There is no word for mental illness in the Hmong language. The term 'mental health' in Hmong translates to 'the pain in the brain, or damage in the brain' (mob hlwb, or xiam hlwb). The term 'Department of Mental Health' translates to 'the House of Damaged Brain' (tsev xiam hlwb). Because of these stigmatizing translations, many Hmong don’t want mental health treatment. They don’t want to be seen as crazy in the community.
According to an article by Linda Genshemier in the Hmong Studies Journal, "Before seeking western mental health services, it is common for traditional Hmong adults to pursue help for problems through their family and clan system, and through the use of traditional healing methods, including the use of tshuaj ntsuab (herbs), treatment by kws tshuaj (medicine doctor) or kws khawv koob (ritual healers), and a soul calling ceremony (hu plig). The tus txiv neeb, or the shaman, is considered to be the supreme folk healer and there are different levels of shamans with varying abilities." [PDF]
But many Hmong do eventually seek western mental health services, and they tend to describe mental health problems as physical health problems. Different kinds of mental health illnesses are often associated with problems of the liver. This is analogous to people saying their heart hurts in English. For example, sab phem, or 'ugly liver' means someone is suddenly feeling destructive and abusive; nyuab sab, or 'difficult liver' means a person is suffering from excessive worry, is confused, cries often, and can’t sleep.
I interviewed Lee Thao of Merced, my cousin’s son-in-law, who is a refugee from Laos and is from the same region as me, Mong Pheng in Vangvieng. Thao and I discussed how the Hmong community in Merced understands mental health issues.
Changvang Her: Do you think problems in living are spiritual or because of your mind?
Lee Thao: It is spirituals, when the souls leave the body, something abnormal happen to you.
Changvang Her: Do you go to shaman when you have problems in living like not being able to sleep or being sad?
Lee Thao: Yes, the souls may be wandering away or being capture by evil spirits so souls calling and shaman ceremony is need.
Changvang Her: Have you ever visited a mental health professional that is a western doctor?
Lee Thao: No, because I do not have mental health illness.
Changvang Her: If you ever got mental health treatment from western doctor, would you be concerned that the Hmong community would find out?
Lee Thao: Yes, because mental health has negative connotation among the Hmong. Hmong patients seeking mental health would be the last resort.
I believe that to get more Hmong patients to seek mental health care, we need more patient education, more Hmong clinicians, Hmong psychiatrists, Hmong psychologists, and of course trained Hmong interpreters on staff. Otherwise when Hmong patients present their symptoms, the meaning will get lost in translation.