Culture Medicine and Psychiatry最新文献

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.

Exposure to multiple vulnerability factors increase the likelihood of refugees experiencing mental health issues. Certain post-migratory factors exacerbate these disorders, while the processes of personal recovery remain unclear. This study explored the experience of personal recovery among West African refugees with mental issue, with the aim of helping health professionals in host countries to provide more appropriate care. We used the qualitative interpretative phenomenological analysis method. Ten participants were purposively sampled for face-to-face semi-structured interviews. Two themes emerged from the analysis. Despite their extreme socio-economic precariousness, mental disorders were perceived as forbidden conditions compared to the processes of acceptance of their somatic pathologies; hindering access to mental healthcare more markedly. Rebuilding a sense of security basis in the host country was seen as an essential step, but was also associated with factors that hindered the care process. Certain encounters could enable a return to care with patience, understanding and warmth. Our results highlighted the need to overcome some short-term self-protection strategies by adopting a benevolent attitude and active listening, ensuring secure socio-economical conditions first to enable mental care, increase the multicultural skills of healers, and support therapies that are not limited to face-to-face approach through activity, art, and group support. This may help to limit the risk of transmission of suffering to future generations.

This article presents an ethnographic study of elementary school children's spontaneous role-plays at the Lod Theater Center in Israel, a site that brings psychodrama, a theater-based form of psychotherapy, to bear on Israel's long-standing institutional form of the community theater center. Based on sixteen months of ethnographic fieldwork (October 2021-January 2023) and in conversation with anthropological and psychodramatic theory, I chart how children growing up in a world of ongoing violence express their knowledge of life and death through spontaneous play. Analysis of the data revealed that children assimilated knowledge of death and political violence not as discrete events, but rather as part of learning something about their world as a whole. I posit that this finding has significant implications for understanding children's subjective experience of violence, showing how, in a particular context, ordinary life cycle events such as the loss of a grandmother from illness may appear just as normally as a terror attack. Shifting the focus of analysis from a bounded event to everyday life opens alternative pathways for conceptualizing how violence marks the self. This ethnographic approach moves beyond trauma discourse's focus on the event to describe how children piece together life lived in conflict.

Self-harm amongst young people has risen significantly in recent years, yet existing models fail to fully explain its underlying mechanisms. This paper applies René Girard's theory of mimetic rivalry and escalation to self-harm, proposing that competition for social status and identity within peer groups and families may contribute to its development. In this framework, self-harm operates as a form of self-punishment, mirroring Girard's concept of scapegoating; a ritualised resolution to the tensions produced by mimetic escalation. The study explores how social media amplifies these dynamics by intensifying social comparison and reinforcing cycles of imitation and rivalry. Current treatments may be limited in their efficacy as they primarily focus on precipitating factors and crisis resolution without addressing the mimetic mechanisms driving self-harm. Integrating mimetic theory into clinical practice could offer a new framework for intervention, helping young people recognise and disengage from destructive social dynamics. Additionally, the paper highlights the potential for systemic and group-based interventions that target mimetic escalation within peer and family relationships. By understanding self-harm as a product of mimetic processes, this perspective offers novel insights for research, clinical practice, and public health strategies aimed at addressing the rise in self-harm amongst adolescents.

The metanarrative of biomedicine and "psy" discipline (psychology, psychoanalysis, psychiatry etc.) asserts that cannabis use is one of the fundamental causes of mental illness among different men in the Rushinga district of Zimbabwe. These metanarratives, however, appear to have universalised, medicalised and marginalised the conception and representation of mental illness as enmeshed in local epistemologies and ontologies of mental illness. Based on local epistemologies, elders in Diwa largely trace mental illness to discursive sociocultural explanations rarely linked to cannabis use. This paper answers the central question: How is the use of cannabis by different persons related to mental illness in the Rushinga district? I argue that community members, health providers and police officers want to think of persons, especially men, with mental illness as "mad" and immoral cannabis users who brought illnesses upon themselves and lack personal responsibility based on Western neoliberal and biomedical metanarratives. However, this framing is not helpful, it is detrimental to treatment and social reputation, as it bypasses local cultural explanations that may be protective and that offer clearer guidelines for treatment.

Understanding how bodies come to matter in eating disorder recovery is complex, particularly given the unresolved question of whether eating disorders are fundamentally about the body. Drawing on Analu Verbin's adaptation of Judith Butler's theory of performativity and Sarah Ahmed's body phenomenology, this paper examines how participants in a narrative and systemic group therapy program at a mental health clinic for eating disorders perceive themselves as recovering or recovered. We explore how the body is presented and understood in their recovery narratives, developing the concept of the 'troublesome body' to highlight the ambiguities these narratives reveal. The body in the participants' narratives is continuously shaped by an external gaze that alternates between recognition and concern, often oscillating between praise and scrutiny. Participants are tasked with cultivating a liberated, sensual body and a more natural relationship with food, achieved through therapeutic strategies such as establishing a mechanical eating pattern and 'neutralizing' the body in group settings. Yet the body resists, asserting its presence through physical sensations-rumbling stomachs and 'blobby' forms-that challenge these efforts. Crucially, the narrative and systemic group therapy is viewed by participants as pivotal in their recovery not because it resolves all eating disorder-related issues, but because it offers a collective space for 'troublesome bodies.' This space allows for bodies to exist without conforming to societal dichotomies or norms that are often imposed in other treatment contexts, thus, offering an alternative model of recovery where bodily ambiguities can be embraced rather than resolved.

The Tukdam Project directed by affective neuroscientist Richard Davidson at the University of Wisconsin-Madison since 2013 has investigated Buddhist practitioners in India entering a Tibetan Buddhist post-death meditative state called tukdam (Tib., thugs dam), where the body demonstrates attenuated decomposition and presents an altered postmortem chronology process. Through a collaboration of Buddhist monastics, Tibetan medical physicians, and biomedical researchers as well as neuroscientists from the Russian Academy of Sciences led by Svyatoslav Medvedev since 2020 and India-based National Institute of Mental Health and Neuro Sciences (NIMHANS) Centre for Consciousness Studies since 2022, an international collaborative team has investigated the phenomenon from an interdisciplinary and cross-cultural lens. Yet, despite the varied paradigms and intellectual lineages of the research teams, they have skillfully employed instruments of knowledge, markers of physiological processes, definitions of consciousness, and varied paradigms of ontological and epistemological realities in Euroamerican traditions of biomedicine and science and Indo-Tibetan traditions of Buddhism and medicine. This special collection explores perspectives from the anthropologists who have served as researchers, managers, and leaders of the Tukdam Project since its inception, striving to collaboratively integrate competing and synergistic investigative regimes in exploring the biocultural nexus of suspended life and embodied mind in meditated deaths of liberation.

Advances in end-of-life technologies increasingly destabilize received notions of personhood, identity, and ethics. As notions of personhood and identity within such systems are made to conform to discrete, binary and less fluid categories, some in the West have sought guidance in the techniques and views related to the dying process cultivated in other cultures, particularly Tibetan Buddhism. This article considers such dynamics as they unfolded in research focused on the postmortem bodies of Tibetan Buddhist practitioners in India. This article introduces the term thanato-technics to highlight the temporalities, imaginary or otherwise, evoked, enabled, and invested through the use of technologies to ascertain or conjecture about the intrasubjectivity of the dead and dying.