The impact of migration on the mental health of the BetaIsrael the Ethiopian Jewish community in Isr

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The impact of migration on the mental health of
the Beta-Israel (the Ethiopian Jewish community
in Israel).Anne-Marie Ulman MDBeer Yaakov
Mental Health CenterSackler Faculty of Medicine,
Tel Aviv University
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• Centre Georges Devereux
• Universite Paris 8 Saint-Denis
• http//www.ethnopsychiatrie.net

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• The Beta-Israel
• The Ethiopian Jewish Community
• in Israel

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• Todays community 120.000 members
• 1984 Operation Moses
• 1991 Operation Solomon

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(No Transcript)
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Ethiopian-Jewish culture

• Lived in the highland villages in the
  north-western regions of Gondar and Tigray
• Tribal cultural model (the Shmaglotchs law)
• Patriarchal family organization
• Oral transmission of the tradition

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History

• 18th century James Bruce uncovers the existence
  of the falasha
• Prof. Joseph Halevy (1867)
• Establishment in Abyssinia before the
  development of the Talmud as cause of the
  difference in rites between Beta-Israel and the
  rest of the Jewish Diaspora
• - Dr. Jacob Faitlovitch Prof. Halevy follower,
  dedicated to the cause of the Ethiopian Jews,
  promoter of their education

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Literature review
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Psychopathology among Jewish Ethiopians
(I)Arieli Aycheh, 1991

• Two major sources of psychological distress
• - The trauma of the journey
• Comparable to the experience of Holocaust
  survivors
• Inability to respect burial tradition
• Guilt feeling toward the family left behind
• The interface with the Israeli reality
• Control of Hebrew
• Economic status
• Place of residence
• Religious issues

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Somatization not yet understood as an expression
of psychological distress Arieli Aycheh, 1991
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Psychopathology among Jewish Ethiopians
(II)Arieli Aycheh 1991

• 37,3 -------------- anxiety
• 28,4 -------------- depression
• 29,4 ------------- somatization
• 11 ---------------- psychosomatic activity
• 28,8 -------------- sleep disturbance, nightmare

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• The culture shock was directly responsible for
  the psychopathology found among the Beta-Israel

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acculturation stress

• the result of the conflict between the need to
  cope with new values of the host culture and the
  need to stay faithful to traditional cultural
  values of reference.

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The acculturation stress of the Ethiopian
community is among the highest that any community
experienced during the immigration process.
Arieli Aycheh 1991
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Somatization

• - Bodily expression of an emotion or physical
  illness
• - Difficult encounter with the Israeli medical
  system
• - Youngmann (1999) Generalized unlocalized pain
  and pain localized typically in the head, heart
  and stomach are common metaphorical somatic
  complaints

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Other ways of coping with distress (I)

• - Brief reactive psychosis
• (Grisaru 2003)
• - Brief psychotic episodes appeared instead of
  classical PTSD (Grisaru 2003)
• - Eating arrest (Gady Ben-Ezer, 1990)
• - Dissociative disorders among the Ethiopian
  origin adolescents (Ratzoni 1993)

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Other ways of coping with distress (II)

• - Adolescents dissociative reaction could be
  connected to the Zar spirits (Ratzoni 1993)
• 10 to 12 of the patients presented a Zar Spirit
  link clinical picture
• (Arieli 1994, Grissaru 1997)

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Zar SyndromeCultural norm or pathology?
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The Zar Spirit
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The Zar Spirit (I) Mythology (Kahana, Nudelman,
Edelstein)

• - Common origin to humans and spirits in Garden
  of Eden
• The Zar spirits are the descendants of Eves
  hidden children who were given the power to
  possess their human relatives
• Parallelism between human and magic world

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The Zar Spirit (II)

• - Zar spirits cause specific physical and mental
  afflictions
• - The mental troubles attributed to the Zar are
  considered as curable by negotiation
• - Wadaja monthly gatherings scheduled according
  to the Ethiopian calendar

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The Zar Spirit (III)

• Once the Zar rides his horse he never gets off
  his back really
• (Ethiopian proverb)

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The Zar Spirit (IV)

• - A balazar is someone afflicted by a Zar spirit
• - Not very Balazar is a Zar-Doctor
• - Zar spirits transmitted over 7 generations
• - Zar-clan rival structures hierarchy organized
  (Zar-Doctor, principal adepts, afflicted)
• - Treatment failure are viewed as an admission of
  human inferiority

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The Zar Spirit (V)

• The Zar afflicted are not considered gods or
  even supernatural, but rather humans altered by
  the divine in a mythical time. Zar is a way of
  dealing with invisible forces, fortune,
  misfortune, illness and well-being
• (Edelstein 2000)

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The Zar Spirit (VI)

• Zar spirits, as well as the Ethiopian Jews with
  whom they immigrated, are still immersed in a
  transition process searching for their own niche
  on their way to integration in their new
  homeland
• (Nudelman, 1995)

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The suicide issue (I)(Shoval and al. 2007,
Arieli 1996 )

• 1984 suicide rate among the Beta-Israel
  25100,000 (6100,000 national suicide rate).
• 1986 suicide rates sevenfold higher among the
  Beta-Israel than the natives
• 1991 1992 3 times higher.

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The suicide Issue (III) A survey Conducted by
Means of a Psychological Autopsy(Arieli al.,
1996)

• High risk factors
• - Young married man with family conflicts
• - Internalization of aggression
• - Depression
• - No communication of suicidal intentions

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The suicide issue (IV)How can this phenomenon
be understood?

• - Suicide of Samsonic nature (Arieli 1996)
• - Epidemic wave because of a traumatic
  transculturation process (Durst 1993)
• - Prejudice, discrimination and consequent social
  seclusion (Ringer 2005)
• - Cultural misunderstanding by professionals
  possible cause for under-diagnosis and
  under-treatment (Shoval 2007)
• - Adolescents suicide result of great stress in
  combination with the learning of a new language
  from Israeli counterparts.

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Group Counseling and PsychopathologyAcross the
Cultural Divide The case of Ethiopian Jewish
Immigrants in Israel (Ben-Ezer,2006)

• Cultural competence
• Cultural code
• Parallel process
• Mutual Creative Space

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Metuku
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Conclusion
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The suicide issue

• - Acute problem
• - Inter-disciplinary work
• - Prevention strategy

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The therapeutic issue (I)

• - What do we do in front of concepts that belong
  to another cultural system?
• - How do we create dialogue with systems of
  reference that are not ours?
• - The capacity to work with cultural concepts
  unfamiliar to all the team is a crucial further
  development in the field of trans-cultural
  psychiatry

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The therapeutic issue (iI)

• By trying to conceptualize otherwise we discredit
  a system on the basis of cultural difference
  (Edelstein 2002).
• A patient without any code of reference cant
  express his psychopathologic suffering. It is why
  the process of cultural referent identification
  is fundamental
• (Tobie Nathan 1996)