Key Issues in Conducting Mental
Health Research in Traditional
Communities:
Examples from Sri Lanka
Gaithri A. Fernando, Ph.D.
California State University,
Los Angeles
Objectives
Identify some issues relevant to conducting
socially responsible mental health research
with traditional communities
Provide some recommendations for
conducting long term programs of research
that is sustaining for both researcher and
communities where research is conducted
Global Mental Health: What is it?
Definition
Overall mental health of an individual
Sum of all knowledge about mental health in
all countries and cultures
Conversations and discourses around mental
health issues
Typically by people in countries with resources
About people in countries without resources
[Measureable?]
Key Issue 1: Etic-Emic Tension
Etic – culture-general
Emic – culture-specific
Pseudo-etic – assuming an etic position
that is actually emic
E.g. PTSD
Key Issue 1: Etic-Emic Tension
Training
Training is often conducted in developed
countries, using etic or pseudoetic perspective
Training often changes or solidifies the
perspective of trainee
Examples
Clinical work with bomb blast
survivors
“PTSD” work ended after 3 weeks
Rest of the time – women supporting
each other
“Renuka” and her husband
Clinical work with torture survivor
How reincarnation impacted coping
Examples
PTSD
Intrapsychic vs. external and psychosocial
SLIPSS-A
Predictors of Life Satisfaction
b = -.64
(p = .000)
SLIPSS-A
Scores
Life Rating
b = .24
(p = .000)
Life Concerns
(Finances,
Education)
R2 = .41, p < .000
Key Issue 1: Etic-Emic Tension
Data gathering
What data are gathered are now colored by
trainee’s training
Value of qualitative vs. quantitative data
If data remains emic, researchers and editors
of journals consider that ‘regional’ and reject
papers
If data become pseudoetic they are of no value
to the local communities (can be harmful)
Researcher has to navigate between two
sometimes competing agendas
Example: Trauma and PTSD
PTSD is the model that was being
used by many researchers after
tsunami
Emic understanding: psychosocial vs.
PTSD
Emic understanding: daily stressors vs.
trauma exposure
Example: Trauma and PTSD
‘Black Box’ Model
Traumatic
Event
c
Negative
Outcomes
Mediation Model
Daily
Stressors
b
a
Traumatic
Event
c′
c
Negative
Outcomes
Example: Resilience Research
Resilience in Sri Lanka: “Aathmashakthiya” –
strength of will; “hitha hadaagaththa” –
mending one’s heart
Psychosocial gratitude an important component of
resilience
Key Issue 2: Classification
“Western”/“Non-Western”
Looking for a new language
HIC-LIC – doesn’t capture cultural aspects
“EA-17”, E. European, Asian, Hispanic, African
(where does Russia fall)?
“Euro-American/Developed” vs. “Asian/ Developed”
vs.“Non-EA-Asian/Developing?
Resistance to changing classification
Why is it an issue?
Precision of scientific language
Identification of players/agendas
Key Issue 3: Identifying Stakeholders
Funder
Researcher’s institution
Researcher
Funder’s stakeholders – research
organizations, national
institutions, individual donors
Key Issue 3: Identifying Stakeholders
Local organizations/liaisons
Local community
Gatekeepers and community leaders
Members of community
Research community
The “premier” or pioneering researchers
Editors of journals
Peer reviewers
Readers
Researchers’ co-workers/students
Key Issue 4: Tying Goals and Outcomes of
Research to Stakeholder Expectations
Educating others (including other
researchers) to the complexities of the
lived experience of communities
“What is needed, even in the poorest
countries, are robust evaluations of
innovative programs” – Kleinman, 2003
Key Issue 4: Tying Goals of Research
to Stakeholder Expectations
Educate the funder/funder’s stakeholders about the
community being studied
Policy implications of the research (e.g. daily stressor project)
Establishing funding priorities
Ensuring that the resources sent match the reality of the
receiving community
Persuade funders to invest in communities and
facilitate that process
Introduce local organizations to funders and making local
communities ‘visible’
Persuade funders to include outcomes they may not have
considered (those that communities consider important)
Key Issue 4: Tying Goals & Outcomes of
Research to Stakeholder Expectations
Standing with local organizations to
empower and educate communities
Use the findings of the research to
enhance quality of life of communities
Encourage community members to
step up as community leaders
Build capacity for both research and
intervention
Key Issue 4: Tying Goals & Outcomes of
Research to Stakeholder Expectations
Educate the researcher
Reflecting on whether/how the research
changed the researcher in some way
Inform future research of the researcher
Reflect on context – historical,
psychological, current realities
Increase the credibility of the
researcher
Increase the fundability of the
researcher
Key Issue 4: Tying Goals & Outcomes of
Research to Stakeholder Expectations
Enhance the profile of the
researcher’s institution
Provide data for the funder to keep
funding mandate alive; generate
reports that justify keeping funder in
business
Key Issue 5: Evaluating the Effort
Who benefits?
Researcher – publications, presentations,
credibility
Institution – prestige, attracting important
faculty
Funder – further funding, credibility
Community – greater understanding from
others? Resources from researchers and
funders?
Recommendations
Be aware of your prejudices
Ask others to hold up the mirror!
Watch out for the power differential
Be open to feedback (be humble)
Learn from the communities in which
you work
Be creative in how you can bring
resources to the communities you
study