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

The population of sub-Saharan children and adolescents is substantial and growing. Even though most of this population is vulnerable, there is no comprehensive understanding of the social-ecological factors that could be leveraged by mental health practitioners to support their resilience. The present study undertakes a narrative scoping review of empirical research (quantitative, qualitative, and mixed) on the resilience of children and adolescents living in sub-Saharan Africa to determine what enables their resilience and what may be distinctive about African pathways of child and adolescent resilience. Online databases were used to identify full-text, peer-reviewed papers published 2000–2018, from which we selected 59 publications detailing the resilience of children and/or adolescents living in 18 sub-Saharan countries. Studies show that the resilience of sub-Saharan children and adolescents is a complex, social-ecological process supported by relational, personal, structural, cultural, and/or spiritual resilience-enablers, as well as disregard for values or practices that could constrain resilience. The results support two insights that have implications for how mental health practitioners facilitate the resilience of sub-Saharan children and adolescents: (i) relational and personal supports matter more-or-less equally; and (ii) the capacity for positive adjustment is complexly interwoven with African ways-of-being and -doing. [ABSTRACT FROM AUTHOR]

This issue of Transcultural Psychiatry presents selected papers from the McGill Advanced Study Institute on "Cultural Poetics of Illness and Healing." The meeting addressed the cognitive science of language, metaphor, and poiesis from embodied and enactivist perspectives; how cultural affordances, background knowledge, discourse, and practices enable and constrain poiesis; the cognitive and social poetics of symptom and illness experience; and the politics and practice of poetics in healing ritual, psychotherapy, and recovery. This introductory essay outlines an approach to illness experience and its transformation in healing practices that emphasizes embodied processes of metaphor as well as the social processes of self-construal and positioning through material and discursive engagements with the cultural affordances that constitute our local worlds. The approach has implications for theory building, training, and clinical practice in psychiatry. [ABSTRACT FROM AUTHOR]

Previous research has shown that worldviews can serve as a coping response to periods of difficulty or struggle, and worldviews can also change on account of difficulty. This paper investigates the impacts worldviews have on the nature and trajectory of meditation-related challenges, as well as how worldviews change or are impacted by such challenges. The context of meditation-related challenges provided by data from the Varieties of Contemplative Experience research project offers a unique insight into the dynamics between worldviews and meditation. Buddhist meditation practitioners and meditation experts interviewed for the study report how, for some, worldviews can serve as a risk factor impacting the onset and trajectory of meditation-related challenges, while, for others, worldviews (e.g., being given a worldview, applying a worldview, or changing a worldview) were reported as a remedy for mitigating challenging experiences and/or their associated distress. Buddhist meditation practitioners and teachers in the contemporary West are also situated in a cultural context in which religious and scientific worldviews and explanatory frameworks are dually available. Furthermore, the context of "Buddhist modernism" has also promoted a unique configuration in which the theory and practice of Buddhism is presented as being closely compatible with science. We identify and discuss the various impacts that religious and scientific worldviews have on meditation practitioners and meditation teachers who navigate periods of challenge associated with the practice. [ABSTRACT FROM AUTHOR]

National histories of violence shape experiences of suffering and the ways that mental health professionals respond to them. In Ecuador, mental health literature addressing this crucial issue is scarce and little debated. In contrast, local psychiatrists and psychologists within the country face contemporary challenges that are deeply rooted in a violent colonial past and the perpetuation of its fundamental ethos. This paper critically reviews relevant literature on collective memory and historical trauma, and focuses on Ecuador as a case study on how to incorporate history into modern mental health challenges. The discussion poses key questions and outlines possible ways for Ecuador to address the link between history and mental health, including insights from countries that have struggled with their violent pasts. This paper contributes to ongoing international debate on the role of cultural history in mental health with implications for social scientists and practising clinicians in former colonised nations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

It is often suggested that the Greek tragedians present clinically credible pictures of mental disturbance. For instance, some modern interpreters have compared the process by which Cadmus brings Agave back to sanity in Euripides' Bacchae with modern psychotherapy. But a reading of medical writers' views on the psychological dimension of medicine offers little evidence for believing that these scenes reflect the practices of late fifth-century Athenian doctors, for whom verbal cures are associated with older traditions of non-rational thought, and thus are scorned in favor of more "scientific cures" based on diet or medication. This paper will argue that Athenian tragedians, working from older traditions that advocated verbal cures for some mental ailments, do understand the potential psychological effects that their work can have on audiences, since tragedy requires psychological interaction with its audience in order to be effective. From a close reading of select scenes in Euripidean tragedy, this paper suggests that the experiences of the characters who experience suffering in Euripides' Heracles and Bacchae are analogues of the experiences undergone by the spectators of tragedy at large. Parallels are made between the way that Agave and Heracles are both talked back to sanity by looking upon what has happened, and the way that tragedians make their audiences observe lamentations and meditations that follow the central tragic act, to help them return from the intense emotion provoked, perhaps, by the violence they have seen. [ABSTRACT FROM AUTHOR]

Patients with an Islamic background who suffer from hallucinations or other psychotic symptoms may attribute these experiences to jinn (i.e., invisible spirits). In this paper, we review the medical literature on jinn as an explanatory model in the context of psychotic disorders. We conducted a systematic search for papers on jinn and psychosis in Pubmed, EMBASE, Ovid Medline, PsycINFO, and Google Scholar databases. Our search yielded 105 scientific texts on jinn and their relationship with mental disorders, including 47 case reports. Among the case reports a definite biomedical diagnosis was provided in 66% of the cases, of which 45.2% involved a schizophrenia spectrum disorder. Fully 10 of 16 hallucinating patients experienced multimodal hallucinations. Although infrequently documented in the biomedical literature, the attribution of psychiatric symptoms to jinn appears to be quite common among Islamic patients, and to have significant impact on the diagnosis, treatment, and course of mental disorders, particularly psychotic disorders. [ABSTRACT FROM PUBLISHER]

Guidelines on psychosocial interventions in postconflict areas commonly mention that interventions should be based on local needs and be built on culture-specific expertise. This paper is based on a dissociative cult, the Kiyang-yang (KYY), in Guinea Bissau. In a previous article, we used a refined definition of the concept of idiom of distress to analyze the dissociative behavior displayed in KYY as a symbolic language addressing politically dangerous truths. This paper uses the concept of “collective trauma processing” to analyze how the idiom offered the local population a pathway to mitigate the consequences of protracted and widespread political violence. The paper first argues that the field of psychotraumatology lacks a comprehensive ecological theory on trauma. Moreover, within clinical psychology and psychiatry, little attention is paid to local cultural healing mechanisms addressing traumatic stress. This paper is an effort to study such mechanisms in their own right. To compare trauma processing mechanisms across the globe, we propose to analyze trauma processing mechanisms with the help of a comprehensive model discerning five ontological dimensions that are considered to be involved in suffering and are addressed in healing approaches. Our paper describes similarities and differences between psychological healing traditions and collective trauma processing within the West African context of Guinea Bissau. We will illustrate how the KYY movement uses the idiom of dissociation as both a collective expression of distress and as a vehicle to process social suffering and traumatic stress as a circular phenomenon. [ABSTRACT FROM AUTHOR]

Although Islam is the world's second-largest religion, there continues to be misconceptions and an overall lack of awareness regarding the religious and social worlds that make up the global Muslim community. This is particularly concerning when examining notions of mental ill-health, where a lack of cultural awareness, understanding, and sensitivity can impede adequate treatment. As a global religion, Islam is practiced within various cultural milieus, and, given the centrality of faith amongst Muslim communities, a conflation of religion and culture can occur when attempting to understand mental health paradigms. Whilst much of the discourse regarding Muslim mental health centres on cultural formulations, this article discusses how, historically, conceptualisations relating to medicine and mental health were ensconced within the particular medical paradigm of the day. Specifically, it considers the frameworks within which mental health and illness were understood within the medieval Muslim medical tradition and their relevance to contemporary debates in psychology and psychiatry. In sum, this paper seeks to demonstrate that cultural formulations of mental illness, often viewed as "Islamic", are distinct from historical Islamic approaches to mental health which employed contemporaneous medical discourse and which act as the reference marker for the emergent revivalist Islamic psychology movement seen today. [ABSTRACT FROM AUTHOR]

This paper reviews the persuasion techniques employed by jihadist websites with particular reference to the patterns of rhetoric, image, and symbolism manifested in text, videos, and interactive formats. Beyond symbolic communication, the online media needs to be also understood through its persuasive tendencies as a medium which elicits social response through its design architecture. This double articulation of new media technologies, as a medium for information and as a form of persuasive technology, has provided new means to market the radical. The marketing techniques of jihadist websites through multimedia formats have consequences for the formation of identities, both collective and individual. As a marketing tool it combines established forms of rhetoric and propaganda with new ways to reach audiences through both popular culture and religious ideologies. The paper analyses the implications for further research and counterterrorism strategies. [ABSTRACT FROM PUBLISHER]

Migrants living in Europe constitute over half of the world's international migrants and are at higher risk of poor mental health than non-migrants, yet also face more barriers in accessing and engaging with services. Furthermore, the quality of care received is shaped by the experiences and attitudes of health professionals. The aim of this review was to identify professionals' attitudes towards migrants receiving mental healthcare and their perceptions of barriers and facilitators to service provision. Four electronic databases were searched, and 23 studies met the inclusion criteria. Using thematic synthesis, we identified three themes: 1) the management of multifaceted and complex challenges associated with the migrant status; 2) professionals' emotional responses to working with migrants; and 3) delivering care in the context of cultural difference. Professionals employed multiple strategies to overcome challenges in providing care yet attitudes towards this patient group were polarized. Professionals described mental health issues as being inseparable from material and social disadvantage, highlighting a need for effective collaboration between health services and voluntary organizations, and partnerships with migrant communities. Specialist supervision, reflective practice, increased training for professionals, and the adoption of a person-centered approach are also needed to overcome the current challenges in meeting migrants' needs. The challenges experienced by health professionals in attempting to meet migrant needs reflect frustrations in being part of a system with insufficient resources and without universal access to care that effectively stigmatizes the migrant status. [ABSTRACT FROM AUTHOR]

This paper suggests that elaborating Winnicott’s idea of “potential space” can provide a conceptual approach to psychotherapy across the cultural divide. The first part of the paper discusses the general problematic of intercultural psychotherapy. This is illustrated with an account of therapeutic work with Ethiopian Jews who have migrated to Israel. There is a significant gap between the Ethiopian cultural codes relevant to psychotherapy and those of the Israeli therapist, who is usually trained in the Western psychotherapeutic tradition. A meaningful and effective therapeutic process can take place if psychotherapist and client cocreate a “mutual creative space.” [ABSTRACT FROM PUBLISHER]

"Sivulirijat aksururnaqtukkuurnikugijangat aktuiniqaqsimaninga kinguvaanginnut" translates as "the trauma experienced by generations past having an effect in their descendants." The legacy of the history of colonialism is starting to take narrative shape as Inuit give voice to the past and its manifestations in the present through public commissions such as the federal Truth and Reconciliation Commission and the Inuit-led Qikiqtani Truth Commission. However, an examination of other discursive contexts reveals a collective narrative of the colonial past that is at times silent, incomplete or seemingly inconsistent. Reading the political narrative through the Nunavut Land Claims Agreement, and the proceedings of the Legislative Assembly of Nunavut since its formation on April I, 1999, exposes an almost complete silence about this history. Oral histories, an important form for the preservation and transmission of traditional cultural knowledge, do narrate aspects of this experience of contact, but in accounts that can appear highly individual, fragmented, even contradictory. In contrast, one domain that does seem to register and engage with the impacts of this history of colonialism is Inuit art, specifically visual art and film. In some cases these artistic narratives pre-date the historical trauma narratives of the commissions, which began with the Royal Commission on Aboriginal Peoples (RCAP) in the mid-1990s. This paper examines these narrative alternatives for recounting historic trauma in Nunavut, while also considering the implications of understanding historical trauma as narrative. [ABSTRACT FROM AUTHOR]

American literature on international adoption suggests that adoptees' pride in the culture of their birth country improves their self-esteem and helps them to cope with experiences of racism. Parents are therefore encouraged to teach their adopted children multicultural skills to improve their psychological well-being. French psychologists, on the contrary, suggest that adoptees should feel fully members of their adoptive country and families. These practices shed light on the respective multicultural and universalist paradigms in the US and France. Few papers, however, consider the opinions of adoptees. This study explores internationally adopted children raised in France and their spontaneous curiosity about their birth country. The present study used semistructured interviews with 19 adoptees aged 8-18 years old, to explore their attitudes towards the culture of their birth country. Transcripts of recorded interviews were analyzed according to interpretative phenomenological analysis. While there was striking consistency of interest in birth countries, adoptees' expression of curiosity varied across time. Children described distinctive goals: knowing more about their history, finding relatives, becoming a multicultural citizen, or simply helping people. Their parents' involvement was thus seen as helpful, but adoptees stress the need to feel ready and may prefer independent ways of learning about their birth country. Adoptees' multiple feelings of belonging derive not only from multicultural training but from a lifelong construction of self. Professionals and parents may need to adapt to adoptees' individual development, distinctive time frames, and ways of learning to provide better support to them. [ABSTRACT FROM AUTHOR]

People in different cultures have different concepts of the person that underlie self-understanding and self-representation. These concepts influence many aspects of individuals’ life experience, including illness and expectations toward recovery. Psychotherapies aim to promote adaptive change in experience and behavior. This goal is embedded in a social and cultural context that promotes or sanctions a particular notion of personhood. If every system of psychotherapy depends on implicit models of personhood, which varies cross-culturally, then the goals and methods of therapeutic change must consider the cultural concept of the person. This paper reviews cultural concepts of the person in relation to communal values, practices, and systems of thought observed across many African cultural contexts. It presents a practical framework that can inform therapists working with African clients. Many African cultures promote a relational-oriented personhood, in which an individual manifests his or her personhood through connections to three distinct forms of agency: (a) spiritual agency, including God, ancestors, and spirits that influence the person; (b) social agency, including the family, the clan, and the community, with extension to humanity; and (c) self-agency, which is responsible for the person’s inner experience. This distinctive form of personhood underlies concepts of the “normal” person, understandings of mental illness, help-seeking behavior, and clients’ needs and expectations. Implications of this cultural concept of the person for psychotherapy with African clients are discussed. [ABSTRACT FROM AUTHOR]

Multicultural societies such as the United Kingdom are host to people with diverse belief systems and behavioral norms. Whilst a country requires that all members of society conform to standardized legal requirements, cases arise that involve certain complexities related to the cultural or religious context in which a certain action was committed. This paper addresses the impact of culture on notions of criminal responsibility and action. Through a case study of a recent event in the United Kingdom, we explore whether a cultural defense is relevant for contextualizing incidents in which an individual commits a criminal action during an alleged period of spirit possession From this analysis, we suggest that using a cultural defense can aid understanding of an individual’s relationship to the society that he or she identifies with and facilitate the practice of justice in a multicultural society. [ABSTRACT FROM AUTHOR]

This paper documents the work of the NIMH Culture and Diagnosis Committee on schizophrenia from its inception in 1991 through publication of the final version of DSM-IV. Detailed comparisons are made between the committee's suggested text and the final published text of the manual, both for general cultural considerations regarding schizophrenia and for specific diagnostic criteria. The paper concludes with a critical assessment of the successes and failures of DSM-IV as a culturally relevant document and a restatement of the rationale for the centrality of culture to any understanding of schizophrenia. [ABSTRACT FROM PUBLISHER]

Prolonged grief disorder (PGD) is a condition characterized by difficulty in coping effectively with the loss of loved ones. The proposed diagnostic criteria for PGD have been based predominantly on research from developed Western nations. The cultural variations associated with experience and expression of grief and associated mourning rituals have not been considered comprehensively. The current study aimed to understand the experience of prolonged grief in India through a qualitative enquiry with mental health professionals (focus group discussions) and affected individuals (key informant interviews). Several novel findings diverging from the current understanding of manifestation and narratives of PGD emerged from the study, including differences in the social contexts of bereavement and culture-specific magico-religious beliefs and idioms of distress. The findings point to limitations of existing diagnostic systems for PGD. The results of this study suggest that the assumption of content equivalence for psychiatric disorders across cultures may not be justified and that there is a need to develop culturally sensitive diagnostic criteria and assessment scales for PGD. [ABSTRACT FROM AUTHOR]

The experience of grief varies across different cultures and contexts. Women in Nepal who lose their husbands confront discrimination, social isolation, and abuse that influence their experience of grief. Through eight focus group discussions with Nepali widows, we elicited socially sanctioned grief reactions and local idioms used to describe common cognitive, behavioral, and emotional symptoms of grief. Accordingly, modifications to an existing instrument for Prolonged Grief Disorder, the PG-13, are suggested to capture grief symptoms as experienced by Nepali widows. Items in the PG-13 were translated to colloquial Nepali and adapted to maintain comprehensibility, acceptability, relevance, and completeness. Based on the grief-related issues reported in the focus group discussions, the addition of five new items and a new criterion to capture symptoms related to social discrimination are proposed. Widows perceived elevated symptoms one year after the loss to be problematic. It is thus recommended that the duration criterion in the original PG-13 be adjusted from at least six months to at least one year after the loss. These proposed modifications to the instrument should be validated through future psychometric testing. [ABSTRACT FROM AUTHOR]

The concept of culture as an analytic concept has increasingly been questioned by social scientists, just as health care institutions and clinicians have increasingly routinized concepts and uses of culture as means for improving the quality of care for racial and ethnic minorities. This paper examines this tension, asking whether it is possible to use cultural categories to develop evidenced-based practice guidelines in mental health services when these categories are challenged by the increasing hyperdiversity of patient populations and newer theories of culture that question direct connection between group-based social identities and cultural characteristics. Anthropologists have grown concerned about essentializing societies, yet unequal treatment on the basis of cultural, racial, or ethnic group membership is present in medicine and mental health care today. We argue that discussions of culture—patients’ culture and the “culture of medicine”—should be sensitive to the risk of improper stereotypes, but should also be sensitive to the continuing significance of group-based discrimination and the myriad ways culture shapes clinical presentation, doctor–patient interactions, the illness experience, and the communication of symptoms. We recommend that mental health professionals consider the local contexts, with greater appreciation for the diversity of lived experience found among individual patients. This suggests a nuanced reliance on broad cultural categories of racial, ethnic, and national identities in evidence-based practice guidelines. [ABSTRACT FROM PUBLISHER]

Current efforts in global mental health (GMH) aim to address the inequities in mental health between low-income and high-income countries, as well as vulnerable populations within wealthy nations (e.g., indigenous peoples, refugees, urban poor). The main strategies promoted by the World Health Organization (WHO) and other allies have been focused on developing, implementing, and evaluating evidence-based practices that can be scaled up through task-shifting and other methods to improve access to services or interventions and reduce the global treatment gap for mental disorders. Recent debates on global mental health have raised questions about the goals and consequences of current approaches. Some of these critiques emphasize the difficulties and potential dangers of applying Western categories, concepts, and interventions given the ways that culture shapes illness experience. The concern is that in the urgency to address disparities in global health, interventions that are not locally relevant and culturally consonant will be exported with negative effects including inappropriate diagnoses and interventions, increased stigma, and poor health outcomes. More fundamentally, exclusive attention to mental disorders identified by psychiatric nosologies may shift attention from social structural determinants of health that are among the root causes of global health disparities. This paper addresses these critiques and suggests how the GMH movement can respond through appropriate modes of community-based practice and ongoing research, while continuing to work for greater equity and social justice in access to effective, socially relevant, culturally safe and appropriate mental health care on a global scale. [ABSTRACT FROM AUTHOR]

What is it like to grow up Yup’ik and come of age today in a traditional hunting-gathering community setting located in a remote region of Alaska? Current research describes a contemporary experience often laden with trauma and crisis. Youth in Yup’ik communities today face threats to their very survival as they encounter, early on, things that their ancestors never faced—including alcohol-related deaths, violence in many forms, and high rates of suicide among their young peers. Yet all is not despair for the youth growing up in these remote indigenous communities. Many youth grow-up to become skilled hunters, strong leaders, and able parents. This paper reports findings from the Alaskan Yup’ik site of the Circumpolar Indigenous Pathways to Adulthood (CIPA) study. The goal of this study is to identify strengths and resilience in youth living in a Yup’ik community in southwest Alaska. Interviews were conducted with 25 youth age 11–18, currently residing in a southwest Alaska community. Qualitative analysis revealed important connections between local stressors, community-level protective resources, and youth-driven, solution-focused strategies for overcoming hardship and learning the “ways how to live.” Findings from this study contribute critical information on indigenous youth protection and resilience, including community and cultural resilience processes beyond the individual level, and enhance our understanding of the types of resources that can lead to improved outcomes for Alaska Native youth. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Research has established connection between indigenous culture—often described in terms of cultural identity, enculturation, and participation in traditional activities—and resilience, the process by which people overcome acute and ongoing challenges. Despite correlations between culture and resilience, research has seldom described the ways these concepts are linked in indigenous people’s narratives. Furthermore, little attention has been paid to the affect of historical trauma on different generations’ understanding and deployment of “culture” in the context of hardship. This project, conducted in the summer of 2008 in an indigenous Arctic community, focuses on narratives from three generations who have experienced different degrees of cultural suppression in their lifetimes. From this starting point, the study explores how individuals make meaning and take strength from particular notions of culture, and illuminates the ways each generation accesses and deploys their cultural understandings in the face of hardship. By identifying the similarities and differences in both the challenges and sources of strength for each generation, the paper highlights how understandings of culture are shaped by historical experiences and modified through time. The differing ways that culture fosters strength, purpose, and fortitude (or does not) in indigenous young people’s, adults’ and Elders’ life stories provide clues for enhancing indigenous youth resilience. Findings suggest that “culture” can galvanize Inupiaq people’s sense of identity, feeling of commitment, and purpose, all of which are protective. However, young people need support in developing particular ideas around cultural identity and group membership that can contribute to resilience. [ABSTRACT FROM AUTHOR]

Ethnography and hermeneutics help us think of the clinical encounter as a meeting of cultures. In this paper, we examine Ernesto De Martino’s concept of critical ethnocentrism and its relevance for psychiatry, arguing for the necessity of a cultural self-assessment on the part of the clinician as a means of optimizing analyses of the patient’s culture. Conceptualizing the clinician as an “ethnologist,” we argue that clinicians should be able to describe and acknowledge patients’ cultural backgrounds, while remaining aware of their own culturally rooted prejudices. Focusing on the case of persons affected by schizophrenia, we suggest that De Martino’s work invites an openness to hermeneutic dialogue that aims for the coconstruction of shared narratives by clinician and patient. [ABSTRACT FROM PUBLISHER]

The article discusses some of the key issues that are crucial for developing a culturally responsive global mental health (GMH) research agenda. Some of the key issues include developing a language of global mental health, the etic-emic balance, identifying stakeholders, tying the goals of research to stakeholders, and evaluation of benefit. The use of bidirectional pathways is the only way to help GMH researchers as well as the communities considered in the study.

Transcultural nursing, psychiatry, and medical anthropology have theorized that practitioners and researchers need more flexible instruments to gather culturally relevant illness experience, meaning, and help seeking. The state of the science is sufficiently developed to allow standardized yet ethnographically sound protocols for assessment. However, vigorous calls for culturally adapted assessment models have yielded little real change in routine practice. This paper describes the conversion of the Diagnostic and Statistical Manual IV, Appendix I Outline for Cultural Formulation into a user-friendly Clinical Ethnographic Interview (CEI), and provides clinical examples of its use in a sample of highly distressed Japanese women. [ABSTRACT FROM PUBLISHER]

This paper examines narratives of women from the Indian subcontinent, including Canadian refugee claimants, emerging from the conflict regions of Pakistan, Punjab, Bangladesh, and Sri Lanka, who have presented suicidal ideation or attempts or died by suicide. The focus is on the relationship of suicide and suicide behavior to particular systemic stressors related to familial, social, and group agendas. The vulnerability of individual women is presented in the context of gender issues, deeply embedded group trauma, historical legacies, and intragenerational dynamics, as well as acute stressors that contribute to the underlying distress of these women. [ABSTRACT FROM PUBLISHER]

The importance of appraisal in the stress process is unquestioned. Experience in the social environment that impacts outcomes such as depression are thought to have these effects because they are appraised as a threat to the individual and overwhelm the individual's capacity to cope. In terms of the nature of social experience that is associated with depression, several recent studies have examined the impact of cultural consonance. Cultural consonance is the degree to which individuals, in their own beliefs and behaviors, approximate the prototypes for belief and behavior encoded in shared cultural models. Low cultural consonance is associated with more depressive symptoms both cross-sectionally and longitudinally. In this paper we ask the question: does perceived stress mediate the effects of cultural consonance on depression? Data are drawn from a longitudinal study of depressive symptoms in the urban community of Ribeirão Preto, Brazil. A sample of 210 individuals was followed for 2 years. Cultural consonance was assessed in four cultural domains, using a mixed-methods research design that integrated techniques of cultural domain analysis with social survey research. Perceived stress was measured with Cohen's Perceived Stress Scale. When cultural consonance was examined separately for each domain, perceived stress partially mediated the impact of cultural consonance in family life and cultural consonance in lifestyle on depressive symptoms. When generalized cultural consonance (combining consonance in all four domains) was examined, there was no evidence of mediation. These results raise questions about how culturally salient experience rises to the level of conscious reflection. [ABSTRACT FROM PUBLISHER]

Clergy in the UK continue to provide health and social care services. However, collaboration between mental health services and clergy may be problematic, particularly in the resolution of conflicting beliefs and therapeutic modalities. For example, belief in demonic possession and other supernatural causes of mental illness, which are contentious among secular medical practitioners, remain prevalent in many ethnoreligious communities. Thus, interpretations of illness by clergy within health systems may be crucial to appropriate intervention for people with mental illness. However, clergy conceptualizations of suffering also reveal something about the secularization within religious institutions through the despiritualization of particular phenomena. This paper on Christian clergy beliefs and attitudes to supernatural explanations, describes how the negotiation of such beliefs are complex and often equivocal among mainstream clergy but integral to the Pentecostal churches and evangelical clergy in the mainstream, institutional churches. These beliefs and their implications for collaboration with psychiatry are discussed in the context of a rapidly changing religious and cultural landscape. [ABSTRACT FROM PUBLISHER]

The Diagnostic and Statistical Manual, Edition IV (DSM-IV) represents a significant advance over past editions in terms of attention to the role of culture in the assessment process. A major share of this accomplishment is due to the work of the National Institute of Mental Health Group on Culture and Diagnosis which orchestrated a large body of knowledge and diverse array of scientists to argue for a more culturally informed approach. This paper focuses on the nature and form of the debate as it unfolded with respect to the mood disorders. Specifically, it considers the Culture and Diagnosis Group's recommendations as to the cultural features of mood disorders to be included in DSM-IV, critically appraises the outcomes and suggests directions for future efforts along these lines. [ABSTRACT FROM PUBLISHER]

This paper addresses the extent to which the recommendations of a Child Committee of the Group on Culture and Diagnosis of the DSM-IV Task Force were incorporated into the DSM-IV text. After a brief introduction and a description of the importance of including cultural variables in childhood psychiatric disorders, we review the cultural recommendations for specific childhood disorders and discuss those areas that were included and those that were omitted in the DSM-IV text. The last section addresses the need for empirical data on culture-bound syndromes in children and on the cultural mechanisms that may explain onset and prognosis of these disorders. [ABSTRACT FROM PUBLISHER]

Traditional explanations of suicide, such as economic strain, are often unable to explain the low incidence of suicide among African Americans. Recent qualitative work has suggested, however, that African American cultural definitions of suicide, derived from religion, may explain the low suicide risk among African Americans. The present paper analyzes quantitative, national survey data to address this issue. The results of a multiple regression analysis show that only one indicator of religiosity (church attendance) significantly lowers suicide acceptability for both Black men and Black women. Further, religiosity is not the most important correlate of Black suicide acceptability. The strongest correlates are western residence for Black men and education level for Black women. A parallel analysis for Whites finds that religiosity is the most important correlate of suicide acceptability for both White men and White women. The importance of the Black church in explaining low Black suicide acceptability may have been overestimated in previous research. [ABSTRACT FROM PUBLISHER]

Elevated rates of mental health difficulties are frequently reported in conflict-affected and displaced populations. Even with advances in improving the validity and reliability of measures, our knowledge of the performance of assessment tools is often limited by a lack of contextualization to specific populations and socio-political settings. This reflective article aimed to review challenges and share lessons learned from the process of administering and supervising a structured clinical interview. We administered the MINI International Neuropsychiatric Interview for Children and Adolescents (MINI Kid) and used the Clinical Global Impression (CGI) severity scale with N = 119 Syrian refugee children (aged 8–17) resident in ITSs in Lebanon. Qualitative data were derived from supervision process notes on challenges that arose during assessments, analyzed for thematic content. Five themes were identified: (1) practical and logistical challenges (changeable nature of daily life, competing demands, access to phones, temporary locations, limited referral options); (2) validity (lack of privacy, trust, perceptions of mental health, stigma, false positive answers); (3) cultural norms and meaning (impact of different meanings on answers); (4) contextual norms (reactive and adaptive emotional and behavioral responses to contextual stress); and (5) co-morbidity and formulation (interconnected and complex presentations). The findings suggest that while structured assessments have major advantages, cultural and contextual sensitivity during assessments, addressing practical barriers to improving accessibility, and consideration for inter-connected formulations are essential to help inform prevalence rates, treatment plans, and public health strategies. [ABSTRACT FROM AUTHOR]

Differences in cultural orientations, such as interdependent and independent self-construals, may influence social anxiety disorder (SAD) symptom presentations. However, prior research on the association between interdependent/independent self-construals and SAD was limited to non-clinical samples. Using a treatment-seeking population with clinical levels of anxiety, the current study extends prior research by examining whether the relationship between interdependent/independent self-construals and SAD is specific to SAD or indicative of a broader relationship with anxiety or depression more generally. We also expand upon prior work by examining the effect of self-construals on treatment outcomes and whether self-construals change over time. The results showed that endorsing a less independent self-construal was associated with greater SAD symptoms specifically, and was not associated with other anxiety or depression symptom measures. Additionally, while interdependent and independent self-construals did not moderate SAD treatment outcomes, there was a decrease in interdependent self-construal and increase in independent self-construal over a course of cognitive behavioral therapy. Notably, this change over time was tied to specific items that correlated strongly with SAD symptoms. Together, these results increase our understanding of the relationship between interdependent/independent self-construals and SAD symptoms in treatment-seeking anxiety patients. [ABSTRACT FROM AUTHOR]

Following decades of prohibition and widespread concern about their mind-altering properties, there is increasing public, scholarly, and clinical interest in the therapeutic potential of psychedelic substances. Serotonergic substances in particular (DMT, psilocybin, and LSD) are now being tested as treatments for such ailments as depression, anxiety, and substance use disorder. This thematic issue of Transcultural Psychiatry presents articles that investigate the cultural assumptions, political dimensions, and clinical and ethical implications that arise from this renewed interest. After reviewing ongoing debates on therapeutic mechanisms of action and the importance of context, we argue that psychedelics can be conceptualized as "active super-placebos"—that is, substances that enhance ritual, symbolic, and interpersonal therapeutic processes by increasing suggestibility and the influence of extra-pharmacological, "non-specific" factors. Rather than simply freeing up habitual constraints on perception, the articles in this issue support the claim that psychedelic encounters typically entail processes of sense-making, crystallization of meaning, and enculturation into contextually mediated assumptive worlds (or ideologies) and behaviours that necessarily install novel constraints with potentially maladaptive consequences. We highlight the importance of clinical and epistemic integrity in the framing of psychedelic therapies. The importance of structuring and providing oversight for the therapeutic context raises difficult questions about the search for appropriate forms of epistemic authority that are at once respectful of the plural cultural origins of psychedelic rituals and mindful of best practices and standards in clinical care. [ABSTRACT FROM AUTHOR]

Mid-20th-century American research on psychedelics evinced a stunning diversity of interpretations of hallucinogenic effects. While some researchers viewed psychedelics as invaluable tools for psychotherapy, others persisted in treating them as psychosis-inducing agents. As some groups considered psychedelics as catalysts for artistic creativity, others investigated their potential use as psychochemical weapons in the battlefield, or conversely as tools for spiritual ecstasy and revelation. This bewildering array of perceptions regarding the nature of hallucinogenic effects led to stark contrasts in the contexts (set and setting) of psychedelic research and experimentation, leading to wildly divergent outcomes and reports on the effects of the drugs, and strident disagreements between the actors in the field. Examining this remarkable historical moment of epistemological unclarity regarding psychedelics and their effects, this article describes how distinct scientific and cultural trends and moments of mid-20th-century America contributed to the creation of diverse microclimates of set and setting that reproduced investigator beliefs and attitudes and brought about a beguiling Pygmalion effect that left researchers befuddled and perplexed. I propose the concept of psychedelic modality to describe how distinct sociocultural microclimates lead to thematic aggregates in which distinct types of expectations, intentions as well as physical, social, and cultural environments all tend to cluster, producing characteristic outcomes and results. By exploring the historical context and consequences of the emergence of seven psychedelic modalities (psychotomimetic, military, psychotherapeutic, spiritual, artistic-creative, tech-innovative, and political) in mid-20th-century America, this article outlines the varieties of psychedelic experiences in their relationship with culture at large, and subcultures in particular. [ABSTRACT FROM AUTHOR]

To date, the clinical and scientific literature has best documented the effects of classical psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, and dimethyltryptamine (DMT), in typical quantities most often associated with macrodosing. More recently, however, microdosing with psychedelics has emerged as a social trend and nascent therapeutic intervention. This variation in psychedelic practice refers to repeat, intermittent ingestion of less-than-macrodose amounts that do not cause the effects associated with full-blown "trips". Microdosing paves the road to incorporating psychedelic drugs into a daily routine while maintaining, or even improving, cognitive and mental function. Unlike macrodosing with psychedelics, the influence of microdosing remains mostly unexplored. And yet, despite the paucity of formal studies, many informal accounts propose that microdosing plays an important role as both a therapeutic intervention (e.g., in mental disorders) and enhancement tool (e.g., recreationally—to boost creativity, improve cognition, and drive personal growth). In response to this relatively new practice, we provide an integrative synthesis of the clinical, social, and cultural dimensions of microdosing. We describe some of the overarching context that explains why this practice is increasingly in vogue, unpack potential benefits and risks, and comment on sociocultural implications. In addition, this article considers the effects that macro- and microdoses have on behavior and psychopathology in light of their dosage characteristics and contexts of use. [ABSTRACT FROM AUTHOR]

For the Miskitu of Nicaragua, Grisi Siknis is a contagious illness that predominantly affects women. It is characterized by numerous psychosomatic symptoms, including headache, fear, aggressive behavior, loss of consciousness, and periods of rapid frenzy. Although Grisi Siknis has gained academic and public attention due to its unique cultural elements and perceived sexual aspects, little is known how the contextual and gender dimensions of Grisi Siknis are played out in relation to the socio-political context in the region. Based on 16 months of ethnographic work in the Nicaraguan Miskitu Coast, including semi-structured interviews (n = 20) and participant observation, this article documents a semantic shift in the embodied and symbolic language of a cultural idiom of distress. I show how duhindu (Miskitu spirit associated with illness and misfortune) and witchcraft are symbols that share cultural resonance in the Miskitu community, while gender violence discourse is a new language incorporated into the logic of this cultural idiom of distress. I argue that this semantic shift allows the individuals in this study to communicate local experiences of complex forms of structural inequalities (migration status, unemployment, ethnic identity) and gender-based violence that tend to be normalized as a ubiquitous cultural problem while preserving the broader socio-cultural meaning the Grisi Siknis represents. The ethnographic accounts of Grisi Siknis provide empirical data to unpack the unexplored contextual processes and local discourses that transform the meaning and logic of cultural idioms of distress at the individual level of experience. [ABSTRACT FROM AUTHOR]

Research premised on the construct of idioms of distress has proliferated in the last 40 years. The aim of this work is to foreground the experiential and socially adaptive functions of cultural expressions of distress around the world. Researchers who work in this field often begin from very different starting points in terms of their prior knowledge of the research context, their interest in theoretical or applied implications of their work, and the target areas of distress that they study. While this multiplicity of approaches ensures that the literature captures diverse manifestations of suffering, it also creates confusion for those who are new to the field and who may not know where to begin. This article seeks to resolve some of that confusion by identifying common conceptual challenges across the idioms of distress literature, and then providing a detailed step-by-step methodological example of an idioms of distress study in India that could be adapted for similar work in other contexts. [ABSTRACT FROM AUTHOR]

Globally, over 13% of children and adolescents are affected by mental disorders, yet relatively little scholarship addresses how risk factors, symptoms, and nosology vary by culture and context, especially in young children living in post-conflict and low-resource settings. To address this gap, we conducted a qualitative study to identify and describe the most salient mental health problems facing children aged 6 to 10 years in Sierra Leone, as well as the thoughts, feelings, and behaviors related to these problems. Free list interviews (N = 200) and semi-structured interviews (N = 66) were conducted among caregivers, children, and other relevant key informants to explore risk factors and locally meaningful concepts of distress. Our findings indicate that children are faced with a variety of challenges in their social environments that contribute to distress, including hunger, unmet material needs, and excessive work. Our research identifies five contextually defined mental health problems faced by young children: gbos gbos (angry, destructive behavior), poil at (sad, disruptive behavior), diskoraj (sad, withdrawn), wondri (excessive worry), and fred fred (abnormal fear). The manifestations of these distress concepts are described in detail and contextualized according to Sierra Leone's history of war and current backdrop of poverty and insecurity. Implications are discussed for locally relevant diagnosis and treatment as well as for the wider literature on global child mental health. [ABSTRACT FROM AUTHOR]

Sexual trauma is associated with PTSD, with perpetrators putting women and girls more at risk than men and boys. Young adulthood is a time where risk of victimization and susceptibility to mental health problems increase. Certain contributors of costly trauma outcomes may be affected by the larger context of societal inequality. Cultural betrayal trauma theory (CBTT) highlights cultural betrayal in within-group trauma in minoritized populations as a dimension of harm that affects outcomes. In CBTT, within-group trauma violates the (intra)cultural trust—solidarity, love, loyalty, connection, responsibility—that is developed between group members to buffer against societal inequality. This violation, termed a cultural betrayal, can contribute to poorer mental health. The purpose of the current study is to address a gap in the CBTT literature by examining the role of (intra)cultural trust on the association between cultural betrayal sexual trauma and symptoms of PTSD among diverse minoritized youth transitioning to adulthood. Participants (N = 173) were diverse minoritized college students, who completed a 30-min online questionnaire at a location of their own choosing. Participants received course credit and could decline to answer any question without penalty. The results reveal that the interaction between cultural betrayal sexual trauma and (intra)cultural trust predicted clinically significant symptoms of PTSD. These findings have implications for increased cultural and contextual specificity in trauma research in minoritized populations, which can aid in the development and implementation of culturally competent interventions for diverse minoritized youth survivors of sexual trauma. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Individuals with dementia and their carers often experience a rupture of relationships that co-occurs with declining functional and cognitive abilities, leading to their increased social exclusion in both intimate relationships and community settings. While initiatives have been developed to support meaningful interaction and participation in society, they have broadly ignored the significance of how cultural factors influence experiences of inclusion/exclusion of these individuals. An ethnographic study was conducted by an interdisciplinary research team between April 2018 and January 2019 to explore the intersections of culture and social inclusion/exclusion in a culturally diverse group of persons with dementia, caregivers and staff members of a non-profit organization located in a multicultural neighborhood of a bilingual Canadian city. The participants' culture was inextricably linked to their experiences in three overarching themes of social inclusion/exclusion: transformation of the person with dementia and the caregiver; participation in social networks and meaningful relations; and styles of care provision in health and social services. Cultural mandates that prescribe practices of intergenerational care shape the way certain caregivers perceive their role and mitigated experiences of exclusion. Culturally specific notions and views associated with dementia prevalent in certain communities increased experiences of inclusion or exclusion. Engagement with the cultural elements of individuals with dementia was shown to be an effective and underexplored tool for fostering inclusion. The results of this study highlight the value of the ethnographic methods for incorporating the perspective of persons with dementia in research. [ABSTRACT FROM AUTHOR]

Culture and socialization influence how individuals perceive and express emotional distress. Research therefore, must consider the context to capture individual experiences. However, the majority of studies on factors associated with emotional distress among migrants use quantitative approaches, limiting an in-depth understanding. This study investigates emic themes of emotional distress among Vietnamese migrants by integrating anthropological and psychiatric approaches. The mixed methods study first quantified differences in reported themes of distress between Vietnamese (n = 104) and German (n = 104) patients, who utilized two psychiatric outpatient clinics in Berlin, Germany. Based on these differences, ethnographic interviews were conducted with 20 Vietnamese patients. In the quantitative part, differences in frequency of reported distress between Vietnamese and German patients indicate cultural and migration-related issues among Vietnamese migrants, such as the upbringing of children in a transcultural context. In the qualitative part, interviews with Vietnamese patients elicited contextualizing information and additional themes of distress. Besides commonly expressed socioeconomic themes, such as work and finances, we identified affectively charged themes concerning roles toward partnership and children. A central emic theme is expressed as "moments of speechlessness," which go beyond a lack of language proficiency and challenge patients in different spheres of life. Migration entails complex affective dynamics, determined by a specific migratory and post-migratory context. Within this context, norms and values determine which themes of distress patients articulate openly. Therefore, an interdisciplinary, mixed-methods approach can yield a contextualized understanding of emotional distress and the complex nature of migration. [ABSTRACT FROM AUTHOR]

This article contributes to the Transcultural Psychiatry special issue of autobiographical articles on: ‘‘The Personal and the Professional: Lives and Careers of Cultural Psychiatrists.’’ The author describes influences and themes in her professional development as a cross-cultural psychiatrist and academic. Growing up as a part-Chinese, part-white child in rural Midwestern America resulted in frequently being asked: ‘‘What are you?’’ This abrupt, bald, but essential question eventually became a useful tool in the productive, repeated re-working of identity, values, and goals throughout her personal and professional life. Experiences of being an outsider, family histories, and early observations of racism are linked to later interests in cross-cultural psychiatry, ethics, and the protection of vulnerable populations. She describes her research on cross-cultural measurement, depression, suicidality, domestic violence and violence in war. Issues of career advancement and internal conflict are described for women academics who occupy three simultaneous, primary roles: academic, doctor and mother. The theme of ‘‘crossing,’’ as in ‘‘cross-cultural,’’ indicates the effort and intention required to move between races, cultures, classes, intellectual disciplines, personal and professional identities, clinical and academic roles, and social roles allocated to men and women. [ABSTRACT FROM PUBLISHER]

Our present understanding of depression relies on a Western nosology that might not be generalizable across diverse cultures around the world. As a consequence, current clinical research and practice may not capture culturally salient features of depression. Expanded cross-cultural research that uses ethnographic methods and local instruments may yield information of clinical utility to enhance culturally sensitive research and practice. In this mixed methods study, we used ethno-semantic interview procedures based on the DSM-5 's cultural formulation process to elicit a broad range of depression features reported by the Luo people of western Kenya. We identified how the Luo conceptualize depression, including idioms of depressive distress, moods associated with persistent negative affect, and other features including context, stressors and support systems. This information informed the co-development of a Luo Depression Questionnaire (LDQ-17). We used the LDQ-17 in a cross-sectional community survey (N = 116) to investigate its association with a standard Western instrument (Patient Health Questionnaire-9; PHQ-9). Factor analysis revealed a one-factor model for the PHQ-9 but not the LDQ-17 for which exploratory factor analysis suggested a three-factor model including cognitive, affective, and physical symptoms. Psychological, environmental/social, and even supernatural causes (i.e., ancestors, God and devil) of these symptoms were identified, as were support systems. Finally, visualizations through multidimensional scaling approaches showed some overlap between the LDQ-17 and the PHQ-9, but the local LDQ-17 identified salient features the Luo associated with depression that the PHQ-9 missed. Our findings illustrate how simple ethnographic procedures may guide the development of local instruments to complement current standardized instruments, potentially enhancing cultural relevance. [ABSTRACT FROM AUTHOR]