Laurence J. Kirmayer

Last updated

Laurence J. Kirmayer (born October 23, 1952 in Montreal, Quebec) is a Canadian psychiatrist and internationally recognized expert in culture and mental health. He is Distinguished James McGill Professor and Director of the Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University. [1] He is a Fellow of the Canadian Academy of Health Sciences [2] and the Royal Society of Canada (Academy of Social Sciences) [3]

Contents

From 1991 through 2022, he was Editor-in-Chief of Transcultural Psychiatry, the official journal of the Section on Transcultural Psychiatry of the World Psychiatric Association. Currently, he is Editor-in-Chief Emeritus. [4]

From 2021 to 2023, he was President of the Society for Psychological Anthropology [5] of the American Anthropological Association.

Career

Kirmayer completed undergraduate training in psychology (1971-1974) and in medicine (1974-78) at McGill University and an internship and residency in psychiatry (1978–81) at the University of California, Davis Medical Center in Sacramento, California. He is a Principal Investigator at the Lady Davis Institute, [6] and Director of the Culture & Mental Health Research Unit at the Institute of Community and Family Psychiatry, Jewish General Hospital in Montreal.

In 1991, he founded the annual McGill Summer Program in Social and Cultural Psychiatry. [7] In Canada, he also founded the national Network for Aboriginal Mental Health Research, [8] the Cultural Consultation Service, [9] [10] and the online Multicultural Mental Health Resource Centre [11] [12] which are based at the Institute of Community and Family Psychiatry of the Jewish General Hospital.

Work

His work has contributed to the development of culturally responsive services and interventions in primary care mental health and psychiatry. [13] He has conducted research on the impact of culture and social context on common mental disorders (depression, anxiety, somatization, dissociation, and trauma-related disorders), symptom experience, and processes of resilience, healing and recovery among Indigenous peoples, migrants and marginalized groups. His most recent work has applied theories of embodied and enactive cognitive science to understand the social determinants of health and illness experience and resilience.

He has done epidemiological and ethnographic research on the mental health of Indigenous peoples in collaboration with communities and Indigenous scholars. [14] This includes studies on Inuit concepts of mental health and illness, [15] [16] risk and protective factors for suicide among Inuit youth, [17] Indigenous concepts of resilience, [18] [19] and mental health promotion for Indigenous youth. [20] With Gail Guthrie Valaskakis, he edited the first book integrating social science and clinical perspectives on the mental health of Indigenous peoples in Canada. [21]

Much of his early research concerned somatization, [22] the bodily expression of psychiatric, psychological or emotional distress and medically unexplained symptoms. [23] He clarified several distinct definitions of somatization [24] and conducted clinical and community epidemiological studies of the cognitive and social correlates of somatoform disorders. [25] With sociologist James Robbins, he co-developed the Symptom Interpretation Questionnaire, [26] a measure of somatic symptom attribution that predicts high levels of health care utilization, persistent somatization, hypochondriacal worry, low rates of physician detection of psychosocial distress, and chronicity of fatigue in primary care patients. [27]

He also co-developed the McGill Illness Narrative Interview, [28] a method for eliciting and studying explanatory models and help-seeking, which has been translated into over 15 languages and widely used in global mental health and clinical ethnographic research. [29]

He has worked to translate insights from cultural psychology and anthropology into new approaches to thinking about culture and social context in clinical settings. [30] This includes establishing an innovative Cultural Consultation Service (CCS) [31] to address cultural diversity in mental health care in primary and specialty care sectors. The CCS model has been adopted in Australia, France, Germany, the Netherlands, Spain, Sweden, Switzerland, the US and UK. [32] Analysis of CCS data demonstrated the impact of systematic attention to culture on diagnosis and treatment [33] and contributed to the development of the DSM-5 Cultural Formulation Interview. [34] He led workgroups for the Canadian Collaboration for Immigrant and Refugee Health developing guidelines for the primary care prevent and treatment of common mental health problems. [35] For the Canadian Psychiatric Association, he has led workgroups developing guidelines for training in cultural psychiatry [36] and on cultural issues in the psychiatric training of international medical graduates. [37]

Kirmayer also has made contributions to medical and psychological anthropology and the philosophy of psychiatry. [38] He has collaborated on applying 4-E cognitive science to psychiatry and developing a model of cultural affordances in computational neuroscience. [39] [40] He has worked extensively on questions of the cognitive and social process of meaning-making in illness experience, developing theories of metaphoric embodiment and enactment of symptom experience and its ritual and therapeutic transformation. [41] [42] Most recently, he has advocated for an integrative ecosocial approach to understanding mental health and illness. [43] [44]

Awards

Bibliography

His publications include over 400 articles and book chapters as well as several co-edited volumes:

Lectures

Video recordings of Kirmayer's lectures in cultural psychiatry are available online [53]

Video interviews as part of an oral history of medical anthropology from Anthropologie et Societé are also available [54] [55] [56] [57] [58]

See also

Related Research Articles

<i>Diagnostic and Statistical Manual of Mental Disorders</i> American psychiatric classification

The Diagnostic and Statistical Manual of Mental Disorders is a publication by the American Psychiatric Association (APA) for the classification of mental disorders using a common language and standard criteria. It is the main book for the diagnosis and treatment of mental disorders in the United States and Australia, while in other countries it may be used in conjunction with other documents. The DSM-5 is considered one of the principal guides of psychiatry, along with the International Classification of Diseases (ICD), Chinese Classification of Mental Disorders (CCMD), and the Psychodynamic Diagnostic Manual. However, not all providers rely on the DSM-5 as a guide, since the ICD's mental disorder diagnoses are used around the world and scientific studies often measure changes in symptom scale scores rather than changes in DSM-5 criteria to determine the real-world effects of mental health interventions.

A mental disorder, also referred to as a mental illness, a mental health condition, or a psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. A mental disorder is also characterized by a clinically significant disturbance in an individual's cognition, emotional regulation, or behavior, often in a social context. Such disturbances may occur as single episodes, may be persistent, or may be relapsing–remitting. There are many different types of mental disorders, with signs and symptoms that vary widely between specific disorders. A mental disorder is one aspect of mental health.

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

Medical anthropology studies "human health and disease, health care systems, and biocultural adaptation". It views humans from multidimensional and ecological perspectives. It is one of the most highly developed areas of anthropology and applied anthropology, and is a subfield of social and cultural anthropology that examines the ways in which culture and society are organized around or influenced by issues of health, health care and related issues.

<span class="mw-page-title-main">Somatization disorder</span> Mental disorder consisting of clinically significant somatic symptoms

Somatization disorder was a mental and behavioral disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. It was recognized in the DSM-IV-TR classification system, but in the latest version DSM-5, it was combined with undifferentiated somatoform disorder to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms. ICD-10, the latest version of the International Statistical Classification of Diseases and Related Health Problems, still includes somatization syndrome.

<span class="mw-page-title-main">Conversion disorder</span> Diagnostic category used in some psychiatric classification systems

Conversion disorder (CD), or functional neurologic symptom disorder, is a diagnostic category used in some psychiatric classification systems. It is sometimes applied to patients who present with neurological symptoms, such as numbness, blindness, paralysis, or fits, which are not consistent with a well-established organic cause, which cause significant distress, and can be traced back to a psychological trigger. It is thought that these symptoms arise in response to stressful situations affecting a patient's mental health or an ongoing mental health condition such as depression. Conversion disorder was retained in DSM-5, but given the subtitle functional neurological symptom disorder. The new criteria cover the same range of symptoms, but remove the requirements for a psychological stressor to be present and for feigning to be disproved. The ICD-10 classifies conversion disorder as a dissociative disorder, and the ICD-11 as a dissociative disorder with unspecified neurological symptoms. However, the DSM-IV classifies conversion disorder as a somatoform disorder.

In medicine and medical anthropology, a culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture. There are no objective biochemical or structural alterations of body organs or functions, and the disease is not recognized in other cultures. The term culture-bound syndrome was included in the fourth version of the Diagnostic and Statistical Manual of Mental Disorders which also includes a list of the most common culture-bound conditions. Counterpart within the framework of ICD-10 are the culture-specific disorders defined in Annex 2 of the Diagnostic criteria for research.

Piblokto, also known as pibloktoq and Arctic hysteria, is a condition most commonly appearing in Inughuit societies living within the Arctic Circle. Piblokto is a culture-specific hysterical reaction in Inuit, especially women, who may perform irrational or dangerous acts, followed by amnesia for the event. Piblokto may be linked to repression of the personality of Inuit women. The condition appears most commonly in winter. It is considered to be a form of a culture-bound syndrome, although more recent studies question whether it exists at all. Piblokto is also part of the glossary of cultural bound syndromes found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Medically unexplained physical symptoms are symptoms for which a treating physician or other healthcare providers have found no medical cause, or whose cause remains contested. In its strictest sense, the term simply means that the cause for the symptoms is unknown or disputed—there is no scientific consensus. Not all medically unexplained symptoms are influenced by identifiable psychological factors. However, in practice, most physicians and authors who use the term consider that the symptoms most likely arise from psychological causes. Typically, the possibility that MUPS are caused by prescription drugs or other drugs is ignored. It is estimated that between 15% and 30% of all primary care consultations are for medically unexplained symptoms. A large Canadian community survey revealed that the most common medically unexplained symptoms are musculoskeletal pain, ear, nose, and throat symptoms, abdominal pain and gastrointestinal symptoms, fatigue, and dizziness. The term MUPS can also be used to refer to syndromes whose etiology remains contested, including chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity and Gulf War illness.

Somatization is a tendency to experience and communicate psychological distress as bodily and organic symptoms and to seek medical help for them. More commonly expressed, it is the generation of physical symptoms of a psychiatric condition such as anxiety. The term somatization was introduced by Wilhelm Stekel in 1924.

Cross-cultural psychiatry is a branch of psychiatry concerned with the cultural context of mental disorders and the challenges of addressing ethnic diversity in psychiatric services. It emerged as a coherent field from several strands of work, including surveys of the prevalence and form of disorders in different cultures or countries; the study of migrant populations and ethnic diversity within countries; and analysis of psychiatry itself as a cultural product.

The classification of mental disorders, also known as psychiatric nosology or psychiatric taxonomy, is central to the practice of psychiatry and other mental health professions.

Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

A psychiatric assessment, or psychological screening, is the process of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and data from specific psychological tests. It is typically carried out by a psychiatrist, but it can be a multi-disciplinary process involving nurses, psychologists, occupational therapist, social workers, and licensed professional counselors.

<span class="mw-page-title-main">Psychiatry</span> Branch of medicine devoted to mental disorders

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, perceptions, and emotions.

The Foundation for Psychocultural Research is a 501(c)(3) nonprofit organization based in Los Angeles that supports and advances interdisciplinary and integrative research and training on interactions of culture, neuroscience, psychiatry, and psychology, with an emphasis on cultural processes as central. The primary objective is to help articulate and support the creation of transformative paradigms that address issues of fundamental clinical and social concern.

Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not deliberately produced or feigned, and they may or may not coexist with a known medical ailment.

<i>Transcultural Psychiatry</i> Academic journal

Transcultural Psychiatry is a peer-reviewed academic journal that publishes papers in the fields of cultural psychiatry, psychology and anthropology. The journal's editor-in-chief is Laurence J. Kirmayer. The Associate Editors are Renato Alarcón, Roland Littlewood and Leslie Swartz. It has been in publication since 1964 and is currently published by SAGE Publications on behalf of the Division of Social and Transcultural Psychiatry of McGill University. It is the official journal of the World Psychiatric Association Transcultural Psychiatry Section and is also published in association with the Society for the Study of Psychiatry and Culture.

Robert Bush Lemelson is an American cultural anthropologist and film producer. He received his M.A. from the University of Chicago and Ph.D. from the Department of Anthropology at the University of California, Los Angeles. Lemelson's area of specialty is transcultural psychiatry; Southeast Asian Studies, particularly Indonesia; and psychological and medical anthropology. He is a research anthropologist in the Semel Institute of Neuroscience UCLA, and an adjunct professor of Anthropology at UCLA. His scholarly work has appeared in journals and books. Lemelson founded Elemental Productions in 2008, a documentary production company, and has directed and produced numerous ethnographic films.


Janis Hunter Jenkins is an American Psychological and Medical Anthropologist. She is Distinguished Professor at the University of California San Diego, on faculty in the Departments of Anthropology, Psychiatry, and the Global Health Program. She is Director for the Center for Global Mental Health at UCSD.

References

  1. ↑ "Division of Social and Transcultural Psychiatry". Division of Social and Transcultural Psychiatry.
  2. ↑ "McGill Heath News CAHS 2023". 14 November 2013.
  3. ↑ "Royal Society of Canada Members Directory". rsc-src.ca.
  4. ↑ "Transcultural Psychiatry: SAGE Journals".
  5. ↑ "Society for Psychological Anthropology of the American Anthropological Association".
  6. ↑ "Lady Davis Institute - Principal Investigators".
  7. ↑ "Division of Social and Transcultural Psychiatry".
  8. ↑ http://www.namhr.ca
  9. ↑ "Cultural Consultation Service".
  10. ↑ "Experience in Cultural Consultation Opens New Era in the Clinic".
  11. ↑ http://www.mmhrc.ca
  12. ↑ "McGill researchers launch Multicultural Mental Health Resource Centre".
  13. ↑ Kirmayer, Laurence J.; Jarvis, G. Eric (2019). "Culturally responsive services as a path to equity in mental healthcare". HealthcarePapers. 18 (2): 11–23. doi:10.12927/hcpap.2019.25925. PMID   31596698. S2CID   204028942.
  14. ↑ "Arctic Council delegates ponder what works best in mental health". Nunatsiaq News. March 30, 2015.
  15. ↑ https://www.mcgill.ca/tcpsych/files/tcpsych/Report4.pdf
  16. ↑ Kirmayer, Laurence J.; Fletcher, Christopher; Watt, Robert (2009). Kirmayer, Laurence J.; Valaskakis, Gail g. (eds.). Locating the ecocentric self: Inuit concepts of mental health and illness. UBC Press. pp. 289–314.
  17. ↑ Kirmayer, Laurence J.; Boothroyd, Lucy J.; Hodgins, S. (1998). "Attempted suicide among Inuit youth: Psychosocial correlates and implications for prevention". Canadian Journal of Psychiatry. 43 (8): 816–822. doi:10.1177/070674379804300806. PMID   9806088. S2CID   22166295.
  18. ↑ "ICIHRP Roots of Resilience Project".
  19. ↑ Kirmayer, Laurence J.; Dandeneau, S.; Marshall, E.; Phillips, M.K.; Williamson, Karla (2011). "Rethinking resilience from indigenous perspectives". Canadian Journal of Psychiatry. 56 (2): 84–91. doi: 10.1177/070674371105600203 . PMID   21333035. S2CID   7549749.
  20. ↑ "Listening to One Another to Grow Strong (LTOA): Mental Health Promotion for Indigenous Youth".
  21. ↑ Kirmayer, Laurence J.; Valaskakis, Gail Guthrie (2009). Healing Traditions: The Mental Health of Aboriginal Peoples in Canada. University of British Columbia Press. ISBN   978-0774815246.
  22. ↑ Kirmayer, Laurence J.; Robbins, James M. (1991). Current Concepts of Somatization: Research and Clinical Perspectives. American Psychiatric Press. ISBN   0880481986.
  23. ↑ Kirmayer, LJ; Groleau, D; Looper, KJ; Dao, MD (October 2004). "Explaining medically unexplained symptoms". Canadian Journal of Psychiatry. 49 (10): 663–72. doi: 10.1177/070674370404901003 . PMID   15560312.
  24. ↑ Kirmayer, Laurence J.; Robbins, James M. (1991). "Three forms of somatization in primary care: prevalence, co-occurrence, and sociodemographic characteristics". The Journal of Nervous and Mental Disease. 179 (1): 647–655. doi:10.1097/00005053-199111000-00001. PMID   1940887. S2CID   46182116.
  25. ↑ Kirmayer, L.J.; Young, A. (1998). "Culture and somatization: clinical, epidemiological, and ethnographic perspectives". Psychosomatic Medicine. 60 (4): 420–430. doi:10.1097/00006842-199807000-00006. PMID   9710287. S2CID   35114279.
  26. ↑ Robbins, James M.; Kirmayer, Laurence J. (1991). "Attributions of common somatic symptoms". Psychological Medicine. 21 (4): 1029–1045. doi:10.1017/S0033291700030026. PMID   1780396. S2CID   22021905.
  27. ↑ Bailer, J; Witthoeft, M.; Bayern, C.; Rist, F. (2007). "Syndrome stability and psychological predictors of symptom severity in idiopathic environmental intolerance and somatoform disorders". Psychological Medicine. 37 (2): 271–281. doi:10.1017/S0033291706009354. PMID   17109778. S2CID   29130212.
  28. ↑ Groleau, Danielle; Young, Allan; Kirmayer, Laurence J. (2006). "The McGill Illness Narrative Interview (MINI): an interview schedule to elicit meanings and modes of reasoning related to illness experience". Transcultural Psychiatry. 43 (4): 671–691. doi:10.1177/1363461506070796. PMID   17166953. S2CID   20732761.
  29. ↑ "McGill Illness Narrative Interview (MINI)". Division of Social and Transcultural Psychiatry.
  30. ↑ Arehart-Treichel, Joan (2004). "Canadian Psychiatrists Confront Cultural-Competency Challenges". Psychiatric News. 39 (22): 1–19. doi:10.1176/pn.39.22.00390001.
  31. ↑ Kirmayer, Laurence J.; Guzder, Jaswant; Rousseau, Cécile (2014). Cultural Consultation: Encountering the Other in Mental Health Care. New York: Springer. ISBN   9781461476146.
  32. ↑ "International Consortium for Cultural Consultation". International Consortium for Cultural Consultation.
  33. ↑ Adeponle, Ademola; Thombs, Brett D.; Groleau, Danielle; Jarvis, G. Eric; Kirmayer, Laurence J. (2012). "Using the cultural formulation to resolve uncertainty in diagnoses of psychosis among ethnoculturally diverse patients". Psychiatric Services. 63 (2): 147–153. doi:10.1176/appi.ps.201100280. PMID   22302332.
  34. ↑ Lewis-Fernandez, Roberto; Aggarwal, Neil Krishan; Hinton, Larson; Hinton, Devon E.; Kirmayer, Laurence J. (2016). DSM-5 Handbook on the Cultural Formulation Interview. American Psychiatric Press. ISBN   9781585624928.
  35. ↑ Kirmayer, L. J.; Narasiah, L.; Munoz, M. (2011). "Common mental health problems in immigrants and refugees: general approach in primary care". Canadian Medical Association Journal. 183 (12): E959-67. doi:10.1503/cmaj.090292. PMC   3168672 . PMID   20603342.
  36. ↑ Kirmayer, Laurence J.; Fung, Kenneth; Rousseau, Cécile; Lo, Hung Tat; Menzies, Peter; Guzder, Jaswant; Ganesan, Soma; Andermann, Lisa; MacKenzie, Kwame (2022). "Guidelines for training in cultural psychiatry". Canadian Journal of Psychiatry. 66 (2): 195–246. doi:10.1177/0706743720907505. PMC   7918872 . PMID   32345034. S2CID   141386932.
  37. ↑ Kirmayer, Laurence J.; Sockalingam, Sanjeev; Fung, Kenneth Po-Lun; Fleisher, William P.; Adeponle, Ademola A.; Bhat, Venkat; Munshi, Alpna; Ganesan, Soma (2018). "International medical graduates in psychiatry: cultural issues in training and continuing professional development". Canadian Journal of Psychiatry. 63 (4): 258–280. doi:10.1177/0706743717752913. PMC   5894917 . PMID   29630854.
  38. ↑ Kirmayer, Laurence J.; Crafa, Daina (2014). "What kind of science for psychiatry?". Frontiers in Human Neuroscience. 8: 435. doi: 10.3389/fnhum.2014.00435 . PMC   4092362 . PMID   25071499.
  39. ↑ Ramstead, Maxwell; Veissiere, Samuel; Kirmayer, Laurence J. (2016). "Cultural affordances: Scaffolding local worlds through shared intentionality and regimes of attention". Frontiers in Psychology. 7: 1090. doi: 10.3389/fpsyg.2016.01090 . PMC   4960915 . PMID   27507953.
  40. ↑ Veissiere, Samuel P.L.; Constant, Axel; Ramstead, Maxwell J.D.; Friston, Karl J.; Kirmayer, Laurence J. (2020). "Thinking through other minds: A variational approach to cognition and culture". Behavioral and Brain Sciences. 43 (e90): e90. doi:10.1017/S0140525X19001213. PMID   31142395. S2CID   169038428.
  41. ↑ Kirmayer, Laurence J. (1992). "The body's insistence on meaning: Metaphor as presentation and representation in illness experience". Medical Anthropology Quarterly. 6 (4): 323–346. doi:10.1525/maq.1992.6.4.02a00020.
  42. ↑ Kirmayer, Laurence J. (2004). "The cultural diversity of healing: meaning, metaphor and mechanism". British Medical Bulletin. 69 (1): 33–48. doi: 10.1093/bmb/ldh006 . PMC   3621226 . PMID   15226195.
  43. ↑ Gómez-Carrillo, Ana; Paquin, Vincent; Dumas, Guillaume; Kirmayer, Laurence J. (2023). "Restoring the missing person to personalized medicine and precision psychiatry". Frontiers in Neuroscience. 17. doi: 10.3389/fnins.2023.1041433 . PMC   9947537 . PMID   36845417.
  44. ↑ Gómez-Carrillo, Ana; Kirmayer, Laurence J. (2023). "A Cultural-Ecosocial Systems View for Psychiatry". Frontiers in Psychiatry. 14. doi: 10.3389/fpsyt.2023.1031390 . PMC   10133725 . PMID   37124258.
  45. ↑ "JGH News".
  46. ↑ "WACP Conference Program 2018" (PDF).
  47. ↑ "History and governance – AMI-Quebec".
  48. ↑ "IACCP 2016 Program".
  49. ↑ "Royal Society of Canada Fellows 2015". 8 September 2015.
  50. ↑ "CAHS Fellows". 14 November 2013.
  51. 1 2 "SSPC Awards".
  52. ↑ "CPA Special Awards".
  53. ↑ "Cultural Psychiatry 711". Division of Social and Transcultural Psychiatry.
  54. ↑ "How I got interested in ethnopsychiatry". Les Possédés et leurs mondes.
  55. ↑ "Transcultural psychiatry and consultations in Nunavik". Les Possédés et leurs mondes.
  56. ↑ "Medical and psychological anthropology in Montreal". Les Possédés et leurs mondes.
  57. ↑ "Bodily expressions of distress". Les Possédés et leurs mondes.
  58. ↑ "Indigenous mental health, cultural concepts of personhood and resilience". Les Possédés et leurs mondes.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.