In the Journals

"Religion and mental health": a special issue of Transcultural Psychiatry

The latest issue of Transcultural Psychiatry is devoted to “Religion and Mental Health.”  Here are the titles and abstracts:

Simon Dein, Judeo-Christian Religious Experience and Psychopathology: The Legacy of William James

This article examines the relationship between Judeo-Christian religious experience and psychopathology. It builds on William James’s Varieties of Religious Experience and more specifically his discussions of self, agency and the subliminal. Contemporary research on Christian conversion, mysticism, and its relationship to psychosis and mental health and healing are discussed. Future themes for research are proposed.

Glòria Durà-Vilà, Simon Dein, Roland Littlewood, and Gerard Leavey, 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.

Gerard Leavey, The Appreciation of the Spiritual in Mental Illness: A Qualitative Study of Beliefs Among Clergy in the UK 

Clergy in the UK continue to provide health and social care services. However, collaboration between mental health services and clergy may be problematic, particularly in the resolution of conflicting beliefs and therapeutic modalities. For example, belief in demonic possession and other supernatural causes of mental illness, which are contentious among secular medical practitioners, remain prevalent in many ethnoreligious communities. Thus, interpretations of illness by clergy within health systems may be crucial to appropriate intervention for people with mental illness. However, clergy conceptualizations of suffering also reveal something about the secularization within religious institutions through the despiritualization of particular phenomena. This paper on Christian clergy beliefs and attitudes to supernatural explanations, describes how the negotiation of such beliefs are complex and often equivocal among mainstream clergy but integral to the Pentecostal churches and evangelical clergy in the mainstream, institutional churches. These beliefs and their implications for collaboration with psychiatry are discussed in the context of a rapidly changing religious and cultural landscape.

Katherine Sorsdahl, Dan J. Stein, and Alan J. Flisher, Traditional Healer Attitudes and Beliefs Regarding Referral of the Mentally Ill to Western Doctors in South Africa

Drawing on data collected from 3 focus groups with 24 traditional healers, the aim of this qualitative study was to use the constructs of the Theory of Planned Behaviour (TPB) to gain an understanding of traditional healer referral practices of their patients with a mental illness. Results indicated that traditional healers possess a concept of mental illness, mainly referring to a patient behaving abnormally. They often report regularly treating patients with these behaviours. Traditional healer referral to Western care is considered a temporary measure or a last resort. A majority of healers feel that allopathic physicians do not treat them with the respect that they feel their contribution to the health of the community warrants. Recommendations include the need for traditional healers to be trained to identify potential cases of mental illness in their communities and for dialogue between traditional and allopathic physicians in regard to mental health care.

Vicky Campbell-Hall, Inge Petersen, Arvin Bhana, Sithembile Mjadu, Victoria Hosegood, Alan J. Flisher, and MHaPP Research Programme Consortium, Collaboration Between Traditional Practitioners and Primary Health Care Staff in South Africa: Developing a Workable Partnership for Community Mental Health Services

The majority of the black African population in South Africa utilize both traditional and public sector Western systems of healing for mental health care. There is a need to develop models of collaboration that promote a workable relationship between the two healing systems. The aim of this study was to explore perceptions of service users and providers of current interactions between the two systems of care and ways in which collaboration could be improved in the provision of community mental health services. Qualitative individual and focus group interviews were conducted with key health care providers and service users in one typical rural South African health sub-district. The majority of service users held traditional explanatory models of illness and used dual systems of care, with shifting between treatment modalities reportedly causing problems with treatment adherence. Traditional healers expressed a lack of appreciation from Western health care practitioners but were open to training in Western biomedical approaches and establishing a collaborative relationship in the interests of improving patient care. Western biomedically trained practitioners were less interested in such an arrangement. Interventions to acquaint traditional practitioners with Western approaches to the treatment of mental illness, orientation of Western practitioners towards a culture-centred approach to mental health care, as well as the establishment of fora to facilitate the negotiation of respectful collaborative relationships between the two systems of healing are required at district level to promote an equitable collaboration in the interests of improved patient care.

David Greenberg, Moshe Kalian, and Eliezer Witztum, Value-Sensitive Psychiatric Rehabilitation

Psychiatric rehabilitation contains value-laden concepts that may be unacceptable to certain cultures and many individuals. The concepts of independence and work are examined in a clash between mental health professionals in charge of national policies in psychiatric rehabilitation in Israel and a rehabilitation center for the severely mentally ill within the ultra-orthodox Jewish community. The government professionals considered that having the living quarters and work site in the same building deemed it unsuitable for rehabilitation, and too few progressed to independent living and working. As such, they ordered the center to be closed. Clients’ families turned to the Supreme Court and the claims and counter claims reveal value-laden positions. The bases for misunderstanding and lack of cooperation between the government professionals and the rehabilitation center are explained in the context of everyday life and values in the ultra-orthodox Jewish community and attitudes in the general population. Fruitful cooperation is based on appreciating core values, identifying and working with the community’s figures of authority, and accepting that the role of the mental health professional is to advise the community, within which the professional has no status.

Rabbi Mark A. Popovsky, Special Issues in the Care of Ultra-Orthodox Jewish Psychiatric In-Patients

This article reviews the literature regarding psychiatric care of ultra-orthodox Jewish patients. The discussion describes common areas of difficulty working with members of this population in an in-patient setting, including ritual observance, gender dynamics, and countertransference. It provides guidelines for mental health professionals to distinguish between culturally-appropriate and pathological behavior in an effort to avoid misdiagnosis, and offers strategies for overcoming these challenges. It suggests possible adjustments to standard treatment plans which may prove effective in this population and recommends further resources, including the involvement of trained chaplains, for especially complicated situations.

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