Transcultural Psychiatry
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Published By Sage Publications

1363-4615
Updated Friday, 22 October 2021

2021 ◽  
pp. 136346152110412
Author(s):  
Hugo Sanches ◽  
Leonardo Villaverde Buback Ferreira ◽  
João Pedro Gonçalves Pacheco ◽  
Luiz Carlos Schenberg ◽  
Marcos Sampaio Meireles

The sociocultural context of psychiatric patients shapes symptoms experience and expression, as well as how patients deal with a disorder and how society appraises its symptoms. Specifically, the context may influence the social appraisal of a behavior as normal or pathological. Therefore, markedly pathological symptoms may not be accordingly recognized by peers when they are in consonance with the sociocultural context. Per “Dead” Ohlin was a Swedish musician who was a member of the Norwegian black metal band Mayhem from 1988 until his suicide in 1991, at age 22. Black metal is a musical movement characterized by death worshiping and anti-Christianism, and is also associated with church arsons and murders during the 1990s. Even among peculiar personalities such as black metal musicians, Ohlin was considered the personification of the movement ideals due to his eccentric and unparalleled beliefs and behaviors, claiming, for instance, that he was already dead. In this article, we propose that Ohlin's eccentric beliefs and behaviors were symptoms of an unrecognized psychiatric condition, Cotard's syndrome, and discuss the diagnostic dilemma presented by Ohlin's artistic persona and singular context. The compatibility between his symptoms and the sociocultural context of black metal may have obscured his mental disorder. If so, Ohlin's unique case may shed light upon one of the effects of context in a psychopathological process: concealing a psychiatric disorder and reinforcing symptoms that fit a particular environment.


2021 ◽  
pp. 136346152110480
Author(s):  
Sarah Gillespie ◽  
Jeffrey P. Winer ◽  
Osob Issa ◽  
B. Heidi Ellis

Acculturation styles have important associations with future adjustment among immigrants and refugees, yet less is known about the individual and interpersonal factors that influence the strategy an individual adopts. High rates of discrimination may signal the receiving community’s rejection of one’s ethnic group, increasing pressure to assimilate and suppress one’s heritage identity. Within a sample of Somali young adults (18–30, N = 185) resettled in North America, this study tested whether two acculturation styles (assimilation and integration) longitudinally mediate the relation between discrimination and three mental health outcomes (i.e., anxiety, depression, and posttraumatic stress disorder), and whether gender moderated these relations. Discrimination had a direct, positive relation with future mental health symptoms for females, which was not mediated by acculturation strategy. By contrast, the association between discrimination and mental health outcomes for males was fully mediated by increased endorsement of assimilation, but not integration. Experiences of marginalization may erode connections to both the Somali community and to the nation of resettlement, which have been identified as particularly strong protective forces within this community. Interventions targeted at the receiving community to reduce the rates of discrimination toward immigrants and refugees and interventions to strengthen youth’s sense of belonging in both the predominant culture and their culture of origin may improve transdiagnostic mental health outcomes.


2021 ◽  
pp. 136346152110412
Author(s):  
Galia Plotkin Amrami

This article explores the moral dimensions of the clinical narration of suffering in a highly political context. Based on an ethnographic analysis of psychotherapists’ discussions of a clinical case related to the Israeli evacuation from Gaza, I illustrate how the care providers navigate competing moral logics while explaining the reasons for the patient's experience. Capturing moments of the simultaneous appearance of different explanatory models, informed by contradictory moral grammars, during the process of clinical reasoning allowed me to obtain a complex and nuanced picture of social reality in which the experience of the patient simultaneously appeared as both a success and a failure of communal education. The ethnographic observation and analysis of clinical reasoning challenge the assumed connection between practitioners’ ideological identifications and their narration of suffering, and allowed to move beyond the idea… moving beyond the idea of coherent moral subjects who act according to a priori moral values informed by political ideology. This perspective is particularly significant for the field of traumatic suffering because it questions the moral grammar of trauma narratives that imply unambiguous and idealized distinctions between victims, perpetrators, and witnesses, revealing the complex dynamics of suffering and caring.


2021 ◽  
pp. 136346152110474
Author(s):  
Élise Bourgeois-Guérin ◽  
Diana Miconi ◽  
Aude Rousseau-Rizzi ◽  
Cécile Rousseau

This article presents a preliminary evaluation of training sessions promoting a systemic approach to violent radicalization (VR) offered to first-line health and education professionals in Quebec. We describe the rationale and content for the training program, its general principles and implementation modalities. The mixed-method evaluation indicated that the participants felt the training increased their level of confidence in dealing with VR in their work. It appeared that training also shifted participants’ attitudes significantly on four items with decreases: (1) worry about the extent of VR of young people in Quebec; (2) belief that VR should automatically be reported to the police; (3) thinking that Islam favors VR; and (4) assumption that enhanced security measures would have a deterrent effect on VR. The conclusion discusses the challenges associated with violent radicalization training programs, emphasizing the delicate ethical and political questions related to the provision of training on this socially divisive topic.


2021 ◽  
pp. 136346152110480
Author(s):  
Cécile Rousseau ◽  
Neil K. Aggarwal ◽  
Laurence J. Kirmayer

This article introduces a thematic issue of Transcultural Psychiatry with selected papers from the McGill Advanced Study Institute in Cultural Psychiatry on “Pluralism and Polarization: Cultural Contexts and Dynamics of Radicalization,” which took place June 20–22, 2017. The ASI brought together an interdisciplinary group scholars to consider the role of social dynamics, cultural contexts and psychopathology in radicalization to violent extremism. Papers addressed four broad topics: (1) current meanings and uses of the term radicalization; (2) personal and social determinants of violent radicalization, including individual psychology, interpersonal dynamics, and wider social-historical, community and network processes; (3) social and cultural contexts and trajectories of radicalization including the impact of structural and historical forces associated with colonization and globalization as well as contemporary political, economic and security issues faced by youth and disaffected groups; and (4) approaches to community prevention and clinical intervention to reduce the risk of violent radicalization. In this introductory essay, we revisit these themes, define key terms, and outline some of the theoretical and empirical insights in the contributions to this issue. Efforts to prevent violent radicalization face challenges because social media and the Internet allow the rapid spread of polarizing images and ideas. The escalation of security measures and policies also serves to confirm the worldview of conspiracy theory adherents. In addition to addressing the structural inequities that fuel feelings of anger and resentment, we need to promote solidarity among diverse communities by building a pluralistic civil society that offers a meaningful alternative to the violent rhetorics of us and them.


2021 ◽  
pp. 136346152110096
Author(s):  
Hanne De Jaegher

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 engag ing—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.


2021 ◽  
pp. 136346152110364
Author(s):  
Ardalan Najjarkakhaki ◽  
Samrad Ghane

Migrants and ethnic minorities are at risk of being under- and overdiagnosed with personality disorders (PDs). A culturally informed approach to the classification of PDs guides clinicians in incorporating migration processes and cultural factors, to arrive at a reliable and valid assessment of personality pathology. In this article, we provide a tentative framework to highlight specific interactions between personality disorders, migration processes, and cultural factors. It is argued that migration processes can merely resemble personality pathology, activate certain (latent) vulnerabilities, and aggravate pre-existing personality pathology. We propose that these migration processes can include manifestations of grief about the loss of pre-migratory psychosocial and economic resources, and the struggle to attain psychosocial and economic resources in the host culture. Moreover, several cultural dimensions are outlined that can either resemble or mask personality pathology. The term “culturally masked personality disorder” is coined, to delineate clinical cases in which cultural factors are overused or misused to rationalize behavioral patterns that are consistently inflexible, distressing, or harmful to the individual and/or significant others, lead to significant impairment, and exceed the relevant cultural norms. Additionally, the role of historical trauma is addressed in the context of potential overdiagnosis of personality disorders in Indigenous persons, and the implications of misdiagnosis in migrants, ethnic minorities, and Indigenous populations are elaborated. Finally, clinical implications are discussed, outlining various diagnostic steps, including an assessment of temperament/character, developmental history, systemic/family dynamics, migration processes, cultural dimensions, and possible historical trauma.


2021 ◽  
pp. 136346152110363
Author(s):  
Janne L. Punski-Hoogervorst ◽  
Sarah N. Rhuggenaath ◽  
Jan Dirk Blom

Brua is an Afro-Caribbean religion and healing tradition predominantly practised on the ABC islands of the former Netherlands Antilles. It is grounded in oral tradition and shrouded in strict social taboos. Existing literature suggests that the majority of people on and from the islands are familiar with Brua and that it plays a substantial role in shaping their illness conception and idioms of distress. A lack of knowledge of Brua may therefore lead biomedically trained health professionals to misdiagnose these patients. This article discusses how religious beliefs related to Brua influence the illness concepts and idioms of distress of psychiatric patients originating from the ABC Islands, based on semi-structured interviews with former islanders receiving treatment at a psychiatric institute in the Netherlands. We found that of the 29 interviewees, 93.1% knew what Brua involved, 72.4% believed in it, 48.2% had first-hand experience with Brua practices, and 34.5% attributed their mental illness to Brua with greater or lesser certainty. However, only one patient had previously discussed her belief in Brua with her psychiatrist and only when asked to do so. The role of psychoactive substances in the context of Brua practices was negligible. Thus, the present study indicates that the majority of psychiatric patients from the ABC islands are familiar with Brua, but feel reluctant to discuss their concerns in this area with mental health professionals. Recommendations for clinical practice and further research are provided, including the need for a culture-sensitive approach and integrative care.


2021 ◽  
pp. 136346152110364
Author(s):  
Tanya Kane ◽  
Suzanne H. Hammad ◽  
Nazmul Islam ◽  
Noor Al-Wattary ◽  
Justin Clark ◽  
...  

Care for persons with dementia in the Middle East and North Africa (MENA) is undertaken predominantly by family members, domestic workers, and private nurses within the home. Domestic caregivers possess different understandings and varying degrees of knowledge of dementia that are influenced by complex socio-cultural and religious factors. With much of the burden falling on the shoulders of “invisible” caregivers, the role and needs of these individuals require deeper scrutiny. The purpose of this scoping review was to examine the empirical studies published on caring for persons with dementia in Arab countries of the MENA region. Using a systematic review technique, searches were conducted on PubMed, Embase, Web of Science, Scopus, and Google Scholar using database-specific terms associated with caregiving, dementia, aging, and the MENA region. To ensure local and regional research was captured, hand searches of regional journals, reference lists of included articles, and Arabic databases Al-Manhal and e-Marefa were also searched. No date restrictions were imposed. Twenty studies met inclusion criteria and the following themes were identified: caregiving experiences and the burden of care; barriers to caregiving; and caregiver recommendations to improve care. Results demonstrate that studies about informal caregivers and dementia within Arab-Muslim populations are underrepresented in the research. This review highlights the paucity of literature on service users’ experiences and underscores the need for future research specific to dementia care within the Arab-Islamic sociocultural context. These trajectories are especially pertinent given the unprecedented aging demographics of the MENA populations.


2021 ◽  
pp. 136346152110363
Author(s):  
David Dupuis

The effects of so-called “psychedelic” or “hallucinogenic” substances are known for their strong conditionality on context. While the so-called culturalist approach to the study of hallucinations has won the favor of anthropologists, the vectors by which the features of visual and auditory imagery are structured by social context have been so far little explored. Using ethnographic data collected in a shamanic center of the Peruvian Amazon and an anthropological approach dialoguing with phenomenology and recent models of social cognition of Bayesian inspiration, I aim to shed light on the nature of these dynamics through an approach I call the “socialization of hallucinations.” Distinguishing two levels of socialization of hallucinations, I argue that cultural background and social interactions organize the relationship not only to the hallucinogenic experience, but also to its very phenomenological content. I account for the underpinnings of the socialization of hallucinations proposing such candidate factors as the education of attention, the categorization of perceptions, and the shaping of emotions and expectations. Considering psychedelic experiences in the light of their noetic properties and cognitive penetrability debates, I show that they are powerful vectors of cultural transmission. I question the ethical stakes of this claim, at a time when the use of psychedelics is becoming increasingly popular in the global North. I finally emphasize the importance of better understanding the extrapharmacological factors of the psychedelic experience and its subjective implications, and sketch out the basis for an interdisciplinary methodology in order to do so.


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