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Ethnic relations
The success of ethnopsychiatry
Someone who believes that a witch has cast a spell on
him is not necessarily paranoid or mythomanic, especially
if the person grew up in a country where the voodoo cult
and tradition are widespread. Unfortunately, according
to Dr. Jose Adolfo Segura, the vast majority of mental
health specialists are not adequately trained to treat
patients whose beliefs or culture are different from those
of the western world.
In 1999, the Chilean-born psychiatrist founded the Ethnopsychiatry
Department at Hôtel-Dieu Hospital in the Université de
Montréal Hospital Centre. Every year he treats dozens
of immigrants suffering from health problems ranging from
difficulty adapting to their new country to major depression.
Dr. Segura tries to understand the sufferings of his patients,
but also pays close attention to the cultural setting in
which they have grown up.
Surprisingly, Dr. Segura's patients are rarely individuals.
Most often whole families come to consult him. “Generally,
immigrants are not individualists, like we are in North
America,” the clinical researcher explains. “When one of
the family is ill, the whole family takes part in the cure.” Perhaps
this is why Dr. Segura readily goes to the homes of his
patients rather than working in his office. To develop
his therapeutic technique, Dr. Segura has taken inspiration
from the shamanic rites of the mapuche, an aboriginal tribe
in Southern Chile. “The shaman goes to the patient's home
and builds a sacred space with branches. When the therapy
is completed, the branches are removed and life returns
to normal,” the psychiatrist explains.
Of course he cannot build this kind of shelter in Québec
homes. No matter: Dr. Segura has designed a device he calls “home
therapy space.” It consists of a round sheet of plastic
which he sets up in a room in the house for the duration
of the treatment. Therapy may last from 6 to 12 months,
with home visits every three to four weeks.
Out of respect for the occupants of the home, Dr. Segura
asks them to choose the room in which his therapy space
will be set up. The room people choose varies with their
culture, and may be a dining room, kitchen, basement, or
living room. Some families opt for the floor in the family
room. “When I let them choose a space that will be set
aside for therapy, I preserve my authority as a therapist.
In addition, when tensions rise, the family treats the
therapist as a guest. They change the subject, ask if I
want a coffee, and then I can no longer work.” At the centre
of the therapy space, Dr. Segura sets up cardboard squares
on which the family members can draw. The participants
use images and speech to talk of their problems, emotions,
culture, beliefs, nostalgia, perception of Québec,
etc.
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