Cultural and Religious Variation in Attitudes to Young People Consenting to Health Interventions.

There is a limited amount of empirical data available regarding the cultural and religious variation in perceptions about the age when young people should be regarded as competent to make decisions in health settings. A public survey of 400 adults from diverse religious and ethnic backgrounds was conducted in the UK and Spain. Attitudes were assessed using case vignettes. It was found that high religious practice was associated with recommending a higher age of consent for medical interventions. White British adults were more likely than Spanish adults to agree that younger adolescents should be allowed to consent to medical interventions. The study suggests that there is social, cultural and religious variation in adults' attitudes regarding the age when youngsters should consent to health interventions.

Integration of sexual trauma in a religious narrative: transformation, resolution and growth among contemplative nuns.

The psychological consequences of sexual abuse are generally serious and enduring, particularly when the perpetrator is known and trusted by the survivor. This paper explores the experiences of five contemplative nuns who were sexually abused by priests and the spiritual journeys that followed. In the context of an ethnographic study of contemplative practice, participant observation and in-depth interviews were used to examine the ways that the nuns sought to make sense of their experiences through a long process of solitary introspection. The pursuit of meaning was shaped by religious beliefs relating to forgiveness, sacrifice, and salvation. Thus, trauma was transformed into a symbolic religious narrative that shaped their sense of identity. They were able to restructure core beliefs and to manage their current relationships with priests more securely. They described regaining their spiritual well-being in ways that suggest a form of posttraumatic spiritual growth. We conclude by discussing the findings in the light of the existing literature on the interaction of trauma and spirituality.

Mental health problems of young refugees: duration of settlement, risk factors and community-based interventions.

Little is known about the characteristics of young psychologically-distressed refugees in mental health services, and how they vary according to the duration of settlement. This study of 102 young refugees referred to a community-based mental health service describes past adversities and current circumstances, referral problems, service utilization and treatment outcomes using the Strengths and Difficulties Questionnaire (SDQ). The more recently-arrived refugees had significantly higher levels of close exposure to war and violence, were more likely to have suffered separation from immediate family and to have insecure legal status. Those refugees settled longer were significantly more likely to be referred because of conduct problems while there was a trend in recent arrivals to present with internalizing pathology. A comparison of the teachers' and parents' mean SDQ scores of the study's young refugees sample and a national study representative of Great Britain as a whole showed that young refugees have higher scores in total problem and all subscales scores than the British scores. Community-based mental health services for young refugees appeared effective - significant improvement was found in SDQ scores for the sub-group (n = 24) who took up the treatments offered. The implications are discussed for service development and practitioners.

Depression and the medicalization of sadness: conceptualization and recommended help-seeking.

BACKGROUND: Critiques of the validity of the DSM diagnostic criteria for depressive disorder argue that it fails to differentiate between abnormal sadness due to internal dysfunction or depression (sadness without an identifiable cause), and normal sadness (sadness with a clear cause). AIMS: and METHODS: A population survey was undertaken in adult education centres in Spain aiming to explore beliefs about depression and normal sadness. Two hypothetical case vignettes portrayed individuals experiencing deep sadness, both fulfilling criteria for major depressive disorder (DSM-IV), one with a clear cause, the other without an identifiable cause. Three hundred and forty-four (344) questionnaires were obtained (95% response rate). RESULTS: Participants statistically significantly differentiated between the sadness-with-cause vignette, seen more frequently as a normal response, while the one without a cause was seen as pathological. Help-seeking behaviour recommendations followed this distinction: a medical option was statistically significantly more common when there was no cause for sadness. Socio-cultural variation in how people understand and deal with sadness was also found. CONCLUSIONS: This study emphasizes the importance of taking into account the context in which depressive symptoms occur as it seems that the absence of an appropriate context is what makes people conceptualize them as abnormal. It also raises questions about the lack of face validity of the current diagnostic classification for depressive disorder that exclusively uses descriptive criteria.

Cross-cultural study of idioms of distress among Spanish nationals and Hispanic American migrants: susto, nervios and ataque de nervios.

PURPOSE: Susto (fright), nervios (nerves) and ataque de nervios (attack of nerves) are idioms of distress widely experienced amongst Hispanic Americans, often associated with psychiatric disorders. This study explores understanding of these idioms of distress and attitudes to help seeking amongst indigenous Spanish and Hispanic American residents in Spain. METHODS: A population survey was undertaken in four adult education centres in Spain. Hypothetical case vignettes of individuals suffering from the idioms of distress were used to investigate understanding and help seeking by a Spanish sample compared with Hispanic American migrants to Spain. 350 questionnaires were obtained (94.6% response rate). RESULTS: The idioms ataque de nervios and nervios were recognised by the majority of the Spanish group but by significantly more of the Hispanic American migrants. However, susto was infrequently recognised by the Spanish group but it was recognised by half of the Hispanic Americans. Hispanic Americans were also more likely to recommend consultation with a psychiatrist/psychologist than Spanish respondents for ataque de nervios and nervios. The Spanish group were more likely to recommend non-medical sources of support such as relatives and priest than Hispanic Americans. Hispanic Americans, more recently arrived, did not show greater recognition of the three idioms than those who have been in Spain longer. Regression analysis showed that being Hispanic American and having lower educational attainment was associated with greater use of susto. CONCLUSIONS: The study suggests that people hold multiple models of distress and disorder. This may influence clinical presentations and help seeking behaviour in Spanish as well as Hispanic American populations.

The Dark Night of the Soul: causes and resolution of emotional distress among contemplative nuns.

An ethnographic study was conducted in the Spanish Monastery of Santa Mónica whose community consists of ten contemplative Augustinian nuns. Through participant observation and interviews the stresses encountered by the nuns and the coping strategies they deployed are explored in depth. It was found that symptoms that otherwise might have been described as evidence of a depressive episode were understood by the nuns within the framework of the so-called Dark Night of the Soul narrative: an active process of transforming emotional distress into a process of self-reflection, attribution of religious meaning and spiritual growth. We conclude by discussing the clinical implications of this religious narrative, highlighting the importance of incorporating existential issues into clinical practice.

Reply to Gold and Olin: antidepressants and the identity of persons.

Gold and Olin (2009) claim that the widespread use of antidepressants is a problem and that neither philosophy nor psychiatry are in a position to provide the conceptual and scientific tools to understand, characterize and, ultimately, solve it. While we agree with their analysis of the problem and the shortcomings of psychiatry to address it, we disagree with their pessimistic assessment of the actual standing of analytical philosophy to do so: we think that the prospects for conceptual help from mainstream Anglo-American philosophy are much more promising than they allow in their paper and we aim to show how this is so.

Children with intellectual disability: A gain not a loss: Parental beliefs and family life.

Raising a child with intellectual disability (ID) has significant consequences for parents and family. The impact of the disability has been found to be influenced by the sociocultural context. This paper aims to show how for some parents the experience of an offspring with ID is not interpreted as a loss but as a gain because of the parents' attribution of sacred meaning. It is suggested that these beliefs influence parental care, and are related to a high level of parental concern and closeness. This has implications for family relationships and life-cycle, as well as help-seeking and service uptake. The article provides a brief review of relevant research studies, a description of two illustrative case reports and discussion, including possible future research directions.