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S54 A. Vardar et al. / European Psychiatry 27 (2012) / supplement n°2 / S50-S55
although using different terms. While native Germans speak
explicitly of “psychotherapy/psychotherapists”, Turkish immigrants
name “therapy/therapist”. To what extent these terms
are connected to the same meaning has yet to be proven in the
next step of the research, the Pile Sorts. In general, the answers
concerning professional help resemble each other in the three
groups and can be interpreted as low infl uence of cultural differences.
This is strengthened by the fact that no “traditional”
help possibilities like hocas were mentioned which extends
Penka’s [16] fi ndings that hocas do not play an important role
for young Turkish immigrants in seeking help from drug addiction.
Thus our fi ndings show that no major cultural divide along
spiritual versus medical lines can be observed as some studies
suggested [2]. Yet as barriers to the mental health care system
in Germany can still be observed for immigrants [9,15], these
may not only lie in different ways of expressing mental disorders
but problems in communication, e.g. not feeling understood by
professionals.
The strength of the study is its semi- qualitative approach.
By using open questions interviewees could list items that
were truly relevant for them. This explorative method is complemented
by counting the frequencies of so found categories
and comparing them among groups. As a result the complexity
and heterogeneity in expressing mental health problem can be
illustrated. Limitations of the study are that the fi ndings reveal
vocabulary concerning mental health problems but not the way
people act or decide in concrete situations. As the Free Listing is
the fi rst step of the research, the next step (Pile Sorts) will show
how the categories are connected to each other.
While most of the literature points out to different health
beliefs of Turkish immigrants and relate them to tradition,
this study shows that there is a large diversity in the Turkish
community concerning expressing mental health problems.
Especially concerning professional help possibilities (Table 4),
answers between native Germans and Turkish immigrants
just vary slightly. The differences in answering behaviour
according to sub groups matches the results of the representative
Sinus study [21] that analyzed everyday life worlds of
immigrants in Germany. The results point out to the fact that
immigrants with the same ethnic background may belong
to quite different everyday- life worlds with different norms
and different sub- cultures. Also Bollini and Siem [3] point
out to the fact that social background of patients is crucial
for utilisation praxis.
For the practical work with patients the results implicate the
importance for looking at each case individually, not ignoring
cultural factors as well as considering the social and educational
background. The avoidance of generalizations is important as
health beliefs of patients of the same ethnic origin may vary considerably.
One should be careful to judge immigrants’ behaviour
through the “cultural” lens like Kürşat- Ahlers stated “It is as if
Turkish people have culture and Germans have a psyche” [18].
Therefore it is useful to keep in mind the questions Kleinman noted
to elicit concrete explanatory models3 [10], i.e. to ask patients
3 The questions are: What do you call this problem? What do you believe
is the cause for this problem? What course do you expect it to take? How
serious is it? What do you think does the problem inside your body? How
does it affect your body and your mind? What do you fear most about this
condition? What do you fear most about the treatment?
for their assumptions about their illness. Using these questions
professionals can avoid to walk right into the cultural trap but
still be aware of different ways of thinking patients might have.
Acknowledgements
The study is funded by the VW-foundation (VW-AZ 84336)
and supported by the German Federal Ministry of Education and
Research (BMBF 01 EL 0807).
Confl ict of interest statement
None.
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