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Hmong face cultural hurdles to mental health care
By Kaomi Goetz
Minnesota Public Radio
August 27, 2001
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Mee Xiong, 27, of St.Paul, is undergoing psychiatric testing to determine whether she should be committed to the Minnesota Security Hospital for mental illness or stand trial. The Hmong immigrant stabbed to death two of her children last month. Court records say Xiong suffers from paranoid schizophrenia and has a long history of mental illness dating back to her days at a refugee camp. The case illustrates a larger problem confronting the Hmong community - how to recognize and effectively treat mental illness.

A pig is slaughtered as a sacrifice to the bad spirits in a shaman ceremony to help a Hmong girl who is having hallucinations. Many Hmong still seek out shaman to deal with mental illness, instead of pursuing western treatments.
(MPR Photo/Kaomi Goetz)
  • See a RealAudio slideshowof a shaman ceremony.
  • Read moreabout the Hmong religion, Ua Dab.
    THERE IS NO WORD FOR MENTAL ILLNESS IN THE HMONG LANGUAGE. What western science knows as mental illness, traditional Hmong religion Ua Dab says is a sign of an evil or unhappy spirit. When an evil spirit takes over the body of a person, a shaman is called in to appease or drive out the spirits.

    Incense fills the air of a living room in St.Paul where 10 relatives of a 17-year old girl have gathered. The girl is suffering hallucinations. The family believes she has been taken over by the Spirit of Death and may soon die. A Hmong shaman wears a black hood and clutches hand cymbals. He gyrates and chants before the group. A slaughtered pig is offered as a sacrifice to the evil spirit. A goat, representing the seriousness of the illness, was sacrificed earlier.

    Chanting in Hmong, the shaman says he's traveling on horseback into the spirit world to reclaim the spirits of the young woman. The shaman warns the evil spirits he is ready to do battle. He stomps his feet to get their attention. The chanting could last for hours.

    Following the ceremony, the family will eat a meal consisting of the sacrificial meat and by doing so, believe they will eat away the evil.

    Since this ritual, her father reports his daughter has been cured. But if the hallucinations return, the family will likely not turn to a doctor, but instead try another shaman. Hmong leaders say while not all immigrants utilize shaman, the practice is still used by the majority of Hmong living in Minnesota to address both physical and mental ailments.

    "Right now, the very first step is getting the community to acknowledge they have mental illness,"says Mee Vang, executive director of Hmong United International Council. The council represents the state's nearly 42,000 Hmong. Vang says the group encourages Hmong to seek out western doctors for treatment of mental illness. But Vang says western medicine is still not widely accepted.

    "A lot of people are still adjusting, that there's other expanations on why someone is sick - not just the soul. Things that the shamanistic rituals can't explain anymore," says Vang.

    Dr. Paul Reitman, a forensic psychologist at Fairview University Hospital, says his Hmong patients often wait until late stages of an illness before seeking help.

    "I don't believe the Hmong community accepts psychiatry as Western culture," says Reitman. "The average person in America might consider that psychiatric care has a place. I think people in the Hmong community will not acknowledge symptoms as a symptoms of a mental illness. Instead they'll look at their symptoms representing a physical ailment, or they might even think of it as demons."

    Reitman says many of his patients come to him only after the shaman has failed to cure them. And he says his Hmong patients will often stop taking prescribed medicine if they believe they're cured. Not understanding the concept of ongoing or preventative treatment can result in tragedy, as in the case of Mee Xiong. Relatives say she had consulted a shaman to cast out the evil spirit. According to court records, Xiong had also seen a Minnesota psychiatrist for the past four years, and was under court order to take medication. Reitman says Hmong people are no more prone to violence or mental illness than people from other cultures.

    Ilean Her of the Council of Asian Pacific Minnesotans, and others in the Hmong community, insist these shaman rituals work in some circumstances. But she admits shamanism can't cure everything. And shaman are not known to recommend a western doctor. She says such sole adherence to shamanism can have negative consequences.

    "I have a friend who teaches in Minneapolis public schools and she has a child with a learning disability. She told the parents, and they say 'Oh no, we go to a shaman to fix it or through traditional Hmong medicine to fix it.' In two or three years the learning disability has gotten worse because the intervention hasn't been given to him," says Her. "It's a detriment to the community. I'm not saying shamanism doesn't work, but at the same time, there are certain conditions if you are not treated right away, your condition becomes worse."

    Her says by coming to the U.S. and jumping 200 years into the technological future from their hill tribe way of life, the Hmong face tremendous stress. Some 35,000 Hmong were killed aiding U.S. forces during the war in Southeast Asia, a high percentage of their overall population. This means nearly every Hmong immigrant in Minnesota lost a friend or relative due to the war. She says turning to a shaman is one way to maintain a link to their traditional culture.

    "Depression, loneliness, isolation, particularly of the older generation, where they feel they don't fit in, they don't belong, they miss home, they miss their country, they miss their food, and then it becomes more complex," Her says. "The experience of coming to America, acculturation, is an additional stress on pre-existing mental illness within the community. It intesifies depression, it intensifies paranoia, and they don't have a basis to understand that."

    Health care providers are discovering ways to reach Hmong acceptance by blending their practices with shaman understanding. A Wilder program is staffed by Hmong and educates about mental illness using Hmong language materials. A St. Paul Hmong women's support group and an elders drop-in center in Minneapolis offer help to combat isolation, family problems and cultural adjustments.