Laurence J. Kirmayer

McGill University | McGill · Division of Social and Transcultural Psychiatry

The article discusses the strengths and limitations of approaches to cultural competence in mental health services. Cultural competence has emerged as an important counter-balance to the movement for evidence-based mental health care, which tends to lead to a ‘‘one-size-fits-all’’ approach. Efforts within heath care systems to develop cultural comp...

Recent years have seen the rise of historical trauma as a construct to describe the impact of colonization, cultural suppression, and historical oppression of Indigenous peoples in North America (e.g., Native Americans in the United States, Aboriginal peoples in Canada). The discourses of psychiatry and psychology contribute to the conflation of di...

Current efforts in global mental health (GMH) aim to address the inequities in mental health between low-income and high-income countries, as well as vulnerable populations within wealthy nations (e.g., indigenous peoples, refugees, urban poor). The main strategies promoted by the World Health Organization (WHO) and other allies have been focused o...

Mindfulness meditation and other techniques drawn from Buddhism have increasingly been integrated into forms of psychotherapeutic intervention. In much of this work, mindfulness is understood as a mode of awareness that is present-centered and nonevaluative. This form of awareness is assumed to have intrinsic value in promoting positive mental heal...

While contemporary psychiatry seeks the mechanisms of mental disorders in neurobiology, mental health problems clearly depend on developmental processes of learning and adaptation through ongoing interactions with the social environment. Symptoms or disorders emerge in specific social contexts and involve predicaments that cannot be fully character...

Decolonial and liberation psychology aims to understand and address the social and epistemic injustices in our mental health systems, practices, and research agenda. To advance this goal, we advocate for deeper engagement with traditional healing systems practiced by various Indigenous Peoples and cultural groups around the world. In this article,...

Cultural psychiatry has documented wide variations in the experience and expression of mental distress around the world. Historically, these variations were often characterized in terms of “culture-bound syndromes”—distinctive patterns of co-occurring symptoms and signs that were assumed to be rooted in or “bound” to local cultural or contextual fe...

Ethnography begins with the recognition that people are deeply situated in local worlds that shape their experience and behavior. Ethnographic research, which employs experiential immersion and participant observation in a cultural context, can reveal the embedding and elaboration of experience through engagement with social institutions and practi...

This essay introduces a thematic issue of Transcultural Psychiatry presenting selected papers from the 2022 McGill Advanced Study Institute in Cultural Psychiatry on "The Fragility of Truth: Social Epistemology in a Time of Polarization and Pandemic." The COVID pandemic, political polarization, and the climate crisis have revealed that large segmen...

Purpose Social psychiatry considers the ways in which mental disorders are shaped by particular social environments. This paper outlines a cultural-ecosocial approach that emphasizes the ways in which cultural meaning and practices mediate the effects of the social determinants of mental health on the mechanisms of illness, disorder, and disease....

Recent challenges to scientific authority in relation to the COVID pandemic, climate change, and the proliferation of conspiracy theories raise questions about the nature of knowledge and conviction. This paper considers problems of social epistemology that are central to current predicaments about popular or public knowledge and the status of scie...

This essay is an introduction to the thematic issue of Transcultural Psychiatry in honor of the work of Michael Chandler and Christopher Lalonde, developmental psychologists who made essential contributions to the study of identity and wellness among Indigenous youth in Canada and internationally. We outline their major contributions and illustrate...

Mental disorders are increasingly understood as involving complex alterations of self that emerge from dynamical interactions of constituent elements, including cognitive, bodily, affective, social, narrative, cultural and normative aspects and processes. An account of self that supports this view is the pattern theory of self (PTS). The PTS is a n...

While the ubiquity and importance of narratives for human adaptation is widely recognized, there is no integrative framework for understanding the roles of narrative in human adaptation. Research has identified several cognitive and social functions of narratives that are conducive to well-being and adaptation as well as to coordinated social pract...

In this chapter, I explore the significance of poiesis for how we understand the articulation and elaboration of symptoms and illness experience and their transformation through healing practices. I begin with reflections on the distinctive nature of poetry and poetic expression and its relation to our capacities for linguistic expression in cognit...

The construct of cultural safety has been advanced as a way to improve clinical training and health services delivery for Indigenous Peoples. In this paper, we discuss its extension to the ethics, politics and practice of implementation research. We convened a three-day workshop, bringing together 23 Indigenous and non-Indigenous collaborators from...

Psychiatry has constructed its objects of concern, "psychiatric symptoms and disorders," as problems located within individuals, in their psychological dynamics and, increasingly, in their neurobiology. This warrants ongoing efforts to identify biological bases of psychopathology and corresponding treatments. However, there are many reasons to beli...

This issue of Transcultural Psychiatry presents selected papers from the McGill Advanced Study Institute on “Cultural Poetics of Illness and Healing.” The meeting addressed the cognitive science of language, metaphor, and poiesis from embodied and enactivist perspectives; how cultural affordances, background knowledge, discourse, and practices enab...

While the ubiquity and importance of narratives for human adaptation is widely recognized, there is no integrative framework for understanding of the functional roles of narrative in human adaptation. Research has identified several functions of narratives that are conducive to well-being and adaptation as well as to coordinated social practices an...

Scholarship on cultural idioms of distress sheds light on illness experience as complementing symptom-based nosological systems. At the same time, the recent salutogenic turn in health research has called for greater attention to processes of mental and physical wellbeing, including transcultural work on resilience and protective factors. A number...

The pandemic dramatized the close links among cognitive, mental, and social health; a change in one reflects others. This realization offers the opportunity to bridge the artificial separation of brain and mental health, as brain disorders have behavioral consequences and behavioral disorders affect the brain. The leading causes of mortality and di...

This chapter reviews the key principles of narrative medicine and its central importance for person-centered medical care. The last two decades have seen the emergence of narrative medicine as a complement to biomedical approaches. Narratives are the vehicles through which patients understand and communicate their health problems, past history, and...

Global migration is expected to continue to increase as climate change, conflict and economic disparities continue to challenge peoples' lives. The political response to migration is a social determinant of mental health. Despite the potential benefits of migration, many migrants and refugees face significant challenges after they resettle. The pap...

Psychiatry has increasingly adopted explanations for psychopathology that are based on neurobiological reductionism. With the recognition of health disparities and the realisation that someone's postcode can be a better predictor of health outcomes than their genetic code, there are increasing efforts to ensure cultural and social-structural compet...

Precision psychiatry has emerged as part of the shift to personalized medicine and builds on frameworks such as the U.S. National Institute of Mental Health Research Domain Criteria (RDoC), multilevel biological “omics” data and, most recently, computational psychiatry. The shift is prompted by the realization that a one-size-fits all approach is i...

In an essay in PPP, Emily Walsh explores the significance of memory for coming to grips with the enduring legacy of colonialism in psychiatry. She argues that “for reasons of self-preservation, racialized individuals should reject collective memories underwritten by colonialism.” Psychiatry can enable this process or collude with the structures of...

Psychedelics have been already used by human societies for more than 3000 years, mostly in religious and healing context. The renewed interest in the potential application of psychedelic compounds as novel therapeutics has led to promising preliminary evidence of clinical benefit in some psychiatric disorders. Despite these promising results, the p...

Social, cultural, and structural factors are associated with delays in seeking help from mental health professionals and poor treatment adherence among patients with mood disorders. This qualitative study examined the perspectives on the services and response to treatments of individuals diagnosed with Bipolar Spectrum Disorder (BSD) in Iran throug...

In Jewish tradition, the sacred books are hidden in an ark, the parchment scrolls curled into themselves and protected from the elements and the casual gaze of those not prepared to view the word of God. An esoteric tradition teaches that the world itself is a sacred scroll written by the hand of God with blac k fire on white fire. Like the cosmic...

As part of the National Action Alliance for Suicide Prevention’s American Indian and Alaska Native (AI/AN) Task Force, a multidisciplinary group of AI/AN suicide research experts convened to outline pressing issues related to this subfield of suicidology. Suicide disproportionately affects Indigenous peoples, and remote Indigenous communities can o...

Depression is now recognized as a global health problem, with estimates that it accounts for up to 10% of years lost to disability in developing countries (Desjarlais et al. 1995; Murray and Lopez 1997). Global disability due to depression has increased over the last two decades, especially for women (GBD 2017 DALYs and HALE Collaborators 2018). Gi...

This paper proposes an integrative perspective on evolutionary, cultural and computational approaches to psychiatry. These three approaches attempt to frame mental disorders as multiscale entities and offer modes of explanations and modeling strategies that can inform clinical practice. Although each of these perspectives involves systemic thinking...

This article introduces a thematic issue of Transcultural Psychiatry on suicide in cultural context. Developmental and social structural factors including exposure to violence, childhood abuse and privation, as well as intractable social problems that create psychic pain and a sense of entrapment have been shown to increase the risk of suicidal beh...

While some early studies suggested that spirit mediums were psychiatrically ill individuals who found a culturally sanctioned role, subsequent work has found that they are generally in good physical and mental health. While the calling to be a healer often involves an initiatory illness, practitioners go on to play demanding social roles, suggestin...

The value of understanding patients' illness experience and social contexts for advancing medicine and clinical care is widely acknowledged. However, methodologies for rigorous and inclusive data gathering and integrative analysis of biomedical, cultural, and social factors are limited. In this paper, we propose a digital strategy for large-scale q...

This article introduces a thematic issue of Transcultural Psychiatry with selected papers from the McGill Advanced Study Institute in Cultural Psychiatry on "Pluralism and Polarization: Cultural Contexts and Dynamics of Radicalization," which took place June 20-22, 2017. The ASI brought together an interdisciplinary group scholars to consider the r...

The Truth and Reconciliation Commission of Canada made it clear that understanding the historical, social, cultural, and political landscape that shapes the relationships between Indigenous peoples and social institutions, including the health care system, is crucial to achieving social justice. How to translate this recognition into more equitable...

Background Traumatic stress is a global mental health problem requiring novel, easily implemented treatment solutions. We compared the effectiveness and efficiency of Reconsolidation Therapy (RT) to the well-established antidepressant paroxetine, in reducing symptoms of traumatic stress among patients from Nepal, a low-income country. Methods Fort...

Gender differences in the prevalence of psychiatric disorders, with higher prevalence of mood and anxiety disorders among women, have been the focus of much debate. In Iran, the adoption of the construct of Bipolar Spectrum Disorder (BSD) and of the concept of “soft bipolarity” has been associated with a large gender difference in rates of diagnosi...

Recent events underscore the morbidity and mortality resulting from structural racism. As cultural specialists , we believe that clinical benefits will accrue from better integrating cultural and societal-structural approaches in psychiatric assessment, care planning, and case management. The Outline for Cultural Formulation (OCF) first appeared in...

This article introduces a thematic issue of Transcultural Psychiatry that presents recent work that deepens our understanding of the refugee experience—from the forces of displacement, through the trajectory of migration, to the challenges of resettlement. Mental health research on refugees and asylum seekers has burgeoned over the past two decades...

Culture and society shape the symptoms, course, and outcome of mental disorders. Cultural frames—including conceptual models, values, norms, attitudes, and practices— influence the experience and expression of psychological distress. These frames reflect community history, ethnicity, religion, gender, politics, and the identity of individuals in sp...

This chapter reviews the key principles of narrative medicine and its central importance for person centered medical care. The last two decades have seen the emergence of narrative medicine as a complement to biomedical approaches. Narratives are the vehicles through which patients understand and communicate their health problems, past history, and...

This chapter reviews the key principles of narrative medicine and its central importance for person centered medical care. The last two decades have seen the emergence of narrative medicine as a complement to biomedical approaches. Narratives are the vehicles through which patients understand and communicate their health problems, past history, and...

Purpose In light of the growing number of refugees and immigrants in Canada, this paper aims to identify barriers to mental health services for newcomer immigrants and refugees in Quebec and to examine how mental health services can be improved for these populations. Design/methodology/approach In this qualitative study, semi-structured individual...

This paper presents the first systematic case-control study of correlates of mass psychogenic illness (MPI) in an adolescent school population. MPI is generally construed as a dissociative phenomenon spread by social contagion to individuals who are prone to dissociation. We sought to test if the correlates of dissociative experiences most commonly...

This paper discusses the lessons learned from a partnership project on suicide prevention carried out with Inuit organisations in Nunavut and Nunavik. The aim was to identify research needs, processes, and opportunities for knowledge translation to guide suicide prevention activities. Key reflections among partners regarding regional needs and the...

Agency refers to the human capacity to choose, initiate, and control actions to influence events in the world. The experience of agency is fundamental to our sense of self but may be altered in certain neurological conditions and forms of psychopathology. In this chapter, we review recent work in cognitive neuroscience that shows how agency depends...

In this introductory chapter, we outline some conceptual building blocks for an ecosocial view of the co-construction of mind, brain, and culture. The brain is the organ of culture; mind and experience are processes located in loops of active engagement of brain and body with the social world. This engagement occurs on multiple time scales, from ev...

Recent neuroscience research makes it clear that human biology is cultural biology-we develop and live our lives in socially constructed worlds that vary widely in their structure values and institutions. This integrative volume brings together interdisciplinary perspectives from the human, social, and biological sciences to explore culture, mind,...

In this epilogue, we reflect on the prospects for advancing interdisciplinarity in the sciences of culture, mind, and brain. Neuroscience is increasingly applied to address questions of central concern to the social sciences. Social sciences, in turn, can contribute to neuroscience research in a variety of ways, including: (1) the study of social f...

We write as academics who study the impact of culture on mental health, clinicians who strive to provide equitable mental health care and representatives of organizations devoted to advancing the field of cultural psychiatry. We join our voices to those in the USA and around the world calling for social change to address the longstanding violence a...

In recent years, psychiatry in Iran witnessed a dramatic increase in the use of the diagnosis of bipolar spectrum disorder (BSD). This qualitative study maps the journey of the BSD diagnosis from the West to Iran, examines the controversy surrounding the diagnosis and its treatment, and explores some of the structural factors that facilitate and ma...

Cultural diversity poses a challenge to mental Health care systems in many settings. Specialized cultural consultation services have been developed in a number of countries as a way to supplement existing services. The objective of this paper is to compare and contrast cultural consultation services in Montreal, London, and Paris to determine how c...

In 2002, WHO launched the Mental Health Gap Action Programme (mhGAP) as a strategy to help member states scale up services to address the growing burden of mental, neurological and substance use disorders globally, especially in countries with limited resources. Since then, the mhGAP program has been widely implemented but also criticised for insuf...

This is a commentary on a provocative essay by Sarah Kamens, which recommends the literature of postcolonial theory as a remedy for some of the limitations of current psychiatric theory and practice. Her provocation lies not advocating engagement with this literature, which certainly has much to offer psychiatry, but in the way she chooses to energ...

The Cultural Formulation Interview (CFI) developed for DSM-5 provides a way to collect information on patients’ illness experience, social and cultural context, help-seeking, and treatment expectations relevant to psychiatric diagnosis and assessment. This thematic issue of Transcultural Psychiatry brings together articles examining the implementat...

While social science research has demonstrated the importance of culture in shaping psychiatric illness, clinical methods for assessing the cultural dimensions of illness have not been adopted as part of routine care. Reasons for limited integration include the impression that attention to culture requires specialized skills, is only relevant to a...

Studies in the psychology and phenomenology of religious experience have long acknowledged similarities with various forms of psychopathology. Consequently, it has been important for religious practitioners and mental health professionals to establish criteria by which religious, spiritual, or mystical experiences can be differentiated from psychop...

[This position paper has been substantially revised by the Canadian Psychiatric Association (CPA)’s Section on Transcultural Psychiatry and the Standing Committee on Education and approved for republication by the CPA’s Board of Directors on February 8, 2019. The original position paper was first approved by the CPA Board on September 28, 2011] Ca...

Research into social determinants of mental and emotional health problems highlighted the need to understand the cultural factors. Mental health of immigrants is influenced by a variety of cultural, psychological, social, and economic factors. There is some evidence to suggest that South Asian people have higher rates of mental and emotional health...

The articles in this issue of Transcultural Psychiatry point the way toward meaningful advances in mental health research pertaining to Indigenous peoples, illuminating the distinctive problems and predicaments that confront these communities as well as unrecognized or neglected sources of well-being and resilience. As we observe in this introducto...

In recent years, efforts in Global Mental Health (GMH) have evolved alongside critical engagement with the field's claims and interventions. GMH has shifted its agenda and epistemological underpinnings, increased its evidence base, and joined other global policy platforms such as the Sustainable Development Goals. This editorial introduction to a t...

This article reviews the clinical and research literature on the Cultural Formulation Interview (CFI) since its publication in DSM-5. The CFI is an interview protocol designed to be used by clinicians in any setting to gather essential data to produce a cultural formulation. The CFI aims to improve culturally sensitive diagnosis and treatment by fo...

The target article Thinking Through Other Minds (TTOM) offered an account of the distinctively human capacity to acquire cultural knowledge, norms, and practices. To this end, we leveraged recent ideas from theoretical neurobiology to understand the human mind in social and cultural context. Our aim was both synthetic — building an integrative mode...

Globalization is bringing new tensions and challenges to efforts to build pluralistic and inclusive societies. In the name of secularism, state neutrality or security, restrictive policies are being enacted that target the cultural, linguistic and religious identities and practices of minorities. Policies of multiculturalism and intercultur- alism...

Purpose The purpose of this paper is to prepare healthcare providers in high-income countries to deal with mental health and psychosocial issues among resettled Syrian refugees. Design/methodology/approach Collaborative work of the authors on a comprehensive review of social context, cultural frameworks and related issues in the mental health and...

Indigenous peoples, immigrants and refugees and racialized groups, as well as some long-established ethnic, linguistic, cultural and religious communities, experience inequities in mental health in Canadian society. These inequities result from social structural determinants of health that are embedded in the cultural knowledge, values and attitude...

Social psychiatry is grounded in the recognition that we are fundamentally cultural beings. To advance the field, we need integrative theory and practical tools to better understand, assess, and intervene in the social-ecological cultural systems that constitute our selves and personhood. Cognitive science supports the view that mental processes ar...

In recent years, many adolescents in Nepal have been affected by episodes of mass psychogenic illness, which seem to involve dissociative symptoms. To identify the potential contributors to dissociation, the present study examined correlates of dissociative experiences among adolescents in Nepal. In a cross-sectional survey, 314 adolescents were as...

Background: Major efforts are underway to improve access to mental health care in low- and middle-income countries (LMIC) including systematic training of non-specialized health professionals and other care providers to identify and help individuals with mental disorders. In many LMIC, this effort is guided by the mental health Gap Action Programm...

The contributions to this issue of Transcultural Psychiatry on cultural concepts of distress show how much work on this topic has evolved and equally what remains to be done. In this Commentary, we take stock of the current state of the field and outline some future directions for research and clinical application.

This study explores the phenomenological experience of the transmitted trauma legacies of Jewish-Israeli Holocaust descendants and their self-perceived sense of vulnerability and resilience. 55 in-depth interviews were conducted with second-generation Holocaust survivors in Israel in 2001-2004 and another 20 interviews in 2010-2011. Ethnographic in...

This article explores the processes of transformation of the self in dang-ki healing, a form of Chinese spirit mediumship in Singapore, drawing on more than a decade of ethnographic research. In dang-ki healing, it is believed that a deity possesses a human, who is called a dang-ki, to help clients (i.e., devotees). Through the dang-ki, clients can...

Efforts to provide culturally appropriate global mental health interventions have included attention to local idioms of distress. This article critically examines the potential gap between lay ethnopsychological understandings of the Cambodian idiom of baksbat (broken courage) on the one hand and clinical conceptualizations of the idiom as a potent...

In this paper, we examine some of the conceptual, pragmatic and moral dilemmas intrinsic to psychosomatic explanation in medicine, psychiatry and psychology. Psychosomatic explanation invokes a social grey zone in which ambiguities and conflicts about agency, causality and moral responsibility abound. This conflict reflects the deep-seated dualism...

The processes underwriting the acquisition of culture remain unclear. How are shared habits, norms, and expectations learned and maintained with precision and reliability across large-scale sociocultural ensembles? Is there a unifying account of the mechanisms involved in the acquisition of culture? Notions such as ‘shared expectations’, the ‘selec...

Challenging meditation experiences have been documented in Buddhist literature, in psychological research, and in a recent qualitative study by the authors. Some of the central questions in the investigation of this topic are: How are meditation-related challenges to be interpreted or appraised? Through which processes are experiences determined to...

This edited volume outlines approaches to cultural clinical psychology in three broad areas: (1) culturally sensitive approaches to PTSD and related mental disorders; (2) cultural values, metaphors, and the search for universals; and (3) global mental health and intervention challenges. In addition to mapping key issues for research, the volume aim...

Background Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression. Aim To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression. Method Cluster randomised clinical trial, conducted in Ibadan,...

Cultural clinical psychology and psychiatry aim to address the mental health needs of diverse communities by integrating attention to cultural differences in knowledge, social institutions, iden- tities, and practices. These differences affect mental health by influencing the causes and mech- anisms of psychopathology, shaping illness experience an...

Scientists now agree that arguments about the relative importance of ‘nature’ versus ‘nurture’ in human functioning have become moot given that both are essential to the development of the brain. Nevertheless, many still look at brain activity as the origin of experience in mental health and illness. Images of the brain seem to provide a window int...