Suggestions for what psychiatry can do to alleviate, contain, and eventually prevent or avoid the demolition of culture and health.
That the world is currently going through a complex and critical phase in its history is an understatement. The background is multifaceted: violence of all types with a different kind of war (but war anyway) at its peak, large migrations in all regions, religion transformed in terrorist codes and strategies with tragically massive sequelae, and politics in many countries (starting with the US) reaching levels of cheap TV shows or grotesque deformity by the words and actions of some of its protagonists. And the main victim, in addition to all the innocent lives of those who died or were injured (physically and emotionally) is humanity itself, the essence of its raison d’etre-culture-as both the repository of history and the expression of our human identity.
Culture is being demolished by grenades, guns, and incendiary speeches. And the world’s mental health is being threatened as never before by viruses of hatred, fanaticism, frivolousness, and a technology-based infectious chain. The challenges to psychiatry as the clinical armor of mental health, and to cultural psychiatry as its vanguard platoon, are indeed enormous in these dramatic and confusing times.
The preceding may sound exaggerated but an objective and close examination of worldwide events these days, conveyed by the media, social networks, or word-of-mouth, confirm the seriousness of the situation. Almost daily attacks by unknown assailants in malls, train stations, bars, churches, or in the streets reflect the contagious nature of violence-be that the result of dysmorphic preaching or the action of “lonely wolves.” Religious and even ethical principles used as reasons to kill, dressed up by coward anonymity, have used European and American cities as worldwide stages. A re-invigorated racism and its mixed-up dialectics play with fear, apprehension, or sheer ignorance to make public places or dark neighborhoods scenarios of death, invoking at times the name of the law. Homicide and suicide-related deaths have increased as a consequence.
The cultural and mental implications of all these behaviors cannot be neglected. Migration within countries or regions has been a phenomenon present for centuries around the world. To mostly socio-economic and occupational needs as main causes of migration, others have been added in the last several decades: prolonged internal political conflicts, religious wars, cruel political persecutions, bloody massive expulsions, or voluntary exile.
Psychiatry can help to alleviate, contain, and eventually prevent demolition of culture and health. That's how powerful it is.
The other big differences are the size and frequency of the migratory waves, particularly between the Middle East and European countries, in the African continent, and the ever-present flow of Hispanics into the US.
International bureaucratic and professional organizations (World Health Organization, World Psychiatric Association, World Association of Cultural Psychiatry) have made strong pronouncements, urging governments and other agencies to study, plan, and intervene in the alleviation and prevention of the health and mental health consequences of migrations, clinical pictures of which fragilities, rejection, resentment, and uncertainties are substantial ingredients.
Moreover, we cannot deny that the political picture of the most powerful country in the world presents evidences of circus and polarization, showmanship and distrust, that make it “different.” The problem is that the “difference” now is not ideological or doctrinal; particularly on one side of the current campaign, it is the accentuation of hate, the use of stereotypes and insults as arguments, the not-too-disguised lies or the not-too-subtle incitements to overt violence. And this fact, violence, is precisely where all the occurrences in today’s world (war, terrorism, migrations, politics) converge and show their shared umbrella.
Violence, without distinctions of age, gender, ethnicity, civil status, socio-economic level, nationality, religious or cultural features, permeates these processes. Violence-be it domestic, collective, verbal, physical, sexual, emotional, or political-is one of the most demonstrative manifestations of social as well as psychological/mental instability.
It corrodes the spaces of tolerance and reason, the roots of dialogue and communication, the capacity to judge and opine. It takes away the visions of future and progress converting them into weak presentism and facile demagoguery. Violence kills people, demolishes buildings, cities, monuments . . . and the whole of culture.
In clinical terms, the mental health consequences of this global socio-political climate affect individuals, groups, communities and the society at large. To the well-known posttraumatic stress manifestations per se, those of depression, anxiety, psychosis, substance use, as well as dissociative, somatic, conversion, and personality disorders, can be triggered or exacerbated by violence, making it the final common pathway of a variety of conditions, the overcrowded catalogue of disorganization, fright, and confusion.
It is also fed by denial, the oldest of what are known as “defense mechanisms;” by duplicities, sophisticated versions of multiplied lying, rationalism, or sloganized justifications. In the cultural realm, again, individual and group/community/ethnic identities are deformed; beliefs and traditions are betrayed or simply set aside; faith is lost. Contagiousness is, many times, an atypical collateral of violence.
In short, violence engenders more violence.
What to do under these circumstances? What can psychiatry and its allied disciplines do to alleviate, contain, and eventually prevent or avoid the demolition of culture and health? A systematic, consistent, tireless call to reason that must include an honest assessment of history and its changes, should constitute the core of a public education campaign.
An analysis of the roots of each problem, the public health/mental health response to the realities of the situation, direct invitations to and active participation in civilized dialogues with government authorities, public citizens, and political groups and academic institutions; an unequivocal protection of civil liberties and human rights, and fostering of preparedness and preventive vigilance from and for all population segments. Concomitant tasks of teaching, learning and training at all levels-students, professionals and public-strengthened by available mental health care infrastructure.
Most importantly, the restoration of cultural consciousness, of the texture of identity and genuine faith (respecting differences and welcoming coincidences), of the force of ideas and practices carrying out genuine understanding, solidarity, and teamwork. The ultimate objective is, of course, the elimination of violence as a resource, the reconstruction of culture as a unifying force, a chalice of diversity.
Globalization is far from being a comprehensive concept, in spite of its etymology. Global health and global mental health are still at the beginning of their conceptual articulation, their presence felt as undeniably strong but their entities still uncertain. Culture is being threatened worldwide, but its perpetual, basic configuration throughout millennia becomes the basis of the most important factor against its destruction: hope, the same quality that Jerome Frank intuited as the most powerful ingredient of all psychotherapies. Hope as a source of action and positive responses, as a pillar of protection and resilience for individuals and nations. Hope as a tool for the survival of human culture.
MORE ABOUT THE AUTHOR
I was born in Arequipa, the second largest city in PerÃº, and graduated from medical school in Lima. My parents were both high school teachers and always voiced their wish to have “a doctor” among their 3 children. I confess I liked letters and humanities but, in the end, I “compromised” by choosing psychiatry as my specialty: I am very happy because I know psychiatry is the last bastion of Humanism in medicine, and because I enjoyed the work and wisdom of great teachers. Let me just mention two: Honorio Delgado (1892-1969), a Peruvian philosopher and researcher who met and worked with giants like Freud; Jaspers; the Schneiders; Gregorio MaraÃ±Ã³n or Pedro Lain-Entralgo, who is considered the greatest Latin American psychiatrist of the 20th century; and Jerome Frank (1909-2005), an accomplished, compassionate and inspiring Hopkins academician, the first and most solid psychotherapy researcher in the world.
Trained in the US, I worked back in Lima for 8 years before returning in 1980 to work at the University of Alabama in Birmingham, Emory and, finally, the Mayo Clinic. I have always kept in close touch with Latin American psychiatry and have its visibility around the world as, perhaps, the fundamental objective of my career. In a globalized world, it is only fair to recognize the contributions of developing countries and continents. I am gratified for having helped a number of Latin American young colleagues, medical students, and residents to come to the US and enjoy learning experiences in American academic centers. I have also assisted in the organization of international events where experience-sharing, teaching, and learning from each other are substantial didactic resources. And, certainly, I plan to continue doing so for as many years as possible.
I love classical music, Latin boleros, and Peruvian waltzes. I used to play soccer and was an adolescent sports anchorman and journalist in my hometown. I lost my brother Javier, an idealist of the left, one of the 80,000 desaparecidos or victims of the “dirty war” of the 1980s in PerÃº; in his memory, social and political reconciliation are frequent themes of my reflections from the cultural and social psychiatry perspectives. I feel moved by Cesar Vallejo’s poetry; Hemingway’s life and novels; Bertrand Russell’s thinking; Elie Wiesel’s, M.L. King’s, or Octavio Paz’s social militancy. And count The Room, Schindler’s List, and To Kill a Mockingbird among my favorite movies.
Dr. AlarcÃ³n is Emeritus Professor and Consultant in the department of psychiatry and psychology at Mayo Clinic College of Medicine in Rochester, MN, and an Editorial Board member of Psychiatric Times.