Year : 2021 | Volume
: 3 | Issue : 3 | Page : 127--130
Anthropology, Social Psychiatry, and Mental Health
President, World Association of Social Psychiatry, Medical Referent of the Sigmund Freud University, Paris, France
Prof. Rachid Bennegadi
President, World Association of Social Psychiatry, Medical Referent of the Sigmund Freud University, Paris
The psychological assistance of a person requires a certain number of competencies: psychiatric competencies to comprehend neuropsychiatric disorders and psychotherapeutic competencies to discern psychological disorders or psychological suffering plus being able to take into account the social determinants. The author describes all the different approaches when it comes to provide ethical answer and help concerning migrants and refugees, focusing on social determinants and cultural references, without the risk of the stigmatization. All scientific approaches are available and it is important to insist on the necessity to train mental professionals to master this complex psychotherapeutic setting and to keep in mind a person centered approach.
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Bennegadi R. Anthropology, Social Psychiatry, and Mental Health.World Soc Psychiatry 2021;3:127-130
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Bennegadi R. Anthropology, Social Psychiatry, and Mental Health. World Soc Psychiatry [serial online] 2021 [cited 2022 Jul 4 ];3:127-130
Available from: https://www.worldsocpsychiatry.org/text.asp?2021/3/3/127/333420
The psychological assistance of a person requires a certain number of competencies: psychiatric competencies to comprehend neuropsychiatric disorders and psychotherapeutic competencies to discern psychological disorders or psychological suffering plus being able to take into account the social determinants.
My long clinical experience as a psychiatrist and anthropologist at the Françoise Minkowska Centre, a French institution where we receive migrants, their challenges of migration and refugees in an exile context, has allowed me to learn a number of primary facts. The mastery of many languages enabled an adequate level of communication, but I realized that plurilingualism does not guarantee a cultural competence.
My patients were mainly affected by their migration trajectories and the disarray of exile in a rather violent way. In addition, they encountered socioeconomic and administrative problems. The interference of these social determinants led me to establish a suitable support scheme for this population by involving as many social workers as possible to team up with the psychotherapists. This cooperation allowed us to tackle the problem in its true complexity.
The social psychiatry point of view of this issue intrigued me as much as transcultural psychiatry. I also realized that this was not just a theoretical problem. I do not mean to minimize the problem and to say that it is enough to be trained to be an expert in the matter, but the most helpful measure we took was the training of our psychotherapists in the assistance of migrants and refugees. I also realized an important concept in social psychiatry, the resistance of mental health professionals to anthropological and social discourses. The therapeutical care of a population that is more or less lost in French society requires a well-codified therapeutic framework.
We find two circumstances, first the patient and the therapist share a common language and second, they do not share a common language. In this case, it is essential to have a linguistic and cultural interpreter to complete the therapeutic framework. The presence of an interpreter is not just a matter of translation but a comparison of explanatory models and cultural references that the interpreter must be able to metaphorize simultaneously for the therapist and for the patient. This requires training and I had often noted the difficulties of this three-way communication that often impedes a coherent clinical framework.
An essential step to ensure an intercultural communication is to discuss with the interpreter beforehand. Moreover, the notion of countertransference is essential in this case, the fact that the therapist and the patient share the same language does not mean that they share the same cultural references.
So, what competences can one expect from therapists, psychiatrists, psychologists, or psychoanalysts?
There has been plenty of research literature on the matter, the World Psychiatric Association has a vast collection of transcultural psychiatry papers that bring to light the intricacies of the therapeutic framework. Furthermore, the work on social and cultural psychiatry of the University of Montreal done by Laurence Kirmayer shows that the social dimension cannot be divided from the cultural dimension. It is necessary to integrate both elements into the therapeutic framework. All ethno-psychiatric theoretical approaches have advanced the debate on “cultural specificity.”
Due to globalization, we have seen an increase in psychotherapeutic demand also because the access to mental health care is increasingly encouraged for people in precarious situations. Arthur Kleinman from Harvard University proposes a theoretical approach with a particular interest, the clinical medical anthropology.
The Interest of Clinical Medical Anthropology on Social Psychiatry
By differentiating “sickness, illness, and disease” as individual concepts, this approach allows us to integrate the social determinants (sickness) that impact the personality by allowing the patient to express his psychological suffering and his psychological or psychiatric disorders by means of his own cultural references and his explanatory models (illness). This allows the therapeutic framework to come together, I would like to emphasize that the therapist must be able, whatever his theoretical approach, to conceive an idea on the disorders of which his patients suffer along with establishing a diagnosis and an appropriate therapeutic indication (disease). The patient may encounter individual difficulties and not only culture and social related difficulties at each stage of this particular setting.
To avoid countertransference concerns, which unconsciously stigmatize or else, overvalue the patient, we must train therapists on this eclectic approach. It allows them and the patient to develop a person-centered framework in the most rewarding way.
The Practical Application and the Therapeutic Reality
How can social psychiatry integrate this person-centered approach without neglecting a therapy's neuroscientific, psychoanalytic, and psychiatric dimensions?
In today's context, with globalization and worldwide human migration, it is no longer possible to assess a person on a single cultural criterion. This universal approach of humanity is not only a humanistic theory but also a pragmatic humanism that respects the person and offers a competent mental health care.
If the therapist and the patient speak the same language, it will effectively allow the therapist to establish an easier-to-manage communication scheme compared to the given scenario where they do not share the same language or where the patient or the therapist does not master the metaphorical competences on the language they are speaking during therapy, thus creating discomfort (transference and countertransference). Any therapist who has had the opportunity to receive a patient who does not really speak the same language knows what I am talking about. This is why, when arranging a linguistic and cultural interpretation, it is necessary to prepare beforehand the first interview by explaining these different aspects. If not, the most frequent outcome is that the dialogue will become exclusive between the patient and the interpreter, leaving the therapist out of the discussion.
The Means that Society has, to Offer Quality Mental Health Care
Without the financial support to enable the therapeutic framework described above, either from an association or private funds, it would be difficult to incorporate the “cultural competences” to the social, psychological, and the anthropological dimensions. It is important to address this matter because it clearly states the therapist's training as one of the main elements of cultural competences.
This training should be included already in university programs or it should be a complementary apprenticeship financed by a given society. Nevertheless, it has become a Cornelian dilemma because of globalization and the current increase of demand in mental health care. We will have to endure with what is available but at the same time, it is impossible to deal with the high demand throughout online counseling. The social and transcultural psychiatry services will eventually become overwhelmed by a high demand, not because it is inadequate but because it requires previous training to be able to put in place an online therapeutic framework.
As important aspects of interpersonal relationship, how should we manage the transference and the counter transference in this case? What's the place for empathy?
Once again, we tend to neglect the access to information when receiving a patient through internet or social media. From one positive point of view, the acceleration of online communication is beneficial for online therapy, but it can also have a disturbing effect because of its pace. In the case of social psychiatry engaging in regular webinars and virtual conferences in the interest to synthesize all the social, anthropological, economic, and ethical determinants, it will have a federating effect while it refers to mental illness with a universal approach of humanity.
However, it seems that social psychiatry cannot accept this strategy regardless of its good will, getting unconsciously trapped by the risk of stigmatization or cultural complicity.
Psychoanalysis, originally founded by Sigmund Freud, is a very good example of an attempt to universalize a problem by using arguments in which all humans should recognize themselves. Even if Freudian concepts of the id, the ego, and the superego knew a true success, the oedipal problematic remains difficult for many theorists because the cultural references of Greek mythology are not necessarily shared by the rest of humanity. Furthermore, Freud's biggest success was to raise awareness about the psychological defense mechanisms of human beings. The Jungian approach and its theory of anima and animus remains very interesting, the current research in Lacanian and post-Lacanian psychoanalysis remains relevant in the debate on the functional capability of the brain and the psyche. Following the psychoanalytic research on the link between neurobiology and psychoanalysis, one must conclude that psychoanalysis remains pertinent regarding human's performance either of its brain, its psyche or its personality.
In addition, Boris Cyrulnik's enlightening work about the establishment of a secure attachment between mother and child on their earlier interactions must be taken into account when taking charge of the posttraumatic syndrome, because in case of trauma, it will allow the person to adopt a resilient posture. The most important point of this approach is that it complements, in a relevant way, the mobilization of energy from a vital impetus and the structure of personality to restore the meaning of a human life.
All of the methods mentioned in this book, which seeks to promote social psychiatry as a human and social science, show that it is important to appreciate clinical practices and clinical research because they enlighten us on the complexity of the mind.
It is also important to remember the cybernetic dimension of social psychiatry, especially the concepts “Transhumanism” and “posthumanism.”,
Finally, it is necessary to establish a relation between the appearance of the homo-cyberneticus and the anguish of death. These will be competences that will allow us to tell the fake news apart from scientific reality. We must not neglect the threat of digital addiction. Ultimately, the responsibilities of each discipline must be clearly defined. Social psychiatry should not disassociate the social dimension and the cultural dimension. It is therefore necessary to train all of the mental health professionals on this new epistemological dimension of social psychiatry by learning to master the changes caused by the new social and cultural paradigms.
To summarize the content of the ideas, projects, and observations, I would like to make a few statements.
The law of market is the one who actually decides the employability of the GAFA software (Google, Apple, Facebook, Amazon) without taking into consideration its impact on our mental health.
In this day and age, the debate over the impact of cybernetics on mental health revolves around the advocacy of transhumanism (improving human beings and increasing their skills and emotions) and posthumanism (disappearance of human beings in favor of humanoid structures).
Anyway, as far as we are concerned, it is important in the area of mental health to anticipate the disruptions that digital addiction may cause in people's daily lives, in their psychological care and in the process of psychotherapeutic care. Consciousness is built within every human being through love and protection of those who educate us, our parents, school, and society. None of us is “programmed,” we all have our own rituals and we have room to create our psychic and social lives. This implies a “right to error” that qualifies human beings as well as a constant search for “the truth” qualifies the human being. Transhumanism or posthumanism, where are we heading to with these new creatures created from cybernetics and meant to improve human intelligence? The question may seem ahead of schedule but the digital world is not moving at the same pace as the field of emotions.
Can we consider those who are not connected to social media as lonely? We have a million friends and at the same time we have no friends.
I suggest three mains plans for the future.
First: Maintain our professional strategies of communication with the WSP Journal, the WASP Newsletter, the website, and the webinarsSecond: Create a mobile Apps on Mental health and Social Psychiatry for mental health professionalsThird: Create a university diploma on “Social psychiatry and globalization.”
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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