Handbook of Culture, Therapy, and Healing

Uwe P. Gielen, Jefferson M. Fish, Juris G. Draguns, Uwe P. Gielen, Jefferson M. Fish, Juris G. Draguns

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781135613778
• Edition: 1
• Topic: Medicina
• Subtopic: Medicina alternativa e complementare

Emotional, as well as physical distress, is a heritage from our hominid ancestors; it has been experienced by every group of human beings since our emergence as a species. And every known culture has developed systems of conceptualization and intervention for addressing it. The editors have brought together leading psychologists, psychiatrists, anthropologists, and others to consider the interaction of psychosocial, biological, and cultural variables as they influence the assessment of health and illness and the course of therapy. The volume includes broadly conceived theoretical and survey chapters; detailed descriptions of specific healing traditions in Asia, the Americas, Africa, and the Arab world. The Handbook of Culture, Therapy, and Healing is a unique resource, containing information about Western therapies practiced in non-Western cultures, non-Western therapies practiced both in their own context and in the West.

1

Approaches to Culture, Healing, and Psychotherapy

Juris G. Draguns

The Pennsylvania State University

Uwe P. Gielen

St. Francis College

Jefferson M. Fish

St. John’s University

CULTURE, HEALING, AND PSYCHOTHERAPY: THEIR CHARACTERISTICS AND INTERRELATIONSHIPS

The subject of this book concerns the relief of mental suffering and physical distress by means of healing and psychotherapy, and the manner in which these objectives are pursued in a wide array of cultures around the world. To this end, our first task is to introduce, anchor, and pinpoint the three key terms in the title: culture, healing, and psychotherapy.

Culture

Definitions of culture abound. Our preference is to introduce culture, with Melville Herskovits (1949), as the part of the environment that has been generated or created by human beings. Social scientists are in agreement that culture encompasses concrete, visible, and tangible products created by human action, as well as that which Hofstede (1991) has called “software of the mind” (p. 4): the systems of communication and the preserved experience of prior generations, and also the shared values and beliefs that, at the same time, represent templates for future action. Cultures differ then not only in their artifacts, but in their languages, subsistence and production systems, and philosophies of life, both implicit and explicit. Closer to the major objective of this volume, it is reasonable to expect that cultures have shaped the healing and psychotherapeutic practices that have evolved within them.

Healing

Healing is an age-old practice found in virtually all cultures across space and time. No culture stands by idly in the face of human suffering; all human societies have evolved methods aimed at restoring physical health, promoting psychological contentment, and achieving spiritual serenity. Healing as a concept then refers to the aggregate of techniques used to make human beings whole again by counteracting distress in the body, mind, and spirit. In traditional cultures, healers tended to address the gamut of human dysfunction. In the modern era, this holistic orientation to healing has been increasingly compromised and strained, if not irretrievably lost. Fragmentation and specialization have supplanted undifferentiated unity as subdisciplines within and outside medicine; psychology, counseling, nursing, and religious ministry complement each other’s services and often minister to, and even compete for, the same clients. Systems of alternative medicine have evolved, largely in order to restore coherence to the human strivings for promoting health and overcoming illness. As several chapters in this volume make clear, practitioners of alternative medicine are widely represented and consulted both within the United States and elsewhere.

In philosophy, Rene Descartes drew a sharp line between the body and the mind. In the ensuing centuries, the secularization of Western civilization largely banished spiritual problems from the purview of scientifically based biomedical and psychological interventions, thereby extending separation of church and state to the individual on the intrapsychic plane. In her chapter in this volume, Michele Hirsch further develops some aspects of this theme.

Psychotherapy

In response to the compartmentalization of human experience, the enterprise of psychotherapy has come into being. It may be provisionally defined as “a method of working with patients/clients to assist them to modify, change, or reduce factors that interfere with effective living” (Fabrikant, 1984, p.184). A crucial aspect of psychotherapy is that it “involves the interaction between psychotherapist and patients/clients in the process of accomplishing its goals” (Fabrikant). In this sense of the term, the advent of psychotherapy as a specific modality of the treatment of human distress can be traced to the last decade of the nineteenth century. As the founder of psychoanalysis, Sigmund Freud is widely regarded as a pivotal figure in this development, although no single person can be identified as its inventor, inaugurator, or first known practitioner. Instead, the advent of psychotherapy can be viewed as the outgrowth of the prevailing Zeitgeist, which placed emphasis on introspection, individualism, and the extension of scientific practices to mental and subjective phenomena.

Within a more general framework, however, it must be recognized that psychotherapy has existed across space and time, much as has healing. In fact, psychotherapeutic interventions are deeply embedded in the traditional healing arts. Prince (1980) was able to discern a number of universal components of psychotherapy in interventions practiced across cultures in all of the world’s regions. These features include a worldview shared by the healer and the sufferer, the ability to provide a culturally meaningful explanation of distress or dysfunction, and the exercise of social influence through suggestion and other means. Overshadowing these external features, however, Prince highlighted the mobilization of the sufferer’s endogenous self-healing or self-corrective mechanisms, often in the form of altered states of consciousness, as the most important and universally valid ingredient of psychotherapy.

In his scholarly volume, Care of the Psyche: A History of Psychological Healing, the medical historian Stanley W. Jackson (1999) has traced essential elements of psychological healing in the Western tradition from antiquity to modern times. According to him, “talking cures” have traditionally included an emphasis on the healer-sufferer relationship; an authoritative and attentive healer; and his or her use of reward or punishment, suggestion and persuasion, explanation, interpretation, and guidance. The healer offers consolation and comfort to the sufferer, and provides support for the client’s efforts “to get things out.” Confession, confiding, and changes in the client’s self-understanding and self-observation have also been essential features of successful psychotherapeutic interventions over the centuries. It should be added that many of these therapeutic processes can also be found in non-Western healing encounters, although cultural influences and expectations typically determine which of these elements are assigned primary importance and which of them are relegated to the tacit background for the encounter between healer and sufferer.

Healing and Psychotherapy Within and Across Cultures

All psychotherapy aims at the relief of personal suffering and distress (Prince, 1980). It attempts to achieve this general objective by means of techniques and interventions that make sense and can be integrated with the preexisting corpus of culturally shared knowledge in the milieu in which they are applied (Torrey, 1972). Thus, interventions that may work in the culture in which they were developed often fail when transferred across cultural barriers. In a culturally diverse society, this state of affairs is often observed when techniques that are demonstrated to be effective within the mainstream segment of the population are extended and applied without modification to members of ethnocultural minority groups. High drop-out rates early in therapy, before any gains are realized, are a frequent result of such interventions (Sue & Sue, 1977). Moreover, psychotherapy, as well as healing, only encompasses interventions that are designed for the suffering person’s benefit in order to bring about improvement in his or her well-being. Therefore, social influence techniques that do not posit this goal are consensually relegated outside of psychotherapy, from torture and brain-washing to sorcery and purification for the group’s good and not the individual’s.

Once the potential relevance of culture in psychotherapy is acknowledged, a host of questions arises. What is the relative weight of culture in determining the effectiveness of psychotherapy, its conduct, and style? What specific cultural dimensions matter in paychotherapy, in what way, and to what extent? Which of the many psychotherapies currently practiced are applicable across ethnic lines, and which are not? Which psychotherapies require modification and how can its degree and nature be established and tested for efficacy? Furthermore, what can we learn from the accounts of psychotherapy from other cultural traditions? What can we adapt from these interventions and apply in our own cultural milieu? How can traditional and modern therapies be creatively combined and integrated in their application to underserved and isolated cultural groups? Finally, what generic features can be identified on the basis of a panoramic view of psychotherapy around the world? Some of these questions are posed and partially answered in the chapters of this book, but most of them are many steps removed from a definitive, empirically based resolution. Collectively, these questions may guide the field for decades to come.

The relationship between psychotherapy and healing remains to be addressed. Healing is the more inclusive activity, psychotherapy the more specific. Perhaps the classical formulation by Jerome Frank (1961) is helpful in making this distinction. Psychotherapy is healing through persuasion, broadly understood as the sum of methods that counteract demoralization, which is the common feature that brings clients to psychotherapy. Healing is a term that is applicable to the techniques, presented in several chapters of this book, that straddle the fence between the biomedical and the psychological. Michele Hirsch’s chapter conceptually addresses the issue of how healing occurs. Specifically, anthropological observations are integrated with the findings of psychoneuroimmunology and the role of expectation and belief in producing biochemical change from illness to health. Jefferson Fish tackles the same problem in his chapter, but does so from a somewhat different point of view as he attempts to specify the psychological and sociocultural commonalities in healing. Two chapters by Ting Lei and his team of collaborators provide substantial information not yet available elsewhere on indigenous Chinese healing procedures and their effects on a variety of psychophysiological indicators. In her chapter, Rashmi Jaipal shares information on the Indian view of mental health and healing. The conception of balance as the main feature of health anticipates Western homeostatic formulations. Moreover, the Indian view avoids the problems that arise when an impenetrable wall is posited between the mind and body, as was historically the case in the West. The chapter by Ihsan Al-Issa and Abdulla Al-Subaie on Arab societies also provides copious illustrations of physical ailments helped by psychological means and of psychological symptoms relieved by biological interventions.

Similarly, chapters about several other regions of the world reveal how porous the boundary is between mental and spiritual healing, not only in Arab countries and in India, but also among the Salish Indians of Canada, as described in the chapter by Wolfgang Jilek, and among spiritual healers of Mexico, which is the topic of Kaja Finkler’s chapter. Skepticism will no doubt be aroused by the claims of successful intercession with the spirit world and other non-naturalistic occurrences. Pending clarification, one might accept verified descriptive accounts of such phenomena and maintain skepticism regarding traditional within-culture explanations. The challenge to which the chapters’ authors have already responded is to integrate the observed effects with the sum total of relevant information that bears on the observed phenomena.

PSYCHOTHERAPY AND HEALING IN CULTURE: HISTORY, PRESENT SITUATION, FUTURE PROSPECTS

Historical Origins

Observations of culturally distinctive healing practices are scattered throughout ethnographic descriptions and psychiatric reports of many decades. Yet a coherent body of literature did not begin to emerge until the second half of the twentieth century. It is perhaps not coincidental that professional interest in this topic was sparked by the early stirrings of the community mental health movement. Thus, Alexander and Dorothea Leighton were involved both in pioneering the epidemiological approach to communities in Nova Scotia (Leighton, Harding, Macklin, MacMillan, & Leighton, 1963) and in extending these explorations to the Yoruba in Nigeria (Leighton, Lambo, Hughes, Leighton, Murphy, & Macklin, 1963). In the process, the Leightons encountered and observed the operations of local healers or witchdoctors whose diagnostic practices and therapeutic interventions sometimes overlapped with and diverged from the familiar procedures of modern Western psychotherapists. What the Leightons and their coworkers confronted was a coherent healing system that was partially based on the accumulated observations and experience by the current practitioners and their predecessors, as well as on the traditions and beliefs shared within the culture in question. Their observations and those of their contemporaries marked the beginning of taking local healers seriously as mental health practitioners within the framework of their culture. A prominent Nigerian psychiatrist, T. A. Lambo (1964), emerged as an articulate mediator between the two systems of care and treatment and was instrumental in incorporating healers into the therapy programs of a Nigerian psychiatric hospital. Another influential contributor was Ari Kiev (1962) whose descriptions of Voodoo practices in Haiti and among West Indian immigrants in London were focused upon the interplay of magical and naturalistic interventions in bringing about therapeutic change. His compendium of clinical reports of interventions embedded in the traditions of different cultures (Kiev, 1964) was widely read by American and other Western psychotherapists. It helped bring about a decentering of outlook in the American community of mental health professionals and called into question the existence of optimal treatment approaches that work in all cultures. Extensive observations in Indonesia and elsewhere were gathered over several decades by Wolfgang Pfeiffer (1994), a German psychiatrist who articulated a number of commonalities, as well as contrasts, among traditional and modern interventions. According to Pfeiffer, culturally patterned techniques aim at and result in integration into the group rather than the individuation of a unique person, a Western tradition that has been traced to the Renaissance, Reformation, and Enlightenment (Murphy, 1978).

Among contemporary psychotherapists who emphasize the cogency of indigenous beliefs and practices is the Parisian psychoanalyst, Tobie Nathan (1994), who rejects the imposition of any extraneous conceptual framework in treating patients who come from radically different cultures. Instead, he advocates accepting cultural reality as it appears to the client and promoting therapeutic change within his or her preexisting network of cognitions and convictions.

In this book, the chapter by Raymond Prince takes us back to the time and place of the discovery of indigenous healing. It is based on the report of clinical observations and experiences over three years during which Prince was a government psychiatrist in Nigeria in the early 1960s. A participant in the early efforts to study and learn from native healers on par with Leighton and others, Prince was surprised to find that insight played a minor role, if any, in bringing about clinical improvement and the disappearance of presenting symptoms. Moreover, nondirective techniques, recently introduced at the time, were found to be ineffective in the Nigerian setting. What worked instead was forceful suggestion, reinforced by the accoutrements of a culturally sanctioned role. Because of its historical importance, we, as editors, encouraged Prince to modify his original report minimally in order to preserve the freshness and immediacy of his observations, which Prince proceeded to conceptualize in accordance with the theories available at the time.

Since then, progress in the field has proceeded from case to case, building upon the field experience of earlier observers. New interventions, combining the traditional and the modern, have often been applied on a trial-and-error basis. In the typical case, the documentation has been in the form of a descriptive naturalistic study in which evidence and inference are sometimes hard to separate. Culture’s influence upon psychotherapy was first noted in remote settings exotically different from the Western therapists’ point of view. During the last three and four decades, culture’s impact upon therapy has been scrutinized in a much wider set of milieus, above all within the culturally diverse nations in North America and elsewhere.

Current State of Evidence: Predominantly Descriptive

We have endeavored to include in this volume a cross section of recent reports on the points of contact among healing, psychotherapy, and culture. Unfortunately, not all regions of the world are represented, but we have striven to maximize geographic and cultural variety across nations, as well as within multicultural North America. Reflecting the current state of methodology, the information in the bulk of the chapters is qualitative rather than quantitative. In a relatively new, yet burgeoning field, this state of affairs reflects the current realities of data gathering. Phenomena must be observed and described before scores and ratings can be meaningfully imposed on them and before any meaningful comparisons can be executed. Thus, there is a continuing need for recording factually the operations and t...