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Fernando Lolas Stepke: Bioethical Implications of Globalization for Global Mental Health (ASI 2016)

Bioethical Implications of Globalization for Global Mental Health

Fernando Lolas Stepke, University of Chile

The main thrust of this presentation is to identify the bioethical implications of the globalization process as it is currently understood, emphasizing those areas in which a “differential ethics” approach, as advocated by HM Sass, may provide a framework for research and intervention. One of the implicit assumptions to be elaborated upon is the notion of the “moral equivalence of cultures”, as presented by Oswald Spengler, with the distinction between a “systematic” and a “physiognomic” approach to cultural diversity and understanding. In this regard, emphasis is placed on language in its denotative, connotative, and performative dimensions and the narrative constitution of human experience, which renders it untranslatable but amenable to comprehension and intervention. In this narrative, the “human dimension of the environment” and its attendant implications for mental health are scrutinized within the scope of its practical implications for furthering and refining a hitherto vague conception of “global mental health” and its relation to “global ethics.”

Fernando Lolas Stepke is Professor and Director of the Interdisciplinary Center for Studies on Bioethics at the University of Chile and Specialist in Psychiatry and Psychosomatic Medicine. He studied Medicine and History at the Universities of Chile and Heidelberg (Germany). He has been Vice President for Academic and Student Affairs of the University of Chile, President of the Chilean Society of Neurology, Neurosurgery and Psychiatry, and Director of the Psychiatric Clinic of the University of Chile. He led the Bioethics Program of the Pan American Health Organization, Regional Office of the World Health Organization and was a member of the International Bioethics Committee of UNESCO. He has received Doctor Honoris Causa and Honorary Professor at numerous universities in Latin America, Europe and the United States. His scientific production has been concentrated in the areas of psychiatry, psychophysiology, bioethics and behavioural sciences. He is an Honorary Member of the Chilean Academy of Language, Chilean Academy of Medicine and numerous other institutions (Mexican National Academy of Bioethics, Iberoamerican Academy of Medical Law, World Association for Social Psychiatry) as well as Corresponding Member of the Royal Spanish Academy. He is also the editor of scientific publications in English, Spanish and German and was awarded the Alumni-Preis of the Alexander von Humboldt Foundation, Germany.

Peter Brown: Why We are Lost (ASI 2016)

Why We are Lost

Peter G. Brown, McGill University
Peter G. Brown is a Professor in the Departments of Natural Resource Sciences and Geography, and the School of Environment at McGill University. He is principal investigator of Economics for the Anthropocene, a graduate training and research partnership supported by the Social Sciences and Humanities Research Council of Canada and twenty-five international university, government, and non-governmental organizations (e4a-net.org). His most recent book is Ecological Economics for the Anthropocene: An Emerging Paradigm, written and co-edited with Peter Timmerman. He is a member of the Society of Friends (Quakers), and the Club of Rome.

Peter Victor: The Trouble with Growth (ASI 2016)

The Trouble with Growth

Peter A. Victor, York University

Economic growth is the over-arching policy objective of governments worldwide. Yet its long-term viability is increasingly questioned because of environmental impacts and impending and actual shortages of energy and material resources. Furthermore, rising incomes in rich countries bear little relation to gains in happiness and wellbeing. Some hope to ‘decouple’ economic growth from its material and energy requirements but will this be enough to allow economies to grow without limit? Others argue that the trouble with growth is not only that it is bound to be short-lived, but that its pursuit prevents the achievement of more important social objectives. These perspectives will be examined in this presentation. What can and ought to grow will be distinguished from what can’t and shouldn’t and scenarios of alternative economic futures will seed discussion of possible ways forward that will better serve humanity and all life on the planet.

Peter A. Victor is an economist who has worked on environmental issues for nearly 50 years as an academic, consultant and public servant. Dr. Victor was one of the founders of the emerging discipline of ecological economics and was the first President of the Canadian Society for Ecological Economics. His most recent books are Managing without Growth. Slower by Design, not Disaster (Edward Elgar, 2008) and The Costs of Economic Growth (ed.) (Edward Elgar, 2013). In 2011 Dr. Victor was awarded the Molson Prize from the Canada Council for the Arts for his contributions to the study of economics and the environment and in 2014 the International Society for Ecological Economics named him as the recipient of the Kenneth E. Boulding Memorial Award. He was elected to the Royal Society of Canada in 2015.

Laurence Kirmayer: Psychiatry for a Small Planet – Introduction to ASI 2016

The view of earth from space provided by the Apollo mission in 1968 offered a new way of thinking about the planet as our shared home—a beautiful blue-green orb floating in space. In recent years, climate change, urbanization, mass migration, and the violence of global geopolitics have created new challenges and a more acute sense of the vulnerability of our planet. This planetary view exists in some tension with the perspective of globalization, which tends to focus on economic growth and development. This international conference and workshop will examine the implications for global mental health of the “anthropocene” in which our context of adaptation is dominated by human effects on the environment. Questions to be discussed include: What ways of thinking about current global or planetary issues can promote empathy, equity and effective action? Does the notion of “planetarization” offer an alternative to globalization for thinking about geopolitical and ecological crises? What are the links between care of the planet and care of the self? What cultural values and practices can contribute to adaptation, flourishing and well-being in the face of the massive environmental and social changes that are on the horizon? Sessions will explore topics related to four themes: (1) rethinking the ethics, politics, and governance of global mental health “from the bottom up” to ensure the voice of diverse communities and stakeholders in addressing global health inequities; (2) the impacts of migration and urbanization on mental health; (3) the effects of climate change on the mental health of populations and communities; and (4) ecosocial approaches to mental health promotion of populations and communities. These interconnected processes are changing the configuration of social worlds, presenting new challenges to mental health and affording new possibilities for intervention. Presenters will examine the ways that ecosocial and ecosystemic approaches to health and illness can inform policies and practices that contribute to the treatment and prevention of mental disorders and the promotion of mental health and well-being.
Laurence J. Kirmayer, MD, FRCPC, FCAHS, FRSC is James McGill Professor and Director, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University and Co-director of the McGill Global Mental Health Program. He is Editor-in-Chief of Transcultural Psychiatry, and Director of the Culture & Mental Health Research Unit at the Institute of Community and Family Psychiatry, Jewish General Hospital in Montreal, where he conducts research on culturally responsive mental health services, the mental health of Indigenous peoples, and the anthropology of psychiatry. He founded and directs the annual Summer Program and Advanced Study Institute in Cultural Psychiatry at McGill. His current research includes studies on: culturally based, family centered mental health promotion for Indigenous youth; the use of cultural formulation in cultural consultation; and the place of culture in global mental health. He co-edited the volumes, Understanding Trauma: Integrating Biological, Clinical, and Cultural Perspectives (Cambridge University Press), Healing Traditions: The Mental Health of Aboriginal Peoples in Canada (University of British Columbia Press), Cultural Consultation: Encountering the Other in Mental Health Care (Springer), DSM-5 Handbook for the Cultural Formulation Interview (APPI), and Re-Visioning Psychiatry: Cultural Phenomenology, Critical Neuroscience and Global Mental Health (Cambridge). He is a Fellow of the Canadian Academy of Health Sciences and of the Royal Society of Canada (Academy of Social Sciences).

Duncan Pedersen: Dream-A-World Cultural Therapy as an innovative approach in Global Mental Health (ASI 2015)

Dream-A-World Cultural Therapy as an innovative approach in Global Mental Health.

Duncan Pedersen, Douglas Mental Health University Institute, McGill University

Much work is being conducted in countries around the world to systematically influence the knowledge and practice around mental health and service provision. Current propositions in GMH seek to scale-up western biomedical psychiatric models, in order to improve access to services and treatment, thus reducing the ‘mental health gap’ and best meeting the needs of users. Others, like Dream-A-World (DAW) Cultural Therapy, focus their work outside-the-box, that is outside the realms of the health sector and depart from a different paradigm which has been called “user/survivor-ledapproach.” DAW chooses their subjects among the most troubled young children, school drop-outs, living in inner-city garrison settlements of Kingston, Jamaica, and uses creative arts to promote social well-being, resilience and improved academic performance; increasing self-control; reducing antisocial behaviour and promoting ‘wholesome’ identity. My contention here is that creativity is the ‘key’ ingredient of DAW Cultural Therapy. Creativity is as important in education as literacy and numeracy, and we should treat it with the same status. However, schools are replicating the same hierarchical model all over the world. Our education system has been designed to kill creativity or to make it a subordinate of mathematics, physics or natural sciences, thus mining our minds in the way that for the future globalized world won’t serve us much. DAW has contributed not only to foster the mind and mental health of vulnerable young children in Jamaica, but above all has made us rethink the
fundamental principles on which we are educating our children, as well as how should we conduct global mental health interventions inspired by equity and social justice, that are both effective and ethically sound.

Geoffrey Walcott – The Kingston Seaview Dream-A-World Cultural Therapy ‘Scale Up’: Methods and Outcome (ASI 2015)

The Kingston Seaview Dream-A-World Cultural Therapy ‘Scale Up’: Methods and Outcome
Geoffrey Walcott, University of the West Indies
presented by Jaswant Guzder, McGill University

Jamaica has the world’s sixth highest rate of lethal violence. Following a successful multi-modal riskreduction proof of concept program for high-risk inner city children called Dream A World Cultural Therapy a 2013 Grand Challenges Canada Grant “Countering Youth and Urban Violence with a Community Engagement Cultural Therapy Program in Kingston Jamaica” provided a 240 hour scale up over 2 years for 100 dysfunctional and academically underachieving 8-year-olds and 100 control children from four primary schools in a Kingston inner city community. At three annual summer programs, and fortnightly ‘refueling’ term-time sessions the children were invited to ‘Dream-A-World’, imagining their life on a new planet. Constructing songs, poems, and dances, they presented a dramatic performance about their fantasized-world to parents, teachers and guests. Using manualized cultural therapy components of circling; centering, culturing, cognitive catalysis and capacity the process achieved qualitative improvement in academic achievement impulse control, self-confidence, group organization and authority management. The intervention group made significant improvements in Mathematics between term 1 and 3, M1=37.60, M2=51.44, p< .001. They also made significant improvements in artistic, musical and dramatic performance, resulting in measurable artistic performances by the group. Using ASEBA, Connors, WRIT and WRAT scales the study cohort showed improvement compared to the control group in their behavioural and academic performance that was statistically significant within 12 months.

Hilary Robertson Hickling: The Eastern Jamaica Dream-A-World Cultural Resiliency ‘Transition to Scale’ (ASI 2015)


The Eastern Jamaica Dream-A-World Cultural Resiliency ‘Transition to Scale’
Hilary Robertson-Hickling, University of the West Indies
presented by Frederick Hickling, University of the West Indies

Success achieved from the Dream-A-World Cultural Therapy (DAW-CT) program resulted in the evolution of the New Dream-A-World Cultural Resiliency (NDAW-CR) program for 35 of the academically poorest preforming primary schools primary schools in Eastern Jamaica. A newly established parallel Grade 4 Class replaced the 240-hour two-year DAW CT process with a 1000-hour program spanning a regular school year. This new parallel class accommodated 25 of the poorest academic performers and most disruptive students from the 2014 Grade 3 cohort. A teacher and a guidance counselor from the 35 schools were trained in the five therapeutic modality elements of the Dream A World Cultural Therapy program – circling, centering, culturing, cognitive catalysis and capacity building. A team of three cultural therapy trainers provides bi-monthly follow-up DAW-CT supplementation assistance to the teachers and students of each school program. The NDAW CR program has been videotaped in the classroom and analyzed by AtlasTi, and the students’ academic grade performance has been followed over the year. The ASEBA TR instrument has been used to evaluate the behavioral performance of the children. The paper examines the qualitative evidence of the task sharing and task shifting to other school classes and teachers that the NDAW-CR program has revealed and the quantitative evidence of improved behavioral and academic outcomes of the students trained. The outcome results will provide the proof of concept evidence for the transition-to-scale of
the NDAW CR program to 1000 schools across Jamaica.

Frederick Hickling: Taking Psychiatry to School in Jamaica: Using Creativity as the Vehicle for Postcolonial… (ASI 2015)

Taking Psychiatry to School in Jamaica: Using Creativity as the Vehicle for Postcolonial Social Reengineering/Healing in Jamaica
Frederick W. Hickling, University of the West Indies

The history of insanity has been a continuous metamorphosis of newly minted orthodoxies that have demanded taking psychiatry to school. The 1962 postcolonial deschooling community mental health revolution in Jamaica began with gradual deinstitutionalization of lunatic asylum beds and reschooling with Community Engagement Mental Health. Postcolonial social reengineering home-schooled Psychohistoriographic Cultural Therapy in the Mental Hospital triggering psychological deinstitutionalization sensitizing the Jamaican population to social healing of madness. With the world’s third highest rate of lethal violence in 2005, the next major wave of psychiatric reschooling placed psychiatry in primary schools. Pioneering primary mental health proof of concept risk-reduction
Dream-A-World Cultural Therapy was implemented for high-risk eight-year-old children exhibiting poor academic performance and behavioral dysfunction at a Kingston inner-city primary school. Significant improvements in academic performance and school social and behavioral adjustment were realized. A scale-up Dream-A-World Cultural Therapy project in 4 inner-city primary schools had similar positive results. This led to New Dream-A-World Cultural Resilience Transition to Scale in 35 failing primary schools with comparable success. This power-shifting metamorphosis took psychiatry out of the office with indigenous creativity realizing the core principle of the cultural therapy process. Placing psychotherapy squarely in the hands of schoolteachers and families, cultural therapy was
positioned as a robust agent of liberation psychiatry in oppressed and impoverished communities. A neurobiological epigenetic model of this cultural creativity process for healing and social reengineering is proposed.

Frederick W. Hickling was educated at the University of the West Indies, University of London, and University of Edinburgh. He was appointed Professor Emeritus of Psychiatry at the University of the West Indies, and is the Executive Director of the Caribbean Institute of Mental Health and Substance Abuse (CARIMENSA) UWI, Mona. Author of more than 100 scholarly articles, and author of six books, he was elected a Distinguished Fellow of the American Psychiatric Association in 2009, and a Fellow of the Royal College of Psychiatrists UK in 2011. He received the Order of Distinction (Commander) by the Government of Jamaica in August 2012.

Panel: Art and Therapeutic Process (ASI 2015)

Panel Participants:

Jaswant Guzder, McGill University
Ian Gold, McGill University
Gilah Yelin Hirsch, California State University Dominguez Hills
Cécile Rousseau, McGill University
Eric Lewis, McGill University

Chair: Laurence Kirmayer, McGill University

Vitor Pordeus – “Madness, yet there’s method in it”: For a New Biology for Mental Health (ASI 2015)

“Madness, yet there’s method in it”: For a New Biology for Mental Health
Vitor Pordeus, People’s University for Art and Science, Rio de Janeiro

Presentation of the 5 year experience of the Centre for Culture, Science and Health – Public Health Office of Rio de Janeiro City, the DyoNises Theatre, the Hotel and Spa of Madness and the People’s University for Art and Science developed in the oldest Brazilian Psychiatric Hospital, the Nise da Silveira Mental Health Institute, formerly know as Pedro II Psychiatric Centre. The hospital was named in year 2000 after the famous revolutionary Brazilian woman psychiatrist Nise da Silveira pioneered the field of art and psychiatry founding the Museum of Images of the Unconscious in 1946. It today counts with a technical archive of more than 350 thousand artworks amongst paintings, drawings, sculptures of chronic psychosis schizophrenic patients that fundament and inspire the present
experience developed mainly through the application of Dr. Nise’s scientific principles on public theatre performed with the communities of the Hospital and Rio de Janeiro’s public spaces. Our therapeutic experience relies on the theatrical collaborative methods and the production of short and long documentary films, that will be exhibited during the presentation with special attention to the last movie produced by our artistic collective: our 2014 theatrical production “Hamlet, madness yet there’s method in it”. These experiences will be put into context of the contemporary scientific revolution of biology considering the experimental and scientific work of the Brazilian immunologist Nelson Vaz and the Chilean biologist Humberto Maturana, former tutors and personal collaborators of the author.

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