2018 Jeanne Spurlock Lecture and Award for Diversity and Culture American Academy of Child and Adolescent Psychiatry Annual Meeting Seattle, WA, USA October 25, 2018 Abstract: Objectives: To provide a perspective on a career in community and cultural child psychiatry through the triple lenses of children, families, and culture, focusing on culture change syndromes, migration, and trauma. Methods: Employing the lenses of children, families, and culture, Di Nicola has argued that these elements have to be brought into dialogue with each other, sometimes radically challenging each other: 1) To study children across culture is to revision how we think about development. 2) To take family therapy seriously is to radically rethink how we imagine all relationships, from attachment and belonging to diverse family configurations and evolving constructions of gender and sexuality. 3) It’s also true that for cultural psychiatry and family therapy to take children seriously, they have rethink received notions of families and culture. None of these domains are fixed, stable or unchanging – th ey are all in flux. Results: This layered and dialogic approach to children, families, and culture led Di Nicola to forge these syntheses: 1) Cultural family therapy (transcultural psychiatry & family therapy). 2) Transcultural child psychiatry (child psychiatry & transcultural psychiatry). 3) Child- and family-centered global mental health (child & family psychiatry with the global mental health movement). Conclusions: Beyond evidence-based medicine, child psychiatry is nourished by meaningful personal and professional values. Di Nicola concludes with metaphors that inspire his work from social adversity to cultural diversity: 1) “A stranger in the family” (title of his book on cultural family therapy that explores three levels of strangeness – the mentally ill child in the family, the family that finds itself estranged in society due to migration or other socio-cultural differences, and finally, the therapist who arrives as a stranger in their midst with often alien or estranging views of their predicament). 2) “Looking across at growing up” (developmental psychologist Charles Super’s view of anthropology's horizontal or cross-cultural approach). 3) “Cultural changelings” (children’s experience of migrating across all the domains relevant to culture, including class, gender, race, religion and other aspects of belonging and community).

1. Borders & Belonging,
Culture & Community:
From Adversity to Diversity in
Cultural Child & Family Psychiatry
Vincenzo Di Nicola, MPhil, MD, PhD
2018 AACAP Jeanne Spurlock Lecture
AACAP 65th Annual Meeting
Seattle, WA, USA
October 25, 2018
9:30-12:00 pm

2. Conflicts of Interest
The presenter has no financial
conflicts of interest to declare

3. Community
The community stagnates without
the impulse of the individual.
The impulse dies without
the sympathy of the community.
– William James
The Will to Believe (1897)

4. Dr. Jeanne Spurlock

5. Mentors in Child, Family & Cultural Psychiatry
Jeanne Spurlock
Michael Rutter Naomi Rae-GrantRay
Prince
Bart Blinder
Mara Selvini Palazzoli
Eliot
Sorel
Sam Okpaku
Maurizio
Andolfi
Richard Mollica
Gaby
Weiss

6. What are we missing?

7. Overview
• Working with children, we need to
address three basic questions:
– Why development matters
– Why family matters
– Why culture matters

8. Three Lenses

9. Culturally
Diverse
Children and
Adolescents:
Assessment, Diagnosis,
and Treatment
Ian A. Canino and
Jeanne Spurlock
(2nd
ed, 2000)

10. Cultural Patterns
When mental health professionals
evaluate children, the influence of
cultural patterns is often
overlooked or attended to much too
briefly.
– Ian A. Canino & Jeanne Spurlock
Culturally Diverse Children &
Adolescents (2000)

11. Three Lenses
• “Child psychiatry is at the crossroads”

12. Three Lenses
• “Therapy is the art of lenses”

13. Letters to a
Young
Therapist
Relational Practices
for the Coming
Community
New York: Atropos, 2011
Awarded annual prize
Quebec Psychiatric
Association, 2012

14. Transcultural Child
Psychiatry
• “Looking across at growing up”

15. “Looking across at growing
up”
• To study children across cultures is
to revision how we think about
development
–Cultural anthropology (Charles Super)
–Culture-inclusive developmental
psychology (Jaan Valsiner)

16. V Di Nicola,
De l’enfant sauvage à
l’enfant fou: A prospectus
for transcultural child
psychiatry*
In: N Grizenko, et al,
Transcultural Issues in
Child Psychiatry.
Montréal: É ditions
Douglas (1992, pp. 5-53)
* From the wild child to the
crazy child

17. Cultural Family Therapy
• “A stranger in the family”

18. Source: The New Yorker

19. “A stranger in the family”
• To take families and family therapy
seriously is to rethink how we
imagine relationships in the family
and beyond
–from attachment & belonging
–to diverse family configurations
–and evolving constructions of gender
& sexuality

20. Cultural Family Therapy
NY: WW Norton, 1997
Porto Alegre: ArtMed, 1998

21. Family Studies
Family therapy is the starting point
for the study of ever wider
social units.
– Mara Selvini Palazzoli
Self-Starvation (1974)

22. Cultural Family Therapy
In a world with huge global flows of
migrants and refugees instigated by
conflict, disasters, or for economic
and social reasons, Cultural Family
Therapy offers clinical tools to
understand and treat families
experiencing severe stress due to
rapid and massive culture change

23. V Di Nicola, Famiglie sulla
soglia. Città invisibili, identità
invisibili *
In: M Andolfi (ed), Famiglie
immigrate e psicoterapia
transculturale. Milano:
FrancoAngeli (2004, pp. 34-47)
* Families on the threshold:
Invisible cities, invisible
identities.
In: Immigrant families and
transcultural
psychotherapy

24. Child & Family Centered
Global Mental Health
• “Cultural changelings”

25. V Di Nicola, Family,
psychosocial, and
cultural determinants of
health.
In: E Sorel (ed), 21st
Century Global
Mental Health.
Burlington, MA:
Jones & Bartlett Learning
(2012, pp. 119-150)

26. “Cultural changelings”
• For CP & FT to take children
seriously, they have to rethink
received notions of families and
culture in order to revision the
development of children
undergoing cultural change

27. “Cultural changelings”
• Culture-bound syndromes
(CBSs)
• Culture-change syndromes
(CCSs)
• Ref: VF Di Nicola, Anorexia multiforme: Self starvation in historical and cultural context.‑
I: Self starvation as a historical chameleon.‑
II: Anorexia nervosa as a culture reactive syndrome.‑
Transcultural Psychiatric Research Review, 1990, 27(3): 165 196;‑
27(4): 245 286.‑

28. Anorexi
a
Nervosa

29. Selective Mutism

30. Trauma

31. Childhood is a knife
planted in your throat.
You don’t remove it
easily.
– Wajdi Mouawad
from his play & film,
Scorched

32. The Nightmare of
Childhood
The history of childhood is a
nightmare from which we have
only recently begun to awaken.
– Lloyd deMause
The History of Childhood (1988)

33. “Changelings”
• Children’s lives are altered by trauma
• They become – in a modern twist on old
folktales – changelings
• With greater or lesser severity, across
more or fewer developmental domains,
for months or decades –trauma alters
lives

34. V Di Nicola,
Two trauma communities: A
philosophical archaeology
of cultural and clinical
trauma communities.
In: P Capretto & E Boynton, eds,
Trauma & Transcendence.
NY: Fordham University Press,
(2018, pp. 17-52).

35. Borders & belonging
“My fellow immigrants.”
“Remember always that all of us
are descended from
immigrants and revolutionists.”
– Franklin Delano Roosevelt
addressing
the Daughters of the American Revolution

36. Without cultural
understanding,
we build walls
instead
of bridges …

37. APA Council on International
Psychiatry

38. UBS
Cidade
Júlia
São Paulo,
Brazil
Photo:
V Di Nicola

39. “Intimate Strangers”
I see humanity as a family
that has hardly met.
– Theodore Zeldin
An Intimate History of
Humanity (1995)

41. Acknowledgments
Barton J. Blinder, MD, PhD
Professor of Psychiatry
University of California-Irvine
Brian Greenfield, MD
Associate Prof of Psychiatry
McGill University
Cheryl S. Al-Mateen, MD
&
Lisa M. Cullins, MD
Co-Chairs, AACAP Diversity
& Culture Committee
Turku, Finland

42. Questions
&
Comments