Elizabeth Carll, Ph.D. with Laura Captari, M.A., M.S.
As part of the series of interviews conducted by student members with trauma psychologists from various parts of the world, Laura Captari, a student member of the International Committee, interviewed Dr.Brian J. Hall, an Associate Professor of Psychology and Director of the Global and Community Mental Health Research Group, Department of Psychology at the University of Macau in China.
The interview series with distinguished trauma psychologists from around the world provides our students with the opportunity to meet psychologist role models from many cultures. The interview article, which follows below, provides a window into the work of trauma psychologists globally and enables a better understanding of cultural issues relating to psychology.
To encourage participation of international students at the APA convention, the Division approved an annual $1000 Student Travel Stipend including convention registration to support travel of a student from a developing country, who has a trauma related poster or paper accepted for the presentation at the convention. The 2019 APA Convention will take place in Chicago, Illinois. A free one-year membership in Division 56 is also included. Interested candidates for the travel stipend should contact:Dr. Elizabeth Carll, at firstname.lastname@example.org.
With the surge in migration occurring globally, the Refugee Mental Health Resource Network, an APA Interdivisional project, is reported in another section of the newsletter.
An International Committee Interview with Brian J. Hall, Ph.D.
By Laura Captari, M.A., M.S.
Dr. Brian Hall is Associate Professor of Psychology and Director of the Global and Community Mental Health Research Group, Department of Psychology at the University of Macau, and Visiting Associate Professor at Johns Hopkins Bloomberg School of Public Health. He was recently appointed as a Fellow of the Chinese Academy of Sciences and has consulted with the World Health Organization, UNAIDS, and UNICEF.
At the intersection of trauma and public health, Dr. Hall’s work addresses health disparities in order to create policy and systemic changes, particularly among migrant populations. How did this all get started? As an undergraduate student interning at The Free Clinic of Greater Cleveland, in Cleveland, Ohio, Hall noticed that although most clients sought treatment due to physical ailments or substance use, “trauma was a major—but often unspoken—critical part of their life stories.”
Dr. Hall views research as a powerful means of advocacy for social justice and equity among oppressed and marginalized groups. He is particularly interested in the larger ecological systems and sociocultural influences that shape mental and physical health. “Trauma is just one piece of a larger puzzle,” he reflects. “It’s vital to develop a holistic understanding of population health and consider not just individual stressors and behavior, but also what is happening outside of the person—within the larger community and culture—that shapes their health.”
Over the last 15 years, Dr. Hall has been involved in intervention and population-level research among vulnerable and at-risk communities globally.Throughout graduate school and as a NIMH T32 pre- and postdoctoral fellow, he documented the impacts of natural disasters, terrorism, forced migration, and sexual violence in multiple contexts. While teaching a university course in Macao (SAR) China, as a postdoc, Dr. Hall became curious about the many Filipino and Indonesian migrant workers in the region.
What unique challenges are these migrants facing? What contextual factors might be influencing their physical and mental health?
Questions such as these led Dr. Hall to pursue the Fogarty Global Health Fellowship in order to develop a program of research around migrant health, working with African migrants in Guangzhou, China, before transitioning to a position in Macao. He is also the inaugural APA-IUPsyS Global Mental Health Fellow, which allowed him to work on a team to develop the cultural guidelines for mental, behavioral, and neurodevelopmental disorders in the ICD-11. Reflecting on what he’s learned through cross-cultural research, Dr. Hall notes, “It’s vital to make communities active participants in the research process.” This included joining migrant workers in community activities, sharing meals together, building relationships, dialoguing, and just listening. In addition, collaborations with government consulates and non-profit organizations set the stage for policy impacts.
“My team’s desire is to join with marginalized communities to document the social determinants of health to better understand how to address health disparities.” One important discovery for Hall has been the multi-faceted nature of trauma exposure among migrant workers. Over half of Filipino and Indonesian migrants reported some form of natural disaster as their key index trauma. Compromised economic conditions and lack of resources frequently necessitate employment abroad to support their family members back home. Despite deleterious work conditions, long hours, and at times labor abuses, migrants in south China are fueled by commitment to their families and make tremendous sacrifices to create a better life.
Dr. Hall emphasized the importance of attending to cultural nuances rather than imposing a Western diagnostic perspective in trauma research. This has included validating common trauma instruments within migrant communities as well as utilizing qualitative and ethnographic approaches to capture cultural understandings of health and illness. When working with trauma cross-culturally, Dr. Hall pointed out the vital importance of recognizing the historical backdrop of colonialism, exposing oppressive hierarchies that exist both between and within communities, and always maintaining empirical skepticism.
For example, while research has documented the buffering effects of social support, a different narrative emerged among Filipino migrants. “We found that those with greater social support reported more psychological distress. In a highly collectivistic culture, social interactions frequently become contexts for venting about family stress, employment challenges, and lack of control. Group rumination and emotional contagion seem to pose greater risks due to a high demand for reciprocity, such that social contexts may increase the burden of stress.” Dr. Hall’s ongoing research seeks to document different types of support within migrant workers’ networks, including relationships that might be more helpful versus emotionally taxing.
Among migrants, there are numerous structural barriers to intervention, including lack of autonomy in the workplace and biases surrounding mental illness. “In many people’s mind, if you have a mental health problem, you’re crazy, and no one wants to be seen that way.” In Macao there are very few mental health providers. Dr. Hall is currently one of four doctoral-level psychologists, with the burden of care being addressed primarily by social workers, master-level clinical psychologists, and a few psychiatrists. “Cultures without psychotherapy frequently have other healing mechanisms built into the community,” Dr. Hall notes. Two potential intervention points under investigation are peer-based/community support and digitally supported mental health treatments.
Hearing about the complexity and challenges inherent to this work, I was curious about what motivates and energizes him. Dr. Hall spoke about creating long-term systemic change. “There’s nothing in global health that happens overnight. I try to pay attention to communities that are invisible—and develop a body of empirical evidence so the world knows about the disparities these populations face.” Currently, migrant organizations are using findings to advocate for policy changes that address less than optimal labor practices, policy enforcement, and lack of access to health care.
In speaking to others engaged with international development and trauma work, Dr. Hall reflects, “It’s natural to be discouraged. Living cross-culturally brings with it unique stressors. I don’t always see the impact that I hope our work will have, and I’ve had to adjust a lot of expectations. But, I go to work every day focusing on the mission and the endgame.”
What is that endgame? To create sustainable, health promoting programs among marginalized groups. For Hall, a major means to that end is mentoring emerging leaders in the field of psychology and public health in China and the region, beginning with his own students and trainees.
Laura Captari is a doctoral candidate at the University of North Texas and incoming pre-doctoral intern at Beth Israel Medical Center in New York.Her research investigates the developmental impacts of trauma, disaster, and loss, including the roles of attachment, spirituality, and cultural factors in facilitating resilience and post-traumatic growth.She is a member of the International Committee of Division 56.