Category Archives: Uncategorized

Cultural Awareness In Psychiatry

renato_alarconI have recently come across several helpful articles by psychiatrist Renato Alarcón.  For instance, in this Article in Psychiatric News, he explains how cultural factors are very important in diagnosis, and says that outcomes would be much improved if psychiatrist paid more attention to them.

Taking culture into consideration enables psychiatrists to depathologize behaviors they might otherwise view as symptomatic, and to obtain a fuller picture of what patients are experiencing. Knowing patients’ traditions and beliefs may allow psychiatrists to employ culture in a psychotherapeutic role, by building rapport and collaboration.

Of course, this is easier said than done.  To help shift attitudes, Dr. Alarcón helped develop the  DSM-5 Cultural Formulation Interview, which helps clinicians account for the influence of culture in their clinical work, improve patient-clinician communications, and ultimately improve outcomes.

In his work, Renato Alarcón demonstrates the power of liminality – of actually meeting people.  (See Key Concepts Page on this blog.)

The important thing is to understand the human entity, the patient’s background, why he or she comes to see you now but didn’t come earlier, and how he or she explains their symptoms and causes of those symptoms.  The individualistic approach, a strong aspect of American life and of Western culture in general, stresses that people need to take responsibility for their own behavior. It often neglects, however, a cultural background that encourages reliance on family and friends. If psychiatrists fail to ask about cultural issues, he said, their work is incomplete.


Small is beautiful, if…


Peter Drucker

The global community of the future will be at its best a series of communities that are interdependent and diverse, embracing differences, releasing energy, and building cohesion.  The broader global community will be enhanced by the health of the many smaller communities that constitute the whole.  Those living within each community define all community. – From the Preface to Community of the Future, published by the Drucker Foundation in 1998

The late Peter Drucker earned a global reputation as a private sector guru, so it may come as a surprise to learn that towards the end of his life, he became a strong advocate for the so-called not-for-profit sector.  His later work inspired the book Communities of the Future – a collection of articles about the critical importance of community-based enterprise.

I am a firm believer in the power of grass-roots activism.  The challenge: learning how to work effectively with other groups while preserving our integrity.  Doing this, we re-frame the meaning of globalization.  As Drucker said (in another context), Culture eats strategy for breakfast.


We Are Not Ourselves

Details from William Utermohlen’s self-portraits


I am not myself. What is it to be “oneself?” What is this self, this “me”? What do we mean when we say “I”? When we lose our mind, where is it to be found? When we go out of our mind, where do we go?

There is so much being written and discussed about dementia.  For a fresh approach, I encourage you to read Nicci Gerrard’s article in The Guardian: Words fail us: dementia and the arts. She challenges us to have empathy – to enter into the experience of people who have dementia.  We can never understand dementia, but as we peek across this threshold, we can learn much about the mysteries of human consciousness.

The child learns to shape sounds into words and make boundaries around things; they tell stories and impose a narrative pattern on to chaos. Only in this way can the flooding world be comprehensible and endurable. But the demented person unshapes, undoes, disintegrates, unravels – from the formation of the self and language to its drastic unmaking. Words become mere sound again.

Gerrard gives several examples of how poets, writers and artists who were able to cross the threshold of dementia quite consciously and to communicate their experiences.  Their works can be quite unsettling – yet deeply stirring.

The art that attempts not simply to observe but to inhabit that desolate place of self-loss becomes like an emotional modernism, in which there is no central narrator, no coherent story, where things are fractured and the safe ground slides away beneath our feet. Exploring the experience of dementia and the loss of memory can bring about a powerful, and vertiginously unsettling, way of thinking about time, place and identity, where the notion of a stable reality and a single self breaks apart. Frank Kermode called it “decreation”, where words and meanings are unmade – an apocalypse of the self.

If we learn to follow them into this world of de-creation – with our still-conscious minds – perhaps we will discover seeds for re-creation.

NOTE: CRACKED: New Light On Dementia is another project which works artistically with this theme.

Addiction As A Failure Of Imagination

heroin_spoonIn recent years, virtually all mainstream advocacy groups, social agencies and philanthropic organizations concerned about mental health and addiction have rallied around a single, common message: Addiction is a disease.  Addicts are powerless to recover on their own, and they must acknowledge this before healing can begin.

Neuroscientist Marc Lewis recently published the book, “The Biology of Desire: Why Addiction is Not a Disease.  He argues that it’s time to change our minds on the roots of substance abuse.  He insists that the illness model for addiction is wrong, and dangerously so.  (See the book review by Laura Miller posted on

Lewis echoes one of the key concepts inspiring this blog: Health is not simply the absence of illness. Healthy communities depend on the contributions of spiritually active, creative people. Together, we can create conditions in which all can thrive.  External intervention, by human or divine agencies, may indeed help to remove the symptoms, and even to create the possibility of a fresh start. However, we must also empower people to take actions themselves. To help them do this, we need to provide a sensitive, intelligent social scaffolding to hold the pieces of their imagined future in place — while they reach toward it.

Deconstructing Oprah

l_3347_oprah.1Oprah Winfrey has earned a worldwide reputation as a champion for oppressed and marginalized people.  There is no doubt that she has been a positive influence for millions, and I have great respect for her work.

A recent article by Nicole Aschoff describes Oprah from a different angle:

Oprah Winfrey: one of the world’s best neoliberal capitalist thinkers

Aschoff writes: Oprah is appealing because her stories hide the role of political, economic and social structures in our lives. They make the American dream seem attainable.  

This critique goes right to the heart of the theme I am developing on this blog.  So many of our efforts have the goal of assimilating marginalized people into “normal” mainstream culture.  What if we had the interest, patience, and courage actually to meet these folks, and shape something new together.  Imagine the possibilities!

Empathy can be disruptive.


The Healthy Torontonian

imgresThis recent article by Jo Snyder (Wellesley Institute) really got me thinking.

The Healthy Torontonian: Unanswered Questions on Public Perceptions of What Causes Poor Health in the GTA

Many of us have been brought up with the belief that good health is fundamentally a personal responsibility.  If we make good choices with diet, exercise and sleep habits, we are much less likely to get sick. However, the research cited in the article paints a different picture.  We learn that socioeconomic factors (e.g. income levels, working conditions, physical environment…) account for lfifty percent of health outcomes.  Large, growing segments of the population are suffering bad health as a result of factors that are beyond their control.

Conclusion: If we invested more time and money in community care, we would need to spend much less on health care.

Good intentions – Bad consequences

In recent weeks I have been doing research about the the growing number of senior citizens who are ‘isolated and disconnected from their communities. It is difficult to identify direct causes ; the problem is systemic.  The psychosocial fabric of our communities is weakening, and vulnerable people are simply being left out.   This serious situation is getting more attention and there are many efforts to remedy the situation (e.g. the recent Request For Proposals from the federal New Horizons Program).

However, two recent news stories highlight well-intentioned projects that are actually creating more problems, at least in the short term.

Seniors being evicted as renovation looms at Unionville’s Heritage Village.  The good news is that lots of new units of affordable housing for seniors are coming on stream.  The bad news is that 110 vulnerable tenants are being evicted, and the new units will not be onstream until 2020.  I am sure that every effort will be made to help the tenants make a transition.  However, I am concerned that planners – even those who are dedicated to housing vulnerable people – underestimate the effects of shocks like this.  Surely we can do better.

mione-kenton007jpg.jpg.size.xxlarge.letterboxState of the art Alzheimer’s facility in Toronto lacks money, patients.  This building with all the latest bells and whistles was opened with fanfare 18 months ago.  The story goes into detail about the lack of transparency  (competence?) in management and governance matters.  There is also the all-to-familiar cry from a failed CEO for a fat payout.  The real story for me, however, is what is NOT said.  What has life been like for residents during these 18 months of confusion?  What is the quality of care now, when the building is up for sale?  How do the families feel?

When will we ever learn that buildings and technology are only a part – and not the heart – of the solution?