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 paper examines the embodied aesthetic experiences of late-blind individuals during tactile engagements with Enrico Castellani's Pseudo-Braille Surface artwork. The study applies a mixed computational-qualitative approach, utilizing the Atlas-Ti software for semantic analysis of interviews with 21 participants. Categories emerging from the analysis suggest a vivid relationship between touch, mental imagery, emotional well-being, and the creation of meaning. Key findings demonstrate a transformation from a traditional pedagogical approach to an immersive aesthetic experience, marked by a significant meta-cognitive shift, transitioning from practical understanding to haptic contemplation and narrative digression. Sometimes, participants initially experience negative well-being due to difficulties in interpreting tactile stimuli, but this evolves into positive well-being as they engage in an imaginative process, invoking autobiographical memories and personal narratives. The study reveals that this personal and relational encounter with original art enables participants to overcome initial feelings of inadequacy, unlock creative freedom, and attain emotional well-being. The participants' experiences are interpreted in the light of Walter Benjamin's notion of Aura, unveiling the unique and authentic interaction between viewer and artwork in the realm of haptic perception. The results advocate for the inclusion of tactile aesthetics in art appreciation, emphasizing the potential for aesthetic experiences to contribute to the well-being and empowerment of visually impaired individuals.

Mental health care is a vibrant part of child protective services in Japan, and the adoption and utilization of psychotherapeutic techniques from abroad mark a complex site of cross-cultural exchanges. This paper explores how art therapy has been brought into Japan's protection system and its implications for professional practice. Focusing on clinical psychologist Yuri and her narratives on learning art therapy, this paper utilizes an interpretive and phenomenological framework to illustrate the importance of embodied experience in delivering care and how practitioners may reform their perspectives on care by reframing their own traumatic memories. Yuri's art therapy offers a culturally contextualized view of the self as social, care purpose, and resilience.

Diagnostic labels aim to classify individuals for treatment in clinical settings. Yet, relatively little attention has been paid to the troubling messaging when a diagnostic label itself carries severe stigma and how relevant stakeholders react to it. Based on twenty-month fieldwork in Shanghai, this article analyzes the adverse effects of the diagnostic label chidai that is used to describe dementia and the relevant stakeholders' responses to the labeling threat. It focuses on the moral context in which the stigma related to dementia unfolds, the power of the medical term chidai in activating stigma, and the efforts that are put into formulating a stigma-free public health message. I found that the label chidai is not only an instance of excess stigma-that discredits one's cognitive capability and deprives one's moral status-but also an instrument used by medical authorities and governments to protect public safety. The debates on the diagnostic labels are meant to reshape new understandings of dementia and to challenge the power of medical authorities who often neglect humanity and care when they form their judgments and interpretations of disease. This paper contributes to the studies of stigma and dementia activism by highlighting the power of diagnostic labels.

The growing inclusion of people with lived experience and their carers in mental health research begs us to consider how their lived experience influences research. In this commentary, I use photographs to show how I used my personal experience of caring in creative ways to research violence against people with mental illness in Grand Forks, North Dakota. Drawing on Byron Good's use of hauntology and my personal experience, I argue for its adaptation as a framework for both analysis and visual representation using a multilayered auto-visual-ethnographic engagement centered around the local Amtrak station. I elaborate how in the basal layer the photographs stem from the interplay of mental images and ethnographic encounters to explore my subjectivity and intersubjective relations. In the second layer, I use an archival map to tie the photographs to the wider historical context of North Dakota. By doing so, I show how the Amtrak station emerges as a site for chaotic personal narratives and contested histories. In conclusion, I address this method's departure from classical photo-ethnography, arguing that such a hauntologically informed auto-visual-ethnographic engagement could help researchers incorporate their experiences of care and loss in mental health research in meaningful, creative, and sensitive ways.

The present study has explored the folk knowledge about the phenomenon of sleep paralysis in Pakistani society. The research aimed to gain a nuanced glimpse focusing on three major factors, culture, religion, and gender, that influence the lived experiences of those who face sleep paralysis. In this qualitative research, to have a holistic perception of indigenous knowledge about it, we selected both male and female participants who have experienced sleep paralysis. The findings indicate that there is an influence of Pakistani culture and religion regarding the experiences of the people with sleep paralysis, and gender is linked with the folklore on creatures that were linked to fairy tales and Islamic teachings. The study also revealed that Pakistani ethnic diversity has created a pool of versatility for identifying different experiences regarding sleep paralysis. These experiences were not just a part of the medical situation but portrayed the multicultural facets that are embedded in the individuals throughout their lives. Lastly, the study suggests that there is a complexity within the interactions between culture, religion, and gender on sleep paralysis. This needs to be further investigated to create culturally appropriate therapies that may have a favorable effect on both physical and mental health outcomes.

Myanmar has experienced decades of military dictatorship, civil wars, religious violence, economic crises, and natural disasters. While these conditions would suggest very high rates of depression and anxiety, government statistics report an exceptionally low depression rate of 0.00006%, compared to the global rate of 3.4%. This study combines analysis of epidemiological data, ethnographic observation of clinics, and in-depth interviews. I argue that Myanmar's low depression rates cannot be explained by the usual arguments about treatment gaps, lack of providers, or medication accessibility. Instead, I suggest that the military regime suppresses depression because it sees it as a form of political protest. While conditions like schizophrenia are readily diagnosed and treated as "purely biological," mood disorders are suspect expressions of dissent. Through living value theory (LVT), I explore health as a process of multimediation. The dictatorship's suppression of depression emerges as the strategic muting of medical interventions in favor of amplifying non-medical remediations.

Health and illness experiences are positioned within social and cultural contexts. Understanding the mental health and psychological distress of people living with HIV in highly affected communities is critical to addressing their needs and to ensure programming and interventions are targeted and appropriate. Grounded in the ethnomedical theoretical perspective, we conducted qualitative interviews to understand the experience and expression of psychological distress by people living with HIV in Rakai, Uganda. Participants included adults living with HIV (n = 20), health workers (counselors, peer health workers, nurses, n = 10), and key informants (n = 12). Interviews were audio recorded, transcribed/translated, coded, and analyzed using thematic analysis. Two idioms of distress, okweraliikirira (worry/apprehension) and okwenyamira (deep/many thoughts/lots of thoughts), were described as impacting people living with HIV. Both idioms were said to be alleviated by social support or counseling, but if left unaddressed could lead to more severe mental health problems and poor ART adherence. People living with HIV understand their psychological distress through culturally specific idioms; such distress can have deleterious impacts on well-being. Incorporating idioms of distress into screening and treatment for people living with HIV may improve identification of individuals in need and overall health services to address this need.

The expansion of mental health discourses within the university has attained global relevance over the course of the past decade. This article focuses on the Chilean case, exploring the diagnostic uses and affective negotiations on campus. The findings presented are part of a broader qualitative research that examined the interrelations between the neoliberal restructuring of the Chilean university, the modes of anxious affection among students, and the strategies implemented by university mental health services. We argue that, although the neoliberalization of higher education in Chile has driven normative and subjective transformations, the phenomenon of university mental health involves students' agency. Our findings demonstrate that, for both mental health professionals and students, university life serves as a "catalyst of anxiety." Despite the existence of individualized diagnostic conceptions, they also allude to the inequalities inherent in the Chilean educational and health systems. We state that diagnostic uses involve strategies that students and professionals deploy to respond to the demands of adjustment/integration to universities, and even facilitate the possibility of re-imagining futures in the face of experiences of failure. Diagnostic uses engage affective negotiations in everyday situations, thereby configuring university life as a dynamic environment, subject to potential and permanent transformations.

Low accessibility to mainstream psychosocial services disadvantages culturally and linguistically diverse (CALD) populations, resulting in delayed care and high rates of unsupported psychological distress. Non-clinical interventions may play an important role in improving accessibility to psychosocial support, but what characterises best practice in this space remains unclear. This critical rapid review addressed this gap by searching for, and critically analysing, existing research on non-clinical psychosocial support services, drawing from a critical realist framework and Brossard and Chandler's (Brossard and Chandler, Explaining mental illness: Sociological perspectives, Bristol University Press, 2022) taxonomy of positions on culture and mental health. We searched PubMed, PsycInfo, LILACS, Scopus and Sociological Abstracts to identify non-clinical psychosocial support interventions for first-generation immigrant CALD populations delivered by lay-health workers. Thirty-eight studies were included: 10 quantitative, 7 mixed-methods and 21 qualitative. Most studies were conducted in North America (n = 19) and Europe (n = 7), with few conducted in low-income countries (Tanzania and Lebanon, n = 3 each, Kenya [n = 1]). Studies often focussed on specific interventions (e.g. psychoeducation) for targeted populations (e.g. refugees, Latinx immigrants); multimodal interventions (e.g. psychological support and food distribution) for broad populations were less common. Thirty-five different outcome scales were identified across quantitative and mixed-methods studies, with most covering depression, stress and trauma. Most studies identified significant improvements for at least one psychosocial outcome despite interventions being relatively short in sessions. Findings from qualitative studies highlighted varied engagement with theory-informed models of service, and identified important barriers to non-clinical psychosocial support services, including precarious resourcing. Our analysis suggests most studies were underpinned by split-relativist frameworks and focussed on interventions aimed at helping clients navigate the eurocentricity and complexity of mainstream services. Recognising the eurocentrism of universalist frameworks, working from a culturally relativist position, prioritising social determinants of health and using models that centre clients, flexibility, context, culture and community are likely to ensure best practice for non-clinical psychosocial support interventions.