Madness and Civilization: A History of Insanity in the Age of Reason

The increasing diversity of America requires a workforce that is able to serve the mental health needs of individuals from multiple backgrounds, with a culturally proficient, inclusive, and affirming approach. To accomplish this, clinicians must be mindful of the multiple challenges presented by social determinants of mental health and access to care; the role of culture in wellness protection, mental illness expression, symptom attribution, and help seeking; the impact of provider factors, such as availability and cultural and linguistic congruence and proficiency; and the interaction of clinician and patient, who are with increasing frequency members of differing identity groups. The authors highlight the central role of clinical providers, academic institutions, and service organizations to advance health equity through training and commitment to increase high-quality services that are available, accessible, affordable, and acceptable, improving the care of all individuals.

Diversity and Inclusion in Psychiatry: The Pursuit of Health Equity

Background: Problem gambling could progressively grow in a period of isolation due to the COVID-19 pandemic to the possibility of gambling directly from home. Objectives: This pilot study highlights if the problem gambling, during a period of isolation such as that of COVID-19, can be explained by personality or sociodemographic characteristics, therefore it investigates the emotional and impulsive characteristics of problem gamblers and examines whether those who are adults, those who have more years of study or who work are less likely to have problem gambling. Methods: A total of 200 subjects completed an online survey to examine the associations between problem gambling, alexithymia, and impulsiveness. The standardized tools used were the South Oaks Gambling Screen (SOGS), the Toronto Alexithymia Scale (TAS-20), and the Barratt Impulsiveness Scale (BIS-11). Results: Problem gambling was positively correlated with male gender, TAS-20 total score, difficulty describing feelings, externally-oriented thinking, attentional, and nonplanning impulsiveness. Furthermore, there was a significant inverse correlation between higher SOGS scores and fewer years of study. Multivariate analysis showed that age, gender, years of study, BIS-11 total score, attentional impulsiveness, and nonplanning impulsiveness were predictors of gambling. Conclusions: The results of this exploratory research suggest that in a period characterized by a pandemic, problem gambling is associated with some personality and sociodemographic characteristics. Moreover, age, male gender, low levels of study and impulsive characteristics play a decisive role in problem gambling.

https://cab.unime.it/journals/index.php/MJCP/article/download/2457/pdf

Problem gambling during Covid-19

This study details the results of a qualitative investigation into the role and
importance of spirituality, religion and traditional healing, as perceived by mental
health practitioners working with culturally and linguistically diverse (CALD)
individuals. A qualitative method was used to extract deeper meaning from
discussion content. This was considered particularly important in catering to CALD
communities, both in terms of how well they understood the meanings of
questions, and how well they conveyed their intended meanings in responses.
The histories of many practitioner participants in this study were informed by
ongoing conflict in their home countries, where they reported distrusting
government-run institutions. Many of them entered this study still bearing the
emotional effects from their experience of war, and many also struggled with
language and other cultural differences. In addition, some had strained relations
with medical systems in their countries of origin. The research design therefore
allowed for subtle nuances to be expressed during focus group discussions, and
was sensitive to the cultural and socio-political issues plaguing these communities,
both in Australia and abroad. Close attention was paid to building rapport and
creating a safe environment for the full participation of each person. This is why
transcultural mental health as a treatment approach was utilised to meaningfully
examine the context in which people exist and the local and global implications of
being estranged from one’s homeland.
Research addressing sensitive topics with people from CALD backgrounds can
present challenges that are difficult to address using conventional methods, as
many of these communities may feel over-researched in a way that sets them up to
feel exploited and more vulnerable to Western influence. Many of these people
speak English as a second language, and so may feel that since they have been
accepted into this country, they cannot disagree with what medical personnel ask
of them. The study was carried out using informal community collaboration, the key factor to the success of this research, which optimised the development of
research questions and engendered a trusting research environment. Most
research in this field to date has been conducted from the perspective of Western
medical practice; however, in contrast, this study gains insight into the perspectives
of a range of CALD communities, in terms of how they address mental health
issues within their respective communities.
The study combined perspectives from a range of mental health practitioner
participants, including professional and para-professional mental health workers
from both CALD and non-CALD backgrounds. Services provided by these groups
are routinely accessed by CALD people at the onset of their wellbeing issues.
Participants included government and non-government mental health practitioners
from various academic disciplines, and there was a balanced representation of
gender and country of origin.
As immigration is taking place globally at an unprecedented rate, consumers from
many CALD communities are presenting in mental health systems with a range of
emotional needs. As a result, mental health services are finding themselves faced
with assessment and treatment challenges. The immigrant journey consists of
complex resettlement issues often associated with visa status, ongoing grief and
loss issues, and trauma from leaving one’s homeland for a host of ecological,
socio-political or religious reasons. Immigration is often accompanied by stressful
adaptation to a new host environment, which can be challenging even if the
migrant is welcomed by their new country and given all the benefits of being able to
begin a new life there.
This study demonstrated that mental health practitioners working with CALD clients
should approach treatment while considering the acculturation process involved in
resettlement, as this may be more traumatic for the individual or community when
they are not accepted, directly or indirectly, by the host environment. Such a
situation, in which the individual or community has been taken away from
everything familiar to them, often leads to an existential crisis. Many of these individuals are placed in detention or are left within the wider Brisbane community
with no financial benefits or resources. This heightens their reliance on a higher
power, as many feel they are stripped bare of all earthly relationships and
possessions and left with only their spiritual, religious and traditional dimensions.
The data from this study show clear evidence for the importance of spirituality,
religion and traditional healing in transcultural mental healthcare, while at the same
time pointing to a level of reluctance on the part of practitioners and management
to fully integrate these issues into their approach. The CALD participants
overwhelmingly agreed that spirituality, religion and traditional healing were
essential cultural entities which form the foundation for who they are as people,
and to forego these practices in, of all places, mental healthcare, would be counterproductive.
The results from this study have implications for current and future
mental health practice, for mental health policy, for training of mental health personnel and for future research.

Exploring Spirituality, Religion and Traditional Healing as Protective Factors in Transcultural Mental Healthcare

This paper is written in the context of a debate within the Jungian clinical and academic communities on whether or not some kind of public statement is required concerning Jung’s writings ...

Jung and ‘Africans’: a critical and contemporary review of some of the issues*

Racial and religious identities are complex, often mired in dynamics of 'othering'. Such dynamics easily become a means of distancing the pain, fear and rage of intergenerational traumas, thus undermining ways race and religion can be powerful vehicles for the transference and countertransference. Drawing from a history of race in America as well as Jung's anxiety when meeting the stranger within himself, this paper focuses on 17 years of work between a black female patient and white female clinician (me). Together we encountered themes of hatred, silence, guilt and intimacy in the transference and countertransference, themes eventually symbolized by the presence of my cat which was locked into the bathroom for each session. This cat came to represent a bridge through developmental traumas and wounds of racism.

Race, religion and a cat in the clinical hour

A type of wilful blindness can pervert an individual's perception of truth or reality, not because that reality is too much to hold, but because it is distasteful. Undesired. The case of Adam will be used to explore perversion as it twists an analytic process, affecting the transference and countertransference in ways that are difficult to see. Theorists of Freudian, Kleinian, Lacanian, and Jungian traditions are drawn from to explore potential roots to this perverted turn, and the way it can rigidify an individuation process. The anxiety that haunts this case echoes Jung's anxiety as he wondered if the stone saw him or he saw the stone. Object and observer blend when both analyst and patient hide from themselves and one another, knowing the truth of what is being discussed but blind to it.

The making of a tragedy: perversion in the perception of truth.

In our increasingly mobile world, more of us are caught between cultures rather than in one culture. We straddle different ethnic, racial, political, geographical, and religious groups, forced into awareness of the precarious nature of our self-definition, involuntarily gazing at the constructed nature of our cultural norms, unable to avoid reckoning with the choices of which collective to honour. The impossibility of separating individual from collective is foundational to work as Jungian practitioners, but a paradox of individuation is becoming free of the control of collective norms while simultaneously living within those very norms. In such a conflict it becomes easy to overlook the fact that when the norms we have incorporated into ourselves are from cultures vastly different from the one in which we live, the cacophony can be overwhelming. In this paper, I will draw from postmodern theorists such as Derrida, Foucault and Irigaray in an effort to re-imagine the role of culture in psychodynamic process. The case of a Muslim Iranian man working with a Christian American woman analyst will be used to explore the complexity of a multitude of cultural norms present in the consulting room.

Caught between cultures: cultural norms in Jungian psychodynamic process.

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Race, religion and a cat in the clinical hour

The making of a tragedy: perversion in the perception of truth.

Caught between cultures: cultural norms in Jungian psychodynamic process.