In spite of the absolute prohibition against torture in international law, this grave human rights abuse is still practiced systematically and with impunity in the majority of countries around the world. Mental health professionals can play a positive role in the fight against torture and impunity, by developing competencies to assess the psychological sequelae of torture. High-quality psychological evidence can help to substantiate allegations of torture, thereby increasing the likelihood of success in civil, administrative, and criminal proceedings. This article will orient mental health professionals to issues specific to forensic assessment of torture survivors. It provides a brief introduction to the sociopolitical context of torture, reviews literature on the psychological sequelae of torture, introduces the reader to key competencies, offers information on strategies for producing documentary evidence and expert opinion, highlights ethical considerations, and suggests areas for development in the field.
This paper reflects upon questions of ontological contingency when the stark, visceral reality of a person’s relentless self-destruction unfolds within institutional mechanisms that systematically withhold certain kinds of care. I consider these issues through the lens of "manipulation" as it is elaborated within an American eating disorders treatment center, where the notion of manipulation does particular kinds of affective and pragmatic work. Specifically, it serves to render clients as, paradoxically, both hyper-agentic and "agentically challenged" in ways that legitimate the withholding of their recognition as full subjects and therefore deserving of care. I propose that the ontological perspectives of the treatment center are ill-equipped for accounting for such dynamics and, in fact, carry certain risks when employed in the consideration of psychiatric conditions where they can even become coopted in unintended ways. This carries special importance when working with people whose ontological status is, in a very real (and not just theoretical) sense, teetering on the brink of the void.
While much literature documents the mental health needs of young people from refugee backgrounds, and the barriers they face in accessing mental health services, researchers have yet to document the perspectives of service users from this population about their contacts with clinicians and services. We therefore individually interviewed 16 young people (aged 18–25 years) who were refugees about their experiences of seeing mental health professionals. Participants were born in 9 different countries and had lived in Australia for an average of 5.2 years. They placed most emphasis on in-session factors, and particularly on interpersonal considerations. Among the main themes identified via thematic analysis were the practitioner's sensitivity to the young person's cultural background and to the stressors affecting him or her, including traumatic refugee experiences, and the therapeutic relationship—especially the qualities of trust, understanding, respect, and a caring connection. The participants had diverse reactions to treatment strategies. They emphasised the role of their preconceptions around mental health services, and called for systematic mental health awareness-raising for young people from refugee backgrounds. Implications for research, policy, and practice are discussed with a focus on findings that may guide efforts to improve service acceptability, accessibility, and effectiveness. In particular, there is a need for practitioners to attend to their clients' experiences of sessions, to adopt an attuned, contextualised, systemic approach, and especially to take a nuanced approach to cultural sensitivity.
Informal, coercive residential centers for the treatment of addiction are widespread and growing throughout Latin America. In Mexico these centers are called "anexos" and they are run and utilized by low-income individuals and families with problems related to drugs and alcohol. This article draws on findings from a 3-year anthropological study of anexos in Mexico City. Participant observation and in-depth interviews were used to describe and analyze anexos, their therapeutic practices, and residents’ own accounts of addiction and recovery. Our findings indicate that poverty, addiction, and drug-related violence have fueled the proliferation of anexos. They also suggest that anexos offer valuable health, social, and practical support, but risk exacerbating the suffering of residents through coercive rehabilitation techniques. Emphasizing this tension, this article considers the complex relationship between coercion and care, and poses fundamental questions about what drug recovery consists of in settings of poverty and violence.
Embracing a shared social identity typically serves to protect group members in the face of threats. However, under some conditions, intragroup dynamics are diverted so that instead, they contribute to disturbances in collective well-being. The present analysis applies a social identity framework to understand how intragroup processes elicited in Indian Residential Schools (IRS) altered the capacity of Indigenous peoples to overcome damage to their identity and collective functioning. With the alleged goal of assimilating the Indigenous population, residential schools in Canada entailed the forced removal of Indigenous children from their communities. A Truth and Reconciliation Commission established in 2008 confirmed the extensive abuse perpetrated by IRS staff, but also raised awareness of the pervasiveness of student-to-student abuse. Supported by qualitative analyses of the reports of social service providers working with IRS survivors (N = 43), it is argued that a key part of the dynamics in the IRSs was the subversion of intragroup processes among Indigenous children in attendance. Understanding intragroup dynamics provides a basis for recognizing the persistent effects of IRSs, and for identifying strategies to heal and reclaim a positive collective identity.
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.
In recent years, the Movement for Global Mental Health (MGMH) and the World Health Organization have worked closely with governments across the global South to redress major treatment gaps to improve access to mental health services. In India, recent reforms include transforming public psychiatric institutions from sites of treatment to research and training institutes, known as "Centres of Excellence," to combat acute manpower shortages and modernize psychiatry. Drawing on ethnographic fieldwork at a public psychiatric hospital in Srinagar, Kashmir, one of the institutions selected to be a future "Centre of Excellence," this article focuses on how these reforms have affected psychiatric institutions themselves. Efforts at modernizing and increasing access to mental health care—that is, emphasizing shortened stays, increasing outpatient treatment, and providing care in the "community"—depend on quarantining stigmatized, chronically ill, long-term patients who reside in custodial conditions with fewer resources and limited attention from providers. Psychiatrists have a radically different vision for redressing manpower shortages than the MGMH and Indian state, revealing contradictions in the reform process. This paper demonstrates how modernizing mental health care splits mental institutions spatially, ontologically, temporally, and epistemologically, so that the process of modernizing the institution is neither seamless nor complete.
This qualitative study explored how Afghan refugees conceptualize frames of mind that may reflect depression in general and as it relates to trauma they experienced. We performed in-depth interviews with 18 Afghans residing in the San Diego area. Views regarding the causes, symptoms, and perceived treatments of depression were gathered through free-listing techniques, and supplemented with narratives relating to pre- and post-resettlement stressors and coping mechanisms. Data were analyzed with standard qualitative content analysis methods. Items endorsed with relation to depression causality included pre-migration war traumas, notably separation from family, and post-migration stressors including status dissonance and cultural conflicts that ranged from linguistic challenges to intergenerational problems. Depressive symptoms were viewed as highly debilitating, and included changes in temperament, altered cognitions, avoidance and dissociative behaviors, and somatic complaints. Relief was sought through family reunification and community support, reliance on prayer, and the academic success of their children in the US. The findings underscore the need for practitioners to take into account situational stressors, cultural aspects of mourning and symptomatology, and existing coping mechanisms in developing interventions that are based on refugees’ articulated needs.
The translation of well established psychometric tools from English into Xhosa may assist in improving access to psychological services for Xhosa speakers. The aim of this study was to translate the Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), a measure of general distress and dysfunction developed in the UK, into Xhosa for use at South African university student counselling centres. The CORE-OM and embedded CORE-10 were translated into Xhosa using a five-stage translation design. This design included (a) forward-translation, (b) back-translation, (c) committee approach, (d) qualitative piloting, and (e) quantitative piloting on South African university students. Clinical and general samples were drawn from English-medium South African universities. Clinical samples were generated from university student counselling centres. General student samples were generated through random stratified cluster sampling of full-time university students. Qualitative feedback from the translation process and results from quantitative piloting of the 34-item CORE-OM English and Xhosa versions supported the reduction of the scale to 10 items. This reduced scale is referred to as the South African CORE-10 (SA CORE-10). A measurement and structural model of the SA CORE-10 English version was developed and cross-validated using an English-speaking university student sample. Equivalence of this model with the SA CORE-10 Xhosa version was investigated using a first-language Xhosa-speaking university sample. Partial measurement equivalence was achieved at the metric level. The resultant SA CORE-10 Xhosa and English versions provide core measures of distress and dysfunction. Additional, culture- and language-specific domains could be added to increase sensitivity and specificity.
There is a growing literature on what contemporary cultural theorists have broadly termed the "postsecular": the abandonment of clear-cut boundaries between the secular and nonsecular in the industrialized West and an embrace of a complex understanding of what is real that neither accepts nor rejects the supernatural. These new cultural currents may affect not only philosophers and theologians, but also the ways in which individuals with psychosis make sense of their experiences. This paper reports on the key findings of an in-depth qualitative analysis of 19 interviews of individuals diagnosed with psychotic disorders. The majority of participants described ongoing and self-conscious struggles to demarcate their experiences as the products of the real world or a "crazy" mind. With equal frequency, participants weighed and debated competing secular and supernatural explanations, often juxtaposing and blending different explanatory frameworks. We found that this syncretic process affected not only the content of psychotic experiences—what delusions or hallucinations are about—but also the type of arguments or logics used to justify particular interpretations. We discuss the implications of these observations with respect to clinical practice and the broader phenomenology of psychosis, challenging often oversimplified discourse on "insight" and suggesting that polarization(s) between "biomedical" and "psychosocial" explanations may be of less relevance to patients’ real-world experiences than is often assumed.
Growing nonmedical prescription opioid analgesic use among suburban and rural Whites has changed the public’s perception of the nature of opioid addiction, and of appropriate interventions. Opioid addiction has been recast as a biological disorder in which patients are victims of their neurotransmitters and opioid prescribers are irresponsible purveyors of dangerous substances requiring controls. This framing has led to a different set of policy responses than the "War on Drugs" that has focused on heroin trade in poor urban communities; in response to prescription opioid addiction, prescription drug monitoring programs and tamper-resistant opioid formulations have arisen as primary interventions in place of law enforcement. Through the analysis of preliminary findings from interviews with physicians who are certified to manage opioid addiction with the opioid pharmaceutical buprenorphine, we argue that an increase in prescriber monitoring has shifted the focus from addicted people to prescribers as a threat, paradoxically driving users to illicit markets and constricting their access to pharmaceutical treatment for opioid addiction. Prescriber monitoring is also altering clinical cultures of care, as general physicians respond to heightened surveillance and the psychosocial complexities of treating addiction with either rejection of opioid dependent patients, or with resourceful attempts to create support systems for their treatment where none exists.
This article examines contemporary Ukrainian psychiatry through the voices of patients, practitioners, and advocates, focusing on shifting objects of knowledge, interventions, and institutional transitions. Currently, we are witnessing the reconfiguration of psychiatry on a global scale through neoliberal rhetoric combined with the call for global mental health. The goal of the movement for global mental health is to scale up psychiatric treatments through greater access to psychiatric drugs, justified through the framing of distress as an illness. Neoliberal rhetoric suggests that cutting social service expenditure through the privatization and decentralization of the health care system will stimulate economic growth and, in the long term, combat poverty. This paper traces how these dynamics are playing out in Ukraine, drawing on ethnographic fieldwork conducted at a psychiatric hospital in south-central Ukraine from 2008–2010, while working with a non-governmental organization.
Clinicians in community mental health settings frequently evaluate individuals suffering from physical health problems. How patients make meaning of such "comorbidity" can affect mental health in ways that may be influenced by cultural expectations and by the responses of clinicians, with implications for delivering culturally sensitive care. A sample of 30 adult mental health intakes exemplifying physical illness assessment was identified from a larger study of patient–provider communication. The recordings of patient–provider interactions were coded using an information checklist containing 21 physical illness items. Intakes were analyzed for themes of meaning making by patients and responses by clinicians. Post-diagnostic interviews with these patients and clinicians were analyzed in similar fashion. Clinicians facilitated disclosures of physical suffering to varying degrees and formulated them in the context of the culture of mental health services. Patients discussed their perceptions of what was at stake in their experience of physical illness: existential loss, embodiment, and limits on the capacity to work and on their sense of agency. The experiences of physical illness, mental health difficulties, and social stressors were described as mutually reinforcing. In mental health intakes, patients attributed meaning to the negative effects of physical health problems in relation to mental health functioning and social stressors. Decreased capacity to work was a particularly salient concern. The complexity of these patient–provider interactions may best be captured by a sociosomatic formulation that addresses the meaning of physical and mental illness in relation to social stressors.
In sub-Saharan Africa, traditional and faith healers provide competing services alongside biomedical professionals. This may be associated with delays in reaching specialised mental health services, and hence with longer duration of untreated illness. As first line care constitutes a crucial stage in accessing of psychiatric care, investigating pathways to mental healthcare can highlight help-seeking choices. This study explored the pathways to care for mental illness preferred by a non-clinical sample of the population in south-eastern Nigeria. Multistage sampling was used to select participants (N = 706) who completed questionnaires on help-seeking. Results showed a significant preference for biomedical (90.8%) compared to spiritual (57.8%) and traditional (33.2%) pathways. Higher education predicted preference for the biomedical model, while low education was associated with traditional and spiritual pathways. Protestants preferred the spiritual pathway more than did Catholics. The use of biomedical care is potentially undermined by poor mental health infrastructure, a lack of fit between the culture of biomedical care and the deep-seated cultural/religious worldviews of the people, stigma surrounding mental illness, and the likelihood of a social desirability bias in responses. A complementary model of care is proposed.
This paper discusses results from a pilot study conducted in the spring of 2014 among young adults living in Montreal. The main objective of this study was to assess the relation between perception of the Charter of Quebec Values,
As applied anthropologists used to working at arm's length from public psychiatry, we step out of the daily grind to take stock of the challenges of taking on ethnography entrained–harnessed to the implementation of a new program. These include the loss of critical distance, the struggles to negotiate locally viable forms of authority and relevance, the necessity of sustaining a Janus-faced relation with principal players, the urgency of seeing time-sensitive information converted into corrective feedback, and the undeniable attraction of being part of "committed work" with game-changing potential. In so doing, we rework the terms of witnessing and revive an old alternative: that documentary dirty work be reclaimed as a variant of public anthropology, one that transforms the work of application from mere afterthought to integral part of the original inquiry.
Sri Lanka has recently emerged from a three decade long civil war between government forces and the Liberation Tigers of Tamil Eelam. Behind the actual arena of conflict, forms of organised violence were often perpetrated on ordinary Sri Lankans who came into contact with law enforcement officials and other state authorities. The effects of these encounters on mental health, well-being, and community participation can be severe and long-lasting. Considering the generally poor availability of mental health services in many low-income countries, brief efficient interventions are required to enhance the lives of individuals and their families affected by torture, trauma, or displacement. In this context, the present study evaluated the effectiveness of testimonial therapy in ameliorating the distress of Sri Lankan survivors of torture and ill-treatment. The results indicated that over a 2- to 3-month period, psychosocial functioning was significantly enhanced in the therapy group compared to the waitlist control group. The general benefits of testimonial therapy, the ease with which it can be incorporated into ongoing human rights activities, and its application by trained nonprofessionals encourage greater use of the approach.
Best practices in global mental health stress the importance of understanding local values and beliefs. Research demonstrates that expectancies about the effectiveness of a given treatment significantly predicts outcome, beyond the treatment effect itself. To help inform the development of mental health interventions in Burundi, we studied expectancies about the effectiveness of four treatments: spiritual healing, traditional healing, medication, and selected evidence-based psychosocial treatments widely used in the US. Treatment expectancies were assessed for each of three key syndromes identified by previous research: akabonge (a set of depression-like symptoms), guhahamuka (a set of trauma-related symptoms), and ibisigo (a set of psychosis-like symptoms). In individual interviews or written surveys in French or Kirundi with patients (N = 198) awaiting treatment at the clinic, we described each disorder and the treatments in everyday language, asking standard efficacy expectations questions about each ("Would it work?" "Why or why not?"). Findings indicated uniformly high expectancies about the efficacy of spiritual treatment, relatively high expectancies for western evidence-based treatments (especially cognitive behavior therapy [CBT] for depression-like symptoms), lower expectancies for medicine, and especially low expectancies for traditional healing (except for traditional healing for psychosis-like symptoms). There were significant effects of gender but not of education level. Qualitative analyses of explanations provide insight into the basis of people’s beliefs, their explanations about why a given treatment would or would not work varied by type of disorder, and reflected beliefs about underlying causes. Implications for program development and future research are discussed.
There is growing concern within the global mental health arena that interventions currently being executed to scale up mental health services in Africa will be ineffective unless simultaneous steps are taken to address people’s help-seeking behaviour. Drawing upon two conceptual tools arising from science and technology studies (STS), those of a "classification system" and "the black box," this paper looks critically at discursive constructions of help-seeking in Africa within mental health research over the last decade. Research in this area can be divided into two dominant traditions: the knowledge-belief-practice survey and indigenous-knowledge-system approaches. Although the content and value-codes between these approaches differ, structurally they are very similar. Both are mediated by the same kind of system of classification, which demarcates the world into homogenous entities and binary oppositions. This system of ordering is one of the most stubborn and powerful forms of classification buried in the "black box" of the modernist/colonial knowledge archive and is fraught with many questionable Eurocentric epistemological assumptions. I consider whether there might be other ways of understanding help-seeking for mental illness in Africa and discuss two studies that illustrate such alternative approaches. In conclusion, I discuss some of the challenges this alternative kind of research faces in gaining more influence within contemporary global mental health discourse and practice.
This qualitative study explores community resilience factors within an indigenous Sámi community in Northern Norway. Semistructured interviews were conducted with 22 informants, 12 females and 10 males, ranging in age from 13 to 19 years old, 12 of whom had reindeer husbandry affiliation. Data analysis used a modified grounded theory approach and narrative analysis. Interpretation of the data was based on ecological perspectives theory and the identification of possible community resilience factors including Sámi language competence, use of recreational and natural resources, and traditional ecological knowledge, such as reindeer husbandry related activities. These cultural factors appear to strengthen adolescents’ ethnic identity and pride, which in turn act as potential resilience mechanisms. Land was a significant arena for traditional practices and recreation. The majority of the youth reported support from relationships with extended godparents (fáddarat) and extended family (sohka) networks. The fáttar network was particularly strong among adolescents with reindeer husbandry affiliations. Native language competence and reindeer husbandry were key components in adolescent social networks. Interconnectedness among the community members and with the environment seemed to promote resilience and well-being. Two factors that excluded adolescents from full community membership and participation were being a nonnative Sámi language speaker and the absence of extended Sámi family networks.
As part of a cross-national collaborative study of resilience among circumpolar youth, we examined the life experiences, stressors, and coping or resilience strategies of Inuit youth in the community of Igloolik, Nunavut, Canada. An Inuit steering committee was formed with youth, adults, and one elder. The steering committee led this project in the community, informing community members of progress and helping direct all aspects of the study from research questions to methods to data collection to dissemination. A structured interview used across sites allowed youth to describe what matters to them, that is, what is at stake for them in terms of challenges and successes. Developing stable and secure relationships with one’s friends and family members enabled Inuit youth to become more resilient in the face of stresses related to social change in the Canadian Arctic.
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.
Of the approximately 13,750 humanitarian refugees who have fled from war and other human rights abuses to resettle in Australia every year, the majority are families arriving with adolescent children. This study used a qualitative methodology to explore Sudanese refugee womens’ narratives around parenting teenagers in the resettlement environment. The data from 17 in-depth interviews was analysed using thematic analysis. Four main themes captured the womens’ main concerns: the transition from parenting in an interdependent society as part of a network of family and community relations to parenting alone in the resettlement context; mothers’ fears and experiences of losing their children, both literally and symbolically; loss of parental authority; and finally, the ways in which mothers adapted to the post-migration setting and found new ways of parenting.
Little is known about the interplay of cultural, parenting, and sociodemographic/socioeconomic factors on children’s behavioral problems, especially within culturally mixed families in Chinese society. This study compares the presence of behavioral problems between children from families with an immigrant mother and those from native-born families in a randomly selected sample of 957 children aged 6 to 12 years from three counties in central Taiwan. Behavioral problems were assessed using the Child Behavior Checklist completed by parents and the Teacher’s Report Form. Parenting styles were assessed using the Parental Bonding Instrument completed by children. Children of immigrant mothers had higher scores for all behavioral syndromes based on the parent’s report. However, in the teacher’s report a difference was only observed for withdrawn/depressed syndrome. Children of immigrant mothers were more likely, and children with high paternal care were less likely, to have internalizing and total problems in the parent’s report. For the teacher’s report, only high education in fathers was associated with decreased internalizing and total problems in children. These findings suggest that children growing up in a cross-cultural environment with an immigrant mother, as opposed to a native-born Taiwanese family environment, are more likely to have higher internalizing problems and total behavioral problem scores, due to a number of cultural, parenting, and sociodemographic factors. Children’s behaviors appear to be more influenced by fathers’ than mothers’ parenting styles, regardless of family type. The study findings imply that unequal health and social conditions exist between cross-cultural and native-born families.
The concept of bipolar disorder has undergone a transformation over the last two decades. Once considered a rare and serious mental disorder, bipolar disorder is being diagnosed with increasing frequency in Europe and North America, and is suggested to replace many other diagnoses. The current article shows how the modern concept of bipolar disorder has been created in the course of efforts to market new antipsychotics and other drugs for bipolar disorder, to enable these drugs to migrate out of the arena of serious mental disorder and into the more profitable realm of everyday emotional problems. A new and flexible notion of the condition has been created that bears little resemblance to the classical condition, and that can easily be applied to ordinary variations in temperament. The assertion that bipolar disorder is a brain disease arising from a biochemical imbalance helps justify this expansion by portraying drug treatment as targeted and specific, and by diverting attention from the adverse effects and mind-altering properties of the drugs themselves. Childhood behavioural problems have also been metamorphosed into "paediatric bipolar disorder," under the leadership of academic psychiatry, with the assistance of drug company financing. The expansion of bipolar disorder, like depression before it, medicalises personal and social difficulties, and profoundly affects the way people in Western nations conceive of what it means to be human.
Increasing attention is paid to impacts of HIV/AIDS on women's mental health, often framed by decontextualized psychiatric understandings of emotional distress and treatment. We contribute to the small qualitative literature extending these findings through exploring HIV/AIDS-affected women's own accounts of their distress—focusing on the impacts of social context, and women's efforts to cope outside of medical support services. Nineteen in-depth interviews were conducted with women experiencing depression or anxiety-like symptoms in a wider study of services in KwaZulu-Natal, South Africa. Thematic analysis was framed by Summerfield's emphasis on contexts and resilience. Women highlighted family conflicts (particularly abandonment by men), community-level violence, poverty and HIV/AIDS as drivers of distress. Whilst HIV/AIDS placed significant burdens on women, poverty and relationship difficulties were more central in their accounts. Four coping mechanisms were identified. Women drew on indigenous local resources in their psychological re-framing of negative situations, and their mobilisation of emotional and financial support from inter-personal networks, churches and HIV support groups. Less commonly, they sought expert advice from traditional healers, medical services or social workers, but access to these was limited. Though all tried to supplement government grants with income generation efforts, only a minority regarded these as successful. Findings support ongoing efforts to bolster strained mental health services with support groups, which often offer valuable emotional and practical support. Without parallel poverty alleviation strategies, however, support groups may sometimes offer little more than encouraging passive acceptance of the inevitability of suffering—potentially exacerbating the hopelessness underpinning women's distress.
Global mental health research is needed to inform effective and efficient services and policy interventions within and between countries. Ethical reflection should accompany all GMHR and human resource capacity endeavors to ensure high standards of respect for participants and communities and to raise public debate leading to changes in policies and regulations. The views and circumstances of ethno-cultural and disadvantaged communities in the Majority and Minority world need to be considered to enhance scientific merit, public awareness, and social justice. The same applies to people with vulnerabilities yet who are simultaneously capable, such as children and youth. The ethical principles of respect for persons or autonomy, beneficence/non-maleficence, justice, and relationality require careful contextualization for research involving human beings. Building on the work of Fisher and colleagues (2002), this article highlights some strategies to stimulate the ethical conduct of global mental health research and to guide decision-making for culturally responsible research, such as developing culturally sensitive informed consent and disclosure policies and procedures; paying special attention to socioeconomic, cultural, and environmental risks and benefits; and ensuring meaningful community and individual participation. Research and capacity-building partnerships, political will, and access to resources are needed to stimulate global mental health research and consolidate ethical practice.
Mental and somatic health was compared between older Somali refugees and their pair-matched Finnish natives, and the role of pre-migration trauma and post-migration stressors among the refugees. One hundred and twenty-eight Somalis between 50–80 years of age were selected from the Somali older adult population living in the Helsinki area (N = 307). Participants were matched with native Finns by gender, age, education, and civic status. The BDI-21 was used for depressive symptoms, the GHQ-12 for psychological distress, and the HRQoL was used for health-related quality of life. Standard instruments were used for sleeping difficulties, somatic symptoms and somatization, hypochondria, and self-rated health. Clinically significant differences in psychological distress, depressive symptoms, sleeping difficulties, self-rated health status, subjective quality of life, and functional capacity were found between the Somali and Finnish groups. In each case, the Somalis fared worse than the Finns. No significant differences in somatization were found between the two groups. Exposure to traumatic events prior to immigrating to Finland was associated with higher levels of mental distress, as well as poorer health status, health-related quality of life, and subjective quality of life among Somalis. Refugee-related traumatic experiences may constitute a long lasting mental health burden among older adults. Health care professionals in host countries must take into account these realities while planning for the care of refugee populations.
Thangals are an endogamous community in Kerala, India, of Yemeni heritage who claim direct descent from the Prophet Muhammad’s family. Due to their sacrosanct status, many thangals work as religious healers and thus are part of the informal mental health care system in Northern Kerala. Using the case of one thangal healer as an illustration of the many ritual healers in Kerala who engage the modern discourse of psychology in their practices, I argue that the psychologisation of ritual healing is part of a wider trend: the increasing rationalisation and scientification of traditional medical practices, whereby an increasing number of traditional healers negotiate science, modernity and religion and position their practice within these contested fields. Based on the analysis of this thangal’s healing practice in the local context of Northern Kerala, I further argue that in order to understand "ritual" healing, scholars should emphasise pragmatic realism more than doctrinal purity.
The paucity of skilled manpower in sub-Saharan Africa limits the delivery of effective interventions for the mentally ill. Individuals with mental disorders and their caregivers frequently consult clergy when mental symptoms cause distress. There is an urgent need for collaboration with nonprofessionals in order to improve mental health care delivery and close the widening treatment gap. Using a cross-sectional descriptive method, we explored clergy’s (Christian and Muslim) aetiological attributions for common mental illness (schizophrenia and depression) from Benin City, Nigeria, as well as their willingness to collaborate with mainstream mental health services. We observed that a majority of clergy surveyed were able to correctly identify mental illnesses depicted in vignettes, embraced a multifactorial model of disease causation, and expressed willingness to collaborate with mental health care workers to deliver care. Clergy with a longer duration of formal education, prior mental health training, and Catholic/Protestant denomination expressed a greater willingness to collaborate. Educational interventions are urgently required to facilitate this partnership.
Global health has been defined as an area of study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide. This article provides an overview of some central issues in global mental health in three parts. The first part demonstrates why mental health is relevant to global health by examining three key principles of global health: priority setting based on the burden of health problems, health inequalities and its global scope in particular in relation to the determinants and solutions for health problems. The second part considers and addresses the key critiques of global mental health: (a) that the "diagnoses" of mental disorders are not valid because there are no biological markers for these conditions; (b) that the strong association of social determinants undermines the use of biomedical interventions; (c) that the field is a proxy for the expansion of the pharmaceutical industry; and (d) that the actions of global mental health are equivalent to "medical imperialism" and it is a "psychiatric export." The final part discusses the opportunities for the field, piggybacking on the surge of interest in global health more broadly and on the growing acknowledgment of mental disorders as a key target for global health action.
Ritual healing is very widespread in the Indian state of Uttarakhand, and is by far the most common option for those with serious behavioral disturbances. Although ritual healing thus accounts for a very large part of the actual health care system, the state and its regulatory agencies have, for the most part, been structurally blind to its existence. A decade of research on in this region, along with a number of shorter research trips to healing shrines and specialists elsewhere in the subcontinent, and a thorough study of the literature, suggest that such techniques are often therapeutically effective. However, several considerations suggest that ritual healing may not be usefully combined with mainstream "Western" psychiatry: (a) psychiatry is deeply influenced by the ideology of individualism, which is incompatible with South Asian understandings of the person; (b) social asymmetries between religious healers and health professionals are too great to allow a truly respectful relationship between them; and (c) neither the science of psychiatry nor the regulatory apparatus of the state can or will acknowledge the validity of "ritual therapy"—and even if they did so, regulation would most likely destroy what is most valuable about ritual healing. This suggests that it is best if the state maintain its structural blindness to ritual healing.
Body learning gives actors basic structures and references that enable them to codify their actions in a script or score. With this score, acquired through training, performing and transmitting, actors who work with theater anthropology methodology offer strategies and tools that healers can use with their patients. This actor’s score has inspired a mode of working with patients both to understand the case history and guide the course of therapy. In this approach, patients are like authors who want to act out their dramaturgy, but who need a director-healer to organize the story and help them build their healing process. Together, patient and therapist work on stage to advance the treatment, at the same time enhancing their strategies and methods for collaboration.
Indigenous circumpolar youth are experiencing challenges of growing up in a context much different from that of their parents and their grandparents due to rapid and imposed social change. Our study is interested in community resilience: the meaning systems, resources, and relationships that structure how youth go about overcoming difficulties. The research reflects an understanding that social and cultural ecologies influence people’s available and meaningful options. The in-depth, qualitative study of 20 youth from the same Arctic community shows Inupiat (Alaska Native) youth are navigating challenges. Findings from this research suggest that Inupiat youth reflect more flexible patterns of resilience when they are culturally grounded. This cultural foundation involves kinship networks that mediate young people’s access to cultural and material assets. Our participants emphasized the importance of taking care of others and "giving back to the community." Being "in the country" linked youth to traditional ontology that profoundly shifted how youth felt in relation to themselves, to others, and the world. The vast majority of participants’ "fulfillment narratives" centered on doing subsistence and/or cultural activities. In relation to this, young people were more likely to demonstrate versatility in their resilience strategies when deploying coherent self-narratives that reflected novel yet culturally resonant styles. Young women were more likely to demonstrate this by reconfiguring notions of culture and gender identity in ways that helped them meet challenges in their lives. Lastly, generational differences in understandings signal particular ways that young people’s historical and political positioning influences their access to cultural resources.
This introduction to the Special Issue Indigenous Youth Resilience in the Arctic reviews relevant resilience theory and research, with particular attention to Arctic Indigenous youth. Current perspectives on resilience, as well as the role of social determinants, and community resilience processes in understanding resilience in Indigenous circumpolar settings are reviewed. The distinctive role for qualitative inquiry in understanding these frameworks is emphasized, as is the uniquely informative lens youth narratives can offer in understanding Indigenous, cultural, and community resilience processes during times of social transition. We then describe key shared cross-site methodological elements of the Circumpolar Indigenous Pathways to Adulthood study, including sampling, research design, procedures, and analytic strategies. The site-specific papers further elaborate on methods, focusing on those elements unique to each site, and describe in considerable detail locally salient stressors and culturally patterned resilience strategies operating in each community. The concluding paper considers these across sites, exploring continuities and discontinuities, and the influence of cross-national social policies.
This study analyses the roles of collective self-esteem and religiosity in the relationship between discrimination and psychological distress among a sample of 432 recent immigrants from Haiti and Arab countries living in Montreal, Quebec. Collective self-esteem (CSE), religiosity, discriminatory experiences, and psychological symptoms of depression and anxiety were assessed. Regression analyses revealed direct negative effects of discrimination, CSE, and religiosity on psychological distress for the entire sample. CSE, however, also appeared to moderate the effects of discrimination on psychological distress. Participants with higher CSE reported lower levels of anxiety and depression as a result of discrimination compared to those who expressed lower CSE levels. The results suggest that the relationship between CSE, discrimination, and psychological distress must be reexamined in light of recent sociopolitical changes and the upsurge in ethnic and religious tensions following the war on terror.
Many mental health clinicians in South Africa use informal interpreters, who are employed to perform other functions, such as cleaners and security guards; there are no formally trained interpreters. Drawing on qualitative semistructured interviews, this paper examines the experiences of informal interpreters working within a psychiatric setting. Furthermore, this paper explores how working in this invisible capacity affects informal interpreters’ views of themselves and the contribution they feel they are making by acting as interpreters. An interpretative phenomenological approach enabled an in-depth analysis of the experiences of the ad hoc interpreters. The results of this study reveal a dilemma. On the one hand, informal interpreters interviewed jeopardize ethical principles by breaching confidentiality and reporting on patient behaviour without their consent. On the other hand, they report fulfilling an additional beneficial role in terms of the overall care of patients which goes beyond the ambit of the interpreting session. The impact and extent of the informal interpreters’ involvement in care could not be ascertained solely from the data obtained in this study, but it is clear that informal interpreting may usefully be viewed as a form of hidden care work. A detailed ethnographic study aimed at exploring this further is therefore recommended.
Many social scientists attribute the health-giving properties of religious practice to social support. This paper argues that another mechanism may be a positive relationship with the supernatural, a proposal that builds upon anthropological accounts of symbolic healing. Such a mechanism depends upon the learned cultivation of the imagination and the capacity to make what is imagined more real and more good. This paper offers a theory of the way that prayer enables this process and provides some evidence, drawn from experimental and ethnographic work, for the claim that a relationship with a loving God, cultivated through the imagination in prayer, may contribute to good health and may contribute to healing in trauma and psychosis.
What can an exploration of contemporary Aboriginal healing programs such as those offered in Canadian prisons and urban clinics tell us about the importance of history in understanding social and psychological pathology, and more significantly the salience of the concept of "historical trauma"? The form of Aboriginal "healing" that has emerged in recent decades to become dominant in many parts of the country is itself a reflection of historical processes and efforts to ameliorate the consequences of what is today often termed "historical trauma." In other words, contemporary notions of "healing" and the social, cultural, medical, and psychological disruption and distress caused by colonialism and captured in the term "historical trauma" have coevolved in an interdependent manner. I also argue that there is a tension between the attribution of this distress to both specific (e.g., residential schools) and generalized (e.g., colonialism) historical factors, as evident in the "historical trauma" concept, and the prevailing emphasis in many healing programs to encourage the individual to take personal responsibility for their situation and avoid attributing blame to other factors. I conclude that "historical trauma" represents an idiom of distress that captures a variety of historical and contemporary phenomena and which provides a language for expressing distress that is gaining currency, at least among scholars, and that the contemporary Aboriginal healing movement represents an effort to deal with the absence or failure of both "traditional" Aboriginal healing and government-sponsored medical and psychological services to adequately deal with this distress of colonialism.
This article examines how middle-class psychotherapy clients in Southern California use work as a coping strategy in the aftermath of distressing life events. It begins by arguing why all such distress in the aftermath of unbidden and unanticipated events are "local" distresses, embedded in particular social and interpersonal contexts, and then discusses the various ways in which people may use cultural resources, including ordinary, mundane, everyday routines and practices, such as work, to express and cope with emotional distress. Three case studies are used to illustrate how work can be used to avoid emotional distress, to conceal it, and also to acknowledge and heal it.
Professional clinicians and human services providers are increasingly attributing the mental health problems of American Indians (AIs) to historical trauma (HT). As an alternative to established psychiatric disorders, AI HT was formulated to explain enduring mental health disparities as originating in tribal experiences of Euro-American colonization. As a result, AI HT has been described as the collective, cumulative, and intergenerational psychosocial disability resulting from massive group-based oppression, such as forced relocation, political subjugation, cultural domination, and genocide. One objective of the HT construct is to frame AI distress and dysfunction in social and historical terms. Given widespread indigenous experiences of colonization, the debilitating effects of HT are presumed to affect most AI communities today. With this background in mind, I explore AI HT with specific reference to a "war narrative" obtained by an anthropologist in 1901 from an elderly Gros Ventre woman. In this account, Watches All described her participation in a historic intertribal battle, and her subsequent captivity and escape from the enemy during the late 1860s. This historical narrative references many first-hand experiences that would today be identified as traumatogenic. Interestingly, however, this account complicates several assumptions underlying AI HT, leading to vexing questions of whether Watches All’s ordeal actually qualifies as an instance of AI HT. No matter how one answers these questions, such ambiguity highlights serious theoretical confusions requiring elaboration and refinement if AI HT is to remain a useful construct in the behavioral health sciences.
Indigenous "First Nations" communities have consistently associated their disproportionate rates of psychiatric distress with historical experiences of European colonization. This emphasis on the socio-psychological legacy of colonization within tribal communities has occasioned increasingly widespread consideration of what has been termed historical trauma within First Nations contexts. In contrast to personal experiences of a traumatic nature, the concept of historical trauma calls attention to the complex, collective, cumulative, and intergenerational psychosocial impacts that resulted from the depredations of past colonial subjugation. One oft-cited exemplar of this subjugation—particularly in Canada—is the Indian residential school. Such schools were overtly designed to "kill the Indian and save the man." This was institutionally achieved by sequestering First Nations children from family and community while forbidding participation in Native cultural practices in order to assimilate them into the lower strata of mainstream society. The case of a residential school "survivor" from an indigenous community treatment program on a Manitoba First Nations reserve is presented to illustrate the significance of participation in traditional cultural practices for therapeutic recovery from historical trauma. An indigenous rationale for the postulated efficacy of "culture as treatment" is explored with attention to plausible therapeutic mechanisms that might account for such recovery. To the degree that a return to indigenous tradition might benefit distressed First Nations clients, redressing the socio-psychological ravages of colonization in this manner seems a promising approach worthy of further research investigation.
"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 1, 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.