INDEX (Volume 9 Num 3)

Mental health literacy among secondary school students in North and Central Uganda: a qualitative study - Original Paper E. Okello, C. Abbo, W. Muhwezi, G. Akello, E. Ovug 70 - 80

Objectives There has been limited effort to explore young people’s perceptions about mental illness in Uganda. For mental health programs targeting young people to succeed, it is important to incorporate their understanding of mental illness, their perceptions about causes of mental illness and their attitudes about mentally ill people. The objective of this study was to explore the mental health of young people in secondary schools in Northern and Central Uganda. Subjects and Methods This was a qualitative study where 24 focus group discussions (FGDs) were held with young people in secondary schools. Respondents aged 14-24 years were purposively selected from 4 secondary schools in the two regions. During the FGDs, young people’s perceptions and understanding of three areas listed below were explored: meaning of mental health/mental illness; causes of mental illness and attitudes toward mental illness. Data management and analysis was done with the help of Atlas.ti, a-qualitative-analysis software. Thematic analysis approach was employed. Results FGD participants used concepts like a sound and normal mind, right thinking, normal behavior and normal thoughts to define mental health. Mental illness on the other hand was defined as loss of sense of reality, malfunctioning of the brain, impaired thinking and bizarre behavior. Young people attributed mental illness to; substance abuse (Marijuana, alcohol), witnessing traumatic events (seeing ones your relatives being killed, or being forced to participate in killing-frequently mentioned by young people in Northern Uganda); witch craft, effect of physical illness e.g. HIV/epilepsy, thinking too much, accidents and genetic explanations. They had mixed opinions about interacting with mentally ill individuals. Unpredictability and dangerousness were known to be a recurrent theme among people with negative views about mentally ill. Nonetheless, some FGD participants believed that the level of interaction with mentally ill persons depended on familiarity with mental illness and the severity of the symptoms. Similarly, there were mixed opinions regarding mental illness and work. Three main clusters of responses emerged. These were: i) “mentally ill people should not work”; ii) “mentally ill people should work but..”; iii) “mentally ill people should work like everyone else”. Conclusions Findings point to key gaps in the knowledge and attitudes of young people that need to be targeted by young-people-focused-interventions for mental health. In order for such interventions to succeed, young people must be able to recognize and respond appropriately to signs of distress, reduced functioning, and other early signs of poor mental health.

Regional differences among ethnic Chinese on level of acculturation to Canadian culture and perceived barriers to mental health help seeking - Original Paper H. Mok, S. Miao, R. Au, S. Ganesan, M. McKenna 81 - 88

Background Ethnic Chinese are the largest immigrant population within Canada, yet they consistently under-utilize mental health services. Acculturation is considered an important factor in accessing services within the target country; however it is unclear if there are differences among ethnic Chinese in terms of accessing services and their level of acculturation. Methods A self-report questionnaire was administered to a convenience sample of ethnic Chinese at two sites in Metro-Vancouver (community & hospital) in order to examine the level of comfort and embarrassment, as well as perceived attitudinal and structural barriers in accessing mental health services. Results Higher levels of embarrassment in mental health seeking were found in subjects from the community, and from Mainland China. Higher attitudinal barriers were found in whereas greater structural barriers were found in the community sample. Subjects with more than 12 years of education or who used English in everyday life identified more with Canadian culture. Conclusion Traditional cultural values appear to be salient in accessing mental health services among ethnic Chinese. This has relevance with respect to improving access and utilization of mental health resources by ethnic Chinese in order to provide screening for common mental health disorders such as depression.

Considerations in the provision of mental health helpline services for minority ethnic groups: A systematic review - Review Article K. Ahmed, E. Cosgrove, T. Craig 89 - 98

Objective There are concerns that individuals from minority ethnic groups in Western countries have higher rates of mental health need but underutilise mental health services compared to white majority groups. International research has shown that helplines can be useful in providing support and advice for mental distress and might go some way to helping address these concerns. This systematic review was conducted to identify challenges in the provision of helpline services for ethnic minority groups in Western countries and potential solutions to them. Method A systematic review of the literature using the search engines Medline, Embase, Psychinfo, HMIC, Healthbusinesselite, BNI, AMED and Cinahl. Results The literature revealed a number of specific challenges that require careful consideration in the provision of helplines for minority ethnic groups. These included the perceived usefulness of helplines, marketing strategies, confidentiality and trust, age considerations, gender differences and cultural competence. Conclusions There are various challenges and potential solutions to providing helpline services that effectively support minority ethnic groups and meet the specific cultural needs of different communities. The issues outlined must be considered in order to provide helpline services that are effective and inclusive.

Culture and stigma: Ethnographic case studies of tiger-widows of Sundarban Delta, India - Original Paper A. Chowdhury, R. Mondal, M. Biswas, A. Brahma 99 - 122

A significant proportion of the population from the villages of Sundarban, India, depends on the reserve forest resources for their livelihood. During their livelihood activities inside the forest, many forest-goers became victims of tiger attacks. Most of the forest-goers are poor people. Husbands are the only bread-earners of the family and, after their untimely accidental death; widows are thrown into extreme poverty and dire hardship. In addition to that, they are subject to social isolation because of the cultural stigma related with tiger killing in the local community. The present case studies from two mouzas (Note 1) of Indian Sundarban reflect the sufferings and continued life struggle of these ‘Tiger-widows’ (locally called Bag-Bidhoba) and different dimensions of stigma that marginalized them from the mainstream community life; the consequent negative impact on their mental health is discussed.

Rites of incubation in the modern world: The symbolic experience of death-rebirth- reconnection in Naikan Therapy - Original Paper V. Chervenkova 123 - 131

The present article aims at drawing attention to one of the original Japanese psychotherapeutic approaches, Naikan therapy. The article discusses the method’s therapeutic mechanisms and effects as originally interpreted through the prism of the author’s personal experience both as a client and an interviewer. Emphasizing the striking similarities between the throughout process of reflection on one’s past done during intensive Naikan practice on one hand, and the spontaneous self-reflection that many people do on the verge of death, on the other, we suggest that it is exactly the symbolic death experience which triggers the method’s therapeutic mechanisms. According to our interpretation, these mechanisms are (i) mirroring function, which results in improved interpersonal relationships and social awareness; and (ii) existential grounding function, which results in a positive transformation on all levels – social, physical and spiritual. To further elucidate the symbolic experience of death and rebirth within the Naikan therapy setting, we briefly relate the intensive Naikan practice to the ancient rites of incubation. In analogy to these rituals practiced in many ancient cultures, Naikan therapy, too, attributes great importance to prolonged seclusion and silence as key factors for evoking transformative experiences, healing included.

From hysteria to conversion disorder: The profile of the sufferers - Review Article 132 - 139

Introduction The aim of this paper is to draw a profile for the people who present with symptoms of conversion disorder through a review of past papers. Methodology Pubmed and PsycInfo were searched using the terms “conversion disorder”, “hysteria” “pseudoseizures”, “dissociative disorders” and “somatoform disorders”. We reviewed the literature published over the last 40 years and examined historical references. Results Conversion disorder has been associated with psychiatric comorbidity, significant life events as well as physical illness while cultural aspects of the patients’ life play an important role as well. Patients with conversion disorder also appear to have certain personality characteristics, level of education and socioeconomic background while in some studies association with preceding neuropsychiatric conditions has been found. Discussion Patients diagnosed with conversion disorder seem to be mainly females in their early thirties and tend to have characteristics of negativism, somatisation and dissociative tendencies, compulsivity and emotional dysregulation. There is a lot of evidence supporting the idea that neglect, physical, emotional and sexual abuse during childhood seems to be related to a later development of conversion disorder in adulthood. Conclusion All the above findings can guide clinicians when it comes to formulating a more robust differential diagnosis for patients presenting with symptoms resembling conversion disorder.

Dhat Syndrome: An extremely unusual presentation - Case Report S. Prakash, P. Mandal 140 - 143

Introduction. Dhat Syndrome, considered a culture bound syndrome of the orient by many, is widely prevalent in the Indian subcontinent. Although passage of vital fluid through the penis is the commonly described route, other routes such as anal or vaginal have also been described. Aim. We describe a patient with a relatively severe presentation, who complained of passage of ‘dhat’ through the mouth in relation to cough. Methods. The patient was interviewed and diagnosis established using standard classificatory systems. The origin and progression of the phenomenology was explored. Standard rating scales were applied. Results. The patient was diagnosed with Dhat Syndrome and additionally, severe depressive episode without psychotic symptoms at the time of presentation. Delineation of Dhat Syndrome from depression was also done. The exploration of phenomenology revealed a gradual progression from a usual to a most unusual presentation. Conclusion. This is a very unusual presentation and has not been described before. It possibly indicates a more severe form of illness. Implications for further research have been discussed.

Group differences in mental health: A role for culture in neuropsychiatry - Original Paper D. Crafa, S. Nagel 144 - 150

There is a need to diversify mental health research that uses brain imaging. Currently, this research almost exclusively includes participants from the 'Western' world, a majority of whom are Caucasian (Henrich et al, 2010a; 2010b). In light of studies from cultural neuroscience, which use brain imaging to demonstrate that people from different countries exhibit different neural activity, the lack of diversity in contemporary mental health research may pose a systematic bias of the data and interpretation. Considering that disorders are highly diverse between patients and across cultural groups, brain-based characteristics of disorders may vary across populations, making aberrant neural signatures difficult to identify if they exist at all. Further research could expand clinical understanding of diverse disorder phenotypes for globally shared disorders (e.g., schizophrenia) as well as generating new knowledge about culture-bound syndromes. This paper begins by demonstrating the underrepresentation of diverse populations in neuropsychiatry and then systematically discusses problems that increasing representation may solve, as well as research opportunities and implications for mental health practice, particularly for fields like transcultural psychiatry and global mental health.

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