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


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)


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.


Family Therapy

This exploration of the family is done in therapy when it is not possible elsewhereor otherwise.


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)


CFT weaves together:

family stories that express their mental and relational predicaments, and

conceptual tools for conducting clinical work


CFT is an ongoing update of our notions of:

family and therapy

culture and psychiatry


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)


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


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


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


“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 …


• 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


• 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


“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


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)


Mikhail Bakhtin

(1895-1975)

Philosopher

of dialogism

• Dialogism• Heteroglossia• Intertextuality• Interior discourse

is social & historical


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


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


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

From the Threshold to the Event: Thirty Years of Cultural Family Therapy - Allan Memorial Institute...

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