Mental Health Taboo in the Ethiopian Community: Interview with Dr. Welansa Asrat

A Dallas police homicide detective stood outside the home where Yayehyirad Lemma and Yenenesh Desta were found shot to death on their front porch. (Dallas Morning News)

Tadias Magazine
By Tadias Staff

Updated: Tuesday, August 21, 2012

New York (TADIAS) – The latest news of suicides and murders in the Ethiopian community, including the tragic killings of a Dallas couple who were gunned down outside their house as they returned home from working at their popular Ethiopian restaurant, is raising the question: Is this the consequence of our taboos about mental illness?

“Although the negative stigma associated with mental illness is prevalent throughout the world, it remains particularly relevant in Ethiopian culture where it is believed to be a sign of weakness,” says Dr. Welansa Asrat, a Psychiatrist practicing in New York City. “Due to the unacceptability of such a stigma, many Ethiopians deny their mental suffering and never get the necessary treatment, which can then result in disastrous outcomes such as suicides or homicides.”

In the Texas case, police documents show that the suspect, also an Ethiopian immigrant, was allegedly motivated to assassinate the parents of an 18-month-old baby because he “felt disrespected.”

What are the social pressures that drive people to this type of irrationality?

According to Dr. Welansa concerns associated with culture-shock or adjustment issues increase the likelihood of developing psychological problems.

“The loss of one’s culture, lack of social support, isolation and loss of self-identity experienced by immigrants are known risk factors of mental illness,” Dr. Welansa said. “When the immigration is involuntary in nature and occurs after traumas such as war, torture and other forms of human rights violations, the individual is that much more vulnerable to mental illness.” She added: “Additional risk factors such as new minority status, language barriers, financial hardship, unemployment, difficulty negotiating educational and occupational systems, discrimination and changing gender roles can overwhelm an individual’s capacity to cope with his or her circumstances and result in a full-blown episode of depression, Post-Traumatic Stress Disorder (PTSD), anxiety disorders or psychosis, with or without suicidal or homicidal behaviors.”

Dr. Welansa notes that there are protective factors such as minority integration, social participation, social support, adaptability, and positive relationships, which can minimize the likelihood of a full-blown mental disorder. “It is the cumulative effect of multiple risk factors combined with an absence of protective factors that increases an immigrant’s risk of mental illness,” Welansa says. Additional factors affecting mental health include one’s biological and psychological makeup.

When it comes to violent crimes within the Ethiopian community, Dr. Welansa points out, however, that it is not as widespread as it seems and could be put under control.

“Despite the historical misconception that immigrant communities have higher crime rates, studies now show that immigrants are, in fact, less prone to violent crimes than native-born Americans,” she said. “In his study on this issue, Harvard sociologist, Robert Sampson showed that first-generation immigrants were 45% less likely to commit violent crimes, and second-generation immigrants were 22% less likely to commit violent crimes.” She added: “This pattern held true for non-Hispanic, black and white immigrants.”

Regarding the Ethiopian community, Dr. Welansa said there are studies that show that the close knit and communal nature of our culture may play a protective role in preventing mental illness.

“The first study that looked at mental health in the Ethiopian community in North America was conducted in Toronto in 2004,” Dr Welansa said. “The study looked at the frequency of depression and the risk factors involved in the occurrence of depression in the Ethiopian immigrant community.” She added: “The study found that the rate of depression in the Ethiopian community in the Toronto area was only slightly higher (9.8%) than the rate within the general Canadian population (7.3%). However, the rate (9.8%) was 3 times higher than the estimated rate in Southeastern Ethiopia, which highlights the extent to which immigration increases one’s risk of depression.” The study corroborated the psychological stages of immigration that have been previously documented, starting with an initial period of elation, moving to a state of depression and ultimately to a recovery period.

“The researchers believe that the initial elation is due to the strong social support that is initially available from their ethnic group and that depression sets in as this support wanes over time,” Dr Welansa said. “Most eventually make it to a recovery period, which occurs when they have become fully acculturated, but some spiral downward into a state of despair.”

The patterns noted in this study suggest that social connections and programs that promote ethnic identity likely protect an immigrant from depression. However, further research is required to substantiate the protective role that ethnic identity plays in preventing depression.

“The one form of violence that is higher in immigrant communities is domestic violence against women,” Dr. Welansa said, citing NYC Mayor’s Office to Combat Domestic Violence, which found that young, foreign-born women have the highest risk of being killed by their partner of any group of women in NYC. “One study found that foreign-born women accounted for 51% of intimate partner homicides in New York City,” she said. “The study also showed that married immigrant women experienced higher levels of physical and sexual abuse than unmarried women.”

She added: “Domestic violence advocates cite three barriers that prevent immigrant women from seeking help: lack of information regarding the law and available services; culturally ingrained tendency towards preserving their family or community reputation combined with a sense of shame in divulging their family issues; and fear of the authorities.”

What is Dr. Welansa’s advice to our community leaders, as well as cultural and religious organizations on how to contribute to help alleviate the various traumas associated with migration?

Dr. Welansa suggests developing educational programs that promote mental wellness and strengthen protective factors such as good parenting, literacy, problem-solving skills, social management skills and stress management, which can be taught and reinforced in community programs.

Implementing measures that address risk factors such work-related stress, discrimination, academic failure, chronic pain, substance abuse & poor work skills, are also important focus points prior to the onset of mental illness.

Additionally, individuals and families can be encouraged to use suicide hotline services that can provide emotional support for those experiencing emotional distress and provide referrals to mental health care workers in their area.

Dr Welansa said: “For those requiring psychotropic medications (antidepressants or antipsychotics), it is worth knowing that the liver enzyme that metabolize most psychotropics do so at an ultra-rapid rate for 20-30% of individuals with Ethiopian or Arabian genetics. For those who are ultra-rapid metabolizers, a higher dose of an anti-depressant or anti-psychotic would be required for the medication to achieve therapeutic efficacy and alleviate the targeted symptoms.”

Dr. Welansa Asrat is Board Certified Psychiatrist, Cross-Cultural Psychiatry, working in New York City. She is on Twitter.

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7 Responses to “Mental Health Taboo in the Ethiopian Community: Interview with Dr. Welansa Asrat”

  1. 1 Mule Aug 20th, 2012 at 8:16 pm

    Thanks for shading light on this topic. As Dr. Asrat mentioned in a culture where mental illness carries a huge stigma and psychiatric help can be a frightening thing. Breaking the silnce is the first step to avoide the heart breaking tragidies.

  2. 2 Mel Tewahade Aug 21st, 2012 at 10:09 am

    The trauma that we as Ethiopians have endured the last 40 years, makes a lot of us border line insane. Severe mood swing,cold shoulder,tendency to get hurt easily,unable to articulate our difficulty,many families that do not talk to each other over perceived infraction,alcoholism,aggressive behavior towards one another,intense jealousy,hatred, loathing, inability to be happy where we are, if we are in Ethiopia, we want to go the US and if we are in the US we want to go back, luck of joy in our heart are some the visible conditions.

    Hopefully the new generation will unload some of this baggage and live a better life.

  3. 3 Dr. Yeshi T. Aug 21st, 2012 at 10:59 am

    We need more doctors like Dr Welnsa who are trained in cross-cultral Psychiatry because even though we have one of the largest pools of medical professionals, they are not geared toward dealing with mental health problems. Thank Dr. for what you do! All the best!

  4. 4 Petrina Yemane Aug 21st, 2012 at 10:14 pm

    Great interview with Dr. Welansa Asrat. Many countries and Caribbean island take the view of Mental Health issues as possession of evil spirits and shun the idea for reaching out to Mental Health Care professionals and clinics. It will take awareness like this article and education within the community to change the stigma to what I like to call “Talk Therapy” which is non-threatening. Practicing in NY and VA, it has become clear there are really two channels or branches for one’s mental health status; being emotional and/or mental. Dr. Asrat outlined the risk factors for mental illness. “Emotional illness” is much more covert, leading to domestic violence, mistreatment of children and suicide.

    The Ethiopian community is excellent at providing support to family members with marriages, child care and individual support based from cultural attributes, as reported in the article. The jewel to this interview is the concept of knowing when helping a particular individual, the family and community support is not enough. Part of family support is also taking action in encouraging the person or couple to seek professional help while having loved ones standing behind them. Please continue posting interviews like this one for increasing education and offering safe and valuable information from clinicians who are culturally sensitive.

    Petrina Yemane, MA, PC/MHC

  5. 5 Hirut Mekonnen Aug 21st, 2012 at 10:27 pm

    There are some very angry people in our community who need some serious anger management like the guy in Dallas. too late for him.

  6. 6 Addis Aug 22nd, 2012 at 12:00 am

    Very informational discussion. shame and stigma that is attached to mental illness in our community is also attached to AIDS patient, fistula paints, etc. I am happy to see such distingushed Ethiopian expert who undeerstands our community educating us on the subject. I especcially found the Canada study eye opening. I think we need to ininiatite similar research in the U.S where there is high concentration of Ethiopians like D.C. Minnesota, etc.

  1. 1 Abey Girma, Suspect in Murder of Ethiopian Dallas Restaurant Owners, Moved From Colorado to Texas at Tadias Magazine Pingback on Nov 22nd, 2012 at 2:44 am
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