Transcultural Psychiatry

Peace studies seeks to understand the negation of violence through conflict transformation, cooperation and harmony by drawing from many disciplines, including psychology, sociology and anthropology, political science, economics, international relations, international law and history. This raises the problem of the complementarity, coexistence and integration of different systems of knowledge. In fact, all of the human and social sciences are products of the post-Westphalian state system and so reify the state and its internal and international system and focus on this as the main source of political conflict. Conflicts, however, can arise from other distinctions involving gender, generation, race, class and so on. To contribute to peace building and conflict resolution, the social sciences must be globalized, developing theories that address conflicts at the levels of interpersonal interaction (micro), within countries (meso), between nations (macro ), and between whole regions or civilizations (mega). Psychiatry and the “psy” disciplines can contribute to peace building and conflict resolution through understanding the interactions between processes at each of these levels and the mental health or illness of individuals.

This article considers some of the main features of so-called truth and reconciliation commissions, their history and structure and their characteristic concerns with respect to their central dilemmas, including: how they grapple with notions of truth, justice, liability, reconciliation, apology and forgiveness, and how they address the need to support the “reconstruction” of selves and identities in the wake of massive trauma and collective violence. A particular concern is with how such commissions or related tribunals engender what can be called a “one-to-many” dynamic, in which they try to effect social reconciliation while focusing attention, via testimony and story-telling, on the traumas and suffering of individual victims.

A normative sequence of six stages is proposed to describe the process of evolution from open conflict to harmonious coexistence, as well at its devolution from the latter to the former. The stages may be termed Confrontation , Truce, Collaboration, Cooperation, Interdependence and Integration. Each of the six stages constitutes an amalgam of practices, narratives and prevalent emotions in a relational “game” that tends to resist change. At the stage of Confrontation, each party assumes that any act of the other is motivated by ill intent, and active hostility prevails. In Truce or Freeze, acts of hostility are curtailed by a real or virtual “neutral zone” controlled by powerful third parties. The dominant emotions are resentment, anger, and mistrust. Collaboration retains some assumptions of ill intent while certain activities in common are carried out. The third party looses visibility, and the dominant emotions include ambivalence. Cooperation entails the assumption of neutral intent of self and other, while activities in common are planned and carried out. Key emotions include cautious compassion for the other. Interdependence is characterized by active involvement in planning toward the common good. The dominant emotions are trust and forgiveness. At the other end of the spectrum, parties at the stage of Integration are actively involved in projects aimed at the common good and each supports the other’s growth. The dominant emotions are solidarity and a friendly trust. Movement from one stage to another shares certain characteristics with other complex systems. For professionals aiming to facilitate evolutionary change, whether in interpersonal or in international relations, the systemic cohesion of each stage constitutes the main challenge, and the promise of similar cohesion at the next stage provides the main hope.

Debates between refugee advocates, institutional actors and the wider public regarding refugee claimants often evoke anger, fear and sadness, as well as more positive emotions such as compassion, suggesting a complex societal emotional response toward refugee stories. This article analyses the emotional interactions surrounding refugee determination hearings, as reflected in the discourse of administrative judges and refugees. Our results show that the concepts of empathy and compassion are often used by judges to confirm the benevolent image that the administrative tribunal wants to project as a representative body of the host country. However, the very unequal power relations of the hearing setting structure the transmission of the refugee stories in a way that often prevents an emotional encounter between decision makers and refugees. Beyond the specific context of the refugee determination process, these results illustrate how prevalent psychological models of empathy and the transmission of trauma implicitly reveal a political dimension that validates representations of the helpless but potentially dangerous Other, representations that often underlie broader north—south power relations.

Collective trauma, be it through colonization (e.g., Aboriginal Peoples), slavery (e.g., African Americans) or war, has a dramatic impact on the psychological well-being of each and every individual member of the collective. Thus, interventions are often conceptualized and delivered at the individual level with a view to minimizing the psychological disequilibrium of each individual. In contrast, we propose a theory of self that emphasizes the primacy of cultural identity for psychological well-being. We present a series of studies that illustrate the importance of cultural identity clarity for personal identity and for psychological well-being. Our theoretical model proposes that interventions aimed at clarifying cultural identity may play a constructive role in the promotion of the well-being of group members exposed to collective trauma.

This exploratory study examined the health care system in relation to communal violence-related psychosocial wellbeing in Poso, Indonesia, as preparation for conducting a cluster randomized trial of a psychosocial intervention. We employed focus groups with children (N = 9), parents (N = 11), and teachers (N = 8), as well as semi-structured interviews with families affected by communal violence (N = 42), and key informants (N = 33). An interrelated set of problems was found that included poverty, an indigenized trauma construct, morally inappropriate behavior, inter-religious tensions, and somatic problems. Participants emphasized social-ecological interactions between concerns at different systemic levels, although problems were mainly addressed through informal care by families. The programmatic and research implications of these findings are discussed.

The use of psychohistoriographic cultural therapy (PCT) developed in Jamaica is described in the context of two workshops in Montreal. PCT is a form of group intervention that seeks to elicit and clarify the “psychic centrality” of a group. Psychic centrality refers to a sense of psychological containment or organization of diverse individual points of view through creating a historical map of collective experience. In PCT, this collective map is constructed and techniques borrowed from creative arts therapies are used to develop a performance. This performance provides additional containment and fosters a group process that can contain collective conflicts. The performance can also be used to engage an audience, working to contain conflict while representing diverse perspectives within the group. Factors that may contribute to the effectiveness of PCT and those that may derail the process are identified through the systematic comparison of the two workshops. PCT was demonstrated to cross successfully from a Third to a First World culture, and established potential as a method to facilitate group conflict resolution and for the promotion of pluralistic civil societies.

This article reviews the life and work of Dr Ravi L. Kapur, a seminal figure in the fields of social and community psychiatry in India. Kapur made significant contributions to the understanding of the role of spirituality in psychology and psychotherapy and the psychological dynamics of sectarian violence.