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Claudius M, Shino EN, Job S, Hofmann D, Thalmayer AG. Still Standing Inside: A Local Idiom Related to Trauma among Namibian Speakers of Khoekhoegowab. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14323. [PMID: 36361207 PMCID: PMC9657148 DOI: 10.3390/ijerph192114323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Euro-centric psychiatric conceptualizations often ignore the interplay of local with universal factors in psychological suffering. Emic, locally focused perspectives can enrich etic knowledge to provide culturally sensitive care and to better elucidate the role of culture in mental illness. This study explored the idiom Tsûsa ǃNaeǃkhais xa hâǃnâ/mâǃnâ/ǂgâǃnâhe hâ (a terrible event has entered a person and remains standing inside), which was understood to relate to experiences of trauma and post-traumatic stress, among speakers of Khoekhoegowab, a southern-African click language. Semi-structured interviews were conducted with 16 participants from six urban and rural communities in Namibia. Questions probed perceptions of the idiom in terms of etiology, course, and risk and resilience factors from a socio-ecological framework. Five key themes were identified using thematic analysis: origin in a shocking event; intrusive recurrence of memories, "it keeps on coming back"; the close interplay between mental and physical suffering; the importance of active engagement in healing through prayer and acceptance; and the role of the community in both alleviating and amplifying distress. Our findings highlight local norms and strategies for adaptive coping, and the benefits of exploring local idioms to elucidate the braiding together of universal and cultural elements in psychological distress.
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Affiliation(s)
- Milena Claudius
- Institute of Psychology, University of Bern, 3012 Bern, Switzerland
- Department of Psychology and Professional Counseling, Webster University Geneva, 1293 Bellevue, Switzerland
| | - Elizabeth N. Shino
- Department of Psychology and Social Work, Faculty of Health Sciences & Veterinary Medicine, University of Namibia, Windhoek 10026, Namibia
| | - Sylvanus Job
- Department of Humanities and Arts, Faculty of Education & Human Sciences, University of Namibia, Windhoek 10026, Namibia
| | - Daniel Hofmann
- Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
| | - Amber Gayle Thalmayer
- Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Institute of Psychology, University of Lausanne, 1015 Lausanne, Switzerland
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Figge CJ, Martinez-Torteya C, Taing S, Chhim S, Hinton DE. Local clinician perspectives on cause, impact, and treatment of key expressions of distress in Cambodian children. Transcult Psychiatry 2022; 59:506-521. [PMID: 32116154 DOI: 10.1177/1363461520905995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Child trauma and posttraumatic stress in Cambodia is highly prevalent, perpetuated within a postwar sociocultural context. The examination of locally meaningful expressions of distress is needed to provide culturally sensitive assessment and treatment of trauma-affected Cambodian children. The acceptable, feasible, and sustainable incorporation of expressions of distress into assessment and intervention development relies on key mental health professionals operating in Cambodia, who can provide invaluable perspectives on child trauma experiences in this particular sociocultural context. In this study, qualitative interviews were conducted with 15 Cambodian mental health professionals (MHPs) who work directly with trauma-affected Cambodian children. MHPs were presented with seven key posttraumatic problems derived from previous qualitative interviews with Cambodian children and caregivers, and discussed 1) the causes of these problems, 2) the impact of the problem on the child or those around them, 3) the current treatment for the problem in Cambodia, and 4) recommended treatment. MHPs provided unique insights and perspectives of trauma-affected children in the Cambodian context regarding key target problems, including palpitations, difficulties in school, headache, and thinking too much, and highlighted future directions for assessment and intervention. Recommendations are discussed in regard to programming design and organizational training development to promote culturally salient, feasible, and sustainable mental health service provision in Cambodia.
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Affiliation(s)
| | | | - Sopheap Taing
- Transcultural Psychosocial Organization (TPO) Cambodia
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Weaver LJ, Krupp K, Madhivanan P. The Hair in the Garland: Hair Loss and Social Stress Among Women in South India. Cult Med Psychiatry 2022; 46:456-474. [PMID: 34156574 DOI: 10.1007/s11013-021-09725-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
Generations of scholars have debated hair's significance as a symbol of womanhood, fertility, and spiritual morality in South India. For contemporary Indian women, hair is a site of concern, often expressed as an everyday preoccupation with hair loss or "hair fall," as it is known in the subcontinent. This exploratory study investigated hair fall among Kannada-speaking Hindu women in the South Indian city of Mysuru, Karnataka. It used a series of focus group discussions to explore how women talk about the causes and consequences of hair fall, and how women cope with hair-related distress. Participants articulated clear, shared ideas about why hair falls and how it can be managed. They connected hair fall to broader stressors in their lives both directly and symbolically. Hair fall, therefore, appears to function idiomatically in this context, both as an idiom of distress in its own right, and as a symptom of other idioms and forms of distress. Additional research is needed to establish the importance of hair fall relative to other distress constructs, and to more directly assess its potential value in research and intervention.
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Affiliation(s)
- Lesley Jo Weaver
- Department of Global Studies, 175 Prince Lucien Campbell Hall, 5281 University of Oregon, Eugene, OR, 97403, USA.
| | - Karl Krupp
- Public Health Research Institute of India, Mysuru, Karnataka, India
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona, USA
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysuru, Karnataka, India
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona, USA
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Hinton DE. Auditory Hallucination Among Traumatized Cambodian Refugees: PTSD Association and Biocultural Shaping. Cult Med Psychiatry 2021; 45:727-750. [PMID: 33386575 DOI: 10.1007/s11013-020-09701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
At a psychiatric refugee clinic for survivors of the Khmer Rouge genocide, a survey revealed that 42% (38/90) had auditory hallucinations (AHs) in the last month. Of those with AHs, 87% (33/38) had PTSD, whereas of those without AHs, 31% (16/52) had PTSD, giving a chi square of 27.8, p < .001, odds ratio 14.8 (4.8-45). Most AHs were of a "ghost summoning" (khmaoch hao), considered an exhortation to go with a ghost (e.g., hearing "Please come with me, younger sister"), experienced by 73% percent of patients with AHs. The voices were always exterior and usually loud and clear. AHs were heard most often during hypnagogia (i.e., upon falling asleep or awakening), experienced by 72% of patients with AHs, whereas 42% of patients with AHs experienced AHs when fully awake. AHs were almost always attributed to a ghost, giving rise to great fear: of having the "soul" called away or of being frightened to death. AH episodes almost always triggered trauma recall. AHs caused patients to undertake certain actions to address acute episodes and to prevent further ones. To illustrate these processes, cases are provided. AH appears to be a key part of the Cambodian bioculturally shaped trauma subjectivity.
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Affiliation(s)
- Devon E Hinton
- Massachusetts General Hospital, Harvard Medical School, Center for Anxiety and Traumatic Stress Disorders, One Bowdoin Square, 6th Floor, Boston, MA, 02114, USA.
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Hinton DE, Reis R, de Jong J. Ghost Encounters Among Traumatized Cambodian Refugees: Severity, Relationship to PTSD, and Phenomenology. Cult Med Psychiatry 2020; 44:333-359. [PMID: 31701326 DOI: 10.1007/s11013-019-09661-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ghost encounters were found to be a key part of the trauma ontology among Cambodian refugees at a psychiatric clinic, a key idiom of distress. Fifty-four percent of patients had been bothered by ghost encounters in the last month. The severity of being bothered by ghosts in the last month was highly correlated to PTSD severity (r = .8), and among patients bothered by ghosts in the last month, 85.2% had PTSD, versus among those not so bothered, 15.4%, odds ratio of 31.8 (95% confidence level 11.3-89.3), Chi square = 55.0, p < .001. Ghost visitations occurred in multiple experiential modalities that could be classified into three states of consciousness: full sleep (viz., in dream), hypnagogia, that is, upon falling asleep or awakening (viz., in sleep paralysis [SP] and in non-SP hallucinations), and full waking (viz., in hallucinations, visual aura, somatic sensations [chills or goosebumps], and leg cramps). These ghost visitations gave rise to multiple concerns-for example, of being frightened to death or of having the soul called away-as part of an elaborate cosmology. Several heuristic models are presented including a biocultural model of the interaction of trauma and ghost visitation. An extended case illustrates the article's findings.
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Affiliation(s)
- Devon E Hinton
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 6th Floor, Boston, MA, 02114, USA.
| | - Ria Reis
- Leiden University Medical Center, Leiden, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
- The Children's Institute, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Joop de Jong
- Center for Anxiety and Related Disorders, Boston University, Boston, USA
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Tietjen GE, Maly EF. Migraine and Ischemic Stroke in Women. A Narrative Review. Headache 2020; 60:843-863. [DOI: 10.1111/head.13796] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/07/2020] [Accepted: 03/08/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Gretchen E. Tietjen
- Department of Neurology University of Toledo College of Medicine and Life Sciences Toledo OH USA
| | - Emily F. Maly
- Department of Neurology University of Toledo College of Medicine and Life Sciences Toledo OH USA
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Stammel N, Heinzl L, Heeke C, Böttche M, Knaevelsrud C. Association Between Prolonged Grief and Attitudes Toward Reconciliation in Bereaved Survivors of the Khmer Rouge Regime in Cambodia. Front Psychiatry 2020; 11:644. [PMID: 32754059 PMCID: PMC7366248 DOI: 10.3389/fpsyt.2020.00644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND During the Khmer Rouge regime in Cambodia, about a quarter of the population died, resulting in many individuals losing close relatives. Still today, many individuals are suffering from the psychological consequences of these losses, which might also affect the process of reconciliation within the Cambodian society. The aim of this paper is therefore to investigate the association between symptoms of prolonged grief and attitudes toward reconciliation. METHODS A sample of 775 survivors of the Khmer Rouge regime who lost relatives during the conflict were interviewed about their losses and traumatic events, prolonged grief (PG; Complicated Grief Assessment Self-Report, CGA-SR), posttraumatic stress disorder (PTSD Checklist - Civilian Version) and attitudes toward reconciliation (Readiness to Reconcile Inventory, RRI). RESULTS A higher symptom severity of PG was significantly associated with readiness to reconcile even when controlling for other relevant variables (β = -0.22; p <.001). Persons who met caseness criteria for PG were significantly less ready to reconcile, t(773) = 5.47, p <.001, than persons who did not meet caseness for PG. CONCLUSION PG seems to be a relevant mental health correlate of attitudes toward reconciliation. The results of the current study underline the importance of also considering PG with regard to the reconciliation process in Cambodia and possibly also in other post-conflict regions.
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Affiliation(s)
- Nadine Stammel
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.,Research Department, CENTER ÜEBERLEBEN, Berlin, Germany
| | - Louisa Heinzl
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.,Research Department, CENTER ÜEBERLEBEN, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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Hinton DE, Seponski DM, Khann S, Armes SE, Lahar CJ, Kao S, Schunert T. Culturally sensitive assessment of anxious-depressive distress in the Cambodian population: Avoiding category truncation. Transcult Psychiatry 2019; 56:643-666. [PMID: 31169469 DOI: 10.1177/1363461519851609] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a large national survey in Cambodia (N = 2689), the present study investigated the prominence of certain culturally salient symptoms and syndromes in the general population and among those with anxious-depressive distress (as determined by the Hopkins Symptom Checklist-25, or HSCL). Using an abbreviated Cambodian Symptom and Syndrome Addendum (CSSA), we found that the CSSA complaints were particularly elevated among those with anxious-depressive distress. Those with anxious-depressive distress had statistically greater mean scores on all the CSSA items as well as severity of endorsement analyzed by percentage: among those with HSCL caseness, 75.3% were bothered "quite a bit" or "extremely" by "thinking a lot" (vs. 27.5% without caseness); 53.8% were bothered by "standing up and feeling dizzy" (vs. 13.8%); and 45.6% by blurry vision (vs. 16.8%). In a logistic regression analysis to predict anxious-depressive distress, 51% of the variance was accounted for by five predictors: "weak heart," "thinking a lot," dizziness, "khyâl hitting up from the stomach," and sleep paralysis. Using ROC analysis, a cut-off score of 1.81 on the CSSA was optimal as a screener to indicate anxious-depressive distress, giving a sensitivity of 0.86. The study results suggest that to avoid category truncation (i.e., the omission of key complaints that are part of an assessed distress domain) when profiling anxious-depressive distress among Cambodia population that items other than those in standard psychopathology measures should be assessed such as "thinking a lot," "weak heart," "blurry vision," and "dizziness upon standing up."
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