Introductions to the plenary sessions
Introductions to the themes of the plenary sessions of the WACP2022 congress in Rotterdam
I Plenary session
Cultural psychiatry: theory and research
Medical systems are cultural systems with deep roots in particular social, historical and political contexts. That holds also true for modern psychiatry, which is strongly embedded in dominant epistemologies of industrialized societies in Western Europe and North America. A truly context-based practice in psychiatry should not be limited to an exploration of the patient’s social and cultural context alone, but also involve a critical review of the contexts in which psychiatric knowledge has emerged, including the concepts and theories we adopt to understand and treat suffering.
This plenary session will focus on fundamental themes such as:
- Decolonizing cultural psychiatry
Our field’s origins in colonial psychiatry and anthropology beg the important question to what extent today’s cultural psychiatry has detached itself from (neo)colonial perspectives. What are other perspectives on mental health and healing, apart from dominant Euro-American perspectives in psychiatry and clinical psychology? How could these perspectives be best integrated in today’s globalized societies for the benefit of culturally superdiverse populations?
- Contextualizing concepts and theories
Cultural psychiatry’s theories, concepts, and instruments determine how patients and their suffering are perceived and represented during the clinical process. How are these concepts and theories to be viewed in the specific social and historical context in which they have been developed? What is the impact of our key concepts, such as ‘culture’ or ‘ethnicity’ on the doctor-patient interaction, and the subsequent clinical reality? What are alternative conceptualizations of culture and identity that ensure greater cultural safety in the clinical encounter?
- Broadening scientific research into contextuality
The past decades have witnessed an increasing interest in social determinants of mental illness. Social exclusion, racism, and other structural factors are major causes of mental health disparities in today’s societies. Still, there are important questions that need to be addressed: e.g., which contextual adaptations in our interventions can enhance their effectiveness? What are promising approaches that more rigorously take into account the role of structural and systemic determinants of mental illness?
II Plenary session
Cultural Psychiatry and the impact of global developments in societies
Globalization processes, international conflicts, epidemics and natural disasters have strongly influenced the development of a contextual approach in cultural psychiatry. Increasing cultural diversity in societies is reflected in patient populations and has led to a growing awareness that mental health care needs to take into account the local worlds of patients. Experiences of social injustice through racism, poverty, forced displacement and unequal access to health care make some groups more vulnerable than others to the impact of global crises. This urges for a an increasingly interdisciplinary approach in (global) mental health care, in which cultural psychiatry can help to better understand the effects these global developments have on mental health and the psychosocial needs of those most affected.
The plenary session of cultural psychiatry and global developments focuses on themes such as:
- Migration, displacement and diasporas
Poverty, war, and natural disasters urge large groups of people to seek refuge within or across national borders. Experience shows that these groups are at risk of becoming victims of violence, exclusion and discrimination, and of consequently developing mental disorders. At the same time modes of social interconnection in modern day diasporas can teach us about the way human networks promote resilience. How does cultural psychiatry incorporate the impact of cultural and contextual factors into the understanding and treatment of those mentally affected by displacement, and engage in public debate about injustice faced by refugees and migrants?
- The impact of global disasters on mental health
Global disasters such as the COVID-19 pandemic, the climate crisis and the way they interact with human rights issues and social polarization between haves and have-nots, have influenced mental health around the globe as well. The COVID-19 pandemic has caused a decrease of global traffic, an enhancement of social and international polarization, and an increased awareness of the vulnerability of transnational human networks. Effects of climate change have caused losses of homes, safety and social structures. What are the consequences of these global disasters and their social impact for the development of theoretical frameworks and concepts in cultural psychiatry?
- Inequalities in mental health care
There is an increasing awareness that social inequalities affect every aspect of human life, including mental health, and that social factors need to be included in prevention of mental disorders, treatment and research. Where do we stand when it comes to the mental health gap in global mental health? How do mental health institutes include and operationalize values of diversity and inclusion? How do they address empowerment and agency of their patients?
III Plenary session
Local worlds of mental illness: clinical practice and therapeutic aspects
Just as experiences of mental illness are inextricably intertwined with macro-level factors such as social class, gender, genetic vulnerability, migration and culture, they are also embedded in the world of systemic processes of families including their transnational connections, and social environments such as work, school, and administrative bodies. Cultures are navigating people in distinctive ways through the challenges and opportunities of these systemic and social environments and they determine the ways people experience and treat the illnesses they are dealing with. In an unfamiliar and rapidly changing world this is challenging and asking for new narratives.
Interacting with the patients’ network in which mental health problems develop and are experienced is relevant for a better understanding of the illness as situated in a local world. This is essential for the purpose of comprehensive diagnostics; as an instrument for building a working relationship; and as a resource for creating an environment in which the different nuances and layers of suffering can come to expression in order to work towards healing and recovery.
In the plenary session we focus on themes such as:
- Transgenerational aspects of suffering
The world faces situations where organized violence beyond human comprehension is used; like war violence, torture, racial violence and sexual abuse. The consequences are experienced in psychiatric, social and physical problems and are faced in mental health services. In this plenary session focus is upon the issue of intergenerational transmittance of the burden of these problems and on the formation of meaningful therapeutic contexts to treat them.
- Working the challenges and contradictions of post-migration family life
Everyday experience of difference, otherness, and even the degree of mastery of the dominant language burdens families after migration. These experiences make it difficult to (re)build family life and to provide children with a safe home and the conditions for attachment and positive and healthy development.
How should different experiences within families be reconciled in the consulting room and which recent insights from clinical practice and science can be reported in this field of systemic working, and child and adolescent psychiatry with migrant families?
- The moral meaning of suffering in the therapeutic practice:
In their 2006 article in PLOS Medicine Kleinman & Benson stated that in cultural psychiatry the practitioner’s ethical task of face-to-face acknowledgement of the moral meaning of suffering - what is at stake for the patient? - is more fundamental than the epistemological and cultural issues of cultural competence.
The challenge is to position the patient’s suffering in the social and systemic context in which it is embedded, to connect and build bridges in the clinical encounter and to create a meaningful symbolic context respectful of the different frames of reference. In this not only the patient's world is at stake, but also that of the therapist.