Advertisement

Culture, Medicine, and Psychiatry

, Volume 39, Issue 4, pp 698–724 | Cite as

Fighting with Spirits: Migration Trauma, Acculturative Stress, and New Sibling Transition—A Clinical Case Study of an 8-Year-Old Girl with Absence Epilepsy

  • Dimitrios Chartonas
  • Ruma Bose
Clinical Case Study

Abstract

In this article, we discuss the impact of migration and acculturation processes on the cultural, personal identity, and mental health of children who immigrate to a Western, multicultural environment, and the challenges clinicians in such environments face, when confronted with non-Western idioms of distress and healing practices. We do that by presenting a challenging clinical case of an 8-year-old girl who presented with very disorganized behavior, which matches a culturally accepted construct of spirit possession, in the context of migration trauma, acculturative stress, and new sibling transition. We identify cultural conflict in school and bullying as major mediators between acculturative stress and mental distress. We also aim at identifying vulnerability, risk and protective factors, and the importance of cultural coping resources. We explore in depth the patient’s cultural background and the family’s belief system and culturally shaped narratives, in order to arrive at a cultural formulation, which focuses on the significance of idioms of distress in shaping psychopathology and influencing the personal and interpersonal course of trauma- and stress-related disorders. We also call attention to the finding that in children, idioms of distress may manifest themselves in a somatic manner. We argue, together with other researchers, that spirit possession deserves more interest as an idiom of distress and a culture-specific response to traumatizing events. We finally emphasize the importance of an anti-reductionist clinical stance, that is able to use different levels of understanding processes of distress and healing, and seeks to reconciliate cultural divides and integrate different explanatory frameworks and help-seeking practices.

Keywords

Migration Acculturative stress Idioms of distress Embodiment Spirit possession Dissociation Absence epilepsy 

Notes

Declaration of interests

None declared.

References

  1. Abramowitz, S.A. 2010 Trauma and humanitarian translation in Liberia: The tale of open mole. Culture, Medicine and Psychiatry, 34(2): 353-79.CrossRefGoogle Scholar
  2. Agikhir, A. 1986 Traditional and Modern Psychiatry: A survey of opinions and beliefs amongst people in Plateau State, Nigeria. International Journal of Social Psychiatry, 28: 203-209.Google Scholar
  3. Arieli A., S. Aychen 1994 Mental disease related to belief in being possessed by the “Zar” spirit. Harefuah, 126(11): 636-42.Google Scholar
  4. Behrens K., M.A. Del Pozo, A. Grosshennig, M. Sieberer, I.T. Graef-Calliess 2014 How much orientation toward the host culture is healthy? Acculturation style as risk enhancement for depressive symptoms in immigrants. International Journal of Social Psychiatry (in press).Google Scholar
  5. Bekele Y.Y., A.J. Flisher, A. Alem, Y. Baheretebeb 2009 Pathways to psychiatric care in Ethiopia. Psychological Medicine, 39(3): 475-83.CrossRefGoogle Scholar
  6. Berhe T. 2005 Budda syndrome/Hmam Budda. Psychiatrische Praxis, 32(2): 93-8.CrossRefGoogle Scholar
  7. Berry J.W. 2007 Acculturation and Identity. In Textbook of cultural psychiatry. Dinesh Bhugra and Kamaldeep Bhui. eds., pp. 169–178. Cambridge: Cambridge University Press.Google Scholar
  8. Betancourt T.S., S. Abdi, B.S. Ito, G.M. Lilienthal, N. Agalab, H. Ellis 2015 We left one war and came to another: Resource loss, acculturative stress, and caregiver-child relationships in Somali refugee families. Cultural Diversity & Ethnic Minority Psychology, 21(1): 114-125.CrossRefGoogle Scholar
  9. Bhattacharrya, D.P. 1986 Pagalami: Ethno-psychiatric Knowledge in Bengal. Foreign and Comparative Studies/South Asian Services No 11. Syracuse University, New York.Google Scholar
  10. Bhugra D. 2000 Migration and schizophrenia. Acta Psychiatrica Scandinavica. Supplementum, 102: 68-73.CrossRefGoogle Scholar
  11. Bhugra, D., R. Cochrane 2001 Psychiatry in a multi-ethnic context. In Psychiatry in Multicultural Britain. Dinesh Bhugra and Ray Cochrane, eds., pp. 6–17. The Royal College of Psychiatrists.Google Scholar
  12. Bhugra D., Jones P. 2001 Migration and mental illness. Advances in Psychiatric Treatment, 7: 216-23.CrossRefGoogle Scholar
  13. Bhugra D., M.A. Becker 2005 Migration, cultural bereavement and cultural identity. World Psychiatry, 4(1): 18-24.Google Scholar
  14. Birbeck G.L., E. Chomba, M. Atadzhanov, E. Mbewe, A. Haworth 2006 Zambian teachers: what do they know about epilepsy and how can we work with them to decrease stigma? Epilepsy and Behavior, 9(2): 275-80.CrossRefGoogle Scholar
  15. Bose R. 1997 Psychiatry and the popular conception of possession among the Bangladeshis in London. International Journal of Social Psychiatry, 43(1): 1-15.CrossRefGoogle Scholar
  16. Bose, R. 2000 Families in Transition. In South Asian Children and Adolescents in Britain. Annie Lau, eds., pp. 47–60. Whurr Publishers Ltd.: London.Google Scholar
  17. Bourgou S., S. Halayem, A. Bouden, M.B Halayem 2012 Tunisian mothers’ beliefs about their child’s first psychotic episode. Encephale, 38(6): 473-9.CrossRefGoogle Scholar
  18. Canitano R., M. Zappela 2005 Autistic epileptiform regression. Functional Neurology, 21(2): 97-101.Google Scholar
  19. Castillo R.J. 1994 Spirit possession in South Asia, dissociation or hysteria? Part 2: Case histories. Culture, Medicine and Psychiatry, 18(2): 141-62.CrossRefGoogle Scholar
  20. Cavanna A.E., S. Cavanna, A. Cavanna 2010 Epileptic seizures and spirit possession in Haitian culture: report of four cases and review of the literature. Epilepsy and Behavior, 19(1): 89-91.CrossRefGoogle Scholar
  21. Clabaugh, G.K. 2000 Teaching the new immigrants: How “multicultural” an educator are you prepared to be? Educational Horizons, 78: 55–57.Google Scholar
  22. Cooper, D., A. Underwood 2010 Eritrean Cultural Profile. EthnoMed. http://ethnomed.org/culture/eritrean/eritrean-cultural-profile.
  23. Crabb J., R.C. Stewart, D. Kokota, N. Masson, S. Chabunya, R. Krishnadas 2012 Attitudes towards mental illness in Malawi: a cross-sectional survey. BMC Public Health, 23(12): 541.CrossRefGoogle Scholar
  24. Csordas, T. J. 1990 Embodiment as a paradigm for anthropology. Ethos, 18: 5–47.CrossRefGoogle Scholar
  25. Cultural Orientation Resource Center 2010. Eritrean Refugees from the Shimelba Refugee Camp. COR Center Refugee Backgrounder No. 5. http://www.cal.org/co/pdffiles/backgrounder_shimelba.pdf.
  26. Da Silva Sousa P., K. Lin, E. Garzon, A.C. Sakamoto, E.M. Yacubian 2005 Self perception of factors that precipitate or inhibit seizures in juvenile myoclonic epilepsy. Seizure, 14: 340-6.CrossRefGoogle Scholar
  27. Davies M. 2000 Interaction without reduction: The relationship between personal and sub-personal levels of description. Mind and Society, 1(2): 87-105.CrossRefGoogle Scholar
  28. Deeley Q., D.A. Oakley, E. Walsh, V. Bell, M.A. Mehta, P.W. Halligan 2014 Modelling psychiatric and cultural possession phenomena with suggestion and fMRI. Cortex, 53: 107-19.CrossRefGoogle Scholar
  29. Delpit, L.D. 2006 Lessons from teachers. Journal of Teacher Education, 57: 220–31.CrossRefGoogle Scholar
  30. DeVylder J.E., H.Y. Oh, L.H. Yang, L.J. Cabassa, F. Chen, E.P. Lukens 2013 Acculturative stress and psychotic-like experiences among Asian and Latino immigrants to the United States. Schizophrenia Research, 150(1): 223-8.CrossRefGoogle Scholar
  31. DeWit, D.J. 1998 Frequent Childhood Geographic Relocation: Its Impact on Drug Use Initiation and the Development of Alcohol and Other Drug-Related Problems Among Adolescents and Young Adults. Addictive Behaviors, 23(5): 623–634.CrossRefGoogle Scholar
  32. Diseth T.H. 2005 Dissociation in children and adolescents as reaction to trauma–an overview of conceptual issues and neurobiological factors. Nordic Journal of Psychiatry, 59(2): 79-91.CrossRefGoogle Scholar
  33. Driscoll M.W., L. Torres 2013 Acculturative stress and Latino depression: The mediating role of behavioural and cognitive resources. Cultural Diversity & Ethnic Minority Psychology, 19(4): 373-82.CrossRefGoogle Scholar
  34. During E.H., F.M Elahi, O. Taieb, M.R. Moro, T. Baubet 2011 A critical review of dissociative trance and possession disorders: etiological, diagnostic, therapeutic, and nosological issues. Canadian Journal of Psychiatry, 56(4): 235-42.Google Scholar
  35. Edwards H.E., D. Dortok, L. Tam, D. Won, W.M. Burnham 2002 Prenatal seizure thresholds and the development of kindled seizures in infant and adult rats. Hormones and Behavior, 42: 437-47.CrossRefGoogle Scholar
  36. Eisenbruch M. 1991 From post-traumatic stress disorder to cultural bereavement: diagnosis of Southeast Asian refugees. Social Science & Medicine, 33: 673–80.CrossRefGoogle Scholar
  37. Elliott B., J. O’Donovan 2011 Psychiatric Disorders. In The Causes of Epilepsy: Common and Uncommon Causes in Adults and Children. Simon D Shorvon Frederick Anderman Renzo Guerrini, eds., pp. 593–606, Cambridge: Cambridge University Press.Google Scholar
  38. Forster M., S.R. Dyal, L. Baezconde-Garbanati, C.P. Chou, D.W. Soto, J.B. Unger 2013 Bullying victimization as a mediator of associations between cultural/familial variables, substance use and depressive symptoms among Hispanic youth. Ethnicity & Health, 18(4): 415-432.CrossRefGoogle Scholar
  39. Frye C.A., L.E. Bayon 1999 Prenatal stress reduces the effectiveness of the neurosteroid 3 alpha, 5 alpha-THP to block kainic-acid-induced seizures. Developmental Psychobiology, 34(3): 227-34.CrossRefGoogle Scholar
  40. Gaw A.C., Q. Ding, R.E. Levine, H. Gaw 1998 The clinical characteristics of possession disorder among 20 Chinese patients in the Hebei province of China. Psychiatric Services, 49(3): 360-5.CrossRefGoogle Scholar
  41. Geleta, A.T. 2000 Case Study: Demonization and the Practice of Exorcism in Ethiopian Churches. Lausanne Committee for World Evangelization, Nairobi.Google Scholar
  42. Gilman, S.E., I. Kawachi, G.M. Fitzmaurice, S.L. Buka 2003 Socio-economic Status, Family Disruption and Residential Stability in Childhood: Relation to Onset, Recurrence and Remission of Major Depression. Psychological Medicine, 33(08): 1341–1355.CrossRefGoogle Scholar
  43. Glissant, E. 1997 Poetics of Relation (B. Wing, Trans.). Ann Arbor: University of Michigan Press.Google Scholar
  44. Goebert, D. 2009 Social Support, Mental Health, Minorities and Acculturative Stress. In Determinants of Minority Mental Health and Wellness. Sana Loue, Martha Sajatovic, eds., pp. 125–148. New York: Springer.Google Scholar
  45. Good, B. J. 1977 The heart of what’s the matter: The semantics of illness in Iran. Culture, Medicine and Psychiatry, 1: 25–58.CrossRefGoogle Scholar
  46. Grisaru N., D. Budowski, E. Witztum 1997 Possession by the ‘Zar’ among Ethiopian immigrants to Israel: psychopathology or culture-bound syndrome? Psychopathology, 30(4): 223-33.CrossRefGoogle Scholar
  47. Hodes R. 1997 Cross-cultural medicine and diverse health beliefs. Ethiopians abroad. The Western Journal of Medicine, 166(1): 29-36.Google Scholar
  48. International Rescue Commission 2006. Refugee Backgrounder: Eritrean Refugees.Google Scholar
  49. Kahana Y. 1988 The Zar spirits, a category of magic in the system of mental health care in Ethiopia. International Journal of Social Psychiatry, 31(2): 125-43.CrossRefGoogle Scholar
  50. Katsiaficas D., C. Suarez-Orozco, S.R. Sirin, T. Gupta 2013 Mediators of the relationship between acculturative stress and internalisation symptoms for immigrant origin youth. Cultural Diversity & Ethnic Minority Psychology, 19(1): 27-37.CrossRefGoogle Scholar
  51. Kaur M., R. Marawar, A. Ritaccio 2012. Journal of Child Neurology, vol. 27, no. 10: 1326-1330.CrossRefGoogle Scholar
  52. Kim J., W. Suh, S. Kim, H. Gopalan 2012 Coping strategies to manage acculturative stress: Meaningful activity participation, social support, and positive emotion among Korean immigrant adolescents in the USA. International Journal of Qualitative Studies on Health and Well-being, 7: 1-10.CrossRefGoogle Scholar
  53. Kirmayer, L.J. 1989 Cultural variations in the response to psychiatric disorders and emotional distress. Social Science and Medicine, 29: 327-339.CrossRefGoogle Scholar
  54. Kirmayer L.J. 2004 The cultural diversity of healing: meaning, metaphor and mechanism. British Medical Bulletin, 69: 33-48.CrossRefGoogle Scholar
  55. Kirmayer, L.J. 2007 Cultural Psychiatry in Historical Perspective. In Textbook of cultural psychiatry. Dinesh Bhugra and Kamaldeep Bhui, eds., pp. 3–19. Cambridge: Cambridge University Press.Google Scholar
  56. Kleinman, A. 1977 Depression, somatization and the ‘new cross-cultural psychiatry’. Social science & Medicine, 11: 3-10.CrossRefGoogle Scholar
  57. Kleinman, A. 1987 Anthropology and psychiatry. The role of culture in cross cultural research on illness. British Journal of Psychiatry, 151: 447-54.CrossRefGoogle Scholar
  58. Kleinman, A., & Becker, A. E. 1998 Sociosomatics: The contributions of anthropology to psychosomatic medicine. Psychosomatic Medicine, 60: 389–93.CrossRefGoogle Scholar
  59. Kohrt, B.A., D.J. Hruschka 2010 Nepali concepts of psychological trauma: The role of idioms of distress, ethnopsychology and ethnophysiology in alleviating suffering and preventing stigma. Culture, Medicine and Psychiatry, 34(2): 322-52.CrossRefGoogle Scholar
  60. Kraidy M. 2005. Hybridity, or the cultural logic of globalization. Philadelphia: Temple University Press.Google Scholar
  61. Lewis I.M., A. Al-Safi, S. Hurreiz 1991 Women’s Medicine: Zar-bori Cult in Africa and Beyond. International African Seminars.Google Scholar
  62. Littlewood, R., M. Lipsedge 1989 Aliens and alienists. Unwin Hyman Ltd: UK.Google Scholar
  63. Littlewood R., S. Dein 2000 Introduction. In Cultural Psychiatry and Medical Anthropology: An Introduction and Reader. Roland Littlewood and Simon Dein, eds., pp. 1–34. London: The Athlone Press.Google Scholar
  64. Magarinos A.M., J.M. Verdugo, B.S. McEwen 1997 Chronic stress alters synaptic terminal structure in hippocampus. Proceedings of the National Academy of Sciences, USA 94: 14002-8.CrossRefGoogle Scholar
  65. Mbewe E., A. Haworth, M. Atadzhanov, E. Chomba, G.L. Birbeck 2007 Epilepsy-related knowledge, attitudes, and practices among Zambian police officers. Epilepsy and Behavior, 10(3): 456-62.CrossRefGoogle Scholar
  66. Moshe S., M. Shilo, G. Chodick, Y. Yagev, I. Blatt, A.D. Korczyn, M.Y. Neufeld 2008 Occurrence of seizures in association with work related stress in young male army recruits. Epilepsia, 49: 1451-6.CrossRefGoogle Scholar
  67. Nakash, O., M. Nagar, A. Shoshani, I. Lurie 2014 The Association Between Acculturation Patterns and Mental Health Symptoms Among Eritrean and Sudanese Asylum Seekers in Israel. Cultural Diversity & Ethnic Minority Psychology (in press).Google Scholar
  68. Neuner F., A. Pfeiffer, E. Schauer-Kaiser, M. Odenwald, T. Elbert, V. Ertl 2012 Haunted by ghosts: prevalence, predictors and outcomes of spirit possession experiences among former child soldiers and war-affected civilians in Northern Uganda. Social Science & Medicine, 75(3): 548-54.CrossRefGoogle Scholar
  69. Neville B. 2007 Epileptic encephalopathy. Annals of Indian Academy of Neurology, 10: 3-6.Google Scholar
  70. Neville B.G., W.F. Harkness, J.H. Cross, H.C. Cass, V.C. Burch, J.A. Lees, D.C. Taylor 1997 Surgical treatment of severe autistic regression in childhood epilepsy. Pediatric Neurology, 16(2): 137-40.CrossRefGoogle Scholar
  71. Nichter M. 1981. Idioms of distress: alternatives in the expression of psychosocial distress: a case study from South India. Culture, Medicine and Psychiatry, 5(4): 379-408.CrossRefGoogle Scholar
  72. Nichter M. 2008 Coming to our senses: Appreciating the sensorial in medical anthropology. Transcultural psychiatry, 45(2): 163-197.CrossRefGoogle Scholar
  73. Nichter M. 2010 Idioms of distress revisited. Culture, Medicine and Psychiatry, 34(2): 401-16.CrossRefGoogle Scholar
  74. Nissenkorn A., M. Moldavsky, M. Lorberboym, A. Raucher, Y. Bujanover, T. Lerman-Sagie 1999 Postictal psychosis in a child. Journal of Child Neurology, 14(12): 818-9.CrossRefGoogle Scholar
  75. Putnam F.W. 1993 Dissociative disorders in children: behavioral profiles and problems. Child, Abuse and Neglect, 17(1): 39-45.CrossRefGoogle Scholar
  76. Rapin I. 1995 Autistic regression and disintegrative disorder: how important the role of epilepsy? Seminars in Pediatric Neurology, 24: 278-285.CrossRefGoogle Scholar
  77. Redfield R., R. Linton, M.J. Herskovits 1936 Memorandum on the study of acculturation. American Anthropologist, 38: 149-152.CrossRefGoogle Scholar
  78. Reis R. 2013 Children enacting idioms of witchcraft and spirit possession as a response to trauma: therapeutically beneficial, and for whom? Transcultural Psychiatry, 50(5): 622-43.CrossRefGoogle Scholar
  79. Rogers-Sirin, L., P. Ryce, S.R. Sirin 2014 Acculturation, Acculturative Stress, and Cultural Mismatch and their Influences on Immigrant Children and Adolescents’ Well-Being. In Global Perspectives on Well-Being in Immigrant Families. Radosveta Dimitrova, Michael Bender, Fons van de Vijver. eds., pp. 11–30. Springer.Google Scholar
  80. Ross C.A., E. Schroeder, L. Ness 2013 Dissociation and symptoms of culture-bound syndromes in North America: a preliminary study. Journal of Trauma and Dissociation, 14(2): 224-35.CrossRefGoogle Scholar
  81. Salzberg M., G. Kumar, L. Supit, N.C. Jones, M.J Morris, S. Rees, T.J. O’Brien 2007 Early postnatal stress confers enduring vulnerability to limbic epileptogenesis. Epilepsia, 49: 2079-85.CrossRefGoogle Scholar
  82. Sanchez, M., F. Dillon, B. Ruffin, M. De La Rosa 2012 The Influence of Religious Coping on the Acculturative Stress of Recent Latino Immigrants. Journal of Ethnic & Cultural Diversity in Social Work, 21(3):171.CrossRefGoogle Scholar
  83. Sargant, W. 1973 The Mind Possessed: A Physiology of Possession, Mysticism and Faith Healing. New York: Penguin Books, Inc.Google Scholar
  84. Scuglik D.L., R.D. Alarcon 2005 Growing up whole: Somali children and adolescents in America. Psychiatry (Edgmont), 2(8): 20-31.Google Scholar
  85. Sharp L.A. 1990 Possessed and dispossessed youth: spirit possession of school children in northwest Madagascar. Culture, Medicine & Psychiatry, 14(3): 339-64.CrossRefGoogle Scholar
  86. Shaw, R.J., K. Atkin, L. Bécares, C. Albor, M. Stafford, K.K. Kiernan, J.Y. Nazroo, R.G. Wilkinson, K.E. Pickett 2012 A systematic review of the impact of ethnic density on adult mental health. British Journal of Psychiatry 201(2012): 11-19.CrossRefGoogle Scholar
  87. Shorter E., L.E. Wachtel 2013. Childhood catatonia, autism and psychosis past and present: is there an ‘iron triangle’? Acta Psychiatrica Scandinavica, 128: 21–33.CrossRefGoogle Scholar
  88. Silberg J.L., S. Dallam 2011 Dissociation in Children and Adolescents: At the Crossroads. In Dissociation and the Dissociative Disorders: DSM V and Beyond, edited by P.F. Dell and J.A. O’Neil, Routledge, New York, 2011, p.67-82.Google Scholar
  89. Sinclair D.B., T. Snyder 2008 Psychosis With Frontal Lobe Epilepsy Responds to Carbamazepine. Journal of Child Neurology, 23(4): 431-434.CrossRefGoogle Scholar
  90. Sirin, S.R., P. Ryce, M. Mir 2009 How teachers’ values affect their evaluation of children of immigrants: Findings from Islamic and public schools. Early Childhood Research Quarterly, 24: 463–73.CrossRefGoogle Scholar
  91. Steiner, H., V. Carrion, B. Plattner, C. Koopman 2003 Dissociative symptoms in posttraumatic stress disorder: diagnosis and treatment. Child and Adolescent Psychiatric Clinics of North America, 12(2): 231-49.CrossRefGoogle Scholar
  92. Suarez-Morales L., B. Lopez 2009 The impact of acculturative stress and daily hassles on pre-adolescent psychological adjustment: examining anxiety symptoms. The Journal of Primary Prevention, 30(3-4): 335-49.CrossRefGoogle Scholar
  93. Teferra S., T. Shibre 2012 Perceived causes of severe mental disturbance and preferred interventions by the Borana semi-nomadic population in southern Ethiopia. BMC Psychiatry, 12: 79.CrossRefGoogle Scholar
  94. Trangkasombat U., U. Su-Umpan, V. Churujiporn, O. Nukhew, V. Haruhanpong 1998 Risk factors for spirit possession among school girls in southern Thailand. Journal of the Medical Association of Thailand, 81(7): 541-6.Google Scholar
  95. Van Duijl M., E. Nijenhuis, I.H. Komproe, H.B.P.E. Gernaat, J.T. de Jong 2010 Dissociative Symptoms and Reported Trauma Among Patients with Spirit Possession and Matched Healthy Controls in Uganda. Culture, Medicine and Psychiatry, 34(2): 380–400.CrossRefGoogle Scholar
  96. Witztum E., N. Grisaru, D. Budowski 1996 The ‘Zar’ possession syndrome among Ethiopian immigrants to Israel: cultural and clinical aspects. British Journal of Medical Psychology, 69(3): 207-25.CrossRefGoogle Scholar
  97. Woods R.J., M. Gruenthal 2006 Cognition induced epilepsy associated with specific emotional precipitants. Epilepsy and Behavior, 9: 360-2.CrossRefGoogle Scholar
  98. World Health Organization 2006 Report on Mental Health System in Eritrea. Asmara, Eritrea.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.LondonUK

Personalised recommendations