The Behavioral and brain sciences
May 30, 2019
Samuel P. L. Veissière, Axel Constant, Maxwell J D Ramstead et al.
362 citations
A unifying account of how humans acquire shared cultural habits, norms, and expectations is developed by integrating the variational free-energy principle from theoretical neuroscience with concepts of cultural evolution and implicit learning. Humans construct social niches that provide epistemic resources called cultural affordances. Through immersive participation in patterned cultural practices, agents learn by inferring what other people expect—a process termed "thinking through other minds" (TTOM). This makes information about others' expectations the primary statistical regularity humans use to predict and organize behavior. The model aims to resolve debates in cognitive science between internalist and externalist accounts of theory of mind and between dynamical and representational views of enactivism.
Transcultural Psychiatry
August 1, 2015
Laurence J. Kirmayer
188 citations
Mindfulness meditation, when integrated into Western psychotherapy, is typically treated as a present-centered, nonevaluative mode of awareness assumed to promote mental health by interrupting distressing thoughts. However, in its original Buddhist contexts, mindfulness is part of a broader system with strong ethical and moral dimensions. Extracting the technique from its cultural setting may alter its nature and effects. This introductory essay examines the cultural meanings of mindfulness and its therapeutic uses, arguing that a contextual view is essential for continued dialogue between Buddhist thought and psychiatry.
Medical Humanities
June 1, 2019
Laurence J. Kirmayer, Ana Gómez-carrillo
104 citations
Psychosomatic explanation in medicine, psychiatry, and psychology creates a social grey zone where conflicts about agency, causality, and moral responsibility arise, reflecting deep-seated dualism in Western concepts of personhood. Illnesses viewed as psychologically mediated tend to be seen as less real or legitimate. New forms of dualism appear in philosophical attacks on Engel's biopsychosocial approach and in the NIMH's Research Domain Criteria program, which favors exclusively biological explanations. The case of resignation syndrome among refugee children in Sweden illustrates how accounting for medically unexplained symptoms raises problems of ascribing agency.
Transcultural Psychiatry
December 1, 2020
Boon-Ooi Lee, Laurence J. Kirmayer
41 citations
In dang-ki healing, a form of Chinese spirit mediumship in Singapore, a deity possesses a human medium to help clients feel hopeful and supported. Many mediums suffer personal conflicts before becoming possessed; they express and transform their distress through possession. Deities embody Chinese cultural traits and moral values, allowing the medium to embody an ideal self and gain spiritual knowledge through cleansing, self-mortification, and altered consciousness. Junior deities also train under senior deities to help clients. Practitioners, clients, and possessing deities are transformed in parallel, reciprocal ways that differ from Western individualistic psychotherapy, highlighting links between healing, cultural beliefs, and concepts of personhood.
Oxford University Press eBooks
April 5, 2018
Michael Lifshitz, Eli Oda Sheiner, Laurence J. Kirmayer
22 citations
Classic serotonergic psychedelics such as psilocybin, LSD, and ayahuasca can induce potent alterations in cognition and perception. The chapter reviews research through cultural neurophenomenology, which traces how neurobiology and sociocultural factors interact to shape experience. Scientific study of psychedelics is rediscovering their potential to promote creative insight, evoke mystical experiences, and improve clinical outcomes. Neuroimaging experiments have begun to unravel the influence of psychedelics on large-scale connectivity networks of the human brain. Culture and context constrain the flexible cognitive states brought about by psychedelics, suggesting that seemingly spontaneous psychedelic thought patterns reflect a complex interaction of biological, cognitive, and cultural factors—from pharmacology and brain function to ritual, belief, and expectation.
Frontiers in Psychiatry
January 1, 2020
Ram P Sapkota, Alain Brunet, Laurence J. Kirmayer
21 citations
In a systematic case-control study of 384 Nepalese adolescents aged 11-18 from 12 public schools, 194 students affected by mass psychogenic illness (MPI) were compared with 190 unaffected controls. MPI is understood as a dissociative phenomenon spread through social contagion among those prone to dissociation. Bivariate analyses linked caseness to childhood physical neglect and abuse, living in nuclear families, peritraumatic dissociation, dissociative tendencies, and depressive and post-traumatic stress symptoms. Hypnotizability was the strongest correlate among cognitive and personality traits. However, multivariable logistic regression found that common correlates of dissociation did not predict caseness, suggesting these factors do not adequately explain MPI. A Classification and Regression Trees analysis indicated that highly hypnotizable adolescents with high peritraumatic dissociation had a 73% probability of being a case.
Frontiers in Psychology
January 1, 2024
Anya Daly, Rosa Ritunnano, Shaun Gallagher et al.
17 citations
Mental disorders involve complex alterations of the self that arise from interactions among cognitive, bodily, affective, social, narrative, cultural, and normative elements. The pattern theory of self (PTS) provides a non-reductive account consistent with embodied-enactive cognition and phenomenological psychopathology, emphasizing the multi-dimensionality of subjects and situated embodiment. This article develops the Examination of Self Patterns (ESP), a flexible methodological framework that front-loads the self-pattern into a minimally structured phenomenological interview. The ESP avoids internalist or externalist assumptions about mind and is guided by person-specific interpretations rather than diagnostic categories, offering advantages for tackling the complexity of mental health research and clinical protocols.
Transcultural Psychiatry
October 1, 2022
Gabriella Gobbi, Antonio Inserra, Kyle T. Greenway et al.
9 citations
Psychedelics have been used by human societies for over 3000 years, primarily in religious and healing contexts. Recent research shows promising clinical benefits for some psychiatric disorders, but applying these consciousness-altering substances outside their traditional sociocultural settings raises concerns. The therapeutic mechanisms of psychedelics depend not only on neurobiology but also on psychological, social, and spiritual processes. Therefore, physicians and psychotherapists need training to guide patients through the experience, promoting positive outcomes and addressing side effects. Psychedelic therapies may lead to a new psychiatric paradigm integrating psychopharmacological, psychotherapeutic, and cultural interventions.
Culture, Medicine and Psychiatry
June 1, 2023
Boon-Ooi Lee, Laurence J. Kirmayer
7 citations
Most dang-ki spirit mediums in Singapore do not show clinically significant emotional distress, contradicting early claims that mediums are psychiatrically ill. Interviews with eight mediums from five temples, along with standardized psychological questionnaires, indicate that involvement in dang-ki healing may be therapeutic. The mediums reported changes in social identity, bodily experiences during possession, and overall sense of self through repeated rituals. The practice illustrates how selfhood is constructed through body-world relations, potentially conferring wellness and social efficacy.
Frontiers in Psychology
July 29, 2020
Jared R. Lindahl, D. James Cooper, Nathan E. Fisher et al.
2 citations
Buddhist meditation practitioners and teachers report a wider range of difficult or distressing experiences than previously discussed, some of which are considered expected on the contemplative path. Distinguishing these from psychopathology requires expanding assessment frameworks beyond normative fit with religious experience or mental illness to include the need for intervention, whether religious or clinical. Decision-making about intervention often depends on contextual factors, aligning with person-centered mental health care that considers interpersonal and cultural dynamics.
Culture, Medicine and Psychiatry
December 1, 2014
Ram P Sapkota, Dristy Gurung, Deepa Neupane et al.
Spirit possession in a Nepali village is a multidimensional phenomenon that cannot be reduced to a psychiatric diagnosis. A mixed-method study compared women who had experienced possession with those who had not: possessed women reported higher rates of traumatic events and more symptoms of anxiety (68% vs. 18%), depression (41% vs. 19%), and PTSD (27% vs. 0%). However, qualitative interviews with possessed individuals, family members, and traditional healers showed they did not view possession as mental illness; instead, it was seen as a form of communication with spirits and an idiom of distress expressing suffering related to mental illness, violence, trauma, and oppression. Clinical efforts must consider socio-cultural context to avoid harm.
Transcultural Psychiatry
October 1, 2023
Laurence J. Kirmayer
An approach to illness experience and healing emphasizes embodied metaphor and social processes of self-construal through material and discursive engagement with cultural affordances. The work outlines implications for theory, training, and clinical practice in psychiatry, drawing on cognitive science, enactivist perspectives, and the cultural poetics of symptom and healing ritual.