It’s also, by government decree, a very happy place. In the late ’70s, the king introduced to Bhutan a concept called “Gross National Happiness,” a rather different yardstick than GDP. “It’s everyone’s patriotic duty to be happy,” one of the king’s bodyguards told me once. “It takes courage to be happy. Even if you’re a prosperous, developed country, what use is that if the people aren’t happy?” Despite the call for happiness, or because of it, the nation’s divorce rate has been as high as 80 percent.
Exiled from the kingdom
But Bhutan has a dark side, too. It has been criticized at times for strictures that to an outsider can carry the faint whiff of totalitarianism—the counterintuitive command to be happy, the mandated national dress code, and most especially the treatment of non-native Bhutanese. Tens of thousands of ethnic Nepalis were exiled from the country in the early 1990s following a government campaign of harassment—Human Rights Watch described it as ethnic cleansing. In the last eight years, the United States has resettled some of the refugees; more than 75,000 now live in cities like Philadelphia, Denver and Kansas City.
It hasn’t been an easy transition for them, as a report from the Kansas Health Institute reveals. The Bhutanese refugees have trouble adapting to life in the United States and develop mental health difficulties at a much higher rate than other refugee groups. Maybe because Bhutan is so unlike anywhere else. Moving from Bhutan to the U.S. arguably results in maximum culture shock.
Says the story:
A report released earlier this year by the Centers for Disease Control and Prevention highlights the acute problems of suicide, anxiety and depression among Bhutanese refugees in the United States, although the causes remain unclear. The CDC said the problems may be related to social isolation, substance abuse or even trauma from torture the refugees endured in Bhutan.
The refugees' emotional distress tends to be somatised—it manifests itself in their bodies as chronic, disabling pain or other physical symptoms even though there is nothing physically wrong with them (this is known as Conversion Disorder or Functional Neurological Symptom Disorder—common among people for whom any psychological symptoms would be socially unacceptable).
Physical therapy, painkillers and medications didn’t work. There has been some work on Nepali-language Dialectical Behaviour Therapy and trauma-focussed CBT. But what LeMaster found most effective was yoga. For people whose psychological pain is expressed in their body, maybe it makes sense to focus treatment on the body, too, especially if that treatment is culturally-relevant to the clients. Yoga has a long history in Nepal—“there was nothing in it that jarred them,” LeMaster said. There were dramatic drops in pain levels among the yoga participants, and they also showed major improvements on measures of anxiety, depression and acculturation. A much-needed respite for them—and a boost to America’s Gross National Happiness.
Mind and body: in it together
The commonest therapy offered in the U.K., CBT, targets our conscious thoughts and behaviours. Some therapists work more with emotions. But what often gets ignored is the thing that we carry ourselves around in, our one and only body. Studies have shown that regular exercise can be at least as effective as medication in combatting depression, possibly even more so. It doesn't have to be “exercise." You don't need to run a marathon. You just need to keep moving. Looking after your body will help your mind, and vice versa.
In the 17th century, Descartes argued that mind and body were separate, and for the most part, western medicine acts as if it agrees with that. Physical illness is viewed in terms of dysfunctional body parts, mental illness in terms of troubling symptoms that must as far as possible be medicated away, and never the twain shall meet. In fact, we ignore the twain—the delicate, complex, mysterious interplay between mind and body—at our peril. As the Bhutanese refugees show, the two cannot be separated, and play a part in every kind of disease. As the book Why Do People Get Ill? argues, all disorders could usefully be approached in a more holistic, mind-body way. We are psychosomatic beings.
“Our body and mind are not two, and not one. If you think your body and mind are two, that is wrong; if you think that they are one, that is also wrong. Our body and mind are both two and one."
—Shunryu Suzuki, Zen Mind, Beginner's Mind