Gawis ay biag a Kankana-ey phrase meaning ‘good life’, ‘living well’, or ‘well-being’ but what constitutes a good life? To look into this, the present research investigates on one aspect of human life – health, specifically on mental illness. Health is sometimes an overlooked topic and the issues regarding mental health and mental illnesses can sometimes be considered taboo.
It is estimated that there are 370 million indigenous peoples in the world (United Nations, 2009). According to the UN Commission on Human Rights (1988),
Indigenous communities, peoples and nations are those which, having a historical continuity with pre-invasion and pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the societies now prevailing on those territories, or parts of them.
They form at present non-dominant sectors of society and are determined to preserve, develop and transmit to future generations their ancestral territories, and their ethnic identity, as the basis of their continued existence as peoples, in accordance with their own cultural patterns, social institutions, and legal system.
Furthermore, indigenous peoples are someone who identifies themselves as part of the group and in return, is accepted by the group.
The Asian Development Bank (2001) claimed that indigenous peoples worldwide are among the poorest and the most marginalized sector of society. Later, a report from the World Bank in 2010 stated that indigenous peoples are still among the poorest in the world and continue to experience inequalities. To add, United Nations Inter-Agency Support Group on Indigenous Issues (UNIASG), 2014, reported that indigenous peoples are likely to have poorer health and are more at risk to experience disability, resulting to a poorer quality of life.
Consequently, an article released in 2019 by Forbes by Banis, stated that there is another pressing issue that is given the least attention by countries worldwide – which is mental health. This issue was also cited in the report of UNIASG on Indigenous Issues (2014) stating these indigenous youths and adolescents do not receive necessary interventions regarding mental health.
If this is then the global status of the indigenous peoples and their mental health, the question then would be, are the experiences of indigenous peoples regarding mental illnesses the same across every country? Leach (2017) pointed out that diagnostic tools and manuals used were developed usually in North America and the European countries, meaning, these manuals were based on traditions and cultures that existed in those areas.
Moreover, he emphasized that cultural differences play different roles in the behavior. In his critique, he mentioned the work of Palgrave in 2002 to take into account race and culture when looking into the mental health of an individual. Despite the acknowledged need, for the most part, there have not been substantial changes in mental health care delivery during the past years (Turekian, Moore, & Rasenick, 2014).
Furthermore, many health systems do not reflect the social and cultural practices and beliefs of indigenous peoples. The United Nations (n.d.) also highlighted that indigenous peoples must be involved in the creation and implementation of health policies and programs. Thus, the present research aims to understand local concepts regarding mental illnesses and acquire knowledge regarding its causes and treatment, of the indigenous peoples in Atok, Benguet for future mental health programs and policy. In studying local concepts, the researchers will consider the working definition of Pottier (2003), stating that local concepts are local knowledge that continuously evolves and reproduces which is idiosyncratic and dependent on culture.
In recent years, there has been a shift in healthcare systems to include cultural competence in delivering mental health services. Anderson, Scrimshaw, Fullilove, Fielding, and Normand (2003), claimed in their review the importance of cultural competence in healthcare systems. In their work, they defined cultural competence in the healthcare system as a set of congruent behaviors, attitudes, and policies which enable effective work in multi-cultural situations. Although they highlighted the importance and role of cultural competence in the healthcare system, the review:
Could not determine the effectiveness of any of these interventions, because there were either too few comparative studies, or studies did not examine the outcome measures evaluated in this review: client satisfaction with care, improvements in health status, and inappropriate racial or ethnic differences in use of health services or in received and recommended treatment. (p.68)
Subsequently, in 2004 the Australian Health Ministers’ Advisory Council, as stated in Walker and Sonn (2014), also claimed that there was a need to create a culturally competent healthcare system where practitioners recognize the cultural background, historical and environmental experiences, and contemporary circumstances of their indigenous peoples, in this literature the Aboriginal peoples and the Torres Strait Islanders, to improve their health and well-being. In their manual, they provided principles, standards, and practice frameworks to enable mental health practitioners to become knowledgeable, skilled, and gain a deeper understanding in dealing with their indigenous peoples.
The importance of recognizing culture competence in the healthcare system was studied by Pasic in 2010. His case studies regarding Muslim patients in emergency psychiatry, lead him to realize that awareness of a patient’s culture leads to efficient and high-quality healthcare. These cultural factors can have an effect on how patients express mental illnesses. He also outlined in the case studies cultural competence can help avoid adverse outcomes and improving care.
In a study conducted by Woods, Zuniga, and David (2010), they paid significant attention to the mental health concerns of Alaska Native people, with emphasis on alcoholism and suicide. Despite the growing concern on the said issues, Alaska Natives still seek mental health services at very low rates since services lack cultural competence. They then created a shift toward incorporating Alaska Native strength and cultural pride into the conceptualization of and interventions for the issues which has then improved existing mental health services. These findings highlighted the importance of incorporating cultural pride and an appreciation of their cultural heritage in current mental health programs.
Gaining knowledge regarding a culture of a specific community is detrimental in creating appropriate public mental health programs (De Jong, 2002). This idea was also supported by the study of Ventevogel, Jordans, Reis, and De Jong (2013). They identified local mental illnesses in conflict-afflicted African communities. In their study, they outlined that some of the mental illnesses present in the communities resembled etiologies defined in the Western psychiatry although there are significant differences. They also, emphasized that gaining knowledge about local concepts avoids clinical diagnosis that are not congruent with the patient’s understanding.
However, Alarcon (2009), argued that culture, in terms of psychiatry, is a very broad concept, very complex content, and very heterogeneous in nature. In his work, he stated that many authors agree that culture should only be integrated with the management and treatment of the disorder and not the identification and description. He also cited that pieces of literature regarding the role of culture in psychiatry are often regarded as soft science since they are mostly descriptive, narrative, or influenced by sociological, anthropological, or even ecological perspectives. Kessler, Abelson, Demler, Escobar, Gibon, Guyer, et. al. (2004) added that there are no valid tools that can be used, and if there are, it will be very complicated and time-consuming. Also, the use of diagnostic tools, specifically the DSM-IV, has a high internal consistency.
Despite this, Alarcon mentioned that ‘culture-bound syndromes’ should be given attention by clinicians since these are unique in cultural groups where it occurs. Their etiological, pathogenic, and clinical manifestations do not match that of the Western psychiatry. Moreover, these studies have started as early as the 1950s. Given this, it has not been given much attention when it was included in the DSM-IV.
Hence, present research will delve into the knowledge of indigenous peoples of Atok, Benguet regarding mental illnesses. It will include local terms they use to describe, local perspectives of causation, and local practices regarding prevention and intervention. These acquired pieces of knowledge can be adapted by policy-making bodies and local health providers, including non-government organizations and private practitioners, to be able to bridge issues regarding culture and mental health services. The researchers aim to contribute to what Kankana-eys call gawis ay biag.