>> Okay. So now, we're going to move ahead 40, 50 years, and we're going to talk about the contemporary context for culture, mental health, and mental illness. So I'm actually going to start us off with talking about culture and mental health. Really looking at practices that are outside of the mental health care system, for the most part. I think this is good for us to cover for a few reasons, one is, I think, it's, important for us to realize that, although there has been this dominance of western methods, and medical methods for treating mental health problems. There are other methods that have been in existence long before that, and that continue to be in existence now, that people use, in various parts of the world. But also, in even the west, and the other things is, more and more, we are finding that when you actually talk to people about what they do to promote their mental health, they are usually mixing, medical treatments with what we might call complimentary or alternative treatments that are from some of these traditions. So, while we tend to talk like there is this division between, medical and non-medical treatments, the truth is, for most people, there's a mixture. And a lot of us are, dabbling in both worlds when we're trying to think about how to promote our mental health, or even to deal with the specifics of a mental disorder. So with that introduction, I'm going to take us into culture and mental health. Our discussion about culture and mental health is going to focus on the ways that different cultural traditions have addressed the promotion of mental health, and the treatment of mental illness. So I want to start us off by positioning what I'm going to call traditional knowledge. There can be a tendency to think of traditional knowledge as knowledge that is old but with a negative connotation that it is also then outdated, backward, primitive, unscientific and all kinds of other negative things that mean it's not useful in contemporary times. However, I believe that traditional knowledge should be understood as knowledge that has been in place for a long time, and that has an ongoing presence. Because it has proven itself useful for meeting the challenges it's designed to address. Tradition, like culture, has its roots in the past, but it continues to evolve in response to changing circumstances and changing needs. The idea of traditional knowledge is closely linked to an understanding of indigenous knowledge. In the same way, indigenous knowledge is knowledge that has been developed over the long-term, usually within a specific locality, to meet the needs and challenges faced by a specific group or society within that locality. Rather than dismissing it as something that is outdated, archaic and unsophisticated, it needs to be understood as something that has stood the test of time and stood the test of various circumstances for a very long time. This type of traditional or indigenous knowledge, is the basis for many of the culture-based approaches to mental health that we encounter all over the, the world. I'm going to start by talking about the approach to mental health that has been described for Aboriginal peoples in Canada, because I'm doing this course in Canada, and mindful of the fact that this land was first occupied by peoples that had knowledge and traditions that proved useful to them in the past, and can continue to be useful to them in the present. The report on aboriginal perspectives of mental health that you see me citing here is available on the internet and the link is provided in your resource list. From the perspective of Canada's indigenous peoples, health is supported by balancing the four dimensions of life: the physical, the mental, the spiritual and the emotional. Some of you may be familiar with the representation of these dimensions in something called the medicine view. Indigenous perspectives on health, also focus on the interconnection between the well-being of all living things, which includes individuals, families, communities, animal life, and the physical environment. This represents to some extent, the ecocentric persp-, perspective that was mentioned in the paper that we read earlier about colonial determinants of mental health. Ill health is believed to result from the disruption of this crucial balance between the four dimensions of health. In addition, health is affected by the connection to other living beings. So if there's damage or disruption in any of these systems, then the others are affected as well. Within that framework, healing is focused on the restoration of balance and reconnections across the systems of individuals, families, communities, and nature. This indigenous perspective actually gives us a different way of thinking about the elevated levels of mental and physical illness in aboriginal communities. Colonialism has not only created circumstances that create negative determinants of health, but has also created circumstances that break these connections that are so crucial to well-being. The indigenous perspective is a good demonstration of the approach that Suman Fernando describes as representing much of the way that the non-western world approaches mental health. Mental health is not focused on just the treatment of illness or disease, but instead it focuses on ways to deal with the everyday stresses of life, addresses potential illness, and promotes spiritual development. In Suman Fernando's book, Race, Culture, and Mental Health, he introduces us to five types of culture based treatments that address these purposes, and we will address them briefly. They are herbal treatments, acupuncture, yoga and meditation, trances and dreams, and spiritual healing, these are all coming up. Before we talk about the specific treatments, it's important to know that Fernando warns us that culture-based treatments are not always transferable. Although a given approach to care may work very well in its original context, when it is transferred, we have to be cautious. It is possible that the interventions may not be transferred accurately, or that they are not as effective when they are used outside of the original cultural context. Another important consideration, is that the introduction of one cultures method of healing into another may result in disruption of the important healing elements that are present in the host culture. Most of the treatments I am about to address have been adopted or adapted for use outside of the original cultures and with all of them I think it is interesting to consider. Do they maintain their effectiveness when they are removed from the original context? So we're going to start with herbal treatments. Herbal treatments are focused on balancing systems of the body. Many healing traditions include practices of the administration of earth, plants, and roots to promote health and healing. There's often a strong emphasis on the procedures that are surrounding the growing, harvesting, preparation, and use of these substances. In addition, the herbal, the herbal practitioner themselves must have specific qualities in order to use these substances properly and effectively. In the west we have adapted and adopted many of these treatments. One way in which we've adapted some of these treatments is through the manufacture of pharmaceuticals. Another way, is that we increasingly see the marketing of herbal treatments to promote health and healing. One example that comes to mind quickly, is the use of Saint John's Wart to treat depression. Not surprisingly, medical specialists and pharmaceutical companies are getting involved with the prescription of herbal treatments as well. Acupuncture is a treatment that originated in China and it is used to balance the forces of yin and yang in the body. Now a full description of this is beyond the scope of this lecture, but traditional Chinese medicine has its own system of diagnosis and treatment, and acupuncture is a possible recommendation for healing, that would also include things like, recommendations for the diet, exercise, and living according to specific principles. Acupuncture has certainly made a transition to western context, although its application is mostly for the management of pain, so it's used in, in quite an isolated way. Yoga and meditation are practices with very long histories in many cultural traditions, and it's often associated with spiritual practice, but also has applications to the overall maintenance of health. Goals such as obtaining liberation or enlightenment, the relief of suffering, cultivating attention and detachment speak to the mental and spiritual benefits of such practices. This type of contemplative practice, is part of many religions, but it is also applied within secular context. You are probably noticing that I've mentioned mindfulness here. Mindfulness is part of the spiritual and mental practices, but in its translation to the West, it has been mostly associated with stress reduction. Yoga, in particular, has become a type of exercise, far removed from its spiritual roots, but of course, that doesn't mean it isn't still benefi-, beneficial for promoting mental health. Trances, dreams, and altered states are used in many culture traditions to facilitate communication with spirits, or to gain insights that are not otherwise available, they are often considered part of conventional practice for maintaining health, because communication with the spiritual world, is considered part of maintaining your health. But then it can be used to treat specific problems or disorders. As assessed here these altered states can be induced by using substances under the direction of a practitioner, and they are usually embedded in some kind of family or community treatment process. So I'm not sure what exactly to say about Western adaptations. There are definitely people using substances to induce altered states but I'm not sure that I can comment on how much of this is used as part of a heath practice and how of this is used for other purposes. One of the most tangible examples I could think of for the western adaptation of trances dream and altered state, was the use of hypnosis or hypnotherapy, Which is sometimes used to treat issues like addiction or sometimes used to help people who are dealing with trauma. Finally, spiritual healing can cover a lot of practices within many traditions, some of the things that are included are rituals, meditations, prayers, and there are many who will point to spirituality or religion as something that aids in the maintenance of mental health. Though I do know that in the forums there was some discussion about whether religion helps or hurts your mental health, so I realize we don't all agree about this. Part of what makes spiritual healing work, is that in its traditional use it is not an isolated practice. Although the person is helping themselves, they are usually doing it within a community that provides additional social support and mutual support. I want to make special mention of exorcism here, because its understanding has been so distorted by, well basically by Hollywood, I think. [laugh] Exorcism in its traditional form is based on an idea that illness is caused by an undesirable presence that must be removed, but not through the kind of dramatic, horrifying circumstances you may remember from films, like The Exorcist; but through a process that is built on compassion for the person who is occupied by this undesirable presence, and also for the presence itself. This is beautifully demonstrated in the YouTube clip, that I'm going to recommend you watch at the end of this section. I'm not aware of any mainstream western adaptations of exorcism, but I will say it reminds me of an approach called narrative therapy, in which problems like depression are treated as unwelcome intruders in a person's life. People will actually talk about when depression entered their life, the affect that depression has had on them. The model of therapy focuses on trying to understand how this unwelcome presence called depression, entered the life. What effect does it, what affect it has had, and how its Influence can be reduced or eliminated. I think that this method of therapy and this type of spiritual practice have in common is the desire to have a person see the potential for being freed from whatever is causing their distress. However in the spiritual context, there's also the involvement of some kind of community of supporting people who are attempting to help you free yourself from this presence. So what can we take from these various traditions that might point us towards some kind of transcountral, trans-cultural principles for mental health? First, that there is a need to develop a shared meaning for what is causing distress or illness. This may be a shared meaning between the practitioner and the person suffering, or between a doctor and his or her patient, or between an individual and the family or community that is trying to help him or her. Second, there is an importance attached to giving people roles and responsibilities in the healing process, so there is a clarity about what is to be done and by whom, and people are not seen as passive or helpless in the healing process. Third, a healer must communicate hope, optimism and confidence in the methods that they are using. When people are in distressing circumstances, it can be very difficult to sustain hope for a better future. Traditional methods suggest that holding this hope, and communicating this hope is an important role for the healer or practitioner. Lastly, ritual has an important role to play. An understanding that there are standardized ways of approaching these highly unusual circumstances, is often a reassurance to people who find themselves in those circumstances. And participation in some kind of set of procedures is another way of helping people to feel empowered And active in their healing process. So I would suggest that there's actually quite a bit we can learn from traditional healing practices. And it's really no surprise that so many people combine that with mainstream medicine or even opt to just go for the so-called healing, so, so called traditional or alternative treatments rather than using the mainstream medical healthcare system. As I've already said there's a beautiful demonstration of these principles in the You Tube segment I'm going to refer you to now. One of the students in this course sent this link to me before the course started and I'm very glad to have the opportunity to share it with all of you now. It is an amusing, but very educational look at an American mans experience of being transferred into a healing context that was very different from what he had experienced before.
