Respectful To The Family

I frequently get young African patients at the hospital - about a dozen a year, which is a lot considering the base we are drawing from. They do not come in for anxiety disorders or personality disorders.  Some affective disorders - depression more than mania - but mostly for psychotic disorders.  I imagine there is a lot of PTSD out there, but families don't tend to bring their children to the emergency room for anything other than psychotic thinking plus some threat of violence.  Perhaps PTSD and depression do not even register on a scale of abnormality in refugee families.

Yet when I speak with the parents, an odd equivalence shows up.

Let me first note that with all families, there is a tendency for the parent to want to launch into discussions of how the child has had problems since kindergarten, or has had not thriven these past fifteen years since graduating highschool, with details about individual events that took place in 2011 that are nearly always irrelevant. (Head injuries are relevant.  Deaths of close relatives maybe.  But even sexual abuse and divorce from a decade ago are not explanations for a crisis today.  "Why now?" is a frequent question of ours.) So the tendency to try and get the hospital to become involved with some overall solution to chronic problems is not confined to African families.  Also, even though it is almost always Mom I am talking to, that is likely a selection bias of Moms remaining involved and wanting to talk about it.

With that out of the way, I notice that African parents speak about things that American parents would regard as minor or typical problems as if they were just as weighty as the suicidal statements.  "She does not speak respectfully to her father."
"He wants to braid his hair and have an earring but I tell him I will not allow that (he is 19) because he is not a girl."
"He uses bad language in front of his sister's children."
"She stays in her room and texts to her friends and does not talk to us."
American parents would certainly recognise these things as behaviors that might be controversial and even lead to grown children being asked to move out.  Yet they are not on the level of suicidal statements. To African families - my experience is at least three each over the years of Sudanese, Congolese, CAR, Gambian, Kenyan, and South African, with six? ten? other countries of one each - these behaviors apparently are equally concerning

I think back and try to remember if Vietnamese, Nepalese, or Bosnian parents (three groups I have more familiarity with) say these things.  A little, perhaps, but I am quite sure not that strong.  Hispanic parents - not at all.  I have never heard these complaints from those parents. Russians, no. Afghanis, interestingly, there is simply no comment from the parents about these things at all.  We just find out that the children were beaten later.

The Middle East. (Recalculating...recalculating...) We receive mostly rich Saudi children, whose bad behavior is tolerated endlessly at home but gets you arrested in America - beating up prostitutes, or taking lots of drugs (but no alcohol) for example; or aged psychotic aunts and uncles, who the families are attempting to farm out to us. The family relations may be important back home, but don't leak out to American social workers.

Some thoughts: In these African cultures, children are not asked to leave the house, no matter how bad their behavior, so bad behavior is more of a concern.  Is that the reason?  Or - in the high-conflict, high-violence cultures that refugees come from, is family solidarity such a hugely greater survival need that such deviations imperil everyone and must be squashed mercilessly?

Reading back over this...  You could turn me in for being horribly racist and prejudiced, couldn't you?  Please do.   I am near retirement and can say things that others cannot, and the real information must leak out somehow.  Not that mine is anything like a complete story.  I might have gotten the Bosnians and Kenyans wrong.  You will have to find one hundred other superannuated social workers to get a fair picture.  Die Gedanken Sind Frei.




Disclaimer: This might be some horrible neo-Nazi group who I would disagree with 99.9% of the time. I just like the feeling of it, not for the whole post, but for my final paragraph.