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   Article Transcultural Psychiatry 48(1–2) 115–126  ! The Author(s) 2011Reprints and permissions: sagepub.co.uk/journalsPermissions.navDOI: 10.1177/1363461510383179 tps.sagepub.com Drawing together psyche, soma andspirit: My career in cultural psychiatry Simon Dein University College London Abstract In this article I discuss my career in cultural psychiatry. I begin by examining theinfluence of my personal background on my interests in cultural psychiatry and religionand health. I then discuss my research, which has focused upon two areas: the cognitiveand phenomenological parallels between religious experiences and psychopathologicalstates, and relationships between biomedicine and religious healing in diverse culturalcontexts. Finally, I discuss plans for future research and teaching. Keywords anthropology, mental health, religion, spirituality Introduction In this article I discuss the formative influences on my career in cultural psychiatry.It is probably more accurate to state that I have really had two separate butinterconnecting careers: the first as a physician and psychiatrist and the secondas an anthropologist with an interest in religion and cultural psychiatry. Over thepast two decades, I have attempted to link the (often contradictory) worlds of anthropology, theology and psychiatry. My academic colleagues are psychiatrists,anthropologists and theologians, and it has often been difficult to reconcilepositions that derive from diverse epistemological premises. Family background and developmental years I was born in 1959 into a lower middle class Jewish family in England and grew upin East London until age twenty. My father worked as the head waiter in Blooms Corresponding author: Simon Dein, Department of Mental Health Sciences, University College London, Charles Bell House,67 Riding House Street, London WC1 7EY, UKEmail: s.dein@ucl.ac.uk   restaurant in Whitechapel, which was the most famous kosher restaurant in theUK until it closed in 1990. My mother was a housewife. My childhood was farfrom harmonious. My family lived with the legacy of the Second World War andthe Holocaust.An important formative influence on my early life was my maternal grand-mother who always shared a house with us while I was growing up. She hadimmigrated to the UK from Poland in 1907, alone, at the age of twelve, havingleft her family in Lodz. Although it was far from clear as to why she had migratedto the UK, my parents repeatedly told me how all her family left behind in Polandhad subsequently perished in Auschwitz. She lost over sixty members of herextended family. It was understandable that she never really recovered from theloss of so many members of her family, and remained depressed for the rest of her life.My grandmother lived in the UK for eighty years, but she never learned to reador write English. She spoke Yiddish to my parents at home. She rarely spoke of hergrief about her family losses, but from time to time when I was perhaps six or sevenyears of age, she would describe the village in which she had lived. Her family wereorthodox Jews (Hasidim) and this fact stimulated me to study and write aboutHasidic culture in my later years.My frequent visits to Whitechapel as a young child further fuelled my interest inEastern European Jewish history. This area is renowned as the place where immi-grants first settle in the UK and has been home, over time, to Huguenots, Irish,Jews, and in the past twenty years, to Bangladeshis. These groups have gonethrough similar processes of social marginalization, followed by advancementand societal integration.Growing up in a Jewish family in East London we were constantly remindedabout the differences between Jews and non-Jews and there was an undercurrent of distrust of other groups in the community who were non-Jewish. Christians werecommonly referred to as  goyim  (gentiles) or  yocks  and many parents were reluctantto allow their children to socialize with the children of Christian neighbours.Perhaps the most demeaning names were reserved for the black population whowere referred to as  Shwartzas  (blacks) and little distinction was made betweenAfrican, Afro-Caribbean and Asian. As children we became aware of racism andracial intolerance from a very young age. East London had a significant proportionof Jewish families, and many Jewish men earned their living by driving taxis. Therewas not much overt anti-semitism, although we were aware that members of fascistgroups such as the National Front party lived nearby. As I was growing up, it wasthe more recent immigrant communities of Africans and Asians who were victim-ized by racism more than Jews who, by then, were generally better sociallyintegrated in the UK.My first personal encounter with anti-semitism was when I started secondaryschool in a school where Jews were in a minority. I remember boys saying to me‘‘Here comes the morning dew’’ and shouting the word  yid   (Jew). The teachersshowed no interest in stopping bullying, and they themselves appeared to take great 116  Transcultural Psychiatry 48(1–2)  pride in hitting any child for even the slightest misdemeanour. The first four yearsat this school were very stressful and like several other children in my class, I wasbadly bullied. Classmates would make fun of my ‘‘Jewish nose’’ which they referredto as a  Schnozzel   and there would be occasional jokes about children being burnedalive in concentration camps. I was frequently beaten up and spat on, until one dayI retaliated and punched another boy in the face. From that time onward I was seenas the class hero and referred to as ‘‘leader’’ by my classmates. Another group thatreceived equally aggressive treatment was the South Asian boys, who were referredto as ‘‘Pakis,’’ even those who srcinated from India. They were frequently tauntedto ‘‘go home,’’ despite being born and brought up in the UK. These experiencesallowed me to empathize with others who experienced discrimination.Despite the fact that I encountered much bullying at school, I was still able toprogress academically and excelled in chemistry and physics. In 1977, at the age of eighteen I was accepted as a first year student at the Middlesex Hospital MedicalSchool in London. Although I found science subjects very stimulating, I also had aflare for languages and enjoyed Latin, which I found quite easy to learn.This predisposed me to my later interest in classical civilizations.I believe that my early background has had a significant influence on my careerchoice as a cultural psychiatrist and on my decision to focus upon religion andpsychiatry. The fact that I experienced anti-semitism has made me aware of the roleof cultural and religious factors in the construction of identity and has sensitizedme to issues of racism and discrimination among other minority groups. The loss of my family during the Holocaust has led me to question God’s existence, and hasstimulated me to examine theories accounting for religion. Throughout my lifeI have been impressed by the fact that religious cognitions and practices are impor-tant coping strategies for some people. It is therefore unsurprising that, as I shalldiscuss below, my research has focused upon religious coping in different religiousgroups. It was my interest in religion that prompted me to study socialanthropology. My life as a medical student I did not enjoy medical school very much. Preclinical sciences were not taught in avery clinically applicable way, and I found studying them quite tedious. We wereleft very much to our own devices during the clinical years. I found the arroganceof some of the teaching physicians very irritating and this was reflected in thearrogance of my fellow students, many of whom had arrived from ‘‘public’’(private) schools. Again I began to feel marginalized on account of my ‘‘ordinary’’background coming from a ‘‘state’’ school. The majority of students who had comefrom public schools appeared more confident academically.Very soon after commencing the clinical course in the third year, I was parti-cularly struck by the fact that patients were really seen as objects, communicationbetween doctors and patients was generally poor, and the emphasis was on iden-tifying organ system pathology. Rarely were patients encouraged to speak about Dein  117  their illness and what it meant to them. I remember my first clinical experience insurgery, in which two young women were dying of rectal carcinoma. The diagnosiswas told to both of them in a very abrupt manner, and when they becamedistressed, the consultant surgeon quickly left the ward, leaving it to the nursingstaff to comfort them.Very early on in my career I became interested in how patients reacted to andcoped with life-threatening illness. I decided to do an elective in oncology atMassachusetts General Hospital, in Boston, but felt quite upset by the way inwhich doctors of all levels of training and seniority spoke to patients. Just as inLondon, communication was poor, and there was little show of empathy betweendoctors and patients. It struck me that as a doctor I had to address patients’ totalsuffering, not just their physical illness and their emotional response to it. For me,sickness could only be understood in its existential and spiritual context, as havingmeaning which transcended the individual. I feel that my own experiences of observing poor doctor–patient communication prompted me to become a psychi-atrist where such skills are paramount. Specializing in psychiatry and palliative medicine After qualifying as a doctor I worked in a number of medical specialities beforesettling on psychiatry. I have always been ambivalent about being a psychiatrist.I have always enjoyed general (family) medicine and worked part-time as a GP(General Practitioner). Although I enjoy the communicative aspect of psychiatry,I have always derived great satisfaction from diagnosing and treating physicalillness. I have missed this in psychiatry and hence my decision later in my life towork in palliative medicine.At the age of 27, I went to work as a Junior Doctor (resident) at Guys Hospitalwhere I obtained the Membership of the Royal College of Psychiatrists. I gainedexcellent experience there, working with ethnic minority patients in South London,predominantly those deriving from West Africa and the Caribbean. After myadvanced psychiatric training at Guys, I started my current job as an HonoraryConsultant (staff) Psychiatrist in Harlow, Essex, in 1995.For the past ten years I have been working in two roles: as a rehabilitationpsychiatrist and as a liaison psychiatrist. I am attracted to working with thosewho suffer from long-term mental illnesses. I view my role as trying to improvepeople’s quality of life and functioning, rather than ‘‘curing’’ them. I am particu-larly interested in working with deprivation, stigma and the effects of institutionalization.In my role as a liaison psychiatrist, I mainly work with women with breastcancer. My focus is on the psychological issues ensuing from the diagnosis of apotentially life-threatening illness, especially the existential questions related tosuffering and dying. My clinical and academic careers are closely linked. I workwith spiritual issues that these women present, especially those relating to religionand death and dying. Ten years ago I undertook additional specialty training in 118  Transcultural Psychiatry 48(1–2)
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