Laurence J. Kirmayer

Laurence J. Kirmayer
McGill University | McGill · Division of Social and Transcultural Psychiatry

MD, FRCPC, FCAHS, FRSC

About

410
Publications
297,577
Reads
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Introduction
I work in the broad area of cultural psychiatry, including the mental health of Indigenous peoples, immigrants and refugees, global mental health, and the anthropology and philosophy of psychiatry. Most of my research has focused on common mental disorders including depression and anxiety, somatization, dissociation, and trauma-related disorders. I have interests in healing and psychotherapy, multiculturalism and mental health services, and culturally based community mental health promotion.
Additional affiliations
July 1991 - present
McGill University
Position
  • James McGill Professor & Director
July 1982 - present
McGill University
Position
  • James McGill Professor & Director
July 1982 - present
Lady Davis Institute for Medical Research
Position
  • Senior Investigator
Education
May 1981
University of California, Davis
Field of study
  • Psychiatry
June 1978
McGill University
Field of study
  • Medicine
August 1974
McGill University
Field of study
  • Psychology

Publications

Publications (410)
Article
Full-text available
This article summarizes the rationale, development and application of the McGill Illness Narrative Interview (MINI), a theoretically driven, semistructured, qualitative interview protocol designed to elicit illness narratives in health research. The MINI is sequentially structured with three main sections that obtain: (1) A basic temporal narrative...
Article
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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...
Article
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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...
Article
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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...
Article
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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...
Article
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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...
Chapter
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...
Article
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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...
Article
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...
Article
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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...
Article
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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...
Article
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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...
Article
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...
Article
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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...
Article
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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...
Article
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...
Article
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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...
Chapter
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...
Chapter
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...
Preprint
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...
Article
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...
Article
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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...
Article
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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...
Chapter
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...
Chapter
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...
Book
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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,...
Chapter
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...
Article
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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...
Article
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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...
Article
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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...
Article
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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...
Article
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...
Article
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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...
Article
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...
Article
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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...
Preprint
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The ubiquity and importance of narratives in human adaptation has been recognized by many scholars. Research has identified several functions of narratives that are conducive to individuals’ well-being and adaptation as well as to coordinated social practices and enculturation. In this paper, we characterize the social and cognitive functions of na...
Article
[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...
Article
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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...
Article
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...
Article
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...
Article
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...
Article
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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...
Article
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...
Article
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...
Article
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...
Article
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...
Article
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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...
Article
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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...
Article
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.
Article
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...
Article
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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...
Article
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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...
Article
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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...
Article
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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...
Chapter
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...
Book
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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...
Article
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,...
Chapter
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...
Chapter
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...
Article
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Efforts to address global mental health disparities have given new urgency to longstanding debates on the relevance of cultural variations in the experience and expression of distress for the design and delivery of effective services. This scoping review examines available information on culture and mental health in Nepal, a low-income country with...
Article
While we take no issue with the premise that genomic medicine may lead to advances in psychiatry, we suggest the authors’ view perpetuates current reductive explanatory approaches and, as such, cannot be considered a paradigm shift. We believe this explanatory reductionism is precisely what has led to psychiatry’s current conceptual crisis. To achi...
Article
Cultural psychiatry (transcultural psychiatry, cross‐cultural psychiatry, or ethnopsychiatry) is an interdisciplinary field of research and clinical practice concerned with the impact of culture on mental health and illness. Key questions for cultural psychiatry include the role of culture in the causes and mechanisms of mental disorders, the cultu...
Chapter
Throughout its history as an academic discipline, psychology has used Western subjects as the basis for research and theory building. The resultant models are shot through with assumptions about the nature of the person presented as universal truths rather than ones contextualized in time and place. This chapter interrogates some of the assumptions...
Article
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This paper explores the significance of cultural variations in emotion for the meaning and impact of torture, focusing on the dynamics of shame, humiliation, and powerlessness. Forms of physical and psychological pain and suffering share some common neurobiological pathways and regulatory systems that are influenced by social and cultural factors....
Chapter
This chapter explores psychedelics as catalysts of spontaneous thought. Classic serotonergic psychedelics such as psilocybin, LSD, and ayahuasca can induce potent alterations in cognition and perception. The chapter reviews research on these substances through the lens of cultural neurophenomenology, which aims to trace how neurobiology and sociocu...
Article
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A position paper developed by the Canadian Psychiatric Association’s Education Committee and approved by the CPA’s Board of Directors on August 15, 2016.
Article
Structural competency is an approach to clinical training and practice that aims to improve health care by directing attention to the social inequities that are among the root causes of health disparities.¹ Recognizing these forms of social adversity may allow clinicians to better understand patients’ predicaments. However, to move beyond mere reco...
Article
In a far-reaching essay, Ramstead and colleagues offer an answer to Schrodinger’s question “What is life?” framed in terms of a thermodynamic/information-theoretic free energy principle. In short, “all biological systems instantiate a hierarchical generative model of the world that implicitly minimizes its internal entropy by minimizing free energy...
Article
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Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver pr...
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Background: Inuit in Canada have experienced dietary changes over recent generations, but how this relates to psychological distress has not been investigated. Objective: To evaluate how nutritional biomarkers are related to psychological distress. Design: A total of 36 communities in northern Canada participated in the International Polar Year Inu...
Article
Full-text available
Background Perinatal maternal depression is common and undertreated in many sub-Saharan African countries, including Nigeria. While culture shapes the social determinants and expression of depressive symptoms, there is a dearth of research investigating these processes in African contexts. Methods To address this gap, we conducted in-depth intervie...
Chapter
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Cultural psychiatry is concerned with understanding the implications of human cultural diversity for psychopathology, illness experience, and intervention. The emerging paradigms of embodiment and enactment in cognitive science provide ways to approach this diversity in terms of variations in bodily and intersubjective experience, narrative practic...
Article
Depression is a major focus of concern in global mental health, with epidemiological surveys indicating high prevalence rates worldwide. Estimates of the global burden of depression in terms of disability, quality of life, and economic impact have been used to argue for scaling up the detection and treatment of depression as a public health and dev...
Article
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Theories of healing have attempted to identify general mechanisms that may work across different modalities. These include altering expectations, remoralization, and instilling hope. In this paper, we argue that many forms of healing and psychotherapy may work by inducing positive psychological states marked by flexibility or an enhanced ability to...