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JOHN DE FIGUEIREDO M.D., USA
I
was born and raised in Goa, a former Portuguese territory on the west
coast of India. The Portuguese conquered Goa in 1510 and were forced
out of Goa by the Government of India, in an act of war in 1961. Like
virtually half of the Goan population at that time, I grew up speaking
two languages, Portuguese and the native Konkani, and as a Roman
Catholic whose ancestors had converted to Christianity from Hinduism
four centuries ago. Hindus and Christians, speaking, to
varying degrees, two languages, Portuguese and Konkani, had made Goa
the site of their cultural marriage. At home, in school, and in the
community I grew up in. and lived in, a bicultural and bilingual world,
and my perceptions became multi-focal from a very young age.
After
graduating from the Liceu Nacional, I studied medicine at the Goa
Medical School, the oldest school of western medicine in Asia and the
alma mater of both my physician father and grandfather. The end of
Portuguese rule and the beginning of Indian administration introduced
the English language as a major vehicle of communication and the
residuals of the Indian colonial experiences under British rule. It was
painfully obvious to me that my most important challenge was to master
the English language and re-learn medicine in this language.
Both
the excitement of broader horizons and the pain of a lonesome
uniqueness dictated many of my lifetime decisions. Probably the most
important decision was my emigration to the United States to become an
academic psychiatrist, an eye-opening, and, in many ways, a liberating
experience that resurrected my search for identity in a rapidly
changing multicultural environment. I was fortunate to be admitted to
Johns Hopkins University, for graduate study under Dr. Paul Lemkau,
leading to the degree of Doctor of Science in Mental
Health. At the
Johns Hopkins School of Public Health I met colleagues from all over
the world, made many friends who later pursued public health careers in
their native countries I gained insight into the struggles of
underserved populations, and a better understanding of innovative
programs to meet their needs.
After graduation I was once again
fortunate to obtain a National Research Service Award from the National
Institute of Mental Health, for postdoctoral study in geriatrics and
psychiatric epidemiology at Columbia University, with Drs Barry Gurland
and Bruce Dohrenwend. After this exciting year in New York City I
returned to Johns Hopkins to complete a residency-training program in
psychiatry, where I learned clinical psychiatry from Dr Paul McHugh and
his disciples and from Dr Jerome Frank.
Interestingly, images
from my Indo-Portuguese cultural upbringing followed me throughout my
career. In New York City, I was astonished to discover two pieces of
furniture built in the Goan Indo-Portuguese style of the 16th and 17th
centuries in the Hispanic Museum in Washington Heights. At Johns
Hopkins, also, my residency director, Dr Phillip Slavney, surprised me
by speaking to me in Portuguese, and one of my best friends during my
residency was Bruno Lima, a fellow resident from Brazil, who, like me,
spoke Portuguese.
After another year as a Senior Staff Fellow at
the National Institute on Aging, I moved to Connecticut and have been
here since 1981, as a faculty member at Yale, where I teach
consultation-liaison psychiatry to residents and medical students. It
was in Connecticut that another Landmark event in my career took place.
I met Dr Ronald Wintrob, who at the time was Professor of Psychiatry at
the University of Connecticut and who gave me a new impetus to pursue
my passion for cultural psychiatry. Heraclitus believed that the
character of
a person defines his or her life, an idea further
developed by Sigmund Freud centuries later. Having grown up in Goa, my
clinical and academic endeavours were fated to be a logical extension
of my bicultural upbringing.
My professional life has been
devoted to the study of demoralization and to topics related to
cultural psychiatry, geriatrics, and consultation-liaison psychiatry. I
also have a strong interest in the history of medicine, particularly in
the study of the interaction of Western and Indian (Ayurvedic) medicine
in Goa in the 16th and 17th centuries.
How I ended up studying
demoralization is a story by itself. I first learned about
demoralization when my esteemed teacher, Dr Jerome Frank, honored me by
giving me two of the best presents I ever received; his books,
Persuasion and Healing and Sanity and Survival. He had been arguing
that the complaints that induced many patients to seek psychotherapy
were expressions of demoralization, irrespective of their psychiatric
diagnosis. Luckily, I stumbled on the topic of demoralization again
when another teacher, Dr Bruce Dohrenwend, proposed that the common
dimension measured bypsychiatric screening scales was demoralization,
or something akin to it. Dr Paul McHugh’s lectures, his humanistic
approach and his stimulating intellect further enhanced my curiosity
about the life stories of my patients, about the pathoplastic aspects
of their personalities, and about my own life story, starting as a
bicultural child and growing up to become a multicultural adult.
Many
well-intentioned friends had discouraged me from studying
demoralization, a concept that had no place in the DSM and, from their
perspective, would probably never gain widespread acceptance in
psychiatry,let alone research grant funding.
However, the impulse
given to my curiosity by my teachers was too strong to be resisted and
I decided to overlook my friends’ scepticism. I was fortunate to have
several of my articles on this concept accepted for publication in
peer-reviewed journals, and today demoralization is widely recognized
as an important construct for the understanding of the boundary between
the homeostatic and the pathological responses to stress.
The
study of demoralization is the unifying theme that brings together my
explorations in cultural psychiatry, geriatrics, consultation-liaison
psychiatry, and the history of medicine.
Time and again, research
has shown that disintegration of cultural patterns is associated with
an increase in the prevalence of demoralization. Social isolation
and/or breakdown of social supports cause demoralization to be more
likely to occur as people age.
Demoralization has been widely
studied in patients suffering from a variety of medical and surgical
problems, and has been shown to be closely linked to the prognosis of
several illnesses.
In the 16th and 17th centuries, when
Europeans suffered from tropical diseases in Goa, they went to
Ayurvedic physicians whom they trusted more than their European
counterparts, and who skilfully alleviated their suffering, to some
extent, by restoring their morale. The essence of being human, as
Ernest Cassirer noted, is the ability to symbolize. Cultural
formulations enable us to reconstruct the universe of meanings that
surround the patient’s symptoms and behaviours, the “meaningful
connections”, to borrow an expression from Karl Jaspers, between the
patient’s past, present and future, and between the person and the
environment.
Throughout my life I was fortunate to have
teachers, mentors and colleagues who have been a constant source of
inspiration and encouragement. They gave me the gift of knowledge, the
courage to pursue the truth, and the fortitude to persist in my
research.
These are blessings I will never be able to return, but I
have tried my best to pass on to my own students and residents, as our
never-ending fight against disease and suffering continues. Above all,
I am grateful to my patients who have been my best teachers by
demonstrating their heroic resilience in overcoming the stigma of
mental illness and barriers to their self-fulfilment. |
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