Cross-cultural counseling

Two weeks ago, Mustafa moved into a bright, newly renovated apartment. Soon the 37 year-old German-Moroccan will start training to become a painter and decorator. Mustafa (who prefers to use a pseudonym) is doing well today - unlike three years ago, when he saw no future for himself. Health problems, divorce and the loss of his job had made him depressed.

It started with difficulty concentrating, Mustafa said. "It was all too much for me. I just wanted to stay at home and not see anyone."

Then he started skipping work - back when he still had a job.

"I felt I couldn't talk to anyone," he said. Finally, he found the confidence to talk to some good Turkish friends and told them what was going on.

Thanks to his friends, Mustafa found out about the immigrants' clinic at the Marien Hospital in Duisburg. There, Dr.Michael Schott and his team of specialists offer assistance to immigrants with mental health issues.

More than just symptoms

The need is enormous: Three months after its establishment in 2007, the clinic already had 500 names on its waiting list. A sign stating "This year, no new patients will be accepted," is also written in Turkish. Chief Physician Michael Schott says his patients with migration backgrounds quickly realize that he is interested in more than just their symptoms.

"For migrants, it is often the case that mental illness is a symptom of more entrenched problems in social areas. And it's often the case that some topics are taboo and that you cannot talk about them directly - for example, depression."

Mustafa, too, didn't want to believe that his poor concentration and lack of energy resulted from depression.

"In eastern, oriental circles, it is common that people with mental health problems are labelled 'crazy,'" he said.

It took several months until he had worked up the courage to follow his friends' advice and make an appointment in the Duisburg immigrant's clinic.

Linguistic obstacles

It's not just negative attitudes toward mental illness that make it difficult for some people to seek treatment. Treatment by a psychotherapist is not common in Muslim countries. In Germany, many immigrants are further discouraged by their lack of German language skills or fear of German institutions. But once the obstacles are overcome, what results is often a positive experience.

In the immigrant clinic in Duisburg, Mustafa found people who were interested both in his immigration history and his family problems.

"I separated from my wife in late 2007. For a long time my parents were fighting with her parents. The family problems broke up our relationship. It really destroyed me," he said.

In traditional psychiatry, illnesses and their symptoms are treated. But in the cross-cultural psychiatric approach, the focus is on the patient and his cultural background. Dr. Michael Schott and his team treat people, not illnesses - a significant shift in emphasis, which so far has led to good treatment results.

Religion is not the problem

Schott also has a copy of the Koran in his office - and through numerous talks has learned a lot about the religion of Islam. But that does not mean that one must master every aspect of a foreign culture or religion to offer culturally sensitive treatment, said Schott. After several years of cross-cultural treatment, therapists can readily identify the common problems.

"Religion ultimately is not a source of psychological problems. The main cause of all the problems are family conflict situations," Schott said, adding that disease "has no culture."

Currently the six-person team treats around 390 patients per quarter, and the duration of treatment varies. About 85 percent of patients have a Turkish background; the rest come from various cultural backgrounds. Significantly more women have managed to break through the cultural barriers surrounding treatment - only 30 percent of patients are men.

For Mustafa, it only took a few appointments to give his life new impetus.

"The few appointments that I had have helped me a lot. I still don't have a job, but I feel much better - so much so that I can live normally again," he said.

Author: Ulrike Hummel (smh)
Editor: Susan Houlton