The psychiatrist as a cultural interpreter

I responded to a BMJ review of Sami Timimi’s book Pathological child psychiatry and the medicalisation of childhood, when the book first came out in 2002 (see response). This was before the publication of Postpsychiatry (discussed in a previous post). So, if Postpsychiatry is seen as one of the first texts of the Critical Psychiatry Network, Sami’s book has priority. Sami has published several other books since (see list on Wikipedia page). He also wrote a chapter for my Critical psychiatry book.

Sami came to England from Iraq when he was aged 14. This means he is very aware of discrimination, although during his training he found himself “becoming more and more critical of ... Arabic culture” (p. 126). Western powers’ involvement in war and destruction in Iraq led to him having a more balanced perspective (see my 2010 Openmind psychiatric update column). As Sami says, "[r]esistance is in my bones" (p.163).

Sami found his psychiatric training “a very confusing experience” (p.1). He found it difficult to understand why he was being indoctrinated in the way he was. He came to appreciate that “the whole mental-health business is about belief systems rather than hard science” (p. 59). He also came to appreciate that "[c]hallenging the mainstream can be a lonely, isolating experience" (p. 71). As I’ve said before (eg. see previous blog), psychiatry is more like a faith than a science. I have tried to take this understanding forward by using Clifford Geertz’s definition of culture as "a system of inherited conceptions expressed in symbolic forms by means of which men [people] communicate, perpetuate, and develop their knowledge about and attitudes toward life" (see eg. another previous post). Sami likened the kind of experience he went through to that described by Frantz Fanon when "black families in Europe often had to choose between alienation or adopting a European outlook and pretending that the racism around them did not exist" (p. 71). When seen as a non-believer at a pro-Ritalin and pro-ADHD conference, Sami "left the conference feeling he had attended an extremist cult convention" (p.85).

Still, Sami is a child and adolescent psychiatrist and this field used to be a haven for those that wanted to escape the abuses within adult psychiatry. Sami rightly worries that the increasing biologising of childhood has brought child and adolescent psychiatry within these parameters. When he and I trained, we were taught that there were emotional and conduct problems in childhood. Now medical students tend not to be taught this, instead being told to focus on ADHD and autistic spectrum disorders. Childhood depression, then, when we trained, was not recognised in the same way as adult depression, like it is now (see my BMJ letter).

In his first book, Sami said, "In essence what all of us who are working in the field of therapy for social suffering are doing is acting as cultural interpreters" (p. 83). Here he is using the notion of symbolic healing. Psychiatric practice is “using culturally meaningful mediated symbols” (p. 80). Sami recognises the way in which the 'new transcultural psychiatry' criticises orthodox psychiatry for "not giving proper consideration to context" (p. 156). He utilises "post-modern therapies" (p.130), defined widely, to include narrative and solution-focused approaches. His honesty even leads to him at times sharing "information from my own life" (p.135).

As Sami himself says, he has used "quiet persistence" (p.163) to get his message across. He has contributed significantly to modern critical psychiatry.