Transcultural Psychiatry最新文献

Although spirit possession is generally considered a psychiatric illness, the class of conditions designated as dön (Tib. gdon, "afflictive external influences," often glossed as "spirit affliction") in Tibetan medicine represents a distinctive paradigm for an etiology where physical and mental facets inhere in every illness. This study draws upon ethnographic fieldwork in eastern Tibet to examine two conditions that represent illness presentations at both ends of the dön spectrum: one that maps onto a biomedical etiology of stroke and another that presents in a way similar to schizophrenia. The case studies illuminate the forms of harmful external influences that (1) have physiological and psychological impacts that present as symptoms and (2) contribute to a pathogenesis common to both conditions. Our analysis considers the dual role of cultural affordances and bio-looping in the cultural presentation of the two conditions, as well as how the Tibetan medical tradition draws upon cultural, social, biological, and psychological determinants to understand this class of conditions. We also explore the implications the dön illness category has for biomedically oriented paradigms through the way in which it accounts for cultural models for both diagnosis and treatment of several chronic inflammatory conditions that have significant concomitant mental health presentations.

This article presents a case study of an innovative culturally based therapeutic approach using collective poiesis to improve the functioning of a youth sports team in Jamaica. In recent decades, Jamaica has endured high levels of violence and corruption, and has been ranked among the top four countries in the world in terms of murder rate per capita. We conjecture that a high prevalence of personality disorder linked to the legacy of slavery and colonialism often impedes Jamaicans from achieving success in diverse fields, including sports. Psychological interventions in the preparation of football teams are a novelty, and have been used mainly to enhance global team performance or individual player skill. The use of psychological interventions to address personality disorder psychopathology on the soccer pitch has not been reported. Psychohistoriographic cultural therapy (PCT) integrates psychological perspectives with a dialectic method of historical analysis and uses collective poiesis as a vehicle to translate insights through an embodied cognitive restructuring process. Two workshops were carried out with a high school football team using PCT techniques. The process of dialectic reasoning engaged their collective ideas and insights to establish a psychic centrality that was expressed in poetic form to illustrate the pathologies of the group in an emotionally safe and psychologically acceptable narrative. This poetic narrative of the group's psychic centrality counters the personality disorder psychopathology caused by the lingering intergenerational wounds of slavery, colonial oppression and collective trauma.

This issue of Transcultural Psychiatry presents selected papers from the McGill Advanced Study Institute on "Cultural Poetics of Illness and Healing." The meeting addressed the cognitive science of language, metaphor, and poiesis from embodied and enactivist perspectives; how cultural affordances, background knowledge, discourse, and practices enable and constrain poiesis; the cognitive and social poetics of symptom and illness experience; and the politics and practice of poetics in healing ritual, psychotherapy, and recovery. This introductory essay outlines an approach to illness experience and its transformation in healing practices that emphasizes embodied processes of metaphor as well as the social processes of self-construal and positioning through material and discursive engagements with the cultural affordances that constitute our local worlds. The approach has implications for theory building, training, and clinical practice in psychiatry.

This article is a narrative and conceptual exploration of the journey towards practicing Indigenous allyship in an academic context. I begin by tracing a trajectory of coming to work with Indigenous peoples as a non-Indigenous, multiple migrant, and queer person of color situated as a therapist and educator in a Canadian academic institution's Faculty of Medicine and Health Sciences. Anti-racist and de/postcolonial theories and concepts abound to label my experiences of tokenization, yet they invariably fall short of the nuanced and complex ways that both reconciliation and oppression unfold in the everyday. Beyond critical theories that speak with certainty of structural violence, I trace my trajectory of coming to understand my work with Indigenous peoples within and for healthcare curricula and community development. I describe an intertextual practice of echopoetics that is trying to make sense of a world where both historical trauma and daily aggressions continually reproduce inequities, in order to reveal spaces of possible hope and healing. Yet, what seems to be happening in this echopoetics is a process of unbelonging from the multiple cultural and institutional narratives in my surround-at times including those that intend to liberate. Focusing on the negation-"non"-as a non-Indigenous/non-White person, I provide a reflection on how this practice cultivates an unbelonging that becomes both a political stance at the point of invisibility, as well as a lonely yet definite healing.

This article offers an epistemological, poetic, and ontological reading of the ways of knowing regarding mental disorders that are characteristic of the traditional healers (curanderas and curanderos) of an Indigenous group in Mexico. The study is based on ethnographic interviews with traditional Purépecha (Tarascan) healers in rural Michoacan. Interviews focused on local conceptions of emotional and mental illness, especially Nervios, Susto, and Locura (nerves, fright, and madness). We discuss the conceptual structure of these Indigenous illness notions, the nature of the associated imagery and notions of the soul, as well as the general sense of meaningfulness and reality implicit in Purépecha curanderismo. The highly metaphorical modes of understanding characteristic of these healers defy analysis in purely structuralist terms. They do, however, have strong affinities with the Renaissance "episteme" or implicit framework of understanding described in The Order of Things, Michel Foucault's classic study of modes of knowing and experiences of reality in Western thought-a work profoundly influenced by Heidegger's interest in the historical and cultural constitution of what Heidegger termed "Being." After examining the individual illness concepts, we explore both the poetic and the ontological dimension (the foundational sense of reality or of Being) that they involve, with special emphasis on supernatural concerns.

This article explores the relationship between metaphors and emotion in the context of adolescent distress and psychotherapeutic treatment. Drawing on data from an ethnographic study of Mexican American adolescents receiving outpatient treatment for a variety of emotional and behavioral problems, the article examines what I call "prescribed" metaphors deployed in mainstream, manualized child and adolescent Cognitive Behavioral Therapies commonly used in mainstream clinical contexts. I explore the models of emotion communicated to youth by one such metaphor, youth responses to this metaphor, and the potential implications for young people as they take up the underlying models and affective practices embedded in the metaphor. Specifically, I examine how youth respond to messages about emotion metacognition and emotion regulation embedded in a metaphor that equates feelings with temperatures that can be monitored and objectively measured. I find that youth are at once convinced that abstract knowledge about internal states is inherently valuable because it is linked to desired forms of personhood, but also concerned about the limits of technical metaphors to capture aspects of lived experience and the flattening and homogenization of affect that might accompany the practices such metaphors help to enact. I analyze alternative interpretations of prescribed metaphors as well as the spontaneous metaphors used by youth to talk about their emotions and experiences of distress, in an effort to think through the politics and poetics of emotion metaphors in the context of an evidence-based psychotherapy for young people.

The comparative study of voice hearing is in its early stages. This approach is important due to the observation that the content of voices differs across different settings, which suggests that voice hearing may respond to cultural invitation and, ultimately, to learning. Our interview-based study found that persons diagnosed with schizophrenia in China (Shanghai), compared to those diagnosed with schizophrenia in the United States, Ghana, and India, reported voices that were strikingly concerned with politics. Compared to participants in the United States in particular, voices seemed to be experienced more relationally: Shanghai participants reported voices notable for a sense of benevolent persuasion rather than harsh command, and knew the identities of their voices more so than in the United States. The voices were striking as well for their religious content, despite the previous prohibition of religion in China. Our findings further support the hypothesis that voice hearing seems to be shaped by context, and we observe that this shaping may affect not only conceptual content but the emotional valence of the experience.

There has been relatively little work which systematically examines whether the content of hallucinations in individuals diagnosed with schizophrenia varies by cultural context. The work that exists finds that it does. The present project explores the way auditory hallucinations, or "voices," manifest in a Russian cultural context. A total of 28 individuals, diagnosed with schizophrenia, who reported hearing voices at the Republican Clinical Psychiatric Hospitals in Kazan, Russia, were interviewed about their experience of auditory hallucinations. The voices reported by our Russian participants did appear to have culturally specific content. Commands tended to be non-violent and focused on chores or other activities associated with daily life (byt). Many patients also reported sensory hallucinations involving other visions, sounds, and smells which sometimes reflected Russian folklore themes. For the most part, religious themes did not appear in patients' auditory vocal hallucinations, though nearly all patients expressed adherence to a religion. These findings support research that finds that the content, and perhaps the form, of auditory hallucinations may be shaped by local culture.

Despite the challenges facing Indigenous youth and their communities due to historical and contemporary institutionalised racism in Canada, communities are drawing on the richness of their own histories to reassert their cultural heritage. Doing so supports mental health outcomes of young people in particular, as highlighted in a compelling body of research. The question facing many communities, however, is how they can facilitate such child and youth engagement in order to support related positive mental health outcomes. This article reports on findings from a Participatory Action Research (PAR) study conducted in a First Nations community in Unama'ki (Cape Breton), Atlantic Canada. The study, Spaces & Places, was a partnership between the community-based mental health service provider (Eskasoni Mental Health Services, EMHS), eight community youth (14-18 years old), and a team of academics. Situated within a resilience framework, the team explored the ways in which the community facilitated, or restricted, youth civic and cultural engagement. Foregrounded against a strong legacy of cultural reassertion within the community, findings highlight the core resilience-promoting resources that support positive youth development. Additionally, findings demonstrate how these resources provide meaningful support for youth because of the way in which they are intertwined with one another. Furthermore, cultural engagement is underpinned by the Two-eyed Seeing model, supporting youth to integrate their own culture with settler culture in ways that work best for them. Findings support community-based service structures, and underscore the importance of community resilience in the effective support of Indigenous children and youth.

Previous research has shown that worldviews can serve as a coping response to periods of difficulty or struggle, and worldviews can also change on account of difficulty. This paper investigates the impacts worldviews have on the nature and trajectory of meditation-related challenges, as well as how worldviews change or are impacted by such challenges. The context of meditation-related challenges provided by data from the Varieties of Contemplative Experience research project offers a unique insight into the dynamics between worldviews and meditation. Buddhist meditation practitioners and meditation experts interviewed for the study report how, for some, worldviews can serve as a risk factor impacting the onset and trajectory of meditation-related challenges, while, for others, worldviews (e.g., being given a worldview, applying a worldview, or changing a worldview) were reported as a remedy for mitigating challenging experiences and/or their associated distress. Buddhist meditation practitioners and teachers in the contemporary West are also situated in a cultural context in which religious and scientific worldviews and explanatory frameworks are dually available. Furthermore, the context of "Buddhist modernism" has also promoted a unique configuration in which the theory and practice of Buddhism is presented as being closely compatible with science. We identify and discuss the various impacts that religious and scientific worldviews have on meditation practitioners and meditation teachers who navigate periods of challenge associated with the practice.