Transcultural Education for Clinical Psychologists, Part #3

Postcolonial Theories

“I think postcolonial scholarship provides a theoretical and historical focus to multiculturalism that makes it attractive to scholars who want to escape the narcissism of mere identity scholarship” Spivak in Hegda & Shome, 2002, p. 271.

“The theoretical base of postcolonial studies also allows for multiplicity to be thought of in a way that is different from just simply the Rainbow Coalition. Within the context of globalization, to be postcolonial seems more appropriate than to be merely metropolitan multicultural. It is a way of dealing with globalization which is after all a fairly recent phenomenon. In order to give globalization historical depth you must move it to postcoloniality” Spivak in Hegda & Shome, 2002, p. 271-272.

Gayatri Chakravorty Spivak’s quotes speak to two of the reasons underlying my proposal for incorporating Postcolonial Theory in a social justice curriculum: (a) the limits of liberal identity politics, and (b) the need to attend to cultural oppression everywhere, particularly now when the politics and economics of globalization are impacting everyone. There are two other reasons, (c) learning from the oppressed, and (d) attending to the psychology of oppression, voiced by Homi Bhabha:

1. "it is from those who have suffered the sentence of history—subjugation, domination, diaspora, displacement—that we learn our most enduring lessons for living and thinking" (p. 172).
   
2. "the affective experience of social marginality—as it emerges in non-canonical cultural forms—transforms our critical strategies. It forces us to . . .engage with culture as an uneven, incomplete production of meaning and value, often composed of incommensurable demands and practices, produced in the act of social survival" (p. 172).

While there is no single uniting definition of what is meant by Postcolonial studies, Homi Bhabha’s elegant introduction captures those elements most relevant to my purpose in this paper:

"Postcolonial criticism bears witness to the unequal and uneven forces of cultural representation involved in the contest for political and social authority within the modern world. Postcolonial perspectives emerge from the colonial testimony of Third World countries and the discourses of ‘minorities’ within the geopolitical divisions of East and West, North and South. . .[their aim is to] intervene in those ideological discourses of modernity that attempt to give a hegemonic ‘normality’ to the uneven development and the differential, often disadvantaged, histories of nations, races, communities, peoples. They formulate their critical revisions around issues of cultural difference, social authority, and political discrimination in order to reveal the antagonistic and ambivalent moments within the ‘rationalizations’ of modernity . . .The postcolonial project, at the most general theoretical level, seeks to explore those social pathologies ‘loss of meaning, conditions of anomie’--that no longer simply ‘luster around class antagonism, [but] break up into widely scattered historical contingencies."

The controversial writings of Fanon, Said, Spivak and Bhabha have decentered European intellectual hegemony in Europe through their criticism of white, patriarchal eurocentrism (Young, 2001). Said extended Foucault’s critique of western epistemic disciplinary power exercised by academic institutions to Orientalism, arguing that European studies of the Middle East had the effect of securing and maintaining western hegemony over the Arabs and Islam (Sharpe, 2005). Gayatri Chakravorty Spivak has revealed imperialism’s “epistemic violence” perpetrated upon colonized women.

Homi Bhabha carried on Said’s poststructural critique incorporating the ‘psychopolitics’ of Antillean Franz Fanon, whose writings demonstrate the unprecedented challenge to understanding unleashed by colonial racism and violence, and convinced one “that the colonial moment of epistemic, cultural, psychical and physical violence makes for a unique kind of historical trauma” (Hook, 2005). Bhabha observed the failure of ideological and discursive approaches “to account for the persistence of racism, its pronounced irrationality, its compulsive qualities, the visceral quality of its hatred, its continuous, seemingly repetitive nature” (Hook, p. 487). Derek Hook suggests that Fanon’s and Bhabha’s application of a psychoanalytic lens to understanding “the vicissitudes of colonial power and its resistances” reflects the hope that these analyses would result in opportunities to intervene “within the life of power” (Hook, 2005, p. 481).

There is a reserved hope that destabilizing the Western canon through resistance could lead to new ways of being that no longer are dependent upon, through accommodation or opposition, imperialist hegemony. For example, Robert Young considers the emergence of postcolonial studies to be “an historical moment of new tricontinental forms of critical analysis and practice” (2001, p.XX) that could lead to the end of western hegemony.

Lyn Carter in Australia, one of the few educators I have found to apply postcolonial theory to diversity issues in teaching (Carter, 2004; 2005), attributes postcolonial theory the means to:

"construct more complex conceptualizations of cultural difference as hybridized and fluid, always in the making, and recast culturally diverse students’ homogenized identities into multiple, mobile, and provisional constructions, more accurately attune to conditions of living and learning under the indeterminacy of the transforming global world” (Carter, 2004, p. 833).

Carter (2005) appreciates in postcolonial criticism what she perceives to exceed western epistemologies, and the practice of double consciousness as “thinking about how thinking intersects with the disciplinary categories themselves” (p. 917).

The postcolonial attitude implicitly calls for immersing oneself in the world of the other. The critical imperative of postcolonial critique, which is addressed by those of the tricontinents to us in the West, is to suspend one’s hegemonic assumptions and disciplinary methodologies and, in true dialogic presence, open oneself to the other from a position of not-knowing. For example, Obioma Nnaemeka asserts that,

"imperialists and colonists never learn from the colonized: they teach them. They do not ask questions; they manufacture answers in search of questions. Border crossing has its dangers, its seduction, its unpredictability, its humbling moments, but it also has its enriching rewards. Border crossing entails learning about the ‘other,’ but more importantly, it should entail learning from the other. Learning about is a gesture that is often tinged with arrogance and an air of superiority; learning from requires a high dose of humility tinged with civility. Learning about often produces arrogant interrogators; learning from requires humble listeners" (2003, p. 374).

From her experiences as an African feminist, Nnaemeka argues for a postcolonial critique that critique lead to the “clearing” of a dialogic third space between borders, where theory and practice, planning and action coexist. She explains:

"Theorizing in a cross-cultural context is fraught with intellectual, political, and ethical questions: the question of provenance (where is the theory coming from?); the question of subjectivity (who authorizes?); the question of positionality (which specific locations and standing [social, political, and intellectual] does it legitimize?). The imperial nature of theory formation must be interrogated to allow for a democratic process that will create room for the intervention, legitimization, and validation of theories formulated ‘elsewhere.’ In other words, theory making should not permanently be a unidirectional enterprise---always emanating from a specific location and applicable to every location---in effect allowing a localized construct to impose a universal validity and application. I argue instead for the possibilities, desirability, and pertinence of a space clearing that allows a multiplicity of different but related frameworks from different locations to touch, intersect, and feed off each other in a way that accommodates different realities and histories" (Nnaemeka, 2003, pp. 362-363).

Nnaemeka’s words point me to the importance of service learning requirements for multicultural education for social justice and a better world. Humbleness and service, combined with openness and not-knowing are the ontological components of a professional’s integration of a heartfelt engagement in social justice work.

Conclusion

I have tried in this essay to articulate a vision of a multicultural education that fosters the commitment to social justice, nourishes the interest in theory, challenges the comfort zones of unconscious hegemony, insists upon informed action, and embodies dialogic reflexivity. I welcome your comments and suggestions.

Transcultural Education for Clinical Psychologists, Part #2

Curriculum: The Linguistic Turn

The position from which my proposed multicultural curriculum emerges is located in the ideas generated since the “linguistic turn” in the humanities and certain branches within the social sciences, including psychology. For the sake of brevity, I will quote Stuart Hall’s definition. The linguistic turn is,

"[a conviction of ] the crucial importance of language and of the linguistic metaphor to any study of culture; the expansion of the notion of text and textuality, both as a source of meaning, and as that which escapes and postpones meaning; the recognition of the heterogeneity, of the multiplicity, of meanings, of the struggle to close arbitrarily the infinite semiosis beyond meaning; the acknowledgement of textuality and cultural power, of representation itself, as a site of power and regulation; of the symbolic as a source of identity" (Stuart Hall, as cited in Chrisman, 2003, pp. 148-149).

In the following section, I will introduce two interrelated, interdisciplinary, humanities disciplines, Culture Studies and Postcolonial Theories, both of which are legacies of the linguistic turn and could provide conceptual frameworks for multicultural education.

Culture Studies

Culture can be conceptualized as a way of life made up of the relationships between all its elements (Golby & Purdue, 1999), or more discursively as “the constant process of producing meanings of and from our social experience, and such meanings necessarily produce a social identity for the people involved” (Fiske, 2000, p. 1). Culture studies seem most interested in understanding how culture is made; how it shapes and is shaped by people various locations and historical settings, its contradictions and its systems of power relations.

Three foci may characterize a critique based on contemporary culture studies. First, it would address the junctures of language, meaning, and power in the construction of cultural meanings and in material practices (Barker & Galasinski, 2001; di Leonardo & Lancaster, 1997). That is, culture studies are in the tradition of poststructuralist thought, which conceives of discourse as the structure through which we perceive reality and views social realities as “organized by signs and meanings patterns in relations of identity and difference” (Seidman, 1997, p. 67). Institutions and social practices are produced by and founded within discursive formations, and are the basis upon which knowledge, values, and norms are justified (Edgar & Sedgwick, 2002). Discourses can and do have hegemonic (repressive) functions. Hegemony, as conceived by Gramsci (2000), is the regulation of social relations by the dominant class through forms of culture. Morag Shiach clarifies:

Gramsci offers us another explanation of the nature of dominant culture. It can be understood as the site of hegemonic representations: those which ‘foster forms of consciousness which accept a position of subordination’. It is also, therefore, a sphere that must be won over by any social group aspiring to social leadership: struggles over definition of culture can thus be seen as struggles for intellectual, moral and philosophical hegemony.” (Schiach 17)

Similarly, sociologist Pierre Bourdieu’s (1984) analysis of the unequal distribution of “cultural capital” (the collection of accepted and esteemed cultural resources) reveals how social hierarchies are reinforced and reproduced in cultural forms. He argues, far from being a neutral expression, cultural consumption is the “means by which [distinctions and differences in social classes] are produced, maintained and reproduced” (Storey, 1999, p. 44). Michel Foucault understands discourse as both “an instrument and effect of power” (Foucault, 1978, pp. 100-101), no matter what one’s social standing is, individuals are both subjects of and subject to discourses. Foucault’s understanding of power as relational rather than material extends the reach of a critique of dominant discourses to resistant “reverse” discourses, the structural necessities of dominant discourses.

Second, a culture theorist is likely to focus in on specific events, intimate relationships, and experiences in relation to their historical contexts, including “changes in production, consumption, technology, and law that set the stage for everyday life” (di Leonardo & Lancaster, 1997) as influenced by Foucault’s geneology of subjectification, which

"focuses directly on the practices that locate human beings in particular ‘regimes of the person’. It does not write a continuous history of the self, but rather accounts for the diversity of languages of ‘personhood’ that have taken shape . . . and the norms, techniques, and relations of authority within which these have circulated in legal, domestic, industrial, and other practices for acting upon the conduct of such persons."

Third, a culture studies critique would incorporate a focus on the co-production of popular culture by consumers, because ideological implications in cultural discourse do not translate automatically into ideological effects. The Italian Marxist, Gramsci (Forgacs, 2000) wrote that, in order for hegemonic forms to be taken in by the subordinated, they had to be chosen, not passively interpolated. Michel Foucault’s theory of power has particular relevance for exploring the boundary phenomenon of popular culture consumption (Foucault, 1978). He conceptualizes power as relations that are immanent in all interrelationships, non-binary and rooted in “local oppositions” and differences (p. 94), “intentional and nonsubjective” (p. 94), and as always co-generative with resistance.

The approach explores the webs of power in both the producers of official and mass discourses and the consumers. Resistance to the oppressive psychological and material effects of the dominant culture for the unprivileged begins with education as critique, as with Friere (2000), including that the persistence of hegemonic power in discourse relies upon everyone’s complicity, and discourse’s multisemic characteristics provides openings for resistance through deconstruction. The culture studies view of the audience has direct relevance for how those of us in the West objectify and erase the Other; we underestimate their powers of resistance because we assume the superiority of our epistemology. The assumed radical potency of Culture Studies lies in the power attributed to making meaning or, to use Foucault’s words, discovering and applying the power of reverse discourses.

Transcultural Education for Clinical Psychologists, Part #1

I will now propose a transcultural expansion to diversity training in which I hope to integrate the critical dialogism of Paulo Friere (2000) and Ignacio Martín-Baró (1994), with the more recent ideas appearing under the label of "postcolonial".

Pedagogy

This section on pedagogy is curriculum-wide proposal. It is crucial that liberation pedagogy not be marginally located only in certain courses, typically those concerned with minorities, such as a required diversity course, but rather should be both the norm in the majority of courses and linked to the establishment of public community dialogue events. Boyle-Baise and Gillette (1998) urge us to prioritize pedagogy in multicultural education, which would include providing “an intellectually safe, respectful place for learning, a place to share personal knowledge, agree to disagree, experiment with new ideas, and wrestle with contested issues…(p. 23). They suggest that educators involve themselves in “encouraging student-generation of knowledge, creating democratic teaching and learning communities, pursuing cultural critique, and fostering activism that makes a difference” (Boye-Baise & Gillette, 1998, p. 23).

In order to address issues of social justice, training in multicultural diversity must be grounded in processes of conscientization. Ignacio Martín-Baró said, “the task of the psychologist must be to achieve the de-alienation of groups and persons by helping them attain a critical understanding of themselves and their reality” (p. 39), and “can only be realized through dialogue” (p. 42). His proposal for a liberation psychology included three elements: (a) focus on serving the needs of the poor rather than on preserving the status of the discipline, (b) view knowledge as something that is created by thinking with the oppressed rather than for them, and (c) recognize that knowledge is informed by taking action in real life for social change, through “a new praxis” (Martín-Baró, 1994, pp.27-28). He warned:

"Thus, to acquire new psychological knowledge it is not enough to place ourselves in the perspective of the people; it is necessary to involve ourselves in a new praxis, an activity of transforming reality that will let us know about what is but also what is not, and by which we may try to orient ourselves toward what ought to be" (Martín-Baró, 1994, pp.28-29).

Conscientization refers to a process of developing critical awareness of contradictions in one’s economic, political and social world, which is followed by action to undue oppressive social structures. Conscientization’s most distinctive feature is its critical attention “to how power and meaning are employed in the construction and organization of knowledge, desires, values, and identities” (Giroux, 1992, p. 52). To my mind, a commitment to conscientization in the training of clinical psychologists for social justice would mean that each learning context (classroom, supervision, advising, collaboration) would involve the co-examinination of power and meaning, as suggested by Giroux, in combination with creative engagement in envisioning and enacting alternatives, however local.

In order to facilitate Paulo Freire’s process of conscientization, there would be instructor-supported dialogic opportunities for engaging students in uncovering and reducing those power differences in their own learning situation (Freire, 2000). Faculty would bear the responsibility of creating an atmosphere that would foster students’ capacities to criticize and affect both the nature and processes of their education, which means a greater commitment from faculty to view education holistically. As bell hooks (1994) explains, in “progressive, holistic education, ‘engaged pedagogy’ is more demanding than conventional critical or feminist pedagogy. For, unlike those two teaching practices, it emphasizes well-being” (p. 15). I would say that engaged pedagogy emphasizes and models “being,” and that an educator embodies specific characteristics of dialogue: an immediacy of presence, openness to unanticipated consequences, willingness to be surprised, vulnerability (openness to being changed, persuaded), belief in human interdependence, and genuineness (Cissna & Anderson, 1994).

I am proposing that an engaged pedagogy founded on dialogue, as described above, that is facilitated and modeled by the teacher, parallels our educational objective: that students feel morally committed to engaging in the dialogic process of multicultural awareness as a practice for social justice. The structural demands for dialogue to occur do not reflect our current social or academic order. Necessary conditions for dialogue are fair and equal access to speech, listening, and decision-making without retaliation (safety). Only when these conditions are met can optimal conditions for dialogue, such as openness, curiosity, reflexivity, occur. Therefore, a teacher will implement basic formal structures and ground rules to build in safety for students. In addition, she will perform a practice of “dialogic reflexivity” (Hawes, 1997) as part of the course’s commitment to conscientization. Dialogic reflexivity is an explicit engagement in “reflexive critique” of oneself, the particular context of hierarchical power relations, the institutionalization of these power relations, and “the multiple, shifting ways in which power is exercised and contested in and across each of these domains.

The next section will argue for the inclusion of postcolonial theories as an important expansion of multicultural training for clinical psychologists, beginning with a brief introduction to some of the ideas most relevant for professional psychology.

Training Clinical Psychologists for a Mulitcultural World

If there could be professional psychology training programs in which the explicit commitments to social justice, where the unpacking and critiques of the values, assumptions, and practices (Prilleltensky & Nelson, 2001) in psychology were incorporated into in their curriculum, what would they look like? What would such programs contain, both in their coverage of theories and research and in their transformative practices (praxis)? I could begin at any number of points, but for now I will consider the competency of Diversity.

Multicultural Education for Social Justice

. . . multiculturalism is about social justice, cultural democracy, and equity. (Sue, Carter, Casas, Fouad, Ivey, Jenson, et al., 1998, p. 5)

In this section, I will begin by introducing some criticism of the current state of multicultural education, the thrust of which is that what began as a transformative endeavor has become controlled and diluted affirmation. I will then emphasize the importance of liberation pedagogy as praxis for social justice. The last two sections recognize the necessity of acknowledging the linguistic turn in theories of oppression and the transformative potential of postcolonial criticism for our contributions in a globalized world.

Critique of contemporary multicultural education

Multicultural education, envisioned at its inception during the 1960s civil rights movement as “an effective counter-hegemonic strategy to reverse centuries of racialized domination in the United States” (Baltodano, 2006, p. 123) has failed to achieve its goal. Baltodano mourns that,

"what began as a politically inspired counterhegemonic movement was gradually appropriated and soon became merely another mainstream policy, more and more defined by the interests of the dominant class. . .Consequently, the institutional and social policies of the multicultural project stagnated, leaving untouched the complex economic conditions that transformed the welfare state of the 1960s to the transnational, global economy of the 21^st century. (2006, p. 124)"

Stephen May (1999) concurs that multicultural education has not resulted in significant improvements for minority students, has not effectively altered majority students’ racism, nor replaced “the inherent monoculturalism of school practice;” further, multicultural education has seemed to have little or no impact on our society’s racial inequities (p. 1). The failure of multiculturalism, according to some, was its oversimplification of social power relations, its “deracialized” conceptualization of education, “an educational approach which reifies culture and cultural difference, and which fails to address the central issues of racism within society” (May, 1999, p. 2). In addition, there has been little “substantive change in the structure of teacher education and in the attitudes of teachers toward cultural diversity” (Baltodano, 2006, p. 124).

On the other hand, there are problems related to a program based on race-oppression alone. For one thing, the focus on color reinforces the binary dimension of black and white, and is thus requires a perpetual bond with its uniformly constructed oppressor. There is also the likelihood that the privileging of race obscures other potentially involved marginal subjectivities, such as gender, class, and religion (May, 1999, p. 2).

The Critical Pedagogies, as articulated by Paolo Friere, Henry Giroux and Peter Mclaren, have introduced a non-racist, theoretically sophisticated, transformative model they have linked to

"wider issues of socio-economic and political inequality. The ongoing ravages of late capitalism-particularly on the poor and the marginalized-are increasingly being addressed and contested by critical multicultural educators, again most notably in the US. . .In the process, the inexorable globalization of capital, its effects on the economies of nation-states, its links with historical and contemporary forms of racism and colonialism, and its impact on the changing nature of work and patterns of employment are also being critically examined."

The critical multiculturalists influenced by Freire and others have been criticized for their failures to effective link their theories to actual educational programming or policies.

Finally, all of the above have stayed within the boundaries of specific western nationalities, addressed themselves to “national markets with their own particular historical and ideological emphases. Little, if any, reference is made to developments elsewhere and attempts to build a cross-national perspective have been extremely rare” (May, 1999, p. 5). In my next post, I propose a shift to a transcultural education for clinical psychologist of the 21^st century.

Threats to Child Development in Developing Countries, continued

The HIV/AIDS Pandemic

According to the UNAIDS data (2006), Southern Africa is the world region most affected by HIV/AIDS, and that is where most of the children living with HIV live. Other high infection regions are in the Caribbean, Latin America, and South/Southeast Asia. South Africa, where I have direct experience, has the 6^th highest prevalence in the world; almost 20% of its citizens are estimated to be infected, and new infections are increasing with no sign of reaching a natural limit. However, the disease is not equally distributed among South African society: Black Africans have the highest prevalence (18.4%) compared to other racial groups (whites-6%; coloured-7%; indians-2%).

Indeed, while anyone can get the virus under the right conditions, HIV/AIDS is not an egalitarian disease; even in affluent countries the groups most at risk for contracting the virus have shifted to the poor, and particularly the female poor. Like the history of Tuberculosis, which today can only be found in impoverished and abandoned communities in the poorest regions of the world (or the poorest sections of western cities), HIV/AIDS is globally selective of its victims; it is most virulent among the poor in the poorest nations and there is evidence that the highest rates of infection now occur in women (Farmer, 2001; Walker, 2007).

The HIV/AIDS pandemic has perpetuated its most devastating effects upon the poor in developing countries across the world, particularly in sub-Saharan Africa, including South Africa. In 2003, one fifth of South Africa’s adults were HIV positive and 16,000 were dying every day (Hunter, 2003). The highest death rates occur among employable adults, decimating the income-generating members of communities, leading to lower tax income to support community infrastructures, such as education and the now over utilized health services. This cycle of AIDS and poverty has meant that South Africa has dropped dramatically over the course of the last five year on the scale of economic development, creating greater numbers of poor and people vulnerable to the virus and without adequate services.

While the afflicted in the early years were predominantly heterosexual men who, due to Apartheid’s system of separate homelands for Black South African employable men, who were forced to become migrants in order to earn a living for white mines and factories in large cities. Far from their wives, these men caught and spread the virus through their exchanges with sex-workers, who also had migrated to cities for money to survive. By 2003, the HIV/AIDS epidemiology statistics made a gender switch: women came to make up two-thirds of Africans infected with HIV (Hunter, 2003). South African women also came to have a higher prevalence than men; 18% compared to 13%, and that gender infection gap is thought to be widening. Women, like children, are more vulnerable than adult men because they have no power or rights in their communities. However, global statistics remind us that, even in our own country, it is poverty that makes misogyny so toxic. [UN on Women}

The high occurrence of HIV in southern African women has meant that, due to vertical infection, rates of HIV in children have also risen. About 90% of infected children get virus from their mothers during pregnancy, birth, and/or breast milk. Without antiretroviral treatment (HAART): (a) 1 in 3 infected newborns will die before age one, (b) over ½ die before reaching their 2^nd birthday, and (c) most are dead before 5 years. In Zimbabwe and Botswana child mortality rates have doubled since 1990. Tragically, only 15% of the 780,000 children living with HIV in these regions were receiving treatment at the end of 2006; every hour, 40 children die due to AIDS.

As the greatest number of infections and deaths are adults ages 20-35, the physical, emotional and cognitive impacts of HIV/AIDS on infants and children has reached a tragic scale; more and more poor households are headed by grandmothers and children who have, respectively, lost their children and parents to AIDS-related diseases. In addition to suffering the stresses of multiple losses, upheaval of their family systems, inadequate care from ill-prepared or frail caregivers, and removal from their homes, infants have been infected with the virus by their HIV+ mothers. Before ART, infection was an early death sentence for a child; with treatment, these children still face the stresses above, and many will grow up in institutional settings.

Linda Richter and colleagues of South Africa’s Human Sciences Research Center (HSCR) report that “it has been argued, particularly where children are concerned, HIV/AIDS needs to be treated as a broad developmental concern rather than as a narrow health or even public health issue” (Richter, Manegold & Pather, 2004, p. 4).

As a result of the AIDS Pandemic, a new international crisis category has emerged: “Orphans and Vulnerable Children” (OVC). These are (Richter, Manegold & Pather, 2004, p. 3):

1. Children infected with the virus
2. Children living in regions with high infection rates affected by the stress, the decrease in services and the damage to social institutions
3. Children

• Who lose a parent or parent substitute
• Who live in a household in which one or more people are ill, dying or deceased
• Who live in households which receive orphans
• Whose caregivers are too ill to continue to look after them
• Living with very old and frail caregivers
• Older than 15 years of age

HIV/AIDS has torn apart South African family structures more effectively than Apartheid’s homeland and migrant worker systems. Here is a partial list of the impact of the virus on South African families (Richter, Manegold & Pather, 2004, p. 5):

1. "The emergence of child- or adolescent-headed households
2. An increase in elderly caregivers, and children caring for old people;
3. Increases in household dependency ratios;
4. Separation of siblings
5. Family breakdown
6. Child abandonment
7. Remarriage”

AIDS has also impacted communities by producing declines in skilled and professional services, strains on health care and educational service delivery, and extreme stress on small communities who must absorb the children of the dead and dying into their care (Richter, Manegold & Pather, 2004, p. 6). HIV/AIDS is ravaging sub-Saharan societies, especially by diminishing health, welfare & education systems due to the extreme volume of needs due to the epidemic, loss of people to staff these institutions due to AIDS-related illness & death, and reduced tax-base because of the illness & death of employable persons (Richter, Manegold & Pather, 2004, p. 5).

The next set of influences on the impact of AIDS in South Africa will leave us in no doubt of its complex web of psychological, social, physical forces and needs. This set consists of the influences of gender, age, and household location (Richter, Manegold and Pather, 2004, p. 7-8):

Gender

• Education for boys valued more highly (they are considered to be potentially more economically productive), so girls are often the ones to leave school or work to care for the sick or younger children;
• Female-headed households are poorer than those headed by men;
• Female-headed households tend to allocate more of the family’s resources to children’s healthcare and education than male heads;

Age

• Infants and toddlers are most vulnerable to effects of AIDS and health risks;
• Preschoolers are vulnerable to malnourishment, abuse and neglect, poor stimulation, and lack of opportunities for schooling;
• Adolescents are vulnerable to school drop-out, sexual exploitation, and overwork;
• All children are vulnerable to the emotional consequences of multiple losses, including parents, and to being separated from their homes and communities.

Location of household

• Rural households are typically poorer and have fewer employed adults than urban households;
• Children are expected to contribute substantially to subsistence activities
• Social networks in informal urban areas are less developed and less supportive;
• Caregivers often leave their children alone because of their “livelihood activities.”

Like on the global stage, South African HIV positive children’s mental health and cognitive developmental needs have historically been neglected in the child development research and in most intervention programs. South Africa is not the only developing country lacking national psychoeducational data. Most child development research and programming has been done with U.S. and European samples, and psychologists in western nations have not concerned themselves with internationalizing their theories and studies, particularly in those parts of the globe with the greatest needs for help and understanding. In the international and national responses to the HIV/AIDS pandemic in southern Africa, “psychological” has, until recently, been considered a less important or less acute problem than HIV/AIDS affected children’s nutrition and shelter, as if, Linda Richter (2003) suggests, their “need for food and shelter is greater than their need to feel loved by others and to respect themselves” (p. 245). The 2007 HIV and AIDS and STI Strategic Plan for South Africa, 2007-2011, makes no mention of insuring that children’s conditions actively contribute to rather than undermine their emotional and social development, and by extension their academic achievement and potential to contribute to South African society. This oversight confirms the relative neglect of orphans’ and vulnerable children’s mental health and achievement by funders and policy makers, at least in South Africa. National policies that support multifaceted treatments in the services of children’s development are crucial components of meeting the first and second UN Millennium Development Goals: (a) eradication of extreme poverty and hunger, and (b) insuring that all children complete primary schooling.

As the preceding suggests, we know a fair amount about the risks and stressful conditions that occur under conditions of chronic poverty and HIV/AIDS; however, there are as yet only a few studies on the psychological effects of HIV/AIDS and poverty on South Africa’s (and other severely affected nations’) children, including their cognitive functions, academic achievement, and mental health (Cluver, 2007; Richter, 2003; Walker, 2007). For example, studies on the mental health of AIDS orphans are not only few in number but incapable being interpreted across studies; the variabilities of procedures, measures and samples used makes it impossible to come to firm conclusions. There are suggestive trends, however, such as the higher levels of psychological problems in AIDS African orphaned children, such as internalizing problems (hence depression and anxiety), symptoms of post-traumatic stress, behavioral problems, and delinquency (Cluver & Gardner, 2007; Cluver, Gardner & Operario, 2007). However, more research on the mechanics of increased mental health problems in these children is needed in order to better understand the factors in their lives “which are acting as stressors or buffers in mental health outcomes” in order to inform options for therapeutic intervention” (Cluver & Gardner, 2007, p.9).

A 2003 round-table on mental health consequences of the pandemic, compiled by the Human Sciences Research Council includes a list of people projected to be likely to experience mental health problems due to AIDS by 2015: those who are uncertain about their HIV status, people living with the infection, families and caregivers of people with HIV/AIDS, children and adolescents orphaned by AIDS, people caring for AIDS orphans, and those who fit into more than one of the previous categories (Social Aspects of HIV/AIDS and Health Research Programme, 2003, p. 40).

International and national studies are unanimous on calling for internationally accepted measures and indicators for child development for planning, monitoring, and assessment (Cluver & Gardner, 2007; Engle, et al., 2007; Irwin, Siddiqi, & Hertzman, 2007; Social Aspects of HIV/AID and Health Research Programme, 2003). “Very few of the programs that try to intervene for children, families and communities have been monitors systematically and none have been rigorously evaluated (experimentally). This has meant an over-reliance on local knowledge to the detriment of building a knowledge base on “the real impacts of AIDS” and “what the responses should be in any given context” (Richter, Manegold & Pather, 2004, p. 7).

Need for Interventions

We must also ask ourselves, where are the western psychologists when there is so much global poverty? A South African psychologist asks why it is that in psychology, have we such a “lack of knowledge in terms of interventions to prevent and ameliorate the effects of poverty on infants and small children. In our professional child development journals and conferences, why is there no strong and growing theme that expresses concern for the compromised conditions which the majority of infants and small children in the world live” (Richter, 2003, 245)?

There are urgent needs for the design and implementation of culturally sensitive and evidence based intervention programs to improve the conditions of infants’ and young children’s psychological development in impoverished communities across the globe. More than ever, psychologists need to prioritize humility and collaboration as practices by cooperating with local networks of community health services (professional and paraprofessional), community members and leaders, nongovernment organizations, and politicians in order to be effective in the developing world. Psychologists living in developing countries are hard at work trying to meet these needs, but there are not enough of them to tackle these problems on their own. Where should we Western psychologists turn, if we want to make a difference?

Thankfully, there are a number of opportunities for western psychologists to explore of sufficient diversity that we can choose the type and degree of investment we want to make from international and global psychological associations and publications. Another way we can help is to expand the engagement of psychologists and trainees in the field of international/global psychology by developing undergraduate and graduate curricula and practice opportunities.

Removing Stones and Demons: Medieval "Psychotherapies"

The image to the right (a "permanent" feature) is a painting by Hieronymous Bosch and is entitled, The Cure of Folly: Extracting the Stone of Madness. This early form of psycho-surgery was emblematic in Renaissance art.

For the time being, I will upload some images I have found. Later on, I will edit for more description and explanation.

In my previous post, I included images of demons being exorcised as examples of the association between insanity and the demonic. I have more images, which I will include below as examples of healing the 'mad'.

Removing the Stone

Let us begin with the stone removal operations. (Much gratitude to Jessica Palmer's bioephemera; I had found these images on my own, but she has well surpassed my efforts with her impressive art history annotations.) The more recent works are actually characatures of 'quacks', so I'm including them under somewhat false pretenses.

Jan Sanders van Hemessen's The Surgeon

Pieter Breughel's Witch of Malleghen

Here is a close-up of the witch at work

Frans Hals, Das Narrenschneiden

HW Weydmans, Removing the Stone

I cannot find the artist for this caricature, L'Operation Inutile

This could be mistaken for a cure of folly: it is a medieval image representing the proper cure for epilepsy


Exorcism

Christ Cures a Madman

Christ exorcises a man's demons
The Possession of St. Catherine

Exorcising frog-demons

Christ exorcising demons

Rubens' The Miracle of St. Ignacius

Images of Madness

Many years ago I had the pleasure of encountering Psychiatrist Sandar Gilman's books, Seeing the Insane (1982) and Disease and representation: Images of illness and madness to AIDS (1988). This was the beginning of what has become for me an obsession with how mental illness, medical, mental health & academic experts, science, and 'the self' have been reflected (projected?) in the arts and popular culture. Later, I discovered that there is an academic discipline that houses persons with similar preoccupations, Culture Theory.

One of the less admirable delights furnished by this arcane interest comes from learning how little awareness psychologists seem to have of the relationship between popular imagery and science. In an attempt to whipe out of my smugness, I am going to post some of the imagery provided by Gilman as well as those I've hunted down myself. I want to popularize popular culture's views of psychological (scientific) matters, as it were.

Images of Insanity, according to Gilman, began to show up during the Middle Ages with such stable features that a veritable iconography for the appearances of persons living outside the boundaries of sanity at the time. These were the Maniac, the Possessed, the Wild Man, the Melancholic, and the Holy Fool.

To those living in medieval Europe, madness was conceived of as a primitive power of revelation capable of upsetting the fragile illusion equilibrium and exposing the terrible perils, desolation and evil that riddled the world.

The wild man resembled an animal more than a human, which secured him a place outside of the higher realm of humanity. He carried a stick, like the Fool, and represented the chaos, isolation, and rootlessness viewed as an anathema to denizens of medieval European towns, villages and rural hamlets.

Madness was understood to bridge the world of appearances in which people lived their lives with all that was sinful, monstrous, inhuman, and unnatural. This realm of nightmare was accessible as temptations to sin, coming to the sane in dreams. The visions of madmen were the dreams of the rest of humanity. The growing preoccupation of Europeans in the late middle ages and early renaissance came in part from their experiences with the decimation and physical horrors of the Black Death, or Bubonic Plagues.
The painting on the left is a wing from the amazing Isenheim Alter, painted by Matthias Grünewald. It is called the Temptation of St. Anthony. Anthony is being tempted by everything that is eval, inhuman and unnatural. Note the Bubonic plague victim in the lower left corner. Parenzano's Temptati from 1492 is another temptation example.

Gilman claims that the renaissance portrayals of madness (and temptation) reflect the perceived threats and secrets in the world.



















In the late 15th century, madness became a kind of "deja-la" of death. Foucault wrote, "It is the tide of madness, its secret invasion, that shows that the world is near its final catastrophe; it is man's insanity that invokes and makes necessary the world's end" (Madness & Civilization, p. 17).

Hieronimous Bosch's Mad-Meg (Dulle Grete) was meant to instill fear of damnation in the viewers, and I find it hair-raising today. Meg, whose insanity is clear from the iconography Bosch includes (the staff & bladder--see below--, her movement or traveling stature,and other oddities in her apparel). She is surrounded by the terrible world she represents.

Images of madness appeared in special relationships to Christianity. Sometimes the mad were believed to have unique access to holiness or divine messages. This may be a carryover from classical times when the oracles in that pantheistic context were typically delirious when channeling a deity.


On the other hand, the insane were also viewed as more susceptible to influences of the devil, requiring exorcisms to rid them of their demons. For example, the image to the left is a very old one of a saint expelling a demon from the man kneeling before him.

The image on the right concerns the same theme: the woman on the right has been brought to some church setting to get rid of her madness/demon. The demon can be seen flying out of her mouth.Similarly, a saint is expelling demons from the man on the left.The demented or possessed also came to develop a special iconographic position that is evident in both of these above examples. The person suffering from possession is often held up by others as his or her head (and sometimes body) collapses backwards, arms stretched out rigidly on either side. In Raphael's Transfiguratio, in which Jesus ascends into heaven, a man whos is possessed is held up and pointed out by others as needing healing by the transfiguring god.

The same posture shows up in one of two etchings by Breugel of mad women being led away from their town. The woman on the right is raising her right arm somewhat, and leaning back into the poor man trying to steer her somewhere else than her home town. This picture also tell the story of the insane as increasingly homeless outcasts from their places of origin. This them of rootlessness will be taken up below with the theme, The Ship of Fools.

This is the position of frenzy, abandon, and loss of reason. We can find the same visual metaphor for submission to higher power for cure in the humanizing of asylums by Pinel, and then in clinic of Charot.

The image to below is a propaganda-like painting of Pinel (for a new rational, humane treatment of the mentally ill) shows him freeing the patients of La Saltpetriere from their chains. His patient is a woman who assumes a position which both suggests her unreason, her vulnerability to patriarchial reason, and the taming of her dangerous sexuality. The association of madness with sexual wantoness, delerium, and women is not new, but took on great resonance in this context of morally righteous 'humane' treatments. The insane are also being freed from their shackles of exile, at least that was the hope. Mental illness was a moral problem, not a sign of demonic possession. Through reason, clean living, and moral training, most of an asylum's men and women could eventually return home; they had only to subject themselves to the authority of their doctor.




Later, we see this same figural relationship reappear in the imagistic pedagogy of French psychiatrist, Charcot, which took place at the same Parisian hospital. Freud spent a short time in attendance at Charot's seminars, many of which consisted of demonstrations by the master like that presented in the painting below.

This painting, commissioned by Charot, is the most famous representation of him: As the man we credit with starting the clinical/medical approach to psychology and with creating the first clinical research lab imbedded in a hospital rather than a university, this image of Charot instructing his students in the treatment of hysteria is iconic. The patient's pose, swooning with her breasts prominently in view, reflects her utter submission to Charcot's brillance. All the medical students are men; the only other woman in the room is a nurse from hysteria ward in Saltpetriere.

The painter, Paul Richer, painted himself into the center-rear of image, as well as his large, if faint, drawing of a woman in a cataclyptic pose from Charcot's Iconographie photographique de la Salpêtrière. His drawing, which could be seen by every patient on Charcot's stage, is on the right.

The Photographic Iconography of Salpêtriere consists of photographs taken by Bourneville and Regnard; most were made in a photographic laboratory created by Charcot for the purpose of documenting the diagnostic phases of hysterical attacks. The drawing of the woman on the left looks like our icon of possession; it was drawn by Richer from a photograph.

George Didi-Huberman in his fascinating book, Invention of Hysteria: Charcot and the Photographic Iconography of the Salpetriere, upacks the theatricality of his Tuesday morning lectures, as well as the performative demands of the setting. Didi-Huberman is not alone in arguing that the "hysteria" that Charcot documented and demonstrated in his lectures was seldom found anywhere else. Freud was on to him.

The Iconography includes photographs of induced postures, brought about by a variety of hypnotic methods. The photograph of "Lethargy" on the right was prompted by a sudden flash of light.

The Holy Fool

One of the most common icons alerting the viewer to the troubled mental status of a human image, like the illuminated Psalm 52 on the left, was the presence of a staff or large stick, often with a bladder tied to its upper end. In evidence from the middle ages through the 17th century, a staff was to be found in the hands of all thought to be possessed by the Devil: fools, melancholics, witches, and madmen. The image on the left is called "A Witch and her Familiars," all of whom require staffs for identification. The cats, I assume we already know about witches.

Fools are widely scattered in medieval and renaissance illuminated texts. Most often the can be found in the minute decorations in the margins of a page--a search for fools in these contexts can be quite entertaining.

Music and dance are also incorporated into images of fools, folly, mania, and madness. The trope of Dancing Fools or Insane can be found from the middle ages up into the 19th century. I've inserted two examples:









Below is another images of a fool with staffs; this one is facing Death:

The painting on the right by Hieronimous Bosch is of a theme popular during the northern Renaissance, A Ship of Fools. While everyone on this ship of fools is intended to be a fool, Bosch also made sure that one of the figures had all the appropriate icons for the role: The seated figure on the upper right has a staff with a bladder at the end and a horned cowl. The cowl was associated with a monk's hood, but in the case of fools is marred by simulated, rather silly, devil's horns. The image to its left is a woodcut by Holbein, whose woodcuts illustrated Sebastian Brandt's widely popular book, Stultifera Navis, Das Narrenschiff, or The ship of Fools.

Rather than a state that mirrored the demonic consequences of humanity's sinfulness, Renaissance Folly came to mean flaws in an individual's moral character. The defects portrayed in the various ships of fools were those found in everyone, not just the mad. Fools lacked the tragic condition of the insane.

Perhaps only an Idiot Fool (Holbein the Younger) would, because its doubled construction, qualify as irrevocably beyond the bounds of sanity, but that was hardly the case. Here, the fool is shown mocking death--his bladder raised to strike and his finger irreverently in his mouth. Meanwhile, death gleefully leads the fool off to the tune of dancing music played on his bagpipe.

And then, of course, there is the Educated Fool....Holbein's woodcut includes a feather-duster rather than a staff; perhaps that was the 15th century version of Ginko.


The Ship of Fools also carries the theme of vagrancy and rootlessness, which was seen by the people of the Renaissance as flaws in character. This was a particular hardship of those seen as mad, for they were little tolerated in their communities and were sent drifting as beggars from place to place until they came more and more to be incarcerated--first into prisons along with imprisoned criminals, and then later into their own separated institutions.

Melancholy

Gilman describes how, at the beginning of the middle ages, the image of the melancholy individual became the iconic figure of madness in general. One of the Four Humors, Melancholy represented an isolated life out of balance with the real world. Gibson includes a poem by the best-loved German poet of the thirteenth century, 

Walther von der Vogelweide, to demonstrate how the position of the body, as image, communicated a state of being we have come to associate as "internal." The state of the "self" described by the Minnesinger, Walther, would be readily understood as melancholic.

I sat down on a stone
And crossed my legs
And set my chin and cheek
In my hand.
Then I pondered very earnestly
How one ought to live one's life on earth.
I could not find the solution. 
from Gilman (1982) "Seeing the Insane"

Solis the Elder's (1514-1562) woodcut, Melancholicus, reflects an emblematic theme at the time; the numbing impact of the conflicts at that time between the humanism sweeping the continent and Roman Catholic tradition. The message is a negative moral judgment of melancholy: melancholy had the effect of paralysis and a state of tension due to a conflict between opposing powers, in this case between nature created by God and science made my mankind. 

Much more well known is the etching on the right, Melancholia I, by Northern Renaissance artist, 
 Albrecht Dürer, is one of my favorite works of art (which may give away my dominant Humor). The posture of the angel, pensive and darkened face, chin and cheek leaning heavily on her hand, exudes melancholy to the viewer, even those who do not know the title of the work of the iconography of melancholy. Her clenched and hidden hands suggest that she is ineffectual and her inactivity, in light of the many tools and recent scientific technologies surrounding her, can suggest the moral defect, sloth. The sleeping dog is also implies an inability to act. Finally, melancholy was associated with characteristics of passivity and excessive emotionality; e.g., the Feminine (Gilman, 1982).

The painting on the left from 1553 has the same iconography and the title is The Melancholy, painted by Lucas Cranach, a contemporary of Albrecht Dürer. Here, too, we see the idle angel and sleeping dog, but the images of humanistic science are missing. The playful children may extend the idleness theme. In the background, inside a dark cloud, is the diabolical image of witches riding on goats and pigs. Cranach may be suggesting that melancholy was a state of suspension between two negative outcomes; the passivity of the indolent or diabolical delusions. The right path was to be found elsewhere. To provide a temporal context, Cranach was a friend to and painted a portrait of Martin Luther (1529).