Illness of the Mind or Illness of the Spirit? Mental Health-Related Conceptualization and Practices of Older Iranian Immigrants

According to the surgeon general's report, there is a recognizable health disparity among immigrant populations in the United States (Satcher, 1999). Nerad and Janczur (2000) reported the following: "Because resettling in a foreign country is a significant source of stress, immigrants are at risk of developing more mental health disorders than members of the host country" (p. 2). Immigrants, particularly those who migrated at a later stage of life, have mental health needs that are different from those of the native-born population (Dhooper & Tran, 1998; Ghaffarian, 1998). Distinct differences have been found in the display of illness and care-seeking behaviors of immigrants compared with the host population (Satcher, 1999). According to Rai (2002), "culture and language influence individual expression of mental distress, psychiatric diagnosis and treatment, and the delivery of mental health care" (p. 28). The purpose of this qualitative phenomenological study was to explore whether the way mental health is conceptualized by older Iranian immigrants influences their mental health-related practices. LITERATURE REVIEW During the past three decades, more than 3 million Iranians have immigrated to other countries, making them one of the largest new immigrant groups from the Middle East (Bozorgmehr, 2001). The current population of Iranians (also known as Persians) in the United States is estimated at about 691,000 (Mostashari, 2004). According to the Central Intelligence Agency's World Factbook (https://www.cia.gov/library/publications/the-world-factbook/ geos/ir.html#Intro), 98 percent of Iranians are Muslims. Many Iranians migrated to the United States as the result of the 1979 Islamic revolution and the 1980 to 1988 Iran-Iraq war (Pliskin, 1992). The biggest concentrations of Iranians in the United States are found in Los Angeles; New York; Washington, DC; and Atlanta (McConatha, Stoller, & Oboudiat, 2001). Despite the large number of Iranian immigrants in the United States, little research has been conducted concerning the health status and health care needs of this population (Ghaffarian, 1998; Jalali, 1982; Lipson, 1992; Lipson, & Melds, 1983; Pliskin, 1992). Literature on the mental health status of Iranian and other Middle Eastern immigrants in the United States is particularly scarce in the field of social work (Al-Krenawi & Graham, 2000). A search of the Social Work Abstracts database using the key word "Iranian" only resulted in 12 hits, ranging from 1978 to the present. Only one of these articles dealt directly with Iranian immigrants in the United States. Using the key words "Middle East," there were only 33 hits, and only five of them (ranging from 1988 to 1992) addressed issues related to immigrants. None of the articles in either search dealt with older adults. Salari (2002) described older Middle Eastern immigrants as "invisible" in the aging literature. Age is an important and often overlooked attribute influencing adjustment to a new cultural context (McConatha et al., 2001). Literature on immigration and acculturation suggests that there is a negative relationship between age at immigration and level of acculturation (Emami, Benner, & Ekman, 2001; Ghaffarian, 1998; Mahdi, 1997; McConatha et al., 2001). Ghaffarian (1998) reported that less acculturated Iranian immigrants experience greater mental health distress. In general, older Iranian immigrants have been found to be resistant to acculturation (Ghaffarian, 1998). Sundquist, Bayard-Burfielf, Johansson, and Johansson (2000) claimed, "Poor acculturation, poor sense of control and economic difficulties in exile are the main risk factors for psychological distress among Iranian immigrants" (p. 361). Emami, Benner, Lipson, and Ekman (2000) and Lipson (1992) found that older Iranian immigrants are more vulnerable than younger immigrants. Despite many years abroad, older Iranian immigrants have been found to struggle with language, feel isolated, and remain highly dependent on their children (Lipson & Meleis, 1983). …