Culture Medicine and Psychiatry最新文献

Military veterans have high rates of posttraumatic stress disorder (PTSD) along with multi-morbid problems, including physical pain and problematic substance use. The etiology of multi-morbid problems likely involves both military experiences and culture. Qualitative research can build understanding of vulnerability for multi-morbid problems. Participants were US veterans with PTSD symptoms, pain, and problematic substance use (n = 20). Qualitative interviews focused on military experiences, multi-morbid problems, and coping. Transcripts were analyzed to develop an explanatory model of multi-morbidity. Military experiences that left veterans vulnerable to PTSD and multi-morbid problems included (1) military deployments, (2) specific discrete events, and (3) the accumulation of stressors over time. In the aftermath of these experiences, military cultural factors that increased vulnerability included (4) the significance of losing one's physical and mental fitness, (5) a tendency to ignore or minimize pain, (6) discrepancies between military and civilian culture, (7) military drinking norms, and (8) treatment stigma. Military cultural factors that decreased vulnerability included (9) camaraderie and (10) service. Military culture moderated the impact of challenging experiences to influence participants' vulnerability for PTSD and multi-morbid problems, in line with bio-cultural models of health. Clinical assessments and treatments should incorporate the range of military cultural risk and protective factors, and veterans' perceptions of how these factors influence their health.

Prolonged grief disorder (PGD) was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) in 2022. It proposed that after persisting in an acute manner for more than a year, grief becomes pathological. This article explores cultural challenges to the application of the DSM-5-TR in diagnosing PGD and discusses culturally sensitive approaches to addressing grief pathology. We have identified three key dimensions that present cultural challenges to the PGD diagnosis: duration of mourning, intensity of emotions, and anomalous cognitions. While the DSM-5-TR clarifies that PGD symptoms must exceed contextual norms (Criterion E), here we critically assess the relevance and limitations of PGD from a cultural perspective and discuss the role rituals and traditional healing might play in grief interventions.

This paper examines the reflections on caregiving provided by a group of Irish mothers who were homeless, struggling with addiction, and had lost primary custody of their children. Drawing on Das's (Slum acts. Polity Press, Cambridge, 2022) discussion of 'inordinate knowledge', or knowledge of real-life and morally dubious scenarios that resist attempts at resolution through philosophical reasoning, the paper explores how women in these situations grappled with the realisation of having neglected their children. I demonstrate my interlocutors' ongoing ethical self-evaluations and continued attempts to make amends for their earlier caregiving lapses, with the limited resources at their disposal. In so doing, I demonstrate how my interlocutors' yearning towards their children, as revealed through the process of reflexive caregiving action, became entwined with their trajectories through homelessness and addiction in Dublin. At the same time, I probe the limits of anthropologists' proclivity for contextualising and rationalising unsettling caregiving behaviours. Instead, inspired by my interlocutors' unflinching self-evaluation, this paper explores the moral quandaries which emerge as a result of care's polyvalent nature by asking if we can ever reconcile a mother's attempt to atone for her faltering engagement with caregiving with her child's experience of neglect.

In her book Death Without Weeping (1992), Nancy Scheper-Hughes coined the term "liberation medicine," which aims to place the individual experience of illness in a larger social context and use it as a starting point for critical thinking and resistance. Illness, so the basic premise of liberation medicine, is a form of resistance that can be turned into an effective political strategy. Accordingly, medicine is understood to have the potential for a "critical practice of freedom" that can create spaces for patients and medical staff in which new ways of dealing with human suffering are negotiated. Taking Scheper-Hughes's reflections as a starting point, this editorial introduction to the special section conceptually develops the notion of liberation medicine, outlines how it relates to similar concepts and debates, and sketches what it might mean in the contemporary era. We argue that radically rethinking health and health care is a powerful way to rethink, and change, society at large. In this sense, we understand liberation medicine, following Wilder (2022), as a "concrete utopia."

Suicide hotlines as a form of teletherapy have been associated since conception with questions of non-consensual reporting and intervention. This article investigates how suicide hotline volunteers in Hong Kong engaged with expertise and anonymity to perform care. The analysis consists mostly of semi-structured interviews with volunteers at a multilingual suicide hotline in Hong Kong. Firstly, we deconstruct expertise in hotline care-volunteers separated enacting expert knowledge from authority to simultaneously respond to cultural nuances in caller expectations toward authority and perform non-interventive care. Secondly, we show how anonymity within hotlines creates obscurations between callers and volunteers that raises the stakes to volunteers' decision-making in care. When volunteers embraced uncertainty and committed to providing confidentiality and control to callers, anonymity facilitated the prioritization of caller choice, even in death. Finally, we reflect on how acts of volunteers recognizing and forming connections with callers can demonstrate how we can meet each other, bridge divides, and connect as strangers in the city.

Taking seriously the idea that liberation medicine should include, or even start from, the perspectives of those who are at the margins of the current medical system, this article draws on the perspective provided by a group of working-class writers who inhabit these margins, through an ethnographic story about medical failure and radical care. The story follows a middle-aged couple, Farid and Shakeela, residents of a working-class neighbourhood in Delhi, who travel to one of the largest public hospitals in the city for the delivery of their baby. Upon arrival, they encounter a hospital as a separate world, a space with its own rules and language, with maze-like pathways. Through the experiences of this couple, this article sheds light on some questions that help to theorize liberation medicine: In a medical system which is vast and overwhelming, does a labourer have any agency in finding a toe hold, or are they completely helpless and dependent on doctors, nurses, and technicians? Doctors diagnose an illness; however, who defines sickness? What makes a daily wage earner determine the condition of their health? Through reading this story, as well as the pedagogy of its writers, this article sheds light on the significance of networks of care which are easy to overlook whilst also calling for perfect institutions.

Caring well for people with profound intellectual disabilities is challenging. This challenge is often framed in terms of their complex needs and the ambiguity of interpreting these needs. Based on ethnographic fieldwork, this article argues that behind these challenges lies a more fundamental challenge of doubt: doubt stemming from uncertainties about the mind of the other, and thus about the purpose of care itself. Drawing on Stanley Cavell's notion of skepticism, the article explores how this challenge arises and how caregivers grapple with it. The study finds that skeptical doubt always threatens care for people with profound intellectual disabilities, but often remains unseen. This is because caregivers deftly manage to ward off their skeptical doubt, by 'placing people into life': imagining the people in their care as participants in a shared human everyday life. The article tracks such exercises of 'placing people into life' to document how caregivers manage to retain faith in the purpose of their care. In this way, the article gives ethnographic texture to the challenge of caring well for people with profound intellectual disabilities and gathers clues for improving this care-which can also aid in improving care in other contexts of cognitive difference.

With this article, we set out to introduce a dynamic and expansive notion of what it means to live with ADHD. Based on ethnographic fieldwork among families living with ADHD in Denmark and inspired by Thomas Fuchs' Eigenzeit [own-time], we forward the notion of "own-time space" as a means of examining the dynamic nature of ADHD. Own-time spaces connect the lived experience of ADHD and time to space. Own-time spaces are situations where the presence or absence of others, and cultural expectations related to timing or tempo enter complex, rhythmic interactions in ways that allow ADHD symptoms to fade into the background. We suggest that own-time spaces are characterized by space, rhythm, and imagistic thinking, and add to our existing knowledge of shielding as a therapeutic effort in ADHD treatment. With own-time space we emphasize that shielding is not just a matter of place or protection from stimuli, but also involves temporal, meaning-making, and relational dimensions. Own-time spaces are dynamic environments where individuals can navigate and negotiate their own rhythms and temporalities and foster a sense of agency and thriving.

Living with a complex chronic illness can be debilitating as people are constantly negotiating new bodily symptoms, constant treatment-seeking, readjustments to identity and routine. In Kenya, millions of people were infected with COVID-19 and surveillance of Long Covid remains limited. We interviewed 23 Kenyans seeking medical care or social support for Long Covid to understand their lived experiences. Participants reported limited access to healthcare; they also described symptoms including disabling fatigue, memory inconsistencies, and acute pain in the muscle, gut, or tissues. However, we found a unique chronic illness stigma-where people did not want to reveal that they had Long Covid because they feared of being perceived to have HIV. Participants reported feeling dismissed or disbelieved by family, friends, and clinicians and turned to online social support groups like Facebook. While some appreciated clinicians who used experimental treatment, others expressed trepidation when treatments caused them to feel sicker. The chronicity and debilitating symptoms of Long Covid may cultivate a unique stigma around the condition and point to a normalization of Long Covid with other chronic conditions, despite limited treatments. A broader understanding of Long Covid symptoms and care must be expanded to include destigmatizing the condition in Kenya.

The proliferation of filters, technologies, and aesthetic procedures has contributed to a surge in body image concerns, with individuals now able to purchase and alter specific body parts. This phenomenon intersects with considerations of self-objectification and cosmetic surgery, mediated by factors such as alienation and body image inflexibility. Moreover, cultural shifts, including the pervasive influence of artificial intelligence, shape perceptions and behaviors. Eating disorders, understood through neuroanthropological lenses, highlight the intricate interplay between culture, body image, and vulnerability to illness. Emerging questions revolve around prevention strategies, especially regarding children's exposure to social media and its impact on body image. Recent cultural events underscore contemporary body image ideals, posing challenges for future generations immersed in digital technology. Understanding the intersection of cultural influences, technological stimuli, and individual perceptions is crucial for addressing the evolving landscape of body image and mental health care.