Volume3, Number6 December 2008

WPA-TPS Chair’s Report on the XIV World Congress of Psychiatry Contents Page Prague, 19-25 Sep 2008 * TPS Chair’s Report on WPA Congress Prague 1 * TPS Symposium abstracts/Prague a. Immigration/Terrorism 5 b. Intermarriage 9 c. Jewish Culture 11 d. TP in Europe 13 * DTPPP Report 15 * Bio-Sketch : Micol Ascoli 17 * Bio-Sketch : John De Figueiredo 19 * Kinzie ’Reading Notes’ 21 * TPS Chair’s welcome to 2nd World Congress of Cultural Psychiatry 25 * CPNN, Nordic Network for Cultural Psychology and Psychiatry 26

Elections for the WPA-TPS Committee for 2008-2011 were held in Spring, 2008. There were fourteen candidates for eight positions on the Committee. A three-person sub-committee of the TPS Committee was appointed to conduct and monitor the election process, comprised of Mitchell Weiss, chair, Joan Obiols and Rachid Bennegadi.

Forty members submitted ballots, comprising 61.5% of the TPS membership in 2008. There was a tie vote for the eighth position, which was resolved by increasing the TPS Committee for 2008-2011 to nine members. They are; Rachid Bennegadi (France), Kamaldeep Bhui (United Kingdom), John de Figueiredo (USA), Mario Incayawar (Ecuador), Fumitaka Noda (Japan), Hans Rohlof (Netherlands), Mitchell Weiss (Switzerland), Ronald Wintrob (USA) and Xudong Zhao (China). The executive committee for 2008-2011 is; Ronald Wintrob, chair, Fumitaka Noda, co-chair, Rachid Bennegadi, secretary and Hans Rohlof, treasurer.

1 The Committee of the Transcultural membership fee for Sep 2011-Sep Psychiatry Section for 2008-2011 had 2014. its inaugural meeting Sep 19. Two of the three newly elected committee These changes in dues structure are members were present, along with five expected to be incorporated in the of the six re-elected committee ‘Membership’ section of the TPS members. The Section chair, co-chair, website in Dec. secretary and treasurer were all able to be there for the meeting, as well as the Along with the transition to the new three-year term of office of the TPS TPS secretary-treasurer for 2005-2008. Committee members, there is a transition of responsibilities for the TPS website and newsletter. The new TPS Webmaster is Rachid Bennegadi. He has taken over this role from Mario Incayawar, who has done an outstanding job over the past three years in launching and continuously improving the design and content of our TPS website; www.wpa-tps.org

Simon Dein is the new editor of the TPS Newsletter and Robert Kohn is the associate editor. David Kinzie has agreed to be editor of the book review At the Committee meeting, we reviewed section and to contribute a new section the details of the recently conducted on ‘reading notes’. election process for the 2008-2011 TPS members are encouraged to Committee. We discussed the communicate with Dr Dein if they would possibility of inaugurating five TPS like to contribute material for the Standing Committees; on International newsletter. Conferences, Awards and Recognition, Membership and Recruitment, At the TPS Committee meeting, and Communication and Publication, and on again at the TPS Business Meeting Sep Finance and Dues Structure. There was 24, these issues were reviewed. Thirty- agreement to go ahead with these seven people attended the Business plans. Meeting, including seven Committee members, 17 other active members and We also discussed and agreed on 13 non-members. revising the current dues structure, so that dues will be based on a three-year membership cycle that starts in Sep of the year that a World Congress of Psychiatry is held, as occurred this Sep. Accordingly, for people who apply for TPS membership between Sep 2008 and Sep 2009, the three-year membership will be reduced by 1/3. For those who apply for membership between Sep 2009 and Sep 2010, the three-year membership will be reduced by 2/3. People who apply for TPS membership after Sep 2010 will have their first year TPS membership fee waived, and will pay the three-year

2 Cultural Psychiatry in the German- speaking World; Zurich; Switzerland; 11-13 Sep.

3- 2nd World Congress of Cultural Psychiatry; Orvieto, Italy; 26-29 Sep.

In 2010: 1- International Conference on Cultural Psychiatry; 26-28 Feb; Wellington, New Zealand.

2- International Conference on "Rekindling the Spirits"; 23-25 Apr; Santa Fe, NM, USA.

3- International Conference on Cultural In addition to the items already Psychiatry; 13-16 Jun; The addressed, several international Netherlands. conferences on cultural psychiatry that are currently in planning were outlined at the Business Meeting. Dr Wintrob 4- International Conference on Cultural reviewed the contribution by TPS to the Psychiatry; 27-29 Sep; Durban, South program of the WPA International Africa Congress to be held in Florence, Italy, 1-4 Apr 2009, in which TPS has three symposia; two on ‘Culture, Humor and 5- 4th International Conference on Psychiatry’, and one on ‘Education and Cultural Psychiatry in the German- Training in Transcultural Psychiatry’. Dr speaking World; Sep; Dusseldorf, Cornelis Laban described plans for the Germany. International Conference on Cultural Psychiatry to be held in the 6- International Conference on Cultural Netherlands, 13-16 June 2010. Dr John Psychiatry in India; Nov; Goa. de Figueiredo spoke about plans for the International Conference on Cultural Psychiatry in India, to be held in Goa in Nov 2010. And Dr Rachid Bennegadi outlined plans for the 1st International Conference on Cultural Psychiatry in the French-speaking World, to be held in Paris, 16-19 Apr 2011.

The plans for TPS sponsored international conferences on cultural psychiatry over the period 2009-2011 are extensive. The full list of conferences sponsored and co- sponsored by TPS is:

In 2009: 1- WPA International Congress; Florence, Italy; 1-4 Apr.

2- 3rd International Conference on

3 In 2011: ‘mental illness in traditional societies’, 1- 1st International Conference on ‘follow-up studies of migrant and Cultural Psychiatry in the French- refugee populations’, and ‘healing speaking World; 16-19 Apr; Paris practices and worldviews among indigenous people’. 2- 1st International Conference on Cultural Psychiatry in the Spanish- The symposia and workshops with speaking World; Jun; Barcelona themes related to cultural psychiatry were well attended and included some 3- XV World Congress of Psychiatry; lively discussion and audience 18-22 Sep; Buenos Aires. participation. There seems little doubt that cultural psychiatry continues to Once again, cultural psychiatry was attract strong interest among our well represented in the content of the colleagues in psychiatry, psychology scientific program of the XIV World and the social scientists, and is having Congress of Psychiatry in Prague. a strong impact on other specialties in medicine and on other health-related disciplines.

There were many ‘early career’ psychiatrists and other clinicians in the audience of the cultural psychiatry- themed symposia and especially so in several of the cultural psychiatry- themed workshops.

Almost every page of the program includes one, and sometimes several symposia on a cultural psychiatry topic, or one closely related to cultural psychiatry. This includes 4 ‘plenary lectures’, 2 ‘special symposia’, 9 ‘Section-sponsored symposia’, 6 ‘regular symposia’ and 5 ‘workshops’. The ‘Section-sponsored symposia’ included; ‘immigration and acculturative stress in an era of fear of terrorism’, ‘the influence of Jewish culture on psychiatry’, ‘inter-racial and inter-ethnic I hope to meet and to have a chance to marriage’, ‘best practice in transcultural talk with many of you at some of the psychiatry in Europe’, ‘from western TPS sponsored international mainstream to culturally diversified conferences on cultural psychiatry psychiatry’ and ‘teaching culturally during the next three years. I invite you competent psychotherapy’. The ‘special to contribute to their success by being symposia’ included one on ‘quality of part of the scientific program, and life and mental health; beyond presenting your work in cultural differences in culture and religion’. psychiatry. ‘Regular symposia’ included themes of ‘mental health and HIV in vulnerable women across cultures’, ‘culture, Ronald Wintrob MD context and psychiatric diagnosis’, Chair WPA-Transcultural

4 Psychiatry Section deported. SYMPOSIUM ON IMMIGRATION AND ACCULTURATIVE STRESS IN AN These fears and experiences of ERA OF FEAR OF TERRORISM discrimination since 9/11 have undermined the sense of security of This two-part symposium, comprising large numbers of immigrants, and 10 presentations, addresses the increased the incidence of psychiatric changes in public sentiment and distress symptoms among them. government policy concerning the in- flow of migrants to countries in North This presentation reviews data about America and Europe during this these issues and discusses their decade. The complex issues related to implications for immigration policy and immigration are described and for the provision of mental health analyzed by presenters who have been services for immigrants and refugees in actively engaged in these issues in the USA. several countries in North America and Europe. Their presentations address changes in acculturative stress and THE ERA OF TERRORISM: ETHICAL emotional distress among immigrants DILEMMAS AND EDUCATIONAL engendered by post-9/11 fears of NEEDS terrorism. Marianne Kastrup

With the strong focus on terrorism in LEARNING TO BREATHE FREE; recent years there is an increasing IMMIGRATION TO THE USA SINCE concern that fundamental human rights 9/11 may be violated in the interest to Ronald Wintrob combat acts of terrorism. It is in particular in situations of interrogations Legal immigration to the USA has been that persons may be exposed to increasing steadily in each decade various kinds of interrogation since the 1970s. There has been strong techniques that go against international public support for an immigration policy conventions. that welcomes legal immigrants, as well as refugees from war-torn regions of According to Article 10 of the UN the world. That ‘open-door’ policy has Convention of 1984 against torture and been challenged, but not reversed, other cruel, inhumane or degrading since the terrorist attacks of 9/11/2001. treatment or punishment, states having signed the Convention shall ensure that Between 2000 and 2005 the number, of education and information regarding the legal immigrants to the USA has risen prohibition of torture are included in the from 9.8% to 12.4% of the total US training of e.g. medical personnel who population. However, the number of may be involved in the custody, or refugees and asylum seekers has been treatment, of individuals deprived of declining since 2000. their liberty. Unfortunately, few countries enforce this, implying that few The US Congress has deadlocked on psychiatrists receive any such efforts to revise immigration policy education and thus have little since 9/11. Public sentiment has clearly knowledge on the issue of organised favoured secure borders and violence in relation to terrorism. responded to fears of terrorism. Immigrants living legally in the USA Knowledge about the mental health have experienced mounting anxiety consequences of state-perpetrated about discrimination and fear of being violence, including torture, is of clear mistaken for illegal immigrants and clinical relevance for psychiatrists worldwide as a significant proportion of

5 e.g. refugees and migrants have IMMIGRATION AND experiences of war, strife, persecution ACCULTURATION IN THE and torture and a large proportion of the NETHERLANDS, IN THE LIGHT OF world’s population lives in countries that TERRORISM condone torture. Hans Rohlof The paper will outline the psychiatric symptomatology following exposure to The Netherlands is not an official state-perpetrated violence and torture, immigration country: immigration is not preventive considerations as well as encouraged and there is no official ethical dilemmas and educational quota for immigration. Nevertheless, needs for the psychiatric profession. there are two groups that have immigrated to the country during the 1990s: families of former migrant workers from Turkey and Morocco, and A LIGHT AT THE END OF THE refugees from Eastern Europe, Africa TUNNEL; IMMIGRATION TO and Asia. The numbers of immigrating GERMANY BEFORE AND AFTER individuals increased because of 9/11 possibilities of family reunion, because of the wars in Bosnia and other places, Wielant Machleidt and because of growing possibilities to Germany, geographically located in “the travel. heart of Europe”, has been a host After the acts of terrorism in recent country for immigrants for centuries. years, political right wing parties started The German constitution after World a public debate focused on immigration War II guaranteed immigration and as a danger for Western democracies. asylum for everybody, especially for This debate has become increasingly war refugees and those who suffered extreme and has had a direct effect on from political persecution and racism. immigration policy and numbers: policy However, the increasing flow of became stricter, numbers decreased. immigrants from south-eastern Europe After the murder on Theo van Gogh in (Turkey and the Balkans) in the 1970s 2004 we performed a study on the and 1980s generated increasing effects of this highly publicized event on resistance to further immigration and patients in mental health care. The led to discrimination against those public paranoia and mistrust in different foreigners. The attitude of hospitality population groups was clear. A new toward migrants switched to hostility by target of mental health care is to help the 1990s. migrant patients adapt themselves to a As a consequence, the German multicultural society where there is a government revised its constitution and growing animosity between population immigration laws to restrict immigration. groups. Clinical implications of this When the terrorist attacks on the WTC attitude will be discussed. towers took place on 9/11/2001, As a consequence, the annual number German immigration laws were already of immigrants did not increase since the most restricted the country has had 1998, and for the first time since 1950, in its recent history. diminished significantly during the years Germany had not been a major focus of 2004 and 2005. Nevertheless, terrorist activities in recent years. But Germany continues to have one of the because it was a country in which highest percentages of citizens who are terrorist attacks were planned, laws foreign-born (20%) among European were passed allowing for increased countries. surveillance of immigrants, and even of Currently, there is an increasing German citizens.

6 acceptance of immigrants once again This presentation will discuss the and a new policy to help in their problems we experience when working integration has been introduced by the with newly arrived Iraqi refugees that German government. are admitted to our centre for treatment and psychological support. Long-term exposure of stress, fear and THE IMPACT OF THE WAR ON accumulated traumatic situations RECENTLY ARRIVED IRAQI influence the newly arrived refugees’ REFUGEES TO SWEDEN-CLINICAL psychosocial life and make it difficult for OBSERVATIONS them to commence an active life in the new country. Riyadh Al-Baldawi

The war in Iraq, which started 2003, is still ongoing. Initially, the war provided IMPACT OF THE GLOBAL CLIMATE the Iraqi people with the possibility to OF FEAR ON THE MENTAL HEALTH put an end to a dictator regime, which OF NEWCOMERS TO CANADA used terror against its own people. However, the war also brought with it Laurence Kirmayer several disasters. Internal conflicts between different militant groups and This presentation explores the impact alliance troops have caused an of the current climate of fear about environment characterized by terrorism on the mental health of socioeconomic chaos. Bomb immigrants, refugees and visible explosions have become a part of the minorities in Canada. Canada has been daily life of the Iraqi people. Civilians a nation of immigrants from its inception are afraid to go to work or even to send with about 18% of the current their children to the schools due to the population born outside the country. risk of kidnapping. In addition, the Although migration policies have electricity and water supply are always been discriminatory, the post currently very limited in several parts of 9/11 climate of fear has fostered a new the country. We can all observe and level of suspicion with increases in follow these dramatic conditions every racism, discrimination and exclusion. In day through the news. Quebec, a political debate on ‘reasonable accommodation’ focused More than 4 million Iraqi people are on the extent to which the dominant forced to leave their homes and seek society should adapt to the values and protections in other places. More than 2 practices of newcomers. This debate million of them have fled the country to singled out specific religious and neighbour countries such as Jordan, cultural groups (Muslims, Jews and Syria, Iran and Turkey. A small part of visible minorities) and allowed the refugees are provided with the xenophobic and racist elements of possibility to seek asylum in different society to voice their fears and hostility parts of Europe and other countries toward whole segments of society. The around the world. More than 60,000 heightened concern with security has Iraqi refugees have fled to Sweden had negative effects on the health and since 2003. Approximately 45,000 of wellbeing of both children and adults these have been provided with among minority groups and newcomers accommodations while the remaining as documented in surveys and clinical refugees are still waiting. The large work. number of Iraqi refugees entering Sweden has put the country and its In addition to this impact on vulnerable health, social care services and school groups, mistrust of the ‘Other’ damages system in front of a large number of the fabric of civil society with potentially challenges. negative effects for everyone. The dynamics of this mistrust will be

7 illustrated with cases drawn from our ISLAMOPHOBIA AND THE MENTAL cultural consultation service. The HEALTH OF MUSLIM MIGRANTS IN Canadian ideal of multiculturalism THE UK POST 9/11 requires renewed commitment to counteract the stereotyping and Simon Dein exclusion that have resulted from the political manipulation of fear. There has been an escalation of anti- Muslim sentiment in the UK following PSYCHOLOGICAL CONSEQUENCES 9/11 largely fuelled by the public OF THE FEAR OF TERRORIST perception of Islam as fanatical‚ and ATTACKS fundamentalist. "Islamophobia" is a term deployed to refer to forms of Joseba Achotegui prejudice, exclusion and violence toward Muslims that have risen to new The terrorist attacks on the trains in levels over the past 20 years. th Madrid on 11 March 2004, with 194 Islamophobia contributes towards deaths and over 1000 people injured, health disparities among Muslim led to great social turmoil in Spain, but minorities in terms of both physical and public manifestations of that distress mental health. did not occur. There was not one anti- Two processes mediate disparities: immigrant demonstration or act of intersectionality and differential revenge. For the Muslim immigrants, racialisation. "Intersectionality" refers to however, it meant the breaking of a link, cases in which individuals or groups the start of a situation in which they experience prejudice toward multiple have become permanently subject to attributes of their identity. Muslims in suspicion, despite the fact that one third the UK and the US are differentiated by of the victims were immigrants and race, ethnicity, national origin, social many were Muslims. class and immigration status, any of which can result in being the target of Faced with this situation, our immigrant social bias. "Differential racialisation" mental health care department, means that each minority or targeted SAPPIR, has noted a significant group becomes defined in relation to a increase in paranoid-type problems. given majority group, often in terms of I shall present the case of a young being "more" or "less" similar. These immigrant of Kurdish origin who, as a issues are discussed in relation to new result of the terrorist attacks on 11th immigrants in the UK. March 2004, started to have delusions of being followed. Mustafa is 29 years Religious discrimination has significant old, a teacher of Arabic and studies effects on mental health. philosophy. He is married to a Spanish Discrimination at work and "chronic woman and speaks Spanish and daily hassles", including insults and Catalan fluently. Mustafá thinks that the assaults, can increase the risk of greengrocer, the baker the mechanic common mental disorders such as and other shopkeepers are all police anxiety and depression. It can also informers who are spying on him. When influence access to and the use of he travels by car, he is convinced that health services. other vehicles follow him and cause him to make dangerous manoeuvres. He The presentation ends by discussing maintains his normal activity, but says how these cultural issues can be that he is suffering great “moral harm” overcome in health-care related through being followed. settings, particularly focusing upon the importance and limitations of cultural The relationship between his personal competency training. story, migratory stress, symptomatology and health care are analysed.

8 IMMIGRATION IN FRANCE: MYTHS largest number of foreign residents was AND REALITY from Italy (303,455) and other European countries (1,412,987 from all Rachid Bennegadi of Europe). As the leading non- European country of origin, Turkey In Europe, the long-term objective of constituted the fifth most common the European Commission is to nationality of foreign residents (78,711). integrate all the elements of border In addition to immigrants who provide management to be managed by a labour, services, and technical Europe-wide integrated service. As part expertise, foreign residents now also of this strategy, it is intended to develop include asylum seekers from conflicted joint training and reciprocal personnel areas (e.g., 46,773 from Bosnia and exchanges within the Schengen area. Herzegovina). Europol will have an increasingly important role in addressing criminal This changing character of migration activities in the Schengen area, and has renewed questions that were moves to secure common standards in resolving from previous waves from the use of technology and document neighbouring countries. Migration and security can be expected. What could mental health policy has been be the link between this strategy and concerned with utilization of psychiatric reinforced laws concerning services and questions of adjustment to immigration? A review of the media an ambivalent reception that grows coverage of this topic will be presented more hostile in an expedient political and discussed relevant to immigration climate. This paper considers priorities policy in France from 1950 through for mental health policy, services, and 2007. research with reference to current needs and changing perceptions of

migrants over the past several CULTURE, POLITICS, AND SOCIAL decades. CHANGE AFFECTING MIGRANT MENTAL HEALTH IN SWITZERLAND SYMPOSIUM ON INTER-RACIAL Mitchell G. Weiss AND INTER-ETHNIC MARRIAGE

The politics of immigration rage with TOWARD MULTICULTURALISM: renewed vigour throughout the world. In INTER-RACIAL AND INTER-ETHNIC Switzerland, such questions have long MARRIAGE IN THE USA been topical in a setting characterised by resistance to social change and Ronald Wintrob policies that may deny Swiss-born children of immigrants’ full social For people who value cultural acceptance as citizens. In a recent diversity, it is distressing to be made political election, a campaign poster aware that racial prejudice continues to depicting 3 white sheep kicking out a be manifest in everyday life in the USA, black sheep sparked a national despite the impressive progress toward controversy, protest, and confrontation its elimination, and despite the progress that became a focus of international in civil rights legislation over the past 40 attention. The campaign also linked years, since the assassination of Martin criminality to foreigners living in Luther King Jr. Switzerland. It still comes as something of a shock With a total population of 7.57 million in to realize that until the 1960s, most 2005, 1.66 million (21.9%) were southern US states had laws against classified as foreign residents, and the inter-racial marriage. The landmark annual immigration was 99,091. The court decision overturning such laws was in 1967; in Virginia. But it took until

9 2001 for the last southern state, PSYCHIATRIC PROBLEMS IN Alabama, to remove from its DESCENDANTS OF DIFFERENT constitution the ban on inter-racial ETHNIC BACKGROUNDS marriage. Marianne Kastrup The number of inter-racial marriages in the USA has increased from less A nationwide study was carried out than 50,000 in 1967, to more than comprising 50,877 persons, who in 500,00 now; representing more than 2003 were registered in the Danish 8% of all US married couples. The Psychiatric Register or the National numbers would be very much higher for Patient Register with a psychiatric ICD- inter-ethnic marriages. 10diagnosis.

This presentation reviews some of the Of the population 4.0 % descendants statistical data and demographic trends with one Danish born parent and one about inter-racial marriage in the USA migrant parent; 0.7 % descendants with over the past 40 years. Influences on both parents born outside Denmark; de-stigmatization of inter-racial 87.1% were ethnic Danes; 7.8 % marriage are considered and some of migrants, and 0.3% foreign adoptees. the psychological, social, educational and political implications of inter-racial The five groups had significant marriage are discussed. differences in diagnostic distribution and utilization of psychiatric care. INTER-CULTURAL OR INTER- RACIAL RELATIONSHIPS: Among the descendants of mixed BEGINNING TO UNDERSTAND THE background we saw particularly in JOYS AND CHALLENGES FOR young women a significantly higher FAMILIES, SOCIETY AND MENTAL contact rate for nervous disorders, HEALTH CARE personality disorders, and self- mutilating behaviour compared to Kamaldeep Bhui young Danish women.

The multicultural discourse is now The paper will discuss possible prominent and being revisited in most explanations to these findings in terms countries but mainly in terms of of e.g. cultural identity, acculturation preserving national identities in the and gender issues. context of increasing in-migration. Analyses are often couched in terms of acculturation, or migration, or race relations as if racial groups are cogent, INTER-ETHNIC MARRIAGE IN THE natural and distinct entities. Although in NETHERLANDS: FACTS AND the US and UK significant consideration CLINICAL IMPLICATIONS is given to race, less thought is given to Hans Rohlof the emotional and mental health impacts of inter-racial friendships, In the Netherlands, 80 % of all sexual relationships, and marriages on marriages are between individuals of the couple, children, the family or the original Dutch origin; after 10 years 17 outside world. Mixed race partnerships % of these couples have separated. may have unique impacts on mixed Marriages between individuals from race young people who have to Turkish origin have led in 20 %, of negotiate cultural and racial identities. Moroccan origin in 30 %, and of This paper considers demographic and Surinam origin in 40 % of the cases to a health data, and explores the separation after 10 years. psychological origins of powerful prejudices against inter-racial Mixed marriages between Dutch relationships. citizens and an individual of Moroccan

10 and Turkish origin have led to a considerable need among them to help separation in 70 % of the cases after 10 each other. Until then, there was very years. Problems with norms and little information about how many values, religion, family interaction, and intermarried couples were living in the mutual understanding are some of the Vancouver area and how they were most common complaints in mixed coping with their inter-racial marriages. marriages. I was recruited as a consultant for this Although mixed marriages can lead to workshop. It was quite interesting to better communication between see that quite a few Canadian population groups, most marriages do husbands became involved in the not seem to be stable. The minority of workshop, although it was originally stable mixed marriages is characterised planned to help and support Japanese by mutual respect and acceptance of women intermarried with Canadian cultural diversity. men. Accordingly, the workshop gradually changed from being In clinical practice, family therapy Japanese-oriented and mono-cultural to seems to be the answer to the being bilingual and bicultural. problems of mixed marriages. In this therapy much attention should be given Other intermarried couples, such as to the mutual understanding of each Chinese and Philipinos intermarried other’s norms and values. In fact, a new with Canadians joined the group, and family culture should be invented, which the workshop became really an is a combination of the cultures of both international workshop for parents. Examples of this family ‘Intermarriage’ itself. This workshop therapy will be presented. lasted until the end of 2003. This series of the workshops contributed tremendously to supporting intermarried couples both socially and EXPERIENCES AS A CONSULTANT psychologically. IN INTERMARRIAGE WORKSHOPS IN VANCOUVER, CANADA They also played a great role in raising the awareness among unmarried Fumitaka Noda Japanese women in Canada about how As a psychiatrist who is interested in demanding and difficult, but also how cross-cultural mental health, I have satisfying intermarriage can be. seen quite a few cases of inter-racial marriage. I have seen both happy and THE INFLUENCE OF JEWISH unhappy sides of stories in CULTURE ON intermarriage. Intermarriage contains a PSYCHIATRY, PSYCHOANALYSIS lot of cross-cultural issues, i.e. issues of AND CULTURAL background cultures, languages, PSYCHIATRY difference of customs, relationships with in-laws and relatives, food Micol Ascoli preference, way of raising children, etc.

The intermarriage workshop was This symposium will highlight how initiated by a group of Japanese-born Jewish culture has influenced the origin women, living in Vancouver, Canada, in and the development of different 1996. They were all women who were branches of psychiatry, namely partners in inter-racial marriages, psychoanalysis and Cultural psychiatry, mainly with Canadian men who were most of whose pioneers and luminaries white, English speaking and Canadian- are of a Jewish ethnic origin. The born. Jewish culture has always been concerned with minority status; They felt that there was a migration, prejudice and discrimination,

11 just like Cultural psychiatry. 2. Rice, Freud and Moses. Albany: Psychoanalysis, on the other hand, State University of New York, shows striking similarities, in its 1990 theoretical constructs, with the Jewish cultural conceptualization of the human being, as well as, in its practice, with THE MYSTICAL ROOTS OF the traditional Jewish methodology of PSYCHOANALYSIS study of the sacred texts. The invited authors will deal with different aspects Simon Dein and theoretical areas of this seldom considered but important subject. The Psychoanalysis is traditionally seen as above-mentioned areas will also be a secular discipline. However there is illustrated in clinical practice through a evidence that Freud was indirectly 30 years follow up study of migrant influenced by the lurianic kabbalah and soviet Jews in Austria. the zohar. Building upon the work of Bakan, I draw parallels between Freud’s concept of free association and SIGMUND FREUD’S JEWISH LIFE rabbi Abraham Afulafia’s notion of AND THE JEWISH ROOTS “Jumping and skipping”. OF PSYCHOANALYSIS Psychoanalysis is compared with the hermeneutic tradition of the Talmud. Micol Ascoli Both can be seen as depth psychologies. The metaphor of Psychoanalysis is, from the cultural excavation can be usefully applied to point of view, one of the strongest and both. Likewise I compare Melanie most successful theories of the Klein’s concepts of introjection and functioning of the human mind ever projection with the Kabbalistic notion of elaborated in the West. Still nowadays, the Tikkun - the act of liberating the its basic constructs are widely applied divine light or energy and restoring it to in different fields of psychiatry. Over the the services of the infinite God. A last one hundred years, scholars have comparison is made between the been more concerned with the psychoanalytic process and the universal validity and applicability of the encounter between the Rebbe and his psychoanalytic theory and practice, followers in Hasidism. What is the rather than with their cultural relativity. relationship between the transference Only a few studies so far have dealt in psychoanalysis and the unio with the issue of the cultural influences mysticain Judaism? on psychoanalysis, and even fewer References: have highlighted its derivation from the 1. Bakan d. Sigmund Freud and the Jewish culture and religion. In this Jewish Mystical tradition. Princeton, presentation I will try to address how New Jersey: Van Nostrand, 1958 the Jewish culture has influenced the 2. Ostow M. Judaism and life, the personality, the work and the psychoanalysis. London: Karnac, 1997 character of Sigmund Freud, how psychoanalysis spread across Europe following specific ethnic paths, and THE INFLUENCE OF JEWISH which psychoanalytic constructs are, in CULTURE ON CULTURAL my opinion, more closely related to the PSYCHIATRY traditional Jewish cultural conceptualization of life and of the Ronald Wintrob human being’s nature. References: For centuries, Jewish culture has been 1. Meghnagi d, il padre e la legge. concerned in a fundamental way with Venezia: Marsilio, 2002 minority status, with prejudice and discrimination, and with perseverance

12 in the face of adversity. Within the field In this paper, the story of the integration of medicine, psychiatry and of the soviet Jews in Austria is psychoanalysis have had a similar illustrated from the perspective of social history of marginalization; seen as and cultural psychiatry through a 30 different, strange, less than the equal of years follow-up, in order to show the other medical specialties. In this context relationship between migration as of the culture of medicine, cultural manifold pathogenic stress and psychiatry can be seen as a minority protective measures to cope with it, within a minority, and one of its main thus indicating methods for psycho concerns is the greater understanding hygienic patterns in transcultural and acceptance of differences between integration. people of diverse racial, ethnic, social The question as to whether these class and religious backgrounds. means and methods, based on Jewish In this presentation I address these ethics and used in this process, could themes as they have influenced the be a formula for solving contemporary personal lives and the contributions to migration problems is to be discussed. Cultural psychiatry of several luminaries References: of our field: Freud, Erikson, Kardiner, 1. Friedmann a, Hofstaetter M, Knapp i. Coles and Wittkower. I will attempt to eine neue heimat? Jüdische assess the significance of these themes emigrantinnen und emigranten aus der in their theoretical and clinical sowjetunion. Vienna: picus, 1993 contributions. BEST PRACTICE IN Finally, I will reflect on the impact of TRANSCUTURAL PSYCHIATRY IN these themes, and personalities, on my EUROPE own career development, in the hope that others will add to the discussion Rachid Bennegadi with their experiences; thereby deepening our understanding of this Immigration no longer concerns seldom considered, but important singular nations strictly. It has now subject. become a concern at the European level. This symposium proposes a A 30 YEAR FOLLOW-UP: THE comparative approach to current mental PSYCHO-SOCIO-CULTURAL healthcare practices, so as to tease out INTEGRATION OF AN ETHNIC a common strategy, which seeks to SUBGROUP IN AUSTRIA improve therapy for migrants and refugees, by means of looking for Alexander Friedmann commonalities between different European institutions. Confronting our Around 3000 Jews from (former) Soviet respective therapeutic practices and Union migrated to Austria between diagnoses will in effect allow for a new 1970 and 1990. The local Jewish impetus to cultural competence, which community, comprising of 7500 has become necessary for all therapists individuals, was faced with the at the European level. problems of the newcomers. Several important social, cultural and AVOIDING THE STIGMATIZATION OF religious differences, as well as THE PATIENT OR THE differences in rites and customs, THERAPIST: THE CLINICAL seemed to be obstacles in the MEDICAL ANTHROPOLOGY integration of the immigrants into the APPROACH local community, itself over aged and burdened by financial problems. Rachid Bennegadi Nevertheless, the Jewish community found its own calculated means to solve The author presents a clinical case in these problems. which the stigmatisation of the patient is

13 induced by therapeutic references THE MIGRATORY STRESS AND limited to culture-bound explanations, GRIEF ASSESSMENT SCALE and in which the therapist -- whatever his theoretical orientations and his Joseba Achotegui clinical experience -- finds himself caught in a mirror stigmatisation. How The migratory stress and grief to avoid such situation at the same time assessment scale is based in as enabling oneself to accommodate psychoanalytical and cognitive the patient’s needs? This is what this approaches and is characterized by: presentation will discuss. 1-the grouping of migratory stress factors into seven types of grief: family, langue, culture, earth, social status, MOROCCAN WOMEN IN group of belonging, physical risks PSYCHOTHERAPY 2-The classification of these types of grief into simple, complicated and Hans Rohlof extreme depending of their difficulty 3-The assessment of subject migratory Moroccan individuals are one of the vulnerability the intensity of stress three largest non-Western population migratory factors groups in the Netherlands: their total The scale integrates the analysis of the number is 332,000, of which 172,000 elements 1, 2 and 3. Symptoms would are males, and 160,000 females. In the be an element associated to these latest years they have a growing situations that may be correlated with demand for psychiatric treatment: the the scale taboo of this kind of treatment seems to be finished. Moroccan women in the Western INTEGRATION AND society are tiered apart by very different ACCULTURATION IN THE CONTEXT cultures. On one side, there is the OF MIGRATION RELATED STRESS Western culture with all its opportunities. On the other side, there Riyadh al Baldawi is the traditional culture, where women play an important role in the family. Integration and acculturation are two In psychotherapy with Moroccan processes that individuals who migrate women the therapist should be aware to a new country have to go throw. of all the dilemmas Moroccan women These processes create stress and encounter. He or she should be other challenges for the individuals to culturally competent, but also have overcome in order to stabilise a understanding for individual choices functional life in the host country. patients make. Next to this, the Success in these processes depend on therapist should be aware of his own several factors interacting with each norms and values. other including the individual’s Case material with Moroccan women resources, flexibility and willingness to will illustrate these findings. change and the individual’s social Objective: to know more about the network in the new society as well as different choices in live migrants have the receiving country’s level of to make. To improve his or her own encountering and socioeconomic therapeutic skills with non-Western preparedness. women. The interplay between all of these factors has to be taken into consideration in order to avoid the failure of integration with following social problems. This presentation is based on extensive clinical experiences on working with immigrants from

14 different parts of the world migrating to On the one hand, all this makes Sweden. immigrants special patients who need culturally sensitive assessment and The relation between migration related psychiatric, psychotherapeutic and stress (MRS) and the way the psychosomatic care programs that take immigrant deals with it is described in a account of their cultural uniqueness. On theoretical way. the other hand, these patients make Most immigrants succeed in their use of available assessment and integration process by adopting a treatment services almost 50 % less functional scheme to over win the than the majority population does. stress and social challenges they encountered on their way while others Compared to the rest of the population, failed by using a dysfunctional scheme. their problems are diagnosed later and they receive insufficient and thus less successful treatment. INAUGURATION AND DEVELOPMENT OF DTPPP; The aim of the German-speaking ASSOCIATION OF Association of Transcultural Psychiatry, TRANSCULTURAL PSYCHIATRY, Psychotherapy and Psychosomatic PSYCHOTHERAPY AND Medicine (DTPPP) is to increase PSYCHOSOMATIC MEDICINE IN access to social and health care THE GERMAN-SPEAKING WORLD services for the immigrant population (DACHVERBAND DER and their families. DTPPP was founded TRANSKULTURELLEN Psychiatrie, in Hamm, Germany, in August 2008, Psychotherapie und Psychosomatik im with 16 founding members. They deutschsprachigen Raum e.V.) represented all clinical and academic disciplines related to mental health, consistent with DTPPP’s commitment Many patients in psychiatric, to being a multi-professional psychotherapeutic and psychosomatic organisation. health care facilities in the German- speaking countries are immigrants or Planning for the launching of DTPPP the children of people who have went on during the preceding year, in migrated to and settled in the German- tandem with planning and organization speaking countries over the past 3-4 of the 1st International Conference of decades. Transcultural Psychiatry, Psychotherapy and Psychosomatic They have, in the majority of cases, Medicine in the German-speaking specific problems which are related World. That conference was held in indirectly and directly to migration and Witten, Germany, Sep 5-8, 2007. The the stressors of acculturation: conference was a great success, psychiatric disorders affected by attracting 250 participants. The traumatic experiences, adapting to a scientific program included some 32 new political and social environment, symposia, in addition to plenary coping with the complexities of presentations, workshops and poster integration in the host countries way of presentations. life, finding adequate housing and schooling for the children, accessing This year, DTPPP was the main social and medical services, becoming organiser of the 2nd International financially secure and independent of Conference of Transcultural Psychiatry, government support. And coping with Psychotherapy and Psychosomatic both subtle and overt discrimination Medicine in the German-speaking during the acculturation process. World. That conference was held in Vienna, Sep 25-28. There were 440 participants at the 2008 conference. The scientific program included 40

15 symposia, in addition to plenary The aims of DTPPP were elaborated at presentations, workshops, poster the 2008 meeting, to include: presentations and plenary presentations. DTPPP plans to hold * Development and definition of these International Conferences recommendations and standards for annually, and plans to rotate their medical diagnosis and forms of therapy. venues between Austria, Germany and Switzerland. * Advancement of transculturally relevant research results and therapy In 2009, the conference will be held in concepts in the health care system. Zurich, Switzerland from September 11 to 13, on the theme; “Cultural * Encouragement of cooperation with Interdependence in Medicine”. In international societies in the field of October 2010, the conference will be transcultural clinical work and held in Dusseldorf, Germany. organisation of workshops, symposia and conferences. By the time the 2nd International Conference of Transcultural Psychiatry, * Planning and organisation of Psychotherapy and Psychosomatic education and advanced training of physicians, psychologists and other Medicine in the German-speaking World was held, DTPPP’s membership professional groups in the field of had expanded to 80 members. transcultural psychiatry, psychotherapy and psychosomatic medicine. They include psychiatrists, neurologists, internists, psychotherapists, * Expansion of transcultural psychologists, nurses, social workers, competence in workshops and events occupational therapists and open to public participation. anthropologists, as well as * Networking of individual institutions on administrative personnel of medical and the Internet site: social service centres who are working in this field. www. transkulturellepsychiatrie.de

The inaugural Business Meeting of WPA-TPS has been a strong supporter DTPPP was convened during the 2008 of the development of DTPPP and its conference in Vienna. An election was annual international conferences on held for the founding Executive and transcultural psychiatry, psychotherapy Board of Directors. Solmaz Golsabahi and psychosomatic medicine in the (Germany) was elected as Chair, German-speaking world, and has been Bernhard Kuechenhoff (Switzerland) as a co-sponsor of the conferences in Co-chair and Karl H. Beine, (Germany) Germany in 2007 and in Austria in as Treasurer. Rebecca Ehret 2008. WPA-TPS intends to continue to (Germany), Max. H. Friedrich (Austria), coordinate closely with the executive Hans Wolfgang Gierlichs (Germany), committee and board of directors of Ljiliana Joksimovic (Germany), Eva van DTPPP in the years ahead. Keuk (Germany) and Barbara Zeman (Austria) were elected to the Board of WPA-TPS members are invited to take Directors. an active interest in DTPPP, and to participate in its future conferences and related activities on behalf of TP in the German-speaking world.

16 BIO-SKETCH In my family, it was always “kind of cool” to be different. For example, Micol Ascoli within a vast Catholic majority in my primary school class, I enjoyed being the only one who was not baptized, and the only one who wouldn’t attend religion classes.

It was perhaps due to all this that I soon became interested in the general topics of identity, diversity, culture and religion.

I was brought up during the 1970s in Italy, a strongly Catholic country with a massive influence from the Vatican, ruled by the Christian Democratic Party for nearly 30 years then, yet in a period of transition from tradition to modernity, in a climate of cultural change, rebellion For the past four years I have been against authority, political terrorism of working as a psychiatrist at a both extreme right and left wings, social community mental health centre in the protest and student protest for the civil UK in an ethnically and culturally rights that we didn’t have yet (abortion, diverse area of East London. divorce, and of course psychiatric reform). My family was interested and I was born in Rome, Italy, in 1970. My involved in politics. Both my parents upbringing consisted of mixed cultural were members of the Radical party. My influences, the most prominent of which mother, a teacher, was involved in the was that of my paternal grandmother, a feminist movement of those years. Polish Ashkenazi Jew who migrated to Italy in the 1920s, to study medicine in Before I was born, my parents had lived Bologna. My ethnic origin is mixed. My in the USA for nearly two years, mother’s family is originally from the establishing longstanding friendships region of Venice, while my father is with people from all over the world, who Jewish and his family is of a mixed would often come to visit Rome and Ashkenazi and Sephardic origin. stay in our house. I met those foreigners throughout my childhood and My family has a three-generation I guess that is how I started to become history of migration. On my father’s curious about the world. side, the family history includes discrimination under the Italian Fascist I studied medicine at “La Sapienza” Racial Laws of 1938, followed by University of Rome, and I soon became persecution by the Nazi invaders. As a interested in psychiatry and result, the most important thing that my psychoanalysis. Although my initial plan parents taught me since I was a child is was to become an orthodox Freudian that it is actually the greatest honour to psychoanalyst, two fundamental be excluded by a law, or marginalized encounters in my life led me in a by a social context which does not different direction. consider all human beings to be entitled to equal rights and dignity, or which I graduated in medicine in 1997. My excludes those who hold beliefs and graduation thesis was on mannerisms traditions that differ from the majority. in schizophrenia and in art. My principal thesis advisor, Professor Nicola Lalli, encouraged me to pursue that thesis topic and throughout the years he

17 helped me develop a solid body of That year, my parents bought me an knowledge in clinical psychiatry and apartment in Rome. This meant that, psychodynamic psychotherapy. When, within a hilariously typical mixed Italian- in 1997, I asked him to refer me to Jewish way of disengagement from the somebody for personal psychotherapy, family, I moved out of my family home Lalli referred me to Goffredo Bartocci. at age 31, moving literally to the other side of the street. After four years of psychotherapy with Goffredo, we began to work together in It didn’t last log, though, as in 2004 I 2001, and it was then that I discovered accepted a job in London. I knew I cultural psychiatry. I’m not sure to what would work within an ethnically and extent the situation in Italy has culturally diverse workforce, with an improved now, but Goffredo in those equally diverse patient population, in a times was one of the very few Italian foreign country, and I would become an psychiatrists interested in culture and immigrant myself. I just couldn’t resist mental health. He was then the Chair of the challenge, and perhaps I really the WPA TP Section and he introduced wanted to go abroad and have an me to the discipline. experience of the world living on my own. Cultural psychiatry seemed to fit naturally with my personal and family Living in London and working with history of diversity, minority and minorities has been the greatest migration. I quickly became interested professional experience of my life so in it and I have never left it since then. far. I became an immigrant working with immigrants. The high profile job I got in I have participated in the annual WPA- the psychiatric facility where I work TPS conferences since 2001 and more made me aware of what it really means recently in the WACP congresses. I for a woman to have to compete with have given several presentations on the men for roles, responsibilities and therapeutic cult of Charismatic resources, and how subtle and Catholics, and I have chaired symposia unconscious sexism can be. on the influence of Jewish culture on psychoanalysis, psychiatry and Living and working in London has transcultural psychiatry. I have also forced me to open my mind beyond my given presentations on PTSD and guilt limitations, to work on my internalized feelings in Holocaust survivors, and on racism; and it taught me that race and mental health legislation across culture are nested at the deepest levels Europe. I have recently given of our personal identity, in ways I would presentations on ‘Migrant Psychiatrists have never been able to appreciate had and Migrant Patients’. I stayed in my own country, living and working as a member of the cultural I have made many friends within WPA- majority. It also taught me how deeply TPS and they have helped me to open nested racism is in European social my mind to the beauty of diversity. sciences… and in cultural psychiatry too. I completed my specialty training in psychiatry in 2002, with a thesis on the In London I met my partner, who is a guilt feelings of Italian Holocaust Ndebele man from Zimbabwe. He got survivors. The day I was to defend my me interested in his culture and I’m thesis, Alberto Sed, one of the survivors currently learning the language. In from Auschwitz whom I had return, by now, he knows everything interviewed, accompanied me to about Italian cooking. support me. Holocaust survivors helped me to understand what it means to be In London I also reunited with my sister, de-humanized. who is married to a Chinese Englishman.

18 The journey continues, and I feel I still language as a major vehicle of have got a long way to go. communication and the residuals of the Indian colonial experiences under British rule. It was painfully obvious to me that my most important challenge BIO-SKETCH was to master the English language and re-learn medicine in this language. John de Figueiredo Both the excitement of broader horizons and the pain of a lonesome uniqueness dictated many of my lifetime decisions. Probably the most important decision was my emigration to the United States to become an academic psychiatrist, an eye-opening, and, in many ways, a liberating experience that resurrected my search for identity in a rapidly changing multicultural environment.

I was fortunate to be admitted to Johns Hopkins University, for graduate study under Dr. Paul Lemkau, leading to the degree of Doctor of Science in Mental Health. At the Johns Hopkins School of Public Health I met colleagues from all I was born and raised in Goa, a former over the world, made many friends who Portuguese territory on the west coast later pursued public health careers in of India. The Portuguese conquered their native countries I gained insight Goa in 1510 and were forced out of into the struggles of underserved Goa by the Government of India, in an populations, and a better understanding act of war in 1961. Like virtually half of of innovative programs to meet their the Goan population at that time, I grew needs. up speaking two languages, Portuguese and the native Konkani, After graduation I was once again and as a Roman Catholic whose fortunate to obtain a National Research ancestors had converted to Christianity Service Award from the National from Hinduism four centuries ago. Institute of Mental Health, for Hindus and Christians, speaking, to postdoctoral study in geriatrics and varying degrees, two languages, psychiatric epidemiology at Columbia Portuguese and Konkani, had made University, with Drs Barry Gurland and Goa the site of their cultural marriage. Bruce Dohrenwend. After this exciting At home, in school, and in the year in New York City I returned to community I grew up in. and lived in, a Johns Hopkins to complete a bicultural and bilingual world, and my residency-training program in perceptions became multi-focal from a psychiatry, where I learned clinical very young age. psychiatry from Dr Paul McHugh and his disciples and from Dr Jerome Frank. After graduating from the Liceu Interestingly, images from my Indo- Nacional, I studied medicine at the Goa Portuguese cultural upbringing followed Medical School, the oldest school of me throughout my career. In New York western medicine in Asia and the alma City, I was astonished to discover two mater of both my physician father and pieces of furniture built in the Goan grandfather. The end of Portuguese Indo-Portuguese style of the 16th and rule and the beginning of Indian 17th centuries in the Hispanic Museum administration introduced the English

19 in Washington Heights. At Johns Dohrenwend, proposed that the Hopkins, also, my residency director, Dr common dimension measured by Phillip Slavney, surprised me by psychiatric screening scales was speaking to me in Portuguese, and one demoralization, or something akin to it. of my best friends during my residency Dr Paul McHugh’s lectures, his was Bruno Lima, a fellow resident from humanistic approach and his Brazil, who, like me, spoke Portuguese. stimulating intellect further enhanced After another year as a Senior Staff my curiosity about the life stories of my Fellow at the National Institute on patients, about the pathoplastic aspects Aging, I moved to Connecticut and of their personalities, and about my own have been here since 1981, as a faculty life story, starting as a bicultural child member at Yale, where I teach and growing up to become a consultation-liaison psychiatry to multicultural adult. residents and medical students. It was in Connecticut that another landmark Many well-intentioned friends had event in my career took place. I met Dr discouraged me from studying Ronald Wintrob, who at the time was demoralization, a concept that had no Professor of Psychiatry at the place in the DSM and, from their University of Connecticut and who gave perspective, would probably never gain me a new impetus to pursue my widespread acceptance in psychiatry, passion for cultural psychiatry. let alone research grant funding. However, the impulse given to my Heraclitus believed that the character of curiosity by my teachers was too strong a person defines his or her life, an idea to be resisted and I decided to overlook further developed by Sigmund Freud my friends’ scepticism. I was fortunate centuries later. Having grown up in to have several of my articles on this Goa, my clinical and academic concept accepted for publication in endeavours were fated to be a logical peer-reviewed journals, and today extension of my bicultural upbringing. demoralization is widely recognized as an important construct for the My professional life has been devoted understanding of the boundary between to the study of demoralization and to the homeostatic and the pathological topics related to cultural psychiatry, responses to stress. geriatrics, and consultation-liaison psychiatry. I also have a strong interest The study of demoralization is the in the history of medicine, particularly in unifying theme that brings together my the study of the interaction of Western explorations in cultural psychiatry, and Indian (Ayurvedic) medicine in Goa geriatrics, consultation-liaison in the 16th and 17th centuries. psychiatry, and the history of medicine. Time and again, research has shown How I ended up studying that disintegration of cultural patterns is demoralization is a story by itself. I first associated with an increase in the learned about demoralization when my prevalence of demoralization. Social esteemed teacher, Dr Jerome Frank, isolation and/or breakdown of social honored me by giving me two of the supports cause demoralization to be best presents I ever received; his more likely to occur as people age. books, Persuasion and Healing and Demoralization has been widely studied Sanity and Survival. He had been in patients suffering from a variety of arguing that the complaints that medical and surgical problems, and has induced many patients to seek been shown to be closely linked to the psychotherapy were expressions of prognosis of several illnesses. demoralization, irrespective of their psychiatric diagnosis. Luckily, I In the 16th and 17th centuries, when stumbled on the topic of demoralization Europeans suffered from tropical again when another teacher, Dr Bruce diseases in Goa, they went to

20 Ayurvedic physicians whom they universities seem more associated with trusted more than their European the original concept of a guild, which is counterparts, and who skilfully often in association with businesses. alleviated their suffering, to some The idea of intellectual ferment and extent, by restoring their morale. The development seems to have been essence of being human, as Ernest bypassed by the rapid dissemination of Cassirer noted, is the ability to knowledge through the Internet. The symbolize. Cultural formulations enable sharing and debate about information us to reconstruct the universe of and knowledge seems especially meanings that surround the patient’s missing in medical schools where symptoms and behaviours, the discussions of budget take precedence “meaningful connections”, to borrow an over discussions of academic issues expression from Karl Jaspers, between and even patient care. I’m mourning the patient’s past, present and future, this change and continue to read, and between the person and the hoping to find an academic association environment. in which interests and ideas can be shared, much like the disciplines of old Throughout my life I was fortunate to and even the letter correspondence of have teachers, mentors and colleagues scholars. For this purpose, I write who have been a constant source of reviews of my books, hoping to rekindle inspiration and encouragement. They some academic interest among gave me the gift of knowledge, the colleagues. Even if it doesn’t, I must courage to pursue the truth, and the acknowledge that I enjoy the intellectual fortitude to persist in my research. stimulation and endless curiosity that I These are blessings I will never be able gain from reading good books. Below to return, but I have tried my best to are brief summaries of some that I read pass on to my own students and this summer. (Reference of history of residents, as our never-ending fight knowledge from: McNeely, I.F. & against disease and suffering Wolverton, L. Reinventing Knowledge: continues. Above all, I am grateful to From Alexandria to the Internet. AW my patients who have been my best Norton and Co., 2008). teachers by demonstrating their heroic resilience in overcoming the stigma of Oliver Sacks mental illness and barriers to their self- Musicophilia: Tales of Music and the fulfilment. Brain. Alfred A. Knopf, 2007. Oliver Sacks, renowned author and

neurologist, in this book turns his READING NOTES clinical observations to music. It is a well-written and easy to read book that J. David Kinzie, MD discusses, often from a neurological point-of-view, how changes in the brain The term universitas in ancient Roman can result in music obsessions or even law referred to a sworn society of musical skills. We learn about why individuals, and later referred to an certain tunes keep going through our association of merchants. It did not brain and how music can provide reach the status of a university where animation and emotions to people with there is all-encompassing knowledge, Parkinson’s Disease. There are stories and a physical place, until the middle- of people with amnesia who still can ages. Eventually, the university was recite music and indeed conduct music. replaced by a new form of knowledge Sacks describes a new syndrome to called a Republic of Letters - that is, me, called William’s Syndrome, a correspondence between scholars - congenital disorder with a mixture of which later was replaced by the intellectual deficit. People with William’s Disciplines, some working in the Syndrome,, even as children, are university and some without. Now, extraordinarily responsive to music.

21 There was an interesting section on articulate, straight-forward and a man of music therapy for dementia. Music seriousness and depth. It would truly clearly stirs a great deal of emotion in be a change in America to have a all of us and perhaps is fundamental to multi-racial and intellectually astute our human-ness. president.

Oliver Sacks David Levering Lewis Oaxaca Journal. National Geographical God’s Crucible: Islam and the Founding Society, 2002. of Europe, 570-1215. W. Norton, 2008. Here, Oliver Sacks turns his keen eye This is a very difficult book to read, to Oaxaca, a province in Mexico. From partly because of its length. In its 400 an early age Sacks developed a strong pages there are complicated names interest in ferns, eventually joining a involved in both Islamic and European fern society and then joining them on a encounters. It also, as a professional botanical tour in Oaxaca. This book is historian might write, requires some one of a series of books on various previous historical knowledge, and the geographical locations, such as Nepal, style is a little too pedantic to read in a Kauai, Sicily, Vermont, Nova Scotia, straight-forward manner. His thesis, and now Oaxaca. This basically is an however, is interesting – that Muslim unedited journal but full of interest, Spain developed a rich, multi-cultural even for people not particularly society which was quite advanced impassioned by ferns. He has good compared to the chaos and vulgarity of observations on other flora and the the rest of Europe in that era. Lewis people of Oaxaca. It is indeed a mixed- describes the rising tide of group which make the trip there and Charlemagne and the eventual defeat they can be quite enthralled with ferns. of the Muslims. He would suggest that Oaxaca is next to Chiapas, which had Europe remained as tolerant as resulted in one perhaps dangerous some places in Spain, like Cordoba, it encounter where men with machine might have avoided the Dark Ages. guns stopped the bus and gave them a Nevertheless, fighting Islamic pretty thorough examination before they fundamentalism and Christian militancy were allowed to continue. Many brought the demise of that remarkable people, let alone physicians, wouldn’t civilization. Unfortunately, it was not be able to make interest out of ferns, replaced for many centuries by but Oliver Sacks certainly did. something as enlightened as what it destroyed. Barack Obama The Audacity of Hope. Three Rivers Jonathan Miles Press, 2006 The Wreck of Medusa. Monthly Press, Barack Obama, who previously wrote 2007. Dreams of my Father, is not only a US The French ship Medusa, bound for Senator but is the Democratic Africa, ran aground on a famously candidate for President. Much of this treacherous reef. Some few clung to book deals with his growing-up lifeboats. 147 men and 1 woman were background and how he arrived at herded into a makeshift raft which was many of the policies for which his set adrift. Their horrific experiences, speeches are noted. He deals with probably including cannibalism, are some very difficult issues, such as his captured by the artist Gericault in the faith, race and the world beyond the famous painting, The Wreck of the borders of the USA (the rest of the Medusa. The book describes the world). The most touching, and perhaps chaotic life of the artist and one of the most inspirational content, is when he survivors, Correard. Gericault said, “I’m deals with his own family, especially his trying to get justice for the surviving sensitivity to his wife and two young crew members and punishment for daughters. Throughout his book he is those who left them.” This also is the

22 story of the French in the 1800s with This is a book of some 300 pages, now the multiple political and intellectual in paperback. Surprisingly, it is easy to intrigues during this time. It is a very read and quite engaging. Looking for good read. where language started takes a long tour, starting with the fossil record, the Glenn Greenwald contributions of Steven Pinker and Paul Great American Hypocrites: Toppling Bloom and a great deal of information the Big Myths of Republican Politics. on animal communication as well as the Crown Publishers, 2008. probable development of speech in the Glenn Greenwald has been a hominid species. Vocalization seems to constitutional law attorney and be a unique human act, probably previously wrote the best-seller A because of brain development as well Tragic Legacy: How a Good vs. Evil as the physiology of the larynx. In some Mentality Destroyed the Bush ways, the evolutionary approach is Presidency. Great American Hypocrites opposed to the influence of Chomsky in takes its model from John Wayne, the linguistics. Clearly, language evolution prototypical “tough guy” who plays the is an evolving field and the author ultimate hero in multiple war and spends much time discussing the western movies, i.e. the “man’s man.” differences among the various In fact, Wayne did not enlist in the researchers. It is complicated and itself military during WWII and got a 2A evolving. The epilogue included some classification – deferred in the support feedback from noted researchers on of national interest. He pretended to be the issues of language and considers a tough-guy but did everything in his the case of if babies had all the food, power to avoid a real fight. Wayne’s water and shelter they needed to personal life was one of personally survive without any adults around, reprehensible and hypocritical behavior. would they develop a language, and As such, he is the prototypical how many individuals would it need for American hypocrite. He set the stage such a language to take off. An for other hypocrites in the Bush interesting question. administration who act as tough guys, real men and swaggering warriors. Martin W. Sandler Those Republicans who favor starting Resolute: The Epic Search for the wars and sending others to fight are Northwest Passage and John Franklin, seen as strong and tough, and those and the Discovery of the Queen’s who oppose sending citizens to war are Ghost Ship. Sterling Press, 2006 portrayed as weak and cowardly. Other The quest for the Northwest Passage ( hypocritical behavior is the personal from the Atlantic to the Pacific Ocean lives of shattered marriages, divorce, through Arctic waters ) has been a long, and promiscuous behavior, despite the very disappointing and dangerous Republicans’ talk of values. Greenwald series of expeditions. As global examines the myth of small government warming changes indicate, perhaps and takes a very hard look at John they were just a couple of hundred McCain and his personal virtues; years too soon. One of the most indicating that they are different than famous ships was that of Franklin’s lost those he espouses as an independent- expedition in 1845. Among the many minded, moderate maverick and expeditions to find what happened to candidate for president. This severe Franklin was the ship The Resolute. indictment of the Republican Party and The Resolute was found deserted, but its leadership would be slanderous if it sailable, by a New England whaling didn’t ring true. boat captained by Buddington in 1855. By heroic efforts, he and a small crew Christine Kenneally were able to bring it and the whaling The First Word: The Search for the boat back to New England. It was Origins of Language. Penguin, 2007. eventually restored and sent to England

23 to improve Anglo-American Ehrman himself offers no answer (a relationships. unique approach) and ends by finding solace in Ecclesiastes “vanity, vanity, Elaine Pagels & Karen L. King all is vanity.” Reading Judas: The Gospel of Judas and the Shaping of Christianity. Newly translated and introduced by In about 180 A.D., Bishop Irenaeus of Jacob Needleman and John Piazza Lyon declared that there were four The Essential Marcus Aurelius. gospels, all the rest were heretical. It Penguin Group, 2008. has been known for many years that Marcus Aurelius, born A.D. 121, is one many of the suppressed, early writings of the most remarkable Roman and texts have existed,. Perhaps best emperors. He was thoughtful and known is the Gospel of Thomas and the introspective and his meditations Testimony of Truth. The Gospel of reflected this sensitivity. This book is a Judas was translated recently and translation of his thoughts. The created quite a stir. It implied that Judas interesting thing is that these were was the only one who really knew written for no one but himself and really Jesus and his turning him over to the for the quest to find what’s going on in authorities was an act of obedience, his own mind. He communicates his rather than disloyalty. Pagels and struggle to detach himself from King’s book has both the commentary emotional judgments and thought and an English translation of the associations. He is somewhat related Gospel of Judas. The translation is to stoic philosophers but, in reading it, difficult to read since parts are missing one finds many similarities to Buddhist and some refers to rather arcane teachings of detachment and information, perhaps only available to forgiveness. The quotations here are the people of the first and second from several books and, while often not centuries. The commentary though is profound, are sensitive and thoughtful. more important – it describes the early This is especially striking, considering church, if it can be called that, as very that he was doing a lot of other things, tumultuous, with many different like ruling an empire, at the time. A few interpretations of Jesus and the early of my favorite quotations… “Remember movement. The Gospel of Judas is that each person lives in this very different than the others in being angry moment and the rest either has already in tone and showing Jesus mocking his happened or is entirely uncertain.” followers. The authors suggest that the “They are all short-lived, both those anger is directed at the call for sacrifice who remember and the remembered.” and the willingness of many martyrs to “The truly fortunate person has created die. The information is new but his own good fortune through good unsettling in tone. habits of the soul, good intention and good action.” “The noblest way of Bart D. Ehrman taking revenge on others is by refusing God’s Problem: How the Bible Fails to to become like them.” “Stop Answer Our Most Important Question-- philosophizing about what a good man Why We Suffer. Harper Collins is and be one.” “…no life is more Publishers, 2008. appropriate for the practice of Ehrman, who is a Professor of philosophy than the life we now happen Religious Studies in North Carolina, is a to be living.” well-known and respected biblical scholar. In God’s Problem he takes on the issue of suffering and comes to an unusual conclusion. Basically he states that the biblical teachings have no answer for the problem of human suffering.

24 2nd World Congress of Cultural a number of cultural psychiatry Psychiatry conferences in Umbria over the past September 26-29, 2009 fifteen years, and I have been fortunate Orvieto, Italy enough to work with him in the planning and organization of three of them, Cultural Brain & Living Societies including the wonderful conference jointly sponsored with the Society for In Sep 2006, the 1st World Congress of the Study of Psychiatry and Culture. Cultural Psychiatry was held in Beijing, That conference, held in 1993 in the China. More than 300 registrants medieval Umbrian town of Narni, participated in the very full scientific and included a breathtaking performance in social program of that memorable and Narni’s town square by the town’s flag- historic Congress. Participants came throwing company on the opening from all over the world to recognize, night, and a medieval banquet in the celebrate and contribute to what just-restored Narni Castle on the seemed like ‘the coming of age’ of closing night. I have been an admirer of cultural psychiatry as an academic and the ambience of the medieval hill towns clinical discipline in harmony with of Umbria ever since…and have been medicine and psychiatry, the social and lucky enough to have become a close behavioural sciences, epidemiology friend of Goffredo Bartocci. We have and public health, philosophy and often discussed culture and psychiatry history; and most importantly, a field together since 1993, and the ways of concerned with health beliefs and the world…and have shared many fine healing practices of all people, not just meals, bottles of wine and glasses of minorities and immigrants. grappa.

The World Association of Cultural I mention these personal associations Psychiatry (WACP) was launched in between Goffredo and me in order to 2005 to encourage the growth of give you a flavour of the warm cultural psychiatry around the world, reception you will experience in Umbria, and in all of its clinical, research and and to give you some sense of the educational dimensions. WACP beauty and history that seems to glow determined to convene a world in the air of Umbrian hill towns. I can congress of cultural psychiatry every assure you that Orvieto is just such a three years, in different regions of the place, and the Congress venue will be world, as a means of stimulating one of the age and sun-mellowed discussion of all aspects of the field historic stone palaces of Orvieto, a among clinicians, educators and short walk from the imposing cathedral researchers from around the world; that square with the glowing mosaic is, with the very people who are covering the façade of the cathedral. expanding the knowledge base and practical application of cultural I think the chances are high that psychiatry in their home countries and participants in the Orvieto Congress will internationally. long preserve fond memories of Orvieto, as well as the satisfactions of The Congress venue in Orvieto, Italy, the informal discussions with our symbolizes the continuity and the colleagues from around the world, and transition to the presidency of WACP of of the scientific and social components Dr Goffredo Bartocci, who is one of the of the Congress program. founding officers of WACP. Dr Bartocci’s family has lived in Umbria, I look forward to helping welcome you where Orvieto is located, for many to Orvieto and to the Congress in Sep generations, and he has a very deep 2009. attachment to the region and its people. Ronald Wintrob MD He and his colleagues have organized Secretary, WACP

25 • for Sweden; Henrik Wahlberg, who is also the coordinator of CPPN ([email protected]) • for Finland; Antti Pakaslahti

The CPPN is linked to the main transcultural institutions in the Nordic

countries: Nordic Network for Cultural Psychology and Psychiatry • The Transcultural Center in Copenhagen • The Transcultural Center in The CPPN is the only Inter-Nordic Stockholm cooperation in the field of cultural • The Norwegian Center for psychology and psychiatry. The Minority Research association promotes cultural • The Norwegian Psychiatric psychology and psychiatry in the Nordic Association, Section for countries by obtaining and sharing Transcultural Psychiatry knowledge and clinical experience • The Finnish Psychiatric among its members. The CPPN is an Association, Section for interface for communication between Transcultural Psychiatry the Nordic countries and the world. In addition to cultural psychology and Through its members the network is psychiatry, the CPPN also covers connected to the universities in Oslo & issues related to refugees and asylum Tromsø (the first university to offer an seekers and relevant aspects of trauma extended training course and a degree and human rights. in transcultural psychiatry) in Norway, The members are working in – or have Stockholm, Uppsala, Umeå, Malmö and experience of - different fields, such as Gothenburg in Sweden, and Tampere adult psychiatry, child and adolescent in Finland. psychiatry, asylum programs, refugee The Nordic countries have been quite centers, primary health care, social homogenous, without multicultural welfare, social policy, university traditions and diversity - except for the teaching and research, and Saami - Scandinavia’s only indigenous international development programs. people of the North. The immigration The association is organized as a that started after WWII requires new communication network, for e.g. email approaches, attitudes, knowledge and list communication. The language of methods throughout the society: health communication is English. The CPPN care and social welfare included. arranges meetings/conferences once or Transcultural knowledge is important twice a year in the Nordic countries, for a successful development, and and promotes participation and professional experience from other supports transcultural topics in other countries should be utilized. professional congresses. “No mental health without cultural The association covers Denmark, bonding!” Norway, Sweden and Finland - but not yet Iceland – and has a coordinator and national coordinators for each country:

• for Denmark; Marianne Kastrup • for Norway; Edvard Hauff

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