Culture Medicine and Psychiatry最新文献

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.

This study investigates the psychological and social impact of the ongoing colonial violence in Gaza, both on the local population and on distant witnesses. Drawing on 30 testimonies collected between November 2023 and June 2024, the research captures the lived experiences from two distinct groups: 15 Palestinian participants living in the Gaza Strip, and 15 mental health professionals (including psychotherapists and academics) based in Europe. Using phenomenological and thematic analysis, the findings reveal the profound effects of genocidal violence on mental health, emotional resilience, and meaning-making processes. For Palestinians, daily exposure of bombardment, displacement, and systemic dehumanization undermines personal and collective agency, resulting in emotional numbness, anger, and alienation. Witnesses from European contexts reported helplessness, disorientation, and moral injury, often struggling with their perceived complicity in global systems of oppression. The study challenges conventional trauma frameworks, emphasizing the need to conceptualize colonial trauma as continuous, collective, and politically rooted. It argues for integrating social and political dimensions into psychological approaches to trauma, and highlight the ethical and political importance of bearing witness. Ultimately, the paper calls for a transnational process of collective healing and solidarity, aimed at dismantling the structural foundations of violence and dehumanization.

The provision of care for suicidal and, perhaps especially, chronically suicidal people walks a fine line: between acknowledging a person's suffering and their desire to die, and trying to accompany them safely through their most difficult moments. In this article, we explore what it means to receive and provide "safe care," as traced through the words of people with lived experiences of suicide. Our data comes from 18 interviews with members of an Australian lived experience of suicide organization, which included people with lived experience of chronic suicidal ideation, the bereaved, peer workers, and Safe Space volunteers. Drawing on the anthropology of care and aligned psychoanalytic theory, particularly Emily Yates-Doerr's (Anthropol Human 45:233-244, 2020) consideration of the seed container and Donald Winnicott's notion of holding, we unpack how suicidality is experienced, what makes care safe, and how notions of holding space for people are becoming anchored in emerging "Safe Spaces." Interview participants called for a paradigmatic shift in suicide care: in contrast to "negative" conceptions (Baril, in: Disability Stud Q 40:1-41, 2020), what arose in their stories were appeals for present-focused and engaged support where emotion, turmoil, and sorrow could be weathered alongside the listener. Thus, safe care works within infrastructures of care to neutralize-not diminish, prevent, or fix-suicidality, and to hold it within a space of concern so that it may transform.

Dominant cultural framings of recovery in psychosis describe a process of increasing social connection, community integration, identity reclamation, and hope. Drawing on 6 months of ethnographic fieldwork on a psychiatric rehabilitation ward for 'complex psychosis' in London, I consider what we might learn from recoveries that appear not to follow this trajectory. My primary case study, of a man diagnosed with treatment-resistant schizoaffective disorder who identifies with/as the famous ex-footballer Ronaldo, interrogates the social implications of his attempts to 'mask' his identity while on leave from the hospital to avoid "caus[ing] trouble"-strategically embodying, in effect, the fictitious 'ordinary' person denoted by the English idiom the man on the Clapham omnibus. I argue that his complex recovery, built on a trial-and-error process of retreat from social connection and caution towards hope, reflects a degree of clinical complexity seldom acknowledged outside psychiatric rehabilitation. Engaging with more nuanced anthropological theories of recovery in psychosis, my analysis illuminates how the time, space, and relative safety of a lengthy involuntary hospital admission proved necessary for his complex recovery to unfold. This insight contrasts with the dominant operationalisation of recovery in contemporary mental health systems, which seems to be fuelling disinvestment in such rehabilitative admissions.

Enduring contests between church, state, and individual control over the body in Mexico have recently manifested in a contentious "life debate" over the definition and ethics of "dignified death" (Roberts in God's laboratory: assisted reproduction in the Andes. University of California Press, 2012). In 2008, Mexico City passed the Advance Directive Law, authorizing the right to refuse or withdraw life-sustaining treatment and affording palliative care services to the terminally ill through public hospitals. While these measures have ostensibly ameliorated end-of-life suffering, a growing movement of activists argues that the law falls short. They advocate for the legalization of assisted dying as central to "dignified death" despite resistance from the Catholic hierarchy and its political allies. Drawing on one year of research in Mexico's National Cancer Institute, we analyze the place of public palliative care clinicians in this fraught debate, parsing their model of care, which is predicated on surrendering to the body's preordained rhythms of life and death. We argue that this orientation gives rise to a paradox at the heart of public palliative care, which simultaneously expands end-of-life choices while making certain choices inconceivable. Our argument has implications for anthropological theories of human agency and choice, provoking complex questions about who is authorized to draw boundaries around life and death.

Body-focused anxiety refers to a wide range of negative emotional and social experiences centered around discontent with one's own body. This widely recognized phenomenon is mainly experienced by women across different contexts, often resulting from gendered socialization (Becker (1995) Body, self, and society: the view from Fiji. University of Pennsylvania Press, p. 2016). In modern Chinese society, it is important to understand these complex experiences within the quickly changing social landscape and ideas of womanhood. This study goes beyond clinical settings and the scope of mental illness (such as disordered eating or body dysmorphia) to include a variety of embodied experiences, including gender-related stress, negative self-awareness, and struggles in intimate relationships in the daily lives of young Chinese women. To grasp the current generation's body-focused anxiety, this research suggests examining it through the lens of intergenerational trauma, particularly the embodiment of patriarchal injustice reflected in the deeply connected relationship between Chinese mothers and daughters. Over 7 years, this article presents person-centered ethnography to show that some of the most intense body-focused anxiety among young women is an intergenerationally shaped existential crisis rooted in their mothers' upbringing within an explicit son-preference culture. As part of the intergenerational trauma, the body-focused anxiety is driven by (1) the mothers' unresolved girlhood trauma of being "born into the wrong gender"; (2) the desire to fulfill social obligations, which reflects both intergenerational trauma and the gender-specific challenges faced in a changing patriarchy. This analysis emphasizes that body-focused anxiety is not just a reaction to current social pressures, but a reflection of identities shaped across generations. It reveals that "becoming women" in a specific cultural context is transhistorical and closely linked to unresolved traumas from previous generations. Manifesting in different forms, understanding young women's body-focused anxiety from an intergenerational trauma perspective highlights how ongoing social forces are embodied even as cultural norms and social structures change.