Mental Health and Wellbeing

Intercultural Perspectives

Charles Watters

• Publisher: Bloomsbury Academic
• Year: 2019
• Print ISBN: 9781137610225
• eBook ISBN: 9781350313118
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

Mental Health and Wellbeing is a timely new book that explores these increasingly important subjects from an intercultural perspective. This is essential reading for anyone studying or working in mental health at this time of unprecedented levels of human migration and when mutual understanding of diverse cultural perspectives is of vital importance.

1	Introduction Charles Watters

A walk through any city or provincial town in, say, contemporary England, France, the USA or Brazil reveals the impact of heterogeneous ideas and services relating to mental health and wellbeing derived from many parts of the globe: Chinese and Ayurvedic medicine, yoga, reiki, tai chi, chi-kung, mindfulness, various forms of massage, sauna and spa treatments. Some of these practices are relatively recent, for example, the growth of mindfulness, in a secularised form outside of a Buddhist context, can be traced to the 1980s while yoga and tai-chi have been present for several decades more. Some practices were brought as part of a migratory process, for example, Chinese medicine was originally established to serve the needs of the Chinese and South East Asian diaspora just as Ayurvedic and Unani medicine travelled with migrants from Hindu India and the Islamic world. With rapidly accelerated migration and exchanges of ideas, treatments and understandings of the relationship between body and mind from many parts of the globe have become co-present with conventional forms of medicine and, in some notable cases, been incorporated into mainstream health systems.

In the contemporary world it is routine for people in many countries to blend diverse practices drawn from many traditions in seeking wellbeing in their daily lives. It is, for example, unremarkable nowadays for someone to go to morning yoga or meditation before coming to work, or for institutions to offer staff sessions on mindfulness, yoga or tai chi. Despite the fact that these systems and practices are informed by distinctive models of the body and understandings of how mind and body interrelate, in practice people seeking wellbeing navigate seamlessly between them. Models and practices may be derived from different parts of the world: e.g. India, China, Scandinavia, Japan and many are centuries old. While these have originated in specific localities they have, over time, crossed continents and, in doing so, adapted and been informed by new environments and cultural contexts. Adherents of particular practices may have been originally from specific ethnic groups, but as these modalities have travelled they have attracted interest from diverse and heterogeneous populations.

This book examines how models and practices of mental health and wellbeing intersect in an age of migration and mobility. It aims to complement an array of recent books that have offered critical overviews of models and theories of mental health and insights into policy and practice (Davidson et al., 2015 Glasby and Tew, 2015) but is significant not least in looking beyond the Western tradition at the dynamic intercultural influences on models of mental health and wellbeing . It is informed by recognition that we live in an age of unprecedented human movement that, accompanied by the development of digital technologies, has given rise to an extraordinarily rapid exchange of ideas. This environment has a profound impact on mental health and wellbeing giving rise to at least two substantive questions:

How does cultural and ethnic diversity impact on people’s mental health and wellbeing?

How is the shape of services and treatments changing in multi-ethnic and multicultural environments?

In addressing these questions the arguments presented in this book challenge notions of boundedness, and national and cultural homogeneity. A brief initial example would be the case of tai-chi, a form of exercise that can be found in many parts of the world including China, Japan, Europe, North and South America and Australasia. Tai-chi is commonly thought to derive from 13^th century Chinese martial arts. However, the roots of tai-chi can be traced further back, to the Tao Te Ching, an ancient Chinese text, from 2,300 to 2,500 years old (Waley, 2013) that emphasises balance between humans and the natural environment as fundamental to wellbeing. The text gave rise to a series of exercises aimed at enhancing bodily and psychological harmony consistent with laws of nature. These exercises are informed by an understanding of nature as consisting of fundamental types of energy, yin and yang. Yin energy is associated with qualities such as femininity, softness, darkness, primordial formlessness while yang is viewed as a male energy associated with dynamism vigour, light and form. For wellbeing, these energies must be brought into balance as imbalance results in poor health; physically, emotionally and psychologically. Tai-chi is a technique that restores and maintains harmony, so that body, mind and emotions become integrated. While rooted in ancient Chinese understandings of the relationship between body, mind and nature, the practice of tai-chi is increasingly recognized in Western countries as having benefits for both mental and physical health. The UK National Health Service (NHS), for example, advises that for tai-chi ‘studies have shown that it can help people aged 65 and over to reduce stress, improve posture, balance and general mobility, and increase muscle strength in the legs’ (NHS 2019).

While the claims made by the NHS are more circumscribed than those that may be found in traditional Chinese and Japanese medicine, it is notable that an exercise form, derived from very different cultural roots has found a degree of official recognition within one of Europe’s largest mainstream health systems. Moreover, the benefits here are identified as both physical and psychological, impacting on both stress and posture, suggesting a holistic perspective on wellbeing. Tai-chi may be seen here an example of the transitions that are made between geographical and cultural contexts and also the transformations that may take place in practices from one cultural context to another. In further examples, mindfulness practices have transitioned between roots in Buddhist monasticism and to incorporation within various Western medical programmes. In the course of this transition the practice has transformed into a secularised form consistent with the organizational cultures of hospitals, schools and workplaces. Thus here I refer to transitions as global movements of ideas and practices relating to mental health and wellbeing and transformations as the way these have been adapted in different cultural, social and economic contexts.

The idea of transitions and transformations is fundamental to the use of the term intercultural in the book. It is employed here to bring into focus the ways in which cultures impact on each other through processes that result in dynamic cultural change. A central argument is that an understanding of the contemporary landscape of mental health and wellbeing, both in terms of ideas and service developments, is best understood as involving these dual aspects of transitions and transformations. This dynamism is arguably not adequately conveyed by the term ‘multicultural’ as this may suggest an image of cultures existing alongside each other with little mutual influence. The Nobel Prize winning philosopher and economist Amartya Sen, for example, points to this limitation in referring to multiculturalism as suggesting what he terms ‘serial monoculturalism’ in which people are seen as existing within fixed cultural worlds with little interpenetration (Sen, 2007). By contrast, the idea of culture employed here echos contemporary anthropological understandings, in which cultures are seen as dynamic and in flux. It thus departs from a view of cultures as ‘homogeneous systems, which produce individuals who are culture-bearers and whose behaviour is largely determined by shared cultural models, values and perspectives’, towards viewing culture as a process, not a thing, and ‘part of, open, fluid, dynamic systems with much internal variation, conflict and contestation’ (Kirmayer, 2012 p97).

The term intercultural here also seeks to convey a sense of cultural transitions and transformations as involving the role of agents, including individuals, communities and institutions. There are parallels to the idea, found in historical studies, of ‘intercultural transfers’ – referring to transitions of cultural products, including artefacts and technologies between countries, and the role of individuals and institutions in giving and receiving countries. The idea of intercultural transitions used here is close to that of cultural diffusion through which behaviour patterns, ideas and artefacts are transmitted within and between locations and generations (Whiten et al., 2016). In the present context the terms intercultural, transitions and transformations are thus used in what may be seen as a nuanced and expanded sense to refer also to transfers between groups who have migrated between countries and processes of cultural appropriation that may be legacies of colonialism and consequently imbued with power relations. The agents here may be people who have migrated, established themselves in a new country and developed new relations with their countries of origin. An example may be those of Indian origin in the UK who may maintain, or may have developed, a wide range of relations of exchange, encompassing ideas and material goods, with the country of origin and perhaps the Indian diaspora elsewhere. It also may encompass examples in which a dominant power simply takes ideas and artefacts from another country or culture and adopts them as their own with scant or no acknowledgement of how they were produced and their place within their original cultural context.

Mental health and wellbeing in an age of migration

A central argument here is that an intercultural perspective is vital at a time of unprecedented human migration and mobility and simultaneously, an historical moment in which there is unparalleled engagement with, and incorporation of, models and practices aimed at enhancing wellbeing and mental health that are derived from very diverse cultural contexts. Indeed, it may be argued that one cannot comprehend or engage fully with current beliefs and practices relating to mental health and wellbeing without deepening one’s understanding of the dynamic interpenetration of diverse cultural perspectives and models. In this, the spheres of mental health and wellbeing are consistent with, and present challenges akin to, other areas of development in science and the humanities. Human history is full of examples of migration and cultural borrowing and acquisition across a spectrum that includes art, architecture, language, philosophy, religious traditions and practices, technology, political models and fashion. Ideas of ‘the good life’ and the components of human wellbeing have also travelled across continents and through centuries with, for example, Aristotle’s ideas relating to hedonic and eudemonic happiness still forming a basis for academic research and debate on wellbeing centuries after being first formulated in ancient Greece.

However, while there is a long history of salient ideas and practices traveling across countries and regions, the present age may be seen as distinctive in terms of the breadth and diversity of cultural influences and the rapidity with which they are transmitted and transformed. A factor here is the scale of human migration which, as Castles and Miller have observed, is increasingly globalised with a ‘tendency for more and more countries to be crucially affected by migratory movements at the same time’ and ‘international movements of people growing in volume in all major regions’ (Castles and Miller, 2009, pp.10–11). Moreover, the contemporary world is characterised by a ‘differentiation of migration’, whereby most countries do not have simply one type of immigration but a whole range of types at once, such as labour migration, permanent settlement, and the arrival of refugees and undocumented migrants. The differentiation is also notable in terms of the range of people who migrate, with women increasingly in the vanguard of migratory movements, as well as children, many of whom are undocumented and separated (Ruis-Casares et al., 2012, Watters, 2007)

As people migrate, they have introduced diverse ideas about what constitutes the good life, including views on how to bring up children, appropriate business practices, suitable modes of dress and manners, perspectives on the purpose of life and the moral codes people should live by. In some cases this has challenged practices within receiving societies and they, in turn, have had mixed and often polarised reactions to migrants, some seeing them as bringing benefits not least in terms of economic development, with others seeing them as a drain on limited public funds and taking employment opportunities from the indigenous population. Tides of resentment towards migrants – that are particularly manifest in contemporary times towards asylum seekers, refugees and undocumented migrants – have been evident across the globe with many harrowing accounts of racial abuse and discrimination as well as denial of access to services and jobs (Castles and Miller, 2009).

While migration in general has increased and diversified, forced migration in particular has undergone a comparable range of transformations. The scale and diversification of forced migration is due in no small part to the changing nature of war, in which large scale conflicts involving battles between soldiers of opposing armies has been accompanied by a plethora of `low intensity conflicts’. These mirror shifting power dynamics in the post-Cold War age, in which conflicts between a relatively small number of `great powers’ and their allies jostling for strategic and material advantage have, in some instances, given way to more fractured forms of conflict. Following military engagements in Iraq, Afghanistan, Libya and other Muslim countries, disparate but often networked groups increasingly resort strategically to civilian targets such as subways, trains, tourist resorts, theatres and airports as evident, for example, from the 9/11 attacks on the World Trade Centre, the 2004 Madrid train bombings, the 2007 subway bombings in London, the attacks at the Bataclan Theatre and the Stade de France in Paris in 2015, the killings of tourists in Tunisia in 2015, and the Brussels Airport and Nice attacks in 2016. The complexities of contemporary conflict are demonstrated in many contexts including the case of Syria where the Assad regime has been supported by an international coalition including Russia and Iran, while opposition forces have been backed by uneasy alliances involving Western powers such as the USA and UK and regional partners including Saudi Arabia and Turkey.

At the time of writing, conflicts in Syria, Iraq and Afghanistan are major driving forces of contemporary forced migration. According to 2018 figures provided by the United Nations High Commission for Refugees, 70.8 million people were forcibly displaced at the end of 2018, the highest figure ever recorded by the agency, a figure roughly equivalent to the total population of the United Kingdom. This figure includes a significant number of internally displaced persons (IDPs) with the number of people uprooted in their own countries growing to an unprecedentedly high number of 41.3 million (UNHCR, 2018). These figures are also exacerbated by a very low proportion of those crossing international borders feeling able to return to their own countries, owing to protracted violence and upheaval. The origin of refugees reflects the changing face of global conflict with over half coming from Syria, Afghanistan and Iraq alone. The broad impacts of displacement are also illustrated in the multiple destinations of refugees showing, for example, that the 4.9 million Syrian refugees are present in no less than 120 receiving countries worldwide. Evidence that all parts of civilian society experience the impact of armed conflicts is provided by breakdown of the population of concern by age and gender, indicating that approximately 48% are women and 51% children under the age of 18 (ibid.). In sum, current trends point to the fact that forced migration is a growing phenomenon in the modern age. It is increasing in terms of the sheer numbers of persons involved, in the types of migrant journeys that are taking place, in the diversity of migrants’ nationalities, ethnicities and religions as well as in the diversity of gender and age.

Besides the issue of migration is that of human mobility. While migration relates to movement with the intention to settle (at the very least temporarily) in another country or region, mobility points to the way in which people move around the world without intention to settle and develop networks in different countries and locations. Eisenlohr has, for example, examined the extreme mobility of Muslims in Mauritius, who have developed networks in the UK, USA, India and the Middle East and through business and family ties maintain valued relations across these countries (Eisenlohr, 2012). The anthropologist Thomas Csordas has pointed to the importance of mobility in generating the flow of religious ideas and practices, including perspectives on wellbeing. These may involve the generation of quite specific links between countries and he offers examples in which practices adopted in the West have subsequently led to the development of teachers who have, in some instances, returned to the country where the practice originated. He notes that ‘travel between Brazil and the Netherlands resulted in expansion of the Santo Daime church to Europe, the mobility of Korean shamans creates a global reach for their activities, and the ability of American yoga practitioners to relocate to India results in a return globalisation of Hindu practices from their instantiation abroad’ (Csordas, 2007, p.262). Contrary to the idea of religion being a manifestation of resistance to globalisation, Csordas has noted the extreme mobility of religions and practices associated with religions. There are numerous examples, from the rise and spread of evangelical churches across the Americas and Europe (a phenomenon that is often linked to migrant populations, for example, Latin American churches such as the Assembly of God, that has found roots in London through the Brazilian population), to Buddhism where different forms of the religion have spread from South East Asia across North America, Europe and Australasia. The practice of mindfulness, rooted in Buddhism, has developed in a secularised form and gained significant traction across the globe entering into mainstream health and social care services across many Western countries. This secularised form of mindfulness practice has been subsequently introduced into Thailand where it forms part of therapeutic hospital programmes (Cassaniti, 2018).

One can discern here a process of ‘return migration’ for certain cultural practices associated with mental health and wellbeing in which a practice adopted in the West has been transformed, appropriated and then exported to a country of origin. The anthropologist Cassaniti provides a vivid account of her conversation with a nurse in a psychiatric hospital in Thailand in which the nurse describes the secularised programme of mindfulness they have introduced from the USA. The nurse acknowledges that mindfulness is ‘totally a Buddhist concept’ but that she cannot teach it in a Buddhist way, ‘because we do the programme from America, and they don’t teach it that way. We get our funds from there … ’ (2018, p.5 author’s emphasis). In this instance, the practice has transitioned to the West, transformed there and reintroduced to a country of origin in its transformed state.

The diffusion of ideas is also influenced by the exponential growth of digital communications. The latest ITU data estimate that more than half of the world’s households (53.6%) by 2016 had access to the Internet at home, compared with less than 20% in 2005 and just over 30% in 2010 (International Telecommunications Union, Geneva 2017). Within the physical context of family households, there is potential to engage with vast global sources of information and networks. However, there is a digital divide in that those in lower income countries have generally more limited access, for example, through low broadband speeds and are more often recipients of internet content rather than its creators. In the sphere of mental health and wellbeing the internet is a powerful tool in disseminating ideas about what it me...

Table of contents

• Cover
• Title Page
• Copyright
• Contents
• Acknowledgement
• 1 Introduction
• Part 1 Perspectives on Migration and Mobility in Mental Health and Wellbeing
• Part 2 The Changing Landscape of Services
• Bibliography
• Index