Thirteen years ago, “Griff,” as he is affectionately called by his colleagues, had an epiphany during dinner at an Ethiopian restaurant in Washington, D.C.
That city, he knew, wasn’t just the nation’s capital, but home to many thousands of immigrants. In Washington, D.C., and its suburbs, there were about 40,000 Afghans, 250,000 people from Central America, and more Ethiopians than anywhere outside of Ethiopia. Moreover, an estimated 40,000 of these were political refugees who had been tortured by the governments of their home countries, with many developing mental health problems as a result. So shouldn’t he, James Griffith, M.D., and his colleagues at George Washington University (GWU) be doing something to help them?
Griffith set out to make that idea a reality.
First he and his colleagues connected with the Center for Multicultural Human Services, now a program of Northern Virginia Family Services, in Falls Church, Va. The center was established to respond to the myriad problems facing immigrants and refugees, but had no psychiatric component. Griffith and his colleagues created a partnership with the center, where he and GWU psychiatry faculty members Lynne Gaby, M.D., and Anjuli Jindal, M.D., would supervise their psychiatry residents in weekly clinics.
Over the past 13 years, Griffith, Gaby, Jindal, and the residents have evaluated and treated immigrants, refugees, and torture survivors during 22,000 patient visits.
Patients who benefited from the program stay fresh in his memory, Griffith said during an interview in his office. Among them, he noted, were a former Sandinista soldier from Central America, a Khmer survivor of the Pol Pot killing fields of Cambodia, Bosnian survivors of ethnic cleansing, Iraqi political prisoners of Saddam Hussein, genocide survivors from Rwanda and Congo, as well as African physicians tortured for advocating human rights in their home countries.
“Among those politically tortured, we have treated patients from perhaps 60 countries,” Griffith said. “They were interrogated relentlessly; deprived of food, water, and sleep; waterboarded; sexually assaulted; subjected to beatings and electric shocks; or forced to commit sexually degrading acts with family members—all efforts to silence or destroy their capacity to speak out or challenge their governments.”
“Yet it often has been amazing, after psychiatric treatment was initiated, how rapidly these individuals’ posttraumatic symptoms improved,” Griffith pointed out. “Psychiatrists are mostly accustomed to treating patients whose psychiatric illnesses stem from genetic risk factors and early childhood trauma. Survivors of political torture often have been emotionally healthy political leaders and activists with no prior risk factors for mental illness. A number have been physicians or other health care professionals in their home countries. It is a powerful lesson for our psychiatry residents to witness how extensively human beings can recover from infliction of tremendous horror and pain.”
To complement the clinical training at Northern Virginia Family Services, Griffith and his colleagues developed an innovative residency curriculum to train psychiatrists for work with patients from other countries. “We teach clinical methods that are portable across different cultures and that can be used in resource-poor environments where efficiency and effectiveness are both priorities,” Griffith said.
Perhaps surprisingly, he has encountered little opposition to the cultural-psychiatry focus of his residency program and its global mental health track. “One reason why is probably because they are a good fit for our Washington environment, given our patient populations, faculty, and local resources,” he speculated. “It also helps that I am program director for the residency,” he added with a chuckle.
Griffith has found the multicultural clinical and training programs he has launched very rewarding. “In many ways, our refugee work is a return to the ancient notion of being a physician, because being a physician has always been about relieving suffering. Refugees may be depressed, or they may have PTSD, but mostly they suffer from demoralization, loneliness due to being away from home, stigma, or grief due to many losses. Psychiatrists have knowledge and skills for relieving human suffering that extend well beyond treating psychiatric disorders.”
“We have what may be the country’s only psychiatry global mental health curriculum that spans all four years of training,” Griffith reported. He noted that residents can spend part of each residency year in regions as diverse as the Middle East, Africa, and Asia. “A lot of medical anthropology, ethnopharmacology, human-rights advocacy, and transcultural psychiatry is embedded in our residency curriculum for all our residents.”
“Griff’s work with refugees and immigrants is unusual in psychiatry and very unusual for residency program directors,” Joan Anzia, M.D., director of the psychiatry residency program at Northwestern University, observed (see "Who is James Griffith, M.D.?" and "Psychiatrists Praise Refugee MH Program" below).
Indeed, there appears to be only one other multicultural psychiatry program like that of Griffith’s in the United States—the Intercultural Psychiatric Program at Oregon Health and Science University. James Boehnlein, M.D., a professor of psychiatry at Oregon Health and Science University and a participant in that program, confirmed that this is the case.
“I very much admire Dr. Griffith’s work with immigrants and refugees because he views treatment in a comprehensive manner,” Boehnlein said. “He focuses on restoring dignity, hope, and meaning in the context of the person’s family, culture, and community. He also correctly sees the role of the psychiatrist comprehensively as someone who can use medication, individual and family psychotherapy, along with the skills of allied health professionals, to reduce symptoms and suffering.”
And the best is yet to come, Griffith believes. “My biggest concern is to find a way to endow the program with philanthropic funding, because immigrants and refugees who are not yet citizens largely have no reimbursable services.”
Watch a video interview with Griffith offering tips on how to help immigrants and refugees at www.youtube.com/watch?v=sJ7jrzBJrfQ&feature=plcp.
“I love Griff!” Joan Anzia, M.D., Northwestern University’s psychiatry residency program director, told Psychiatric News. “He is truly unique among psychiatrists…so modest and soft-spoken that I suspect that many people don’t know even a portion of his interests or accomplishments…. He is a profoundly spiritual and reflective man, both deep and transparent…. He has been involved in global mental health well before it became fashionable [and] has worked in the international arena to create innovative responses to community trauma in postconflict areas such as Kosovo, and at home he is both an expert clinician and advocate for émigré survivors of political violence.”
“With his deep interests in the influence of culture, the family, and spirituality on mental health, Griff is unusual as a training director in the current era of biological psychiatry,” Steven Wolin, M.D., a clinicial professor of psychiatry at George Washington University, observed. “He has applied these passions to his teaching and clinical activities as well as in his writing. Through his work with immigrant families and refugee victims of torture, Griff has attracted trainees with significant prior research and clinical experience in violence-prone third-world countries.”
“Several factors in Griff’s own personal history and professional development have undoubtedly played a role in this special focus on the immigrant and multiculturalism,” Wolin said. “He was raised in the fundamentalist deep South, but received his psychiatric training in the ‘Brahmin’ culture of psychoanalytic Boston. As a result, he is an inherent multiculturalist, translating charismatic religious experiences to the secular psychoanalytic trainee and Eastern philosophy to the Midwestern WASP.”
“I have known Dr. Griffith for over 10 years,” said Francis Lu, M.D., a professor and director of cultural psychiatry at the University of California, Davis. “He is an outstanding training director, and I believe that his program is an innovative one worthy of recognition…. I nominated Dr. Griffith for the 2011 Creative Achievement Award of the Society for the Study of Psychiatry and Culture, which he did win.”
Eindra Khin Khin, M.D., received her psychiatric training in James Griffith, M.D.,’s residency program. “Its multicultural focus was one of the main draws for me,” said Khin Khin, originally from Myanmar (Burma) and now an assistant professor of psychiatry at George Washington University.
Still other draws, she said, were “its emphasis on humanistic approaches to mental health well-being; its well-maintained balance between psychotherapy and psychopharmacology; its commitment to community, public, and global mental health issues; and an opportunity to pursue a master’s degree in public health while in residency.”
The program, she continued, “is not about producing the best psychopharmacologists or making sure that residents publish a certain number of articles in four years. It is truly about cultivating personal growth and professional development in a supportive collegial climate for the residents so that by the end of the residency, they emerge as well-rounded psychiatrists.”
Brandon Kohrt, M.D., Ph.D., a current resident in Griffith’s program, also chose it because of its multicultural focus. “Dr. Griffith’s residency program stands out for the intense focus on psychotherapy that can be applied across cultures,” he said. “The psychotherapy training program is rooted in the common factors that lead to efficacy in psychotherapy. Among these core elements are hope and expectancy of change…. Dr. Griffith is uniquely suited to train in this domain because … he has found ways to promote hope among individuals with profoundly severe trauma exposures from different cultures around the world.”
As part of his residency, Kohrt noted, he has also “been able to work with the Carter Center Mental Health Initiative in Liberia to develop an intervention … to reduce the stigma associated with mental illness.” He added that he is conducting research and helping to develop services in Nepal, Liberia, and Haiti.