Transcultural

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TRANSCULTURAL

For a long time the question of alterity (Julia Kristeva), and in particular cultural alterity, has been raised by psychoanalysis (Sigmund Freud, Sándor Ferenczi, Géza Roheim): psychic alterity and its avatars, working within the analytic framework, and the transformation of this alterity, which can be painful or difficult to come to terms with, into human creative potential. New ways of shedding light on this question are being found in the areas of both epistemology (Isabelle Stengers) and clinical work (adaptation of the analytic framework to non-Western populations, migrants, and so forth).

There are several modalities of integration of cultural representations into our clinical systems. Advances in anthropology have required practitioners to consider the two-way interactions between outside (culture) and inside (the individual's psychic functioning). Two different currents of thinking have emerged: those that hold that the therapeutic relationship is constituted from the outset by elements inferred to be universal, and those that hold that the detour through the particular with its own specific coding, including cultural coding, is necessary. And yet, even among those who accept the presence of cultural presuppositions in the therapeutic relationship, two different epistemological positions can be noted, and regrettably, these have led to heated debates, more ideological than clinical, in many Western countries.

Some thinkers have adopted an essentially comparatist perspective: What are the invariant features that are found in our patients' culture and our own? This view leads to the construction of equivalencies and parallelisms between cultural elements of different worlds, but also between the cultural elements of one group and pathological behaviors of individuals belonging to other groups. This option was present in some of Freud's texts, such as Totem and Taboo (1912-1913a). On the clinical level, this choice leads to inserting the patient's language into certain mechanisms, and even becoming familiar with his or her cultural representations. But all of these elements are posited as a particular coloration of the clinical relationship, its nucleus (the effective part) being the same as what would be established in an intracultural situation. The approach here can be psychological (in France, Hélène Stork or Blandine Bril), psychiatric (this is especially the case in English-speaking countries, such as in the United States, with Arthur Kleinman), or, more rarely, psychoanalytic (the field called psychoanalytic anthropology).

Others, following Georges Devereux, have adopted a perspective based on complementarity and make requisite but not simultaneous use of psychoanalysis and anthropology. This complementary approach differs from the comparatist one in that cultural logics are explored as such and are used to support associations. The tool of anthropology makes it possible to establish and explore the framework of the relationship and to co-construct cultural meanings with the patient, to which individual meanings will be linked. This perspective, ethnopsychoanalysis, is the most developed one in France. It is represented by the works of Tobie Nathan (1986), for the first generation, and those of Marie-Rose Moro (1994) for the second. In "L'Ethnopsychiatrie" (1978; Ethnopsychiatry), Devereux proposed a classification that recognizes three types of therapies that take into account the cultural dimension of mental disorders: "1. Intracultural, where the therapist and the patient belong to the same culture, but the therapist takes sociocultural dimensions into account. . . . 2. Intercultural (or transcultural, as it was first defined), where although the patient and the therapist do not belong to the same culture, the therapist is well acquainted with the culture of the patient's ethnic group and uses this knowledge as a therapeutic tool. . . . 3. Metacultural: the therapist and the patient belong to two different cultures. The therapist is not familiar with the culture of the patient's ethnic group, but nevertheless has a thorough understanding of the concept of culture and uses it in establishing the diagnosis and carrying out the treatment."

In English-speaking countries, working from Devereux's classification, a distinction is made between cross-cultural psychiatry or psychology (intercultural) and transcultural psychiatry or psychology (transcultural or metacultural).

The term transcultural is used in an imprecise way to refer in the broadest sense to the inter-, intra-, and metacultural perspectives. In a more restricted and precise sense, it refers to the metacultural form, which presupposes a perfect understanding of the concept of culture. Thus, in clinical practice the issue of the trans-cultural takes on very different forms depending on country and on theories relating to intellectual history, and psychoanalysis in a given context.

Marie-Rose Moro

See also: Anthropology and psychoanalysis; Basic Problems of Ethnopsychiatry ; Devereux, Georges; Ethnopsychoanalysis; Totem and Taboo .