The Role of Culture, Values and Trauma in Shaping Abnormal Bodily Experience in Migrants

The way somatization is expressed—including the actual somatoform symptoms experienced—varies in different persons and in different cultures. Traumatic experiences are intertwined with cultural and social values in shaping the resulting psychopathological phenomena, including bodily experiences. Four ideal-typical cases are presented to show the different levels involved. The effects of trauma, culture and values may be pathofacilitating (creating a social context which is necessary for the experience to take place), pathogenetic (taking a causal role in the onset of the psychopathological reaction), pathoplastic (shaping the form such a psychopathological reaction takes) or pathointerpretive (different interpretation of the same symptoms depending on the patient’s beliefs). While the roles of trauma and culture were already well recognized in previous accounts, this chapter adds an exploration of the importance of values, including cultural values, in the aetiology, presentation and management of somatization disorders. As a consequence, the therapeutic approach has to be adjusted depending on the way these factors intervene in the patient’s construction of mental distress.

Linking Science with People: An Introduction to Part IV, Science

This chapter outlines how the contributions to this Part illustrate the role of a culturally enriched model of values-based practice in linking science with people. Chapters 25, “A Cross-Cultural Values-Based Approach to the Diagnosis and Treatment of Dissociative (Conversion) Disorders,” 26, “Treatment of Social Anxiety Disorder or Neuroenhancement of Socially Accepted Modesty? The Case of Ms. Suzuki,” 27, “Nontraditional Religion, Hyper-religiosity, and Psychopathology: The Story of Ivan from Bulgaria,” and 28, “Journey into Genes: Cultural Values and the (Near) Future of Genetic Counselling in Mental Health” explore the three principles of values-based practice defining its relationship with evidence-based practice. Chapters 29, “Policy-Making Indabas to Prevent “Not Listening”: An Added Recommendation from the Life Esidimeni Tragedy,” 30, “Covert Treatment in a Cross-Cultural Setting,” and 31, “Discouragement Towards Seeking Health Care of Older People in Rural China: The Influence of Culture and Structural Constraints” then give examples of the rich resources of the wider values tool kit for linking science with people (the African indaba, transcultural ethics, and anthropology). The concluding chapter, the autobiographical chapter 32, “Discovering Myself, a Journey of Rediscovery,” illustrates the role of cultural values (particularly of the positive StAR values) in recovery. A cross-cutting theme of the contributions to this Part is the importance of the cultural and other values impacting on psychiatric diagnostic assessment in supporting best practice in person-centered mental health care.

Disha: Building Bridges-Removing Barriers: Where Excluded and Privileged Young Adults Meet

The Chapter aims to detail out the need and process for setting up a Peer Support and Speak Out group in 1992 against the backdrop of early years of globalization in India. The chapter describes how the group has evolved, describing some of the activities and its outcomes. Case studies of Disha Coordinators (using narratives) place before the reader, both the challenges and vantage point views of student diversity. The coordinators are a mix from underprivileged and privileged backgrounds. In the last 27 years, Disha has managed to help students from diverse backgrounds (rural and urban poor, Dalit, Bahujan, urban upper middle class, international students) to come together and look at mental health issues from their varied locations of caste, class, gender, region and reconstitute their identities and look at life afresh. The chapter tries to document some of these rich insights and in doing so attempts to add to the value-based mental health practice from a small margin of the largest democracy in the world that is pushing and challenging the centre.

Values-Based Practice When Engaging with Voice-Hearers

This chapter explores the values issues arising in voice-hearing through the resources of a new skills-based approach to working with values called values-based practice. The chapter is focused on the experiences of two voice-hearers, Paul and Mary, so as to highlight the diversity of ways that people experience voice-hearing, and how a correspondingly nuanced way of supporting voice-hearers is needed. It employs an inclusive definition of values covering anything that matters or is important to the person concerned. The chapter demonstrates that values-based practice in voice-hearing supports shared decision-making when working with values challenges in health care. Both Paul’s and Mary’s stories offer illustrations of the complex and sometimes conflicting values associated with voice-hearing.

Case Studies in the Culture of Professional Football Players and Mental Welfare and Wellbeing

This chapter draws on the author’s personal experience together with the findings from his qualitative research, to explore the cultural values driving problems of mental health and well-being among professional footballers. The study makes explicit the way in which players are expected to hide their experiences of being objectified—of being subject to gendered, racialised and other forms of dehumanisation—and denied a legitimate lived experience, an authentic heard voice. The chapter illustrates the importance in values-based practice of knowledge of values gained as in this instance by way of qualitative methods from the social sciences being used to fill out knowledge derived from individual personal experience.

Colonial Values and Asylum Care in Brazil: Reclaiming the Streets Through Carnival in Rio de Janeiro

This chapter shows how carnival has been used to counter the impact of Brazil’s colonial history on its asylums and perceptions of madness. Colonisation of Brazil by Portugal in the nineteenth century led to a process of Europeanisation that was associated with dismissal of non-European customs and values as “mad” and sequestration of the poor from the streets into asylums. Bringing together the work of the two authors, the chapter describes through a case study how a carnival project, Loucura Suburbana (Suburban Madness), in which patients in both long- and short-term asylum care play leading roles, has enabled them to “reclaim the streets,” and re-establish their right to the city as valid producers of culture on their own terms. In the process, entrenched stigmas associated with having a history of mental illness in a local community are challenged, and sense of identity and self-confidence can be rebuilt, thus contributing to long-term improvements in mental well-being. Further illustrative materials are available including photographs and video clips.

Antonella: ‘A Stranger in the Family’—A Case Study of Eating Disorders Across Cultures

The story of Antonella illustrates the way in which cultural and other values impact on the presentation and treatment of eating disorders. Displaced from her European home culture to live in Canada, Antonella presents with an eating disorder and a fluctuating tableau of anxiety and mood symptoms linked to her lack of a sense of identity. These arose against a background of her adoption as a foundling child in Italy and her attachment problems with her adoptive family generating chronically unfixed and unstable identities, resulting in her cross-cultural marriage as both flight and refuge followed by intense conflicts. Her predicament is resolved only when after an extended period in cultural family therapy she establishes a deep cross-species identification by becoming a breeder of husky dogs. The wider implications of Antonella’s story for understanding the relationship between cultural values and mental health are briefly considered.

Vectors of Best Practice: An Introduction to Part III, Practice

This chapter introduces Part III of the book. Contributing chapters illustrate the role of a culturally enriched form of values-based practice in building best practice in the design and delivery of contemporary mental health services. Topics covered from the model of values-based practice set out in chapter ‘Surprised by Values: An Introduction to Values-Based Practice and the Use of Personal Narratives in this Book’ include, person-values-centred care, the extended multidisciplinary team, shared clinical decision-making supported by dissensus within frameworks of shared values, and recovery practice. The bottom-line message is that incorporated into values-based practice, cultural values cease to operate as barriers to, and instead become effective vectors of, best practice in mental health.

Living at the Edge of Compromise: Balkan Pluralism as a Resource for Balanced Decision-Making

This chapter presents a case study from Eastern Europe illustrating Balkan pluralist cultural values as a resource for balanced dissensual decision-making in values-based practice. In responding to his neighbor Ivailo’s request for a loan, Dr. Petrov has to balance the conflicting demands of financial prudence and humanitarian neighborliness. In this, he draws on the Balkan tradition of ‘living at the edge of compromise’ required to survive several centuries of occupation by different colonizing powers. Balkan pluralism so derived provides a counter example to the idea that people are inherently monistic rather than pluralistic in their response to conflicting values and thus opens up new approaches to implementing values-based practice.

Inside and Out: How Western Patriarchal Cultural Contexts Shape Women’s Relationships with Their Bodies

In response to the view that suggests eating disorders are a form of individual psychopathology, this chapter is written to suggest that individuals with eating disorders exist within a social context with values about appearance ideals, the construction of gender, and the threat of sexualized violence. This chapter uses the story of a woman named Annie with an Anorexia Nervosa diagnosis, and her experiences with clinical treatment which in some cases contributed to her sense of psychopathology, and in other cases help with both a decrease in her symptoms and her sense of discovery of herself as a person. Values implicit in the narrative, and implications for psychotherapy are also discussed.