Cultural Psychiatry

The poet must remember that it is his poetry which bears the guilt for the vulgar prose of life, whereas the man of everyday life ought to know that the fruitlessness of art is due to his willingness to be unexacting and to the unseriousness of the concerns to his life. The individual must be answerable through and through: all of his constituent moments must not only fit next to each other in the temporal sequence of his life, but must also interpenetrate each other in the unity of guilt and answerability-M.M. Bakhtin, 1919

As health care continues to shift in the United States from fee-for-service to managed care, and away from specialist-driven care to the primary care gatekeeper, it is necessary to re-examine psychiatric training and the psychiatric services that are being provided.

A new booklet released in April of this year provides, for the first time in modern medical history, a road map for ending life with physician assistance. Entitled The Oregon Death With Dignity Act: A Guidebook for Health Care Providers, the publication was the product of a two-year project sponsored by the Center for Ethics in Health Care at the Oregon Health Sciences University in Portland.

In more than two dozen programs throughout the United States, telepsychiatry is ushering in a new way of bringing mental health services to thousands of individuals who, in the past, may have gone without. More often than not, however, they are pilot projects or grant-supported endeavors, meaning that these prototypes of the psychiatrist's office of the future have yet to prove themselves in the medical marketplace.

The dramatic series of recent school shootings in nearly every region of the country has forever altered the way American society views its children. Fueled by media accounts that convey the drama of kids out of control, politicians, public policymakers, school administrators and parents now struggle for answers.

Among the specialized refugee population in the United States, there is little research on the gender differences in psychological distress, which is considerable. Southeast Asian refugee women have been identified as an at-risk group for developing serious psychiatric disorders primarily due to their premigration experiences.

There is a substantial constituency for alternative medicine. Worldwide, 70% to 90% of all health care "ranges from self-care according to folk principles, to care given in an organized health care system based on an alternative tradition or practice." As many as one-third of all Americans are reported to have some belief in alternative medicine or to be actively using nonmainstream remedies.

My Bosnian psychiatric colleagues reported to me that there was the usual adolescent stew of identity crisis among them: delinquency, drugs and sex; but also much, much more. I asked the students, "What do you suffer from?" Lack of opportunity was mentioned most often. A few said that they wanted someone to talk with when it all got to be too much. They welcomed the new school-based initiative of the adolescent mental health clinic in Sarajevo.

For elders confronted with the necessity of living in a nursing home, the choice of facility is a decision with profound consequences-for their health, their quality of life and their family finances. Nursing home care may cost $50,000 a year or even more, and more than half of all elders begin their nursing home stays by paying the costs out of pocket. That imposing sum can purchase excellent care, or can pay the rent for a place that is literally "worse than death" for the unfortunates who live there.

"Hwa-byung" and "ataque de nervios," listed in the Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) as culture-bound syndromes, can serve as gateways to understanding anger's role in psychiatric morbidity, according to a panel of experts.

The role of psychiatry in primary care is an area of rapid expansion and increasing significance. Given the fact that inadequate diagnosis and treatment of psychiatric disorders are major public health problems, it is essential to integrate psychiatrists into multidisciplinary primary care teams. Since primary care physicians are increasingly called upon to act as "gatekeepers" in managed care programs, they will have to meet the important and growing need for broader psychiatric diagnostic and referral skills.

To understand our fascination with drugs in the first place, we need to ask some basic questions, such as "Why do we like to take poison in small quantities?" The truthful answer is always some variation of "To feel better." How does this come about, and why do we have so much trouble with it?

During this first century of Western psychotherapy, arguments among and between the schools of psychotherapy have dominated discourse. The psychotherapy of the next century is likely to place theory and associated techniques in their appropriate, practical places in the psychotherapy outcome puzzle.

The power of Superman's spell endures mightily, and the values of truth and justice he communicated through comics, and then television and movies continue to pass undiminished from generation to generation.

The important thing about teachers listening to Ebonics is for them not to equate it with the students' being stupid, says Alvin Poussaint, M.D., professor of psychiatry. "It means they've learned a way to speak in their community or home that's a natural way for them to speak, which they then carry with them to school." While the language is part of who they are and their connection to their community, it doesn't absolutely have to exist to preserve a black identity.

The state of North Carolina has relatively liberal policies regarding petitions for involuntary commitment. If such documents bear words like "dangerous" or "mentally ill," even in the most nebulous sense imaginable, the police will surely locate the relevant individuals and dutifully bring them to the emergency department. This generosity of interpretation produces some sticky situations for the lucky ED resident of the day.

As a practicing psychiatrist, I have watched with growing dismay and outrage the rise and triumph of the hegemony known as biologic psychiatry. Within the general field of modern psychiatry, biologism now completely dominates the discourse on the causes and treatment of mental illness, and in my view this has been a catastrophe with far-reaching effects on individual patients and the cultural psyche at large. It has occurred to me with forcible irony that psychiatry has quite literally lost its mind, and along with it the minds of the patients they are presumably supposed to care for. Even a cursory glance at any major psychiatric journal is enough to convince me that the field has gone far down the road into a kind of delusion, whose main tenets consist of a particularly pernicious biologic determinism and a pseudo-scientific understanding of human nature and mental illness.

Psychotherapy is as old as civilization. Literally soul therapy, the term is a misnomer, since soul is a mystical notion and what is meant is the whole person. The misnomer also survives in the name psychiatry, literally soul medicine. Yet nobody is crusading against psychiatry and psychotherapy because soul is unscientific. What is important is that psychotherapy and psychiatry are job descriptions that refer to what we actually do when as providers or recipients of the service called psychotherapy, we use words to convey meaningful messages to each other, or to evoke desirable acts from each other.

An explanation of the cycle of abusive dynamics as it exists in abusive relationships, in commonsense language.

Historically, cult refers to a system of worship and more specifically to an innovative religious system, as opposed to a sect, which is a breakaway group from an established religion. During the past 30 years, however, cult has taken on a pejorative connotation arising from disasters such as Jonestown and Waco, and hundreds of media reports of individuals and families devastated by involvement in cults.

Paraphilias as defined by DSM-IV, are sexual impulse disorders characterized by intensely arousing, recurrent sexual fantasies, urges and behaviors (of at least six months' duration) that are considered deviant with respect to cultural norms and that produce clinically significant distress or impairment in social, occupational or other important areas of psychosocial functioning.