I first met Kabir years ago while serving as the chaplain of an in-patient psychiatric unit at a large teaching hospital. I often joined patients for lunch in the common area: sharing a meal provided an easy way to introduce my role as a spiritual care provider and to hear and share stories in a non-threatening and open environment. Kabir was sitting alone at a table close to the window and motioned with a hand wave for me to join him. Over the next half hour we shared what I often refer to in chart notes as a “get to know me conversation,” touching upon medical diagnosis, family, work, and spiritual beliefs.
Originally from Sudan, he lived in the Boston area with close relatives and worked “when feeling good” at the family-owned business. He was in the hospital again because he had stopped taking medications for his bi-polar disorder and was coming off a manic phase. Not married, Kabir hoped to find a bride during his bi-annual trip home to visit his parents. He stated he had been experiencing “this sickness” as a teen and had spent many years struggling to identify the “real reason I have this sickness.” Kabir had multiple thoughts on the etiology of his illness—a test from God, or maybe someone wishing him harm had released an evil spirit.
The power of belief reflected in the patient’s own world view and his or her place within that world view is essential knowledge to clinicians when providing a therapeutic intervention.
I asked how he handled being bi-polar in Sudan and he said: “When I am home and get the sickness, I go to the sheikh and he reads from the Quran. Here [in hospital], I take the tablets.” During rounds I shared what Kabir had said with his care team. A few chuckled and one person added “The tablets? Does he think he’s Moses coming down from the mountain?”
I do not believe that spiritual life is separate from other experiences. On the contrary, it influences and is influenced by all parts of one’s personal and family experiences. There is nothing static about the process; it is always organic. While the medical team focuses predominantly on a cure or on symptom management, my role as a spiritual caregiver focuses on healing and reintegration. Although we cannot cure or control a patient’s or family’s suffering, chaplains can help by building and holding a safe and sacred space, where, in the middle of seemingly desperate situations, the process of mutual exploration may lead to a process of healing. I believe the presence of simply being and not doing is therapeutic.
I’ve reflected many times on Kabir’s ability to seek and receive relief in totally different cultural contexts, from both Western medical models (“the tablets”) as well as Sudanese faith healers (recitation of the Quran ). Traditional healers and healing centers are the most common ways of treating psychiatric disorders in Sudanand are also sought out by 70 percent of Sudanese mothers caring for children with epilepsy. [3,4] Kabir believed sincerely in the efficacy of both treatment models because both treatment plans alleviated his suffering. The power of belief reflected in the patient’s own world view and his or her place within that world view is essential knowledge to clinicians when providing a therapeutic intervention. The clinicians at the hospital jokingly discounted Kabir’s experience of traditional spiritual healing while validating their own treatment plan. But in doing so, they missed the bigger picture.
In my experience, transcultural psychiatry, a treatment methodology more sensitive to cases like Kabir’s, addresses the diverse cultural aspects of mental health, including assumptions by a clinical team that do not reflect the patient’s own world view. It explores the identification, assessment, and treatment of mental disorders as well as the links that exist between culture and psychiatric classification.
Transcultural psychiatry challenges predominant, Western, psychological epistemologies by acknowledging and respecting social constructs internalized and carried by individuals throughout the globe.
In an age of globalization and migration, transcultural psychiatry challenges predominant, Western, psychological epistemologies by acknowledging and respecting social constructs that are internalized and carried by individuals throughout the globe. It recognizes the differing experiences of non-Western patients, and the ways that religious and medical practices overlap and mingle. For example: did Kabir view “the tablets” as a ritual? Would “the tablets” provide relief in Sudan, or would a cleric reciting the Quran in the US? Was his family’s provision of a transnational circle of care (in Sudan and the US) a consideration in his treatment going forward?
This method of psychiatric treatment works toward a more comprehensive understanding of wellness that includes personal beliefs and behavior principles. Acknowledging the potential tension between Western medicine and personal beliefs allows mental health practitioners to talk directly to the ambiguities and frustrations of life as a human being. This relationship is very evident in the hospital setting, where understanding a patient is more than pure rationality Human experience has a distinctive character; life is a continuous action and reaction of people with each other and with their perceived world. My goal as a chaplain is to acknowledge and celebrate the presence and power of what I call the true person within the person, the affirmation of human worth. I accept the very personal risk of trying to make life better, not by cure or hope, but by creating a safe place of respect and trust in relationship with patients and their families, with staff and colleagues; to ask questions I do not know the answers to; to give a blessing.
Katrina M. Scott received her Masters of Divinity from Harvard Divinity School in 2005 and has been the Oncology Chaplain and Palliative Care Service Chaplain Liaison at Massachusetts General Hospital since 2006. Author of several journal articles focusing on best practices of spiritual care in healthcare settings, she is dedicated to promoting a multi-disciplinary team approach in the provision of patient/ family centered care. Endorsed by the American Ethical Union for Health Care Chaplaincy, Katrina is an Officiant of the Ethical Society of Boston and Board Certified by the Association of Professional Chaplains with a Speciality Certification in Hospice & Palliative Care. She lives in Newton with her spouse Fred and dog Moxie.
 The intuitive, age-old act of sharing bread and the intersubjective wellbeing and bonding that often results has been the topic of countless research from various disciplines, including anthropology, psychology, epidemiology, and more recently, cognitive neuroscience.
 Koenig, H. & Shohaib,S., “Health and Well-Being in Islamic Societies,” (London: Springer, 2014). The first and last three suras of the Quran are noted for healing powers when read aloud.
 Sorketti, E., Zanal, N., & Habil M., “The characteristics of people with mental illness who are under treatment in traditional healer centres in Sudan,” International Journal of Social Psychiatry 58.2 (2012): 204-216. This research was the first cross-sectional study of patients receiving treatment within the traditional healer system in Sudan. Kabir fits the patient demographic of this study very closely. Recitation of the Quran and other holy readings is referred to as Rogya in Sudan. Other interventions include but are not limited to dietary changes, Bakhra (burning holy writings and surrounding the patient in the healing smoke), physical chaining, and Mehaya (healing words written and then removed with water that the patient either drinks or washes with).
 Mohammed and Babikir, “Traditional and spiritual medicine among Sudanese children with epilepsy,” Sudanese Journal of Paediatrics 13.1 (2013).
A. Kleinman’s research on cultural differences in depressive disorders (1977) paved the way for including cultural aspects in professional mental health programs. Transcultural psychiatry received a big boost with inclusion of a Cultural Formulation section in the DSM V (Section III, 2013). There are multiple peer reviewed transcultural journals as well as transcultural research programs at Harvard, McGill, and other universities.
 Baldassar, L., & Merla, L., eds., Transnational Families, Migration and the Circulation of Care: Understanding Mobility and Absence in Family Life (New York: Routledge, 2014).
Image of Charles MGH Hospital via Rodriguez Guarionex Jr. for flickr.