Health, Illness and the Mind-Body Connection: A Student’s Cross-Cultural Perspective

Emma Barteau, OTS

When I arrived on the island of Curaçao for the first time, I had little idea of what was to come from the culture, the people, or the healthcare system. Having only left the US once before, this was a bit of a leap: finishing my occupational therapy (OT) schooling with a capstone experience in a foreign country. Though, yes, I did plenty of research, Google searching - and even joined Facebook groups before arriving - there is no way to grasp the fullness of a new place without stepping foot in it!

Once there, it didn't take long to fall into the rhythm of life on the island, figuring out how to navigate the busy streets and finding the local shops in the area. The site of my capstone project - the physical rehabilitation centre for the island - also became familiar, following days of observation, interviews and asking plenty of questions.

It became evident that OT here was not an alien profession; many treatments and activities echoed those I had seen in the US.

The island of Curaçao - location for this OT capstone project

As my understanding of the facility and the OTs grew, it also became clear that there was a need for the project I hoped to enact. I arrived with the purpose of advocating for mental health care to be provided from the perspective of OT - which I quickly learned would require a multifaceted approach to balance the influencing factors...

Physical and Mental Health (the 'mind-body connection')

This rehabilitation facility, like most, provides care for a variety of people needing inpatient services, following major changes in health: strokes, amputations, spinal cord injuries, etc. could be expected to be seen in the patient population. Just by following along with patient treatments and conversations among practitioners, I could see very early on that depression and anxiety were not uncommon and often had influence on the course of treatment. Diving into the literature further confirmed this, as I learned that physical disorders are highly associated with changes in mental health, including mental distress (Cree et al., 2020; Damsbo et al., 2020; Kang et al., 2015; Terrill et al., 2018). Interestingly, this relationship appears to work both ways, as other sources identified mental distress as a contributor to disability (Rai et al., 2011).

This relationship of the body and mind paints a picture of a patient population in a vulnerable situation, with increases in mental health risks.

At this facility, there is a psychology team, who work with patients who demonstrate the need for psychological intervention. This is a great service to have available, sure, but there is a distinct isolation of the mind and body in this structure. Psychology addresses the mind, OT addresses the upper body, physiotherapy (/physical therapy, PT) addresses the lower body, that kind of thing.

Instead, our profession has been rooted in holism; several models and frameworks describe the interwoven relationship of the personal and environmental factors, as well as the mind-body connection. In our education to become OTs, we don't only cover pathologies and treatments of the upper extremity, but learn to assess the whole person. 

Role of Culture

Curaçao is a constituent island country within the Kingdom of the Netherlands, in the southern Caribbean Sea, about 65 km (40 miles) north of Venezuela

When talking about the whole person, culture must also be considered - especially in the circumstances of this project. Curaçao, a Caribbean melting pot, contains Dutch, Portuguese, South American, Indian and African influences, with additional visitors to the island year-round. In this blend, there are attitudes and beliefs of health and illness which influence the help-seeking and treatment of mental health conditions. Unfortunately, there are reports of stigmatisation of physical and mental illness in Curaçao, which impact individuals' participation in society.

Due to the cultural diversity of the island, though, it is impossible to identify a single belief system by which the population operates, requiring more emphasis to be placed on a person's individual background, experiences and values.

The benefit for patients in the rehabilitation facility is that mental health needs are commonly identified by staff who spend time with the patients every day, such as the OTs. The ultimate willingness to discuss mental health and receive treatment still remains the patient's prerogative. 

---

The Project

The final design of the project reflects a balance of the factors discussed:

• Adjoining the assessment and treatment of the mind and body

• Working inter-professionally with psychology and other professions

• Maintaining cultural respect, while exploring beliefs

To do this, three strategies are being employed:

1. Staff education: As there appears to be some general confusion about the scope of OT assessment and treatment, advocacy will be provided for the profession among the facility staff, through a presentation. Then, mental health basics will be introduced, with an emphasis on what OT can do in this sphere. 
   

2. Development of a screening tool: A short screening tool has been written to meet the needs of the site population, while maintaining OT scope and cultural needs. This tool will be piloted among the site population and OTs will receive training on its use. 
   

3. Development of a resource library: Based on the outcome of the screening tool, a practitioner can then employ use of this library, by locating relevant handout and activity materials for a patient. These educational and interventional materials have been designed to provide a brief but effective mode of addressing mental health skills. 

All materials are also being translated into the prominent local languages: Papiamento and Dutch. 

Reflecting

Although I am still in the midst of this project, I already feel as though I have gained invaluable experience, both as a future practitioner and as a person. I have grown a passion for unifying mental and physical health services - a need I know exists in the US as well.

I hope that my gained awareness of cultural influences on health and illness will help me as I assess and treat future clients, refraining from making assumptions of their experiences. I am more than thankful for the time I have in Curaçao - and for the holistic and client-centred spirit of occupational therapy.

---

References

• Cree, R.A., Okoro, C.A., Zack, M.M. and Carbone, E. (2020) Frequent mental distress among adults, by disability status, disability type and selected characteristics - United States, 2018. MMWR. Morbidity and Mortality Weekly Report, 69 (36), 1238-1243. https://doi.org/10.15585/mmwr.mm6936a2

• Damsbo, A.G., Kraglund, K.L., Buttenschøn, H.N., Johnsen, S.P., Andersen, G. and Mortensen, J.K. (2020) Predictors for wellbeing and characteristics of mental health after stroke. Journal of Affective Disorders, 264 (264), 358-364. https://doi.org/10.1016/j.jad.2019.12.032

• Kang, H.-J., Kim, S.-Y., Bae, K.-Y., Kim, S.-W., Shin, I.-S., Yoon, J.-S. and Kim, J.-M. (2015) Comorbidity of depression with physical disorders: Research and clinical implications. Chonnam Medical Journal, 51 (1), 8-18. https://doi.org/10.4068/cmj.2015.51.1.8

• Rai, D., Kosidou, K., Lundberg, M., Araya, R., Lewis, G. and Magnusson, C. (2011) Psychological distress and risk of long-term disability: Population-based longitudinal study. Journal of Epidemiology and Community Health, 66 (7), 586-592. https://doi.org/10.1136/jech.2010.119644

• Terrill, A.L., Schwartz, J.K. and Belagaje, S.R. (2018). Best practices for the interdisciplinary rehabilitation team: A review of mental health issues in mild stroke survivors. Stroke Research and Treatment, 2018, 1-8. https://doi.org/10.1155/2018/6187328