Cultural Psychiatry

The chief psychiatrist of the Community-University Health Care Clinic in Minneapolis reflects on what he's learned caring for refugees from Southeast Asia and Somalia. His experiences can educate others caring for immigrants and refugees.

In the wake of the report issued by the Institute of Medicine detailing the number of medical errors each year, the American Psychiatric Association has issued a set of patient safety recommendations. Will these recommendations reduce the number of psychiatric patient deaths and injuries?

The World Trade Center attack changed the face of the United States and of psychiatry. Men and women of the cloth and of the clinic came together to care for the stricken masses. Yet, members of the clergy do not always refer congregants who exhibit duress to the psychiatrist, nor do psychiatrists refer patients to the clergy. What keeps these two fields apart? What is best for your patient?

Groups are important throughout the course of a patient's therapy, especially for patients who have substance use disorders. Group therapy's clinical and cost benefit is evaluated for its efficacy in preventing and treating substance abuse.

Is history repeating itself? Has China taken up the political abuse of psychiatry by adopting the methods that made the Soviet Union infamous? That is the claim now being made by human rights groups who are calling on organized psychiatry to intervene.

Many patients, particularly those living in colder climates, can suffer from seasonal affective disorder (SAD). What causes SAD and what are the treatment options for these patients?

Many adolescents experience depressive symptoms and some have episodes that go beyond transient feelings. Risk factors and predictive strategies are thwarted by the power of individual differences. Communicating with patient families; using the available innovative pharmacological, diagnostic and behavioral tools; and individualizing treatment approaches can improve outcomes.

The World Health Organization (WHO) has distributed for comments the draft of a Manual on Mental Health Legislation as a guide for all the countries of the world. It is to serve as a model for new legislation and as a guide for countries amending their legislation. Given the different legal systems, the cultural diversity and the vast inequalities in economic resources among the nations of the world, one can certainly question the wisdom of the WHO's top-down approach. In addition, everyone who knows the scarcity of competent mental health care professionals and the limited resources in third world countries will recognize that most of the proposals are quite unrealistic. How can nations who cannot feed their poor or meet the basic necessities of public health measures and primary care be expected to provide "incompetent" mental patients with counsel (lawyers) and independent tribunals (courts) before they begin to treat them?

While anorexia nervosa was the first eating disorder to be recognized through the 19th century reports of Gull (1874) and Lassque (1873), bulimia nervosa and the less well-defined eating disorder not otherwise specified (EDNOS) syndromes are more common.

Patient Drug Information From Mass Media Sources

In warn-torn Afghanistan, refugees continue to struggle to survive in 20-year-old "temporary" shelters, without proper food and suffering from the psychiatric consequences of trauma. What are psychiatrists doing to help?

In the 1800s there was widespread concern over the increase in the number of individuals with severe mental illnesses. Evidence from the 20th and 21st centuries is building that shows a similar trend. Why, then, is this increase not being currently addressed?

A report released by former Surgeon General David Satcher, M.D., outlines the disparity in mental health diagnoses and treatment between majority and minority ethnic groups. The report also discusses ways of closing the gap in mental health treatment.

Compared with Caucasians, African Americans receive an excess of schizophrenia-spectrum diagnoses. Potential explanations for the ethnic differences in clinical assignment of psychiatric diagnoses are reviewed.

Psychodynamic concepts such as the Self and the collective unconscious are helpful in understanding "our millennial event"3/4Sept. 11, 2001. Because it aims to help patients become aware of and free themselves from social contexts, psychotherapy may be more useful than ever.

The very immediacy of the recent terrorist attacks makes the diagnosis of posttraumatic stress disorder problematic since there is no distance of time or space from the event itself. How can clinicians deal with this shift to best treat patients?

In the glossary of our book The Culture-Bound Syndromes, Charles C. Hughes, Ph.D., listed almost 200 folk illnesses that have, at one time or another, been considered culture-bound syndromes (Simons and Hughes, 1986). Many have wonderfully exotic and evocative names: Arctic hysteria, amok, brain fag, windigo.

The issue for us is whether positive thinking is relevant in certain situations. Would it help, or would it create more problems than it would solve?

With so many Americans lacking appropriate health care insurance and so much of the large insurance companies' premiums going to overhead and profit, it makes sense to move forward with a single payer system. The author discusses some of the basic features of a proposed system.

Stemming from evolutionary man and his simple, primitive act of help in exchange for help and Darwinian theory, Paul Genova, M.D., discusses the role reciprocal altruism plays in the "helping profession" of psychiatry.

This is the second part of an article series discussing the high risk of suicide attempts in patients with schizophrenia. Herbert Y. Meltzer, M.D., continues the discussion with treatment options and efficacy.

People are different, according to conventional wisdom - the saying generally used in explaining varying opinions, attitudes or ways of thinking. Why then is it not a given that people are different in basic brain functions such as learning and intelligence?

Men's Reactions to Female Sexual Coercion

Two studies of patients who switched from Clozaril to generic clozapine are being evaluated by the U.S. Food and Drug Administration to determine whether the rating of the generic drug as bioequivalent (AB) to the brand-reference drug should be reconsidered and whether additional bioavailability assessment should be undertaken.

Although comprehensive theories of addiction recognize the etiological importance of environmental and cognitive factors, it has been widely accepted for many years that addiction is also a brain disease and that individuals differ in their susceptibility to this condition.

After this Tibetan monk's release, he fled across the Nepali border, made his way to India and then to New York City, where he was referred to a program for survivors of torture.

A man named Edward Charles Allaway walked into a college library at California State University in Fullerton, Calif., and, using a .22-caliber rifle, killed seven people and wounded two others in 10 minutes. One of the few individuals who was successfully defended with a plea of insanity, Allaway was ultimately committed to a state psychiatric institution. This incident is not ripped from today's headlines, but from newspapers with a 1976 dateline.

Present-day psychiatry has fallen into crisis because of the severe limitations of its conception of the person and, as a result, its conception of the patient. It objectifies the patient in a number of ways. Because of this reductionism, psychiatry fails to distinguish between healthy and pathological features of human life. It fails to consider adequately the psychological and social factors that cause and maintain each patient's problems.

Let us begin with an example. Suppose I am traveling from the United States to Switzerland, anticipating skiing with my son in the Alps. My anticipation becomes vivid and lively. I recall excitement mixed with joy at rapidly soaring down the mountainside, and I am now quite anxious to re-experience this thrilling adventure with my son-eager to be heading down the mountain with him. Later, as we stand on the crest of a deep and winding slope, the speed, thrill and admixture of danger and adventure will infuse my being.

Alternative medicine was the theme of this issue of JAMA and in each of the other nine American Medical Association journals published in November. The editors of these scientific journals made an effort to provide physicians and other health care professionals with clinically relevant, reliable, fresh scientific information on alternative therapies.