In the United States, the risk of suicide is higher for refugees. It’s even higher if you’re a refugee from Burma. The trauma of fleeing a country in conflict can often turn into mental illness, even years later. But the Western concept of mental health doesn’t exist in Burmese culture. Words like “depression” often don’t translate. As a result, some Burmese refugees aren’t getting the care they need.
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.
"I think it started because I didn’t have a job," said Burma Center Executive Director Martha Thawnghmung translating for P.C.
P.C. says he quit school to find work, but he couldn’t find any and he got depressed. He also started getting into fights, one time he broke into a car. P.C. went to jail for almost a year — that was the first time he got mental health treatment. He says he felt better on the medication they gave him. But he also started drinking and it cost him his relationship.
"Yeah, she hate me so when I drunk," said P.C.
Michigan has a lot of Burmese refugees — more than 3,700. 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 any more. 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,” said Thawnghmung.
“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.
“As direct interpreters, we have to interpret as best we can what the therapist says, sometimes understanding that it didn’t land anywhere,” she said.
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 and helps to make Refugee Country Wellness Guides.
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,” she said.
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 an art project.
“Then perhaps one of the staff provides some kind of psycho-education," Lange explains. "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 she 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, for about a year, the council was in talks with the Burma Center about how to address drunk driving. If a driver is considered "super drunk" — or has a blood-alcohol level of .17 or above — they can face higher penalties than a regular drunk driving offense in Michigan.
"The numbers for people within [the Burmese] community — which really shocked us — was there were folks coming in at .23, .24. So that was significantly higher," said SAC Program Coordinator Sean Washington.
Though both parties hoped to address the problem, the Burma Center put the talks with the Substance Abuse Council 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. 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,” she said.
We also reached out to the local mental health agency Summit Pointe, which declined to comment. (In the interest of full disclosure, I’m married to a former employee of Summit Pointe.)
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. We asked him if he still has those troubling thoughts.
"Yes, it’s still there," he said.
The Burma Center is making its own efforts to help people like P.C. It’s seeking grant funding to explain Western mental health concepts in the Chin language. It’s also looking to create its own support groups.
This story was produced with the help of WMUK’s Sehvilla Mann.