New America Media, News Feature, Joel Grostephan — Editor’s Note: A 31-year-old Somali woman goes missing after she’s diagnosed with psychosis, and her family is baffled when the county won’t tell them where she is so they could begin the spiritual healing treatment they believe will help her, writes NAM contributor, Joel Grostephan.

ST. PAUL, Minn. — Samira Iman was missing for nearly two years. The 31-year-old Somali didn’t run away. She wasn’t kidnapped. She didn’t go to Africa to fight in Somalia’s decades-old civil war. She was living in St. Cloud, Minn., in a group home for the mentally ill. But Samira’s family lost track of her, and mental health officials did not help them locate her.

One day in the fall of 2007, Samira fainted at the poultry processing plant where she had begun working. She was taken to a hospital, where she was diagnosed with mental illness, according to her family. After she was discharged, she was either sent to a group home or released on to the street, but not to her family. When her younger brother, Yahya Iman, tried to find out where she was, Stearns County Human Services cited government privacy laws and would give no information.

Then, earlier this month, Samira reappeared as mysteriously as she disappeared. Now she’s living with her family. But in the two years she was away, she got herself into trouble. Samira faces felony assault charges for allegedly hitting staff members at the group home last fall. Given her mental state and the nature of the crime, she is likely to be convicted of a less serious offense. She missed her court hearing scheduled for February 2009, so Judge Paul Midwick issued a warrant for her arrest. Yahya doesn’t understand that.

“It don’t make sense how they would charge someone who is mentally ill with something,” he said.

Since the family arrived in the United States in 2001, many things haven’t made sense to them. They still are trying to figure out why the county didn’t allow the family to care for Samira for two years. Why would they not let them know where she was so she could be taken to an Islamic priest to treat her mental illness? Why would the county let Samira make decisions for herself when she wasn’t well?

The Imans are among 30,000 refugees from the civil war who have settled down in Minnesota. It wasn’t long after they came here that they realized that freedom from persecution comes with a price. Many have found that their culture and values don’t have a place in the United States. In Somalia, family takes care of family. Not being able to take care of them is considered shameful. Samira’s family is upset that for the past two years, they could not use traditional Islamic healing practices to help her.

“It’s a huge stigma when a family is unable to take care of one’s own,” said Abdirizak Bihi, a Somali community activist and former interpreter at Hennepin County Medical Center. “People in the community will feel that the family abandoned its own, and the family will feel it’s been robbed,” he said.

When Samira was in a county hospital in Willmar last fall, she was diagnosed with psychosis, and her doctor noted she was delusional. Psychosis is a broad diagnosis that could include anything from post-traumatic stress disorder to schizophrenia. In discharge papers obtained by New America Media, Dr. Richard Kokkila wrote about Samira’s violent outbursts at the facility, including throwing hot coffee at staff.

“She has been mocking staff, staring at staff, laughing hysterically at times,” his report stated. He also noted that “she doesn’t want anyone involved in her life,” including her social worker, group home providers or her family, who she believed tried to poison her food.

The emphasis on individual rights, including privacy, is a foreign concept for Somalis, said Dr. Abdirahman Mohamed, a Somali-born family doctor in Minneapolis, who treats mental illness. Somali culture is still communal, he said, and no one would decline help from family. “Her interest to be left alone doesn’t supersede the interest of the family’s need to help,” Mohamed said.

Health officials do not have statistics on the rate of mental illness in Minnesota’s Somali community, but a 2004 study of 1,134 Eritreans and Somalis in the state found that as many as 47 percent of Somali women and 25 percent of men had been tortured before they arrived in the United States. Many Somalis could therefore be suffering from post-traumatic stress disorder (PTSD). Few Somalis want to follow up with treatment because they are wary of authorities.

“You don’t share your problems with professionals,” said Dr. James Jaranson, a psychiatrist and author of the study. “You talk to family or religious leaders or traditional healers.”

Jaranson said if problems are severe enough, Somalis utilize both western and traditional medicine.

Since the 1990s, when Somalis started to arrive in Minneapolis, some mental health professionals have tailored treatment to fit with Somali culture, said therapist David McGraw Schuchman.

“What family means in the Somali community is different,” Schuchman said. “It is a source of identity, strength, comfort, and protection.”

Doctors and therapists describe patients are routinely accompanied by their family members — sometimes four or five of them.

Then there are other cultural beliefs in the community. About 90 percent of them believe spirit possession, or jinn, causes mental illness, according to Mohamed.

Mary Bradmiller, a psychologist who works with refugees at Hennepin County Medical Center, said being comfortable talking about religion is critical for health providers. She frequently hears about jinn possession, which her Somali patients insist can be treated by a priest.

“Reading the Koran might bring symptom reduction for a period of months,” Bradmiller said.

Samira’s family believes she is suffering from jinn possession. In the past, the family used a number of different priests to read the Koran over her. Samira would be fine for about six months after that, Yahya maintained.

Hassan Mohamud, head priest of the Dawa Center in St. Paul said jinn are invisible to humans. Some of them are neutral – they don’t mean any harm — but some of them are evil. Mohamud acknowledges that western medicine can help treat mental illness, but he believes Islamic traditional medicine should be tried first.

A priest’s exorcism of jinn involves reading certain prayers and verses from the Koran. “We ask the jinn: ‘Who are you? What’s your name? Where are you from? And, why are you harming this person?’” Mohamud said. That generally sends the jinn away.

The religious support may also encourage patients to take their medication.

When Samira joined her family in the United States in 2005, she refused to eat for nearly a month, her brother, Yahya, said. Sometimes Samira would get angry and have fainting spells, but her condition was remedied through prayer, her brother recalled.

When she was gone, contact with her was sporadic. In the fall of 2008 her younger sister, Bisharo Iman, said she met with Samira at a motel where she was staying temporarily. At that time, her sister didn’t want to come home to the family and declined their offer to rent an apartment for her.

For the Iman family, language and cultural barriers made it even more difficult in dealing with the bureaucratic challenges many families face in caring for a loved one with mental illness.

About a month before Samira returned home, Yahya spent the day trying to find his sister at her last known address: a church-run shelter. A worker there told him Samira’s social worker placed her in a group home for the mentally ill. He went downtown to find her. But like other trips to Stearns County Human Services, he came up empty. He said that he was told by Stearns County Human Services officials that privacy laws prevented them from discussing her case with the family. His mother had been there the day before and was told the same thing.

Sue Abderholden, of the National Alliance on Mental Illness of Minnesota, said releasing some information against the client’s wishes is not against the law. She said many counties believe it is, but even so, they could still help the family. But on the other hand, if someone has dementia, the hospital will make efforts to contact the family.

It is unclear what steps the county took over the past two years to put Samira in touch with her family. When asked about this, Stearns County Human Services Community Support Division Director Janet Reigstad said she was “unable to give any information on this case due to restrictions of government data privacy act.”

After Samira returned home, her mother, Mano Dhuhul, began the process of getting legal guardianship of her. That would give her a say in her daughter’s life when dealing with social workers and health providers. Dhuhul speaks a little English, but relies on her kids to interpret for her. She sometimes regrets coming to the United States. “Back home, we had the power to do something,” Dhuhul said.

Dhuhul knows her daughter is not well. She paces around and around and laughs inappropriately. She doesn’t eat “normally,” the family says. In some ways, her condition seems worse than before she went missing, Dhuhul said. Despite all this, Dhuhul is hopeful that she will recover and be able to work again.

Yahya visits his sister regularly. The family hasn’t taken her to a priest yet, but everyday Samira listens to a CD of an priest reading the Koran.

“I feel good now, she’s safe in our hands,” he said.

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