Saturday, May 20, 2017

CONCEPTS IN TRANSCULTURAL PSYCHIATRY

I. Transcultural psychiatry is a concept that should yield dividends​ to the extent that it implies a real two-way transaction if not integration. In practice, for a variety of historical reasons, this transaction might degenerate into a one-way induction of conceptual frameworks, axioms and implications that have acquired prestige in the economically well developed countries. This pitfall is all the greater when all the participants have had their basic training in these countries and when their very fitness to practice the profession and expound it had to be so certified in terms of the text books, teachers and concepts of these countries. This is not to preach chauvinism but to pinpoint a fact of essential importance to trans cultural transactions in mental health. It requires conscious, sincere efforts to overcome this. Otherwise we will be manufacturing mental health concepts about whole masses of peoples by distortion at more than one level - at the level of language itself whereby all real transactions with these peoples is first translated into a different language and then this material is further tortured into concepts and terms that are presently acceptable semantic currency in the West.


No wonder, then, when quite a number of psychiatrists​, not only psychiatrists​, but other technologists, too, in the economically backward countries face frustration when their jargon fails them in day-to-day contact, and when their value systems, lightly worn as one wears a suit, rarely apply to themselves or to the persons they contact. Dr Bulatao’s concept of split-level personality in the Filipino has some reference to this state of affairs.


II. There is an implied belief that the many ills of the economically backward countries are due to some sort of cultural deficit and that we have the authority or the power to change this. It is sometimes taken for granted that that technologic progress  induces large scale changes in the cultural and personality characteristics. This is very doubtful. It is only necessary to visualise the large scale technologic progress and yet note the very material differences in basic cultural and personality traits that have persisted. Culture subdues and masters a technology; technology merely touches the superficial aspects of behaviour. It is true that many Indians today sit at table and have their dinner instead of squatting on the floor. It is also true that many of them ride in a car instead of in a bullock cart. All this does not automatically make them German or American riding in the automobile.

The rapidity with which a technology spreads in a culture depends on leadership which can consciously utilize the available cultural cues for adequate motivation. One cannot import leadership as one can import radar equipment. Not only for the purposes of psychiatric practice, but for the larger purposes of leadership training cultural studies are imperative. They are also imperative for transcultural integration and creative resolution of transcultural conflicts.


III. Apparently scientific and objective papers from Western authority on transcultural matters are loaded with terms, words, and implications that are value laden. This is unavoidable, perhaps, but indefensible and requires conscious effort in the interests of both science as well as transcultural understanding. Some examples follow:


  1. Literacy is unconsciously permitted to be an index of positive cultural maturity. Events of the Second World War, for instance, the concentration camps and brutalities and psychopathic murders, the emergence of dictatorships go to show that literacy is desirable but has no relevance to positive cultural maturity or even to sound democracy.
  2. The adjective “superstition” is applied to beliefs that are not current in one's own culture. The fundamental, basic fact is denied, pushed away, that all normal perception is based on  omission and addition of objectively non-existent data. The respectable words ‘selectivity of perception’; ‘mental set’; ‘situational set’; anything but hallucination is used for this purpose. Each culture chooses its own areas of selectivity of perception and experience, and their own criteria of reality. Greater care is needed in using such words as superstition, hallucination etc., in reference to cultures and peoples as a whole.
  3. The word “primitive”, too, requires some care when being used to apply to a people or culture as a whole or even to generations of the past.


IV. Some transcultural studies seem to be mainly occupied with the study of behavioural abstractions derived from the study of:
  1. so called average representatives of a people;
  2. from clinical populations;
  3. paranormal phenomena in the culture.


This would be an excellent thing in itself if merely  some kind of observation was the sole aim. If the aim, however, is to obtain abstractions, extract principles that should help in the positive changes in the people or in the patient, if the aim were some kind of preventive or curative action then one should consider more deeply the adequacy of this approach.


Each culture provides positive and negative cues in modes of reaction leading to integrative and creative behaviour in the culture. It also provides how positively and negatively to meet threatening changes. But, in all cultures a majority of the people can only represent the negative or lower levels of behaviour - so to say a vast majority become reflex victims of their own culture. Only a minority are the reflective, conscious representatives of the best in their , so to say the leadership. The codes are provided by the religion, philosophy and such other structures.


There has been a pronounced tendency to studiously avoid the study of the successful leaders and representatives of a culture. If one were really concerned with studying how people fail, it is one thing. The picture would be incomplete if one also did not study how people succeed. To say that we should only study the rock bottom average sample of a culture is statistically sound but it would be like studying a car by its average parts and neglecting its engine. The successful leadership in a culture, the ideals that have grown in the culture and thrown them forward are the engines of a culture.


I humbly suggest that a concentrated anthropological study of the elite of a culture is an urgent necessity.


The dynamics of adaptive failure have to be studied against the dynamics of adaptive successes.

V. Most transcultural studies involve the use of questionnaires arrived at in a Western setting, and sample areas of behaviour meaningful to them. Such questionnaires are then applied to a different culture. A concession to culture is made by conceding a translation, often laboriously arrived at. However, mere translation does not solve the problem: For example, questions on psycho-sexual maturity, management of hostility and so on. But it is conceivable that a particular culture does not give the same emphasis or significance to this zone of behaviour.


More damaging is the interpretation placed on such grafted questionnaires, whether in terms of pathology or diagnosis.


VI. Equally unhelpful are the studies that laboriously demonstrate the similarity between all cultures. Such spurious similarity is reassuring about possibilities of transcultural cooperation and harmony but hardly convincing in the face of hard realities which abound with differences in their implications as evidenced by our present world.


It is of utmost importance to our existence that real differences are apprehended and understand. Whenever a transcultural study highlights the similarity one must seriously ask:
  1. Is it an artefact of the questionnaire;
  2. Have we omitted significant areas, that is to say significant to a particular culture.

Having arrived at conclusions by use of one-way loaded questionnaires the situation is made worse by implying remedial actions based on experience in the dominant culture.


VII. For transcultural study I might be permitted to suggest (all suggestions are only too easy, I know!) the following:


Whenever transcultural study is presented, let us say an American Psychiatric or Psychological study of the Japanese character structure, the same team should study a comparable American group, and preferably by questionnaires drawn up by a Japanese team as to what they consider is a proper character eliciting questionnaire. Whenever situations permit, this would be the ideal way of extracting meaningful variables and differences.


VIII. The true value of transcultural studies will evade us if such studies were to occupy themselves with attempts to reduce all phenomena encountered to words and terms already accepted and familiar to us. This is very necessary, no doubt. But, the qualitative richness of phenomena is lost if some energy were not expended in understanding the differences in the phenomenon encountered.


In constructing or operating personality theories it is highly uneconomical, and unproductive and even disadvantageous to start with well developed concepts imported from outside and then to attempt laborious amendment and annotation. This does not touch even the fringe of the problem. One has not to neglect the broad high roads of thinking, acting, theories of personality, one's own culture has accepted - one has to travel this road and by intensive and extensive interaction with the people make the necessary amendments and deviations. The tardiness with which our (Indian) technologic leadership moves is because of this perpetual activity of amending borrowed conceptual plumes instead of walking, so to say, with one’s people before pretending to lead them.


I can not enough emphasize this point. For example, even the word ‘ego’ is too much in current respectable use to be challenged as a concept. However, one should not forget the whole network of associations and uses this word has acquired are rooted in a socio cultural historic setting and philosophies and practices relevant to that. The word ‘Aham’ in Sanskrit, is not an equivalent. An Indian operates with this word, its implication and anticipations. The Indian Psychiatrist who tries to interpret Indian personality and interacts with the whole conceptual head loads based on the word ego can hardly have transactional influence on questions of mental health of his people. This is but one example. The Indian psychiatrist (with the split-level personality) finds it natural and incumbent on him to laboriously get his whole people measured on the Procrustean bed of the concept ego to get the word Aham and its implications across.


This is no mere verbal jugglery - but has interactional reality. And this is but one example.


IX. In the universe of possible experiences each culture seems to be influenced by definite sets. Within each culture there might be subgroups which share ways of experiencing with another major culture. It is unfortunate, but true, that cultural practices and modes of experiencing that acquired dominance tend to suppress other practices and experiences. The Malleus Maleficarum for a long span of history successfully suppressed scientific thought in Europe. Subtly but equally successfully the present day scientific fashion blocks all thinking that is outside its technologic and methodologic sovereignty.


Some cultures are deeply influenced by experience of and belief in forms of consciousness and powers that may be beyond our sense-limited universe of perception. Serious students of mental health cannot avoid discussion of this area. However, most research in transcultural fields take it to easily for granted that such experiences are merely psychological artefacts and expend the whole of attention in reducing observations on these experiences into accepted psychological terminology.


It will be naive to decry the scientific method. It would be equally naive to ignore the heavy cultural bias that certain lines of scientific inquiry acquire during the course of history. It would be very deep detrimental to the progress of the scientific understanding of human behaviour. In the field of transcultural mental health it is premature to lay down binding dicta on what should be the criteria for calling a work scientific. It is too easy to deceive oneself into thinking that one’s preferred mode of perceptual organisation is the only valid one especially when international organisations and funds in the field of research have a heavy bias with certain dominant trends. Conscious effort is needed to overcome this.


X. As a continuing student of psychiatry and presently involved in teaching I may be permitted to remark as under:


We psychiatrists have taken great pains to point to the dehumanising pseudo-scientific influence to which the medical graduate is subjected during his medical college career. But somehow, looking at the zeal with which psychiatric research uses the word ‘detached’ ‘objective’, ‘statistical rigour’ and installs them as exclusive criteria for respectability in psychiatric research one wonders if we are not letting the devil in through the back door the very one which we exorcise in public with trumpets and fanfare. The orthodoxy of the newly converted is well known. The so called idolatry of the ‘detached observer’ is having baneful effect on the trainees from the developing countries. Their medical college education has already dehumanised them. The further from their people the better is ‘scientific detachment’. Their psychiatric training should help to correct this. But psychiatry’s new found enthusiasm for ‘detachment’ produces further grotesque departures and when they come back to their operational work in the field their respect for statistical tables and dessicated formularies regarding human behaviour is truly amazing and the zeal for getting into print doing research is hardly matched by the patience and perseverance necessary to understand and help. I have great respect for the ‘scientific method’, but I also plead against the subtle implication that all workers and work in the field of mental health that do not fit in with this is somehow automatically an inferior zone. Senior teachers in psychiatry have a duty to seriously ponder over this - the sociology of research respectability.
***

No comments: