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Hmong Cultural Behaviors Impacting Psychotherapy
Willie B. Garrett, MS, LP, Ed.D.
Hmong History
Fled Chinese oppression and relocated to Laos, Thailand, Vietnam, and Cambodia.
Sought independence from government influence, and preferred living in rural farming or mountain regions.
Joined the French in the 1940s, and then Americans in the 1950s against the communists. Became the “secret army” of the CIA during the Vietnam War.
Hmong History
Fought under the leadership of revered General Vang Pao.
Hmong soldiers fought in the most dangerous battles and were fierce fighters, who were feared by the communists.
When the U.S. pulled out in 1975 most Hmong were left behind, resulting in genocide comparable to the holocaust.
Hmong History
Communist atrocities included executions, sexual assaults, bombing, torture, poisoning, ambushes, and biological chemical sprays from aircraft on the people or vegetation.
Hmong people escaped through the jungle or mountains, sleeping by day, running at night. Some got to Thailand in a month while others took years. Most were malnourished or starving. Some Hmong escapees still hide in remote areas of Laos.
Thailand Refugee Camps
The Mekong River was the border between Laos and Thailand, and many Hmong were ambushed, crossed mine fields, sprayed with poisons, or drowned crossing the river.
Hmong survivors were often separated from family members in the chaos.
Once in Thailand refugees were then often robbed, assaulted, raped, or abused by Thai citizens, police, or soldiers.
Thailand Refugee Camps
Hmong lived under harsh conditions in the refugee camps with limited nutrition and medical care, poor sanitation, crowding leading to violence, boredom, exploitation, and high rates of Hepatitis and TB.
The Thai government also repatriated some Hmong back to Laos, where they were certain to be persecuted. Thai also desecrated Hmong graves for financial gain.
Coming to America
About 40 years ago refugees began coming to the U.S. France, Australia, and other countries. The last large group of refugees left Thailand in 2004.
Minnesota now has 70-80 thousand Hmong. In Minnesota the largest Hmong population resides in St. Paul, however small groups of Hmong are scattered throughout the state and living in small communities.
Hmong Culture
Hmong have 18 clan last names. Many first names are not gender based.
Ethnic groups of White, Green, and Black Hmong. Slightly different clothing style, dialect, and customs.
Some have converted to Christianity, but most believe in traditional Shamanism of three souls, and spirits that affect health and emotions.
Hmong Culture
Values balance, calmness, peace, quietness, and harmony.
Collectivist and holistic practices. Healing and growth through harmony between mind, body, and spirits.
Paternalistic. Spirituality, wealth, and goodness through male lineage.
Females have few traditional rights, marry as teens, and average six children.
Hmong Culture
Believe fresh food and water, fresh air, massage , exercise, and sunshine are healing.
Believe in rebirth, and views death as just passing through a door into new life.
Family is defined as all members from the great grandparents to the present.
Funerals are usually 3 or 4 days, and family community events costing about 30K.
Hmong Culture
Some celebrate American holidays. The two big holidays is the July 4th soccer tournaments, and the “New Year”. The New Year is the day after the last harvest, and a time of giving thanks, honoring ancestors, forgiveness, and renewal.
Children do not become adults until married. Children are highly valued despite disabilities. Traditionally use positive parenting.
Integrated Care
Ergonomics of trying to fit into American sized clothing, furniture, etc; causes stress, discomfort, and self esteem issues.
Traditional herbal medicine to cure. Higher rate of accidental overdose using American “maintenance medicines.”
Intense loneliness of living in an individualist culture. High rate of metabolic disorders.
Stress from poverty and cultural losses.
Integrated Care
Stress response of increased use of nicotine, alcohol, and street drugs.
Opium and Methadone use. Stained fingers and teeth may be signs of abuse.
Shaman spirit ceremonies for illness, bad luck, or blessings.
Many Hmong use acupuncture, massage, chiropractor, or physical therapy to treat emotional disorders.
Psychotherapy
Respond well to respect, calmness, support and empathy.
Prefer 30 minute sessions. Intense emotion often reflected in the eyes,
rather than the forehead or chin. Hmong join with the therapist and view as the
“healer.” May invite to family events or offer small gifts.
May respond to mail with anxiety.
Psychotherapy
Always ask “what do you believe is the cause of your ….”
Always ask early in the session if they have forms for you to fill out.
Tell stories about your own experiences. Acknowledge waiting family members. Listen intensely with a deep understanding. Counseling from the context of family and
history, obligation, culture, and spirituality.
Psychotherapy
Use non-verbals of smiling and positive body language.
Respond well to cognitive-behavioral methods, relaxation, assertiveness, etc.
Assess for trauma, as this is a population of war and genocide survivors with high rates of PTSD.
Approximately 75% present with significant depression and anxiety.
Psychotherapy
Older adults often use metaphors to report their concerns.
Very little stigma for suicide. Depression is often presented as a cause of death.
Hanging or poisoning are the preferred methods for self harm.
Attempt to normalize, interpret, validate, and describe cultural differences.
Interpreters
Use interpreters as a resource for understanding Hmong culture.
Resource for identifying speech, hearing, memory, and cognitive functioning.
Not all interpreters are proficient in English or Hmong culture.
Some are dishonest and exploit the client, or lie to the therapist, for their own financial gain.
Bibliography
Chan, S: Hmong Means Free: Life in Laos and America. Philadelphia: Temple University Press: 1994.
Fadiman, A: The Spirit Catches You and You Fall Down. New York, NY; Farrar, Straus, and Giroux: 1997.
Hamilton-Merritt, J: Tragic Mountains: The Hmong, The Americans, and the Secret Wars for Laos, 1942-1992. Bloomington, IN; Indiana University Press: 1993.
Bibliography Her, Vincent K, Buley-Meissner, Mary L:
Hmong and American: From Refugees to Citizens. Minnesota Historical Society Press, St. Paul, MN, 2012.
Vang, Chai: Hmong in Minnesota (People of Minnesota). Minnesota Historical Society Press. St. Paul, MN 2008.
Yang, Kao K: The Latehomecomer: A Hmong Family Memoir. Coffee House Press, Minneapolis, MN 2008.
