Orphans in post-conflict Liberia: Seeking care in fractured communities

Orphans in post-conflict settings have unique needs that have not been well-characterized. In post-conflict Liberia, maternal orphans are more likely to be without care than paternal orphans. This study examined the experiences of maternal orphans in Liberia, as they attempted to care for themselves and seek care from others, and the barriers they faced. In-depth interviews were conducted with 75 post-conflict Liberian orphans. We performed a secondary narrative analysis of interview transcripts from all maternal or double orphans (n = 17). We identified similar elements across narratives: traumatic loss, disconnection from family and community, and the desire for a savior. Female high-risk orphans were more likely to have formal substitute caregiving arrangements in which they were living with someone who was a relative or had been selected by a relative. Male orphans more commonly lacked arranged substitute care, but this allowed them to form relationships with substitute caregivers of their choosing. Sex also played a role in the provision of caregiving; substitute care was provided by women. Findings highlighted the syndemic relationship between poverty, violence, transactional sex, trauma, and substance use that traps high-risk Liberian orphans. Interventions are needed to improve access to mental health care, sober communities, housing, and education support. The need to integrate these services into indigenous institutions and address barriers related to stigma is explored.

Identity and memory as resilience: Applications of liberation psychology in a rural Maya Achi community

This study sought to understand interpretations of interconnections between historical trauma, contemporary violence, and resilience in a Maya Achi community currently engaged in promoting peace and social change through popular education. In particular, the ways in which participants drew upon identity and memory in articulating characteristics of community distress and resilience are discussed. The research is informed by liberation psychology and critical perspectives of mental health, particularly considering the challenges inherent in the promotion of collective memory of trauma and resistance in contexts of violence and humanitarian settings. Participant reflections on historical and contemporary violence highlight elements of collective distress, connecting identity and memory with acts of both oppression and resistance. Education and development are signaled as possible sites of resilience but also experienced as sites of power upholding the status quo. Diverse experiences and applications of identity and memory provide insight into the ways in which community organizations working in contexts of political violence might navigate polarizing and paradoxical discourses in order to subvert, co-opt, or adapt to hegemonic cultural, political, and economic power relations in the process of transformation for collective resilience.

Perceived Discrimination, Experiential Avoidance, and Mental Health among Hispanic Adults in Primary Care

The Hispanic population is the largest minority group in the United States and frequently experiences racial discrimination and mental health difficulties. Prior work suggests that perceived racial discrimination is a significant risk factor for poorer mental health among Hispanic in the United States. However, little work has investigated how perceived racial discrimination relates to anxiety and depression among Hispanic adults. Thus, the current study evaluated the explanatory role of experiential avoidance in the relation between perceived racial discrimination and anxiety/depressive symptoms and disorders among Hispanic adults in primary care. Participants included 202 Spanish-speaking adults ( Mage = 38.99, SD = 12.43, 86.1% female) attending a community-based Federally Qualified Health Center. Results were consistent with the hypothesis that perceived racial discrimination had a significant indirect effect on depression, social anxiety, and anxious arousal symptoms as well as the number of mood and anxiety disorders through experiential avoidance. These findings suggest future work should continue to explore experiential avoidance in the association between perceived racial discrimination and other psychiatric and medical problems among the Hispanic population.

A comparative study of mental health diagnoses, symptoms, treatment, and medication use among Orthodox Jews

Historical clinical reports and media narratives suggest that Orthodox Jews are reticent to seek treatment for mental illness, present only with serious concerns, and hesitate to comply with treatment in general and psychopharmacology in particular. On the other hand, recent developments, and some limited research, suggest that Orthodox Jews may be likely to seek and comply with treatment. The current study compared the diagnostic, symptomatic, and treatment characteristics of 191 Orthodox Jews and 154 control patients all presenting to a large private mental health clinic with offices throughout greater New York. Results indicated that the groups were largely demographically similar, and that their diagnoses did not significantly differ. Orthodox Jews initially presented with lower levels of symptoms, terminated with similar symptom levels, attended a similar number of sessions, and were equally likely to use psychopharmacological interventions of similar types, compared to controls. This was equally true of ultra-Orthodox and modern Orthodox Jews. Clinicians providing mental health services to Orthodox Jews should be aware of these findings, which contrast with existing clinical and popular stereotypes. Further, excessive efforts to protect Orthodox Jewish patients against stigma may be unnecessary and counterproductive.

Refugee posttraumatic growth: A grounded theory study

In response to the unprecedented refugee crisis around the world, a growing body of research has focused on psychological distress among individuals and families forced to flee their homelands. Less attention has been directed toward understanding resilience, adaptation, and growth among this population. This grounded theory study explored the posttraumatic growth experiences of Middle Eastern and Afghan refugees resettled in the United States. The principal researcher conducted 23 interviews with seven couples and 16 individuals aged 25 to 67 years, from Afghanistan, Iraq, Iran, and Syria. This study aimed to explore how refugees understand, process, overcome, and grow from the trauma and adversity they have experienced. Findings were used to delineate a model of the process through which refugees experience posttraumatic growth. The overarching theme of moving forward had five specific growth themes: increased awareness of context; tolerating uncertainty; spiritual/religious attunement; consideration of others; and integrating into society. Findings shed light on the complex process of growth and adaptation in the aftermath of war and forced migration. The model can serve as a tool for clinicians to facilitate more empowering posttraumatic narratives with refugee clients rooted in growth experiences.

Metaphor and the politics and poetics of youth distress in an evidence-based psychotherapy

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.

Overcoming epistemic injustices in the biomedical study of ayahuasca: Towards ethical and sustainable regulation

After decades of biomedical research on ayahuasca's molecular compounds and their physiological effects, recent clinical trials show evidence of therapeutic potential for depression. However, indigenous peoples have been using ayahuasca therapeutically for a very long time, and thus we question the epistemic authority attributed to scientific studies, proposing that epistemic injustices were committed with practical, cultural, social, and legal consequences. We question epistemic authority based on the double-blind design, the molecularization discourse, and contextual issues about safety. We propose a new approach to foster epistemically fair research, outlining how to enforce indigenous rights, considering the Brazilian, Peruvian, and Colombian cases. Indigenous peoples have the right to maintain, control, protect, and develop their biocultural heritage, traditional knowledge, and cultural expressions, including traditional medicine practices. New regulations about ayahuasca must respect the free, prior, and informed consent of indigenous peoples according to the International Labor Organization Indigenous and Tribal Peoples Convention no. 169. The declaration of the ayahuasca complex as a national cultural heritage may prevent patenting from third parties, fostering the development of traditional medicine. When involving isolated compounds derived from traditional knowledge, benefit-sharing agreements are mandatory according to the United Nations’ Convention on Biological Diversity. Considering the extremely high demand to treat millions of depressed patients, the medicalization of ayahuasca without adequate regulation respectful of indigenous rights can be detrimental to indigenous peoples and their management of local environments, potentially harming the sustainability of the plants and of the Amazon itself, which is approaching its dieback tipping point.

Climate change and Indigenous mental health in the Circumpolar North: A systematic review to inform clinical practice

Climate change is disproportionally impacting the Circumpolar North, with particular impacts among Indigenous populations. Environmental changes are felt in many aspects of daily life of Northern communities, including both physical and mental health. Thus, health institutions from around the Arctic must meet emerging needs, while the phenomenon remains marginal to their southern counterparts. In this systematic review, we aimed to review current scientific knowledge on the mental health impacts of climate change in Indigenous Peoples across the Circumpolar North. Seven databases were searched. Original peer-reviewed research articles were included if they addressed links between climate change and mental health in Arctic or Subarctic Indigenous Populations. After extraction, data were synthesized using thematic analysis. Of the 26 articles that met inclusion criteria, 16 focused on Canadian Inuit communities and 21 were exclusively qualitative. Being on the land was identified as a central determinant of wellbeing. Immediate impacts of climate change on mental health were felt through restricted mobility and disrupted livelihoods. Effects on mental health were further felt through changes in culture and identity, food insecurity, interpersonal stress and conflicts, and housing problems. Various ways in how communities and individuals are coping with these effects were reported. Understanding climate-related pathways of mental health risks in the Arctic is crucial to better identify vulnerable groups and to foster resilience. Clinicians can play a role in recognizing and providing support for patients affected by these disruptions. Policies sensitive to the climate–mental health relationship must be advocated for.

Starving to death and the anorexic frame of mind

Because some forms of self-starvation such as hunger striking are exempt from attributions of pathology, and due to incomplete understanding of its etiology, anorexia nervosa (AN) is and must presently be defined by psychological criteria as well as behavioral and bodily measures. Although opaque, typical motivational frames of mind in AN lack the apparent cognitive and volitional dysfunction usually indicating disorder. In contrast to other conditions that exhibit more evident dysfunction, this distinguishes AN from the perspective of medical epistemology: the opacity of AN motivation jeopardizing the epistemic warrant for assigning it to the category of a mental disorder (and so influencing decisions over diagnosis and recovery). This seems to invite non-medical approaches to its prevention and care.

Psychosocial concerns in a context of prolonged political oppression: Gaza mental health providers’ perceptions

In this qualitative exploratory study, we investigated the perspectives of mental health providers in Gaza, Palestine, regarding the primary concerns of their clients who are exposed to low-intensity warfare and structural violence. We conducted qualitative interviews with 30 psychologists, social workers, psychiatric nurses, and psychiatrists providing services to communities in Gaza. Participants were asked to discuss their clients’ most commonly occurring mental health problems, diagnoses, and psychosocial conditions. Thematic analysis identified one superordinate theme (Impact of the Blockade on Mental Health and Quality of Life) and four second-order themes (Concerns about Social Problems, General Concerns about Quality of Life, Concerns about the Mental Health of the Community, and Concerns Related to Children's Mental Health). Participants indicated that the social and political dimensions of mental health and the economic, educational, and health-related consequences of the ongoing blockade of Gaza were the main determinants of psychological burden among their clients. Findings demonstrated the importance of adopting an approach to mental health that includes understanding psychological indicators in a broader framework informed by human rights and social justice. Implications for research and clinical work are discussed, including the role of investments in social capital that may provide individuals with access to resources such as social support, which may in turn promote overall mental health.