In 1992, a married couple and their daughter arrived as refugees in the Netherlands to escape a civil war in Somalia. They settled in a three-bedroom house located in a melting-pot neighbourhood. Hodan and her two siblings were born here before the family left for the United Kingdom in 2002. A family of six turned nine rebuilt their lives in a multicultural city. A traditional Somali household adheres to strict gender roles, which involve social norms, attitudes and activities deemed appropriate for men and women (1). In this cultural context, other female relatives support domestic duties and care for minor children. Also, it is common practice for adults living in the community to discipline children in the interest of good manners. However, studies on Somali diasporas illustrate a change in gender behaviours acquired through challenges in the host country (2). Likewise, Hodan recalls her father would complete household chores after returning from work. Her mother performed unconventional tasks, such as being the primary disciplinarian and managing household expenditures. In addition, a monthly budget was allocated to relatives back home in Somalia despite the family being low-income.
Hodan noticed during childhood that her parents were harder on girls than boys. They often scrutinised their daughters’ conduct and dress code to ensure they conformed to cultural expectations. As a result, the girls learned to be responsible early by helping with household chores and babysitting younger siblings. However, the parents implemented physical punishment and harsh language to enforce discipline. As a result, Hodan often found herself reading their facial expressions and looking for signs of disapproval in case she needed to adjust her behaviour. “I would often either reassess past events or picture a beautiful future,” she states. Here Hodan describes rumination in which the person dwells on excessively analysing a particular thought. A cross-cultural longitudinal study found mothers who implemented harsh punishment with their daughters increased ruminative tendencies making them vulnerable to depression and anxiety (3).
The older Somali generation values science and health courses for better career prospects. Therefore, Hogan’s parents discouraged her from studying English Literature at university. She obeyed their wishes and chose a healthcare-related degree under one condition—study in London. The transition to university life can pose an increased risk for loneliness making students unable to cope with stress and exacerbating mental distress (4). Hodan experienced a culture shock during freshers week after being invited to bars and clubs. She would make excuses to avoid these events instead of staying indoors. “I used to stay up at night on my phone interacting with my friends,” says Hodan. Poor sleeping patterns, concentration difficulties and unable to cope with academic stress, she reached out to her professor, where her mental health journey started.
At first, Hodan went to the university counselling services. Still, after several sessions, she discontinued the approach as it was ineffective. Next was a phone call to the NHS seeking advice about her physical pain. They immediately sent a letter to the GP after she disclosed to have been in bed for three days, unable to move. The doctor completed a thorough health examination, but all the test results returned normal. It left her confused and hopeless, and she struggled silently. Finally, Hodan admitted herself to A&E during her mid-third year of undergrad. She says, “I felt shameful to disclose my intimate issues to a stranger. For him to find out made me feel worthless, I just cried.” The psychiatrist suspected severe depression and anxiety and referred her to the GP. After the appointment, the doctor prescribed antidepressants with a referral to IAPT. It took several months for the psychological well-being practitioner to book Hodan for assessment. By then, she had completed her degree and returned home. Unfortunately, the antidepressant proved ineffective as she could not adhere while hiding the medicine from her parents. Twelve weeks of a cognitive behavioral therapy course only gave her temporary relief. Seven years later, Hodan continues to struggle with mental health problems with no treatment. She concludes that talking therapy from her experience cannot resolve complex cultural distress.
