Jose ADOLFO SEGURA : Ethnic relations The success of ethnopsychiatry

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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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