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Research on the effects of collective trauma tends to take a psychocentric approach, focusing on the impact of being geographically near the traumatic event (physical proximity) or personally knowing a victim (social proximity). We theorize that this approach falls short in describing the effect of collective trauma among interdependent cultural groups, such as Indigenous Peoples, for whom the self and one's group are inextricably tied. Using a concurrent embedded mixed-methods design (N = 545), the current study explores the influence of cultural proximity (having a shared cultural connection to victims) in the wake of a fatal school shooting involving students from both a Native American tribe and a predominantly White city. After controlling for physical and social proximity, student distress behaviors and staff support behaviors, but not staff members' own psychological distress, were significantly higher in schools with higher Native student populations, where a larger proportion of students shared cultural connections with the victims. We discuss implications regarding the importance of providing adequate support for Indigenous Peoples, and interdependent cultural groups in general, following collective trauma. [ABSTRACT FROM AUTHOR]

Sociocultural, mental, behavioral, and physical factors are interrelated associates of chronic health conditions—such as diabetes, obesity, and cardiovascular disease—all of which are disproportionally high and drive much of the mortality and morbidity for Indigenous peoples. Indigenous worldviews conceptualize health holistically, with inseparability across social, spiritual, cultural, familial, mental, behavioral, physical, and social dimensions of wellness. Food, family, and culture are fundamental to Indigenous wellness. The purpose of this article is to use the Framework of Historical Oppression, Resilience, and Transcendence (FHORT) conceptualization of relational wellness to honor urban and rural U.S. Indigenous perspectives that highlight the intersections of family, culture, physical health, spiritual, and mental health to promote resilience and wellness. This research focused on interconnections between wellness, culture, health, and family. Thirty-one critical ethnographic interviews used a life-history approach with methodology following an Indigenous toolkit for ethical and culturally sensitive research strategies, such as building upon cultural strengths, engaging in long-term, relational commitments with communities, incorporating storytelling and oral history traditions, centering Indigenous methodologies and preferences, working with cultural insiders, and prioritizing the perspectives of Indigenous peoples. Emergent themes included: (a) roots of Indigenous wellness: cultural values promoting balance and connection; (b) practicing resilience: family transmission of health information; and (c) wholistic mental wellness and resilience, with the subtheme culture and wellness. Interventions can be developed in collaboration with tribes for optimum efficacy and cultural relevancy and can approach wellness holistically in culturally relevant ways that center foodways, culture, family, and spirituality. [ABSTRACT FROM AUTHOR]

Heavy drinking and smoking have been found to be among the leading causes of morbidity and mortality within Indigenous youth in North America. The focus of this study was to examine the relative roles of cultural identity, parent–child communication about the harms of substance use (SU), and perception about peers' opinions on heavy drinking and cigarette smoking among Indigenous youth. Strong Indigenous cultural identity, parent–child communication about SU, and affiliation with peers who do not use and/or who disapprove of substance use were all expected to reduce risk for heavy drinking and smoking. Substance use beliefs were hypothesized to mediate these effects. Youth (N = 117; M age = 14.07; grades 6–11) from two Indigenous communities in Quebec completed self-reports. Consistent with the hypotheses, strong cultural identity predicted increased negative beliefs about substance use, which predicted reduced drinking and smoking. Similarly, affiliating with peers who did not use alcohol predicted decreased positive beliefs about alcohol use, which predicted reduced drinking. Affiliating with peers who did not smoke cigarettes predicted reduced cigarette smoking. Parental influences were not supported in this model. Intervention strategies may benefit from targeting cultural identity, peer groups, and substance use beliefs among Indigenous youth. [ABSTRACT FROM AUTHOR]

The well-being of Indigenous peoples continues to be affected by intergenerational effects of numerous harmful government policies, which are considered root causes for bullying and cyberbullying that exist in some communities. Despite ongoing stressors, Indigenous youth demonstrate resilience, which often appears grounded in connecting to their cultural identities and traditional practices. However, few studies have tested the direct and stress-buffering role of various aspects of culture in relation to well-being among First Nations youth. Analyses of the 2015–16 First Nations Regional Health Survey (RHS) revealed that bullying and cyberbullying were associated with increased psychological distress among youth aged 12–17 living in First Nations communities across Canada (N = 4,968; weighted = 47,918), and that these links were stronger for females. Feelings of community belonging were directly associated with lower distress and buffered the relationships between bullying/cyberbullying and distress. Among youth who experienced cyberbullying, those who participated in community cultural events at least sometimes reported lower distress compared to those who rarely or never participated. Those who disagreed that traditional cultural events were important reported the highest levels of distress, but perceived importance of such events failed to buffer the associations between bullying/cyberbullying and distress. These national data highlight the importance of certain culture-related variables as key factors associated with the well-being of youth living in First Nations communities across Canada. [ABSTRACT FROM AUTHOR]

The effectiveness of third-wave psychotherapies has been demonstrated in a range of mental and physical health conditions in Western cultures. However, little is known about the cultural appropriateness and effectiveness of third-wave psychotherapies for Gulf Cooperation Council (GCC) populations. This review aimed to critically evaluate cultural adaptations to third-wave psychotherapies and explored the effectiveness of these interventions on physical and mental health outcomes in GCC populations. Five bibliographic databases and grey literature were searched; both English and Arabic studies conducted in the GCC were included. Mental and physical health-related outcomes were included. Eleven studies were identified. The overall degree of cultural adaptation ranged from 2 to 5, based on Bernal et al.'s cultural adaptation framework. Language and assessment tools were most frequently adapted. Several studies incorporated goal, method, and context adaptations, whereas metaphor and content were least frequently adapted. None of the studies incorporated person or concept adaptations. Culturally adapted third-wave psychotherapies were associated with improvement in numerous mental health outcomes, including psychological distress, well-being, and psychological traits. No physical health outcomes were identified. Although findings are promising with respect to the effectiveness of third-wave psychotherapies for GCC populations, they should be interpreted with caution due to the small number of studies conducted, cultural adaptation evaluations relying on explicit reporting in studies, and the weak methodological quality of studies. Future rigorous research is needed in the evaluation of culturally adapted third-wave psychotherapies in GCC populations, with more comprehensive reporting of cultural considerations. [ABSTRACT FROM AUTHOR]

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 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]

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]

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]

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]

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]

This article offers an epistemological, poetic, and ontological reading of the ways of knowing regarding mental disorders that are characteristic of the traditional healers (curanderas and curanderos) of an Indigenous group in Mexico. The study is based on ethnographic interviews with traditional Purépecha (Tarascan) healers in rural Michoacan. Interviews focused on local conceptions of emotional and mental illness, especially Nervios, Susto, and Locura (nerves, fright, and madness). We discuss the conceptual structure of these Indigenous illness notions, the nature of the associated imagery and notions of the soul, as well as the general sense of meaningfulness and reality implicit in Purépecha curanderismo. The highly metaphorical modes of understanding characteristic of these healers defy analysis in purely structuralist terms. They do, however, have strong affinities with the Renaissance "episteme" or implicit framework of understanding described in The Order of Things, Michel Foucault's classic study of modes of knowing and experiences of reality in Western thought—a work profoundly influenced by Heidegger's interest in the historical and cultural constitution of what Heidegger termed "Being." After examining the individual illness concepts, we explore both the poetic and the ontological dimension (the foundational sense of reality or of Being) that they involve, with special emphasis on supernatural concerns. [ABSTRACT FROM AUTHOR]

Metaphors are frequently seen in individuals' descriptions of their illness and healing experiences. These figurative phrases are not ornamental, or distracting, but often reveal the particularities of what it is like to be ill or healing. Culture plays a big role in shaping the particular metaphors employed to express one's thoughts about illness and different healing rituals. However, a significant reason why metaphor emerges in illness narratives is because people ordinarily reason via embodied simulation processes in which they imaginatively project themselves into different real-world and fantastic situations, such as imagining one's struggle with cancer as being a complex dance with the disease. These simulations can play a major role in therapeutic interventions to help those who are ill and in distress. [ABSTRACT FROM AUTHOR]

Among the cultural conceptualizations of distress, susto is defined in the DSM-5 as "a cultural explanation of distress and misfortune in Latin America that refers to an illness attributed to a terrifying event that causes the soul to leave the body and leads to unhappiness and illness, as well as difficulties in performing key social functions" (American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC: APA, p. 836). Thus, susto represents a cultural explanation that encompasses the symptoms of various mental disorders and physical diseases. We analyzed the descriptions of susto from different scientific fields and related them to definitions of DSM-5 syndromes. Three syndromic subtypes of susto show a symptomatic overlap with depression, post-traumatic stress disorder (PTSD) and somatic disorder. However, linguistic metaphors describing symptoms and perceived causes that are specific for Latin American culture support the concept of susto as a specific idiom of distress (e.g., loss of soul, shadow or ajayu ; sunken, closed or white eyes; jumping and screaming in the night; being thrown to the ground). In addition, if diagnostic criteria are met for mental disorders, then susto describes a perceived cause of psychopathological states (e.g., depressive disorder, PTSD, somatic disorder, panic disorder, generalized anxiety disorder). Future research with people who have experienced susto is needed to clarify whether susto precedes the onset of other mental disorders (perceived cause) or whether it is a way of designating distress (idiom of distress). [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]

There is considerable variation in the presentation of mental health problems across cultural contexts. Most screening and assessment tools do not capture local idioms and culturally specific presentations of distress, thus introducing measurement error and overlooking meaningful variation in mental health. Before applying screening and assessment tools in a particular context, a qualitative exploration of locally salient idioms and expression of distress can help assess whether existing measures are appropriate in a specific context as well as what adaptations may improve their construct validity. We aimed to employ a mixed-methods approach to describe and measure cultural concepts of distress among female Congolese survivors of intimate partner violence in Nyarugusu refugee camp, Tanzania. This sequential study used data from 55 qualitative (free-listing and in-depth) interviews followed by 311 quantitative interviews that included assessments of symptoms of common mental disorder to explore whether the symptom constellations were consistent across these methodologies. Results from thematic analysis of qualitative data and exploratory factor analysis of quantitative data converged on three concepts of distress: huzuni (deep sadness), msongo wa mawazo (stress, too many thoughts), and hofu (fear). The psychometric properties of these constructs were comparable to those of the three original common mental disorders measured by the quantitative symptom assessment tools—anxiety, depression, and post-traumatic stress disorder—adding weight to the appropriateness of using these tools in this specific setting. This mixed-methods approach presents an innovative additional method for assessing the local "cultural fit" of globally used tools for measuring mental health in cross-cultural research. [ABSTRACT FROM AUTHOR]

The increasing global need for mental health care has led to a search for efficient, effective treatments that are based on both local cultural healing traditions and scientific evidence. In this article, I describe the development of a brief, culturally responsive, transdiagnostic approach to psychotherapy for common mental disorders in Bhutan, a rapidly changing culture firmly grounded in Vajrayana Buddhism. Buddhist-Informed Therapy for Bhutan (BT-B) supports Bhutan's goals of preserving traditional culture, improving psychological well-being for its citizens, and integrating Buddhism into solutions for contemporary social issues. More broadly, BT-B extends the range of culturally responsive treatment approaches in several ways. First, BT-B is innovative in its identification and therapeutic use of conceptual links between specific Western evidence-based principles of therapeutic change and core Buddhist principles. Listening empathically to the client's narrative, the therapist identifies an evidence-based principle to address and uses conceptually linked deeply rooted Buddhist beliefs to guide the client in applying their own cultural wisdom to resolve problems. Second, the model illustrates the value of an ecological approach to culturally responsive treatment development that takes into account local cultural beliefs, practices, and institutions, including those that shape health care delivery and use. Third, evidence from case examples adds to the growing body of literature that supports the utility of transdiagnostic therapeutic approaches across cultures and in settings where resources are limited. [ABSTRACT FROM AUTHOR]

This study explored the lived experiences and meanings of recovery from mental distress from the perspective of mental health service users in Romania, along with investigating cultural particularities of recovery in this country. Research in this area is essential in the context of Romania's mental health reform marked by a transition from institutionalised mental health services to a recovery-based approach, and profound social and economic changes during the post-communist era. Subscribing to the recovery framework, this study employed a qualitative phenomenological design involving 15 adults with mental health problems purposively recruited from a community day centre in Romania. The phenomenological background was enriched with elements of participatory photography to elicit subjective experiences and meanings of recovery. The outcome of this study was a better understanding of recovery in Romanian adults living with mental distress, as a complex and multi-layered phenomenon. Three key themes were identified through Interpretative Phenomenological Analysis: awakening, healing, and reconstructing life. The findings add to the current recovery models by showing that recovery cannot be fully understood unless situated in a socio-political, cultural, and historical context. Implications for mental health practice in Romania are discussed and directions for future research are recommended. [ABSTRACT FROM AUTHOR]

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

Migrants and ethnic minorities are at risk of being under- and overdiagnosed with personality disorders (PDs). A culturally informed approach to the classification of PDs guides clinicians in incorporating migration processes and cultural factors, to arrive at a reliable and valid assessment of personality pathology. In this article, we provide a tentative framework to highlight specific interactions between personality disorders, migration processes, and cultural factors. It is argued that migration processes can merely resemble personality pathology, activate certain (latent) vulnerabilities, and aggravate pre-existing personality pathology. We propose that these migration processes can include manifestations of grief about the loss of pre-migratory psychosocial and economic resources, and the struggle to attain psychosocial and economic resources in the host culture. Moreover, several cultural dimensions are outlined that can either resemble or mask personality pathology. The term "culturally masked personality disorder" is coined, to delineate clinical cases in which cultural factors are overused or misused to rationalize behavioral patterns that are consistently inflexible, distressing, or harmful to the individual and/or significant others, lead to significant impairment, and exceed the relevant cultural norms. Additionally, the role of historical trauma is addressed in the context of potential overdiagnosis of personality disorders in Indigenous persons, and the implications of misdiagnosis in migrants, ethnic minorities, and Indigenous populations are elaborated. Finally, clinical implications are discussed, outlining various diagnostic steps, including an assessment of temperament/character, developmental history, systemic/family dynamics, migration processes, cultural dimensions, and possible historical trauma. [ABSTRACT FROM AUTHOR]

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]

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]

The successful integration of cultural competence with evidence-based practices in mental health services is still limited for particular cultural populations. The current study explored culturally adapted family psychoeducation intervention for immigrants from the former Soviet Union (FSU) in Israel who care for a family member with severe mental illness (SMI). Semi-structured in-depth interviews were conducted with 18 immigrant mothers about their experience of taking part in Russian-speaking multi-family psychoeducation groups (MFPGs). Qualitative content analysis revealed five salient processes and changes that participants attributed to their engagement in the intervention: 1) from a language barrier to utilization of and satisfaction with services; 2) from a lack of information to acquiring new mental health knowledge; 3) from harboring a family secret to exposure and sharing; 4) from social isolation to cultural belonging and support; 5) from families blurring boundaries to physical and emotional separation. The results showed that these changes—linguistic, cognitive, emotional, socio-cultural and relational—improved family coping and recovery. Implications for cultural adaptation of family psychoeducation for Russian-speaking immigrants are discussed. [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]

Multiple theories, including attachment, family systems, and epigenetics, among many others, have been invoked to explain the mechanisms through which trauma is transmitted from one generation to the next. To move toward integration of extant theories and, thus, acknowledgement of multiple pathways for transmission of trauma, the authors explore the potential of applying a culturally enhanced bioecological theory to transgenerational trauma (TGT). Data from in-depth qualitative interviews in Rwanda more than two decades after the genocide, with 44 mothers of children born of genocidal rape, and in-depth interviews and focus groups with a total of 60 youth born of genocidal rape, were analyzed according to the processes of culturally enhanced bioecological theory. The findings from a hybrid inductive and deductive thematic analysis suggest that a culturally enhanced bioecological theory of human development allows for an integrated, multi-dimensional analysis of individual, family, cultural, and societal factors of transmission of TGT. Some facets of the data, however, are not accounted for in the theory, specifically, how some mothers were able to create and sustain a positive bond with their children born of genocidal rape, despite societal and family pressure to abandon or abort them. Nonetheless, the findings demonstrate how a culturally enhanced bioecological theory can be an important overarching framework for developing policies and practices to help interrupt or mitigate TGT, strengthen resilience, and facilitate healing for children born of genocidal rape, their mothers, and their families. [ABSTRACT FROM AUTHOR]

Psychedelics have been already used by human societies for more than 3000 years, mostly in religious and healing context. The renewed interest in the potential application of psychedelic compounds as novel therapeutics has led to promising preliminary evidence of clinical benefit in some psychiatric disorders. Despite these promising results, the potential for large-scale clinical application of these profoundly consciousness-altering substances, in isolation from the sociocultural contexts in which they were traditionally used, raises important concerns. These concerns stem from the recognition that the mechanisms of therapeutic action of psychedelics are not entirely dependent on neurobiology, but also on the psychological, social and spiritual processes for their efficacy. For these reasons, physicians or psychotherapists involved in psychedelic-assisted psychotherapy need training in ways to accompany patients through this experience to promote positive outcomes and address potential side effects. Psychedelic therapies may foster the emergence of a novel paradigm in psychiatry that integrates psychopharmacological, psychotherapeutic, and cultural interventions for patients with mental health issues. [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]

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]

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

The present study examines the links between different types of morality and obsessions in university students from Leuven, Belgium ( N  = 252) and İstanbul, Turkey ( N  = 301) using validated scales for morality and obsessions. Belgium and Turkey were chosen as two exemplar cultural contexts expected, and in the current study found, to differ in the relative levels of individualizing and binding morality. We hypothesized that obsessions involving potential harm (e.g., aggressive obsessions) are cross-culturally associated with individualizing morals, and obsessions indicating impurity (e.g., contamination) are cross-culturally associated with binding morals. Moreover, we expected that cultural differences in the frequency of obsessions could be linked to differences in culturally prevalent moralities. As predicted, contamination obsessions were cross-culturally linked to binding morals. Also, the frequency of contamination obsessions was higher in the Turkish sample compared to the Belgian, which was predicted by higher levels of binding morals in Turkey. Doubts were cross-culturally endorsed at similar rates and were associated with individualizing morals. Aggressive obsessions were relatively more frequent in the Belgian compared to the Turkish sample, however-unexpectedly-these intrusions were not positively linked to either type of morality, neither in Belgium nor in Turkey. Taken together, these findings provide initial support for the role of morality in obsessive-compulsive disorder (OCD), at least for certain types of obsessions (contamination and doubts), as well as suggest that some differences in the moral foundations may play a role in explaining the prevalence of certain obsessions (i.e., contamination)., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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]

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]

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]

The sociocultural context of psychiatric patients shapes symptoms experience and expression, as well as how patients deal with a disorder and how society appraises its symptoms. Specifically, the context may influence the social appraisal of a behavior as normal or pathological. Therefore, markedly pathological symptoms may not be accordingly recognized by peers when they are in consonance with the sociocultural context. Per "Dead" Ohlin was a Swedish musician who was a member of the Norwegian black metal band Mayhem from 1988 until his suicide in 1991, at age 22. Black metal is a musical movement characterized by death worshiping and anti-Christianism, and is also associated with church arsons and murders during the 1990s. Even among peculiar personalities such as black metal musicians, Ohlin was considered the personification of the movement ideals due to his eccentric and unparalleled beliefs and behaviors, claiming, for instance, that he was already dead. In this article, we propose that Ohlin's eccentric beliefs and behaviors were symptoms of an unrecognized psychiatric condition, Cotard's syndrome, and discuss the diagnostic dilemma presented by Ohlin's artistic persona and singular context. The compatibility between his symptoms and the sociocultural context of black metal may have obscured his mental disorder. If so, Ohlin's unique case may shed light upon one of the effects of context in a psychopathological process: concealing a psychiatric disorder and reinforcing symptoms that fit a particular environment. [ABSTRACT FROM AUTHOR]

This article introduces a thematic issue of Transcultural Psychiatry on suicide in cultural context. Developmental and social structural factors including exposure to violence, childhood abuse and privation, as well as intractable social problems that create psychic pain and a sense of entrapment have been shown to increase the risk of suicidal behavior. However, all of the major social determinants identified in suicide research are influenced or mediated by particular cultural meanings and contexts. To move beyond crude generalizations about suicide based on psychological theories developed mainly in Western contexts and culture-specific prototypes or exemplars, we need more fine-grained analysis of the experience of diverse populations. The articles in this issue provide clear illustrations of the impact of cultural and contextual factors in the causes of suicide, with implications for psychiatric research, theory, and practice. Cross-cultural research points to the possibility of developing a typology of social predicaments affecting specific sociodemographic groups and populations. This typology could be elaborated and applied in clinical and public health practice through an ecosocial approach that considers the ways that suicide is embodied and enacted in social systemic contexts. [ABSTRACT FROM AUTHOR]

Rural Indigenous communities in Alaska suffer staggeringly high rates of suicide. In close-knit Alaska Native villages, each suicide leaves a trail of affected family and community members in its wake. This research aimed to understand community perceptions of what causes suicide in rural Alaska Native villages and generate recommendations for prevention strategies. In-depth interviews were conducted with 25 Alaska Native university students who moved from rural villages to an urban area to attend college. All had been profoundly affected by others' suicides and shared their beliefs about causal factors and recommendations for prevention efforts. Perceived causes included resistance to seeking help or discussing personal problems, loss of culture, traumatic experiences, geographical and social isolation, lack of opportunity, substance abuse, and exposure to others' suicides. Participants believed that suicide is preventable and recommended multi-level approaches to address suicide disparities. They provided recommendations for potentially effective and culturally appropriate prevention strategies, including increasing cultural and social connections, educating community members about mental health, and increasing accessibility of counseling services/reducing barriers to mental health services utilization. [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]

Eating disorders (EDs) have been documented in various cultural settings. A continuous increase in ED' rates among non-Western cultures (e.g., Arab cultures and East-Asian cultures) has been reported. We aimed to investigate the relations among culture, ED symptoms, and psychological features that are highly relevant in EDs through a cultural comparison of three groups. The groups included female university students in Israel with varying levels of exposure to Westernization: 118 Jewish students, 132 Arab students studying at a mixed university with a Jewish majority, and 111 Arab students studying at Sakhnin College, a college for Arab students only. The groups differed significantly on the Conservation Value dimension from the Short Portrait Values Questionnaire. Four psychological features were examined as predictors of ED symptoms: Interoceptive-deficits, Ineffectiveness, Asceticism, and Maturity-fear. The results revealed a comparable prevalence of self-reported ED symptoms among Arabs and Jews, with a small exception for bulimic symptoms, which were less prevalent among those in the Sakhnin group, who also scored lower on Ineffectiveness and higher on asceticism than the other groups. Testing the relations between the four psychological features and ED symptoms revealed that culture played a moderating role in predicting the strength of ineffectiveness and maturity-fear. Ineffectiveness was not a predictor among the Sakhnin group, whereas maturity-fear was not a predictor in the least conservative Jewish group. Asceticism and interoceptive-deficits predicted ED symptoms across all study groups. Our findings indicate that the problem of EDs may be similar among Arab and Jewish women in Israel. Moreover, despite some similarities in the relevance of some ED-related psychological features, other features are moderated by culture., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Research on self- and cultural continuity has contributed to our understanding of resilience processes in Indigenous communities, as connecting oneself to the past, present, and future of one's family, community, and traditional culture has been found to protect against deleterious developmental outcomes. To examine factors associated with self-continuity for Indigenous youth in the current study, Indigenous youth from six rural Ojibway and Métis communities in Treaty 2 Territory completed self-report questionnaires aimed at understanding the relationship between the concept of oneself across time and protective and risk factors at different systemic levels (family, community, culture, and colonial). The concept of oneself across time was measured by self-efficacy (global self-worth) and future orientations (optimism and sense of self in the future). The findings indicated that connectedness to caregivers, siblings, friends, neighborhoods, and culture was associated with higher self-efficacy, seeing oneself as more connected to the future, and seeing the future more positively. These findings support the notion that familial, community, and cultural connectedness are associated positive self-concepts in the present and future, which aligns with our understanding of self- and cultural continuity in Indigenous communities., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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]

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]

This study aimed to explore key professionals' attitudes towards people with intellectual disability (ID) and inclusion of said people in the community. Eighteen participants from three professional groups, comprising health practitioners (medical doctors, psychologists), mainstream/special education teachers, and religious leaders (Islam, Catholicism, Protestantism, Hinduism, and Buddhism) were recruited. Semistructured interviews, aided by two vignettes depicting mild and severe ID, were conducted. Thematic analysis was used to analyse the data. Seven themes were identified exploring: perceived causes; use of terminology; attitudes towards people with ID; attitudes towards inclusion, religion and ID; family-centric support; and challenges faced by people with ID in a wider context. Perceived capabilities of persons with ID were found to influence attitudes towards people with ID and their inclusion. Availability and accessibility of good quality services were also found to influence attitudes towards the inclusion of people with ID. Cultural factors related to attitudes towards ID are discussed. [ABSTRACT FROM AUTHOR]

Raising a child with Autism Spectrum Disorder (ASD) can often be a difficult and stressful process for families and caregivers. Though research on ASDs in Africa is burgeoning, very little is known about autism in francophone West Africa. Furthermore, no known ASD studies have explored parental experiences in particular from a cross-cultural perspective. This research used Interpretative Phenomenological Analysis to analyze in-depth, semi-structured interviews with seven Senegalese and seven American families to investigate parental experiences within the Senegalese community with further illustration by cross-cultural comparison. Comparative analysis of data across the two countries was undertaken to identify cultural variables previously unreported, especially those that may affect Senegalese family experience. Analysis of interviews revealed thematic differences in social and community support. Although access to effective treatment services was low among Senegalese families compared to the American families, traditional Senegalese household structures and community relations were hypothesized to serve as protective factors against the high social isolation and resulting logistical struggles reported in the U.S. sample. Further targeted research within the Senegalese environment is recommended, particularly to explore social stigma and its possible effects on families with autism, causal beliefs and treatment practices, and parental mental health and wellbeing. [ABSTRACT FROM AUTHOR]

Previous research has found supernatural beliefs about sleep paralysis (SP) to be very prevalent in Italy, with over one third of SP sufferers believing that their SP might have been caused by a supernatural creature known locally as the Pandafeche. The current study further examined features of SP in Italy. All participants had experienced SP at least once in their lifetime. Participants were recruited from the general population (N = 67) in the region of Abruzzo. The Sleep Paralysis Experiences and Phenomenology Questionnaire (SP-EPQ) was orally administered to participants. As hypothesized, we found that Italians from the general population reported high lifetime rates of SP, prolonged duration of immobility during the event, and great fear of the experience (with as many as 42% of SP sufferers fearing that they could die from the experience), all of which were particularly elevated as compared to cultures where there are no such elaborate traditions of SP (e.g., Denmark). In addition, 78% of participants experienced some type of hallucination during their SP. The results we present here suggest that cultural beliefs about SP in Italy (e.g., as being caused by the Pandafeche, as reported elsewhere) potentially can profoundly shape certain aspects of the experience – a type of mind-body interaction. [ABSTRACT FROM AUTHOR]