Transcultural Psychiatry最新文献

This study investigated the association between prolonged grief (PG) severity and meaning-making narration in a cross-cultural context, and specifically aimed to illustrate the role of value orientation in shaping the grieving process. 30 Chinese and 22 Swiss parents who lost their child were asked to narrate and appraise specific memories to reflect their self-evaluation of traditional and modern values. The self-reported Prolonged Grief Disorder Scale (ref ICD-11) assessed PG severity. Compared with the Swiss sample, the Chinese sample provided more elaborated memories, which was not associated with symptom severity. Both Chinese and Swiss bereaved parents with more severe PG provided more narratives of loss-related memories, particularly in response to modern values. They also provided more appraisals of negative meanings for self-defining memories, particularly in relation to their traditional values. These findings indicate that, despite cultural differences in narration tendency, PG severity in bereaved parents was associated with the maladaptive integration of autobiographical memories across different cultures, in relation to value orientations. A clinical implication is the potential value of facilitating narrations of grieving clients that center on value orientations to mitigate the hardship of the personal loss.

Migrant workers have higher rates of mental health problems than non-migrant workers, with Ethiopian migrant workers in the United Arab Emirates appearing to be overrepresented in the psychiatric inpatient population compared with their numbers in the general population. We sought to investigate the pattern of psychiatric inpatient admissions in Ethiopian migrant workers over a 10-year period (2011-2020) in order to highlight demographic and clinical characteristics, and to investigate factors predicting the length of hospital stay. We reported the mean and frequency of demographic and clinical data of Ethiopian psychiatric inpatients at one of the largest governmental hospitals in eastern Abu Dhabi between 2011 and 2020, and investigated factors predicting length of stay in hospital using linear regression. Our results show that Ethiopian expatriates made up 7.9% of all admissions over a 10-year period, had a mean length of hospital stay of almost 20 days, with 98.1% of them being female, 92.8% being domestic workers, 90.1% having a language barrier, 57.4% being single and 55.5.% having one or more recent stressors prior to admission. The most common diagnoses were acute stress reaction (31.6%), psychosis (29.3%), bipolar disorder (14.8%) and adjustment disorder (11.0%). Work-related stress, termination of employment and several clinical factors significantly predicted length of stay in hospital.

Haitian expressions of resilience also hold deep knowledge of human vulnerability. This longitudinal, qualitative study with young Haitians from urban shantytowns combines ethnographic and participatory methods to explore the complexities behind such idioms. Artistic and creative products made by or with the youth facilitated interviews, focus group discussions, and workshops. Through the life stories of participants and rich ethnographic material, this study presents locally situated idioms of resilience (and distress). By including local social ecology, the idioms were framed as historically and culturally rooted, thus shaping contextual, pragmatic, and gendered coping strategies grounded in embodied experiences of vulnerability and resistance. The study adds essential insights into Haitian resilience, revealing the local logics behind seemingly paradoxical statements. By drafting a conceptual framework for further studies on idioms of resilience, the study also makes a theoretical contribution to international resilience research.

Experiencing the continued presence of the deceased is common among the bereaved, whether as a sensory perception or as a felt presence. This phenomenon has been researched from psychological and psychiatric perspectives during the last five decades. Such experiences have been also documented in the ethnographic literature but, despite the extensive cross-cultural research in the area, anthropological data has generally not been considered in the psychological literature about this phenomenon. This paper provides an overview aimed at bridging these two areas of knowledge, and approaches the post-bereavement perception or hallucination of the deceased in cultural context. Ongoing debates are addressed from the vantage point of ethnographic and clinical case study research focusing on the cultural repertoires (in constant flux as cultures change) from which these experiences are labelled as desirable and normal, on the one hand, or as dangerous and pathological, on the other.

Social and cultural poetics take us beyond language to an embodied sensibility. To explore the relevance of social poetics in medical training, this article uses as an exemplar an innovative program in geriatrics in a residency program in primary care. The program began with a series of meetings in which medical residents consulted community elders invited for their advice and wisdom on healthcare dilemmas as Senior Faculty, effectively becoming co-teachers and co-learners with one another. Through iterative reflection, residents, faculty and community elders all reported feeling struck by the unexpected responses and were often guided and called to action by them to ask new questions, to shift their stance, or offer greater accompaniment and care. These experiences illuminated what might otherwise have passed by unnoticed, particularly in regards to human suffering. The reflecting process made visible what mattered to each actor, shifting from negative assumptions and attitudes about older adults to a positive engagement with them, co-creating new possibilities for participants to articulate their lived experience of illness and healing. These are creative and moral acts, honoring the voices of those seldom invited to speak, resonating with them, acknowledging what matters to each participant, while taking into account wider issues of disparity and social justice.

What does it take to see how autistic people participate in social interactions? And what does it take to support and invite more participation? Western medicine and cognitive science tend to think of autism mainly in terms of social and communicative deficits. But research shows that autistic people can interact with a skill and sophistication that are hard to see when starting from a deficit idea. Research also shows that not only autistic people, but also their non-autistic interaction partners, can have difficulties interacting with each other. To do justice to these findings, we need a different approach to autistic interactions-one that helps everyone see, invite, and support better participation. I introduce such an approach, based on the enactive theory of participatory sense-making and supported by insights from indigenous epistemologies. This approach helps counteract the homogenizing tendencies of the "global mental health" movement, which attempts to erase rather than recognize difference, and often precludes respectful engagements. Based in the lived experiences of people in their socio-cultural-material and interactive contexts, I put forward an engaged-even engaging-epistemology for understanding how we interact across difference. From this perspective, we see participatory sense-making at work across the scientific, diagnostic, therapeutic, and everyday interactions of autistic and non-autistic people, and how everyone can invite and support more of it.

Metaphors are frequently seen in individuals' descriptions of their illness and healing experiences. These figurative phrases are not ornamental, or distracting, but often reveal the particularities of what it is like to be ill or healing. Culture plays a big role in shaping the particular metaphors employed to express one's thoughts about illness and different healing rituals. However, a significant reason why metaphor emerges in illness narratives is because people ordinarily reason via embodied simulation processes in which they imaginatively project themselves into different real-world and fantastic situations, such as imagining one's struggle with cancer as being a complex dance with the disease. These simulations can play a major role in therapeutic interventions to help those who are ill and in distress.

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.