Neurocognition and its predictors in a linguistically and culturally diverse cohort of people with HIV.

Objective: HIV/AIDS disproportionately affects Black and Latino people in the United States, yet there is a lack of research on predictors of neurocognitive outcomes in these groups. We examined neurocognitive performance and its key predictors across White, Black, and Latino people with HIV (PWH). Method: Participants included 586 PWH of White, Black, and Latino (English- and Spanish-speaking) background. Neurocognition was assessed via demographically-adjusted Fluid Cognition Composite T-scores from the NIH-Toolbox cognition battery, and individual tests comprising this composite. Predictors examined included sociodemographic and HIV disease characteristics, and medical, psychiatric and substance comorbidities. Results: Compared to White PWH, English-speaking Latino PWH had lower T-scores on the Fluid Cognition Composite, as well as Flanker Inhibition and Picture Sequence Memory tests. While there were no other significant group differences on Fluid Cognition, both Latino PWH language groups performed worse than Black PWH on Flanker Inhibition, and Black PWH performed worse than White PWH on List Sorting. Separate multivariable linear regression models by ethnic/racial/language group showed that significant correlates of worse Fluid Cognition included depressive symptoms among White PWH; hepatitis C co-infection among Black PWH; hypertension among English-speaking Latino PWH; and higher estimated duration of HIV disease and depressive symptoms in Spanish-speaking Latino PWH. Conclusions: Findings suggest worse neurocognition among English-speaking Latino PWH compared to Whites. Predictors of neurocognitive function among PWH differ across ethnic/racial and language groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in developing targeted culturally-relevant interventions aimed at ameliorating neurocognitive dysfunction among diverse PWH.

Etnia e nominação: ancestralidades em disputa e recomposições / Ethnicity and nomination: disputed ancestries and recompositions / Ethnicité et nomination: ascendances contestées et recompositions / Etnicidad y nominación: ascendencias en disputa y recomposiciones

O nome próprio, para além de designativo de uma identidade transmitida intergeracionalmente, pode abrigar memórias sociais consubstanciais às representações de uma genealogia familiar, entrecruzada a processos históricos transgeracionais. Neste estudo de caso, as ressonâncias de sentidos atrelados ao significante "Terena" são analisadas à luz do processo social onomástico de transformação de etnônimos em sobrenomes, com base em fundamentos teóricos e metodológicos etnopsicanalíticos. Encontrou-se não haver transparência nem correspondência linear, pelo menos neste caso, entre o significante Terena na qualidade de etnônimo e na condição de sobrenome familiar, ficando em aberto em que medida a sua multivocidade se prende ao recalque da memória familiar e/ou a resistências a uma identificação genealógica que em diferentes momentos históricos terá assumido valorações distintas e eventualmente antagônicas

The proper name, in addition to designating an identity transmitted intergenerationally, can harbor social memories consubstantial with the representations of a family genealogy, intertwined with transgenerational historical processes. In this case study, the resonances of meanings linked to the signifier "Terena" are analyzed in the light of the onomastic social process of transforming ethnonyms into surnames, based on ethnopsychoanalytic theoretical and methodological foundations. It was found that there was no transparency or linear correspondence, at least in this case, between the signifier Terena as an ethnonym and the same as a family surname, leaving open the extent to which its multivocality is linked to the repression of family memory and/or to resistance to a genealogical identification that at different historical moments will have assumed different and eventually antagonistic valuations

Le nom propre, en plus de désigner une identité transmise intergénérationnellement, peut abriter des mémoires sociales consubstantielles aux représentations d'une généalogie familiale, entremêlées de processus historiques transgénérationnels. Dans cette étude de cas, les résonances des significations liées au signifiant « Terena ¼ sont analysées à la lumière du processus social onomastique de transformation des ethnonymes en noms de famille, sur la base de fondements théoriques et méthodologiques ethnopsychanalytiques. Il a été constaté qu'il n'y avait pas de transparence ou de correspondance linéaire, du moins dans ce cas, entre le signifiant Terena en tant qu'ethnonyme et le même en tant que nom de famille, laissant ouverte la mesure dans laquelle sa multivocalité est liée au refoulement de la mémoire familiale et /ou à la résistance à une identification généalogique qui, à différents moments historiques, aura assumé des valorisations différentes et éventuellement antagonistes

El nombre propio, además de designar una identidad transmitida intergeneracionalmente, puede albergar memorias sociales consustanciales a las representaciones de una genealogía familiar, entrelazadas con procesos históricos transgeneracionales. En este estudio de caso se analizan las resonancias de significados vinculados al significante "Terena" a la luz del proceso social onomástico de transformación de etnónimos en apellidos, a partir de fundamentos teóricos y metodológicos etnopsicoanalíticos. Se constató que no existe transparencia ni correspondencia lineal, al menos en este caso, entre el significante Terena como etnónimo y el mismo como apellido familiar, dejando abierta la medida en que su multivocalidad está ligada a la represión de la memoria familiar y /oa la resistencia a una identificación genealógica que en diferentes momentos históricos habrá asumido valoraciones distintas y eventualmente antagónicas

Traditional and biomedical care pathways for mental well-being in rural Nepal.

BACKGROUND: There is increasing access to mental health services in biomedical settings (e.g., primary care and specialty clinics) in low- and middle-income countries. Traditional healing continues to be widely available and used in these settings as well. Our goal was to explore how the general public, traditional healers, and biomedical clinicians perceive the different types of services and make decisions regarding using one or both types of care. METHODS: We conducted in-depth interviews using a pilot tested semi-structured protocol around the subjects of belief, traditional healers, and seeking care. We conducted 124 interviews comprising 40 traditional healers, 79 general community members, and five physicians. We then performed qualitative analyses according to a grounded theoretical approach. RESULTS: A majority of the participants endorsed belief in both supernatural and medical causes of illness and sought care exclusively from healers, medical practitioners, and/or both. Our findings also revealed several pathways and barriers to care that were contingent upon patient-, traditional healer-, and medical practitioner-specific attitudes. Notably, a subset of community members duplicated care across multiple, equally-qualified medical providers before seeing a traditional healer and vice versa. In view of this, the majority of our participants stressed the importance of an efficient, medically plural society. Though participants desired a more collaborative model, no consistent proposal emerged on how to bridge traditional and biomedical practices. Instead, participants offered suggestions which comprised three broad categories: (1) biomedical training of traditional healers, (2) two-way referrals between traditional and biomedical providers, and (3) open-dialogue to foster mutual understanding among traditional and biomedical providers. CONCLUSION: Participants offered several approaches to collaboration between medical providers and traditional healers, however if we compare it to the history of previous attempts, education and understanding between both fields may be the most viable option in low- and middle-income contexts such as Nepal. Further research should expand and investigate opportunities for collaborative learning and/or care across not only Nepal, but other countries with a history of traditional and complimentary medicine.

Dissociative Disorder in the Iranian Culture: The Lawless Utopia.

Epidemiologic and etiological studies of dissociative disorders are a challenging area in psychiatry. These challenges become more complex when noting that the existing theories cannot explain the differences observed in certain cases; for example, studies in Iran have reported the prevalence of dissociative disorders (dissociative amnesia, dissociative fugue, and depersonalization disorder) as less than 0.6%, and there has been no reported case of dissociative identity disorder (DID) in this country; meanwhile, the prevalence of all dissociative disorders in the general population of the US has been reported as 18.3%, and the prevalence of DID as about 1.1%. Although several studies indicate the high prevalence of dissociative symptoms in many Iranian psychiatric illnesses, dissociative disorders as a stand-alone disorder have a very low prevalence in Iran. The present article attempts to propose a possible hypothesis for the answer to the above questions through a different cultural conceptualization and seeks to be of some help to future studies in this area. Certainly, this hypothesis requires a careful study to be validated.

Reassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness?

In this Fresh Focus, we reassess what the mental health treatment gap may mean if we consider the role of traditional healing. Based on systematic reviews, patients can use traditional healers and qualitatively report improvement from general psychological distress and symptom reduction for common mental disorders. Given these clinical implications, some high-income countries have scaled up research into traditional healing practices, while at the same time in low-and middle-income countries, where the use of traditional healers is nearly ubiquitous, considerably less research funding has studied or capitalized on this phenomena. The World Health Organization 2003-2020 Mental Health Action Plan called for government health programs to include traditional and faith healers as treatment resources to combat the low- and middle-income country treatment gap. Reflection on the work which emerged during the course of this Mental Health Action Plan revealed areas for improvement. As we embark on the next Mental Health Action Plan, we offer lessons-learned for exploring potential relationships and collaborations between traditional healing and biomedicine.

O campo minado: recomendações ético-metodológicas para a pesquisa em etnopsicologia / The minefield: ethical-methodological recommendations for research in ethnopsychology / El campo minado: recomendaciones ético-metodológicas para la investigación en etnopsicología

A etnopsicologia é um referencial que congrega conhecimentos da Psicologia, da Antropologia e da Psicanálise, sendo largamente empregada nas investigações que possuem como cenário as comunidades religiosas de matriz africana. A pesquisa etnopsicológica, fiel às áreas que a constituem, tem sido desenvolvida dentro de uma gama multifacetada que comporta diversos métodos, formas de registros e possibilidades interpretativas combinadas. O objetivo deste estudo é apresentar e discutir alguns aspectos ético-metodológicos que permeiam as pesquisas em comunidades religiosas, sobretudo no contexto brasileiro, a partir do referencial da etnopsicologia. Em termos do percurso deste estudo teórico, foram abordados alguns procedimentos que podem orientar o trabalho nessas comunidades, iniciando pelo desenvolvimento da escuta, passando pela construção e análise do corpus analítico e, por fim, o momento da devolutiva com a comunidade de referência. O referencial etnopsicológico deve ser assumido pelo pesquisador desde a escolha do objeto de estudo que, muitas vezes, acaba sendo delimitado em função da escuta do próprio campo. A devolutiva, nesse sentido, não pode ser considerada a entrega de um resultado aos participantes, como nas perspectivas positivistas, mas como mais uma possibilidade de escuta que é potente na contínua interpretação do campo e na construção dos sujeitos-pesquisadores.

Ethnopsychology is a reference that brings together knowledge of Psychology, Anthropology and Psychoanalysis, being widely used in the investigations that have as scenery the religious communities of African matrix. Ethnopsychological research, faithful to the areas that constitute it, has been developed within a multifaceted range that includes several methods, forms of records and interpretative possibilities combined. The objective of this study is to present and discuss some ethical-methodological aspects that permeate research in religious communities, especially in the Brazilian context, based on ethnopsychology. In terms of the course of this theoretical study, some procedures were approached that can guide the work in these communities, beginning with the development of listening, passing through the construction and analysis of the analytical corpus and, finally, the moment of devolution with the reference community. The ethnopsychological reference must be assumed by the researcher since the choice of the object of study that, many times, ends up being delimited due to the listening of the field itself. The devolution, in this sense, cannot be considered as the delivery of a result, as in the positivist perspectives, but as a possibility of listening that is potent in the continuous interpretation of the field and in the construction of the subjects-researchers.

La etnopsicología es un referencial que congrega conocimientos de la Psicología, de la Antropología y del Psicoanálisis, siendo ampliamente empleada en las investigaciones que poseen como escenario las comunidades religiosas de matriz africana. La investigación etnopsicológica, fiel a las áreas que la constituyen, ha sido desarrollada dentro de una gama multifacética que comporta diversos métodos, Scorsolini-Comin, F. formas de registros y posibilidades interpretativas combinadas. El objetivo de este estudio es presentar y discutir algunos aspectos ético-metodológicos que permean las investigaciones en comunidades religiosas, sobre todo en el contexto brasileño, a partir del referencial de la etnopsicología. En términos del recorrido de este estudio teórico, se abordaron algunos procedimientos que pueden orientar el trabajo en esas comunidades, iniciando por el desarrollo de la escucha, pasando por la construcción y análisis del corpus analítico y, por fin, el momento de la devolución con la comunidad de referencia. El referencial etnopsicológico debe ser asumido por el investigador desde la elección del objeto de estudio que, muchas veces, termina siendo delimitado en función de la escucha del propio campo. La devolución, en ese sentido, no puede ser considerada como la entrega de un resultado, como en las perspectivas positivistas, sino como una posibilidad de escucha que es potente en la continua interpretación del campo y en la construcción de los sujetos-investigadores.

Índice de Tradicionalismo Cultural / Index of Cultural Traditionalism

Resumen Partiendo que la cultura es una variable sumamente importante en el estudio del comportamiento humano, que los significados y la cultura subjetiva dependen del contexto sociocultural de referencia y que la etnopsicología requiere del desarrollo de conocimiento y herramientas que permitan generar una mejor amalgama entre la psicología universal (occidental y de primer mundo), con La Psicología. Bajo este marco la presente investigación tuvo como objetivo, generar un índice de tradicionalismo cultural, a través de las Premisas Histórico-Socioculturales. Se aplicaron 1017 baterías que además de evaluar las PHSCs, también se evaluó el Individualismo-Colectivismo y la Instrumentalidad- Expresividad en hombres y mujeres provenientes de zonas urbanas y rurales del Norte, Centro y Sur de México, todas bajo el consentimiento informado. Los resultados reflejan un modelo con ajustes adecuados que permiten garantizar dicho índice. A su vez, el índice es sensible a variables culturales como el Individualismo - Colectivismo y a constructos socioculturales como la Instrumentalidad - Expresividad. Los resultados garantizan una herramienta que puede ser utilizada en la investigación psicológica o del comportamiento, así como en la aplicación de la psicología.

Abstract Culture is an extremely important variable in the study of human behavior, where the work done in this regard has allowed to identify that the meanings and the subjective culture depend on the sociocultural context of reference, where ethnopsychology requires the development of knowledge and tools that allow generating a better amalgam between universal psychology (Western and First World), with Psychology. Under the frame of reference that defines culture as a system of meanings shared by a group and transmitted from generation to generation, which allows the group to satisfy their basic survival needs, seek happiness and well-being and understand the meaning of life; and with the support that different studies have reported differences in psychological variables according to the socio-cultural context, the present investigation had as objective, to generate an index of cultural traditionalism, through the Sociocultural Historical Premises (PHSCs). 1017 batteries were applied that, in addition to evaluating the PHSCs, Individualism-Collectivism and Instrumentality- Expressivity were also evaluated in men and women from urban and rural areas of North, Central and South Mexico, all under the informed consent. The results reflect a factorial structure formed by Machismo, Virginity, Respect over love, Social reproduction, cultural dynamics and Gender inequality. A model was obtained with adequate adjustments that allow guaranteeing this index with variables associated exclusively with the traditional culture, where Virginity and Social Reproduction represent the greatest weight within the index of cultural traditionalism. In turn, the index is sensitive to cultural variables such as Individualism - Collectivism and sociocultural constructs such as Instrumentality - Expressivity, reflecting significant differences in different factors, with effects ranging from small to moderate. The results guarantee a tool that can be used in psychological or behavioral research, as well as in the application of psychology.

Mulher e verdade: onde mora pombagira cigana?

Embora nos últimos anos tenham sido feitos e publicados estudos a respeito do significado psicológico de operadores umbandistas, ainda são praticamente inexistentes os que se debruçam sobre o significado e a forma como as categorias de intersecção operam. Com base em uma recensão e sistematização de resultados de um programa de pesquisa etnopsicológico sobre cultos afro-brasileiros, pretende-se ilustrar como algumas categorias abstratas se traduzem corporalmente, mediante gestos e sentires. Para efeito dessa exemplificação selecionou-se a categoria espiritual Pombagira Cigana, na qual se personificam em concomitância um operador de gênero e um operador de verdade. Exercícios similares poderiam fazer-se e devem cumprir-se relativamente a outros segmentos do panteão para que cada vez mais seja possível alcançar uma interlocução mais profunda e relevadora dos benefícios auferíveis de uma Etnopsicologia afro-brasileira, tanto no atinente a uma escuta em profundidade da experiência social brasileira, como relativamente ao que se possa aprender e aproveitar científica e metodologicamente com base na originalidade das suas estratégias cognitivas.

Although in recent years studies on the psychological meaning of Umbandist operators have been made and published, there are still practically none that deal with the meaning and the way how intersection categories operate. Based on a review and systematization of results of an ethnopsychological research program on Afro-Brazilian cults, it is intended to illustrate how some abstract categories, through gestures and feelings, are performed in the Umbandist context. For the purpose of this exemplification, was selected the Gypsy Pombagira, an Umbandist spiritual category that combine a gender operator and a true operator. Similar exercises could be carried out and should be carried out in relation to other segments of the pantheon so that it is possible to achieve a deeper and more effective dialogue with Afro-Brazilian Ethnopsychology, both in terms of an in-depth listening Brazilian social experience, as well as what can be learned and exploited scientifically and methodologically based on the originality of their cognitive strategies.

Espíritos compositores e instrumentistas: a música na umbanda / Espíritus compositores e instrumentistas: la música en la umbanda / Composer and instrumentalist spirits: the music in umbanda

RESUMO A umbanda é uma religião de possessão em que espíritos são venerados, incorporados e desincorporados em meio a música, geralmente composta pelo som do atabaque (instrumento de percussão) e pelo canto. Conhecidas como pontos-cantados, as canções rituais estão presentes no culto e na vida cotidiana dos médiuns, contudo pouco se sabe sobre a compreensão nativa a seu respeito. Mediante um estudo de caso etnográfico, investigou-se a concepção de música umbandista, numa perspectiva etnopsicológica. Os participantes foram dez médiuns e seis espíritos, uma vez que são considerados pelo campo sujeitos interlocutores com personalidade própria. As informações foram coletadas e analisadas com base num procedimento etnopsicanalítico que combina entrevistas semiestruturadas e observação participante com uma escuta atenta aos implícitos e às repetições discursivas e discutidos com base numa revisão da literatura. Encontrou-se que os pontos-cantados ajudam o médium a concentrar-se no mundo simbólico umbandista, podendo ser disparadores de sentimentos, sensações e pensamentos, associados aos espíritos que eles descrevem. Os médiuns percussionistas disseram que tocam sob a influência dos espíritos que os instruem a fazer movimentos corporais organizados. Conclui-se que o sujeito da musicalidade umbandista não é entendido como a pessoa que aparentemente a compõe e a executa. O termo música apenas pode ser usado mediante a subordinação do entendimento nativo do emprego ritual da sonoridade a uma concepção etnomusicológica que a inclui. O sentido geral do uso da música na umbanda é propiciar concentração mental e, portanto, entender seu papel é crucial para o desenvolvimento do conhecimento etnopsicológico a respeito do culto.

RESUMEN La umbanda es una religión de posesión en que los espíritus son venerados, incorporados y desincorporados en medio a la música, generalmente compuesta por sonido del atabal (instrumento de percusión) y por el canto. Conocidas como puntos-cantados, las canciones rituales están presentes en culto y en el cotidiano de los médiums, todavía poco se sabe sobre la comprensión nativa a su respecto. Mediante un estudio de caso etnográfico, se investigó la concepción de música umbandista, en perspectiva etnopsicológica. Los participantes fueran 10 médiums y 6 espíritus, considerados sujetos interlocutores con personalidad propia. Las informaciones fueron recolectadas y analizadas con base en un procedimiento etnopsicoalítico que combina entrevistas semiestructuradas y observación participante con una escucha atenta a los implícitos y las repeticiones discursivas y discutidos sobre la base de una revisión de la literatura. Los datos apuntan que los puntos-cantados ayudan al médium a concentrarse en el mundo simbólico umbandista, pudiendo ser disparadores de sentimientos, sensaciones y pensamientos, asociados a espíritus que ellos describen. Los médiums percusionistas dijeron que tocan bajo la influencia de los espíritus que los instruyen a hacer movimientos corporales organizados. Se concluye que el sujeto de la musicalidad umbandistano es entendido como la persona que aparentemente la compone y la ejecuta. El término música sólo puede ser usado mediante la subordinación del entendimiento nativo del empleo ritual de la sonoridad a una concepción etnomusicológica que la incluye. El sentido general del uso de la música en el umbanda es propiciar concentración mental y por lo tanto entender su papel es crucial para el desarrollo del conocimiento etnopsicológico acerca del culto.

ABSTRACT Umbanda is a religion of possession in which spirits are venerated, embodied and disembodied in the midst of music, usually composed of the sound of atabaque (percussion instrument) and singing. Known as sung points, ritual songs are present in cult and in mediums' daily lives, yet little is known about native understanding of them. Through an ethnographic case study, the umbandist conception of music was investigated in an ethnopsychological perspective. The participants were 10 mediums and 6 spirits, which are considered by the field as interlocutor subjects with their own personality. Information was collected and analyzed based on an ethno-psychoanalytic procedure that combines semi-structured interviews and participant observation with an attentive listening to the implicit ones and the discursive repetitions and discussed based on a review of the literature. The data points that sung points help the medium to focus on the umbandist symbolic world, and can be triggers to feelings, sensations and thoughts associated with the spirits they describe. The percussionist mediums said they play under the influence of the spirits who instruct into making organized body movements. It can be concluded that the subject of umbandist musicality is not understood as the person who apparently composes and executes it. The term music can only be used by subordination of the native understanding of ritual use of sonority to an ethnomusicological conception that includes it. The general sense of the use of music in umbanda is to provide mental concentration and therefore understanding its role is crucial for the development of ethnopsychological knowledge about worship.

Umbanda e quimbanda: alternativa negra à moral branca / Umbanda et Quimbanda: une alternatif noir à la moralité blanche / Umbanda y Quimbanda: una alternativa negra a la moral branca / Umbanda and quimbanda: black alternative to white morality

Resumo A quimbanda, modalidade de culto afro-brasileiro habitualmente apresentada como mera inversão ético-moral da umbanda, preservou-se em rituais com entidades espirituais que supostamente contestam ou invertem a ordem moral vigente. Neste estudo acompanharam-se esses rituais e coletaram-se depoimentos de sacerdotes em comunidades religiosas afro-brasileiras, com o objetivo de revisar se de fato há uma pressão exercida por padrões ético-religiosos da sociedade envolvente que poderiam ter moderado ou modificado concepções africanas subjacentes. Na contramão de análises que implicitamente pressupõem a subordinação dos cultos afro-brasileiros a uma única concepção de moralidade, constatou-se que a vivência do sagrado implicada na quimbanda e na umbanda não atrela-se a essa moralidade vigente, e que nenhuma das suas manifestações pode ser corretamente descrita como amoral.

Résumé Le Quimbanda, une modalité de secte afro-brésilienne généralement présenté comme une simple inversion éthique et morale d'Umbanda, conservé dans les rituels avec des entités spirituelles qui sont supposés contester ou inverser l'ordre moral actuelle. Dans cette étude, ces rituels ont été suivis et les témoignages de prêtres ont été recueillis dans des communautés religieuses afro-brésiliennes, afin de vérifier si, en effet, il y a une pression exercée par les normes éthiques et religieuses de la société environnante qui pouvait modérer ou modifier les conceptions africaines sous-jacentes. Contrairement aux analyses qui supposent implicitement la subordination des sectes afro-brésiliens à une seule conception de la moralité, on a été constaté que l'expérience du sacré impliquée dans le Quimbanda et l'Umbanda n'est pas liée à cette moralité actuelle, et qu'aucune de ses manifestations peut être correctement décrit comme immorale.

Resumen La Quimbanda, modalidad de culto afrobrasileño y que generalmente se presenta como una mera inversión ético-moral de la Umbanda, conservó sus rituales con entidades espirituales que supuestamente invierten el orden moral vigente o lo contestan. En este estudio se acompañaron estos rituales y se recogieron declaraciones de sacerdotes en comunidades religiosas afrobrasileñas, con el objetivo de revisar si y en qué medida las presiones ejercidas por patrones ético-religiosos de la sociedad circundante podrían haber moderado o modificado las concepciones africanas subyacentes. Al contrario de los análisis que implícitamente presuponen la subordinación de los cultos afrobrasileños a una única concepción de moralidad, se encontró que la experiencia de lo sagrado involucrada en la Quimbanda y en la Umbanda no se vincula a esta moralidad vigente, y que ninguna de sus manifestaciones puede ser correctamente descrita como amoral.

Abstract Quimbanda is an African-Brazilian religious modality generally presented as a mere ethical and moral inversion of Umbanda that has been preserved through rituals made with spiritual entities that supposedly contest or reverse the prevailing morality. In this study, we followed rituals and collected interviews with priests in African-Brazilian religious communities, aiming to verify if there really is influence of an ethical standard from the surrounding society that could have moderated or modified subjacent African conceptions. Contrary to analyses that implicitly assume African-Brazilian cults as subjected to a single conception of morality, we found that the sacred experience involving Quimbanda and Umbanda is not attached to the prevailing morality, and that none of its manifestations can be properly described as amoral.

Tension Among Women in North India: An Idiom of Distress and a Cultural Syndrome.

The existing literature on Indian ethnopsychology has long asserted that somatization is a key aspect of experiences of distress. The study of idioms of distress arose out of work done in India (Nichter in Cult Med Psychiatry 5(4):379-408, 1981), but ironically, little subsequent work has systematically explored idioms of distress in this part of the world. This ethnographic study focused on the term tension (tensan) and its relation to a cultural syndrome among women in urban North India. This syndrome appears to involve rapid-onset anger, irritation, rumination, and sleeplessness as key symptoms. It is often linked to specific circumstances such as domestic conflict and is associated with the stresses of modern urban life. People who report more symptoms of tension had consistently higher scores on the Hopkins Symptoms Checklist-25 for depression and anxiety. In this cultural context where psychiatric care is highly stigmatized, the language of tension can aid providers of mental healthcare (many of whom, in India, are not psychiatrists or psychologists) to identify and communicate effectively with potential patients whose mental healthcare needs might otherwise go unaddressed.

Espiritualidade e brasilidade na clínica etnopsicológica / Spirituality and Brazilianness in ethnopsychological clinic / Espiritualidad y brasilidad en la clínica etnopsicológica

O objetivo deste estudo é discutir de que modo a espiritualidade e a brasilidade podem ser incorporadas na clínica etnopsicológica. Trata-se de um estudo de caso amparado na abordagem qualitativa de pesquisa, a partir do processo psicoterápico realizado com um idoso em um espaço terapêutico construído em um terreiro de umbanda do qual é frequentador. O corpus de análise é formado por transcrições das sessões e por relatos elaborados após os atendimentos, que compuseram duas vinhetas clínicas. Na primeira vinheta, o participante evoca constantemente elementos como retidão de caráter, coragem e respeito à natureza como sendo marcas transmitidas pela sua origem indígena. Na segunda vinheta, a frequente menção a uma profecia espírita desvela a necessidade de ser ouvido e compreendido em termos de seus valores e crenças, notadamente em família. A clínica etnopsicológica, prenhe da brasilidade que atravessa mitos, crenças e aspectos da espiritualidade mestiça que constituem o povo brasileiro, pode ser evocada para compreender o pedido de ajuda e, mais do que isso, acompanhar o participante na travessia de seu processo psicoterápico. Acolher a espiritualidade, portanto, passa pela necessidade de incluir elementos da brasilidade que atravessam práticas, saberes e crenças transmitidos pela coletividade.

The aim of this study is to discuss how spirituality and Brazilianness can be incorporated into ethnopsychological clinic. It is a case study supported in qualitative research from the psychotherapeutic process conducted with an elderly in a therapeutic space built in Umbanda yard which is goer. The analysis corpus consists of transcriptions of meetings and reports prepared after the calls, who composed two clinical vignettes. In the first vignette, the participant constantly evokes elements as uprightness of character, courage and respect for nature as marks transmitted by their indigenous origin. In the second vignette, the frequent mention of a spirit prophecy reveals the need to be heard and understood in terms of their values and beliefs, especially with family. The ethnopsychological clinic, pregnant with Brazilianness running through myths, beliefs and aspects of the mixed spirituality that make up the Brazilian people, may be invoked to understand the request for help and, more than that, accompany the participant in crossing his psychotherapeutic process. Welcome spirituality, therefore, is the need to include Brazilianness elements crossing practices, knowledge and beliefs transmitted by the community.

El objetivo de este estudio es analizar cómo la espiritualidad y la brasilidad se pueden incorporar en la clínica etnopsicológica. Es un estudio de caso apoyado en la investigación cualitativa del proceso psicoterapéutico llevado a cabo con un anciano en un espacio terapéutico construido en un centro de Umbanda. El corpus de análisis consiste en transcripciones de las sesiones y informes elaborados después de las sesiones, que compusieron dos viñetas clínicas. En la primera viñeta, el participante constantemente evoca elementos como rectitud de carácter, valor y respeto por la naturaleza como marcas transmitidas por su origen indígena. En la segunda viñeta, la frecuente mención de una profecía espírita revela la necesidad de ser escuchado y entendido en sus valores y creencias, especialmente con la familia. En la clínica etnopsicológica, la brasilidad a través de mitos, creencias y aspectos de la espiritualidad del pueblo brasileño, pueden ser invocadas para comprender la solicitud de ayuda y, más que eso, acompañar al participante en el proceso psicoterapéutico. Para incorporar la espiritualidad es necesario incluir elementos de la brasilidad en las prácticas, conocimientos y creencias transmitidas por la comunidad.

Com a licença de Oxalá: a ética na pesquisa etnopsicológica em comunidades religiosas / With the licence of Oxalá: the ethics in the ethnopsychological research in religious communities / Con la licencia de Oxalá: la ética en la investigación etnopsicológica en comunidades religiosas

O objetivo deste estudo é discutir as especificidades da pesquisa etnopsicológica em comunidades de terreiro à luz dos dispositivos da minuta de 2016 do Conselho Nacional de Saúde (Resolução 510/2016). A pesquisa em terreiros envolve métodos que preveem a possibilidade de fotografar, realizar vídeos e audiogravação de rituais, consultas mediúnicas e demais atividades que ocorrem em terreiros, bem como observações participantes, entrevistas com consulentes, médiuns em transe de possessão, bem como seus diferentes adeptos. A partir da nova minuta, o processo de esclarecimento do participante não deverá passar, necessariamente, por um termo formal. Essa alternativa contempla a possibilidade de que a autorização para a pesquisa (envolvendo diferentes métodos de coleta) passe pela anuência do responsável pela comunidade não necessariamente pela via escrita, de modo a valorizar a "palavra" do sacerdote, dada como selo de concordância e que possibilita que a comunidade, de fato, abra-se à ação mais direta do pesquisador e suas intervenções. Considerar essas especificidades garante o respeito à dimensão ética do sujeito e sua comunidade de referência.

The aim of this study is to discuss the specificities of ethnopsychological research in the religious communities based on Resolution 510/2016 of the National Health Council. Research in terreiros involves methods that allow the possibility of photographing, making videos and audiotaping of rituals, médiumistic consultations and other activities that take place in terreiros, as well as participant observations, interviews with consultants, mediums in possession trance, as well as their different followers. From the new draft, the process of clarification of participants must not necessarily go through a formal term. This alternative contemplates the possibility that the authorization for the research (involving different methods of data collection) will pass through the consent of the person in charge of the community, not necessarily through the written way, in order to value the priest's "word", given as a seal of agreement and makes it possible for the community, in fact, to open it self to more direct action of the researcher and his interventions. Considering these specificities guarantees respect for the ethical dimension of the subject and his community of reference.

El objetivo de este estudio es discutir las especificidades de la investigación etnopsicológica en comunidades de terreiro a la luz de los dispositivos del borrador de 2016 del Consejo Nacional de Salud (Resolución 510/2016). La investigación en terreros involucra métodos que prevean la posibilidad de fotografiar, realizar videos y audiograbación de rituales, consultas mediúmnicas y demás actividades que ocurren en terreros, así como observaciones participantes, entrevistas con consultores, médiums en trance de posesión, así como sus diferentes adeptos. A partir del nuevo borrador, el proceso de esclarecimiento del participante no deberá pasar, necesariamente, por un término formal. Esta alternativa contempla la posibilidad de que la autorización para la investigación (involucrando diferentes métodos de recolección) pase por la anuencia del responsable de la comunidad no necesariamente por la vía escrita, para valorar la "palabra" del sacerdote, dada como sello de concordancia y que permite que la comunidad, de hecho, se abra a la acción más directa del investigador y sus intervenciones. Considerar estas especificidades garantiza el respeto a la dimensión ética del sujeto y su comunidad de referencia.

Sleep Paralysis in Brazilian Folklore and Other Cultures: A Brief Review.

Sleep paralysis (SP) is a dissociative state that occurs mainly during awakening. SP is characterized by altered motor, perceptual, emotional and cognitive functions, such as inability to perform voluntary movements, visual hallucinations, feelings of chest pressure, delusions about a frightening presence and, in some cases, fear of impending death. Most people experience SP rarely, but typically when sleeping in supine position; however, SP is considered a disease (parasomnia) when recurrent and/or associated to emotional burden. Interestingly, throughout human history, different peoples interpreted SP under a supernatural view. For example, Canadian Eskimos attribute SP to spells of shamans, who hinder the ability to move, and provoke hallucinations of a shapeless presence. In the Japanese tradition, SP is due to a vengeful spirit who suffocates his enemies while sleeping. In Nigerian culture, a female demon attacks during dreaming and provokes paralysis. A modern manifestation of SP is the report of "alien abductions", experienced as inability to move during awakening associated with visual hallucinations of aliens. In all, SP is a significant example of how a specific biological phenomenon can be interpreted and shaped by different cultural contexts. In order to further explore the ethnopsychology of SP, in this review we present the "Pisadeira", a character of Brazilian folklore originated in the country's Southeast, but also found in other regions with variant names. Pisadeira is described as a crone with long fingernails who lurks on roofs at night and tramples on the chest of those who sleep on a full stomach with the belly up. This legend is mentioned in many anthropological accounts; however, we found no comprehensive reference on the Pisadeira from the perspective of sleep science. Here, we aim to fill this gap. We first review the neuropsychological aspects of SP, and then present the folk tale of the Pisadeira. Finally, we summarize the many historical and artistic manifestations of SP in different cultures, emphasizing the similarities and differences with the Pisadeira.

Prescribing Pattern of Antidepressants in Children and Adolescents: Findings from the Research on Asia Psychotropic Prescription Pattern.

OBJECTIVE: Pharmacotherapy of depression in children and adolescents is complex. In the absence of research into the efficacy and safety of antidepressants in this group of patients, their off-label prescription is common. This paper aimed to illustrate the prescription pattern of antidepressants in children and adolescents from major psychiatric centres in Asia. METHODS: The Research on Asia Psychotropic Prescription Pattern on Antidepressants worked collaboratively in 2013 to study the prescription pattern of antidepressants in Asia using a unified research protocol and questionnaire. Forty psychiatric centres from 10 Asian countries / regions participated and 2321 antidepressant prescriptions were analysed. RESULTS: A total of 4.7% antidepressant prescriptions were for children and adolescents. Fluoxetine, sertraline, and escitalopram were the most common antidepressants prescribed for children and adolescents. Almost one-third (30.3%) of prescriptions were for diagnoses other than depressive and anxiety disorders. There was less antidepressant polypharmacy and concomitant use of benzodiazepine, but more concomitant use of antipsychotics in children and adolescents compared with adults. CONCLUSION: Off-label use of antidepressants in children and adolescents was reported by 40 Asian psychiatric institutions that participated in the study. In-service education and regulatory mechanisms should be reinforced to ensure efficacy and safety of antidepressants in children and adolescents.

"Thinking too much": A systematic review of a common idiom of distress.

Idioms of distress communicate suffering via reference to shared ethnopsychologies, and better understanding of idioms of distress can contribute to effective clinical and public health communication. This systematic review is a qualitative synthesis of "thinking too much" idioms globally, to determine their applicability and variability across cultures. We searched eight databases and retained publications if they included empirical quantitative, qualitative, or mixed-methods research regarding a "thinking too much" idiom and were in English. In total, 138 publications from 1979 to 2014 met inclusion criteria. We examined the descriptive epidemiology, phenomenology, etiology, and course of "thinking too much" idioms and compared them to psychiatric constructs. "Thinking too much" idioms typically reference ruminative, intrusive, and anxious thoughts and result in a range of perceived complications, physical and mental illnesses, or even death. These idioms appear to have variable overlap with common psychiatric constructs, including depression, anxiety, and PTSD. However, "thinking too much" idioms reflect aspects of experience, distress, and social positioning not captured by psychiatric diagnoses and often show wide within-cultural variation, in addition to between-cultural differences. Taken together, these findings suggest that "thinking too much" should not be interpreted as a gloss for psychiatric disorder nor assumed to be a unitary symptom or syndrome within a culture. We suggest five key ways in which engagement with "thinking too much" idioms can improve global mental health research and interventions: it (1) incorporates a key idiom of distress into measurement and screening to improve validity of efforts at identifying those in need of services and tracking treatment outcomes; (2) facilitates exploration of ethnopsychology in order to bolster cultural appropriateness of interventions; (3) strengthens public health communication to encourage engagement in treatment; (4) reduces stigma by enhancing understanding, promoting treatment-seeking, and avoiding unintentionally contributing to stigmatization; and (5) identifies a key locally salient treatment target.

Custody, care and country of origin: demographic and diagnostic admission statistics at an inner-city adult psychiatry unit.

Involuntary detention is a feature of psychiatric care in many countries. We previously reported an involuntary admission rate of 67.7 per 100,000 population per year in inner-city Dublin (January 2008-December 2010), which was higher than Ireland's national rate (38.5). We also found that the proportion of admissions that was involuntary was higher among individuals born outside Ireland (33.9%) compared to those from Ireland (12.0%), apparently owing to increased diagnoses of schizophrenia in the former group. In the present study (January 2011-June 2013) we again found that the proportion of admissions that was involuntary was higher among individuals from outside Ireland (32.5%) compared to individuals from Ireland (9.9%) (p<0.001), but this is primarily attributable to a lower rate of voluntary admission among individuals born outside Ireland (206.1 voluntary admissions per 100,000 population per year; deprivation-adjusted rate: 158.5) compared to individuals from Ireland (775.1; deprivation-adjusted rate: 596.2). Overall, admission rates in our deprived, inner-city catchment area remain higher than national rates and this may be attributable to differential effects of Ireland's recent economic problems on different areas within Ireland. The relatively low rate of voluntary admission among individuals born outside Ireland may be attributable to different patterns of help-seeking which mental health services in Ireland need to take into account in future service-planning. Other jurisdictions could also usefully focus attention not just on rates on involuntary admission among individuals born elsewhere, but also rates of voluntary admission which may provide useful insights for service-planning and delivery.

Plantão psicológico centrado na pessoa: intervenção etnopsicológica em terreiro de Umbanda / Person-centered psychological emergency attendance: ethnopsychological intervention in an Umbanda terreiro (Backyard) / Orientación psicológica centrada en la persona: intervención etnopsicológica en Umbanda

O objetivo deste estudo é apresentar e discutir a implantação de um serviço de plantão psicológico em um terreiro de umbanda no interior do Estado de São Paulo, o contexto dos atendimentos, suas características, demandas, dificuldades e possibilidade de atenção à comunidade. Trata-se de um estudo de caso coletivo por meio de duas vinhetas escritas a partir de registros em diários de campo sobre os plantões, conduzidos por dois psicólogos. A análise foi conduzida a partir da abordagem centrada na pessoa e da literatura sobre etnopsicologia. A postura de alteridade e respeito ao outro possibilita a assunção de um cuidado alinhado com as necessidades da comunidade. O plantão constitui um serviço auxiliar na instituição e tem se apresentado como possibilidade de escuta e acolhimento de conflitos considerando as características do funcionamento do terreiro. Conclui-se que o plantão psicológico não pode ser oferecido com a intenção de se diferenciar do apoio já existente no terreiro, mas como uma prática paralela e integrada ao contexto cultural no qual as pessoas da comunidade estão imersas. Aponta-se para a inovação da proposta no campo do aconselhamento multicultural e espera-se que novas pesquisas deem prosseguimento a esta experiência..

This study aims to present and discuss the implementation of psychological service in an Umbanda backyard in a city in the state of São Paulo, Brazil, its their characteristics, demands, difficulties and possibility of attention to community. This paper refers to a study of a collective case through two vignettes registered on a field diary about the attendances. Analysis was conducted based on the person-centered approach and on the ethnopsychological literature. Respectful alterity promotes due care to the necessities of the community. Emergency attendances constitute an auxiliary service in the institution, which allows conflicts to be listened and treated, considering how the Terreiro (backyard) works and its characteristics. It has been concluded that emergency attendance cannot be offered with the intention of differentiating the support already present at the backyard, but as a parallel practice integrated to its cultural context, in which people from the community are immersed. Innovations on the proposal are needed in the field of multicultural counseling and new researches are expected in order to continue this experience.

Este trabajo objetivó presentar y discutir la implantación de un servicio de orientación psicológica en un espacio de expresión religiosa umbandista situado en el interior del estado de São Paulo, Brasil, sobre el contexto de las asistencias, características, demandas, dificultades y posibilidades de atención a la comunidad. Se trata de un estudio de caso colectivo por medio de dos viñetas escritas de registros en diarios de campo sobre las visitas realizadas por dos psicólogos. El análisis se realizó sobre el enfoque centrado en la persona y en la literatura sobre etnopsicología. La actitud de respeto y alteridad entre los demás permite la asunción de un cuidado alineado con las necesidades de la comunidad. La guardia constituye un servicio auxiliar en institución y se presenta como una posibilidad de escuchar y acomodar los conflictos considerando las características del funcionamiento del espacio religioso. Se concluye que la guardia psicológica no puede ser ofrecida con la intención de diferenciarse del apoyo existente en el espacio religioso, pero como una practica paralela y integrada al contexto cultural de la comunidad en la cual las personas hacen parte. Señalase la innovación de la propuesta en el campo de la orientación multicultural y se espera que nuevas investigaciones futuras continúen esta experiencia.

Trajetórias Investigativas da Possessão: Uma Abordagem Etnopsicológica / Investigative Courses on Spirit Possession: An Ethnopsychological Approach

Não obstante a sua grande difusão na sociedade nacional, o estudo da possessão tem recebido relativamente pouca atenção por parte dos psicólogos brasileiros. Neste artigo, com base em uma revisão da principal literatura clássica e contemporânea sobre possessão e na descrição sumária dos resultados de algumas pesquisas, discutem-se vantagens comparativas de uma abordagem etnopsicológica da possessão embasada na psicanálise lacaniana.(AU)

Despite its large diffusion in the national society, the study of possession has received relatively little attention from Brazilian psychologists. In this article, based on a review of major classic and contemporary literature about possession and on a brief description of some researches' results, comparative advantages of an ethnopsychological approach to possession, grounded in Lacanian psychoanalysis, are discussed.(AU)