The Working with Culture seminar is offered as a course during the month long Annual McGill Summer Program for Social and Transcultural Psychiatry, attended by local and international participants each May since 1994. The article outlines some of the premises and pedagogical approaches of this clinically oriented biweekly seminar series with discussions and didactic teaching on cultural dimensions of mental health care. The course readings, seminar topics and invited speakers focus mainly on therapist client encounters constructed by the multiple voices with dimensions of psychiatric, social, historical, legal, ethical, political, systemic and intra-psychic domains. The dual leadership emphasizes the gaps and complementarity amongst voices, and it invites and supports a destabilizing decentering process and the creation of solidarities amongst participants. Applying a bio-psychosocial case study method, each 3-h seminar engages the participants in a critical dialogue on apprehending the enmeshment of social suffering with psychiatric disorders whilst examining the usefulness and the limits of cultural formulation models. The seminar working group and teaching approach acknowledges cultural hybridity as a dynamic process marked by continuous therapist attunement to uncertainty or 'not knowing' which implies a dethroning of an expert position.
Comment In: Cult Med Psychiatry. 2013 Jun;37(2):390-723564248
Debates between refugee advocates, institutional actors and the wider public regarding refugee claimants often evoke anger, fear and sadness, as well as more positive emotions such as compassion, suggesting a complex societal emotional response toward refugee stories. This article analyses the emotional interactions surrounding refugee determination hearings, as reflected in the discourse of administrative judges and refugees. Our results show that the concepts of empathy and compassion are often used by judges to confirm the benevolent image that the administrative tribunal wants to project as a representative body of the host country. However, the very unequal power relations of the hearing setting structure the transmission of the refugee stories in a way that often prevents an emotional encounter between decision makers and refugees. Beyond the specific context of the refugee determination process, these results illustrate how prevalent psychological models of empathy and the transmission of trauma implicitly reveal a political dimension that validates representations of the helpless but potentially dangerous Other, representations that often underlie broader north-south power relations.
This article describes a school-based preventive pilot project for recent immigrant children, designed to decrease anxiety and intergroup tensions associated with the Iraq war. Results suggest that clinicians should address the multiplicity of meanings associated with international events when planning a prevention program in multiethnic schools to help children to cope with the increasingly common gap between the ways traumatic events covered by the media are understood at home and at school.
In multiethnic societies, the consequences of the war on terror (WOT) for Muslim youth are still not well understood and the school's role remains to be defined. This article documents the parent-child transmission of understanding and emotional reaction to the WOT in South Asian Muslim families in Montreal, Canada. For this qualitative study, the researchers interviewed 20 families. Results indicated that the families' emotional reactions and communication about these events were interlinked with family patterns of identity assignation. The majority of parents avoided talking with their children about the WOT and felt that these issues should not be discussed at school. Most children shared their parents' feelings of helplessness and familial patterns of identity assignation. Parents reporting a greater sense of agency displayed less avoidance, had a more complex vision of self and other, and favored the school's role in helping children make sense of these events. These results suggest that school interventions in neighborhoods strained by international tensions should emphasize immigrant parents' empowerment and provide spaces where their children feel comfortable expressing their concerns.
Although the distinction between independent immigrants and refugees has an impact on policy, services, and public opinion because it implies differences in resettlement needs, few recent studies have documented the validity of this assumption. In this population-based survey of recent migrants in Quebec (N = 1871), immigration status (refugee, independent, or sponsored immigrant) is examined in relation to premigration exposure to political violence and refugees' emotional distress, assessed with the SCL-25. A higher percentage of refugees reported exposure to political violence in their homeland, but the percentages of exposed independent (48%) and sponsored (42%) immigrants were unexpectedly high. Emotional distress was significantly higher among Chinese respondents who had witnessed acts of violence and in subjects from Arab countries who reported persecution. These results suggest that service providers and policy makers should not assume that independent immigrants have not been exposed to political violence before their migration.
To examine the association between brief detention and psychiatric symptom levels among adult asylum seekers.
The Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25 were used to assess psychiatric symptoms and premigration trauma exposure in 122 detained and 66 nondetained adult asylum seekers in Montreal and Toronto.
After a mean detention of 31 days, the proportion of asylum seekers scoring above clinical cutpoints was significantly higher in the detained than the nondetained group for posttraumatic stress (?² = 4.117, df = 1, P = 0.04), depression (?² = 13.813, df = 1, P
This research documents the cultural norms around physical discipline and physical abuse among immigrant parents and youth, and assesses the impact that perceived divergences in these norms have on the relation between the family and the outer social world. Interviews were conducted with 10 parents and 10 adolescents from North African Arab countries, and 10 parents and 10 adolescents from Latin America living in Canada. Results highlight that divergent discipline practices were perceived by participants as an important source of tension when they were accompanied with a demeaning image, projected by the host society onto the immigrant family.
This study analyses the roles of collective self-esteem and religiosity in the relationship between discrimination and psychological distress among a sample of 432 recent immigrants from Haiti and Arab countries living in Montreal, Quebec. Collective self-esteem (CSE), religiosity, discriminatory experiences, and psychological symptoms of depression and anxiety were assessed. Regression analyses revealed direct negative effects of discrimination, CSE, and religiosity on psychological distress for the entire sample. CSE, however, also appeared to moderate the effects of discrimination on psychological distress. Participants with higher CSE reported lower levels of anxiety and depression as a result of discrimination compared to those who expressed lower CSE levels. The results suggest that the relationship between CSE, discrimination, and psychological distress must be reexamined in light of recent sociopolitical changes and the upsurge in ethnic and religious tensions following the war on terror.
This brief report illustrates how the migration context can affect specific item validity of mental health measures. The SCL-25 was administered to 432 recently settled immigrants (220 Haitian and 212 Arabs). We performed descriptive analyses, as well as Infit and Outfit statistics analyses using WINSTEPS Rasch Measurement Software based on Item Response Theory. The participants' comments about the item You feel everything requires a lot of effort in the SCL-25 were also qualitatively analyzed. Results revealed that the item You feel everything requires a lot of effort is an outlier and does not adjust in an expected and valid fashion with its cluster items, as it is over-endorsed by Haitian and Arab healthy participants. Our study thus shows that, in transcultural mental health research, the cultural and migratory contexts may interact and significantly influence the meaning of some symptom items and consequently, the validity of symptom scales.
This article describes a collaborative mental health care project for youths, implemented in Montreal in a multiethnic setting. The authors examine the adjustments needed in the shared-care model to address the complexity of cultural and cooperation issues raised in the provision of services to a multiethnic population. A preliminary qualitative evaluation of the project shows how first-line workers face many uncertainties, stemming from both the institutional context and the multicultural reality of the population served. Results from this study advance the hypothesis that although uncertainties may generate discomfort and confusion, they may also open a space for innovation and acceptance of otherness.