Cultural Identity Among Afghan and Iraqi Traumatized Refugees: Towards a Conceptual Framework for Mental Health Care Professionals

Abstract

Cultural identity in relation with mental health is of growing interest in the field of transcultural psychiatry. However, there is a need to clarify the concept of cultural identity in order to make it useful in clinical practice. The purpose of this study is to unravel the complexity and many layers of cultural identity, and to assess how stress and acculturation relate to (changes in) cultural identity. As part of a larger study about cultural identity, trauma, and mental health, 85 patients from Afghanistan and Iraq in treatment for trauma-related disorders were interviewed with a Brief Cultural Interview. The interviews were analysed through qualitative data analysis using the procedures of grounded theory. The analysis resulted in three domains of cultural identity: personal identity, ethnic identity and social identity. Within each domain relationships with stress and acculturation were identified. The results offer insight into the intensity of changes in cultural identity, caused by pre-and post-migration stressors and the process of acculturation. Based on the research findings recommendations are formulated to enhance the cultural competency of mental health workers.

A framework of meaning attribution following loss

“…Cultural identity concerns all the norms and values that constitute an image that the individual holds of him or herself, that urges an individual to decide what is right or wrong and what kind of behaviour is appropriate or not. These individual norms and values originally were shaped by norms and values negotiated within the cultural group and local society to which the individual belonged (Groen, Richters, Laban, & Devillé, 2018 ). With the loss of connection with the cultural group and a change of local society, the entire foundation of individual norms and values are gone and have to be rebuilt.…”

Culturally Informed Manifestations of Trauma

“…These developments in theories of culture, and traumatology have enriched cross-cultural understanding of mental health dynamics and case conceptualization, informing the development of intervention models which aim to go beyond a singletrauma focus to address cumulative trauma dynamics as well collective identity and culture-specific traumas (Groen et al, 2017;Kira, 2010). The implications for both mental health interventions and for research is a focus on the dynamic interrelationship of past traumatic experiences, ongoing daily stressors and the fundamental ruptures to core psychosocial systems extending beyond the individual to their sociocultural environment (Silove et al, 2017).…”

Collective Trauma, Collective Healing

“…A recent desk review released by the World Health Organization (WHO) and the United Nations High Commissioner for Refugees (UNHCR), the United Nations Refugee Agency, has argued that the development of effective MHPSS programmes requires knowledge of existing health systems and sociocultural context, and that familiarising international humanitarian practitioners with local culture and contextualising programmes is essential to minimise risk of harm, maximise benefit and optimise efficient use of resources (Greene et al, 2017). Developments in theories of identity, culture and traumatology have enriched cross-cultural understanding of mental health dynamics and case conceptualisation, informing the development of intervention models which aim to address cumulative trauma dynamics as well collective identity and culture-specific traumas (Groen et al, 2017;Kira, 2010). As noted by Wind & Komproe (2018), researchers and practitioners have called for interventions which incorporate the socioecological perspective into their design.…”