This blog reflects my deep interest in the different ways the various cultures and subcultures in this world conceive of the world and our lives within it. I was born in Asia, hold a UK passport, lived for most of my adult life in France, and now live in the US as a resident alien, working as a psychotherapist in private practice in San Francisco. Issues of cultural identity and displacement are very close to 'home' for me, and for many of my clients.

Friday, March 11, 2011

Cultural Casebook: Still-Living Ancient Cultures

Wade Davis's book "The Wayfinders: Why Ancient Wisdom Matters in the Modern World" is an utterly compelling, beautifully written series of pieces originally presented as lectures. Each piece describes a particular ancient culture that is still living, thriving and evolving today.

For example, the first chapter is about the ancient Polynesian art and science of long distance ocean navigation--using no instruments other than the perceptions, knowledge and experience of the human navigator, and the design of the canoe itself. The navigator does not sleep during the entire voyage, in order to keep the whole narrative of the voyage intact in his or her mind, using dead reckoning to know where he or she is now, in relation to the voyage up till now. By virtue of his or her ability to combine knowledge of the currents and waves, the travels of birds, the colours of the sea and the sky, the rising the setting of the stars, and a myriad of other natural data, the navigator positions the canoe on its voyage, and 'calls the islands up from the sea'.

By sharing his detailed, loving, knowledge about certain human civilisations, Davis implicitly and explicitly pleads for us to drop the Modernist fallacy that the "Western" secular, rational world view is the pinnacle of our development, and open our minds to entirely different--and one could say far superior--systems of conceiving of and interacting with the world. What matters, he says, is not which belief system is right or wrong per se, but rather "the potency of a belief, the manner in which a conviction plays out in the day-to-day lives of a people, for in a very real sense this determines the ecological footprint of a culture...[determining] both the actions of a people and the quality of their aspirations, the nature of the metaphors that propel them onward".

What metaphors propel you onward?

Here's an extract from the beginning of the book:

"Just to know that in the Amazon, Jaguar shaman still journey beyond the Milky Way, that the myths of the Inuit elders still resonate with meaning, that the Buddhists in Tibet still pursue the breath of the Dharma is to remember the central revelation of anthropology: the idea that the social world in which we live does not exist in some absolute sense, but rather is simply one model of reality, the consequence of one set of intellectual and spiritual choices that our particular cultural lineage made, however successfully, many generations ago.

"But whether we travel with the nomadic Penan in the forests of Borneo, a Vodoun acolyte in Haiti, a curandero in the high Andes of Peru, a Tamashek caravanseri in the red sands of the Sahara, or a yak herder on the slopes of Chomolungma, all these peoples teach us that there are other options, other possibilities, other ways of thinking and interacting with the earth. This is an idea that can only fill us with hope.

Together, the myriad of cultures makes up an intellectual and spiritual web of life that envelops the planet and is every bit as important to the well-being of the planet as the biological web of life that we know as the biosphere. You might think of this social web of life as the "ethnosphere", a term best defined as the sum total of all thoughts and intuitions, myths and beliefs, ideas and inspirations brought into being by the human imagination since the dawn of consciousness. The ethnosphere is humanity's greatest legacy. It is the product of our dreams, the embodiment of our hopes, the symbol of all that we are and all that we, as a wildly inquisitive and astonishingly adaptive species, have created."

(The bolding is mine.)

Tuesday, March 8, 2011

Smile-Mask Syndrome

A new psychological syndrome is hitting headlines in Japan and neighbouring Asian countries. Named "smile-mask syndrome" by leading Osaka psychiatrist Makoto Natsume, the disorder primarily affects women in service industries whose jobs require them to smile all day. After a day of smiling, he says, these women find themselves increasingly unable to turn off the smile. Even devastating bad news can't wipe the inappropriate smile off their faces, much to their distress.

Dr Natsume predicts a national wave of mental illness including depression and other disorders as a result of women being forced to repress authentic emotions in order to wear a smile all day.

There may be another effect happening in addition to the repression of real feelings. According to the New York Times, "some researchers have tried to ... understand the states of mind that produce smiles. We think of them as signifying happiness, and indeed, researchers do find that the more intensely people contract their zygomaticus major muscles, the happier they say they feel. But this is far from an iron law. The same muscles sometimes contract when people are feeling sadness or disgust, for example."

So the wearer of the false smile may, paradoxically, be led to feel sad, by being forced to chronically contract the muscles required to produce smile.

Cultural Casebook: The Myth of American Innocence

Barry Spector's new book, Madness at the Gates of the City: The Myth of American Innocence, has been ten years in the making. It's a wide-sweeping, provocative look at on American culture, from mythical, psychological and political perspectives, incorporating wisdom from ancient Greek traditions as well as from indigenous cultures in African and Central America.

Using the central image of the Ancient Greece god Dionysus, Barry looks at the archetype of the Other. According to Jungian psychology, the Other allows us to define ourselves by what we are not--defining Self by contrast with Other. Here in America, the ruling white (male) culture has historically defined itself by that which it is not--creating Others out of Native Americans, Black Americans, women, and most recently the Islamic world.

Barry adds an interesting extra layer of his own, defining the Inner Other and the Outer Other--others within the culture, and others without, and says this way of seeing ourselves and those around us grew from the very roots of the development of America, which combined a predatory world view, with a paranoid world view. His examination of American history and current foreign policy in light of all this is fascinating, and thought-provoking.

Refering to Ancient Greece, which venerated Apollo--god of reason, rationality, masculinity--Barry says the god Dionysus represented the Other, and held the shadow of the culture. But the Greeks gave room to Dionysus, in rites that celebrated sexuality, wildness--and grief. We in America, however, do not acknowledge our shadow, or allow the Other any humanity. Barry Spector's thesis is that this is because if we did, we would be pole-axed by grief at the reality of our 400 year history of oppression at home and abroad.

Instead, America lives by an unexamined myth of innocence. Our central myth has been created through 400 years of narratives about our need to defend ourselves against the dangerous Other. So without thinking about it, we believe we have a destiny of violent clashes with an evil enemy, in service of good and innocence. It's a myth of violent redemption, in which we play the role of savior. This myth hides the reality of American disenfranchisement, injustice, colonialism, and empire.

This short review doesn't come close to doing justice to the book. I urge you to read it. It's important, it's wise, and it makes you wonder about the unexamined stories you yourself live by, projecting them onto the world about you.

Saturday, March 5, 2011

Cultural Casebook: Counter Culture Kids

I just found a small gem in my local library. Wild Child: Girlhoods in the Counterculture, is a collection of memoirs written by women who grew up in hippie families.

"Tofu casseroles, communes, clothing-optional kindergarten, antiwar protests — these are just a few of the hallmarks of a counterculture childhood. What became of kids who had been denied meat, exposed to free love, and given nouns for names? In Wild Child, daughters of the hippie generation speak about the legacy of their childhoods."

The stories, collected by Chelsea Cain, describe a winsome existence, all too often underpinned by insecurity, neglect, and even outright abuse. This is essential reading for anyone who wants to understand the childhoods of the current 40 - 50 somethings who grew up in the counter-culture of the 70's in California and elsewhere.

Finding The Feet: Connecting Immigrant Children With Their Lineage

Much of the work I do with elementary school children who are immigrants to the US is an attempt to help them reconnect with their lineage, healing the internal split between them and their ancestral culture, in order to forge a positive bi-cultural identity.

In doing this I am drawing not only on theoretical work, such as Tobie Nathan's ethnopsychiatry or the writings of Gloria Anzaldua on bilinguality/biculturality. But also, and more profoundly, on my own experience as a multiply-dislocated and bilingual child--experience which informs the field of the therapy, as well as the narrative of my life.

While I lived in France, as a bilingual adult, I had several experiences where a bilingual child between the ages of about five and nine, whose parents were both monolingual, would be introduced to me in either French or English. The child would politely ignore me, as children do grown ups, until at some point I spoke equally fluently in the other language. Suddenly the child would become very animated, want to talk to me, and in some cases literally follow me around for the rest of the day. After this happened a few times, I realised these children were the only bilingual people in their family. Bilingual-bicultural children need bilingual-bicultural role models so they can integrate the dual self into a unified bilingual-bicultural identity.

Children of immigrants are not only living between and across two cultures, but are also coping, to a greater or lesser extent, with the trauma of dislocation. Working with this trauma takes many forms. Usually I begin by simply opening a space to talk about where their grandparents are, how their parents came to this country, and the fact that they themselves have two cultures and languages inside them--framing all of this in an unambiguously positive light. For example, talking about how brave their parents were to walk all that way.

Case example
For a while I was seeing a five year old girl from El Salvador*, who was referred following a series of tantrums during which she threatened to call the police, so they would take her away from her home.

In our first session the client drew her family in the US, with great care, and with a lot of very carefully shaded colours. The people were perfectly drawn, with smiling faces, but they had no feet. Their unfinished legs hovered above the carefully drawn green line of the ground.

I asked where her grandparents were, and she said, "El Salvador". I acknowledged that El Salvador was far away, and asked if they were here in her heart, and she said yes. So I suggested she might want to add them to the picture too. She drew them in the top right hand corner, and I was astonished to see that they had feet, connecting directly to a new green grounding line.

The contrast between the US family, who were 'ungrounded', and the family members in El Salvador, who had a connection, quite literally, with the land, was striking. I felt that this marked a dislocation-related trauma, and that this was probably linked to the theme of being taken away, as evidenced in the child's threats to her parents. In control mastery terms, this child was trying to control who would be taken away and when.

In subsequent sessions of undirected play the client chose to draw her grandmother's house in El Salvador, and then to make a meal of tortillas out of Play Doh. "My mom taught me to make tortillas", she told me. "And her mom taught her."

I repeated this. "Your grandma taught your mom, and then your mom taught you." And then added that when she had a little girl, she could teach her too, and then her daughter could teach her daughter--marking the thread of her lineage and the possibility of its continuation in this new country.

Whatever the client chose to draw, we would label, and whenever we labelled anything, I would do the writing in both English and Spanish, always asking the client what the Spanish word was. For example, we wrote 'Grandma" and then we wrote "Abuelita". Every time I did this the client seemed surprised and delighted. My Spanish is rudimentary, but this was less important than my openness (particularly as a representative of the host culture) to the fact that there were two languages in our shared field, and that their worldviews are equally true and valid.

Conclusion
This work was all about creating feet--establishing a connection backwards to the land that had been lost, which in turn would enable a more grounded existence per se.

It's noteworthy that the immigration trauma was announced and investigated within the child's own self-directed play, and that she used the play to re-connect to her lineage and integrate the split within her internalised family.

Six weeks after the start of therapy, the teacher reported that the child's family had called to tell her the child's tantrums had stopped.

*Details have been changed to protect the client's confidentiality.

Friday, March 4, 2011

Tobie Nathan: Ethnopsychiatry

I first encountered the notion of "ethnopsychology" in the works of Egyptian-born French psychoanalyst Tobie Nathan. His centres provided mental health services to African and North African families in France, using a unique combination of psychoanalytical diagnosis, family systems perspectives, multicultural clinical teams, and ritualised interventions designed within the mythical systems of the client's culture.

For Nathan's bio and bibliography in English, click here.

The ethnopsychiatry website is unfortunately one of the worst websites I have ever seen. For articles in English, click the link "Textes en anglais" in the left-hand menu bar. (Scroll for an article on PTSD and fright disorders: rethinking trauma from an ethnopsychiatric perspective.)

This site also contains articles in several languages on working with holocaust survivors and their children, written by
Nathalie Zajde.

Nathan has edited several journals:
Here's a video of Nathan, talking about some differences between an African and a Western worldview: Le Chaos et la Fracture.


Loss of the World: The Trauma of Dislocation

In this video, Dr Salman Akhtar discusses the trauma of dislocation suffered by immigrants and exiles, and defenses we use to cope with it.

Surprisingly (but immediately it rings true), he says it is not the loss of human relationships that creates the trauma--those we can, and will replace--instead, it's the loss of the world itself. The loss of the way the world looks: the shapes of houses, the lay of the land, the way the everyday objects are designed. And more subtly, the way time is constructed, and the cultural ways we conceive of our lives within the world--ways we don't realise are culturally specific until we find ourselves in a different culture. ("When I was living in India, I was not living in India, I was just living. I didn't realise I had been living in India until I left and came to the US.")

These dislocations cause the immigrant to continually be subliminally looking for aspects of home, however banal--the colour of mailboxes, or the flash of bouganvilea--which feel somehow more trustworthy than the equivalents in the new country. The sudden flash of 'home', and the happiness of recognition of an aspect of home, reveals that we have been missing a feeling of home all this time. Furthermore, without the subtle triggering of memories implicitly evoked by familiar objects and surroundings, we are psychically impoverished.

The clinical situation
In a clinical situation, Akhtar says, it is vital to validate the fact of immigration in the client's identity from the start, showing interest so that this material is flagged as important, and psychic space is opened for its exploration.

People with migration trauma, he says, can take a while to settle into the physical surroundings of the office. The physical surroundings can be crucial to them--being transitional and also totemic objects. These clients bring things in, and want to borrow things, very often. This is all about the trauma of loss.

Defenses
The immigrant defends against the dislocation trauma through several means:
1. Denial, subtly repudiating the host country. "I am not really here."
2. The fantasy of return. "I'm here for a little while but I'll go back." This return is continually deferred, sometimes to the point of "I want to be buried at home when I die."
3. Minimisation, via the fantasy of replication. "I'll re-create my country right here." Home can become a shrine for the immigrant, who owns more cultural artifacts than they would if they were living in their home country.
4. Idealisation of the home country (aka lost and idealised object). This in turn causes wounding if you do return--you can never find what you are looking for when you go back, because it has changed, and no longer the ideal, lost object.
5. Reparation--this is the key to healing. It involves the awareness that I was the one who left, thereby attacking my good internal object. So I have fix it. With this awareness comes altruism, philanthropy and creativity.

Nostalgia for home
The client's nostalgia for home must be analysed. It can often serve to mask aggression and frustration in the now: "Bombay was so lovely" can hide the fact that life right now here seems intolerable. On the other hand, nostalgia can be acting as a method for displacement of transference love: "Bombay was so lovely" can indicate that the client is also happy to be here in your office.

Exiles may never show nostalgia, never mentioning their home country, or only negatively. It's like a bad divorce. They spread the trauma backwards, spoiling the good memories. Here the crucial thing is to analyse the defenses against nostalgia. Even though there was trauma, "there were also trees, and birds, and lollipops..."

Space has to be provided for the migrant to elaborate on the nostalgia. Then it will be easier to analyse its defensive functions.

Non-human transferences
When working with migrants remember and note the issue of non-human transferences. The relationship with objects and places around the child (chair, rain, moon,...). These are not merely symbolic of human relationships, they are important in themselves, particularly for immigrants, because they mediate our difference, and the difference between our worlds, old and new. Environment can be mother, reversing Winnicott's "mother as environment".

Conclusion
Finally, Akhtar reminds us that none of this is the main work in the analysis, but rather it sets a crucial background to the work, with immigrant and exiled clients. Analysis of the immigration trauma allows resumption of development, the search for new objects, and the internal journey of self actualisation.

On a personal note, Akhtar mentions bouganvilea several times. This touched me, because bouganvilea is important to my internal landscape also. Its bright splash serves me as a transitional object, linking me to external landscapes I have lost, and symbolising aspects of myself which I am still seeking to integrate in a new country.