Books by Laurence J Kirmayer
This is a book about the place of language in illness experience and healing.
My aim is to exami... more This is a book about the place of language in illness experience and healing.
My aim is to examine how metaphors structure illness experience and
symbolic healing. I come at this as a practitioner and participant-observer,
trained in psychiatry and psychotherapy, but also engaged in medical and
psychological anthropology and the philosophical critique of psychiatry.
The twin tasks of this book, then, are to illustrate the ways in which
metaphors can constitute and transform experience in illness and healing
and to examine some of the central or root metaphors of contemporary
medical, psychological, and psychiatric practice for their social and rhet-
orical implications. Throughout, my goal is to advance an embodied and
enactive theory of language that can deepen our understanding of the
poetics of illness experience and the process of healing.
Culture, Mind, and Brain: Emerging Concepts, Models, and Applications, 2020
This book explores current advances in the scientific study of the inter-relationships among cult... more This book explores current advances in the scientific study of the inter-relationships among culture, mind and brain. The contributors draw from social sciences, psychology and neuroscience to show the interplay of biology, cognition, and social contexts in human experience. Part 1 of the book includes three sections presenting diverse theoretical models lines of research. The first section addresses the dynamic interactions of culture, mind and brain on multiple timescales: evolutionary, co-evolutionary, historical, developmental and everyday contexts. The section section considers ways of thinking about the brain in social context, beginning with an enactivist perspective, and then presenting a constructivist view of emotion, experimental studies of priming effects, and a discussion of emergence of the sense of agency. A third section considers how social coordination and cooperation are achieved through joint action, acquiring social norms, and engaging in ritual practices. Part 2 of the book considers the intersection of neuroscience and social science in specific domains, including history, spatial learning, education, music, literature, film, global mental health, urbanization, the Internet, and neurodiversity. Taken together the chapters contribute to a multilevel, multiscale view of the co-construction of mind, brain and culture. An epilogue considers the challenges and prospects for future interdisciplinary work.
Re-Visioning Psychiatry explores new theories and models from cultural psychiatry and psychology,... more Re-Visioning Psychiatry explores new theories and models from cultural psychiatry and psychology, philosophy, neuroscience, and anthropology that clarify how mental health problems emerge in specific contexts and points toward future integration of these perspectives. Taken together, the contributions point to the need for fundamental shifts in psychiatric theory and practice: restoring phenomenology to its rightful place in research and practice; advancing the social and cultural neuroscience of brain-personenvironment systems over time and across social contexts; understanding how self-awareness, interpersonal interactions, and larger social processes give rise to vicious circles that constitute mental health problems; locating efforts to help and heal within the local and global social, economic, and political contexts that influence how we frame problems and imagine solutions. In advancing ecosystemic models of mental disorders, contributors challenge reductionistic models and culture-bound perspectives and highlight possibilities for a more transdisciplinary, integrated approach to research, mental health policy, and clinical practice.
Cultural Clinical Psychology and PTSD, 2019
How to provide culturally sensitive care for clients with posttraumatic stress disorder (PTSD) an... more How to provide culturally sensitive care for clients with posttraumatic stress disorder (PTSD) and related disorders This book, written and edited by leading experts from around the world, looks critically at how culture impacts on the way posttraumatic stress disorder (PTSD) and related disorders are diagnosed and treated. There have been important advances in clinical treatment and research on PTSD, partly as a result of researchers and clinicians increasingly taking into account how "culture matters." For mental health professionals who strive to respond to the needs of people from diverse cultures who have experienced traumatic events, this book is invaluable. It presents recent research and and practical approaches on key topics, including: • How culture shapes mental health and recovery • How to integrate culture and context into PTSD theory • How trauma-related distress is experienced and expressed in different cultures, reflecting local values, idioms, and metaphors • How to integrate cultural dimensions into psychological interventions Providing new theoretical insights as well as practical advice, it will be of interest to clinical psychologists, psychiatrists, and other health professionals, as well as researchers and students engaged with mental health issues, both globally and locally.
Papers by Laurence J Kirmayer
American Psychologist, 2025
Decolonial and liberation psychology aims to understand and address the social and epistemic inju... more Decolonial and liberation psychology aims to understand and address the social and epistemic injustices in our mental health systems, practices, and research agenda. To advance this goal, we advocate for deeper engagement with traditional healing systems practiced by various Indigenous Peoples and cultural groups around the world. In this article, we consider examples of Indigenous healing from Canada, China, Singapore, and the United States, to address a central question: What can we learn from these unique Indigenous healing traditions to inform mental health practices globally? Comparison shows that all these practices involve communal healing rituals grounded in spiritual, religious, and cultural knowledge systems related to embodied ways of knowing and that are embedded in social–ecological systems, including kinship, ancestral ties, and lial connections to the cosmology. To support further development of decolonial practice, it is crucial to attend to the complex interactions of cultural identity and sociocultural (relational, communal, political, and spiritual) factors underlying healing traditions in Indigenous communities
Qualitative Psychology, 2025
Ethnography begins with the recognition that people are deeply situated in local worlds that shap... more Ethnography begins with the recognition that people are deeply situated in local worlds that shape their experience and behavior. Ethnographic research, which employs experiential immersion and participant observation in a cultural context, can reveal the embedding and elaboration of experience through engagement with social institutions
and practices. Ethnographic methods are well-suited to explore the impact of culture and social context on behavior and experience. The social dynamics revealed by ethnographic research have profound implications for how we understand mental health and illness, challenging the reduction of human predicaments to discrete disorders without attention to meaning and context. While psychology and psychiatry frame mental health problems as located within the individual in mental or neurobiological processes, an ecosocial perspective shows the ways in which mental health problems are always embedded in and constituted by configurations of the social world that vary by culture and context. Individuals actively negotiate meaning and pursue plans of action that are both scaffolded and constrained by social structure. Lack of attention to these structures may lead researchers and clinicians to misattribute the causes of experience and behavior to individual states or traits rather than to the dynamics of social systems and the affordances of specific contexts. Ethnographic research can inform a cultural–ecosocial approach to research, theory, and practice in mental health.
Somatoform Disorders
Oxford Bibliographies Online Datasets
Around the world, physical symptoms are the most common manifestation of psychological distress. ... more Around the world, physical symptoms are the most common manifestation of psychological distress. This seeming contradiction presents a diagnostic challenge for health care professionals who are consulted to provide treatment and illness management. In many situations, it is difficult to clearly identify the psychological cause of physical symptoms, and, at times, it is equally difficult to exclude the possibility of an underlying biomedical process. This clinical challenge has led to the construction of the diagnostic category of somatoform disorders, a group of psychiatric disorders characterized by the presence of physical symptoms causing significant distress or functional impairment that cannot be fully explained by a general medical condition, substance use, or any other mental disorder. This category of disorders was established based on clinical utility and the need to exclude medical causes in health care settings rather than on a theoretical model of psychopathology or shar...
Transcultural Psychiatry, 2024
This essay is an introduction to the thematic issue of Transcultural Psychiatry in honor of the w... more This essay is an introduction to the thematic issue of Transcultural Psychiatry in honor of the work of Michael Chandler and Christopher Lalonde, developmental psychologists who made essential contributions to the study of identity and wellness among Indigenous youth in Canada and internationally. We outline their major contributions and illustrate the ways their innovative theory and methods have inspired decades of research, including the recent work presented in this issue, which addresses four broad themes: (1) the importance of a developmental perspective in mental health research; (2) the role of individual and collective continuity of identity in suicide prevention and mental health promotion; (3) Indigenous perspectives on trauma and resilience; and (4) Indigenous knowledge and values as a basis for culturally adapted and culturally grounded mental health services and interventions.
Transcultural Psychiatry, 2024
Recent challenges to scientific authority in relation to the COVID pandemic, climate change, and ... more Recent challenges to scientific authority in relation to the COVID pandemic, climate change, and the proliferation of conspiracy theories raise questions about the nature of knowledge and conviction. This paper considers problems of social epistemology that are central to current predicaments about popular or public knowledge and the status of science. From the perspective of social epistemology, knowing and believing are not simply individual cognitive processes but based on participation in social systems, networks, and niches. As such, knowledge and conviction can be understood in terms of the dynamics of epistemic communities, which create specific forms of authority, norms, and practices that include styles of reasoning, habits of thought and modes of legitimation. Efforts to understand the dynamics of delusion and pathological conviction have something useful to teach us about our vulnerability as knowers and believers. However, this individual psychological account needs to be supplemented with a broader social view of the politics of knowledge that can inform efforts to create a healthy information ecology and strengthen the civil institutions that allow us to ground our action in well-informed picture of the world oriented toward mutual recognition, respect, diversity, and coexistence.
Transcultural Psychiatry, 2024
This essay introduces a thematic issue of Transcultural Psychiatry presenting selected papers fro... more This essay introduces a thematic issue of Transcultural Psychiatry presenting selected papers from the 2022 McGill Advanced Study Institute in Cultural Psychiatry on "The Fragility of Truth: Social Epistemology in a Time of Polarization and Pandemic." The COVID pandemic, political polarization, and the climate crisis have revealed that large segments of the population do not trust the best available knowledge and expertise in making vital decisions regarding their health, the governance of society, and the fate of the planet. What guides information-seeking, trust in authority, and decision-making in each of these domains? Papers in this issue include case studies of the dynamics of misinformation and disinformation; the adaptive functions and pathologies of belief, paranoia, and conspiracy theories; and strategies to foster and maintain diverse knowledge ecologies. Efforts to understand the psychological dynamics of pathological conviction have something useful to teach us about our vulnerability as knowers and believers. However, this individual psychological account needs to be supplemented with a broader social view of the politics of knowledge and epistemic authority that can inform efforts to create healthy information ecologies and strengthen the civic institutions and practices needed to provide well-informed pictures of the world as a basis for deliberative democracy, pluralism, and coexistence .
Alternative: An International Journal of Indigenous Peoples, Mar 1, 2024
In this article, we discuss the construct of cultural safety in relation to the ethics, politics,... more In this article, we discuss the construct of cultural safety in relation to the ethics, politics, and practice of implementation research in Indigenous communities. We convened a 3-day workshop, bringing together 23 Indigenous and non-Indigenous collaborators from First Nation communities and universities across Canada to reflect on experiences with implementing an Indigenous youth and family mental health promotion program in First Nation communities. Participants identified three dimensions central to achieving culturally safe space in implementation research: (1) interpersonal dynamics of collaboration between Indigenous and non-Indigenous partners; (2) structural and temporal arrangements necessary for collaborative work; and (3) the systematic recognition and incorporation of Indigenous cultural knowledge, values, and practices. Within implementation research, attention to cultural safety can mitigate the epistemic injustice that arises from research frameworks and methodologies that exclude Indigenous perspectives and values. Cultural safety can increase the likelihood that the research process itself contributes to mental health promotion.
Philosophy, Psychiatry, & Psychology, 2024
This commentary on a series of three articles in PPP by Giulio Ungaro endorses his call for a soc... more This commentary on a series of three articles in PPP by Giulio Ungaro endorses his call for a socially oriented psychiatry informed by ethnographic research. It addresses some limitations of his argument: i) the lack of attention to a large body of work in social epidemiology, psychosomatics, and cultural psychiatry that speaks directly to the goals of the biopsychosocial (BPS) approach and that vitiates much of the recent critique of that model; ii) the use of an ethnographic example to idealize an ‘externalist’ system of medicine that patently cannot address the many social structural and sociophysiological processes that psychiatry needs to understand; and iii) most importantly from a philosophical perspective, the fact that the enactivist framework he endorses actually breaks down the distinctions between internalist/externalist psychiatry and naturalist/constructivist ontologies around which he organizes his critique and proposed remedy
The Role of Afro-Canadian Status in Police or Ambulance Referral to Emergency Psychiatric Services
Psychiatric Services, 2005
This study tested the hypothesis that among patients admitted to a hospital with psychosis, Afro-... more This study tested the hypothesis that among patients admitted to a hospital with psychosis, Afro-Canadian patients would be more likely than Euro-Canadian or Asian-Canadian patients to be brought to emergency services by police or ambulance. Data on psychotic patients admitted to the psychiatry ward in 1999 were extracted from records of a general hospital in Montreal. Logistic regression models examined the relationship between being Afro-Canadian and being brought to the emergency service by police or ambulance, while controlling for age, gender, marital status, and number of psychotic symptoms. Of the 351 patients with psychosis, 59 percent were Euro-Canadian, 11 percent were Afro-Canadian, and 18 percent were Asian Canadian. Most Afro-Canadian patients in the study were immigrants from the Caribbean and Africa. Being Afro-Canadian was independently and positively associated with police or ambulance referral to emergency services. Afro-Canadians admitted to the hospital with psychosis are overrepresented in police and ambulance referrals to emergency psychiatric services.
Examination of self patterns: framing an alternative phenomenological interview for use in mental health research and clinical practice
Frontiers in psychology, Jul 9, 2024
Mental disorders are increasingly understood as involving complex alterations of self that emerge... more Mental disorders are increasingly understood as involving complex alterations of self that emerge from dynamical interactions of constituent elements, including cognitive, bodily, affective, social, narrative, cultural and normative aspects and processes. An account of self that supports this view is the pattern theory of self (PTS). The PTS is a non-reductive account of the self, consistent with both embodied-enactive cognition and phenomenological psychopathology; it foregrounds the multidimensionality of subjects, stressing situated embodiment and intersubjective processes in the formation of the self-pattern. Indications in the literature already demonstrate the viability of the PTS for formulating an alternative methodology to better understand the lived experience of those suffering mental disorders and to guide mental health research more generally. This article develops a flexible methodological framework that front-loads the self-pattern into a minimally structured phenomenological interview. We call this framework ‘Examination of Self Patterns’ (ESP). The ESP is unconstrained by internalist or externalist assumptions about mind and is flexibly guided by person-specific interpretations rather than pre-determined diagnostic categories. We suggest this approach is advantageous for tackling the inherent complexity of mental health, the clinical protocols and the requirements of research.
Narrative as active inference: an integrative account of cognitive and social functions in adaptation
Frontiers in psychology, Jun 6, 2024
While the ubiquity and importance of narratives for human adaptation is widely recognized, there ... more While the ubiquity and importance of narratives for human adaptation is widely recognized, there is no integrative framework for understanding the roles of narrative in human adaptation. Research has identified several cognitive and social functions of narratives that are conducive to well-being and adaptation as well as to coordinated social practices and enculturation. In this paper, we characterize the cognitive and social functions of narratives in terms of active inference, to support the claim that one of the main adaptive functions of narrative is to generate more useful (i.e., accurate, parsimonious) predictions for the individual, as well as to coordinate group action (over multiple timescales) through shared predictions about collective behavior. Active inference is a theory that depicts the fundamental tendency of living organisms to adapt by proactively inferring the causes of their sensations (including their own actions). We review narrative research on identity, event segmentation, episodic memory, future projections, storytelling practices, enculturation, and master narratives. We show how this research dovetails with the active inference framework and propose an account of the cognitive and social functions of narrative that emphasizes that narratives are for the future—even when they are focused on recollecting or recounting the past. Understanding narratives as cognitive and cultural tools for mutual prediction in social contexts can guide research on narrative in adaptive behavior and psychopathology, based on a parsimonious mechanistic model of some of the basic adaptive functions of narrative.
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Books by Laurence J Kirmayer
My aim is to examine how metaphors structure illness experience and
symbolic healing. I come at this as a practitioner and participant-observer,
trained in psychiatry and psychotherapy, but also engaged in medical and
psychological anthropology and the philosophical critique of psychiatry.
The twin tasks of this book, then, are to illustrate the ways in which
metaphors can constitute and transform experience in illness and healing
and to examine some of the central or root metaphors of contemporary
medical, psychological, and psychiatric practice for their social and rhet-
orical implications. Throughout, my goal is to advance an embodied and
enactive theory of language that can deepen our understanding of the
poetics of illness experience and the process of healing.
Papers by Laurence J Kirmayer
and practices. Ethnographic methods are well-suited to explore the impact of culture and social context on behavior and experience. The social dynamics revealed by ethnographic research have profound implications for how we understand mental health and illness, challenging the reduction of human predicaments to discrete disorders without attention to meaning and context. While psychology and psychiatry frame mental health problems as located within the individual in mental or neurobiological processes, an ecosocial perspective shows the ways in which mental health problems are always embedded in and constituted by configurations of the social world that vary by culture and context. Individuals actively negotiate meaning and pursue plans of action that are both scaffolded and constrained by social structure. Lack of attention to these structures may lead researchers and clinicians to misattribute the causes of experience and behavior to individual states or traits rather than to the dynamics of social systems and the affordances of specific contexts. Ethnographic research can inform a cultural–ecosocial approach to research, theory, and practice in mental health.