Psychiatry and Decolonization: Histories of Transcultural Psychiatry in the Twentieth Century.

This review essay explores recent historical and anthropological literature on the emergence and development of transcultural psychiatry in the second half of the twentieth century. It examines how postcolonial psychiatry attempted to remove itself from its erstwhile colonial frameworks and strove to introduce new concepts and paradigms to make itself relevant in the context of decolonization and postwar reconstruction. The essay looks at both continuities and discontinuities between colonial and post-colonial transcultural psychiatry, asking how the recent surge of scholarly literature in this field engaged with these issues. It also aims to identify the most important avenues for future research.

Völkerpsychologie as a field science: José Miguel de Barandiarán and Basque ethnology.

José Miguel de Barandiarán considered the central figure of Basque anthropology, played a prominent role in the Basque people's cultural rescue (material and spiritual). His dual status as an ethnologist and priest prepared him to study collective mentalities and rural societies. However, the scientific approach of the Völkerpsychologie (roughly translated as ethnic psychology), as proposed by Wilhelm Wundt, greatly influenced him and aroused broad interests of ethnological and sociological-religious concerns. This essay examines the scope and depth of Wundt's influence on Barandiarán, and suggests that, by combining the techniques of folklore with those of ethnography, Barandiarán stamped Basque anthropology with a unique defining quality in Europe.

Entre zelar e cuidar: sentidos sobre saúde-doença em dirigentes da Umbanda / Entre celar y cuidar: significados sobre salud-enfermedad en los líderes de Umbanda / Between watching over and caring: meanings about health-disease in Umbanda leaders

RESUMO Por meio da antropologia da saúde, podemos compreender o terreiro de umbanda como parte de um sistema popular de cuidado. Este estudo teve por objetivo investigar as concepções de saúde e doença produzidas por zeladores de terreiro de umbanda. Participaram dez zeladores de terreiro da cidade de Uberaba (MG/Brasil), sendo três mulheres e sete homens, com idades entre 40 e 76 anos. O tempo médio de atuação como dirigente foi de 18,4 anos, variando de cinco a 43 anos. Os terreiros chefiados por esses participantes atendem entre 15 e 280 pessoas por dia de funcionamento. Pela análise das entrevistas, destaca-se que o cuidado em saúde oferecido pelos zeladores ultrapassa os limites rituais, nas cerimônias públicas, sendo prestado de modo contínuo nos terreiros. As posturas assumidas pelos entrevistados envolvem ações de escuta, acolhimento e proximidade física no momento da urgência. Pelas narrativas, pode-se concluir que o zelar, no sentido de gerenciar o espaço do terreiro, espiritual e materialmente, não pode ser dissociado do cuidar, significando os zeladores como importantes agentes populares de saúde.

RESUMEN A través de la antropología de la salud podemos entender el terreiro de umbanda como parte de un sistema de atención popular. Este estudio tuvo como objetivo investigar las concepciones de salud y enfermedad producidas por los cuidadores del terreiro de umbanda. Participaron diez cuidadores de terreiro de la ciudad de Uberaba (MG/Brasil), tres mujeres y siete hombres, con edades comprendidas entre 40 y 76 años. El tiempo promedio como gerente fue de 18.4 años, que van de cinco a 43 años. Los terreiros encabezados por estos participantes atienden entre 15 y 280 personas por día de operación. Del análisis de las entrevistas, se destaca que la atención médica ofrecida por los cuidadores va más allá de los límites rituales, en ceremonias públicas, que se brindan continuamente en los terreiros. Las actitudes asumidas por los entrevistados implican escuchar, acoger y proximidad física en el momento de urgencia. A través de las narrativas, se puede concluir que el cuidado, en el sentido de administrar el espacio del terreiro, espiritual y materialmente, no se puede disociar del cuidado, lo que significa que los cuidadores son importantes agentes de salud populares.

ABSTRACT Through health anthropology we can understand the umbanda terreiro (specific place for the religious ritual) as part of a popular system of care. This study aimed to investigate the conceptions of health and illness produced by saint keepers of umbanda terreiro. Ten leaders of the terreiros in the city of Uberaba (MG/Brazil) participated, being three women and seven men, between 40 and 76 years old. The average time of performance as a manager was 18.4 years, ranging from 5 to 43 years. The terreiros led by these participants attend between 15 and 280 people working day. The health care offered by saint keepers exceeds ritual limits in public ceremonies and is provided on a continuous basis in the terreiros. The postures assumed by the interviewees involve actions of listening, welcoming and physical proximity at the moment of urgency. From the narratives, it can be concluded that care, in the sense of managing the space of the terreiro, both spiritually and materially, can not be dissociated from caring, meaning saint keepers as important popular health.

La lutte continue: Louis Mars and the genesis of ethnopsychiatry.

The scientific contributions of Western mental health professionals have been lauded and leveraged for global mental health responses to varying degrees of success. In recent years, the necessity of recognizing the inefficiencies of solely etic and Western-based psychological intervention has been reflected in certain decolonial scholars like Frantz Fanon gaining more recognition. Despite this urgent focus on decolonial psychology, there are still others whose work has historically and contemporarily not received a great deal of attention. There is no better example of such a scholar than Dr. Louis Mars, Haiti's first psychiatrist. Mars made a lasting impact on the communities of Haiti by shifting the conversation around Haitian culture and the practice of how people living with a mental illness were treated. Further, he influenced the global practice of psychiatry by coining "ethnopsychiatry" and asserting that non-Western culture should be intimately considered, rather than stigmatized, in treating people around the world. Unfortunately, the significance of his contributions to ethnopsychiatry, ethnodrama, and the subsequent field of psychology has effectively been erased from the disciplinary canon. Indeed, the weight of Mars' psychiatric and political work deserves focus. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Cross-cultural, transnational or interdisciplinary? Eric Wittkower's psychosomatic medicine and transcultural psychiatry in historical context.

This article traces the career, scientific achievements, and emigration of the Berlin-born physician, psychoanalyst, and psychosomatic researcher Eric Wittkower. Trained in Berlin and practicing internal medicine, he became persecuted by the Nazi regime and, after fleeing Germany via Switzerland, continued his professional career in the United Kingdom, where he turned to psychosomatic medicine and worked in the service of the British Army during World War II. After two decades of service in the UK, Wittkower joined McGill University in Canada. His increasingly interdisciplinary work contributed to the establishment of the new research field of transcultural psychiatry. Finally the paper provides a detailed history of the beginning of the section of transcultural psychiatry at the Allan Memorial Institute.

Global migration: Moral, political and mental health challenges.

Global migration is expected to continue to increase as climate change, conflict and economic disparities continue to challenge peoples' lives. The political response to migration is a social determinant of mental health. Despite the potential benefits of migration, many migrants and refugees face significant challenges after they resettle. The papers collected in this thematic issue of Transcultural Psychiatry explore the experience of migration and highlight some of the challenges that governments and healthcare services need to address to facilitate the social integration and mental health of migrants. Clinicians need training and resources to work effectively with migrants, focusing on their resilience and on long-term adaptive processes. Efforts to counter the systemic discrimination and structural violence that migrants often face need to be broad-based, unified, and persistent to make meaningful change. When migrants are free to realize their talents and aspirations, they can help build local communities and societies that value diversity.

Contribuições de Georges Devereaux à metodologia de pesquisa em ciências humanas / On Thomas Aquinas's psychology: an analysis of the will in the Summa Theologica

O objetivo deste artigo é expor uma síntese das principais contribuições de Georges Devereux para o campo da metodologia de pesquisa em ciências humanas: a epistemologia complementarista e a análise da contratransferência do pesquisador. O complementarismo, em Devereux, fundamenta-se na ideia de que a compreensão dos fenômenos humanos necessita de pelo menos uma dupla análise, nunca simultânea: do exterior (da cultura), pela antropologia, e do interior (psiquismo), pela psicanálise. Essa proposta respeita a especificidade de cada disciplina e também pode articular outras disciplinas e saberes na compreensão dos fenômenos humanos. A análise da contratransferência, por sua vez, é entendida como o caminho para a obtenção da objetividade na pesquisa e principal fonte de dados na pesquisa em ciências humanas, embora geralmente negligenciada. Como Devereux é um autor ainda pouco conhecido no Brasil, acreditamos que suas contribuições no campo da metodologia merecem ser estudadas e divulgadas.

This article aims to present a synthesis of Georges Devereux's main contributions to research methodology in the human sciences: complementarist epistemology and the analysis of the researcher's countertransference. Complementarism in Devereux is based on the idea that understanding human phenomena requires at least a double analysis, never simultaneous: from the outside (culture) by anthropology and from the inside (psychism) by psychoanalysis. This proposal respects the specificity of each discipline and may also articulate other disciplines and knowledges in understanding human phenomena. Countertransference analysis, in turn, is understood as the way to obtain objectivity in re-search and the primary source of data in research in the humanities, although generally neglected. As Devereux is still an author little known in Brazil, we believe his contributions in the field of methodology deserve to be studied and publicized.

Etnopsicologia e compreensão da pessoa indígena: contribuições da fenomenologia e da antropologia filosófica / Ethnopsychology and comprehension of the indigenous person: contributions of phenomenology and philosophical anthropology

Este artigo apresenta uma proposta epistêmica e metodológica de investigação e práxis etnopsicológicas com pessoas indígenas, apontando para suas contribuições na pesquisa e na assistência psicológica a essas pessoas. Inicialmente, busca contextualizar a etnopsicologia, delimitando seu campo e respectivas possibilidades de investigação e intervenção. Na sequência, explora os conceitos fenomenológicos husserlianos deepoché (o abandono de suposições ou crenças) e intencionalidade da consciência, e sua respectiva retomada no modelo metodológico de Amedeo Giorgi. Em seguida, traz a noção de pessoa dada pela antropologia filosófica de Max Scheler, diferenciando-a de outras noções hegemônicas predominantes no Ocidente e buscando apreciar sua aplicabilidade na pesquisa e no atendimento às pessoas indígenas. Discute, então, o potencial dessas duas abordagens na etnopsicologia, na medida em que ambas assumem que o conhecimento se constitui em relação, tendo como fundamento axiológico o mundo da vida das pessoas, repleto de valores, sentidos e significados existenciais. (AU)

This article presents an epistemological and methodological proposal for investigation and ethnopsychological praxis involving indigenous people, indicating their contributions to the study and to the psychological support offered to them. Firstly, it seeks to put ethnopsychology into context by defining its field of study and the respective options for research and intervention. It then goes on to explore the Husserlian phenomenological concepts ofepoché (the setting aside of assumptions or beliefs) and intentionality of conscience, and their resurrection in the methodological model of Amedeo Giorgi. Next, the notion of theperson is introduced, as defined by the philosophical anthropology of Max Scheler, differentiating it from other hegemonic notions that were predominant inthe Western world, seeking to appraise its applicability to the study and care of indigenous people. It will then discuss the potential of these two approaches in ethnopsychology, insofar as both assume that knowledge is constituted in relations, having its axiological basis in the world of the lives of people, full with existential values, meaning and significance. (AU)

[Cultural diversity in mental health care]. / Culturele diversiteit in de geestelijke gezondheidszorg.

Background  Of the total Dutch population, 25.7% has a migration background. The countries of origin, migration motives and time in the Netherlands are very diverse. Aim  To provide an overview of the cultural diversity within the psychiatry of different groups of people with a migration background, and to address the challenges and mental health care to these groups and the position of transcultural psychiatry in the Netherlands. Method  Based on integration of a narrative literature review (without a systematic search), own experiences and a fictitious case, we discuss the most important groups. This concerns the so-called guest workers as a specific group of first-generation migrants, second-generation migrants with their specific problems, and finally refugees and undocumented migrants with an accumulation of risk-increasing factors. Results  In addition to predisposition and migration factors, insufficient understanding of cultural context contributes to the psychiatric problems of first- and second-generation migrants. Refugees and undocumented migrants also have limited access to care. There is a reimbursement system in the Netherlands for undocumented migrants, through which they can also rely on care. By understanding cultural backgrounds, professionals can further improve their skills and communication in the field of intercultural psychiatry. Conclusion  Cultural diversity of patient groups demands additional attention to diagnosis and therapy.

From idioms of distress, concern, and care to moral distress leading to moral injury in the time of Covid.

In this invited commentary on the thematic issue of Transcultural Psychiatry on idioms of distress, concern, and care, I provide a brief overview of how my research agenda evolved over the years while conducting community and clinic-based research in South and Southeast Asia as well as North America. I then suggest areas where future research on idioms of distress, concern, care, and resilience will be needed among different demographics given social change and shifts in how we communicate face to face and in virtual reality, the impact of medicalization, pharmaceuticalization and bracket creep, changes in indigenous healing systems, and hybridization. I further call attention to the importance of conducting idioms guided research in occupational settings. Toward this end I highlight the moral distress health care workers in the U.S. have experienced during the Covid-19 pandemic and point out the importance of differentiating individual burnout from moral injury related to structural distress. I conclude by discussing the general utility of an idioms of distress perspective in the practice of cultural psychiatry and suggest that this perspective needs to be included in the training of all practitioners regardless of the system of medicine they practice. Doing so may enable the formation of mental health communities of practice in contexts where there are pluralistic health care arenas.

Training in cultural psychiatry: Translating research into improvements in mental health care for migrants.

This special issue of Transcultural Psychiatry on training in cultural psychiatry discusses translating research into improvements in mental health care for refugees and migrants. This topic is timely because, in addition to a global increase in migration, the number of forcibly displaced people is growing rapidly due to war and conflicts. We know that migrants, particularly refugees, are at increased risk of psychiatric disorders, including psychotic disorders and post-traumatic stress. Despite this, there is evidence of major disparities in care for minorities, migrants, and refugees. The gap between needs related to mental health care for migrants, refugees, and minority groups and available services points to the need to improve accessibility and adapt systems, services, and interventions. Health professionals have a key role in ensuring the quality of care. Their capacity to cope with new challenges depends on their competence, knowledge, skills, and attitudes toward their patients' needs. Mental health professionals need training in working with cultural diversity and structural competence to understand, treat, and support migrant and refugee patients-and to respond to racial discrimination. Mental health care services need to reduce barriers to providing adequate resources, including supporting skills training for mental health professionals. Hopefully, this thematic special issue will motivate further research, discussion, and sharing of local experience and pedagogical methods in this vital field.

The ephemeral effects of fact-checks on COVID-19 misperceptions in the United States, Great Britain and Canada.

Widespread misperceptions about COVID-19 and the novel coronavirus threaten to exacerbate the severity of the pandemic. We conducted preregistered survey experiments in the United States, Great Britain and Canada examining the effectiveness of fact-checks that seek to correct these false or unsupported beliefs. Across three countries with differing levels of political conflict over the pandemic response, we demonstrate that fact-checks reduce targeted misperceptions, especially among the groups who are most vulnerable to these claims, and have minimal spillover effects on the accuracy of related beliefs. However, these reductions in COVID-19 misperception beliefs do not persist over time in panel data even after repeated exposure. These results suggest that fact-checks can successfully change the COVID-19 beliefs of the people who would benefit from them most but that their effects are ephemeral.

Suicide in cultural context: An ecosocial approach.

This article introduces a thematic issue of Transcultural Psychiatry on suicide in cultural context. Developmental and social structural factors including exposure to violence, childhood abuse and privation, as well as intractable social problems that create psychic pain and a sense of entrapment have been shown to increase the risk of suicidal behavior. However, all of the major social determinants identified in suicide research are influenced or mediated by particular cultural meanings and contexts. To move beyond crude generalizations about suicide based on psychological theories developed mainly in Western contexts and culture-specific prototypes or exemplars, we need more fine-grained analysis of the experience of diverse populations. The articles in this issue provide clear illustrations of the impact of cultural and contextual factors in the causes of suicide, with implications for psychiatric research, theory, and practice. Cross-cultural research points to the possibility of developing a typology of social predicaments affecting specific sociodemographic groups and populations. This typology could be elaborated and applied in clinical and public health practice through an ecosocial approach that considers the ways that suicide is embodied and enacted in social systemic contexts.

The Effects of Adult Aging and Culture on Theory of Mind.

OBJECTIVES: Older adults tend to have poorer Theory of Mind (ToM) than their younger counterparts, and this has been shown in both Western and Asian cultures. We examined the role of working memory (WM) in age differences in ToM, and whether this was moderated by education and culture (the United Kingdom vs. Malaysia). METHODS: We used 2 ToM tests with differing demands on updating multiple mental states (false belief) and applying social rules to mental state processing (faux pas). We also looked at the role of education, socioeconomic status, and WM. A total of 298 participants from the United Kingdom and Malaysia completed faux pas, false belief, and WM tasks. RESULTS: Age effects on some aspects of ToM were greater in the Malaysian compared to the UK sample. Malaysian older adults were poorer at faux pas detection, aspects of false belief, and WM compared to young adults. In subsequent moderated mediation analyses, we found that, specifically in the Malaysian sample, the mediating effects of WM on the age and ToM relationship occurred at the lowest levels of education. DISCUSSION: This pattern of results may reflect changes in the familiarity and cognitive load of explicit mental state attribution, along with cultural differences in the pace and nature of cognitive aging. Cultural differences in education and WM should be considered when researching age differences in ToM.

Casting and scripting: Visibility, responsibility, and legitimacy in transcultural psychiatry apprenticeships in Paris.

Transcultural psychiatry was developed in France to promote cultural and linguistic diversity and address the mental health needs of immigrants who were excluded from accessing other public mental health services. Professionals in health and social services refer patients to transcultural psychiatry consultations when miscommunications arise or when professionals determine that patients need culturally sensitive therapy. In transcultural psychiatry consultations, a group of therapists, composed primarily of psychologists and psychiatrists, as well as other health and social service professionals, receives a patient, the patient's family, and referring professionals. Previous research on transcultural psychiatry has emphasized the importance of culturally diverse therapy teams and the ways that therapists' diversity could permit patients to open up in consultation sessions. This study draws on ethnographic research in two transcultural psychiatry consultations in Île-de-France, and pays particular attention to the experiences of apprentice therapists, who were often graduate students in clinical psychology. Apprentice therapists reported being introduced to patients in ways that they would not choose themselves. As a result, therapists felt that they had to overemphasize their cultures or countries of origin and French therapists questioned their place in the group. This article describes how transcultural therapy groups are a theater in which belonging, identity, and Frenchness are contested and performed. Apprentice therapists proposed more intersectional and inclusive ways of portraying diversity in the transcultural groups.

Understanding mental distress in Arcahaie, Haiti: Heterogeneous uses of idioms of distress in communicating psychological suffering.

Research on mental health in specific communities requires careful attention to cultural context and language. Studies on global mental health have increasingly analyzed idioms of distress, or culturally situated ways of conceptualizing, experiencing, and expressing distress. This study examines how idioms of distress are used and understood in Arcahaie, Haiti. The goal was to enrich current understanding of mental health conceptualization and communication by exploring the heterogeneity of common idioms of distress. Interviews with community members (N = 47) explored meanings and perceived causations of 13 idioms of distress. Major themes included pervasiveness of poverty, ruminative thinking, effects of Vodou and Christian belief systems, embodied distress, and the behavior of "crazy" people (moun fou). The findings suggest some specific pathways for potential community engagement projects, including training lay-leaders in cognitive behavioral therapy using existing socioreligious infrastructure and expanding access to social engagement activities. This research contributes to a small but growing body of literature on mental illness in Haiti and to methods for studying idioms of distress.

Tension and Other Idioms of Distress Among Slum Dwelling Young Men: A Qualitative Study of Depression in Urban Bangladesh.

In low- and middle-income countries (LMIC) it is vital to understand acceptable, comprehensive, and culturally appropriate ways of communicating about mental distress. Diagnostic terminology is rarely used, may be stigmatizing, and is subject to misinterpretation. Local terms, such as idioms of distress, can improve mental health literacy and service delivery. Our objective was to examine lived experience and coping connected to distress and depression in an under-researched population: young men from LMIC urban slums. We conducted 60 qualitative interviews with men (ages 18-29) in Bhashantek slum, Bangladesh. Themes were generated using thematic analysis and grounded theory techniques. The heart-mind (mon), mentality (manoshikota), mood (mejaj), head (matha or "brain"), and body (shorir) comprised the self-concept, and were related to sadness, hopelessness, anger, worry, and mental illness. The English word "tension" was the central idiom of distress. "Tension" existed on a continuum, from mild distress or motivational anxiety, to moderate distress including rumination and somatic complaints, to severe psychopathology including anhedonia and suicidality. Respondents connected "tension" to burnout experiences and mental illness which was summarized in an ethnopsychological model. These findings can inform culturally sensitive measurement tools and interventions that are acceptable to the community, potentially increasing engagement and enhancing therapeutic outcomes.