Transcultural Psychiatry

Viewed historically and cross-culturally, orthostatic-induced dizziness, i.e., dizziness caused by standing up from a sitting or a lying position, forms a key aspect of many syndromes: irritable heart (American Civil War), effort syndrome (World War I and World War II), chronic fatigue syndrome (contemporary USA), Gulf War syndrome (contemporary USA), and orthostatic dysregulation (contemporary Japan). Among Vietnamese refugees attending a psychiatric clinic, this study documents a high rate of orthostatic panic (OP), as well as certain processes seemingly generating these panic attacks, viz., flashbacks and culturally specific catastrophic cognitions. Case examples are used to demonstrate OP's phenomenology and relevance to clinical care. To illustrate the mechanisms producing OP, we adduce the multiplex model of panic generation. Culturally appropriate care of Vietnamese refugees should include assessment and treatment of OP.

Drawing upon data collected through in-depth interviews with 20 victims of the Ethio-Eritrean war, this article addresses how psychosocial impacts of political violence are coped with in a Tigrayan context in northern Ethiopia. Qualitative procedures of condensation and categorization of interview texts revealed that informants presented three kinds of coping strategies, all aimed at avoiding indulging in sorrow: (1) diverted thinking, (2) distraction, and (3) future investment. As their main rationale for employing such coping strategies, informants reported the belief that grieving and crying would have negative impacts on their health, their household, and on their relationship with God. This belief is discussed in terms of how it is informed by sociocultural discourses of the Tigrayan community in general, and discourses of the Ethiopian Orthodox Church in particular. Some implications concerning the mismatch between the western trauma discourse and local discourses for psychosocial coping are discussed.

September 11, 2001 profoundly affected the American public. We share the views of a cohort of refugees and those seeking asylum from the Boston Center for Refugee Health and Human Rights. Of the 63 individuals from 18 countries interviewed, many had concerns about their personal safety following September 11, as well as fears related to deportation, arrest, detention, imprisonment, discrimination, physical violence and the destruction of property, and war. Asylum seekers were more likely than refugees to have concerns about their safety before their departure and during flight, as well as fear deportation and arrest after September 11. In the wake of September 11, most common coping strategies utilized included prayer (77.8%), speaking with friends from their own social group (47.6%), family (44.4%), and belief in fate (42.9%).

To identify and explore cultural dynamics influencing the psychiatric care of immigrant Somalis in the USA, we reviewed demographic data from Minnesota Departments of Human Services, and interviewed health professionals, exploring community perceptions of medical/psychiatric needs, cultural characteristics, barriers to care, and potential solutions. An informal survey of 37 members of the Mayo Clinic Department of Psychiatry and Psychology, to determine caregiver perceptions of care of Somali patients, cited language barriers (74%), and cultural misperceptions (68%) as the most frequent obstacles. Difficulties working within the patriarchal family structure, limited community resources, poor compliance, and financial issues ranged between 18 and 8%. Additional barriers mentioned were problems working with interpreters from `warring clan factions,' patients' fears of being labeled `crazy,' difficulties viewing illness within an emotional framework, and the need to address mental health from a physical framework through a focus on somatic symptoms. Somalis rarely acknowledge psychiatric problems and common traditional treatments have become ineffective in the new context. Recommendations include alternative health care approaches utilizing family values, `bargaining,' and educational approaches to acculturation.

We investigated the sociodemographic and clinical characteristics of asylum-seeking and refugee children and adolescents referred to a child and adolescent psychiatry service in the Netherlands. Children with families and unaccompanied minors were compared. Unaccompanied minors had significantly higher frequencies of symptoms and psychiatric disorders than the children with families, both considered a high-risk population for mental health problems.

This article explores how elderly English-speaking Indian immigrant women living in Edmonton, Alberta, Canada perceive and manage mental distress. With elders' consent, in-depth interviews were recorded, transcribed and transcripts were thematically analyzed. The findings suggest that these women believed that to lower the risk of mental distress it is critical for individuals to `maximize control over inner self' by `being busy.' The elder's busy behavior is framed within the Indian cultural and spiritual/faith matrix in dialogue with acculturation experiences in Canada. `Staying busy' allows these elders to use culture as a `moral medicine' to facilitate coping and adaptation.

Depression has important cultural and social components. Interviews with 16 women living in the poor and violent outskirts of São Paulo were analyzed to identify local concepts of depression. The interviews were conducted with women who were diagnosed with depression and patients in treatment at a primary care unit. For these women, depression was inextricably woven into their violent and downtrodden daily lives, as well as with other sources of suffering. The local community identified two types of depression: `true' and `false,' suggesting a concept enmeshed with morality.

Little research has been conducted on media representations of psychiatric de-institutionalization in low-income countries. We set out to examine whether the Jamaican media takes a positive or negative orientation to psychiatric de-institutionalization, and which arguments and rhetorical devices are employed to support the media's position. This was done by the collection, review, and analysis of all stories related to psychiatric de-institutionalization published over a 26-month period from 2003 to 2005 by Jamaica's principal broadsheet newspaper. All of the stories were positive in orientation. Articles alluded to the therapeutic and economic benefits of de-institutionalization. To allay public fears, articles gave prominence to the views of senior psychiatric experts, quoted supporting statistics and international trends, and translated relevant research findings into lay language. Our results are contrary to most studies in high-income countries indicating negative media portrayals of mental illness and the mentally ill.

The aim of this study was to determine the validity and reliability of a Portuguese version of the Postpartum Depression Screening Scale (PDSS). A total of 120 new mothers completed the translated version of PDSS and later were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders, our gold standard for clinical status. The best cut-off score for the Portuguese version was 102, with a sensibility of 94%, a specificity of 95%, a positive predictive value of 75% and a negative predictive value of 99%. Reliability, measured by the alpha coefficient of internal consistency, was .95. The PDSS is considered ready for use in the screening of Brazilian new mothers for postpartum depression.