Psychiatrists and Peacemaking: A Cultural Psychiatry Perspective

Neil Krishan Aggarwal, MD, MBA, MA, DFAPA

Introduction

-H. Steven Moffic, MD

Today is the 80th anniversary of D-Day, the landing of Allied troops at Normandy that turned the tide of World War II against Hitler and the Nazis. It also led to the 1947 British conflictual partition of India into the independent states of India and Pakistan, as well as the 1948 establishment of the state of Israel.

The coalition’s goal since is to try to prevent wars, especially any devastating nuclear war, but with only partial success so far. The Western alliance seems somewhat shaky in addressing the war ensuing from another invasion of Europe, that of Ukraine.

At least in my mind, serendipitously or not, today’s column is one of our occasional very special ones and has an unexpected connection to D-Day. It focuses on how psychiatrists can contribute to enhancing cross-cultural relationships, including political ones, and more.

Following is an online interview that I conducted with Neil Krishan Aggarwal, MD, MBA, MA, DFAPA. We started without any prearranged plan, so did it with one question at a time, like a live interview, leaving the opportunity for improvising. Everything turned out to be an unedited first take without any revisions.

The reason for the interview is that Dr Aggarwal has contributed to the publishing landing of a new book, along with 2 former spies from India and Pakistan, all together working on an innovative approach, called Track II, to large-scale conflict and its potential prevention and resolution. It is certainly a prime example of the first in our recent series of columns of psychoexemplaries: peacemaking. It also connects well with the increase of interest in peace exhibited by many psychiatrists at the recent annual meeting of the APA in New York.

Interview

Moffic: For our readers who may not know you, can you share some of your background and particular interests in psychiatry, leading up to this most promising project and new book hot-off-the-press that we will discuss in some depth?

Aggarwal: Thank you for this question. I am interested in 3 main areas: cultural psychiatry, psychiatric and psychological anthropology, and South Asian studies. After medical school, I completed a self-designed master’s program in South Asian studies where my coursework focused on South Asian languages and anthropology. Afterwards, I entered psychiatry residency training and then completed a NIMH-funded T32 research fellowship where I specialized in converting theories from medical anthropology for clinical use. I think I am searching for answers in several areas that relate to clinical work and beyond: how much individual agency we have vs behaviors being constrained by social structures; how we come to understand ourselves and articulate this understanding to others; and the relationship between language, cultural identity, and how we live in the world. Cultural psychiatry and psychiatric/psychological anthropology are broad fields that accommodate these interests.

Moffic: Thank you for this background. We know that backgrounds are always important in psychiatry, both that of the psychiatrist and patients. We have mainly worked together on the religion and psychiatry books I recently edited. You wrote the basic clinical applications and recommendations to consider in helping those of Islamic, Jewish, and the Eastern faiths and spirituality where Islamophobia, anti-Semitism, and so-called Eastern Traditions are involved. Now, it looks like you are branching into new social psychiatric territory, as if you are addressing countries as individuals needing help. That leads us to your fascinating new book. Tell us about it!

Aggarwal: Thanks for this question. I would like to clarify the scope of what we are trying to accomplish. I would not posit that we are trying to address countries as individuals. Instead, I would frame this differently. Like the world “culture,” the word “state” has a social science origin that people often use monolithically without looking at internal variation. For instance, when we think of the “state” in our lives, who are we thinking about? The list is endless and could include politicians, bureaucrats, government employees, or impersonal systems. To think about contemporary examples, when people say that Israelis and Palestinians or Ukrainians and Russians are at war, then that becomes shorthand for the state, especially key decision makers involved in deciding war and peace. I have met plenty of Israelis and Palestinians who get along just fine, but are powerless to change the course of governments. My book is an attempt to break down what we mean by the “state” to focus on psychological experiences of 2 key decision makers who were once in government and influences matters of war and peace.

Moffic: I like your explanation—much more nuanced than mine. Let’s dig into the book some. I understand that it is out in India and doing very well, even better right now than Salman Rushdie’s new one! Will it be out soon in the United States, if so, when, and what will be its title? Right now, it almost sounds to me like it is a psychiatric spy story. Is it?

Covert: The Psychology of War and Peace

Aggarwal: By god’s grace, the book has achieved some success. It is out in hardcover only in India for now, but it is available worldwide as an electronic book. Its title is: Covert: The Psychology of War and Peace. I mediate conversations between 2 rival spychiefs—one from India and one from Pakistan—that explore their developmental histories from childhood and adolescence into their professional trajectories. We ask about their cultural identities, and how cultural/religious/linguistic/ethnic identities are responsible for the souring of relations between India and Pakistan. Finally, we review past peace initiatives to explore why some have worked, others have not, and what are realistic prospects ahead. The idea is that if we understand the psychologies of people at the frontlines of making war and peace, we may understand how they calculate foreign policy decisions.

Moffic: We in psychiatry occasionally have breakthroughs in medication and other biological treatments, as well as sometimes in the psychotherapies. But social psychiatric breakthroughs seem very few and far between. Could this be called a potential social psychiatric breakthrough? Or am I getting too excited about this?

Aggarwal: I think it depends on what we mean by “breakthrough.” In terms of process, perhaps, in that the participants got to learn a great deal about each other. In terms of outcomes toward peace; however, it is debatable. I do not think that this is specific to our project, by the way. As our book indicates, Track II initiatives have not led to durable results in terms of outcomes.

Moffic: That sounds like a more modest and appropriate expectation. Perhaps the book and its approach will also complement the increased interest in peace and psychiatry that emerged in the recent annual meeting of the American Psychiatric Association. Regardless, I am looking forward to reading and hopefully reviewing the book in the near future. Anything else you would like to add before we close out the interview?

Aggarwal: We are trying to use the book to have 2 types of conversations. First, what are ways to promote peace specifically between India and Pakistan? Second, what are ways that psychiatry can contribute to improving cross-cultural understandings toward peace? There had been media interest in our work, and curious readers may find the link below a good introduction to the benefits that psychiatry has to offer.

You can learn more about the book here: https://m.youtube.com/watch?v=1Qfogd5jAv4

Afterword: As Dr Aggarwal added after the formal Q&A that the book builds on the scholarship of Vamik Volkan and others who pioneered the idea that psychiatrists could have productive roles to play in negotiations toward peace.