By Yasir Abbasi

Clinical director and consultant psychiatrist for addiction services, Mersey Care NHS trust

“Iam already dead! I have been buried.” said a young south Asian girl on the psychiatric ward. Prior to her admission she had stopped going to school, and instead isolated herself in her room spending hours on the internet searching for her grave. She was not eating much and losing weight. There had been occasions when she wandered off at night. With poor eye contact and slow speech, she added: “I can feel the worms crawling inside my body.”

After an assessment she was found to have developed a severe form of depression with Cotard syndrome (a rare mental illness in which the affected person holds the delusional belief that he or she is already dead). She wanted me to let her access the internet so she could view her grave online. Her family thought that the girl was possessed by a jinn (a demon in Muslim culture). The family wanted to take her to a spiritual healer, away from the hospital, but we were concerned about her wellbeing.

I spent hours explaining to them the need for medical treatment while listening to their cultural understanding of such mental health problems. As mental illness is a taboo in so many cultures, it is easier to see it as a spiritual problem rather than a medical one. I agreed to talk to the spiritual healer, so that he could explain to the family the serious nature of her mental health problems. We finally came to an agreement whereby the girl would continue to have treatment in hospital and the family would place spiritual amulets around the room. There was a good outcome and the young girl was discharged after recovery.

This was my first exposure, as a psychiatry trainee, to cultural issues entwined with mental health problems in England. Although I had an understanding of some of the cultural issues highlighted in this case, I learned it was important to make sure we listened to and respected all views before coming to a decision.

Read more