(1) Common mental disorders in global mental health
The global mental health movement has advocated vigorously for the diagnosis and treatment of common mental disorders. Although this literature often mentions cultural issues, it generally assumes that diagnostic and treatment methods developed in the West can be readily transported to low- and middle-income countries with profoundly different cultural contexts. Confidence in this transportability generally rests on assumptions of biological universality. Our studies will combine clinical research and experience-near ethnographic research to build on previous work on illness experience and behavior to examine the influence of cultural concepts of personhood on attentional and attributional processes, and coping strategies of patients with trauma-related affective, anxiety, somatoform and dissociative disorders. The aim of this project is to attempt to refine clinical assessment and treatment of mental disorders, and to explore the social, psychological and neurobiological mechanisms that underlie psychopathology and recovery.
To clarify the place of culture in the global mental health research agenda and address policy and practice implications, we are holding an Advanced Study Institute on Global Mental Health: Bridging the Perspectives of Cultural Psychiatry and Public Health July 5-7, 2012 in conjunction with the annual McGill Summer Program in Social and Cultural Psychiatry.
(2) Trauma-related disorders
Recent years have seen a burgeoning literature linking a wide variety of conditions to trauma exposure. At the same time, there has been a vigorous critique of the over-extension of notions of PTSD, which do not capture many of the co-existing mental health problems and contextual issues that are paramount for patients and clinicians. This axis of our research brings together psychological expertise in trauma intervention with neuroscience and ethnography to develop and evaluate culturally-informed clinical interventions as well as the studying mechanisms of indigenous healing practices, social support, resilience and recovery. The first line of research in this area is to explore how neurobiological mechanisms mediate therapeutic effects of clinical interventions: specifically, we will investigate the potential for using memory reconsolidation blockade (with propranolol) during trauma recall to treat post traumatic stress disorder (PTSD) by reducing the association of traumatic memories with autonomic over-arousal. The research will be conducted in partnership with the Centre for Victims of Torture in Kathmandu, Nepal. A related line of research in this area will explore how neuroendocrine mechanisms may modulate processes of recovery: building on research on the role of the “prosocial hormone” oxytocin in mediating the effects of social support. Bringing together ethnography, cognitive psychology and social neuroscience, we will examine the interplay between culturally-shaped ways of narrating distress, social support and the neurobiology of memory.
(3) The nature of healing, placebo responding and recovery
There is a long tradition in cultural psychiatry that seeks to understand the common, universal or non-specific elements of healing practices across cultures. Recent years have seen important advances in our understanding of the cognitive and neurobiological mechanisms involved in such processes. These have demonstrated the role of endogenous pain control and other mechanisms in responding to suggestion and placebos. These same mechanisms may help explain some of the efficacy of symbolic healing practices. At the same time, the ethnographic study of healing brings to light other potential cognitive and interactional mechanisms involving attention, emotion, and interpersonal processes that can be studied with the methods of cognitive and social neuroscience. This part of the project investigates the interaction between social, cultural and unconscious attentional processes that interact to mediate symptom reduction and recovery by bringing together cognitive neuroscience on the nature of attention in hypnosis and placebo effects, and ethnographic work on social mediation and transformation of self-experience. Specifically, we are approaching the process of trance, possession and healing working with three kinds of indigenous healers at our second research site in Singapore. This research on the social-contextual basis of responding to healing interventions can contribute to an integrative theory of healing.
A conference at McGill University is planned for May 2012 entitled, Placebos in the Clinic? Fostering Ethical, Educational, Policy and Practical Consensus. The meeting will bring together prominent placebo researchers from diverse fields as well as physicians, policy makers and related experts to discuss the realities of using placebos, placebo effects and placebo-like treatments in clinical practice.