Brief synopsis of Greek Americans

Greeks count as a large number of ethnic minorities in the Unites States. They put an

emphasis on family, honor, religion, education, and Greek heritage, but central values are

honor, respect and shame. Purnell writes that “Although values of honor and shame are found

in all societies, they are particularly important among Mediterranean groups” (153). In a

traditional Greek family father is the head of the house responsible for providing care to the

family and represent authority, whereas the mother is responsible for raising children and

household and are expected to be submissive to their husbands. To keep family honorable and

out of shame from the community some fathers engage in abusive behavior. They are family

oriented and responsible for the elders and it’s very common that they will live under the same

roof, and placing an older parent in an institution is prohibited. Discipline for their children is

“teasing” because they believe that teasing will make them tough and conscious of the public

opinion (Purnell, 157). Adolescent girls have less freedom than boys and as a result are under

high stress from being pressured by parents, and generally adolescents of both genders are

stressed because of differences of family conservatism and peer importance leading them to

commit suicide. According to Purnell Greeks are expressive people when they experience

anger, but when they experience depression or anxiety they tend to hide it from outside

people. They practice Greek Orthodox religion and their church is viewed as a foundation for

their culture. They tend to wear a crucifix around neck, and icons with the saints are present in

their homes. According to their religion they do fasting, mostly on Wednesdays and Fridays,

before important holidays such as Easter. During fasting they do not eat animal products

including meat, eggs and milk.  In workforce they push toward self reliance and that “is

sometimes seen as reluctance to be told what to do” (Purnell, 157).

Greek Americans are not fond of health care as they are with other aspects of life. Purnell

points out that “Greeks immigrants tend to be anxious about health, to lack trust in health

professionals, and to rely on family and community for advice and remedies” (165). For them

health is being strong, happy, pain free, and able to take care of oneself. If they have health

problems they consider them to be credited to God, evil, or others envy. Because of self

reliance trait they do not use welfare services or other support groups, however folk healing

practices are used such as evil eye, herbs, cupping. To ward off the evil they wear blue “eye”

bead, crucifix, charms, garlic cloves attached to one’s shirt, prayers by family member or priest.

Evil eye is said to be cured by “magissa” a witch. Different herbs are used for various

treatments including chamomile for gastric distress, abdominal pain and cold. Liquors alone or

with combination with tea, lemon and honey, are used to treat cold, sore throat and coughs, or

to relieve “nerves”. Garlic, raw or cooked, is used for many different problems. Cupping is a

practice to relieve colds, high blood pressure, and backache, and is mostly performed by older

generation.  Mental illness is seen as stigma in this culture and has negative consequences. Pain

is seen as evil and has to be eliminated. Greeks that are in pain will not suffer quietly therefore

pain medication would be used so the person has self control. Families are expected to take

care of the sick family member. They will be present at the bedside to protect the patient from

malpractice and will ensure that serious diagnosis would not be divulged to patient until they

think he is ready. During hospitalization Greeks are distrustful and seek more medical advice

from other health professionals and very demanding (Purnell, 167).

 

Leading Health Objective

Mental health is viewed as a stigma in a Greek community and they do not seek

professional care, but keep it private and isolated from the society. Many issues that lead to

metal illness are domestic violence, rape, child sexual abuse, homosexuality and adoption.

Some of the diseases, that Greeks face, are depression, social isolation and anxiety which have

increased lately (Georgiades, 55). Even though religion prohibits taking one’s life many

vulnerable people still commit suicide. Greeks believe that such issues should be resolved

within the family. They hold strongly to the idea of conservatism and that keeps them away

from getting help from therapy. Bagourdi and Vaisman-Tzachor say that “Greeks are not likely

to disclose concerns, family issues, or conflicts to a member of the out-group, and dependency

on outsiders is generally frowned upon” (38). They will distrust the therapist who for them

represents authoritative figure. These mental problems will lead Greeks to social isolation and

mental disturbances because of cultural stigma that is placed upon them. Many times they use

religion as a support, and that protects them from hurting themselves. According to Healthy

People 2020, in 2004 1 in 4 adults suffered from mental illness and mental health is important

to everybody to live a fulfilled life.

 

Consideration for the interview and health history of a Greek patient

To effectively communicate trust has to be established in order to get information from a

Greek patient especially if the nurse is of different culture. According to Giger and Davidhizar to

gain trust nurses need to  allow time before starting questioning, have positive attitude, and

listen actively to patients concerns. Greek people are very proud nation that like to keep

sensitive issues like mental health private, so privacy during an interview is really important.

Many older generation Greeks do not speak English therefore an interpreter would be helpful

to translate. Purnell says that family member should not be used to translate because of honor

and shame would keep some issues hidden. Allow family members to participate in the

interview since they are family oriented and it’s very common they will accompany patient.

Greeks are warm and social people, little space would be provided during interview questioning

because Greeks are comfortable being close and maintaining direct eye contact.  If they are

angry they will express it openly and noisily so no one should be offended by this free

expression. Also, they are an independent and self-reliant community that does not like orders

on what to do from others, so be patient and calmly explain the purpose of the interview that is

to obtain health history.  Screening of suicide would be of highest importance especially for

adolescents, females and elders. In addition health remedies would be assessed to avoid any

drug reactions.

 

Health promotion plan for mental illness among Greek American

To develop a plan that would promote mental health I consider the best approach for

Greek people would be to create a Community Center. This center would place an importance

on teaching, and counseling to prevent negative consequences of mental problems and these

interventions would be done by a health care professionals, like a nurse.  Teaching can be done

by showing videos, handouts, booklets, group presentation preferably in both Greek and

English . In here they can be taught about mental health and mental disorders, its signs and

symptoms, causes, treatment and side effects of the therapy. Also, they need to be educated

about signs of suicide and what to do and who to call in case of suicidal thoughts. In addition

community center would help them meet other people from the same community and share

problems. To strengthen the relationship between Greeks and the center I would suggest

participation of people that are viewed as role models from their community to contribute,

share and encourage them to seek help with their mental issues. Indeed the community center

would be situated in an area where Greeks reside for the center to work effectively. Even

though they are self reliant community this center would attract them since they are

considered collectivistic nation. The goal of this community center is to improve mental health

among Greek Americans and seek professional help if needed, and most importantly minimize

the stigma regarding mental problems.

To reduce stigma related to mental issues among this Mediterranean community,

Greeks the need to first and utmost accept mental problems and view them as a clinical

problem that can be solved with the help of a professional. They have to understand that

mental health is as important to ones being as any other medical condition and need to know

that sometimes there is no control over it.  According to Healthy People 2020 mental illness is

associated with many medical conditions such as diabetes, heart disease and cancer. Also,

mental health disorders “can have harmful and long standing effects” for the patient and his

family. Nurses have to be sensitive to their culture and mental health and approach them with

respect. Knowing their cultural honor that represents them nurse would discuss about mental

health with great caution. Referral to mental health providers would be suggested.  Greeks

tend to show distrust and do not comply with treatment plan, so the nurse should persist about

the importance of complying with health care professionals and treatment (Purnell, 154). To

expect compliance with drugs Greeks need to be taught about side effects and ways to manage

those unwanted reactions. For example dry mouth is a common side effect of antidepressants

and to manage it patient would rinse the mouth frequently to avoid oral infections.

Furthermore, the nurse would teach the patient by considering another explanation for the

problems and not relying on own assumptions and beliefs. Help patient identify situations that

lead to negative outcomes. For example patient blames self for everything bad happens, or

thinks that others dislike him, or focuses only on bad things. By identifying these practices

Greek patients would be able to look at situations differently and prevent suicide. However

suicide ideation has to be assessed. To evaluate suicide patients have to be asked directly if

they think of harming themselves. Teach relatives about signs of suicide like “Everything will be

fine now”, or they start giving away precious things.

Then measures to improve quality of life among Greek population would be taken. Patients

need to be taught coping strategies to relieve anxiety or depression, or any mental dysfunction.

Whenever patients are under stressful conditions there are steps to eliminate negative

thoughts. For example mild exercise like walking has many great advantages. It can improve

mood and eliminate negative thinking. Also, join support groups. Giger and Davidhizar point out

that “A network of friends, relatives, and neighbors can be crucial to psychological wellbeing

and can relieve social isolation, promote mental health, facilitate coping, alleviate problems by

preventive problem solving and assist persons in preparing for stressful events in life” (98).

Even though they are reluctant to use any assistance programs, stress the benefits of support

groups and any other programs that can be helpful toward their health. Greek people are

known to be collectivistic community.  Sharing problems to friends and relatives can reduce

social isolation thus promote wellbeing. For example a woman would be more open about her

violent husband with someone from her community who had experienced the same problems.

An alternative would be to seek help from the church and discuss problems with the priest.

Greek people are very proud of being Greek orthodox and sharing problems to someone they

admire and respect would help with negative thoughts they endure.  A priest plays an

important role in Greeks life. He counsels them and they are submissive to him. But sometimes

is better to seek professional help because they would benefit greatly from treatment. Mental

disorders need long term treatment and drugs would benefit them because there is chemical

imbalance with many mental disorders. Healthy People 2020 suggests that early treatment and

diagnosis can reduce the “burden” of mental problems as well as problems associated with it.

In summary, in order to assist a patient from a different culture nurses have to be familiar

with that culture. It’s impossible to know every culture therefore listening to patients can be of

great importance. To expect cooperation with patients from different cultures the best is to

respect them. Each one of us value different customs and believe in different practices that are

thought to be the best, but we also have to look at others values and practices. To be culturally

competent a nurse should be nonjudgmental and respectful toward each culture. It is very easy

to judge someone but to control those feelings and become aware of others beliefs is really

important to provide best health care and gain trust of your patients.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References:

Bagourdi, Elena. Vaisman-Tzachor, Reuben. Are Greek Americans Likely to Seek Psychotherapy? www.americanpsychotherapy.com. Annals Spring2010, Vol.13 Issue 1, p36-41

Georgiades, Savvas. Sensitive Practice with Greek Immigrants: A Review of Evidence. International Journal of Culture and Mental Health. Vol.3, No. 1, 2010. 52-60

Giger, Newman Joyce. Davidhizar, Elaine Ruth. Transcultural Nursing Assessment and Intervention. 5^th Edition.

Healthy People 2020. http://www.healthypeople.gov/2020/LHI/mentalHealth.aspx

Purnell, Larry D. Guide to Culturally Competent Care.  2^nd Edition, F.A. Davis Company. Philadelphia, 2009.

Varcalosis, Elisabeth. Halter, Margaret Jordan. Essentials of Psychiatric Mental Health Nursing. A communication Approach to Evidence-Based Care. Saunders Elsevier. 2009.