Mental Health Beliefs and Practices Among Low German Mennonites

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Mental Health Beliefs and Practices
Among Low German Mennonites:
Application to Practice
Judith C Kulig, RN, PhD & HaiYan Fan, MA
A heartfelt thank you is extended to the Low German
Mennonites who were involved in the research project;
they willingly shared their beliefs and ideas with us. We
also thank the health and social service providers and the
pastoral ministers who shared their time and knowledge
with us. We are also grateful to the research assistants who
not only devoted care and attention while conducting the
interviews but also assisted in meaningful discussions of the
This document would not have been developed without
the dedication, interest and knowledge of the clinicians
and individuals involved with the Low German Mennonites
who have worked within the Mental Health Wellness &
Illness Knowledge and Beliefs among Low German-speaking
Mennonites: Development of Best Practice Guidelines research
project. These include:
Alberta Health Services:
Ruth Babcock, Shirley Hill, Irma Rempel, Vivien Suttorp, Cathy
Price and Marni Bercov
Southern Health-Santé Sud:
Kim Dyck, Kathy McPhail, Cornelius Woelk, Ken Kroeker
Eden Health Centre:
James Friesen, Stanley Krahn, Nicole Szmerski
Formerly within Mennonite Central Committee,
Winnipeg Office:
John Janzen
Heather deBruyn, Canadian Mental Health Association, Elgin
Henry Unger, Community Member
Funding for the research was provided by the Canadian
Institutes of Health Research, FRN: 119533.
Suggested Citation:
Kulig, J. & Fan, HY., (2016). Mental health beliefs and practices
among Low German Mennonites: Application to practice.
Lethbridge, AB: University of Lethbridge. 978-1-927770-06-1.
Executive Summary
Low German (LG) Mennonites are a group whose lifestyle is
based upon their religious principles and values. Our study
findings regarding their mental health beliefs and practices
note the significance of spirituality and religion in how they
understand and care for those with mental health problems.
Our accompanying Best Practices Document (Kulig & Fan,
2016) is meant to assist those unfamiliar with this group to
provide care and assistance to those who are mentally unwell,
or to family members who act as caregivers.
The purpose of this mixed-methods study was to identify
the cultural and religious understandings and beliefs related
to mental health wellness and illness in general among the
LG Mennonites, with the intention of applying what was
learned to assist in the development and deployment of
more appropriate healthcare services for the LG Mennonite
communities. Specifically, the research questions were
as follows:
1. What are the knowledge and beliefs about mental health
wellness and illness among LG Mennonites in the locations
where they reside in Alberta, Manitoba and Ontario?
2. What are best practice guidelines for mental
healthcare of LG Mennonites in the three participating
geographic areas?
We developed an advisory group consisting of individuals
from the clinical and social service sector; these individuals
provided guidance and advice about all aspects of the project
and assisted in ensuring that appropriate dissemination of
the findings took place in their agencies. The latter helped
fulfill our goal of integrated Knowledge Translation (iKT),
which helped to ensure that all aspects of the project would
be shared in a respectful but informative manner. We also
approached and worked with LG Mennonite ministers to
build trust with the population while being transparent about
our purpose. This particular study was conducted in Alberta,
Manitoba and Ontario and also included fieldwork and
interviews in Durango Colony, Mexico conducted by the first
author. The theoretical framework for the study was based in
cultural safety which goes beyond cultural competence; it was
chosen because it offered an opportunity to develop care that
meets the community’s specific cultural and religious needs.
Data Collection
The majority of the interviews were conducted by Mennonite
individuals who could speak Plautdietsch (Low German, the
language spoken by this group). Research assistants (RAs)
were hired in each province; the second author travelled to
Ontario to conduct the interviews there when the RA for that
province was unable to continue in this role. The first author
conducted the interviews in Mexico. The second author also
conducted several interviews with health and social service
providers (HSSCPs) in Alberta.
The research included qualitative interviews with healthcare
providers (i.e., psychiatrists, psychologists, nurses, teacher
aides) and other relevant individuals (i.e., ministers). We had
also planned to conduct a review of relevant documents
that focused on the mental healthcare of diverse groups, but
found an insufficient set of materials and hence abandoned
this aspect of our research plan. In total we interviewed
47 LG Mennonite individuals (28 females and 19 males)
and 47 individuals who work with this population. The care
providers represented mental health nurses, counsellors,
social workers, pastoral care providers, physicians, and
teaching assistants.
Data collection and analysis were conducted simultaneously
allowing for revisions of the interview guide and discussion
about the ideas that were being generated at the time of the
interviews. This process also led to the RAs generating a list
of Low German terms that the participants used to describe
information related to mental health; these terms helped
enhance understanding of their perspectives.
The interviewees found the concepts of mental health and
mental illness difficult to discuss but with encouragement
were able to explain their own personal perspectives. A
recurring theme throughout the interviews was the links
between spirituality and good mental health; being guided by
God helped individuals to be mentally well.
Particular kinds of mental illness were noted among the group
particularly narfun trubble or “nerve troubles,” also referred
to as “broken nerves;” some people are believed to have weak
nerves. An important distinction among attitudes toward
mental illness was whether or not the participants believed it
was within the control of the individual or was beyond their
control. Mental illness was believed to “run in the family” by
those who felt that mental illness was outside the individual’s
control. When being mentally well was considered to be
within the control of the individual, it was thought that the
unwell individual could make changes and become well.
Mental Health Beliefs and Practices Among Low German Mennonite: Application to Practice
Those who were mentally ill or their relatives might have
experienced shame and judgment by others in their
communities and did not always feel supported by their
ministers. We found that mental illness was often associated
with other factors including substance abuse and family
factors such as domestic violence.
The providers noted that it was challenging to provide care to
the LG Mennonite population who were experiencing mental
health issues because of the differences in language and
understanding of their signs and symptoms, which meant
that treatments such as counselling and medication were not
always understood or accepted.
In conclusion, mental health illness is viewed within a
spiritual context among the LG Mennonites. Although this
finding cannot be generalized to other Mennonites because
of variations among groups, care providers need to consider
this context when working with individuals and families from
LG communities.
Mental Health Beliefs
and Practices Among
Low German Mennonites:
Application to Practice
Mental illness continues to be one of the most stigmatized
conditions in society (Scheyett, 2005). In Canada, one in ten
individuals will experience major depression in their lifetimes,
and each year more than a million Canadians experience
a major depressive episode (Patten & Juby, 2008). Mental
illnesses include a range of mood disorders (e.g., major
depressive disorder, bipolar disorders) and anxiety disorders
(e.g., panic disorder, post-traumatic disorders). Suicidal
behavior also needs to be considered within the rubric of
mental health wellness and illness because it is often the
result of a number of inter-related factors. Substance abuse
disorders are also associated with mental illness, and are
often experienced as a concurrent disorder with emotional
or psychiatric problems. In addition to understanding
these key definitions, consideration needs to be given to
Canadians’ access to healthcare services that address mental
health. A seminal document in this regard was Out of the
Shadows at Last: Transforming Mental Health, Mental Illness
and Addiction Services in Canada, a report of The Standing
Senate Committee on Social Affairs, Science and Technology
(Kirby & Keon, 2006), which highlighted the need to address
mental health issues from a national perspective, including
ensuring that services are available. The recommendations
from this report ultimately led to the development of the
Canadian Mental Health Commission which has identified
seven specific goals, including developing a mental health
system that responds to the diverse needs of Canadians, and
responding to the mental health needs in underserved areas
of Canada including rural areas (Mental Health Commission
of Canada, 2009).
Religion represents a complex domain of human life which
includes behaviors, attitudes, beliefs and values. It can be
considered a protective factor against stressful events that
an individual experiences due to the resources it provides
(i.e., prayer, support), while also providing an opportunity to
construct a sense of meaning relating to stressful experiences
including mental illness (Ellison & Levin, 1998). “Spirituality”
refers to the personal experience of the meaning and purpose
of life that is not tied to any particular religious affiliation
(Hinshaw, 2002). It is a deeply personal experience of the
search for the meaning of life (Koenig, 2005).
The links between religious beliefs and mental health
wellness and illness show that they can be at various times
both mutually supportive and non-supportive. On the
negative side, because religious communities help individuals
develop their values and norms, the kinds of violations of
such values and norms as may be experienced during times
of mental illness may lead to feelings of guilt, shame or
fear of divine abandonment (Ellison & Levin, 1998; Leavey,
Loewenthal, & King, 2007) or even divine punishment
(Ellison & Levin, 1998; Idler, 1995; Peres, Moreira-Almeida,
Nasello, & Koenig, 2007; Wright, Watson & Bell, 1996).
In some religious groups, mental illness is believed to be a
result of sin (Stanford, 2007), leading to additional feelings of
guilt and shame. Framing the illness in this manner may lead
the person to believe that they are responsible for their own
symptoms due to their flawed character (Ellison & Levin, 1998,
Leavey et al., 2007; Marshall, Bell, & Moules, 2010; Raphael,
2008). This belief can further erode their self-esteem and
competence, causing more emotional stress further reducing
their coping abilities. In addition, the possibility of gossip and
judgmental attitudes from their fellow parishioners can have
an additional negative impact on the ability of the mentally
ill individual to cope (Ellison & Levin, 1998; Leavey et al., 2007;
Raphael, 2008; Marshall, Bell, & Moules, 2010; Wright &
Bell, 2009).
Other researchers have noted that some ministers focus on
the church as a collective rather than the individual, which
can lead to the marginalization of the individual who is
mentally ill (Leavey et al., 2007). Further, not all ministers have
the training to deal with mental illness, and some associate
mental disorders with spiritual issues that they feel need to
be resolved before the individual feels mentally well (Leavey
et al., 2007). Many LG Mennonite churches and their members
are reliant on part-time ministers who have juggled their time
and schedules to fill the church’s needs and their own life.
On the positive side, commitment to a religious community
may denote the availability of social resources including social
ties, and formal and informal support (Ellison & Levin, 1998;
Evans, 1999; Mindell, 2004; Wright et al., 1996), as well as the
provision of moral and ethical teachings and the adherence
to a positive, low-stress lifestyle (Loewenthal, 2006; Wright
et al., 1996; Ysseldyk, Matheson & Anisman, 2010). For some
religious individuals, suffering and mental illness provide the
opportunity for spiritual growth or learning (Stanford, 2007).
Mental illness may also be seen as part of God’s plan and help
remind individuals that they need to reflect on who they are
and the nature of their relationship with God.
Affiliation with religious groups may be a positive experience
for those who are mentally ill in other ways as well. For
example, prayer and worship may lead to the expression of
certain emotions such as forgiveness, love and contentment
that could positively affect outcomes. Prayer and confession
may also enhance personal willpower and the ability to
cope with mental illness. Finally, focusing on hope may help
individuals with mental illness to deal with negative emotions
such as guilt and fear (Mindell, 2004; Wright, et al., 1996;
Wright & Bell, 2009).
Low German Mennonites
Mennonites are members of the Anabaptist religious group
which also includes the Amish and Hutterites. Menno
Simons, a former Roman Catholic priest who was born in
modern-day Netherlands, was the founder of this particular
branch of faith (Redekop, 1969). Starting in the mid 1800s,
large groups of Mennonites relocated to the Americas from
Europe, including Russia and Germany, seeking countries
where they could practice their religion without interference
from others (Jaworski, et al, 1988). Today, there are different
religious groupings of Mennonites and variations within
the different denominations based on economic and social
factors. Anabaptists believe in adult baptism, pacifism
and a literal interpretation of the Bible, which among the
more conservative denominations includes maintaining a
separation from the modern world (Redekop, 1969; DeLuca
& Krahn, 1998; Sawatzky, 1971). “Low German” or Plautdietsch
is the predominantly oral “everyday” language that is most
often used by these conservative Mennonite groups; the
term “Low German” is used to distinguish it from “High
German,” which refers to the more formal language used
by the larger German population (Hedges, 1996). The LG
Mennonites view themselves primarily as a religious group
because their everyday decisions and lifestyle are dictated by
biblical interpretation.
The LG Mennonites are a conservative denomination among
the Mennonites, with three primary groups: Kleine Gemeinde
(most liberal); Sommerfelder; and Old Colony Church (most
conservative). The Reinlanders are another, less prominent
denomination that falls between the Kleine Gemeinde and
the Sommerfelder in its level of conservatism. In all of these
denominations, the ministers are responsible for interpreting
the Bible and determining its application to everyday life;
therefore, decisions regarding healthcare practices, including
such details as whether a woman can cut her hair prior to
head surgery, may involve the minister. It is expected that the
minister’s interpretations of religious documents typically
has a significant impact on a congregation’s views of mental
health wellness and illness.
Large groups of Old Colony Mennonites immigrated to
Canada from Eastern Europe between 1874 and 1880
(Jaworski, 1988; Loewen, 2001) and these people were known
as “Kanadier Mennonites.” When they settled on the Canadian
prairies, they received a charter of rights that allowed them
to educate their children in German. As the provinces became
more established, and as non-Mennonite communities
around them expanded, there was a growing tendency
from non-Mennonites to believe it was inappropriate for
Mennonite children to be educated separately from other
children. Disagreements also occurred among the Mennonite
populations themselves. The more conservative populations
wanted to maintain their traditional lifestyle, while more
liberal families supported changes, such as integrated
education for their children. The debate was fueled by the
growing sense of prejudice experienced by the Mennonites
who, as pacifists, had refused to be involved in World War I
(Janzen, 1990; Loewen, 2001).
Mennonite elders who felt their way of life was threatened
in Canada turned to the government of Mexico, from which
they sought and were given a privilegium (i.e., a statement
confirming their religious freedom) to live peacefully in
Mexico and maintain their own educational systems.
In the 1920s, more than 7,000 conservative Mennonites
emigrated from Canada to Northern Mexico (Benson,
1998; Sawatzky, 1971) and became colloquially known as
“Mexican” Mennonites. Even in Mexico, however, conservative
Mental Health Beliefs and Practices Among Low German Mennonite: Application to Practice
Mennonites faced pressure to change and modernize. In
some cases, splinter groups developed and moved to other
countries, such as Belize and Paraguay (Sawatzky, 1971). Many
of the families that had moved to Mexico found it difficult to
adapt to the climate and agricultural differences and returned
to Canada (Benson, 1998). Some of these families established
communities in isolated areas such as Fort St. John and Burns
Lake, British Columbia and La Crete, Alberta (Benson, 1998).
By the 1970s and 1980s, other conservative Mennonites
returned to Canada from Mexico and Belize, setting up
residence predominantly in Ontario, Manitoba, and Alberta.
It is now more common and acceptable to the Mennonite
communities to refer to these groups as “Low German” (LG),
rather than “Kanadier” or “Mexican” Mennonites.
Accurate statistics for the LG Mennonites in Canada are
difficult to obtain because of the historical migrations of this
population back and forth between southern locales and
Canada. We do know that these migrations are occurring
less often, and large numbers of LG Mennonites are now
staying in Canada. In 2004, there were approximately
57,000 LG Mennonites in Canada (Janzen, 2004) but current
information from Mennonite Central Committee Canada
indicates that there are now about 80,000 – 100,000 LG
Mennonites in Canada with 20,000 in Alberta, 15,000 in
Manitoba and 40,000 – 50,000 in Ontario. In all of these
provinces, the majority of LG Mennonites have been attracted
to the southern regions, where they live near or in agricultural
communities and work in feedlots or on other agricultural
operations, such as potato and sugar-beet farms.
Most individuals who live in these communities have low
literacy skills, a limited education (usually only to age 12), and
little exposure to technology. This leads to many challenges
for them in Canada, including limited access to healthcare.
Some health regions have employed health promotion
specialists who work exclusively with the LG Mennonites to
provide translation and advocate on their behalf. In other
locales, non-profit groups have been created to assist in this
regard. For example, in southern Alberta, the Southern Alberta
Kanadier Association (SAKA) was founded by the first author
of this report and members of her research advisory teams.
In other geographic areas, Mennonite Central Committee
(MCC) and Mennonite Community Services (MCS) are actively
involved in the resettlement of LGS Mennonites.
Cultural Safety as a Framework
As Canada has become a more ethnically diverse country,
cultural diversity challenges healthcare systems and providers
in various ways. Culture affects both healthcare providers’
and patients’ experiences, such as the choice of treatments
and prevention strategies. Some ethnic groups and other
minorities have experienced health disparities that are closely
associated with differences in social identity, language,
religious beliefs, cultural knowledge or other sociocultural
factors (Kirmayer, 2012).
Cultural competence is described as having behaviors that
help the individual care provider to effectively function in
situations where there are cultural differences between
the provider and care recipient (Leavitt, 2002). The attribute
helps reduce disparities in access to healthcare, and to
improve the quality of healthcare services. In general, cultural
competence has been mentioned or emphasized as a guiding
principle in some of the healthcare policies implemented
in Canada, which include A Cultural Competence Guide for
Primary Health Care Professionals in Nova Scotia created
by the Nova Scotia Department of Health and Wellness,
Enhancing Cultural Competency: A Resource Kit for Health
Care Professionals developed by Alberta Health Services, and
Cultural Competency and Safety: A Guide for Health Care
Administrators, Providers and Educators developed by the
National Aboriginal Health Organization (NAHO) to improve
the health status of Aboriginal people in Canada.
However, many cultural disparities and cultural barriers
in mental healthcare services continue to be overlooked.
Cultural, social and spiritual practices and barriers have
prevented members of ethnic minorities from receiving
appropriate care. These barriers include mistrust and fear of
being judged on the part of patients from minority groups,
beliefs about factors associated with illness and health, a
lack of effective communication, and a lack of diversity in
the healthcare workforce (Sullivan & Mittman, 2010). A few
policies and guidelines have been developed for mental
healthcare providers in Canada. The Canadian Code of Ethics
for Psychologists 2005 does emphasize that psychologists
should respect the dignity of their patients and the patient’s
personal characteristics, social status and cultural background
(Canadian Psychological Association, 2005). The Canadian
Mental Health Association and the Centre for Addiction
and Mental Health have developed some resources that
aim to improve the ability of mental healthcare providers to
work sensitively and efficiently with people within different
cultural contexts. Such measures are intended to enhance
the delivery of quality and accessible mental healthcare
services for ethnic minorities or people with limited
English proficiency.
However, although it seems that many mental health
organizations are aware of or acknowledge the importance
of providing cultural competence training programs, there
remains “little guidance on how to proceed” (Ryder & Dere,
2010, p. 6).
The term “cultural competence” has in recent years grown
beyond the description of mere competence to include
the concept of “cultural safety,” which describes the
empowerment of both healthcare providers and the users of
healthcare services (Richardson & Williams, 2007). It asked
the question: “How safe did the service recipient experience
a service encounter in terms of being respected and assisted
in having their cultural location, values, and preferences taken
into account in the service encounter?” (Ball, 2007, p.1).
In Canada, “cultural safety” has been used as a way of
describing health inequalities encountered by diverse
Aboriginal people. It is well demonstrated that racism
and social discrimination against minorities have
created pervasive inequalities that have long-lasting and
intergenerational effects on people’s health and social wellbeing. Cooney (1994) defined culturally unsafe practices as
“any actions that diminish, demean, or disempower the
cultural identity or well-being of an individual.” Cultural safety
as an improvement strategy encourages healthcare providers
to reflect on their own cultural and social identities and to
recognize the impact of their own cultural beliefs or practices
on their professional practices (Baba, 2013). It allows the
healthcare service users, especially people from marginalized
groups, to define “culturally safe care” according to their own
cultural beliefs and practices (Brascoupé &Watters, 2009).
This, in turn, will help to improve the healthcare systems
and professional practices to provide more supportive and
efficient care to meet the special or specific needs of those
from marginalized groups (Native Mental Health Association
of Canada, 2010).
The LG Mennonites are not just “culturally diverse;” they are
a group that emphasizes its religious beliefs in its everyday
decisions. Hence, cultural safety with these individuals means
recognizing the importance of understanding, acknowledging
and incorporating religious beliefs and practices when
providing care to this group. One way to achieve this approach
is to apply the following framework when planning and
implementing care (Ball, 2007): access personal knowledge
(i.e., providers reflect on their own attitudes); process (i.e.,
assess the individual patient’s preference for information);
positive purpose (i.e., help the individual build his or her
spiritual comfort); and partnerships (i.e., engage the support
of family members).
The purpose of this mixed-methods study was to identify
the cultural and religious understandings and beliefs related
to mental health wellness and illness in general among the
LG Mennonites, with the intention to of applying what was
learned to assist in the development and deployment of
more appropriate healthcare services for the LG Mennonite
communities. Specifically, the research questions were
as follows:
1. What are the knowledge and beliefs about mental
health wellness and illness among LGS Mennonites in
the locations where they reside in Alberta, Manitoba
and Ontario?
2. What are best practice guidelines for mental healthcare
of LGS Mennonites in the three participating
geographic areas?
The research included qualitative interviews with healthcare
providers (i.e., psychiatrists, psychologists, nurses, teacher
aides) and other relevant individuals (i.e., ministers). We had
also planned to conduct a review of relevant documents
(i.e., grey literature and policy reports) that focused on the
mental healthcare of diverse groups, but found an insufficient
set of materials and hence abandoned this aspect of our
research plan.
It was imperative that trust be established and maintained
with the LG Mennonites in order to be successful when
conducting the research. This study is the fourth one our
research team has conducted with this group; the others
focused on other health topics – many of which related to
mental health, including the ones into women’s health (Kulig,
Babcock, Wall, & Hill, 2009; Kulig, Wall, Hill & Babcock, 2008)
and death and dying (Kulig & Fan, 2013). While conducting
these previous studies, we were often encouraged by the
community and our clinical partners to engage with the LG
Mennonites to generate information about their specific
perspectives on mental health. It was noted by social service
and healthcare personnel that this particular group was
experiencing problems with postpartum depression and
substance abuse. The clinicians wanted to provide the most
appropriate care but were not always sure of how to proceed.
Thus, a decision was made to conduct a formal study of
mental health in the LG Mennonite communities, and thereby
generate information for the development of a care guideline
for this unique group.
We learned early on in our work that establishing an advisory
group, consisting of the most appropriate individuals from
clinical agencies and other relevant organizations, as well as
representatives from Mennonite Central Committee (MCC),
Mental Health Beliefs and Practices Among Low German Mennonite: Application to Practice
was an important first step in conducting research with
the LG Mennonite communities (Hall & Kulig, 2004). We
therefore continued this practice in the current study and
were able to include a LG Mennonite individual as an advisor
at the Ontario site. As was the case in previous studies, our
advisory group members have been instrumental in guiding
the research into mental health by providing input on the
research question, the interview guide, the data collection
process and the analysis and interpretation of the results.
They have also provided assistance and advice about the
dissemination of the results.
subsequently transcribed by the transcriber or the research
assistant for future analysis.
The research discussed in this report was conducted in
Southern Alberta, Manitoba and Ontario in 2012 to 2015, with
fieldwork being conducted in Durango Colony, Mexico in 2012.
When the data collection was complete, the authors
undertook a data analysis to generate themes that reflected
the perspectives of those who had been interviewed. The
data analysis was enhanced by discussions with the RAs
about the meaning of Plautdietsch words and the beliefs
that the LG Mennonites shared. We ensured that we fulfilled
established standards for trustworthiness of the findings
by meeting the criteria set out by Lincoln and Guba (1986)
for: credibility (i.e., the data “fits” the viewpoints of the
participants); transferability (i.e., the data can be generalized
to other LG Mennonites); dependability (i.e., the results
match the data that were generated); and confirmability
(i.e., the interpretation matches the participants’ viewpoints).
The “credibility” criterion was met through our hiring of LG
Mennonite individuals as RAs, and through the discussions
we held to discuss the data that was generated and to
ensure we interpreted its meaning correctly. “Transferability”
was established through the feedback we received from
our research advisory members about our findings and the
practice guideline that was developed. The details about the
data collection and analysis process helped to ensure that
the “dependability” criterion was met. Finally, by obtaining
agreement among team members about the themes, we
were able to establish “confirmability.”
Before we began collecting data, both authors (i.e., the
principal investigator [PI] and the project coordinator [PC])
held meetings with some of the LG ministers in Manitoba
to explain the study. In past studies, we had used similar
opportunities to interview the ministers and talk at length
about the topic that was being investigated, but this time our
meetings were briefer because the research assistants (RAs)
– rather than the PI and PC – would be conducting formal
interviews, including some with ministers. In Ontario, we met
with some ministers when we were preparing the research
proposal, but due to logistics it was not possible to meet
them all individually before the interviews began. However,
the PC did meet and interview some ministers when she
went to Ontario to conduct interviews there. We were unable
to hold similar meetings in Alberta, due to the fact that the
ministers of the LG churches there – particularly the more
conservative – are not supportive of our research and have
openly indicated that they believe the interviews “mix up”
their congregation members.
For the most part, the interviews were conducted by
Mennonite individuals who could speak Plautdietsch.
Interviewers were hired in each province; those hired in
Alberta and Manitoba had worked with the authors on
other research projects and were therefore familiar with
the research process, including ethics and confidentiality.
The individual who was hired in Ontario was provided with
training, to ensure that there was consistency in the quality of
interviews across sites. When it happened that this individual
was no longer able to continue in the role as RA, the PC
travelled to Ontario to conduct the interviews there.
The interviews were normally held in participants’ homes
or work places. The LG Mennonite interviews were not
tape-recorded, due to this group’s general concerns with
technology. Short notes were taken and thereafter a summary
of the information was taped by the research assistant and
The research team used telephone meetings and email to
discuss interviews and address any concerns throughout the
data collection period. The team also discussed the meaning
of particular Plautdietsch words in relation to mental health,
and compared interpretations of what was being discussed
by the LG participants in the different provinces. The RAs also
provided us with a list of Plautdietsch words that were used
in the interviews to supplement the data.
The research included an integrated Knowledge Translation
(iKT) to help ensure that all aspects of the project would
be shared in a respectful but informative manner. The web
site was updated to indicate that
the research was being conducted; this final report and the
practice guideline will be available free of charge on the site,
and details about publications and presentations relating to
this study and the others will also be noted there. With the
assistance of the advisory committee members and other
contacts, during the study we established connections with
contributing agencies, and we reconnected with them to
plan presentations of the findings and to hold small group
discussions about the practice guideline that was developed
(Kulig & Fan, 2016). Scientific presentations about this study
were also made at conferences.
Perspectives of the Low
German Mennonites
In total 43 interviews were conducted in the LG Mennonite
communities, involving 47 LG Mennonite individuals (n=47).
These included 24 females and 19 males, with a range of
ages from 24 to 79 years.1 The interviews were conducted
in four places: Manitoba, Alberta, and Ontario, Canada, and
the Durango area in Mexico. Four female LG Mennonite
individuals were interviewed in Alberta, and the range of
age was 31 to 46 years. In Manitoba, 18 LG Mennonites were
interviewed, including ten males and eight females; their
ages ranged from 35 to 79 years. In Ontario, ten LG Mennonite
participants were interviewed, including four males and two
females, with ages ranging from 37 to 49. In the Durango,
Mexico area, 15 LG Mennonites were interviewed, including
five males and ten females; their ages ranged from 24 to 72.
The majority of the LG Mennonite participants in this
study had been born in Mexico and were members of the
Old Colony Mennonite churches. After they had moved or
resettled in Canada, many of them had started attending
different, less conservative, Mennonite churches. According to
the demographic information collected from the participants,
most of the LG Mennonite men had more years of education
than did the LG Mennonite women in this study. The private
LG Mennonite schools in Mexico have their own educational
system that provide a different curriculum from that of the
public schools in Canada. Therefore, the grade levels used in
the private Mennonite schools may not be equivalent to the
ones used in Canada (Kulig & Fan, 2013).
Mental Health and Illness Beliefs
For this study, we interviewed either LG Mennonites who
had mental illness or were caregivers for individuals who
were mentally unwell. Several of the participants were caring
for husbands who had been diagnosed with depression or
schizophrenia, or were women who were struggling with
postpartum depression. Although for a number of the
participants the mental health challenges may have started
in Mexico, we focused on their circumstances in Canada
since their resettlement here. To gain a better understanding
of how their lifestyles in other countries has affected the
LG Mennonites’ mental well-being, we also interviewed LG
Mennonites in the Durango colony in Mexico to talk about
their concerns and challenges associated with mental
health issues.
The interviews all started with a general question about
the meaning of health, and then moved to a question
about the meaning of mental health. For the most part, the
participants found these difficult concepts to discuss and
explain. Those who were more comfortable in talking about
these ideas mentioned that those with good mental health
can think clearly, and that they are able to “take care of
their minds.” There was acknowledgement that focusing on
stressful situations is detrimental to people’s mental health.
A recurring theme throughout the interviews was the link
between spirituality and good mental health; thus there was
mention of the need to read the Bible and pray not only to
support good mental health but also to restore mental health.
Individuals who did not have good mental health were
thought to have something wrong with their vestaunt or
brain and were described in a variety of ways: they were
sometimes referred to as dvautsch (i.e., “crazy” or “different”)
and were described as having antisocial or unusual behaviors.
They were often described as having narfun trubble or “nerve
troubles,” or sometimes as having “weak” or “bad” nerves.
Despite these types of descriptions, those we interviewed
noted that they believed that these individuals did not have a
choice in how they felt or behaved.
One interpretation of having mental illness was that it serves
a purpose; one participant said:
Illness is allowed by God…illness brings a new insight. A
person who never had illnesses remains in a particular
mindset; having gone through a time of stress [brings] new
insights and new ways of thinking, new ways of coping, and
new ways of understanding or compassion for those who
were suffering. Mental illness is definitely suffering. Suffering
both for the family and community.
Some of the participants said that pondering the causes of
mental illness was not helpful in their everyday coping. One
of our female participants, who cares for her mentally unwell
husband, said, “I think about [why he is unwell] sometimes
and wonder. But when it comes down to it I really just
live it.” Still others saw mental illness as God-given and as
representing “our cross to bear” while on earth. There was
some indication that the participants felt that our lives are
pre-determined in terms of what we will experience, and that
what we have to endure has therefore been already decided.
Participants frequently noted that mental illness led to
suffering. One woman we interviewed said:
Having a mental illness makes everyone around me suffer.
If I am in a depression I get angry easily, overwhelmed, and
this causes tension in all of my relationships – I snap at my
kids and my family. I do not know why people suffer; it is
something I wonder about a lot. I think that God wants to
There are four demographic sheets missing in the mail for four interviews conducted in Ontario; we are aware that the participants are female but no
other information is known about them.
Mental Health Beliefs and Practices Among Low German Mennonite: Application to Practice
test us to see if we can use our strength and rely on him.
Mental illness is Satan’s work and this is when I need to rely
on my spirituality. I question what God wants for me. He has
a plan and I question why I go through it but I know it is on
God’s time. I need to be patient.
Some other participants did not view mental illness as
based in Satan; one said that if this was the case, then
physicians would not be successful in helping ease mental
health problems.
Spiritual wellness was an important part of the discussions
in the interviews. The participants emphasized the need to
have a relationship with God which was maintained through
reading scriptures, praying and attending church services.
They felt that there had to be a focus on trusting one’s life
in God’s hands. Being “spiritually well” meant that you had
purpose in your life; this was described in the following
way: “If you are spiritually good then you feel like you are
somebody and aren’t useless; you have meaning in life. I think
[mental and spiritual wellness] are equally important. They
are all dependent on each other.”
An important point related to mental illness was whether or
not the participants believed that mental illness was within
the control of the individual or that it was beyond their
control. Those who believed that mental illness was outside of
individual control said that mental illness could be attributed
to genetics or, in other words, that it “ran in the family.”
Although they did not completely understand how this
happened, they provided examples of families where there
were frequent instances of anxiety, panic attacks and other
symptoms of mental illness among the family members.
However, more often the participants expressed that being
mentally well was within the control of the individual, and
that the unwell individual could make changes and be well.
Participants offered examples of judgments made about
those with mental illness. For example, the community
may decide that an individual who is mentally ill cannot be
baptized because they would not understand the significance
of this event. In addition, those who are mentally unwell are
not expected to contribute to the community and do not hold
any kind of specific role. Gossip and rumors about individuals
whose behaviors suggest mental illness were commonly
noted by those whom we interviewed. The participants
felt that the communities should be kind and show
understanding in these circumstances. In further support
of this concern, a female participant said: “I think people are
more likely to go for medical help over the church though,
because they do not want people from the community to
know they are dealing with depression or having problems.
There’s too much shame with mental illness. I was not taught
to seek help or ask for prayer when I was younger, but it
was the thing that helps me the most when I deal with my
depression. I think Mennonites keep things back too much.
It builds up and gets out of control. This is when you get
spiritually ill and mentally unhealthy.” This same woman
noted that for the LG Mennonites who attend conservative
churches, Bible study is not allowed. She felt it was difficult to
become spiritually well when there was limited opportunity
to engage in Bible study, reading and reflecting on God’s
word directly.
Extreme examples of the care of the mentally ill by family
members suggested that they were at a loss about what to
do with their ill relative. In one case in Mexico, the parents of
a young woman had broken off her relationship with a young
man. She displayed out-of-control behavior (e.g., destroying
bedding, ripping off her clothing) and eventually the family
perceived that their only choice was to place her in a locked
box outside the house. Even when neighbors attempted
to bring the young woman into their home to help out,
her behavior did not improve. We can speculate that the
young woman was schizophrenic; with limited resources
and understanding in the Mennonite community in Mexico,
it is easy to see the challenges the family would face in
these circumstances. In another case, a man confronted
and argued with ministers during church services about
the interpretation of the Bible. Such behavior would not be
expected nor welcomed, and would challenge the ministers
as to how to handle the situation.
Questions about the basis for mental illness clearly showed
the links and beliefs between health and spirituality that were
held by the LG Mennonites. According to the perspectives of
some of the LG Mennonites we interviewed, mental illness
was believed to be rooted in sin. Humans were perceived as
weak, and vulnerable to sinfulness; to avoid this, it would
be best for them to follow God’s plan as set out in the Bible.
Reflecting on one’s spirituality and engaging in prayer would
assist in this process, as would choosing a lifestyle that
adhered to a spiritual life. In other words, these interviewees
believed that individuals who chose a lifestyle that did not
exemplify their Christian beliefs would be prone to mental
illness. Those who chose to abuse substances such as alcohol
or drugs, for example, would stray further and further from
God. The long-term impact of substance abuse was noted
among the participants; one individual who we interviewed
had heard that individuals who abused drugs burned their
brains (“abused drugs dee hauden daut Vestaunt vebrent”)
and were not able to think clearly. Stress was seen as a
major factor in causing mental illness. There was no clear
answer however about how stress could be avoided or
managed. Others perceived that stress was a precursor to
substance abuse.
once and had to be hospitalized for treatment, which included
medication. Those within the communities who have more
understanding and empathy in these circumstances describe
women in this situation as having “low nerves,” and believe
that they need supplements such as Vitamin B12 or folic acid.
One of our female participants told us: “My sister and I had
weak nerves after we delivered babies. She asked for help
first, and she helped me. We talked a lot and prayed together.
It is suffering for me but God did not make [the suffering]. It
is Satan.” She also told us that she did not share her worries
with her husband, and explained: “It is women’s problem. I
need to pray more, and God can help me.”
We asked participants to list types of mental illness. On the
basis of their own experiences or those of relatives, they
offered the following: depression (considered to be the
most common disorder among the LG Mennonites); anxiety;
bipolar disorder (referred to as “manic depression” by some
of the participants); and schizophrenia which was the most
commonly noted psychotic condition by the participants. Also
mentioned were eating disorders (such as bulimia), Attention
Deficit Hyperactivity Disorder (ADHD), autism and Alzheimer’s
disease, even though these final examples are not considered
forms of mental illness by mainstream medicine.
Interviewees said that mental illness could occur among the
young and old, although some of the participants believed
that those who were older had more life experience and
therefore a greater ability to cope with the challenges of life.
Women were considered stronger and more able to cope, but
this opinion was in sharp contrast to descriptions of gender
differences in response to mental illness such as these: “Men
turn to drinking; women have nerves;” and “Men get angry
and violent; women stay in bed and cry.”
We also talked with the participants about the care of the
mentally ill; particularly those who were cared for at home.
There was no shortage of comments about the challenges
that this brought to the family. One woman whose husband
was mentally ill and whose daughters had postpartum
depression said:
(I) spent a lot of time listening to my daughters and talking
to them…on one occasion when I talked to my daughter I said
something like: you’re sitting here crying and I’m at home
and my husband is crying, I come here and you’re crying. I feel
like being somewhere in the middle between your house and
my house. And then I felt bad; that had not been the right
thing to say. But recently my daughter had said that it gave
her something to think about, some perspective to what she
was experiencing and she thought it had helped her.
Incidences of psychosis were noted as occurring among
the LG Mennonites but little understanding of psychotic
conditions was evident among the participants. They realized
that medication and counselling would be helpful, and they
talked about how such treatments were more easily available
in Canada compared to Mexico. They also noted that an
individual with psychosis can act in unusual ways which
are not understood by the community and hence in some
situations, they are hidden from public view to prevent gossip
and judgment from occurring.
Postpartum depression was cited by participants as common
among women in their communities, as distinct from
“depression” which can occur in both women and men. Among
the sample, postpartum depression is mistakenly equated
with “baby blues,” which are mood swings that can occur
after birth and end quickly once the woman’s hormones are
stabilized. In contrast, postpartum depression is a serious
form of depression that can be debilitating for the mother. In
extreme cases, the woman may commit suicide or infanticide
or not be able to care for her child, her family or herself.
Women in LG communities who suffer from postpartum
depression may be seen as “lazy” when they do not attend to
everyday chores such as housecleaning – an important part
of being a “good” LG Mennonite wife and mother. In reality,
the mother may require medication to feel better and will
likely require assistance in her everyday chores. One male
participant related how difficult it was to find people in the
community to trust; he himself also struggled with his wife’s
postpartum depression in part because she was unable to
express how badly she felt. She did attempt suicide more than
It is not just women in the LG Mennonite communities
who are criticized for not attending to their chores; an LG
Mennonite man who was mentally unwell and could not
deal with his farm chores was also seen in a negative way.
Although it is common for other community members to
help those with their chores when they are physically ill,
when someone is mentally ill there is limited understanding.
Community members have been heard to say: “Wuarom halpt
dee sich nich selfst?” (“Why does he not help himself?”).
Suicides do occur among the LG Mennonites. There is shame
about being mentally ill and some individuals believe that
Satan takes over at the point the person chooses to end
their life. There is not only shame involved in suicide but it is
considered a sin, and the communities believe that the person
will be judged by God in some Mennonite churches.
Repeatedly in the interviews there was expression of
disappointment in the lack of assistance from the ministers.
The participants felt that a number of the church leaders
were unable to understand the behavior of the mentally
ill and hence were incapable of dealing with them in any
positive manner.
Mental Health Beliefs and Practices Among Low German Mennonite: Application to Practice
Perspectives of Healthcare
and Social Service Providers
In addition to the 47 interviews with the LG Mennonites, we
also interviewed 47 individuals who provided care or helped
the LG Mennonites and their families to deal with their
mental health issues. The care providers were from different
disciplines, including mental health nurses, counsellors,
social workers, pastoral care providers, physicians, and
teaching assistants. Out of the 47 care providers, 28 worked in
Manitoba, six in Alberta, 12 in Ontario, and one had worked in
Mexico. More than half of the participants had a Mennonite
background and could speak Plautdietsch, High German or
both languages at different levels.
Health and social service care providers in the three provinces
indicated that from their experience the number of LG
Mennonite patients requiring assistance with mental health
issues has increased in the last few decades. HSSCPs said that
many of their clients or patients were suffering from various
mental health problems, such as depression, anxiety disorders,
and substance abuse. Mental health issues, in general, were
seen as having been caused by a variety of sociocultural and
environmental factors, and genetics was not discussed as a
contributing factor.
Depression and Domestic Violence
Depression was one of the major health issues identified by
both the LG Mennonite participants and the HSSCPs in this
study. Domestic abuse was cited as one of the contributing
factors to depression. One of the pastors interviewed in this
study indicated that most of the church members who came
to him for help had experienced serious abuse. Among these
were LG Mennonite women who had been beaten severely by
their fathers when they were children, and then were beaten
again by their husbands after being married. Some women
tried to suppress certain emotions and keep quiet about their
needs or unhappiness in order to keep the peace or avoid
being criticized. These experiences caused emotional strain on
these women, giving them a fragile sense of self-worth.
The HSSCPs also indicated that people who had depression
problems might also simultaneously suffer from other mental
health issues, such as substance abuse. Alcohol and selfprescribed anti-depression pills have been used to address
mental health problems among the LG Mennonite population.
One of the HSSCPs explained that:
I’ve noticed that with a lot of my Mennonite women that
they assume that the pills are going to treat their depression,
even though – I mean, there may be some underlying issues
that they’re not really talking about …Yeah, or even selfmedicating, right? Like, they’re able to get their pills from
Mexico and then they come here. And if that’s not working
then they’ll still be taking their pills on the side but, you know,
they want something else from the doctor.
Fear and Anxiety
Some LG Mennonite patients or clients were overwhelmed
by fear and anxiety, which seriously reduced their working
ability, which in turn affected the quality of their lives. The one
cause for their anxiety disorders was closely related to their
living environments, specifically having lived in Mexico where
there are security issues related to the drug trade. One of the
HSSCPs stated that:
I would say fear is very high, anxiety is high…And just talking
to a few ladies that I’ve worked with, too, [it] is just [that]
they’re very anxious for everything. It’s almost like that has
[…] come into their everyday life [...]: the fear that they have
from leaving, running away, and then here they get phone
calls or stories from […]. They hear stories in the community
about how another person was murdered related to the drug
cartel or whatever that’s going on down there, and then
they’re so afraid for their families over there. They still have
family there. And then they come to the doctor and they
say, I’m having this sort of pain and that, but [they are] not
connecting the two. They don’t connect the fear and anxiety
that they have, [be]cause they would never say that they
have anxiety or fear. It’s just – you can tell, right? – when they
tell their stories, it’s all in their story when they tell you, and
what sort of details they’re telling you, I find [that] it depends
on the details that they tell you, you can tell what sort of fear
or anxiety they’re having.
The HSSCPs explained that sometimes their patients’ anxiety
disorders were very complex because sometimes they were
accompanied by other health issues, such as depression and
substance abuse.
The Use of Mental Healthcare Services
Similar to people from other ethnic or diverse groups, some LG
Mennonites also have difficulties in accessing or using mental
healthcare. Difficulties arise for a variety of reasons. Some LG
Mennonites have told the HSSCPs that they have financial
problems and they cannot afford certain treatments. Others
are not comfortable in seeking care because of their religious
beliefs, which say that God is the one to provide assistance
and help with their symptoms. Other LG Mennonites do not
have a public health card, or they do not know how to use
Cultural Safety and
the LG Mennonites
the card, so the card remains inactive. Other factors, such
as insufficient English language skills, lack of awareness
of the availability of services, or the lack of services in local
communities also affect the LG Mennonites’ use of mental
healthcare. One of the most important factors that prevents
the LG Mennonites from seeking treatment, however, is their
limited knowledge about mental health and illness.
Religious Beliefs and
Mental Health Knowledge
According to the HSSCPs, when seeing physicians or
counsellors the LG Mennonites would identify various physical
signs and symptoms, such as migraines or sleeplessness.
However, generally speaking, there was a lack of general
knowledge and understanding about how these signs and
symptoms reflected their mental health status. Some of the
LG Mennonites may believe that prayer should be used to cure
people’s “weak nerves,” instead of medical treatments. One
HSSCP said:
A lot of depression, a lot of anxiety. And I think the large
barrier too is the not knowing about it being a biological
issue, right? So a lot of them by the time they’re coming
to me they’ve had a few hospitalizations but yet they’re
struggling with the fact that religion is kind of telling them,
well, if they prayed more or if they went to church more it
would all go away, and I’m here on the other side saying
“No, it’s a biological-chemical issue that’s going on in your
body, and the medication…” – then it’s getting past the
medication you’re going to have to take long-term. It’s not
like an antibiotic.
Also some LG Mennonites were not familiar with mental
healthcare, including counselling services. According to some
of the HSSCPs, the denial of the existence of the problems
was common.
I think the key thought that a lot of them have is that if they
go in for counselling there’s something wrong with them. I’m
okay with there being something wrong with me as long as
I can fix myself but now I have to go to someone else so you
must – there must be something really wrong with you if
you’re going to a counsellor.
There are several ways in which cultural safety can be applied
when working with the LG Mennonites who are mentally
unwell. Specifically, personal knowledge, process, positive
purpose and partnerships can be applied in these situations.
The caregiver can reflect on their personal knowledge and
understanding about mental illness while also identifying
their knowledge and awareness about the LG Mennonites.
Second, an understanding of the process regarding mental
illness needs to be developed among the LG Mennonite
clients and their family members. This process may require the
use of an interpreter to ensure that all terms are understood
while allowing the family members to ask questions for their
own clarification. A positive purpose is established when the
family is provided the opportunity to discuss their situation
with their minister and are given the time to make decisions
about the care of their mentally unwell relative in a manner
that reflects their spiritual beliefs. Finally, partnerships can be
developed between the care provider and the LG Mennonite
family and communities when activities such as prayer
are supported.
In conclusion, this mixed methods study generated
information about mental health illness being viewed within
a religious and spiritual context among the LG Mennonites.
Care providers need to consider this when working with
individuals and families from this group; however, they also
must avoid generalizing from one group to all LG Mennonites
because of the variations among the groups. There was much
discussion among the LG Mennonite participants about
whether or not mental illness was within the control of the
individual. For those who believe that it is, there is a lack of
understanding that the individual cannot automatically make
changes and be well. In addition, providers find that in these
circumstances, individuals do not understand the importance
of regular medication and counselling to assist them become
well. The interviewees also expressed that they experienced
shame and a lack of support within their communities.
A cultural safety framework can be applied allowing the
provider, in conjunction with the unwell individual and their
family members, to reflect on what process would be most
useful in enhancing their care.
Mental Health Beliefs and Practices Among Low German Mennonite: Application to Practice
Key Recommendations
for Decision Makers
• Respect LG Mennonite individuals’ religious practices
that impact on their interpretation and understanding of
mental health beliefs and practices.
• Work with the LG Mennonites to help ensure that their
beliefs are respected and incorporated into their mental
health counselling and support.
• Provide simple explanations about mental health illness
and relevant services.
• Provide interpretation services for LG Mennonites who are
not fluent in English.
• Be cognizant that LG Mennonite patients simultaneously
ingest over-the-counter medications and home remedies
with prescription medications.
• Provide inservice education to all healthcare and social
service providers to help ensure provision of culturally safe
and religiously respectful mental health services.
• Work with patients and their families to help ensure that
members do not feel excluded or ashamed of their beliefs
or practices.
• Work with LG Mennonite communities to help build
capacity and recruit members into the health and social
service workforce.
• Work with LG Mennonite school teachers and students
to promote mental health among children, teenagers
and youth.
• Encourage the LG Mennonite communities to use
protective strategies, such as social activities and family
cohesion, to improve their mental well-being.
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Mental Health Beliefs and Practices Among Low German Mennonite: Application to Practice
Mennonite Health
University of Lethbridge
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