title: Going 'walli' and having 'jinni': Exploring Somali expressions of psychological distress and approaches to treatment

authors: Ryan, Juanita Frances

subjects: Somali

abstract: Western researchers conducting studies with Somali refugee participants have identified Somali-specific idioms of psychological distress as well as high rates of Western psychological disorders such as depression and post-traumatic stress disorder (PTSD) in this refugee group.  Methodological limitations of these previous studies, however, have limited the validity of the conclusions drawn.  These limitations include the use of Western psychometric instruments and diagnostic nosologies, limited information about the methodological procedures undertaken, the apparently unqualified use of terms such as  mental illness,  madness  and  craziness  in interview schedules, minimal exploration of psychosomatic idioms of distress, and limited applicability of some of the research findings to Somali women..   The current research primarily aimed to address these methodological short-comings and build on the findings of previous studies that have explored Somali conceptions of distress.  Two additional objectives were to (i) identify protective and resilience factors which may decrease vulnerability to experiencing psychological distress in Somali women, (ii) gauge non-Somali health professionals' understanding of (a) the nature of distress and suffering experienced by Somali women, and (b) effective treatment modalities to ameliorate this distress.   The analytical style employed in all three studies of this thesis was thematic.  
In the first study, ten Hamilton (New Zealand) based Somali women were interviewed.  Particular areas of interest explored in the first study included psychological, physical and spiritual conceptions of distress, the symptoms of key idioms of distress, and the way in which these are managed/treated at the individual, community, and family levels. 
The findings of Study 1 identified spirit (jinn) possession as a form of distress known by at least some members of the local Somali community.  Jinn appeared to be an explanation for both milder forms of distress akin to depression and anxiety, as well as more severe forms of distress similar to psychosis.  Treatment for jinn possession tended to focus on Koran readings in conjunction with family and community-based support.  Generally participants considered there was a very limited role for mental health professionals and Western psychiatric medication in the extraction of jinn.
Faith was considered a key protective factor against experiencing non-spiritual forms of distress such as stress, worry, anxiety and depression.  Although war trauma was acknowledged to have an adverse impact on the psychological functioning of Somali women it was not considered to impact on a woman's ability to manage her day-to-day responsibilities.  The impact of having family in refugee camps in Africa was, however, identified as a common and very distressing issue impacting on many Somali women.  The only way of alleviating the distress associated with this stressor, according to participants, was reunification.  Interviewees stated that Western interventions for distress were rarely pursued by Somali as they were not considered efficacious.  
Given there is evidence that Somali communities residing in various cities in New Zealand are at various stages of acculturation, it was considered important to ascertain how valid the results from Study 1 were considered to be by women from other Somali communities.  Six focus groups were conducted with a total of 27 Somali women recruited from three New Zealand cities.
The findings of Study 2 identified numerous culturally specific forms of distress reported by participants.  These states were qalbijab, boofis, murug, welwel and jinn.  These Somali idioms of distress were akin to some Western psychological disorders, particularly the depression and anxiety spectrums.  Treatment for Somali forms of suffering were reported to focus on Koran readings, in addition to family and community support.  Generally, participants in Study 2 considered there was a very limited role for general practitioners (GPs) and mental health professionals in assisting Somali to deal with psychological and spiritual distress.  Consistent with the findings of Study 1, faith was considered the most important protective factor, family separation was described as one of the most significant stressors, and war related trauma was suggested to cause significant distress only if the sufferer had family still in Africa.
Study 3 explored non-Somali health practitioners' understanding of Somali idioms of distress, as well as their perspectives about how to best treat Somali presenting with psychological distress.   A total of 18 mainstream mental health practitioners, general health practitioners (both GPs and primary care nurses), and specialist refugee mental health practitioners took part in this research.  
Few practitioners mentioned spirit possession as an aetiology for distress and none mentioned other Somali-specific forms of distress.  The psychosocial stressors identified as contributing to the psychological distress of Somali women were relatively consistent across the three groups of practitioners and also consistent with the stressors identified by participants in Studies 1 and 2 (e.g., family separation, social isolation, financial concerns).  Interviewees did not consider PTSD to be a common psychological disorder amongst Somali women living in New Zealand.  
Advocacy work and assistance with day-to-day concerns were suggested by many participants as more efficacious for the amelioration of psychosocial stressors than medication-based treatment.  Generally, participants in Study 3 were supportive of traditional forms of healing being used as the treatment of choice by Somali clients.  
The findings of the current thesis suggest that there are clear parallels between Somali idioms of distress and those of Western cultures.  However, the data indicate that equating Somali idioms with Western diagnostic labels would be rejected by Somali.  Regardless of the similarity of symptom profile of some of the Somali states to Western states, the manner in which these states are conceptualised, understood and treated is markedly different.  
The findings of all three studies suggested that Somali tend to opt for their own traditional interventions to treat psychological and spiritual forms of distress rather than engage with Western mental health services.  Numerous barriers including long waiting lists, mental health practitioners' apparent lack of knowledge/expertise working cross-culturally and poor treatment outcomes were provided for Somali not engaging with such services.  The stigma attached to having a mental illness was also considered a barrier to engaging with mental health services.  
With respect to improving service provision for non-Western clients, an intermediate service that sits between primary and secondary health care agencies is recommended as an effective means of meeting the needs of non-Western clients experiencing psychosocial stressors and mild to moderate psychological distress.  It is imperative, however, that any such service involves key stakeholders from the community groups it would serve, in the design, development, and implementation of interventions.

text: Going 'walli' and having 'jinni': Exploring Somali expressions of psychological distress and approaches to treatment Western researchers conducting studies with Somali refugee participants have identified Somali-specific idioms of psychological distress as well as high rates of Western psychological disorders such as depression and post-traumatic stress disorder (PTSD) in this refugee group.  Methodological limitations of these previous studies, however, have limited the validity of the conclusions drawn.  These limitations include the use of Western psychometric instruments and diagnostic nosologies, limited information about the methodological procedures undertaken, the apparently unqualified use of terms such as  mental illness,  madness  and  craziness  in interview schedules, minimal exploration of psychosomatic idioms of distress, and limited applicability of some of the research findings to Somali women..   The current research primarily aimed to address these methodological short-comings and build on the findings of previous studies that have explored Somali conceptions of distress.  Two additional objectives were to (i) identify protective and resilience factors which may decrease vulnerability to experiencing psychological distress in Somali women, (ii) gauge non-Somali health professionals' understanding of (a) the nature of distress and suffering experienced by Somali women, and (b) effective treatment modalities to ameliorate this distress.   The analytical style employed in all three studies of this thesis was thematic.  
In the first study, ten Hamilton (New Zealand) based Somali women were interviewed.  Particular areas of interest explored in the first study included psychological, physical and spiritual conceptions of distress, the symptoms of key idioms of distress, and the way in which these are managed/treated at the individual, community, and family levels. 
The findings of Study 1 identified spirit (jinn) possession as a form of distress known by at least some members of the local Somali community.  Jinn appeared to be an explanation for both milder forms of distress akin to depression and anxiety, as well as more severe forms of distress similar to psychosis.  Treatment for jinn possession tended to focus on Koran readings in conjunction with family and community-based support.  Generally participants considered there was a very limited role for mental health professionals and Western psychiatric medication in the extraction of jinn.
Faith was considered a key protective factor against experiencing non-spiritual forms of distress such as stress, worry, anxiety and depression.  Although war trauma was acknowledged to have an adverse impact on the psychological functioning of Somali women it was not considered to impact on a woman's ability to manage her day-to-day responsibilities.  The impact of having family in refugee camps in Africa was, however, identified as a common and very distressing issue impacting on many Somali women.  The only way of alleviating the distress associated with this stressor, according to participants, was reunification.  Interviewees stated that Western interventions for distress were rarely pursued by Somali as they were not considered efficacious.  
Given there is evidence that Somali communities residing in various cities in New Zealand are at various stages of acculturation, it was considered important to ascertain how valid the results from Study 1 were considered to be by women from other Somali communities.  Six focus groups were conducted with a total of 27 Somali women recruited from three New Zealand cities.
The findings of Study 2 identified numerous culturally specific forms of distress reported by participants.  These states were qalbijab, boofis, murug, welwel and jinn.  These Somali idioms of distress were akin to some Western psychological disorders, particularly the depression and anxiety spectrums.  Treatment for Somali forms of suffering were reported to focus on Koran readings, in addition to family and community support.  Generally, participants in Study 2 considered there was a very limited role for general practitioners (GPs) and mental health professionals in assisting Somali to deal with psychological and spiritual distress.  Consistent with the findings of Study 1, faith was considered the most important protective factor, family separation was described as one of the most significant stressors, and war related trauma was suggested to cause significant distress only if the sufferer had family still in Africa.
Study 3 explored non-Somali health practitioners' understanding of Somali idioms of distress, as well as their perspectives about how to best treat Somali presenting with psychological distress.   A total of 18 mainstream mental health practitioners, general health practitioners (both GPs and primary care nurses), and specialist refugee mental health practitioners took part in this research.  
Few practitioners mentioned spirit possession as an aetiology for distress and none mentioned other Somali-specific forms of distress.  The psychosocial stressors identified as contributing to the psychological distress of Somali women were relatively consistent across the three groups of practitioners and also consistent with the stressors identified by participants in Studies 1 and 2 (e.g., family separation, social isolation, financial concerns).  Interviewees did not consider PTSD to be a common psychological disorder amongst Somali women living in New Zealand.  
Advocacy work and assistance with day-to-day concerns were suggested by many participants as more efficacious for the amelioration of psychosocial stressors than medication-based treatment.  Generally, participants in Study 3 were supportive of traditional forms of healing being used as the treatment of choice by Somali clients.  
The findings of the current thesis suggest that there are clear parallels between Somali idioms of distress and those of Western cultures.  However, the data indicate that equating Somali idioms with Western diagnostic labels would be rejected by Somali.  Regardless of the similarity of symptom profile of some of the Somali states to Western states, the manner in which these states are conceptualised, understood and treated is markedly different.  
The findings of all three studies suggested that Somali tend to opt for their own traditional interventions to treat psychological and spiritual forms of distress rather than engage with Western mental health services.  Numerous barriers including long waiting lists, mental health practitioners' apparent lack of knowledge/expertise working cross-culturally and poor treatment outcomes were provided for Somali not engaging with such services.  The stigma attached to having a mental illness was also considered a barrier to engaging with mental health services.  
With respect to improving service provision for non-Western clients, an intermediate service that sits between primary and secondary health care agencies is recommended as an effective means of meeting the needs of non-Western clients experiencing psychosocial stressors and mild to moderate psychological distress.  It is imperative, however, that any such service involves key stakeholders from the community groups it would serve, in the design, development, and implementation of interventions.

year: 2008

title: Current honey research at the University of Waikato

authors: Molan, Peter C.

subjects: biology

abstract: To put what has become a very large part of our research into context, I briefly outline the history of the chance finding by a PhD student at the University of Dresden in 2005 that few samples of manuka honey examined in a survey of foodstuffs contained an exceptionally high level of MGO, which lead to the proposal in 2006 that MGO, is the antibacterial component of manuka honey.  It was the bringing of this to the attention of the world by Manuka Health in July 2007 that led to six of our research group having to work very hard for the past year on gaining an understanding of how MGO forms in manuka honey, seeking scientific substance can be safely consumed when it is in manuka honey, and that when in contact with wound tissues at the high levels at which it occurs in undiluted honey, it does not interfere with the healing process.

text: Current honey research at the University of Waikato To put what has become a very large part of our research into context, I briefly outline the history of the chance finding by a PhD student at the University of Dresden in 2005 that few samples of manuka honey examined in a survey of foodstuffs contained an exceptionally high level of MGO, which lead to the proposal in 2006 that MGO, is the antibacterial component of manuka honey.  It was the bringing of this to the attention of the world by Manuka Health in July 2007 that led to six of our research group having to work very hard for the past year on gaining an understanding of how MGO forms in manuka honey, seeking scientific substance can be safely consumed when it is in manuka honey, and that when in contact with wound tissues at the high levels at which it occurs in undiluted honey, it does not interfere with the healing process.

year: 2008

title: Māori wards in Tauranga Moana and Aotearoa: Liminal local government democracy

authors: Des Forges, Sandra

subjects: Māori wards

abstract: This thesis focuses on Māori representation within the highly contested arena of local government democracy in Aotearoa New Zealand. Limitations of the current Eurocentric model of local government democracy are considered at various spatial scales. Legislative changes to enable councils to establish Māori wards were launched in the early 2000s. Māori wards are defined locations where those on the Māori electoral roll vote for Māori ward candidates, resulting in dedicated Māori representation at elected member level. Until 2021 when the legislation was amended to remove the ability for public referenda to challenge council decisions on establishing Māori wards, however, little change occurred. Since then, 35 councils have established Māori wards for the 2022 local body elections.
The research asks how, and in what ways, do Māori wards decolonise local government and encourage greater Māori representation? To explore this question, the empirical chapters are framed around three key aspects of liminality; the in-between positioning of Māori wards reflecting a time of change; this liminal space being a time where unease and discomfort is experienced by some as Indigenous disparity is addressed; and the threshold positioning of Māori wards as a place of opportunity and creativity, where new ideas and practices may be considered. Geographical concepts of (un)belonging, exclusion and deep colonising reveal challenges for Māori participation at the level of local government decision-making. 
The research uses an Indigenous methodological framework, Te Ara Tika, based on a framework of Kaupapa Māori, and developed specifically for non-Māori researchers. Māori wards have been widely debated in the media, particularly at the time of changes to the Māori ward legislation in 2021. Thematic analysis of 122 media representations of the Māori ward debate constitutes part of the empirical evidence. Fourteen individual interviews with local government representatives, including elected Council members from Tauranga Moana and members of Te Rangapū Mana Whenua o Tauranga Moana Partnership, were conducted. Additionally, participant observations took place at three public meetings on Māori wards.
The way the current form of local government representative democracy impacts Māori representation is identified. The research demonstrates how local government continues to act as a tool of colonialism by privileging Western worldviews, institutions, and systems. The research finds that Māori wards are liminal democratic options that are both decolonising and deep colonising. Evidence shows that the liminal space of Māori wards is an opportunity to consider options for a way forward to reimagine local government as a place of belonging underpinned by Te Tiriti o Waitangi and Te Ao Māori principles. 
The research builds on decolonisation literatures that seek to unsettle the hegemony of Eurocentric institutions and systems within colonised countries such as Aotearoa. Providing a critical spatial perspective on the intersection of democracy, colonisation and Indigeneity, this thesis advances decolonising geographical knowledges. In particular, this research advances debates about democratic processes, exposing ways in which colonially-based local authority democratic mechanisms contribute to under-representation issues. A reimagined local government allows current hegemonic approaches to be rethought and provides insights for a shift towards genuine decolonising processes.

text: Māori wards in Tauranga Moana and Aotearoa: Liminal local government democracy This thesis focuses on Māori representation within the highly contested arena of local government democracy in Aotearoa New Zealand. Limitations of the current Eurocentric model of local government democracy are considered at various spatial scales. Legislative changes to enable councils to establish Māori wards were launched in the early 2000s. Māori wards are defined locations where those on the Māori electoral roll vote for Māori ward candidates, resulting in dedicated Māori representation at elected member level. Until 2021 when the legislation was amended to remove the ability for public referenda to challenge council decisions on establishing Māori wards, however, little change occurred. Since then, 35 councils have established Māori wards for the 2022 local body elections.
The research asks how, and in what ways, do Māori wards decolonise local government and encourage greater Māori representation? To explore this question, the empirical chapters are framed around three key aspects of liminality; the in-between positioning of Māori wards reflecting a time of change; this liminal space being a time where unease and discomfort is experienced by some as Indigenous disparity is addressed; and the threshold positioning of Māori wards as a place of opportunity and creativity, where new ideas and practices may be considered. Geographical concepts of (un)belonging, exclusion and deep colonising reveal challenges for Māori participation at the level of local government decision-making. 
The research uses an Indigenous methodological framework, Te Ara Tika, based on a framework of Kaupapa Māori, and developed specifically for non-Māori researchers. Māori wards have been widely debated in the media, particularly at the time of changes to the Māori ward legislation in 2021. Thematic analysis of 122 media representations of the Māori ward debate constitutes part of the empirical evidence. Fourteen individual interviews with local government representatives, including elected Council members from Tauranga Moana and members of Te Rangapū Mana Whenua o Tauranga Moana Partnership, were conducted. Additionally, participant observations took place at three public meetings on Māori wards.
The way the current form of local government representative democracy impacts Māori representation is identified. The research demonstrates how local government continues to act as a tool of colonialism by privileging Western worldviews, institutions, and systems. The research finds that Māori wards are liminal democratic options that are both decolonising and deep colonising. Evidence shows that the liminal space of Māori wards is an opportunity to consider options for a way forward to reimagine local government as a place of belonging underpinned by Te Tiriti o Waitangi and Te Ao Māori principles. 
The research builds on decolonisation literatures that seek to unsettle the hegemony of Eurocentric institutions and systems within colonised countries such as Aotearoa. Providing a critical spatial perspective on the intersection of democracy, colonisation and Indigeneity, this thesis advances decolonising geographical knowledges. In particular, this research advances debates about democratic processes, exposing ways in which colonially-based local authority democratic mechanisms contribute to under-representation issues. A reimagined local government allows current hegemonic approaches to be rethought and provides insights for a shift towards genuine decolonising processes.

year: 2023