Culture Medicine and Psychiatry最新文献

Disasters create and intensify stress for communities, with many factors contributing to how that stress results in mental health outcomes. Guided by the stress process model, this article presents findings from a qualitative investigation of the meaning of stress among community leaders in the context of the water crisis in Flint, Michigan. Semi-structured interviews were conducted with six community leaders in Flint and analyzed using grounded theory techniques. Secondary stressors such as necessary changes to everyday routines, being discredited by government officials, and perceptions of a lack of government action and accountability were perceived to impact the community's mental health, with potentially more influence than the impact of the primary stressor of contaminated water. Findings indicate that both stressors and coping resources evolve with profound intrapersonal impact, such that proposed social coping resources become stressors when they do not meet individual or community needs or expectations.

This short historical note dates the earliest ethnomedical reference to koro back to the 1840s (about a half-century earlier than universally presumed), and the earliest ethnopsychiatric reference to 1883 (over a decade earlier than universally presumed).

In this paper, I share insights from ongoing ethnographic fieldwork among adult Danes who identify as having Attention Deficit Hyperactivity Disorder (ADHD) but do not meet the clinical standards and have yet to receive a diagnosis. These individuals are particularly relevant to the ongoing debates about under- and overdiagnosis of ADHD, as their claims to the diagnosis influence and mirror societal perceptions of what is considered normal and what is seen as a condition. Despite their symptoms not strictly meeting diagnostic criteria, thus risking overdiagnosis and associated psychiatric labeling, they perceive themselves as distinct from 'normal' people. Through a critical anthropological lens, I argue that medicalizing variations in human personality represents a contemporary societal epistemic error, drawing on Gregory Bateson's work. I highlight the dynamics of diagnosis versus notions of normality in diagnosing and self-diagnosing ADHD. Understanding these dynamics is crucial for addressing concerns of overdiagnosis as well as underdiagnosis and misdiagnosis. By illuminating the complexities of diagnostic processes and their societal implications, I aim to contribute to a richer understanding of mental health discourse and practice.

Can the fraught relation between disability and aging ever become untangled? What is the place of the catastrophically disabled in a time when giving voice and being seen are significant lodestars of political activism? And what becomes of the caregivers, who often labor in silence, and who hope to work well enough just to get through another day? This essay draws on the memoirs of Simone de Beauvoir, Annie Ernaux, Amy Bloom, and my own experiences to show the complicated imbrications of age, disability, and caretaking. I attempt to demonstrate through these experiences that age and disability, which appear to be intimately woven together, are oftentimes misleadingly connected. I suggest that an ethic of vulnerability, rather, is a more useful heuristic that avoids collapsing the categories of age and disability together. Nevertheless, these reflections inevitably lead to a discussion of death and the choices, policies, and other care structures (un)available for persons who sometimes desire to make significant decisions about ending their life when confronted with the possibility of terminal and catastrophic mental and bodily decline. Finally, I suggest that these relationships and the decisions about (end of life) care must be understood to be ambiguous and require a deep reciprocity of care based upon love, sympathy, and respect.

Cultural consonance, defined as the extent to which one is able to approximate a given cultural model in one's own life, is a highly adaptive theory and method which anthropologists have used for decades to demonstrate direct connections between individuals' variation in relation to meaning systems and their health outcomes. However, it has been limited by use of a "cultural consonance score" which treats cultural consonance unidimensionally. Because people enact cultural models in multiple ways, cultural consonance may be better operationalized multidimensionally. Applying correspondence analysis to young South Korean men's responses to a cultural consonance scale measuring their approximation of the local ideal male body, cultural consonance is rather demonstrated to be a multiplicity. In the case of South Korean men's body ideals, two dimensions-men's overall attractiveness and whether they pursue a "flower boy" or a "beastly man" embodiment-are identified. These two dimensions are also significantly associated with university prestige and sexual identity, and predict disordered eating beyond body dissatisfaction. These data suggest that well-being in relation to cultural consonance is a product of its assemblage: both of degree of approximation of a cultural model and the manner by which individuals enact it.

Through a longstanding collaboration, psychiatrists and anthropologists have assessed the impact of sociocultural context on mental health and elaborated the concept of culture in psychiatry. However, recent developments in ecological anthropology may have untapped potential for cultural psychiatry. This paper aims to uncover how "ecologies" inform patients' and clinicians' experiences, as well as their intersubjective relationships. Drawing on my ethnography with Jerome, a carriage driver who became my patient in a shelter-based psychiatric clinic, and on anthropological work about how psychic life is shaped ecologically, I describe how more-than-human relationality and the affordances of various places-a clinic and a stable-influenced both Jerome's well-being and my perceptions as a clinician. I also explore how these ecologies shaped our different roles, including my dual roles as psychiatrist and ethnographer. In the discussion, I define ecological factors, describe their implications for clinical practice, and suggest how they could be integrated into DSM's cultural formulation.

Although the need to train clinicians to provide effective mental health care to individuals from diverse backgrounds has been recognized worldwide, a bulk of what we know about training in cultural competence (CC) is based on research conducted in the United States. Research on CC in mental health training from different world populations is needed due to the context-dependent nature of CC. Focusing on India and USA, two diverse countries that provide complementary contexts to examine CC, we explored graduate students', practicing clinicians', and faculty members' perspectives regarding CC training they received/provided and future training needs using mixed-methods. The data were collected using focus groups (n = 25 groups total: 15 in India, 11 in USA), and a survey (n = 800: 450 in India, 350 in USA). Our data highlight the salient social identities in these countries, and the corresponding constituents of CC training. Participants in India described a practical emphasis to their CC training (e.g., learning about CC through life experiences and clinical practice experiences) more so than through coursework, whereas participants in USA described varying levels of coursework related to CC along with practice. Participants in both countries considered enormity of CC as a challenge, while those in the US also identified CC training limited to a white, straight, male perspective, hesitancy in engaging with diversity topics, and limited time and competence of the faculty. Strengths of CC training in India and USA are mutually informative in generating recommendations for enhancing the training in both countries.

The refugee experience has been associated with increased rates of psychosocial challenges. At the same time, evidence suggests that those who resettled in Western countries including Canada underutilize the formal mental health services in these countries. The low uptake has been attributed to barriers such as language, complexity of the health systems, and differing explanatory models of illness. The same is true for Somali refugees in the West. Studies suggest that Somali refugees prefer spiritual healing for psychosocial illness and that some return to East Africa for such healing. However, little is known about Somali Canadian's experiences with the Canadian mental health services and transnational health seeking. The study aimed to understand psychosocial challenges faced by Somali Canadians, their health seeking behaviors, and service utilization. Because some sought psychosocial services outside the country, fieldwork was conducted in Kenya to provide new evidence on transnational healing services. Ethnographic fieldwork and in-depth interviews were utilized. Thirty-seven interviews of about an hour each were undertaken. Fieldwork in Nairobi focused on spiritual healing centers and medical clinic. The findings reveal important findings regarding psychosocial challenges experienced by participants. It discusses psychosocial illnesses as variedly experienced, challenges with accessing Canadian healthcare services, and seeking culturally appropriate services in East Africa. The study highlights participants and their families struggle with psychosocial distress, the challenges of accessing culturally appropriate services within Canada, the role of spiritual healers and the existence of transnational health seeking practices.