistic and
collectivistic cultural differences. But the differences can not be limited only to this or read
from this reductionist perspective. Normal and pathological have different meanings too. For
instance, studies reveal that Bosnian people understood memories of the events that had
befallen them as normal as opposed to pathological (Weine et al., 1995).

The manifestations of traumatic reactions may be very different in settings in which there
exists a relative orientation toward stoicism, where a fatalistic perspective dominates, and
where primary import is placed on the social network of the family and the community rather
than the individual (Summerfield, 2004). In such cases, the exportation of models presuming
vulnerability may be contraindicated.

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Since events such Rwandan genocide or the Bosnian conflicts, there were set up many
programs and humanitarian interventions meant to address the mental health of those
affected.
Despite their very good intentions, many interventions proved to be inappropriate or at least
ignorant of local cultural and needs. Aid workers responding to a disaster or a crisis situation
have had little local experience and knowledge and imposed their unilateral way of assessing
the needs and the way to address them. From that moment on, the debate started to
concentrate on whether wars, natural disasters and other crisis and humanitarian emergencies
generate indeed a real need of mental health, as Western approach claim, and if needed how
to respond to it.
A relevant example may be Sri Lanka whose recent history was dominated by civil war from
1983 to 2009. The international humanitarian interventions of United Nations, of Human
Rights Council were strongly criticized for failing to address violations of international
human rights law and humanitarian law by the Sri Lankan government forces.
The carnage in Sri Lanka has led to an internal United Nations (UN) review that examined
the role and effectiveness of varied UN entities and the larger UN system to deliver on its
political and protection responsibilities during the final stages of the war.

Another example can be the case of some Asian American groups that place a higher
emphasis on suppression of affect and, as a consequence tend not to dwell on negative
thoughts, thinking that avoidance is more helpful than outward expression. African
Americans are more inclined, according to some studies, to rely on themselves when
handling distress or to seek help in spirituality providers than in mental professionals. When
they use mental health services, Some African Americans prefer therapists of the same race or
ethnicity showing distrust in foreign help.

When clinician and patient do not come from the same ethnic or cultural background, there is
greater potential for cultural differences to emerge. Clinicians may be more likely to ignore
symptoms that the patient deems important, or less likely to understand the patients fears,
concerns, and needs. The clinician and the patient also may harbor different assumptions
about what a clinician is supposed to do, how a patient should act, what causes the illness,

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and what treatments are available. And the consequence may be misdiagnosis and the
unliklihood to show any receptivity to seeking or receving help even if generously provided.

Unfortunately, psychological tools and approaches are sometimes used in ways that cause
unintended harm. I shall mention some example found following my reasearch:
In 1999 in Tirana, Albania, where camps filled with Kossovar survivors of Serb attacks, an
American psychologist had set up a tent for counseling women survivors of rape. For a
woman to have entered the tent would have identified herself as a survivor of rape, which
many families regard as a stain on family honor that must be rectified by killing the survivor.

In 1996 in Rwanda, orphans from the 1994 genocide were placed in small orphanages or
centers, many of which were funded by Western groups, including churches, who wanted to
provide care and protection for unaccompanied and separated children. An unfortunate and
unanticipated consequence was that the centers contributed to family separation, as mothers
desperate to support their babies abandoned the babies on the orphanages doorsteps.

In emergency settings, one often encounters well-meaning Western psychologists who have
no experience in international emergencies, little understanding of the local culture or
context, and no relationships with the agencies or people in the affected areas. Although the
psychologists are nobly motivated by the feeling that I just had to come and help, this
approach has been described as disaster tourism or parachuting rather than as
professional humanitarian response.

Counseling methods in general place significant emphasis on disclosing feelings and personal
information, which may be useful in some contexts. The disclosure of distress, however, is
inappropriate in some cultures, particularly if negative disclosures reflect badly on ones
family (Lee & Sue, 2001).
Moreover, talking about ones experiences can be harmful in some contexts. In rural Angola,
teenagers who had been recruited into armed groups and who had killed people were viewed
as spiritually contaminated or haunted by the angry spirits of the people they had killed.
Local people see these spirits as enormously powerful and capable of causing illness in ones
family or crop failures in the community. To treat this af- fliction, traditional healers conduct
purification rituals designed to clean the young people of the angry spirits (Wessells &
Monteiro, 2004). At the end of the ritual, the healer often tells the young former recruits,

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 Dont look back, because talking about the ritual or ones experiences is believed to bring
the angry spirits back.

Looking at these some examples, one can have a more clear understanding of the seriousness
and complexity of the relashionship between cultural values, the likelihood of seeking
professional help in crisis situations and the receptivity to that help.

2. 2. Explain culture shock and its possible manifestations in a

client.

Now when an individual enters a strange culture, all or most of these

familiar cues are removed. He or she is like a fish out of water (Kalervo
Oberg).

Exaltation, curiosity, fascination; misunderstanding, frustration, confusion,

reluctance, hostility, anxiety, even depression; understanding, comfort,
tolerance; more or less like a fish in his water. These are some of the
feelings one may experiences, at different levels of intensity, when
leaving the home country and decide to immerse into the host culture.

The term coined by Oberg for describing this mixed of feelings and
emotions was culture shock as a psychological reaction of individual to
adapt and to adjust to the challenges of a new cultural environment. At
individual level, the identity is placed into a conflictual state as the
individual has to face the unknown, the unfamiliar, and find himself into
an ignorant position. The gap between unrealistic expectations and reality
usually makes deeper the difficult the process of adaptation to the new
culture. In the process of conciliate the two identities the individual has
to pass through some psychological adaptations and will uses defence

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mechanisms in order to easily integrate the new cultural patterns into the
old ones.

The transition from cultural shock to a reasonable adjustment is

accompanied by a set of defence mechanisms the individual has to
manage. Some of these defence mechanisms appear during the stages
described by Oberg, Adler and others authors and whatever their names
or number of stages they are characterised by more or less the same
psychological states.

Richardson (1974) named the four stages as elation, depression, recovery

and acculturation. Adler (1975) divided the process into five stages:
contact, disintegration, reintegration, autonomy and independence.

Oberg (1960) pointed out that there are four discerning stages in the
process where a sojourner transits from culture shock to satisfactory
adjustment.

The first stage is the honeymoon stage, which might last from a few days
to weeks even and a few months depending on the circumstances of the
individuals. In this stage, the sojourner usually is fascinated by the new
environment as he is in the discovery stage and his status is that of a
tourist.
But if the foreign visitor remains abroad, he will have to face and
overcome real problems, such as language, accommodation, work,
studies, transportation, shopping, etc.

At this point, the second stage begins. The sojourner could feel frustrated,
anxious, worried, angry, unable to cope with different situations. He
proves feelings of loneliness, frustration but in order to survive and
succeed his project abroad he has to find his way and deal with day to day
situations. The third stage is recovery, which is a process of crisis
resolution and culture learning, and then the sojourner steps into the last

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stage of complete full recovery, reflecting enjoyment of and adaptation to
the new environment.

Some of the symptoms of culture shock are: excessive washing of the

hands; excessive concern over drinking water, food, dishes, and bedding;
fear of physical contact with attendants or servants; the absentminded; a
feeling of helplessness and a desire for dependence on long-term
residents of ones own nationality; fits of anger over delays and other
minor frustrations; delay and outright refusal to learn the language of the
host country; excessive fear of being cheated, robbed, or injured; great
concern over minor pains and eruptions of the skin; and finally, that
terrible longing to be back home.
The main defence mechanisms in psychology and psychoanalyse are
denial, regression, acting out, dissociation, projection, reaction formation,
repression, displacement, rationalization, sublimation, compensation,
assertiveness, etc. I am not going to enter in any details of these defence
mechanisms but I find it interesting how/ to what extend they are related
to these cultural shock stages and to analyse how they are managed by
individuals. For instance, projection or reaction formation correspond are
among the typical reactions when facing stress or difficult manageable
situations from a psychological point of view. An individual may react
using reaction formation when feels stressed by the new cultural
environment and had already invested a lot of energy, time, and
resources in order to integrate and adjust. Now even if angry and
frustrated may show a strong affiliation to the new culture, like a
compensation reaction. It works like a sort of compensation for all the
resources invested and as a justification for restoring the wellbeing of
mind.

Rationalization and compensation are also usually used by individuals to

cope with cultural shock experiences or, as Berry names this,
acculturative stress.

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An interesting theory developed on the basis of Berrys acculturation
theory is Affect-Behaviour-Cognition (ABC) which emphasises the
behavioural aspect of intercultural contact and regards social interaction
as a mutually organised and skilled behavioural performance. The theory
argues that the culture is a concept that can be learned. It also argues
that the conflicts or stress caused by intercultural contact are largely due
to the sojourner lacking the social skills of the new society (Argyle, 1969).
In order to fill this gap the individual has to embark in a learning process
of new cultural skills, of new practices. It is always true that the individual
will learn a lot in order to adapt to the new cultural environment but it
does not mean, in my opinion, that he will learn the culture. He will
become aware of many cultural differences, will search for similarities,
and will try to integrate differences in his cultural baggage. All this
adjustment, integration process or even rejection will help individuals to
cope with the cultural shock and add new cultural features to his identity.

3. 3. Ask 3 people from three different sub-cultures what kinds of

crisis they experience, and what a counsellor could do to best
help them deal with it. (The aim is to understand their experience
and expectations, not to evaluate them).

For this assignment, I will discuss three different psychological crises from
three different sub-subcultures or cultural groups. The cases will be
followed by a short analysis of the cultural context and values and how
that experience is generally perceived, and the relationship between the
patients expectations and the counsellor service.

1. Trauma after the genocide in Rwanda

Context:

Following the genocide, millions of Rwandans are likely living with

posttraumatic stress disorders and the rates of mental disorders are

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elevated. The dezumanised brutality experienced or witnessed horrified
people and left them physically seriously injured, mutilated, and
psychologically deeply traumatized. Murders, sexual violence, rape, in
unimaginable torture were common. Most of people are still living under
shock, pain, fear, distress, distrust. Apart from the lack in the medical
infrastructure, providing adequate counseling and treatment for post-
traumatic stress disorder following the genocide is a considerable
challenge to the existing capacity in Rwanda.

A great number of international organisations, public of NGO involved

actively for providing humanitarian support. Their initiatives and actions
were generally well- received but there were interventions lacking in
cultural sensitivity, as some studies relate.

Example :

One of the problems relates to the huge gap between western and
traditional approaches to mental health that caused problems in the
immediate aftermath of the Rwandan genocide.

The intervenants seemed to have come culturally unprepared to deal with

the complexity of trauma experienced by the community and ignoring
basic thinks in approaching the sufferers. Despite all good intentions and
first aid, the issue regarding the mental problems and trauma was most of
the time inappropriately approached.

Westerners were optimistically hoping they could heal what had gone
wrong, says Solomon. But people who hadnt been through the
genocide couldnt understand how bad it was and their attempts to
reframe everything were somewhere between offensive and ludicrous.
The Rwandan felt that the aid workers were intrusive and re-traumatising
people by dragging them back through their stories.

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This is one testimony I have chosen for this assignment as an example of
the differences in perceptions between the need and expectations of the
patient and the medical approach and treatment received.

We had a lot of trouble with western mental health workers who came here immediately
after the genocide and we had to ask some of them to leave. They came and their practice did
not involve being outside in the sun where you begin to feel better. There was no music or
drumming to get your blood flowing again. There was no sense that everyone had taken the
day off so that the entire community could come together to try to lift you up and bring you
back to joy. There was no acknowledgement of the depression as something invasive and
external that could actually be cast out again. Instead they would take people one at a time
into these dingy little rooms and have them sit around for an hour or so and talk about bad
things that had happened to them. We had to ask them to leave."
A Rwandan talking to a western writer, Andrew Solomon, about his experience with western
mental health and depression.

The role of the counsellor would be first of all to be not only aware but
cognizant of the cultural ingredients before preparing an intervention plan
and design actions. One next step would be to have the support of local
competent people and organism to advise them and support in the
process. The arrogance of knowing already how to face the situation must
to be left behind if really there is a genuine willingness to help people in
extreme despair. No one can do miracles or has the recipe for success but
as good intentions are not enough, an ethical approach and respect is a
must. Ideally the counsellor has to have the opportunity of integrating
combined methods, tools and approaches. Even if for him some beliefs
like exorcism or spirits do not make any sense he has the moral and
professional duty to take into account and integrate into his mental plan
these approaches as his main aim is to provide help, cure and treatment
to his patient.

Community dance rituals have been used for the good health of
indigenous cultures worldwide for thousands of years.

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According to Bradford Keeney, cultural anthropologist and author of
Bushman Shaman: Awakening the Spirit through Ecstatic Dance a
healing context is one where you create a swirling of the life force, an
amplification, a movement, a transmission, an energy field so that when
another person steps into it, an awakening of their own inner healing
sources is encouraged.

We have to keep in mind that the culture and its language, Kinyarwanda, still lack words for
common depressive and anxiety syndromes. Only since the 1994 civil war has a word
emerged for PTSD: ihahamuka, which means "breathless with frequent fear."

It may come as a non-sense to an occidental mind trying to cope with

depression recurring to this kind of methods but, because of this
reluctance to adopt and integrate in the process of healing such methods,
the growing burden of mental illness will remain largely unknown and
untreated.

It may come as a surprise but its a very foreign concept in many

countries to sit down with a stranger and talk about your most intimate
problems.

A counsellor, to be on the safe side, may integrate the assumption that

despite all commonalities between human beings, psychological issues
may not transcend around the globe or at least the remedies may not be
the same.

2. Chinese perspective on the therapeutic process

The second assignmement will be dedicated to analysing the expectations

of patients from their therapists. We will see how the two approaches
differ in regards to the usual classical expectations of Western tradition.

Research investigating the cultural differences suggests that Chinese

people and westerners may differ in the forms of social and emotional
support they find helpful.

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Chinese people and westerners differ in the presentation of depressive
symptoms (Shweder, 1991; Lee et al., 2007), and they may also differ in
their expectations of client-therapist interactions and types of
intervention.

Specifically, Chinese clients tend to expect directive, goal oriented, time

limited, and pragmatic approaches in therapy (Leong, 1986; Sue and
Zane, 1987)

Studies showed that Chinese clients appeared to prefer a therapeutic style

characterized by information and solution offering, action taking, problem
solving, and an orientation toward presence.

Chinese patients seem to find therapist credible when offered strategies

on problem solving, such as encouraging to manage their problems, giving
suggestions on how to cope with their issues, and providing concrete
ideas on how to proceed. As well, these studies indicated that Chinese
clients prefer therapists who emphasize collectivism (Kuo et al., 2011) and
client confidentiality

Through open-ended surveys, Zhang et al. (2001) conducted an

investigation on Chinese peoples expectations for psychotherapy using
Chinese visitors recruited from the clinics of local hospitals in China. The
authors found that these visitors expected therapists to be profoundly
knowledgeable and experienced, skillful, affable, patriarchal and
experienced, talkative, friendly, similar to tutors, and to have a high moral
sense.

As we can see, this approach is quite different from the usual occidental
one where the attitude is usually more passive, more of a listener, letting
the client to have the control of the conversation. The therapists are not
expected to be listeners from the Chinese perspective and the clients may
find themselves frustrated, discontent, dissatisfied if the approach would
be different to their expectations. Moreover he therapists might be
perceived as less competent, or as not doing their job properly if they
miss to get involved actively in the therapeutic process.

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She [Chens therapist] gave me lots of information. I wanted to
understand this. I know that its a theory or a strategy she learned,
strategies. So I think try to give your clients some professional knowledge.
Its very helpful. Because that way, you try to make your client think in a
professional way

It appears that informants found the information acquired through therapy

helpful. Without receiving information, informants perceived effectiveness
of therapy appears to diminish.

While these informants appreciated their therapist guiding the therapeutic

process, Chen talked about what happened when she felt that one of her
therapists was not taking the lead:

Shes [the therapists] still the dominant person who is in control the
situation, but not bossy. But with the Canadian therapist, I feel that she let
me control the session. Because [my] talk [took] a large part of the
session. She became a listener. And I did 10 sessions we yet didnt
achieve any practical goal.

The therapy session is perceived as a two-way relationship. According to a

respondent Two-way means, within an hour conversation, you talk, she
[the therapist] answers. She talks and you are willing to share more. Not
one-way: only one person talking, only depending on one side, forcing you
to talk.

These differences in approach are extremely important for the therapist to

be aware of in order to build up a trustworthy relationship with his
patients coming from Chinese culture.

Despite the professionalism of the counsellor, she/he may appear as

incompetent, inefficient or unwilling to do his job properly if not live up to
the cultural expectations of the patient. Small details than may have a big
impact on the success of the therapeutic process.

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 3. Domestic Violence and Islam The challenges for a Western
counseller

Introduction

The relationship between Islam and domestic violence is very

controversial and subject to a lot of contradictions due to a wide range of
stereotypes and preconceptions widely spread across cultures, especially
nowadays. The lack of a deep knowledge of Islam religion and culture may
generate serious obstacles for all professional having to deal with issues
relating to such sensitives cultural aspects, like religion and cultural
values. Sometimes even a deep knowledge may not be enough for a
professional to deal competently with delicate family problems culturally
so different from their own.

Apart from the cultural challenges and obstacles, there are many other
differences which have to be taken into consideration when approaching
the analysis of domestic differences within a Muslim home.

Culture has a remarkable impact on how people understand their world

and assign meaning to their experiences, which means it greatly affects
victims of intimate partner violence and the communities in which they
live. There are differences in defining the violence occurring between
domestic partners (verbal, physical emotional, sexual etc). there are
cultures for which only the severe physical aggression is considered
violence. There are cultures where violence is a legitimate and acceptable
way of maintaining the patriarchal structure of the family and educating
the wife and the children. Moreover, sometimes it is viewed as the duty of
the man to make sure his wife behaves well, supports him well, obeying
his wishes, respecting and honouring him; and teaching her a lesson is
only a common means used for re-establish the order of things. There are
not rare the cultural groups where is a common is a common belief even
among women that if a husband does not beat his wife, it means he does
not love her (Senegal, Cambodia, Congo, Zambia).
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Generally domestic violence is viewed as a private family matter and
sharing information about the family with outsiders is viewed as
inappropriate, shameful, blaming and even punished being viewed as an
attack to the family honour.

Intimate partner violence is a pattern of assaultive and coercive

behaviours, including physical, sexual, psychological, and spiritual attacks
and economic coercion that adults use against their intimate partners.
While each form of violence manifests in different ways, all abuse is
motivated by the perpetrators desire to exert power and control over his
intimate partner

There are a lot of research studies on domestic violence analysed from a

diversity points of views and I shall focus only on some aspects relating to
cultural differences between Western and Arabic perceptions on
approaching domestic violence, and the victim ` s expectations from the
therapist.

Case Study

A Muslim woman meets a Muslim man while living in Massachusetts. They

fall in love, get married, and have children. The husband starts becoming
physically and sexually abusive and controls every aspect of his wifes life.
She is not allowed to keep any money and is completely isolated from her
friends and family. The woman knew almost immediately that she needed
help and even taking in consideration of leaving the husband. However,
her husband had threatened her that if she ever left, he would keep all
children and will be severely punished. In therapy, she was in more
distress because of the fear she felt over losing her children than the
abuse she had endured
We can imagine this general case study and try to imagine what kind of
expectations the women may have from the counsellor and how the
counsellor may help.

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Muslims are not a homogenous group and so their attitudes and beliefs
towards intimate partner violence are not going to be homogenous.
When looking at intimate partner violence through an Islamic framework,
two contradictory perspectives one can find Islam can be used to justify
spousal abuse; and Islam can be used to condemn spousal abuse.

General cultural/ religious considerations

The sources of authority in Islam are the Quran, which is Gods sacred
and holy revelation to Muslims, and the example (Sunna) of the prophet
Muhammad, as recorded in the Hadith. The Hadith are the sayings and
deeds of the prophet, as recorded by his members. Some Hadith are
regarded as more authoritative than other and this explains the
discrepancies between Islamic scholars and imams concerning intimate
partner violence. The differences are related to how the Quran and
Hadith are interpreted.

Men are the protectors and maintainers (qawwmn)of women, because

Allah has given (faddala) the one more (strength)than the other, and
because they support them from their means. Therefore the righteous
women (sliht)are devoutly obedient (qnitt).

As to those women on whose part ye fear disloyalty and ill conduct

(nushz),admonish them (first), (Next), refuse to share their beds, (And
last) beat them (lightly) (wadribhunna);but if they return to obedience
(atanakum), seek not against them Means (of annoyance): For Allah is
Most High, great (above you all). (4:34)

This Islamic verse has been used grant husbands the right to hit their
wives. The husband takes possession of his women, of her reproductive
capacity. It is part of her duty to raise children, take care of the home, and
sexually satisfy her husband. The Quran compares women to fields and
says husbands can approach their wife (sexually), as

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they would till their field.

Your wives are as a tilth unto you; so approach your tilth when or how ye
will; but do
some good act for your souls beforehand; and fear Allah. And know that
ye are to meet
Him (in the Hereafter), and give (these) good tidings to those who
believe (2:223).

I will stop here with exposing the religious and cultural details which are
extremely important though for having a chance of meaningfully
understanding and approaching the specific issues. Once again it would
be a nave and inexcusable mistake to think that one can dissociate
psychological issues from their cultural context.

Counsellor intervention

Now let`s see how the counsellor (coming from another culture) may help
his patient dealing with the crisis situation, the intimate partner violence,
in particular. We are going to assume, obviously that the victim of violence
abuse decided eventually to seek for professional help, which is not such a
taken for granted situation.

Usually an ideal relationship between the therapist and the client appears
when the therapist succeeds to build a therapeutic alliance, a bond, a
connection, a relationship of trust these are the main first ingredients for
a potential successful collaboration.

This therapeutic alliance can be hard to form if the client comes from a
different ethnic or cultural background than the clinician. Both the
counsellor and client can bring preconceived ideas and stereotypes into
counselling, which need to be openly addressed in order to build a
productive therapeutic relationship.

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Therapists need to have a deep knowledge and previous exposure to
cultural context in order to be able to competently provide interventions
to domestic violence victims.

Usually the majority of mental health professionals receive limited training

in the area of religions, specific cultures, and in the case of the most
debated cultural contexts, like Islam there are a lot of things taken for
granted, a lot of misconceptions and stereotypes.

In many cities of USA, where the Muslim communities is big, there is a

genuine interest in knowing more about the culture and religion and
integrate this in the medical services provided. The counsellors, according
to research, started to become aware of the importance of approaching
more the realities of the communities and establish contacts with the
Imams for instance in order to gain a more insight of cultural matters and
become multicultural equipped in regards to the methods and tools for
interventions.

The client expects from this counsellor to be culturally competent and to

provide meaningful support in line with the particular cultural context. The
methods, the questions, the limits of intervention, the actions, the taboos
are all delicate ingredients a counsellor has to integrate in his intervention
plan.

The client may have reservations about bringing a non-Muslim into her
private life. The counsellor should be able to adapt and to change the
intervention plan according to the particularities of the client and to make
sure, along the process that does not become intrusive or in total
opposition with the fundamental values of his client. Topics like family are
among the most sensitive one.

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 The family is the basic unit of society in Islam and divorce should be
presented as a final option, not an automatic response or first resort.
While the safety of the victim always has be a first priority for the
counsellor, failing to understand the importance of the family or the main
guiding values may be a huge professional and human mistake.

The counsellor has to keep in mind that many clients may look for ways of
stopping the abuse and the violence and preserve the marriage.

The client expects that the counsellor may be able to understand

cognitions expressed in religious terms like, God must be punishing me
for being a bad Muslim or If I were more patient or stronger in my faith,
I would not be here. and answers in accordance with his cultural views or
at least not to have reactions that might be in contradictions with his
expectations or his feelings, which may jeopardize seriously the
relationship between counsellor and patient.

There is not an easy task to find the right point to meet different values
and to live up successfully to all expectations of your clients, but a
competent counsellor should be able not only to avoid to do any harm but
to provide his client with new thinking perspectives and set of mind to
decide according to his wellbeing.

4. 4. Compare your societys typical responses to the responses

described by people from different cultures, noting both similarities

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and differences.

I shall try to answer this topic by analysing the previous three cultural
perspectives from my cultural paradigm even if there will be very hard to
find any similarities given the cultural context so different.

Concerning the first topic, entitled Trauma after the genocide in Rwanda it
is hard to find any similarities as the historical and cultural conditions are
totally different but in the same time, I will try to discuss very shortly the
perception most Romanian people have had after the Revolution in 1989
when a lot of American, English, French, German humanitarian
organisations tried to offer their help to different social problems.

As far as I remember and I could find reading the newspapers or different

articles or studies, after the euphoria of the external aid, the public
opinion did not have a good perception about the foreign humanitarian
organisations. Personally I can still remember the negative image and all
the propaganda and false comments usually sent to media about the
Romanian realities with orphans, gypsies, poverty, etc. Despite the real
problems this country faced, the way of providing help according to their
rules and their way was far from what people wished for. The adoption of
Romanian children for instance was one of the most sensitive issues; there
is a famous movie, Nascuti la comanda - Decreteii (2005) that speaks
volume indeed about the realities Romanian women had to face during
the Communist regime. Sometimes the humanitarian help can do more
harm and in this case I should point out only the negative image this help
caused to a whole country creating a lot of stereotypes and denaturation
that still persist in the memory of foreign people even today.

In regards to the second topic, Chinese perspective on the therapeutic

process, the Romanian perception about the therapeutic process is in
many regards similar to the Chinese one, particularly in regards to the

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expectation s from the therapist. Influenced by French culture, the therapy
techniques were assimilated into the university curriculum and a lot of
psychological offices started to open some days after the Revolution.

The American psychological approach started to find its way also in the
current practices.

As a general character trait, Romanian may be more oriented towards a

more open approach towards the counsellor expecting advice or ways of
solving the problems. I would say that the approach may be at mid-way
between extroversion and introversion and the expectations very
pragmatic - To solve the problems. The frustration may come from this
willingness to have the problem solved immediately. The counsellors are
expected professionalism and expertise and usually have a good image
and are respected. The main difference between Chinese and Romanian
therapy approach may consist of the lack of our tradition in approaching
the therapists or counsellor for solving the mental problems even if lately
the perception changed significantly.

In regards to the third topic, Domestic Violence and Islam The

challenges for a Western counseller I may identify some similarities
particularly in the integration of religious and moral values into the
therapeutic approach.

Generally Romanian people are quite religious, their religion being

Christian orthodox mainly. The family and the traditional values play an
important role in everyday life and decision and the divorce usually is the
last option and particularly in the past used to be extremely the last
choice as the children were divided equally between parents (where the
case). Domestic violence is a common phenomenon especially in the
countryside and gypsy families. The Orthodox religion or at least the
teachings mostly widespread collectively are quite patriarchal and the
man is the head of the family. The masculine figure is associated with
authority, decision, source of income, etc and the wife has a subordinate

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role. However in the collective folklore we have a lot of expressions like:
The man is the head but the woman is the neck or In your house who is
singing the cock or the hen? which reveal a certain power women gave in
running the house.

However, despite these funny sentences, the reality is that domestic

violence is widely spread and, on religious grounds, a lot of women endure
violence as the Eva was created from Adam ribs.

Set task

1 Jean-Pierre Quebec

Jean Pierre, thank you so much for accepting to answer some questions
regarding the depression among youth. From your experience, as a
counsellor for more than 10 years with several private and public
organisms in Quebec, specialised in counselling services, is depression a
problem among youth especially in Quebec City?

How likely are youth to seek counselling and how/ when are they approach
professional organisms?

Thank you so much, Georgeta for involving me in your project and giving
me this opportunity to share my view on depression and mental issues
among Youth in Quebec city.

My direct experience with young people is focused mainly on education

counselling and only accidentally I collaborate and participate directly in
projects dedicated to depression management. However, in my research
projects, inevitably I approach this topic because unfortunately this is one
of the main concerns for schools, organisms, and families in Quebec
community.

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I collected for you some data just to give you a to give you a brief
overview of the situation. I hope I hope that I am not boring you with all
these dry information but they speak volumes about the phenomenon
among teenagers.

According to statistics, in Canada an estimated 15% or 1.2 million young

Canadians will experience mental illness during their adolescence. 50% of
mental illnesses start appear before the age of 18; 80% to 90% of young
people who died by suicide have a mental illness, usually depression; an
estimated 70% of depressed youth are undiagnosed are not receiving
treatment

The suicide rate for Canadians, as measured by the WHO, is 15 per

100,000 people. Yet, according to numerous studies, rates are even higher
among specific groups.

For example, the suicide rate for Inuit peoples living in Northern Canada is
between 60 and 75 per 100,000 people, significantly higher than the
general population.

Other populations at an increased risk of suicide include youth, the

elderly, inmates in correctional facilities, people with a mental illness, and
those who have previously attempted suicide

In Canada, suicide accounts for 24 percent of all deaths among 15-24 year
olds and 16 percent among 16-44 year olds.

Suicide is the second leading cause of death for Canadians between the
ages of 10 and 24. Seventy-three percent of hospital admissions for
attempted suicide are for people between the ages of 15 and 44.

People with mood disorders are at a particularly high risk of suicide.

Studies indicate that more than 90 percent of suicide victims have a
diagnosable psychiatric illness, and suicide is the most common cause of
death.

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Both major depression and bipolar disorder account for 15 to 25 percent
of all deaths by suicide in patients with severe mood disorders.

Late July and August have the highest suicide rate out of all the months of
the year. Some studies suggest that the increase is due to the seasonal
change and that this period is one that often brings about changes in
personal situations as well. It is suggested that all these elements of
change whether there are dramatic changes happening in someones
life, or whether someone feels defeated because their situation seems to
never change can lead people to suicide. A number of studies indicate
that an especially high-risk time for vulnerable teens is when they go back
to school. Whatever the reason, the rates are so high among aboriginal
youth at this time of year that the Centre for Addiction and Mental Health
says autumn is referred to as the suicide season.

Males were three times more likely to die by suicide than females. This
much higher rate of suicide for men compared to women has been a trend
consistent over time in Canada. Although men are more likely to die by
suicide, females are 3-4 times more likely to attempt to end their lives. In
addition, women are hospitalized 1.5 times more often than males for
suicide related behaviors. This discrepancy may be due to the fact that
females tend to use less immediately lethal methods.

I will stop here with these data shat are showing how seriously depression
affects youth and not only in Quebec and the rest of Canada. In Canada,
suicide is the second leading cause of death among teenagers

Here is in Quebec, depression is a leading cause of school dropouts and

the rate of youth suicide in Quebec is one of the highest in the world.

As a school counsellor, I can testify that public and private authorities are
taking active measures to prevent and treat people affected with
depression and there is a vast network in place managing intensive
programs within schools and community services. And a lot of resources
are allowed to address that phenomenon.

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The aim is to make people aware of the resources government and
private organisms make at the disposal of its citizens. Many learning
programs and activities are integrated even in school curricula and
significant human and material resources are involved for prevention and
healing.

Usually families and even teenagers themselves approach school

counsellors or private organisms and get involved in different programs
by themselves. Other times, the counsellors themselves take initiative
when they suspect signs or possible symptoms such as sadness, loss of interest
in daily activities, loss of appetite, sleep problems, concentration and memory problems,
sudden social isolation, sudden aggressive behavior, or other abnormal reactions.

Upsetting events, a family history of depression, lack of family support, harsh discipline, and
a negative attitude towards oneself, the world, and the future can all contribute to depression.

We believe that making parents aware of depression as a serious problem and of the
importance of prevention and keeping a constant eye on the emotional state of their children.

I could not stress more that awareness and education are important. Identifying those at risk
makes it much easier for those affected to seek help and treatment.

People in distress are the responsibility of everybody and we all have to engage actively by
small everyday gesture to bring back the joy and wellbeing of our people.

2 Francois my French friend, having dealt with depression for more than 4 years
now but nowadays fully recovered

Thank you so much, Francois (not real name) for accepting to share with me some aspects
of your hard experience you had had in the last some few years. It is about your constant
battle with what is named in medical science, depression. When and how do you think it
started, how did you try to manage it, when and why did you ask for help, who tried to

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 help you and in which way? Please be free to share with us what you think it is relevant
and feel like

I will try to expose some of the main ideas my friend, Francois (as I said, it is not his real
name, aged 34) shared with me for this assignment. I shall try to limit the presentation to
some of the points relating to the assignment` s requirements even if there are a plenty of
more details that would be interesting to know in order to have a better understanding of
his experience.

I have met Francois four years ago at my arrival in Ireland. He was one of my flatmates
for one year and our friendship started when I dared to tell him that I really like his accent
and I kindly ask him to help me with improving mine. Since then our relationship became
closer and closer and, at some point he let me know about his ups- and down, better said,
more downs than ups he passed through in the last years.

There was maybe more than one year when I was on medication but I decided to stop it
as it did not make me feel better. I felt for a long time that my life had no meaning. I was
very depressed to the point of being suicidal. I was struggling to get through day to day.
For short periods of time, I tried to get into Buddhism, to go to the gym, to restart my
studies, to spend more time with my friends, to read more. I followed some of the advices
my therapist gave to me and they worked for me only for short periods of time. The
problem was that my enthusiasm did not last. My self- esteem was at zero. I gave up to
follow the treatment and to go to the counsellor but I came back as my feeling of useless
was overwhelming.

I hated myself and I hated all around me. I was feeling very angry or inert. I was hating
any advice my friends or my family used to give me and I wished only to stay away from
eveybody. Eventually, I accepted to go back to the therapist But his time I went to another
one. I have to admit that after a while I started to feel better. I was reluctant at the idea
first, as I knew already what they are doing. In retrospect it was one of my best decisions
I could make. She helped me to better understand the cause of my distress, to find
answers, to reflect more about me and upon my past, present and future. I liked that she
did not gave me any pills, any prescriptions, any solutions, any advice at all, as all
around me used to. Just from time to time, I rememebr, as she was just saying What if,
Have you ever thought , What do you think about, this kind of approch. Thanks to her

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 support, I started to become a little more myself. I quitted even smoking, which was
unthinkable of, believe me I am grateful to my friends that bore with me, that tried their
best to help and to support me. I apologise for all the times I behaved so ungratefully to
them. It was not me, I was not myself.

I know that I was depressed. I knew from the very beginning why, but I did not know how
to escape it, how to recover. I was lucky as it happened to meet a wonderful counsellor.
She is Hindus. She made me confident, receptive. I do not know how but she made me
question myself, my life, my way of doing everything. A matter of karma maybe.

***********

My last interviewee is Ismail. He was once again so kind to accept my invitation and help me
with my assignment. He is from Algeria and lives Ireland for more than 10 years now.

Ismail, a huge and warm thank you for accepting to share with us your personal opinion on
all topics I invited to help me in my reasearch.

The last time we spoke about the identity and today our topic is related to how people from
different cultures deal with crisis situations in general. How depression is perceived in your
culture among youth, women or senior people? How these people usually seek from help?
How they usually cope with managing different crisis situation like grief, depression, family
violence, poverty or war?

Thank you Georgeta for thinking once again to me for your research. I find all these
assignments yours very interesting and a good exercise for reflection.

I shall try my best to answer some aspects of your questions from my personal point of view
trying also not to be very personal and to encompass different cultural Algerian perspectives.

Depression is an abstact noun, is a word like any other word and like any other word that is
overused lost a lot of its meaning. We can hardly take it seriously when we hear about
someone suffering from stress, or that is stressed. We are all stressed in one way or another,
more or less in different moments for various reasons. It seems like it became our natiral
state of mind and body being stressed. Nobody seems to get seriusly worried. The same
seems to be happening with depression. Experiencing depression seems to have beme the
natural response of our mind and body to the challenges of life nowadays. It may sound like a

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joke if someone tells us that he had never had something similar. Yes, normal moments of
being down but after some good sleep, meal, distraction or after a while everything passed.
We would be very suspicious and anyway we would not believe him much.

Unfortunatelly we are overusing the words to the point of making them meningless. Like
another unfortunate word: organic.

Anyway, returning to our topic, in Arabic there are a lot of word to express sadness,
depression or similar feelings. We have Ihitisar, Mutidhayq, Dhaig, Maqhoor, Zahaan,
Mutidhayq depending on the region, country. We may use Kaaba for depression or describe
themselves as Kaeeb when they are depressed, which is the translation of depression as a
diagnosis in Arabic.

Researching a little on depression, I found that evidence of the earliest accounts of

depression in the Arabic language can be found in the Quran, our Islamic Holy Scripture.
Depression is expressed as Hozn, the Arabic word for sadness where we Muslims are
advised to avoid it, as extreme cases can lead to suicide: ...nor kill (or destroy) your selves,
for verily God hath been to you most merciful. Hozn is sadness and hazeen is sad. There are
other expressions in different writings about tightness of space or of breath to indicate
discomfort and depression such dheeq.

In our culture, the supreme place belongs to Allah and when one feels depressed or sad
means that he is not entirely with Allah, he let him distance form Allah. As human beings we
all have our ups and downs, we all suffer when negative things happen in our live, no one
regardless of religion, race, time may remain like a stone in front of his or others` distress,
loss, pain, unhappiness. We all experience hardship and loss, but our faith and trust in
Allahs infinite wisdom will help us endure these trials and keep us focused on the greatest
goal in the Hereafter. We should return to the Quran often to hear this message, remind us of
the favors of Allah, and keep this worldly existence in the right perspective. It is by the
Quran, the greatest remembrance, that our hearts will find rest and assurance.

Allah said: No doubt, by the remembrance of ALLAH hearts are assured.

There is not such a miraculous pill to help you recover or heal you from depression, sadness
or unhappiness. The medication may help you when you suffer form an organic problem, may

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help you to sleep better for a while, to calm you down. With all due respect for professional
in psychiatry, I do not believe in their so-called science and help. Apart from the severe
mental impairment, taking care of your soul will help you to have a healthy mind and body,
May ALLAH have mercy and Help Us.

There is a specific supplication the Prophet taught us for curing depression and anxiety
which reveals how important sound creed is to our mental health:

O Allah, I am your servant, the son of your servant, the son of your maidservant. My forelock
is in your hand, your command concerning me prevails, and your decision concerning me is
just. I call upon you by every one of the beautiful names with which you have described
yourself, or which you have revealed in your Book, or you have taught to any of your
creatures, or which you have chosen to keep in the knowledge of the unseen with you, to
make the Quran the delight of my heart, the light of my chest, and to remove my sadness and
dispel my anxiety.

Overcoming depression and anxiety when they have a stranglehold over our lives is an
exceptionally difficult task, yet there is hope for healing and a clear path forward in Islam.
All things are possible with Allah and no pit of despair is too deep to rise above with His
help. It will take effort and perseverance as we take charge of our well-being. Each of us
experiences a unique set of circumstances and challenges in our lives, which means the
details of our treatment plans will vary, but our complete restoration will always involve
healing each aspect of our being: body, mind, and soul. Muslims will endure many trials
throughout their lives. Allah tests us with hardship and also prosperity in order to validate
the sincerity of our faith.

A good Muslim even in despair will remain with his faith, even stronger as faith in
overcoming everything is the most miraculous solution. Being close to your family, doing
your duty and doing your best will help you to overcome all hardships.

Our faith and thoughts have a powerful ability to determine and control our feelings and
emotional states. Islam teaches us to direct the act reflection (tafakkur), or deep thought,
towards the signs of Allah, the names and attributes of Allah, to his blessings and wonders, to
hope in the Hereafter, and to optimism. By controlling our thought processes in a positive

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manner, we can increase the effectiveness of our prayers and worship as well as relieve
ourselves from the anger, depression, and anxieties that worldly thoughts induce.

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