Beyond “Psychosocial”: The Social Ecology of Care in Two Bhutanese Refugee Communities
The Bhutanese refugees represent an ethnically and linguistically Nepali minority group that was forced to flee Bhutan in the early 1990s (Evans, 2010; Hutt, 2003). Throughout their protracted displacement, the Bhutanese refugee camp population has been subject to considerable psychiatric study and intervention. Moreover, in the five years since the onset of resettlement, Bhutanese refugee mental health has become a public health concern among governments and communities welcoming refugees as well as multilateral organizations facilitating the resettlement process.
The bulk of previous scholarship on Bhutanese refugee mental health has focused on issues of vulnerability, morbidity, and manifestations of distress, including suicide. To date, exploration of family- and community-level processes that aim to promote healing in Bhutanese refugee communities, hereafter encompassed under the heading of “care,” has been limited. This paper works at the margins of existing literature to recount findings of a systematic exploration of society as healing context and the broad spectrum of “non-formal” practices of care operating in Bhutanese refugee communities. It contests the claim that Nepal is a country with “extremely few mental health resources” (Tol et al., 2005, p. 319), arguing instead that many of the most important culturally proscribed responses to suffering fall between the cracks of dominant conceptual frameworks in psychology and applied medical anthropology and are easily overlooked by investigations structured around the “psychosocial.”
Drawing on ethnographic case studies from field sites in the refugee camps of eastern Nepal and a resettled community in Burlington, VT, the paper explores Bhutanese refugee community groups as primary sites of care, attending to the ways in which the healing of “psychosocial” suffering is embedded within more holistic, ecologically oriented agendas. The cases are also used to consider the role of family and community in identifying and responding to distress. Idioms of vulnerability and help-providing behaviors are introduced as important complementary theoretical concepts to account for collective approaches to the management of suffering among Bhutanese refugees. The relevance of the social ecological model of community psychology is also discussed.
At the pragmatic/therapeutic level, this paper outlines the important role community-based organizations may play in Bhutanese refugee society as well as public health interventions targeting Bhutanese refugees. At a more theoretical level, it disrupts the widespread conflation of the absence of a discrete mental health care sector in indigenous societies with the absence of a sophisticated body of knowledge and resources related to the pursuit of mental health and wellbeing. Finally, at the level of methodology, this paper points to potential risks associated with the application of theory in the absence of deep ethnography. It suggests that as medical anthropological concepts such as “idioms of distress” once used to uncover complexity and cross-cultural variation gain currency in clinical circles, they also undergo processes of ossification and instrumentalization, becoming ostensible “short-cuts” to cultural competency.