Culture Medicine and Psychiatry最新文献

The mixed-methods study aimed to explore revenge fantasies among Indians, focusing on gender and religious differences, and to evaluate the alignment between quantitative measures and qualitative expressions through drawings and narratives. The sample comprised 97 Indian women and 55 men, aged 18-56, who identified as either Hindu or Christian. Quantitative assessments included the demographics sheet, Traumatic Events Questionnaire (TEQ), and Injustice Experiences Questionnaire (IEQ). Qualitative measures involved drawings and narratives depicting a personal injustice and the participant's desired outcome for the perpetrator. Analysis employed non-parametric tests and Interpretative Phenomenological Analysis for the drawings and narratives. The findings revealed no overall gender differences in the revenge fantasies depicted in drawings, though differences emerged in the types of perpetrators and central themes in narratives. Religious affiliation influenced the type of revenge fantasy, with Hindus and Christians showing significant differences in narrative organization, central themes, and resolution. Additionally, significant correlations were found between IEQ scores and various drawing indicators (event type, perpetrator type, and hierarchy) as well as narrative themes. These results suggest that gender and religious affiliation intricately shape revenge fantasies, highlighting the importance of considering cultural and social factors in understanding responses to perceived injustices.

Mental pain is commonly defined as an experience situated on a continuum between cognitive appraisal of the painful event and the affective disposition of the person experiencing it. Drawing on ethnographic material and interviews on severe psychiatric disorders in Bali and Java, I will try to understand what mental pain does to the person experiencing it, as well as to their immediate environment. To answer this question, I will first describe the salient attributes of mental pain as they emerged during my conversations with outpatients and observations of their milieu. These were a challenged "realness" of the experience of mental pain, its ability to take hold of one's subjective experience, an elusive and relational quality, and a perceived ambiguous and indeterminate temporal dimension. Moreover, I will describe the uncertainties of people navigating a severe psychiatric disorder (health, sanative, social, and behavioral uncertainties), and I will suggest that the salient attributes of mental pain contribute to the makeup of these uncertainties. Finally, this article illustrates that the interrelated nature of mental pain and experienced uncertainties can inform certain illness behaviors, particularly instances of self-isolation.

This article explores the potential of liberation medicine through an ethnographic account of a primary healthcare van operating in Cañada Real, an informal settlement on the margins of Madrid. Drawing from 10 years of clinical experience and anthropological inquiry, the article offers a situated analysis of "context-based medicine"; a mode of practice grounded in relationality, trust, and responsiveness to structural violence. Engaging with María Lugones' concept of pilgrimages and Hannah Arendt's idea of power with, the paper examines how this interstitial program disrupts dominant rationales within the healthcare system (gatekeeping, managerialism, and evidence-based medicine) by fostering collective, care-based alternatives. Through fieldwork and reflective practice, the author argues that the van's displacement (which is physical, institutional, and professional) creates a liminal space where emancipatory practices can emerge. While not a utopian model, the van provides a lens to imagine how clinical work might transgress spatial and institutional boundaries to align more closely with the political and ethical stakes of care.

Since the 1980s, French police forces have used less-lethal weapons (armes à létalité reduite)-meant to neutralize targets without killing them-to enforce order. At first mostly deployed against working-class and racialized citizens living in the margins of French cities, they have been used against wider sections of the population during recent demonstrations against neoliberal reform. These weapons can cause severe injury, with longstanding physical, social, and emotional consequences. Moreover, citizens who suffer these injuries endure a stigma of criminality, making widespread social recognition of their pain difficult, which motivates them to look for acknowledgement of their victimhood in court. Based on 22-months of ethnographic research amongst people who have been mutilated or wounded with these weapons during police operations, this article is divided in two parts. In the first part, I describe people's bodily sensations-anger, tension, pain, etc.-while awaiting trial and during court hearings. I show how, much like the initial police violence, the process of waiting for justice, the events in court, and the final verdicts also become a form of violence that is inscribed on their bodies. In the second part, I turn to my interlocutors' close networks of support and care. In contrast to official proceedings, these networks allow for the refusal of socially attributed criminality and the acknowledgement and validation of their pain. I argue that they create a form of reparation that could serve as a model for a liberation medicine, a core aspect of which is the recognition of socially inflicted pain.

The Coyolxauhqui Imperative offers a decolonial framework for reimagining trauma and healing in psychiatric practice by drawing on the Aztec myth of Coyolxauhqui's dismemberment and celestial transformation. Challenging Western biomedical assumptions of linear recovery and pathologization of fragmentation, this paradigm centers cultural epistemologies of nepantla (liminal space), conocimiento (embodied truth-telling), and mythic temporality (cyclical reintegration). Through critical analysis of Nahuatl cosmology, Gloria Anzaldúa's theoretical expansion, and contemporary ritual practices, the model reconceives psychological crises as sacred processes of disintegration and reassembly. We delineate theoretical foundations, clinical applications (including narrative pharmacology, ritual reassembly, and decolonial charting), and policy implications that foreground communal re-membering over individual symptom suppression. The Imperative advances an integrative praxis that honors fragmentation as generative, privileges cultural sovereignty, and undermines psychiatric coloniality. Our interdisciplinary synthesis establishes pathways for culturally resonant assessments, participatory methodologies, and land-based healing initiatives. By repositioning fragmentation as luminous, this work invites psychiatry to adopt borderlands healing practices that valorize ancestral wisdom, collective narrative sovereignty, and ritual space-holding.

Compared to the biomedical model of mental suffering, the increasingly influential trauma model has received little critical attention. We examine the discursive practices justifying and promoting the trauma-informed care: a set of assumptions and clinical recommendations presented as universal and uncontested guidelines for mental health practitioners. Critical review of two major guidelines for trauma-informed care - the SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach (2014) and A paradigm shift: relationships in trauma-informed mental health services by Sweeney et al. (2018) - was inspired by critical discourse analysis and the analysis of reification. Trauma-informed care is a diverse set of recommendations combining generally accepted standards with the notion of broadly defined trauma as the primary cause of mental suffering. We have identified mechanisms that (1) present the broad trauma model as an assumption-free description of reality, (2) portray it as superior to other models, and (3) elevate the authority of those who adopt the broad trauma model to interpret the suffering of others. The discursive procedures found in the trauma-informed manuals are similar to those documented in the biomedical-psychiatric literature. Potential risks include iatrogenic harm, politicization of mental health care, and reduction of its diversity and effectiveness. Evaluation of the guidelines from the perspectives of safety, cultural validity, ethics, and cost-effectiveness should precede their implementation into clinical practice.

Indigenous peoples in Colombia face an elevated risk of experiencing spiritual disharmonies, a term used by Indigenous communities to describe mental health challenges, due to a range of factors, including barriers to accessing care and recovery systems, extractivist policies, armed conflict, food insecurity, and the erosion of cultural identity, among others. These risks are more effectively addressed when elements of Indigenous cultural practices are integrated into biomedical care processes. This study aimed to analyze the role of cultural practices in the management of public mental health in two Indigenous communities from the Colombian Amazon and Pacific regions. Using a qualitative study design with an epistemological approach grounded in contextual constructivism, we conducted a thematic analysis and identified a central theme: "Culture as the foundation for managing public mental health." This theme encompassed categories such as "Structural Competence in the Biomedical Health System" and "Ancestral Practices for Recovery." The ancestral knowledge and practices of Colombia's Indigenous peoples can contribute to a deeper, culturally sensitive understanding of spiritual disharmonies, offering potential points of integration with biomedical health systems that are tailored to each community. This culturally informed perspective supports more effective approaches to expanding access to integrated care systems that not only address mental health concerns but also tackle the social determinants underlying these disharmonies.

The horizon of critical theories and their target audience (i.e., the subjects exposed to social suffering) have drifted apart. While the former relies on its own set of diagnostic concepts (e.g., alienation), the actors are socialized within the frames of biomedical discourses. This creates a rupture between theory and praxis: the concepts of social suffering fail to orient collective action. To overcome this challenge, a translator category is elaborated, which can link the distinct biomedical and critical discourses, while reconnecting theory and praxis. Burnout is chosen as a translator category because it is located at the border of the psychological discourses (on depression) and the critical sociological discourses (on alienation). First, the birth of the concept is reconstructed in a genealogical fashion. Second, the psychological measurement tools and explanations are overviewed with a special emphasis on the failed attempt of discursive medicalization. Third, the sociological explanations are analyzed from the perspective of their potential of breaking the biomedical and psychological discursive hegemony. In the last section, it is discussed how burnout can link the discourses of alienation (as a cause of burnout) and depression (as a consequence of burnout), while remaining accessible to the biomedically socialized subjects.

In this article, we address the potential of mythological narratives to contribute to understanding meaning in life. Drawing on contemporary theories concerning meaning in life including the existential psychotherapeutic approach, discrepancy-based model and hierarchical meaning-making model, we highlight key principles of the meaning-making process that are reflected also in world mythological narratives. These common principles include encountering a profoundly impactful event, dissatisfaction with the current state, meaning-making attempts, and providing a vision of the desired state. Consequently, by integrating insights from psychology and anthropology, we propose that myths not only continue to hold enduring relevance in contemporary life but also possess considerable potential as frameworks for enriching knowledge on what makes life meaningful and pathways that help individuals experience meaning in their lives.