Antti Pakaslahti

Being asked to contribute a short bio-sketch was an honour and a challenge. How was I drawn to transcultural psychiatry, presently my natural intellectual environment? What follows are some notes on my voyages in time and place, coincidences, choices, perhaps ascending spirals.

By nationality and mother tongue I am Finnish. My family background is a composite; a grandmother from the Stockholm French school, and elements of Russian and Scottish as well. As a boy, I spent a long period in war-torn France. Back in Helsinki, I attended the new French primary school – one of the post-war links between Finland with the West. At home, I listened to discussions in several languages, as my parents conversed with their guests in half a dozen tongues they learned in the course of their international diplomatic activities.

During my teenage years my father was posted to India and other Asian countries. From my boarding school in Mussoorie, the snow-capped Himalayas invited trekking and exploration. In addition to English, I learned Hindi. The intriguing complexities and cultural flavours of India made their indelible mark on me. I started to record my impressions in photography. After the years in India, I had shorter stays in Turkey and in Spain, with my parents. Transcultural riches; but also some identity diffusion for me.

Back in Finland, I studied Indian culture and languages at university, but I realized in time that future job prospects in this field might be very limited. I opted for medicine, another career attraction I had considered. However, I continued with my fascination with India as a sideline: tasting (and preparing) curries, hearing (and meeting) Ravi Shankar, learning Sanskrit, and translating Hindi poetry into Finnish (winning a small prize for that along the way). I was a fan of cinema, discovering Satayjit Ray.

As a young doctor specializing in psychiatry, I had an opportunity to return to India for several months. It was by car; through Turkey, Iran and Afghanistan. In India, I was once again subject to its exuberant charm. I talked Hindi and practiced my photography. I observed the tensions and paradoxes around unequally developing modernity. I sensed in many ordinary people their backbone of traditional culture and solid family bonds; despite the hardships of material poverty and life-crises. I wondered what kind of cultural and psychiatric research might exist on such issues?

In the 1980s, I submitted my doctoral dissertation on schizophrenia, with a follow-up study on protective and risk factors affecting outcome. The empiric material was from Helsinki, but included an extensive international literature review and discussion. Finding out about the WHO multi-centre studies, with their surprising results of a better outcome in schizophrenia in the developing countries, I pondered about what might be the role of culture, family and social networks in that improved outcome?

Soon afterward, I was assigned to a project starting new emergency services for acute psychotic patients in the community, near Helsinki. By then I had completed my training in psychotherapy and had gained some experience in community psychiatry. I wondered whether there was a workable alternative to the usual hospitalization of psychotic patients in crammed closed wards? Our multi-professional team began to offer family and group interventions in psychoses, on an immediate outpatient basis. Effective mobilization of supportive and healthy resources in patients, their families and social groups proved to be effective in stabilizing a number of problematic situations, without resorting to hospitalization. Later this emergency approach was also applied to crises involving suicide risk. A new family, network and community-oriented treatment “culture” was evolving.

I came across some ethnographic accounts of healing of mental problems in traditional societies. Rather than being excluded, the afflicted individuals became a centre of caring and attention by their relatives and fellow villagers. As cultural professionals of crisis solving, healers organized and led group sessions aimed at interpersonal healing and community reintegration. Had we western psychiatrists just started to do something similar – across distances in time, place and culture?

My next project started to take shape slowly in my mind, during vacation trips to India. Could I locate traditional healers in India and study their therapeutic approaches and techniques; perhaps even with video documentation, which I had been utilizing by then for over a decade?

Starting in the early 1990s, I participated in the meetings and symposia of the WPA- Transcultural Psychiatry Section. I plunged in to learning from the work of many well-known cultural researchers, surrounded by stimulating, and at times, fascinating discussions. All this helped me to develop and contextualize my transcultural field research ideas.

Ultimately, I arrived at the famous healing shrine of Balaji in Rajasthan, North India, where I could communicate in Hindi. Well-received locally, I embarked on a series of annual field research trips. I succeeded in finding a number of respected healers associated with this shrine. These were serious professionals who treated psychiatric and interpersonal problems in the culturally-congenial idiom of “spirit illness”. Their techniques consisted basically of family and group-oriented therapeutic interventions. I was able to obtain in-depth audio and video interviews of healers, patients, and their families. As many allowed me also to film actual healing sessions, I was able to assemble an extensive body of authentic field material for subsequent analysis. Direct field experience and later analyses revealed highly sophisticated and culturally relevant therapeutic techniques. To date, my results have been presented in transcultural psychiatry congresses, research papers and two documentary films. The second film, “Kusum”, has received several international awards. Further work on this subject is forthcoming.

I now feel that transcultural psychiatric research has become a unifying process for me, bringing together disparate life strands: linguistic attractions, some translation work, cultural curiosity, my attraction to India, visual documentation, psychiatric and psychotherapeutic investigation, professional and human interactions.

What about future transcultural projects? Some have started, including collaborative efforts in Finland, the Nordic countries and elsewhere – but that is a story for future telling.

Closing Reflections

I hear a polyphony of voices in space and time. Every voyage involves both departure and return. My three year-old daughter is a fan of videos about the Finnish Moomin family. The touching Moomins are curious and open toward all kinds of strangers emerging into their lives. Many become their friends. The Moomin father tries to put all this together in his memoirs. So, last week my daughter asked me to give her a big notebook and pencils. I asked: “what for”? She replied: “I want to write my memoirs”.

Recent and ongoing transcultural activities

• Associate Professor (docent) of Psychiatry; teaching transcultural psychiatry at the Universities of Oulu and Tampere, Finland
• Member of the WPA-Transcultural Psychiatry Section; Committee member, 1999-2002
• Editorial board member; Anthropology and Medicine,
• International advisory board member; Indian Journal of Psychiatry
• 2002- founder and chairman of the Transcultural Section of the Finnish Psychiatric Association
• 2003- founding member; Nordic Cultural Psychology and Psychiatry Network (CPPN); co-ordinator, 2005-2006
• Scientific Committee member & transcultural program co-ordinator, 28th Nordic Congress of Psychiatry; 16-19 Aug 2006
• Editor of the forthcoming issue of the Finnish Medical Journal, Duodecim; on transcultural psychiatry

October 5, 2006