[Sexuality--a taboo topic?]

Looking at the media one might believe there are no sexual taboos. On the contrary: People hardly discuss their own sexual experiences and behaviour. This applies in equal measure to day-to-day clinical and medical practice, although many studies definitely underline that patients do need information and counselling. The present contribution highlights a few fundamental aspects when treading on such delicate ground and provides helpful pointers.

[Clinical and epidemiological aspects of traditional therapeutic scarification in epilepsy in Togo]

One of the major problems of epilepsy in Africa are its social implications. Prejudice against the disease is common and epileptics are marginalised. Epilepsy is concealed from all non-family members. The very pronunciation of the word "falling disease" (as epilepsy is called) is taboo, the disease being regarded as supernatural. This unfavourable context introduces considerable bias in hospital and population-based studies. Traditional doctors are consulted by patients especially when they have such a "supernatural" disease. Traditional scarifications are used for the treatment of epileptics in Togo. We examined the skin of 36,000 patients in the neurological department of Lomé's teaching hospital between 1985 and 1995 and conducted a similar, population-based study on about 20,000 inhabitants in the Kloto district of south-western Togo and on 10,000 inhabitants in the Tone district of northern Togo. Interviews with 40,000 traditional doctors revealed that forehead scarifications are characteristic of epilepsy treatment. More than 80% of epileptics have forehead scarifications. When the seizures are rare, scarifications are slim, short (1-3 mm), near the roots of hair on the forehead and concealed; but when they are frequent, known by many people, scarifications are large, long, visible on forehead, the patient showing the sign of his social sentence.. On the skin of epileptics in Togo, is written the diagnosis of his affection. It only needs to look at it.

Freud's presentation of 'the psychoanalytic mode of thought' in Totem and taboo and his technical papers

Freud considered 'the psychoanalytic mode of thought' to be an instrument of research. In 'Totem and Taboo', he demonstrated his mode of thinking by applying it to the data of contemporary studies of totemism. While taking the reader along the paths of his selection and weighing of information, he also applied clinical discoveries about mental life in reconstructing 'primitive psychological situations' in the distant past. In the technical papers that appeared concurrently with his book, he applied to the clinical situation the ideas on transference, narcissism, primitive mental mechanisms and unconscious communication that he had explored in 'Totem and Taboo'. In this paper, the author presents material showing the structure of Freud's exposition as a model of analytic exploration. Some of the principles of mental organisation mentioned by Freud are discussed. Examples are given of the close parallels between 'Totem and Taboo' and two technical papers. The author suggests that 'Totem and Taboo' is an important step in Freud's development of his theory of object relations and his ideas about the intersubjectivity of unconscious mental life.

Cultural themes in family stress and violence among Cambodian refugee women in the inner city

Cambodian refugee women frequently face the cumulative trauma of war experiences and cultural adaptation to the American inner-city environment. This qualitative study investigated cultural beliefs, coping strategies, and management of family stress among Cambodian refugee women living in the inner-city environment. Focused and open-ended interviews were conducted in the informants' homes using the Cambodian language. Stressful and violent events were managed by nonconfrontation and withdrawal. These two themes are hypothesized as the culturally identified means by which inner-city Cambodian refugee women control and harmonize situations of stress. Further study is needed to develop the theoretical base for developing culturally sensitive nursing intervention strategies with this high risk population.

Palliative care and taboos within motor neurone disease

Taboos, whether held by professional carers, patients or families have the capacity to influence a whole range of choices that must be made during the course of any illness. In the case of motor neurone disease, decisions regarding if, when and how to break bad news, the place of care (home, hospital or hospice), the introduction of aids and devices, and, ultimately, choices regarding the place of death, will all be influenced by a range of taboos. If professional carers have major unresolved issues concerning their own mortality, it is unlikely that they will be able to truly stand alongside those who are facing their own imminent death. In discussing taboos, essentially what is of concern is attitudes. A basic change in attitudes is required if we are to stop viewing patients with incurable illness as some kind of medical failure.

Spiritual and natural etiologies on a Polynesian outlier in Papua New Guinea

Several writers have challenged recently the long-held contention that non-Western peoples tend to emphasize spirits, sorcerers, and other supernatural forces in their explanations for the cause of illness. Here, I examine indigenous theories of illness-causation on Nukumanu, a Polynesian outlier atoll in Papua New Guinea. Although Nukumanu invoke mundane as well as supernatural explanations, their major preoccupation is with spirits as etiological agents. In this light, I suggest a number of potential reasons for the difference between my findings on Nukumanu and those of commentators who have emphasized naturalistic etiologies among the peoples they have studied. In addition to real ethnographic variation, I argue that a major reason for the difference lies in the level of causality (instrumental as opposed to efficient and ultimate) sought by various investigators.