B. Mainguy, Canada

Coyote Institute - Canada Education Division
Ms. Mainguy works with addictions and mental health among North American indigenous people.

Presenter of 5 Presentations

e-Poster Presentations (ID 1106) AS08. Cultural Psychiatry

EPP0481 - Distinguishing cultural experiences from psychotic symptoms in indigenous settings: Maori and North American perspectives.

Session Name
e-Poster Presentations (ID 1106)
Date
Sun, 11.04.2021
Session Time
07:30 - 23:59
Room
e-Poster Gallery
Lecture Time
07:30 - 07:30
Presenter

ABSTRACT

Introduction

Indigenous people think about mind and mental health differently from contemporary psychiatry, particularly in relation to the symptoms that comprise psychosis.

Objectives

We aim to present the Maori (New Zealand) and the North American indigenous (primarily Lakota, Cherokee, and Wabanaki) views of extraordinary experience and to explore opportunities for dialogue and understanding among these perspectives, leading to genuine, respectful collaboration.

Methods

Auto/ethnographic methodology was used to describe a process in which psychiatrists and traditional cultural healers came to understand each others' perspectives, dialogued, and forged a collaboration. We describe how this process unfolded in New Zealand and in North America, discussing similarities and differences among these two regions and cultures. We present cases to illustrate the level of cultural collaboration.

Results

The opportunity for cross-cultural dialogue arose when the psychiatrists observed that the traditional cultural healers were reaching and helping patients with whom they had been unsuccessful. This led to dialogue in the fashion of Two-Eyed Seeing, a North American indigenous concept of explanatory pluralism. We present the case of a young man whom the psychiatrist described as hallucinating and prescribed medication that did not help. The cultural healer assisted the young man to see how he had broken cultural taboos, helped him repair the damage, and the hallucinations disappeared. Other cases further illustrate the collaboration. Two-eyed seeing allows both perspectives to be correct and permits genuine dialogue.

Conclusions

Through cultivation of genuine listening without interpretation or judgment (see Jacques Lacan), cultures can begin to understand and collaborate together for the benefit of patients.

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e-Poster Presentations (ID 1106) AS08. Cultural Psychiatry

EPP0485 - Models for Successful Interactions between Psychiatrists and Indigenous People

Session Name
e-Poster Presentations (ID 1106)
Date
Sun, 11.04.2021
Session Time
07:30 - 23:59
Room
e-Poster Gallery
Lecture Time
07:30 - 07:30
Presenter

ABSTRACT

Introduction

Conventional psychiatric services are not always acceptable to indigenous communities and people.

Objectives

We used qualitative methodology to explore a successful collaboration of psychiatrists and addiction medicine specialists with indigenous communities in Maine, USA, in North America, comparing these results to previously unsuccessful collaborations. We wanted to delineate what leads to success.

Methods

We used constant comparative, iterative methodology within a constructivist, grounded theory approach to generate differences to discuss.

Results

Successful strategies address the highly relational approach to defining the self of the indigenous communities, a collectivist mindset in which the needs of the group can supersede the needs of the individual, a reliance upon stories for transmission of knowledge and culture, and a commitment to a biopsychosocial and spiritual approach, which, in North America, is often symbolized by the metaphor of the Four Cardinal Directions. Successful psychiatrists working in these communities needed to share more personal details than what they are usually accustomed to provide. They acknowledged local culture and spirituality and worked with traditional knowledge holders to create collaborative approaches. As part of this, the use of a narrative approach worked best in which the psychiatrist worked within the stories and beliefs of the community which required taking the time in dialogue to learn those stories and beliefs.

Conclusions

We addressed the challenges of consulting to tribal-based treatment programs, of modifying usual counseling techniques such as motivational interviewing to an indigenous population. We propose that these sorts of participatory-action-based approaches go far to improve service delivery to indigenous people and reduce health disparities.

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e-Poster Viewing (ID 1107) AS08. Cultural Psychiatry

EPV0238 - An exploration of the elements of effective cultural healing in North America

Session Name
e-Poster Viewing (ID 1107)
Date
Sun, 11.04.2021
Session Time
07:30 - 23:59
Room
e-Poster Gallery
Lecture Time
07:30 - 07:30
Presenter

ABSTRACT

Introduction

Introduction: How traditional cultural healing works is difficult for biomedical science to understand. Outcomes do occur that defy the conventional logic of materialistic, reductionistic cause-and-effect.

Objectives

Objectives: We aimed to understand how participants understood what happens in traditional cultural healing.

Methods

Methods: We identified 26 cases of results in which improvement occurred beyond what biomedicine would expect from a placebo response. We interviewed the healers and their clients to understand their experience and how they saw what had happened.

Results

Results: Seven cases involved resolution of cancer; 2 cases, musculoskeletal disorders; 9 cases of rheumatological disorders; 8, other disorders. Each person spoke about the importance of spiritual transformation and described such an experience. They spoke about an attitude of the cultural healer that involved what could best be translated as radical empathy coupled with non-judgmental listening without interpretation. Many of healers had been initiated into their healing roles via a life-threatening illness that resolved when an extra-ordinary being(s) (a spirit or god, or God) entered their life world and became an integral part of their being. This was also a common description given by the participants for what had happened. The healers often described themselves as a hollow bone, a conduit through which spiritual forces flow.

Conclusions

Conclusions: Traditional cultural healing remains important to psychiatry because it defies explanation in our usual paradigm. Spiritual transformation and radical empathy may be necessary, though not sufficient components. For the person who undergoes a profound spiritual transformation, extensive changes in self and world view may occur.

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Oral Communications (ID 1110) AS08. Cultural Psychiatry

O094 - Two-Eyed Seeing As A Philosophy To Facilitate Communication Between Indigenous Counselors And Psychiatry About Mind And Mental Health

Date
Sat, 10.04.2021
Session Time
07:00 - 21:00
Room
On Demand
Lecture Time
21:36 - 21:48
Presenter

ABSTRACT

Introduction

The term "two-eyed seeing" is spreading across North America as a concept for explanatory pluralism. The concept was brought into academic science by Albert Marshall, a M'iqmaq from Nova, Scotia, Canada. It speaks to the idea that indigenous knowledge is an equally valid way of conceptualizing a phenomenon as is contemporary science. Marshall's famous example compares a traditional M'iqmaq story about the origins of the large tides in the Bay of Fundy with contemporary oceanographic geology findings and simulations.

Objectives

We wanted to explore how this two-eyed seeing model could be applied to mental health to facilitate a dialogue between psychiatry and traditional cultural healers.

Methods

We reviewed the existing literature on two-eyed seeing within mental health care using PubMed, IndexMedicus, OneSearch, and Google Scholar. We presented a course on two-eyed seeing for indigenous mental health services and two-eyed seeing for addressing trauma in indigenous communities and surveyed the participants about the two-eyed seeing concept. We offered this course primarily to providers within indigenous communities and also for other interested counsellors.

Results

Participants in our trainings were enthusiastic about the role of two-eyed seeing for improving communication among indigenous providers and patients and non-indigenous providers. Most indigenous counselors had not heard of two-eyed seeing and were quite enthusiastic about its affirming nature and how it gave them a basis for dialogue with non-indigenous practitioners.

Conclusions

Two-eyed seeing allows a rich dialogue between European-derived practitioners and indigenous people that enabls each to appreciate the other's perspectives, leading to greater cooperation and collaborative treatment.

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Oral Communications (ID 1110) AS25. Old Age Psychiatry

O197 - Modeling the Appearance and Progression of Cognitive Impairment

Date
Sat, 10.04.2021
Session Time
07:00 - 21:00
Room
On Demand
Lecture Time
12:48 - 13:00
Presenter

ABSTRACT

Introduction

It remains difficult to predict which individuals will develop cognitive impairment and progress to major neurocognitive disorders. Prevention studies suffer from the long time frames and the manner in which this topic does not lend itself to randomized, double-blinded controlled trials.

Objectives

We aimed to construct a computer simulation model that would accurate portray the time course for a series of individuals to develop cognitive impairment and to progress to major neurocognitive disorder.

Methods

We built a computer simulation model that incorporated the role of exercise, genetic load, age, quality of diet, presence of diabetes and level of hemoglobin A1C, ongoing levels of cognitive stimulation, presence or absence of micronutrients, presence or absence of other co-morbidities, an overall general health index, levels of smoking and other substance use, and family history. We modeled the life course of 10 individuals, adjusting parameters to make correct predictions for all 10 people. Then we entered the data from another 10 people to determine how accurate the model would be with ten new individuals for whom it had not been developed.

Results

We defined success as a prediction of onset within 10% of the actual date and a prediction of the slope of the trend within 20%. We had 7 successes. We were able to engage 6 of the 10 in interacting with the model to change health behaviors.

Conclusions

Computer simulation modeling may provide an opportunity to study the long-term effects of health behaviors and to engage people in interacting with the program to change behavior.

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