1 Transcultural Mental Health Interview Dorothy Nyairo Felician University NURS 345: Mental Health Nursing Practicum Professor Laureen Woods 09/017/2023 "I pledge my honor that I have neither given nor received inappropriate aid on this assignment." 2 Transcultural Mental Health Interview I had the privilege of interviewing my neighbor Sumrat, who moved to the United States from Southern India 5 years ago. Sumrat is Hindu and grew up in a traditional family in Kerala. Before moving here, he worked as an engineer in India. He now works for a tech company in our city. Through our conversation, I gained insight into how certain behaviors are viewed differently in Indian culture compared to mainstream American culture. One notable difference is how hearing voices or talking to oneself is perceived. In the US, hearing voices may be considered a symptom of mental illness such as psychosis or schizophrenia. However, Sumrat explained that in India, hearing voices or talking to oneself is often considered a spiritual experience, not necessarily a sign of mental illness. He said many Hindus and Muslims believe hearing voices is a message from God or their ancestors speaking to them. Thus, behaviors that would likely be viewed as pathological in the mainstream American culture are seen as normal, even sacred, religious experiences in Indian culture. When I asked Sumrat if there were any behaviors that are concerning in India but not as much here in the US, he first described public displays of affection like kissing, hugging, holding hands or showing intimacy. In India, outward physical affection goes against cultural norms of modesty and humility especially within higher castes. But in the US, public displays of affection are common and socially acceptable. He also mentioned that excessive worry can be seen as problematic in India if it interferes with one's duties, while Americans may dismiss it as just part of someone's personality. In terms of how mental illness is viewed in India, Sumrat said it carries significant stigma, especially in rural areas. Families feel deep shame and humiliation if someone is mentally ill, so they often try to hide it from others. Some even believe mental illness is a 3 punishment inflicted for sins committed in a past life. There are also formidable barriers to seeking mental health treatment in India, including lack of access to and affordability of care, lack of trained providers, the stigma around acknowledging psychological problems, and belief in traditional healing practices instead. Sumrat feels the stigma related to mental illness is less in the United States, but as an immigrant he still faces challenges accessing care. The cultural taboos remain strong for him, making it difficult to open up about personal problems, especially to strangers. Language barriers also hinder finding a therapist he can communicate with fully. And the Western models of therapy do not always resonate with his more collective, spiritual Indian worldview. He believes having providers from his own background would ease some of these issues. We also discussed broader cultural differences in communication styles. Sumrat explained that in India, time is viewed in a more fluid way rather than rigidly scheduled and quantified. Silence is comfortable between friends, not necessarily needing to be filled with constant conversation. Physical proximity is closer with less need for personal space. Body language like gestures and head movements is very important for communicating and conveying meaning indirectly. And while direct eye contact can seem disrespectful towards elders and authority figures, intermittent eye contact conveys active listening. In contrast, Sumrat feels Americans tend to be bound and stressed by time, always worried about being late. They seem uncomfortable with silence, filling any gaps in conversation right away. They maintain more physical distance, with less tolerance for crowding. They rely more heavily on direct, literal words to convey meaning, using less gesture and nonverbal cues. And they maintain steady, unbroken eye contact to show confidence and attentiveness. 4 This insightful interview highlighted for me how normalcy and mental health are culturally defined based on the values, customs and worldviews of a society. What may be seen as abnormal in one culture can be accepted in another. I gained appreciation for the differences in perspective between Eastern and Western cultures, and the difficulties members of minority groups can face in having their mental health needs understood and met within the US healthcare system. Stepping outside our own cultural lens as providers requires humility, openness and curiosity. But it allows us to expand our empathy and cultural sensitivity, so we can serve diverse populations more effectively. Though I am still an outsider to Sumrat's culture, this experience provided a small window into his experiences migrating between India and the US. Connecting with people from other backgrounds enriches our lives infinitely. Overall, this interview was an invaluable learning opportunity, for which I am extremely grateful.
