Lindsey Wells

Bountiful, UT
Senior, Social Work
Utah State University

El Sistema de Salud Mental¬

La salud mental comienza con el primer abrazo. . expresando nuestras sentimientos, opiniones y deseos de manera saludable, libre y espontanea.

INTRODUCTION

"Crazy, loco, schizo, abnormal and freak!"! These are the words of fear that many people think of when they meet or hear about a person who has a mental illness. Of course, they are far from the truth and only ugly, stereotypes of ignorance. However, because some of these beliefs are so strong in U.S. culture, I wanted to explore the mental health system in vicinity of Trujillo Peru and find out first if some of this same mentality existed here and also how it functions in general.

I wanted to learn how the local mental health community views mental illness and if that perspective affects the help and treatment that patients receive from caregivers. This led me to question whether social stigma, local customs, and traditions played a role in the diagnosis and treatment of mental illnesses as well as the experience of people who live with them. I also sought to find out which mental illnesses are most common (or at least those which are known and treated), in this area and why.

It didn't take too long to figure out that mental health cannot be viewed in isolation. One must also take into account social, economic and various environmental factors. I had to revise my research question to be more holistic. As much as we scientists would love to organize our themes into neat little categories, we can't do that, especially with people. With respect to the human brain, emotions, behaviour and drives, psychological abnormalities are not usually mutually exclusive from other outside influences, so neither can be my investigations with such.

BACKGROUND

My original interest in this subject matter came from my academic/professional background in social work. Next year I will finish my last year in the social work program by completing my practicum in a private behavioural/mental health clinic in Logan, Utah. I have always had an interest and sensitivity for people who struggle with mental health issues; for this reason, when I came to Huanchaco, Peru, I was very interested in their mental health system, perception of abnormal psychology and how the local Peruvians define mental health and illnesses as well as what kinds of treatments are available in both private and public sectors.

In the past, some students from this field school had looked at various aspects of healing and illnesses and others at societal problems, but none to my knowledge had conducted a study specifically on mental health and psychiatric illnesses here in Huanchaco or, more generally, in Peru. When I began this project I had hoped to at least break through the surface of this topic and discover what makes their system tick and how it compares and contrasts to that of the U.S. The following were some questions that I had before I started, some of which I already had some preset ideas and stereotypes about and others which I had no idea: How do they define mental health and illness, what framework do they use? What kind or role does folk healing medicine play on determining and treating mental illnesses? What psych problems are the most common here and why? Who seeks help and how do they go about it ? Are more children seen by mental health professionals or adults, what ages? What services are available (more private or public)? What stigmas are attached to Peruvians who are diagnosed with mental illnesses?

Part of my interest for this last question and for the hospital system in general, stemmed from the two weeks I spent in Fortaleza, Brazil in August of 2000. I was part of a youth team on a medical mission with a humanitarian group called, Operation Smile. In short, they conduct missions around the world in third world countries to perform surgeries on children that have facial deformities, such as cleft lips and palates. I will never forget this one experience I had there at the hospital in the pre-operation room with a boy named Luis. He was a fifteen year old boy with a severe cleft lip that was visible from across the room and he had been selected to receive facial reconstruction surgery today. With the help of a translator, I was asking him questions about his life in school and about his history. As he explained that he had attended home school for the past few years due to the excessive teasing by his classmates, tears began streaming down his cheeks. When I realized what a sensitive topic this was for him, I immediately ceased the interview and we shared some tears along with an embrace.

The reason I relate this story, is that this boy had suffered the detrimental effects of social intolerance for differences in cosmetic appearance. It appears that childish teasing for petty differences doesnÕt stop in the vain United States with cosmopolitan magazines plastered on every corner. Kids are kids and intolerance exists all over the world. Relating to my project, I was curious as to what level of stigma exists here in Peru (being another country in Latin America, aside from Brazil) for persons with mental illnesses and abnormalities. I wanted to learn how local Peruvian society views mental illness and does that perspective effect the help and treatment that patients receive from caregivers. This led me to question whether social stigma, local customs, and traditions played a role in the diagnosis and treatment of mental illnesses as well as the experience of people who live with them.

METHODS

I collected my data from a variety of sources including: formal ethnographic interviews, discussion groups, informal conversations and interactions, participant-observation and un-obtrusive observation. My key informants were psychology professors and students at a local university called, University of San Pedro (USP), psychologists, psychiatrists, nurses and other mental health professionals who work at the local regional hospital (Hospital Regional de Trujillo) in the mental health unit (Salud Mental), as well two social workers.

I also had the opportunity to attend an international psychology conference for professionals, professors and students in the discipline of psychology, which gave me a broad view at various topics in this field, mixed with a bit of Latino influence. The attending speakers hosted by the University of Sipan, were from a variety of Latin American countries, including Peru, Argentina, Brazil and Mexico.

Additionally, I was also able to talk to the directors of and visit three different homes dealing with different social needs. One was Mundo de los Ni–os, which houses kids who previously lived in the streets and who were sometimes involved in delinquent activity. The other was a temporary shelter/school for kids who live in violent situations, and need the opportunity for them and their parents to receive training and therapy.

Thirdly, I visited a rehabilitation home for young men from their teens up to their late thirties, to recuperate from drug abuse/addiction and other delinquent activity. In addition, I was able to interact with five to seven of the patients/residents in the psychiatric unit of the general hospital, who were institutionalized for rehabilitation, which was the highlight of my research, as I became friends with the patients. Here is a sample of my last day visiting with one of my friends, Milagros, a resident in the psychiatric hospital in Trujillo.

I went into the med room where the nurses were working and chatted with them a bit about my project, then some of the clients led me into the activity room in the back to make stuff (coloring, putting together rubber/plastic decorations) and chatting. I asked what was new, if anything and they told me that Miguel (one of the young men that was here the previous week) had left. I was sad to hear that, he was the one who had come into the office when I was talking to Nancy, the nurse and asked why I was there and if we were talking about him, and what my purpose was). This time, Milagros opened up to me even more, it was so interesting, she told me about her Depression and how her father brought her to the hospital to receive help as well as get her on medications. Unfortunately, there wasn«t time to gather the whole story, but she told me about how she wants to find work here in Trujillo to stay. By the way, her English is excellent, she speaks very slow and it is easy for me to understand her, she has been studying English in the university for about 2 years (about the same as my Spanish). She is so smart and nice, I can tell that she has a lot of talent, but just needs to get past some issues and maybe gain a little more confidence. Aside from Depression, I don«t know if she has anything else. She also opened up to me about how sometimes she feels like a rock, strong and that she can get through anything and that especially with the help of God and the Spirit, that she always has support and guardian angels looking out for her. I was touched by her story, faith and her willingness to share her personal thoughts and history with a stranger, and to a gringa that speaks poor Spanish at that.

DISCUSSION

For the most part, I have come to find that the methodology and ideology for teaching psychology here is not much different than the system in the schools in the U.S. It seems that since the late 80Õs, the views and treatments surrounding mental illnesses taken more or less, a Western/European approach, and left behind the older beliefs involving traditional healing and shamanism. For example, I observed from the university psychology classes and conference that I attended, that they use the framework, theories and categories of the well known Freud, Jung, and various sorts of perspectives (Gestalt and Humanistic), the types of perspective used just depends on the preference of the practicing psychologist.

An additional factor that I touched on was the influence (if in fact there was any) of folkloric beliefs around Shamanism and other ritualistic healing on patientsÕ perceptions and help-seeking behaviour with mental illnesses. I didnÕt go too deep with this, but the general consensus I gathered from a few mental health professionals was that it did play a role in the behaviour of some patients before they came into a formal clinic. It wasnÕt totally unheard of for patients to first try to treat psychological problems and abnormal behaviour as though they were the results of evil spirits or demons by using their naturalistic healing patterns at home and then if the problem persisted, to finally bring the ailed one into a "doctor". One psychologist mentioned that was more prevalent in conservative areas (more around Trujillo than Lima) or in rural areas such as in the sierra or selva (jungle), which are more isolated and usually less formally educated. She didnÕt have any experience with this in her practice, but told me that her father (a neuropsychologist) did and would in fact at times, incorporate folkloric medicine with his clients who had this system of belief.

Two of the psychology nurses whom I held a focus group with had the opinions that "brujeria", witchcraft was a thing of the past that wasnÕt so prevalent here in Trujillo. They felt that at times was carried out in extremes, dealing with "diablo", the devil, human sacrifices and sometimes even abuse and neglect. Another nurse in the psychiatric unit mentioned, however, that this belief has faded out over the past five years for the most part. I received a variety of choppy responses on this topic, thus I canÕt come to any sort of consensus, so I will leave this topic for another day and another anthropologist.

As in the U.S., the needs of mental health facilities take a back seat to the physical medical facilities. Dr. Navarro stated as a matter of fact that here in Peru, education is second to last in order of importance and mental health is last. This previous statement canÕt be used for all of Peru of course, because I only had access to part of one region in northern Peru, La Libertad, but I would assume that similar issues are present elsewhere. More than one of the mental health professionals I spoke to mentioned that Trujillo is behind Lima in the advancement of mental health facilities, due to lack of central government support, physical location and a more conservative mentality. Gabriela Navarro also told me that she thought that more kids here in Trujillo have problems with Depression and anxiety than in Lima because they do not have the same strong net or close resources and family close by. This of course was just one opinion, but she really seemed convinced that Lima has its own community and infrastructure of networks that Trujillo lacks in the same quality.

According to various sources, the mental health sector of the Hospital Regional is grossly under-funded, however it is at least functioning with human rights and health laws in place. One contrast from their system and that of the U.S. is that the social workers mainly work in social service agencies and donÕt specialize in specific areas, such as mental health or gerontology. When I told my informants that I was studying social work with an emphasis in mental health, they thought that to be quite foreign.

Although the growth of awareness and support for mental health and psychology facilities seems dauntingly slow, there is hope. As is true in many parts of the world, there is a great need for more psychologists here in Trujillo, but not enough funding to pay them, so therefore creating work overload for the current ones. Dr. Navarro and six of her colleagues were the first group of psychologists to arrive in Trujillo. Adding to their fame, they also were the founders of the "Asociaci—n de Psic—logos" here in Trujillo!

All of the mental health workers I conversed with felt more or less, the same frustrations with the lack of support and attention here in Trujillo for the mental health community, but they also expressed hope for improvement in the future through people working together for a common goal: to educate clients, their family and the general public about the importance of caring for mental health.

Si, juzgas a la gente no tienen tiempo para amaria. . . no esperes ser amado para amar

As with any behaviour or characteristic that is out of the ordinary, stigmas, stereotypes and fear are bound to be present. Aside from making jokes about people who have mental disabilities, or treating them like their "crazy", many people have real fears and misunderstandings about those who suffer from these very real ailments of the mind. Some might believe that they are just crying out for help or attention because they canÕt fend for themselves. Either way, the fact that these people are looked down upon in society, is a cultural/societal problem, and a pattern of thinking that needs to change. Due to the vulnerable nature of mental health patients, they need an extra bit of care and patience to help them endure the plethora of hardships that already accompany their mental illnesses, whether as a cause or result of them.

One last observation that IÕve noticed is that much of the mental illnesses here involve substance abuse and addiction and are mostly centered around the poor state of the socio/economic status here in Peru. Obviously four weeks isnÕt sufficient time to get a complete sample of the population, however, the issue of drug abuse came up in every facility that I visited and with almost every informant. The majority of the cases that I was able to observe and hear about involved children and adolescence as a result of stressful family and home conditions or life on the street.

All of the psychologists who I spoke with reported that there are many cases of depression, anxiety and misconduct with the youth of Trujillo, partly due to one common factor: absence of one or both parents in the home. Often the father of the home is forced to work out of the country (such as in Chile, Argentina or Japan) for extended periods of time, sometimes even years, just to be able to support his family, because of the shortage of local work. This causes children to feel neglected and lonely, often left to be cared for by their grandparents, aunts, or other extended family.

Other youth turn to life on the street and consume drugs, partly to receive support from their peers and partly to dull the pain of hunger which they suffer daily. After taking these socio-economic factors into account, we can better understand the root of many psychological problems here in Peru. IÕll share a few thoughts from David about the effects of drugs on his life, one of the young men I interviewed at a rehabilitation clinic in Las Lomas. ¬

Consumes drogas y ellas te hacen olvidar solo temporalmente pero una vez que dejas de consumir ya no tienes un problema si no ya tienes 10 problemas. Porque como consumen las drogas tan solo voy a consumir drogas , por ejemplo si peleo con mi familia, me voy con un problema a consumir drogas, pero en el consuma de las drogas ya robe, ya corte, ya termine de consumen drogas y ya tengo 5 problemas.(He is basically saying that rather than solving your problems, the drugs multiply the problems and add many more to your life).

This was the response I received from Ricardo, another youth in rehab when I asked him if whether he thought that the problem of drug abuse was specific to Trujillo or was more universal throughout Peru.

Lo que te puedo decir es que la droga no respetan clases social, no respeta raza geografia que puede agarrar a cualquiera y a si como hay un gran indice de droga addicion en el Peru, a si como en gran parte de mundo lo hay. Pienso que se basa tanto en un problema emocional como conductual.

Finally, some last thoughts about how he was able to quit and recover from a life of drug abuse.

Lo primero que debes aceptar es que tienes una enfermedad. No hay cura si no aceptas que estas enferma. Aceptar que tienes una enfermedad para dejarte tratar. Y pienso que la mejor ayuda que puede recibir es la ayuda espiritual, la mejor que puedes que tener es Jesœs, El es el œnico que puede guiar tus pasos y rescatarte de la inmundicia (ambiente mal) en la que haz vivido. El Se–or Jesœs Cristo es el œnico que puede darte la salvaci—n. No solamente a los que consumen drogas si no a todo la gente que se encuentra sin esperanzas. En general el mensaje de salvaci—n es para todos.

All of the young men I spoke to at Las Lomas expressed their faith in God and Jesus Christ as being the principal guide in their process of recovery. I also received similar responses from a few of the residents in the psychiatric unit in the general hospital. Many of the social and humanitarian organizations here in Trujillo and Huanchaco are founded in Christian principles of faith, prayer, meditation and study of The Bible.

CONCLUSION

At this point, were another student to come and follow in my footsteps in researching the mental health system, I would say to first get a phone book and review all the services that exist under psychology (¬psicolog’a¬), psychiatry (¬psiquiatr’a¬), and social work (¬asistencia social¬) and go from there, followed by contacting existing people in the community who Bonnie already has connections with in the program.

The key word lacking in my research is time. I feel like perhaps I made the common mistake of stretching myself to thin and made too many contacts, and therefore wasn«t able to give as much as myself or gain as much information from each one as I would have liked. This is partly the fault of my scatterbrained personality in that I always try to do a bit of everything rather than focus my energy on fewer, more succinct sources. That's okay, because it was definitely a valuable learning process!

Although there will probably never be enough time or books in the world to answer all of my questions, I feel like if I had a few more weeks or months, I could dig profoundly deeper into my topic. However, such is the case with anthropologists and I will just have to be content with the material I was able to gather. It has been so fascinating to explore something new everyday and discover how many connections actually exist when one is looking for them, and even sometimes by sheer incidence. With every new contact and every new interview and observation, I have encountered numerous questions and new possible research topics that I would be interested in pursuing further. For example, after visiting the drug rehab clinic with Dr. Luis, I became much more interested in the whole process of drug attainment, rehabilitation and the personal stories of persons with addictions and their recoveries. This is something to look at more deeply, because so much of this part of mental health is intertwined with social work as well as medical issues to be dealt with. I would also be interested to know how, if at all the current mental health sector has changed, improved, or expanded and what laws are in place. It would also be interesting to know, what kinds of jobs current students of psychology and psychiatry have found after completing their education in this field here in Trujillo. My experience here in Huanchaco/Trujillo has been invaluable and I will not only take with me my impressions, observations and research, but also the priceless friendships and connections with the wonderful people here. ¬

La felicidad esta en uno mismo y procede de la forma que uno piensa

ACKNOWLEDGEMENTS

Ahora, para terminar, quiero decir gracias para todo la gente que me ayudaron mucho en mi proyecto. En La Universidad Privada San Pedro en Trujillo, agradezco a: Mg. Eber W. Zavaleta Llanos, Abel Barrena, Ma–uela Jiménez, y a la Prof. Rocio Garcia. En el Hospital Regional de Trujillo quiero agradecer a Gladys Figeroua, Rosa Contreras, y todos los de la unidad de psiquiatría y departmento de psicología. En el Baywatch Medical Clinic en Huanchaco, agradezco a Dr. Luis Alvarado y a la Sra. Ingaborge En el CAEF- Centro de Atenci—n y Educaci—n a la Familia Maria y Judith MelŽndez Villalobos. En el Mundo de los Ni–os a Monica Carrera. Igualmente, agradezco a Pilar Reategui, Dr. Jorge Zelada Lazaro, Dra. Gabriela Navarro, al Pastor Bert Elliot, a la gente de la Universidad del Se–or de Sipan en Chiclayo y a toda la gente que trabaja a Huanchaco Hostal, quienes han sido muy amables y quienes me han ayudado mucho con mi trabaja, transcribiendo entrevistas y dando me su apoyo. ÁMuchas Gracias Amigos! Finalmente, agradezco a Bonnie Glass-Coffin y Chad Balagna por todo! Gracias!!

Some interesting sites include: www.upss.edu.pe and www.bruceperu.org