Migration, traumatic bereavement and transcultural aspects of psychological healing: loss and grief of a refugee woman from Begameder county in Ethiopia.

Post-traumatic stress disorder (PTSD), grief and bereavement may be manifested in a variety of ways in different populations and cultures. Following is the description of an Ethiopian immigrant woman from the county of Begameder whose baby died during the long exodus from Ethiopia and who, because of the different environmental conditions in 'the new land', could not undergo traditional purification rituals. Subsequently she suffered various cultural signs and symptoms of PTSD due to complicated bereavement and, on top of that, was seen as 'impure' by both her family and herself. For two years her symptoms were attributed to a severe form of bronchial asthma and she did not respond to treatment. When eventually brought to psychiatric attention, she was erroneously diagnosed as suffering from psychosis and treated inappropriately. Accurate anamnesis, combined with adequate counselling, provided the correct diagnosis, and a combination of supportive psychotherapy, traditional healing and purification rituals resulted in a resolution of the syndrome. Thirty months of follow-up showed that the results of the treatment were stable and satisfactory. The specific aspects of cultural manifestations of grief and mourning, the meaning of hallucinations not in the context of psychosis, purification rituals, the role of traditional healing among immigrants from a totally different culture, and the difficulties that helpers may have interpreting and making sense of the immigrants' behaviour and complaints are discussed.