|
|
|
|||||||
|
|
    |
|||||||
|
PSYCHIATRISTS
AND HEALERS: UNWITTING PARTNERS ____________________________________________________________ |
|
|||||||
MAY 18-21, 2005, QUITO, ECUADOR |
|
|||||||
Accepted Abstracts The following abstracts have been aproved by the Scientific Committee.
Many thanks to our colleagues from Russia whom submitted abstracts but were unable to attend the TPS symposium in Quito. Their contributions are listed below.
A
CROSS-CULTURAL REVIEW OF THE PSYCHIATRIC SERVICE AND MENTAL HEALTH
ISSUES IN THE PROVINCE OF BINH DIN, VIETNAM, WITH SPECIAL REFERENCE TO
RELIGIOUS BELIEFS AND TRADITIONAL HEALING Charles
Whan MBBCh BAO, Dip Obst, JCTG, FRANZCP, Consultant Psychiatrist and
Senior Clinical Lecturer, Canterbury Health Board, New Zealand. Kate
Gibson, Senior Psychiatric Nurse Aims.
To review how mental illness and mental health issues are managed in the
province of Binh Dinh, Vietnam. Method.
On a two week visit in April 2004, supported by the New Zealand-
Vietnam Health Trust, we reviewed the full range of mental health services
in the region, with special reference to the contextural role of
Vietnamese religions, political beliefs, and traditional healers Results.
We have produced a report outlining the current structure of the mental
health services and how in particular these relate to the Qhui Nhon
district hosptial and community Health Centres. This includes a review of
how mental illness is perceived and managed both in the general
community and the public system. We have also indicated ways to
improve care following the idenification of strengths and weakness in the
current system. Conclusion.
There is an effective mental health infrastructure in the region although
issues of stigma regards psychiatric illness, little integration with
other sectors, and limited public psychoeducation, all continue to
compromise identification and mangement of mental health issues. References. 'Left behind, a mental health crisis' Time magazine, Nov 2003, p42-51 'Attitudes
of the Vitenamese community to mental illness' O'Lien, Australian
Psychiatry, vol 1 no 3, Aug 93
A WESTERN PSYCHIATRIST AMONG THE SHUAR PEOPLE OF ECUADOR Joan
Obiols-Llandrich During
two summers, an anthropological-psychiatric field research was conducted
among the shuar people of the Upper Amazonian area of Ecuador. The shuar
–known as jívaro- maintain their traditional way of life living in
small communities inside the forest. The research dealt in the beginning
with the shamanistic practices kept by the shuar with the hallucinogenic
compound known as nate’m or ayahuasca. Besides the anthropological
description, several EEG recordings were made, both to shamans and
volunteers pre and post nate’m ingestion. In
the following year, the research was centered in the use of western
instruments to screen both neurotic and psychotic syndromes. The
contradictory results will be presented. Some
issues as the apparent low incidence of schizophrenia among the shuar and
the high rate of stress related neurotic symptoms will be discussed. (A
video –around 15 minutes will be presented )
Poster
HEALERS' MEDICINAL KNOWLEDGE:
THE NEED FOR CULTURALLY ADAPTED PATENT CRITERIA
Sioui
Maldonado Bouchard, B.Sc. Psychology (in completion), McGill University,
Montreal, Canada. Aims.
The advancement of medicine has repeatedly benefited from traditional
healers' knowledge, without duly acknowledging it. It is imperative
that indigenous medicinal knowledge be recognized as intellectual
property, be respected legally and protected by ethics boards.
Method.
We present a review of case study series: (1) The Amazonian
people’s successful biopiracy case brought to U.S. court and won in 1999
to have Miller’s 1986 patent of Ayahuasca revoked; (2) The past
untackled case of the cinchona bark (quinine) used for malaria treatment,
and (3) A possible future case, the phantasmal poison dart frog
(Epipedobates tricolor, analgesic more potent than morphine by a
hundred-fold.)
Results.
Arguments are presented showing how indigenous South American traditional
healers’ knowledge accelerates the creation of new effective drugs by
decreasing trial-and-errors of research and allowing for new uses of
natural resources. We suggest that a re-evaluation of patents'
criteria is needed. The ones currently held were conceptualized by and for
western societies, and these (Novelty, non-obviousness and utility
requirement) are in frequent cases inapplicable to indigenous contexts.
Conclusion.
With such evidence of the utility and contributions of healers'
medicinal knowledge to the advancement of scientific knowledge despite its
failure to meet current patent criteria, we argue that these must be
revised and be culturally adapted.
References.
Borchardt, JK. Native American drug therapy: United States and Canada.Drug
News Perspect. 2003 Apr;16(3):187-91.
BRINGING
TOGETHER TRADITIONAL AND WESTERN MEDICINE: A UNIVERSITY
INITIATIVE Dan
Lamla Mkize, MB ChB, DCH
(SA),MFGP (SA), DFM (SA), M Med (Psych) (Natal). Professor of
Psychiatry, Univeristy of KwaZulu-Natal, Durban, South Africa. The
history of medicine and heatlh care in Africa is shaped by complex
socio-political and economic processes. Like many people throughout
the world, Africans, from time inmemorial, developed their own health and
healing systems including ways of diagnosing, classifying and treating
diseases and illnesses. Traditional
healers drew on extensive knowledge of healing methods and materials
accumulated and passed down from one generation to the next and based upon
complex socio-cultural and religious beliefs and systems. Today,
both the African Health Care System (AHCS) and the Western Health Care
System (WHCS) exist side by side and are utilized by the African
population, each catering to the needs of the individual and the
community. As we enter the African century, health related trends should include an
increased recognition of the benefits of adopting a variety of approaches
to diagnosis and healing; achieving and maintaining wellness through the
use of natural, mental and spiritual influences, in addition to
pharmacological and surgical remedies. This
paper discusses the University of KwaZulu-Natal's approach to bringing
together the traditional and western practices.
Factors
associated with use of traditional healers in American Indians and
Alaska Natives: implications for future research and policy Jeffrey A. Henderson, M.D., M.P.H., President & CEO, Black Hills Center for American Indian Health, Rapid City, South Dakota, United States Aims:
To examine factors influencing traditional healer utilization among
American Indians and Alaska Natives, and discuss the subsequent
implications for both research and policy. Methods:
A cross-sectional analysis of data collected as part of the Survey of
American Indians and Alaska Natives (SAIAN), a unique oversampling within
the larger National Medical Expenditure Survey. SAIAN is a random
probability sample of ~2000 American Indian and Alaska Native (AIAN)
households in which at least one adult was Indian Health Service-eligible.
Results:
The overall prevalence of traditional healer use in this cohort was 4.9%.
In a multivariate analysis English as a second language, education beyond
12th grade, participation in native social occasions, chronic disease
count, and disability bed-days were significantly related to traditional
healer use. Conclusion: Several important factors were associated with traditional healer use, though the very low prevalence of use of traditional healers by this cohort deserves explanation. Just as important are the implications of these findings both for future research on traditional healing and AIAN health care delivery, access, and utilization.
Micol
Ascoli, Consultant Psychiatrist, East London and the City Mental Health
NSH Trust, London, UK
Aims.
About one hundred millions of people in the world are followers of the
Catholic Charismatic Renewal. In Italy this cult, called “Renewal in the
Spirit”, counts more or less three hundred thousand faithful who gather
for religious healing purposes. The healing is lead by animators who, upon
completion of a long spiritual journey within the community, have the
following gifts (“charisma”), which are specific to charismatic
prayer: prophecy, the “gift of language”, the gift of interpretation,
the language of knowledge and science, discernment, and healing. In this
paper, the author analyses: 1.
the therapeutic procedures of Charismatic Catholics as they are displayed
within the groups reunions 2.
the therapeutic mechanisms entailed in these procedures, resulting in
healing 3.
the undermining conception of illness of these religious groups and its
differences with the one of modern medicine 4.
the differences between these religious healing practices and modern
western psychotherapies, according to different definitions of the
latters. 5.
the differences between religious healers and psychotherapists in western
societes.
References.
Tseng W.S "Handbook of Cultural Psychiatry, Academic Press, San
Diego, 2001; Kareem J., Littlewood R. "Intercultural therapy",
Blackwell Science, Oxford, 1992
TOWARD
MULTICULTURALISM; IS BI-NATIONAL IDENTITY POSSIBLE? Ronald
Wintrob, MD., Brown University, Providence, RI, USA. The
twentieth century could be characterized as one of wave after wave of
internal displacement, migration and emigration; followed by the social,
financial and emotional turmoil of resettlement, and ultimately,
acculturation. This
complex process shows every sign of continuing as far into the 21st
century as political scientists, demographers and social scientists can
foresee. Accordingly,
psychiatrists of the 21st century need to be prepared to treat populations
that will be even more multi-national, multi-ethnic and multicultural. This
presentation addresses an issue that is intrinsic to migration and
acculturative stress, but has been little studied; that of the quite
recently recognized phenomenon of bi-national identity formation. The
concept is based on the ability of some migrants to maintain close and
continuous affective, business, professional and even political ties with
their homeland of origin, at the same time as they go through the process
of acculturation and integration in the country to which they have
emigrated. Case
examples will be presented and both the theoretical and clinical
implications of bi-national identity will be discussed.
TRADITIONAL VERSUS FORMAL APPROACHES TO DOCTOR-PATIENT RELATIONSHIP IN PSYCHIATRY Vijoy K. Varma, Professor of Psychiatry, Columbia University, New York, USA, Indiana University, Indianapolis, USA, and Postgraduate Medical Institute (Retired), Chandigarh, India. Modern clinical psychiatry developed, along with psychoanalysis and psychotherapy, at a particular epoch in history in a certain part of the world. The setting was central Europe and the age Victorian. It subsequently was extrapolated to North America, and only much later to other parts of the globe. As such, it imbibed the cultural ethos and norms and the social mores and organization of the era and the place of its inception. The doctor-patient relationship also developed deriving from the social and professional relationships. It took from the European and North American norms, based on formality, distance between individuals, individual autonomy, and self-rights and prerogatives, the concept of confidentiality, etc. Health care became formalized and professionalized to address only to specific needs. As opposed to West, in the traditional societies of Asia and Africa, all relationships are multi-dimensional, subserving a myriad of functions. The same applies to a doctor-patient relationship. The doctor has been and remains a friend, philosopher and guide, a wise person, a village elder, and a benevolent senior, as also a family member. His objective is to help in all possible ways, to total growth, development and actualization, and not just in the narrow confines of the illness. There is a clear need to take cognizance of cross-cultural differences in doctor-patient relationship, so that various cultures can benefit from each other’s model and experience.
Why
Indigenous Healers Should Collaborate with Psychiatrists in the
Americas? Mario
Incayawar, M.D., M.Sc., D.E.S.S., Director Runajambi (Institute for the
Study of Quichua Culture and Health), Otavalo, Ecuador
Aims.
The scarcity of mental health programs serving the Indigenous Peoples
is alarming in Latin America. We attempt to take a critical look at
the colonial roots of this disparity and neglect. Method.
A review of some socio-economic and historical factors affecting the
mental health status of the Indigenous Peoples of the Americas. Results. Indigenous Peoples are poor, dispossessed, and powerless throughout the Americas. Mental disorders and psychological suffering are widespread but receive little or no attention by the dominant governments. We present biomedical and psychiatric arguments for promoting the collaboration of traditional healers and psychiatrists. Furthermore, the Indigenous Peoples’ mental health initiatives seem to favor the collaboration of healers and doctors as a key element for building culturally appropriate mental health services for Amerindian communities. Finally, we present Jambihuasi an innovative health care service in the Andes that combines Quichua traditional medicine with Western medicine, and enjoy broad acceptance by Quichua communities. Conclusion. Partnerships of healers and psychiatrists could be a good mental health care strategy for Amerindians living in poor countries in the Americas, where mental health services and resources are almost nonexistent. References.
Krippner, S. Some contributions of native healers to knowledge about the
healing process. Int.J Psychosom; 40:96-99,
1993.
CONTEXTUAL ISSUES IN TRADITIONAL LAKOTA SIOUX HEALING: A PROPOSED STUDY Jeffrey
A. Henderson, M.D., M.P.H., Spero M. Manson, Ph.D., President & CEO,
Black Hills Center for American Indian Health, Rapid City, South Dakota,
United States Objectives.
To examine notions of efficacy as understood by traditional Lakota Sioux
healers, their patients, and the patients’ extended family members. Background.
Despite over a century of anthropological study among American Indians,
including the Lakota Sioux, surprisingly little is known about the concept
of efficacy as it relates to traditional healing encounters. The author
argues that this concept must be fully understood and characterized,
before studies can begin to look directly at the actual healing practices
themselves, and especially before any randomized, controlled studies
(RCTs) can be conducted. Methods.
A variety of qualitative methods will be used to explore the concept of
efficacy, including key informant interviews, focus groups, and direct
observation. Healing through both spiritual and herbal means will be
examined. Conclusions. The successful conduct of this study and characterization of efficacy should provide a firm foundation upon which future studies of discrete traditional healing interventions among the Lakota Sioux may be based.
NON-PHARMACOLOGICAL APPROACHES TO THE TREATMENT OF NEUROTIC AND PSYCHOSOMATIC DISORDERS Vijoy K. Varma, Professor of Psychiatry, Columbia University, New York, USA, Indiana University, Indianapolis, USA, and Postgraduate Medical Institute (Retired), Chandigarh, India. The limitations and complications of pharmacological approaches are becoming increasingly apparent, particularly in psychosomatic and neurotic disorders and notably so in preventive and promotive roles. As such, there is increasing emphasis on non-pharmacological approaches such as yoga, various types of meditation, including transcendental meditation and relaxation techniques, such as autogenic training and breathing relaxation. Furthermore, non-pharmacological treatments have the added advantage of greater acceptance and freedom from side-effects. In a study, we found yoga to be effective in the treatment of chronic neuroses, favourably influencing neuroticism, anxiety, depression and disability. Other studies reported from my Institute and from elsewhere in India have found yoga to be effective also in the treatment of tension headache, hypertension, bronchial asthma and in the promotion of well-being. In a study comparing non-pharmacological approaches with anti-anxiety medication in the treatment of Generalized Anxiety Disorder (GAD), we found that autogenic training and breathing relaxation produced at least as much reduction in the anxiety score as drugs. The WORKSHOP will present the methods of autogenic training, breathing relaxation training and YOGA, with practical demonstration, and will present and discuss the findings to highlight the role and advantages of these non-pharmacological approaches in therapeutic, preventive and promotive goals.
LEGITIMACY
AND TRADITIONAL INDIAN HEALING Jeffrey A. Henderson, M.D., M.P.H., Spero M. Manson, Ph.D., President & CEO, Black Hills Center for American Indian Health, Rapid City, South Dakota, United States Objective.
To examine recent actions that relate to use of traditional healing and
the relationship of classic legitimacy theory (Weber) for such use,
including attempts to integrate traditional healing systems with
allopathic medicine. Methods.
A PowerPoint presentation of key concepts, allowing time for a Q&A
period. Conclusions. Attempts to integrate traditional healing systems and/or methods with allopathic medicine (i.e., biomedicine) carry both promise and peril, particularly with respect to the different sources and types of legitimacy that underlie each system. If aware of such issues, individuals involved in the dialogue about integration will be more sensitive to potential perils for the traditional healing systems, and thus be in a position to act with greater cultural sensitivity.
DO
YACHACTAITA (QUICHUA HEALERS) HAVE CLINICAL SKILLS TO
IDENTIFY MENTAL DISORSERS? Mario Incayawar, M.D., M.Sc., D.E.S.S., Director Runajambi (Institute for the Study of Quichua Culture and Health), Otavalo, Ecuador. Aims.
Traditional healers practices are widespread around the world.
Yet their diagnostic skills have been scarcely studied. We present
suggestive data on the psychiatric case identification ability of
yachactaita (Quichua healers).
Method.
Over 18 months, ten yachactaitas participated in a study in the
identification and recruitment of 15 patients suffering from llaqui, a
Quichua illness category.
Results.
The clinical evaluation (physical and psychiatric), including the
administration of Zung's depression scale indicates that patients labeled
with llaqui are suffering from mental disorders and physical diseases.
Eighty-two percent of patients made the DSM III-R criteria for depressive
disorders; 44% for somatoform disorders; and 40% for anxiety disorders.
Over 80% of them were also suffering from infectious and parasitic
diseases. None of the patients suffering from llaqui were considered
normal in Western medical or psychiatric terms.
Conclusion.
It is suggested that yachactaitas could be competent diagnosticians,
skillful in identifying psychiatric cases in the community. The
healers’ diagnostic abilities could be useful in the design and
implementation of epidemiological and public health programs as well as
the provision of mental health services in poor countries, such as
Ecuador.
References.
Bastien JW. Healers of the Andes - Kallawaya herbalists and their
medicinal plants. Salt Lake City: University of Utah Press, 1987. Westermeyer J, Zimmerman R. Lao folk diagnoses for mental disorder: comparison with psychiatric diagnosis and assessment with psychiatric rating scales. Med Anthropol 1981; 5:425-443.
Challenges
to building national mental health programs Semke
V.Ya. SI Mental Health Research Institute TSC SB RAMSci, Tomsk, Russia Conducted
throughout long time monitoring of mental health of aboriginals and
population-epidemiological analysis testify to high prevalence among
native population of the Asian North of borderline neuro-mental disorders
and alcoholism. Their clinical picture differs by essential variety having
its roots in ethnogenesis and culturogenesis of the people in question.
Traditional criteria of diagnosis and identification of mental health
level of studied ethnoses have a relative value and must be revised with
account for clinical-dynamic, cultural, social, demographic, ethnic and
regional peculiarities. It is obligatorily needed to review the limit of
mental norm, notion of normative behavior, which not always correspond to
the European ones. From the same positions strategy of psychiatric and
addictological assistance rendering needs to be reformed, first of all on
the way of dialectic combination of principles centralization and
decentralization (with account for low density of the population of the
regions). Theoretic significance and practical value of distinguishing the
“risk group” and of so called premorbid states as well as prognostic
criteria of the progredientness of borderline and addictive states are
exactly outlined. During development of preventive activities, the entire
complex of interacting biological, psychological and sociocultural
peculiarities of the population should be taken into account. They should
be flexible and not to violate human rights: it concerns especially the
peoples of the Asian North with account of their ethnocultural traditions. Two
ways of consideration the shaman’s personality Bokhan
N.A. SI Mental Health Research Institute TSC SB RAMSci, Tomsk, Russia Phenomenon
of acculturation in northern mongoloids leads to various mental disorders,
first of all to alcohol abuse. Characteristic peculiarity developed by
centuries and maintained in rudimentary form up to present time in ethnos
was traditional religious-mythological system in which basis of attitude
was ideology of a shaman. Ritual of shamanism and its psychotechnique were
necessary and always were useful for archaic society. Personality of the
shaman proper was considered by the civilized society in two ways: shaman
– mentally ill, suffering from mental disorders (epilepsy,
schizophrenia, psychopatia etc.), on the other hand, shaman – the first
psychotherapist, an prototype of all the psychotherapists. Northern
mongoloids are not inclined to seek a doctor for treatment of
psychopathology and alcoholism. Probably, their archaic thinking
taking its roots in far past is a anosognosic determinant to present
psychopathology in population as a whole. In particular,
psychiatrists-clinicians if they are not familiar with ethnocultural
peculiarities have difficulty to understand mental deviations within
nosology. Hystoriogenesis, archaic thinking and syncretic ritual happening
still live in the ethnos, what must be taken into account in the
clinic of mental diseases and methodology of preventive
programs. Division
of shaman’s kamlanie into its constituting phases and identification
of purposefulness of his actions Tolstobrova
S.V., Semke V.Ya., Bokhan N.A. SI
Mental Health Research Institute TSC SB RAMSci, Tomsk, Russia Aim: To compare the ritual of shamans’ kamlanie belonging to various nationalities (mostly, regions of Siberia and Far East). Method: Review of the literature. Results:
In spite of variety and principal improvisation of the ritual of kamlanie,
the basic scheme was repeated. Ritual of the shaman in one case
represented by itself a magic action (Ergis), in the other, silent, to
himself dialogue of the shaman with a spirit - lord of all the words
from whom he obtains all the causes of the illness (Ionov) and in the
third a whole kamlanie beginning from declaration of the illness and call
of spirits-helpers and finishing with administration of the treatment and
dissolution of the spirits (Ksenofontov). Ergis
magic action Ionov question answer Ksenofontov
call guess
administration dismissal
work of
of
treatment spirits Conclusion:
Basic task of this process is removal of the source of the illness out of
the body of the patient (Selkups) what is characterized.
Trauma Recovery in War-Torn Africa: Incorporating Traditional Healing in Psychosocial Recovery Programs Leslie Snider, M.D., M.P.H., Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine In this presentation, the author will explore the roles of traditional healers in assisting the psychosocial recovery of African communities impacted by conflict. More than 90% of modern day wars are internal conflicts, waged increasingly against civilians rather than formal armies. Africa has been home to some of the most brutal wars of the past decade and 6 of the 10 largest refugee groups in the world in 1999 were in Africa. The tactic of these wars is the creation of states of terror that penetrate the entire fabric of social relations and subjective mental life of the community. Atrocities such as rape, torture, mutilation and interment become commonplace, and the deliberate targeting of social and cultural institutions deliberately aims to undermine the means by which people endure and recover from the suffering of war. Restoring post-conflict societies to health and well-being cannot be divorced from their psychological and social recovery. However, as biomedically trained mental health professionals have begun working in this area, the appropriateness and cross-cultural applicability of their diagnostic tools and treatments have been seriously questioned. The author will explore the limitations of western cosmologies in assisting communities in recovery from experiences that may be collectively felt and imbued with specific personal and cultural meaning. Indigenous healers play an important role in recovery approaches that honor cultural values, beliefs and particular meanings of those who have survived. They have assisted in burial rituals, cleansing ceremonies for rape victims and child soldiers to pave the way for their meaningful re-entry into society, and treatment of persons with addictions or severe trauma. In these settings, indigenous healers function not only as health practitioners, but also as guardians of native history, beliefs, culture, values and social order – all critical for the recovery of post-war societies.
BREVE APROXIMACIÓN - LOS PUEBLOS Y NACIONALIDADES INDÍGENAS DEL ECUADOR [The Indigenous Peoples of Ecuador - An Outline.] Gina
Maldonado Ruiz, M.A., Director, Kuntur Samay - Center
for Ethnocultural Research En esta presentación se realizará un viaje de breve aproximación al contexto geográfico, socio cultural e histórico de las nacionalidades y pueblos indígenas del Ecuador . Conoceremos a las 13 nacionalidades y 14 pueblos indígenas; sus idiomas, expresiones y manifestaciones culturales, organización sociopolítica y población. Ubicaremos
los territorios ancestrales de las nacionalidades y pueblos indígenas a
través de un recorrido general de la geografía ecuatoriana.
Descubriremos además, la riqueza natural de sus cuatro regiones; costa,
sierra, amazonia y región insular. La rica y exuberante riqueza cultural y natural del Ecuador hacen de el, un país único en su género y es hacia el que intentaremos acercarnos.
|
|
|||||||
| Hosted by Runajambi - Institute for the Study of Quichua Culture & Health | ||||||||
