The Somali community in the UK: What we know and how we ... - ICAR

emerges as the most significant factor in Somali
women’s experience.
Mental health
But the area of health does not only cover disease
and management of life cycle events. ‘Health’
refers to a state of wellbeing, in which physical
and psychological aspects are intertwined. Mental
disturbance is often somatised - anxiety and stress
expressed in aches and pains. Both mind and body
need attention, but it is sometimes easier for
busy doctors to dole out medication. As a Somali
refugee in Liverpool commented:
The doctor does not give me enough time
to explain my symptoms. Before hearing me
out, he gives me painkillers. I am always given
painkillers as a solution. (Xifaras, 1996: 43)
Significantly, there is more material on mental than
physical problems. 111 In her study of the health
needs of refugees in Tower Hamlets, Green (2001:
26) found that it was the Somali community that
had the greatest mental health requirements. In
discussing health, Somalis themselves speak of
the prevalence of mental suffering, ranging from
symptoms of stress to the alarming increase in
suicide, especially among young men. 112 This
is borne out by studies. Farah and Smith (1999:
110; 115-116) found that 46% of the 56 children
referred to the Somali Support Initiative in east
London schools had health problems. Roughly
categorised, 23% had physical symptoms, and 37.5%
mental conditions. The psychological difficulties
ranged from autism and severe conduct disorder
and/or severe learning difficulties to behavioural
problems and traumatic reaction to stress.
In a two year project, Somali Mobility and Mental
Health Research (SOMMER), researchers at King’s
College and Queen Mary, London, are measuring
the prevalence rates of common mental health
problems, levels of geographical mobility and health
service utilisation among Somali refugees living
in the London boroughs of Tower Hamlets and
Lambeth. Preliminary findings, which are based
on a population sample of 143 Somalis, show that
depression, post-traumatic stress disorder (PTSD),
and anxiety disorders are the most common
mental health problems among this community. For
some, geographical mobility and constant changing
of address are also associated with depressive
disorders. 113
Hermione Lovell and Zeinab Mohamed’s ongoing
study of Worries and well-being in the Somali
community in Manchester illustrates the diversity of
the Somali community both in its experience and
interpretation of mental distress. The high levels
of depression which they found appear to have
different roots according to generation. Older
people are laid low by the comparison between
their British reality and their memories of Somalia
- isolation compared with sociable communality;
grey skies, cold, and rain in contrast to the warmth
and brightness of Somali sun. The preoccupations
of their children, with little or no recall of their
homeland, have more to do with the conflict
between their home environment and the culture
of school and peers.
Class and generation are further factors affecting
the level of vulnerability. Elite urbanites may have
suffered the effects of war, but will not feel as lost
as a rural refugee with a nomadic background,
accustomed to the slow rhythm of herding rather
than the rush of cities. Such a transition can
generate a corroding fearfulness, not understanding
how to handle novel situations, alarmed at the
changes in their children, and, as one young woman
put it, “afraid of what they don’t know”. 114 For
the more educated, it is the loss of status and selfesteem
that undermines their confidence.
Cross-cultural diagnosis of mental illness is
famously difficult. Part of the problem is translation.
This is reflected in practice, in the surgery or
consulting room, where, as is most often the case,
practitioner and patient do not share a common
tongue. A friend, relative, or child may be brought
along to interpret, but the lack of privacy can
inhibit discussion of intimate matters or emotional
states. But there are more fundamental problems
of language which go beyond command of English.
Diagnosis is culturally determined, and many of
the categories of western medicine and psychiatry
have no Somali equivalent. Marian Bullivant and
54 The Somali community in the UK