Keefe, a professor emeritus of anthropology at Appalachian State University, where she taught for 38 years, frequently used the word “mountain people” as a substitute for those populations living in the Appalachian Mountain region.
This wasn’t meant in a negative way, but as a way to discuss some of the differences these people have from other regions in the U.S.
The medical anthropologist cited the work she’d done with her colleagues in talking with a crowd of nearly 200 students; academics; medical, mental and social professionals; among others, about some of those differences.
Mainly, the thrust of her discussion centered on how the majority Appalachian religious belief — Evangelical Christianity — might add to negative health outcomes for those who live here.
“Our findings indicate that individuals living in rural Appalachia are likely affected by the Evangelical Christian interpretation of depressive symptoms as a sign of spiritual weakness rather than symptoms of mental illness,” Keefe said.
Keefe provided a part of her presentation that explained exactly what the Evangelical Christian belief looks like in practice and how that might translate to Appalachian people seeking mental health help they need.
Complete faith in God, who takes control of everything in a person’s life, the possibility of miracles and the possible lifting of suffering are all major facets of this.
She emphasized characteristics of Appalachians to be about self-reliance, independence, humility, family loyalty and social respectability.
According to her research, Keefe operates on the conclusion that rates of depression, suicide and poverty are high in the Appalachian region, while education and medical insurance rates are low. There’s also a lack of accessibility for mental health services.
When you combine that with a religiously related stigma surrounding seeking proper mental health help, a vicious cycle is in motion.
“To experience feelings of doubt or depression is to question one’s faith in God,” Keefe said of Evangelical Christians’ experience with depression.
And because the basis of that belief centers on the spirit, it’s a commonly held thought that medication won’t help as much as more church-based remedies.
Relief from this depression is often found in prayer, Bible study and worship, not to mention seeking counseling from Christian counselors, rather than those more secular licensed and trained counselors outside of the church.
Keefe acknowledged that those who deal with people need to learn about this culture and carry it out in their practices. That would mean understanding Appalachian culture and being able to discuss religious matters with their patients.
This goes with communication of important information. Sometimes it’s not what you say, but how you say it.
“Mountain people do not like to be given orders,” Keefe quoted about this communication. ”More often than not, if you give someone an order, then you get the remark, ‘ain’t nobody going to tell me what to do.’ ”
An example of how to word an “order” was given to reach a positive outcome.
“We need to get your blood pressure down,” she suggested. “Eating less salt would help.”
Keefe said practitioners need to be grounded in the community rather than one step above it.
Melissa Schrift, a professor of anthropology in the Department of Sociology and Anthropology at East Tennessee State University brought in Keefe. Schrift is the director of the department’s Culture and Health program.
With there being obvious overlay between her department’s work and the work of the Quillen College of Medicine, Schrift says she sees more integration between the two campuses as time goes on.
Along with Keefe’s presentation, Schrift also brought in Robert Pack from ETSU’s College of Public Health, where he serves as the associate dean for academic affairs.
Pack gave a talk on substance disorder in “Central Appalachia: Challenges for Cultural Competency.” Andrea Darr, director of the West Virginia Center for Children’s Justice, presented “Handle With Care: Creative Collaborations to Service Children of Abuse and Trauma.”
The keynote speaker was Damon Scott Tweedy, a medical doctor who spoke about his book, “Black Man In A White Coat: A Doctor’s Reflections On Race And Medicine.” Tweedy is a professor of psychiatry at Duke University.
To learn more about these topics and ETSU’s Department of Sociology and Anthropology, visit www.etsu.edu/cas/sociology.
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