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This paper is divided into two parts. First I argue for the existence of a death-conscious culture in Iran, traceable in religious and literary texts, and manifested strongly in the discourse following the Iran-Iraq war. I then look at how this culture influences articulations and experiences of depression as felt by Iranian patients. Adopting a phenomenological perspective and drawing on empirical data, I show how death-consciousness, as a point of cultural divergence between the UK and Iran, can be used to account for some of the phenomenologically significant cultural variations in the experience of depression. These include attitudes towards suicide, the significance of feelings of hopelessness, and the existence of a sense of absurdity among Iranian patients. [ABSTRACT FROM AUTHOR]

Cultural diversity poses a challenge to mental Health care systems in many settings. Specialized cultural consultation services have been developed in a number of countries as a way to supplement existing services. The objective of this paper is to compare and contrast cultural consultation services in Montreal, London, and Paris to determine how culture and society have shaped the evolution of these services to meet local sensitivities and imperatives. Historical contexts of the sites, their descriptions and origins, how they categorize cultural, ethnic, and linguistic diversity, and their intake procedures are compared and contrasted according to a standardized template of themes. Data came from site visits and participant observation at each site. For historical, political, and cultural reasons, categorization of diversity and intake procedures differ markedly by site: Montreal focuses on language categories and language proficiency; London enumerates ethnic diversity according to officially mandated categories; and Paris does not gather ethnic data on its patients in any form. The process of cultural consultation, specifically its triage and intake procedures, is profoundly influenced by local histories and social norms that are maintained by professional cultures of psychiatry in each setting. To properly place their patients in context, cultural psychiatrists must not only aim to understand the culture of the other, but also must consider the culture of the mainstream society and how it shapes the delivery of services. [ABSTRACT FROM AUTHOR]

Eating disorder diagnoses are characterised by a pattern of disordered eating behaviour alongside symptoms such as body dissatisfaction and preoccupation with food, weight or shape (APA in Diagnostic and statistical manual of mental disorders, DSM-5, APA, Washington, DC, 2013). Incidence rates for eating disorders have increased during the last 50 years. However, epidemiological studies have suggested that such trends may not be a true representation of the occurrence of these illnesses in the general population, with figures underestimated due to reduced help seeking and poor access to care, particularly amongst ethnic minorities. This case study explores the experiences of a young British Indian woman with bulimia nervosa. Arising from an in-depth semi-structured interview, analysed with interpretative phenomenological analysis, her narrative offers a critical lens onto how diverse fragments of cultural practices and meanings come together to produce the clinical category of 'bulimia.' It thereby offers an alternative portrait of relationships between eating disorders and 'culture,' one that goes beyond a framing of these illnesses as culture inscribed on the body. Interrogating relationships between culture and the development, expression and maintenance of bulimia is suggested to be key to forging culturally-sensitive understandings of this illness; this paper begins to provide the evidence base for the design and development of appropriate support services, thereby aiming to contribute to a reduction in health inequalities and barriers to treatment. [ABSTRACT FROM AUTHOR]

Drawing on participant-observation and semi-structured interviews, this paper examines the local forms of clinical practice in a 26-bed acute psychiatric inpatient unit located within a private psychiatric hospital in the Northeastern United States. It focuses on how clinicians, staff, and management understand and utilize the concepts of culture, race, and ethnicity in their daily work, finding that a humanistic approach to care that that treats patients as "individuals" was dominant. Clinicians and staff categorized patients using descriptive, behavior based categories including language, propensity for violence, and whether patients are "from the streets." They also used additional forms of difference such as the patient's pathway to care, their illness category or severity, and whether they use drugs. These forms of difference were shaped by the urgent needs of daily work. These local practices of categorization directly affected the quality of care when staff members assigned cultural characteristics to group members and treated them differently as a result. These findings suggest that anthropologists and clinicians should focus on the way new forms of cultural difference are constructed in small social settings in order to provide equitable treatment to all patients. [ABSTRACT FROM AUTHOR]

Mental disorders or altered psychological states are prevalent in all populations, regardless of race or ethnic origin, while at the same time, culture also shapes the conceptions of mental disorders. Religion is deeply rooted in the daily life of the Muslim-majority countries, while Arab countries are affected by an ongoing modernization. Thus, how does the traditional religious conception of mental disorders interact with Western psychological conceptions in contemporary Arab-Muslim society? This study explores the conceptions of mental disorders and their causes among Muslims in contemporary Jordan. By employing cognitive anthropological method (free listing), forty participants were asked to provide three lists of (a) typical names of mental disorders, (b) causes of mental disorders and (c) determining features of mental disorders. Collected qualitative data have been quantitatively analysed and interpreted in the context of relevant ethnographic and interview data. While Western terms of mental disorders are well known among young and educated Jordanians, the study demonstrates that Jordanians employ cultural and religious notions alongside. This co-existence of different conceptions confirms an importance of Islamic notion in the modern rendering of mental health. As a result, despite rapid modernization, mental health is still highly stigmatized. [ABSTRACT FROM AUTHOR]

This paper focuses on traditional healers (balian) in Bali, Indonesia, to raise new arguments concerning the nature of the initiatory sufferings reportedly experienced by shamans in many cultures. Our evidence suggests that a) contrary to our expectations, an initiatory madness or illness is experienced by a minority rather than the majority of balian, and b) whether or not a balian undergoes initiatory sufferings seems to be linked to gender and to the methods of healing employed - thus women healers who employ trance possession are those most likely to report an initiatory madness or illness. This leads to the central argument of the paper: c) the nature of the initiatory sufferings, where they do occur, can be clearly distinguished on several grounds from the onset of mental illness among Balinese, both emically in terms of cultural understandings, and ethically in terms of objective criteria. Finally we discuss the concept of "autonomous imagination," suggesting that the key to becoming a balian is not overcoming an initiatory madness but gaining control over this special mode of imagery thought. We further suggest that Western ideas concerning the self and self healing, the superficial resemblance of the initiatory sufferings to schizophrenia, and the dramatic nature of the initiatory sufferings when they occur, have combined to give a misleading prominence to the role of an initiatory madness in shamanism. [ABSTRACT FROM AUTHOR]

This paper examines the effect of the cultural category ataques de nervios on responses to the Puerto Rican Diagnostic Interview Schedule (DIS), a Spanish version of structured psychiatric diagnostic interview developed for the NIMH Epidemiologic Catchment Area study. An ataque de nervios scale was created from the Somatization items of the DIS to explore the effect of this culturally meaningful category of distress on responses to a standard psychiatric interview. Analysis of 1,513 cases from a representative sample of the island of Puerto Rico indicated that people reporting ataque symptoms fit the social characteristics described for ataques sufferers in the ethnographic literature. Qualitative data indicated that Puerto Ricans were reporting ataques de nervios in the panic section of the DIS. Questions are raised about the validity of the somatization and panic sections of the DIS in cross-cultural research with Hispanics. [ABSTRACT FROM AUTHOR]

The notion of 'mental health literacy' has been proposed as a way of improving mental health problem recognition, service utilisation and reducing stigma. Yet, the idea embodies a number of medical-model assumptions which are often at odds with diverse communities' spiritual traditions and local belief systems. Twenty participants were recruited to this study consisting of mental health service users (N = 7), family carers (N = 8) and community members (N = 5) in a temple town in Kerala, South India participated in semi-structured interviews exploring the variety of beliefs and practices relating to mental health. Our findings indicate that the issue may be better understood in terms of multiple mental health literacies which people deploy in different circumstances. Even those sceptical of traditional and spiritual approaches are knowledgeable about them, and the traditional practices themselves often involve detailed regimes of activities aimed at effecting an improvement in the person's mood or condition. Therefore, we argue it is appropriate to consider mental health literacy not as a unitary universal phenomenon but instead as a mosaic of different literacies which may be deployed in different settings and in line with different experiences and which may operate in synergy with each other to enable treatment but also facilitate a sense of meaning and purpose in life. [ABSTRACT FROM AUTHOR]

While much of Medical Anthropology was and is what we can call "Normal" (following Kuhn) Medical Anthropology, I coined the term Millennial Medical Anthropology for that branch of the discipline that, in the 1990s, was departing from the Normal research paradigms and was deserving of a distinct sobriquet. This paper considers the Strong Program in Medical Anthropology's Millennial Medical Anthropology and its key subdivisions, the Cultural Studies of Science and Cultural Bioethics. Specifically it considers Medical Anthropology's movement from the past into an ethical future wherein Normal Biomedicine, Bioethics and Global Health are problematized. This provides the basis for the construction of a truly anthropological global health (i.e., Global, Global Health or Global Health 2.0). [ABSTRACT FROM AUTHOR]

Accumulating evidence suggests that folktales in some societies are characterized by a culturally constructed underlying emotional structure, or Cultural Emotion Schema. In this paper we argue that Matsigenka illness narratives and folk stories share an underlying emotion schema, in which death and suffering result from conflicts between strong-willed individuals prompting anger and aggression. Analysis of illness narratives collected by Izquierdo in the Matsigenka community of Kamisea in the Peruvian Amazon between 1996 and 1999 reveals a common pattern in which envy and frustration lead to the belief in sorcery as the main cause of illness and death. This pattern contrasts with the typical stories of a previous generation collected by the Johnsons among the Matsigenka of Shimaa and other Matsigenka researchers, where sorcery beliefs were virtually absent. Our argument is that important changes in ecology, community, politics, and religion have led to a systematic rise in feelings of envy and frustration, and that these have increased the likelihood that sorcery accusations will occur. We explore the likelihood that such beliefs increase as egalitarian peoples become more crowded into settlements where they are likely to experience greater inequality, more competition for resources and increased societal and personal stress. [ABSTRACT FROM AUTHOR]

Cultural consonance is the degree to which individuals, in their own beliefs and behaviors, approximate widely shared cultural models. In previous research in Brazil and the United States we found that higher cultural consonance in the cultural domains of lifestyle and social support was associated with lower psychological distress. The aim of this paper is to expand on these results in two ways. First, the measurement of cultural consonance has been improved through a closer link of cultural domain analyses and survey research. Second, the number of domains in which cultural consonance has been examined has been expanded to include-along with lifestyle and social support-family life, national identity, and food. We found that cultural consonance in these five domains can be conceptualized as two latent variables of generalized cultural consonance, and that this generalized cultural consonance is associated with lower psychological distress. These results continue to support the usefulness of cultural consonance as a theoretical construct in the explanation of human social suffering. [ABSTRACT FROM AUTHOR]

The main goal of this paper is to evaluate the Supplement to the Surgeon General's Report on Mental Health, with an eye toward informing future efforts to prevent and treat mental illness among racial and ethnic minorities. I first briefly discuss the historical background of the Supplement. I then present its strengths, which include the authority and visibility of the Office of the Surgeon General, the organization of the report by racial/ethnic group, the examination of the social and historical context of each of the racial/ethnic groups, and the emphasis on science. Last, I identify three major tensions within the Supplement, focusing on groups versus cultural processes, situating culture within individuals or social worlds, and examining differences between minority groups and whites versus examining conceptually informed processes. The Supplement makes a significant contribution to advancing our understanding of the mental health of racial and ethnic minority groups. The actions that follow (or don't follow), however, will determine the import of this document. [ABSTRACT FROM AUTHOR]

The August 2001 issuance of Mental Health: Culture, Race, and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General, represents a landmark in the dialogue--political and scientific--regarding health disparities in the United States. This paper offers a critical appraisal of the process and structure of generating these reports, paying particular attention to issues that marked serious epistemological tensions among the participants. These issues revolved around the relative emphasis placed on (1) mental illness and mental health; (2) risk, etiology, and treatment versus prevention and promotion; (3) large-scale, population-based surveys and randomized clinical trials as the standard bearers of scientific evidence; (4) variation related to gender, social class, and culture; (5) ethnicity and culture as dispositional variables or individual glosses as opposed to dynamic, collective phenomena; and (6) the historical forces that shaped the contemporary context for much of this discussion. It describes the sometimes subtle, other times stark differences in assumptions and experience that sprang from disciplinary orientations, investigative methods, institutional affiliations, and personal histories and agendas. [ABSTRACT FROM AUTHOR]

While attention has been paid to the study of panic disorder (PD) with or without agoraphobia among Caucasians, surprisingly little empirical research within the United States has looked at the phenomenology of PD among minority groups. In this paper we present data we have collected and review other research on the phenomenology, social supports, and coping behavior among African-Americans with panic disorder. Our studies indicate that, in comparison to Caucasians, African-Americans with PD reported more intense fears of dying or going crazy, as well as higher levels of numbing and tingling in their extremities. African-Americans reported higher rates of comorbid post traumatic disorder and more depression. African-Americans also used somewhat different coping strategies (such as religiosity and counting one's blessings), less self-blame, and were somewhat more dissatisfied with social supports. The incidence of isolated sleep paralysis was, as per previous reports, higher in African-Americans. These findings, results of other research, and the implications for assessment and treatment are discussed within a semantic network analysis of panic (Hinton and Hinton 2002, this issue). [ABSTRACT FROM AUTHOR]

Introduces a series of articles on the state of knowledge about anxiety and panic disorders including its diagnostic formulation.

This paper presents the results from a qualitative study conducted with the aim of exploring structures of illness meaning among somatizing Turkish-born migrant women (age 31-48) living in a poor and low status suburb of Stockholm in contact with local health care services. Two to three interviews regarding experiences and understanding of illness were conducted as well as one year, validating follow-up interviews. Interviews were analysed with a grounded theory approach. Results are presented as the participants' agenda of understanding. Distress was communicated by concrete expressions about the body, emotions, social and life situation. Pain was prominent and often lateralised to one side of the body. The use of traditional expressions of distress ranged from open use to avoidance. Attribution was characterised by verbalising links of coherence between health and aspects of life. Psychiatric attribution was rarely accepted or valued as a tool for recovery, or as helpful in linking bodily symptoms to emotional distress. Three main sources for healing were used: medical care in Sweden and in Turkey and traditional treatment. Own capacity to influence recovery was mostly regarded as low. Relations to family and the clinician were regarded as important to recovery. The encounter with local health care had brought the participants in contact with a psychological agenda of understanding their illness and new ways of dealing with illness and healing. Some expressed a feeling of being misunderstood whereas some related positive experiences of re-evaluation. They were all actively trying, but experiencing varying degrees of difficulty, to grasp the meaning of the caregiver. The results of the study point to the mutual need of exploring meaning in the clinical encounter to help patients make sense out of different perspectives of illness and healing. The need for enhanced knowledge about this process in a migration context will be discussed. [ABSTRACT FROM AUTHOR]

This paper seeks to demonstrate that rapid economic development in Hong Kong has transformed not only social structures but also Chinese women's subjectivity and bodily experience, thereby producing new forms of identity, aesthetics and aspirations, in addition to novel patterns of distress. Evidence is assembled to show that women's being-thin-yet-feeling-fat and being-active-yet-feeling-tired reflect not so much psychopathology as transformation in embodied moral experience. Because such normative experiences are grounded in the conflicting demands of production and reproduction that recent social transformations have brought to bear on women's lives, "fat" and "fatigue" can be said to embody what it is to become a woman in contemporary Hong Kong. [ABSTRACT FROM AUTHOR]

The goal of this retrospective pilot study was to provide a naturalistic description of the decision-making process regarding dementia, a chronic illness. The hypothesis was that in-depth descriptions by caregivers in a community setting would provide a more comprehensive and realistic representation of decision-making in the case of chronic illness than has been provided by most models. Data were gathered from in-depth, qualitative interviews with seven Chinese-American families living in the Boston area and caring for an elderly family member with dementia. These were supplemented with interviews with medical professionals and ethnography done in the community regarding the care of elders with dementia. Based on the findings, this paper proposes a dynamic, more comprehensive model for the social process of decision-making which is particularly applicable to clinical and life situations of decision-making in the case of chronic illness. The model describes: 1) the decision-maker constellation, including multiple family members, professionals and service systems; 2) relationships between decision-makers as "allies" or "competitors"; 3) variations in the nature of the decision-making process; and 4) the interaction of decision-making with larger social, economic and cultural forces. Decision-making in the case of dementia is placed within the conceptual framework of the "social course" of chronic illness. [ABSTRACT FROM AUTHOR]

As culture-bound syndromes, Japanese shinkeishitsu ("constitutional neurasthenia") and taijinkyofusho ("anthropophobia") have received considerable attention in the Japanese literature. While these disorders are viewed as diagnostically distinct from Western psychiatric categories, recent studies by the Japanese suggest some affinity with Western social phobias, depression, and schizophrenia. The paper reviews this literature and offers suggestions for further cross-cultural research. [ABSTRACT FROM AUTHOR]

Based on Saedi's description of spirit possession beliefs and practices on the southern coasts of Iran, this paper attempts to isolate the culturally and psychologically significant categories through which the possessed define and differentiate their possessing spirits or "Winds." It examines the play of these categories in the complex of relationships between the possessing spirits, the possessed, ritual specialists, "symptoms" of possession, and their "negotiations" in rituals of possession or exorcism. It examines from a semiotic perspective the double transformations of spirit and host which in the beliefs and practices of the People of the Air constitute "therapy." It points out areas for further research and analysis. [ABSTRACT FROM AUTHOR]

The author has gathered data from Havik Brahmin women on depression. Cultural factors predisposing to depression are especially salient to this analysis. Beck's triad of negative self image, negative interpretation of life events, and negative view of the future is regarded as the cultural ideal for older women. With cultural changes including an increased marriage age, increased educational level, and increased decision-making for women Beck's triad is no longer culturally sanctioned. Although these cultural changes are recent and the sample is too small for a statistical analysis, the article concludes that there is a possible association between depression and cultural factors such as early marriage. Additional possible associations with depression reviewed in this paper are separation from important people, support systems, loss of parent at an early age, poor marital relationship, and the perception of helplessness. [ABSTRACT FROM AUTHOR]

The deinstitutionalization of psychiatric patients is a deeply cultural as well as political task. It entails the sharing of responsibility for human distress with family and community. Consequently, the locus of social control has also shifted from psychiatric and medical expertise to community and legal institutions. Diagnosis and treatment models must be more compatible with lay explanatory models. This paper explores the various meanings of "going 'mental"' and "being 'mental"' in the white, working class, ethnic neighborhood of South Boston. The data are extracted from a study of the impact of deinstitutionalization on a cohort of middle-aged, psychiatric patients discharged from Boston State Hospital in the attempt to return them to community living. Individual, family, and community responses to, and interpretations of, the symptoms of mental distress are discussed. The study indicates that even seriously disturbed individuals are sensitive to cultural meanings and social cues regarding the perception, expression, and content of psychiatric episodes. While madness invariably disenfranchises, it does not necessarily deculturate the individual. [ABSTRACT FROM AUTHOR]

The rapid changes experienced by non-Western ethnic groups as they become "acculturated" to Western life-styles are frequently associated with disintegration of the traditional cultures and psychosocial dysfunction of the groups' members. How culture changes lead to maladaptation remains a mystery. As a first step in clarifying this relationship, this paper proposes a method for analyzing the interaction of cultural change and psychosocial maladjustment. It uses Native Alaskans as a paradigmatic example of a group that is undergoing rapid changes and describes in detail a maladjusted subgroup of Native Alaskans--mentally ill criminal offenders. It compares 567 Native Alaskan criminal offenders who were referred to mental health professionals (from 1977 thru 1981) to 939 White Alaskan offenders. We find that alcohol abuse, the dominant social problem for Native Alaskans, is not clearly associated with the degree of sociocultural change. Residence in larger communities and higher educational achievement are associated with greater psychosocial maladjustment. The region of residence (i.e., Native Corporation) has a stronger influence on the rate and type of maladjustment than the ethnic group (i.e., Eskimo, Indian, or Aleut) or the "ethnic density" of the community of residence (i.e., the proportion of Native Alaskans in the population). We emphasize the importance of using such quantitative findings to focus the questions that should be addressed by ethnographic research. [ABSTRACT FROM AUTHOR]

Despite a growing interest in bereavement in cross-cultural perspective, few reports have described a comparative analysis of bereavement. By examining the social contexts in the transformations of Western bereavement practices, structures common to bereavement in a range of cultures can be identified. The paper compares the contemporary bereavement practices of several ethnic and cultural groups in North America: Blacks; ethnic Chinese; Southeast Asian refugees; Haitians; Italians; Greeks; and Spanish-speaking groups. Consideration is given to the state of widowhood in different cultural systems. The impact of modernization among traditional societies demonstrates that even though Western technologies are incorporated into the procedures followed by these modernizing societies, the deep cultural code remains intact. Five questions require further clarification: is bereavement an illness, or a rite de passage and a normal life event? How widespread and useful are protective factors, such as group support, that facilitate successful resolution of grief? How effective are mourning practices of various ethnic groups in preventing "bad grief", and might some of these practices be beneficial if taken up by other ethnic groups? How can the Western health practitioner know that a bereaved person from an unfamiliar cultural group is suffering "bad grief"? How acceptable is Western grief counseling to non-Western clients? [ABSTRACT FROM AUTHOR]

A survey of the literature in medicine and in comparative education finds virtually no reports of systematic studies of professional education across national boundaries. This paper describes the use of the Priority Sort of Educational Objectives in Mental Health with samples of psychiatric and psychiatric nurse educators in the United States and South Korea. The data suggests a somewhat different pattern of cultural influences in professional education priorities between these disciplines in the two countries. The relative impact of the culture of a profession and of national culture are examined through the data generated on these populations of educators in two culturally dissimilar countries. Despite these differences of culture there has been a great impact of professional education from one country to the other. The resulting data suggest a stronger impact of professional culture with one profession, psychiatry, and a greater impact of national culture with the psychiatric nurse educators. [ABSTRACT FROM AUTHOR]

Most studies of 'evil eye' link economic and political inequality to the fear of appropriation of property while tying envy (invidia) to paranoia. In both psychiatric and anthropological studies of evil eye, explanation of the phenomenon is problematic because the data are retroductive - involving a rationalization of the part of the patient or informant in terms of either delusions or world-view respectively. In this paper the connection between invidia and paranoia is questioned by grounding the analysis of Hutterian beliefs in evil eye in social interaction rather than retroductive explanation. In the case of the Hutterities it is envy itself which is feared and linked to high anxiety levels and sometimes to anxiety attacks or even depression. [ABSTRACT FROM AUTHOR]

There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia ( n = 776), India ( n = 504) and Sarawak, Malaysia ( n = 259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form. [ABSTRACT FROM AUTHOR]

At a psychiatric refugee clinic for survivors of the Khmer Rouge genocide, a survey revealed that 42% (38/90) had auditory hallucinations (AHs) in the last month. Of those with AHs, 87% (33/38) had PTSD, whereas of those without AHs, 31% (16/52) had PTSD, giving a chi square of 27.8, p <.001, odds ratio 14.8 (4.8–45). Most AHs were of a "ghost summoning" (khmaoch hao), considered an exhortation to go with a ghost (e.g., hearing "Please come with me, younger sister"), experienced by 73% percent of patients with AHs. The voices were always exterior and usually loud and clear. AHs were heard most often during hypnagogia (i.e., upon falling asleep or awakening), experienced by 72% of patients with AHs, whereas 42% of patients with AHs experienced AHs when fully awake. AHs were almost always attributed to a ghost, giving rise to great fear: of having the "soul" called away or of being frightened to death. AH episodes almost always triggered trauma recall. AHs caused patients to undertake certain actions to address acute episodes and to prevent further ones. To illustrate these processes, cases are provided. AH appears to be a key part of the Cambodian bioculturally shaped trauma subjectivity. [ABSTRACT FROM AUTHOR]

The article introduces some changes to "Culture, Medicine and Psychiatry," including the changes in the journal's sections and editorial boards.

A small-scale epidemic of genital shrinking occurred in six West African nations between January 1997 and October 2003. This article presents a summary and analysis of 56 media reports of these cases. A clinical formulation of these cases considers a variety of explanations from theory and research in social and cultural psychology, psychopathology, and anthropology. Of particular interest is a comparison of genital-shrinking distress in West African settings with koro, a culture-bound syndrome involving fears of genital retraction that is prominent in Southeast Asian settings. The paper concludes with a brief discussion of the role of culture in both the experience of genital-shrinking distress and conceptions of psychopathology. [ABSTRACT FROM AUTHOR]

This paper discusses research on men's reproductive health and sexuality in Oaxaca, Mexico, and specifically why some men there choose to be sterilized. Men who opt for vasectomies do so after considering numerous cultural, historical, physiological, commercial, and other concerns. Men and women in Oaxaca negotiate certain cultural folk beliefs about supposed male sexual desires and practices before arriving at the decision to get the operation. Vasectomy as a method of birth control is chosen despite folk beliefs that take the form of a totemic illusion which treats male sexuality as naturalized, something fixed, and as entirely distinct from female sexuality. Among its many consequences, this totemic illusion serves to conceal inequalities in the sphere of reproductive health and sexuality in relation to contraception. [ABSTRACT FROM AUTHOR]

Analyzes the role of social and cultural changes in the emergence of eating disorders in non-Western countries. Reason for the appearance of eating disorders in non-Western places; Behaviors associated with eating disorders; Definition of acculturation.

My earlier considerations of Flathead loneliness and depressive disorder yielded an interpretation that emphasized the lack of necessary pathology in the Flathead experience of loneliness. In this paper I detail a shift in my thinking about the pathological character of loneliness, a shift traceable to a set of interactions that have led me away from illness experience and diagnosis to questions of treatment, intervention, and healing. I explore how this new set of questions refocused my attention—away from an exclusive preoccupation with the lonesome individual. I conclude with a reimagination of the pathological dimensions of Flathead loneliness as aspects of both group and individual health. [ABSTRACT FROM AUTHOR]

This paper presents the results of a larger study conducted among Southern Sudanese refugees in Cairo, Egypt. "Illness talk" and body metaphors are the focus of the present work, which is based mainly on an analysis of the illness narratives of people attending a church-run medical clinic. The findings suggest that refugees use certain narrative styles in discussing their illnesses that highlight the interconnection of bodily ills and refugee-related trauma. The refugees narrated the histories of their illnesses in terms consistent and coterminous with their refugee histories, and articulated illness causes in terms of threatening assaults on their sense of self as human beings and as part of a distinct community and culture. The use of embodied metaphors to understand and cope with their current and past traumatic experiences was echoed in narratives that were nonillness related. Metaphors such as "the heart," "blood," and "body constriction" were consistently used to discuss social and cultural losses. Understanding the role that the body plays in experience and communication within a given cultural context is crucial for physicians and others assisting refugees. [ABSTRACT FROM AUTHOR]

Interoceptive awareness is the conscious perception of sensations that create a sense of the physiological condition of the body. A validation study for the Japanese translation of the Multidimensional Assessment of Interoceptive Awareness (MAIA) surprised with a factor structure different from the original English-language version by eliminating two of eight scales. This prompted an exploration of the similarities and differences in interoceptive bodily awareness between Japanese and European Americans. Bicultural Japanese-Americans discussed concepts and experiences in the two cultures. We conducted focus groups and qualitative thematic analyses of transcribed recordings. 16 participants illustrated cross-cultural differences in interoceptive bodily awareness: switching between languages changes embodied experience; external versus internal attention focus; social expectations and body sensations; emphasis on form versus self-awareness; personal space; and mind–body relationship; context dependency of bodily awareness and self-construal. The participants explained key concepts that present challenges for a Japanese cultural adaptation of the MAIA, specifically the concept of self-regulation lost in the factor analysis. In Japanese culture, self-regulation serves the purpose of conforming to social expectations, rather than achieving an individual self-comforting sense of homeostasis. Our findings will inform the next phase of improving the MAIA's cross-cultural adaptation. [ABSTRACT FROM AUTHOR]

Anthropological studies of mortuary ceremonies have focused primarily on their social and structural correlates and functions. Little attention has been given to their role in facilitating the expression and resolution of grief by the bereaved. The elaborate and extended mortuary rites of the people of northeastern Arnhem Land, Australia (the "Murngin") have several characteristics which promote and structure the mourning process and facilitate the full reintegration of the bereaved into the social life of the community. [ABSTRACT FROM AUTHOR]

Offers gratitude to the editorial staff of the periodical "Culture, Medicine & Psychiatry." Significance of scholarship on the journal; Variety of topics featured in the periodical; Papers from international contributors of the periodical.

Beauty ideals in the Caribbean are shifting with increased exposure to Western and European standards of appearance. Previous research has shown a consistent link between internalization of Western beauty ideals and depressive symptoms and other forms of psychological disturbance among diverse populations including Caribbeans. We examined the association between internalization of Western beauty ideals and depressive symptoms as well as the potential mediating role of self-esteem on this relation in N = 222 students (155 females, 79 males) attending a tertiary institution in Kingston, Jamaica. Internalization of Western ideals was inversely associated with self-esteem (r =- .35, p < .01) and positively associated with depressive symptoms (r =.13, p < .05). In a model adjusted for age and sex, results revealed a significant indirect effect of internalization of Western ideals of appearance on depressive symptoms via self-esteem (estimate= .21, SE = .05, 95% confidence interval [.13, .32]). The potent effects of culture must be better understood as intercontinental travel becomes less important as a mechanism for cultural exposure and exchange, and there is a significant increase of digital and internet access in the Caribbean. The current study suggest that Caribbeans are at significant risk for internalizing Western ideals of beauty, subsequently diminishing their self-esteem, and ultimately increasing depression symptomatology. The benefits and consequences of cultural exchange should continue to be a topic for research studies. [ABSTRACT FROM AUTHOR]

To explore the role of culture in communicating with cancer patients about mental health distress and suicidality. The Grounded Theory method of data collection and analysis was used. Healthcare professionals (HCPs) reported that language competency was a facilitator while being unable to speak the language or understand the nuances of their patient's communication could be a barrier. HCPs noted that being culturally matched with their patients helped them communicate effectively. HCPs also spoke about religious taboos on suicide as being a barrier to having conversations, either because patients did not feel comfortable discussing these issues, or because they perceived that this was not a topic they could bring up. Some HCPs reported that the culture/ethnicity of their patients had no effect on their ability to communicate effectively with them about mental health distress or suicidality. Advancing effective cross-cultural communication is a challenge faced by HCPs. Raising awareness about communication styles is an important step in addressing communication gaps about mental health and suicide with cancer patients. Training should facilitate skill development to engage in a culturally humble approach to cross-cultural communication including diversity training which encourages asking and actively listening to patients' needs and preferences. [ABSTRACT FROM AUTHOR]

Drawing on a historical ethnography conducted in Southern Brazil, this article explores how public health programs for adolescent reproductive and mental health have emerged in Brazil and begun to intersect with the growing field of "global mental health" (GMH). The story I recount begins not in the 2010s with the rapid rise of expert interest in adolescent health within GMH, but in the 1990s, the decade when young teens in Brazil were first coming into contact with practices and approaches in research, schools and clinics that have both underpinned and critiqued the production of an adolescent mental and reproductive health sub-field. In parsing what young women's encounters with the then newly-emerging questionnaires, measurement tools, school-based programs and clinical practices came to mean to them, I use a genealogical approach to consider how histories of education reform, population control, psychoanalysis, social medicine, the transition to democracy, feminism and grass-roots politics all entered the fold, shaping the way adolescent sex-and-psyche materialized as a contested object of expertise. I end by exploring what this case can teach global mental health advocates and social theorists about practices of critique. [ABSTRACT FROM AUTHOR]

We provide an experimental evaluation of the impact of aesthetic experiences in terms of stress reduction (cortisol levels) and wellbeing increase. The test experience is a visit to the vault of the Sanctuary of Vicoforte, Italy. Data have been collected using a double step method. A structured interview in relation to the individual subjective well-being has been administered to a sample of 100 subjects. In addition, a sample of their saliva has been taken, and its cortisol level measured, before and after the experience, and likewise for momentary wellbeing measured on a Visual Analogous Scale. Subjects reported an average increase of 40% in wellbeing and a decrease of the 60% in the cortisol level. The recorded cortisol level values dropped on average well beyond the decrease normally associated to its circadian cycle. The modulating role of various variables has been appreciated, and profiling of the typical subjects who are wellbeing respondents/non-respondents and cortisol respondents/non-respondents has been carried out. We conclude that aesthetic experience seems to have a noticeable impact on individual physical and mental health. In both dominions, cultural participation intensity is significantly correlated to the response. The study underlines the potential of the arts and culture as a new platform for public health practices and new approaches to welfare policy design. [ABSTRACT FROM AUTHOR]

We describe how self-reported health (SRH) varies with gender and John Henryism (a strong behavioral predisposition to engage in high-effort coping to overcome adversity) in a low income sample of Serbian Roma. Data were collected in 2016 in several Roma settlements around Belgrade, Serbia. The sample consisted of 90 men and 112 women. In addition to John Henryism (JH), measured by a Serbian version of the John Henryism Scale, demographic data and data on SRH and family relationships dynamics were collected. SRH was positively correlated with age and JH, and negatively correlated with a history of chronic disease. Roma males and females differed significantly on JH and a number of other variables. For Roma women, multiple regression analyses revealed that a history of chronic disease, unemployment, age and daily stress level were negatively associated with SRH, while JH, SES and harmonious relationships with one's family/children were positively associated with SRH. For Roma men, there was no association between JH and SRH, but older age, being on welfare, a diagnosis of hypertension and extended family disputes were associated with poorer SRH. Hence, despite economic disadvantage and social exclusion from mainstream society, some Roma report good health and the ability to cope actively with economic disadvantage and social exclusion. This study adds to the literature on the cross-cultural relevance of JH theory for understanding health variations within socially and economically marginalized populations. [ABSTRACT FROM AUTHOR]

This article profiles visual auras among traumatized Cambodian refugees attending a psychiatric clinic. Thirty-six percent (54/150) had experienced an aura in the previous 4 weeks, almost always phosphenes (48% [26/54]) or a scintillating scotoma (74% [40/54]). Aura and PTSD were highly associated: patients with visual aura in the last month had greater PTSD severity, 3.6 (SD = 1.8) versus 1.9 (SD = 1.6), t = 10.2 (df = 85), p < 0.001, and patients with PTSD had a higher rate of visual aura in the last month, 69% (22/32) versus 13% (7/55), odds ratio 15.1 (5.1-44.9), p < 0.001. Patients often had a visual aura triggered by rising up to the upright from a lying or sitting position, i.e., orthostasis, with the most common sequence being an aura triggered upon orthostasis during a migraine, experienced by 60% of those with aura. The visual aura was often catastrophically interpreted: as the dangerous assault of a supernatural being, most commonly the ghost of someone who died in the Pol Pot period. Aura often triggered flashback. Illustrative cases are provided. The article suggests the existence of local biocultural ontologies of trauma as evinced by the centrality of visual auras among Cambodian refugees. [ABSTRACT FROM AUTHOR]

In this article, we discuss the impact of migration and acculturation processes on the cultural, personal identity, and mental health of children who immigrate to a Western, multicultural environment, and the challenges clinicians in such environments face, when confronted with non-Western idioms of distress and healing practices. We do that by presenting a challenging clinical case of an 8-year-old girl who presented with very disorganized behavior, which matches a culturally accepted construct of spirit possession, in the context of migration trauma, acculturative stress, and new sibling transition. We identify cultural conflict in school and bullying as major mediators between acculturative stress and mental distress. We also aim at identifying vulnerability, risk and protective factors, and the importance of cultural coping resources. We explore in depth the patient's cultural background and the family's belief system and culturally shaped narratives, in order to arrive at a cultural formulation, which focuses on the significance of idioms of distress in shaping psychopathology and influencing the personal and interpersonal course of trauma- and stress-related disorders. We also call attention to the finding that in children, idioms of distress may manifest themselves in a somatic manner. We argue, together with other researchers, that spirit possession deserves more interest as an idiom of distress and a culture-specific response to traumatizing events. We finally emphasize the importance of an anti-reductionist clinical stance, that is able to use different levels of understanding processes of distress and healing, and seeks to reconciliate cultural divides and integrate different explanatory frameworks and help-seeking practices. [ABSTRACT FROM AUTHOR]

There is a growing literature on recovery from schizophrenia. Most studies, however, focused on outcome, with insufficient attention paid to the process of recovery. The aim of this study was to explore the process of recovery from first episode psychotic illness in a Javanese cultural setting. An ethnographic method was applied where researcher conducted a field work and followed seven participants in their natural setting. This study identified three phases of recovery process in the context of Javanese culture: Bangkit, gaining insight; Usaha, struggling to achieve recovery; and Rukun, harmonious integration with family and community integration. Recovery entails regaining insight, followed by simultaneous inward and outward efforts that reconstitute one's inner and outer world, respectively. Participants also expressed their recovery in terms of a movement through physical space, from confinement in their own home to the wider spaces shared with family and community. Movements in physical space parallel movements in social space, where participants accomplish a social recovery. The Javanese phase of recovery found in this study is comparable to the phase of recovery identified by previous literatures in the Western context. [ABSTRACT FROM AUTHOR]

In the current research we report data from two studies that examined rates and characteristics of sleep paralysis (SP) in the general population of Denmark and Egypt. In Study I, individuals from Denmark and Egypt did not differ in age whereas there were more males in the Egyptian sample (47 vs. 64 %); in Study II, individuals from Denmark and Egypt were comparable in terms of age and gender distribution. In Study I we found that significantly fewer individuals had experienced SP in Denmark [25 % (56/223)] than in Egypt [44 % (207/470)] p < .001. In Study II we found that individuals who had experienced at least one lifetime episode of SP from Denmark ( n = 58) as compared to those from Egypt ( n = 143) reported significantly fewer SP episodes in a lifetime relative to SP experiencers from Egypt ( M = 6.0 vs. M = 19.4, p < .001). SP in the Egyptian sample was characterized by high rates of SP (as compared to in Denmark), frequent occurrences (three times that in the Denmark sample), prolonged immobility during SP, and great fear of dying from the experience. In addition, in Egypt, believing SP to be precipitated by the supernatural was associated with fear of the experience and longer SP immobility. Findings are discussed in the context of cultural elaboration and salience theories of SP. [ABSTRACT FROM AUTHOR]

For an overwhelming majority of commentators, including many anthropologists, 'Japanese culture' is still associated with a positive view of suicide. Western-language writings have contributed by feedback loop to perpetuate this stereotype. Besides the local 'samurai ethic', Japanese Buddhism is also said not to prohibit taking one's life. However, the most popular examples of heroic self-sacrifice, from the Edo period to WWII, are fraught with covert contradictions. From ancient times to the present religious practitioners of all sorts have maintained that suicide creates unhappy, resentful spirits who harm the living. This article discusses many examples of a diverse series of narratives, from spirit medium's séances to drama to contemporary films, in which the anguished spirits of suicides are allowed to express themselves directly. After the figures rose alarmingly in the late 1990s various religious organisations have attempted to fight the stigma suffered by bereaved family members and have introduced new interpretations and new rituals. [ABSTRACT FROM AUTHOR]

The task of caring for those with chronic illnesses has gained a new centrality in health care at a global level. We introduce the concept of 'chronic homework' to offer a critical reflection on the treatment of chronic illnesses in three quite different national and local contexts: Uganda, Denmark, and the United States. A major challenge for clinicians, patients, and family caregivers is how to navigate the task of moving health care from clinic to home. By 'chronic homework,' we refer to the work patients and families are expected to carry out in their home contexts as part of the treatment of chronic conditions. Families and patients spend time receiving training by clinical experts in the various tasks they are to do at home. While this 'colonization' of the popular domain could easily be understood from a Foucauldian perspective as yet another emerging mode of governmentality, this a conceptualization can oversimplify the way specific practices of homework are re-imagined and redirected by patients and significant others in their home surroundings. In light of this re-invention of homework in local home contexts, we foreground another conceptual trope, describing chronic homework as a borderland practice. [ABSTRACT FROM AUTHOR]

Standard psychiatric criteria for depression developed in the United States and United Kingdom are increasingly used worldwide to establish the prevalence of clinical disorders and to help develop services. However, these approaches are rarely sensitive to local and cultural expressions of symptoms or beliefs about treatment. Mismatch between diagnostic criteria and local understanding may result in underreporting of depression and underutilization of services. Little such research has been conducted in Malaysia, despite the acknowledged high rate of depression and low access to services. This study examines depression in Moslem Malay women living in Johor Bahru, Southern Peninsular Malaysia, to explore depression symptoms using the Structured Clinical Interview for DSM-IV. The 61 women interviewed were selected on the basis of high General Health Questionnaire scores from a large questionnaire survey of 1,002 mothers. The illustrative analysis looks at descriptions of depressed mood, self-depreciation and suicidal ideation, as well as attitudes toward service use. The women gave full and open descriptions of their emotional symptoms, easily recognizable by standard symptom categories, although somatic symptoms were commonly included, and the spiritual context to understanding depression was also prevalent. However, few women had knowledge about treatment or sought medical services, although some sought help from local spiritual healers. Attending to such views of depression can help develop services in Malaysia. [ABSTRACT FROM AUTHOR]

Researchers have hypothesized that the degree to which an individual’s actual behavior approximates the culturally valued lifestyle encoded in the dominant cultural model has consequences for physical and mental health. We contribute to this line of research by analyzing data from a longitudinal study composed of five annual surveys (2002–2006 inclusive) of 791 adults in one society of foragers-farmers in the Bolivian Amazon, the Tsimane’. We estimate the association between a standard measure of individual achievement of the cultural model and (a) four indicators of psychological well-being (sadness, anger, fear and happiness) and (b) consumption of four potentially addictive substances (alcohol, cigarette, coca leaves and home-brewed beer) as indicators of stress behavior. After controlling for individual fixed effects, we found a negative association between individual achievement of the cultural model and psychological distress and a positive association between individual achievement of the cultural model and psychological well-being. Only the consumption of commercial alcohol bears the expected negative association with cultural consonance in material lifestyle, probably because the other substances analyzed have cultural values attached. Our work contributes to research on psychological health disparities by showing that a locally defined and culturally specific measure of lifestyle success is associated with psychological health. [ABSTRACT FROM AUTHOR]