Culture and psychiatry

Maeve Haldane | Plenty of academic conferences have films sprinkled in among the speakers, but how many invite classical Indian dancers to perform, show art in the back of the room, and bring in theatre troupes?

Researchers from McGill and away discussed the nuances of culture as found in fairy tales and dance therapy, spirit mediums in Brazil and suicide in Indian cinema at the annual get-together for the Society for the Study of Psychiatry and Culture. The event (October 2--5, at the Omni Hotel) was sponsored by McGill's Faculty of Medicine and Office of Continuing Education, and featured artistic activities in keeping with the conference's theme of "Creativity, Spirituality and the Arts."

Contact between disparate cultures doesn't only occur on street corners, but in the wards of hospitals. Yet within the field of psychiatry, culture used to be disregarded. With today's increased mingling of cultures in North America through globalization, migration and influx of refugees, cultural awareness has moved from the fringes of medical practice to become a crucial part of health care.

Psychiatry professor Laurence Kirmayer is the director of the social and transcultural psychiatry division in McGill's Faculty of Medicine, and was on the conference's program committee. In an interview, he explains that cultural psychiatry is the study of the impact of culture on mental health and illness, and looks at healing as well as resources available to the clinicians who treat people from different backgrounds. "We're interested in solutions, what we can offer to people," Kirmayer says. This can range from ethnopharmacology (the medicinal use of plants) to helping others at a symbolic level.

Montreal has two units devoted to helping clinicians: the Transcultural Psychiatry Clinic of the Montreal Children's Hospital, headed by psychiatrist Cécile Rousseau, and the Cultural Consultation Service of the Jewish General Hospital, which Kirmayer helped start up a few years ago that is now directed by Dr. Eric Jarvis.

Rousseau's team helps clinicians appreciate their patients' plights. The Children's treats immigrant refugee families, who have problems unique to their situation. They've experienced trauma in their country of origin, are waiting for their claim for official refugee status, and often lost their families and home.

Dr Lucie Nadeau works in this unit, and in a conference presentation on her McGill graduate research she pointed out that migrant and refugee children have special needs. As with any child or adolescent, their identities are forming, shifting over time, yet "they're even more susceptible to changes and new spaces," she said.

The consultation service at the Jewish General uses cultural brokers to help clinicians get beyond language and cultural misunderstandings. If a doctor's confronted with psychosis or sleep paralysis, or any number of mental health disorders in someone from a culture they're unfamiliar with, misinterpretations can occur and the patient's treatment is compromised.

"Canadians have failures of imagination," Kirmayer says. "They don't understand the violence of other worlds." Other differences can be seen in how families are raised, or in variations in values. It's easy for clinicians to attribute what they don't understand to characteristics of the person, not the culture.

During her conference talk on negotiating meaning in the clinical setting, McGill professor of psychiatry and anthropology Ellen Corin said that it is not just enough to be aware of how the cultural dimension can have an impact upon the patient, but also on where the clinician is situated in cultures. "We should challenge more generally how we listen to families with emerging psychosis. Not just the 'other' but also look at anglo-Quebecers, Franco-Quebecers." Those with long-standing roots in our society are just as much products of their own culture as people who come from far away.

When asked why this year's conference focused on art and spirituality, Kirmayer said, "The most elaborate expression of culture is through art." He explained that creative engagement is a signifier for people, and often used to express spirituality. The accessibility of art to people, both creating it and sharing an appreciation of it, makes art an attractive — and fun — field to explore. It can help bridge the gap of understanding between cultures.

In the west, Kirmayer explains, "art is seen as a individual idiosyncratic expression. In other places it's more closely tied with tradition and the person's lineage." When Sujatha Venkatesh performed at the conference, she executing the traditional form of Indian classical dance, not creating de novo as a modern dancer would.

As well, various forms of art are useful in expressing and reflecting the dilemmas encountered in cultural psychiatry, and can be good tools to help comprehend the alienation of belong to another culture, or having a mental illness. Not only for children, for whom art is a natural, but for adults. "Artists go to an extreme," Kirmayer said at the conference. "Art itself is an other."

"Poetics fashion an understanding of the world through language," Kirmayer said at his conference talk, "Black milk of daybreak." He spoke of the twentieth century German-speaking Jewish poet Paul Celan, who committed suicide by throwing himself in the Seine at age 49.

"The feeling of otherness is intrinsic to the human condition," Kirmayer said, "which does present problems." Celan's own sense of estrangement dogged him his entire life.

Celan struggled with writing poetry in German. The language was both his mother tongue and the language of the murderers of his family. How could he possibly use it as an instrument of healing? Kirmayer said that Celan's view was that "a poem always hoped to speak on behalf of the strange, the other."

For more information on the conference, see www.psychiatryandculture.org

Acting up in class

At the pre-conference meeting on transcultural child and family mental health, six people dressed in black demonstrated the technique of using improvisational theatre in Montreal high schools to give new-to-town students an expressive space for their stories. These actors, musicians and therapists form Pluriel, which sprung from the cultural psychiatry team at the Children's Hospital, and their workshops are part of Montreal's "welcoming classes," for students new to Quebec.

Pluriel asked those in the room for a personal story about an encounter with art. A middle-aged man described the mixed feeling he had bringing his ten-year-old daughter to a Shakira concert. Despite his ambivalent feelings for the pop artist, he found himself being totally swept away in the excitement of the event, and hooting and hollering with the rest of the crowd.

By using a technique called "Playback," Pluriel created a fluid, living sculpture to recapture a moment in this man's experience. One actor cheered, another cringed with self-consciousness, another played the embarrassed daughter — each repeating a phrase or exultation, overlapping the other until it quickly came together in a synchronous swoop.

Pluriel also uses the method employed by Augusto Boal's forum theatre, in which the troupe acts out roles from a scenario given by an audience member.

Marie France Gauthier, a Children's Hospital drama therapist, explained how the group realized after a year that telling stories is not enough and by creating alternative scenarios, they could go further.

These energetic expressions of the students' stories and concerns give them a safe, yet creative, space to deal with loss, adolescence, the immersion into the host country and identity crises.

Over ten workshops over as many weeks, Pluriel's unique form of theatre can help decrease the students' sense of isolation and validate their concerns and experiences. Each session starts with the actors introducing a different theme, such as racism, peer pressure, and family. The group finds the balance between seriousness and fun, and tries to attain a level of intensity necessary to make the interaction meaningful, yet bearable. Often they deal with the traumatic. "Sometimes it's too much for teachers," who can be left overwhelmed, Gauthier said. But the students can handle it.

Even though the conference goers' reaction was "this is odd," they were won over. Pluriel may seem radical, but they are only working in the oldest form of engagment: oral tradition.