Psychiatrist on demand in Greenland
- Anne Lindhardt
- Jan 4, 2018
- 4 min read
In March 2025 I flew to Nuuk - the capital of Greenland - to work as a consultant for 3 weeks. President Trump had once again, in the State of Union speech, threatened to take over Greenland. The atmosphere amongst Greenlanders (Inuit) was tense in the quiet and gentle way that is so typical for the mindset of the population. But they are worried with good reason about the unpredictability of world affairs and the sudden focus of interest.
For the past more than 20 years I have been working on and off short time appointments. As there is only one - elderly - specialist in psychiatry in Greenland, who is native and speaks the language, psychiatry is served by psychiatrists like me, Scandinavian speaking, partly at the only psychiatric department in Nuuk, and partly as a consultant to some of the small towns along the coast. Furthermore, young doctors in training are covering a lot of the work, getting valuable cultural and psychiatric experiences.
Greenland is the largest Island in the world, placed in the Arctic as the only independent Inuit Country. It is 2600 km from North to South and 1050 km from East to West.
Greenland has been inhabited for 5000 years - the nomadic population being hunters moving with the animals. They have been living and surviving on the borders of what is possible for human existence.
Greenland was colonized by Denmark in 1721 and gained home rule in 1979. In 2009 it was expanded giving the Greenlandic people full authority over internal affairs and control over natural resources. The population is small - 57. 000 inhabitants - with 19.000 living in the capital Nuuk. Along the vast coastline are scattered 16 small towns and more than 30 settlements. Transportation is either by plane, helicopter or by boat, as no roads connect the towns. It has its own language West Greenlandic/Kalaallisut, an Inuit language very different from the Indo-European languages. However, a great number of Greenlanders speaks and understands Danish especially in the capital and the mayor cities.
Weather in the Arctic is a mayor player, and you are often delayed for hours, days or weeks. “Immaqa” is a Greenlandic word for “maybe” and is integrated in the mindset of Greenlanders. One never knows what will happen, but you grasp the opportunity when it is there.
Accelerated modernization happened within a few decades in from the 1950ies through 1970ies and the aftermath showed itself in the high number of traumatized people. The alcohol consumption was very high in the 1980ies but through a determined effort today it is less than in Denmark. Numbers of suicides are 9 times the numbers in Denmark, and sadly very high in the age group of 15- 24. Sexual offences are very high too as a sign of an imbalance between traditional culture and modern society. That said Greenland has a growing middle class of highly functioning people along with a political and cultural elite.
Culture and Communication
Until the middle of the 1700th century there was no written language. There was an oral tradition handing down, myths, taboos, and stories of great endeavors through generations. Still today the storytelling is in focus. When the psychiatrist takes her time and listens to the patient’s narrative it gives much more information about the mind, experiences and psychopathology than the usual Q and A trying to assess the diagnosis. The patient will often tell her story in an open and straightforward way. The many questions of a personal and intimate nature usually asked by the psychiatrist can be perceived as invasive - maybe linking to a colonial attitude. Sensitivity and attentiveness to the cultural differences in belief systems, in way of expressing and in self-understanding are important
Historically society is based on collectivity and a strong family attachment. Fundamental values are quietness, unobtrusiveness and modesty- and humor. Autonomy and respect for the integrity of the individual are central. Unlike Denmark, silence, patience and the ability to wait are part of the culture. Emotions are seldom expressed - especially aggressiveness. That comes to light as explosions - often under the influence of alcohol - as homicide or suicide.
In Greenland there is a much more prominent belief in magical phenomena, like demons, ghosts etc. This is culturally significant and should not in itself be understood as psychotic symptoms.
The interpreter is a key figure in psychiatric examinations and treatment in Greenland. Even though many patients speak Danish it is not their mother tongue, and a sensitive and professional interpreter is necessary. In the small towns the interpreter is often one of the health professionals - and their knowledge of the local culture is essential for the functioning of the psychiatrist from another culture.
Patient population
Most of the patients at the unit in Nuuk suffers from paranoid schizophrenia. They can be very expressive and as such the prognosis is often bad. Compared to a Danish population there is a higher ratio of men, a higher ratio of criminal offenders, and a greater consumption of antipsychotic drugs. The sociodemographic background is often characterized by poor upbringing, neglect, alcohol- and sexual abuse and suicides amongst close family members. The stories the patients can tell of their lives are often very dramatic and traumatic.
Hash is available in Greenland, but other kinds of drugs are difficult to obtain. One finds psychotic episodes based on hash, but with a good prognosis. Alcohol abuse is treated in a special unit.
Dissociative symptoms with paranoid ideation and hallucinations can provide difficulty in differential diagnosis. But trauma is more prominent in the history of the patients, and there will be other PTSD symptoms.
Bipolar disorders, depression and anxiety disorders are found to the same extent as in Denmark, but the latter is mainly treated in outpatient care. The high number of forensic patients are treated in a special unit in Denmark.
Through 2022 and 2023 an anti-stigma campaign took place in 6 towns in Greenland with a good attendance, and good publicity, bringing more light on the psychiatric patients and the possibilities for treatment. □
