Ethnopsychiatry
Yves Lecomte, Sophie Jama, Gisèle Legault.
This introduction is a literature review of the
two major models of intervention in ethnopsychiatry : transcultural
psychiatry and ethnopsychoanalysis. After distinction of these
two approaches, the authors describe cultural competence considered
as the central concept of transcultural psychiatry, followed by a
description of the major parameters of ethnopsychoanalytic intervention
: foundations, problems related to consultation, operation, role
of professionals who refer, principal therapist and co-therapists,
translator and finality of this approach.
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Recognizing
difference: the challenge of ethnopsychiatry
Jean-Bernard Pocreau, Lucienne Martins Borges
Recognizing difference of the Other is the basis of legitimacy
of ethnopsychiatry that is necessarily multiple, changing, and itself bearing
subtleties and variations. It is from their practice at the Service d’aide
psychologique spécialisée aux immigrants et réfugiés
(SAPSIR), that the authors propose another perspective of this discipline
taking into account of course, the cultural and psychological dimension
of the individual; they also consider existential and humanistic universals
such as the need of giving meaning, of continuity of the self and coherence
as well as the various dimensions of identity. Their clinical approach,
respectful of the principles of ethnopsychiatry, is structured around three
axis : work on links, work on different dimensions of identity, work on
coherence and meaning of situations experienced. This approach allows to
accompany and facilitate essential elaborations involved in the psychological
work of refugees as well as individuals exposed to extreme situations such
as torture.
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The Paediatric
Transcultural Clinic of the Maisonneuve-Rosemont Hospital: From filiation
to affiliation
Caroline Pedneault, Gisèle Ammara, Tinh Nhan Luong, Selim Rashed
The Paediatric Transcultural
Clinic of the Maisonneuve-Rosemont Hospital is unique in the fact that
it is part of a General Paediatric Unit. Therefore, the child’s symptoms
are often the result of a larger problem affecting the whole family. This
clinic aims to provide a complete care by addressing physical, emotional
and cultural issues. The clinic’s professionals among the most often
use the concepts of filiation and affiliation and the authors attempt to
explain and illustrate them with two clinical cases. Their analysis raises
an important question: how resilient can children be in an immigration
context when dealing with issues of filiation and affiliation?
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Children of
the République are also migrants: school, an ethnopsychiatric laboratory
Rébecca Duvillié
The author describes an ethnopsychological consultation service
at the Charles Hermite school in Paris’ 18ème arrondissement.
The author, herself trained in ethnopsychiatry by T. Nathan, opened this
first consultation service which objectives are to promote the ethnopsychiatric
approach in the fields of school psychology, psychotherapy and education,
in order to sustain a reflection with a dialectic questioning : how to
take into account at the same time, the cultural and linguistic specificities
that constitute the symbolic world of the migrant child, and the strictly
coded world of a Jules Ferry inspired school, and finally, how to put into
practice an operative that is directed towards the problems of a specific
population without bringing about processes of stigmatization, so
often present in schools.
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Dreams and the dead
Claire Mestre
In this article, the
author examines the issue of dreams and the dead as an essential tool for
transcultural psychotherapy and how the dreamlike vision of the dead and
its interpretation constitute a turning point in transcultural threapy.
Drawing from a clinical example, the author illustrates how the spatial
analogy between dreams and the world of the dead has allowed a patient
to reconstruct a psychological space severely disturbed by trauma endured.
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Secondary elaboration of the dream has long been considered
minor in psychoanalysis. Yet, it is this elaboration that integrates in
the dream related work, the significant elements of the dreamer’s
conscious “vision of the world.” As such, it allows entering
directly with the dreamer’s unconsciousness, whatever his cultural
background. Three brief clinical cases illustrate this theoretical conception.
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Working with
young immigrants: towards a practice promoting culturally sensitive child
psychiatry
Sylvaine De Plaen
Transcultural psychiatry appears to be a precious tool to
help us reflect on our ways of doing and thinking in complex clinical situations.
This paper presents three concepts associated with the practice of transcultural
psychiatry: continuity, multiplicity and articulation of different spaces. “The
variable geometry frame” elaborated by Moro underlines the importance
of mobility and dynamism of clinical work. The analysis of a specific clinical
situation shows us how transcultural psychiatry can help us navigate better
in complex clinical situations. We propose the concept of
“culturally sensitive child psychiatry” to describe our way of
integrating culture in clinical practice.
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Playing with
identities, transforming shared realities: School theatre workshop for
immigrant and refugee adolescents
Cécile Rousseau, Marie-France Gauthier, Maryse Benoît, Louise Lacroix, Alejandro Moran, Musuk Viger Rojas. Dominique Bourassa
Migration during adolescence represents a challenge for the
youth who need to simultaneously work through the multiple losses associated
with the migratory journey and adapt to a young adult status. The drama
workshop program described here was designed to facilitate the adjustment
of newly arrived immigrant teens. The aim of the program is to make it
easier for adolescents to adjust to their new environment through creative
group work around identity issues. The program also seeks to improve intergroup
relations in multiethnic schools. The workshops are inspired both from
playback theater and from Boal’s form theater which emphasizes the
collective transformation of the singular experience. The qualitative assessment
of the program effects on the adolescents suggests that the workshops constitute
a safe space of expression, in which the team and the ritual nature of
the play hold the participants. The workshops facilitate the representation
of the multiplicity of values in the adolescent world and invite them
to reconsider the way in which they interact, with their environment, without
splitting between “us” and
“them,” but rather creating solidarities around issues of social
justice. The workshops also address the life transformation associated both
with adolescence and migration and help the elaboration of the losses linked
to the migratory journey and the construction of a hybrid identity.
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Mental health
for the Aboriginals: a transcultural response
Denise Noël
This article examines how the issue of clinical intervention
with the Aboriginals presents itself within Montreal’s transcultural
psychiatric services. The cultural consultation service at Montreal
Jewish Hospital created by Dr. Kirmayer as well as the transcultural psychiatric
clinic at Montreal Children’s Hospital founded by Dr. Rousseau are
relatively recent settings of care. Their mandate being to provide care
and services to Montreal’s cultural diversity, the author questions
the place and response given to the demands of a minority unlike the others,
the Aboriginals.
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Out of wedlock
pregnancies in Haitian families
Frantz Raphaël
Early pregnancies in
Haitian teenagers entails crisis situations within many families in addition
to questioning and involving many professionals of various fields. This
subject is addressed in a transcultural context with reference to Haitian
biculturalism both in Haiti and abroad. In this article, the author examines
more specifically the situation of Haitians within Quebec society. Analysis
of the parents’ attitude of both cultural group, the western as well
as creole, constitutes a light of mediation regarding help and support
or psychotherapeutic intervention. In the Haitian community, problems of
cultural identity on one side, and lack of affiliation to family on the
other, are at the basis of conflicts between parents and children. The
author concludes with proposals aiming at improving interventions with
these families in their process of migratory adaptation.
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Ethno-psychiatry
in Québec: assessment and perspective of a key actor and witness
Carlo Sterlin
In this “interview,” C. Sterlin, founder of the
Transcultural Clinic of Jean-Talon Hospital (Montreal) describes the historical
background of the intercultural movement in the clinical field, and proposes
a clinico-political classification of the intercultural approaches in psychiatry.
He describes the development of the Jean-Talon Project, and the circumstances
of its failure. He argues that, in spite of this failure, Quebec is in
a privileged position to develop and implement new approaches in the field
of
“ethno-psychiatry.”
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The scope of
forensic psychiatry : Ethical responsibilities and conflicts of values
Julio Arboleda-Flórez, David N. Weisstub
To write about ethics in specialties that straddle the lines
of multiple systems cannnot be done without discussing values and
decisional rules that underlie each one of those systems. By virtue of
its multiple associations, forensic psychiatry is an archetype of such
specialties ; it works within a set of values that might be viewed as antithetical,
even irreconcilable, with other aspects of psychiatry. The extensive scope
of action of forensic psychiatry compels its practitioners to hold alternate
world views and to apply decisional rules that may clash with the classical
values and ethical considerations of medicine (Weisstub, 1980). In this
article, following an historical précis, the authors review the
scope of action of forensic psychiatry as the basis for the definition
of this subspecialty. The concepts, themes and controversies pertaining
to the ethical practice of this specialty will be reflected upon in the
light of issues encountered in actual practice.
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Job tenure among
people with mental illness
Marc Corbière, Alain Lesage, Kathe Villeneuve, Céline Mercier
Work integration for people with mental illness is complex
and difficult. For those who obtain employment, job tenure is typically
brief. The purpose of this article is to identify the personal determinants
of job tenure of people with severe mental illness registered in prevocational
programs. Out of 105 people with mental illness who are employed during
the nine month follow-up after their registration in a prevocational program,
close to 50 % kept their first job. According to the job tenure indicators
(first or last job obtained), the results from survival analyses show that
the significant variables are related to background characteristics (financial
aid), work-related characteristics (length of absence from the workplace,
type of job), cognitive (executive functions), and clinical aspects (paranoid
symptoms). In conclusion, the authors propose not only to assess personal
variables to better understand the work integration process for people
with mental illness, but also to conduct a systematic evaluation of the
job site.
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Deadlock in
psychodynamic psychotherapy or the relevance of paradox
Wilfrid Reid
The author refers here to the saying : prevention is better
than cure. In this context, he describes some pitfalls that are inherent
in the process of psychodynamic psychotherapy. In trying to avoid these
pitfalls, they are presented following the chronological unfolding of the
psychotherapy. In so doing, the author brings out a new paradigm of
the analytic method, the paradigm of transitionnality. These considerations
tend to emphasize the heuristic value of the notion of paradox.
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Creating contexts
of cooperation to get out of therapeutic deadlock
Suzanne Lamarre
This article aims at
: 1) describing the management of mental health problems according to two
models that are opposed and differentiate themselves when tensions arise,
the cooperation model and the traditional medical model ; 2) illustrating
with clinical examples these essential differences ; and 3) proposing possible
solutions to the obstacles to cooperation because of the protectionist
attitudes of the traditional medical model that accentuate during crises.
To stick to the treatment of pathologies by ignoring the nature of relational
contexts, as suggests the traditional medical model, risks bringing all
actors involved in a therapeutic deadlock the most frequent being the psychiatric
solution. The author proposes an intervention model she calls the
4Rs to install a context of cooperation.
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The issue of
therapeutic deadlock in a transcultural clinic
Taïeb Ferradji, Laetitia Bouche-Florin, Kouakou Kouassi, Yoram Mouchenik, Félicia Heidenreich, Katherine Levy, A. Trepied, Salim Mehallel, Marie-Rose Moro
The transcultural consultation service at the Avicenne hospital
is often a setting where patients with long, painful trajectory tainted
with trauma and break-ups and teams of professionals overwhelmed by the
complexity of certain situations both converge. Confusion and feelings
of deadlock are doubly experienced with a reinforced risk of therapeutic
wandering, lack of comprehension and misunderstanding if not reject. The
transcultural mechanism that mediates the interaction between patient and
therapist allows the elaboration of a compromise preserving the position
of the therapist while being coherent with the patient’s cultural
representations.
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