Culture Medicine and Psychiatry最新文献

Touch is a fundamental sense and the most unexplored of the five senses, despite its significance for everything we do in relation to ourselves and others. Studies have shown that touch generates trust, care and comfort and is essential for constituting the body. Based on ethnographic fieldwork, this study explores the absence and presence of touch in interactions between people with mental illness and professionals, in health care encounters with general practitioners, neurologists and physiotherapists, as well as masseurs. We found that touch and physical examination of patients with mental illness is absent in health care encounters, leaving the patients with feelings of being out of place, misunderstood, less socially approved and less worthy of trust. Drawing on Honneth and Guenther, we conclude that touch and being touched is an essential dimension of recognition-both of the patients' bodily sensations and symptoms and of them as human beings, detached from the psychiatric label-as well as contributing to the constitution of self and personhood. These findings confirm that touch works as an existential hinge that affirms a connection between the patient, the body and others and gives a sense of time, space and existence.

Susto is one of the most common disorders referenced in the medical anthropological and cultural psychiatric literature. This article questions if "susto" as understood in cultural psychiatric terms, especially in the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM), is in fact a single "cultural concept of distress." There is extensive cross-cultural and intracultural variability regarding fright-related disorders in the ethnographic literature. What is often labeled "susto" may be in reality a variety of distinct disorders, or lacking in the two signature components found in the cultural psychiatric literature: the existence of a "fright," and subsequent soul loss. There has been significant polysemic and geographical drift in the idiom label, the result of colonialism in Mesoamerica, which has overlayed but not necessarily supplanted local knowledge. Using data from fifteen years of research with Q'eqchi' (Maya) healers and their patients, we demonstrate how important variability in signs, symptoms, diagnosis, treatment, and prognosis of fright-related disorders renders any simple declaration that this is a singular "susto" problematic. We argue for a careful consideration of the knowledge of Indigenous medical specialists charged with treating fright-related disorders and against the inclination to view variability as insignificant. Such consideration suggests that Indigenous forms of fright-related disorder are not susto as presented commonly in the DSM and cultural psychiatric literature.

Men's body image is an issue of increasing importance as related illnesses continue to grow in prevalence around the world. However, cross-cultural attention to men's body image experiences has been relatively understudied. Based on data derived from cognitive anthropological methods of cultural domain analysis, I develop the concept of "muscularities" to more effectively examine the expectations inherent in multifarious models of body image men continuously navigate. Related to but distinct from "masculinities"-the recognition of culture-bound hierarchies of ways of doing-being a man-"muscularities" attends to the culturally particular ways in which muscles are conceived and evaluated as indices of socioeconomic status, intelligence, social skills, and professionalism, to name a few. Young South Korean men's experiences of chan'gŭnyuk ("small muscle") and manŭn kŭnyuk ("large muscle") challenge universalist assumptions about the kinds of muscles people value in global perspective, demonstrate the necessity of recognizing multiple muscularities in research, and encourage new directions of inquiry that attend to the consequences of variable embodiments of muscularities.

Obsessive-compulsive features are commonly found in high-achieving people including psychiatrists, psychologists, and scientists. These traits have a substantial but unrecognized cultural influence on psychiatric and psychological science and practice. This article reviews obsessive-compulsive mechanisms and discusses the ways they both promote and impede psychiatric and psychological science and practice. It examines them in relation to two of the dominant psychiatric and psychological paradigms of our era, the Diagnostic and Statistical Manual (DSM), and Cognitive-Behavioral Therapy. Finally, the article suggests that better awareness of our collective obsessive-compulsive tendencies can facilitate a cultural shift toward a broader, more useful science of mind and brain, as well as therapies informed by more comprehensive scientific understanding.

Hallucinations are currently associated almost exclusively with psychopathological states. While it is evident that hallucinations can indicate psychopathology or neurological disorders, we should remember that hallucinations also commonly occur in people without any signs of psychopathology. A similar case occurs in the case of hallucinogenic drugs, which have been long associated with psychopathology and insanity. However, during the last decades a huge body of research has shown that certain kinds of hallucinations, exerted by hallucinogenic drugs, may serve to improve mental health. We propose that, in light of historical, epidemiological, and scientific research, hallucinations can be better characterized as a common phenomenon associated sometimes with psychopathology but also with functional and even beneficial outcomes. In the last sections of the manuscript, we extend our argument, suggesting that hallucinations can offer a via regia to knowledge of the mind and the world. This radical shift in the cultural interpretation of hallucinations could have several implications for fields such as drug policy, civil law, and psychiatry, as well as for the stigma associated with mental disorders.

Prolonged grief disorder (PGD) is a new mental health disorder, recently introduced in the International Classification of Diseases (ICD-11), World Health Organization Classification of Diseases (WHO). The new ICD-11 guidelines reflect an emerging wave of interest in the global applicability of mental disorders. However, the selection of diagnostic core features in different cultural contexts has yet to be determined. Currently, there is debate in the field over the global applicability of these guidelines. Using semi-structured interviews with 14 key informants, we explored the acceptability of ICD-11 guidelines for PGD according to Japanese health professionals as key informants. The interviews revealed symptoms of grief possibly missing in the ICD-11 PGD guidelines including somatization and concepts such as hole in the heart. Additionally, sociocultural barriers such as stigma and beliefs about the social desirability of emotions may challenge patients' and clinicians' acceptance of the new ICD-11 criteria.

In the United States, HIV outbreaks are occurring in areas most affected by the opioid epidemic, including West Virginia (WV). Cultural Theory contends that multiple cultures co-exist within societies distinguished by their differing intensities of rules or norms of behavior ('grid') or degree of group allegiance/individual autonomy ('group'). Accordingly, we would expect that perceptions about HIV, including stigma, correspond with individuals' grid/group attributes. To explore this, we conducted qualitative interviews with people who inject drugs (PWID) recruited from a WV syringe service program. This paper focuses on our unexpected findings on stigma during a coinciding HIV outbreak. PWID living homeless identified as belonging to a 'street family'. Its members were mutually distrustful and constrained by poverty and drug dependence but despite their conflicts, reported openness between each other about HIV + status. Interviewees living with HIV perceived little enacted stigma from peers since the local outbreak. Contrasting stigmatizing attitudes were attributed to the town's mainstream society. The 'High Five' (Hi-V) Club, expressing defiance towards stigmatizing behavior outside the street family, epitomized the tensions between a desire for solidary and mutual support and a fatalistic tendency towards division and distrust. Fatalism may hinder cooperation, solidarity and HIV prevention but may explain perceived reductions in stigma.

For thirty years, psychiatrists and anthropologists have collaborated to improve the validity of psychiatric diagnosis. This collaboration has produced the DSM-IV Outline for Cultural Formulation (OCF) and the DSM-5 Cultural Formulation Interview (CFI). Nonetheless, some anthropologists have critiqued the concept of culture in DSM-5 as too focused on patient meanings and not on clinician practices. This article traces the evolution of the culture concept from DSM-IV through DSM-5-TR by analyzing publications from the American Psychiatric Association on the OCF and CFI alongside scholarship in psychiatry and anthropology. DSM-IV relied on a culture concept of coherent ethnic communities sharing coherent cultures, primarily for minoritized ethnoracial individuals in the United States. Changing demographics and newer immigration patterns around the world deminoritized the culture concept for DSM-5. After George Floyd's death and demands for social justice, the culture concept in DSM-5-TR emphasized social structures. The article proposes an intersubjective model of culture through which patients and clinicians work through similarities and differences. It recommends a revised formulation that attends to clinician practices such as communicating, diagnosing, recommending treatments, and documenting, beyond collecting patient meanings. It also raises the question of whether an intersubjective model of culture prompts reconsiderations of culture-related text in other sections of the DSM. The social sciences can redirect attention to the clinician's culture of biomedicine to close patient health disparities.

In France, women can be incarcerated during pregnancy and can keep their babies with them in prison up to the age of 18 months. The small number of nurseries in France and their unequal geographic distribution as well as the high percentage of foreign prisoners often result in women's isolation from their usual cultural environment. Family members and cultural community play a crucial role in the process of mothering. The aim of this study is to explore through these mothers' narratives how they experience the cultural aspects of this process in the prison environment. We conducted semi-structured interviews to collect the experience of 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data. Four different themes emerged: prison: repression of cultural practices, prison: a culture of its own, loss of traditional culture, and cultural hybridization. The specific environmental architecture and operating rules in prison nurseries may induce acute repression regarding cultural ways of mothering. Considering both cultural permeability specific to the peripartum period during which women tend to more easily embrace cultural aspects from their environment, and family distance which restrains cultural transmission, these mothers gather multiple factors of vulnerability for full prisonization, as a form of forced assimilation to prison culture. But a sort of specific hybrid prison culture around motherhood seems to emerge instead, in a process similar to creolization.

While some early studies suggested that spirit mediums were psychiatrically ill individuals who found a culturally sanctioned role, subsequent work has found that they are generally in good physical and mental health. While the calling to be a healer often involves an initiatory illness, practitioners go on to play demanding social roles, suggesting that involvement in mediumship may be therapeutic for the practitioner. This study focuses on dang-ki healing, a form of Chinese spirit mediumship practiced in Singapore to explore whether participation in dang-ki healing is therapeutic for the mediums. We interviewed eight dang-kis from five temples about their life trajectories and assessed their mental health status with standardized psychological questionnaires. Most of the dang-kis did not appear to suffer from clinically significant emotional distress. Their narratives suggest that involvement in dang-ki mediumship may have therapeutic effects in which the embodied experience of self plays a central role. The dang-kis experienced changes in social identity, bodily experiences during spirit possession, and their overall sense of self through recurrent possession rituals. In general, the practice of spirit mediumship illustrates how the experiences and meanings of the self are constructed and reconstructed through body-world relations in ways that may confer a sense of wellness and social efficacy.