A thing about MSF field work that is both a challenge and a reward is that one gets to work in different cultural settings. Naturally the culture affects all parts of the field work, but I would say the psychological work is among the most culture-dependent.
Some weeks ago a psychiatric patient talked to me about how goblins were affecting his life, and it showed how much the cultural context affects the way a psychologist would interpret such a report.
In my native Finland in 2016, I would be tempted to view such a statement as indicating possible psychotic symptoms, but in a culture where folk tales and cultural beliefs about goblins are much more common I would be very careful before drawing any conclusions. Similarly, a Finnish person’s habit of mostly being quiet and not speaking, especially not to strangers (which is a characteristic part of our culture) could in a different context be seen as very rude or almost pathological.
It is sometimes difficult to draw a line between what beliefs reflect a psychotic belief and which do not. It is especially difficult when it comes to religion. Is believing in angels a sign of mental illness? What about hearing the voice of god? Being god?
It is difficult to assess if a religious belief is a delusion or not – the experiences cannot be measured and people place very different meaning and interpretations on religious beliefs. When the patient is from a culture and religion that are not familiar to the clinician, the situation becomes even trickier.
I am very lucky to have a very knowledgeable team of local psychologists and other to work with, who can teach me about common cultural beliefs and practices. It is all about team work!