Frank Kortmann

Frank Kortmann, MD, PhD
The Netherlands

I was born in 1942, in Boskoop, in The Netherlands. I am the 10th and youngest child of a traditional roman catholic family. My father had a nursery. I studied medicine at the State University in Groningen and fulfilled a rotating intership in Worcester City Hospital in Worcester Massachusetts, USA. Back in The Netherlands I specialised in psychiatry and was for eight years teaching in the Department of Psychiatry of the University of Groningen.

At the same time I started my psychoanalytical training. After ten years of psychoanalysis and therefore being bound to the place where my psychoanalyst was living, I felt a strong urge to broaden my scope. It happened that one of my fellow teachers in Groningen was Robert Giel. He was strongly engaged in psychiatry in Ethiopia, especially in the introduction of this subject in the medical curriculum of Addis Ababa University in Ethiopia. He invited me to take the position of Associate Professor in Psychiatry in Addis Ababa University. Quite unprepared I jumped into this adventure. There I fell in love with transcultural psychiatry. This has never left me anymore. My psychoanalytic background might have been an important factor for my choice for this speciality, because transcultural psychiatry and psychoanalysis have much in common. The basic attitude of the therapist is an anthropological one in both. There is always a cultural gap between the psychiatrist and the patient. In order to understand the patient and to feel empathy for him or her, the therapist has to have a genuine attitude of interest an curiosity. In this relationship of interest the patient feels respected, known and understood, which might be the most important factor for compliance to treatment. For two years I was teaching Ethiopian students psychiatry. I treated many Ethiopian patients in an OPD, together with the students. Now I realise that the students were teaching me sometimes even more than I did to them. In Ethiopia I also got to know the instruments of WHO for the implementation of mental health care in primary care in developing countries. One of these instruments is the so called Self Reporting Questionnaire (SRQ). At that time WHO pretended that the SRQ was applicable all over the world, regardless the culture of the patient. I was curious to know whether this was true for Ethiopia. So I started some research on the validation of the SRQ and found out that the claim of the WHO was too pretentious. I wrote my PhD-thesis on this subject and a number of articles. After coming back to The Netherlands, I changes the type of work completely.

For seven years I was general and medical director in psychiatric hospital ‘Wolfheze’ (840 beds), now ‘De Gelderse Roos’. In that period a specialized centre for asylum seekers and refugees with psychiatric problems was opened in that hospital. That gave me the opportunity to keep in touch with transcultural psychiatry. In 1993 I became professor in General Psychiatry in the University of Nijmegen in The Netherlands. I was the chairman of the Department of Psychiatry and Director of the psychiatric residency training. After seven years I felt the strong urge to exchange my management tasks for a type of work that was more close to transcultural psychiatry. I got a professorship in Transcultural Psychiatry. My main cause for my change in work was that I saw many non-western patients in The Netherlands who quit the treatment against advice because of a poor relationship with their mental health workers. I became more and more interested in the causes for it. In many supervisions I learned that my supervisants realised that things went not as it should be with their patients, but that they could not pinpoint what the reason was for it. Therefore it was difficult for them to think of methods for improvement. I realized gradually that there was hardly any theoretical basis for transcultural psychiatry. Developing a theoretical frame of reference for transcultural psychiatry became my main point of interest during this professorship. I wrote a Dutch textbook “Transculturele Psychiatrie. Van praktijk naar theorie” (Transcultural Psychiatry. From Practice to Theory), that can be used in teaching, training and research. Up until now my professorship in Transcultural Psychiatry is the first and only one of that kind in The Netherlands. One of the reasons is that academic psychiatry focus more and more on biological issues for many reasons. One is a methodological one. Many researchers avoid research in transcultural psychiatry because of the difficulties they may encounter in the methodology. That may lessen the change to get their articles publicized in international journals. At that time we established a section ‘Transcultural Psychiatry’ in the Dutch Psychiatric Association, to put this very important subject more on the agenda. I became the first chairman of that section. I did a lot of training and supervision on transcultural psychiatry, as there was a increasing need for it, due to the great influx of immigrants at that time from Turkey, Morocco, Suriname and The Netherlands Antilles in The Netherlands. At the same time I shifted my focus of attention also to third world countries. I assisted national and local authorities in designing mental health plans and trained many non-western doctors and other mental health workers in implementing some basic mental health care in primary care. Being single it was quite easy for me to work in East Timor, Cambodia, Nepal, Afghanistan, Jemen, Turkey, Bosnia, Kosovo, Suriname, Sierra Leone and Ethiopia. My employers were manly WHO and international NGOs. I kept a special tie with Ethiopia. Four years ago a residency training in psychiatry was started in Addis Ababa. The majority of trainers were recruited from Canada. But for the training in psychotherapy the Ethiopian Department of Psychiatry invited me, being a psychotherapis, to do the teaching and supervision of the residents because knew the Ethiopian culture to a certain extent. For me this was the ultimate challenge in transcultural psychiatry in my life.

Recently I am also part time working as psychotherapist especially for non-western mentally ill offenders in a forensic psychiatric clinic in The Netherlands,. After being involved in transcultural psychiatry for many years, I became more and more convinced that all psychiatry is transcultural psychiatry, as there is always a cultural gap between the doctor and the patient. Therefore what I am teaching and practicing is just ordinary normal psychiatry!

July 5, 2007