Cultural Translation of Refugee Trauma: Cultural Idioms of Distress Among Somali Refugees in Displacement

Background and Purpose: Decades of war and chaos in Somalia has led to forced migration of millions of Somali refugees. Common mental disorders (CMDs) is among various issues generated as devastating consequences of such refugee situations in the Somali community. In an effort to provide effective and culturally relevant assessment and treatment of CMDs, it is important to understand how lay people construct and express mental disorders and psychological distress. The current study explores cultural idioms of distress (CIDs) among Somali refugees displaced in a low-resource urban setting, in an effort to lessen cultural barriers and offer insight for stakeholders in the field on how to better understand mental health needs in cultural context and serve this vulnerable population.

Methods: The authors conducted key informant interviews (KIIs) with 15 Somali mental health service providers and four focus group interviews (FGIs) with lay Somali refugees in urban Nairobi, Kenya. Purposive sampling was applied to recruit information-rich participants, with assistance from local community leaders and mental health experts in the Somali community. The KIIs yielded a set of CIDs commonly used to describe psychological impact of refugee trauma in the Somali community and each obtained CID was further explored using Explanatory Model Interview Catalogue (EMIC). A template analysis was adopted to analyze the qualitative data from KIIs and CIDs.

Results: Somali conceptualization of mental health is not formally organized and yet unique set of symptomatology is grouped into each CID. The main CIDs identified by KIIs included Buufis, Buqsanaan and Welwel (anxiety disorders), Murug (depression), Qaracan (PTSD), Jinn (Islamic spirit possession), Mingis (traditional spirit possession), and Waali(severe mental illness). Symptomatology was organized into four categories: physical; psychological; social/interpersonal & externalized symptoms; and religious/spiritual. An observable theme within the symptomatology is that as the CIDs increase in severity, the symptoms become more physically expressed rather than psychologically. Additionally, the more severe CIDs are often described in terms of social or external perceptions of behaviors and interpersonal interactions than the less severe CIDs. A similar trend was noted in the types of etiological causes reported, with the more severe CIDs being characterized by traumatic events and other mental health symptoms, while the less severe CIDs were more commonly associated with daily stressors.

Conclusion and Implications: The findings revealed that ascribing mental health symptoms to certain CIDs (ex. Jinn or Buufis) may represent a less stigmatized manner of discussing mental health since the perceived causes are entirely external and not associated with personal defects or characteristics. These less stigmatized CIDs tend to have known options for treatment in the community, such as religious practice or traditional healing methods, which seemingly promotes help-seeking. Also, these CIDs included a wider range of symptomatology, both somatic and behavioral, which indicates that they provides a culturally acceptable and safe way for individuals to communicate mental distress within specific contexts. This study implies that understanding of CIDs can help improve mental health practice, including detection, awareness, screening, diagnosis, and treatment that is more culturally grounded.