Colonialism, science, and health.

In addition to genocide, slavery, and the dispossession of indigenous people, colonialism, as a form of control, meant the suppression of traditional knowledge. The imposition of Christianity, the modern Western paradigm, and modern science that followed perpetrated this suppression. The universal role held by modern science is supported neither by epistemic nor social aspects. It is ineffective and complicit in the collapse of civilization, and it is worsened by comprehensive and unifying ideas to be reduced to an input-process of technological innovation for the benefit of social control industries such as the military, information technology, communication, or health. Furthermore, it suppresses ancestral knowledge related to health and medicine that may be beneficial and must be researched (stimulant medicines). Coupled with the health industry, it promotes the medicalization of life, spreading uncertainty, anxiety, and unease. Therefore, it is an instrument of neocolonialism that imposes its priorities, supplanting problems in subordinated countries, and extracts substantial resources, which is detrimental to social policies and programs. The biggest objection to the universality of modern science is derived from its empiricist and reductionist nature. Through the practically impossible idea of a unifying and explanatory knowledge, it impedes researchers the understanding of the complexity of the world and their historical moment and to act accordingly. It transforms great creative and liberating potential to submissiveness for the interests of capital and its representatives.

El colonialismo, como forma de dominación, significó, además de genocidio, esclavitud o despojo de pueblos originarios, la supresión de saberes tradicionales perpetrada por la imposición del cristianismo, del paradigma moderno occidental y de la ciencia moderna que le siguió. El carácter universal detentado por la ciencia moderna no se sostiene en lo epistémico ni en lo social; es inoperante con y cómplice del colapso civilizatorio; se empobrece de ideas comprensivas e integradoras para reducirse al insumo-proceso de la innovación tecnológica en provecho de las industrias del control social (militar, informática, de comunicación o de la salud); y suprime saberes ancestrales de la esfera de la salud que encierran beneficios y posibilidades que es preciso investigar (medicina estimulante). Aunada a la industria de la salud, impulsa la medicalización de la vida, preñándola de incertidumbre, angustia y desasosiego. Es instrumento del neocolonialismo al imponer sus prioridades, que suplantan las propias de los países subordinados y sustraen cuantiosos recursos en detrimento de políticas y programas sociales. La mayor objeción a la universalidad de la ciencia moderna deriva de su carácter empirista y reduccionista que, al condicionar la imposibilidad práctica de un conocimiento integrador y explicativo, aleja a los investigadores del entendimiento de la complejidad del mundo, de su momento histórico y de actuar en consecuencia, y transforma la gran potencialidad creativa y liberadora de este enorme contingente en docilidad a los designios de los intereses del capital y sus agentes.

[Relationships between Medicine and Spirituality].

This review aims at analysing the links between medicine and spirituality, two seemingly distant concepts. Medicine at its beginnings was imbued with rituals that invoked the intervention of supernatural powers, as man were unable to treat diseases and struggled to bear the suffering caused by them and the fragility of their own bodies. Today, in the post-genomic era, medicine has gained great benefits from new and extraordinary scientific and technological achievements, permitting sophisticated therapeutic and diagnostic approaches, which assure cures not previously possible. Even considering these great accomplishments in medicine and technology, it should be borne in mind that diseases not only induce bodily changes in sufferers, but also affect their emotional state and social interactions. Illness, especially when serious and in presence of a poor prognosis, raises profound questions around the meaning of life, affections, suffering and death. In the last few decades scientists, doctors, theologians, psychologists and others, in considering these questions, have emphasized the importance of spirituality as a relevant factor in the care of the sick and their illnesses. Drawing from some thoughts expressed in the book, "When the Breath Becomes Air," authored by the physician Paul Kalanithi, we claim that spirituality should be perceived as an important contributing factor in the therapeutic path. Our aim is to deepen the meaning of spirituality, differentiating it from religion, faith and mysticism, and to understand how it should be integrated with post-genomic medicine to enhance its positive aspects and effects.

[Participation in art and cultural activities has a positive effect on somatic illnesses].

The increasing international research into the use of arts and cultural activities in clinical contexts documents a number of beneficial effects in relation to many illness and diagnoses. A systematic review has identified a large number of studies documenting that art, culture and creative activities can have a positive effect on both mental and physical health. In this article, selected results are presented with the purpose of drawing attention to the possibilities for non-pharmacological methods, which are increasingly available, also in Denmark.

La vocación de curar a través del arte / The vocation of healing through art

La humanización del ejercicio de la medicina considera la vivencia de enfermar del paciente, así como el verdadero sentido del curar, aliviar, sanar y acompañar a la persona. Esa vivencia pone en juego la sensibilidad. La experiencia sensible y afectiva es motor de la capacidad simbólica del género humano, y el símbolo es lazo afectivo-representativo y acuerdo imaginario entre la persona y su mundo. Las imágenes, como símbolos, no pueden ser reducidas al lenguaje verbal racional. El Arte Terapia, a través de esas imágenes, acompaña a la persona en la prevención o tratamiento de enfermedades. Es una disciplina del campo de la salud en desarrollo en todo el mundo, con un creciente número de estudios que sustentan sus efectos positivos. Sus herramientas terapéuticas son la estimulación de la sensibilidad, el uso de la imagen como lenguaje, el juego creativo, la simbolización y la experiencia grupal. Su inclusión en el ámbito hospitalario tiene una fuerte razón de ser: el Arte siempre ha acompañado al hombre y a la Medicina, como otra forma de la vocación de curar. (AU)

Humanization of medical practice takes into account the patient's experience of illness, as well as the true sense to cure, to alleviate, to heal and to care about the person. Sensitiveness comes into play in that experience. The sensitive and emotional experience is the engine of the symbolic capacity of humankind; and the symbol is the representative-affective tie and the imaginary agreement between the person and his world. Images, as symbols, cannot be reduced to the rational verbal language. Art Therapy, through those images, takes care about the person in the prevention or treatment of different diseases. Art Therapy is a health-related discipline in development around the world with an increasing number of studies supporting its positive effects. Its therapeutic tools are the stimulation of the sensitivity, the use of the image as a language, the creative play, the symbolization, and the group experience. Art Therapy incorporation in the hospital setting has a strong rationale: Art has always been along with humankind and Medicine as another vocational way to heal. (AU)

Systematic Review: A Reevaluation and Update of the Integrative (Trajectory) Model of Pediatric Medical Traumatic Stress.

OBJECTIVE: The objective of this systematic review is to reevaluate and update the Integrative Model of Pediatric Medical Traumatic Stress (PMTS; Kazak et al., 2006), which provides a conceptual framework for traumatic stress responses across pediatric illnesses and injuries. METHODS: Using established systematic review guidelines, we searched PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and PubMed (producing 216 PMTS papers published since 2005), extracted findings for review, and organized and interpreted findings within the Integrative Model framework. RESULTS: Recent PMTS research has included additional pediatric populations, used advanced longitudinal modeling techniques, clarified relations between parent and child PMTS, and considered effects of PMTS on health outcomes. Results support and extend the model's five assumptions, and suggest a sixth assumption related to health outcomes and PMTS. CONCLUSIONS: Based on new evidence, the renamed Integrative Trajectory Model includes phases corresponding with medical events, adds family-centered trajectories, reaffirms a competency-based framework, and suggests updated assessment and intervention implications.

[Is disease merely illness?: Biomedicine, "parallel" forms of care and power]. / Las enfermedades ¿son solo padecimientos?: biomedicina, formas de atención "paralelas" y proyectos de poder.

Following Giovanni Berlinguer's proposal that health/disease processes are one of the primary spies into the contradictions of a system, this article describes cases that occurred in central and peripheral capitalist contexts as well as in the so-called "real socialist" States that allow such a role to be seen. Secondly, we observe the processes and above all the interpretations developed in Latin America and especially Mexico regarding the role attributed to traditional medicine in the identity and sense of belonging of indigenous peoples, which emphasize the incompatibility of indigenous worldviews with biomedicine. To do so we analyze projects that were carried out under the notion of intercultural health, which in large part resulted in failure both in health and political terms. The almost entirely ideological content and perspective of these projects is highlighted, as is the scant relationship they hold with the reality of indigenous people. Lastly, the impact and role that the advance of these conceptualizations and health programs might have had in the disengagement experienced over the last nearly ten years in the ethnic movements of Latin America is considered.

The relation between the phenomena of disease, illness, and suffering.

Persons experiencing disease and illness experience suffering as well. How nurses assess patients' problems holistically has been debated a lot. This article suggests one possible way of assessing patients' situation as a whole by seeing patients' diseases in relation to suffering.

Relationship between nonprescribed therapy use for illness prevention and health promotion and health-related quality of life.

OBJECTIVES: This study describes the nonprescribed therapy use (prayer, over-the-counter medications [OTC's], home remedies, vitamins, herbs and supplements, and exercise) for health promotion among rural elders. It also delineates the association of such therapy use with physical and mental health-related quality of life (HRQoL). METHOD: The sample (N = 200) consisted of African American and White elders from south-central North Carolina. Participants completed baseline interviews and repeated measures of nonprescribed therapy use over a 6-month follow-up. RESULTS: Prayer had the highest percentage (80.7%) of use for health promotion followed by OTC (54.3%); vitamins only (49.3%); herbs and supplements (40.5%); exercise (31.9%); and home remedies (5.2%). Exercise was significantly associated with better physical HRQoL (p < .05). However, elders who used nonprescribed therapies had poorer mental HRQoL than nonusers, adjusting for potential confounders. CONCLUSION: This analysis suggests that use of some nonprescribed therapies for health promotion is associated with poorer mental HRQoL.

Meeting the psychological needs of the physically ill.

The psychological health of physically ill people has received more attention from other healthcare professions than it has from nursing. Many patients with physical health conditions have high rates of psychological distress resulting in poorer quality of life, higher rates of consultations, a greater use of healthcare services and poor adherence to treatment. This article explores the issue in terms of policy, prevalence, patient presentation and practice implications. It argues that nurses have a pivotal role in addressing the issue and offers models of delivery that may be helpful in developing a strategy to overcome this inequality.

Depression in medically ill patients.

In medically ill patients, given the many entities the phenotype of depression may represent, clinicians must be prepared to cast their diagnostic nets widely, not settling for the obvious but frequently incorrect choice of major depressive episode and throwing antidepressants at it willy nilly. Having chosen the correct diagnosis from among a broad differential of depression "look-alikes," clinicians can draw upon a broad swath of treatment modalities including medications, psychotherapy, social supports, and spiritual interventions. Working as a psychiatrist in the medical arena requires the curiosity and analytic skills of a detective and the breadth of knowledge of a polymath adapting therapeutic tools from across the biopsychosociospiritual spectrum to the specific needs of the patient.

Self-organizing biopsychosocial dynamics and the patient-healer relationship.

The patient-healer relationship has an increasing area of interest for complementary and alternative medicine (CAM) researchers. This focus on the interpersonal context of treatment is not surprising as dismantling studies, clinical trials and other linear research designs continually point toward the critical role of context and the broadband biopsychosocial nature of therapeutic responses to CAM. Unfortunately, the same traditional research models and methods that fail to find simple and specific treatment-outcome relations are similarly failing to find simple and specific mechanisms to explain how interpersonal processes influence patient outcomes. This paper presents an overview of some of the key models and methods from nonlinear dynamical systems that are better equipped for empirical testing of CAM outcomes on broadband biopsychosocial processes. Suggestions are made for CAM researchers to assist in modeling the interactions among key process dynamics interacting across biopsychosocial scales: empathy, intra-psychic conflict, physiological arousal, and leukocyte telomerase activity. Finally, some speculations are made regarding the possibility for deeper cross-scale information exchange involving quantum temporal nonlocality.

State-space grid analysis: applications for clinical whole systems complementary and alternative medicine research.

This paper presents state space grids (SSGs) as a mathematically less intensive methodology for process-oriented research beyond traditional qualitative and quantitative approaches in whole systems of complementary and alternative medicine (WS-CAM). SSGs, originally applied in developmental psychology research, offer a logical, flexible, and accessible tool for capturing emergent changes in the temporal dynamics of patient behaviors, manifestations of resilience, and outcomes. The SSG method generates a two-dimensional visualization and quantification of the inter-relationships between variables on a moment-to-moment basis. SSGs can describe dyadic interactive behavior in real time and, followed longitudinally, allow evaluation of how change occurs over extended time periods. Practice theories of WS-CAM encompass the holistic health concept of whole-person outcomes, including nonlinear pathways to complex, multidimensional changes. Understanding how the patient as a living system arrives at these outcomes requires studying the process of healing, e.g., sudden abrupt worsening and/or improvements, 'healing crises', and 'unstuckness', from which the multiple inter-personal and intra-personal outcomes emerge. SSGs can document the indirect, emergent dynamic effects of interventions, transitional phases, and the mutual interaction of patient and environment that underlie the healing process. Two WS-CAM research exemplars are provided to demonstrate the feasibility of using SSGs in both dyadic and within-patient contexts, and to illustrate the possibilities for clinically relevant, process-focused hypotheses. This type of research has the potential to help clinicians select, modify and optimize treatment plans earlier in the course of care and produce more successful outcomes for more patients.

[The influence of faith on illness experience in the elderly; spiritual assessments]. / Vliv víry na prozívání nemoci u senioru, dotazníky spirituality.

Spiritual life of the elderly patients is very important, but in practice the medical staff hardly thinks about the spiritual needs. According to foreign studies, a lively faith has a positive curative effect. The aim of our work was the evaluation of the influence of faith to the survival of illness in the elderly and the description of spiritual assessments. FICA assessment is an easy screening test which can be used for obtaining spiritual anamnesis in health care institutions.

A systematic review of resilience in the physically ill.

BACKGROUND: Resilience is the capacity of individuals to maintain, or regain, their mental health in the face of significant adversity, including physical illness. OBJECTIVE: We conducted a systematic review of resilience and related concepts in the physically ill to determine factors associated with predicting or promoting resilience. METHODS: An electronic search of PsychInfo, Medline, and CINAHL databases between 1950 and May 2009 was performed using the terms resilience, and various types of physical illnesses. Inclusion criteria were broad and exclusion criteria were not published in English or not focused on resilience in physical illness. RESULTS: A total of 475 articles were retrieved and 52 articles met inclusion/exclusion criteria. Psychological factors associated with resilience were self-efficacy, self-esteem, internal locus of control, optimism, mastery, hardiness, hope, self-empowerment, acceptance of illness, and determination. Social support was highly predictive of, and associated with, resilience. Coping strategies such as positive cognitive appraisal, spirituality, active coping, and mastery were also associated with resilience. Resilience factors directly salient to physical illness such as self-care, adherence to treatment, health related quality of life, illness perception, pain perception, exercise adherence, and physical outcomes were also found. DISCUSSION: These findings need to be considered and when appropriate incorporated into the psychological and psychiatric care of physically ill individuals.

Developmental levels in adult's conceptions of health and disease / Níveis de desenvolvimento nas concepções dos adultos sobre saúde e doença

A socio-cognitive developmental perspective suggests that conceptions regarding health and disease processes may present different levels of openness, flexibility, inclusiveness and differentiation, and thus can be ordered into different levels. We present a qualitative study on lay significations regarding health and disease processes, endorsed by 67 adults. The results show that these adults have different socio-cognitive developmental competences related to health and disease processes. For each dimension of significations of health and disease, it is possible to sequence lay person's conceptions developmentally. Each level is distinct qualitatively, including responses characterized by a higher degree of differentiation, integration and complexity than the previous level. Finally, the implications of this approach to clinical and educational methods are discussed.(AU)

Na perspectiva do desenvolvimento sociocognitivo, as concepções de saúde e doença podem apresentar diferentes níveis de abertura, flexibilidade, inclusividade e diferenciação e podem ser ordenadas em diferentes níveis de desenvolvimento. O presente estudo incidiu sobre as significações leigas de saúde e doença de um grupo de 67 adultos. Os resultados indicam que esses adultos se situam em diferentes níveis nas suas competências de desenvolvimento sociocognitivo relacionadas com os processos de saúde e doença, tendo sido possível sequenciar as suas significações em níveis distintos. Cada nível é distinto qualitativamente, incluindo respostas caracterizadas por uma maior diferenciação, integração e complexidade em relação ao nível precedente. As implicações dessa abordagem para os métodos clínicos e educativos são discutidas.(AU)

Affects, trauma, and mechanisms of symptom formation: a tribute to John C. Nemiah, MD (1918-2009).

John Nemiah was interested in the impact of emotionally traumatic events on mental and bodily processes and in conceptualizing the psychological defenses and deficits that contribute to the development of psychological and somatic symptoms. He viewed dissociation as the central psychological mechanism in the formation of a spectrum of symptoms, and conceptualized alexithymia as a deficit in the cognitive processing of emotion such that stress-induced arousal could bypass the psyche and produce somatic symptoms. This article briefly reviews some of Nemiah's conceptual ideas and relates them to several new theories and concepts and findings from empirical research. His concept of the 'psychic elaboration' of emotion is consistent with contemporary theories of the cognitive processing of emotions that emphasize the importance of imagery and linguistic symbolizations. Alexithymia is inversely related to mentalization and is associated with insecure attachment styles and emotional trauma, which influence the capacity to regulate affects induced by stressful events. A multiple code theory of emotional information processing links psychological and somatic symptoms to various degrees of dissociation within and between the elements comprising emotion schemas and to compensatory attempts at repair. Recent studies support Nemiah's view that alexithymia and intrapsychic conflicts may both contribute to the pathogenesis of panic attacks. There is also substantial evidence of an association between childhood trauma and the development of somatic disease in adult life. Secure attachments and well-developed capacities for symbolization and affect regulation seem to render individuals more resilient to the traumas and stressful events of everyday life.

Moral transgression and illness in the Early Modern North.

This article seeks to understand how people in the early modern age interpreted the nature of illness and the role that morality played in these interpretations. From this point of view illnesses were not only psycho-physical states or subjects for medical diagnosis but they were also subjects for narratives or stories through which people tried to understand what had caused their illness, and why it was happening to them. Illnesses were understood as strictly connected with the patient's character and were regarded as possible consequences of his personality. On the other hand, the interpretations also emphasised the ambivalence of a healer. Personal experiences and an understanding of one's life situation intertwined in these stories.

Moral transgression, disease and holistic health in the Livingstonia Mission in late nineteenth and early twentieth-century Malawi.

This article examines ideas of morality and health, and connections between moral transgression and disease in both Scottish missionary and Central African thought in the context of the Livingstonia Mission of the Presbyterian Free Church of Scotland in Malawi during the late nineteenth and early twentieth centuries. By concentrating on debates, conflicts and co-operation between missionaries and Africans over the key issues of beer drinking and sexual morality, this article explores the emergence of a new "moral hygiene" among African Christian communities in Northern Malawi.

Home as place for healing.

Although environment is a core concept in nursing, it has had little theoretical or empirical attention, especially related to healing. This article explores the following aspects of the meaning of healing as they relate to environment as place: (a) healing is grounded in suffering; (b) healing is active and requires presence of the patient and the nurse; and (c) healing is private, spiritual, and profound. Home is explored as a place for healing. The article explores implications for the study of meaning of home, when home is not a place for healing, and future directions for theory and research.