issue 1 09 - APS Member Groups - Australian Psychological Society

States of Micronesia113people of Micronesia. By the early 1980’s,about one dozen programs were initiated withthe purpose of training mental health serviceproviders (Robillard, 1987). Also, a handful ofreports detailing the incidence ofschizophrenia, as well as the status of othermental health issues and the health care systemwere developed during this early period(Hezel, 1987a).However, early attempts at establishingmental health services were largelyunsuccessful (Robillard, 1987). Services werenot only incompatible with cultural norms;there was a lack of fit between services andcommunity needs. For example, standardWestern methods of diagnosing and treatingpatients were implemented based on anindividual-centred framework, with littleknowledge of the importance of theMicronesian’s interrelations with family andcommunity. In addition, although suicide anddrug abuse were the most salient issues, mentalhealth programs paid little attention to them.Robillard’s (1987) evaluation of mental healthservices in Micronesia was quite incisive:“The history of U.S. ‘development’of Micronesia, of which mentalhealth services is but a phase,wears a very thick pair ofinstitutional blinders, a mask sototally composed of the structuraldynamics of the centre that there isvirtually no space and time toconceive of or implement anythingbut the most conventional Americanmental health servicesystems.” (p.235)It was evident that for interventions tosucceed, knowledge of the causes andtreatment of mental illness amongMicronesians had to be broadened. Severalauthors have embarked on this undertaking andtheir analyses have generally pointed to theeffect of increasing Western influence (Dale,1981; Hezel 1987a, 1987b, 1989, 1993; Lowe,2003; Rubenstein, 1983, 1987, 1995, 2002).These authors have linked such social changesto suicide and psychosis, especiallyschizophrenia.Hezel (1987a) may have been one of thefirst to suggest that the increase in the rate ofmental illness was linked to social changes inMicronesia. More specifically, Hezel (1987a,1987b, 1989) provided insightful explanationsof the relationship of changes in social andfamily dynamics and suicide in Truk.Examining the types of suicide committed, itwas found that most related to family problems.It is the changes in values and relationshipsamong parents and children that lead toconflicts. For example, youth may increasinglydemand acknowledgement of their ‘rights’,which was never an issue in traditional society;on the other hand, parents may be pressured todemand that children prove themselves withsubstantial cash incomes rather than traditionalfood production and tending to the home.Changes in the distribution of wealth andauthority, as fathers are encouraged to earnmore money and become independent fromtheir wives’ lineages, subsequently impact theinterdependence and security within theextended family.These changes often clash with preexistingways. Under stress, historical culturalnorms such as bravado (in males), enduringsuffering as proof of love, and need forrecognition, also influence one’s decision tocommit suicide (Hezel, 1987b). The culturalnorm of avoiding conflict may also be a factorin suicide, as it provides a means of removingoneself from the situation (Saleh, 1996). Inaddition, the suicides appear to be highlyculturally patterned and influenced by previousacts, appearing to be to some extentromanticized (Rubenstein, 1987).Lowe’s (2003) more recent analysis ofadolescent and youth well-being in Chuukprovides a complementary and expandedaccount of precursors to psychosocial stress. Hediscussed the importance of identity formationfor young people and their challenges innegotiating their identities across multiplesettings. When constructing an identity in oneThe Australian Community Psychologist Volume 21 No 1 June 2009