This dissertation examines refugees’ mental health conceptualizations in their resettled contexts, their views on Western mental health services, and their perspectives on how changing experiences related to discrimination affect their mental health. Despite refugees’ social and cultural contexts changing multiple times, little is known about their views on and interactions with the dominant biomedical model of mental health in their country of resettlement and how their hybrid identities and experiences embedded in multiple locations affect their understanding of mental health and healing practices. A transnational framework emphasizing continuity between various locations and “in-between the designations of identity” across borders, and the concept of hybridity can provide a more nuanced understanding of mental health in transnational contexts (Bhabha 2012). Using postcolonial theory, this study provides a counter-narrative to prevailing assumptions underlying biomedical models that deem these understandings and approaches to mental health to be universal and marginalize non-biomedical healing practices associated with non-hegemonic "cultural" beliefs. To examine how refugees negotiate different meanings of mental health in new social contexts, this study involved qualitative semi-structured interviews with 45 refugees resettled in the United States from Afghanistan, Iraq, Syria, and the Great Lakes Region of Africa (Burundi, Democratic Republic of Congo, Rwanda, and Tanzania). Findings reveal that refugees generally hold narrower definitions of mental illness and frequently do not perceive mood disorders as medical conditions in the same way they are understood in the United States. Instead, they viewed many forms of psychological distress as normal reactions to war experiences and resettlement stressors, emphasizing the perceived relevance of underlying social determinants of mental health. They often resisted embracing Western diagnoses and critiqued treatments that heavily rely on the biomedical model, as they believe these approaches neglect the broader context and minimize the epistemological reasons explaining why many refugees do not utilize therapy or medications. Most refugees did not value talk therapy, as they found talking about distress to a stranger who did not necessarily share their lived experiences and having to pay for it to be culturally incomprehensible. They preferred a communal wisdom model, which involves seeking support from family members, friends, and/or community elders with lived experiences and more generous and flexible time commitments. They also focused on moving on from the source of distress rather than dwelling on the past and prioritized addressing resettlement stressors over mental health symptoms. In terms of the impact of racism on mental health, many refugees had different understandings of race compared to the predominant views within the U.S. context. While some acknowledged racism, they emphasized that language barriers exerted a more significant impact on their distress and overall quality of life. When their basic needs (e.g., paying rent) were unmet, racism and other forms of discrimination were considered “secondary.” Although most refugees did not identify a link between racism and mental health outcomes, younger Great Lake African refugees discussed the salience of racism and microaggressions in the U.S. context and their impacts on mental health.
This study illuminates the agency of refugees by showing that refugees are active agents engaged in building critical understandings and approaches to address suffering and distress. Based on refugees’ hybrid identities shaped by their multiple resettlement experiences, they become transnational agents with a critical perspective on understanding and negotiating new social meanings of mental health. Refugees actively construct mental health within various structural constraints and negotiate different cultural understandings of distress encountered in the United States. They make decisions about how to make sense of these beliefs and approaches by negotiating new meanings of mental health in the U.S. context to navigate their situations and achieve meaningful understandings of their suffering. Through their meaning-making of mental health/illness and race, refugees’ narratives provide tools for individuals in countries where the biomedical model of mental health is dominant to think critically about the broad adoption of medical diagnosis and treatment of psychological distress as mental illness. Understanding refugees’ views and experiences of mental health in a transnational context can contribute to a decolonizing approach to mental health by challenging the dominant biomedical model in the United States and highlighting the limitations of medicalizing distress.
Level of Degree
First Committee Member (Chair)
Second Committee Member
Third Committee Member
Fourth Committee Member
mental health, medicalization, transnationalism, hybridity, postcolonial theory, refugee, qualitative research
Choe, Ryeora and Ryeora Choe. "Mental Health in Transnational Contexts: Reconsidering Conceptualizations, Coping Strategies, and Racism through the Narratives of Refugees Resettled in the United States." (2023). https://digitalrepository.unm.edu/soc_etds/100
Available for download on Thursday, May 15, 2025
Medicine and Health Commons, Migration Studies Commons, Multicultural Psychology Commons, Quantitative, Qualitative, Comparative, and Historical Methodologies Commons, Social and Cultural Anthropology Commons