from the threshold to the event: thirty years of cultural family therapy - allan memorial institute...
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Multiples, Multiplicity & The MultitudeDedication
Raymond H. Prince, MD, MSc (1925 - 2012)
Professor of Psychiatry
Director, Division of Social and Transcultural Psychiatry
McGill University
Learning Objectives
At the conclusion of the presentation, the participant should be able to:
1. Understand families in cultural contextto learn to listen to family stories in order to identify their mental and relational predicaments as expressions of their unique cultures.
Learning Objectives
At the conclusion of the presentation, the participant should be able to:
2. Define culture change and identify its mental health impacts on families as a cascade of consequences.
Multiples, Multiplicity & The MultitudeCommunities of Practice
Several communities of practice:
Child and adolescent psychiatrist
Social and cultural psychiatrist
Psychotherapist and relational therapist
Philosopher
Multiples, Multiplicity & The MultitudeCommunities of Practice
The solutions we seek are shaped by the problems we address
The problems that capture our attention are shaped by our therapeutic temperaments
Two therapeutic temperaments
Refs: Di Nicola (1997, 2011) Slavoj Zizek, The Parallax View (2009)
Multiples, Multiplicity & The MultitudeCommunities of Practice
Two therapeutic temperaments
Phenomenological temperament
Technocratic temperament
Refs: Di Nicola (1997, 2011)
Cultural Family Therapy
An integration of cultural psychiatry
McGill social and transcultural psychiatry
Later: elements of French ethnopsychiatry
and family therapy
Milan systemic family therapy
Later: Reflecting team, Dialogism,
“Face to face” encounter
Raymond H. Prince, MD, MSc
(1925 – 2012)
Multiples, Multiplicity & The MultitudeRaymond Prince
Three ethnocentric Western assumptionsregarding psychotherapy:
The importance accorded to the individual
Personal independence as a therapeutic goal
Introspection as a therapeutic method
Cartoon by Thomas Zummer
Implications
Many of our therapies and professionalconstructions are Western cultural products
We could say that they form part of the folk psychology of Western postindustrial, postmodern societies
Cf. “Liquid modernity” (Zygmunt Bauman, LiquidModernity, 2000)
Multiples, Multiplicity & The Multitude
Mara Selvini Palazzoli, MD
(1916-1999)
Multiples, Multiplicity & The MultitudeMara Selvini Palazzoli
La terapia familiare è il punto di partenza
per lo studio di unità sociali sempre più ampié.
Family therapy is the starting point
for the study of ever wider social units.
Mara Selvini Palazzoli Maurizio Andolfi
Family Therapy
Family therapy is the space
that we open to explore
the possibilities of the family.
Family Therapy
What is the task of family therapy?
To give structure and meaning to the family’s predicament.
Multiples, Multiplicity & The Multitude
Family Therapy
This exploration of the family is done in therapy when it is not possible elsewhereor otherwise.
Multiples, Multiplicity & The Multitude
Family Therapy
Family therapy provides guidelines for research and instruments for change
Soins partagés en pédopsychiatrieFamily Therapy Interventions
Family therapists do three simple things:
Enhance uncertainty
Introduce novelty
Encourage diversity
Ref: Di Nicola, A Stranger in the Family (1997)
Cultural Family Therapy
CFT weaves together:
family stories that express their mental and relational predicaments, and
conceptual tools for conducting clinical work
Cultural Family Therapy
CFT is an ongoing update of our notions of:
family and therapy
culture and psychiatry
Cultural Family Therapy
CFT was constructed:
to deal with threshold peopleundergoing rapid cultural change
Multiples, Multiplicity & The MultitudeKey Features of CFT
Recognizing families as unique cultures
Immigrants as threshold people in transitional states
Three Basic Principles and Processes for CFT
1. Parallels between the notions of “family” and “culture”
2. Each family is the bearer of the larger culture
3. Systemic family theory and sociocultural psychiatry share a relational psychology that inverses theorizing from self to society
Key Words“The Threshold”
Cultural family therapy (CFT)
Families as unique cultures
Liminality versus community
Threshold people and transitional states
Key Theme: Liminality vs Community
Victor Turner – The Ritual Process (1969)
Liminality – “betwixt and between”
Jean-Luc Nancy – La Communauté désœuvrée (1983) –The Inoperative Community (1986)
Community –
“The community that becomes a single thing (body, mind, fatherland, Leader) ... necessarily loses the in of being-in-common.
Or, it loses the with or the together that defines it. It yields its being-together to a being of togetherness. The truth of community, on the contrary, resides in the retreat of such a being.”
Key Theme: Liminality vs Community
Giorgio Agamben – La comunità che viene (1990) –
The Coming Community (1993)
A philosopher of the threshold – he has written on indeterminate being, infancy, potenza, potentiality
Culture of Origin
Enculturation
Host Culture
Acculturation
Positive
Negative
Negative and Positive Conceptions
of Cultural Encounters
Negative conceptions
Shock
Trauma
Anxiety
Mourning
Overall theme –Dislocation and loss
Positive conceptions
Surprise
Learning
Delight
Celebration
Overall theme –Discovery and growth
A STRANGER IN THE FAMILY
Culture, Families, and Therapy
(NY: W.W. Norton, 1997)
Elements of CFT
Milan Sytemic Positive connotation Family Therapy
Tom Andersen Reflecting team
Tobie Nathan “Bombardementsémantique”
Mikhail Bakhtin Dialogism
Emmanuel Levinas Face-to-face encounter
Key Aspects Cultural Family Therapy
CFT is a cultural encounter
CFT examines the presenting culture
CFT generates a subjective perspective
CFT adds cultural complexity to family therapy
CFT deals with rapid culture change
CFT is itelf a cultural product
Clinical ToolsCultural Family Therapy
Tool
Spirals
Masks
Roles
Codes
Cultural Strategies
Bridges
Stories
Suture
Explanation
Meeting strangers
Cultural camouflage
Insiders & outsiders
Translation – Cultural & therapeutic
Adaptation & acculturation
Family life cycle in cultural context
Narrative – the garden of forking paths
CFT as story repaire
UM ESTRANHO NA FAMÍLIA
Cultura, Famílias e Terapia
(Porto Alegre: ArtMed, 1998)
Taking Stock To sum up, suturing a number of concepts and practices
together –
The family as a storying culture where narrative (Bakhtin’s dialogism) and culture (anthropology) are privileged
liminality is acknowledged and threshold people in transitional states (Victor Turner) become more visible and more present to us
in the face-to-face encounter (Levinas)
where witnessing (Primo Levi, Agamben, Richard Mollica) is possible for the re-signification of past experiences (Freud/Lacan, Michael White)
Therapy as Translation
All therapy is a form of translation –
of language, of culture,
and of family process.
Ref: Beyond Babel: Family therapy as cultural translation. Int J Fam Psychiatry, 1986, 7(2): 179-191.
Perdido na tradução: Tradutor da Google anuncia festival do clítoris
Lost in translation: Google translator announces clitoris festival
Therapy as Translation
Cultural Translation
Therapeutic Translation
Ref: Beyond Babel: Cultural and therapeutic translation. In: A Stranger in the Family (1997)
Cultural Translation The elucidation of an individual’s or a family’s
idioms of distress, explanatory models of illness, and perceived predicaments
using:family members, culture brokers, and other informants, including language translators,
in a collaborative effort.
Ref: Chapt 4: Beyond Babel: Cultural and therapeutictranslation. In: A Stranger in the Family (1997)
Therapeutic Translation
Rendering an individual’s or a family’sidioms of distress, explanatory models of illness, and perceived predicaments
into therapeutic idioms.
Ref: Chapt 4: Beyond Babel: Cultural and therapeutictranslation. In: A Stranger in the Family (1997)
Threshold Therapy
When applied to
children and families undergoingrapid culture change, and
the study of liminal people and transitional states,
cultural family therapy may be calledthreshold therapy.
Threshold TherapyThe objectives of studying liminal people and
transitional states are to:
1. Identify the conditions of culture change
2. Study its impact on children (“cultural changelings ”) and the famly life cycle
3. Catalogue patterns of adaptation to culture change
4. Recognize psychiatric disorders that emergefrom conditions of culture change
5. Construct models of identity formation and culture change
Famiglie Immigrate e
Psicoterapia Transculturale (2004)
Transcultural
Issues
in
Child
Psychiatry
(1992)
“Looking Across at Growing Up”
Working with children and their familiesacross cultures, especially during periodsof cultural transition, is a complex andchallenging task requiring knowledge ofchildren’s normal growth and changeunder stable circumstances in theirculture of origin and their host culture as well as their adapational difficulties acrosscultures.
Transcultural Child Psychiatry What “changelings” can teach us
• “Changelings” – Defining transcultural childpsychiatry
• “Cultural blindspots” – Gaps in current thinkingand practice in working with children acrosscultures
• “On the threshold” – A call for more studies ofchildren in cultural transition.
“A 3-Sided Puzzle” –Kids, Families, Culture
While child specialists often expressinterest in families, differential rates ofcultural adaptation among the members ofa family confound the perception andorigins of children’s problems.
Dèyè Chak Timoun
“A 3-Sided Puzzle” –Kids, Families, Culture
Moreover, the difficulties of adaptationduring times of cultural transition are inadequately conceptualized, poorlydocumented, and often trivialized as transitional problems of adaptation orignored altogether under the rubric ofyouthful “resilience.”
Dèyè Chak Timoun
“A 3-Sided Puzzle” –Kids, Families, Culture
In the vocabulary of psychology, psychiatryand other health care discourses, theseproblems can be summed up throughthree complex lenses, a veritable 3-sidedpuzzle:
children (development) family (attachment, relationships,
transmission) culture (the context for the first
enculturation and subsequentacculturations of children)
Dèyè Chak Timoun
Maya: A Cultural Changeling
“Behind every child is a family and a culture.”
Adolescent – 16 years
Ambiguous, ambivalent, fluctuatingidentity
Charming/attachante
Dèyè Chak Timoun
Maya: A Cultural Changeling
“I’m American”
or
“I’m bisexual”
Family
Culture: Identity vs Belonging
• Haiti
• USA
• Montreal
Dèyè Chak Timoun
Maya lives an ongoing process of change, adaptation …
Maya: A Cultural Changeling
• Haïtienne/“American”/québecoise
• Mother: older, single parent, déracinée
• Evangelical Christian who reads the Bible daily
• Bible reading and prayer are sources of comfort and healing
Family
Family Culture
Dèyè Chak Timoun
Maya: A Cultural Changeling
• School:
Équipe ad hoc / “Ad hoc team” (en français)
• Social services:
CLSC team – SMJ – Santé mentale jeunes –Youth Mental Health (en français, anglais et créole)
• Health care services:
Child & Adolescent Psychiatry (ER, Outpatient, Inpatient)
(en français, anglais, créole)
Family
School, Social and Health Care Services
Dèyè Chak Timoun
Maya: Psychiatric Diagnoses
Outpatient Psychiatry:
• Dx Deferred – no evidence of psychotic disorder or ODD
• Parent-child relationship problem
• Possible search for sexual identity
Inpatient Psychiatry:
• Schizophreniform Disorder
• Borderline intellectual functioning
Neuropsychology:
• Dyslexia,
• Language Acquisition Disorder
Speech Therapy:
• Severe language disorder
Dèyè Chak Timoun
Maya: Psychiatric Diagnosis
Family
Narratives of suffering, Beliefs, rituals
• “Psychiatric problems
belong in the asylum”
• Prayer and Bible readingare healing
Culture
Explanatory models
• Haitian Creole culture
• Religion
Dèyè Chak Timoun
Maya: Predicament
Family CultureCultural
translation
• Haiti (parents)
• Miami (birth)
• Montreal (since age of 10)
Dèyè Chak Timoun
Therapeutic
Therapeutic
translation
• Parent-childconflict
• Attribution
re: illness andrecovery
• Alien and alienatingsymptoms
• Lack of insight in psychosis
• unawareness
• misattribution
Maya: PredicamentDèyè Chak Timoun
Therapeutic Translation
“The Kraepelinian paradigm encouraged an ‘us’ and‘them’ distinction between the mad and the sane ... [yet] we are mad to varying degrees, ... theboundaries of madness are subject to negotiation, and... some of us get on very well despite being (in psychiatric terms) quite psychotic for much of thetime.”
– Richard Bentall, Madness Explained (2004, p. 496)
Maya: PredicamentDèyè Chak Timoun
Therapeutic Translation
There are two sources for this paradigm ...
• Emil Kraepelin’s categorical classification
• Karl Jaspers’ phenomenological psychiatry
which established psychosis as
incomprehensible due to an unbridgeable
empathic chasm between psychiatrist and
psychotic patient
Maya: Predicament Dèyè Chak Timoun
“[T]he trouble is, you want to cure hallucinators, whereas I want to liberate them. I think they are likehomosexuals in the 1950s – in need of liberation, notcure.”
“[W]hy not help some psychotic people just to acceptthat they are different from the rest of us? Fear ofmadness may be a much bigger problem thanmadness itself.”
– Richard Bentall, Madness Explained (2004, p. 511)
Therapeutic Translation
Mikhail Bakhtin
(1895-1975)
Philosopher
of dialogism
• Dialogism• Heteroglossia• Intertextuality• Interior discourse
is social & historical
Multiples, Multiplicity & The Multitude
Letters to a Young Therapist
Relational Practices for the Coming Community
(New York: Atropos, 2011)
Face à
faceLa plénitude de l’amour
du prochain, c’est
simplement d’être
capable de lui demander :
« Quel est ton
tourment? »
- Simone Weil,
Attente de Dieu (1942)
The Event
Alain Badiou
(Born in Rabat, 1937)
Philosopher of
the Event
• L’Être et l’événement (1988)
• Being and Event(Trans, 1995)
Being and EventTrauma and Event
• Radical disjuncture between being and event
• Radical disjuncture between trauma and event
The philosophy of the Event is
a theory of change
Trauma
L’enfance est un couteau planté dans la gorge. On ne le
retire pas facilement.
– Wajdi Mouawad, dramaturge
Multiples, Multiplicity & The MultitudeI see humanity as a family that has hardly met.
—Theodor Zeldin
We are still strangers to each other.
That is why the stranger at the gate, as much as the neighbour and the friend, the face of the other …continue to pose the critical aporias for a relational psychology and an evental psychiatry
Multiples, Multiplicity & The Multitude
ON THE THRESHOLD
Selected Papers of Vincenzo Di Nicola, MD, PhD
Volume I: Children, Families,
and Culture Change
Edited with an Introduction by Armando Favazza, MD, MPH
Atropos Press2016
Multiples, Multiplicity & The Multitude
ON THE THRESHOLD
Selected Papers of Vincenzo Di Nicola, MD, PhD
Volume II: The Body and
Culture Change
Edited with an Introduction by Barton Blinder, MD, PhD
Atropos Press(forthcoming)
Bibliography Di Nicola, V.F. Le Tiers-monde à notre porte : Les
immigrants et la thérapie familiale, Systèmes Humains,1(3), 1985, pp. 39-54.
Di Nicola, V.F. De l’enfant sauvage à l’enfant fou : A prospectus for transcultural child psychiatry. In Grizenko, N., et al. (ed.), Transcultural issues in child psychiatry.Montréal, Éditions Douglas, 1992, pp. 7-53.
Di Nicola, V.F. Ethnocultural aspects of PTSD and related disorders among children and adolescents. In Marsella, A.J., Friedman, M.J., Gerrity, E.T. & Scurrfield, R.M. (eds.), Ethnocultural aspects of posttraumatic stress disorder: Issues, research, and clinical applications. Washington, DC, American Psychological Association, 1996, pp. 389-414.
Bibliography
Di Nicola, V. A Stranger in the family : culture, families and therapy. New York: W.W. Norton & Co., 1997.
Di Nicola, V. Famiglie sulla soglia. Città invisibili, identità invisibili. In: Andolfi, M. (ed.), Famiglieimmigrate e psicoterapia transculturale. Milano: FrancoAngeli, 2004, p. 34-47.
Di Nicola, V. Letters to a Young Therapist: Relational Practices for the Coming Community. Foreword by Maurizio Andolfi. NewYork: Atropos Press, 2011.
Bibliography
Di Nicola, V. Family, psychosocial, and cultural determinants of health. In: Sorel, Eliot, ed., 21st
Century Global Mental Health. Burlington, MA: Jones & Bartlett Learning, 2012, pp. 119-150.
Mollica, R.F. Healing Invisible Wounds: Paths to Hope and Recovery in a Violent World. New York: Harcourt, International, 2006.
Acknowledgements
Turku, Finland
Dr. A.M Ghadirian
Dr. Tewfik Said
Supervisors in Family Therapy:
Dr. Gerry Wiviott
Dr. Ronald Feldman
Dr. Gaby Weiss
Mentors in Cultural Psychiatry:
Dr. Laurence Kirmayer
Dr. H.B.M. Murphy
Dr. Raymond H. Prince