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Abstract
Studies of refugee mental health have largely focused on epidemiological assessments of posttraumatic stress disorder and other diagnoses using Western-derived assessment measures. However, research has increasingly highlighted the role of culture in shaping refugee mental wellbeing and suggests that local idioms of distress may be more salient to refugee populations than Western-derived constructs of psychopathology.
The central aim of the study was to explore experiences and perceptions of suffering and distress amongst Karen refugee women in Sydney, Australia. The Karen, an ethnic group from Burma, have been gravely affected by decades of conflict and human rights abuses in their homeland yet there is a dearth of information concerning their psychosocial needs.
Informed by a critical realist theoretical paradigm, the research was guided by ethnographic, feminist and grounded theory methodological traditions. Data was drawn from over 200 hours of ethnographic observations and 67 interviews with Karen women and key informants between 2009 and 2011. Data analysis was based on principles of grounded theory.
The findings revealed important relationships between pre-migration cultural context, persecutory experiences (including but not limited to trauma), post-migration psychosocial stressors and current experiences of emotional distress. Women s daily social and material stressors, such as interacting with service providers, were central to their distress. They conceptualised their experiences of suffering and trauma within cultural frameworks and idioms of distress, which often differed from the Western psychiatric models. Karen women primarily coped through traditional community and religious networks. Language was a key barrier to seeking support from Australian service providers. Women s timidity and communication patterns, stemming from the interplay of cultural, gendered and pre-migration experiences, were further barriers.
The study contributes to an empirical understanding of Karen refugee women s experiences and conceptualisations of mental wellbeing. It enhances existing knowledge and developments in cross-cultural mental health and adds a new dimension by demonstrating how pre-migration culture, refugee-specific migration experiences, post-migration difficulties and wellbeing were linked through the interconnected issues of power(lessness), use(fulness) and identity. The findings have implications for service provision and suggest that Western mental health practitioners should reflexively explore prevailing discourses concerning traumatic suffering and healing.