Cultural Psychiatry

Several forums at the May 2006 American Society of Addiction Medicine (ASAM) addressed the issue of the gap between the number of investigational addiction treatment drugs and the few actually available on the market.

Research conducted over the past 30 years leads to the conclusion that televised violence does influence viewers' attitudes, values and behavior.

A report from the Government Accountability Office supports an earlier accusation in the New England Journal of Medicine that the FDA is failing to protect the public from unsafe drugs.

Every young woman who reads Pride and Prejudice imagines herself as the heroine, Elizabeth. Can a male director who confesses a lack of literary influences create a faithful adaptation of Jane Austen’s beloved work?

The authors argue that adopting a single payer system would be like jumping out of the fire and into the frying pan. They look at three perspectives-the doctor's, the patient's and the health care policy-maker's.

Evidence-Based Therapies in Child and Adolescent Psychiatry by Jon McClellan, M.D. Given the lack of large, randomized controlled studies of psychiatric medications that involve children and adolescents, it can be difficult to establish evidence-based therapies that are effective for this population. However, there are studies that have shown the effectiveness of various medications, as well as for various psychotherapy techniques.

Childhood Reactions to Terrorism-Induced Trauma by Wanda P. Fremont, M.D. The unpredictable, indefinite threat of terrorist events, the profound effect on adults and communities, and the effect of extensive terrorist-related media coverage can contribute to a continuous state of stress and anxiety in children. Current treatment strategies are discussed as well as direction for further research.

The infamous trial of People v Schmidt, presided over by Justice Benjamin Cardozo, provides a cautionary tale for forensic psychiatrists. In his commentary on a biography of the celebrated judge, Stone assesses the quest to clarify the meaning and scope of the insanity defense.

Psychiatrists have often turned to literature for theory building, clinical understanding and teaching. Hamlet is a common example, beginning with Freud. Most psychiatrists, like Freud, look at content (character and motivation) when using literature. However, the process (interaction between characters) can also teach us much about the psychiatrist-patient encounter.

Ever since antiquity, thinkers have associated creativity with psychopathology--the classic idea of the "mad genius."

During a trip to Beijing on behalf of the World Psychiatric Association, Dr. Stone witnessed up close how the psychiatry is practiced in today's China. What he found may surprise you--it certainly surprised him.

Little attention has been paid to the prevalence of sexual assault and its sequelae among military men. The past-year prevalence of sexual assault among enlisted men ranges from 0.4% to 3.7%, a figure equal to or exceeding the lifetime prevalence among civilian men in some studies. Increased awareness and understanding of male sexual assault as well as routine screening of all patients, regardless of gender, for exposure to sexual victimization will enhance their recovery.

Dr. Gabbard discusses using psychotherapy and psychiatry combined, how media portray psychiatrists and why Tony Soprano does the things he does.

Comorbid substance use disorders may complicate treatment for both the hepatologist and psychiatrist. Comprehensive assessment of psychiatric illness and psychopharmacological management may be critical.

Worldwide, nonfatal deliberate self-harm is common among young people. However, when studying this phenomenon, methodological issues arise. Differences between genders have been found in presenting to the hospital following self-harm and in motive for engaging in this troubling behavior.

In the second part of this series, read about the special issues psychiatrists face when treating women, children and adolescents, and elderly people with bipolar disorder and dementia. What are the recommendations for care and monitoring strategies to maintain patients on effective, long-term treatment regimens?

Allegations of complicity by Chinese psychiatrists in abuse and persecution of members of the Falun Gong continues to trouble the World Psychiatric Association. Are the steps being taken to learn the truth enough? Dr. Stone provides a look at the events that have unfolded to date.

Underdiagnosis of sexual dysfunction occurs frequently, even though more than two out of five adult women and one out of five adult men experience it in their lifetime. To increase recognition and care of sexual dysfunction, multidisciplinary teams of medical experts recently published diagnostic algorithms and treatment guidelines that include comprehensive psychosocial assessments, sexual histories, and discussions of selected psychotherapies and pharmacotherapies.

Homosexual identities can be described as closeted, homosexually self aware, gay/ lesbian and non-gay identified. This classification privileges the role of self-definition. In coming out, gay people integrate, as best as they can, dissociated aspects of the self. As gay people must decide on a daily basis whether to reveal and to whom they will reveal, coming out is a process that never ends.

A cross-cultural comparison of suicide in old age, including a discussion of recent epidemiological trends in suicide rates. The authors also discuss the impact of social and cultural variables on the detection of depression and the formulation of suicide prevention strategies.

Although eating disorders have been considered to be largely sociocultural in origin, findings from family, twin and molecular genetic studies conducted during the last decade are refuting that perspective. Recent studies have had significant success in isolating specific chromosome regions that may harbor susceptibility loci for anorexia and bulimia nervosa and are helping to shed light on the degree of heritability of eating disorders.

This introduction article elucidates how the various contributions to this special report help make psychiatry such a rich and varied field.

What are some of the pitfalls of treating patients from varying cultural backgrounds, what cultural issues should psychiatrists be aware of and how can they fit varying culturally based psychiatric disorders into a proper diagnostic framework? Using case studies, Dr. Moldavsky explores the clinical implications of culture in psychiatric practice.

In modern practice, psychiatrists will invariably have patients who come from different ethnic or cultural backgrounds. Practitioners will need to consider socioeconomic status, diet, use of herbal medications and immigration status, as well as patients' own self-perception of ethnicity, in assessing patients and planning treatment.

Despite increased knowledge of child and adolescent mental health disorders worldwide, there is still a dearth of economic and human resources available to meet treatment needs, especially in developing countries. In this article, the impact of developed countries and the dimensions of this problem are discussed.

While the symptoms of somatoform and dissociative disorders are influenced by the patient's culture, these syndromes are heterogeneous and may have overlapping features. Although more frequently reported in non-Western cultures and thought of as exotic and culture-bound, multiple personality disorder may be a North American example of one such disorder.

How does the role of culture affect disease presentation? The author reviews the impact of religion, ideology and upbringing on the epidemiology of OCD in Egypt.

Comparing the consequences of caregiving across countries for a person with a serious mental illness needs to take into account not only different languages, but also different cultures, quality of mental health services and standards of living. So far, one questionnaire has shown the most validity and become the exemplar in cross-national research; yet it is still not free from possible cultural bias or criticism from its creators who acknowledge that much more research needs to be done.

Little attention has been paid in the professional literature to a phenomenon that non-professionals have recognized since ancient times: Trauma can lead to personal growth. This article focuses on how traumatic events set processes in motion that produces new perspectives on the self, relationships and philosophy of life. Implications for clinical work with trauma survivors are discussed.

There is a long tradition in psychiatry, reaching at least back to World War I, of studying the response of people who are faced with traumatic circumstances and devising ways to restore them to psychological health. The main focus of this work has been on the ways in which traumatic events are precursors to psychological and physical problems.