I am an immigrant who has been diagnosed as a manic-depressive by Caucasian male psychiatrists some twenty five years ago. I was hospitalized several times in mental institutions without choice. In March 1999, I was in a coma for two weeks as a result of the wrong combination of medications given to me by a psychiatrist at Mount Sinai Hospital. That was and will forever be my last admission to any psychiatric wards.
Right now, I am teaching ESL/Literacy to psychiatric immigrant survivors at ACROSS BOUNDARIES, an ethnoracial mental health centre at the west end of the city. My clients are mainly from the Caribbean, Africa, Afghanistan, Sri Lanka, and India.
It is the contention of my presentation today that the mental health of immigrant women are often affected by their lack of language skills, coping skills in Canada, information about medications and their understanding of their rights within the mental health institutions.
Take myself as an example. When I was first diagnosed as a manic-depressive, I was new to Canada. Though English Literature was my major at the University of Minnesota, my knowledge in Science and in Medicine was very poor. I did not know what was the equivalence of manic or depressive in Chinese. I did not know how to say the word syringes in English. When it came to medical terms and medications, I was tongue-tied.
What does Lithium mean? What are its functions? What does Ativan mean? Besides, I was not exposed to the talk therapy with psychiatrists. Very often, I would find myself either nothing to say or rambling on with the psychiatrists. I could not quite express my reactions to the different kinds of medications that were given to me. Why could not the psychiatrists give me a quick fix of medications as my family physician would?
Besides, my mother and I were ignorant of the mental health system. She was also a new Canadian and does not speak the language. How then could we understand the system? Just like what I had written in my memoir, THE TORMENTED MIND, “not knowing much about the rules and regulations of these hospitals, I was at the mercy of the doctors and the nurses.” I was, indeed, shuffled from one hospital to another.
Then came the different kinds of hospitals and their locations. Are they, like schools in Toronto, that there are differences in the quality of care?
I was ignorant of the different kinds of admissions too. For example, I did not understand what was meant by the word “Form 1”. To me, the word Form 1 means Grade 7 in Hong Kong because of the British system. Yet, here it means the different kinds of hospitalization one is in. Then, how about Form 3? It means involuntary hospitalization after a certain period of time. (Still now, I am confused).
I was equally ignorant of the importance of having a Power of Attorney. In March 1999, at the time when I was hospitalized at Mount Sinai, I did not have a Power of Attorney. The psychiatrist then placed me under the Public Trustee for consent of my treatment. Just imagine! To have one’s hands under a stranger! The psychiatrist, though he knew of my mother’s daily visit, did not contact my mother at all until the time when I was in a coma. According to the medical report, he wrote that my mother did show a lot of concerns for my care, but that he would let my mother know once I became conscious.
There was a Chinese Outreach Service at Mount Sinai where they have Chinese social workers for translations. However, nothing was done. In other words, was this an oversight of this psychiatrist or that this psychiatrist had deprived of the rights of me as a patient and that of my mother’s?
In short, as an immigrant woman in the mental health institution, I was ignorant of the medications given to me as well as my rights.
At ACROSS BOUNDARIES, I have immigrant women from countries such as Afghanistan and Somalia. Though some of them were well-educated in their own countries, they lack English skills or the confidence to speak the language. There are several women who have had their University degrees in their own countries. Yet, because of traumatic events that had taken in their own countries, they suffer from post-traumatic disorders. Some suffer from depression as a result of their homesickness, having to live in a strange country when some of their loved ones still live miles apart in their homeland. Some suffer from depression as a result of their lack of life skills in Canada—for example, how to find jobs and to get the “Canadian experience.” And some also suffer anxiety disorders because of new environment of having to live in Canada.
To quote you one example. There is this woman from Afghanistan who was a doctor there. But because of post-traumatic disorder and the fact that she faced discrimination of having to do menial jobs, she also suffered from depression. She has lived in Toronto for over 15 years. She wanted to find a job, but couldn’t. She wished that she were not in Canada. She lives with her husband and a son.
Considering the vulnerable backgrounds of many of my clients, they would probably suffer the same way that I had suffered—that is, the loss of their rights within the mental health system.
Many of the psychiatrists, though well-trained, may not fully understand this kind of cultural differences that had taken in the lives of many immigrant women. This is especially true that a lot of them are male psychiatrists. Can they fully comprehend when an immigrant woman from Somalia describes to them about witnessing the killings of their siblings and their loved ones? Could they fully understand the loneliness of being miles away from home, alone in a city that does not speak one’s language?
In Canada, the DSM-IV is the Bible for psychiatrists and residents. Yet DSM-IV very often deals with symptoms rather than causes. And all Cross-cultural psychiatrists agree that DSM-IV lacks the cultural component to it.
How then can we make treatment of immigrant women be better in the mental health field? Some suggestions are as follows:
- To develop more cultural competence courses for mental health workers, residents, and psychiatrists. For example, give workshops or information sessions. Then, hopefully, they will know as to how to treat immigrant women better.
- To develop anti-racism programs for the mental health workers and residents.. Hopefully then, this will enlarge their horizons and reshape their thinking.
- To expose the psychiatrists to other ways of dealing with mental health problems in another culture. For example, how do people in the Caribbean treat those afflicted?
- To translate the information about the hospital system in the language of the immigrant women and their caregivers.
- To give information about the kind of medications given either to the afflicted or their caregivers.
- To educate the immigrant women about their rights about the hospital system.
It has taken me more than 20 years in order to learn more about the mental health system in Toronto, the kinds of medications that were given to me, and my rights as a survivor.
In fact, these days, after reading a book called DRUGS MAY BE YOUR PROBLEM, I have withdrawn from taking any tranquilizers about three and a half years ago. I only told my psychiatrist afterwards. I am just on a minimum dosage of Epival for fear of having to be an in-patient again. Yet, these days, I am surviving very well. I have not lost any nights of sleep even with my long-distance travel to Hong Kong last year. I was able to handle the death of my mother and an extremely emotional traumatic experience last year.
Professor John Nash describes in his book, A BEAUTIFUL MIND, about his recovery from being a paranoid schizophrenic, as attributed to “safety, freedom, and friends.” I think that this also applies to my case too. More so, it has to do with the fact that many of my dreams have come true.
I hope that somehow, the immigrant clients of mine at ACROSS BOUNDARIES would be able to achieve their own dreams with safety, freedom, and friends that Canada offers.
But more so, it is of utmost importance that as immigrant women consumers/ survivors, we should know our rights within the mental health system here.
Caroline Fei-Yeng Kwok, B.A., B.E.D., M.E.D, teaches English as a Second Language/Literacy to immigrant psychiatric survivors at Across Boundaries. The rationale behind the class is to motivate their interests in reading and writing through positive encouragement and in a non-coercive manner with the hope that her clients will be able to build up their confidence and self-esteem.