Cultural/ Spiritual Family Beliefs

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Home – NEW Forums Module 2 – Care for Early Psychosis Fall 2023 Cultural/ Spiritual Family Beliefs

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    • #10620

      Hi all!

      I’ve heard from multiple people some of the challenges of working with families specifically around their spiritual/religious/cultural understandings of psychosis.
      What have you found that has helped? What has not gone as you had hoped?

    • #10626

      Hi Katy, I’m really glad you posed this question because I’ve been thinking about this topic since I started the training. In the past I worked with a family whose 12 year old daughter was referred for CYMH service by her school after school staff had observed her talking to herself (a few minutes a day, almost every other day) and appeared to be distracted in class due to internal stimuli. The family brought the youth in for service but did not appear concerned about their daughter’s symptoms. After talking with my client I learned that she knew her peers and teachers may be concerned as she stated she was talking to people that others couldn’t see due to her ability to converse with dead relatives. When I conveyed this information to parents they too already were aware and reported that they were pleased their daughter had this gift as within their culture this was a revered ability. As defined by the DSM/western lens, the youth was experiencing hallucinations, however, neither the parents nor the youth reported they had concerns and denied that the symptoms were life interfering aside from the youth sometimes being self-conscious when peers noticed. The youth was also not distressed by these hallucinations. My attempts to engage the family were ultimately not successful as the youth and the family indicated that they did not think treatment was necessary, and I closed the file. This experience caused me to have a lot of questions, one being: Is not pathologizing symptoms, and in fact celebrating them, correlated with a better prognosis?

      • #10641

        Hi Katy, thank you for your post. This is something I have been thinking a lot about as well. I’m a new MSW counselor with E.P.I., so I have more questions than answers at this point.

        Amber, thank you for sharing your example. I would love to learn more about comforting figures people experience in their hallucinations, and how this can mitigate distressing hallucinations and enhance self-efficacy. Also, I wonder if this individual and their family would have held the same perspective if the youth experienced distressing hallucinations. This is a very interesting case study.

        Amber, you pose an excellent question – a question I see as related to stigma, attitude toward mental “illness”, and influence on stress, symptoms, and prognosis. A few months ago, I began slowly collecting research on various cultural perspectives of psychosis, schizophrenia, bipolar, and alike “disorders”. It is hard to find time in my schedule to do this research, but I hope to bring some of this into future posts.

        How our practice might shift if we pre-emptively engage in cross-cultural learning, expanding the way we view these “disorders” and our clients?

        • #10644

          Thank you Holly. This is something I have wanted to build knowledge on also. It would help to know different views so as to better communicate with families in a way that is more open and accepting. I fear that with pathologizing people would put up walls. Having a more open approach from the beginning may help mitigate these walls going up.

          • This reply was modified 5 months, 1 week ago by Mandy.
          • This reply was modified 5 months, 1 week ago by Mandy.
      • #10685

        Amber– I agree with Holly. What an interesting case study! I would be super curious to know if she continued to see/ converse with her deceased relatives and the “symptoms” stopped at that, or if she ended up experiencing more/ distressing signs of psychosis.

        Holly– I look forward to you sharing your research. I appreciate the idea of pre-emptively engaging in cross-cultural learning. I now wish this was a live discussion!

        Katy

    • #10630

      I have had a couple experiences with families not agreeing with treatment options related to their family members while working in acute care. They were attempting to treat their family members with herbal tinctures which in one case was exacerbating the symptoms their family member was experiencing. It was a difficult situation to be caught in as they were firm in their belief systems and it was a very Western vs Eastern medicine. In the end, the family took the patient home, the decompensated and required on the unit and were treated under the mental health act. Even now this still sits with me and I wish that there was a better way to incorporate their views and those of Western medicine. It made for very difficult interactions with family for those working on the unit and a distrust in the care being provided by the family and the client.

      • #10686

        Oh man I’m sorry to hear that Shannon. It sounds really distressing, especially to hold the competing ideals of treating with Western medicine and also honouring their views. Have you ever seen this done?

        During covid, I worked in the ICU as a social worker for a few months. There was one nurse in particular who was amazing. This was during peak delta-virus, where the precautions were super high. We had some Indigenous families who would bring stuff in for their loved ones whose room they were not allowed to enter. This nurse would take their bear grease and things they brought and rub on it on the patient as the family directed. I thought it was a really beautiful way to incorporate some traditional Indigenous beliefs in a really intense westernized hospital setting. I never had the chance to speak with the family about their perspective on it though.

    • #10632

      I live in an area with varying cultures and population with different beliefs. There are many different perspectives and beliefs regarding psychosis and related mental health symptoms in my own experience, respecting cultural differences is key. What has helped me with this in my own career is learning about the different cultural pieces whether from family, the client, or research based resources while integrating this into my own practice. I have had youth that vary with their on beliefs in comparison to heir family, working to empower youth with a neutral lens is key, especially when supporting youth and family who may have different thoughts from each other.
      In regards to your discussion Amber, I have had similar experiences, I have found again that with little to no safety risks identified or aligning direction from legal responsibility appreciating the individual experience and respecting their own outlooks is key to practicing in a world with such diversity. It sounds like you did just that, reflecting on this interaction is there anything you wish you knew at the time you were working with the client?

    • #10647

      Great Question Katy!

      I too have thought about the complexities of working with clients and families whose beliefs or spirituality do not align with Western Medicine principles. In case of one EPI client I have worked with the family recognized that their child’s behavior (delusions and hallucinations) was atypical but were opposed to most Western Medicine treatment practices (medications, lab work etc.). It was quite difficult as the treatments they were preferring to use were not working. However, with time we were able to come to a compromise of sorts and found it helpful to focus on the fact that both the mental health team and parents just wanted what was best for the child.

      • #10687

        Zoe, this sounds like a similar perspective to some families that we also work with. I really liked how you were able to build enough trust to find something you could agree on– what was best for the child.

    • #10689

      Super appreciative of you starting this thread, Katy, and all of the comments and questions brought forward, as I can relate to a few of the challenges mentioned.

      Similarly to Amber, I once supported a young person who was hearing voices of deceased loved ones, or other “spirits” and her mother described her as clairvoyant and having a special gift. To our team’s knowledge, this young client was also actively using meth, so there was great concern that the symptoms were substance-induced. It was challenging to get her to engage in treatment, due to her family’s views and not seeing the presentation as a problem. Unfortunately, in her case, and similarly to the case shared by Shannon, the youth decompensated to the degree that she was also certified and admitted to the Carlile Centre involuntarily. We saw huge improvement once the substance use had been treated. It really is unfortunate that, in many of these cases, folks have to get worse and be admitted under the mental health act in order for their psychosis to be treated. Our team is currently dealing with a client who is at great risk of relapse, after having been taken off extended leave and discontinued his medication. The narrative is that he will just “end up back in hospital” and then be certified again.

      Looking forward to hearing more about your research, Holly! Perhaps there may be an opportunity for a future discussion around how we can engage in cross-cultural learning and better hold space for and honour multiple perspectives on psychosis, while also attending to our responsibilities as clinicians working within the medical model and provide care that supports the best possible outcomes for our clients.

    • #10886

      Great question, and thank you all for some great discussion. When we listen and focus on understanding, this is always a great place to start. I think it’s the best chance of bridging any gaps in how we understand what is happening and then also how we would see treatment going. Of course, over the years, teams will encounter families with a range of beliefs, experiences, and wishes that do not align with the Western Medical model approach. When possible, the family are a great source of information about who else could educate the team – who are the leaders in their group? what is generally done to assist people facing similar things? do they even think this is a problem? are there times that even within their own practices that people would seek help because what started out seeming like a gift has taken a turn in some way? I’ve seen our teams be able to bridge these big gaps, and I’ve also seen times when we have not been able to. Many examples come to mind. The best results seemed to come from us reaching out to a leader in the family’s faith group to ask about the beliefs and how they would want to take care of a young person with these experiences. Then, we had a flexible psychiatrist who would delay medications and give family the opportunity to try what they thought would help. Eventutally, if/when the rituals or treatments did not seem to make the person more at ease, or return them to being able to function, they agreed to try adding medication while still following traditional practices. It’s really not an all or nothing approach.

    • #11432

      I’ll be choosing this topic for my Continuing Education Plan. If anyone wants to continue the conversation around this, we could create an email thread (informal community of practice) to share resources, thoughts, questions, cases, and learnings. If you’re interested, feel free to comment on this post or email me at holly.williams@islandhealth.ca 🙂

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