 ‘It is the obligation of every person born in a safer room to open the door when someone in danger knocks.’ (Dina Nayeri) Reading Gill Martin’s insightful book, ‘Borders and Boundaries – Community Mental Health Work with Refugees and Asylum-Seekers’ has been an illuminating experience. It resonates well with some of the issues and dynamics I have witnessed too, albeit outside of the therapeutic arena. I remember when, after a long and agonising wait, a Kurdish-Iranian friend in the UK was granted refugee status. It meant that, finally, he could bring his wife over to join him and he could get a job to fulfil his passion and potential as a gifted architect. His pent-up talents had opportunity for release and he’s now making an outstanding contribution at an architects’ firm. Gill comments on the need, at times, to cross (not violate) what may be regarded as fixed professional boundaries, to meet refugees and asylum seekers at their point of need. She draws attention to the therapeutic meaning, significance and value of being-with, of being-alongside, in authentic human relationship. Much of our sense of identity is founded on e.g. our country and culture of origin; the groups and communities of which we are a part; our shared experiences; the work and roles we fulfil. When forced to leave all we associate with home to flee to a starkly different culture and environment, it can feel isolating relationally and dislocating existentially. Gill observes that talking therapies have their place but aren’t always what refugees and asylum seekers want or need. Sometimes, it’s because they come from cultural backgrounds that hold very different beliefs about health and wellbeing, including what influences, nurtures, sustains or harms it; or, perhaps, cultural taboos that would deem seeking and receiving help of this kind to be shameful. Sometimes, interventions akin to social prescribing, involving people in activities that they experience as worthwhile and life-giving, can be beneficial. Health and healing often emerge through enabling powerless people to regain a sense of agency over their own lives. (Further reading: Working with Asylum Seekers and Refugees: What to Do, What Not to Do, and How to Help; Counselling and Psychotherapy with Refugees; A Practical Guide to Therapeutic Work with Asylum Seekers and Refugees; Refuge: Transforming a Broken Refugee System; Strangers in our Midst: The Political Philosophy of Integration)
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 ‘What is the human being? In our anti-metaphysical age, we regard the question as having little importance. It is, however, the most crucial of all.’ (Felipe M. De Leon) A good friend in the Philippines – St. Paul as I affectionately call him because of his dedication to the Jesus and the poor – works with student educators, teachers of the future. Today, he supported his students to create their own art exhibition as a way of exploring the relationship between art and humanities. It’s a topic that interests me too. I’ve travelled and worked in many different countries in the world but I’ve never encountered a culture as vibrantly and spontaneously artistic and creative as the Philippines. Music, dance and colour are everywhere, and with such natural richness of talent. I find myself wondering – why is this? By stark contrast, in terms of art, my own part of the world can appear and feel quite cerebral, introverted and restrained. (I notice that even using the word ‘feel’ in that sentence can feel edgy and a bit risky in my context.) St, Paul’s students, like so many others I’ve had the great privilege of encountering in the Philippines, inspire me by their passion, energy and uninhibited emotional expression. They danced for me on my birthday even though I’ve never met them before, rather than offering me a simple written greeting. They bring the ordinary things of life to life. In ‘Life as Art’, Felipe M. De Leon makes similar observations and explores cultural and contextual conditions that contribute to this gift-phenomenon. In Filipino society, in which, ‘a person learns to develop an expanded sense of self – a sphere of being which includes not only his (or her) individual self but encompasses immediate family, relatives, friends…closeness to others allows (one) to be more trusting, open and freely expressive. Arts and crafts are richest, most creative and diverse in communal cultures. Food is tastier, speech more melodic and things of everyday life more colourful.’ De Leon goes on to comment on other distinctive dimensions of Filipino culture and spirituality that also play a part. Yet there’s something about the relational dimension that resonates very powerfully with me. I notice when I work with people and groups that, if they feel genuinely loved, valued and involved, they often find themselves at their most free, experimental and creative too. Conversely, if they feel isolated, undervalued or excluded, they are more likely to become defended, closed-in or shut-down. These amazing Filipino students have a lot to teach the Western world, and me…and I’m still learning.  'Diagnosis determines intervention.'
There’s a very big difference between ‘What’s wrong with you?’ and ‘What’s happened to you?’ Jo Watson’s book, Drop the Disorder (2019) is a timely and courageous personal-professional challenge to the creeping influence of the biomedical model into social-psychological therapeutic thinking and practice. In her aptly titled article in the book, ‘There’s an intruder in our house!’, she reflects with a pained air of near-despair on this gradual, alarming and depressing diagnostic drift: ‘It wasn’t always like this. I joined a profession that held a shared belief about the nature of human emotional distress. We understood that the many forms of human suffering we witnessed – ranging from feeling low and suicidal to self-injury, hearing voices, overwhelming anxiety and dissociative experiences – were responses and reactions to what had happened in people’s lives and, in many cases, the resourceful and creative coping strategies they had developed to survive. We clearly and consistently made links between emotional distress and causal factors like poverty, racism and abuse. There was a deep, collective ‘knowing’ that social circumstances were linked directly to human suffering and this acknowledgement translated into a connection with the political arena. Yet, as I write, this work has been consumed by a biomedical monster that has crept into our house and made itself very much at home. In fact, I don’t feel this is my home anymore.’ Jo is challenging a fundamental risk of the biomedical therapeutic model, that it locates a perceived problem in an individual, irrespective of a broader context. In doing so, Jo echoes disaster management expert Marcus Oxley’s insight (in a different arena) that, if we see a pattern of symptoms in people attending an Accident & Emergency unit, it may well reveal something implicitly about conditions in that context. It’s always about the person, but it’s rarely only about the person.  In my first encounters with the Philippines, I was surprised by how often people asked me about my meals. ‘Have you eaten?’ This included during conversations online. I learned, over time, that the question arises out of an economic context in which food is often scarce owing to high levels of poverty, and a cultural context in which the health and well-being of one’s neighbour is considered important. It means the question is literal and it calls for a literal response. If I answer ‘no’ while I’m there physically, I’m likely to be offered and given a meal; even if the person who’s asking is poor. Rudo Kwaramba, a Zimbabwean colleague, explained a similar dynamic whilst working together on an assignment in Uganda. I had been invited there to help an NGO address a key challenge: that managers in rural community-based projects were, apparently, bad at addressing poor performance. Rudo reflected: ‘In wealthy countries, if you can’t earn an income or lose your job, your government provides you with financial support; if you become injured or unwell, your health system or insurance covers you. In poorer countries, people can only look to each other for support.’ It means that, in such contexts, to establish and maintain positive relationships with one’s extended family and neighbours is essential for survival. It also means that to support the health and wellbeing of one’s neighbours is critical too. There is a sense of radical interdependence, a pragmatic-ethical need, that drives cultural behaviour. Against that backdrop, we discovered that managers who were living and working in the same communities as their staff felt unwilling and unable to address poor performance – in case it damaged the network of relationships. It was the core issue for them. This insight moved the culture-shift question in the work from a simplistic-transactional, ‘How to change the performance management system’, to a deeper-relational, ‘How can we hold honest conversations that don’t harm community?’. It proved transformational. As I focus back on South East Asia, I notice that as some countries have grown in wealth, they have experienced a corresponding shift towards individual-orientated cultures. It's as if: the richer I am, the less I need you. ‘Have you eaten?’ is often retained, yet as a simple greeting, not as a literal inquiry or as an invitation to a meal. So, I’m curious: what have been your experiences of working cross-culturally? What have you learned? |
Nick WrightI'm a psychological coach, trainer and OD consultant. Curious to discover how can I help you? Get in touch! 
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