Culture Medicine and Psychiatry最新文献

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.

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.

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.

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.