Diaries From the Field Blog

When it Comes to Mental Health, Don’t Discount Culture and Tradition

June 27, 2017
Elderly Woman Praying in Temple
An elderly woman praying in a temple devastated by the earthquake. Photo credit: Pratap Thapa.

By Sauharda Rai, DGHI associate in research

Throughout my schooling and my years of work as a health researcher, I was told and said it myself a hundred times that there is a deep and unique relationship between culture and health.

Growing up in Nepal, in a traditional South Asian society, I had never been able to fully understand and experience this relationship until I moved out of my cultural comfort zone to the United States. In this blog, I write about these experiences, especially in relation to mental health and post-disaster. 

It was the spring of 2015 when Nepal got hit by two major earthquakes, followed by numerous large aftershocks. The most affected places were around the capital city—Kathmandu—the place I call home and where most of my friends and family are from. I had just moved earlier that spring from Nepal to the U.S.; for the first time after spending almost my entire lifetime in Nepal, I was in a new place. 

Here I was, having spent less than a month in the U.S., struggling to cope with the new culture, food and work environment, and suddenly a big earthquake had hit back home. This event gave me an added feeling of helplessness, stress and anxiety. At that moment, I realized the importance of cultural connection. Though I was physically in a very safe place, I was somewhere where I had been drifted away from my culture and things that were familiar to me. The physical risk was not there, but mentally, I was shredded. 

A month after the earthquake, I was fortunate to go back to Nepal for my fieldwork and get involved in relief activity. When I got there, the situation was no better: my friends and families were still living outside in an open space, fearing another big earthquake. Constant aftershocks reminded them about the great earthquake and kept their anxiety and stress at the highest levels. 

As I talked to people around Nepal, I was fascinated by how people were connecting the earthquake with their traditional and cultural theories. Some linked it with the sweating of an idol of a Hindu deity before the earthquake, which is seen to be a bad omen for the whole country. Others believed it was a god’s way of punishing them for moving away from traditional values. 

Though educated people understood the science behind the earthquake, they also attributed them to these cultural causes. They pointed to the fact that some buildings remained safe because they were the places where the main god resided. For example, Pashupatinath—the holiest Hindu temple and house of Kumari, the living goddess—stayed intact while places around it were destroyed. 

Also during that time, I saw people staying together in groups in those open spaces and praying that there wouldn’t be another earthquake. In certain places, people and organizations were doing different forms of pujas (prayers) to calm the earth and mollify gods' anger. The most notable were “chyama puja” (prayer to forgive), “bhumi puja” (prayer to earth) and “shanti puja” (prayer for peace). 

These acts during this time of disaster brought calmness and lowered people’s stress. For example, one of my friend’s grandparents agreed to go inside their home (though they got the safe sticker) only after they did the house puja, citing that they had not done enough puja when they first laid the foundation stone. 

People actually talked about how these acts were helping them to cope with the stress and build their resiliency. The counselors at Transcultural Psychosocial Organization Nepal (TPO Nepal)—one of our key partners in Nepal—supported these facts and encouraged people to do these acts instead of thinking too much. 

A month after that, representatives from the Duke Global Health Institute, TPO Nepal and the WHO conducted a workshop with psychiatrists in Nepal. The workshop focused on culturally adapting a post-disaster mental health guide. During the workshop, some of the psychiatrists talked about training traditional healers and gurus on mental health. 

This notion may seem like the combination of two opposite ends. But the reality is that when people have mental health problems in areas like Nepal, most of the patients’ first point of contact is the traditional healers—not the psychiatrist or health posts—so it would be impossible to ignore them and push them out of the health care system. 

Similarly, I interviewed a principal of a school in a very rural area of Nepal that was having a problem with mass hysteria. He mentioned that he was bringing in traditional healers and conducting puja in the school, hand in hand with bringing in counselors and caretakers, because this is what was actually calming down the students in the school. 

My point? When we, as researchers or practitioners, talk about mental health, it’s important to approach it from both biomedical and cultural standpoints, especially in the context of countries like Nepal, where health is very much related to culture and tradition. 

This blog post was adapted from a story told at the Triangle Global Health Consortium conference in the fall of 2016.

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