Murug, Waali, and Gini: Expressions of Distress in Refugees From Somalia

OBJECTIVE: To study how mental illness is understood, expressed, and treated among Somali refugees and how these factors influence use of health services for mental problems. METHOD: Seventeen adult Somali refugees (9 women, 8 men) were recruited by mail or by word-of-mouth to participate in the study. The study setting was an urban community health center in Rochester, N.Y., that provides family practice patient care to local Somali refugees. A qualitative design was used that incorporated a combination of methods, chiefly semistructured interviews. Interviews focused on the ways in which sadness, depression, and anxiety are expressed and on the participants' understanding of the origins of and treatment strategies for these problems. Interview transcripts were analyzed to identify recurrent themes. RESULTS: Nearly all participants felt that mental illness was a new problem for their community that did not exist to the same extent in prewar Somalia. Themes that emerged to explain the causes of mental illness included the shock and devastation of war; dead, missing, or separated family members; and spirit possession or a curse. Three major types of mental problems were identified that were associated with specific behaviors and treatment strategies: murug (sadness or suffering), gini (craziness due to spirit possession), and waali (craziness due to severe trauma). Rather than seek help from a clinician, participants preferred to first use family support, prayer, or traditional therapies for most situations. CONCLUSION: Somali refugees have distinct ways of conceptualizing, expressing, and treating commonly understood mental problems. Participants differed in their opinions about whether they would consult a doctor to discuss feelings of sadness or craziness. Effective mental health care of refugees should address culture-specific belief systems in diagnosis and treatment.