Culture Medicine and Psychiatry最新文献

This clinical case study presents the case of a Latina Veteran experiencing psychosis and draws on eclectic theoretical sources, including user/survivor scholarship, phenomenology, meaning-oriented cultural psychiatry & critical medical anthropology, and Frantz Fanon's insight on 'sociogeny,' to emphasize the importance of attending to the meaning within psychosis and to ground that meaning in a person's subjective-lived experience and social world. The process of exploring the meaning and critical significance of the narratives of people experiencing psychosis is important for developing empathy and connection, the fundamental prerequisite for developing trust and therapeutic rapport. It also helps us to recognize some of the relevant aspects of a person's lived experiences. To be understood, this Veteran's narratives must be contextualized in her past and ongoing life experience of racism, social hierarchy, and violence. Engaging in this way with her narratives pushes us towards a social etiology that conceptualizes psychosis as a complex response to life experience, and in her case, a critical embodiment of intersectional oppression.

Among young people who use drugs in the context of entrenched poverty and homelessness, pregnancy is often viewed as an event that can meaningfully change the trajectory of their lives. However, youth's desires and decision-making do not always align with the perspectives of various professionals and systems regarding how best to intervene during pregnancies and early parenting. Drawing on longitudinal interviews and fieldwork with young people in Vancouver, Canada, we explore how their romantic relationships powerfully shaped understandings of what was right and wrong and which actions to take during pregnancy and early parenting, and how these moral worlds frequently clashed with the imperatives of healthcare, criminal justice, and child protection systems. We demonstrate how a disjuncture between youth's desires, decision-making and moralities, and the systems that are intended to help them, can further entrench young people in cycles of loss, defeat, and harm. These cycles are powerfully racialized for young Indigenous people in our context.

This article uses ethnography and coproduced ethnography to investigate mental health labels amongst university students in the UK. We find that although labels can still be a source of stigma, they are also both necessary and useful. Students use labels as 'campus technologies' to achieve various ends. This includes interaction with academics and administrators, but labels can do more than make student distress bureaucratically legible. Mental health labels extend across the whole student social world, as a pliable means of negotiating social interaction, as a tool of self-discovery, and through the 'soft-boy' online archetype, they can be a means of promoting sexual capital and of finessing romantic encounters. Labels emerge as flexible, fluid and contextual. We thus follow Eli Clare in attending to the varying degrees of sincerity, authenticity and pragmatism in dealing with labels. Our findings give pause to two sets of enquiry that are sometimes seen as opposed. Quantitative mental health research relies on what appear to be questionable assumptions about labels embedded in questionnaires. But concerns about the dialogical power of labels to medicalise students also appears undermined.

Culturally differing approaches to the distinction between physical and mental health contribute to cultural differences in explanatory models of what we call "mental" health in a Western context. For this reason, we use "(mental) health" in this study when referring to these models or differences in understanding. This interpretative, interview-based qualitative study focuses on Belgian mental health professionals' perceptions of the (mental) health explanatory models held by their patients of sub-Saharan African (SSA) descent. The study goals were threefold: first, to assess professionals' perceptions of the explanatory models of their patients of SSA descent; second, to examine how these perceptions influence treatment practices; and third, to investigate the role of the professionals' cultural backgrounds, comparing the results between professionals with and without an SSA background. Twenty-two in-depth interviews with mental health professionals were thematically analyzed, with ten of the participants of SSA descent. Results show that all professionals perceived differences between Western and SSA explanatory models of (mental) health. Causal beliefs were mentioned as the most important difference, including their influence on coping strategies and health-seeking behavior among patients of SSA descent. Professionals' perceptions and familiarity with SSA explanatory models of (mental) health affected their treatment practices. Language and conceptual interpretation difficulties were encountered less frequently by professionals of SSA descent. Those with a Western background applied "culturally sensitive" practices, while professionals of SSA descent implemented an integrated approach. These results contribute to ongoing discussions about what is considered "cultural competency."

Historians and ethnographers have described biomedicine as a modernist project that imagines accumulating ever-more stable knowledge over time. This project broke down in heavily hit hospitals at the onset of the COVID-19 pandemic in the U.S., when bureaucratic, physical and knowledge structures collapsed. A combination of terror, a partially characterized disease entity and clinicians' inability to operate without disease models drove them to draw on rapidly changing and contradictory information via social media, changing medical practice minute-to-minute. The result was a unique form of knowing described as "hallucination": a hyperreal, unstable ecology of imagined viral particles distributed in physical spaces, transforming with each text message and tweet. The nature, experience and practice of this ecology sheds light on what happens when instability comes to otherwise stable places.

This article considers the ways in which empathy for patients and related solidarity with communities may be trained out of medical students during medical school. The article focuses especially on the pre-clinical years of medical school, those that begin with orientation and initiation events such as the White Coat Ceremony. The ethnographic data for the article come from field notes and recordings from my own medical training as well as hundreds of hours of observant participation and interviews with medical students over the past several years. Exploring the framework of language socialization, I argue that learning the verbal, textual and bodily language of medical practice contributes to the increasing experience of separation between physicians and patients. Further considering the ethnographic data, I argue that we also learn a form of empathy limited to performance that short circuits clinical care and the possibility for solidarity for health equity. The article concludes with implications for medical education and the medical social sciences and humanities.

In most Mediterranean countries, people diagnosed with severe mental disorders (SMDs) are typically cared for by the mother, causing a significant burden on people in this family role. Based on a broader mental health participatory action and qualitative research carried out in Catalonia (Spain) of 12 in-depth interviews and 3 focus groups, this article analyses the mother-caregivers' experience in the domestic space. The results show that patients and caregivers are engaged in a relationship of "nested dependencies", which create social isolation. This produces the conditions of "reactionary care", practices that limit the autonomy of those affected and that reproduce forms of disciplinary psychiatric institutions. We conclude that both institutional violence derived from economic rationality and that which stems from the gender mandate feed off each other into the domestic sphere. This research argues for placing care at the center of clinical practice and shows the need to consider the structural forces shaping it.

Tricyclic antidepressants (TCAs) are frequently prescribed for chronic functional pain disorders. Although the mechanism of action targets pain perception, treating patients with TCAs for disorders conceptualized as "functional" can promote stigmatization in these patients because it hints at psychological dimensions of the disorder. The goal of this study was to understand how physicians prescribe TCAs in the face of this challenge. We interviewed eleven gastroenterologists in tertiary care clinics specializing in functional gastrointestinal disorders, such as irritable bowel syndrome. We found that the physicians interviewed (1) were aware of the stigma attached to taking antidepressants for a medical condition, (2) emphasized biological, as opposed to psychological, mechanisms of action, (3) while focusing on biological mechanisms, they nevertheless prescribed TCAs in a way that is highly attentive to the psychology of expectations, making specific efforts to adjust patients' expectations to be realistic and to reframe information that would be discouraging and (4) asked patients to persist in taking TCAs despite common and, at times, uncomfortable side effects. In this context of shared decision making, physicians described nuanced understanding and behaviours necessary for treating the complexity of functional disorders and emphasized the importance of a strong patient-provider relationship.

Based on ethnographic fieldwork and interviews conducted with Turkish egg donors at a Northern Cypriot clinic, this article investigates tactical biosociality of cross-border egg donors that allows them to manage social relations and orient themselves in transnational egg donation (including the processes from recruitment to self-management in and beyond the clinic) under legally restrictive and socially stigmatizing conditions. Addressing the social and collective dimensions of tactics and recognizing the fragmented and conflictual forms of biosociality, it aims to shed light on the complex and ambivalent aspects of tactical biosociality in relation to selective disclosure and stigma within the context of transnational egg donation. Tactical biosociality involves possibilities for solidarity and alliances, and also for conflict and competition among egg donors. It is because for young Turkish women, egg donation retains both gendered moral and financial values that must be tactically negotiated while navigating the wider context of heteropatriarchal cultural norms and expectations, precarious economic and social conditions, biomedical profit and biopolitical control.

The latest form of cognitive behavioral therapy, virtual reality therapy has been developing in France since 2012, in both university hospitals and private practices. Patients receiving this therapy are immersed in a digitally created environment, using a virtual reality headset, in order to be exposed to their phobias. How does the introduction of technical objects such as the virtual reality headset affect and transform the care relationship between the patient and the therapist? Based on an ethnographic study conducted between 2012 and 2018 in the psychiatric unit of a French university hospital, this article outlines the emergence of virtual reality therapy, describes how it operates, and analyzes how it shapes the patient-therapist relationship. I argue that this device-namely virtual reality therapy-promotes a new therapeutic style in psychiatry, whose format and therapeutic indications align with the requirements of evidence-based medicine.