This book makes a compelling case for collaboration between mainstream psychiatry and indigenous cultural practices. In New Zealand where this book is based, and where I work as a UK-trained psychiatrist, Maori case workers mediate between psychiatric services and Maori patients, a connection that may otherwise be strained, given the adverse colonial history and continuing cultural differences.
Wiremu Nia Nia, a traditional healer, and Allister Bush, a child and adolescent psychiatrist working in Poirirua, push biculturalism further by combining traditional healing with mainstream clinical practice, even when there is a spiritual component that is not accessible to all members of the team. This account of their work is aspective, through the narratives of patient, relative, healer and doctor, so that all frames of reference are included. An account of Maori world views puts these narratives in context.
Through these fascinating stories we learn how adverse events may be transmitted through more generations than the two that we may be accustomed to in the nuclear family. The history of this is complicated: the late cultural effects of colonisation, rifts in the grandparent's generation and further back, and the continuing presence of the dead among the concerns of the living. It is in this context that conditions such as depression, psychosis or a cultural manifestation of disorder are interpreted. The traditional healer acknowledges Western psychiatry, and adds the expertise that comes from their own community. At times this role may not be substantial, when there does not seem to be a marked spiritual or cultural component, and at other times it is the Maori healer's intervention that changes things for the better; in either case assisting the psychiatrist in directing their efforts.
One parallel for this is pastoral psychiatry, as practised in European institutions of the past and in some parts of the USA today, which relies upon a Christian model to complete the bio-psycho-social-spiritual approach.
How can different belief systems work together for the benefit of patients? How might a family respond to someone who understands illness from a cultural perspective? How might a cultural healer help a family whose grievances from a family rift stretch to multiple generations? This book answers these questions and demonstrates how bicultural practice can work with Maori and other indigenous belief systems. In the process, it illuminates how such cultures determine the experience of mental disorder, with well-illustrated practical examples.
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