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This issue of Transcultural Psychiatry presents selected papers from the McGill Advanced Study Institute on "Cultural Poetics of Illness and Healing." The meeting addressed the cognitive science of language, metaphor, and poiesis from embodied and enactivist perspectives; how cultural affordances, background knowledge, discourse, and practices enable and constrain poiesis; the cognitive and social poetics of symptom and illness experience; and the politics and practice of poetics in healing ritual, psychotherapy, and recovery. This introductory essay outlines an approach to illness experience and its transformation in healing practices that emphasizes embodied processes of metaphor as well as the social processes of self-construal and positioning through material and discursive engagements with the cultural affordances that constitute our local worlds. The approach has implications for theory building, training, and clinical practice in psychiatry.

This article introduces a thematic issue of Transcultural Psychiatry on suicide in cultural context. Developmental and social structural factors including exposure to violence, childhood abuse and privation, as well as intractable social problems that create psychic pain and a sense of entrapment have been shown to increase the risk of suicidal behavior. However, all of the major social determinants identified in suicide research are influenced or mediated by particular cultural meanings and contexts. To move beyond crude generalizations about suicide based on psychological theories developed mainly in Western contexts and culture-specific prototypes or exemplars, we need more fine-grained analysis of the experience of diverse populations. The articles in this issue provide clear illustrations of the impact of cultural and contextual factors in the causes of suicide, with implications for psychiatric research, theory, and practice. Cross-cultural research points to the possibility of developing a typology of social predicaments affecting specific sociodemographic groups and populations. This typology could be elaborated and applied in clinical and public health practice through an ecosocial approach that considers the ways that suicide is embodied and enacted in social systemic contexts.

Mindfulness meditation and other techniques drawn from Buddhism have increasingly been integrated into forms of psychotherapeutic intervention. In much of this work, mindfulness is understood as a mode of awareness that is present-centered and nonevaluative. This form of awareness is assumed to have intrinsic value in promoting positive mental health and adaptation by interrupting discursive thoughts that give rise to suffering. However, in the societies where it originated, mindfulness meditation is part of a larger system of Buddhist belief and practice with strong ethical and moral dimensions. Extracting techniques like mindfulness meditation from the social contexts in which they originate may change the nature and effects of the practice. The papers in this issue of Transcultural Psychiatry explore the implications of a cultural and contextual view of mindfulness for continued dialogue between Buddhist thought and psychiatry. This introductory essay considers the meanings of mindfulness meditation in cultural context and the uses of mindfulness as a therapeutic intervention in contemporary psychiatry and psychology.

Although pain appears to be one of the most basic and obdurate sensations its meaning and experience are richly elaborated in many cultural traditions. The study of the cognitive processes that underlie metaphor provides a model of how sensory and affective qualities of bodily events are translated into symptom experience. Basic sensorimotor experiences provide the conceptual vocabulary used to build up more complex and abstract models. These are elaborated within specific traditions, communities, or local worlds in ways that fit with overarching cultural models. In turn, culturally elaborated metaphors influence basic cognitive, perceptual and attentional processes that modify sensory processing. This article will consider three sites of the metaphoric mediation of pain experience: bodily posture or stance, facial expression, and the experience of temporal duration. Each of these basic aspects of embodiment gives rise to bodily metaphors that shape the experience and expression of pain. Tracing how metaphoric constructions regulate cognitive affective and attentional processes provides a way to understand the cultural malleability of pain experience.

Psychotherapies are distinguished from other forms of symbolic healing by their emphasis on explicit talk about the self. Every system of psychotherapy thus depends on implicit models of the self, which in turn, are based on cultural concepts of the person. The cultural concept of the person that underwrites most forms of psychotherapy is based on Euro-American values of individualism. This individualistic and egocentric concept of the person can be contrasted with more sociocentric, ecocentric or cosmocentric views, which understand the person in relation to the social world, the environment, and the cosmos. Intercultural psychotherapy must consider the cultural concept of the person implicit in therapeutic discourse and practice to determine how well it fits or conflicts with the concepts, values and way of life of the patient.

The 'new cross-cultural psychiatry' heralded by Kleinman in 1977 promised a revitalized tradition that gave due respect to cultural difference and did not export psychiatric theories that were themselves culture bound. In the ensuing years, the view of culture within anthropology has continued to change, along with our understanding of the relationship of biological processes to cultural diversity, and the global political economic contexts in which mental health care is delivered. This article considers the implications of these new notions of culture, biology and the context of practice for theory in cultural psychiatry. The future of cultural psychiatry lies in advancing a broad perspective that: (a) is inherently multidisciplinary (involving psychiatric epidemiology, medical anthropology and sociology, cognitive science and social psychology), breaking down the nature/culture dichotomy with an integrative view of culture as a core feature of human biology, while remaining alert to cultural constructions of biological theory; (b) attends to psychological processes but understands these as not exclusively located within the individual but as including discursive processes that are fundamentally social; and (c) critically examines the interaction of both local and global systems of knowledge and power. Globalization has brought with it many ironies for cultural psychiatry: Transnational migrations have resulted in cultural hybridization at the same time as ethnicity has become more salient; the call for evidence-based medicine has been used to limit the impact of cultural research; and cultural psychiatry itself has been co-opted by pharmaceutical companies to inform marketing campaigns to promote conventional treatments for new populations. Cultural psychiatry must address these ironies to develop the self-critical awareness and flexibility needed to deliver humane care in shifting contexts.

The clinical encounter is structured hierarchically: explicit technical action is embedded in levels of organization that reflect the personality and biography of the clinician, which in turn, are embedded in a larger matrix of cultural values or ethos. Systems of medicine can be compared at each of these levels. Shamanism and other elementary systems of medicine are built on an ethos that identifies healers' calling, authority and effectiveness with their own initiatory illness experiences. The Asklepian religious cults of ancient Greece also drew from the image of the wounded-healer. This essay argues that ethos of the wounded-healer remains relevant to contemporary medicine, psychiatry and psychotherapy. Developmental changes in the relationship of the healer to his wounds during psychiatric training are illustrated by a series of dreams. The ethos of the wounded-healer has implications for the training of clinicians, as well as for the ethics and pragmatics of clinical work.