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Journal: Transcultural psychiatry


Modern exponents of mindfulness meditation promote the therapeutic effects of “bare attention”-a sort of non-judgmental, non-discursive attending to the moment-to-moment flow of consciousness. This approach to Buddhist meditation can be traced to Burmese Buddhist reform movements of the first half of the 20th century, and is arguably at odds with more traditional Theravāda Buddhist doctrine and meditative practices. But the cultivation of present-centered awareness is not without precedent in Buddhist history; similar innovations arose in medieval Chinese Zen (Chan) and Tibetan Dzogchen. These movements have several things in common. In each case the reforms were, in part, attempts to render Buddhist practice and insight accessible to laypersons unfamiliar with Buddhist philosophy and/or unwilling to adopt a renunciatory lifestyle. In addition, these movements all promised astonishingly quick results. And finally, the innovations in practice were met with suspicion and criticism from traditional Buddhist quarters. Those interested in the therapeutic effects of mindfulness and bare attention are often not aware of the existence, much less the content, of the controversies surrounding these practices in Asian Buddhist history.

Concepts: Anapanasati, Mahayana, 20th century, Buddhist philosophy, Buddhism, Zen, Buddhist meditation, Meditation


This systematic review aimed to explore the effects of different degrees of parental disclosure of traumatic material from the past on the psychological well-being of children in refugee families. A majority of studies emphasize the importance of the timing of disclosure and the manner in which it takes place, rather than the effects of open communication or silencing strategies per se. A pattern emerged in which the level of parental disclosure that promotes psychological adjustment in refugee children depends on whether the children themselves have been directly exposed to traumatic experiences, and whether the children are prepubescent or older. The process of trauma disclosure is highly culturally embedded. Future research needs to address the culturally shaped variations in modulated disclosure and further explore how modulated disclosure can be facilitated in family therapy with traumatized refugee families.

Concepts: Academic degree, Psychology, Pattern, Marriage, Sociology, Family therapy, Family, Psychological trauma


Exposure to violence, vulnerability due to lack of shelter, alienation due to stigma, the experiences of severe mental illness (SMI) and subsequent institutionalization, make homeless persons with SMI uniquely susceptible to trauma exposure and subsequent mental health consequences. This study aims to contribute to the development of culturally sensitive interventions for identifying and treating trauma in a population of homeless persons with SMI in Tamil Nadu, India by understanding the manifestations of trauma and its associated consequences in this population. Free-listing exercises followed by in-depth interviews were conducted with a convenience sample of 26 user-survivors who have experienced homelessness or were at risk of homelessness, and suffered from SMI. Topics explored included events considered to be traumatic, pathways to trauma, associated emotional, physical and social complaints, and coping strategies. Results indicate discrepancies in classification of traumatic events between user-survivors and the Diagnostic and Statistical Manual of Mental Disorders. Traumatic experiences, particularly relating to social relationships and poverty, mentioned by user-survivors did not match traditional conceptualizations of trauma. Positive coping strategies for trauma included being mentally strong, knowledge and awareness, whereas the main negative coping strategy is avoidance. User-survivors attributed their experiences of homelessness and SMI to past traumas. Differing views of trauma between user-survivors and mental health professionals can lead to misdiagnosis and under-recognition of trauma in this population of homeless persons with SMI.


This cross-cultural study compared explanations of sleep paralysis (SP) in two countries and two groups with different levels of education in one country. Comparisons were made between individuals having experienced SP at least once in a lifetime from Cairo, Egypt (n = 89), Copenhagen, Denmark (n = 59), and the American University in Cairo, Egypt (n = 44). As hypothesized, participants from the general Egyptian population were more likely to endorse supernatural causal explanation of their SP compared to participants from Denmark; participants from the American University in Cairo were less likely to endorse supernatural causes of their SP compared to participants from the general Egyptian population. Moreover, participants from the American University in Cairo were marginally significantly more likely to endorse supernatural causes of their SP compared to participants from Denmark. Additionally, we explored which culturally bound explanations and beliefs about SP existed in Egypt and Denmark. We found that nearly half (48%) of the participants from the general Egyptian population believed their SP to be caused by the Jinn, a spirit-like creature with roots in Islamic tradition, which constitutes a culturally bound interpretation of the phenomenology of SP in this region of the world. Case studies are presented to illustrate these findings.

Concepts: Quantum mechanics, Metaphysics, Islam, Cairo, Cosmological argument, Egypt, American University in Cairo, Causality


The current paper reviews research that has explored the intergenerational effects of the Indian Residential School (IRS) system in Canada, in which Aboriginal children were forced to live at schools where various forms of neglect and abuse were common. Intergenerational IRS trauma continues to undermine the well-being of today’s Aboriginal population, and having a familial history of IRS attendance has also been linked with more frequent contemporary stressor experiences and relatively greater effects of stressors on well-being. It is also suggested that familial IRS attendance across several generations within a family appears to have cumulative effects. Together, these findings provide empirical support for the concept of historical trauma, which takes the perspective that the consequences of numerous and sustained attacks against a group may accumulate over generations and interact with proximal stressors to undermine collective well-being. As much as historical trauma might be linked to pathology, it is not possible to go back in time to assess how previous traumas endured by Aboriginal peoples might be related to subsequent responses to IRS trauma. Nonetheless, the currently available research demonstrating the intergenerational effects of IRSs provides support for the enduring negative consequences of these experiences and the role of historical trauma in contributing to present day disparities in well-being.

Concepts: Indigenous Australians, First Nations, Canadian Indian residential school system, Aboriginal peoples in Canada


Studies have suggested that in African countries, symptoms of cognitive decline are commonly seen as part of “normal ageing” or attributed to supernatural causes. The impact of folk beliefs about causality upon help-seeking is unclear. Likewise, there is a lack of evidence relating to how families cope with living with an older resident with dementia. Our study’s aim was to explore the sociocultural beliefs, understandings, perceptions and behaviours relating to living with dementia in Kintampo, Ghana. We conducted in-depth interviews with a total of 28 people, using a series of case studies among 10 older people living with dementia and their families. Results revealed that symptoms of cognitive impairment were generally linked to inexorable bodily decline understood to be characteristic of “normal” ageing. Stigma was therefore perceived to be non-existent. Whilst managing the costs of care was often a challenge, care-giving was largely accepted as a filial duty, commonly shared among female residents of large compound households. Families experimented with biomedical and traditional medicine for chronic conditions they perceived to be treatable. Our findings suggest that whilst families offer a holistic approach to the needs of older people living with chronic conditions including dementia, health and social policies offer inadequate scaffolding to support this work. In the future, it will be important to develop policy frameworks that acknowledge the continued social and economic potential of older people and strengthen the existing approach of families, optimising the management of non-communicable diseases within primary care.


Idioms of distress have become a central construct of anthropologists who aspire to understand the languages that individuals of certain sociocultural groups use to express suffering, pain, or illness. Yet, such idioms are never removed from global flows of ideas within biomedicine that influence how cultural idioms are conceived, understood, and expressed. This article proposes a preliminary model of ethnopsychology described by urban Kenyans, which incorporates local (traditional) and global (biomedical) idioms of distress that are both distinct and overlapping in symptomology and experience. This ethnopsychology was generated from analyzing 100 life history narrative interviews among patients seeking care in a public hospital in Nairobi, Kenya, which explicitly probed into how people experienced and expressed the Kiswahili idioms huzuni (roughly translated as sadness or grief) and dhiki (stress or agony) and English terms stress and depression. Kufikiria sana, or “thinking too much”, emerged organically as a powerful cultural idiom and as a symptom or sign of other forms of psychological distress. We propose a preliminary model of ethnopsychology that: 1) highlights social and political factors in driving people to express and experience idioms of distress; 2) reveals how the English terms “stress” and “depression” have been adopted into Kiswahili discourse and potentially have taken on new meaning; 3) suggests that the role of rumination in how people express distress, with increasing severity, is closely linked to the concept of “thinking too much”, and; 4) emphasizes how somatization is central to how people think about psychological suffering.


The Rohingya of Myanmar are a severely persecuted minority who form one of the largest groups of stateless people; thousands of them reside in refugee camps in southeastern Bangladesh. There has been little research into the mental health consequences of persecution, war, and other historical trauma endured by the Rohingya; nor has the role of daily environmental stressors associated with continued displacement, statelessness, and life in the refugee camps, been thoroughly researched. This cross-sectional study examined: trauma history, daily environmental stressors, and mental health outcomes for 148 Rohingya adults residing in Kutupalong and Nayapara refugee camps in Bangladesh. Results indicated high levels of mental health concerns: posttraumatic stress disorder (PTSD), depression, somatic complaints, and associated functional impairment. Participants also endorsed local idioms of distress, including somatic complaints and concerns associated with spirit possession. The study also found very high levels of daily environmental stressors associated with life in the camps, including problems with food, lack of freedom of movement, and concerns regarding safety. Regression and associated mediation analyses indicated that, while there was a direct effect of trauma exposure on mental health outcomes (PTSD symptoms), daily environmental stressors partially mediated this relationship. Depression symptoms were associated with daily stressors, but not prior trauma exposure. These findings indicate that daily stressors play a pivotal role in mental health outcomes of populations affected by collective violence and statelessness. It is, therefore, important to consider the role and effects of environmental stressors associated with life in refugee camps on the mental health and psychosocial well-being of stateless populations such as the Rohingya, living in protracted humanitarian environments.

Concepts: Prolonged exposure therapy, Statelessness, Vietnam War, PTSD, Burma, Cognitive behavioral therapy, Psychological trauma, Refugee


The concept of bipolar disorder has undergone a transformation over the last two decades. Once considered a rare and serious mental disorder, bipolar disorder is being diagnosed with increasing frequency in Europe and North America, and is suggested to replace many other diagnoses. The current article shows how the modern concept of bipolar disorder has been created in the course of efforts to market new antipsychotics and other drugs for bipolar disorder, to enable these drugs to migrate out of the arena of serious mental disorder and into the more profitable realm of everyday emotional problems. A new and flexible notion of the condition has been created that bears little resemblance to the classical condition, and that can easily be applied to ordinary variations in temperament. The assertion that bipolar disorder is a brain disease arising from a biochemical imbalance helps justify this expansion by portraying drug treatment as targeted and specific, and by diverting attention from the adverse effects and mind-altering properties of the drugs themselves. Childhood behavioural problems have also been metamorphosed into “paediatric bipolar disorder,” under the leadership of academic psychiatry, with the assistance of drug company financing. The expansion of bipolar disorder, like depression before it, medicalises personal and social difficulties, and profoundly affects the way people in Western nations conceive of what it means to be human.

Concepts: Caffeine, Mental disorder, Medicine, Pharmacology, Bipolar disorder, Antipsychotic, Schizophrenia, Psychology


Both geographically and historically, schizophrenia may have emerged from a psychosis that was more florid, affective, labile, shorter lived and with a better prognosis. It is conjectured that this has occurred with a reflexive self-consciousness in Western and globalising societies, a development whose roots lie in Christianity. Every theology also presents a psychology. Six novel aspects of Christianity may be significant for the emergence of schizophrenia-an omniscient deity, a decontexualised self, ambiguous agency, a downplaying of immediate sensory data, and a scrutiny of the self and its reconstitution in conversion.

Concepts: Conceptions of self, Social sciences, Self, Humanities, God, Religion, Western culture, Greek loanwords