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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.

Jacques Arpin – Body and Performance in Theater Anthropology and other Art Forms (ASI 2015)

Body and Performance in Theater Anthropology and other Art Forms: Clinical Applications in
Cultural Psychiatry
Jacques Arpin, Geneva

What can I, a healer, learn from the arts, traditions and techniques? How can I apply such learning to my clinical work in medical anthropology and cultural psychiatry? I put “body” at the centre of the crossroads of health, culture and performance. The latter concerns all art forms relevant to the narration and the dramaturgy of patients’ case-history making. It is also helpful in the elaboration of various forms of therapies, including somatic medicine. We can thus improve and develop these medical actions with methodologies borrowed from the arts: learning, training, practicing, performing and transmitting. Theater anthropology is the study of the performer in a situation of performance. It considers traditions and techniques; the body as a vehicle, the body as a tool. Through exercises and training methods, this body will eventually produce narrative elements and express segments of stories. These I can then edit, using methods of montage, to finally make sense of the whole dramaturgy. There is a montage of the director and a montage of the actor, both of which will, at one point, be confronted with the montage of the spectator. Applications to our fields of professional actions are convenient and useful. The patient/healer work parallels that of the actor/director interactive strategies and methods. The healer, here the cultural psychiatrist, becomes the director of the patient’s dramaturgy, as expressed in the case-history making and in the course of the psychotherapy. The same can apply to the clinical situations seen in surgery, internal medicine et al. Theater anthropology and the performance studies have developed active networks, the International School of Theater Anthropology (ISTA) and the Performance Studies international (PSi), comparable to our own SSPC, TS and WACP. My Masters of Their Conditions project began 30 years ago. Three stepping-stone articles have been
published in TP. The focus is on the body in its clinical, cultural and performing forms: (1) the performance of health, illness and care – introducing theater anthropology; (2) narration in intercultural theater and the visual arts – bringing patients on stage; (3) the actor’s score and its applications to the patient’s score – a collaboration with actors of the Odin Teatret, founded by Eugenio Barba who also created ISTA. I am currently working on the next stage of the project: body modifications in the era of the new media (Internet, communication, technologies of the image).

Stephen Snow – Ethnodramatherapy: Performance Ethnography Combined with Drama Therapy in… (ASI 2015)

Ethnodramatherapy: Performance Ethnography Combined with Drama Therapy in the Framework of Theatrical Performance
Stephen Snow, Concordia University

Ethnodramatherapy is a new methodology that integrates the art of theatre with Drama Therapy, all within the methodological context of Performance Ethnography. The latter has its roots in the groundbreaking “Performing Ethnography” work of Victor Turner. Mienczakowski, who further developed this work into his own method, “Ethnodrama,” speaks of how Turner influenced him to combine “the aesthetic assumptions of performance and the methodological and theoretical ambitions of research.” What I have added to this mix are the clinical interventions of Drama Therapy. In this way, the approach can also encompass therapeutic goals and outcomes. This presentation will explore the application of Ethnodramatherapy through case studies with marginalized populations: (1) female
adolescents under youth protection in regards to self and social perception; (2) the exploration of intimacy and sexuality in the lives of adults with developmental disabilities: (3) the lived experience of caregivers for the mentally ill. Slides and video clips will be used.

Cécile Rousseau – Giving a Voice? Art, Exclusion and Caring Illusions (ASI 2015)

Giving a Voice? Art, Exclusion and Caring Illusions
Cécile Rousseau, Caroline Beauregard, Marie-France Gauthier, Anousheh Machouf & Tomas Sierra

In immigrant neighbourhoods, immigrant and refugee youth who attend special classes because of learning and behavioural difficulties, suffer from a double exclusion linked to their minority status and to their academic delay. This presentation will describe the implementation and the results of a randomized control trial to evaluate the efficacy of drama workshops to reduce the symptoms and impairment of youth in 30 special classes in Montréal. During the intervention, the structural violence and the hurt associated with exclusion were enacted by the youth and shattered the team and the teachers’ sense of safety. Although the results showed that the drama intervention was beneficial for first generation immigrants, they also suggested that the availability of an expression space may have reactivated feelings of impotence and anger associated with the life experience of second generation youth. These observations confirm the powerful role of art in the face of social exclusion, and suggest that in situations where impotence dominates and possibilities of transformation are slim, artistic expression may be considered as a doubled-edged sword.

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