Cultural Psychiatry

As hundreds of so-called "psychotherapies" have been foisted onto the public, all claiming to treat "mental illness," newer understandings of how the human brain actually works and the processes which drive the formations of mentation that we refer to as "the mind," demand a reassessment of what exactly we are referring to by the term "mental illness" and what kinds of intervention would be feasible in both the prevention of and recovery from cognitive and behavioral disorder. A fundamental process in the formation of an individual's mentation is the associations of experience. These associations not only account for constructive behavior, but can also lead to deleterious or negative behavior, suggesting that some associations are negative and therefore the negative behavior can be remolded through contrasting positive associations; however, to understand what this really means and how it works, we must start at the beginning and define what exactly is this negative behavior that we refer to by the term "mental illness." One of the most important axioms of life so simply but profoundly phrased by Oscar Wilde, is that "the truth is rarely pure and NEVER simple" (emphasis mine). Nothing can ever be explained by simple sound bites – oversimplification is just another word for misrepresentation – so to understand, we must truly engage the subject, and to engage the subject, we must first and foremost clearly define what it is that we are seeking to understand. In this case, it demands that we understand what exactly is mental illness.

In the following essay I propose some thoughts concerning stability (percepts and affects) and modification (desire). The two works written by Deleuze and Guattari that I consider are What is Philosophy? and the two volumes of Capitalism and Schizophrenia – Anti-Oedipus and A Thousand Plateaus. I make reference to Joyce’s literature, although mention of Joyce in Deleuze and Guattari is rare. The reason for using Joyce is that the Irish writer seems to have more than one affinity with the texts produced in the intersecting lives (Dosse, 2011) of the two French writers.
At the same time, Spinoza, among the philosophers who influenced Deleuze, is the benchmark of my essay for understanding the distinction between stability, concerning the work of art, and the work of the unconscious. The distinction between the philosophical mainstream (particularly Aquinas) in regards to “desire” and the importance of body in Spinoza’s philosophy is the path I follow for demonstrating that Schizoanalysis is a breaking point for philosophy, for psychology and for psychoanalysis.
In continuing the line traced out by Spinoza, and followed by Nietzsche and Bergson, Deleuze and Guattari break with the psychoanalytical vision of desire as a negative instance (the missing of something to be endlessly fulfilled) and foster the positive instance of desire as a production of the unconscious. Finally I note that the distinction between the stability of the work of art and the modification of desire – in connection with the distinction made by Spinoza – permits Deleuze to entirely regain the issue concerning: “what a body can do”.

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"It is a common experience that a problem difficult at night is resolved in the morning after the committee of sleep has worked on it." --John Steinbeck Scientific research confirms what people have always known: answers, ideas, and inspiration do come to us in dreams. Harvard psychologist and world-renowned dream specialist Deirdre Barrett, Ph.D., offers this rich collection of examples of how the world's most creative practitioners in art, music, film, science, literature and other fields have used the revelations of their dream life to inform their work. Dr. Barrett offers insights showing us how to encourage lucid, meaningful dreaming, and how to apply the meanings of our dreams to solving problems--from the everyday to the extraordinary. This is the stuff dreams are made of. In the visual arts, Jasper Johns couldn't find his unique artistic vision until he dreamed it in the form of a large American flag. Salvador Dali and his colleagues built the startling new genre of surrealism out of dreams. Kubla Kahn dreamed the design for his stately pleasure dome; thousands of years later, Lucy Davis, chief architect at a major firm, continues the tradition of dreaming designs into life in her extraordinary buildings. Film is a fertile avenue for dreams: "Twice I have transferred dreams to film exactly as I had dreamed them," confides director Ingmar Bergman, as have Federico Fellini, Orson Welles, Akira Kurosawa, Robert Altman, and John Sayles. From Mary Shelley's terrible nightmare, which became Frankenstein, to Stephen King's haunting dream as a little boy, which led to his first bestseller, countless writers have consulted the Committee. Musicians from Beethoven to Billy Joel and Paul McCartney have whistled the Committee's tunes. In science, physiologist Otto Loewi dreamed the medical experiment that earned him the Nobel Prize. In sports, Marion Jones dreamed she'd broken a world record, then brought the dream to life. Gandhi translated his dream of resistance into a movement that changed the world. Since Freud, we take it for granted that our dreams reflect our past. In The Committee of Sleep, Barrett reveals how dreams can also tell us about our future potential--and how to reach it.

We read with great interest the editorial by Krüger (2020) in which she provides a review of some of the cultural aspects of dissociation and trauma. We especially appreciate her call for the study of the “entire spectrum of dissociation” (p. 1) from normal to pathological. We have been working along similar lines (e.g., Maraldi et al., 2017; Maraldi et al., 2019) and would like to take the opportunity offered by Krüger to explore further the literature on possession experiences, which she mentions only briefly in her paper. Cardeña et al. (2009, p. 173) define possession trance as “a temporary alteration of consciousness, identity, and/or behavior, attributed to possession by a spiritual force or another person”. When involuntary, unwanted and incompatible with cultural or religious norms and practices, such experiences might be classified as pathological. The diagnosis of “possession trance disorder” was first proposed in the DSM-IV (APA, 1994) as a condition for further study, but in the DSM-5 (APA, 2013) pathological experiences of possession were subsumed under the dissociative identity disorder (DID) category. Pathological possession is now thought in terms of a “possession-form presentation” of DID. But the link between DID and possession trance has been contested by researchers from different countries (e.g., Delmonte et al., 2015; Maraldi et al., 2017; Van Duijl et al., 2013). Also, it is still unclear to what extent pathological possession differs from other pathological phenomena, such as possession delusions in psychosis and some of the so-called cultural syndromes (e.g., ataque de nervios, LewisFernández, 1994), which are considered by some authors as instances of dissociative phenomena (Hegeman, 2013; Ross et al., 2018). On the other hand, there are many nonpathological dissociative experiences about which we know very little, including spiritual experiences reported during religious or ritualistic practices (Alvarado, 2005; Queiroz, 2017). The DSM

The concepts of mental health and illness of the Inuit of Nunavik (Northern Québec) were studied through ethnographic interviews, participant observation and a questionnaire survey. The aim was to document Inuit knowledge and practices in order to inform mental health workers and planners working in Nunavik of the range of different perspectives and identified needs. The research involved the participation of the community in the selection of survey sites and the identification of appropriate problems for study. Three communities differing in their existing resources and average level of acculturation were studied.
Three types of research interview were conducted, corresponding to distinct parts of the project: (1) problem identification interviews with Inuit health care and community workers identified the range of problems in the community and the usual terminology used to describe them, resulting in a list of specific registers of potentially problematic behavior; (2) problem register interviews with key informants from the community identified the perceived prevalence of problems in the community and the typical signs and symptoms associated with each type of behavior or problem; (3) case history interviews with key informants reconstructed detailed accounts of cases with which they were personally familiar.
Major findings of the study include:
• There is no general term for mental health or illness in Inuktitut. When pressed, informants either used an English term (‘mental health problem’) or offered two terms with different connotations: Isumaluttuq and Isumaqanngituq. Isumaluttuq implies thinking too much while Isumaqanngituq means ‘having no mind’ or not thinking at all.
• According to informants, the most prevalent mental health problems were alcohol and drug abuse, family violence and abuse, and suicidal behavior.
• Most people were not very familiar with mental health problems. Although many had heard of demon possession, only a small number of cases were actually described.
• Although some people who completed suicide were described as withdrawn, isolated, depressed, having heavy thoughts, low self-esteem or hating themselves prior to their suicide, in many cases their suicide came as a complete surprise even to close friends and relatives.
• Inuit recognized four broad types of causes of mental health problems: (1) physical and environmental; (2) psychological or emotional; (3) demon or spirit possession; and, (4) culture change and social disadvantage. In many cases, multiple causes were offered for the same problem.
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• The presence of hallucinations or bizarre behavior prompted people to think of mental illness or demon possession.
• Violence, drug abuse and suicide were all commonly attributed to abuse and neglect in childhood or to ongoing family violence.
• Inuit tended to label behaviors or states of mind rather than individuals. This left open the possibility that someone who had an affliction or troublesome behavior could change and improve.
• People tended to be very tolerant of others’ unusual behavior. This may improve the integration and prognosis for people with psychiatric disorders. It may also, however, delay the recognition of depression, psychosis and suicidality.
• Talking with others was widely recognized as a good way to prevent and/or resolve mental health problems.
• Religious exorcism was viewed as an appropriate treatment in cases of demon possession by people who believed this was a cause of unusual behavior or illness.
From the interviews and survey, a model of indigenous concepts of and attitudes toward mental health and illness was developed. An Inuktitut/English lexicon of mental health related terms was also prepared. The model and lexicon can be used in future research on the prevalence, causes and consequences of specific social and psychiatric problems.
The research also has more immediate implications for the design and delivery of mental health care among the Inuit, including community education programs to improve the recognition, treatment and rehabilitation of people with major psychiatric disorders and community and professional interventions for people facing life crises.

This is the framing document for the presentation “English as Therapy” delivered September 27 to the 2015 NeuroELT Brain Days International Conference, Kyoto, Japan. This presentation introduces CNE (Cognitive Neuroeducation), a new learning-based, noninvasive, nonpharmacological modality for intervention in cognitive and behavioral disorder with the promise of full recovery therefrom. CNE is unique in that it is the only modality in the fields of learning and mental health that is strictly tied to how the brain actually works within a tightly constructed, exhaustively comprehensive model of the mind as formed exclusively from rigorous hermeneutic and phenomenological analysis.

Humans – through the biological determinants of evolutionary selection – have developed a uniquely social brain. In the human social brain, learning is the principal mechanism that shapes all behavior, and language is the medium through which learning takes place and cognition is formed. Cognition is the understanding of ourselves, others and the world around us. But the processes of cognitive development – that is, how we learn, what we learn, how we understand the world around us, and, consequently, how we are molded to behave – can be blocked or can become distorted.

In this presentation we explore the processes in the human social brain by which learning is realized and cognition and behavior are shaped, and the principles of CNE that can be applied, both in the classroom and in a remedial setting, to stimulate these processes in engendering positive learning realization and self-affirming, socially adaptable behavior.

This paper is the first comprehensive cultural critique of India's official community mental health policy and programme. Data is based on a literature review of published papers, conference proceedings, analysis of official policy and popular media,
interviews with key Indian mental health professionals, together with field work in
Kanpur district, Uttar Pradesh, India (2004-2006). The paper demonstrates how three influences have shaped community psychiatry in India: a culture asymmetry between health professionals and the wider society; psychiatry's search for both professional and social legitimacy; and WHO policies that have provided the overall direction to the development of services. Taken together the consequences have been that rural
community voices have been edited out. The paper hypothesizes that community psychiatry in India is a bureaucratic and culturally incongruent endeavour that increases the divide between psychiatry and local rural communities. Such a claim requires sustained ethnographic field work to reveal the dynamics of the gap between
community and professional experiences. The development of culturally sensitive psychiatric theory and clinical services is essential to improve the mental health of rural citizens who place their trust in India's biomedical network.

This book explores current advances in the scientific study of the inter-relationships among culture, mind and brain. The contributors draw from social sciences, psychology and neuroscience to show the interplay of biology, cognition, and social contexts in human experience. Part 1 of the book includes three sections presenting diverse theoretical models lines of research. The first section addresses the dynamic interactions of culture, mind and brain on multiple timescales: evolutionary, co-evolutionary, historical, developmental and everyday contexts. The section section considers ways of thinking about the brain in social context, beginning with an enactivist perspective, and then presenting a constructivist view of emotion, experimental studies of priming effects, and a discussion of emergence of the sense of agency. A third section considers how social coordination and cooperation are achieved through joint action, acquiring social norms, and engaging in ritual practices. Part 2 of the book considers the intersection of neuroscience and social science in specific domains, including history, spatial learning, education, music, literature, film, global mental health, urbanization, the Internet, and neurodiversity. Taken together the chapters contribute to a multilevel, multiscale view of the co-construction of mind, brain and culture. An epilogue considers the challenges and prospects for future interdisciplinary work.

「產後憂鬱」的現形，來自於精神醫學的建制化（institutionalization）
、醫學知識的推廣，並被國家納入健康治理的一環；個
人的文化信念與道德世界，也因為社會急遽變遷而有所變化，逐漸認
納「疾病」作為尋求改變的角色認同。本文藉由分析「產後憂鬱」在
台灣逐步浮現的過程及其現代性意義，闡釋當代精神醫學尋求「文化
能力」的思辨路徑。透過作者的臨床經驗觀察，並且爬梳跨文化精神
醫學的論述與臨床研究文獻，以跨學科的視角，對產後憂鬱的認識論
與診斷的政治進行檢驗與對話。
本文認為，產後憂鬱的疾病經驗是隨著社會變遷而浮現的。診斷
如同「雙面刃」，一來有助人改善處境的意義，卻也有縮限問題解釋
空間的可能。因此本文強調，產婦的病痛與就醫的主體經驗需要更進
一步的探究。臨床工作者的文化能力，在於對受苦經驗進行脈絡化的
理解，避免污名的產生，並致力於協助產婦於當代更新變動的社會條
件下，持續賦權以面對當代的困境。
The appearance of post-partum depression in Taiwan is due to the
institutionalization of psychiatry, the promotion of medical knowledge
over indigenous understandings, and the state’s health policy.
Individuals’ cultural and moral beliefs have also been reshaped under
rapid societal changes. Hence the disease identity then has been
reinforced. In this article, I analyze the gradual emergence and modern
significance of post-partum depression in Taiwan, and explain
contemporary processes in the search for cultural competence in the
field of psychiatry. I apply observations from my own clinical
experience to explore cross-cultural aspects of psychiatric treatment. I
also review the clinical research literature to examine and discuss the
epidemiology of postpartum depression and the politics of diagnosis
from an interdisciplinary perspective.
I propose that post-partum depression has emerged along with
social change. Making a diagnosis is a double-edged sword. Medical
intervention can be helpful, but it can also narrow the interpretation of
the experience. Therefore, there is a need for further exploration of maternal subjectivity, both in the illness itself and in receiving medical
treatment. Clinicians’ cultural competence lies in contextualized
understanding for patients in need, empowering patients to handle their
everyday struggles, and avoiding possible stigma.

How to provide culturally sensitive care for clients with posttraumatic stress disorder (PTSD) and related disorders This book, written and edited by leading experts from around the world, looks critically at how culture impacts on the way posttraumatic stress disorder (PTSD) and related disorders are diagnosed and treated. There have been important advances in clinical treatment and research on PTSD, partly as a result of researchers and clinicians increasingly taking into account how "culture matters." For mental health professionals who strive to respond to the needs of people from diverse cultures who have experienced traumatic events, this book is invaluable. It presents recent research and and practical approaches on key topics, including: • How culture shapes mental health and recovery • How to integrate culture and context into PTSD theory • How trauma-related distress is experienced and expressed in different cultures, reflecting local values, idioms, and metaphors • How to integrate cultural dimensions into psychological interventions Providing new theoretical insights as well as practical advice, it will be of interest to clinical psychologists, psychiatrists, and other health professionals, as well as researchers and students engaged with mental health issues, both globally and locally.

There’s method in the madness
Religious Studies, Psychiatry and Mad Studies

2016 British Association for the Study of Religion – Religion beyond the textbook - Abstract:

In the secure psychiatric units of the Western World 25% articulate their experience in religious terms.

Historically, some Western psychiatrists retrospectively diagnosed the likes of Moses, Jesus, Mohammed, a host of saints and whole traditions, Sufis, Sadhus and the Spirit Possessed, finding them victims of mental disorders.

Some contemporary Psychiatrics suggest that, apart from language, “there is no difference between a religious experience (with psychotic phenomenology) and other psychotic experiences.”

If there might be something ‘not mad’ about religious ‘innovators and entrepreneurs’ like Moses, Jesus, Mohammed, etc., might there be something ‘not mad’ about some of the 25% in secure psychiatric units.

What are we supposed to do with this idea?

One obvious approach might be to listen to the people in secure units, beyond the text. However recent evidence shows NHS ethics committees reluctant to support non-medical research among ‘very sick people’. Whilst this raises questions about whose interests they serve, it perpetuates the silence of the mad.

Mad studies suggests another response. By including the voices of the Mad within the Academy it may be possible to engage in different ways of seeing which are not so obvious to the Religious Studies text(s).

Recent events underscore the morbidity and mortality resulting from structural racism. As cultural specialists, we believe that clinical benefits will accrue from better integrating cultural and societal-structural approaches in psychiatric assessment, care planning, and case management.

Inuit approaches to childrearing reflect a particular concept of person- hood that may be termed relational, ecocentric, and cosmocentric (Kirmayer, 2007; Kirmayer, Fletcher, & Watt, 2008). As described in the first part of this commentary, Inuit understand the self as being in constant transaction with larger forces in the environment. This ecocentric and cosmocentric view gives different meaning to the challenges described by Briggs in her portrait of Inuit childrearing. It suggests that teasing has more than one goal. One objective is to impress on the child the importance of adhering to norms of interpersonal behavior (while tacitly acknowledging the com- plexity of our conflicting desires and emotions as human beings). Another objective of teasing is to encourage the child to engage in an active pro- cess of searching for the right way to think and act pro-socially in everyday encounters. A third objective is to reduce anthropocentrism and instil a cos- mocentric view. Within Inuit culture, teasing communicates social norms in a powerful way that the child is unlikely to forget. Rather than setting out clear rules to follow, however, it serves to create anxiety or concern about a whole domain of behavior. This focus encourages an active engagement with questions of the child’s place in the social world and the cosmos.

As chemsex becomes more common within our gay communities, it’s more common to hear from our friendship circles and networks, stories of chemsex psychosis. Perhaps we’ve hooked-up with people who are experiencing these complicated symptoms – or maybe even we’ve experienced these symptoms ourselves.
Although it’s frightening, and difficult to understand, difficult to manage... we need to talk about it more, so we can understand it better, de-mystify it, and to help each other out when it happens.

This document is a community resource; a guide that seeks to explain;
-what chemsex psychosis is, the most common symptoms
-what is causing it
-how we can help ourselves
-how we can help our our friends and lovers

This chapter presents ethnographic and social neuroscientific insights on the emerging subculture of juicing: an extreme eating practice grounded in food beliefs about purity and pollution enacted through a set of highly prescriptive rituals to ‘flush’ out undesirable substances and achieve ‘cleansing’. Drawing on our ethnographic evidence and recent work in cognitive anthropology, the philosophy of psychiatry, and social neuroscience, we argue that the positive results achieved by juicers are largely attributable to the prosocial rewards of constructing a juicer identity reinforced in ritual, and to implicit sociocognitive substrates of the placebo effects. The cult-like dimensions of juicing culture, in turn, presents us with a fascinating window for the study of emergent sociality and its physiological effects, and, by extension, for the theoretical and empirical study of embodiment in cultural epidemiology

Cultural awareness, knowledge, and responsiveness are essential components of person-centered psychiatry. The construct of culture refers to the systems of knowledge, values, institutions, and practices that constitute social institutions, including families, communities, and societies. Culture and social context influence the causes of psychiatric disorders by creating identities and social positions that may differentially expose individuals to social stressors including racism, discrimination, and forms of structural violence, as well as to positive social support and resources that promote health, resilience, and well-being. Culture shapes symptom experience, and expression as well as modes of coping and the social response of others in ways that affect the recognition, diagnosis, and treatment of mental health problems. The course and outcome of psychiatric disorders depend on the interplay between culturally mediated processes of individual psychology, family and community dynamics, and relationships with the larger society. In this chapter, we outline current thinking about the role of culture in mental health and illness and review approaches to integrating attention to culture and social context in person-centered care. We discuss some specific tools and strategies for culturally informed assessment and treatment and outline some issues for culturally responsive mental health services, health care policy, and mental health promotion.

The term ‘‘cultural concepts of distress’’ (CCD) was introduced in DSM-5 to better characterize the broad set of constructs identified in clinical and ethnographic research on cultural variations in distress. The contributions to this issue of Transcultural Psychiatry on cultural concepts of distress show how much work on this topic has evolved and equally what remains to be done. In this Commentary, we take stock of the current state of the field and outline some future directions for research and clinical application.

Cultural clinical psychology and psychiatry aim to address the mental health needs of diverse communities by integrating attention to cultural differences in knowledge, social institutions, identities, and practices. These differences affect mental health by influencing the causes and mechanisms of psychopathology, shaping illness experience and expression, and guiding processes of coping, adaptation, healing and recovery. Various theoretical models, borrowed from social sciences, have been used to understand the interaction of culture and mental health and the nature of psychiatric disorders. These models reflect the cultural assumptions of psychiatry itself and becoming aware of some of these tacit assumptions is essential to open up a space for intercultural work. In this chapter, we will advance an ecosocial approach to culture in mental health in terms of “culturally responsive care.” This aims to identify crucial dimensions of culture and social context relevant to the lived experience of mental health problems and apply that to understanding to clinical assessment and interventions.

In this chapter, we review some of the salient features of Indigenous contexts and characteristics that affect the well-being of Indigenous youth. We outline an approach to mental health promotion that takes into account historical, transgenerational, and contemporary contexts and seeks to build on the strength and resilience of Indigenous communities and youth. Our examples come from Canada but have broader application for Indigenous peoples in many countries as well as for youth from other marginalized communities that have faced historical loss and devaluation and must meet the challenges of globalization and ongoing culture change.

[AMAZON LINK BELOW TO BOOK ITSELF -- TOC and book summary in downloadable .doc]      Our instincts—for food, sex, or territorial protection— evolved for life on the savannah 10,000 years ago, not in today’s world of densely populated cities, technological innovations, and pollution. We now have access to a glut of larger-than-life objects, from candy to pornography to atomic weapons—that gratify these gut instincts with often-dangerous results. Animal biologists coined the term “supernormal stimuli” to describe imitations that appeal to primitive instincts and exert a stronger pull than real things, such as soccer balls that geese prefer over eggs. Evolutionary psychologist Deirdre Barrett applies this concept to the alarming disconnect between human instinct and our created environment, demonstrating how supernormal stimuli are a major cause of today’s most pressing problems, including obesity and war. However, Barrett does more than show how unfettered instincts fuel dangerous excesses. She also reminds us that by exercising self-control we can rein them in, potentially saving ourselves and civilization.

Mindfulness meditation and other techniques drawn from Buddhism have increasingly been integrated into forms of psychotherapeutic intervention. In much of this work, mindfulness is understood as a mode of awareness that is present-centered and non- evaluative. This form of awareness is assumed to have intrinsic value in promoting positive mental health and adaptation by interrupting discursive thoughts that give rise to suffering. However, in the societies where it originated, mindfulness meditation is part of a larger system of Buddhist belief and practice with strong ethical and moral dimensions. Extracting techniques like mindfulness meditation from the social contexts in which they originate may change the nature and effects of the practice. The papers in this issue of Transcultural Psychiatry explore the implications of a cultural and contextual view of mindfulness for continued dialogue between Buddhist thought and psychiatry. This introductory essay considers the meanings of mindfulness meditation in cultural context and the uses of mindfulness as a therapeutic intervention in contemporary psychiatry and psychology.

Anthropology and psychiatry have long shared common intellectual and scientific ground. Both are interested in human beings, the societies within
which they live and their behaviours. A key starting difference between the two is anthropology’s interest in relativism, whereas psychiatry has been interested in universalism. Also, both anthropology and psychiatry
have a long history of common interest in phenomenology and the qualitative dimensions of human experience, as well as a broader comparative and epidemiological approach. Jenkins illustrates the
common ground by emphasizing that both disciplines contribute to the philosophical questions of and experience raised by cultural diversity
in mental illness and healing. Both disciplines also contribute to the practical problems of identifying and treating distress of patients from diverse ethnic, gender, class and religious backgrounds. Psychiatry
focuses on individual biography and pathology, thereby giving it a unique relevance and transformation.Patient narratives thus become of great interest to clinicians and anthropologists. Development of specializations such as medical or clinical anthropology puts medicine in general and psychiatry in particular under a magnifying glass. The nexus between anthropology of emotion and the study of psychopathology looks at normality and abnormality, feeling and emotion, variability of
course and outcome, among others. The article concludes by highlighting the convergence between these two disciplines as a very fertile ground for the burgeoning field of Global Mental Health.

In this chapter, we consider what is known about cultural variations in somatization and in its obverse, psychologization (White 1982). The term “somatization” is used clinically in several conceptually distinct ways (Kirmayer 1984): to refer to a family of psychiatric disorders (somatoform disorders in DSM-IV); to refer to a process of transforming or transducing psychological conflict into bodily symptoms (often including medically unexplained and functional somatic symptoms); to describe a pattern of illness behavior, especially a style of clinical presentation, in which somatic symptoms are presented to the exclusion or eclipse of emotional distress and social problems. These different uses of the term are not equivalent and involve varying degrees of inference about underlying processes which are, at present, unmeasurable. In research studies, somatization has been operationalized in three main ways (Kirmayer and Robbins 1991): (1) as medically unexplained somatic symptoms (for example, in the somatization disorder module of the Diagnostic Interview Schedule: (Escobar et al. 1989)); (2) as hypochondriacal worry or somatic preoccupation (Barsky 1992); and (3) as somatic clinical presentations of affective, anxiety or other psychiatric disorders (Goldberg and Bridges 1988). Although somatization is often thought to be characteristic of specific ethnocultural groups, recent evidence shows that somatization is common in all cultural groups and societies. Differences between groups may reflect cultural styles of expressing distress (‘idioms of distress’) that are influenced not only by cultural beliefs and practices but also by familiarity with health care systems and pathways to care.

This paper proposes an integrative perspective on evolutionary, cultural and computational approaches to psychiatry. These three approaches attempt to frame mental disorders as multiscale entities and offer modes of explanations and modeling strategies that can inform clinical practice. Although each of these perspectives involves systemic thinking, each is limited in its ability to address the complex developmental trajectories and larger social systemic interactions that lead to mental disorders. Inspired by computational modeling in theoretical biology, this paper aims to integrate the modes of explanation offered by evolutionary, cultural and computational psychiatry in a multilevel systemic perspective. We apply the resulting Evolutionary, Cultural and Computational (ECC) model to Major Depressive Disorder (MDD) to illustrate how this integrative approach can guide research and practice in psychiatry.

Hallucinations possess two main components: (i) a sensory content; and (ii) a sense that the sensory content is real. Influential models of schizophrenic hallucination claim that both the sensory content and the sense of reality can be explained in terms of metacognitive dysfunction. This chapter assesses whether such a claim holds for schizophrenic and drug-induced hallucinations; it further attempts to determine the actual role of metacognition in hallucination and how this role is liable to vary across cultures. It is first argued that the notion of sense of reality is heterogeneous and should therefore be divided into distinct kinds. Next, some monitoring-based models of hallucination are presented. After having briefly distinguished between different levels of metacognitive processing, I show that these monitoring-based models are metacognitive only to a limited extent and that they fail to explain important aspects of the content and sense of reality of hallucinations. I subsequently suggest that the main mechanisms of serotoninergic-hallucinogens are not metacognitive whereas those of anticholinergic-hallucinogens importantly tap into subpersonal metacognitive processes. Looking specifically at the use of ayahuasca across different Amazonian indigenous groups, I put forward the idea that the metacognitive properties of hallucinogenic experiences can be variously exploited or ignored depending on cultural expectations. Finally, I examine how anthropological and linguistic evidence of the ritualized use of hallucinogens supports the existence of multiple metacognitive norms in religion.