Overcoming depression in a strange land: A hmong woman's journey in the world of western medicine

As the world of collaborative family healthcare evolves in synchrony with advancements in medicine and medical technologies, new and emerging clinical and psychotherapeutic approaches, and macrosystemic changes in care delivery and management systems, we are continuously challenged to step outside the comfort zones of our baseline training and competence. We push ourselves to learn about and value the respective contributions of providers who represent disciplines other than our own, and to work effectively together en route to common goals as they relate to the patients and families who seek our help. But this is only part of a much larger system of care, and accordingly facilitates (and limits) our access to the confines of professional expertise that is found in textbooks. As our efforts in medicine and mental health care extend beyond visit-based services into the comparatively less familiar territory of preventive and patientoriented care, a call has emerged for increased partnerships between providers and patients.1-2 These partnerships stand in contrast to traditional hierarchal modes of care that position providers as experts who deliver services to passive patients. Tapping the lived experience and wisdom of patients, themselves, facilitates access to understandings and insights that cannot be found in textbooks. It empowers patients and providers alike to work together as active participators in treatment, each bringing with them a unique set of knowledge and skills. The case presented here highlights these and related processes in collaborative care. It documents the clinical journey of a Hmong refugee from Thailand, who initially presented at a family medicine clinic with what conventional Western diagnostic systems would label as depression. The complex juxtapositions of culture relevant to the case highlight how this initially straightforward diagnosis was not actually so straightforward, and they point to the importance of engaging the patient as an active participator in treatment across time. This patient's clinical journey through the world of Western medicine encompassed an active integration of conventional therapies that were sensitive to culture and an active collaboration between the patient and professional and lay (cultural broker) providers. And over the course of this journey, the patient did more than recover from depression. She evolved from being a recipient of services to actively giving back to her community, working in partnership with providers and other community members to ease the suffering of those who are hurting-and those with whom she can so well relate.