The risk of suicide is higher for refugees in this country. It’s higher still if you’re a refugee from Burma, the Southeast Asian country also known as Myanmar. The trauma of fleeing a country in conflict often turns into mental illness, even years later. But the Western concept of mental health doesn’t exist in Burmese culture, and words like “depression” don’t translate.
P.C. is in his mid-twenties. We’re using his initials to protect his privacy. He came to the U.S. with his family almost ten years ago.
Burma Center Executive Director Martha Thawnghmung translates. P.C. says he quit school to find work, but he couldn’t find any and he got depressed.
"I think it started because I didn’t have a job," said P.C. through Thawnghmung. "Lot of eat, then lot of sleep.”
P.C. also started getting into fights, one time he broke into a car. He went to jail for almost a year — that was the first time he got mental health treatment. P.C. says he felt better on the medication they gave him. But he also started drinking and it cost him his relationship.
Michigan has a lot of Burmese refugees — more than 37 hundred. Martha Thawnghmung says most Burmese people in Battle Creek are from the Chin state, a mostly Christian region of Burma. Much like the Muslim Rohingya, the Chin people have been persecuted for their religion in their majority Buddhist country.
Thawnghmung says she’s seen a lot of good kids like P.C. end up in jail or even commit suicide. She says Burmese people don’t have the support systems they have in Burma.
“Nobody visits each other just to visit anymore," said Thawnghmung. "We don’t walk to our neighbor’s house a couple of blocks away just to chit chat the day and release tension, right? In Burma, that was very prevalent.”
“Mental health is a concept that is still very new to a point where we don’t even have terms for it," said Burma Center Program Manager Elizabeth Lian. “Even “mental health” those two words are non-existent.”
Thawnghmung and Lian serve as interpreters for Burmese mental health patients. Thawnghmung says to get the idea across, interpreters would have to add a lot of context — sentences would become paragraphs. But that could be seen as changing what the therapist says. So, Thawnghmung says they don’t add that context.
“So as direct interpreters, we have to interpret as best we can what the therapist says, sometimes understanding that it didn’t land anywhere," said Thawnghmung.
But how should health professionals talk to Burmese refugees about mental health? Jennifer Lange is with Gulf Coast Jewish Family & Community Services in Florida. She’s worked with refugees. Lange says for Burmese refugees, it’s usually best to describe things in physical terms — like asking about symptoms.
“So instead of ‘Are you depressed?’ You can ask, ‘Are you having trouble sleeping? Are you staying at home more often than you used to?’ Just common things," said Lange.
Even so, Lange says one-on-one therapy sessions might not be the best way to help. She says she’s had more success meeting with Burmese refugees in groups. For example, they might work on a an art project.
“And then perhaps one of the staff provides some kind of psycho-education," said Lange. "You know, it’s not what someone in the U.S. would necessarily consider a stereotypical therapy group, but it’s definitely culturally comfortable for a lot of refugees from Burma.”
Martha Thawnghmung of the Burma Center says they brought up this idea with local health agencies in Battle Creek. But they say the agencies don't seem interested in learning about their community much less creating new programs. Substance Abuse Council Executive Director Dawn Smith disagrees. She says the council was in talks with the Burma Center about how to address drunk driving. But the center put those talks on hold due to budget constraints. Smith says it’s the Burma Center’s job to restart them.
“If they need a service, they’re going to get it," said Smith. "But we need to know if it’s not working, what we can do better. And that is where their role has to come in.”
As for P.C. — the Burmese man we talked to at the beginning of this story — he’s taking his medication but he still struggles with alcohol and depression.